scholarly journals Comparative Study on the Need for Postoperative Analgesic Medication After Surgical Treatment of Inguinal Hernia with Surgical Mesh through Laparoscopic or Classic Approach

2018 ◽  
Vol 55 (3) ◽  
pp. 380-384
Author(s):  
Bogdan Andrei Suciu ◽  
Ioana Halmaciu ◽  
Decebal Fodor ◽  
Cristian Trambitas ◽  
Dumitru Godja ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Surgical Treatment ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Laparoscopic Technique ◽  
Adequate Treatment ◽  
Surgical Meshes ◽  
Significant Difference ◽  
Analgesic Medication ◽  
Classic Approach

The incidence of postoperative pain in patients operated for inguinal hernia can reach up to 40% of cases, depending on different authors, and depending on the approach used in the surgical treatment of these patients. Currently, there are two commonly accepted ways of surgical treatment of inguinal hernias, the classic approach with polypropylene mesh (Liechtenstein technique) and the laparoscopic approach. The purpose of this study was to conduct a comparative analysis on the need for analgesic medication in patients treated for inguinal hernia either by classic (group A) or by laparoscopic (group B) approach. Surgical meshes were used in all patients enrolled in our trial. The average age of the patients included in this study was 53.79 years, ranging from 20 to 88 years. Regarding the distribution of cases by gender, we observed in the studied lots that 12 cases were women (11.53%) and 92 cases were males (88.46%). In female patients, the classic inguinal hernia approach was performed in 3 cases (25% of cases), and in 9 cases the laparoscopic approach was performed in the surgical treatment of the inguinal hernia (75% of the cases). In male patients, laparoscopic approach was performed in 33 cases (35.86% of cases), and in 59 cases the surgical approach was performed in a classical manner using the Liechtenstein technique (64.13% of the cases). From the statistical analysis of the data we noticed a statistically significant difference in the need for analgesic medication administered to these patients (p = 0.0001). Although surgical correction of inguinal hernia, both classic and laparoscopic approaches, provide adequate treatment for these patients, in case of the laparoscopic technique, immediately after the operation, the need for analgesic medication is lower compared to the classical technique.

scholarly journals Postoperative condition of patients as a result of treatment of inguinal hernias by laparoscopic and open methods

2021 ◽  
pp. 30-35
Author(s):  
V.V. Skyba ◽  
◽  
A.V. Ivanko ◽  
N.V. Voytyuk ◽  
V.V. Lysytsia ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Surgical Treatment ◽  
Open Access ◽  
Hospital Stay ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Lower Percentage ◽  
Hernia Surgery ◽  
Inguinal Hernias ◽  
Inguinal Hernia Surgery

Purpose – to analyze condition of patients after surgical treatment of inguinal hernias by laparoscopic and open methods. Materials and methods. A retrospective review of medical histories and outpatient charts of all patients who underwent inguinal hernia surgery at the Kyiv City Clinical Hospital No. 1 from January 2018 to July 2020 was conducted. Results. During the above period of time in our hospital open hernioplasty was performed in 86 patients, laparoscopic hernioplasty – 138 patients. With open hernioplasty, the average duration of surgical treatment was 40±12 minutes. The laparoscopic technique was 35±12 minutes. The length of hospital stay was significantly longer in the group of patients with the open method (48±12 hours) than in the group of laparoscopic plastic surgery (12±3 hours). From the group of patients who underwent open hernioplasty, 62 patients complained of long-term pain syndrome, from the group of laparoscopy – 12 patients. The cosmetic appearance was dissatisfied with 34 patients in the open access group and only 2 patients in the laparoscopic plastic group. Postoperative complications were observed in 34 patients who underwent surgical treatment through open access, and in 15 patients – by laparoscopy. Conclusions. The laparoscopic approach of inguinal hernia surgery is superior to open access, as it reduces the length of hospital stay, postoperative recovery, improves the aesthetic effect of the operation, reduces the frequency of infection of incisions. According to the results of the study, this technique gives a better result in the early postoperative period, a lower percentage of chronic pain and a higher degree of patient satisfaction compared to open access with the same low recurrence rate. Therefore, in our opinion, laparoscopic access to hernioplasty is the optimal method of treatment and can be recommended as a method of choosing inguinal hernia surgery. Postoperative assessment of the quality of life of patients after treatment of inguinal hernia by laparoscopic and open methods. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: inguinal hernia, laparoscopy, open access surgery, analysis of methods, operation.

