AIM: Femoral hernia is associated with a higher complication risk compared to inguinal hernia. Most groin hernia research studies today are performed on men. The Lichtenstein technique is a well-studied, safe, and widely used method in men, but not recommended in women, where the recommended approach is either endoscopic or an open preperitoneal technique.
MATERIALS AND METHODS: A case-control pilot study was performed on adult women with groin hernia repaired using a modified Lichtenstein (ML) technique. The technique is the same as the original Lichtenstein method, with the addition of an incision in the posterior wall of the inguinal canal. If a femoral hernia or weakening is found, a mesh flap is applied to cover the femoral orifice. The primary outcome was perioperative complications, and the secondary outcome was long-term complications.
RESULTS: In this pilot study, 48 women were operated with the ML technique. Only minor perioperative complications were seen, and no serious adverse events occurred. The complications were transient, and no unplanned hospital admission was necessary. No recurrent hernias occurred during the follow-up period, only a few women were dissatisfied with the procedure, and even less reported persisting pain.
CONCLUSION: This ML technique could be an alternative method for female groin hernia repair. This pilot study paves the way for further research and development of this method, which eventually could be used in resource-limited settings or where the surgeon is not specialized in hernia repair.
BACKGROUND: Recently, use of hybrid meshes has been proposed owing to its different meshrelated properties. This study reviews our longer term experience with a hybrid mesh.
MATERIALS AND METHODS: We retrospectively reviewed all patients undergoing ventral hernia repair at our single medical center using a hybrid mesh from April 2016 through September 2019. Demographic, perioperative, and short- and long-term outcomes, reoperation, and recurrence rates were reviewed, and descriptive statistics were calculated.
RESULTS: A total of 48 patients who underwent ventral hernia repairs using a hybrid mesh were included. The average age of participants was 58 years (range 42-77 years), 85.7% were Caucasian, and 51% female. A minimally invasive approach was performed in 63.3%, with 20.4% converting to open hernia repair. Eighteen patients (36.7%) underwent open hernia repair. Thirty-day complications occurred in 12 patients (24.5%), with the most common complication being seroma formation. Hernia recurrence occurred in four of 49 (8.2%) patients. Results of a univariate analysis comparing groups of patients who did and did not experience recurrence resulted with body mass index (BMI) (45.85 vs. 30.70) as the only statistically significant risk factor. All recurrences occurred in open (three) or laparoscopic converted to open (one) cases. Over the full follow-up period, 11 patients (22.4%) underwent abdominal reoperation.
CONCLUSIONS: We report longer-term outcomes of a new permanent synthetic hybrid mesh with long-term hernia recurrence rates comparable to reported national averages. This study found BMI to be a statistically significant predictor of hernia recurrence. Synecor mesh appears to be safe and offers potential benefits of both bioabsorbable and permanent synthetic meshes.
INTRODUCTION: Hernia outcome reports in Asia remain sparse compared to Western counterparts. This multicenter prospective observational study aimed to assess the short-term outcomes of laparoscopic groin hernia repair in Japan.
METHODS: This study included adult patients undergoing laparoscopic groin hernia repair surgery for primary unilateral hernias at participating institutes from March 2021 to November 2022. Patients with previous surgery in the lower abdomen or with scrotal hernia were excluded. At the ward or during follow-up clinic visits, the patients were given a printed copy of the questionnaire that we developed to assess pain intensity, daily life interference, and surgical outcomes. This was administered before surgery, at 1 week, 1 month, and 3 months postoperatively, which they then completed and submitted. The primary outcome was complication rate at the end of the 3-month postoperative period.
RESULTS: A total of 1,467 cases from 21 institutes were registered. The response rate at the end of 3 months after the surgery was 87.1%. Nearly 70% of the surgeries were performed by surgeons with an experience of over 500 cases. The average operation time was 74.6 ± 27.6min with a negligible rate of intraoperative complications. No complications above Clavien-Dindo Grade II were reported. Short-term outcomes indicated low rates of chronic pain (0.16%) and seroma (1.7%) and high patient satisfaction (98.27%).
