PMD13 POST INGUINAL HERNIA REPAIR PAIN MANAGEMENT COSTS: A STUDY USING THE PREMIER PERSPECTIVE ™ DATABASE (PPD)

ImportanceTo our knowledge, a systematic review has not yet been performed that specifically addresses the management of inguinal hernia in women. Recurrence after repair of inguinal hernia is not unusual in women and may be a previously undiagnosed femoral hernia, which is rarely seen in men.ObjectiveTo investigate rates and types of recurrences in women who had undergone repair of primary inguinal hernia.Evidence ReviewPubMed, Embase, and the Cochrane databases were searched in September 2017 for studies reporting recurrences after repair of primary inguinal hernia in women. Crude rates of recurrence (number of recurrences/number of women) were calculated after open and laparoscopic repairs, and the type of recurrent hernia was registered, if noted in the studies. This review is reported according to the PRISMA guideline.FindingsA total of 55 studies were included, comprising 43 870 women (mean age, 42-69 years; median age, 57 years). Five studies were randomized clinical trials, 14 were prospective cohort studies, 7 were prospective database studies, and 29 were retrospective cohort studies. Twenty studies reported recurrence after laparoscopic repair, with a crude recurrence rate of 1.2% (27 of 2257) (range, 0%-5%) and a median follow-up of 24 months. Thirty-seven studies reported open repair, with a crude recurrence rate of 2.4% (818 of 33 971) (range, 0%-12.5%) and a median follow-up of 36 months. The crude recurrence rate in randomized clinical trials and prospective studies was 1.2% (18 of 1525) after laparoscopic repair compared with 4.9% (490 of 10 058) after open repair. The recurrent inguinal hernia was a femoral hernia in 203 of 496 patients (40.9%) after open repair, compared with 0% of patients after laparoscopic repair. Recurrence rates were similar when open mesh vs nonmesh techniques were used.Conclusions and RelevanceRecurrence rates after repair of primary inguinal hernia in women are lower after laparoscopic repair compared with open repair. Intraoperative findings during repair of recurrent inguinal hernia are often femoral hernias in women.

Fertility in males after childhood, adolescent, and adult inguinal operations

A Canadian national survey: Perspectives on routine pathological examination of hernia sacs after inguinal hernia and hydrocele repair among pediatric urologists, surgeons, and pathologists

Background Inguinal hernia repair is one of the most widely performed surgical procedure. Among the techniques used, the open Lichtenstein repair is still the most widely performed. However, in the last decade there has been an increased interest in the laparoscopic approach for inguinal hernia repair, mainly represented as the trans-abdominal pre- peritoneal (TAPP) technique. As described in recent studies, TAPP approach entails the benefits of minimally invasive surgery, such as less pain and early recovery. Objective s: This study aims to compare between lichtenstein repair of inguinal hernia and trans-abdominal pre-peritoneal repair of inguinal hernia (TAPP) as regard their hospital stay, cost, intra-operative & post-operative complications and short term recurrence. Patients and Methods Our study was carried out on (50) male patients with inguinal hernia, 25 patients underwent laparoscopic TAPP repair and 25 patients underwent open Lichtenstein repair. We found a highly significant difference of laparoscopic TAPP Repair in decreasing post-operative pain than in open repair. Results Comparative study between the 2 groups revealed non-significant difference as regards age and sex of the patients. Comparative study between the 2 groups revealed non-significant difference as regards all socio-demographic data. Comparative study between the 2 groups revealed non-significant difference as regards type and side of hernia. Comparative study between the 2 groups revealed; highly significant increase in operative duration in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in post-operative pain score and post-operative hospital stay; in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in intra-operative complications in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Conclusion Our study showed that laparoscopic TAPP approach for inguinal hernia repair reduces early post-operative pain. Furthermore, it is related to less complications, although it takes a longer operative time and higher cost.

