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Aim: The aim of this study was to explore the advantages and disadvantages of laparoscopic hernioplasty by comparing them with conventional surgeries.Materials and methods: The study included 376 patients (344 men and 32 women) who underwent inguinal hernia repair in inpatient settings over a 3-year period (2017–2020). The patients were divided into two groups: patients with conventional hernioplasty (CH) - 312 patients (291 men and 32 women, mean age 55±15 years, range 18–93) and 64 patients with laparoscopic hernioplasty (LH), all of them middle-aged men at mean age 45±15 years (range 24–69).Results: Thirty-eight patients (59.38%) with LH were ASA class 1 patients while the CH patients were stratified in ASA classes 1 to 4. The LH group consisted of 39 patients who had transabdominal preperitoneal (TAPP) surgery and 25 who received total extraperitoneal (TEP) repair. The average operating time was 12 minutes (range 90–200 min) for TAPP and 50 minutes (range 20-125 min) for TEP. The mean intensity of pain score measured by VAS (0-10) was 4 (2-5) for CH patients and 3 (2-4) for LH patients. The duration of pain was 3 days (2-4) for CH patients and 2 days (1-3) for the LH group. Ninety-five percent (61/64) of LH patients defined their quality of life as “better”.Conclusions: The following factors are of particular importance for the choice of hernioplastic technique: operating time, possible intraoperative complications, the level of postoperative pain and potential postoperative analgesics, possible complications, patient recovery, length of hospital stay, cost, quality of life, and long-term results of the treatment.

Inguinal endometriosis is a very rare entity with uncertain pathophysiology, that poses several diagnostic and therapeutic challenges. This study aimed to summarize published literature on the diagnosis and treatment of this condition. Thus, a systematic literature search was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library. An effort was made to numerically analyze all parameters included in case reports and retrospective analyses, as well. The typical and atypical features of this condition, investigations used, type of treatment and histopathology were recorded. More specifications about the surgical treatment, such as operations previously performed, type of surgery and treatment after surgery have been acknowledged. Other sites of endometriosis, the presence of pelvic endometriosis and the follow-up and recurrence have been also documented. Overall, the search yielded 61 eligible studies including 133 cases of inguinal endometriosis. The typical clinical presentation includes a unilateral inguinal mass, with or without catamenial pain. Transabdominal or transvaginal ultrasound was typically used as the first line method of diagnosis. Groin incision and exploratory surgery was the treatment indicated by the majority of the authors, while excision of part of the round ligament was reported in about half of the cases. Chemotherapy and radiotherapy were initiated in cases of coexisting endometriosis-related neoplasia. Inguinal recurrence or malignant transformation was rarely reported. The treatment of inguinal endometriosis is surgical and a long-term follow-up is needed. More research is needed on the effectiveness of suppressive hormonal therapy, recurrence rate and its relationship with endometriosis-associated malignancies.

El colgajo perforante de la arteria circunfleja ilíaca superficial se utiliza para la reconstrucción de los miembros, sobre todo, en el dorso de las manos y los pies, en la zona de flexión articular y en cirugía maxilofacial, porque es un colgajo fino, flexible y versátil. Presentamos tres pacientes: dos casos pediátricos para la reconstrucción de secuelas traumáticas de la mano y el dorso del pie, y un adulto para la reconstrucción de una quemadura del dorso de la mano. Conclusiones: El colgajo perforante de la arteria circunfleja ilíaca superficial es ideal para el dorso de la mano, el pie y los pliegues articulares. Pese a las variaciones anatómicas en el nacimiento de la arteria circunfleja ilíaca superficial, el dominio de las técnicas microquirúrgicas y de la supermicrocirugía permite tomar, con seguridad, un colgajo de dimensiones moderadas o grandes, fino, con baja morbilidad en la zona dadora.

Inguinal complete lymph node dissection (CLND) for metastatic melanoma exposes the femoral vein and artery. To protect femoral vessels while preserving the sartorius muscle, we developed a novel sartorius and adductor fascial flap (SAFF) technique for coverage. The SAFF technique includes dissection of fascia off sartorius and/or adductor muscles, rotation over femoral vasculature, and suturing into place. Patients who underwent inguinal CLND with SAFF for melanoma at our institution were identified retrospectively from a prospectively-collected database. Patient characteristics and post-operative outcomes were obtained. Multivariate logistic regression assessed associations of palpable and non-palpable disease with wound complications. From 2008 to 2019, 51 patients underwent CLND with SAFF. Median age was 62 years, and 59% were female. Thirty-one (61%) patients were presented with palpable disease and 20 (39%) had non-palpable disease. Fifty-five percent (95% confidence interval CI: 40%-69%) experienced at least one wound complication: wound infection was most common (45%; 95% CI: 31%-60%), while bleeding was the least (2%; 95% CI: 0.05%-11%). Complications were similar, with and without palpable disease. The SAFF procedure covers femoral vessels, minimizes bleeding, preserves the sartorius muscle, and uses standard surgical techniques easily adoptable by surgeons who perform inguinal CLND. • Sartorius and adductor fascial flap can be useful after inguinal dissection. • Fascial flap provides adequate coverage of femoral vessels. • Outcomes after fascial flap are consistent with other CLND operations. • Bleeding complications were minimal after fascial flap technique. [ABSTRACT FROM AUTHOR]

