Explore the vast range of titles available.

No consensus has yet been reached regarding the best anesthetic technique for inguinal hernia repair. This study aimed to compare postoperative clinical outcomes and inflammatory markers among patients who were anesthetized using local, spinal, or general anesthesia for inguinal hernia repair. This randomized controlled trial included patients scheduled to undergo elective unilateral inguinal hernioplasty at Siriraj Hospital during November 2014 to September 2015 study period. Patients were randomly assigned to the local (LA), spinal (SA), or general (GA) anesthesia groups. Primary outcomes were postoperative pain at rest and on mobilization at 8 and 24 hours after surgery. Fifty-four patients were included, with 18 patients randomly assigned to each group. Patient demographic and clinical characteristics were similar among groups. There were no significant differences among groups for postoperative pain at rest or on mobilization at 8 and 24 hours after surgery. No significant differences were observed for interleukin-1β, interleukin-6, and interleukin-10 at any time points in any groups. Patients with local anesthesia was associated with less time spent in anesthesia (p = 0.010) and surgery (p = 0.009), lower intraoperative cost (p = 0.003) and total cost in hospital (p = 0.036); however, patient satisfaction in the local anesthesia group (94/100) was statistically significantly lower than the spinal and general anesthesia groups (100/100) (p = 0.010). No statistically significant difference was observed among groups for postoperative pain scores, duration of hospital stays, complications, or change in inflammatory markers. However, time spent in anesthesia and surgery, the intraoperative cost and total cost for hernia repair, and patient satisfaction were significantly lower in the local anesthesia group than in the other two groups.

Background There is very scant literature on the impact of inguinal hernia mesh repair on testicular functions and sexual functions following open and laparoscopic repair. The present randomized study compares TAPP and TEP repairs in terms of testicular functions, sexual functions, quality of life and chronic groin pain. Methods This study was conducted from April 2012 to October 2014. A total of 160 patients with uncomplicated groin hernia were randomized to either trans-abdominal pre-peritoneal (TAPP) repair or totally extra-peritoneal (TEP) repair. Testicular functions were assessed by measuring testicular volume, testicular hormone levels preoperatively and at 3 months postoperatively. Sexual functions were assessed using BMSFI, and quality of life was assessed using WHO-QOL BREF scale preoperatively and at 3 and 6 months postoperatively. Chronic groin pain was evaluated using the VAS scale at 3 months, 6 months and at 1 year. Results The median duration of follow-up was 13 months (range 6–18 months). The mean preoperative pain scores ( p value 0.35) as well as the chronic groin pain were similar between TEP and TAPP repairs at 3 months ( p value 0.06) and 6 months ( p value 0.86). The testicular resistive index and testicular volume did not show any significant change at follow-up of 3 months ( p value 0.9) in the study population. No significant difference was observed in testicular resistive index and testicular volume when comparing TEP and TAPP groups at at follow-up of 3 months ( p value >0.05). There was a statistically significant improvement in the sexual drive score, erectile function and overall satisfaction over the follow-up period following laparoscopic inguinal hernia repair. However, sexual function improvement was similar in patients undergoing both TEP and TAPP repairs. All the domains of quality of life in the study population showed a significant improvement at a follow-up of 3 and 6 months. Subgroup analysis of all the domains of quality of life in both TAPP and TEP groups showed a similar increment as in the study population ( p value <0.001); however, the mean scores of all the domains were comparable between the two subgroups ( p value >0.05), preoperatively and 3 and 6 months follow-up. Conclusions Laparoscopic groin hernia repair improves the testicular functions, sexual functions and quality of life, but TEP and TAPP repairs are comparable in terms of these long-term outcomes.

