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INTRODUCTION: Post-operative prescription opioid use is a known risk factor for persistent opioid use. Despite the increased utilization of robotic-assisted surgery (RAS) for inguinal hernia repair (IHR), little is known whether this minimally invasive approach results in less opioid consumption. In this study, we compare long-term opioid use between RAS versus laparoscopic (Lap) versus open surgery for IHR. METHODS: A retrospective cohort study of opioid-naïve patients who underwent outpatient primary IHR was conducted using the Merative™ MarketScan® (Previously IBM MarketScan®) Databases between 2016 and 2020. Patients not continuously enrolled 180 days before/after surgery, who had malignancy, pre-existing chronic pain, opioid dependency, or invalid prescription fill information were excluded. Among patients exposed to opioids peri-operatively, we assessed long-term opioid use as any opioid prescription fill within 90 to 180 days post-surgery. Secondary outcomes were controlled substance schedule II/III opioid fill, and high-dose opioid fill defined as > 50 morphine milligram equivalent per day. An Inverse-probability of treatment weighted logistic regression was used to compare outcomes between groups with p-value of

PURPOSE: To determine the relationship between abdominal hernia and obesity. Although obesity is frequently cited as a risk factor for abdominal hernia, few studies have confirmed this association (Menzo et al. Surg Obes Relat Dis 14:1221-1232. 10.1016/j.soard.2018.07.005, 2018). METHODS: A cross-sectional study of primary care ambulatory patients aged older than 16 years treated at UCLA Health from 01/01/2018 to 06/06/2023. Abdominal hernia was identified by clinic encounter ICD-10 codes (K40-K46). RESULTS: There were 41,703 hernias identified among 1,362,440 patients (306.1 per10,000) with a mean age of 62.5 ± 16.1 years, and 57.6% were men. Nearly half (44.7%) of all abdominal hernias were diaphragmatic. There was an approximately equal distribution of the ventral (28.7%) and inguinal (24.3%) hernia. Each hernia type had a different relationship with obesity: The odds of having a ventral hernia increased with BMI in both sexes: BMI 25-29.9 kg/m2 odds ratio (OR) = 1.65, (CI 1.56-1.74); BMI 30-39.9 kg/m2 OR = 2.42 (CI 2.29-2.56), BMI 40-49.9 kg/m2 OR = 2.28 (CI 2.05-2.54) and BMI >  = 50 kg/m2 OR = 2.54 (CI 2.03-3.17) all relative to normal BMI. In contrast, the odds of having an inguinal hernia decreased with obesity relative to normal weight [obesity (BMI 30-39.9 kg/m2): OR = 0.60 (CI 0.56-0.65)], morbid obesity (BMI 40-49.9 kg/m2): OR = 0.29 (CI 0.23-0.37). The OR for diaphragmatic hernia peaks with obesity in women and overweight status in men but was found to decrease with morbid obesity [OR = 1.18 (CI 1.07-1.30)]. There was no significant difference between men and women in the prevalence of femoral hernia (men: 0.7/per10,000, women: 0.9/per10,000, p = 0.19). CONCLUSIONS: The relationship between hernia and obesity is complex with some hernias decreasing in prevalence as obesity increases. Further research is needed to better understand this paradoxical relationship.

Objective: Totally extraperitoneal (TEP) surgeries were considered contraindicated in patients who underwent lower abdominal surgery until recently. However, in recent surgeries, it has been reported that they can be performed safely in those cases. Our aim in this study is to investigate the effectiveness of laparoscopic hernia repair methods in patients who have and have not had lower abdominal surgery before. Patients and Method: This study was a prospective observational study between May 2018 and May 2023. Two hundred eighty-eight patients were included in the study. The operation was started with the TEP technique in all patients. Patients, classified in two groups who had not previously undergone abdominal surgery (n = 216) (Group I) and who had surgery (n = 72) (Group II). Demographic characteristics of patients, intraoperative and postoperative complications were determined. In addition to descriptive statistical methods (mean, standard deviation), Shapiro–Wilk normality test, independent t test, and chi-square test were used to evaluate the data. Logistic regression analysis was performed to determine the factors affecting the presence of Previous Surgery and Peritoneal Tear. Results were evaluated at the significance level of P <.05. Results: Two hundred fifty-nine patients were operated with TEP method. TEP method was converted to transabdominal preperitoneal (TAPP) in 9 patients from Group I and 20 patients from Group II. Intraoperative and postoperative complications were recorded. Conclusion: With increasing experience in laparoscopic hernia surgery, it is now possible to perform hernia surgeries with preperitoneal (TEP) and abdominal approaches (TAPP) in patients who have previously undergone lower abdominal surgery. [ABSTRACT FROM AUTHOR]

Introduction The Nuck duct cyst (NCC) was initially documented by Anton Nuck in 1961 in a female patient. NCC is a rare condition in adult women, and its exact incidence is unknown. A small number of case reports have been documented in the literature. Case report This case report presents a 70-year-old female patient who underwent a conventional mass excision after being diagnosed with a cystic mass in the right inguinal region. The surgical specimen of the patient was histopathologically diagnosed as NCC. Conclusion Although NCC is typically diagnosed peroperatively, it is frequently misdiagnosed preoperatively as an inguinal hernia. Hence, the utilization of radiological imaging techniques is advised to facilitate treatment planning and differential diagnosis. NCC should be considered in the differential diagnosis, particularly in the context of inguinal region pathologies during the reproductive period, given that all of the patients in the aforementioned case reports in the literature are female in their reproductive years. NCC should remain in the differential diagnosis of inguinal region pathologies in elderly female patients in the non-reproductive period, given that the patient in this case report is in the non-reproductive period, in contrast to most patients described in the literature. [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]

