The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA Cooperative Hernia Study Group. Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study A study of wound infections following inguinal hernia repair. Three-year results of randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty The use of porcine small intestinal submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up Long-term Results of a Randomized Controlled Trial of a Nonoperative Strategy (Watchful Waiting) for Men With Minimally Symptomatic Inguinal Hernias Randomized controlled trial of preservation or elective division of ilioinguinal nerve on open inguinal hernia repair with polypropylene mesh. Repeated Groin Hernia Recurrences Psychological risk factors for chronic post-surgical pain after inguinal hernia repair surgery: a prospective cohort study. Does nerve identification during open inguinal herniorrhaphy reduce the risk of nerve damage and persistent pain? Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: long-term follow-up of a randomized controlled trial. Effectivity of laparoscopic inguinal hernia repair (TAPP) in daily clinical practice: early and long-term result [Pain and rehabilitation after inguinal hernia repair in adult male patients]. A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias Effect of Single-Dose Prophylactic Ampicillin and Sulbactam on Wound Infection After Tension-Free Inguinal Hernia Repair With Polypropylene Mesh: The Randomized, Double-Blind, Prospective Trial Male infertility after endoscopic Totally Extraperitoneal (Tep) hernia repair (Main): rationale and design of a prospective observational cohort study
Background The extent to which lifestyle factors such as tobacco consumption and obesity affect the outcome after inguinal hernia surgery has been poorly studied . This study was undertaken to assess the effect of smoking , smokeless tobacco consumption and obesity on postoperative complications after inguinal hernia surgery . The second aim was to evaluate the effect of tobacco consumption and obesity on the length of hospital stay . Methods A cohort of 12,697 Swedish construction workers with prospect ively collected exposure data on tobacco consumption and body mass index ( BMI ) from 1968 onward were linked to the Swedish inpatient register . Information on inguinal hernia procedures was collected from the inpatient register . Any postoperative complication occurring within 30 days was registered . In addition to this , the length of hospitalization was calculated . The risk of postoperative complications due to tobacco exposure and BMI was estimated using a multiple logistic regression model and the length of hospital stay was estimated in a multiple linear regression model . Results After adjusting for the other covariates in the multivariate analysis , current smokers had a 34 % ( OR 1.34 , 95 % CI 1.04 , 1.72 ) increased risk of postoperative complications compared to never smokers . Use of “ Swedish oral moist snuff ” ( snus ) and pack-years of tobacco smoking were not found to be significantly associated with an increased risk of postoperative complications . BMI was found to be significantly associated with an increased risk of postoperative complications ( P = 0.04 ) . This effect was mediated by the underweighted group ( OR 2.94 ; 95 % CI 1.15 , 7.51 ) . In a multivariable model , increased BMI was also found to be significantly associated with an increased mean length of hospital stay ( P < 0.001 ) . There was no statistically significant association between smoking or using snus , and the mean length of hospitalization after adjusting for the other covariates in the model . ConclusionS moking increases the risk of postoperative complications even in minor surgery such as inguinal hernia procedures . Obesity increases hospitalization after inguinal hernia surgery . The Swedish version of oral moist tobacco , snus , does not seem to affect the complication rate after hernia surgery at all BACKGROUND We sought to determine perioperative variables predictive of complications or recurrence for patients undergoing surgical repair of inguinal hernias . PATIENTS AND METHODS Using data from the Veterans Affairs trial , regression analyses were utilized to identify perioperative factors significantly associated with complications ( overall , short-term and long-term ) , long-term pain , and to develop a risk model for recurrence . RESULTS Recurrent and scrotal hernias were predictors for short term and overall complications , regardless of technique . Older age and higher Mental Component Score of the SF-36 were associated with higher risk of