Laparoscopic assisted trans-scrotal orchiopexy versus traditional orchiopexy for inguinal cryptorchidism: a retrospective study based on 154 patients.

BACKGROUND: The purpose of this study was to investigate the clinical effect of laparoscopic assisted trans-scrotal orchiopexy versus traditional orchiopexy for inguinal cryptorchidism. METHODS: A retrospective analysis of cryptorchidism patients who were admitted to our hospital from July 2018 to July 2021. The patients were divided into the laparoscopic assisted trans-scrotal surgery group (n = 76) and the traditional surgery group (n = 78) according to the surgical method. RESULTS: All patients were successfully operated. There was no significant difference in operation time between the laparoscopic assisted trans-scrotal group and the traditional group (P>0.05). Although there was no significant difference in the postoperative hospital stay between the two groups, the time of postoperative hospital stay of the laparoscopic assisted trans-scrotal surgery group was lower than that in the traditional surgery group (P = 0.062). Additionally, there was no significant difference in discharge rate on the first day after surgery between the two groups, but the discharge rate on the first day after surgery was more than 90% in both groups. In terms of postoperative complications, there were no cases of testicular retraction, testicular atrophy, inguinal hernia, or hydrocele that occurred in both groups. There was no significant difference in the incidence of scrotal hematoma between the two groups(P>0.05). Although there was no significant difference in the incidence of poor wound healing between the two groups(P>0.05), the incidence in the laparoscopic assisted trans-scrotal surgery group was lower than that in the traditional surgery group (2.6% vs. 6.4%). CONCLUSION: Laparoscopic assisted trans-scrotal surgery is as safe and effective method as traditional surgery for patients with inguinal cryptorchidism, and could also provide a good appearance.

Final results of the PräVAC trial: prevention of wound complications following inguinal lymph node dissection in patients with penile cancer using epidermal vacuum-assisted wound closure.

PURPOSE: Inguinal lymphadenectomy in penile cancer is associated with a high rate of wound complications. The aim of this trial was to prospectively analyze the effect of an epidermal vacuum wound dressing on lymphorrhea, complications and reintervention in patients with inguinal lymphadenectomy for penile cancer. PATIENTS AND METHODS: Prospective, multicenter, randomized, investigator-initiated study in two German university hospitals (2013-2017). Thirty-one patients with penile cancer and indication for bilateral inguinal lymph node dissection were included and randomized to conventional wound care on one side (CONV) versus epidermal vacuum wound dressing (VAC) on the other side. RESULTS: A smaller cumulative drainage fluid volume until day 14 (CDF) compared to contralateral side was observed in 15 patients (CONV) vs. 16 patients (VAC), with a median CDF 230 ml (CONV) vs. 415 ml (VAC) and a median maximum daily fluid volume (MDFV) of 80 ml (CONV) vs. 110 ml (VAC). Median time of indwelling drainage: 7 days (CONV) vs. 8 days (VAC). All grade surgery-related complications were seen in 74% patients (CONV) vs. 74% patients (VAC); grade 3 complications in 3 patients (CONV) vs. 6 patients (VAC). Prolonged hospital stay occurred in 32% patients (CONV) vs. 48% patients (VAC); median hospital stay was 11.5 days. Reintervention due to complications occurred in 45% patients (CONV) vs. 42% patients (VAC). CONCLUSIONS: In this prospective, randomized trial we could not observe a significant difference between epidermal vacuum treatment and conventional wound care.

Using e-health in perioperative care: a survey study investigating shortcomings in current perioperative care and possible future solutions.

BACKGROUND: An e-health care program has previously shown to have a positive effect on return to work, quality of life and pain in patients who underwent gynaecological surgery. Plausibly, providing the care program to a population undergoing other types of surgery will be beneficial as well. The objectives of this study are to evaluate patients' opinions, needs and preferences regarding the information and guidance supplied to patients during the perioperative period, to investigate whether e-health may be of assistance and to explore if gender specific needs exist. METHODS: A questionnaire was sent to all patients between 18 and 75 years (n = 362), who underwent various forms of abdominal surgery between August 2013 to September 2014 in a university hospital in the Netherlands. The questionnaire contained questions about the current situation in perioperative care and questions about patients' preferences in an e-health care program. Gender differences were evaluated. RESULTS: Two hundred seven participants (57.2%) completed the survey. The majority of the participants were relatively satisfied with the perioperative care they received (68.6%). Most reported shortcomings in perioperative care concerning the supply of information regarding the resumption of activities and guidance during the recovery course. An e-health care program was expected to be of added value in perioperative care by 78% of the participants; a website was reported as most useful. In particular practical functions on a website focusing on the preparation to surgery and monitoring after surgery were appraised to be highly valuable. Overall, women had slightly more needs for extra information and support during the perioperative course than men. CONCLUSIONS: In abdominal surgery, there is a need for an e-health care program, which should focus mainly on the supply of information about the resumption of activities as well as guidance in the postoperative course.