Background: Available reports of surgeon efficiency when transitioning from laparoscopic to robotic-assisted (RA) inguinal hernia repair (IHR) are retrospective or describe single-center experience. The purpose of this study is to provide a prospective, multi-surgeon, multi-center assessment of surgeon efficiency when transitioning from Lap-IHR to RA-IHR. Methods : General surgeons with Lap-IHR experience (≥300 Lap-IHRs prior to the study) but with no robotic experience (no RA cases one year prior to the study) consented to participate in this prospective, observational pilot study of their surgical efficiency as they adopted RA-IHR. Efficiency was measured through procedure durations, including skin-to-skin time and time to establish critical view of the myopectineal orifice (MPO). Rates of conversions, and adverse events (AEs) through 30 days post RA-IHR procedure were also reported. Outcomes with 95% confidence intervals (95% CI) describe surgeons’ collective and individual unilateral and bilateral early, middle, and late-phase cases, with each surgeon contributing 25 consecutive cases at each phase. Results : Four surgeons consented to enroll in the study and provided 75 consecutive, prospective RA-IHR cases. Collectively, the surgeons reached relative skin-to-skin time efficiencies for their unilateral repairs in the mid-phase of their prospective cases. For RA-IHR bilateral procedures, skin-to-skin time efficiency was reached in the late-phase cases. Surgeons’ skin-to-skin efficiency times varied relative to their retrospective Lap-IHRs. Possible confounders included practice patterns, referrals, proctoring periods, and—for one surgeon—Covid interruptions. One conversion from RA-IHR to open resulted from severe adhesions present after prior prostatectomy. AEs varied broadly from surgeon to surgeon. Conclusions: The four surgeons improved their skin-to-skin efficiencies [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]

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]

Introduction: Inguinal hernia surgery is preferably performed under Subarachnoid Block (SAB) or General Anaesthesia (GA). However, some patients may have contraindications for both types of anaesthesia. An Ilioinguinal-Iliohypogastric Nerve (IINIHN) block can be administered for inguinal hernia surgery, but sometimes it provides unsatisfactory anaesthesia, and combining it with the genital branch of the genitofemoral nerve is suggested. The use of ultrasound is recommended to increase efficacy and reduce adverse effects of the block. Aim: To compare the intraoperative anaesthetic efficacy of ultrasound-guided ilioinguinal, iliohypogastric, and genitofemoral nerve blocks, collectively referred to as Hernia Block (HB), with SAB in patients undergoing elective unilateral uncomplicated open indirect inguinal hernia repair. Materials and Methods: An open-label randomised clinical study was designed to include 40 adults aged 18 to 80 years, classified as American Society of Anaesthesiologists (ASA) class I-III, undergoing elective open surgery for indirect inguinal hernia. Patients were randomised into two groups: Group A received SAB, while group B received ultrasound-guided HB only. A comparison was made between both groups in terms of intraoperative anaesthetic efficacy, success rate, duration of analgesia, haemodynamic changes, complications, time to ambulation, patient satisfaction, surgeon satisfaction, and adverse effects. Statistical analysis was performed using Analysis of Variance, Student's t-test, and the Mann-Whitney test. Results: The median age (range) of group A was 56 (33-68) years, while that of group B was 50 (26-76) years. Mean arterial pressure showed a statistically significant reduction between 30 to 90 minutes in group A patients (p-value <0.05). The median time taken to perform the block was significantly shorter in group A, at 11 (5-22) minutes, compared to 41 (27-70) minutes in group B (p-value of 0.002). The median time to onset of surgical anaesthesia was significantly shorter in group A, at 5 (3-10) minutes, compared to 30 (15-75) minutes in group B (p-value=0.003). The duration of analgesia was significantly longer in group B, at 8 (2-11) hours, compared to 5 (3-7) hours in group A (p-value=0.002). The success rate in the ultrasound-guided HB group was 80%, while it was 100% in the SAB group (p-value=0.05). Adverse events related to the procedure were significantly higher in the SAB group (55% vs 10%, p-value=0.003). Both surgeon and patient satisfaction were significantly better in SAB group. The median ambulation time was significantly faster in the ultrasound group, at 5.5 hours, compared to 11.5 hours in the SAB group. Conclusion: The ultrasound-guided HB may be considered an effective alternative with an acceptable success rate to SAB for unilateral indirect inguinal hernia repair, particularly in terms of haemodynamic stability, postoperative analgesia, fewer complications, and early ambulation. [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]

