The majority of patients who were admitted as emergencies with complicated groinhernias have not sought previous medical attention or been diagnosed with the condition in the out patient department. This observation implies that most hernias that develop complications do so within a relatively short time in the natural history of the disease. In adults, Gallegos estimated the cumulative probability of strangulation for inguinal hernia is 2.8% after three months, rising to 4.5% at the end of 2 years.
This is to certify that “GROINHERNIAS PRESENTING AS ACUTE EMERGENCIES” is a bonafide work done by Dr. ARAVIND S KAPALI, post graduate in department of General Surgery, Kilpauk Medical College, Chennai- 10 under my guidance and supervision in fulfillment of regulation of The Tamilnadu Dr. M. G. R. Medical University for award of M.S. Degree Branch I, Part II (General Surgery) during academic period from march 2005 to march 2008.
Commonest groin hernia in females is inguinal hernia. Often it may contain Fallopian tube or ovary. Round ligament attached to labia. Sac is in close relation with round ligament. Sac is adherent and is often difficult to dissect. It is invariably indirect sac. Direct hernia is rare in females. Surgery is the treatment. Laparoscopic or open approach can be used. Round ligament is excised and inguinal canal is entirely closed. Mesh is placed in preperitoneal plane. That also prevents femoral hernia to develop. Incision and technique are same. Bilateral inguinal hernia can be treated surgically in same sitting.
Recently, studies have shown low incidence of infectious complications for emergency mesh repair. Atila et al, found an incidence rate of 11% in their prospective clinical study consisting of prosthetic repair of acutely incarcerated groinhernias.  Similarly, Birolini C, found a 15% incidence of wound related complications in their clinical study.  Legnani GL, found a low incidence of complications in their initial evaluation of 9 cases of strangulated inguinal hernias repaired laparoscopically. 
Similar to the above studies, Oishi et al.  found that age was a significant risk factor for complicated hernia presentation in a cohort of over 1800 patients over 15 years of age. Advanced age predisposed to presenting with a bowel obstruction, requiring resection, and higher mortality. Unfavorable outcomes also occurred in women and in femoral hernias. In their study, the mean age for those with bowel obstruction was 65, which was statistically significantly older than those without (51.7), and this was consistent with our results: complicated (mean age 67.5) and uncomplicated (45.8). Furthermore, Rai et al.  also found age to be a risk factor in hernia complication in a study of the risk of strangulation and bowel obstruction in groinhernias. In a combination prospective and retrospective ten- year study, Rai et al.  showed that age, hernia type, gender, and duration of symptoms were significantly associated with complicated hernia presentation. In their analysis, complicated hernias were more common in adults in the 45-54 age group, while uncomplicated hernias were more common in the 15-24 age group, again a pattern consistent with our findings. Moreover, complicated inguinal hernias were more common in males, femoral hernias were more common in females and femoral hernias, overall, were more likely to be complicated. In our study, sex was not statistically significantly associated with complicated presentation of inguinal hernias. Duration of symptoms is an important variable not included in the dataset of our study and may be a more significant risk factor for the older complicated patients than insurance status. The results of these several studies, as well as our findings, highlight that advanced age is clearly associated with unfavorable outcomes and complicated presentation of a groin hernia.
The high accuracy of ultrasonography in detecting groinhernias has been reported by many authors -. Yet this noninvasive method has not been applied to study the function of the groin from a physiological pers- pective. In 1995 the author reported blind sonography estimation analysis of seven different methods of inguinal hernia repair . The analysis was done on the basis of three static and four dynamic criteria, the latter being physiological in nature. The aim of this article is to elaborate on my earlier studies  , and to add some new findings to the existing knowledge of the physiology of the groin.
Lipoma is the most common soft tissue tumor, considered the universal tumor in the body. The differential diagnosis of a lipoma in the groin will in- clude groinhernias, safina varex, lymphadenopathy, hydrocele and sarcoma. Due to the similarity of clinical symptoms and signs, the differentiation be- tween inguinal, femoral hernias and groin lipoma is difficult. To avoid the high risk of intraoperative complications, correct diagnosis is an indication. We are reporting a case with huge lipoma arisen from the right groin mainly from right labium major of a 19-year-old single girl grown in a relatively short period to reach dimensions of a football and weighing 7200 grams. Painless, pedunculated tumor arose from labium major to the level of the knee, asymptomatic except unsightly huge mass, which treated successfully by surgical excision without complications and proved benign with no ma- lignant changes detected.
