OBJECTIVE: Incisional hernia (IH) is a common complication following abdominal surgery. Surgical repair of IH is associated with the alleviation of symptoms and improvement of quality of life. Operative intervention can pose a significant burden to the patient and healthcare facilities. This study aims to describe and compare outcomes of elective and emergency surgical repair of IH.
METHODS: This study is a single-centre comparative retrospective study including patients who had repair of IH. Patients were divided into Group I (Emergency) and Group II (Elective), and a comparison was conducted between them.
RESULTS: Two hundred sixty-two patients were identified with a mean age of 61.8 ± 14.2 years, of which 152 (58%) were females. The mean BMI was 31.6 ± 7.2 kg/m2. More than 58% had at least one comorbidity. 169 (64.5%) patients had an elective repair, and 93 (35.5%) had an emergency repair. Patients undergoing emergency repair were significantly older and had higher BMI, p = 0.031 and p = 0.002, respectively. The significant complication rate (Clavien-Dindo III and IV) was 9.54%. 30 and 90-day mortality rates were 2.3% (n = 6) and 2.68% (n = 7), respectively. In the emergency group, the overall complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p ≤ 0.001, 0.002 and 0.001, respectively. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) experienced a recurrence, and 41 (15.71%) were readmitted within 90 days, without significant differences between the two groups.
CONCLUSIONS: Patients who underwent emergency repair were significantly older and had a higher BMI than the elective cases. Emergency IH repair is associated with higher complication rates and mortality than elective repair.

Aim: Women have the highest prevalence of epigastric hernia repair. Outcomes after epigastric hernia repair are rarely reported independently, although pathology and surgical techniques may be different than for other primary ventral hernias. The aim of this study was to evaluate long-term outcomes after epigastric hernia repairs in women on a nationwide basis. Methods: Nationwide cohort study from the Danish Hernia Database. Complete data from women undergoing elective epigastric hernia repair during a 12 years period (2007-2018) was extracted. A 100% follow-up was obtained by combining data from the National Civil Register. The primary outcome was operation for recurrence, secondary outcomes were readmission and operation for complications. Outcomes for open sutured repair, open mesh repair mesh, and laparoscopic repairs were compared. Results: In total, 3,031 women underwent elective epigastric hernia repair during the study period. Some 1,671 (55.1%) women underwent open sutured repair, 796 (26.3%) underwent open mesh repair, and 564 (18.6%) underwent laparoscopic repair. Follow-up was median 4.8 years. Operation for recurrence was higher after sutured repairs than after open mesh and laparoscopic repairs (7.7% vs. 3.3%, vs. 6.2%, p < 0.001). The risk of operation for complications was slightly higher after open mesh repair compared with sutured repair and laparoscopic repair (2.6% vs. 1.2%, vs. 2.0%, p = 0.032), with more operations for wound complications in the open mesh group (2.0%, p = 0.006). Conclusion: More than half of the women underwent a suture-based repair, although mesh repair reduces risk of recurrence. Open mesh repair had the lowest risk of recurrence, but on the expense of slightly increased risk of wound-related complications.

Background Ventral hernias affect millions of patients each year. Surgery is the main line of management and various techniques have been advocated; however, mesh repair has become the norm and different approaches have been described regarding the plane of mesh fixation, but none of them are standardized. Open repair is commonly practiced, and the two most commonly performed methods are retrorectus and properitoneal mesh placement. Objectives To compare the postoperative outcomes between the retrorectus plane and the properitoneal plane of fixation of mesh in open ventral hernia repair. Methods Between September 2018 and August 2020, 56 patients with midline ventral hernia admitted to Ramaiah Hospital, Bengaluru were chosen for this prospective comparative study. Group A had 28 patients who underwent open retrorectus mesh repair and 28 patients in Group B underwent open properitoneal mesh repair. The postoperative outcomes were studied in terms of operating time, postoperative complications, and early recurrence at the end of six months and 24 months post-surgery. Results The operative time for retrorectus mesh placement was significantly lower than properitoneal mesh placement. The latter had a higher complication rate overall with an incidence of 18%, with seroma being the most common complication; however, the difference in complication rates was not statistically significant. Skin necrosis was identical in both groups and 0% of cases in both groups had SSI or mesh infection. Three patients (10.71%) in the retrorectus group and two patients (7.10%) in the properitoneal group developed recurrence at 24 months follow-up. Conclusion Retrorectus mesh repair and properitoneal mesh repair in open ventral abdominal hernias have equally good postoperative outcomes.

