WorldWideScience

Sample records for hernia inguinal bilateral

  1. Bilateral inguinal hernias containing ovaries.

    Science.gov (United States)

    Basrur, Gurudutt Bhaskar

    2015-01-28

    Inguinal hernias are rare in females. The authors report a case of bilateral inguinal hernias in a 10-year-old female. On exploration, the patient was found to be having a sliding hernia containing incarcerated ovary as contents on both sides. Peroperatively the contents were reduced, the sac was transfixed at its base and the redundant sac was excised. The repair of this form of hernias is more difficult because of adhesions between the contents and the wall of the sac and risk of damage during dissection. A description of this clinical presentation in the pre operative assessment and operative management are discussed in this report.

  2. Bilateral inguinal hernias containing ovaries

    Directory of Open Access Journals (Sweden)

    Gurudutt Bhaskar Basrur

    2015-03-01

    Full Text Available Inguinal hernias are rare in females. The authors report a case of bilateral inguinal hernias in a 10-year-old female. On exploration, the patient was found to be having a sliding hernia containing incarcerated ovary as contents on both sides. Peroperatively the contents were reduced, the sac was transfixed at its base and the redundant sac was excised. The repair of this form of hernias is more difficult because of adhesions between the contents and the wall of the sac and risk of damage during dissection. A description of this clinical presentation in the pre operative assessment and operative management are discussed in this report.

  3. Amyad's hernia while reparing the bilateral inguinal hernia

    Directory of Open Access Journals (Sweden)

    Arif Aslaner

    2015-01-01

    Full Text Available Amyand's hernia is the term used for inguinal hernia containing appendix. It is a rare condition and found in 1% of inguinal hernia repairs. Here we report a case of Amyand's hernia in a 61 years old male who was diagnosed with bilateral inguinal hernia. He underwent surgery and bilateral inguinal hernia repair with prosthetic meshes and without appendectomy. The patient was discharged uneventfully. 

  4. Amyad's hernia while reparing the bilateral inguinal hernia

    OpenAIRE

    Arif Aslaner; Tuğrul Çakır; Umut Rıza Gündüz; Burhan Mayir; Nurullah Bülbüller

    2015-01-01

    Amyand's hernia is the term used for inguinal hernia containing appendix. It is a rare condition and found in 1% of inguinal hernia repairs. Here we report a case of Amyand's hernia in a 61 years old male who was diagnosed with bilateral inguinal hernia. He underwent surgery and bilateral inguinal hernia repair with prosthetic meshes and without appendectomy. The patient was discharged uneventfully. 

  5. Inguinal Hernia

    Science.gov (United States)

    ... gentle massage. What are the complications of inguinal hernias? Inguinal hernias can cause the following complications: Incarceration. An ... pass gas nausea and vomiting fever How are inguinal hernias diagnosed? A health care provider diagnoses an inguinal ...

  6. Bilateral totally extraperitoneal (TEP) repair of the ultrasound-diagnosed asymptomatic contralateral inguinal hernia.

    Science.gov (United States)

    Malouf, Phillip A; Descallar, Joseph; Berney, Christophe R

    2018-02-01

    The aim of this series is to determine the clinical utility of routine ultrasound (US) of the contralateral, clinically normal groin when a unilateral inguinal hernia is referred for hernia repair-specifically assessing the morbidity and short-term change in quality-of-life (QoL) due to repair of this occult contralateral hernia when also repairing the symptomatic side. TEP inguinal hernia repair affords the opportunity to repair any groin hernia through the same small incisions. US detects 96.6% of groin hernias with 84.4% specificity. 234 consecutive male patients with clinically unilateral and clinically bilateral hernia were enrolled; those with a clinically unilateral hernia were sent for groin US and if positive, a bilateral TEP groin hernia repair was performed (USBH). If negative, a unilateral TEP groin hernia repair was performed (UNIH). Carolina's comfort scales (CCS) and visual analogue scores (VAS) were recorded at 2 and 6 weeks postoperatively, while a modified CCS (MCCS) was recorded for all patients preoperatively. Bilateral TEP repair resulted in higher VAS scores than unilateral repair at 2 weeks but not 6 weeks. CCS were worse in the USBH group than UNIH group at 2 weeks but were similar by 6 weeks. Complications' rates were similar amongst all 3 groups. Factors contributing to worse scores were: smaller hernia, complications, worse preoperative MCCS results, recurrent hernia and bilateral rather than unilateral repair. Bilateral TEP for the clinically unilateral groin hernia with an occult contralateral groin hernia can be performed without increased morbidity, accepting a minor and very temporary impairment of QoL.

  7. Laparoscopic totally extra-peritoneal hernia repair for bilateral Spigelian hernias and coincident inguinal hernia: A case report.

    Science.gov (United States)

    Matsui, Shimpei; Nitori, Nobuhiro; Kato, Ayu; Ikeda, Yoshifumi; Kiatagwa, Yuko; Hasegawa, Hirotoshi; Okabayashi, Koji; Tsuruta, Masashi; Kitajima, Masaki

    2016-01-01

    Spigelian hernia (SH) is a rare ventral hernia occurring near the lateral border of the rectus muscle. The treatment remains controversial and depends on institutional expertise. Although laparoscopic surgery is a good adaptation for the repair of ventral hernias, only a few cases have been reported in the literature. Here, we report a case of totally extra-peritoneal (TEP) repair for bilateral SHs. A 74-year-old Japanese man presented with asymptomatic bulges in the right lower abdominal quadrant. On physical examination, the bulges were located to the right of the lateral border of the abdominal rectus muscle and the right inguinal region in an upright position. We diagnosed right SH and coincident homonymous ipsilateral inguinal hernia (IH) by abdominal computed tomography and planned a curative operation by laparoscopy. By first laparoscopic exploration, we found an asymptomatic SH to the left of the lateral border of the abdominal rectus muscle and performed TEP repair for all hernias. The second laparoscopic exploration after fixing the mesh in place revealed that the orifice of the right SH was scarred and stiffened by repeated prolapse. We finally eliminated the sac by ligation because of a fear causing of reduction en masse of the SH. The use of laparoscopy simplified the diagnosis and facilitates the subsequent repair of the hernia. TEP approach is the ideal treatment for the simultaneous laparoscopic repair of SH and IH. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  8. Inguinal hernia repair

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007406.htm Inguinal hernia repair To use the sharing features on this ... Inguinal hernia repair is surgery to repair a hernia in your groin. A hernia is tissue that bulges out of ...

  9. Laparoscopic Inguinal Hernia Repair

    Science.gov (United States)

    ... Global Affairs and Humanitarian Efforts Log In Laparoscopic Inguinal Hernia Repair Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon About Your Inguinal Hernia and Laparoscopic Repair: Approximately 600,000 inguinal or ...

  10. Laparoscopic hernioplasty by Eyeglass-Shaped Mesh in 54 patients with bilateral inguinal hernia

    Directory of Open Access Journals (Sweden)

    Talebpour M

    2007-09-01

    Full Text Available   Background: Laparoscopic hernioplasty is a standard technique with increasing interest of patients and surgeons. Bilateral hernioplasty can be performed by laparoscopy as well. The aim of this study is to show laparoscopic bilateral hernioplasty is an acceptable method and use of eye-shaped mesh getting the best result.Methods: In 54 cases with bilateral inguinal hernia, under general anesthesia laparos-copic reconstruction with eye-shaped prolene mesh performed. All cases of recurrent, big, direct, indirect and femoral hernia were entered in the study.Results: Seven of 54 cases were female. Four cases (male had direct hernia, four female had femoral hernia and remaining of the study group had indirect form. Direct hernia 4 case (male, femoral hernia 4 (female and remaining were indirect hernia. Operation performed without any complications in all cases. In 12 cases sac of hernia was too much enlarged so technique of bridge at the base of sac used. In five cases diameter of defect was more than 2 centimeter. In three of them defect repaired by suture before mesh insertion. Postoperative complications were seroma at distal of mesh in 23 cases (absorbed during 3 weeks spontaneously, reaction to mesh in one case (mesh and protack removed after 3 months of operation. Conservative management was ineffective and anterior repair performed, recurrence in one case (after 2 months of operation due to displacement of mesh in big direct hernia. Post operative hospital stay was 1.3 day (mean time. Painless movement and mobilization was obvious after 48 hours.Conclusion: Laparoscopic bilateral hernioplasty using eye-shaped prolene mesh is an acceptable method with good results especially in indirect hernia. In direct hernia, repair of defect by suturing and fixation of mesh is preferred.

  11. Is unilateral laparoscopic TEP inguinal hernia repair a job half done? The case for bilateral repair.

    Science.gov (United States)

    Pawanindra Lal; Philips, Prejesh; Chander, Jagdish; Ramteke, Vinod K

    2010-07-01

    Bilateral laparoscopic totally extraperitoneal (TEP) repair of unilateral hernia is conspicuous in published literature by its absence. There are no studies or data on the feasibility, advantages or disadvantages of bilateral repair in all cases or in any subset of patients with unilateral primary inguinal hernia. The objective of this study is to investigate the feasibility of bilateral laparoscopic exploration for all unilateral cases followed by laparoscopic TEP in all cases and to compare complications, recurrence rates, postoperative pain, patient satisfaction, and return to work retrospectively with a similar number of age-matched retrospective controls. One hundred fifty TEP operations were performed in 75 patients (group A) prospectively and were compared with 75 unilateral TEP operations (group B) in age-matched controls done previously by the same surgeon. All cases were performed under general anesthesia, and TEP repair was performed using three midline ports. All uncomplicated patients were discharged at 24 h, in keeping with departmental policy. Of 75 patients (group A), 25 (33.3%) were clinically diagnosed with bilateral hernia and the rest (50, 66.66%) with unilateral hernia. The distribution of the 25 bilateral cases was 11 bilateral direct and 14 bilateral indirect inguinal hernias. The distribution of the 75 age-matched controls (group B) was all unilateral hernia, of which 47 were right-sided and 28 were left-sided. There were 23 direct hernias and 52 indirect hernias among the control group. The mean operative time for all 150 cases was 76.66 +/- 15.92 min. The operative time in the control group (unilateral hernias) was 66.16 +/- 12.44 min, whereas the operative time in the test group (bilateral repair) was 87.2 +/- 11.32 min. The operative time in the bilateral group was significantly higher, by 21.04 min or 31.88% (p = 0.000). The operative time in the true unilateral group was 82.45 +/- 9.38 min, whereas the operative time in the former

  12. Inguinal hernia (image)

    Science.gov (United States)

    Inguinal hernia is the result of an organ, usually bowel, protruding through a weak point or tear in the thin muscular abdominal wall. Inguinal hernias can restrict blood supply to the bowel herniated ...

  13. Etiology of Inguinal Hernias

    DEFF Research Database (Denmark)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    BACKGROUND: The etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias. RESULTS: Lateral...... with patients with lateral hernias. However, connective tissue alteration may play a role in development of both subtypes. Inguinal hernias have a hereditary component with a complex inheritance pattern, and inguinal hernia susceptible genes have been identified that also are involved in connective tissue...... homeostasis. CONCLUSION: The etiology of lateral and medial hernias are at least partly different, but the final explanations are still lacking on certain areas. Further investigations of inguinal hernia genes may explain the altered connective tissue observed in patients with inguinal hernias. The precise...

  14. Bilateral endoscopic totally extraperitoneal (TEP) inguinal hernia repair does not impair male fertility.

    Science.gov (United States)

    Roos, M M; Clevers, G J; Verleisdonk, E J; Davids, P H; van de Water, C; Spermon, R J; Mulder, L S; Burgmans, J P J

    2017-12-01

    Endoscopic totally extraperitoneal (TEP) hernia repair with polypropylene mesh has become a well-established technique. However, since the mesh is placed in close contact with the spermatic cord, mesh-induced inflammation may affect its structures, possibly resulting in impaired fertility. The aim of this observational prospective cohort study was to assess fertility after bilateral endoscopic TEP inguinal hernia repair in male patients. Fifty-seven male patients (22-60 years old) with primary, reducible, bilateral inguinal hernias underwent elective bilateral endoscopic TEP hernia repair with use of polypropylene mesh. The primary outcome was testicular perfusion; secondary outcomes were testicular volume, endocrinological status, and semen quality. All patients were assessed preoperatively and 6 months postoperatively. Follow-up was completed in 44 patients. No statistically significant differences in measurements of testicular blood flow parameters or testicular volume were found. Postoperative LH levels were significantly higher [preoperative median 4.3 IU/L (IQR 3.4-5.3) versus postoperative median 5.0 IU/L (IQR 3.6-6.5), p = 0.03]. Levels of inhibin B were significantly lower postoperatively [preoperative median 139.0 ng/L (IQR 106.5-183.0) versus postoperative median 27.0 ng/L (IQR 88.3-170.9), p = 0.01]. No significant changes in FSH or testosterone levels were observed. There were no differences in semen quality. Our data suggest that bilateral endoscopic TEP hernia repair with polypropylene mesh does not impair fertility, as no differences in testicular blood flow, testicular volume, or semen quality were observed. Postoperative levels of LH and inhibin B differed significantly from preoperative measurements, yet no clinical relevance could be ascribed to these findings.

  15. Occult hernias and bilateral endoscopic total extraperitoneal inguinal hernia repair: is there a need for prophylactic repair? : Results of endoscopic extraperitoneal repair over a period of 10 years.

    Science.gov (United States)

    Saggar, V R; Sarangi, R

    2007-02-01

    An advantage of the endoscopic total extraperitoneal approach over the conventional hernia repair is detection of an unsuspected, asymptomatic hernia on the contralateral side. A high incidence of occult contralateral hernias has been reported in the literature. However, few studies have examined the incidence of development of a hernia on the healthy side evaluated previously during an endoscopic unilateral hernia repair. This study aims to evaluate the incidence of development of a contralateral hernia after a previous bilateral exploration. The need for a prophylactic contralateral repair is also addressed. We retrospectively reviewed the results of 822 endoscopic total extraperitoneal inguinal hernia repairs done in 634 patients over a period of 10 years from May 1993 to 2003. Incidence of hernia undetected clinically and during previous contralateral repair was assessed over a follow up period ranging from 10 to 82 months. About 7.97% of bilateral hernias were clinically occult hernias. Only 1.12% of unilateral hernia repairs (who had undergone a contralateral evaluation at surgery) subsequently developed a hernia on the other side. The endoscopic approach to inguinal hernia repair is an excellent tool to detect and treat occult contralateral hernias. The incidence of hernia occurring at the contralateral side after a previous bilateral exploration is low, hence a prophylactic repair on the contralateral side is not recommended on a routine basis.

  16. Synchronous femoral hernias diagnosed during endoscopic inguinal hernia repair.

    Science.gov (United States)

    Putnis, Soni; Wong, April; Berney, Christophe

    2011-12-01

    During totally extraperitoneal (TEP) endoscopic repair of inguinal hernias, it is possible to see the internal opening of the femoral canal. The aim of our study was to determine the incidence of synchronous femoral hernias found in patients undergoing TEP endoscopic inguinal hernia repair. This was a retrospective review of prospectively collected data on 362 consecutive patients who underwent 484 TEP endoscopic inguinal hernia repairs during a 5-year period, May 2005 to May 2010. During surgery, both inguinal and femoral canal orifices were routinely inspected. The presence of unilateral or bilateral inguinal and femoral hernias was recorded and repaired accordingly. There were a total of 362 patients. More males (343, 95%) underwent a TEP hernia repair than females (19, 5%). There were more cases of unilateral (240/362, 66%) than bilateral (122/362, 34%) inguinal hernias. A total of 18 cases of synchronous femoral hernias were found during operation. There was a higher incidence of femoral hernia in females (7/19, 37%) compared to males (11/343, 3%) (P hernias were clinically detectable preoperatively. Females undergoing elective inguinal hernia repair are more likely to have a synchronous femoral hernia than males. We suggest that all women presenting with an inguinal hernia also have a formal assessment of the femoral canal. TEP endoscopic inguinal hernia repair is an ideal approach as both inguinal and femoral orifices can be assessed and hernias repaired simultaneously during surgery.

  17. Prospective, randomized, controlled trial comparing lightweight versus heavyweight mesh in chronic pain incidence after TEP repair of bilateral inguinal hernia.

    Science.gov (United States)

    Chui, L B; Ng, W T; Sze, Y S; Yuen, K S; Wong, Y T; Kong, C K

    2010-11-01

    This prospective, clinical, randomized, controlled study was performed to define the incidence of chronic pain after total extraperitoneal (TEP) repair with a light-weighted mesh compared with heavyweight mesh in patients with bilateral inguinal hernias. Consecutive patients with bilateral inguinal hernias were recruited for TEP inguinal hernia repair under general anesthesia. Heavyweight mesh was randomly assigned to one side of the groin and lightweight mesh to the other. Patients were followed up regularly for up to 1 year by an independent surgeon who was unaware of the mesh assignment. The postoperative pain score by means of a visual analogue scale (VAS) and other data were recorded. Fifty bilateral TEP hernia repairs were performed between September 2007 and February 2009. Six patients (12%) complained of chronic pain 3 months after the operation. A higher average pain score was observed for the side of hernia repaired by heavyweight mesh compared with lightweight mesh, but the difference was not statistically significant. More patients complained about foreign body sensation on the side repaired with heavyweight mesh (24%) compared with the side with lightweight mesh (8%; P TEP inguinal hernia repair because it provides less postoperative foreign body sensation; however, there was no significant difference in the incidence of chronic pain.

  18. Endoscopic inguinal hernia repair

    NARCIS (Netherlands)

    M.T.T. Knook

    2002-01-01

    textabstractInguinal hernias are among the oldest surgical challenges, having been recognized by the Egyptians in 1500 BC and Hippocrates in 400 BC. Celsus in 40 AD described Roman surgical practice, including manual hernia reduction for strangulated hernia, truss for reducible hernia and surgery

  19. Bilateral and Unilateral Total Extraperitoneal Inguinal Hernia Repair (TEP) have Equivalent Early Outcomes: Analysis of 9395 Cases.

    Science.gov (United States)

    Köckerling, F; Schug-Pass, C; Adolf, D; Keller, T; Kuthe, A

    2015-08-01

    To date, no randomized controlled trials have been carried out to compare the perioperative outcome of unilateral and bilateral inguinal hernia repair using an endoscopic technique. In a Swiss registry study comparing unilateral with bilateral inguinal hernias, no further details were given regarding the nature of the intra- and postoperative complications. In addition, some authors have raised the issue of prophylactic repair of a clinically healthy other groin side. In the Herniamed Registry, in total 9395 patients with a TEP were enrolled. These comprised 6700 patients with unilateral (71.31%) and 2695 patients (28.69%) with bilateral inguinal hernia repair. The outcome variables, analyzed in a multivariable model, were the intra- and postoperative as well as general complication rates, reoperation rate, duration of operation, and length of hospital stay. While no significant difference was found in the overall number of intraoperative complications between the unilateral and bilateral group (p=0.310), a significantly higher number of urinary bladder injuries in the bilateral TEP operation of 0.28% compared with 0.04% for unilateral TEP (p=0,008) were noted. The greater probability of reoperation (0.82% for unilateral vs. 1.78% for bilateral TEP; pTEP which that warrants attention. Based on these results, prophylactic operation of the healthy other groin should not be recommended.

  20. Giant prosthesis for reinforcement of visceral sac for complex bilateral and recurrent inguinal hernias: a prospective evaluation.

    Directory of Open Access Journals (Sweden)

    Thapar V

    2000-04-01

    Full Text Available AIMS: To evaluate giant prosthesis for reinforcement of visceral sac (GPRVS as a treatment for complex bilateral and recurrent inguinal hernias. SUBJECTS AND METHODS: The prospective study carried out in a single surgical unit at a tertiary health care center involved consecutive series of 31 patients with complex bilateral and recurrent inguinal hernias who underwent GPRVS. All were men and the mean age was 58 years (range 49-95 years. Factors predicting high risk for recurrence included a large hernia ( greater, similar5cms, 32%, 10/31 patients, failure of one or more previous repairs (45%, 14/31 patients, chronic obstructive pulmonary disease (25%, 8/31 patients and poor muscle tone (70%, 22/31 patients. Operative time, length of postoperative stay, complications and death were the main outcome measures. RESULTS: Mean -/+ SEM operative time was 65 -/+ 11 minutes (range 45-115 minutes. Mean -/+ SEM length of stay was 3.5 -/+ 0.7 days (range 2-5 days. There were 4 minor complications, but no mesh infections and death. Follow up was obtained for a mean period of 14.6 months (range 12-23 months; there were no recurrences. CONCLUSION: GPRVS provides a definitive and safe cure for repair of complex bilateral and recurrent inguinal hernias because of its simplicity, ease of the procedure, good results and low recurrence rate.

  1. Reconstrucción en linfedema peneano y escrotal secundario a hernia inguinal bilateral gigante Reconstruction in penile and scrotal lymphedema secondary to billateral giant inguinal hernia

    Directory of Open Access Journals (Sweden)

    A. Fernández García

    2009-12-01

    Full Text Available El linfedema peneano y escrotal tiene consecuencias funcionales, estéticas, sociales y psicológicas significativas para el paciente que lo padece. Es una enfermedad infrecuente en los países desarrollados, aunque relativamente prevalente en los países tropicales. Su causa más común es la filariasis, aunque en nuestra práctica diaria se asocia más frecuentemente a cirugía, radioterapia, procesos inflamatorios y neoplásicos. Presentamos un caso singular de linfedema penoescrotal secundario a cirugía por hernia inguinal gigante bilateral que persistía un año después de la intervención. El tratamiento quirúrgico consistió en la exéresis de toda la piel linfedematosa del escroto involucrada y el uso de colgajos de piel escrotal posterior para la cobertura testicular. En un segundo tiempo quirúrgico se llevó a cabo una extirpación total de la piel del pene y del tejido subcutáneo superficial a la fascia de Buck. Empleamos injertos de piel de grosor parcial para cubrir el pene denudado. El resultado estético postoperatorio fue aceptable y los resultados funcionales y psicológicos son satisfactorios para el paciente 3 años después de la cirugía.Lymphedema of the penis and scrotum has important functional, cosmetic, social, psychological consequences for the affected patient. It is a rare disease in the developed countries, although it is relatively frequent in tropical countries. Globally, the most common cause is filariasis, although in our practice it is most frecuently associated to surgery, radiotherapy, inflammatory and neoplasic diseases. We report one rare case of penoscrotal lymphedema due to billateral giant inguinal hernia reconstrction. The lymphedema was persistent one year after the repair of the billateral hernia. The technique of reconstruction consisted of excision of all involved lymphedematous skin of the scrotum, and use of posterior scrotal flaps for testicular coverage. In a second surgical time, a total

  2. Bilateral endoscopic total extraperitoneal (TEP) inguinal hernia repair does not induce obstructive azoospermia: data of a retrospective and prospective trial.

    Science.gov (United States)

    Skawran, S; Weyhe, D; Schmitz, B; Belyaev, O; Bauer, K H

    2011-07-01

    The endoscopic totally extraperitoneal (TEP) mesh repair is nowadays a well-established tension-free method for inguinal hernia repair. Mainly based on animal studies and case reports, a concern about the risk of postoperative infertility was expressed. This clinical study aimed to evaluate the risk of infertility due to obstructive azoospermia in men of fertile age who underwent a bilateral hernia repair. Over 3 years (2005-2008) 59 male patients, 18-60 years of age, underwent a bilateral TEP repair. Twenty-one of them were prospectively ("light mesh") and 38 retrospectively ("heavy mesh") evaluated for testicular volume and perfusion, serum levels of sexual hormones, ejaculate volume, and number of spermatic cells. Those parameters were determined preoperatively (prospective group) and not earlier than 3 months postoperatively (both groups). No significant difference between pre- and postoperative values was detected in the prospectively studied group. All postoperative parameters were within the normal range in the retrospective group. There was no evidence of impaired fertility in any patient due to the operation. The standardized TEP technique for simultaneous bilateral inguinal hernia repair in male patients was not associated with a higher risk for postoperative infertility after mesh implantation. The use of heavy-weight meshes had no negative effect on fertility.

  3. Direct diverticular inguinal hernia

    Energy Technology Data Exchange (ETDEWEB)

    Ekberg, O.; Kullenberg, K.

    Nineteen patients with direct diverticular inguinal hernia (DDIH) were examined with herniography and surgically explored. A lump medially in the groin and pain were the prominent clinical manifestations in 18 patients. Physical examination indicated the presence of a DDIH in 6 patients. In 16 patients herniography revealed hernial sacs protruding from the supravesical fossa in 5 and from the medial inguinal fossa in 11. At operation a circumscribed defect was found in the transverse fascia laterally and cranially to the pubic tubercle in all patients. In 16 patients peritoneal hernial sacs were demonstrated at surgery while in 3 only lipomas (fatty hernia) were contained within the defect. In our opinion DDIH is a specific variety of inguinal hernia with a fairly typical clinical presentation and radiographic appearance but probably often overlooked at surgery.

  4. Early assessment of bilateral inguinal hernia repair: A comparison between the laparoscopic total extraperitoneal and Stoppa approaches

    Directory of Open Access Journals (Sweden)

    Edivaldo Massazo Utiyama

    2016-01-01

    Full Text Available Background: The present clinical trial was designed to compare the results of bilateral inguinal hernia repair between patients who underwent the conventional Stoppa technique and laparoscopic total extraperitoneal repair (LTE with a single mesh and without staple fixation. Patients and Methods: This controlled, randomised clinical trial was conducted at General Surgery and Trauma of the Clinics Hospital, Medical School, the University of São Paulo between September 2010 and February 2011. Totally, 50 male patients, with a bilateral inguinal hernia, older than 25 years were considered eligible for the study. The following parameters were analysed during the early post-operative period: (1 The intensity of surgical trauma, operation time, C-reactive protein (CRP levels, white blood cell count, bleeding and pain intensity; (2 quality of life assessment; and (3 post-operative complications. Results: LTE procedure was longer than the Stoppa procedure (134.6 min ± 38.3 vs. 90.6 min ± 41.3; P 0.05. There was no difference in pain during the 1st and 7th post-operative, physical functioning, physical limitation, the impact of pain on daily activities, and the Carolinas Comfort Scale during the 7th and 15th post-operative (P > 0.05. Complications occurred in 88% of Stoppa group (22 patients and 64% in LTE group (16 patients (P < 0.05. Conclusion: The comparative study between the Stoppa and LTE approaches for the bilateral inguinal hernia repair demonstrated that: (1 The LTE approach showed less surgical trauma despite the longer operation time; (2 Quality of life during the early post-operative period were similar; and (3 Complication rates were higher in the Stoppa group.

  5. Randomised clinical trial: conventional Lichtenstein vs. hernioplasty with self-adhesive mesh in bilateral inguinal hernia surgery.

    Science.gov (United States)

    Porrero, Jose L; Castillo, María J; Pérez-Zapata, Ana; Alonso, María T; Cano-Valderrama, Oscar; Quirós, Esther; Villar, Sol; Ramos, Beatriz; Sánchez-Cabezudo, Carlos; Bonachia, Oscar; Marcos, Alberto; Pérez, Brígido

    2015-10-01

    To compare the results of conventional Lichtenstein hernioplasty with polypropylene mesh (PLP) with a lightweight self-adhesive mesh (Parietene Progrip®; Covidien, Dublin, Ireland) (PPG) used in patients with bilateral inguinal hernia. Randomised clinical trial with 89 patients with a minimum follow-up of 1 year. Every patient had bilateral inguinal hernia and had both prostheses implanted randomly, one on each side. Early postoperative and chronic pain was evaluated using the visual analogue scale. Also recurrence rate and subjective evaluation of patients were analysed. Pain in the early postoperative period was inferior on the side where the self-adhesive mesh had been implanted (6.12 vs. 6.62, p=0.005 during the 1st postoperative day; 2.12 vs. 2.62, p=0.001 during the 7th postoperative day). Differences disappeared with the long-term evaluation (0.71 vs. 0.98, p=0.148 1 year after the surgery). The operative time was significantly shorter on the PPG mesh side (24.37 ± 5.1 in case of the PPG mesh and 29.66 ± 5.6 in case of the PLP mesh, p<0,001). Recurrence occurred in seven patients (7.8%), six of them (6.7%, CI 3.0-14.4) on the PPG mesh side and one (1.1%, CI 0.2-7.8) on the PLP side. These differences were not statistically significant (p=0.125) CONCLUSIONS: Although hernioplasty with self-adhesive mesh reduced early postoperative pain, this reduction was clinically irrelevant and it had no influence on chronic pain. There was a trend towards a higher recurrence rate when self-adhesive meshes were used, and although in this study differences were not statistically significant they should be confirmed in later studies using larger samples. Surgical procedures that do not need fixing sutures are promising, but further studies are needed before they become the gold standard of inguinal hernia repair.

  6. Hernias inguinales bilaterales operadas con anestesia local mediante hernioplastia de Lichtenstein Bilateral inguinal hernias operated on with local anesthesia by Lichtenstein hernioplasty

    Directory of Open Access Journals (Sweden)

    Bárbaro Agustín Armas Pérez

    2009-03-01

    Full Text Available INTRODUCCIÓN. La hernioplastia inguinal bilateral libre de tensión de Lichtenstein es una posibilidad real de tratamiento en pacientes con hernia inguinal bilateral. Este método es en esencia menos costoso para el paciente, la institución y la economía en general, y permite una reincorporación rápida a la sociedad, por lo cual en el presente estudio se presentaron los resultados de este protocolo de tratamiento, con la finalidad de evaluar su efectividad. MÉTODOS. Se realizó un estudio descriptivo transversal con los primeros 38 pacientes operados con la técnica de Lichtenstein mediante anestesia local (técnica combinada de Braun y de Shleider. Los pacientes fueron operados de forma ambulatoria entre enero de 2001 y diciembre del 2007. Se dio el alta en la tarde, si la operación fue en la mañana; y al amanecer del día siguiente, si se operó en la tarde, con el objetivo de evitar la equimosis declive con la movilización precoz. RESULTADOS. Cuatro de los pacientes presentaban hernias recurrentes. El material protésico más empleado fue el polipropileno (86,9 %. Las complicaciones alcanzaron el 9,1 % (referidas no a los 38 pacientes, sino a las 76 hernioplastias; y después de un seguimiento que osciló entre 1 y 36 meses, se presentó un rechazo al material protésico (1,3 % y una recidiva (1,3 %. CONCLUSIONES. Se concluyó que este procedimiento es aplicable a las hernias bilaterales, ya que el estrés, los costos institucionales y las molestias del paciente se reducen, con lo cual demuestra su eficacia.INTRODUCTION. Lichtenstein's tension free bilateral inguinal hernioplasty is a real possibility for treating patients with bilateral inguinal hernia. This method is essentially less expensive for the patient, the institution and the economy in general, and it allows a fast reincorporation to society. Therefore, the results of this treatment protocol were included in the present study aimed at evaluating its effectiveness. METHODS

  7. Prospective randomized trial comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic totally extra peritoneal (TEP) approach for bilateral inguinal hernias.

    Science.gov (United States)

    Sharma, Deborshi; Yadav, Kamal; Hazrah, Priya; Borgharia, Saurabh; Lal, Romesh; Thomas, Shaji

    2015-10-01

    Bilateral inguinal hernias form a part of the complex spectrum of weakness in the region of the myopectineal orifice. Laparoscopic surgery is one of the standard approaches for bilateral hernias. We describe the results of a randomized trial that was undertaken to compare and evaluate TAPP and TEP repair for bilateral inguinal hernias. Sixty patients were randomized into two groups. Group I (TAPP) and Group II (TEP) were compared in terms of procedure related variables, conversion, post-operative recovery and complications. Analysis was done using SPSS software version 17. Seventy-seven patients were assessed for fitness to include in the study. Seventeen patients had to be excluded due to either not meeting the inclusion criteria's or for not giving consent. The median age (52 yrs) was comparable in both groups. In Group II (TEP) mean operating time was 120.89 ± 29.28 min compared to 108.16 ± 16.10 min in Group I (TAPP). Post-operative pain scores were less in Group I(TAPP) at all levels of recording (8 h-48 h), though most patients required injectable analgesic for 32 h in both groups (p-value 0.029). Subcutaneous emphysema was more commonly noted in the Group II (TEP) (p-value 0.038). In Group I (TAPP) mean hospital stay was 52.0 ± 14.21 h while in Group II (TEP) it was 52.29 ± 9.36 h (p-value 0.427). Mean time for return to work was 11.8 ± 2.35 days in Group I (TAPP) and 12.41 ± 2.22 days in Group II (TEP) (p-value 0.339). The procedures though different in approach were quite similar in outcome. Mean operating time was increased in the TEP repairs along with immediate post-operative pain scores. The pattern of some complications like subcutaneous emphysema was significantly more in the TEP group while minor vascular injury though not significant was different in both groups. The indirect cost incurred from consumables did not vary other than need for more tacks in the TAPP group. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd

  8. Are there any predictive factors of metachronous inguinal hernias in children with unilateral inguinal hernia?

    Science.gov (United States)

    Jallouli, M; Yaich, S; Dhaou, M B; Yengui, H; Trigui, D; Damak, J; Mhiri, R

    2009-12-01

    This study was done to identify risk factors for metachronous manifestation of contralateral inguinal hernia in children with unilateral inguinal hernia. This is a retrospective study of 565 patients with inguinal hernia during a nine-year period at a single institution. Age, sex, and side of the hernia at presentation were recorded. The incidence of metachronous inguinal hernia and its risk factors were analyzed. Of 565 children, 62 (11%) were presented with synchronous bilateral hernias. Of the remaining 503, a metachronous contralateral hernia developed in 22 (4.4%). The age at hernia repair of the patients with contralateral manifestation (18 ± 3.67 months; mean ± SD), was significantly younger than observed in the control patients (34 ± 1.34 months; p = 0.000). There was no significant difference between the groups in other factors such as the age at hernia presentation, the initial side of the hernia, birth weight. and the percentage of patients who had experienced incarceration. We believe that the incidence is still too low to recommend routine contralateral exploration. Therefore, infants younger than 18 months appear to be a higher-risk subpopulation and should receive closer follow-up over this time period.

  9. The Danish Inguinal Hernia database

    DEFF Research Database (Denmark)

    Friis-Andersen, Hans; Bisgaard, Thue

    2016-01-01

    the medical management of the database. RESULTS: The Danish Inguinal Hernia Database comprises intraoperative data from >130,000 repairs (May 2015). A total of 49 peer-reviewed national and international publications have been published from the database (June 2015). CONCLUSION: The Danish Inguinal Hernia......AIM OF DATABASE: To monitor and improve nation-wide surgical outcome after groin hernia repair based on scientific evidence-based surgical strategies for the national and international surgical community. STUDY POPULATION: Patients ≥18 years operated for groin hernia. MAIN VARIABLES: Type and size...... of hernia, primary or recurrent, type of surgical repair procedure, mesh and mesh fixation methods. DESCRIPTIVE DATA: According to the Danish National Health Act, surgeons are obliged to register all hernia repairs immediately after surgery (3 minute registration time). All institutions have continuous...

  10. Groin hernia subtypes are associated in patients with bilateral hernias

    DEFF Research Database (Denmark)

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian

    2015-01-01

    BACKGROUND: To investigate the relation between groin hernia subtypes in patients operated for bilateral hernias. METHODS: With data from the Danish Hernia Database, we identified all patients operated for primary groin hernias from 1998 to 2012. Within this cohort all patients that were...... bilaterally operated were analyzed. Risk factors for bilateral groin hernia operation as well as the relationship between groin hernia subtypes bilaterally, were analyzed using multivariate Cox proportional hazards analysis and Kappa statistics. RESULTS: A total of 108, 775 persons with primary groin hernia...... repair (89.9% males) were registered, and of those were 12,041 persons operated bilaterally (94.9% males). Females and males operated for a unilaterally direct inguinal hernia (DIH) had increased Hazard Ratios (HR) of 3.85 (CI 95% 2.14-6.19) and 4.46 (CI 95% 2.57-7.88) of being contralaterally operated...

  11. [Connective tissue dysplasia as a reason of recurrent inguinal hernia].

    Science.gov (United States)

    Dzheng, Sh; Dobrovol'skiĭ, S P

    2014-01-01

    The examination results of 78 patients with recurrent inguinal hernia revealed presence of systemic connective tissue abnormalities in addition to dysplasia of posterior wall of inguinal canal in 48 (61.6%) patients. Hernial disease was observed in 37 (47.4%) patients including umbilical hernia in 12 cases, femoral hernia in 8 patients, hiatal hernia in 3 patients and bilateral inguinal hernia in 14 cases. Group of other diseases included varicose veins of lower limbs in 15 (19.2%) patients, mitral valve prolapse in 3 (3.8%) patients, violation of skin elasticity (striae) in 6 (7.7%) cases, diverticulum of bladder in 2 (2.6%) patients, diverticulum of esophagus in 1 (1.3%) patient, diverticulosis of small intestine in 2 (2.6%) cases. Our data prove that inguinal hernia is local manifestation of systemic disease.

  12. Bilateral total extraperitoneal inguinal hernia repair (TEP) has outcomes similar to those for unilateral TEP: population-based analysis of prospective data of 6,505 patients.

    Science.gov (United States)

    Gass, Markus; Rosella, Laura; Banz, Vanessa; Candinas, Daniel; Güller, Ulrich

    2012-05-01

    Whether bilateral total extraperitoneal (TEP) inguinal hernia repair is associated with worse outcomes than unilateral TEP continues to be a matter of debate. This study aimed to compare different outcomes of large cohorts of patients undergoing bilateral versus unilateral TEP. Based on prospective data of the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS), all patients undergoing elective unilateral or bilateral TEP from 1995 to 2006 were included in the study. The outcomes compared included conversion rates; intraoperative, surgical, and general postoperative complications; duration of operation; and length of hospital stay (LOS). Unadjusted and risk-adjusted multivariable analyses were performed. Data for 6,505 patients undergoing unilateral (n = 3,457) and bilateral (n = 3,048) TEP were prospectively collected. The average age and the American Society of Anesthesiologists (ASA) score were similar in the two groups. The patients undergoing bilateral TEP repair had a slightly increased rate of intraoperative complications (bilateral, 3.1% vs. unilateral, 1.9%) and surgical postoperative complications (bilateral, 3.2% vs. unilateral, 2.3%). The operation time was longer for bilateral TEP repair (86 vs. 67 min). No significant differences in postoperative LOS, general postoperative complications, or conversion rates were found. This is the first population-based analysis in the literature to compare different outcomes in a prospective cohort of more than 6,500 patients undergoing bilateral versus unilateral TEP. Although the rates for intraoperative and surgical postoperative complications were slightly higher for the patients undergoing bilateral TEP repair, the absolute differences were small and of minor clinical relevance. Bilateral TEP repair is associated with a minimal increase in operating time and similar LOS, general postoperative complications, and conversion rates. Therefore, for patients with bilateral inguinal hernia, a

  13. Risk of femoral hernia after inguinal herniorrhaphy

    DEFF Research Database (Denmark)

    Mikkelsen, T; Bay-Nielsen, M; Kehlet, H

    2002-01-01

    BACKGROUND: Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available. METHODS: Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July...... 2001, and included 34 849 groin hernia repairs. RESULTS: Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7.9 per cent of all reoperations for groin hernia recorded in the database....... The median time to reoperation for a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia...

  14. The Danish Inguinal Hernia database

    DEFF Research Database (Denmark)

    Friis-Andersen, Hans; Bisgaard, Thue

    2016-01-01

    access to their own data stratified on individual surgeons. Registrations are based on a closed, protected Internet system requiring personal codes also identifying the operating institution. A national steering committee consisting of 13 voluntary and dedicated surgeons, 11 of whom are unpaid, handles...... of hernia, primary or recurrent, type of surgical repair procedure, mesh and mesh fixation methods. DESCRIPTIVE DATA: According to the Danish National Health Act, surgeons are obliged to register all hernia repairs immediately after surgery (3 minute registration time). All institutions have continuous...... the medical management of the database. RESULTS: The Danish Inguinal Hernia Database comprises intraoperative data from >130,000 repairs (May 2015). A total of 49 peer-reviewed national and international publications have been published from the database (June 2015). CONCLUSION: The Danish Inguinal Hernia...

  15. Developments in inguinal hernia repair

    NARCIS (Netherlands)

    Voorbrood, C E H

    2016-01-01

    Performing inguinal hernia surgery in a high volume clinic allows for gaining expertise and achieving considerable experience and knowledge. This results in the recognition of benefits of tailored treatment, selection of patients, and structured aftercare rendering improvement of patients´ outcome

  16. The Danish Inguinal Hernia database

    Science.gov (United States)

    Friis-Andersen, Hans; Bisgaard, Thue

    2016-01-01

    Aim of database To monitor and improve nation-wide surgical outcome after groin hernia repair based on scientific evidence-based surgical strategies for the national and international surgical community. Study population Patients ≥18 years operated for groin hernia. Main variables Type and size of hernia, primary or recurrent, type of surgical repair procedure, mesh and mesh fixation methods. Descriptive data According to the Danish National Health Act, surgeons are obliged to register all hernia repairs immediately after surgery (3 minute registration time). All institutions have continuous access to their own data stratified on individual surgeons. Registrations are based on a closed, protected Internet system requiring personal codes also identifying the operating institution. A national steering committee consisting of 13 voluntary and dedicated surgeons, 11 of whom are unpaid, handles the medical management of the database. Results The Danish Inguinal Hernia Database comprises intraoperative data from >130,000 repairs (May 2015). A total of 49 peer-reviewed national and international publications have been published from the database (June 2015). Conclusion The Danish Inguinal Hernia Database is fully active monitoring surgical quality and contributes to the national and international surgical society to improve outcome after groin hernia repair. PMID:27822094

  17. Two Ports Laparoscopic Inguinal Hernia Repair in Children

    Directory of Open Access Journals (Sweden)

    Medhat M. Ibrahim

    2015-01-01

    Full Text Available Introduction. Several laparoscopic treatment techniques were designed for improving the outcome over the last decade. The various techniques differ in their approach to the inguinal internal ring, suturing and knotting techniques, number of ports used in the procedures, and mode of dissection of the hernia sac. Patients and Surgical Technique. 90 children were subjected to surgery and they undergone two-port laparoscopic repair of inguinal hernia in children. Technique feasibility in relation to other modalities of repair was the aim of this work. 90 children including 75 males and 15 females underwent surgery. Hernia in 55 cases was right-sided and in 15 left-sided. Two patients had recurrent hernia following open hernia repair. 70 (77.7% cases were suffering unilateral hernia and 20 (22.2% patients had bilateral hernia. Out of the 20 cases 5 cases were diagnosed by laparoscope (25%. The patients’ median age was 18 months. The mean operative time for unilateral repairs was 15 to 20 minutes and bilateral was 21 to 30 minutes. There was no conversion. The complications were as follows: one case was recurrent right inguinal hernia and the second was stitch sinus. Discussion. The results confirm the safety and efficacy of two ports laparoscopic hernia repair in congenital inguinal hernia in relation to other modalities of treatment.

  18. Preoperative progressive pneumoperitoneum for giant inguinal hernias

    OpenAIRE

    Piskin, Turgut; Aydin, Cemalettin; Barut, Bora; Dirican, Abuzer; Kayaalp, Cuneyt

    2010-01-01

    Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient?s tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal her...

  19. Clinical features and therapeutic strategies of obstructive azoospermia in patients treated by bilateral inguinal hernia repair in childhood

    Directory of Open Access Journals (Sweden)

    Xiang-Feng Chen

    2014-10-01

    Full Text Available Childhood inguinal herniorrhaphy is one common cause of seminal tract obstruction. Vasovasostomy (VV can reconstruct seminal deferens and result in appearance of sperm and natural pregnancy in some patients. Secondary epididymal obstruction caused by a relatively long-term vasal obstruction is a common cause of lower patency compared with VV due to vasectomy in adults. From July 2007 to June 2012, a total of 62 patients, with history of childhood inguinal herniorrhaphy and diagnosed as obstructive azoospermia were treated in our center. The overall patency rate and natural pregnancy rate were 56.5% (35/62 and 25.8% (16/62, respectively. 48.4% (30/62 of the patients underwent bilateral VV in the inguinal region, with a patency rate of 76.7% (23/30 and a natural pregnancy rate of 36.7% (11/30, respectively. 30.6% (19/62 of the patients underwent bilateral VV and unilateral or bilateral vasoepididymostomies due to ipsilateral epididymal obstruction with the patency and natural pregnancy rate decreasing to 63.2% (12/19 and 26.3% (5/19. 21.0% (13/62 of the patients merely underwent vasal exploration without reconstruction due to failure to find distal vasal stump, etc. Our study indicate that microsurgical reanastomosis is an effective treatment for some patients with seminal tract obstruction caused by childhood inguinal herniorrhaphy.

  20. Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences

    DEFF Research Database (Denmark)

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian

    2014-01-01

    PURPOSE: The purpose of this study was to establish the risk of recurrence after direct and indirect inguinal hernia operation in a large-scale female population and to establish the relationship between the type of hernia at the primary and recurrent procedure. METHODS: Using data from the Danish...... Hernia Database (DHDB), a cohort was generated: all females operated on electively for a primary inguinal hernia by either Lichtenstein’s technique or laparoscopy from 1998 to 2012. Within this prospectively collected cohort, the hernia type at the primary procedure (direct inguinal hernia (DIH......), indirect inguinal hernia (IIH), combination hernia), the hernia type at the recurrent procedure (DIH, IIH, combination hernia, femoral hernia), anesthesia type, and time from primary procedure to reoperation were registered. RESULTS: A total of 5,893 females with primary elective inguinal hernia operation...

  1. Etiology of Inguinal Hernias: A Comprehensive Review.

    Science.gov (United States)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    The etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias. Lateral and medial hernias seem to have common as well as different etiologies. A patent processus vaginalis and increased cumulative mechanical exposure are risk factors for lateral hernias. Patients with medial hernias seem to have a more profoundly altered connective tissue architecture and homeostasis compared with patients with lateral hernias. However, connective tissue alteration may play a role in development of both subtypes. Inguinal hernias have a hereditary component with a complex inheritance pattern, and inguinal hernia susceptible genes have been identified that also are involved in connective tissue homeostasis. The etiology of lateral and medial hernias are at least partly different, but the final explanations are still lacking on certain areas. Further investigations of inguinal hernia genes may explain the altered connective tissue observed in patients with inguinal hernias. The precise mechanisms why processus vaginalis fails to obliterate in certain patients should also be clarified. Not all patients with a patent processus vaginalis develop a lateral hernia, but increased intraabdominal pressure appears to be a contributing factor.

  2. Do we really know the symptoms of inguinal hernia?

    Science.gov (United States)

    Pérez Lara, F J; Del Rey Moreno, A; Oliva Muñoz, H

    2015-10-01

    Although there is a high incidence of inguinal hernia in developed countries, few studies have been conducted to describe the symptoms, and these few only address the local symptoms, not those presenting at other levels. The aim of the present study is to conduct a detailed review of the symptoms, both inguinal and otherwise, of patients with inguinal hernia. A case-control study was designed to compare the symptoms presented by 231 patients diagnosed with inguinal hernia with those of a second group of 231 randomly-selected subjects. In the hernia group, the symptoms were also evaluated according to the location of the hernia (right, left, bilateral). Significant differences (more symptomatology in patients with hernia) were found for the following items: groin pain, genital pain, urinary symptoms, abdominal pain, increased peristalsis and tenesmus. On the contrary, the control patients presented greater symptomatology with respect to back pain and diaphragm pain. Patients with inguinal hernia present a wide variety of symptoms, and these are not restricted to the inguinal area. It is important to be aware of this fact to convey accurate information to the patient, especially with regard to postoperative expectations.

  3. Bilateral Retrovascular Femoral Hernia

    OpenAIRE

    Papanikitas, Joseph; Sutcliffe, Robert P.; Rohatgi, Ashish; Atkinson, Simon

    2008-01-01

    A 34-year-old woman with cystic fibrosis presented with bilateral femoral hernias, which were found to be retrovascular at operation. The hernias were not amenable to conventional open or laparoscopic repair, and were repaired using pre-peritoneal mesh inserted deep to transversalis fascia. The anatomical basis and management of uncommon variants of femoral hernia are discussed.

  4. Occult hernias detected by laparoscopic totally extra-peritoneal inguinal hernia repair: a prospective study.

    Science.gov (United States)

    Dulucq, J-L; Wintringer, P; Mahajna, A

    2011-08-01

    One distinct advantage of laparoscopic inguinal hernia repair is the opportunity for clear visualization of the direct, indirect, femoral, obturator and other groin spaces. The aim of this study was to examine/assess the potential of the laparoscopic totally extraperitoneal (TEP) inguinal hernia repair method in detecting unexpected additional hernias. Patients who underwent an elective inguinal hernia repair, in the department of abdominal surgery at the institute of laparoscopic surgery (ILS, Bordeaux, France) between September 2003 and July 2005 were enrolled prospectively in the study. The patients' demographic data, operative, postoperative course and outpatient follow-up were studied. A total of 337 laparoscopic inguinal hernia repairs were performed in 263 patients. Of these, 189 patients had unilateral hernia (109 right and 80 left) and 74 patients had bilateral hernias. Indirect hernias were the most common, followed by direct and then femoral hernias. There were 218 male patients and 45 female patients with a mean age of 60 ± 15 years. There were 44 unexpected hernias: 6 spegilian hernias, 19 obturator hernias and another 19 femoral hernias. Two patients were converted to transabdominal preperitoneal (TAPP) due to surgical difficulties. There were no major intraoperative complications in all patients except for three cases of bleeding arising from the inferior epigastric artery. Only one patient had postoperative bleeding and was re-operated on several hours after the hernia repair. No recurrence occurred in the present series. The laparoscopic inguinal hernia repair approach allows viewing of the entire myopectineal orifice, facilitating repair of any unexpected hernias and thereby reducing the chance of recurrence.

  5. Inguinal Hernia Management: Focus on Pain

    NARCIS (Netherlands)

    A.R. Wijsmuller

    2010-01-01

    textabstractIn the Netherlands approximately 31,000 inguinal hernias are corrected yearly, making it one of the most frequently performed operations in surgery. The majority of inguinal hernia repairs is conducted in male patients older than 50 years. Since recurrence rates have been reduced to a

  6. Convalescence after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette Astrup; Rosenberg, Jacob; Bisgaard, Thue

    2016-01-01

    BACKGROUND: Duration of convalescence after inguinal hernia repair is of major socio-economic interest and an often reported outcome measure. The primary aim was to perform a critical analysis of duration of convalescence from work and activity and secondary to identify risk factors for unexpected...... prolonged convalescence after laparoscopic inguinal hernia repair. METHODS: A qualitative systematic review was conducted. PubMed, Embase and the Cochrane database were searched for trials reporting convalescence after laparoscopic inguinal hernia repair in the period from January 1990 to January 2016...... factors for prolonged convalescence extending more than a few days after laparoscopic inguinal hernia repair. CONCLUSIONS: Patients should be recommended a duration of 1-2 days of convalescence after laparoscopic inguinal hernia repair. Short and non-restrictive recommendations may reduce duration...

  7. Muscle degeneration in inguinal hernia specimens.

    Science.gov (United States)

    Amato, G; Agrusa, A; Romano, G; Salamone, G; Gulotta, G; Silvestri, F; Bussani, R

    2012-06-01

    There are few articles in the literature reporting the histological changes of groin structures affected by inguinal hernia. A deeper knowledge of this matter could represent an important step forward in the identification of the causes of hernia protrusion. This study aimed to recognise the pathological modifications of muscular structures in autopsy specimens excised from tissues surrounding the hernia orifice. Inguinal hernia was identified in 30 autopsied cadavers, which presented different varieties of hernia, including indirect, direct and mixed. Tissue specimens were resected for histological study from structures of the inguinal area surrounding the hernia opening, following a standardised procedure. The histological examination was focussed on the detection of structural changes in the muscle tissues. The results were compared with biopsy specimens resected from corresponding sites of the inguinal region in a control group of 15 fresh cadavers without hernia. Significant modification of the muscular arrangement of the inguinal area was recognized. Pathological alterations such as atrophy, hyaline and fibrotic degeneration, as well as fatty dystrophy of the myocytes were detected. These findings were observed consistently in the context of multistructural damage also involving vessels and nerves. In cadavers with hernia these alterations were always present independent of hernia type. No comparable damage was found in control cadavers without hernia. The high degree of degenerative changes in the muscle fibres in the inguinal area involved in hernia protrusion described in this report seems to be consistent with chronic compressive damage. These alterations could embody one important factor among the multifactorial sources of hernia genesis. Conjectures concerning its impact on the physiology and biodynamics of the inguinal region are made. The relationship between the depicted degenerative injuries and the genesis of inguinal hernia is also a focus of

  8. Bilateral inguinal hernias detected by peritoneal scintigraphy during the evaluation of scrotal swelling in a patient on continuous ambulatory peritoneal dialysis

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Seok Tae; Sohn, Myung Hee [School of Medicine, Chonbuk National Univ., Chonju (Korea, Republic of)

    2001-02-01

    A 47-year-old man with end-stage renal disease due to diabetic nephropathy underwent a peritoneal scintigraphy to evaluate the cause of recently developed scrotal swelling. Two liters of dialystate mixed with 111 MBq of Tc-99m sulfur colloid were adminstered into the peritoneal cavity via the dialysis catheter. Various anterior images of the abdomen and pelvis were obtained at 15 min, 2 hr and 4 hr after the tracer instillation. At 15 min, anterior images of the abdomen and pelvis demonstrated linear tracts of activity through both inguinal canals, which were more prominent in the right side (A). Images at 2 hr revealed a passage of the radioactive fluid into the right hemiscrotum. At the same time, there was a considerable accumulation of activity in the right inguinal canal (B). In the delayed image, there was a progressive accumulation of activity in the inguinal canals and a prominent passage of the tracer into the scrotum (C). Both abdominal and inguinal hernias are commonly associated with continuous ambulatory peritoneal dialysis (CAPD). Overall incidence of CAPD-induced hernia ranges from 2.7% to 25%. Inguinal hernias were frequently manifested as scrotal swelling. Leakages f dialysate fluid into the scrotum has been noted in CAPD patients with scrotal swelling, with or without clincal findings of inguinal hernia. In the present case, the right side had leakage from a clinical inguinal hernia and the left side, leakage, from a subclinial inguinal hernia. A subclinical inguinal hernia was easily demonstrable with peritoneal scintigraphy. Peritoneal scintigraphy is extremely helpful in the evaluation of scrotal swelling in a patient on CAPD.

  9. Incidental non-inguinals hernias in totally extra-peritoneal hernia repair.

    Science.gov (United States)

    Old, O J; Kulkarni, S R; Hardy, T J; Slim, F J; Emerson, L G; Bulbulia, R A; Whyman, M R; Poskitt, K R

    2015-03-01

    Totally extra-peritoneal (TEP) inguinal hernia repair allows identification and repair of incidental non-inguinal groin hernias. We assessed the prevalence of incidental hernias during TEP inguinal hernia repair and identified the risk factors for incidental hernias. Consecutive patients undergoing TEP repair from May 2005 to November 2012 were the study cohort. Inspection for ipsilateral femoral, obturator and rarer varieties of hernia was undertaken during TEP repair. Patient characteristics and operative findings were recorded on a prospectively collected database. A total of 1,532 TEP repairs were undertaken in 1,196 patients. Ninety-three patients were excluded due to incomplete data, leaving 1,103 patients and 1,404 hernias for analyses (1,380 male; 802 unilateral and 301 bilateral repairs; median age, 59 years). Among the 37 incidental hernias identified (2.6% of cases), the most common type of incidental hernia was femoral (n=32, 2.3%) followed by obturator (n=2, 0.1%). Increasing age was associated with an increased risk of incidental hernia, with a significant linear trend (p60 years of age was 4.0% vs 1.4% for those aged hernias were found in 29.2% of females vs 2.2% of males, (phernia in those with a recurrent inguinal hernia was 3.0% vs 2.6% for primary repair (p=0.79). Incidental hernias during TEP inguinal hernia repair were found in 2.6% of cases and, though infrequent, could cause complications if left untreated. The risk of incidental hernia increased with age and was significantly higher in patients aged >60 years and in females.

  10. Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences.

    Science.gov (United States)

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian; Bisgaard, Thue; Rosenberg, Jacob

    2014-01-01

    The purpose of this study was to establish the risk of recurrence after direct and indirect inguinal hernia operation in a large-scale female population and to establish the relationship between the type of hernia at the primary and recurrent procedure. Using data from the Danish Hernia Database (DHDB), a cohort was generated: all females operated on electively for a primary inguinal hernia by either Lichtenstein’s technique or laparoscopy from 1998 to 2012. Within this prospectively collected cohort, the hernia type at the primary procedure (direct inguinal hernia (DIH), indirect inguinal hernia (IIH), combination hernia), the hernia type at the recurrent procedure (DIH, IIH, combination hernia, femoral hernia), anesthesia type, and time from primary procedure to reoperation were registered. A total of 5,893 females with primary elective inguinal hernia operation on in the study period (61 % IIH, 37 % DIH, 2 % combined hernias) were included with a median follow-up time of 72 months (range 0 to 169). A total of 305 operations for suspected recurrences were registered (61 % inguinal recurrences, 38 % femoral recurrences, 1 % no hernias), which corresponded to an overall reoperation rate of 5.2 %. All femoral recurrences occurred after a previous open anterior operation. The crude reoperation rate after primary DIH operation was 11.0 %, 3.0 % after primary IIH operation and 0.007 % after combined hernia operation (p hernia recurrences exclusively existed after anterior open primary operation.

  11. [Spontaneous bilateral Petit hernia].

    Science.gov (United States)

    Fontoura, Rodrigo Dias; Araújo, Emerson Silveira de; Oliveira, Gustavo Alves de; Sarmenghi Filho, Deolindo; Kalil, Mitre

    2011-01-01

    Petit's lumbar hernia is an uncommon defect of the posterior abdominal wall that represents less than 1% of all abdominal wall hernias. It is more often unilateral and founded in young females, rarely containing a real herniated sac. There are two different approaches to repair: laparoscopy and open surgery. The goal of this article is to report one case of spontaneous bilateral lumbar Petit's hernia treated with open surgery.

  12. Male Fertility After Inguinal Hernia Mesh Repair

    DEFF Research Database (Denmark)

    Kohl, Andreas Pagh; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    OBJECTIVE:: To determine whether patients who receive an inguinal hernia repair father the same number of children as the background population. BACKGROUND:: Although the effect of inguinal hernia repair on male fertility has previously been investigated through indirect measures, no previous...... studies have evaluated the final measure of male fertility, which is the number of children fathered by patients. METHODS:: Prospectively collected data on 32,621 male patients between the ages of 18 and 55 years who received 1 or more inguinal hernia repairs during the years 1998 to 2012 were found in 5...... hernia repair using Lichtenstein technique or laparoscopic approach did not father fewer children than expected. Thus, inguinal hernia repair using Lichtenstein or laparoscopic approach did not impair male fertility....

  13. Outpatient Simultaneous Bilateral Inguinal Herniorrhaphy In A Rural ...

    African Journals Online (AJOL)

    A retrospective review of all inguinal herniorrhaphies performed on outpatient basis in a rural practice between 1983 and 1999 was undertaken to determine if simultaneous bilateral repair carried a greater risk than unilateral herniorrhaphy. In the 16 – year period, 2880 unilateral and 393 bilateral hernias were repaired on ...

  14. Outcome of laparoscopic inguinal hernia repair in a South African ...

    African Journals Online (AJOL)

    Laparoscopic inguinal herniorrhaphy was first described by. Ger in 1982.1 Proponents of this technique have claimed several advantages over open repair: less postoperative discomfort or pain; reduced recovery time and earlier return to full activity; easier repair of a recurrent and bilateral hernia, fewer wound.

  15. PELVIC HYDATID MIMICKING INGUINAL HERNIA

    Directory of Open Access Journals (Sweden)

    Ashwani Kumar Dalal

    2017-11-01

    Full Text Available PRESENTATION OF CASE The classical finding in hydatid disease caused by Echinococcus granulosus with liver or lung involvement is well known. However, diagnosing hydatid disease at unusual locations maybe challenging even in endemic areas causing diagnostic confusion as primary extrahepatic extrapulmonary hydatid cysts are rare and only a few sporadic cases have been reported. We present a case where a painless progressive cystic swelling was present in left inguinal region with positive cough impulse and irreducibility mimicking an inguinal hernia. CECT was done, which confirmed it to be multiple hydatid cysts. The patient underwent excision of the cysts with mesh repair and left inguinal orchiectomy as the cord structures couldn’t be separated from the cyst wall. Patient was discharged in satisfactory condition on oral antibiotics and albendazole. No recurrence noted on 6 months of follow up. So, a high suspicion for hydatid cyst should be kept in mind especially in endemic areas for any intra-abdominal swelling. The surgeon must keep in mind that this parasitosis can occur even in uncommon locations and therefore it should be regarded as a potentially systemic disease. In these cases, the diagnosis is challenging and can be achieved only through a complete interdisciplinary evaluation clinical, laboratory and radiological data.

  16. OPEN INGUINAL HERNIA REPAIR IN ADULT PATIENTS

    Directory of Open Access Journals (Sweden)

    M. S. Tomin

    2014-06-01

    Full Text Available The review presents the frequency, anatomy, classification, diagnosis, and the most effective open methods of inguinal hernia’s operative therapy in adult patients. These findings are in agreement with the recommendations of the Ukrainian association of surgeons-herniologists and the European European Hernia Society (EHS. The article does not deal with laparoendoscopic options of hernia repair (TAPP and TEP, as they require a separate section in the anatomy of the inguinal region and endoscopic techniques’ volumetric description. Besides, in Ukraine inguinal hernia repair is most frequently performed of open access that causes the topic’s timeliness.

  17. ONSTEP versus laparoscopy for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

    2015-01-01

    INTRODUCTION: The optimal repair of inguinal hernias remains controversial. It is recommended that an inguinal hernia be repaired using a mesh, either with a laparoscopic or an open approach. In Denmark, the laparoscopic approach is used in an increasing number of cases. The laparoscopic repair has...... clinical trial described in this protocol is to evaluate chronic pain after inguinal hernia repair using the ONSTEP method versus the laparoscopic approach. METHODS: This study is designed as a non-inferiority, two-arm, multicentre, randomised clinical trial, with a 1:1 allocation to ONSTEP or laparoscopic...

  18. Mesh Inguinal Hernia Repair and Appendectomy in the Treatment of Amyand’s Hernia with Non-Inflamed Appendices

    Directory of Open Access Journals (Sweden)

    Emin Kose

    2017-01-01

    Full Text Available Amyand’s hernia is defined as protrusion of the vermiform appendix in an inguinal hernia sac. It is a rare entity with variable clinical presentation from normal vermiform appendix to abscess formation due to perforation of acute appendicitis. Although surgical treatment includes appendectomy and hernia repair, appendectomy in the absence of an inflamed appendix and use of a mesh in cases of appendectomy remain to be controversial. The aim of this study was to review the experience of mesh inguinal hernia repair plus appendectomy performed for Amyand’s hernia with noninflamed appendices. There were five male patients with a mean age of 42.4 ± 16.1 years in this retrospective study in which Amyand’s hernia was treated with mesh inguinal hernia repair plus appendectomy for noninflamed appendices. Patients with acute appendicitis and perforated vermiform appendix were excluded. There were four right sided and one bilateral inguinal hernia. Postoperative courses were uneventful. During the follow-up period (14.0 ± 7.7 months, there was no inguinal hernia recurrence. Mesh inguinal hernia repair with appendectomy can be performed for Amyand’s hernia in the absence of acute appendicitis. However, presence of fibrous connections between the vermiform appendix and the surrounding hernia sac may be regarded as a parameter to perform appendectomy.

  19. The incidence of inguinal hernia and associated risk factors of incarceration in pediatric inguinal hernia: a nation-wide longitudinal population-based study.

    Science.gov (United States)

    Chang, S-J; Chen, J Y-C; Hsu, C-K; Chuang, F-C; Yang, S S-D

    2016-08-01

    This study uses a national database to evaluate the incidence of inguinal hernia and associated risk factors of incarcerated hernia in children from birth to 15 years of age. The study selected children born from 1997 to 2005 from a randomly selected cohort of 1,000,000 from an insured population of 23 million. We regarded children that were classified with code 550 and hernia surgery in accordance to the International Classification of Diseases, 9th Revision, as having inguinal hernia. We used the 2 chi-square test and logistic regression modeling for statistical analyses. In total, 79,794 children (41,767 male and 38,027 female) were enrolled in the study. The cumulative incidence of inguinal hernia in males and females from birth to 15 years old were 6.62 and 0.74 %, respectively (p inguinal hernia was at 0 years of age for males and 5 years of age for females. The ratio of unilateral vs. bilateral repair was 5.54:1. Females tend to have more bilateral inguinal hernia than males (25.4 vs. 12.9 %, p hernia occurred in 4.19 % children with inguinal hernia without significant gender discrepancy. Approximately 40 % of incarcerated hernia underwent hernia repair immediately after visiting the emergent department. In patients who presented with reducible hernia, we did not find significant correlation between waiting time to hernia repair and occurrence of incarceration. The cumulative incidence of inguinal hernia from birth to 15 years of age was 6.62 and 0.74 % in males and females, respectively. Incarceration was not related to prematurity or the waiting time for surgery.

  20. The effects of unilateral and bilateral spinal anaesthesia on hemodynamic parameters in patients surgically treated for inguinal hernia: Hemodynamic parameters and spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Milosavljević Snežana

    2016-01-01

    Full Text Available Introduction: Conventional bilateral spinal anaesthesia is commonly used for surgical treatment of inguinal hernia because it causes fast development of block with relatively small dosage of local anaesthetic; furthermore, it is easily administered, reduces the level of metabolic response to stress, reduces the incidence of deep venous thrombosis and respiratory depression. On the other hand, the main side effect is hypotension Objective: The goal of the research was to determine which of the two methods of spinal anaesthesia (conventional bilateral, achieved with regular dosage of long-lasting bupivacaine or hypobaric unilateral, achieved with combined application of bupivacaine and fentanyl ensures higher hemodynamic stability during tension-free hernioplasty in patients from group I and II of ASA classification system. Methods: The research was conducted as a prospective, controlled clinical study with the total amount of 50 patients, males and females, and within the age span ranging from 17 to 77, who all had indications for surgical treatment of one-sided inguinal hernia under spinal anaesthesia. The hemodynamic parameters (heart rate, systolic, diastolic and mean arterial pressure were measured during following intervals: T1 - during preanaesthetic visit, T2 - after premedication and the iv administration of Ringer's lactate solution, T3 - 15 minutes after the administration of spinal anaesthesia, T4 - after the surgical incision, T5 - intraoperatively, T6 - during the placement of the last surgical stitch on the skin, T7 - one hour postoperatively. Results: The results showed that the frequency of clinically relevant hypotension was statistically much higher in patients with bilateral spinal anaesthesia (24 % when compared to patients administered with unilateral spinal anaesthesia (4%. Ten minutes after the application of spinal anaesthesia the mean arterial pressure has decreased by 20% when compared to basic values in group BB, and by

  1. Pain characteristics after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette A; Strandfelt, Pernille; Rosenberg, Jacob

    2011-01-01

    Previous studies have shown different pain characteristics in different types of laparoscopic operations, but pain pattern has not been studied in detail after laparoscopic inguinal hernia repair. To optimise preoperative patient information and postoperative analgesic treatment the present study...

  2. Planned inguinal herniorrhaphy but no hernia sac?

    DEFF Research Database (Denmark)

    Jensen, P; Bay-Nielsen, M; Kehlet, H

    2004-01-01

    Planned inguinal herniorrhaphy may present a clinical dilemma when no hernia is found. No large-scale data are available on the incidence of this problem, and, therefore, no recommendations exist for choice of surgical intervention.......Planned inguinal herniorrhaphy may present a clinical dilemma when no hernia is found. No large-scale data are available on the incidence of this problem, and, therefore, no recommendations exist for choice of surgical intervention....

  3. Nerve degeneration in inguinal hernia specimens.

    Science.gov (United States)

    Amato, G; Ober, E; Romano, G; Salamone, G; Agrusa, A; Gulotta, G; Bussani, R

    2011-02-01

    The histological study of the herniated inguinal area is rare in the literature. This report is focused on the detection of structural changes of the nerves within tissues bordering the inguinal hernia of cadavers. Their physiopathological consequences are hypothesized. Primary inguinal hernia was diagnosed in 30 fresh cadavers. Tissue specimens from the inguinal region close to and around the hernia opening were excised for histological examination. A control of the data was achieved through tissue samples excised from equivalent sites of the inguinal region in 15 cadavers without hernia. The detected nerves in the inguinal area demonstrated pathological changes such as fibrotic degeneration, atrophy, and fatty dystrophy of the axons. The thickening of the perineural sheath was constantly seen. These findings were consistently present, independent of the hernia type. The detected nerve alterations lead us to imagine a worsening, or even the cessation, of the nervous impulse to the muscles, leading to atrophy and weakening of the abdominal wall. This could represent one of the multifactorial causes of hernia genesis.

  4. Direct and Recurrent Inguinal Hernias are Associated with Ventral Hernia Repair

    DEFF Research Database (Denmark)

    Henriksen, Nadia A; Sorensen, Lars T; Bay-Nielsen, Morten

    2013-01-01

    A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal hernias as opposed to patients with indirect inguinal hernias. The aim...... of the present study was to assess whether direct or recurrent inguinal hernias are associated with an elevated rate of ventral hernia surgery....

