INGUINAL HERNIA REPAIR BY THE “MESH PLUG” TECHNIQUE

2014 ◽  
pp. 40-46
Author(s):  
Doan Van Phu Nguyen ◽  
Loc Le ◽  
Van Lieu Nguyen
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Operating Time ◽  
Life Assessment ◽  
Medium Size ◽  
Mesh Plug ◽  
Indirect Hernia ◽  
Postoperative Rehabilitation ◽  
Early Return ◽  
Direct Hernia

Background:In 1989, Lichtenstein I. L., Shulman A. G., Amid P. K., and Montlor M. M. presented an idea of using Mesh Plug to repair the defect inguinal canal. The new technique quickly became accepted by surgeons all over the world for several reasons: faster overall rehabilitation, less postoperative pain, less complication, shorter stay in the hospital and early return to normal activities and work. Materials and method:From December 2011 to October 2012, 97 patients with inguinal hernia were surgically treated with 110 Mesh Plugs applied at the Surgery Unit of Hue University of Medicine and Pharmacy. Result:The patients’ mean age was 48.96±23.19. There were 60 patients over 40 years old, accounting for 61.9%, and 93 of the group were males, accounting for 95.8%. 24 cases were direct hernia, accounting for 21.8%, 86 cases were indirect hernia accounting for 78.2% and 11cases were direct hernia associated with indirect hernia. Based on Nyhus’s classification, there were 76 cases of IIIA and IIIB (69.1%). Based on the position of protrusion, there were 66 cases of right inguinal hernia (60.0%), 44 cases of left inguinal hernia (40.0%), and 13 cases of hernia on both sides. The average size of the deep ring is 2.19±1.54cm. 65 cases used Mesh Plug of medium size (59.1%). The mean operating time was 37.26 minutes. The time of staying in the hospital was 3.58±1.17 days. Quality of life assessment after the surgery showed 93 very good and good cases 95.8% and 4 cases (4.2%) with satisfactory result. No case of bad outcome was recorded. Conclusion: Surgical treatment of inguinal hernia by the Mesh Plug technique is really effective, safe with faster postoperative rehabilitation, less postoperative pain, less complications, shorter hospital stay and early return to normal activities and work. Key words: Inguinal hernia, Mesh Plug.

EARLY RESULTS OF INGUINAL HERNIA REPAIR BY THE “MESH PLUG” TECHNIQUE

2012 ◽  
pp. 43-51
Author(s):  
Doan Van Phu Nguyen ◽  
Loc Le ◽  
Van Lieu Nguyen
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Operating Time ◽  
Life Assessment ◽  
Medium Size ◽  
Mesh Plug ◽  
Postoperative Rehabilitation ◽  
Early Return ◽  
Early Results ◽  
Average Size

Background: In 1989, Lichtenstein I. L., Shulman A. G., Amid P. K., and Montlor M. M. presented an idea of using Mesh Plug to repair the defect inguinal canal. The new technique quickly became accepted by surgeons all over the world for several reasons: faster overall rehabilitation, less postoperative pain, less complication, shorter stay in the hospital and early return to normal activities and work. Materials and method: From Dec 2011 to July 2012, 42 patients with inguinal hernia were surgically treated with 48 Mesh Plugs applied at the Surgery Unit of Hue University of Medicine and Pharmacy. Result: The patients’ average age was 49.12±21.17. There were 25 patients over 40 years old, accounting for 59,5%, and 39 of the group were males, accounting for 92.8%. 10 cases were direct hernia, accounting for 20.8%, and 38 cases were indirect hernia accounting for 79.2%. Based on Nyhus’s classification, there were 33 cases of IIIA and IIIB (68.8%). Based on the position of protrusion, there were 30 cases of right inguinal hernia (62.5%), 18 cases of left inguinal hernia (37.5%), and 6 cases of hernia on both sides. The average size of the deep ring is 2.16±1.64cm. 24 cases used Mesh Plug of medium size (54.5%). The mean operating time was 35.75 minutes. The time of staying in the hospital was 3.52±1.14 days. Quality of life assessment after the surgery showed 46 very good and good cases 95.8% and 2 cases (4.2%) with satisfactory result. No case of bad outcome was recorded. Conclusion: Surgical treatment of inguinal hernia by the Mesh Plug technique is really effective, safe with faster postoperative rehabilitation, less postoperative pain, less complications, shorter hospital stay and early return to normal activities and work.

