A case of indirect inguinal bladder hernia treated by laparoscopic hernia repair

Inguinal bladder hernia is a rare clinical condition, and only a small number of reported cases have been treated by laparoscopic surgery. In the present case, the patient was a 78-year-old man who presented to our emergency department with a chief complaint of right inguinal bulge and pain. CT imaging revealed an incarcerated right inguinal hernia containing the small intestine and a portion of the urinary bladder. We performed manual reduction of the incarcerated intestine, and he was admitted to the surgical ward for follow-up. On the 19th day after discharge, recurrence of incarceration developed, and he was readmitted after manual reduction. A laparoscopic transabdominal preperitoneal repair was performed. After careful reduction of the protruding bladder from the hernial orifice, we repaired the right inguinal hernia with a mesh prosthesis. We experienced a rare case of right indirect inguinal bladder hernia that was treated successfully with laparoscopic repair.     

腹腔镜TAPP术治疗复发性腹股沟疝的临床效果

目的探讨腹腔镜经腹腹膜前修补术(TAPP)治疗复发性腹股沟疝的临床效果。方法回顾性分析我院2011年9月至2016年2月行TAPP治疗的腹股沟疝162例患者的临床资料,根据腹股沟疝情况将患者分为原发疝组(142例)与复发疝组(20例)。所有患者在全身麻醉下行腹腔镜TAPP治疗。比较两组的手术时间、术中出血量、术后住院时间、术后并发症发生情况以及复发情况。结果原发疝组的手术时间短于复发疝组(P<0.05);两组的术中出血量及术后住院时间比较,差异无统计学意义(P>0.05)。两组的术后近、远期并发症总发生率及复发率比较,差异无统计学意义(P>0.05)。结论腹腔镜TAPP治疗复发性腹股沟疝可避开前次手术的解剖异常及粘连,疗效可靠,且不增加术后并发症发生率和复发率。     

Development of a novel training system for laparoscopic inguinal hernia repair

Background: Laparoscopic inguinal hernia repair is considered technically difficult. Although a simulation-based curriculum has been developed to help trainees, access to simulation training outside North America is limited. This study aimed to develop an educational system for the transabdominal preperitoneal (TAPP) approach based on the TAPP checklist, an assessment tool we had developed and validated earlier.

Material and methods: Consensus within the TAPP education working group consisting of local TAPP experts, hernia experts and a surgical educator to develop educational tools and the educational system based on the TAPP checklist. The system was piloted in several institutes, and participants were surveyed on its efficacy.

Results: We systematically developed an educational video and training manual explaining each item of the TAPP checklist and conveying basic knowledge of the procedure. We integrated the training tool with evaluation and feedback to develop an educational system. In a pilot study, seven trainees at five hospitals were trained using this system and found it very useful for mastering the TAPP procedure.

Conclusions: We have developed a training system for TAPP procedure and successfully implemented it in several hospitals. Further research will focus on the educational value of this tool.     

腹腔镜经腹腔腹膜前网片疝修补术和开放疝修补术的随机对照研究

目的 通过一项随机临床试验对腹腔镜经腹腔腹膜前网片疝修补术（TAPP）和开放式疝修补术进行比较.方法 将101例腹股沟疝病人随机分成腹腔镜组（n=51）及开放手术组（n=50）,分别行TAPP和开放无张力疝修补术（Lichtenstein修补）,术后对病人进行随访,比较2组病人的相关参数.结果 腹腔镜组病人的手术时间比开放组长（P＜0.05）.2组术中并发症率无差异.术后1周的腹腔镜组的并发症率较开放组高（P＜0.05）.腹腔镜组病人的住院时间、恢复工作的时间比开放组短（P＜0.05）.术后1年,腹腔镜组病人发生慢性疼痛的比率与开放组相比差异无显著性（P＞0.05）.结论 TAPP治疗腹股沟疝是可行的、安全的,且在术后恢复方面较开放无张力修补更有优势.     

