A Review of the Incidence, Manifestation, Predisposing Factors, and Management of Recurrent Pediatric Inguinal Hernia

2017 ◽  
Vol 27 (06) ◽  
pp. 478-483 ◽  
Author(s):  
Antti Koivusalo
Keyword(s):  
Inguinal Hernia ◽  
Recurrence Rate ◽  
Wide Spectrum ◽  
Laparoscopic Approach ◽  
Recurrent Hernia ◽  
University Hospital ◽  
Current Evidence ◽  
Recurrent Inguinal Hernia ◽  
Recurrence Rates ◽  
Pediatric Inguinal Hernia

AbstractRecurrent pediatric inguinal hernia is relatively rare. In a large series, the recurrence rates vary from 0.3 to 1.2%. In a university hospital with surgical service for a wide spectrum of sick pediatric patients, the real recurrence rate may be 3 to 6%. Recurrence manifests typically 6 months after first repair. Current evidence indicates that recurrence rates in open and laparoscopic repair are similar. Laparoscopic repairs are, however, still performed by a minority of skilled pediatric surgeons, whereas the majority of pediatric surgeons rely on open repair not least because of the assumed lower risk of recurrence. After repair of an indirect hernia, the majority of recurrences (97%) are indirect, whereas in rare cases the recurrence turns out to be a formerly undiagnosed direct or femoral hernia. In Children's Hospital of Helsinki, Finland, recurrence rate from 2012 to 2016 was 2.8% and operations for recurrent hernias comprised 3.3% of the total. From 1991 to 2017, a total of 130 operations for recurrent hernias were performed with open inguinal approach (n = 75, 58%), laparoscopy (n = 49, 38%), and laparotomy (n = 4, 4%). One teenage patient underwent a Lichtenstein Prolene net repair. A recurrent inguinal hernia can be repaired either with an open or laparoscopic approach. In laparoscopy, the nature of the recurrent hernia can be clarified and an immediate repair performed either by laparoscopic or open technique. In expert hands new laparoscopic techniques using muscular arch, lateral umbilical ligament, iliopubic tract, and division of the sac may be an alternative to a simple purse-string closure.

Recurrence Rate of Lumbar Disc Herniation After Standard Discectomy and Microdiscectomy: A 5-Year Study

2019 ◽  
Vol 12 (2) ◽  
pp. 139-146
Author(s):  
Mladen E. Ovcharov ◽  
Iliya V. Valkov ◽  
Milan N. Mladenovski ◽  
Nikolay V. Vasilev
Keyword(s):  
Recurrence Rate ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Reoperation Rate ◽  
University Hospital ◽  
Recurrence Rates ◽  
Chi Square ◽  
Common Procedure

Summary Lumbar disc herniation (LDH) is the most common pathology in young people, as well as people of active age. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation (rLDH) could not be avoided. LDH recurrence rates, reported in different studies, range from 5 to 25%. The purpose of this study was to estimate the recurrence rates of LDH after standard discectomy (SD) and microdiscectomy (MD), and compare them to those reported in the literature. Retrospectively, operative reports for the period 2012-2017 were reviewed on LDH surgeries performed at the Neurosurgery Clinic of Dr Georgi Stranski University Hospital in Pleven. Five hundred eighty-nine single-level lumbar discectomies were performed by one neurosurgeon. The diagnoses of recurrent disc herniation were based on the development of new symptoms and magnetic resonance/computed tomography (MRI/CT) images showing compatible lesions in the same lumbar level as the primary lumbar discectomies. The recurrence rate was determined by using chi-square tests and directional measures. SD was the most common procedure (498 patients) followed by MD (91 patients). The cumulative reoperation rate for rLDH was 7.5%. From a total number of reoperations, 26 were males (59.1%) and 18 were females (40.9%). Reoperation rates were 7.6% and 6.6% after SD and MD respectively. The recurrence rate was not significantly higher for SD. Our recurrence rate was 7.5%, which makes it comparable with the rates of 5-25% reported in the literature.

scholarly journals Pre-peritonial Repair for Recurrent Inguinal Hernia after Tension free Hernioplasty

2019 ◽  
Vol 2 (3) ◽  
pp. 126-129
Author(s):  
Suresh Raj Poudel ◽  
Narendra Vikram Gurung ◽  
Dhruba Bahadur Adhikari ◽  
Arjun Acharya ◽  
Santosh Shrestha ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Return To Work ◽  
Hospital Stay ◽  
Operative Time ◽  
Operating Time ◽  
Recurrent Hernia ◽  
Recurrent Inguinal Hernia ◽  
Tension Free ◽  
Lichtenstein Hernioplasty ◽  
Stay Time

