PURPOSE: The optimal surgical technique for inguinal hernia repair continues to be debated. This study was designed to investigate optimal surgical procedures in inguinal or femoral hernia. METHOD: We analyzed 153 cases of herniorrhaphy on inguinal or femoral hernias between August 1996 and November 2000. We divided patient into four groups according to the methods of hernia repair, i.e., 1) 78 cases of laparoscopic herniorrhaphy, 2) 42 cases of Lichtenstein herniorrhaphy, 3) 24 cases of Bassini herniorrhaphy and 4) 9 cases of McVay herniorrhaphy. RESULTS: The patient in the laparoscopic and Lichtenstein herniorrhaphy groups needed shorter hospital stays than those in the Bassini or McVay herniorrhaphy groups. The severity of pain was assessed by the total amount and duration of nonsteroidal anti-inflammatory drug injections, which was minimal in the laparoscopic group. There were no differences in complications between the groups. One patient in the laparoscopy group had a hernia recurrence and was reoperated with Lichtenstein herniorrhaphy. We compared two tension-free herniorrhaphies with each other. The numbers of patients not needing analgesic injections were more in the laparoscopic than the Lichtenstein herniorrhaphy group, reflecting less pain in the former group. Hospital stays were also shorter in the laparoscopic than the Lichtenstein herniorrhaphy group. CONCLUSION: We concluded that tension-free herniorrhaphy is superior to tension herniorrhaphy in terms of postoperative pain & recovery. Of the tension-free herniorrhaphies, laparoscopic herniorrhaphy is associated with less postoperative pain and shorter hospital stays than Lichtenstein herniorrhpahy.
Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Laparoscopy* ; Length of Stay ; Pain, Postoperative ; Recurrence

PURPOSE: Unlike males, inguinal hernia surgery in females is an uncommon surgical procedure. The efficacy of laparoscopic surgery for female hernia must be proven. This study compared the clinical characteristics of male and female hernia as well as the efficacy of laparoscopic surgery with that of open surgery in female hernia. METHODS: From March 2007 to February 2011, one surgeon (C.S.) at the authors' institution operated on 965 patients (male/female=884/81) who were each more than 19 years old. The female patients were divided into the laparoscopic (n=67, TEP/TAPP=66/1) and open surgery groups (n=14). RESULTS: The mean age of the female patients was lower than that of the male patients. The incidence of bilateral and direct hernia was higher in the male patients but the incidence of femoral hernia was higher in the female patients (0.6 vs. 8.6%, p<0.001). Among the 81 female patients, the mean age of the patients with femoral hernia was higher than that of the patients with other types of hernia (56.4+/-12.5/43.0+/-15.1, p<0.026). The operation times and pain scores of the two groups 7 days after surgery were comparable. CONCLUSION: The findings revealed a higher incidence of femoral hernia in the female patients than male patients. Patients with a femoral hernia were older than those with other types of hernia. Therefore, laparoscopic surgery must be considered for elderly female patients who have a high incidence of femoral hernia.
Aged ; Female ; Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Humans ; Incidence ; Laparoscopy ; Male

Femoral hernias are very uncommon in children and very easily misdiagnosed. During a period of three years, three children of femoral hernia were treated by one pediatric surgeon at Severance Hospital. Only one case was diagnosed correctly before surgery; the other two were thought to be either an indirect inguinal hernia or groin mass. Only one patient had curative hernioplasty (McVay hernioplasty) at the first operation; the other two did not have curative hernioplasty at the first operation. Femoral hernia in childhood is a challenging clinical problem because of its rarity and similar clinical presentation as indirect inguinal hernia. The frequency with which an incidental indirect inguinal hernia sac or patent processus vaginalis can be found at surgery can perpetuate a misdiagnosis. The absence of an expected indirect inguinal hernia sac or an apparent recurrence of an indirect inguinal hernia should lead to consideration of possible femoral hernia.
Child* ; Diagnostic Errors ; Groin ; Hernia, Femoral* ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Recurrence

Inguinal hernia refers to an extraperitoneal hernia occurring in the inguinal region. The etiology of inguinal hernia is not completely clear, but is related to gender, age and family history. According to the anatomy of hernia, there are indirect hernia, direct hernia, femoral hernia, composite hernia and peripheral femoral hernia. According to the content of the hernia sac, it is divided into reducible hernia, irreducible hernia, incarcerated hernia and strangulated hernia. There are also several special types of hernia. Typical inguinal hernia can be diagnosed by medical history, symptoms and physical examination. If the diagnosis is unclear or difficult, the imaging examination can assist the establishment of diagnosis. Only through surgery, inguinal hernia in adult patients could heal. The following requirements should be fulfilled: (1)The surgeons need to acquire accreditation of medical residency and should have corresponding surgical training; (2)The qualification of laparoscopic surgeons require the completion of basic laparoscopic training and hernia fellowship training as well as passing relative examinations; (3)Training of hernia and abdominal wall surgeons should be completed in centers with corresponding qualifications; (4)Preoperative education should be provided to patients and/or their families, emphasizing the communication with patients before surgery and indicating the operation principle and measures, whether mesh should be used, and informed consent should be given. Hernia repair materials are mainly non-absorbable inert mesh. Surgery could be divided into two types: open and laparoscopic surgery, including tissue suture repair, repair with materials, total extraperitoneal repair (TEP) and trans-abdominal preperitoneal repair(TAPP), etc. Combined with the clinical practice in China,we completed the "Guideline for Diagnosis and Treatment of Adult Groin Hernia (2018 edition)" on the basis of the previous edition of the guideline. The relevant medical institutions and peers in China are requested to carry out this guideline according to actual clinical reference.
Adult ; China ; Groin ; Hernia, Femoral ; Hernia, Inguinal ; surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Surgical Mesh

