Could My Umbilical Hernia Repair Be Infected

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Worst Case Scenarios! Complications Related to Hernial Disease

Ahmed Alwahab, Abdulrahman AlAwadhi, Asmaa Abd Alwahab Nugud and Shomous Abd Elwahab Nugud

Submitted: Nov 21st, 2022 Reviewed: March 1st, 2022 Published: April twelfth, 2022

DOI: x.5772/intechopen.76079

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Incarceration, obstruction and strangulation are well recognized common complications of hernias. Several risk factors decide patients' morbidity and mortality. Hernia surgery complications encompass infections, fascial dehiscence, recurrence, neuralgia, visceral injury, and mesh erosion or migration predetermined by many risk factors. The types and criteria for surgical site infections are divers by the extent of the infection. Whether the open or laparoscopic approaches are attempted, the rates of the respective complications depend on the arroyo. Post-operative hernias are appreciated because of their prevalence and complications. The criteria for enhanced recovery afterwards surgery depend on whether patient is in the pre-operative, intra-operative or mail service-operative phase. Within the pediatric population, the gamble of developing umbilical and inguinal is variable.

Keywords

• hernia
• surgical complications
• hernia surgery complications
• recovery after hernia surgery
• post-surgical complications
• watchful waiting
• recurrence
• endoscopic approach
• open approach

• Ahmed Alwahab*

  • Dubai Wellness Say-so, UAE
  • Sharjah Constitute for Medical Research, UAE

• Abdulrahman AlAwadhi

  • Dubai Health Authorization, UAE

• Asmaa Abd Alwahab Nugud

  • RAK Medical and Health Sciences University, UAE

• Shomous Abd Elwahab Nugud

  • Community and Family Medicine department, College of Medicine, University of Sharjah, UAE

*Address all correspondence to: a7md13@gmail.com

1. Introduction

Weakness or defects of the body wall, mainly the fibro-muscular tissue is known every bit hernia. The hernial illness is among the oldest diseases described in the medical literature with reports equally sometime equally 1500BC. It was not until the nineteenth century for the surgical approach to be recognized as a treatment modality when Bassini published novel approach and primary outcomes. Since then, the improvements in surgical approach emphasized intended to reduce the long-term hernia recurrence and complications. The employ of synthetic material for support was introduced in the early 1900s by Handly past using silk for prosthetic support, but soon later it was found to increase the incidence of wound infection [1]. Risk factors for hernia include, just are not limited to, previous operations, physical stress, constipation, smoking, aging, trauma, family history, systemic disease, and obesity. Hernia repair is amid the most mutual surgeries performed worldwide today, in which more 75% establish to be in the groin region, mainly inguinal culvert hernias [2, 3]. The overall gamble of developing hernia in a lifespan is effectually xv% in males and 5% in females, with proportionate increase in risk every bit the historic period increases. Inguinal hernias affect around three–four% of the general population worldwide [iv]. Differential diagnoses encompass whatever pathology that could pb to pain or mass formation in the groin area in particular. Such diagnoses include, just non limited to, soft tissue, lymphoid tissue, associated vessels, bony structures, and reproductive organs [five, 6]. Even though hernias, in general, are associated with overall promising short and long-term outcomes, there are still some complications to be recognized [7].

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2. Complications of an untreated hernia

2.1. Incarceration and strangulation

Incarceration is the process by which hernia contents are trapped within a hernial sac in which reducing them is not possible. This result in decreased venous and lymphatic menstruation thus edema of incarcerated tissue. As a result, normal gut flora start flourishing and gas accumulates due to bacterial fermentation. As the swelling enlarges, the arterial blood flow to the hernial sac contents is compromised leading to ischemia and tissue necrosis, which is known as hernia strangulation [8]. These 2 entities are complications of hernia itself and are associated with increased rates of mortality and morbidity. The adventure of incarceration and subsequent strangulation tend to be higher in the first few months to years and subtract with time. Gallegos et al. [9] estimated the probability of incarceration to be effectually 2.8% at iii months and 4.eight% at 2 years, which might be partially due to weakening of the abdominal wall and decreased pressure on the sac and its contents [9, 10]. Some of the gamble factors for incarceration and subsequent strangulation include avant-garde age at the time of presentation, femoral hernia, and recurrent hernia [eight]. Morbidity and mortality are determined past many factors including the patient age, comorbidities, and elapsing of the strangulation, the longer the duration, the greater the strangulation gamble. For the reasons mentioned higher up forth with an increased chance of perforation, a strangulated hernia is considered a surgical emergency that mandates surgical intervention with possible bowel resection. If the strangulation lasts longer than 4–6 hours on boilerplate bowel resection may be warranted. In such scenarios, placement of prosthetic mesh is usually non advised, as in that location will be a higher chance of bacterial translocation and wound infection [11, 12].