Rare presentation of De Garengeot hernia treated by transabdominal preperitoneal hernia repair: A case report

We present a rare case of De Garengeot hernia treated with simultaneous laparoscopic appendectomy and transabdominal preperitoneal hernia repair. Our patient was an 85-year-old man with a bulging mass in the right groin. De Garengeot hernia was observed on contrast-enhanced CT. Urgent laparoscopy showed the distal part of the appendix passing through a right-sided femoral hernia. Laparoscopic appendectomy was performed, followed by transabdominal preperitoneal repair of the femoral hernia. Pathological examination revealed ischemic necrosis of the appendix. The patient's postoperative recovery was uneventful.     

Incarcerated obturator hernia treated using a hybrid laparoscopic and anterior preperitoneal approach: A case report

Obturator hernia (OH) is a rare cause of bowel obstruction. Although several surgical approaches, including the laparoscopic approach, have been reported to date, a standard approach for treating OH has not been established. A 101‐year‐old woman who presented with constipation and vomiting was admitted to our hospital. CT revealed an incarcerated small bowel within the left obturator foramen, and a diagnosis of left‐sided incarcerated OH with small bowel ileus was made. With the patient under general anesthesia, exploratory laparoscopy was performed; we identified an OH with an incarcerated small bowel, which was judged viable after hernia reduction. We repaired the hernia using an anterior preperitoneal approach under laparoscopic assistance and placed a prosthetic mesh over the obturator foramen. The patient recovered with no postoperative complications and was discharged on postoperative day 4. A hybrid laparoscopic and anterior preperitoneal approach is safe and effective for treating an incarcerated OH in an elderly patient.     

腹腔镜经腹腔腹膜前疝修补术治疗复发性腹股沟疝的效果及安全性

目的 探讨腹腔镜经腹腔腹膜前疝修补术治疗复发性腹股沟疝的效果及安全性。方法 回顾性选取2018年1月至2021年1月本院收治的72例复发性腹股沟疝患者,依据手术方法将其分为对照组（疝环充填式无张力疝修补术）和研究组（腹腔镜经腹腔腹膜前疝修补术）,每组36例。比较两组的手术相关指标、疼痛程度、应激反应指标及术后并发症发生情况。结果 研究组的术中出血量少于对照组,首次下床时间、疼痛持续时间及住院时间均短于对照组（P<0.05）。术后1、3 d及1周,研究组的SF-MPQ评分均低于对照组（P<0.05）。手术后,两组的β-EP、Cor、CRP水平均较手术前明显升高,但研究组低于对照组（P<0.05）。研究组的术后并发症总发生率为5.56%,低于对照组的25.00%(P<0.05)。结论 与疝环充填式无张力疝修补术相比,采用腹腔镜经腹腔腹膜前疝修补术治疗复发性腹股沟疝可减轻疼痛程度及应激反应,促进患者恢复,安全性更高。     

Bilateral inguinal hernia after axillary‐femoral artery bypass effectively treated with laparoscopic repair: A case report

We report herein our experience with bilateral inguinal hernia surgery for a patient who had previously undergone a Y‐shaped vascular graft for an abdominal aortic aneurysm and then right axillary‐bilateral femoral artery bypass surgery. Preoperative physical examination and imaging revealed a subcutaneous vascular graft passing from the right axilla through the right flank region and branching at the lower abdomen to reach the femoral areas on both sides. As repair surgery by inguinal incision was considered difficult, we performed laparoscopic surgery. Bilateral direct hernia was observed on intraperitoneal observation. Essentially no intraperitoneal organ adhesion to the abdominal wall was present, and the previous surgery was also confirmed not to have reached the inguinal preperitoneal space. Transabdominal preperitoneal repair was therefore performed, yielding favorable results.     