Objective: Ultrasonography (US) is a non-invasive, non-ionizing radiation modality highly successful at diagnosing inguinal hernia. The aim of this study is to demonstrate the accuracy of ultrasound in evaluating defects of fascia in inguinal hernias and compare with surgical findings. Material and methods: A total of 33 patients with a sonographic diagnosis of an inguinal hernia are included to study. After US, all patients underwent a blinded surgery and the surgical findings are compared with the US results. Results: The sensitivity of US was found to be 100% and 80% for indirect and direct types, respectively. The mean size of the defect was found to be 22 mm (max: 70 mm, min: 6 mm) with US; and 27 mm (max: 50 mm, min: 4 mm) at surgery. The size of defects at US and in surgery were correlated with each other (p = 0.001). [ABSTRACT FROM AUTHOR]

Inguinal hernias (IH) are widespread in the human population and occur in 27–43 % of men and 3–6 % of women. Many risk factors for IH have been overestimated in the last decade: male gender is considered the leading factor (the ratio between men and women is approximately 1:7), less significant factors are heredity (most significant for women), physical activity (more significant for men), age (peak prevalence of IH occurs at 5 years and 70–80 years), congenital or acquired connective tissue dysplasia, history of prostatectomy, low body mass index.Hernioplasty with the use of synthetic mesh prostheses remains the most popular technique for surgical correction of IH. Performing non-prosthetic hernioplasty is only recommended if mesh prostheses are not available, for example in poor countries. In open hernioplasty using mesh prostheses, different methods are used today: Plug & Patch, Prolene Hernia System, Parietene Progrip, sutureless plastic according to Trabucco, Stoppa, preperitoneal techniques TIPP (trans-inguinal pre-peritoneal), TREPP (transrectus pre-peritoneal), TEP (total extraperitoneal), however, none of them showed significant advantages over the gold standard of open hernioplasty – tensionfree repair according to Liechtenstein.Laparoscopic IH correction is represented by the TAPP (transabdominal preperitoneal) technique, performed through the abdominal cavity, and TEP (total extraperitoneal) – extraperitoneal prosthetic hernioplasty. None of them has a significant advantage in the treatment of IH; therefore, when choosing a treatment method, the surgeon should be guided by the cost of the operation and the level of proficiency in one or another hernioplasty technique.

Abstract Background Omentum and bowel loops are commonly seen in inguinal hernia. An unusual case of extraperitoneal herniation of ureter was detected in hernial sac with other contents, on computed tomography (CT) urography. Case presentation A 54-year-old male presented with inguinal hernia, with no previous history of surgery or trauma. Pre-operative screening showed a unilateral hydroureteronephrosis involving the pelvicalyceal system and entire ureter. No calculus was visualized in the ureter on ultrasound. On non-contrast CT (NCCT) followed by CT urography, the ureter was seen descending into the hernia sac causing hydroureteronephrosis. The patient subsequently underwent mesh repair surgery of the inguinal hernia with meticulous reduction of the herniated contents including the ureter, resulting in complete resolution of the hydroureteronephrosis. Conclusion An isolated extraperitoneal inguinal herniation of the ureter without concomitant urinary bladder involvement is extremely rare, especially with no prior history of trauma or surgery, as seen in our case. The case also exemplifies the role of pre-operative imaging as a protocol in cases of inguinal hernia to prevent per-operative complications.

Background: Recurrence after surgical treatment of inguinal hernia is still a challenge facing surgeons during their daily practice. Aim of the Work: The current trial aims to compare single and double mesh placement in huge inguinal hernia repair. Patients and Methods: 40 cases were involved in the study. They were classified into two equal groups according to the operative technique [A for single mesh and B for double mesh]. The study's candidates were examined and investigated thoroughly regarding their complaint, the presence of a clinically detectable hernia in the inguinal region, its size, characters, onset, duration, and associated symptoms. Then, all were examined clinically and prepared for surgical intervention after lab investigations. Results: The mean ages were 56 and 56.9 years for groups A and B. Both groups were comparable to body mass index, risk factors, type of hernia, hernia side, and intraoperative blood loss. There was a significant decrease in operative time in group A when compared to group B [54.50 ± 8.256 vs. 61.25 ± 6.664 minutes, respectively]. The overall rate of complications was lower in group B when compared to group A [30.0% vs. 50.0%, respectively]. Complications in group A were seroma [10.0%], wound infection [5.0%], scrotal edema [25.0%], and chronic pain [10.0%]; while in group B, seroma [10.0%], scrotal edema [5.0%], chronic pain [15.0%]. Recurrence was confined to group A, and reported to three patients [15.0%]. However, the difference was statistically nonsignificant. Conclusion: Double mesh technique is a safe and efficacious approach for managing huge inguinal hernia. It is associated with lower rate of recurrence than the single mesh approach with comparable operative time, complications, and outcomes.

