RESUMO
We encountered a rare case of appendiceal carcinoma associated with Amyand's hernia, which was difficult to diagnose preoperatively. A 74-year-old man presented to our hospital with right lower abdominal pain. A hard mass was palpable in the right lower abdomen, and blood tests showed a slightly elevated inflammatory response. Computed tomography revealed a 7 × 5 cm mass with indistinct borders and heterogeneous internal density extending from the cecum to the right lower abdominal wall. We diagnosed appendiceal abscess, however, percutaneous biopsy which was performed for differential diagnosis with appendiceal carcinoma showed no malignancy. Thereafter, the patient was followed up. Two months later, a blood test showed insignificant changes in the inflammatory response and a high serum carcinoembryonic antigen level (48.6 ng/mL). An ultrasound showed a mass contiguous to the appendix, extending to the abdominal wall, with abundant blood flow signals. Fluorodeoxyglucose-positron emission tomography showed a high accumulation of fluorodeoxyglucose in the mass. Four months after the initial visit, the patient had an open ileocecal resection combined with an abdominal wall resection based on the preoperative diagnosis of appendiceal carcinoma invading the abdominal wall. During laparotomy, an enlarged appendix tip extended from the internal inguinal ring outside the inferior epigastric artery to the abdominal wall. Histopathological examination of the appendiceal tumor revealed well-differentiated adenocarcinoma, T4b (abdominal wall), N0, Ly0, and V0. When a right lower abdominal mass extends from the cecum to the abdominal wall, appendiceal tumors associated with Amyand's hernia should be considered.
Assuntos
Adenocarcinoma , Neoplasias do Apêndice , Hérnia Inguinal , Humanos , Masculino , Idoso , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/cirurgia , Neoplasias do Apêndice/complicações , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Although laparoscopic inguinal hernia repair (LIHR) has advantages over open surgery, postoperative seroma formation remains an issue. This study aimed to investigate the risk factors and clinical outcomes of seroma formation in patients undergoing LIHR. METHODS: From January 2016 to March 2023, clinical data of patients who underwent LIHR were retrospectively analyzed. Patients who developed seroma and those who did not were classified into the seroma and non-seroma groups, respectively. The demographic and clinical characteristics were compared between the two groups. Univariate and multivariate logistic regression analyses were performed for variables of interest. The receiver operating characteristic curve was used to evaluate the risk factors of the binary logistic model, and the cutoff value for each risk factor was obtained. RESULTS: Data of 128 patients were evaluated. Compared with patients in the non-seroma group, those in the seroma group had a higher body mass index (BMI) (P < 0.001), more direct hernias (P < 0.001), larger hernial orifice size (P < 0.001), more laparoscopic total extraperitoneal hernioplasty (TEP) (P < 0.001), more frequent reduction of hernial sac (P = 0.011), and lower preoperative serum albumin level (PSAL) (P < 0.001). Multivariate logistic regression analyses performed on these variables showed that high BMI (P = 0.005), large hernial orifice (P = 0.001), TEP (P = 0.033), and low PSAL (P = 0.009) were risk factors for seroma formation. Compared with the non-seroma group, the seroma group exhibited a higher numerical rating scale score for postoperative pain (P < 0.001), and longer hospital stays (P = 0.032). CONCLUSIONS: BMI (> 24.5 kg/m2), hernial orifice size (> 2.5 cm), TEP, and PSAL (< 32.5 g/L) were independent risk factors of postoperative seroma formation in patients who underwent LIHR. Although most seromas resolve spontaneously without surgical intervention, seroma formation results in increased patient pain and prolonged hospital stay.