Improved perioperative analgesia with ultrasound-guided ilioinguinal/iliohypogastric nerve or transversus abdominis plane block for open inguinal surgery: a systematic review and meta-analysis of randomized controlled trials.

[Purpose] Ultrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve and transversus abdominis plane (TAP) blocks have been increasingly utilized in patients for perioperative analgesia. We conducted this meta-analysis to evaluate the clinical efficacy of ultrasound-guided II/IH nerve or TAP blocks for perioperative analgesia in patients undergoing open inguinal surgery. [Subjects and Methods] A systematic search was conducted of 7 databases from the inception to March 5, 2015. Randomized controlled trials (RCTs) comparing the clinical efficacy of ultrasound-guided vs. landmark-based techniques to perform II/IH nerve and TAP blocks in patients with open inguinal surgery were included. We constructed random effects models to pool the standardized mean difference (SMD) for continuous outcomes and the odds ratio (OR) for dichotomized outcomes. [Results] Ultrasound-guided II/IH nerve or TAP blocks were associated with a reduced use of intraoperative additional analgesia and a significant reduction of pain scores during day-stay. The use of rescue drugs was also significantly lower in the ultrasound-guided group. [Conclusion] The use of ultrasound-guidance to perform an II/IH nerve or a TAP block was associated with improved perioperative analgesia in patients following open inguinal surgery compared to landmark-based methods.

Agony of Choice: Caudal Block versus Ilioinguinal/Iliohypogastric Nerve Block in Unilateral Orchidopexy.

Objective: This prospective study aimed to compare the efficacy of caudal block (CB) and ilioinguinal/iliohypogastric nerve block (IINB) for providing additional analgesia during unilateral orchidopexy. Methods: Seventy-one boys aged <48 months, classified as ASA I/II, were assigned into CB (n = 37) and IINB (n = 34) groups. Outcome measures included intra- and postoperative analgesic requirements, pain scores, and administration duration. Additional intraoperative analgesia was administered for a 10% increase in heart rate, while postoperative pain was assessed using the Children's and Infants Postoperative Pain Scale (CHIPPS), with scores >4 prompting supplementary analgesia. Monitoring was extended for 24 h post-surgery. Results: CB significantly reduced the need for intraoperative (p < 0.001) and early postoperative (p = 0.008) analgesia compared to IINB. However, the CB group exhibited a slightly higher but non-significant analgesic requirement on the ward. No clinically relevant side effects were observed in either group. Conclusions: Both CB and IINB are effective and safe methods for providing regional analgesia during orchidopexy. CB demonstrates superior efficacy intraoperatively and in the early postoperative period, while IINB may offer advantages in the later recovery phase. However, additional analgesia is often required for orchidopexy, especially in outpatient settings.

Surgical Technique and Chronic Postoperative Inguinal Pain in Patients Undergoing Open Inguinal Hernioplasty in Portugal: A Prospective Multicentric Cohort Study.

INTRODUCTION: Evidence about the advantage of Lichtenstein's repair, the guidelines' recommended technique, is scarce regarding postoperative chronic inguinal pain (CPIP). The primary aim of this study was to compare CPIP in patients undergoing Lichtenstein versus other techniques. METHODS: Prospective multicentric cohort study including consecutive adults undergoing elective inguinal hernia repair in Portuguese hospitals (October - December 2019). Laparoscopic and mesh-free hernia repairs were excluded. The primary outcome was postoperative pain at three months, defined as a score of ≥ 3/10 in the European Hernia Society Quality of Life score pain domain. The secondary outcome was 30-day postoperative complications. RESULTS: Eight hundred and sixty-nine patients from 33 hospitals were included. Most were men (90.4%) and had unilateral hernias (88.6%). Overall, 53.6% (466/869) underwent Lichtenstein's repair, and 46.4% (403/869) were treated with other techniques, of which 83.9% (338/403) were plug and patch. The overall rate of CPIP was 16.6% and 12.2% of patients had surgical complications. The unadjusted risk was similar for CPIP (OR 0.76, p = 0.166, CI 0.51 - 1.12) and postoperative complications (OR 1.06, p = 0.801, CI 0.69 - 1.60) between Lichtenstein and other techniques. After adjustment, the risk was also similar for CPIP (OR 0.83, p = 0.455, CI 0.51 - 1.34) and postoperative complications (OR 1.14, p = 0.584, CI 0.71 - 1.84). CONCLUSION: The Lichtenstein technique was not associated with lower CPIP and showed comparable surgical complications. Further investigation as- sessing long term outcomes is necessary to fully assess the benefits of the Lichtenstein technique regarding CPIP.

Laparoscopic Management of Inguinal Hernia: A Systematic Review and Updated Network Meta-Analysis of Randomized Controlled Trials.

