Single-incision laparoscopic transabdominal preperitoneal repair in the treatment of adult female patients with inguinal hernia

BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia repair is becoming in-creasingly popular in the management of inguinal hernia in women.However,there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal(CL-TAPP)inguinal hernia repair for the treatment of inguinal hernia in women.AIM To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients.METHODS We retrospectively compared the clinical information and follow-up data of fe-male inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hos-pital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts.RESULTS This study included 123 patients,with 71 undergoing SIL-TAPP repair and 52 un-dergoing CL-TAPP repair.The two cohorts of patients and inguinal hernia charac-teristics were similar,with no statistically meaningful difference.The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort(0,0%)than in patients in the CL-TAPP cohort(4,7.7%)and was significantly different(P<0.05).In addition,the median[interquartile range(IQR)]total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort[$3287(3218-3325)]than in patients in the CL-TAPP cohort[$3511(3491-3599)].Postoperatively,the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort(0,0%)than in the CL-TAPP cohort(4,7.7%),and the median(IQR)cosmetic score was significantly higher in the SIL-TAPP cohort[10(10-10)]than in the CL-TAPP cohort[9(9-10)].CONCLUSION SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female in-guinal hernia patients.Moreover,female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who un-derwent CL-TAPP repair.In addition,female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision.Therefore,SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.

Omental fibroma combined with right indirect inguinal hernia masquerades as a scrotal tumor: A case report

BACKGROUND The most common causes of scrotal enlargement in patients include primary tumor of the scrotum,inflammation,hydrocele of the tunica vaginalis,and indirect inguinal hernia;scrotal enlargement caused by external tumors of the scrotum is rare.The patient had both a greater omentum tumor and an inguinal hernia,and the tumor protruded into the scrotum through the hernia sac,which is even rarer.Moreover,omental tumors are mostly metastatic,and primary omental fibroma is rare.CASE SUMMARY Here,we report a rare case of a 25-year-old young man with scrotal enlargement and pain for 3 months.Preoperative examination and multidisciplinary discu-ssions considered intra-abdominal tumor displacement and inguinal hernia,and intraoperative exploration confirmed that the greater omentum tumor protruded into the scrotum.Therefore,tumor resection and tension-free inguinal hernia repair were performed.The final diagnosis was benign fibroma of the greater omentum accompanied by an indirect inguinal hernia.CONCLUSION This unusual presentation of a common inguinal hernia disease illustrates the necessity of performing detailed history taking,physical examination,and imaging before surgery.

Comparative Analysis of the Efficacy of Transabdominal Pre-Peritoneal Vs Open Tension-Free Hernia Repair in Treating Inguinal Hernia

Objective:To investigate and analyze the clinical outcomes of inguinal hernia patients treated with transabdominal pre-peritoneal repair(TAPP)versus open tension-free hernia repair.Methods:The study was carried out from January 2021 to August 2023,and a total of 50 inguinal hernia patients were selected for this study.The patients were randomly divided into a study group(n=25)and a control group(n=25)by the numerical table method.The patients in the control group were treated with open tension-free hernia repair,whereas the patients in the study group were treated with TAPP.The surgical and postoperative recovery indexes,complication rates,and recurrence rates of the two groups were compared.Results:There was no significant difference in the operative time and intraoperative blood loss between the two groups(P>0.05),and the postoperative feeding time,time out of bed,and hospitalization time of the study group were shorter than those of the control group(P<0.05);the incidence rate of postoperative complications in the study group was lower than that in the control group(P<0.05);and there was no significant difference in the recurrence rate of the two groups after operation(P>0.05).Conclusion:Compared to open tension-free hernia repair,TAPP offers a shorter postoperative recovery duration and hospitalization time,and reduces the incidence of complications.Therefore,this surgical method should be popularized in the treatment of inguinal hernia.

