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PubMed1997

Quality of life in patients undergoing inguinal hernia repair.

Inguinal hernia repair is one of the most common surgical procedures undertaken in the NHS. Despite this, no previous work has examined quality of life in this patient group. This study examines quality of life preoperatively and at 3 and 6 months postoperatively in 140 patients undergoing inguinal hernia repair in the context of a randomised controlled trial of laparoscopic versus open hernia repair. Surgery was undertaken on a day case basis, and quality of life was assessed using the Short Form 36 (SF36). In the initial phase of the study, 57% of those screened for suitability met the study inclusion criteria and were randomised. No significant differences were found between laparoscopic and open hernia repair in terms of quality of life at 3 and 6 months postoperatively. No difference was found between 3 and 6 month scores, suggesting that patients had already made a good recovery by 3 months. A significant improvement was found between preoperative and postoperative scores, with the greatest change arising on dimensions assessing pain, physical function, and role limitation owing to physical restriction. After standardising for age, sex, and social class, a comparison of the hernia patients to population norms for the SF36 was consistent with improvement from preoperative to postoperative assessment. This study has demonstrated the improvement in quality of life in patients undergoing elective inguinal hernia repair by experienced surgeons on a day case basis. It has also demonstrated the feasibility of assessing quality of life using generic measures in this patient group. Further work in this area is required. Ultimately, the priority given to elective inguinal hernia repair will depend on how the demonstrated benefits compare with those derived from other elective surgical procedures.

Adolescent↗
PubMed1983

The anatomical basis for the inguinal hernia.

The inguinal regions of 100 adult cadavers were dissected. 20 male cadavers had inguinal hernia. The pubic arch was in a low position in 80 percent of the cases, a very large percentage and much greater than in any other population. The origin of internal oblique muscle from the inguinal ligament was away from the pubic tubercle and its lower fibres did not cover the deep inguinal ring in the indirect inguinal hernia cases. Most of the inguinal hernias were noticed on the right side.

Adolescent↗
PubMed2002

Functional and morphologic properties of a modified mesh for inguinal hernia repair.

Inguinal hernia repair is one of the most frequently performed operations. Next to conventional techniques, open and laparoscopic tension-free methods using mesh implants to reinforce the abdominal wall are increasingly carried out, even becoming the standard procedure in many countries. Because of the benefits of material-reduced meshes for incisional hernia repair, a new mesh modification for tension-free inguinal hernia repair has been developed. In the present study this new low-weight mesh (Vypro II) made of polypropylene and polyglactin multifilaments was compared to a common heavy-weight polypropylene mesh (Prolene) regarding their functional consequences and the morphologic tissue response. After implantation in rats as an inlay, abdominal wall mobility was recorded by three-dimensional photogrammetry and the tensile strength of the suture zone and the mesh itself was measured at 3, 21, and 90 days. Explanted tissue samples have been investigated for their histologic reaction in regard to the inflammatory infiltrate, vascularization, and connective and fat tissue ingrowth. Numbers of granulocytes, macrophages, fibroblasts, lymphocytes, and foreign giant body cells have been evaluated to reflect the quality of the tissue response. The cellular response was assessed by measuring DNA strand breaks and apoptosis (TUNEL), proliferation (Ki67), and cell stress (HSP70). The results indicated that restriction of abdominal wall mobility was significantly reduced with Vypro II compared to that seen with heavy-weight mesh modification, and the inflammatory reaction and connective tissue formation were markedly diminished. Apoptosis and cell proliferation showed considerably lowered levels, and expression of cytoprotective HSP70 was significantly increased. The present study thus confirms the benefits of material-reduced mesh modifications. The new low-weight mesh (Vypro II) could be advantageous in inguinal hernia repair.

Animals↗
PubMed1999

Needlescopic extraperitoneal repair of inguinal hernias.

