Ligation of Processus Vaginalis During Orchidopexy: Is It Mandatory?

Introduction: Undescended testis is one of the commonest presentations in pediatric population. Conventionally, high ligation of the hernia sac was done after vas and vessels were dissected in order to prevent post-operative hernia. However, recent studies have shown that hernia sac ligation was unnecessary. Aims: To evaluate the role of hernia sac ligation during orchidopexy to prevent the development of postoperative hernia and to compare the mean operative time with and without sac ligation. Methods: A prospective comparative study was conducted with a total of 94 patients with undescended testis, age ranging from six months to 16 years were included in the study from November 2018 to May 2021. Cases were randomly divided into two groups. In Group A cases, orchidopexy was carried out with sac ligation, while in Group B, the hernia sac was not ligated. Mean operative time was recorded in each case. All the patients were followed up at one, four and eight weeks post-operatively and examined for postoperative hernia. Results: Of the total 94 cases, there were 18 bilateral and 76 unilateral cases of which 56 were right-sided and 22 left-sided. Most of the patients (45) of the study were between six months and 2 years. None of the patients of either group developed post-operative hernia or any significant complications. The mean operative time for group A and B were 36.72 and 46.96 minutes respectively. Conclusion: It was concluded that ligation of processus vaginalis was unnecessary during orchidopexy and sac ligation consumed more operative time.

Internal hernia through dual defects: defects in transverse mesocolon and lesser omentum a rare presentation: case report

Internal hernias have the potential to cause small bowel obstruction. Congenital internal hernias are impossible to diagnose clinically and radiologically in asymptomatic patients. We presented a case of 36 years male with complaints of pain abdomen abdominal distension and vomiting, contrast-enhanced CT showed an internal hernia with small bowel obstruction. On exploration, small bowel loops were identified near the lesser curvature and they are congested an edema was present, a defect of 5×1 cm was identified in the transverse mesocolon and was managed by reducing the hernia sac and closure of the defect in the mesentery of the transverse colon. If the intervention was delayed internal hernia might lead to ischemia, gangrene increasing morbidity and mortality. Early intervention is the key to decrease morbidity and mortality.

ONE OF THE METHODS OF PREVENTING THE OCCURRENCE OF POSTOPERATIVE VENTRAL HERNIAS

Снижение количества коллагена первого типа, существенно влияет на развитие ПВГ. Снизить частоту развития послеоперационных вентральных грыж можно вследствие раннего диагностирования факторов риска снижения коллагена на амбулаторном этапе подготовки к лапаротомии. Чем раньше сделана операция, тем меньше выражены изменения в тканях и органах, а само хирургическое вмешательство является менее сложным и более эффективным. При гладком течении и заживлении после первой операции можно оперировать послеоперационную грыжу спустя 6-8-10 месяцев в зависимости от вида и обширности первого вмешательства, общего состояния больного, величины и динамики роста грыжевого выпячивания. При склонности к ущемлению, а также при развивающемся синдроме спаечной непроходимости следует оперировать в возможно ранние сроки. Если в анамнезе есть указания на тяжело протекавший послеоперационный период в связи с обширным нагноением в ране, длительной тампонадой брюшной полости, тяжелой интоксикацией, перитонитом либо весьма длительным пребыванием в стационаре по поводу релапаротомии, следует выждать больший срок, примерно 12-18 месяцев. На это время надо назначить больному определенный режим, принять меры к улучшению общего состояния, уменьшению страданий в связи с развитием спаечного процесса в грыжевом мешке и в брюшной полости. По показаниям следует рекомендовать ношение хорошо прилаженного бандажа. Тhe decrease in the amount of collagen of the first type significantly affects the development of PVG. It is possible to reduce the incidence of postoperative ventral hernias due to early diagnosis of risk factors for collagen loss at the outpatient stage of preparation for laparotomy. The earlier the operation, the less pronounced changes in tissues and organs, and the surgery itself is less complex and more effective. When you smooth over and heal after the first operation can be operated incisional hernia after 6-8-10 months depending on the type and extensiveness of the first intervention, the patient's General condition, size and growth of hernial protrusion. With a tendency to infringement, as well as with the developing syndrome of adhesive obstruction, it is necessary to operate as early as possible. If in the history there are indications of a difficult postoperative period due to extensive suppuration in the wound, prolonged tamponade of the abdominal cavity, severe intoxication, peritonitis or a very long stay in the hospital for relaparotomy, you should wait a longer period, about 12-18 months. At this time, it is necessary to assign the patient a certain regime, take measures to improve the General condition, reduce suffering in connection with the development of adhesions in the hernia SAC and in the abdominal cavity. According to the indications, it should be recommended to wear a well-adjusted bandage.