Background: Groin hernia repair is considered to be one of the most commonly performed operations by general surgeons however, there is no gold standard operation for treatment of inguinal hernias. The optimal surgical approach must be selected individually for the patient, considering patient age, hernia size, unilaterality or bilaterality, primary or recurrent status, and type of anesthesia, occupation, and leisure activities. The laparoscopic revolution has increased the debate about the safest and most effective inguinal hernia repair. This revolution has broadened our understanding of inguinal anatomy and hernia repair. At the least, surgeons should be aware of the current indications and contraindications for laparoscopic inguinal hernia repair, because some hernias should have a laparoscopic repair. To increase versatility, surgeons should consider becoming skilled at both techniques, with the understanding that outcomes are optimal if one is committed to achieving expertise in laparoscopic repair. Objectives: Our objective in this study is to compare the outcome of mesh fixation using non-absorbable tacks versus absorbable tacks in transabdominal preperitoneal (TAPP) laparoscopic repair of inguinal hernia regarding their efficacy and postoperative complications to improve the outcome of patients undergoing surgery for inguinal hernia in Ain Shams University Hospitals. Patients and methods: The present study is a prospective, randomized comparative study that was conducted in Ain Shams University Hospitals in Egypt, and included sixty (60) patients who had inguinal hernia. The patients were divided into two groups each group including 30 patients. In the first group (Group A) titanium non-absorbable tacks were used and in the other group (Group B) absorbable tacks were used. The patients underwent a trans-abdominal preperitoneal (TAPP) laparoscopic repair of inguinal hernia using prolene mesh. The study was conducted from July 2016 to July 2017, with 12 months of follow-up post-operatively until July 2018. Results: The mean age of the patients was 36.93 ± 10.23 (19-55) and the mean BMI was 24.83 ± 2.79 (19-32). There was no significant difference between 2 groups as regard preoperative comorbidities. Patients presented mainly with swelling in the groin region 71.67%. Right sided hernia was 46.7% and bilateral hernia was 15%. There was no difference between 2 groups as regard the operative time (p-value=0.056) and intraoperative complications: bleeding (p-value=0.150) and bladder injury (p-value=0.313). Post-operative complications, postoperative hospital stay, time needed to return to normal activity and the recurrence were all alike between the 2 groups. Pain analysis was done four times, and revealed no significant difference between the 2 groups at any time of follow-up. Conclusion: Both non-absorbable tacks and absorbable tacks used in mesh fixation are similarly effective in terms of operative time, the incidence of recurrence, complications and pain at least in the first year of follow up, but it may be less painful after one year after the complete absorption of the absorbable tacks but this needs further investigations and studies containing more patients and with follow-up for longer time.

Background: Groin hernia repair is considered to be one of the most commonly performed operations by general surgeons however, there is no "gold standard" operation for treatment of inguinal hernias. The optimal surgical approach must be selected individually for the patient, considering patient age, hernia size, unilaterality or bilaterality, primary or recurrent status, and type of anesthesia, occupation, and leisure activities. The laparoscopic revolution has increased the debate about the safest and most effective inguinal hernia repair. This revolution has broadened our understanding of inguinal anatomy and hernia repair. At the least, surgeons should be aware of the current indications and contraindications for laparoscopic inguinal hernia repair, because some hernias should have a laparoscopic repair. To increase versatility, surgeons should consider becoming skilled at both techniques, with the understanding that outcomes are optimal if one is committed to achieving expertise in laparoscopic repair. Objectives: Our objective in this study is to compare the outcome of mesh fixation using non-absorbable tacks versus absorbable tacks in transabdominal preperitoneal (TAPP) laparoscopic repair of inguinal hernia regarding their efficacy and postoperative complications to improve the outcome of patients undergoing surgery for inguinal hernia in Ain Shams University Hospitals. Patients and methods: The present study is a prospective, randomized comparative study that was conducted in Ain Shams University Hospitals in Egypt, and included sixty (60) patients who had inguinal hernia. The patients were divided into two groups each group including 30 patients. In the first group (Group A) titanium non-absorbable tacks were used and in the other group (Group B) absorbable tacks were used. The patients underwent a trans-abdominal preperitoneal (TAPP) laparoscopic repair of inguinal hernia using prolene mesh. The study was conducted from July 2016 to July 2017, with 12 months of follow-up post-operatively until July 2018. Results: The mean age of the patients was 36.93 ± 10.23 (19-55) and the mean BMI was 24.83 ± 2.79 (19-32). There was no significant difference between 2 groups as regard preoperative comorbidities. Patients presented mainly with swelling in the groin region 71.67%. Right sided hernia was 46.7% and bilateral hernia was 15%. There was no difference between 2 groups as regard the operative time (p-value=0.056) and intraoperative complications: bleeding (p-value=0.150) and bladder injury (p-value=0.313). Post-operative complications, postoperative hospital stay, time needed to return to normal activity and the recurrence were all alike between the 2 groups. Pain analysis was done four times, and revealed no significant difference between the 2 groups at any time of follow-up. Conclusion: Both non-absorbable tacks and absorbable tacks used in mesh fixation are similarly effective in terms of operative time, the incidence of recurrence, complications and pain at least in the first year of follow up, but it may be less painful after one year after the complete absorption of the absorbable tacks but this needs further investigations and studies containing more patients and with follow-up for longer time.

