Modified Lichtenstein Procedure for Repair of Direct or Indirect Inguinal Hernia by Triangulation of the Inguinal Canal

The purpose of the study is experimental development of preperitoneal inguinal hernioplasty with synthetic mesh, according assessment of the need of its fixation to the tissues. Materials and methods. An inguinal hernia was simulated on human cadaveric material. The study used 27 male corpses. Two inguinal hernias were modeled on one corpse: on one side - indirect, on the other - direct. A polypropylene mesh (standard density, 15 x 15 cm) was placed in the preperitoneal space. The endoprosthesis was impacted from the side of the abdominal cavity by a special designed device. The effect of a peak intra-abdominal pressure of 200 mm Hg was simulated. The degree of displacement of the reticular endoprosthesis into the inguinal canal was estimated at the moment of peak pressure on it from inside the abdominal cavity. For a simulated indirect inguinal hernia, two variants of the technique were considered: with fixation of the endoprosthesis to the underlying tissues and without fixation. For the modulated direct inguinal hernia, the following options were considered: non-fixative, with fixation at one point to the pubis and with plasty of the transverse fascia. Results. When modeling preperitoneal plasty of a direct inguinal hernia, there is a pronounced displacement of the endoprosthesis into the inguinal canal with a non-fixing plasty, unlike the method with transverse fascia plasty or fixation to the pubis. In indirect inguinal hernia, there was no significant displacement of the endoprosthesis in both considered variants. Conclusions. According to the obtained results, conclusions were drawn on the need for additional plasty of the transverse fascia or fixation of the endoprosthesis at a single point in a direct inguinal hernia. With indirect inguinal hernia in the experiment, no significant difference in the displacement of the mesh endoprosthesis into the inguinal canal was obtained with and without fixation.

Download Full-text

A Minor Modification of Lichtenstein Repair of Primary Inguinal Hernia: Postoperative Discomfort Evaluation

The American Surgeon ◽

10.1177/000313481007600737 ◽

2010 ◽

Vol 76 (7) ◽

pp. 764-769

Author(s):

Salvatore Fricano ◽

Eugenio Fiorentino ◽

Calogero Cipolla ◽

Domenica Matranga ◽

Alessandro Bottino ◽

...

Keyword(s):

Inguinal Hernia ◽

Inguinal Canal ◽

Oblique Muscle ◽

Inguinal Hernioplasty ◽

Unilateral Inguinal Hernia ◽

Slight Pain ◽

Lichtenstein Procedure ◽

A Minor ◽

Internal Oblique ◽

Postoperative Discomfort

The aim of this study was to evaluate the usefulness of a modification of the Lichtenstein hernioplasty procedure by evaluating its impact on postoperative discomfort. From December 1999 to May 2006, the Lichtenstein inguinal hernioplasty was performed in 406 patients with noncomplicated unilateral inguinal hernia. During reconstruction, the mesh was fixed to the inguinal canal floor without stitching its upper margin to the internal oblique muscle. Control of postoperative pain proved to be satisfactory; 72 hours after surgery, 26.1 per cent of patients no longer felt any pain, whereas 54.4 per cent had slight pain without the need for painkillers; on Day 7, 92.8 per cent felt no pain at all. After 10 days, 86.7 per cent of those with sedentary jobs were able to return to work, whereas 79.1 per cent of those with heavier jobs resumed work in 11 to 15 days. Our modification of the original Lichtenstein procedure permitted us to obtain satisfactory results with regard to the control of postoperative chronic pain and a rapid reprisal of normal working activity.

Download Full-text

Diagnosis of Ovary-Containing Indirect Inguinal Hernia of the Canal of Nuck by Ultrasound

Journal of Enam Medical College ◽

10.3329/jemc.v7i1.30750 ◽

2017 ◽

Vol 7 (1) ◽

pp. 39-41

Author(s):

Khaleda Parvin Rekha ◽

Sohel Abdullah ◽

Mashah Binte Amin

Keyword(s):

