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The aim of this study was to evaluate our 5 year experience in the surgery of umbilical (UH) and epigastric hernias (EH) on an ambulatory basis. Sixty three point seven of UH (88/138) and 68.4% of EH (13/19) could be successfully operated in our ambulatory unit. Morbid obesity, ASA III-IV and insulin dependent diabetes were exclusion criteria. After a preoperative local anesthesia infiltration with 1% lidocaine a repair was undertaken in all 101 patients under monitored anesthesia care. Most patients underwent a mesh hernioplasty as definite treatment. Only three patients could not be discharged on the day of operation. There has been a 2% recurrence rate in long term follow-up. These results demonstrate that two thirds of primary aponeurotic hernias can be satisfactorily operated on ambulatory basis. PMID:11063948
Almost 20 years after the first laparoscopic inguinal herniarepair was performed, single incision laparoscopic surgery (SILS™) is set to revolutionize minimally invasive surgery. However, the loss of triangulation must be overcome before the technique can be popularized. This study reports the first 100 laparoscopic total extraperitoneal herniarepairs using a single incision. The study cohort comprised 68 patients with a mean age of 44 (range, 18 to 83): 36 unilateral and 32 bilateral hernias. Twelve patients also underwent umbilical herniarepair with the Ventralex patch requiring no additional incisions. A 2.5-cm to 3-cm crescentic incision within the confines of the umbilicus was performed. Standard dissecting instruments and 52-cm/5.5-mm/300 laparoscope were used. Operation times were 50 minutes for unilateral and 80 minutes for bilateral. There was one conversion to conventional 3-port laparoscopic repair and none to open surgery. Outpatient surgery was achieved in all (except one). Analgesic requirements were minimal: 8 Dextropropoxyphene tablets (range, 0 to 20). There were no intraoperative or postoperative complications with a high patient satisfaction score. Single-incision laparoscopic herniarepair is safe and efficient simply by modifying dissection techniques (so-called “inline” and “vertical”). Comparable success can be obtained while negating the risks of bowel and vascular injuries from sharp trocars and achieving improved cosmetic results.
Billroth (1878) envisaged prostheses before Bassini’s sutured cure (1887). Phelps (1894) reinforced with silver coils. Metals were replaced by plastic (Aquaviva 1944). Polypropylene (Usher 1962), resisting infection, became popular. Usher instituted tensionless, overlapping preperitoneal repair. Spermatic cord was parietalized, to obviate keyholing. Stoppa (1969) championed the sutureless Cheatle-Henry approach encasing the peritoneum. His technique, “La grande prosthese de renforcement du
Study was conducted to evaluate the feasibility and benefits of inguinal herniarepair with prolene hernia system (PHS) mesh\\u000a under local anaesthesia as a day surgery procedure in a multinational society of United Arab Emirates. One hundred and seventy-eight\\u000a inguinal hernias in 172 consecutive adults of whom 154 (89.5%) fitted the criteria of inclusion in the day-case surgery settings\\u000a were
M. Farrakha; V. Shyam; G. A. Bebars; M. Yacoub; K. Bindu; S. Kolli
The use of nonabsorbable prosthetic materials such as polypropylene, polyester, and ePTFE, have expanded and are now widely used in reparative surgery for abdominal wall hernias. There are still difficulties to find correct indication for prosthetic implant in emergency herniasurgery: as a matter of fact there is still a great debate if to use non-absorbable prostheses in potentially or
... inguinal herniarepairs are performed using a small telescope known as a laparoscope. If your surgeon has ... in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). If may offer a ...
Because wound infection is a major cause of incisional hernia, the question posed is whether or not repairs of incisional hernias are at a higher risk for wound infection also. To answer this, we analyzed the incidence of wound infection after repair of incisional hernias during a 30 month period and compared it with the infection rate in all other clean procedures performed during the same period. All repairs of incisional hernias were performed upon patients with completely healed incisions without clinical signs of infection. Patients undergoing concomitant procedures upon the gastrointestinal tract were excluded. During the 30 month period, 995 clean operations were performed. In the 80 repairs of incisional hernias, there were 13 infections proved by culture, yielding an over-all infection rate of 16 per cent. In the remaining 915 clean procedures, there were 14 wound infections (1.5 per cent, p less than 0.0001). Of these 915 clean operations, 241 were repairs of inguinal hernias. Two infections occurred in this subgroup (0.8 per cent, p less than 0.0001, compared with repairs of incisional hernias). In patients undergoing repairs of incisional hernias with previously documented wound infections, 41 per cent had infected repairs. By comparison, only 12 per cent of patients without a prior infection had infections develop in the hernial repair (p less than 0.05). The infection rate for patients not receiving prophylactic antibiotics (21 per cent) was almost twice the rate for those receiving antibiotics (11 per cent), p = 0.07. We concluded that repair of incisional hernias has a significantly higher rate of infection than do other clean general surgical procedures. Herniorrhaphy of a wound that was previously infected is at a higher risk for reinfection, despite complete healing of the skin and absence of clinical signs of infection. Perioperative antibiotic prophylaxis may be indicated, but randomized studies are needed. For reporting and surveillance purposes, repairs of incisional hernias should not be classified as clean surgical procedures. PMID:2530641
Houck, J P; Rypins, E B; Sarfeh, I J; Juler, G L; Shimoda, K J
Since the introduction of laparoscopic cholecystectomy in the late 1980s, video technology has continued to find new applications in the field of general surgery. Laparoscopic inguinal herniorrhaphy is touted by many to provide a minimally invasive approach to the most commonly performed general surgical procedure, possibly with a lower incidence of recurrence. Additionally, laparoscopic repair of an incisional hernia with synthetic mesh allows a tension-free procedure while potentially reducing the risk of complications such as wound and mesh infections by avoiding the use of large abdominal wall incisions through old surgical scars. The parapubic hernia is a rare form of incisional hernia resulting from the detachment of muscular attachments to the pubic bone. It is a diagnostic and therapeutic challenge that is often misdiagnosed and mismanaged. We have found the laparoscopic approach to the parapubic hernia to be a superior method of managing this often challenging condition. PMID:11695979
Occurrence of parastomal hernia is considered a near inevitable consequence of stoma formation, making their management a common clinical dilemma. This article reviews the outcomes of different surgical approaches for herniarepair and describes in detail the laparoscopic Sugarbaker technique, which has been shown to have lower recurrence rates than other methods. Also reviewed is the current literature on the impact of prophylactic mesh placement during ostomy formation. PMID:24035081
Background: Abdominal lipectomy is becoming an increasingly common surgical procedure in patients with esthetic deformities\\u000a resulting from massive weight loss induced by bariatric surgery. Sometimes a midline incisional hernia coexists with the pendulus\\u000a abdomen. Herein presented is a technique to perform a retromuscular mesh repair of the incisional hernia while sparing the\\u000a umbilicus.\\u000a \\u000a \\u000a Methods: The abdominal lipectomy with concomitant retro-muscular
Antonio Iannelli; Abdi Bafghi; Chiara Negri; J. Gugenheim
Hernias are one of the most common causes of symptoms in the groin. Surgery is needed for all femoral and indirect inguinal hernias to prevent incarceration and strangulation. Asymptomatic direct hernias can be observed if they are not enlarging. Atypical symptoms in a patient with a hernia must be evaluated to exclude other disease. Fortunately, most groin hernias can be repaired electively. PMID:2296562
The search for safe and effective means of herniorrhaphies has been ongoing for more than a century. Evidence strongly supports tension-free herniarepairs in most patients, which result in a 50% reduction in a ten-year cumulative rate of hernia recurrence compared with tissue repairs. Polypropylene mesh revolutionized the field approximately 50 years ago; however, limitations of traditional polypropylene mesh have fueled the research and development of other prosthetic and biologic mesh products. Newer polyester and expanded polytetrafluoroethylene (ePTFE) products are designed to improve pliability and reduce adhesiogenic potential. Combination meshes capitalize on the ideal properties of biomaterials by strategically positioning particular mesh surfaces to selectively impede or promote tissue ingrowth. The most recent improvement in mesh products is the introduction of "lightweight" meshes. In response to mounting evidence that the traditional formulations of polypropylene meshes are over-engineered, lightweight meshes were designed with less polypropylene per surface area. Future research may prove that most meshes used currently are "mechanical overkill," which may lead to a widespread use of lightweight meshes to provide a durable repair, minimize chronic mesh-related discomfort, and improve the overall quality of life of hernia patients. PMID:17429779
Novitsky, Yuri W; Harrell, Andrew G; Hope, William W; Kercher, Kent W; Heniford, B Todd
Background and Objectives: Since the introduction of single-incision laparoscopic surgery in 2009, an increasing number of surgical procedures including herniarepair are being performed using this technique. However, its large-scale adoption awaits results of prospective randomized controlled studies confirming its potential benefits. Parallel with single-port surgery development, the issue of the chronic lack of good camera assistants is being addressed by the robotic Freehand® camera controller, which has the potential to replace camera assistants in a large percentage of routine laparoscopic surgery. Although the robotic Freehand has been used in certain operations in urology and gynecology, there have been no published reports in robotic (single-port) herniasurgery. Methods: This study reports the first case and a series of 16 patients who underwent robotic single-port total extraperitoneal inguinal herniarepair compared to 16 consecutive cases of conventional single-port inguinal herniarepair. Patients were matched for age, sex, body mass index, American Society of Anesthesiologists classification, and types of hernia. Results: Although operation time was comparable in both, the time wasted for scope cleaning was 8.5 minutes for conventional compared to 1.5 minutes for robotic surgery. Conclusion: Robotic single-port inguinal herniarepair is feasible and efficient. This represents a further milestone in laparoscopic surgery.
Purpose Operative approach, including minimally invasive surgery (MIS) in the repair of congenital diaphragmatic hernia (CDH), is variable among institutions. The short-term recurrent hernia rate is not well described. We evaluated the in-hospital recurrence rate of MIS repairs of infants with CDH from the Congenital Diaphragmatic Hernia Registry (CDHR). Methods Prospectively collected data from CDH infants were analyzed from the CDHR from January 1995 to January 2010. Recurrent hernia was defined as reoperations during initial hospitalization. Operative approaches included abdominal, thoracic, laparoscopic, and thoracoscopic techniques. Results 5,480 infants with CDH were identified of which 4,516 (82.4%) were repaired. Operative data was available in 4,390 infants. One hundred fifty-one infants (3.4%) underwent MIS repairs with twelve reported recurrences (7.9%) compared to one hundred fourteen for open techniques (2.7%, p < 0.05). MIS demonstrated a significant increased odds for recurrence (OR 3.59, 95% CI:1.92 – 6.71) after adjusting for gestational age, birth weight, patch repair, and ECMO. Conclusion Minimally invasive techniques appear to have a significant higher recurrent hernia rate with thoracoscopy being the highest. Although adjusted for patch repair, other factors with regards to disease severity may contribute to differences in outcomes among centers. This study is limited to short-term recurrence during initial hospitalization.
In this study, 101 consecutive laparoscopic transabdominal preperitoneal herniarepairs (LTPR) were performed in 62 patients by a single surgeon. The series was begun in April 1991, and involved repair of 49 direct, 41 indirect, 4 femoral, 3 umbilical, 3 sliding, and 1 incisional hernias. Twelve cases were bilateral, eleven hernias were incarcerated, and fifteen hernias were recurrent. There were no intraoperative complications, and none of the procedures required conversion to open surgery. Patients experienced the following postoperative complications: transient testicular pain (1), transient anterior thigh paresthesias (2), urinary retention requiring TURP (1), and hernia recurrences (2). Follow up has ranged from 4 - 15 months and initial results have been encouraging.
Background: Incisional hernia is a frequent complication of abdominal surgery. Various types of repair are recommended for incisional\\u000a hernia. Suture and mesh repair are compared in the present study. Method: One hundred seventy one patients with incisional hernia underwent Cardiff repair (far and near sutures with reinforcement\\u000a sutures) which was used as an open suture repair while onlay polypropylene mesh
V. K. Shukla; R. Mongha; N. Gupta; V. S. Chauhan; Ć Puneet
Incisional hernia is one of the most common complications of abdominal surgery, with a reported occurrence rate of up to 20% after laparotomy. The high incidence of hernia formation significantly contributes to both patient morbidity and health care costs. Although a variety of approaches have been described to repair these defects, historically the results have been disappointing. Recurrence rates after primary repair have been reported to range from 24% to 54%. The recent advent of laparoscopic ventral herniarepair (LVHR) has offered promising outcomes by combining tension-free repair using a prosthesis with minimally invasive techniques, lowering reported recurrence rates to <10%. This review discusses standardized, well-researched techniques that have contributed to the success of LVHR. We also discuss how these techniques have been modified for laparoscopic repair of suprapubic lumbar hernias, hernias near the iliac crest, and parastomal hernias. In addition, we review our own experience with LVHR in the context of the principles discussed.
The 1994 meeting of the European Association for Endoscopic Surgery (E.A.E.S.) in Madrid highlighted a consensus-developing conference on the then new laparoscopic procedure for herniarepair. The conference was chaired by A. Paul from Cologne, Germany, and A. Fingerhut, from Poissy, France. The other members of the jury were B. Millat (France), L. Nyhus (USA), J. Himpens (Belgium), J.-L. Dulucq (France), V. Schumpelick (Germany), E. Laporte Rosello (Spain), C. Klaiber (Switzerland), J. Mouiel (France), P. Go (Netherlands), and J.-H. Alexandre (France). At that time, there were, in all, only three randomized trials available for analysis. Today, there are more than 60 trials and more than 12,500 patients have been entered into them. An update, presented this year in Vienna, is summarized herein. PMID:11443425
Fingerhut, A; Millat, B; Bataille, N; Yachouchi, E; Dziri, C; Boudet, M J; Paul, A
A ventral and incisional hernia is one of the serious complications.?Recently under? lay mesh repair using a laparoscope is frequently performed.?As a result a new surgical posi? tion for LRVIH has thus been devised.?Methods:The subjects are comprised of 1 5 patients with a primary or recurrent hernia who underwent LRVIH during the period of 2 0 0 6 to 20
Conventional repair of recurrent ventral incisional hernia is associated with a higher recurrence rate (30%-50%) than repair\\u000a of primary incisional hernia (11%-20%). Laparoscopic incisional herniarepair (LIHR) can significantly reduce the recurrence\\u000a rate of primary hernia to less than 5%. In this study, we evaluate the efficacy of repairing recurrent incisional hernia laparoscopically.\\u000a One-hundred and seventy consecutive patients undergoing LIHR
Local anesthetics decrease postoperative pain when placed at the surgical site. Patients benefit from laparo- scopic extraperitoneal herniarepair because this allows earlier mobilization than the more classical open surgical approach The purpose of this study was to determine the pain-sparing efficacy of local anesthetics placed in the pre- peritoneal fascial plane during extraperitoneal laparo- scopic inguinal herniasurgery. Forty-two
Gary N. Saff; Richard A. Marks; Max Kuroda; Jonathan P. Rozan; Ronnie Hertz
Obturator hernia is a rare cause of bowel obstruction. Occurring primarily in elderly women, it has a high incidence of incarceration and a high mortality rate. This report describes the successful laparoscopic reduction and repair of an incarcerated obturator hernia. Using open laparoroscopy, an incarcerated obturator hernia was diagnosed intraoperatively. After laparoscopic reduction, a transabdominal preperitoneal repair was completed using
Introduction Incisional hernia is the most frequent postoperative complication following abdominal surgery and is a common and costly source\\u000a of morbidity. Conventional mesh repair is the standard treatment today, but the use of laparoscopic incisional herniarepair\\u000a (LIHR) seems to be a good alternative. We performed a retrospective analysis comparing open incisional herniarepair with\\u000a the laparoscopic approach.\\u000a \\u000a \\u000a \\u000a Methods Between June 2004
Introduction Groin herniarepair is a commonly performed surgical procedure in the western world but large-scaled epidemiologic data are sparse. Large-scale data on the occurrence of groin herniarepair may provide further understanding to the pathophysiology of groin hernia development. This study was undertaken to investigate the age and gender dependent prevalence of groin herniarepair. Methods In a nationwide register-based study, using data from the Civil Registration System covering all Danish citizens, we established a population-based cohort of all people living in Denmark on December 31st, 2010. Within this population all groin herniarepairs during the past 5 years were identified using data from the ICD 10th edition in the Danish National Hospital Register. Results The study population covered n?=?5,639,885 persons. During the five years study period 46,717 groin herniarepairs were performed (88.6% males, 11.4% females). Inguinal hernias comprised 97% of groin herniarepairs (90.2% males, 9.8% females) and femoral hernias 3% of groin herniarepairs (29.8% males, 70.2% females). Patients between 0–5 years and 75–80 years constituted the two dominant groups for inguinal herniarepair. In contrast, the age-specific prevalence of femoral herniarepair increased steadily throughout life peaking at age 80–90 years in both men and women. Conclusion The age distribution of inguinal herniarepair is bimodal peaking at early childhood and old age, whereas the prevalence of femoral herniarepair increased steadily throughout life. This information can be used to formulate new hypotheses regarding disease etiology with regard to age and gender specifications.
Burcharth, Jakob; Pedersen, Michael; Bisgaard, Thue; Pedersen, Carsten; Rosenberg, Jacob
Incisional hernia is a common long-term complication of abdominal surgery. Historically the open repair with or without mesh\\u000a was the mainstay of treatment. However, many recently published laparoscopic repair studies have challenged surgeons to re-evaluate\\u000a which technique provides the best short and long-term outcomes. A Medline search of all English-language literature was performed\\u000a using the keywords ‘incisional’, ‘ventral’, ‘hernia’, ‘laparoscopic’,
This report describes a laparoscopic procedure for prosthetic repair of inguinal hernias using an extraperitoneal approach. A total of 51 primary direct and indirect hernias were repaired in this series, including 11 recurrent and 12 bilateral hernias. Operative time for this laparoscopic procedure was similar to that of the comparable open surgery and no unusual complications were noted. All patients
Herniasurgery continues to draw the attention of surgeons, patients, and the industry. This strong interest has driven the establishment of professional medical societies with the sole purpose of furthering the understanding of hernias and herniarepair. In the more than 100 years of development, industry has played a major role in advancing the technology to perfect the performance of herniarepair with the hope of establishing the "best" technique and its associated technology. However, with the development of newer prosthetics and approaches to herniarepair, many surgeons do not fully understand the properties of the available prosthetics. The goal of this review is to highlight the different types of meshes in an effort to clarify to surgeons what types of materials are available to them and how to select an appropriate one for a given case. PMID:22588090
Background\\/Purpose: There has been great interest in natural orifice transluminal endoscopic surgery (NOTES) in recent years. We report another new approach for pediatric inguinal herniarepair: transumbilical endoscopic surgery (TUES). Compared with the NOTES technique, TUES can obtain similar scarless results on the abdomen.Methods: In our hospital, two-trocar TUES was the standard procedure used to repair pediatric inguinal hernias. Through
Background: In addition to its well-known benefits of decreased postoperative pain and shorter recovery time, laparoscopic herniarepair\\u000a has the major advantage of allowing the surgeon to explore the side contralateral to the clinically diagnosed hernia. The\\u000a purpose of this study was to evaluate the incidence of incipient unsuspected contralateral hernia during totally extraperitoneal\\u000a (TEP) laparoscopic inguinal herniorrhaphy and to
Morgagni hernia is a rare type of congenital diaphragmatic hernia found in the anterior aspect of the diaphragm. It typically\\u000a presents in the pediatric population and rarely is diagnosed in adults. Only 3% of diaphragmatic hernias are the Morgagni\\u000a type, and only 4% of these are found to present bilaterally. Surgical repair of Morgagni hernia has been performed through\\u000a various
Repair of a groin hernia is strongly influenced by prosthetic mesh implantation carried out in nearly 50 % of all operations. Recurrency rates, however, did not decrease by this policy. Many different materials are available. Due to bioinstability on the long-term and elevated infection rates PTFE is not suitable for inguinal herniarepair. Polyester also provides no long-term stability and induces a chronic foreign body reaction. Polypropylene initially leads to an acute inflammatory reaction and often ends in fibrosis. Both reactions are related to the weight of the used mesh. All materials may lead to specific complications. These include seroma formation, infection, migration of the prosthesis with arrosion of organs, damage of the vas deferens, development of recurrency by shrinkage of the fibers around the mesh, formation of adhesions in the preperitoneal position, and chronic inguinal pain. Therefore, meshes should be used only after individual estimation of risks and benefit. This includes the hernia classification, the number of previous operations and the possibility of a defect in collagen metabolism. The unknown long-term risks for the patient may be taken only in strong indications. PMID:12122583
We report a case of necrotising fasciitis following inguinal herniarepair. It is rare for clean operations such as herniarepair to be associated with infection, and even rarer for them to be associated with necrotising fasciitis, with only a few reports in the literature.
Turner, Eleanor J; Owen, Eoghan R T C; Reddy, Kalakata
In recent years, general surgeons who perform inguinal herniarepair have paid attention to successful reduction in the recurrence rate. The Lichtenstein technique is widely used because it is easy to learn and is associated with a low rate of complication and recurrences. Today, the new objective in primary herniasurgery should be to reduce complications such as chronic pain. Chronic pain after herniarepair can be disabling, with considerable impact on quality of life and there is evidence to suggest increased use of health services by patients who have chronic pain. We have proposed an international randomized controlled trial with seven referenced European centers: The TI.ME.LI. trial. The aim of this study is to evaluate pain and further disabling complications in patients undergoing Lichtenstein technique for primary inguinal herniarepair by fixing the mesh with fibrin sealant versus sutures (control group).
Inguinal herniarepair in infants and babies is a routine operation, but many issues have not been addressed scientifically.\\u000a Thus, it is not known, e.g., if all children with a hernia should be operated on, what is the best timing of surgery, or if\\u000a the operation should be performed with an open approach or laparoscopically. The review is a critical
Introduction: Although natural orifice transluminal endoscopic surgery promises truly scarless surgery, this has not progressed beyond the experimental setting and a few clinical cases in the field of ventral herniarepair. This is mainly because of the problem of sterilizing natural orifices, which prevents the use of any prosthetic material because of unacceptable risks of infection. Single-incision laparoscopic ventral herniarepair has gained more widespread acceptance by specialized hernia centers. Even so, there is a special subset of patients who are young and/or scar conscious and find any visible scar unacceptable. This study illustrates an innovative way of performing single-incision laparoscopic ventral herniarepair by a transverse suprapubic incision below the pubic hair/bikini line in 2 young male patients who had both umbilical and epigastric hernias as well as attenuated linea alba in the upper abdomen. Case Description: Both patients underwent successful laparoscopic repair, and both were highly satisfied with the procedure, which produced no visible scars on their abdomen. Discussion: Willingness to adopt new innovative procedures, such as single-incision laparoscopic surgery, has allowed modification of the incision site to produce invisible scars and hence become highly attractive to the young and scar-phobic segment of the population.
The development of polypropylene prosthetics revolutionized surgery for the repair of abdominal wall hernias. A tension-free mesh technique has drastically reduced recurrence rates for all hernias compared to tissue repairs and has made it possible to reconstruct large ventral defects that were previously irreparable. The repair of abdominal wall defects is one of the most commonly performed general surgical procedures, with over 1 million polypropylene implants inserted each year. Surprisingly, little research has been performed to investigate the interaction of abdominal wall forces on a ventral herniarepair or the required amount or strength of the foreign-body material necessary for an adequate herniarepair. The long-term consequences of implantable polypropylene prosthetics are not without concern. The body generates an intense inflammatory response to the prosthetic that results in scar plate formation, increased stiffness of the abdominal wall, and shrinkage of the biomaterial. Reducing the density of polypropylene and creating a ''light weight'' mesh theoretically induces less foreign-body response, results in improved abdominal wall compliance, causes less contraction or shrinkage of the mesh, and allows for better tissue incorporation. A review of the laboratory data and short-term clinical follow-up is reviewed to provide a strong basis or argument for the use of ''light weight'' prosthetics in herniasurgery. PMID:15846448
Cobb, William S; Kercher, Kent W; Heniford, B Todd
Inguinal herniarepair is one of the most common surgical procedures undertaken in the NHS. Despite this, no previous work has examined quality of life in this patient group. This study examines quality of life preoperatively and at 3 and 6 months postoperatively in 140 patients undergoing inguinal herniarepair in the context of a randomised controlled trial of laparoscopic versus open herniarepair. Surgery was undertaken on a day case basis, and quality of life was assessed using the Short Form 36 (SF36). In the initial phase of the study, 57% of those screened for suitability met the study inclusion criteria and were randomised. No significant differences were found between laparoscopic and open herniarepair in terms of quality of life at 3 and 6 months postoperatively. No difference was found between 3 and 6 month scores, suggesting that patients had already made a good recovery by 3 months. A significant improvement was found between preoperative and postoperative scores, with the greatest change arising on dimensions assessing pain, physical function, and role limitation owing to physical restriction. After standardising for age, sex, and social class, a comparison of the hernia patients to population norms for the SF36 was consistent with improvement from preoperative to postoperative assessment. This study has demonstrated the improvement in quality of life in patients undergoing elective inguinal herniarepair by experienced surgeons on a day case basis. It has also demonstrated the feasibility of assessing quality of life using generic measures in this patient group. Further work in this area is required. Ultimately, the priority given to elective inguinal herniarepair will depend on how the demonstrated benefits compare with those derived from other elective surgical procedures.
Lawrence, K.; McWhinnie, D.; Jenkinson, C.; Coulter, A.
... are common. They can affect men, women, and children. A combination of muscle weakness and straining, such as with heavy lifting, might contribute. Some people are born with weak abdominal muscles and may be more likely to get a hernia. Treatment is usually surgery to repair the opening ...