scholarly journals Laparoscopic versus open mesh repair of unilateral inguinal hernia: a comparative study

2017 ◽  
Vol 4 (3) ◽  
pp. 921
Author(s):  
Sudarshan P. B. ◽  
Sundaravadanan B. S. ◽  
Kaarthik V. P. ◽  
Prabu Shankar S.
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Return To Work ◽  
Inguinal Hernia Repair ◽  
Laparoscopic Group ◽  
Laparoscopic Inguinal Hernia Repair ◽  
Unilateral Inguinal Hernia ◽  
Laparoscopic Inguinal Hernia ◽  
Post Operative Pain ◽  
Significant Difference

Background: Inguinal hernia repair is now one of the most commonly performed general surgical procedures in practice. Laparoscopic inguinal hernia repair was started in year 1999 and since then has gained popularity over the last 2 decades. The introduction of a laparoscopic technique has sparked a debate in the literature over the superiority of this method versus open repair. Even though for bilateral and recurrent inguinal hernias, laparoscopic approach is recommended, there is not enough literature to recommend its routine use in unilateral inguinal hernia repair.Methods: A randomised prospective study was conducted at a tertiary care teaching hospital, comparing both Laparoscopic inguinal hernia repair and lichensteins tension free mesh repair as treatment modalities for unilateral inguinal hernia. Total number of patients in the study group was 60. Patients who were willing for the study were selected for the open or laparoscopic procedure in a randomised way. Open procedure was done by 2 senior surgeons and laparoscopic procedure was performed by 2 other senior surgeons at associate professor designation. Various parameters like the complication rate, post-operative pain, post-operative stay and time to return to work were analysed.Results: Out of the 60 patients, 30 patients underwent open inguinal hernia repair and another 30 patients underwent Laparoscopic inguinal hernia repair. The mean age group was 46.73 in open surgery group and 42.10 in laparoscopic group. 23.3% of the patients in open hernioplasty developed seroma, hematoma in the post-operative period. Whereas 10% had seroma collection in laparoscopic group. No incidence of recurrence in both the groups. No significant difference in pain score between both the groups during immediate post-operative period on POD 0, however there was significant difference in pain score on POD 3 (mean pain in open group 4.13 and lap group 2.87) and POD 7(mean pain in open group 2.90 and lap group 1.23). Mean duration of stay in hospital for open hernioplasty was 7.8 days and for Laparoscopic hernioplasty was 3.07 days. Mean duration of return to work in open hernioplasty was 14.37 days and in laparoscopy group was 9.13 days.Conclusions: There are potential benefits for laparoscopic inguinal hernia repair over lichtenstein’s repair for unilateral inguinal hernias in terms of post-operative pain, hospital stay and early return to work.

scholarly journals A 9-year experience study of single-port micro-laparoscopic repair of pediatric inguinal hernia using a simple needle

Hernia ◽  
2019 ◽  
Vol 24 (3) ◽  
pp. 639-644
Author(s):  
R. Chen ◽  
S. Tang ◽  
Q. Lu ◽  
X. Zhang ◽  
W. Zhang ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Single Port ◽  
Average Length ◽  
Operating Time ◽  
Laparoscopic Approach ◽  
Invasive Procedure ◽  
High Ligation ◽  
Laparoscopic Technique ◽  
Inguinal Hernias ◽  
Laparoscopic Techniques

