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.
Background: Inguinal hernioplasty, also called Lichtenstein repair, is a common surgical procedure for inguinal hernia which can lead to chronic groin pain. Local anesthetic blocks combined with ...corticosteroids like lidocaine and triamcinolone have been used for post-operative pain management. This study aimed to compare the efficacy of lidocaine with triamcinolone acetonide versus lidocaine alone for chronic pain management in patients who underwent inguinal hernioplasty. Methods: A randomized control trial study was conducted at the Department of Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan, from June 2022 to June 2023. The study included patients undergoing inguinal hernioplasty who were over 18 years of age. Group 1 (n=75) received a combination of lidocaine with triamcinolone acetonide, while group 2 (n=75) received lidocaine alone. Pain levels were assessed using the visual analog scale (VAS) during 1st week, 1st month, and 3rd month after the surgery. Results: In group 1, the incidence of pain in the 1st week was 25%, significantly lower than the 41.3% in group 2 (p=0.024). The risk ratio (RR) was 0.65 (95% CI=0.43-0.97, p=0.037). In the 1st month, group 1 had a 13.3% incidence of pain compared to 29.3% in group 2 (p=0.017), with an RR of 0.56 (95% CI=0.33-0.97). Similarly, in the 3rd month, group 1 had a 9.3% incidence of pain compared to 22.7% in group 2 (p=0.026), with an RR of 0.48 (95% CI=0.23-0.97). Conclusion: Lidocaine with triamcinolone acetonide is an effective approach for managing chronic postoperative pain in inguinal hernioplasty.
Objective: development, clinical application of a new original method of hernioplasty of median postoperative ventral hernias and biomechanical experimental substantiation of the effectiveness of ...this method. Materials and methods: the method of hernioplasty of median postoperative ventral hernias with strengthening of fascial-aponeurotic structures of the anterior abdominal wall was developed and clinically tested on 63 patients. An anatomical experiment was performed in which the biomechanical parameters of the reinforced scar-altered structures of the median parts of the anterior abdominal wall were studied according to the method developed by us. Results: an increase in the biomechanical parameters of the median structures reinforced by the original method with a frame thread was found: the strength limit of the fascia — by 59.4%, and the modulus of elasticity — by 40.2%, compared with the scar-altered fascia in herniators. These results suggest a confident prevention of recurrence of herniation when using this technique. This assumption was confirmed after the introduction of the technique into clinical practice. In all 63 observed patients, there is no recurrence of herniation for 1-5 years. There were no significant complications of the course of the early postoperative period associated with the applied method of plastic surgery. The method is characterized by material and financial accessibility, the absence of complex technical manipulations that increase the duration of hernioplasty. Conclusions: the effectiveness in preventing recurrence of herniation, accessibility and simplicity of the proposed method of surgical treatment of postoperative and recurrent ventral hernias allows us to recommend it for wide clinical use.
Background: Chronic groin pain (Inguinodynia) is a potential complication following inguinal hernia mesh repair and has a significant impact on the quality of life. The incidence varies among studies ...ranging between 0% and 62.9%.
Aims and Objectives: The present study was conducted with the objectives of estimating the prevalence of post-surgical inguinodynia among the patients undergoing open hernioplasty. The secondary objective was to assess the factors associated with the development of post-surgical inguinodynia.
Materials and Methods: A longitudinal study was carried out in a tertiary care center in Bangalore, Karnataka among the hernia patients attending the outpatient department of General Surgery department. A pro forma prepared with expert validation was used to collect details regarding pre-operative characteristics, type of anesthesia, intraoperative findings, and post-operative complications. The pain was assessed by the visual analog scale. Descriptive statistics and Chi-square test were used to identify the risk factors.
Results: A total of 112 patients underwent hernioplasty. Out of this, 108 were males and 4 were females. The mean age of the patients was 48±10.8 years. Majority of them (84, 77.7%) presented with indirect inguinal hernia. The prevalence of inguinodynia at 3-month post-hernia surgery was 21.4% (n=24). Patients with significant pre-operative pain had higher chances of developing chronic pain (P=0.000). It was found that post-operative surgical site infection was associated with increased chances of development of chronic pain (P=0.000).
