One inch incision-mesh plug repair versus laparoscopic trans-abdominal preperitoneal repair of the primary indirect inguinal hernia: a prospective comparative study

Background: Management of inguinal hernia by minimally invasive incision and minimal dissection with optimal outcomes remains an unmet need for general surgeons. The most common hernia repair procedures are Lichtenstein hernioplasty and laparoscopic hernia repair; TAPP and TEP. The modification of mesh plug repair (MPR); one inch incision-MPR (OI-MPR); could achieve optimal outcomes comparable to that of laparoscopic hernia repair. The objective of the study was to assess OI-MPR approach for management of primary indirect inguinal hernia and its outcomes in comparison to laparoscopic TAPP repair.Methods: During the period from September 2017 to March 2019, 63 patients with indirect inguinal hernia were selected randomly to one of two groups; group-A included 35 patients underwent one inch incision-mesh plug repair (OI-MPR), group-B included 28 patients underwent laparoscopic TAPP.Results: The mean operative time of group-A was 31.74±4.74 min which was significantly shorter than that of group-B (81.22±7.44 min). The mean hospital stay duration in group-A was 0.57±0.18 day and in group-B, it was 1.18±0.39 day. The patients of group-A returned to normal physical activities earlier than the patients of group-B. The duration of postoperative pain was shorter and less severe in group-A than that of group-B. Regarding complications, there was no statistically significant difference found between both groups.Conclusions: One inch incision-MPR is a simple, feasible and cost-effective approach with low morbidities and low burden on the patients and the healthcare facilities.

Management of an obstructed recurrent inguinal hernia using a hybrid method: a case report

Background For recurrent incarcerated and strangulated hernias, the optimal treatment strategy for each case is needed. Case presentation The study patient was a 70-year-old man. TAPP repair was performed for a left inguinal hernia (JHS Classification II-1) 7 years earlier. The patient experienced transient pain and swelling of the left inguinal region for 5 months and visited our emergency department for abdominal pain and vomiting. A CT scan showed a recurrent left inguinal hernia and small bowel incarceration, and emergency surgery was performed. Laparoscopic observation of the abdominal cavity revealed recurrent left inguinal hernia (Rec II-1) with small bowel incarceration. The small bowel was reduced after pneumoperitoneum, and no findings suggested intestinal tract necrosis. Adhesions around the herniated sac were dissected using an extraperitoneal approach and then shifted to mesh plug repair. No perioperative complications or hernia recurrence were observed in the 10 months after the surgery. Conclusions This report describes a novel, successful surgical treatment for a recurrent incarcerated hernia. In our patient, we could easily perform dissection and understand the positional relationship by hybrid surgery using the TEP method. Additionally, in patients with incarcerated hernias, we believe that performing hybrid surgery by combining the TEP method would be useful because bowel dilation caused by intestinal obstruction would not disturb the operative field.

Mesh Plug Technique for Umbilical and Paraumbilical Hernias Repair; A Novel Technique

Background: Umbilical and paraumbilical herniae are the most common ventral herniae occurring at or around the umbilical ring.Umbilical hernia accounts for almost 6-10% of all abdominal wall herniae. A ventral hernia is abnormal protrusion of peritoneal sacthrough the musculo-aponeurotic abdominal wall defect. Females are affected five times more as compared to males. The variousrisk factors include obesity, chronic cough and constipation, ascites and pregnancy in females.Objective: To determine the outcome of mesh plug repair of umbilical and paraumbilical hernias in terms of operative time andpostoperative complications.st Material and Methods: This study was conducted at surgical department of Khyber Teaching Hospital, Peshawar from 1 Januaryst 2012 to 31 December 2016. Total of 131 patients with umbilical and Para umbilical hernias were studied. Patients were operatedusing mesh plug technique and operative time and postoperative complications were recorded.Results: There were 91 female patients compared to 40 male patients (M/F ratio 2.2:1). The overall mean age was 41±19.3 years.The mean operative time was 23±9.2minutes. In the early postoperative period 3 patients had superficial surgical site infection.Seroma was observed in 2 patients. Mesh plug infection was observed in 1 patient while chronic pain was observed in 2 patients.None of the patients had recurrence on 24 months follow up.Conclusion: Mesh plug for small umbilical and paraumbilical hernias in adults is a safe, convenient, fast and minimally invasivetechnique with a lower rate of postoperative complications and recurrence.