OBJECTIVE: Seroma formation is the most common cause of morbidity associated with laparoscopic inguinal hernia repair. This study aimed to examine the relationship between the thickness of subcutaneous fat (TSF) and the risk of postoperative seroma.
METHODS: We reviewed data from a prospective cohort of 229 male patients who underwent laparoscopic total extra-peritoneal (TEP) hernioplasty for indirect inguinal hernia between August 2018 and July 2021. The TSF was assessed using preoperative ultrasound images. The risk factors for postoperative seroma were determined using univariate and multivariate logistic regression models.
RESULTS: Postoperative seromas occurred in 26 patients (11.4%). The factors associated with postoperative seroma included longer hernia duration, larger hernia defects, extension into the scrotum, and greater TSF (P < 0.05). In multivariate analysis, a greater TSF was independently associated with a greater risk of postoperative seroma (per 1 mm: odd ratio [OR] 1.105, 95% confidence interval [CI] 1.048-1.165, P < 0.001; TSF ≥ 26.0 mm: OR 7.033, 95% CI 2.485-19.901, P < 0.001). Similar results were obtained in the subgroup analysis. The area under the curve of TSF for predicting seroma formation was 0.703 (95% CI 0.601-0.806).
CONCLUSIONS: Ultrasound-derived TSF may be a promising prognostic factor for postoperative seroma in patients undergoing laparoscopic TEP repair. Further validation is required and then this parameter can be used to improve decision-making process.

OBJECTIVE: Seroma represents the most prevalent postoperative complication following laparoscopic inguinal hernia repair, particularly in the case of large inguinoscrotal hernias. This randomized controlled trial was undertaken with the objective of assessing the effects of internal orifice narrowing achieved by suturing the divided distal hernia sac in laparoscopic repair of indirect inguinoscrotal hernias.
METHODS: A total of 58 patients aged 18 years or older, were randomized into two groups: Group I, which underwent internal orifice narrowing, and Group II, which served as the control without narrowing. The study\'s primary endpoint was the incidence and volume of seroma in the inguinal region on postoperative days 1 and 7, as well as at 1, 3, and 6 months following the procedure. Secondary outcomes encompassed metrics like total operative time, acute and chronic pain levels, duration of hospital stay, recurrence rates, and the occurrence of any additional complications.
RESULTS: In comparison to the control group, the experimental group exhibited a significantly lower incidence of seroma formation at 7 days (P = 0.001). Furthermore, the ultrasonic assessment indicated a reduced seroma volume in the operative group on postoperative day 7 (8.84 ± 17.71 vs. 52.39 ± 70.78 mL; P < 0.001). Acute pain levels and hospital stay were similar between the two groups (1.22 ± 0.76 vs. 1.04 ± 0.53, P = 0.073; 1.22 ± 0.07 vs. 1.19 ± 0.08, P = 0.627, respectively). Notably, neither chronic pain nor early recurrence, nor any other postoperative complications were observed in either group throughout the follow-up period, which extended for at least 6 months (range: 6-18 months).
CONCLUSIONS: In the context of laparoscopic inguinoscrotal hernia repair, the incidence and volume of seroma can be significantly reduced through the implementation of internal orifice narrowing achieved by suturing the divided distal hernia sac. And, this reduction in seroma formation was not associated elevation in postoperative pain levels or recurrence rates.

OBJECTIVE: To find the superiority of extended total extraperitoneal (E-TEP) repair and trans-abdominal pre-peritoneal (TAPP) mesh repair in inguinal hernia repair.
METHODS: A total of 30 patients with a unilateral or bilateral inguinal hernia (IH), and recurrent IH, following open repair were studied. Out of 30 patients, laparoscopic TAPP or E-TEP mesh repair was performed in an equal number of inguinal hernia patients. The patient\'s demographic parameters, duration of surgery, postoperative hospital stay, and complications were compared.
RESULTS:  In the E-TEP group, 33.33% of patients had left inguinal hernia (LIH), 60% of patients were diagnosed with right inguinal hernia (RIH) and 6.67% of patients had right inguinal and right direct hernia (RDH). In the TAPP group, 33.33% of patients had LIH and 53.33% of patients were suffering from RIH. Moreover, 6.67% of patients were diagnosed with a left inguinal direct hernia, and a similar proportion of patients had a right inguinal direct hernia. The mean duration of surgery was found to be significantly higher in the TAPP group (P<0.0000). The mean postoperative hospital stay was 2.07±0.59 and 2.80±1.32 days in E-TEP and TAPP groups, respectively (P=0.044).
CONCLUSIONS: In the present study, E-TEP mesh repair is a superior technique in the management of inguinal hernia as compared with TAPP repair.

