The incidence and analysis of ipsilateral occult hernia in patients undergoing hernia repair: a single institution retrospective study of 1066 patients

Abstract Background Misdiagnosis or failure to intraoperatively detect occult hernia in the inguinal region can lead to the recurrence of postoperative hernia and the appearance of local pain symptoms, which affect the patient’s quality of life and make it difficult to reperform hernia repair. Methods This study included 1066 inguinal hernia patients who underwent surgical treatment at Shanghai Tongren Hospital between January 2016 and October 2018 to investigate ipsilateral occult hernia epidemiology, to analyze the characteristics of ipsilateral occult hernias with regards to patient age, gender, classification and anatomical site, and to explore the superiority and inferiority of the expert hernia surgeons/ non-expert hernia surgeons group and of operation methods in finding occult inguinal hernias. Results The incidence of ipsilateral occult hernia in the surgical population was 8.26%. Ipsilateral occult hernia included indirect inguinal hernia, direct inguinal hernia, femoral hernia, obturator hernia, and spigelian hernia, among which the highest incidence was direct inguinal hernia (4.11%), followed by indirect inguinal hernia (2.45%). There was no difference in the incidence of ipsilateral occult hernia between males and females, but there were significant differences in the incidence of ipsilateral occult hernia, which decreased gradually with increasing age in patients younger than 70 years-old; there was no difference in incidence in patients over 70 years-old. There were significant differences in the incidence of ipsilateral occult hernia in the bilateral inguinal region between direct and femoral hernia, with the higher incidence found on the right side; in contrast, there was no difference in the incidence of indirect inguinal hernia in the bilateral inguinal region. There was no difference in the ability of experienced physicians to detect ipsilateral occult inguinal hernias, either professionally or by surgery. Conclusions Ipsilateral occult inguinal hernia has a higher incidence in patients with inguinal hernia, especially older patients; therefore, it is necessary for experienced surgeons to carefully detect for possible occult hernia during the operation and in elderly patients.

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Direct inguinal hernias in children

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic949 ◽

2021 ◽

Vol 11 (2) ◽

pp. 161-167

Author(s):

Vyacheslav G. Svarich ◽

Ilya M. Kagantsov ◽

Violetta A. Svarich

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Ultrasound Examination ◽

Laparoscopic Hernia Repair ◽

Abdominal Cavity ◽

Treatment Method ◽

Long Term Results ◽

Direct Inguinal Hernia ◽

Surgical Department ◽

Inguinal Hernias

AIM: Based on the accumulated clinical material, this study aims to show the possibilities of diagnosing and treating direct inguinal hernias in children. MATERIALS AND METHODS: During the period from 2000 to 2020, 3221 children with inguinal hernias were treated in the surgical department of the Republican Childrens Clinical Hospital in Syktyvkar. Of the above group of children with inguinal hernias, seven patients (0.22%) had direct inguinal hernias. The above was confirmed by ultrasound examination. In laparoscopic imaging, a rectal hernia was defined as a recess of the peritoneum of a stellate or rounded shape in the projection of the medial umbilical fossa. Two patients underwent the Bassini herniation procedure. Two children underwent laparoscopic hernia repair with intracorporeal suture insertion. In three patients, hernia repair was performed using the PRMS method. RESULTS: Long-term results were followed up from six months to 15 years. Immediate and postoperative complications were noted. No recurrence of hernia was reported. CONCLUSIONS: When establishing direct inguinal hernia diagnosis in children is clinically determined in the form of a rounded, soft-elastic formation localized medially and above the Pupart ligament next to the projection of the external (superficial) inguinal ring of the inguinal canal. It is easily set into the abdominal cavity with rumbling and confirmed by ultrasound examination results. The most preferred treatment method for direct inguinal hernia in children, in our opinion, is hernia repair using the percutaneous internal ring suturing (PIRS) method.

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Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair Using Memory-Ring Mesh: A Pilot Study

Surgery Research and Practice ◽

10.1155/2016/9407357 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5

Author(s):

Takeshi Matsutani ◽

Tsutomu Nomura ◽

Nobutoshi Hagiwara ◽

Akihisa Matsuda ◽

Yoshimune Takao ◽

...