long term complications in the open group while prostatism and increased body mass index were the significant predictors in the laparoscopic group . Long-term pain complaints decreased as patient age increased in both groups . Patient and surgeon factors were predictive of recurrence but varied greatly depending on surgical technique . CONCLUSIONS Regardless of technique , scrotal and recurrent hernias were associated with a greater risk of complications and younger patients had more long-term pain . Predictors of recurrence vary based on surgical technique Background The current prospect i ve r and omized controlled clinical study aim ed to assess the short- and long-term results of recurrent inguinal hernia repair , and to compare the results for transabdominal preperitoneal ( TAPP ) and totally extraperitoneal ( TEP ) procedures with those for open tension-free repair . Methods For this study , 82 patients were r and omly assigned to undergo TAPP ( group A , n = 24 ) , TEP ( group B , n = 26 ) , or open Lichtenstein hernioplasty ( group C , n = 32 ) . All the patients with recurrent inguinal hernias had undergone previous repair using conventional open procedures . Physical examination showed  Nyhus type II hernia in the vast majority of the patients ( 59 % ) . High-risk patients ( American Society of Anesthesiology [ ASA ] III or IV ) ; coagulation disorders ; previous abdominal or pelvic surgery ; and irreducible , congenital , and massive scrotal or sliding hernias were excluded from the study . Results There was a statistically significant difference ( p = 0.001 ) in operating time favoring the open procedure . The intensity of postoperative pain was greater in the open hernia repair group 24 h , 48 h , and 7 days after surgery ( p = 0.001 ) , with a greater consumption of pain medication among these patients ( p < 0.004 ) . The median time until return to work was 14 days for group A , 13 days for Group g , and 20 days for group C. The comparison was in favor of laparoscopically treated patients . Nine recurrences ( 4 in the laparoscopic groups and 5 in the open group ) were documented within 3 years of follow-up evaluation . Conclusion Laparoscopic inguinal hernia repair ( TAPP or TEP ) is the method of choice for dealing with recurrent inguinal hernia A prospect i ve study was carried out to determine the incidence of  wound infection following surgery for inguinal hernia repair in a day surgery unit . The study incorporated surveillance for 1 month postoperatively . All patients were contacted by telephone , and reports of possible wound infection investigated via their General Practitioners . Ninety-seven patients were included in the study and the infection rate was 4 % Purpose The aim of the present r and omised study was to find out whether usage of lightweight mesh in inguinal hernia repair , compared with heavyweight mesh , results in decreased incidence of chronic groin pain and foreign body feeling , as well as to evaluate the risk factors for chronic pain development and hernia recurrences . Methods The patients were r and omised into the heavyweight mesh ( HW ) group and lightweight mesh ( LW ) group . A tension-free mesh repair using the Lichtenstein technique was performed on all patients . Pain scores during different activities were measured on visual analogue scale . All patients underwent a clinical examination for any evidence of hernia recurrence . Results Of the patients , 17.2 % in the HW group and 29.3 % in the LW group reported that they experienced pain at 3-year follow-up ( P = 0.1323 ) . Pain was most often reported during physical activity . The median VAS score of all studied activities was 30.5 in the HW group and 30.0 in the LW group . There were more patients in the HW group than in the LW group who stated that they could feel the mesh in the groin ( 27.6 vs. 20.7 % , P = 0.3967 ) . Among all patients , 42.9 % who had severe pain preoperatively also reported pain during different activities and 19.6 % of the patients who did not have severe pain preoperatively reported pain during different activities ( P = 0.0481 ) . At 3-year follow-up , there was 1 hernia recurrence in the HW group and 1 hernia recurrence in the LW group . Conclusions Our study shows that compared with HW mesh , LW mesh has no advantage in reducing chronic groin pain and foreign body feeling at the operation site after inguinal hernioplasty at 3-year follow-up . Severe preoperative pain was correlated with the development of chronic pain . There was no difference between the two study groups in the recurrence rates Introduction The treatment of hernias remains