Desarda’s Repair Vs Lichtenstein Repair in Indirect Inguinal Hernia -Preferred technique

Aim: To compare the outcome of Desarda`s technique with that of Lichtenstein mesh hernioplasty in terms of chronic pain, recurrence and infection. Methods: A prospective comparative study with randomized controlled trial was conducted at Lahore General Hospital in Surgical Department to appraise the outcome of Desarda Hernioplasty in comparison with Lichtenstein Hernioplasty technique to evaluate recurrence, wound infection and chronic groin pain. The Desarda repair is used to treat inguinal hernia without the use of mesh. Results: Total sixty (n=60) patients were included in the study by dividing into two groups Group A and B with mean age 40.5 and 39.5 years for Desarda vs Lichtenstein groups correspondingly. Insignificant statistical difference was noted in both groups regarding wound infection but considerable statistical advantage was noted regarding recurrence and Chronic groin pain for Group A patients in comparison to Group B. Conclusion: We concluded that Desarda repair is emerging technique and cost effective with lesser pain, infection and recurrence than other techniques. Keywords: Desarda`s repair, Lichtenstein repair, wound infection, chronic groin pain and recurrence

P081 CHRONIC GROIN PAIN IN SPORTSMEN. EVIDENCE-BASED IN EXPERIENCE

Aim The main objective of this study is to describe and analyze the assessment and treatment of chronic groin pain (CGP) based on the experience collected in 20 years. Material and Methods Descriptive, observational, and retrospective study. It is a multidisciplinary team formed by surgeons, physiotherapists, orthopedists, and imaging specialists. That had developed an assessment, diagnosis, and treatment algorithm for (CGP), which have been implemented for more than 20 years. Follow-up included a record of clinical examination findings, clinical entities diagnosed, ultrasound findings, physiotherapy treatment, operation notes, and postoperative recovery, time to return to sporting activity, and complications. Results In the period between August 2000 and August 2020, we assessed 9996 patients with CGP. (91%) men and (9%) women with a mean age of 30 (SD: 11.21). The most frequently practiced sports were: football (43%), rugby (25%), tennis (12%). The most frequent clinical entities registered were tendinopathies (69%): iliopsoas-pectineus- related (36%) and adductor-related (33%). Tendinopathy sports rehabilitation treatment: (95.7%) presented total recovery in 45 days; 260 patients (4.3%)intra-tissue percutaneous electrolysis was used with favorable recovery. Only 16 patients required tenotomies The ultrasound has been used to detect signs of adductor tendinopathy (92%) and sportsman hernia, but has low sensitivity in iliopsoas-pectineus tendinopathy (21%). Conclusions The algorithm used has proven to be safe and successful. Tendinopathies and Sportsman's hernia are the most common causes of chronic groin pain in sportsmen, presenting together in 82% of the cases. TAPP hernioplasty repair, followed by physical rehabilitation offered excellent results to treat sportsman hernia.

P133 ROBOTIC ASSISTED REINFORCED BIOLOGIC AUGMENTED REPAIR (REBAR) IN INGUINAL HERNIA: TWO-YEAR OUTCOMES

Aim The objective of this study is to identify two-year recurrence and complication rates using robotic assisted reinforced biologic augmented repair (ReBAR) in inguinal hernia repair. Material and Methods A retrospective review identified all robotic inguinal hernia repairs utilizing a reinforced biologic mesh performed by a single surgeon from May 2018 through May 2019. All repairs employed the robotic transabdominal preperitoneal (rTAPP) approach combined with the ReBAR technique. Patients with prior repairs and bilateral hernias were included. All patients were followed post-operatively using secure messaging to assess outcomes, including hernia recurrence and other complications. Results A total of 57 patients undergoing the rTAPP ReBAR were identified. Of these patients, there were 18 bilateral hernias repaired for a total of 75 inguinal hernia repairs. In addition, 5 of the hernias had previously been repaired. Two-year outcomes identified 1 recurrence (1.3%) at 345 days post-operatively and one complication of small bowel obstruction requiring takeback unrelated to the ReBAR. There were no complications of chronic groin pain or seromas in this cohort. Conclusions In conclusion, the two-year recurrence rate in this population of 75 inguinal hernias repaired using the robotic assisted ReBAR was 1.3%. With low recurrence and complication rates, the robotic assisted ReBAR technique appears to be a safe and durable option for inguinal hernia repairs.