Rhabdomyosarcoma is a rare tumor that is diagnosed mostly in children and adolescents, rarely in adults, representing 2–5% of all soft tissue sarcomas. It has four subtypes that are recognized: embryonal (50%), alveolar (20%), pleomorphic (20%), and spindle cell/sclerosing (10%). The diagnosis of rhabdomyosarcoma is based on the histological detection of rhabdomyoblasts and the expression of muscle-related biomarkers. Spindle cell/sclerosing rhabdomyosarcoma consists morphologically of fusiform cells with vesicular chromatin arranged in a storiform pattern or long fascicles, with occasional rhabdomyoblasts. Also, dense, collagenous, sclerotic stroma may be seen more commonly in adults. We present a rare case of an adult who presented to the hospital with a tumor in the left inguinal area, was first diagnosed with a left strangulated inguinal hernia and was operated on as an emergency, although the diagnosis was ultimately a spindle cell rhabdomyosarcoma of the inguinal region.

Hernias containing organs like the cecum, appendix, sigmoid colon, ureter, and omentum are less common compared to typical inguinal hernias involving the small intestine. Patients typically present with inguinoscrotal swelling. A 53-year-old male with ischemic heart disease, diabetes, and hypertension presented with vomiting and no bowel movement for 24 h. He had a long-standing left inguinoscrotal hernia and recently underwent cardiac catheterization. Examination showed a massive hernia and an empty rectum. Imaging confirmed a small bowel obstruction. Surgery revealed an incarcerated hernia containing multiple organs, which were reduced, and hernioplasty was performed. Postoperatively, he developed abdominal compartment syndrome, necessitating decompressive laparotomy. His abdomen was closed on day 13, and he was discharged on day 30. Hernias, particularly when they become incarcerated, pose significant risks to patients. If untreated, they can progress to strangulated hernias, leading to bowel ischemia and potentially fatal outcomes. Inguinal hernias are diagnosed primarily through clinical examination. It is rare for these hernias to contain the cecum, appendix, sigmoid colon, ureter, and omentum, and such cases are typically associated with intestinal obstruction. • Uncommon inguinal hernias may contain organs such as the cecum, appendix, sigmoid colon, ureter, or omentum, which differ from the more typical involvement of the small intestine. • These hernias often present with noticeable inguinoscrotal swelling due to the presence of larger organs within the hernia sac. • Despite their rarity, hernias containing these organs can lead to significant symptoms and complications if left untreated, necessitating timely surgical intervention. [ABSTRACT FROM AUTHOR]

Purpose: Inguinal hernia repair using surgical mesh is a very common surgical operation. Currently, there is no consensus on the best technique for mesh fixation. We conducted an overview of existing systematic reviews (SRs) of randomised controlled trials to compare the risk of chronic pain and recurrence following open and laparoscopic inguinal hernia repairs using various mesh fixation techniques. Methods: We searched major electronic databases in April 2020 and assessed the methodological quality of identified reviews using the AMSTAR-2 tool. Results: We identified 20 SRs of variable quality assessing suture, self-gripping, glue, and mechanical fixation. Across reviews, the risk of chronic pain after open mesh repair was lower with glue fixation than with suture and comparable between self-gripping and suture. Incidence of chronic pain was lower with glue fixation than with mechanical fixation in laparoscopic repairs. There were no significant differences in recurrence rates between fixation techniques in open and laparoscopic mesh repairs, although fewer recurrences were reported with suture. Many reviews reported wide confidence intervals around summary estimates. Despite no clear evidence of differences among techniques, two network meta-analyses (one assessing open repairs and one laparoscopic repairs) ranked glue fixation as the best treatment for reducing pain and suture for reducing the risk of recurrence. Conclusion: Glue fixation may be effective in reducing the incidence of chronic pain without increasing the risk of recurrence. Future research should consider both the effectiveness and cost-effectiveness of fixation techniques alongside the type of mesh and the size and location of the hernia defect. [ABSTRACT FROM AUTHOR]

Introduction:  Inguinal hernia repair represents the most common operation in childhood; however, consensus about the optimal management is lacking. Hence, recommendations for clinical practice are needed. This study assesses the available evidence and compiles recommendations on pediatric inguinal hernia.Materials and Methods:  The European Pediatric Surgeons' Association Evidence and Guideline Committee addressed six questions on pediatric inguinal hernia repair with the following topics: (1) open versus laparoscopic repair, (2) extraperitoneal versus transperitoneal repair, (3) contralateral exploration, (4) surgical timing, (5) anesthesia technique in preterm infants, and (6) operation urgency in girls with irreducible ovarian hernia. Systematic literature searches were performed using PubMed, MEDLINE, Embase (Ovid), and The Cochrane Library. Reviews and meta-analyses were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement.Results:  Seventy-two out of 5,173 articles were included, 27 in the meta-analyses. Laparoscopic repair shortens bilateral operation time compared with open repair. In preterm infants, hernia repair after neonatal intensive care unit (NICU)/hospital discharge is associated with less respiratory difficulties and recurrences, regional anesthesia is associated with a decrease of postoperative apnea and pain. The review regarding operation urgency for irreducible ovarian hernia gained insufficient evidence of low quality.Conclusion:  Laparoscopic repair may be beneficial for children with bilateral hernia and preterm infants may benefit using regional anesthesia and postponing surgery. However, no definite superiority was found and available evidence was of moderate-to-low quality. Evidence for other topics was less conclusive. For the optimal management of inguinal hernia repair, a tailored approach is recommended taking into account the local facilities, resources, and expertise of the medical team involved. [ABSTRACT FROM AUTHOR]