scholarly journals Comparison of Totally Extraperitoneal versus Transabdominal Preperitoneal repair of inguinal hernias

2020 ◽  
Vol 23 (2) ◽  
pp. 47-51
Author(s):  
Rohit Prasad Yadav ◽  
Manish Gautam ◽  
Ashok Koirala ◽  
Sameer Bhattarai ◽  
Sachhidanand Shah ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Operating Time ◽  
Total Duration ◽  
Recurrent Inguinal Hernia ◽  
Transabdominal Preperitoneal ◽  
Significant Difference ◽  
Scrotal Hematoma ◽  
Duration Of Operation

Introduction: Laparoscopic inguinal hernia repair is a tension-free mesh repair that is based on pre-peritoneal approach of repair. It provides mechanical advantage to the surgeon, by being able to place a large piece of mesh and by using the natural force of the abdominal wall to disperse the intra-abdominal pressure over a large area to support the mesh. This retrospective study is aimed to study the demography of inguinal hernia and to compare operating time, complications and postoperative pain between patients undergoing Total Extrapritoneal (TEP) or Transabdominal Preperitoneal (TAPP) repair.Methods: A retrospective comparative study was conducted in patients with inguinal hernia who underwent laparoscopic repair by either TEP or TAPP, between April 2019 to July 2020 at Nobel Medical Collage Teaching Hospital, Biratnagar, Morang. Age, sex, type of hernia, duration of operation, post-operative complications, severity of pain and duration hospital stay were analyzed between two groups of patients undergoingsurgery by either TEP or TAPP.Results: One hundred and five patients underwent either TEP or TAPP during study period. There were 96 males and 9 females. There were 50 patients with right, 40 with left and 6 patients with bilateral inguinal hernia. Four patients had left sided irreducible inguinal hernia, 2 patients had bilateral recurrent inguinal hernia, 2 patients had right sided recurrent inguinal hernia and 1 patient had left sided recurrent inguinal hernia.There was significant difference in duration of operation (TEP 64.43min) / (TAPP 84.46min), p<0. 001. Total duration of hospital stay and postoperative pain were not significant between patients operated with TEPor TAPP. Accidental pneumoperitoneum was noticed in 8 cases, 10 cases of subcutaneous emphysema, 5 cases of seroma and 1 case of scrotal hematoma in TEP group. In TAPP group scrotal hematoma occurred in 4 cases and seroma in 5 cases which was not significantly different from TEP group.Conclusion: TAPP had significantly longer operating time as compared to TEP. However, there was no significant difference in post-operative pain and hospital stay in both group.

scholarly journals Evaluation of Outcome Between Excisional Haemorrhoidectomy and Longo's Technique (PPH)

2019 ◽  
Vol 17 (2) ◽  
pp. 66-72
Author(s):  
Md Atiar Rahman ◽  
Md Shahidul Lslam ◽  
Md Shahadot Hossain Sheikh ◽  
Md Ibrahim Siddique ◽  
Md Ahsan Ullah ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Hospital Stay ◽  
Operating Time ◽  
Normal Activity ◽  
Controlled Study ◽  
Anal Stenosis ◽  
Recurrent Prolapse ◽  
Time Frequency ◽  
Early Return ◽  
Rapid Healing

Objective: The introduction of a Longo’s technique for the treatment of haemorrhoids has the potential for less postoperative pain, a short operating time, rapid healing and an early return to full activity. The outcome of Longo’s technique was compared with that of current standard surgery in a randomized controlled study, and followed up two years. Methods: In a prospective randomized study, 140 patients requiring surgical treatment for haemorrhoids grade 2, 3 and 4 were assigned to either MMF (Milligan-Morgan, Park Ferguson) or PPH (Procedure for prolapse and haemorrhoids) 70 each. Operating time, frequency of postoperative analgesic intake, hospital stay, time to return to normal activity and postoperative complications were also recorded. Results: The Longo’s group had a shorter operating time, less frequent postoperative analgesia intake, and earlier return to normal activity. Postoperative pain at rest and during defecation was less important after PPH if no resection of external piles or skin tags was associated. After a mean follow-up of 24 months (12-46), recurrent haemorrhoidal symptoms, mostly mild and temporary, were reported after both MMF and PPH (Table-3). Four patients (5.71 %) complained of recurrent prolapse and/or external swelling after PPH, requiring re-do surgery in 3 of them between 18 to 32 months. Recurrent prolapse or external piles were also observed in 5 patients (7.14%) after MMF and re-do surgery was needed in 3 of them between 14 and 41 months. Long term patient's satisfaction after PPH was more or less same like after MMF. None of the patients had anal stenosis, incontinence, fecal urgency or sepsis. Conclusions: Postoperative pain is less after PPH. This advantage disappears if any resection is associated with the stapling. Use of a Longo's technique in the treatment of haemorrhoidal disease promotes rapid healing, shorter hospital stay and early return to normal activities. Journal of Surgical Sciences (2013) Vol. 17 (2) :66-72

