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Prostate cancer and inguinal hernia frequently coexist in elderly men, with 20-33% of patients undergoing radical prostatectomy also presenting with an inguinal hernia. Combining robot-assisted radical prostatectomy (RARP) with transabdominal preperitoneal (rTAPP) hernia repair offers both clinical and logistical benefits, although concerns regarding mesh-related complications remain. This retrospective cohort study analyzed 40 patients who underwent combined RARP and rTAPP hernia repair between August 2021 and September 2024. The mean operative time was 192.83 ± 32.57 min, with 54.2 ± 16.75 min dedicated to hernia repair. No mesh-related complications, including seromas or hematomas in the inguinal region, were observed. Minor complications (Clavien-Dindo ≤ 2) occurred in 25.64% of patients, with seromas (12.82%) and surgical site infections (7.69%) being the most common. The average hospital stay was 1.9 ± 0.50 days, and no hernia recurrences were noted during a mean follow-up of 16.03 ± 10.32 months. These findings support the safety and feasibility of simultaneous RARP and rTAPP hernia repair, maintaining low complication rates and eliminating the need for additional surgeries. Further multicenter studies are needed to validate these results and assess long-term outcomes., Competing Interests: Declarations. Conflict of interest: The authors declare no relevant financial or non-financial conflicts of interest. Ethics approval: The study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Since this was a retrospective analysis using anonymized data obtained during routine clinical care, formal ethics committee approval was not required under institutional and national research guidelines. Data confidentiality and privacy were strictly maintained throughout the study., (© 2025. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of penetrating versus non-penetrating mesh fixation in adults receiving laparoscopic groin hernia repair., (Copyright © 2025 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.)

Background: Orchialgia is a rare but significant complication experienced after open and minimally invasive inguinal hernia repairs with or without mesh. Causes have been theorized to include trauma to the spermatic cord, mesh-induced inflammation, vascular insult, fibrosis or mesh scarring of the cord, and neuropathic injury to the autonomic paravasal nerve fibers supplying the testicle. Though less frequently described than inguinodynia, orchialgia can be severely debilitating., Methods: Retrospective review of consecutive adult patients who underwent surgical intervention for inguinodynia with coexisting orchialgia between September 2011 and April 2023. Primary outcome was percent improvement of orchialgia, reported by patients in postoperative follow up. Secondary outcomes included surgical approach, type of neurectomy performed, the need for orchiectomy, and remedial operations., Results: A total of 173 patients were identified. Of this cohort, 89.6% (155) underwent paravasal neurectomy, 96% (166) underwent inguinal neurectomy, 14% (24) underwent orchiectomy, and 5.2% (9) underwent vasectomy. These operations were conducted via an open approach in 18% (31) and via hybrid approach in 62% (108). Improvement was noted in 99% (173) of cases, with greater than 50% improvement in pain in 64% (111)., Conclusion: Orchialgia is less common than inguinodynia but is encountered in approximately 10% of patients with chronic pain after inguinal hernia repair resulting from all variants of operative repairs. Utilization of a patient-tailored surgical approach to address the likely mechanisms of testicular pain after prior inguinal hernia repair allows for favorable surgical results. A careful examination and assessment of the potential mechanisms of orchialgia after inguinal hernia repair allows for identification of specific causes and potential options for remediation., Competing Interests: Declarations. Disclosures: Zachary N. Weitzner MD, Gabriel L. Oland MD, David C. Chen MD have no conflicts of interest or financial ties to disclose. Ethical approval: This study design was independently reviewed and approved by the Institutional Review Board (IRB) prior to initiation (IRB #20-001051)., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE) monitor is an objective, non-invasive tool for the assessment of pain in children under 2 years of age. The aim of this study was to objectively compare pain in infants undergoing open and laparoscopic inguinal hernia surgery using the NIPE monitor., Method: This prospective observational study included neonates and infants (<2 years of age) undergoing elective open inguinal herniotomy and laparoscopic inguinal hernia repair under general anaesthesia with a caudal block. The NIPE monitor was connected to the electrocardiogram monitor with continuous monitoring performed intraoperatively, and postoperatively in the Post Anaesthesia Care Unit. The NIPE index was recorded at different intraoperative steps. The median NIPE index (NIPE m ) was calculated for the entire procedure and postoperative period. The NIPE index ranges from 0 to 100; lower values indicate greater levels of pain, values < 50 indicate severe pain. P values < 0.05 were considered significant., Results: There were 40 infants recruited: 27 underwent open herniotomy and 13 underwent laparoscopic repair. Intraoperatively, NIPE m was found to be significantly lower in the laparoscopic group (59.00 vs. 77.00, p = 0.0018). Postoperatively, NIPE m was also found to be significantly lower in the laparoscopic group (49.00 vs. 57.50, p = 0.0001)., Conclusion: This is the first study to objectively demonstrate that laparoscopic inguinal hernia repair is more painful intraoperatively and leads to greater levels of pain in the early postoperative period compared to open inguinal herniotomy. This difference might explained by painful stimuli in anatomical areas not covered by the caudal block., Type of Study: Treatment Study/Prospective Study., Level of Evidence: Level II., Competing Interests: Conflict of interest None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

To optimize the efficacy of analgesia for patients receiving laparoscopic inguinal hernia repair, peri-operative pain neuroscience education (PNE) as a pain-specific cognitive therapy was incorporated into multi-modal analgesia. A randomized controlled trial was conducted to compare conventional analgesia (group CA) and the addition of pain neuroscience education into it (group PNE) in patients receiving laparoscopic inguinal hernia repair. Characteristics of peri-operative pain was evaluated with Douleur Neuropathique 4 questionnaire (DN-4), central sensitization inventory (CSI), pain catastrophizing scale (PCS) post-operatively and pressure pain threshold. Post-operative quality of recovery was measured with EuroQol five dimensions questionnaire (EQ-5D-5L). The incidence of chronic post-operative pain was also recorded. A total of 184 patients consented to participate in this study and finished follow-up. Compared with those receiving conventional analgesia (group CA, N = 91), patients in group PNE (N = 93) reported reduced incidence of moderate-to-severe pain and less dosages of opioid during hospitalization (p < 0.05). Catastrophing, sensitization related to pain were reduced in group PNE (p < 0.05). Quality of recovery was improved till 1 month after surgery (p < 0.05). The addition of pain neuroscience education improved analgesic effect and quality of recovery for patients undergoing laparoscopic inguinal hernia repair. It also helped reduce sensitization and catastrophic of acute surgical pain. This psychologically-oriented analgesic approach merits future research and application for these patients., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval: Ethics approval was received from the Instutional Review Board of The First Affiliated Hospital of Chongqing Medical University (IRB number: 2022-068)., (© 2025. The Author(s).)

Background: Given the increasing prevalence of antiplatelet agent use and the lack of high-quality evidence, the CAPTAIN trial aimed to investigate the safety and provide recommendations on continuing acetylsalicylic acid perioperatively in patients undergoing elective laparoscopic totally extraperitoneal inguinal hernia repair (LIHR)., Methods: The CAPTAIN trial was a multicentre, surgeon blind, randomized controlled trial conducted from April 2016 to April 2023. Patients undergoing LIHR were eligible for inclusion. Participants were randomized to either the acetylsalicylic acid cessation group or the continued acetylsalicylic acid group. The primary endpoint was the incidence of hematoma formation at discharge., Results: After a total of 69 patients were randomized, four patients dropped out, leaving 35 patients in the acetylsalicylic acid cessation group and 30 in the continued acetylsalicylic acid group. The baseline characteristics of both groups were similar. While the distribution of hernia types was largely comparable, there were significantly more direct inguinal hernias in the continued acetylsalicylic acid group (p < 0.001). The primary outcome, hematoma formation at discharge, was similar between groups (3.3% vs. 2.9%, p = 1.000). Secondary outcomes, including wound bruising, post-discharge hematomas, pain, seroma formation, wound infection rates, and length of hospital stay, did not differ significantly between groups. No thromboembolic complications, readmissions, chronic pain, or recurrences were observed during follow-up in either group., Conclusion: This study found that it is safe to continue acetylsalicylic acid perioperatively in selected patients undergoing LIHR without an increased risk of complications., Competing Interests: Declarations. Conflict of interest: None to declare., (© 2025. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Purpose: The AFTERHERNIA Project aims to shift the focus of hernia surgery towards patient-reported outcomes by examining the impact of surgical methods and long-term complications on a national level. Groin and ventral hernia repairs are common surgical procedures with significant impact on patient quality of life and healthcare costs. Most large-scale studies focus on clinical outcomes like reoperation and readmission rates, rather than patient-reported outcomes., Methods: This nationwide survey involves Danish patients who have undergone groin or ventral hernia repair over a ten-year period. Patients will be identified in the Danish National Patient Registry, and they will receive either the Abdominal Hernia-Q or Groin Hernia-Q questionnaire to collect data on patient-reported outcomes. Data from the questionnaire will be linked with clinical and patient-related data from the Danish Hernia Database. The Danish National Patient Registry also contains information on long-term surgical complications. Thereby, it will be possible to link specific perioperative details with patient-reported outcomes and long-term surgical complications., Conclusion: The AFTERHERNIA Project aims to redefine the understanding of hernia surgery outcomes by emphasizing patient-reported outcomes on a nationwide basis. By capturing a broad spectrum of patient experiences and outcomes, the project expects to inform and possibly transform clinical guidelines and patient care practices., Competing Interests: Declarations. Ethical approval: Approval was obtained from the Capital Region of Denmark authorized under the Danish Data Protection Agency (p-2023-14805). Ethical review board approval is neither possible nor required under Danish law. Consent to participate: Informed consent will be obtained from all participants. Consent for publication: Informed consent will be obtained from all participants. Competing interests: All authors declare no competing interest., (© 2025. The Author(s).)