The treatment of all hernias, regardless of their location or type, is surgical repair. Elective repair is performed to alleviate symptoms and to prevent the significant complications of hernias, such as incarceration or strangulation. While the limited data available on the natural history of groinhernias show that these complications are rare, the complications are associated with a high rate of morbidity and mortality when they occur. At the same time, the risks of elective groin hernia repair, even in the patient with a complicated medical history, are exceedingly low. Outcomes of surgical repair are generally excellent with minimal morbidity and relatively rapid return to baseline health.
Open pre peritoneal hernioplasty is a versatile and time tested method of treating all types of groinhernias like direct, indirect, femoral, complicated, obstructed, strangulated, recurrent and for patients having high anaesthetic risk due to associated co- morbidities. It is an important asset in the armamentarium of a general surgeon because this can be executed in any basic operative set up with very satisfying results. Open preperitoneal repair is not performed routinely and surgeons may have to learn the procedure before implementing into current surgical practice. It is a simple procedure with less steep learning curve as compared to laparoscopic hernioplasty.
group. However, this group has engendered such confidence in the method that they now recommend it for routine use in patients more than 60 years of age even with a unilateral hernia, and at the slightest doubt in the patients under 60 years of age, such as those with bilaterial hernias, with a weak abdominal wall, or whose work demands heavy physical labor. They summarized their indications for GPRVS as “those hernias that present a high risk of recurrence such as recurring hernias, bilateral groinhernias, groinhernias associated with low incisional hernias, simultaneous direct and indirect hernias, large hernias, recurring hernias when poupart’s and/or Cooper’s ligaments are destroyed, and prevascular hernias.” To this list he added those hernias related to collagen diseases such as Ehlers-Dan-es and Marfan syndromes and patients in whom surgery is a risky proposition because of old age, obesity or cirrhosis. This is indeed a long list of patients who make up 30% to 40% of groinhernias in Stoppa’s practice. He reports a series of 2000 cases of GPRVS followed from 1 to 12 years with recurrence rates of 0.56% for primary groinhernias and 1.1% for recurrent groinhernias – a truly remarkable success story when one considers that the “best” cases were operated on by conventional inguinal methods, whereas the “worst” cases were repaired by GPRVS.
Between the period of January 2011 to September 2012, 185 cases of ventral hernias treated at TVMCH were studied and followed for a period of 6 to 18 months. Ventral hernias were common surgical problems second only to groinhernias. More than 45% of ventral hernias were Incisional followed by, umbilical, paraumbilical hernias and epigastric hernias.. Most of the Incisional hernias developed >5yrs of previous surgery. Swelling, pain and complications along with aesthetic concerns are the causes for seeking surgical solution .Most of ventral hernias were uncomplicated at the time of presentation, remaining presented with either obstruction or strangulation necessitating emergency repair. Incidence of Incisional hernias was more in females with male to female ratio of 6.7:1, while epigastric and umbilical hernias were more common in males with male to female ratio of 4:1 and 1.2:1 respectively. Previous surgery was the single most important cause for ventral (Incisional) hernias. Other etiological factors were multiparity, obesity, anemia, COPD, BPH, diabetes mellitus, alcoholism and smoking. Post operative wound infection was important cause for development of Incisional hernias.
The group comprised 24 international experts from 14 different countries. There were 7 sports medicine physicians, 6 phy- siotherapists, 5 general surgeons, 4 orthopaedic surgeons, 1 radiologist and 1 combined orthopaedic and general surgeon. The members had been practising for an average of 22.8 (SD ±8.9) years since qualifying. Twenty-one members had clinical practice roles and three had full-time research and education posts. The clinicians estimated that they saw a median of 150 (IQR 30 – 400) patients with groin pain in a year, of which 90 (IQR 30 – 150) were athletes. One expert (RJdV) was brought in for his expertise on research and reviews, and to present a summary of current terminology.
muscular fascia and an NPWT dressing was applied (pressure –125 mmHg, continuous mode). After 5 days, tissues from the groin, scrotum and inguinal sites were excised with the margin (Fig. 2). The perianal site was saved to maintain tightness with NPWT close to the excreting anus. A sub- atmospheric dressing was placed on the whole wound with 3 soft ports (Fig. 3). Tightness was achieved using adhesive gel patches.
