UNASSIGNED: The dissection of the preperitoneal space is performed using a monopolar instrument to prevent bleeding in laparoscopic transabdominal preperitoneal hernia repair (TAPP). It may also cause energy injuries and nerve damage.
UNASSIGNED: To assess the effectiveness and safety of dissection of the preperitoneal space without electrocoagulation (DPSWE) in TAPP throughout the process.
UNASSIGNED: A retrospective analysis of data of 134 patients was made. The electrocoagulation group (EG) relied on monopolar instruments. In the non-electrocoagulation group (NEG) mainly scissors were used without electrocoagulation. The patients were followed for up for 3 months. Intraoperative and postoperative conditions and other complications were observed.
UNASSIGNED: The VAS scores in the NEG were lower than those in the EG (p < 0.05). The operation time in the NEG was shorter than that in the EG (p < 0.05). Hospitalization expenses, scrotal seroma formation, and rupture of hernia sac in the NEG were lower than those in the EG (p < 0.05). The intraoperative bleeding volume above 20 ml in the NEG was higher than that in the EG. There was no significant difference in the incidence of postoperative bleeding, vas deferens injury, intestinal injury, surgical site infection, length of hospital stay, urinary retention and hernia recurrence in the NEG and the EG (p > 0.05). There was no significant difference in the incidence of surgical site infections (SSIs) in the NEG and the EG.
UNASSIGNED: DPSWE is effective and safe. DPSWE may reduce postoperative pain and have no significant increase in postoperative bleeding.

Inguinal hernia is a prevalent surgical condition in pediatric patients. Despite the efficacy of current treatment modalities, a certain recurrence rate still persists. Hence, our objective in this study is to introduce an innovative surgical technique designed to minimize surgical complications. We conducted a retrospective analysis on 809 pediatric cases that underwent laparoscopic repair with our innovative technique for inguinal hernia from June 2020 to June 2022. Demographic information, perioperative details, and postoperative follow-up outcomes were thoroughly assessed. All surgeries were conducted laparoscopically under general anesthesia. The procedure commenced by encircling the hernia sac with two sutures under laparoscopic guidance. Subsequently, the sac was exteriorized from the body using the two sutures, followed by ligation and excision of the hernia sac. The research findings demonstrate that the duration of unilateral and bilateral procedures was recorded as 15.9 ± 4.8 and 21.7 ± 3.9 min, respectively. Incision infection occurred in 7 patients (0.87%), and Male Complicated Inguinal Hernia (MCIH) was observed in 2 patients (0.23%). Notably, there were no occurrences of iatrogenic cryptorchidism, testicular atrophy, or recurrence (0%) during the follow-up period. In conclusion, our novel modification shows a notable reduction in postoperative recurrence rates and alleviates the impact of the procedure on the positioning of the testis or uterus. This modified technique is both safe and valuable, thus warranting broader adoption and promotion.

BACKGROUND: Laparoscopic hernia repair in recent times has gained the most acceptance among both the surgical community and the patient groups, as it has proven benefits of lesser postoperative hospital stay and less pain scores. The incidence of both inguinal and ventral hernias has increased significantly in the present days. Various methods have been postulated by different surgical groups for repairing the same but no there is no standard consensus on managing concomitant inguinal and ventral hernias. The conventional e-TEP requires an extensive dissection with increased operative time. We present our experience in managing cases with both inguinal and primary M2/M3 and W1 ventral hernias with or without divarication of recti using a modified up to down approach for inguinal hernia followed by down to up approach for the ventral hernia, from a tertiary care center in South India.
METHODS: We managed 16 cases with simultaneous incidence of inguinal and primary M2/M3 and W1 ventral hernias with or without divarication of recti between January 2022 and November 2023. Institute ethical committee clearance and informed consent was obtained from all the 16 patients. They were all subjected to an extra peritoneal repair of both the hernias. All the demographic data, intraoperative data, postoperative complications and follow up were digitally stored. All patients were followed up for six months after surgery.
RESULTS: Out of 16 patients, 15 were males and 1 was female. The mean age was 48 years and the mean BMI of all the patients was 29.2 kg/m2. The postoperative recovery was smooth in all patients and being discharged within 24 h after surgery. The pain scores of all patients were significantly lower than patients who underwent intraperitoneal repair.
CONCLUSIONS: e-TEP hernia repair is gaining popularity and has amused the hernia surgical community. Our method of e-TEP RS repair in cases with concomitant inguinal and primary M2/M3 W1 ventral hernias with or without divarication helps in addressing both the hernias in the extra-peritoneal space. Our technique reduces the area of dissection needed for mesh placement and preserves the integrity of abdominal musculature in the upper abdomen when compared with the conventional technique. It further allows extension of the e-TEP inguinal space into the Rectro rectus space without much alteration in the port arrangement allowing simultaneous repair of groin and umbilical hernias. Good knowledge of anatomy and laparoscopic skills are pertinent for safe and effective hernia repair by this technique.

