Managing bilateral inguinal hernia laparoscopically: is it gold standard?

Background:Even after many studies done in recent years, no consensus has been achieved on the surgical technique of inguinal hernia repair. It was believed that in bilateral inguinal hernia cases laparoscopic surgery is very much advantageous as it can be done through same incisions as unilateral laparoscopic inguinal hernia repair (no additional incision required), whereas in open surgery for bilateral case separate groin incision for each side required. Aim of this study is to evaluate and compare results of bilateral inguinal hernia patients operated by laparoscopic (transabdominal preperitoneal) or open (lichenstein) repair.Methods: A prospective comparative study was conducted in a tertiary care teaching hospital over the period of two years. 60 patients with bilateral inguinal hernia were taken up and randomly divided into two groups. Group I (study group) includes patients operated by bilateral laparoscopic hernia repair (TAPP) and Group II (control group) includes patients operated by open hernia repair (lichenstein tension free hernioplasty). All patients were followed up for 18 months post-operatively. All patients of both groups were monitored for operative time, conversion rate, length hospital stay, post-operative complications and recurrence, time to return to work.Results:Statistically there was significant difference between both groups in terms of length of hospital stay and time to return to work. Group I patients where TAPP surgery performed, 22 patients (73.33%) were discharged within 36 hours of surgery, whereas in Group II patients - control group where open surgery performed, only 4 patients (13.33%) discharged within 36 hours. All 30 patients (100%) in group I had joined their routine work within 10 days of surgery; whereas in Group II patients only 4 cases (13.33%) joined duties on or before 10 days and most of the patients 26 (86.67%) had taken more than 10 days to resume their duties. But there was no significant difference between operative time, complication rates and recurrence rates. All cases in group I were completed laparoscopically (no conversion to open repair).Conclusions:Simultaneous bilateral inguinal hernia repair laparoscopically does not increase the risk for the patient and has an equal morbidity compared with unilateral repair, length of hospital stay, and return to normal work and over all recovery after laparoscopic repair is faster than after open bilateral simultaneous repair. Laparoscopic inguinal hernia repair of bilateral hernias should be recommended as the gold standard.

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P035 EMERGENCY BILATERAL GORIN HERNIA REPAIR IN UNILATERAL COMPLICATED INGUINAL HERNIA REAPIR WITH CONCOMITNAT CONTRALATERAL HERNIA. COHORTS COMPARATIVE OUTCOMES ANALYSIS USING PROPENSITY SCORE MATCHING

British Journal of Surgery ◽

10.1093/bjs/znab395.033 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Alejandro Bravo-Salva ◽

Francisco Rómulo Ochoa-Segarra ◽

Ana María Gonzálz-Castillo ◽

Joan Sancho-Insenser ◽

Miguel Pera-Roman ◽

...

Keyword(s):

Inguinal Hernia ◽

Propensity Score ◽

Hernia Repair ◽

Hospital Stay ◽

Propensity Score Matching ◽

Inguinal Hernia Repair ◽

Morbidity And Mortality ◽

High Morbidity ◽

Bilateral Inguinal Hernia ◽

Bilateral Hernia

Abstract Aim Aim of our study was to analyze outcomes and safety of bilateral inguinal hernia repair in unilateral groin complicated hernia with contralateral groin hernia. Material and Methods Retrospective cohorts study following STROBE statements on a prospective Emergency Surgery Department database. Inclusion criteria were: patients with emergency hernia repair from 2008 to 2018, 18 years old. Unilateral or bilateral inguinal hernia repair without other abdominal wall hernia repairs. Comparative analysis between two group unilateral hernia repair (UH) vs bilateral hernia repair (BH) those patients with unilateral complicated inguinal hernia with contralateral inguinal hernia. Propensity score matching (PSM) between groups was performed to eliminate statistically groups differences. Outcomes between groups were analyzed with special attention to postoperative morbimortality and hernia recurrence. Results 341 patients were included, 38(11.1%) were performed bilateral hernia repair. Groups differences were: higher rate of inguinoscrotal inguinal hernia (36.8 vs 22.8), prophylactic antibiotics use (94.7 vs 81.8) and general Anesthesia use (52.6% vs 50.2%). General high rates of morbidity and mortality were observed (5.9% and 41.9) and 22 (6.5%) hernia repair recurrence were detected. After PSM no differences between surgery outcomes groups were observed with similar morbidity, recurrence or hospital stay. Conclusions Emergency inguinal hernia repair has high morbidity and mortality rates in our experience. Emergency Bilateral inguinal hernia repair in context of hernia complication seems safe without recurrence or hospital stay increase.