In the past two decades, laparoscopy has provided an alternative approach to inguinal hernia repair. The aim of this review is to carry out a retrospective systematic analysis of articles dealing with laparoscopic hernia repair in children and a review of the Maltese experience. Data was obtained from publications from 2002 to 2019. The endpoints include: patient demographics, clinical presentations, laparoscopic tools, ports, suture used, technical remarks, length of surgery, hospital stay, complications and follow-up. 32 studies were included with a total of 10,183 patients. Most articles documented the use of 1 port. Length of surgery ranged from an average of 10 to 138 min. Ipsilateral recurrences were reported in 0.83% of cases, while 0.17% required conversion to open. In our centre, a population of 514, 564 is covered (16% under the age of 18). A total of 14 cases of laparoscopic inguinal hernia repair were carried out from August 2018 till October 2020. The neonatal laparoscopic set-up involves a 30⁰ laparoscope, inserted via a 5 mm umbilical port, with 2 stab incisions allowing the use of 3 mm devices. Intra-corporeal purse string suture technique is used. The length of surgery ranged from 1 hr to 2 hr 30 min. There was 1 case of ipsilateral recurrence and another requiring conversion to open surgery. Laparoscopic inguinal hernia repair in children is a versatile and safe procedure that can be carried out with minimal complications and low reoperation rates. Level of Evidence: Level IV [ABSTRACT FROM AUTHOR]

The present case report aims to describe surgical repair and management of inguinal hernia in a 2‐month‐old, 5 kg, female kid admitted to the Veterinary Teaching Hospital. General and clinical examination revealed a large swelling in the left groin, progressing to the groin area that could be reduced to the ring. After aseptic preparation of the surgical site, stabilisation with diazepam at 0.1 mg/kg and circular infiltration with 2% lidocaine hydrochloride at 3.4 mg/kg, a sharp linear incision was made in the skin and subcutaneous tissue over the swelling slightly lateral to the udder. Then the contents were identified and relocated. From there, the ring was renewed and sutured with the appropriate threads and patterns followed by muscle layer and skin. After the operation, the kid was administered with antibiotics and analgesics intramuscularly for 3 days, incision site was dressed with diluted chlorhexidine solution and the kid successfully recovered without complications. [ABSTRACT FROM AUTHOR]

We report a rare case of ectopic breast tissue situated in a unique location. A 50-year-old female patient came to our institution complaining of a bulge in the inguinal area. CT was unremarkable other than a benign-looking conglomeration of lymph nodes around the inguinal canal. However, excisional biopsy proved otherwise, with strong expression of breast-related immunohistochemical markers on pathology. Based on histological findings, the diagnosis of ectopic breast tissue was made. Since the vast majority of ectopic breast tissue is found around the breast mound, axilla, and along the milk line, this case is peculiar in its location. This report shares our experience and provides indications for excision of incidental ectopic breast tissue.

Cryptorchidism is a common congenital malformation in pediatric urology. Although there have been many studies on the etiology of the disease, it has not been fully clarified, and while its diagnostic and treatment models have gradually approached standardization and systematization, some controversies regarding treatment remain. Additionally, although ultrasound is a non-invasive examination without ionizing radiation, its role in the evaluation of cryptorchidism remains controversial. The main basis for treating cryptorchidism is orchidopexy, and the main view on treatment age is that treatment should be performed between 6 and 12 months after birth, but no more than 18 months after birth. The view on hormone therapy is still controversial because most scholars believe that early surgery is the key to treatment. There are many surgical treatment methods for cryptorchidism, including traditional open surgery and laparoscopic surgery, which provide satisfactory results. In conclusion, the treatment of undescended testis (UDT) had been largely standardized, apart from the treatment of high intra-abdominal testis (IAT), which remains a matter of debate.

PurposeBoth pediatric urologists and pediatric surgeons perform hernia repairs, hydrocelectomies and orchiopexies. We hypothesized that surgeons perform more incarcerated and female hernia repairs while urologists perform more orchiopexies and hydrocelectomies.MethodsThe Vizient-AAMC Faculty Practice Solutions Center® database was queried from January 2009 to December 2014 to identify patients 10years or younger who underwent the above procedures performed by pediatric specialists. Age, gender, race, insurance, geographic region and surgeon volume were examined.ResultsIn the study 55,893 surgeries were identified: 26,073 primary hernia repairs, 462 recurrent hernia repairs, 3399 laparoscopic hernia repairs, 9414 hydrocele repairs and 16,545 orchiopexies. Pediatric surgeons performed 89% of primary hernia repairs with an annual median surgeon volume of 4 cases/year. Pediatric urologists performed 62% of hydrocelectomies and 83% of orchiopexies with annual median surgeon volumes of 6 and 24, respectively. Pediatric surgeons performed all procedures in younger patients and performed more female and incarcerated hernia repairs.ConclusionsPediatric surgeons operate on younger patients and treat more patients with inguinal hernias while pediatric urologists care for more boys with undescended testes and hydroceles. This knowledge of referral patterns and care between specialties with overlapping expertise will allow improvements in training and access.Levels of evidenceCost Effectiveness Study, Level of Evidence III.

