OBJECTIVE: To analyze the value of ultrasonography in predicting metachronous contralateral inguinal hernia (MCIH) and diagnosing contralateral persistent processus vaginalis (CPPV) in children with unilateral inguinal hernia, a prospective study was conducted.
METHODS: All participants underwent a preoperative ultrasound on the contralateral groin. Patients in group A1 received operating procedure according to ultrasound results (patients with negative contralateral US results received hernia repair on the affected side), and patients in group A2 received operation according to laparoscopic results (patients received hernia repair and CPPV ligation). All patients were followed up 2 years and compared to a historical control (group B) who underwent open hernia repair only on the affected side regardless of contralateral US results.
RESULTS: In groups A1 and A2, laparoscopic exploration revealed the presence of a CPPV in 490 cases. Ultrasound was found to be accurate in 104 out of the 490 cases with four false-positive and 386 false-negative results. This yielded an accuracy of 59.3%, a sensitivity of 21.2%, and a specificity of 99.2%. 10 patients in group A1, and 74 patients in group B developed MCIH. The accuracy, sensitivity, and specificity of the value of ultrasonography in predicting MCIH were 89.3%, 52.4%, and 92.5%, respectively.
CONCLUSIONS: Preoperative ultrasonography of the contralateral groin is currently unable to accurately detect CPPV, but it appears to be a promising method in predicting MCIH by using rigorous diagnosing criteria.

BACKGROUND: Wound infection after inguinal hernia surgery is not uncommon in the clinical setting. The common microbial aetiology of postoperative inguinal hernia wound infection is Gram-positive bacteria. Staphylococcus aureus is a common pathogen causing wound infection while Staphylococcus epidermidis and Pseudomonas are rare. Staphylococcus epidermidis as a cause of severe wound infection is rarely described in literature. We herein present a case of a 79-year-old man with a rare wound infection after bilateral inguinal herniorrhaphy caused by MRCNS (Methicillin Resistant Coagulase Negative Staphylococcus).
METHODS: We present a case of wound infection accompanied by fever with a temperature of 38.8 °C after bilateral inguinal herniorrhaphy in a 79-year-old man. Bilateral inguinal wounds were marked by redness and swelling, with skin necrosis. In addition, an abscess of approximately 1.5 cm × 1.5 cm was seen on the left wrist. A small amount of gas under the skin in the wound area was observed after pelvic computed tomography (CT) scans. No bacteria were cultured from the inguinal wound discharge, while blood culture detected MRCNS, and Acinetobacter lwoffi was cultured from the pus in the left wrist. We chose appropriate antibiotics based on the results of the bacterial culture and the drug susceptibility results. Vacuum assisted closure (VAC) therapy was used after debridement. The patient was discharged after the wounds improved. He was followed up for ten months and showed no signs of complications. We are sharing our experience along with literature review.
CONCLUSIONS: We are presenting a rare case of MRCNS wound infection following open inguinal hernia surgery. Although a rarity, clinicians performing inguinal hernia surgery must consider this entity in an infected wound and follow up the patient for complications of MRCNS.

Cryptorchidism is a common congenital malformation in pediatric urology. Although there have been many studies on the etiology of the disease, it has not been fully clarified, and while its diagnostic and treatment models have gradually approached standardization and systematization, some controversies regarding treatment remain. Additionally, although ultrasound is a non-invasive examination without ionizing radiation, its role in the evaluation of cryptorchidism remains controversial. The main basis for treating cryptorchidism is orchidopexy, and the main view on treatment age is that treatment should be performed between 6 and 12 months after birth, but no more than 18 months after birth. The view on hormone therapy is still controversial because most scholars believe that early surgery is the key to treatment. There are many surgical treatment methods for cryptorchidism, including traditional open surgery and laparoscopic surgery, which provide satisfactory results. In conclusion, the treatment of undescended testis (UDT) had been largely standardized, apart from the treatment of high intra-abdominal testis (IAT), which remains a matter of debate.

