BACKGROUND: Laparoscopic inguinoscrotal hernia repair is a challenging procedure. The surgeon must perform large dissections to reduce the hernial sac, although he has the alternative technique of leaving the sac at the deep inguinal orifice level from the beginning.
OBJECTIVE: We aimed to determine the postoperative morbidity of laparoscopic inguinoscrotal hernia repair with the primary abandon-of-the-sac (PAS) technique and to compare it with complete dissection and reduction (CD). Operative times were compared as a secondary outcome.
METHODS: A retrospective analysis was conducted between January 2021 and May 2022. The minimum follow-up was 3 months. Postoperative morbidity and operative times in the PAS group were analyzed and compared with those in the CD group.
RESULTS: Seventy-eight patients were evaluated. The mean follow-up was 5 months (range, 3–18 months). PAS was performed in 15 patients, while the remaining 63 patients underwent CD. There were no significant differences in demographic and hernia characteristics. An overall morbidity of 30.7% was recorded. No statistical differences were observed in postoperative morbidity between the PAS group and the CD group (33.3% vs. 30.1%; P = 0.81). No statistical differences were found in terms of seromas (13.3% vs. 9.5%; P = 0.662), hematomas (6.6% vs. 9.5%; P = 0.727), or hydrocele (13.3% vs. 11.1%; P = 0.808). No recurrence or chronic pain was observed during the study period. Finally, a significantly shorter median operative time was recorded in the PAS group (50 vs. 80min; P = 0.0026).
CONCLUSION: The PAS technique is safe and feasible for the management of inguinoscrotal hernias. In our series, comparable morbidity rates were found when comparing it with CD. The benefit of the PAS technique is a significant reduction in operative time, despite the fact that it requires more postoperative ultrasounds.
BACKGROUND: Nintedanib (previously known as BBIF 1120) was approved by the United States Food and Drug Administration and European Medical Agency to treat idiopathic lung fibrosis in the year 2014 and 2015, respectively. It is now gaining interest for its anti-fibrotic activity in other organs and disease conditions. Although a surgical mesh is used as a mainstay therapy for herniorrhaphy, postoperative peritoneal adhesion with a polypropylene mesh is a significant drawback. This study aims to assess the efficacy of nintedanib in preventing postoperative adhesion incited with a polypropylene mesh in a rabbit model of ventral hernia.
MATERIALS AND METHODS: Ventral hernia was induced surgically in ten adult healthy New Zealand White rabbits of either sex. Hernioplasty was performed with a polypropylene mesh, and the rabbits were randomly allocated into two groups to receive either oral 1 mL sterile water or 100 mg nintedanib in 1 mL of sterile water for 7 days. The adhesion of the implanted mesh with the intra-abdominal organs was assessed clinically, by histological and ultrastructural studies with scanning electron microscopy (SEM) at 30 days postoperatively.
RESULTS: All rabbits were clinically healthy for 30 days post-surgery with no complication at the site of surgery. The incidence of peritoneal adhesion and tenacity was less in the nintedanib group versus the control group (P = 0.00105). Histopathological and SEM evaluations also indicated less fibrosis and adhesion in the nintedanib-treated group versus control.
CONCLUSION: Our results show successful prevention of mesh-associated adhesion with nintedanib, but further studies on the mechanistic pathway, pharmacokinetics, dose standardization, and evaluation of systemic side effects are warranted.
BACKGROUND: Flank incision, a common approach in kidney surgery, has several types. This study was carried out to examine the effect of using subcostal and intercostal flank incisions on post-operative pain, incisional hernia or bulging, and incision time and wound closure time in patients undergoing open kidney surgery.
MATERIALS AND METHODS: This randomized clinical trial was conducted Iran (2023–2024). Sixty-four patients were randomly divided into two groups of 32 patients, subcostal and intercostal, based on available sampling technique. The Visual Analog Scale was used to assess post-operative pain. The abdominal wall asymmetry (AWA) technique was used for both hernia and bulge, and clinical examination was done by a urology surgeon for diagnosing AWA. Data analysis was done using SPSS-23.
RESULTS: In the subcostal group, a higher incidence of AWA was observed when compared to the intercostal group at 6 months post-operation, and this difference was statistically significant (P = 0.039). However, there was no significant difference between the two groups at 3 months post-operation in this regard (P > 0.05). The mean pain score of patients at 24 and 72h post-operation was significantly higher in the intercostal group than in the subcostal group (P < 0.05); however, at the first hour and on day 7 post-surgery, no significant difference was found between the two groups in this regard (P > 0.05). In addition, no significant differences existed between the two groups regarding incision time and wound closure time (P > 0.05).
CONCLUSION: Intercostal incision, when compared to subcostal incision, was associated with lower probability of development of hernia or bulge, in spite of its higher-level post-operative pain.
TRIAL REGISTRATION: This study was registered with the Iranian Clinical Trials Registry under the code IRCT20230208057358N1 on 2023.02.11.