OBJECTIVE: The best way to reduce seroma formation after laparoscopic indirect hernia repair is debated. We noticed that internal ring defect closure in laparoscopic mesh hernioplasty could provide promising outcomes with an effect on diminishing seroma formation. We introduce our closure technique and report our experience.
METHODS: This prospective study was conducted from May 2019 to May 2021. Patients with European Hernia Society classification L3 indirect or scrotal hernia were recruited and underwent laparoscopic transabdominal patch plasty (TAPP). Hernia defect closure was performed before mesh deployment. The primary outcomes were seroma formation, postoperative pain, and hernia recurrence. Perioperative data and postoperative complications were also recorded.
RESULTS: Consecutive 77 patients with 89 indirect hernias (including 51 scrotal hernias) were recruited in two regional tertiary hospitals. All operations were successful without open conversion. The mean size of the hernia defect was 3.7 ± 0.5 cm (range, 2.5-5.0 cm). The mean operative time for each hernia repair (peritoneum to peritoneum) was 48.3 ± 10.8 min (range, 33-72 min), and the mean time required for internal ring closure was 6.7 ± 2.2 min (range, 4-10 min). Intraoperative bleeding was minimal. The mean visual analog scale pain score at rest on the first postoperative day was 2.2 (range, 1-4). The average postoperative length of hospital stay was 18 h (range, 14-46 h). During a mean follow-up period of 9.4 months (range, 3-23 months), no hernia recurrence or chronic pain were noted. Seroma formation was detected on six sides of unilateral hernias (6.7%) on postoperative day 7, with a mean volume of 45.8 ml (range, 24-80 ml). All seromas were mild and resolved spontaneously within 3 months, with no need for evacuation or other treatment and without major impact on the final outcome.
CONCLUSIONS: Defect closure in laparoscopic mesh hernioplasty for large indirect hernias is safe and feasible and can significantly reduce postoperative seroma formation and relative complications. This approach is recommended in large indirect or scrotal hernia repair.

OBJECTIVE: To evaluate the results of using titanium thread mesh implants in the treatment of anterior abdominal wall hernias.
METHODS: This article evaluates the titanium thread mesh implant used by us in the treatment of 240 patients with anterior abdominal wall hernias; describes the features of this type of implants and the technical features of various types of operations using them.
RESULTS: The overall rate of postoperative complications was 2.9%. Hernia recurrence was observed in 2.4% of patients after laparoscopic transabdominal preperitoneal hernioplasty.
CONCLUSIONS: The use of a mesh implant made of titanium thread did not reveal any specific complications for this implant. At the stage of gaining experience with a mesh implant made of titanium thread, technical difficulties may occur when placing and fixing it, which increases the duration of surgery.
UNASSIGNED: Оценка результатов использования сетчатых имплантатов из титановой нити при лечении грыж передней брюшной стенки.
UNASSIGNED: Наблюдали 240 больных с грыжами передней брюшной стенки, которым было проведено лечение с применением сетчатого имплантата из титановой нити. Выявляли особенности применения имплантатов этого типа и технические особенности выполнения разных видов операций с их использованием.
UNASSIGNED: Общая частота послеоперационных осложнений составила 2,9%. Рецидив грыжи отмечали у 2,4% больных после лапароскопической трансабдоминальной предбрюшинной герниопластики.
UNASSIGNED: Использование сетчатого имплантата из титановой нити не выявило специфических осложнений. На этапе приобретения опыта работы с сетчатым имплантатом из титановой нити возможны технические сложности при его размещении и фиксации, что увеличивает продолжительность оперативного вмешательства.

