[Total endoscopic pre-peritoneal mesh implant in primary or recurrent inguinal hernias]. Synchronous femoral hernias diagnosed during endoscopic inguinal hernia repair Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study Outcomes of Lichtenstein Hernioplasty for Primary and Recurrent Inguinal Hernia A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias Effectivity of laparoscopic inguinal hernia repair (TAPP) in daily clinical practice: early and long-term result Randomized clinical trial of mesh versus non-mesh primary inguinal hernia repair: long-term chronic pain at 10 years. Prospective, randomized, controlled trial comparing lightweight versus heavyweight mesh in chronic pain incidence after TEP repair of bilateral inguinal hernia The Endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach A randomized prospective trial comparing clinical outcomes 3 years after surgery by Marcy repair and Prolene Hernia System® repair for adult indirect inguinal hernia 
Totally extraperitoneal repair of recurrent inguinal hernia
 Longterm results of a prospective study of 225 femoral hernia repairs: indications for tissue and mesh repair. [Tension-free laparoscopic versus open inguinal hernia repair]. Low reoperation rates in young males after sutured repair of indirect inguinal hernia: Arguments for a tailored approach. Scrotal hernias: a contraindication for an endoscopic procedure? Randomized clinical trial of Desarda versus Lichtenstein repair for treatment of primary inguinal hernia. Does nerve identification during open inguinal herniorrhaphy reduce the risk of nerve damage and persistent pain? Randomized, Controlled, Blinded Trial of Tisseel/Tissucol for Mesh Fixation in Patients Undergoing Lichtenstein Technique for Primary Inguinal Hernia Repair: Results of the TIMELI Trial Groin hernia repair in young males: mesh or sutured repair? Sperm motility after laparoscopic inguinal hernia repair with lightweight meshes: 3-year follow-up of a randomised clinical trial Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: Are there differences in the outcome? Laparoscopic repair of recurrent inguinal hernias. A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair
INTRODUCTION Since 1994 we perform laparoscopic total extraperitoneal hernia repair ( TEP ) for primary and recurrent inguinal hernias at our institution . The aim of this study was to investigate and compare the results of TEP in primary inguinal hernias and recurrent inguinal hernias and to determine whether there are differences in patient data , complication rates and outcome between these two groups . METHODS In a prospect i ve trial 338 patients were analyzed who underwent 500 laparoscopic TEP repairs .  In all , 431 TEP repairs were performed for primary inguinal hernias , and 69 for recurrent inguinal hernias . For data acquisition the SALTC study protocol was used . All patients were clinical ly examined 3 and 12 months after the operation . RESULTS The mean operation time was 67.3 min for TEP repair of primary hernias and 68.1 min for TEP repair of recurrent hernias , respectively . The conversion rate to an open procedure was 0 % . Conversion from TEP into TAPP was required in 0.5 % of patients with primary inguinal hernias and 1.4 % of patients with recurrent inguinal hernias . As the sole difference between the two groups the intraoperative complication rate could be identified . In the TEP repair group of recurrent inguinal hernias a higher incidence of injury to the peritoneum and a higher occurrence of bleeding from the epigastric vessels was found ( P = 0.03 ) . The postoperative complication rate was identical in the two groups , amounting to 5.1 % and 5.7 % , respectively . No differences were found in the 1 year follow-up between the two groups . The 1-year recurrence rate was 0.5 % for primary hernias . However , in the group of recurrent hernias there have been no recurrences to date . CONCLUSIONS The use of laparoscopic TEP repair has proven to be a safe and effective treatment in patients with primary and recurrent inguinal hernias . Because of scar tissue with possible adhesions a higher intraoperative complication rate was observed in the TEP repair of recurrent hernias than in TEP repair of primary inguinal hernias . However , no single recurrence was observed in the TEP repair group of recurrent hernias . In our opinion TEP is the optimal hernia repair for recurrent and bilateral inguinal hernias Background During totally extraperitoneal ( TEP ) endoscopic repair of inguinal hernias , it is possible to see the internal opening of the femoral canal . The aim of our study was to determine the incidence of synchronous femoral hernias found in patients undergoing TEP endoscopic inguinal hernia repair .  Method This was a retrospective review of prospect ively collected data on 362 consecutive patients who underwent 484 TEP endoscopic inguinal hernia repairs during a 5-year period , May 2005 to May 2010 . During surgery , both inguinal and femoral canal orifices were routinely inspected . The presence of unilateral or bilateral inguinal and femoral hernias was recorded and repaired accordingly . Results There were a total of 362 patients . More males ( 343 , 95 % ) underwent a TEP hernia repair than females ( 19 , 5 % ) . There were more cases of unilateral ( 240/362 , 66 % ) than bilateral ( 122/362 , 34 % ) inguinal hernias . A total of 18 cases of synchronous femoral hernias were found during operation . There was a higher incidence of femoral hernia in females ( 7/19 , 37 % ) compared to males ( 11/343 , 3 % ) ( P < 0.001 ) . None of the femoral hernias were clinical ly