Long‐term pain after inguinal hernia repair in a population‐based cohort; risk factors and interference with daily activities

In the Swedish Hernia Register 2834 inguinal hernia repairs in 2583 patients were registered in the county of Uppsala 1998–2004. In May 2005 the 2421 patients still alive were requested by mail to fill in a validated questionnaire concerning postherniorrhaphy pain. The final response rate became 72%. Altogether 519 patients (29%) stated that they had pain in the operated groin to some extent during past week. In 98 patients (6%) the pain interfered with daily activities. Factors associated with an increased risk of residual pain in a multivariate logistic regression analysis were age below median, operation for recurrence, open repair technique, history of preoperative pain, and less than three years from surgery. Factors not associated with occurrence of residual pain were gender, method of anaesthesia during surgery, hernia sac diameter, postoperative complications, hernia type, need for emergency operation, reducibility of the hernia sac and complete dissection of the hernia sac. Factors found to be associated with impairment of function due to pain in a multivariate logistic regression analysis were: age below median, female gender, medial hernia, open repair technique, postoperative complications, need for operation for recurrence, presence of preoperative pain and less than three years from surgery. The possibility of long‐term pain as an outcome after hernia operations should be taken into consideration in the decision making prior to operation.     

Use of the transabdominal approach to repair Morgagni hernia in a 28‐year‐old symptomatic female: A case report

Morgagni''s hernia is a congenital diaphragmatic hernia, which represents only 3% of all diaphragmatic hernias. Herein, we report a case of a 28‐year‐old symptomatic female patient with Morgagni''s hernia who underwent a transabdominal surgery for hernia repair and mesh placement.     

Short‐term outcome of single‐incision laparoscopic totally extra‐peritoneal inguinal hernia repair

We performed single‐incision laparoscopic surgery for totally extra‐peritoneal (SILS‐TEP) repair using a lightweight mesh fixed by absorbable tacks and without balloon dilation. Thirty‐four patients (mean age, 66.5 years) underwent SILS‐TEP repair in our hospital between September 2011 and April 2012; 30 patients had unilateral hernia and 4 had bilateral hernias. Mean operative time was 85.6 min for unilateral hernia and 137.7 min for bilateral hernias. All patients underwent successful SILS‐TEP repair. Mean hospital stay was 3.4 days. Mean duration of follow‐up was 7.1 months. Four seromas were observed, but no recurrences or major complications occurred. SILS‐TEP is an economical and useful method for decreasing postoperative complications, such as neuralgia and recurrence, and it could be an attractive approach for inguinal hernia.     

Asymptomatic mesh infection 6 years after laparoscopic totally extraperitoneal inguinal hernia repair: A rare case report

This report aims to discuss a case of asymptomatic mesh infection 6 years after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair and to reveal that the risk of mesh infection may occur after a long period of this surgery. This report is also intended to suggest surgeons pay more attention to the follow‐up of such patients and to be aware of the possibility of mesh infection to assist in early diagnosis and treatment. A 63‐year‐old male patient, who underwent TEP inguinal hernia repair 6 years ago for right inguinal hernia, fell down accidentally 2 weeks ago. Enhanced computed tomography(CT) showed right lower abdomen cystic lesions, so he underwent laparoscopic surgery during which abscess caused by delayed mesh infection was found. After removing the mesh and abscess, he was discharged. The risk of mesh infection after TEP inguinal hernia repair is low, but it can last for more than 6 years and can even be asymptomatic as long as the mesh remains in the body.     

Unusual case of De Garengeot hernia: femoral hernia containing purulent appendicitis in a 69-year-old man

A De Garengeot hernia is a rare type of femoral hernia that involves a vermiform appendix within a femoral hernia sac. Because of the rarity of this disease, a standard surgical procedure has not been established, and most cases are diagnosed intraoperatively. Preoperative diagnosis of a De Garengeot hernia is quite difficult. Computed tomography is the most sensitive and specific technique among the available imaging tests for preoperative diagnosis of a De Garengeot hernia. Although a standard surgical procedure is lacking, prompt surgery has become the consensus. The most common procedure is the open anterior approach; this allows exploration of the hernia sac and rapid treatment of its contents, routine appendectomy through a single incision, and preperitoneal repair of the femoral hernia.     