Purpose: Prior investigations regarding the effect of obesity on inguinal hernia repair have been mixed. The aim of our study was to retrospectively compare perioperative outcomes, recurrence rate, and quality of life between obese and non-obese patients undergoing inguinal hernia repair. Methods: Patients who underwent inguinal hernia repair by any approach at a single institution were identified from a prospectively maintained quality database. Patients with a body mass index (BMI) greater than or equal to 30 kg/m2 were considered obese. Quality of life was measured with the Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CSS) surveys. Differences between obese and non-obese patients were assessed using independent samples t-tests, Wilcoxon rank-sum, and chi-square tests. Results: Between 2010 and 2021, a total of 5575 patients underwent inguinal hernia repair. Fifteen percent of patients were identified as obese (835 patients, mean BMI 33.2 ± 3.3 kg/m2). A significantly higher percentage of obese patients were diabetic, and operative time and estimated blood loss were higher in the obese group (all p < 0.001). Rates of hernia recurrence in obese patients was significantly more likely than in non-obese patients (4.2% vs 2.0%, p < 0.001). Up to 2 years postoperatively, a greater percentage of obese patients reported worse quality of life on the SOMS and more bothersome symptoms on the CCS. Conclusions: Inguinal hernia repair in obese patients is a more technically challenging operation. Long-term follow-up revealed a greater risk of hernia recurrence and worse quality of life up to 2 years postoperatively in this patient population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Laparoscopic transabdominal preperitoneal repair of inguinal hernia (TAPP) is routinely done by general surgeons. (1) One crucial step is peritoneal closure post-mesh placement to prevent contact with the bowel. (2) There are various techniques available for peritoneal closure. (3) This prospective comparative cohort study compares the effectiveness of sutures versus tackers in terms of time efficiency, cost, postoperative patient comfort, and complications. MATERIALS AND METHODS: This prospective comparative cohort study included patients undergoing unilateral TAPP at a tertiary care hospital in South India from December 2022 to April 2024. A total of 80 patients were included in the study, of which 50 underwent peritoneal closure by tackers and 30 underwent peritoneal closure by sutures based on the standard of care of the operating surgeon. These patients were observed intra-operatively, post-operatively, and during the first follow-up visit at 10–14 days and at 3 months. RESULTS: Peritoneal closure time was significantly lower for the tacker group (2.78 min vs. 11.17 min, P < 0.001). The tacker group had a higher cost (₹5313 vs. ₹1855, P < 0.001) and experienced increased postoperative pain at both 10–14 days (36% vs. 10%, P = 0.011) and 3 months (24% vs. 6.7%, P = 0.048). CONCLUSION: This study shows that although suturing for peritoneal closure is more time-consuming and technically challenging, it can significantly reduce the material cost and reduce both early and late postoperative pain. Using barbed suture materials can help reduce operative times. TRIAL REGISTRATION: Study registered under the Clinical Trial Registry of India. CTRI Number: CTRI/2022/11/047211.

Background: Lower extremity lymphedema (LEL) can develop because of inguinal lymph node dissection in the treatment of gynecologic, genitourinary, and dermatological malignancies. To optimize patient counseling and patient selection for microsurgical interventions aimed at preventing or treating LEL, its prevalence and associated patient characteristics must be accurately documented. This systematic review and meta-analysis provides a comprehensive overview of literature on the reported prevalence of LEL in patients undergoing inguinal lymphadenectomy. Methods: From Embase, PubMed, and Web of Science databases, 23 studies were identified that met the inclusion criteria. This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies-of Exposure tool. Results: Random-effects meta-analyses of proportions estimated a 24% (95% confidence interval [CI]: 17-31) pooled prevalence of LEL with a high degree of heterogeneity between the studies (I2=96%, p < 0.01). Subgroup analysis revealed significant differences in LEL prevalence based on the indications for inguinal lymphadenectomy. The pooled LEL prevalence was 25.75% (95% CI: 0.00-96.16) for patients who underwent lymphadenectomy for melanoma, 12.22% (95% CI: 1.03-23.40) for penile cancer, 30.96% (95% CI: 21.08-40.84) for vulvar cancer, and 13.62% (95% CI: 0.00-51.02) for miscellaneous indications. Conclusion: The findings from this study emphasize the importance of considering malignancy etiology when assessing the risk of LEL following inguinal lymphadenectomy. This knowledge could aid physicians in informing patients about the risk of LEL, while also facilitating proper patient selection for microsurgical interventions.

Bilateral hydrocele of the canal of Nuck (HCN) is very rare, in adult females. Primary care physicians can misdiagnose this pathology without diagnostic imaging. A 37-year-old female complained of right lower quadrant (RLQ) pain, for a few months, reported to the emergency room. A non-reducible bulging protrusion was visualized in the RLQ. After performing the necessary blood work, the emergency physician ordered an emergent sonogram and computed tomography (CT). A transvaginal sonogram was performed to exclude gross adnexal masses, in the RLQ. An HCN canal was suspected in the right inguinal region. A non-contrast CT demonstrated a bilateral HCN, with the left significantly smaller than the right. In this case, a bilateral surgical excision of the hydrocele was recommended. Owing to the recurrence of the HCN, a cyst aspiration was not suggested. Physicians should consider the diagnosis of HCN in any female presenting with inguinolabial swelling. Sonography, CT, and magnetic resonance imaging (MRI) are the three diagnostic imaging techniques commonly used to diagnose this pathology. A multimodality approach is sometimes necessary when the sonography diagnosis is no definitve. [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]

Purpose: To investigate the differences in the visibility and size of abdominal wall hernias in computed tomography (CT) with and without Valsalva maneuver. Methods: This single-center retrospective study included consecutive patients who underwent abdominal CTs with Valsalva maneuver between January 2018 and January 2022. Inclusion criteria was availability of an additional non-Valsalva CT within 6 months. A combined reference standard including clinical and surgical findings was used. Two independent, blinded radiologists measured the hernia sac size and rated hernia visibility on CTs with and without Valsalva. Differences were tested with a Wilcoxon signed rank test and McNemar's test. Results: The final population included 95 patients (16 women; mean age 46 ± 11.6 years) with 205 hernias. Median hernia sac size on Valsalva CT was 31 mm compared with 24 mm on non-Valsalva CT (p < 0.001). In 73 and 82% of cases, the hernias were better visible on CT with Valsalva as compared to that without. 14 and 17% of hernias were only visible on the Valsalva CT. Hernia visibility on non-Valsalva CT varied according to subtype, with only 0 and 3% of umbilical hernias not being visible compared with 43% of femoral hernias. Conclusions: Abdominal wall hernias are larger and better visible on Valsalva CT compared with non-Valsalva CT in a significant proportion of patients and some hernias are only visible on the Valsalva CT. Therefore, this method should be preferred for the evaluation of abdominal wall hernias. [ABSTRACT FROM AUTHOR]