Introduction Inguinal hernia is a common surgical problem throughout the world. Currently, the management options available are open mesh hernioplasty and laparoscopic mesh repair. Laparoscopic mesh repair can be performed by either transabdominal preperitoneal (TAPP) repair or totally extraperitoneal (TEP) repair. Many studies comparing the two procedures have been unable to establish the superiority of one procedure over the other and have yielded conflicting results. Thus, we performed this study to compare TAPP and TEP. Aim The aim of this study is to compare the clinical outcomes and safety of laparoscopic TEP and laparoscopic TAPP for inguinal hernia repair. Materials and methods Patients were randomly divided into two groups on the basis of surgical procedures. The first group of patients underwent laparoscopic TAPP mesh repair, and the second group of patients underwent laparoscopic TEP mesh repair. Their intraoperative and postoperative findings were noted. Patients were followed up at regular intervals for up to six months. Results The mean age and mean weight distribution between the two groups were not significant. The duration of surgery needed (in minutes) for TAPP was found to be significantly less compared to TEP. In the TEP group, conversion to open occurred for three subjects (6.7%) while there was no conversion in the TAPP group. Postoperative pain at 24 hrs was found to be higher in TAPP subjects compared to that in TEP subjects, but the difference was statistically insignificant. Tolerance to a liquid diet started few hours after surgery was found to be the same in both groups. Association of the duration of hospital stays with the type of surgery was not significant. Six subjects (13.2%) showed hematoma in the TEP group while five subjects (11%) in the TAPP group showed hematoma after one week of surgery. Eight subjects (17.6%) showed seroma in the TEP group while three subjects (15.4%) in the TAPP group showed seroma after one week of surgery. Two subjects (4.4%) showed superficial wound infection in both the TEP group and TAPP group after one week of surgery. Four subjects each (8.9%) showed scrotal edema in the TEP group as well as the TAPP group after one week of surgery. No subject showed port site hernia without closure of the sheath at one-week, one-month, and six-month follow-up visits. Two subjects (4.4%) each showed groin pain in the TEP group as well as the TAPP group after one week of surgery. There were no instances of bowel obstruction or mesh infection. Conclusion TEP is a more skill-demanding procedure as compared to TAPP and thus takes more time to perform. However, it is superior on account of not breaching the peritoneum. TAPP is favorable for larger hernias. The choice of procedure should be individualized according to the patient\'s characteristics and surgeon\'s preference.

Objective The objective of this prospective cohort study was to compare the time to return to work between patients who underwent laparoscopic transabdominal preperitoneal (TAPP) hernia repair and those who underwent Lichtenstein tension-free hernia repair with mesh for unilateral inguinal hernia. Methodology Patients were registered for unilateral inguinal hernia review at Aga Khan University Hospital, Karachi, Pakistan, from May 2016 to April 2017 and followed till April 2020. All patients aged 16-65 planned for unilateral transabdominal preperitoneal hernia repair or Lichtenstein tension-free hernia mesh repair were included. Patients with bilateral inguinal hernia repair, limited activity, or above retirement age were excluded. A non-probability consecutive sampling technique was implemented, and patients were divided into two cohort groups: Group A underwent laparoscopic transabdominal preperitoneal hernia repair, while Group B underwent Lichtenstein tension-free mesh repair. Patients were followed up at one week to inquire about the resumption of activities and then at one and three years for recurrence. Results Sixty-four patients met the inclusion criteria; three patients opted out of research, and 61 patients agreed to participate; one patient was excluded due to the conversion of the procedure. The remaining 30 in Group A and 30 in Group B were followed for the study period. The mean time to return to work in Group A was 5.33 ± 4.46 days; in Group B, it was 6.83 ± 4.58 days, with a p-value of 0.657. One recurrence was observed at three years in Group A. Conclusion Although the time to return to work at our hospital was slightly shorter in laparoscopic hernia repair than in the open technique, the results were not statistically significant. In addition, there was no significant difference in hernia recurrence at the one-year follow-up between laparoscopic transabdominal preperitoneal hernia repair and Lichtenstein tension-free hernia mesh repair for unilateral inguinal hernia.

Despite the availability of laparoscopy, open surgery remains the most common practice for primary inguinal hernia repair in general surgery. This study aimed to evaluate the combined mesh and darn (CMD) repair compared to mesh alone (MA) repair in treating adult inguinal hernias regarding recurrence and postoperative complications. We conducted a prospective randomized study, including 330 patients with primary inguinal hernias who underwent primary inguinal hernia repair at our facilities between February 2015 and January 2018. Time spent in the hospital, time to resume regular activities, postoperative sequelae, and recurrence rates were assessed. Patients were randomly assigned to 2 groups: CMD repair was performed on 165 patients (Group 1), and MA repair was done on 165 patients (Group 2). Patients were monitored for three years. The average operation time for MA was 62.2 minutes, compared to 72.9 minutes for CMD. The average time to return to normal work was comparable for both groups at around 3 weeks. In Group 2, 12 (7.1%) patients experienced postoperative complications and 3 (1.7%) recurrences. In the CMD repair group, 13 (8.1%) patients had postoperative complications, but no recurrences were observed. Hospitalization duration and postoperative pain were similar between the two groups. At the three-year follow-up, the CMD repair demonstrated a lower recurrence rate than MA, while both groups had similar postoperative complications, hospital stays, and return to normal activities. The operative time was slightly longer for CMD repair compared to MA repair.