CONCLUSION: Our study provides valuable insights into the short-term outcomes of laparoscopic groin hernia repair from multiple institutes in Japan, demonstrating favorable results with low complication rates and high patient satisfaction.
TRIAL REGISTRATION: The study was registered in UMIN-CTR (
INTRODUCTION: Ventral hernia (VH), associated with diastasis rectus abdominis, is a relatively common pathology in general surgery. Extended-view Totally Extraperitoneal Technique (e-TEP) is a promising surgical technique for its correction. However, it requires extensive dissection and, therefore, can cause postoperative pain. The aim of this study is to propose a new technique for analgesia and to compare it to existing techniques.
MATERIALS AND METHODS: Thirty patients were submitted to VH and diastasis correction surgery applying e-TEP technique and randomly divided into three groups, according to the type of analgesia administered: general anesthesia (GA) alone; GA and TA plane block guided by ultrasound (US-TAPB); GA and TAPB by direct laparoscopic view (DV-TAPB). Pain scores using the Numeric Rating Scale were collected at 2, 6, and 24h postop. The time to administer local anesthetic (LA) was also measured.
RESULTS: No significant differences for gender, age, or body mass index (BMI) were observed, nor for the mean defect area and diastasis length, mesh size, and operation time between groups. The DV-TAPB group presented the lowest pain scores at 2h (P = 0.001), 6h (P = 0.02), and 24h (P = 0.01) postoperatively. Additionally, the mean time required to administer the LA was significantly lower in the DV-TAPB group (1.9min) compared to the US-TAPB group (11.8min).
CONCLUSION: E-TEP is a relatively new and promising technique to treat VH and diastasis. Additional analgesia by DV-TAPB is faster and offers better pain relief in the first 24h postop period.
TRIAL REGISTRATION:
PURPOSE: The Shouldice method has shown promising outcomes in reconstruction of the inguinal canal without mesh. However, measuring actual recurrence rates is difficult in clinical practice. Some studies have been applying algorithms based on Patient-Reported Outcomes (PRO) to facilitate the detection of recurrence. The aims of this study were to assess the medium- to long-term recurrence rate of the three-layer Shouldice technique in a population composed solely of doctors, validate the PRO questionnaire compared to clinical examination and ultrasound, and measure the patients’ degree of satisfaction.
MATERIALS AND METHODS: This retrospective cohort study investigates the medium- to long-term outcomes of the three-layer Shouldice technique, with a minimum follow-up of 12 months postoperatively. Patients were evaluated by comparing clinical examination results, PRO questionnaire, and ultrasound.
RESULTS: Sixty-one patients comprising 76 hernias underwent primary inguinal hernia repair with a minimum follow-up of 12 months. Results indicate a low recurrence rate of 1.3%, with one patient requiring reoperation after 18.5 years. Self-perception of recurrence through the PRO questionnaire correlated well with clinical examination findings. Ultrasonographic evaluation detected incidental findings in three cases, highlighting the selective role of imaging in postoperative care. Patient satisfaction, assessed by the Net Promoter Score (NPS), was notably high, at 96, underscoring the procedure’s acceptability among this cohort.
CONCLUSION: Overall, the three-layer Shouldice technique demonstrates comparable efficacy to that of standard methods, with minimal complications and high patient satisfaction, suggesting its viability as a suitable alternative in inguinal hernia repair.
BACKGROUND: Nuck canal cysts, or the hydrocele of the canal of Nuck, are rare conditions primarily affecting females. Over the past two decades, research interest in this area has increased, leading to a growing number of scientific publications. This bibliometric analysis aims to evaluate the trends in scientific publications related to Nuck canal cysts, identify leading contributors, and understand the global research landscape.
MATERIALS AND METHODS: A comprehensive literature search on PubMed using the terms “Nuck canal cyst,” “canal of Nuck,” and “female hydrocele” was conducted. Limited to English-language articles and reviews published since 2000, the search concluded on July 5, 2024, yielded 166 relevant articles. After a review by two independent authors, 21 articles were deemed irrelevant, leaving 145 articles for further analysis.