Background: Pre-operative ilioinguinal-iliohypogastric nerve block (II-IHNB) has a proven role in lessening acute postoperative pain and opioid consumption following hernia repair. However, its role in preventing post-herniorrhaphy groin pain (PHGP) is still unknown. The current study aims to assess pre-operative II-IHNB's impact on PHGP three and six months after open inguinal hernia repair under spinal anesthesia. Methods: Seventy patients posted for inguinal hernia surgery were randomly allocated into group A (received ultrasound-guided II-IHNB with 10 mL of 0.5% ropivacaine and 4 mg [1 mL] dexamethasone) and group B (received ultrasound-guided II-IHNB with 11 mL of 0.9% normal saline). The time to first analgesic request, pain scores, opioid consumption, DN4 score, and PHGP at 3 and 6 months were analyzed using appropriate statistical tests. Results: The numerical pain rating scale at movement in group A was significantly reduced at all the time intervals of 3, 6, 12, and 24 hours compared to group B. Total opioid usage was lower in group A (3.71 mg [3.90]) versus group B (12.14 mg [4.90]) with a mean difference of -8.43 mg (95% CI -10.54, -6.32), P < 0.001. The time required for the first rescue analgesic was significantly longer in group A (360 min [180--360]) versus (180 min [180--360]) in group B (P < 0.001). However, there was no difference in the incidence of PHGP at three and six months between the two groups. Conclusions: Pre-operative ultrasound-guided II-IHNB reduces postoperative analgesic requirement but does not reduce the incidence of chronic PHGP following hernia surgery at 6 months. [ABSTRACT FROM AUTHOR]

A retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic surgery, aiming to determine the feasibility of totally extraperitoneal (TEP) repair within this population. All patients who underwent elective TEP inguinal hernia repair by one consultant surgeon across three London hospitals from January 2017 to May 2023 were retrospectively analysed to assess perioperative outcomes. Two hundred sixty-two patients were identified, of whom two hundred forty-three (93%) underwent laparoscopic TEP repair. The most frequent complications were haematoma (6.2%) and seroma (4.1%). Recurrence occurred in four cases (1.6% of operations, 1.1% of hernias). One hundred eighty-four patients (76%) underwent day-case surgery. There were no mesh infections or explanations, vascular or visceral injuries, port-site hernias, damage to testicle, or persisting numbness. There were no requirements for blood transfusion, returns to theatre, or readmissions within 30 days. There was one conversion to open and one death within 60 days of surgery. Eighty-three (34%) had a history of previous AP surgery. There was no significant difference in perioperative outcomes between the AP and non-AP arms. This finding carried true for subgroup analysis of 44 patients whose AP surgical history did not include previous inguinal hernia repair and for those undergoing repair of recurrent hernia. In expert hands, laparoscopic TEP repair is associated with excellent outcomes and low rates of long-term complications, and thus should be considered as standard for patients regardless of a history of AP surgery. [ABSTRACT FROM AUTHOR]

Introduction There is a lack of consensus on the management of inguinal hernia with limited symptoms. To address this issue a systematic review of existing randomized clinical trials (RCTs) was performed to critically appraise all existing data on asymptomatic hernia management, focusing on generalizability. Methods A scoping review to identify all RCTs comparing surgical and conservative management of patients with inguinal hernias was undertaken. Medline, Embase, Cochrane and ClinicalTrials.gov databases were searched. Data collected included study characteristics and definitions of population, intervention/comparator, and outcomes; and limitations of each study were also extracted. The quality and generalizability of included RCTs were evaluated using Cochrane's ROB-2 and the PRECIS-2 tool, respectively. Results Searches returned 661 papers; 14 full-text papers were assessed and three RCTs were identified. All RCTs included only male patients with a mean age above 55 years. All RCTs included asymptomatic patients and two included those with minimal symptoms. Different definitions for 'minimally symptomatic' were used in RCTs and none provided details of what was meant by conservative treatment. Follow-up periods varied between studies (1, 2, 3 years). All RCTs had an overall high risk of bias. According to PRECIS-2, two RCTs were classified as pragmatic, and one was equally pragmatic and explanatory. Discussion This systematic review highlights a high risk of bias but a good generalizability of the findings from the RCTs conducted on minimally symptomatic inguinal hernia patients. To improve the guidelines for the management of this group of patients, more generalizable data are needed. [ABSTRACT FROM AUTHOR]

Abstract Background Inguinal hernia repair is a frequently performed surgical procedure, with laparoscopic repair emerging as the preferred approach due to its lower complication rate and faster recovery compared to open repair. Mesh-based tension-free repair is the gold standard for both methods. In recent years, robotic hernia repair has been introduced as an alternative to laparoscopic repair, offering advantages such as decreased postoperative pain and improved ergonomics. This study aims to compare the short- and long-term outcomes, including the surgical stress response, postoperative complications, quality of life, and sexual function, between robotic-assisted transabdominal preperitoneal (rTAPP) and laparoscopic TAPP inguinal hernia repairs. Methods This randomized controlled trial will involve 150 patients from the Surgical Department of the University Hospital of Southern Denmark, randomized to undergo either rTAPP or laparoscopic TAPP. Surgical stress will be quantified by measuring C-reactive protein (CRP) and cytokine levels. Secondary outcomes include complication rates, quality of life, sexual function, and operative times. Data analysis will adhere to the intention-to-treat principle and will be conducted once all patient data are collected, with outcomes assessed at various postoperative intervals. Discussion This study holds significance in evaluating the potential advantages of robotic-assisted surgery in the context of inguinal hernia repairs. It is hypothesized that rTAPP will result in a lower surgical stress response and potentially lower the risk of postoperative complications compared to conventional laparoscopic TAPP. The implications of this research could influence future surgical practices and guidelines, with a focus on patient recovery and healthcare costs. The findings of this study will contribute to the ongoing discourse surrounding the utilization of robotic systems in surgery, potentially advocating for their broader implementation if the benefits are substantiated. Trial registration ClinicalTrials.gov NCT05839587. Retrospectively registered on 28 February 2023.