scholarly journals Stapled haemorrhoidectomy versus openhaemorrhoidectomy: a prospective comparative study

2015 ◽  
Vol 4 (4) ◽  
pp. 7-11
Author(s):  
R S Bhandari ◽  
P J Lakhey ◽  
Y P Singh ◽  
P R Mishra ◽  
K P Singh
Keyword(s):  
Postoperative Pain ◽  
Comparative Study ◽  
Operating Time ◽  
Symptom Duration ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Early Return ◽  
Sh Group ◽  
Prospective Comparative Study

Open haemorrhoidectomy (OH) treatment has been reserved for prolapsing haemorrhoidal disease (third and fourth grade) and comprehends excision of haemorrhoidal tissue and is associated with significant postoperative pain. As an alternative approach, many randomized controlled trials have shown consistent advantage with haemorrhoidopexy (SH) in terms of postoperative pain, analgesic requirement, length of surgical procedure, short recovery time and early return to normal activities. This study has been conducted to compare the short-term outcome of SH with OH. A prospective comparative study, which included grade 3 and 4 haemorrhoids and comparing short Term outcomes between SH and OH was conducted in the Surgical Gastroenterology units of University Teaching Hospital. A total 44 patients, 22 in each group were compared. Age (SH 42±10.80 Vs. OH 45±13.30) and sex (SH, M:F-9:13 Vs. OH, M:F-14:8) distribution was comparable. Also, the groups were comparable in terms of symptom duration in years (SH, 3.20±2.26 Vs. OH, 2.31±2.47) and distribution of haemorrhoid grades. The SH group showed significant advantage in terms of postoperative pain (Average pain score SH, 2.73±1.20 Vs. OH, 5.20±1.91) and analgesic use (SH 2.32±0.94 Vs. OH 9.32±2.62). Similarly the operating time (time in minutes SH, 42±7.34 Vs. OH, 57.50±8.27), hospitals stay (days of stay SH, 2.90±0.68 Vs. OH, 3.77±0.86) and return to preoperative activity (days to return SH, 7.9±4.90 Vs. OH, 13.6±5.60) were also significantly shorter in the SH group than the OH group. The short-term complications were similar in both groups (P value >0.05). In conclusion, SH has better short-term outcome compared with OH and SH is a viable addition to the therapy options available for haemorrhoids.DOI: http://dx.doi.org/10.3126/jcmc.v4i4.11956

scholarly journals A comparative study of inguinal hernia repair: Shouldice versus Lichtenstein repair

2018 ◽  
Vol 5 (6) ◽  
pp. 2238
Author(s):  
Ram Sagar Shah ◽  
Ajay Kumar
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Wound Infection ◽  
Operating Time ◽  
Cost Effective ◽  
Lichtenstein Repair ◽  
Shouldice Repair ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Inguinal hernia is a common problem and its repair is one of the most frequently performed operation in general surgical practice. There are appreciable advantages of Lichtenstein over Shouldice repair in terms of simplicity, less time consuming and postoperative pain; there in the context of less developed countries with limited economic resources, however Shouldice repair is more cost effective and there are no differences in recurrences and other complications which would be a better proposition. The present study aims at comparing the results of Shouldice versus Lichtenstein’s repair in inguinal hernia in adult male (≥18 years).Methods: Total of fifty cases was included in this study, were equally divided into 2 groups; Group A and Group B and subjected for Shouldice and Lichtenstein mesh repair respectively. Operating time, postoperative complications as Wound infection, Seroma, Hematoma, Postoperative pain, and days of hospital stay, total costs and time to return to usual activity was noted.Results: Out of 50 patients, 36 (72%) were had indirect hernia and most of them were in between 18-29.9 years of age. There were no difference between two groups with respect to postoperative pain, Wound infection 12% and 8%, Seroma  8% and 4% and Hematoma 4% and 4% in Group A and Group B respectively. However, there is significant difference noted in operating time period in which Shouldice repair took more time (Mean time in Shouldice 84.16 min and Lichtenstein 58.80 min). There were no recurrences in either group.Conclusions: So, comparing our results of both groups, Lichtenstein repair were found to be better as it is simple procedure and is less time consuming than Shouldice repair.  However, Shouldice repair was found to be cost effective which could be an important consideration in developing countries.