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iii. Complications of hernia surgery

3.ane. Surgical complications

The incidence of complications associated with laparoscopic surgery is low on average when compared with an open up arroyo. Most of the serious complications occur during admission to the intestinal cavity or while ports are created [thirteen, 14]. Chandler et al. [fifteen] reported the incidence of complications after laparoscopic surgery to be around 30 per 10,000, with half of the complications present in the showtime 24 hours mail service-surgery. Most mutual injuries were to the small bowel, iliac artery, and colon; while the least injured organs were the bladder and liver [15]. At that place is an increased take a chance of complications in patients with a history of previous abdominal surgery for whatever intra-abdominal pathology such as diverticulitis, history of extensive bowel resection, diaphragmatic hernia, and in patients with multiple cardiopulmonary risks [sixteen].

iii.2. Infection (wound, UTI, pneumonia)

Despite the fact that in the modern era advanced hygienic measures have decreased the incidence of mail service-operative infection; it is yet a leading cause and a well-known complication of hernia surgery. Infections could be from multiple sources including the suture used and/or mesh. It is reported that infection incidences are every bit low as i%, or even less, in multidisciplinary specialized hernia practise [17]. The about common underlying organisms are gram-positive skin flora. It was found that there is a slightly increased chance of infection with groin herniorrhaphy. Usually, it is hard to determine the extent of infection, whether skin and soft tissue are only involved, or deeper infection involving the mesh is at that place. Either way, should be treated with aggressive antibiotics and drainage, especially in the setting of a strange body such equally mesh [18].

From a broader perspective, surgical site infections are seen in around i% of clean wounds and around 35% of contaminated wounds. Table 1 lists different types of surgical wound infections. Clinical features include erythema, induration, warmth, and frothy belch later in the course [19, 20]. The incidence of surgical wound infections can be reduced past following elementary measures. For case, avoiding surgery in the setting of an active infection, antibiotic prophylaxis, proper skin preparation, maintaining sterile conditions throughout the surgery, and proper wound dressing [21].

Depth of infection	Comments
Superficial incisional	Infection occurs within 30 days after the surgery and involves skin and subcutaneous tissue of the incision and encompasses the post-obit criteria: Purulent discharge Isolated organism Acute inflammatory reaction with pain, swelling, redness, and heat
Deep incisional	Infection occurs within 30 days later the performance if there are no implants or within 1 yr from the surgery if there are implants. Infections are related to implanted prosthetic material and involves deep fascial layers and muscle tissue, and encompass the following criteria: Purulent discharge from deep tissue layer Deep incisional spontaneous dehiscence Deep tissue infection or abscess constitute by straight examination Diagnosis made by an experienced surgeon
Organ infinite	Infection occurs within thirty days after the operation if there are no implants or within 1 year from the surgery if at that place are implants. Infections are related to implanted prosthetic and involve organs or anatomical spaces that were manipulated during surgery, and encompass the post-obit criteria: Purulent discharge from a bleed Organisms isolated from suspected area Deep tissue infection or abscess found by directly examination Diagnosis made past an experienced surgeon

Table 1.

Types and criteria for the diagnosis of surgical wound infection [22].

3.iii. Fascial dehiscence

Dehiscence is usually due to abdominal wall tension that exceeds the tissue and suture strength. Information technology can be seen early in the post-operative menstruum, and it could also happen as a tardily complication that might involve the full length of the surgical suture or part of it. Its incidence is estimated to be around 1–3% depending on the blazon of abdominal surgery. Despite of the improvement in the surgical techniques and wound management, the overall run a risk of fascial dehiscence remains unchanged [23, 24, 25].

Take a chance factors for wound dehiscence can be sub-classified into patient run a risk factors and those related to surgical site and surgeons' techniques. Patient risk factors include age, male gender, ascites, chronic pulmonary disease, mail-operative cough, obesity, malnutrition, and chronic glucocorticoid therapy [xix, 26]. Surgical technique take chances factors include the length of the surgical wound if bigger than 18 cm or not. Suture failure is a major cause of fascial dehiscence, and information technology is said that in around 95% of cases knots are intact, merely they accept been pulled through the fascia resulting in fascial edge necrosis [27, 28].

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iv. Hernia surgery complications

4.1. Recurrence

Recurrence of hernia is unremarkably seen as a late complication of hernia surgery. When it occurs, it is generally due to deep infection or due to the excessive tension of the repaired tissues and tissue ischemia. Early over-activity is a principal causative amanuensis of recurrent hernia, as it results in inadequate gristly tissue germination around the mesh or suture used to approximate the hernia sac. OʼReilly et al. [29] found that patients who underwent a laparoscopic repair for an inguinal hernia had a higher take chances of having a recurrence in comparison to those who underwent open up repair. Recurrence should be differentiated from other etiologies that could have similar clinical presentations such equally seromas in the obliterated hernia sac [30]. Seroma tin exist divers every bit fluid-filled dead space in the distal remnants of hernial sac, seromas are usually seen after laparoscopic repair and are sometimes termed as a pseudo-hernia. Other etiologies include hematomas that could be seen in anti-coagulated patients. They could be of a business organization if they were of large volume, as they could provide an optimal environment for bacterial growth and infection. Overall hematomas are far more common than seromas and both could exist prevented with a careful hemostasis during surgery [31]. One of the master causes of hernia recurrence is wound tension; excessive tension could lead to tissues pulling apart thus recurrence at an early stage post-operatively. Excessive tension tin also lead to tissue ischemia leading to sutures pulling autonomously or even falling off. Henceforth new modalities of tension free and suture-free hernia repairs are beingness promoted by experts such as Lichtenstein [7, 32].

