Quality of life of patients after inguinal hernioplasty by endoscopic methods

A comparative analysis of the indicators of 53 men who underwent inguinal hernioplasty using the TEP (n = 20) and TAPP (n = 33) methods was carried out. Quality of life was assessed using the international questionnaire EQ-5D on the 1st day, 1 month and 12 months after surgery. Monitoring of quality of life parameters showed differences in the assessment of their condition by patients who underwent TEP and TAPP, which were most pronounced on the first day after surgery. The presence of problems during this period for all components of the EQ-5D questionnaire, to a greater extent, was associated by patients with pain / discomfort in the operation area. The latter were maximally manifested in the majority of those who underwent TAPP (64%), which also affected their lower assessment of their health status. The revealed differences disappear within a month after the interventions and are absent 12 months after the operation. Key words: quality of life, inguinal hernioplasty, endoscopic methods.

Endovideogernioplasty in patients with inguinal hernias: advantages and disadvantages

This study analyzed the results of treatment of patients with inguinal hernias, with an assessment of the advantages and disadvantages of endovideosurgical hernioplasty techniques. The clinical study used the data of 1317 patients with inguinal hernias. The results revealed that the totally extraperitoneal inguinal hernia repair had some advantages over laparoscopic hernioplasty, such as a shorter duration of surgery (43 15 min), mild pain on a visual analog scale, and an average bed-day after surgery. Complications were diagnosed in 16 (1.2%) patients, and most had ClavienDindo grade II complications. Relapses were detected in 7 (0.5%) cases. Thus, endoscopic hernioplasty (laparoscopic and totally extraperitoneal inguinal hernioplasty) was the preferred surgery for patients with bilateral inguinal hernia, recurrent hernia after traditional hernioplasty, and metabolic syndrome and young people of working age. The use of a modified technique of totally extraperitoneal inguinal hernioplasty with a clear understanding of the multifascial structure of the anterior abdominal wall may reduce the risks of both intraoperative and postoperative complications and increase the cost-effectiveness of treatment of patients with inguinal hernias, allowing us to obtain good results.

P078 SURGICAL PLANNING WITH 3D TECHNOLOGY UN PATIENT WITH MORGAGNI HERNIA AND INGUINAL HERNIA

Aim The use of 3D technology is increasingly used for surgical planning in cases of complex surgery. In the case of the abdominal wall, its use is not very widespread. In this video we present the case of a patient with inguinal hernia and Morgagni hernia in which 3D planning provided us with multiple benefits Material and Methods 71-year-old patient awaiting intervention for right inguinal hernia, presenting progressive dyspnea, abdominal pain and vomiting. A thoraco-abdominal CT scan was performed, which reported a Morgagni hernia containing the transverse colon and omentum. Due to 3D planning, we were able to obtain the abdominal and hernial sac volumes, evaluate the hernial orifice and its relationship with the adjacent structures. Results Laparoscopic repair of the Morgagni hernia was performed by reducing the hernial content, placement of visceral contact mesh fixed with resorbable tackers. In the same surgical act, an inguinal hernioplasty was performed via TAPP. The postoperative period was correct, without complications, and the patient was discharged after 3 days. Two years after the intervention, the patient remains asymptomatic. Conclusions The use of 3D technology for surgical planning facilitates the repair of complex hernias, helping us to assess the surgical indication, hernial volumes and hernial content. Good surgical planning facilitates the performance of the intervention through minimally invasive surgery, in this case two hernias were repaired in the same surgical procedure and with the same incisions, which facilitated the recovery of the patient.

P066 ELECTIVE LICHTENSTEIN INGUINAL HERNIOPLASTY IN GERIATRIC PATIENTS WITHOUT ANTIBIOTIC PROPHYLAXIS : HOW SAFE IS IT ?