Ventral hernias with large defects (≥ 2 cm) are managed with tension free mesh repair. The growing consensus that sublay (retrorectus) mesh repair is superior to onlay mesh repair due to fewer complications is based on literature dominated by retrospective studies from high and upper-middle income countries. There is thus a need of more prospective studies from various countries to resolve the controversy. The objective of this study was to compare the outcomes of onlay versus sublay mesh repair in the management of ventral hernias. Our single centre, prospective comparative study set in a low-middle income country comprised of 60 patients with a ventral hernia undergoing open surgical repair using either onlay technique (n = 30) or sublay technique (n = 30). Surgical site infections, seroma formation, recurrence were found in 3.33%, 6.67%, 0% patients in sublay repair group and in 16.67%, 20%, 6.67% patients in onlay repair group respectively. Mean duration of surgery, mean Visual Analogue Scale (VAS) score for chronic pain, mean duration of hospital stay were 46 min, 4.5, 8 days in onlay repair group and 61 min, 4.2, 6 days in sublay repair group respectively. Onlay repair group was associated with shorter duration of surgery. However, sublay repair was associated with lesser rates of surgical site infections, chronic pain and recurrence than onlay repair. Sublay mesh repair had better outcomes than onlay mesh repair for the management of ventral hernias, however superiority of any one technique could not be established.

Background Postoperative pain is a significant problem encountered by patients after a surgical intervention, and there is a crucial need for effective postoperative pain control. The studies have shown that multimodal analgesia and wound infiltration are effective ways to reduce this pain and have a substantial role in the reduction of postoperative medications requirement. This study aimed to evaluate the effect of subcutaneous infiltration of bupivacaine hydrochloride and intravenous (IV) diclofenac as postoperative pain relief in adults undergoing inguinal hernia repair. Methods A single-center retrospective study included 104 patients aged 18-65 undergoing unilateral inguinal herniorrhaphy at the selected hospital. The patients were in two groups of 52 each. Group A received a 75 mg dose of IV diclofenac plus a subcutaneous injection of 10 mL of bupivacaine hydrochloride (HCl) 0.5% while Group B only received the IV diclofenac without the bupivacaine injection. The postoperative pain was assessed at one, two, three, six, and 12 hrs after the operation using the visual analog scale (VAS), which exhibited a range of pain from zero (no pain) to 10 (extreme pain). Results Of a total of 104 patients, 92% of patients were male. The patients\' mean age was 36 ± 11 years, and the mean body mass index (BMI) was 22 ±3 kg/m2. American Society of Anesthesiologists physical class I was similar in both groups (90.4% versus 84.6%). Patients in Group A had significantly lower VAS pain scores at one, two, three, six, and 12 hrs after the operation and a longer emergence time than Group B (all p-values were < 0.001). Subcutaneous bupivacaine infiltration and IV diclofenac were also found to be an effective analgesic technique in open hernia repair with mesh (p-value < 0.001 for all). Conclusion Subcutaneous injection of bupivacaine combined with IV diclofenac provides superior analgesia to monotherapy intravenous diclofenac after inguinal hernia repair.

Femoral hernias often present with incarceration or strangulation that requires emergency surgery. However, recommendations vary regarding optimal approaches for incarcerated femoral hernia. The aim of this study is to compare clinical efficacy between mesh repair and suture repair for the treatment of incarcerated femoral hernia.
Retrospective, single-center analysis of the clinical data from 48 patients with incarcerated femoral hernia, including 16 patients who underwent mesh repair (mesh repair group) and 32 patients who underwent traditional suture repair (suture repair group).
The mean age, body mass index, incarceration duration, hernia sac size, operation duration, and the rates of postoperative incision infection, recurrence, chronic pain, and mortality were not significantly different between the suture repair and mesh repair groups (P > 0.05 for all). In contrast, the female/male ratio; the rates of bowel obstruction, coexisting diseases, and nighttime operation; and the American Society of Anesthesiologists grade were higher and the rate of prophylactic antibiotic use and the mean cost of hospitalization were lower in the suture repair group than in the mesh repair group (P < 0.05 for all).
The surgical approach should be chosen based on the patient\'s condition. Mesh repair for the emergency treatment of incarcerated femoral hernia is safe and effective, whereas suture repair is suitable for elderly patients, those with more coexisting diseases, and those with limited life expectancy.

At present, the most widely favored technique for treating adult inguinal hernia is the use of tension-free mesh repair, while traditional means of tissue repair have been gradually phased out. Mesh repair seeks to prevent the occurrence of hernias by covering the entire myopectineal orifice with artificial mesh. Yet in doing so, it fails to reinforce the naturally weak area between the transversus abdominis arch and the iliopubic tract. To rectify this and reduce the chance of recurrence following inguinal hernia surgery, the author has combined mesh repair with autologous tissue repair to create a method called TMC repair (tissue and mesh combined repair). From Jan 1, 2010 to Dec 31, 2015 the author applied TMC repair to treat adult inguinal hernia in 1,169 patients, achieving a recurrence rate of 0.68%. It is therefore a highly recommended method for treating adult inguinal hernia.