Use of sugammadex in prevention of post-operative urinary retention in minimally invasive hernia surgery.

PURPOSE: Post-operative urinary retention (POUR) is a known complication of hernia surgery. Minimally invasive inguinal hernia repair (IHR) is typically done under general anesthesia with neuromuscular blockade (NMB), which is commonly reversed with an anticholinesterase inhibitor paired with an anticholinergic agent. Sugammadex is a unique NMB reversal agent that does not have to be paired with an anticholinergic. We sought to explore the role of sugammadex in reducing the rate of POUR following these procedures. METHODS: Data were collected retrospectively at a single institution between February 2016 and October 2019. We identified and studied patients who underwent minimally invasive IHR and received either sugammadex or neostigmine/glycopyrrolate for NMB reversal. The primary endpoint was POUR requiring bladder catheterization. Secondary endpoints included post-operative and 30-day readmissions. RESULTS: 274 patients were included in this study (143 received neostigmine and glycopyrrolate, 131 sugammadex). The sugammadex patients were on average 5 years older than the neostigmine/ glycopyrrolate patients (63.2 vs 58.2, p = 0.003), and received less median intravenous fluids (IVF) (900 ml vs 1000 ml; p = 0.015). There was a significant difference in the rate of POUR between the sugammadex and neostigmine/glycopyrrolate patients (0.0% vs 8.4%, p ≤ 0.001). The difference remained significant after controlling for age and IVF. The odds of POUR for those who received neostigmine/glycopyrrolate were 25 × higher than the odds of those who received sugammadex. CONCLUSION: The results of this study reflect the protective role of sugammadex against POUR in minimally invasive IHR cases.

Congenital lumbar herniae: a systematic review.

PURPOSE: Congenital lumbar hernia is defined as the protrusion of intraperitoneal or extraperitoneal viscera through a defect of the posterior abdominal wall, present at birth. The aim of our study was to perform a systematic review of this rare pathology, with emphasis on surgical decision-making. METHODS: The English literature (2000-2020) was reviewed, using PubMed, EMBASE and GoogleScholar databases, combining the terms "hernia", "lumbar", "flank", "Grynfeltt", "Petit" and "congenital". Overall, 35 studies were included, describing 85 patients. RESULTS: Mean age was 9.7 ± 20.7 months (range 1 day-10 years). 55.7% were males and 44.3% were females. All patients presented electively, with flank bulging as the main symptom. Superior lumbar triangle (Grynfeltt) herniae accounted for 41.8%, inferior lumbar triangle (Petit) herniae for 32.8%, whereas 25.4% were classified as diffuse. A left-sided hernia was observed in 47%, a right-sided in 42.4%, while 10.6% were bilateral. 71.8% of the patients had associated anatomical anomalies, mainly the lumbocostovertebral syndrome. Most patients (83.3%) were treated surgically, while 16.7% conservatively with surveillance. In 93.3%, the surgical approach was open, with laparoscopy employed in 6.7% of cases. The majority (71.7%) underwent primary suture repair of the hernia defect, whereas a mesh was required in 28.3%. Post-operative morbidity was 6.7% and recurrence rate was 3.3% at a mean follow-up of 26.4 months. CONCLUSION: Congenital lumbar hernia is a rare pathology in the paediatric population, with only 85 cases reported since 2000. Although the diagnosis is frequently straightforward, it should raise the suspicion for associated congenital anomalies and further investigation is required, with cross-sectional imaging. Surgical repair is usually performed during the first year, to allow for symmetrical torso development.