Clinical and Therapeutic Aspects of Inguinal Hernia in Children in the General Surgery Department of Reference Health Center in Commune I of Bamako Mali

Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to study inguinal hernia in children in the general surgery department of the Reference Health Center of Commune I of the Bamako District;to determine the frequency of inguinal hernia;describe the epidemiological, clinical and therapeutic aspects of inguinal hernias and in order to evaluate the cost of treatment. This was a prospective study from April 2017 to March 2018 during which 60 children with an inguinal hernia were collected. Inguinal hernias in children represented 9.23% of patients operated on in the department. The average age was 59.23 months with extremes of one month and 180 months and a standard deviation of 49.23 years. The male sex was dominant with a sex ratio equal to 9:1. The notion of prematurity was found in 11.7% and was associated with a testicle not in place in 1.7% of cases. 41.7% of our patients were referred by a doctor and 66.7% of patients presented with painless, intermittent inguino-scrotal swelling (83.3% of cases). The hernia was discovered before one week of life in 50% of cases. Inguinal swelling was absent in 11.7% but observed intraoperatively. The inguinal hernia was unilateral in 91.7% of cases and 70% of hernias were discovered by the parents during pushing efforts. The inguinal hernia was located on the right in 61.7% of cases. The hernia swelling was soft, painless, impulsive and reducible in 78.3% of cases. The swelling was inguino-scrotal in 58.3% of cases. The hernia was simple in 95% of patients and hernial strangulation was observed in 3 cases or 5% of cases. 98.3% of patients were ASA I. The treatment was carried out openly in all our patients including closure of the vaginal peritoneal canal in 95% of cases under general anesthesia in 98.3% of cases. The morbidity rate was 8.4% (surgical site infection: 6.7% of cases and hematoma: 1.7%). The immediate consequences were simple in 96.6% of cases. No cases of recurrence occurred during the 6 months after the intervention. The average cost of care was estimated at 69,743 FCFA.

Simultaneous Management of Inguinal Hernia and Benign Prostatic Hypertrophy in a Single Operation at the Chu D’abeche/Chad

Introduction: Benign prostatic hypertrophy and inguinal hernia are related and frequent pathologies in people over 50 years old. Their incidence is 15% to 25% according to the literature. The occurrence of hernia during benign prostatic hyperplasia is favored by disorders of the lower urinary tract. Simultaneous single-stage treatment of these two pathologies makes it possible to obtain satisfactory results that can reduce the cost of hospital stay and the multiple risk of anesthesia. The aim of our study was to: 1) Report the epidemiological, anatomo-clinical and para-clinical aspects of hernias during benign prostatic hypertrophy;2) Evaluate the feasibility and the results of the combined treatment of inguinal hernia and prostatic adenectomy in a single operation. Patients and Method: This was a retrospective descriptive study over a period of 7 years from March 2014 to February 2021, including patients operated on simultaneously at the University Hospital of Abeche for inguinal hernia and benign prostatic hypertrophy. The variables studied were: age, antecedents, favouring factors, clinical symptomatology, para-clinical elements, treatments and results: Results: 356 patients underwent surgery for benign prostatic hyperplasia, 36 of whom had an associated inguinal hernia. The mean age was 65.5 years, ranging from 50 to 93 years. The main reason for consultation was chronic urinary retention. The average consultation time was 10.2 months. The inguinal hernia was located on the right in 51% of cases and on the left in 18.4%. The mean prostatic volume measured by suprapubic ultrasound was 60.5 ± 25 cc. 14% and 10.2% of patients respectively were found to have struggle bladder and bilateral ureterohydronephrosis. Transvesical suprapubic adenectomy of the prostate was performed in all patients. The Bassini technique was the most commonly used (91%) for hernia repair. The average hospital stay was 7.5 days. Conclusion: Simultaneous treatment of benign prostatic hypertrophy and inguinal hernia reduces the number of hospital admissions in elderly patients, as well as the length of hospital stay.

Utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection

AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.