Abdominal wall and inguinal hernia repair are the most frequently performed surgical procedures in the United States and Europe. However, traditional methods of mesh fixation are associated with a number of problems including substantial risks of recurrence and of postoperative and chronic pain. The aim of this systematic review is to summarize the clinical safety and efficacy of Tisseel/Tissucol fibrin sealant for hernia mesh fixation. A PubMed title/abstract search was conducted using the following terms: (fibrin glue OR fibrin sealant OR Tisseel OR Tissucol) AND hernia repair. The bibliographies of the publications identified in the search were reviewed for additional references. There were 36 Tisseel/Tissucol studies included in this review involving 5,993 patients undergoing surgery for hernia. In open repair of inguinal hernias, Tisseel compared favorably with traditional methods of mesh fixation, being associated with shorter operative times and hospital stays and a lower incidence of chronic pain. Similarly, after laparoscopic/endoscopic inguinal hernia repair, Tisseel/Tissucol was associated with less use of postoperative analgesics and less acute and chronic postoperative pain than tissue-penetrating mesh-fixation methods. Other end points of concern to surgeons and patients are the risks of inguinal hernia recurrence and of complications such as hematoma formation and intraoperative bleeding. Comparative studies show that Tisseel/Tissucol does not increase the risk of these outcomes and may, in fact, decrease the risk compared with tissue-penetrating fixation methods. When used in the repair of incisional hernias, Tisseel/Tissucol significantly decreased both postoperative morbidity and duration of hospital stay. Clinical evidence published to date supports the use of Tisseel/Tissucol as an option for mesh fixation in open and laparoscopic/endoscopic repair of inguinal and incisional hernias. Guidelines of the International Endohernia Society recommend fibrin sealant mesh fixation, especially in inguinal hernia repair. Nonfixation is reserved for selected cases.