Purpose Groin herniorrhaphy is the most common operation performed by general surgeons. Annually, more than 20 million groin hernias\\u000a are repaired worldwide. The general approach towards groin hernias is surgical repair regardless of the presence of symptoms.\\u000a The rationale to recommend surgery for asymptomatic groin hernias is prevention of visceral strangulation. The goal of this\\u000a review is to evaluate the appropriateness of
B. van den Heuvel; B. J. Dwars; D. R. Klassen; H. J. Bonjer
The paraesophageal hernia is an unusual disorder of the esophageal hiatus that may be associated with life-threatening mechanical\\u000a problems. Elective repair is recommended at the time the condition is diagnosed, and open surgery can be accomplished with\\u000a a low incidence of complications. The option of performing these repairs through a laparoscopic approach may further reduce\\u000a morbidity and recovery time associated
R. P. DeRosa; P. E. Petrucci; M. L. Palmer; S. H. Danovitch
Open repair of incisional hernia is a simple surgery. Nevertheless, uncountable traps wait for the operator during surgery. They mark out all the stages of the procedure, from incision to skin closure. They are source of intraoperative incidents and postoperative complications. Some of these complications could be very serious and require removing the prosthesis. To avoid these incidents and these complications, the surgeon has to remain watchful throughout the procedure and has to anticipate all the traps that could arise. PMID:18065923
Umbilical and epigastric hernias are primary midline defects that are present in up to 50% of the population. In the United States, only about 1% of the population carries this specific diagnosis, and only about 11% of these are repaired. Repair is aimed at symptoms relief or prevention, and the patient's goals and expectations should be explicitly identified and aligned with the health care team. This article details some relevant and interesting anatomic issues, reviews existing data, and highlights some common and important surgical techniques. Emphasis is placed on a patient-centered approach to the repair of umbilical and epigastric hernias. PMID:24035076
Abdominal wall hernias after trauma have been recognized for more than a century, with the first case reported as occurring after a fall. Traumatic abdominal wall hernias (TAWHs) after blunt trauma are uncommon. The timing of definitive repair, early or delayed, is not clear. We report a case on TAWH and mesenteric avulsion, highlighting the reasons for immediate or delayed repair. A single case study can hardly be considered as a basis for profound changes in the management of post traumatic hernias. However, damage to all layers of the abdominal wall indicates high-energy trauma. In such cases, the damage is not, in all probability, limited to the integumentary system. For the moment, the timing of surgery in any TAWH should be considered differently according to the trauma, the wall defect, clinical and radiological findings, associated injuries, and the clinical status of the patient. PMID:19153644
Sall, I; El Kaoui, H; Bouchentouf, S M; Ait Ali, A; Bounaim, A; Hajjouji, A; Baba, H; Fahssi, M; Alhyane, A; Zentar, A; Sair, K
Background: The popularity of laparoscopic repair of incisional hernias is increasing due to the apparent advantages of laparoscopy.\\u000a Patients and methods: A group of 150 consecutive patients with incisional hernias were treated by laparoscopic IPOM technique\\u000a with a Goretex Dualmesh between September 1999 and September 2001 and subsequently followed up. Some minor and major complications\\u000a could clearly identify advantages as
Background Foramen of Morgagni’s hernia is an uncommon congenital diaphragmatic hernia. Repair is mostly performed through laparotomy.\\u000a We prefer the transthoracic approach, which allows better and safer control during thoracic dissection, although it is considered\\u000a more painful and related to greater morbidity. In recent years we introduced the transxiphoid hand-assisted videothoracoscopic\\u000a approach, which combines the advantages of the thoracic route with
V. Ambrogi; D. Forcella; A. Gatti; G. Vanni; T. C. Mineo
Background Ventral hernia is a common surgical condition occurring most often as a complication following abdominal surgery. Laparoscopic\\u000a repair of a ventral hernia has been shown to be safe with low rates of complications, shortened length of stay, and low rates\\u000a of early recurrence as compared to open surgery. Few studies have documented long-term outcomes of laparoscopic repair in\\u000a elderly patients.
Y. K. Lee; A. Iqbal; M. Vitamvas; C. McBride; J. Thompson; D. Oleynikov
BackgroundThe development of laparoscopic herniarepair has provided an alternative approach to the management of incarcerated inguinal hernia in children. Different laparoscopic techniques for herniarepair have been described. However, we hereby review the role of laparoscopic herniarepair using the hook method in the emergency setting for incarcerated inguinal hernias in children.
Kin Wai Edwin Chan; Kim Hung Lee; Yuk Him Tam; Jennifer Dart Yin Sihoe; Sing Tak Cheung; Jennifer Wai Cheung Mou
For laparoscopic anterior resection, an additional small incision is usually placed in the left lower quadrant or the suprapubic portion. As a left inguinal hernia incision is close to both the left lower quadrant and the suprapubic portion, such an incision can be used for anastomosis in laparoscopic anterior resection, without additional incisions. We report a laparoscopic anterior resection using a left inguinal hernia incision for colorectal anastomosis, in a patient who underwent concomitant left inguinal herniarepair. After a total mesorectal excision was performed laparoscopically, the distal portion of the rectum was transected by a stapler. A 4 cm skin incision was made in the left inguinal region and carried down to the peritoneum through the hernia sac. The bowel resection was performed extracorporeally, and an anvil was placed at the proximal end of the colon over a purse-string suture. After colorectal anastomosis was performed using a circular stapler inserted through the anus, the inguinal hernia was repaired with a mesh. The inguinal wound healed without surgical site infection, and the patient was discharged ten days after surgery.
INTRODUCTION Lumbar hernia is a rare condition with fewer than 300 cases reported in the literature. It arises through posterolateral abdominal wall defects, named the inferior triangle (Petit) and superior triangle (Grynfelt). It can be congenital or acquired, primary or secondary, peritoneal or extraperitoneal, reducible or complicated. PRESENTATION OF CASE We report a 63 year old female patient who presented to our hospital with a reducible right superior lumbar hernia. She underwent repair with underlay mesh after inversion of the sac and had a smooth postoperative course. DISCUSSION In contrast to the classical procedure the underlay mesh modification saved us from enlarging the defect, and was quick and associated with minimal tissue injury. CONCLUSION Underlay mesh repair for spontaneous lumbar hernia is feasible when the defect is small.
Purpose The aim of this study was to compare the preemptive effects of systemic midazolam and diclofenac on postoperative analgesia when used before surgical incision. Methods Ninety patients, aged 35–65 years, scheduled for herniarepairsurgery were included in the study. Forty five patients in the midazolam group (group M + D) received 0.05 mg\\/kg midazolam and 1.5 mg\\/kg diclofenac, 15 min before surgical incision; 45
A. Hasani; H. Maloku; F. Sallahu; V. Gashi; S. U. Ozgen
Local anesthetics decrease postoperative pain when placed at the surgical site. Patients benefit from laparoscopic extraperitoneal herniarepair because this allows earlier mobilization than the more classical open surgical approach. The purpose of this study was to determine the pain-sparing efficacy of local anesthetics placed in the preperitoneal fascial plane during extraperitoneal laparoscopic inguinal herniasurgery. Forty-two outpatients were included in a double-blind, randomized, placebo-controlled, institutional review board-approved study. At the conclusion of a standardized general anesthetic, 21 patients received 60 mL of 0.125% bupivacaine into the preperitoneal fascial plane before incisional closure, whereas the other 21 patients received 60 mL of the isotonic sodium chloride solution placebo. Postoperative pain was assessed 1, 4, 8, 24, and 72 h postoperatively. In addition, postoperative fentanyl and outpatient acetaminophen 500 mg/hydrocodone 5 mg requirements were recorded. All herniarepairs were performed by the same surgeon. Appropriate statistical analyses were used. There were no significant differences between the bupivacaine and isotonic sodium chloride solution groups with regard to postoperative pain scores, length of postanesthesia care unit stay, or analgesic requirements. Furthermore, neither unilateral versus bilateral repair nor operative time affected the measured parameters. The addition of 60 mL of 0.125% bupivacaine into the preperitoneal fascial plane during extraperitoneal laparoscopic herniarepair did not significantly alter pain scores, supplementary analgesic requirements, or recovery room length of stay. Implications: The placement of 60 mL of 0.125% bupivacaine into the preperitoneal fascial plane during extraperitoneal laparoscopic herniarepair did not significantly alter pain scores, supplementary analgesic requirements, or recovery room length of stay. PMID:9706934
Saff, G N; Marks, R A; Kuroda, M; Rozan, J P; Hertz, R
Diaphragm rupture is associated with approximately 5% of blunt abdominal trauma. However, rupture of the central tendon of\\u000a the diaphragm leading to an intrapericardial diaphragmatic hernia is very rare, with less than 100 cases reported in the world\\u000a literature. All previously reported cases have been repaired via laparotomy or thoracotomy. In this paper, we present the\\u000a first laparoscopic repair of
B. L. McCutcheon; U. Y. Chin; G. J. Hogan; J. C. Todd; R. B. Johnson; C. P. Grimm
Several anaesthetic options are now available for the repair of groin hernias. The benefits of the local and general anaesthetic techniques are well outlined in the literature. No studies, however, have assessed the patient's preference for different anaesthetic approaches of their suitability of choice in elective herniarepair. A cohort of 284 consecutive patients seen in a dedicated hernia clinic
Background: Techniques for performing laparoscopic incisional herniarepair have been described and some advantages over conventional open repair reported. However, most reported series of laparoscopic incisional hernia procedures are small, and only one has included a comparison with open repairs. Methods: From December 1993 to January 1998, we prospectively collected operative and outcome data on 56 consecutive laparoscopic prosthetic repairs
Purpose Postoperative perineal hernias are rare complications from procedures, which compromise the pelvic floor, mainly abdominoperineal\\u000a resection, proctocolectomy, and partial or total pelvic exenteration. Surgical repair can be accomplished through abdominal,\\u000a laparoscopic, or transperineal approaches.\\u000a \\u000a \\u000a \\u000a \\u000a Methods We present a case report of a 70-year-old man who underwent two prior operations for recurrent perineal hernia and was ultimately\\u000a successfully treated with a third
Between 1986 and 1992, 265 men of mean age 51 (range 16-75) years with a primary inguinal hernia were randomized to undergo surgery by staff surgeon or surgical resident and further randomized to receive a modified Bassini operation (transversalis fascia not divided but included in the repair) or Shouldice procedure. The follow-up rate was 92.1 per cent with a mean follow-up of 3.3 years. Recurrence developed in 12 of 125 patients with a Bassini procedure and two of 119 after a Shouldice repair (9.6 versus 1.7 per cent, P = 0.006). The recurrence rate was no different for staff surgeons and trainees (5.9 versus 5.6 per cent, P not significant). Multivariate analysis identified the presence of a direct hernia (P = 0.003) as the additional main factor for the development of recurrence. PMID:7646633
Purpose Herniarepairs are a common surgical procedure, and are associated with a significant cost. Despite the acceptance of the\\u000a advantages of early elective herniarepairs, the incidence of emergency admissions with complicated presentations remains\\u000a high, and the natural history of an untreated hernia is not obvious. This study aimed to define risk factors related with\\u000a unfavorable outcomes in groin hernia
M. Akinci; Z. Ergül; B. Kulah; K. B. Yilmaz; H. Kulaco?lu
Results on herniasurgery from numerous centers confirm that tensionless repair with various meshes reduces the complication\\u000a rates and the frequency of recurrences. Some evidence on incisional hernias suggests, however, that the use of mesh seems\\u000a to transfer the onset of recurrences by several years. Persistent pain and other discomfort is also an unpleasant complication\\u000a of otherwise successful surgery in
Background: The characteristics of the ideal type of mesh are still being debated. Mesh shrinkage and fixation have been associated with complications. Avoiding shrinkage and fixation would improve hernia recurrence rates and complications. To our knowledge, this is the first study of a device with a self-expanding frame for laparoscopic herniarepair. Methods: Six Rebound HerniaRepair Devices were placed laparoscopically in pigs. This device is a condensed polypropylene, super-thin, lightweight, macro-porous mesh with a self-expanding Nitinol frame. The devices were assessed for adhesions, shrinkage, and histological examination. Laboratory and radiologic evaluations were also performed. Results: The handling properties of the devices facilitated their laparoscopic placement. They were easily identified with simple x-rays. The mesh was firmly integrated within the surrounding tissue. One device was associated with 3 small adhesions. The other 5 HRDs had no adhesions. We noted no shrinkage or folding. All devices preserved their original size and shape. Conclusions: At this evaluation stage, we found that the Rebound HerniaRepair Device may serve for laparoscopic herniarepair and has favorable handling properties. It prevents folding and shrinkage of the mesh. It may eliminate the need for fixation, thus preventing chronic pain. The Nitinol frame also allowed radiologic evaluation for gross movement. Further studies will be needed to evaluate its clinical application.
Torres-Villalobos, Gonzalo; Sorcic, Laura; Ruth, George R.; Andrade, Rafael; Martin-del-Campo, Luis A.
Background Incisional hernia, found in up to 25% of patients, is a typical complication of open bariatric surgery.\\u000a \\u000a \\u000a \\u000a Methods Open Roux-en-Y gastric bypass (RYGB) was performed in 204 patients. They have been followed-up for at least 6 months. Thirty-two\\u000a patients in whom incisional hernia was diagnosed were divided into two groups—they were scheduled for herniarepair or hernia\\u000a repair with abdominoplasty. The surgery
A. Iljin; D. Szymanski; J. Kruk-Jeromin; J. Strzelczyk
Purpose In this retrospective study, we aimed to compare the clinical characteristics of inguinal hernia developed after radical retropubic surgery for prostate cancer to the hernia without previous radical prostatectomy. Methods Twenty-three patients (group A) who had radical retropubic surgery for prostate cancer underwent laparoscopic or open tension-free inguinal herniarepair from March 2007 to February 2011. Nine hundred and forty patients (group B) without previous radical retropubic surgery received laparoscopic or tension-free open hernia operation. Results Group A was older than group B (mean ± standard deviation, 69.6 ± 7.2 vs. 54.1 ± 16.1; P < 0.001). Right side (73.9%) and indirect type (91.3%) in group A were more prevalent than in group B (51.5% and 69.4%, respectively) with statistic significance (P = 0.020 and P = 0.023). The rate of laparoscopic surgery in group B (n = 862, 91.7%) was higher than in group A (n = 14, 64.3%, P < 0.001). In comparing perioperative variables between the two groups, operative time (49.4 ± 23.5 minutes) and hospital stay (1.9 ± 0.7 days) in group A were longer than in group B (38.9 ± 16.9, 1.1 ± 0.2; P = 0.046 and P < 0.001, respectively) and pain score at 7 days in group A was higher than in group B (3.1 ± 0.7 vs. 2.3 ± 1.0, P < 0.001). Postoperative recurrence rate was not significantly different between the two groups. Conclusion Inguinal hernia following radical retropubic surgery for prostate cancer was predominantly right side and indirect type with statistic significance compared to hernias without previous radical prostatectomy.
OBJECTIVE:: To assess the incidence of groin herniarepair after radical prostatectomy for prostate cancer compared with the incidence in a control population without prostate cancer in a nationwide, population-based study. BACKGROUND:: Recent reports indicate an increase in the incidence of groin herniarepair after radical prostatectomy. Inadequate knowledge of the incidence of groin hernia in the general population makes this information hard to interpret. METHODS:: Information was retrieved from the Prostate Cancer Database (PCBaSe) and Swedish Hernia Register for events between 1998 and 2010. The incidence of groin herniasurgery was calculated for a group of men treated with radical prostatectomy (open and minimally invasive) and for a group treated with radiation therapy, and these were compared with the incidence in a control cohort of men matched for age and county of residence. Multivariate analysis was used to assess the hazard ratio (HR) of groin herniarepair according to age, tumor risk category, and Charlson Comorbidity Index. RESULTS:: A total of 28,608 cases and 105,422 controls were included in the study. Men treated with radical prostatectomy and radiation therapy had a significantly higher incidence of groin herniarepair than the control cohort: HR: 3.95 (95% confidence interval: 3.70-4.21) for retropubic prostatectomy, HR: 3.37 (95% confidence interval: 2.95-3.87) for minimally invasive prostatectomy, and HR: 1.84 (95% confidence interval: 1.66-2.04) for radiation therapy. CONCLUSIONS:: An almost 4-fold increase in groin herniarepair was observed after radical prostatectomy compared with controls, and men who received radiation therapy had an almost 2-fold increase in incidence. As well as postoperative changes in the abdominal wall, increased vigilance for groin hernia seems to be important for the increased incidence of groin herniarepair seen after radical prostatectomy or radiation therapy for prostate cancer. PMID:23732267
Background Incisional hernias are a common complication following abdominal surgery and represent about 80% of all ventral hernia. In\\u000a uncomplicated postoperative follow-up they develop in about 11% of cases and in up to 23% of cases with wound infections or\\u000a other forms of wound complications. While conventional mesh repair has been the standard of care in the past, the use of
Falk Müller-Riemenschneider; Stephanie Roll; Meik Friedrich; Juergen Zieren; Thomas Reinhold; J.-Matthias Graf von der Schulenburg; Wolfgang Greiner; Stefan N. Willich
Laparoscopic repair of ventral or incisional hernia is among the most commonly performed minimally invasive procedures. Different modes of recurrence have been reported in literature, including missed defects, mesh migration, mesh infection, etc. Transfascial suture fixation in addition to tackers is an established method to prevent recurrence due to mesh migration. We report possibly the third case of recurrent ventral hernia with multiple defects at transfascial suture sites of previous laparoscopic ventral hernia mesh repair. The patient was treated by laparoscopy with a large intraperitoneal PROCEED mesh, covering the new hernia defects and older mesh. PMID:20874415
Khandelwal, Radha Govind; Bibyan, Monika; Reddy, Prasanna K
Introduction Herniarepair is one of the most frequently performed surgical procedures worldwide, yet more than half of hernias may be\\u000a untreated in African countries that lack adequate and affordable surgical care. Although this disease burden can be effectively\\u000a reduced by surgical repair, public health efforts to promote repair have been sparse because of the presumed high cost of\\u000a surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Objective To
J. Yang; D. Papandria; D. Rhee; H. Perry; F. Abdullah
Inguinal hernia is a very common problem. Surgical repair is the current approach, whereas asymptomatic or minimally symptomatic hernias may be good candidate for watchful waiting. Prophylactic antibiotics can be used in centers with high rate of wound infection. Local anesthesia is a suitable and economic option for open repairs, and should be popularized in day-case setting. Numerous repair methods have been described to date. Mesh repairs are superior to "nonmesh" tissue-suture repairs. Lichtenstein repair and endoscopic/laparoscopic techniques have similar efficacy. Standard polypropylene mesh is still the choice, whereas use of partially absorbable lightweight meshes seems to have some advantages.
INTRODUCTION Epigastric hernia is a rare form of ventral hernia, occurring along the linea alba anywhere from the xiphoid process to the umbilicus. PRESENTATION OF CASE We present the case of a 19-month-old boy with an epigastric hernia who underwent a single-port laparoscopic repair using an epidural needle. A nonabsorbable suture was threaded through an epidural needle, with one end of the suture threaded back through the needle tip to make a loop. The loop-shaped suture was left in the abdominal cavity through the rectus muscle at the site of the defect. Another suture was inserted into the looped suture through the opposite rectus muscle. The loop was pulled taut and the defect was closed by tying the suture extracorporeally with a subcutaneous knot. DISCUSSION In epigastric hernia, the surgical technique involves overlapping muscle layers, and currently laparoscopic surgery is introduced to repair the hernia defect. Laparoscopy is a minimally invasive method of repairing epigastric hernias. CONCLUSION The epidural needle proved a simple and cosmetically acceptable device with which to close the epigastric hernia defect.
Introduction: We evaluated the effect of the postgraduate medical education level (PGY) of surgery residents on recurrence of inguinal hernia, complications, and operative time. Methods: Post hoc analysis was performed on prospectively collected data from a multicenter Veterans Affairs (VA) cooperative study. Men were randomly assigned to open or laparoscopic inguinal herniarepairs with mesh. Surgery residents performed repairs with designated attending surgeons present throughout all procedures. PGY level of the resident was recorded for each procedure. All patients were followed for 2 years for hernia recurrence and complications. PGY levels were grouped as follows: group I = PGY 1 and 2; group II = PGY 3; group III = PGY ? 4; rates of recurrence, complications and mean operative time were compared. Results: A total of 1983 patients underwent herniarepair. group III residents had significantly lower recurrence rates for open repairs when compared with group I (adjusted odds ratio = 0.24, 95% confidence interval [CI], 0.06, 0.997). The recurrence rate was similar among the groups for laparoscopic repair (P > 0.05) Complication rates were not different for either repair (P > 0.05). Mean operative time was significantly shorter for group III compared with group I for both open (?6.6 minutes; 95% CI, ?11.7, ?1.5) and laparoscopic repairs (?12.9 minutes; 95% CI, ?19.8, ?6.0) and between group II and group I for laparoscopic repair (?15.0; 95% CI, ?24.3, ?5.7). Conclusions: Despite the presence of an attending surgeon, open herniarepairs performed by junior residents were associated with higher recurrence rates than those repaired by senior residents. Lower resident level was associated with increased operative time for both open and laparoscopic repair.
Wilkiemeyer, Mark; Pappas, Theodore N.; Giobbie-Hurder, Anita; Itani, Kamal M. F.; Jonasson, Olga; Neumayer, Leigh A.
The development of Morgagni hernias is related to malformations of the embryologic septum transversum after failure of the sternal and costal fibrotendinous elements of the diaphragm to fuse. The overall incidence of Morgagni hernias among all congenital diaphragmatic defects is 3% to 4%. Inguinal hernias are the most common hernias in males and females (25% and 2%, respectively). An inguinal hernia is defined as a protrusion of the abdominal cavity contents through the inguinal canal. The combination of Morgagni and inguinal hernias is rare, and treatment using laparoscopic surgery has not been previously reported. This case presents a one-stage laparoscopic repair of Morgagni and inguinal hernias in a 2-month-old male.
Bae, Mi Ju; Kim, Dae Hwan; Jeong, Yeon Joo; Kim, Yeong Dae; Cho, Jeong Su
Introduction Inguinal hernia is one of the commonest surgical conditions that one comes across in a surgical career. Operative repair is the only successful treatment for hernias. As with other surgical procedures, this is also associated with possible complications. Scrotal haematoma is one of the well-known complications following herniarepair, but massive penoscrotal haematoma requiring surgical intervention is very rare. Case presentation A 53-year-old black man had undergone elective herniarepair. He underwent standard open herniarepair with a prolene mesh and developed massive scrotal haematoma which required drainage. Eventually he recovered well, although slowly. Conclusion To achieve adequate bleeding control during and at the end of operation is the key preventive measure to avoid scrotal haematoma. Here, we report a case of massive penoscrotal haematoma following repair of a moderate sized inguinal hernia. We strongly emphasize the importance of adequate control of bleeding, even in small to moderate sized inguinal hernias in order to avoid such disastrous complications with long-term cosmetic disfigurement.
Background: Recurrence rates after primary repair of ventral and incisional hernias range from 25% to 52%. Recurrence after open surgery is less likely if mesh is used, but the wide fascial dissection and required flap creation increase complication rates. Laparoscopic techniques offer an alternative.Study Design: To assess the safety and efficacy of laparoscopic ventral and incisional herniorrhaphy, we reviewed the
B. Todd Heniford; Adrian Park; Bruce J Ramshaw; Guy Voeller
Almost 40 years of lucky existence is enough time for questioning and/or updating the Stoppa method for herniarepair. In this paper, the author reports the circumstances of the birth of this method more than 30 years ago, recalls its innovative principles, describes its technical aspects, and exposes its good results. Not simply approving old concepts, the author concludes with critical remarks with regard to a so-called political correctness of today's groin herniarepair, which gives great importance to reducing patient trauma arising from surgery. For belief without doubt can be wrong belief! PMID:12612790
Ureteric obstruction of the transplanted kidney is the most common late urological complication and is caused mostly by ureteric stricture. We report the case of a patient who developed ureteric obstruction following trans-abdominal pre-peritoneal repair of a recurrent inguinal hernia (TAPP). High level evidence exists to support the laparoscopic approach to recurrent inguinal herniarepair; however, this case reports the potential complications and difficulties that may occur in the presence of a kidney transplant. PMID:21909778
Polypropylene mesh is the most commonly used mesh for open and laparoscopic herniarepair in the United States. A variety\\u000a of newly developed polyester mesh products have recently become available. This is the first U.S. multiinstitutional study\\u000a evaluating the initial experience of polyester mesh use for total extraperitoneal (TEP) laparoscopic inguinal herniarepair.\\u000a Between January 2000 and June 2001, 337
B. Ramshaw; F. Abiad; G. Voeller; R. Wilson; E. Mason
Background Incisional hernia is an important complication of abdominal surgery. Its repair has progressed from a primary suture repair\\u000a to various mesh repairs and laparoscopic repair. Laparoscopic mesh repair is a promising alternative, and in the absence of\\u000a consensus, needs prospective randomized controlled trials.\\u000a \\u000a \\u000a \\u000a Methods Between April 2003 and April 2005, 66 patients with incisional, primary ventral and recurrent hernias were randomized
M. C. Misra; V. K. Bansal; M. P. Kulkarni; D. K. Pawar
Background To describe the rationale and design of an observational cohort study analyzing the effects of endoscopic Totally Extraperitoneal (TEP) herniarepair on male fertility (MAIN study). Methods and design The MAIN study is an observational cohort study designed to assess fertility after endoscopic TEP herniarepair. The setting is a high-volume single center hospital, specialized in TEP herniarepair. 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 herniarepair (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 herniarepair. 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 herniarepair 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 prospective 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 herniarepair, 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)
Objectives: The components separation technique (CST) is a widely described abdominal wall reconstructive technique. There have, however, been no UK reports of its use, prompting the present review. Methods: Between 2008 and 2012, 13 patients who underwent this procedure by a single plastic surgeon (C.M.M.) were retrospectively evaluated. The indications, operative details, and clinical outcomes were recorded. Results: There were 7 women and 6 men in the series with a mean age of 53 years (range: 30-80). Patients were referred from a variety of specialties, often as a last resort. The commonest indication for CST was herniation following abdominal surgery. All operations except 1 were jointly performed with general surgeons (for bowel resection, stoma reversal, and hernia dissection). The operations lasted a mean of 5 hours (range: 3-8 hours). There were no major intra- and postoperative problems, except in 1 patient who developed intra-abdominal compartment syndrome, secondary to massive hemorrhage. All patients were satisfied with the cosmetic improvement in their abdominal contours. None of the patients have developed a clinical recurrence after a mean follow-up of 16 months (range: 3-38 months). Conclusions: The components separation technique is an effective method of treating large recalcitrant hernias but appears to be underutilized in the United Kingdom. The management of large abdominal wall defects requires a multidisciplinary approach, with input across a variety of specialities. Liaison with plastic surgery teams should be encouraged at an early stage and the CST should be more widely considered when presented with seemingly intractable abdominal wall defects.