O17 CHRONIC GROIN PAIN DUE TO OR DESPITE THE HERNIA REPAIR

Aim There is a discrepancy between the high frequency of chronic post-operative pain reported in questionnaire-based studies after groin hernia surgery and the clinical experience of many surgeons in which it is infrequent that patients return after surgery because of chronic post-operative pain. This is supported by the Swedish Hernia Registry, where the proportion of patients who are re-operated for chronic post-operative pain is 0.02-0.03% for open methods and less than 0,01% for laparo-endoscopic methods. The aim of this study is to find the incidence of non-surgical causes of chronic groin pain and other patient-reported outcomes after inguinal hernia surgery. Material and Methods Prospective cohort observation study of patients evaluated for suspected inguinal hernia-related symptoms at a hernia clinic in Sweden during 1 year. Patients completed validated pain forms before surgery and 6 and 12 months after surgery. Patients were assessed preoperatively about the possible causes of groin pain according to a checklist. For this purpose, a questionnaire of inguinal hernia-related symptoms was used. Patients with moderate or severe chronic groin pain after surgery were offered to participate in a clinical examination where the pain was evaluated for probable cause according to a checklist. Results 574 patients were included in the study, of which 372 were operated on and answered the post-operative questionnaires. Preliminary results on surgical and non-surgical causes of chronic groin pain after hernioplasty and other patient-reported outcomes will be presented at Hernia 2021 EHS-AHS Joint Congress. Conclusions Proportion of patients with chronic groin pain related to groin hernia surgery and other non-surgical pathologies will be reported.

Long-term pain relief after groin hernia repair for sports groin: A nationwide cohort study

Background: The groin is a complex anatomical area with multiple structures that can be injured and cause pain. One condition with groin pain is the so-called “sports groin,” which can be treated with a groin hernia repair even though no hernia is present. The aim of this study was to assess the prevalence of chronic groin pain several years after a groin hernia repair performed in patients with a sports groin. Methods: This nationwide cohort study included adults who had a groin hernia repair for a sports groin through the years 1998–2011. The patients were identified through the Danish Hernia Database and in surgical records. Patients were asked to fill out four questionnaires several years after the repair: a visual analogue scale, the Activity Assessment Scale, the Inguinal Pain Questionnaire, and a questionnaire about treatment satisfaction. Results: Of 118 contacted patients, 71 gave informed consent and were included in the study (60%), and of these the response rate was 100%. The questionnaires were filled out median 14 years after surgery. Most of the patients were pain-free in the operated groin (87%), and only a few had physical impairment caused by groin pain (20%). Prior to surgery, 79% had groin pain that they could not ignore. Overall, 90% of the patients were satisfied with the treatment. Conclusions: Most patients were pain-free and without physical impairment several years after groin hernia repair for a sports groin and with high satisfaction rate.

TP7.2.12 Robotic versus laparoscopic inguinal hernia repair: a systematic review

Aims Robotic inguinal hernia repair (RIHR) is considered to improve surgical outcomes in patients undergoing inguinal hernia surgery. The objective is to present a systematic review of RIHR compared to laparoscopic repair (LIHR). Methods A systematic review of comparative studies until January 2021 published on Embase, Medline, PubMed, PubMed Central and Cochrane databases reporting the surgical outcomes in patients undergoing RIHR versus LIHR was performed. Results A total of 12565 patients in 10 comparative studies were included. In the random effects model analysis using the statistical software Review Manager, statistically the RIHR prolonged the duration of operation (Standardized mean difference (SMD), 3.33; z = 5.84; P = 0.00001) but the length of stay (SMD, -0.8; z = 0.66; P = 0.51) and post-operative pain score (SMD, -0.47; z = 1.19; P = 0.24) were similar in both groups. In addition, the recurrence rate was similar in both groups (p = 0.92). The incidence of post-operative complications (OR 1.67; 95% CI, 1.14, 2.45; z = 2.64; P = 0.008) and chronic groin pain (OR 2.14; 95% CI, 0.97, 4.72; z = 1.88; P = 0.06) was higher in RIHR group. Conclusion RIHR is feasible and safe, but the duration of operation is significantly longer with equivocal other variables such as stay and pain score. There was higher incidence of post-operative morbidity and chronic groin pain as well. Major multi-center randomized controlled trial is mandatory to assess the long terms outcomes and cost effectiveness before the routine use of RIHR.