detectable preoperatively . Conclusion Females undergoing elective inguinal hernia repair are more likely to have a synchronous femoral hernia than males . We suggest that all women presenting with an inguinal hernia also have a formal assessment of the femoral canal . TEP endoscopic inguinal hernia repair is an ideal approach as both inguinal and femoral orifices can be assessed and hernias repaired simultaneously during surgery Background The current prospect i ve r and omized controlled clinical study aim ed to assess the short- and long-term results of recurrent inguinal hernia repair , and to compare the results for transabdominal preperitoneal ( TAPP ) and totally extraperitoneal ( TEP ) procedures with those for open tension-free repair . Methods For this study , 82 patients were r and omly assigned to undergo TAPP ( group A , n = 24 ) , TEP ( group B , n = 26 ) , or open Lichtenstein hernioplasty ( group C , n = 32 ) . All the patients with recurrent inguinal hernias had undergone previous repair using conventional open procedures . Physical examination showed  Nyhus type II hernia in the vast majority of the patients ( 59 % ) . High-risk patients ( American Society of Anesthesiology [ ASA ] III or IV ) ; coagulation disorders ; previous abdominal or pelvic surgery ; and irreducible , congenital , and massive scrotal or sliding hernias were excluded from the study . Results There was a statistically significant difference ( p = 0.001 ) in operating time favoring the open procedure . The intensity of postoperative pain was greater in the open hernia repair group 24 h , 48 h , and 7 days after surgery ( p = 0.001 ) , with a greater consumption of pain medication among these patients ( p < 0.004 ) . The median time until return to work was 14 days for group A , 13 days for Group g , and 20 days for group C. The comparison was in favor of laparoscopically treated patients . Nine recurrences ( 4 in the laparoscopic groups and 5 in the open group ) were documented within 3 years of follow-up evaluation . Conclusion Laparoscopic inguinal hernia repair ( TAPP or TEP ) is the method of choice for dealing with recurrent inguinal hernia Introduction The Lichtenstein hernioplasty for the repair of primary inguinal hernia in male patients is well established and constitutes the current gold st and ard . However a gold st and ard technique for the repair of recurrent inguinal hernia has not been established . The aim of this study was to analyze the outcomes of Lichtenstein hernioplasty for the repair of primary inguinal hernia and recurrent inguinal hernia , applying for that purpose the Qualitative and Quantitative Measurement Instrument ( QQMI ) . Methods We studied 75 recurrent inguinal hernia patients and 287 primary inguinal hernia patients with a follow-up period ranging from 60 to 107 months . Results The final QQMI score demonstrated that most patients in both groups reached scores between 8 and 11 points , with a significant difference in the maximum score ( 11 points ) favoring primary hernia patients . Conclusions All evaluated parameters showed better outcomes in primary hernia patients . Applying the QQMI , we have demonstrated that the outcomes of  Lichtenstein hernioplasty  are not similar between primary and recurrent inguinal hernia ; there is a tendency toward better outcomes for primary inguinal hernia patients , although the Lichtenstein hernioplasty st and s as a safe option for repair of recurrent inguinal hernias Background Inguinal hernia recurrence after surgical repair is a major concern . The authors report their experience with open and laparoscopic repair of recurrent inguinal hernias . Methods After institutional review board approval , a retrospective review was performed with the charts of 197 patients who had undergone surgical repair of recurrent inguinal hernias from January 2000 through August 2009 , and the data for 172 patients who met the inclusion criteria were analyzed .  Surgical variables and clinical outcomes were compared using Student ’s t test , the Mann – Whitney U test , chi-square , and Fisher ’s exact test as appropriate . Results The review showed that 172 patients had undergone either open mesh repair ( n = 61 ) or laparoscopic mesh repair ( n = 111 ) for recurrent inguinal hernias . Postoperative complications were experienced by 8 patients in the open group and 17 patients in laparoscopic group ( p = 0.70 ) . Five patients ( 8.2 % ) in the open group and four patients ( 3.6 % ) in the laparoscopic group had re-recurrent inguinal hernias ( p = 0.28 ) . Four patients in the open group ( 9.5 % ) and no patients in the laparoscopic group had recurrence during long-term follow-up evaluation ( p = 0.046 ) . In the laparoscopic group , 76 patients ( 68.5 % ) underwent  total extraperitoneal  ( TEP ) repair , and 35 patients ( 31.5 % ) had  transabdominal preperitoneal ( TAPP ) repair . Postoperative complications were experienced by 13 patients in the TEP group and 4 patients in the TAPP group ( p = 0.44 ) . Two patients ( 2.6 % ) in the TEP group and two patients ( 5.7 % ) in the TAPP group had re-recurrent inguinal hernias ( p = 0.59 ) . Conclusions This retrospective review showed no statistical difference in the re-recurrence rate between the two techniques during short-term follow-up evaluation . However , the laparoscopic technique had a significantly lower re-recurrence rate than the open technique during long-term follow-up evaluation . Both procedures were comparable in terms of intra- and postoperative complications . Among laparoscopic techniques , TEP and TAPP repair are acceptable methods for the repair of recurrent