Another gene to consider is the size of the initial hernia defect which is proposed proportional to the risk of developing recurrence in the aftermath of hernia repair. This fact might exist explained past the quality of the tissue and fascia surrounding the defect surface area. Every bit the defect grows bigger it affects the surrounding fascial plans making them weaker and relatively more than ischemic in comparison to smaller sized defects. Isik et al. [33] found that college levels of matrix metalloproteinase due south-i-2-9-thirteen, in addition to decreased levels of tissue inhibitors of metalloproteinases-1-2-iii played an integral function in the formation of inguinal hernia, leading to dysfunction of collagen fibers, which will result in weakening of fascia, indicating that a hernia is non only a local issue, but rather a reflection of systemic disease [33]. Other etiologies for hernia recurrence include complicated hernia at presentation such as incarceration or strangulation, in which the tissue will be inflamed and edematous providing a good medium for recurrence as the tissue is unhealthy, to begin with. Another causative agent for recurrence is smoking which is said to increase proteolytic enzymes and subtract protective factors involved in tissue healing [11].

4.2. Neuralgia

Nerve injury could be a terrible consequence of an otherwise successful surgery presenting with pain, loss of sensation or muscular weakness. Neuralgia, commonly known equally post-operative hurting, is a rather common complication with varying degrees of pain subsequently herniorrhaphy and follows nerve distribution. While some degree of post-operative pain is expected later on surgery, for the diagnosis of postal service-herniorrhaphy neuralgia to exist made, pain should persist for more iii months, not to be attributed to any other cause and interfere with patient social and/or sexual life [34, 35]. The differential diagnosis for post-herniorrhaphy neuralgia includes hernia recurrence, mesh infection or displacement, osteitis pubis, and fluid collection. Open up approach injuries usually affects the ilioinguinal nerve, iliohypogastric nerve, genital branch of the genitofemoral nerve, while injuries to the lateral femorocutaneous nerve is more common with laparoscopic approach, see Tabular array 2 [1, 36].Near of the time, the mechanism of injury is attributed to nerve entrapment inside the mesh or the suture line. This can exist prevented with careful handling of the tissue and preventing over manipulation of the nerves. In laparoscopic arroyo staple placement beneath the iliopubic tract decreases the take a chance of nerve entrapment [37].

Nerve	Area afflicted
Ilioinguinal nerve	Proximal and medial thigh Mons pubis and Labia majora The root of the penis and upper scrotum
Iliohypogastric nerve	Skin of the hypogastric area Peel of the gluteal expanse
Genitofemoral nervus	Mons pubis and scrotum/labia Anterior lateral thigh area
Afterwards femoral cutaneous nerve	Inductive lateral thigh area
Femoral nervus	Motor nerve to quadriceps femoris Inductive thigh expanse

Table ii.

Commonly injured fretfulness post-herniorrhaphy [1].

Ilioinguinal and iliohypogastric fretfulness are mostly injured during meridian of the external oblique fascia. The genitofemoral nerve is idea to be injured following cord isolation for cremasteric muscle fibers stripping. As before long as the fretfulness are identified, they are retracted out of the field past encircling them with a vessel loop and retraction. While injury happens with mesh tacking in the laparoscopic approach, which can be side stepped by avoiding tacking in known areas of fretfulness distribution [ane]. OʼReilly et al. [29] found that the risk for post-herniorrhaphy neuralgia and/or numbness was significantly lower with laparoscopic approach when compared with open approach [28].

The first line in the direction of neuralgia is unremarkably bourgeois, mainly by local anesthesia injections in the afflicted groin. When this modality fails, surgical re-exploration is advocated to identify the affected nerve and excise it. On rare cases of patients presenting with pain not matching the distribution of a unmarried nervus, surgical re-exploration is not advised equally it normally will fail improving the pain and may consequence in damaging more structures [15, 38].

iv.three. Visceral injury

Bladder, testicular, and vas deferens injuries are amongst the usually injured visceral organs with groin herniorrhaphy procedures Among the to the lowest degree injured structures are the ureters which are more than often seen with the laparoscopic approach- the virtually mutual type of injury is incomplete transection of the ureter and ureteral perforation [39, 40, 41]. Bladder injuries are often reported with direct inguinal hernias, and in rare cases could result in a sliding hernia, in which part of the bladder adheres to the hernia sac. Thus, straight sacs are usually inverted back into the peritoneal cavity to avert unnecessary dissection [42, 43].