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Using inferior epigastric vascular anatomical landmarks for anterior inguinal hernia repair

BMC Surgery ◽

10.1186/s12893-019-0627-0 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Weiming Li ◽

Yijun Li ◽

Lili Ding ◽

Xiongzhi Chen ◽

Qingwen Xu ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

Foreign Bodies ◽

Length Of Hospital Stay ◽

Operation Time ◽

Complication Rates ◽

Anatomical Landmarks ◽

Post Operative Pain

Abstract Background Inferior epigastric vascular anatomical landmarks for anterior inguinal hernia repair is an alternative surgical procedure. We present our experience and outcome of the way. Methods We performed a retrospective analysis of 230 patients who received anterior tension-free hernia repair between May 2016 to May 2017. Among these cases, 120 were performed using the traditional transinguinal preperitoneal (TTIPP) technique while 100 were performed using the vascular anatomic landmark transinguinal preperitoneal (VALTIPP) technique. Between these two groups, we compared the operation time, length of hospital stay, complication rates, and the visual analog scale (VAS) for pain at 2 days, 3 months, and 6 months after surgery. Results Surgery was well-tolerated in both groups with no significant hemorrhage or complications. The operation times for the VALTIPP and TTIPP groups were 42.52 ± 9.15 and 53.84 ± 10.64 min (P < 0.05), respectively. Ten patients in the VALTIPP group and 17 patients in the TTIPP group reported sensations of foreign bodies (P < 0.05). The VAS pain score in VALTIPP patients at 2 days (4.0 ± 0.5), 3 months (1.0 ± 0.3), and 6 months (0.9 ± 0.3) were significantly lower when compared with those of TTIPP patients (5.3 ± 0.9 at 2 days, 1.8 ± 0.4 at 3 months, and 1.1 ± 0.1 at 6 months, p < 0.05). No statistically significant differences were found in age, gender, BMI, hernia type and location, follow-up period, incidence of post-operative seromas, recurrence rate, or length of hospital stay. Conclusion Anterior inguinal hernia repair using inferior epigastric vascular anatomical landmarks may lead to reduced operation times, reduced sensations of foreign bodies, and reduced post-operative pain. This technique is simple, practical, and effective in the management of inguinal hernias.

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Inguinal hernia repair – TEP or TAPP?? A comparative analysis between both the laparoscopic procedures in a tertiary care center

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i6.30776 ◽

2020 ◽

Vol 11 (6) ◽

pp. 84-88

Author(s):

Atia Zaka Ur Rab ◽

Sheikh Saif Alim ◽

Wasif Mohammad Ali ◽

Syed Amjad Ali Rizvi

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Prospective Study ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

Tertiary Care ◽

Number Of Patients ◽

Significant Difference ◽

Duration Of Surgery ◽

Normal Work

Background: Inguinal hernia surgery is one of the most common elective procedures performed by the surgeons and has evolved from open to the laparoscopic technique. Aims and Objectives: This prospective study was conducted to find out intra-operative and post-operative outcomes in patients undergoing TEP and TAPP for inguinal hernia repair. Materials and Methods: A prospective study was conducted on 50 adult patients who underwent laparoscopic inguinal hernia repair between November 2017 to November 2018. It was a randomized study and equal number of patients were allocated to TAPP and TEP group based on the surgeon’s preference. Results: Operative time [p<0.0001], intensity of pain (VAS) was significantly higher in TAPP compared to TEP in the immediate post-operative period (6 hours) and during hospital stay [p=0.0299]. No significant difference observed in VAS between TEP and TAPP during follow up [after 1 week (p=0.2298), 2 weeks (p=0.2337), and 4 weeks (p=0.3944)]. Both TEP and TAPP were comparable in terms of Intra-operative and Post-operative complications {seroma [during hospital stay (p=0.1573), after 1 week (p=0.6375), after 2 weeks (p=0.5513)]; haematoma [during hospital stay (p=0.1492), after 1 week (p=0.3125)]} and Conversion (p=0.3125), and Length of hospital stay (p=0.3960). Time to resume normal work [p<0.0001] was significantly more in TAPP than TEP. Conclusion: TEP has a definite edge over TAPP taking into consideration the lesser intensity of post-operative pain during hospital stay, shorter duration of surgery and relatively early return to normal work associated with the former procedure. TEP should therefore be regarded as the procedure of choice for inguinal hernia repair.