A comparative prospective study of laparoscopic guided needle assisted hernial sac ligation versus open herniotomy surgery in congenital inguinal hernia management

Background: To evaluate if significant difference exists in surgical outcome following laparoscopic guided needle assisted congenital hernial sac ligation versus conventional open Herniotomy as later is treatment of congenital hernia and laparoscopy guided emerged as newer alternative. Objective was to know whether a significant difference exists in surgical outcomes following laparoscopic guided needle assisted congenital hernial sac ligation and conventional herniotomy in terms of mean operative time, post operative pain, recurrence, local complication, cosmetic results.Methods: Patients were randomized on basis of odd and even registrations for surgery in our institute. Patients who undergone laparoscopic guided needle assisted congenital hernial sac ligation or who undergone conventional open herniotomy for congenital hernia between November 2018 to April 2020 (50 in each arm) were followed for 1, 3, 6 and 12 months to evaluate the outcomes.Results: In our study, major complication in open herniotomy group was surgical site infection (22%), hematoma (10%), intra operative bleeding (16%), seroma formation (8%) with minimum operative duration was ~60 minutes, hospital stay of 2-3 days while no such complication reported in laparoscopic guided needle assisted hernia sac ligation group being operative time of ~20 minutes, hospital stay of 1 day with better cosmetic results.Conclusions: We conclude that laparoscopic guided needle assisted hernial sac ligation is simple, safe, efficacious with its own advantage in comparison to conventional open herniotomy and should be acceptable alternative to traditional open herniotomy approach for congenital hernia.

“Locus minoris resistentiae” and connective tissue weakness in older women: a case report and literature review on pelvic organ prolapse with inguinal bladder hernia

Background Conditions such as genital prolapse and hernia are known to be related to connective tissue dysfunction. In this report on cases of the rare simultaneous finding of large genital prolapse and post-prolapse repair female inguinal bladder hernia, we aim to contribute to the discussion of a possible clinical definition of connective tissue weakness, for its clinical assessment and preoperative patient counselling. Case presentation Three cases of medial third-grade (MIII, Aachen classification) inguinal bladder hernia developing or enlarging after successful stage-IV pelvic organ prolapse (POP) repair at a university pelvic floor centre are presented. All patients were aged ≥ 80 years with long-standing postmenopausal status. One patient was followed for 5 years and two patients were followed for 6 months. In all patients, ultrasound revealed that the hernia sac contained the urinary bladder, which had herniated through the inguinal hernia orifice. A literature search revealed only one case report of direct female inguinal bladder hernia and few investigations of the simultaneous occurrence of POP and hernia in general. Conclusion The simultaneous occurrence of inguinal hernia and female POP can lead to bladder herniation following prolapse surgery in the sense of a “locus minoris resistentiae”. Clinical examination for simultaneous signs of connective tissue weakness and counselling prior to pelvic reconstructive surgery could help to increase patients’ compliance with further surgical treatment for hernia.

Lipogranulema of the hernia sac. Clinical case

Lipogranulomas in surgical practice, are the most often encountered in the mammary glands, penis and facial area associated with subcutaneous injections for cosmetic purposes of various types of fillers that cause chronic granulomatous inflammation. Atypical localization occurs due to the development of reactions to foreign bodies after traumatic injuries and reactions to suture material used in surgical interventions. The article presents a clinical case of revealing a large peritoneal lipogranuloma localized in the area of the hernial sac in a patient who 7 years ago suffered from endometrial cancer and underwent extirpation of the uterus using median incision access. Subsequently, the patient was treated for a long time in an outpatient care because of the ligature abscesses with the formation of fistulas; several rough ligatures were removed from the subcutaneous tissue. Lipogranuloma, found in the wall of the hernial sac measuring 15 × 6 × 5 cm, covered from all sides with an unaltered peritoneum, contained a cystic cavity with a light fluid, thick synthetic ligatures of a braided structure were present in the cyst wall. The use of large-diameter braided non-absorbable sutures for suturing the peritoneum does not meet modern requirements for the use of suture material and can cause complications.