Blood Flow ◽

Inguinal Hernia ◽

Inguinal Canal ◽

Color Doppler ◽

Rare Condition ◽

Round Ligament ◽

Parietal Peritoneum ◽

Indirect Inguinal Hernia ◽

Processus Vaginalis ◽

Canal Of Nuck

In women, the round ligament is attached to the uterus near the origin of the fallopian tube, and a small evagination of parietal peritoneum accompanies the round ligament through the inguinal canal to the labium majorum. This small evagination of parietal peritoneum, named the canal of Nuck in women, is the equivalent of the processus vaginalis in men. Incomplete obliteration of the processus vaginalis causes indirect inguinal hernia or hydrocele of the canal of Nuck, a very rare condition in women. Here, we report a case of ovary-containing hernia of the canal of Nuck that was diagnosed with ultrasonography and was surgically confirmed. Gray scale and color Doppler ultrasonographic features studied were: the site and the size of the hernia, the texture of the hernia contents and the presence or absence of blood flow in the hernia contents.J Enam Med Col 2017; 7(1): 39-41

Download Full-text

Non-Descended Testicle Presenting as an Inguinal Hernia

Surgical Case Reports ◽

10.31487/j.scr.2020.01.10 ◽

2020 ◽

pp. 1-2

Author(s):

Wouter J Bakker ◽

C. V. van Hessen ◽

J. P. J. Burgmans ◽

W. D. Rinkel ◽

Wouter J Bakker

Keyword(s):

Inguinal Hernia ◽

Groin Pain ◽

Undescended Testis ◽

Inguinal Canal ◽

Preperitoneal Space ◽

Indirect Inguinal Hernia ◽

Left Testis ◽

Left Groin ◽

Case Presentation ◽

Adult Men

Background: An inguinal hernia is one of the most common surgical diagnosis worldwide and the most frequent anomaly of the groin area. Cryptorchidism, the failure of the testes to descend into the scrotum, is also a prevalent congenital abnormality, with a reported incidence of 1% to 2% at 12 months of age. However, it is rarely diagnosed in adult men. Case Presentation: We present the case of a 63-year-old male who presented to the Emergency Department with severe left-sided groin pain since a couple of days. A bulge in the left groin was visibly obvious and was painful but reducible. An inguinal hernia was diagnosed, and since the patient had no previous (abdominal) surgery, he was scheduled for a totally extraperitoneal (TEP) endoscopic inguinal hernia repair. Per-operatively, an indirect inguinal hernia was initially seen; however, after further dissection and displacement of the peritoneal fold cranially, it became clear that the alleged hernia was the left testis situated in the preperitoneal space. The testis was surgically brought out through the inguinal canal. A preperitoneal mesh was placed. Conclusion: In case of a painful and reducible inguinal swelling that occurs in a patient with an empty hemiscrotum, surgeons must consider the possibility of an undescended testis.

Download Full-text

Outcome of tension free open mesh repair of inguinal hernia

Journal of Surgical Sciences ◽

10.3329/jss.v22i1.44010 ◽

2020 ◽

Vol 22 (1) ◽

pp. 21-24

Author(s):

Mohammad Masum ◽

Md Aminul Islam ◽

Masflque Ahmed Bhuiyan ◽

Kazi Mazharul Lslam ◽

Md Selim Morshed ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Mesh Repair ◽