UNASSIGNED: Posterior rectus canal assumed immense importance with newer laparoscopic technique of total extra-peritoneal pre-peritoneal (TEPP/TEP) hernioplasty for inguinal hernia. However, scientific study of live surgical anatomy of posterior rectus canal is almost totally lacking in the English literature, and hence the present study was conducted.
UNASSIGNED: 3-midline-port technique through posterior rectus sheath approach; Initial telescopic dissection under direct CO2 insufflation followed by instrument dissection.
UNASSIGNED: 68 TEPP hernioplasties were successful in 60 patients with mean age of 50.1 ± 17.2 years (range 18-80) and mean BMI of 22.6 ± 2.0 kg/m2 (range 19.5-31.2). Rectusial fascia was a definite anatomical entity, dividing traditional posterior rectus canal into two channels, namely, true retromuscular space and true posterior rectus canal (T-PRC). Rectusial fascia was variable, i.e., thick diaphanous (n= 47), thick membranous (n= 13), thin membranous (n= 3) and thin flimsy (n= 5). Posterior rectus sheath (PRS) was also variable, incomplete (n= 54) and complete (n= 14). Incomplete PRS showed seven variations in both extent and/or morphology. Complete PRS show five morphological variations. Transversalis fascia demonstrated three morphological variations, namely, single diaphanous (n= 41), single membranous (= 10) and thin flimsy (n= 3). TEPP hernioplasty was readily feasible through avascular true posterior rectus canal.
UNASSIGNED: Posterior rectus canal is divided by \'rectusial fascia\' into two channels, namely, true retromuscular space and true posterior rectus canal, latter being proper avascular plane of dissection for TEPP hernioplasty. Rectusial fascia, posterior rectus sheath and transversalis fascia showed morphological variations. Timely recognition of variable real-time anatomy is recommended to perform adequate proper surgical dissection for seamless TEPP hernioplasty with ease, rapidity and safety.

BACKGROUND: Technical factors leading to hernia recurrence after transabdominal preperitoneal repair include insufficient dissection, inadequate prosthetic overlap and prosthetic size, improper fixation and folding, or crinkling of the prosthesis. However, determining intraoperatively if a case will develop recurrent hernias due to these factors remains unclear.
METHODS: Five surgeons blind-reviewed operation videos of primary laparoscopic hernioplasty in 13 lesions that went on to develop recurrent hernias (i.e., future recurrence), as well as 28 control lesions, to assess twelve items of surgical techniques. Since we changed a surgical policy of covering myopectineal orifice (MPO) in April 2003, we analyzed the data for the earlier and later periods. The data was analyzed with hierarchical clustering to obtain a gross grouping. The differences of the ratings between the future recurrent and control lesions were then analyzed and the association of the techniques with the hernia recurrence rate, the size of the prosthesis, and the hernia type across hernia recurrence were explored.
RESULTS: The lesions were grouped based on the time series, and its boundary was approximated when we changed our surgical policy. This policy change caused ratings to progress from 34% satisfactory, to 79% satisfactory. The recurrence rate decreased to 0.7% (5/678), compared with 6.2% (10/161) before the policy was implemented (p < 0.001). With univariate analysis, the ratings of posterior prosthesis overlap to the MPO in the recurrent lesions were significantly lower than controls in the later period (p = 0.019). Although various types of recurrences were noted in the earlier period, only primary indirect and recurrent indirect hernias were observed in the later period (p = 0.006).
CONCLUSIONS: Fully covering the MPO with mesh is essential for preventing direct recurrence hernias. Additional hernia recurrence prevention can be obtained by giving appropriate attention to prosthesis overlap posterior to the MPO in a large indirect hernia.