Abstract Purpose As laparoscopic techniques and equipments improve, laparoscopic inguinal hernia repair has been gaining popularity. The objective of the study was to summarize 9 years of experience using a single-port micro-laparoscopic approach to repair pediatric inguinal hernias with a simple hernia needle. Methods 1880 children with inguinal hernias were enrolled using micro-laparoscopic surgery between June 2009 and 2018. All patients underwent high ligation surgery using a single-port micro-laparoscopic technique. The clinical data were retrospectively analyzed. Results All micro-laparoscopic surgeries were successfully performed in the 1880 patients, who ranged in age from 2 months to 14 years (3.66 ± 2.96 years) including 1622 males and 258 females. Among them, 1299 cases were unilateral hernias and 581 cases were bilateral hernias. The average operating time was 12.5 ± 3.5 min for a unilateral hernia and 20.5 ± 4.5 min for bilateral hernias. All patients were discharged 1–2 days after surgery, and the average length of their hospital stay was 2–4 days. Complications of knot reaction and pneumoscrotum occurred in 5 cases (0.27%) and 54 cases (2.87%), respectively, but these cases were properly managed, with no major impact on the operational outcomes. All patients were followed up for 3–65 months; there were 13 recurrent cases (0.69%). Conclusions Single-port micro-laparoscopic herniorrhaphy in children using a simple hernia needle is a reliable and minimally invasive procedure.

scholarly journals Litigation claims following laparoscopic and open inguinal hernia repairs

Hernia ◽  
2020 ◽  
Vol 24 (5) ◽  
pp. 1113-1120
Author(s):  
R. Varley ◽  
C. Lo ◽  
B. Alkhaffaf
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Vascular Injury ◽  
Laparoscopic Hernia Repair ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Hernia Surgery ◽  
Visceral Injury ◽  
Inguinal Hernia Surgery ◽  
The Uk

Abstract Purpose Groin hernia repair is the most frequently performed general surgical operation in the UK. Complications from laparoscopic and open repair are well recognised; however, potential differences are yet to be considered in relation to litigation. Methods Administrative data were obtained and analysed from the NHS Litigation Authority for inguinal hernia-related claims from 1995 to 2016. Claims identified as using an open or laparoscopic approach were compared. Results 880 claims were made, 760 had been settled. 88 laparoscopic and 241 open procedures were identified; 65% laparoscopic and 63% open hernia claims were found to be in favour of the claimant. Payouts totalled to 4.1GBP/4.8EUR/5.3USD million and 9.4GBP/11.0EUR/12.1USD million for laparoscopic (mean 82,824GBP/96,579EUR/106,453USD) and open (mean 66,796GBP/77,892EUR/85,852USD) approaches, respectively. The most common reasons for claim initiation were visceral/vascular injury (54%) in the laparoscopic group, and testicular complications or chronic pain (35%) in the open group. Additional procedures were necessary for 48% and 44% of laparoscopic and open claims, respectively. The highest average payouts were associated with visceral injury, (laparoscopic 116,482GBP/135,820EUR/149,715USD; open 199,103GBP/232,246EUR/255,905USD) and vascular injury (laparoscopic 88,624GBP/103,369EUR/113,892USD; open 64,460GBP/75,163EUR/82,870USD). Additional procedures resulted in an average payout of 93,352GBP/108,917EUR/120,008USD (laparoscopic) and 60,408GBP/70,506EUR/77,657USD (open). The most common additional procedures were corrective visceral/vascular repairs, orchidectomy and recurrent hernia repair. Conclusions The rate of litigation for clinical negligence in inguinal hernia surgery in the UK is increasing. Whilst there has been a recent increase in laparoscopic hernia repair claims, the volume and burden of claims related to open procedures remain greater.

A Comparison of Outcomes between Lichtenstein and Laparoscopic Transabdominal Preperitoneal Hernioplasty for Recurrent Inguinal Hernia

2018 ◽  
Vol 84 (11) ◽  
pp. 1774-1780 ◽  
Author(s):  
Bin Yang ◽  
Shengning Zhou ◽  
Yingru Li ◽  
Jianan Tan ◽  
Shuang Chen ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Intraoperative Complications ◽  
Incidence Rates ◽  
Laparoscopic Technique ◽  
Recurrent Inguinal Hernia ◽  
Complication Rates ◽  
Transabdominal Preperitoneal ◽  
Inguinal Hernias ◽  
Significant Difference

