title: Multiple Ipsilateral Inguinal Hernias: More Frequent Than Imagined, If Undetected Source of Discomfort, Pain, and Re-interventions.
abstract: The article reports the incidence of multiple inguinal protrusions in the same groin in a patient collect who underwent open hernia repair. Multiple ipsilateral inguinal hernias compose an almost neglected topic that, if not identified during hernia repair, could lead to unclear discomfort, pain, and reoperation. A collect of 100 consecutive open anterior inguinal hernia procedures was analyzed. The patients were divided into two subsets-A: patients with a single protrusion and B: patients with more than one protrusion simultaneously arising from the inguinal floor. The single hernias from cohort A and the multiple hernias from cohort B were further categorized using the Nyhus classification system. Eighty-eight single unilateral hernias were detected and 12 multiple inguinal hernias were ipsilaterally arising from the same groin. Nine percent of the multiple protrusions were double (three double indirect and six in combination direct + indirect). Three patients (3%) presented with triple protrusions; of those two individuals, one had a combination of double indirect, one had a direct hernia, and the third patient showed a tricomponent protrusion (hernia of the fossa supravescicalis + hernia of the fossa inguinalis media + indirect hernia). These numbers demonstrate that multiple ipsilateral inguinal hernias are more frequent than imagined. If undiscovered during a herniorrhaphy, the "forgotten" protrusion may generate unclear groin pain requiring reoperation. Consequently, is to envisage that many re-interventions will likely involve false "recurrences." Therefore, during hernia repair, more attention and adhesiolysis is essential during inspection of the inguinal floor. In fact, a careful exposure of the anatomical structures of the groin could be very advantageous in properly managing such conditions. This kind of surgical approach can help to prevent patient's discomfort and re-interventions.
authors.affiliation: Department of General Surgery and Emergency University of Palermo Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Amato
authors.affiliation: Department of General Surgery and Emergency University of Palermo Palermo, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Romano
authors.affiliation: Department of General Surgery and Emergency University of Palermo Palermo, Italy.
authors.forename: AgrusaAntonino
authors.initials: A
authors.lastname: Agrusa
authors.affiliation: Department of General Surgery and Emergency University of Palermo Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Buono
authors.affiliation: Department of General Surgery and Emergency University of Palermo Palermo, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Cocorullo
authors.affiliation: Department of General Surgery and Emergency University of Palermo Palermo, Italy.
authors.forename: Gaspare
authors.initials: G
authors.lastname: Gulotta