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Hérnia Inguinal , Herniorrafia , Laparoscopia , Complicações Pós-Operatórias , Seroma , Humanos , Seroma/etiologia , Seroma/epidemiologia , Seroma/diagnóstico , Estudos Retrospectivos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Hérnia Inguinal/cirurgia , Feminino , Fatores de Risco , Pessoa de Meia-Idade , Herniorrafia/métodos , Herniorrafia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , AdultoRESUMO
This review is devoted to laparoscopic preperitoneal and open Lichtenstein unguinal hernia repair. Considering the PubMed, Google, the Springer Link online library and the Cochrane Systematic Review databases, we analyzed the reviews, prospective and retrospective studies devoted to comparison of these most common methods of treating inguinal hernias. Indications and contraindications for endoscopic hernia repair, features of laparoscopic surgeries, causes of conversion to open interventions, early and long-term results of laparoscopic and open operations were estimated.
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Hérnia Inguinal , Herniorrafia , Laparoscopia , Hérnia Inguinal/cirurgia , Humanos , Laparoscopia/métodos , Herniorrafia/métodos , Herniorrafia/efeitos adversos , Telas Cirúrgicas , Resultado do TratamentoRESUMO
INTRODUCTION: There is a lack of consensus on the management of inguinal hernia with limited symptoms. To address this issue a systematic review of existing randomized clinical trials (RCTs) was performed to critically appraise all existing data on asymptomatic hernia management, focusing on generalizability. METHODS: A scoping review to identify all RCTs comparing surgical and conservative management of patients with inguinal hernias was undertaken. Medline, Embase, Cochrane and ClinicalTrials.gov databases were searched. Data collected included study characteristics and definitions of population, intervention/comparator, and outcomes; and limitations of each study were also extracted. The quality and generalizability of included RCTs were evaluated using Cochrane's ROB-2 and the PRECIS-2 tool, respectively. RESULTS: Searches returned 661 papers; 14 full-text papers were assessed and three RCTs were identified. All RCTs included only male patients with a mean age above 55 years. All RCTs included asymptomatic patients and two included those with minimal symptoms. Different definitions for 'minimally symptomatic' were used in RCTs and none provided details of what was meant by conservative treatment. Follow-up periods varied between studies (1, 2, 3 years). All RCTs had an overall high risk of bias. According to PRECIS-2, two RCTs were classified as pragmatic, and one was equally pragmatic and explanatory. DISCUSSION: This systematic review highlights a high risk of bias but a good generalizability of the findings from the RCTs conducted on minimally symptomatic inguinal hernia patients. To improve the guidelines for the management of this group of patients, more generalizable data are needed.
Assuntos
Tratamento Conservador , Hérnia Inguinal , Ensaios Clínicos Controlados Aleatórios como Assunto , Hérnia Inguinal/cirurgia , Humanos , Tratamento Conservador/métodos , Herniorrafia/métodos , Herniorrafia/efeitos adversos , MasculinoRESUMO
BACKGROUND: Finding an ovary and/or fallopian tube within an indirect inguinal hernia is a rare occurrence that can be detected incidentally during elective surgery or present as a medical emergency requiring immediate intervention. Hence, it poses a difficult clinical picture in a reproductive-age woman with groin mass. CLINICAL PRESENTATION: We describe the case of a 45-year-old Ethiopian woman of Amhara ethnicity who presented with a left inguinal swelling that persisted for 5 years. Physical examination revealed an irreducible, non-tender lump in the left groin and an ultrasonography scan confirmed the presence of an indirect inguinal hernia. The patient was then scheduled for elective hernia repair. During the surgery, both her left ovary and fallopian tube were found within the hernial sac. The contents were released from the sac, high ligation performed, and the inguinal floor repaired with mesh. DISCUSSION: Inguinal hernias in women are rare and often present a diagnostic challenge. Although the exact pathogenesis of inguinal hernias containing female genital organs is unknown, some risk factors have been postulated. Diagnosis should start with a physical exam and imaging, but many of the cases have been intraoperative surprises. Management is primarily surgical, ranging from simple reduction and hernia repair to salpingo-oophorectomy depending on the status of the hernia contents. CONCLUSION: This report emphasizes the importance of maintaining a high index of suspicion when examining females with inguinal hernias to ensure accurate diagnosis and management of tubo-ovarian hernias. Although rare, inguinal hernias containing female genital organs should be considered in the differential diagnosis of inguinal hernias, as early detection and appropriate surgical management can prevent potential complications.