PURPOSE: Inguino-femoral hernias in women are less common than that in a man, and we have had limited experience for hernia repair in women. The purpose of this study was to evaluate the characteristics of inguino-femoral hernias in females and to establish the choice of specific treatment for inguino-femoral hernia in females. METHODS: This retrospective study was based on the medical records of 566 patients who underwent 657 cases of herniorrhaphies for treating inguino-femoral hernia in adult females from January 1998 to June 2006. We evaluated the incidence of hernia, the operative technique and the length of the operation, the complications and the postoperative recurrence rate. The operative findings and median time to reoperation for a recurrent hernia were also evaluated. RESULTS: During the 8.5-year period, we performed 2,931 herniorrhaphies in 2,274 patients. Of these, 657 herniorrhaphies were done in females (22.4%). The types of hernia in females were indirect inguinal hernia (67.3%), direct inguinal hernia (10.2%), the pantaloon type (10%) and femoral hernia (14.9%). Femoral hernia was more frequent in females (14.9%) compared to males (3.5%) (P<0.001). The overall rate of reoperation due to incarceration in the females was higher (2.5%) than that in the men (1.1%)(P<0.001). Femoral hernias in females was found at reoperation in 39.7% compared with 17.2% in the males (P<0.001). CONCLUSION: The incidence of inguino-femoral hernia in females was higher than the results of most published studies and the reoperation rate was higher in females. The increased frequency of femoral hernia at reoperation in females suggests avoiding injuries to the posterior wall of the inguinal canal and the need for exploration of the femoral canal at the time of the primary operation.
Adult ; Female ; Hernia* ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Incidence ; Inguinal Canal ; Male ; Medical Records ; Recurrence ; Reoperation ; Retrospective Studies

PURPOSE: The aim of this study was to see if there are any differences in the post-surgical outcomes between 2 tension-free hernioplasty methods. METHODS: We selected those patients with unilateral, bilateral inguinal hernias and femoral hernias who had undergone Lichtenstein n=224) and PHS (n=62) mesh hernioplasty at the Pundang Jaesang Hospital, Department of Surgery, between January 2000 and February 2004, and compared the post-surgical results of each method. The factors analyzed for this comparative study included the patient's age, gender, operation time, length of hospital stay, use of analgesics, cost and recurrences. RESULTS: The results from the statistic showed significant differences between the 2 methods with respect to postoperative pain, cost, duration of hospital stay and recurrences. CONCLUSION: The PHS hernioplasty is a superior method to that of Lichtenstein's herni-oplasty in terms of hospital stay, operation time, postoperative pain & recurrences.
Analgesics ; Hernia* ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Pain, Postoperative ; Polypropylenes* ; Recurrence

PURPOSE: Compared with other types of hernia, femoral hernias in adults are less common and we have had little literature about femoral hernia. The purpose of this study was to evaluate the incidence of femoral hernias in adults and to analyze the characteristics of femoral hernias. METHODS: This retrospective study was based on the medical records of 60 patients who underwent herniorrhaphies for treating femoral hernia in adults from January 2001 to December 2007. We analyzed the incidence of femora hernias, the symptoms, the operative techniques, the complications, the mortality and the postoperative recurrence rates. RESULTS: The incidence of femoral hernia was 4.6% in all cases of inguinal hernias. The incidence in females was about 4 times higher than in males (P<0.001). The most common symptom was bulging. The operative technique was changed from plug technique to bilayer technique. Seroma including swelling and pain were prominent complications. We experienced one case of mortality. CONCLUSION: Femoral hernia is a rare type of inguinal hernia in adult. Femoral hernia is more frequent in females and in the aged; it is an important surgical pathology with high rate of incarceration or strangulation. In consideration of the pathology of hernia and difficulty of the peri-operative diagnosis, the Prolene Hernia System herniorrhaphy is a superior method to other methods in femoral hernia.
Adult ; Female ; Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Incidence ; Male ; Medical Records ; Pathology, Surgical ; Polypropylenes ; Recurrence ; Retrospective Studies ; Seroma

