inguinal hernia

腹股沟疝
  • 文章类型: Journal Article
    饮食因素与疝气之间的关系目前尚不清楚。
    英国生物库用于提取用作暴露的饮食因素,包括酒精的摄入,非油性鱼,牛肉,新鲜水果,油性鱼,沙拉/生蔬菜,干果,咖啡,麦片,盐,茶,水,煮熟的蔬菜,奶酪,羊肉/羊肉,猪肉,家禽,加工肉,和面包。FinnGen生物库用于获得关于疝气的GWAS数据作为结果。这项研究的主要分析是使用加权中位数进行的,MR-Egger,和IVW方法。Cochran的Q检验用于评估异质性。为了找到潜在的异常值,使用MR-PRESSO方法。采用留一法分析评估IVW方法的稳健性。
    每周饮酒(OR:0.614;p=0.00614)可降低腹股沟疝的风险。饮酒频率(OR:1.309;p=0.0477)增加了腹侧疝(主要包括切口疝和造口旁疝)的风险。摄入非油性鱼(OR:2.945;p=0.0214)会增加腹股沟疝的风险。添加到食物中的盐(OR:1.841;p=0.00267)会增加脐疝的风险。奶酪摄入量(OR:0.434;p=0.000536)和干果摄入量(OR:0.322;p=0.00716)降低了腹壁疝的风险,而摄入煮熟的蔬菜(OR:4.475;p=0.0380)会增加腹侧疝的风险。未发现其他饮食因素与疝气的因果关系。
    腹股沟,脐带缆,脐带缆腹侧疝都与饮食因素有关。
    UNASSIGNED: The relationship between dietary factors and hernias is currently unclear.
    UNASSIGNED: The UK Biobank was used to extract dietary factors that were used as exposures, including intake of alcohol, non-oily fish, beef, fresh fruit, oily fish, salad/raw vegetables, dried fruit, coffee, cereal, salt, tea, water, cooked vegetables, cheese, Lamb/mutton, pork, poultry, processed meat, and bread. The FinnGen biobank was used to obtain GWAS data on hernias as outcomes. The main analysis of this study was performed using the weighted median, MR-Egger, and IVW methods. Cochran\'s Q test was utilized to assess heterogeneity. To find potential outliers, the MR-PRESSO method was used. Leave-one-out analysis was employed to assess the IVW method\'s robustness.
    UNASSIGNED: Alcoholic consumption per week (OR: 0.614; p = 0.00614) reduced the risk of inguinal hernia. Alcohol intake frequency (OR: 1.309; p = 0.0477) increased the risk of ventral hernia (mainly including incisional hernia and parastomal hernia). The intake of non-oily fish (OR: 2.945; p = 0.0214) increased the risk of inguinal hernia. Salt added to food (OR: 1.841; p = 0.00267) increased the risk of umbilical hernia. Cheese intake (OR: 0.434; p = 0.000536) and dried fruit intake (OR: 0.322; p = 0.00716) decreased the risk of ventral hernia, while cooked vegetable intake (OR: 4.475; p = 0.0380) increased the risk of ventral hernia. No causal relationships were found with hernias from other dietary factors.
    UNASSIGNED: Inguinal, umbilical, and ventral hernias are all related to dietary factors.
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  • 文章类型: Case Reports
    Amyand\'s疝是腹股沟疝的一种罕见变种,其特征是疝囊内存在阑尾状阑尾。由于其低发病率和各种临床表现,它代表了外科医生独特的诊断和管理挑战。这里,我们介绍了一个45岁的男性,有一年的右腹股沟阴囊肿胀病史,诊断为右腹股沟斜疝.术前影像学显示疝囊内存在网膜。术中,网膜和阑尾均在囊内发现,无炎症迹象。患者成功进行了Lichtenstein膜成形术,未进行阑尾切除术。该病例强调了在腹股沟疝的鉴别诊断中考虑Amyand\'s疝的重要性以及术中发现在指导手术治疗中的意义。需要进一步的研究和病例报告来增强我们对这种罕见的临床实体的理解并优化患者的预后。
    Amyand\'s hernia is a rare variant of inguinal hernia characterized by the presence of the vermiform appendix within the hernia sac. It represents a unique diagnostic and management challenge for surgeons due to its low incidence and varied clinical presentations. Here, we present a case of a 45-year-old man with a one-year history of right inguinoscrotal swelling, diagnosed as a right indirect inguinal hernia. Preoperative imaging revealed the presence of omentum within the hernia sac. Intraoperatively, both the omentum and the vermiform appendix were found within the sac without evidence of inflammation. The patient underwent successful Lichtenstein meshplasty without appendicectomy. This case highlights the importance of considering Amyand\'s hernia in the differential diagnosis of inguinal hernias and the significance of intraoperative findings in guiding surgical management. Further studies and case reports are needed to enhance our understanding of this rare clinical entity and optimize patient outcomes.