Objectives: To compare the outcome prophylactic antibiotics and routine pre-surgical and post-surgical in terms of incidence of surgical site infection (SSI) and to explore the effect of various factors such as duration of surgery and patient characteristics (if any). Methods: A double-blinded prospective analysis of a total of 60 patients with the primary inguinal hernia was conducted from 24th August 2020 to 24th August 2021 at the Surgical Department of Nishtar Medical University & Hospital, Multan. The participants of the study were categorized into two groups such that 30 consecutive patients were placed in the study group who were administered with a single dose of prophylactic antibiotic 30 minutes before to mesh repair surgery and the remaining 30 patients were placed in the control group who were administered routine antibiotics pre and post-operatively. The effects in patients were observed till 30 days following surgery for any sign of infection. All the collected data were analyzed through SPSS (version 19). Results: The rate of infection in both groups was noted. The incidence of infection in the study group (13.3%) was higher as compared to the control group (10%). No patient underwent mesh removal and no significant difference in terms of post-operative complications was observed in the results of both groups. Conclusion: Both the treatments, prophylactic antibiotics and routine pre-surgical and post-surgical were equally effective. However, we recommend the administration of prophylactic since they are cost-effective and prevent bacterial drug resistance. [ABSTRACT FROM AUTHOR]

Introduction and purpose Risk factors and causes of recurrence following inguinal hernia repair in the pediatric age group are not well understood. In this work, we aimed to describe a cutoff value of internal ring diameter in male children who presented with large inguinoscrotal hernia above which internal ring narrowing (plication of inguinal canal floor) may affect the rate of hernia recurrence. Patients and methods A prospective study was conducted on male children who presented clinically with large unilateral or bilateral inguinoscrotal hernias. Preoperative ultrasound was performed for all of them to assess the diameter of the internal inguinal ring. Cases were categorized into two groups: group 1, internal ring diameter less than 12 mm, and group 2, internal ring diameter 12 mm and more. Patients in either group were blindly selected to be operated upon by one of the two operative techniques, either just high ligation of the sac or high ligation of the sac followed by plication of the floor of the inguinal canal (narrowing of the internal ring). The recurrence rate was compared between the two operative techniques, and the results were statistically analyzed. Results This study included 204 inguinoscrotal hernias divided into two groups: group 1 included 142 cases in which the internal ring diameter was below 12 mm. Half of them were operated upon by just high ligation of the sac, and the other half were operated upon by high ligation of the sac and internal ring narrowing. We encountered no recurrence in either group. Group 2 included 62 cases in which the internal ring diameter was 12 mm or more. A total of 31 patients were operated upon by high ligation of the sac only, and we encountered three (10%) recurrent cases. The other 31 cases were operated upon by high ligation of the sac and narrowing of the internal ring, with no recurrence. Conclusion Narrowing of the internal ring if dilated above 12 mm or more may decrease the recurrence rate in such cases. [ABSTRACT FROM AUTHOR]

Abstract Background The hernia is defined as the protrusion of any organ or a part of it through the wall or fascia or any connective tissue which normally encloses that organ. Among the hernias, an inguinal hernia is the most common type. In the inguinal hernia, Amyand hernia is one of the rare types, in which the appendix will herniate through the inguinal canal. The incidence of Amyand hernia is less than 1% (Namdev et al., Int Surg J 7:2072, 2020). Case presentation We are reporting a case of Amyand hernia, which was diagnosed incidentally in the patient who had been referred to computerized tomography (CT) for a malignant melanoma metastasis screening. Our case is unique in that pre-operative diagnosis of the Amyand hernia is rarely reported in the literature. We can diagnose the type 1 Amyand hernia with utmost confidence. Conclusion Pre-operative diagnosis of type 1 Amyand hernia can be made with utmost certainty by CT.

Omental torsion secondary to inguinal hernia has rarely been reported as a cause of acute abdominal pain. However, in our case, omental infarction due to prolonged inguinal hernia-associated omental torsion led to the formation of a large omental mass with marginal fibrosis, and the patient presented with chronic abdominal pain. A 74-year-old man presented with complaints of lower abdominal pain for 1 month; subsequently, bilateral inguinal hernias were identified through inguinal ultrasonography. CT scans revealed that the greater omentum was trapped within the right inguinal canal, leading to omental torsion. The greater omentum, distal to the pedicle, appeared as a 30 cm-sized oblong fibrofatty mass in the right lower abdomen and pelvic cavity. Laparoscopic omentectomy with hernia repair was successfully performed.

Abstract Background Discuss the superiority of laparoscopic orchiopexy in the treatment of inguinal palpable undescended testes. Methods Inclusion criteria: Preoperative examination and color Doppler ultrasound examination confirmed that the testes were located in the inguinal canal and could not be pulled into the scrotum, except for retractive and ectopic testes. The surgical steps were depicted as follow. The retroperitoneal wall was carved by ultrasonic scalpels, separates the spermatic vessels closed to the inferior pole of the kidney if necessary, dissects the peritoneum of vas deferens, cuts the testicular gubernaculum, and pulls back the testicle into the abdominal cavity. Besides, protect the vas deferens, and descend the testes to the scrotum and fix them without tension. Results There were 773 patients with 869 inguinal undescended palpable testes, 218 cases on the left side, 459 cases on the right side and 96 cases with bilateral undescended testes, whose age ranged from 6 months to 8 years, with an average of 20 months. All testes were successfully operated, no converted to open surgery. The average operation time was (34.8 ± 5.4) min. There were 692 testes have an ipsilateral patent processus vaginalis (89.5%); In 677 cases of unilateral cryptorchidism, 233 cases (34.4%) have a contralateral patent processus vaginalis, and laparoscopic percutaneous extraperitoneal closure the hernia sac carry out during the surgery. There was no subcutaneous emphysema during the operation, no vomiting, no abdominal distension, no wound bleeding and obvious pain after surgery, especially wound infection is rarely. Doppler ultrasound was evaluated regularly after surgery. The patients were followed up for 6 to 18 months. All the testes were located in the scrotum without testicular retraction and atrophy. No inguinal hernia or hydrocele was found in follow-up examination. Conclusion Laparoscopic orchiopexy manage inguinal palpable cryptorchidism is safe and effective, and there are obvious minimally invasive advantages. Furthermore, It could discover a contralateral patent processus vaginalis, and treat at the same time, which avoid the occurrence of metachronous inguinal hernia.