BACKGROUND: Hernia is a common condition requiring abdominal surgery. The current standard treatment for hernia is tension-free repair using meshes. Globally, more than 200 new types of meshes are licensed each year. However, their clinical applications are associated with a series of complications, such as recurrence (10% - 24%) and infection (0.5% - 9.0%). In contrast, 3D-printed meshes have significantly reduced the postoperative complications in patients. They have also shortened operating time and minimized the loss of mesh materials. In this study, we used the myopectineal orifice (MPO) data obtained from preoperative computer tomography (CT)-based 3D reconstruction for the production of 3D-printed biologic meshes.
OBJECTIVE: To investigate the application of multislice spiral CT-based 3D reconstruction technique in 3D-printed biologic mesh for hernia repair surgery.
METHODS: We retrospectively analyzed 60 patients who underwent laparoscopic tension-free repair for inguinal hernia in the Department of General Surgery of the First Hospital of Shanxi Medical University from September 2019 to December 2019. This study included 30 males and 30 females, with a mean age of 40 ± 5.6 years. Data on the MPO were obtained from preoperative CT-based 3D reconstruction as well as from real-world intraoperative measurements for all patients. Anatomic points were set for the purpose of measurement based on the definition of MPO: A: The pubic tubercle; B: Intersection of the horizontal line extending from the summit of the inferior edge of the internal oblique and transversus abdominis and the outer edge of the rectus abdominis, C: Intersection of the horizontal line extending from the summit of the inferior edge of the internal oblique and transversus abdominis and the inguinal ligament, D: Intersection of the iliopsoas muscle and the inguinal ligament, and E: Intersection of the iliopsoas muscle and the superior pubic ramus. The distance between the points was measured. All preoperative and intraoperative data were analyzed using the t test. Differences with P < 0.05 were considered significant in comparative analysis.
RESULTS: The distance between points AB, AC, BC, DE, and AE based on preoperative and intraoperative data was 7.576 ± 0.212 cm vs 7.573 ± 0.266 cm, 7.627 ± 0.212 cm vs 7.627 ± 0.212 cm, 7.677 ± 0.229 cm vs 7.567 ± 0.786 cm, 7.589 ± 0.204 cm vs 7.512 ± 0.21 cm, and 7.617 ± 0.231 cm vs 7.582 ± 0.189 cm, respectively. All differences were not statistically significant (P > 0.05).
CONCLUSIONS: The use of multislice spiral CT-based 3D reconstruction technique before hernia repair surgery allows accurate measurement of data and relationships of different anatomic sites in the MPO region. This technique can provide precise data for the production of 3D-printed biologic meshes.

Discuss the superiority of laparoscopic orchiopexy in the treatment of inguinal palpable undescended testes.
Inclusion criteria: Preoperative examination and color Doppler ultrasound examination confirmed that the testes were located in the inguinal canal and could not be pulled into the scrotum, except for retractive and ectopic testes. The surgical steps were depicted as follow. The retroperitoneal wall was carved by ultrasonic scalpels, separates the spermatic vessels closed to the inferior pole of the kidney if necessary, dissects the peritoneum of vas deferens, cuts the testicular gubernaculum, and pulls back the testicle into the abdominal cavity. Besides, protect the vas deferens, and descend the testes to the scrotum and fix them without tension.
There were 773 patients with 869 inguinal undescended palpable testes, 218 cases on the left side, 459 cases on the right side and 96 cases with bilateral undescended testes, whose age ranged from 6 months to 8 years, with an average of 20 months. All testes were successfully operated, no converted to open surgery. The average operation time was (34.8 ± 5.4) min. There were 692 testes have an ipsilateral patent processus vaginalis (89.5%); In 677 cases of unilateral cryptorchidism, 233 cases (34.4%) have a contralateral patent processus vaginalis, and laparoscopic percutaneous extraperitoneal closure the hernia sac carry out during the surgery. There was no subcutaneous emphysema during the operation, no vomiting, no abdominal distension, no wound bleeding and obvious pain after surgery, especially wound infection is rarely. Doppler ultrasound was evaluated regularly after surgery. The patients were followed up for 6 to 18 months. All the testes were located in the scrotum without testicular retraction and atrophy. No inguinal hernia or hydrocele was found in follow-up examination.
Laparoscopic orchiopexy manage inguinal palpable cryptorchidism is safe and effective, and there are obvious minimally invasive advantages. Furthermore, It could discover a contralateral patent processus vaginalis, and treat at the same time, which avoid the occurrence of metachronous inguinal hernia.