Transabdominal preperitoneal patch plasty (TAPP) versus total extraperitoneal patch plasty (TEP) are surgical techniques commonly used to treat inguinal hernia. However, studies indicate that both procedures may lead to significant complications, particularly gastrointestinal complications, some of which can be life-threatening. We statistically analyzed the complications caused by adult inguinal hernia patients admitted from 2018 to 2022. We focused on gastrointestinal complications and conducted a case-by-case analysis on their causes and treatment processes. A total of 1034 patients were included in the final analysis, with 783 patients receiving TAPP treatment and 251 patients undergoing TEP. The overall complication rate for the TAPP group was slightly higher at 4.72% compared to 3.58% in the TEP group, but the difference was not statistically significant (p = 0.446). The incidence of both common and gastrointestinal complications is similar between the two groups, with no significant difference observed. Five patients (0.48%) suffered gastrointestinal complications, one with gastric perforation after TEP surgery, and four during TAPP surgery. All five cases of gastrointestinal complications were Grade III or higher according to the Clavien-Dindo classification, and all required reoperation. Gastrointestinal complications, though rare in LIHR, often require readmission and reoperation. Attempting non-operative management of such complications may lead to disastrous consequences. The majority of these complications are attributed to improper use of surgical instruments, necessitating vigilance on the part of the surgical team in preventing them., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: While surgeons agree that perioperative field blocks should be performed for open inguinal hernia surgery, there lacks consensus in the minimally invasive context. Prior small-scale randomized trials study pain scores only up to 24 h postoperatively. Thus, we sought to investigate the analgesic benefits of a bupivacaine transversus abdominis plane (TAP) block in the first 4 postoperative days., Methods: This is a prospective single-institution randomized control trial involving patients undergoing elective totally extraperitoneal inguinal hernia repairs, who received either a TAP block with bupivacaine 0.25% or saline placebo. Postoperatively, patients completed a pain survey (based on a 0-10 visual analog score) and an opioid/non-opioid pain medication log. Differences were detected using a Wilcoxon rank sum test for continuous variables, and a Fisher's exact test or chi-squared for categorical variables., Results: A total n = 90 patients were included in the per-protocol analysis, of which n = 46 received TAP blocks with bupivacaine versus n = 44 placebo. Patient characteristics were similar between the groups, including recurrent hernias and number of tacks placed (p > 0.05). All cases were bilateral. Postoperatively, pain scores (at rest and with movement) and pain medication use were similar for all postoperative days 1-4., Conclusion: Our study shows no significant difference in pain or opioid requirement within the first 4 days postoperatively, suggesting that the analgesic benefits of plain bupivacaine TAP blocks in totally extraperitoneal inguinal hernia repairs do not exist beyond the recovery unit. This will help inform anesthesiologists and patients in discussing risks and benefits of a TAP block in their surgical context., Competing Interests: Declarations. Conflict of interest: The authors have no conflicts of interest to disclose. Ethical standard: This study was approved by our institutional review board and registered with Clinicaltrials.gov (NCT05672680). Consent to participate: Informed consent was obtained from all individual participants included in the study., (© 2025. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Surgical treatment of inguinal hernias in children is one of the most common operative procedures worldwide. During surgery for inguinal hernias in adults, chronic pain develops in approximately 10% of all cases. In children, there has been limited research to determine whether they may also develop this chronic postsurgical inguinal pain (CPIP). The aim of this study was to investigate the prevalence of CPIP in children after open inguinal hernia surgery and to identify possible risk factors and protective factors for the development of CPIP., Methods: A single center retrospective analysis of patients aged 4 to 15 years who underwent inguinal hernia repair from 2020 to 2022 was performed. A detailed analysis based on the local database was used to analyze existing pre-existing conditions, perioperative information and the use of a cauda epidural block. A standardized follow-up questionnaire was used to evaluate the prevalence of CPIP and the duration of postoperative analgesic medication., Results: A total of 176 cases were included in the detailed analysis. 3.4 % of the children complained CPIP 3 months after surgery with a mean follow-up period of 26.4 months. At the time of the survey, 50% of CPIP patients reported a resolving from chronic pain. Our analyzes showed a potential higher CPIP rate in females (83.3%; p=0.040), older children (8.3 years vs. 5 years; p=0.006) and chronic pain history (16.7% vs. 2.4%; p=0.038).Furthermore, Children mitght profit from a intraoperative cauda epidural block since we observed a lower rate of CPIP (66.7% (4/6) vs. 97% (164/170); p=0.019) in these patients., Conclusion: We were able to identify initial risk factors such as female gender, older patient age and a history of chronic pain. In addition, we were able to obtain information on possible protective factors such as an intraoperative cauda epidural block and adequate postoperative analgesia. However, further studies are required to clarify the pathogenesis and to confirm predictors and protective factors in order to improve therapeutic approaches., Competing Interests: Declarations. Conflict of interest: Prof. Dr. med. Christoph-Thomas Germer, Prof. Dr. med. Nicolas Schlegel, Prof. Dr. med. Armin Wiegering, Priv.-Doz. Dr. med. Michael Meir, Priv.-Doz. Dr. med. Johan Friso Lock, Dr. med. Lukas Maroske, Prof. Dr. med. Thomas Meyer, Hannah Bucher, Priv.-Doz. Ann-Kathrin Reinhold, Prof. Dr. med. Heike Rittner and Dr. med. Anna Widder declare, that they have no competing interests and informed consent was obtained from all individual participants included in the study. , (© 2025. The Author(s).)

Introduction: Up to 12% of patients undergoing minimally invasive inguinal hernia repair may develop chronic postoperative inguinal pain (CPIP), possibly explained by the presence of mesh. Recent studies reported that laparoscopic mesh removal is feasible and safe. However, the risk of a hernia recurrence is unknown. This observational study describes the rate of hernia recurrence and evolution in pain score following laparoscopic mesh removal for CPIP after preperitoneal inguinal hernia repair., Methods: Prospectively collected questionnaires and operative notes of consecutive patients undergoing a laparoscopic mesh removal for CPIP in our center of expertise between November 2011 and July 2022 were studied. Pain scores were quantified using the Numeric Pain Rating Scale (NRS, 0-10). The presence of a hernia recurrence was based on patient history and clinical findings., Results: A total of 89 patients underwent laparoscopic mesh removal, and data of 83 patients (93% response rate) were available for analysis. Median decrease in pain score (NRS) after mesh removal was 4 (range + 2 to - 9). After a median 4.3 years follow up period, a hernia recurrence was present in 18 patients (21.7%). Of these, eight were symptomatic requiring correction using a Lichtenstein repair with a favorable outcome whereas a wait-and-see approach was successfully followed in the remaining 10 patients., Conclusion: Laparoscopic mesh removal for CPIP following preperitoneal inguinal hernia repair resulted in an inguinal hernia recurrence in one of five patients requiring remedial surgery in one in ten patients. This knowledge may inform the preoperative counseling process., Competing Interests: Declarations. Disclosures: Ahmed M. Chaoui, Jonas P. Rops, William Van Dijk, Marc Scheltinga, Willem Zwaans and Gerrit Slooter have no conflicts of interest or financial ties to disclose., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Cholelithiasis and inguinal hernias are common surgical conditions that often coexist. Laparoscopic techniques are increasingly used for both cholecystectomy and inguinal hernia repair. This study aimed to systematically review the available evidence on the safety and efficacy of simultaneous laparoscopic cholecystectomy (LC) and laparoscopic inguinal hernia repair (LIHR). Methods: A systematic search of the PubMed/MEDLINE and Google Scholar databases was performed for articles published until March 2024 using specific keywords. Studies meeting predetermined inclusion and exclusion criteria were analyzed. Results: Ten studies comprising 199 patients were included in the review. The mean operative time for combined LC and LIHR ranged from 55 to 157 minutes, with an average hospital stay between 1 and 4 days. The overall complication rate was 22%, with seroma/hematoma formation (6.5%) being most common. There were no reported mortalities or cases of mesh infection. Discussion: This review suggested that simultaneous LC and LIHR is a safe and effective option for patients with both conditions. The combined procedure offers potential benefits such as reduced hospital stay, faster recovery, and cost savings. Although the optimal sequence of surgical procedures for LIHR and LC remains debatable, the risk of mesh infection appears to be minimal.

