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1

Safe and uncomplicated inguinal hernia surgery in the elderly – message from anesthesiologists to general surgeons

100%

Chlebny T., Zelga P., Pryt M., Zelga M., Dziki A.

Polish Journal of Surgery

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2017

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vol. 89(2)

5-10

EN

Introduction Elderly patients are often discouraged from surgery due to the risk of complications that increases with age. Aim We wanted to assess mortality, morbidity, and complications in patients older than 75 years who underwent elective or emergency inguinal hernia repair in a single center. Methods All patients older than 75 years who were operated on because of inguinal hernia in the Department of General and Colorectal Surgery, Medical University of Lodz between 2003 and 2015 were analyzed. Detailed information was collected with regard to patient demographics, mode of admission, comorbidities, type of intervention, applied anesthesia, and 30-day outcomes. Postoperative outcomes included medical and surgical complications, readmissions, and survival status. Results One hundred thirty-two patients older than 75 years were operated on for inguinal hernia, 16 (12.1%) in an emergency setting and 116 (87.9%) in an elective setting. Eighteen patients (13.6%) developed complications, 8 (50%) in the emergency group, and 10 (8.6%) in the elective group. In the emergency group, severe medical complications (Clavien-Dindo 4) were frequent, whereas in the elective group, severity of surgical and medical complications was not significantly different (Clavien-Dindo median score 2, p=0.6084), and these complications were classified as mild (Clavien-Dindo 1-2). One death occurred in the emergency group. Conclusion Inguinal hernia surgery in the elderly may be safe and effective in an elective setting and if regional anesthesia is used. Careful examination of patients before surgery and identification of potential risk factors associated with co-existing diseases are vital for reducing the risk of complications. Key point: Hernia surgery in patients older than 65 years is a low-risk intervention, if carried out in an elective setting.

2

Do we need changes in the organization of training in the hernia treatment in Poland? A survey on the acknowledgment of the recommendations of international hernia societies by surgeons

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Mitura K., Dąbrowiecki S., Śmietański M., Matyja A.

Polish Journal of Surgery

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2017

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vol. 89(5)

12-18

EN

In the therapy of an inguinal hernia, there is a huge variety in the way of treating and the choice of surgical technique. Practice shows that the intraoperative improvisation and surgeons’ own modifications of the original techniques have become part of routine procedure. No mandatory hernia registration system causes the actual detailed herniology status in our country remains unknown. The aim of the study was to summarize the results of a survey on knowledge of a hernia according to the standards developed by international hernia societies compared with everyday clinical practice. During the International Conference Hernia in Poland, which took place on 10 December 2016 in Zakopane we conducted an interactive session among 106 surgeons dealing with hernias. Surgeons responded to 66 questions about daily surgical practice and decision making in their centers, and 27 questions for the assessment of the world’s latest treatment recommendations regarding groin hernias. The most common method of using the implant technique Lichtenstein, used by 91% of doctors. 20% of surgeons in planned operations in adult men routinely uses no mesh technique. Almost 80% of respondents do not apply TEP or TAPP. Only 45.7% of surgeons customize surgical technique to the patient. Only 7 of the 27 analyzed recommendation has been accepted by more than 90% of respondents. 9 of the 27 recommendations were approved by less than half of the surgeons. In the case of 11 recommendations, surgeons simultaneously failed to comply with these recommendations in daily practice. Deficiencies in the system of training and the underfunding of medical procedures cause insufficient TAPP/ TEP availability in Poland in an inguinal hernia. Improvement of the surgeons’ knowledge on how to perform surgery

3

Assesment of Inflammatory Response Intensity in Early Postoperative Period in Patients After Hernioplasty Operated on with Classic Stoppa Method and Videoscopic TEP Method

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Libiszewski M., Drozda R., Białecki J., Wieloch M., Hedayati M., Kuzdak K., Kołomecki K.

