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PubMed2005

Epiploic appendicitis in inguinal hernia sac presenting an inguinal mass.

Inguinal hernia sometimes surprises surgeons with its unexpected content. Epiploic appendagitis in hernia sac is a very rare entity. We report a 60-year-old male patient with a painless inguinal mass. Surgical exploration showed a 4-cm mass beneath the external oblique aponeurosis that consisted of a hernia sac containing an inflamed and remarkably swollen appendix epiploica of the sigmoid colon secondary to torsion. The patient recovered after the resection of epiploic appendix and a tension-free hernia repair.

Colon, Sigmoid↗

PubMed1983

Ureter within a sliding inguinal hernia.

Large sliding inguinal hernias may contain a variety of either intraperitoneal or retroperitoneal anatomical structures. A ureter within a sliding inguinal hernia has been reported rarely. The author presents such a case to alert the unwary surgeon of this possibility and to indicate a successful method of treatment. Pyelography is indicated as a routine preoperative diagnostic procedure in morbidly obese patients with large irreducible inguinal hernias, particularly if the patient complains of frequency or other urinary symptoms. The ureter should be carefully dissected with its blood supply from the sliding tissues and laid back in the retroperitoneal space with resection or reimplantation. The hernia may then be repaired by standard methods. The patient described in the report is well and free of symptoms 10 years after the operation.

Hernia, Inguinal↗

PubMed2004

Endoscopic totally extraperitoneal repair of incarcerated inguinal hernia.

BACKGROUND: Incarcerated inguinal hernias have been considered a relative contraindication for endoscopic surgery, as its efficacy and safety is as yet unproven. With more experience and improved techniques, management of incarcerated hernias by the endoscopic approach has become possible with decreased patient discomfort and acceptable results. AIM AND OBJECTIVE: To analyze the feasibility and effectiveness of Endoscopic Totally Extraperitoneal repair in incarcerated inguinal hernias. METHODS: We retrospectively analyzed 34 patients-admitted under a single surgical unit with chronically incarcerated inguinal hernias-who underwent an elective endoscopic totally extraperitoneal repair. The 6-year period studied was from May 1997 to May 2003. Demographic characteristics, operative details (including modifications in technique and use of drains) and postoperative outcome including analgesic requirements, hospital stay, complications, and time taken to resume normal activity, were evaluated. A comparison was made with the results of 286 endoscopic primary, non-incarcerated, unilateral endoscopic totally extraperitoneal hernia repairs done during the same period. RESULTS: With the help of modified techniques for reduction of the hernial sac, all the patients underwent a successful TEP repair. There were no conversions. The mean operating time was 84.4 min compared to 57 min in the non-incarcerated group. Three-fourths of the patients could be discharged within 24 h. Analgesic requirement was for an average of 5.5 days (vs 4.2 days in the non-incarcerated group). Time taken to resume normal activity was 7.5 days (vs 5.6 days in the non-incarcerated group). Two recurrences occurred. Follow-up period ranged from 13 months to 84 months. CONCLUSIONS: With the help of modifications in operating technique, Endoscopic Totally Extraperitoneal repair is feasible and effective in patients with incarcerated inguinal hernias and encompasses the advantages of endoscopic procedures.

Adult↗

PubMed1997

Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair.

BACKGROUND: Inguinal hernias can be repaired by laparoscopic techniques, which have had better results than open surgery in several small studies. METHODS: We performed a randomized, multicenter trial in which 487 patients with inguinal hernias were treated by extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior repair. We recorded information about postoperative recovery and complications and examined the patients for recurrences one and six weeks, six months, and one and two years after surgery. RESULTS: Six patients in the open-surgery group but none in the laparoscopic-surgery group had wound abscesses (P=0.03), and the patients in the laparoscopic-surgery group had a more rapid recovery (median time to the resumption of normal daily activity, 6 vs. 10 days; time to the return to work, 14 vs. 21 days; and time to the resumption of athletic activities, 24 vs. 36 days; P<0.001 for all comparisons). With a median follow-up of 607 days, 31 patients (6 percent) in the open-surgery group had recurrences, as compared with 17 patients (3 percent) in the laparoscopic-surgery group (P=0.05). All but three of the recurrences in the latter group were within one year after surgery and were caused by surgeon-related errors. In the open-surgery group, 15 patients had recurrences during the first year, and 16 during the second year. Follow-up was complete for 97 percent of the patients. CONCLUSIONS: Patients with inguinal hernias who undergo laparoscopic repair recover more rapidly and have fewer recurrences than those who undergo open surgical repair.

Activities of Daily Living↗

PubMed1990

Embryonal remnants in inguinal hernia sacs.