Multifactor study of efficacy and recurrence in laparoscopic surgery for inguinal hernia

BACKGROUND Inguinal hernia is a common clinical manifestation in children with a low selfhealing rate.AIM To determine the effect of laparoscopic surgery on indirect inguinal hernia and the risk factors for postoperative recurrence and to provide a reference for the clinical treatment and prevention of recurrence.METHODS We selected 360 children who underwent laparoscopic high ligation in our hospital as the laparoscopic group and 120 patients treated for inguinal hernia with conventional surgery as the control group.The operation time,blood loss,incision length,hospitalization time,total hospitalization cost and surgical complications were compared between the two groups.According to telephone follow-up or return visits,the children who had recurrence within 2 years after the operation in the laparoscopic group were analyzed,and the laparoscopic high ligation hernia sac level was analyzed by the logistic multifactor method.Ligation was used to treat recurrence in children with inguinal hernia.RESULTS The operation time,blood loss,length of incision,and length of hospital stay in the laparoscopic group were lower than those in the control group(P<0.05).The total hospitalization cost in the laparoscopic group was higher than that in the control group(P<0.05).The operative complication rate was 1.67%lower than that in the control group(12.50%)(P<0.05).In 360 children with laparoscopic high ligation of the hernia sac,14 patients had recurrence within 2 years after surgery.After analysis,14 cases in the recurrence group did not recur.The preoperative incarceration rate,inner ring diameter,ligature use and age difference were statistically significant(P<0.05).According to logistic regression multivariate analysis,an inner ring diameter≥1.0 cm,the use of an absorbable ligature line and age>3 years increased the risk of postoperative recurrence in children with inguinal hernia after laparoscopic high ligation of the hernia sac(P<0.05).CONCLUSION Laparoscopic surgery for indirect inguinal hernia in children has the advantages of low trauma and a rapid postoperative recovery.An inner ring diameter≥1.0 cm,the use of absorbable ligature,and age>3 years may increase the risk of recurrence after laparoscopic high ligation of the hernia sac.

Laparoscopic bilateral inguinal hernia repair: Should it be the preferred technique?

Inguinal hernias are amongst the most common conditions requiring general surgical intervention.For decades,the preferred approach was the open repair.As laparoscopy became more popular and available and more surgeons became familiarized with this modality,laparoscopic inguinal hernia repair became an alternative.The aim of this study is to assess the effectiveness of laparoscopic inguinal repair,with a focus on bilateral inguinal hernias.Initial reports have shown promising clinical outcomes compared to those of conventional repair of bilateral hernias.However,there are only a few studies concerning laparoscopic repair of bilateral hernias.It is yet to be proven that laparoscopy is the“gold standard”in the treatment of bilateral inguinal hernias.So far,the choice of an inguinal hernia repair technique has been up to each surgeon,depending on their expertise and available resources after taking into consideration each patient’s needs.

Evaluation of Ultrasound-guided Genitofemoral Nerve Block Combined with Ilioinguinal/iliohypogastric Nerve Block during Inguinal Hernia Repair in the Elderly

To evaluate the anesthetic effect of ultrasound-guided(USG)ilioinguinal/iliohypogastric nerve(Ⅱ/IHN)block combined with genital branch of genitofemoral nerve(GFN)block in the elderly undergoing inguinal hernia repair,54 old patients(aged 60-96years,ASAⅠ-Ⅲ)with indirect hernia were enrolled and scheduled for unilateral tensiofree herniorrhaphy.Patients were grouped randomly to receive either USGⅡ/IHN plus GFN block(Group G)or USGⅡ/IHN block alone(GroupⅠ).The intraoperative visual analogue scale(VAS)scores were recorded at skin incision,at spermatic cord/round ligament traction and at sac ligation.The resting and dynamic VAS scores were recorded postoperatively.The requirements of extra sedatives and analgesics for intra-and postoperative analgesia were assessed.Occurrence of complications of the block,postoperative nausea and vomiting and femoral nerve palsy was also reported.Both groups showed similar sensory block.When stretching spermatic cord/round ligament,the patients in group G had significantly lower VAS scores than in group.And group G used much fewer adjuvant sedatives and analgesics to achieve adequate anaesthesia.In addition,group G was presented with better intraoperative anaesthesia and lower postoperative dynamic VAS scores at all time points tested.No significant difference was found in the postoperative requirement of rescue medication.Both groups showed no complications related to the block and group G reported no femoral nerve palsy.The addition of GFN block toⅡ/IHN block improves the quality of perioperative anesthesia and analgesia in the elderly and reduces the consumption of extra sedatives and analgesics during the surgery.

