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Background: Venous thromboembolism (VTE) events after hernia surgery influence prognosis and life quality and may be preventable. This study aimed to develop a useful model for predicting in-hospital VTE in Chinese patients after hernia surgery., Methods: Patients after hernia surgery were retrospectively recruited from 58 institutions (n = 14 322). Totally, 36 potential predictors were involved in the regression analysis. Weighted points were assigned to the predictors of in-hospital VTE identified in the multivariate logistic regression analysis and a prediction model was established. Decision curve analysis was performed to evaluate the net clinical benefit between the established and Caprini models., Results: A total of 11 707 patients were included and five variables were explored as predictors related to in-hospital VTE: varicose veins of lower extremity, history of VTE, family history of thrombosis, interruption of antithrombotic agents, and reducible hernia. The prediction model (the CHAT score) revealed a good performance metrics (c-statistic, 0.81 [95% CI, 0.80 to 0.81]; Nagelkerke R 2 , 0.27 [95% CI, 0.26 to 0.30]; Brier score, 0.16 [95% CI, 0.13 to 0.23]). The rate of in-hospital VTE after hernia surgery at low-risk (-4 points), intermediate-risk (0-1 points), high-risk (4 points) and very high-risk (≥5 points) were 0.05%, 0.39%, 0.73% and 8.62%, respectively. The CHAT score identified a considerable variability (from 0.05% to 8.62%) for in-hospital VTE among the overall population after hernia surgery. Decision curve analysis found a superior net benefit of the established model than the Caprini score., Conclusions: The CHAT score is likely to be a practical 5-item supporting tool to identify patients at high risk of in-hospital VTE after hernia surgery that might assist in decision making and VTE prevention. Further validated study will strengthen this finding.

Background Fenugreek seeds have shown antinociceptive effect in animal studies. This double-blind placebo controlled trial was designed to study the effect of fenugreek transdermal patch 10% (FDP) for management of inguinal hernia (IH) post-operative pain. Methods Standardized extract of fenugreek seeds was used for FDP formulation. Ninety patients treated with 10% FDP, diclofenac dermal patch 1% (DP) and placebo twice daily after IH surgery. The pain intensity score was evaluated using a visual analogue score (VAS) up to 48 h after operation. Morphine consumption and diclofenac suppository demand were evaluated too. Results The pain score was significantly reduced in FDP group in comparison with the placebo group. This effect was also significantly different from DP up to 6 h after surgery (p<0.05). Morphine consumption and diclofenc suppository demand were significantly decreased in FDP group (p<0.05). Conclusion In all, results of the present study indicated that FDP decreases pain score and demand for morphine in post-surgery patients in comparison to diclofenac patch, and this preparation could be a suit option as a natural antinociceptive agent for pain management.

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. [ABSTRACT FROM AUTHOR]

Introduction: Amyand's hernia, an uncommon condition characterized by the presence of the appendix within an inguinal hernial sac (< 1% incidence), poses diagnostic and therapeutic challenges. Often it is an intraoperative finding, with almost no clinical symptoms. Case presentation: This is a case of an Indian male in his early 80 years, diagnosed with bilateral direct inguinal hernias, one of which contained a noninflamed appendix. Given the thinned out abdominal wall, dense adhesions, and no demarcation between layers, the decision to proceed with a modified Bassini's with Lichtenstein mesh repair without appendectomy, guided by intraoperative findings and the Losanoff–Basson Classification, reflecting the complex interplay between individual patient factors and intraoperative considerations. The patient did well during his postoperative stay and was in good health on a 45 day follow-up, with no complaints suggestive of recurrence or obstruction. Conclusion: This case underscores the importance of tailored management strategies and highlights, especially in cases where recurrence and postoperative wall integrity are in question, the ongoing need for research to refine treatment guidelines for Amyand's hernia, especially in cases of appendicitis not diagnosed preoperatively. [ABSTRACT FROM AUTHOR]