Inguinal herniorrhaphy is the most common general surgical procedure performed on the neonate or young pediatric patient. The vas deferens and epididymis are vulnerable to damage, including transection during inguinal exploration or hernia repair. Occasionally the surgical pathologist encounters glandular or tubular epithelial-lined structures in hernia sac tissue. Significant medicolegal implications arise when embryonal remnants are mistakenly identified as true vas deferens or epididymis. This study evaluates the incidence and morphology of these embryonal remnants in hernia sacs from patients of The Children's Hospital, Denver, CO. Embryonal remnants were found in 1.5% of 599 hernia sacs from 427 consecutively operated males aged 37 weeks gestation to 19 years. True vas deferens and epididymis were each identified once for an incidence of 0.33%. The remnants resemble either vas deferens or epididymis. The average remnant diameter is 0.17 mm, and did not change significantly with age. Remnants are surrounded by varying amounts of condensed mesenchyme, trichrome-negative for muscle. The testes and vasa differentia from 32 autopsy cases, ranging in age from 26 weeks gestation to 7 years of age, were used to evaluate normal development and morphology of the vas deferens, epididymis and embryonal remnants. The vas deferens is well developed by 26 weeks gestation. The surrounding smooth-muscle coat does not stain with trichrome until 32 weeks gestation. The vas deferens increases in diameter in a linear fashion during gestation, and continues to increase in diameter in the postnatal period. The vas deferens at 4 months of age is 1.2 to 1.4 mm in diameter; this is also the age of highest incidence of bilateral herniorrhaphies and presence of remnants.

Adolescent↗

PubMed2005

Evidence-based change of practice in the management of unilateral inguinal hernia.

PURPOSE: Contralateral inguinal exploration in children with unilateral inguinal hernia is still controversial. Only 20% of patients with patent processus vaginalis would develop a clinically apparent hernia [Miltenburg DM, Nutctern JG, Jaksic Tkozinetz CA. Meta-analysis of the risk of metachronous hernia in infants and children. Am J Surg 1997;174:741-4]. In 1999, our unit changed the practice of performing routine contralateral inguinal exploration of male children younger than 2 years and female children younger than 5 years to inguinal herniotomy of the symptomatic side only based on a meta-analysis published by Miltenburg et al [Meta-analysis of the risk of metachronous hernia in infants and children. Am J Surg 1997;174:741-4]. We explored the contralateral inguinal area only in babies with a history of prematurity. METHODS: A prospective study of patients subjected to unilateral inguinal herniotomy from 1999 to 2001 was performed. Age, sex, side of the hernia, and incarceration at presentation were recorded. The incidence of metachronous inguinal hernia (MIH) and its risk factors were analyzed. The follow-up ranged from 36 to 72 months. RESULTS: Of the 409 patients who presented with inguinal hernia, 264 underwent unilateral inguinal herniotomy. The rest were either children with bilateral inguinal hernia or premature babies who were offered bilateral inguinal herniotomy. Of these 264 patients, 180 (68%) had right-sided inguinal hernia and 84 (32%) had left-sided inguinal hernia. Fourteen (5%) patients subsequently presented with MIH. Of these 14 patients, 8 were younger than 2 years at the initial presentation and 11 originally presented with left-sided inguinal hernia. No female child presented with MIH. Twelve (85%) re-presentations with MIH occurred within 1 year of the original operation. CONCLUSIONS: The treatment of only the symptomatic inguinal hernia has not significantly increased the incidence of MIH. This evidence-based change of practice has avoided 152 operations in 264 patients. Presentation with incarceration and age at presentation have no significant impact on the incidence of MIH. Left-sided presentation has a statistically significant high incidence of MIH.

Age Factors↗

PubMed2006

Is contralateral exploration necessary in preterm infants with unilateral inguinal hernia?

PURPOSE: Contralateral inguinal exploration has been the preferred approach to preterm infants with unilateral inguinal hernia. There is no literature evidence to justify this. The aim of this prospective study is to analyze the incidence and to determine any risk factors for the development of contralateral metachronous hernia (MH) in the preterm when compared with term infants. METHODS: Preterm and term infants with unilateral inguinal hernia younger than 6 months who underwent surgery were included. Those infants who subsequently developed MH were analyzed. RESULTS: Two hundred sixty-six patients met the inclusion criteria. One hundred five were preterm and 161 were term. Ten preterm (10.31%) and 9 term infants (5.92%) presented subsequently with MH (P =.18). All but 1 were male. There was no relation between the side of hernia, presentation with incarceration, age at surgery, sex of the patient, and the development of MH. However, a trend toward a higher incidence of MH in very low birth weight and early gestational age preterms was noted. CONCLUSION: There is no significant difference between the occurrence of MH in preterm when compared with term infants. Routine contralateral exploration in preterm infants with its associated risks is therefore not justified in unilateral hernia.

