Laparoscopic transabdominal preperitoneal (TAPP) repair enables inspection of the entire peritoneal cavity and both inguinal regions without additional dissection. Although widely used electively, evidence on emergency strangulated or incarcerated groin hernias remains limited. We evaluated the feasibility, safety, and short-term outcomes of emergency TAPP repair in adults. We retrospectively reviewed adult patients who underwent emergency laparoscopic TAPP repair for incarcerated or strangulated groin hernias at our hospital from January 2022 to December 2024. Data collected included demographics, hernia type and contents, operative details, and postoperative outcomes. Thirty-five patients underwent successful emergency TAPP repair, including 30 inguinal and five femoral hernias. Mean operative time was 96.9 ± 21.7 min (range: 75–135), and mean postoperative length of stay was 3.8 ± 1.3 days (range: 2–6). The small bowel was the most frequent hernia content (62.8%), followed by the omentum (31.4%). All incarcerated organs were preserved without bowel resection, and no conversion to open surgery was required. Early postoperative morbidity was low, with one case (2.86%) of urinary retention and no hematoma, vascular injury, or surgical site infection. At 1-month follow-up, three patients (8.6%) developed seroma and two (5.7%) reported groin pain; no mesh infection, ischemic orchitis, or hernia recurrence was observed. In experienced hands, emergency laparoscopic TAPP repair for incarcerated and strangulated groin hernias in adults is feasible and safe, providing favorable short-term outcomes.
The role of prophylactic drains in retromuscular ventral hernia repair remains controversial. Although drains have traditionally been used to prevent seroma or hematoma formation, evidence regarding their necessity in minimally invasive robotic extended totally extraperitoneal (eTEP) Rives–Stoppa (RS) repairs is limited. This study evaluates the need for prophylactic drain placement following robotic-assisted eTEP RS hernia repair. A retrospective review of 53 patients who underwent robotic-assisted eTEP RS hernia repair at a single high-volume hernia center between July 2021 and December 2022 was conducted. No prophylactic drains were placed. Postoperative evaluation included 30-day follow-up visits, and computed tomography (CT) scans were obtained 30–60 days postoperatively, which were reviewed for retromuscular fluid (RMF) accumulation and classified by severity. Of the 53 patients, 41 (77%) underwent postoperative CT scanning. Among these, 27 (66%) had no RMF, 9 (22%) had minimal RMF, 4 (10%) had moderate RMF, and 1 (2%) had large RMF. All fluid collections resolved spontaneously within approximately 5.5 months without intervention. No cases of infection, seroma-related morbidity, or recurrence were identified during the follow-up. Prophylactic drain placement may not be necessary in robotic-assisted eTEP RS hernia repair. Most patients in this series demonstrated no or minimal postoperative fluid accumulation, and all observed collections resolved without intervention. These findings support omitting routine drain use in robotic eTEP RS repairs.
Sportsman's hernia and athletic pubalgia (SH/AP) represent a chronic microtrauma groin injury, distinct from typical inguinal hernia, characterized by exertion-related pain due to underlying groin and pubic injury results for muscular imbalance. Mild cases may respond to conservative management, but advanced cases often require surgical repair. Because persistent neuromuscular dysfunction may limit full recovery and contribute to recurrence, structured postoperative rehabilitation is considered an important component of care after surgery. This study aimed to describe the mandatory Athletic Muscles Rehabilitation Program (AMRP), a surgeon-supervised, three-component postoperative protocol initiated immediately after totally extraperitoneal release-and-reinforce technique (TEP-RRT) surgery, and to characterize long-term functional and patient-reported outcomes in athletes treated with TEP-RRT and AMRP, a protocol not widely recognized as essential for successful full recovery. We retrospectively surveyed 461 athletes who underwent TEP-RRT for SH/AP between 2016 and 2024 and completed a standardized AMRP. A structured telephone survey (October 2024–January 2025) captured return-to-sport status, time to return, recurrence, additional treatments, and patient satisfaction. Descriptive statistics were used. During the follow-up of 6 months to 9 years, 98.5% of athletes returned to sports after completing the AMRP and remained active. Rehabilitation lasted 6–12 weeks. Most resumed full activity within 8 weeks, and nearly all resumed full activity within 12 weeks. No recurrences occurred. Additional treatments were required in 10% of the cases. Satisfaction was high (96.2% rated outcomes very good). Surgeon-supervised, structured rehabilitation after TEP-RRT for SH/AP was associated with favorable functional outcomes, including high return-to-sport rates and no reported recurrences during the long-term follow-up. Prospective comparative studies are needed.
