INTRODUCTION: A significant complication of inguinal hernia repair is chronic postoperative groin pain, which may be influenced by the method of mesh fixation. This randomized controlled trial was conducted with the objective of comparing the efficacy of N-butyl-2-cyanoacrylate (NBCA) glue fixation with conventional suture fixation of polypropylene mesh in Lichtenstein repairs. MATERIALS AND METHODS: This clinical trial enrolled 60 patients with unilateral, uncomplicated inguinal hernias. Participants were randomly allocated to either the suture fixation group (Group A) or the glue fixation group (Group B). The primary outcome, which included postoperative pain, was recorded at 24 h and at 7 days, 15 days, 30 days, and 90 days. The secondary outcomes included mesh fixation time, postoperative complications, and short-term recurrence. RESULTS: The mean mesh fixation time was significantly shorter in the glue group, at 4.5 min, than 13.63 min in the suture group (P < 0.0001). Postoperative pain scores were consistently and statistically lower in the glue group. Logistic regression showed that glue fixation was associated with a statistically significant reduction in the odds of developing chronic pain at 90 days (P = 0.0025). No statistically significant differences were observed between the two groups in postoperative complications, including hernia recurrence. CONCLUSION: NBCA glue fixation constitutes a safe and effective alternative to conventional suture fixation for polypropylene mesh in Lichtenstein hernia repair. This method demonstrably reduces both postoperative pain and operative time without elevating the risk of complications or early recurrence. Consequently, this patient-friendly advancement merits serious consideration for broader clinical adoption. CTRI REGISTRATION NUMBER: CTRI/2024/11/077136.
BACKGROUND AND OBJECTIVES: Incisional hernia remains a significant complication following abdominal surgery, with the incidence ranging from 5% to 20%. This systematic review compared the incidence of incisional hernia incidence between laparoscopic and open surgical approaches and identified effect modifiers. MATERIALS AND METHODS: We searched PubMed, Cochrane Library, Embase, Web of Science, and SCOPUS for studies published from January 2000 to December 2023. This review was not registered in PROSPERO, representing a methodological limitation. Randomized controlled trials (RCTs) and observational studies comparing laparoscopic versus open surgery with a minimum 6-month follow-up were included. Risk of bias was assessed using Cochrane risk of bias 2.0 and Newcastle–Ottawa Scale. Random-effects meta-analysis calculated risk ratios (RR) with 95% confidence intervals (CI). RESULTS: Twenty-eight studies (15 RCTs, 13 observational) comprising 14,567 patients were analyzed. Laparoscopic surgery demonstrated significantly lower incisional hernia risk (RR = 0.62, 95% CI: 0.51–0.75, P < 0.001; I2 = 45%). Benefits were consistent across colorectal (RR = 0.58), ventral hernia repair (RR = 0.55), and bariatric procedures (RR = 0.67). Meta-regression revealed stronger protective effects with higher body mass index (P = 0.03). Benefits persisted across follow-up periods and detection methods. CONCLUSION: Laparoscopic approaches significantly reduce incisional hernia risk across diverse abdominal procedures, with effects particularly pronounced in patients with obesity. These findings should inform surgical approach selection and patient counseling, though limitations include lack of protocol registration and limited representation of contemporary robotic techniques.
Incisional hernia represents one of the most common complications following abdominal surgery, occurring in 10%–20% of patients after midline laparotomy and imposing a substantial healthcare burden through reoperation costs, morbidity, and reduced quality of life. Despite being a frequent complication, incisional hernias are potentially preventable through evidence-based surgical techniques, patient optimization, and selective prophylactic mesh reinforcement. This narrative review synthesizes current evidence on strategies for preventing incisional hernia development, emphasizing preoperative risk stratification, technical aspects of fascial closure, the role of prophylactic mesh augmentation, and postoperative care optimization. A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases covering publications from 2000 to 2024, focusing on randomized controlled trials, systematic reviews, and high-quality observational studies. Patient-specific risk factors, including obesity, diabetes, smoking, chronic cough, immunosuppression, and malnutrition, substantially increase hernia risk and guide preventive strategy selection. Surgical technique factors, including suture material selection, suture-to-wound length ratio, stitch interval, and closure method, profoundly influence hernia incidence. The small bites technique using continuous, slowly absorbable monofilament suture with a suture-to-wound length ratio of at least 4:1 reduces incisional hernia rates by approximately 50% compared to traditional large-bite closures based on high-quality randomized controlled trials. Prophylactic mesh reinforcement in high-risk patients, particularly those undergoing abdominal aortic aneurysm repair or with multiple risk factors, demonstrates efficacy in reducing hernia incidence, though optimal patient selection, mesh type, and placement location remain areas requiring further investigation. This review acknowledges inherent limitations of narrative synthesis, including potential selection bias, heterogeneity in study populations and follow-up duration, and challenges in establishing definitive evidence hierarchies across diverse clinical contexts.