Teaching point: An ureteroinguinal hernia is a very rare diagnosis with typical radiological findings that must be reported, particularly in surgical candidates.

Objective: To evaluate operative outcomes and postoperative complications of laparoscopic treatment for pediatric inguinal hernia using meta-analysis., Methods: We conducted a comprehensive search of databases including the Chinese Journal Full-text Database, Wanfang, PubMed, Web of Science, ScienceDirect, VIP Chinese Science, and Technology Journal Database, ProQuest, JSTOR, Wiley, and IEEE Xplore. Relevant randomized controlled trials (RCTs) on laparoscopic surgery for pediatric inguinal hernia were collected, and data were analyzed using Review Manager 5.3., Results: A total of 18 RCTs involving 5,750 children (3,357 in the laparoscopic group and 2,393 in the open surgery group) were included. Compared to the open surgery group, the laparoscopic group had significantly shorter operative times for bilateral hernias [(mean difference (MD) = -11.43, P = 0.04)], and lower incidences of metachronous contralateral inguinal hernia (MCIH) (MD = 0.17, P = 0.02) and testicular ascent (MD = 0.19, P = 0.03). However, there were no significant differences in operative time for unilateral hernia (MD = 0.47, P = 0.87), complication rate (MD = 0.87, P = 0.60), postoperative recurrence (MD = 1.46, P = 0.18), incision infection rate (MD = 2.54, P = 0.34), or testicular atrophy rate (MD = 0.36, P = 0.19)., Conclusion: Laparoscopic surgery for pediatric inguinal hernia is effective, especially for bilateral cases, reducing operative time and lowering the risk of MCIH and testicular ascent., Competing Interests: None., (AJTR Copyright © 2024.)

The use of mesh in emergency repair of complicated groin hernias has been a subject of discussion for decades. While it is now generally accepted that mesh could safely be used in incarcerated (irreducible) and obstructed hernias (without strangulation), with wound infection rates comparable to suture repairs, the use of mesh in strangulated hernias involving bowel resection is still controversial. The aim of this study, therefore, was to analyse the safety of mesh use in strangulated hernias with ischaemic bowel at the time of surgery. A literature search was carried out using relevant keywords. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework anddata analysis was done using the Review Manager version 5.4 (The Cochrane Collaboration, Oxford, UK) meta-analysis software. Seven studies comprising 1,159 patients who had emergency surgery for strangulated groin hernias were analysed. A pooled random effect meta-analysis did not show any significant difference in the surgical site infection rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) = 0.39-1.96, p = 0.75), seroma formation (OR = 3.39; 95% CI = 0.70-16.43; p = 0.13), and hernia recurrence (OR = 0.33; CI = 0.05-2.22; p = 0.26) between the two groups. The long-held concern that mesh could not be safely used in strangulated groin hernias has not been validated by the results obtained from this systematic review and meta-analysis. However, more randomised controlled trials in this clinical area would need to be carried out to further validate the results of this study., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ekwesianya et al.)

It is incredibly rare to find stomach content inside an inguinal hernia. Here, we report a 77-year-old male patient with a long-standing history of a left inguinal hernia spanning over a decade. Notably, the hernia had become irreducible for the past 20 days. CT scan of the abdomen and pelvis revealed a substantial left inguinal hernia extending into the left scrotal region causing bowel obstruction. The hernial neck measured approximately 5.5 cm in transverse diameter. Protrusion through this defect included the stomach, small and large bowel loops, and free mesenteric fat and vessels into the hernial sac. The patient underwent a life-saving exploratory laparotomy and the hernial sac was reduced and repaired. In conclusion, inguinal hernias are common, but stomach content cases are extremely rare and they usually present with gastric outlet obstruction or gastric perforation. CT is recommended to visualize the stomach within the hernia and to exclude complications. Surgical repair is usually the management of choice., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alhajjaji et al.)