Adekunle, Shola; Pantelides, Nicholas M.; Hall, Nigel R.; Praseedom, Raaj; Malata, Charles M.
Objectives: The components separation technique (CST) is a widely described abdominal wall reconstructive technique. There have, however, been no UK reports of its use, prompting the present review. Methods: Between 2008 and 2012, 13 patients who underwent this procedure by a single plastic surgeon (C.M.M.) were retrospectively evaluated. The indications, operative details, and clinical outcomes were recorded. Results: There were 7 women and 6 men in the series with a mean age of 53 years (range: 30-80). Patients were referred from a variety of specialties, often as a last resort. The commonest indication for CST was herniation following abdominal surgery. All operations except 1 were jointly performed with general surgeons (for bowel resection, stoma reversal, and hernia dissection). The operations lasted a mean of 5 hours (range: 3-8 hours). There were no major intra- and postoperative problems, except in 1 patient who developed intra-abdominal compartment syndrome, secondary to massive hemorrhage. All patients were satisfied with the cosmetic improvement in their abdominal contours. None of the patients have developed a clinical recurrence after a mean follow-up of 16 months (range: 3-38 months). Conclusions: The components separation technique is an effective method of treating large recalcitrant hernias but appears to be underutilized in the United Kingdom. The management of large abdominal wall defects requires a multidisciplinary approach, with input across a variety of specialities. Liaison with plastic surgery teams should be encouraged at an early stage and the CST should be more widely considered when presented with seemingly intractable abdominal wall defects. PMID:24058718
Adekunle, Shola; Pantelides, Nicholas M; Hall, Nigel R; Praseedom, Raaj; Malata, Charles M
BACKGROUND: Authors report incise, dissect, excise and suture (IDES) technique of laparoscopic repair of paediatric male inguinal hernia (LRPMIH). This series retrospectively evaluates a consecutive personal series of children undergoing laparoscopic herniarepair by this new technique. MATERIALS AND METHODS: It is a retrospective review of the LRPMIH done by single surgeon from January 2001 to December 2007. All male patients who were referred to the first author for management of inguinal hernia were given the option of laparoscopic repair. Parents who gave consent for their child to undergo LRPMIH were retrospectively reviewed. RESULTS: A total of 155 patients were operated. Age group was 2 months to 13 years (average-5 years). Follow-up period ranges from 1 to 7 years. Average operating time was 29 min for unilateral and 40 min for bilateral inguinal hernia. Maximum time required was 50 min which was for bilateral inguinal hernia. Bilateral inguinal hernia was present in 10 (6.4%) patients. There were no intraoperative complications. Contralateral processus vaginalis was patent in 25 (16.12%) patients. In the immediate post-operative period 8 patients had port site surgical emphysema which resolved on its own. There are no recurrences so far. One patient developed port site hernia, which was repaired with the standard surgery. There is no incidence of clinical testicular atrophy. CONCLUSION: LRPMIH can be done as routine procedure and also has fewer complications. It has advantage of diagnosing and repairing contra lateral patent processus vaginalis. However a double-blind controlled study is required to establish the results.
Background Open surgery for parastomal hernia has been associated with high morbidity and recurrence rates exceeding 50%. Laparoscopic\\u000a mesh repair is a promising alternative. Published series on laparoscopic mesh repair of parastomal hernia, however, are few\\u000a with relative short follow-up.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Seventy-two consecutive patients with 48 paracolostomy and 24 paraileostomy hernias were studied prospectively. Using a two-layer\\u000a mesh with polypropylene on the
Successful repair of most hernias requires the use of a prosthetic implant for reinforcement of the defect. Because of the need for prosthetic implants to resist infections as well to support repairs in contaminated or potentially contaminated fields, biological meshes have been developed to take the place of nondegradable synthetic meshes in cases where mesh infection is of high concern. The ideal is a biological matrix that resists infection while providing durable reinforcement of a herniarepair. This article reviews the validity of assumptions that support the purported notion of the biological behavior of biological meshes. PMID:24035083
Background: The repair of indirect inguinal hernia (IH) is one of the most common pediatric surgical procedures, and open surgery (OS) is the standard treatment. The aim of this study was to determine whether the recently developed laparoscopic repair (LR) of IH is superior to OS. Methods: Between February 2003 and February 2004, we randomly assigned 97 consecutive IH patients
Purpose Although laparoscopic total extraperitoneal repair (TEP) has been reported to have a low recurrence rate and relatively little\\u000a postoperative pain, there have been few studies reported regarding contralateral occurrence after TEP. Although a high incidence\\u000a of occult contralateral hernias has been reported in the literature, it is unknown whether occult hernias have any significance\\u000a in clinical settings. The aim of
H. Uchida; T. Matsumoto; H. Ijichi; Y. Endo; T. Koga; H. Takeuchi; T. Kusumoto; Y. Muto; S. Kitano
Management of all types of hernias continues to evolve as technology evolves. Prosthetic options continue to play a pivotal role in selection of techniques for herniarepair. There are 3 broad categories of prosthetics including synthetic, biologic, and the new absorbable biosynthetics. Paralleling prosthetic technology is the evolution of fixation for laparoscopic and open hernia techniques. Evaluations of new permanent and absorbable fixation methods are ongoing by multiple companies. There is a great interest in adhesives for mesh fixation as well as self-adhering prosthetics. Studies in fixation revolve around understanding the compromise between fixation strength and pain caused by different fixation methods. Understanding of the biomechanical properties of fixation options coupled with the understanding of the thresholds of force created by the functional abdominal wall are key to optimizing surgical technique. The clinical ramifications of furthering our understanding of all of these technologies will impact perspectives on future technique selection for herniarepair. PMID:23700182
Laparoscopic repair of abdominal wall hernias has been introduced recently to treat both spontaneous and incisional hernias with reported good results. In the Mafraq and Al Jaziera Hospitals in the United Arab Emirates, 18 patients have been treated using the laparoscopic technique. These cases included 11 incisional hernias, 5 spontaneous paraumbilical hernias, and 2 combined incisional and paraumbilical hernias. A bilayer repair was performed in all cases using a layer of polyester mesh to bridge the defect and a sheet of Gore-Tex (W. L. Gore & Associates, Flagstaff, AZ, USA) to prevent adhesions between first layer and the bowel. Seroma at the hernia site was the most frequent postoperative complication. Hospital stay ranged from 2 to 7 days (mean, 3.2 days). Recurrent hernia developed in one patient after a mean follow up of 22.3 months. This technique is in its evolution. Long follow-up evaluation is required before the effect on recurrence is known, and further development regarding the composition of prosthetic biomaterials and the methods of its fixation is expected. PMID:11148788
Background We report on a new method of incisional herniarepair applicable to any size of hernia and the long-term results of this method.\\u000a Musculus rectus abdominis is bandaged or partially bandaged in a loose way with a 2-cm-wide band of polypropylene (Prolene®) on both sides at a distance of 2 cm, depending on the size of the hernial opening. The aims
M. Sahm; R. Kube; J. Rose; G. Kubo; M. Pross; H. Lippert
Primary laparoscopic repair of Morgagni-Larrey hernia has been described in adult patients but not in children. This is the first report of primary laparoscopic correction in the pediatric age group without using a prosthesis. A Morgagni-Larrey hernia was found incidentally in a 3-year-old-girl. Laparoscopic correction of the defect was performed. After 6 months the patient is doing well. The chest
Mario Lima; Marcello Dňmini; Michele Libri; Antonino Morabito; Giovanni Tani; Remigio Dňmini
Inguinal hernia is a common problem among children, and herniotomy has been its standard of care. Laparoscopy, which gained\\u000a a toehold initially in the management of pediatric inguinal hernia (PIH), has managed to steer world opinion against routine\\u000a contralateral groin exploration by precise detection of contralateral patencies. Besides detection, its ability to repair\\u000a simultaneously all forms of inguinal hernias (indirect,
Ramanathan Saranga Bharathi; Manu Arora; Vasudevan Baskaran
Background and aim of the study: An incisional hernia is represented by the escape of organs from their physiologic position through an area of weakness on the surgical scar. An original technique, based on a Rives intervention, which is the golden standard in the treatment of incisional hernias, is presented in this study. Methods: From January 1995 to December 2003,
Ludovico Docimo; Fulvio Manzi; Luigi Sparavigna; Massimo De Rosa; Felice Granato; Vincenzo Amoroso; Giovanni Docimo; Franca Ferraraccio
Background: Inguinal herniarepair is the most common operation in general surgery. Prosthetic reinforcement of the inguinal area with polypropylene mesh has increased dramatically in the last decade. The aim of this study was to evaluate how different types of mesh affect the spermatic cord structures. Methods: Thirty rats were divided into three groups. The spermatic cord was dissected free
F. H. Berndsen; L.-M. Bjursten; M. Simanaitis; A. Montgomery
PurposeLaparoscopic herniarepair in infancy and childhood is still debatable. There are many techniques available for laparoscopic herniarepair in children. The objective of this study was to compare intracorporeal suturing and knotting with extracorporeal knotting for repair of congenital inguinal hernia in infants and children about operative time, recurrence rate, hydrocele formation, and postoperative cosmetic results. A randomized controlled
Background Laparoscopic herniarepair has emerged as an effective alternative method for treating inguinal hernias. The ability to provide\\u000a this service as day surgery or short-stay (23-h stay) treatment makes it an attractive method in this age of resource limitations.\\u000a The technique is cost-effective when the use of disposable instruments is kept to a minimum.\\u000a \\u000a \\u000a \\u000a Methods Our team performed laparoscopic transabdominal pre-peritoneal
S. Balakrishnan; T. Singhal; T. Samdani; A. Hussain; S. Shuaib; S. Grandy-Smith; J. Nicholls; S. El-Hasani
Quality assurance is a concept intended to ensure the quality of a surgical therapy on a defined level. But what is "quality" in surgical therapy? Quality can be described in a lot of different ways. Quality has something to do with taste, especially with individual preferences. The testing of the quality of wine is a good example. Even though this is quite difficult, it can still be done and has been done for hundreds of years. In surgery we are still at the beginning. Discussions regarding the definition of quality, the best method of quality assurance and, not least, who is responsibility for its measurement are well-known obstacles on the path to improvement. Quality has basically little to do with research. It is not a matter of finding the right technique, but of ensuring that the right technique, when found, is correctly used. Defined quality standards will allow this. Quality standards in inguinal herniasurgery are: outstanding comfort directly before and after the therapy, few or no side effects troubling the patient, most of all no disastrous side effects, disaster, low rate of relapse and, in our times, decent economy. The question: "Is the target to be oriented on the average or must the standard be brought nearer the best performance?" has to be answered. Surgery and average performance do not match; surgical performance cannot be oriented on the average. The next question is: "Which methods are suitable for this?". The "tracer method" is one method, one aspect within quality assurance methods in general. It is designed for obtaining information on the quality of a clinic/department. The obtained data on complication rates, for example (10%), and their striking points should above all give insight into the complete department, i.e., on complication rates of a surgical department in general. The same counts for infection rates or striking points. The essential question remains: "Who should carry it out?" Bureaucrats lacking expertise will buy it. The principle of autonomy, "expertise connected to competence" has to be kept when answering the question of who should do it and how. The tracer method, using herniasurgery as a tracer, is not necessarily suitable as a measure of the quality of inguinal herniasurgery. Even though it supplies--as a side effect--information about inguinal herniasurgery, like complication rates (10%) and relapse operations (10%), as well as the varying anaesthetic procedures, or the use for changes in therapeutic procedures, the tracer method is not suitable to sufficiently inform about the quality of inguinal herniasurgery in particular. A further essential aspect when analysing quality assurance--showing up clearly at the moment--is the fact, that "another" control will develop if this inactivity remains. In this case the "controllers" will certainly not be the surgeons. The nightmare vision of bureaucrats (insurance companies or other parties) as controllers is in sight. This would be the same situation as if Michael Schumacher's Ferrari were checked by clerks and not by engineers. PMID:9483344
Background: Laparoendoscopic single-site surgery has rapidly progressed from the animal laboratory to clinical use since mass production of multichannel ports began in 2007. Indeed, it has now been shown to be feasible and safe for many commonly performed operations. Methods: This study cohort comprised 22 unselected patients with abdominal wall hernias of varying types: multiply recurrent inguinal (n=2), suprapubic (n=1), ventral/incisional (n=17), and parastomal hernias (n=2), who underwent laparoendoscopic single-site ventral herniarepair between December 2009 and February 2011. Standard dissecting instruments and a 52cm/5.5mm/30°angle laparoscope were used. Results: Patients included 14 men and 8 women, with a median age of 56 (range, 32 to 78) years and a mean body mass index of 31.5±4.7kg/m2. The mean mesh size was 460cm2 (range, 225 to 884cm2). Mean operation time was 125 minutes for ventral/incisional hernias and 270 minutes for parastomal hernias. No conversions to multiport or open surgeries were necessary. There was no mortality or morbidity, and no recurrence at 6- to 18-month follow-up. The mean satisfaction score was 2.7 (range, 2 to 3) with no patients reporting dissatisfaction with the procedure. Conclusion: This series, though relatively small, represents a diverse group of patients with varying abdominal wall hernias, including parastomal hernias. These successful laparoendoscopic single-site surgeries, with no complications, demonstrate safety and efficacy, albeit in a specialized hernia center. This study is a prelude to the eventual validation of laparoendoscopic single-site herniasurgery with prospective randomized controlled trials.
Background Inguinal hernia in children is traditionally repaired through a groin incision by dissecting the hernia sac from the spermatic\\u000a cord and suture ligating its base. A laparoscopic modification of this procedure involves placement of a transcutaneous suture\\u000a around the neck of the sac through a 2-mm stab incision under visualization with an umbilically placed 2.7-mm 30o lens. We reviewed the
Background In herniarepair, particularly laparoscopic herniarepair, direct contact between mesh and abdominal organs cannot always\\u000a be avoided. Several mesh materials and composite meshes have been developed to decrease subsequent adhesion formation. Recently,\\u000a new meshes have been introduced. In an experimental rat study, their value was established and compared with that of meshes\\u000a already available on the market.\\u000a \\u000a \\u000a \\u000a Methods In 200
J. W. A. Burger; J. A. Halm; A. R. Wijsmuller; S. ten Raa; J. Jeekel
Lumbar hernia is an infrequent pathology that is difficult to treat through open surgery. A 65-year-old man presented with\\u000a a right-sided lumbar mass responsible for pain. This was a fatty mass of 10×15 cm, located in the lumbar fossa. A CT scan\\u000a showed the hernia and the defect. Through a small incision in the flank, dissection was initiated with one
Background Minimally invasive surgery (MIS) has been described for the repair of congenital diaphragmatic hernias (CDH) in neonates,\\u000a infants, and children. This report evaluates patient selection, operative technique, and clinical outcomes for MIS repair\\u000a of CDHs from a single center’s experience.\\u000a \\u000a \\u000a \\u000a Methods All cases of CDH at a tertiary care pediatric hospital with an initial attempt at MIS repair from January 2001
Sohail R. Shah; Jessica Wishnew; Katherine Barsness; Barbara A. Gaines; Douglas A. Potoka; George K. Gittes; Timothy D. Kane
At the Shouldice Clinic pre-operative weight loss is used prior to incisional herniarepairs. Mesh repair is selectively used, based on specific hernia characteristics. A series of 236 patients were reviewed and followed up for 36 months. Data were available on 188 patients (80%). There were 15 recurrences (8%). The number of obese patients was reduced from 67 (35.6%) to 25
Background: The surgical repair of paraesophageal hiatal hernias (PHH) can be performed by endoscopic means, but the procedure is not standardized and results have not been evaluated systematically so far. The aim of this review article was to clarify controversial subjects on the surgical approach and technique, i.e., recurrence rate after conventional versus laparoscopic PHH treatment, results of mesh reinforcement
W. A. Draaisma; H. G. Gooszen; E. Tournoij; I. A. M. J. Broeders
Background: Laparoscopic repair of congenital diaphragmatic hernias has been sparsely reported. Moreover, each report has primarily been a single operative case. In most of the reports, prosthetic mesh has not been used, and when used, it has been nonabsorbable in nature. Most of these case reports have documented only a few months of clinical follow-up. Methods: After institutional review board
George W. Holcomb III; Daniel J. Ostlie; Kelly A. Miller
Summary The growing popularity of prosthetic herniarepair has resulted in a larger number of complications such as a chronically discharging sinus; in such cases, the infected mesh may have to be removed. Five reoperations were performed in the past five years, all in male patients aged 52 to 73 years. A cylinder plug was removed in two cases, and
A. Coda; F. Botto Micca; M. Bossotti; S. Manfredi; M. Mattio; G. Ramellini; N. Canavesio; A. Bona
INTRODUCTION: Inguinal herniarepair is the most common surgical procedure performed in the UK. Evidence from several earlier studies suggests that primary inguinal herniarepair has a high recurrence rate of 10-15%. The Royal College of Surgeons of England guidelines suggested the use of layered suture (Shouldice) or prosthetic (Lichtenstein) repair. Per-fix plugs have been used in the US for more than a decade with excellent results. This study was a series of 200 consecutive cases. The aim was to evaluate the mesh plug technique in the repair of all types of inguinal hernias and its results in one consultant practice within a district general hospital. PATIENTS AND METHODS: In a 15-month period between 1997 and 1998, all patients with inguinal hernias presenting to the general surgical clinic of one consultant were recruited to the study. All had mesh plug repair under local (n = 40), regional (n = 50) or general (n = 110) anaesthesia either by the consultant, associate specialist or specialist registrar (following initial training), using the same standard technique. The majority 80% (n = 160) were done as day cases. The results were evaluated by questionnaire and personal outpatient review initially at 3 weeks, then at 1 year (9-13 months). RESULTS: 200 consecutive patients with inguinal hernias underwent mesh plug repair; mean age was 54 years (95% CI, 46-61). The majority of patients had primary (n = 180) and others had recurrent (n = 20) hernia. All types of hernia (Gilbert's I-VII) were included. Median follow-up was 1 year (9-15 months). Groin pain, which was the leading symptom at presentation, was relieved in 96% of the patients; 79% returned to previous jobs within 4 weeks (95% CI, 0.71-0.87). All retired patients resumed normal life activities within 2 days. Postoperative pain was minimal; 28 patients did not require any postoperative analgesia. There were very few minor (n = 6) and no major complications. During the follow-up, one recurrence occurred. CONCLUSIONS: Mesh plug repair is associated with minimal postoperative pain, quick recovery and return to work. It is an ideal technique for day-case surgery. Although longer follow-up will be required to assess true recurrence rate, so far the recurrence rate at 0.5% is acceptable, particularly in the light of other published series.
Background: The purpose of this study was to determine whether laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic\\u000a patch (LIPP) repair of a ventral hernia is superior to open prefascial polypropylene mesh (OPPM) repair in a tertiary care\\u000a university hospital in an urban environment.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Data on 39 consecutive patients undergoing either LIPP repair (n= 21) or OPPM repair (n= 18) were compared.
BACKGROUND: The aim of this study was to assess whether the application of a lightweight mesh for mesh plug repair (MPR) for primary inguinal hernia could reduce chronic pain or other symptoms associated with the insertion of the prosthesis. METHODS: Patients over 20 years of age with a unilateral primary inguinal hernia were eligible to participate in the study. The patients were randomly assigned to a lightweight mesh (LWM) or a heavyweight mesh (HWM) group. All the operations were performed under local anesthesia. The operative details, including the hernia type and the nerves that were identified, and the postoperative complications were recorded. All follow-up and outcome measures were obtained based on a physical examination and a questionnaire regarding pain and other symptoms at 1 week, 1, 3, 6, and 12 months after the surgery in a double-blinded manner. RESULTS: The use of LWM significantly reduced foreign body sensation after 12 months to one-third of the incidence reported for the use of HWM (5.8 vs. 17.9 %; P = 0.013), while no significant differences were found in pain parameters, including the use of pain relief medications, between the groups throughout the study period. CONCLUSION: This study indicated that the use of LWM in the MPR decreases the incidence of foreign body sensation at 1 year after surgery for primary inguinal hernia. LWM may be preferable to MPR, similar to results described previously for Lichtenstein repair. PMID:23657862
The popularity of laparoscopic repair of ventral hernias is increasing due to the apparent advantages of the procedure, but this approach is still a controversial technique. The aim of our study was to evaluate the mortality rate of laparoscopic ventral herniarepair and analyse the literature. The authors performed a prospective study in 90 patients with ventral hernia who were
D. A. Moreno Egea; J. A. Torralba Martinez; G. Morales Cuenca; J. De Miquel; JG Martín Lorenzo; JL Aguayo Albasini; M. Canteras Jordana
Background: Demands on the medical profession to develop performance measures and demonstrate cost-effectiveness make it imperative that a uniform approach to the measurement of outcomes for common conditions be adopted. We report here on patient acceptance, response rates, and utility of a new set of core outcomes measures for patients with inguinal hernia (IH), which incorporates patient reporting of outcomes.Methods:
Richard E Burney; Katherine R Jones; Jane Wilson Coon; Darby K Blewitt; Ann Herm; Melissa Peterson
Purpose Although at present nonabsorbable meshes are the preferred material for tension-free hernioplasty, some problems with their\\u000a use have yet to be addressed (i.e., chronic pain and infections). In order to address these disadvantages, a collagen-based\\u000a material, the porcine small-intestinal submucosa mesh (Surgisis Inguinal Hernia Matrix, Cook Surgical, Bloomington, IN, USA),\\u000a has recently been developed for herniarepair.\\u000a \\u000a \\u000a \\u000a Methods With the aim
L. Ansaloni; F. Catena; S. Gagliardi; F. Gazzotti; L. D’Alessandro; A. D. Pinna
\\u000a Spigelian hernia is a rare partial\\u000a abdominal wall defect. The frequent lack of physical findings along\\u000a with vague associated abdominal complaints makes the diagnosis elusive.\\u000a A retrospective review of Mayo Clinic patients was performed to find\\u000a all patients who had undergone surgical repair of a Spigelian hernia\\u000a from 1976 to 1997. Patients were scrutinized for presentation, work-up,\\u000a therapy, and
BACKGROUND: Congenital inguinal hernias are a common paediatric surgical problem and herniotomy through a groin incision is the gold standard. Over the last 2 decades minimally invasive surgery (MIS) has challenged this conventional surgery. Over a period, MIS techniques have evolved to making it more minimally invasive – from 3 to 2 and now single port technique. All studies using single port technique are from tertiary care centres. We used a modification of the technique described by Ozgediz et al. and reviewed the clinical outcome of this novel procedure and put forth our experience at a secondary level hospital. MATERIALS AND METHODS: Prospective review of 37 hernias in 31 children (29 male and 2 female) (8 months - 13 years) performed laparoscopically by a single surgeon at a single centre between September 2007 and June 2010. Under laparoscopic guidance, the internal ring was encircled extraperitoneally using a 2-0 non-absorbable suture and knotted extraperitoneally. Data analyzed included operating time, ease of procedure, occult patent processus vaginalis (PPV), complications, and cosmesis. RESULTS: Sixteen right (52%), 14 left (45%) and 1 bilateral hernia (3%) were repaired. Five unilateral hernias (16.66%), all left, had a contralateral PPV that was repaired (P = 0.033). Mean operative time for a unilateral and bilateral repair were 13.20 (8–25) and 20.66 min (17 -27 min) respectively. Only one of the repairs (2.7%) recurred and another had a post operative hydrocoele (2.7%). One case (2.7%) needed an additional port placement due to inability to reduce the contents of hernia completely. There were no stitch abscess/granulomas, obvious spermatic cord injuries, testicular atrophy, or nerve injuries. CONCLUSION: Single port laparoscopic inguinal herniarepair can be safely done in the paediatric population. It permits extension of benefits of minimal access surgery to patients being managed at secondary level hospitals with limited resources. The advantage of minimal instrumentation and avoidance of intracorporeal knotting makes it a feasible technique for a secondary care centre.
Background Open repair of recurrent paediatric inguinal hernias (IH) is difficult and there is definite risk of damaging the vas deferens\\u000a and testicular vessels during dissection of the previous open herniotomy field. Laparoscopic repair (LR) has the benefit of\\u000a avoiding the previous operative site.\\u000a \\u000a \\u000a \\u000a Method Records of patients with recurrent IH that had LR after open repair were reviewed and evaluated retrospectively.