The aim of this thesis has not just been to expose problems, obstacles, or lacking consensus, but to provide pragmatic solutions and recommendations to optimize inguinal hernia surgery. This thesis focusses on three key-aspects of inguinal hernia surgery that remain controversial in the present-day treatment of inguinal hernia patients. What type of mesh should be used for open and laparo-endoscopic inguinal hernia surgery? Do specific patient populations benefit from patient-tailored surgery? And what is the purpose and necessity of follow-up after inguinal hernia surgery, and how should follow-up be organized?
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\nThis thesis has provided an end to the debate on the type of mesh, which has been ongoing for almost 2 decades. Open (Lichtenstein) inguinal hernia repairs can be optimized using a lightweight mesh. The use of lightweight mesh decreases the risk of developing chronic pain and foreign body feeling, while no difference in risk of recurrence was established. Laparo-endoscopic inguinal hernia repairs can be optimized using a heavyweight mesh for direct or large inguinal hernias. For indirect inguinal hernias, no difference was detected. Using lightweight mesh significantly increased, and more than doubled, the risk of developing a recurrence, especially in non-fixated lightweight mesh. 
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\nIn this thesis the treatment strategy was optimized for three specific patient populations with inguinal complaints: young patients with an inguinal hernia, athletes that suffer from inguinal disruption, and inguinal hernia patients in the work-up for a radical prostatectomy.
\nThis thesis demonstrated that young adults (18-30 years) compared to older adults (≥31 years) do not experience more CPIP after TEP hernia repair in a high-volume hernia clinic. Moreover, athletes with inguinal disruption, selected through a multidisciplinary work-up, benefit from TEP repair. Furthermore, urological surgeons report technical surgical difficulties that can lead to aborted radical prostatectomies, additional interventions for mesh explantation or inguinal hernia recurrences, and increased healthcare costs. In particular, a less adequate pelvic lymph node dissection is undisputed and considered clinically most important since it can result in under-staging and under-treatment of prostate cancer patients.
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\nFollow-up after inguinal hernia surgery is performed with a patient-related purpose, in research settings, and to register data for internal quality control and national or international benchmarking. 
\nIn this thesis the efficiency and purpose of regular follow-up after TEP inguinal hernia repair was evaluated, and patient appreciation with follow-up was determined. It was determined that follow-up after TEP inguinal hernia surgery serves no clinical purpose. The purpose of follow-up is patient satisfaction and data registration for quality objectives. Additionally, the PINQ-PHONE was found to be a valuable tool in TEP repair follow-up by telephone to detect recurrences, and further optimized to have more patients refrain from visiting the outpatient clinic and still safely detect all recurrences. Finally, a study protocol was presented to determine the validity, relaibility and patient satisfaction with the Inguinal Hernia Application that can potentially substitute follow-up after inguinal hernia surgery by telephone or at the outpatient clinic.

What's known on the subject? and What does the study add? Some studies have evaluated preoperative and intraoperative examination for inguinal hernias and their repair, noting a decrease in the rate of post-prostatectomy hernias. However, this did not eradicate post-prostatectomy hernias, indicating that this method probably missed subclinical hernias. Other studies looked at prophylactic procedures to prevent the formation of inguinal hernias at the time of prostatectomy and showed a decrease in the rate of postoperative hernias. To our knowledge this is the only series evaluating a multi-modal approach with magnetic resonance imaging, ultrasonography and examination to identify all clinical and subclinical hernias and repair them at the time of prostatectomy. This approach only subjects those patients at risk for symptomatic hernias to an additional procedure and decreases the post-prostatectomy hernia rate to <1%. • To assess if a comprehensive evaluation to diagnose clinical and subclinical hernias and repair of these hernias at the time of open radical retropubic prostatectomy (ORRP) decreases the incidence of clinical inguinal hernias (IHs) after ORRP. • Between 1 July 2007 and 31 July 2010, 281 consecutive men underwent ORRP by a single surgeon. • Of these men, 207 (74%) underwent comprehensive preoperative screening for IH, which included physical examination, upstanding ultrasonography and magnetic resonance imaging. • Between 12 and 24 months after ORRP, 178 (86%) of these men completed a questionnaire designed to capture development of clinical IHs. • Of the 178 evaluable patients, 92 (52%) were diagnosed preoperatively with IH by at least one diagnostic modality. • Forty-one and 51 of the men had bilateral or unilateral IHs, respectively for a total of 133 IHs. • No preoperative factor was significantly associated with the presence of an IH before prostatectomy. • No groin subjected to IH repair (IHR) at the time of ORRP developed a clinical IH compared with four of the 21 patients with postoperative IHs who did not undergo repair of their preoperatively diagnosed IH at the time of ORRP (P= 0.024). • Only one (0.4%) clinical IH developed in a groin that had no evidence of IH by physical examination, upstanding ultrasonography and magnetic resonance imaging before prostatectomy. • Our comprehensive evaluation increases the detection of IHs before ORRP. • Repair of these IHs at the time of ORRP significantly decreases the risk of developing post-prostatectomy clinical IHs.