Various surgical approaches for inguinal hernia repair have been outlined in medical literature. In most cases, these lesions are repaired by general surgeons. A variety of surgical techniques for the treatment of inguinal hernias have been documented in the medical literature. In 2018, the European Hernia Society (EHS) recommended laparo-endoscopic repair as a preferred approach for adults. This method involves a combination of laparoscopic and endoscopic techniques for hernia repair. The goal of this systematic review is to conduct a thorough examination of the total extraperitoneal vs. transabdominal preperitoneal comparison in inguinal hernia repair, with an emphasis on randomized controlled trials (RCTs). It also intends to conduct a trial sequential analysis (TSA) in order to determine whether more trials and investigations are required or whether there is sufficient evidence to draw a firm conclusion. The study's systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used the PubMed and Google Scholar databases to conduct a thorough web search for articles published between January 2019 and December 2023. The meta-analysis was carried out using Resource Manager Revman version 5.4.1 (Revman International, Inc., New York City, New York). After a review of the studies was done, ten studies were selected to be used in conducting the systematic review and meta-analysis. The recurrence rate of TEP treatment was found to be slightly lower than transabdominal preperitoneal (TAPP). The two techniques did not differ in terms of postoperative complications; however, TEP had a marginally lower rate of postoperative pain. Further, the study revealed that there was a decreased risk of wound infections, seromas, and hematomas with total extraperitoneal (TEP) as opposed to transabdominal preperitoneal (TAPP). TEP also reduced the amount of recovery time needed. After conducting successful hernia treatments, total extraperitoneal and transabdominal preperitoneal both had low rates of complications and recurrence. Based on the information obtained from the study analysis, this meta-analysis provides evidence for the efficacy of TAPP and TEP techniques in the management of inguinal hernias. Though there was a statistically significant difference while applying both methods in the treatment of hernia (p=0.001), TEPs have been shown to have a lower recurrence rate than TAPPs. Similarly, the TEP method has been revealed to have a slight reduction in postoperative pain compared to transabdominal preperitoneal. However, the two techniques have been shown to have no significant difference in postoperative complications. Further, laparoscopic procedures have proved to be a little bit safer and more effective than open procedures. This has been shown by reduced risk of wound infection, hematoma, seroma, and decreased sensibility while using this method. It accelerated the healing process as well. Thus, depending on the needs of the patients and the experience level of the surgeons responsible for the treatments, inguinal hernias can be repaired using either transabdominal preperitoneal or total extraperitoneal techniques since both treatment techniques have generally minimal chance of complications or recurrence as both have proved to safer method.

Transversus Abdominis Plane Block in the Treatment of Chronic Postsurgical Abdominal Wall Pain Improves Patient Quality of Life: A Retrospective Study and Literature Review.

BACKGROUND: Although poorly studied, chronic postsurgical neuropathic pain (CPNP) represents the second most frequent chronic neuropathic pain etiology, probably affecting 0.5% to 75% of patients with a severe impact on quality of life (QoL). No consensus or treatment algorithm has been elaborated to date, despite a large variety of approaches now available. Transversus abdominis plane (TAP) block has been endorsed as an efficient treatment for acute postoperative pain although its effect on CPNP in terms of intensity and QoL has yet to be considered. OBJECTIVES: The main aim of this study was to evaluate the efficacy of TAP blocks in terms of QoL on patients suffering from abdominal CPNP, including a socio-economic analysis. Results were compared with those published in the recent literature. STUDY DESIGN: Retrospective, monocentric, observational clinical study. SETTING: This single-center retrospective study was conducted at the Chronic Pain Center, Department of Anesthesia, Robert Debré University Hospital, Reims, France. METHODS: From January 2018 through April 2021, all patients suffering from abdominal CPNP treated with a TAP block were enrolled. QoL was assessed using the SF-12 survey. Socio-economic and demographic data were also collected. A literature review was performed using appropriate Medical Subject Headings (MeSH) terms. RESULTS: A TAP block was administered to 44 consecutive patients suffering from CPNP. After a mean follow-up of 11.8 weeks, 86.7% of the patients reported significant effectiveness of the treatment, including an improvement in QoL (P < 0.001), pain scale ratings (P < 0.001) and analgesic requirement (P < 0.001). In term of socio-economic results, one-fifth of the patients returned to work after treatment. The literature review yielded 60 research studies, only 2 of which met our inclusion criteria. These retrospective studies indicated a 76.5% and 81.9% efficacy rate after 12 and 15.5 weeks, respectively. LIMITATIONS: This was a retrospective study with a small sample size. Further investigation should include medical and economic parameters as well as a comparison of TAP block with second-line drug therapies such as transcutaneous neurostimulation, and capsaicin and lidocaine patches. Other anesthetic molecules such as onobotulinumtoxin A (botulinum toxin) combined with steroids should be assessed for these patients. CONCLUSION: The TAP block is easy to learn, easy to reproduce, and easy to administer. After pooling our results with those from the literature, a TAP block is deemed to be effective for the treatment of CPNP with 82.25% effectiveness over a mean time of 13.9 weeks. A TAP block improves long-term QoL, reduces consumption of painkillers and lowers pain scale scores. Thus, it may reduce health care costs. We argue that A TAP block should be considered early, from the onset of the first pain symptoms.