inguinal hernia . A multicenter prospect i ve r and omized control trial is needed to confirm the findings of this study Introduction The aim of the study was to investigate the effectiveness of laparoscopic inguinal hernia repair in daily clinical practice . Patients and methods All patients admitted to the hospital for surgery of an inguinal hernia during a 1-year period were prospect ively documented and included in a follow-up study . The follow-up was performed at least 5 years after surgery and consisted of a clinical examination , ultrasound investigation and a question naire . Results From January 2000 to January 2001 a total of 1208 inguinal hernias in 952 patients were consecutively operated by a total of 11 general surgeons in daily clinical routine . Of the patients , 98.02 % were operated on laparoscopically with the transabdominal preperitoneal patch plasty technique ( TAPP ) and 1.98 % had an open repair . The frequency of intraoperative and early postoperative complications was 2.8 % . The complication rate in the patients presenting a complex hernia was not higher than in patients with uncomplicated unilateral hernias . Life-threatening complications were seen in four patients ( bowel lesion—0.4 % ) , but all four patients presented extensive adhesions in the abdominal cavity after previous abdominal surgery . The follow-up rate after 5 years was 85.3 % . After 5 years the recurrence rate was 0.4 % and the rate of severe chronic pain 0.59 % . None of the patients took analgesics or had to change his occupation . Conclusion Laparoscopic repair can be applied to all types of inguinal hernia as a daily routine procedure with low rates of recurrences and chronic pain . Limiting factor may be extensive adhesions after previous major surgery in the lower abdomen BACKGROUND Open mesh or non-mesh inguinal hernia repair may influence the incidence of chronic postoperative pain differently . METHODS A total of 300 patients scheduled for repair of a primary unilateral inguinal hernia were r and omized to non-mesh or mesh repair .  The primary outcome measure was clinical outcome including persistent pain and discomfort interfering with daily activity . Long-term results at 3 years of follow-up have been published . Included here are 10-year follow-up results with respect to pain . RESULTS Of the 300 patients , 87 patients ( 30 % ) died and 49 patients ( 17 % ) were lost to follow-up . A total of 153 were physically examined in the outpatient clinic after a median long-term follow-up of 129 months ( range , 109 to 148 months ) . None of the patients in the non-mesh or mesh group suffered from persistent pain and discomfort interfering with daily activity . CONCLUSIONS Our 10-year follow-up study provides evidence that mesh repair of inguinal hernia is equal to non-mesh repair with respect to long-term persistent pain and discomfort interfering with daily activity . An important new finding from the patient 's perspective is that chronic postoperative pain seems to dissipate over time Background This prospect i ve , clinical , r and omized , controlled study was performed to define the incidence of chronic pain after total extraperitoneal ( TEP ) repair with a light-weighted mesh compared with heavyweight mesh in patients with bilateral inguinal hernias . Methods Consecutive patients with bilateral inguinal hernias were recruited for TEP inguinal hernia repair under general anesthesia . Heavyweight mesh was r and omly assigned to one side of the groin and lightweight mesh to the other . Patients were followed up regularly for up to 1 year by an independent surgeon who was unaware of the mesh assignment . The postoperative pain score by means of a visual analogue scale ( VAS ) and other data were recorded . Results Fifty bilateral TEP hernia repairs were performed between September 2007 and February 2009 . Six patients ( 12 % ) complained of chronic pain 3 months after the operation . A higher average pain score was observed for the side of hernia repaired by heavyweight mesh compared with lightweight mesh , but the difference was not statistically significant . More patients complained about foreign body sensation on the side repaired with heavyweight mesh ( 24 % ) compared with the side with lightweight mesh ( 8 % ; P < 0.05 ) . There was no recurrence or need for reintervention for either type of mesh . Conclusions Lightweight polypropylene mesh may be preferable to heavyweight mesh for TEP inguinal hernia repair because it provides less postoperative foreign body sensation ; however , there was no significant difference in the incidence of chronic pain Introduction Seroma is a frequent complication of endoscopic totally extraperitoneal ( TEP ) mesh repair of direct inguinal hernia that may cause discomfort and anxiety . Its volume is proportional to the size of the preperitoneal dead space created after the reduction of the hernia . Attempts to reduce its incidence have included tacking the transversalis fascia ( TF ) to the pubic ramus or closed suction drainage of the preperitoneal space . Both of these techniques are not without problems . The aim of this study was to evaluate the efficiency of a new alternate technique that must be safe and easily reproducible , using a widely available and inexpensive pre-tied suture loop ( Endoloop ® Ligature ) for plication of the weakened TF . Methods This is a prospect i ve study of consecutive patients diagnosed with inguinal hernia during a 33-month period and eligible for endoscopic TEP repair . A single surgeon performed all operations . Each of the M2 or M3 direct defects , according to the European Hernia