Comparison of Incidence of Inguinal Hernia among Obese and Normal Individuals: A Retrospective Analysis

Objective: The objective of the present study was to verify whether obesity is associated with the occurrence of inguinal hernia. This is a cross-sectional study carried out in a tertiary hospital, including 84 patients, with clinical diagnosis of inguinal hernia, who underwent hernia mesh repair during a 6-month period (January 2021 to June 2021). Demographic, anthropometric and diagnostic data for inguinal hernia were taken from the patients' medical records. The Chi-square test was used to calculate the significance of association. Results: A total of 84 patients were included in this study. The age of patients varied between 39 - 75 years, averaging 54.8 years. The study showed an association between BMI and two factors, namely: Age (P = .023) and size of the defect (P = .005). However, hernia type (P = .797) and its content (P = 0.061) did not show such an association. Conclusion: In conclusion, these results may be a useful guide for future studies about the relationship between BMI and hernia and may provide foundation for better understanding of the pathophysiology of hernia is obese.

SP7.2.7 Consenting practice in open inguinal hernia mesh repair and compliance with the British Hernia Society Standards

Aims Inguinal hernia repairs (IHRs) are one of the most frequently performed procedures worldwide with approximately 100,000 taking place in the UK each year. This study analyses open IHR consent practice against British Hernia Society standards, in particular, whether the term ‘mesh’ and significant postoperative complications were stated on consent forms. We also identified whether adequate post operative advice was given upon discharge in order to prevent recurrence. Methods This was a retrospective audit of all patients above 18 years old, who underwent open IHR 1 January - 31st December 2019. A total of 94 patients were included. Results Although in all cases a prolene mesh was inserted, 8.5% of patients received no mention of mesh in either the clinic letter or consent form. Postoperative readmission was 5.3% at one week, and 8.5% at one month. Reasons for readmission included pain (1%), haematoma (2%), and wound dehiscence (1%). In over 90% of consent forms, non-specific complications (bleeding, infection) were documented. However, common IHR postoperative complications, such as chronic pain (not mentioned in 15%), were not mentioned in consent forms. Only 38% of patients received written postoperative advice. Conclusion Adherence to consenting standards benefits both patients and doctors. Our study highlights that further intervention is required to ensure surgeons are consenting patients adequately, as well as providing sufficient postoperative advice. We advise use of pre-filled forms and patient information leaflets, both in line with GMC guidance, to improve the quality of service offered.

Dermatome Mapping Test in the analysis of anatomo-clinical correlations after inguinal hernia repair

Background Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic neuropathic postoperative inguinal pain (CPIP) after 6 months. Material A total of 115 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between July 2018 and January 2019, were included in this prospective observational study. The mean age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). Furthermore, these patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation. Results Identification rates of the iliohypogastric (IH), ilioinguinal (II) and genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI < 25 than BMI ≥ 25 P (< 0.05). After inguinal hernia mesh repair, 8 patients (6.9%) had chronic postoperative neuropathic inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (P = 0.542). Conclusion The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI < 25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified.

A comparative study of laparoscopic technique versus open repair for inguinal hernia

Background: The repair of inguinal hernias has seen an evolution over the past few decades and more research on the same is still underway. Though laparoscopy has gained widespread acceptance in today’s era of surgery, there is still a debate between laparoscopic and open hernia mesh repair. Methods: A randomized prospective study was conducted at a tertiary care teaching hospital to compare laparoscopic hernioplasty and Lichtenstein’s open mesh repair. The study consisted of 70 subjects with unilateral or bilateral inguinal hernia and they were randomly allocated into either group. Various parameters like duration of surgery, intra and post-operative complications, post-operative pain, recurrence, stay in the hospital and resumption of daily activities were compared.Results: Out of the 70 patients, 35 underwent laparoscopic hernioplasty and 35 underwent open hernia repair. The mean operative time for laparoscopic hernioplasty (unilateral 63.44mins, bilateral 123.80mins) was greater than open hernioplasty (unilateral 47.35mins, bilateral 90.42 mins). Post-operative complications, like wound infection, seroma formation and urinary retention were noted more in the open hernioplasty group. The mean pain score for laparoscopic hernia repair was lower than open hernia repair on postoperative day 3 and 7. The average duration of hospital stay was 3.5 days in laparoscopy group and 6 days in open group. The mean duration for resumption of daily activities was 4.8 days following laparoscopic hernioplasty and 8.1 days following open hernioplasty.Conclusions: Laparoscopic hernioplasty is more beneficial than Lichtenstein’s open hernia mesh repair as it is safer, with faster recovery, lesser post-operative complications and reduced morbidity.