BACKGROUND: The aim of this article was to compare and analyze the outcomes of surgical repair and watchful waiting (WW) in the treatment of asymptomatic or minimally symptomatic inguinal hernias.
METHODS: A systematic literature review was undertaken to identify studies that compare surgical repair and watchful waiting in asymptomatic or minimally symptomatic inguinal hernias. And all related data matching our standards were abstracted for Meta-analysis with RevMan 5.0.1.
RESULTS: Less pain was observed in Operation group. However, there were no significant differences in Physical Component Score (PCS), mortality, surgical complications and postoperative hernia recurrence between WW group and Operation group. But a great number of patients would develop significant hernia-related symptoms and cross over to surgery over time in WW group.
CONCLUSIONS: Patients have relative less pain in operation group compared with WW group. Although WW is safe in patients with asymptomatic or minimally symptomatic inguinal hernias, however, this strategy would merely delay rather than avoid surgical repair of hernias in the majority of inguinal hernia patients.

Seroma is a virtually unavoidable early sequela after TEP hernioplasty. This randomised controlled trial evaluated the outcomes of preperitoneal closed-system suction drainage in laparoscopic totally extraperitoneal (TEP) hernioplasty for inguinal hernia.
Ninety patients aged 18-80 years who presented to our hospital between May 2016 and February 2017 with primary unilateral inguinal hernia were randomised into the preperitoneal drain and no-drain groups. The primary outcome was seroma size on postoperative day 6. Secondary outcomes included clinical seroma formation and seroma size on day 1, day 6, 1 and 7 months postoperatively, length of postoperative stay, pain score, and recurrence.
There was no significant difference in age, sex, co-morbidities, hernia side, mean hernia size, operating time, fixation adjuncts, or postoperative stay. The overall incidence of clinical seroma formation was 25.6% on postoperative day 1, 60.3% on postoperative day 6, 13.2% 1 month and 0% 7 months postoperatively. The mean drain output was 57.9 ml. The drain group had significantly fewer patients with seroma on day 1 (6 vs 14, p = 0.022) and day 6 (17 vs 30, p = 0.000), and a smaller mean seroma size on days 1 and 6 (p = 0.000). Subgroup analysis showed that sac ligation versus reduction, peritoneal perforation, and fixation adjuncts had no significant effects on seroma formation or size. There is a trend of lower early post-operation VAS score and more urinary retention in drain group was observed but not reaching statistical significance. No differences in postoperative pain score or complications were observed at 1 and 7 months\' post operation.
Preperitoneal drainage for 23 h after laparoscopic TEP hernioplasty for inguinal hernia can effectively decrease seroma formation in the early postoperative period, and potentially improving postoperative pain. The benefit is short-term and no significant difference was demonstrated after 1-month post operations. This tradition technique applied to novel operative repair of inguinal hernia is safe and feasible with no significant morbidity demonstrated. Preperitoneal drainage after TEP can be considered as an option to improve patient satisfactions and recovery in selected patient group for maximal benefit, especially for those with prolonged operation which may associate with higher chance of seroma formation.