Society ( EHS ) , were systematic ally closed prior to the introduction of the prosthetic mesh and as follows : grasping and inversion of the attenuated TF at its apex , using a laparoscopic forceps and plication of the TF by placing a tight Endoloop of Polydioxanone ( PDS ) at its base . All meshes were secured with fibrin sealant only . Patients were review ed in the clinic 2 and 6 weeks after the operation . Further follow-up was scheduled if it was deemed necessary . The primary post-operative outcome parameter was seroma formation ; secondary outcome parameters included groin pain , surgical complications , and recurrence . Results Two hundred and fifty hernia repairs were prospect ively recorded during this period . All procedures were carried out endoscopically . Seventy-nine patients with 94 direct inguinal hernias were selected in a sequential manner . There were 75 males and four females , with a median age of 57 years . Of those , 55 were combined with an indirect inguinal defect . In total , Endoloops of PDS were used to close the weakened TF in 76 cases ( 30 M3 , 44 M2 , and two M1 ) . Only one patient ( 1.3 % ) complained of a residual seroma formation , which was still clinical ly present at 3 months post-operatively , but was not symptomatic . There were only two minor post-operative complications , which occurred in the same patient and were not related to the Endoloop technique . Finally , no patient complained of chronic groin pain and there was no hernia recurrence after a median follow-up of 18 months . Conclusions The primary closure of direct inguinal hernia defects with a pre-tied suture loop during endoscopic TEP repair is safe , efficient , and very reliable for the prevention of post-operative seroma formation , without increasing the risk of developing chronic groin pain or hernia recurrence . This technique should be the preferred method over stapling of the TF or the insertion of a closed suction drainage device in such a situation Purpose The use of mesh in the surgical repair of adult indirect inguinal hernias is widely recommended in Western countries , but no r and omized controlled trials have so far been reported in Japan . The purpose of the present r and omized prospect i ve trial was to compare a mesh method with non-mesh method for surgical repair of primary adult indirect inguinal hernias in which the diameter of the internal inguinal ring was up to 3.0 cm ( I-1 or I-2 of Japanese Hernia Society Classification ) . Methods Patients with a primary unilateral inguinal hernia and I-1 or I-2 surgical findings were r and omized to undergo either Marcy repair or Prolene Hernia System ® repair . Primary endpoints were recurrence , infection , and pain , with follow-up continued for 3 years postoperatively . Results Ninety-one of 479 patients with an inguinal hernia during the study period did not meet the exclusion criteria , and 46 were allocated to Marcy repair and 45 were allocated to Prolene Hernia System ® repair .  No recurrence was observed in either group , and no significant differences were identified between the groups in any of the primary endpoints . Conclusion This r and omized prospect i ve trial of I-1 and I-2 inguinal hernias suggests that Marcy repair is not inferior to PHS repair . A large-scale r and omized controlled trial appears warranted to confirm whether to use mesh for Japanese adult I-1 and I-2 hernias Background : A variety of procedures with substantial differences in results are employed to treat recurrent inguinal hernia . The advantages of totally extraperitoneal patch repair ( TEP ) are even more evident when it is applied to recurrent compared to primary hernias . To investigate the superiority of this method more closely , we review ed our results obtained for recurrent inguinal hernias over a period of 2 years . Methods : We performed a prospect i ve single-center study using data obtained in consecutive patients with recurrent inguinal hernia who were operated on in 1997 and 1998 . Results : A total of 179 patients with recurrent inguinal hernia were recruited . Overall , 1329 patients with inguinal hernia were treated in the 2-year period , of whom 1270 underwent TEP .  The percentage of recurrent hernias was 14 % . The average age of the patients was 56 years . The follow-up rate was 87.5 % , and the mean follow-up period was 2.3 years . The 154 patients who were followed up underwent a total of 225 hernia repairs  , of which 181 were for recurrent hernias . The average operating time was 57 min . In 68 % ( 104/154 ) of the patients , adhesions , adherent epigastric vessels , or cicatricial changes were found , which result ed in the inadvertant opening of the peritoneum in 26.3 % of the patients . All the openings in the peritoneum were closed by endoscopic suturing . Intraoperative complications developed in 4 patients ( 2.3 % ) , including one injury to the bladder and three cases of bleeding from side branches of the epigastric vessels . The conversion rate was 0 % . The sole postoperative complication was treatment requiring hematomas in 7 patients , in 2 of whom reoperation became necessary . In both cases , a diffuse hemorrhage due to a preoperatively undiagnosed coagulation disorder was found . No cases of wound or patch infection were observed . In a patient undergoing both primary and recurrent hernia repair , displacement of a mesh led to a recurrence on the primary hernia side ( recurrence rate , 0.4 % ; re-recurrence rate , 0 % ) . Conclusions : Although for its definitive management , recurrent hernia requires a reliable operative technique , current data do not support the