Background & aims: Hernia is a very common surgical condition affecting all ages and both sexes. Data regarding abdominal wall hernias is essential to hernia management in an institution. With the absence of data regarding the prevalence, characteristics, and associations of abdominal wall hernias in Sudanese patients, we aimed to describe and find the possible differences in the spectrum of abdominal hernias, their rates, and associated predisposing factors. Methodology: This was a retrospective cross-sectional chart review of surgical patients admitted at a Sudanese tertiary teaching Hospital, Department of Surgery, from January 2019-December 2021. Data were collected from the medical records using a checklist. The data obtained included age, gender, occupation, chronic medical conditions, past medical history (PMH), and year of admission. Data were analyzed using SPSS 22. Results: Results showed that between January 2019 and December 2021, a total of 1158 patients were admitted to the department of surgery, and abdominal hernia had a frequency of 16.23% (n = 188). There was a male predominance (55.3%), ages below 20 years constituted the majority of cases (45.2%), and those between (50–60 years) were the least. The most frequent subtype was the inguinal hernia. The association between sociodemographic variables, PMH, chronic medical conditions, and the diagnosis was found to be statistically significant. The rate of recurrence was found to be 10.1%. Conclusion: There was a high rate of abdominal Herniation, and a difference between subtypes of abdominal herniation regarding demographic data, past medical history, and comorbidities. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic inguinal hernia repair utilizes either a transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The literature remains mixed on outcomes comparing TAPP versus TEP. The objective of our study was to assess outcomes, healthcare utilization, and cost differences between TAPP and TEP inguinal hernia repair. Methods: Adult patients who underwent elective inguinal hernia repair between 2013 and 2021 were retrospectively identified from our institution's electronic health record. Baseline characteristics and postoperative complications were compared using chi-squared test. Multivariable logistic regression was used to model the odds of experiencing a postoperative emergency department visit, readmission, and/or reoperation within 6 months were surgery. Generalized linear models were used to investigate differences in cost between TAPP and TEP groups. Results: 1086 patients underwent TAPP repair, while 1277 patients underwent TEP repair. TAPP patients had more than double the rates of readmissions (3.1% vs. 1.3%, p = 0.002) and reoperations (1.5% vs. 0.2%, p = 0.001) within 6 months of surgery. On multivariable analysis, undergoing TAPP inguinal hernia repair was associated with higher odds of reoperations and/or readmissions within 6 months of surgery (OR 2.8, CI [1.5, 5.1], p = 0.001). TAPP repair had a higher index surgery cost and higher costs associated with reoperations and readmissions compared to TEP repair. Conclusion: Although both approaches are very safe, TAPP inguinal hernia repair had higher rates of postoperative complications, increased healthcare utilization, and higher associated costs. Future studies should be directed toward decreasing postoperative healthcare utilization in order to decrease costs in inguinal hernia repair. [ABSTRACT FROM AUTHOR]

The recurrence rate of inguinal hernia is 1–10%, most often in the inguinal region, and seldom in different locations. A 72-year-old man with a large soft swelling in the right ventrolateral abdominal region without swelling in the scrotum, operated on right inguinal hernia at pediatric age. Clinical findings revealed a giant right ventrolateral hernia and abdominal CT showed weakness of the abdominal wall with a 25 cm long hernial sac with an apex under the right costal arch and a base at the deep inguinal opening, that was diagnosed as a recurrent inguinal hernia with unusual presentation. Hernioplasty without opening the hernial sac was performed in an atypical manner. The patient was discharged from the hospital without pain or discomfort at the follow-up. The common presentation of recurrent inguinal hernia is inguinal-scrotal but an unusual presentation should be reconsidered with a proper diagnosis and adequate surgical treatment. [ABSTRACT FROM AUTHOR]