Incarceration of a colonoscope in an inguinal hernia: Case report and literature review

Incarceration of an endoscope in an inguinal hernia may occur during the course of routine colonoscopy. The incarceration may occur on insertion or withdrawal and frequently the hernia is not suspected prior to the colonoscopy. Most commonly, a left sided inguinal hernia is involved, however right inguinal hernias may be implicated in subjects with altered anatomy post abdominal surgery. Incarceration of an endoscope in an inguinal hernia has been seldom reported in the literature which is likely to be related to under reporting. A range of techniques have been suggested by various authors over the last four decades to manage this unusual complication of colonoscopy. These techniques include utilizing fluoroscopy, manual external pressure and/or the fitting of a cap onto the tip of the colonoscope to facilitate colonoscopic navigation. The authors present a case report of incarceration of the colonoscope on withdrawal in an unsuspected left inguinal hernia with a review of the literature on the management of this colonoscopic complication. A management strategy is suggested.

Analysis of the Causes of Chronic Pain after Inguinal Hernia Repair without Tension and Its Prevention and Treatment

Purpose: Analyzing the causes of pain after tension-free repair in the inguinal hernia, and propose corresponding treatment strategies. Results: The patients in this group were followed up for 3 - 12 months. A total of 5 patients still had pain relief within 3 months after surgery. Further treatment was needed, and the incidence rate was 5%. Conclusion: Skilled surgical procedures are performed in patients with local anesthesia, and some of the absorbable repair materials can be used. The improved patch fixation and extra peritoneal repair can reduce the pain after inguinal hernia repair without tension.

Cost effective use of mosquito net mesh in inguinal hernia repair

Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery,divided into the polypropylene mesh(PPM)group and the mosquito net mesh(MNM)group each containing fifty patients.All cases were completed successfully and results revealed no difference in two groups.The results of the present study,in consistent with the published literature,reveal that the cheap indigenous mosquito mesh,which has similar properties of an imported mesh,can be safely used for tension-free inguinal hernia repair in adults.Further trials with a larger number of patients and longer follow-ups are justified and recommended.

Omental mass combined with indirect inguinal hernia leads to a scrotal mass: A case report

BACKGROUND Primary omental tumors are uncommon,and omental fibromas account for 2%of these tumors.Due to the low incidence of omental fibromas and the limited relevant literature,it is challenging for clinicians to make an accurate diagnosis of this condition,especially before surgery.CASE SUMMARY A 30-year-old man was admitted to the hospital because of a left epididymal mass with vague discomfort for more than 1 mo.A physical examination was performed,and the findings showed that the epididymal mass may have entered the abdominal cavity.Pelvic computed tomography was performed in our hospital and revealed a left inguinal hernia with a mass in the hernial contents,and no masses were found in the left epididymis.A traditional inguinal hernia incision was made.Intraoperative hernia contents were found to be of the greater omentum,and a 2.5 cm-diameter mass was found at the distal end of the greater omentum.The scrotum and epididymis did not exhibit other masses.Then,the mass of the greater omentum was excised.Intraoperative frozen pathological examination suggested a spindle cell tumor.The postoperative pathological examination suggested that the mass was an omental angiofibroma.Postoperatively,the patient recovered well and was discharged.Outpatient re-examinations were performed at 1 mo and half a year after the operation and showed no obvious abnormalities.CONCLUSION Due to the low morbidity rate associated with and latent nature of omental tumors,these tumors are difficult to diagnose preoperatively;thorough medical history taking,detailed physical examinations,and necessary imaging auxiliary examinations can help clinicians diagnose and treat these cases.