Female↗

PubMed2003

[Inguinal hernias in children].

The inguinal hernia repair account among surgical procedures the most frequently performed in children. Most inguinal hernias in infants and children are indirect due to patent processus vaginalis. Failure of closure of the processus vaginalis accounts for nearly all the inguino scrotal abnormalities seen in infancy and childhood. In little girls, the processus (canal de Nuck) may remain patent and may allow the ovary and fallopian tube to enter the inguinal region. Incarceration represents the most common complications associated (30 per-cent during the first year of life). Consequences concern in the first place the testicular blood supply before to interest the vitality of the incarcerated intestine. The surgically repair is recommended shortly after the diagnosis. The concurrence rate of recurrent inguinal hernia after uncomplicated inguinal hernia repairs is generally reported at 0.5-1 per cent, increasing for premature infant and complicated inguinal hernia.

Child↗

PubMed1996

Laparoscopic inguinal hernia repair.

Laparoscopic inguinal hernia repair may cause a revolution in general surgery if it proves to be the best treatment for inguinal hernia. Today there are several laparoscopic techniques that have been shown to be feasible. However, no information concerning long-term recurrence rates and cost-effectiveness is available. This review summarizes current knowledge, including all randomized studies that have appeared hitherto, and concludes that it is still premature to advocate a transition from the preferred individualized conventional technique to a laparoscopic technique on a large scale. However, a definite statement on the place of laparoscopic repair may be given in the near future in the light of larger randomized studies.

Forecasting↗

PubMed2001

Previous appendicitis may affect peritoneal overlap of the mesh in laparoscopic inguinal hernia repair.

Laparoscopic inguinal hernia repair is now increasingly performed in bilateral and recurrent groin hernias. The avoidance of direct exposure of the commonly used meshes to the abdominal viscera is considered essential to reduce the risk of bowel adhesions. We report a case of bilateral inguinal hernia repair in a patients who had had an appendectomy performed 8 years earlier for a perforated appendicitis. Probably as a result of previous inflammation, any attempt to dissect the preperitoneal layer in the right side resulted in peritoneal lacerations. Since the peritoneum could not be used to cover the mesh, we decided to position an expanded polytetrafluoroethylene (e-PTFE) mesh to avoid postoperative adhesions. The mesh was fixed with tacks to the symphysis pubis, Cooper's ligament, the ilio-pubic tract, and the transversalis fascia 2 cm above the hernia defect. This case suggests that in patient with previous appendicitis, a difficult preperitoneal dissection can be expected. In such cases, especially in young patients for whom future surgical operations cannot be excluded, any attempt to reduce adhesions is justified. At the present time, the use of e-PTFE meshes, which induce no tissue reaction, is a good option in this situation.

Appendectomy↗

PubMed1979

[Operative methods and our results in the surgery of inguinal hernias in children].

Inguinal hernias in children are encountered very frequently in the surgical wards. The aim of surgical treatment of such hernias is to close and resect the nonobliterated - opened vaginal process. The distal portion of the vaginal process may left unaltered however, the position of the funiculus must not be changed. The operative procedure used by the authors has yielded excellent results with complications in less than 1% of the cases. A much larger percentage of complications (over 6%) occurs in those cases in which surgical procedures intended for adults are used for children. Testicular atrophy has been seen in 13% of such cases. Keeping in mind the difference in percentage in complications between the two above mentioned surgical approaches, it is obvious that only those procedures that yield the least complications should be used in pediatric hernioplasty. 430 inguinal hernia repairs were performed on children in our clinic and only one recidivism occurred in one child and in another, the testes did not descend completely into the scrotum. No other complications had occurred.

Adolescent↗

PubMedDate not supplied

Laparoscopy for hemoperitoneum after traditional inguinal hernia repair.

Hemoperitoneum after inguinal hernia repair, with the exception of laparoscopic herniorrhaphy, is extremely rare. No other case of hemoperitoneum after traditional open inguinal hernia repair has been reported in the English-language literature. A 39-year-old woman had undergone inguinal hernia repair with the Bassini repair technique. Lower abdominal pain and anemia occurred on postoperative day 1. Laparoscopy was performed and revealed hemoperitoneum caused as a complication of inguinal hernia repair. The abdominal cavity was thoroughly washed with saline solution, and the aspirated blood was processed and reinfused. Laparoscopy for hemoperitoneum as a complication after inguinal hernia repair was very useful for both diagnosis and treatment.

Adult↗

PubMed2006

Inguinal hernia repair in a developing country.

