Giant Inguinoscrotal Hernia

The following article devoted to the case of surgical treatment of giant inguinoscrotal hernia of a patient which signed the informed consent to the processing of personal data with dimensions of hernial sac 400x330x306 mm, size of hernial gates 9x8x7cm, loops of the small intestine, mesentery, a large number of heterogeneous liquid up to 14.7 L were determined in the hernial sac. Left herniotomy was performed. Back wall plastic of the inguinal canal was performed according to Liechtenstein. Mesh implant was used for the plastic.

A comparative prospective study of laparoscopic guided needle assisted hernial sac ligation versus open herniotomy surgery in congenital inguinal hernia management

Background: To evaluate if significant difference exists in surgical outcome following laparoscopic guided needle assisted congenital hernial sac ligation versus conventional open Herniotomy as later is treatment of congenital hernia and laparoscopy guided emerged as newer alternative. Objective was to know whether a significant difference exists in surgical outcomes following laparoscopic guided needle assisted congenital hernial sac ligation and conventional herniotomy in terms of mean operative time, post operative pain, recurrence, local complication, cosmetic results.Methods: Patients were randomized on basis of odd and even registrations for surgery in our institute. Patients who undergone laparoscopic guided needle assisted congenital hernial sac ligation or who undergone conventional open herniotomy for congenital hernia between November 2018 to April 2020 (50 in each arm) were followed for 1, 3, 6 and 12 months to evaluate the outcomes.Results: In our study, major complication in open herniotomy group was surgical site infection (22%), hematoma (10%), intra operative bleeding (16%), seroma formation (8%) with minimum operative duration was ~60 minutes, hospital stay of 2-3 days while no such complication reported in laparoscopic guided needle assisted hernia sac ligation group being operative time of ~20 minutes, hospital stay of 1 day with better cosmetic results.Conclusions: We conclude that laparoscopic guided needle assisted hernial sac ligation is simple, safe, efficacious with its own advantage in comparison to conventional open herniotomy and should be acceptable alternative to traditional open herniotomy approach for congenital hernia.

Lipogranulema of the hernia sac. Clinical case

Lipogranulomas in surgical practice, are the most often encountered in the mammary glands, penis and facial area associated with subcutaneous injections for cosmetic purposes of various types of fillers that cause chronic granulomatous inflammation. Atypical localization occurs due to the development of reactions to foreign bodies after traumatic injuries and reactions to suture material used in surgical interventions. The article presents a clinical case of revealing a large peritoneal lipogranuloma localized in the area of the hernial sac in a patient who 7 years ago suffered from endometrial cancer and underwent extirpation of the uterus using median incision access. Subsequently, the patient was treated for a long time in an outpatient care because of the ligature abscesses with the formation of fistulas; several rough ligatures were removed from the subcutaneous tissue. Lipogranuloma, found in the wall of the hernial sac measuring 15 × 6 × 5 cm, covered from all sides with an unaltered peritoneum, contained a cystic cavity with a light fluid, thick synthetic ligatures of a braided structure were present in the cyst wall. The use of large-diameter braided non-absorbable sutures for suturing the peritoneum does not meet modern requirements for the use of suture material and can cause complications.

Method of internal drainage of seroma after hernioplasty

A method for allohernioplasty of indirect inguinal hernia has been developed, in which an additional layer consisting of the peritoneum of the hernial sac is formed between the spermatic cord and the mesh. The peritoneal flap prevents direct contact between the mesh and the spermatic cord and ensures rapid absorption of inflammatory serous fluid. The manifestations of implant-associate inflammation of the spermatic cord and persistent seromas decrease in the tissues. The method was applied in 25 patients in the period from 2017 to 2021.

A case of congenital hernia

Joining the view of H. M. Nikolaev that every case of deformity that occurs should be studied within the limits of modern possibility, we decided to publish our case of congenital hernia with contents in the hernial sac of the liver, spleen and intestines, as a deformity that, judging by the literature available to us, is infrequent.