  5. New Clinical Concepts in Inguinal Hernia

    NARCIS (Netherlands)

    R.N. Veen, van (Ruben Nico)

    2008-01-01

    textabstractHernia surgery is one of the earliest forms of surgery and currently the most frequently performed operation in general surgery. Relatively modest improvements of clinical outcomes or savings of resource use in inguinal hernia repair would already have a signifi cant medical and

  6. Pain characteristics after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette A; Strandfelt, Pernille; Rosenberg, Jacob

    2011-01-01

    Previous studies have shown different pain characteristics in different types of laparoscopic operations, but pain pattern has not been studied in detail after laparoscopic inguinal hernia repair. To optimise preoperative patient information and postoperative analgesic treatment the present study...... investigated postoperative pain in terms of time course, pain intensity and individual pain components during the first 4 days after transabdominal preperitoneal hernia repair (TAPP)....

  7. Surgical approach for recurrent inguinal hernias

    DEFF Research Database (Denmark)

    Öberg, S; Andresen, K; Rosenberg, J

    2016-01-01

    Purpose: Guidelines recommend that the reoperation of a recurrent inguinal hernia should be by the opposite approach (anterior–posterior) than the primary repair. However, the level of evidence supporting the guidelines is partially low. The purpose of this study was to compare re-reoperation rates...... between repairs performed according to the guidelines with the ones performed against it. Methods: This cohort study was based on the Danish Hernia Database, including 4344 patients with two inguinal hernia repairs in the same groin. Four groups were compared as follows: Lichtenstein–Lichtenstein vs......-reoperation for Lichtenstein–Lichtenstein was only seen if the primary hernia was medial. Conclusions: A primary Lichtenstein repair of a primary medial hernia should be reoperated with a laparoscopic repair. A primary Lichtenstein repair of a primary lateral hernia can be reoperated with either a Lichtenstein...

  8. Sequelae of Endoscopic Inguinal Hernia Repair : Incidence, evaluation and management

    NARCIS (Netherlands)

    Burgmans, J.P.J.

    2015-01-01

    The endoscopic preperitoneal technique (TEP) is an appealing inguinal hernia repair technique, theoretically superior to other approaches. In practice some problems remain unsolved. Real incidences of chronic postoperative inguinal pain (CPIP) and other important sequelae of endoscopic hernia repair

  9. Lichtenstein versus Onstep for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

    2013-01-01

    Inguinal hernia is a common condition that affects millions of people world-wide every year. In Denmark (population of 5.5 million), more than 10,000 repairs of inguinal hernias are performed annually. The optimal surgical procedure for mesh placement and fixation is still being debated because...... of which is to evaluate chronic pain and sexual dysfunction after inguinal hernia repair using the Lichtenstein repair compared with the Onstep approach....... of long-term complications such as persisting pain and impairment of sexual function. The Onstep approach is a newer type of groin hernia repair with promising preliminary results in terms of very few cases of chronic pain and recurrences. This protocol describes a randomised clinical trial the objective...

  10. Sliding inguinal hernia is a risk factor for recurrence

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Bisgaard, Thue; Rosenberg, Jacob

    2015-01-01

    PURPOSE: A sliding inguinal hernia is defined as a hernia where part of the hernial sac wall is formed by an organ, e.g., the colon or bladder. Thus, repair of a sliding inguinal hernia may have higher risk of complications and recurrence compared with non-sliding inguinal hernia. The aim...... of this study was to investigate the incidence and reoperation rates following sliding inguinal hernia repair. METHODS: This study was based on data from the Danish Hernia Database covering the period between January 1, 1998 and February 22, 2012. Data were collected prospectively and nationwide. RESULTS......: In total, 70,091 primary hernia repairs were included for analysis. The occurrence of sliding inguinal hernias of the total group of included hernia repairs was 9.4 % among males and 2.9 % among females (p inguinal hernias had a higher cumulated reoperation rate...

  11. Prediction of contralateral inguinal hernias in children: a prospective study of 357 unilateral inguinal hernias.

    Science.gov (United States)

    Hoshino, M; Sugito, K; Kawashima, H; Goto, S; Kaneda, H; Furuya, T; Hosoda, T; Masuko, T; Ohashi, K; Inoue, M; Ikeda, T; Tomita, R; Koshinaga, T

    2014-06-01

    Previously, we established a pre-operative risk scoring system to predict contralateral inguinal hernia in children with unilateral inguinal hernias. The current study aimed to verify the usefulness of our pre-operative scoring system. This was a prospective study of patients undergoing unilateral inguinal hernia repair from 2006 to 2009 at a single institution. Gender, age at initial operation, birth weight, initial operation side, and the pre-operative risk score were recorded. We analyzed the incidence of contralateral inguinal hernia, risk factors, and the usefulness of our pre-operative risk scoring system. The follow-up period was 36 months. We used forward multiple logistic regression analysis to predict contralateral hernia. Of the 372 patients who underwent unilateral hernia repair, 357 (96.0 %) were completely followed-up for 36 months, and 23 patients (6.4 %) developed a contralateral hernia. Left-sided hernia (OR = 5.5, 95 %, CI = 1.3-24.3, p = 0.023) was associated with an increased risk of contralateral hernia. The following covariates were not associated with contralateral hernia development: gender (p = 0.702), age (p = 0.215), and birth weight (p = 0.301). The pre-operative risk score (cut-off point = 4.5) of the patients with a contralateral hernia was significantly higher, compared with the patients without a contralateral hernia using the area under the receiver operating characteristic curve (p = 0.024). Using multivariate analysis, we confirmed usefulness of our pre-operative scoring system and initial side of the inguinal hernia, together, for the prediction of contralateral inguinal hernia in children.

  12. A cadaveric massive strangulated left indirect inguinal hernia | Yinka ...

    African Journals Online (AJOL)

    Many forms of inguinal hernias have been found to have different contents ranging from abdominal to pelvic organs. A form of inguinal hernia with its contents made up of almost the whole of the small intestine and having a herniating sac as long as 28cm in length is indeed a rare form of inguinal hernia. Strangulated ...

  13. Recurrence and complications of pediatric inguinal hernia repair ...

    African Journals Online (AJOL)

    Introduction and aim Inguinal hernia is one of the most common pediatric diseases in children and it presents most commonly during the first year of life. The aim of this study was to determine epidemiologic indexes and complications of inguinal hernia repair in pediatric patients who underwent inguinal hernia surgery.

  14. Groin hernia subtypes are associated in patients with bilateral hernias: a 14-year nationwide epidemiologic study.

    Science.gov (United States)

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian; Rosenberg, Jacob

    2015-07-01

    To investigate the relation between groin hernia subtypes in patients operated for bilateral hernias. With data from the Danish Hernia Database, we identified all patients operated for primary groin hernias from 1998 to 2012. Within this cohort all patients that were bilaterally operated were analyzed. Risk factors for bilateral groin hernia operation as well as the relationship between groin hernia subtypes bilaterally, were analyzed using multivariate Cox proportional hazards analysis and Kappa statistics. A total of 108, 775 persons with primary groin hernia repair (89.9% males) were registered, and of those were 12,041 persons operated bilaterally (94.9% males). Females and males operated for a unilaterally direct inguinal hernia (DIH) had increased Hazard Ratios (HR) of 3.85 (CI 95% 2.14-6.19) and 4.46 (CI 95% 2.57-7.88) of being contralaterally operated for a DIH. Females and males operated for a unilaterally indirect inguinal hernia (IIH) had HRs of 6.93 (CI 95% 3.66-13.11) and 1.89 (CI95% 1.24-2.88) for being contralaterally operated for an IIH. The same tendency was seen for femoral hernias. All hernia subtypes were bilaterally associated in both genders and the hernia subtypes could be localized manifestations of generalized conditions or inheritable traits instead of localized defects.

  15. Absorbable Meshes in Inguinal Hernia Surgery

    DEFF Research Database (Denmark)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    PURPOSE: Absorbable meshes used in inguinal hernia repair are believed to result in less chronic pain than permanent meshes, but concerns remain whether absorbable meshes result in an increased risk of recurrence. The aim of this study was to present an overview of the advantages and limitations...... of fully absorbable meshes for the repair of inguinal hernias, focusing mainly on postoperative pain and recurrence. METHODS: This systematic review with meta-analyses is based on searches in PubMed, Embase, Cochrane, and Psychinfo. Included study designs were case series, cohort studies, randomized...... controlled trials (RCTs), and non-RCTs. Studies had to include adult patients undergoing an inguinal hernia repair with a fully absorbable mesh. RESULTS: The meta-analyses showed no difference in recurrence rates (median 18 months follow-up) and chronic pain rates (1 year follow-up) between absorbable...

  16. Breast-feeding and inguinal hernia.

    Science.gov (United States)

    Pisacane, A; de Luca, U; Vaccaro, F; Valiante, A; Impagliazzo, N; Caracciolo, G

    1995-07-01

    A case-control study was conducted to study the association between breast-feeding and inguinal hernia. The case group was significantly less often breast fed than control subjects (odds ratio, 0.49; 95% confidence interval, 0.29 to 0.83) and exclusive breast-feeding was associated with a significant dose-response risk reduction. The association was not confounded by birth weight, maternal education, type of birth, number of other children in the family, or gender. Breast-feeding may represent a protective factor against inguinal hernia.

  17. Complicated childhood inguinal hernias in UITH, Ilorin

    Directory of Open Access Journals (Sweden)

    Kayode T Bamigbola

    2012-01-01

    Full Text Available Background: Complicated inguinal hernias pose a threat to the life of the child as well as increase the morbidity associated with management of an otherwise straightforward condition. The aim of this study was to determine the presentation, treatment and management outcome of complicated inguinal hernias in children. Materials and Methods: A retrospective study of all children 15 years and less managed for complicated inguinal hernia between 2002 and 2010. Data obtained included demographic characteristics, presentation, operative findings and outcome. Results: Complicated hernia rate was 13.9%.There were 41 children, 38 boys (92.7% and 3 girls. Ages ranged between 4 days and 15 years (Median = 90days. Most were infants (48.8%, n = 20 and neonates accounted for 19.5% (n = 8. Median duration of symptoms prior to presentation was 18 h (range = 2-96 h. Seven patients had been scheduled for elective surgery. Hernia was right sided in 68.3% (n = 28. Symptoms included vomiting (68.3%, abdominal distension (34.1% and constipation (4.9%; one patient presented with seizures. In 19 (46.3% patients hernia was reducible while 22(53.7% had emergency surgery. Associated anomalies included undescended testis (12.2%, umbilical hernia (14.6%. Intestinal resection rate was 7.3% and testicular gangrene occurred in 14.6%. Mean duration of surgery was 60.3 ± 26.7 min. Wound infection occurred in six patients (14.6%. Overall complication rate was 24.4%, 30% in infants. The mortality rate was 2.4% (n = 1. Conclusions: Morbidity associated with complicated inguinal hernia is high in neonates and infants. Delayed presentation is common in our setting. Educating the parents as well as primary care physicians on the need for early presentation is necessary.

  18. Groin hernia diagnostics: dynamic inguinal ultrasound (DIUS).

    Science.gov (United States)

    Niebuhr, Henning; König, Anita; Pawlak, Maciej; Sailer, Marco; Köckerling, Ferdinand; Reinpold, Wolfgang

    2017-11-01

    Although clinical examination is the gold standard for the diagnosis of groin hernia, imaging procedures can improve the detection of femoral hernias, incipient hernias, and less-common types of hernias (e.g., an obturator hernia). The aim of this study is to evaluate the sensitivity and specificity of dynamic inguinal ultrasound (DIUS). Between July 2010 and June 2015, 4951 clinical and ultrasound examinations of the groin area were conducted at the Hanse-Hernienzentrum in Hamburg, Germany. The ultrasonographic findings were prospectively evaluated to determine the number of inguinal and femoral hernia diagnoses that were ultrasonically confirmed and also to consider cases in which clinical examination overlooked these diagnoses. The results were compared with the intraoperative findings. The results show that standardized ultrasound examination of the groin area with high-frequency, small-part linear transducers also serves to accurately display femoral and small or occult groin hernias. The high-level specificity (0.9980) and sensitivity (0.9758) are proof of the procedure's quality. To ensure high-quality hernia treatment, regular use of standardized ultrasound examinations is recommended.

  19. The Onstep Method for Inguinal Hernia Repair

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Andresen, Kristoffer

    2016-01-01

    Inguinal hernia repair is one of the most common surgical procedures and several different surgical techniques are available. The Onstep method is a new promising technique. The technique is simple with a number of straightforward steps. This paper provides a full description of the technique...

  20. Inguinal Hernia Surgery: a patient centered approach

    NARCIS (Netherlands)

    H.R. Langeveld-Benders (Hester)

    2014-01-01

    markdownabstract__Abstract__ The introduction of surgical mesh to create a tension free repair in inguinal hernia surgery in the 1990s, was quickly implemented worldwide, because recurrence rates dropped dramatically. Debate on the best surgical approach for this tension-free mesh repair is

  1. IPSILATERAL INGUINAL HERNIA IN TODDLERS: IS IT NECESSARY TO EXPLORE OTHER SIDE?

    Directory of Open Access Journals (Sweden)

    H.A DAVARI

    2001-12-01

    Full Text Available Introduction: Inguinal hernia is one of the most common disease in pediatric surgery. Operation is the only definite treatment for it, yet. Bilateral inguinal exploration is recommended by some authors due to high incidence of bilateral inguinal hernia in children. Methods: In a cross sectional study 336 children (99 female and 237 male with inguinal hernia were investigated. Contralateral exploration was done in all patients after repair of involved side. Data was categorized and analyzed according to sex and age. Results: Positive exploration in females and males was 76 and 62 percent, respectively. 44.3 percent of patients younger than one year old and 55.7 percent of patients between 1 to 3 years old had hernia in both sides. Sex and age correlated to coexisting of inguinal hernia in both sides (P < 0.03. Discussion: Contralateral exploration is more positive in lower age group. Contralateral exploration is recommended in ipsilateral inguinal hernia, specialy in girls with left sided hernia.

  2. Recurrence and Pain after Mesh Repair of Inguinal Hernias

    African Journals Online (AJOL)

    Hernia System and Lichtenstein Method for Open. Inguinal Hernia Repair. J Clin Diagn Res. 2015;. 9(6): PC04-PC07. 3. Grant AM. Open Mesh Versus Non-Mesh Repair of Groin Hernia: Meta-Analysis of Randomised. Trials Based on Individual Patient Data. EU Hernia. Trialists Collaboration. Hernia. 2002; 6(3):130-6. 4.

  3. Irreducible Inguinal Hernias in the Paediatric Age Group | Ezomike ...

    African Journals Online (AJOL)

    BACKGROUND: An inguinal hernia is said to be irreducible when the content fails to return into the peritoneal cavity without surgical intervention. Irreducibility is an ever present risk in untreated inguinal hernias and its management remains an important part of pediatric surgery practice. When a hernia is irreducible ...

  4. Laparoscopic Total Extraperitoneal (TEP) Inguinal Hernia Repair Using 3-dimensional Mesh Without Mesh Fixation.

    Science.gov (United States)

    Aliyazicioglu, Tolga; Yalti, Tunc; Kabaoglu, Burcak

    2017-08-01

    Approximately one fifth of patients suffer from inguinal pain after laparoscopic total extraperitoneal (TEP) inguinal hernia repair. There is existing literature suggesting that the staples used to fix the mesh can cause postoperative inguinal pain. In this study, we describe our experience with laparoscopic TEP inguinal hernia surgery using 3-dimensional mesh without mesh fixation, in our institution. A total of 300 patients who had undergone laparoscopic TEP inguinal hernia repair with 3-dimensional mesh in VKV American Hospital, Istanbul from November 2006 to November 2015 were studied retrospectively. Using the hospital's electronic archive, we studied patients' selected parameters, which are demographic features (age, sex), body mass index, hernia locations and types, duration of operations, preoperative and postoperative complications, duration of hospital stays, cost of surgery, need for analgesics, time elapsed until returning to daily activities and work. A total of 300 patients underwent laparoscopic TEP hernia repair of 437 inguinal hernias from November 2006 to November 2015. Of the 185 patients, 140 were symptomatic. Mean duration of follow-up was 48 months (range, 6 to 104 mo). The mean duration of surgery was 55 minutes for bilateral hernia repair, and 38 minutes for unilateral hernia repair. The mean duration of hospital stay was 0.9 day. There was no conversion to open surgery. In none of the cases the mesh was fixated with either staples or fibrin glue. Six patients (2%) developed seroma that were treated conservatively. One patient had inguinal hernia recurrence. One patient had preperitoneal hematoma. One patient operated due to indirect right-sided hernia developed right-sided hydrocele. One patient had wound dehiscence at the umbilical port entry site. Chronic pain developed postoperatively in 1 patient. Ileus developed in 1 patient. Laparoscopic TEP inguinal repair with 3-dimensional mesh without mesh fixation can be performed as safe as

  5. Inguinal hernia repair: anaesthesia, pain and convalescence

    DEFF Research Database (Denmark)

    Callesen, Torben

    2003-01-01

    Elective surgical repair of an inguinal or femoral hernia is one of the most common surgical procedures. The treatment, however, presents several challenges regarding anaesthesia for the procedure, the postoperative analgesic therapy and convalescence, as well as planning of the procedure. Local......, general, and regional anaesthesia are all used for hernia repair, but to different degrees, primarily depending on traditions and whether the institution has specific interest in hernia surgery. Thus, the use of local anaesthesia varies from a few percent in Sweden, 18% in Denmark and up to almost 100......% in specialised institutions, dedicated to hernia surgery. The feasibility of local anaesthesia is high, as judged by the rate of conversion to general anaesthesia (

  6. Retroperitoneal vascular malformation mimicking incarcerated inguinal hernia

    Directory of Open Access Journals (Sweden)

    Dubey Indu

    2011-01-01

    Full Text Available A 30-year-old man presented to the Department of Surgery with a painful groin swelling on right side. Exploration revealed a reddish-blue hemangiomatous mass in the scrotum extending through inguinal canal into the retroperitoneum. On further dissection swelling was found to be originating from right external iliac vein. The swelling was excised after ligating all vascular connections. The histopathological examination of excised mass confirmed the diagnosis of venous variety of vascular malformation. This is the first reported case of vascular malformation arising from retroperitoneum and extending into inguinoscrotal region, presenting as incarcerated inguinal hernia.

  7. Inguinal hernia repair - series (image)

    Science.gov (United States)

    While the patient is sleepy (sedated) and pain-free (local anesthesia or spinal anesthesia) or deep asleep and pain-free (general anesthesia), an incision is made over the hernia. The bulging tissue ...

  8. Adductor longus tendon rupture mistaken for incarcerated inguinal hernia.

    Science.gov (United States)

    Aerts, Bas R J; Plaisier, Peter W; Jakma, Tijs S C

    2014-03-01

    An incarcerated inguinal hernia is a common diagnosis, since the risk of an inguinal hernia incarcerating or strangulating is around 0.3-3%. An acute rupture of the adductor longus tendon is rarely seen and mostly affects (semi-) professional sportsmen. We present a case of a patient with an assumed incarcerated inguinal hernia which turned out to be a proximal adductor longus tendon rupture. If patients without a history of inguinal hernia present themselves with acute groin pain after suddenly exorotating the upper leg, a rupture of the adductor longus tendon should be considered. Both surgical and non-surgical treatment can be performed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Multicentric evaluation by Verbal Rate Scale and EuroQoL-5D of early and late post-operative pain after TAPP and TEP procedures with mechanical fixation for bilateral inguinal hernias.

    Science.gov (United States)

    Zanghì, Antonio; Di Vita, Maria; Lo Menzo, Emanuele; Castorina, Sergio; Cavallaro, Andrea Sebastiano; Piccolo, Gaetano; Grosso, Giuseppe; Cappellani, Alessandro

    2011-01-01

    Aimed to evaluate the postoperative pain and other complications among two cohorts of patients undergone transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) laparoscopic hernia repairs with mechanical fixation, the chart of 305 TAPP and 134 TEP for bilateral not recurrent inguinal hernias were reviewed. The postoperative pain was assessed by using the Verbal Rating Scale (VRS) at one week, one month, 3 months ad six months postoperatively. A subgroup of 60 patients was also administered the QoL EQ-5D questionnaire and follow up for at least 6 months. We found a statistically significant difference in the first day (p = 0.001), in the 7th day (p = 0.002), 30th, and 90th day (p = 0.008) between patients perception of pain in TAPP group and TEP group, but after the 180th day there was not any considerable distinction. On the short term the postoperative pain seems slightly lesser in TEP group.

  10. Prospective nationwide analysis of laparoscopic versus Lichtenstein repair of inguinal hernia

    DEFF Research Database (Denmark)

    Ware, P; Bay-Nielsen, M; Juul, P

    2005-01-01

    BACKGROUND: According to a Cochrane review, laparoscopic inguinal hernia repair compares favourably with open mesh repair, but few data exist from surgical practice outside departments with a special interest in hernia surgery. This study compared nationwide reoperation rates after laparoscopic...... and Lichtenstein repair, adjusting for factors predisposing to recurrence. METHODS: Some 3606 consecutive laparoscopic repairs were compared with 39 537 Lichtenstein repairs that were prospectively recorded in a nationwide registry between 1998 and 2003. Patients were subgrouped according to type of hernia...... primary indirect hernia (0 versus 1.0 per cent), primary direct hernia (1.1 versus 3.1 per cent), unilateral recurrent hernia (4.6 versus 4.8 per cent) and bilateral recurrent hernia (2.6 versus 7.6 per cent) did not differ. However, laparoscopic repair of a bilateral primary hernia was associated...

  11. Inguinal hernia recurrence: Classification and approach

    Directory of Open Access Journals (Sweden)

    Campanelli Giampiero

    2006-01-01

    Full Text Available The authors reviewed the records of 2,468 operations of groin hernia in 2,350 patients, including 277 recurrent hernias updated to January 2005. The data obtained - evaluating technique, results and complications - were used to propose a simple anatomo-clinical classification into three types which could be used to plan the surgical strategy:Type R1: first recurrence ′high,′ oblique external, reducible hernia with small (< 2 cm defect in non-obese patients, after pure tissue or mesh repairType R2: first recurrence ′low,′ direct, reducible hernia with small (< 2 cm defect in non-obese patients, after pure tissue or mesh repairType R3: all the other recurrences - including femoral recurrences; recurrent groin hernia with big defect (inguinal eventration; multirecurrent hernias; nonreducible, linked with a controlateral primitive or recurrent hernia; and situations compromised from aggravating factors (for example obesity or anyway not easily included in R1 or R2, after pure tissue or mesh repair.

  12. Laparoscopic repair of inguinal hernia in adults

    Science.gov (United States)

    Yang, Xue-Fei

    2016-01-01

    Laparoscopic repair of inguinal hernia is mini-invasive and has confirmed effects. The procedures include intraperitoneal onlay mesh (IPOM) repair, transabdominal preperitoneal (TAPP) repair and total extraperitoneal (TEP) repair. These procedures have totally different anatomic point of view, process and technical key points from open operations. The technical details of these operations are discussed in this article, also the strategies of treatment for some special conditions. PMID:27867954

  13. Direct and recurrent inguinal hernias are associated with ventral hernia repair: a database study.

    Science.gov (United States)

    Henriksen, Nadia A; Sorensen, Lars T; Bay-Nielsen, Morten; Jorgensen, Lars N

    2013-02-01

    A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal hernias as opposed to patients with indirect inguinal hernias. The aim of the present study was to assess whether direct or recurrent inguinal hernias are associated with an elevated rate of ventral hernia surgery. In the nationwide Danish Hernia Database, a cohort of 92,457 patients operated on for inguinal hernias was recorded from January 1998 until June 2010. Eight-hundred forty-three (0.91 %) of these patients underwent a ventral hernia operation between January 2007 and June 2010. A multivariate logistic regression analysis was applied to assess an association between inguinal and ventral hernia repair. Direct (Odds Ratio [OR] = 1.28 [95 % CI, 1.08-1.51]) and recurrent (OR = 1.76, [95 % CI, 1.39-2.23]) inguinal hernias were significantly associated with ventral hernia repair after adjustment for age, gender, and surgical approach (open or laparoscopic). Patients with direct and recurrent inguinal herniation are more prone to ventral hernia repair than patients with indirect inguinal herniation. This is the first study to show that herniogenesis is associated with type of inguinal hernia.

  14. Inguinal Hernia in Athletes: Role of Dynamic Ultrasound.

    Science.gov (United States)

    Vasileff, William Kelton; Nekhline, Mikhail; Kolowich, Patricia A; Talpos, Gary B; Eyler, Willam R; van Holsbeeck, Marnix

    Inguinal hernia is a commonly encountered cause of pain in athletes. Because of the anatomic complexity, lack of standard imaging, and the dynamic condition, there is no unified opinion explaining its underlying pathology. Athletes with persistent groin pain would have a high prevalence of inguinal hernia with dynamic ultrasound, and herniorrhaphy would successfully return athletes to activity. Case-control study. Level 3. Forty-seven amateur and professional athletes with sports-related groin pain who underwent ultrasound were selected based on history and examination. Patients with prior groin surgery or hip pathology were excluded. Clinical and surgical documentation were correlated with imaging. The study group was compared with 41 age-matched asymptomatic athletes. Ultrasound was positive for hernia with movement of bowel, bladder, or omental tissue anterior to the inferior epigastric vessels during Valsalva maneuver. The 47-patient symptomatic study group included 41 patients with direct inguinal hernias, 1 with indirect inguinal hernia, and 5 with negative ultrasound. Of 42 patients with hernia, 39 significantly improved with herniorrhaphy, 2 failed to improve after surgery and were diagnosed with adductor longus tears, and 1 improved with physical therapy. Five patients with negative ultrasound underwent magnetic resonance imaging and were diagnosed with hip labral tear or osteitis pubis. The 41-patient asymptomatic control group included 3 patients with direct inguinal hernias, 2 with indirect inguinal hernias, and 3 with femoral hernias. Inguinal hernias are a major component of groin pain in athletes. Prevalence of direct inguinal hernia in symptomatic athletes was greater than that for controls ( P inguinal hernia became asymptomatic. Persistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic ultrasound imaging. Herniorrhaphy is successful at returning athletes to sports activity.

  15. Giant recurrent retroperitoneal liposarcoma presenting as a recurrent inguinal hernia

    Directory of Open Access Journals (Sweden)

    Ajay H. Bhandarwar

    2011-11-01

    Full Text Available Retroperitoneal liposarcoma presenting as an inguinal hernia is a rare entity. We present the first case of Giant recurrent liposarcoma presenting as a recurrent inguinal hernia in a 40-year-old male. Physical examination showed an irreducible lump in the right inguinal region and a scar in the right lumbar and right inguinal region. Computed tomography (CT scan of abdomen revealed it to be a retro peritoneal mass extending into the right inguinal region along and involving the cord structures. Wide local excision of the tumour with right orchidectomy and inguinal hernioplasty was performed. Histo-pathology confirmed it to be a liposarcoma. Patient received postoperative radio therapy. Follow up of two years has shown him to be disease free. Retroperitoneal liposarcoma can grow along cord structures into the inguinal canal and mimic an irreducible indirect inguinal hernia.

  16. A preoperative hernia symptom score predicts inguinal hernia anatomy and outcomes after TEP repair.

    Science.gov (United States)

    Knox, Robert D; Berney, Christophe R

    2015-02-01

    The Carolinas comfort scale (CCS) is an ideal tool for assessing patients’ quality-of-life post hernia repair, but its use has been barely investigated preoperatively. The aim was to quantify preoperative symptoms and assess their relevance in predicting postoperative clinical outcomes following totally extraperitoneal (TEP) inguinal hernia repair. The CCS was modified for preoperative use (modified or MCCS) by omitting mesh sensation questioning. Data collection was prospective over a 16 months period. (M)CCS questionnaires were completed preoperatively and at 2 then 6 weeks post repair. Intraoperative findings were also recorded. One hundred and four consecutive patients consented for TEP repair were included using a fibrin glue mesh fixation technique. All three questionnaires were completed by 88 patients (84.6 %). Preoperative MCCS scores did not differ with age, obesity, the presence of bilateral or recurrent inguinal herniae or hernia type. Higher MCCS grouping [OR 4.3 (95 % CI 1.5–12.6)] and the presence of bilateral herniae [OR 8.5 (1.2–61.8)] were predictors of persisting discomfort at 6 weeks, with lower scores on MCCS [OR 16.4 (3.9–67.6), obesity (OR 9.9 91.6–63.2)] and recurrent hernia repair [OR 11.4 (1.4–91.0)] predicting increased discomfort at 2 weeks versus preoperatively. MCCS scores were inversely correlated with the size of a direct defect (r −0.42, p = 0.011) but did not differ with the intraoperative finding of an incidental femoral and/or obturator hernia. Female sex was strongly associated with recognition of a synchronous incidental hernia (5 vs 57 %, p = 0.001). Pre- and post-operative scoring of hernia specific symptoms should be considered as part of routine surgical practice, to counsel patients on their expectations of pain and discomfort post repair and to select those who might be more appropriate for a watchful waiting approach. Females with inguinal hernia warrant complete assessment of their groin hernial orifices

  17. Efficacy of Local Anesthetic With Dexamethasone on the Quality of Recovery Following Total Extraperitoneal Bilateral Inguinal Hernia Repair: A Randomized Clinical Trial.

    Science.gov (United States)

    Sakamoto, Bryan; Harker, Gene; Eppstein, Andrew C; Gwirtz, Kenneth

    2016-12-01

    Quality of recovery (directly associated with patient satisfaction) is an important clinical outcome measurement and a surrogate of anesthetic/surgical care quality. To compare the efficacy of a transversus abdominis plane (TAP) block with dexamethasone sodium phosphate and preperitoneal instillation of local anesthetic (PILA) with dexamethasone vs control on postoperative quality of recovery following a bilateral total extraperitoneal inguinal hernia repair (TEP-IHR) (>24 hours). Secondary objectives included efficacy of this technique on postoperative opioid use, nausea and vomiting, and pain scores. Conducted from November 2013 to August 2015, this randomized, prospective, single-blinded study compared 2 groups (a TAP block and PILA) with a standard anesthetic technique with no regional technique (control) following bilateral TEP-IHR. This study at the Veterans Affairs Medical Center (Indianapolis, Indiana) included patients ages 18 to 80 years with an American Society of Anesthesiologists physical status of 1 to 3 scheduled for an outpatient bilateral TEP-IHR. Nurses assigning pain scores and administrating opioids for pain and staff anesthesiologists administering the Quality of Recovery-40 (QoR-40) questionnaire were blinded. Patients randomized to receive a TAP block with local anesthetics and dexamethasone, PILA with dexamethasone, or no regional technique (3 groups). Patient's response to the QoR-40 questionnaire following a TEP-IHR surgery. The mean (SD) ages in the TAP block (n = 19), PILA (n = 24), and control (n = 23) groups were 58.2 (9.4) years, 62.5 (8.1) years, and 62.9 (7.8) years, respectively. The global QoR-40 scores on postoperative day 1 for the TAP block group (median [interquartile range (IQR)], 178 [173-188]) were comparable with the control group (median [IQR], 174 [150-181]), while the PILA group had better global QoR-40 scores (median [IQR], 184 [175.5-190.75]) (P = .002). The effects of the TAP block and PILA on pain in

  18. Radiologic investigation after laparoscopic inguinal hernia repair

    Energy Technology Data Exchange (ETDEWEB)

    Larmark, Martin; Ekberg, Olle [Department of Diagnostic Radiology, Malmoe University Hospital, 205 02, Malmoe (Sweden); Montgomery, Agneta [Department of Surgery, Malmoe University Hospital, 205 02, Malmoe (Sweden)

    2003-12-01

    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 Malmoe 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. (orig.)

  19. Hernia

    Science.gov (United States)

    Hernia - inguinal; Inguinal hernia; Direct and indirect hernia; Rupture; Strangulation; Incarceration ... when there is weakness in the belly wall. Inguinal hernias are common in boys. Some children do not ...

  20. Factors Influencing Choice of Inguinal Hernia Repair Technique

    African Journals Online (AJOL)

    may influence decisions concerning inguinal hernia repair techniques. Methods: This descriptive cross- sectional study was carried out in September 2014 among surgical trainees and surgeons. Data collected included: qualification of the operating doctor, level at which practical training on inguinal hernia repair occurred ...

  1. Early Complications of Prosthetic Inguinal Hernia Repair | Fadlalla ...

    African Journals Online (AJOL)

    Objectives: to evaluate the use of mesh repair in inguinal hernia and its early complications. Patients & Methods: prospective study, in the period from January 2004 to January 2005. Ninety-one patients who had mesh repair for inguinal hernia in the Ribat University Hospital (Sudan) were the base for this study. Results: ...

  2. Laparoscopic Inguinal Hernia Repair in a Developing Nation: Short ...

    African Journals Online (AJOL)

    Background: There are no published data on the outcomes of inguinal hernia repair from the Anglophone Caribbean. To the best of our knowledge, this is the first report of a series of laparoscopic inguinal hernia repairs from the region. Materials and Methods: Data was extracted from a prospectively maintained database of ...

  3. Strangulated Inguinal Hernia in Adult Males in Kumasi | Ohene ...

    African Journals Online (AJOL)

    Background: The complications of untreated inguinal hernias are common surgical emergencies in adult Ghanaian men. Objective: To describe the epidemiology of strangulated inguinal hernia in adult males in Kumasi. Method: From the hospital records the age and sex of all male adult patients treated for strangulated ...

  4. Factors Influencing Choice of Inguinal Hernia Repair Technique ...

    African Journals Online (AJOL)

    Background: Inguinal hernia repair surgery is one of the most frequently performed surgical procedures worldwide. This study sought to highlight factors that may influence decisions concerning inguinal hernia repair techniques. Methods: This descriptive crosssectional study was carried out in September 2014 among ...

  5. Outcome of laparoscopic inguinal hernia repair in a South African ...

    African Journals Online (AJOL)

    Objectives. The aim of this study was to determine the recurrence and complication rates of laparoscopic inguinal hernia repair performed in a private practice in Cape Town. Design and subjects. An unselected cohort of 507 patients who underwent laparoscopic totally extraperitoneal (TEP) inguinal hernia repair before ...

  6. Genitourinary complications of pelvic and inguinal hernia surgery ...

    African Journals Online (AJOL)

    Objective: Complications may be encountered during pelvic and inguinal hernia surgery, among them iatrogenic urogenital lesions. The objective of this study is to report on our experience in the management of genitourinary complications of pelvic and inguinal hernia surgery. Patients and Methods: This retrospective study ...

  7. An Adult Right-sided Bochdalek Hernia Accompanied with Hepatic Hypoplasia and Inguinal Hernia.

    Science.gov (United States)

    Choi, Yun Kyung; Ahn, Jae Ho; Kim, Kwan Chang; Won, Tae Hee

    2012-10-01

    We herein report a very rare case of adult right-sided Bochdalek hernia accompanied with hepatic hypoplasia and inguinal hernia. A 29-year-old man was admitted with right-sided pneumothorax. A computed tomography was performed and revealed large right sided Bochdalek hernia with hepatic hypoplasia. Under thoracolaparotomy, the defect was closed with Gore-Tex soft tissue patch. After the operation, left-sided inguinal hernia was found. However, it turned out that it had been present during infancy and spontaneously resolved during adolescence. This is the first report of right-sided Bochdalek hernia with hepatic hypoplasia and inguinal hernia in an adult.

  8. Impact of childhood inguinal hernia repair in adulthood: 50 years of follow-up.

    Science.gov (United States)

    Zendejas, Benjamin; Zarroug, Abdalla E; Erben, Young M; Holley, Christopher T; Farley, David R

    2010-12-01

    Short-term follow-up of pediatric inguinal herniorrhaphies has yielded low morbidity and recurrence rates. Nonetheless, the impact of childhood inguinal herniorrhaphy on the adulthood risk for repeat groin operation, chronic groin pain, and infertility has not been established. A survey was mailed to all patients who underwent a primary inguinal hernia repair as a child at our institution from 1956 to 1960. The survey inquired about repeat groin operation, chronic groin pain, and fertility status. Demographic and operative information from respondents was obtained from medical record review. Of 332 eligible patients, 213 (66%) responded to the survey, accounting for 252 inguinal herniorrhaphies (174 unilateral, 33 bilateral, and 6 sequential contralateral). All hernias were indirect, more common on the right (right, 49%; left, 25%; bilateral, 26%), with males predominating (91%). History of premature birth was present in 5 (2%) patients. High ligation of the hernia sac was performed in 90% of the repairs. Hydrocelectomy was performed in 25 (13%) and orchidopexy in 37 (19%) patients. With a median follow-up of 49 years (range 47.2 to 52.1 years), a total of 21 (8.4%) repeat and 13 (6%) contralateral groin operations were observed. Chronic groin pain and a medical diagnosis of infertility were reported by 7 (3%) and 10 (5%) patients, respectively. Childhood inguinal hernia repairs do not appear to decrease or increase the risk of inguinal hernia development in adulthood. Parents and children undergoing a childhood inguinal hernia repair should be informed that although the risk for a true indirect hernia recurrence is low, the risk of repeat groin operation (8.4%) and chronic groin pain (3%) remain present in adulthood. Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  9. ONSTEP versus laparoscopy for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

    2015-01-01

    clinical trial described in this protocol is to evaluate chronic pain after inguinal hernia repair using the ONSTEP method versus the laparoscopic approach. METHODS: This study is designed as a non-inferiority, two-arm, multicentre, randomised clinical trial, with a 1:1 allocation to ONSTEP or laparoscopic...... repair. Patients are recruited from surgical departments in Denmark and follow-up is one year. In total, 188 patients will be included. DISCUSSION: This protocol describes one of the first randomised clinical trials investigating the ONSTEP technique. To our knowledge, it is the first clinical trial...

  10. Histological findings in direct inguinal hernia : investigating the histological changes of the herniated groin looking forward to ascertain the pathogenesis of hernia disease.

    Science.gov (United States)

    Amato, G; Agrusa, A; Romano, G; Salamone, G; Cocorullo, G; Mularo, S A; Marasa, S; Gulotta, G

    2013-12-01

    The study is focused on recognizing the histological changes of the structures close to and around the hernia opening in patients having direct inguinal hernia. In 15 patients with primary bilateral direct inguinal hernia who underwent a Stoppa open posterior inguinal hernia repair, tissue specimens from the abdominal wall surrounding a direct hernia border were excised for histological examination. These findings in patients with direct inguinal hernia were compared with tissue specimens excised from the fossa inguinalis media of cadavers without hernia. Significant degenerative modifications such as fibrohyaline degeneration and fatty substitution of the muscle fibers were seen in the biopsy samples. Inflammatory infiltration with lympho-histiocitary elements, artery sub-occlusion and vascular congestion were also constantly identified. Noteworthy injuries of the nervous structures such as edema, degenerative fibrosis and atrophy were also detected. No comparable tissue damage was witnessed in the control samples. Presence of inflammatory infiltration, vascular damage and regressive nerve lesions, as well as fibrohyaline degeneration and fatty dystrophy of the muscle fibers are the features seen within the examined structures surrounding the direct hernia opening. These findings could represent a reason for a structural and functional weakening of the inguinal region. Consequently, the described results lead the authors to depict these changes as a plausible cause of direct inguinal hernia protrusion.

  11. Endoscope-assisted Inguinal Hernia Repair

    Science.gov (United States)

    Lal, Pawan; Ganguly, P. K.; Arora, M. P.; Hadke, N. S.

    2005-01-01

    Background: Since the advent of laparoscopic inguinal hernia repair, the procedure has invited numerous controversies, and although the procedure has some definitive advantages, no definitive indications for its use have been formulated. The objective of this study was to investigate a novel method for inguinal hernia repair (through a small 2 cm to 2.5 cm) single skin incision that combines the time-tested fundamentals of Lichtenstein's tension-free repair with the advantages of laparoscopic assistance. Methods: The study was conducted as a randomized, controlled trial over a 1-year period and included 50 patients. Only patients with simple reducible hernias without associated comorbid conditions were included. The patients were randomized into 2 groups of 25 patients each. One group underwent conventional tension-free meshplasty, while the other group underwent the repair through a single 2-cm to 2.5-cm skin incision with laparoscopic assistance. This repair was carried out with the help of an indigenously designed steel retractor, 10-mm laparoscope, and conventional instruments; the mesh was fixed with the help of endotacks. Univariate analysis of variance techniques using SPSS 7.5 software was used for data analysis. Results: Two groups were compared for time taken for the procedure, size of skin incision, postoperative pain, complications, return to work, and cosmetic appearance. The results showed a significant decrease in postoperative pain and an earlier return to work, along with much improved cosmesis for the new procedure. Conclusions: Although the study was conducted with a limited number of patients and a very short follow-up, it is worth considering this method over laparoscopic and conventional techniques, especially in reducible hernias. PMID:15791969

  12. Inguinal hernia: an Overview | Agbakwuru | Journal of the Obafemi ...

    African Journals Online (AJOL)

    A hernia is the protrusion of a viscus or a part of it though a defect in the walls of its containing cavity. A hernia may be internal when the protrusion is not seen on the body wall or external when the protrusion may be seen on the body wall. External hernias, including inguinal, femoral, epigastric, incisional, umbilical, ...

  13. Inguinal hernias associated with a single strenuous event.

    Science.gov (United States)

    Williamson, J S; Jones, H G; Radwan, R R; Rasheed, A

    2016-10-01

    There is debate regarding the role of physical activity and, in particular, a single strenuous event (SSE) in the development of inguinal hernia. This study aims to identify the incidence and associated features of hernias perceived to be due to a single strenuous event and to compare their features with published guidelines. All consecutive patients surgically treated for primary inguinal hernia at a single NHS trust between April 2010 and April 2011 were identified and contacted to participate in a questionnaire. Clinical details from operative records and case notes were compared with patients' responses to identify features of their presentation attributable to a single strenuous event according to previously published guidelines. Three hundred and thirty five eligible patients were contacted with a response rate of 292 (87 %). 41/292 (14 %) of patients reported an SSE associated with the onset of their hernia. Only 2 of 41 (5 %) patients reporting a hernia associated with SSE met published criteria for association of the hernia with SSE, and this represented less than 1 % of all patients treated for inguinal hernia at a single centre in a 1-year period. The relationship between physical activity and development of inguinal hernia is under debate; however, we find that inguinal hernia that can be attributed to SSE is a rare event, despite the fact that many patients present with acute symptoms. Updated guidelines for the assessment of 'cause' in industrial claims for the association of hernia with workplace activity are required.

  14. Bowel Perforation complicating an incarcerated inguinal hernia

    Directory of Open Access Journals (Sweden)

    Adam Sigal

    2017-04-01

    Full Text Available History of present illness: A 51-year-old male presents complaining of increasing right groin pain and an enlarging bulge. Symptoms started as a “bubble” 6 weeks prior to presentation. One week prior to presentation, thinking the bulge was an abscess, the patient attempted to “pop” the bulge with a sewing needle, the needle became lodged in the site and he attempted retrieval with a second sewing needle, which also became lodged. No purulent material was obtained. The patient denied any nausea, vomiting or constipation as well as any fevers or urinary symptoms. His abdomen was soft, non-tender, non-distended with active bowel sounds. The groin exam demonstrated an incarcerated right inguinal hernia and cellulitis of the right hemiscrotum with associated induration and tenderness. Significant findings: The AP and lateral pelvis x-rays revealed two sewing needles, 60 mm in length, within the soft tissue over the anterior right lower hemipelvis. In addition, the AP view showed emphysema involving the right hemiscrotum (arrow, concerning for perforated bowel. Discussion: Groin hernias have a lifetime risk of 27% for men and 3% for women and the incidence increases with age.1 Groin hernias can be either direct or indirect, and inguinal or femoral. The distinction is made during surgery. Femoral hernias make up only 5% of groin hernias but are more common in women.1 Concerning complications include incarceration, in which a hernia cannot be reduced, and strangulation in which vascular compromise occurs.1 Incarcerated hernias often present with a painful, tender mass and are difficult to distinguish from strangulation. Patients with strangulation may present with fevers and peritonitis. The overlying skin may also be red.2 The percentage of patients presenting with strangulation varies by region. Western developed countries report only 1%-3% of patients presenting as surgical emergencies whereas in Africa the percentage can be as high as 26

  15. Prosthetic Mesh Repair for Incarcerated Inguinal Hernia

    Directory of Open Access Journals (Sweden)

    Cihad Tatar

    2016-08-01

    Full Text Available Background: Incarcerated inguinal hernia is a commonly encountered urgent surgical condition, and tension-free repair is a well-established method for the treatment of noncomplicated cases. However, due to the risk of prosthetic material-related infections, the use of mesh in the repair of strangulated or incarcerated hernia has often been subject to debate. Recent studies have demonstrated that biomaterials represent suitable materials for performing urgent hernia repair. Certain studies recommend mesh repair only for cases where no bowel resection is required; other studies, however, recommend mesh repair for patients requiring bowel resection as well. Aim: The aim of this study was to compare the outcomes of different surgical techniques performed for strangulated hernia, and to evaluate the effect of mesh use on postoperative complications. Study Design: Retrospective cross-sectional study. Methods: This retrospective study was performed with 151 patients who had been admitted to our hospital’s emergency department to undergo surgery for a diagnosis of incarcerated inguinal hernia. The patients were divided into two groups based on the applied surgical technique. Group 1 consisted of 112 patients treated with mesh-based repair techniques, while Group 2 consisted of 39 patients treated with tissue repair techniques. Patients in Group 1 were further divided into two sub-groups: one consisting of patients undergoing bowel resection (Group 3, and the other consisting of patients not undergoing bowel resection (Group 4. Results: In Group 1, it was observed that eight (7.14% of the patients had wound infections, while two (1.78% had hematomas, four (3.57% had seromas, and one (0.89% had relapse. In Group 2, one (2.56% of the patients had a wound infection, while three (7.69% had hematomas, one (2.56% had seroma, and none had relapses. There were no statistically significant differences between the two groups with respect to wound infection

  16. Giant right groin lipoma mimicking inguinal hernia.

    Science.gov (United States)

    Gerych, Igor; Ivankiv, Taras; Ogurtsov, Oleksii; Kalynovych, Nazar

    2015-01-01

    Groin lipoma is a rare condition. Such localization may lead to erroneous interpretation of inguinal hernia diagnosis. In case of incorrect diagnosis, there is clinically high risk for development of intraoperative complications. The medical history of 70-year old female patient P., who has been hospitalized at Surgical Department No.1 of Danylo Halytsky Lviv National Medical University (Surgical Department of Lviv Regional Clinical Hospital), was processed retrospectively. Medical case history totals approximately 20 years. Examination in the right groin revealed a tumor falling to the right labia lip: soft, elastic, moderately painful, passive and active reduction into the abdominal cavity was impossible, and the "cough impulse" symptom was negative. CT correctly diagnosed giant right groin lipoma, which was intraoperatively confirmed. Lipoma in the groin may be treated as inguinal hernia. Thus, for the accurate verification of correct diagnosis, it is necessary to perform a follow-up examination involving computer tomography (CT) and nuclear magnetic resonance imaging (NMRI). Copyright © 2015. Published by Elsevier Ltd.

  17. Recurrence mechanisms after inguinal hernia repair by the Onstep technique

    DEFF Research Database (Denmark)

    Öberg, S; Andresen, K; Hauge, D

    2016-01-01

    PURPOSE: Inguinal hernia repairs should have few complications and a short learning curve. A new operation called Onstep has promising results, but still some recurrences. The aim of the study was to find reasons for recurrence, by studying the re-operations. METHODS: The study is a case series......, where 565 patients operated with Onstep at six hospitals between December 2011 and April 2015 were identified. If a recurrence had occurred, the description of the re-operation was studied and compared to the primary Onstep operation. RESULTS: We found 26 inguinal hernia recurrences, giving a recurrence...... further improvement in the Onstep method for inguinal hernia repair....

  18. An unusual case of inguinal hernia with spontaneous evisceration.

    Science.gov (United States)

    Zaz, Muneer A; Dass, T; Muhee, A; Kawoosa, U

    2011-12-01

    Spontaneous evisceration is a very rare and potentially fatal complication of abdominal wall hernia. It has been commonly reported in the case of umbilical hernia in patients with chronic liver disease with tense ascites. With other hernias, such as incisional hernia and inguinal hernia, the complication has been reported only once. Here we present a case report of spontaneous evisceration in an inguinal hernia in a patient with comorbid chronic obstructive airway disease. Management of the condition using prosthetic mesh repair risks mesh infection, while the use of non-prosthetic repair risks recurrence of the hernia due to the absence of stout natural tissues. Use of a biological mesh for the condition seems quite plausible. Thorough saline washes of the eviscerated organ, excision of redundant/unhealthy skin and strict adherence to the fundamental principles of hernia repair is desired in managing the condition.

  19. Diagnosis of an Inguinal Hernia after a Blunt Inguinal Trauma with an Intestinal Perforation

    Directory of Open Access Journals (Sweden)

    Farès Moustafa

    2014-01-01

    Full Text Available Introduction. Inguinal hernias are very common in men. A clinical exam can do the diagnosis easily. But bowel perforation inside an inguinal hernia caused by a directly blunt trauma is rare and can have important consequences. Up to now, there have been a few case reports that described blunt injury to the inguinal area causing traumatic perforation of the bowel in the inguinal hernia. Case Report. We present a case of a 45-year-old Eastern European man with a small perforation of ileal bowels and a peritonitis after direct blunt trauma to the inguinal hernia region, with no inguinal hernia known by the patient, and show how the diagnosis can be difficult. Conclusion. This case shows that external forces, that may seem too trivial to cause intraperitoneal injury, can cause significant injury when applied to a patient with a hernia and shows how a careful examination, with the help of an abdominal CT scan, is important even if the patient do not seem to have an inguinal hernia.

  20. [Totally extraperitoneal endoscopic surgery of inguinal hernia: results of 250 hernia repairs].

    Science.gov (United States)

    Zamora-Amorós, Carmen; Calado-Leal, Carlos; Illán-Riquelme, Azahara; Camacho-Lozano, Julio; Ripoll-Martín, Roberto; Diego-Esteve, Manuel

    2012-10-01

    The totally extraperitoneal endoscopic approach in the surgery of the inguinal hernia has experienced an important change, enabling a mesh to be implanted in the pre-peritoneal space with a comfortable access, as well as contributing to the advantages of minimally invasive surgery (less post-operative pain and a faster recovery). The objective of this study is to analyse the results of TEP endoscopic hernioplasty, mainly in the repair of bilateral hernias and recurrences or multiple recurrences. A total of 250 TEP endoscopic hernioplasties have been performed on 150 patients in the las 5 years. The majority (63%) of the patients subjected to surgery had bilateral hernias, and 16%, recurrent. Large and complicated iguinal-scrotal hernias were excluded. A short stay regimen was followed, establishing a protocol of, analgesia, antibiotic, antithrombotic prophylaxis, and collection of post-surgical data such as analgesia demand. The patients were given a questionnaire on discharge, in which they filled in the fields on post-surgical pain, as well as an attached satisfaction questionnaire. The reduced need for post-surgical analgesia was noteworthy in this series, being totally unnecessary at 24h in 70 patients (46.6%), reaching 121 (80.6%) one month after surgery. There were 6 cases (4%) of reconversion, always due to opening of the peritoneal sac. There were no wound infections, 2% mild orchiepididymitis, 6 (2.4%) recurrence, and one (0.4%) inguinal neuralgia. There was a high level of satisfaction (95%). TEP endoscopic hernioplasty is a very effective and safe procedure in the hands of experienced surgeons with specific training. It is an interesting option in bliateral and recurrent hernia as it obtains satisfactory results in terms of postoperative pain and morbidity. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.

  1. Tailored approach in inguinal hernia repair – Decision tree based on the guidelines

    Directory of Open Access Journals (Sweden)

    Ferdinand eKöckerling

    2014-06-01

    Full Text Available The endoscopic procedures TEP and TAPP and the open techniques Lichtenstein, Plug and Patch and PHS currently represent the gold standard in inguinal hernia repair recommended in the guidelines of the European Hernia Society, the International Endohernia Society and the European Association of Endoscopic Surgery. 82 % of experienced hernia surgeons use the tailored approach, the differentiated use of the several inguinal hernia repair techniques depending on the findings of the patient, trying to minimize the risks. The following differential therapeutic situations must be distinguished in inguinal hernia repair: unilateral in men, unilateral in women, bilateral, scrotal, after previous pelvic and lower abdominal surgery, no general anaesthesia possible, recurrence and emergency surgery. Evidence-based guidelines and consensus conferences of experts give recommendations for the best approach in the individual situation of a patient. This review tries to summarized the recommendations of the various guidelines and to transfer them into a practical dicision tree for the daily work of surgeons performing inguinal hernia repair.

  2. SEGMENTAL EPIDURAL ANAESTHESIA FOR INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Sachidanand

    2015-09-01

    Full Text Available BACKGROUND: Epidural anaesthesia is suitable as a sole agent for lower abdominal surgery and surgery on lower limbs. It has some definite advantages over spinal anaesthesia like avoidance of post spinal headache, minimal chances of meningitis, and minimal chances of nausea and vomiting in postoperative period. But administration of conventional dosage of local epidural anaesthetics (15ml and above for surgical anaesthesia frequently results in multiple hemodynamic changes, including decreases in chronotropism, inotro pism, dromotropism, systemic vascular resistance, cardiac output, and myocardial oxygen consumption. The segmental epidural block denotes the use of a small volume enough to block only the segments involved in the field of surgery. AIM: To study the effect iveness of segmental epidural anaesthesia for inguinal hernia repair. DESIGN: R andomized control study. METHODS: 100 pts belonging to ASA PS I & II posted for inguinal hernia repair given 5ml of 0.5% bupivacaine through epidural route at L1 - L2 level and a fter conforming the adequacy and level of analgesia, the surgery was commenced. If the patient complained of pain during needle prick, then injected local anaesthetic (0.5% Bupivacaine with an incremental dosage of 1ml at a time, till the complete onset o f analgesia Pulse Rate and Blood Pressure were recorded at an interval of 1 minute for first 5 minutes and then every 5 minutes till the end of the surgery. Oxygen saturation and ECG monitoring was done continuously. Onset of analgesia, level of analgesia ( P re & post operatively, duration of analgesia, total dosage of local anaesthetic used were recorded. Complications like bradycardia, hypotension, respiratory depression, shivering, nausea and vomiting, sweating and inadvertent dural puncture were recorde d. RESULTS: 53% of patients had excellent quality of analgesia and relaxation. 34% patients had good quality analgesia and relaxation, mild discomfort while handling sac

  3. Acceptable nationwide outcome after paediatric inguinal hernia repair

    DEFF Research Database (Denmark)

    Bisgaard, Thue; Kehlet, H; Oehlenschlager, J

    2014-01-01

    PURPOSE: The primary objective was to describe 30-day outcomes after primary inguinal paediatric hernia repair. METHODS: Prospectively collected data from the National Patient Registry covering a 2-year study period 1 January 2005 to 31 December 2006 were collected. Unexpected outcomes were defined...... was not associated with the inguinal hernia repair. The usual technique was a simple sutured plasty (96.5 %). Emergency repair was performed in 54 patients (2.2 %) mainly in children between 0 and 2 years (79.6 %). During the 1 year follow-up, reoperation for recurrent inguinal hernia was performed in 8 children...... after elective repair (recurrence rate 0.3 %). Paediatric repairs were for most parts performed in surgical public hospitals, and most departments performed less than 10 inguinal hernia repairs within the 2 years study period. CONCLUSION: These nationwide results are acceptable with low numbers...

  4. A national trainee-led audit of inguinal hernia repair in Scotland.

    Science.gov (United States)

    O'Neill, S; Robertson, A G; Robson, A J; Richards, C H; Nicholson, G A; Mittapalli, D

    2015-10-01

    This audit assessed inguinal hernia surgery in Scotland and measured compliance with British Hernia Society Guidelines (2013), specifically regarding management of bilateral and recurrent inguinal hernias. It also assessed the feasibility of a national trainee-led audit, evaluated regional variations in practise and gauged operative exposure of trainees. A prospective audit of adult inguinal hernia repairs across every region in Scotland (30 hospitals in 14 NHS boards) over 2-weeks was co-ordinated by the Scottish Surgical Research Group (SSRG). 235 patients (223 male, median age 61) were identified and 96 % of cases were elective. Anaesthesia was 91 % general, 5 % spinal and 3 % local. Prophylactic antibiotics were administered in 18 %. Laparoscopic repair was used in 33 % (30 % trainee-performed). Open repair was used in 67 % (42 % trainee-performed). Elective primary bilateral hernia repairs were laparoscopic in 97 % while guideline compliance for an elective recurrence was 77 %. For elective primary unilateral hernias, the use of laparoscopic repair varied significantly by region (South East 43 %, North 14 %, East 7 % and West 6 %, p Scotland. Increased compliance on recurrent cases appears indicated. National re-audit could ensure improved adherence and would be feasible through the SSRG.

  5. Quality-of-life scores in laparoscopic preperitoneal inguinal hernia repair.

    Science.gov (United States)

    Wennergren, John E; Plymale, Margaret; Davenport, Daniel; Levy, Salomon; Hazey, Jeffrey; Perry, Kyle A; Stigall, Kyle; Roth, J Scott

    2016-08-01

    Published support exists for using lightweight polypropylene mesh (PPM) to repair inguinal hernias with increased biocompatibility and decreased foreign body reaction and pain. However, quality of life (QOL) has not been assessed. We assess QOL in patients undergoing laparoscopic totally extraperitoneal hernia repair (TEP) with lightweight PPM. We performed an IRB-approved study of patients undergoing TEP hernia repair. Demographic information and hernia characteristics were collected perioperatively. Baseline Short Form-36 (SF-36), Carolinas Comfort Scale (CCS), and visual analog scale (VAS) for pain were performed preoperatively, and then after 1, 26, and 52 weeks. Forty-eight patients undergoing TEP with mesh were selected. Average age was 43.2 years (SD = 13.2), and average BMI was 26.1 kg/m(2) (SD = 4.3). Procedures include bilateral hernia, right inguinal hernia, and left inguinal hernia repairs. Mean scores on the CCS(®) and VAS were low during the immediate post-op period and 1 year. SF-36 mean scores for body pain, physical function, and role physical showed decreases at the postoperative survey and then subsequent increases. Pain-associated scores increased during the immediate post-op period. CCS and SF-36 scores demonstrated improvement after 1 year. There was no significant difference in VAS. Bilateral repair patients reported more pain and reduced physical function versus unilateral repairs. Patients with larger mesh reported greater pain scores and reduced physical function scores. Laparoscopic inguinal hernia repair is associated with initial declines in QOL in the postoperative period. Improvements appear in the long term. General health does not appear to be impacted by laparoscopic TEP. Smaller mesh and unilateral repairs are associated with improved QOL following laparoscopic TEP with PPM. Multiple metrics for QOL are required to reflect patient recovery.

  6. Reduction en masse of inguinal hernia: MDCT findings of two cases.

    Science.gov (United States)

    Hoshiai, S; Mori, K; Shiigai, M; Uchikawa, Y; Watanebe, A; Shiotani, S; Atake, S; Minami, M

    2015-12-01

    Reduction en masse of inguinal hernia is an extremely rare complication arising from manual reduction of a hernia. The hernial content remaining in the hernia sac returns above the inguinal canal but remains in the abdominal wall. Accurate preoperative diagnosis of reduction en masse of inguinal hernia is challenging because the hernia appears to be reduced upon physical examination. We experienced two cases of reduction en masse. In both cases, multidetector row computed tomography revealed a closed loop obstruction near the inguinal fossa. In addition, we observed a continuous tract of the hernia sac to the inguinal canal and prominent peritoneal thickening suggestive of the hernia sac.

  7. An animal model to train Lichtenstein inguinal hernia repair

    DEFF Research Database (Denmark)

    Rosenberg, J; Presch, I; Pommergaard, H C

    2013-01-01

    pigs, and a total of 55 surgeons have been educated to perform Lichtenstein's hernia repair in these animals. CONCLUSIONS: This new experimental surgical model for training Lichtenstein's hernia repair mimics the human inguinal anatomy enough to make it suitable as a training model. The operation...

  8. Post Operative Pain Control in Inguinal Hernia Repair: Comparison ...

    African Journals Online (AJOL)

    ADMIN

    Local wound infiltration has often been used to control postoperative pain following hernia surgery, with the use of the ... maximizing postoperative pain control, inguinal hernia repair can be done as a day case. Patients and Methods ..... inflammation: local opioid receptors and beta endorphins. J Neurosci 1990; 10:1292-. 8.

  9. Pediatric inguinal hernia repair-a critical appraisal

    DEFF Research Database (Denmark)

    Rosenberg, J.

    2008-01-01

    Inguinal hernia repair in infants and babies is a routine operation, but many issues have not been addressed scientifically. Thus, it is not known, e.g., if all children with a hernia should be operated on, what is the best timing of surgery, or if the operation should be performed with an open...

  10. Prospective randomized trial of laparoscopic (transabdominal preperitoneal-TAPP) versus open (mesh) repair for bilateral and recurrent inguinal hernia: incidence of chronic groin pain and impact on quality of life: results of 10 year follow-up.

    Science.gov (United States)

    Bignell, M; Partridge, G; Mahon, D; Rhodes, M

    2012-12-01

    The incidence of chronic groin pain (CGP) and its impact on quality of life (QoL) after hernia repair are not clear with follow-up either being short or retrospective. We present 10-year prospective follow-up of a randomized trial for bilateral and recurrent hernia repair focusing on CGP and its impact on QoL. Patients enrolled between 1997 and 2000 were contacted by telephone and asked about the presence of CGP. Those patients with CGP were sent two validated questionnaires: a SF-12v2 Health Survey and a Pain Impact Questionnaire (PIQ-6) (QualityMetric, USA). One hundred and twenty patients were recruited into the original study, and of these, 14 complained of CGP and were sent a PIQ-6 and a SF-12 v2 health survey. Overall, there was a higher incidence of CGP in the laparoscopic group compared with the open group (15 vs. 8 %, ns), but the severity of the pain in the laparoscopic group was less (2 vs. 3.5, p = 0.0558). QoL was significantly reduced in patients with CGP compared with the US norm. The laparoscopic group scored higher in 5 out of 8 of the QoL categories compared with the open group, but this was not significant. Overall age-adjusted scores revealed those under 65 years of age felt they had poorer physical health, and this reduced their QoL compared to normal values. CGP following laparoscopic surgery for inguinal hernia repair is less severe than open repair, but this does not translate into a significant improvement in QoLin this study.

  11. Unsuspected femoral hernia in patients with a preoperative diagnosis of recurrent inguinal hernia

    DEFF Research Database (Denmark)

    Henriksen, N A; Thorup, J; Jorgensen, L N

    2012-01-01

    Small femoral hernias may be difficult to diagnose by physical examination and are sometimes identified unexpectedly by laparoscopy. The aim of this study was to examine the incidence of unsuspected femoral hernia discovered during laparoscopic inguinal hernia repair in two well-defined patient...

  12. Incidence of inguinal hernia in children with congenital cerebral palsy

    DEFF Research Database (Denmark)

    Reimers, J I; Latocha, J E

    1990-01-01

    The incidence of inguinal hernia among 247 children with cerebral palsy was ascertained. During the first year of life, 20 of the 153 boys developed hernia, as did one of the 94 girls. Among boys with birthweights of 1000 to 2000g the incidence was 31 per cent, which is twice the rate for normal ......, particularly for boys with birthweights less than 2000g and with spastic tetraplegia. Conversely, one should be alert to the possibility of concurrent spasticity in preterm males with inguinal hernia....

  13. A rare case of Spigelian hernia combined with direct and indirect inguinal hernias.

    Science.gov (United States)

    Kılıç, Murat Özgür; Değirmencioğlu, Gürkan; Dener, Cenap

    2017-01-01

    Spigelian hernia is a rare type of ventral hernias with nonspecific symptoms and signs. Therefore, its diagnosis is often difficult and requires more clinical attention. Although intermittent abdominal swelling and pain are the main symptoms, Spigelian hernias can be sometimes asymptomatic and are discovered incidentally at the operation. In some cases, these hernias can be associated with other abdominal wall hernias, therefore a detailed physical examination of the patients is necessary to avoid mistakes in diagnosis. Herein, we report an interesting and educational case of Spigelian hernia with accompanying ipsilateral both direct and indirect inguinal hernias in a male patient treated by open surgical repair with use of polypropylene mesh.

  14. Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study

    DEFF Research Database (Denmark)

    Jess, P; Schultz, Karen; Bendtzen, K

    2000-01-01

    To see if the inflammatory responses during and after laparoscopic and open inguinal hernia repairs differed.......To see if the inflammatory responses during and after laparoscopic and open inguinal hernia repairs differed....

  15. Current status of laparoscopic inguinal hernia repair in Denmark

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Bay-Nielsen, M

    2008-01-01

    BACKGROUND: Laparoscopic inguinal hernia repair is becoming more common in many countries, but the quality of care, experience of the operating surgeon, and details of the surgical technique are not known in detail on a national level in Denmark. In a period of expanding surgical volume...... for laparoscopic inguinal hernia repair, it is important to know the typical indications for surgery, re-operation rates, details of surgical technique, and status of surgical training on a national level in order to rationalize interventions to improve outcome. METHODS: Data from the National Hernia Database...... for the last 8 years regarding laparoscopic inguinal hernia repair were used in combination with questionnaire data obtained from all surgical units in Denmark. The questionnaire included issues such as the number of operating surgeons in the department, number of residents training in the laparoscopic...

  16. Laparoscopic Repair of Inguinal Hernia TEP versus TAPP.

    Science.gov (United States)

    Vărcuş, Flore; Duţă, Ciprian; Dobrescu, Amadeus; Lazăr, Fuger; Papurica, Marius; Tarta, Cristi

    2016-01-01

    The purpose of the study was to compare the results of laparoscopic inguinal hernia repair using two different methods: transabdominal preperitoneal (TAPP) repair and the technique of totally extraperitoneal repair (TEP). In this retrospective study were included 90 cases of inguinal hernia that underwent for laparoscopic approach of inguinal hernia repair at the Emergency County Hospital Timisoara at the 2nd Surgical Clinic between 2012 and 2013. The primary outcome was recurrence of the hernia at two years follow-up. Secondary outcomes were short and long-term complications: hematoma and seroma formation, inflammation of the testis, chronic inguinal pain, reoperation, 30 days mortality. Of the 90 patients who underwent unilateral hernia repair, 70 were completely followed-up for 24 months, 36 (81.81%) patients with TEP and 34 (73.91%) with TAPP. Regarding the main outcome there was no recurrence of the hernia at two years follow-up.There were two cases of bleeding in the TAPP group;both were managed by laparoscopic sealing of the damaged vessels, 8 cases of post-operative edema of testis in TAPP and 3 cases in TEP. Regarding thesubcutaneous emphysema there were 16 cases in TAPP and 3 cases in TEP. Differences between TEP and TAPP in our study were related to minor complications, no major complications occurred. After the two years follow-up of 70 of a total of 90 patients, there was no recurrence of the hernia. Celsius.

  17. Post operation recurrence of inguinal hernia in children and its relation with suture material

    Directory of Open Access Journals (Sweden)

    Omid Amanollahi

    2011-09-01

    Full Text Available Background: Using non-absorbable suture in children hernia repair to decrease of recurrence is recommended in the most pediatric surgery centers. The aim of this study was to determine relationship between kind of suture material and rate of hernia recurrence. Methods: In this clinical trial 200 children (age 1-5 years with inguinal hernia who operated in Imam-Reza Hospital (kermanshah –Iran Between April 2007 until April 2008 enrolled into the study. Cases were selected by convenience sampling method and then randomly divided into two groups (100 cases per group and operated with absorbable (silk 3-0 and non-absorbable (vicryli 3-0 suture material. Following period was 12 months after operation and collected data analyzed by statistical software. Emergency operations were excluded from the study.Results: 83% of patients were boy and 17% were girl. %53 showed right side inguinal, 29% left side and %18 were bilateral hernia. After one year follow up only one case of recurrence was observed in each group.Conclusion: Our study confirmed that recurrence of inguinal hernia in children after surgery, is not related to kind of suture material (absorbability and we didn’t find any significant difference. Other factors than suture material may influence recurrence rate of hernia operation in children.

  18. An inguinal hernia sac tumor of extrahepatic cholangiocarcinoma origin

    Directory of Open Access Journals (Sweden)

    Yamazaki Hidehiro

    2006-03-01

    Full Text Available Abstract Background Metastatic hernia sac tumor from biliary malignancy is extremely rare with only one such case previously reported. We herein report an additional case of extrahepatic cholangiocarcinoma presenting as a hernia sac tumor. Case presentation A 78-year-old man presented with an irreducible right inguinal hernia associated with a firm tumor, 2.0 cm in diameter. A computed tomography scan demonstrated a soft tissue density mass with heterogeneous enhancement within the right inguinal canal. The patient underwent a hernia repair and the hernia sac tumor was resected. Histological examination of the tumor revealed a metastatic adenocarcinoma suggesting the tumor was of pancreato-biliary origin. Further investigation using imaging studies disclosed a primary tumor in the upper bile duct. The patient died of the disease nine months after the resection. Conclusion Hernia sac tumors should be considered when an irreducible, growing mass appears within an inguinal hernia. Computed tomography may be useful for the early detection of hernia sac tumors from undiagnosed intra-abdominal malignancies.

