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Concept: Herniorrhaphy


The use of mesh has become the gold standard in hernia operations recently due to advantages such as lower recurrence rates, lower post-surgical pain and earlier return to work. Plug mesh application, first described by Robins and Rutkow [Robbins AW, Rutkow IM (1993) The mesh-plug hernioplasty. Surg Clin North Am 73:501-512], is a popular method of hernia repair. Although rare, there may be complications of surgery using plug mesh. This report presents a case of mechanic bowel obstruction due to mesh migration, 3 years after a left inguinal hernia repair with plug mesh method.

Concepts: Surgery, Engineering, Inguinal hernia, Hernia, Gold, Bowel obstruction, Hernias, Herniorrhaphy


Elective repair for umbilical or epigastric hernia is a frequent minor surgical procedure. Several studies have demonstrated chronic pain after groin hernia repair but long-term complaints have been only scarcely studied. This study was undertaken to investigate long-term pain and discomfort after open repair for small umbilical or epigastric hernias.

Concepts: Medicine, Surgery, Hernia, Cultural studies, Hernias, Herniorrhaphy, Pediatric surgery, Epigastric hernia


BACKGROUND: Transabdominal preperitoneal (TAPP) repair is widely used to treat bilateral or recurrent inguinal hernias. Recently a self-gripping mesh has been introduced into clinical practice. This mesh does not need staple fixation and thus might reduce the incidence of chronic pain. This prospective study aimed to compare two groups of patients with bilateral (BIH) or monolateral (MIH) primary or recurrent inguinal hernia treated with TAPP using either a self-gripping polyester and polylactic acid mesh (SGM) or a polypropylene and poliglecaprone mesh fixed with four titanium staples [standard technique (ST)]. METHODS: In this study, 96 patients (mean age, 58 years) with BIH (73 patients with primary and recurrent hernia) or MIH (22 patients with recurrent hernia) underwent a TAPP repair. For 49 patients, the repairs used SGM, and for 46 patients, ST was used. The patients were clinically evaluated 1 week and then 30 days postoperatively. After at least 6 months, a phone interview was conducted. The short-form McGill Pain Questionnaire was administered to all the patients at the 6-month follow-up visit. RESULTS: The mean length of the procedure was 83 min in the SGM group and 77.5 min in the ST group. The mean follow-up period was 13.8 months (range 1.3-42.0 months) for the SGM group and 18.2 months (range 1.9-27.1 months) for the ST group. The recurrence rate at the last follow-up visit was 0 % in the SGM group and 2.2 % (1 patient) in the ST group. The incidence of mild chronic pain at the 6-month follow-up visit was 4.1 % in the SGM group and 9.1 % in the ST group, and the incidence of moderate or severe pain was respectively 2.1 and 6.8 %. CONCLUSIONS: The study population was not large enough to obtain statistically significant results. However, the use of SGM for TAPP repairs appeared to give good results in terms of chronic pain, and the incidence of recurrences was not higher than with ST. In our unit, SGM during TAPP repair of inguinal hernias has become the standard.

Concepts: Statistics, Surgery, Inguinal hernia, Pain, Hernia, Hernias, Herniorrhaphy, Recurrence relation


BACKGROUND: The best approaches to repairing large inguinoscrotal hernias and handling of the distal sac are still debated. Complete dissection of a distal sac which extends deep into the scrotum carries a risk of orchitis and damage to the cord structures. However, failure to deal with the distal sac often results in the formation of a large and bothersome seroma or pseudohydrocele. We describe a technique for managing large distal sacs to avoid clinically important seromas when repairing large inguinoscrotal hernias, using the enhanced view totally extraperitoneal (e-TEP) endoscopic technique. METHODS: From October 2010 to November 2011, 94 consecutive elective hernia repairs were performed using the e-TEP technique. Six of these patients had large inguinoscrotal hernias, defined as hernias extending deep into the scrotum with a distal sac not amenable to dissection. In these six patients, we managed the distal sac by pulling it out of the scrotum and fixing it high and laterally to the posterior inguinal wall. We prospectively followed these patients and examined them at 8 days and 1 and 3 months postoperatively, looking specifically for signs or symptoms of seroma. Ultrasonography was performed at each follow-up visit. RESULTS: Only one of the patients had developed a seroma by the eighth postoperative day. The seroma was drained and did not recur or produce symptoms during the following 3 months. There were no major complications or early recurrences in the series. CONCLUSIONS: Patients with large inguinoscrotal hernias and sacs extending deep into the scrotum can benefit from reduction and fixation of the distal sac high and laterally to the posterior inguinal wall. This technique lowers the risk of developing clinically significant seroma.

