OBJECTIVE: The purpose of this study was to perform a meta-analysis comparing the short-term and long-term outcomes in laparoscopic groin hernia repair with or without preservation of the uterine round ligament (URL) in females.
METHODS: We searched several databases including PubMed, Web of Science, Cochrane Library, and and CNKI databases. This meta-analysis included randomized clinical trials, and retrospective comparative studies regarding preservation or division of the URL in laparoscopic groin hernia repair in females. Outcomes of interest were age, BMI, type of hernia, type of surgery, operating time, estimated blood loss, time of hospitalization, seroma, concomitant injury, mesh infection, recurrence, uterine prolapse, foreign body sensation, chronic pain, and pregnancy. Meta-analyses and trial sequential analysis were performed with Review Manager v5.3 and TSA software, respectively.
RESULTS: Of 192 potentially eligible articles, 9 studies with 1104 participants met the eligibility criteria and were included in the meta-analysis. There were no significant difference in age (MD-6.58, 95% CI - 13.41 to 0.24; P = 0.06), BMI (MD 0.05, 95%CI - 0.31 to 0.40; P = 0.81), blood loss (MD-0.04, 95% CI - 0.75 to 0.66; P = 0.90), time of hospitalization (MD-0.22, 95% CI-1.13 to 0.69; P = 0.64), seroma (OR 0.71, 95% CI 0.41 to 1.24; P = 0.23), concomitant injury (OR 0.32, 95% CI 0.01 to 8.24; P = 0.68), mesh infection (OR 0.13, 95% CI 0.01 to 2.61; P = 0.18), recurrence (OR 1.13, 95% CI 0.18 to 7.25; P = 0.90), uterine prolapse(OR 0.71, 95% CI 0.07 to 6.94; P = 0.77), foreign body sensation (OR 1.95, 95% CI 0.53 to 7.23; P = 0.32) and chronic pain(OR 1.03 95% CI 0.4 to 2.69; P = 0.95). However, this meta-analysis demonstrated a statistically significant difference in operating time (MD 6.62, 95% CI 2.20 to 11.04; P = 0.0003) between the preservation group and division group. Trial sequential analysis showed that the cumulative Z value of the operating time crossed the traditional boundary value and the TSA boundary value in the third study, and the cumulative sample size had reached the required information size (RIS), indicating that the current conclusion was stable.
CONCLUSIONS: In summary, laparoscopic groin hernia repair in women with the preservation of the round uterine ligament requires a longer operating time, but there was no advantage in short-term or long-term complications, and there was no clear evidence on whether it causes infertility and uterine prolapse.

Laparoscopic incisional hernia repair is increasingly performed worldwide and expected to be superior to conventional open repair regarding hospital stay and quality of life (QoL). The INCisional Hernia-Trial was designed to test this hypothesis.
A multicenter parallel randomized controlled open-label trial with a superiority design was conducted in six hospitals in the Netherlands. Patients with primary or recurrent incisional hernias were randomized by computer-guided block-randomization to undergo either conventional open or laparoscopic repair. Primary endpoint was postoperative length of hospital stay in days. Secondary endpoints included QoL, complications, and recurrences. Patients were followed up for at least 5 years.
Hundred-and-two patients were recruited and randomized. In total, 88 patients underwent surgery and were included in the intention-to-treat analysis (44 in the open group, 44 in the laparoscopic group). Mean age was 59.5 years, gender division was equal, and BMI was 28.8 kg/m. The trial was concluded early for futility after an unplanned interim analysis, which showed that the hypothesis needed to be rejected. There was no difference in primary outcome: length of hospital stay was 3 (range 1-36) days in the open group and 3 (range 1-12) days in the laparoscopic group (p = 0.481). There were no significant between-group differences in QoL questionnaires on the short and long term. Satisfaction was impaired in the open group. Overall recurrence rate was 19%, of which 16% in the open and 23% in the laparoscopic group (p = 0.25) at a mean follow-up of 6.6 years.
In a randomized controlled trial, short- and long-term outcomes after laparoscopic incisional hernia repair were not superior to open surgery. The persisting high recurrence rates, reduced QoL, and suboptimal satisfaction warrant the need for patient\'s expectation management in the preoperative process and individualized surgical management.
Netherlands Trial Register NTR2808.