  19. Contralateral metachronous inguinal hernias in adults: role for prophylaxis during the TEP repair.

    Science.gov (United States)

    Zendejas, B; Onkendi, E O; Brahmbhatt, R D; Greenlee, S M; Lohse, C M; Farley, D R

    2011-08-01

    Contralateral exploration during laparoscopic totally extraperitoneal (TEP) inguinal herniorrhaphy allows for the repair of incidentally found hernias. Nonetheless, some patients with a negative contralateral exploration subsequently develop a symptomatic hernia on that side. We pondered the incidence of contralateral metachronous hernia development and whether prophylactic "repair" in these circumstances would be beneficial. A retrospective analysis of patients who underwent laparoscopic TEP exploration at our institution was performed. Demographic, operative and follow-up information was obtained through medical record review, physical examination and telephone/mailed survey. From 1995 to 2009, a total of 1,479 inguinal herniorrhaphies on 976 patients were performed by a single staff surgeon. Bilateral exploration was completed in 923 (95%) of these patients, of whom bilateral repair was performed on 503 (55%). The study cohort comprises the 409 (42%) patients having a unilateral repair with a negative contralateral exploration and no previous contralateral hernia repair (n = 11). With a median follow-up of 5.9 years (range 0-14), 33 (8.1%) hernias developed on the previously "healthy" side, yielding incidence rates at 1, 5 and 10 years of 1.6, 5.9 and 11.8%, respectively. The median time to hernia development was 3.7 years (range 0.1-12.4). Of the 30 inguinal hernias that have been repaired, 25 (83%), 3 (10%) and 2 (7%) were of indirect, direct and pantaloon types, respectively. When considering prophylactic repair during TEP explorations, a yearly risk of 1.2% of developing a contralateral hernia after negative exploration needs to be balanced against the low but potential risk of groin pain following prophylactic repair.

  20. The collagen turnover profile is altered in patients with inguinal and incisional hernia

    DEFF Research Database (Denmark)

    Henriksen, Nadia A; Mortensen, Joachim H; Sorensen, Lars T

    2015-01-01

    in the interstitial matrix (types I, III, and V collagens) and in the basement membrane (type IV collagen). MATERIAL AND METHODS: Patients with 3 different types of hernias were included: Primary unilateral inguinal hernia (n = 17), multiple hernias defined as ≥3 hernias (n = 21), and incisional hernia (n = 25......, and C4M) were measured in serum by validated, solid-phase competitive assays. RESULTS: In inguinal hernia patients, the turnover of the interstitial matrix collagens type III (P ... turnover profile of type IV collagens may predict the presence of inguinal and incisional hernia. Regulation of type IV collagen turnover may be crucial for hernia development....

  1. Acute Osteomyelitis of the Symphysis Pubis after Inguinal Hernia Surgery

    Directory of Open Access Journals (Sweden)

    Recep Tekin

    2015-01-01

    Full Text Available Osteomyelitis of pubic symphysis is infectious inflammatory condition of the symphysis pubis and rare complication of surgery around inguinal and groin region. It should be kept in mind in the differential diagnosis of lower pelvic pain and should be sought in cases of pelvic insufficiency fractures. Herein, we present a case of a 55-year-old man with osteomyelitis of the symphysis pubis following inguinal hernia surgery for diagnosis and management of this rare condition.

  2. [Congenital lumbar hernia and bilateral renal agenesis].

    Science.gov (United States)

    Barrero Candau, R; Garrido Morales, M

    2007-04-01

    We report a new case of congenital lumbar hernia. This is first case reported of congenital lumbar hernia and bilateral renal agenesis. We review literature and describe associated malformations reported that would be role out in every case of congenital lumbar hernia.

  3. Combined inguinal hernia in the elderly. Portraying the progression of hernia disease.

    Science.gov (United States)

    Amato, Giuseppe; Agrusa, Antonino; Rodolico, Vito; Puleio, Roberto; Di Buono, Giuseppe; Amodeo, Silvia; Gulotta, Eliana; Romano, Giorgio

    2016-09-01

    Identification of a combined hernia is a common occurrence in the course of inguinal hernia repair. This type of protrusion disease seems to affect the elderly, in particular. Very few investigations have been carried out to ascertain the structural changes that occur in the groin affected by this clinical condition. Analysis of intraoperative findings of combined inguinal hernias evidenced in the elderly, from the most recent 100 groin hernia repair procedures carried out by a single operator, represents the basis of the article. Protrusions that presumably represent the forerunner of this type of hernia were also analyzed: double ipsilateral inguinal hernias composed of a direct and an indirect protrusion. The gross anatomical, as well as histological, modifications occurring during the development of combined protrusions were also evaluated. Combined hernia was the most frequent protrusion in patients over 65 years, accounting for 36% of the total in this patient group. In the same patient cohort, double inguinal hernia further involves 22% of elderly subjects. Macroscopically, progressive disruption of the inguinal back wall and degenerative reabsorption of the inferior epigastric vessels were evidenced. Histologically, inflammatory infiltrate, significant nerve and vascular injuries, along with severe muscle degeneration were recognized. The results seem to confirm that inguinal hernia is an unremitting progressive disease caused by chronic compressive structural damage. Combined hernias represent a frequent clinical condition in the elderly consequent to long-term degenerative damage. Therapy of combined protrusions must consider the impact of visceral vector forces. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  4. Open preperitoneal mesh repair of inguinal hernias using a mesh with nitinol memory frame.

    Science.gov (United States)

    Berrevoet, F; Vanlander, A; Bontinck, J; Troisi, R I

    2013-06-01

    To prospectively evaluate the use of a continuous Nitinol containing memory frame patch during a TIPP-technique in the open repair of inguinal and femoral hernias. Over a 3-year period all consecutive adult patients that needed treatment for an inguinal or femoral hernia were treated by the TIPP repair using the Rebound Shield mesh. Intra-operatively the type and size of the hernia were evaluated according to the EHS classification, as well as the size of the mesh used. Baseline characteristics for all patients were evaluated considering age, gender, BMI and American society of Anesthesiologists score. Standard X-ray was performed to evaluate mesh position. All patients were evaluated for post-operative pain using the visual analogue scale (VAS 0-10 scale). In total 289 groin hernias were operated using a nitinol containing patch in 235 patients. The mean operating time was 38 min for unilateral hernias and 59 min for bilateral hernias. The median follow-up is 21.2 months (14-33 months) during which three patients died, unrelated to the groin hernia repair. At the time of re-evaluation 12 patients (5.0 %) complained of chronic pain, with a VAS score higher than 3 after 3 months (range 3-10). Two of these patients already had severe pain pre-operatively. A total of 3 recurrences (2.9 %) were noted with strong correlation with X-ray findings. A nitinol memory frame containing mesh is a valuable tool to achieve complete deployment of a large pore mesh in a TIPP repair for inguinal hernias with acceptable morbidity and a low recurrence rate.

  5. Rare variant of inguinal hernia, interparietal hernia and ipsilateral abdominal ectopic testis, mimicking a spiegelian hernia. Case report.

    Science.gov (United States)

    Hirabayashi, Takeshi; Ueno, Shigeru

    2013-07-20

    We report a case in which the combination of an interparietal inguinal hernia and ipsilateral ectopic testicle mimicked a spigelian hernia. The patient was a 22-day-old boy who presented with a reducible mass that extended from the right lumbar region to the iliac fossa region. The right testis was palpable in the right lumbar region. Ultrasonography and magnetic resonance imaging revealed that a small bowel had herniated through the inguinal region below the external oblique aponeurosis. Surgery was performed when the patient was 23 months old. Laparoscopic examination to identify the hernia orifice revealed that it was the deep inguinal ring, and the testicular vessels and the vas deferens passed beneath the hernia sac. An inguinal incision was made, and a hernia sac was observed passing through the deep inguinal ring and extending superiorly below the aponeurosis. The testis was found in the hernia sac. Traditional inguinal herniorrhaphy and traditional orchidopexy were performed, and the postoperative course was uneventful. It is difficult to understand the surgical anatomy of interparietal hernias, but once the surgical anatomy is understood, surgical repair is simple. We report the case with a review of the literature and also emphasize that laparoscopic exploration is helpful during surgery.

  6. Left Amyand’s hernia: An unexpected finding during inguinal hernia surgery

    Directory of Open Access Journals (Sweden)

    Ahmed M. Al Maksoud

    2015-01-01

    Conclusion: There are less than 20 cases reported in the literature describing left-sided Amyand’s hernia. Awareness of such very unusual condition may help surgeons to be prepared for appropriate management of a very usual procedure as inguinal hernia repair.

  7. Inguinal hernias in patients of 50 years and above. Pattern and outcome

    Directory of Open Access Journals (Sweden)

    Devajit Chowlek Shyam

    Full Text Available OBJECTIVE: to evaluate a one year experience with inguinal hernia repair, in patients of > 50years, with respect to the type of inguinal hernia, type of surgery, postoperative complications and recurrence. METHODS: a prospective descriptive study of patients (n=57 > 50 years operated for inguinal hernia during a one year period. Tension-free meshplasty and herniorrhaphy, using 3"x6" polypropylene mesh and 2-0 polypropylene suture, were performed in elective and emergency surgery respectively. Follow-up visits were scheduled at six weeks, three and six months postoperatively. RESULTS: the most representative age group was 61-70 years, and all patients were male. 52 (91.22% patients had unilateral inguinal hernias, while five (8.77% had bilateral hernias. In 50 (87.71% patients, the hernia was uncomplicated, while seven (12.28% patients presented with some complication such as obstruction or strangulation. Elective surgery was performed in 50 (87.71% patients while seven (12.28% patients were operated in emergency. Postoperatively, 50 (87.7% patients had uneventful recovery, while seven (12.28% patients developed some complications which were treated conservatively. Mean hospital stay was six days. One recurrence was observed and there was no peri/postoperative death. CONCLUSION: tension-free meshplasty and herniorrhaphy are safe, simple and applicable even in elderly patients after adequate pre-operative assessment and optimization. Although associated with longer hospital stay, the mortality rate is nil and complication as well as recurrence rate is low. Hence, timely repair is necessary in elderly patients even in those with comorbid conditions.

  8. Inguinal hernia in neonates and ex-preterm: complications, timing and need for routine contralateral exploration.

    Science.gov (United States)

    Pini Prato, A; Rossi, V; Mosconi, M; Disma, N; Mameli, L; Montobbio, G; Michelazzi, A; Faranda, F; Avanzini, S; Buffa, P; Ramenghi, L; Tuo, P; Mattioli, G

    2015-02-01

    Aim of this study was to present a series of neonates and ex-preterm babies who underwent inguinal hernia repair focusing on complications and possible indication to perform routine contralateral groin exploration. This is a retrospective study of a series of consecutive patients weighing less than 5 kg who underwent inguinal hernia repair between January 2007 and December 2012. Only the affected side was treated. Patients have been routinely followed up postoperatively. We resorted to available outpatients' charts and admission notes to record demographic data, surgical details, complications and the occurrence of metachronous hernias. A questionnaire was administered to all patients' relatives to confirm the long-term outcome. One hundred fifty-four patients were operated for a total of 184 herniotomies (88 right sided, 36 left sided and 30 bilateral). Median length of follow-up was 42 months (range 6 months-7.5 years). Thirteen patients (13/124 = 10.5 %) developed metachronous hernia that proved to be significantly more frequent in patients weighing less than 1,500 g at birth (p hernia but surgery to be performed only on the symptomatic side, as soon as possible after initial diagnosis. Very low birth weight patients should be followed with care in the early postoperative period due to the higher likelihood of developing a metachronous hernia.

  9. Amyand's hernia-a vermiform appendix presenting in an inguinal hernia: a case series

    Directory of Open Access Journals (Sweden)

    Pavlidis Theodoros

    2011-09-01

    Full Text Available Abstract Introduction A vermiform appendix in an inguinal hernia, inflamed or not, is known as Amyand's hernia. Here we present a case series of four men with Amyand's hernia. Case presentations We retrospectively studied 963 Caucasian patients with inguinal hernia who were admitted to our surgical department over a 12-year period. Four patients presented with Amyand's hernia (0.4%. A 32-year-old Caucasian man had an inflamed vermiform appendix in his hernial sac (acute appendicitis, presenting as an incarcerated right groin hernia, and underwent simultaneous appendectomy and Bassini suture hernia repair. Two patients, Caucasian men aged 36 and 43 years old, had normal appendices in their sacs, which clinically appeared as non-incarcerated right groin hernias. Both underwent a plug-mesh hernia repair without appendectomy. The fourth patient, a 25-year-old Caucasian man with a large but not inflamed appendix in his sac, had a plug-mesh hernia repair with appendectomy. Conclusion A hernia surgeon may encounter unexpected intraoperative findings, such as Amyand's hernia. It is important to be prepared and apply the appropriate treatment.

  10. Mesh Plug Repair of Inguinal Hernia; Single Surgeon Experience

    Directory of Open Access Journals (Sweden)

    Ahmet Serdar Karaca

    2013-10-01

    Full Text Available Aim: Mesh repair of inguinal hernia repairs are shown to be an effective and reliable method. In this study, a single surgeon%u2019s experience with plug-mesh method performs inguinal hernia repair have been reported. Material and Method: 587 patients with plug-mesh repair of inguinal hernia, preoperative age, body / mass index, comorbid disease were recorded in terms of form. All of the patients during the preoperative and postoperative hernia classification of information, duration of operation, antibiotics, perioperative complications, and later, the early and late postoperative complications, infection, recurrence rates and return to normal daily activity, verbal pain scales in terms of time and postoperative pain were evaluated. Added to this form of long-term pain ones. The presence of wound infection was assessed by the presence of purulent discharge from the incision. Visual analog scale pain status of the patients was measured. Results: 587 patients underwent repair of primary inguinal hernia mesh plug. One of the patients, 439 (74% of them have adapted follow-ups. Patients%u2019 ages ranged from 18-86. Was calculated as the mean of 47±18:07. Follow-up period of the patients was found to be a minimum of 3 months, maximum 55 months. Found an average of 28.2±13.4 months. Mean duration of surgery was 35.07±4.00 min (min:22mn-max:52mn, respectively. When complication rates of patients with recurrence in 2 patients (0.5%, hematoma development (1.4% in 6 patients, the development of infection in 11 patients (2.5% and long-term groin pain in 4 patients (0.9% appeared. Discussion: In our experience, the plug-mesh repair of primary inguinal hernia repair safe, effective low recurrence and complication rates can be used.

  11. Male infertility following inguinal hernia repair: a systematic review and pooled analysis.

    Science.gov (United States)

    Kordzadeh, A; Liu, M O; Jayanthi, N V

    2017-02-01

    The aim of this systematic review is to establish the clinical impact of open (mesh and/or without mesh) and laparoscopic hernia repair (transabdominal pre-peritoneal (TAP) and/or totally extra-peritoneal (TEP)) on male fertility. The incidence of male infertility following various types of inguinal hernia repair is currently unknown. The lack of high-quality evidence has led to various speculations, suggestions and reliance on anecdotal experience in the clinical practice. An electronic search of the literature in Medline, Scopus, Embase and Cochrane library from 1966 to October 2015 according to PRISMA checklist was conducted. Quality assessment of articles was conducted using the Oxford Critical Appraisal Skills Programme (CASP) and their recommendation for practice was examined through National Institute for Health and Care Excellence (NICE). This resulted in ten studies (n = 10), comprising 35,740 patients. Sperm motility could be affected following any type and/or technique of inguinal hernia repair but this is limited to the immediate postoperative period (≤48 h). Obstructive azoospermia was noted in 0.03% of open and 2.5% of bilateral laparoscopic (TAP) hernia repair with mesh. Male infertility was detected in 0.8% of the open hernia repair (mesh) with no correlation to the type of mesh (lightweight vs. heavyweight). Inguinal hernia repair without mesh has no impact on male fertility and obstructive azoospermia. However, the use of mesh in bilateral open and/or laparoscopic repair may require the inclusion of male infertility as the part of informed consent in individuals that have not completed their family or currently under investigations.

  12. An animal model to train Lichtenstein inguinal hernia repair.

    Science.gov (United States)

    Rosenberg, J; Presch, I; Pommergaard, H C; Burcharth, J; Bagot d'Arc, M

    2013-04-01

    Inguinal hernia repair is a common surgical procedure, and the majority of operations worldwide are performed ad modum Lichtenstein (open tension-free mesh repair). Until now, no suitable surgical training model has been available for this procedure. We propose an experimental surgical training model for Lichtenstein's procedure on the male and female pig. In the pig, an incision is made 1 cm cranially to the inguinal sulcus where a string of subcutaneous lymph nodes is located and extends toward the pubic tubercle. The spermatic cord is located in a narrow sulcus in the pig, thus complicating the procedure if operation should be done in the inguinal canal. The chain of lymph nodes resembles the human spermatic cord and can be used to perform Lichtenstein's hernia repair. This experimental surgical model has been tested on two adult male pigs and three adult female pigs, and a total of 55 surgeons have been educated to perform Lichtenstein's hernia repair in these animals. This new experimental surgical model for training Lichtenstein's hernia repair mimics the human inguinal anatomy enough to make it suitable as a training model. The operation facilitates the training in the positioning and fixation of the mesh and can be performed numerous times on the same pig. It is therefore a useful training method for inexperienced surgeons to obtain experience in aspects of the Lichtenstein procedure.

  13. Incarcerated inguinal hernias surgical treatment specifics in elderly patients.

    Science.gov (United States)

    Pesić, Ivan; Karanikolić, Aleksandar; Djordjević, Nebojsa; Stojanović, Miroslav; Stanojević, Goran; Radojković, Milan; Nestorović, Milica

    2012-09-01

    Incarcerated inguinal hernias surgical treatment represents one of the most frequent surgical treatments in elderly patients. The percentage of incarcerated inguinal hernias urgent surgical treatments is growing exponentially with the age in patients over 50. The aim of the study was to investigate some of the factors that may have impact on the incarcerated inguinal hernias surgical treatment outcome in elderly patients. The study included 180 patients classified in two groups: the study group (> 65 years of age) and the control group (Synthetic material was implanted in 124 (68.90%) patients, while the tension technique was performed in 65 (31.1%) patients. The duration of incarceration more than 24 h (p = 0.015), previous abdominal surgery (p = 0.001), the American Society of Anesthesiologists physical status classification system (ASA classification) (p = 0.033) and the presence of chronic diseases (p = 0.01) appeared to be statistically significant risk factors for performing intestinal resection in the study group, while in the control group they represented risk factors, but not at the level of statistical significance (p < 0.05), except for the duration of incarceration (p = 0.007). A higher ASA stage (p = 0.001) and the presence of bowel resection (p <0.001) are the most important risk factors for lethal outcome in both groups of patients. Incarcerated inguinal hernia in elderly patients is a serious problem. A higher ASA score and the presence of bowel resection are the most important factors related to unfavorable outcome.

  14. Day case inguinal hernia surgery in Nigerian children: Prospective ...

    African Journals Online (AJOL)

    Background: There has been an increase in day case surgery for children worldwide, but there have been few reports of the practice (most of them being retrospective) by many of the surgical sub-specialties in the sub-region. The aim of this study was to document our experience with day case inguinal hernia surgery in a

  15. Ultrasound-guided nerve block for inguinal hernia repair

    DEFF Research Database (Denmark)

    Bærentzen, Finn; Maschmann, Christian; Jensen, Kenneth

    2012-01-01

    Open inguinal hernia repair in adults is considered a minor surgical procedure but can be associated with significant pain. We aimed to evaluate acute postoperative pain management in male adults randomized to receive an ultrasound-guided ilioinguinal and iliohypogastric nerve block administered...

  16. Recurrence and Pain after Mesh Repair of Inguinal Hernias ...

    African Journals Online (AJOL)

    Background: Surgery for inguinal hernias has evolved over a prolonged period of time with the main outcome of interest being recurrence and pain. Mesh hernioplasty has been practiced with increasing frequency at Kenyatta National hospital (KNH) since its formal introduction in 2006. There has not been any published ...

  17. Anastomosis Procedure through an Inguinal Hernia Incision in ...

    African Journals Online (AJOL)

    For laparoscopic anterior resection, an additional small incision is usually placed in the left lower quadrant or the suprapubic portion. As a left inguinal hernia incision is close to both the left lower quadrant and the suprapubic portion, such an incision can be used for anastomosis in laparoscopic anterior resection, without ...

  18. Stone ingestion causing obstructed inguinal hernia with perforation ...

    African Journals Online (AJOL)

    We report a rare case of obstructed right inguinal hernia caused by ingested stones. A 2 year-old boy from Northern Thailand was transferred to our hospital with low-grade fever, vomiting, and acute painful swelling at his right hemiscrotum for one day. The physical examination revealed marked enlargement with ...

  19. Inguinal Hernia: The Quest for the Best Repair | Ismaila | Nigerian ...

    African Journals Online (AJOL)

    Background: Inguinal hernia repair may be the most common procedure in general surgery. Many repairs have been described but none appears completely satisfactory. A brief look at the popular methods of repair from the traditional tissue approximation to the current meshbased techniques is presented. Methods: The ...

  20. Recurrence and complications of pediatric inguinal hernia repair ...

    African Journals Online (AJOL)

    three pediatric surgeons and support the Khouzestan province with a population of more than four million. Their hospital records up to 2007 were reviewed for surgical complications and inguinal hernia recurrence. Patients with a history of kidney, liver, and heart failure were excluded from the study. Healthy neonates and.

  1. Secondary inguinal hydatidosis mimicking irreducible inguinal hernia: report of a rare case.

    Science.gov (United States)

    Singh, A; Soni, M L; Khandelwal, R G; Gora, N

    2016-06-01

    Peritoneal hydatidosis secondary to liver hydatid disease is not uncommon but peritoneal hydatidosis herniating to the inguinal canal is rare, with fewer than five cases reported in the literature. We describe a 54-year-old man who presented with a progressively enlarging soft, cystic swelling in the right inguinal region. Clinical examination suggestive of irreducible right inguinal hernia and ultrasonography revealed it to be a cystic swelling within the hernial sac. The swelling was excised en bloc and open mesh hernioplasty was performed. Cyst biopsy revealed hydatid disease; hence, the patient was put on adjunctive albendazole chemotherapy for 3 months.

  2. A survey of general surgeons regarding laparoscopic inguinal hernia repair: practice patterns, barriers, and educational needs.

    Science.gov (United States)

    Trevisonno, M; Kaneva, P; Watanabe, Y; Fried, G M; Feldman, L S; Lebedeva, E; Vassiliou, M C

    2015-10-01

    Practice patterns for inguinal hernia repair vary significantly among surgeons. The purpose of this study was to identify perceived indications for laparoscopic inguinal hernia repair (LIHR), and to identify barriers to its adoption and educational needs for surgeons. A web-based survey was sent to general surgery members of several North American surgical societies, and to surgical residents through program directors. The 33-item survey was divided in 4 sections: demographics, utilization of techniques, management based on 11 clinical scenarios, reasons for not performing LIHR and educational needs for those who want to learn. Six hundred and ninety-seven general surgeons and 206 general surgery residents responded to the survey. Surgeons with MIS fellowships, and surgeons at the beginning of their careers are more likely to perform LIHR. Out of the 11 clinical scenarios, surgeons preferred a laparoscopic approach (totally extraperitoneal or transabdominal preperitoneal) for bilateral (48 %) and recurrent (44 %) hernias. However, 46 % of respondents never perform LIHR. Of these, 70 % consider the benefits of laparoscopy to be minimal, 59 % said they lack the requisite training, and 26 % are interested in learning. Surgeons (70 %) and residents (73 %) agreed that the best educational method would be a course followed by expert proctoring. Surgeons remain divided on the utility of laparoscopic surgery for inguinal hernia repair. Nearly half of responding surgeons never perform LIHR, and the other half offer it selectively. One quarter of surgeons who do not perform LIHR are interested in learning. This reveals a knowledge gap that could be addressed with educational programs.

  3. The Anterior Preperitoneal Approach for Repair of Complex Inguinal Hernias

    Directory of Open Access Journals (Sweden)

    Safa Onel

    2014-08-01

    Results: A total of 40 patients (Male:32, Female:8 underwent hernia repair with our technique during the study period. The mean age was (+/-SD 44+/-6.8 years. Four patients had giant direct hernia,12 patients had giant inguino-scrotal hernia, 14 patients had recurrent and 10 patients had femoral hernia. 4 patients were underwent emergent surgery due to incarceration. The mean operation time was (+/-SD 61+/-11 min. There was no recurrence with the mean follow-up time of 7+/-2.2 years. Cnclusion: Our surgical technique allows to repair all types of inguinal hernia with one piece of prolene mesh by covering all potential defects. [Cukurova Med J 2014; 39(4.000: 822-828

  4. Patient-Related Risk Factors for Recurrence After Inguinal Hernia Repair

    DEFF Research Database (Denmark)

    Burcharth, Jakob; Pommergaard, Hans-Christian; Bisgaard, Thue

    2015-01-01

    Background. Several factors influence the risk of recurrence after inguinal hernia surgery; however, a systematic review and meta-analysis of patient-related risk factors for recurrence after inguinal hernia surgery has not been performed earlier. Methods. MEDLINE, Embase, and Cochrane databases...... were searched in June 2013 for studies evaluating patient-related risk factors for recurrence after inguinal hernia operation. Observational studies evaluating nontechnical patient-related risk factors for recurrence after inguinal hernia surgery were included. Outcome variables were grouped under...... patient demographics, hernia characteristics, connective tissue composition and degradation, habits and social relations, and conditions related to inguinal hernia recurrence. Results. From a total of 5061 records screened, we included 40 observational studies enrolling 720 651 inguinal hernia procedures...

  5. Incarcerated inguinal hernias surgical treatment specifics in elderly patients

    Directory of Open Access Journals (Sweden)

    Pešić Ivan

    2012-01-01

    Full Text Available Background/Aim. Incarcerated inguinal hernias surgical treatment represents one of the most frequent surgical treatments in elderly patients. The percentage of incarcerated inguinal hernias urgent surgical treatments is growing exponentially with the age in patients over 50. The aim of the study was to investigate some of the factors that may have impact on the incarcerated inguinal hernias surgical treatment outcome in elderly patients. Methods. The study included 180 patients classified in two groups: the study group (> 65 years of age and the control group (≤ 65, managed in the period from January 2005 till March 2009 at the General Surgery Clinic, Clinical Center Niš. Results. Most of the patients had right inguinal hernia (52.6%, the study group; 59.1%, the control group. All the study group patients suffered from some of accompanying chronic diseases (100%, opposite to 39 (59% patients of the control group. Synthetic material was implanted in 124 (68.9% patients, while the tension technique was performed in 65 (31.1% patients. The duration of incarceration more than 24 h (p = 0.015, previous abdominal surgery (p = 0.001, the American Society of Anesthesiologists physical status classification system (ASA classification (p = 0.033 and the presence of chronic diseases (p = 0.01 appeared to be statistically significant risk factors for performing intestinal resection in the study group, while in the control group they represented risk factors, but not at the level of statistical significance (p <0.05, except for the duration of incarceration (p = 0.007. A higher ASA stage (p = 0.001 and the presence of bowel resection (p <0.001 are the most important risk factors for lethal outcome in both groups of patients. Conclusion. Incarcerated inguinal hernia in elderly patients is a serious problem. A higher ASA score and the presence of bowel resection are the most important factors related to unfavorable outcome.

  6. Surgical management of chronic pain after inguinal hernia repair

    DEFF Research Database (Denmark)

    Aasvang, E; Kehlet, H

    2005-01-01

    BACKGROUND: Chronic pain after inguinal hernia repair is an adverse outcome that affects about 12 per cent of patients. Principles of treatment have not been defined. This review examines neurectomy and mesh or staple removal as possible treatments. METHOD: A literature search was carried out using...... the Medline and Ovid databases. Keywords were 'pain; chronic', 'herniorrhaphy; inguinal', 'neurectomy' and similar words. Article references were cross-checked for additional references. Articles were reviewed for data on surgical treatment of chronic pain after hernia repair. RESULTS: Neurectomy...... a pathological lesion or nerve and quality of follow-up; this hindered interpretation of the data. Insufficient information is available at present on the effect of removal of mesh or staples. CONCLUSION: Chronic pain after hernia repair is a significant problem and there is a need for a definitive assessment...

  7. Diagnosis of inguinal hernia by prone- vs. supine-position computed tomography.

    Science.gov (United States)

    Miyaki, A; Yamaguchi, K; Kishibe, S; Ida, A; Miyauchi, T; Naritaka, Y

    2017-10-01

    The aim of this study was to investigate the efficacy of prone-position computed tomography (CT) for detecting and classifying inguinal hernia relative to supine-position CT before laparoscopic inguinal hernia repair. Seventy-nine patients who underwent laparoscopic transabdominal preperitoneal repair of inguinal hernia were enrolled in this prospective study. Patients diagnosed with inguinal hernia by physical examination underwent abdominal CT in the supine and prone positions for preoperative assessment. The anatomy of the right and left inguinal regions was confirmed during the surgery and compared with the preoperative CT findings. The 79 cases included 87 operated lesions and 71 non-operated contralateral inguinal sites. Of the 84 clinical hernias, inguinal hernia was detected significantly more frequently on prone-position CT images (84, 100%) than on supine-position CT images (55, 65.5%). In addition, the inguinal hernia type was determined with significantly greater accuracy on prone-position CT images (96.4%) than on supine-position CT images (58.3%). Twenty-two occult hernias were detected by laparoscopy. The detection rate and accuracy for determining the type of occult hernia were significantly greater when using prone-position CT images [19 of 22 lesions (86.4%) and 77.3%, respectively] than when using supine-position CT images [8 of 22 lesions (36.4%) and 27.3%, respectively]. Prone-position CT is adequate for detecting and classifying inguinal hernia and for evaluating occult hernia.

  8. [Hernia surgery in urology: part 1: inguinal, femoral and umbilical hernias - fundamentals of clinical diagnostics and treatment].

    Science.gov (United States)

    Franz, T; Schwalenberg, T; Dietrich, A; Müller, J; Stolzenburg, J-U

    2013-05-01

    Hernias are a common occurrence with correspondingly huge clinical and economic impacts on the healthcare system. The most common forms of hernia which need to be diagnosed and treated in routine urological work are inguinal and umbilical hernias. With the objective of reconstructing and stabilizing the inguinal canal there are the possibilities of open and minimally invasive surgery and both methods can be performed with suture or mesh repair. Indications for surgery of umbilical hernias are infrequent although this is possible with little effort under local anesthesia. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostics and therapy of inguinal, femoral and umbilical hernias.

  9. Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair : Laparoscopic approach for inguinodynia.

    Science.gov (United States)

    Ramshaw, Bruce; Vetrano, Vincent; Jagadish, Mayuri; Forman, Brandie; Heidel, Eric; Mancini, Matthew

    2017-12-01

    Traditional methods of clinical research may not be adequate to improve the value of care for patients with complex medical problems such as chronic pain after inguinal hernia repair. This problem is very complex with many potential factors contributing to the development of this complication. We have implemented a clinical quality improvement (CQI) effort in an attempt to better measure and improve outcomes for patients suffering with chronic groin pain (inguinodynia) after inguinal hernia repair. Between April 2011 and June 2016, there were 93 patients who underwent 94 operations in an attempt to relieve pain (1 patient had two separate unilateral procedures). Patients who had prior laparoscopic inguinal hernia repair (26) had their procedure completed laparoscopically. Patients who had open inguinal hernia repair (68) had a combination of a laparoscopic and open procedure in an attempt to relieve pain. Initiatives to attempt to improve measurement and outcomes during this period included the administration of pre-operative bilateral transversus abdominis plane and intra-operative inguinal nerve blocks using long-acting local anesthetic as a part of a multimodal regimen, the introduction of a low pressure pneumoperitoneum system, and the expansion of a pre-operative questionnaire to assess emotional health pre-operatively. The results included the assessment of how much improvement was achieved after recovery from the operation. Forty-five patients (48%) reported significant improvement, 39 patients (41%) reported moderate improvement, and 10 patients (11%) reported little or no improvement. There were 3 (3%) complications, 13 (11%) hernia recurrences, and 15 patients (13%) developed a new pain in the inguinal region after the initial pain had resolved. The principles of CQI can be applied to a group of patients suffering from chronic pain after inguinal hernia repair. Based on these results additional process improvement ideas will be implemented in an attempt

  10. Differentiation of a Femoral Hernia from an Inguinal Hernia on Isotropic Multidetector-Row CT (MDCT): the Benefit of Inguinal Ligament Coronal-Oblique Images

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ju Hyun; Jang, Kyung Mi; Kim, Min Jeong; Ko, Ji Young; Koh, Sung Hye; Yie, Mi Yeon; Min, Kwang Seon; Kim, In Gyu [Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Choi, Dong Il; Park, Yul Ri [Samsung Medical Center, Seoul (Korea, Republic of)

    2009-04-15

    This study was designed to evaluate the diagnostic value of the use of inguinal ligament coronal-oblique CT images in the differentiation of femoral hernias from inguinal hernias. A total of 32 patients (with 11 femoral hernias and 21 inguinal hernias) underwent CT imaging. All of the examinations were performed with a 16- multidetector row CT (MDCT) scanner with contrast enhancement, and transverse sections, coronal sections and coronal-oblique CT images were reformed along an imaginary inguinal ligament plane. Two independent observers retrospectively evaluated the CT scans. Image analysis was first performed with only transverse and coronal images. A second analysis was then performed with transverse, coronal and coronal- oblique images. The mean angle difference between coronal and coronal-oblique CT images was 8.0 degrees (range, 0-22 degrees). A radiologist correctly diagnosed the presence of a femoral hernia in nine (82%) of 11 patients and a radiology fellow correctly diagnosed the presence of a femoral hernia in seven (64%) of 11 patients in the first session. Both of the reviewers made the correct diagnosis in all patients in the second session. For inguinal hernias, both reviewers correctly diagnosed all patients during both sessions. The coronal-oblique CT images were the most valuable images for the evaluation of the relationship between hernias of the neck and inguinal ligament. Inguinal ligament coronal-oblique CT images can provide additional diagnostic value in the evaluation of groin hernias.

  11. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Bisgaard, Thue; Kehlet, Henrik

    2011-01-01

    The nationwide Danish Hernia Database, recording more than 10,000 inguinal and 400 femoral hernia repairs annually, provides a unique opportunity to present valid recommendations in the management of Danish patients with groin hernia. The cumulated data have been discussed at biannual meetings...... and guidelines have been approved by the Danish Surgical Society. Diagnosis of groin hernia is based on clinical examination. Ultrasonography, CT or MRI are rarely needed, while herniography is not recommended. In patients with indicative symptoms of hernia, but no detectable hernia, diagnostic laparoscopy may...... be an option. Once diagnosed, hernia repair is recommended in the presence of symptoms affecting daily life. In male patients with minimal or absent symptoms watchful waiting is recommended. In females, however, repair is recommended also in asymptomatic patients. In male patients with primary unilateral...

  12. The etiology of indirect inguinal hernia in adults: congenital or acquired?

    Science.gov (United States)

    Jiang, Z P; Yang, B; Wen, L Q; Zhang, Y C; Lai, D M; Li, Y R; Chen, S

    2015-10-01

    During hernioplasty focal thickened tissue containing smooth muscle is found at the neck of the hernia sac in most patients with indirect inguinal hernia. These thickenings may be related to the processus vaginalis and reveal the etiology of indirect inguinal hernia. The study included 50 male adults with indirect inguinal hernia and 50 male adults with direct inguinal hernia, all of them were initial cases. Hernioplasty and excision of the hernia sac were performed, meanwhile anatomical features of the hernia sac and the spermatic cord were recorded, then followed by histological investigation of the hernia sacs. Focal thickenings were observed at the neck of the hernia sac in 88 % of adults with indirect inguinal hernia. Dense adhesion between the hernia sac and the spermatic cord was found where the thickening located. Histological examination identified smooth muscle cells in 57 % of the thickened tissues. No similar findings were observed in patients with direct inguinal hernia. The focal thickening which contains smooth muscle tissue may be remnant of the processus vaginalis after its obliteration. In other word, the presence of the thickening means that fusion of the processus vaginalis has previously taken place. Thus, most indirect inguinal hernias in adults may represent acquired diseases.

  13. Transabdominal preperitoneal laparoscopic approach for incarcerated inguinal hernia repair

    Science.gov (United States)

    Yang, Shuo; Zhang, Guangyong; Jin, Cuihong; Cao, Jinxin; Zhu, Yilin; Shen, Yingmo; Wang, Minggang

    2016-01-01

    Abstract To investigate the efficacy, key technical points, and complication management of the transabdominal preperitoneal (TAPP) approach for incarcerated inguinal hernia repair. Seventy-three patients with incarcerated inguinal hernias underwent TAPP surgery in our department between Jan 2010 and Dec 2015. A retrospective review was performed by analyzing the perioperative data from these patients. The operation was successfully completed in all 73 patients. Operation time was 54.0 ± 18.8 minutes (range, 35–100 minutes). Length of stay was 3.9 ± 1.1 days (range, 3–9 days). There was 1 case of incisional infection, 32 cases of seroma, and 3 cases of postoperative pain during follow-up. All patients recovered after the appropriate treatment. No recurrence or fistula was observed. The TAPP approach represents a safe and effective technique for incarcerated inguinal hernia repair because of its potential in assessment of hernia content and decreasing incisional infection rate. However, it requires experienced surgeons to ensure safety with special attention paid to the key technical points as well as complication management. PMID:28033260

  14. Low reoperation rates in young males after sutured repair of indirect inguinal hernia

    DEFF Research Database (Denmark)

    Haastrup, Emil; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    Background: The aim of this study was to investigate the reoperation rates after open indirect inguinal hernia repair with and without mesh in young males and other age groups. Younger males have higher risk of developing chronic pain after open inguinal hernia repair with mesh compared with older...... males with primary indirect inguinal hernia, repaired with Lichtenstein or annulorrhaphy from the period January 1, 1998 to December 31, 2015. Reoperation rate for recurrence was used as outcome. Results: In total 52,281 primary repairs of open indirect inguinal hernia were included of which 49,951 were...... the results indicate, that annulorrhaphy could be a valid option for young men with indirect inguinal hernias. Thus, we propose a tailored approach for this patient group. Summary for the table of contents: Avoiding mesh among younger patients with inguinal hernias could be justified, if an acceptable low...

  15. Single-incision laparoscopic transabdominal preperitoneal inguinal hernia repair using only conventional instruments: an initial report.

    Science.gov (United States)

    Sinha, Rajeev

    2011-05-01

    Notes is the logical answer to scarless surgery, but despite being around for almost 4-5 years, it has to still garner a major support because of a number of limitations. Single-incision laparoscopic surgery, especially when done through the umbilicus, should be the perfect answer as far as the absence of any visible scar is concerned. All the 67 patients were operated by the same surgeon through a transversely placed umbilical incision in the lower half of the umbilicus. Three conventional ports, 10, 5, and 5  mm, were introduced through the same skin incision but separate transfacial punctures. The instruments included 10-mm and 5-mm 30° rigid telescopes and rigid instruments as in standard laparoscopic cholecystectomy. Patients with irreducible hernia and obstructed hernia were included, and those with strangulated hernia were excluded. All the patients were men, with an average age of 38.6 years. Three patients had bilateral hernia and 2 each had irreducible and obstructed hernia. The mean operating time was 42.8 minutes for unilateral hernias when tackers were used and 51.7 minutes in those in whom intracorporeal suturing was done. The operating time for bilateral hernias was 71.7 minutes. There was minimal flap discharge, without infection, in 3 patients. There were no other complications. There were no conversions and no recurrences upto 9 months of follow-up. Transumbilical single-skin-incision laparoscopic transabdominal preperitoneal repair for groin hernias, performed solely with conventional instruments, is feasible, easy to learn, and probably the future of laparoscopic inguinal hernia repair.

  16. Current options in inguinal hernia repair in adult patients

    Science.gov (United States)

    Kulacoglu, H

    2011-01-01

    Inguinal hernia is a very common problem. Surgical repair is the current approach, whereas asymptomatic or minimally symptomatic hernias may be good candidate for watchful waiting. Prophylactic antibiotics can be used in centers with high rate of wound infection. Local anesthesia is a suitable and economic option for open repairs, and should be popularized in day-case setting. Numerous repair methods have been described to date. Mesh repairs are superior to "nonmesh" tissue-suture repairs. Lichtenstein repair and endoscopic/laparoscopic techniques have similar efficacy. Standard polypropylene mesh is still the choice, whereas use of partially absorbable lightweight meshes seems to have some advantages. PMID:22435019

  17. Inguinal hernia repair with Parietex ProGrip mesh causes minimal discomfort and allows early return to normal activities.

    Science.gov (United States)

    Batabyal, Pikli; Haddad, Richard L; Samra, Jaswinder S; Wickins, Simon; Sweeney, Edmund; Hugh, Thomas J

    2016-01-01

    The type of inguinal hernia repair used depends on many factors but predominantly the surgeon's training, interpretation of the literature, and personal preference. This prospective cohort study describes a consecutive series of open mesh inguinal hernia repairs (modified Lichtenstein technique) performed as an outpatient procedure using 2 different mesh types. Analysis was undertaken on 540 consecutive patients who underwent inguinal hernia repair between January 2007 and December 2012. Short-term outcomes were compared between those repaired with conventional polypropylene mesh and those with Parietex ProGrip mesh. Most patients were male (89%) and the mean age was 63 years. The median operative time was 50 minutes for unilateral hernias and 90 minutes for bilateral hernias. The use of Parietex ProGrip mesh reduced the operative time to 40 minutes for unilateral hernias (P hernias (P hernia repair, 88% of the patients were discharged home within 4 hours of operation. There was no mortality and the overall complication rate was 7.4%. One patient developed a pulmonary embolus but the remainder of the complications were minor. Twenty-four hours postoperatively, 74% of the patients were either totally pain free or had minimal discomfort. At 4 weeks, 97% of the patients were either pain free or had minimal discomfort. Patients who underwent unilateral inguinal hernia repair with Parietex ProGrip mesh had the most rapid return to normal activities (10 vs 14 days, P < .04). Open anterior inlay mesh repair is safe and results in minimal postoperative pain and early return to normal activities. ProGrip mesh resulted in a shorter operative time and more rapid return to normal activities compared with polypropylene mesh (10 vs 14 days). Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Utilization of laparoscopic and open inguinal hernia repair: a population-based analysis.

    Science.gov (United States)

    Smink, Douglas S; Paquette, Ian M; Finlayson, Samuel R G

    2009-12-01

    Laparoscopic inguinal hernia repair is a safe, effective treatment for inguinal hernias and is considered, by some, to be the procedure of choice for recurrent inguinal hernias. Little is known, however, about the frequency with which laparoscopic inguinal hernia repair is performed and the determinants of its utilization. We performed a retrospective cohort study of all patients undergoing outpatient inguinal hernia repairs in Florida in 2002 and 2003, using the AHRQ State Ambulatory Surgery Database. We compared patient demographics, indication for procedure, location of procedure (i.e., hospital or ambulatory surgery center), and charges for laparoscopic and open repairs. Of 58,172 outpatient inguinal hernia repairs, 11,351 (19.5%) were performed laparoscopically. In the subset of 6221 recurrent inguinal hernias, only 1276 (20.5%) were performed laparoscopically. Patients undergoing a laparoscopic repair were younger (52.7 versus 57.4 years; P ambulatory surgery centers (ASCs) than at hospitals (13.7 versus 20.9%; P hernia repairs than did hospitals ($6,973 versus $12,860; P hernia repairs and is used more commonly at hospitals than at ASCs. Although clinical indications play a role, the use of laparoscopy for inguinal hernia repair may also be influenced by financial considerations.

  19. Endoscopic surgeons' preferences for inguinal hernia repair: TEP, TAPP, or OPEN.

    Science.gov (United States)

    Morales-Conde, Salvador; Socas, María; Fingerhut, Abe

    2012-09-01

    The use of endoscopic inguinal hernia repair has slowly increased in the past years, but the indications have remained vague. Some surgeons perform a tailored approach depending on patient or hernia characteristics, whereas others perform the same approach and technique for all hernias. Based on these principles, a survey of 19 questions was conducted during the 18th Congress of the European Association of Endoscopic Surgeons, which took place in Geneva, Switzerland, in 2010, to determine surgeons' preference depending on the hernia and the patient. All surgeons who attended the session (N = 100) responded to all questions. Eighty two percent of surgeons preferred a tailored approach, whereas 18 % used the same technique in all cases. Endoscopic techniques are used more frequently than the open approach in bilateral (7 vs. 93 %) and recurrent hernias (19 vs. 81 %), whereas in primary unilateral hernias all three techniques were used with almost similar frequency (32 % open, 39 % TAPP vs. 29 % TEP). TAPP was used more frequently than TEP, and even those surgeons who are expert in TEP preferred to perform a TAPP in difficult hernias, such as in obese patients and large scrotal hernias. Based on the age of patients, the open approach is preferred in patients younger than 18 years and older than 70 years, whereas the endoscopic approach is preferred in young active males and females, with a trend to use TAPP (44 %) more frequently than TEP (40 %) in females. Surgeons tended to use the open (vs. endoscopic) approach in patients with hematologic disorders (58 % open vs. 42 % endoscopic), previous laparotomy (59 % open vs. 41 % endoscopic) or emergency surgery (66 vs. 33 % in incarcerated hernias and 74 vs. 26 % in strangulated hernia). This survey showed that most surgeons who perform an endoscopic approach for inguinal hernia as the first option are convinced that not all hernias are good indications for this approach. On the other hand, most surgeons think that it is

  20. Herniorrafia inguinal em potro neonato Repair of congenital inguinal hernia in a newborn foal

    Directory of Open Access Journals (Sweden)

    Marcelo Weinstein Teixeira

    1998-03-01

    Full Text Available As hérnias inguinais congênitas em potros não são um achado raro na casuística hospitalar. A maioria dos casos são conduzidos clinicamente, por se tratar de hérnias indiretas. As hérnias inguinais congênitas diretas, irredutíveis, em potros são uma urgência cirúrgica e se não tratadas imediatamente causam 100% de óbito. Um potro da raça Quarto-de-milha, com 36 horas de vida, apresentando volume parcialmente redutível na região inguinal esquerda, desconforto abdominal contínuo e congestão de mucosas aparentes, foi admitido no hospital veterinário. O animal foi imediatamente encaminhado à cirurgia, onde a herniorrafia com ressecção de alça intestinal, por acesso inguinal foi realizada. A recuperação pós-operatória foi satisfatória e o animal apresenta desenvolvimento físico normal para a raça.Equine congenital inguinal hernias are a common finding in clinical practice. Since most cases are indirect hernias, these usually are treated clinically. Inguinal hernias in newborn foals represent a surgical emergency, that, if not treated result in 100% mortality. A quarter-horse mth 36 hours of life with a volume on the left inguinal region, continous signs of abdominal pain and mucosal congestion was admitted at the hospital. The animal was imediately sent to surgery, where a hernioraphy by inguinal acces with ressection of an intestinal loop was realized. Post-surgical evolution was satifactory and the animal today presents normal physical growth for the breed standarts.

  1. Histología del anillo inguinal interno en pacientes con hernia inguinal indirecta: serie de casos observacional y descriptiva

    OpenAIRE

    BARRÍA M,CARLOS; Ayala S,Patricio; Cortés,Víctor J; JARAMILLO R,LUIS; Contreras G,Mario A; LARRAÍN T,CRISTÓBAL; Tapia P,Rodrigo; Cruces B,Karina S

    2012-01-01

    Introducción: El presente estudio tiene como objetivo investigar la estructura histológica básica del anillo inguinal interno en pacientes operados por hernia inguinal indirecta primaria. Pacientes y Métodos: Se estudió una muestra de 72 pacientes consecutivos mayores de 15 años de edad con hernia inguinal indirecta unilateral sometidos a cirugía electiva. El objetivo principal fue la histología básica del anillo inguinal interno. Las muestras fueron procesadas con técnicas histoquímicas. Los...

  2. Cost-effectiveness of inguinal hernia surgery in northwestern Ecuador.

    Science.gov (United States)

    Shillcutt, Samuel D; Sanders, David L; Teresa Butrón-Vila, M; Kingsnorth, Andrew N

    2013-01-01

    Cost-effectiveness of tension-free inguinal hernia repair at a private 20-bed rural hospital in Esmeraldas Province, Ecuador, was calculated relative to no treatment. Lichtenstein repair using mosquito net or polypropylene commercial mesh was provided to patients with inguinal hernia by surgeons from Europe and North America. Prospective data were collected from provider, patient, and societal perspectives, with component costs collected on site and from local supply companies or published literature. Patient outcomes were forecasted using disability adjusted life years (DALYs) averted. Uncertainty in patient-level data was evaluated with Monte-Carlo simulation. Surgery was provided to 102 patients with inguinal hernias of various sizes. Local anesthesia was used for 80 % of operations during the first mission, and spinal anesthesia was used for 89 % in the second mission. Few complications were observed. An average 6.39 DALYs (3,0) were averted per patient (95 % confidence interval: 6.22-6.84). The average cost per patient was US$499.33 (95 % CI: US$490.19-$526.03) from a provider perspective, US$118.79 (95 % CI: US$110.28-$143.72) from a patient perspective, and US$615.46 (95 % CI: US$603.39-$650.40) from a societal perspective. Mean cost-effectiveness from a provider perspective was US$78.18/DALY averted (95 % CI: US$75.86-$85.78) according to DALYs (3,0) averted using the West Life Table level 26, well below the Ecuadorian per-capita Gross National Income (US$3,850). Results were robust to all sensitivity analyses. Inguinal hernia repair was cost-effective in western Ecuador through international collaboration.

  3. Technical aspects of modified totally extraperitoneal hernia repair for inguinal hernia

    Directory of Open Access Journals (Sweden)

    A. I. Bilai

    2016-01-01

    Full Text Available A number of technical shortcomings has been revealed recently despite huge inguinal hernias treatment progress according to numerous studies in modern herniology. The problem of surgical treatment results improving is considered to be a part of technical aspects issue in which videoendoscopic TEP-repair is extremely important. Aim. Our goal was to improve surgical treatment results of inguinal hernia repairs by modifying totally extraperitoneal hernia repair. Methods and results. 67 patients underwent modified totally extraperitoneal hernia repair. In every patient we used meticulous step by step dissection of the extraperitoneal space which substitutes dangerous and expensive balloon dilation and prevents from excessive extraperitoneal space sack formation and bleeding. Intraoperative anatomic landmarks and hernia defect measurements specify and individualise a mesh size and help to avoid any torsion and migration of the mesh and subsequent rough scar and chronic pain formation. We used inguinal bandage postoperatively for early mesh shift prevention. Conclusion. No hernia recurrence, low complication rate and good life quality in postoperative period after modified TEP-repair proved its high efficacy and superiority.

  4. Liposarcoma of the Spermatic Cord Masquerading as an Inguinal Hernia

    Directory of Open Access Journals (Sweden)

    William Londeree

    2014-01-01

    Full Text Available This is a case of a 70-year-old male who presented with a mass in his right testicle. He was treated with antibiotics for epididymitis while undergoing serial ultrasounds for one year due to testicular swelling and pain. His fourth ultrasound revealed a mild hydrocele with a large paratesticular mass of undescribed size, superior to the right testicle, thought to be an inguinal hernia. Preoperative CT scan demonstrated a large fat-containing inguinal hernia extending into the scrotal sac. An inguinal hernia repair was complicated by fatty tissue surrounding the testicle requiring a right orchiectomy. Pathology review of the tissue demonstrated well-differentiated liposarcoma with a small focus of dedifferentiation grade 2 tumor. Tumor was identified at the inked margins indicating an incomplete resection. It was decided that no further surgical intervention was needed and the patient would undergo surveillance for local tumor recurrence. Six-month follow-up MRI scan was negative for any recurrence of disease. A liposarcoma presenting as a paratesticular mass with spermatic cord involvement is rare, and imaging studies may fail to distinguish a liposarcoma from normal adipose tissue.

  5. Risk factors for perioperative complications in inguinal hernia repair – a systematic review

    Directory of Open Access Journals (Sweden)

    Weyhe Dirk

    2017-02-01

    Full Text Available The current literature suggests that perioperative complications occur in 8%–10% of all inguinal hernia repairs. However, the clinical relevance of these complications is currently unknown. In our review, based on 571,445 hernia repairs reported in 39 publications, we identified the following potential risk factors: patient age, ASA score, diabetes, smoking, mode of admission (emergency vs. elective surgery, surgery in low resource settings, type of anesthesia, and (in men bilateral and sliding hernias. The most commonly reported complications are bleeding (0.9%, wound infection (0.5%, and pulmonary and cardiovascular complications (0.2%. In 3.9% of the included publications, a reliable grading of the reported complications according to Clavien-Dindo classification was possible. Using this classification retrospectively, we could show that, in patients with complications, these are clinically relevant for about 22% of these patients (Clavien-Dindo grade ≥IIIa. About 78% of all patients suffered from complications needing only minor (meaning mostly medical intervention (Clavien-Dindo grade inguinal hernia repair, future studies should use the Clavien-Dindo classification to achieve better comparability between studies, thus enabling better correlation with potential risk factors.

  6. Inguinal hernia repair: can one identify the three main nerves of the region?

    Directory of Open Access Journals (Sweden)

    João Vicente Machado Grossi

    Full Text Available OBJECTIVE: To identify the nerves in the groin during inguinal hernia repair by inguinotomy.METHODS: We conducted a prospective, sequenced, non-randomized study comprising 38 patients undergoing inguinal hernia repair with placement of polypropylene mesh.RESULTS: The male patients were 36 (94.7%, with a mean age and standard deviation of 43.1 ± 14.5, body mass index of 24.4 ± 2.8. Comorbidities were hypertension in two (5.2%, smoking in 12 (31.5% and obesity in two (5.2%. The hernia was located only on the right in 21 (55.2% patients, only on the left in 11 (28.9%, and was bilateral in six (15.7% patients. Prior hernia repair was present in seven (18.4% patients. The identification of the three nerves during operation was made in 20 (52.6% patients, the ilioinguinal nerve and the iliohypogastric nerve were identified in 33 (86.8%, and the genital nerve branch of the genitofemoral nerve, in 20 (52.6%. Resection of at least one of the nerves was performed in seven (18.4% cases, two iliohypogastric nerves and five ilioinguinal nerves. The average operating time was 70.8 ± 18.2 minutes. The hospital stay was 1.42 ± 1.18 days. Ten patients (26.3% returned to physical activity around the first postoperative visit, and 37 (97.3% in the last. The follow-up time was 95.6 ± 23.5 days. The inability to identify the ilioinguinal nerve was associated with previous repair (p = 0.035.CONCLUSION: The identification of the three nerves during inguinal hernia surgery has been described in more than half of the cases and prior repair interfered with the identification of ilioinguinal nerve.

  7. Inguinal hernia repair: can one identify the three main nerves of the region?

    Science.gov (United States)

    Grossi, João Vicente Machado; Cavazzola, Leandro Totti; Breigeiron, Ricardo

    2015-06-01

    To identify the nerves in the groin during inguinal hernia repair by inguinotomy. We conducted a prospective, sequenced, non-randomized study comprising 38 patients undergoing inguinal hernia repair with placement of polypropylene mesh. The male patients were 36 (94.7%), with a mean age and standard deviation of 43.1 ± 14.5, body mass index of 24.4 ± 2.8. Comorbidities were hypertension in two (5.2%), smoking in 12 (31.5%) and obesity in two (5.2%). The hernia was located only on the right in 21 (55.2%) patients, only on the left in 11 (28.9%), and was bilateral in six (15.7%) patients. Prior hernia repair was present in seven (18.4%) patients. The identification of the three nerves during operation was made in 20 (52.6%) patients, the ilioinguinal nerve and the iliohypogastric nerve were identified in 33 (86.8%), and the genital nerve branch of the genitofemoral nerve, in 20 (52.6%). Resection of at least one of the nerves was performed in seven (18.4%) cases, two iliohypogastric nerves and five ilioinguinal nerves. The average operating time was 70.8 ± 18.2 minutes. The hospital stay was 1.42 ± 1.18 days. Ten patients (26.3%) returned to physical activity around the first postoperative visit, and 37 (97.3%) in the last. The follow-up time was 95.6 ± 23.5 days. The inability to identify the ilioinguinal nerve was associated with previous repair (p = 0.035). The identification of the three nerves during inguinal hernia surgery has been described in more than half of the cases and prior repair interfered with the identification of ilioinguinal nerve.

  8. The enhanced view-totally extraperitoneal technique for repair of inguinal hernia.

    Science.gov (United States)

    Daes, Jorge

    2012-04-01

    The totally extraperitoneal (TEP) approach for repair of inguinal hernia is the preferred technique since it does not penetrate the peritoneal cavity, thus avoiding potential intraperitoneal complications. The TEP technique allows for regional or even local plus sedative anesthesia, and it gives us an incomparable view of the inguinal region and hernias exactly where they originate. Part of the difficulty with the TEP technique is the limited space it provides for dissection. We describe a modification of the classical TEP approach which overcomes this limitation: the e-TEP technique. Since October 2010 we have performed 36 e-TEP procedures. Many of these were in difficult cases such as inguinoscrotal and incarcerated hernias and patients with previous radical prostatectomy. We present an initial evaluation of this group of patients. Results in terms of pain and time off work were the same as with the classical technique. The average operating time was 38 min. This is longer than usual, probably due to the complexity of the cases performed and the time spent in documenting the technique for educational purposes. The peritoneum was often accidentally opened and air leaked into the peritoneal cavity without interfering with the completion of the surgery. We had two small seromas and one case of skin sloughing at the umbilical wound in a case of umbilical and bilateral inguinal hernias. We have had no recurrences, but follow-up has been short. Our initial experience with the e-TEP technique has been satisfactory. We have had no conversions in spite of the difficult cases selected. There were no major complications, and functional results were excellent. We believe this modification has a place in the armamentarium for hernia repair.

  9. Needlescopic Surgery Versus Single-port Laparoscopy for Inguinal Hernia.

    Science.gov (United States)

    Chan, Yi-Wei; Hollinsky, Christian

    2015-01-01

    In recent years, 2 modifications of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair-needlescopic (nTAPP) surgery and single-port (sTAPP) surgery-have greatly improved patient outcomes over traditional approaches. For a comparison of these 2 modifications, we sought to investigate and compare the extent of surgical trauma and postoperative consequences for the abdominal wall in these two procedures. In a retrospective study, 50 nTAPP and 35 sTAPP procedures occurring at a community hospital from November 1, 2009, through July 31, 2012 were reviewed. Intraoperative data, including length of the umbilical skin incision and operative time, were recorded. A follow-up evaluation included investigation of hernia recurrence, postoperative pain, abdominal wall mobility, cosmetic satisfaction, and period of sick leave. The mean umbilical skin incision was 13 ± 4 mm in nTAPP vs 27 ± 3 mm in sTAPP (P hernia recurrence. In patients with uncomplicated inguinal hernia, the nTAPP procedure, with less surgical trauma and operating time, has distinct advantages in reduction of immediate postoperative pain and sick leave time.

  10. Open versus laparoscopic unilateral inguinal hernia repairs: defining the ideal BMI to reduce complications.

    Science.gov (United States)

    Willoughby, Ashley D; Lim, Robert B; Lustik, Michael B

    2017-01-01

    Open inguinal hernia repair is felt to be a less expensive operation than a laparoscopic one. Performing open repair on patients with an obese body mass index (BMI) results in longer operative times, longer hospital stay, and complications that will potentially impose higher cost to the facility and patient. This study aims to define the ideal BMI at which a laparoscopic inguinal hernia repair will be advantageous over open inguinal hernia repair. The NSQIP database was analyzed for (n = 64,501) complications, mortality, and operating time for open and laparoscopic inguinal hernia repairs during the time period from 2005 to 2012. Bilateral and recurrent hernias were excluded. Chi-square tests and Fisher's exact tests were used to assess associations between type of surgery and categorical variables including demographics, risk factors, and 30-day outcomes. Multivariable regression analyses were performed to determine whether odds ratios differed by level of BMI. The HCUP database was used for determining difference in cost and length of stay between open and laparoscopic procedures. There were 17,919 laparoscopic repairs and 46,582 open repairs in the study period. The overall morbidity (across all BMI categories) is statistically greater in the open repair group when compared to the laparoscopic group (p = 0.03). Postoperative complications (including wound disruption, failure to wean from the ventilator, and UTI) were greater in the open repair group across all BMI categories. Deep incisional surgical site infections (SSI) were more common in the overweight open repair group (p = 0.026). The return to the operating room across all BMI categories was statistically significant for the open repair group (n = 269) compared to the laparoscopic repair group (n = 70) with p = 0.003. There was no difference in the return to operating room between the BMI categories. The odds ratio (OR) was found to be statistically significant when comparing the obese

  11. Outcomes of surgery on patients with a clinically inapparent inguinal hernia as diagnosed by ultrasonography.

    Science.gov (United States)

    van Hout, L; Bökkerink, W J V; Ibelings, M S; Heisterkamp, J; Vriens, P W H E

    2018-01-27

    Chronic post-operative inguinal pain (CPIP) is the most significant complication following inguinal hernia repair. Patients without a palpable hernia prior to surgery seemed to report more CPIP. Our aim was to evaluate the effects of surgery on patients with a clinically inapparent inguinal hernia as diagnosed using ultrasonography. A total of 179 hernia repairs in patients with a positive ultrasonography but negative physical examination were analysed retrospectively. Patients with recurrent hernias, femoral hernias or previous surgery to the inguinal canal were excluded. The primary outcome was the presence of chronic postoperative inguinal pain (pain > 3 months postoperatively). Data on preoperative complaints, surgical technique and findings during ultrasonography and surgery were also studied in relation to the development of CPIP. A quarter (25.1%) of the patients reported chronic postoperative pain. Female gender (p = 0.03), high BMI (p = 0.04) and atypical symptoms prior to surgery (p inguinal hernia as diagnosed using ultrasonography report a high incidence of CPIP after elective hernia repair. Patients with atypical groin pain prior to surgery are especially prone to CPIP. It is questionable whether these hernias should be classified and treated as symptomatic inguinal hernias. The results advocate taking other causes of groin pain into consideration before choosing surgical treatment.

  12. A STUDY OF POSTOPERATIVE COMPLICATIONS FOLLOWING OPEN MESH INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Abdul Kalam

    2016-09-01

    Full Text Available BACKGROUND Inguinal hernia is the most common type of hernia. Inguinal region consists of deep inguinal ring, inguinal canal and superficial inguinal ring, which make the region weak and susceptible to hernia. 65% of inguinal hernias are indirect hernias and 35% direct hernias. Hernioplasty is the strengthening of posterior wall of inguinal canal. It can be done either with the help of mesh repair or darning. Hernioplasty is indicated in recurrent hernia cases, inguinal hernia with weak abdominal muscle tone where mesh plasty is preferred and inguinal hernia with good muscle tone where darning can be done. In mesh repair, posterior wall (Lichtenstein repair of inguinal canal is strengthened by a Prolene or Marlex mesh. Over time, fibroblasts and capillaries grow over the mesh converting it into a thick sheath strengthening the posterior wall. Complications which can be encountered postsurgery are pain, bleeding, urinary retention, scrotal swelling, abdominal distension, seroma and wound infections, chronic pain, keloid and testicular atrophy. MATERIALS AND METHODS  The study was conducted in the Department of General Surgery, Travancore Medical College, Kollam.  The study was done from January 2015 to January 2016.  One hundred cases were identified and were chosen for the study. INCLUSION CRITERIA 1. Inguinal hernia cases treated by open mesh repair. EXCLUSION CRITERIA 1. Other types of inguinal hernia repair. RESULTS All the cases studied belonged to male sex. In our study, age group twenty to forty years amounted to sixty one cases followed by age group forty to sixty years, which amounted to twenty eight cases. Age group zero to twenty years amounted to six cases and age group more than sixty years amounted to five cases. In the study group, seventy two cases were indirect inguinal hernias and twenty eight cases were direct inguinal hernias. Based on the complications encountered, pain at the site was the commonest complaint, which

  13. A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia.

    LENUS (Irish Health Repository)

    O'Reilly, Elma A

    2012-05-01

    Laparoscopic inguinal hernia repair (LIHR), using a transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) technique, is an alternative to conventional open inguinal hernia repair (OIHR). A consensus on outcomes of LIHR when compared with OIHR for primary, unilateral, inguinal hernia has not been reached.

  14. Indirect Inguinal Hernia Containing the Uterus, Both Ovaries, and Fallopian Tubes in an Infant: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Hyun, Su Jeong; Cho, Bum Sung; Han, Gi Seok; Lee, Seung Young; Kang, Min Ho [Dept. of Radiology, Chungbuk National University Hospital, Jeonju (Korea, Republic of)

    2012-08-15

    In female infants, an inguinal hernia containing an ovary with or without Fallopian tubes is not uncommon. However, an inguinal hernia containing the entire uterus and both ovaries is extremely rare. Herein, we report on a case of an inguinal hernia containing the uterus, both ovaries, and both Fallopian tubes, diagnosed by ultrasonography. We discuss the case and review the relevant literature.

  15. Laparoscopic repair of pediatric inguinal hernia--is vascularity of the testis at risk? A study of 125 testes.

    Science.gov (United States)

    Parelkar, Sandesh V; Oak, Sanjay; Bachani, Mitesh K; Sanghvi, Beejal; Prakash, Advait; Patil, Rajashekhar; Sahoo, Subrat; Patel, Jiwanlal

    2011-09-01

    The aim of this study was to study the effects of laparoscopic inguinal hernia repair on testicular perfusion and size. A prospective study concerning laparoscopic inguinal hernia repair was performed for an 18-month period to evaluate testicular perfusion and size in the preoperative, early postoperative (within 48 hours of surgery), and late postoperative periods (6 months after surgery) using Doppler ultrasound (DUS) (both duplex and power Doppler mode). Laparoscopic closure of the deep inguinal ring was accomplished with a purse string suture (Nylon 3-0) using standard 3-port technique. The testis units were divided in 2 groups: group 1 comprising testis units in which a resistive index (RI) could be calculated and group 2 with instances in which an RI could not be calculated but showed blood flow consistently on DUS. A total of 112 boys underwent laparoscopic inguinal hernia repair with 100 available for complete follow-up and data analysis. One hundred twenty-five inguinal (25 bilateral) hernia repairs were performed. Group 1 had 80 testis units. There was no significant difference in values of RI between preoperative, early postoperative, and late postoperative periods. Group 2 had 45 testis units. Resistive index could not be calculated. Seventy-five percent showed only systolic blood flow on spectral analysis; hence, RI, 1; and the rest showed the presence of blood flow on power Doppler scan. All testis units consistently showed blood flow in the early and late postoperative period. No testicular atrophy was found at 6-month follow-up examination on DUS. Laparoscopic repair of inguinal hernia in children does not affect testicular perfusion or growth. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Pubic inguinal pain syndrome: the so-called sports hernia.

    Science.gov (United States)

    Cavalli, Marta; Bombini, Grazia; Campanelli, Giampiero

    2014-03-01

    The "sportsman's hernia" commonly presents as a painful groin in those sports that involve kicking and twisting movements while running, particularly in rugby, football, soccer, and ice hockey players. Moreover, sportsman's hernia can be encountered even in normally physically active people. The pain experienced is recognized at the common point of origin of the rectus abdominis muscle and the adductor longus tendon on the pubic bone and the insertion of the inguinal ligament on the pubic bone. It is accepted that this chronic pain caused by abdominal wall weakness or injury occurs without a palpable hernia. We proposed the new name "pubic inguinal pain syndrome." In the period between January 2006 and November 2013 all patients afferent in our ambulatory clinic for chronic groin pain without a clinically evident hernia were assessed with medical history, physical examination, dynamic ultrasound, and pelvic and lumbar MRI. All patients were proposed for a conservative treatment and then, if it was not effective, for a surgical treatment. Our etiopathogenetic theory is based on three factors: (1) the compression of the three nerves of the inguinal region, (2) the imbalance in strength of adductor and abdominal wall muscles caused by the hypertrophy and stiffness of the insertion of rectus muscle and adductor longus muscle, and (3) the partial weakness of the posterior wall. Our surgical procedure includes the release of all three nerves of the region, the correction of the imbalance in strength with the partial tenotomy of the rectus and adductor longus muscles, and the repair of the partial weakness of the posterior wall with a lightweight mesh. This treatment reported excellent results with complete relief of symptoms after resumption of physical activity in all cases.

  17. Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study

    OpenAIRE

    Felipe Araujo; Eduardo Simao Starling; Marco Maricevich; Marcos Tobias-Machado

    2014-01-01

    Objective: To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. Background : TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior...

  18. Impact of occupational mechanical exposures on risk of lateral and medial inguinal hernia requiring surgical repair

    DEFF Research Database (Denmark)

    Vad, Marie Vestergaard; Frost, Poul; Bay-Nielsen, Morten

    2012-01-01

    We undertook a register-based cohort study to evaluate exposure-response relations between cumulative occupational mechanical exposures, and risk of lateral and medial inguinal hernia repair.......We undertook a register-based cohort study to evaluate exposure-response relations between cumulative occupational mechanical exposures, and risk of lateral and medial inguinal hernia repair....

  19. A 5‑year Review of Darning Technique of Inguinal Hernia Repair ...

    African Journals Online (AJOL)

    Context: The Darning technique of inguinal hernia repair is a tissue‑based technique with documented low recurrence rate in some parts of the world. Though practiced in our setting, little is documented on its outcome. Aims: The aim was to review the outcome of Darning technique of inguinal hernia repair in our setting.