Concepts: Inguinal hernia, Hernia, Aortic dissection, Fix, Herniorrhaphy, Illinois


OBJECTIVE: To describe successful repair of a diaphragmatic hernia in a standing sedated horse using a minimally invasive thoracoscopic technique. STUDY DESIGN: Clinical report. ANIMALS: Warmblood mare with a diaphragmatic hernia. RESULTS: An 18-year-old Warmblood mare with severe colic was referred for surgical treatment of small intestinal strangulation in a diaphragmatic defect. Twelve days after initial conventional colic surgery, left-sided laparoscopy in the standing sedated mare for diaphragmatic herniorrhaphy failed because the spleen obscured the hernia. One week later, a left-sided thoracoscopy was performed in the standing sedated horse and the hernia repaired by an intrathoracic suture technique. No long-term complications occurred (up to 4 years) and the mare returned to her previous athletic activity, followed by use as a broodmare. CONCLUSIONS: To avoid the high risks associated with general anesthesia, and to reduce surgical trauma and postoperative recovery, central diaphragmatic hernias are amenable to repair using a minimally invasive thoracoscopic technique in the standing sedated horse.

Concepts: Surgery, Anesthesia, Hernia, Horse, Hernias, Herniorrhaphy, Congenital diaphragmatic hernia, Diaphragmatic hernia


BACKGROUND: Although laparoscopic intra-peritoneal mesh repair (LVHR) is a well-established treatment option to repair ventral and incisional hernias, no consensus in the literature can be found on the best method of fixation of the mesh to the abdominal wall. METHODS: Between December 2004 and July 2008, 76 patients undergoing a LVHR were randomized between mesh fixation using a double row of spiral tackers (DC) (n = 33) and mesh fixation with transfascial sutures combined with one row of spiral tackers (S&T) (n = 43), in the WoW trial (with or without sutures). Patients were clinically examined and evaluated using a visual analog scale for pain (VAS) in rest and after coughing 4 h post-operatively, after 4 weeks and 3 months after surgery. Primary endpoint of the study was abdominal wall pain, defined as a VAS score of at least 1.0 cm, at 3 months post-operative. Quality of life was quantified with the SF-36 questionnaire preoperatively and after 3 months. Secondary endpoint was the recurrence rate at 24-month follow-up. RESULTS: The DC and S&T group were comparable in age, gender, ASA score, BMI, indication, hernia, and mesh variables. The DC group had a significant shorter operating time compared with the S&T group (74 vs 96 min; p = 0.014) and a significant lower mean VAS score 4 h post-operatively (in rest; p = 0.028/coughing; p = 0.013). At 3 months, there were significant more patients in the S&T group with VAS score ≥1.0 cm (31.4 vs 8.3 %; p = 0.036). Clinical follow-up at 24 months was obtained in 63 patients (82.9 %). The recurrence rate at 24 months was 7.9 % overall (5/63). There were more recurrences in the S&T group (4/36) than in the DC group (1/27), but this difference was not significant (11.1 vs 3.7 %; p = 0.381). CONCLUSION: We found that double-crown fixation of intra-peritoneal mesh during laparoscopic ventral hernia repair was quicker, was less painful immediately post-operative and after 3 months, and did not increase the recurrence rate at 24 months. In hernias at a distance from the bony borders of the abdomen, transfascial sutures can be omitted if a double crown of tackers is placed.