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Tubas Uterinas , Hérnia Inguinal , Herniorrafia , Ovário , Humanos , Feminino , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Pessoa de Meia-Idade , Tubas Uterinas/patologia , Tubas Uterinas/cirurgia , Tubas Uterinas/diagnóstico por imagem , Ovário/diagnóstico por imagem , Ovário/patologia , Ovário/cirurgia , UltrassonografiaRESUMO
Inguinal bladder hernia is a rare clinical condition, and only a small number of reported cases have been treated by laparoscopic surgery. We report a case of a patient aged 65-year-old who presented to our outpatient care unit for a right inguinal swelling. Computer tomography (CT) imaging showed a direct inguinal hernia with bladder and epiploic content. We performed a laparoscopic transabdominal preperitoneal repair, which involved carefully reducing the bladder's protrusion from the hernial orifice. Subsequently, a mesh prosthesis was employed to treat the right inguinal hernia. This case represents an unusual instance of a successful laparoscopic repair for a right direct inguinal bladder hernia.
Assuntos
Hérnia Inguinal , Herniorrafia , Laparoscopia , Telas Cirúrgicas , Tomografia Computadorizada por Raios X , Humanos , Hérnia Inguinal/cirurgia , Laparoscopia/métodos , Idoso , Masculino , Herniorrafia/métodos , Doenças da Bexiga Urinária/cirurgiaRESUMO
Inguinal hernias are the most common type of enterocele and are frequently caused by defects in the abdominal wall muscles in the groin area. Numerous animal models and human studies have shown that the gut microbiota is associated with skeletal muscle aging and loss. However, the causation between the gut microbiota and inguinal hernia remains unclear. To reveal the causal association between the gut microbiota and inguinal hernia, we conducted a two-sample double-sided Mendelian randomization analysis. We used genome-wide association analysis (GWAS) summary statistics of the gut microbiota from the MiBioGen consortium and GWAS statistics of inguinal hernia from the FinnGen R10 database. The causation between the gut microbiota and inguinal hernia was explored through the inverse variance weighted (IVW) method, MR Egger regression method, weighted median method, weighted model method, and simple model method. Sensitivity analysis was used to test whether the Mendelian randomization analysis results were reliable. Reverse Mendelian randomization was used to conduct effect analysis and sensitivity analysis using the entire gut microbiota as the outcome. The IVW results indicated that Verrucomicrobia, Lactobacilliales, Clostridiaceae1, Butyricococcus, Categorybacter, Hungatella, Odoribacter, and Olsenella had a direct negative causation with the gut microbiota. The reverse Mendelian Randomization results showed that Eubacterium brachygroup, Eubacterium eligensgroup, Eubacterium xylanophilumgroup, Coprococcus3, Ruminococcus1, and Senegalimassilia were directly related to inguinal hernia. The bilateral sensitivity analysis revealed no heterogeneity or horizontal pleiotropy. The results confirmed that 8 bacterial traits had a negative causation with inguinal hernia. Reverse MR analysis revealed a positive correlation between inguinal hernia and 6 bacterial traits. Modulating the diversity and components of the gut microbiota is envisaged to contribute to improving the incidence and prognosis of inguinal hernia.
