The laparoscopic posterior approach adapts the advantages of Kugel hernioplasty, making it possible to perform it at the new layer even if the inguinal hernia is recurrent following the anterior ...approach, producing a high level of completion. However, in laparoscopic surgery for recurrent inguinal hernia using posterior approaches, dissecting the extraperitoneal space is difficult. Robotic surgery may enable precise dissection, even if the space is severely adhered. Here, we report a robotic approach after extraperitoneal approach for recurrent inguinal hernia, which developed after Kugel hernioplasty.
A 78-year-old Japanese man, who underwent left inguinal hernia repair (Kugel hernioplasty) 2 years ago, presented with recurrent reducible left inguinal swelling. A peritoneal incision was created above the deep inguinal ring to treat the primary right inguinal hernia. The pressure in the left inguinal region revealed a spermatic cord lipoma protruding from the internal inguinal ring as a recurrent inguinal hernia of the abdominal cavity.
Robotic transabdominal preperitoneal repair for recurrent inguinal hernia is effective, especially after posterior approach Kugel hernioplasty, in which dissection of the extraperitoneal space is difficult. In the present case, the peritoneal flap was conserved without removing the direct Kugel patch.
Kugel hernioplasty, which is a posterior approach, would result in severe extraperitoneal space adhesion. Essentially, a new and previously unused approach is preferable to the previous approach in patients with recurrent inguinal hernias.
Robotic approach is effective for recurrent inguinal hernias even if the space was severe adhesion.
•Robotic transabdominal preperitoneal repair for recurrent inguinal hernia is effective especially after posterior approach Kugel hernioplasty•The robotic platform dimensional visualization, offering an increased range of instrument motion and improved surgeon ergonomics seemed to be beneficial for recurrent case through three-•Robotic approach for recurrent inguinal hernia is rare, especially after Kugel hernioplasty.
Background: Bupivacaine is most commonly used amino-amide drug for subarachnoid block in hernioplasty. Levobupivacaine has similar pharmacological activity to that of bupivacaine with minimal ...cardiotoxicity. Clonidine, an α2 adrenergic agonist, potentiates the action of local anesthetics when used intrathecally and enhances post-operative analgesia. Aims and Objectives: This prospective, comparative, observational study was aimed to compare the effects of 0.5% levobupivacaine with clonidine and 0.5% hyperbaric bupivacaine in patients undergoing hernioplasty for the quality of surgical anesthesia and hemodynamic changes with any significant intraoperative complications. Materials and Methods: After receiving approval from the institutional ethics committee and written informed consent, 80 male patients aged between 18 and 60 years, BMI <30 kg/m2, height>150 cm, and American society of anesthesiologists physical status1 and 2 posted for elective hernioplasty were enrolled into two equal groups of 40 patients, group LC and group B. Patients in group LC received 15 mg 0.5% isobaric levobupivacaine with 30 μg clonidine and patients in group B received 15 mg hyperbaric bupivacaine intrathecally. SPSS version 20 was used for analysis, and P<0.05 was considered statistically significant. Results: In group LC, onsets of both sensory and motor blocks were delayed, whereas durations of motor and sensory block with analgesia were longer. Tachycardia, hypotension, nausea, vomiting, and shivering were observed greater in numbers in group B, whereas incidence of bradycardia was more in group LC. Conclusion: Prolonged duration of sensory and motor block, prolonged analgesic effect, and hemodynamic stability without any significant adverse effects may make this combination a better alternative to hyperbaric bupivacaine for hernioplasty.
Background: Mesh placement and subsequent fixation are an important aspect of hernia surgery. Different methods are available in modern days for fixing the mesh in inguinal hernioplasty surgery in ...both open and laparoscopic approach. However, sutures are still preferred by most of the surgeons because of its easy availability and cost- effectiveness. Conventionally, non-absorbable sutures are used to fix mesh.
Aims and Objectives: The objective of our present study is to compare the post-surgical outcomes of mesh fixation with monofilament non-absorbable sutures versus monofilament delayed absorbablesutures.
Materials and Methods: This prospective and randomized study was conducted at the Department of Surgery, ESIC-PGIMSR, Joka during the period of January 2017 –March 2019. Total 160 patients having unilateral uncomplicated inguinal hernia were included in this study; operated by the same surgical team. The patients were divided into two groups, each of 80 patients. In Group I, mesh fixation was done with delayed absorbable sutures whereas, in Group II, mesh was fixed with non-absorbable sutures. The data were analyzed with appropriate statistical tests such as Chi-square test and P < 0.05 that were considered as statistically significant.