Testicular swelling and atrophy could develop afterward inguinal hernia repair. Swelling and edema of the scrotum are due to hematoma or edema of the inguinal culvert that progress inferiorly to the scrotum with gravity. On i mitt, testicular cloudburst is associated with claret supply injury during the process of dissection and isolation of the cord and ordinarily is a painless complication. On the other hand, testicular pain post-operatively could be a issue of torsion or abscess and ruling out such suspicion is done by ultrasound imaging. In the pediatric population cord traction might cause testicular migration into the inguinal culvert. Therefore, before the end of the surgery testes are palpated to ensure the right placement [i, 44].

Vas Deferens injury is considered a rare complication yet the near feared. However, if such an injury was to happen, it requires an urgent urological consultation; injuries range from equally astringent every bit transection to a mild laceration. Untreated injuries can effect in the formation of anti-sperm antibodies and infertility. Avoiding such dreaded complications is possible by gentle traction of the vas and avoiding grasping or squeezing the Vas Deferens [21].

4.4. Mesh erosion\migration

Mesh migration or erosion may occur after femoral or inguinal hernias and depends on the extent of the symptoms; hence mesh removal might be advised. Mesh migration can exist categorized into primary and secondary. Principal, besides known as mechanical, is when the mesh dislodges along the path with least resistance as a event of inadequate fixation or external forces. While secondary, is the slow move of the mesh through nearby anatomical structures due to torso response to a foreign trunk. The result is an erosion of adjacent structures such as the urinary bladder leading to urinary tract infections or hematuria, bowel injury and subsequent fistula formation, and spermatic cord erosion causing vessel obstruction [45, 46].

Ott et al. [47] reported a case of belatedly abdominal fistula germination as a consequence of an incisional hernia repair using an inter-peritoneal mesh. Beast studies showed that micro-erosions and mesh migration and consequent fistulae formation is decreased when mesh covered with biological textile such every bit collagen [48]. In addition, Leber [49] reported a higher incidence entero-cutaneous fistula formation with the use of Mersilene mesh.

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5. Post-operative hernia

Likewise known as an incisional hernia, post-operative hernias occur as a directly result of fascial tissue failure to heal postal service laparotomy. Although incisional hernias are often seen either post mid line and/or transverse incisions, it tin, in theory, happen after any surgical incisions similar paramedian and McBurney incisions, and are also seen post laparoscopic surgeries [fifty]. Such hernias tin abound to huge sizes and contain a significant amount of small-scale and large bowel. Previously, the incidence was believed to be around twenty%, but recent epidemiological studies gauge the number to exist 11%. Around two-thirds of cases may present within the kickoff 12 months subsequently the operation, while the other -3rd present equally a late complication after five–ten years [51, 52, 53]. Adventure factors of incisional hernias are increased with advanced patient age, malnutrition, allowed-compromised land, smoking, and obesity [12, fifteen, 54, 55]. Other factors that play an of import role include emergency surgery and mail-operative wound infection. Ane major complication of incisional hernia repair surgery is a loftier recurrence charge per unit, which might attain upwardly to 50%. In some cases this hazard is related to the type of surgical approach, whether suture repair or mesh supported repair, and too to the amount of tension practical on the wound edges. Recurrence in this type of hernia is too related to the appearance of unrecognized hernia sites [56]. Some other set of complications is related to the empty hernia cavity that is left backside post reduction of hernia sac, such as hematomas and seromas. Henceforth, experts recommend placement of closed suction drainage; which by itself along with mesh will increase the risk of infection post-operatively [57, 58].

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6. Enhanced recovery after hernia surgery

The aim of enhanced recovery after surgery protocols is to improve outcomes, lower wellness toll, while harnessing the benefits by standardizing the medical intendance [59, lx]. Such protocols are evidence-based guidelines that include minimizing surgical trauma, post-operative hurting, reduce complications, and improve outcomes past decreasing the expected length of hospital stay and spike the patient recovery [61]. Such approach to patient care should be a multidisciplinary arroyo including surgeon, anesthesiologists or hurting specialists, nursing staff, physical rehabilitation service, and most chiefly patient cooperation [62, 63]. Patients who are followed with an enhanced recovery protocol will have the aforementioned discharge criteria but will reach these milestones sooner. This approach will usually comprise 15–20 elements and volition span through the full patient hospital stay; preoperatively, intra-operatively, and post-operatively (Table 3) [64]. Earlier surgery, patient instruction and counseling about current handling options and all-time arroyo should be discussed. Later that, a meticulous overview of the patient general health condition and management of whatsoever comorbidities such as renal, cardiac, or respiratory should be done. Intra-operatively safety antibiotics are recommended before surgery, and fluids should exist managed judiciously along with continuous monitoring of the patient vital condition [65, 66, 67]. While post-operative menstruation is mainly concerned with pain management, fluid and diet, avoidance of nasogastric tube and early urinary catheter removal, early mobilization, and finally early discharge [68, 69].