  20. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

    DEFF Research Database (Denmark)

    Miserez, M; Peeters, E; Aufenacker, T

    2014-01-01

    PURPOSE: In 2009, the European Hernia Society published the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. The guidelines expired January 1, 2012. To keep them updated......: indications for treatment, treatment of inguinal hernia, day surgery, antibiotic prophylaxis, training, postoperative pain control and chronic pain. The addendum contains all current level 1 conclusions, Grade A recommendations and new Grade B recommendations based on new level 1 evidence (with the changes...... in bold). CONCLUSIONS: Despite the fact that the Working Group responsible for it tried to represent most kinds of surgeons treating inguinal hernias, such general guidelines inevitably must be fitted to the daily practice of every individual surgeon treating his/her patients. There is no doubt...

  1. The role of surgical expertise with regard to chronic postoperative inguinal pain (CPIP) after Lichtenstein correction of inguinal hernia : a systematic review

    NARCIS (Netherlands)

    Lange, J. F. M.; Meyer, V. M.; Voropai, D. A.; Keus, E.; Wijsmuller, A. R.; Ploeg, R. J.; Pierie, J. P. E. N.

    The aim of this study was to evaluate whether a relation exists between surgical expertise and incidence of chronic postoperative inguinal pain (CPIP) after inguinal hernia repair using the Lichtenstein procedure . CPIP after inguinal hernia repair remains a major clinical problem despite many

  2. Recurrence patterns of direct and indirect inguinal hernias in a nationwide population in Denmark

    DEFF Research Database (Denmark)

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian

    2014-01-01

    BACKGROUND: Detailed knowledge on risk of reoperation after direct and indirect inguinal hernia (IIH) repair could be useful in preoperative counseling as well as in the planning of postoperative follow-up. This knowledge is not available in the literature. METHODS: Using data from the Danish...... Hernia Database, we included all male patients operated on for an elective, primary inguinal hernia from 1998 to 2012. Within this prospectively collected cohort, the type of inguinal hernia at primary and recurrent procedures was registered. Furthermore, time from primary procedure to reoperation...... and number of reoperations was registered. Data were compared using multivariate Cox proportionate hazard analysis and by first-order, semipartial correlation. RESULTS: Among the 85,314 male patients who had a primary inguinal hernia repaired electively in the study period (56% IIH; 44% direct inguinal...

  3. The Surgical Treatment of Inguinal Hernia Using the Laparoscopic Totally Extra-Peritoneal (TEP) Technique.

    Science.gov (United States)

    Mihăileanu, Florin; Chiorescu, Stefan; Grad, Ovidiu; Negrea, Voicu; Silaghi, Horatiu; Mironiuc, Aurel

    2015-01-01

    The surgical repair of inguinal hernia represents one of the most frequent procedures used in general surgery. The new surgical techniques are simpler, with a lower morbidity and recurrence of less than 2%. The laparoscopic totally extra-peritoneal (TEP) technique is contraindicated in complicated hernias (occlusion, incarceration) and in voluminous inguino-scrotal hernias. The evaluation of the TEP technique, of the risk factors and of the postoperative results on the group of patients who have undergone surgery in the Surgical Clinic 2 Cluj Napoca. The study is prospective, on a group of 40 patients operated with the TEP technique in the Surgical Clinic 2 during the period May 2013 - July 2014. The following have been assessed: the demographic data, the risk factors, the immediate complications, the recurrence of the hernias. The average duration of hospitalization was 6.79 days. The intraoperative incidents were: 7 minimal peritoneal lesions with pneumoperitoneum and a hemorrhagic lesion of the epigastric vessels repaired endoscopically by the clipping of the lesion. There were 2 recurrences, 24 hours and 1 year after surgery, solved by the Lichtenstein technique. After 30 interventions, the average duration of the surgery was of 64 minutes, being longer in the case of bilateral hernias and being influenced by the team's learning curve. The TEP technique is a safe option followed by a low rate of complications, a low recurrence rate and low intensity postoperative pain.

  4. Amyand's hernia masquerading inguinal abscess complicated with appendico-cutaeneous fistula in an infant with Hirschsprung's disease

    Directory of Open Access Journals (Sweden)

    Ruzaimie Noor

    2017-06-01

    Full Text Available A normal or diseased vermiform appendix located inside the inguinal hernia is called Amyand's hernia (AH. The incidence of appendicitis in Amyand's hernia is rare. The appendicitis per se is uncommon disease in infancy. We reported an extremely rare case of undiagnosed right Amyand's hernia mimicking inguinal abscess complicated with appendico-cutaneous fistula in total colonic Hirschsprung's Disease.

  5. Endoscopic TEP inguinal hernia repair in the management of occult obturator and femoral hernias.

    Science.gov (United States)

    Rath, Alok; Bhatia, Parveen; Kalhan, Sudhir; John, Suviraj; Khetan, Mukund; Bindal, Vivek; Ali, Asfar; Singh, Rahul

    2014-08-01

    The gold standard technique for the repair of groin hernias has always been a controversial issue. Richard Ger introduced the endoscopic approach for the repair of groin hernias in 1991.The endoscopic technique follows the basic principle of preperitoneal placement of a polypropylene mesh over the myopectineal orifice. During the course of dissection of the preperitoneal space, occult obturator and femoral hernias were discovered. Patients who underwent endoscopic totally extraperitoneal repair of inguinal hernias over a period of 2 years were included in this retrospective study. A total of 305 cases of groin hernias were operated in 208 patients over a period of 2 years from January 2010 to January 2012 in a single institution. Eleven synchronous clinically occult obturator hernias were found in 8 patients (3.84%) and 5 synchronous clinically occult femoral hernias were found in 5 patients (2.40%) during repair. Preoperative and perioperative findings were discordant in quite a few cases. Preperitoneal dissection discovered coincidental occult hernias in 6.25% of patients.

  6. Mesh erosion into urinary bladder following laparoscopic inguinal hernia repair

    Directory of Open Access Journals (Sweden)

    Arjun Singh Sandhu

    2017-01-01

    Full Text Available Along with advantages, evolving surgical techniques bring unique complications. A young male developed urinary symptoms a few months after undergoing laparoscopic inguinal hernia repair. On evaluation, mesh erosion into the urinary bladder was found. Removal of mesh with repair of bladder was done. A vesico-cutaneous fistula resulted which was managed with repeat surgery. We review all such cases reported in literature; discuss the etiopathogenesis, presentation, management and possible preventive measures. To the best of our knowledge, this is only the 12th case being reported.

  7. Stone ingestion causing obstructed inguinal hernia with perforation

    Directory of Open Access Journals (Sweden)

    Paiboon Sookpotarom

    2014-01-01

    Full Text Available We report a rare case of obstructed right inguinal hernia caused by ingested stones. A 2 year-old boy from Northern Thailand was transferred to our hospital with low-grade fever, vomiting, and acute painful swelling at his right hemiscrotum for one day. The physical examination revealed marked enlargement with inflammation in his right hemiscrotum. The radiological findings showed huge number of stones in the right hemiscrotum. At surgery, the content of hernia sac was ascending colon, which was full of hard masses. With the help of additional lower transverse abdominal incision, the obstructed segment was successfully reduced and revealed a perforation. Most of the stones were removed through the perforation. The colonic wound was primarily repaired and both incisions were primarily closed. Although he developed post-operative wound infection, the boy had uneventfully recovered. The psychological exploration in this "stone pica" revealed no other psychological disorders.

  8. Trauma to an inguinal hernia resulting in bowel rupture: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Daquan Liu

    2017-01-01

    Conclusion: Trauma directly to a known inguinal hernia is an uncommon, but a dangerous event, and the abnormal alterations of intestine in the hernial sac may be one of the major reasons for such event, so it is mandatory for the physician to explain the complication of the hernia to the patient, for the hernia being repaired as early as possible.

  9. The safety and effectiveness of laparoscopic total extraperitoneal (TEP) repair for recurrent inguinal hernia after open hernioplasty.

    Science.gov (United States)

    Choi, Yoon Young; Kim, Zisun; Hur, Kyung Yul

    2010-01-01

    Many studies have reported that laparoscopic total extraperitoneal (TEP) repair for recurrent inguinal hernia after an open hernioplasty was safe and effective. This study was conducted to evaluate TEP repair for recurrent inguinal hernia through a retrospective analysis of our data. We performed a retrospective analysis of the medical records of patients who were scheduled for laparoscopic TEP repair from December 2000 to December 2008. A total of 1065 cases of laparoscopic TEP repairs were performed for 944 patients by a single surgeon, and 100 cases of recurrent inguinal hernias were enrolled. The mean operation time was longer in the recurrent hernia group than that in the primary hernia group (P TEP repair is safe and effective for treating recurrent inguinal hernia after an open hernioplasty, because the recurrence rate was low (2%) and other complications were similar for both groups. Direct inguinal hernia was more frequent in patients who had recurrent inguinal hernia.

  10. Outpatient repair for inguinal hernia in elderly patients: still a challenge?

    Science.gov (United States)

    Palumbo, Piergaspare; Amatucci, Chiara; Perotti, Bruno; Zullino, Antonio; Dezzi, Claudia; Illuminati, Giulio; Vietri, Francesco

    2014-01-01

    Elective inguinal hernia repair as a day case is a safe and suitable procedure, with well-recognized feasibility. The increasing number of elderly patients requiring inguinal hernia repair leads clinicians to admit a growing number of outpatients. The aim of the current study was to analyze the outcomes (feasibility and safety) of day case treatment in elderly patients. Eighty patients >80 years of age and 80 patients ≤55 years of age underwent elective inguinal hernia repairs under local anesthesia. There were no mortalities or major complications in the elderly undergoing inguinal herniorraphies as outpatients, and only one unanticipated admission occurred in the younger age group. Elective inguinal hernia repair in the elderly has a good outcome, and age alone should not be a drawback to day case treatment. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Amyand′s hernia masquerading as a strangulated inguinal hernia: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Shahbaz Habib Faridi

    2014-01-01

    Full Text Available We report a rare case of a 62-year-old male who presented to surgical emergency department with the complaints of sudden onset pain and swelled in the right inguinal region with nausea, vomiting and abdominal distension. There was a history of a reducible swelling in the right inguino-scrotal region for the last 1 year. Based on history, clinical examination and investigations a provisional diagnosis of right-sided strangulated inguinal hernia was made and patient was planned for an emergency surgery. On the exploration, the hernial sac revealed a gangrenous vermiform appendix and the diagnosis of Amyand′s hernia was made. Appendectomy was performed through the same incision, and hernial repair was done using a polypropylene mesh.

  12. A laparoscopic high anterior resection for sigmoid cancer with extraction through incarcerated left inguinal hernia repaired with Permacol mesh.

    Science.gov (United States)

    Carr, William Reginald Joseph; O'Dair, Graham

    2012-09-21

    A 65-year-old man presented to the general surgical outpatients with an incarcerated left inguinal hernia. Initial investigations revealed an iron deficiency anaemia that was investigated with a colonoscopy and gastroscopy. This revealed a sigmoid cancer and the staging CT scan confirmed a tumour incarcerated in the sac of the left inguinal hernia. We proceeded with a laparoscopic high anterior resection using the inguinal hernia as the extraction site. The hernia was repaired using Permacol mesh. No postoperative complications occurred.

  13. Pain during sexual activity before and after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette A; Rosenberg, Jacob

    2015-01-01

    BACKGROUND: Sexual life may be impaired by pain during sexual activity in patients with inguinal hernia. On the other hand, inguinal hernia repair has also been reported to cause sexual dysfunction in terms of pain during sexual activity and ejaculation. The primary aim of this study...... was to estimate the prevalence of pain during sexual activity before and after laparoscopic inguinal hernia repair, and the secondary, to describe pain location, frequency of pain during sexual activity, and to which degree sexual life was affected by the pain. Furthermore, to examine whether preoperative pain...... during sexual activity was a risk factor for postoperative pain during sexual activity. METHODS: A prospective questionnaire study before and 6 months after hernia repair was conducted. Men (age 18-85 years) undergoing laparoscopic inguinal hernia repair were included. RESULTS: In total, 160 men were...

  14. A Giant Retroperitoneal Abscess Mimicking Incarcerated Inguinal Hernia

    Directory of Open Access Journals (Sweden)

    Naciye Sinem Gezer

    2015-06-01

    Full Text Available An 82-year-old man was admitted to the emergency room with an acute left-sided groin pain and scrotal swelling. He has suffered from a groin hernia for two years. Abdominal x-ray demonstrated air-fluid levels in the left upper quadrant suggesting an intestinal obstruction (Figure 1. Abdominal computed tomography (CT scan was obtained with an initial diagnosis of an incarcerated inguinal hernia. However, it showed multiple perirenal abscesses and a giant-sized retroperitoneal abscess extending from the retroperitoneal space into the scrotum through the inguinal canal (Figure 2 and 3. Retroperitoneal abscesses are most frequently seen in the 3rd to 6th decades of life (1. Gram-negative bacteria, most commonly E. coli, are the cause of infection which usually develops secondary to pyelonephritis, urinary stasis or immune suppression. The onset of clinical manifestations of the infection, including flank, abdomen and groin pain, chills, fever, tachycardia, weakness and anorexia are often insidious (2,3. Laboratory findings include leukocytosis, increased serum creatinine levels and pyuria. The literature emphasizes the possibility of diagnostic delay and postponed treatment of retroperitoneal abscess due to the fact that its prodrome phase may be long.

  15. Should we perform elective inguinal hernia repair in the elderly?

    Science.gov (United States)

    Wu, J J; Baldwin, B C; Goldwater, E; Counihan, T C

    2017-02-01

    Many surgeons are reluctant to offer elective inguinal and femoral hernia repair (IHR) to the elderly due to concerns of increased risk. The authors sought to evaluate the outcomes of elderly patients undergoing IHR compared to the general population. We performed a retrospective review of the 2011 NSQIP database evaluating 19,683 patients undergoing IHR. Patients were divided by age into three categories: 80. Logistic regression analysis was used to assess impact of comorbid conditions and type of surgery on outcomes. Patients were analyzed for mortality and complications based on their age and the types of surgery (elective, urgent, emergent, laparoscopic versus open) and comorbid conditions. There were 17,375 male patients (88 %). 92.7 % were elective. 70 % were performed using an open technique. Age distribution was 63.4 % 80. Mortality was similar across age groups in elective repair. Mortality was increased in emergency repair in all age groups (p 80 (OR = 57, p 80 OR 56.5 and 14.9, respectively). Elective inguinal hernia repair carries a similar mortality in the elderly compared to the general population. Emergent IHR carries a very high risk of death in the elderly. The authors recommend considering elective IHR regardless of age.

  16. Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing post-prostatectomy hernia.

    Science.gov (United States)

    Marien, Tracy; Taouli, Bachir; Telegrafi, Shpetim; Babb, James S; Lepor, Herbert

    2012-12-01

    What's known on the subject? and What does the study add? Some studies have evaluated preoperative and intraoperative examination for inguinal hernias and their repair, noting a decrease in the rate of post-prostatectomy hernias. However, this did not eradicate post-prostatectomy hernias, indicating that this method probably missed subclinical hernias. Other studies looked at prophylactic procedures to prevent the formation of inguinal hernias at the time of prostatectomy and showed a decrease in the rate of postoperative hernias. To our knowledge this is the only series evaluating a multi-modal approach with magnetic resonance imaging, ultrasonography and examination to identify all clinical and subclinical hernias and repair them at the time of prostatectomy. This approach only subjects those patients at risk for symptomatic hernias to an additional procedure and decreases the post-prostatectomy hernia rate to hernias and repair of these hernias at the time of open radical retropubic prostatectomy (ORRP) decreases the incidence of clinical inguinal hernias (IHs) after ORRP. • Between 1 July 2007 and 31 July 2010, 281 consecutive men underwent ORRP by a single surgeon. • Of these men, 207 (74%) underwent comprehensive preoperative screening for IH, which included physical examination, upstanding ultrasonography and magnetic resonance imaging. • Between 12 and 24 months after ORRP, 178 (86%) of these men completed a questionnaire designed to capture development of clinical IHs. • Of the 178 evaluable patients, 92 (52%) were diagnosed preoperatively with IH by at least one diagnostic modality. • Forty-one and 51 of the men had bilateral or unilateral IHs, respectively for a total of 133 IHs. • No preoperative factor was significantly associated with the presence of an IH before prostatectomy. • No groin subjected to IH repair (IHR) at the time of ORRP developed a clinical IH compared with four of the 21 patients with postoperative IHs who did not

  17. "One step procedure" local anaesthesia for inguinal hernia repair in ambulatory surgery conditions--district general hospital experience.

    Science.gov (United States)

    Dabić, Dejan; Perunicić, Vladan; Marić, Biljana

    2012-01-01

    Ambulatory surgery refers to hospitalization that does not exceed 24 hours, during which a surgical procedure is performed. Inguinal hernia repairs done under local anaesthesia on an outpatient basis are no longer performed exclusively in specialized hernia centers. They are becoming widely accepted by surgeons working in district hospitals, which was significantly contributed to by the publication of the EHS Guidelines on the Treatment of Inguinal Hernia. The objective of this retrospective study is to show local anaesthesia practicability for inguinal hernia repairs through "one -step procedure", being a one-day procedure used in District General Hospital. From January 2006 to June 2011, 460 elective surgery procedures were performed on 428 patients with inguinal hernia (396 with unilateral and 32 with bilateral inguinal hernia), using Lichtenstein technique, UHS/PHS, plug repair, and Shouldice technique. All the proceduress were performed under local anaesthesia by the same surgeon using "one-step procedure" in ambulatory surgery. The following anaesthetics were used: Lidocaine for intradermal and subcutaneous anaesthesia as well as Bupivacaine/Levobupivacaine for subfascial anaesthesia. From January 2006 to June 2011, 460 surgical procedures were performed on 428 patients with inguinal hernia (396 with unilateral and 32 with bilateral inguinal hernia). The mean age was 58.2 yrs (20-84). All the patients were in the ASA I-III group. In unilateral hernias, the mean operating time using Lichtenstein technique was 38mins (28-56), using PHS/UHS 28mins (22-40), with plug 33mins (27-39) and using Shouldice technique 43mins (32-53). In bilateral hernias, the mean operating time using Lichtenstein technique was 71mis (56-87), and using PHS /UHS 56mins (49-64). The mean hospital stay was 2.9hrs (2-6). The mean distance of residence from the hospital was 23km (1-150). During the course of the surgery, 15 patients (3.5%) had problems such as pain, bradycardia, hypotension

  18. Perforated Sigmoid Colon Cancer within an Irreducible Inguinal Hernia: a Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Kai Hsiung; Yu, Chih Yung; Kao, Chien Chang; Tsai, Shih Hung; Huang, Guo Shu; Chang, Wei Chou [Tri-Service General Hospital, Taipei (China)

    2010-04-15

    A perforated sigmoid colon cancer within an inguinal hernia is extremely rare. This unexpected finding is usually discovered during surgery and causes an unavoidable septic evolution. Here, we describe the case of an 84-year-old man who presented with fever, abdominal distension, and a painful, enlarged, left scrotum. A CT showed a left, incarcerated, inguinal hernia containing a perforated sigmoid adenocarcinoma (which was confirmed by histopathology). The possibility of an irreducible inguinal hernia in association with perforated sigmoid colon cancer should be considered in the array of diagnoses. A pre-operative CT scan would be helpful in facilitating an accurate diagnosis.

  19. Predictors of chronic groin discomfort after laparoscopic totally extraperitoneal inguinal hernia repair.

    Science.gov (United States)

    Ali, Shahzad M; Zendejas, Benjamin; Yadav, Siddhant; Hernandez-Irizarry, Roberto C; Lohse, Christine M; Farley, David R

    2013-07-01

    Chronic groin discomfort is an undesired complication of laparoscopic totally extraperitoneal (TEP) inguinal hernia repairs. We examined whether perioperative factors may be associated with an increased risk of developing this problem and if their recognition could lead to preventive strategies. We performed a retrospective review of 1 surgeon's experience with 1,479 TEP repairs on 976 patients from 1995 to 2009. A mailed survey, which included a groin discomfort questionnaire (Carolinas Comfort Scale), was distributed to all patients. Symptom severity grading (range 0, none to 5, severe) was used to sort individual responses. Perioperative factors were compared between asymptomatic and symptomatic patients with varying levels of discomfort. There were 691 patients (71%) who provided complete responses to the questionnaire. Median follow-up was 5.7 years (range 0 to 14.4 years). The majority (n = 543, 79%) denied any symptoms of mesh sensation, pain, or movement limitation. In the remaining 148 (21%) patients, symptoms were most often mild (n = 108), followed by mild but bothersome (n = 25), and 15 patients (2%) had moderate or severe symptoms. Symptomatic patients were younger (median age 52 vs 57 years, p = 0.002) and were more likely to have had the TEP repair for recurrent hernias (24% vs 17%, p = 0.035). Operative diagnosis, bilateral exploration, mesh fixation techniques, perioperative complications, American Society of Anesthesiologists grade, and length of hospital stay were not associated with chronic groin discomfort. The majority of patients are asymptomatic after a laparoscopic TEP inguinal hernia repair. Most of the symptomatic patients do not have any bothersome symptoms. Given that younger age and a repair for recurrent hernia were predictors of chronic groin discomfort, we counsel these patients about their increased risks. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Prospective randomized study comparing single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal (TEP) inguinal hernia repair at 2 years.

    Science.gov (United States)

    Cardinali, Luca; Mazzetti, Claudia Hannele; Cadenas Febres, Anny; Repullo, Deborah; Bruyns, Jean; Dapri, Giovanni

    2018-01-23

    Inguinal hernia repair via multi-trocar laparoscopy (MTL) has gained an increasing popularity worldwide. Single-incision laparoscopy (SIL) has been introduced to reduce the port-related complications and to improve the cosmetic results. The authors report a prospective randomized study comparing SIL versus MTL totally extraperitoneal (TEP) inguinal hernia repair. Between January 2013 and May 2015, 113 versus 97 patients were prospectively randomized between SILTEP and MTLTEP. Perioperative, short-term, and mid-term outcomes have been assessed. The primary endpoint was the mid-term outcomes (late postoperative complications, late inguinal hernia recurrence, surgical and cosmetic satisfactions). Secondary endpoints were perioperative outcomes (operative time, mesh fixation, operative complications, postoperative pain, and hospital stay) and short-term outcomes (early postoperative complications, early inguinal hernia recurrence, and days to return to normal activities). After a mean follow-up of 27 ± 8 months, a statistically significant difference was found between the two groups in terms of mean operative time for both unilateral and bilateral inguinal hernia repair (p = 0.016; p = 0.039) and cosmetic satisfaction (p = 0.003). Perioperative, short-term, and mid-term outcomes were comparable between the two groups. At 2-year follow-up, a significant shorter operative time after MTLTEP and a greater cosmetic satisfaction after SILTEP have been found.

  1. Whole-exome sequencing identifies a potential TTN mutation in a multiplex family with inguinal hernia.

    Science.gov (United States)

    Mihailov, E; Nikopensius, T; Reigo, A; Nikkolo, C; Kals, M; Aruaas, K; Milani, L; Seepter, H; Metspalu, A

    2017-02-01

    Inguinal hernia repair is one of the most common procedures in general surgery. Males are seven times more likely than females to develop a hernia and have a 27 % lifetime 'risk' of inguinal hernia repair. Several studies have demonstrated that a positive family history is an important risk factor for the development of primary inguinal hernia, which indicates that genetic factors may play important roles in the etiology of the disease. So far, the contribution of genetic factors and underlying mechanisms for inguinal hernia remain largely unknown. The aim of this study was to investigate a multiplex Estonian family with inguinal hernia across four generations. The whole-exome sequencing was carried out in three affected family members and subsequent mutation screening using Sanger sequencing was performed in ten family members (six affected and four unaffected). Whole-exome sequencing in three affected family members revealed a heterozygous missense mutation c.88880A>C (p.Lys29627Thr; RefSeq NM_001256850.1) in the highly conserved myosin-binding A-band of the TTN gene. Sanger sequencing demonstrated that this mutation cosegregated with the disease in this family and was not present in ethnically matched control subjects. We report that missense variant in the A-band of TTN is the strongest candidate mutation for autosomal-dominant inguinal hernia with incomplete penetrance.

  2. Academic Performance in Adolescence after Inguinal Hernia Repair in Infancy: A Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Hansen, Tom G; Pedersen, Jacob K; Henneberg, Steen Winther

    2011-01-01

    for inguinal hernia repair in infancy and subsequent academic performance. METHODS:: Using Danish birth cohorts from 1986-1990, we compared the academic performance of all children who had undergone inguinal hernia repair in infancy to a randomly selected, age-matched 5% population sample. Primary analysis...... found no evidence that a single, relatively brief anesthetic exposure in connection with hernia repair in infancy reduced academic performance at age 15 or 16 yr after adjusting for known confounding factors. However, the higher test score nonattainment rate among the hernia group could suggest...

  3. Cystogram with dumbbell shaped urinary bladder in a sliding inguinal hernia

    Directory of Open Access Journals (Sweden)

    Joseph Thomas

    2009-01-01

    Full Text Available Sliding inguinal hernias present with various symptoms and these are usually direct inguinal hernias containing various abdominal viscera.  Case reports and series have been published with various organs and rare organs being part of the hernia.  Urinary bladder is a known content of sliding hernias.  This case report emphasizes this aspect in a picturesque manner and the importance of radiological investigations for pre-surgical evaluation.

  4. Follow-up period of 13 years after endoscopic total extraperitoneal repair of inguinal hernias: a cohort study

    NARCIS (Netherlands)

    Brandt-Kerkhof, Alexandra; van Mierlo, Marjolein; Schep, Niels; Renken, Nondo; Stassen, Laurents

    2011-01-01

    Endoscopic inguinal hernia repair was introduced in the Netherlands in the early 1990s. The authors' institution was among the first to adopt this technique. In this study, long-term hernia recurrence among patients treated by the total extraperitoneal (TEP) approach for an inguinal hernia is

  5. Laparoscopic Inguinal Hernia Repair With a Novel Hernia Mesh Incorporating a Nitinol Alloy Frame Compared With a Standard Lightweight Polypropylene Mesh.

    Science.gov (United States)

    Bower, Curtis; Hazey, Jeffrey W; Jones, Edward L; Perry, Kyle A; Davenport, Daniel L; Roth, J Scott

    2015-10-01

    Numerous mesh materials are available for laparoscopic inguinal hernia repair. The role of fixation of mesh in laparoscopic inguinal hernia repair remains controversial. Mesh materials have been engineered to anatomically conform to the pelvis to potentially reduce or eliminate the need for fixation. This study evaluates the outcomes of laparoscopic inguinal hernia utilizing a device consisting of a lightweight polypropylene mesh with a nitinol frame (Rebound HRD) compared with repair with lightweight polypropylene mesh with permanent tack fixation. A prospective randomized trial evaluating the outcomes of laparoscopic inguinal hernia repair with a lightweight polypropylene mesh with a nitinol frame (N-LWM) compared with standard lightweight polypropylene mesh (LWM) was conducted. Randomization was performed at an N-LWM to LWM ratio of 2:1. Repairs were standardized to a laparoscopic extraperitoneal approach without fixation for N-LWM and titanium tack fixation for LWM repairs. Follow-up assessments were performed at 7 days, 6 months, and 1 year. Outcome measures include visual analog pain scale (VAS), Short Form 36 (SF-36), Carolinas Comfort Scale (CCS), operative details, complications, and recurrences. There were 47 patients that underwent laparoscopic inguinal hernia repair and adhered to study protocol (31 N-LWM, 16 LWM). The groups did not differ significantly in age, body mass index, ethnicity, or employment. The N-LWM group had bilateral mesh placed in 51.6% and LWM 43.8% (P = .76). Operative duration was similar, 59.6 ± 23.1 minutes for LWM and 62.4 ± 26.7 minutes for N-LWM (P = .705) as was mesh handling time was 5.4 ± 3.1 minutes LWM versus 7.3 ± 3.9 minutes N-LWM (P = .053). VAS, CCS, and SF-36 survey results were similar between groups. There was one recurrence (0.03%) in the N-LWM group. Nitinol-framed lightweight polypropylene mesh may be safely used during laparoscopic inguinal hernia repair with outcomes comparable to LWM at 1 year. N-LWM does

  6. Dynamic self-regulating prosthesis (protesi autoregolantesi dinamica): the long-term results in the treatment of primary inguinal hernias.

    Science.gov (United States)

    Valenti, Gabriele; Baldassarre, Emanuele; Testa, Alessandro; Arturi, Alessandro; Torino, Giovanni; Campisi, Costantino; Capuano, Giorgio

    2006-03-01

    The dynamic self-regulating prosthesis (protesi autoregolantesi dinamica, PAD) is a double-layered prosthesi, in use since 1992 in inguinal hernia repair. In 1999, we published the short-term results on 500 patients and herein we report the long-term follow-up. Five hundred eighty-five PAD procedures were performed on 500 adult male, unselected patients. Hernias were unilateral in 415 patients, were bilateral in 85 patients, were direct in 197 patients (33.7%), were indirect in 269 patients (46.0%), and were combined in 119 patients (20.3%). Four hundred sixty-four patients were alive at the follow-up period of minimum 5 years, whereas 36 died (7.2%) of causes unrelated to the hernia. No information was available on 73 patients (14.6%). Therefore, the follow-up was consisted of 391 patients (78.2%) with 469 hernias. The recurrence and testicular atrophy rates were nil. Three patients (0.77%) presented chronic pain and 18 (4.6%) suffered persistent discomfort or paresthesia. A hydrocoele was observed in one patient (0.2%). The long-term data confirm the efficacy of the dynamic self-regulating posthesis hernioplasty. We propose it as a standard of care in all cases of primary inguinal hernia in adult males, retaining it as a definitive and comfortable solution.

  7. The totally extraperitoneal method versus Lichtenstein's technique for inguinal hernia repair

    DEFF Research Database (Denmark)

    Koning, G G; Wetterslev, J; van Laarhoven, C J H M

    2013-01-01

    Lichtenstein's technique is considered the reference technique for inguinal hernia repair. Recent trials suggest that the totally extraperitoneal (TEP) technique may lead to reduced proportions of chronic pain. A systematic review evaluating the benefits and harms of the TEP compared...

  8. Genome-wide linkage analysis of inguinal hernia in pigs using affected sib pairs

    OpenAIRE

    Grindflek, Eli; Moe, Maren; Taubert, Helge; Simianer, Henner; Lien, Sigbjørn; Moen, Thomas

    2006-01-01

    Background Inguinal and scrotal hernias are of great concern to pig producers, and lead to poor animal welfare and severe economic loss. Selection against these conditions is highly preferable, but at this time no gene, Quantitative Trait Loci (QTL), or mode of inheritance has been identified in pigs or in any other species. Therefore, a complete genome scan was performed in order to identify genomic regions affecting inguinal and scrotal hernias in pigs. Records from seedstock breeding farms...

  9. Study of open inguinal hernia repair by mosquito net mesh versus polypropylene mesh

    OpenAIRE

    Anil Darokar; Kishor Bele; Rajiv Mulmule; Rizwanuddin Qazi

    2016-01-01

    Background: Inguinal hernia is one of the commonest medical problems and treatment with Lichtenstein repair using polypropylene mesh is considered as gold standard. In developing countries, cost of the prosthesis is a significant factor in health care delivery. Methods: A clinical trial of 73 patients of inguinal hernia operated by Lichtenstein tension free technique from 1st January 2013 to 31st December 2014 was undertaken to evaluate the safety, complications and recurrence rate using ...

  10. Totally extraperitoneal (TEP) endoscopic inguinal hernia repair with TAP (transversus abdominis plane) block as a day-case: a prospective cohort study.

    Science.gov (United States)

    Meyer, A; Bonnet, L; Bourbon, M; Blanc, P

    2015-06-01

    Totally extraperitoneal (TEP) endoscopic inguinal hernia repair is indicated for recurrent and bilateral inguinal hernias and traditionally is performed under general anesthesia. However, interventions that minimize pain and reduce opioid consumption have certain advantages for patients by avoiding side effects such as nausea and vomiting. The transversus abdominis plane (TAP) block has been used to minimize pain in a diverse range of surgical procedures but its safety on patients undergoing TEP repair has yet to be investigated. To assess the results of outpatient TEP repair with TAP block without curare. Consecutive patients undergoing elective TEP procedure were prospectively enrolled. Patients in two institutes received a similar anesthetic, surgical, and analgesic treatment protocol. Fifty consecutive day-case patients were included in this series. The TEP repair was successful in 49 patients and there was one conversion to transabdominal pre-peritoneal (TAPP) endoscopic inguinal hernia repair. The mean duration of surgery was 20min for unilateral hernia and 40min for bilateral hernia. These preliminary results suggest that day-case endoscopic hernia repair (TEP) with TAP block without curare is effective, safe, reproducible and can be proposed in all patients. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. Concomitant inguinal endometriosis and groin hernia – Case report

    Directory of Open Access Journals (Sweden)

    Daniel Ion

    2017-12-01

    Full Text Available Endometriosis is a condition which affects women during their reproductive age. We present the case of a 42 years old Caucasian nulliparous woman accusing in the last three months a painful bulging mass in the right groin. The patient reported that the mass increases in size during prolonged standing and lifting of heavyweights. In addition, the inguinal pain was exacerbated during ovulation. The patient underwent surgery, during which wide excision of the nodule was performed. Furthermore, both direct and indirect hernia sacs were found and dissected, the content was reduced and the sacs were excised. Four months after the surgery, the patient was free of symptoms and had no signs of recurrence.

  12. Uniformity of Chronic Pain Assessment after Inguinal Hernia Repair : A Critical Review of the Literature

    NARCIS (Netherlands)

    Molegraaf, Marijke; Lange, Johan; Wijsmuller, Arthur

    Background: Chronic postoperative inguinal pain (CPIP) is the most common long-term complication of inguinal hernia repair. As such procedures are routinely performed, CPIP can be considered a significant burden to global health care. Therefore, adequate preventative measures relevant to surgical

  13. Hypogonadism and man’s infertility at patients with indirect inguinal hernia after hernioplasty

    Directory of Open Access Journals (Sweden)

    I. S. Sobennikov

    2014-11-01

    Full Text Available The article estimates hydrologic status and fertility prognosis of 35 year-old reproductive age men with unilateral inguinal hernioplasty in past history from the system syndrome-based approach perspective to the etiology and pathogenesis of indirect inguinal hernia and hypogonadism.

  14. Inguinal hernia surgery in The Netherlands: a baseline study before the introduction of the Dutch Guidelines

    NARCIS (Netherlands)

    de Lange, D. H.; Aufenacker, Th J.; Roest, M.; Simmermacher, R. K. J.; Gouma, D. J.; Simons, M. P.

    2005-01-01

    BACKGROUND: In 2003 the Dutch Guidelines for treatment of inguinal hernia (IH) were published. For treatment of IH in adults, the evidence-based guidelines recommend the use of a mesh repair technique. In order to be able to evaluate the effects of these guidelines, a baseline analysis of inguinal

  15. Chronic pain after TEP inguinal hernia repair, does MRI reveal a cause?

    NARCIS (Netherlands)

    Burgmans, J. P J; Voorbrood, C. E H; Van Dalen, T.; Boxhoorn, R. N.; Clevers, G. J.; Sanders, F. B M; Naafs, D. B J; Simmermacher, R. K J|info:eu-repo/dai/nl/119478692

    2016-01-01

    Purpose: Persistent pain is a known side effect after TEP inguinal repair disabling 2–5 % of patients. A standardized diagnostic work-up so far is not available. MRI is a diagnostic tool in the work-up of inguinal hernias. In the present study the yield of MRI in evaluating chronic pain after TEP

  16. Hypogonadism and man’s infertility at patients with indirect inguinal hernia after hernioplasty

    Directory of Open Access Journals (Sweden)

    I. S. Sobennikov

    2012-01-01

    Full Text Available The article estimates hydrologic status and fertility prognosis of 35 year-old reproductive age men with unilateral inguinal hernioplasty in past history from the system syndrome-based approach perspective to the etiology and pathogenesis of indirect inguinal hernia and hypogonadism.

  17. A 5‑year Review of Darning Technique of Inguinal Hernia Repair

    African Journals Online (AJOL)

    with the sutures forming a weave in the posterior wall of the inguinal canal.[3,4]. Studies evaluating the Darning technique have shown satisfactory outcomes in terms of recurrence and other postoperative complications. Some of these are comparable to Lichtenstein technique of inguinal hernia repair,[5,6] which is currently ...

  18. Frequency and complications of inguinal hernia repair in giant omphalocele.

    Science.gov (United States)

    Partridge, Emily A; Peranteau, William H; Flake, Alan W; Adzick, N Scott; Hedrick, Holly L

    2015-10-01

    Giant omphalocele (GO) is a challenging problem owing to aberrant anatomy and complex comorbidities. Large inguinal hernias (IH) are known to occur in this population, but have not been well described in the literature. We sought to characterize rates and complications of IH in GO patients. A retrospective chart review was performed on all patients with the diagnosis of GO from 2004 to 2012, with a minimum follow-up period of 12 months. Statistical significance was calculated using Fisher's exact test and Mann-Whitney test (pomphalocele patients were born during the 8-year study period, with IH diagnosed in 21 patients (41%). IH was not associated with gestational age, birth weight, or method of GO closure, but was significantly associated with male gender (p<0.0001). Incarceration occurred in 4 patients (19%). Recurrence was noted in 7 cases, with 6/7 recurrences following repair by high ligation of the sac alone. All recurrences were repaired with the Bassini repair. Postoperative complications were noted in 7 patients (33%) and included prolonged ileus following incarceration, testicular tethering, testicular atrophy, persistent hydrocele, and death following acute incarceration. Our study suggests a high incidence of IH in GO patients. The prevalance of incarceration and recurrences in these patients support a role for inguinal herniorrhaphy via a Bassini repair prior to initial hospital discharge. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. [The value of diagnostic ultrasound for detecting occult inguinal hernia in patients with groin pain].

    Science.gov (United States)

    Lorenzini, Cesare; Sofia, Lorenzo; Pergolizzi, Francesca Pia; Trovato, Massimo

    2008-01-01

    The value of diagnostic ultrasound for detecting occult inguinal hernia in The aim of this study was to demonstrate the accuracy of ultrasound in diagnosing occult hernia in patients with recurrent inguinal pain and a negative clinical examination. Over a period of three years, a total of 51 patients were referred for ultrasound examination with clinically suspected occult inguinal hernia. Patients with positive US scans were offered surgery, while those with negative US findings were offered further imaging or other diagnostic tests. The ultrasound examination of the inguinal region was conducted using a 5-10 MHz linear probe. The scan was performed with the patient in the supine and erect positions, in a relaxed state, as well as during coughing and during a Valsalva manoeuvre. Overall, ultrasound diagnosed 20 inguinal hernias and all 20 patients with positive scans underwent surgery. Surgery confirmed the ultrasound diagnosis in 19 patients, only 1/20 having no hernia at operation (100% ultrasound sensitivity and 96.9% specificity). Patients undergoing surgery showed complete symptom resolution at a three-month follow-up. This study confirms that ultrasound is capable of accurately diagnosing groin hernia and this may justify its use in patients with chronic groin pain due to a suspected occult hernia.

  20. TAPP or TEP for Recurrent Inguinal Hernia? Population-Based Analysis of Prospective Data on 1309 Patients Undergoing Endoscopic Repair for Recurrent Inguinal Hernia.

    Science.gov (United States)

    Gass, M; Scheiwiller, A; Sykora, M; Metzger, J

    2016-10-01

    Whether total extraperitoneal inguinal hernia repair (TEP) is associated with worse outcomes compared to transabdominal preperitoneal inguinal hernia repair (TAPP) for the treatment of recurrent inguinal hernia continues to be a matter of debate. The objective of this large cohort study is to compare complications, conversion rates and postoperative length of hospital stay between patients undergoing TEP or TAPP for unilateral recurrent inguinal hernia repair. Based on prospective data of the Swiss Association of Laparoscopic and Thoracoscopic Surgery, all patients who underwent elective TEP or TAPP for unilateral recurrent inguinal hernia between 1995 and 2006 were included. The following outcomes were compared: conversion rates, intraoperative complications, surgical postoperative complications and duration of operation. Data on 1309 patients undergoing TEP (n = 1022) and TAPP (n = 287) for recurrent inguinal hernia were prospectively collected. Average age, BMI and ASA score were similar in both groups. Patients undergoing TEP had a significantly increased rate of intraoperative complications (TEP 6.3 % vs. TAPP 2.8 %, p = 0.0225). Duration of operation was longer for patients undergoing TEP (TEP 80.3 vs. TAPP 73.0 min, p TEP 2.6 vs. TAPP 3.1 day, p = 0.0145). Surgical postoperative complications (TEP 3.52 % vs. TAPP 2.09 %, p = 0.2239), general postoperative complications (TEP 1.47 % vs. TAPP 0.7 %, p = 0.3081) and conversion rates (TEP 2.15 % vs. TAPP 1.39 %, p = 0.4155) were not significantly different. This study is the first population-based analysis comparing outcomes of patients with recurrent inguinal hernia undergoing TEP versus TAPP in a prospective cohort of over 1300 patients. Intraoperative complications were significantly higher in patients undergoing TEP. The TEP technique was associated with longer operating times, but a shorter postoperative length of hospital stay. Nonetheless, the absolute outcome differences are small

  1. An inguinal hernia with cryptorchidism with a Leydig cell tumor in an elderly man: A case report

    Directory of Open Access Journals (Sweden)

    Toru Zuiki

    2017-01-01

    Conclusion: The combination of laparoscopic and anterior approaches facilitated the surgical treatment of an unusual inguinal hernia with cryptorchidism. The resected ectopic testis should undergo thorough histopathologic examination.

  2. Inguinal Hernia Repair is Safe in Africa | Warwick | East and Central ...

    African Journals Online (AJOL)

    Background: Inguinal hernias are a major problem in the developing world. Many patients do not have access to safe elective surgery. They therefore present with the complications of hernia. Those who do have access to elective surgery mostly have non-mesh repairs because of lack of knowledge of Lichtenstein repair, ...

  3. Inguinal hernia surgery in the Netherlands: are patients treated according to the guidelines?

    NARCIS (Netherlands)

    de Lange, D.H.; Kreeft, M.; van Ramshorst, G.H.; Aufenacker, T.J.; Rauwerda, J.A.; Simons, M.P.

    2010-01-01

    In 2003, a dedicated Dutch committee developed evidence-based guidelines for the treatment of inguinal hernia (IH) in children and adults. The aim of this study was to describe trends in hernia care before and after the publication of the guidelines on IH surgery in the Netherlands. Originally, a

  4. [A case report of eosinophilic funiculitis difficult to distinguish from incarceration of inguinal hernia].

    Science.gov (United States)

    Araki, Azumi; Yanagisawa, Masahiro; Nagasima, Masazumi; Komiya, Atushi; Takano, Tetuzo; Ikeda, Ichiro

    2013-02-01

    A 45-year-old man visited our emergency room with left inguinal pain, mass and high-grade fever. Emergency surgery was performed with a primary diagnosis of left inguinal hernia. Although there was no hernia, there was a mass involving the spermatic cord in the left inguinal canal. We performed high orchiectomy because of the possibility of malignancy. Pathological findings showed eosinophilic infiltration in the mass lesion. An allergic inflammation was suspected to have occurred in the spermatic cord. His postoperative course was good.

  5. Persistent Mullerian duct syndrome presenting as an inguinal hernia : A case report

    Directory of Open Access Journals (Sweden)

    Amit Dangi

    2016-10-01

    Full Text Available A brief report of persistent mullerian duct syndrome (PMDS with 46XY karyotype which is one of the rarest variety of disorders of sexual differentiation (DSD accounting only 5% cases of all is being presented. A 21 years old male with left inguinal hernia and absent right testis presented in surgical outdoor and was operated. On exploration female genital organs like uterus and fallopian tubes along with contralateral testis were present in left inguinal canal as a content of sliding left inguinal hernia.

  6. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males

    DEFF Research Database (Denmark)

    Bay-Nielsen, M; Nilsson, E; Nordin, P

    2004-01-01

    males operated on for an indirect inguinal hernia with a Lichtenstein mesh repair, Shouldice or Marcy (annulorrhaphy) repair. METHODS: This was a postal questionnaire study carried out within the Danish and Swedish Hernia Database Collaboration. Some 2612 patients responded (response rate 80.9 per cent...... it as worse after than before surgery, and 56.6 per cent stated that it interfered with social activities. CONCLUSION: Chronic pain is common after primary inguinal hernia repair in young males, but there is no difference in the pain associated with open mesh and non-mesh repair....

  7. PROSPECTIVE STUDY ON DARNING AND LICHTENSTEIN MESH HERNIOPLASTY (LMH IN INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Affin

    2016-01-01

    Full Text Available INTRODUCTION Prospective study on Darning and Lichtenstein Mesh Hernioplasty in Inguinal Hernia Repair is a study of 61 cases of inguinal hernias which were treated by either open Inguinal hernia mesh repair (Lichtenstein or darning repair. The study was conducted with an objective to compare the effectiveness of these procedures and complications if any. 61 cases of inguinal hernia admitted in Yenepoya Medical College Hospital, Mangalore were selected on the basis of the non-probability (prospective sampling method. All patients with uncomplicated direct and indirect hernias treated by darning or mesh repair were included. After preoperative preparation they were randomly chosen for darning or mesh repair. The age/sex incidence, mode of presentation, precipitating factors, surgical treatment and postoperative complications were all evaluated and compared with standard published literature. The total number of postoperative complications was reported in 13.9% patients, complications was high after Mesh repair when compared to Darning. Seroma was the most common complication followed by funiculitis and wound infection. There was one recurrence each noted till date in the two groups under study. Darn repair is equally effective and much less costly treatment for inguinal hernia than mesh repair which had more risk of infection.

  8. The diagnosis and classification of inguinal and femoral hernia on multisection spiral CT

    Energy Technology Data Exchange (ETDEWEB)

    Cherian, P.T. [Good hope Hospital, Rectory road, Sutton Coldfield (United Kingdom)], E-mail: tomcherian@hotmail.co.uk; Parnell, A.P. [Good hope Hospital, Rectory road, Sutton Coldfield (United Kingdom)

    2008-02-15

    Aim: To assess the contribution of high-quality multiplanar reconstructions of the groin from multisection computed tomography (CT) to the accurate diagnosis of inguinal and femoral hernias. Materials and Methods: Twenty-eight patients who had undergone both a contrast-enhanced CT and a herniorrhaphy were identified from hospital records. Seventeen were excluded, as the images did not include the groin area. The remaining 11 images were re evaluated on a workstation without knowledge of the surgical findings and the hernias were identified and classified using the axial data and coronal and sagittal reconstructions. Anatomical structures and radiological details that hindered or aided this classification were recorded. Results: Hernias were identified in nine out of the 11 patients. Of the seven inguinal hernias, six were identified with the correct side recorded in each case. Of the four patients with surgical data that distinguished direct from indirect inguinal hernias, the correct diagnosis was provided in all cases using CT. Of the four patients with a femoral hernia CT was used to correctly classify three. Among the three available planes, the axial was particularly poor for the identification of the inguinal ligament compared with the other planes. In contrast, the coronal views were very useful in the evaluation of femoral hernias. Conclusions: The high-resolution coronal and sagittal images available from multisection CT now permit the accurate diagnosis of groin hernias. Using simple anatomical criteria, direct and indirect inguinal hernias and femoral hernias can be reliably distinguished, abolishing the need for surrogate markers, which was hitherto necessary.

  9. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Kehlet, H

    2001-01-01

    To evaluate the feasibility and safety of unmonitored local anesthesia (ULA) for elective open inguinal hernia repair, we made a prospective, consecutive data collection from 1000 operations on primary and recurrent hernias. Follow-up consisted of a questionnaire 1 mo after surgery and retrieval...... anesthesia, day-case setup, or both, primarily because of intraoperative pain (n = 74; 7.8%). We conclude that open inguinal hernia repair can be conducted under ULA, regardless of comorbidity, with a small rate of deviation from day-case setup and minimal morbidity. It provides a safe alternative to other...... anesthetic techniques with an acceptable rate of satisfaction, but intraoperative pain relief needs improvement. IMPLICATIONS: Inguinal hernia repair can be safely performed under unmonitored local anesthesia with infrequent postoperative morbidity and acceptable satisfaction, but intraoperative pain may...

  10. Emergency repair of inguinal hernia in the premature infant is associated with high direct medical costs.

    Science.gov (United States)

    Verhelst, J; de Goede, B; van Kempen, B J H; Langeveld, H R; Poley, M J; Kazemier, G; Jeekel, J; Wijnen, R M H; Lange, J F

    2016-08-01

    Inguinal hernia repair is frequently performed in premature infants. Evidence on optimal management and timing of repair, as well as related medical costs is still lacking. The objective of this study was to determine the direct medical costs of inguinal hernia, distinguishing between premature infants who had to undergo an emergency procedure and those who underwent elective inguinal hernia repair. This cohort study based on medical records concerned premature infants with inguinal hernia who underwent surgical repair within 3 months after birth in a tertiary academic children's hospital between January 2010 and December 2013. Two groups were distinguished: patients with incarcerated inguinal hernia requiring emergency repair and patients who underwent elective repair. Real medical costs were calculated by multiplying the volumes of healthcare use with corresponding unit prices. Nonparametric bootstrap techniques were used to derive a 95 % confidence interval (CI) for the difference in mean costs. A total of 132 premature infants were included in the analysis. Emergency surgery was performed in 29 %. Costs of hospitalization comprised 65 % of all costs. The total direct medical costs amounted to €7418 per premature infant in the emergency repair group versus €4693 in the elective repair group. Multivariate analysis showed a difference in costs of €1183 (95 % CI -1196; 3044) in favor of elective repair after correction for potential risk factors. Emergency repair of inguinal hernia in premature infants is more expensive than elective repair, even after correction for multiple confounders. This deserves to be taken into account in the debate on timing of inguinal hernia repair in premature infants.

  11. Prolene hernia system, ultrapro hernia system and 3D patch devices in the treatment of inguinal, femoral, umbilical and small incisional hernias in outpatient surgery.

    Science.gov (United States)

    Dabić, D; Cerović, S; Azanjaç, B; Marić, B; Kostić, I

    2010-01-01

    The employment of a diversity of prosthetic materials and several types of mesh different in construction is opening a new chapter in hernia surgery and tension-free techniques are becoming a "golden standard" for repairing abdominal wall defects, whereas the conventional methods, i.e., the tension techniques are performed on young patients having small direct, indirect, or femoral hernias. The aim of this retrospective study is to present the results of using Prolene Hernia System (PHS), Ultrapro Hernia System (UHS) and 3D Patch (3DP) devices in the treatment of inguinal, femoral, umbilical and small incisional hernias in outpatient surgery. From January 2006 to January 2009, 70 patients were operated on for abdominal wall hernias (54 inguinal, 4 femoral, 8 umbilical and 4 small incisional hernias) using PHS, UHS and 3DP devices. All the patients underwent surgery under local infiltrative anaesthesia. All the surgical operations were performed by a single surgeon, 19 of them in the General Hospital and 51 in a private polyclinic. The mean size of the hernia defect in the inguinal, femoral and umbilical hernias was 2.5 cm (1-4 cm), while in the incisional hernias it was 4.5 cm (3-6 cm). The mean operating time was 2.4 hrs (2-6 hrs). There were no requirement for urinary drains. The mean follow-up was 18 months (0-36 months). The incidence of infection, chronic pain and recurrence was 0%. Three of the patients had complications: seroma in one patient with an incisional hernia and hematoma in two patients after inguinal hernia repair. The employment of PHS, UHS and 3DP devices, which have not yet been widely accepted in our hospitals, has had outstanding results in outpatient surgery. In addition, the type of anaesthesia and the 3D mesh construction prepare the way for a short hospital stay, smooth recovery and a swift return to normal activity.

  12. A genome-wide association study identifies four novel susceptibility loci underlying inguinal hernia

    Science.gov (United States)

    Jorgenson, Eric; Makki, Nadja; Shen, Ling; Chen, David C.; Tian, Chao; Eckalbar, Walter L.; Hinds, David; Ahituv, Nadav; Avins, Andrew

    2015-01-01

    Inguinal hernia repair is one of the most commonly performed operations in the world, yet little is known about the genetic mechanisms that predispose individuals to develop inguinal hernias. We perform a genome-wide association analysis of surgically confirmed inguinal hernias in 72,805 subjects (5,295 cases and 67,510 controls) and confirm top associations in an independent cohort of 92,444 subjects with self-reported hernia repair surgeries (9,701 cases and 82,743 controls). We identify four novel inguinal hernia susceptibility loci in the regions of EFEMP1, WT1, EBF2 and ADAMTS6. Moreover, we observe expression of all four genes in mouse connective tissue and network analyses show an important role for two of these genes (EFEMP1 and WT1) in connective tissue maintenance/homoeostasis. Our findings provide insight into the aetiology of hernia development and highlight genetic pathways for studies of hernia development and its treatment. PMID:26686553

  13. Genome-wide linkage analysis of inguinal hernia in pigs using affected sib pairs

    Directory of Open Access Journals (Sweden)

    Taubert Helge

    2006-05-01

    Full Text Available Abstract Background Inguinal and scrotal hernias are of great concern to pig producers, and lead to poor animal welfare and severe economic loss. Selection against these conditions is highly preferable, but at this time no gene, Quantitative Trait Loci (QTL, or mode of inheritance has been identified in pigs or in any other species. Therefore, a complete genome scan was performed in order to identify genomic regions affecting inguinal and scrotal hernias in pigs. Records from seedstock breeding farms were collected. No clinical examinations were executed on the pigs and there was therefore no distinction between inguinal and scrotal hernias. The genome scan utilised affected sib pairs (ASP, and the data was analysed using both an ASP test based on Non-parametric Linkage (NPL analysis, and a Transmission Disequilibrium Test (TDT. Results Significant QTLs (p Conclusion For the first time in any species, a genome scan has revealed suggestive QTLs for inguinal and scrotal hernias. While this study permitted the detection of chromosomal regions only, it is interesting to note that several promising candidate genes, including INSL3, MIS, and CGRP, are located within the highly significant QTL regions. Further studies are required in order to narrow down the suggestive QTL regions, investigate the candidate genes, and to confirm the suggestive QTLs in other populations. The haplotype associated with inguinal and scrotal hernias may help in achieving selection against the disorder.

  14. Short-term outcome after Onstep versus Lichtenstein technique for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, K; Burcharth, J; Fonnes, S

    2015-01-01

    PURPOSE: Because of the high number of patients with chronic pain following inguinal hernia repair, a new, simple and safe method of repair is needed. Onstep is a new type of inguinal hernia repair that might be able to reduce postoperative acute and chronic pain. The aim of this study was to inv......PURPOSE: Because of the high number of patients with chronic pain following inguinal hernia repair, a new, simple and safe method of repair is needed. Onstep is a new type of inguinal hernia repair that might be able to reduce postoperative acute and chronic pain. The aim of this study...... for this study were male patients, >18 years, with a primary inguinal hernia. Experimental treatment in this study was the Onstep technique, which was compared with the Lichtenstein repair. Primary outcome was postoperative pain during the first 10 days following surgery. Secondary outcomes included duration...... of surgery, period for return to normal daily activities (days), and recurrence. Randomization was done in blocks and stratified on centers. Participants and study personnel handling questionnaires and analysis were blinded to the allocation. RESULTS: In total, 290 participants were randomized. We found...

  15. Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair.

    Science.gov (United States)

    Olsson, Anders; Sandblom, Gabriel; Fränneby, Ulf; Sondén, Anders; Gunnarsson, Ulf; Dahlstrand, Ursula

    2017-02-01

    Chronic pain is common after inguinal hernia repair and has become one of the most important outcome measures for this procedure. The purpose of this study was to determine whether or not there is a relationship between specific postoperative complications and risk for chronic pain after open inguinal hernia repair. A prospective cohort study was designed in which participants responded to the Inguinal Pain Questionnaire regarding postoperative groin pain 8 years after inguinal hernia repair. Responses to the questionnaire were matched with data from a previous study regarding reported postoperative complications after open inguinal hernia repair. Participants were recruited originally from the Swedish Hernia Register. Response rate was 82.4% (952/1,155). The primary outcome was chronic pain in the operated groin at follow-up. Grading of pain was performed using the Inguinal Pain Questionnaire. A total of 170 patients (17.9%) reported groin pain and 29 patients (3.0%) reported severe groin pain. The risk for developing chronic groin pain was greater in patients with severe pain in the preoperative or immediate postoperative period (odds ratio 2.09; 95% confidence interval 1.28-3.41). Risk for chronic pain decreased for every 1-year increase in age at the time of operation (odds ratio 0.99, 95% confidence interval 0.98-1.00). Both preoperative pain and pain in the immediate postoperative period are strong risk factors for chronic groin pain. Risk factor patterns should be considered before operative repair of presumed symptomatic inguinal hernias. The problem of postoperative pain must be addressed regarding both pre-emptive and postoperative analgesia. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Tacks, staples, or suture: method of peritoneal closure in laparoscopic transabdominal preperitoneal inguinal hernia repair effects early quality of life.

    Science.gov (United States)

    Ross, Samuel W; Oommen, Bindhu; Kim, Mimi; Walters, Amanda L; Augenstein, Vedra A; Heniford, B Todd; Todd Heniford, B

    2015-07-01

    TAPP inguinal hernia repair (IHR) entails the development of a peritoneal flap (PF) in order to reduce the hernia sac and create a preperitoneal space in which to place mesh. Many methods for closure of the PF exist including sutures, tacks, and staples. We hypothesized that patients who had PF closure with suture would have better short-term QOL outcomes. A prospective institutional hernia-specific database was queried for all adult, TAPP IHRs from July 2012 to August 2013. Unilateral and bilateral patients were included and each hernia was analyzed separately. The main outcome of interest was quality of life (QOL) at two- and four-week follow-up, as measured by the Carolinas Comfort Scale. There were 227 patients who underwent TAPP, with 99 bilateral and 128 unilateral IHR, for a total of 326 IHR. PF closure was performed using tacks in 45.1%, suture in 19.0%, and staples in 35.9%. Patient characteristics were statistically similar between the tack, suture, and staple group. There were 32.9% direct, 46.5% indirect, and 20.6% pantaloon hernias, which were not significantly different when compared by PF closure method. Post-operative complications and length of stay were same for the three groups. There were no hernia recurrences. Post-operative activity limitation at two weeks was significantly better in the suture group when compared to the stapled group (p = 0.005). Additionally, sutured PF closure had less early post-operative pain when compared to the tack group (p = 0.038). Following TAPP IHR, suture closure of the PF significantly improves 2-week post-operative movement limitation compared to stapled and tacked PF closure. Continued randomized studies are needed to determine the best surgical hernia repair methods for ideal post-op QOL.

  17. Follow-up after inguinal hernia repair. Questionnaire compared with physical examination: a prospective study in 299 patients

    NARCIS (Netherlands)

    Vos, P. M.; Simons, M. P.; Luitse, J. S.; van Geldere, D.; Koelemaij, M. J.; Obertop, H.

    1998-01-01

    To assess the value of a written questionnaire in the follow-up of patients after inguinal hernia repair. Prospective study. University and two district hospitals. The Netherlands. 314 patients with 362 inguinal hernias. Correlation between answers to questionnaire and clinical examination in the

  18. Lack of association between inguinal hernia and abdominal aortic aneurysm in a population-based male cohort

    DEFF Research Database (Denmark)

    Henriksen, N A; Sorensen, L T; Jørgensen, Lars Nannestad

    2013-01-01

    Previous studies have reported a higher prevalence of inguinal hernia in patients with abdominal aortic aneurysm (AAA). The aim of this study was to explore the association between inguinal hernia and AAA in a large population-based cohort of men who had screening for AAA....

  19. Risk factors for inguinal hernia in middle-aged and elderly men: Results from the Rotterdam Study

    NARCIS (Netherlands)

    B. de Goede (Barry); L. Timmermans (Lucas); B.J.H. van Kempen (Bob); F.J.A. van Rooij (Frank); G. Kazemier (Geert); J.F. Lange (Johan); A. Hofman (Albert); J. Jeekel (Johannes)

    2015-01-01

    textabstractBackground Prospective data on risk factors and the incidence of inguinal hernia are sparse, especially in an elderly population. The aim of this study was to determine the incidence of and risk factors for inguinal hernia. Methods We analyzed data from the Rotterdam Study, a prospective

  20. A Low-Cost Teaching Model of Inguinal Canal: A Useful Method to Teach Surgical Concepts in Hernia Repair

    Science.gov (United States)

    Ansaloni, Luca; Catena, Fausto; Coccolini, Frederico; Ceresoli, Marco; Pinna, Antonio Daniele

    2014-01-01

    Objectives: Inguinal canal anatomy and hernia repair is difficult for medical students and surgical residents to comprehend. Methods: Using low-cost material, a 3-dimensional inexpensive model of the inguinal canal was created to allow students to learn anatomical details and landmarks and to perform their own simulated hernia repair. In order to…

  1. Ten-year review of groin laparoscopy in 1001 pediatric patients with clinical unilateral inguinal hernia: an improved technique with transhernia multiple-channel scope.

    Science.gov (United States)

    Saad, Saad; Mansson, Jonas; Saad, Adam; Goldfarb, Michael A

    2011-05-01

    The purpose of this 10-year review of data is to verify the effectiveness, safety, and appropriate age group for using a multichannel scope during inguinal herniorrhaphy in pediatric patients with clinical unilateral inguinal hernia to evaluate for contralateral patent processus vaginalis (CPPV). The data evaluated are age, sex, negative findings, positive findings, false positives, false negatives, recurrences, date of recurrence, and complications. Patients who clinically had bilateral hernias or were born prematurely were excluded. A 5-mm, 30° multichannel scope was used through the ipsilateral open hernia sac to explore the contralateral internal ring. A Fogarty catheter was used through one of the channels of the scope to probe the contralateral side in instances of questionable patent processus vaginalis. One thousand one patients were studied, and a total of 237 CPPVs (23%) were identified. The highest incidence of CPPV was found in those patients younger than 1 year (44%). Contralateral patent processus vaginalis was identified and ligated in 34% of patients younger than 2 years, 20% in patients 2 to 8 years old, and 17% of patients 9 to 18 years old. There were no false positives and 6 false negatives (0.6%) of the contralateral side. There were 3 (0.3%) recurrent inguinal hernias of the ipsilateral side and no complications. The use of a multichannel scope through the ipsilateral open hernia sac during inguinal herniorrhaphy in pediatric patients with clinical unilateral inguinal hernia to evaluate for CPPV proved to be effective, cost-effective, and safe. Our procedure eliminated any additional scars and the cost of trocars and permitted us to probe the contralateral internal ring. Unnecessary open exploration was spared in 56% of children younger than 1 year and proved to be useful in all pediatric patients up to the age of 18 years. Copyright © 2011 Elsevier Inc. All rights reserved.

  2. Genome-wide linkage analysis of inguinal hernia in pigs using affected sib pairs.

    Science.gov (United States)

    Grindflek, Eli; Moe, Maren; Taubert, Helge; Simianer, Henner; Lien, Sigbjørn; Moen, Thomas

    2006-05-03

    Inguinal and scrotal hernias are of great concern to pig producers, and lead to poor animal welfare and severe economic loss. Selection against these conditions is highly preferable, but at this time no gene, Quantitative Trait Loci (QTL), or mode of inheritance has been identified in pigs or in any other species. Therefore, a complete genome scan was performed in order to identify genomic regions affecting inguinal and scrotal hernias in pigs. Records from seedstock breeding farms were collected. No clinical examinations were executed on the pigs and there was therefore no distinction between inguinal and scrotal hernias. The genome scan utilised affected sib pairs (ASP), and the data was analysed using both an ASP test based on Non-parametric Linkage (NPL) analysis, and a Transmission Disequilibrium Test (TDT). Significant QTLs (p pigs. The most interesting result was one haplotype on SSC5 that was found to be transmitted to hernia pigs with four times higher frequency than to healthy pigs (p hernias. While this study permitted the detection of chromosomal regions only, it is interesting to note that several promising candidate genes, including INSL3, MIS, and CGRP, are located within the highly significant QTL regions. Further studies are required in order to narrow down the suggestive QTL regions, investigate the candidate genes, and to confirm the suggestive QTLs in other populations. The haplotype associated with inguinal and scrotal hernias may help in achieving selection against the disorder.

  3. TEP or TAPP for recurrent inguinal hernia repair-register-based comparison of the outcome.

    Science.gov (United States)

    Köckerling, F; Bittner, R; Kuthe, A; Hukauf, M; Mayer, F; Fortelny, R; Schug-Pass, C

    2017-10-01

    The guidelines of the international hernia societies recommend laparo-endoscopic inguinal hernia repair for recurrent hernias after open primary repair. To date, no randomized trials have been conducted to compare the TEP vs TAPP outcome for recurrent inguinal hernia repair. A Swiss registry study identified only minor differences between the two techniques, thus suggesting the equivalence of the two procedures. Between September 1, 2009 and August 31, 2013 data were entered into the Herniamed Registry on a total of 2246 patients with recurrent inguinal hernia repair following previous open primary operation in either TAPP (n = 1,464) or TEP technique (n = 782). Univariable and multivariable analysis did not find any significant difference between TEP and TAPP with regard to the intraoperative complications, complication-related reoperations, re-recurrences, pain at rest, pain on exertion, or chronic pain requiring treatment. The only difference identified was a significantly higher postoperative seroma rate after TAPP, which was influenced by the surgical technique, previous open primary operation and EHS-classification medial and responded to conservative treatment. TEP and TAPP are equivalent surgical techniques for recurrent inguinal hernia repair following previous open primary operation. The choice of technique should be tailored to the surgeon's expertise.

  4. Inguinal hernia repair among men in relation to occupational mechanical exposures and lifestyle factors

    DEFF Research Database (Denmark)

    Vad, Marie Vestergaard; Frost, Poul; Rosenberg, Jacob

    2017-01-01

    OBJECTIVES: To evaluate exposure-response relationships between occupational mechanical exposures and first-time lateral and medial inguinal hernia repair and effects of lifestyle factors. To estimate if occupational mechanical exposures advance the repairs. METHODS: This longitudinal study...... was based on a cohort of men aged 18-65 years with questionnaire data from the Musculoskeletal Research Database at the Danish Ramazzini Centre. We estimated occupational mechanical exposures using a job exposure matrix. First-time inguinal hernia repairs from 1998 to 2014 were identified in the Danish...... showed lower HRs for both repair types. Leisure-time physical activity and smoking status were not related to any of the outcomes. CONCLUSIONS: Assuming a causal relationship, the results suggest that around 30% of all first-time lateral inguinal hernia repairs in the highest exposure category would...

  5. Sexual dysfunction after inguinal hernia repair with the Onstep versus Lichtenstein technique

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Fonnes, Siv

    2017-01-01

    Background. Sequelae after inguinal hernia repair include pain-related impairment of sexual function. Pain during intercourse can originate from the scar, scrotum, penis, or during ejaculation. The aim of this study was to investigate if the Onstep technique resulted in better results than...... the Lichtenstein technique regarding pain-related impairment of sexual function. Methods. This study was part of the randomized ONLI trial (NCT01753219, Onstep versus Lichtenstein for inguinal hernia repair). Separate reporting of pain-related impairment of sexual function was planned before the study start......, with a separate sample size calculation. Participants were randomized to the Onstep or Lichtenstein technique for repair of their primary inguinal hernia and followed up at 6 months postoperative with the use of a questionnaire specific for pain-related impairment of sexual function. Results. A total of 259...

  6. The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair

    DEFF Research Database (Denmark)

    Petersen, Pernille Lykke; Mathiesen, Ole; Stjernholm, Pia

    2013-01-01

    was evaluated versus placebo and versus an active comparator (ilioinguinal block and wound infiltration). DESIGN: Randomised controlled trial. SETTING: Single centre trial. Study period from June 2010 to November 2011. PATIENTS: Adults (18 to 75 years) with American Society of Anesthesiologists' status 1......CONTEXT: The analgesic effect of transversus abdominis plane (TAP) block after inguinal hernia repair is unclear. OBJECTIVE: The aim of this randomised and double-blind study was to evaluate the analgesic effect of a TAP block in patients scheduled for primary inguinal hernia repair. The TAP block......-3 scheduled for primary inguinal hernia repair as day case surgery were included in the study. INTERVENTIONS: Ninety patients were allocated to one of three groups: group TAP, group infiltration (ilioinguinal nerve block and wound infiltration) and group placebo. MAIN OUTCOME MEASURES: The primary outcome...

  7. Dedifferentiated retroperitoneal liposarcoma presenting as right inguinal hernia: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Myung; Lee, Su Lim; Ku, Young Mi [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of); Choi, Moon Hyung [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2016-01-15

    Retroperitoneal liposarcomas usually present as painless, slow-growing abdominal masses. When masses grow large enough to compress surrounding structures, symptoms may occur. Retroperitoneal liposarcoma clinically manifesting as inguinal hernia is a very rare entity; only 11 cases have been reported. Herein, we present radiographic features of a 37-year-old male with a painless palpable mass in the right groin that was identified as dedifferentiated retroperitoneal liposarcoma herniated through the right inguinal canal.