Laparoscopic inguinal herniorrhaphy has traditionally been performed using one 5-mm and two 11-mm trocars. In this report, we evaluate the feasibility of the preperitoneal repair of inguinal hernias using the needlescopic method (2-mm ports) and describe the technique used in this repair. A total of 11 inguinal hernias were treated with needlescopic extraperitoneal repair. There were five direct and six indirect hernias. One patient had a bilateral hernia. The average operative time was 54 min. One patient was converted to the standard laparoscopic extraperitoneal method. All patients were discharged a few hours after the procedure. They were able to resume activity within a few days and required only minimal analgesic intake. Follow-up ranged from 1 to 6 months. All patients were followed up by one of the surgeons at 1, 3, and 6 weeks, and then at 6 months. No complications were encountered. There have been no recurrences to date. Overall, needlescopic extraperitoneal repair of inguinal hernias is a feasible procedure in male patients seeking better cosmetic results than can be achieved with standard laparoscopic extraperitoneal repair. This procedure is technically more demanding. The operative time is longer. The cosmetic aspect is the only advantage of this technique.

Adult↗
PubMed2003

Inguinal hernia: obligatory indication for elective surgery? A prospective assessment of quality of life before and after plug and patch inguinal hernia repair.

BACKGROUND: Incarcerated inguinal hernia may be treated effectively by recent surgical techniques with a low rate of complications, but it is unclear whether quality of life is improved by elective inguinal hernia repair. Therefore we investigated the quality of life before and after inguinal hernia repair using plug and patch technique. PATIENTS AND METHODS: Quality of life was prospectively assessed in 123 patients before and 3 months after plug and patch inguinal hernia repair using the Short Form 36 questionaire and a visual analog scale. All patients complained preoperatively of pain associated with the clinical findings of inguinal hernia (visual analog scale: reduced quality of life 6.8+/-2.7; reduced daily activity: 5.5+/-2.6). Clinical characteristics (operation times, in-hospital stay, complications, need for pain medication) were documented. Inclusion criteria were patients with symptomatic inguinal hernia, scheduled for elective unilateral inguinal hernia repair by plug and patch technique. RESULTS: There were no major in-hospital complications. At 3 months no recurrences of inguinal hernia or late onset complications were observed; seven patients complained of dumbness, and eight felt pressure at the operation site with a tendency for resolving pain within this time. At 3 months patients had a significantly improved quality of life regarding freedom from pain, vitality, and physical activity compared to preoperatively. CONCLUSIONS: Plug and patch repair of unilateral inguinal hernia improves quality of life with a very low rate of procedural complications. Regarding freedom from pain, vitality, and physical activity there is significant improvement as compared to preoperatively. Therefore inguinal hernia repair should be intended in all elective cases and plug and patch repair appears as an excellent technique to improve quality of life.

Aged↗
PubMed2001

When a hernia is not a hernia: the evaluation of inguinal hernias in the cirrhotic patient.

Herniorrhapy in patients with advanced portal hypertension and ascites should be approached with caution, and treated conservatively whenever possible. Cirrhosis increases the risk of significant perioperative complications such as infection, recurrence, and ascites leak. This paper reports two patients operated on for suspected inguinal hernias. The first patient was referred for elective repair of a presumed inguinal hernia before liver transplantation. The second patient presented with a history of an incarcerated inguinal hernia that was previously reduced in the emergency center. After examination by residents and senior faculty the patients were scheduled for elective herniorrhaphy. Intraoperatively no inguinal hernia could be identified in either patient. However, massively dilated veins (1.5-2.0 cm in diameter) were noted entering with the spermatic cord at the internal inguinal ring. In both cases the veins were clamped, transected, and suture ligated at the internal ring. Given the unusual presentation of these dilated veins in both patients we advocate the use of preoperative Doppler ultrasound in patients with cirrhosis and suspected inguinal hernias.

Aged↗
PubMed2005

[Children's strangulated inguinal hernia].

The inguinal hernia, malformations caused by persistence of peritonea-vaginal duct, is frequent in children. It is a benign affection as long as it is not strangled. During our five-year-retrospective study, we have found 32 cases (30 boys and 2 girls) of strangled inguinal hernia. There are 78,12% of cases under five years old. In 54%, the hernia was on the right side. Malnutrition and inguinoscrotal hernia are very exposed to strangulation. We observed obstruction syndrome in 81,25% of cases. We have to deplore one case of scrotal fistulae by intestinal necrosis and two cases of testicle necrosis. For all of our patients, the peritonea-vaginal duct was closed with ligature, associated with pre-funicular parietal refection. One case of recurrence is found in postoperative time.

Adolescent↗
PubMed2004

Ruptured ectopic pregnancy presenting as an irreducible inguinal hernia.