Conclusion: Our study found that around one-fifth of the hernia patients had developed chronic post-surgical inguinal pain following open hernioplasty. There was no significant relationship between patients’ characteristics and development of chronic post-operative pain. The presence of pre-operative pain and post-operative infection in the patients was significantly associated with the development of chronic pain. Intraoperative nerve identification and chronic post-operative pain did not have a significant relationship in our study. Most of the patients who developed chronic pain had experienced only mild pain and none of them had severe inguinal pain. From the findings of our study, we would like to recommend that all measures must be taken to prevent and treat post-operative surgical site infection which leads to the development of chronic pain in patients.
The guidelines for this experiment were designed to assess the histopathological and immunohistochemical parameters after the topical application of plasma-rich fibrin during hernioplasty in sheep. ...Twenty-four rams enrolled into two groups, 12 of each. In the control group, hernioplasty was done with polypropylene mesh and a modified sub-lay technique; in the treatment group done the same as the control and reinforced with plasma-rich fibrin (PRF). Tissue samples were collected for histopathological and immunohistochemical investigations. The clinical investigation results indicated developing seroma at the lower region of the surgical site that continued 25 days post-surgery in the control group as a comparison of group PRF which indicated mild seroma. The histopathological examination at 30 days in the control group indicated the presence of focal infiltration of mononuclear inflammatory cells around the mesh and hyperplasia of fibrocytes, deposition of collagen with edema as compared with the treatment group at 15th days post-surgery; there was a high number of new blood vessels, deposition of collagen fibers. Immunohistochemistry indicated a strong positive reaction at seven days post-surgery in control, and the PRF group with IL-6 appeared as golden-brown granules in the cytoplasm of cells around the surgical mesh. At seven days post-surgery, the reaction of VEGF antibody IHC indicated negative and strong positive reactions with VEGF appearing as golden-brown granules in the cytoplasm of cells in the treatment group. In conclusion, using PRF to repair the hernia reduces the incidence of inflammation, and histopathological and immunohistochemistry investigations emphasize an improvement in the healing process of hernia.
Despite the high frequency of hernioplasties worldwide, their complications and recurrences are still a challenge to be overcome. The search for prostheses that aim to promote the correction of ...hernia defects has been a challenge. For this purpose, the materials used in hernioplasties must be biocompatible, promote the formation of little or no peritoneal adhesion, possess compatible texture and flexibility, providing the necessary resistance to protect the viscera and allow the movement of the abdomen.
The aim of the present study was to evaluate the effectiveness of bubble plastic (low density polyethylene, LDPE) as a material for the correction of hernia in the abdominal wall. For this, twenty male rats (Rattus norvegicus, Wistar variety) were used and divided into four groups of five animals. The animals were evaluated at 7, 15, 30 and 90 days after surgery according to clinical, thermographic and morphological parameters (macroscopic and microscopic).
The results showed that the bubble plastic induced inflammatory reaction in the initial period (7 day), followed by a reduction (30 day) to increase considerably at 90 days after the operation.
So, bubble plastic can be used for temporary implants (up to 30 days).
Topicality: One of the negative sides of the inguinal canal plastics with a mesh implant is cicatricial changes in the structures of the spermatic cord in the place of its junction with the mesh. ...Purpose. Improvement of non-tension plastics of the posterior wall of the inguinal canal in patients with inguinal hernias. Material and methods. A technique of inguinal hernia repair with a combined plasty of the posterior wall of the inguinal canal with a polypropylene mesh and aponeurosis of the external oblique abdominal muscle was elaborated. The mesh implant is fixed on the posterior wall of the inguinal canal. From the upper flap of the aponeurosis its strip is cut out on two legs. After its fixation to the inguinal ligament, the internal oblique and transverse abdominal muscles, an aponeurotic posterior wall of the inguinal canal is formed. Results. In the elaborated operation of the inguinal hernia, the posterior wall of the inguinal canal is strengthened not only by the mesh implant, but also by the aponeurosis of the external oblique abdominal muscle. At the same time, the spermatic cord lies on the aponeurosis and not on the mesh, which is physiological and prevents the development of fibrous processes in the elements of the spermatic cord. All patients were discharged from the hospital on the 6th day in a satisfactory condition. Conclusions. The results of the elaborated operation for inguinal hernia indicate the absence of clinically significant complications in the early postoperative period. The proposed operation enables to avoid the negative effects of the mesh on the spermatic cord due to the inclusion of the latter in the “aponeurotic tunnel”.