BACKGROUND: Laparoscopic transabdominal preperitoneal repair of inguinal hernia (TAPP) is routinely done by general surgeons. (1) One crucial step is peritoneal closure post-mesh placement to prevent contact with the bowel. (2) There are various techniques available for peritoneal closure. (3) This prospective comparative cohort study compares the effectiveness of sutures versus tackers in terms of time efficiency, cost, postoperative patient comfort, and complications.
MATERIALS AND METHODS: This prospective comparative cohort study included patients undergoing unilateral TAPP at a tertiary care hospital in South India from December 2022 to April 2024. A total of 80 patients were included in the study, of which 50 underwent peritoneal closure by tackers and 30 underwent peritoneal closure by sutures based on the standard of care of the operating surgeon. These patients were observed intra-operatively, post-operatively, and during the first follow-up visit at 10–14 days and at 3 months.
RESULTS: Peritoneal closure time was significantly lower for the tacker group (2.78 min vs. 11.17min, P < 0.001). The tacker group had a higher cost (₹5313 vs. ₹1855, P < 0.001) and experienced increased postoperative pain at both 10–14 days (36% vs. 10%, P = 0.011) and 3 months (24% vs. 6.7%, P = 0.048).
CONCLUSION: This study shows that although suturing for peritoneal closure is more time-consuming and technically challenging, it can significantly reduce the material cost and reduce both early and late postoperative pain. Using barbed suture materials can help reduce operative times.
TRIAL REGISTRATION: Study registered under the Clinical Trial Registry of India. CTRI Number: CTRI/2022/11/047211.
BACKGROUND: This cross-sectional pilot study aimed to evaluate awareness and management strategies among obstetricians and surgeons in the Kingdom of Saudi Arabia for round ligament varicosities (RLV) during pregnancy.
MATERIALS AND METHODS: An online questionnaire was distributed through convenience sampling to surgeons and obstetricians across the Kingdom of Saudi Arabia. It assessed demographics, clinical knowledge, experience in diagnosing and managing groin lumps during pregnancy, and engagement in continuing medical education.
RESULTS: Of the 39 participants, 56.41% (n = 22) were obstetricians and 43.59% (n = 17) were surgeons, with the majority having 5–10 years of practice (35.90%, n = 14). Groin hernia was reported as the most frequent diagnosis for groin lumps during pregnancy (43.59%, n = 17), whereas only 7.69% (n = 3) identified RLV, indicating a significant gap in recognizing RLV. Furthermore, 35.90% (n = 14) recognized RLV as a differential diagnosis, but only 25.64% (n = 10) were aware of its management.
CONCLUSION: RLV, which is more common than hernias during pregnancy, is often misdiagnosed due to its similar presentation. Accurate differentiation, often achieved through ultrasound, is crucial as management strategies significantly differ. This study underscores the need for enhanced awareness and training among obstetricians and surgeons to accurately diagnose and manage RLV. The observed knowledge gaps highlight the critical role of continuous medical education in improving patient care. These findings will guide a larger study to assess practices across the Kingdom and develop national recommendations for the management of RLV and groin hernias during pregnancy.
Paraesophageal hernia is an uncommon condition where the gastric fundus herniates through the diaphragm without the accompanied migration of the gastroesophageal junction. A woman in her late 60s presented with symptoms of vomiting and decreased appetite for 1 year, accompanied by abdominal fullness in the epigastrium, nausea, and retrosternal burning sensation. Her symptoms worsened over the past month, leading to intolerance to a liquid diet. Upon examination, a vague, tender mass was palpated over the epigastrium, and decreased breath sounds were noted over the right hemithorax. Computed tomography suggested the presence of paraesophageal hernia. An exploratory laparotomy was performed. Intraoperatively, a 4cm paraesophageal diaphragmatic defect was found through which the antrum and the first part of the duodenum had herniated. The hernial contents were reduced, and anatomical closure was performed. Paraesophageal hernias necessitate careful history and examination, along with an individualized treatment approach, to achieve optimal patient outcomes.
Internal hernia is the protrusion of a viscus through a normal or abnormal peritoneal or mesenteric aperture within the confines of the peritoneal cavity. They can be congenital or acquired after abdominal surgery. We report a case of a 58-year-old woman who presented with complaints of abdominal pain and nonbilious vomiting for 2 days. She underwent an abdominal hysterectomy 15 years ago. After baseline blood investigations and imaging, a diagnosis of subacute intestinal obstruction was made. As she clinically worsened over 24h, CT imaging was done, which suggested acute small bowel obstruction secondary to adhesions. Surgery revealed herniation with incarceration of distal ileal loops through a defect in the sigmoid mesocolon. Bowel resection was done, and the defect was closed. The clinical presentation of internal hernias, especially transmesosigmoid hernia, is nonspecific, and they rapidly progress to bowel ischemia. Early intervention and surgical correction are prudent for good clinical outcomes.