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  • 文章类型: Case Reports
    背景:横向睾丸异位(TTE)是一种罕见的先天性疾病,其特征是两个睾丸通过相同的腹股沟管迁移,通常表现为腹股沟疝。TTE与各种泌尿生殖系统异常有关。
    方法:一个三岁男孩在左侧腹股沟区表现为无法触及的右睾丸和明显的未下降的左睾丸。超声(US)表明左腹股沟管中存在两个睾丸。在手术中,发现两个睾丸有分离的脊髓和一个疝囊,该疝囊被解剖并结扎,因此两个脊髓被释放。接下来,在阴囊两侧都制作了subdartos袋,所以睾丸首先放在左侧,然后在阴囊隔膜中创建一个窗口,该窗口允许右睾丸移位并固定在右下dartos袋中而没有张力。
    结论:TTE是一种罕见的疾病,病因尚不明确。TTE通常表现为腹股沟疝和对侧隐睾。诊断是在手术过程中做出的,但是一些放射学方法可以帮助诊断。管理通常是手术,涉及干预措施,如疝修补术,睾丸和睾丸的减少。持续监测对于确保术后睾丸健康和评估恶性肿瘤的风险至关重要。
    结论:单侧阴囊空虚且有生殖器疾病家族史的患者应怀疑为TTE。美国对准确定位睾丸至关重要,随着手术探查,进行适当的手术干预。
    BACKGROUND: Transverse testicular ectopia (TTE) is a rare congenital condition characterized by migration of both testes through the same inguinal canal and often presents with an inguinal hernia. TTE is associated with various genitourinary anomalies.
    METHODS: A three-year-old boy presented with a non-palpable right testis and a palpable undescended left testis in the left inguinal area. Ultrasound (US) indicated the presence of both testes in the left inguinal canal. In surgery, the two testes were found with separated cord and one hernia sac which was dissected and ligated thus the two cords freed. Next, subdartos pouches were created on both scrotum sides, so that testes placed into the left side first, and then a window created in the scrotal septum which allowed the right testis to be translocated and secured in the right subdartos pouch without tension.
    CONCLUSIONS: TTE is a rare condition and the etiology is not definitively known. TTE usually presents with an inguinal hernia and contralateral cryptorchidism. The diagnosis is made during surgery, but some radiological methods can help in diagnosis. Management is usually surgical and involves interventions such as hernia repair, reduction of the testis and orchiopexy. Continuous monitoring is essential for ensuring postoperative testes health and evaluating the risk of malignancy.
    CONCLUSIONS: TTE should be suspected in cases with unilateral empty scrotum and family history of genital disorders. US is critical for accurately localizing the testes, along with surgical exploration, to proceed with the appropriate surgical intervention.
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  • 文章类型: Journal Article
    背景:Spigelian疝是罕见的原发性腹侧疝。诊断通常很困难,因为许多病例是无症状的。在当前的科学文献中,通常分别考虑Spigelian和腹股沟疝。有了这个案例系列,我们想说明相邻疝气类型之间可能的关系。
    方法:在本文中,我们报道了1月1日在五个疝气中心进行手术的一系列Spigelian疝病例,2021年10月31日,2023年。我们总结了以前手术的所有患者特征以及二次手术的结果。
    结果:我们报告了一个24例Spigelian疝的病例系列,其中15个与以前的腹股沟疝有关。在这些情况下,然而,尚不确定这些是主要被忽视的疝还是隐匿性疝,或者这些Spigelian疝是次要出现的,因为之前的疝气手术.有了这个案例系列,我们想指出Spigelian疝和腹股沟疝之间的可能联系。需要进一步的研究来进一步阐明这一实体并解释其起源。
    BACKGROUND: Spigelian hernias are among the rare primary ventral hernias. Diagnosis is often difficult, as many cases are asymptomatic. Spigelian and inguinal hernias are usually considered separately in current scientific literature. With this case series, we want to illustrate a possible relationship between the neighboring hernia types.
