More work should be done in laparo-endoscopic direct hernia repair

Background: Posterior wall strengthening is the essential aim of Bilateral Inguinal hernia repair. The two methods for it are tissue repair and tension free repair. Tension free repair have become the gold standard. The preperitoneal repair for Bilateral Inguinal hernia is performed by wrapping the lower part of the parietal peritoneum with a large chevron shape polypropylene mesh.Methods: This study presents a modification of stoppas repair using a polypropylene mesh of size 15×9 cm to cover the myopectineal ostium of fruchaud on each side. The direct hernia sac was inverted with a purse string suture. Indirect hernia was opened and margins approximated with a 2-0 polyglycolic acid suture. No drainage was used.Results: Post-operative period was uneventful in all the patients. This new technique uses less post-operative time and the cost of surgery is reduced. There was one post-operative recurrence on one side only on follow up at one week, three weeks and three months.Conclusions: The use of two small size mesh covering both Fruchaud’s myopectineal orifices for bilateral inguinal hernia repair instead of a large size mesh is a promising technique. It saves the operative time and shortens the hospitalization time.

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Technical Standardization of Laparoscopic Direct Hernia Repair in Pediatric Patients

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2011.0324 ◽

2012 ◽

Vol 22 (1) ◽

pp. 113-116 ◽

Cited By ~ 7

Author(s):

Ciro Esposito ◽

Francesca Alicchio ◽

Ida Giurin ◽

Michele Castellano ◽

Alessandro Settimi

Keyword(s):

Hernia Repair ◽

Pediatric Patients ◽

Direct Hernia ◽

Technical Standardization

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Incarcerated sigmoid large-cell neuroendocrine carcinoma in an inguinal hernia

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa585 ◽

2021 ◽

Vol 2021 (2) ◽

Author(s):

Martino Gerosa ◽

Niccolò Incarbone ◽

Emanuele Di Fratta ◽

Giulio Maria Mari ◽

Angelo Guttadauro ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Histopathological Examination ◽

Laparoscopic Approach ◽

Large Cell ◽

Surgical Trauma ◽

Incarcerated Hernia ◽

Left Groin ◽

First Case ◽

Direct Hernia

Abstract Large-cell neuroendocrine carcinomas (NECs) of the colon are extremely rare aggressive tumors. A 79-year-old man presented at our hospital for muco-hematic diarrhea, weight loss and incarcerated hernia in his left groin. Colonoscopy revealed sigmoid stenosis. Computed tomography confirmed an incarcerated hernia containing sigmoid mass and massive abdominal adenopathy. In absence of colonic obstruction, the patient underwent elective palliative sigmoid resection and colostomy by laparoscopic approach, and direct hernia repair through inguinal access. Histopathological examination revealed a large cells sigmoid NEC. We report the first case of large-cell neuroendocrine colon cancer incarcerated in an inguinal hernia. Due to the advanced stage, we have performed a palliative laparoscopic resection in order to reduce surgical trauma, confirm pre-operative results and minimize post-operative complications, and direct hernia repair through inguinal access.

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Anatomical variations of the inguinal morphometric features in patients with inguinal hernia and its association with the type of inguinal hernia: a prospective clinical study

International Surgery Journal ◽

10.18203/2349-2902.isj20192955 ◽

2019 ◽

Vol 6 (7) ◽

pp. 2358

Author(s):

Balaiya Anitha ◽

Sathasivam Sureshkumar ◽

Karuppusamy Aravindhan ◽

Manwar Ali

Keyword(s):

Inguinal Hernia ◽

Clinical Study ◽

Hernia Repair ◽

Inguinal Ligament ◽

Prospective Clinical Study ◽

Indirect Inguinal Hernia ◽

Transversalis Fascia ◽

Indirect Hernia ◽

Direct Hernia ◽

The Mean

Background: Variations of inguinal canal and inguinal nerves are not uncommon. Knowledge about those variations is important to avoid inadvertent injury to the vital structures and to prevent recurrence.Methods: This prospective clinical study included all patients undergoing open inguinal hernia repair. Laparoscopic hernia repair, emergency surgery for complication and recurrent inguinal hernia were excluded. Parameters studied include interspinous distance, length and obliquity of inguinal ligament, attachment of conjoint tendon, condition of transversalis fascia and position and variations of ilioinguinal nerve.Results: The study included 192 patients. The mean interspinous distance (ISD) was 22±3.45 cm (CI: 30-32). ISD was not significant different among the two types of hernia. The mean length of internal oblique on inguinal ligament from anterior superior iliac spine was significantly longer in patients with indirect inguinal hernia (4±0.791 vs. 4.27±1.34; p=0.000). Significant patients in the direct hernia had weak transversalis fascia ((95% vs. 43%). 80% of the patients with direct hernia had defect in the transversalis fascia compared to only 8.8% in the indirect hernia. The difference is statistically significant. The nerve variation was present in only 1.3% in direct hernia group compared to 3.5% in the indirect hernia group.Conclusions: It was observed that the type of hernia did not significantly influenced by the length of inguinal ligament, the mean distance of midinguinal point, obliquity of the inguinal ligament. The nerve variation was present in only 1.3% in direct hernia group compared to 3.5% in the indirect hernia group.

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Conversion of Total Extraperitoneal (TEP) to Transabdominal Preperitoneal (TAPP) for repair of inguinal hernia; Frequency and causes.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.02.3157 ◽

2020 ◽

Vol 27 (02) ◽

pp. 242-245

Author(s):

Muhammad Ghayasuddin ◽

Fareya Usmani ◽

Imran Munir ◽

Mahwash Anjum Shafiq ◽

Syed Muhammad Sheraz Raza Naqvi

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

P Value ◽

Indirect Hernia ◽

Transabdominal Preperitoneal ◽

Total Extraperitoneal ◽

Direct Hernia ◽

Study Population ◽

Transabdominal Preperitoneal Inguinal Hernia

Objectives: Our study aims to determine the incidence of and reasons for the conversion of hernia operations from laparoscopic guided total extraperitoneal (TEP) to transabdominal preperitoneal inguinal hernia repair (TEPP). Study Design: Cross-sectional study. Setting: A large tertiary care hospital in Karachi Pakistan. Period: From August 2016 to November 2018. Material & Methods: The sampling technique utilized was consecutive non-probability sampling. The study population consisted of patients between the ages of 22 and 50 years, males, having unilateral inguinal hernia, both direct and indirect presentation. A complete history and physical examination was performed and recorded in a pre-designed proforma for all the patients. Laboratory investigations were performed per routine. The patients underwent laparoscopic total extraperitoneal hernia repair and were noted for complications and conversion to transabdominal preperitoneal inguinal hernia repair. Data was analyzed using IBM SPSS statistics version 20. Chi-square test was used to analyze categorical variables, while mean and percentages were used for numerical data. A p value of less than 0.05 is considered to be statistically significant. Results: The study population was n= 150, mean age of the patients was 36.25 +/- 7.08 with a minimum of 22 and a maximum of 50 years. The direct hernia was present in 47.33% (71 patients) while an indirect hernia was present in 52.67% (79 patients). Out of the total patient population, 21 (14%) of the patients (having a p-value of 0.013) were converted to the TAPP procedure of which 10 (14.08%) has a direct hernia and 11 (13.92%) had an indirect hernia respectively (having a p-value of 0.953). The most common reason for conversion was peritoneal tear, hemorrhage and instrument failure. Conclusion: According to the results of our study, 14% of cases of direct and indirect hernia had to convert from TEP to TAPP procedure, and the main reasons for this conversion were found to be hemorrhage, peritoneal tear and instrument failure.

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