In the light of introduction of the concept of rapid recovery and the use of miniinvasive methods of treatment of postoperative ventral hernias, laparoscopic herniology attracts more and more ...attention of practical surgeons. This is due to virtually no wound complications, a reduction of the duration surgery and inpatient stay, which greatly improves social and labor adaptation. Objective. Evaluate the benefits of laparoscopic hernioplasty over the open one in the light of the concept of rapid recovery of ERAS – enhanced recovery after surgery. Materials and methods. For a comparative evaluation in the period from 2015 to 2017, 81 patients with postoperative ventral hernias were examined and surgically treated. According to the methods of hernioplasty, all patients were divided into two groups. The group 1 consisted of 38 (46.91 %) persons who underwent laparoscopic hernioplasty. The group 2 consisted of 43 (53.09 %) persons who underwent "open" allohernioplasty. The multimodal patient management program provided for common elements for both groups aimed at rapid recovery in the postoperative period. Results. The average duration of "open" hernioplasty was (143±25) min, laparoscopic – (98±14) min. The laparoscopic technique of hernioplasty does not require routine drainage of the abdominal cavity. When open allohernioplasty drainage was performed in 72 (69.20 %) cases. 5–6 hours after the surgery, using the "sublay" technique 66 (63.50 %), patients were able to take the vertical position and activate the motor activity within the hospital ward, the rest – during the first day. The postoperative stay in the stanionarium in the group of patients after the "open" hernioplasty was on average (7.98±1.36) days, after the laparoscopic operation – (2.63±1.28) days, respectively. Conclusions. Endovideo-surgical methods for the elimination of primary and postoperative ventral hernias are effective, safe, provide early mobilization of patients and their rapid labor and social adaptation due to a significant smaller number of early and late complications. Restrictions in the use of these treatments are considered to be hernia of a gigantic size, especially postoperative with pronounced joint process and severe concomitant diseases, in which the increase in intraabdominal pressure will be critical and will negatively affect the immediate results of surgical treatment.
In the light of introduction of the concept of rapid recovery and the use of miniinvasive methods of treatment of postoperative ventral hernias, laparoscopic herniology attracts more and more ...attention of practical surgeons. This is due to virtually no wound complications, a reduction of the duration surgery and inpatient stay, which greatly improves social and labor adaptation. Objective. Evaluate the benefits of laparoscopic hernioplasty over the open one in the light of the concept of rapid recovery of ERAS – enhanced recovery after surgery. Materials and methods. For a comparative evaluation in the period from 2015 to 2017, 81 patients with postoperative ventral hernias were examined and surgically treated. According to the methods of hernioplasty, all patients were divided into two groups. The group 1 consisted of 38 (46.91 %) persons who underwent laparoscopic hernioplasty. The group 2 consisted of 43 (53.09 %) persons who underwent "open" allohernioplasty. The multimodal patient management program provided for common elements for both groups aimed at rapid recovery in the postoperative period. Results. The average duration of "open" hernioplasty was (143±25) min, laparoscopic – (98±14) min. The laparoscopic technique of hernioplasty does not require routine drainage of the abdominal cavity. When open allohernioplasty drainage was performed in 72 (69.20 %) cases. 5–6 hours after the surgery, using the "sublay" technique 66 (63.50 %), patients were able to take the vertical position and activate the motor activity within the hospital ward, the rest – during the first day. The postoperative stay in the stanionarium in the group of patients after the "open" hernioplasty was on average (7.98±1.36) days, after the laparoscopic operation – (2.63±1.28) days, respectively. Conclusions. Endovideo-surgical methods for the elimination of primary and postoperative ventral hernias are effective, safe, provide early mobilization of patients and their rapid labor and social adaptation due to a significant smaller number of early and late complications. Restrictions in the use of these treatments are considered to be hernia of a gigantic size, especially postoperative with pronounced joint process and severe concomitant diseases, in which the increase in intraabdominal pressure will be critical and will negatively affect the immediate results of surgical treatment.
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