In our institution, an open (groin incision) approach is selected for emergency surgery for an incarcerated inguinal hernia. However, a laparoscopic approach may also be recommended for some cases to confirm the viability of the strangulated organ and assess the condition of the whole abdominal cavity. Laparoscopy through the inguinal hernia sac is known as hernioscopy. We herein report a case of an incarcerated inguinal hernia that underwent hernioscopy with the single-incision laparoscopic surgery (SILS) technique during emergency surgery. By using forceps in the abdominal cavity during hernioscopy, we were able to safely confirm the viability of the strangulated organ. Hernioscopy with the SILS technique has potential as a useful surgical option for incarcerated inguinal hernia surgery.
Inguinal bladder hernias (IBHs) are relatively rare, and patients often present with urinary discomfort. Early recognition of bladder involvement in inguinal hernias is critical to prevent iatrogenic bladder injury and associated complications. Here, we report a case of urinary tract infection secondary to an IBH, which was successfully repaired surgically, with an uneventful postoperative recovery. This report highlights the diagnostic and therapeutic strategies for managing IBH. Clinicians should maintain a high index of suspicion for bladder involvement in patients presenting with both lower urinary tract symptoms and an inguinal mass.
BACKGROUND:Obesity increases the risk of abdominal wall hernia (AWH). Body mass index (BMI) is widely used to define obesity, but it does not reflect fat distribution, especially visceral fat. Therefore, relying solely on BMI may be insufficient for assessing the relationship between obesity and AWH. This study examined the associations of visceral fat area (VFA) and waist circumference (WC) with AWH.MATERIALS AND METHODS:A total of 417 participants were included in this study, including 209 patients with AWH and 208 healthy controls. VFA and WC were measured by bioelectrical impedance analysis. Multivariable logistic regression, smooth curve fitting, and subgroup analyses were used to evaluate the associations between VFA, WC, and AWH. Additionally, receiver operating characteristic (ROC) curves were used to assess diagnostic performance.RESULTS:Compared with the controls, AWH patients had significantly higher VFA and WC (P < 0.001). After adjustment for potential confounders, both VFA and WC were strongly and positively associated with AWH risk, with evidence of nonlinear relationships. Subgroup analysis demonstrated that the correlation remained consistent across various populations (P-interraction > 0.05). ROC analysis indicated good diagnostic value for both indices (area under the curve: VFA = 0.726; WC = 0.727).CONCLUSION:Our findings that increased VFA and WC are associated with a higher risk of AWH contribute to our understanding of the relationship between visceral fat distribution and AWH. This finding further supports that keeping VFA and WC within healthy ranges may help prevent AWH. However, inference is limited by the cross-sectional, single-center design and incomplete data on hernia type, defect size, and certain risk factors. Confirmation in multi-center prospective cohorts is needed.
Inguinal hernia associated with disorders of sex development (DSD) is uncommon, and an occurrence further complicated by Sertoli-Leydig cell tumors (SLCTs) is exceedingly rare. A woman underwent surgery for recurrent inguinal hernia. Intraoperatively, the hernia sac contents were identified as adnexal tissue. Postoperative pathological examination revealed a 46,XY DSD with SLCTs. Although rare, hernia surgeons should maintain awareness of these conditions.
BACKGROUND:Diastasis recti abdominis (DRA) is characterized by a widened linea alba, but its pathophysiology may involve complex biomechanical failure. This pilot study utilized shear-wave elastography (SWE) to characterize the mechanical properties of the abdominal wall in healthy adults and investigate the influence of obesity on DRA presentation.MATERIALS AND METHODS:The study was conducted on a group of 10 healthy adult volunteers. All participants underwent ultrasonographic assessment. Morphological measurements and SWE of the linea alba, rectus sheaths, and lateral fasciae were performed at rest and during three maneuvers: Valsalva, curl-up, and side plank.RESULTS:Four participants had DRA. A divergent biomechanical response was observed: during an isolated curl-up, the linea alba stiffened in obese individuals with DRA but softened in non-obese individuals. A visible epigastric bulge was universally linked to DRA, but its manifestation depended on body habitus and the type of muscle activation. Obese individuals exhibited bulging during global maneuvers (Valsalva, side plank), whereas non-obese individuals showed bulging only during the curl-up.CONCLUSION:Obesity fundamentally alters the abdominal wall's response to load, suggesting a dual pathophysiology for DRA-related bulging. These preliminary findings highlight that management strategies, including physical therapy, may need to be tailored based on patient body habitus.