Influence of inguinal hernia repair on sperm autoimmunity: The largest single center experience.

BACKGROUND: Studies on immunological infertility after inguinal hernia correction are few and not very representative. Anti-sperm antibodies have been shown to reduce male fertility. Although the extent of infertility due to anti-sperm antibodies alone is not very clear, data indicates that about 8%-10% of infertile patients have immunological infertility DESIGN: This retrospective study includes all infertile male patients (n = 2258) who underwent mixed antiglobulin reaction tests and urologic examination from 2000 to 2020. Sperm quality (assessed by the number of spermatozoa, their motility, vitality, and normal form) was also evaluated. Among these patients, 191 had previously undergone unilateral or bilateral inguinal hernia surgery repair. The aim of the study is to evaluate if there is a higher incidence of positive mixed antiglobulin reaction test among patients undergoing inguinal hernioplasty compared to the unselected infertile population. RESULTS: Anti-sperm antibodies would seem to increase in both patients who performed general andrological surgery and groin hernia correction, respectively 3.48 (95% Confidence Interval: 1.70-7.10; p < 0.001) and 2.45 (95% Confidence Interval: 1.01-5.99; p < 0.05) times more than the unselected infertile population. CONCLUSIONS: Mixed antiglobulin reaction test could be useful in patients undergone previous scrotal surgery or hernia correction men, to avoid false unexplained infertility diagnoses and to direct the couple to assisted reproductive technology procedures. Basal evaluation of spermatozoa does not actually consider andrological surgery as an indication to autoimmunity investigation.

Difficulties in Diagnosing Extraperitoneal Ureteroinguinal Hernias: A Review of the Literature and Clinical Experience of a Rare Encounter in Acute Surgical Care Settings.

Although inguinal hernia repair is one of the most common surgical procedures, finding a retroperitoneal structure, such as the ureter, is a rather rare occurrence. Ureteroinguinal hernias may arise in the presence or absence of obstructive uropathy, the latter raising difficulties in diagnosis for the general surgeon performing a regular inguinal hernia surgery. This study aims to collect the relevant literature describing the diagnosis and management of ureteroinguinal hernias and update it with a case encountered in our clinic. The following study was reported following the SCARE guidelines. The relevant literature describes less than 150 cases of ureteroinguinal hernias overall, considering the 1.7% prevalence of inguinal hernias in the general population. With only 20% of these hernias being described as extraperitoneal, such an encounter becomes an extremely rare finding. Our clinical experience brings a case of a 75-year-old male with frequent urinary tract infections and a large irreducible inguinoscrotal hernia of about 20/12 cm located at the right scrotum. The patient underwent an open inguinal hernia repair technique under general anesthesia, incidentally finding an extraperitoneal ureteral herniation. Segmental ureterectomy was performed with uneventful recovery. Intraoperatively, finding an incidental ureteroinguinal hernia raises concerns about probable urinary tract complications during regular hernia repair surgery and whether the diagnosis is likely to happen prior to surgical intervention. Although imaging is rarely indicated in inguinal hernias, the case reports show that a pelvic CT scan with urography in symptomatic patients with urinary symptoms will provide accurate confirmation of the diagnosis. The relevant literature is limited due to the rarity of respective cases, thus making standardized management of such cases unlikely.

Characterization of cerebral cortical endocannabinoid levels in a rat inguinal surgery model using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

BACKGROUND: The brain endocannabinoid system is believed to play significant roles in anti-nociception, fear response, anxiety, and stress. This study investigated the effects of rat inguinal surgery on the levels of endocannabinoids in the cerebral cortex. AIM: The aim of this study was to investigate the effects of acute post-surgical pain on the levels of endocannabinoids in the cerebral cortex. METHODS: Quantitation of endocannabinoids in the rat cerebral cortex was performed by liquid chromatography-tandem mass spectrometry. RESULTS: There was no significant difference in the cerebral cortical levels of anandamide (AEA) and 2-arachidonoylglycerol (2-AG) between the sham and surgery experimental groups. However, there were lateralized differences in the levels of these endocannabinoids between the right and left cerebral cortices irrespective of the two groups. The concentrations of AEA and 2-AG were significantly higher in the right cerebral cortex compared to the contralateral cerebral cortex. CONCLUSION: Acute post-surgical pain did not induce significant alterations in the cerebral cortical levels of endocannabinoids in this study, but the phenomenon of lateralization of the cerebral cortical AEA and 2-AG levels was observed; this latter finding may be related to the role played by endocannabinoids in fear conditioning.