Background: Inguinal herniorrhaphy is a common general surgical operation. The repair of recurrent hernia is difficult surgery due to obscured and distorted anatomy and risk of further recurrence. The aim of this study is to determine the outcome in terms of operative time, hospital stay, return to work, complications and recurrence of open pre-peritoneal repair for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty. Materials and Method: It is a prospective observational study conducted at Western Regional Hospital, Pokhara from 2013 to 2016. A total of eight patients including referred from other centers were included. Pre-peritoneal repair was performed on recurrent hernias after Lichtenstein tension-free hernioplasty. Age, sex, operating time, hospital stay, time to return work, postoperative complications and recurrence of patients were noted. Statistical analysis was done using SPSS- 21. Patients were called for follow up in 2 weeks, 3 months and 12 months time. Results: Out of eight patients, seven were male, one was female with mean age of 59.5 years. Recurrence was common on direct inguinal hernia (six patients) who had previous Lichtenstein hernioplasty. Mean operative time was 43.13 minutes (35 to 50 minutes), mean hospital stay was 2.5 days (2 to 4 days) and mean time to return to work was 8.12 days (7 to 10 days). There was hematoma formation in one patient. Conclusion: Pre-peritoneal mesh repair is easy, safe, with less operative time, short hospital stay, low recurrence and complication rate for recurrent inguinal hernia after Lichtenstein hernioplasty.  

scholarly journals Outcome of Desarda repair in incarcerated inguinal hernia repair: experience in university hospital

2019 ◽  
Vol 6 (6) ◽  
pp. 2084 ◽  
Author(s):  
Avtar Pachauri ◽  
Awanish Kumar
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Low Cost ◽  
Total Duration ◽  
Recurrent Hernia ◽  
University Hospital ◽  
Complication Rates ◽  
Incarcerated Inguinal Hernia ◽  
Wall Stiffness

Background: Synthetic mesh based hernia repair is usually avoided in contaminated and dirty inguinal hernia repair to minimize the risk of infection. Desarda’s technique is a tissue based inguinal hernia repair method which avoids the use of prosthetic mesh. So this study was conducted with the aim to observe the outcome of Desarda’s technique in incarcerated inguinal hernia repair as an alternative procedure to mesh repair.Methods: This study was conducted in Emergency surgery department KGMU Lucknow. Total 30 patients with incarcerated inguinal hernia were included. Patients with recurrent hernia were excluded. Desarda repair was done in all patients. Patients were followed for 1 year to assess the outcome.Results: The mean age was 52±3 years. Mean operative time was 55±5 mins. Total duration of hospital stay was 4-16 days. Mild to moderate pain observed more frequently on 3rd and 7th post-operative day. Complication rates were found to be SSI (6%), seroma (3%), and recurrence (3%). Time taken to return to daily basic and work activities was 3 (3-5) and 15 days respectively. Patients’ subjective assessment of foreign body sensation done at 6th and 12th month follow up was found in 16% and 13% cases and that of abdominal wall stiffness in 23% followed by a reduction of upto 16% cases by 12th month.Conclusions: Desarda’s method is a safe, effective technique and may potentiate the use of tissue based repair for treating incarcerated, contaminated inguinal hernia repair. It has very low rate of recurrence and low cost of treatment.

Two-center Analysis of Long-term Outcomes after High Ligation Inguinal Hernia Repair in Adolescents

2015 ◽  
Vol 81 (12) ◽  
pp. 1260-1262 ◽  
Author(s):  
Alessandra C. Gasior ◽  
E. Marty Knott ◽  
Arielle Ranters ◽  
Shawn D. Peter ◽  
Todd A. Ponsky
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Recurrent Hernia ◽  
High Ligation ◽  
Long Term Outcomes ◽  
Recurrence Rates ◽  
Hernia Sac ◽  
Telephone Surveys ◽  
Low Incidence

High ligation of the inguinal hernia sac is standard practice for many pediatric surgeons in post-pubertal adolescents. Most adult surgeons do not use this technique to repair indirect inguinal hernias because of concerns for higher recurrence rates compared with mesh repairs. Therefore, we examined long-term outcomes of adolescent high ligation hernia repair performed by pediatric surgeons. Telephone surveys were conducted on children over 12 years old at the time of repair, and patients and/or their parents were contacted 18 months postrepair. Patients were identified from two institutions between 1998 and 2010. The incidences of reoperation, recurrence, presence of bulge, chronic pain, or numbness were determined. A total of 210 patients (40.7% response rate) were available for phone interviews at 18.6 to 159.5 months postrepair. Mean age was 14.6 ± 1.8 (range: 12.0–19.0 years). Fourteen patients had pain (6.7%) and five had numbness (2.4%). There were four (1.9%) patients with a second operation, two of which confirmed a recurrent hernia. Three patients expressed concern about possible recurrence. Two report a bulge, but have not been evaluated. Pediatric hernia repair with high sac ligation appears effective in patients anatomically similar to adults with low recurrence rate and low incidence of chronic symptoms. These data suggest that prospective trials on the adequacy of high ligation in adults are warranted.