There remain concerns about the optimal technique for repairing recurrent inguinal hernias because of the high risks of complications and recurrence. The aim of this study was to compare Lichtenstein hernioplasty with the transabdominal preperitoneal (TAPP) laparoscopic technique in the treatment of recurrent inguinal hernias. One hundred twenty-two patients who underwent surgery for recurrent inguinal hernia were prospectively randomized to receive either Lichtenstein (n = 63) or TAPP (n = 59) hernioplasty between January 2010 and December 2014. Baseline characteristics, intraoperative complications, and short- and long-term postoperative factors were evaluated. Preoperative factors were comparable between the two groups. The average follow-up period was 46.2 ± 8.5 months. The two groups had similar intraoperative and short-term postoperative complication rates, whereas the rate of long-term postoperative complications was lower for the TAPP group than the Lichtenstein group (6.8% vs 23.8%, respectively, P = 0.012). The TAPP group had significantly lower visual analogue scale scores, fewer analgesics consumption, and faster recovery than the Lichtenstein group ( P < 0.05). Chronic pain was more prevalent in the Lichtenstein group than the TAPP group (15.9% vs 3.4%, respectively, P = 0.031). The recurrence rate was 4.8 per cent for the Lichtenstein group and 1.7 per cent for the TAPP group, with no significant difference ( P = 0.62). Both the Lichtenstein and TAPP procedures are safe and effective methods for repairing recurrent inguinal hernia with low incidence rates of life-threatening complications and recurrence. The TAPP procedure is superior to the Lichtenstein repair in terms of reduced postoperative pain, shorter sick leave, faster recovery, and better cosmetic results. Careful selection of the surgical procedures and implementation of technical essentials are necessary.

scholarly journals Comparison of Laparoscopic VS Open Inguinal Hernioplasty in a Tertiary Care Hospital

2020 ◽  
Vol 10 (1) ◽  
pp. 17-22
Author(s):  
Md Mahfuzul Momen ◽  
Ashok Kumar Sarker ◽  
Deb Prosad Paul ◽  
Debasis Das ◽  
Sonia Akhter ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Surgical Treatment ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Tertiary Care ◽  
Laparoscopic Group ◽  
Open Group ◽  
Care Hospital ◽  
Laparoscopic Hernioplasty ◽  
The Mean

Background: Inguinal hernia repair is one of the most common surgical procedures in Bangladesh. The option of surgical treatment remains controversial. Laparoscopic hernia repair has all the benefits of a tension free repair. We aimed to compare postoperative outcome and cost between laparoscopic and open inguinal hernia repair. Objective: This study was conducted with an objective to compare the effectiveness of each procedure and complications if any. Materials and Methods: Fifty cases of inguinal hernia admitted in the tertiary care center were selected by nonprobability (purposive) sampling method. All patients with uncomplicated hernia treated by open or laparoscopic method were included. The age/sex, incidence, mode of presentation, surgical treatment and postoperative complications were evaluated and compared with standard published literature. Results: Postoperative wound infection developed in three cases of open hernioplasty and one case in laparoscopic surgery. Hematoma and seroma at the operated site were found in one case of laparoscopic hernioplasty and in two cases of open hernioplasty. Orchitis was more prevalent in the laparoscopic hernioplasty patient with incidence among two cases as compared to one in open group. The mean duration of hospitalization was 59.62±6.11 hours in case of laparoscopic hernioplasty while 53.33±8.26 hours in open hernioplasty. The mean duration of procedure was 72.33 minutes in laparoscopic group while 64.62 minutes in open surgery. The mean cost for the laparoscopic repair group was around taka 63000/= whereas in the open group it was around 42000/= only with significant difference. Prolonged groin pain was seen in four cases in open group as compared to one in laparoscopically operated cases. Conclusion: There were less post-operative complications in the laparoscopic group. J Enam Med Col 2020; 10(1): 17-22

scholarly journals P163 ROLE OF THE LAPAROSCOPIC APPROACH IN EMERGENT INGUINAL HERNIA REPAIR

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Joan Ricard Soler Frias ◽  
Anabel García León ◽  
Luis Tallon-Aguilar ◽  
Jose Tinoco González ◽  
Alejandro Sánchez Arteaga ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Elective Surgery ◽  
Intestinal Resection ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Reoperation Rate ◽  
Open Group ◽  
Open Approach