recommendation of any of the currently available procedures as the gold st and ard . In a representative patient population with recurrent hernia , we were able to demonstrate that TEP achieves very good results in terms of re-recurrence rate , intraoperative and postoperative complications , and rehabilitation . Prerequisites for the reliable and low-complication application of the method are a high level of st and ardization of the procedure and an advanced learning curve BACKGROUND Femoral hernias are uncommon , and there are relatively few clinical studies of longterm outcomes after repair . Although the McVay repair has been classically described , the infrainguinal plug technique has gained popularity in recent years . Evidence supporting these repairs is sparse . STUDY DESIGN A prospect i ve study of elective femoral hernia repairs was done at the Shouldice Hospital from June 1999 until June 2003 . The tissue-based complete groin repair ( CGR ) and a preperitoneal mesh repair were performed for specific indications . Patients were followed annually for 5 years to examine for recurrences and complications . RESULTS Two hundred fifty-six patients were enrolled , with 225 completing 5 years of followup . Median age was 55 years , and hernias on the right side were more common ( 63.1 % ) . Concurrent inguinal hernias were found in 115 patients ( 51 % ) , and 41 ( 18.2 % ) had a previous inguinal hernia repair . A complete groin repair was performed in 120 patients and a preperitoneal mesh repair in 78 . The remaining had an infrainguinal mesh repair . The overall recurrence rate was 3.1 % , with a median time to recurrence of 12 months . There was no significant difference between mesh and suture repairs . Chronic postoperative pain was experienced by 20 patients ( 8.9 % ) . CONCLUSIONS Femoral hernias can be repaired electively with a tissue-based or a preperitoneal mesh technique , with durable longterm results . Mesh repair is indicated for recurrent femoral hernias , inguinofemoral hernias , prevascular hernias , association with concurrent direct hernias , and , if tension is anticipated , with complete groin repair . Infrainguinal mesh repair is used only when there has been a successful previous inguinal hernia repair AIM During the last decade laparoscopic techniques have been applied to the treatment of inguinal hernia to combine tension-free technique , esthetic , and functional benefits of mini-invasive surgery . Anyway controversy persists regarding the most effective inguinal hernia repair . The aim of this study is to compare the open technique and the laparoscopic approach concerning : complications , recurrences , recovery time and return to usual activity . METHODS A r and omized prospect i ve analysis of 121 consecutive inguinal hernia repairs was performed over a 12-month period . Male well-informed patients with primary monolateral inguinal hernia ( ASA I-II ) were divided into 2 groups and consecutively treated ; group A was treated with  laparoscopic transabdominal preperitoneal approach ( TAPP ) ( median age 47+/-7 years , 57 patients ) , group B with open mesh herniorrhaphy ( 45+/-6 years , 64 patients ) . RESULTS Complication rate was 5.26 % for group A ( none needed conversion ) and 4.68 % for group B. All complications were considered minor . No recurrences were observed over a 12-month follow-up in both groups . Post-operative hospital stay and return to activity show statistically significant differences . Median post-hospital stay was 1.7 days for group A while it was longer ( 2.9 days ) for group B. Significant difference was observed in the duration of convalescence too ( group A 9.3+/-7.2 days ; group B 12.1+/-7 . 1 days ) . CONCLUSION On the basis of our experience , even if a longer follow-up is needed , the validity of laparoscopic approach to inguinal hernia is confirmed . General anesthesia and higher costs are reasonable compromises for a shorter period of discomfort in patients with a low ASA index and busy job/sport activity BACKGROUND The aim of this study was to investigate the reoperation rates after open indirect inguinal hernia repair with and without mesh in young males and other age groups . Younger males have higher risk of developing chronic pain after open inguinal hernia repair with mesh compared with older patients . Avoiding mesh among younger patients could be justified , if they have an acceptable low risk of recurrence compared with other groups and compared with Lichtenstein repair . METHODS Data were extracted from the nationwide Danish Hernia Data base which is recording prospect ively . Included were males with primary indirect inguinal hernia , repaired with Lichtenstein or annulorrhaphy from the period January 1 , 1998 to December 31 , 2015 .  Reoperation rate for recurrence was used as outcome . RESULTS In total 52,281 primary repairs of open indirect inguinal hernia were included of which 49,951 were Lichtenstein repairs and 2330 were annulorrhaphies .  