Background: The evolution of minimally invasive surgery has transformed inguinal hernia repair (IHR). The innovative single-port technique reduces the number of surgical incisions. However, the benefits of single-port IHR remain controversial. Our systematic review and network meta-analysis assess the efficacy and clinical outcomes of single-port laparoscopic inguinal hernia repair (SPL-IHR), multi-port laparoscopic inguinal hernia repair (MPL-IHR), single-port robotic inguinal hernia repair (SPR-IHR), and multi-port robotic inguinal hernia repair (MPR-IHR)., Methods: A comprehensive search was conducted in PubMed, EMBASE, Cochrane, and Ovid for articles published before January 2024, focusing on complication rates, recurrence, seroma, hematoma, operative time, post-operative pain, and cosmetic outcomes of laparoscopic or robotic IHR. Both extraperitoneal (TEP) and transabdominal (TAPP) approaches were analyzed using MetaInsight. MPL-TAPP was used as the standard for comparison., Results: Thirty-seven studies, including 5,038 patients, 36.92% (1,860 patients) underwent MPL-TEP, 23.64% (1,191 patients) SPL-TEP, 22.23% (1,120 patients) MPR-TAPP, 10.08% (508 patients) MPL-TAPP, 5.40% (272 patients) SPL-TAPP, and 1.73% (87 patients) SPR-TAPP. There were no significant differences in the rates of post-operative complications, hernia recurrence, hematoma, or seroma among the techniques when compared to MPL-TAPP. For secondary outcomes, MPR-TAPP significantly increased the operative time for unilateral hernia repair by a mean difference (MD) of 10.60 min [95% CI: 2.16-19.04]. Conversely, for bilateral hernia repair, there was no significant difference. Post-operative pain was significantly higher for MPL-TEP and SPL-TEP, with MDs of 1.44 [95% CI: 0.43 to 2.44] and 1.22 [95% CI: 0.18 to 2.26], respectively. SPL-TEP was significantly favored in cosmetic outcomes over MPL-TEP, with an MD of 0.65 [95% CI: 0.07 to 1.24]., Conclusion: In our network meta-analysis, the risk of post-operative complications, including recurrence, hematoma, and seroma, does not significantly vary among single-port and multi-port laparoscopic or robotic techniques. This suggests that surgical technique selection can rely on surgeon expertise and resource availability, without compromising outcomes., Competing Interests: Declarations. Disclosures: Theethawat Thanawiboonchai, Amanda Cyntia Lima Fonseca Rodrigues, Alba Zevallos, Fatemeh Shojaeian, and Hao Deng have no conflicts of interest. Brett Parker reports an unrelated disclosure of honoraria for research and consulting for EndoGastric Solutions. Alisa Coker reports an unrelated disclosure of honoraria for research and consulting for Intuitive Surgical. Gina Adrales reports an unrelated disclosure of honoraria for research and consulting for Caresyntax, Inc., and Ethicon, Johnson & Johnson., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Inguinal hernia is one of the most common visceral surgical conditions in industrialised countries. The aim of the present observational clinical study was to investigate the dermatome patterns after nerve injury following inguinal hernia surgery and to demonstrate the marked individual anatomical and topographical variability of peripheral nerves in the inguinal region., Methods: 220 patients were followed up for one year after inguinal herniotomy. Surgical treatment was performed either with tension-free mesh techniques or open according (Lichtenstein)., Results: One year after inguinal herniotomy, 25 patients (11.4 %) reported postoperative symptoms. Of these, 15 patients showed evidence of a distinct nerve lesion. The results of the clinical neurological examination sometimes differed considerably from the subjective perceptions of the patients. In addition, a marked individual variability in the dermatomes of surgically lesioned nerves was found, with discrepancies to the classical and conventional dermatome data in textbooks., Conclusions: This study has shown that it is hardly possible to assign a specific lesional inguinal dermatome to a specific nerve, as nerves show a large individual variability in their anatomical, topographical location and thus in their dermatome boundaries. Therefore, we propose a descriptive approach to the terminology of peripheral inguinal nerve lesions using common regional landmarks. This will avoid a potentially erroneous dermatome assignment to a certain nerve and facilitate the reproducibility of lesion descriptions between different observers, thus facilitating communication in clinical practice., Competing Interests: Declaration of Competing Interest None. On behalf of all authors, the corresponding author states that there is no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Background: Seroma formation is a prevalent postoperative complication following laparoscopic inguinal hernia repair. While seromas are mostly self-absorbed, they can cause discomfort for the patient and complicate the assessment of hernia recurrence. Two primary techniques for managing the hernia sac are sac transection and complete sac reduction. This article aims to evaluate whether sac transection leads to a higher incidence of seroma compared to sac reduction and to review the main preventive strategies for seroma., Methods: Four databases (PubMed, MEDLINE, Embase and Cochrane Library) and ClinicalTrials.gov were comprehensively searched for relevant studies. The date of the last search was 25 March 2024. The results reported should include reliable information on seroma incidence, mean operation time, hospital stay and postoperative complications., Results: The present study included 6 studies compared the results of indirect hernia sac transection and complete sac reduction. The pooled results indicated that indirect hernia sac transection was associated increased seroma formation (OR = 1.74, 95% CI: 1.35-2.24%), and there was no statistical difference in mean operation time, hospital stay and recurrence between the sac transection (TS) and sac reduction (RS) groups. Postoperative pain was evaluated in 4 studies. There was no statistical difference between the two groups in postoperative pain reported in each of the four articles., Conclusions: The study revealed that transection of the indirect hernia sac is associated with a higher incidence of seroma, but does not increase the occurrence of other complications., Competing Interests: Declarations. Ethical approval: This article did not require ethical approval of any kind. Human and animal rights: This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent: This article does not include patients, and therefore informed consent was not applicable. Conflict of interest: No conflict of interest to be declared by the authors., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Total extra peritoneal inguinal hernia repair is established approach to inguinal hernia repair usually performed under general anesthesia. Aim of the study was to compare Total extra peritoneal inguinal hernia repair outcome when operated under spinal anesthesia and general anesthesia., Methods: A prospective cross-sectional study was conducted at Bir hospital on patients undergoing Total extra peritoneal inguinal hernia repair under either spinal anesthesia or general anesthesia for inguinal hernia from September 2022 to August 2023. Operative time, postoperative hospitalization time, postoperative pain, postoperative adverse effects, level of satisfaction and recurrence rate at one year was compared., Results: Fifty-eight patients were included, divided into two groups TEP-GA and TEP-SA, 29 in each arm. All procedures were completed by allocated method of anesthesia. Though pain score was low in TEP-SA in initial four hours, 2.79±1.08 (GA) and 1.99±0.97 (SA) and 2.28±1.09 (GA) and 1.80±0.80 (SA) at one and four hours post-operative respectively, no statistical difference was noted between two groups regarding surgery time, pain score complications, hospital stay, recovery or recurrence., Conclusions: Spinal anesthesia is at par with general anesthesia for total extra peritoneal inguinal hernia repair, if not better. It may be appropriate anesthetic modality in patients considered high risk for general anaesthesia.

Purpose: To investigate long-term chronic postoperative inguinal pain (CPIP), QoL and recurrence in patients with a primary inguinal hernia comparing TEP to Lichtenstein., Material and Methods: A questionnaire-based follow-up containing the Inguinal Pain Questionnaire (IPQ), the Cunningham Pain Scale and SF-36 was done 8 years after the TEPLICH RCT. The main objective was non-ignorable pain last week according to IPQ. A phone interview was performed with patients reporting new non-ignorable pain and those having a suspected recurrence. Records were scanned for long-term CPIP and recurrences. A lost to follow-up analysis was performed., Results: A total of 322 of 366 patients (88%) completed the follow-up of mean 7.94 years (5-10.75 years). Non-ignorable pain last week was reported by 7.6% in TEP and 6.7% in Lichtenstein (p < 0.73). New non-ignorable pain was reported by 5 patients. No difference in non-ignorable pain over time (1-8 years) was observed within groups. Moderate to severe pain, according to Cunningham, was reported by 3.8% in TEP and 5.5% in Lichtenstein (p < 0.48). QoL remained above the Swedish norm. No recurrences occurred after 3 years follow-up. The lost to follow-up analysis showed no difference in non-ignorable pain., Conclusions: RCTs, comparing TEP to Lichtenstein repair with follow-up ≥ 5 years regarding CPIP are sparse with conflicting data. In this study, low frequencies of CPIP present at 3 years seem to persist at 8 years. Recurrences occured within the first 3 years. Patients need to be informed of the risk of long-term CPIP., Competing Interests: Compliance with Ethical Standards. Conflict of interest: Author A. Gutlic, U. Petersson, P. Rogmark and A. Montgomery declare that they have no conflict of interest. Ethical approval: The study was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Ethical approval for this study was given by the Regional Ethical Review Board in Lund, Sweden 2019-00304. Informed consent: Informed consent was signed by the patients when they completed the questionnaires. Trial registration: The TEPLICH trial was registered the 5th of December 2008 at www.clinicaltrials.gov (NCT00803985). Human and animal rights: The Ethical principles involving human participants according to the Helsinki Declaration as well as ethical approval by the Ethical Review Board are described under the heading Compliance with Ethical Standards. Application ofinformed is also described under this section (Informed consent)., (© 2024. The Author(s).)

Background: Postoperative pain is a common complication following surgery, with severity and duration varying between patients. Chronic postoperative pain after inguinal hernia surgery has an incidence rate of approximately 10%. Risk factors for acute and chronic pain following hernia surgery include age, sex, psychosocial factors, and demographic background. Additionally, genetic polymorphisms in enzymes involved in pain mechanisms, as well as the metabolism of analgesics might influence pain perception, pain development, and response to pain medications. Key enzymes include the catechol-o-methyltransferase (COMT), the µ-opioid receptor 1 (OPRM1), and the cytochrome P450 2D6 (CYP2D6). CYP2D6 plays a crucial role in metabolizing analgesics such as tramadol, codeine, and oxycodone. It is also suspected to be involved in the synthesis of catecholamines and endogenous morphines suggesting a potential role in pathophysiology of pain. We hypothesize that the CYP2D6 activity influences the development of postoperative pain after hernia surgery., Methods: This study is a prospective, observational, multicenter association study investigating adult patients scheduled for inguinal hernia surgery using a robotic-assisted (rTAPP) approach. Patients are enrolled during the preoperative surgical consultation. A buccal swab is collected for genetic testing at this time. Pain at the site of the hernia is assessed using the validated EuraHSQoL score preoperatively and at 2, 4, and 6 weeks postoperatively. Additionally, information on co-medication and details of the surgery will be collected. The planned number of participants is 350 patients. The primary objective is to analyze the association between different genotype-predicted CYP2D6 phenotypes and patient-reported pain intensity 6 weeks after surgery. Secondary objectives include the association between further genetic variants, such as the COMT rs4680 and OPRM1 rs1799971 genotype, and pain severity. Additionally, the potential of pharmacogenetic panel testing to optimize analgesic therapy in hernia surgery patients will be explored., Discussion: The findings of this study are expected to provide valuable insights into identifying patients at higher risk for postoperative pain before surgery. This knowledge could pave the way for tailored interventions during and after surgery for these specific patients., Trial Registration: Deutsches Register Klinischer Studien https://www.drks.de/DRKS00034796 Registered on August 07, 2024., Competing Interests: Declarations. Ethics approval and consent to participate: The local ethics committees (Ethikkommission Nordwest- und Zentralschweiz, Basel, Switzerland, and Kantonale Ethikkommission Zürich, Zürich, Switzerland) approved the described study protocol version 2, dated on July 24, 2024, as of October 01, 2024 (reference number 2024–01080). We will obtain consent from all trial participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: In inguinal hernia repair, mesh weight and pore size are used to describe the mesh characteristics. One meta-analysis of laparo-endoscopic inguinal hernia repairs identified 12 prospective randomized controlled trials (RCTs) with 2,909 patients who had all been treated with lightweight (≤ 50 g/m²) or heavyweight (> 70 g/m²) meshes. None of the 12 RCTs gave details of the pore size. There were more recurrences when using lightweight meshes, in particular in the case of medial defects without mesh fixation and/or large defects. In terms of pain, no significant differences were seen. This retrospective analysis of data from the Herniamed Registry now aims to analyze whether mesh pore size is related to the outcome in laparo-endoscopic inguinal repair., Materials and Methods: To analyze the association between mesh pore size and the outcome in laparo-endoscopic inguinal repair, it was necessary to select meshes with comparable properties. Polyester meshes and PTFE meshes had to be excluded and polypropylene and polyvinylidene fluoride meshes (PVDF) were included. 83,768 included patients were retrospectively analyzed. The meshes analyzed were eight small-pore and 13 large-pore meshes. Using a binary logistic regression model, it is possible to simultaneously analyze several factors being potentially associated with the outcome., Results: Higher BMI, lower weight meshes, higher ASA score and medial EHS classification were associated with a higher risk of recurrence. It was not possible to find any significant association between pore size and recurrences at one-year follow-up. This also applied for pain on exertion and pain requiring treatment., Conclusion: No association was identified between the pore size of the meshes used in laparo-endoscopic inguinal repair and the recurrence rate, pain on exertion rate or the rate of chronic pain requiring treatment at one-year follow-up., Competing Interests: Declarations. Ethical approval: Only cases of routine hernia surgery were documented in the Herniamed Registry and all patients have signed a special informed consent declaration agreeing to participate. The Herniamed Registry has ethical approval (BASEC No. 2016 − 00.123, 287/2017 BO2). Human and animal rights: This article does not contain any Study with animals performed by any of the authors. Informed consent: All patients with routine hernia surgery documented in Herniamed Registry have signed an informed consent declaration agreeing to participate. Conflict of interest: F. Köckerling reports grants to fund Herniamed from Johnson&Johnson, Norderstedt, Karl Storz, Tuttlingen, MenkeMed, Munich, DB Karlsruhe and personal fees from BD Karlsruhe. J. Wrede, H. Riediger, D. Jacob have nothing to disclose., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Purpose: The impact of non-fixation of mesh in transabdominal preperitoneal (TAPP) inguinal hernia repair has not been fully assessed. The aim of this meta-analysis was to comprehensively compare the clinical outcomes of non-fixation and fixation of mesh in TAPP to determine whether non-fixation could affect the outcomes., Methods: PubMed, Embase and CENTRAL were searched for studies on TAPP repair of inguinal hernia and mesh fixation published up to June 2023. The literature search was completed on June 22, 2023. Randomized controlled trials that compared perioperative outcomes between mesh fixation and non-fixation without using self-gripping mesh were included. The primary outcome measures were recurrence and evaluation of postoperative pain, while secondary outcome measures included time to normal activity, infection rate and formation of seroma. Subgroup analyses and sensitivity analysis were also conducted., Results: Six randomized controlled trials were included, involving 679 patients who underwent TAPP with non-fixation and 964 patients with fixation of mesh. There was no significant difference in recurrence between the two groups (RR: 0.83; 95% CI, 0.29-2.39, P = 0.73). The non-fixation group had less pain than the fixation group at 6 months postoperatively (MD: -0.16; 95% CI, -0.23--0.10, P < 0.0001). Additionally, there was no significant difference in the time to return to normal activity or rates of infection or seroma formation between the two groups (MD: -4.95; 95% CI, -11.36-1.45, P = 0.13; RR: 1.18; 95% CI, 0.39-3.62, P = 0.77; RR: 0.94; 95% CI, 0.63-1.40, P = 0.75)., Conclusion: Based on the current evidence, non-fixation without using self-gripping mesh may not affect the efficacy of TAPP. It does not increase recurrence rate and may result in less postoperative pain in inguinal hernia with small hernia defect (less than 3cm)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: To compare the indicators, postoperative pneumoretroperitoneum-related complications, and postoperative recovery of laparoscopic preperitoneal inguinal hernia repair under different CO2 pneumoperitoneum pressures., Methods: The total of 187 adult patients with primary inguinal hernia who successfully underwent transabdominal preperitoneal prosthesis (TAPP) from September 2021 to September 2023 in the Department of General Surgery, Haimen People's Hospital affiliated to Nantong University, were collected. These patients were randomly divided into low abdominal pressure group (group A: pneumoperitoneum pressure = 8 mmHg), sub-low abdominal pressure group (group B: pneumoperitoneum pressure = 10 mmHg), moderate abdominal pressure group (group C: pneumoperitoneum pressure = 12 mmHg), and standard pressure group (group D: pneumoperitoneum pressure = 14 mmHg), with 40 patients each., Results: The operation time in group C (43.90 ± 9.75) was significantly lower than group A (51.98 ± 12.65, p 0.001), group B (46.70 ± 10.59, p 0.001), and was higher than that in group D without significant statistical differences (38.15 ± 7.98, P = 0.05). The peritoneal suturing time in group C (5.03 ± 1.07) was significantly higher than group A (4.23 ± 0.70, p 0.001), group B (4.55 ± 0.85, p = 0.03), and was significantly lower than that in group D (6.95 ± 1.96, p 0.001)., Conclusion: Selecting sub-low abdominal pressure (12 mmHg) can help to have a shorter operation time, with less blood loss, and it did not add pneumoretroperitoneum-related complications. Changing the pneumoperitonium pressure during different phases of the surgery is also an optimal option.