Period	Criteria
Pre-operative	Patient educational activity Medical comorbidities optimization Bowel preparation
Intra-operative	Thromboprophylaxis Antibody prophylaxis Thermal regulation Fluid maintenance Avoid drains and nasogastric tube
Post-operative	Enteral nutrition from day 1 mail service-operative Multimodal analgesia Antiemetic prophylaxis Early removal of urinary catheter Early mobilization

Tabular array 3.

Main criteria for enhanced recovery after surgery protocol [66].

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7. Hernia and the pediatric population

7.1. Umbilical hernia

An umbilical hernia is commonly seen in the pediatric population with an incidence of x–xxx% at nascency in infants of Caucasian ethnicity and higher in those of African-American ethnicity, for unknown reasons [ane]. It is also more than common in premature infants of all races, and some report a tendency for familial inheritance. While the cause is yet to be identified in about of the cases, an umbilical hernia ordinarily will regress and close on its own by 2–3 years of age with less than 10% needing surgical intervention.

Meanwhile, umbilical hernias in adults have a different clinical presentation, almost being caused non congenital with a male to female ratio of 3:1. The developed-type umbilical hernia usually will need surgical intervention for it to close and commonly are symptomatic at time of presentation. A typical presentation volition be of an exquisitely tender peri-umbilical mass overlying the skin; long-standing untreated umbilical hernia might event in thinning of covering pare and ulceration due to force per unit area necrosis of the adjacent peel. While small umbilical hernias could pass unnoticed and discovered incidentally. This type of hernia is associated unremarkably with recurrence in the setting of loftier intra-abdominal pressure level. For this reason, surgical repair is offered for incarcerated hernia or a progressively symptomatic type [3, 11, 70].

vii.2. Inguinal hernias

Although the overall incidence of inguinal hernia in the pediatric population is low when compared with adults, the complexity that might arise is nearly the same. In the age group, bowel incarceration is incidence is low, but should this be the case, bowel infarction would happen within 2–3 hours. With bowel infarction, information technology is not uncommon to get testicular blood supply compromise leading to ischemic necrosis and testicular atrophy with an incidence around 9% according to some studies [71, 72, 73]. While in girls, ovarian torsion is reported to happen with inguinal hernia strangulation in about third of patients with incarcerated hernia that comprise an irreducible ovary. For this reason, some experts recommend not to filibuster surgical intervention in this population [74].

7.3. Congenital diaphragmatic hernia

The congenital diaphragmatic hernia is caused by a diaphragmatic defect resulting intestinal viscera herniating to the chest. It usually presents in the outset few hours of life with respiratory distress and then severe that it could exist incompatible with life [75]. In many cases, this status tin can be diagnosed in utero via ultrasound, and for those non diagnosed prenatally, this condition should be suspected in neonates with respiratory distress and absent breath sounds soon after commitment and can be hands diagnosed by chest 10-ray [76]. Built diaphragmatic hernia complications are categorized into acute, and tardily-onset complications, the nigh serious acute complication is persistent pulmonary hypertension of the new born other complications include chylothorax, hemorrhage, and recurrent infection. Furthermore, the spectrum of late complications includes chronic respiratory disease, recurrent hernia, spinal/chest wall abnormalities, neurological, and gastrointestinal complications [77, 78].

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eight. Watchful waiting vs. intervention in hernial affliction

The complexity of hernia surgery is depression; but it could have a pregnant touch on the patient life, should it happen. Thus, many patients with asymptomatic hernias prefer to delay surgical intervention until needed. As the natural history of an untreated hernia is mostly unknown, many practitioners recommend an elective surgery to treat the hernia. Fitzgibbons et al. [79] followed 720 men, half of which had a surgical intervention and half underwent watchful waiting and were followed upwardly to 4.five years. The authors concluded that watchful waiting was a suitable option to manage a minimally symptomatic inguinal hernia as the overall risk of complication is depression [lxxx].