Polish Journal of Surgery

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2011

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vol. 83

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issue 9

497-501

EN

The aim of the study was comparison of inflammatory response intensity through estimation of CRP, IL-6 and WBC concentration in blood serum in patients before and after inguinal hernia operations with Stoppa and TEP method.Material and methods. The study involoved 117 patients operated on inguinal hernia between 2006-2008. The patients were divided into two groups. In the first group (group I - 56) Stopp'a method was used, in the second (group II - 61) TEP method. The patients selection was coincidental. All examined patients were men between 25-75 years old (mean age 54.3). Moreover, the operation's time, state of postoperative wound, the average hospitalization time and intensity of pain were estimated. The observations were directed over two weeks after operation.Results. The inflammatory response estimated with CRP, IL-6 concentration in blood serum was considerably higher in patients operated with Stoppa method. There wasn't observed a relevant difference in increase of white blood cells' concentration in both groups. Moreover, the patients operated on with TEP method experienced lower pain. In group, operated on with Stoppa method, 3 cases of wound healing complications were observed. The operation's time was considerably shorter in the first group. The hospitalization time, was considerably shorter in patients operated on with videoscopic method.Conclusions. The operation of inguinal hernia with TEP technique in comparison with Stopp'a method is connected with considerably lower inflammatory response of organism, what directly involve with postoperative pain abridgment and reduction of hospitalization time. Moreover it may have influence on frequency of postoperative complications related with wound healing.

4

Current treatment of the inguinal hernia — the role of the totally extraperitoneal (TEP) hernia repair

100%

Łomnicki J., Leszko A., Kuliś D., Szura M.

Folia Medica Cracoviensia

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2018

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vol. 58

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issue 3

5

Outcomes of Endoscopic Totally Extraperitoneal (TEP) repair of clinically occult inguinal hernia diagnosed with ultrasonography

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Kebabci E., Ozturk S., Unver M.

Polish Journal of Surgery

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2021

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vol. 93

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issue 4

11-14

EN

Inguinal hernias generally present with groin lump and pain. Although inguinal hernias can be diagnosed clinically in most cases, patients without a groin lump pose a considerable diagnostic challenge. The first-line diagnostic imaging tool in these cases is ultrasound (US) and the recommended surgical procedure is laparoscopic-endoscopic repair. This retrospective study aims at evaluating postoperative results and complication rates of TEP technique in patients with occult contralateral hernias diagnosed with US in comparison to patients with clinically diagnosed hernias. A retrospective study was conducted to evaluate the outcomes of TEP procedure in patients with radiologically diagnosed occult contralateral hernias in comparison to patients with clinically diagnosed hernias. All hernias included in this study were repaired by TEP technique and secured with an extraperitoneal mesh. Demographic data, patient characteristics and perioperative information were obtained by reviewing medical records. A total number of 109 patients were enrolled in the study. The majority of patients were male and the mean age was 48.9 ± 14.6 years. In 56 cases, hernias were repaired unilaterally, while the remaining 53 were repaired bilaterally. Right-sided hernias were more common than left-sided hernias. The morbidity rate was 7.1% in unilateral repairs and 3.8% in bilateral repairs. The recurrence rate was 3.6% for unilateral repairs and 5.7% for bilateral repair. Some studies report that the incidence of clinical contralateral inguinal hernias identified after primary unilateral surgery is approximately 10%. If these contralateral hernias were diagnosed prior to the primary surgery, the risk of performing another operation could be avoided. Laparoscopic surgery enables bilateral hernia repair without any additional incisions, presenting similar morbidity rates when compared to unilateral repair. There was no significant difference between unilateral and bilateral TEP repair in terms of intraoperative and postoperative surgical complications. These results suggest that laparoscopic inguinal hernia repair is a safe and effective surgical technique for both unilateral and bilateral procedures. In order to prevent second operation, all patients with suspected inguinal hernia should undergo an US examination before surgery.

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Inguinal hernia management in preterm infants: addressing current issues of interest

88%

Patoulias I., Gkalonaki I., Patoulias D., Patoulias I., Gkalonaki I., Patoulias D.

Folia Medica Cracoviensia

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2020

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vol. 60

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issue 4

7

Groin Hernia Surgery in Northern Ghana - Humanitarian Mission of Polish Surgeons in Tamale

88%

Mitura K., Kozieł S., Pasierbek M.

Polish Journal of Surgery

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2015

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vol. 87

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issue 1

16-21

EN

Availability of surgical care in Africa is severely limited. This is due to the lack of surgeons and a small number of public hospitals. Only 25 out of 100,000 patients with inguinal hernia undergo a surgical treatment. As many as 65% of inguinal hernia repairs are performed urgently because of incarceration. Among patients with incarceration who do not reach the hospital there is recorded as many as 87 deaths per 100 cases. In order to improve the availability of treatment of inguinal hernia in Africa, humanitarian medical missions involving surgeons from Europe are organized. During regular visits to selected centers in Africa, they also carry out intensified treatment of patients and training of the local staff. The aim of the study was to present the experience of Polish surgeons from the humanitarian medical mission in Tamale in northern Ghana undertaken in fall of 2014. Material and methods. Surgical repair was performed in 87 patients (74 men – 85% and 13 women – 15%) between the ages of 26 to 70 years (mean 52.8 years; SD 10.3), who underwent a total of 98 inguinal hernia repairs under local anesthesia. Results. Lichtenstein procedure was performed in 93 and Desarda technique in 5 patients. Patients reported the long-term presence of hernia symptoms - from one to 7 years (mean 3.4 years, SD 1.4). In most patients, hernia occurred more than 3 years earlier (61 patients; 70%). There were no intraoperative complications. All patients were discharged the next day after surgery. There was one wound infection in postoperative period which required mesh explantation. Conclusions. Inguinal hernia commonly found in Ghana is a major issue for the inefficient health care system. Humanitarian medical missions can help to improve the treatment results, as long as they are carried out periodically and allow for training of local personnel. Scarce equipment of medical facilities in Ghana is not a significant difficulty in performing the Lichtenstein repair under the local anesthesia.