Purpose: The role of abdominal compliance in pneumoperitoneum is not fully understood. This study aimed to clarify the association between abdominal wall stretching tendency and surgical stress in laparoscopic groin hernia repair., Methods: We conducted a retrospective single-center cohort study, evaluating 51 patients who underwent elective transabdominal preperitoneal groin hernia repair. Abdominal compliance was assessed using the abdominal compliance index (ACI; insufflated intra-abdominal volume [L] / body surface area [m²]) at 8 mmHg intra-abdominal pressure. Surgical stress and recovery were evaluated with patient-reported outcome measures (PROMs), including QOR-15 and pain visual analog scale (VAS) scores. Associations between ACI, PROMs, and clinical outcomes were analyzed., Results: The median ACI was 1.229 L/m² (0.369-2.091). Eleven patients (21.6%) above the 75th percentile cutoff (1.576 L/m²) were categorized as high ACI. While body constitution was similar between groups, the high ACI group had significantly greater insufflated intra-abdominal volume (2.88 L vs. 1.89 L, P < 0.0001). Pre-operative QOR-15 scores were similar. However, on postoperative day 1, the high ACI group had significantly lower QOR-15 scores (90.2 vs. 110.1, P = 0.017), with subcategory analysis showing reduced physical well-being. Multivariate analysis indicated that high ACI was a significant predictor of poorer QOR. The high ACI group also reported higher, though not statistically significant, postoperative pain., Conclusion: Abdominal walls with greater elasticity, which stretch excessively under pneumoperitoneum, were more susceptible to surgical stress. Further studies are warranted to evaluate the efficacy of tailored pneumoperitoneum pressure adjustment based on abdominal compliance to mitigate surgical stress., Competing Interests: Declarations. Ethical approval: All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). This study was approved by the institutional review board (Yamatotakada Municipal Hospital Ethics Committee, No. R5-5). Informed consent: Written informed consent was obtained from all patients before treatment. Conflict of interest: All authors declare no conflict of interest., (© 2024. The Author(s).)

Introduction: Umbilical surgical site infection (U-SSI) is the most common complication of laparoscopic percutaneous extraperitoneal closure (LPEC) for the treatment of inguinal hernia in children. Prolonged operative time is known to increase the risk of SSI in general pediatric surgery; however, the association between prolonged operative time and post-LPEC U-SSI is unclear. The present study aimed to elucidate the association between umbilical port insertion time and the incidence of U-SSI. Materials and Methods: The present study included all patients <16 years of age who underwent LPEC for the treatment of inguinal hernia between June 2018 and May 2023 at our institution. Those who underwent umbilical hernia repair or other procedures were excluded. We retrospectively collected and analyzed the following: patient demographics; operative data; and U-SSI data. The cutoff value for the umbilical port insertion time was determined using receiver operating characteristic analysis, and the incidence of U-SSI was compared based on the cutoff value, determined to be 8 minutes. Results: A total of 232 patients (133 boys; mean age, 4.6 ± 3.3 years) were eligible for the present study, 7 (3.0%) of which developed superficial incisional post-LPEC U-SSI within a median of 7.5 [4-19] days. The incidence of U-SSI was 20.0% in the long (≥8 minutes) versus 2.3% in the short (<8 minutes) umbilical port insertion time group ( P = .03). Conclusion: Prolonged umbilical port insertion time (≥8 minutes) increases the incidence of post-LPEC U-SSI during the treatment of inguinal hernia in children.

There is a debate over whether to transect or completely reduce the hernia sac during laparoscopic tension-free repair of inguinal hernia. This study endeavors to systematically assess the efficacy and safety of two approaches, namely transected sac (TS) and completely reduced sac (RS), in laparoscopic tension-free repair of inguinal hernia. Utilizing a meta-analysis methodology, we aim to provide a comprehensive analysis of these techniques. A comprehensive search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases to identify comparative studies focusing on laparoscopic tension-free repair of inguinal hernia, specifically comparing TS and RS techniques. The selected studies were subjected to meta-analysis using RevMan 5.3 software. A total of 8 studies, involving 2995 patients with inguinal hernia, were included in the analysis. The meta-analysis results revealed that the TS group had a higher incidence of seroma compared to the RS group [OR = 1.74, 95% CI (1.35, 2.25), P < 0.0001], and a prolonged time to return to normal activity postoperatively [MD = 0.99, 95% CI (0.85, 1.14), P < 0.00001]. However, no statistically significant differences were observed between the two groups in terms of operation time [MD = -1.75, 95% CI (- 8.72, 5.22), P = 0.62], incidence of postoperative pain [OR = 1.00, 95% CI (0.41, 2.44), P = 1.00], overall postoperative complication rate [OR = 0.98, 95% CI (0.43, 2.20), P = 0.95], and recurrence rate fOR = 2.53, 95% CI (0.61, 10.39), P = 0.20]. Transected sac in laparoscopic inguinal hernia repair is associated with an increased incidence of seroma and a longer recovery time for patients to return to normal activity. Clinical trial registration Registration number is INPLASY20223110070., Competing Interests: Declarations. Conflict of interest: The authors have no conflicts of interest to declare that are relevant to the content of this article. Ethical approval: For this type of study, formal consent was not needed. Informed consent: Informed consent is not required for this type of study. Research involving human participants and/or animals: This article does not contain any studies with human participants or animals performed by any of the authors., (© 2024. Italian Society of Surgery (SIC).)