Background: In recent years, laparoscopic hernia repair, i.e. transabdominal pre-peritoneal and totally extraperitoneal repairs have been considered the method of choice, especially for recurrent hernias after open repair or bilateral inguinal hernias. However, they pose numerous challenges such as increased post-operative pain due to tacking or fixation of mesh, chronic pain syndrome due to entrapment of nerves and mesh migration or invagination. A 3-dimensional (3D) mesh was introduced to overcome the shortcomings of a 2-dimensional (2D) mesh which does not conform to inguinal anatomy. However, in a resource-limited country like India, the widespread use of a 3D mesh may not be possible owing to its high cost. Patients and Methods: We included a total of 55 patients in our study who underwent laparoscopic extended totally extraperitoneal repair hernia repair for 1 year beginning from December 2021 to November 2022 with a follow-up of a minimum of 1 year till November 2023. In our study group (n = 27), we used a novel technique of converting a 2D mesh to a 3D mesh, which was subsequently placed without fixation. In our control group (n = 28), we used a standard polypropylene mesh with one-point suture fixation. Results and Conclusions: All patients in our study showed satisfactory post-operative recovery. There was no significant difference in the post-operative pain (assessed by mean Visual Analogue Scores 1.24 ± 0.44 vs. 1.87 ± 0.56; P > 0.1) and the mean length of hospital stay in days (1.12 ± 0.33 vs. 1.16 ± 0.38; P > 0.1), respectively, in the study and control groups. None of our patients showed signs or symptoms of chronic pain or recurrence in our period of follow-up. Our technique of converting 2D to 3D mesh is a safe and feasible approach and maybe a potential alternative to a traditional 3D mesh in resource-limited settings. [ABSTRACT FROM AUTHOR]

Objective: To determine that inguinal hernia is an inherited disease running in families. Study Design: Prospective Observational. Setting: Surgical Unit I & III of Ghulam Mohammad Mahar Medical College Hospital, Sukkur. Period: June 2017 to May 2022. Methods: A total of 1590 patients of inguinal hernia who presented to surgical OPD or emergency of GMMM College were included in the study. A detailed history was taken and examination done. Important parameters noted were age, gender, occupation, family history of inguinal hernia, degree of relative with inguinal hernia, type of inguinal hernia, primary or recurrent Hernia. Results: Out of total 1590 patients, 1499 (94%) were males and 91 (5.75%) females with male to female ratio of M: F=16.47:1 (Figure-1). Age ranged from 6 to 81 years with mean age of 52.32±15.25 years (Table-I). Out of 1590 patients, 1558 (97%) patients had primary while 32 (3%) had recurrent hernia. Out of 1590 patients, 1081 (68%) patients had direct hernia whereas 509 (32%) had indirect hernia; 843 (53%) were right sided, 722 (45.4%) left sided and 25 (1.6%) were bilateral hernia. Out of 1590 patients, 1312 (82.52%) had positive family history of inguinal hernia whereas 278 (17.48%) had negative family history for inguinal hernia. Out of 1312 with positive family history 971 (74%) patients had first degree relative with hernia, while 341 (26%) had 2nd degree relative with hernia (Table-II). Out of 32 cases of recurrent inguinal hernia, 22 (68.8%) had positive history of 1st degree relative with hernia, 9 (28.1%) had second degree relative with hernia whereas only 1 (3.1%) had negative family history for hernia. Conclusion: Our study concludes that family history of inguinal hernia poses a significant risk for developing hernia. [ABSTRACT FROM AUTHOR]