Aim Elective surgery is becoming increasingly common in geriatric patients, particularly as the population is aging. The incidence of inguinal hernia in the elderly is also increasing. Lichtenstein inguinal hernioplasty is the most frequent procedure for the elective repair. There is ambiguity about the usefulness of antibiotic prophylaxis in inguinal mesh hernioplasty and the evidence for its value is still a matter of debate. Our aim was to evaluate the outcomes of Lichtenstein inguinal hernioplasty without antibiotic prophylaxis in geriatric patients. Material and Methods A database of patients aged 70 and more undergoing elective Lichtenstein inguinal hernioplasty was established. Patients were randomly categorized in antibiotic (received antibiotics) and placebo group (received placebo). Demographics, American Society of Anesthesiologists (ASA) classification, comorbidity, hernia type, operating time and hospitalisation were analyzed. Infections were evaluated 1 week, 2 weeks and 1 month postoperatively according to Center for Disease Control criteria. Results Between 2015.-2019., 400 patients were evaluated, 200 patients in each group. All patients were operated under local anaesthesia with 24-hours hospitalisation. Groups were well matched regarding demographics, ASA-type, comorbidity, hernia type, operation time. Superficial surgical site infection developed in 16 patients from the antibiotic and 19 from the placebo group. Three from each group developed deep infection. Two mesh removal was required in the placebo group. Conclusions Prophylactic antibiotic usage in geriatric patients undergoing Lichtenstein inguinal hernioplasty did not show any significant beneficial efects in reduction of surgical site infection. Our results do not support the routine use of antibiotics for elective inguinal hernioplasty.

Prospective study to evaluate the value of Identification of nerves crossing inguinal canal during inguinal mesh hernioplasty

Background Long-term morbidity associated with open inguinal hernia repair mainly consists of postoperative chronic pain. The mechanism responsible for the development of this postoperative pain is thought to be the entrapment, inflammation, and fibrotic reactions of the nerve around the mesh. Aim of the Work To analyse and provide comprehensive data on their incidence (identification rates), anatomical characteristics, and possible sources of heterogenecity, to decrease the risk of iatrogenic injury/ entrapment to these nerves during inguinal hernioplasty. Patients and Methods This study identified 40 patients who underwent inguinal hernia repairs with either routine repair or nerve identification and preservation. As several studies point out, a nerve-recognizing procedure is a logical step for minimizing postoperative groin pain. Such an approach can be advocated for two reasons: identification of the nerves for preservation or for performing standard neurectomy in case of interference with the position of the mesh. Results In the present study, there was no difference in pain scorings at one or 3-months after repair between different surgical techniques in patients undergoing open repair of a primary inguinal hernia. In present work, in addition to identifying and preserving all neural structures, specific maneuvers have been adopted for preventing postherniorrhaphy inguinodynia Conclusion The results indicated that routine nerve identification and preservation was associated with a significantly lower incidence of postoperative neuralgia compared with no nerve identification.

Mesh Migration into Sigmoid Colon after Inguinal Hernioplasty Presenting as Lower Abdominal Mass: A Case Report

Mesh related visceral complications are, in general, considered to be infrequent and rarely reported in literature, but in the last decade, incidence of such complications have increased. Our study highlights the case of an elderly patient, who developed rare complication of Mesh migration after laparoscopic inguinal hernioplasty.

Outcome of Prolene Sutures and Skin Staples for Mesh Fixation in Inguinal Hernioplasty - A Comparative Study