controversial , with multiple prosthetic meshes being exalted for a variety of their characteristics . In the event of incarcerated/strangulated hernias and other potentially contaminated fields the placement of prosthetic material remains controversial because of increased risk of recurrence and infection . Porcine small intestinal submucosa mesh ( Surgisis , Cook Bloomington , IN ) has been demonstrated safe and feasible in laparoscopic hernia repairs in this scenario . We present our 5-year experience , with placement of Surgisis mesh in potentially or grossly contaminated fields . Methods From May 2000 to October 2006 , 116 patients ( 52 male , 64 female ) with 133 procedures were performed . Placement of Surgisis mesh for either incisional , umbilical , inguinal , femoral or parastomal hernia repairs in an infected or potentially contaminated setting were achieved , and studied in a prospect i ve fashion . Results All procedures were laparoscopically with two techniques [ intraperitoneal onlay mesh ( IPOM ) and two-layered “ s and wich ” repair ] . Mean follow-up was 52 ± 20.9 months . Thirty-nine cases were in an infected field and the rest in a potentially contaminated field . Ninety-one procedures were performed concurrently with a contaminated procedure . Twenty-five presented as  intestinal obstruction  , 16 strangulated hernias  , and 17 required small bowel resection ; 29 were inguinal hernias , 57 incisional , and 38 umbilical . In 13 patients more than two different hernias were repaired . Eighty-five percent 5-year follow-up was achieved , during which we identified 7 recurrences , 11 seromas ( all resolved ) , and 10 patients reporting mild pain . Six second looks were performed and in all cases except one the mesh was found to be totally integrated into the tissue with strong scar tissue corroborated macro- and microscopically . Conclusions In our experience the use of small intestine submucosa mesh in contaminated or potentially contaminated fields is a safe and feasible alternative to hernia repair with minimal recurrence rate and satisfactory results in long-term follow-up Objective : To assess the long-term crossover ( CO ) rate in men undergoing watchful waiting ( WW ) as a primary treatment strategy for their asymptomatic or minimally symptomatic inguinal hernias . Background : With an average follow-up of 3.2 years , a r and omized controlled trial comparing WW with routine repair for male patients with minimally symptomatic inguinal hernias led investigators to conclude that WW was an acceptable option [ JAMA . 2006;295(3):285–292 ] . We now analyze patients in the WW group after an additional 7 years of follow-up . Methods : At the conclusion of the original study , 254 men who had been assigned to WW consented to longer-term follow-up . These patients were contacted yearly by mail question naire . Nonresponders were contacted by phone or e-mail for additional data collection . Results : Eighty-one of the 254 men ( 31.9 % ) crossed over to surgical repair before the end of the original study , December 31 , 2004 , with a median follow-up of 3.2 ( range : 2–4.5 ) years . The patients have now been followed for an additional 7 years with a maximum follow-up of 11.5 years . The estimated cumulative CO rates using Kaplan-Meier analysis was 68 % . Men older than 65 years crossed over at a considerably higher rate than younger men ( 79 % vs 62 % ) . The most common reason for CO was pain ( 54.1 % ) . A total of 3 patients have required an emergency operation , but there has been no mortality . Conclusions : Men who present to their physicians because of an inguinal hernia even when minimally symptomatic should be counseled that although WW is a reasonable and safe strategy , symptoms will likely progress and an operation will be needed eventually HYPOTHESIS Our study aim ed to evaluate the effect of preservation or elective division of the ilioinguinal nerve on pain and postoperative symptoms after open inguinal hernia repair with mesh . DESIGN Double-blind , r and omized trial . SETTING Four public , government-financed hospitals in Italy . PATIENTS From January 1 , 1997 , to June 30 , 2002 , 813 patients with primary inguinal hernia were r and omly allocated to undergo inguinal hernia repair either with ilioinguinal nerve preservation ( 408 patients , group A ) or elective transection ( 405 patients , group B ) . INTERVENTION Hernia repair with sutureless apposition of a polypropylene mesh . MAIN OUTCOME MEASURES The primary outcome was the evaluation of chronic pain 1 year after operation . Secondary outcomes were postoperative symptoms assessment at 