Background: Negative Pressure Wound Therapy (NPWT) is a therapeutic technique of applying sub-atmospheric pressure to a wound to reduce inflammation, manage exudate, and promote the formation of granulation tissue. It aims to optimise the natural physiological processes of wound healing for more effective recovery, and NPWT has emerged as a promising alternative to traditional dressings. Methods: The protocol followed in the study was prospectively registered. Appropriate search terms and Boolean operators were used to search electronic databases for relevant articles. Screening of articles was performed, and data extraction was done. The effect measure was chosen according to the nature of the variable, and the effect model was chosen as per heterogeneity. Forest plot was used to give visual feedback. Results: This study included 11 randomized controlled trials (13 publications) with a total of 1310 patients (1497 inguinal wounds). The NPWT group had lesser odds of developing surgical site infection (OR: 0.40; 95 % CI: 0.29–0.54; n = 1491; I2 = 20 %; p-value ≤0.00001) and lesser odds of needing surgical wound revision (OR: 0.48; 95 % CI: 0.26–0.91; n = 856; I2 = 0 %; p-value = 0.02) as compared to the normal dressing group. No significant difference was observed in duration of hospital stay, cost of care, wound healing time, or other complications. Conclusion: NPWT application in inguinal wounds significantly reduces the surgical site infection and the need for wound revision in patients who have undergone vascular surgery.

Background: Inguinal hernia repair is a frequently performed surgical procedure, with laparoscopic repair emerging as the preferred approach due to its lower complication rate and faster recovery compared to open repair. Mesh-based tension-free repair is the gold standard for both methods. In recent years, robotic hernia repair has been introduced as an alternative to laparoscopic repair, offering advantages such as decreased postoperative pain and improved ergonomics. This study aims to compare the short- and long-term outcomes, including the surgical stress response, postoperative complications, quality of life, and sexual function, between robotic-assisted transabdominal preperitoneal (rTAPP) and laparoscopic TAPP inguinal hernia repairs. Methods: This randomized controlled trial will involve 150 patients from the Surgical Department of the University Hospital of Southern Denmark, randomized to undergo either rTAPP or laparoscopic TAPP. Surgical stress will be quantified by measuring C-reactive protein (CRP) and cytokine levels. Secondary outcomes include complication rates, quality of life, sexual function, and operative times. Data analysis will adhere to the intention-to-treat principle and will be conducted once all patient data are collected, with outcomes assessed at various postoperative intervals. Discussion: This study holds significance in evaluating the potential advantages of robotic-assisted surgery in the context of inguinal hernia repairs. It is hypothesized that rTAPP will result in a lower surgical stress response and potentially lower the risk of postoperative complications compared to conventional laparoscopic TAPP. The implications of this research could influence future surgical practices and guidelines, with a focus on patient recovery and healthcare costs. The findings of this study will contribute to the ongoing discourse surrounding the utilization of robotic systems in surgery, potentially advocating for their broader implementation if the benefits are substantiated. Trial registration: ClinicalTrials.gov NCT05839587. Retrospectively registered on 28 February 2023. [ABSTRACT FROM AUTHOR]

Purpose: Approximately 20 million individuals worldwide undergo inguinal hernia surgery annually. The Lichtenstein technique is the most commonly used surgical procedure in this setting. The objective of this study was to revisit this technique and present ten recommendations based on the best practices. Methods: PubMed and Scientific Electronic Library Online were used to systematically search for articles about the Lichtenstein technique and its modifications. Literature regarding this technique and surgical strategies to prevent chronic pain were the basis for formulating ten recommendations for best practices during Lichtenstein surgery. Results: Ten recommendations were proposed based on best practices in the Lichtenstein technique: neuroanatomical assessment, chronic pain prevention, pragmatic neurectomy, spermatic cord structure management, femoral canal assessment, hernia sac management, mesh characteristics, fixation, recurrence prevention, and surgical convalescence. Conclusion: The ten recommendations are practical ways to achieve a safe and successful procedure. We fell that following these recommendations can improve surgical outcomes using the Lichtenstein technique. [ABSTRACT FROM AUTHOR]

Purpose: The TransREctus sheath PrePeritoneal procedure (TREPP) was introduced as an alternative open and preperitoneal technique for inguinal hernia mesh repair, demonstrating safety and efficacy in retro- and prospective studies. However, little is known about the technique's inherent learning curve. In this study, we aimed to determine TREPP learning curve effects after its implementation in high-volume surgical practice. Methods: All primary, unilateral TREPP procedures performed in the first three years after implementation (between January 2016 and December 2018) were included out of a large preconstructed regional inguinal hernia database. Data were analyzed on outcome (i.e., surgical complications, hernia recurrences, postoperative pain). Learning curve effects were analyzed by assessing outcome in relation to surgeon experience. Results: In total, 422 primary, unilateral TREPP procedures were performed in 419 patients. In three patients a unilateral TREPP procedure was performed on both sides separated in time. A total of 99 surgical complications were registered in 83 procedures (19.6% of all procedures), most commonly inguinal postoperative pain (8%) and bleeding complications (7%). Hernia recurrences were observed in 17 patients (4%). No statistically significant differences on outcome were found between different surgeon experience (< 40 procedures, 40–80 procedures, > 80 procedures). Conclusion: Implementation of TREPP seems not to be associated with a notable increase of adverse events. We were not able to detect a clear learning curve limit, potentially suggesting a relatively short learning curve among already experienced hernia surgeons compared to other guideline techniques. [ABSTRACT FROM AUTHOR]