    METHODS: In this article, we report on a case series of Spigelian hernias that were operated on in five hernia centers in the period from January 1st, 2021 to October 31st, 2023. We have summarized all patient characteristics with previous operations and the result of the secondary operation.
    RESULTS: We report a case series with 24 Spigelian hernias, 15 of which have a connection to previous inguinal hernias. In these cases, however, it is not certain whether these are primarily overlooked or occult hernias or whether these Spigelian hernias have arisen secondarily, as a result of previous hernia surgery. With this case series, we would like to point out a possible connection between Spigelian hernia and inguinal hernia. Further studies are needed to shed more light on this entity and explain its genesis.
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  • 文章类型: Journal Article
    背景:知情同意对于确保患者了解其医疗状况至关重要,治疗,和潜在风险。这项研究的目的是调查在选定的普通外科手术中,使用视频同意书与标准同意书对患者知识和满意度的影响。
    方法:我们纳入了118例阑尾切除术患者,胆囊切除术,腹股沟疝修补术,奥马哈的两家医院的胃底折叠术,NE.患者被随机分配到标准同意或视频同意。结果包括对其程序的前测和后测客观知识评估,以及在同意后和出院后立即完成的满意度调查。鉴于岗前设计,对两种结局均采用线性混合效应模型进行估计.双向相互作用效应是评估随机分配给标准或视频同意的患者之间结果的前后变化是否不同的主要兴趣。
    结果:除患者性别外,组间基线特征大多相似,p=0.041。从前测到后测,两组知识均有统计学上的显着增加(标准组:0.25,95%CI0.01至0.51,p=0.048;视频组:0.68,95%CI0.36至1.00,p<0.001),视频组显示出显著更大的变化(交互p=0.043),这表明将视频纳入同意过程可以更好地改善患者对拟议程序的了解.Further,两组出院后满意度均有所下降,但两组之间的下降幅度没有统计学上的显着差异(相互作用p=0.309)。
    结论:视频同意可显著改善患者对拟议治疗的认识。尽管患者满意度调查没有显示出显著差异,它确实显示出一种趋势。我们建议将视频纳入常规普外科手术的同意过程。
    BACKGROUND: Informed consent is essential in ensuring patients\' understanding of their medical condition, treatment, and potential risks. The objective of this study was to investigate the impact of utilizing a video consent compared to standard consent for patient knowledge and satisfaction in selected general surgical procedures.
    METHODS: We included 118 patients undergoing appendectomy, cholecystectomy, inguinal hernia repair, and fundoplication at two hospitals in Omaha, NE. Patients were randomized to either a standard consent or a video consent. Outcomes included a pretest and posttest objective knowledge assessment of their procedure, as well as a satisfaction survey which was completed immediately after consent and following discharge. Given the pre-post design, a linear mixed-effect model was estimated for both outcomes. A two-way interaction effect was of primary interest to assess whether pre-to-post change in the outcome differed between patients randomized to standard or video consent.
    RESULTS: Baseline characteristics were mostly similar between groups except for patient sex, p = 0.041. Both groups showed a statistically significant increase in knowledge from pretest to posttest (standard group: 0.25, 95% CI 0.01 to 0.51, p = 0.048; video group: 0.68, 95% CI 0.36 to 1.00, p < 0.001), with the video group showing significantly greater change (interaction p = 0.043) indicating that incorporating a video into the consent process resulted in a better improvement in patient\'s knowledge of the proposed procedure. Further, both groups showed a decrease in satisfaction post-discharge, but no statistically significant difference in the magnitude of decrease between the groups (interaction p = 0.309).
    CONCLUSIONS: Video consent lead to a significant improvement in a patient\'s knowledge of the proposed treatment. Although the patient satisfaction survey didn\'t show a significant difference, it did show a trend. We propose incorporating videos into the consent process for routine general surgical procedures.