Assuntos
Microbioma Gastrointestinal , Estudo de Associação Genômica Ampla , Hérnia Inguinal , Análise da Randomização Mendeliana , Microbioma Gastrointestinal/genética , Humanos , Hérnia Inguinal/genética , Polimorfismo de Nucleotídeo ÚnicoRESUMO
Bilateral femoral hernia is extremely rare in children. The diagnosis is challenging, and it often requires multiple surgeries before the correct treatment can be provided. In this case report, a five-year-old boy had two surgeries on suspicion of a right-sided inguinal hernia, but no hernia was found. After the second operation, the suspicion of a hernia was still present. This led to a diagnostic laparoscopy, where a bilateral femoral hernia was found. Laparoscopic McVay procedure was performed on both sides with minor modifications, which consisted of hernia sac plication and fixation to fortify the abdominal wall.
Assuntos
Hérnia Femoral , Laparoscopia , Humanos , Masculino , Hérnia Femoral/cirurgia , Hérnia Femoral/diagnóstico , Hérnia Femoral/diagnóstico por imagem , Pré-Escolar , Herniorrafia , Hérnia Inguinal/cirurgia , Hérnia Inguinal/diagnósticoRESUMO
BACKGROUND: Formation of seroma/hematoma is one of the most common postoperative complications following laparoscopic inguinal hernia repair. This study aimed to identify risk factors associated with seroma/hematoma and construct a prediction model. METHODS: Elderly subjects undergoing laparoscopic Transabdominal preperitoneal Patch Plasty (TAPP) were included in this study. The observation endpoint was set as the occurrence of seroma/hematoma within 3 months after TAPP surgery. Independent risk factors were identified through preliminary univariate screening and binary logistic regression analysis. These risk factors were then used to construct a nomogram predictive model using R software. RESULTS: A total of 330 patients were included in the analysis, of which 51 developed seroma/hematoma, resulting in an incidence rate of 15.5%. Obesity (OR: 3.54, 95%CI: 1.45-8.66, P = 0.006), antithrombotic drug use (OR: 2.73, 95%CI: 1.06-7.03, P = 0.037), C-reactive protein (CRP) ≥ 8 (OR: 2.72, 95%CI: 1.04-7.10, P = 0.041, albumin/fibrinogen ratio (AFR) < 7.85 (OR: 2.99, 95%CI: 1.28-7.00, P = 0.012), and lymphocyte/monocyte ratio (LMR) < 4.05 (OR: 12.62, 95%CI: 5.69-28.01, P < 0.001) were five independent risk factors for seroma/hematoma. The nomogram model has well predictive value for seroma/hematoma, with an AUC of 0.879. CONCLUSIONS: The nomogram model based on obesity, antithrombotic drug, CRP, AFR, and LMR has a proved good predictive value and it has potential in clinical practice.
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Hematoma , Nomogramas , Complicações Pós-Operatórias , Seroma , Humanos , Seroma/etiologia , Masculino , Feminino , Idoso , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Hematoma/etiologia , Hérnia Inguinal/cirurgia , Laparoscopia/efeitos adversos , Herniorrafia/efeitos adversos , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismo , Obesidade/complicações , Fibrinolíticos/uso terapêuticoAssuntos
Hérnia Inguinal , Herniorrafia , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Humanos , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Herniorrafia/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Laparoscopia/instrumentação , Laparoscopia/métodosRESUMO
BACKGROUND: Inguinal hernia repair is a common surgical procedure with significant variability in hospitalization costs. Traditional cost analysis methods often overlook the distribution of costs across patient demographics and clinical factors. This study employs a quantile regression model to explore the determinants of hospitalization costs for adult inguinal hernia surgery, providing a detailed understanding of cost variations across different quantiles. METHODS: We analyzed data from adult patients who underwent inguinal hernia surgery at Beijing Chaoyang Hospital from January 2015 to June 2023. The study included patient demographics, hernia-related information, surgery-related details, and cost-related data. A quantile regression model was used to assess the impact of various factors on hospitalization costs at different quantiles (10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%). Data were processed using StataSE 15.0 software. RESULTS: Our study included 16,602 patients, predominantly male (91.86%) and Han Chinese (96.48%), with the 51-64 years age group being the largest (26.80%). The quantile regression analysis revealed significant cost variations across different quantiles. Younger patients incurred higher costs, with age coefficients ranging from -40.541 at the 90th quantile to -3.082 at the 10th quantile. Uninsured patients faced higher costs, with