Purpose: Individual studies indicate poorer outcomes for smokers after hernia repair. Previous meta-analyses have examined the impact of smoking on specific outcomes such as recurrence and surgical site infection, but there has been a lack of comprehensive consensus or systematic review on this subject. Addressing this gap, our study undertakes a systematic review and meta-analysis to assess the impact of smoking on the outcomes of ventral hernia repair (VHR) and inguinal hernia repair., Source: A thorough search of Cochrane Central, Scopus, SciELO, and PubMed/MEDLINE, focusing on studies that examined the effect of smoking on inguinal and VHR outcomes was conducted. Key outcomes evaluated included recurrence, reoperation, surgical site occurrences (SSO), surgical site infection (SSI), and seroma., Principal Findings: Out of 3296 screened studies, 42 met the inclusion criteria. These comprised 25 studies (69,295 patients) on VHR and 17 studies (204,337 patients) on inguinal hernia repair. The analysis revealed that smokers had significantly higher rates of recurrence (10.4% vs. 9.1%; RR 1.48; 95% CI [1.15; 1.90]; P < 0.01), SSO (13.6% vs. 12.7%; RR 1.44; 95% CI [1.12; 1.86]; P < 0.01) and SSI (6.6% vs. 4.2%; RR 1.64; 95% CI [1.38; 1.94]; P < 0.01) following VHR. Additionally, smokers undergoing inguinal hernia repair showed higher recurrence (9% vs. 8.7%; RR 1.91; 95% CI [1.21; 3.01]; P < 0.01), SSI (0.6% vs. 0.3%; RR 1.6; 95% CI [1.21; 2.0]; P < 0.001), and chronic pain (9.9% vs. 10%; RR 1.24; 95% CI [1.06; 1.45]; P < 0.01) rates. No significant differences were observed in seroma (RR 2.63; 95% CI [0.88; 7.91]; P = 0.084) and reoperation rates (RR 1.48; 95% CI [0.77; 2.85]; P = 0.236) for VHR, and in reoperation rates (RR 0.99; 95% CI [0.51; 1.91]; P = 0.978) for inguinal hernias between smokers and non-smokers. Analysis using funnel plots and Egger's test showed the absence of publication bias in the study outcomes., Conclusion: This comprehensive meta-analysis found statistically significant increases in recurrence rates, and immediate postoperative complications, such as SSO and SSI following inguinal and VHR. Also, our subgroup analysis suggests that the MIS approach seems to be protective of adverse outcomes in the smokers group. However, our findings suggest that these findings are not of clinical relevance, so our data do not support the necessity of smoking cessation before hernia surgery. More studies are needed to elucidate the specific consequences of smoking in both inguinal and ventral hernia repair., Prospero Registration: ID CRD42024517640., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Aim: Minimally invasive inguinal hernia repair has become increasingly accepted, demonstrating superior outcomes over open procedures in postoperative complications. However, certain postoperative complications, such as seroma, remain a dilemma, with many attributing it to the management of the hernia sac. We aimed to perform a systematic review and meta-analysis comparing the reduction versus abandonment of the hernia sac during laparoscopic inguinal hernia repair., Material and Methods: Cochrane, Scopus, SciELO, and PubMed were searched for studies comparing reduction and abandonment of the hernia sac. Our primary outcome was seroma. Secondary outcomes were overall complications, postoperative pain, surgical site infection, recurrence, hospital length of stay (LOS), and operative time. We performed a subgroup analysis of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques. Statistical analysis was performed with R Studio., Results: 2388 studies were screened, and seven studies were included, comprising 3153 patients, of which 916 (29%) were in the abandonment group. We found higher seroma rates for the abandonment group (RR 1.52; 95% CI 1.22 to 1.89; P < 0.001). No differences were found in overall complications (RR 0.88; 95% CI 0.55 to 1.42; P = 0.61), postoperative pain (RR 1.15; 95% CI 0.46 to 2.87; P = 0.76), recurrence (RR 2.67; 95% CI 0.51 to 14.05; P = 0.25), operative time (MD - 4.45 min; 95% CI - 12.77 to 3.86; P = 0.29), and LOS (MD -0.06 days; 95% CI - 0.14 to 0.02; P = 0.14) between both groups. Subgroup analysis of seroma showed no differences between the groups when analyzing TAPP (19.3% vs. 13%; RR 1.65; 95% CI 0.91 to 2.99; P = 0.1) and TEP (9% vs. 4.3%; RR 1.69; 95% CI 0.62 to 4.6; P = 0.3) procedures., Conclusion: Our systematic review and meta-analysis support that hernia sac abandonment may be associated with increased early seroma rates following laparoscopic inguinal hernia repair, but limited data are available for technique-specific analyses., Competing Interests: Declarations. Disclosures: Diego Lima, Carlos Silveira, Ana Rasador, João Kasakewitch, Gabriele Lech, and Prashanth Sreeramoju declare no conflict of interest. Flavio Malcher discloses consulting fees from BD, Intuitive, Integra, DeepBlue, Allergan & Medtronic, outside the submitted study., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: This study aimed to develop, validate, and evaluate machine learning (ML) algorithms for predicting Surgical site infections (SSI) and surgical site occurrences (SSO) after elective open inguinal hernia surgery., Methods: A cohort of 491 patients who underwent elective open inguinal hernia surgery at Fudan University Affiliated Huadong Hospital between December 2019 and December 2020 was enrolled. To create a strong prediction model, we employed five ML methods: generalized linear model, random forest (RF), support vector machines, neural network, and gradient boosting machine. Based on the best performing model, we devised online calculators to facilitate clinicians' access to a linear predictor for patients. The receiver operating characteristic curve was utilized to evaluate the model's discriminatory capability and predictive accuracy., Results: The incidence rates of SSI and SSO were 4.68% and 13.44%, respectively. Four variables (diabetes, recurrence, antibiotic prophylaxis, and duration of surgery) were identified for SSI prediction, while four variables (diabetes, size of hernias, albumin levels, and antibiotic prophylaxis) were included for SSO prediction. In the test set, the RF model showed the best predictive ability (SSI: area under the curve (AUC) = 0.849, sensitivity = 0.769, specificity = 0.769, and accuracy = 0.769; SSO: AUC = 0.740, sensitivity = 0.513, specificity = 0.821, and accuracy = 0.667). Online calculators have been developed to assess patients' risk of SSI ( https://wuqian17.shinyapps.io/predictionSSI/ ) and SSO ( https://wuqian17.shinyapps.io/predictionSSO/ ) after surgery., Conclusions: This study developed a prediction model for SSI/SSO using ML methods. It holds the potential to facilitate the selection of appropriate treatment options following elective open inguinal hernia surgery., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Purpose: Pediatric surgery in a free-standing children's ambulatory surgery center (C-ASC) is a common practice. The implementation of minimally invasive surgery in this setting may be associated with unique challenges. The purpose of this study was to compare a cohort of children who underwent laparoscopic (LHR) and open inguinal hernia repairs (OHR) at the C-ASC as part of a quality assurance initiative to assess safety and efficacy., Methods: From January 2021 to December 2021, the records of all children who underwent LHR or OHR at our C-ASC were analyzed. The following data was retrieved and compared with the Student's t-test: age, weight, gender, procedure type, total room time (RT), total operative time (OT), and outcomes., Results: Eighty-eight (n = 88) children underwent LHR or OHR during this period. There was no difference between the two groups regarding their age or weight. Both groups had equal outcomes, specifically, no wound infections or recurrent hernias. (2.5 year follow-up). There was a significant reduction in RT and OT in those children who underwent unilateral LHR compared to unilateral OHR (15% and 17% respectively, p < 0.05). In those children who underwent bilateral LHR and bilateral OHR, there was a reduction in RT and OT in the LHR group compared to OHR, but it was not significant (10% and 12% respectively, p > 0.05)., Conclusions: Pediatric LHR is safe and effective in the C-ASC. The unilateral LHR technique is associated with a significant reduction in total room time and operative time compared to the unilateral OHR technique. Additional analyses would be important to examine the relationship of time and outcomes in this setting., Type of Study: Original Research Retrospective Case-control study., Competing Interests: Conflict of interest No competing financial interests for the authors., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The perioperative use of gabapentin has been suggested to reduce postoperative pain and opioid consumption. However, there is a variation in clinical practice, the type of surgery and the administration time seem to be distinct between the available studies. We assess whether gabapentin administered before surgery reduces postoperative pain in patients who have undergone inguinal hernioplasty., Design: This is a double-blind, randomized, and placebo-controlled trial., Methods: Seventy-seven patients scheduled for inguinal hernioplasty were randomized in two groups to receive gabapentin (900 mg) or placebo in the perioperative period. The primary outcome was analgesia measured by visual analog scale up to 30 days after surgery. The secondary outcomes such as morphine consumption, nausea, headache, and sedation have been also described., Findings: Patients who received gabapentin had lower postoperative pain scores compared to the control group, P < .001. The postoperative morphine use was significantly lower in the gabapentin (5.3%) versus placebo group (74.4%), P < .001. No significant difference between groups was observed for the occurrence of adverse events., Conclusions: The perioperative administration of gabapentin was effective in reducing postoperative pain and had an important effect in decreasing morphine use. Together, our data reveal a long-lasting opioid-sparing effect of gabapentin in patients who underwent inguinal hernioplasty., Competing Interests: Declaration of Competing Interest None to declare., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: The optimal surgical approach for inguinal hernia (IH) repair in adolescents has not been established. This study aimed to analyze and compare the perioperative results and long-term outcomes of adolescent patients with IH treated with laparoscopic (LHR) versus open hernia repair (OHR)., Methods: This study retrospectively reviewed the clinicopathological data of adolescent patients with IH who underwent LHR or OHR as initial treatment from March 2012 to February 2018 at Xinxiang Central Hospital. Clinicopathological factors associated with the prognosis of patients were identified using univariate and multivariate Cox regression analysis. Recurrence-free survival (RFS) curves between different cohorts of patients were generated using the Kaplan-Meier method and compared using the log-rank test. Propensity score matching (PSM) analysis was used to match patients of the LHR and OHR groups in a 1:1 ratio., Results: Adolescent patients with IH were enrolled, including 243 patients in the LHR group and 252 patients in the OHR group. After PSM, 189 patients were matched in each of the study group. Compared with the OHR group, the LHR group had a shorter hospitalization, less blood loss, fewer overall postoperative complications and lower rates of recurrence and chronic pain. The LHR group had a significantly better RFS than the OHR group before and after PSM., Conclusions: Laparoscopic inguinal hernia repair for adolescent patients with IH can be safely performed with favorable perioperative and long-term outcomes.