Purpose: The most common surgical intervention in childhood is inguinal hernioplasty. The advantage of laparoscopic approach is still questionable, therefore our aim was to compare open hernia repair (OHR) and PIRS (Percutaneous Internal Ring Suturing) technique at the authors' institute. Methods: An observational retrospective cohort study was conducted between 2013 and 2021. Patients were included with hernioplasties under 18 years. The number of contralateral patent processus vaginalis, length of hospital stay, complications and recurrences were analysed. Results: 1,072 surgeries were performed (OHR: 836, PIRS: 236) in 959 patients with the mean age of 4.2 years. During the study period 86 incarcerated hernias were treated: 85/86 following successful reduction with postponed surgery (77 open and eight PIRS) and 1/86 acute (open) surgery. Only six complications (OHR: 5, PIRS: 1, p = 0.86) and 22 recurrences were registered (open:15, PIRS: 7, p = 0.22). The average length of hospital stay was 1.13 days (OHR: 1.3, PIRS: 1.13 days, p = 0.82). PIRS identified contralateral patent processus vaginalis in 22.45% of cases initially diagnosed as unilateral. Conclusions: Our findings indicate that both techniques are equally safe, with no statistically significant differences observed in terms of hospital stay duration, recurrence rates, or complication rates. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Occult inguinal hernias are inguinal hernias that are not felt on physical exam but can often be seen on imaging. Their diagnosis can be challenging, leading to unnecessary surgeon referrals, undue patient stress, and even unneeded surgery. The aim of this project was to develop recommendations for the diagnosis of occult inguinal hernias using a modified Delphi technique. Methods: Iterative rounds of surveys were administered to an expert panel of surgeons and radiologists. Panelists were asked to rate potential hernia-related topics by levels of importance. Items with 80% agreement were included for further discussion. Panelists were asked to provide their opinion on each included subject. A virtual meeting was conducted to discuss areas without agreement and determine final recommendations. Results: Three surgeons and five radiologists participated. There was strong agreement that dynamic ultrasound is a good first/confirmatory imaging choice. There was agreement that the radiology reports for studies assessing inguinal hernias should include hernia contents (80%) and hernia size (100%). Information that should be provided to the radiologist when ordering an imaging study include indication for study, patient symptoms, prior hernia surgery. Items that should be included in a radiology report include whether the presence of an inguinal hernia was assessed, hernia contents, size of defect, +/- hernia type. Conclusions: This collaboration between surgeons and radiologists creates a diagnostic imaging pathway and standardizing imaging reporting which will be used to improve the diagnosis of occult inguinal hernias. Future studies testing these recommendations in a prospective study are warranted. [ABSTRACT FROM AUTHOR]

Peritoneal dialysis (PD) is a risk factor for inguinal hernia, and herniorrhaphy on PD might be complicated by PD fluid.Although sac resection should contribute to preventing indirect hernia recurrence, the safety on PD has not beendescribed. This case series describes the detailed surgical procedures and long-term outcomes of 16 cases ofinguinal herniorrhaphy on PD. Results are shown as median (range). The age was 67.5 (53–83) years. Beginning atthe 6th case, we omitted interim hemodialysis and performed the Lichtenstein procedure. We performed sac excisionin the 14 patients. No complication related to PD was found. The follow-up period was 41.5 (4–124) months. Norecurrence occurred. They could continue PD for 21.5 (4–103) months after surgery. The total PD duration was 38.5(18–152) months. In conclusion, inguinal herniorrhaphy with sac resection may not compromise safety even forpatients on PD and achieve the expected PD duration without recurrence. [ABSTRACT FROM AUTHOR]

Purpose: In an era where telehealth is gaining traction within healthcare systems, its integration into preoperative assessment protocols presents both challenges and opportunities. Preoperative assessments have an important role in determining the best plan of action for each patient. Recent studies have reported adequate operative outcomes after telemedicine preoperative consultations. This study examines telehealth's efficacy relative to traditional in-person evaluations in the context of preoperative consultations for inguinal hernia repairs and provides a deeper insight into how telemedicine might be utilized for pre-surgical assessments. Methods: We analyzed a prospectively maintained single-center database at a tertiary referral hospital with a dedicated hernia and abdominal wall reconstruction center for pre, intra and postoperative variables comparing patients that received telemedicine (phone or video) preoperative consultations versus in-person clinic visits only. Secondary analysis with propensity score matching was employed to adjust for possible confounders. Results: 265 patients that underwent inguinal hernia repair were included, with 60 encounters being telemedicine only and the rest in-person. This analysis found no difference in rates of postoperative complications between the telemedicine and in-person groups. The telemedicine group required less preoperative encounters with their surgeon (P < 0.001). In the preoperative in-person group, 41% switched to virtual follow-ups, while in the virtual group, only 18% chose in-person follow-ups (P = 0.003). Conclusions: Based on our analysis, the use of telemedicine for preoperative assessments in inguinal hernia repairs as a feasible and safe choice for patients opting for this approach, potentially reshaping the preoperative paradigm in surgical practices. [ABSTRACT FROM AUTHOR]

Spigelian hernia is a rare type of abdominal hernia; diagnosis is primarily through computed tomography, which is crucial for accurate diagnosis and planning early surgical intervention to preserve the herniated sac's contents. [ABSTRACT FROM AUTHOR]