coefficients from 214.747 at the 80th quantile to 501.78 at the 10th quantile. Longer hospital stays correlated with increased costs, with coefficients from 342.15 at the 80th quantile to 405.613 at the 90th quantile. Patients hospitalized multiple times (≥3) had lower costs, with coefficients from -767.353 at the 40th quantile to -311.575 at the 80th quantile. Comorbidities significantly raised costs, with coefficients for three or more comorbidities ranging from 806.122 at the 80th quantile to 1,456.02 at the 40th quantile. Laparoscopic surgery was more expensive than open surgery, with coefficients from 1,834.206 at the 80th quantile to 2,805.281 at the 10th quantile. Bilateral surgeries and the use of biological mesh also resulted in higher costs, with coefficients for bilateral surgeries ranging from 1,067.708 at the 10th quantile to 2,871.126 at the 90th quantile and for biological mesh from 3,221.216 at the 40th quantile to 6,117.598 at the 90th quantile. CONCLUSIONS: Hospitalization costs for inguinal hernia surgery are influenced by multiple factors, with significant variations across different patient groups. Strategies to control costs should be tailored to address the specific needs of patients, optimize surgical methods, and improve perioperative care. Future research should extend these findings across different healthcare settings and consider the latest advancements in medical technology and policy changes.
Assuntos
Hérnia Inguinal , Herniorrafia , Custos Hospitalares , Hospitalização , Humanos , Hérnia Inguinal/cirurgia , Hérnia Inguinal/economia , Masculino , Pessoa de Meia-Idade , Feminino , Adulto , Herniorrafia/economia , Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Idoso , Análise de Regressão , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/economia , Adulto Jovem , Estudos RetrospectivosRESUMO
OBJECTIVE: Barros et al. demonstrated a 3D printed model that exhibits anatomical representativeness, low cost, and scalability. The model was created based on subtraction data obtained from computed tomography scans. Images were modeled and reconstructed in 3D to display the male inguinal region, typically viewed using a laparoscopic approach. To evaluate the functionality and quality of the anatomical representation of the hernia 3D training model. METHODS: A model was created based on subtraction data derived from computed tomography scans of the pelvic bones and lumbar spine using the Blender 3.2.2 software program. Images were modeled and reconstructed in 3D to display the male inguinal region, typically viewed using a laparoscopic approach. Polylactic acid plastic was used to print the model. Some structures were made using ethylene vinyl acetate to enable possible material replacement and model reutilization. Thirty surgeons with various training levels were invited to use the model. Transabdominal inguinal hernioplasty was performed by simulating the same steps as those of a laparoscopic surgery, and the surgeons answered a questionnaire regarding the simulation. RESULTS: Twenty-eight surgeons responded, seven of whom were experts in the treatment of abdominal wall hernias. The model was deemed easy to use, realistic, and anatomically precise, establishing it as a valuable supplement to minimally invasive surgery training. CONCLUSION: The evaluation of this 3D model was favorable, as it accurately depicted the inguinal region anatomically, while also proving to be cost-effective for training purposes. The model could be a good option, particularly beneficial for training surgeons at the beginning of their careers.
Assuntos
Hérnia Inguinal , Herniorrafia , Modelos Anatômicos , Treinamento por Simulação , Humanos , Masculino , Hérnia Inguinal/cirurgia , Herniorrafia/educação , Laparoscopia , Impressão Tridimensional , Treinamento por Simulação/métodos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Testicular ischemia requires timely diagnosis and definitive management to avoid serious consequences such as orchiectomy. It is almost always caused by testicular torsion; however, there are other causes to be aware of. CASE REPORT: A 32-year-old man developed testicular ischemia following a laparoscopic robotic-assisted inguinal hernia repair with preperitoneal mesh. The ischemia progressed to a fully infarcted testicle with no evidence of torsion on subsequent surgical exploration. He ultimately did require an orchiectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: While extremely rare, testicular ischemia or infarct must be considered in patients presenting with testicular pain shortly after inguinal hernia repair. Emergent surgical evaluation and loosening of the hernia mesh may be required to salvage the testicle.
