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.

SCIENTIFIC STUDY OF VITAP MARMA

Marma is a vital point of the body where trauma or injury may cause a various range of signs and symptoms from Ruja (pain) to even death. Ayurvedic Acharya’s has explained 107 Marma” that are present in the anterior and posterior aspect of the human body. Depending upon the effect of injury on Marma is five types like Sadhyo pranhara, Kalantara pranhara, Vishlyaghna, Vaikalykara & Rujakara Marma. Out of them, Vaikalykar Marma are the points where an injury causes structural or functional deformity. Another type of classification of Marma has also been made as Mamsa (muscle) marma, Sira (artery/vein) marma, Snayu (ligament) marma, Asthi (bone) marma and Sandhi (joint) marma. The Vitap Marma is placed under the Snayu Marma by Acharya Sushrut and Sira Marma by Acharya Vaghbhata. Vitap Marma is situated between Vankshan (Groin) and Vrishna (Testes) and the Viddha lakshan (symptoms of trauma) is Shandata (impotency) and Alpashukrata (oligospermia). The struc- ture present at this point is the inguinal canal. The clinical importance of the inguinal canal is related to the inguinal hernia. Direct or indirect Injury at this particular point affects the physiology of the reproductive system and may cause sterility, which is similar to Viddha lakshan of Vitap marma as described by Sushrut. Keywords: Vitap marma, Vaikalyakar marma, Inguinal canal, Spermatic cord, round ligament

P114 ROBOTIC INGUINAL HERNIA REPAIR (RTAPP): ANATOMY LESSONS AND RESULTS OF A CASUISTIC OF 302 OPERATED HERNIAS

Aim The purpose of this study is to apply the resources of robotics to inguinal hernia repair (r-TAPP) and to investigate where specific optimizations to the surgical technique of can be achieved. Material and Methods The results of 302 consecutive r-TAPP surgeries performed over an 18-month period are presented. It is a cohort study without a control group. The study was approved by the ethics committee (Ref. No. 2019-02046). Decisions on interventions (suturing of the transverse fascia or fibrin glue sealing of the inguinal canal) and mesh size were made intraoperatively. Patients were followed up six weeks postoperatively. Results In every fourth patient, a femoral, obturator, or Spieghel hernia was diagnosed in addition to symptomatic inguinal hernia. Mesh fixation with absorbable suture at 4 points was matured. The operative time averaged 71 minutes for unilateral, 103 minutes for bilateral and 95 minutes for unilateral recurrent hernias. 48% of procedures were performed by residents. Seroma incidence decreased from 15.0% in the first period to 5.1% in the third study period. None of the patients experienced pain symptoms due to nerve lesion. The study provided new clarity about the blood supply patterns of the lipoma, the course of the genital branch and the constitution iliac fascia. Conclusions Suturing of the transversal fascia, fibrin glue sealing of the inguinal canal, and suture fixation of the mesh are steps who must be validated in future studies. Robotics provides optimal conditions for residents training, without learning curve on the patient and with predictable OR times. Postoperative seroma formation and complication rate of r-TAPP are low.

Radical direct inguinal hernia surgery

E. Balogh (Zentrbl. F. Chir. No. 44/1929) suggests, when opening the inguinal canal, to dissect longitudinally the fascia transversa and separate it from all sides as far as possible from the underlying preperitoneal fatty tissue. Then, on the inside of the transverse fascia, apply a purse-string suture, removing the peritoneum with the instrument inward. Further, the operation ends, typically according to Basini.

Right Transverse Testicular Ectopia: A Nonclassified Variant Confirmed on Laparoscopy

Transverse testicular ectopia is a rare anomaly characterized by testicular descent into the scrotum through the same inguinal canal. Here, we report the case of a 15-year-old boy diagnosed with transverse testicular ectopia wherein both testes descended through separate inguinal canals. He underwent a diagnostic laparoscopy which helped to identify both spermatic cords entering both inguinal canals separately. During scrotal exploration, both testes were found in the same side. Transseptal orchidopexy was performed. The short-term follow-up is uneventful.

EP.TH.96Recurrent Retroperitoneal Liposarcoma Presenting as Irreducible Inguinal Hernia

Introduction Retroperitoneal sarcomas protruding though the groin are extremely rare with only about 12 cases reported in the past 31 years to our knowledge. . As the retroperitoneal space communicates with the inguinal canal, large lipomatous tumors, may protrude through this natural weak spot which may present as irreduciible inguinal hernia. Case Report We report a 43 year old male, previously operated for retroperitoneal liposarcoma with 4 cycles of adjuvant chemotherapy and 5 cycles of radiotherapy 4 years back now presented with irreducible inguinal hernia. On examination, a firm fixed mass of about 15 x 10 cm, with indistinct margins was palpable in right hemiabdomen, abdomen was soft with audible bowel sounds. A firm swelling of 8 x 5 cm in right inguinal region extending into scrotum with no cough impulse was also present. On CT imaging a large mixed density lesion noted in Right lower abdomen measuring 16.2 x 14.8 x 23.5 cm. It showed internal fat and solid components and recurrence with herniation through right inguinal canal which is a rare entity. The patient was treated symptomatically, bilateral DJ stenting was done by the urology team and the patient was prepared for debulking surgery. Patient was classified as ASA IV. Unfortunately, the patient died 6th post admission day secondary to cardiopulmonary arrest. Conclusion A retroperitoneal tumor especially a liposarcoma should be ruled out in a large, painless, non-reducible inguinal mass with abdominal complaints. Patients need regular follow up after resection of retroperitoneal liposarcoma for early detection of recurrence.

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.