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Operation Time ◽

Indirect Inguinal Hernia ◽

Trocar Site ◽

Transabdominal Preperitoneal ◽

Tapp Repair ◽

Inguinal Hernias

Purpose.To evaluate the feasibility, safety, and effectiveness of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using a memory-ring patch (Polysoft™mesh).Patients and Methods.Between April 2010 and March 2013, a total of 76 inguinal hernias underwent TAPP repair using Polysoft mesh in 67 adults under general anesthesia. Three different senior resident surgeons performed TAPP repair under the instruction of a specialist surgeon. Nine patients had bilateral hernias. The 76 hernias included 37 indirect inguinal hernias, 29 direct hernias, 1 femoral hernia, 1 pantaloon hernia (combined direct/indirect inguinal hernia), and 8 recurrent hernias after open anterior hernia repair. The immediate postoperative outcomes as well as the short-term outcomes (mainly recurrence and incidence of chronic pain) were studied.Results.There was no conversion from TAPP repair to anterior open repair. The mean operation time was 109 minutes (range, 40–132) for unilateral hernia repair. Scrotal seroma was diagnosed at the operation site in 5 patients. No patient had operation-related orchitis, testicle edema, trocar site infection, or chronic pain during follow-up.Conclusions.The use of Polysoft mesh for TAPP inguinal hernia repair does not seem to adversely affect the quality of repair. The use of this mesh is therefore feasible and safe and may reduce postoperative pain.

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Non-plug technique of bilayer patch device insertion for indirect inguinal hernia repair

Vojnosanitetski pregled ◽

10.2298/vsp150901258i ◽

2017 ◽

Vol 74 (8) ◽

pp. 773-777

Author(s):

Miroslav Ilic ◽

Srdjan Putnik ◽

Ivan Kuhajda ◽

Dejan Ivanov

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Hernia Repair ◽

Recurrent Hernia ◽

Indirect Inguinal Hernia ◽

Hernia Surgery ◽

Prolene Hernia System ◽

Inguinal Hernias ◽

Low Incidence ◽

Almost All

Background/Aim. Despite a huge success in decrease rate of recurrences of inguinal hernia in mesh and ?plug in? techniques, a new problem appears such as chronic pain and other complications. The aim of this paper was to present the original modification of bilayer patch device (Prolene Hernia System?, Ethicon) insertion in ?non-plugged? fashion and 11-year experience with this open technique for the indirect hernia repair in a male. Methods. This retrospective study included 96 male patients with 103 indirect unilateral and bilateral inguinal hernias, operated due to a primary or recurrent hernia in an 11-year interval (2004?2015). In all operation an extended Prolene Hernia System? (PHS) bilayer patch device was inserted medially of inferior epigastric vessels through a small incision in Hasselbach's triangle, thus avoiding plug component of device connector into the internal ring. All data were taken from the medical records, operative protocols, and telephone questionnaire. Results. Non-plugged technique of bilayer patch device insertion was presented in details. Mean age of patients was 59 years. There were 3 (2.91%) patients with procedure-related complications, two patients with postoperative seroma and one with scrotal ecchymosis. There were 86 (89.6%) patients who answered on the questionnaire. During 11 years of following, recurrence of a hernia occurred in 1 patient, one had funiculocele and only one had chronic pain during 6 months. Almost all patients (97.68%) were satisfied with the procedure and results of hernia surgery. Conclusion. Nonplugged insertion of bilayer patch device is a safe technique for solving the primary and recurrent indirect inguinal hernias. The low incidence of the recurrence and chronic pain many years after the operation justifies this technique even in hospitals not specialized for the hernioplasty.

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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

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A comparative study of Desarda’s mesh free inguinal hernia repair with modified Bassini’s repair

Journal of Clinical and Investigative Surgery ◽

10.25083/2559.5555/6.2.4 ◽

2021 ◽

Vol 6 (2) ◽

pp. 104-115

Author(s):

Hosni Mubarak Khan ◽

◽

Tirumal Rao Patwari

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Open Approach ◽

Medical College ◽

Inguinal Hernias ◽

Mesh Free ◽

Hospital Stays ◽

A Prospective Study ◽

Repair Techniques

Objective. This is a prospective study of 50 cases of inguinal hernias which were treated through open inguinal hernia repair techniques. The study was conducted with the objective of comparing the effectiveness of these procedures and complications. Materials and Methods. A number of 50 cases of inguinal hernias admitted to Dr. BR Ambedkar Medical College and Hospital were selected on the basis of the non-probability (purposive) sampling method. All the patients with direct and indirect uncomplicated hernias treated by means of an open approach were included. After the preoperative preparation, they were randomly chosen either for Desarda’s or Modified Bassini’s repair techniques. Results. In the postoperative period, moderate pain was experienced by 19 patients included in the Desarda group and 17 patients included in the Modified Bassini’s repair group on day 1. The postoperative wound infection developed in 2 cases of Desarda and 3 cases of Modified Bassini’s, erythema was observed in 2 cases of Desarda and 3 cases of Modified Bassini’s, 3 cases reported the occurrence of seroma in the Desarda group and 4 cases of seroma were recorded in the Modified Bassini’s group. Conclusions. The patients who underwent Desarda repair complained of a higher intensity of pain, which could probably be attributed to the extensive dissection involved. The duration of Desarda repair was longer due to the learning curve of the surgeons in our hospital. The return to normal gait and normal activities was significantly lower in the Desarda group. The duration of hospital stays and the postoperative complications was not significantly different in the two groups. There were no recurrences in either of the groups until the current study.