The overall reoperation rates increased year after year in both groups but the 18 - 29 year old males had a significant lower risk of reoperation after annulorrhaphy compared with all other age groups ( cumulative reoperation rate 8.1 % versus 12.5 % , log rank p = 0.001 ) . CONCLUSIONS The cumulative reoperation rate after annulorrhaphy for 18 - 29 year old males was significantly lower compared with all other age groups . When taken into consideration , that young males at the same time have the highest risk of developing chronic pain after mesh repair the results indicate , that annulorrhaphy could be a valid option for young men with indirect inguinal hernias . Thus , we propose a tailored approach for this patient group Abstract Introduction : Endoscopic repair was introduced for use with inguinal hernia therapy more than 10 years ago . The technique as well as the indications for this method are debated , however . As a borderline inguinal hernia situation , the scrotal hernia in particular evokes vehement objections to an endoscopic procedure because of the anticipated problems and complications in dissecting the extended hernia sac . The efficiency of the laparoscopic transabdominal preperitoneal ( TAPP ) technique in the treatment of scrotal hernia therefore is discussed in this article . methods : Laparoscopic hernia repair ( TAPP ) has been performed in our department since 1993 . Data are collected by a prospect i ve documentation of operative and follow-up results . For evaluation , a comparison of scrotal and normal hernia repair was performed . Results : Between April 1993 and June 1998 the TAPP technique was used to treat 191 scrotal hernias , 42 ( 22 % ) of which were recurrent hernias . The median operating time for a nomal inguinal hernia repair was 45 min , whereas scrotal hernias required a median of 65 min and irreducible scrotral hernias a median of 68.5 min . Major complications were observed in 1.6 % of scrotal and 0.6 % of normal inguinal hernia repairs . The most frequent scrotal hernia repair problem was the formation of a seroma , 10.5 % of which had to be avacuated . During a follow-up period of 30 months , we found a total of two recurrences ( 1.05 % ) . Conclusion : In scrotal hernia repair , TAPP is not associated with higher complication rates and can be performed with efficiency comparable with that in normal inguinal hernia repair BACKGROUND The ideal operation to treat inguinal hernia is still far to define . We analyzed the outcomes of the Desarda tissue-based repair in comparison with the st and ard Lichtenstein procedure in treatment of primary  inguinal hernia .  METHODS A total of 168 patients were r and omly allocated into two groups to undergo one of two repairs : Desarda ( group I ) or Lichtenstein ( group II ) ( 85 vs. 83 , respectively ) . The primary outcome measures were recurrence of inguinal hernia and chronic groin pain . Secondary outcome measures included operating time , postoperative pain scores , time to return to normal gait and to work , foreign body sensation in the groin , and postoperative complications . RESULTS During 2-year follow up , one recurrence was detected in each group ( P = 0.99 ) . Chronic groin pain was experienced by 5.6 % and 4.2 % of patients from Desarda and Lichtenstein groups respectively ( P = 0.68 ) . There was no significant statistical difference in mean postoperative VAS scores for pain at the five time points between the two study groups . There was significantly shorter operating time and earlier return to normal gait in favor of Desarda repair . Foreign body sensation was not different between the two groups . CONCLUSION Successful inguinal hernia treatment without mesh implantation can be achieved using Desarda repair , as it is effective as the st and ard Lichtenstein procedure . Shorter operating time , early return to normal gait and lower cost ( no mesh ) are potential benefits of Desarda repair . The suitability of Desarda repair for patients found to have thin , weak or divided external oblique aponeurosis intraoperatively needs further evaluation Purpose Nerve identification during open inguinal hernia herniorrhaphy  has been suggested as one of the factors that may reduce the risk of development of persistent postherniorrhaphy pain . In this prospect i ve study , we evaluated whether intraoperative inguinal nerve identification influenced the risk of development of persistent postherniorrhaphy pain , sensory dysfunction in the groin and functional ability score after open hernia repair . Methods A total of 244 men with a primary inguinal hernia underwent open Lichtenstein repair in a high-volume hernia surgery centre , where information on inguinal nerve identification was registered during operation . Before the operation and 6 months postoperatively , functional pain-related impairment was assessed with Activities Assessment Scale and pain intensity scores with Numeric Rating Scale ( NRS 0–10 ) . Quantitative sensory testing in the groin was performed before operation and 6 months postoperatively , in order to investigate intraoperative inguinal nerve damage . Results The intraoperative nerve identification rates for the iliohypogastric , ilioinguinal and genitofemoral nerves were 94.7 , 97.5 and 21.3 % , respectively . Thirty-nine patients ( 16.0 % ) had substantial pain-related functional impairment at 6 months follow-up . There was no difference in risk of development of substantial pain-related functional impairment in patients with identification compared with non- identification of the iliohypogastric nerve ( P = 1.0 ) , the ilioinguinal nerve ( P = 0.59 ) , the genitofemoral nerve ( P = 0.40 ) or all nerves ( P = 0.52 ) . There were no differences in regard to sensory loss in the groin area or in regard to improvement in functional outcome following surgery , between patients with and without nerve identification . Conclusions Although intraoperative inguinal nerve identification should be aim ed at , other factors may contribute to the risk of nerve damage and persistent pain after open groin hernia repair Objective : Test the hypothesis that fibrin sealant mesh fixation can reduce the incidence of postoperative pain/numbness/groin discomfort by up to 50 % compared with sutures for repair of inguinal hernias