The Ideal Size of Mesh for Open Inguinal Hernia Repair: A Morphometric Study in Patients with Inguinal Hernia

Analysis of influencing factors of complications after laparoscopic inguinal hernia repair: An observational study

To explore the influencing factors of complications after laparoscopic inguinal hernia repair (LIHR). A case retrospective analysis was conducted to collect clinical data of 212 patients with inguinal hernia who underwent LIHR in our hospital from July 2020 to October 2022. The patients were followed up by telephone and subsequent visit, and the enrolled patients were divided into the complication group (n = 36) and the non-complication group (n = 176) according to the presence or absence of complications. Chi-square test was used for univariate analysis, and the data with statistical significance between groups were included in the multivariate Logistic regression analysis model to investigate the risk factors for complications associated with LIHR. Common complications in patients undergoing LIHR included seroma, hematoma, urinary retention, unexplained chronic pain, etc. Body mass index (BMI), intraoperative blood loss, medical history time, hernia sac management, intraoperative adhesions, abnormal coagulation function, recurrent hernia, and hypertension were the influencing factors for complications after LIHR (χ2 = 6.809, 13.393, 5.371, 5.775, 4.128, 5.331, 4.920, and 6.675, P < .05). Multivariate analysis showed that BMI (odd ratio [OR] = 5.201, 95% confidence interval [CI] = 0.816-6.965, P < .05), intraoperative blood loss (OR = 2.512, 95% CI = 1.712-3.689, P < .05), intraoperative adhesions (OR = 6.352, 95% CI = 0.162-6.669, P < .05), abnormal coagulation function (OR = 6.352, 95% CI = 0.162-6.669, P < .05), recurrent hernia (OR = 2.208, 95% CI = 1.415-3.446, P < .05), and hypertension (OR = 3.365, 95% CI = 0.009-6.326, P < .05) were independent risk factors for complications after LIHR (P < .05). Common complications of LIHR included seroma, hematoma, urinary retention, etc. BMI, intraoperative blood loss, intraoperative adhesions, abnormal coagulation function, recurrent hernia, and hypertension were risk factors for complications after LIHR.

The Myopectineal Orifice: A Study of Thai Cadavers

Objective

This study aimed to determine the myopectineal orifice size measured in Thai human cadavers.

Materials and Methods

A total of 30 human cadavers, comprising 55 groins, were assessed. Myopectineal orifices (MPOs) were measured in two dimensions: height from the lower border of the conjoined tendon to the upper border of the pectineal ligament and width from the lateral border of pubic tubercle to the medial border of the iliopsoas muscle.

Results

The mean MPO size is 7.13 + 0.14 cm in width and 6.66 + 0.32 m in height. The mean width and height in male cadavers are 7.16 + 0.14 and 6.84 + 0.27 cm, respectively. The mean width and height in female cadavers are 7.09 + 0.12 and 6.45 + 0.24 cm, respectively. The mean MPO area is 37.26 ± 0.027 cm², compared with the area of mesh graft 10 cm × 15 cm, 150 cm². Although the shrinkage of cadaveric tissue and mesh size were adjusted, which were 39.56 ± 0.029 and 81 cm², respectively, they were found to be sufficient for the mean MPO area. It was found that the mesh size was sufficient for the mean MPO area.

Conclusion

A mesh size of 10 cm × 15 cm is found to be the appropriate size to cover the MPO among Thais.

Three-dimensional visualization and measurement of myopectineal orifice in non-inguinal hernia patients

PURPOSE

The myopectineal orifice (MPO) is a weak area at lower part of the anterior abdominal wall that directly determines the mesh size required in inguinal hernia repair. However, MPO data have mainly been acquired from measurements of cadavers or anesthetized patients. Furthermore, there are very few reports on the measurement of the MPO in Chinese patients. The present study aimed to use three-dimensional visualization technology to measure the MPO in live non-anesthetized Chinese patients, and to use this information to indicate the appropriate mesh size required for inguinal hernia repair.

