Recurrent Inguinal Hernia

Prophylactic alpha-blockade for prevention of post-operative urinary retention after inguinal hernia repair: a systematic review and meta-analysis

BACKGROUND

The rate of post-operative urinary retention (POUR) in inguinal hernia repairs (IHR) is estimated to be approximately 5.9% to 38% worldwide. Currently, there are minimal studies on the prophylaxis of POUR after IHR. Pre-operative administration of alpha-blockers such as (but not limited to) Tamsulosin, Prazosin and Alfuzosin has shown promising results in the prevention of POUR in patients undergoing IHR. This study aims to determine the effectiveness of prophylactic alpha-blockade in the prevention of POUR after IHR.

METHODS

This study reports the findings of a systematic review and meta-analysis. Randomised controlled trials (RCTs) using prophylactic alpha-blockade for the prevention of POUR after open and/or laparoscopic IHR in patients aged more than 18 years in all sex groups were included. Multiple databases were searched from inception to October 2021 using the PRISMA flow diagram. Data were extracted and analysed to include eligibility criteria, comparator, intervention, study and participant characteristics. Studies excluded were non-RCT studies and patients with known urinary tract disorders such as benign prostate hypertrophy, urinary incontinence and cancer of the bladder or prostate. Subgroup analyses were also conducted. All effect measures of each data were odds ratio with 95% confidence interval. All studies were pooled using the dichotomous random effects Mantel-Haenszel statistical mode and I2 was used to assess heterogeneity. Publication bias was detected using the Cochrane risk-of-bias tool for randomised trials (RoB-2) involving two independent reviewers.

RESULTS

A total of eight RCTs were identified which provided adequate numeric data for incorporation into the meta-analysis. Overall, administration of pre-operative alpha-blocker prior to IHR did not prevent POUR (95% CI 1.20 (0.96-1.49), I2: 34%). Subgroup analysis comparing pre-operative use of prophylactic alpha-blocker in open versus laparoscopic IHR has shown statistically significant reduction of POUR prevention in the laparoscopic group (95% CI 0.66 (0.47-0.92)), I2: 43%). The older age group benefited from pre-operative alpha-blocker use with reduced incidence of POUR post-IHR (95% CI 0.14 (0.08, 0.23), I2: 0%)). Gender did not affect the difference of incidence of POUR post-IHR despite pre-operative alpha-blockers (95% CI 0.62 (0.27, 1.44)), I2: 53%)).

CONCLUSION

Overall, this meta-analysis has shown that administration of prophylactic alpha-blockers did not prevent POUR. However, there was statistically significant reduction of POUR in patients undergoing laparoscopic IHR as compared to open, as well as in older patients (age more than 60 years) after administration of pre-operative alpha-blocker. Hence, the use of pre-operative alpha-blocker especially in older patients should be considered and more RCTs should be undertaken.

Combined transurethral prostatectomy and inguinal hernioplasty

AIM

Evaluation of combined transurethral resection of the prostate (TURP) and inguinal hernia repair with Vypro II mesh in comparison with patients undergoing TURP and hernioplasty sequentially.

METHODS

Thirty patients were randomly categorized into two groups through a computer randomization program. Group I included 15 patients operated by TURP and inguinal hernioplasty in the same session. Group II included 15 patients operated by TURP followed by inguinal hernioplasty in separate sessions.

RESULTS

The mean operative time was 84.6 +/- 23.4 min in group I versus 95.5 +/- 15.3 min in group II. The mean hospitalization time was 3.07 +/- 0.46 days in group I and 4.07 +/- 0.59 days in group II. No significant increase in the complication rate was seen when the TURP and inguinal hernioplasty operations were performed together. Hernia recurrence did not occur in either group. Hospitalization cost was reduced by 26% when performing the two operations in the same session. The numerical patient satisfaction score 3 months after surgery was 8.87 +/- 0.99 for group I patients versus 7.80 +/- 0.94 for group II patients.