Irving Lichtenstein pioneered tension-free hernioplasty and radically changed the patient’s experience by introducing the concepts of early ambulation, short hospital stay, and local anesthesia (LA) . Open herniasurgery routinely incorporates the first three of these concepts, but data from national and regional databases show that general anesthesia (GA) is used in 60% to 70% of cases, central neuraxis blockade
PURPOSE: The outcomes of open incisional herniarepair from the patients' point of view have variations over time, and only continuous follow-up would reflect the real outcomes. The purpose of this study is to validate a standard measurement instrument in the form of a questionnaire to report the evolutionary outcomes of a specific open technique to repair incisional hernias. METHODS: Prospective study follows up a cohort of 82 consecutive patients submitted to elective intraperitoneal open hernioplasty of midline incisional hernias. The follow-up consisted in an interview and physical examination 30 days after surgery, at 6 months, 1 year, 2 years, 3 years, and 4 years. Primary outcome measure was reporting the outcomes of herniarepair according to a standardized scale obtained from a questionnaire. RESULTS: There was no correlation between complications suffered by patients and score results (p = 0.722). The length of hospital stay was 6.5 ± 4.3 days, and a prolonged hospital stay was related to complications (p = 0.002) and did not influence the score results (p = 0.365). The final score demonstrated that patients had a very good impression on this procedure 1 month after surgery (p = 0.003). This impression shifted to an excellent perception 1 year after surgery remaining similar until the last control (p < 0.0001). CONCLUSIONS: In this series, the intraperitoneal hernioplasty was a procedure associated with minor morbidity and without recurrences 4 years after the operation. The outcomes from the patients' point of view were excellent 1 year after the procedure with a tendency to improve in the long term. PMID:23292369
Beltrán, M A; Rioseco, M-P; Molina, M; Vera, A; Arcos, F R
Chronic groin pain is a common symptom experienced by soccer players, resulting in many athletes undergoing prolonged periods of conservative treatment. In a high proportion of these cases, however, the cause of groin pain is due to impalpable hernias, thus nullifying the usefulness of a conservative approach. Of the current surgical procedures for inguinal herniarepair, the Lichtenstein technique is widely used. The present study aims to evaluate the efficacy of mesh fixation with human fibrin glue (Tissucol) in open, tension-free inguinal repair, in the treatment of soccer players with groin hernia. A sutureless Lichtenstein technique was employed in 16 consecutive soccer players with primary groin hernia. Inguinal nerves were prepared and preserved. Human fibrin glue was used for mesh fixation, in place of conventional sutures. Results were rated as excellent in all cases, with no reported intra- or postoperative complications. All patients were discharged 4 - 5 h after the operation, and all returned to full pre-injury level sporting-activity, on average, 31 days (range 24 - 42 days) post surgery. This study confirms the efficacy of sutureless tension-free herniarepair with human fibrin glue for the treatment of soccer players suffering from chronic groin pain due to impalpable groin hernia. PMID:17497595
Canonico, S; Benevento, R; Della Corte, A; Fattopace, A; Canonico, R
Despite the benefits of using surgical meshes to repair abdominal and inguinal hernias, there are increasing reports of mesh migration into the gastrointestinal and urinary tracts-a complication that cannot be overlooked or neglected. Resolution of such cases can be difficult and depends on the degree of migration and the anatomical site involved. The present paper reports the case of a 68-year-old patient undergoing a trans-ureteral resection of a possible bladder malignancy diagnosed following clinical and radiological evaluation. During the procedure (cytoscopy), it was found that migration of a mesh was mimicking the urological disease initially suspected. A polypropylene mesh had been inserted into the right inguinal region 20 years previously to repair an inguinal hernia. This is one of only a few case reports on mesh migration presenting as a suspected bladder malignancy. PMID:21140183
Novaretti, J P T; Silva, R D P; Cotrim, C A C; Souto, L R M
Background: Polymer mesh has been used to repair incisional hernias with lower recurrence rates than suture repair. A new generation of mesh has been developed with reduced polypropylene mass and increased pore size. The aim of this study was to compare standard mesh with new lightweight mesh in patients undergoing incisional herniarepair. Methods: Patients were randomized to receive lightweight
J. Conze; A. N. Kingsnorth; J. B. Flament; R. Simmermacher; G. Arlt; C. Langer; E. Schippers; M. Hartley; V. Schumpelick
Inguinal herniarepair is one of the most frequently performed operations. Next to conventional techniques, open and laparoscopic\\u000a tension-free methods using mesh implants to reinforce the abdominal wall are increasingly carried out, even becoming the standard\\u000a procedure in many countries. Because of the benefits of material-reduced meshes for incisional herniarepair, a new mesh modification\\u000a for tension-free inguinal herniarepair
BACKGROUND: Several methods for using a prosthetic material to repair incisional hernias have been described, but only one previous report discussed pure intraperitoneal placement of expanded polytetrafluoroethylene (ePTFE).METHODS:Retrospective review of medical records of 84 patients in whom pure intraperitoneal placement of ePTFE was used between March 1995 and October 1997.RESULTS:No intraoperative complications occurred. Postoperatively, 2 patients required mechanical ventilation, 5
Antonio Utrera González; Fernando de la Portilla de Juan; Gonzalo Carranza Albarrán
A 53-year-old man with an Amyand hernia with indirect and direct components was repaired with a Bio-A (Gore, Newark, Delaware) plug and a patch made of Bio-A tissue reinforcement material. The repair of an Amyand hernia addresses the pathology of the appendix as well as the hernia. We report a case in which a plug and patch repair was undertaken using Bio-A implants in a clean-contaminated field with no signs of infection or recurrence in the follow-up period, and we review the literature regarding the diagnosis and repair of an Amyand hernia. PMID:21292218
Burgess, Pamela L; Brockmeyer, Joel R; Johnson, Eric K
Objective: To compare tension›free open mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic herniarepair under general anaesthetic. Design: A randomised controlled trial of 403 patients with inguinal hernias. Setting: Two acute general hospitals in London between May 1995 and December 1996. Subjects: 400 patients with a diagnosis of groin hernia, 200 in each group. Main outcome measures: Time
James Wellwood; Mark J Sculpher; David Stoker; Graham J Nicholls; Cathy Geddes; Anne Whitehead; Rameet Singh; David Spiegelhalter
The controversy over the need to explore the asymptomatic contralateral groin for the existence of a hernia sac in children who undergo inguinal herniarepair is not easy to resolve. To detect the patency of the contralateral processus vaginalis, we used intraoperative nonpuncture laparoscopy. By insufflating carbon dioxide and inserting a laparoscope through the open hernia sac, the opening of
Sciatic hernia is a surgical rarity. One such hernia was incidentally diagnosed in a 79-year-old woman who underwent Robot\\u000a assisted laparoscopic radical cystectomy for locally invasive bladder cancer. Intra-operatively, a patent hernia sac was noted\\u000a in the sciatic notch. The hernia was successfully repaired during the same operation by using robot assisted laparoscopic\\u000a technique. This appears to be the first
Iqbal Singh; Jon E. Hudson; Kyle A. Richards; Ashok K. Hemal
Background and Objectives: Materials utilized for the repair of hernias fall into 2 broad categories, synthetics and biologics. Each has its merits and drawbacks. The synthetics have a permanent, inherent strength but are associated with some incidence of chronic pain. The biologics rely on variable tissue regeneration to give strength to the repair, limiting their use to specific situations. However, thanks to their transient presence and tissue ingrowth, the biologics do not result in a significant incidence of chronic pain. We studied the use of a biomimetic (REVIVE, Biomerix Corporation, Fremont, CA) in this setting in an attempt to obviate the disadvantages of each material. Methods: Fourteen patients underwent laparoscopic repair by totally extraperitoneal and transabdominal preperitoneal techniques of 16 inguinal hernias. Follow-up was as long as 19 mo, and 8 patients were followed for > 12 mo. There were no recurrences and a 5% incidence of functionally insignificant discomfort. Results: REVIVE is shown in histology and in vivo to demonstrate regeneration and tissue ingrowth into the polycarbonate/polyuria matrix similar to that in the biologics rather than scarring or encapsulation. There were no recurrences, indicating its strength and resilience as a permanent repair similar to that in the synthetics. Conclusion: This is proof of the concept that a biomimetic may bridge the gap between the biologics and synthetics and may be able to be utilized on a regular basis with the benefits of both materials and without their drawbacks.
Laparoscopic inguinal herniarepair started over two decades ago. It has been gaining ground as a mode of treatment for inguinal hernia in children. Several surgical techniques have emerged since its inception. The aim of this article is to review the role of laparoscopy in inguinal herniarepair in children, the various emerging laparoscopic surgical techniques, and their current trend in pediatric surgical practice. In this study, extensive review and analysis of recent articles on laparoscopic inguinal herniarepair in children revealed that laparoscopy plays a great role in the treatment of inguinal hernia in children. There were several emerging laparoscopic techniques, with trends toward extracorporeal suturing and knotting technique and single-port access technique as well. The recent advance is toward the use of tissue adhesives in laparoscopic inguinal herniarepair in children.
Laparoscopic inguinal herniarepair started over two decades ago. It has been gaining ground as a mode of treatment for inguinal hernia in children. Several surgical techniques have emerged since its inception. The aim of this article is to review the role of laparoscopy in inguinal herniarepair in children, the various emerging laparoscopic surgical techniques, and their current trend in pediatric surgical practice. In this study, extensive review and analysis of recent articles on laparoscopic inguinal herniarepair in children revealed that laparoscopy plays a great role in the treatment of inguinal hernia in children. There were several emerging laparoscopic techniques, with trends toward extracorporeal suturing and knotting technique and single-port access technique as well. The recent advance is toward the use of tissue adhesives in laparoscopic inguinal herniarepair in children. PMID:23066453
A Bochdalek hernia is a rare type of diaphragmatic defect, generally presenting in early childhood with acute signs of cardiorespiratory distress. We herein report a case of acute abdomen in a pregnant patient with pain increasing when lying on her right side. Laparoscopic evaluation revealed a right-sided Bochdalek hernia with incarcerated bowel. A successful reduction was possible, and laparoscopic repair appears to be a safe and feasible technique for the repair of these hernias. PMID:23291903
ObjectivesInguinal hernias occur in 15% of men within 1 to 2 years after radical retropubic prostatectomy (RRP). This suggests that many of these hernias may have been present at surgery, but not diagnosed. Beginning in September 2001, all patients undergoing RRP were carefully examined intraoperatively for the presence of a hernia or a dilated internal inguinal ring. In this study
Background: The aim of this study was evaluate a novel technique of laparoscopic herniarepair in children. Methods: Eighty two consecutive patients aged ‡2 years old were operated on for herniarepair using a laparoscopic technique that reproduced every step of the conventional open procedure. Technical details and clinical results are reported. Results: Ninety six sacs were divided in 82
F. Becmeur; P. Philippe; A. Lemandat-Schultz; R. Moog; S. Grandadam; A. Lieber; D. Toledano
Diaphragmatic hernias can present as retrocostoxiphoid hernias (RCXH) or diaphragmatic dome hernias. The RCXH include the\\u000a Larrey hernia (LH), the Morgagni hernia (MH), and the Larrey–Morgagni hernia (LMH). These congenital hernias are usually asymptomatic,\\u000a and the diagnosis is simplified by two exams: chest X-ray, and thoraco-abdominal computed tomography (CT) scan. The potential\\u000a risk in this condition is small-bowel incarceration in
G. Dapri; J. Himpens; B. Hainaux; A. Roman; E. Stevens; E. Capelluto; O. Germay; G. B. Cadičre
Chronic Groin Pain (Inguinodynia) following inguinal herniarepair is a significant, though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal herniarepair. However, moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain, as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair, use of heavyweight vs lightweight mesh and mesh fixation with sutures vs glue. Though there is no convincing evidence favouring one over the other, lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain, though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both non-surgical and surgical options have been tried for chronic groin pain, with their consequent risks of analgesic side-effects, recurrent pain, recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre- and post-herniorraphy.
For years, surgical dictum has posited that permanent synthetic mesh is contraindicated in the repair of a hernia in a contaminated field. Numerous investigators, however, have demonstrated the acceptably low morbidity associated with the use of heavy-weight polypropylene mesh in clean-contaminated and contaminated fields. Recently, experience utilizing more modern, light-weight polypropylene mesh constructs in contaminated fields has grown considerably. The time has come to critically reevaluate the unfounded fear of utilizing permanent synthetic mesh in contaminated fields, as we will review the data speaking to the safety of mesh in these contaminated fields. PMID:24035085
Purpose To evaluate two bioprostheses derived from bovine pericardium, one cross-linked (Peri-Guard®) and the other non-cross-linked\\u000a (Veritas®), and to compare them with Alloderm® and Permacol® for abdominal wall repair.\\u000a \\u000a \\u000a \\u000a Methods The four prostheses were tested in acute and chronic hernia models. Prostheses were either sutured to the edge of the abdominal\\u000a wall defect (inlay) or secured as an underlay with surgical tacks.
Wolfgang B. Gaertner; Margaret E. Bonsack; John P. Delaney
The Platypnea-Orthodeoxia syndrome is characterised by dyspnoea and deoxygenation accompanying a change from the recumbent to the upright position. An 81-year-old woman had an elective paraesophageal herniarepair. She developed dyspnoea and hypoxemia post-operatively that was worse when upright. An agitated saline echocardiogram revealed a right-to-left shunt through a patent foramen ovale that increased when the patient was upright. Over 3 weeks the patients' shunt, dyspnoea and hypoxemia improved and she was discharged home. PMID:23355569
Background. Laparoscopic herniarepair in infancy and childhood is still debatable. The objective of this study is to compare laparoscopic assisted herniarepair versus open herniotomy as regards operative time, hospital stay, postoperative hydrocele formation, recurrence rate, iatrogenic ascent of the testis, testicular atrophy, and cosmetic results. Patients and Methods. Two hundred and fifty patients with inguinal hernia were randomized into two equal groups. Group A was subjected to laparoscopic inguinal herniarepair. Group B was subjected to open herniotomy. The demographic data were matched between both groups. Assessment of the testicular volume and duplex assessment in preoperative, early, and late postoperative periods were done. Results. All cases were completed successfully without conversion. The mean operative time for group A was 7.6 ± 3.5 minutes, 9.2 ± 4.6 minutes and 11.4 ± 2.7 minutes, for unilateral hernia, unilateral hernia in obese child, and bilateral hernia, respectively. The recurrence rate was 0.8% in group A, whereas in group B the recurrence rate was 2.4%. Conclusion. Laparoscopic herniarepair by RN is an effective line of herniarepair. It resulted in marked reduction of operative time, low rate of recurrence, no testicular atrophy, no iatrogenic ascent of the testis, and excellent cosmetic results. PMID:23326656
Introduction: Bowel injury during laparoscopic surgery is a rare but serious complication. A Bovie injury to the bowel can cause delayed perforation of the viscus, thus increasing the possibility of a preventable morbidity. Patients presenting with perforation peritonitis within 24 hours and up to 2 to 3 weeks after laparoscopic Bovie injury to the bowel have been reported in the literature. Case Description: A 74-year-old woman underwent a laparoscopic ventral hernia mesh repair. Intraoperatively, a small area of superficial Bovie injury to the small bowel was repaired with Lembert sutures and tissue glue. Postoperatively, the patient recovered well, but she presented with perforation peritonitis 3 months after surgery. An exploratory laparotomy showed a jejunal perforation in the same area that was injured with cautery and repaired during the previous surgery. The patient was only using inhaled steroids for asthma on and off but had a remote history of chemotherapy and radiation for colorectal cancer. Conclusion: Bovie injury to the bowel has a hidden depth, causing a slow transmural tissue necrosis, and it might also impair local healing and eventually lead to perforation. Thus, the patient may present later than the usual period for wound healing and remodeling as previously reported. Given the disastrous consequence, it is imperative to perform a good surgical repair of even a minor Bovie injury to the bowel. This is the first report of a delayed presentation (>1 month) of a Bovie injury of the bowel.
Gayagoy, Jennifer; Chaudhary, Sushant; Kolachalam, Ramachandra B.
INTRODUCTION Diaphragmatic hernia complicating pregnancy rarely occurs while it is frequently misdiagnosed. PRESENTATION OF CASE A pregnant woman who had suffered from recurrent right upper-quadrant abdominal pain for 4 months was hospitalized near full term because the unrelieved abdominal pain was so severe that she couldn’t lie down. Following the emergency caesarean, we found a part of the transverse colon and a part of omentum were trapped in the thorax through a 3 cm by 3 cm laceration in the patient's diaphragm. We removed all trapped intestine which was about 40 cm long and repaired diaphragmatic hernia at the same time. DISCUSSION Radiography is useful to diagonisis diaphragmatic hernia, but it had little use for pregnant women. An irreducible diaphragmatic hernia represent a surgical emergency irrespective of fetal maturity. In our case, she had her herniarepaired just during caesarean section by laparotomy. CONCLUSION Careful examination and a timely operation are needed to treat diaphragmatic hernia complicating pregnancy.
During laparoscopic ventral herniarepair (LVHR), it is not always possible to reduce incarcerated omentum through a tight\\u000a defect and it may tear or require transection within the abdomen. This leaves an ischemic mass of tissue within the hernia\\u000a sac which can cause pain, infection, or the appearance of hernia recurrence postoperatively. We describe a technique which\\u000a allows extraction of
Kyle A. Perry; Keith W. Millikan; Wendy W. Huang; Jonathan A. Myers
Background Long-term results after laparoscopic repair of large incisional hernias remain to be determined. The aim of this prospective\\u000a study was to compare early and late complications between laparoscopic repair and open repair in patients with large incisional\\u000a hernias.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Only patients with a hernia diameter of ?5 cm were included in this study and were prospectively followed. We compared 56\\u000a patients who
Anita Kurmann; Eva Visth; Daniel Candinas; Guido Beldi
Congenital diaphragmatic hernia (CDH) continues to account for significant mortality in neonates. Advances in postnatal therapies have reduced mortality rates in the less severely affected infants, though surviving infants continue to display significant comorbid conditions. The history of fetal treatment for CDH is a microcosm for the development of fetal therapy in general. This paper traces this history from early clinical observations and imaging advances to experimental animal studies and finally to safe human application and development of clinical trails. Encouraging recent results and improved outcomes lend credence to the idea than prenatal interventions may give clinicians and families more hope. PMID:16509904
Bochdalek hernia is a congenital defect of the diaphragm that usually presents in the neonatal period with life-threatening cardiorespiratory distress. It is rare for Bochdalek hernias to remain silent until adulthood. A 57-year-old woman presented with history of difficulty in swallowing, as well as retching. There was no history of abdominal or thoracic trauma. A chest x-ray showed the herniated stomach clearly. Computed tomography (CT) of the abdomen showed a herniated volvulus of the stomach, along with left posterolateral diaphragmatic hernia. The defect was repaired by a single incision laparoscopic technique. We present the first case of a posterolateral diaphragmatic herniarepaired by a reduced port laparoscopic technique in an adult, after an extensive literature search yielded no precedents. This report validates the feasibility of reduced port laparoscopic repair of Bochdalek hernia in an adult, and should be within the remit of the advanced laparoscopic surgeon.
PURPOSES: Single-incision laparoscopic surgery improves the cosmetic outcome after surgery. We herein report six cases of successful single-incision laparoscopic (SILS) herniorrhaphy. METHODS: Six patients, five with unilateral inguinal hernias and one with bilateral inguinal hernias, underwent SILS herniorrhaphy. A Covidien SILS port was inserted via an umbilical incision, through which three trocars of 5, 5 and 12 mm (or 5 mm) were inserted. The peritoneum was then opened with flexible scissors and electrocoagulation, after which, the preperitoneal space was dissected. A mesh was then fixed, and the peritoneum was finally closed using Covidien SILS Stitch or AbsorbaTack. RESULTS: The mean length of the operation for the unilateral cases was 136 min. The increased time was due to difficulties unrelated to this methodology. However, the length of the operation in the bilateral case was 94 min. All patients were discharged without complications. CONCLUSIONS: SILS herniorrhaphy requires experience and more time than conventional three-port herniorrhaphy. However, if the length of the operation can be shortened, then this novel surgical technique is considered to be feasible and it is expected to improve the cosmetic outcome without any additional risk. PMID:23408084
Objective To compare patient outcome following repair of a primary groin hernia under local (LA) or general anesthesia (GA) in a randomized clinical trial. Summary Background Data LA herniarepair is thought to be safer for patients, causes less postoperative pain, cost less, and is associated with a more rapid recovery when compared with the same operation performed under GA. Methods All patients presenting to three surgeons during the study period with a primary groin hernia were considered eligible. Outcome parameters measured including tests of vigilance, divided attention, sustained attention, memory, cognitive function, pain, return to normal activity, and costs. Results Two hundred seventy-nine patients were randomized to LA or GA herniarepair; 276 of these had an operation, with 138 participants in each group. At 6, 24, and 72 hours postoperatively there were no differences in vigilance or divided attention between the groups. Similarly, memory, sustained attention, and cognitive function were not impaired in either group. Although physical activity was significantly impaired at 24 hours, this and return to usual social activities were similar in both groups. While patients in the LA group had significantly less pain on moving, at 6 hours they were less likely to recommend the same operation to someone else. GA herniarepair cost 4% more than the same operation under LA. Conclusions There are no major differences in patient recovery after LA or GA herniarepair. Patients should be offered a choice of anesthesia, LA or GA, for repair of their groin hernia.
O'Dwyer, Patrick J.; Serpell, Michael G.; Millar, Keith; Paterson, Caron; Young, David; Hair, Alan; Courtney, Carol-Ann; Horgan, Paul; Kumar, Sudhir; Walker, Andrew; Ford, Ian
Pseudoaneurysm of the inferior epigastric artery (IEA) is a recognized complication of surgery; however, it is a very rare clinical occurrence. The anatomic position of the IEA subjects patients to possible IEA injury during abdominal wall procedures that are close to the artery, such as insertions of drains, Tenckhoff catheters, laparoscopic trocars, or paracentesis. Treatment options include open surgery, percutaneous coil embolization, embolization with N-butyl cyanoacrylate, sonographic-guided thrombin injection, or sonographic-guided compression. We report the first case of a pseudoaneurysm arising from the IEA after a laparoscopic ventral herniarepair. To our knowledge, 17 IEA pseudoaneurysms have been reported, only 3 of which were spontaneous. The pseudoaneurysm in our patient was successfully treated by percutaneous injection of thrombin by interventional radiology. PMID:22318072
Nichols-Totten, Kysha; Pollema, Travis; Moncure, Michael
The basic cause of paracolostomy hernia is enlargement of the trephine opening in the abdominal wall, due to tangential forces working on the circumference of the opening. Our attempts of herniarepair with polypropylene mesh were not successful, as the diameter of the hole in the mesh tended to enlarge with time. For this reason we developed a new device,
Background Today, the laparoscopic approach is a stan- dard procedure for the repair of incisional hernias. How- ever, the direct contact of visceral organs with mesh material is a major issue. Patients and methods This prospective observational study presents the data of 344 patients treated for incisional and parastomal hernias with a new mesh made of polyvi- nylidene Xuoride (PVDF;
. A 44-year-old woman undergoing abdominoplasty, laparoscopic cholecystectomy, and incisional herniarepair is presented. Abdominal wall lipodystrophy and incisional hernia, both pathologies leading to esthetic deformity, and cholelithiasis causing biliary symptoms were treated at the same operation without any complications. Combining two or multiple abdominal procedures may reduce the potential risks of multiple anesthesia for each procedure, shorten total hospital
Background: This study presents a novel technique for laparoscopic ventral herniarepair using the da Vinci Robot and intracorporeal suturing. Thus, it offers an alternative to transabdominal sutures and tackers. Methods: A ventral hernia model was created in six pigs. The mesh was fixed to the circumference of the fascia using interrupted sutures. The outer border of the mesh was
S. Schluender; J. Conrad; C. M. Divino; B. Gurland
Male veterans with unilateral primary inguinal hernia, classified intraoperatively as Gilbert Type III or IV, were randomized to subaponeurotic (Lichtenstein, n=126) or preperitoneal (Read-Rives, n=121) repair under general or spinal anesthesia. The two groups of patients were comparable in age, body weight index, comorbidities, and size and type of hernia. Of the 247 patients enrolled, 224 were followed for at
R. L. Muldoon; K. Marchant; D. D. Johnson; G. G. Yoder; R. C. Read; M. Hauer-Jensen
Chronic infection of a prosthetic mesh implant is a severe complication of ventral herniarepair, and mesh explantation is\\u000a usually required in these cases. Biologic mesh implants have a possible role in ventral herniarepair in this setting. Here\\u000a we present a case of chronic mesh infection following ventral herniarepair and the use of a biologic mesh to repair
T. M. Saettele; S. L. Bachman; C. R. Costello; S. A. Grant; D. S. Cleveland; T. S. Loy; D. G. Kolder; B. J. Ramshaw
Since 1993 laparoscopy has become a popular technique of repair of ventral hernias. The authors review the long-term results\\u000a of a systematic laparoscopic repair of ventral hernias and discuss the current problems compared to open repair. Between 1997\\u000a and 2003, 146 patients had a laparoscopic ventral herniarepair using an intraperitoneal Goretex Dualmesh with a 3–5-cm mesh\\u000a overlap secured with
Ph. Topart; L. Ferrand; F. Vandenbroucke; P. Lozac’h
Background Mesh repair of incisional hernia is superior to the conventional technique. From all available materials for open surgery polypropylene (PP) is the most widely used. Development resulted in meshes with larger pore size, decreased mesh surface and lower weight. The aim of this retrospective non randomized study was to compare the quality of life in the long term follow up (> 72 month) after incisional herniarepair with "light weight"(LW) and "heavy weight"(HW) PP meshes. Methods 12 patients who underwent midline open incisional herniarepair with a HW-PP mesh (Prolene® 109 g/m2 pore size 1.6 mm) between January 1996 and December 1997 were compared with 12 consecutive patients who underwent the same procedure with a LW-PP mesh (Vypro® 54 g/m2, pore size 4-5 mm) from January 1998. The standard technique was the sublay mesh-plasty with the retromuscular positioning of the mesh. The two groups were equal in BMI, age, gender and hernia size. Patients were routinely seen back in the clinic. Results In the long term run (mean follow up 112 ± 22 months) patients of the HW mesh group revealed no significant difference in the SF-36 Health Survey domains compared to the LW group (mean follow up 75 ± 16 months). Conclusions In this study the health related quality of life based on the SF 36 survey after open incisional herniarepair with light or heavy weight meshes is not related to the mesh type in the long term follow up.