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Prospective Randomized Blinded Study to Compare Laparoscopic and Open Inguinal Hernioplasty

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.32 ◽

2020 ◽

Vol 3 (1) ◽

pp. 149-154

Author(s):

Mohd. Ilyas ◽

Venkat Vaijnath Cholleti

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

Randomized Study ◽

Early Assessment ◽

Post Operative Pain ◽

Number Of Patients ◽

Study Results ◽

Significant Difference

Background: Hernia is one of the common surgical problems. Repair of inguinal hernia is one of the commonest surgical procedures worldwide, irrespective of country, race or socio-economic status and constitutes a major health-care in every country. Subjects and Methods: This is a randomised prospective study done over 50 patients in the department of general surgery of Kamineni hospitals, LB Nagar, Hyderabad during the period of October 2010 to August 2012 with the aim to compare laproscopic inguinal hernia repair and open inguinal hernia repair with regards to post-operative pain, surgical site infections, hospital stay and time taken to return to work, by a randomized study. Results: Compare laparoscopic and mesh inguinal hernia repairs, there is no significant difference in early assessment with regards to duration of operation, post-operative pain, analgesic requirements on the day of surgery and first post-operative day, hospital stay, return to daily and normal activities and post-operative complications. Conclusion: Laparoscopic mesh hernioplasty still remains to be validated with larger number of patients and longer duration of follow up.

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Comparison of postoperative analgesic effects of two doses of dexamethasone in ultrasound-guided transversus abdominis plane block for inguinal hernia repair: a randomized controlled trial

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00139-5 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Amani H. Abdel-wahab ◽

Ekram A. Osman ◽

Abubakr Y. Ahmed

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Controlled Trial ◽

Transversus Abdominis ◽

Tap Block ◽

Group Iii ◽

Randomized Controlled ◽

Group I ◽

Group Ii

Abstract Background Ninety patients American Society of Anesthesiologists (ASA) I–II, aged (18–60 years), were enrolled in this randomized controlled trial. All enrolled patients had undergone elective primary unilateral open inguinal hernia repair under spinal anesthesia; at the end of the surgery, transversus abdominis plane (TAP) block was done by bupivacaine combined with 4 mg dexamethasone in (group I), 8 mg dexamethasone in (group II), or saline in (group III.). We aimed to compare the analgesic efficacy of two different doses of dexamethasone (4 mg and 8 mg) added to bupivacaine in a unilateral single-injection (TAP) block. The first outcome measure was the time of the first analgesic request, and the secondary outcome measure was the VAS scale in the first postoperative 24 h. Results There was no need for any analgesia in group I and group II in the first postoperative 24 h. The time of the first analgesic request in group III was 720 ± 90 min. VAS scores were significantly lower in group I and group II than in group III, with no significant difference between group I and group II. Conclusions There is no difference in the first postoperative 24 h analgesic effect of the two doses of dexamethasone when added to a long-acting local anesthetic mixture in TAP blocks in patients undergoing inguinal hernia repair. Trial registration ClinicalTrials.gov, NCT03863977

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Reduction of opioid use using regional anesthetic blocks after inguinal hernia repair in a high risk, safety net population

Journal of Opioid Management ◽

10.5055/jom.2021.0665 ◽

2021 ◽

Vol 17 (4) ◽

pp. 327-335

Author(s):

Sayeeda Rab, BS ◽

Sudeepti Vedula, BS ◽

Aziz M. Merchant, MD, FACS

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Safety Net ◽

Transversus Abdominis ◽

University Hospital ◽

Control Group ◽

Tap Block ◽

Significant Difference ◽

Patient Reported

Objective: The transversus abdominis plane (TAP) block is currently being used perioperatively to reduce postoperative opioid requirements. It is unclear whether TAP blocks reduce postoperative opioid requirements for inguinal hernia repairs. The purpose of this retrospective chart study was to determine whether a TAP block reduces postoperative opioid requirements after an inguinal hernia repair in a safety net hospital.Design: This was a retrospective chart review that evaluated patients at University Hospital in Newark, NJ, who had inguinal hernia repairs from January 2011 to July 2019. Patients were divided into two groups depending on whether they had a TAP block or not. The primary outcome was the amount of opioid required in the first 24 hours postoperatively by a patient reported as morphine equivalent dosing (MED).Results: The group that received the TAP block had a mean (95 percent CI) MED of 7.01 mg (6.70, 7.33), and the control group (no TAP block) had a mean MED of 11.6 mg within 24 hours of the inguinal hernia (p = 0.03). There was no significant difference for postoperative visual analog scale (VAS) pain score, presence of nausea, or length of stay.Conclusions: Patients with TAP block required less morphine equivalence of opioid within a 24 hours period after an inguinal hernia repair.

