Early assessment of bilateral inguinal hernia repair: A comparison between the laparoscopic total extraperitoneal and Stoppa approaches.

BACKGROUND: The present clinical trial was designed to compare the results of bilateral inguinal hernia repair between patients who underwent the conventional Stoppa technique and laparoscopic total extraperitoneal repair (LTE) with a single mesh and without staple fixation. PATIENTS AND METHODS: This controlled, randomised clinical trial was conducted at General Surgery and Trauma of the Clinics Hospital, Medical School, the University of São Paulo between September 2010 and February 2011. Totally, 50 male patients, with a bilateral inguinal hernia, older than 25 years were considered eligible for the study. The following parameters were analysed during the early post-operative period: (1) The intensity of surgical trauma, operation time, C-reactive protein (CRP) levels, white blood cell count, bleeding and pain intensity; (2) quality of life assessment; and (3) post-operative complications. RESULTS: LTE procedure was longer than the Stoppa procedure (134.6 min ± 38.3 vs. 90.6 min ± 41.3; P < 0.05). The levels of CRP were higher in the Stoppa group (P < 0.05) but the number of leucocytes, haematocrit, and haemoglobin were similar between the groups (P > 0.05). There was no difference in pain during the 1st and 7th post-operative, physical functioning, physical limitation, the impact of pain on daily activities, and the Carolinas Comfort Scale during the 7th and 15th post-operative (P > 0.05). Complications occurred in 88% of Stoppa group (22 patients) and 64% in LTE group (16 patients) (P < 0.05). CONCLUSION: The comparative study between the Stoppa and LTE approaches for the bilateral inguinal hernia repair demonstrated that: (1) The LTE approach showed less surgical trauma despite the longer operation time; (2) Quality of life during the early post-operative period were similar; and (3) Complication rates were higher in the Stoppa group.

Great saphenous vein aneurysm: A differential diagnosis of femoral hernia and review.

INTRODUCTION: Venous aneurysms are unusual clinical entities that might be difficult to diagnose and usually appear as an asymptomatic incidental finding on physical examination or imaging study and discovered only during the surgical exploration. They are important differential diagnosis of groin and other subcutaneous mass. PRESENTATION OF CASE: We report a case of a 67-years-old woman who had a groin mass misdiagnosed as femoral hernia, which was subsequently diagnose as great saphena vein aneurysm in the intraoperative set and treated with ligature and resection. DISCUSSION: In conclusion, venous aneurysms of the superficial system are lesions that are important differential diagnosis of groin and other subcutaneous mass. CONCLUSION: Diagnosis is readily available by duplex ultrasonography; however, in most cases, the diagnosis is done only in the operative field.

Elastin ( ELN ) gene point mutation in patients with inguinal hernia

Groin hernias emerge at the myopectineal orifice of Fruchaud which is closed off by the fascia transversalis. Our previous studies showed structural and quantitative changes of the fascia transversalis elastic fibers of inguinal hernia patients and elderly people. The present study used single-strand conformation polymorphism (SSCP) elastin (analysis to investigate the 34 exons of the ELN gene of 49 inguinal hernia patients (7 females, 42 males aged 58.7 ± 19.82 years) and 75 non-herniated controls (35 females, 40 males aged 46.2 ± 14.32 years). We found that 47 patients and 24 controls had an abnormal exon 20 pattern caused by a g28197A > G missense mutation leading to an S422G amino acid substitution in the elastin hydrophobic domain. The g28197A > G allele frequency was 0.71 ± 0.045 in hernia patients and 0.21 ± 0.030 in controls and 23 patients and 7 controls were g28197A > G homozygous and 24 patients and 17 controls were heterozygous. This point-mutation showed a statistically significant association with inguinal hernia, chi-squared being 46.89 (p < 0.001) and the odds ratio 49.93 (95 percent confidence interval of @11 to 223). These results indicate that the g28197A > G mutation is involved in the genesis of inguinal hernia (possibly due to abnormal elastic fiber production) and explains impaired fascia transversalis function.

Alterações moleculares do gene da elastina nos pacientes portadores de hérnia inguinal / Molecular alterations of elastin gene in inguinal hernia patients

O objetivo do presente estudo foi verificar a ocorrência de mutações do gene da elastina nos pacientes portadores de hérnia inguinal. Estudou-se o DNA genômico de 19 pacientes com hérnia inguinal e 16 controles. Os 34 exons do gene foram amplificados e foi realizada a análise conformacional de fita simples. Observou-se bandas anormais no exon 20. O seqüenciamento do exon 20 revelou uma dupla substituição de bases no códon 404 em 78 por cento e 50 por cento dos pacientes idosos e adultos com hérnia inguinal respectivamente e a substituição de uma base no códon 422 em todos os pacientes com hérnia inguinal, em todos os indivíduos controles idosos e em 37,5 por cento dos indivíduos controles adultos. É possível que estas mutações possam estar relacionadas à produção de moléculas de elastina alteradas e desempenhem papel na gênese da hérnia inguinal.The present study was designed to verify the presence of elastin gene mutations from genomic DNA in patients with inguinal hernia. Nineteen adult patients with diagnosed inguinal hernia and 16 controls were analyzed. All 34 exons were amplified and mutations were sought by single strand conformation polymorphism. DNA amplification revealed an abnormal band in exon 20. Sequencing showed a double base substitution in codon 404 in 78 per cent of the elderly hernia patients and in 50 per cent of the younger hernia group. It also revealed a single base substitution in codon 422 in all inguinal hernia patients, in all the elderly controls as well as in 37,5 per cent of the younger controls. It is possible that these elastin mutations may be responsible for the production of abnormal elastic fibers, thus playing a role in inguinal hernia genesis...