Morgagni hernias are anomalies of the sternal insertions of the diaphragmatic bundles and represent 1% to 4% of all surgically treated diaphragmatic hernias. We present a case of a laparoscopic repair of Morgagni hernia incidentally found in a 4-year-old boy. Primary laparoscopic closure of the defect with interrupted silk sutures was performed. The patient had uneventful recovery and is asymptomatic at 2 months of follow-up. We propose that the laparoscopic approach is feasible and effective treatment of this kind of hernia. PMID:12709618
We evaluate the factors that affect morbidity and mortality in patients who underwent surgery due to femoral hernia. The medical\\u000a records of 83 patients who underwent femoral herniarepair between January 1996 and June 2004 were retrospectively analyzed.\\u000a The femoral hernias were repaired either with McVay or mesh plug hernioplasty. Sex, age, surgical repair technique, presence\\u000a of incarceration\\/strangulation, incarcerated\\/strangulated organs,
O. Alimoglu; B. Kaya; I. Okan; F. Dasiran; D. Guzey; G. Bas; M. Sahin
Background Reconstruction of giant midline abdominal wall hernias is difficult, and no data are available to decide which technique should be used. It was the aim of this study to compare the “components separation technique” (CST) versus prosthetic repair with e-PTFE patch (PR). Method Patients with giant midline abdominal wall hernias were randomized for CST or PR. Patients underwent operation following standard procedures. Postoperative morbidity was scored on a standard form, and patients were followed for 36 months after operation for recurrent hernia. Results Between November 1999 and June 2001, 39 patients were randomized for the study, 19 for CST and 18 for PR. Two patients were excluded perioperatively because of gross contamination of the operative field. No differences were found between the groups at baseline with respect to demographic details, co-morbidity, and size of the defect. There was no in-hospital mortality. Wound complications were found in 10 of 19 patients after CST and 13 of 18 patients after PR. Seroma was found more frequently after PR. In 7 of 18 patients after PR, the prosthesis had to be removed as a consequence of early or late infection. Reherniation occurred in 10 patients after CST and in 4 patients after PR. Conclusions Repair of abdominal wall hernias with the component separation technique compares favorably with prosthetic repair. Although the reherniation rate after CST is relatively high, the consequences of wound healing disturbances in the presence of e-PTFE patch are far-reaching, often resulting in loss of the prosthesis.
van Goor, H.; Charbon, J. A.; Rosman, C.; Hesselink, E. J.; van der Wilt, G. J.; Bleichrodt, R. P.
Objective To determine whether any common maternal-fetal variable has prenatal predictive value of prosthetic repair in congenital diaphragmatic hernia. Methods This was a 5-year single-center retrospective review of fetal congenital diaphragmatic hernia referrals. Multiple prenatal variables were correlated with the need for a prosthetic repair. Statistical analyses were by Fisher's exact and Mann-Whitney U-tests, as appropriate (p < 0.05). Results Fetal liver position was a predictor of prosthetic repair. The presence or absence of liver herniation was correlated with prosthetic repair rates of 83.3 and 23.1%, respectively (p < 0.001). All patients with moderate/severe liver herniation required a prosthetic patch. Conclusion Liver herniation has prenatal predictive value for the need for prosthetic repair in congenital diaphragmatic hernia. This finding should be valuable during prenatal counseling for clinical trials of engineered diaphragmatic repair.
Kunisaki, Shaun M.; Barnewolt, Carol E.; Estroff, Judy A.; Nemes, Luanne P.; Jennings, Russell W.; Wilson, Jay M.; Fauza, Dario O.
A 14-year-old boy was seen at an outside hospital after falling over the handlebar of his bicycle and was discharged home. He was subsequently seen in our emergency department with complaints of persistent abdominal pain. A computed tomography scan of the abdomen revealed disruption of the muscles of the upper right abdominal wall containing the hepatic flexure of the colon, with a small amount of intraperitoneal free fluid noted. The patient underwent laparoscopic exploration using 3 ports (2-5 mm and 1-12 mm) and 2 separate stab incisions. The traumatic abdominal wall hernia was repaired with interrupted sutures placed with an ENDO CLOSE (Covidien, Mansfield, MA) device, and a mesenteric defect in the colon was approximated with intracorporeal sutures. The trocar sites were sutured closed. The patient recovered well and was discharged home. Follow-up examination revealed no abdominal wall defect and resolution of his symptoms. Laparoscopic repair of a traumatic abdominal wall defect and exploratory laparoscopy after trauma is feasible and safe in the pediatric patient. It should be considered as an alternative approach with potentially less morbidity than an exploratory laparotomy for handlebar injuries in a stable patient. PMID:21616228
Background Trans-abdominal laparoscopic inguinal herniarepair allows rapid assessment and exploration of the contralateral groin and\\u000a repair of an occult hernia. Although previous studies have shown that the totally extra-peritoneal (TEP) herniarepair can\\u000a be used to assess the contralateral groin, there is little data pertaining to the trans-abdominal pre-peritoneal (TAPP) approach.\\u000a The aim of this study was to document the
K. J. Griffin; S. Harris; T. Y. Tang; N. Skelton; J. B. Reed; A. M. Harris
Major malformations, surgery and persistent pulmonary hypertension (PHT) have been considered contraindications to therapeutic hypothermia (TH) in newborns with hypoxic-ischemic encephalopathy (HIE). We report two patients with undiagnosed congenital diaphragmatic hernia (CDH) who developed HIE after birth. Diagnosis of moderate HIE was formulated based on clinical, laboratory and electroencephalographic criteria. The patients were treated with whole body hypothermia (33.5?°C) for 72?h. During hypothermia the patients underwent surgical repair with regular perioperative course. Ventilatory support with high-frequency oscillatory ventilation, oxygen requirements and inotropic support remained stable during hypothermia. Serial echocardiographic evaluations did not demonstrate any change in pulmonary pressure values. In our experience TH did not increase the risk of hemodynamic instability, PHT or bleeding. Hypothermia may be considered in patients with HIE and CDH or other surgical conditions with favorable prognosis. PMID:23190939
Inguinal herniarepair is one of the most frequently performed surgical procedures in infants and young children. This prospective comparative study was conducted with initial experience in the department of pediatric surgery, Dhaka Shishu (children) hospital during the period of July 2007 to August 2008. We enrolled 62 children undergoing surgery for inguinal hernia, of which 30 underwent laparoscopic procedure (bilateral in 21, unilateral 9) and 32 open procedures (bilateral in 5, unilateral in 27). Mean±SD patient age was 5.92±2.11 months in laparoscopic group and 6.63±2.64 months in open group (p=0.264), 3 months to 5 years in both groups. Patients were studied under variables of operative time, duration of postoperative hospital stay & post operative complications. During laparoscopy a contralateral patent processus vaginalis of ?2cm was noted and repaired peroperatively in 18 out of 27 children (66%), who were initially diagnosed as unilateral hernia. For unilateral repair mean±SD operative time was significantly longer in Group A (62.63±52.75) minutes compares to the Group B (29.37±9.40), p<0.001. On the contrary, for bilateral repair Mean±SD operative time was comparable between the two groups (64.65±49.70) minutes for laparoscopy & (35.65±11.53 minutes) for open herniotomy & P=0.01, that was not remarkably significant. The mean±SD post operative length of hospital stay (in hours) 36.00±32.7 hours in Group A compared to 29.97±11.82 hours in Group B which was not statically significant (p=0.342). The mean±SD follow up was 24.5±10.5 months in laparoscopic group (Group A) & 22.5±10.5 months in open group (Group B), p=0.251. Regarding post operative complication, in this study, contra lateral metachronous inguinal hernia (CMIH) manifested in none of the patient out of 27 (total unilateral repaired number) patients in laparoscopic group but contrary to this in open group 2 patients out of 27 had developed CMIH & p value was <0.05, which is statistically significant. There were 2 cases of scrotal hydrocele out of 30, observed in Group A whereas 1 case out of 32 in Group B, p=0.49, which was statistically insignificant. The scrotal hydrocele was lasted only for 2 days & resolved spontaneously. About recurrence after operation, our study noted that, 1 case (3.3%) out of 30 in laparoscopic group and 2 cases (6%) out of 32 in open surgery group had developed recurrent inguinal hernia in about one year follow up where p value was 0.459, & it was statistically insignificant. In this study, none of the patient had developed post operative testicular atrophy (due to any vas or vascular injury) or testicular ascend. So, overall this study result implies that, Laparoscopic herniotomy might be a safe and effective option as open herniotomy for the treatment of inguinal hernia in children but which one would be superior or best option it requires a large series of randomized trial. PMID:23715341
The authors report a rare case of 17-year-old lady with late presentation of congenital diaphragmatic hernia. She presented with vague abdominal pain and was thought to have urinary tract infection, ruptured ovarian cyst, and appendicitis by different medical teams in the first few days. She eventually underwent a diagnostic laparoscopy with no significant findings. In the early postoperative recovery period, she suffered from severe cardiorespiratory distress and a large intestinal left diaphragmatic hernia was diagnosed subsequently. At further operation a strangulated loop of large bowel herniating through a left antero-lateral congenital diaphragmatic hernia was discovered, which was reduced and repaired with a prolene mesh through thoracotomy. She made an excellent recovery and was discharged a few days after the operation. The authors postulate a mechanism of positive pressure from laparoscopic surgery causing herniation of large bowel through a pre-existing diaphragmatic defect. This case highlights the diagnostic challenge of this disease due to its diverse clinical presentation, the importance of prompt diagnosis and intervention.
Morgagni hernia represents a rare type of diaphragmatic hernia which usually occurs on the right side, in the anterior mediastinum.\\u000a Predisposing factors of Morgagni hernia include pregnancy, obesity or other causes of increased intraabdominal pressure, and\\u000a a history of trauma. Most of adults diagnosed with a foramen of Morgagni are asymptomatic. We report a case of an overweight\\u000a 23-year-old asymptomatic
Ventral herniarepair is frequently performed with one of a number of mesh products, usually with good results. The current emphasis on laparoscopic repair has resulted in multiple composite mesh products for use in the peritoneal cavity. The addition of a second layer of more inert material to the mesh is intended to prevent adhesions with the underlying viscera, and multiple studies demonstrate effectiveness in doing this. Despite this, occasional complications may still present. We present the case of a 65-year-old man coming to our clinic 5 years after a third ventral herniarepair/revision with composite mesh. PMID:20058043
Prosthetic repair of inguinal hernias has low recurrence and infection rates in practice. However, surgical site infection is still a potential complication. A limited number of cases have been reported to date describing late-onset deep mesh infection following prosthetic repairs. We herein report a new case of postherniorrhaphy infection with a very late onset. PMID:20941982
Although the clinical picture of discogenic sciatica is well known already in the ancient world, it is not until 1933 that WJ Mixter and JS Barr provide the correct pathogenetic interpretation and suggest surgery as the treatment of choice. The work of the American Authors was however based on the knowledge acquired during the previous centuries starting with Domenico Cotugno, who first suggested the neurogenic nature of sciatica (1764) and later with the neurologists of the french school Valleix, Lasčgue, Dejerine, Sicard who elucidated the semeiology and debated in detail the etiopathogenesis of the condition. The german pathologists Schmorl and Andrae (1927-29) are to be credited for their contribution to the pathology of intervertebral disc, recognizing the frequency and degenerative (not neoplastic) nature of nucleus pulposus herniation. Surgery of disc herniation starts with Oppenheim and Krause (1909). Mixter and Barr used laminectomy and a transdural route although a more limited approach to the spinal canal had already been proposed by the italian Bonomo (1902), unknown to many. Love, of the Mayo Clinic (1937-39) introduced the extradural/interlaminar approach while Caspar and Yasargil (1977) applied the concepts of microsurgery to the procedure. The latest advances are represented by percutaneous and endoscopic techniques. PMID:9835099
Background Complicated hernias often involve contaminating surgical procedures in which the use of polypropylene meshes can be hazardous.\\u000a Prostheses made of porcine dermal collagen (PDC) have recently been proposed as a means to offset the disadvantages of polypropylene\\u000a meshes and have since been used in humans for herniarepairs. The aim of our study was to evaluate the safety and efficacy
F. Catena; L. Ansaloni; F. Gazzotti; S. Gagliardi; S. Di Saverio; L. D’Alessandro; A. D. Pinna
The bladder is involved in 1% to 3% of all hernia cases. We report a case of a large paraperitoneal bladder hernia (BH) in a 59-year-old man who had a palpable scrotal mass. Several techniques and approaches have been described for managing BHs. We performed a laparoscopic partial cystectomy and herniorrhaphy. This is the first case report on the repair of a large BH by use of a laparoscopic technique in Korea.
Lee, Jong Yeon; Chang, In Ho; Choe, Jung Won; Park, Sang Ho; Ryu, Jae Hyung; Lee, Dong Min; Ryu, Young Woo; Lim, Song Won
The aponeurotic inguinal herniarepair is essentially a union of the aponeuroses of the external oblique and transversus abdominis muscles in the groin. Its tension-free status and resistance to intra-abdominal stress were measured in a biomechanical study. Comparative studies were made with the American Bassini procedure. Suture tensions were measured at three sites in six aponeurotic repairs and the mean tension was 3.9 +/- 2.9 grams, which was within the accuracy of the combined transducer and recorder measurement. Similar measurements in six American Bassini operations registered 633 +/- 230 grams mean tension. A relaxing incision in the Bassini repair reduced but did not eliminate tension. Mean tension figures remained at 401 +/- 198 grams. Specimens of external oblique aponeuroses in six random patients were tested, counter to their parallel fibers, in a tensiometer. The thickness of the specimens varied from 0.21 to 1.2 millimeters. The tissue mean stress capacity under tension was 4.1 +/- 1.9 x 10(6) pascals with a range of 2.5 to 6.5 x 10(6) pascals. An analysis was made of the impact of intra-abdominal pressure at five possible sites of failure in the aponeurotic repair. Established values of suture bite tissue tear resistance and our values of external oblique aponeurosis stress tension were used to calculate the resistance of the aponeurotic repair to established values of intra-abdominal pressure. The maximum reported intra-abdominal pressure is 26.6 kilopascals. In this series, the largest reconstructed inguinal floor was 5 square centimeters and supported a load of 1,360 grams force. There was a safety margin of 2.4 against a failure of tissue of minimal thickness (0.2 millimeter) in the aponeurotic repairs when subjected to maximum intra-abdominal pressure. With average thickness of specimen (0.45 millimeter) there was a safety margin of 5.4. The 2-0 polypropylene suture had a requirement of 1,590 grams force maximum knot pull strength, which was much greater than our measured tensions. The added suture-line tension created by the assumed intra-abdominal pressure with sutures spaced one-half centimeter apart was calculated to be 65 grams force. This figure is well below the reported tensions of 5,300 and 9,100 grams force resisting tissue pull through failure in the external oblique and transversus aponeurosis, respectively. The transversalis aponeurosis component of the repair had shown in the proceeding study a tensile strength greater than the external oblique aponeurosis, and by analogy, a competence to resist intra-abdominal pressure.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8193752
Patch closure is necessary to achieve tension-free repair in large congenital diaphragmatic hernia. However, the use of prosthetic\\u000a material may lead to granulation, allergic reaction, infection, recurrence of hernia, and thoracic deformity. Tissue engineering\\u000a may become an alternative treatment strategy for diaphragmatic herniarepair, since the regenerated autologous tissue is expected\\u000a to grow potentially without rejection or infection. We evaluated
Background and Objectives: Laparoscopic treatment of incisional hernias reduces surgical traumas and postoperative pain. It requires intraperitoneal placement of a foreign body that might cause adhesions, leading to postoperative complications. The aim of this study was to improve reliability of ultrasound in quantitatively estimating adhesions to exploit the other advantages of ultrasound, such as availability and versatility. Methods: The ultrasound examination was performed by using a hand-held 3.5MHz curved linear probe. The image data were analyzed prior to scan conversion. Two square regions of interest were defined, one in the abdominal wall and one in the underlying bowels. A cross correlation-based algorithm tracked each region by using a time span of 3 frames. Subtracting the 2 displacement functions from each other yielded a relative displacement function, indicating the degree of bowel adhesions. This was compared with the intraoperative findings. Results and Conclusions: The method was proven to be a rapid and robust method for quantitatively estimating the degree of bowel adhesions. It is limited to evaluation of adhesions between bowel and abdominal wall. However, this ultrasound technique could assist in the safe placement of ports prior to redo laparoscopic surgery.
Background: Minimally invasive (MI) congenital diaphragmatic hernia (CDH) repair can be challenging. Placing rib anchoring stitches without creating skin incisions and closing wider defects are some of the difficulties. In Bochdaleck’ herniarepair maintaining visceral reduction and minimizing pneumothorax use are additional obstacles. We describe the use of hollow-needle snares (HNS) and transthoracic traction stitches (TTS) to overcome these challenges.Methods:
PURPOSE: In endoscopic inguinal herniarepair, the use of fibrin glues for mesh fixation instead of staples and sutures can demonstrably reduce postoperative morbidity without increasing the recurrence rate. Various fibrin glues differ in terms of their mesh fixation strength. As an alternative to fibrin glue, there is an increasing trend toward using synthetic glues for mesh fixation in both open and endoscopic inguinal herniasurgery. To date, no studies have been conducted comparing the fixation strength of (semi-) synthetic glues with that of fibrin glues. Here, using a biomechanical model, we compared the adhesive strength of two glues (BioGlue and Glubran) used in surgery with a fibrin glue. METHODS: We used light-weight polypropylene meshes (TiMesh light). In each case, the biomechanical stability of five meshes in each group was tested with 2 ml fibrin glue (Evicel), 2 ml BioGlue or 2 ml Glubran (cyanoacrylate). The defect in the muscle tissue used was 4.5 cm in diameter for a mesh size of 10 × 15 cm. Measurements were taken using a standardized stamp penetration test while aiming not to remain under a minimum fixation strength of 32 N. RESULTS: Using Evicel for mesh fixation, an adhesive strength of 64.3 N was achieved. This was significantly greater than that obtained in the absence of fixation (2.9 N, p < 0.001) and higher than the requisite value of 32 N. Using Glubran, it was possible once again to significantly improve the adhesive strength (105.4 N, p = 0.008). The use of BioGlue improved the adhesive strength to 131.7 N, but not significantly so compared with Glubran (p = 0.110). CONCLUSIONS: In terms of adhesive strength, (semi-) synthetic glues can be used for mesh fixation instead of fibrin glue and even achieve significantly better adhesive strength than fibrin glue. However, further clinical studies are needed to identify the role of (semi-) synthetic glues compared with fibrin glues in endoscopic inguinal herniasurgery. PMID:23064973
Schug-Pass, C; Jacob, D A; Rittinghausen, J; Lippert, H; Köckerling, F
New surgical procedures in the aftermath of their benefits beget new complications as well. Laparoscopic repair of inguinal hernia is widely practised now. It involves reinforcement of hernial defect with a synthetic mesh. We report a rare case of migration of mesh into urinary bladder following this mode of hernial repair. We also present a review of literature involving migration of mesh following all inguinal hernial repairs. PMID:16258705
Background Salvaging infected prosthetic material after ventral herniarepair is rarely successful. Most cases require mesh excision\\u000a and complex abdominal wall reconstruction, with variable success rates. We report two cases of mesh salvage with a novel use\\u000a of percutaneous drainage and antibiotic irrigation.\\u000a \\u000a \\u000a \\u000a Cases Two patients developed infected seromas after laparoscopic ventral herniarepair. One patient with a remote history of methicillin-resistant
J. A. Trunzo; J. L. Ponsky; J. Jin; C. P. Williams; M. J. Rosen
Background Biologic grafts used in ventral herniarepair are derived from various sources and undergo different post-tissue-harvesting\\u000a processing, handling, and sterilization techniques. It is unclear how these various characteristics impact graft response\\u000a in the setting of contamination. We evaluated four materials in an infected herniarepair animal model using fluorescence\\u000a imaging and quantitative culture studies.\\u000a \\u000a \\u000a \\u000a \\u000a Methods One hundred seven rats underwent creation
K. C. Harth; A.-M. Broome; M. R. Jacobs; J. A. Blatnik; F. Zeinali; S. Bajaksouzian; M. J. Rosen
. This subject has been well covered in recent years. Yet it seems appropriate to search for major advances in hernia methodology\\u000a during the last 100 years. Eduardo Bassini is credited with pioneering the modern era. His \\
Background\\/PurposeThere are numerous techniques of minimally invasive surgery for pediatric inguinal hernia. However, laparoscopic percutaneous extraperitoneal closure (LPEC) is one of the most simple and reliable methods. Single-incision laparoscopic surgery has recently been developed to reduce the invasiveness of traditional laparoscopy. This study aimed to assess the safety and feasibility of the single-incision approach for LPEC.
Female pelvic organ prolapse refers to the descent of the pelvic organs towards or through the vagina. The similarities between vaginal prolapse and herniae in their aetiology and treatment make this an interesting area for all those operating in the pelvis. It is a common condition with prevalence estimates varying from 2% for symptomatic prolapse to 50% for asymptomatic prolapse [Samuelsson EC, Arne Victor FT, Tibblin G, Svardsudd KF. Signs of genital prolapse in a Swedish population 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 1999;180:299-305]. Approximately 50% of parous women will have some degree and only 10-20% of these seek medical help [Beck RP. Pelvic relaxation prolapse. In: Kase NG, Weingold AB, editors. Principles and practice of clinical gynecology. New York: John Wiley; 1983. p. 677-85]. The lifetime risk for surgery for prolapse has been estimated to be around 11.1%, and 30% will undergo re-operation for recurrent prolapse [Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapsed and urinary incontinence. Obstet Gynecol 1997;89:501-6]. The aetiology of prolapse is multifactorial. Advancing age, parity and collagen weakness are all quoted as significant predisposing factors [Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapsed and urinary incontinence. Obstet Gynecol 1997;89:501-6; Maclennan AH, Taylor AW, Wilson, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. Br J Obstet Gynaecol 2000;107:1460-70]. Pathophysiological mechanisms that have been proposed include pelvic floor denervation, direct trauma to the pelvic floor musculature, abnormal synthesis and degradation of collagen and defects in endopelvic fascia [Al-Rawi ZS, Al-Rawi ZT. Joint hypermobility in women with genital prolapse. Lancet 1982;I:439-41; Gilpin SA, Gosling JA. Smith ARB, Warrell DW. The pathogenesis of genitourinary prolapse and stress incontinence in women. A histological and histochemical study. Br J Obstet Gynaecol 1989;96:15-23; Smith ARB, Hosker GL, Warrell DW. The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study. Br J Obstet Gynaecol 1989;96:24-8; Allen RE, Hosker GL, Smith ARB, Warrell DW. Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol 1990;97:770-9]. The procedure of choice for reconstructive surgery to the vagina should be tailored to the individual patient and be of low morbidity and mortality, but at the same time with long-term durability. PMID:17462358
Background The treatment of ventral hernias is still a subject of debate. The affixing of a prosthesis and the subsequent introduction of laparoscopic treatment have reduced complications and recurrences. The high incidence of seromas and high costs remain open problems. Methods At our Department between January 2008 and December 2011, 87 patients (43 over 65 years), out of a total of 132, with defects of wall whose major axis was less than 10 cm, or minor and multiple defects (Swiss-cheese defect) on an axis not exceeding 12 cm underwent laparoscopic ventral herniarepair (LVHR) with primary and transparietal closure of the hernial defect. Through small incisions in the skin we proceeded to close the parietal defect with sutures tied outside. Then the mesh was fixed as usual with double row of stitches and an overlap of 3-5cm. Results In all patients, 43 of them elderly, surgery was successfully conducted. The juxtaposition of the edges of the hernial defect has not been time consuming and has not developed new complications. The postoperative course was uneventful, with discharge on the third day, except in 5 patients. Were observed only small gaps and not the formation of large seromas. There were no infections wall. We do not have relapses, but some small and asymptomatic solutions continuously up to 2 cm at the sonographic study. In elderly patients the absence of dead space and the feeling of greater stability of the wall, early mobilization and pain control have facilitated the post-operative course. Conclusions The positioning of sutures transcutaneous is simple and effective, the reduced incidence of seromas and the greater stability of the wall suggest to adopt this procedure fully. The possibility to close the margins of the defect may allow to change the size and setting of the mesh, since the absence of dead space allows to download physiologically tensions of the wall.