1 week and 1 , 6 , and 12 months after operation . Telephone interview was performed 35.5 months ( range , 12 - 59 months ) after operation to assess the presence of chronic pain . RESULTS Of the 302 group A and 291 group B patients who made an office visit 1 year postoperatively , pain was absent in 231 ( 76.5 % ) and 213 ( 73 % ) ( difference , 3.30 % ; 95 % confidence interval , -3.68 % to 10.28 % ) , mild in 55 ( 18 % ) and 60 ( 21 % ) , moderate in 11 ( 4 % ) and 9 ( 3 % ) , and severe in 5 ( 2 % ) and 9 ( 3 % ) , respectively ( P = .55 ; Pearson chi2(3 ) test ) . At 1-month and 6-month follow-up visits , no difference was found between the 2 groups with respect to pain , but loss of pain or touch sensation were significantly greater when the ilioinguinal nerve was divided . One year after operation , the 2 groups were also comparable with respect to loss of pain sensation , but touch sensation remained decreased in group B. At telephone interview , the presence of chronic pain was similar in both groups . CONCLUSIONS Pain after open hernia repair with polypropylene mesh is not affected by elective division of the ilioinguinal nerve ; sensory disturbances in the area of distribution of the transected nerve are significantly increased Objective : To describe the characteristics of patients undergoing multiple groin hernia repairs  and to identify strategies that prevent further recurrence . Summary Background Data : Although relatively infrequent , recurrent groin hernias where several repairs have previously been undertaken constitutes a major problem in hernia surgery . Low numbers and heterogeneity have made it difficult to perform large prospect i ve studies on this group . Methods : The study was design ed as an observational population -based register study . All repairs for recurrent hernia recorded in the Swedish Hernia Register ( SHR ) 1992–2006 were identified . Risk for reoperation by number of previous repairs , with adjustment for gender and age , and risk for reoperation by unit responsible for previous repair were determined using Cox proportional hazard analysis . Results : There were 12,104 cases of hernia repaired once , 2 repairs in 4199 cases , 3 repairs in 310 cases , 4 repairs in 32 cases , and 5 repairs in 3 cases . The risk for further reoperation increased with the number of previous repairs ( P < 0.001 ) . The hazard ratios for reoperation following  open preperitoneal mesh repair and  laparoscopic repair  decreased ; whereas , the hazard ratio for sutured repair  increased with the number of previous repairs . The difference between Lichtenstein repair and laparoscopic repair was significant for the first 2 repairs ( P < 0.05 ) . Conclusion : Laparoscopic preperitoneal repair provides the best surgical outcome in repeated groin hernia recurrence A significant proportion of patients experience chronic post-surgical pain ( CPSP ) following inguinal hernia surgery .  Psychological models are useful in predicting acute pain after surgery , and in predicting the transition from acute to chronic pain in non-surgical context s. This is a prospect i ve cohort study to investigate psychological ( cognitive and emotional ) risk factors for CPSP  after inguinal hernia surgery . Participants were asked to complete question naires before surgery and 1 week and 4 months after surgery . Data collected before surgery and 1 week after surgery were used to predict pain at 4 months . Psychological risk factors assessed included anxiety , depression , fear-avoidance , activity avoidance , catastrophizing , worry about the operation , activity expectations , perceived pain control and optimism .  The study included 135 participants ; follow-up question naires were returned by 119 ( 88.1 % ) and 115 ( 85.2 % ) participants at 1 week and 4 months after surgery respectively . The incidence of CPSP ( pain at 4 months ) was 39.5 % . After controlling for age , body mass index and surgical variables ( e.g. anaesthetic , type of surgery and mesh type used ) , lower pre-operative optimism was an independent risk factor for CPSP at 4 months ; lower pre-operative optimism and lower perceived control over pain at 1 week after surgery predicted higher pain intensity at 4 months . No emotional variables were independently predictive of CPSP . Further research should target these cognitive variables in pre-operative psychological preparation for surgery Purpose Nerve identification during open inguinal hernia herniorrhaphy  has been suggested as one of the factors that may reduce the risk of development of persistent postherniorrhaphy pain . In this prospect i ve study , we