Assuntos
Hérnia Inguinal , Infarto , Laparoscopia , Testículo , Humanos , Masculino , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Adulto , Testículo/irrigação sanguínea , Infarto/etiologia , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Herniorrafia/métodos , Orquiectomia/métodos , Telas Cirúrgicas/efeitos adversosRESUMO
BACKGROUND: The repair of inguinal hernias is a common surgical procedure. Some patients will need a second operation after developing a metachronous contralateral inguinal hernia (MCIH). The suggestion has been made to strengthen the contralateral side at the same time as primary unilateral surgery. In this systematic review we aim to determine how many adult patients with a unilateral inguinal hernia will develop a MCIH. METHODS: This review was reported in line with PRISMA guidelines. We performed a literature review in PubMed Publisher, Embase, Google Scholar and Cochrane Library until May 2021, including articles reporting MCIH after unilateral inguinal hernia repair in adults. As outcome measure, the number of patients diagnosed with a MCIH was registered. RESULTS: A total of 19 articles with a total of 277,288 patients were included. The combined estimate for MCIH after meta-analysis equaled 8.3% (95% CI 7.1%-9.5%), with a high index of heterogeneity (I2 = 97.9%). A random-effects meta-regression was performed to obtain the percentage of MCIH as a function of median follow-up time. The percentage of MCIH at 3, 5 and 10 years was estimated at 5.2%, 8.0% and 17.1%, respectively. CONCLUSION: We suggest that there is insufficient clinical evidence to support prophylactic contralateral repair in all patients. We propose a patient-specific approach in the decision to perform prophylactic repair, taking into account potential risk factors for hernia development, type of surgical approach, and general risk factors for chronic postoperative inguinal pain. More long-term prospective data are needed to guide the decision for prophylactic contralateral mesh placement.
Assuntos
Hérnia Inguinal , Herniorrafia , Humanos , Seguimentos , Hérnia Inguinal/epidemiologia , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Incidência , Reoperação/estatística & dados numéricosRESUMO
INTRODUCTION: There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice. METHODS: MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p values inferior to 0.10 and I2 > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing). RESULTS: Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24 h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I2 = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I2 = 84%). The use of tacks was associated with shorter operative time (MD-25.80 [min]; 95% - 34.31- - 17.28; P < 0.00001; I2 = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates. CONCLUSION: In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24 h and one week.
Assuntos
Hérnia Inguinal , Herniorrafia , Ensaios Clínicos Controlados Aleatórios como Assunto , Técnicas de Sutura , Humanos , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Telas Cirúrgicas , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversosRESUMO
OBJECTIVE: To assess the effectiveness of a modified Lichtenstein Repair combined with Herniorrhaphy in reducing postoperative chronic pain and enhancing recovery and quality of life in inguinal hernia patients. METHODS: This retrospective study, conducted at the Taleghani training center between January 2021 and February 2023, retrospectively examined 289 hernia surgeries, of which 130 employed a modified Lichtenstein technique. The investigation encompassed a detailed analysis of patient demographics, employed surgical techniques, operative methods with a focus on minimal dissection, and an evaluation of postoperative outcomes. RESULTS: In this study of 289 participants, primarily males aged 60-80 years, the modified technique group demonstrated a notably lower incidence of hernia recurrence (1.5%) compared to the Lichtenstein group (3.1%). Additionally, the modified technique was more effective in reducing postoperative pain, with a significantly lower mean Visual Analogue Scale (VAS) score of 0.15, compared to 0.31 in the Lichtenstein group. This suggests enhanced patient comfort and a potentially quicker recovery in the modified technique group. CONCLUSION: The modified Lichtenstein hernioplasty technique, characterized by minimal tissue trauma and precise mesh placement, emerges as an effective approach in inguinal hernia repair. It offers significant benefits in reducing postoperative discomfort and chronic pain, thereby enhancing patient recovery and overall quality of life. This method aligns with current surgical trends towards patient-centric and minimally invasive procedures.