scholarly journals PROFILE OF THE PATIENTS WHO UNDERWENT PROLENE HERNIA SYSTEM EXTENDED FOR INGUINAL HERNIA IN A TEACHING INSTITUTE IN SUBHIMALAYAN REGION

2020 ◽  
pp. 1-2
Author(s):  
Rohit Kumar ◽  
Arvind Bhatia ◽  
Shelja Rawat ◽  
Ritu Rawat ◽  
Shikha Rawat ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Surgical Repair ◽  
Previous History ◽  
Controlled Study ◽  
History Of Surgery ◽  
Indirect Hernia ◽  
Prolene Hernia System ◽  
Direct Hernia ◽  
History Of ◽  
Scrotal Swelling

Introduction: Worldwide, inguinal hernia repair is probably the most commonly performed general surgical procedure. Hence, a slight refinement of surgical repair of inguinal hernia would mean a substantial benefit to the patient. Aim: The study aimed to study profile of the patients who underwent Prolene Hernia System Extended (PHSE) for Inguinal Hernia in a teaching institute in Sub-Himalayan region. Materials and Methods: This was a controlled study conducted over 30 adult patients of both genders admitted at Dr RPGMC Tanda at Kangra from September 2016 to September 2017. Patients clinically diagnosed with inguinal hernias both direct and indirect on examination were enrolled in the trial after their informed consent. Results: Mean age of the patients was 54.9±13.66 years (range 30 to 80 years). 33% of the patients were elderly. All the patients were males. 43% of the patients were smokers and 53% were consuming alcohol. 20% of the patients had associated co-morbidities. 7% patients had previous history of surgery. Fifty percent of the patients had direct hernia while 33% had indirect hernia. Among 10% patients, it was bubonocele type. Seven patients had complications. Scrotal swelling was the most common welling (n=3) followed by inguinodynia (n=2), and seroma formation and urinary retention in one patient each. Conclusion: PHSE for management of inguinal hernia is associated with better outcomes.

scholarly journals Comparison of laparoscopic totally extraperitoneal mesh hernioplasty with Lichtenstein tension free mesh hernioplasty

2019 ◽  
Vol 6 (10) ◽  
pp. 3590
Author(s):  
Abhishek Thakur ◽  
Dhruv Kumar Sharma ◽  
K. J. S. Jaswal
Keyword(s):  
Inguinal Hernia ◽  
Laparoscopic Surgery ◽  
Postoperative Pain ◽  
Operative Time ◽  
Recurrent Inguinal Hernia ◽  
Lichtenstein Repair ◽  
Tension Free ◽  
Tep Repair ◽  
Early Return ◽  
Mesh Hernioplasty

Background: The purpose of the study was to observe the differences between the two methods of inguinal hernia repair in terms of operative time, postoperative pain, need for analgesia, hospital stay and postoperative complications.Methods: This prospective study conducted in the department of Surgery, IGMC Shimla, included 40 patients of inguinal hernia who were randomized to TEP and Lichtenstein tension free mesh hernioplasty groups randomly. After thorough clinical examination, whereas all patients with unilateral incomplete inguinal hernia fit for laparoscopic surgery were included in the present study, those with bilateral inguinal hernia, unwilling for laparoscopic surgery or who had complicated and recurrent inguinal hernia, poor cardiopulmonary reserve or were immunocompromised were excluded from the study.Results: Laparoscopic TEP is significantly lengthier procedure than open Lichtenstein repair especially in the learning phase as the mean operative time of TEP repair was 75.6 minutes and that of open Lichtenstein repair was 54 minutes. Not only postoperative pain recorded by using VAS was significantly less in the in the first 4 postoperative hours there was significantly less consumption of post-operative analgesic in TEP as compared to Lichtenstein group. No major complications in either group but only minor complications were observed in TEP group.Conclusions: TEP can be recommended to those desiring better cosmetic results and early return to work as TEP was found to be associated with less pain in the first 4 hours after surgery. 