RESULTS: The annual scientific research production showed a significant increase in publications from 2011 onward, peaking around 2021. Leading institutions included Fujita Health University Okazaki Medical Center, Kurume University School of Medicine, and Sapporo Higashi Tokushukai Hospital. The USA, Japan, and Turkey emerged as the top contributing countries, with Japan leading in the number of overall publications.
CONCLUSION: There has been a notable increase in research studies on Nuck canal cysts over the past decade, with significant contributions from specific institutions and countries. This growing body of research underscores the increasing interest and advancements in understanding, diagnosing, and treating Nuck canal cysts. Future research should continue to build on this foundation, exploring new diagnostic techniques, treatment options, and long-term patient outcomes.
When a swelling arising in the gluteal region herniates into the pelvic cavity through the sciatic foramen, it is referred to as inverse or reverse sciatic hernia and is a rare occurrence. We present the case of a 62-year-old female who presented with swelling in the left gluteal region with features of sciatica and abdominal pain. Magnetic resonance imaging showed 27 cm × 22 cm × 9cm soft tissue swelling arising from the gluteal region and inversely herniating into the pelvic cavity through the sciatic foramen. We were successful in delivering the tumor through a gluteal approach. Lipomatous tumors presenting as inverse sciatic hernia are a rare event.
Inguinoscrotal hernia containing the urinary bladder is a rare entity, found in 1%-5% of inguinal hernias. We herein present a rare case of a 60-year-old female status post open hysterectomy who presented to emergency department with painful groin swelling and contrast enhanced computerized tomography of abdomen showed features of incarcerated urinary bladder hernia. She underwent emergency laparo-endoscopic bilateral inguinal hernia mesh repair. After extensive literature search, we believe that this is the first case report of incarcerated urinary bladder hernia in a female with infra-umbilical scar who underwent emergency laparo-endoscopic bilateral inguinal hernia mesh repair.
Botulinum toxin has been used for the treatment of numerous medical conditions. Recently, preoperative botulinum toxin A (BTA) injections into the lateral abdominal wall muscles are beneficial for facilitating ventral hernia repairs and improving surgical outcomes. Early and late, local and systemic adverse effects of BTA application have been described, some of them are flu-like symptoms (FLS). However, no case of FLS following botulinum toxin injections before ventral hernia repair has been described. In this report, we present a 58-year-old female patient who developed FLS episodes throughout preoperative and postoperative periods following BTA injections.
Lumbar hernias, defined as the protrusion of intra- or extra-peritoneal contents through a defect in the posterolateral abdominal wall between the 12th rib and the iliac crest, are extremely rare. Until 2015, only about 300 cases had been reported since the first formal publication on the subject by the French surgeon R.J.C. de Garangeot in 1731. Lumbar hernias can be classified anatomically and etiologically. Anatomically, they can be divided into superior and inferior hernias, appearing in the upper or lower lumbar triangle, respectively, and diffuse hernias, which are considerably larger and not defined by specific anatomical structures. Etiologically, they are classified as primary or secondary. Primary lumbar hernias form spontaneously, while secondary lumbar hernias result from an event such as surgical procedures or trauma. Both types of lumbar hernia are rare, but the primary hernia is the least common. Thus, when a physician encounters a patient with this complaint, it is important to report the case in order to include the incidence in available literature on this rare defect and gradually achieve a comprehensive understanding of lumbar hernias, including their risk factors, clinical presentation, diagnosis, and treatment. In this study, we present the case of a 56-year-old female patient who attended the Conde de Lara outpatient clinic at the Santa Casa de Misericórdia Hospital in São Paulo, Brazil, with the complaint of a bulge in the left lumbar region, associated with pain and constipation, which she had been experiencing for at least 3 years. The patient had a clinical history, and imaging studies had indicated diagnosis of primary lumbar hernia. She underwent laparoscopic surgery for hernia repair, with satisfactory recovery. It is worth noting that there is no consensus regarding the best surgical technique for the treatment of lumbar hernias, and the treatment performed in this case was successful. The patient’s clinical history, the diagnostic process, and the treatment will be thoroughly described in this article.
