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.

Rotator cuff repair with an interposition polypropylene mesh:A biomechanical ovine study

BACKGROUND Chronic large to massive rotator cuff tears are difficult to treat and re-tears are common even after surgical repair.We propose using a synthetic polypropylene mesh to increase the tensile strength of rotator cuff repairs.We hypothesize that using a polypropylene mesh to bridge the repair of large rotator cuff tears will increase the ultimate failure load of the repair.AIM To investigate the mechanical properties of rotator cuff tears repaired with a polypropylene interposition graft in an ovine ex-vivo model.METHODS A 20 mm length of infraspinatus tendon was resected from fifteen fresh sheep shoulders to simulate a large tear.We used a polypropylene mesh as an interposition graft between the ends of the tendon for repair.In seven specimens,the mesh was secured to remnant tendon by continuous stitching while mattress stitches were used for eight specimens.Five specimens with an intact tendon were tested.The specimens underwent cyclic loading to determine the ultimate failure load and gap formation.RESULTS The mean gap formation after 3000 cycles was 1.67 mm in the continuous group,and 4.16 mm in the mattress group(P=0.001).The mean ultimate failure load was significantly higher at 549.2 N in the continuous group,426.4 N in the mattress group and 370 N in the intact group(P=0.003).CONCLUSION The use of a polypropylene mesh is biomechanically suitable as an interposition graft for large irreparable rotator cuff tears.

Inguinodynia following Lichtenstein tension-free hernia repair:A review

Chronic Groin Pain (Inguinodynia) following inguinal hernia repair is a significant,though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However,moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain,as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair,use of heavyweight vs lightweight mesh and mesh fixation with sutures vs glue. Though there is no convincing evidence favouring one over the other,lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain,though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both nonsurgical and surgical options have been tried for chronic groin pain,with their consequent risks of analgesic sideeffects,recurrent pain,recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre-and post-herniorraphy.

Analysis of Ultrasound-guided Ilioinguinal and Iliohypogastric Nerve Block in Tension-Free Inguinal Hernia Repair in Elderly Patients

Objective:To explore the value of ultrasound-guided ilioinguinal and iliohypogastric nerve block(IINB)in tension-free inguinal hernia repair in elderly patients.Methods:A total of 70 elderly patients with tension-free inguinal hernia repair who treated in the hospital from April 2018 to November 2019 were selected and divided into two groups according to the random number table method,with 35 cases each.The control group underwent infiltration of local anesthesia(LA),and the study group added with IINB.The visual analogue scale(VAS)scores of the two groups of patients were compared.Results:The VAS score of the study group when pulling the hernia sac was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion:IINB has good analgesic effect in tensionfree inguinal hernia repair in elderly patients,and it is worth promoting.

Analysis of the Effect and Efficiency of Tension- Free Hernia Repair and Traditional Surgery in The Treatment of Hernia

Objective: To analyze the efficiency of tension-free hernia repair and traditional surgery in the treatment of hernia. Methods: A total of 80 patients with hernias were selected and randomly into a control group (traditional hernia repair) and an observation group (tension-free hernia repair), of 40 cases each. The perioperative indicators, pain, physiological stress indicators, complications, and recurrence rates between the two groups were compared. Results: The perioperative indexes of the observation group were better than those of the control group (P < 0.05). The postoperative pain score, postoperative physiological stress index level, incidence of complications, and recurrence rate of the observation group were lower than those of the control group (P < 0.05). Conclusion: In the surgical treatment of hernia, tension-free hernia repair was less traumatic and had a better effect than traditional hernia repair.