Mesh repair of sacrococcygeal hernia via a combined laparoscopic and sacrococcygeal approach: A case report

BACKGROUND Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a patient who had no history of sacrococcygeal operation, present the operative procedures of mesh repair via a combined laparoscopic and sacrococcygeal approach that has not been described,and discuss our experience in diagnosis and treatment with a review of the literature.CASE SUMMARY A 54-year-old woman who chiefly complained of a 10-year history of a reversible bulge in her right sacrococcygeal region was admitted to our hospital. The physical examination revealed a bulge in the right sacrococcygeal region upon standing, which disappeared in the prone position but relapsed when performing the Valsalva manoeuvre. Computed tomography displayed an abnormality in the structure of the tissues between the midline of the sacrococcygeal region and the right gluteus muscle. The patient was diagnosed with sacrococcygeal hernia and received hernia repair with mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally, and a defect was identified in the right anterior sacrococcygeal region through which part of the rectum protruded. This was followed by the placement of a self-gripping polyester mesh via a sacrococcygeal approach. There were no postoperative complications. The patient was discharged on postoperative day 7 and was followed for more than 6 mo with no recurrence.CONCLUSION Laparoscopic mesh repair is recommended as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.     

Laparoscopic surgery for a hydrocele of the canal of Nuck with an ovarian tumor: An extremely rare clinical finding

This clinical image presents an unusual report of simultaneous laparoscopic resection of a hydrocele of the canal of Nuck and an ovarian tumor. Laparoscopic treatment with a proper approach is a useful technique in some cases.     

Mesh plug erosion into the small intestine after inguinal hernia repair: A case report

BACKGROUNDMesh plug (MP) erosion into the intra-abdominal organs is a rare but serious long-term complication after inguinal hernia repair (IHR), and may lead to aggravation of symptoms if not treated promptly. It is difficult to diagnose MP erosion as there are no obvious specific clinical manifestations, and surgery is often needed for confirmation. In recent years, with the increased understanding of postoperative complications, MP eroding into the intra-abdominal organs has been a cause for concern among surgeons.CASE SUMMARYA 50-year-old man was referred to the Department of General Surgery with the complaint of abdominal pain in the right lower quadrant for 2 d. He had a surgical history of right open IHR and partial thyroidectomy performed 20 years and 15 years ago, respectively. Computed tomography revealed a circinate high-density image with short segmental thickening of the ileum stuck to the abdominal wall, and no evidence of recurrent inguinal hernia. Laparoscopic abdominal exploration confirmed adhesion of the middle segmental portion of the ileal loop to the right inguinal abdominal wall; the rest of the small intestine was normal. Further exploration revealed migration of the polypropylene MP into the intraperitoneal cavity and formation of granulation tissue around the plug, which eroded the ileum. Partial resection of the ileum, including the MP and end-to-side anastomosis with an anastomat, was performed.CONCLUSIONSurgeons should aim to improve their ability to predict patients at high risk for MP erosion after IHR.     

Laparoscopic repair of a large perineal hernia after laparoscopic abdominoperineal resection: A case report

A 75‐year‐old woman underwent laparoscopic abdominoperineal resection. Four months after abdominoperineal resection, the patient complained of a perineal bulge and urination disorder. Abdominal CT showed protrusion of the small intestine and bladder to the perineum. The patient underwent laparoscopic hernia repair with mesh. The size of the hernial orifice was 7.0 × 9.0 cm, and it had no solid rim. The mesh was tacked ventrally to the pectineal ligament and dorsally to the sacrum, and then sutured on the lateral side. The hernia has not recurred 10 months after the operation. Laparoscopic repair is a good treatment choice for secondary perineal hernia and fixing the mesh to the pectineal ligament, and the sacrum prevents the mesh from sagging.