study by A Hair et al; have found 66% of patients presented with swelling and pain  . The differences could be due to a difference in the pain threshold of individuals. In the present study right side was involved in indirect inguinal hernia in 57.5% of cases. The right side appeared to be commonly involved in the indirect inguinal hernia and is predominantly indirect or inguinoscrotal. The number of cases of the bilateral presentation was n=4 (10%), which supports that some hernias are having a congenital basis. They appear early in life and present as inguinoscrotal hernias. In group I, 60% of patients were found with right side inguinal hernia. The embryological origin and descent of testis explain the right side predominance. The right testis descends later than the left and hence higher incidence of patent processes viginalis on right is side is present  . Most of the clinical cases of hernias are indirect hernia hence these cases were utilized for the results of the present study [15, 16] . The incidence of postoperative infection in the current study was 10% and the pain was found in 15% of the patients. It was also found that patients undergoing herniorrhaphy were having a greater degree of pain as compared to herniotomy patients on pain scales. The postoperative analgesic requirements of group II were significantly greater as compared to group I. In the present study the postoperative infection rate was found to be 5% in herniotomy group and 10% in herniorrhaphy group. The other complication was the presence of hematoma in one patient of group I seroma in group II. In a similar study conducted on 1369 patients in Jaipur with a follow of 1340 subjects for a period of ten years revealed except minor scrotal hematoma no other complication was seen. The incidence of recurrence was found in 0.15% of cases  . In the present study, late complications like recurrence were found in 2 cases of group II and testicular atrophy in one case of group II. A retrospective analysis of late complications with a mean follows up period of 13.2 years in 837 cases of interventions including
tients in our relatively small series experienced such 2-stage urination. Although our series is small, it does highlight 2-stage urination to be a common symptom in patients with bladder hernias. Associated pathologies include BPH, bilateral hydronephrosis with or without acute renal failure, stones within the herniated bladder, vesicoureter- al reflux, necrosis of the bladder and scrotal abscess. Among previously cited cases, the rate of these comorbidities is about 24%. 7 In addition, patients
diaphragm, and the abdominal contents, including stom- ach, bowel loops, liver, spleen or fat tissues, may be displaced into the thoracic cavity. A posterolateral hernia on the right side is very rare and this is probably attrib- utable to the protection provided by the liver. Foramen of Morgagni hernias are rare diaphragmatic hernias, usually occurring on the right and located in the anterior mediastinum because of the retrosternal location of the foramen of Morgagni, described as an anterior diaphrag- matic defect. In adults, foramen of Morgagni hernia is also associated with obesity, trauma, weight lifting, or other causes of increased intra-abdominal pressure.
Inguinal hernia repair is commonly done and constitutes part of a significant proportion of surgical workload in many centres [7,8]. Undoubtedly, inguinal hernias are the commonest hernia type  and our result showed that they comprised 71.5% of all abdominal wall hernias which is similar to the 75
There were three patients in this study ; who had undergone previous open groin hernia repair. Two were successfully repaired by TAPP; while one patient was converted to open hernia repair due to difficult dissection.
In rural areas of Burkina Faso, incisional hernias occur in young patients. Peri- tonitis and occlusions are the main indications of first surgery. The vertical mid- line incisions are involved in more than half of the cases. Prostheses are less ac- cessible financially. As such, the treatment mainly involves open suture repair with a high rate of recurrence. The technique of Lázaro Da Silva could be an al- ternative choice.
One of the predominant mitigation measures taken by local property owners along the coast to prevent beach erosion is the construction of so-called espolones, or self-made groins constructed out of timber and rocks, as displayed in figure 2. Groins are one of the oldest forms of coastal protection structures, and are used in multiple ways and forms around the world. Generally, groins can be described as solid, shore-normal constructed structures, emplaced for the purpose of maintaining the beach behind them or controlling the amount of sand moving alongshore (Kraus & Hanson, 1994). However, application of impermeable groins, the most found type of groin along the coast of Yucatán, tends to stimulate rip currents and seaward loss of sand around the groin, and most of all stimulate downdrift erosion alongshore (Bakker, 1984). However, making groins permeable may be a solution to the downdrift problem caused by impermeable groins. As discussed in a paper by Otay et al. (1997), permeable groins may cause the deposition of sediment to be equal on the updrift and the downdrift side of the groin. Therefore, permeable groins might remove the negative effects of downdrift erosion seen in applications with impermeable groins.