Tumors of the round ligament rarely happen; leiomyomas are considered the most common. Round ligament leiomyomas are benign tumors mimicking inguinal hernia, lymph nodes, or other inguinal masses. They are usually asymptomatic and take place in premenopausal female patients. This paper will present a case of a postmenopausal female patient who presented to our outpatient surgical clinic complaining of a right groin mass for 3 months. She was clinically diagnosed as a case of an irreducible inguinal hernia. After investigations, it turned out to be a round ligament leiomyoma, confirmed by the histopathological examination. There are broad differential diagnoses of inguinal masses. Although imaging exams could help diagnose leiomyomas, surgical excision followed by histopathological assessment is the best to confirm the diagnoses. [ABSTRACT FROM AUTHOR]

Background Inguinal lymph node dissection plays an important role in the management of melanoma, penile and vulval cancer. Inguinal lymph node dissection is associated with various intraoperative and postoperative complications with significant heterogeneity in classification and reporting. This lack of standardization challenges efforts to study and report inguinal lymph node dissection outcomes. The aim of this study was to devise a system to standardize the classification and reporting of inguinal lymph node dissection perioperative complications by creating a worldwide collaborative, the complications and adverse events in lymphadenectomy of the inguinal area (CALI) group. Methods A modified 3-round Delphi consensus approach surveyed a worldwide group of experts in inguinal lymph node dissection for melanoma, penile and vulval cancer. The group of experts included general surgeons, urologists and oncologists (gynaecological and surgical). The survey assessed expert agreement on inguinal lymph node dissection perioperative complications. Panel interrater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. Results Forty-seven experienced consultants were enrolled: 26 (55.3%) urologists, 11 (23.4%) surgical oncologists, 6 (12.8%) general surgeons and 4 (8.5%) gynaecology oncologists. Based on their expertise, 31 (66%), 10 (21.3%) and 22 (46.8%) of the participants treat penile cancer, vulval cancer and melanoma using inguinal lymph node dissection respectively; 89.4% (42 of 47) agreed with the definitions and inclusion as part of the inguinal lymph node dissection intraoperative complication group, while 93.6% (44 of 47) agreed that postoperative complications should be subclassified into five macrocategories. Unanimous agreement (100%, 37 of 37) was achieved with the final standardized classification system for reporting inguinal lymph node dissection complications in melanoma, vulval cancer and penile cancer. Conclusion The complications and adverse events in lymphadenectomy of the inguinal area classification system has been developed as a tool to standardize the assessment and reporting of complications during inguinal lymph node dissection for the treatment of melanoma, vulval and penile cancer. [ABSTRACT FROM AUTHOR]

Aim: The significance of lymphadenectomy and its indications in patients with inguinal lymph node metastasis (ILNM) of anorectal adenocarcinoma is unclear. This study aimed to clarify the surgical outcomes and prognostic factors of inguinal lymphadenectomy for ILNM. Method: This study included patients who underwent surgical resection for ILNM of rectal or anal canal adenocarcinoma with pathologically positive metastases between 1997 and 2011 at 20 participating centres in the Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer organized by the Japanese Society for Cancer of the Colon and Rectum. Clinicopathological characteristics and short‐ and long‐term postoperative outcomes were retrospectively analysed. Results: In total, 107 patients were included. The primary tumour was in the rectum in 57 patients (53.3%) and in the anal canal in 50 (46.7%). The median number of ILNMs was 2.34. Postoperative complications of Clavien–Dindo Grade III or higher were observed in five patients. The 5‐year overall survival rate was 38.8%. Multivariate analysis identified undifferentiated histological type (P < 0.001), pathological venous invasion (P = 0.01) and pathological primary tumour depth T0–2 (P = 0.01) as independent prognostic factors for poor overall survival. Conclusion: The 5‐year overall survival after inguinal lymph node dissection was acceptable, and it warrants consideration in more patients. Further larger‐scale studies are needed in order to clarify the surgical indications. [ABSTRACT FROM AUTHOR]

Background and Aims: Moderate-to-severe intensity pain is reported on the first day following lower abdominal surgery. No study has compared transversus abdominis plane (TAP) block with retrolaminar block (RLB) in laparoscopic inguinal hernia surgery for postoperative pain relief. Material and Methods: In this prospective, randomized trial, 42 male patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18–65 years, and having a BMI

Inguinal masses are common presentations in clinical practice, often attributed to hernias. However, atypical features may lead to diagnostic difficulties and delayed intervention. We present a case of a 32-year-old Ethiopian woman with a prolonged history of a growing groin mass 2 months following childbirth, her diagnosis potentially challenged by her recent obstetric history. Despite previous evaluations suggesting inguinal hernia, her symptoms worsened, prompting an emergency department visit. Further investigation revealed an unexpected diagnosis of intraabdominal tuberculosis, manifesting as a large iliopsoas abscess. This case underscores the importance of considering uncommon etiologies in the differential diagnosis of inguinal masses, particularly in high-risk populations with comparable situations, to ensure timely diagnosis and intervention. [ABSTRACT FROM AUTHOR]

A giant inguinal hernia is a rare clinical presentation in patients refusing hernia repair for different reasons during a long period. The appearance is remarkable, and the preoperative preparation and the surgery itself might be challenging. They can present in an emergency (hernia incarceration) or elective setting. Most of the patients are male, but exclusions exist. This is a rare case of a female patient with a giant inguinal hernia left untreated for 40 years. [ABSTRACT FROM AUTHOR]