Abdominal hernia is a common disease, and the most effective treatment of it is using surgical meshes. However, it was found that due to the mismatch of the mechanical properties between the mesh and the tissues around the hernia, there was still a recurrence rate of more than 33% and a high probability of postoperative discomfort. Currently, because of the complex mechanical environment provided by the abdominal tissues and the lack of quantitative research, it is still difficult to select a mesh with suitable mechanical properties for a hernia with specific position and size. Therefore, the purpose of this study is to use numerical models to evaluate the mechanical behavior of both abdominal wall and meshes after repair, and to determine the most suitable mechanical properties of meshes for specific hernias, including elastic modulus and tensile strength. To realize that purpose, defects with different locations and sizes were considered, including defects of 20 mm and 40 mm in diameter on linea alba (LA20 and LA40) and on rectus abdominis (RA20 and RA40), and laparoscopic repair was simulated. The mechanical properties of the most suitable mesh we determined are as follows: suitable modulus for LA20, LA40, RA20 and RA40 are 1 MPa, 3 MPa, 2 MPa and 4 MPa, respectively; suitable tensile strength for LA20, LA40, RA20 and RA40 are 0.35 MPa, 0.89 MPa, 0.77 MPa and 1.43 MPa, respectively. These data could give a standard of mechanical properties which can be referenced in mesh design and evaluation and provide surgeons with treatment advice for specific patients.

BACKGROUND: The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand\'s hernia. It is even rarer with complicated appendicitis. Formerly it was treated via an open groin approach; recently there are new trends involving the use of laparoscopy for reduction and management of appendix. Conversely the role of laparoscopy in the following hernia repair was less discussed, with no standard care. We reported a case of Amyand\'s hernia complicated with appendix which was managed via a total laparoscopic strategy.
METHODS: A 49-year-old male presented with right groin mass with progressive pain for 3 days. Physical exams revealed incarcerated right inguinal hernia. Amyand\'s hernia with acute appendicitis was diagnosed preoperatively via computed tomography (CT). Emergent diagnostic laparoscopy was performed. Appendix was reduced, with appendectomy justified for signs of appendicitis. An interval total extraperitoneal (TEP) hernioplasty was performed 3 month later, with no adverse events postoperatively.
CONCLUSIONS: In virtue of previous literature, we proposed a total laparoscopic strategy for Amyand\'s hernia which consists of transabdominal diagnostic laparoscopy, management of appendix, and either immediate or elective laparoscopic hernioplasty, based on status of appendix.
CONCLUSIONS: This laparoscopic treatment strategy is feasible for Amyand\'s hernia, with minimized risk of surgical site infection (SSI), fair recovery and cosmesis.

We analyzed the results of treatment of 80 patients of elderly and senile age with strangulated inguinal hernias, which were divided into two groups. From 2011 to 2014 were treated 58 patients (group 2) - in the treatment of this group used the traditional approach without the use of endovideosurgical technologies. From 2015 to 2016, it treated 22 patients (group 1) in the treatment of this group used individual diagnostic and treatment tactics with the use of diagnostic laparoscopy and laparoscopic hernioplasty. In the course of work were developed indications and contraindications to the use of prosthetic hernioplasty and endovideosurgical methods. The proposed algorithm allowed to reduce the level of complications from 27,6% (16) to 4,5% (1) (p<0,05) and local complications from 24,1% (14) to 4,6% (1) (p<0,05), as well as the fatality rate from 10,3% (6) to 0%.
Проанализированы результаты лечения 80 пациентов пожилого и старческого возраста с ущемленными паховыми грыжами, которые были разделены на две группы. С 2011 по 2014 г. были пролечены 58 пациентов (2-я группа), у которых был применен традиционный подход, без использования эндовидеохирургических технологий. С 2015 по 2016 г. пролечены 22 пациента (1-я группа), которым применяли индивидуальную лечебно-диагностическую тактику с активным использованием диагностической лапароскопии и лапароскопической герниопластики. В ходе работы были определены показания и противопоказания к использованию протезирующей герниопластики и эндовидеохирургических методик. Предложенный алгоритм позволил снизить уровень общих осложнений с 27,6% (16) до 4,5% (1) (p<0,05) и местных осложнений — с 24,1% (14) до 4,6% (1) (p<0,05), а также уровень летальности с 10,3% (6) до 0%.