Groin Hernia ◽

Synthetic Mesh ◽

Indirect Inguinal Hernia ◽

Prolene Mesh ◽

Tension Free ◽

Open Mesh Repair

Background: In the practice of General Surgery, hernia repair is the second most common procedure after appendectomy. Several methods have been developed over the years to try to improve hernia repair. Good result can be expected using Bassini's, McVay's, Shouldice's techniques provided the exact nature of hernia is recognized and the repair is done without tension using healthy tissue. The introduction of synthetic mesh started a new era in hernia surgery. The use of synthetic mesh repair of primary and recurrent hernias has gradually gained acceptance among surgeons. Objective: To find out the outcome and complications of open inguinal hernia repair with prolene mesh. Methods: This is a prospective cross sectional study conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from December, 2011 to May, 2012. One hundred patients of inguinal hernia admitted in different surgical units of BSMMU, Dhaka for elective surgery were studied. We have given 1 gm ijv Cephradine per operatively and then 500 gm cephradine ijv 6 hourly for 24 hours followed by oral form of Cephradine for next 5 days. Polypropylene mesh of 11 cm x 7 cm size was used in all cases. All the operations were done by open tension free prolene mesh repair technique. Patients were followed for one year to see the outcome. Results: Out of 100 cases of inguinal hernia, 71 patients (71%) had indirect inguinal hernia and 29 cases (29%) had direct inguinal hernia; 90 cases (90%) were primary hernia and only 10 cases (10%) were recurrent hernia; 58 cases were right sided, 34 cases (34%) were left sided and 8 cases (8%) were bilateral. Complications of mesh repair of groin hernia in this study included wound infection (5%), scrotal oedema (2%), mesh infection (0%), scrotal hematoma (2%), echymoces of peri-incisional skin (5%), early wound and groin pain (7%), chronic inguinodynia (2%), hernia recurrence (1%). Conclusion: In the present study an attempt is made to evaluate the outcome of patients undergoing inguinal hernia repair by prolene mesh. The results confirm that Lichtenstein tension free mesh repair of inguinal hernia is safe and reliable for both primary and recurrent groin hernia, with less recurrence rate. Patient's compliance was good with minimum morbidity. Journal of Surgical Sciences (2018) Vol. 22 (1): 21-24

Download Full-text

A Clinical Study and Management of Inguino-scrotal Swellings In Children

Journal of Medical Research and Innovation ◽

10.15419/jmri.125 ◽

2018 ◽

Vol 2 (S1) ◽

pp. e000125

Author(s):

Khyati Vaja ◽

Mukesh Suvera

Keyword(s):

Inguinal Hernia ◽

Pediatric Surgery ◽

Pediatric Patients ◽

Undescended Testis ◽

Length Of Hospital Stay ◽

Indirect Inguinal Hernia ◽

Short Term ◽

One Year ◽

Groin Hernias ◽

Inguinal Hernia In Children

Aims and Objectives: To know the most common surgical problems in pediatric patients presented with inguino-scrotal swellings and management done routinely. Methodology: This study was carried out in the department of general surgery, Sharadaben hospital and pediatric surgery of VS hospital, Ahmedabad. The cases were studied for a period of about one year (January, 2017 to Dec, 2017) and all children below 12 years of age, presenting to us with inguinoscrotal swellings were included in this study. The information was analysed in terms of age, diagnosis, procedure carried out and outcome. Results: Amongst the 150 children under the age of 12 years, 143 patients were males and 7 were females. Among these 150, 52 cases were of hydrocoele, 70 cases of hernia (of which 63 were males and 7 were females), 25 cases of undescended testis and 3 cases of epididymo orchitis were documented. All cases underwent simple herniotomy for hernia and hydrocoele, orchidopexy for undescended testis. The length of hospital stay ranged from 2-4 days with mean of 2.46 days. 11 children in the study were documented to have short term complications, all of which were recognised in the hospital and managed with good results. Conclusion: Hernia and Hydrocoele in children are often congenital and diagnosed clinically (history and examination). Indirect inguinal hernia are more common than other groin hernias. Open herniotomy is the operation of choice for inguinal hernia in children.

Download Full-text

Functional testicular torsion secondary to an incarcerated inguinal hernia in a 4-month old: complete recovery at 18-hours

Journal of Surgical Case Reports ◽

10.1093/jscr/rjab022 ◽

2021 ◽

Vol 2021 (2) ◽

Author(s):

Gregory M Taylor ◽

Christian C Strachan

Keyword(s):

Inguinal Hernia ◽

Testicular Torsion ◽

Pediatric Patients ◽

Complete Recovery ◽

Cord Compression ◽

Acute Scrotum ◽

Indirect Inguinal Hernia ◽

Incarcerated Inguinal Hernia ◽

Scrotal Swelling ◽

Urological Emergencies

Abstract One of the most common urological emergencies encountered in pediatric patients in the emergency department (ED) is the acute scrotum. We present the case of a 4-month-old male that presented to our community ED with scrotal swelling and vomiting of 16-hours duration. He was diagnosed with a functional testicular torsion from an incarcerated inguinal hernia, transferred to a hospital with pediatric urological capabilities and was taken to the operating room ~2 hours later. His hospital course was unremarkable, and he was discharged on day 3, having made a full recovery without any loss of bowel or testicle. There have only been a handful of cases in the literature of a pediatric patient presenting with a functional testicular torsion as a result of spermatic cord compression from an indirect inguinal hernia, with no reported cases of complete salvage at nearly 18 hours since symptom onset.