Abstract Aim Analyze the evolution of the laparoscopic approach in emergent inguinal hernia repair at our center. Material and Methods Retrospective review of patients with emergent inguinal hernia repair in our center from January 2011 to June 2020. Demographic, clinical and postoperative data were analyzed as well as the evolution of the laparoscopic approach. Results 385 patients with incarcerated/strangulated inguinal hernia were registered. 58.96% were men, with a median age of 71. Of those, 22 patients (5.71%) were treated by laparoscopic approach and 363 (94.29%) by open approach. The open approach had a longer median hospitalization (4.82 vs 1.66 days), higher rate of surgical wound infection (5.51% vs. 0%), higher reoperation rate (3.31% vs 0%) and higher incidence of respiratory complications (1.97% vs 0%). 1 patient (4.54%) with laparoscopic approach required intestinal resection vs 48 patients (13.22%) of the open group, with a dehiscence rate of 0% vs 4.76% respectively. Mortality rate was 0% for the laparoscopic group and 2.75% in the open group. In the last 18 months, 28.98% of urgent hernias repaired have been performed laparoscopically, while previously from 2011 to 2017 only 0.95%, due to the learning curve obtained in elective surgery where the laparoscopic approach has had a major development in the last 3 years. Conclusions Despite the evident patient selection bias because the approach choice by the surgeon in emergent inguinal hernia repair, laparoscopic approach is feasible and has lower morbidity-mortality compared to open approach in our center. In specialized centers this may be a treatment option for selected patient groups.

Comparative Study between Lichtenstein Repair and Trans Abdominal Pre Peritoneal Repair of Inguinal Hernia (TAPP)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Prof. Dr./Adel Faheem Ain-shoka ◽  
Dr/Mohamed Ibrahim Hassan ◽  
General Dr./Khaled Abdel-Aziz Elkholy ◽  
Ahmed Wahid Said Mohamed Matter
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Comparative Study ◽  
Statistical Difference ◽  
Laparoscopic Group ◽  
Open Group ◽  
Lichtenstein Repair ◽  
Significant Statistical Difference ◽  
Post Operative Pain ◽  
Significant Difference

Abstract Background Inguinal hernia repair is one of the most widely performed surgical procedure. Among the techniques used, the open Lichtenstein repair is still the most widely performed. However, in the last decade there has been an increased interest in the laparoscopic approach for inguinal hernia repair, mainly represented as the trans-abdominal pre- peritoneal (TAPP) technique. As described in recent studies, TAPP approach entails the benefits of minimally invasive surgery, such as less pain and early recovery. Objective s: This study aims to compare between lichtenstein repair of inguinal hernia and trans-abdominal pre-peritoneal repair of inguinal hernia (TAPP) as regard their hospital stay, cost, intra-operative & post-operative complications and short term recurrence. Patients and Methods Our study was carried out on (50) male patients with inguinal hernia, 25 patients underwent laparoscopic TAPP repair and 25 patients underwent open Lichtenstein repair. We found a highly significant difference of laparoscopic TAPP Repair in decreasing post-operative pain than in open repair. Results Comparative study between the 2 groups revealed non-significant difference as regards age and sex of the patients. Comparative study between the 2 groups revealed non-significant difference as regards all socio-demographic data. Comparative study between the 2 groups revealed non-significant difference as regards type and side of hernia. Comparative study between the 2 groups revealed; highly significant increase in operative duration in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in post-operative pain score and post-operative hospital stay; in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in intra-operative complications in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Conclusion Our study showed that laparoscopic TAPP approach for inguinal hernia repair reduces early post-operative pain. Furthermore, it is related to less complications, although it takes a longer operative time and higher cost.

scholarly journals Analysis of a series for surgical management of insulinomas in central China

2021 ◽  
Author(s):  
Shishi Qiao ◽  
Hao Liu ◽  
Xin Hu ◽  
Minghao Dong ◽  
Liangjie Feng ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Management ◽  
Average Length ◽  
Laparoscopic Group ◽  
Perioperative Period ◽  
Central China ◽  
Pancreatic Tumors ◽  
Significant Difference ◽  
The Mean ◽  
Operative Notes