References

1. ane. Zinner Thou. Maingot'due south Intestinal Operations. [S.l.]: Mcgraw-Hill Education; 2022
2. 2. Rutkow I, Robbins A. Demographic, classificatory, and socioeconomic aspects of hernia repair in the United states of america. Surgical Clinics of Northward America. 1993;73(3):413-426
3. 3. Rutkow I. Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surgical Clinics of Due north America. 2003;83(5):1045-1051
4. four. Caglayan F, Caglayan O, Cakmak M, Saygun O, Somuncu S, Ulusoy Southward, et al. Investigation of OH-proline contents of hernia sacs in children and comparison with adults. European Journal of Pediatric Surgery. 2005;fifteen(4):258-261
5. 5. Paring B, Al Samaraee A, Coyne P, Overnice C, Katory M. Varices of the round ligament mimicking an inguinal hernia: An important differential diagnosis during pregnancy. The Annals of the Regal Higher of Surgeons of England. 2022;92(seven):e10-e11
6. 6. Ijpma F, Boddeus K, de Haan H, van Geldere D. Bilateral circular ligament varicosities mimicking inguinal hernia during pregnancy. Hernia. 2008;13(i):85-88
7. 7. Schumpelick P. Inguinal hernia repair in adults. The Lancet. 1994;344(8919):375-379
8. eight. O'Dwyer P, Norrie J, Alani A, Walker A, Duffy F, Horgan P. Observation or functioning for patients with an asymptomatic inguinal hernia. Annals of Surgery. 2006;244(2):167-173
9. ix. Gallegos N, Dawson J, Jarvis K, Hobsley 1000. Hazard of strangulation in groin hernias. British Journal of Surgery. 1991;78(10):1171-1173
10. ten. Ścierski A. Duration of groin hernias and accompanied symptoms before beginning of treatment of hernias. Smooth Journal of Surgery. 2008;80(12)
11. 11. Srinath S, Prashanth H, Suma Yard. Complicated groin hernias: Take a chance factors, conservative management and timing of surgical management. Periodical of Evolution of Medical and Dental Sciences. 2022;2(34):6502-6508
12. 12. Ge B, Huang Q, Liu L, Bian H, Fan Y. Hazard factors for bowel resection and outcome in patients with incarcerated groin hernias. Hernia. 2009;fourteen(three):259-264
13. 13. Molloy D, Kaloo P, Cooper M, Nguyen T. Laparoscopic entry: A literature review and analysis of techniques and complications of primary port entry. The Australian and New Zealand Journal of Obstetrics and Gynaecology. 2002;42(3):246-254
14. xiv. Ahmad Grand, Gent D, Henderson D, O'Flynn H, Phillips Yard. Laparoscopic entry techniques. Cochrane Database of Systematic Reviews. 2022;31(8):6583
15. 15. Chandler JG, Corson SL, Way LW. 3 spectra of laparoscopic entry access injuries. Journal of the American Higher of Surgeons. 2001;192:478
16. 16. McGoldrick M. Surgeon book and operative bloodshed in the United states. Survey of Anesthesiology. 2004;48(ii):111-112
17. 17. Samee A, Adjepong S, Pattar, J. Late-onset mesh infection following laparoscopic inguinal hernia repair. Example Reports, 2022(nov 11 one), bcr0920114863-bcr0920114863
18. xviii. Delikoukos S, Tzovaras G, Liakou P, Mantzos F, Hatzitheofilou C. Late-onset deep mesh infection later on inguinal hernia repair. Hernia. 2006;eleven(1):15-17
19. 19. Ovington 50. Hanging wet-to-dry out dressings out to dry out. Advances in Pare and Wound Care. 2002;15(2):79-84
20. xx. Madhok B, Vowden K, Vowden P. New techniques for wound debridement. International Wound Periodical. 2022;x(3):247-251
21. 21. Cruse P, Foord R. The epidemiology of wound infection: A x-year prospective study of 62,939 wounds. Surgical Clinics of Due north America. 1980;sixty(i):27-40
22. 22. Mangram A, Horan T, Pearson M, Silver 50, Jarvis W. Guideline for prevention of surgical site infection. Infection Control and Hospital Epidemiology. 1999;20(04):247-280
23. 23. Carlson Chiliad. Astute wound failure. Surgical Clinics of Northward America. 1997;77(3):607-636
24. 24. van Ramshorst G, Nieuwenhuizen J, Hop W, Arends P, Boom J, Jeekel J, Lange J. Abdominal wound dehiscence in adults: Development and validation of a risk model. World Journal of Surgery. 2009;34(1):twenty-27
25. 25. Harris R, Dodson M. Surgical wound infection and management of extrafascial wound disruption. Postgraduate Obstetrics and Gynecology. 1996;16(7):1
26. 26. Pollock A. Commentary on consummate dehiscence of the abdominal wound and incriminating factors past Pavlidis TE et al. The European Journal of Surgery. 2001;167(5):355-355
27. 27. Greenall One thousand, Evans M, Pollock A. Midline or transverse laparotomy? A random controlled clinical trial. Part I: Influence on healing. British Journal of Surgery. 1980;67(3):188-190
28. 28. Ellis H, Coleridge-Smith P, Joyce A. Abdominal incisions: Vertical or transverse? Postgraduate Medical Periodical. 1984;lx(704):407-410
29. 29. OʼReilly E, Burke J, OʼConnell P. A meta-assay of surgical morbidity and recurrence after laparoscopic and open repair of main unilateral inguinal hernia. Annals of Surgery. 2022;255(v):846-853