Surgical Outcomes of Inguinal-, Pubic-, and Adductor-Related Chronic Pain in Athletes: A Systematic Review Based on Surgical Technique

Background: Controversies remain regarding the surgical treatment of inguinal-, pubic-, and adductor-related chronic groin pain (CGP) in athletes. Purpose: To investigate the outcomes of surgery for CGP in athletes based on surgical technique and anatomic area addressed. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed and Embase databases were searched for articles reporting surgical treatment of inguinal-, pubic-, or adductor-related CGP in athletes. Inclusion criteria were level 1 to 4 evidence, mean patient age >15 years, and results presented as return-to-sport, pain, or functional outcomes. Quality assessment was performed with the CONSORT (Consolidated Standards of Reporting Trials) statement or MINORS (Methodological Index for Non-randomized Studies) criteria. Techniques were grouped as inguinal, adductor origin, pubic symphysis, combined inguinal and adductor, combined pubic symphysis and adductor, or mixed. Results: Overall, 47 studies published between 1991 and 2020 were included. There were 2737 patients (94% male) with a mean age at surgery of 27.8 years (range, 12-65 years). The mean duration of symptoms was 13.1 months (range, 0.3-144 months). The most frequent sport involved was soccer (71%), followed by rugby (7%), Australian football (5%), and ice hockey (4%). Of the 47 articles reviewed, 44 were classified as level 4 evidence, 1 study was classified as level 3, and 2 randomized controlled trials were classified as level 1b. The quality of the observational studies improved modestly with time, with a mean MINORS score of 6 for articles published between 1991 and 2000, 6.53 for articles published from 2001 to 2010, and 6.9 for articles published from 2011 to 2020. Return to play at preinjury or higher level was observed in 92% (95% CI, 88%-95%) of the athletes after surgery to the inguinal area, 75% (95% CI, 57%-89%) after surgery to the adductor origin, 84% (95% CI, 47%-100%) after surgery to the pubic symphysis, and 89% (95% CI, 70%-99%) after combined surgery in the inguinal and adductor origin. Conclusion: Return to play at preinjury or higher level was more likely after surgery for inguinal-related CGP (92%) versus adductor-related CGP (75%). However, the majority of studies reviewed were methodologically of low quality owing to the lack of comparison groups.

Assessment of early outcome in laparoscopic totally extraperitoneal inguinal hernia repair using lightweight mesh

Background: Laparoscopic surgery is dominating in the field of hernia. The search for the ideal prosthetic biomaterial has been a longstanding issue with debate over simple versus composite biomaterial and lightweight versus heavyweight meshes. This study was done to evaluate the early outcome of lightweight mesh in laparoscopic totally extraperitoneal (TEP) repair.Methods: This prospective observational study was done for a period of 16 months. On the basis of selection criteria patient underwent laparoscopic TEP repair using light weight mesh, early outcomes were evaluated in terms of immediate postoperative pain (analysed via visual analog scale) and chronic groin pain (analysed by visual analogue scale and graded according to Cunningham), patients were also evaluated for operation time, intraoperative bleeding, seroma, stiffness or numbness around groin, or any other complications.Results: There was no intraoperative bleeding among any of the patients. Immediate post-operative pain assessed by visual analogue scale 20% scored one in the visual analogue scale in post-operative day 1. None of the patients were having any complications (like stiffness or numbness in groin or thigh and any other complication) during post-surgery follow up. Only one patient reported mild chronic groin pain at the end of 3 months after surgery.Conclusions: The short term results of laparoscopic TEP repair for inguinal hernia using light weight mesh are quite encouraging. We can conclude that light weigh mesh is fulfilling important role in successful hernia repair as it is associated with very less morbidity.