Bilateral persistent sinus tracts formation post bilateral microsurgical inguinal varicocelectomy: A case report.

Varicocele is a common case encountered in urology practice accounting for 15-20% of the general population. We are reporting a rare case of infected inguinal wounds post bilateral microsurgical varicocelectomy which led to persistent bilateral wound sinus formation. After multiple bedside wound debridement and sinus tract excision in operation theater, the patient's wounds were healed. We advise managing post-operative subcutaneous collections very closely to avoid such complications. When it happens and wound debridement is planned, we advise not to leave any dead space behind via using fat flaps.

Female reproductive structures found in inguinal hernia sacs: A retrospective review.

BACKGROUND: In female infants undergoing herniorrhaphy, there is a reported incidence of 15%-20% of prolapsed adnexal structures. Our primary aim is to confirm the incidence of adnexal tissue in hernia sacs at the time of repair and to further delineate the clinical characteristics of this population at a major pediatric institution. METHODS: Retrospective chart review of all cases of herniorrhaphy in female patients less than the age of 18 from June 2009 to December 2015 in a large tertiary referral children's hospital. RESULTS: The overall incidence of patients with gynecological findings during herniorrhaphy was 11.2%. For patients with positive findings, the average gestational age at birth was 34.07 weeks, the age at surgery was 0.99 years, and the rate of right-sided hernias was 43.2%. For patients with negative findings, the average gestational age at birth was 38.23 weeks, the age at surgery was 5.14 years, and the rate of right-sided hernias was 23.2%. CONCLUSIONS: Incidence of adnexal structures found in hernia sacs is comparable to previously reported figures. These patients had a significantly lower gestational age at birth, lower age at surgery, and lower rate of right-sided hernias from the general population and from those without gynecological findings during herniorrhaphy. LEVEL OF EVIDENCE: Level II.

Ultrasound-Guided Erector Spinae versus Ilioinguinal/Iliohypogastric Block for Postoperative Analgesia in Children Undergoing Inguinal Surgeries.

CONTEXT: Erector spinae plane (ESP) block is a promising technique in the field of pediatric postoperative analgesia considering its safety and simplicity. OBJECTIVE: The objective of the study is to compare the efficacy of ultrasound (US)-guided ilioinguinal/iliohypogastric nerve (IIN) block and ESP block for postoperative analgesia after pediatric unilateral inguinal hernia repair. PATIENTS AND METHODS: Sixty patients randomized into two equal groups. ESP group received US-guided ESP block, and IIN group received US-guided IIN block. Block in both groups was done with 0.5 mL/kg 0.125 bupivacaine + fentanyl 1 µg/mL injectate. Primary outcome is to compare both groups regarding time to first analgesic request. Secondary outcomes include evaluation of postoperative FLACC score, number of patients requiring rescue analgesic, number of rescue analgesic doses, parental satisfaction, incidence of postoperative vomiting, and motor weakness. RESULTS: IIN group showed a significantly higher FLACC score at 4 and 6 h, significantly higher number of rescue medication doses and number of patients needed rescue analgesia. The ESP group carries a significantly higher parental satisfaction and a significantly longer time to first rescue analgesic compared to IIN group. CONCLUSION: The findings suggest that US guided ESP block resulted in a more effective and longer duration of postoperative analgesia following a pediatric unilateral inguinal hernia repair compared to IIN block.

[Chronic Pain After Outpatient Inguinal Hernioplasty: Retrospective Cohort Study]. / Dor Crónica Pós-Hernioplastia Inguinal em Regime de Ambulatório: Estudo de Coorte Retrospetivo.

INTRODUCTION: Chronic postoperative pain is the most frequent late complication of inguinal hernia repair surgery. The aim of this study is to evaluate the incidence of chronic post-hernioplasty pain in outpatient care at Centro Hospitalar do Porto, describe it, analyse its relation with other variables defined in the literature and study its functional interference. MATERIAL AND METHODS: We performed a retrospective cohort study between February and May 2016, using a structured telephone interview composed of questions from the authors and sections of published questionnaires, two of which are validated for the Portuguese language and culture. We included men who underwent ambulatory inguinal hernioplasty, by laparotomy or laparoscopy, at Centro Hospitalar do Porto, between January 2011 and October 2015. RESULTS: In a final sample of 829 surgeries, the incidence of chronic post-hernioplasty pain was 24.0% [confidence interval: 21.2 - 27.1]. The development of chronic post-hernioplasty pain was higher in patients with pre-surgical pain and younger age and was related with the presence of pain during the first month after surgery. No relationship was found between surgical technique and the development of chronic post-hernioplasty pain. Of the individuals with chronic pain, 65.0% mentioned moderate-severe 'pain on the average' and 37.7% presented descriptors suggestive of neuropathic pain. The only parameter evaluated with which chronic post-hernioplasty pain 'did not interfere completely' was sleep. DISCUSSION: The prevalence found for chronic posthernioplasty pain with significant functional interference is in line with data retrieved from literature. The predictive potential of pre-surgical pain and young age for the development of chronic posthernioplasty pain is also in agreement with previous studies. Limitations were found to this study given its retrospective nature. CONCLUSION: The high prevalence of chronic post-hernioplasty pain raises the urgent need for raising awareness regarding this issue among health care professionals. The main areas for improvement are diagnosis, follow-up and treatment of pain.