<p><strong>Background and Objective:</strong> Inguinal hernia is one of the most common type of hernia affecting both genders. New surgical interventions to repair hernia are being developed for the better outcome of patients by reducing the operative time and postoperative complications. The objective of this study was to compare the prolene sutures and skin staples for mesh fixation in inguinal hernioplasty with mean operative time and post-operative pain as outcome determinants.</p> <p><strong>Methods:</strong> This randomized controlled trial was conducted in the Department of General Surgery, DHQ Teaching Hospital, Sahiwal Medical College, Pakistan from January 1st, 2019 to December 31st, 2019. A total of 180 patients admitted for hernioplasty were recruited after institutional ethical approval. The study participants were randomized into group A and B. Mesh fixation was done by using prolene suture in group A, while skin staples were used in group B. The duration of procedure and post-operative pain after 1 week was noted using visual analogue scoring system. The comparison between groups was done through independent sample t-test. p-value &lt; 0.05 was considered to be statistically significant.</p> <p><strong>Results: </strong>Mean age of the patients in group A and B was 39.21 &plusmn; 11 years and 40.16 &plusmn; 5.72 years respectively. The mean operative time was 52.15 &plusmn; 9.78 minutes in group A and 36.92 &plusmn; 3.95 minutes in group B (p = 0.000). Post-operative pain after 1 week was reported in 26.7% cases in group A while it was seen in only 10% cases in group B (p = 0.004).</p> <p><strong>Conclusion:</strong> The outcome determinants of mean operative time and postoperative pain after inguinal hernioplasty were better achieved in cases treated by skin staples as compared to prolene sutures.</p>

PATHOHISTOLOGICAL PRERECONDITIONS FOR DEVELOPMENT OF COMPLICATIONS AND R ECURRENCES I N INGUINAL HERNIOPLASTY

Summary. Inguinal hernioplasty is the most frequently performed surgical operation in the world, but the level of complications still reaches 11 % and of recurrences — 5 %. According to some authors, the reason may be in chronic inflammatory changes of the hernia sac and perihernial tissues. Aim. To study the pathohistological changes of the hernia sac and perihernial tissues of patients with inguinal hernias for development of adequate methods of complications prophylactics. Material and methods. The pathohistological examination of fragments of hernial sac and perihernial tissues of 24 patients with groin hernias was performed. Results and discussion. The investigation detected the signs of chronic inflammation in fragments of tissue of hernial sac in all patients. In 8 (33,3 %) patients the signs of inflammation were found only in fragments of hernial sac, and in 16 (66,7 %) – they were combined with the inflammation of perihernial tissues. Among them, the pronounced signs of chronic inflammation were found in 6 (25,0 %) patients with recurrent groin hernias, they were combined with the pronounced scarring changes of hernial sac and perihernial tissues. Conclusions. 1. Chronic inflammatory changes of the hernia sac and perihernial tissues are among the reasons for the development of postoperative complications and recurrences. 2. An important component of prevention of complications can be use of antibacterial and anti-inflammatory drugs.

TO COMPARE THE DURATION OF SURGERY IN SINGLE DOSE INTRAVENOUS ANTIBIOTIC PROPHYLAXIS OVER NO ANTIBIOTIC PROPHYLAXIS IN THE PREVENTION OF WOUND INFECTION FOLLOWING LICHTENSTEIN TENSION FREE INGUINAL HERNIOPLASTY

Background: We conducted a study to compare the duration of surgery in single dose intravenous antibiotic prophylaxis over no antibiotic prophylaxis in the prevention of wound infection following Lichtenstein tension free inguinal hernioplasty Methods: This prospective study was conducted in the Department of Surgery, Dr. Rajendra Prasad Government Medical College Kangra at Tanda from May 2018 to December 2019after being approved by institutional protocol review committe and ethics committee.50 patients were included in the study.These patients were randomised into two groups i.e. Group A (Antibiotic Group) and Group B (Non-antibiotic Group). Results: The mean duration of surgery in Antibiotic group (Group-A) was 56.6±15.66 minutes whereas it was 50.2±9.62 minutes in Non-antibiotic group (Group-B). The mean duration of surgery was more in Antibiotic group (Group-A) as compared to Non-antibiotic group (Group-B), however the difference was not statistically significant (p= 0.088). Conclusion: In our study, we concluded that statistically insignificant difference was found in the duration of surgery in Antibiotic and Non-antibiotic Group Keywords: Duration of surgery, Antibiotic, Pre-operative