Longterm followup (12–15 years) of a randomized controlled trial comparing bassini-stetten, shouldice, and high ligation with narrowing of the internal ring for primary inguinal hernia repair

Patients undergoing prostatectomy for cancer are at risk for onset/worsening of inguinal hernia (IH). Preperitoneal inguinal hernia repair (IHR) concurrent with radical prostatectomy (RP) should be considered. Dissection of the preperitoneal space at RP provides an ideal opportunity for the repair of inguinal hernia. We describe our efforts with patients undergoing RP and IHR to determine whether this approach is safe. Records of patients undergoing RP and simultaneous IHR were identified from a prospective prostatectomy database from 1995 to 2007. Clinical hernia presentation, repair techniques, operative time, and complications were recorded. During the study period, 4,311 RPs were performed at our institution. Of these, 108 patients (2.5%) had 141 simultaneous IHRs. The mean patient age was 61 years (range 45-79), with an average body mass index (BMI) of 27.5 (range 19-37.6). Most patients underwent repair of a unilateral IH (n = 75; 69%) and 33 patients (31%) had a bilateral repair. The operative time was a median of 224 min in patients undergoing simultaneous IHR compared with 180 min in patients undergoing RP only. Records of the time required for IHR were available for 21 patients undergoing unilateral repair and for 18 patients undergoing bilateral repair. The median times for unilateral and bilateral IHR were 42 and 33 min, respectively. Only one patient had postoperative complications (perineal discomfort, bilateral neuralgia/paresthesia) possibly related to IHR. There were no wound infections in patients undergoing simultaneous hernia repair. Of the 141 IH repairs, four recurrent hernias (2.8%) required reoperation at a median of 16 months following initial repair. In our experience, preperitoneal IHR at the time of RP should be strongly considered, as it is not associated with an increased risk of complications and adds less than an hour of additional operative time to RP alone.

Background and aim: To find the superiority of extended total extraperitoneal (E-TEP) repair and trans-abdominal pre-peritoneal (TAPP) mesh repair in inguinal hernia repair.Material and methods: A total of 30 patients with a unilateral or bilateral inguinal hernia (IH), and recurrent IH, following open repair were studied. Out of 30 patients, laparoscopic TAPP or E-TEP mesh repair was performed in an equal number of inguinal hernia patients. The patient's demographic parameters, duration of surgery, postoperative hospital stay, and complications were compared.Results: In the E-TEP group, 33.33% of patients had left inguinal hernia (LIH), 60% of patients were diagnosed with right inguinal hernia (RIH) and 6.67% of patients had right inguinal and right direct hernia (RDH). In the TAPP group, 33.33% of patients had LIH and 53.33% of patients were suffering from RIH. Moreover, 6.67% of patients were diagnosed with a left inguinal direct hernia, and a similar proportion of patients had a right inguinal direct hernia. The mean duration of surgery was found to be significantly higher in the TAPP group (P<0.0000). The mean postoperative hospital stay was 2.07±0.59 and 2.80±1.32 days in E-TEP and TAPP groups, respectively (P=0.044).Conclusion: In the present study, E-TEP mesh repair is a superior technique in the management of inguinal hernia as compared with TAPP repair.