Background Kugel repair, a minimally invasive technique, has become an alternative to laparoscopic groin hernia repair, but the technique has not been adequately evaluated by assessment of objective parameters. A prospective randomized clinical study was carried out to compare the systemic inflammatory response to surgical trauma and clinical outcomes in patients who underwent groin hernia repair by the Kugel and totally extraperitoneal (TEP) laparoscopic methods. Methods Forty consecutive patients admitted for unilateral groin hernia were randomized to Kugel ( n  = 20) or TEP ( n  = 20) repair under general anesthesia. Operation time, length of hospital stay, pain severity, time to return to normal activities, cost, and systemic inflammatory and hormone responses to surgical trauma were compared. Results There were no significant between-group differences in duration of operation, length of hospital stay, time to return to normal activities, or mean visual analogue scale (VAS) score ( p  > 0.05 for each). Serum cortisol, high-sensitivity C-reactive protein (hsCRP), and interleukin (IL)-6 concentrations before surgery, and 1 and 24 h after surgery, did not differ significantly in the two groups ( p  > 0.05). There were no recurrences or complications during follow-up. Cost per patient was US $546 lower in the Kugel group. Conclusion Kugel herniorrhaphy is a minimally invasive technique that offers all the advantages of TEP and is more cost-effective.

Background Diagnosing incarcerated groin hernia and predicting its progression to strangulation remains challenging. This study investigates whether blood inflammatory markers can aid in diagnosing incarcerated groin hernias and assessing their severity. Methods A retrospective analysis was conducted on patients who underwent surgery for incarcerated groin hernia between 2018 and 2024. Preoperative blood tests were performed, and patients were categorized into bowel resection and non-resection groups. Results Among 203 patients, 78 required bowel resection. Significant differences were observed in hernia type, white blood cell count, neutrophil percentage, C-reactive protein, neutrophil-to-lymphocyte ratio, and serum Sodium-ion levels between the two groups. Conclusion White blood cell count, neutrophil percentage, neutrophil-to-lymphocyte ratio, and C-reactive protein are effective diagnostic markers for incarcerated groin hernia. Combining these inflammatory markers provides a reliable method for predicting disease severity.

In previous comparisons of inflammatory and stress responses to open (OR) and laparoscopic (LR) hernia repair, all operations were performed under general anesthesia. Since local anesthesia is widely used for OR, a comparison of this approach with LR seemed relevant. Patients with recurrent inguinal hernia were randomized to OR under local anesthesia (n = 30) or LR under general anesthesia (n = 31). The magnitude of the surgical trauma was assessed by measuring markers of coagulation (prothrombin fragment 1 + 2), endothelial activation (von Willebrand factor), inflammation [leukocytes, interleukin-6, -8 and -10, granulocyte macrophage colony-stimulating factor, and C-reactive protein (CRP)], and endocrine stress (cortisol) in blood collected before operation, 4 h postincision, and on postoperative day 2. Leukocyte counts and interleukin-6 and CRP levels increased in both groups, with the CRP increase being significantly greater in the OR group. The other markers did not increase significantly. The acute phase response was more pronounced after OR, even when this was done under local anesthesia. Both techniques seemed rather atraumatic.

Independent studies reported metabolic alterations in connective tissues of hernia patients, especially involving collagen fibers, compared to healthy controls. In the present work, we evaluated plasma concentrations of metalloproteinases (MMPs) and lysyl oxidase (LOX), enzymes involved in collagen metabolism, and peptides produced during collagen biosynthesis (PINP, PIIINP, and PIVNP) as potential biomarkers for the estimation of hernia risk. Zymography and ELISA assays were performed with plasma samples of 51 patients with primary or recurrent inguinal hernia and 42 healthy controls. A reduction in PINP (p = 0.007) and a concomitant increase in PIIINP (p < 0.001) were observed in patients. In controls, PINP levels were inversely related to age, whereas in patients PIIINP levels increased with age. Body mass index (BMI) showed a strong positive correlation with PIIINP plasma levels in controls but not in patients (p < 0.001). Moreover, patients with larger lesions had the lowest PINP/PIIINP ratio (p = 0.003). PIVNP collagen did not differ between controls and hernia patients. Plasma MMP-9 was reduced in patients (p = 0.015), while MMP-2 and LOX were unchanged. However, MMP-2 concentrations appeared lower in patients with familial history of hernia compared to those without. In regression analysis, the PINP/PIIINP ratio was inversely related to hernia risk, and a cut-off value of 0.948 was found by ROC analysis which classified hernia patients with a sensitivity of 82.9% and a specificity of 77.1%. In conclusion, our findings identified the PINP/PIIINP ratio as the most relevant molecular predictor of inguinal hernia risk.