using the Lichtenstein technique . Background : Inguinal hernia repair is the most common procedure in general surgery , thus improvements in surgical techniques , which reduce the burden of undesirable postoperative outcomes , are of clinical importance . Methods : A r and omized , controlled , patient- and evaluator-blinded study ( Tissucol/Tisseel for MEsh fixation in LIchtenstein hernia repair [ TIMELI ] ; trial NCT00306839 ) was conducted among patients eligible for Lichtenstein repair of uncomplicated unilateral primary inguinal small – medium sized hernia . Patients were subject to mesh fixation with either fibrin sealant or sutures . Main outcome measures were visual analogue scale ( VAS ) assessment s for “ pain , ” “ numbness , ” and “ groin discomfort ” on a scale of 0 = best and 100 = worst outcome . The primary endpoint was a composite that evaluated the prevalence of chronic disabling complications ( VAS score > 30 for pain/numbness/groin discomfort ) at 12 months after surgery . Results : In total , 319 patients were r and omized between January 2006 and April 2007 ( 159 fibrin sealant , 160 sutures ) . At 12 months , the prevalence of 1 or more disabling complication was significantly lower in the fibrin sealant group than in the sutures group ( 8.1 % vs 14.8 % ; P = 0.0344 ) . Less pain was reported in the fibrin sealant group than in the sutures group at 1 and 6 months ( P = 0.0132 ; P = 0.0052 ) , as reflected by a lower proportion of patients using analgesics in the fibrin group over the study duration ( 65.2 % vs 79.7 % ; P = 0.0009 ) . Only 3 of 316 patients ( 0.9 % ) experienced recurrence . The incidences of wound-healing complications and other adverse events were comparable between groups . Conclusions : Fibrin sealant for mesh fixation in Lichtenstein repair of small – medium sized inguinal hernias is well tolerated and reduces the rate of pain/numbness/groin discomfort by 45 % relative to sutures without increasing hernia recurrence ( NCT00306839 ) Background Large-scale data for the optimal inguinal hernia repair in younger men with an indirect hernia is not available . We analysed nationwide data for risk of reoperation in younger men after a primary repair using a Lichtenstein operation or a conventional non-mesh hernia repair .  Methods Prospect i ve recording of all inguinal hernia repairs  from 1 January 1998 to 31 December 2005 in the national Danish Hernia Data base , using reoperation rate as a proxy for recurrence . We included only men between the age of 18 and 30 years with a primary repair of a primary indirect inguinal hernia . Results A primary sutured repair was performed in 1,120 men ( median age 23 years , range 18–30 ) and a Lichtenstein mesh repair in 2,061 young men ( 24 years , range 18–30 ) ( total 3,181 patients ) . The observation time after  conventional hernia repair  was median 62 months ( range 0–96 ) and 41 months ( range 0–96 ) after a Lichtenstein repair . The cumulative incidence of reoperation at 5 years was 1.6 % ( Lichtenstein ) versus 3.9 % ( sutured repair ) , while overall reoperation rates were almost three-fold as high after a sutured repair ( 39 reoperations , overall reoperation rate = 3.5 % ) compared to a Lichtenstein repair ( 24 reoperations , overall reoperation rate = 1.2 % ; P = 0.0003 ) . Conclusions Lichtenstein repair for an indirect inguinal hernia reduces the risk of recurrence in young men between the age of 18 and 30 years compared with a sutured repair . The use of a Lichtenstein mesh repair in young males must be balanced against the risk of chronic pain Purpose To analyse the effects of lightweight meshes in laparoscopic inguinal hernia repair on male fertility aspects , chronic pain development and recurrence at 3-year follow-up . Methods Fifty-nine male patients with a primary , unilateral or bilateral inguinal hernia were r and omised to laparoscopic inguinal hernia repair using a st and ard polypropylene ( Marlex ® ) or lightweight mesh ( VyproII ® , TiMesh ® ) . Patients attended clinical follow-up 3 years postoperatively , at which male fertility aspects , by semen analysis and scrotal ultrasound , chronic pain status ( McGill Pain Question naire ) , quality of life ( SF-36 ) and recurrence were assessed , or completed quality of life , pain and hernia-specific question naires at home . Results In total , 49 patients ( 83.1 % ) completed follow-up ( median follow-up = 39.1 months ) , by question naire and /or clinical follow-up . As other semen parameters and scrotal ultrasound results , sperm motility was unchanged compared to 1 year postoperatively , but not significantly different between VyproII ® and TiMesh ® versus Marlex ® patients ( −8.5 % and −8 % vs. −2.8 % ; P = 0.23 ) . Pain perception and quality of life were comparable between the heavyweight and lightweight groups , and no change was noted in comparison with 1 year postoperatively . Chronic pain incidence was 6.1 % ( 3 patients ) , without occurrence of disabling pain . Three patients were clinical ly diagnosed with a recurrent hernia ( 5.9 % ) . Conclusions The decrease in sperm motility in patients operated on with a lightweight mesh compared to patients operated on with a heavyweight mesh 1 year after laparoscopic inguinal hernia repair could not be confirmed at 3 years follow-up . Furthermore , heavyweight and lightweight groups were comparable regarding quality of life , chronic pain and recurrence rate Abstract Introduction To date , there are no prospect i ve r and omized studies that compare the outcome of endoscopic repair of primary versus recurrent inguinal hernias . It is therefore now attempted