scholarly journals A clinical study of inguinal hernia with special reference to laparoscopic trans-abdominal pre peritoneal repair

2016 ◽  
Vol 4 (1) ◽  
pp. 282
Author(s):  
Suraj Singh ◽  
Rajkumar Prakash ◽  
Vasundhara Singh
Keyword(s):  
Inguinal Hernia ◽  
Clinical Study ◽  
Hernia Repair ◽  
Abdominal Cavity ◽  
Operating Time ◽  
Abdominal Viscus ◽  
Conversion To Open Surgery ◽  
Early Return ◽  
Operative Complications ◽  
Post Operative Complications

Background:Hernia may be generally defined as the protrusion of an abdominal viscus outside the abdominal cavity through a natural or acquired defect. Latin meaning of the word “hernia” is tear or rupture. A Clinical study on inguinal hernia is undertaken to assess the incidence of inguinal hernia in relation to age, gender and occupation, the different types and modes of clinical presentation of patients, the management of patients with special consideration to laparoscopic (TAPP) repair, to evaluate the operating time, pre-operative and post-operative complications, duration of hospital stay, time taken for recovery, recurrence rate and limitations with respect to laparoscopic TAPP repair.Methods: This is a prospective study of 54 cases of inguinal hernia admitted and underwent surgery for inguinal hernia in Department of General Surgery in Guwahati Medical College and Hospital during the study period of August 2014 to July 2015.Results:The highest number of cases presenting with inguinal hernia were over 45 years and it was more common in males which constituted 96.3 percent of cases. It is more common on right side and indirect hernia is more common than direct hernia. The major possible risk factors are smoking and strenuous work. The commonest presenting mode was swelling followed by swelling with pain. The mean time taken for TAPP was 91.85±15.85 minutes and the median time was 87.50 minutes. There were no intra operative (neurovascular, visceral) complications in any of the patient and there was no conversion to open surgery. There was no mortality in present study and none of the patient had any testicular complication.Conclusions:Laparoscopic hernia repair is associated with steep learning curve for surgeons and is more costly both to patients and health care system in the present scenario. Laparoscopic TAPP hernia repair is found to have encouraging results which is a safe and viable option for repair of inguinal hernia with less postoperative pain and discomfort, improved cosmesis, less post-operative complications and early return to work.

scholarly journals Late-Onset Bowel Strangulation due to Reduction En Masse of Inguinal Hernia

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Ikuo Watanobe ◽  
Noritoshi Yoshida ◽  
Shin Watanabe ◽  
Toshirou Maruyama ◽  
Atsushi Ihara ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Late Onset ◽  
Daily Practice ◽  
Indirect Hernia ◽  
Incarcerated Hernia ◽  
Incarcerated Inguinal Hernia ◽  
Long Period ◽  
Manual Reduction ◽  
Direct Hernia ◽  
Bowel Strangulation

Incarcerated inguinal hernia is often encountered by surgeons in daily practice. Although rare, hernial reduction en masse is a potential complication of manual reduction of an incarcerated hernia. Manual reduction was performed in a case of Zollinger classification type VII (combined type) hernia in which the indirect hernia portion included an incarcerated small intestine. This procedure caused hernial reduction en masse, but this went unnoticed, and the remaining portion of the direct hernia in the inguinal region was treated surgically by the anterior approach. Because the incarcerated small bowel that had been reduced en masse was not completely obstructed, the patient’s general condition was not greatly affected, and he was able to resume eating. Twenty days after surgery, he developed sudden abdominal pain as a result of gastrointestinal perforation. When performing manual reduction of an incarcerated hernia in cases after self-reduction over a long period, the clinician should always be aware of the possibility of reduction en masse.

scholarly journals 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

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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