Mesh fixation in inguinal hernia repair, has been a controversial subject for many years. Therefore, in this study, we evaluated and compared fixation and non-fixation of mesh in Transabdominal Preperitoneal (TAPP) Inguinal hernia repair.
In this randomized control trial, 100 patients diagnosed with unilateral inguinal hernia were included. We divided the study population into two groups of fifty. For both groups, a 15 × 13 cm Prolene(polypropylene) mesh was used for repair. In the fixation group, mesh was fixed to the abdominal wall by endoscopic tacks, while in the non-fixation group, mesh was secured at the proper place without any fixation. Postoperative outcomes were complications, recurrence, and pain intensity after 1-, 3- and 6-months.
Postoperative pain intensity in the 1st month [Median of 2 and 0, (P < 0.001)], and 3rd month [Median of 0.5 and 0, (P < 0.001)], in the fixation group were significantly higher than the non-fixation group. However, 6 months after surgery, pain intensity was almost similar for both groups. In the 6th postoperative month, only one patient experienced recurrence who was in the fixation group. The rate of recurrence and urinary retention between the groups was not significant.
It was observed that until 6 months after surgery patients who received the non-fixating method of TAPP repair experienced lower levels of pain in comparison to the fixation group while other complications did not differ between the two groups. This trail was registered at www.irct.ir with Trial Registration Number of IRCT20210224050491N1.

UNASSIGNED: Laparoscopic ventral hernia repair (LVHR) may be associated with chronic pain, seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence and poor quality of life (QoL). Our study evaluates whether robotic-assisted ventral hernia repair (rVHR) diminishes these complications compared to LVHR with primary closure of the defect (hybrid).
UNASSIGNED: Thirty-eight consecutive patients undergoing incisional ventral hernia operation with fascial defect size from 3 to 6 cm were recruited between November 2019 and October 2020. Nineteen patients underwent rVHR and nineteen underwent hybrid operation. The main outcome measure was postoperative pain, evaluated with a visual analogue scale (VAS: 0-10) at 1-month and at 1-year. Hernia recurrence was evaluated with ultrasound examination and QoL using the generic SF-36 short form questionnaire.
UNASSIGNED: At the 1-month control visit, VAS scores were significantly lower in the rVHR group; 2.5 in the hybrid group and 0.3 in the rVHR group (p < 0.001). At the 1-year control, the difference in VAS scores was still significant, 2.8 vs 0.1 (p = 0.023). There was one hernia recurrence in the hybrid group (p = 0.331). QoL did not differ significantly between the study groups when compared to preoperative physical status at 1-year follow-up (p = 0.121). However, emotional status (p = 0.049) and social functioning (p = 0.039) improved significantly in the rVHR group.
UNASSIGNED: Robotic-assisted ventral hernia repair (rVHR) was less painful compared to hybrid repair at 1-month and at 1-year follow-up. In addition, improvement in social functioning status was reported with rVHR.
UNASSIGNED: 5200658.

Perforated peptic ulcer (PPU) is a surgical emergency needing swift operative resolution. While laparoscopic and open approaches are viable options, it remains unclear whether laparoscopic repair has significantly improved outcomes. We use a national surgical database to compare perioperative and 30-d postoperative (30POP) outcomes.
The 2016-2018 ACS-NSQIP database was used to create the patient cohort, using ICD-10 and CPT codes. An unmatched analysis identified factors that likely contributed to the laparoscopic versus open treatment allocation. Propensity score matching (PSM) was used to identify outcomes that were not explained by underlying differences in the patient cohorts.
A total of 3475 patients were included: 3135 in open group (OG), 340 (~10%) in laparoscopic group (LG). After PSM to control for comorbidities and illness severity that differed between groups on univariate analysis, 288 patients remained in each group. Analysis of the matched cohorts revealed no statistically significant difference in mortality (5.9% OG versus 3.8% LG, P = 0.245). The LG had significantly longer operative times (92 versus 79 min, P = 0.003), shorter hospital stays (8.2 versus 9.4 d, P = 0.044) and higher probability of being discharged home (81% versus 73%, P = 0.017). 30POP outcomes were largely equivalent, except that OG had higher risk for bleeding (14.6% versus 8%, P = 0.012) and pneumonia (8.7% versus 4.5%, P = 0.044).
While laparoscopic repairs take longer, they lead to shorter hospital stays and higher likelihood of discharge home. Further study to identify patients that are candidates for this technique is warranted.