Abdominal wall hernias are one of the most common surgical diseases present in both males and females nowadays. However, with only a few cases reported in the literature, hepatic round ligament hernias are a rare clinical manifestation. This case shows how a common symptom such as epigastric pain can be associated with this rare condition. In general, abdominal computed tomography (CT) images are the choice of study to evaluate complications and the involvement of different intestinal sections. Some laboratory tests can be performed to suspect intestinal ischemia secondary to strangulated hernias. Primary repair utilizing mesh is the preferred surgical treatment. This procedure can be performed through laparoscopic or open technique, depending on the surgeon\'s skills and patient preference.

Multiple complicated concurrent hernias with obturator hernia and paraesophageal hernia unusually occur in clinical settings. The obturator hernias belong to a rare pelvic hernia that accounts for a minority of all abdominal hernias. Besides, paraesophageal hernias occur commonly in elderly female patients. Clinical manifestations of these hernias are usually unspecific and the diagnosis is based on computed tomography (CT). In this paper, we presented a case of multiple complicated hernias in an 81-year-old woman. She was admitted to our hospital due to intestinal obstruction that was caused by a simultaneous obturator and paraesophageal hernia. She was successfully treated by laparoscopic hernia repair. Postoperative progression was favorable. She was then discharged from the hospital after four hospital days.

暂无摘要。

Paraduodenal hernias, particularly those on the right side, are rare but clinically significant occurrences characterized by the abnormal protrusion of abdominal contents through mesenteric defects adjacent to the duodenum. These hernias result from embryologic malformations and can lead to complications such as intermittent abdominal pain, nausea, and, in severe cases, bowel obstruction. This case describes a 48-year-old male who presented with a 24-hour history of colicky abdominal pain in the right upper quadrant, associated with nausea. Further investigation, including a computed tomography scan, revealed a right paraduodenal hernia with herniation of small bowel loops through a mesenteric defect. Timely surgical intervention via laparoscopic exploration confirmed the diagnosis and facilitated the reduction of herniated bowel, followed by meticulous repair of the mesenteric defect using nonabsorbable sutures. The patient\'s recovery was uneventful, with a return to normal bowel function, and postoperative follow-up showed the resolution of symptoms. This case underscores the clinical complexity and management challenges associated with right paraduodenal hernias. Surgical intervention, guided by laparoscopic exploration, emerged as an effective and minimally invasive approach. The successful reduction of herniated small bowel loops and meticulous closure of the mesenteric defect contributed to a favorable postoperative course, highlighting the importance of timely intervention to prevent complications.