We present the case of an ectopic kidney located in the scrotum, discussing decision-making, surgical management, and outcomes. Although this is a rare pathology, we aimed to correlate this case with other reports of inguinal hernias and provide a literature review focusing on surgical and urological findings and management in similar patients. The patient is a 73-year-old man who presented with a progressive enlargement of his right inguinal area over the past 4 years. A routine computed tomography scan revealed an ectopic kidney in the scrotum, extending into a similar to 10 cm inguinal hernia, with severe hydronephrosis and a dilated ureter. Management options included nephropexy versus nephrectomy. A multidisciplinary approach involving general surgery and urology was employed, and the patient underwent a robot-assisted laparoscopic right inguinal hernia repair and kidney relocation. Postoperatively, renal function showed slight improvement, and no hernia recurrence was reported at the 6-month follow-up. This case highlights the importance of a multidisciplinary approach in the management of ectopic kidneys associated with inguinal hernias and contributes to the limited literature on this rare condition.
BACKGROUND: Inguinal hernia is a common surgical condition; however, rare entities such as transverse testicular ectopia (TTE) can present with similar symptoms, often resulting in misdiagnosis and inappropriate initial management. This report underscores the diagnostic value of laparoscopy in such challenging cases. CASE PRESENTATION: We present two adult male patients who were initially diagnosed with inguinal hernia based on the clinical evaluation and imaging. Both had a history of urogenital anomalies, including cryptorchidism or prior inguinal surgery. Due to persistent symptoms or atypical findings, both underwent laparoscopic exploration, during which TTE was identified: both testes were located on the same side with no evidence of hernia. CONCLUSION: These cases highlight the importance of considering TTE in the differential diagnosis of atypical inguinal hernia, particularly in adults with relevant surgical or urogenital history. Laparoscopic exploration is a valuable tool for both diagnosis and definitive surgical management. Early recognition of this rare entity is essential to prevent misdiagnosis and optimize clinical outcomes.
AIM: The incidence of parastomal hernia (PH) following the transperitoneal end sigmoid colostomy (TP) with prophylactic mesh placement has been reported unexpectedly high. We reviewed the incidence of PH after laparoscopic abdominoperineal excision (lap APE) using extraperitoneal end sigmoid colostomy (EP) in principle since 2013 to examine the appropriateness of prophylactic mesh placement for PH prevention in the laparoscopic setting. MATERIALS AND METHODS: From September 2013 to August 2021, 28 consecutive patients underwent lap APE for local curative resection of rectal adenocarcinoma with a postoperative follow-up period of at least 20 months at the Department of Gastrointestinal Surgery, Kansai Medical University Hospital. We diagnosed a PH (+) based on either the findings of a follow-up CT examination or those of a certified wound, ostomy, and continence nurse. We examined the causes of PH based on the clinical and surgical findings. RESULTS: We have experienced PH in 6 out of 28 patients (PH (+)). Of these, 5 were cases where EP was technically abandoned in favor of TP. The Cox proportional hazard model revealed that the risk factors of the PH were significant in the TP (relative risk = 46.8; 95% confidence interval = 2.3-940.4). The Kaplan-Meier curve showed that the 3-year PH occurrence rate was significantly lower in EP (5.1%) than in TP (71.4%; P < 0.001). CONCLUSION: The EP is a highly effective method for preventing PH, and the intraperitoneal onlay mesh methods, in which TP is used as a pseudo-EP in cases where TP is necessary, warrants further investigation.
BACKGROUND: Isolated traumatic appendicular perforation is an extremely rare complication of blunt abdominal trauma. The concurrent occurrence with blunt traumatic abdominal hernia represents an exceptionally rare combination, with fewer than 10 cases documented in the literature worldwide. CASE PRESENTATION: We present a case of an 18-year-old male who sustained isolated traumatic appendicular perforation with concurrent blunt traumatic abdominal wall hernia following a high-speed motor vehicle accident. The patient presented with right lumbar swelling and underwent emergency exploratory laparotomy, which revealed perforation at the base of the appendix with complete disruption of the mesoappendix and active bleeding from the appendicular artery, herniated through a traumatic abdominal wall defect. CONCLUSION: This case emphasizes the importance of maintaining high clinical suspicion for complex intra-abdominal injuries in blunt trauma patients. Early recognition and surgical intervention are crucial for optimal outcomes in these rare combined injuries.