Intestinal erosion caused by meshoma displacement:A case report

BACKGROUND A meshoma formation and erosion to the small intestine is rare.Herein,we report one case of a meshoma that was not treated early;causing it to displace and erode the small intestine,with infection,complete control of symptoms was achieved after removal of the infected patch mass,no recurrence of hernia after 2 years of follow-up.CASE SUMMARY A 62-year-old male patient presented with recurrent abdominal pain repeatedly for 1 wk,which has worsened 2 d before admition,accompanied by fever.Five years before presentation he underwent right inguinal hernia Plug and patch repair approach.Two years ago,a computed tomography scan revealed a right lower abdominal mass with soft tissue density,measuring approximately 30 mm×17 mm,which was diagnosed as meshoma that was not treated.The patient had poorly controlled diabetes in the past year.CONCLUSION The formation of meshoma is rare,and that if not treated in time it might erode and require resection of the involved organ.

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.

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.

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.

Synthetic vs biologic mesh for the repair and prevention of parastomal hernia

AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.METHODS Relevant databases were searched for studies reporting hernia recurrence, wound and mesh infection, other complications, surgical techniques and mortality. Weighted pooled proportions （95%CI） were calculated using StatsDirect. Heterogeneity concerning outcome mea-sures was determined using Cochran’s Q test and was quantifed using I2. Random and fxed effects models were used. Meta-analysis was performed with Review Manager software with the statistical signifcance set at P ≤ 0.05.RESULTSForty-four studies were included： 5 reporting biologic mesh repairs; 21, synthetic mesh repairs; and 18, prophylactic mesh repairs. Most of the studies were retrospective cohorts of low to moderate quality. The hernia recurrence rate was higher after undergoing biologic compared to synthetic mesh repair （24.0% vs 15.1%, P = 0.01）. No significant difference was found concerning wound and mesh infection （5.6% vs 2.8%; 0% vs 3.1%）. Open and laparoscopic techniques were comparable regarding recurrences and infections. Prophylactic mesh placement reduced the occurrence of a parastomal hernia （OR = 0.20, P 〈 0.0006） without increasing wound infection [7.8% vs 8.2% （OR = 1.04, P = 0.91）] and without differences between the mesh types.

Urethral complications after tension-free vaginal tape procedures:A surgical management case series

AIM： To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures.METHODS： This study encompasses a retrospective review of nine patients presented with urethral complic-ations after midurethral sling procedures. The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden. The time from sling placement to diagnosis, the risk factors, clinical features, diagnosis, surgical management, and functional outcome are presented. The presenting symptoms were described as either early onset （〈 12 mo） or late onset （〉 12 mo） according to when they were frst reported.RESulTS： Eight cases of urethral erosion and one case of bladder-neck erosion were detected. The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years. The most common presenting symptoms included de novo urgency with or without incontinence （7/9 patients）, urinary retention/voiding dysfunction （4/9 patients）, urethritis （4/9 patients）, relapse of stress-incontinence （3/9 patients）, recurrent urinary tract infections （5/9 patients）, and hematuria （1/9 patient）. In most cases, voiding dysfunction and urethritis occurred early after the operation. The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh. The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptoms in 5/7 patients with urgency. Four patients were reoperated with a new stress-incontinence surgery, one with laparoscopic Burch, and three with retropubic tension-free vaginal tape procedures. COnCluSIOn： Urethral complications should be suspected in the case of de novo urgency and relapse of stress-incontinence. Transurethral excision of the intraurethral mesh is the recommended treatment.

Mesh repair of sacrococcygeal hernia via a combined laparoscopic and sacrococcygeal approach: A case report

BACKGROUND Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a patient who had no history of sacrococcygeal operation, present the operative procedures of mesh repair via a combined laparoscopic and sacrococcygeal approach that has not been described,and discuss our experience in diagnosis and treatment with a review of the literature.CASE SUMMARY A 54-year-old woman who chiefly complained of a 10-year history of a reversible bulge in her right sacrococcygeal region was admitted to our hospital. The physical examination revealed a bulge in the right sacrococcygeal region upon standing, which disappeared in the prone position but relapsed when performing the Valsalva manoeuvre. Computed tomography displayed an abnormality in the structure of the tissues between the midline of the sacrococcygeal region and the right gluteus muscle. The patient was diagnosed with sacrococcygeal hernia and received hernia repair with mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally, and a defect was identified in the right anterior sacrococcygeal region through which part of the rectum protruded. This was followed by the placement of a self-gripping polyester mesh via a sacrococcygeal approach. There were no postoperative complications. The patient was discharged on postoperative day 7 and was followed for more than 6 mo with no recurrence.CONCLUSION Laparoscopic mesh repair is recommended as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.