Background: Total extraperitoneal (TEP) approach is one of the commonly used minimally invasive method in inguinal hernia repair. There are limited data that compares the results of the telescopic dissection and balloon trocar for preperitoneal dissection. In our study, we aimed to retrospectively evaluate the TEP cases performed at our center and compare the results of these two techniques. Methods: TEP cases performed between 2020 and 2024 were evaluated. Strangulated and recurrent hernia cases were excluded. Telescopic dissection and balloon trocar techniques were compared in terms of conversion, postoperative pain, complications, and recurrence. Results: A total of 177 patients were included. Telescopic method was used in 122 cases, while a balloon trocar was used in 55 cases. The median age was 50 years (range: 20–86), and 163 patients (92%) were male. Bilateral inguinal hernia was present in 61 patients (35%). The median operative time was 100 minutes (IQR: 80–120 minutes). Conversion was required in a total of 3 cases (1.5%); specifically, the transabdominal preperitoneal method was employed in 2 cases, and Lichtenstein-style anterior approach hernia repair was performed in one case. Between the telescopic dissection and balloon trocar groups, no significant differences were observed in operation time (P =.407), conversion rates (P =.228), postoperative pain scores (P =.505, P =.264, P =.681, P =.743), complication rates (P =.205), or recurrence rates (P =.311). Conclusions: The results of using a balloon trocar and telescopic dissection in inguinal hernia repair with TEP are similar, and telescopic dissection could be a cost-effective alternative to the balloon trocar. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated that access to robotic surgery is influenced by socioeconomic factors, including insurance status. The 2010 Affordable Care Act established an avenue for states to expand Medicaid coverage, which has increased access to surgical care for many conditions. We hypothesized that socioeconomic disparities in access to robotic repair of non-elective emergency general surgery (EGS) hernias are less prevalent in California, a Medicaid expansion state, compared to Florida, which has not adopted Medicaid expansion. Methods: The 2021 California and Florida State Inpatient Databases were used to identify all EGS admissions with an ICD-10 procedure code for ventral or inguinal hernia repair. Elective procedures and those with concurrent unrelated abdominal procedures were excluded. Patient demographics, comorbidity burden, payor status, and income quartile were abstracted. Aggregation of hospital data identified high-volume trauma, robotic, and EGS centers. Results: There were 15,683 EGS hernia procedures of which 11% underwent robotic repair: 14% in Florida and 8% in California. On multivariable logistic regression, older age, male sex, lower income, and Medicare insurance were associated with reduced odds of robotic hernia repair in California, but not in Florida, despite an uninsured rate of 10%. The greatest predictor of robotic surgery in both states was treatment at a robotic surgery center. Overall, accounting for patient- and hospital-level factors, hernia surgeries in Florida were more likely to involve robotics (OR 1.61, CI 1.42–1.81, p < 0.001) compared to California. Conclusion: There were fewer disparities in access to EGS robotic hernia repairs in Florida than in California. This suggests that robotic surgery access for EGS hernia repairs is primarily determined by institutional adoption of robotic surgery, not income or payor status. Compared to California, Florida appears to have greater market penetration of robotic surgery, which has increased access to robotic EGS for all patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: Recurrence and contralateral metachronous inguinal hernia (CMIH) are important postoperative complications in patients with inguinal hernia (IH) who undergo laparoscopic percutaneous extraperitoneal closure (LPEC). This study aimed to evaluate the incidence and causes of recurrence and CMIH after LPEC. Methods: Among the included patients, 2484 hernias were included in the analysis of recurrence. CMIH was analyzed in 2094 cases with unilateral IH without a history of contralateral IH. Results: Overall, 21 hernias (0.85%) recurred and seven patients (0.34%) experienced CMIH. Based on the video inspection, injury and skipping of the peritoneum were suspected as the cause of recurrence in eight cases, while loose ligation was suspected in five cases. The cause of recurrence could not be predicted in the remaining eight patients. Of the seven patients with CMIH, three had a mild depression around the internal inguinal ring at the first surgery. In the remaining four CMIH cases, no noteworthy findings were noted around the internal ring. Conclusions: More than half of the recurrences, in which skipping of the peritoneum and loose ligation were suspected, could have been prevented by secure ligation during the first surgery. Extending the indications of prophylactic surgery for shallow depressions may reduce CMIH. [ABSTRACT FROM AUTHOR]