IntroductionThe ideal prosthetic material for ventral herniarepair has yet to be described. Each prosthetic material has unique advantages and disadvantages in terms of tissue ingrowth, adhesion formation, and shrinkage profiles. Polyester-based mesh has shown minimal shrinkage and excellent tissue ingrowth in animal models. However, the macroporous, braided nature of this material has raised several concerns regarding the incidence of
Within the last years meshes have become essential for the repair ofabdominal wall hernias. While the type of mesh obviously influencesthe clinical result, the selection of the best suitablemesh-modification should have favourable effects onto the rate ofcomplications. Available surgical meshes mainly differ in the typeand amount of the basic polymers. The most common meshes are madeeither out of monofilament polypropylene
B. Klosterhalfen; U. Klinge; V. Schumpelick; L. Tietze
. Loss of abdominal wall substance is a major cause of incisional hernia formation. It makes repair of this iatrogenic human\\u000a ailment a difficult surgical problem. The abdominal wall substance loss has compelled the world's surgical community dealing\\u000a with this condition to substantiate the repair with extra material such as skin, fascia, wire mesh, and lately biocompatible\\u000a synthetic mesh. Even
B. G. Matapurkar; A. Bhargave; Leelawathi Dawson; B. Sonal
Lumbar hernias, which are rare hernias of the posterolateral abdominal wall, can be divided into two groups: primary lumbar hernias, often the expression of a congenital defect, which typically arise in two areas of weakness, the superior triangle and inferior triangle and acquired (or diffuse) lumbar hernias which are usually due to previous lumbar trauma or surgery. Clinical examination may be adjuvated by ultrasound or CT scan, which can reveal the abdominal wall defect with the hernia content (viscera or extraperitoneal tissue). Surgical repair of lumbar hernias, both primary and acquired, has rapidly developed through recent years, similarly to the treatment of more frequent kinds of hernia (groin, epigastric), evolving from direct repair to mini-invasive techniques, even if, since the rarity of these hernias, precise knowledge of this complex anatomic region is required. Nowadays there are two valid alternatives: open tension-free repair (with use of mesh), and mini-invasive repair. Both are safe and effective, even if smaller hernias can be treated by open approach, with loco-regional anesthesia and good cosmetic effect. Larger hernias, or hernias with suspected viscera involvement, should require larger incisions and viscera exploration. For this reason laparoscopic access would be preferable. PMID:19999919
Cavallaro, Giuseppe; Sadighi, Arash; Paparelli, Claudia; Miceli, Mario; D'Ermo, Giuseppe; Polistena, Andrea; Cavallaro, Antonino; De Toma, Giorgio
Morgagni-Larrey hernia is a rare type of diaphragmatic hernia, the diagnosis of which is made incidentally by routine chest X-ray film. We describe a technique for the laparoscopic repair of Morgagni-Larrey hernia which was successfully performed in three adult patients; two women and one man. Two of the patients were asymptomatic and had herniation of only omentum into the right hemithorax; however, one was symptomatic and had herniation of the omentum and large bowel. Tension-free closure of the defects was done using Prolene mesh with a hernia stapler, helical fastener, and Endostitch. There were no early complications and the patients were discharged on the fourth postoperative day. The mean follow-up period was 41 months, and there has been no late morbidity or mortality related to this procedure. Using a laparoscopic approach to repair a Morgagni-Larrey hernia provides an excellent view of the surgical field and allows easy manipulation with minimal surgical trauma, followed by rapid recovery of the patient. PMID:12376790
Purpose Biologic meshes are increasingly used in parastomal herniarepair. This study evaluates the efficacy and safety of diisocyanate\\u000a cross-linked acellular porcine dermal collagen mesh for parastomal herniarepair, with particular reference to the relationship\\u000a of the stoma site to the rectus sheath.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Hernias were repaired via a lateral approach, with onlay placement of the biologic mesh. A retrospective case note
We present a case of bilateral Morgagni hernia in a 68-year-old male with an intermittent history of progressive onset of breath shortness and occasional cardiac arrhythmias. Diagnosis was made by clinical examination and the findings in a plain chest radiograph and was confirmed by computed tomography scan. The patient was operated electively and subjected to a transabdominal approach. A bilateral
Background Today, the laparoscopic approach is a standard procedure for the repair of incisional hernias. However, the direct contact\\u000a of visceral organs with mesh material is a major issue.\\u000a \\u000a \\u000a \\u000a Patients and methods This prospective observational study presents the data of 344 patients treated for incisional and parastomal hernias with\\u000a a new mesh made of polyvinylidene fluoride (PVDF; Dynamesh IPOM®) between May 2004
Background The da Vinci robot laparoscopic incisional herniarepair with intracorporeal suturing may offer an alternative to transabdominal\\u000a sutures and tackers.\\u000a \\u000a \\u000a \\u000a Methods From 2003 to 2005, 11 patients (median age, 71 years; median body mass index [BMI], 28) with small and medium-sized incisional\\u000a hernias (median fascial defect, 19.6 cm2) were treated with the da Vinci robot system using intracorporeal mesh fixation with
Internal hernia after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery can lead to acute small bowel obstruction or chronic recurrent abdominal pain. We present two cases of internal hernias after antecolic antegastric LRYGB. Both patients presented to the emergency room with acute diffuse abdominal pain. Other than that, a physical examination and routine laboratory workup did not reveal any pathological finding. An abdominal CT was performed in both cases. It showed mesenteric torsion as a sign of internal hernia in one case, but remained inconclusive in the other patient. Immediate diagnostic laparoscopy was performed in both cases. Intraoperatively, both patients revealed an internal hernia, where the common channel herniated through the mesojejunal space. The conversion to upper median minilaparotomy was necessary for hernia reduction in both cases. No bowel resection was required and both patients recovered fully. PMID:24072825
Däster, Silvio; Droeser, Raoul A; Delko, Tarik; Oertli, Daniel
Background. To evaluate the use, indications, and short-term outcomes for human acellular dermis. Methods. We retrospectively reviewed patients having human acellular dermis placed for ventral herniarepair from January 2008 through October 2009. Demographic information, operative details, and outcomes of patients with and without recurrences were compared; a P value <0.05 was considered significant. Results. 115 patients met inclusion criteria. The average age was 60 years (range, 24–89). The technique of repair included primary repair with overlay of mesh in 76%, bridge repair in 13%, and underlay in 11%. Average cost of mesh per operation was $3,709 (range $191–10,630). Open repairs were performed in 90% of patients with addition of component separation in 12%. At an average of 13 months, 58 patients were available for followup (50%), with a 47% recurrence rate. The morbidity rate was 48% and the mortality rate was 2%. Technique of repair was the only significant risk factor for recurrence with bridge repairs associated with a higher rate of recurrence (P < 0.05). Conclusions. The use of biologic grafts for ventral herniarepair is becoming more popular especially in clean cases. Although followup is limited, there remains a high recurrence rate associated with the use of human acellular dermis.
Hope, William W.; Griner, Devan; Adams, Ashley; Hooks, W. Borden; Clancy, Thomas V.
Use of synthetic materials in herniplasty has been a controversial issue. In order to determine the influence of Mersilene mesh on the strength of healing abdominal wounds and its effectiveness in repair of hernia, experimental and clinical studies were undertaken. Experimental study included 175 male rats divided into three groups subjected to either: 1) an incision made only through the skin and closed with 3-0 silk sutures; 2) a 2.5 cm midline incision through the musculature and peritoneum closed with 2-0 Mersilene suture; or 3) the same procedure as group 2 with the addition of a Mersilene mesh onlay graft. Bursting strength of abdominal wounds as determined in all groups at intervals. Wounds of the group treated with the mesh exhibited significantly greater (P less than 0.01) bursting strength. Clinical trial consisted of 100 consecutive adult patients in which an onlay graft of Mersilene mesh was used in the hernioplasty. Mesh was used as an adjunct in patients with: 1) large ventral hernias; 2) direct hernias resulting from severely attenuated transversialis fascia; 3) indirect hernias associated with a large internal ring and a weak posterior inguinal wall; or 4) combined direct and indirect hernias. All were followed for a minimum of one year to determine the incidence of complication and rate of recurrence. This study suggests that: 1) Mersilene mesh increases the strength of healing abdominal wounds in rats; and 2) repair of large hernias with Mersilene mesh results in an acceptable morbidity and a lowered rate of recurrence. Images Fig. 3.
Cerise, E J; Busuttil, R W; Craighead, C C; Ogden, W W
Introduction: Since laparoscopic inguinal herniarepair has become a frequently performed surgical procedure, it is inevitable that patients\\u000a who have been candidates for laparoscopic radical prostatectomy (LRP) may have had such prior intervention. The inguinal hernia\\u000a repair might take the form of either total extraperitoneal hernioplasty (TEP) or transabdominal extraperitoneal hernioplasty\\u000a (TAPP), with mesh placement. The objective was to show
Jens-Uwe Stolzenburg; Chris Anderson; Robert Rabenalt; Minh Do; Kossen Ho; Michael C. Truss
Objective To assess the value of single-dose, intravenous, prophylactic ampicillin and sulbactam (AS) in the prevention of wound infections during open prosthetic inguinal herniarepair by a double-blind, prospective, randomized trial. Summary Background Data The use of antibiotic prophylaxis during open prosthetic inguinal herniasurgery is controversial, and no prospective trial has been conducted to examine this issue. Methods Patients undergoing unilateral, primary inguinal herniarepair electively with the Lichtenstein technique using polypropylene mesh were randomized 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 resulted 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 herniarepair. 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.
Yerdel, Mehmet A.; Akin, Emin B.; Dolalan, Sukru; Turkcapar, Ahmet G.; Pehlivan, Mevlut; Gecim, Ibrahim E.; Kuterdem, Ercument
\\u000a Background Abdominal wall hernias are a common complication following open gastric bypass (RYGBP) surgery. In an effort to reduce the\\u000a incidence of incisional hernias with our form of open RYGBP, progressively smaller, upper midline epigastric incisions have\\u000a been utilized along with permanent sutures. The purpose of this study is to analyze whether incision location, size and choice\\u000a of suture material affect
Rafael F. Capella; Vincent A. Iannace; Joseph F. Capella
The members of the Section on Surgery of the American Academy of Pediatrics were surveyed to determine the practice of North American pediatric surgeons in infants with inguinal hernia (IH). Case-scenario multiple-choice-design questionnaires regarding hernias and hydroceles were sent to all members of the Surgical Section, and responses were received from 292 (50%). In healthy full-term infant boys with asymptomatic
Eugene S. Wiener; Robert J. Touloukian; Bradley M. Rodgers; Jay L. Grosfeld; Edwin I. Smith; Moritz M. Ziegler; Arnold G. Coran
Background Incisional hernia remains as one of the most common surgical complications. Different mesh techniques are used in 75–80% of\\u000a herniarepair. The aim of this study was to evaluate the dependence of mesh positioning and the type of mesh implanted on\\u000a foreign body reaction and collagenous ingrowth.\\u000a \\u000a \\u000a \\u000a Materials and methods In 24 male Chinchilla rabbits, an incisional herniarepair was performed
M. Binnebösel; C. D. Klink; J. Otto; J. Conze; P. L. Jansen; M. Anurov; V. Schumpelick; K. Junge
Obturator hernia is the protrusion of intraperitoneal or extraperitoneal organs or tissues through the obturator canal. The first case was published by de Ronsil in 1724. Obturator hernia is more common in older malnourished women due to loss of supporting connective tissue and the wider female pelvis. The hernia sac usually contains small bowel, especially ileum. It may follow the anterior or posterior division of the obturator nerve. In most cases, obturator hernia presents with intestinal obstruction of unknown cause. It may present with obturator neuralgia, as a palpable mass or, in cases of bowel necrosis, as ecchymosis of the thigh. A correct diagnosis is made in 20 to 30 per cent of cases. CT scan is considered the gold standard for diagnosis, whereas ultrasonography, contrast studies, herniography and plain films are less specific. Surgery is the only treatment option for obturator hernia. Hesitancy to intervene surgically for chronically ill patients results in high mortality. Transabdominal approach is indicated in cases of complete bowel obstruction or suspected peritonitis. The extra-abdominal approach is used in preoperatively diagnosed cases and in absence of bowel strangulation. The laparoscopic approach is minimally invasive and effectively reduces morbidity. The defect is closed using sutures, tissue flaps, or prosthetic mesh. PMID:21944623
Stamatiou, Dimitrios; Skandalakis, Lee J; Zoras, Odysseas; Mirilas, Petros
Background Anterior open treatment of the inguinal hernia with a tension-free mesh has reduced the incidence of hernia recurrence. The Lichtenstein procedure is the current reference technique for inguinal hernia treatment. Chronic pain has become the main postoperative complication after surgical inguinal herniarepair, especially following Lichtenstein. Preliminary experiences with a soft mesh positioned in the preperitoneal space (PPS) by transinguinal preperitoneal (TIPP) or total extraperitoneal (TEP) technique, showed promising results considering the reduction of postoperative chronic pain. Evolution of surgical innovations for inguinal herniarepair led to an open, direct approach with preperitoneal mesh position, such as TIPP. Based on the TIPP procedure, another preperitoneal repair has been recently developed, the transrectus sheath preperitoneal (TREPP) mesh repair. Methods The ENTREPPMENT trial is a multicentre randomized clinical trial. Patients will be randomly allocated to anterior inguinal herniarepair according to the TREPP mesh repair or TIPP procedure. All patients with a primary unilateral inguinal hernia, eligible for operation, will be invited to participate in the trial. The primary outcome measure will be the number of patients with postoperative chronic pain. Secondary outcome measures will be serious adverse events (SAEs), including recurrence, hemorrhage, return to daily activities (for example work), operative time and hospital stay. Alongside the trial health status, an economic evaluation will be performed. To demonstrate that inguinal herniarepair according to the TREPP technique reduces the percentage of patients with postoperative chronic pain from 12% to <6%, a sample size of 800 patients is required (two-sided test, ??=?0.05, 80% power).The ENTREPPMENT trial aims to evaluate the TREPP and TIPP procedures from patients’ perspective. It is hypothesized that the TREPP technique may reduce the number of patients with any form of postoperative chronic pain by 50% compared to the TIPP procedure. Trial registration Current Controlled Trials: ISRCTN18591339
Background: Fixation of the mesh is crucial for the successful laparoscopic repair of incisional hernias. In the present\\u000a experimental study, we used a pig model to compare the tensile strengths of mesh fixation with helical titanium coils (tackers)\\u000a and transabdominal wall sutures. Methods: Thirty-six full-thickness specimens (5 × 7 cm) of the anterior abdominal wall of\\u000a nine pig cadavers were
M. Riet; P. J. Steenwijk; G. J. Kleinrensink; E. W. Steyerberg; H. J. Bonjer
To study the role of prophylactic antibiotics in open inguinal herniarepair. A total of 200 patients were included, they\\u000a were randomised in two groups. Group 1 was given prophylactic dose of inj amoxy-clav while group 2 was given placebo only.\\u000a Results were compared and Data analysed using the Chi-square test. Complications in both the groups were compared. Rate of
Amit Goyal; Rajeev Garg; R. K. Jenaw; D. K. Jindal
Background Prosthetic mesh reinforcement is standard practice for inguinal herniarepair but can cause considerable pain and stiffness\\u000a around the groin and affect physical functioning. This has led to various types of mesh being engineered, with a growing interest\\u000a in a lighter weight mesh. The aim of this prospective study was to compare the outcome after laparoscopic totally extra-peritoneal\\u000a (TEP) inguinal
L. R. Khan; S. Liong; A. C. de Beaux; S. Kumar; S. J. Nixon
Prosthetic mesh reinforcement is now routine in the management of inguinal hernia but can cause considerable pain and stiffness\\u000a around the groin. The aim of this study was to compare the outcome after laparoscopic TEP inguinal repair using new lightweight\\u000a or traditional heavyweight mesh performed in a single unit. Between November 2004 and March 2005, 113 patients underwent laparoscopic\\u000a TEP
Aim An ideal mesh should produce minimal foreign-body reaction and be compatible with human tissue. Studies focusing on these\\u000a aspects indicate that a biological mesh acts as a scaffold for herniarepair. In this paper, we retrospectively evaluate a\\u000a consecutive series of patients who underwent laparoscopic transabdominal pre-peritoneal (TAPP) hernioplasty using a biological\\u000a mesh—Surgisis—fixed with fibrin glue, focusing on the feasibility
Purpose Organ transplantation is widely accepted as the treatment of choice for native organ failure. Due to required immunosuppression,\\u000a however, organ recipients are prone to wound infections, incisional hernias, and fascial dehiscence. These complications are\\u000a especially dangerous in this patient population, as they can compromise the survival of the transplanted organ. Various methods\\u000a have been employed to repair ventral and incisional
M. B. Brewer; E. M. Rada; M. L. Milburn; N. H. Goldberg; D. P. Singh; M. Cooper; R. P. Silverman
Background Laparoscopic treatment of large hiatal hernias seems to be associated with a high recurrence rate that some authors suggest\\u000a to bring down by performing prosthetic closure of the hiatus. However, prosthetic repair remains controversial owing to severe\\u000a and still underestimated complications. The aims of this study were to assess the long-term functional and objective results\\u000a of laparoscopic treatment without prosthetic
Background Tissue sealants have been proposed as an alternative to permanent fixation devices in herniarepair with the aim of reducing\\u000a perforation-associated complications and chronic pain. Sealants can be divided into three main categories: synthetic glues\\u000a (e.g., cyanoacrylate based), biologic products (e.g., fibrin sealant), and genetically engineered polymer protein glues. The\\u000a beneficial effects of fibrin sealant have been reported in both
R. H. Fortelny; A. H. Petter-Puchner; N. Walder; R. Mittermayr; W. Öhlinger; A. Heinze; H. Redl
Epidermolysis bullosa is a group of inherited disorders characterized by blistering of the skin as a result of minor trauma. We managed an infant with epidermolysis bullosa undergoing inguinal herniarepair. Anaesthesia was induced with oxygen\\/nitrous oxide mixture and sevoflurane. Oral tracheal intubation was done with a lubricated laryngoscope blade with KY jelly using atracurium 0.5 mg\\/kg and fentanyl 0.1
Secondary repair of recurrent ventral hernia is difficult, and success depends on re-establishing the functional integrity of the abdominal wall. Current techniques used for closure of these defects have documented recurrence rates as high as 54 percent. The authors' 8-year experience utilizing variations of the components separation technique for autologous tissue repair of recalcitrant hernias emphasizes that recurrent or recalcitrant hernias benefit from the creation of a dynamic abdominal wall. A total of 389 patients were retrospectively identified as having abdominal wall defects, and 284 of these patients met the selection criteria. Study patients were grouped according to the type of surgical repair used. The recurrence rate was 20.7 percent over all study groups and was directly related to the extent of repair required. Group 1 patients (wide tissue undermining) had a recurrence rate of only 15 percent, while in group 2 (complete components separation), the recurrence rate was 22 percent. Group 3 patients (interpositional fascia lata graft) had a 29 percent recurrence rate. Time to recurrence was also significantly different across treatment groups, with study group 3 experiencing earlier hernia recurrence. The most frequent postoperative complication was wound infection, which was directly related to the repair performed. The relative odds of recurrence versus the risk factors of age, sex, perioperative steroid use, wound infection, defect size, and the presence of enterocutaneous fistula were studied with a logistic regression analysis. These factors did not possess statistical significance for predicting hernia recurrence. The preoperative presence of mesh was independently significant for hernia recurrence, increasing the relative odds 2.2 times (p = 0.01). Similarly, when other risk factors were controlled for, increasing the complexity of the treatment group, from study group 1 (wide tissue undermining) to study group 3 (interpositional fascia lata graft), also increased the odds of hernia recurrence 1.5-fold per group (p = 0.04). Average inpatient cost was $24,488. The length of inpatient stay ranged from 2 to 172 days (average, 12.8 days). The length of inpatient stay and costs were directly related to the extent of repair required. Using the analysis of variance test for multiple factors, the presence of an enterocutaneous fistula (p = 0.0014) or a postoperative wound infection (p = 0.008) independently increased the length of inpatient stay and hospital costs. A total of 108 successfully repaired patients were contacted by telephone and agreed to participate in a self-reported satisfaction survey. The patients noticed improvements in the appearance of their abdomen, in their postoperative emotional state, and in their ability to lift objects, arise from a chair or a bed, and exercise. These results suggest that recalcitrant hernia defects should be solved, when possible, by reconstructing a dynamic abdominal wall. PMID:12832883
Girotto, John A; Chiaramonte, Michael; Menon, Nathan G; Singh, Navin; Silverman, Ron; Tufaro, Anthony P; Nahabedian, Maurice; Goldberg, Nelson H; Manson, Paul N
\\u000a Background Surgical repair of parastomal hernias is usually performed through a laparotomy (stoma translocation) or a peristomal incision\\u000a (mesh repair). Laparoscopic approach may minimize the risks of mesh infection and, thus, represents an attractive alternative.\\u000a Permacol™ (Tissue Science Laboratories plc, Aldershot, Hampshire, U.K.) is a new biomaterial implant, which combines the strength\\u000a and biocompatibility.\\u000a \\u000a \\u000a \\u000a Technique Case 1: A 67-year-old patient presented with
Ihsan Inan; Pascal Gervaz; Monica Hagen; Philippe Morel
Rectal prolapse repair techniques using laparoscopic abdominal surgery are the treatments of choice. However, in patients with increased morbidity, perineal surgical techniques are indicated. Transanal endoscopic surgery is presented as a possible alternative option in groups with increased experience in it. PMID:22854204
Serra-Aracil, Xavier; Alcántara, Manel; Corredera, Costanza; Mora, Laura; Navarro, Salvador
Lumbar hernias (and namely transiliac hernias) are not frequent. We report the case of a 76-year-old man presenting with an incarcerated transiliac hernia, in a context of exacerbated chronic obstructive pulmonary disease, 30 years after iliac bone harvesting for femur surgery. After imaging, the patient underwent a laparotomy, and a herniated left colic segment was identified through a hole in
François Radais; Olivier Facy; Pablo Ortega-Deballon
Purpose In 2003, a dedicated Dutch committee developed evidence-based guidelines for the treatment of inguinal hernia (IH) in children\\u000a and adults. The aim of this study was to describe trends in hernia care before and after the publication of the guidelines\\u000a on IH surgery in the Netherlands.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Originally, a retrospective baseline analysis of IH surgery in 90 Dutch hospitals was performed
D. H. de Lange; M. Kreeft; G. H. van Ramshorst; T. J. Aufenacker; J. A. Rauwerda; M. P. Simons
Background Human acellular dermal matrix (HADM) is used for ventral herniarepair, as it resists infection and remodels via surrounding tissue. However, the tissue source and impact of basement membrane (BM) on cell and vessel infiltration have not been determined. We hypothesized that musculofascia would be the primary tissue source of cells and vessels infiltrating into HADM and the BM would inhibit infiltration. Methods Fifty-six guinea pigs underwent inlay HADM ventral herniarepair with the BM oriented toward or away from the peritoneum. At postoperative weeks 1, 2, or 4, repair sites were completely excised. Histologic and immunohistochemical analyses were performed to quantify cell and vessel density within repair-site zones, including interface (lateral, beneath musculofascia) and center (beneath subcutaneous fat) zones. Cell and vessel quantities were compared as functions of zone, BM orientation, and time. Results Cellular and vascular infiltration increased over time universally. The interface demonstrated greater mean cell density than the center (weeks 1 and 2, p=0.01, p<0.0001). Cell density was greater with the BM oriented toward the peritoneum at week 4 (p=0.02). The interface zone had greater mean vessel density than the center zone at week 4 (p<0.0001). Orienting the BM toward the peritoneum increased vessel density at week 4 (p=0.0004). Conclusion Cellular and vascular infiltration into HADM for ventral herniarepairs was greater from musculofascia than subcutaneous and the BM inhibited cellular and vascular. HADM should be placed adjacent to the best vascularizing tissue to improve fibrovascular incorporation.
Campbell, Kristin Turza; Burns, Nadja K.; Ensor, Joe; Butler, Charles E.