METHODS

In this study, we used the parameters of the MPO and the pelvis that were measured in 40 patients with peripheral arterial disease of the lower limb arteries (80 inguinal regions) using Medraw software (Image Medraw Technology Co., Ltd., China).

RESULTS

The result showed that the average width and height of the MPO were 5.71 ± 0.99 cm and 4.96 ± 0.69 cm, respectively (5.22 ± 0.77 cm and 5.13 ± 0.63 cm in males, and 6.20 ± 0.95 cm and 4.80 ± 0.71 cm in females). The average projected area of the MPO was 16.06 ± 4.37 cm² on the left, and 15.61 ± 4.10 cm² on the right (P > 0.05).

CONCLUSION

Three-dimensional visualization was used to measure the area, width, and height of the MPO in living non-anesthetized Chinese patients. MPO area was correlated with age, but not with pelvic parameters.

Appropriate mesh size in the totally extraperitoneal repair of groin hernias based on the intraoperative measurement of the myopectineal orifice

BACKGROUND

Insufficient coverage of the area of a possible groin hernia is an important risk factor in hernia recurrence. To prevent recurrence, it is important to use the appropriate mesh size based on the size of the myopectineal orifice (MPO), which is the weak area of the abdominal wall where inguinal hernias occur. We aimed to estimate the appropriate mesh size for groin hernias by investigating MPO size.

METHODS

Four hundred and six patients underwent groin hernia repair using a totally extraperitoneal (TEP) approach at the Zeze Hospital between July 2009 and December 2017. We investigated patients' backgrounds, MPO components dimensions, and hernia recurrence, and evaluated the appropriate mesh size.

RESULTS

The 359 male and 47 female patients had an average age of 63 ± 15 years. In 171, 147, and 88 cases, hernias were localized to the right, left, and bilaterally, respectively. The number of lateral, medial, femoral, and combined hernias was 317, 124, 11, and 42, respectively. The 95th percentile for the horizontal and vertical lengths in cases of hernia orifice ≥ 3 cm were 9.6 cm and 7.0 cm, respectively, while it was 9.2 cm and 6.4 cm in cases of hernia orifice < 3 cm. We added 2 cm and 3 cm to the 95th percentile for the length and width of the MPO, resulting in 13.2 × 10.4 cm and 15.6 × 13.0 cm in cases with hernia orifice < 3 cm and ≥ 3 cm, respectively. Relapse after TEP occurred in 1 patient (0.2%).

CONCLUSION

The appropriate mesh size for TEP repair, derived from intraoperative MPO measurements, was estimated as 13.2 × 10.4 cm and 15.6 × 13.0 cm when the hernia orifice was < 3 cm and ≥ 3 cm, respectively. Using appropriate mesh sizes based on MPO measurement may reduce groin hernia recurrence after TEP.

Individual mesh size for open anterior inguinal hernia repair: an anthropometric study in Turkish male patients

PURPOSE

To conduct a study to determine the measurements of the inguinal region in male patients with inguinal hernias to reveal the proper mesh size for each patient.

METHODS

In this prospective study, the anthropometric measurements were obtained from 100 consecutive adult male patients with unilateral primary inguinal hernias. First, the distance between the pubic tubercle and the medial border of the deep inguinal ring was measured (x). Second, the distance between the inner edge of the inguinal ligament and the uppermost level of the internal oblique aponeurosis at the midpoint of the inguinal ligament corresponding to the Hesselbach triangle was measured (y). Individual mesh sizes were calculated according to the original recommendations for mesh overlap.

RESULTS

The mean x value was 41.6 mm (22-55 mm), the mean y value was 45.2 mm (30-68 mm). The mean dimensions of the mesh were 126.6 mm × 65.2 mm. The largest mesh was 140 mm × 88 mm, and the smallest one was 107 mm × 62 mm. The mean mesh area was 8320 mm². It was larger than the index mesh area recommended by the Lichtenstein Hernia Institute in 45 patients and smaller in 55 patients.

CONCLUSIONS

The intraoperative measurements for ideal mesh size in Lichtenstein repair of inguinal hernias may present somewhat different mesh dimensions in many patients. Individualization of mesh size may be of importance in surgical outcomes.