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.

High Scalp Tension after Three-Dimensional Titanium Mesh Repair for Skull Defect: 2 Case Reports

Rationale: The three-dimensional (3D) computer-made titanium mesh is widely used in the skull repair for those patients receiving decompression of the bone flap. It can restore normal anatomy to a greater extent and make a better appearance. Case Presentation: We reported two cases of patients admitted to our hospital who have experienced high scalp tension after skull repair. At first, these two patients underwent decompression of the bone flap, and the physical examination results showed a defect of skull. No neurological symptoms and signs were found. The 3D computed tomography (CT) reconstruction of skull was performed, and then the skull repair with 3D titanium mesh was conducted. But because of high scalp tension, they underwent a second operation, during which we re-trimmed and reduce the arc of the titanium mesh. The scalp incision of both patients healed well and no titanium mesh was exposed. Both patients have a good prognosis. Lessons: We highlight that the high tension of scalp due to overstretching after 3D titanium mesh repair for skull defect should be paid much attention to. Trimming and reducing the arc of titanium mesh is an effective treatment for this situation.

Algorithms for mesh repairing to represent automobile parts

In representing automobile parts with mesh in the field of reverse engineering or finite element generation, the mesh reconstruction and data exchanging between different CAD/CAM systems often introduce many invisible topological and geometrical errors into mesh. These artifacts can cause serious problems in subsequent operations such as finite element analysis, reverse engineering, animation, and simulation. In this study we propose a practical method for repairing topological and geometrical errors on mesh. First, coincident vertices during mesh input are removed, fol- lowed by the identification of non-manifold vertices and edges. The non-manifold vertices are modified, and the facets having non-manifold edges are removed. Finally, faces that have the wrong orientations in the mesh are re-oriented. Experiments show that our methods can eliminate most common mesh errors quickly and effectively. The refined mesh can be properly used in subsequent operations.

A Long-term Follow-up: Suture versus Mesh Repair for Adult Umbilical Hernia in Saudi Patients. A Single Center Prospective Study

Objective: To report results of mesh repair vs. the modified Mayo’s suture overlap in the surgical treatment of adult umbilical and paraumbilcal hernias in our medical center. Patients & Methods: The study is a Saudi single center single surgeon trial composed of sixty two patients. It was performed in the Surgical Department of King Abdul-Aziz University Hospital at Jeddah. The patients were randomly assigned into 2 groups. Group A patients underwent onlay mesh repair while modified Mayo’s repair was used in group B patients. Median follow-up was 28 months, and data were collected regarding size of hernia, type of the operation, complications, length of follow-up and the recurrence rate. Chi square test was used to compare results at 0.05 levels. Results: Complication was reported in 17% in group A and 8% in group B .There was no difference in scar pain, cosmetic result, and overall patient satisfaction between both groups. The recurrence rate was 10% for mesh repair and 18.8% for suture repair. Conclusions: Despite higher complication rate, mesh repair is superior to suture repair due to lower recurrence rate. Suture repair still has a place under certain circumstances, also it is simple less costly and has insignificant infection rate.

Novel Technique Combining Tissue and Mesh Repair for Umbilical Hernia in Adults

Introduction: Umbilical hernia in adults poses a challenge to the surgeon. Understanding the anatomical and pathological intricacies of the hernia is pivotal in evolving a good repair. A multitude of repairs have been tried for repair of umbilical hernias. However none of them have withstood the test of time. Objective: The study aims at evolving a technique which provides mesh reinforced anatomical reconstruction of the defect. Materials and Methods: 20 patients underwent a combination repair for umbilical hernia. The results were tabulated and analysed. Results: None of the 20 patients developed any recurrence. Conclusion: A combined mesh reinforcement of tissue repair is advocated for umbilical hernias in adults.