Background: Hernia is an unusual bulging of the intra-abdominal viscera through a weak area of the abdominal wall or groin region. Inguinal hernia repair is one of the most frequently performed surgical procedures. In recent years, inguinal hernia (IH) repair was changed from pure tissue repair to prosthetic laparoscopic repair. Objective: we propose to find a new application for the well-known surgical open mesh inguinal hernia in the treatment of inguinal hernias in adults aiming to improve patients' comfort and to reduce the incidence of chronic neuralgia. Patients and Methods: . A comparative study was designed to study the outcome of different sizes of mesh used in the hernia operations. In the present study, patients diagnosed with primary unilateral inguinal hernia (n=130) were enrolled from May 2019 to March 2020 at Baquba teaching hospital in Diyala governorate. Enrolled patients were divided into two groups. Group A include patients who have inguinal hernia operated with all in one procedure (n=65) and group B included patients with inguinal hernia operated by the classical method (n=65). Spinal and general anaesthesia were used. Before incision for the patient, ceftriaxone (1gm, intravenously) was administrated over 30 min. The process was accomplished on a one-day surgery basis .According to the devised technique, a new smaller prosthesis was placed on the floor of the inguinal canal in order to strengthen all areas of weakness from which hernias may originate. The mesh was enveloped by a fibro-cremasterico sheath avoiding contact with neural structures. Follow-up was carried out at 1week, 1month, 3months for evaluation of postoperative pain using numbering scale score, need of medication, patients' comfort, and postoperative complications. Results: all patients operated by all in one procedure were discharged within 24 h from surgery. Slight pain was reported by the majority of patients and (07.69%) of them required pain medication at home. After the 1st postoperative week (95.36%) reported no pain and (04.62%) show bruising genitaliao, (01.54%) had seroma and no wound infection recorded. No relevant limitation of normal activities was reported. There have been no postoperative neuralgias. Conclusion: This new hernioplastyo technique respects the anatomy of the inguinal canal, uses a smaller mesh, and seems to avoid neuralgias with maximum comfort for the patients. We recommended to all in one technique o because gives better results and fewer complications. Keywords: Hernia ;Open mesh inguinal hernia; patients

Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. We have innovated a "555 Technique" for completing Mini TEP repair of inguinal hernia by using all three 5 mm ports. Sixty-one consecutive patients were subjected for TEP repair of inguinal hernia by our innovative "555 Technique" since October 2014. A simple "Manish Retractor" is devised to make extra-peritoneal space with 5 mm trocar. Fifty-nine cases were men and 2 cases were women. The mean age of patients was 44.6 years (range 23-82 years). Out of 61 cases, 27 were indirect inguinal hernia (23 unilateral, 4 bilateral), 32 direct inguinal hernia (21 unilateral, 11 bilateral), 1 femoral hernia, and 1 obturator hernia. One patient of indirect inguinal hernia had sliding hernia with sigmoid colon. Sixty cases were successfully operated by "555 Technique." There was conversion to trans-abdominal pre-peritoneal repair (TAPP) in 1 case. The average time for insertion of 5 mm trocar in preperitoneal space by our technique was 150 seconds. No complications were noted on 6 months follow-up. Small infra-umbilical scar was cosmetically more acceptable to patients. "555 Technique" is a feasible option without compromising the principles of TEP repair for inguinal hernia. Innovation of simple "Manish Retractor" is the key in completing Mini TEP repair. This technique is simple, less invasive, less morbid, and cost effective as it avoids dependence over costly Hasson trocar with better cosmetic results.

Background: Inguinal hernias are a common medical problem that can significantly decrease the quality of life.Repair of inguinal hernia is one of the commonest surgical procedures worldwide irrespective of the country, race, or socioeconomic state. The inguinal hernia repair has been a controversial area in surgical practice from the time it has been conceived. Laparoscopic inguinal hernia repair has shown a great deal of promise as a treatment for the condition.Objectives: To compare the outcome of laparoscopic versus open inguinal hernia mesh repair in terms of operative time , analgesics requirement , postoperative complication , hospital stay and return to daily activities and work.Patients and methods: A prospective study of 80 patients with inguinal hernia repair, carried out during the period from January 2010 till January 2013, Baghdad Teaching Hospital\Medical City, Iraq, to compare the effectiveness and safety of laparoscopic and conventional open mesh techniques. Those patients were divided into 2 groups (each group of 40 patients); 1st group treated by laparoscopic (TAPP) repair and the 2nd one by open technique (mesh repair).Results: The mean operating time in laparoscopic repair was 55 minutes (45-120) while in open repair it was 38 minutes (30-110) .The laparoscopic repair was superior to open repair in regard to ; less analgesic requirement post operatively , short hospital stay , and faster return to daily activities and workThere was no statistically significant difference between the two groups regarding complications.Conclusion: Laparoscopic hernia repair is equally safe and can provide less postoperative morbidity in experienced hands Therefore laparoscopic hernia repair can be safely recommended for most cases of inguinal hernia unless laparoscopy itself is contraindicated.