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  • 文章类型: Journal Article
    暂无摘要。
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  • 文章类型: Journal Article
    目的:前列腺癌根治术后复发疝的发生率较高,因此本文探讨前列腺癌根治术后腹股沟疝的发生率及危险因素。
    方法:回顾性分析湖州市第一人民医院2019年3月至2021年5月251例前列腺癌根治术患者的临床资料。根据腹股沟疝的发生,将受试者分为研究组和对照组,并对各组临床资料进行统计学分析,采用多因素Logistic分析寻找预测腹股沟疝发生的独立影响因素。根据腹股沟疝的发生和时间绘制Kaplan-Meier生存曲线。
    结果:前列腺癌手术后腹股沟疝的总发病率为14.7%(37/251),平均时间为8.58±4.12个月。淋巴结清扫术患者腹股沟疝的平均时间为7.61±4.05(月),未进行淋巴结清扫的患者为9.16±4.15(月),两者比较差异无统计学意义(P>0.05)。腹股沟疝的发病率随年龄的变化无统计学意义,BMI,高血压,糖尿病,PSA,既往腹部手术及手术入路(P>0.05),手术方式和盆腔淋巴结清扫方式差异有统计学意义(P<0.05)。腹股沟疝组盆腔淋巴结清扫的发生率为24.3%(14/57),显著高于对照组11.8%(23/194)。Logistic回归分析显示盆腔淋巴结清扫是前列腺癌术后腹股沟疝的危险因素(OR=0.413,95%Cl:0.196~0.869,P=0.02)。Kaplan-Meier生存曲线显示,盆腔淋巴结清扫组腹股沟疝发生率明显高于对照组(P<0.05)。
    结论:盆腔淋巴结清扫是前列腺癌根治术后腹股沟疝的危险因素。
    OBJECTIVE: The incidence of recurrent hernia after radical resection of prostate cancer is high, so this article discusses the incidence and risk factors of inguinal hernia after radical resection of prostate cancer.
    METHODS: This case control study was conducted in The First People\'s Hospital of Huzhou clinical data of 251 cases underwent radical resection of prostate cancer in this hospital from March 2019 to May 2021 were retrospectively analyzed. According to the occurrence of inguinal hernia, the subjects were divided into study group and control group, and the clinical data of each group were statistically analyzed, Multivariate Logistic analysis was performed to find independent influencing factors for predicting the occurrence of inguinal hernia. The Kaplan-Meier survival curve was drawn according to the occurrence and time of inguinal hernia.
    RESULTS: The overall incidence of inguinal hernia after prostate cancer surgery was 14.7% (37/251), and the mean time was 8.58 ± 4.12 months. The average time of inguinal hernia in patients who received lymph node dissection was 7.61 ± 4.05 (month), and that in patients who did not receive lymph node dissection was 9.16 ± 4.15 (month), and there was no significant difference between them (P > 0.05). There were no statistically significant differences in the incidence of inguinal hernia with age, BMI, hypertension, diabetes, PSA, previous abdominal operations and operative approach (P > 0.05), but there were statistically significant differences with surgical method and pelvic lymph node dissection (P < 0.05). The incidence of pelvic lymph node dissection in the inguinal hernia group was 24.3% (14/57), which was significantly higher than that in the control group 11.8% (23/194). Logistic regression analysis showed that pelvic lymph node dissection was a risk factor for inguinal hernia after prostate cancer surgery (OR = 0.413, 95%Cl: 0.196-0.869, P = 0.02). Kaplan-Meier survival curve showed that the rate of inguinal hernia in the group receiving pelvic lymph node dissection was significantly higher than that in the control group (P < 0.05).
    CONCLUSIONS: Pelvic lymph node dissection is a risk factor for inguinal hernia after radical resection of prostate cancer.