Laparoscopic Inguinal Hernia Repair in Infants and Children: State-of-the-Art Technique

2017 ◽  
Vol 27 (06) ◽  
pp. 465-471 ◽  
Author(s):  
Paul Tam ◽  
Ivy Chan
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Open Repair ◽  
State Of The Art ◽  
Laparoscopic Hernia Repair ◽  
Standard Technique ◽  
Current Evidence ◽  
Routine Procedure ◽  
Pediatric Inguinal Hernia ◽  
Surgical Conditions

AbstractPediatric inguinal hernia is one of the most common surgical conditions with open herniotomy being the gold standard of treatment. With the advances of laparoscopic surgery, it has emerged as an alternative to open repair with reported good results. However, laparoscopic hernia repair is not yet a routine procedure in many centers, and debate of laparoscopic versus open repair still exists. After 20 years of development of laparoscopic hernia repair, different techniques have been described with no consensus on the standard technique right now. This article reviews the latest updates of laparoscopic repair from the current evidence in the literature. Laparoscopic management of hernia in premature/small infants and hernia incarceration are also discussed here.

Surgical Aspects of Recurrent Inguinal Hernia in Adults

2016 ◽  
Vol 82 (11) ◽  
pp. 1063-1067 ◽  
Author(s):  
Sang Su Lee ◽  
Hyuk Jae Jung ◽  
Byung Soo Park ◽  
Gyung Mo Son ◽  
Yong Hoon Cho
Keyword(s):  
Inguinal Hernia ◽  
Primary Repair ◽  
Recurrent Hernia ◽  
Recurrent Inguinal Hernia ◽  
Inguinal Herniorrhaphy ◽  
Increased Risk ◽  
Significant Difference ◽  
Surgical Aspects ◽  
The Relationship

Surgeons occasionally encounter a case of recurrent hernia in adult patients after the primary repair, and these cases are challenging to manage appropriately. This study was conducted to describe the clinical nature of recurrent inguinal hernia, compare the results of management, and identify the relationship between the specific risk factors and the occurrence of recurrent hernia. Retrospectively reviewed 58 patients who underwent the inguinal herniorrhaphy for recurrent hernia in a single institution. Analyzed clinical characteristics of recurrent hernia and tried to verify the relationship between smoking, obesity, and occurrence of recurrent hernia. Recurrent inguinal hernia was 13.5 per cent of all hernia repairs in the study period. Most of the recurrence was the first event (74.1%) and showed an interval to recurrence with a mean duration of 40.7 months. There was no significant difference in procedure time, development of postoperative complications, and duration of hospital stay according to the procedure. Compromise of smoker and overweight was significantly higher in the recurrent group (P < 0.05). Surgeons should be aware of the increased risk for recurrence in adult inguinal hernia patients when they smoke or are overweight (body mass index ≥ 25 kg/m2), also it needs to follow-up during the adequate period.

scholarly journals Comparison of Laparoscope-Assisted Single-Needle Laparoscopic Percutaneous Extraperitoneal Closure versus Open Repair for Pediatric Inguinal Hernia

2021 ◽  
Author(s):  
Shaofeng Wu ◽  
Xiaoyu Xing ◽  
Rong He ◽  
Haiteng Zhao ◽  
Liang Zhong ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Operative Time ◽  
Open Repair ◽  
Operating Time ◽  
Laparoscopic Approach ◽  
Bilateral Hernia ◽  
Pediatric Inguinal Hernia ◽  
The Past ◽  
Attractive Option ◽  
Contralateral Inguinal Hernia