Background: Inguinal hernia repair is a common surgical procedure, with more than 20 million cases yearly. Choice between mesh types varies in clinical practice. To compare light-weight polypropylene (LW-PP, 34-36 g/m2) and heavy-weight polypropylene (HW-PP, 95 ​g/m2) meshes., Methods: Data from patients who underwent open inguinal hernia repair between 2020 and 2022. Selection criteria ensured homogeneity. Endpoints were to assess the impact of different mesh weights on overall health-related quality of life (HRQoL), using Short Form 36 (SF-36), and to monitor postoperative complications., Results: Two hundred patients were included in both groups. Lateral and direct hernias occurred in 60.5 ​% and 39.5 ​%. According to EHS, 31.5 ​%, 22.3 ​% and 46.2 ​% were classified as size 1, 2, 3. Follow-up showed similar HRQoL at 30-days, with a favorable trend towards LW-PP mesh offering fewer limitations, better comfort, and improved general health after 12-months. No difference in postoperative paresthesia, wound hematoma, and interference with daily activities., Conclusion: 1-year after surgery HRQoL evaluation highlights the non-inferiority of LW-PP. Mesh selection should be tailored, aiming at improving outcomes and postoperative comfort., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: In laparoscopic inguinal hernia repair, it is thought that the mesh can be displaced more in the enhanced-view totally extraperitoneal (eTEP) technique. The aim of this study was to compare eTEP and totally extraperitoneal (TEP) techniques without mesh fixation in terms of mesh displacement and hernia recurrence., Methods: Between December 2022 and April 2023, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups; eTEP group (n = 30) and TEP group (n = 30). There was without mesh fixation in both groups. Study was registered at http://Clinicaltrials.gov (NCT06070142). The mesh was marked with three radiopaque clips. Pelvic radiographs were performed to evaluate the displacement of the mesh. The primary outcome of this study was mesh displacement. In addition, this is the first study in the literature to compare eTEP and TEP techniques in terms of mesh displacement without fixation in laparoscopic inguinal hernia., Results: There was no significant difference between the groups in terms of mesh displacement, recurrence, postoperative VAS scores, length of hospital stay, hematoma, and seroma formation. The operation time was higher in the eTEP group and was statistically significant., Conclusion: Without mesh fixation, the eTEP technique does not increase the risk of mesh displacement and recurrence. The eTEP technique can be safely applied without mesh fixation in laparoscopic inguinal hernia repairs., Trial Registration: ClinicalTrials number: NCT06070142., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Introduction: Polypropylene material is commonly used for posterior wall reconstruction in hernia repair, in contrast with the classically described stainless-steel wire used at Shouldice Hospital. This study was conducted to evaluate possible differences in Shouldice Repair outcomes using polypropylene or stainless-steel wire sutures., Methods: A prospective follow-up of consecutive patients who underwent elective unilateral Shouldice primary inguinal hernia repair at Shouldice Hospital between December 6, 2021, and September 1, 2022, was conducted. Data was collected from follow-up telephone calls as well as manually reviewing patient's charts. The primary objective was to determine whether the use of polypropylene was non-inferior to the use of stainless-steel wire, regarding the recurrence rate reported by the patients with a minimum follow-up of 1 year after Shouldice primary inguinal hernia repair., Results: A total of 1120 patients were contacted by telephone (polypropylene: 560; stainless-steel wire: 560). The median follow-up period was 16 months (interquartile range: 15-18). In 22 (1.96%) cases a surgical site infection was diagnosed. There was a total of 18 recurrences reported by the patients (1.6%). There was no statistical difference between the groups (polypropylene: 7 (1.25%) vs. stainless steel wire: 11 (1.96%), p > 0.05) for the recurrence rate., Conclusion: The use of polypropylene is non-inferior to the use of stainless-steel wire regarding recurrence rate at a median follow-up period of 16 months after elective unilateral Shouldice primary inguinal hernia repair. This finding may encourage other centers where stainless-steel wire is not easily available to perform the Shouldice Repair., (© 2024. The Author(s).)

Background: Inguinal hernia repair is one of the most common surgical procedures in the world. Each repair technique, open, laparoscopic, and robotic, has its advantages and advocates. Prior studies have compared 2 techniques, but there are little data comparing all 3 approaches with long-term follow-up., Methods: Prospectively collected data for unilateral inguinal hernia repair between 2007 and 2022 were reviewed. Using more than 3,300 inguinal hernia repairs, a 1:1:1 propensity score match was performed for open inguinal hernia repair, laparoscopic inguinal hernia repair, and robotic inguinal hernia repair based on patient age, sex, body mass index, and laterality. Standard descriptive and comparative statistics were performed. Data below is reported consistently as open inguinal hernia repair versus laparoscopic inguinal hernia repair versus robotic inguinal hernia repair., Results: A total of 420 patients were matched, with 140 in each group. There was no difference in age, body mass index, or smoking status between groups. Open inguinal hernia repair had significantly more comorbidities (2.8 vs 2.6 vs 2.3; P = .035), including higher rates of chronic obstructive pulmonary disease (5.0% vs 0.0% vs 1.4%; P = .013), cirrhosis (4.3% vs 0.0% vs 1.4%; P = .032), and congestive heart failure (5.0% vs 0.7% vs 0.7%; P = .023). American Society of Anesthesiologists scores differed significantly between groups (stage III and IV: 35.0% vs 20.0% vs 28.6%; P = .004). Open inguinal hernia repair were more often recurrent (48.6% vs 27.9% vs 17.1%; P < .001). The mean operative time was significantly different between groups (88.0 vs 86.1 vs 101.4 minutes; P < .001). There was no difference in wound infection (0.7% vs 0.0% vs 0.0%; P > .99), hematoma (1.4% vs 0.7% vs 1.4%; P > .99), seroma requiring intervention (2.9% vs 0.7% vs 0.7%; P = .377), or readmission (0.0% vs 2.1% vs 1.4%; P = .378). The rate of prolonged discomfort, requiring more than 2 pain medication refills, was similar between groups (2.9% vs 2.1% vs 2.1%; P = .903). Robotic inguinal hernia repair was significantly more expensive than laparoscopic inguinal hernia repair and open inguinal hernia repair ($10,005 ± $7,050 vs $17,155 ± $6,702 vs $31,173 ± $8,474; P < .001). With follow-up of at least 2.4 years in each group (3.6 vs 4.8 vs 2.4 years; P < .001), the recurrence rate was comparable (3.6% vs 0.7% vs 0.7%; P = .226)., Conclusions: All techniques are safe and effective in qualified hands. Open inguinal hernia repair was more commonly used in comorbid patients and recurrent hernias, but the techniques had comparable rates of wound complications, postoperative prolonged discomfort, and recurrence., Competing Interests: Conflict of Interest/Disclosure Drs Lorenz, Holland, Mead, Kercher, Ms Adams, and Mr Scarola have no financial ties or conflicts of interest to disclose. Dr Augenstein is a consultant for Medtronic and Vicarious Surgical and is a speaker for Allergan, Bard, and Pacira. Dr Heniford is a speaker and surgical research grant recipient for WL Gore., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Minimal invasive inguinal hernia repair is conducted using among others the laparoscopic transabdominal preperitoneal (TAPP) procedure or the extended totally extraperitoneal (eTEP) approach. Robotic-assisted TAPP (R-TAPP) has recently been introduced as an alternative to laparoscopic TAPP and TEP, and a growing number of robotic-assisted procedures are performed worldwide. The present study was conducted to determine the risk of chronic pain and recurrence associated with the two methods., Methods: Three hundred ninety-five patients were retrospectively included in the study and underwent either laparoscopic TAPP (n = 177) or R-TAPP (n = 218). Data on patient demographics, hernia characteristics, and postoperative outcomes were retrieved from medical records. Kaplan-Meier curves and Cox proportional hazards regression were used to assess hernia recurrence. Logistic regression was used to analyze secondary outcomes such as inpatient status, hematoma, and chronic pain., Results: The Kaplan-Meier curves indicated a consistently higher cumulative incidence of recurrence in the TAPP group compared to the R-TAPP. Consistent with this finding, the Cox regression showed a higher risk of recurrence in patients undergoing TAPP, with a hazard ratio (HR) of 3.489 (95% CI: 1.232 to 9.880, p = 0.019). The E-value for this HR was 6.44, suggesting robustness to unmeasured confounding. There was no difference in the rates of chronic pain between the groups (OR: 1.233, 95% CI: 0.430 to 3.533, p = 0.696). A logistic regression analysis for other postoperative complications revealed no significant differences., Conclusion: This study provides evidence that robotic-assisted TAPP is associated with a lower risk of recurrence than laparoscopic TAPP., Competing Interests: Declarations. Ethical approval: This research study was conducted retrospectively from data obtained for clinical purposes. According to MRC regulations, this study does not require ethical approval. Human and animal rights: This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent: Data on patient characteristics and short and long-term outcomes was anonymously retrieved from patient records. The local ethical committee assessed data collection under these circumstances not to require a statement of informed consent. Conflict of interest: Dr. Inan Ihsan has no conflict of interest to declare in direct relation to this article. Outside the context of this article, he has worked as a consultant for Intuitive Surgical Inc. and Medtronic Inc. Otherwise, the authors declare no conflicts of interest as stated by the authors’ ICMJE forms for disclosure of potential conflicts of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Purpose: Postoperative pain is a common complication following inguinal hernia repair. Progrip mesh is a self-adhesive mesh claimed to reduce postoperative pain compared to traditional mesh types. This meta-analysis aimed to compare postoperative pain, operative time, hospital stay, complications, and recurrence rates between Progrip mesh and other mesh types for inguinal hernia repair., Methods: A systematic search was conducted to identify randomized controlled trials comparing Progrip mesh with other mesh types for inguinal hernia repair. Primary outcome was postoperative pain assessed using the Visual Analogue Scale (VAS). Secondary outcomes included operative time, hospital stay, complications, and recurrence rates. Meta-analyses were performed to calculate pooled effect estimates with heterogeneity assessment., Results: Twenty-one studies involving 3827 participants were included. Progrip mesh was associated with significantly lower postoperative pain at 6 h (MD = - 1.21, p = 0.05), 1st day (MD = - 0.50, p = 0.03), 7th day (MD = - 0.38, p = 0.01), 2 weeks (MD = - 0.32, p = 0.007), 3 months (MD = - 0.48, p < 0.00001), and 6 months (MD = - 0.43, p < 0.0001) postoperatively compared to other mesh types. However, at 3 days, 1 month, and 1 year, the differences in pain scores were not statistically significant. Operative time was significantly shorter in the Progrip mesh group (MD = - 9.65 min, p < 0.00001). Recurrence rates were significantly higher in the Progrip mesh group (RR = 1.62, p = 0.02). No significant differences were observed in hospital stay (MD = - 0.32, p = 0.22) or postoperative complications (RR = 0.93, p = 0.59)., Conclusion: Progrip mesh demonstrated a significant reduction in operative time and postoperative pain compared to traditional mesh types for inguinal hernia repair. Though, it was associated with higher recurrence rates. There were no significant differences in other outcomes. Further high-quality studies with longer follow-up are needed to assess the long-term effects of Progrip mesh., Competing Interests: Declarations. Conflict of Interest: The authors declare that they have no conflict of interest. Ethics approval: Ethical approval was waived by the local Ethics Committee of Northern Border University in view of the nature of the study., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Given the 4-times higher prevalence of femoral hernias among females compared to males, this diagnosis may be missed during inguinal hernia repair (IHR), causing risk of reoperation for pseudo recurrence of femoral hernias (FH). Minimally invasive approaches are suggested as potential reducers of missed FH since they provide a posterior view of all defect areas, despite studies suggesting that women receive less MIS than men. We aim to assess the missed FH during IHR and after reoperation for recurrence following IHR in women., Methods: PubMED, Cochrane, and EMBASE databases were searched for studies assessing patients undergoing recurrent IHR, analyzing the incidence of reoperation for FH and occult femoral hernias during IHR. Statistical analysis was performed using R software., Results: From 6,226 records, 10 retrospective observational studies were included, totaling 15,863 patients (20% females). We found that 19.56 per 100 women (95% CI 8.34, 39.37) who are reoperated for an inguinal hernia are found as having a FH during the new repair. Compared to men, women were at a significantly higher risk to be reoperated for FH after IHR (RR 8.97; 95% CI 7.35, 10.93; P < 0.001). Our analysis also showed that 20.7% of females received MIS approaches for groin hernia repair, while 79.3% received open procedures. Furthermore, our study found a pooled incidence of occult FH during the initial IHR of 6.85 per 100 patients for both genders (95% CI 2.78, 15.90), which increased to 21.42 per 100 patients when assessing females only (95% CI 15.46, 28.89)., Conclusions: Females have a higher incidence of FH following reoperation for recurrence of inguinal hernia repair. Added to the high rate of occult FH encountered during inguinal procedures, this suggests a missed diagnosis of FH during IHR. The adoption of MIS IHR for women is fundamental to reduce the underdiagnosis of FH., Competing Interests: Declarations Ethical approval We prospectively registered our research protocol in the International Prospective Register of Systematic Reviews (PROSPERO) with ID number (CRD42024571882). As this concerns a systematic review and meta-analysis study, no ethical approval or informed consent was required. Informed consent Not applicable. Conflicts of interest Carlos AB Silveira, Gabriele Lech, Ana Rasador, Bruno Veronez de Lima and Diego Lima declare no conflict of interest. Flavio Malcher MD MSc - discloses consulting fees from BD, Intuitive, Integra, DeepBlue, Allergan & Medtronic, outside the submitted study., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Chronic inguinal pain (CIP) can be caused by musculoskeletal or neurological pathologies and by surgical trauma after inguinal hernia repair among other. The aim of this prospective cohort observational study was to find the incidence and causes of CIP unrelated to surgical trauma 12 months after inguinal hernia repair., Methods: During sixteen months patients consulting a hernia center for groin-related symptoms were included in the study. Patients were evaluated by surgeons and filled out preoperatively the Inguinal Pain Questionnaires and a Numerical Rating Scale pain-questionnaire. For patients undergoing inguinal hernia repair, postoperative questionnaires similar to the pre-operative ones were sent out at 12 months. Patients scoring pain on pain questionnaires were evaluated by phone and physical examination., Results: 289 patients (78.1%) of 370 repaired patients filled in the postoperative questionnaires. 62 (21.4%) patients scored pain, of these patients 5 (1.7%, 5/289) answered incorrectly in the pain questionnaires and 14 (4.8%, 14/289) had non-surgical trauma causes of pain: 5 musculoskeletal, 4 neurological and 3 other medical pathologies., Conclusions: This cohort study found CIP unrelated to surgical trauma in 4.8% of patients undergoing a groin hernia repair. Most causes of pain unrelated to surgical trauma were musculoskeletal and neurological pathologies. Nearly a third of patients scoring inguinal pain on pain-questionnaires did not have chronic post-surgical pain (CPSP), therefore incidence of CPSP should not be based solely on pain questionnaires. Clinical assessment of patients with pain is necessary to excluded CIP unrelated to the surgical trauma., Competing Interests: Declarations Previous presentation of the study Part of the paper has previously been presented as abstracts at the EHS-AHS joint congress Hernia 2021 in Copenhagen, at the EHS-2022 congress in Manchester, at the AHS-22 congress in Charlotte, USA and at the BJS prize of the EHS-24 congress in Prag, therefore the abstract was published as a supplement of BJS (https://doi.org/10.1093/bjs/znae122.001). The original paper has not been published and will not be simultaneously submitted or published elsewhere. Disclosure The authors have nothing to disclose., (© 2024. The Author(s).)