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A comparative study examining laparoscopic and open inguinal hernia repair in children: a retrospective study from a single center in China

BMC Surgery ◽

10.1186/s12893-020-00912-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jie Liu ◽

XiongWei Wu ◽

WenLi Xiu ◽

XiWei Hao ◽

Jing Zhao ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Operation Time ◽

Indirect Inguinal Hernia ◽

Bilateral Inguinal Hernia ◽

Pediatric Inguinal Hernia ◽

Advantages And Disadvantages ◽

Unilateral Inguinal Hernia ◽

Significant Difference

Abstract Background Pediatric inguinal hernia (PIH) is a common disease in children. Laparoscopic hernia repair (LHR) has developed rapidly in recent years, but there are still different opinions compared with traditional open hernia repair (OHR). The purpose of this study was to compare the advantages and disadvantages of LHR and OHR in the treatment of pediatric inguinal hernia. Methods We performed a retrospective review of all children (< 14 years) who underwent repair of inguinal hernia in the pediatric surgery center of the Affiliated Hospital of Qingdao University from January 2015 to December 2015. We collected the medical records of all the children and analyzed the clinical characteristics, operation-related information and follow-up. Results In the OHR group, 202 cases underwent unilateral inguinal hernia repair, and 43 cases underwent bilateral inguinal hernia repair. In the LHR group, 168 cases underwent unilateral inguinal hernia repair, and 136 cases underwent bilateral inguinal hernia repair. There was a significant difference in the operation time between the two groups, but there were no significant differences in postoperative hospitalization time and incidence of ipsilateral recurrent hernia between the two groups. The incidence rates of metachronous contralateral hernia (MCH) and surgical site infection in LHR group were significantly lower than those in the OHR group. Conclusion Our study shows that compared with OHR, LHR has the advantages of concealed incision, minimal invasiveness, reduced operation time, detection of contralateral patent processus vaginalis, and reduced incidence of MCH. In conclusion, LHR is safe and effective in the treatment of pediatric indirect inguinal hernia.

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A COMPARATIVE AND RANDOMIZED STUDY BETWEEN TRANS ABDOMINAL PRE-PERITONEAL VERSUS TOTALLY EXTRA-PERITONEAL LAPAROSCOPIC TECHNIQUES OF INGUINAL HERNIA REPAIR

10.36106/ijsr/6207373 ◽

2020 ◽

pp. 26-29

Author(s):

Nikhil Agrawal ◽

Swapnil Sen

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

Operative Time ◽

Length Of Hospital Stay ◽

Statistical Hypothesis ◽

Categorical Variables ◽

Chi Squared

A hernia, an abnormal protrusion of an organ or tissue through a defect in its surrounding wall is a very common surgical problem. Approximately 75% of all hernias are usually groin hernias, among which 95% are inguinal region hernias. Various methods of repair have been employed which have progressed from open repair to various laparoscopic approaches. There is insufficient data to draw conclusions about the relative effectiveness of the two laparoscopic methods. Overall superiority of the two laparoscopic methods has not been demonstrated in available literature. AIM: The purpose of this study is to compare the clinical effectiveness and relative efficiency of laparoscopic TAPP and laparoscopic TEP for inguinal hernia repair. MATERIALS AND METHODS: Hospital based comparative randomised study on 100 patients admitted in General Surgical wards with Inguinal hernia at a tertiary care centre of Eastern India. Randomization in two groups was done by lottery system. A well designed proforma containing various parameters under study was used for data collection. Baseline information were collected via structured interview using predesigned questionnaire. For statistical analysis data were entered into a Microsoft excel spreadsheet and then analyzed by SPSS version 24 and GraphPad Prism version 5. Data had been summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Two-sample t-tests for a difference in mean involved independent samples or unpaired samples. Paired t-tests were a form of blocking and had greater power than unpaired tests. A chi-squared test (χ2 test) was any statistical hypothesis test wherein the sampling distribution of the test statistic is a chi-squared distribution when the null hypothesis is true. Unpaired proportions were compared by Chi-square test or Fischer’s exact test, as appropriate. RESULTS: TAPP was associated with significantly higher incidence of haematoma, length of hospital stay, early postoperative pain and longer operative time as compared to TEP. Visceral injury and vascular injury were found more in TAPP as compared to TEP but this was not statistically significant. Seroma, port site hernia, persisting numbness and mesh/deep infection was higher in group-A (TAPP) as compared to group-B (TEP) but this was not statistically significant. Conversion to open procedure and persistent pain were comparable among the two methods. Hernia recurrence rates were higher in the TEP group in this study although it was statistically insignificant. CONCLUSION: TAPP was associated with significantly higher incidence of haematoma, length of hospital stay, early postoperative pain and longer operative time as compared to TEP.