BACKGROUND: Concurrent prosthetic mesh abdominal wall reconstruction during bowel resection remains controversial due to concerns over contamination risks. This study evaluates the safety and efficacy of single-stage mesh repair in bowel resection and compares outcomes between resection and non-resection cohorts. This study evaluates the safety and efficacy of single-stage mesh repair in bowel resection and compares outcomes between resection and non-resection cohorts. MATERIALS AND METHODS: A retrospective analysis included 79 patients undergoing abdominal wall reconstruction (2018-2023), stratified into bowel resection (n = 22) and non-resection (n = 57) groups. Surgical techniques included open sublay and laparoscopic laparoscopic intraperitoneal onlay mesh plus mesh implantation. Outcomes assessed complication rates, recurrence, and quality of life through Carolinas comfort scale (CCS). Statistical analysis utilized Statistical Package for the Social Sciences 26.0 with P < 0.05 as significance threshold. RESULTS: Operative time and hospitalization were longer in the bowel resection group (P < 0.05). No significant differences were observed in overall complication rates (36.36% vs. 36.84%, P > 0.05), including mesh infection (4.55% vs. 7.02%), and recurrence (9.09% vs. 8.77%). CCS scores indicated comparable quality of life, with 77.27% of resection and 71.93% of non-resection patients reporting minimal discomfort (scores <= 10). CONCLUSIONS: Single-stage mesh repair with bowel resection demonstrates safety and efficacy equivalent to non-resection procedures under rigorous infection control. The findings challenge traditional multi-stage approaches, supporting individualized decisions based on contamination severity and patient factors.
INTRODUCTION:Laparoscopic repairs for pediatric inguinal hernia have gained gradual acceptance in the past. The objective of this study was to evaluate the clinical efficacy and significance of single-site laparoscopic percutaneous extraperitoneal closure of the internal ring using an epidural needle for children with inguinal hernia.MATERIALS AND METHODS:We retrospectively analyzed clinical data of 529 children with inguinal hernia who underwent single-site laparoscopic percutaneous extraperitoneal closure of the internal ring using an epidural needle at our hospital from January 2019 to August 2024.RESULTS:All micro-laparoscopic surgeries were successfully performed in the 529 patients, among them, a contralateral patent processus vaginalis was present in 208 patients with unilateral pathology and thus simultaneously repaired; a total of 737 cases of inguinal hernia were repaired. The average operating time was 13.42 +/- 4.42 min for unilateral hernioplasty and 19.20 +/- 2.49 min for bilateral hernioplasty. Only one male patient experienced a recurrence that required reoperation. In terms of postoperative complications, there were no surgical site infections, testicular atrophy, or abdominal adhesions. The mean follow-up time was 14.12 +/- 3.45 months. All the patients had a small operative scar, which was minimally visible.CONCLUSION:Single-port laparoscopic surgery using an epidural needle for children is a technically straightforward and reliable approach for treating pediatric inguinal hernias, characterized by high applicability, minimal postoperative complications, reduced recurrence risk, rapid convalescence, and superior aesthetic outcomes.
Amyand’s hernia, characterized by the presence of an appendix within an inguinal hernia sac, is a rare clinical entity. When complicated by acute appendicitis, it presents both diagnostic and therapeutic challenges, particularly in recurrent hernias where scar tissue and altered anatomy complicate surgical management. An 85-year-old male presented with recurrent right inguinal hernia, localized pain, nausea, and leukocytosis. Imaging revealed an inflamed appendix within the hernia sac. Laparoscopic exploration confirmed Amyand's appendicitis, and concurrent transabdominal preperitoneal hernia repair with appendectomy was performed. The minimally invasive approach allowed for definitive management of both pathologies without conversion to open surgery. This case highlights the feasibility and utility of laparoscopy in managing Amyand’s appendicitis in recurrent hernias. It underscores the importance of considering dual pathology in patients with atypical presentations of inguinal hernia.