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Tailored Repair in Inguinal Hernia Surgery Using the Head-Score

88%

Peiper C., Schinkel S., Brinkmann D., Junge K., Klinge U., Schumpelick V.

Polish Journal of Surgery

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2007

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vol. 79

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issue 2

63-69

EN

The aim of the study. To support a tailored inguinal hernia repair, we developed a score system based on anamnestic risk factors for recurrence.Material and methods. We used the HEAD-Score in a county hospital and suggested mesh repair in scores of 15 or greater. Patients were followed in a prospective study for 2 weeks and 12 months.Results. We used mesh repair in 61.5% of the 281 inguinal hernia repairs. In mesh repair, we observed significantly more seroma formation (48.5% vs 20.4%). We found only two recurrences after Lichtenstein repair. In the Shouldice group, two patients underwent re-operation due to an ilioinguinal entrapment syndrome.Conclusions. Tailored inguinal hernia repair with the help of the HEAD-Score is possible and leads to acceptable complication rates and a low recurrence rate (0.9%) after one year. The risk of mesh-depended complications can be reduced with this approach.

9

Inguinal pain syndrome. The influence of intraoperative local administration of 0.5% bupivacaine on postoperative pain control following Lichtenstein hernioplasty. A prospective case-control study.

88%

Cybułka B.

Polish Journal of Surgery

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2017

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vol. 89(2)

11-25

EN

With current technological advancement and availability of synthetic materials used in inguinal hernia repair, a recurrence after first intervention is not a common and important adverse event. On the other hand, however, some patients complain about chronic pain of the operated site after surgeries using a polypropylene mesh. Many patients are constrained to a prolonged use of analgesics and increased frequency of control visits, which may eventually result in loss of trust in the operator. Every surgical intervention is associated with the risk of immediate or delayed complications. Genitofemoral neuralgia is associated with dysfunction of peripheral nerves passing through the inguinal canal or the surrounding tissue and it is a chronic, troublesome and undesired complication of an inguinal hernia repair. The possibility of minimizing chronic inguinal pain by proper management during herniorraphy should be considered in all cases of an inguinal canal reconstruction. The aim of the study was to investigate whether an intraoperative injection of 0.5% bupivacaine into the operated site (preemptive analgesia) has an influence on the postoperative pain assessed on the day of operation as well as the 1st and 2nd postoperative day after Lichtenstein hernioplasty of an inguinal, scrotal or recurrent hernia. In the studied population, we attempted to identify risk factors affecting pain level after surgical repair of an inguinal, scrotal or recurrent hernia. Materials and methods. During the period between December 2015 and May 2016, 133 patients with preoperative diagnosis of an inguinal (81.95%, n=109), scrotal (13.53%, n=18) or recurrent hernia (4.51%, n=6) underwent an elective intervention and were randomly allocated to the group, which intraoperatively received 20 mL of 0.5% bupivacaine locally in selected anatomical points of the inguinal canal. In the group with preoperative diagnosis of an inguinal hernia, this intervention was applied in 56.88% of cases (n=62). In the case of scrotal or recurrent hernia, a similar intervention was applied in 41.67% (n=10) of patients. During the hospital stay, pain was assessed four times a day using the NRS numeric scale. All patients received preoperative antibiotic prophylaxis, and, during observation, analgesics and low-molecular-weight heparin were used. In the studied group, risk factor were identified, which affect the pain level associated with surgical treatment of an inguinal hernia. Results: Mean pain level score according to the NRS scale (0-10) for an inguinal hernia was 4.17 on day 0 (standard deviation 2.22; minimum 0; maximum 10). On day 1 – 2.86 (standard deviation 1.86; minimum 0; maximum 8). On day 2 – 0.84 (standard deviation 1.21; minimum 0; maximum 5). The values of those parameters for a scrotal and recurrent hernia were as follows: on day 0 – 3.67 (standard deviation 1.76; minimum 0; maximum 7). On day 1 – 3.79 (standard deviation 1.67; minimum 0; maximum 7). On day 2 – 2.25 (standard deviation 1.54; minimum 0; maximum 4). Intraoperative application of 20 mL 0.5% bupivacaine did not reduce the postoperative pain on the postoperative day 0, 1, 2. Among independent risk factors exacerbating pain, the following variables were identified: local complications of the operated site including edema, ecchymosis and hematoma of the inguinal region. More frequent dressing changes were directly correlated with an increased pain sensation. Postoperative urethral catheterization due to urinary retention was associated with an increased pain immediately after surgery. In the case of intraoperative diagnosis of concurrent direct and indirect hernia (so-called pantaloon hernia), less intense pain was observed on postoperative day 0. Other parameters such as age, sex, duration of operation, duration of hospitalization and wound drainage did not influence the pain sensation. Conclusions: Local injection of an analgesic into the operated site was not associated with the reduction of pain assessed on postoperative day 0, 1 and 2 after an isolated inguinal, scrotal or recurrent hernia repair. Pathologies of the operated site such as edema, ecchymosis or hematoma were associated with an increased pain sensations on observation. Also, postoperative urinary retention and urethral catheterization increased the pain sensation after an inguinal hernia repair. A lack of wound complications significantly decreased the pain sensation during the immediate postoperative period after hernia repair.