A Technique of Bilateral Inguinal Hernia Repair Using 10 mm Single Port Access and Bioresorbable Composite Mesh Fixed with Endoclose Sutures: Three Cases Reported

Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in 3 cases of bilateral inguinal hernia. Methods: Laparoscopic SPA-IPOM is done through a 10 mm trocar with one 10 mm instrument that has 5 mm optical lens and 5 mm channel for grasper. After inserting 10 mm trocar at umbilicus using semi-open technique, intraperitoneal anatomical landmark of inguinal her-nia is identified. A 10 × 15 cm pre-tied bioresorbable composite mesh is then placed to cover hernia defect and all three potential area of indirect, direct and femoral hernia. Using Endoclose? needle, each pair of pre-tied sutures is retrieved percutaneously through a needle wound and extracorporeal tied with knot in subcutaneous space. After the upper half of mesh is sutured to the posterior surface of abdominal wall, the lower half of mesh is fixed by hernia tacker to Symphysis Pubis, Cooper Ligament and Iliopubic tract. Re-sults: Three men, average 48 year olds were operated by laparoscopic 10 mm SPA-IPOM for bilateral in-guinal hernia repair using bioresorbable composite mesh. Average operative time was 36 minutes. No imme-diate complication. All patients were discharge on the 2nd post-operative day and average 6 months follow up has no recurrence. Conclusions: Laparoscopic SPA-IPOM is an optional operation and is much easier to be performed. Benefits include operative time saving, cosmesis, early discharge and early return to work. Bio-resorbable composite mesh prevents bowel adhesion, however, is much more expensive. Long term follow up study for complications and recurrence is needed.

Laparoscopic Inguinal Hernia Repair with Closure of Hernial Defect and Central Mesh Fixation Using Glubran 2

Background: Laparoscopic tension-free repair of inguinal hernia was presented in 1990s, promising less pain and short recovery period, but carrying the risk mesh bulging and migration. Objective: We have presented our technique in which central zone of mesh is fixed only after closure of hernial defect. Patients and Methods: This study included 27 males patients (14 indirect inguinal hernias, 9 direct inguinal hernias, 4 both direct and indirect inguinal hernias on the same side). These cases are undergoing tension-free mesh repair after closure of hernial defect, and the mesh is fixed only at its central zone using Gulbran 2, between April 2011 and March 2013. The follow-up period ranged from 6 to 30 months. The intra and postoperative complications were recorded. Results: Mean hospital stay was 1 day. The age of this group of patients ranged from 23 to 63 years (mean, 47 years). The operative time ranged from 30 to 100 minutes (mean, 45 minutes). The intraoperative complications were in form of mild bleeding in 7 patients (25.9%) during hernial sac dissection. Postoperative complications were mild inguinal pain in 4 patients (14.8%) for three weeks. Mild hydrocele in 3 patients (11%) was recorded. No recurrence or bulging at hernia site was noticed during the period of follow-up. Conclusion: Laparoscopic inguinal hernia repair with central mesh fixation after closure of hernial defect is effective, easy and free of complications.

Transabdominal Pre-Peritoneal Mesh for Inguinal Hernia Repair with External Fixation versus Mesh Stapling

Background: It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, and port-site hernia. We chose to fix it to the exterior reducing port size, cost and pain, at the same comparing this with traditional mesh stapling. Methods: We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 120 patients in which we fixed the mesh to the anterior abdominal wall using either two prolene threads that passed to the exterior and tied in place or traditional mesh stapling. Results: The operative time is ranged from 35 to 70 minutes for external fixation, 30 to 60 minutes for mesh stapling, and 4 to 51 months for follow-up, and no recurrence occurred in both groups during the procedure. Two cases with post TAPP pain in mesh stapling patients are discussed with reduction of the cost and port size in external fixation patients. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair from the interior and it is fixed only to the exterior allowing a reduction in size of the ports and considerable reduction in cost with elimination of TAPP associated post operative pain.