  8. Trends in operation rates for inguinal hernia over five decades in England: database study.

    Science.gov (United States)

    Maisonneuve, J J; Yeates, D; Goldacre, M J

    2015-10-01

    We aimed to study trends over time in operation rates for inguinal hernia with and without obstruction over five decades. Routine hospital statistics were used to analyse trends in National Health Service hospitals in England (1968-2011). All-England admission rates for elective repair of unobstructed inguinal hernia in males were 240.8 episodes per 100,000 population [95 % confidence interval (CI) 234.5-247.2] in 1968 and were relatively stable until 2003 after which they declined to 217.1 (215.4-218.8) by 2011. However, the stability of the all ages rates masked a large decline in admission rates in the young (e.g. 425 per 100,000 in 1968-1970 in males under 1 year of age, down to 155 per 100,000 in 2007-2011) and a large increase in the elderly (e.g. 247 in 1968-1970 per 100,000 males aged 75-84, up to 799 per 100,000 in 2007-2011). All-England admission rates for obstructed inguinal hernia in males almost halved, from 19.3 episodes (17.4-21.2) in 1968 to 10.7 episodes (10.3-11.0) per 100,000 population in 2011. Admission rates for females gradually declined over time for both unobstructed and obstructed inguinal hernia. Hospital admission rates for elective operation on inguinal hernia without obstruction, for all ages combined, have been relatively stable over five decades, but this masked big differences between age groups. Rates of obstructed hernia have declined over time, particularly in the early years covered by the study, and have not shown an increase associated with the recent fall in elective surgery for hernia repair.

  9. Biologic vs synthetic inguinal hernia repair: 1-year results of a randomized double-blinded trial.

    Science.gov (United States)

    Bochicchio, Grant V; Jain, Ajay; McGonigal, Kelly; Turner, Douglas; Ilahi, Obeid; Reese, Stacey; Bochicchio, Kelly

    2014-04-01

    Various surgical meshes are used in the repair of inguinal hernia and are associated with numerous complications. Our main objective in this study was to determine whether a biologic hernia matrix is equivalent to polypropylene mesh in an open inguinal hernia repair using the Lichtenstein technique. A prospective, randomized, double-blinded, single-center trial was conducted to evaluate the efficacy of a biologic Inguinal Hernia Matrix (IHM; Cook Medical) compared with polypropylene (PP) mesh using Lichtenstein's inguinal hernia repair in a 3-year outcomes study. Patients were evaluated for recurrence and complications by a blinded surgeon at 2 weeks, 3 months, 6 months, and 1 year post procedure. Patient demographics, including comorbidities and nutrition status, were recorded. Intraoperative information including hernia type and location, procedure time, level of difficulty, degree of surgeon frustration, and surgical experience were collected. One hundred male patients provided informed consent and were randomized into the study in a 1:1 fashion. There were no significant differences in degree of difficulty and level of frustration between the 2 groups. At 1-year follow-up, 3 recurrences were diagnosed in the IHM group as compared with none in the PP group (p = 0.11). Persistent pain trended higher in the PP group (6% vs 4%). All 3 recurrences occurred in the direct inguinal hernia group and were performed by attendings in the first year post training (3 different attendings). No recurrences occurred in patients operated on by more senior surgeons. The IHM hernioplasty compares favorably with PP mesh at 1-year follow-up with similar recurrence rates and complications. Surgeon experience appears to be a major factor affecting successful outcomes. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  10. The role of fibrin glue polypropylene mesh fixation in open inguinal hernia repair.

    Science.gov (United States)

    Odobasic, Amer; Krdzalic, Goran; Hodzic, Mirsad; Hasukic, Sefik; Sehanovic, Aida; Odobasic, Ademir

    2014-01-01

    The aim of this study was to compare two methods of polypropylene mesh fixation for inguinal hernia repair according to Lichtenstein using fibrin glue and suture fixation. The study included 60 patients with unilateral inguinal hernia, divided into two groups of 30 patients--Suture fixation and fibrin glue fixation. All patients were analyzed according to: age, gender, body mass index (BMI), indication for surgery--the type, localization and size of the hernia, preoperative level of pain and the type of surgery. Overall postoperative complications and the patient's ability to return to regular activities were followed for 3 months. Statistically significant difference in the duration of surgery, pain intensity and complications (p polypropylene mesh-fibrin glue and method B, where inguinal hernia was repaired with polypropylene mesh using suture fixation. Given the clinical research, this systematic review of existing results on the comparative effectiveness, will help in making important medical decisions about options for surgical treatment of inguinal hernia. The results of this study may impact decision making process for recommendations of methods of treatment by professional associations, making appropriate decisions on hospital procurement of materials, as well as coverage of health funds and insurance.

  11. Minilaparoscopic technique for inguinal hernia repair combining transabdominal pre-peritoneal and totally extraperitoneal approaches.

    Science.gov (United States)

    Carvalho, Gustavo L; Loureiro, Marcelo P; Bonin, Eduardo A; Claus, Christiano P; Silva, Frederico W; Cury, Antonio M; Fernandes, Flavio A M

    2012-01-01

    Endoscopic surgical repair of inguinal hernia is currently conducted using 2 techniques: the totally extraperitoneal (TEP) and the transabdominal (TAPP) hernia repair. The TEP procedure is technically advantageous, because of the use of no mesh fixation and the elimination of the peritoneal flap, leading to less postoperative pain and faster recovery. The drawback is that TEP is not performed as frequently, because of its complexity and longer learning curve. In this study, we propose a hybrid technique that could potentially become the gold standard of minimally invasive inguinal hernia surgery. This will be achieved by combining established advantages of TEP and TAPP associated with the precision and cosmetics of minilaparoscopy (MINI). Between January and July 2011, 22 patients were admitted for endoscopic inguinal hernia repair. The combined technique was initiated with TAPP inspection and direct visualization of a minilaparoscopic trocar dissection of the preperitoneum space. A10-mm trocar was then placed inside the previously dissected preperitoneal space, using the same umbilical TAPP skin incision. Minilaparoscopic retroperitoneal dissection was completed by TEP, and the surgical procedure was finalized with intraperitoneal review and correction of the preperitoneal work. The minilaparoscopic TEP-TAPP combined approach for inguinal hernia is feasible, safe, and allows a simple endoscopic repair. This is achieved by combining features and advantages of both TAPP and TEP techniques using precise and sophisticated MINI instruments. Minilaparoscopic preperitoneal dissection allows a faster and easier creation of the preperitoneal space for the TEP component of the procedure.

  12. Mesh fixation methods and chronic pain after transabdominal preperitoneal (TAPP) inguinal hernia surgery

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Qwist Fenger, Andreas; Burcharth, Jakob

    2017-01-01

    INTRODUCTION: Mesh fixation techniques have been associated with pain after groin hernia surgery. The aim of this study was to compare fibrin sealant and tacks for mesh fixation in laparoscopic inguinal hernia repair regarding long-term persistent pain. METHODS: Through the Danish Hernia Database......, we identified patients operated for groin hernia using the transabdominal preperitoneal laparoscopic technique (TAPP) from 2009 to 2012 with fibrin sealant for mesh fixation. These were matched in a ratio of 1:2 with patients operated with TAPP using tacks. All patients were sent a validated...... questionnaire (the inguinal pain questionnaire) between March 2013 and June 2014. The primary outcome was pain at follow-up. RESULTS: A total of 1421 patients (84% males) answered the questionnaire (34% fibrin sealant, 66% tacks). The median follow-up was 35 months (range 12-62). Preoperative pain...

  13. Imaging Findings of Angiomyxolipoma of the Spermatic Cord Mimicking Inguinal Hernia

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Hyun Suk; Woo, Ji Young; Hong, Hye-Suk; Yang, Ik; Lee, Yul; Jung, Ah Young [Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 150-950 (Korea, Republic of); Yang, Dae Hyun; Kim, Ji Won [Department of General Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 150-950 (Korea, Republic of); Kim, Jeong Won [Department of Pathology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 150-950 (Korea, Republic of)

    2013-07-01

    We report the case in a 72-year-old man who presented with a right inguinal mass and with a one month history that was initially interpreted as an inguinal hernia. Ultrasonography (US) and computed tomography (CT) demonstrated a right inguinal mass, including myxoid and fat component, extending from the right spermatic cord to the right inguinal subcutaneous layer. Mass excision was performed, and the diagnosis turned out to be angiomyxolipoma. Angiomyxolipoma is a rare tumor and the preoperative diagnosis of this disease is very difficult. However, angiomyxolipoma of the spermatic cord should be considered in the differential diagnosis in patients with an irreducible inguinal mass. Imaging diagnosis, such as US and CT may help to make a preoperative diagnosis.

  14. Ultrasonographic and clinical findings of inguinal hernia containing the ovary or omentum in girls

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Su Mi; Chai, Jee Won [Dept. of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of)

    2016-09-15

    To characterize the ultrasonographic and clinical findings of inguinal hernia containing the ovary or omentum in girls. We studied 46 girls (49 cases) who were diagnosed with inguinal hernia on ultrasonography between March 2009 and December 2015. The ultrasonographic findings were retrospectively analyzed with respect to location, age at detection, contents of hernia, diameter of the canal of Nuck, and incidence of reducibility, incarceration and strangulation. The clinical findings included the number of cases that underwent operation, contents of hernia discovered during operation, and duration between ultrasonographic diagnosis and operation. The two groups in which inguinal hernia contained the ovary and omentum were statistically compared. Of the 49 cases, the contents of hernia were the ovary or tube in 14 cases, omentum in 32 cases, and bowel in 3 cases. The ovarian herniation group was significantly younger (10.1 months vs. 4.9 years, p < 0.001), had a lower incidence of reducibility (n = 3 vs. n = 29, p < 0.001), higher incidence of incarceration (n = 4 vs. n = 0, p = 0.006), and a shorter duration between ultrasonographic diagnosis and operation (5.7 days vs. 55.8 days, p = 0.032) than the omental herniation group. The ovarian herniation group was younger, had a lower incidence of reducibility, higher incidence of incarceration, and a shorter duration between ultrasonographic diagnosis and operation.

  15. Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia.

    Science.gov (United States)

    Taylor, D C; Meyers, W C; Moylan, J A; Lohnes, J; Bassett, F H; Garrett, W E

    1991-01-01

    There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. Groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the public tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symptoms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, including inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months.

  16. An inguinal hernia with cryptorchidism with a Leydig cell tumor in an elderly man: A case report.

    Science.gov (United States)

    Zuiki, Toru; Ohki, Jun; Komatsubara, Toshihide; Lefor, Alan Kawarai; Miyahara, Yuzo; Ochi, Masanori; Hirota, Norio

    2017-01-01

    Cryptorchidism is common in children but is rare in the elderly. It often presents with a constellation of signs and symptoms similar to routine inguinal hernias. We present the case of an elderly man with cryptorchidism containing a Leydig cell tumor and provide clinical insights. An-84-year old man was admitted with an incarcerated right lower quadrant hernia. Both testes were absent on palpation of the scrotum. After reduction of the hernia, computed tomography scan revealed a round lesion in the hernia sac, which was suspected to be the ectopic testis. Laparoscopic exploration was performed in combination with an open anterior approach. The hernia orifice was the right internal inguinal ring, and the inguinal canal was obliterated by adhesions because the spermatic cord did not pass through it. The ectopic testis was resected with the hernia sac, and the hernia repaired with a KUGEL™ patch (Bard, USA). Laparoscopic exploration was useful to delineate the anatomy of this unusual inguinal hernia. The open anterior approach was necessary to dissect the ectopic testis and the hernia sac. Pathological findings revealed tumor cells with clear cytoplasm in the resected testis, diagnosed as a Leydig cell tumor. The combination of laparoscopic and anterior approaches facilitated the surgical treatment of an unusual inguinal hernia with cryptorchidism. The resected ectopic testis should undergo thorough histopathologic examination. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  17. Bilateral giant inguinoscrotal Hernia: psychosocial issues and a new ...

    African Journals Online (AJOL)

    Background: Bilateral giant inguinoscrotal hernias pose challenging psychosocial problems to the patient. The engulfed phallus and hernia size are socially embarrassing and may make penetration during coitus increasingly difficult and uncomfortable. This paper presents a classification and the psychosocial aspects of ...

  18. A large incarcerated Meckel's diverticulum in an inguinal hernia

    Directory of Open Access Journals (Sweden)

    Michael J. Horkoff

    2014-01-01

    CONCLUSION: Littre's hernia, although rare, should be a consideration at the time of repair for any abdominal hernia involving small bowel as resection of the Meckel's diverticulum is critical in avoiding recurrent complications.

  19. Bilateral giant inguinoscrotal Hernia: psychosocial issues and a new ...

    African Journals Online (AJOL)

    EB

    100.00%). All the patients (100.00%) had ... improved access to free surgical health care services particularly in rural African communities. Keywords: Bilateral giant inguinoscrotal hernia, classification, quality of life. African Health Sciences ...

  20. Long-term outcome after randomizing prolene hernia system, mesh plug repair and Lichtenstein for inguinal hernia repair.

    Science.gov (United States)

    Nienhuijs, Simon W; Rosman, Camiel

    2015-02-01

    To assess long-term superiority in terms of chronic pain between prolene hernia system (PHS), mesh plug repair (MPR) and Lichtenstein (L) technique for inguinal hernia repair. Eight years after randomizing three commonly used techniques for primary inguinal hernia repair, the outcome was evaluated with a questionnaire measuring pain on verbal descriptor and visual analogue scales, including limitations on daily life activities, sensory disturbances and recurrences. From previous results patients characteristics, operative details and short- and mid-term pain outcome were extracted. 270 out of 308 eligible patients (88%) completed the follow-up after median 7.6 years (range 6.9-9.2) after the inguinal hernia operation. No significant differences between the repair techniques were found for pain, sensory disturbances or recurrences. Overall, the hernia recurrence rate was 6.3%. In total 63 patients (23%) reported long-term pain of which one-fourth graded this moderate to severe. Pain was experienced at least weekly by 26 patients (10%) and limiting daily activities for 36 patients (13%). With regard to the previously reported pain at 3 and 15 months follow-up, 106 patients (39%) experience no pain at all. For 101 patients (37%), initial pain disappeared. 41 patients (15%) suffered persisting pain at all three measure moments. 22 patients (8%) reported pain at 8 years follow-up after an initial pain-free period. Long-term outcome after randomizing PHS, MPR and L showed no clinically relevant differences in chronic pain and its consequences. Although chronic pain is diminishing over time it remains a serious complication and has sometimes an onset long after the inguinal repair.

  1. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery

    DEFF Research Database (Denmark)

    Joshi, G P; Rawal, N; Kehlet, H

    2012-01-01

    BACKGROUND: Open inguinal hernia repair is associated with moderate postoperative pain, but optimal analgesia remains controversial. The aim of this systematic review was to evaluate the available literature on the management of pain after open hernia surgery. METHODS: Randomized studies......, in English, published between January 1966 and March 2009, assessing analgesic and anaesthetic interventions in adult open hernia surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases. In addition to published evidence, clinical practice was taken into account to ensure...

  2. Academic Performance in Adolescence after Inguinal Hernia Repair in Infancy: A Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Hansen, Tom G; Pedersen, Jacob K; Henneberg, Steen W

    2011-01-01

    compared average test scores at ninth grade adjusting for sex, birth weight, and paternal and maternal age and education. Secondary analysis compared the proportions of children not attaining test scores between the two groups. RESULTS:: From 1986-1990 in Denmark, 2,689 children underwent inguinal hernia...

  3. Polypropylene mesh repair of a unilateral, congenital hernia in the inguinal region in a Thoroughbred filly

    Science.gov (United States)

    Moorman, Valerie J.; Jann, Henry W.

    2009-01-01

    A 2-day-old Thoroughbred intact female was presented for a large subcutaneous swelling in the right inguinal region. Surgical repair was performed using a double layer polypropylene mesh. To the authors’ knowledge, there have been no previous reports of surgical repair of congenital body wall hernias with polypropylene mesh in foals. PMID:19721780

  4. A 5‑year Review of Darning Technique of Inguinal Hernia Repair

    African Journals Online (AJOL)

    Inguinal hernia repair has undergone several modifications since the description of the Bassini technique.[1] The various techniques described are aimed at improving outcome, particularly recurrence rate. The underlying factor identified as a cause of recurrence in most of these methods of repair is the fraying and tearing ...

  5. Rare complication of pediatric inguinal hernia repair: case report of transection of the femoral vein

    NARCIS (Netherlands)

    Ossendorp, R. R.; Koelemay, M. J. W.; Vermeulen, J.

    2016-01-01

    The incidence of pediatric inguinal hernias ranges up to 13 %. Currently, many different techniques are being used to successfully perform herniotomy and risks of complications are minor. This case report describes a 4-year-old male patient who underwent routine herniotomy during which the femoral

  6. Combined procedure of cesarean delivery and preperitoneal mesh repair for inguinal hernia: An initial experience

    Directory of Open Access Journals (Sweden)

    Onder Surgit

    2017-09-01

    Conclusion: Single anesthesia, single incisional scar, and single hospitalization are the major advantages of this simultaneous approach of cesarean delivery and preperitoneal mesh repair for inguinal hernia. Our analysis suggests that this combined procedure can be performed safely in selected cases.

  7. An unusual foreign body in an inguinal hernia sac: Case report and ...

    African Journals Online (AJOL)

    A 13-month-old boy accidentally ingested a 5 cm dressmaker's pin. On presentation, the pin was in the duodenum and there was a right inguinal hernia. After 17 days, the pin failed to progress. At surgery, the sac contained appendix perforated by the pin. This is the fi rst case in the literature.

  8. Preferred mesh-based inguinal hernia repair in a teaching setting: results of a randomized study.

    NARCIS (Netherlands)

    Nienhuijs, S.W.; Kortmann, B.B.M.; Boerma, M.; Strobbe, L.J.; Rosman, C.

    2004-01-01

    HYPOTHESIS: Surgeons' preferences for any of 3 methods of inguinal hernia repair are comparable in terms of operating time, incision length, perceived difficulty, and surgeon's satisfaction. DESIGN: Randomized patient-blinded study. SETTING: Teaching hospital. PATIENTS: A total of 334 patients

  9. Needlescopic Totally Extraperitoneal Hernioplasty for Unilateral Inguinal Hernia in Adult Patients

    Directory of Open Access Journals (Sweden)

    Wong-Hoi She

    2011-01-01

    Conclusion: Needlescopic TEP hernioplasty was a feasible technique in selected patients for inguinal hernia repair. Postoperative recovery following both approaches was similar. However, because this was a small cohort study, larger prospective, randomized controlled trials are required to establish the longterm benefit, safety and complications of needlescopic surgery.

  10. Feasibility and safety of laparoendoscopic single-site surgery of total extraperitoneal inguinal hernia repair after previous open groin hernia repair: a comparative study.

    Science.gov (United States)

    Lin, Chia-Da; Wu, Chih-Hsuan; Liu, Ying-Buh; Tsai, Yao-Chou

    2016-05-01

    This study is aimed at evaluating the feasibility and safety of laparoendoscopic single-site surgery (LESS) for totally extraperitoneal (TEP) endoscopic hernia surgery after previous open groin hernia repair that may hamper preperitoneal dissection. This prospective cohort study included 213 consecutive patients undergoing LESS TEP hernia repair between January 2009 and December 2013. The study group consisted of 36 patients with a history of previous open inguinal hernia repair before undergoing LESS TEP hernia repair. The study enrolled the other 177 patients who underwent LESS TEP during the same period and were enrolled as the control group. We obtained perioperative data for all patients including demographic data, operation time, length of hospital stay, narcotic dose, conversions, and complications. A total of 213 patients with inguinal hernia underwent LESS TEP repair. One case in the control group (0.56 %) required conversion to LESS transabdominal preperitoneal hernia repair, while no cases in the study group required conversion. We observed no differences between the two groups in terms of operative time, analgesic use, hospital stay, and postoperative complications. LESS TEP hernia repair for patients with previous open inguinal hernia repair can be performed safely by experienced surgeons. Operative outcomes were comparable between both the primary inguinal and recurrent hernia groups.

  11. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Kehlet, H

    2001-01-01

    To evaluate the feasibility and safety of unmonitored local anesthesia (ULA) for elective open inguinal hernia repair, we made a prospective, consecutive data collection from 1000 operations on primary and recurrent hernias. Follow-up consisted of a questionnaire 1 mo after surgery and retrieval...... from the electronic patient data management system. In 921 ASA Group I and II and 79 ASA Group III and IV patients, the median age was 60 yr (range, 18-95 yr). ULA was converted to general anesthesia in 5 of 1000 cases, and 961 patients were discharged on the day of surgery after 95 min (median...... anesthesia, day-case setup, or both, primarily because of intraoperative pain (n = 74; 7.8%). We conclude that open inguinal hernia repair can be conducted under ULA, regardless of comorbidity, with a small rate of deviation from day-case setup and minimal morbidity. It provides a safe alternative to other...

  12. Minimally invasive surgical technique integrating multiple procedures with large specimen extraction via inguinal hernia orifice.

    Science.gov (United States)

    Mani, Vishnu R; Ahmed, Leaque

    2015-12-24

    While laparoscopic surgery can be performed using small skin incisions, any resected specimen must still be able to fit through these opening. For procedures, such as cholecystectomies and appendectomies, this is not usually a problem; however, for large specimens such as bowel or large tumors, this becomes problematic. Currently, the standard technique is to attempt piecemeal removal of the specimen or enlarge one of the laparoscopic incisions, effectively creating a mini laparotomy. Creating a larger incision adds many of the drawbacks of open laparotomy and should be avoided whenever possible. In this article, we present a new technique of combining the repair of an inguinal hernia, umbilical hernia with a duodenal tumor resection in order to extract the specimen through the inguinal hernia orifice. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2015.

  13. Review of 1000 fibrin glue mesh fixation during endoscopic totally extraperitoneal (TEP) inguinal hernia repair.

    Science.gov (United States)

    Berney, Christophe R; Descallar, Joseph

    2016-10-01

    Chronic pain is a common complication arising after conventional open herniorrhaphy and to a lesser extent postlaparoscopic inguinal hernia repairs as groin incision is avoided. Although published studies support elimination of mesh fixation during endoscopic procedures, the vast majority of surgeons will still recommend it by fear of encountering increased recurrence rates, if omitted. Regrettably, penetrating staple or tack fixation devices are the preferred methods to secure the mesh and cannot be applied at the level of the triangles of 'doom' and 'pain' where hernia tends to reoccur the most. This ongoing prospective cohort study aimed to confirm the safety and advantages of fibrin glue, as a substitute to staple mesh fixation during totally extraperitoneal (TEP) inguinal hernia repair. Over a 10-year period, 703 patients underwent 1000 elective TEP inguinal hernia repairs. Mesh fixation was achieved using exclusively fibrin sealant. Patients were reviewed at 2, 6 weeks and thereafter on an ad hoc basis if judged necessary until complete resolution of their symptoms. Quality of life (QoL) was assessed in a subgroup of 320 patients using the Carolina Comfort Scale (CCS). No conversion to open surgery was observed. There were three cases of major morbidities and no mortality. Three months after surgery, only seven patients (1 %) experienced chronic groin or testicular discomfort and none of them required prescription painkillers. When using the CCS, at 2 weeks 93.1 % of the patients were either satisfied or very satisfied with their outcome. This satisfaction index increased up to 99.2 % at 6 weeks post surgery. Finally, only eight hernia recurrences (1.1 %) were reported, of which five occurred during the first month of the study. Fibrin glue mesh fixation of inguinal hernia during TEP repair is extremely safe and reliable, with a very high satisfaction index for the patients and limited risk of developing chronic pain.

  14. Study protocol for a randomized controlled trial for anterior inguinal hernia repair: transrectus sheath preperitoneal mesh repair compared to transinguinal preperitoneal procedure

    NARCIS (Netherlands)

    Prins, M.W.; Koning, G.G.; Keus, E.; Vriens, P.W.H.E.; Mollen, R.M.H.G.; Akkersdijk, W.L.; Laarhoven, C.J. van

    2013-01-01

    BACKGROUND: Anterior open treatment of the inguinal hernia with a tension-free mesh has reduced the incidence of hernia recurrence. The Lichtenstein procedure is the current reference technique for inguinal hernia treatment. Chronic pain has become the main postoperative complication after surgical

  15. The Tilburg double blind randomised controlled trial comparing inguinal hernia repair according to Lichtenstein and the transinguinal preperitoneal technique

    Directory of Open Access Journals (Sweden)

    Gerritsen Pieter G

    2009-09-01

    Full Text Available Abstract Background Anterior open treatment of the inguinal hernia with a tension free mesh has reduced the incidence of recurrence and direct postoperative pain. The Lichtenstein procedure rules nowadays as reference technique for hernia treatment. Not recurrences but chronic pain is the main postoperative complication in inguinal hernia repair after Lichtenstein's technique. Preliminary experiences with a soft mesh placed in the preperitoneal space showed good results and less chronic pain. Methods The TULIP is a double-blind randomised controlled trial in which 300 patients will be randomly allocated to anterior inguinal hernia repair according to Lichtenstein or the transinguinal preperitoneal technique with soft mesh. All unilateral primary inguinal hernia patients eligible for operation who meet inclusion criteria will be invited to participate in this trial. The primary endpoint will be direct postoperative- and chronic pain. Secondary endpoints are operation time, postoperative complications, hospital stay, costs, return to daily activities (e.g. work and recurrence. Both groups will be evaluated. Success rate of hernia repair and complications will be measured as safeguard for quality. To demonstrate that inguinal hernia repair according to the transinguinal preperitoneal (TIPP technique reduces postoperative pain to Discussion The TULIP trial is aimed to show a reduction in postoperative chronic pain after anterior hernia repair according to the transinguinal preperitoneal (TIPP technique, compared to Lichtenstein. In our hypothesis the TIPP technique reduces chronic pain compared to Lichtenstein. Trial registration ISRCTN 93798494

  16. A minimally invasive treatment of an asymptomatic case of mesh erosion into the caecum after total extraperitoneal inguinal hernia repair.

    Science.gov (United States)

    Mulleners, Gert; Olivier, Frederick; Abasbassi, Mohamed

    2017-12-28

    Mesh migration and erosion into adjacent viscera is a rare complication after laparoscopic inguinal hernia repair. We present a minimally invasive treatment of an asymptomatic case of mesh erosion into the caecum after total extraperitoneal inguinal hernia repair, including an overview of the relevant recent literature. A male patient underwent a laparoscopic inguinal hernia repair at the age of 42. Two years after this procedure, a screening colonoscopy revealed erosion of the mesh into the caecum. A laparoscopy was performed with partial resection of the mesh and minimal resection of the involved colon. Results of a systematic review of English PubMed articles on mesh migration and erosion after inguinal hernia repair is presented. We report a first-time minimally invasive treatment of mesh erosion into the colon. A laparoscopic approach is feasible and provides an excellent exposure. Partial removal of the mesh is suggested in uncomplicated cases to avoid complications associated with complete mesh removal.

  17. Neurophysiological characterization of persistent pain after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Linderoth, G; Kehlet, H; Aasvang, E K

    2011-01-01

    About 2-5% of patients undergoing laparoscopic inguinal repair experience persistent pain influencing everyday activities. However, compared with persistent pain after open repair, the combined clinical and neurophysiological characteristics have not been described in detail. Thus, the aim...

  18. Proposed technique for inguinal hernia repair with self-gripping mesh: avoiding fixation to undesired structures.

    Science.gov (United States)

    Porrero, J L; Cano-Valderrama, O; Castillo, M J; Alonso, M T

    2015-10-01

    Self-gripping meshes have been developed to avoid fixing sutures during inguinal hernia repair. Operative time is shorter when using a self-gripping mesh than with conventional Lichtenstein repair. However, these meshes can be difficult to handle because they fix to undesired structures. The aim of this report is to describe a new technique to avoid this problem. Inguinal hernia dissection is made as usual. Once dissection is finished, a Parietex ProGrip(®) (Covidien, Dublin, Ireland) flat sheet mesh is cut depending on the size needed. A small split is made between the lower and medium third of the mesh to mark where the split for the spermatic cord will be. Using this mark, the upper third of the mesh is folded over the medium third, hiding the microgrips that make this a self-gripping mesh. In this way, only the lower third of the mesh has the microgrips exposed and the mesh can be fixed to the pubic bone and inguinal ligament without fixation to undesired structures. Once the lower third of the mesh is fixed, the split for the spermatic cord is completed and the upper part of the mesh is passed below the spermatic cord. Then, the mesh is unfolded to expose the microgrips again and the medium and upper third of the mesh are descended to its final position. This proposed technique for inguinal hernia repair with self-gripping mesh makes the surgery easier, avoiding mesh fixation to undesired structures.

  19. External Genital Abnormalities and Inguinal Hernia among Males of Children Nurseries, North West of Iran

    Directory of Open Access Journals (Sweden)

    Hossein Haratipour

    2016-02-01

    Full Text Available Background Abnormalities of external genitalia in male children nurseries and inguinal hernia are the most common congenital disorders in children. We aimed to determine prevalence rate of inguinal hernia and other genital among children nurseries, in Shahrood-Iran. Materials and Methods In this descriptive cross-sectional study, we examined 920 children nurseries boys. Physical examination of children was performed in presence of a parent in a warm room in supine and upright position with and without Valsalva maneuver. A written consent was obtained from parents before examination. Past medical history and history of surgery on inguinal and genital area was taken. Examination was performed 2 interns who were trained about genital system examination.   Results A total of 920 children nurseries boys aged 3 to 6 years were examined which were detected in 88 children and prevalence rate of these abnormalities were 9.6%. The prevalence of abnormalities in the children under study were as follows: Inguinal hernia (5.1%, cryptorchidism (2.1%, Hydrocele (1.5%, hypospadias (0.4%, Varicocele (0.1%, micropenis (0.4%. Conclusion Regarding to relatively high prevalence rate of these abnormalities and low level of people knowledge, seem screening systems for diagnosis and appropriate treatment of these abnormalities to be necessary.

  20. STRANGULATED INGUINAL HERNIA IN ADULT MALES IN KUMASI

    African Journals Online (AJOL)

    2014-06-01

    Jun 1, 2014 ... Michael Ohene-Yeboah. E-mail: mikeoheneyeboah@yahoo.co. uk. Conflict of Interest: None declared. SUMMARY. Background: The complications of untreated ..... Sanders DL, Porter CS, Mitchel KCD, Kingsnorth. AN. A prospective cohort study of comparing the. African and European hernia. Hernia 2008 ...

  1. Inguinal hernia repair at the Aga Khan Hospital, Nairobi: Practice ...

    African Journals Online (AJOL)

    Objectives: To review the current hernia repair methods at the Aga Khan University Hospital (AKUH) and relate to the preferred method of choice for groin hernia repair among the practicing general surgeons. Design: An audit from retrospective practices. Setting: A tertiary referral hospital, Aga Khan University Hospital, ...

  2. Inguinal hernia repair at the Aga Khan Hospital, Nairobi: Practice ...

    African Journals Online (AJOL)

    Objectives: To review the current hernia repair methods at the Aga Khan University. Hospital (AKUH) and relate to the preferred method of choice for groin hernia repair among the practicing general surgeons. Design: An audit from retrospective practices. setting: A tertiary referral hospital, Aga. Khan University Hospital ...

  3. A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair.

    Science.gov (United States)

    Tai, Huai-Ching; Lin, Chia-Da; Chung, Shiu-Dong; Chueh, Shih-Chieh Jeff; Tsai, Yao-Chou; Yang, Stephen Shei-Dei

    2011-09-01

    Laparoscopic inguinal hernia repair has been around since the 1990s. A novel surgical approach known as laparoendoscopic single-site surgery (LESS) has been developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery, including totally extraperitoneal (TEP) inguinal hernia repair. The aim of the present study was to evaluate the safety and feasibility of the LESS TEP technique for inguinal hernia repair and compare the outcomes with the standard TEP approach. Between January and May 2009, 54 consecutive healthy patients (48 men and 6 women) underwent LESS TEP inguinal hernia repair at our institute. All procedures were performed using our homemade single port for simultaneous passage of the laparoscope and instruments. The perioperative data, including patient age, sex, body mass index (BMI), hernia characteristics, operative time, complications, length of hospital stay, return to normal activity, pain score, and cosmetic result, were prospectively collected. All LESS TEP procedures were completed successfully without conversion to standard laparoscopic or open surgery. A total of 98 LESS TEP hernia repairs were performed in 54 patients and compared with 152 standard TEP operations. The mean operative time was significantly shorter in the standard TEP series (61.8 ± 26.0 vs. 70.9 ± 23.8 min, p = 0.04). Other perioperative parameters, including the length of hospital stay, time until return to full activity, complication rate, pain score, and cosmetic result, were all comparable between the two techniques. Our short-term experience with LESS TEP inguinal hernia repair has shown that in experienced hands, inguinal hernia repair via the LESS TEP technique is as safe as the standard TEP technique. However, based on our evidence, we currently believe that the LESS TEP technique is not an efficacious surgical alternative to the standard TEP technique for inguinal hernias.

  4. Aetiology of femoral hernias revisited: bilateral femoral hernia in a young male (two cases).

    Science.gov (United States)

    Kochupapy, R T; Ranganathan, G; Dias, S; Shanahan, D

    2013-01-01

    Bilateral femoral hernias are less common in men than in women and rare in young adults. Only one case of a bilateral femoral hernia in a young man has been reported in the literature before. Three main theories have been postulated for femoral hernias. The theory that they are an acquired disease is the most accepted due to the common occurrence of such hernias in multiparous women but the theory lacks enough evidence. We report two cases in young men. Anatomical variations in the femoral canal could be the primary aetiological factor in these patients. A unilateral femoral hernia in young men with acquired aetiological factors requires a clinical examination of the opposite side.

  5. Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for Inguinal Hernia : The First 1,000 Patients

    NARCIS (Netherlands)

    Lange, J.F.M.; Lange, M. M.; Voropai, D. A.; van Tilburg, M. W. A.; Pierie, J. P. E. N.; Ploeg, R. J.; Akkersdijk, W. L.

    After the introduction of mesh in inguinal hernia repair, the focus to improve surgical technique has changed from recurrence to chronic postoperative inguinal pain. At present, the most common surgical techniques are the Lichtenstein hernioplasty and total extraperitoneal procedure. Both techniques

  6. A Pleomorphic Rhabdomyosarcoma Mimicking an Inguinal Hernia: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Anna Koumarianou

    2012-02-01

    Full Text Available A 59-year-old male presented with a painful right inguinal swelling and deep vein thrombosis at the ipsilateral leg. An inguinal hernia was initially diagnosed, but during surgery a large mass was found anteriorly to the peritoneal sheaths. Histology revealed a high-grade pleomorphic rhabdomyosarcoma. The mass advanced rapidly, occupying the whole right iliac fossa and metastasizing to the lung. Despite first- and second-line chemotherapy, the patient deteriorated rapidly and died. Rhabdomyosarcomas should be managed in specialized centres as they have prognostic factors and histologic features still controversial and poorly clarified.

  7. Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario, Canada.

    Science.gov (United States)

    Malik, Atiqa; Bell, Chaim M; Stukel, Thérèse A; Urbach, David R

    2016-02-01

    The effect of hospital specialization on the risk of hernia recurrence after inguinal hernia repair is not well described. We studied Ontario residents who had primary elective inguinal hernia repair at an Ontario hospital between 1993 and 2007 using population-based, administrative health data. We compared patients from a large hernia specialty hospital (Shouldice Hospital) with those from general hospitals to determine the risk of recurrence. We studied 235 192 patients, 27.7% of whom had surgery at Shouldice hospital. The age-standardized proportion of patients who had a recurrence ranged from 5.21% (95% confidence interval [CI] 4.94%-5.49%) among patients who had surgery at the lowest volume general hospitals to 4.79% (95% CI 4.54%-5.04%) who had surgery at the highest volume general hospitals. In contrast, patients who had surgery at the Shouldice Hospital had an age-standardized recurrence risk of 1.15% (95% CI 1.05%-1.25%). Compared with patients who had surgery at the lowest volume hospitals, hernia recurrence among those treated at the Shouldice Hospital was significantly lower after adjustment for the effects of age, sex, comorbidity and income level (adjusted hazard ratio 0.21, 95% CI 0.19-0.23, p hernia repair at Shouldice Hospital was associated with a significantly lower risk of subsequent surgery for recurrence than repair at a general hospital. While specialty hospitals may have better outcomes for treatment of common surgical conditions than general hospitals, these benefits must be weighed against potential negative impacts on clinical care and the financial sustainability of general hospitals.

  8. Gender-related differences of inguinal hernia and asymptomatic patent processus vaginalis in term and preterm infants.

    Science.gov (United States)

    Burgmeier, Christine; Dreyhaupt, Jens; Schier, Felix

    2015-03-01

    The aim of this study was to analyze the gender-related differences of inguinal hernia (IH) and patent processus vaginalis (PPV) in term and preterm infants. Over a nine-year-period 411 infants underwent laparoscopic herniorrhaphy within the first six months of life. 246 term (191 male; 55 female) and 165 preterm (118 male; 47 female) infants were included in this retrospective study. Initial presentation of IH and intraoperative anatomical findings of PPV were reviewed. We found that term boys (58.6%) and girls (58.2%) predominantly presented with right-sided IH whereas preterm boys (36.4%) and girls (44.7%) mostly presented with bilateral IH. Female babies had a higher incidence of initial left-sided IH. Term and preterm girls with initial left-sided hernia were found to have highest incidence of PPV. Male term babies with initial left-sided IH were found to have the lowest incidence of PPV (25.0%). The highest incidence of PPV in male was found in preterm boys with either left- or right-sided IH. Incidence and laterality of IH and PPV differ between term and preterm girls and boys. In open hernia repair decision concerning contralateral groin exploration should consider term/preterm birth as well as gender. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Single-Port Onlay Mesh Repair of Recurrent Inguinal Hernias after Failed Anterior and Laparoscopic Repairs

    Science.gov (United States)

    Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne J.

    2015-01-01

    Background and Objectives: Despite the exponential increase in the use of laparoscopic inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, a growing number of patients are presenting with recurrent hernias after conventional anterior and laparoscopic repairs have failed. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair of these hernias. Methods: Patients referred with two or more recurrences of inguinal hernia underwent SIL-IPOM from November 1, 2009, to June 24, 2014. A 2.5-cm infraumbilical incision was made, and an SIL port was placed intraperitoneally. Modified dissection techniques were used: chopstick and inline dissection, 5.5-mm/52-cm/30° angled laparoscope, and conventional straight dissecting instruments. The peritoneum was incised above the pubic symphysis, and dissection was continued laterally and proximally, raising the inferior flap below the previous extraperitoneal mesh while reducing any direct, indirect, femoral, or cord lipoma before placement of antiadhesive mesh, which was fixed to the pubic ramus, as well as superiorly, with nonabsorbable tacks before the inferior border was fixed with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh. Results: Nine male patients underwent SIL-IPOM. Their mean age was 53 years and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes, with a hospital stay of 1 day. The umbilical scar length was 23 mm at the 6-week follow-up. There were no intra-/postoperative complications, port-site hernias, chronic groin pain, or recurrence of the hernia during a mean follow-up of 24 months. Conclusion: Inguinal hernias recurring after two or more failed conventional anterior and laparoscopic repairs can be safely and efficiently treated with SIL-IPOM. PMID:25848186

  10. Acute appendicitis in inguinal hernia: report of two cases | Kidmas ...

    African Journals Online (AJOL)

    Amyand's hernia). One patient had gangrenous appendicitis that affected the adjoining caecum. A limited right hemicolectomy was done by extending the groin incision laterally and proximally. The second patient had simple appendicectomy.

  11. Fournier's Gangrene Complicating Ruptùred Richter's Inguinal Hernia

    African Journals Online (AJOL)

    s Gangrene compliquer rompu Richter hernie inguinale: Case Report. U. U. Onakpoya, O. O. Lawal, O. D. Onovo, F. O. Oribabor. ABSTRACT. BACKGROUND: The deceptive entity of Richter's hernia typically presents with complications' that ...

  12. Determinants of a short convalescence after laparoscopic transabdominal preperitoneal inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette Astrup; Strandfelt, Pernille; Forsberg, Gert

    2012-01-01

    Evidence-based recommendations for the expected duration of convalescence after laparoscopic groin hernia repair are not available, and objective reasons for prolonged convalescence are not clear. Our main aim was to establish the expected duration of convalescence using preoperative recommendati......Evidence-based recommendations for the expected duration of convalescence after laparoscopic groin hernia repair are not available, and objective reasons for prolonged convalescence are not clear. Our main aim was to establish the expected duration of convalescence using preoperative...... recommendations to the patient and to identify the limiting factors for early (postoperative) resumption of normal activities after laparoscopic transabdominal preperitoneal inguinal herniorraphy (TAPP)....

  13. Application of tension-free hernia repair under local anesthesia in patients with liver cirrhosis complicated by inguinal hernia

    Directory of Open Access Journals (Sweden)

    SUN Libo

    2017-06-01

    Full Text Available ObjectiveTo investigate the clinical effect of tension-free hernia repair under local anesthesia in patients with liver cirrhosis complicated by inguinal hernia and related application experience. MethodsA retrospective analysis was performed for the clinical data of 167 patients with liver cirrhosis complicated by inguinal hernia who underwent tension-free hernia repair under local anesthesia in our hospital from January 2007 to December 2015. The t-test was used for comparison of continuous data between two groups, and the chi-square test and Fisher’s exact test were used for comparison of categorical data between groups. ResultsAll tension-free hernia repair surgeries were successfully completed, with a mean time of operation of (55.22±21.67 min and a mean postoperative hospital stay of (3.14±186 d. Of all patients, 25 (14.97% experienced complications, and there were 47 complications in total. According to the Child-Pugh class, the patients were divided into Child-Pugh class A/B group and Child-Pugh class C group, and there were significant differences in the mean postoperative hospital stay ((2.72±1.25 d vs (4.43±3.11 d, t=1.984, P<0.05 and incidence rate of postoperative complications (8.78% vs 63.1%, χ2=2.861, P<0.05. In the Child-Pugh class C group, there was no significant difference in the incidence rate of postoperative complications between the patients without improvement in liver function and those with improvement (100% vs 86.7%, P>0.05, but there was a significant difference in the length of postoperative hospital stay (6.85 d vs 3.80 d, P<005. ConclusionTension-free hernia repair under local anesthesia is a simple, safe, and effective method for the treatment of inguinal hernia complicated by liver cirrhosis. Perioperative liver function evaluation and maintenance is important to ensure the implementation of surgery and good postoperative recovery.

  14. Follow-up period of 13 years after endoscopic total extraperitoneal repair of inguinal hernias: A cohort study

    NARCIS (Netherlands)

    A. Brandt-Kerkhof (Alexandra); M. van Mierlo (Marjolein); N.W.L. Schep (Niels); N. Renken (Nondo); L. Stassen (Laurents)

    2011-01-01

    textabstractBackground: Endoscopic inguinal hernia repair was introduced in the Netherlands in the early 1990s. The authors' institution was among the first to adopt this technique. In this study, long-term hernia recurrence among patients treated by the total extraperitoneal (TEP) approach for an

  15. Non-absorbable sutures are associated with lower recurrence rates in laparoscopic percutaneous inguinal hernia ligation.

    Science.gov (United States)

    Grimsby, G M; Keays, M A; Villanueva, C; Bush, N C; Snodgrass, W T; Gargollo, P C; Jacobs, M A

    2015-10-01

    Laparoscopic hernia repair with percutaneous ligation of the patent processes vaginalis is a minimally invasive alternative to open inguinal herniorrhaphy in children. With the camera port concealed at the umbilicus, this technique offers an excellent cosmetic result. It is also faster than the traditional laparoscopic repair with no differences in complication rates or hospital stay. The goal of this study was to describe a series of consecutive patients, emphasizing the impact of suture materials (absorbable vs. non-absorbable) on hernia recurrences. A retrospective review was performed of consecutive transperitoneal laparoscopic subcutaneous ligations of a symptomatic hernia and/or communicating hydrocele by 4 surgeons. Patients > Tanner 2 or with prior hernia repair were excluded. The success of the procedure and number of sutures used was compared between cases performed with absorbable vs. non-absorbable suture. Risk factors for surgical failure (age, weight, number of sutures used, suture type) were assessed with logistic regression. 94 patients underwent laparoscopic percutaneous hernia ligation at a mean age of 4.9 years. Outcomes in 85 (90%) patients with 97 hernia repairs at a mean of 8 months after surgery revealed 26% polyglactin vs 4% polyester recurrences (p = 0.004) which occurred at mean of 3.6 months after surgery, Table 1. Repairs performed with non-absorbable suture required only 1 suture more often than those performed with absorbable suture (76% vs 60%, p = 0.163). Logistic regression revealed suture type was an independent predictor for failure (p = 0.017). Weight (p = 0.249), age (p = 0.055), and number of sutures (p = 0.469) were not significantly associated with recurrent hernia. Our review of consecutive hernia repairs using the single port percutaneous ligation revealed a significantly higher recurrent hernia rate with absorbable (26%) versus non-absorbable (4%) suture. This finding remained significant in a logistic regression model

  16. Wound infections due to Mycobacterium fortuitum after polypropylene mesh inguinal hernia repair.

    Science.gov (United States)

    Celdrán, A; Esteban, J; Mañas, J; Granizo, J-J

    2007-08-01

    Mycobacterium fortuitum complex is a group of rapidly growing mycobacteria (RGM). These opportunistic pathogens are frequently associated with infections related to surgical procedures involving biomaterials. Two cases of Mycobacterium fortuitum infection occurred in a prospective study of inguinal hernia prosthesis repairs. These infections differed from those caused by other bacteria in terms of pathogenic mechanisms, clinical manifestation and resistance to both prophylactic and therapeutic antibiotics.

  17. Endoscopic totally extraperitoneal (TEP) hernia repair for inguinal disruption (Sportsman's hernia): rationale and design of a prospective observational cohort study (TEP-ID-study).

    Science.gov (United States)

    Voorbrood, C E H; Goedhart, E; Verleisdonk, E J M M; Sanders, F; Naafs, D; Burgmans, J P J

    2016-01-06

    Chronic inguinal pain is a frequently occurring problem in athletes. A diagnosis of inguinal disruption is performed by exclusion of other conditions causing groin pain. Up to now, conservative medical management is considered to be the primary treatment for this condition. Relevant large and prospective clinical studies regarding the treatment of inguinal disruption are limited; however, recent studies have shown the benefits of the totally extraperitoneal patch (TEP) technique.This study provides a complete assessment of the inguinal area in athletes with chronic inguinal pain before and after treatment with the TEP hernia repair technique. We describe the rationale and design of an observational cohort study for surgical treatment with the endoscopic TEP hernia repair technique in athletes with a painful groin (inguinal disruption).The study is being conducted in a high-volume, single centre hospital with specialty in TEP hernia repair. Patients over 18 years, suffering from inguinal pain for at least 3 months during or after playing sports, and whom have not undergone previous inguinal surgery and have received no benefit from physiotherapy are eligible for inclusion. Patients with any another cause of inguinal pain, proven by physical examination, inguinal ultrasound, X-pelvis/hip or MRI are excluded.Primary outcome is reduction in pain after 3 months. Secondary outcomes are pain reduction, physical functioning, and resumption of sport (in frequency and intensity). An unrestricted research grant for general study purposes was assigned to the Hernia Centre. This study itself is not directly subject to the above mentioned research grant or any other financial sponsorship. We intend to publish the outcome of the study, regardless of the findings. All authors will give final approval of the manuscript version to be published. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. An inguinal hernia with cryptorchidism with a Leydig cell tumor in an elderly man: A case report

    OpenAIRE

    Zuiki, Toru; Ohki, Jun; Komatsubara, Toshihide; Lefor, Alan Kawarai; Miyahara, Yuzo; Ochi, Masanori; Hirota, Norio

    2017-01-01

    ?Abstract Introduction Cryptorchidism is common in children but is rare in the elderly. It often presents with a constellation of signs and symptoms similar to routine inguinal hernias. We present the case of an elderly man with cryptorchidism containing a Leydig cell tumor and provide clinical insights. Presentation of case An-84-year old man was admitted with an incarcerated right lower quadrant hernia. Both testes were absent on palpation of the scrotum. After reduction of the hernia, comp...

  19. [Total extraperitoneal endoscopic hernioplasty (TEP) in the treatment of incarcerated and irreponible inguinal and femoral hernias].

    Science.gov (United States)

    Mainik, F; Flade-Kuthe, R; Kuthe, A

    2005-12-01

    To estimate the value of TEP in the treatment of incarcerated and irreponible inguinal and femoral hernias more exactly we prospectively collected and evaluated the data of our clinic for the period of Oct. 1999 until Dec. 2003. In this period we performed in total 1 671 hernia repairs including 79 patients suffering from an incarcerated (n = 33) or irreponible (n = 46) inguinal or femoral hernia. Using only the TEP-technique we treated mainly the irreponible hernias (46 patients). In the combination of LAP (laparoscopy) and TEP (27 patients) the laparoscopy provided the possibility to classify as well the incarcerated tissue as the result of the reposition. With this combined technique we treated the majority of the incarcerated hernias. To confirm the recovery of the incarcerated tissue laparoscopy can be of high value at the end of the combined LAP + TEP (2 patients). Thus TEP was performed in 92 % of the cases. In 2 cases we performed a conventional hernioplasty and one operation was finished conventionally after switching from endoscopic to conventional procedure. In 2 patients we performed a laparoscopically supported resection of the incarcerated tissue without patch implantation. 1 patient acquired TAPP. The use of different operative techniques and their combinations demonstrates as well the possibility as the necessity of a differentiated and case adapted proceeding in the treatment of incarcerated hernias. Lethality with 1.2 % and early postoperative morbidity with only 5.0 % were low. The hospitalisation period was 4.7 d on average. Our results are comparable to results of literature and show that TEP-technique and combined TEP + LAP-technique are possible and reasonable for the treatment of incarcerated and irreponible hernias.

  20. The initial experience of introducing the Onstep technique for inguinal hernia repair in a general surgical department

    DEFF Research Database (Denmark)

    Andresen, K; Burcharth, Jakob Hornstrup Frølunde; Rosenberg, J

    2015-01-01

    BACKGROUND AND AIMS: A new technique for the repair of inguinal hernia, called Onstep, has been described. This technique places the mesh in the preperitoneal space medially and between the internal and external oblique muscles laterally. The Onstep technique has not yet been described outside...... the inventors' departments. This study was based on the first 80 patients operated by the Onstep technique in a general surgical department. The objective of the study was to investigate postoperative pain and complications following the Onstep repair of inguinal hernia. MATERIAL AND METHODS: A total of 80...... repair. Inguinal Pain Questionnaire results: 95.5% reported no pain or pain that was easily ignored. CONCLUSIONS: It seems from this study that the Onstep technique is a safe method for inguinal hernia repair regarding perioperative and postoperative complications. The postoperative pain seems...

  1. ULTRAPRO Hernia System versus lichtenstein repair in treatment of primary inguinal hernias: a prospective randomized controlled study.

    Science.gov (United States)

    Karateke, Faruk; Ozyazici, Sefa; Menekse, Ebru; Özdogan, Hatice; Kunt, Mevlüt; Bozkurt, Hilmi; Bali, İlhan; Özdogan, Mehmet

    2014-01-01

    The Lichtenstein repair has been recommended as the gold standard for inguinal hernia repair. However, postoperative discomfort still constitutes a concern and an area for improvement. New mesh materials have been continuously introduced to achieve this goal. The goal of the present study was to investigate the outcomes of ULTRAPRO Hernia System (UHS) compared with Lichtenstein mesh repair. A total of 99 male patients with primary unilateral inguinal hernia were included in the study during the period of September 2010-January 2012. Patients with body mass index>30, comorbid diseases, and anesthetic risk of ASA-III and ASA-IV were excluded. The patients were randomly allocated to operation with the Lichtenstein technique (group L) or UHS. Demographics, operative and postoperative/recovery data, and short- and medium-term outcomes of the patients were recorded. A total of 50 patients in group L and 49 patients in group UHS were analyzed. The median follow-up time for the study was 33 months. There were no significant differences regarding demographics, complications, and rehabilitation between the groups. Overall, there was a prolonged operation time in the UHS group compared with the L group (UHS: 53.7±5.7 minutes; L: 44.5±5.5 minutes; Phernias regarding perioperative course, complications, recovery, and recurrence rates. However, because of reduced costs and the lack of need for the exploration of the preperitoneal space, we conclude that the Lichtenstein technique should be recommended as the first choice.

  2. Caudal anesthesia with sedation for inguinal hernia repair in high risk neonates.

    Science.gov (United States)

    Balent, Eric; Edwards, Mary; Lustik, Michael; Martin, Paul

    2014-08-01

    The use of caudal anesthesia with sedation (CAS) has theoretical benefits over general anesthesia (GA) in high risk neonates undergoing inguinal hernia repair. This benefit has not been established in clinical studies. We compare outcomes of these two approaches at a single institution. A retrospective review was performed of all neonates and preterm infants undergoing inguinal hernia over an 8year period. Of 71 infants meeting inclusion criteria, 50 underwent repair with caudal block and systemic sedation, and 21 with general anesthesia. Minor incidents of respiratory depression requiring non invasive interventions were common in the first 24h post operatively (24% for CAS, 14% with GA), 4% of patients receiving CAS had a respiratory complication which prolonged their hospital stay beyond 24h post operation. Both required conversion to general anesthesia. Statistically significant differences between the two groups were lacking in terms of preoperative risk and post operative outcome. CAS is a safe, effective anesthetic option for high risk neonates undergoing inguinal hernia repair. Patients requiring conversion to GA from CAS may be at increased risk for complications. Large, randomized trials are needed to determine any benefit over GA. Published by Elsevier Inc.

  3. Ultrasound-guided transversus abdominis plane catheters and ambulatory perineural infusions for outpatient inguinal hernia repair.

    Science.gov (United States)

    Heil, Justin W; Ilfeld, Brian M; Loland, Vanessa J; Sandhu, NavParkash S; Mariano, Edward R

    2010-01-01

    Transversus abdominis plane (TAP) blocks anesthetize the lower abdominal wall, and TAP catheters have been used to provide prolonged postoperative analgesia after laparotomy. The use of TAP catheters on an outpatient basis has not yet been described. We present our experience with ultrasound-guided TAP perineural catheter insertion and subsequent management of ambulatory TAP local anesthetic infusions after inguinal hernia repair. Three patients scheduled for unilateral open inguinal hernia repair underwent preoperative posterior TAP catheter placement for postoperative pain management using a technique employing ultrasound guidance alone. A bolus of local anesthetic solution was injected via the catheter in divided doses, and block onset was confirmed before surgery. Postoperatively, a continuous infusion of ropivacaine 0.2% was delivered using a portable infusion pump, and patients were discharged with a prescription for oral analgesics for breakthrough pain and perineural infusion instructions. Patients were followed up daily by telephone. All patients underwent successful TAP catheter insertion and maintained their catheters until postoperative day 2. All patients reported minimal pain for the duration of infusion without the need for any supplemental opioid analgesics, high satisfaction with postoperative analgesia, and no infusion-related complications. An ultrasound-guided TAP catheter and ambulatory local anesthetic perineural infusion are a promising option for prolonged postoperative analgesia after outpatient inguinal hernia repair. A posterior insertion permits preoperative placement by keeping the catheter away from the planned surgical field.

  4. Repair of inguinal hernia: a comparison between extraperitoneal laparoscopy and Lichtenstein open surgery

    Directory of Open Access Journals (Sweden)

    Tavassoli A

    2010-06-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: The inguinal hernia is a common disorder in general surgery. Different methods have been described for repair of these hernias. In modern methods, synthetic mesh is used to cover the wall defect and the most known method is Lichtenstein surgical repair. The laparoscopic totally extra peritoneal procedure (TEP is a newer technique of repairing hernia. The aim of this study is to compare the outcomes of totally extraperitoneal laparoscopic inguinal hernia repair versus Lichtenstein open repair in patients with inguinal hernia."n"nMethods: Among 50 patients, 25 cases underwent Lichtenstein procedure and 25 patients underwent TEP technique for repairing primary unilateral inguinal hernia. Findings during the operation have been recorded and the 12-months follow-up of patients in different views was performed through a questionnaire and then the results were compared."n"nResults: The operation duration, the rate of complications and frequency of recurrence were similar in two groups; but the hospital stay, postoperative pain, chronic groin pain and the required time to return to normal activity were significantly lower in patients who underwent the TEP method compared to the patients who underwent the

  5. A modified laparoscopic hernioplasty (TAPP) is the standard procedure for inguinal and femoral hernias: a retrospective 17-year analysis with 1,123 hernia repairs.

    Science.gov (United States)

    Peitsch, Werner K J

    2014-02-01

    hernias) represented the complete group of hernia sufferers. Patients with symptoms after hernia surgery (n = 5) were invited for a medical checkup by a specialist in hernia surgery at our outpatient unit. The sex, age, and the number of complex hernias of the patients did not differ significantly among the four patient subgroups or in comparison with the entire group. The patients who had received surgery in 1994, 1999, 2004, and 2009 were quizzed by a questionnaire and represented all patients who had hernia surgery from 1993 to 2009. The follow-up response of the living patients in each of the subgroups ranged from 89.5% of those who had hernia surgery 17 years earlier to 95.9% of those who had surgery 2 years earlier. The primary end point of the study was the hernia recurrence rate after a modified TAPP for primary, recurrent, and complex hernias performed 2, 7, 12, and 17 years earlier. The secondary end points of the study focused on the following questions: Is a modified TAPP practicable with acceptable recurrence rates for complex hernias? Do relapse rates show individual surgeon-dependent differences in relation to the learning curve? How many years of postoperative follow-up evaluation are required to determine quantitative recurrence rates (>90% recurrence)? All inguinal and femoral hernias were repaired with a modified TAPP procedure. Hernia defects larger than 1 × 1 cm were closed with nonabsorbable sutures before the mesh was implanted. Within 17 years after surgery, 4 (4.3%) of the 94 study participants treated with a modified TAPP procedure for primary or recurrent inguinal and femoral hernias experienced recurrent hernias (4 recurrences after 117 hernioplasties, 3.4%). Within 12 years after surgery, 4 (1 %) of 302 patients experienced recurrent hernias (4 recurrences after 398 modified TAPP procedures, 1%). Within 7 years after surgery for inguinal or femoral hernias, 8 (3.2%) of 251 patients had relapsed (8 recurrences after 337 modified TAPP

  6. Single-Incision Laparoscopic Intraperitoneal Onlay Mesh Repair for the Treatment of Multiple Recurrent Inguinal Hernias

    Science.gov (United States)

    Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne

    2014-01-01

    Introduction: Despite an exponential rise in laparoscopic surgery for inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, an increasing number of patients present with recurrent hernias after having failed anterior and laparoscopic repairs. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair for these hernias. Materials and methods: All patients referred with multiply recurrent inguinal hernias underwent SIL-IPOM from November 1 2009 to October 30 2013. A 2.5-cm infraumbilical incision was made and a SIL surgical port was placed intraperitoneally. Modified dissection techniques, namely, “chopsticks” and “inline” dissection, 5.5 mm/52 cm/30° angled laparoscope and conventional straight dissecting instruments were used. The peritoneum was incised above the symphysis pubis and dissection continued laterally and proximally raising an inferior flap, below a previous extraperitoneal mesh, while reducing any direct/indirect/femoral/cord lipoma before placement of antiadhesive mesh that was fixed into the pubic ramus as well as superiorly with nonabsorbable tacks before fixing its inferior border with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh. Results: There were 9 male patients who underwent SIL-IPOM. Mean age was 55 years old and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes with hospital stay of 1 day and umbilical scar length of 21 mm at 4 weeks' follow-up. There were no intraoperative/postoperative complications, port-site hernias, chronic groin pain, or recurrence with mean follow-up of 20 months. Conclusions: Multiply recurrent inguinal hernias after failed conventional anterior and laparoscopic repairs can be treated safely and efficiently with SIL-IPOM. PMID:25392643

  7. Chronic pain after TEP inguinal hernia repair, does MRI reveal a cause?

    Science.gov (United States)

    Burgmans, J P J; Voorbrood, C E H; Van Dalen, T; Boxhoorn, R N; Clevers, G J; Sanders, F B M; Naafs, D B J; Simmermacher, R K J

    2016-02-01

    Persistent pain is a known side effect after TEP inguinal repair disabling 2-5% of patients. A standardized diagnostic work-up so far is not available. MRI is a diagnostic tool in the work-up of inguinal hernias. In the present study the yield of MRI in evaluating chronic pain after TEP hernia repair is addressed. In our database patients receiving an MRI scan for groin pain lasting more than 3 months after TEP inguinal hernia repair were identified. A checklist with potential pathologic findings was filled out for each groin by two blinded observers. Findings in painful, pain-free and unoperated groins were compared and statistical analysis done based upon their relative incidences. Cohen's kappa coefficients were calculated to determine interobserver agreement. Imaging studies of 53 patients revealed information regarding 106 groins. Fifty-five groins were painful after the initial operation, 12 were pain-free postoperatively and 39 groins were not operated. None of the predefined disorders was observed statistically more often in the patients with painful groins. Only fibrosis appeared more prevalent in patients with chronic pain (P = 0.11). Interobserver agreement was excellent for identifying the mesh (κ = 0.88) and observing bulging or a hernia (κ = 0.74) and was substantial for detecting fibrosis (κ = 0.63). In 40% of the patients, MRI showed a correct mesh position and observed nothing else than minor fibrosis. A wait and see policy resolved complaints in the majority of the patients. In 15 % of the patients, MRI revealed treatable findings explanatory for persisting groin pain. For patients with post-TEP hernia groin pain, MRI is useful to confirm a correct flat mesh position and to identify possible not operation-related causes of groin pain. It is of little help to identify a specific cause of groin repair-related pain.

  8. Single-incision laparoscopic intraperitoneal onlay mesh repair for the treatment of multiple recurrent inguinal hernias.

    Science.gov (United States)

    Tran, Hanh Minh; Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne

    2014-01-01

    Despite an exponential rise in laparoscopic surgery for inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, an increasing number of patients present with recurrent hernias after having failed anterior and laparoscopic repairs. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair for these hernias. All patients referred with multiply recurrent inguinal hernias underwent SIL-IPOM from November 1 2009 to October 30 2013. A 2.5-cm infraumbilical incision was made and a SIL surgical port was placed intraperitoneally. Modified dissection techniques, namely, "chopsticks" and "inline" dissection, 5.5 mm/52 cm/30° angled laparoscope and conventional straight dissecting instruments were used. The peritoneum was incised above the symphysis pubis and dissection continued laterally and proximally raising an inferior flap, below a previous extraperitoneal mesh, while reducing any direct/indirect/femoral/cord lipoma before placement of antiadhesive mesh that was fixed into the pubic ramus as well as superiorly with nonabsorbable tacks before fixing its inferior border with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh. There were 9 male patients who underwent SIL-IPOM. Mean age was 55 years old and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes with hospital stay of 1 day and umbilical scar length of 21 mm at 4 weeks' follow-up. There were no intraoperative/postoperative complications, port-site hernias, chronic groin pain, or recurrence with mean follow-up of 20 months. Multiply recurrent inguinal hernias after failed conventional anterior and laparoscopic repairs can be treated safely and efficiently with SIL-IPOM.

  9. Usefulness of {sup 18}F-FDG PET/CT to detect metastatic mucinous adencarcinoma within an inguinal hernia

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Hyo Jung; Min, Byung Wook; Eo, Jae Seon; Lee, Sun Il; Kang, Sang Hee; Jung, Sung Yup; Oh, Sang Chul; Choe, Jae Gol [Korea University College of Medicine, Guro Hospital, Seoul (Korea, Republic of)

    2016-03-15

    Metastatic mucinous adenocarcinoma in an inguinal hernia is a rare disease and the image findings of {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) positron emission tomography (PET)/computed tomography (CT) are little known. Here, we introduce a 57-year-old man with metastatic mucinous adenocarcinoma in an inguinal hernia. On initial {sup 18}F-FDG PET/CT, hypermetabolism was observed in mucinous adenocarcinoma of the cecum, and adenocarcinomas of the transverse and ascending colon, respectively. Follow-up {sup 18}F-FDG PET/CT revealed newly developed multiple hypermetabolism in peritoneal seeding masses and nodules in the pelvic cavity and scrotum. Peritoneal carcinomatosis in the right pelvic side wall was extended to the incarcerated peritoneum and mesentery in the right inguinoscrotal hernia. {sup 18}F-FDG PET/CT was useful to reveal unexpected peritoneal seeding within the inguinal hernia. Also, this case demonstrated that metastatic mucinous adenocarcinomas had variably intense FDG uptake.

  10. Exploration Of The Contralateral Groin In Paediatric Inguinal Hernia Or Hydrocele Based On Ultrasound Findings - Is It Justified?

    Science.gov (United States)

    Zaidi, Syed Hashim; Rahman, Javed Ur; Siddiqui, Tariq Saeed; Rehman, Habib Ur; Ahmed, Naveed; Fraz, Muhammad Omar

    2017-01-01

    Routine exploration of contralateral side in cases of unilateral inguinal hernia or hydrocele is a highly debatable topic because of various reasons. The purpose of this study was to analyse whether the contralateral groin exploration in unilateral inguinal hernia/ hydrocele is justified or not, based on ultrasonographic measurements of the inguinal ring diameter. This cross-sectional study was conducted at two naval hospitals, PNS Rahat and PNS Shifa in Karachi, Pakistan, from June 2007 to Aug 2012. Children presenting with unilateral inguinal hernia or hydrocele were included in the study. Ultrasound examination of the contralateral, apparently normal, groin was carried out using a high-resolution 7.5-11 MHz linear array with the patients in supine position. Surgical exploration of the contralateral groin was carried out in those children in whom the diameter of the inguinal canal at the internal ring was 4.5 mm or greater. All those children in whom the contralateral exploration was not done were followed up to 2 years. A total of 287 patients completed the study, including 264 (92%) boys and 23 (8%) girls. In 242 (84%) cases, the mean diameter of internal ring on contralateral (clinically uninvolved) side was 3.5±0.4 mm, considered negative. Out of these 13 (5.4%) cases, however, proved to be false negative after a follow up of two year. There were 45 (16%) cases that underwent contralateral exploration on basis on positive ultrasound findings; 25 (55.6%) were hernias and 14 (31.1%) were hydroceles. In the remaining 6 (13.3%) cases surgical exploration failed to demonstrate hernia or PPV. Contralateral exploration in children with unilateral inguinal hernia or hydrocele, based on ultrasonographic findings, is not only cost effective but can also prevent unnecessary routine contralateral explorations and complications related to inguinal hernias.

  11. Closure of a direct inguinal hernia defect in laparoscopic repair with barbed suture: a simple method to prevent seroma formation?

    Science.gov (United States)

    Li, Junsheng; Zhang, Weiyu

    2018-02-01

    Seroma is a frequent postoperative complication after laparoscopic direct inguinal hernia repair (both in TAPP and TEP). There are several methods to address this problem; however, these techniques are not without problems. The purpose of this study was to introduce and evaluate a new technique to address this problem. This is a prospective study of consecutive patients. All patients diagnosed with direct inguinal hernias eligible for laparoscopic repair were included. A single surgeon performed all the included operations. During laparoscopic inguinal hernia repair (TAPP or TEP), we closed the direct hernia defect with barbed sutures around the transversalis fascia, inverted the apex of the attenuated transversalis fascia, and sutured it at the base to completely eradicate the defect cavity. Prosthetic mesh was not additionally fixed in all patients. The primary postoperative outcome parameter was seroma formation, and secondary outcome parameters included groin pain, surgical complications, and hernia recurrence. Twenty-five male patients with 36 sides of direct hernias were included in this study, and all procedures were carried out laparoscopically and successfully. Only one patient developed significant seroma, which resolved 1 month later. The early postoperative pain was minimal, and no recurrence and chronic pain occurred during the follow-up period (4-13 months). The present direct inguinal hernia defect closing technique with barbed suture is a simple, easily reproducible, and effective method for the prevention of seroma formation.

  12. The Comparison of Lichtenstein Procedure with and without Mesh-Fixation for Inguinal Hernia Repair

    Directory of Open Access Journals (Sweden)

    Feyzullah Ersoz

    2016-01-01

    Full Text Available Aim. Although inguinal hernia repair is the most frequently performed surgical procedure in the world, the best repair method has not gained acceptance yet. The ideal repair must be safe, simple, and easy to perform and require minimal dissection which provides enough exploration, maintain patient’s comfort in the early stage, and also be cost-effective, reducing operation costs, labor loss, hospital stay, and recurrence. Materials and Methods. There were eighty-five patients between the ages of 18 and 75, diagnosed with inguinal hernia in our clinic. Lichtenstein procedure for hernia repair was performed under spinal anesthesia in all patients. Forty-two patients had the standard procedure and, in 43 patients, the polypropylene mesh was used without fixation. All patients were examined and questioned on the 7th day of the operation in terms of pain, scrotal edema, and the presence of seroma and later on in the 6th postoperative month in terms of paresthesia, neuropraxia, and recurrence by a single physician. Results. Operative time and pain scores in the nonfixation group were significantly lower, without any increase in rates of recurrence. Conclusion. Based on these findings, in Lichtenstein hernia repair method, nonfixation technique can be used safely with better results.