Transverse Testicular Ectopia: A Rare Case Report

Transverse testicular ectopia (TTE) is a rare but well-known congenital anomaly that occurs 1 in 4 million in which both testes migrate toward the same hemiscrotum. In most of the cases it is an intra-operative finding, but preoperative diagnosis can be made by careful history taking, physical examination and imaging studies. Further evaluation is very important because it can be associated with other congenital anomalies. We report a case of TTE in a 32 years old male who presented with sudden painful swelling in right inguinoscrotal region. Physical examination revealed right sided obstructed inguinal hernia and left sided non palpable testis with underdevelopment of left hemiscrotum. On exploration, one testis is found within the hernial sac and the other testis within scrotum of same side. The testis which was already in right side of scrotum was kept in same place and the other testis which was found within hernial sac was kept in subdartos pouch at the root of right side of scrotum. Faridpur Med. Coll. J. 2021;16(1):52-54

Cases of retrograde infringement in a "sliding" hernia

The concept of retrograde infringement is understood as infringement of one or more loops of the intestines, in which an eating disorder involves not only the parts in the hernial sac into suffering, but also, and to a greater extent, especially the part located in the free abdominal cavity. This, rare, form of infringement by Bendel was given the name Hernie en W, since in typical cases there are two loops in the hernial sac outward from the restraining ring, and inwardly from it in the abdominal cavity one connecting with a more severe eating disorder, depending on its bending mesentery or twisting of the entire loop. It is extremely rare that the median loop is little changed in comparison with the two in the hernial sac (the case of Nevsky).

A case of wrong diagnosis of paraesophageal hernia in a patient with a white line hernia

Among all the anatomical variants for the hiatal hernia development, a true paraesophageal hernia is the most rare. The clinical manifestations of this type of hiatal hernia are caused by the infringement of the diaphragmatic crus or by transient obstruction of the esophagus with the development of organic dysphagia. The leading method of instrumental diagnostics of this pathology is contrast x-ray study of the esophagus and stomach with functional tests. The article describes a clinical case of an incorrect interpretation of the symptoms of the disease and the results of EGD in favor of paraesophageal hernia in association with GERD in a patient with a large white line hernia under conditions of migration into the hernial sac of the stomach and duodenum.

RESULTS OF THE METHOD OF TOTAL EXTRAPERITONEAL ENDOSCOPIC ASSISTED HERNIA SAC LIGATION IN CHILDREN WITH INGUINAL HERNIA (PHELPS)

The aim of the study was to evaluate the effectiveness of the new technology for laparoscopic treatment of inguinal hernia (IH) in children (PHELPS) in comparison with the popular extraperitoneal SEAL technique. Materials and methods of research: a retrospective comparative single-center non-randomized study was carried out. The analysis of the results of laparoscopic treatment of 680 patients with IH was performed, out of them 206 patients were operated on using the new PHELPS technique, in 474 cases the laparoscopic extraperitoneal SEAL technique was used. The gender composition of patients in the groups did not differ statistically significantly (m/f: 151/55–73.3%/26,7% versus 349/125–73.6%/26,4%, p=0,929). The median age of children in the PHELPS group was 169,5 [80,8; 261,3] days, in the SEAL group – 210,5 [78,0; 258,0] days (p=0,137). The difference between the new technique for treating IH in children consisted in the method of carrying out a hernial ligature around the neck of the hernial sac in such a way that the knot after percutaneous tying was located at the level of the peritoneum and did not include the tissues of the abdominal wall (aponeurosis and muscles). At the end of the study, a comparison of demographic data, intra- and postoperative results in the two groups of patients was made. Results: the median of the total duration of inguinal herniorrhaphy, including the operation time in patients with single and double sided hernia localization, confirmed statistically unchanged values of this indicator in the comparison groups (20,0 [15,0; 20,0] min versus 15,0 [15,0; 20,0] min, р=0,518). The study demonstrated a faster recovery of patients after using the PHELPS technique for the treatment of IH, with a statistically significantly lower number of doses of postoperative analgesia (1,0 [1,0; 1,0] versus 1,0 [1,0; 2,0 ], p<0,001) and a shorter hospital stay (8,0 [6,0; 8,0] hours versus 8,0 [8,0; 9,0] hours, p=0,031). Despite the fact that there were no statistically significant differences in the frequency of formation of dropsy of the testicle (0 (0,0%) versus 6 (1,3%), p=0,185), a statistically significantly better condition of patients was revealed as a result of the use of the innovative PHELPS technique, consisted in the absence of the return of symptoms of the disease – 0 (0,0%) versus 17 (3,6%), p=0,003. Conclusion: the new PHELPS method of treating IH in children allows to improve the quality of known extraperitoneal methods of treating the disease. The placement of a hernial ligature node at the level of the hernial sac neck, rather than over the aponeurosis, is expected to lead to a decrease in the number of relapses after surgery.