Abstract The aims of this study were to summarize the characteristics of insulinoma in central China and to present our experience with surgical management in the Department of Hepatobiliary and Pancreatic Surgery of The First Affiliated Hospital of Zhengzhou University. 617 patients were enrolled in this retrospective analysis, including 89 cases of insulinoma and 528 cases of other pancreatic tumors. All patients had been confirmed by histopathology reports and underwent surgical treatment. Medical data and operative notes were incorporated into the database. Among the 617 patients, 4 died during the perioperative period. In the insulinoma group, no deaths occurred. The average size of the insulinoma tumor was 1.4±0.8 cm. The ratio of open surgical procedure (57) to laparoscopic resection (32) was 1.8/1. The mean interoperation blood loss was significantly lower in the laparoscopic group (LA) (mean 35.2±17.4ml, range from 10 to 170ml) than that in the open surgical (OA) group (mean 64.7±38.6ml, range from 25 to 400ml). The mean postoperative hospital stay was also lower in the LA group (mean 8.1 ± 3.2days, range from 5 to 20 days) than that in the OA group (Mean 13.1±8.2days, range from 9 to 60 days). There was no significant difference for postoperative complications between the two groups (LA:37.5% vs OA:40.3% ). The rate of clinically significant postoperative-pancreatic-fistula (POPF) was 21.3 %, and there was only one case of C-degree-POPF. The average length of postoperative- gastrointestinal function recovery was 2.8 ± 0.9 days. And the average length of blood glucose fluctuation was 18±7.2 days. During the follow-up, 2 cases were found to be hypoglycemic again, and the rate of significant weight loss was 57.3% (51/89). Insulinoma was rare among patients who underwent surgical treatment at the Department. Their cases were benign, and their treatment was unproblematic. However, there was a small group of cases that could be associated with problematic clinical situations, and, therefore, treatment of patients with insulinoma should be conducted at specialist centers. Correct diagnostic and therapeutic management, involving close cooperation between multiple medical specialists, results in completely curing most patients.

The most recent recommendations for the surgical treatment of inguinal hernia

2019 ◽  
Vol 98 (7) ◽  
pp. 268-272
Keyword(s):  
Inguinal Hernia ◽  
Surgical Treatment ◽  
Hernia Repair ◽  
Mesh Repair ◽  
Laparoscopic Hernia Repair ◽  
Laparoscopic Approach ◽  
Safe Procedure ◽  
Recurrence Rates ◽  
Hernia Sac ◽  
Minimal Invasiveness

Introduction: The publication of new guidelines in recent years shows that surgical treatment of inguinal hernia remains topical. The main goal is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain. The main purpose of this article is to summarize the latest recommendations in surgical treatment of the groin hernias, especially in the case of strangulation. Methods: The authors made literature review of all the guidelines published by the hernia societies, including related articles, in the last ten years. Results: The use of the EHS classification system is suggested. In elective operations, mesh repair is recommended. The Lichtenstein technique is the standard in open inguinal hernia repair. Transabdominal preperitoneal and totally extraperitoneal approach have comparable outcomes. Their clear advantages include minimal invasiveness. Mesh repair is recommended also in the case of strangulation, but only in clean and clean-contaminated operations. A laparoscopic approach should be considered as well. Inter alia, it allows an assessment of bowel viability during the whole procedure. The need of bowel resection is hence lower compared to open surgery. If it is not possible to use the mesh, the Shouldice method is regarded as the best non-mesh repair technique. If there is concern about bowel viability, visualization, either by formal laparoscopy, hernia sac laparoscopy or laparotomy, is recommended. Hernioscopy is a simple and safe procedure that uses the hernia sac for insertion of a port following insufflation and diagnostic examination. It requires less advanced laparoscopic skills than does emergency laparoscopic hernia repair. It can be performed even by surgeons who lack sufficient experience with laparoscopy. Conclusion: In elective procedures, the mesh repair is recommended. It is recommended also in the case of strangulation, but not in a contaminated- dirty surgical field. If there is concern about bowel viability, visualization, either by formal laparoscopy, hernia sac laparoscopy or laparotomy, is needed.

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