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Contralateral exploration and repair of occult inguinal hernias during laparoscopic inguinal hernia repair: systematic review and Markov decision process

BJS Open ◽

10.1093/bjsopen/zraa020 ◽

2020 ◽

Vol 5 (2) ◽

Author(s):

N H Dhanani ◽

O A Olavarria ◽

S Wootton ◽

M Petsalis ◽

N B Lyons ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Markov Decision Process ◽

Decision Process ◽

Expectant Management ◽

Contralateral Exploration ◽

Unilateral Inguinal Hernia ◽

Inguinal Hernias ◽

Markov Decision

Abstract Background Contralateral clinically occult hernias are frequently noted at the time of laparoscopic unilateral inguinal hernia repair. There is no consensus on the role of contralateral exploration and repair. This systematic review assessed the safety and efficacy of operative repair of occult contralateral inguinal hernias found during unilateral repair. Methods PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to February 2020. Adults diagnosed with a unilateral inguinal hernia undergoing laparoscopic repair were included. The primary outcome was the incidence of occult contralateral hernias. Summative outcomes of operative and expectant management were reported along with development of a Markov decision process. Results Thirteen studies (1 randomized trial, 12 observational cohorts) with 5000 patients were included. The incidence of occult contralateral inguinal hernias was 14.6 (range 7.3–50.1) per cent. Among patients who underwent repair, 10.5 (4.3–17.0) per cent experienced a postoperative complication. Of patients managed expectantly, 29 per cent later required elective repair for symptoms. Mean follow-up was 36 (range 2–218) months. Using a Markov decision process, it was calculated that, for every 1000 patients undergoing unilateral inguinal hernia repair, contralateral exploration would identify 150 patients with an occult hernia. Repair would result in 15 patients developing a postoperative complication and 105 undergoing unnecessary repair. Alternatively, expectant management would result in 45 patients requiring subsequent repair. Conclusion Contralateral repair is not warranted in patients with occult hernias diagnosed at the time of elective hernia repair. The evidence is largely based on observational studies at high risk of bias.

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Modified Lichtenstein Hernia Repair with Invagination of Inguinal Hernial Sac in Comparison with Ligation and Excision in Indirect Inguinal Hernia

New Indian Journal of Surgery ◽

10.21088/nijs.0976.4747.11320.15 ◽

2020 ◽

Vol 11 (3) ◽

pp. 353-358

Author(s):

S N Shirbur

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Indirect Inguinal Hernia ◽

Hernial Sac ◽

Lichtenstein Hernia Repair

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LIPOSARCOMA OF SPERMATIC CORD PRESENTING AS INDIRECT INGUINAL HERNIA- A RARE CASE REPORT

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703524 ◽

2011 ◽

Vol 01 (01/03) ◽

pp. 63-65

Author(s):

Padma Shetty K. ◽

Harish S. Permi ◽

Michelle Mathias ◽

Kishan Prasad ◽

Teerthanath S. ◽

...

Keyword(s):

Case Report ◽

Inguinal Hernia ◽

Spermatic Cord ◽

Rare Case ◽

Surgical Excision ◽

Myxoid Liposarcoma ◽

Clinical Findings ◽

Inguinal Region ◽

Indirect Inguinal Hernia ◽

Rare Case Report

AbstractLiposarcoma in the inguinal region though rare are clinically significant lesions. Preoperative diagnosis is difficult since the clinical findings are very similar to that of inguinal hernia. We report a rare case of Liposarcoma of the spermatic cord in 85 year old male, clinically diagnosed as left sided indirect inguinal hernia. Surgical excision specimen showed multiple globular lipomatous masses which were yellowish and grey tan with areas of myxoid degeneration and necrosis seen. Microscopic examination showed adipocytes arranged in lobules with numerous blood vessels, lipoblasts and myxoid stroma confirming the diagnosis of myxoid liposarcoma. He is on regular follow up since two years without any recurrence or metastasis. Our case report highlights the importance of sampling and examination of fatty masses in the inguinal region to rule out the possibility of liposarcoma as they are mistaken for lipoma at surgery.

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