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Dor Crônica , Hérnia Inguinal , Herniorrafia , Dor Pós-Operatória , Qualidade de Vida , Telas Cirúrgicas , Humanos , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Herniorrafia/métodos , Hérnia Inguinal/cirurgia , Feminino , Dor Crônica/etiologia , Dor Crônica/epidemiologia , Dor Crônica/prevenção & controle , Idoso de 80 Anos ou mais , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/epidemiologia , Adulto , Resultado do Tratamento , Recidiva , Medição da DorRESUMO
Inguinal hernias are commonly encountered and are primarily managed by surgeons; however, it is unusual for retroperitoneal structures, such as the ureter, to herniate into it. More importantly, hernias containing ureters are not usually identified preoperatively unless specific imaging was ordered prior, as they are generally asymptomatic. This poses a risk to the patient as unidentified structures can be mistakenly injured during the surgery. We describe a case of a man in his 60s, who presented with a large left-sided indirect inguinoscrotal hernia. Intraoperatively, a large amount of irreducible retroperitoneal fat was encountered in addition to a cord-like structure, which was discovered to be the left ureter after reviewing imaging intraoperatively. Initially, the hernia repair was done robotically, but it was converted to open repair due to its irreducibility and the potential risk imposed on the ureter. Additionally, we discuss the aetiology and common presentations of this kind of hernia.
Assuntos
Hérnia Inguinal , Herniorrafia , Ureter , Humanos , Hérnia Inguinal/diagnóstico por imagem , Hérnia Inguinal/cirurgia , Hérnia Inguinal/diagnóstico , Masculino , Pessoa de Meia-Idade , Ureter/diagnóstico por imagem , Ureter/patologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Inguinal hernia repair is a frequently performed surgical procedure, with laparoscopic repair emerging as the preferred approach due to its lower complication rate and faster recovery compared to open repair. Mesh-based tension-free repair is the gold standard for both methods. In recent years, robotic hernia repair has been introduced as an alternative to laparoscopic repair, offering advantages such as decreased postoperative pain and improved ergonomics. This study aims to compare the short- and long-term outcomes, including the surgical stress response, postoperative complications, quality of life, and sexual function, between robotic-assisted transabdominal preperitoneal (rTAPP) and laparoscopic TAPP inguinal hernia repairs. METHODS: This randomized controlled trial will involve 150 patients from the Surgical Department of the University Hospital of Southern Denmark, randomized to undergo either rTAPP or laparoscopic TAPP. Surgical stress will be quantified by measuring C-reactive protein (CRP) and cytokine levels. Secondary outcomes include complication rates, quality of life, sexual function, and operative times. Data analysis will adhere to the intention-to-treat principle and will be conducted once all patient data are collected, with outcomes assessed at various postoperative intervals. DISCUSSION: This study holds significance in evaluating the potential advantages of robotic-assisted surgery in the context of inguinal hernia repairs. It is hypothesized that rTAPP will result in a lower surgical stress response and potentially lower the risk of postoperative complications compared to conventional laparoscopic TAPP. The implications of this research could influence future surgical practices and guidelines, with a focus on patient recovery and healthcare costs. The findings of this study will contribute to the ongoing discourse surrounding the utilization of robotic systems in surgery, potentially advocating for their broader implementation if the benefits are substantiated. TRIAL REGISTRATION: ClinicalTrials.gov NCT05839587. Retrospectively registered on 28 February 2023.