NCT00659542 (http://www.clinicaltrials.gov).

IntroductionBochdalek hernia is a type of congenital diaphragmatic hernia that typically presents in childhood - the clinical manifestation of symptoms and diagnosis in adults is extremely rare. There are fewer than 20 cases of right-sided Bochdalek hernia reported in adults in the literature.Case presentationWe review a case of a 38-year-old woman with a right-sided Bochdalek hernia who was experiencing abdominal pain and pleural effusion. The diagnosis of Bochdalek hernia was made by chest X-ray and computed tomography. The right lobe of the liver and flexura hepatica of the colon were herniated into the thorax cavity. The hernia was treated via thoracotomy assisted with laparoscopy and she made an uneventful recovery.ConclusionWe report a rare case of a right-sided Bochdalek hernia for which our patient was treated successfully. Even though rare, this disorder should be recognised, examined and treated appropriately to avoid complications.

This randomized trial failed to prove that mesh fixation without sutures causes less inguinodynia than suture fixation in Lichtenstein hernioplasty. Mesh fixation without sutures is feasible without compromising postoperative outcome.

The laparoscopic technique with mesh in the treatment of recurrent inguinal hernia was proven superior to the open mesh repair in several important clinical aspects, with concomitant improvement in patient satisfaction.

Only the presence of recurrent hernia and early severe pain after index operation seemed to predict longstanding inguinal pain.

NCT00659542.

Background This was a prospective, multicentre, non-blinded, randomized clinical trial involving two parallel groups of patients. Methods Adult patients with symptomatic unilateral primary inguinal hernia were included in this study. Patients were enrolled and treated in five Finnish hospitals. Eligible patients were randomized by use of a computer-based program to receiving either open anterior repair (modified Lichtenstein) with glue mesh fixation or totally extraperitoneal (TEP) repair. The primary aims were to compare 30-day patient-reported pain scores and return to work after surgery between the two groups. Results A total of 202 patients were randomized: 98 patients to TEP repair and 104 patients to open repair. All randomized patients received their allocated treatment. A total of 86 patients (88 per cent) in the TEP group and 94 patients (90 per cent) in the Lichtenstein group completed the 30-day follow-up. Patients experienced less early pain (P < 0.001) and used less analgesics after TEP repair, compared to those who had modified Lichtenstein repair. Two patients in the TEP group and five in the Lichtenstein group developed superficial wound infection (P = 0⋅446). Only one reoperation was performed in the Lichtenstein group due to haematoma. Conclusion TEP inguinal hernia repair is associated with less early postoperative pain compared to the open glue mesh fixation technique. Trial registration NCT03566433 (http://www.clinicaltrials.gov).

Carefully evaluated preoperative pelvic MRI was usually normal in patients with high pain scores prior to operation. Preoperative pain scores may serve as indicators of development of prolonged inguinal pain.