Introdução: A dor crónica pós-cirúrgica é a complicação tardia mais frequente da cirurgia de reparação de hérnia inguinal. Este trabalho visa determinar a incidência de dor crónica pós-hernioplastia inguinal em ambulatório no Centro Hospitalar do Porto, estudar a sua relação com determinadas variáveis descritas na literatura, avaliar as suas características e interferência funcional.Material e Métodos: Realizámos um estudo de coorte retrospetivo, entre fevereiro e maio de 2016, por entrevista telefónica estruturada composta por perguntas dos autores e secções de três questionários publicados, dois dos quais validados para a língua e cultura portuguesas. Incluímos os homens submetidos a hernioplastia inguinal, por laparotomia ou laparoscopia, em ambulatório, no Centro Hospitalar do Porto, entre janeiro de 2011 e outubro de 2015.Resultados: Na amostra final de 829 hernioplastias, a incidência de dor crónica pós-hernioplastia foi de 24,0% [intervalo de confiança: 21,2 - 27,1]. O desenvolvimento de dor crónica foi superior nos doentes com dor pré-cirúrgica, nos doentes mais jovens e relacionou-se com o momento de início da dor pós-cirúrgica. Não encontrámos relação com a via de abordagem, clássica ou laparoscópica. Dos indivíduos com dor crónica, 65,0% apresentaram dor 'em média' moderada ou forte e 37,7% apresentavam descritores sugestivos de dor de origem neuropática. A dor crónica pós-hernioplastia do ponto de vista funcional apenas 'não interferiu completamente' com o sono.Discussão: A prevalência encontrada de dor crónica pós-hernioplastia, com interferência funcional importante, é congruente com os dados disponíveis na literatura. O potencial preditor da presença de dor pré-cirúrgica e idade jovem do doente para o desenvolvimento de dor crónica pós-hernioplastia é também corroborado pela literatura. Tratando-se de um estudo de coorte retrospetivo, o estudo apresenta as limitações inerentes.Conclusão: A elevada prevalência de dor crónica pós-hernioplastia encontrada apontam para a urgência na sensibilização dos profissionais de saúde para esta problemática e otimização do follow-up, diagnóstico e tratamento da dor.

Comparison of the effect of mesh-plug, Lichtenstein, transabdominal preperitoneal, and totally extraperitoneal hernia repair: A network meta-analysis

SUMMARY OBJECTIVE To compare Mesh-plug, Lichtenstein, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) repairs in regards to operation time, seroma, infection, and recurrence of inguinal hernia repair. METHODS Relevant literature was searched in the Cochrane Library, Pubmed, and Embase. Furthermore, the analysis of randomized controlled studies (RCTs) was performed using methods recommended by the Cochrane Collaboration. The main outcomes including operation time, seroma, infection, and recurrence were evaluated. RESULTS A total of 38 RCTs with 3255 patients were included in the meta-analysis. In addition, the comparison between Mesh-plug, Lichtenstein, TAPP, and TEP showed the differences were not significant regarding operation time, seroma, infection, and recurrence. CONCLUSIONS Meta-analysis suggests that Mesh-plug, Lichtenstein, TAPP, and TEP are comparable in the outcomes of hernia repair, such as operation time, seroma, infection, and recurrence.

RESUMO OBJETIVO Comparar as abordagens de tampão com tela (mesh plug), Lichtenstein, transabdominal preperitoneal (TAPP) e totalmente extraperitoneal (TEP) em relação ao tempo de operação, seroma, infecção e recorrência no reparo de hérnias inguinais. MÉTODOS Estudos relevantes na literatura foram pesquisados nos bancos de dados Cochrane, PubMed e Embase. Além disso, a análise dos estudos clínicos controlados randomizados (RCTs) foi feita utilizando métodos recomendados pela Cochrane Collaboration. Os principais resultados, incluindo tempo de operação, seroma, infecção e recorrência, foram avaliados. RESULTADOS Um total de 38 RCTs com 3.255 pacientes foram incluídos na meta-análise. Além disso, a comparação entre mesh plug, Lichtenstein, TAPP e TEP mostrou que não havia diferenças significativas nos aspectos de tempo de operação, seroma, infecção e recorrência. CONCLUSÕES A meta-análise sugere que mesh plug, Lichtenstein, TAPP e TEP oferecem resultados comparáveis no reparo das hérnia inguinais em relação a tempo de operação, seroma, infecção e recorrência.