  13. The Comparison of Lichtenstein Procedure with and without Mesh-Fixation for Inguinal Hernia Repair

    Science.gov (United States)

    Ersoz, Feyzullah; Culcu, Serdar; Duzkoylu, Yigit; Bektas, Hasan; Sari, Serkan; Arikan, Soykan; Deniz, Mehmet Mehdi

    2016-01-01

    Aim. Although inguinal hernia repair is the most frequently performed surgical procedure in the world, the best repair method has not gained acceptance yet. The ideal repair must be safe, simple, and easy to perform and require minimal dissection which provides enough exploration, maintain patient's comfort in the early stage, and also be cost-effective, reducing operation costs, labor loss, hospital stay, and recurrence. Materials and Methods. There were eighty-five patients between the ages of 18 and 75, diagnosed with inguinal hernia in our clinic. Lichtenstein procedure for hernia repair was performed under spinal anesthesia in all patients. Forty-two patients had the standard procedure and, in 43 patients, the polypropylene mesh was used without fixation. All patients were examined and questioned on the 7th day of the operation in terms of pain, scrotal edema, and the presence of seroma and later on in the 6th postoperative month in terms of paresthesia, neuropraxia, and recurrence by a single physician. Results. Operative time and pain scores in the nonfixation group were significantly lower, without any increase in rates of recurrence. Conclusion. Based on these findings, in Lichtenstein hernia repair method, nonfixation technique can be used safely with better results. PMID:27200411

  14. Bilateral lumbar hernias in a domestic shorthair cat.

    Science.gov (United States)

    Olin, Shelly J; Holmes, Shannon P; Jeffs, Ashley; Cornell, Karen K

    2012-12-01

    A 2.8-kg (6.1-lb) 4-month-old sexually intact female domestic shorthair cat was referred for evaluation of bilateral, subcutaneous lumbar masses that were presumed to be the kidneys. Physical examination findings included 2 mobile, nonpainful, 3×3-cm, bilaterally symmetric masses in the dorsolateral lumbar region. Abdominal radiography, ultrasonography, and CT confirmed bilateral body wall defects with renal herniation. Serum biochemistry profile, urinalysis, and excretory urography confirmed normal renal function. Exploratory laparotomy, reduction of the kidneys, repair of the body wall defects, bilateral nephropexy, and ovariohysterectomy were performed. There were no perioperative complications. Lumbar hernia has not been reported previously in a cat. It is important for veterinarians to be aware that although rare, lumbar hernia should be included in the list of differential diagnoses for a lumbar mass or signs of chronic lumbar pain in cats.

  15. UltraPro Hernia System, Prolene Hernia System and Lichtenstein for primary inguinal hernia repair: 3-year outcomes of a prospective randomized controlled trial.

    Science.gov (United States)

    Magnusson, J; Nygren, J; Gustafsson, U O; Thorell, A

    2016-10-01

    Chronic pain and discomfort are common after inguinal hernia repair (IHR). In this study, results from a 3-year follow-up from a randomized controlled study comparing three different mesh repairs for postoperative pain, discomfort, Quality of Life (QoL) and patient satisfaction are reported. Between November 1, 2006 and January 31, 2009, 309 men, who underwent day surgery for primary unilateral inguinal hernia under local anesthesia, were randomized to three different mesh repairs; UltraPro Hernia System (U), Prolene Hernia System (P) and Lichtenstein procedure (L). Preoperatively, there were no differences between groups regarding demographics, symptoms, inguinal pain or QoL (SF-36 and a hernia-specific questionnaire). Operating time, postoperative pain, complications and time to full recovery were similar. At 36 months, 21 patients indicated pain [L, n = 6, P, n = 6 and U, n = 9; VAS (median (IQR)): L 0.4 (0.2-1.7), P 0.2 (0.1-2.3) and U 1.6 (0.7-4.6), p = ns]. Physical QoL was reduced in all groups before surgery and was similarly increased to normal levels after 3 months without further changes throughout the study. Although 92 % of participants were satisfied, sixteen percent reported any discomfort from the groin (ns between groups). Five recurrences were reported (L, n = 2, P, n = 1 and U, n = 2, p = ns). After 3 years of follow-up, all three procedures provided equally good results regarding, pain, discomfort and QoL and could therefore be recommended for primary IHR in LA.

  16. Post operative pain control in inguinal hernia repair: comparison of ...

    African Journals Online (AJOL)

    Background: Post-operative pain control is a key factor in surgery. It greatly increases patient satisfaction, and influences the hospital stay period. Local wound infiltration has often been used to control postoperative pain following hernia surgery, with the use of the conventional local anesthetics like Lidocaine or ...

  17. Inguinal hernia repair at the Aga Khan Hospital, Nairobi: Practice ...

    African Journals Online (AJOL)

    Nairobi between 2004-5 by all surgeons with admitting privileges were reviewed. The methods of repair were ... is difficult to justify its utility in an environment where meshes are easily available. Introduction. The repair of .... principle including plug repairs, plug and onlay meshes and the prolene hernia system (8). The.

  18. Inguinal hernia repair: is there a benefit to using the robot?

    Science.gov (United States)

    Charles, Eric J; Mehaffey, J Hunter; Tache-Leon, Carlos A; Hallowell, Peter T; Sawyer, Robert G; Yang, Zequan

    2017-10-24

    The number of robotic surgical procedures performed yearly is constantly rising, due to improved dexterity and visualization capabilities compared with conventional methods. We hypothesized that outcomes after robotic-assisted inguinal hernia repair would not be significantly different from outcomes after laparoscopic or open repair. All patients undergoing inguinal hernia repair between 2012 and 2016 were identified using institutional American College of Surgeons National Surgical Quality Improvement Program data. Demographics; preoperative, intraoperative, and postoperative characteristics; and outcomes were evaluated based on method of repair (Robot, Lap, or Open). Categorical variables were analyzed by Chi-square test and continuous variables using Mann-Whitney U. A total of 510 patients were identified who underwent unilateral inguinal hernia repair (Robot: 13.8% [n = 69], Lap: 48.1% [n = 241], Open: 38.1% [n = 191]). There were no demographic differences between groups other than age (Robot: 52 [39-62], Lap: 57 [45-67], and Open: 56 [48-67] years, p = 0.03). Operative duration was also different (Robot: 105 [76-146] vs. Lap: 81 [61-103] vs. Open: 71 [56-88] min, p Robot: 2.9% [2], Lap: 3.3% [8], Open: 5.2% [10], p = 0.53). Although rare, there was a significant difference in rate of postoperative skin and soft tissue infection (Robot: 2.9% [2] vs. Lap: 0% [0] vs. Open: 0.5% [1], p = 0.02). Cost was significantly different between groups (Robot: $7162 [$5942-8375] vs. Lap: $4527 [$2310-6003] vs. Open: $4264 [$3277-5143], p robotic-assisted inguinal hernia repair were similar to outcomes after laparoscopic or open repair. Longer operative duration during robotic repair may contribute to higher rates of skin and soft tissue infection. Higher cost should be considered, along with surgeon comfort level and patient preference when deciding whether inguinal hernia repair is approached robotically.

  19. Inguinal Hernia Development in Very Low-Birth-Weight Infants: A Case-Control Study.

    Science.gov (United States)

    Unal, Sezin; Isik, Dilek Ulubas; Bas, Ahmet Yagmur; Arslan, Zehra; Demirel, Nihal

    2017-08-01

    Introduction The incidence and risk factors for inguinal hernia (IH) is not a thoroughly evaluated issue of preterms. Prematurity is the single most important risk factor. There exists no study in our country which reported the incidence of IH in preterms. The purpose of this study is to investigate the incidence and time of diagnosis of IH in very low-birth-weight (VLBW) infants. Patients and Methods This retrospective case-control study was conducted in Etlik Zubeyde Hanim Women's Health Training and Research Hospital and included discharged VLBW infants with gestational age less than 32 weeks. Control group included gender, birth weight, and gestational age matched VLBW infants without IH. Results The incidence of IH was 10.1% in VLBW infants (70/693) and 16.1% in extremely low-birth-weight infants (19/174). Male/female ratio was found as 3.4:1. Most IH appeared as bilateral (40.0%). Time of diagnosis was 39 (37-42) weeks of postmenstrual age while 68.6% of infants were diagnosed after discharge. IH development increased by 2.3-folds by having respiratory distress syndrome and by 4.5 folds by achieving full enteral feeds on or after the 10th day. Conclusion Preterms with respiratory distress syndrome and those reach full enteral feeding on or after the 10th day should be monitored carefully for IH development. Bearing in mind that a significant amount of IH cases exhibit symptoms after discharge, neonatologists should inform the parents of premature infants of the issue and close attention should be paid in postdischarge follow-up examinations. Georg Thieme Verlag KG Stuttgart · New York.

  20. A COMPARATIVE STUDY IN LAPAROSCOPIC INGUINAL HERNIA REPAIR BETWEEN FIXATION VS NON-FIXATION OF MESH

    Directory of Open Access Journals (Sweden)

    Ayush

    2016-02-01

    Full Text Available INTRODUCTION An inguinal hernia is a weakness in the wall of the abdominal cavity that is large enough to allow escape of soft body tissue or internal organ, especially a part of the intestine. It usually appears as a lump and for some peoples can cause pain and discomfort, limit daily activities and the ability to work. If the bowel strangulates or becomes obstructed it can be life-threatening. A hernia is repaired generally using a synthetic mesh either with open surgery or increasingly using less invasive laparoscopic procedures. AIMS AND OBJECTIVES To compare and evaluate Laparoscopic hernia repair (trans-abdominal pre-peritoneal and total extra peritoneal repair (TAPP & TEP using Prolene mesh with or without fixation. MATERIAL AND METHODS Our study was conducted in dept. of surgery, Government Medical College and associated Dr. Susheela Tiwari Hospital. A total sample of 100 patients who underwent inguinal hernia repair as an elective surgery. 50 of whom underwent fixation of mesh (fixation will be done either by tacker or suture. Rest 5o underwent non fixation of mesh. RESULTS In our study Statistically there was non-significant heterogeneity in operating time (p = 0.15, post-operative pain (p = 0.45, post-operative complications (p = 0.55 and length of hospital stay (p = 0.11 were statistically comparable between two techniques of mesh fixation in LIHR. The risk of developing chronic groin pain (p = 0.67 and risk of hernia recurrence (p = 0.77 was also similar. CONCLUSION NMF in LIHR does not increase the risk of hernia recurrence. It is comparable with TMF in terms of operation time, post-operative pain, post-operative complications, length of hospital stay and chronic groin pain. Therefore, based upon the results of our study NMF approach may be adopted routinely and safely in LIHR.

  1. [Cost analysis of inguinal hernia surgery in ambulatory and inpatient management].

    Science.gov (United States)

    van den Oever, R; Debbaut, B

    1996-01-01

    In Belgium 27,426 hernia repairs were performed in 1994 but only 1,451 (5.29%) were done on ambulatory basis, whereas in the U.S. over 50% of the yearly 600,000 hernia repairs are one day surgery procedures with interstate variation ranging from 6% to 89%. The mean treatment cost of inguinal hernia repair (doctors fees + hotel cost) was 53,704 BEF for inpatients vs. 30,510 BEF (general anesthesia) and 27,501 BEF (local anesthesia) for outpatients. Rates of complication and recurrence were not significantly different. This difference in total costs for hospital admission are determined by the mean length of stay and by the individual forfeitairy day price according to size of the hospital. Also the use of routine diagnostic procedures (clinical chemistry and medical imaging) - not necessarily essential for treatment - is higher at hospitalization. Even with 50% of all hernia repairs carried out in the one day clinic, total cost savings for treatment will hardly exceed 20% if the mean length of stay of the remaining inpatients will not decrease simultaneously. Supplementary and dramatic cost reductions however are possible by an earlier resumption of professional activities. The mean advised sick leave period of 4 weeks (+/- 2) still depends on irrelevant parameters as tradition, patients' preferences, job characteristics and type of insurance. Total costs for work incapacity add up to 2.5 billion BEF (vs. 1.4 billion BEF for total treatment costs) and can be cut by 50.18% via a mean 2 weeks earlier return to work. Since open primary hernia repair under local anesthesia can be easily carried out on outpatients resuming unrestricted daily activities in less than 1 week, the laparoscopic procedure with general anesthesia, higher treatment cost (endoscopic material) and still debated advantages in convalescence time and long-term outcome is not the gold standard for uncomplicated inguinal hernia.

  2. An Incarcerated Colon Inguinal Hernia That Perforated into the Scrotum and Exhibited an Air-Fluid Level

    Directory of Open Access Journals (Sweden)

    Seisuke Ota

    2015-01-01

    Full Text Available There are few reports of a transverse colon inguinal hernia; furthermore, an inguinal hernia perforating the scrotum is rare. Here we report the case of a 79-year-old man who died after developing an incarcerated colon inguinal hernia that perforated the scrotum and exhibited an air-fluid level. The patient was referred to our hospital in November 2011 with a complaint of inability to move. Physical examination revealed an abnormally enlarged left scrotum and cold extremities. He reported a history of gastric cancer that was surgically treated more than 30 years ago. His white blood cell count and C-reactive protein level were elevated. Abdominal and inguinal computed tomography revealed that his transverse colon was incarcerated in the left inguinal canal. Free air and air-fluid level were observed around the transverse colon, suggestive of a perforation. The patient and his family refused any surgical intervention; therefore, he was treated with sultamicillin tosilate hydrate and cefotiam hydrochloride. However, he succumbed to panperitonitis 19 days after admission. The findings from this case indicate that the transverse colon can perforate into an inguinal hernia sac.

  3. Health status one year after TransInguinal PrePeritoneal inguinal hernia repair and Lichtenstein’s method : An analysis alongside a randomized clinical study

    NARCIS (Netherlands)

    Koning, G.G.; de Vries, J.; Borm, G.F.; Koeslag, L.; Vriens, P.W.; van Laarhoven, C.J.

    2013-01-01

    Background The Lichtenstein technique is the treatment of first choice according to guidelines for primary inguinal hernia treatment. Postoperative chronic pain has been reported as complication in 15–40 % after Lichtenstein’s repair. The postoperative effects on health status after open

  4. Tension free open inguinal hernia repair using an innovative self gripping semi-resorbable mesh

    Directory of Open Access Journals (Sweden)

    Chastan Philippe

    2006-01-01

    Full Text Available Aims: Inguinal hernia repair according to Lichtenstein technique has become the most common procedure performed by general surgeons. Heavy weight polypropylene meshes have been reported to stimulate inflammatory reaction responsible for mesh shrinkage when scar tissue evolved. Additionally, some concerns remain regarding the relationship between chronic pain and mesh fixation technique. In order to reduce those drawbacks, we have developed a new mesh for anterior tension free inguinal hernia repair which exhibits self-gripping absorbable properties. Materials and Methods: 52 patients (69 hernias were prospectivly operated with this mesh (SOFRADIM-France made of low-weight isoelastic large pores knitted fabric which incorporated resorbable micro hooks that provides self gripping properties to the mesh during the first months post-implantation. The fixation of the mesh onto the tissues is significantly facilitated. The mesh is secured around the cord with a self gripping flap. After complete tissular ingrowth and resorption of the PLA hooks, the low-weight (40 g/m2 polypropylene mesh insures the long term wall reinforcement. Results: Peroperativly, no complication was reported, the mesh was easy to handle and to fix. Discharge was obtained at Day 1. No perioperative complication occurred, return to daily activities was obtained at Day 5.5. At one month, no neurological pain or other complications were described. Conclusions: Based on the first results of this clinical study, this unique concept of low density self gripping mesh should allows an efficient treatment of inguinal hernia. It should reduce postoperative complications and the extent of required suture fixation, making the procedure more reproducible

  5. Laparoscopic versus open inguinal hernia repair in patients with obesity: an American College of Surgeons NSQIP clinical outcomes analysis.

    Science.gov (United States)

    Froylich, Dvir; Haskins, Ivy N; Aminian, Ali; O'Rourke, Colin P; Khorgami, Zhamak; Boules, Mena; Sharma, Gautam; Brethauer, Stacy A; Schauer, Phillip R; Rosen, Michael J

    2017-03-01

    The laparoscopic approach to inguinal hernia repair (IHR) has proven beneficial in reducing postoperative pain and facilitating earlier return to normal activity. Except for indications such as recurrent or bilateral inguinal hernias, there remains a paucity of data that specifically identities patient populations that would benefit most from the laparoscopic approach to IHR. Nevertheless, previous experience has shown that obese patients have increased wound morbidity following open surgical procedures. The aim of this study was to investigate the effect of a laparoscopic versus open surgical approach to IHR on early postoperative morbidity and mortality in the obese population using the National Surgical Quality Improvement Program (NSQIP) database. All IHRs were identified within the NSQIP database from 2005 to 2013. Obesity was defined as a body mass index ≥30 kg/m2. A propensity score matching technique between the laparoscopic and open approaches was used. Association of obesity with postoperative outcomes was investigated using an adjusted and unadjusted model based on clinically important preoperative variables identified by the propensity scoring system. A total of 7346 patients met inclusion criteria; 5573 patients underwent laparoscopic IHR, while 1773 patients underwent open IHR. On univariate analysis, obese patients who underwent laparoscopic IHR were less likely to experience a deep surgical site infection, wound dehiscence, or return to the operating room compared with those who underwent an open IHR. In both the adjusted and unadjusted propensity score models, there was no difference in outcomes between those who underwent laparoscopic versus open IHR. The laparoscopic approach to IHR in obese patients has similar outcomes as an open approach with regard to 30-day wound events. Preoperative risk stratification of obese patients is important to determining the appropriate surgical approach to IHR. Further studies are needed to investigate the

  6. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Bisgaard, Thue; Kehlet, Henrik

    2011-01-01

    and guidelines have been approved by the Danish Surgical Society. Diagnosis of groin hernia is based on clinical examination. Ultrasonography, CT or MRI are rarely needed, while herniography is not recommended. In patients with indicative symptoms of hernia, but no detectable hernia, diagnostic laparoscopy may...... a mesh secured with a nonabsorbable monofilament suture. In laparoscopic repair a mesh without a slit and with a minimum size of 15 by 10 cm is used. For mesh fixation absorbable or nonabsorbable tacks or glue can be used. Elective surgery for groin hernia should be performed in an outpatient setting...

  7. [Spinal anesthesia versus general anesthesia in the surgical treatment of inguinal hernia. Cost-effectiveness analysis].

    Science.gov (United States)

    Fernández-Ordóñez, M; Tenías, J M; Picazo-Yeste, J

    2014-05-01

    To compare the costs related to the clinical effectiveness of general anesthesia versus spinal anesthesia in inguinal hernioplasty ambulatory surgery. An observational, retrospective cohort study measurement and analysis of cost-effectiveness, in the ambulatory surgery unit of a general hospital. All patients over 18 years of age diagnosed with primary inguinal hernia and scheduled for unilateral hernioplasty between January 2010 and December 2011 were included. Duration of anesthetic induction, length of stay in both the operating room, and in the post-anesthesia care unit, the anesthetic effectiveness (the incidence of adverse effects and the patient's comfort level), and variable economic costs associated with the use of drugs, as well as the use of human resources, were compared. The final analysis included 218 patients, 87.2% male, with a mean age of 53 years (range: 18-85 years). Of these, 139 (63.76%) received subarachnoid anesthesia and 79,(36.2%) general anesthesia. The length of time a patient remained in the post-anesthesia care unit was 337.6±160.2min in the subarachnoid anesthesia group, and 210.0±97.5min for the general anesthesia group (Poutpatient inguinal hernia repair surgery. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  8. COMPARISON OF UNILATERAL PARAVERTEBRAL BLOCK WITH SUBARACHNOID BLOCK FOR POSTOPERATIVE ANALGESIA IN UNILATERAL INGUINAL HERNIA SURGERIES

    Directory of Open Access Journals (Sweden)

    Girish Sharma

    2017-10-01

    Full Text Available BACKGROUND Paravertebral Block (PVB is emerging as an alternative anaesthesia technique for inguinal hernia repair with some advantages over Subarachnoid Block (SAB. This study compares unilateral paravertebral block with subarachnoid block for postoperative analgesia in unilateral inguinal hernia surgeries. The aim of the study is to study the comparison of Paravertebral Block (PVB with Subarachnoid Block (SAB for postoperative pain at 0, 1, 2, 4, 6, 12 and 24 hours and analgesic requirement in first 24 hours in unilateral inguinal hernia surgeries. The onset and extent of sensory and motor block, time to ambulation and patient and surgeon comfort level were also assessed. MATERIALS AND METHODS Sixty adult male patients, aged 18-65 years with American Society of Anaesthesiologist (ASA grade I and II presenting for unilateral inguinal hernia repair over a period of one year were allocated into two groups to receive SAB (Group I, 2.5 cc of 0.5% bupivacaine with clonidine 30 µg at L3-4 level or PVB (Group II, 30 mL of 0.25% bupivacaine and clonidine 30 µg given at T10, T12 and L2 level. The primary objective was to assess postoperative pain scores on Visual Analogue Scale (VAS of 0- 10 at 0, 1, 2, 4, 6, 12 and 24 hours and analgesic requirement in first 24 hours after surgery. Secondary objectives were to compare onset and depth of sensory and motor block, intraoperative haemodynamic, patient and surgeon comfort level and time for ambulation were also recorded. RESULTS Onset of sensory block was faster in Group I (4.5 ± 0.5 vs. 13.1 ± 0.6 mins. in Group II (P value ˂0.001. PVB had advantage of limited extent of sensory and motor block (T8 to L3 as compared to T6 to S5 in Group I. Postoperative Visual Analogue Scale (VAS was lower in Group II at 4, 6 and 12 hours (P value ˂0.001. The mean consumption of diclofenac sodium in first 24 hours in Group I was 72.5 mg while in Group II was 7.5 mg (P value ˂0.001. Patient (76.6% vs. 56.6% and

  9. Bilateral Morgagni hernias association with left Bochdalek diaphragmatic hernia: a very rare anomaly.

    Science.gov (United States)

    Niramis, Rangsan; Poocharoen, Wannisa; Watanatittan, Sukawat

    2008-10-01

    Morgagni hernia association with Bochdalek diaphragmatic hernia is a very rare congenital anomaly. The authors reported a 2-year-and-2-month-old boy with Down syndrome who has a history of recurrent pneumonia over a one-year period. A chest film of the first admission at 6 months of age revealed only minimal pulmonary infiltration and normal findings of both sides of the diaphragm. The last investigations with chest films and CT scan were suggestive of sequestration of the right lung with left Morgagni and left Bochdalek diaphragmatic hernias. An exploratory laparotomy revealed bilateral Morgagni and left Bochdalek hernias with hernial sacs in all of the diaphragmatic defects. All of the hernial sacs were excised and the diaphragmatic defects were closed with 2-0 silk interruptedly. Postoperative course was uneventful and he was doing well during his follow-up at one year.

  10. Laparoscopic (TEP) versus Lichtenstein inguinal hernia repair: a comparison of quality-of-life outcomes.

    Science.gov (United States)

    Myers, Eddie; Browne, Katherine M; Kavanagh, Dara O; Hurley, Michael

    2010-12-01

    Laparoscopic inguinal hernia repair has emerged as a viable alternative to the open procedure. To date, few studies have included validated measures of quality of life as end points. We compared quality-of-life outcomes following laparoscopic versus open repair of inguinal hernia. All laparoscopic repairs were performed via the totally extraperitoneal route (TEP). All open procedures were Lichtenstein repairs (LR). Hernia repairs performed between January 1999 and December 2006 were included in the study. Data was recorded prospectively and each TEP repair was matched with a LR for analysis. The SF-36 form was used to assess quality of life. Statistical significance was determined using the two-sample Wilcoxon rank-sum (Mann-Whitney) test. Three hundred fourteen procedures were performed during the study period, 164 (52%) had a TEP repair and 150 (48%) had a LR. Ninety TEP repairs were matched with 90 LR. Recurrence rates were 3% following TEP repair and 2% following LR. There was a significant difference between the laparoscopic and open groups in terms of physical function (p = 0.0001), physical role (p TEP repair results in less postoperative pain, a quicker return to normal functional status, and improved quality-of-life outcomes with equivalent recurrence rates when compared to the LR.

  11. Immunohistochemical evaluation of fibrillar components of the extracellular matrix of transversalis fascia and anterior abdominal rectus sheath in men with inguinal hernia

    Directory of Open Access Journals (Sweden)

    Rogério De Oliveira Gonçalves

    Full Text Available OBJECTIVE: to evaluate the role of fibrillar extracellular matrix components in the pathogenesis of inguinal hernias. METHODS: samples of the transverse fascia and of the anterior sheath of the rectus abdominis muscle were collected from 40 men aged between 20 and 60 years with type II and IIIA Nyhus inguinal hernia and from 10 fresh male cadavers (controls without hernia in the same age range. The staining technique was immunohistochemistry for collagen I, collagen III and elastic fibers; quantification of fibrillar components was performed with an image analysis processing software. RESULTS: no statistically significant differences were found in the amount of elastic fibers, collagen I and collagen III, and the ratio of collagen I / III among patients with inguinal hernia when compared with subjects without hernia. CONCLUSION: the amount of fibrillar extracellular matrix components did not change in patients with and without inguinal hernia.

  12. Laparoscopic Repair of Primary Inguinal Hernia Performed in Public Hospitals or Low-Volume Centers Have Increased Risk of Reoperation for Recurrence

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Friis-Andersen, Hans; Rosenberg, Jacob

    2016-01-01

    BACKGROUND: Inguinal hernia repair is traditionally carried out as either open or laparoscopic repair. Laparoscopic repair has been shown to be superior in terms of pain and discomfort, but has a higher risk of reoperation. Quality of inguinal hernia repair is related to factors such as method...... of care. METHODS: This study was based on data from the Danish Hernia Database covering the period from January 1, 1998, to December 31, 2013. Hernia repairs included in this study were laparoscopic repair of primary, inguinal hernias in the elective setting, performed on adult male patients. RESULTS...... reoperation rate compared with public centers: 5.36% versus 8.53%, P ≤ .0001. Type of center and center volume were both independent risk factors for reoperation in a Cox regression model. CONCLUSION: Hospital volume had an effect on the reoperation rate for recurrence after laparoscopic inguinal hernia...

  13. Use of resterilized polypropylene mesh in inguinal hernia repair: a prospective, randomized study.

    Science.gov (United States)

    Cingi, Asim; Manukyan, Manuk N; Güllüoğlu, Bahadir M; Barlas, Afşar; Yeğen, Cumhur; Yalin, Rifat; Yilmaz, Nuray; Aktan, A Ozdemir

    2005-12-01

    Inguinal hernia repair consumes considerable health-care resources worldwide. Open mesh repairs are commonly used and the feasibility of using a resterilized mesh, which is a general practice in certain countries, has not been evaluated. In this randomized prospective study, original and resterilized meshes were used in two groups of patients with unilateral inguinal hernia. Microbiologic changes, textile mechanical properties, overall complication rates, and cost-effectiveness of resterilized mesh were investigated. A time period of 3 years was determined for patient enrollment to this pilot feasibility study, with the goal of 100 patients in each group. Ninety-one patients were enrolled in the original group and 93 in the resterilized mesh group. Median followup was 735 and 739 days and calculated interquartile ranges were 454 and 513 days, respectively. Average tensile strength of the original polypropylene mesh changed slightly with resterilization, as maximum load decreased from a mean of 66.6 to 58.2 N/cm. Overall complication rates were similar in the two groups. The 6.6% infection rate in the original mesh group was not statistically different from the 7.5% rate in the resterilized group (p = 0.80, relative risk = 0.88, 95% confidence interval, 0.31-2.51). There was only one recurrence in the original mesh group in the 21st month. Use of a resterilized mesh decreased the overall cost of operation by decreasing the cost of mesh from 15.9% to 8.3% of the total amount. Use of a resterilized mesh for inguinal hernia repair is feasible without considerable changes in infection and recurrence rates.

  14. Implante con el sistema de reparación herniaria inguinal de prolene (Prolene hernia system

    Directory of Open Access Journals (Sweden)

    José Goderich Lalán

    2002-04-01

    Full Text Available Se realizó un estudio clinicodescriptivo y prospectivo del seguimiento de 21 pacientes a los que se les realizó implante sistema de reparación herniaria inguinal de prolene en hernias inguinales, reproducidas entre el 15 de octubre de 1998 y el 31 de marzo de 1999, con el objetivo de evaluar sus resultados. En todos los casos se utilizó el método de cirugía de corta estadía, anestesia local y sedación o espinal y antibioticoterapia profiláctica. En el seguimiento a muy corto plazo no se reportan recidivas y ninguna complicación posoperatoria. Más de la mitad de los pacientes había recibido más de 2 operaciones. La media de edad fue 49 años y el sexo predominante el masculino. La técnica que se utilizó para implante fue la recomendada por los fabricantesA clinical descriptive and prospective study of the follow-up of 21 patients who received implant of the Prolene inguinal hernia repair system in inguinal hernias reproduced between October l5th, 1998, and March 31st, 1999, was conducted aimed at evaluating the results. The short-stay surgery method, local anesthesia and sedation, or spinal anesthesia and prophylactic antibiotic therapy were used in all cases. No relapses or postoperative complications were reported in a very short-term follow-up. More than half of the patients had undergone more than 2 operations. Average age was 49 and there was a predominance of males. The technique used for the implant was the one recommended by the manufacturers

  15. The Ultrasound Diagnosis of Round Ligament Varices That Mimicked Inguinal Hernias During Pregnancy:A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hyung Jo; Shin, Hyun Woong; Kim, Seong Hun [Daegu Fatima Hospital, Daegu (Korea, Republic of); Cho, Sang Hee; Byun, Kyung Hwan [CHA Gumi Medical Center, CHA University, Gumi (Korea, Republic of)

    2010-03-15

    Round ligament varices during pregnancy are an important part of the differential diagnosis of inguinal hernia as they may cause symptoms and clinical features that are similar to those of inguinal hernia. When this condition is correctly diagnosed, an unnecessary operation may be prevented. The diagnosis of round ligament varices should be considered for pregnant women who present with a palpable mass in the groin. We describe here a case of round ligament varices that presented during pregnancy and this was readily diagnosed with Doppler sonography

  16. Ultrasonographic diagnosis of round ligament varicosities mimicking inguinal hernia: report of two cases with literature review

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Kyeong Hwa; Yoon, Jung Hee [Dept. of Radiology, Inje University Haeundae Paik Hospital, College of Medicine, Busan (Korea, Republic of)

    2014-10-15

    Round ligament varicosities are rare, and the mass mimics an inguinal hernia. Round ligament varicosities should be considered in the differential diagnosis of a groin swelling in a female, especially during pregnancy. The diagnosis of round ligament varicosities can be established on grayscale and color Doppler ultrasonography. We report two cases of round ligament varicosities in a 33-year-old non pregnant woman and a 28-year-old pregnant woman, and these patients were diagnosed using ultrasonography. We also reviewed the literature on round ligament varicosities including the present cases. Ultrasonography is diagnostic and can prevent unnecessary surgical intervention and associated morbidity.

  17. Laparoscopic Partial Cystectomy With Excision of Mesh Migration Into the Bladder Following Repair of Inguinal Hernia

    Directory of Open Access Journals (Sweden)

    Satoshi Funada

    2016-09-01

    Full Text Available Migration of hernia mesh into the bladder is a rare complication of inguinal hernioplasty. We present the case of an 85-year-old man who complained of hematuria and fever some 20 years after right hernioplasty. Cystoscopy and computed tomography revealed mesh migration into the right anterior wall of the bladder. Laparoscopic partial cystectomy with excision of the migrated mesh was performed successfully. To our knowledge, this is the first case of mesh migration into the bladder treated by laparoscopic partial cystectomy.

  18. [Pre-surgical period and non-work-related sickness absence due to inguinal hernia].

    Science.gov (United States)

    Ruiz-Moraga, Montserrat; Catalina-Romero, Carlos; Martínez-Muñoz, Paloma; Cobo-Santiago, María Dolores; González-López, Maite; Cabrera-Sierra, Martha; Porrero-Carro, José Luis; Calvo-Bonacho, Eva

    2014-04-01

    To analyze non-work-related sickness absence (NWR-SA) due to inguinal hernia and the factors related to its duration, paying particular attention to the pre-surgical period of NWR-SA. Prospective cohort study was conducted on 1,003 workers with an episode of NWR-SA due to an inguinal hernia, belonging to the insured population of a mutual insurance company. We assessed the duration of the NWR-SA episodes and the main demographic, occupational and clinical variables potentially related to it. Cox regression analyses were conducted to establish the predictors of NWR-SA duration. The mean duration of NWR-SA due to inguinal hernia was 68.6 days. After multivariate analysis (Cox regression), having a pre-surgical period of NWR-SA (HR = 0.35; 95%CI: 0.28-0.43), manual occupations (HR=0.68; 95%CI: 0.49-0.95), construction sector (HR=0.71; 95%CI: 0.58-0.88), direct payment methods by a Mutual Insurance Company during sick leave in self-employed workers (HR=0.58; 95%CI, 0.41-0.82), or employees (HR=0.51; 95%CI: 0.36-0.72), comorbidity (HR=0.45; 95%CI:0.34-0.59), and surgery performed under an entity other than the Public Health System or a mutual insurance company (HR=0,76; 95%CI: 0.59-0.97) were associated with longer NWR-SA. The Mutual Insurance Company always performed the surgery when a pre-surgery period of NWR-SA existed (mean duration=47 ±39.6 days); that was associated with shorter periods of post-surgical NWR-SA (P=.001). The NWR-SA due to inguinal hernia is a multifactorial phenomenon in which the pre-surgery period plays an important role. The collaboration between organizations involved in the management of NWR-SA seems to be an effective strategy for reducing its duration. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  19. Duplicate Vas Deferens Encountered during Inguinal Hernia Repair: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Maxwell C. Breitinger

    2016-01-01

    Full Text Available Duplication of the vas deferens is a rare anomaly, defined as the presence of two distinct vasa deferentia within one spermatic cord, with only 28 cases reported worldwide since 1959. We report the case of a 63-year-old man with a duplicate vas deferens, presenting with abdominal pain from bowel obstruction secondary to incarcerated inguinal hernia. Spermatic cord dissection during hernioplasty revealed duplication of the vas deferens within the right spermatic cord. Doppler ultrasonography confirmed absence of waveforms in both vasa deferentia with arterial signal in the accompanying vessel. The hernia was repaired without complication. This report emphasizes recognition of duplicate vas deferens in avoiding iatrogenic injury and optimizing surgical outcome.

  20. Laparoscopic and open inguinal hernia repair: Patient reported outcomes in the elderly from a single centre - A prospective cohort study

    Directory of Open Access Journals (Sweden)

    K. Bowling

    2017-10-01

    Conclusion: Time off work is not an absolute appropriate measure of return to premorbid status with respect to the elderly as a substantial number of >65 year olds have retired. We therefore present this interesting insight into patient perceptions following hernia repair by age group. Overall patients over 65 can expect the same high levels of satisfaction and low levels of pain following either technique for inguinal hernia repair as younger patients.

  1. A rare complication from total extraperitoneal (TEP) laparoscopic inguinal hernia repair: bladder rupture associated with a balloon dissector.

    Science.gov (United States)

    Chow, P-M; Su, Y-R; Chen, Y-S

    2013-12-01

    We report a rare complication of TEP herniorrhaphy. A 47-year-old man underwent TEP inguinal hernia repair. Bladder rupture was noted after balloon dissection. The defect was sutured, and the hernia was repaired under laparoscopy. Cystoscopy showed the site of injury at anterior bladder neck. This is the first report of bladder rupture associated with balloon dissector in a patient with no prior abdominal surgery.

  2. Epithelioid malignant mesothelioma of tunica vaginalis with deciduoid features: An unusual malignancy clinically masquerading an inguinal hernia

    Directory of Open Access Journals (Sweden)

    Sharique Ahmed

    2012-01-01

    Full Text Available Paratesticular/scrotal and inguinal canal mass lesions in elderly patients may pose a diagnostic challenge to both the surgeon as well as the pathologist. In most cases, these represent hernial sacs with their contents, and true neoplasms like lipomas, rhabdomyosarcomas, and fibrous pseudotumors are infrequent. Malignant mesotheliomas arising from the tunica layers are rare cause of inguinal and paratesticular tumors. Herein, we report a case of an elderly patient who presented with an inguinal hernia which pathologically had features of deciduoid malignant mesothelioma.

  3. A pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair in infants.

    Science.gov (United States)

    Bong, Choon L; Yeo, Angela S H; Fabila, Teddy; Tan, Josephine S K

    2016-06-01

    Recent concerns regarding possible long-term effects of early anesthesia exposure on neurodevelopment in children have provided an impetus to explore alternative anesthetic techniques using potentially neuroprotective agents. Dexmedetomidine has not been implicated in anesthesia-induced neurotoxicity and has been shown to be neuroprotective in preclinical studies. We describe a case series of 50 neonates and infants who received dexmedetomidine sedation with caudal anesthesia instead of general endotracheal anesthesia for inguinal hernia surgery. We conducted a retrospective chart review on all neonates and infants who underwent inguinal hernia surgery with dexemetomidine sedation and caudal anesthesia in our institution. We started exploring this technique since October 2011 and established a protocol of administering dexmedetomidine 2 mcg·kg(-1) over 10 min, followed by 1 mcg·kg(-1) over the next 10 min. This led to satisfactory conditions for caudal placement in 20 min, with minimal need for airway intervention during surgery. The median gestational age of the infants was 31.4 (28.7, 36.0) weeks and median postconceptual age was 39.7 weeks (IQR 37.8, 45.7) at time of surgery. Of patients, 86% had surgery successfully completed under this technique alone. Seven patients required sevoflurane or nitrous oxide due to failed caudal block (n = 1) or difficult or prolonged surgery (n = 6). After establishing the sedation protocol and excluding patients with large or complicated hernias, the success rate was 96%. Transient intra-operative apnea or hypoventilation occurred in five patients and postoperative apnea in two patients. All respiratory events were easily reversed and no patient developed significant bradycardia or required intubation. Dexmedetomidine sedation with caudal anesthesia is a feasible alternative to spinal or general anesthesia in selected infants undergoing uncomplicated hernia surgery. It avoids the need for endotracheal intubation and may be

  4. Long-term follow-up evaluation of chronic pain after endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia

    NARCIS (Netherlands)

    A.E.M. van der Pool (Anne); J.J. Harlaar (Joris Jan); P.Th. den Hoed (Pieter); W.F. Weidema (Wibo); R.N. van Veen (Ruben)

    2010-01-01

    textabstractBackground Long-term data on chronic pain after endoscopic total extraperitoneal (TEP) hernia repair are hardly available. Methods Between January 1997 and December 1998, 416 patients with consecutive primary and recurrent inguinal hernia underwent endoscopic TEP hernia repair. Long-term

  5. Risk factors for postoperative hematoma after inguinal hernia repair: an update.

    Science.gov (United States)

    Zeb, Muhammad H; Pandian, T K; El Khatib, Moustafa M; Naik, Nimesh D; Chandra, Abhishek; Morris, David S; Smoot, Rory L; Farley, David R

    2016-09-01

    We recently sensed an increase in the frequency of groin hematoma after inguinal hernia repair (IHR) at our institution. The aim of this study was to provide a more updated assessment of the risk factors inherent to this complication. We performed a case-control study of all adult patients (age ≥ 18 y) who developed a groin hematoma after IHR at our institution between 2003 and 2015. Univariate and multivariable analyses were performed to assess for independent predictors for groin hematoma. A total of 96 patients (among 6608 IHR) developed a groin hematoma, (60 were observed, 36 required intervention). The hematoma frequency increased from our previous study (1.4 % versus 0.9%, P hernia (3.7, [1.4-9.7], P hernia were independent predictors of hematoma development. Independent risk factors for the development of groin hematoma after IHR included warfarin use and recurrent hernia. Careful consideration for anticoagulation and surgical hypervigilance remains prudent in all patients undergoing IHR and especially those with recurrence. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Direct application of single-port laparoscopic totally extraperitoneal (TEP) inguinal hernia repair by an experienced single-port laparoscopic surgeon who was inexperienced in conventional TEP hernia repair: initial experience with 100 cases.

    Science.gov (United States)

    Choi, Byung-Jo; Lee, Kwan Ju; Lee, Sang Chul

    2014-05-01

    Single-port laparoscopic surgery (SPLS) has been introduced for totally extraperitoneal (TEP) inguinal hernia repair. The aim of this study was to report our initial experience with SPLS TEP inguinal hernia repair in 100 patients by a single-port laparoscopic surgeon who had no prior experience of conventional TEP hernia repair. Between October 2012 and December 2013, 100 patients underwent SPLS TEP inguinal hernia repair by a single surgeon. The procedures that were performed in the preperitoneal space did not differ from those in conventional TEP repair. Patient demographics, type of hernia, and operative and postoperative outcomes were analyzed. Also, we compared the results of current series with the data of the other studies for single-port TEP inguinal hernia repair. Among the 100 patients, SPLS TEP inguinal hernia repair was successful in 99 patients; 1 patient required additional incisions for inserting the trocar. The mean operative time and postoperative length of stay were 97.8 minutes (range, 55-185 minutes) and 1.3 days (range, 1-4 days), respectively. In the current series, the operation time was longer than those in the other studies for SPLS TEP repair. Recurrent hernia, history of lower abdominal surgery, and peritoneal tear during the operation were significantly associated with prolonged operation time. The other data, including perioperative complications, were similar. In our experience, the transition from standard hernioplasty to SPLS TEP inguinal hernia repair by an experienced SPLS surgeon was feasible. However, a learning curve is necessary.

  7. The totally extraperitoneal method versus Lichtenstein's technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials.

    Directory of Open Access Journals (Sweden)

    G G Koning

    Full Text Available BACKGROUND: Lichtenstein's technique is considered the reference technique for inguinal hernia repair. Recent trials suggest that the totally extraperitoneal (TEP technique may lead to reduced proportions of chronic pain. A systematic review evaluating the benefits and harms of the TEP compared with Lichtenstein's technique is needed. METHODOLOGY/PRINCIPAL FINDINGS: The review was performed according to the 'Cochrane Handbook for Systematic Reviews'. Searches were conducted until January 2012. Patients with primary uni- or bilateral inguinal hernias were included. Only trials randomising patients to TEP and Lichtenstein were included. Bias evaluation and trial sequential analysis (TSA were performed. The error matrix was constructed to minimise the risk of systematic and random errors. Thirteen trials randomized 5404 patients. There was no significant effect of the TEP compared with the Lichtenstein on the number of patients with chronic pain in a random-effects model risk ratio (RR 0.80; 95% confidence interval (CI 0.61 to 1.04; p = 0.09. There was also no significant effect on number of patients with recurrences in a random-effects model (RR 1.41; 95% CI 0.72 to 2.78; p = 0.32 and the TEP technique may or may not be associated with less severe adverse events (random-effects model RR 0.91; 95% CI 0.73 to 1.12; p = 0.37. TSA showed that the required information size was far from being reached for patient important outcomes. CONCLUSIONS/SIGNIFICANCE: TEP versus Lichtenstein for inguinal hernia repair has been evaluated by 13 trials with high risk of bias. The review with meta-analyses, TSA and error matrix approach shows no conclusive evidence of a difference between TEP and Lichtenstein on the primary outcomes chronic pain, recurrences, and severe adverse events.

  8. Inguinal Hernias Represent the Most Frequent Surgical Complication after Kasai in Biliary Atresia Infants

    Directory of Open Access Journals (Sweden)

    Omid Madadi-Sanjani

    2015-01-01

    Full Text Available Biliary atresia (BA is an orphan medical condition of the newborn, resulting in end-stage liver cirrhosis due to obliterative cholangiopathy of the extrahepatic bile duct. Although Kasai’s hepatoportoenterostomy (KPE is the well-established first-line therapy, little is known about its surgical complications. 153 patients receiving open KPE treated at a single center between 1994 and 2014 were analysed retrospectively regarding short-term complications and survival with the native liver. In brief, 40.5% of patients suffered from 1–3 surgical complications, inguinal hernias (IH being most prevalent (40.0%. In BA patients, incidence of IH was associated with male gender (p=0.002, the syndromic form of BA (p=0.038, and percutaneous drainage for ascites (p=0.002. No association was found with prematurity (p=0.074 or birth weight (p=0.912 in our study. In conclusion, IH frequently develops after open KPE of BA patients, but this complication does not negatively affect the patient’s outcome. Nevertheless, inspection of the internal inguinal ring and prophylactic closure of inapparent hernias should be discussed in order to prevent secondary surgical procedures.

  9. Genome wide association study using deregressed breeding values for cryptorchidism and scrotal/inguinal hernia in two pig lines

    NARCIS (Netherlands)

    Sevillano Del Aguila, C.A.; Soares Lopes, M.; Harlizius, B.; Hanenberg, E.H.A.T.; Knol, E.F.; Bastiaansen, J.W.M.

    2015-01-01

    Background Cryptorchidism and scrotal/inguinal hernia are the most frequent congenital defects in pigs. Identification of genomic regions that control these congenital defects is of great interest to breeding programs, both from an animal welfare point of view as well as for economic reasons. The

  10. Complete transection of the urethra and corpora cavernosa: a complication after laparoscopic repair (TEP) of an inguinal hernia.

    Science.gov (United States)

    Rehme, C; Rübben, H; Heß, J

    2016-06-01

    Complete transection of both corpora cavernosa and the urethra is a very rare condition in urology. We report the case of a 59-year-old man with complete transection of the corpora cavernosa and the urethra during a laparoscopic repair of a recurrent inguinal hernia.

  11. Genome-wide association study using deregressed breeding values for cryptorchidism and scrotal/inguinal hernia in two pig lines.

    Science.gov (United States)

    Sevillano, Claudia A; Lopes, Marcos S; Harlizius, Barbara; Hanenberg, Egiel H A T; Knol, Egbert F; Bastiaansen, John W M

    2015-03-21

    Cryptorchidism and scrotal/inguinal hernia are the most frequent congenital defects in pigs. Identification of genomic regions that control these congenital defects is of great interest to breeding programs, both from an animal welfare point of view as well as for economic reasons. The aim of this genome-wide association study (GWAS) was to identify single nucleotide polymorphisms (SNPs) that are strongly associated with these congenital defects. Genotypes were available for 2570 Large White (LW) and 2272 Landrace (LR) pigs. Breeding values were estimated based on 1 359 765 purebred and crossbred male offspring, using a binary trait animal model. Estimated breeding values were deregressed (DEBV) and taken as the response variable in the GWAS. Heritability estimates were equal to 0.26 ± 0.02 for cryptorchidism and to 0.31 ± 0.01 for scrotal/inguinal hernia. Seven and 31 distinct QTL regions were associated with cryptorchidism in the LW and LR datasets, respectively. The top SNP per region explained between 0.96% and 1.10% and between 0.48% and 2.77% of the total variance of cryptorchidism incidence in the LW and LR populations, respectively. Five distinct QTL regions associated with scrotal/inguinal hernia were detected in both LW and LR datasets. The top SNP per region explained between 1.22% and 1.60% and between 1.15% and 1.46% of the total variance of scrotal/inguinal hernia incidence in the LW and LR populations, respectively. For each trait, we identified one overlapping region between the LW and LR datasets, i.e. a region on SSC8 (Sus scrofa chromosome) between 65 and 73 Mb for cryptorchidism and a region on SSC13 between 34 and 37 Mb for scrotal/inguinal hernia. The use of DEBV in combination with a binary trait model was a powerful approach to detect regions associated with difficult traits such as cryptorchidism and scrotal/inguinal hernia that have a low incidence and for which affected animals are generally not available for genotyping. Several novel

  12. Bilateral Morgagni Hernia: Primary Repair without a Mesh

    Directory of Open Access Journals (Sweden)

    Vassilios Papanikolaou

    2008-07-01

    Full Text Available We present a case of bilateral Morgagni hernia in a 68-year-old male with an intermittent history of progressive onset of breath shortness and occasional cardiac arrhythmias. Diagnosis was made by clinical examination and the findings in a plain chest radiograph and was confirmed by computed tomography scan. The patient was operated electively and subjected to a transabdominal approach. A bilateral subcostal incision revealed a large right side anterior diaphragmatic defect with a hernia containing the ascending colon, the majority of the transverse colon and a huge amount of omentum. Also a second smaller defect was found on the left side with no hernia inside. After large bowel and omentum had been taken down to the peritoneal cavity, both defects were primarily closed using interrupted nylon sutures without the use of a mesh. The patient recovered very well, had an uneventful postoperative course and was released on the 5th postoperative day. 15-month follow-up failed to reveal any signs of recurrence.

  13. Costs and cost-effectiveness of pediatric inguinal hernia repair in Uganda.

    Science.gov (United States)

    Eeson, Gareth; Birabwa-Male, Doreen; Pennington, Mark; Blair, Geoffrey K

    2015-02-01

    Surgically treatable diseases contribute approximately 11% of disability-adjusted life years (DALYs) worldwide yet they remain a neglected public health priority in low- and middle-income countries (LMICs). Pediatric inguinal hernia is the most common congenital abnormality in newborns and a major cause of morbidity and mortality yet elective repair remains largely unavailable in LMICs. This study is aimed to determine the costs and cost-effectiveness of pediatric inguinal hernia repair (PIHR) in a low-resource setting. Medical costs of consecutive elective PIHRs were recorded prospectively at two centers in Uganda. Decision modeling was used to compare two different treatment scenarios (adoption of PIHR and non-adoption) from a provider perspective. A Markov model was constructed to estimate health outcomes under each scenario. The robustness of the cost-effectiveness results in the base case analysis was tested in one-way and probabilistic sensitivity analysis. The primary outcome of interest was cost per DALY averted by the intervention. Sixty-nine PIHRs were performed in 65 children (mean age 3.6 years). Mean cost per procedure was $86.68 US (95% CI 83.1-90.2 USD) and averted an average of 5.7 DALYs each. Incremental cost-effectiveness ratio was $12.41 per DALY averted. The probability of cost-effectiveness was 95% at a cost-effectiveness threshold of $35 per averted DALY. Results were robust to sensitivity analysis under all considered scenarios. Elective PIHR is highly cost-effective for the treatment and prevention of complications of hernia disease even in low-resource settings. PIHR should be prioritized in LMICs alongside other cost-effective interventions.

  14. Effects of non-woven mesh in preperitoneal tension-free inguinal hernia repair: a retrospective cohort study.

    Science.gov (United States)

    Liu, Yiting; Shen, Yingmo; Chen, Jie

    2017-08-01

    Tension-free hernia repair has been recognized as the gold standard for the treatment of inguinal hernia. Different mesh has different characteristics that influence the efficiency of surgery. We conducted this study to evaluate the effectiveness of non-woven mesh in preperitoneal tension-free inguinal hernia repair under local anesthesia. The medical records of patients who received preperitoneal tension-free inguinal hernia repair under local anesthesia in our hospital from 2012 to 2015 were reviewed. Patients were included if their surgery was conducted using non-woven or woven mesh. Outcome measures were operation time, length of stay in hospital, hospital fees, complications and degree of chronic pain, foreign body sensation and recurrence. A total of 389 cases were included. 186 cases were repaired with non-woven mesh (observation group), and 203 cases were repaired with woven mesh (control group). There were no significant differences in operation time and length of stay in the hospital, but hospital fees were significantly higher in the observation group. Seroma of the inguinal region occurred in 6 cases of the observation group and 8 cases of the control group with no significant difference and no other complications and recurrence in both groups. No cases of chronic pain were recorded in the observation group; 8 cases were recorded in the control group. Foreign body sensation was found in 1 case of the observation group and 9 cases in the control group, which showed attractive advantages of non-woven mesh. Preperitoneal tension-free repair for inguinal hernia under local anesthesia using non-woven or woven mesh is available. The hospital cost of using non-woven mesh is higher than that of woven mesh, but the incidence rate of chronic pain and foreign body sensation are lower in the use of non-woven mesh. Therefore, non-woven mesh may be worth using in the clinical setting.

  15. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair

    Directory of Open Access Journals (Sweden)

    Venkatraman R

    2016-01-01

    Full Text Available Rajagopalan Venkatraman, Ranganathan Jothi Abhinaya, Ayyanar Sakthivel, Govindarajan Sivarajan Department of Anaesthesia, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India Background and aim: Transversus abdominis plane block (TAP block is a novel procedure to provide postoperative analgesia following inguinal hernia surgery. The utilization of ultrasound has greatly augmented the success rate of this block and additionally avoiding complications. The aim of our study was to gauge the analgesic efficacy of ultrasound-guided TAP block in patients undergoing unilateral inguinal hernia repair. Materials and methods: Sixty patients scheduled for elective inguinal hernia repair were selected for the study. At the end of the surgical procedure, they were randomly divided into two groups. Ultrasound-guided TAP block was performed with 20 mL of ropivacaine 0.2% (group A or normal saline (group B. Visual analog scale (VAS scores were used to assess pain. Paracetamol was given if VAS >3 and tramadol was used when VAS >6. Patients were monitored for VAS scores and total analgesic consumption for the 24-hour period. Results: The TAP block with ropivacaine (group A reduced VAS scores at 4, 6, and 12 hours. There was no distinction in VAS scores at 0, 2, and 24 hours between the two groups. The duration of analgesia for TAP block with ropivacaine lasted for 390 minutes. Total analgesics consumption was also significantly reduced in group A than group B. No complication was reported to TAP block in both the groups. Conclusion: The ultrasound-guided TAP block provides good postoperative analgesia, reduces analgesic requirements, and provides good VAS scores with fewer complications following inguinal hernia surgery. Keywords: inguinal hernia repair, postoperative analgesia, ropivacaine, transversus abdominis block, ultrasound

  16. A self-adhering mesh for inguinal hernia repair: preliminary results of a prospective, multicenter study.

    Science.gov (United States)

    Champault, G; Torcivia, A; Paolino, L; Chaddad, W; Lacaine, F; Barrat, C

    2011-12-01

    Prosthetic reinforcement is the gold standard treatment for inguinal hernia and reduces the risk of recurrence. Yet up to one-third of patients complain of post-surgical pain due to irritation and inflammation caused by the mesh and the fixation materials. Of these patients, 3-4% will experience severe and disabling chronic pain. We performed a prospective multicenter clinical study of a self-adhering prosthesis, consisting of a lightweight polypropylene mesh (40 g/m²) coated on each side with synthetic glue, to evaluate early postoperative complications and patient outcomes. Between August 2008 and June 2010, 186 patients underwent hernia repair using the Lichtenstein technique and the self-adhering prosthesis. Primary endpoints were the frequency of disabling complications and quality of life (QoL) at 3-month follow-up. Pain, numbness, and groin discomfort were evaluated pre- and postoperatively (1 week, 1 and 3 months) using a visual analogue scale (VAS). Patients' pre- and postoperative QoL were measured using the SF12 questionnaire. Secondary endpoints were number of complications and recurrence rate, use of analgesic drugs, length of hospital stay, delay to return to normal activities, and patient satisfaction. The quality of the self-adhering mesh and its clinical utility were also evaluated by the participating surgeons. A total of 186 patients were enrolled and followed for at least 3 months after inguinal hernia repair. A total of 174 (95%) primary hernias and 12 (5%) recurrent hernias were treated. There were no intraoperative complications, no recurrences, and no repeat interventions performed during the study. The post-surgical complication rate was 4.5%. The mean delay to recover normal physical activity was 4 days. For the primary endpoint of pain, a VAS of zero was reported by 93/184 (50.5%) patients at 1 week, 130/171 (76.0%) patients at 1 month and 119/132 (90.2%) patients at 3 months' follow-up (P post-surgical complications or pain, a

  17. As in Real Estate, Location Is What Matters: A Case Report of Transplant Ureteral Obstruction Due to an Inguinal Hernia.

    Science.gov (United States)

    Bugeja, Ann; Clark, Edward G; Sood, Manish M; Ali, Sohrab N

    2018-01-01

    Kidney allograft dysfunction is common and often reversible but can lead to allograft loss if not promptly evaluated. Transplant ureteral obstruction in an inguinal hernia is a rare cause of allograft dysfunction, but early recognition may prevent allograft loss. We present a case of a man with acute kidney allograft dysfunction who received a deceased donor kidney transplant 6 years earlier for end-stage kidney disease secondary to polycystic kidney disease. Abdominal ultrasounds revealed hydronephrosis without full visualization of the transplant ureter. Abdominal computed tomography revealed moderate hydronephrosis of the transplant kidney due to obstructed herniation of the transplant ureter in a right inguinal hernia. A stent was inserted into the transplant ureter to prevent further allograft dysfunction and facilitate hernia repair. Transplant ureteral obstruction is a rare cause of acute kidney allograft dysfunction, and its detection can be challenging. The recognition of transplant ureteral obstruction is vital to timely management for preventing allograft loss.

  18. A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair.

    Science.gov (United States)

    Wijerathne, Sujith; Agarwal, Narendra; Ramzy, Ahmad; Lomanto, Davide

    2014-11-01

    The success of laparoscopic surgery is due to the less surgical trauma, including less operative pain, complications and better cosmetics. Objective of our study was to compare in two blind randomized groups of patients, the surgical outcome of total extra-peritoneal (TEP) inguinal hernia repair using either single-port or conventional surgical technique. We will report our interim results in the first group of 50 patients. Our study is a prospective, randomized, controlled clinical trial conducted from August 2011 to June 2013. Fifty patients aged between 21 and 80 years undergoing surgery for unilateral inguinal hernia were randomised into two groups: conventional laparoscopic TEP inguinal hernia repair versus single-port TEP repair. Clinical data on patient demographics, surgical technique and findings, postoperative complications and pain scores were collected. Primary endpoint is the postoperative pain while secondary endpoints are recurrence, chronic pain, postoperative hospital stay and complications. Out of the 50 patients, 26 underwent single-port hernia TEP repair and 24 had conventional 3-port TEP hernia repair after randomization. Mean operative time was 51.7 (±13.4) min in the multiport group and 59.3 (±14.9) min in the single-port group, respectively (P = 0.064). Mean hospital stay was 19.7 (±4.8) h in the conventional group and 22.1 (±4.5) h in the single-port group (P = 0.079). No statistically significant differences were observed between the two groups for postoperative complications, and no recurrence reported at 11 months follow-up. There was no significant difference in the pain scores (visual analog scale) between the two groups at regular intervals post surgery. The outcomes after laparoscopic TEP inguinal hernia repair with a single-port device are comparable to the standard three-port technique.

  19. Single-port versus conventional three-port laparoscopic totally extraperitoneal inguinal hernia repair: a randomized controlled trial.

    Science.gov (United States)

    Choi, B J; Jeong, W J; Lee, I K; Lee, S C

    2016-12-01

    Single-port laparoscopic surgery (SPLS) has been introduced for totally extraperitoneal (TEP) inguinal hernia repair. Clinically, however, the benefits of single-port TEP (SP TEP) are unclear. This study aimed to compare short-term surgical outcomes between SP TEP and conventional laparoscopic TEP(CL TEP) inguinal hernia repair. Between January 2013 and February 2015, 99 men with primary unilateral inguinal hernia were randomized to the single-port or conventional 3-port TEP procedures. The primary end point was postoperative pain. Secondary end points were complications, postoperative hospital stay, days to return to daily normal activities, cosmesis, and quality of life (QOL). We randomized 50 patients to SP TEP and 49 to CL TEP repair. The SP TEP group patients had significantly lower pain scores (visual analog scale) 7 days postoperation (p = 0.017). However, there were no significant differences between the two groups in postoperative pain scores 24 h (p = 0.44) and 4 weeks (p = 0.677) after operation and analgesic requirements on the operation day (p = 0.303) and 7 days after the operation (p = 0.204). Operation time, postoperative hospital stay, and complications were comparable between the two groups. The days to return to daily normal activities, QOL, and cosmetic satisfaction were not different between the two groups. The outcomes of SP TEP hernia repair for operation time and morbidities were comparable to CL TEP, and postoperative pain was lower at 7 days than in CL TEP hernia repair. The SP TEP technique can be recommended as an alternative treatment for inguinal hernia repair in experienced hands.

  20. Single-Incision Laparoscopic Repair of Spigelian Hernia

    Science.gov (United States)

    Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne J.

    2015-01-01

    Introduction: Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair. Methods: From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh. Results: There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m2. An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1–15 months). Conclusions: Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal

  1. Inguinal endometriosis.

    Science.gov (United States)

    Kapan, Metin; Kapan, Selin; Durgun, A Vedat; Goksoy, Ertugrul

    2005-01-01

    Extrapelvic endometriosis is a rarely seen condition and it is occasionally presented to the general surgeons. It is often diagnosed incidentally. In this report we presented three cases of inguinal endometriosis all of which were thought to be inguinal hernia preoperatively. They were diagnosed during the operation for inguinal hernia repair and treated with simple excision of the lesions with a part of the round ligament.

  2. Testicular rerouting by modified Prentiss maneuver: usefulness in bilateral synchronous orchidopexy for high inguinal undescended testes.

    Science.gov (United States)

    Prakash, Jai; Dalela, Deepansh; Goel, Apul; Dalela, Divakar; Kumar, Manoj; Sankhwar, Satya Narayan; Kureel, Shiv Narain

    2014-08-01

    To describe our experience and illustrate the surgical procedure of synchronous bilateral testicular rerouting in high inguinal undescended testes (HIUT) by extending the use of "modified Prentiss maneuver" in bilateral situation, to establish this as a procedure of choice in bilateral HIUT and secondly to demonstrate the length gained by maneuver itself. Between January 2011 and December 2012 ten boys (8months-6years) with diagnosis of bilateral HIUT were included in the study. Bilateral orchidopexy was done by "modified Prentiss maneuver" under general anesthesia. Postoperatively all patients were evaluated at 3 months ,6 months and 1 year by physical examinations and ultrasound. It was possible to reroute the testes underneath inferior epigastric artery (IEA) without its mobilization and thus locate testicular pedicle through a fascial hole above pubic tubercle, well medial to IEA. The average gain in scrotal positioning was 16mm (10-22mm).No retractions, atrophy of testis, clinical weakness of anterior abdominal wall or inguinal herniation was noted in any patient up to one year follow up. Testicular re-routing by "modified Prentiss maneuver" is a simple, feasible, safe and efficient method for bilateral orchidopexy in bilateral HIUT. Preserving the inferior epigastric artery bilaterally has physiologic advantages. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Randomized, Controlled, Blinded Trial of Tisseel/Tissucol for Mesh Fixation in Patients Undergoing Lichtenstein Technique for Primary Inguinal Hernia Repair

    DEFF Research Database (Denmark)

    Campanelli, Giampiero; Pascual, Manuel Hidalgo; Hoeferlin, Andreas

    2012-01-01

    : Test the hypothesis that fibrin sealant mesh fixation can reduce the incidence of postoperative pain/numbness/groin discomfort by up to 50% compared with sutures for repair of inguinal hernias using the Lichtenstein technique.......: Test the hypothesis that fibrin sealant mesh fixation can reduce the incidence of postoperative pain/numbness/groin discomfort by up to 50% compared with sutures for repair of inguinal hernias using the Lichtenstein technique....

  4. A standardized resident training program in endoscopic surgery in general and in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in particular

    DEFF Research Database (Denmark)

    Miserez, Marc; Arregui, Maurice; Bisgaard, Thue

    2009-01-01

    The need for acquisition of specific laparoscopic skills has emphasized the role of a preclinical laboratory-training program. However, for laparoscopic inguinal hernia repair with a steep learning curve, especially for totally extraperitoneal repair, preclinical skill training remains a challenge....... A standardized preclinical resident training program in endoscopic surgery is described. Also, a standardized clinical training program is proposed with systematic dissection in 10 different consecutive steps for totally extraperitoneal inguinal hernia repair. Continuous mentoring by an expert is an absolute...

  5. Quality of life of inguinal hernia patients in Taiwan: The application of the hernia-specific quality of life assessment instrument.

    Directory of Open Access Journals (Sweden)

    Chi-Cheng Huang

    Full Text Available With the development of prosthetic mesh and tension free techniques, the recurrence rate following inguinal hernia repair has been reduced, and hernia outcomes research should focus on post-operative quality of life and potential complications.A novel hernia quality of life assessment instrument, HERQL, was developed. The HERQL questionnaire comprises a 4-item summative pain score measuring pain and discomfort resulting from various strenuous activities. Symptomatic and functional domains, as well as post-operative satisfaction are evaluated as well.A total of 386 HERQL surveys were completed by 183 patients with inguinal hernias. Internal consistency reliability of the summative pain score was satisfactory, with a Cronbach's alpha of 0.85. Criterion validity was examined by concomitant assessment of the pain/discomfort and health impact subscales of the EQ-5D questionnaire, with substantial to moderate correlations. Pre-operative patients reported more severe hernia protrusion, more pain during mild to heavy exercise, and worse activity restriction and health impairment than the follow-up patients, indicating clinical validity. The conceptual structure of the HERQL demostrated the causal relationship between the formative symptomatic subscales and the reflective functional status indicators. Repeated measurement of the summative pain scores revealed an estimated time effect of -1.63, which was the rate of change in the summative pain score across the pre-operative, immediately post-operative, and follow-up 3-month periods suggesting the clinical responsiveness of the HERQL.This study will facilitate inguinal hernia outcomes research and enhance the quality of care for this common disease by providing a validated HERQL instrument with enhanced sensitivity.

  6. Quality of life of inguinal hernia patients in Taiwan: The application of the hernia-specific quality of life assessment instrument

    Science.gov (United States)

    Huang, Chi-Cheng; Tai, Feng-Chuan; Chou, Tzung-Hsin; Lien, Heng-Hui; Jeng, Jaan-Yeh; Ho, Thien-Fiew; Huang, Ching-Shui

    2017-01-01

    Background With the development of prosthetic mesh and tension free techniques, the recurrence rate following inguinal hernia repair has been reduced, and hernia outcomes research should focus on post-operative quality of life and potential complications. Study design A novel hernia quality of life assessment instrument, HERQL, was developed. The HERQL questionnaire comprises a 4-item summative pain score measuring pain and discomfort resulting from various strenuous activities. Symptomatic and functional domains, as well as post-operative satisfaction are evaluated as well. Results A total of 386 HERQL surveys were completed by 183 patients with inguinal hernias. Internal consistency reliability of the summative pain score was satisfactory, with a Cronbach’s alpha of 0.85. Criterion validity was examined by concomitant assessment of the pain/discomfort and health impact subscales of the EQ-5D questionnaire, with substantial to moderate correlations. Pre-operative patients reported more severe hernia protrusion, more pain during mild to heavy exercise, and worse activity restriction and health impairment than the follow-up patients, indicating clinical validity. The conceptual structure of the HERQL demostrated the causal relationship between the formative symptomatic subscales and the reflective functional status indicators. Repeated measurement of the summative pain scores revealed an estimated time effect of -1.63, which was the rate of change in the summative pain score across the pre-operative, immediately post-operative, and follow-up 3-month periods suggesting the clinical responsiveness of the HERQL. Conclusions This study will facilitate inguinal hernia outcomes research and enhance the quality of care for this common disease by providing a validated HERQL instrument with enhanced sensitivity. PMID:28817703

  7. Chronic pain after inguinal hernia repair with the ONSTEP versus the Lichtenstein technique, results of a double-blinded multicenter randomized clinical trial

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Fonnes, Siv

    2017-01-01

    Purpose: The open new simplified totally extraperitoneal (ONSTEP) technique for the repair of inguinal hernia was presented some years ago with promising initial results regarding chronic pain. We conducted a randomized clinical trial investigating the ONSTEP technique versus the Lichtenstein...... participants with primary unilateral hernias, having surgical repair of their hernia at one of five participating general surgical departments. At surgery, participants were allocated (1:1) to the ONSTEP or the Lichtenstein technique for inguinal hernia repair. Participants were followed up with questionnaires...... was not seen in the ONSTEP group. Conclusion: The ONSTEP technique was not superior to the Lichtenstein technique regarding chronic pain following repair of primary inguinal hernias in males. Trial registration: https://clinicaltrials.gov NCT01753219...

  8. Long-term follow-up of laparoscopic total extraperitoneal (TEP) repair in inguinal hernia without mesh fixation.

    Science.gov (United States)

    Golani, S; Middleton, P

    2017-02-01

    From the current evidence, non-fixation of the mesh (NMF) in laparoscopic total extraperitoneal (TEP) repair appears to be a safe alternative for inguinal hernia patients in the short term. This study aims to demonstrate that NMF is as effective in the long term by following up a large number of patients with a mean follow-up of 6 years. The primary outcomes are chronic pain and recurrence rate. A thorough review of medical records was conducted from a prospectively maintained database of 538 patients who underwent a laparoscopic TEP inguinal hernia repair by a single surgeon working in Sydney from the year 2005 to 2010. Patient demographics, perioperative outcomes, and postoperative complications were extracted from this database. All these patients were then interviewed using a modified questionnaire based on Franneby et al. [10]. 538 patients had TEP repair between 2005 and 2010. Out of this 11 were excluded as tacks were used for fixation of mesh. Out of the 649 repairs done on 527 patients during this period, 463 hernia repairs in 387 patients could be followed up with a mean follow-up of 6 years and 4 months. The mean age of patients was 63 years. Overall, there were seven (1.5%) recurrences, and the incidence of chronic pain was 1%, however 2.9% patients in total complained of pain. This is the only study in literature having a long-term follow-up of more than 5 years for the patients having inguinal hernia repair by TEP technique without mesh fixation. It demonstrates that fixation of mesh with tacks or glue is unnecessary for TEP repair of inguinal hernia.

  9. Surgical treatment of chronic groin and testicular pain after laparoscopic and open preperitoneal inguinal hernia repair.

    Science.gov (United States)

    Amid, Parviz K; Chen, David C

    2011-10-01

    Standard triple neurectomy does not address inguinodynia secondary to neuropathy of the genitofemoral nerve and the preperitoneal segment of its genital branch seen after inguinal hernia repair performed laparoscopically or in open preperitoneal fashion. Standard triple neurectomy was extended to include the genitofemoral nerve. Sixteen patients with chronic groin pain after laparoscopic and open preperitoneal inguinal hernia repair underwent operative triple neurectomy, with resection of the main trunk of the genitofemoral nerve in the retroperitoneum over the psoas muscle. All patients had previously undergone unsuccessful extensive nonsurgical pain management. Fourteen of 16 patients had significant improvement of their pain, as evidenced by a decrease in subjectively reported postoperative pain levels as compared with their preoperative baseline, a decrease or complete elimination of daily narcotic dependence, and return to baseline activities of daily living and work. One of the nonresponder patients underwent a previous open prostatectomy, and exposure of the genitofemoral nerve was not possible due to scarring from the prostatectomy. The other nonresponder patient continues to experience subjective pain equivalent to preoperative levels due to the sensation of firmness and incisional pain that arose in the setting of a postoperative wound infection. He does, however, report that his pain is of different character and quality from his preneurectomy pain and is primarily centered around the incision. His follow-up has not been long enough to determine if his symptoms will improve as his incision and scar remodel. Extension of the standard triple neurectomy to include the genitofemoral nerve for treatment of inguinodynia after open and laparoscopic preperitoneal mesh repair is a safe and effective procedure. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Radiofrequency denervation of the inguinal ligament for the treatment of 'Sportsman's Hernia': a pilot study.