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  • 文章类型: Journal Article
    目的:本研究旨在探讨使用内窥镜机械手(EMARO)进行腹腔镜腹股沟疝修补术的手术效果。
    方法:这项回顾性研究包括51例接受腹腔镜腹股沟疝修补术的患者。经腹腹膜前入路(TAPP)已用于治疗腹股沟疝。将患者分为两组:一组采用EMARO(E-TAPP)进行腹腔镜手术,另一组采用常规腹腔镜手术(L-TAPP)。EMARO是一个气动驱动的内窥镜支架机器人。比较两组腹腔镜腹股沟疝修补术的手术效果。
    结果:15例患者接受了E-TAPP,36例接受了L-TAPP。L-TAPP操作需要两名人员,而E-TAPP可以由一名外科医生执行。E-TAPP和L-TAPP组的中位手术时间为81分钟(范围,77-87)和70分钟(范围,60-94),分别,中位失血量为5mL(范围,1-5)和2mL(范围,1-5).然而,这些差异没有统计学意义.EMARO的设置时间约为8分钟(范围,5-12).无患者复发,两组术后并发症发生率相似。在E-TAPP和L-TAPP组中使用术后镇痛药的患者人数分别为4(n=15)和22(n=36),分别,两组之间存在显着差异(p=0.042)。
    结论:使用EMARO进行腹腔镜手术可以减少人工成本和术后疼痛。E-TAPP组的手术效果不劣于L-TAPP组,和E-TAPP也可以安全地进行。
    OBJECTIVE: This study aimed to investigate the surgical outcomes of laparoscopic inguinal hernia repair using an Endoscope Manipulator Robot (EMARO).
    METHODS: This retrospective study included 51 patients who underwent laparoscopic inguinal hernia repairs. The transabdominal preperitoneal approach (TAPP) has been used to treat inguinal hernias. The patients were divided into two groups: one group underwent laparoscopic surgery using EMARO (E-TAPP) and the other group underwent conventional laparoscopic surgery (L-TAPP). The EMARO is a pneumatically driven endoscope-holder robot. The surgical outcomes of laparoscopic inguinal hernia repair were compared between the two groups.
    RESULTS: Fifteen patients underwent E-TAPP, and 36 underwent L-TAPP. The L-TAPP operation requires two personnel, whereas E-TAPP can be performed by one surgeon. The median operation times of the E-TAPP and L-TAPP groups were 81 min (range, 77-87) and 70 min (range, 60-94), respectively, and the median blood loss was 5 mL (range, 1-5) and 2 mL (range, 1-5). However, these differences were not statistically significant. The setup time for EMARO was approximately 8 min (range, 5-12). No patient experienced recurrence, and the postoperative complication rates were similar between the two groups. The number of patients who used postoperative analgesics in the E-TAPP and L-TAPP groups was four (n = 15) and 22 (n = 36), respectively, with a significant difference between the two groups (p = 0.042).
    CONCLUSIONS: Laparoscopic surgery using EMARO can reduce labor costs and postoperative pain. The surgical outcomes of the E-TAPP group were not inferior to those of the L-TAPP group, and E-TAPP could also be safely performed.
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  • 文章类型: Journal Article
    在新毕业的外科医生中,缺乏在开放方法方面的丰富经验,开始腹腔镜手术的可行性仍然是一个令人感兴趣的话题。我们旨在评估该人群中腹腔镜腹股沟疝修补术(LHR)与开放式腹股沟疝修补术(OHR)的安全性和有效性。
    这项回顾性队列研究是在学习阶段由一名最近毕业的外科医生进行的腹股沟疝手术。患者数据收集时间为2021年7月至2022年11月,重点是人口统计学,术中细节,和术后1年的结果。采用非劣效性测试,预定幅度为15%,以比较并发症发生率。复发率,以及LHR和OHR之间的其他次要结果。
    研究队列包括66名患者(OHR组,n=45和LHR组,n=21)。组间患者特征相似。并发症发生率无显著差异(OHR,26.7%和LHR,19.0%;p=0.50)或复发率(OHR,2.2%和LHR,4.8%;p=0.54)。与OHR组相比,LHR组的并发症结局不差,复发,重新接纳,和再操作率。除了手术时间,两组间次要结局无显著差异.
    LHR对于刚毕业的外科医生来说是可行的,与开放修复相比,显示非较差的结果。因此,在开始腹腔镜检查之前必须掌握开腹手术的观点可能是错误的。
    UNASSIGNED: The feasibility of starting laparoscopic surgery among newly graduated surgeons lacking extensive experience in open approaches remains a topic of interest. We aimed to evaluate the safety and efficacy of laparoscopic inguinal hernia repair (LHR) compared to open inguinal hernia repair (OHR) in this population.