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. 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. 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. 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/2024/11/077136.
Hepatic and colonic eventration secondary to denervation following lumbotomy is a complex complication involving the protrusion of abdominal viscera through a defect in the lateral abdominal wall, caused by the loss of innervation to the abdominal muscles after a lumbotomy. Based on an exhaustive review of the medical literature, three well-documented cases of hepatic eventration secondary to lumbotomy have been identified. This article presents the case of a 50-year-old female patient (body mass index: 28.5 kg/m2) who developed hepatic eventration and eventration of the hepatic flexure of the colon, through an area of muscular atony secondary to denervation from a previous lumbotomy. Bacteriologic investigation of the perirenal abscess indicated growth of Escherichia coli. The authors repaired the defect with a muscular plication without mesh placement given the presence of an actively infected surgical field (Centers for Disease Control and Prevention [CDC] wound class Ⅳ). At the 6-month follow-up, no clinical or radiographic evidence of recurrence was observed. Although denervation following lumbotomy is common, hepatic and colonic eventrations are rare and remain difficult to manage. Surgical treatment modalities are still not well defined, and there are no precise recommendations, which is likely due to the relative rarity of these cases. The rationale for mesh avoidance in a contaminated/infected field and the evidence supporting staged repair strategies are discussed.
Incisional hernia repair is commonly complicated by infection and delayed wound healing, usually attributed to contamination or mesh-related factors. Rarely, persistent or atypical wounds may indicate an underlying malignancy. Choriocarcinoma is an aggressive trophoblastic tumor, with extrauterine forms being uncommon and typically metastatic. Primary involvement of the abdominal wall is exceptionally rare. We report a case of an infected incisional hernia presenting as a chronic nonhealing wound, with incidental choriocarcinoma diagnosed on histopathology. A 40-year-old woman with two prior cesarean deliveries had previously undergone a combined hysterectomy and incisional hernioplasty with onlay polypropylene mesh at another center. Her postoperative course was complicated by persistent wound infection requiring multiple debridements, but the wound failed to heal over 2 years. She later presented to us with foul-smelling discharge from the abdominal wound, for which mesh explantation and secondary closure were performed. After being lost to follow-up, she presented a year later with purulent discharge from multiple sinus tracts. Imaging revealed a large infraumbilical incisional hernia with subcutaneous fluid collection. She underwent diagnostic laparoscopy, followed by wide excision of the infected abdominal wall and reconstruction with a biological mesh. Histopathological examination (HPE) demonstrated high-grade choriocarcinoma, confirmed on immunohistochemistry. She subsequently received multiagent chemotherapy and had an uneventful recovery. Persistent or recurrent wound infection following incisional hernia repair should prompt consideration of atypical etiologies, including malignancy. Histopathological evaluation of the excised tissue in such cases is essential to avoid missed diagnoses. Early detection and a multidisciplinary approach are key to optimal outcomes.
Traumatic Spigelian hernia is an exceptionally rare clinical entity, often resulting from low-velocity, high-pressure blunt force, such as a bicycle "handlebar injury." It may pose a diagnostic challenge and can be associated with occult intra-abdominal pathologies. A 39-year-old female presented with a reducible right iliac fossa swelling and dull aching pain 7 days after a bicycle handlebar impact. She also reported nonpassage of stools for 48 h without features of bowel obstruction. Clinical examination and ultrasonography suggested a traumatic abdominal wall hernia. Contrast-enhanced computed tomography (CECT) confirmed a 1.85-cm defect in the right Spigelian fascia containing bowel loops and omentum. It also revealed an incidental, right adnexal mass of 6.5 cm × 8.2 cm × 7 cm with fat attenuation and calcific foci, suggestive of a mature cystic teratoma. The patient underwent open surgical exploration. The hernia was repaired using a sublay (preperitoneal) synthetic mesh technique. Simultaneously, a right ovarian cystectomy was performed. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. Histopathological examination confirmed a mature cystic teratoma. On follow-up, the surgical site healed well with no evidence of recurrence. This case report highlights the "handlebar hernia" as a diagnostic challenge that requires a high index of clinical suspicion. CECT remains the gold standard for identifying fascial defects and associated intra-abdominal pathologies. Early imaging and thorough surgical exploration enable single-stage management of traumatic hernias and incidental findings, with sublay mesh repair providing a reliable and effective treatment approach for traumatic Spigelian hernias.