• Laparoscopic inguinal herniorrhaphy is associated with higher recurrence rates compared to open herniotomy. • Our laparoscopic herniotomy (LIH) cohort shows low recurrence (1%), despite risk factors. • Our data supports growing favourable evidence on laparoscopic sac division techniques. Recent evidence suggests simple laparoscopic inguinal herniorrhaphy is associated with higher rates of recurrence and testicular ascent. We instigated a standardised approach to laparoscopic inguinal herniotomy (LIH), with circumferential sac division and 'purse-string' closure (4/0 monofilament polypropylene). An active follow-up programme was pursued. We reviewed our outcomes of this technique and compared them to an open herniotomy (OIH) cohort. LIH patients were identified prospectively (2017–2021): OIH retrospectively from 2016. Risk factors for complications were defined: extremely to very preterm (< 32 weeks), emergency presentation with incarceration, and redo surgery for recurrence. Data are presented as median [IQR]. Comparisons used Fisher's exact and Mann-Whitney U tests: significance defined as p < 0.05. 192 inguinal herniae in 140 patients were included in the LIH group and 214 herniae in 179 patients in the OIH group. Groups were similar in age and gender. The LIH group had a significantly larger proportion of cases that were premature, had emergency surgery, or had redo surgery after previous OIH. Follow-up was 24.4 months [10.8–33.6] vs. 66.4 [64.5–68.5] (LIH vs. OIH). Hernia recurrence occurred in 2/192 (1.0%) vs. 4/214 (1.9%) (LIH vs. OIH), p = 0.69. There was one known case of testicular ascent after OIH but none in the LIH group. Recreation of the open herniotomy laparoscopically appears to confer excellent outcomes, with low rates of recurrence despite a high proportion of patients having known risk factors. Further long-term data on rates of testicular ascent after active follow-up are required. [ABSTRACT FROM AUTHOR]

Background: Incarcerated inguinal hernias (IGHs) combined with abdominal cocoons (ACs) are uncommon in adults. Abdominal cavity exploration using laparoscopy via the hernial sac (hernioscopy) has rarely been reported. Here, an elderly man with unilateral IGH complicated by a contralateral inguinal hernia and AC was found using hernioscopy. We present the surgical decision-making points in an elderly patient with IGH, enrich the diversity of AC, and propose a relatively novel hernioscopy approach. Case Report: A 90-year-old man presented with chronic constipation and reducible right inguinal masses. A lump in the right groin was strangulated for 2 days, accompanied with progressive abdominal pain, distension, and vomiting. The levels of inflammatory markers were elevated. Abdominal computed tomography revealed a dilated small bowel and a large mass in the right groin. Subsequently, the patient's condition quickly deteriorated. Therefore, he underwent surgical repair of bilateral hernias. Additionally, in our hospital, a total of 46 patients underwent hernioscopy because of IGH. No intraoperative or postoperative complications were observed. According to our clinical practice, hernioscopy via the bilateral hernial sacs was performed in this elderly patient. We found that almost the entire small bowel and colon were encapsulated in a fibrous and cocoon-like membrane, which postoperative pathological results revealed as AC. Conclusions: This is the first report to reveal that AC complicated with IGH could occur in a 90-year-old man. Hernioscopy is a relatively novel and safe surgical approach to abdominal pathology associated with incarcerated or strangulated inguinal hernias. It is rarely used in adults with IGH. [ABSTRACT FROM AUTHOR]

Background: The first case of inguinal endometriosis was described by Cullen. Endometriosis in the round ligament could be in the pelvic or inguinal area and is a rare disease occurring in 0.6% of women. Women with inguinal endometriosis have a painful inguinal mass during menstrual cycles and they mostly have a history of surgery. The right side is more commonly involved in inguinal endometriosis than the left side (90-94%). A history of gynecologic or abdominal surgery is common in women with inguinal endometriosis. Case presentation: In our case, a 39-yr-old virgin woman presented with localized pain in the right inguinal that had been present for 4 yr. She did not have any history of previous surgery, and abdominal ultrasonography showed a hypoechoic mass with minimal vascularity. Inguinal endometriosis was correctly diagnosed by two expert radiologists preoperatively, and she underwent laparoscopic surgery. Conclusion: Considering inguinal endometriosis in the differential diagnosis of women with inguinal masses is important, even if there is no history of gynecologic or abdominal surgery. [ABSTRACT FROM AUTHOR]

Amyand's hernia is defined as the presence of the vermiform appendix within an inguinal hernial sac. Less than 1% of the world medical publications on hernias address this disease, out of which very few come from Latin America and the Caribbean. This is the case of a 78-year-old male patient who experienced signs and symptoms for approximately five months. He felt a lump in the right inguinal region which progressively increased in size. Two days prior to admission to the intensive care unit, he said his pain level was 8/10. During the right inguinal approach, the hernial sac was opened, revealing parts of the right colon, cecum and appendix with edematous changes. Therefore, the patient underwent an appendectomy and repair with polypropylene mesh. [ABSTRACT FROM AUTHOR]

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Objective: Rare disease Background: Endometriosis is a common gynecological disorder occurring in around 10% of women of reproductive age. Inguinal endometriosis is a rare condition; however, it should be considered in the differential for inguinal masses in women of reproductive age. Usually, it occurs after implantation of endometrial tissue during previous surgical procedures. Patients with inguinal endometriosis are often multiparous women with a history of previous gynecological or obstetric surgery. It represents a diagnostic dilemma, as it is often misdiagnosed as other inguinal pathologies. Case Report: Herein, we report a case of a 33-year-old nulliparous woman with left groin pain for 2 years increasing in the severity during menstruation. A physical examination revealed a 1.5-cm left inguinal mass. Ultrasound showed an ill-defined speculated solid hypoechoic left inguinal mass measuring 1.6×1.4 cm. Computed tomography (CT) of the pelvis revealed a left inguinal mass measuring 1.7×1.2 cm, demonstrating central hypo-attenuation with thickening of the round ligament. Exploration of the inguinal region revealed an adherent mass to the round ligament and floor of the canal, which was excised completely with a safety margin. The inguinal canal floor was strengthened using proline mesh. Histopathological examination of the mass confirmed the diagnosis of left inguinal endometriosis. Conclusions: Inguinal endometriosis is a rare clinical entity mimicking other common inguinal conditions. A high index of suspicion is crucial for its preoperative diagnosis, especially in the presence of an inguinal mass associated with cyclic changes in size and pain severity. Its standard management is surgical excision. [ABSTRACT FROM AUTHOR]