    UNASSIGNED: This retrospective cohort study was conducted on inguinal hernia surgeries performed by a single recently graduated surgeon during the learning phase. Patient data were collected from July 2021 to November 2022 with a focus on demographics, intraoperative details, and 1-year postoperative outcomes. Noninferiority testing was employed with a predetermined margin of 15% to compare the complication rates, recurrence rates, and other secondary outcomes between LHR and OHR.
    UNASSIGNED: The study cohort comprised 66 patients (OHR group, n = 45 and LHR group, n = 21). Patient characteristics were similar between groups. No significant differences were observed in the complication rates (OHR, 26.7% and LHR, 19.0%; p = 0.50) or recurrence rates (OHR, 2.2% and LHR, 4.8%; p = 0.54). The LHR group demonstrated noninferior outcomes compared with the OHR group in terms of complication, recurrence, readmission, and reoperation rates. Except for the operative time, secondary outcomes did not differ significantly between the groups.
    UNASSIGNED: LHR is a feasible initiation for recently graduated surgeons, demonstrating noninferior outcomes compared with open repair. Therefore, the belief that one must master open surgery before beginning laparoscopy may be untrue.
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  • 文章类型: Journal Article
    目的:腹股沟疝修补术仍然是最常见的择期普外科手术之一。先前的研究表明,以后的慢性疼痛发生率很高。这项研究的目的是评估在初级保健环境中进行局部麻醉(LA)腹股沟疝手术后生活质量的变化。
    方法:使用欧洲疝学会评分工具在所有患者术前和术后6个月测量生活质量(QoL)。根据初始症状评分,通过三元分组对数据进行分析。
    结果:497名患者在2020年6月至2022年5月之间填写了术前QoL表格。术后QoL评分来自179名患者(164名男性(91.6%))。术前中位数评分为33分(IQR20-48)。术后中位数评分为4分(IQR1-11)。QoL评分的平均改善为27.8。与手术前相比,9例患者在6个月时得分更差(5%)。当按预期的术前QoL组分析数据时,低症状组(评分0-10)的QoL改善最小(0.23),13例患者中有5例(38%)的评分较差。中等组(得分11-40)的QoL平均改善为17.25,92人中有3人(3.2%)的得分较差。高症状组(得分为41-90)的QoL平均改善为45.4,76人中只有1人(1.3%)的得分较差。
    结论:LA腹股沟疝修补术可显著改善术后6个月的QoL。然而,在那些术前评分较低(<11)的患者中,增加幅度很小,术后慢性症状的发生率非常高.我们建议在该组中避免手术,而是采用监测方法。
    OBJECTIVE: Inguinal hernia repair remains one of the most common elective general surgical procedures. Previous studies have suggested high rates of chronic pain afterwards. The aim of this study was to evaluate changes in quality of life after local anaesthetic (LA) inguinal hernia surgery performed in a primary care setting.
    METHODS: Quality of life (QoL) was measured in all patients both pre-operatively and at 6-months post-operatively using the European Hernia Society Scoring tool. Data was analysed by tertile grouping according to initial symptom score.
    RESULTS: 497 patients filled out pre-operative QoL forms between June 2020 and May 2022. Post-operative QoL scores were received from 179 patients (164 male (91.6%)). Median pre-operative score was 33 (IQR 20-48). Median post-operative score was 4 (IQR 1-11). Mean improvement in QoL score was 27.8. Nine patients had a worse score at 6-months compared to pre-op (5%). When the data was analysed by pre-op QoL group as expected the low symptom group (score 0-10) had minimal improvement in QoL (0.23) and 5 out of 13 patients (38%) had a worse score. The medium group (score 11-40) had a mean improvement in QoL of 17.25 with 3 out of 92 (3.2%) experiencing a worse score. The high symptom group (score 41-90) had a mean improvement in QoL of 45.4 with only 1 of 76 (1.3%) experiencing a worse score.
    CONCLUSIONS: LA Inguinal hernia repair improves QoL substantially 6-months after surgery. However, in those patients with low pre-operative scores (< 11) the gain is minimal and rates of chronic symptoms following surgery are very high. We recommend avoiding surgery in this group and instead adopting a surveillance approach.
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