An inguinal hernia that suddenly becomes irreducible may be secondary to a variety of other underlying conditions which can occasionally mislead the attending surgeon. Benign, inflammatory or neoplastic processes, as well as surgical emergencies such as intraperitoneal or retroperitoneal haemorrhage, have all been previously reported to mimic an inguinal hernia that suddenly becomes irreducible with or without clinical features of strangulation. We add an additional interesting presentation to this list in the form of a ruptured ectopic pregnancy, which is the first such case reported in the literature. A swelling in the groin may be much more complicated than it seems on superficial consideration and good clinical acumen is constantly required in managing such cases if a satisfactory outcome without any morbidity is to be expected.

Adult↗
PubMedDate not supplied

Comparison of laparoscopic vs open modified Shouldice technique in inguinal hernia repair.

Inguinal hernia repair has been a common procedure performed by general surgeons. Recently, a newly developed approach has been introduced using the pre-peritoneal laparoscopic repair. The laparoscopic approach allows patients to recover faster, with less pain, however, a disadvantage is the higher cost. We conducted a retrospective study of inguinal hernia repairs performed by one surgeon at the same institution, comparing the laparoscopic technique to the modified Shouldice procedure with regard to surgical time, postoperative recovery time, charge, and time to return to work and to activities. Patients undergoing laparoscopic hernia repairs were able to return to work and to activities sooner than patients undergoing the modified Shouldice procedure. The results obtained in this study showed a higher charge for the laparoscopic procedure, with longer surgical and recovery room time. The more rapid return to work and activities may outweigh the higher charge and longer surgical and recovery room time.

Adult↗
PubMed1999

[Tension-free "plug and patch" inguinal hernia repair].

Inguinal hernias are common and have highly variable clinical presentations, ranging from the asymptomatic to surgical emergencies when incarcerated, sometimes necessitating bowel resection. Several techniques have been described for repair of inguinal hernias based on the unique anatomic structure of the inguinal region. In 1989 Lichtenstein and co-workers described a "tension free" repair based on using a synthetic mesh patch to reinforce the inguinal canal floor and as a plug to prevent recurrence through the internal inguinal ring. This technique has been used in many centers worldwide with good rates of success.

Hernia, Inguinal↗
PubMed2004

Preperitoneal gridiron hernia repair for inguinal hernia: single-center experience with 2 years of follow-up.

The optimal operation technique for groin hernia repair has not been established. This study evaluates the long-term recurrence rate and perioperative complications after posterior inguinal mesh hernia repair using a gridiron incision described by Frans Ugahary. A retrospective analysis was performed of the medical records of 366 patients who underwent Ugahary hernia repair. Operative results and perioperative morbidity were evaluated retrospectively. Follow-up was done by clinical examination. The main outcome measure was recurrence rate at a mean follow-up of 2 years. Of the 386 groin hernia repairs, 263 hernia repairs were examinated in the outpatient clinic. The overall recurrence rate was 6.5% with a mean follow-up of 2 years, and 10.1% of the patients had minor complications. This retrospective study demonstrates that the repair according to Ugahary is a safe technique for operating on groin hernia. However, the procedure is difficult to reproduce in nonexpert hands. This technique must be compared to other inguinal hernia operation techniques in the near future.

Adult↗
PubMed2006

Patent processus vaginalis in the adult as a risk factor for the occurrence of indirect inguinal hernia.

BACKGROUND: Inguinal hernias are a common entity with nearly 31,000 repairs annually in The Netherlands and over 800,000 in the USA. The aim of the present study is to determine whether a laparoscopically diagnosed patent processus vaginalis (PPV) is a risk factor for the development of groin hernia. METHODS: The study population was originally composed of 599 consecutive cases (189 male, 32%) of laparoscopic transperitoneal surgery for different indications performed in 4 teaching hospitals in The Netherlands between November 1998 and February 2002. During laparoscopy, the deep inguinal ring was inspected bilaterally. The PPV group was compared with the obliterative processus vaginalis (OPV) group. RESULTS: After a mean follow-up of 5.5 years, the studied population consisted of 337 cases (94 male, 28%). In this study 12% of the studied population appeared to have PPV in adult life. The percentage PPV of our study group is much higher than the percentage of hernia repairs performed in the Dutch population. A greater proportion (12%) of hernia repairs in the PPV group was found as compared with the OPV group (3%). The chance of developing an inguinal hernia within 5.3 years is four times higher in the group with PPV. No significant correlation between age and the prevalence of PPV was observed. CONCLUSION: This study demonstrates that PPV is an etiologic factor and a risk factor for acquiring an indirect inguinal hernia in adults.