BACKGROUND: Chronic pain following inguinal hernia repair is a non-negligible issue, yet accurately assessing patients’ postoperative quality of life remains challenging. This study aims to evaluate the reliability, validity, and acceptability of the EuraHS-QoL scale within the Chinese patient population. MATERIALS AND METHODS: Using the Chinese version of the EuraHS-QoL as a questionnaire, 80 patients with abdominal wall hernias (enrolled between September and November 2024) were tested preoperatively, on postoperative day 1, and at 3 months postoperatively. Additionally, the Visual Analog Scale and SF-36 Health Survey were completed on the first day after surgery. Through data analysis, the scale’s reliability, validity, and acceptability were confirmed. RESULTS: The internal consistency of the three dimensions of the Chinese version of the EuraHS-QoL scale was confirmed, with high correlations among similar dimensions of the three scales. Meanwhile, the EuraHS-QoL scale demonstrated advantages in hernia-specific areas and exhibited higher patient compliance. Notably, EuraHS-QoL scores across all three modules were significantly lower at 3 months postsurgery than at the preoperative and 1 day postoperative assessments (p < 0.05), suggesting that hernia repair surgery enhances patients’ physical and psychological well-being and overall quality of life. CONCLUSION: The Chinese version of the EuraHS-QoL scale has good reliability, validity, and acceptability, and it can serve as a reference tool for assessing quality of life in studies of abdominal wall hernia patients in China.
BACKGROUND: Intestinal stomas remain an essential aspect of surgical practice despite medical technology advances. This study aimed to evaluate the early postoperative morbidity associated with diversion stomas in both elective and emergency settings. MATERIALS AND METHODS: A prospective observational study was conducted over 3 years (June 2020 to May 2023) in the Department of General and Minimal Invasive Surgery. All patients aged >18 years undergoing intestinal stoma formation for benign and malignant conditions were included. Early postoperative complications were recorded and analyzed. RESULTS: A total of 148 patients were included, with 102 (69%) males. The most common procedure was loop ileostomy (105, 71%). Early postoperative complications occurred in 101 (68%) patients, with skin excoriation (53, 36%), mucosal necrosis (31, 21%), and retraction (21, 14%) being the most frequent. Multivariate logistic regression analysis identified emergency surgery (odds ratio [OR]: 2.6, 95% confidence interval [CI]: 1.4-4.9, P = 0.002), low serum albumin (<3 g/dL) (OR: 3.1, 95% CI: 1.5-6.3, P = 0.001), and ileostomy formation (OR: 2.8, 95% CI: 1.3-5.7, P = 0.003) as independent predictors of early postoperative complications. Trainee-led surgeries (OR: 2.4, 95% CI: 1.2-4.8, P = 0.009) and malignancy (OR: 2.2, 95% CI: 1.1-4.5, P = 0.025) were also significantly associated with increased morbidity. CONCLUSION: Early postoperative complications following stoma formation remain significant. Ileostomies were associated with higher complication rates than colostomies. Patient factors, surgical expertise, and operative conditions significantly influence outcomes. The development of specialized stoma care teams and early involvement of enterostomal therapists may help in early detection and management of complications. Regular audit of outcomes and complications can identify areas for improvement in surgical technique and perioperative care.
Large ventral hernias, often with significant defects and loss of domain, present a challenge even for experienced surgeons. Traditionally, surgical management of large incisional hernias involves tension-free mesh repair, either via open or laparoscopic methods. Bridging these defects has involved artificial prostheses. However, failure to close the midline can lead to adverse effects on posture, respiration, micturition, defecation, and overall biomechanical function, severely affecting the patient's quality of life. Albanese et al. first proposed a model for abdominal wall component separation in 1951, which was later refined by Ramirez et al. in 1990 through a cadaveric study. This technique offers a novel approach to closing midline defects by utilizing native, vascularized tissue-either alone or in combination with prosthetic materials. Over time, this technique has evolved, incorporating various modifications, including anterior and posterior component separation. Component separation has become more widely used, with ongoing modifications aimed at addressing the key challenges of the technique. Hence, here we present a case of a 42-year-old male with a large ventral hernia at the site of midline abdominal surgery performed a decade earlier. The hernia was successfully repaired using a combination of anterior and posterior (dual) component separation techniques, complemented by mesh reinforcement, resulting in a satisfactory outcome and restoring the patient's functional capacity and quality of life. In conclusion, for complex cases, dual component separation techniques may be used to facilitate defect closure, ensuring abdominal wall integrity and promoting recovery while minimizing complications and recurrence.