Introduction Inguinal hernia is the most common hernia among the abdominal wall hernias. This study aims to estimate the long-term recurrence rate and laparoscopy-related risk factors for inguinal hernia at King Fahad Specialist Hospital in Buraidah, Al Qassim region, Saudi Arabia. Methods A single-center retrospective study of all laparoscopic hernia repair patients admitted in the surgical department of King Fahad Specialist Hospital in Buraidah, Al Qassim region, Saudi Arabia from January 2016 to July 2020. Results A total of 64 patients were included in the present study. All patients were male with a mean age 42.27±15.79 years. Out of 64 patients, 71.9% were married and 11 (17.2%) were smokers. Most patients were found to be in the elective priority (89.1%) and the emergency cases were 10.1%. A total of 6.3% had a recurrent hernia and 93.7% had a primary hernia. After testing the association of hernia repair and the patient-related factors, it was observed that there is no significant association between recurrent hernia repair and the mean age (p=0.072), body mass index (BMI) (p=0.962), smoking (p=0.347), married patients (p=0.196), and diabetes (p=0.446). Conclusion A total of 6.3 % of patients developed a recurrent inguinal hernia after laparoscopic repair. In contrast to the literature, this study showed that patient-related risk factors were not statically significant among our patients. However, the reasons behind the recurrence rate tend to be multifactorial, including surgical, technical, hospital capability, and patients factors. Therefore, early recognization and management of these risk factors are essential to prevent further cases.

OBJECTIVE: Patients taking acetylsalicylic acid are common in surgical departments; in most cases, acetylsalicylic acid is discontinued 5-7 days before the operation to minimize the intra- and postoperative bleeding, but the perioperative management of patients under antithrombotic and anticoagulative treatments is controversial. This study aims to address whether the low-dose acetylsalicylic acid increases bleeding and occurrence of postoperative complications after laparoscopic inguinal hernia repair when it was only ceased on the operation day.
METHODS: From July 2017 to January 2019, 901 patients including 781 (86.7%) male and 120 (13.3%) female patients underwent laparoscopic inguinal hernia repair using trans-abdominal preperitoneal (TAPP) technique were recruited, among whom 152 (16.9%) had been taking low-dose (100 mg per day) acetylsalicylic acid which was continued during hospitalization except the operation day. The intra-operative bleeding volume, postoperative pain, overall occurrence of complications such as seroma, hematoma, scrotal edema, calf muscle venous thrombosis, and the time of resuming normal activities were compared with patients on whom these medications were not needed.
RESULTS: The age, BMI, hospital stay, ASA classification, morbidity of CHD and hypertension, FIB value, and the time of resuming normal activities of patients taking acetylsalicylic acid were higher (p < 0.05). There was no significant difference on mean operative time, intra-operative bleeding volume, and the occurrence postoperative complications among two groups.
CONCLUSIONS: For patients with inguinal hernias, laparoscopic TAPP repair is completely safe to be performed on those taking low-dose acetylsalicylic acid when it was only ceased on the operation day, with intravenous salvianolate given after the operation instead.