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Analysis of exercise tolerance on the basis of six-minute walk test – 6MWT and Borg RPE scale in men with inguinal hernia before and after Lichtenstein repair

75%

Machała E., Redynk M., Gruchała A., Kołomecki K.

Polish Journal of Surgery

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2021

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vol. 93

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issue 1

1-8

EN

Introduction: Assessment of exercise tolerance (ET) plays an important role in qualifications for treatment and rehabilitation. Aim: The aim of the study was to assess ET in patients before and after inguinal hernia operations with Lichtenstein method. Material and methods: The cohort study included men with inguinal hernia divided into the study group (SG) (n = 50) and control (CG) (n = 50) undergone the Lichtenstein surgery. Patients from the SG met the criterion of coexistence of cardiovascular and respiratory diseases. Day before and on the second day after surgery, patients performed 6MWT and subjectively rate the exertion according to Borg- RPE- Scale (before, immediately after and 10 minutes after the test). 6MWT distance, Borg scale ratings were analysed. On the second day after surgery 66% of patients from the SG and 58% from the CG did not complete the test. Patients from the SG before (500,07 ± 40,38 m) and on the second day after surgery (243,46 ± 18,18 m) achieved shorter distances compared to the CG (565,93 ± 20,41 m; 249,47 ± 26,66 m), p < 0,001 i p = 0,481. A statistically significant negative correlation between 6MWT distance before surgery and age of the patients was confirmed. Patients who did not develop complications achieved significantly longer distances on admission (p = 0,003 for SG, p = 0,004 for CG). For 6MWT before surgery and 2 days after surgery, patients from the SG showed a significantly higher level of fatigue compared to the CG after the test (before: p = 0,001, after: p = 0,001). Patients form the SG often discontinued 6MWT and less tolerated effort compared to the CG. Hence, 6MWT is useful tool for ascertaining physical capacity and ET.

Refine search results

Safe and uncomplicated inguinal hernia surgery in the elderly – message from anesthesiologists to general surgeons

Do we need changes in the organization of training in the hernia treatment in Poland? A survey on the acknowledgment of the recommendations of international hernia societies by surgeons

Assesment of Inflammatory Response Intensity in Early Postoperative Period in Patients After Hernioplasty Operated on with Classic Stoppa Method and Videoscopic TEP Method

Current treatment of the inguinal hernia — the role of the totally extraperitoneal (TEP) hernia repair

Outcomes of Endoscopic Totally Extraperitoneal (TEP) repair of clinically occult inguinal hernia diagnosed with ultrasonography

Inguinal hernia management in preterm infants: addressing current issues of interest

Groin Hernia Surgery in Northern Ghana - Humanitarian Mission of Polish Surgeons in Tamale

Tailored Repair in Inguinal Hernia Surgery Using the Head-Score

Inguinal pain syndrome. The influence of intraoperative local administration of 0.5% bupivacaine on postoperative pain control following Lichtenstein hernioplasty. A prospective case-control study.

Analysis of exercise tolerance on the basis of six-minute walk test – 6MWT and Borg RPE scale in men with inguinal hernia before and after Lichtenstein repair