OBJECTIVE: To evaluate the relationship between preoperative grade and postoperative changes of semen parameters following left inguinal varicocelectomy.
METHODS: This study included 44 patients undergoing left microsurgical inguinal varicocelectomy. Internal spermatic veins were classified as large (4 mm or more in diameter), medium (2-4 mm), or small (2 mm or less). Changes in sperm activity, morphology and count were estimated perioperatively. The introperative findings and semen parameters were compared between varicocele groups of grades 2 and 3.
RESULTS: Both sperm motility and count improved significantly postoperatively (from (31.9 ± 16.3)% to (47.3  ± 15.5)%, from (28.1 ± 28.1) × 106/mL to (52.1 ± 74.2) × 106/mL). In varicoceles with grade 2 and 3, significant differences were found in the number of large veins (0.4 ± 0.6 vs. 1.2 ± 0.7, p < 0.001) and ultrasonographic maximum diameters of spermatic vein in supine and standing positions (2.3 ± 0.4 cm vs. 2.8 ± 0.6 cm, 3.1 ± 0.7 cm vs. 3.9 ± 0.7 cm, p = 0.001 and 0.001 respectively). However no difference of changes in sperm motility and count was detected ((16.3  ±  13.5)% vs. (14.4  ±  12.6)%, (30.5 ± 84.4) × 106/mL vs. (12.9 ± 20.6) × 106/mL respectively, p = 0.65 and 0.40 respectively).
CONCLUSIONS: Preoperative varicocele grade might not predict postoperative semen changes regardless of possible existence of anatomic and ultrasonographic associations.

OBJECTIVE: To determine the clinical significance and prognostic value of femoral lymph node metastasis (FLNM) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage III vulvar carcinoma.
METHODS: The medical records of patients with vulvar carcinoma who underwent inguinofemoral lymphadenectomy between 1990 and 2013 were retrospectively reviewed.
RESULTS: Of 66 patients with stage III vulvar carcinoma, 42 had superficial lymph node metastasis (SLNM) only and 24 had FLNM. Significantly higher rates of extracapsular invasion (P = 0.008), multiple nodal metastasis (P = 0.042), and advanced FIGO substage (P = 0.026) as well as a larger tumor diameter (≥4 cm, P = 0.023) and greater depth of invasion (≥5 mm, P = 0.020) were observed among patients with FLNM compared to those with SLNM only. After a median follow-up of 46 months (range, 6-172 months), 35 patients experienced relapse and 30 died from disease. The 5-year cancer-specific survival (CSS) rates were 70.1% and 30.8% for patients with SLNM only and FLNM, respectively (P = 0.001). In multivariate analysis, only FLNM was found to be an independent risk factor for reduced recurrence-free survival (RFS) and CSS among patients with stage III vulvar cancer (hazard ratio [HR] = 2.277, P = 0.037 for RFS; HR = 2.360, P = 0.042 for CSS). When the FLNM cases were considered together as stage IIIC, significant differences emerged in the RFS (P = 0.002) and CSS (P = 0.004) among the re-divided FIGO substages.
CONCLUSIONS: FLNM represented an unfavorable status of node metastasis with a worse prognosis compared to that of SLNM alone, and this should be considered in a future FIGO staging system for vulvar cancer.

OBJECTIVE: The aim of this study was to compare the effect of transabdominal preperitoneal (TAPP) inguinal hernioplasty with or without mesh fixation on chronic pain and quality of life of patients.
METHODS: One hundred patients with a simple oblique inguinal hernia were included and treated at the Second Affiliated Hospital of Kunming Medical University from July of 2015 to July of 2016. Patients were randomly assigned to TAPP inguinal hernioplasty with mesh fixation (fixation group, n = 50) or without mesh fixation (non-fixation group, n = 50). Observation indices such as mean operative time, time to ambulation, hospitalization expense, and complications were recorded. The visual analog scale (VAS) was adopted for pain evaluation 2 days, 3 months, and 6 months postoperatively. The 36-item short-form health survey (SF-36) was adopted for life quality scoring 3 months postoperatively.
RESULTS: No recurrence or incisional infections were observed during follow-up in either group. The mean operative time, time to ambulation, and hospitalization expense of the non-fixation group were all significantly reduced compared to those of the fixation group. The VAS score 2 days, 3 months, and 6 months postoperatively of the non-fixation group were significantly lower than in the fixation group. The physical function, role physical, bodily pain, and general health in the non-fixation group were each significantly higher than in the fixation group. In contrast, vitality, social function, role emotional, and mental health showed no significant differences across groups.
CONCLUSIONS: For patients with primary unilateral oblique inguinal hernia with a defect size less than 4.0 cm in diameter, TAPP inguinal hernioplasty without mesh fixation was safe and effective. Furthermore, this shortened the operative time, promoted early ambulation, decreased hospitalization expenses, alleviated postoperative pain, and improved quality of life.