Aim The aim of this prospective study is to investigate if there is a relationship between inguinal hernia, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs). Materials and methods This case control study was performed on patients admitted to the general surgery department of Erzincan University Hospital. Four groups were created: control, indirect hernia, direct hernia, and bilateral hernia. All groups were comprised of 11 patients. Serum and tissue levels of MMP-1, MMP-2, MMP-9, MMP-13, TIMP-1, TIMP-2, TIMP-3, and hydroxyproline were evaluated. Results MMPs values were significantly high at hernia groups, especially at bilateral hernia group ( p  < 0.05), whereas TIMPs values were significantly low at bilateral hernia group ( p  < 0.05). MMPs values were increasing at hernia groups in an order as control, indirect, direct, and bilateral. TIMPs values were decreasing at hernia groups in an order as control, indirect, direct, and bilateral. Conclusion Increased levels of MMP-1-2-9-13 and decreased levels of TIMP-1-2-3 may have played role in the formation of inguinal hernia. Hernia is not only a local defect, but a reflection of systemic disease. This is even more significant for bilateral hernias.

Matrix metalloproteinases (MMPs) are associated with the alteration of extracellular matrix. The purpose of this study was to investigate how the levels of matrix metalloproteinases and their inhibitors – TIMPs are influenced by the presence of inguinal hernia as well as by its surgical treatment. The studied group consisted of 25 patients with inguinal hernia and 21 healthy controls for comparison. Two blood samples - before and after the treatment were collected from patients. Serum concentrations of MMPs and TIMPs were analysed by multiplex immunoassays. There was a difference in circulating levels of MMPs in patients before the surgery compared to healthy controls – the concentrations of MMP-2 and MMP-9 were significantly lower (p=0.026, p=0.018, respectively). After the surgery, the levels of MMPs, especially MMP-2 (p<0.0001), were significantly decreased in patients compared to the preoperative values, apart from MMP 9. On the contrary, MMP-9 showed significant increase after the surgery (p<0.0001). Circulation levels of TIMP-2 in patients were significantly decreased in comparison with controls (p=0.004), whereas levels of TIMP-1 were similar to controls. Both tested metalloproteinase inhibitors showed a significant decrease in detected levels (TIMP-1 p=0.0004; TIMP-2 p<0.0001) after the procedure compared to the preoperative values. The levels of MMPs, especially MMP-2 and MMP-9, and their inhibitors TIMP-1 and TIMP-2 are involved by the presence of inguinal hernia as well as are influenced by the surgery.

PurposeDegradation of collagen has been suggested involved in the pathogenesis of inguinal hernia. In this study, we aim to evaluate circulating biomarkers of procollagen type I N-terminal propeptide (PINP), procollagen type III N-terminal propeptide (PIIINP), matrix metalloproteinases (MMP)-2, MMP-9, copper and zinc in primary and recurrent inguinal hernia patients.MethodsThis study included 110 inguinal hernia patients: 45 patients had primary indirect inguinal hernia, 40 patients had primary direct inguinal hernia, 15 patients had recurrent indirect inguinal hernia and 10 patients had recurrent direct inguinal hernia. Additional 45 patients operated for reasons other than hernia were included as a control group. All blood samples were obtained preoperatively. Circulating PINP, PIIINP, MMP-2 and MMP-9 were investigated using enzyme-linked immunoabsorbent assay (ELISA) methods, and copper and zinc were measured using an air acetylene flame atomic absorption spectrometer.ResultsSerum MMP-2 levels in patients with direct and recurrent inguinal hernias were significantly higher than controls. The ratios of PINP/PIIINP decreased more apparent in recurrent indirect or direct inguinal hernia group than primary indirect or direct inguinal hernia group. Based on receiver operating characteristic curve analysis, PINP/PIIINP can effectively diagnose recurrent inguinal hernia from primary inguinal hernia with area under the curve (AUC) of 0.919 for recurrent indirect inguinal hernia and 0.808 for recurrent direct inguinal hernia, respectively.ConclusionThe ratio of serum PINP/PIIINP was lower in patients with recurrent inguinal hernia, demonstrating more serious damage of collagen metabolism in these patients. Serologic ratio of PINP/PIIINP may be used to identify the presence of recurrent inguinal hernia in patients.