Adolescent↗
PubMed2002

Postoperative convalescence after inguinal hernia surgery: prospective randomized multicenter study of laparoscopic versus shouldice inguinal hernia repair in 1042 patients.

Interest in inguinal hernia surgery has increased significantly with the introduction of new operating techniques during the past decade. This multicenter study compared short-term results in patients treated by the laparoscopic transabdominal preperitoneal patch technique (TAPP; n = 518) and the Shouldice technique (n = 524). We evaluated demographics, operative data, complications, hospital stay, postoperative pain, use of cs, functional status, sick leave, and complaints up to 3 months postoperatively. The median operating time was shorter in the Shouldice group (55 vs. 65 min), but there were no significant differences in complication rates, and major complications were rare. The hospital stay was 1 day or less in over 98% of cases in both groups, but more operations were performed on outpatient basis in the Shouldice group. In the TAPP group postoperative pain and analgesic consumption were less, postoperative functional status was better, and sick leave was shorter (10 vs. 14 days). These results show that the two methods are equally safe and have few major complications. The TAPP operation is associated with less postoperative pain, better postoperative functional status, and shorter sick leave, but at the price of a longer operating time.

Aged↗
PubMed2002

Open mesh versus non-mesh for repair of femoral and inguinal hernia.

BACKGROUND: Inguinal hernia repair is the most frequent operation in general surgery. Until recently the standard procedure has been open musculo-aponeurotic repair using sutures under tension to close the defect but 'tension-free' repair using prosthetic mesh is becoming increasingly common in many countries. OBJECTIVES: The purpose of this review is to evaluate open mesh techniques in comparison with open non-mesh techniques for the surgical repair of groin hernia. SEARCH STRATEGY: Electronic databases were searched and further trials were sought from the reference lists of reports of known trials. Through the EU Hernia Trialists Collaboration authors of identified randomised controlled trials were asked for information on any other trials known to them. There was no language restriction. SELECTION CRITERIA: Studies were eligible for inclusion if they were randomised or quasi-randomised trials comparing either a) open mesh with open non-mesh repair of groin hernia or b) open flat mesh repair with plug and mesh repair of groin hernia. DATA COLLECTION AND ANALYSIS: For each outcome the results were derived using data from the best available source. The majority of data for this review came from individual patient data (IPD) supplied by the trialists. When these were unavailable data came from additional aggregated information or from published trial reports. All trials were analysed using the 'intention to treat' principle. MAIN RESULTS: Twenty trials comparing open mesh with open non-mesh repair were identified. Open mesh methods, on average, took 7-10 minutes less to perform than Shouldice procedures, but took 1-4 minutes longer than other non-mesh methods. There were no clear differences between mesh and non-mesh groups for haematomas, seromas or wound/superficial infections. Three serious operative complications were reported after open mesh repair and three following non-mesh repair. Overall, those in the mesh groups had a shorter length of hospital stay and quicker return to usual activities, but this pattern was not observed for all trials. There was a suggestion that persisting pain was less frequent after mesh repair than after non-mesh repair but this result was dependent on one trial and data were not available for 11 trials. There was no evidence of a difference between the groups with respect to persisting numbness. Fewer hernia recurrences were reported after mesh repair (Peto OR: 0.37, 95% CI: 0.26 to 0.51). There were too few data to reliably address differential effects for patients with recurrent, bilateral or femoral hernias. Two trials comparing flat mesh with plug and mesh were identified. There was no clear evidence of differences between the groups. REVIEWER'S CONCLUSIONS: There is evidence that the use of open mesh repair is associated with a reduction in the risk of recurrence of between 50% and 75%. Although the trials were heterogeneous there is also some evidence of quicker return to work and of lower rates of persisting pain following mesh repair.

Clinical Trials as Topic↗
PubMed1984

Scrotal reconstruction for giant inguinal hernias.

Giant inguinal hernias require special consideration for repair of the abdominal wall. The associated greatly thickened, enlarged scrotum should be discarded and a neoscrotum should be reconstructed from the uninvolved perineal-scrotal skin. A cloverleaf design flap is used for this reconstruction.

Abdominal Muscles↗