Concepts: Clinical trial, Surgery, Hernia, Clinical research, Abdomen, Hernias, Herniorrhaphy, Human abdomen


INTRODUCTION: The aim of this study was to demonstrate the safety and the efficacy of the self-gripping Parietex ProGrip™ mesh (Sofradim Production, Trévoux, France) used with the laparoscopic approach for inguinal hernia repair. The incidence of chronic pain, post-operative complications, patient satisfaction and hernia recurrence at follow-up after 12 months was evaluated. METHODS: Data were collected retrospectively from patient files and were analyzed for 169 male and female patients with 220 primary inguinal hernias. All patients included had undergone surgical repair for inguinal hernia by the laparoscopic transabdominal preperitoneal approach using Parietex ProGrip™ meshes performed in the same clinical center in Germany. Pre-, per- and post-operative data were collected, and a follow-up after 12 months was performed prospectively. Complications, pain scored on a 0-10 numeric rating scale (NRS), patient satisfaction and hernia recurrence were assessed. RESULTS: The only complications were minor and were post-operative: hematoma/seroma (3 cases), secondary hemorrhage through the trocar’s site (2 cases), hematuria, emphysema in the inguinal regions (both sides) and swelling above the genital organs (1 case for each). At mean follow-up at 22.8 months, there were only 3 reports of hernia recurrence: 1.4 % of the hernias. Most patients (95.9 %) were satisfied or very satisfied with their hernia repair with only 1.2 % reporting severe pain (NRS score 7-10) and 3.6 % reported mild pain. CONCLUSION: This study demonstrates that in experienced hands, inguinal hernia repair surgery performed by laparoscopic transabdominal preperitoneal hernioplasty using Parietex ProGrip™ self-gripping meshes is rapid, efficient and safe with low pain and low hernia recurrence rate.

Concepts: Hospital, Surgery, Inguinal hernia, Pain, Hernia, Laparoscopic surgery, Hernias, Herniorrhaphy


There is a lack of consensus about the surgical management of umbilical hernias. The aim of this study is to analyze the medium-term results of 934 umbilical hernia repairs. In this study, 934 patients with an umbilical hernia underwent surgery between 2004 and 2010, 599 (64.1%) of which were evaluated at least one year after the surgery. Complications, recurrence, and the reoperation rate were analyzed. Complications were observed in 5.7 per cent of the patients. With a mean follow-up time of 35.5 months, recurrence and reoperation rates were 3.8 per cent and 4.7 per cent, respectively. A higher percentage of female patients (60.9 % vs 29 %, P = 0.001) and a longer follow-up time (47.4 vs 35 months, P = 0.037) were observed in patients who developed a recurrence. No significant differences were observed between complications and the reoperation rate in patients who underwent Ventralex(®) preperitoneal mesh reinforcement and suture repair; however, a trend toward a higher recurrence rate was observed in patients with suture repair (6.5 % vs 3.2 %, P = 0.082). Suture repair had lower recurrence and reoperation rates in patients with umbilical hernias less than 1 cm. Suture repair is an appropriate procedure for small umbilical hernias; however, for larger umbilical hernias, mesh reinforcement should be considered.

Concepts: Time, Surgery, Hernia, Hernias, Herniorrhaphy, Navel, Pediatric surgery, Umbilical hernia


The identification of retropubic vasculature is not easy under the pressure of insufflated gas during totally extraperitoneal (TEP) inguinal hernioplasty. We aimed to present the usefulness of a maneuver that allows the clear identification of retropubic vasculature.

Concepts: Hernia, Herniorrhaphy


The aim of this study was to compare the efficacy of different methods of sutureless fixation of lightweight meshes made of different polymers for repair of experimental hernias. Two lateral hernia defects were modeled in male rats and covered with polyester and polypropylene prostheses. The meshes were fixed with Histacryl glue (group 1), or self-gripping meshes were used (group 2), or the meshes were implanted without fixation (group 3). On day 5 after surgery, mesh position and efficiency of fixation were evaluated. It was found that fixation is necessary for all light surgical meshes. Polyester meshes demonstrated better adhesive properties than polypropylene meshes. The most pronounced differences in the adhesive properties were found for self-gripping prosthesis, while in the groups with glue fixation, the differences were less pronounced.

Concepts: Surgery, Hernia, Touring car racing, Amputation, Hernias, Herniorrhaphy, Adhesive, Pediatric surgery