Objective: We aim to perform a systematic review and meta-analysis to analyze the efficacy and safety of low-cost meshes compared to polypropylene meshes for IHR., Methods: We searched Pubmed, Embase, Cochrane, and Web of Science for randomized controlled trials (RCTs) comparing low-cost and standard meshes for IHR. Low-cost mesh was defined as a material non-designed for medical use. The primary outcomes analyzed were postoperative pain, recurrence, surgical site infection (SSI), seroma, and hematoma rates. Statistical analysis was done using R software., Results: 8 RCTs were ultimately included in our study with 788 patients, of which 394 (50%) underwent IHR repair with low-cost mesh. Surgical techniques employed were Lichtenstein repair in 7 studies, and laparoscopic totally extraperitoneal (TEP) repair in 1 RCT. No statistically significant differences for both superficial (2.8% vs. 2.8%; RR 0.98; 95%CI 0.4-2.43; P = 0.97; I 2  = 0%), deep SSI (0% vs. 0.31%; RR 0.33; 95%CI 0.01-7.91; P = 0.5; I 2  = 0%) and overall SSI (3.6% vs. 4.3%; RR 0.83; 95%CI 0.42-1.66; P = 0.6; I 2  = 0%) were evidenced. Recurrence rate at 1 year was similar between the groups analyzed (0.66% vs. 0%; RR 2.95; 95%CI 0.31-27.95; P = 0.35; I 2  = 0%). No differences were found for hematoma (12.6% vs. 12.6%; RR 0.99; 95%CI 0.67-1.47; P = 0.98; I 2  = 0%) and seroma (1.97% vs. 2.33%; RR 0.83; 95%CI 0.29-2.4; P = 0.73; I 2  = 0%) rates., Conclusion: This meta-analysis found similar postoperative complication rates for both low-cost and standard polypropylene meshes following IHR., Prospero Registration: ID CRD42024555273., Competing Interests: Declarations Ethical approval No ethical approval or informed consent was required. Informed consent Not applicable., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background and Objectives : The COVID-19 pandemic disrupted healthcare systems worldwide, leading to the postponement of elective surgeries, including inguinal hernia repair (IHR), as healthcare resources prioritized critical care. This study aims to evaluate the impact of the pandemic on the incidence and outcomes of IHR procedures. Materials and Methods : A retrospective review was conducted on 604 patients who underwent IHR over six years, spanning pre-pandemic, pandemic, and post-pandemic periods. Data on patient demographics, type of surgical procedure (elective or emergency), use of mesh, surgical duration, hospitalization period, and postoperative outcomes were analyzed across the three time frames. Results : Patient age remained consistent across the three periods, but a significant increase in female patients was observed during and after the pandemic ( p < 0.001). Elective IHR surgeries significantly decreased during the pandemic ( p < 0.001), paralleled by an increase in emergency cases ( p = 0.004). In the post-pandemic period, elective surgeries rebounded, while emergency interventions declined (21.9% vs. 10.3%). Mesh repair usage increased notably in the post-pandemic phase ( p < 0.001). Although surgeries took longer during the pandemic ( p < 0.001), both total and postoperative hospital stays were reduced during and after the pandemic ( p < 0.001). Minimal postoperative complications were reported throughout, with only one mortality during the pandemic. Conclusions : This study highlights the need for robust healthcare strategies to maintain elective surgical care during global crises, as delays in IHR may elevate risks for complications like hernia incarceration and strangulation.

Introduction: Inguinal hernia repair is one of the most common surgeries in children. Recently, the use of minimally invasive techniques for inguinal hernia repair has increased in children. Laparoscopic percutaneous internal ring suturing (PIRS) is a technique described for paediatric inguinal hernia repair. The primary objective of this study is to demonstrate the efficacy and reliability of PIRS in paediatric patients through a comparative analysis with an open method., Methods: Between January 2017 and June 2023, records of patients who underwent surgery for inguinal hernia were retrospectively reviewed. In total 126 patients were included in the study. They were divided into two groups: 33 patients underwent PIRS (group 1) and 93 patients underwent open repair (group 2). Operation time, cost and complications were compared., Results: The mean age of the 126 patients was 3.23 ± 2.4 years. The mean unilateral operative time was 25.13 ± 5.32min in group 1 and 30.28 ± 4.73min in group 2, and there was a statistically significant difference in operative time ( p < 0.001). Two patients in group 1 underwent surgery owing to patent processus vaginalis, whereas three patients in group 2 underwent surgery owing to metachronous hernia. There were no major complications such as bleeding requiring surgical intervention or conversion to an open approach during surgery in group 1. No recurrent hernia was observed in any of the 126 patients., Conclusions: PIRS offers a safe, easy-to-learn method with low complication rates. PIRS has a distinct advantage over open surgical repair because of its capacity to evaluate the contralateral inguinal ring.

Background: The Lichtenstein technique is the standard treatment for adult open inguinal hernia repair. Among the non-mesh repair techniques, Shouldice has shown the best results and is comparable to mesh repairs in selected cases. Due to the risk of chronic groin pain associated with the Lichtenstein technique, Shouldice has increased in popularity, and some surgeons have adopted it as a viable first-line option., Methods: MEDLINE, Cochrane, Central Register of Clinical Trials, and EMBASE for randomized controlled trials (RCT) published until February 2024. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the Cochran Q test and I 2 statistics with p-values <0.10 and I 2 > 25% considered significant. Statistical analysis was performed using R Software, version 4.1.2., Results: Fourteen RCTs comprising 2784 patients were included, of whom 1379 (47.5%) were submitted to the Shouldice hernia repair and 1513 (52.5%) to the Lichtenstein technique. Shouldice was associated with a significant increase in the recurrence rate (4.2% vs. 0.9%; RR 3.68; 95% CI 2.05-6.60; p < 0.001; I 2  = 0%) compared with Lichtenstein. The number needed to treat (NNT) to prevent one Shouldice recurrence was 30.3. There were no significant differences between groups in chronic pain, urinary retention, bladder injury, testicular atrophy, wound infection, hematoma-seroma, or hypesthesia., Conclusion: The Lichtenstein technique was associated with reduced recurrence rates compared with Shouldice in patients undergoing inguinal hernia repair. However, the overall recurrence rate with the Shouldice technique was still low (4.2%), suggesting that it may be a viable option in selected patients., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Background: Transversus abdominis plane block is becoming more common as part of multimodal analgesia for post-abdominal operation pain relief. This study compared the analgesic effects of adding dexmedetomidine to levobupivacaine (transversus abdominis plane) block in elderly patients undergoing inguinal hernia surgery to adding fentanyl., Methods: Overall, 90 elderly patients with a simple inguinal hernia repair were randomly assigned to one of three groups. After spinal anaesthesia, an ultrasound-guided transversus abdominis plane block was performed. Transversus abdominis plane block was accomplished with 0.25% levobupivacaine + 0.9% normal saline in Group L (n = 30) (20mL). Transversus abdominis plane block was accomplished with 0.25% levobupivacaine + 1 µg/kg dexmedetomidine in Group D (n = 30) (20mL). Transversus abdominis plane block was obtained with 0.25% levobupivacaine + 1 µg/kg fentanyl in Group F (n = 30) (20mL). The primary outcome was the first analgesic request, and the secondary outcomes were the visual analog scale, postoperative analgesic requirements, sedation, hemodynamic stability, and related complications 24 hours postoperatively. 1gm paracetamol intravenously was provided as rescue analgesia., Results: The time to first analgesic request in the dexmedetomidine group was substantially more prolonged than in the fentanyl and control groups (516.5±27.8, 451.2±11.1, and 403.9±10.5min, respectively; p < 0.05). Postoperative analgesic requirements were significantly decreased in dexmedetomidine 1(1-2) than control 2(1-3) and fentanyl 1.5(1-2) respectively (P<0.01). VAS was significantly lower in Group D and Group F than in Group L postoperatively. No significant difference in side effects was noted between the groups., Conclusion: The transversus abdominis plane block is the best multimodal analgesia choice for inguinal hernia repair in older patients. Combining dexmedetomidine with levobupivacaine in the transversus abdominis plane block can improve the quality of postoperative analgesia while avoiding significant side effects.