Background: Learning curves describe the rate of performance improvements according to the surgeon's caseload, followed by a plateau where limited additional improvements are observed. The aim of this study was to evaluate the learning curve for robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias in surgeons already experienced in laparoscopic TAPP. Methods: The study was approved by local ethic committee. Male patients undergoing rTAPP for inguinal hernia from October 2017 to December 2019 at the Bellinzona Regional Hospital were selected from a prospective database. Demographic and clinical data, including operative time, conversion to laparoscopic or open surgery, intra- and postoperative complications were collected and analyzed. Results: Over the study period, 170 rTAPP were performed by three surgeons in 132 patients, and mean age was 60.1 ± 13.7 years. The cumulative summation (CUSUM) test showed a significant operative time reduction after the 43rd operation, once the 90% proficiency on the logarithmic tendency line was achieved. The corrected operative time resulted 71.1 ± 22.0 vs. 60.8 ± 13.5 min during and after the learning curve (p = 0.011). Only one intraoperative complication occurred during the learning curve and required an orchiectomy. Postoperatively, three complications (one seroma, one hematoma, and one mesh infection) required invasive interventions during the learning curve, while no cases were recorded after it (p = 0.312). Conclusion: Our study shows that the rTAPP, performed by experienced laparoscopists, has a learning curve which requires 43 inguinal hernia repairs to achieve 90% proficiency and to significantly reduce the operative time. [ABSTRACT FROM AUTHOR]

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

Discovery of scrotal swelling in a neonate can be a source of anxiety for parents, clinicians, and sonologists alike. This pictorial essay provides a focused review of commonly encountered scrotal masses and mimics specific to the neonatal setting. Although malignancy is a concern, it is very uncommon, as most neonatal scrotal masses are benign. Key discriminating features and management options are highlighted to improve the radiologist's ability to diagnose neonatal scrotal conditions and guide treatment decisions. Neonatal scrotal processes ranging from common to uncommon will be discussed.

The majority of inguinal hernia repairs today, open or laparoscopic, are performed with mesh tension-free repair. The introduction of mesh, though beneficial, posed a new set of post-operative problems related with the mesh, and mesh migration or penetration is one of the most unusual ones with considerable morbidity. Mesh migration following laparoscopic repair is rare, and only a handful of cases have been reported in the literature. Here we present the first ever case report of mesh migration and penetration through rectum developing after two years post-operatively. The mesh was removed and the patient was discharged in a stable condition.

Objective To investigate the CT findings and diagnostic strategies of inguinal lymphadenopathy. Methods Preoperative non-enhanced and enhanced 64-slice helical CT of 20 patients with pathologically confirmed unilateral inguinal lymphadenopathy was analyzed retrospectively. Results The lymph nodes were benign(6) or malignant(14) including metastasis(9) and lymphoma(5). The patients with metastatic lymph nodes(age range: 37-66 years) had history of primary malignancy and progressive lymph node enlargement. All were superficial inguinal lymph nodes either in the upper medial group(6) with the primary malignant tumor located in the vulva or pelvic cavity or in the vertical group(3) with the primary tumor located in the lower limb. CT showed ill-defined boundary, heterogeneous attenuation, rim or irregular contrast enhancement in 7/9 patients. The 5 patients with lymphoma(age range:46-76 years) had elevated blood lactate dehydrogenase level, slowly enlarging and firm lymph nodes( 4/5). CT showed uniform attenuation(4), conglomeration(1), extracapsular invasion(1), ill-defined boundary, mild to moderate enhancement. Of 6 patients with benign lymphadenopathy, 2 had Castleman’s disease(age: 22 and 30 years) with hyperglobulinemia. CT showed uniform attenuation and smooth boundary with or without punctate calcification, marked homogeneous enhancement. One 26-year-old patient with Kimura disease had slowly enlarging painless inguinal mass, eosinophilia and elevated serum IgE. CT showed uniform attenuation, ill-defined boundary, and hypervascularity with moderate uniform enhancement. One 27-year-old patient with IgG4 associated progressive tender lymphadenopathy had elevated IgG4 positive plasma cells. CT showed uniform density, clear boundary, moderate and uniform enhancement. Two patients with tuberculosis(age: 22 and 25 years) had low-grade fever and positive PPD skin test. The tender lymph nodes were heterogeneous in CT attenuation with ill-defined boundary and irregular thick enhancing walls. Conclusion The distribution and CT appearance combined with patient’s age, clinical features and serological examination can aid in the differential diagnosis of benign and malignant unilateral inguinal lymphadenopathy. [ABSTRACT FROM AUTHOR]