    Science.gov (United States)

    Comin, Jules; Obaid, Haron; Lammers, Greg; Moore, James; Wotherspoon, Mark; Connell, David

    2013-04-01

    Chronic groin pain is a common and debilitating condition in highly active athletes. Symptoms are often ascribed to the so-called Sportsman's Hernia, and these patients frequently undergo prolonged and often painful remedial physiotherapy, or, if the condition is refractory, surgery to repair the posterior inguinal wall. We hypothesised that radiofrequency denervation (RFD) of both the ilioinguinal nerve and inguinal ligament could be used to desensitise the groin region and enable the athlete to become pain-free. A prospective randomised controlled trial of three groups of patients with chronic groin pain. Thirty-six patients with chronic groin pain of greater than 6 months duration, with no identifiable structural cause and which was refractory to conservative treatment, were randomised into two groups. Group 1 was treated with RFD (n=18), while group 2 was treated with local anaesthetic (Bupivicaine) and steroid (Trimacinolone) injection (n=18). A further 10 patients with previous failed surgery for the same condition were treated with RFD without randomisation. All patients then underwent a standardised physiotherapy regimen. The Visual Analogue Scale at rest (VASr) and with activity (VASa) was used to assess pain, and London Adductor and Abdominal Groin Score was used to assess function, at baseline and at 1 week, 3 months and 6 months post-treatment. RFD treatment resulted in a significant improvement above baseline in all measures and at each time intervals up to 6 months, in both the randomised Group 1 and in the postsurgery group (p values ranging from Hernia is safe and efficacious at least in the short term, and is superior to anaesthetic/steroid injection. The results suggest that symptoms are related to tendon inflammation and ilioinguinal nerve compression, and can be abolished with pharmacological or radiofrequency treatment, without the need for surgery. This novel technique could help athletes suffering from chronic groin pain return to play more

  11. Inguinal herniorrhaphy in women

    DEFF Research Database (Denmark)

    Bay-Nielsen, Morten; Kehlet, Henrik

    2006-01-01

    Inguinal hernias in women are relatively rare, and an outcome in this specific subgroup of hernias has not been documented in the literature. An analysis was performed using data from the prospective recording of 3,696 female inguinal hernia repairs in the national Danish hernia database, in the 5...

  12. Outcomes and charges associated with outpatient inguinal hernia repair according to method of anesthesia and surgical approach.

    Science.gov (United States)

    Bourgon, Adam L; Fox, Justin P; Saxe, Jonathan M; Woods, Randy J

    2015-03-01

    We conducted this study to compare short-term outcomes and charges between methods of hernia repair and anesthesia in the outpatient setting. Using New York's state ambulatory surgery databases, we identified discharges for patients who underwent inguinal hernia repair. Patients were grouped by method of hernia repair. We compared hospital-based acute care encounters and total charges across groups. Locoregional anesthesia (5.2%) experienced a similar frequency of hospital-based acute care encounters within 30 days of discharge when compared with patients receiving general (6.0%) or having a laparoscopic procedure (6.0%). Risk-adjusted charges increased across groups (locoregional = $6,845 vs general = $7,839 vs laparoscopic = $11,340, P hernia repair under local anesthesia reduces healthcare charges. Published by Elsevier Inc.

  13. Tailored anterior tension-free repair for the treatment of recurrent inguinal hernia previously repaired by anterior approach.

    Science.gov (United States)

    Erdas, E; Medas, F; Gordini, L; Licheri, S; Pisano, G; Nicolosi, A; Calò, P G

    2016-06-01

    The purpose of this study is to describe our policy in selecting different types of anaesthesia and anterior tension-free techniques for the repair of recurrent inguinal hernias previously treated by anterior approach and to evaluate early and late outcomes. The medical records of 111 patients who underwent recurrent inguinal hernia repair by anterior approach in the period 2000-2013 were reviewed. Fifty patients (45 %) were over 70 years old and 63 (56.7 %) had one or more co-morbidities. Hernias with large defects were the most frequently observed (59.5 %), and no-mesh techniques were the most frequent failed repair (75.7 %). Different anterior tension-free techniques and types of anaesthesia were used, depending on hernia and patient characteristics. Seventy-three patients (65.8 %) were operated on an outpatient basis. Mean follow-up period was 89 months (range 10-183). No perioperative deaths, medical events, or visceral injuries were recorded. Early postoperative complications occurred in 11 patients: 4 haematomas (3.6 %), 5 seromas (4.5 %), 1 superficial wound infection (0.9 %) and 1 ischemic orchitis (0.9 %). Late complications consisted in 3 cases of chronic moderate pain (3.2 %) and 2 re-recurrences (2.1 %). Recurrent inguinal hernia previously treated by open anterior technique can be repaired using the same approach, often on an outpatient basis, with a low rate of recurrence and postoperative complications. To be safe and effective, the repair should be performed by appropriately trained surgeons, well versed in the use of different types of anaesthesia and surgical techniques depending on patient and hernia characteristics.

  14. Coagulation, inflammatory, and stress responses in a randomized comparison of open and laparoscopic repair of recurrent inguinal hernia

    DEFF Research Database (Denmark)

    Rahr, H B; Bendix, J; Ahlburg, P

    2006-01-01

    with recurrent inguinal hernia were randomized to OR under local anesthesia (n = 30) or LR under general anesthesia (n = 31). The magnitude of the surgical trauma was assessed by measuring markers of coagulation (prothrombin fragment 1 + 2), endothelial activation (von Willebrand factor), inflammation......BACKGROUND: In previous comparisons of inflammatory and stress responses to open (OR) and laparoscopic (LR) hernia repair, all operations were performed under general anesthesia. Since local anesthesia is widely used for OR, a comparison of this approach with LR seemed relevant. METHODS: Patients...

  15. Difficulties and Problematic Steps in Teaching the Onstep Technique for Inguinal Hernia Repair, Results from a Focus Group Interview

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Laursen, Jannie; Rosenberg, Jacob

    2016-01-01

    technique for inguinal hernia repair, seen from the instructor's point of view. Methods. We designed a qualitative study using a focus group to allow participants to elaborate freely and facilitate a discussion. Participants were surgeons with extensive experience in performing the Onstep technique from...... course should preferably have experience with other types of hernia repairs. If trainees are inexperienced, the training setup should be a traditional step-by-step programme. A training setup should consist of an explanation of the technique with emphasis on anatomy and difficult parts of the procedure...

  16. Post-operative benefits of Tisseel®/Tissucol® for mesh fixation in patients undergoing Lichtenstein inguinal hernia repair: secondary results from the TIMELI trial

    DEFF Research Database (Denmark)

    Campanelli, G; Pascual, M H; Hoeferlin, A

    2014-01-01

    PURPOSE: The Tisseel/Tissucol for mesh fixation in Lichtenstein hernia repair (TIMELI) study showed that mesh fixation with human fibrin sealant during inguinal hernia repair significantly reduced moderate-severe complications of pain 12 months post-operatively compared with sutures. Further...

  17. Comparison of institutional costs for laparoscopic preperitoneal inguinal hernia versus open repair and its reimbursement in an ambulatory surgery center.

    Science.gov (United States)

    Jacobs, Volker R; Morrison, John E

    2008-02-01

    To compare institutional costs for open versus laparoscopic inguinal hernia repair and its relationship to reimbursement in an ambulatory surgery center in the United States. Analysis of institutional costs in US$ of 2006 for all nonreusables used in a laparoscopic total extraperitoneal (TEP) hernia repair using a polyester mesh compared with open hernia repair using polypropylene mesh. A comparison of the institution's disposable costs related to reimbursement at an ambulatory surgery center in Southeastern United States was performed to identify the most cost-effective procedure for the outpatient facility. As fixed and indirect costs of the ambulatory surgery center are similar for both procedures, a cost difference can only be found in direct disposable costs with that being US$ 235.57 for the procedure-specific disposables in the laparoscopic hernia repair as compared with US$ 117.15 for the open hernia repair. Cost for identical disposables used in both procedures amounted to US$ 32.57. Laparoscopic TEP hernia repair has a higher cost for procedure related disposables versus the open hernia repair at +US$ 118.42 mainly being due to the more costly polyester mesh. A flat rate reimbursement of US$ 1800 for a laparoscopic procedure compared with only US$ 950 for the open procedure minus all disposable cost results in a higher institutional income of +US&$ 731.58 (US$ 1531.86 vs. US$ 800.28), from which other institutional costs can be paid. Despite marginally higher procedure-related disposable costs for laparoscopic TEP hernia repair, the institutional income is remarkably higher owing to a better reimbursement for this procedure in ambulatory surgery centers. From the institution's point of view, laparoscopic hernia repair is by far the more cost-effective procedure when compared with an open hernia procedure at the present time.

  18. Genome wide association study using deregressed breeding values for cryptorchidism and scrotal/inguinal hernia in two pig lines

    OpenAIRE

    Sevillano Del Aguila, C.A.; Soares Lopes, M.; Harlizius, B; Hanenberg, E.H.A.T.; Knol, E F; Bastiaansen, J. W. M.

    2015-01-01

    Background Cryptorchidism and scrotal/inguinal hernia are the most frequent congenital defects in pigs. Identification of genomic regions that control these congenital defects is of great interest to breeding programs, both from an animal welfare point of view as well as for economic reasons. The aim of this genome-wide association study (GWAS) was to identify single nucleotide polymorphisms (SNPs) that are strongly associated with these congenital defects. Genotypes were available for 2570 L...

  19. Genome-wide association study using deregressed breeding values for cryptorchidism and scrotal/inguinal hernia in two pig lines

    OpenAIRE

    Sevillano, Claudia A.; Marcos S. Lopes; Harlizius, Barbara; Hanenberg, Egiel HAT; Knol, Egbert F; Bastiaansen, John WM

    2015-01-01

    Background Cryptorchidism and scrotal/inguinal hernia are the most frequent congenital defects in pigs. Identification of genomic regions that control these congenital defects is of great interest to breeding programs, both from an animal welfare point of view as well as for economic reasons. The aim of this genome-wide association study (GWAS) was to identify single nucleotide polymorphisms (SNPs) that are strongly associated with these congenital defects. Genotypes were available for 2570 L...

  20. A DIFFERENT TECHNIQUE OF PRIMARY INDIRECT INGUINAL HERNIA REPAIR BY INSERTING A SYNTHETIC MESH INTO THE PRE AND RETROPERITONEAL SPACES TO WRAP THE PERITONEAL REFLECTION: PRELIMINARY REPORT

    Directory of Open Access Journals (Sweden)

    Professor Aydın Altan

    2010-01-01

    Full Text Available In most methods of indirect inguinal hernia repair, the region of the sac stump remains a potential site of recurrence. A different technique that covers the site of the indirect sac stump is presented. Anterior parietal peritoneum is reflected posteriorly in the inguinal canal. In cases with Gilbert type I-II inguinal hernia, after the indirect sac is removed, the pre and retroperitoneal spaces in this region are dissected. A synthetic mesh is placed into these spaces, lateral to the inferior epigastric vessels. The posterior wall of this type hernia is intact. In cases with Gilbert type III inguinal hernia, either posterior wall repair is accomplished by using one of the tissue approximation techniques after placing a mesh in the region of the sac stump, or the entire peritoneal reflection in the inguinal canal is wrapped with a mesh after dissecting the pre and retroperitoneal spaces. This technique was performed in five patients. Of five patients, mesh was inserted on the region of stump in three (Gilbert I and II and along the entire peritoneal reflection in two (Gilbert III. There were no postoperative complications such as seroma and pain and no recurrence till follow-up. This technique effectively wraps the peritoneal reflection and may prevent recurrences in primary indirect inguinal hernia, but it needs to be performed in a large number of cases for further evaluation.

  1. Impact of Mesh Fixation on Chronic Pain in Total Extraperitoneal Inguinal Hernia Repair (TEP): A Nationwide Register-based Study.

    Science.gov (United States)

    Gutlic, Nihad; Rogmark, Peder; Nordin, Pär; Petersson, Ulf; Montgomery, Agneta

    2016-06-01

    Mesh fixation is used to prevent recurrence at the potential risk for chronic pain in TEP. The aim was to compare the impact of permanent fixation (PF) with no fixation (NF)/nonpermanent fixation (NPF) of mesh on chronic pain after TEP repair for primary inguinal hernia. Men, 30 to 75 years old, consecutively registered in the Swedish Hernia Register for a TEP primary repair in 2005 to 2009, were included in a mail survey using SF-36 and the Inguinal Pain Questionnaire (IPQ). Primary endpoint was IPQ question "Did you have pain during past week that could not be ignored." Risk factors for chronic pain and recurrent operations were analyzed. A total of 1110 patients were included (325 PF, 785 NF/NPF) with 7.7% reporting pain at median 33 months follow-up. No difference regarding primary endpoint pain (P TEP procedure for primary inguinal hernia repair in men is associated with a low frequency of chronic pain and recurrent operations, with no difference between permanent fixation and no/nonpermanent fixation of mesh in a nationwide population-based study. TEP without fixation reduces costs and is safe for all patients.

  2. Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair.

    Science.gov (United States)

    Bouras, G; Burns, E M; Howell, A M; Bottle, A; Athanasiou, T; Darzi, A

    2017-04-01

    To study the effects of short-term complications on recurrence following laparoscopic inguinal hernia repair using routine data. Linked primary and secondary care databases can evaluate the quality of inguinal hernia surgery by quantifying short- and long-term outcome together. Longitudinal analysis of linked primary care (Clinical Practice Research Datalink) and hospital administrative (Hospital Episodes Statistics) databases quantified 30-day complications (wound infection and bleeding) and surgery for recurrence after primary repair performed between 1st April 1997 and 31st March 2012. Out of 41,545 primary inguinal hernia repairs, 10.3% (4296/41,545) were laparoscopic. Complications were less frequent following laparoscopic (1.8%, 78/4296) compared with open (3.5%, 1288/37,249) inguinal hernia repair (p hernia repair (OR = 1.49; 95% CI 0.97-2.30, p = 0.069). Complications following laparoscopic repair was significantly associated with increased risk of recurrence (OR = 7.86; 95% CI 3.46-17.85, p inguinal hernia repair. Focus must, therefore, be placed on achieving good short-term outcome, which is likely to translate to better longer term results using the laparoscopic approach.

  3. Standard polypropylene mesh vs lightweight mesh for Lichtenstein repair of primary inguinal hernia: a randomized controlled trial.

    Science.gov (United States)

    Demetrashvili, Zaza; Khutsishvili, Kakhi; Pipia, Irakli; Kenchadze, Giorgi; Ekaladze, Eka

    2014-12-01

    The aim of the present clinical study was to compare early and late outcomes after inguinal hernia repair with the heavyweight mesh (HW) and lightweight mesh (LW) during a 3 year follow-up period. 226 patients were randomized into LW and HW mesh groups, both of which underwent unilateral primary inguinal hernia repair via the Lichtenstein technique. Wound complications (infection, hematoma, seroma), hernia recurrence, pain and feeling of foreign body in inguinal area were determined in patients. Pain was measured by visual analogue scale. No statistical difference has been found between LW and HW groups by wound complication (P = 0.80). One case of hernia recurrence has been mentioned in both groups one year after hernioplasty. But there was no detectable difference between the two groups. No significant difference has been found between LW and HW groups by frequency of chronic pain 7 days, 1 and 3 months, 1, 2, and 3 years after surgery. As for the feeling of foreign body in groin it is similar in both groups after 1 and 3 months. Level of feeling of foreign body was significantly lower in LW group 1, 2, and 3 years after surgery, than in HW group (P = 0.03, P = 0.02, P = 0.02, respectively). Our research shows no significant difference in wound complications, hernia recurrence and chronic pain after Lichtenstein hernioplasty, by using of LW and HW meshes. The usage of the LW mesh was associated with less feeling of foreign body than that of the HW mesh, what can be considered as prevalence of LW mesh hernioplasty. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  4. Comparison of the Effects of Laparoscopic and Open Repair Techniques on Postoperative Pain and Analgesic Consumption in Pediatric Unilateral Inguinal Hernia

    Directory of Open Access Journals (Sweden)

    Ferda Yılmaz İnal

    2014-06-01

    Full Text Available Aim: Although laparoscopic inguinal hernia (IH repair in adults is widely accepted, its advantages in pediatric age group are questionable. We aimed to compare the effects of open inguinal hernia repair and laparoscopic inguinal hernia repair on length of anaesthesia, postoperative pain and analgesic consumption in boys who underwent unilateral inguinal hernia repair. Methods: Forty patients aged between 7 and 14 years who underwent open and laparoscopic inguinal hernia repair were included in this study. The patients were randomly divided into two groups: unilateral open inguinal hernia repair group (OR n=20 and unilateral laparoscopic inguinal hernia repair group (LR n=20. All patients underwent general anesthesia. The duration of anaesthesia and the duration of surgery were recorded. The Patient Controlled Analgesia (PCA device was set at a 0.01 mg/kg bolus dose, 10 minutes lockout interval and 4 hour limit of 4 mg morphine. The patients, who received morphine PCA for 24 hours postoperatively, were monitored with continuous oximetry. The Visual Analogue Scale (VAS was used to measure pain (0 cm: no pain, 10 cm: worst possible pain. We recorded the side effects of morphine, such as respiratory depression, nausea, vomiting, urinary retention, pruritus. SpO2 level and Ramsay Sedation Scale (RSS, Numerical Rating Scale (NRS, and Visual Analogue Scale (VAS scores at intervals 1, 2, 4, 12, 24 hours as well as amount of analgesics consumed and number of requests within 24 hours postoperatively were recorded. Time to first walking was recorded. Results: In group OR, the mean duration of anaesthesia and surgery were 39.85 minutes and 28.85 minutes, respectively. In group LR, the mean duration of anaesthesia and surgery were 26.11 and 20.53 minutes, respectively. VAS scores and time to first walking were similar in both groups. There was no significant difference in amount of analgesics consumed and number of request between the two groups. In group OR

  5. Laparoscopic management of mesh erosion into small bowel and urinary bladder following total extra-peritoneal repair of inguinal hernia

    Directory of Open Access Journals (Sweden)

    Sandeep Aggarwal

    2016-01-01

    Full Text Available Mesh erosion into visceral organs is a rare complication following laparoscopic mesh repair for inguinal hernia with only 15 cases reported in English literature. We report the first case of complete laparoscopic management of mesh erosion into small bowel and urinary bladder. A 62-year-male underwent laparoscopic total extra-peritoneal repair of left inguinal hernia at another centre in April 2012. He presented to our centre 21 months later with persistent lower urinary tract infection (UTI. On evaluation mesh erosion into bowel and urinary bladder was suspected. At laparoscopy, a small bowel loop was adhered to the area of inflammation in the left lower abdomen. After adhesiolysis, mesh was seen to be eroding into small bowel. The entire infected mesh was pulled out from the pre-peritoneal space and urinary bladder wall using gentle traction. The involved small bowel segment was resected, and bowel continuity restored using endoscopic linear cutter. The resected bowel along with the mesh was extracted in a plastic bag. Intra-operative test for leak from urinary bladder was found to be negative. The patient recovered uneventfully and is doing well at 12 months follow-up with resolution of UTI. Laparoscopic approach to mesh erosion is feasible as the plane of mesh placement during laparoscopic hernia repair is closer to peritoneum than during open hernia repair.

  6. Preoperative ultrasonographic evaluation of the contralateral patent processus vaginalis at the level of the internal inguinal ring is useful for predicting contralateral inguinal hernias in children: a prospective analysis.

    Science.gov (United States)

    Kaneda, H; Furuya, T; Sugito, K; Goto, S; Kawashima, H; Inoue, M; Hosoda, T; Masuko, T; Ohashi, K; Ikeda, T; Koshinaga, T; Hoshino, M; Goto, H

    2015-08-01

    The current study aimed to verify the usefulness of preoperative ultrasonographic evaluation of contralateral patent processus vaginalis (PPV) at the level of the internal inguinal ring. This was a prospective study of patients undergoing unilateral inguinal hernia repair at two institutions during 2010-2011. The sex, age at initial operation, birth weight, initial operation side, and the preoperative diameter of the contralateral PPV as determined using ultrasonography (US) were recorded. We analyzed the incidence of contralateral inguinal hernia, risk factors, and the usefulness of the preoperative major diameter of the contralateral PPV. The follow-up period was 36 months. All 105 patients who underwent unilateral hernia repair completed 36 months of follow-up, during which 11 patients (10.5 %) developed a contralateral hernia. The following covariates were not associated with contralateral hernia development: sex (p = 0.350), age (p = 0.185), birth weight (p = 0.939), and initial operation side (p = 0.350). The preoperative major diameter of the contralateral PPV determined using US was significantly wider among patients with a contralateral hernia than those without a contralateral hernia (p = 0.001). When the 105 patients were divided into two groups according to cut-off values of the preoperative major diameter of the contralateral PPV (wide group, >2.0 mm; narrow group, ≤2.0 mm), a significant association was observed between the preoperative major diameter of the contralateral PPV and patient outcomes (p = 0.001). We used US and confirmed the usefulness of a preoperative evaluation of the major diameter of the contralateral PPV at the level of the internal inguinal ring in pediatric patients with unilateral inguinal hernias.

  7. Low recurrence rate and low chronic pain associated with inguinal hernia repair by laparoscopic placement of Parietex ProGrip™ mesh: clinical outcomes of 220 hernias with mean follow-up at 23 months.

    Science.gov (United States)

    Birk, D; Hess, S; Garcia-Pardo, C

    2013-06-01

    The aim of this study was to demonstrate the safety and the efficacy of the self-gripping Parietex ProGrip™ mesh (Sofradim Production, Trévoux, France) used with the laparoscopic approach for inguinal hernia repair. The incidence of chronic pain, post-operative complications, patient satisfaction and hernia recurrence at follow-up after 12 months was evaluated. Data were collected retrospectively from patient files and were analyzed for 169 male and female patients with 220 primary inguinal hernias. All patients included had undergone surgical repair for inguinal hernia by the laparoscopic transabdominal preperitoneal approach using Parietex ProGrip™ meshes performed in the same clinical center in Germany. Pre-, per- and post-operative data were collected, and a follow-up after 12 months was performed prospectively. Complications, pain scored on a 0-10 numeric rating scale (NRS), patient satisfaction and hernia recurrence were assessed. The only complications were minor and were post-operative: hematoma/seroma (3 cases), secondary hemorrhage through the trocar's site (2 cases), hematuria, emphysema in the inguinal regions (both sides) and swelling above the genital organs (1 case for each). At mean follow-up at 22.8 months, there were only 3 reports of hernia recurrence: 1.4 % of the hernias. Most patients (95.9 %) were satisfied or very satisfied with their hernia repair with only 1.2 % reporting severe pain (NRS score 7-10) and 3.6 % reported mild pain. This study demonstrates that in experienced hands, inguinal hernia repair surgery performed by laparoscopic transabdominal preperitoneal hernioplasty using Parietex ProGrip™ self-gripping meshes is rapid, efficient and safe with low pain and low hernia recurrence rate.

  8. Extraperitoneal vs. transperitoneal robot-assisted radical prostatectomy in patients with a history of prior inguinal hernia repair with mesh.

    Science.gov (United States)

    Horovitz, David; Feng, Changyong; Messing, Edward M; Joseph, Jean V

    2017-12-01

    Robot-assisted radical prostatectomy (RARP) may be performed via an extraperitoneal (eRARP) or transperitoneal (tRARP) approach. There are no published studies comparing these two methods in patients with a history of prior inguinal hernia repair with mesh (IHRm), but the latter is often advocated in this setting. A retrospective review of patients who underwent RARP with prior IHRm who had a minimum follow-up of 3 months from July 1, 2003 to December 31, 2014 was undertaken. Of 2927 patients who underwent RARP for primary treatment of adenocarcinoma of the prostate, 286 patients had a clear history of IHRm. Of these, 116 patients underwent eRARP and 170 patients underwent tRARP. No differences were noted between the groups with respect to age, body mass index or American Society of Anesthesiology score. Patients in the tRARP group had higher D'Amico risk classification scores (p < 0.0001) and as such, underwent less nerve-sparing procedures (p < 0.0001) and had a higher rate of concomitant pelvic lymph node dissections (p < 0.0001). The tRARP group had a higher incidence of laparoscopic and bilateral IHRm. On univariate analysis, EBL was lower in the tRARP group (172.41 vs. 201.98, p = 0.05) but all other parameters were similar. After controlling for covariates using regression analysis with model selection, a trend was noted towards lower operating room time in the tRARP group (p = 0.0624) but no other differences were noted. The presence of prior IHRm does not seem to be a contraindication to eRARP. OR time may be lower with tRARP (trend) but all other quality indicators studied were similar.

  9. Use of Fibrin Sealant for Prosthetic Mesh Fixation in Laparoscopic Extraperitoneal Inguinal Hernia Repair

    Science.gov (United States)

    Katkhouda, Namir; Mavor, Eli; Friedlander, Melanie H.; Mason, Rodney J.; Kiyabu, Milton; Grant, Steven W.; Achanta, Kranti; Kirkman, Erlinda L.; Narayanan, Krishna; Essani, Rahila

    2001-01-01

    Objective To evaluate the efficacy of mesh fixation with fibrin sealant (FS) in laparoscopic preperitoneal inguinal hernia repair and to compare it with stapled fixation. Summary Background Data Laparoscopic hernia repair involves the fixation of the prosthetic mesh in the preperitoneal space with staples to avoid displacement leading to recurrence. The use of staples is associated with a small but significant number of complications, mainly nerve injury and hematomas. FS (Tisseel) is a biodegradable adhesive obtained by a combination of human-derived fibrinogen and thrombin, duplicating the last step of the coagulation cascade. It can be used as an alternative method of fixation. Methods A prosthetic mesh was placed laparoscopically into the preperitoneal space in both groins in 25 female pigs and fixed with either FS or staples or left without fixation. The method of fixation was chosen by randomization. The pigs were killed after 12 days to assess early graft incorporation. The following outcome measures were evaluated: macroscopic findings, including graft alignment and motion, tensile strength between the grafts and surrounding tissues, and histologic findings (fibrous reaction and inflammatory response). Results The procedures were completed laparoscopically in 49 sites. Eighteen grafts were fixed with FS and 16 with staples; 15 were not fixed. There was no significant difference in graft motion between the FS and stapled groups, but the nonfixed mesh had significantly more graft motion than in either of the fixed groups. There was no significant difference in median tensile strength between the FS and stapled groups. The tensile strength in the nonfixed group was significantly lower than the other two groups. FS triggered a significantly stronger fibrous reaction and inflammatory response than in the stapled and control groups. No infection related to method of fixation was observed in any group. Conclusion An adequate mesh fixation in the extraperitoneal

  10. ADMINISTRATION OF EPIDURAL ANESTHESIA IN OPERATIONS OF INGUINAL HERNIAS – COMPARISON OF DIFFERENT ANESTHETICS’ CONCENTRATIONS

    Directory of Open Access Journals (Sweden)

    Dragana Todorović

    2005-12-01

    Full Text Available In operations of inguinal hernias, different techniques of anesthesia administration are used, but in the last years, there has been a great interest in the local-regional anesthesia, primarily in epidural. The aim of the study was to ascertain the efficiency and safety of administration of minor anesthetics’ concentrations in epidural anesthesia in operations of inguinal hernias. The assessment of patient’s stability by monitoring of vital functions included: noninvasive measuring of blood pressure, pulse, ECG, respiratory frequency and diuresis. Also, in order to assess the effect of anesthetic action of lidocaine, we followed up the onset and ending of sensory blockade, motor blockade, pain intensity during surgical intervention with the use of VAS.There was no statistically significant difference regarding the onset and ending of sensory blockade between greater (20 ml 2% lidocaine and minor concentrations (20 ml 1,5% lidocaine administered epidurally. However, all the examinees to whom 2% lidocaine was administered, had the motor blockade which occurred after 14,37 ±1,04 min, and was in duration of 110,45±13,20 min. Only 20% of patients to whom 1,5% lidocaine was administered had the motor blockade, in whom it occurred after 11,16± 2,02 min, and was in duration of 100,30 ±8,40 min.Systolic pressure significantly decreased between the fifth and tenth minute after 20 ml of 2% lidocaine administration compared to the group to whom 20 ml of 1,5% lidocaine was administered, with statistical significance (p<0,01. Also, we registered decrease in pulse frequency in both groups, as well as the fact that the patients to whom 20 ml of 2% lidocaine was administered, had to stay in bed longer in the postoperative period. Comparing other hemodynamic parameters, there was no statistically significant difference. We can conclude that minor concentrations of anesthetics can be efficient and safe to administer in epidural anesthesia, because they

  11. [Repair of primary inguinal hernia: Lichtenstein versus Shouldice techniques. Prospective randomized study of pain and hospital costs].

    Science.gov (United States)

    Porrero, José L; Bonachía, Oscar; López-Buenadicha, Adolfo; Sanjuanbenito, Alfonso; Sánchez-Cabezudo, Carlos

    2005-02-01

    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.

  12. A nationwide survey of incidence rates and risk factors of inguinal hernia in preterm children.

    Science.gov (United States)

    Fu, Yu-Wei; Pan, Mei-Lien; Hsu, Yao-Jen; Chin, Tai-Wai

    2018-01-01

    Clinical observations showed a higher incidence rate of inguinal hernia (IH) in preterm infants. In this study, we calculated the incidence rate of preterm IH from the National Health Insurance Research Database (NHIRD) of Taiwan. From NHIRD, 92,308 subjects born in the year of 1997-2005 were randomly selected as the study cohort. The medical claims of these subjects from birth to 6th year of age were analyzed. Preterm births were defined using ICD code 765.1*. Risk factors such as birth weight, lung disorders, and ventilator supports before IH repairs were investigated. The risk of incarceration and bowel resection were also evaluated. From 92,308 subjects, 2560 preterm births were identified. IH was repaired in 231 preterm (9.02%) and 3650 term subjects (4.07%). Male (preterm 13.3% and non-preterm 6.3%) had more hernia repairs than female (preterm 3.8% and non-preterm 1.6%). The incidence rate of IH is 13.7% for those under 1500 g, 8.2% for those 1500-1999 g, 7.7% for those 2000-2499 g, and 6.3% for those above 2500 g. The incidence rate of IH in preterms with past history of lung disorders and ventilation supports is 8.7 and 13.6%, respectively. There was no significant difference in the incidences of incarceration and bowel resection between preterms and non-preterms. Birth weight under 2500 g is a significant risk factor for IH repairs. Other risk factors are male gender, past history of lung diseases, and ventilator supports.

  13. Quantitative analysis of collagen and elastic fibers in the transversalis fascia in direct and indirect inguinal hernia Análise quantitativa do colágeno e de fibras elásticas na fascia transversal de pacientes com hernia inguinal direta e indireta

    Directory of Open Access Journals (Sweden)

    Aldo Junqueira Rodrigues Junior

    2002-01-01

    Full Text Available PURPOSE: Our previous studies demonstrated structural and quantitative age-related changes of the elastic fibers in transversalis fascia, which may play a role in inguinal hernia formation. To verify whether there were differences in the extracellular matrix between direct and indirect inguinal hernia, we studied the amount of collagen and elastic fibers in the transversalis fascia of 36 male patients with indirect inguinal hernia and 21 with direct inguinal hernia. MATERIAL AND METHODS: Transversalis fascia fragments were obtained during surgical intervention and underwent histological quantitative analysis of collagen by colorimetry and analysis of elastic fibers by histomorphometry. RESULTS: We demonstrated significantly lower amounts of collagen and higher amounts of elastic fibers in transversalis fascia from patients with direct inguinal hernia compared to indirect inguinal hernia patients. The transversalis fascia from direct inguinal hernia patients showed structural changes of the mature and elaunin elastic fibers, which are responsible for elasticity, and lower density of oxytalan elastic fibers, which are responsible for resistance. These changes promoted loss of resiliency of the transversalis fascia. CONCLUSION: These results improve our understanding of the participation of the extracellular matrix in the genesis of direct inguinal hernia, suggesting a relationship with genetic defects of the elastic fiber and collagen synthesis.OBJETIVO: Estudos prévios nossos demonstraram alterações estruturais e quantitativas de fibras elásticas na fascia transversal com o envelhecimento, tendo papel na gênese da hérnia inguinal. Com o objetivo de verificar diferenças na matriz extracellular da fascia transversal de pacientes com hernia inguinal direta e indireta, quantificamos o colágeno e as fibras elásticas na fascia transversal de 36 pacientes masculinos com hernia inguinal indireta e 21 pacientes masculinos com hernia inguinal

  14. Anterior transversalis fascia approach versus preperitoneal space approach for inguinal hernia repair in residents in northern China: study protocol for a prospective, multicentre, randomised, controlled trial

    Science.gov (United States)

    Fan, Qing; Zhang, De-wei; Yang, Da-ye; Li, Hong-wu; Wei, Shi-bo; Yang, Liang; Yang, Fu-quan; Zhang, Shao-jun; Wu, Yao-qiang; An, Wei-de; Dai, Zhong-shu; Jiang, Hui-yong; Wang, Fu-rong; Qiao, Shi-feng; Li, Hang-yu

    2017-01-01

    Introduction Many surgical techniques have been used to repair abdominal wall defects in the inguinal region based on the anatomic characteristics of this region and can be categorised as ‘tension’ repair or ‘tension-free’ repair. Tension-free repair is the preferred technique for inguinal hernia repair. Tension-free repair of inguinal hernia can be performed through either the anterior transversalis fascia approach or the preperitoneal space approach. There are few large sample, randomised controlled trials investigating the curative effects of the anterior transversalis fascia approach versus the preperitoneal space approach for inguinal hernia repair in patients in northern China. Methods and analysis This will be a prospective, large sample, multicentre, randomised, controlled trial. Registration date is 1 December 2016. Actual study start date is 6 February 2017. Estimated study completion date is June 2020. A cohort of over 720 patients with inguinal hernias will be recruited from nine institutions in Liaoning Province, China. Patient randomisation will be stratified by centre to undergo inguinal hernia repair via the anterior transversalis fascia approach or the preperitoneal approach. Primary and secondary outcome assessments will be performed at baseline (prior to surgery), predischarge and at postoperative 1 week, 1 month, 3 months, 1 year and 2 years. The primary outcome is the incidence of postoperative chronic inguinal pain. The secondary outcome is postoperative complications (including rates of wound infection, haematoma, seroma and hernia recurrence). Ethics and dissemination This trial will be conducted in accordance with the Declaration of Helsinki and supervised by the institutional review board of the Fourth Affiliated Hospital of China Medical University (approval number 2015–027). All patients will receive information about the trial in verbal and written forms and will give informed consent before enrolment. The results will

  15. TEP versus Lichtenstein: Which technique is better for the repair of primary unilateral inguinal hernias in men?

    Science.gov (United States)

    Köckerling, F; Stechemesser, B; Hukauf, M; Kuthe, A; Schug-Pass, C

    2016-08-01

    In the update of the guidelines of the European Hernia Society, open Lichtenstein and endoscopic techniques continue to be recommended as the surgical technique of choice for repair of unilateral primary inguinal hernias in men despite the fact that a meta-analysis had identified a higher recurrence rate for TEP compared with Lichtenstein operation. The Guidelines Group had taken that decision because one surgeon in one of the randomized controlled trials included in the meta-analysis had had a very high recurrence rate. Therefore, this study based on registry data now compares the outcome of TEP versus Lichtenstein repair. The analysis of the Herniamed Registry compares the prospective data collected for male patients undergoing primary unilateral inguinal hernia repair using either TEP or open Lichtenstein repair. Inclusion criteria were minimum age of 16 years, male patient, primary unilateral inguinal hernia, elective operation, and availability of data on 1-year follow-up. In total, 17,388 patients were enrolled between September 1, 2009, and August 31, 2013. Of these patients, 10,555 (60.70 %) had a Lichtenstein repair and 6833 (39.30 %) a TEP repair. On multivariable analysis, the surgical technique was not found to have had any significant effect on the recurrence rate (p = 0.146) or on the chronic pain rate (p = 0.560). Nor did the complication-related reoperation rates differ significantly between the two techniques (p = 0.084). But TEP was found to have benefits as regards the postoperative complication rate (p TEP and Lichtenstein technique. TEP was found to have benefits compared with Lichtenstein repair as regards the postoperative complication rates, pain at rest, and pain on exertion.

  16. INFLUENCE OF TOBACCO, ALCOHOL AND DIABETES ON THE COLLAGEN OF CREMASTER MUSCLE IN PATIENTS WITH INGUINAL HERNIAS.

    Science.gov (United States)

    Módena, Sérgio Ferreira; Caldeira, Eduardo José; Peres, Marco Antonio O; Andreollo, Nelson Adami

    2016-01-01

    New findings point out that the mechanism of formation of the hernias can be related to the collagenous tissues, under activity of aggressive agents such as the tobacco, alcohol and diabetes. To analyze the collagen present in the cremaster muscle in patients with inguinal hernias, focusing the effect of tobacco, alcohol, and diabetes. Fifteen patients with inguinal hernia divided in three groups were studied: group I (n=5) was control; group II (n=5) were smokers and/or drinkers; and group III (n=5) had diabetes mellitus. All subjects were underwent to surgical repair of the inguinal hernias obeying the same pre, intra and postoperative conditions. During surgery, samples of the cremaster muscle were collected for analysis in polarized light microscopy, collagen morphometry and protein. The area occupied by the connective tissue was higher in groups II and III (pluz polarizada, morfometria do colágeno e de proteínas. A área ocupada por tecido conjuntivo foi maior nos grupos II e III (p<0,05). O tecido colágeno ocupou a maior parte das amostras analisadas, em comparação à área ocupada pelas células musculares. O conteúdo de proteínas totais foi maior nos grupos II e III, quando comparado com o grupo controle (p<0,05). O tabaco, o álcool e o diabete ocasionam remodelação no músculo cremaster, levando à perda de suporte ou alteração estrutural nesta região, podendo intensificar as ocorrências e os danos relacionados às hérnias inguinais.

  17. Management of asymptomatic inguinal hernia: a systematic review of the evidence.

    Science.gov (United States)

    Mizrahi, Hagar; Parker, Michael C

    2012-03-01

    To establish a literature-based surgical approach to asymptomatic inguinal hernia (IH). PubMed, the Cochrane Library database, Embase, national guidelines (including the National Library of Guidelines Specialist Library), National Institute for Health and Clinical Excellence guidelines, and the National Research Register were searched for prospective randomized trials comparing surgical treatment of patients with asymptomatic IH with conservative treatment. The literature search retrieved 216 article headlines, and these articles were analyzed. Of those studies, a total of 41 articles were found to be relevant and 2 large well-conducted randomized controlled studies that published their results in several articles were reviewed. The pain and discomfort, general health status, complications, and life-threatening events of patients with asymptomatic IH managed by surgery or watchful waiting were determined. No significant difference in pain scores and general health status were found when comparing the patients who were followed up with the patients who had surgery. A significant crossover ratio ranging between 23% and 72% from watchful waiting to surgery was found. In patients with watchful waiting, the rates of IH strangulation were 0.27% after 2 years of follow-up and 0.55% after 4 years of follow-up. In patients who underwent elective surgery, the range of operative complications was 0% to 22.3% and the recurrence rate was 2.1%. Both treatment options for asymptomatic IH are safe, but most patients will develop symptoms (mainly pain) over time and will require operation.

  18. Suture choice matters in rabbit model of laparoscopic, preperitoneal, inguinal hernia repair.

    Science.gov (United States)

    Kelly, Katherine B; Krpata, David M; Blatnik, Jeffrey A; Ponsky, Todd A

    2014-06-01

    We evaluated the effect of different suture materials in a laparoscopic preperitoneal ligation of the patent processus vaginalis in a rabbit survival model. New Zealand White rabbits underwent laparoscopic assisted preperitoneal ligation of the patent processus vaginalis. The processus vaginalis was closed with silk (n=10), polyglactin 910 (Vicryl(®); Ethicon, a Johnson & Johnson Company, Somerville, NJ) (n=10), or polypropylene (Prolene(®); Ethicon) (n=10). At necropsy, the suture was removed, and repair integrity was evaluated. All rabbits survived to necropsy without complications. No suture material was identified during necropsy of the Vicryl group. Eight (80%) of the Vicryl closures failed, with six (60%) failing at initial inspection. Following removal of suture material, nine (90%) of the Prolene closures failed, and only one (10%) of the silk closures failed (P=.009). The silk suture resulted in an improved closure rate. Ligation with silk suture probably incited an increased inflammatory response that likely created a scar while persisting long enough for the scar to become established. In contrast, the Vicryl sutures probably failed because the sutures dissolved before a scar was able to fully develop. Finally, the Prolene closures were suture dependent as evidenced by failure when the suture was removed. Nonabsorbable braided suture may improve closure of pediatric indirect inguinal hernias during laparoscopic-assisted preperitoneal ligation.

  19. MYOMA OF THE ROUND LIGAMENT MIMICKING THE CLINICAL APPEARANCE OF THE INGUINAL HERNIA – A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Aleš Pišek

    2004-12-01

    Full Text Available Background. Myomas are the most frequent gynecological tumors. They first occur during puberty; however, they are most frequent among aged between 35 and 50. In this age group their incidence is 15–20%. They are rare after menopause. The majority of myomas arise in the uterus, but they may arise from other extrauterine sites such as the fallopian tubes, ovaries, round ligament, ligamentum latum, sacrouterine ligament, vagina and even the urethra. Most authors agree that there are numerous causes for the occurrence of myomas; however, they have not yet been clearly proven. They however agree that the myomas appear most frequently in the reproductive age, when the ovarian hormone levels are high and they diminish after menopause. They equally agree that the risk factors for the clinically significant myomas are nulliparity, obesity, a positive family history of myomas and African racial origin.Patients and methods. A 43-year-old patient was referred to our institution for operative treatment by her personal gynaecologist who clinically and sonografically verified a solid tumor situated to the right side of the uterus. The size of the tumor was that of a newborn’s head. The patient, however, had been observing a reponible inguinal hernia the size of a female fist for a period of four years. A solid tumor (22×6×7 cm arising from the right round ligament, was remowed during surgery. Half of its size was situated in the inguinal canal thus mimicking the clinical appearance of the inguinal hernia. After the tumor was removed the inner door of the inguinal canal closed by itself, no surgical repair was necessary. On histological examination the tumor was classified as a leiomyoma.Conclusions. Although the leiomyoma of the round ligament is the most frequent tumor of that region it is a rare gynecological tumor. The described case is especially interesting due to the unusual position of the tumor. It was situated partly intraabdominally and partly

  20. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial.

    Science.gov (United States)

    Krishna, Asuri; Misra, M C; Bansal, Virinder Kumar; Kumar, Subodh; Rajeshwari, S; Chabra, Anjolie

    2012-03-01

    Minimal access approaches to inguinal hernia repair have added to the ongoing debate over the "best groin hernia repair." The present prospective randomized controlled trial was done to compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques of laparoscopic inguinal hernia repair. The present prospective randomized study was conducted between May 2007 and March, 2009 and included 100 patients suffering from uncomplicated primary groin hernia. Patients were randomized into group I (TEP) and group II (TAPP). Intraoperative variables and postoperative pain scores were recorded in a prestructured form. One hundred patients were included in the study (TEP, 53; TAPP, 47). Both groups were comparable in terms of demographic profile and hernia characteristics. The average operative time was higher in the TAPP group (p = 0.209). The pain scores at 1 h and 24 h after surgery and at 3-month follow-up were significantly higher in the TAPP group (p TEP group, 37.8% of patients had seroma compared to 18.3% in the TAPP group (p = 0.021). However, there was a higher incidence of scrotal edema in the TAPP group (16 vs. 9, p = 0.009). The wound infection rates were equal (2% vs. 3%). There has been no recurrence in either group during the follow-up period of 44 months. Overall, the patients were more satisfied with TEP rather than TAPP (p TEP had a significant advantage over TAPP for significantly reduced postoperative pain up to 3 months, which resulted in a better patient satisfaction score. The other intraoperative complications, postoperative complications, and cost were similar in both groups. In terms of results, both repair techniques seemed equally effective, but TEP had an edge over TAPP.

  1. Internal plug mesh without fixation in laparoscopic total extraperitoneal (TEP) repair of inguinal hernias: a pilot study.

    Science.gov (United States)

    Choi, Yoon Young; Kim, Zisun; Hur, Kyung Yul

    2013-06-01

    Mesh fixation is essential in laparoscopic total extraperitoneal (TEP) repair of inguinal hernia; however, fixation sometimes causes post-operative pain. This study investigated a novel method of laparoscopic TEP repair without mesh fixation. This study reviewed data from about two-hundred and forty-one laparoscopic TEP repairs on 219 patients, which were performed between December 2004 and October 2005. There were no statistically significant differences in the recurrence rate, seroma formation, and hospital stay. However, the mean operation time was shorter in the internal plug mesh group than the fixation group (p = 0.009), and post-operative pain only occurred in 4 cases in the internal plug mesh group in comparison to 29 cases in the mesh fixation group (p = 0.014). An internal plug mesh without fixation might reduce post-operative pain after laparoscopic TEP repair of an inguinal hernia. Internal plug mesh without fixation may be an alternative method in laparoscopic TEP repair, especially for those involving indirect hernias.

  2. Robotic bilateral inguinal lymphadenectomy in penile cancer, development of a technique without robot repositioning: a case report.

    Science.gov (United States)

    Sotelo, Rene; Cabrera, Marino; Carmona, Oswaldo; de Andrade, Robert; Martin, Oscar; Fernandez, Golena

    2013-01-01

    Inguinal lymphadenectomy is the treatment of choice for patients with penile cancer and inguinal lymph node metastases. We describe the performance of the robotic bilateral inguinal lymphadenectomy technique without repositioning the robot in a patient with penile carcinoma and high risk for nodal metastases and no palpable lymph nodes. A 64-year-old male patient was diagnosed with penile cancer (TNM: T3 N 0 M 0) and underwent a total penectomy with perineal urethrostomy. We performed a robotic bilateral inguinal lymphadenectomy four weeks after the penectomy. The entire procedure was performed with the robot-assisted technique. The operative time, median estimated blood loss, and hospital stay was 360 min, 100 ml (50 ml in the right side and 150 ml in the left side), and three days, respectively. Metastatic nodes were present in both inguinal regions, with a yield of 19 lymph nodes on the right and 14 on the left. The patient presented with a left-side lymphocele that was drained at follow-up. No other complications were reported. Robotic bilateral inguinal lymphadenectomy secondary to penile cancer is feasible, safe, and provides a good performance. Prospective studies are required to include a larger number of patients and long-term monitoring to assess the results of this procedure in comparison with open and laparoscopic techniques.

  3. TAPP or TEP? Population-based analysis of prospective data on 4,552 patients undergoing endoscopic inguinal hernia repair.

    Science.gov (United States)

    Gass, Markus; Banz, Vanessa M; Rosella, Laura; Adamina, Michel; Candinas, Daniel; Güller, Ulrich

    2012-12-01

    Whether total extraperitoneal inguinal hernia repair (TEP) is associated with worse outcomes than transabdominal preperitoneal inguinal hernia repair (TAPP) continues to be a matter of debate. The objective of this large cohort study is to compare outcomes between patients undergoing TEP or TAPP. Based on prospective data of the Swiss association of laparoscopic and thoracoscopic surgery, all patients undergoing unilateral TEP or TAPP between 1995 and 2006 were included. The following outcomes were compared: conversion rates, intraoperative and postoperative complications, duration of operation. Data on 4,552 patients undergoing TEP (n=3,457) and TAPP (n=1,095) were collected prospectively. Average age and American Society of Anesthesiologists score were similar in the two groups. Patients undergoing TEP had a significantly higher rate of intraoperative complications (TEP 1.9% vs. TAPP 0.9%, p=0.029) and surgical postoperative complications (TEP: 2.3% vs. TAPP: 0.8%, p=0.003). The postoperative length of stay was longer for patients undergoing TAPP (2.9 vs. 2.3 days, p=0.002), whereas the duration of the operation was longer for TEP (66.6 vs. 59.0 min, pTEP 1.0% vs. TAPP 0.2%, p=0.011). This study is one of the first population-based analyses comparing TEP and TAPP in a prospective cohort of more than 4,500 patients. Intraoperative and surgical postoperative complications were significantly higher in patients undergoing TEP. TEP is also associated with longer operating times and higher conversion rates. Therefore, on a population-based level, the TAPP technique appears to be superior to the TEP repair in patients undergoing unilateral inguinal hernia repair.

  4. Has endoscopic (TEP, TAPP) or open inguinal hernia repair a higher risk of bleeding in patients with coagulopathy or antithrombotic therapy? Data from the Herniamed Registry.

    Science.gov (United States)

    Köckerling, F; Roessing, C; Adolf, D; Schug-Pass, C; Jacob, D

    2016-05-01

    Inguinal hernia operations in the presence of antithrombotic therapy, based on antiplatelet or anticoagulant drugs, or existing coagulopathy are associated with a markedly higher risk for onset of postoperative secondary bleeding. To date, there is a paucity of concrete data on this important clinical aspect of inguinal hernia surgery. Up till now, the endoscopic (TEP, TAPP) techniques have been considered to be more risky because of the extensive dissection involved. Out of the 82,911 patients featured in the Herniamed Hernia Registry who had undergone inguinal hernia repair, 9115 (11 %) were operated on while receiving antithrombotic therapy or with existing coagulopathy. The implications of that risk profile for onset of postoperative bleeding were investigated in multivariable analysis. In addition, other influence variables were identified. The rate of postoperative secondary bleeding, at 3.91 %, was significantly higher in the risk group with coagulopathy or receiving antithrombotic therapy than in the group without that risk profile at 1.12 % (p TEP, TAPP) inguinal hernia repair, the risk of bleeding complications and complication-related reoperation appears to be lower.

  5. Higher Recurrence Rate After Endoscopic Totally Extraperitoneal (TEP) Inguinal Hernia Repair With Ultrapro Lightweight Mesh: 5-Year Results of a Randomized Controlled Trial (TULP-trial).

    Science.gov (United States)

    Roos, Marleen; Bakker, Wouter J; Schouten, Nelleke; Voorbrood, Charlotte; Clevers, Geert Jan; Verleisdonk, Egbert Jan; Davids, Paul; Burgmans, Josephina

    2018-01-04

    The aim of this study was to determine inguinal hernia recurrence rates 5 years after endoscopic totally extraperitoneal (TEP) inguinal hernia repair when either lightweight or heavyweight mesh was used. Recurrence is an important complication of inguinal hernia surgery. Higher recurrence rates of Ultrapro lightweight meshes after TEP repair have been demonstrated, yet data regarding long-term follow-up are limited. From 2010 to 2012, 950 male adult patients with primary unilateral hernias were randomized to TEP hernia repair with heavyweight (Prolene) or lightweight (Ultrapro) mesh. Five years postoperatively, the validated PINQ-PHONE telephone questionnaire was carried out. Participants with a positive questionnaire reply were scheduled for a clinical visit. A recurrence was defined as a clinically detectable bulge in the operated groin on physical examination. Data on development of recurrence could be obtained from 790 patients (83.2% 5-year follow-up rate). Four patients presented with a recurrence at the outpatient clinic between 2 and 5 years postoperatively. Thirty-five patients (4.6%) with a positive PINQ-PHONE reply (60.0% lightweight vs 40.0% heavyweight) were physically examined at the outpatient clinic. In 2 patients (lightweight) a recurrence was detected. The total 5-year recurrence rate after TEP hernia repair was 2.4% (3.8% lightweight, 1.1% heavyweight, P = 0.01). A significantly higher recurrence rate for lightweight mesh in primary direct hernias was found (P = 0.003). The overall recurrence rate 5 years after TEP repair was low. Ultrapro lightweight meshes showed higher recurrence rates than heavyweight meshes and are not recommended for endoscopic TEP inguinal hernia repair.

  6. Early versus late inguinal hernia repair in extremely low-birthweight infants.

    Science.gov (United States)

    Pandey, Rajesh; Dako, Joleen; Venus, Sarah; Kumar, Deepak; Mhanna, Maroun

    2017-10-01

    Compare outcomes of extremely low-birthweight (ELBW) infants following early (before discharge) versus late (after discharge) inguinal hernia (IH) repair. In a retrospective study of ELBW infants with IH, data were abstracted for clinical characteristics, IH and related outcomes. Of the 39/252 (15.4%) ELBW infants who developed IH, those with early (59%) versus late (41%) repair were comparable in birth weight (753 ± 158 versus 744 ± 131 g, p = 0.84), gestation age (26 ± 2 versus 26.2 ± 2 weeks, p = 0.92), with comparable rate of broncopulmonary dysplasia (87% versus 75%, p = 0.41), but early repair group had prolonged respiratory support (60.6 ± 28.6 versus 39 ± 30 days, p = 0.032). Both groups had comparable diagnosis to repair interval (51.2 ± 29.2 versus 60.5 ± 30.6 days, p = 0.38) and early repair group has earlier corrected gestation (41.6 ± 3.9 versus 45.4 ± 4.6 weeks, p < 0.01) at time of repair. Post-IH repair complications (incarceration, postoperative apnea, infections, recurrence and testicular atrophy) were not different. We did not find significant differences in outcomes of IH in early and late repair groups of ELBW infants.

  7. Diagnóstico de masa inguinal, más allá de la hernia inguinal

    Directory of Open Access Journals (Sweden)

    María Trigás Ferrin

    2012-12-01

    Full Text Available Caso clínico de mujer de 86 años con masa inguinal izquierda como hallazgo incidental en la exploración física y diagnóstico final de quiste de canal de nuck, una rara entidad en adultos y que obliga a revisar el diagnóstico diferencial de las masas inguinales

  8. The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein open mesh repair of primary inguinal hernia: a multicenter double-blind randomized controlled trial.

    Science.gov (United States)

    Aufenacker, Theo J; van Geldere, Dirk; van Mesdag, Taco; Bossers, Astrid N; Dekker, Benno; Scheijde, Edo; van Nieuwenhuizen, Roos; Hiemstra, Esther; Maduro, John H; Juttmann, Jan-Willem; Hofstede, Diederik; van Der Linden, Cunera T M; Gouma, Dirk J; Simons, Maarten P

    2004-12-01

    To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair. A recent Cochrane meta-analysis (2003) concluded that "antibiotic prophylaxis for elective inguinal hernia repair cannot be firmly recommended or discarded." Patients with a primary inguinal hernia scheduled for Lichtenstein repair were randomized to a preoperative single dose of 1.5 g intravenous cephalosporin or a placebo. Patients with recurrent hernias, immunosuppressive diseases, or allergies for the given antibiotic were excluded. Infection was defined using the Centers for Disease Control and Prevention criteria. We included 1040 patients in the study between November 1998 and May 2003. According to the intention-to-treat principle, 1008 patients were analyzed. There were 8 infections (1.6%) in the antibiotic prophylaxis group and 9 (1.8%) in the placebo group (P = 0.82). There was 1 deep infection in the antibiotic prophylaxis group and 2 in the placebo group (P = 0.57). Statistical analysis showed an absolute risk reduction of 0.19% (95% confidence interval, -1.78%-1.40%) and a number needed to treat of 520 for the total number of infections. For deep infection, the absolute risk reduction is 0.20% (95% confidence interval, -0.87%-0.48%) with a number needed to treat of 508. A low percentage (1.7%) of wound infection after Lichtenstein open mesh inguinal (primary) hernia repair was found, and there was no difference between the antibiotic prophylaxis or placebo group. The results show that, in Lichtenstein inguinal primary hernia repair, antibiotic prophylaxis is not indicated in low-risk patients.

  9. Bilateral Paratesticular Liposarcoma ‑ A Rare Case Report

    African Journals Online (AJOL)

    scrotal swelling which was misdiagnosed as inguinal hernia. Intraoperative diagnosis of testicular tumor was made. High inguinal orchiectomy was done. Histopathological examination revealed it to be liposarcoma of the cord. To our knowledge, there is no reported case of bilateral paratesticular liposarcoma in English ...

  10. Comparison of Porcine Small Intestinal Submucosa versus Polypropylene in Open Inguinal Hernia Repair: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Nie, Xin; Xiao, Dongdong; Wang, Wenyue; Song, Zhicheng; Yang, Zhi; Chen, Yuanwen; Gu, Yan

    2015-01-01

    Background A systematic review and meta-analysis was performed in randomized controlled trials (RCTs) to compare porcine small intestinal submucosa (SIS) with polypropylene in open inguinal hernia repair. Method Electronic databases MEDLINE, Embase, and the Cochrane Library were used to compare patient outcomes for the two groups via meta-analysis. Result A total of 3 randomized controlled trials encompassing 200 patients were included in the meta-analysis. There was no significant difference in recurrence (P = 0.16), hematomas (P = 0.06), postoperative pain within 30 days (P = 0.45), or postoperative pain after 1 year (P = 0.12) between the 2 groups. The incidence of discomfort was significantly lower (P = 0.0006) in the SIS group. However, the SIS group experienced a significantly higher incidence of seroma (P = 0.03). Conclusions Compared to polypropylene, using SIS in open inguinal hernia repair is associated with a lower incidence of discomfort and a higher incidence of seroma. However, well-designed larger RCT studies with a longer follow-up period are needed to confirm these findings. PMID:26252895

  11. Our Results in Patients with Inguinal Hernia in Whom Total Extraperitoneal Preperitoneal (Tepp Method Has Been Used

    Directory of Open Access Journals (Sweden)

    Akgün Çelik

    2012-12-01

    Full Text Available Aim: TEPP (Total extraperitoneal preperitoneal inguinal hernia repair is a laparoscopic technique. In this study, we aimed to evaluate the clinical outcomes of TEPP. Methods: Hospital records of 130 patients who underwent TEPP in Bezm-i Alem Valide Sultan Gureba Training and Research Hospital between January 2005 and January 2010 were retrospectively evaluated. Demographic characteristics, length of hospital stay, return to an active life, complications, and recurrence rates were determined. Results: The mean age was 41 years and 85% of the patients were male. Most of the patients had inguinal hernia type 3B according to Nyhus classification (92. Seven patients had 3C and, type 3A was found in 22 patients. Of the 130 patients, 9 had recurrence. The mean duration of surgery was 30 minutes and the mean length of hospital stay was 1.2 days. The most common complication was accumulation of fluid in the scrotum (24 patients. Major vascular injury, organ injury, and wound infection were not detected. There was no recurrence during 3-60-month-follow-up. Conclusion: Return to an active life, duration of surgery, complication rates, and cosmetic results in TEPP were better than that in other techniques. (The Me di cal Bul le tin of Ha se ki 2012; 50: 119-21

  12. Inguinal hernia in stage M0 prostate cancer: a comparison of incidence in men treated with and without radical retropubic prostatectomy--an analysis of 1105 patients

    DEFF Research Database (Denmark)

    Stranne, Johan; Hugosson, Jonas; Iversen, Peter

    2005-01-01

    To analyze the incidence of inguinal hernia (IH) in a large group of patients with nonmetastatic prostate cancer who were treated nonoperatively, and to compare it with the incidence in a subset of patients who had undergone radical retropubic prostatectomy (RRP). IH has been reported in 12% to 2...

  13. The totally extraperitoneal method versus Lichtenstein's technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials

    NARCIS (Netherlands)

    Koning, G.G.; Wetterslev, J.; Laarhoven, C.J. van; Keus, F.

    2013-01-01

    BACKGROUND: Lichtenstein's technique is considered the reference technique for inguinal hernia repair. Recent trials suggest that the totally extraperitoneal (TEP) technique may lead to reduced proportions of chronic pain. A systematic review evaluating the benefits and harms of the TEP compared

  14. Inguinal hernia in stage M0 prostate cancer: a comparison of incidence in men treated with and without radical retropubic prostatectomy--an analysis of 1105 patients

    DEFF Research Database (Denmark)

    Stranne, Johan; Hugosson, Jonas; Iversen, Peter

    2005-01-01

    To analyze the incidence of inguinal hernia (IH) in a large group of patients with nonmetastatic prostate cancer who were treated nonoperatively, and to compare it with the incidence in a subset of patients who had undergone radical retropubic prostatectomy (RRP). IH has been reported in 12% to 21...

  15. Resultados imediatos da herniorrafia inguinal com anestesia local associada com sedação Immediate results of inguinal hernia repair with local anesthesia associated with sedation

    Directory of Open Access Journals (Sweden)

    Edgar Valente de Lima Neto

    2003-10-01

    Full Text Available OBJETIVO: Avaliar os resultados imediatos da herniorrafia inguinal com anestesia local associada com sedação. MÉTODOS: Foram operados 30 pacientes portadores de hérnia inguinal, sendo 26 (86,6% do sexo masculino e 4 (13,4 do sexo feminino. Os anestésicos utilizados foram lidocaína a 1% e bupivacaína a 0,5% sem adrenalina, tendo sido adicionado 1mL de bicarbonato de sódio para cada 9mL da solução anestésica. A sedação foi realizada com midazolan. As hérnias mais freqüentes, de acordo com a classificação de Nyhus, foram as do tipo I, encontradas em 16 (53,3% pacientes. Praticou-se o reparo da parede posterior a em 17 (56,6% e em 13 (43,2% o reparo com prótese. Para a análise estatística utilizou-se o teste de McNemar para avaliar a correlação entre os escores de dor na escala E.V.A. agrupada. RESULTADOS: Em nenhum paciente houve necessidade de mudança da técnica anestésica. Entre as complicações, observaram-se: 1 (3,3% hematoma; 1 (3,3% sangramento e 1 (3,3% infecção da ferida operatória. A deambulação foi precoce em 28 (93,3% pacientes, assim como a alimentação oral. O tempo de internação médio foi 18 horas, e o escore de dor na escala visual analógica (E.V.A. foi menor ou igual a 3 em 80% dos pacientes. CONCLUSÃO: A anestesia local com sedação é um método seguro, eficaz, com baixos índices de complicações imediatas, e alto índice de satisfação para pacientes selecionados, portadores de hérnia inguinal.PURPOSE: To present the immediate results of the inguinal hernia repair with local anesthesia associated with sedation. METHODS: Thirty patients were operated on of which 26 (86,6% were male. The age varied from 21 to 76, and the average was of 47 years. The anesthetics used were lidocaine and bupivacaine, and the sedation was accomplished with midazolan. RESULTS: Among the complications was observed: 1 (3,3% bruising; 1 (3,3% blood; and 1 (3,3% case of infection of the operative wound. Early rise

  16. Comparison of inguinal hernia repairs performed with lichtenstein, rutkow-robbins, and gilbert double layer graft methods.

    Science.gov (United States)

    Karaca, A Serdar; Ersoy, Omer Faik; Ozkan, Namik; Yerdel, Mehmet Ali

    2015-02-01

    Tension-free repairs are performed commonly in inguinal hernia operations. The objective of the present study is to compare the outcomes of three different tension-free repair methods known as Lichtenstein, Rutkow-Robbins, and Gilbert double layer. One-hundred and fifty patients diagnosed with inguinal hernia were randomly split into three groups. The comparisons across groups were carried out in terms of operation length, postoperative pain, femoral vein flow velocity, early and late complications, recurrence rates, length of hospital stay, time required to return to work, and cost analysis. No difference was found between the groups regarding age, gender, type and classification of hernia, postoperative pain, and late complications (p > 0.05). Operation length was 53.70 ± 12.32 min in the Lichtenstein group, 44.29 ± 12.37 min in the Rutkow-Robbins group, and 45.21 ± 14.36 min in the Gilbert group (p Robbins group, and 16.02 ± 3.19 and 15.52 ± 3.358 cm/s for the Gilbert group, respectively. Statistical difference was found between all the groups (p Robbins group, and three (6 %) patients of Gilbert group (p = 0.033). Cost analysis produced the following results for Lichtenstein, Rutkow-Robbins, and Gilbert groups: US $157.94 ± 50.05, $481.57 ± 11.32, and $501.51 ± 73.59, respectively (p < 0.001). Lichtenstein operation was found to be more advantageous compared with the other techniques in terms of cost analysis as well as having unaffected femoral blood flow. Therefore, we believe that Lichtenstein repair is still the most appropriate surgical option in patients diagnosed with inguinal hernia.

  17. Diagnostic laparoscopy through deep inguinal ring: a literature-based review on the forgotten approach to visualize the abdominal cavity during emergency and elective groin hernia repair.

    Science.gov (United States)

    Sajid, Muhammad S; Ladwa, Nikhil; Colucci, Gianluca; Miles, William F A; Baig, Mirza K; Sains, Parv

    2013-06-01

    To systematically review the published literature on the role of diagnostic laparoscopy through deep inguinal ring (DL-DR) during groin hernia repair. Standard electronic databases were searched reporting article in any language on the role of DL-DR during groin hernia repair regardless of the age and sex of patients. Thirty-one articles on 5745 patients undergoing DL-DR during groin hernia repair were retrieved from the electronic databases. There was 1 randomized, controlled trial, 7 case reports and 2 case series on 58 adult patients mainly targeting assessment of bowel viability following spontaneous reduction of the strangulated groin hernia. Twenty-one articles, either retrospective or prospective case series on 5687 were reported on pediatric patients aiming to detect a contralateral patent processus vaginalis or synchronous groin hernia. Overall, the laparoscopy group had a reduced operative time, reduced length of hospital stay, lower complication rate, and earlier return to normal activity. DL-DR success rates were reported in >95% of patients. Contralateral patent processus vaginalis indicative of inguinal hernia was found in >48% of children. There was no major morbidity reported in any group. DL-DR during groin hernia repair may be performed safely when indicated. The routine use of DL-DR is an established practice in pediatric surgery. There is still insufficient evidence to recommend the routine use of DL-DR in adults.

  18. Cono extendido, nueva variante técnica en la cirugía de la hernia inguinal Extended cone a new technical variant in the inguinal hernia surgery

    Directory of Open Access Journals (Sweden)

    Hiram Rodríguez Blanco

    2011-06-01

    Full Text Available INTRODUCCIÓN. El tratamiento de la hernia inguinal continúa siendo un tema controvertido y no existe un punto común de acción en cuanto a la modalidad terapéutica que se emplea. Con el desarrollo de las técnicas protésicas la controversia continúa a pesar de las demostradas ventajas de estas. El objetivo de este estudio fue evaluar los primeros casos intervenidos quirúrgicamente mediante la técnica del cono extendido, una modificación de las técnicas clásicas de Liechtenstein y Rutkow. MÉTODOS. Se realizó un estudio prospectivo lineal en 45 pacientes operados mediante una técnica protésica denominada cono extendido. Los pacientes fueron operados en un período de 2 años en la Clínica Multiperfil de Luanda (Angola y para clasificarlos se utilizó la clasificación de Gilbert modificada. RESULTADOS. Hubo un predominio del sexo masculino. La localización más frecuente fue la región inguinal derecha. Predominaron los pacientes clasificados de grado III según la clasificación de Gilbert. Hubo 6 complicaciones menores y hasta el momento no han ocurrido recidivas. CONCLUSIONES. La técnica del cono extendido es una opción más para el tratamiento de los pacientes que presenten hernias inguinales de grado III y VI de la clasificación de Gilbert.INTRODUCTION. The treatment of the inguinal hernia remains being a controversial subject and there is not a common point of action as regards the therapeutic modality used. With the development of the prosthetic techniques the controversy remains despite their demonstrated advantages. The objective of present study was to assess the first cases operated on with the extended cone technique a modification of the classic Liechtenstein's and Rutkow's techniques. METHODS. A linear and prospective study was conducted in 45 patients operated on by a prosthetic technique called extended cone. The patients were operated on in a period of two years in the Multiprofile Clinic of Luanda (Angola and

  19. Acupuncture for post-operative pain after inguinal hernia repair: a placebo controlled, double-blinded clinical trial

    Directory of Open Access Journals (Sweden)

    Raji B

    2007-10-01

    Full Text Available Background: Acupuncture is one of the most effective methods of alleviating pain in different situations including chronic and acute pain management. The aim of this study was to evaluate the effectiveness of acupuncture in the reduction of post-operative pain after hernia repair.Methods: In this placebo-controlled, double-blinded clinical trial, we enrolled 60 male patients aged 30 to 60 years old with an ASA physical status of I or II undergoing elective inguinal hernia repair under general anesthesia in Imam Khomeini Hospital, Tehran, Iran. All patients experienced standard anesthetic and surgical procedures. After completion of the operation and while the patients were still under general anesthesia, they were randomly assigned to two groups: acupuncture (with stimulation of GV2, GV4 and SP6 points with sterile acupuncture needles, and control (with sham acupuncture stimulation. After termination of anesthesia, during the first six hours, the pain intensity was evaluated hourly. Pethidine (25 mg was administered for the patients when necessary. Pain intensity and pethidine use were recorded and compared between the two groups.Results: The mean age of two groups did not differ. Pain intensity was significantly lower in the acupuncture group between the second and fifth postoperative hours. Moreover, pethidine use was significantly lower in the acupuncture group versus the control group during the first six hours after surgery (12.07±7.5 mg vs. 12.91±6.5 mg, respectively; p=0.0001.Conclusion: The application of acupuncture in patients is associated with a marked decrease in pain after inguinal hernia repair and does not have any serious complications. Acupuncture is strongly recommended for all post-operative patients."n 

  20. Re-operation due to severe late-onset persisting groin pain following anterior inguinal hernia repair with mesh.

    Science.gov (United States)

    Delikoukos, S; Fafoulakis, F; Christodoulidis, G; Theodoropoulos, T; Hatzitheofilou, C

    2008-12-01

    Mild pain lasting for a few days is common following mesh inguinal hernia repair. In some patients however, severe groin pain may appear months or even years postoperatively. The aim of this study was to report our experience of late-onset persisting severe postoperative groin pain occurring years after mesh hernioplasty. In a 9-year period, 1,633 patients (1,073 men), median age 63 years (range 19-88), underwent mesh groin hernia repair. Between 1.5 and 4 years postoperatively, six patients (0.35%) presented with severe chronic groin pain unrelieved by conservative measures and surgical exploration was essential. The patients' records were retrospectively reviewed for the purpose of this study. Ilioinguinal nerve entrapment was detected in four patients. The meshes appeared to be indistinguishable from the nerve and were removed along with the stuck nerve. New meshes were properly inserted. Mesh fixation on the periostium of the pubic tubercle by a staple was found in the other two patients. The staples were removed from the periostium in both patients. Neither hernia recurrence nor chronic groin pain was persisting in all six patients during a follow-up of 6-44 months postoperatively. From the results of this study, it appears that ilioinguinal nerve entrapment and/or mesh fixation on the periostium of the pubic tubercle are the causes of late-onset severe chronic pain after inguinal mesh hernioplasty. Mesh removal, along with the stuck ilioinguinal nerve and staple detachment from the periostium, are the gold-standard techniques if conservative measures fail to reduce pain.