Background: The Lichtenstein technique is the gold standard for adult open inguinal hernia repair with mesh. The Desarda technique emerged in 2001 as a novel, promising non-mesh technique that has demonstrated low recurrence and postoperative complications., Methods: We searched MEDLINE, the Cochrane Central Register of Clinical Trials, and Embase for randomized controlled trials (RCT) published until April 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using Cochran's Q test and I 2 statistics, with p-values <0.10 and I 2 >25% considered significant. Statistical analysis was performed using the R software, version 4.1.2., Results: Eighteen RCTs comprising 1756 patients were included, of whom 861 (49%) were submitted to Desarda and 895 (51%) were submitted to Lichtenstein. Desarda was associated with lower seroma rates (OR 0.55; 95% CI 0.35-0.89; and p = 0.014), less operative time (MD -8.6 min; 95% CI -14.5 to -2.8; and p < 0.01), lower postoperative pain on day one (MD -1.3 VAS score; 95% CI -2.3 to -0.3; p < 0.01) or chronic pain (OR 0.32; 95% CI 0.12-0.88; and p = 0.028), and faster return-to-work activities (MD -2.1 days; 95% CI -3.7 to -0.6; and p < 0.01). The recurrence rate was 1.4% for Desarda versus 2.1% for Lichtenstein, with no statistical difference between techniques., Conclusion: In this meta-analysis, Desarda significantly decreases seroma operative time, postoperative pain on day 1, chronic pain, and return-to-work activities., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Background: Contemporarily, transabdominal preperitoneal repair (TAPP) procedure in inguinal hernia treatment is counted among the routine minimal invasive general surgery practices. Increased patient's comfort, namely less postoperative pain, is considered to be its greatest advantage. However, pain following surgery can still be an important problem. Port site local anesthetic injection (PSLAI), iliohypogastric-/ilioinguinal nerve block (IINB), and preperitoneal local anesthetic spraying (PLAS) are relatively new techniques with sparse data to address this issue. Therefore, we conducted this prospective study to evaluate these three methods in patients who underwent TAPP for inguinal hernia repair. Methods: A total of 99 patients were enrolled and randomized equally into three groups. Every patient received a patient-controlled analgesia (PCA) device. PCA usage, total analgesic demands, and numerical rating scale values were recorded at 2, 6, 12, and 24 hours postoperatively (p.o). Results: Patients' demographic data (age, gender, BMI) did not reveal any significant difference between groups ( P > .05). Procedure duration was found to be significantly longer in IINB group compared with others ( p < .05). Number of PCA usages, total analgesic demand, additional analgesic requirement did not differ significantly between groups at 24-hour p.o ( P > .05). PLAS group was found to have less average NSR score compared with other groups at 24 hours p.o ( p < .05). Conclusions: All three procedures show promising outcomes with PLAS technique appearing to be slightly superior in terms of pain management in the immediate postoperative period. However, to reach a conclusion more randomized controlled trials covering various aspects and techniques of minimal invasive approach to inguinal hernia repair should be published.

Objective: To compare postoperative pain scores at rest and on movement in patients undergoing open inguinal hernia repair between those receiving illioinguinal/illiohypogastric nerve block with ropivacaine or wound infiltration with ropivacaine., Methods: The randomised clinical trial was conducted at the Department of Anaesthesiology, Aga Khan University Hospital a tertiary care centre from March to August 2019 and comprised patients of either gender scheduled for elective unilateral open inguinal hernia repair under general anaesthesia. They were randomised into illioinguinal/illiohypogastric nerve block group A, and wound infiltration group B. In group A, 20 ml of 0.25% ropivacaine was infiltrated in the vicinity of the nerves under ultrasound guidance, while group B received wound infiltration with ropivacaine 10ml 0.25% at the end of surgery. Postoperative static and dynamic pain was assessed at 0, 2, 6, 12 and 24 hours using visual analogue scale. Total usage of opioids in 24 hours postoperatively in both groups, patient satisfaction and complications were recorded. Data was analysed using SPSS 19., Results: Of the 60 patients, 30(50%) were in each of the 2 groups. There were 29(96.7%) males and 1(3.3%) female in group A with mean age 45.63±17.43 years, and 28(93.3%) males and 2(6.7%) females in group B with mean age 49.33±15.39. The mean pain score at rest was not significantly different between the groups (p>0.05). On movement, the mean pain score between the groups was different only at 6 hours (p=0.02). There were no significant intergroup difference in total usage of opioids in 24 hours postoperatively and patient satisfaction (p>0.05)., Conclusions: Illioinguinal/illiohypogastric nerve block and wound infiltration with ropivacaine were found to be equally effective methods in controlling postoperative pain., Clinicaltrials.gov Id: NCT04462510.

Background: The slit-mesh technique for laparoscopic groin hernia repair remains controversial. We present the largest cohort of patients to date that have undergone laparoscopic hernia repair with this technique and aim to evaluate the impact of both techniques on postoperative recurrence and other secondary outcomes., Methods: A retrospective, single-institution cohort study of patients who underwent a laparoscopic groin hernia repair over a 5.5-year period was performed. Univariate and multivariate analyses were performed to identify factors associated with recurrence, chronic pain, complications, length of stay, and operative time. A propensity score analysis also was performed. Time to recurrence was then subsequently plotted on a Kaplan-Meier survival analysis., Results: In total, 611 laparoscopic groin hernia repairs (nonslit: n = 353; slit: n = 258) were reviewed. Mean follow-up duration was 6.6 months. On the multivariate analysis, body mass index was inversely correlated with recurrence (odds ratio, 0.792; 95% confidence interval, 0.656-0.956), whereas a slit mesh had lower recurrence (odds ratio, 0.228; 95% confidence interval, 0.064-0.809). In the propensity score-adjusted analysis, slit mesh remained significantly associated with reduced recurrence (adjusted odds ratio, 0.251; 95% confidence interval, 0.070-0.900), with no differences in chronic pain (adjusted odds ratio, 1.297; 95% confidence interval, 0.275-6.128) or postoperative complications (adjusted odds ratio, 1.808; 95% confidence interval, 0.429-7.620). Operative time also was reduced in the slit-mesh group (P = .009)., Conclusions: The slit-mesh technique was associated with a reduced likelihood of postoperative recurrence and shorter operative time, with no impact on postoperative chronic pain or complications. A lower body mass index was also correlated with increased likelihood of postoperative recurrence., Competing Interests: Conflict of Interest/Disclosure The authors have no relevant financial disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Groin hernia repair (GHR) is a performed procedure worldwide, with approximately 20 million surgeries carried out each year. Despite being less common in females, there is a lack of research on how sex influences the outcomes of GHR. This systematic review and meta-analysis aim to assess how patient sex impacts results in GHR., Methods: We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We searched for studies up to October 2023 in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. The studies included focused on sex outcomes for both robotic and open GHR procedures. Data extraction and quality assessment were conducted using the Risk of Bias in Non-Randomized Studies - Of Interventions tool. Our statistical analysis was performed using the metafor package in RStudio., Results: After screening a total of 3917 articles, we identified 29 studies that met our criteria, comprising a total of 1,236,694 patients. Among them, 98,641 (7.98%) patients were females. Our findings showed that females had higher rates of hernia recurrence (RR 1.28), chronic pain (RR 1.52), and surgical site infections (SSIs) (RR 1.46) compared to males. Females showed a lower tendency to undergo minimally invasive surgery (MIS) with a relative risk of 0.82 (95% CI 0.69-0.97; p = 0.02)., Conclusion: Females tend to face higher rates of complications after GHR such as an elevated risk of chronic pain, recurrence, and surgical site infections (SSI). Moreover, they undergo fewer MIS options compared to males. These results underscore the importance of research to enhance outcomes for women undergoing GHR., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Background: The quality of total extraperitoneal groin hernia repair and recurrence rates are influenced by various factors, potentially including the annual surgical unit volume of repairs. The precise nature of this relationship remains unclear. The aim of this study was to investigate the influence of surgical unit volume on reoperation rates for recurrence following total extraperitoneal groin hernia repair., Methods: This observational nationwide population-based study utilized prospectively collected data from the Swedish Hernia Register. Patients aged 15 years old or older who underwent a total extraperitoneal groin hernia repair from 1 January 2015 to 31 August 2019 were eligible. Follow-up time was until 31 August 2022. Surgical units were grouped into low-volume (fewer than 12 repairs per year), low-medium-volume (12-50 repairs per year), medium-high-volume (greater than 50-150 repairs per year), and high-volume (greater than 150 repairs per year) units. The primary outcome was reoperation for recurrence. The secondary outcome was postoperative complications., Results: A total of 20 656 elective total extraperitoneal groin hernia repairs were included across 75 surgical units. The reoperation rate for recurrence was higher in all three lower-volume groups (low-volume, 5.3%; low-medium-volume, 3.8%; and medium-high-volume, 3.5%) compared with the high-volume group (2.9%). Adjusted multivariable Cox regression analysis revealed a statistically significant increased HR for reoperation for recurrence in the low-volume group (1.87 (95% c.i. 1.31 to 2.67)) and the low-medium-volume group (1.32 (95% c.i. 1.07 to 1.62)) compared with the high-volume group. No difference was seen between the groups regarding the risk of postoperative complications., Conclusion: The risk of reoperation for recurrence following total extraperitoneal groin hernia repair is significantly increased in surgical units that perform fewer than 51 repairs per year. The findings may influence guidelines on required annual surgical unit volume to improve patient outcomes following total extraperitoneal groin hernia repair., (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)