Femoral hernias are at a high risk of strangulation due to their narrow necks. They are an exceptionally rare occurrence in males. In many cases, differentiation between a femoral and inguinal hernia is difficult. We present the case of a bilateral strangulated femoral hernia in a 70-year-old male. To our knowledge, there has been only one previously published report of such a case in males. Our patient presented with generalized abdominal pain and bilateral irreducible groin swellings, originally thought to be bilateral strangulated inguinal hernia. Upon initial inguinal incision, a diagnosis of a strangulated femoral hernia was made. A modified lower midline laparotomy incision was made to gain access to and diagnose both femoral hernias and allow for bowel resection and abdominal washout. Our case highlights the importance of modifying the surgical approach when encountering with a different diagnosis intraoperatively. [ABSTRACT FROM AUTHOR]

Richter's hernia is a rare but serious surgical emergency involving the entrapment or strangulation of part of the bowel's circumference in the hernial orifice, often without causing complete luminal obstruction. This case report describes a man in his 70s presenting with a 3-day history of abdominal pain and vomiting, despite normal bowel movements. Blood results revealed raised inflammatory markers, and computed tomography imaging suggested small bowel obstruction due to an incarcerated left inguinal hernia. Emergency surgery confirmed a Richter's hernia with a strangulated but viable bowel loop. Early surgical intervention led to a positive outcome. This case underscores the importance of high suspicion, early referral, and timely imaging in managing Richter's hernia to prevent severe complications, such as gangrene and perforation. Despite the absence of obstructive symptoms, early surgical intervention is critical when there is clinical concern regarding strangulation. [ABSTRACT FROM AUTHOR]

Malignant melanoma, a highly aggressive skin cancer, accounts for 75% of skin cancer-related deaths. This case report details a 59-year-old Sudanese male with a malignant melanoma of the left foot, presenting with nodal melanosis, a rare condition involving benign pigmented deposits in the lymph nodes. The patient underwent below-knee amputation and inguinal lymph node dissection. Significant black discoloration was observed in the lymph nodes, indicating nodal melanosis. Histopathological examination of excised lymph nodes confirmed the presence of both malignant melanoma and benign melanosis. Despite surgical intervention, the patient eventually developed distant metastases, including lung nodules and a liver lesion. This case underscores the importance of recognizing nodal melanosis in metastatic malignant melanoma and highlights the challenges of managing advanced cases in resource-limited settings. Surgical management remains critical, particularly wide resection and lymph node dissection, even as systemic therapies advance. [ABSTRACT FROM AUTHOR]

Flap-based reconstruction techniques have shown promise in preventing scar contractures and enhancing healing in fold areas by providing vascularized and thick tissue. We report a septic rupture of the superficial femoral artery treated with an arterial allograft and covered with a contralateral pedicled Deep Inferior Epigastric Artery Perforator (DIEP) flap. The patient presented favorable outcomes, including optimal healing at 8 months, with no functional limitation. A literature review also discusses alternative pedicled perforator flaps. These modern techniques present several advantages, including reliability, and can be of great interest in complex vascular surgery cases. [ABSTRACT FROM AUTHOR]

Clear cell acanthoma (CCA) and squamous cell carcinoma (SCC) represent distinct entities within dermatological oncology, each posing unique diagnostic and therapeutic challenges. CCA is a rare, benign epidermal growth, often not associated with human papillomavirus (HPV) infection, whereas SCC, a more aggressive form of skin cancer, has been linked to both ultraviolet (UV) exposure and HPV. Understanding the co-occurrence of these conditions in a single patient can enhance diagnostic accuracy and therapeutic outcomes. We report a 64-year-old male who underwent an operation for a verruciform lesion in the right groin, which was diagnosed as HPV-positive CCA alongside keratinised SCC. A literature search across January 2024 revealed limited evidence directly linking HPV to CCA, suggesting a need for further investigation. The speculative association between HPV and CCA warrants deeper exploration, especially considering the potential for HPV to contribute to lesion development through indirect mechanisms. The coexistence of CCA and SCC in an elderly patient presents a unique clinical scenario. This emphasises the need for vigilant diagnosis and tailored treatment strategies, highlighting the gap in understanding the pathogenesis of CCA, particularly its potential association with HPV. Further research is crucial for elucidating the complex interactions governing these conditions and for developing targeted interventions. [ABSTRACT FROM AUTHOR]

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Background: The current study aims to investigate the superior mesh fixation method, single absorbable tacker versus conventional method, in patients undergoing bilateral inguinal hernia repair through the laparoscopic total abdominal preperitoneal (TAPP) approach. Materials and Methods: The current randomized clinical trial has been conducted on 81 patients undergoing bilateral hernia repair through TAPP. The patients were randomly assigned into one of the mesh fixation groups including single absorbable tacker (Group S) (n = 41) and conventional method (Group C) (n = 40). All patients were assessed during the hospital stay and 1 month postoperatively to assess the surgery associated complications and days for return to daily activity. Eura Hs questionnaire was applied to assess the quality of life (QOL) after hernia surgery during 12 month follow up. Results: The duration of bilateral inguinal hernia operation (P = 0.067), postoperative urinary catheterization (P = 0.813), and hospital stay duration (P = 0.779) did not differ between the groups; whereas Group C significantly required a longer time for returning to daily activity (P < 0.001). Only a patient in Group C represented hematoma (P = 0.494). Seroma incidence was not statistically different between the two groups (P = 0.712). Postoperative pain was statistically less in Group S (P < 0.001 for all the assessments). Postoperative QOL within a year after hernia repair revealed an insignificant difference between the groups in general (P > 0.05); however, a pain subscale was significantly less in Group S (P = 0.002). Conclusion: Based on the findings of this study, a single absorbable tacker was generally superior to the conventional method considering its less pre and postoperative complications. However, the two methods did not differ regarding 1 year follow up QOL. [ABSTRACT FROM AUTHOR]