Indirect inguinal hernia containing portosystemic shunt vessel: A case report

BACKGROUND Inguinal hernia repair is one of the most common general surgical operations worldwide.We present a case of indirect inguinal hernia containing an expanded portosystemic shunt vessel.CASE SUMMARY We report a 72-year-old man who had a 4 cm×4 cm swelling in the right inguinal region,which disappeared with light manual pressure.Abdominal-pelvic computed tomography(CT)revealed a right inguinal hernia containing an expanded portosystemic shunt vessel,which had been noted for 7 years due to liver cirrhosis.We performed Lichtenstein’s herniorrhaphy and identified the hernia sac as being indirect and the shunt vessel existing in the extraperitoneal cavity through the internal inguinal ring.Then,we found two short branches between the expanded shunt vessel and testicular vein in the middle part of the inguinal canal and cut these branches to allow the shunt vessel to return to the extraperitoneal cavity of the abdomen.The hernia sac was returned as well.We encountered no intraoperative complications.After discharge,groin seroma requiring puncture at the outpatient clinic was observed.CONCLUSION If an inguinal hernia patient has portal hypertension,ultrasound should be used to determine the contents of the hernia.When atypical vessels are visualized,they may be shunt vessels and additional CT is recommended to ensure the selection of an adequate approach for safe hernia repair.

Mesh migration into the sigmoid colon after inguinal hernia repair presenting as a colonic polyp:A case report and review of literature

Mesh migration and penetration into abdominal visce-ra rarely occur after laparoscopic inguinal hernia repair. We present the first case of mesh migration into the sigmoid colon identified as a colonic polyp at initial co-lonoscopic examination. The patient complained of mild abdominal distention in the lower abdomen over the previous year without changes in bowel habits or stool appearance and without weight loss. By complement-ary endoscopic ultrasonography, a cavity--like structure beneath the suspected polyp was further confirmed. Enhanced abdominal computed tomography merely re-vealed local bowel wall thickening and inflammation of the colosigmoid junction. The migrating mesh, which was lodged in the sigmoid colon and caused intra--abdomi-nal adhesion in the lower abdominal cavity, was finally identified via exploratory surgery. The components of inflammatory granulation tissue around the mesh mate-rial were diagnosed based on histological examination of the surgical specimen after sigmoidectomy. In this patient, nonspecific endoscopic and imaging outcomes during clinical work--up led to the diagnostic dilemma of mesh migration. Therefore, the clinical, radiological and endoscopic challenges specific to this case as well as the underlying reasons for mesh migration are discussed in detail.

Polypropylene versus Polyester Mesh for Laparoscopic Inguinal Hernia Repair: Short-Term Results of a Comparative Study

Background: Polypropylene meshes are commonly used in laparoscopic inguinal hernia repair, although they may cause complications. In this prospective study, a polyester mesh was compared to a polypropylene mesh. Methods: Transabdominal preperitoneal (TAPP) laparoscopic repair was performed in 160 consecutive male patients suffering from unilateral inguinal hernia. The first 80 cases received a polypropylene mesh (Parietene, Covidien, France), and a polyester mesh (Parietex, Covidien, France) was implanted in the second half of patients. Both groups were comparable with respect to clinical and demographic variables. Patients rated their pain using the visual analogue scale (VAS), and ultrasonography was performed on postoperative days 1 and 3 to measure seroma formation. Results: The duration of surgery and the length of stay were similar in both groups. Postoperative pain, measured on day 1 and 3, was significantly less in patients who had received a polyester mesh as compared to the polypropylene group. The size of local seroma was also significantly reduced in the polyester group. Complication rates were 10% in the polypropylene and 9% in the polyester group and included one early recurrence in each group. Conclusions: Polyester meshes may be useful in TAPP, as this mesh material produces less foreign body reaction with less seroma formation and lower pain levels than conventional polypropylene.

Mesh plug erosion into the small intestine after inguinal hernia repair: A case report