Results: The development of post-operative pain was more common in Group II. The difference was statistically significant at 6 months post-operative time (P =0.042). When we compared the post-operative par esthesia in both surgical groups, more number of patients developed it in Group II but no significant statistical difference was observed (P-value came as 0.784, 0,221, and 0.385 after analyzing 3 months, 6 months, and 1 year data, respectively). Regarding other complications such ash ematoma, wound infection, seroma formation, and scrotal/ cord edema, no statistically significant differences were observed in either group (P-values were 0.339, 0.149, 0.313, and 0.117, respectively). No patient developed chronic discharging sinus post operatively in either group. No recurrence was noted in any patients included in this study, after 1 year of follow- up.
Conclusion: Using delayed-absorbable suture material with air knotting technique for mesh fixation in Lichtenstein tension-free open inguinal hernioplasty causes less chance of post-operative inguinal pain and pare sthesia. Hence, it is a good alternative choice for surgeons; in terms of safety and efficacy.
Background. Modern ventral hernia surgery is closely related to the use of prosthetic materials. The development in the postoperative period of pain syndrome associated with the excessive development ...of coarse fibrous connective tissue and a reduction in the area of synthetic implants justified the interest of researchers in biological materials that could be used as a hernioprosthesis. Information on the integration of a xenopericardial implant with the tissues of the human anterior abdominal wall is presented in isolated publications. Materials and methods. The data on the reaction of tissues in the area of application of a biological prosthesis 15 months after hernioplasty are presented. Results and conclusions. At the site of implantation, active formation of connective tissue was noted. The described changes suggest that the repair of ventral hernias using the xenopericardial plate will be accompanied by adequate restoration of the integrity of the abdominal wall.
Background: According to the greatest reviews of inguinal hernia repairs, there is no discernible difference between laparoscopic and open mesh hernia repair techniques in terms of recurrence.Aim of ...the work: This study compares open and laparoscopic hernia repair procedures performed in hospitals.Patients and Methods: In this retrospective cohort study, the open and laparoscopic approaches to inguinal hernia repair were compared and evaluated for their effects on post-operative pain, hospital stay, operating room time, seroma, urinary retention, paresthesia, numbness, wound infection, and recurrence. From June 2020 to June 2022, 30 patients underwent hernioplasty surgery for a unilateral primary inguinal hernia. A laparoscopic hernioplasty TAPP was performed on Group A, while an open hernioplasty was performed on Group B.Results: There was a statistically significant difference between the two groups regarding the surgical time p-value = 0.0001 and hospital stay p-value = 0.0001. While 20% of group B reported paresthesia and numbness, group A had no complications in terms of paresthesia and numbness P=0.22. There was no statistically significant difference between the two groups in terms of seroma and infection results P-Values =0.329 and 1, respectively. 13.3% of group A patients experienced recurrence of their hernias compared to group B's 6.7% p-value =1.Conclusion: The laparoscopic technique of tension-free repair is preferable to the open technique in terms of immediate postoperative problems as well as delayed pain and paresthesia, as well as in terms of safety.
Totally preperitoneal hernioplasty (TPP) is a concept which was introduced for distinguishing with totally extraperitoneal (TEP). There is few evidence reflecting the single incision laparoscopic ...totally preperitoneal (SIL-TPP) characteristic. The aim of study is to demonstrate the feasibility of single incision laparoscopic totally preperitoneal hernioplasty (SIL-TPP) and compare the outcomes with the single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP) technique.
During August 2018 and July 2022, 200 inguinal hernia patients received SIL-TPP and 56 patients received SIL-TEP in the First hospital of Ningbo university. The demographics, clinical characteristics, intraoperative and postoperative parameters were retrospectively analysed.
SIL-TPP and SIL-TEP hernia repair were successfully conducted in all patients. There was no conversation happened in two group. Patients' demographics were comparable when compared between the two groups adding the comparison initial 52 cases analysis (P > 0.05). The mean unilateral hernia operative time was significant shorter in the SIL-TPP group than SIL-TEP group (unilateral: 81.38 ± 25.32 vs. 95.96 ± 28.54, P: 0.001). Further study of unilateral hernia operative time revealed the mean indirect hernia operative time was significant shorter in the SIL-TPP group than SIL-TEP group (indirect: 81.38 ± 25.33 vs. 95.87 ± 28.54, P: 0.001). The unilateral hernia operation time trend of initial 52 cases of two group analysis revealed the operation time of SIL-TPP reduced faster than SIL-TEP along with treating number increasing (Figs. 2 and 3). The comparison of initial equal quantity unilateral hernia patient mean operative time revealed the SIL-TPP group was significant shorter than SIL-TEP group (85.77 ± 22.76 vs. 95.87 ± 28.54, P: 0.049). The rate of peritoneum tearing of SIL-TPP group was significant high than SIL-TEP (P = 0.005).
SIL-TPP hernia repair is a superior procedure and possess its own distinguished advantages. We recommend it rather than SIL-TEP for treating inguinal hernia, especially for indirect hernia. However, large-scale randomized controlled trials comparing SIL-TPP and SIL-TEP are needed to confirm these results.
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