evaluated whether intraoperative inguinal nerve identification influenced the risk of development of persistent postherniorrhaphy pain , sensory dysfunction in the groin and functional ability score after open hernia repair . Methods A total of 244 men with a primary inguinal hernia underwent open Lichtenstein repair in a high-volume hernia surgery centre , where information on inguinal nerve identification was registered during operation . Before the operation and 6 months postoperatively , functional pain-related impairment was assessed with Activities Assessment Scale and pain intensity scores with Numeric Rating Scale ( NRS 0–10 ) . Quantitative sensory testing in the groin was performed before operation and 6 months postoperatively , in order to investigate intraoperative inguinal nerve damage . Results The intraoperative nerve identification rates for the iliohypogastric , ilioinguinal and genitofemoral nerves were 94.7 , 97.5 and 21.3 % , respectively . Thirty-nine patients ( 16.0 % ) had substantial pain-related functional impairment at 6 months follow-up . There was no difference in risk of development of substantial pain-related functional impairment in patients with identification compared with non- identification of the iliohypogastric nerve ( P = 1.0 ) , the ilioinguinal nerve ( P = 0.59 ) , the genitofemoral nerve ( P = 0.40 ) or all nerves ( P = 0.52 ) . There were no differences in regard to sensory loss in the groin area or in regard to improvement in functional outcome following surgery , between patients with and without nerve identification . Conclusions Although intraoperative inguinal nerve identification should be aim ed at , other factors may contribute to the risk of nerve damage and persistent pain after open groin hernia repair BACKGROUND We have conducted a r and omized controlled trial of totally extraperitoneal hernia repair ( TEP ) versus tension-free open repair ( Lichtenstein repair ) ; we have presented the results previously up to 1 year after the operation . The aim of this study was to compare patient outcome in both groups at a median follow-up of 7.3 years after operation . METHODS Of 168 patients included in a prospect i ve , r and omized controlled trial design ed to compare TEP with an open tension-free technique , 154 patients ( 92 % ) answered a question naire and 147 patients ( 88 % ) were followed up at an outpatient clinic after a minimum of 6 years after operation . RESULTS Overall , 89 % of patients in the TEP group and 95 % of patients in the open group reported complete long-term recovery ( P = .23 ) . Permanent impaired inguinal sensibility was more common in the open group ( P = .004 ) , whereas the proportion of patients with reported testicular pain was higher in the TEP group ( P = .003 ) . Three recurrences were found in the TEP group , and 4 recurrences were found in the open group ( P = .99 ) . Four patients in the TEP group underwent operations for complications related to the hernia repair ( small bowel obstruction , umbilical hernia , testicular pain , and neuralgia ) . CONCLUSION Overall , both groups showed good long-term results with low rates of recurrences . However , the TEP group was associated with a higher proportion of patients with long-term testicular pain , whereas impaired inguinal sensibility was more common in the open group Introduction The aim of the study was to investigate the effectiveness of laparoscopic inguinal hernia repair in daily clinical practice . Patients and methods All patients admitted to the hospital for surgery of an inguinal hernia during a 1-year period were prospect ively documented and included in a follow-up study . The follow-up was performed at least 5 years after surgery and consisted of a clinical examination , ultrasound investigation and a question naire . Results From January 2000 to January 2001 a total of 1208 inguinal hernias in 952 patients were consecutively operated by a total of 11 general surgeons in daily clinical routine . Of the patients , 98.02 % were operated on laparoscopically with the transabdominal preperitoneal patch plasty technique ( TAPP ) and 1.98 % had an open repair . The frequency of intraoperative and early postoperative complications was 2.8 % . The complication rate in the patients presenting a complex hernia was not higher than in patients with uncomplicated unilateral hernias . Life-threatening complications were seen in four patients ( bowel lesion—0.4 % ) , but all four patients presented extensive adhesions in the abdominal cavity after previous abdominal surgery . The follow-up rate after 5 years was 85.3 % . After 5 years the recurrence rate was 0.4 % and the rate of severe chronic pain 0.59 % . None of the patients took analgesics or had to change his occupation . Conclusion Laparoscopic repair can be applied to all types of inguinal hernia as a daily routine procedure with low rates of recurrences and chronic pain . Limiting factor may be extensive adhesions after previous major surgery in the lower abdomen BACKGROUND Increased awareness of post-hernia repair pain motivated a study of pain and rehabilitation after day surgery . MATERIAL AND METHODS Forty male patients were prospect ively r and omized to conventional ( McVay ) or open mesh repair .  