Eficacia de la técnica Halsted II en pacientes geriátricos con hernia inguinal / Efficacy of the Halsted II technique in geriatric patients with inguinal hernia

RESUMEN Fundamento: el tratamiento ideal de la hernia inguinal en pacientes geriátricos siempre ha sido un reto. Objetivo: evaluar la eficacia de la técnica de Halsted II en pacientes geriátricos con hernia inguinal. Métodos: se realizó un estudio descriptivo transversal, con el objetivo de demostrar la eficacia de la técnica de Halsted II en pacientes geriátricos con hernia inguinal en el Servicio de Cirugía General del Hospital Militar Clínico Quirúrgico Docente Octavio de la Concepción y de la Pedraja, Camagüey desde julio de 2014 a julio 2017. El universo estuvo constituido por 84 adultos mayores con hernia inguinal y la muestra fue de 72 pacientes. Resultados: en el estudio predominaron los hombres caucásicos entre 60 y 74 años de edad, con hernia indirecta con aumento del anillo interno, además del tabaquismo y las enfermedades pulmonares obstructivas crónicas. La infección de la herida quirúrgica fue la complicación temprana más frecuente, sin ser significativo el número de rechazo al material de sutura no absorbible y recurrencia de la hernia. Conclusiones: la hernia inguinal en el adulto mayor, es más frecuente en los hombres blancos en edades comprendidas entre los 60 y 74 años. El tabaquismo y las enfermedades pulmonares obstructivas crónicas son factores de riesgo para padecer de hernia inguinal y a su vez son agentes asociados a la menor eficacia de la técnica. La herniorrafía de Halsted II es una técnica segura y eficiente en el adulto mayor, con escasa recurrencia y complicaciones postoperatorias.

ABSTRACT Background: the ideal treatment of inguinal hernia in geriatric patients remains a challenge. Objective: to evaluate the effectiveness of the Halsted II technique in geriatric patients with inguinal hernia. Methods: a cross-sectional descriptive study was carried out, with the objective of demonstrating the effectiveness of the Halsted II technique in geriatric patients with inguinal hernia in the General Surgery Service of the Teaching Surgical Clinical Military Hospital Octavio de la Concepción y La Pedraja, Camagüey, in the period from July 2014 to July 2017. The universe consisted of 84 older adults with inguinal hernia and the sample was 72 patients. Results: the study was dominated by Caucasian men between 60 and 74 years of age, with indirect hernia with increased internal ring, in addition to smoking and chronic obstructive pulmonary diseases. Infection of the surgical wound was the most frequent early complication, without being significant the number of rejection to the non-absorbable suture material and recurrence of the hernia. Conclusions: inguinal hernia in the elderly is more common in white men between the ages of 60 and 74. Smoking and chronic obstructive pulmonary diseases are risk factors for suffering from inguinal hernia and in turn are agents associated with the lower efficacy of the technique. Halsted II herniorrhaphy is a safe and efficient technique in the elderly, with low recurrence and postoperative complications.

TEP versus Lichtenstein, which one to choose? A retrospective cohort study

SUMMARY OBJECTIVES Inguinal hernioplasty techniques have been improved since the first hernioplasty. Tension-free techniques that apply synthetic mesh materials, as in the Lichtenstein approach, are the gold standard. Laparoscopic hernioplasty is the strongest alternative to Lichtenstein. The superiority of laparoscopic hernioplasty over Lichtenstein is a major topic of debate. In this study, we aimed to find a conclusion to this debate by comparing our totally extraperitoneal (TEP) experiences with Lichtenstein experiences. METHODS Patients who underwent inguinal hernioplasty at the Gulhane Training and Research Hospital from 2013 to 2018 were included in this retrospective cohort study. The sample included 96 TEP and 90 Lichtenstein patients for a total of 186 patients. The variables assessed were hospitalization duration, postoperative early visual analog scale score, chronic pain, paresthesia, recurrence, and early postoperative complications. Data were collected from patient records and via telephone questionnaire if needed. Data analysis was done by SPSS v20, using chi-square, Fisher's exact, and Mann-Whitney U tests. RESULTS Male/female ratios were similar between the TEP and Lichtenstein groups. There was no difference in mean age between groups (p=0.1). The hospital stay was shorter (p=0.0001), and early postoperative visual analog scale score was lower in the TEP group (p=0.003). Chronic pain, paresthesia, recurrence, and early postoperative complications (hematoma, seroma, wound infection) were similar. CONCLUSIONS TEP is superior to Lichtenstein with shorter hospitalization duration and lower rates of early postoperative pain. No difference between the two techniques was found for chronic pain. We believe that laparoscopic hernioplasty approach may be the best alternative technique for inguinal hernia repair.