Cryptorchidism is defined as the extra-scrotal position of the testes. It is a common disorder in male children, but rarely in adult patients. The association of cryptorchidism with hernia is a common finding in childhood, but is not frequent in adults or the elderly. Herein, we report a series of three cases (28-, 24-, and 34-year-old men) of adult inguinal hernia combined with cryptorchidism successfully managed by laparoscopic surgery under the same operative view. Laparoscopic transabdominal preperitoneal repair and orchiectomy were performed in all patients. No complications occurred in the postoperative period, and the patients were discharged on the first or second postoperative day. Pathological examination of the specimens revealed atrophic testes without malignancy. No hernia recurrence was observed during follow-up. The laparoscopic approach in the combined pathology of inguinal hernia and cryptorchidism is feasible in adult patients and has multiple advantages in terms of diagnosis and management. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of mesh with non-mesh techniques in the management of primary inguinal hernias. Study Design: Randomized Clinical Trail. Setting: Teaching Hospital Peshawar. Period: March 2022 till January 2023. Methods: This RCT study was conducted 166 on individuals with primary, reducible inguinal or inguino-scrotal hernias based on predetermined inclusion criteria. For the purpose of hernia repair, they were split into two groups: non-mesh and mesh repair. Computer-generated random numbers were contained in sealed opaque envelopes. Acute groin discomfort, the amount of time needed to return to duty, and sequelae were evaluated as clinical outcomes. SPSS version 23 was used to enter and analyzed the data. Results: Age range for mesh group was 33-65 while for non-mesh 34-65. Observed Male to female ratio was 9:1. In both groups, there was no discernible difference in pain. There were notable variations in the amount of time needed to resume work. Conclusion: Both repairs techniques are effective to treat hernias but mesh repair has superior results. [ABSTRACT FROM AUTHOR]

Background: Hernias, particularly inguinal, femoral, and abdominal, present a global health challenge. While the global burden of disease (GBD) study offers insights, systematic analyses of hernias remain limited. This research utilizes the GBD dataset to explore hernia implications, combining current statistics with 2030 projections and frontier analysis. Methods: We analyzed data from the 2019 GBD Study, focusing on hernia-related metrics: prevalence, incidence, deaths, and disability-adjusted life years (DALYs) across 204 countries and territories, grouped into 21 GBD regions by the socio-demographic index (SDI). Data analysis encompassed relative change calculations, as well as annual percentage change (APC) and average annual percentage change (AAPC), both of which are based on joinpoint regression analysis. The study additionally employed frontier analysis and utilized the Bayesian age-period-cohort model for predicting trends up to 2030. Analyses utilized R version 4.2.3. Results: From 1990 to 2019, the global prevalence of hernia cases surged by 36%, reaching over 32.5 million, even as agestandardized rates declined. A similar pattern was seen in mortality and DALYs, with absolute figures rising but age-standardized rates decreasing. Gender data between 1990 and 2019 showed consistent male dominance in hernia prevalence, even as rates for both genders fell. Regionally, Andean Latin America had the highest prevalence, with Central Sub-Saharan Africa and South Asia noting significant increases and decreases, respectively. Frontier analyses across 204 countries and territories linked higher SDIs with reduced hernia prevalence. Yet, some high SDI countries, like Japan and Lithuania, deviated unexpectedly. Predictions up to 2030 anticipate increasing hernia prevalence, predominantly in males, while age-standardized death rates and age-standardized DALY rates are expected to decline. Conclusions: Our analysis reveals a complex interplay between socio-demographic factors and hernia trends, emphasizing the need for targeted healthcare interventions. Despite advancements, vigilance and continuous research are essential for optimal hernia management globally. [ABSTRACT FROM AUTHOR]

Background and Aims: Moderate-to-severe intensity pain is reported on the first day following lower abdominal surgery. No study has compared transversus abdominis plane (TAP) block with retrolaminar block (RLB) in laparoscopic inguinal hernia surgery for postoperative pain relief. Material and Methods: In this prospective, randomized trial, 42 male patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-65 years, and having a BMI <40 kg/m2 received TAP or RLB following laparoscopic inguinal hernia surgery. A standard general anesthetic technique was performed. Patients were randomized into two groups: single-shot TAP block (group I) (n = 21) or the RLB (group II) (n = 21) with bilateral 20 ml of 0.375% ropivacaine. Postoperatively, IV paracetamol 1 g was administered as rescue analgesia. Postoperative cumulative Visual Analogue Scale (VAS) score 24 hours after surgery was considered as the primary outcome. Results: Postoperative cumulative VAS score at rest at 24 h, represented as mean ± S.D (95% CI), in the TAP block group was 3.54 ± 3.04 (2.16-4.93) and in the RLB group was 6.09 ± 4.83 (3.89-8.29). P value was 0.112 and VAS on movement was 7.95 ± 3.41 (6.39-9.50 [2.5-15.0]) in TAP block group, whereas P value was 0.110 and VAS on movement was 10.83 ± 5.51 (8.32-13.34) in the RLB group. Conclusion: Similar postoperative cumulative pain score on movement at 24 h was present in patients receiving TAP block or RLB. However, VAS score at rest and on movement was reduced in patients receiving TAP block at 18 and 24 h postoperatively. [ABSTRACT FROM AUTHOR]

This case series highlights the importance of a thorough differential diagnosis in patients with groin swelling, often mistaken for inguinal hernias. It presents three patients with groin swelling initially suspected of having inguinal hernias but diagnosed differently upon further investigation. Patient 1 had a recurrence of endometrial adenocarcinoma in the right groin, Patient 2 had penile carcinoma with left inguinal metastasis, and Patient 3 had a metastasis of prostate carcinoma in the left groin. These cases underline the need to consider various pathologies beyond the common diagnosis of inguinal hernia. Accurate diagnosis requires a careful clinical examination and appropriate diagnostic tools, ensuring correct treatment. [ABSTRACT FROM AUTHOR]