Self- assessment of postoperative pain was based on a four-step verbal scale . Patients and the physicians conducting the study were blinded to the surgical method . Clinical follow-up was performed twice , after four weeks and median 21 months . RESULTS The open mesh technique generated less pain during the first postoperative week . Chronic light to moderate pain occurred in 20 % of patients irrespective of surgical method . A sick leave of one to three weeks was sufficient in 20 out of 27 patients . INTERPRETATION The study showed no clinical advantage of a tension-free method in terms of rehabilitation and post-hernia repair after the first postoperative week . Because of the relatively high incidence of late treatment-related pain , non-symptomatic adult patients should not be referred for inguinal hernia surgery . The primary sick leave period should not exceed three weeks Background Inguinal hernia recurrence after surgical repair is a major concern . The authors report their experience with open and laparoscopic repair of recurrent inguinal hernias . Methods After institutional review board approval , a retrospective review was performed with the charts of 197 patients who had undergone surgical repair of recurrent inguinal hernias from January 2000 through August 2009 , and the data for 172 patients who met the inclusion criteria were analyzed .  Surgical variables and clinical outcomes were compared using Student ’s t test , the Mann – Whitney U test , chi-square , and Fisher ’s exact test as appropriate . Results The review showed that 172 patients had undergone either open mesh repair ( n = 61 ) or laparoscopic mesh repair ( n = 111 ) for recurrent inguinal hernias . Postoperative complications were experienced by 8 patients in the open group and 17 patients in laparoscopic group ( p = 0.70 ) . Five patients ( 8.2 % ) in the open group and four patients ( 3.6 % ) in the laparoscopic group had re-recurrent inguinal hernias ( p = 0.28 ) . Four patients in the open group ( 9.5 % ) and no patients in the laparoscopic group had recurrence during long-term follow-up evaluation ( p = 0.046 ) . In the laparoscopic group , 76 patients ( 68.5 % ) underwent  total extraperitoneal  ( TEP ) repair , and 35 patients ( 31.5 % ) had  transabdominal preperitoneal ( TAPP ) repair . Postoperative complications were experienced by 13 patients in the TEP group and 4 patients in the TAPP group ( p = 0.44 ) . Two patients ( 2.6 % ) in the TEP group and two patients ( 5.7 % ) in the TAPP group had re-recurrent inguinal hernias ( p = 0.59 ) . Conclusions This retrospective review showed no statistical difference in the re-recurrence rate between the two techniques during short-term follow-up evaluation . However , the laparoscopic technique had a significantly lower re-recurrence rate than the open technique during long-term follow-up evaluation . Both procedures were comparable in terms of intra- and postoperative complications . Among laparoscopic techniques , TEP and TAPP repair are acceptable methods for the repair of recurrent inguinal hernia . A multicenter prospect i ve r and omized control trial is needed to confirm the findings of this study Objective To assess the value of single-dose , intravenous , prophylactic ampicillin and sulbactam ( AS ) in the prevention of wound infections during open prosthetic inguinal hernia repair by a double-blind , prospect i ve , r and omized trial . Summary Background Data The use of antibiotic prophylaxis during open prosthetic inguinal hernia surgery is controversial , and no prospect i ve trial has been conducted to examine this issue . Methods Patients undergoing unilateral , primary inguinal hernia repair electively with the Lichtenstein technique using polypropylene mesh  were r and omized to receive 1.5 g intravenous AS before the incision or an equal volume of placebo according to a predetermined code of which the surgeons were unaware . Patients with recurrent , femoral , bilateral , giant , or incarcerated