RESUMO OBJETIVOS As técnicas de hernioplastia inguinal foram melhoradas desde a primeira hernioplastia. Técnicas livres de tensão que aplicam materiais de malha sintética, como na abordagem de Lichtenstein, são o padrão ouro. A hernioplastia laparoscópica é a alternativa mais forte ao Lichtenstein. A superioridade da hernioplastia laparoscópica sobre o Lichtenstein é um dos principais temas debatidos. Neste estudo, procuramos encontrar uma conclusão para esse debate comparando nossas experiências totalmente extraperitoneais (TEP) com as experiências de Lichtenstein. MÉTODOS Pacientes submetidos à hernioplastia inguinal no Gulhane Training and Research Hospital de 2013 a 2018 foram incluídos neste estudo de coorte retrospectivo. A amostra incluiu 96 pacientes TEP e 90 pacientes Lichtenstein para um total de 186 pacientes. As variáveis avaliadas foram tempo de internação, escore da escala analógica visual precoce no pós-operatório, dor crônica, parestesia, recidiva e complicações pós-operatórias precoces. Os dados foram coletados dos prontuários e do questionário por telefone, se necessário. A análise dos dados foi realizada pelo SPSS v20, utilizando os testes qui-quadrado, exato de Fisher e U de Mann-Whitney. RESULTADOS As razões homem/mulher foram semelhantes entre os grupos TEP e Lichtenstein. Não houve diferença na média de idade entre os grupos (p=0,1). A permanência hospitalar foi menor (p=0,1) e a escala visual analógica precoce foi menor no grupo TEP (p=0,003). Dor crônica, parestesia, recorrência e complicações pós-operatórias imediatas (hematoma, seroma, infecção da ferida) foram semelhantes. CONCLUSÕES O TEP é superior ao Lichtenstein, com menor tempo de internação e menores taxas de dor pós-operatória precoce. Nenhuma diferença entre as duas técnicas foi encontrada para dor crônica. Acreditamos que a abordagem de hernioplastia laparoscópica pode ser a melhor técnica alternativa para correção de hérnia inguinal.

The effect of acupuncture on relieving pain after inguinal surgeries.

BACKGROUND: Postoperative pain is one of the most prevalent and bothersome issues found in the surgical department. Nowadays, there are various methods of acupuncture used for relieving pain without the complications found in some routine postoperative analgesics. These methods could be especially useful for high risk patients prone to complications from analgesics, such as transplantation recipients. The aim of this study was to evaluate the efficacy of electro-acupuncture on postoperative pain control after inguinal surgeries. METHODS: Ninety male patients, who were referred to our department with indications of inguinal surgery, were included in the study and randomly divided into two groups, such as acupuncture and control. We used electro-acupuncture for the acupuncture group and no actual acupuncture (but placed needle electrodes similar to the acupuncture group) for the control group. Postoperative pain was quantified by a blind observer in both groups using a visual analogue scale (VAS) standard score before being compared. RESULTS: Pain intensity and analgesic use were significantly higher in the control group (P < 0.05). In the acupuncture group, the VAS pain scores were significantly lower than the control group at 0.5, 1 and 2 hours post operation. When the opioid related side effects were compared for each group, the results showed that the number of subjects who experienced dizziness in the acupuncture group was significantly lower than the control group (P < 0.05). CONCLUSIONS: Acupuncture in patients, after inguinal surgery, can reduce the need of analgesics, which also directly reduces the complications that may occur when analgesics are used in relieving pain postoperatively.

A Comparative Analysis of Single Umbilical Tangential Incision vs. Conventional Three-port Totally Extraperitoneal Inguinal Hernia Repair

PURPOSE: We have explored the question of what benefits SUTI-TEP can provide over conventional three-port TEP (C-TEP) surgery for the treatment of inguinal hernia. METHODS: One hundred forty cases (70 SUTI-TEP and 70 C-TEP) were reviewed in this study. SUTI-TEP procedure was carried out with SILS™ port as we reported before. Patient demographics and perioperative outcomes of SUTI-TEP were analyzed and compared with those of C-TEP. RESULTS: There was no conversion to open surgery or C-TEP in SUTI-TEP group. Median VAS immediate postoperatively was slightly higher in SUTI-TEP group, but it was statistically significant. POD 7th day pain after surgery were similar in both groups. Regarding the length of operation time, SUTI-TEP group (71.2 min) was significantly longer than that of the C-TEP group (41 min) (p<0.001). There was no major morbidity or mortality postoperatively in either group. There was also no recurrence or chronic pain during follow up. Patient overall satisfaction including cosmetic outcome was excellent in SUTI-TEP group. CONCLUSION: Although the longer operation time tends to be required, SUTI-TEP can provide better cosmesis and patient satisfaction, and also safety. That may be good indicator of the success of after surgery. Also we should not presume that one large incision causes less pain than small multiple incision because it is just single one. If there is more pain in one single wound, we should find the solution through the innovation of technology or preventive measures.