30. 30. Mayo Due west. An operation for the radical cure of umbilical hernia. Annals of Surgery. 1901;34(1):276-280
31. 31. Zaid T, Herring Westward, Meeks Thou. A randomized trial of secondary closure of superficial wound dehiscence by surgical tape or suture. Female person Pelvic Medicine and Reconstructive Surgery. 2022;xvi(4):246-248
32. 32. Glassow F. Recurrent inguinal and femoral hernia. British Medical Journal. 1970;1(5690):215-216
33. 33. Isik A, Gursul C, Peker Thousand, Aydın Grand, Fırat D, Yılmaz İ. Metalloproteinases and their inhibitors in patients with inguinal hernia. World Periodical of Surgery. 2022;41(v):1259-1266
34. 34. Bay-Nielsen M, Perkins F, Kehlet H. Pain and functional impairment 1 year later inguinal Herniorrhaphy: A Nationwide questionnaire study. Annals of Surgery. 2001;233(1):1-7
35. 35. Kehlet H, Jensen T, Woolf C. Persistent postsurgical pain: Hazard factors and prevention. The Lancet. 2006;367(9522):1618-1625
36. 36. Tverskoy Grand, Cozacov C, Ayache Thousand, Bradley E, Kissin I. Postoperative pain after inguinal Herniorrhaphy with different types of anesthesia. Anesthesia and Analgesia. 1990;70(1):29-35
37. 37. Klein S, Greengrass R, Warner D. Paravertebral somatic nerve block for outpatient inguinal herniorraphy. Regional Anesthesia and Pain Medicine. 1998;23(Sup 1):54
38. 38. Mirdehghan Thou, Yazdanjo 1000, Sadri B, Akhavantafti East, Ghaei E. Postoperative analgesia in inguinal Herniorrhaphy: Infiltration of 0.25% bupivacaine before incision vs earlier repair of incision. Regional Anesthesia and Pain Medicine. 2008;33(1):e152
39. 39. Al-Awadi Thou, Kehinde E, Al-Hunayan A, Al-Khayat A. Latrogenic ureteric injuries: Incidence, aetiological factors and the upshot of early management on subsequent outcome. International Urology and Nephrology. 2005;37(2):235-241
40. 40. Basic D, Ignjatovic I, Potic M. Latrogenic ureteral trauma: A 16-year single tertiary centre experience. Srpski Arhiv za Celokupno Lekarstvo. 2022;143(three-4):162-168
41. 41. Marcelissen T, Den Hollander P, Tuytten T, Sosef Chiliad. The incidence of Iatrogenic ureteral injury during open and laparoscopic colorectal surgery. Surgical Laparoscopy, Endoscopy and Percutaneous Techniques. 2022;26(vi):513-515
42. 42. Edye Chiliad. Complications of endoscopic and laparoscopic surgery: Prevention and direction. Athenaeum of Surgery. 1998;133(iv):464-464
43. 43. Das D. Meta-analysis of randomized clinical trials comparison open and laparoscopic inguinal hernia repair. British Journal of Surgery. 2004;91(5):647-647, 91: 253
44. 44. Amid P. A strategy for circumventing the problem of prostate surgery subsequent to preperitoneal inguinal hernia repair. Hernia. 2004;viii(3)
45. 45. ocot A, Gerharz Due east, Riedmiller H. Urological complications of laparoscopic inguinal hernia repair: A case series. Hernia. 2022;xv(v):583-586
46. 46. Agrawal A, Avill R. Mesh migration post-obit repair of inguinal hernia: A example study and review of the literature. Hernia. 2005;10(1):79-82
47. 47. Ott V, Groebli Y, Schneider R. Tardily intestinal fistula formation afterward incisional hernia using intraperitoneal mesh. Hernia. 2004;ix(i):103-104
48. 48. Aubé C, Pessaux P, Tuech J, du Plessis R, Becker P, Caron C, Arnaud J. Detection of peritoneal adhesions using ultrasound examination for the evaluation of an innovative intraperitoneal mesh. Surgical Endoscopy and Other Interventional Techniques. 2003;eighteen(i):131-135
49. 49. Leber Grand. Long-term complications associated with prosthetic repair of incisional hernias. Archives of Surgery. 1998;133(four):378
50. 50. Bucknall T, Cox P, Ellis H. Burst abdomen and incisional hernia: A prospective study of 1129 major laparotomies. BMJ. 1982;284(6320):931-933
51. 51. LeBlanc Thou. Laparoscopic incisional and ventral hernia repair: Complications?How to avoid and handle. Hernia. 2004;8(4):323-331
52. 52. Mudge M, Hughes Fifty. Incisional hernia: A 10 year prospective study of incidence and attitudes. British Journal of Surgery. 1985;72(1):lxx-71
53. 53. Read R. Contempo trends in the management of incisional herniation. Archives of Surgery. 1989;124(4):485
54. 54. Rosin D. Prevention of incisional hernia in midline laparotomy with Onlay mesh: A randomized clinical trial. Earth Journal of Surgery. 2022;38(nine):2231-2232
55. 55. Meena G, Ali S, Chawla A, Aggarwal L, Suhani South, Kumar South, Khan R. A prospective written report of factors influencing wound dehiscence after midline laparotomy. Surgical Scientific discipline. 2022;04(08):354-358
56. 56. Mäkelä J, Kiviniemi H, Juvonen T, Laitinen Southward. Factors influencing wound dehiscence after midline laparotomy. The American Periodical of Surgery. 1995;170(iv):387-390