Hernia surgery is typically same-day surgery and can be safely conducted in a developing country. We describe a collaborative effort of the American Hernia Society, the Institute of Latin American Concerns, medical industries, the United States Peace Corps, physicians, surgical residents and nurses from many institutions. During three 5-day periods, we operated on 236 patients and repaired 252 hernias (73% inguinal). In addition, an education day for local physicians was conducted on three occasions and included televised live surgical demonstrations and interactive lectures with question and answer sessions. We suggest this to be a viable public health initiative and demonstrate the role of surgeons in advancing and providing state-of-the-art inguinal hernia surgery to a developing country and its underserved population.

Developing Countries↗

PubMed1999

Laparoscopic preperitoneal repair of recurrent inguinal hernias.

Repair of recurrent inguinal hernias using the conventional open technique has been associated with high rates of recurrence and complications. Stoppa has reported a low recurrence rate using the open preperitoneal approach. Evolution of laparoscopic techniques has allowed the reproduction of the open preperitoneal repair via an endoscopic totally extraperitoneal (TEP) approach. This study reviewed all the recurrent inguinal hernias repaired laparoscopically and evaluated the complication and recurrence rate. A total of 512 inguinal hernias were treated laparoscopically using the TEP approach. Of these, 75 were recurrent. The ages of the 61 men ranged from 36 to 65 years. There were 41 direct and 34 indirect hernias. Fourteen were bilateral. None of the repairs was converted to an open procedure. The operating time ranged from 20 to 145 min (median 42 min). All patients were discharged home on the same day. There were no deaths. The complications consisted of two instances of urinary retention and one groin collection. Patient follow-up ranged from 6 to 72 (median 40) months, and there have been no recurrences to date. The TEP repair for recurrent inguinal hernias can produce results comparable to the open preperitoneal technique with low morbidity and recurrence rates.

Adult↗

PubMed1992

Prenatal ultrasonographic diagnosis of fetal scrotal inguinal hernia.

Fetal scrotal inguinal hernia was diagnosed at 33 weeks of pregnancy by ultrasonographic examination. Moving, echo-free, cystlike structures representing peristalsis within trapped loops of bowel in an abnormally enlarged scrotum were the main ultrasonographic finding. The diagnosis was confirmed post partum, and surgery was successfully carried out 4 days after delivery.

Female↗

PubMed2005

Pediatric surgeons and pediatric emergency physicians' attitudes towards analgesia and sedation for incarcerated inguinal hernia reduction.

UNLABELLED: Inguinal hernias become incarcerated in 10% to -15% of children and reduction of the hernia is an urgent painful procedure. No recommendations exist for analgesia during this procedure. We surveyed pediatric emergency physicians (PEP) and pediatric surgeons (PS) for their analgesia and sedation use during the reduction. The survey was mailed to 19 centers in North America. A total of 56% (185/331) surveys were completed by PEP and 56% (68/122) from PS. A total of 96.7% (245/253) of responders reported giving analgesia or sedation during reduction. PS were more likely to use intravenous drugs, try for a longer time, wait longer between trials, and conduct more trials compared to the PEP. Clinically related variables were more important for PEPs than PS for analgesia and sedation. System-related variables were more important by PS for admission. PERSPECTIVE: This survey shows significant variability between specialties in the drugs, route, and number of attempts during reduction of a painful incarcerated hernia in children. Development of a sedation and analgesia protocol may be useful in order to unify management of pain and discomfort during hernia reduction.

Adult↗

PubMed1990

[Reduced hospitalization stay after surgery for inguinal hernia].

Operations of inguinal hernias hold among all surgical operations, as regards frequency, the second place after appendectomy. They deserve thus not only practical but also theoretical attention. In the course of two years in 110 investigated operated patients the mean hospitalization period was 6.5 days, the mean period of work incapacity 4.6 weeks. Relapses were recorded in two patients and postoperative complications in 14 patients. In the group of patients with a hospitalization period shorter than 7 days (45.5% of the whole group) postoperative complications developed in four patients, the mean period of work incapacity being 4.08 weeks. The mean hospitalization period was reduced by one day, from 7.5 days to 6.5 days. This reduction did not increase the incidence of complications and did not prolong the period of work incapacity.

Adolescent↗

PubMed1994

[Classification of inguinal hernias].

Classification of inguinal hernia is a necessary prerequisite for a reliable analysis of different methods of repair. The underlying categorization is done intraoperatively based on the localization ('M' medial, 'L' lateral, 'F' femoral) and transverse diameter (I = < 1.5 cm, II = 1.5-3.0 cm, III = > 3.0 cm) of the hernial orifice. In cases of combined hernias the diameters of both fascial defects is added up, the hernia is classified according to the part of major importance for the development of recurrences, the medial defect, with the index 'c'. The classification can be applied to open as well as laparoscopic approaches. The diameters of the tip of the index finger or the length of branch of endoscopic scissors (1.5 cm), respectively, serve as standards for measurement.

Fasciotomy↗