Chronic postoperative pain is associated with inguinal hernia mesh repair. The aim of the present study is to evaluate the surgical outcomes and cost-effectiveness analysis of inguinal repair using fixed sutured, self-gripping and self-adhering mesh. A non-randomized single-centre observational study was conducted with a sample size of 159 inguinal hernia mesh repair from October 2012 to December 2014. Patients with primary unilateral inguinal hernia were treated with sutured mesh polypropylene, self-gripping and self-adhering mesh by two consultant surgeons. All patients were followed prospectively for a period of 5 years. Mean operating time was significantly shorter in the self-gripping and self-adhering group than in sutured mesh (self-gripping vs sutured: p<0.05; self-adhering vs sutured: p<0.05). At two early time points, the pain level was significantly lower in patients with no sutured meshes (self-gripping vs sutured: p<0.01; self-adhering vs sutured: p<0.01). Chronic pain did not significantly differ between groups. Overall, of recurrence were 2.5%, without significant difference between groups. In this non-randomized comparative study, the use of self-adhesive and self-gripping meshes in inguinal hernia repair will reduce early postoperative pain. However, with their uses, there is no evidence of reduction on postoperative chronic pain. Despite self-fixating meshes are more expensive, our cost-effective analysis compared with standard sutured mesh showed advantage in terms of cost as their use. [ABSTRACT FROM AUTHOR]

The objective is to compare needlescopic hernial repair versus open herniotomy (OH). Hernia is one of the most common operations performed in children which can be repaired by open technique or needlescopic technique. Case series analysis study was performed on 160 children; they were divided into two groups; 80 children were included in group A (needlescopic hernial repair), and 80 children were included in group B (open hernia repair). In group A, the average age was 2.8 years (SD 2.6); 60 cases were unilateral, and 20 cases were bilateral hernia (6 of these bilateral hernias were detected intraoperatively by patent processus vaginalis); scrotal hematoma appeared in 2 cases (2.5%), postoperative hydrocele appeared in 2 cases (2.5%), and postoperative recurrence for 12 months follow-up appeared in 2 cases. In group B, the average age was 2.6 years (SD 2.8), 62 cases were unilateral, 18 cases were bilateral, and postoperative hydrocele appears in 4 cases (5%) and no recurrence. No testicular atrophy or testicular ascent occurred in both groups. The one trocar needlescopic-assisted repair of pediatric inguinal hernia is safe and feasible in comparison to open herniotomy especially in bilateral, obese cases and can help in the diagnosis and repair of the contralateral side if patent. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the feasibility, safety, and efficacy of laparoscopic transabdominal preperitoneal hernia repair (TAPP) for inguinal hernias in emergency settings, providing insights from a long‐term follow‐up. Methods: We retrospectively analyzed all patients who underwent emergency TAPP repair in ASST Nord Milano from January 2005 to December 2023. A prospectively collected database of 54 consecutive TAPP hernia repairs was reviewed. The study evaluated the feasibility and safety of TAPP through operative time and the conversion rate. Effectiveness was gauged by recurrence and complication rates as well as acute and chronic pain using the Visual Analog Scale (VAS). Long‐term follow‐up included assessing recovery to normal activity. Results: Overall, data from 54 consecutive patients were analyzed. Median age was 72 (IQR = 11), with 21 men and 33 women (38.8% vs. 61.2%). The primary diagnosis was a primary hernia (61.1%), while a recurrent type was identified in 21 patients (38.9%). Femoral hernia was identified in 36 cases (48%). The median operative time was 100 min (IQR = 53 min) with 6 cases of conversion (11.1%). One recurrence (1.85%) was noted and the complication rate was 5.55 %. At a median follow‐up of 38 months, there was a low grade of chronic pain (VAS 3) in a patient (1.85%) and one recurrence (1.85%). Conclusion: TAPP is a safe, feasible, and effective option for emergency inguinal hernia repair, exhibiting low complication and recurrence rates on long‐term follow‐up when performed by surgeons with minimally invasive surgery experience and in selected patients. [ABSTRACT FROM AUTHOR]