OBJECTIVE: This paper explores the causes of paediatric inguinal hernia (PIH) recurrence after single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC).
METHODS: From January 2015 to December 2020, the clinical data of 3480 children with PIHs who underwent SPLPEC were retrospectively reviewed, including 644 children who underwent SPLPEC with a homemade single-hook hernia needle from January 2015 to December 2016 and 2836 children who underwent the SPLPEC with a double-hook hernia needle and hydrodissection from January 2017 to December 2020. There were 39 recurrences (including communicating hydrocele) during the 2-5 years of follow-up. The findings of redo-laparoscopy were recorded and correlated with the revised video of the first operation to analyse the causes of recurrence.
RESULTS: Thirty-three males and 6 females experienced recurrence, and 8 patients had a unilateral communicating hydrocele. The median time to recurrence was 7.1 months (0-38). There were 20 cases (3.11%) in the single-hook group and 19 cases (0.67%) in the double-hook group. Based on laparoscopic findings, recurrence most probably resulted from multiple factors, including uneven tension of the ligation (10 cases), missing part of the peritoneum (14 cases), loose ligation (8 cases), broken knot (5 cases), and knot reaction (2 cases). All children who underwent repeat SPLPEC were cured by double ligations or reinforcement with medial umbilical ligament.
CONCLUSIONS: The main cause of recurrence is improper ligation. Tension-free and complete PIH ligation are critical to the success of surgery, which requires avoiding the peritoneum skip area and the subcutaneous and muscular tissues. Redo-laparoscopic surgery was suitable for the treatment of recurrent inguinal hernia (RIH). For giant hernias, direct ligation of the internal ring incorporating the medial umbilical ligament (DIRIM) may be needed.

BACKGROUND: Larrey hernias (LH) are birth defects causing abdominal viscera to protrude into the thoracic cavity. With an incidence of 2-4 %, they are exceptional in adults.
METHODS: A 65-year-old female patient was admitted for an elective laparoscopic cholecystectomy. During history intake, besides biliary colic, no additional symptoms were reported. Physical examination yielded normal results. Chest-X ray did not reveal any anomalies. Intraoperatively, an inspection of the diaphragm revealed a 3 cm defect in the left-sided sternocostal triangle, with the omentum protruding through the thorax. After performing cholecystectomy, the content of the LH was cautiously reduced. The hernia sac was not resected, to prevent potential injury to the neighboring anatomical structures. The defect was closed using non-resorbable interrupted sutures. The postoperative course was uneventful. No recurrence was detected during follow-up.
UNASSIGNED: LH diagnosis is challenging due to its unspecific symptoms. Only 10 % of patients are asymptomatic. CT imaging establishes a positive diagnosis and identifies acute complications requiring emergency management.
CONCLUSIONS: Asymptomatic LH cases mandate surgery. Laparoscopic management is safe and efficient. The trans-abdominal approach offers easier access to hernia content. Hernia sac resection is still debatable. The selection of defect closure technique hinges on the quality and elasticity of the tissue, as well as the size of the defect, all under the unwavering banner of the tension-free principle. Literature remains conflicting on mesh use.

Background and objective The role of the pre-peritoneal infiltration of local anesthetic (PILA) in laparoscopic hernia repair has been equivocal. Ultrasound-guided transversus abdominis plane (TAP) block has been extensively studied. However, studies comparing these two methods are very scarce. Hence, this study was undertaken to compare the efficacy of pre-peritoneal plus portal infiltration with TAP block in this population. Materials and methods This double-blinded randomized comparative study was conducted on a total of 32 patients by allotting 16 patients in each group. Group A patients were given pre-peritoneal plus portal infiltration of 15 mL of 0.5% ropivacaine for each technique by the operating surgeon, while Group B patients were administered bilateral TAP block with 0.5% ropivacaine, 15 mL on each side under ultrasound guidance by the anesthesiologist. Results The demographic variables and duration of surgery were comparable between the two groups. Also, the postoperative requirement of fentanyl between the two groups was insignificant. However, the duration of anesthesia was significantly longer in Group B attributing to the extra time taken for the administration of the TAP blocks. Conclusion Both ultrasound-guided TAP block and the PILA plus portal infiltration are effective techniques for pain relief after laparoscopic hernia repair. Either of these two techniques can be chosen depending on the availability of resources, expertise, etc.