OV01 A LOW-COST HERNIA MODEL FOR THE TRAINING OF THE SHOULDICE AND THE LICHTENSTEIN INGUINAL HERNIA REPAIR

Aim Based on an international European survey, residents prefer to study inguinal hernia repair through lectures or video-demonstrations or want to practice either on simulation or cadaveric models. Simulation models in inguinal hernia are scarce or expensive. Material and Methods A low-cost model was developed that can be produced everywhere with the aid of the instruction video: “How to build an inguinal hernia model”. Initially, the model was designed to practice the Lichtenstein technique but after some minor modifications (adding the conjoint tendon, enough slack in the transversalis fascia) it was also possible to practice the Shouldice technique on the same model. It only needs the removal of the stitches of the third and fourth layer before the Lichtenstein can be performed. Results The model was used for several studies with students and residents and proved to be realistic and was approved by an international survey among experienced hernia surgeons. It has been used once in a national training session of residents. Conclusions The video shows the execution of both procedures on the same model.

Comparative Study for Application of Polypropylene Monofilament Light Mesh, Polypropylene Monofilament Heavy Mesh and Self Gripping Polypropylene Mesh in Patients with Inguinal Hernia Surgically Treated with Lichtenstein Technique

Background / Objective. In our clinical study we have compared the results of intraoperative and postoperative period in patients with inguinal hernia treated operatively with Lichtenstein technique, where one of three different polypropylene meshes has been applied: polypropylene monofilament light mesh, polypropylene monofilament heavy mesh and self gripping polypropylene mesh. Follow up period have been one year. Methods. This study represents randomized, retrospective-prospective, comparative clinical study where 243 patients have been divided into three groups depends of prosthetic mesh that was applied with Lichtenstein technique. We have evaluated the connection between types of used mesh with some of followed parameters: postoperative pain intensity, postoperative patient mobilization, postoperative surgical site occurrences, duration of hospitalization, chronic pain, filling of foreign body in inguinal area and development of recurrences. Results. Patients with applied self gripping polypropylene mesh have significantly lowest pain, lowest hospital stay and lowest duration of surgical procedure than other two groups of patients. In term of chronic pain, only statistically significance we confirmed between the groups of heavy monofilament mesh and self griping polypropylene mesh, where higher number of patients from group with monofilament polypropylene light mesh reported chronic pain. In our study we confirmed that working status and patient age have significant influence on the intensity of postoperative pain in all three patients group. There is no statistical correlation between type of the mesh and surgical site occurrence rate. Conclusion. Patients with applied self gripping polypropylene mesh have significantly lowest pain, lowest hospital stay, lowest duration of surgical procedure and less number of patients experienced feeling of “foreign body” in their groin than other two groups of patients.

Urinary bladder-containing incarcerated inguinoscrotal hernia: a case report

Inguinoscrotal hernia containing the urinary bladder is a rare entity found in 1–4% of inguinal hernias, while patients rarely present symptoms of urinary dysfunction. We present the case of a 79-year-old Caucasian male with acute renal dysfunction and incarcerated inguinoscrotal hernia containing the entire urinary bladder. The patient presented in the surgical emergency department due to an incarcerated right inguinoscrotal hernia and deteriorated renal function. Preoperatively, ultrasound imaging was performed, which showed the presence of the whole bladder in the hernia sac. The bladder was repositioned to its anatomic position and hernia was repaired through a modified Lichtenstein technique. In patients with inguinoscrotal hernia and acute urinary tract symptoms, surgeons should be aware of the possibility of inguinal bladder hernia. Preoperative imaging can help in preventing intraoperative bladder damage.