Laparoscopic ventral and incisional hernia repair (LVIHR) has become a common procedure because of its feasibility and safety, but it is not free of complications. Acute and chronic post-operative pain and bleeding caused by traumatic fixation of the mesh are frequently prolonging the hospital stay. The aim of this study was to analyze the behavior of n-butyl-cyanoacrylate (GLUBRAN® 2) as only mesh fixation METHODS: Ten female pigs were involved in the study and were divided into two groups of five (A and B). Animals in each group underwent a laparoscopic procedure in which two meshes were placed intraperitoneally and fixed with the same synthetic glue only. Animals in group A were sacrificed after 3 weeks, and those in group B were sacrificed after 12 weeks. We studied the morphological, biomechanical, and histological characteristics of the intraperitoneal mesh-tissue interface RESULTS: No disruption, migration or folding was observed in any of the pigs. In group A, the mean tensile strength was 1.4 N/cm (± 0.2) while in group B, the mean tensile strength was 2.5 N/cm (± 0.8). Histological analyses, in areas where mesh was fixed using the glue, showed a chronic lymphocytic inflammatory reaction with a granulomatous component and a marked desmoplastic reaction made up of immature collagen and numerous fibroblasts acquiring myofibroblastic characteristics. In some areas corresponding to fixation, the desmoplastic reaction originated from mature lamellar bone tissue with osteocytes and osteoblasts.
Laparoscopic mesh fixation with only the synthetic comonomer glue GLUBRAN® 2 is feasible, effective, and safe in intraperitoneal incisional/ventral hernia repair in this animal model.

Sports hernia is a condition with longstanding groin pain without an obvious pathology. Even though no hernia is present, some of these patients have a groin hernia repair to relieve the pain. The aim of this study was to establish an overview of patient characteristics and surgical techniques in patients that have a groin hernia repair without a hernia present.
This cohort study is based on nationwide data on hernia repairs from the Danish Hernia Database. Patients having a primary groin hernia repair without having a hernia between 1998 and 2011 were included and followed for minimum 4 years. We evaluated patient characteristics, type of surgery, and re-operation rates for laparoscopic and open surgeries.
Groin hernia repairs were performed in 1,028 groins where no hernia was present. The median follow-up after primary surgery was 11 years (range 4-17). Men represented 78% of the patients, and the mean age was 50 years (standard deviation 16.4). The most frequent type of surgery was the open Lichtenstein repair. The overall re-operation rate was 7% and this was evenly distributed across the different types of primary surgeries with no difference in neither the crude nor the cumulated re-operation rates. During re-operation, a groin hernia was found in 88% of the repairs.
Groin hernia repairs in groins without a hernia are performed at all ages and with the typical patient being a middle-aged man receiving an open mesh repair.

The introduction of laparoscopy for hernia repair permits intra-abdominal observation of a hernia and contralateral persistent processus vaginalis (CPPV). The current study\'s aim was to investigate the diameter of opening of an inguinal hernia and CPPV in patients with unilateral inguinal hernia, and to evaluate their correlation with age.
From September 2012 to August 2017, 569 pediatric patients underwent laparoscopic repair of unilateral inguinal hernia. We retrospectively evaluated the size of the hernia and CPPV by measuring the diameter of opening. Pearson correlation analysis and linear-by-linear association were used in the statistical analysis.
The median age at operation was 32.4 months (range 0.2-219 months). CPPV was observed in 330 patients (58.0%), and its incidence was significantly higher in patients with left inguinal hernias than in those with right inguinal hernias (62.8 versus 54.0%, p < 0.001). The mean diameter of opening for the hernias was significantly larger than that for CPPV (11.2 ± 3.1 vs. 6.1 ± 2.5 mm, p < 0.001). The incidence of CPPV gradually decreased from 77.2% in infants to 46.6% in the oldest age group (≥ 6 years) (p trend < 0.001). The diameter of the opening of a hernia was not correlated with increasing age, and the diameter of the opening of a CPPV was not correlated with increasing age, as well.
The diameters of a hernia and CPPV were identified in the current study, and the diameter was not correlated with increasing age. The incidence of CPPV was more common in patients with left inguinal hernias than in those with right inguinal hernias, and it gradually decreased with increasing age.