Download Full-text

The etiology of indirect inguinal hernia in adults: congenital, acquired or both?

Hernia ◽

10.1007/s10029-015-1365-6 ◽

2015 ◽

Vol 19 (6) ◽

pp. 1037-1038 ◽

Cited By ~ 8

Author(s):

V. Mouravas ◽

D. Sfoungaris

Keyword(s):

Inguinal Hernia ◽

Indirect Inguinal Hernia

Download Full-text

Hernias in the Emergency Department

10.2310/gastro.4113 ◽

2017 ◽

Author(s):

Mary C. Westergaard ◽

Daniel Berhanu ◽

Ciara J. Barclay-Buchanan

Keyword(s):

Risk Factors ◽

Inguinal Hernia ◽

Incisional Hernia ◽

Abdominal Wall ◽

Abdominal Mass ◽

Abdominal Wall Hernia ◽

The United States ◽

Abdominal Hernia ◽

Indirect Inguinal Hernia ◽

Benign Condition

Hernia is defined as an abnormal protrusion of an organ or tissue through a pathologic defect in its surrounding wall. Overall, hernia is common and is generally believed to be a benign condition associated with some morbidity, although it is not thought to be associated with significant mortality. Between 2001 and 2010, 2.3 million inpatient abdominal hernia repairs were performed in the United States, of which 567,000 were performed emergently. In some cases, a hernia can be a deadly condition. In 2002, hernia was listed as the cause of death for 1,595 US citizens. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of hernia. Figures show anatomic locations of the various abdominal wall, groin, lumbar, and pelvic floor hernias; a direct inguinal hernia; an indirect inguinal hernia; point-of-care sonograms showing a ventral wall hernia and an abdominal wall hernia; and the differential diagnosis of an abdominal mass based on anatomic location. Tables list risk factors for the development of inguinal hernia, sex-based differences in inguinal hernia development, risk factors for the development of incisional hernia, factors to consider when assessing the patient for a hernia, and factors associated with the highest rates of incarceration in patients with groin hernia. Key words: emergent hernia, hernia incarceration, incisional hernia, inguinal hernia, strangulated hernia This review contains 6 highly rendered figures, 5 tables, and 66 references.

Download Full-text

Hernias in the Emergency Department

10.2310/fm.4113 ◽

2018 ◽

Author(s):

Mary C. Westergaard ◽

Daniel Berhanu ◽

Ciara J. Barclay-Buchanan

Keyword(s):

Risk Factors ◽

Inguinal Hernia ◽

Incisional Hernia ◽

Abdominal Wall ◽

Abdominal Mass ◽

Abdominal Wall Hernia ◽

The United States ◽

Abdominal Hernia ◽

Indirect Inguinal Hernia ◽

Benign Condition

Hernia is defined as an abnormal protrusion of an organ or tissue through a pathologic defect in its surrounding wall. Overall, hernia is common and is generally believed to be a benign condition associated with some morbidity, although it is not thought to be associated with significant mortality. Between 2001 and 2010, 2.3 million inpatient abdominal hernia repairs were performed in the United States, of which 567,000 were performed emergently. In some cases, a hernia can be a deadly condition. In 2002, hernia was listed as the cause of death for 1,595 US citizens. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of hernia. Figures show anatomic locations of the various abdominal wall, groin, lumbar, and pelvic floor hernias; a direct inguinal hernia; an indirect inguinal hernia; point-of-care sonograms showing a ventral wall hernia and an abdominal wall hernia; and the differential diagnosis of an abdominal mass based on anatomic location. Tables list risk factors for the development of inguinal hernia, sex-based differences in inguinal hernia development, risk factors for the development of incisional hernia, factors to consider when assessing the patient for a hernia, and factors associated with the highest rates of incarceration in patients with groin hernia. Key words: emergent hernia, hernia incarceration, incisional hernia, inguinal hernia, strangulated hernia This review contains 6 highly rendered figures, 5 tables, and 66 references.

Download Full-text