Abstract Background: Laparoscopic repairs have gained gradual acceptance in pediatric inguinal hernia over the past decade. However, consensus about the optimal management is still lacking. The aim of this study is to present a modified single-needle laparoscopic approach with the assistance of a laparoscope and to evaluate the surgical outcomes in comparison with traditional open repair method. Materials and Methods: We retrospectively reviewed the medical data of children who underwent laparoscope-assisted single-needle laparoscopic percutaneous extraperitoneal closure (LPEC) and open repair (OR) for inguinal hernia from 2014 to 2019. Data were reviewed and analyzed with respect to the operating time, the incidence of metachronous contralateral inguinal hernia (MCIH), recurrence, and other complications. Results: In our cohort, 961 patients in the OR group and 1098 patients in the LPEC group were analyzed retrospectively. Mean operative time was significantly shorter in the LPEC group (22.3±3.5 min) than in the OR group (27.8±5.9 min) for bilateral hernia repair (p<0.001). Iatrogenic cryptorchidism occurred statistically more frequently in the OR group than in the LPEC group (0.4% vs. 0%, p=0.013). In addition, the incidence of MCIH was 3.7% (33/887) in the OR group and 0.3% (3/1014) in the LPEC group (p<0.01). Conclusion: Based on the current outcomes, laparoscope-assisted single-needle LPEC provides a simple and attractive option for the administration of pediatric patients with inguinal hernia/hydrocele to reduce the MCIH.

scholarly journals Is a Technically Challenging Procedure More Likely to Fail? A Prospective Single-Center Study on the Short- and Long-Term Outcomes of Inguinal Hernia Repair

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
M. R. Berndsen ◽  
Tomas Gudbjartsson ◽  
Fritz Hendrik Berndsen
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Recurrence Rate ◽  
Recurrent Hernia ◽  
Single Center ◽  
Single Center Study ◽  
Center Study

Background and Aims. The aim of this prospective single-center study was to evaluate the outcome of inguinal hernia repair. Materials and Methods. A total of 485 inguinal hernias (452 patients and 33 patients with bilateral hernias) were operated between January 2004 and December 2010. Mean age was 56 years, and 93% were male. Patient demographics and operative data were collected, and the operating surgeon assessed the technical difficulty of the operation. Five years after surgery, a questionnaire evaluated recurrence and chronic discomfort according to the Cunningham scale. 372 responded (82%), and mean follow-up was 5.5 years. Results. There were 390 repairs for a primary and 62 for a recurrent hernia. Totally extraperitoneal (TEP) operation was most frequently performed (56%), transabdominal preperitoneal (TAPP) operation in 31%, and Lichtenstein and Shouldice in 12% and 2%, respectively. At 5-year follow-up, the primary outcome of chronic discomfort was 19.5%. The independent positive predictors were young age and operation for a recurrent hernia (OR: 3.7), with TEP operation reducing the risk of chronic discomfort (OR: 0.5). The secondary outcome was the recurrence rate of 2.5%. Risk factors were strenuous work (OR: 13.7), technically difficult repairs (OR: 7.2), and chronic discomfort (OR: 6.7). Conclusions. Every fifth patient had chronic discomfort in long-term follow-up. The recurrence rate was 2.5%, and a technically difficult procedure was a risk factor.

The most recent recommendations for the surgical treatment of inguinal hernia

2019 ◽  
Vol 98 (7) ◽  
pp. 268-272
Keyword(s):  
Inguinal Hernia ◽  
Surgical Treatment ◽  
Hernia Repair ◽  
Mesh Repair ◽  
Laparoscopic Hernia Repair ◽  
Laparoscopic Approach ◽  
Safe Procedure ◽  
Recurrence Rates ◽  
Hernia Sac ◽  
Minimal Invasiveness

Introduction: The publication of new guidelines in recent years shows that surgical treatment of inguinal hernia remains topical. The main goal is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain. The main purpose of this article is to summarize the latest recommendations in surgical treatment of the groin hernias, especially in the case of strangulation. Methods: The authors made literature review of all the guidelines published by the hernia societies, including related articles, in the last ten years. Results: The use of the EHS classification system is suggested. In elective operations, mesh repair is recommended. The Lichtenstein technique is the standard in open inguinal hernia repair. Transabdominal preperitoneal and totally extraperitoneal approach have comparable outcomes. Their clear advantages include minimal invasiveness. Mesh repair is recommended also in the case of strangulation, but only in clean and clean-contaminated operations. A laparoscopic approach should be considered as well. Inter alia, it allows an assessment of bowel viability during the whole procedure. The need of bowel resection is hence lower compared to open surgery. If it is not possible to use the mesh, the Shouldice method is regarded as the best non-mesh repair technique. If there is concern about bowel viability, visualization, either by formal laparoscopy, hernia sac laparoscopy or laparotomy, is recommended. Hernioscopy is a simple and safe procedure that uses the hernia sac for insertion of a port following insufflation and diagnostic examination. It requires less advanced laparoscopic skills than does emergency laparoscopic hernia repair. It can be performed even by surgeons who lack sufficient experience with laparoscopy. Conclusion: In elective procedures, the mesh repair is recommended. It is recommended also in the case of strangulation, but not in a contaminated- dirty surgical field. If there is concern about bowel viability, visualization, either by formal laparoscopy, hernia sac laparoscopy or laparotomy, is needed.

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