  1. The economic impact of laparoscopic inguinal hernia repair: results of a double-blinded, prospective, randomized trial.

    Science.gov (United States)

    Butler, Ralph E; Burke, Rachel; Schneider, James J; Brar, Harpreet; Lucha, Paul A

    2007-03-01

    For this study, 66 patients with a preoperative diagnosis of unilateral primary inguinal hernia were randomized to undergo laparoscopic totally extra peritoneal (TEP), laparoscopic transabdominal (TAPP), or open inguinal hernia repair with polypropylene mesh (Lichtenstein type). Both the operative team caring for the patient postoperatively and the patient were blinded to the operative approach by placement of a large dressing covering the abdomen, which was not removed until postoperative day 3. The patients recorded their pain level on a visual analog pain scale daily. Medication usage also was recorded. All patients were seen at 7-day intervals until they returned to work. The patients were interviewed during their postoperative visits by an investigator blinded to the operative approach and questioned regarding their ability to return to work and their pain levels. The average number of lost work days in all the groups was 12, and there was no significant difference between the three groups (p = 0.074). The average operating time for the TAPP procedure was 59 min, less than the time required to complete either the TEP or the Lichtenstein approach, which had equivalent operative times (p = 0.027). The material cost was significantly lower for the Lichtenstein repair (1,200 dollars less) than for either of the laparoscopic approaches, a saving primarily related to consumable operating room supplies. The TEP repair costs were minimally higher than those for the TAPP repair (125 dollars more). No significant differences were noted in the postoperative pain scales, and the use of postoperative oral analgesics was equivalent. The higher operative costs noted for the laparoscopic hernia repairs were not offset by a shortened convalescence. Postoperative pain appears to be equivalent regardless of the operative approach chosen and is easily managed with oral analgesics.

  2. A New Proposal for Learning Curve of TEP Inguinal Hernia Repair: Ability to Complete Operation Endoscopically as a First Phase of Learning Curve

    Directory of Open Access Journals (Sweden)

    Mustafa Hasbahceci

    2014-01-01

    Full Text Available Background. The exact nature of learning curve of totally extraperitoneal inguinal hernia and the number required to master this technique remain controversial. Patients and Methods. We present a retrospective review of a single surgeon experience on patients who underwent totally extraperitoneal inguinal hernia repair. Results. There were 42 hernias (22 left- and 20 right-sided in 39 patients with a mean age of 48.8±15.1 years. Indirect, direct, and combined hernias were present in 18, 12, and 12 cases, respectively. The mean operative time was 55.1±22.8 minutes. Peritoneal injury occurred in 9 cases (21.4%. Conversion to open surgery was necessitated in 7 cases (16.7%. After grouping of all patients into two groups as cases between 1–21 and 22–42, it was seen that the majority of peritoneal injuries (7 out of 9, 77.8%, P=0.130 and all conversions (P=0.001 occurred in the first 21 cases. Conclusions. Learning curve of totally extraperitoneal inguinal hernia repair can be divided into two consequent steps: immediate and late. At least 20 operations are required for gaining anatomical knowledge and surgical pitfalls based on the ability to perform this operation without conversion during immediate phase.

  3. Laparoscopic TEP repair of inguinal hernia does not alter testicular perfusion.

    Science.gov (United States)

    Lal, P; Bansal, B; Sharma, R; Pradhan, G

    2016-06-01

    The effect of laparoscopic TEP repair on testicular perfusion is unclear. The procedure entails dissection of testicular blood vessels off the hernial sac and incorporation of a prosthetic mesh. This carries at minimum, a theoretical risk of compromise in testicular blood supply, which in turn may affect fertility. Our study aims to establish if any alteration in testicular perfusion occurs in very early (24 h), early (1 week) or late postoperative period (3 months) after laparoscopic TEP repair in the Indian population. In our prospective trial, 20 patients underwent unilateral and 8 underwent bilateral laparoscopic TEP hernia repairs using standard technique by experienced surgeons. Flow parameters of testicular, capsular and intratesticular artery were noted using color Doppler ultrasound preoperatively and postoperatively and the postoperative resistive indexes of operated side (n = 36) were compared with preoperative values. Additionally, for unilateral repairs, flow parameters on operated side were compared with the non-operated side. No statistically significant difference was noticed in the resistive index of the arteries upon comparing these postoperative with preoperative values. For unilateral repairs, the flow parameters of the operated side were comparable with that of non-operated side (i.e. p > 0.05). Laparoscopic TEP performed by experienced surgeons does not alter testicular flow dynamics in early or late postoperative period.

  4. Cephalad-renal ectopia: Bilateral subdiaphragmatic kidneys in a patient of omphalocele with ventral hernia

    Directory of Open Access Journals (Sweden)

    Jitendra Parmar

    2016-04-01

    Full Text Available Renal ectopia is a rare congenital anomaly. Thoracic ectopic kidney was being considered as rarest, however no case of bilateral subdiaphragmatic kidneys in omphalocele patients presented with ventral hernia has been reported yet, as per our best of knowledge. This is a report of a 5- year-old male patient who presented with ventral hernia after omphalocele. A thorough examination, laboratory, and radiological investigations including ultrasonography, plain abdominal x-ray, intravenous urogram, and computerized tomography revealed bilateral subdiaphragmatic ectopic kidneys with azygos continuation of inferior vena cava, retro-aortic left renal vein and spina bifida

  5. An additional strip of mesh minimizes hernia recurrence after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. An analysis of 490 cases over 10 years.

    Science.gov (United States)

    Clark, J; Wong, R; Richardson, A; Haque, A; Vatish, J; Bello, A; Al-Musawi, D

    2014-10-01

    The laparoscopic inguinal hernia repair has gained significant interest over the years as an alternative to the conventional open technique as a result of its faster recovery time, reduced postoperative pain and numbness. However the recurrence rates are in the order of 2.3% compared to the 1.3% quoted for the equivalent open approach. Much of these recurrences occur either caudal to the fold created in the mesh once in-situ or lateral to the border of the mesh. This technique aims to address both these areas of concern using an additional strip of mesh across the centre to brace the mesh and create a bolster to maintain mesh stability. The technique involves cutting a 2 cm strip from the 15x15 cm mesh which is laid length-ways over the remaining 13x15 cm mesh, keeping the longest dimension in the medial to lateral plane, and loosely tacked. The strip over hangs the lateral border of the mesh to control the lateral space. Recurrence rates were evaluated from a prospectively collected data series as well as outcomes collected from a questionnaire over a 10 year period between January 2001 and October 2011. Primary outcomes were confirmed hernia recurrence requiring surgical repair. Four hundred ninety-one patients underwent laparoscopic totally extraperitoneal (TEP) hernia repair with outcomes including recurrence rates were retrospectively examined through a prospectively collected database. Subsequently 400 patients were sent a validated questionnaire. 246 responded (62% response rate). One recurrence (0.3%), which occurred 4 years after the original laparoscopic repair, was described across the series. The use of the additional mesh strip potentially reduces TEP hernia recurrence rates beyond simply the benefits of the learning curve. Although, questionnaires are notoriously inaccurate, the value and consistency between both evaluation techniques suggests that this level of reduction is significant to warrant further prospective trials.

  6. Persistent postherniorrhaphy pain following inguinal hernia repair: A cross-sectional study of prevalence, pain characteristics, and effects on quality of life.

    Science.gov (United States)

    Ergönenç, Tolga; Beyaz, Serbülent Gökhan; Özocak, Hande; Palabıyık, Onur; Altıntoprak, Fatih

    2017-10-01

    Chronic inguinal pain due to the inguinal hernia repair is still a serious consideration, and its incidence is evident in approximately 3%-6% of the patients. The purpose of this study was performed to assess the prevalence of chronic pain after inguinal hernia repair and the effects on the quality of life in our patient. The records of the patients who were 18 years of age or older and had had an inguinal hernia repair under spinal anesthesia after receiving a diagnosis of inguinal hernia at this hospital from 2009 to 2015 were accessed through the hospital's data system. Patients who had signed the informed consent agreement were given an Inguinal Pain Questionnaire (IPQ) and a Douleur Neuropathique 4 (DN-4) questionnaire after recording their demographic data on the appointment day. Surgical incision line was evaluated with a dolorimeter and mild touch hypoesthesia, needle-touch hypoesthesia, brushing allodynia were evaluated with cotton, and 0.711 mm diameter Von-Frey filament (Touch-Test Sensory Evaluator Kit; North Coast Medical, Inc., Gilroy, CA, USA). The total number of patients who had ASA I-II scores and who had undergone a one-sided inguinal hernia repair under spinal anesthesia in elective conditions with at least three or more months of recovery time months was 619. Of these 264 patients, 203 with absence of pain (score of the severest pain over the past week and now was 0) were classified as the Non-Pain group and 61 patients with inguinal pain (score of the severest pain over the past week or now was 1 or more) were classified as the Pain group. The incidence of chronic pain after inguinal hernia surgery was 23.48% (n = 61) in our study. The pain was localized at and near the surgical incision and radiated into the scrotum in 17.73% (n = 36) of the male patients having chronic pain. While chronic pain developed in 60 out of 239 patients who had pain prior to the surgery. The presence of pain prior to the surgery was evaluated as an effective

  7. An atypical lateral hernia and concomitant inguinal and umbilical hernias in a patient with polycystic kidney disease and an intracranial aneurysm - a combined approach of clinical and radiological investigation, endoscopic hernia repair, and anatomical cadaver model documentation and a systematic review of the literature.

    Science.gov (United States)

    Veréb-Amolini, László; Betschart, Thomas; Kiss, Emilia; Ullrich, Oliver; Wildi, Stefan; Eppler, Elisabeth

    2015-01-01

    Atypical hernias are difficult to diagnose due to their rarity and often unspecific symptoms. In the literature there exist hints to peri-inguinal hernias, i.e. direct lateral hernia, but most of them are forms of Spigelian hernias. Since the majority were described during the first half of the past century or even earlier, only very few cases have been documented using modern diagnostic techniques. We report a unique case of a 51 year old patient presenting with an atypical inguinal hernia with concomitant inguinal and umbilical hernias in combination with cystic kidney disease and intracranial aneurysm. The atypical position of the hernia was assumed from clinical inspection, ultrasound and CT scan and verified during pre-peritoneoscopy. Using an anatomical cadaver dissection approach, we followed the unusual position of the hernia through the abdominal wall below the aponeurosis of the external oblique muscle. After a thorough literature search, we assume that the present hernia containing a hernial sac has not been documented before, especially not in such a multidisciplinary approach comprising radiological, surgical and anatomical localisation and endoscopic treatment in a patient with a clinical situation being aggravated by large cystic kidneys leading to dialysis-dependency. Rare hernias have been described as being often associated with concomitant inguinal or other hernias, a predisposition for the male gender and a pathogenic mechanism related to other soft tissue defects such as cystic kidney disease or cranial aneurysm. Thus, we consider this a unique case that has not been documented in this constellation previously, which may increase the awareness for these rare hernias.

  8. Conventional mesh repair of a giant iatrogenic bilateral diaphragmatic hernia with an enterothorax

    Directory of Open Access Journals (Sweden)

    Lingohr P

    2014-02-01

    Full Text Available Philipp Lingohr,1 Thomas Galetin,2 Boris Vestweber,2 Hanno Matthaei,1 Jörg C Kalff,1 Karl-Heinz Vestweber2 1Department of Surgery, University of Bonn, Bonn, Germany; 2Department of Surgery, Klinikum Leverkusen, Leverkusen, Germany Purpose: Diaphragmatic hernias (DHs are divided into congenital and acquired hernias, most of which are congenital. Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare. For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur. Methods: In 2009, we performed three partial diaphragm replacements in our clinic for repairing DHs using a PERMACOL™ implant. Results: As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax. Conclusion: We see a good indication for diaphragm replacements by using a PERMACOL™ implant for fixing especially DHs with huge hernial gaps and in cases with fragile tissue. Keywords: bilateral diaphragmatic hernia, enterothorax, conventional hernia repair, PERMACOL™, biological implant, diaphragm replacement, mesh repair

  9. [Inguinal herniotomy in prematurely born infants].

    Science.gov (United States)

    Marinković, S; Bukarica, S; Cvejanov, M; Peković-Zrnić, V; Jokić, R; Dobanovacki, D

    1998-01-01

    Inguinal hernia is the most common surgical condition in childhood; more than half of the cases occur during infancy (1, 2). As the number of surviving premature infants continues to grow, the pediatric surgeon has become more involved in the management of these hernias (3, 4). Several issues are contentious, such as the optimal time for herniotomy after diagnosis (5), the role of contralateral exploration, and the proper management for incarcerated inguinal hernia (6). Based on our experience, we attempted to study the above points in the infant population and we also examined the role of ventilator therapy in the etiology of inguinal hernia. We performed a retrospective review of records of all infants under 6 months of age who underwent a repair of inguinal hernia at the Clinic for Pediatric Surgery in Novi Sad between January 1994 and December 1996. After surgery, all infants were included in a 6-week follow-up examination. During this period, 144 infants under 6 months of age underwent inguinal hernia repair. There were 114 males and 30 females. Fourteen patients had bilateral hernias at the time of presentation. Incarceration occurred in 32 infants (22%), that is in 27 of the 99 full-term cases (27%) and in 5 of the 45 preterm cases (11%). Only in three cases (8%) did it occur while the infant was awaiting repair. Over 90% of the full-term infants had their hernias repaired within 3 weeks from diagnosis. After reduction of incarceration, our policy is to operate within 24 to 48 hours. Four testicles appeared to be ischemic; one of these was excised. Patchy bowel ischemia was present in six cases, and bowel resection was required in one. The ovary and tube were twisted and ischemic at the time of operation, requiring oophorectomy in two female infants. Forty-five infants were premature. The mean age at the time of diagnosis was 8 weeks; at the time of herniotomy, it was 13 weeks. In the 24- to 28-week group, 44 of hernias were bilateral, and 7 of the 9 infants

  10. Bilateral congenital lumbar hernias in a patient with central core disease--A case report.

    Science.gov (United States)

    Lazier, Joanna; Mah, Jean K; Nikolic, Ana; Wei, Xing-Chang; Samedi, Veronica; Fajardo, Carlos; Brindle, Mary; Perrier, Renee; Thomas, Mary Ann

    2016-01-01

    Congenital lumbar hernias are rare malformations caused by defects in the development of the posterior abdominal wall. A known association exists with lumbocostovertebral syndrome; however other associated anomalies, including one case with arthrogryposis, have been previously reported. We present an infant girl with bilateral congenital lumbar hernias, multiple joint contractures, decreased muscle bulk and symptoms of malignant hyperthermia. Molecular testing revealed an R4861C mutation in the ryanodine receptor 1 (RYR1) gene, known to be associated with central core disease. This is the first reported case of the co-occurrence of congenital lumbar hernias and central core disease. We hypothesize that ryanodine receptor 1 mutations may interrupt muscle differentiation and development. Further, this case suggests an expansion of the ryanodine receptor 1-related myopathy phenotype to include congenital lumbar hernias. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Systematic training model for teaching, development and training of instructors in inguinal hernia treatment using the Lichtenstein technique. Hernia campaign 2014 & 2015.

    Directory of Open Access Journals (Sweden)

    CARLOS JOSÉ LAZZARINI-MENDES

    Full Text Available ABSTRACT Objective: to evaluate the method of training and continuing education of 18 surgeons in 2014, and 28 surgeons in 2015, in the Holy Homes of Ribeirao Preto, Araraquara, Franca and San Carlos of São Paulo, in the performance of Lichtenstein inguinal herniorrhaphy, tutored by the Faculty of Medical Sciences of the São Paulo Holy Home and the organization HERNIA HELP - "Hernia Repair for the Underserved". Methods: the training was tutored and systematized through an active methodology of teaching and learning, aiming to offer competence, skills and attitudes, measured by a previously validated Qualification Form, qualifying leaders in trainees' improvement. Results: in 2014 the outcomes were: the difficulty of the case, direction, incision, dissection, mesh preparation, mesh cutting, mesh setting, closing, instruments, respect to tissues, flow, time and motion, and performance, all presented change in the general rating (p=0.000002; there was greater confidence in the execution of the procedure in 80% of trainees, considered "very valuable" in 93.3% of the interventions. In 2015, 28 surgeons were trained by ten surgeons previously qualified in 2014. The nerve identification rate, a relevant time the Lichtenstein technique, was 95.5% for the Iliohypogastric, 98.5% for the ilioinguinal and 89.4% for the genital branch of the genitofemoral nerve. Conclusion: the applied teaching method is possible, reproducible, reliable and valid. The joint efforts offer enormous opportunity of directed education, reaching underserved populations, revealing the great teacher-student social responsibility.

  12. Prospective randomized clinical trial of Jean Rives technique versus laparoscopic TEP repair for primary inguinal hernia: 10-year follow-up.

    Science.gov (United States)

    Tomaoglu, K; Sarı, Y S; Bektas, H; Koc, O; Gunes, E; Uzum, G; Kucukyılmaz, M

    2015-06-01

    The purpose of the present randomized trial was to compare the Jean Rives (JR) technique and the laparoscopic totally extraperitoneal (TEP) repair for the treatment of primary inguinal hernias with respect to operating time, hospital stay, sick leave, chronic pain and recurrences after a follow-up of 10 years. 110 patients with primary inguinal hernia were randomized to either a JR repair (53 patients) or to a laparoscopic (TEP) repair (57 patients). All the interventions were exclusively realized by two experienced surgeons. Follow-up examinations were performed after 1, 6 months, 1, 5 and 10 years. Both groups were identical concerning age and hernia type, which were type II and type IIIa according to Nyhus classification. No significant difference was found concerning hospital stay, chronic pain and recurrences. The operating time was significantly lower in JR group, whereas the sick leave was significantly in favor of TEP group. Jean Rives technique is a relatively easy technique to perform, requires shorter operating time when compared to laparoscopic TEP technique. JR technique should be taken into consideration while planning surgical treatment of inguinal hernia.

  13. Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials

    Science.gov (United States)

    Sajid, Muhammad S.; Craciunas, L.; Singh, K.K.; Sains, P.; Baig, M.K.

    2013-01-01

    Objective: The objective of this article is to systematically analyse the randomized, controlled trials comparing transinguinal preperitoneal (TIPP) and Lichtenstein repair (LR) for inguinal hernia. Methods: Randomized, controlled trials comparing TIPP vs LR were analysed systematically using RevMan® and combined outcomes were expressed as risk ratio (RR) and standardized mean difference. Results: Twelve randomized trials evaluating 1437 patients were retrieved from the electronic databases. There were 714 patients in the TIPP repair group and 723 patients in the LR group. There was significant heterogeneity among trials (P inguinal hernia recurrence (RR, 0.18; 95% CI, 0.36, 1.83; z = 0.51; P = 0.61). Risk of developing postoperative complications and moderate-to-severe postoperative pain was similar following TIPP repair and LR. In addition, duration of operation was statistically similar in both groups. Conclusion: TIPP repair for inguinal hernia is associated with lower risk of developing chronic groin pain. It is comparable with LR in terms of risk of hernia recurrence, postoperative complications, duration of operation and intensity of postoperative pain. PMID:24759818

  14. General endotracheal vs. non-endotracheal regional anesthesia for elective inguinal hernia surgery in very preterm neonates: A single institution experience.

    Science.gov (United States)

    Gurria, Jean; Kuo, Phillip; Kao, Angie; Christensen, Luisa; Holterman, AiXuan

    2017-01-01

    Very pre-term infants (VP) at complications from general endotracheal anesthesia GE during elective inguinal hernia repair. A retrospective cohort study was done to compare pulmonary-related perioperative risks between VP patients undergoing non-emergent inguinal hernia repair prior to NICU discharge under GE (n=58) vs regional anesthesia RA (n=37). Median PMA (RA 26 vs GE 27 weeks), operative weight (RA 2.2 vs GE 2.27 kg), % with BPD, medical and surgical comorbidities, number of concurrent procedures are similar between groups, except for sac laparoscopy (0% RA vs 36% GE). Procedural anesthesia time was 40 minutes for RA vs 69 minutes for GE, (p Oral feeding was fully tolerated in RA (97%) vs GE (72%, p=0.002) by 48h after surgery. The statistical differences hold after regression analysis controlling for sac laparoscopy and procedure time. No difference in intraoperative or postoperative hernia complications is found. RA is safe. RA is associated with early resumption of full feed, avoidance of prolonged mechanical intubation. We recommend a randomized controlled trial comparing the safety and efficacy of GE vs RA in VP infants undergoing elective NICU inguinal hernia repair. II Retrospective study. Copyright © 2017. Published by Elsevier Inc.

  15. Randomized clinical trial comparing ambulatory and inpatient care after inguinal hernia repair in patients aged 65 years or older.

    Science.gov (United States)

    Mattila, Kristiina; Vironen, Jaana; Eklund, Anne; Kontinen, Vesa K; Hynynen, Markku

    2011-02-01

    There is a lack of evidence from randomized studies of the feasibility of ambulatory surgery in patients aged 65 years and older. Medically stable patients scheduled for open inguinal hernia repair, with postoperative care available at home, were randomized to receive treatment either as outpatients or inpatients. Younger patients undergoing the same procedure served as a reference group. Outcome measures during the 2 weeks after surgery were complications, unplanned admissions, visits to the hospital, unplanned visits to primary health care, and patients' acceptance of the type of provided care. Of 151 patients, 89 were included. Main reasons for exclusion were lack of postoperative company (16%), unwillingness to participate (13%), and medical conditions (10%). All outpatients were discharged home as planned, and none of the study patients were readmitted to the hospital. Patient satisfaction was high with no differences between the groups. Ambulatory surgery was safe and well accepted by older, medically stable patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Difficulties and Problematic Steps in Teaching the Onstep Technique for Inguinal Hernia Repair, Results from a Focus Group Interview

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Laursen, Jannie; Rosenberg, Jacob

    2016-01-01

    Background. When a new surgical technique is brought into a department, it is often experienced surgeons that learn it first and then pass it on to younger surgeons in training. This study seeks to clarify the problems and positive experiences when teaching and training surgeons in the Onstep...... technique for inguinal hernia repair, seen from the instructor's point of view. Methods. We designed a qualitative study using a focus group to allow participants to elaborate freely and facilitate a discussion. Participants were surgeons with extensive experience in performing the Onstep technique from...... Germany, UK, France, Belgium, Italy, Greece, and Sweden. Results. Four main themes were found, with one theme covering three subthemes: instruction of others (experience, patient selection, and tailored teaching), comfort, concerns/fear, and anatomy. Conclusion. Surgeons receiving a one-day training...

  17. Unilateral Giant Varicocele Mimicking Inguinal Hernia Resulting from Portosystemic Shunt without Evidence of Portal Hypertension: An Unusual Case Report

    Science.gov (United States)

    Zahir, Muhammed; Al Muttairi, Hassan R.; Upadhyay, Surjya Prasad; Mallick, Piyush N.

    2013-01-01

    Isolated giant varicocele has been reported with portal hypertension that results in abnormal communication between portal venous system and testicular vein venous system resulting in retrograde backflow of blood into the testicular venous system which leads to varicosity of the pampiniform plexuses. 65-year-old male with no past medical or surgical history presented to us with soft inguinoscrotal swelling that disappears on lying down mimicking inguinal hernia. Clinical examination revealed soft inguionoscrotal swelling that disappears on pressure. Ultrasonography revealed varicosity of pampiniform plexus, and CT angiography to trace the extent of the varicosity revealed abnormal communication of right testicular vein with superior mesenteric vein. There was no evidence of any portal hypertension; the cause of the portosystemic shunt remains obscure, and it might be a salvage pathway for increasing portal pressure. The case is noteworthy for its rare presentation and abnormal communication with portal venous system in the absence of evidence of portal hypertension. PMID:23533916

  18. Obstruction of an ileal urinary conduit in an incarcerated right inguinal hernia

    Science.gov (United States)

    Weston, PMT

    2015-01-01

    We present the case of a 72-year-old man with a history of anuria from his ileal conduit 15 months following its formation. That conduit had become incarcerated in a right-sided ingunial hernia. The patient presented with anuria and an acute kidney injury. A clincal diagnosis of an incarcerated hernia was made, and he was taken to theatre for reduction and repair of the hernia. On removal of the conduit from the hernial sac, it began to drain immediately. He made a full recovery, with normalisation of his renal function. PMID:26491738

  19. Reparación protésica en la hernia inguinal con el uso del tapón de Rutkow

    Directory of Open Access Journals (Sweden)

    Jorge Rafael Roselló Fina

    2002-12-01

    Full Text Available Se presentan 35 enfermos operados de hernia inguinal utilizando el método de plug and patch, entre diciembre de 1999 y diciembre del 2000. Los tapones y parches fueron construidos artesanalmente mediante piezas de malla plana de polipropileno. El 77 % de los pacientes fue operado electivamente, y existió un predominio del masculino sobre el femenino en relación de 6:1. En todos los casos se usó anestesia regional y antibioticoterapia profiláctica. La mitad de los pacientes mostraron hernias recidivadas una o varias veces. Según la clasificación de Gilbert modificada, 5 hernias eran tipo 2, 16 tipo 3, 6 tipo 4, 6 tipo 5 y 2 tipo 6 al ser hernias dobles o en pantalón. Sólo se presentaron complicaciones leves en 2 enfermos, recidivas, con un control que oscila entre 6 y 18 meses, y un seguimiento promedio de 12,4 meses del 100 % de los casos35 patients operated on of inguinal hernia by the plug and patch method from December, 1999, to December, 2000, were presented. The plugs and patches were made by hand, using pieces of flat polypropylene mesh. 77 % of the patients underwent elective surgery. There was a predominance of males over females with a ratio of 6:1. Regional anesthesia and prophylactic antibiotic therapy were used in all cases. Half of the patients had hernias that had relapsed one or more times. According to the modified Gilbert’s classification, 5 hernias were type 2; l6, type 3; 6, type 4; 6, type 5; and 2, type 6, on being double hernias. Mild complications were just observed in 2 patients, relapses, with a control that ranges between 6 and 18 months, and an average follow-up of 12.4 months of 100 % of the cases

  20. Hernias

    Science.gov (United States)

    ... of hernia requires another surgery to repair it. Hiatal Hernias This type of hernia occurs at the opening ... you might feel heartburn, indigestion, and chest pain. Hiatal hernias can be treated with medication and diet changes, ...

  1. Metastatic Prostatic Adenocarcinoma in an Inguinal Hernia Sac in a Patient with Undetectable Serum Prostate Specific Antigen Level

    Directory of Open Access Journals (Sweden)

    Shiu-Dong Chung

    2007-05-01

    Full Text Available Metastatic prostate cancer found within the hernia sac contents is a rare clinical manifestation. We report a 64-year-old male patient who presented with rare clinical features of prostate cancer. A focal metastasis of prostate cancer was incidentally found in an incised inguinal hernia sac 5 years after radical prostatectomy. The serum prostate specific antigen (PSA level remained undetectable (< 0.01 ng/mL prior to herniorrhaphy without any adjuvant therapy. In addition, serial studies performed right after herniorrhaphy disclosed no evidence of overt clinical metastasis. However, his serum PSA level started rising 12 months later and bladder invasion as well as a mass in the cul-de-sac was identified subsequently. The serum PSA level was 2.45 ng/mL at his latest visit, which was 5 years after herniorrhaphy. This case implies that physicians should be more alert in patients with a low preoperative serum PSA level during the period of follow-up. Both serum PSA and digital rectal examination may be important in patients with low preoperative PSA level after radical prostatectomy.

  2. Eosinophilic funiculitis initially diagnosed as irreducible inguinal hernia: A case report

    Directory of Open Access Journals (Sweden)

    Kohei Yamada

    2017-01-01

    Conclusion: Eosinophilic funiculitis is very rare; only three cases have been reported to date. We should always consider unusual causes of groin masses during a surgical approach to hernia-like lesions.

  3. A weeping umbilical hernia: bilateral ovarian mucinous cystadenoma with disseminated peritoneal adenomucinosis.

    Science.gov (United States)

    Singh, Varun Kumar; Nishant, Kumar; Sharma, Barun Kumar; Lamichaney, Rachna

    2014-05-22

    A young woman was referred to us for the management of an umbilical hernia with macerated overlying skin through which massive ascites was leaking. On examination we found a jelly-like substance seeping out of the opening. A contrast-enhanced CT scan of the abdomen revealed bilateral ovarian cystadenocarcinoma with pseudomyxoma peritonei. The patient underwent cytoreductive surgery along with hysterectomy and bilateral oophorectomy followed by hyperthermic intraperitoneal chemotherapy with mitomycin C. Histopathological examination showed bilateral borderline cystadenoma with peritoneal adenomucinosis. Follow-up at 1 year showed no signs of recurrence. 2014 BMJ Publishing Group Ltd.

  4. Spontaneous scrotal faecal fistula: A rare complication of incarcerated inguinal hernia in infancy

    Directory of Open Access Journals (Sweden)

    Sowande O

    2006-01-01

    Full Text Available Spontaneous scrotal faecal fistula is a rare complication of incarcerated inguino-scrotal hernia in the neonate and infants. Only five previous cases have been reported in the English medical literature. We report another case of a 28-day-old neonate, who presented with fecal fistula following prolonged incarceration of a right inguino-scrotal hernia. The etiology and management of this rare complication is discussed.

  5. Randomized clinical trial of dexamethasone versus placebo in laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, M A; Strandfelt, P; Bryld, Clara E

    2012-01-01

    The effect of dexamethasone on recovery and length of convalescence has not been evaluated in patients after laparoscopic groin hernia repair. It was hypothesized that preoperative intravenous dexamethasone would reduce postoperative pain.......The effect of dexamethasone on recovery and length of convalescence has not been evaluated in patients after laparoscopic groin hernia repair. It was hypothesized that preoperative intravenous dexamethasone would reduce postoperative pain....

  6. How to Surgically Remove the Permanent Mesh Ring after the Onstep Procedure for Alleviation of Chronic Pain following Inguinal Hernia Repair

    DEFF Research Database (Denmark)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

    2016-01-01

    A promising open inguinal hernia operation called Onstep was developed in 2005. The technique is without sutures to the surrounding tissue, causing minimal tension. A specific mesh is used with a memory recoil ring in the border, which may cause pain superficial to the lateral part of the mesh......-month follow-up, the patient was free of pain, without a recurrence. It is advised to wait some months after the initial hernia repair before removing the ring, since the mesh needs time to become well integrated into the surrounding tissue. The operation is safe and easy to perform, which is demonstrated...

  7. Randomized clinical trial comparing inguinal hernia repair with Lichtenstein technique using non-absorbable or partially absorbable mesh. Preliminary report

    Directory of Open Access Journals (Sweden)

    Konrad Pielaciński

    2011-12-01

    Full Text Available Introduction: The Lichtenstein technique is currently considered the “gold standard” of open, anterior inguinal herniarepair. It is not free, however, of adverse effects, which may be caused by the implemented synthetic material. Aim: Determination the influence of the mesh employed on treatment results including immediate complications,return to everyday activities, chronic pain occurrence and hernia recurrence. Material and methods: Tension-free hernia repair using the Lichtenstein technique was performed in all the 59patients randomized to trial groups. Group P with heavyweight polypropylene mesh contained 34 patients; group Vwith lightweight, partially absorbable mesh (polypropylene/polyglactin 910 consisted of 25 people. Controlled, scheduledfollow-up appointments took place after the 7th day and the 3rd and 6th month. Patients were clinically assessedand pain intensity was determined on an analogue-visual scale.Results: No statistically significant influence of the type of mesh on the risk of early complications, severe pain intensity,the length of hospital stay, time of recovery, or patients’ satisfaction with treatment was observed. After 6 monthsalso no statistically significant differences were observed between groups with regard to recurrence rate (P 3.4% vs.V 4.0%, chronic pain (P 5.9% vs. V 4.0% and ailments such as “foreign body presence” (V vs. P, OR = 0.30, 95% CI0.077-1.219, p = 0.093 incidence, although their probability was 70% lower for V mesh. Conclusions: The preliminary results confirm the effectiveness of the Lichtenstein technique for hernia repair withboth types of meshes. It appears that use of a partially absorbable mesh is connected with

  8. Burden of congenital inguinal hernia and hydrocele in northern and southern Nigeria: An opportunity for awareness creation

    Directory of Open Access Journals (Sweden)

    Musa Ibrahim

    2014-01-01

    Full Text Available Background: Nigeria, with a population of >150 million people in which half of the population are children encounters challenges in paediatric surgery practice in rural areas. There are paediatric surgeons in Nigeria, but majority practice in tertiary health facilities in cities. The poor rural dwellers have little or no access to such highly trained specialists. Hence, children with congenital and acquired paediatric surgical pathologies including anterior abdominal wall defects not only grow up with these diseases to adulthood, they are also exposed to various health hazards posed by unqualified personnel. Therefore, we are evaluating the burden of congenital inguinal hernia/hydrocele in northern and southern Nigeria for awareness creation and the way forward. Materials and Methods: Data obtained from organised free hernia missions to the rural populace from northern and southern Nigeria by the West African Collage of Surgeons in 2010 and Kano State Government in 2013 was analysed. Results: A total of 811 patients aged from 3 months (0.25 years to 35 years was screened and found to have congenital hernia and/or hydrocele from the two centres. 171 (21.1% were successfully operated, while the remaining 640 (78.9% could not benefit from a surgical procedure during the missions. There were n = 46 (26.9% patients with various forms of genital mutilations/and or surgical mismanagements among the operated patients. Conclusion: The burden of congenital anterior abdominal wall defects among Nigerian children is high. A little effort could bring succor and create awareness among this group of people.

  9. Laparoscopic hernia repair--when is a hernia not a hernia?

    National Research Council Canada - National Science Library

    Bunting, David; Szczebiot, Lukasz; Cota, Alwyn

    2013-01-01

    A wide range of diagnoses can present as inguinal hernia. Laparoscopic techniques are being increasingly used in the repair of inguinal hernias and offer the potential benefit of identifying additional pathology...

  10. Comparison of Heavy- and Light-Weight Composite Mesh in Pain Reduction Among Patients with Inguinal Hernia: A 1-Year Randomized Control Trial

    Directory of Open Access Journals (Sweden)

    Gogate AS

    2017-05-01

    Full Text Available Background: Inguinal hernia is commonly addressed complication among men and women. Surgical mesh repair is widely used as a treatment. Postoperative chronic pain is a major complication and concern, as it restricts the patient’s regular activities. Objective: To compare the heavy-weight polypropylene and the light-weight prolene mesh for the reduction of postoperative pain in patients undergoing Lichtenstein mesh repair of inguinal hernia. Methodology: This 1-year randomized study included 60 patients with inguinal hernia. They were divided into two equal groups (n=30- light-weight prolene (SP-study group and heavy-weight polypropylene mesh (RP-control group. Lichtenstein mesh repair surgery was performed on the patients according to the groups assigned. Postoperative pain was assessed based on visual analog score ranging from 0 to 10. Patients were followed up postoperative for the first, second, and third week. Microsoft Excel was used to enter the data and categorical data were expressed as rates, ratios and percentages. Data were compared using Fishers exact test and chi-square test. Results: During the first follow-up, all the patients in group SP reported moderate pain; however, 60% of patients in group RP reported pain (p<0.001. During second follow-up, majority of the patients (90% in group SP reported mild pain compared to 26.67% patients in group RP (p<0.001. At the third follow-up, all the patients (100% in group SP reported mild pain compared to 53.33% patients in group RP (p<0.001. Conclusion: The prolene light mesh significantly reduced the postoperative pain in patients undergoing Lichtenstein mesh repair for inguinal hernia as compared to heavy-weight mesh.

  11. Femoral hernia, a rare complication following deep inguinal lymph node dissection

    DEFF Research Database (Denmark)

    Muus Steffensen, Signe; Ahm Sørensen, Jens

    2015-01-01

    A 72-year-old woman underwent complete deep inguinal lymph node dissection on her right side subsequent to metastasis from malignant melanoma. On the second postoperative day, the patient reported of nausea and vomiting. She presented with a mass in the resected area that gradually increased in s...

  12. Incarcerated Pediatric Hernias.

    Science.gov (United States)

    Abdulhai, Sophia A; Glenn, Ian C; Ponsky, Todd A

    2017-02-01

    Indirect inguinal hernias are the most commonly incarcerated hernias in children, with a higher incidence in low birth weight and premature infants. Contralateral groin exploration to evaluate for a patent processus vaginalis or subclinical hernia is controversial, given that most never progress to clinical hernias. Most indirect inguinal hernias can be reduced nonoperatively. It is recommended to repair them in a timely fashion, even in premature infants. Laparoscopic repair of incarcerated inguinal hernia repair is considered a safe and effective alternative to conventional open herniorrhaphy. Other incarcerated pediatric hernias are extremely rare and may be managed effectively with laparoscopy. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Lightweight Titanium-coated Mesh Versus Standard-Weight Polypropylene Mesh in Totally Extraperitoneal Inguinal Hernia Repair (TEP): A Cohort Analysis.

    Science.gov (United States)

    Prassas, Dimitrios; Rolfs, Thomas-Marten; Sirothia, Nishank; Schumacher, Franz-Josef

    2016-12-01

    The study objective is to compare the outcomes of laparoscopic to tally extraperitoneal repair using the standard-weight polypropylene mesh or a lightweight titanium-coated mesh. A retrospective review was conducted on 138 adult patients with unilateral inguinal hernias, who underwent totally extraperitoneal inguinal hernia repair between 2010 and 2013 using either a standard-weight polypropylene mesh (Prolene mesh, 80 g/m) or a lightweight titanium-coated mesh (Ti Mesh light, 35 g/m). There was no difference in reported pain at 24 hours postoperatively. The difference in reported pain at follow-up (mean: 21 mo) was insignificant [PP vs. Ti: 7.8% (n=5) vs. 8.3% (n=3), P=0.92], the differences regarding chronic inguinal pain was also insignificant [PP vs. Ti: 14% (n=9) vs. 5.5% (n=2), P=0.191], and there was no difference in the development of hernia recurrence [PP vs. Ti: 1.5% (n=1) vs. 0, P=0.42]. No statistically significant differences of the overall postoperative outcome were observed between the 2 mesh types.

  14. Prospective double-blind randomised study of a new regimen of pre-emptive analgesia for inguinal hernia repair: evaluation of postoperative pain course.

    Science.gov (United States)

    Fischer, S; Troidl, H; MacLean, A A; Koehler, L; Paul, A

    2000-07-01

    To evaluate the effectiveness of a new regimen of pre-emptive analgesia on the development of postoperative pain after inguinal hernia repair. Prospective, double-blind, randomised study. University Hospital, Germany. 70 consecutive patients who had primary unilateral inguinal hernia repairs. A new regimen of pre-emptive analgesia with bupivacaine that was infiltrated preoperatively, intraoperatively, and postoperatively was tested. The control group were given saline infiltrations at the same times. Pain was measured up to postoperative day 30 using the visual analogue scale (VAS), the verbal rating scale (VRS), and by recording patient-controlled use of ibuprofen suppositories. Pain was significantly less in the pre-emptive analgesia group than in the control group during the first 10 days postoperatively as assessed by VAS and VRS (p < 0.05). Analgesic consumption was also significantly reduced in the pre-emptive analgesia group (p < 0.05). Multivariate analysis showed that bupivacaine infiltration (pre-emptive analgesia) was associated with significantly less postoperative pain (p < 0.0001). This regimen of pre-emptive analgesia is an effective and safe method of reducing postoperative pain and analgesic consumption after inguinal hernia repair.

  15. Use of a dynamic self-regulating prosthesis (P.A.D.) in inguinal hernia repair: our first experience in 214 patients.

    Science.gov (United States)

    Ferranti, Fabrizio; Marzano, Marco; Quintiliani, Alberto

    2009-01-01

    Numerous techniques exist for inguinal hernia treatment. Currently, open mesh tension-free repair is regarded as the repair method of choice. In particular Lichtenstein repair is the most common procedure performed, although several articles have reported long-lasting postoperative pain and a higher recurrence rate than originally reported. This study describes the P.A.D. (Protesi Autoregolantesi Dinamica) prosthesis implantation technique and reports postoperative complications and long-term results. From June 2002 to May 2005 a total of 214 patients underwent P.A.D. prosthesis inguinal repair. All patients were male, with a mean age of 51 years. All hernias were treated via an open inguinal approach using the original technique described by Valenti, with slight modifications. A total of 171'patients (80%) were available to follow-up 3 years after surgery. Early postoperative complications occurred in 14 patients (8.4%). Four patients (12.1%), who had undergone regional anaesthesia, developed urinary retention. Wound infection occurred in 3 patients (1.4%). There were two direct recurrences (0.93%) whereas chronic postoperative inguinal pain was reported in 4.2% of patients. Within the limitations of a short follow-up, our results show that the P.A.D. prosthesis procedure is a reliable technique with a low recurrence rate and low postoperative morbidity.

  16. Prospective randomized controlled study using polyethylene mesh for inguinal hernia meshplasty as a safe and cost-effective alternative to polypropylene mesh.

    Science.gov (United States)

    Gundre, Nitin P; Iyer, Sandhya P; Subramaniyan, Prabhakar

    2012-03-01

    Most patients who come to a general hospital in a developing country are poor. The most important prohibiting factor for use of polypropylene mesh in hernia repair is its exorbitant cost. Hence, research workers have been on the lookout for an equally effective but economically affordable mesh. Worldwide, surgical repair of inguinal hernia is the most common general surgery procedure performed at the present. Lifetime risk of groin hernia is 15% in males and 5% in females. Most of the patients who visit a general hospital are from either lower middle class or poor socioeconomic strata. The most important prohibiting factor for use of polypropylene mesh in hernia repair for the common man is its exorbitant cost. The aim of this study is to document the feasibility, safety and cost-effectiveness of the use of polyethylene mesh. A single blind, prospective, randomized controlled study, comparing 35 patients of two groups was conducted in a tertiary teaching hospital over a period of 5 years. The patients in both groups underwent inguinal hernioplasty, and were administered similar antibiotics and analgesics. The postoperative course with regard to pain, seroma formation, infection, hospital stay, recurrence and scar quality was evaluated and compared. Statistical analysis was performed with Chi square test. The properties of both meshes were the same with respect to ease of handling, pain score, seroma formation, infection rate, resumption of daily activities, scar quality and mesh rejection. Recurrence rate was zero for both groups. Polyethylene mesh was 2,808 times cheaper than the commercially available polypropylene mesh. This study proved the safety, simplicity, efficacy and cost-effectiveness of polyethylene mesh for inguinal hernia meshplasty, insuring economical, accessible health care for the financially weak section of the population.

  17. Systematic training model for teaching, development and training of instructors in inguinal hernia treatment using the Lichtenstein technique. Hernia campaign 2014 & 2015.

    Science.gov (United States)

    Lazzarini-Mendes, Carlos José; Pacheco, Adhemar Monteiro; Destro, Bárbara Bozzoli; Tamaro, Caroline; Nogueira, Fábio Antonio Del Picchia DE Araújo; Chen, David; Reinpold, Wolfgang; Bruscagin, Vitor; Roll, Sergio; Silva, Rodrigo Altenfelder

    2016-01-01

    to evaluate the method of training and continuing education of 18 surgeons in 2014, and 28 surgeons in 2015, in the Holy Homes of Ribeirao Preto, Araraquara, Franca and San Carlos of São Paulo, in the performance of Lichtenstein inguinal herniorrhaphy, tutored by the Faculty of Medical Sciences of the São Paulo Holy Home and the organization HERNIA HELP - "Hernia Repair for the Underserved". the training was tutored and systematized through an active methodology of teaching and learning, aiming to offer competence, skills and attitudes, measured by a previously validated Qualification Form, qualifying leaders in trainees' improvement. in 2014 the outcomes were: the difficulty of the case, direction, incision, dissection, mesh preparation, mesh cutting, mesh setting, closing, instruments, respect to tissues, flow, time and motion, and performance, all presented change in the general rating (p=0.000002); there was greater confidence in the execution of the procedure in 80% of trainees, considered "very valuable" in 93.3% of the interventions. In 2015, 28 surgeons were trained by ten surgeons previously qualified in 2014. The nerve identification rate, a relevant time the Lichtenstein technique, was 95.5% for the Iliohypogastric, 98.5% for the ilioinguinal and 89.4% for the genital branch of the genitofemoral nerve. the applied teaching method is possible, reproducible, reliable and valid. The joint efforts offer enormous opportunity of directed education, reaching underserved populations, revealing the great teacher-student social responsibility. avaliar resultados do método de treinamento e educação continuada de 18 cirurgiões, em 2014, e 28 cirurgiões, em 2015, nas Santas Casas de Ribeirão Preto, Araraquara, Franca e São Carlos do Estado de São Paulo, na realização da Herniorrafia Inguinal à Lichtenstein, tutorados pela Faculdade de Ciências Médicas da Santa Casa de São Paulo e pela organização HERNIA HELP - "Hernia Repair for the Underserved

  18. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis.

    Science.gov (United States)

    Bracale, Umberto; Melillo, Paolo; Pignata, Giusto; Di Salvo, Enrico; Rovani, Marcella; Merola, Giovanni; Pecchia, Leandro

    2012-12-01

    Totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are the most used laparoscopic techniques for inguinal hernia treatment. However, many studies have shown that laparoscopic hernia repair compared with open hernia repair (OHR) may offer less pain and shorter convalescence. Few studies compared the clinical efficacy between TEP and TAPP technique. The purpose of this study is to provide a comparison between TEP and TAPP for inguinal hernia repair to show the best approach. We performed an indirect comparison between TEP and TAPP techniques by considering only randomized, controlled trials comparing TEP with OHR and TAPP with OHR in a network meta-analysis. We considered the following outcomes: operative time, postoperative complications, hospital stay, postoperative pain, time to return to work, and recurrences. The two techniques improved some short outcomes (such as time to return to work) with respect to OHR. In the network meta-analysis, TEP and TAPP were equivalent for operative time, postoperative complications, postoperative pain, time to return to work, and recurrences, whereas TAPP was associated with a slightly longer hospital stay compared with TEP. TEP and TAPP improved clinical outcomes compared with OHR, but the network meta-analysis showed that TEP and TAPP efficacy is equivalent. TAPP was associated with a slightly longer hospital stay compared with TEP.

  19. The use of sterilised polyester mosquito net mesh for inguinal hernia repair in Ghana

    NARCIS (Netherlands)

    Clarke, M. G.; Oppong, C.; Simmermacher, R.; Park, K.; Kurzer, M.; Vanotoo, L.; Kingsnorth, A. N.

    The use of alloplastic mesh is now commonplace in hernia repair. However, in developing countries, cheaper alternatives to commercial mesh are required due to the high associated cost. Whilst nylon mosquito net mesh has been trialled previously, this study aimed to assess the use of polyester

  20. Early pain after laparoscopic inguinal hernia repair. A qualitative systematic review

    DEFF Research Database (Denmark)

    Tolver, M A; Rosenberg, J; Bisgaard, T

    2012-01-01

    Early post-operative pain after laparoscopic groin hernia repair may, as in other laparoscopic operations, have its own individual pain pattern and patient-related predictors of early pain. The purpose of this review was to characterise pain within the first post-operative week after transabdominal...

  1. Cadaveric Dissection vs Homemade Model: What is the Best Way to Teach Endoscopic Totally Extraperitoneal Inguinal Hernia Repair?

    Science.gov (United States)

    AlJamal, Yazan; Buckarma, EeeLN; Ruparel, Raaj; Allen, Samuel; Farley, David

    2017-09-29

    Endoscopic totally extraperitoneal inguinal hernia repair (TEP-IHR) requires practice and training to perform well. We developed a simple, low-cost, inanimate model to teach surgical residents inguinal anatomy and the technique of mesh insertion for a safe, endoscopic TEP-IHR. The objective of this study was to compare our model vs cadaveric dissection for teaching anatomy and mesh insertion. A total of 14 general surgery residents participated in an institutional review board approved, prospective, and randomized study. Participants received a timed, web-based, interactive pretest assessing relevant anatomy and operative-based techniques. They then performed endoscopic TEP-IHRs on either a cadaver or our low-cost model. Participants then received a timed, web-based interactive posttest consisting of the same questions. Participants were surveyed anonymously regarding the degree to which either the model or the cadaver was educationally effective. Both groups of trainees (cadaver = 7, low-cost model = 7) scored higher on the posttest (pmodel group: 77% vs 86%). Survey results revealed the trainees preferred for both initial learning and understanding of mesh placement using low-cost models (5 out of 5, 4.8/5, respectively) over cadavers (4.0/5, 3.8/5, respectively; pmodel (3.9, pmodel (4.7) in the overall educational value. While the overall educational experience of 14 learners favored a cadaver experience to learn TEP-IHR, initial anatomical learning and placing the mesh was better with an inanimate model. Given the educational value of the 2 methods was equivalent, the $1500 cost for cadavers make the inexpensive and repeatable inanimate model an attractive early resource for learning TEP-IHR. Published by Elsevier Inc.

  2. Ultrasound-guided transversalis fascia plane block versus anterior transversus abdominis plane block in outpatient inguinal hernia repair.

    Science.gov (United States)

    López-González, J M; López-Álvarez, S; Jiménez Gómez, B M; Areán González, I; Illodo Miramontes, G; Padín Barreiro, L

    2016-11-01

    The aim of the study was to assess the effectiveness of ultrasound-guided transversalis fascia plane block (TFP) compared to anterior transversus abdominis plane block (TAP-A) for post-operative analgesia in outpatient unilateral inguinal hernia repair. Retrospective observational study conducted on ASA I-II patients. Two groups (TAP-A and TFP), which were given 30ml of 0.25% levobupivacaine prior to surgical incision. The primary endpoint was the post-operative pain evaluated by verbal numerical scale (VRN at rest and movement) at 10, 30, 60, 90min, coinciding with ambulation, and 24hours by telephone. An evaluation was also made of the sensory block level reached prior to surgery, the need for additional analgesia, side effects, ease of performing the technique, and the level of satisfaction of patients with the anaesthetic-analgesic technique. A total of 61 patients were included, 30 patients in the TAP-A group and 31 in the TFP group. The analgesic efficacy obtained in both groups was similar, although some higher values were found in the VNR on moving in the TAP-A group, reaching statistical difference at 10minutes (P=.014) and 30minutes (P=.013) post-operatively. A higher level of sensory block was achieved in the TFP group than in the TAP-A group (P<.01). There were no significant differences in additional analgesia requirements, and the cumulative dose of morphine was similar in both groups in the post-operative period. There were no differences in side effects or complications. The technical ease of the block was similar in both groups and the level of satisfaction of patients very high. Both blocks with a multimodal approach achieve good post-operative analgesia of inguinal hernia repair, are easy to perform and have few complications. TFP achieves the highest sensory level, but there are no differences in the requirements for additional analgesia. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado

  3. Tumescent TAPP: laparoscopic inguinal hernia repair after the preperitoneal tumescent injection of diluted lidocaine and epinephrine saline solution and carbon dioxide gas.

    Science.gov (United States)

    Tokumura, Hiromi; Nomura, Ryohei; Saijo, Fumito; Matsumura, Naoki; Yasumoto, Akihiro; Muto, Mitsuhisa; Katayose, Yu; Takahashi, Kennichi; Haneda, Sho

    2017-01-01

    Laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) is technically difficult and not infrequently followed by postoperative complications and pain, especially when performed by inexperienced surgeons. To simplify TAPP and reduce postoperative pain, we devised a novel procedure whereby TAPP is carried out after the inguinal preperitoneal infiltration of diluted lidocaine and epinephrine saline solution and carbon dioxide gas (tumescent TAPP). This report introduces the concept of tumescent TAPP and summarizes its operative results. About 120 ml of diluted lidocaine and epinephrine solution and 60 ml of CO2 gas were infiltrated into the inguinal preperitoneal space through a transabdominal needle before TAPP. Tumescent TAPP was performed for 400 patients (355 men, 45 women; mean age, 63.2 years). Using tumescent TAPP, we found it easier to confirm the inguinal anatomy and dissect the preperitoneal layer and inguinal floor, with less bleeding. The mean operation time was 101.9 min and there were few perioperative complications and minimal pain. Tumescent TAPP makes conventional TAPP easier and safer; however, this procedure should be verified by a comparative study with conventional TAPP.

  4. Mesh fixation methods in open inguinal hernia repair: a protocol for network meta-analysis and trial sequential analysis of randomised controlled trials.

    Science.gov (United States)

    Ge, Long; Tian, Jin-hui; Li, Lun; Wang, Quan; Yang, Ke-hu

    2015-11-19

    Randomised clinical trials (RCTs) have been used to compare and evaluate different types of mesh fixation usually employed to repair open inguinal hernia. However, there is no consensus among surgeons on the best type of mesh fixation method to obtain optimal results. The choice often depends on surgeons' personal preference. This study aims to compare different types of mesh fixation methods to repair open inguinal hernias and their role in the incidences of chronic groin pain, risk of hernia recurrence, complications, operative time, length of hospital stay and postoperative pain, using Bayesian network meta-analysis and trial sequential analysis of RCTs. A systematic search will be performed using PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Biomedical Literature Database (CBM) and Chinese Journal Full-text Database, to include RCTs of different mesh fixation methods (or fixation vs no fixation) during open inguinal hernia repair. The risk of bias in included RCTs will be evaluated according to the Cochrane Handbook V.5.1.0. Standard pairwise meta-analysis, trial sequential analysis and Bayesian network meta-analysis will be performed to compare the efficacy of different mesh fixation methods. Ethical approval and patient consent are not required since this study is a meta-analysis based on published studies. The results of this network meta-analysis and trial sequential analysis will be submitted to a peer-reviewed journal for publication. PROSPERO CRD42015023758. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  5. A prospective, multicenter, observational study on quality of life after laparoscopic inguinal hernia repair with ProGrip laparoscopic, self-fixating mesh according to the European Registry for Abdominal Wall Hernias Quality of Life Instrument.

    Science.gov (United States)

    Muysoms, Filip E; Vanlander, Aude; Ceulemans, Robrecht; Kyle-Leinhase, Iris; Michiels, Maarten; Jacobs, Ivo; Pletinckx, Pieter; Berrevoet, Frederik

    2016-11-01

    There is an increasing interest in patient-reported outcome measurement to evaluate hernia operations. Several hernia-specific quality of life (QoL) scales have been proposed, but none are constructed for preoperative assessment. The European Registry for Abdominal Wall Hernias (EuraHS) proposed the short, 9-question EuraHS-QoL instrument for assessment pre- and postoperatively. The EuraHS-QoL was evaluated in a prospective, multicenter validation study alongside the Visual Analogue Scale, Verbal Rating Scale, and Carolina Comfort Scale (https://clinicaltrials.gov; NCT01936584). We included 101 patients undergoing unilateral laparoscopic inguinal hernia repair with ProGrip laparoscopic, self-fixating mesh. Clinical follow-up at 12 months was 87% complete. The EuraHS-QoL score shows good internal consistency (Cronbach's α ≥ .90), good test-retest reliability (Spearman correlation coefficient r ≥ 0.72), and high correlation for pain with the Visual Analogue Scale, the Verbal Rating Scale, the Carolina Comfort Scale pain scale (r between 0.64 and 0.86), and for restriction of activity with the Carolina Comfort Scale movement scale (r between 0.65 and 0.79). Our results show significant improvement in quality of life at 3 weeks compared with preoperative and further significant improvement at 12 months (P 75%) or with a 95%) in the majority of the patients. The EuraHS-QoL instrument is a short and valid patient-reported outcome measurement following groin hernia repair. Laparoscopic inguinal hernia repair with ProGrip laparoscopic, self-fixating mesh results in a favorable outcome and significant improvement of quality of life compared with the preoperative assessment. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Ruptured appendiceal cystadenoma presenting as right inguinal hernia in a patient with left colon cancer: A case report and review of literature

    Science.gov (United States)

    Lee, Yueh-Tsung; Wu, Hurng-Sheng; Hung, Min-Chang; Lin, Shang-Tao; Hwang, Yome-Shine; Huang, Min-Ho

    2006-01-01

    Background Mucoceles resulting from cystadenomas of the appendix are uncommon. Although rare, rupture of the mucoceles can occur with or without causing any abdominal complaint. There are several reports associating colonic malignancy with cystadenomas of the appendix. Herein, we report an unusual and interesting case of right inguinal hernia associated with left colon cancer. Case presentation A case of ruptured mucocele resulting from cystadenoma of the appendix was presented as right inguinal hernia in a 70-year-old male. The patient underwent colonoscopy, x-ray, ultrasound and computed tomography. Localized pseudomyxoma peritonei associated with adenocarcinoma of the descending colon was diagnosed. The patient underwent segmental resection of the colon, appendectomy, debridement of pseudomyxoma and closure of the internal ring of right inguinal canal. He is free of symptoms in one year follow-up. Conclusion Synchronous colon cancer may occur in patients with appendiceal mucoceles. In such patients, the colon should be investigated and colonoscopy can be performed meticulously in cases of ruptured mucoceles and localized pseudomyxoma peritonei. Surgical intervention is the current choice of management. PMID:17074081

  7. Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up.

    Science.gov (United States)

    Eklund, Arne S; Montgomery, Agneta K; Rasmussen, Ib C; Sandbue, Rune P; Bergkvist, Leif A; Rudberg, Claes R

    2009-01-01

    To compare a laparoscopic (totally extraperitoneal patch (TEP)) and an open technique (Lichtenstein) for inguinal hernia repair regarding recurrence rate and possible risk factors for recurrence. Laparoscopic hernia repair has been introduced as an alternative to open repair. Short-term follow-up suggests benefits for those patients operated with a laparoscopic approach compared with open techniques; ie, less postoperative pain and a shorter convalescence period. Long-term results, however, are less well known. The study was conducted as a multicenter randomized trial with a 5-year follow-up. A total of 1512 men aged 30 to 70 years, with a primary unilateral inguinal hernia, were randomized to either TEP or Lichtenstein repair. Overall, 665 patients in the TEP group and 705 patients in the Lichtenstein group were evaluable. The cumulative recurrence rate was 3.5% in the TEP group and 1.2% in the Lichtenstein group (P = 0.008). Test for heterogeneity revealed significant differences between individual surgeons. The exclusion of 1 surgeon, who was responsible for 33% (7 of 21) of all recurrences in the TEP group, lowered the cumulative recurrence rate to 2.4% in this group, which was not statistically different from that of the Lichtenstein group. The recurrence rate for both TEP and Lichtenstein repair was low. A higher cumulative recurrence rate in the TEP group was seen at 5 years. Further analysis revealed that this could be attributable to incorrect surgical technique.

  8. A prospective randomised controlled trial comparing chronic groin pain and quality of life in lightweight versus heavyweight polypropylene mesh in laparoscopic inguinal hernia repair

    Directory of Open Access Journals (Sweden)

    Pradeep Prakash

    2016-01-01

    Full Text Available Background: The aim of our study was to compare chronic groin pain and quality of life (QOL after laparoscopic lightweight (LW and heavyweight (HW mesh repair for groin hernia. Materials and Methods: One hundred and forty adult patients with uncomplicated inguinal hernia were randomised into HW mesh group or LW mesh group. Return to activity, chronic groin pain and recurrence rates were assessed. Short form-36 v2 health survey was used for QOL analysis. Results: One hundred and thirty-one completed follow-up of 3 months, 66 in HW mesh group and 65 in LW mesh group. Early post-operative convalescence was better in LW mesh group in terms of early return to walking (P = 0.01 and driving (P = 0.05. The incidence of early post-operative pain, chronic groin pain and QOL and recurrences were comparable. Conclusion: Outcomes following laparoscopic inguinal hernia repair using HW and LW mesh are comparable in the short-term as well as long-term.

  9. A prospective randomised controlled trial comparing chronic groin pain and quality of life in lightweight versus heavyweight polypropylene mesh in laparoscopic inguinal hernia repair.

    Science.gov (United States)

    Prakash, Pradeep; Bansal, Virinder Kumar; Misra, Mahesh Chandra; Babu, Divya; Sagar, Rajesh; Krishna, Asuri; Kumar, Subodh; Rewari, Vimi; Subramaniam, Rajeshwari

    2016-01-01

    The aim of our study was to compare chronic groin pain and quality of life (QOL) after laparoscopic lightweight (LW) and heavyweight (HW) mesh repair for groin hernia. One hundred and forty adult patients with uncomplicated inguinal hernia were randomised into HW mesh group or LW mesh group. Return to activity, chronic groin pain and recurrence rates were assessed. Short form-36 v2 health survey was used for QOL analysis. One hundred and thirty-one completed follow-up of 3 months, 66 in HW mesh group and 65 in LW mesh group. Early post-operative convalescence was better in LW mesh group in terms of early return to walking (P = 0.01) and driving (P = 0.05). The incidence of early post-operative pain, chronic groin pain and QOL and recurrences were comparable. Outcomes following laparoscopic inguinal hernia repair using HW and LW mesh are comparable in the short-term as well as long-term.

  10. Isolated bilateral inguinal lymphadenopathy in the absence of other symptoms, due to LGV in known HIV-positive MSM: is it more common than we think?

    Science.gov (United States)

    Cherif, Soumeya; Yoganathan, Kathir; Danino, Susannah

    2016-06-02

    The current resurgence of lymphogranuloma venereum (LGV) has drawn most attention to its potential for causing proctitis; however, this case highlights the need for awareness of LGV as a cause of isolated painful bilateral inguinal lymphadenopathy in a high-risk population and the importance of routine screening for LGV. We describe a case of a 37-year-old HIV positive man, in the population of men who have sex with men (MSM) who presented with bilateral enlarged inguinal lymph nodes and no other symptoms or signs. Urine nucleic acid amplification test was positive for chlamydia LGV-specific DNA. Tests from other sites were negative. 2016 BMJ Publishing Group Ltd.

  11. Study on the anesthetic effect of combined intravenous-inhalation general anesthesia under nasopharyngeal airway-mask spontaneous breathing for laparoscopic inguinal hernia surgery in children

    Directory of Open Access Journals (Sweden)

    Jing Liu

    2016-05-01

    Full Text Available Objective: To analyze the anesthetic effect of combined intravenous-inhalation general anesthesia under nasopharyngeal airway-mask spontaneous breathing for laparoscopic inguinal hernia surgery in children. Methods: A total of 118 cases of children with inguinal hernia who received laparoscopic surgery in our hospital from August 2012 to August 2014 were enrolled as research subjects and randomly divided into observation group 59 cases and control group 59 cases. Control group received conventional tracheal intubation intravenous general anesthesia, observation group received combined intravenous-inhalation general anesthesia under nasopharyngeal airway-mask spontaneous breathing, and then differences in respiratory and circulatory indicators, awareness-related indicators, G-6PD, PFK and inflammatory factor levels and oxidative stress levels between two groups were compared. Results: HR and MAP values of observation group at T1 and T2 were lower than those of control group, and SpO2 value was higher than that of control group; intraoperative Ppeak, Pplat, Raw, D(A-aO2 and RI levels of observation group were lower than those of control group, and levels of Cdyn and OI were higher than those of control group; intraoperative G-6PD, PFK, CRP and IL-6 levels of observation group were lower than those of control group, and IL-10 level was higher than that of control group; intraoperative NO, SOD and GSH levels of observation group were higher than those of control group, and levels of ET-1, CAT and blood glucose were lower than those of control group. Conclusion: Combined intravenous-inhalation general anesthesia under nasopharyngeal airway-mask spontaneous breathing for laparoscopic inguinal hernia surgery in children can effectively stabilize respiratory and circulatory level, reduce intraoperative systemic inflammation and oxidative stress state and contribute to early postoperative rehabilitation.

  12. The analgesic effect of Magnesium Sulfate in postoperative pain of inguinal hernia repair

    Directory of Open Access Journals (Sweden)

    Mehraein A

    2007-08-01

    Full Text Available Background: Magnesium Sulfate (MgSO4 has been used as a pharmacologic agent in different situations for many years in the treatment of tachyarrhythmias, myocardial ischemia, preeclampsia, and tocolysis among others. The analgesic effect of MgSO4 for postoperative pain has been used since the 1990s. Postoperative pain is one of the most common complications in the perioperative period and can result in serious consequences in different organs if left untreated. Inguinal herniorrhaphy is among the most common surgeries and is almost always accompanied by severe pain. The object of this study is to determine the effect of a pre-induction infusion of MgSO4 on the reduction of postsurgical pain after herniorrhaphy. Methods: This double-blind, randomized clinical trial included 105 ASA class I and class II herniorrhaphy patients at Shariati Hospital in years 2004 and 2005. For statistical analysis, the 2 and T tests were used. The patients were divided into three groups based on block randomization. Patients in the following groups received: Group A, 200 ml of normal saline infusion (placebo; Group B, 25 mg/kg MgSO4 in 200 ml of normal saline; Group C, 50 mg/kg MgSO4 in 200 ml of normal saline. All groups were infused twenty minutes before induction of anesthesia using identical methods and dosage in all three groups. Heart rate and mean arterial pressure (MAP at pre- and postintubation and so at skin incision time were charted. Visual analog scale (VAS pain score, nausea, vomiting and the amount of morphine used before recovery room discharge and in six, twelve and twenty-four hours after recovery discharge was recorded. Results: The average age for the different groups was as follows: Group A: 33.6, Group B: 37.37, Group C: 32.74. Nausea and vomiting between the case and control groups were not statistically different (60% vs. 71.4%, p=0.0499, nor was the amount of Morphine used. On recovery room discharge, the VAS scores were 8.1, 7.2, and 5

  13. How to Surgically Remove the Permanent Mesh Ring after the Onstep Procedure for Alleviation of Chronic Pain following Inguinal Hernia Repair

    Directory of Open Access Journals (Sweden)

    Stina Öberg

    2016-01-01

    Full Text Available A promising open inguinal hernia operation called Onstep was developed in 2005. The technique is without sutures to the surrounding tissue, causing minimal tension. A specific mesh is used with a memory recoil ring in the border, which may cause pain superficial to the lateral part of the mesh for slender patients. The aim of this study was to illustrate an easy procedure that alleviates/removes the pain. A male patient had persistent pain six months after the Onstep operation and therefore had a ring removal operation. The procedure is presented as a video and a protocol. At the eleven-month follow-up, the patient was free of pain, without a recurrence. It is advised to wait some months after the initial hernia repair before removing the ring, since the mesh needs time to become well integrated into the surrounding tissue. The operation is safe and easy to perform, which is demonstrated in a video.

  14. CT and ultrasound normal findings after laparoscopic surgery of inguinal hernia; CT- und Ultraschallnormalbefunde nach laparoskopischer Leistenhernienoperation

    Energy Technology Data Exchange (ETDEWEB)

    Hergan, K. [Zentrales Inst. fuer Radiologie, LKH Feldkirch (Austria); Scheyer, M. [Abt. fuer Chirurgie, LKH Feldkirch (Austria); Oser, W. [Zentrales Inst. fuer Radiologie, LKH Feldkirch (Austria); Zimmermann, G. [Abt. fuer Chirurgie, LKH Feldkirch (Austria)

    1995-01-01

    Common surgery has been revolutionised by minimal invasive surgery in a very short period of time. Laparoscopic operations of inguinal hernias are routinely done by many surgeons. For interpreting correctly postoperative complications with radiological techniques it is necessary to know the sonographical and CT changes of the normal postoperative situs. For evaluating these changes 23 patients without symptoms were examined between the first and third postoperative day. Typical sonographic findings are high echogenicity of the hernial orifice (17x) and echolucent thickening of the spermatic cord. The surgical clips and fleece and CO{sub 2} bubbles could not be detected by ultrasound. Using CT we found free peritoneal fluid collection (2x), streaky thickenings in the area of operation (20x), oedema at the hernial orifice (19x), residual CO{sub 2} bubbles (22x), thickening of the spermatic cord (22x) and visualisation of the surgical clips. The surgical fleece was invisible in all patients. (orig.) [Deutsch] Die minimal invasive Chirurgie hat in kurzer Zeit die Allgemeinchirurgie r