Left Amyand’s hernia with inflamed appendix and sealed of perforated caecum an unusual case

Amyand’s hernia is defined as the hernia with appendix normal, inflamed or perforated as content. 1% of inguinal hernias are Amyand’s and amongst them 0.1% contains inflamed appendix. Commonly encountered on right size due to anatomical position of appendix. Left Amyand’s is rare and associated with intestinal malrotation, situs invertus and mobile caecum. Here, we presented an interesting case of left irreducible hernia in 70 years old gentleman with no signs of acute obstruction or strangulation, patient underwent emergency laparotomy in which hernial sac contents were inflamed ileal loop, inflamed appendix and perforated caecum in 70 years old man is rare presentation and not reported in any literature as per our knowledge. Resection of inflamed bowel loop with ceacum done along with ileo ascending anastomosis with primary tissue repair done. Post-operative period was uneventful. Hernia sac contents are most of the time surprising and their management sometimes differ according to the content. Appendix in hernia sac is found in 1% of all hernia but lack of facility for the pre-operative diagnosis and varied presentation it is challenging to diagnose and operate accordingly.

Treatment for right-sided intrathoracic kidney with congenital diaphragmatic hernia by combined thoracoscopic and laparoscopic approach: a case report and literature review

BackgroundIntrathoracic kidney (ITK) associated with congenital diaphragmatic hernia (CDH) is rare congenital anomaly and usually requires surgery. The surgical methods and approaches are diverse.Case presentationWe reported a case of a 5-year-old boy who was diagnosed as right-sided ITK with CDH. Surgical treatment was performed by combined thoracoscopic and laparoscopic approach. Anatomical reposition of the right kidney and nephropexy were carried out under laparoscopy, and repair of the hernia was performed under thoracoscopy. The postoperative recovery was uneventful and long-term follow-up demonstrated normal function and development of the kidney.ConclusionCombined thoracoscopic and laparoscopic approach is minimally invasive and effective for treatment of ITK associated with CDH. It provides better visualization of the diaphragmatic foramen and the hernia sac, and can achieve anatomical reposition and fixation of the ectopic kidney.

OV08 TREATMENT OF THE INGUINAL HERNIA USING THE SHOULDICE REPAIR

Aim The Shouldice procedure is a layered reconstruction of the posterior wall in inguinal hernia repair and currently the preferred method if the layers of the abdominal wall are of good quality, the wish of the patient for a non-mesh repair and if a mesh method is not possible or available. The correct performance of the reconstruction of the posterior wall is essential part of the operation. Material and Methods A life educational video was made with the four-layer reconstruction in detail. The first layer of the reconstruction starts at the medial corner and the conjoint tendon is sutured to the caudal flap of the transversalis fascia using a continuous non resorbable suture. The second layer of the reconstruction is made by approximating the cranial flap of the transversalis fascia and the posterior part of the inguinal ligament. The third layer starts at the level of the deep internal inguinal ring and approximates the lower border of the internal oblique muscle with the inguinal ligament. The fourth and final layer approximates the internal oblique muscle again with the inguinal ligament. Results The four-layer reconstruction after splitting the transversalis fascia is shown in detail since treatment of the hernia sac is like the other techniques. Conclusions The instructional video can be used for the resident training as a start in a hernia course followed by the execution on a model before the actual execution on a patient.

P155 DE GARENGEOT HERNIA: A CASE REPORT

Aim “The De Garengeot’s hernia, from Rene De Garengeot, who was the first to describe the appendix inside a femoral hernia sac in 1731, is a rare type of crural hernia. The diagnosis is challenging and surgery must be performed without delay. The incidence of appendicitis in this type of hernia is about 0.08-0.13%. The aim of this work is to describe our experience in the management of this rare subtype of hernia in a 82-year-old women” Material and Methods “A 82-year-old patient with a right groin bulge presented to the Emergency. At the physical examination the abdomen was treatable; there was no sign of bowel obstruction. Blood test values were normal, except for a high PCR value. The US of the groin region demonstrated a right femoral hernia containing a bowel tract, irreducible at the probe’s pressure. The patient underwent surgery, with diagnosis of De Garengeot’s hernia; a direct hernia repair followed by an open appendectomy were performed. The patient did not present any complications and was discharged on the second postoperative day” Results “The De Garengeot hernia is a rare entity that requires an early treatment; the preoperative diagnosis is difficult and often clinical features are similar to a common incarcerated hernia. There are many surgical options for the management of the De Garengeot hernia, but there is not a consensus for the best surgical approach” Conclusions “De Garengeot's hernia is rare, being indistinguishable from an incarcerated femoral hernia in general. This case report is about a De Garengeot’s hernia patient, who presented a good recovery after surgery.”