CONCLUSION

Combined TURP and inguinal hernioplasty is a practical, safe, and effective operative procedure that can reduce hospitalization cost. It allows patients to undergo only one anesthetic procedure, hospital admission, and convalescence.

Combined transurethral prostatectomy and inguinal hernia repair: a retrospective audit and literature review

OBJECTIVE

To audit the results of combined transurethral resection of the prostate (TURP) and inguinal hernia repair, often carried out under the same anaesthetic (because bladder outlet obstruction from prostatic disease and inguinal hernia are both common conditions in elderly men), to avoid two separate operations.

PATIENTS AND METHODS

The study included 85 patients who underwent primary inguinal hernia repair with TURP in the urology unit of Nottingham City hospital between 1989 and 1995, and who were recalled to a special clinic. The type of hernia and repair carried out were recorded and complications audited with specific reference to recurrence of hernia and wound infection.

RESULTS

The 85 patients underwent 88 primary inguinal hernia repairs with TURP (three were bilateral). Maloney's darn repair was used on 55 and a Bassini repair on 33 occasions, respectively. Two patients developed mild wound infection after surgery, but only two patients (2%) had recurrence of hernia.

CONCLUSIONS

The recurrence rate after primary inguinal herniorraphy with conventional methods of repair, performed with TURP, was comparable with published results of hernia repairs alone, before the introduction of Lichtenstein's mesh repair.

Combined inguinal herniorrhaphy and transurethral prostatectomy

Between January 1979 and June 1988, 41 men underwent combined inguinal herniorrhaphy and transurethral prostatectomy at the Instituto Nacional de la Nutrición in México. These cases (group 1) were compared retrospectively with 100 consecutive cases of inguinal herniorrhaphy alone (group 2) and 100 consecutive cases of transurethral prostatectomy alone (group 3) during the same period. Group 1 had the highest incidence of preoperative risk factors because of age and associated medical problems. However, there were no significant differences in the rate of operative or postoperative complications between groups. No recurrences of inguinal hernia were recorded in group 1 after a follow-up period of 47.1 months. The length of hospitalization was similar between groups, and no patient died. Our observations suggest that when an inguinal hernia and symptomatic prostatism occur together, combined inguinal herniorrhaphy and transurethral prostatectomy is a practical, safe and effective operative procedure. The advantages of this combined procedure include one anaesthetic period, one operative procedure, one hospital stay and one convalescence with morbidity and mortality rates that are comparable to those of inguinal herniorrhaphy or transurethral prostatectomy alone.

Combined retropubic prostatectomy and preperitoneal inguinal herniorrhaphy

Inguinal hernia and an enlarged prostate causing urinary obstruction are 2 disorders with a higher frequency among elderly patients. The anatomical proximity of an inguinal hernia to the enlarged prostate raises the possibility of joint, concurrent surgical treatment of both disorders. We report on the successful preperitoneal repair via a Pfannenstiel incision of 131 inguinal hernias in 97 patients who had undergone retropubic prostatectomy owing to benign enlargement of the prostate. Followup averaged 7 years and included 91 patients with 122 direct and indirect, unilateral or bilateral hernias. Summation of our results shows a low recurrence rate (4.9 per cent) and no complications in the wake of the combined operation. In our opinion prostatectomy combined concurrently with inguinal hernia repair via a preperitoneal retropubic approach should be applied routinely in urological practice.

Restoration of the shutter mechanism in inguinal herniorrhaphy

A technique of inguinal herniorrhaphy that restores the normal shutter mechanism at the internal ring by completing the lateral portion of the repair anterior to the cord is described. We believe that this technique will decrease the incidence of recurrent hernia.

LOCAL ANESTHESIA FOR HERNIOPLASTY. IMMEDIATE AMBULATION AND RETURN TO WORK: A PRELIMINARY REPORT

In 50 cases in which hernioplasty was carried out with atraumatic technique under local anesthesia, the patients walked away from the operating table, then through the corridors, without assistance. They usually drove home the next day and returned to their regular occupations immediately. Few had pain necessitating more than mild analgesia. In a period of follow-up ranging from six months to three years at the time of this report, two patients had recurrence.