to answer that key question on the basis of registry data . Patients and methods In total , 20,624 patients were enrolled between September 1 , 2009 , and April 31 , 2013 . Of these patients , 18,142 ( 88.0 % ) had a primary and 2482 ( 12.0 % ) had a recurrent endoscopic repair . Only patients with male unilateral inguinal hernia and with a 1-year follow-up were included . The dependent variables were intra- and postoperative complications , reoperations , recurrence , and chronic pain rates . The results of unadjusted analyses were verified via multivariable analyses . Results Unadjusted analysis did not reveal any significant differences in the intraoperative complications ( 1.28 vs 1.33 % ; p = 0.849 ) ; however , there were significant differences in the postoperative complications ( 3.20 vs 4.03 % ; p = 0.036 ) , the reoperation rate due to complications ( 0.84 vs 1.33 % ; p = 0.023 ) , pain at rest ( 4.08 vs 6.16 % ; p < 0.001 ) , pain on exertion ( 8.03 vs 11.44 % ; p < 0.001 ) , chronic pain requiring treatment ( 2.31 vs 3.83 % ; p < 0.001 ) , and the recurrence rates ( 0.94 vs 1.45 % ; p = 0.0023 ) . Multivariable analysis confirmed the significant impact of endoscopic repair of recurrent hernia on the outcome . Conclusion Comparison of perioperative and 1-year outcome for endoscopic repair of primary versus recurrent male unilateral inguinal hernia showed significant differences to the disadvantage of the recurrent operation . Therefore , endoscopic repair of recurrent inguinal hernias calls for particular competence on the part of the hernia surgeon BACKGROUND Repair of  recurrent inguinal hernias  is associated with recurrence rates as high as 30 % and complication rates higher than for primary hernias . PATIENTS AND METHODS In a prospect i ve study , results were evaluated after  laparoscopic transabdominal preperitoneal hernia repair in 192 patients with 200 recurrent inguinal hernias . A total of 132 hernia repairs  followed one previous repair , 41 followed two repairs , 17 followed three repairs , 6 followed four , 3 followed five , and 1 followed six previous repairs . The surgical technique is described . RESULTS Follow-up ranged from 9 to 31 months ( mean 18.4 ) . Twelve patients ( 6 % ) had groin seromas or hematomas ; 3 ( 1.5 % ) had transient thigh numbness . One patient ( 0.5 % ) underwent laparoscopy a second time because of a large hematoma . In 1 patient ( 0.5 % ) , a staple on the n. cutaneus femoris lateralis was removed laparoscopically . Patients described postoperative pain as being much less severe compared with their previous operation . Of the total group , 76 % of patients were able to return to work within 2 weeks of surgery . One recurrence ( 0.5 % ) occurred after 6 months because of too small a prosthetic mesh . CONCLUSIONS This laparoscopic technique can be applied to recurrent hernias , even in difficult cases , with low morbidity rates . Recurrence rates as low as for laparoscopic repair of primary hernias can be expected Background Laparoscopic inguinal hernia repair has been around since the 1990s . A novel surgical approach known as laparoendoscopic single-site surgery ( LESS ) has been developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery , including totally extraperitoneal ( TEP ) inguinal hernia repair . The aim of the present study was to evaluate the safety and feasibility of the LESS TEP technique for inguinal hernia repair and compare the outcomes with the st and ard TEP approach . Methods Between January and May 2009 , 54 consecutive healthy patients ( 48 men and 6 women ) underwent LESS TEP inguinal hernia repair at our institute . All procedures were performed using our homemade single port for simultaneous passage of the laparoscope and instruments . The perioperative data , including patient age , sex , body mass index ( BMI ) , hernia characteristics , operative time , complications , length of hospital stay , return to normal activity , pain score , and cosmetic result , were prospect ively collected . Results All LESS TEP procedures were completed successfully without conversion to st and ard laparoscopic or open surgery . A total of 98 LESS TEP hernia repairs were performed in 54 patients and compared with 152 st and ard TEP operations . The mean operative time was significantly shorter in the st and ard TEP series ( 61.8 ± 26.0 vs. 70.9 ± 23.8 min , p = 0.04 ) . Other perioperative parameters , including the length of hospital stay , time until return to full activity , complication rate , pain score , and cosmetic result , were all comparable between the two techniques . Conclusion Our short-term experience with LESS TEP inguinal hernia repair has shown that in experienced h and s , inguinal hernia repair via the LESS TEP technique is as safe as the st and ard TEP technique . However , based on our evidence , we currently believe that the LESS TEP technique is not an efficacious surgical alternative to the st and ard TEP technique for inguinal hernias
There is insufficient epidemiologic evidence to draw meaningful conclusions about ( i ) the existence of causal associations between specific occupational mechanical exposures and the development of inguinal hernia , and ( ii ) the influence of these exposures on prognosis after inguinal hernia repair with respect to hernia recurrence and persistent pain
OBJECTIVES The aim of this review was to evaluate the epidemiologic evidence for ( i ) a causal effect of occupational mechanical exposures on incidence of inguinal hernia , and ( ii ) a prognostic effect of such exposures on hernia recurrence and persistent pain after inguinal hernia repair .