OBJECTIVE: The objective of this study was to determine the best treatment\\u000a of incisional hernia, taking into account recurrence, complications,\\u000a discomfort, cosmetic result, and patient satisfaction. BACKGROUND:\\u000a Long-term results of incisional herniarepair are lacking. Retrospective\\u000a studies and the midterm results of this study indicate that mesh repair is\\u000a superior to suture repair. However, many surgeons are still performing\\u000a suture
Jacobus W. A. Burger; Roland W. Luijendijk; Wim C. J. Hop; Jens A. Halm; Emiel G. G. Verdaasdonk; Johannes Jeekel
Background Today, local anesthesia is used in specialized hernia clinics in most cases. The technique for establishing local anesthesia\\u000a for inguinal surgery may differ among surgeons. Few articles to date have mentioned the exact doses of local agents. This\\u000a prospective study aimed to research the doses of local anesthetic agents needed in practice and determine the patient-related\\u000a and other factors which
An 84-year-old woman presented with ileus. Ultrasonography, a computed tomography scan, and small bowel contrast examination\\u000a showed a Richter-type hernia in her left obturator orifice. Under general anesthesia, laparoscopic surgery with low-pressure\\u000a (4mmHg) pneumoperitoneum was carried out using a peritoneal needle retractor, and a reduction of the strangulated intestinal\\u000a loop was thus achieved. Because the hernial opening measured 5mm in
Background Diaphragmatic hernias may be congenital or acquired (traumatic). Some patients present in adulthood with a congenital hernia\\u000a undetected during childhood or due to trauma, known as the adult-onset type. The authors present their series of adult-onset\\u000a type diaphragmatic hernias managed successfully by laparoscopy.\\u000a \\u000a \\u000a \\u000a Methods This study retrospectively investigated 21 adult patients between 1995 and 2007 who underwent laparoscopic repair at the
Background Bilateral inguinal hernias are relatively common in children. This fact has led to a controversy of more than 50 years concerning\\u000a the necessity of bilateral surgical exploration during the repair of unilateral inguinal hernias in children. The advent of\\u000a transinguinal laparoscopic visualization of the contralateral side is a turning point and a major contribution to the subject,\\u000a offering the opportunity
Baruch Klin; Yigal Efrati; Ibrahim Abu-Kishk; Sorin Stolero; Gad Lotan
What is known on the subject? and What does the study add? Substantial experience of the outcomes has been gathered regarding the acute and sub-acute experience with various types of corrective procedures for POP. These include long-term POP correction as well as more recent recognition of improvement in functional disorders associated with POP such as UI, colorectal dysfunction, and sexual dysfunction. Long-term follow-up is available for some of the older types of interventions and current multicentre trials are being accrued with longer term follow-up for new interventions including mesh-type repairs. The study adds a condensed and summarized version of the current literature regarding the various interventions for POP and also provides an overview of the current controversies and areas where knowledge is incomplete and in need of further elaboration for definitive answers regarding optimization of surgical care for POP. Our aim is to summarise the available data on the transvaginal placement of synthetic mesh for pelvic organ prolapse (POP) repair, with a focus on the outcomes and complications of commercial POP-repair kits. As the stability and durability of autologous tissues may be questionable, nonabsorbable, synthetic materials are an attractive alternative for providing additional support during POP surgery. These materials are not novel, and most have been used for many years in surgical applications, e.g. herniarepairs. While theoretically appealing, the implantation of synthetic mesh in the pelvis may be associated with inherent adverse consequences, such as erosion, extrusion, and infection. Additionally, the routine use of these materials may carry potential long-term complications, such as dyspareunia, chronic pelvic pain, and vaginal distortion. The success and failure of mesh-augmented POP repair is related not only to the synthetic material itself, but also to patient- and surgeon-related factors. Recent warnings by the USA Food and Drug Administration and other groups regarding adverse events further complicate the decision to use synthetic mesh. PMID:21592280
Gomelsky, Alex; Penson, David F; Dmochowski, Roger R
Purpose: The aim of this study was to document the authors' experience with laparoscopy in the treatment of inguinal hernia in girls and boys. Methods: The internal inguinal ring was closed with 1 or 2 stitches of 4-0 monofilamentous material. Two 2-mm needle holders were inserted through the inferolateral abdominal wall. The laparoscope was advanced through the umbilicus. A total
Numerous techniques exist for inguinal hernia treatment. Currently, open mesh tension-free repair is regarded as the repair method of choice. In particular Lichtenstein repair is the most common procedure performed, although several articles have reported long-lasting postoperative pain and a higher recurrence rate than originally reported. This study describes the P.A.D. (Protesi Autoregolantesi Dinamica) prosthesis implantation technique and reports postoperative complications and long-term results. From June 2002 to May 2005 a total of 214 patients underwent P.A.D. prosthesis inguinal repair. All patients were male, with a mean age of 51 years. All hernias were treated via an open inguinal approach using the original technique described by Valenti, with slight modifications. A total of 171'patients (80%) were available to follow-up 3 years after surgery. Early postoperative complications occurred in 14 patients (8.4%). Four patients (12.1%), who had undergone regional anaesthesia, developed urinary retention. Wound infection occurred in 3 patients (1.4%). There were two direct recurrences (0.93%) whereas chronic postoperative inguinal pain was reported in 4.2% of patients. Within the limitations of a short follow-up, our results show that the P.A.D. prosthesis procedure is a reliable technique with a low recurrence rate and low postoperative morbidity. PMID:19536991
Ferranti, Fabrizio; Marzano, Marco; Quintiliani, Alberto
Bacterial infections by antibiotic-resistant Staphylococcus aureus strains are among the most common postoperative complications in surgical herniarepair with synthetic mesh. Surface coating of medical devices/implants using antibacterial peptides and enzymes has recently emerged as a potentially effective method for preventing infections. The objective of this study was to evaluate the in vitro antimicrobial activity of herniarepair meshes coated by the antimicrobial enzyme lysostaphin at different initial concentrations. Lysostaphin was adsorbed on pieces of polypropylene (Ultrapro) mesh with binding yields of ?10 to 40% at different coating concentrations of between 10 and 500 ?g/ml. Leaching of enzyme from the surface of all the samples was studied in 2% (wt/vol) bovine serum albumin in phosphate-buffered saline buffer at 37°C, and it was found that less than 3% of adsorbed enzyme desorbed from the surface after 24 h of incubation. Studies of antibacterial activity against a cell suspension of S. aureus were performed using turbidity assay and demonstrated that the small amount of enzyme leaching from the mesh surface contributes to the lytic activity of the lysostaphin-coated samples. Colony counting data from the broth count (model for bacteria in wound fluid) and wash count (model for colonized bacteria) for the enzyme-coated samples showed significantly decreased numbers of CFU compared to uncoated samples (P < 0.05). A pilot in vivo study showed a dose-dependent efficacy of lysostaphin-coated meshes in a rat model of S. aureus infection. The antimicrobial activity of the lysostaphin-coated meshes suggests that such enzyme-leaching surfaces could be efficient at actively resisting initial bacterial adhesion and preventing subsequent colonization of herniarepair meshes.
Background This study aimed to determine whether the strength and extensibility of herniarepair materials are negatively influenced\\u000a by the application of helical titanium tacks.\\u000a \\u000a \\u000a \\u000a \\u000a Methods This study evaluated 14 meshes including bare polypropylene, macroporous polytetrafluoroethylene, absorbable barrier, partially\\u000a absorbable mesh, and expanded polytetrafluoroethylene materials. Each mesh provided 15 specimens, which were prepared in 7.5 × 7.5-cm\\u000a squares. Of these, 5 “undamaged” specimens were
Sopon Lerdsirisopon; Margaret M. Frisella; Brent D. Matthews; Corey R. Deeken
Introduction The use of non-absorbable meshes for the repair of inguinal hernias has become standard; however, these meshes have been associated\\u000a with complications including long-term postoperative pain. To this end, a new partially absorbable composite mesh has been\\u000a developed, and the aim of this study was to investigate its efficacy in animal and human trials.\\u000a \\u000a \\u000a \\u000a Materials and methods Sixty male Wistar rats
J. L. Leroy; D. Mutter; A. Forgione; H. Inoue; M. Vix; C. Bailey; J. Marescaux
Aim The aim of the study was to evaluate the frequency of superficial and prosthetic mesh infection following polypropylene mesh\\u000a repair of different abdominal wall hernia in individual patients and to analyze the manifestation, clinical process and outcomes\\u000a in patients with prosthetic mesh infection.\\u000a \\u000a \\u000a \\u000a Methods This was a retrospective analysis of 375 patients with 423 implanted meshes for groin, femoral, umbilical, incisional
Purpose The objective of the present study was to review the pertinent literature and analyze the evidence for and against the use\\u000a of mesh for hiatal herniarepair, with a focus on the effects on recurrence and postoperative dysphagia.\\u000a \\u000a \\u000a \\u000a \\u000a Methods A literature search was performed between January 1990 and March 2010. Studies were considered for inclusion, provided (1)\\u000a they comprised a series
Stavros A. Antoniou; Oliver O. Koch; George A. Antoniou; Rudolph Pointner; Frank A. Granderath
Despite universal acceptance of the value of elective herniarepair, many patients present with incarceration or strangulation, which are associated with significant morbidity and mortality. We reviewed 147 patients who underwent emergency surgery for incarcerated groin hernias during a 10-year period in order to analyze the presentation and outcome in our practice. Median age of the patients was 70 years. There
J. A. Álvarez; R. F. Baldonedo; I. G. Bear; J. A. S. Solís; P. Álvarez; J. I. Jorge
\\u000a Incisional hernia is a frequent complication of abdominal surgery developing in 11–20 % of patients undergoing an abdominal\\u000a operation. Regarding morbidity and loss of manpower, incisional hernias continue to be a fundamental problem for surgeons.\\u000a In this experimental study, three commonly used mesh materials (Goretex PTFE; Tutoplast Fascia lata; Tutopatch Pericardium\\u000a bovine) were compared according to effectiveness, strength, adhesion
S. Kapan; M. Kapan; E. Goksoy; I. Karabicak; H. Oktar
Incisional hernia is a frequent complication of abdominal surgery with an incidence reported in the literature of 2–20%. The\\u000a condition is associated with local and systemic, potentially severe risks. The incidence of incisional-hernia recurrence is\\u000a even higher, between 8 and 55%, depending on the initial type of repair technique. Thus, incisional hernia should be regarded\\u000a as a serious and disabling
Giuseppe Paolo Ferulano; Saverio Dilillo; Ruggero Lionetti; Michele ?Ambra; Domenico Fico; Domenico Pelaggi
Background Obesity and serum C-reactive protein (CRP) (a sensitive marker of inflammatory activity) are associated with most chronic diseases. Abdominal adiposity along with age is the strongest determinant of baseline CRP levels in healthy subjects. The mechanism of the association of serum CRP with disease is uncertain. We hypothesized that baseline serum CRP is a marker of inflammatory responsiveness to injury and that abdominal adiposity is the main determinant of this responsiveness. We studied the effect of abdominal adiposity, age and other environmental risk factors for chronic disease on the CRP response to a standardised surgical insult, unilateral herniarepair to not only test this hypothesis but to inform the factors which must be taken into account when assessing systemic inflammatory responses to surgery. Methods 102 male subjects aged 24-94 underwent unilateral herniarepair by a single operator. CRP was measured at 0, 6, 24 and 48 hrs. Response was defined as the peak CRP adjusted for baseline CRP. Results Age and waist:hip ratio (WHR) were associated both with basal CRP and CRP response with similar effect sizes after adjustment for a wide-range of covariates. The adjusted proportional difference in CRP response per 10% increase in WHR was 1.50 (1.17-1.91) p?=?0.0014 and 1.15(1.00-1.31) p?=?0.05 per decade increase in age. There was no evidence of important effects of other environmental cardiovascular risk factors on CRP response. Conclusion Waist:hip ratio and age need to be considered when studying the inflammatory response to surgery. The finding that age and waist:hip ratio influence baseline and post-operative CRP levels to a similar extent suggests that baseline CRP is a measure of inflammatory responsiveness to casual stimuli and that higher age and obesity modulate the generic excitability of the inflammatory system leading to both higher baseline CRP and higher CRP response to surgery. The mechanism for the association of baseline CRP and waist:hip ratio to chronic disease outcomes could be through this increase in inflammatory system excitability.
The techniques of minimal access surgery for pediatric inguinal hernia are numerous and they continue to evolve, with a trend toward increasing use of extracorporeal knotting and decreasing use of working ports and endoscopic instruments. Single-port endoscopic-assisted percutaneous extraperitoneal closure seems to be the ultimate attainment, and numerous techniques have mushroomed in the past decade. This article comprehensively reviews and compares the various single-port techniques. These techniques mainly vary in their approaches to the hernia defect with different devices, which are designed to pass a suture to enclose the orifice of the defect. However, most of these emerging techniques fail to entirely enclose the hernia defect and have the potential to lead to higher incidence of hernia recurrence. Accompanying preperitoneal hydrodissection and keeping identical subcutaneous path for introducing and withdrawing the suture, the suture could tautly enclose the hernia defect without upper subcutaneous tissues and a lower peritoneal gap, and a trend towards achieving a near-zero recurrence rate.
Pouch of Douglas hernias are uncommon forms of pelvic hernia. They are most commonly seen in multiparous, elderly women and those having undergone previous pelvic surgery (Stamatiou et al. in Am Surg 76(5):474-479, 2010). Herein, we present a case of a 77-year-old female presenting with groin pain due to a Pouch of Douglas hernia. She had no previous abdominal or pelvic surgery. This was repaired via a trans-abdominal pre-peritoneal approach and the patient's symptoms resolved. To our knowledge, this is the first case report in the literature of an idiopathic Pouch of Douglas hernia managed laparoscopically. PMID:21290155
Chilaiditi syndrome, symptomatic interposition of bowel beneath the right hemidiaphragm, is uncommon and usually managed without surgery. Morgagni hernia is an uncommon diaphragmatic hernia that generally requires surgery. In this case a patient with a longstanding diagnosis of bowel interposition (Chilaiditi sign) presented with presumed Chilaiditi syndrome. Abdominal computed tomography was performed and revealed no bowel interposition; instead, a Morgagni hernia was found and surgically repaired. Review of the literature did not reveal similar misdiagnosis or recommendations for advanced imaging in patients with Chilaiditi sign or syndrome to confirm the diagnosis or rule out other potential diagnoses.
Purpose. Mesh surgeries are counted among the most frequently applied surgical procedures. Despite global spread of mesh applying surgeries, there is no current systematic analysis of incidence and possible prevention of adverse events after mesh implantation. Materials and Methods. Based on the recommendations of IDEAL an in vitro test system for biocompatibility of surgical meshes has been generated (Innovation). Coating strategies for biocompatibility optimization have been developed (Development). The native and modified alloplastic materials have been tested in an animal model over 2 years (Exploration and Assessment and Long-term study). Results. In 3 meshes, implanted in sheep and explanted at 4 different time points (a, 3 months; b, 6 months; c, 12 months; and d, 24 months) over 24 months, thickness of inflammatory tissue (TVT a, 35 µm; b, 32 µm; c, 33 µm; d, 28 µm; UltraPro, a, 25 µm; b, 24 µm; c, 21 µm; d, 22 µm; PVDF a, 20 µm; b, 21 µm; c, 14 µm; d, 15µm), connective tissue (TVT a, 37 µm; b, 36 µm; c, 43 µm; d, 41 µm; UltraPro a, 33 µm; b, 32 µm; c, 40 µm; d, 38 µm; PVDF a, 25 µm; b, 22 µm; c, 22 µm; d, 24 µm), and macrophage infiltration (TVT a, 36%; b, 33%; c, 23%; d, 20%; UltraPro a, 34%; b, 28%; c, 25%; d, 22%; PVDF a, 24%; b, 18%; c, 18%; d, 16%) revealed comparable ranking characteristics at every time point after explantation. The in vivo performance of these meshes in a sheep model was predictable with a previously developed in vitro test system. Coating of meshes with autologous plasma prior to implantation seems to have a positive effect on the meshes biocompatibility. Conclusion. We have applied IDEAL criteria on a new innovation for surgical meshes. The results permit the generation of a ranking of currently available meshes with potential to optimize future meshes. PMID:23339146
Background Herniarepair is the most common surgical procedure in the world. Augmentation with synthetic meshes has gained importance in recent decades. Most of the published work about hernia meshes focuses on the surgical technique, outcome in terms of mortality and morbidity and the recurrence rate. Appropriate biomechanical and engineering terminology is frequently absent. Meshes are under continuous development but there is little knowledge in the public domain about their mechanical properties. In the presented experimental study we investigated the mechanical properties of several widely available meshes according to German Industrial Standards (DIN ISO). Methodology/Principal Findings Six different meshes were assessed considering longitudinal and transverse direction in a uni-axial tensile test. Based on the force/displacement curve, the maximum force, breaking strain, and stiffness were computed. According to the maximum force the values were assigned to the groups weak and strong to determine a base for comparison. We discovered differences in the maximum force (11.1±6.4 to 100.9±9.4 N/cm), stiffness (0.3±0.1 to 4.6±0.5 N/mm), and breaking strain (150±6% to 340±20%) considering the direction of tension. Conclusions/Significance The measured stiffness and breaking strength vary widely among available mesh materials for herniarepair, and most of the materials show significant anisotropy in their mechanical behavior. Considering the forces present in the abdominal wall, our results suggest that some meshes should be implanted in an appropriate orientation, and that information regarding the directionality of their mechanical properties should be provided by the manufacturers.
Pott, Peter P.; Schwarz, Markus L. R.; Gundling, Ralf; Nowak, Kai; Hohenberger, Peter; Roessner, Eric D.
Infants affected with congenital diaphragmatic hernias (CDH) suffer from some degree of respiratory insufficiency arising from a combination of pulmonary hypoplasia and pulmonary hypertension. Respiratory care strategies to optimize blood gasses lead to significant barotrauma, increased morbidity, and overuse of extracorporeal membrane oxygenation (ECMO). Newer permissive hypercapnia/spontaneous ventilation protocols geared to accept moderate hypercapnia at lower peak airway pressures have led to improved outcomes. High-frequency oscillatory ventilation can be used in infants who continue to have persistent respiratory distress despite conventional ventilation. ECMO can be used successfully as a resuscitative strategy to minimize further barotrauma in carefully selected patients. PMID:22595714
Background The extent to which lifestyle factors such as tobacco consumption and obesity affect the outcome after inguinal herniasurgery\\u000a has been poorly studied. This study was undertaken to assess the effect of smoking, smokeless tobacco consumption and obesity\\u000a on postoperative complications after inguinal herniasurgery. The second aim was to evaluate the effect of tobacco consumption\\u000a and obesity on the
D. Lindström; O. Sadr Azodi; R. Bellocco; A. Wladis; S. Linder; J. Adami
Background: Wound pain remains the commonest problem after ambulatory open repair of inguinal hernia. Postoperative subfascial infusion of the wound with bupivacaine extends local analgesia at home and may achieve superior analgesia compared with oral analgesics alone. The objective of the present trial was to evaluate the efficacy of postoperative subfascial infusion of the wound with 0.5% bupicavaine at 2
Littre’s hernia is a rare complication of Meckel’s diverticulum. It was originally defined as ‘the presence of a Meckel’s\\u000a diverticulum in any hernia sac’ by Rieke in 1841. It is difficult to diagnose before surgery. With the advances in the development\\u000a of laparoscopic surgery in children, diagnosis of this rare condition, together with subsequent repair of Littre’s hernia\\u000a and Meckel’s
K. W. Chan; K. H. Lee; J. W. C. Mou; S. T. Cheung; Y. H. Tam
Intrapericardial diaphragmatic herniation of the stomach is reported in a patient who had undergone coronary artery bypass surgery 6 years earlier. The peritoneopericardial defect was iatrogenic and emphasizes the danger of inadvertent diaphragmatic injury during cardiac surgery. PMID:1567630
Waller, D A; Satur, C M; Mitchell, I M; Sivanathan, U M
IMPORTANCE Regional anesthetic techniques can be used to alleviate postoperative pain in children undergoing pediatric surgical procedures. Use of ultrasonographic guidance for bilateral rectus sheath block (BRSB) has been shown to improve immediate pain scores and reduce use of postoperative analgesia in the postanesthesia care unit (PACU). OBJECTIVE To compare efficacy of ultrasonography-guided BRSB and local anesthetic infiltration (LAI) in providing postoperative analgesia after pediatric umbilical herniarepair. DESIGN Prospective, observer-blinded, randomized clinical trial. SETTING Tertiary-referral urban children's hospital. PARTICIPANTS Eligible children 3 to 12 years of age undergoing elective umbilical herniarepair from November 16, 2009, through May 31, 2011. INTERVENTIONS Ropivacaine hydrochloride administered at the conclusion of surgery as LAI by the surgeon (n?=?25) or as ultrasonography-guided BRSB by the anesthesiologist (n?=?27). MAIN OUTCOMES AND MEASURES Scores on the FACES Pain Rating Scale measured at 10-minute intervals and all use of analgesic medications in the PACU. RESULTS Median FACES scores in the PACU were lower in the BRSB group compared with the LAI group at 10 minutes (0 vs 1; P?=?.04), 30 minutes (0 vs 1; P?=?.01), and 40 minutes or later (0 vs 1; P?=?.03). Fewer doses of opioid and nonopioid medications were given to the BRSB group compared with the LAI group (5 vs 11 doses for opioids; 5 vs 10 for nonopioids). CONCLUSIONS AND RELEVANCE In the PACU, ultrasonography-guided BRSB after umbilical herniarepair in children is associated with lower median FACES scores and decreased use of opioid and nonopioid medications compared with LAI. Future studies could examine the use of longer-acting anesthetic agents with ultrasonography-guided BRSB. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01015053. PMID:23760519
Dingeman, R Scott; Barus, Lindsay M; Chung, Hyun Kee; Clendenin, David J; Lee, Christopher S; Tracy, Sarah; Johnson, Victor M; Dennett, Kate V; Zurakowski, David; Chen, Catherine
The transinguinal preperitoneal (TIPP) technique using a soft mesh with a memory ring was developed recently for inguinal herniarepair. To compare TIPP with the Lichtenstein method, a randomised trial was conducted (ISRCTN93798494). The aim of this study was to perform an economic evaluation of the TIPP modality compared to the Lichtenstein modality from both a hospital and societal perspective alongside the clinical trial. The TULIP study was a double-blind randomised clinical trial comparing two techniques for inguinal herniarepair (TIPP and Lichtenstein). Correct generation of the allocation sequence, allocation concealment, blinding, and follow-up were used/applied according to the recommendations of the Cochrane Handbook. Next to the cost drivers, the short-form-36 health survey (SF-36) data from the TULIP trial was used to determine utility. The SF-36 data from the TULIP trial were revised using the SF-6D algorithm according to Brazier. Two scenarios-a hospital and a societal perspective-were presented. If the analyses showed no difference in effects (on the SF-6D) the cost effectiveness decision rule to cost minimisation was altered. No significant difference in SF-6D utility between both modalities was found (mean difference: 0.888, 95 % CI -1.02 to 1.23); consequently, the economic decision rule became cost minimisation. For the hospital perspective no significant differences in costs were found (mean difference: -13, 95 % CI -130 to 104). However, when including productivity gains in the analysis, significant differences (P = 0.037) in costs favouring the TIPP modality (mean saving: 1,472, 95 % CI 463-2,714) were found. The results show that TIPP is a cost-saving inguinal herniarepair technique compared to the Lichtenstein modality against equal effectiveness expressed as quality adjusted life week at 1 year given a societal perspective. In the trial, TIPP patients showed on average a quicker recovery of 6.5 days compared to Lichtenstein patients. PMID:23271350
Koning, G G; Adang, E M M; Stalmeier, P F M; Keus, F; Vriens, P W H E; van Laarhoven, C J H M
Background Symptomatic results of laparoscopic repair of large type III hiatal hernias, with\\/without prosthetic mesh, are often excellent;\\u000a however, a high recurrence rate is detected when objective radiological\\/endoscopic follow-up is performed. The use of mesh\\u000a may reduce the incidence of postoperative hernia recurrence or wrap migration in the chest.\\u000a \\u000a \\u000a \\u000a Methods We retrospectively studied 54 patients (10 men, 44 women; median: age 64.5
Giovanni Zaninotto; Giuseppe Portale; Mario Costantini; Pietro Fiamingo; Sabrina Rampado; Emanuela Guirroli; Loredana Nicoletti; Ermanno Ancona
INTRODUCTION In the present paper, we show a rare case of the large abdominal wall defect and enterocutaneous fistulas after the tension free repair using prostheses for incisional hernia. PRESENTATION OF CASE The patient, a 70-year-old man, had a history of a hemicolectomy for a perforating colon cancer, complicated by a large incisional hernia that was closed primarily but recurred. Three years later, the hernia was repaired at the time of a second colectomy using a Composix Kugel Patch. His course was complicated by a chronic postoperative wound infection with eventual development of enterocutaneous fistulas. The patient was successfully treated with extirpation of the prosthesis, resection of the fistulized bowel, and placement of a tensor fasciae latae myocutaneous flap. DISCUSSION Enterocutaneous fistulas are a known complication of incisional herniarepairs using prostheses. Additional clinical data are required to confirm the safety and efficacy of this procedure as it becomes more widely adopted. CONCLUSION Extirpation of the prosthesis should be performed without delay to prevent serious complications. Reconstruction with a tensor fasciae latae myocutaneous flap was useful for the large abdominal wall defect.
Intrapericardial diaphragmatic herniation of the stomach is reported in a patient who had undergone coronary artery bypass surgery 6 years earlier. The peritoneopericardial defect was iatrogenic and emphasizes the danger of inadvertent diaphragmatic injury during cardiac surgery. (Eur J Cardio-thorac Surg (1992) 6:156-1571
D. A. Waller; C. M. R. Satur; I. M. Mitchell; U. M. Sivanathan
Bochdalek hernia is a congenital posterolateral diaphragmatic defect. It is usually diagnosed in newborns and children; the mortality rate is high due to further congenital anomalies such as pulmonary hypoplasia and pulmonary hypertension. In adulthood, the diagnosis is often incidental, while sometimes it is related to gastrointestinal or respiratory symptoms, or to herniated viscera complications. Thus, surgical treatment is advocated. We herein report a case of an 86-year-old woman with dyspnea and dysphagia. After the diagnosis by barium enema and CT scan of the herniated stomach and the greater omentum through a left side foramen of Bochdalek, she underwent a successful laparoscopic dual mesh repair and was discharged on the 6th postoperative day. PMID:20859719
Congenital diaphragmatic hernias (CDHs) occur mainly in two locations: the foramen of Morgagni and the more common type involving the foramen of Bochdalek. Hiatal hernia and paraesophageal hernia have also been described as other forms of CDH. Pulmonary hypertension and pulmonary hypoplasia have been recognized as the two most important factors in the pathophysiology of congenital diaphragmatic hernia. Advances in surgical management include delayed surgical approach that enables preoperative stabilization, introduction of fetal intervention due to improved prenatal diagnosis, the introduction of minimal invasive surgery, in addition to the standard open repair, and the use of improved prosthetic devices for closure.