57. 57. Cobb W, Kercher K, Heniford B. Laparoscopic repair of incisional hernias. Surgical Clinics of North America. 2005;85(one):91-103
58. 58. Awaiz A, Rahman F, Hossain M, Yunus R, Khan Southward, Memon B, Memon K. Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia. 2022;19(3):449-463
59. 59. Kehlet H, Wilmore D. Evidence-based surgical care and the evolution of fast-runway surgery. Register of Surgery. 2008;248(2):189-198
60. threescore. Ljungqvist O, Scott M, Fearon K. Enhanced recovery after surgery. JAMA Surgery. 2022;152(three):292
61. 61. Delaney C, Fazio V, Senagore A, Robinson B, Halverson A, Remzi F.'Fast track' postoperative management protocol for patients with high co-morbidity undergoing complex intestinal and pelvic colorectal surgery. British Journal of Surgery. 2001;88(11):1533-1538
62. 62. Gustafsson U, Scott M, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced recovery later on surgery (ERAS®) gild recommendations. Clinical Nutrition. 2022;31(half dozen):783-800
63. 63. Slim K, Joris J. The egg-and-chicken situation in postoperative enhanced recovery programmes. British Journal of Amazement. 2022;118(one):5-6
64. 64. Kehlet H, Joshi G. Enhanced recovery after surgery. Anesthesia and Analgesia. 2022;125(6):2154-2155
65. 65. Feldheiser A, Aziz O, Baldini Thousand, Cox B, Fearon One thousand, Feldman L, et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, office two: Consensus statement for anaesthesia practice. Acta Anaesthesiologica Scandinavica. 2022;60(3):289-334
66. 66. Maurice-Szamburski A, Auquier P, Viarre-Oreal V, Cuvillon P, Carles One thousand, Ripart J, et al. Effect of sedative premedication on patient experience after general anesthesia. Periodical of the American Medical Association. 2022;313(9):916
67. 67. Rollins K, Lobo D. Intraoperative goal-directed fluid therapy in elective major abdominal surgery. Register of Surgery. 2022;263(3):465-476
68. 68. Kamel H, Iqbal 1000, Mogallapu R, Maas D, Hoffmann R. Time to ambulation after hip fracture surgery: Relation to hospitalization outcomes. The Journals of Gerontology Serial A: Biological Sciences and Medical Sciences. 2003;58(11):M1042-M1045
69. 69. Muller S, Zalunardo One thousand, Hubner M, Clavien P, Demartines N. A fast-runway program reduces complications and length of hospital stay after open up colonic surgery. Gastroenterology. 2009;136(3):842-847.e1
70. 70. Darling J. Radical performance for the cure of umbilical hernia. The Dublin Periodical of Medical Science. 1910;129(six):428-430
71. 71. Puri P, Guiney E, O'Donnell B. Inguinal hernia in infants: The fate of the testis following incarceration. The Journal of Urology. 1984;132(2):425
72. 72. Rowe M. Incarcerated and strangulated hernias in children. Athenaeum of Surgery. 1970;101(2):136
73. 73. Walc L, Bass J, Rubin Southward, Walton M. Testicular fate after incarcerated hernia repair and/or orchiopexy performed in patients under half dozen months of age. Journal of Pediatric Surgery. 1995;30(eight):1195-1197
74. 74. Boley S, Cahn D, Lauer T, Weinberg G, Kleinhaus S. The irreducible ovary: A true emergency. Journal of Pediatric Surgery. 1991;26(9):1035-1038
75. 75. Wiener E. Congenital diaphragmatic hernia: Pathophysiology and pharmacologic back up. Periodical of Pediatric Surgery. 1981;16(6):1043
76. 76. Sakurai Chiliad, Donnelly L, Klosterman L, Strife J. Congenital diaphragmatic hernia in neonates: Variations in umbilical catheter and enteric tube position. Radiology. 2000;216(1):112-116
77. 77. Dillon P, Cilley R, Mauger D, Zachary C, Meier A. The relationship of pulmonary artery pressure and survival in congenital diaphragmatic hernia. Journal of Pediatric Surgery. 2004;39(3):307-312
78. 78. Jancelewicz T, Chiang M, Oliveira C, Chiu P. Belatedly surgical outcomes among built diaphragmatic hernia (CDH) patients: Why long-term follow-upward with surgeons overall. Journal of Pediatric Surgery. 2022;48(5):935-941
79. 79. Fitzgibbons R, Giobbie-Hurder A, Gibbs J, Dunlop D, Reda D, McCarthy Chiliad, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men. The Periodical of the American Medical Association. 2006;295(3):285
80. 80. Nugud A, Nugud S. Long-standing asymptomatic Inguinoscrotal hernia. Sultan Qaboos Academy Medical Periodical. 2022:e250-e251

Written By

Ahmed Alwahab, Abdulrahman AlAwadhi, Asmaa Abd Alwahab Nugud and Shomous Abd Elwahab Nugud

Submitted: November 21st, 2022 Reviewed: March 1st, 2022 Published: April 12th, 2022

© 2022 The Author(southward). Licensee IntechOpen. This affiliate is distributed under the terms of the Creative Commons Attribution iii.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original piece of work is properly cited.

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