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ACUTE APPENDICITIS: DELAYED SURGERY DOES NOT INCREASE THE NUMBER OF POSTOPERATIVE COMPLICATIONS

Visuomenės sveikata ◽

10.5200/sm-hs.2018.019 ◽

2018 ◽

Vol 28 (2) ◽

pp. 52-56

Author(s):

Romualdas Riauka ◽

Povilas Ignatavičius ◽

Žygimantas Tverskis ◽

Žilvinas Dambrauskas

Keyword(s):

Postoperative Complications ◽

Acute Appendicitis ◽

Hospital Stay ◽

Operating Time ◽

Length Of Hospital Stay ◽

Pathology Report ◽

Perforation Rate ◽

Group I ◽

Significant Difference ◽

Group Ii

Introduction. Historically appendicitis is tending to be operated as soon as possible to prevent future complications. Recent discussions show, that urgent operation does not always reduce the rate of postoperative complications. Immediate appendectomy can be delayed in some cases. Methods. Retrospective, non-randomized, single center, cohort study was performed. During one-year period 167 consecutive patients diagnosed with acute appendicitis were included in the study. The study population was divided into two groups according to the time from the onset of the symptoms to the operation. Group I (≤ 24 hours) - 74 patients and Group II (≥ 24 hours) – 93 patients. Primary (postoperative complications) and secondary (operating time, length of hospital stay and perforation rate at the final pathology report) endpoints were evaluated and compared. Results. There was no statistically significant difference in the rate of postoperative complications when comparing both groups. In Group I – 21.9% patients (87.5% Grade I) and in Group II – 25.8% patients (83% Grade I) had postoperative complications. Operating time was similar between the groups (72.97±29.1 (Group I) vs 79.95±35.4 minutes (Group II)). Length of hospital stay was longer in Group II, but no statistically significant difference was found (2.85±2.3 vs 3.34±4.88 days accordingly). Perforation rate at the final pathology report was twice higher in Group II (8 (10.8%) vs 17 (18.3%)), but no statistically significant difference was found. Conclusions. This study findings support earlier reports showing that delayed appendectomy is safe surgical procedure without higher rate of postoperative complications and may be applied in certain cases.

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Effect of Adding Dexamethasone as a Ropivacaine Adjuvant in Ultrasound-Guided Transversus Abdominis Plane Block for Inguinal Hernia Repair

PRILOZI ◽

10.1515/prilozi-2015-0076 ◽

2015 ◽

Vol 36 (3) ◽

pp. 35-41 ◽

Cited By ~ 3

Author(s):

Andrijan Kartalov ◽

Nikola Jankulovski ◽

Biljana Kuzmanovska ◽

Milka Zdravkovska ◽

Mirjana Shosholcheva ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

General Anesthesia ◽

Inguinal Hernia Repair ◽

Morphine Consumption ◽

Tap Block ◽

Group Iii ◽

Group I ◽

Open Inguinal Hernia Repair ◽

Group Ii

Abstract Background: The transverses abdominals plane block (TAP) is a regional anesthesia technique that provided analgesia to the parietal peritoneum, skin and muscles of the anterior abdominal wall. The aim of this randomized double-blind study was to evaluate postoperative analgesia on patients undergoing open inguinal hernia repair under general anesthesia (GA), (GA + TAP) block preformed with ropivacaine and (GA + TAP-D) block preformed with ropivacaine and 4 mg dexamethasone. Methods: 90 (ASA I-II) adult patients for unilateral open inguinal hernia repair were included in this study. In group I (n = 30) patents received only general anesthesia (GA). Patients in group II (n = 30) received GA and unilateral TAP block with 25 ml of 0.5% ropivacaine and the patients in group III (n = 30) received GA and unilateral TAP-D block with 25 ml of 0.5% ropivacaine + 4 mg Dexamethadsone. In this study we assessed the pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after the operation and the total analgesic consumption of morphine over 24 hours. Results: There were statistically significant differences in the VAS scores between group I, group II and group III at all postoperative time points - 2hr, 4hr, 6hr, 12hr and 24hr. (p < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in group III (5.53 1.21 mg) than in group II (6.16 2.41 mg) and group I (9.26 2.41 mg). This difference is statistically significant (p < 0.00001). Conclusion: Concerning the inguinal hernia repair we found better postoperative pain scores and 24 hours reduction of the morphine consumption in group III (GA and TAP-D block) compared with group I (GA) and group II (GA + TAP block).

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