hernias or any systemic diseases were excluded . Age , sex , body mass index , American Society of Anesthesiologists score , type of hernia , type of anesthesia , duration of surgery , and use of drains were recorded . Infection was defined according to the criteria of Centers for Disease Control . Patients were evaluated 1 week , 1 month , 6 months , and 1 year after surgery by an independent surgeon . All complications were recorded . Results were assessed using chi-square , Fisher ’s exact , and Student t tests as appropriate . Results Between September 1996 and July 1998 , 280 patients ( 140 AS , 140 placebo group ) entered the protocol . Four patients from the AS group and seven from the placebo group were excluded because of inadvertent antibiotic administration or follow-up problems . Groups were well matched for all the variables studied and postoperative complications , excluding wound infections , which occurred at a rate of 0.7 % in the AS group and 9 % in the placebo group ( P = .00153 ) . Twelve patients in the placebo group developed wound infections , requiring five repeat hospital admissions in three patients . These three patients suffered deep infections reaching the graft , which result ed in graft loss in two . The single infected patient in the AS group had his graft removed as well because of deep persistent infection . Conclusions This study documented a significant ( 10-fold ) decrease in overall wound infections when single-dose , intravenous AS was used during Lichtenstein hernia repair . Deep infections and wound infection-related readmissions were also reduced by the use of AS . Proponents of mesh repairs may therefore be advised to use prophylactic single-dose intravenous antibiotic coverage in the light of the results of this trial . AS proved to be an effective antimicrobial agent Background To describe the rationale and design of an observational cohort study analyzing the effects of endoscopic Totally Extraperitoneal ( TEP ) hernia repair on male fertility ( MAIN study ) . Methods and design The MAIN study is an observational cohort study design ed to assess fertility after endoscopic TEP hernia repair . The setting is a high-volume single center hospital , specialized in TEP hernia repair . Male patients of 18 - 60 years of age , with primary , reducible , bilateral inguinal hernias and no contraindications for endoscopic TEP repair are eligible for inclusion in this study . Patients with an ASA-classification ≥ III and patients with recurrent and /or scrotal hernias and /or a medical history of pelvic surgery and /or radiotherapy , known fertility problems , diabetes and /or other diseases associated with a risk of fertility problems , will be excluded . The primary outcome is the testicular perfusion before and 6 months after TEP hernia repair ( assessed by means of a scrotal ultrasonography ) . Secondary endpoints are the testicular volume ( Ultrasound ) , semen quality and quantity and the endocrinological status , based on serum levels of the sexual hormones follicle-stimulating hormone ( FSH ) , luteinizing hormone ( LSH ) , testosterone and inhibin B before and 6 months after TEP hernia repair . Discussion The use of polypropylene mesh is associated with a strong foreign body reaction which could play a role in chronic groin pain development . Since the mesh in ( endoscopic ) inguinal hernia repair is placed in close contact to the vas deferens and spermatic vessels , the mesh-induced inflammatory reaction could lead to a dysfunction of these structures . Relevant large and prospect i ve clinical studies on the problem are limited . This study will provide a complete assessment of fertility in male patients who undergo simultaneous bilateral endoscopic TEP hernia repair  , by analyzing testicular perfusion and volume , semen quantity and quality and endocrinological status before and 6 months after TEP repair . Trial registration The MAIN study is registered in the Dutch Trial Register ( NTR2208
There is insufficient epidemiologic evidence to draw meaningful conclusions about ( i ) the existence of causal associations between specific occupational mechanical exposures and the development of inguinal hernia , and ( ii ) the influence of these exposures on prognosis after inguinal hernia repair with respect to hernia recurrence and persistent pain
OBJECTIVES The aim of this review was to evaluate the epidemiologic evidence for ( i ) a causal effect of occupational mechanical exposures on incidence of inguinal hernia , and ( ii ) a prognostic effect of such exposures on hernia recurrence and persistent pain after inguinal hernia repair .