PURPOSE: Misdiagnosis is frequent in femoral hernia as inguinal hernia. The aims of this study were to examine the diagnostic concordance and to define the factors having influence on the correct diagnosis of femoral hernia. METHODS: Thirty-two patients who underwent femoral hernia operations were analyzed retrospectively. RESULTS: The mean age of the study subjects was 65.8+/-15.5 (36~97) and the female to male ratio was 5.4:1. The mean body mass index (BMI) was 19.8 kg/m2 (14.6~26.9 kg/m2). Twelve patients (37.5%) showed pre- and post-operative diagnostic concordance and 20 patients (62.5%) did not. Among the 20 misdiagnosed cases, 16 cases were misdiagnosed as inguinal hernia, 2 cases as lipoma, and 1 case as lymphadenopathy. The factors related to the correct diagnosis of femoral hernias were associated with groin mass (96.9%, 31/32: 23 painless and 8 painful), size fluctuation of mass (cyclic wax and wane pattern) (84.4%, 27/32), long duration of mass (over 1 month) (75.0%, 24/32), femoral venous compression CT findings (63.6%, 14/22), and positive ultrasonographic findings (42.1%, 8/19). Emergency operation was done in 12 cases (37.5%). Incarceration was found in 23 cases (71.9%) and most of the incarcerated organs were omental fat (11 cases) and small bowel (10 cases). Bowel resection was done in 4 cases and 2 patients combined inguinal hernia. CONCLUSION: Through the careful taking of medical history and physical examination, physicians can achieve the correct diagnosis and can also decrease the frequency of emergency operations and their related complications.
Body Mass Index ; Diagnostic Errors ; Emergencies ; Female ; Groin ; Hernia, Femoral ; Hernia, Inguinal ; Humans ; Lipoma ; Lymphatic Diseases ; Male ; Physical Examination

PURPOSE: Lichtenstein`s tension-free repair & mesh-plug hernia repair are the most frequently used procedures for inguinal hernia repair by american surgeons. A new tension- free hernioplasty procedure, maintaining the advantages of both of these procedures, was invented by an experienced surgeon in our hospital. In this procedure, an umbrella- shaped mesh is applied to the entire posterior wall, not only to the defective area. We analyzed the results of this procedure in comparison with those from conventional repair (Bassini procedure). METHODS: From March 1998 to March 2001, 69 cases of hernioplasty were performed by one staff surgeon. Among these cases, we excluded 2 cases of bilateral inguinal hernia, 1 case of femoral hernia, and 6 cases which were impossible to follow up. In addition, we analyzed 29 cases of tension-free hernioplasty using an umbrella-shaped mesh (U group) and 31 cases of conventional repair (B group). Retrospective chart reviews and telephone interviews were carried out. Operation duration, length of hospital stay, period of analgesics use, complications, time required to return to usual activity, and recurrence were compared between these two groups. RESULTS: No significant differences were found concerning operation duration, period of hospital stay, complications, and time for return to usual activity. The period of analgesic use was significantly shorter in the U group than in the B group (p=0.001, 2.0 days vs 2.9 days). Only one recurrence occurred in B group. CONCLUSION: This new procedure has all the properties of tension free hernioplasty and plug hernia repair. This procedure can be used for all types of inguinal hernia and for a much lower cost than the preformed plug method. No incidence of recurrence was found folling the use of this procedure.
Analgesics ; Follow-Up Studies ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy* ; Incidence ; Interviews as Topic ; Length of Stay ; Recurrence ; Retrospective Studies

PURPOSE: Laparoscopic herniorrhaphy (LH) has an advantage for evaluating the viability of incarcerated bowel. In this retrospective study, we aimed to review the data for use of the TEP technique in treating incarcerated hernias in order to document the feasibility of the laparoscopic procedure. METHODS: During a 2-year period from January 2008 to December 2009, one surgeon (C.S) at our institution operated on 27 patients with acutely (n=3) or chronically (n=24) incarcerated hernia. Incarcerated hernias were divided into acute or chronic types arbitrarily, based on who had symptoms of acute abdominal pain and signs of intestinal obstruction. For acute cases, the TEP procedure was done following laparoscopic transperitoneal evaluation to assess viability of the incarcerated bowel. RESULTS: All patients except one having a femoral hernia were male. Mean age was 41 years old (range, 25~75). No case converted from a laparoscopic to an open procedure. Two acute incarcerated cases contained a segment of small bowel and the other contained small bowel and omentum. All acute cases were operated on successfully on an emergency basis by laparoscopic TEP repair. All chronic cases contained omentum without bowel. In one case of acute and seven cases of chronic type, a small inguinal incision was made to reduce hernia contents. No recurrence was noticed at a mean of 13 months of follow-up. CONCLUSION: If there is no entrapment of bowel in chronic incarcerated cases, the TEP procedure will be satisfactory. It may be reasonable, however, to evaluate viability of bowel transperitoneally before doing a TEP procedure in acute cases.
Abdominal Pain ; Emergencies ; Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Imidazoles ; Intestinal Obstruction ; Laparoscopy ; Male ; Nitro Compounds ; Omentum ; Pyrazines ; Recurrence ; Retrospective Studies