BACKGROUND Mesh plug(MP)erosion into the intra-abdominal organs is a rare but serious long-term complication after inguinal hernia repair(IHR),and may lead to aggravation of symptoms if not treated promptly.It is difficult to diagnose MP erosion as there are no obvious specific clinical manifestations,and surgery is often needed for confirmation.In recent years,with the increased understanding of postoperative complications,MP eroding into the intra-abdominal organs has been a cause for concern among surgeons.CASE SUMMARY A 50-year-old man was referred to the Department of General Surgery with the complaint of abdominal pain in the right lower quadrant for 2 d.He had a surgical history of right open IHR and partial thyroidectomy performed 20 years and 15 years ago,respectively.Computed tomography revealed a circinate highdensity image with short segmental thickening of the ileum stuck to the abdominal wall,and no evidence of recurrent inguinal hernia.Laparoscopic abdominal exploration confirmed adhesion of the middle segmental portion of the ileal loop to the right inguinal abdominal wall;the rest of the small intestine was normal.Further exploration revealed migration of the polypropylene MP into the intraperitoneal cavity and formation of granulation tissue around the plug,which eroded the ileum.Partial resection of the ileum,including the MP and end-to-side anastomosis with an anastomat,was performed.CONCLUSION Surgeons should aim to improve their ability to predict patients at high risk for MP erosion after IHR.

Delayed Mesh Infection: A Rare Complication of Laparoscopic Inguinal Hernia Repair (TEP—Totally Extra-Peritoneal Repair)

Hernias are amongst the oldest afflictions of mankind. The tension-free mesh repairs revolutionized and radically changed the whole concept of anatomical tissue repairs. The introduction of mesh, though beneficial, posed a new set of postoperative problems with the mesh infection being the most morbid one. Laparoscopic surgery has been able to reduce the incidence of mesh infection as opposed to the open hernia repairs. The infection occurs mostly early but rarely does it present several years after the surgery. Herein we report our case of delayed mesh infection developing 6 years postoperatively. This is our first such case in a series of more than 1000 laparoscopic hernia repairs over a period of 6 years (2010-2016). The patient needed an open exploration which revealed a large preperitoneal cavity containing 770 ml of pus with a mesh floating in it. The mesh was removed and the thorough toileting of the wound was done.

Perioperative Local Cooling Reduce Significantly Early Pain after Open Inguinal Hernia Repair:A Prospective Randomized Study

Pain and local complications are the major determinants of outcome after inguinal hernia repair. To evaluate the respective impact of peri-operative cooling of surgical site and usual care after open inguinal hernia repair, we performed a prospective randomized study. Methods: One hundred and eight consecutive patients with primary unilateral inguinal hernia were included the study. Repair was performed by local direct access during ambulatory surgery. The first study group underwent standard pre- and postoperative local care (control group). In the second group (cold compress group), a single-use disposable sterile cold compress was applied on the surgical site for at least 30 minutes before and 2 hours after surgery. Primary endpoints were immediate postoperative pain using a visual analogue scale, and local complications. Secondary endpoints included: analgesic drug consumption, length of hospital stay, delay to return to normal activity and patient satisfaction. Results: There was no difference concerning operative time (36.3 ± 14.0 vs 39.6 ± 7.2 minutes) and early (one-week) complications, although there was a non significant reduced incidence of hematoma and ecchymosis (0/54 versus 4/54) for the cold compress group. Analgesic drug consumption was significantly (p = 0.01) reduced. During the day of surgery and the first postoperative day, the visual analogue scale was significantly lower after cooling. There was a non-significant reduction in length of hospital stay (150 ± 37 versus 210 ± 47 min), and time to return to normal activity was shorter in the cold compress group. Conclusion: For open inguinal hernia repair, immediate pre- and post operative surgical site cooling, targeting a controlled temperature between 12?C and 15?C significantly reduced postoperative pain, analgesic drug consumption and resulted in improved immediate outcomes. This technique is safe, simple, easy to use, inexpensive and well tolerated by the patient.

Novel use of cap-assisted enteroscopy for detection of colorectal tumor in a patient with incarcerated inguinal hernia

Multiple reports have documented unsuspected ingui-nal hernias which result in difficulties during the colo-noscopic examinations of patients. In most cases, the colonoscopy can be delayed until a surgical consult has further evaluated the inguinal hernia. This case report documents a patient who required a colonoscopy but surgical intervention for the detected inguinal hernia was not appropriate due to his co-morbid medical con-ditions. With the use of the combination of an entero-scope fitted with a cap and fluoroscopy, the inguinal hernia was able to be negotiated and the diagnosis of a cecal carcinoma was able to be confirmed.