We present a case of a 50-year-old morbidly obese woman who presented with a case of necrotizing fasciitis of the anterior\\u000a abdominal wall due to a strangulated umbilical hernia. The case was managed through damage control surgery (DCS) with an initial\\u000a surgery to stabilise the patient and a subsequent definitive operation and biological graft herniarepair. We emphasise the\\u000a relevance
Lighter-weight, large pore meshes with absorbable layers are designed for intra-abdominal placement in laparoscopic ventral herniarepair. This retrospective review of 86 patients who underwent ventral herniarepair with PROCEED? Surgical Mesh (Ethicon, Inc., Somerville, NJ) represents an evaluation of a cohort of patients implanted with this mesh. All patients implanted with PROCEED Mesh for ventral herniarepair between October 2006 and December 2007 were contacted and asked to participate in an evaluation of their herniarepair. Patients were evaluated for pain, recurrence of their hernia and other potential complications. Eight patients underwent open repair; all others were performed laparoscopically. One patient continued to have pain at 1 year. Twelve developed seromas early on and 5 required drainage by a single puncture each. None persisted. There were 4 recurrences with none in patients with a Body Mass Index 3 32. One case of abdominal wall cellulitis responded to antibiotics. There were no wound infections, mesh infections, bowel obstructions or enteric fistulas. This study demonstrates the utility of a lighter-weight, large pore, partially absorbable mesh for intraperitoneal use in laparoscopic ventral herniarepair and indicates this mesh is strong enough for use in obese patients. PMID:22504983
BackgroundFemoral hernias in children are rare and often misdiagnosed. The classic treatment is through an open anterior approach. Since the advent of laparoscopic treatment of inguinal hernia in children, laparoscopy has been proposed to offer an accurate diagnosis and treatment, especially in case of recurrent hernia or bilateral disease. This review was undertaken to report our experience with the primary
Background The ultrasound-guided transverse abdominis plane block (TAPB) reduces postoperative pain after laparoscopic abdominal surgery. But, its effect post laparoscopic totally extraperitoneal herniarepair (TEP) is not clear. In this study, we evaluated the analgesic effect of ultrasound-guided TAPB in TEP. Methods In this prospective, randomized study, forty adult patients (ASA I-II) scheduled for a TEP under general anesthesia were studied. In the TAPB group (n = 20), an ultrasound-guided bilateral TAPB was performed with 0.375% ropivacaine 15 ml on each side after the induction of general anesthesia. The control group (n = 20) did not have TAPB performed. Fentanyl 50 µg was repeatedly injected as per the patient's request in the recovery room. Pain scores at rest and on coughing were assessed postoperatively in the recovery room (20 min, at discharge) and at 4, 8, and 24 hours after surgery. Results In the recovery room, pain scores (numeric rating scale, 0-10) at postoperative 20 min were lower in the TAPB group (3.9 ± 1.6, 4.9 ± 1.8) than the control group (6.9 ± 1.6, 8.0 ± 1.6) at rest and on coughing. Also, pain scores upon discharge from the recovery room were lower in the TAPB group (3.2 ± 1.2, 4.2 ± 1.5) than the control group (5.3 ± 1.6, 6.5 ± 1.8) at rest and on coughing. Conclusions The ultrasound-guided TAPB in patients that had undergone TEP reduced postoperative pain scores and the fentanyl requirement in the recovery room. Also, pain scores on coughing were reduced until postoperative 8 hours.
Kim, Mun Gyu; Ok, Si Young; Kim, Sang Ho; Lee, Se-Jin; Park, Sun-Young; Lee, Su Myung; Jung, Bo-Il
Purpose. Operative efficiency improvements for laparoscopic ventral herniarepair (LVHR) have focused on reducing operative time while maintaining overall repair efficacy. Our objective was to evaluate procedure time and positioning accuracy of an inflatable mesh positioning device (Echo PS Positioning System), as compared to a standard transfascial suture technique, using a porcine model of simulated LVHR. Methods. The study population consisted of seventeen general surgeons (n = 17) that performed simulated LVHR on seventeen (n = 17) female Yorkshire pigs using two implantation techniques: (1) Ventralight ST Mesh + Echo PS Positioning System (Echo PS) and (2) Ventralight ST Mesh + transfascial sutures (TSs). Procedure time and mesh centering accuracy overtop of a simulated surgical defect were evaluated. Results. Echo PS demonstrated a 38.9% reduction in the overall procedure time, as compared to TS. During mesh preparation and positioning, Echo PS demonstrated a 60.5% reduction in procedure time (P < 0.0001). Although a trend toward improved centering accuracy was observed for Echo PS (16.2%), this was not significantly different than TS. Conclusions. Echo PS demonstrated a significant reduction in overall simulated LVHR procedure time, particularly during mesh preparation/positioning. These operative time savings may translate into reduced operating room costs and improved surgeon/operating room efficiency.
Hanna, Erin M.; Voeller, Guy R.; Roth, J. Scott; Scott, Jeffrey R.; Gagne, Darcy H.; Iannitti, David A.
Background\\/Purpose: Poor prognosis (approximately 50% survival rate and significant morbidity) traditionally has been associated with congenital diaphragmatic hernia (CDH). The authors reviewed a single institution experience and challenged conventional wisdom in the context of a care strategy based on permissive hypercapnea\\/spontaneous respiration\\/elective repair. Methods: From August 1992 through February 2000, all infants with CDH and (1) respiratory distress requiring mechanical
Judd Boloker; David A. Bateman; Jen-Tien Wung; Charles J. H. Stolar
The increasing use of mesh insertion for groin herniarepair is dashed by a worrying prevalence of chronic pain frequently\\u000a related as a reaction to the biomaterial implantation. Thus, new biocompatible prosthesis, designed as a composite material\\u000a associating polypropylene (PP) and long-term absorbable material, are now under development. In the present study, the typical\\u000a commercially available Prolene mesh has been
Keitaro Tanaka; Didier Mutter; Harutaka Inoue; Véronique Lindner; George Bouras; Antonello Forgione; Joël Leroy; Marc Aprahamian; Jacques Marescaux
Introduction In recent years, laparoscopic repair of abdominal wall hernias has become increasingly established in routine clinical practice\\u000a thanks to the myriad advantages it confers. Apart from the risk of intestinal damage following adhesiolysis, to date no information\\u000a is available on the best way of preventing the formation of new adhesions in the vicinity of the implanted meshes. Numerous\\u000a experimental investigations,
Christine Schug-Pass; Florian Sommerer; Andrea Tannapfel; Hans Lippert; Ferdinand Köckerling
Purpose To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific\\u000a community concerning the prevention and the treatment of chronic groin and testicular pain.\\u000a \\u000a \\u000a \\u000a \\u000a Methods A group of nine experts in herniasurgery was created in 2007. The group set up six clinical questions and continued to work\\u000a on the answers, according to evidence-based literature.
S. Alfieri; P. K. Amid; G. Campanelli; G. Izard; H. Kehlet; A. R. Wijsmuller; D. Di Miceli; G. B. Doglietto
We report the case of a white male who underwent a classic hemipelvectomy due to a femur fibrosarcoma with inguinal metastases,\\u000a which 33 years later, developed into a posthemipelvectomy hernia in the amputation stump that impaired the use of his Canadian\\u000a prosthesis. The hernia was repaired with a polypropylene mesh in a subaponeurotic position. A seroma was drained in the postoperative
J. Die Trill; J. M. Fernández. Madrid; E. Ferrero; J. Igea; A. Torres; J. L. Gómez; I. Medina; C. Canales; F. Perea; P. Carda; A. García Villanueva; A. Die Goyanes
INTRODUCTION: Bochdalek hernia is a congenital defect of the diaphragm that usually presents in the neonatal period with life-threatening cardiorespiratory distress. It is rare for Bochdalek hernias to remain silent until adulthood. Once a Bochdalek hernia has been diagnosed, surgical treatment is necessary to avoid complications such as perforation and necrosis. CASE PRESENTATION: We present a 17-year-old Japanese boy with
Background: For the scientific evaluation of the endoscopic and open mesh techniques for the repair of inguinal hernia, meta-analyses of randomized controlled trials (RCT) are necessary. The Lichtenstein repair is one of the most common open mesh techniques and therefore of special interest. Methods: After an extensive search of the literature and a quality assessment, a total of 34 RCT
Introduction Frequent complications in incisional herniasurgery are re-herniation, wound infection and seroma formation. The use of subatmospheric\\u000a pressure dressings such as the vacuum-assisted closure (VAC) device has been shown to be an effective way to accelerate healing\\u000a of various wounds. Here, we describe the application of the VAC device as a postoperative dressing to prevent seroma formation\\u000a after open incisional
The aim of this prospective study was to compare the efficacy of oral versus parenteral prophylactic amoxicillin–clavulanic acid for preventing surgical site infection after open prosthetic mesh repair of inguinal hernia. A total of 480 inguinal-hernia patients were randomly assigned to two groups. Group I (n = 240) received 1.313 g oral amoxicillin–clavulanic acid 2 hours before operation, and group
Mehmet A. Kuzu; Selçuk Hazinedaro?lu; ?ükrü Dolalan; Nam?k Özkan; Samet Yalç?n; A. Bülent Erkek; Hatem Mahmoudi; Acar Tüzüner; Atilla H. Elhan; Ercümet Kuterdem
Background Biologic implants have been recommended for reinforcement in routine and challenging herniarepair. However, experimental\\u000a and clinical studies have reported adverse effects (e.g., slow implant integration and pronounced foreign body reaction).\\u000a To evaluate the impact of different material processing methods (cross-linking vs. non-cross-linking of collagen) and implant\\u000a design, four different biologic hernia implants were compared directly in experimental intraperitoneal onlay
A. H. Petter-Puchner; R. H. Fortelny; K. Silic; J. Brand; S. Gruber-Blum; H. Redl
A 60-year-old patient reported a slight decrease in visual acuity with loss of field of vision. He also noted a mild sense of vertigo and a feeling of "pressure in his head". He had undergone laparoscopic bilateral herniarepair 3 days before on an outpatient basis. Diagnostic work-up revealed shock-induced anterior ischemic optic neuropathy (AION) of the left eye. Without special treatment measures the head pressure and feeling of weakness subsided considerably in a spontaneous course within 24 h. Three months later partial optic atrophy of the affected eye was observed with stable visual acuity of 0.8 and unchanged loss of field of vision. PMID:19018540
Background Open inguinal herniarepair with high ligation is an excellent method of repair in the pediatric population. Advantages of\\u000a endoscopic repairs include the ability to evaluate the contralateral side, avoidance of access trauma to the vas deferens\\u000a and gonadal vessels, and decreased operative time. We now report our experience with subcutaneous endoscopically assisted\\u000a ligation (SEAL), a novel technique that has
D. Ozgediz; K. Roayaie; H. Lee; K. K. Nobuhara; D. L. Farmer; B. Bratton; M. R. Harrison
Introduction With an average incidence rate of 11%, chronic pain is considered the most serious complication of inguinal hernioplasty after surgical site infection. One of the proposed solutions to this problem is to use tissue adhesive for mesh fixation, which helps prevent nerve and tissue damage. Aim The goal of this study was to compare mesh fixation with the use of sutures vs. adhesive in Lichtenstein's inguinal herniarepair in a randomized, double-blind one-center study. Material and methods The study group consisted of 41 males with primary inguinal hernia undergoing Lichtenstein's repair (20 – adhesive; 21 – suture) and remaining in follow-up from July 2008 to November 2010. Randomization took place during the operation. The follow-up was performed by one surgeon (blinded) according to a pre-agreed schedule; the end-of-study unblinding was performed during the last follow-up visit, usually 16 months postoperatively. Results In 1 patient from the “adhesive” group, a recurrence was observed one year after the initial repair. The early postoperative pain was less intense in this group. In later postoperative periods the method of mesh fixation had no influence on the pain experienced by the patient. Other complications were not correlated with the method of mesh fixation. Conclusions In this randomized, one-center double-blind clinical study of males with primary inguinal hernia it has been show during follow-up that the use of Glubran 2 cyanoacrylate adhesive for mesh implant fixation yields similar recurrence and chronic pain rates as the classical suture technique. In the early postoperative period, the pain reported by these patients was relatively weaker; patients undergoing adhesive mesh fixation experienced a quicker return to daily household activities.
The Rives repair for ventral/incisional (V/I) hernias involves sublay mesh placement requiring retrorectus dissection and transfascial stitches. Chevrel described a repair by onlaying mesh after a unique primary fascial closure. Although Chevrel fixated mesh to the anterior fascia with sutures, he used fibrin glue for fascial closure reinforcement. We describe an onlay technique with mesh fixated to the anterior fascia solely with fibrin glue without suture fixation. From January 2010 to January 2012, 50 patients underwent a V/I hernia onlay technique with fibrin glue mesh fixation. Records were reviewed for technical details, demographics, mesh characteristics, and postoperative outcomes. Primary fascial closure with interrupted permanent suture was done with or without myofascial advancement flaps. Onlay polypropylene mesh was placed providing 8 cm of overlap. Fibrin glue was applied over the prosthesis and subcutaneous drains were placed. Mean age was 62.4 years. Mean body mass index was 30.1 kg/m(2). Average mesh size was 14.5 cm × 19.1 cm. Mean operative time was 144.4 minutes (range, 38 to 316 minutes). Mean discharge was postoperative Day 2.9 (range, 0 to 15 days). Morbidity included eight seromas, one hematoma, and three wound infections. Seventeen patients required components separation. Mean follow-up was 19.5 months with no recurrences. This is the first series describing fibrin glue alone for mesh fixation for V/I herniarepair. It allows for immediate prosthesis fixation to the anterior fascia. Early results are promising. Potential advantages include less operative time, less technical difficulty, and less long-term pain. A prospective trial is needed to evaluate this approach. PMID:24165253
Stoikes, Nathaniel; Webb, David; Powell, Ben; Voeller, Guy
Objectives Mild pain lasting for a few days is common following mesh inguinal herniarepair. In some patients however, severe groin pain\\u000a may appear months or even years postoperatively. The aim of this study was to report our experience of late-onset persisting\\u000a severe postoperative groin pain occurring years after mesh hernioplasty.\\u000a \\u000a \\u000a \\u000a Methods In a 9-year period, 1,633 patients (1,073 men), median age
S. Delikoukos; F. Fafoulakis; G. Christodoulidis; T. Theodoropoulos; C. Hatzitheofilou
Purpose Biologic meshes have unique physical properties as a result of manufacturing techniques such as decellularization, crosslinking, and sterilization. The purpose of this study is to directly compare the biocompatibility profiles of five different biologic meshes, AlloDerm® (non-crosslinked human dermal matrix), PeriGuard® (crosslinked bovine pericardium), Permacol® (crosslinked porcine dermal matrix), Strattice® (non-crosslinked porcine dermal matrix), and Veritas® (non-crosslinked bovine pericardium), using a porcine model of ventral herniarepair. Methods Full-thickness fascial defects were created in 20 Yucatan minipigs and repaired with the retromuscular placement of biologic mesh 3 weeks later. Animals were euthanized at 1 month and the repair sites were subjected to tensile testing and histologic analysis. Samples of unimplanted (de novo) meshes and native porcine abdominal wall were also analyzed for their mechanical properties. Results There were no significant differences in the bio-mechanical characteristics between any of the mesh-repaired sites at 1 month postimplantation or between the native porcine abdominal wall without implanted mesh and the mesh-repaired sites (P > 0.05 for all comparisons). Histologically, non-crosslinked materials exhibited greater cellular infiltration, extracellular matrix (ECM) deposition, and neovascularization compared to crosslinked meshes. Conclusions While crosslinking differentiates biologic meshes with regard to cellular infiltration, ECM deposition, scaffold degradation, and neovascularization, the integrity and strength of the repair site at 1 month is not significantly impacted by crosslinking or by the de novo strength/stiffness of the mesh.
Melman, L.; Jenkins, E. D.; Hamilton, N. A.; Bender, L. C.; Brodt, M. D.; Deeken, C. R.; Greco, S. C.; Frisella, M. M.; Matthews, B. D.
Pulmonary intercostal hernias are extremely rare. They have been reported to occur in children after blunt trauma to the chest wall as a result of disruption of intercostal muscle fibers. We present a case of a left anterior chest lung hernia caused by blunt handlebar chest trauma in a 13-year-old boy treated with placement of a mesh using a video-assisted thoracoscopic approach. PMID:21745099
A 9-month-old female baby was brought to our hospital with a large ventral hernia which had developed after conservative treatment of an exomphalos. A hitherto undescribed technique involving serial tightening of a Prolene mesh was utilised to close the ventral hernia. We were able to achieve a good result within a short period of 2 weeks, without resorting to ventilation. We propose this procedure as an alternative to other existing techniques in similar situations. PMID:16341536
OBJECTIVE:: We aimed to evaluate the effect of thoracoscopy in neonates on intraoperative arterial blood gases, compared with open surgery. BACKGROUND:: Congenital diaphragmatic hernia (CDH) and esophageal atresia with tracheoesophageal fistula (EA/TEF) can be repaired thoracoscopically, but this may cause hypercapnia and acidosis, which are potentially harmful. METHODS:: This was a pilot randomized controlled trial. The target number of 20 neonates (weight > 1.6 kg) were randomized to either open (5 CDH, 5 EA/TEF) or thoracoscopic (5 CDH, 5 EA/TEF) repair. Arterial blood gases were measured every 30 minutes intraoperatively, and compared by multilevel modeling, presented as mean and difference (95% confidence interval) from these predictions. RESULTS:: Overall, the intraoperative PaCO2 was 61 mm Hg in open and 83 mm Hg [difference 22 mm Hg (2 to 42); P = 0.036] in thoracoscopy and the pH was 7.24 in open and 7.13 [difference -0.11 (-0.20 to -0.01); P = 0.025] in thoracoscopy. The duration of hypercapnia and acidosis was longer in thoracoscopy compared with that in open. For patients with CDH, thoracoscopy was associated with a significant increase in intraoperative hypercapnia [open 68 mm Hg; thoracoscopy 96 mm Hg; difference 28 mm Hg (8 to 48); P = 0.008] and severe acidosis [open 7.21; thoracoscopy 7.08; difference -0.13 (-0.24 to -0.02); P = 0.018]. No significant difference in PaCO2, pH, or PaO2 was observed in patients undergoing thoracoscopic repair of EA/TEF. CONCLUSIONS:: This pilot randomized controlled trial shows that thoracoscopic repair of CDH is associated with prolonged and severe intraoperative hypercapnia and acidosis, compared with open surgery. These findings do not support the use of thoracoscopy with CO2 insufflation and conventional ventilation for the repair of CDH, calling into question the safety of this practice. The effect of thoracoscopy on blood gases during repair of EA/TEF in neonates requires further evaluation. (ClinicalTrials.gov Identifier: NCT01467245). PMID:23604057
Bishay, Mark; Giacomello, Luca; Retrosi, Giuseppe; Thyoka, Mandela; Garriboli, Massimo; Brierley, Joe; Harding, Louise; Scuplak, Stephen; Cross, Kate M; Curry, Joe I; Kiely, Edward M; De Coppi, Paolo; Eaton, Simon; Pierro, Agostino
The aim of this study was to report our experience in robotic-assisted surgery of hiatus hernia and gastroesophageal reflux\\u000a disease in a large series of complex cases. From March 2009 until July 2010, 21 patients were operated due to hiatus hernia\\u000a or reflux disease using robotic-assisted surgery at Albert Einstein Hospital, Săo Paulo, Brazil. All patients were selected\\u000a for the
Vladimir Schraibman; Antonio Luiz de Vasconcellos Macedo; Samuel Okazaki; Fernando Concilio Mauro; Marina Gabrielle Epstein; Suzan Menasce Goldman; Suzana Lustosa; Delcio Matos
Background The inguinal hernia is one of the most common diseases in the elderly. Treatment of this type of pathology is exclusively surgical and relies almost always on the use of local anesthesia. While in the past herniasurgery was carried out mainly by general anesthesia, in recent years there has been growing emphasis on the role of local anesthesia. Methods The aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine compared with that of bupivacaine. Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty. Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity. The study was conducted from April 2010 to May 2012. We collected data of forty male patients, aged between 73 and 85 years, who underwent inguinal hernioplasty with local anesthesia for the first time. Results Minimal pain is the same in both groups. Mild pain was more frequent in the group who used bupivacaine, moderate pain was slightly more frequent in the group who used levobupivacaine, and the same for intense pain. It is therefore evident how Bupivacaine is slightly less preferred after four and twenty four hours, while the two drugs seem to have the same effect at a distance of twelve and forty-eight hours. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. The request for an analgesic was slightly higher in patients receiving levobupivacaine. Conclusions After considering all these elements, we can conclude that the clinical efficacy of levobupivacaine and racemic bupivacaine are essentially similar, when used under local intervention of inguinal hernioplasty.
Background Persistent, activity-limiting pain after laparoscopic ventral or incisional herniarepair (LVIHR) appears to be related to fixation of the implanted mesh. A randomized study comparing commonly used fixation techniques with respect to postoperative pain and quality of life has not previously been reported. Methods A total of 199 patients undergoing non-urgent LVIHR in our unit between August 2005 and July 2008 were randomly assigned to one of three mesh-fixation groups: absorbable sutures (AS) with tacks; double crown (DC), which involved two circles of tacks and no sutures; and nonabsorbable sutures (NS) with tacks. All operations were performed by one of two experienced surgeons, who used a standardized technique and the same type of mesh and mesh-fixation materials. The severity of the patients’ pain was assessed preoperatively and at 2 weeks, 6 weeks and 3 months postoperatively by using a visual analogue scale (VAS). Quality of life (QoL) was evaluated by administering a standard health survey before and 3 months after surgery. Results in the three groups were compared. Results The AS, DC, and NS mesh-fixation groups had similar patient demographic, hernia and operative characteristics. There were no significant differences among the groups in VAS scores at any assessment time or in the change in VAS score from preoperative to postoperative evaluations. The QoL survey data showed a significant difference among groups for only two of the eight health areas analyzed. Conclusion In this trial, the three mesh-fixation methods were associated with similar postoperative pain and QoL findings. These results suggest that none of the techniques can be considered to have a pain-reduction advantage over the others. Development of new methods for securing the mesh may be required to decrease the rate or severity of pain after LVIHR.
Schoenmaeckers, Ernst; Raymakers, Johan; van der Palen, Job; Rakic, Srdjan
Background: The ideal mesh for laparoscopic ventral herniarepair is not yet identified. Methods: We laparoscopically placed polypropylene (PPM), expanded polytetrafluoroethylene (ePTFE), and polyester with antiadhesive collagen layer (PCO) in eight pigs using sutures and tacks for fixation. After 28-day survival, we compared adhesion formation, fibrous ingrowth, and shrinkage among the types of mesh. Results: Mean area of adhesions to
J. J. McGinty; N. J. Hogle; H. McCarthy; D. L. Fowler
PurposeTo achieve satisfactory surgical and cosmetic results with minimal surgical invasiveness without laparoscopic assistance in childhood inguinal herniarepair, a novel technique, the selective sac extraction method (SSEM), was devised. The technical feasibility of this method was retrospectively examined.
Background: Roux-en-Y gastric bypass (RYGBP) has long been associated with the possible development of internal hernias, with\\u000a a reported incidence of 1-5%. Because it induces fewer adhesions than laparotomy, the laparoscopic approach to this operation\\u000a appears to increase the rate of this complication, which can present dramatically. Methods: Data from all patients undergoing\\u000a bariatric surgery are introduced prospectively in a
The aim of this study was to demonstrate the efficacy and safety and report the results of prosthesis fixation by means of fibrin glue during laparoscopic treatment of inguinal and femoral hernias. From September 2001 to December 2004 we employed fibrin glue (Tissucol, Baxter, Maurepas) as a means of fixation during a transabdominal preperitoneal procedure in 230 patients (225 M, 5 F) with an average age of 45 years (range: 20-75) presenting a total of 320 hernias: 140/230 (60.8%) were monolateral and 90 (39.2%) bilateral; 267/320 hernias (83.6%) were primary and 53 (16.4%) recurrent. We had no perioperative complications. After an average follow-up of 26 months (range: 1-40) the only postoperative complications we encountered were 6 seromas (1.8%) and 1 trocar-site haematoma (0.3%). None of the patients developed scrotal haematomas. None of the patients complained of immediate or subsequent paraesthesia or cruralgia. No recurrences have occurred to date. The mean operative time was 30 minutes for monolateral hernias (range: 15-45) and about 50 minutes for bilateral hernias (range: 30-75). This was true of both primary and recurrent hernias. Patients are usually discharged on day 1 postoperatively. In the absence of pain, working activities are resumed after 5 days and sports can be practiced after 10 days. In our experience, fibrin glue (Tissucol) is the best way of fixing the mesh during a transabdominal preperitoneal procedure. It is better than mechanical devices because, though guaranteeing prosthetic stability, it is completely non-traumatic and presents none of the problems of metal clips. PMID:16400772
Large incisional hernias are difficult to treat surgically because of the post-operative respiratory complications and abdominal compartment syndrome. Pre-operative progressive pneumoperitoneum is a technique which has been used in such cases. We describe a case of a large incisional hernia, where this technique was employed by objectively calculating abdominal and hernial sac volumes on the basis of computerized tomography scan of abdomen with a satisfactory outcome. A review of literature and issues involved in pre-operative progressive pneumoperitoneum have been discussed. PMID:22392573
Quraishi, Abdul Haque M; Borkar, Mrinalini M; Mastud, Mayur M; Jannawar, Gaurav G
Incisional hernias represent one of the most frequent complications of abdominal surgery. The incidence is probably underestimated. The pathogenesis is complex and not fully understood, implying patient-related factors (i.e., collagen biochemistry, obesity, age) as well as technical factors, including, among others, wound infection, suture material, and types of incisions and closures. In this paper, the first of two, the authors
IntroductionInfected incisional hernias are common in kidney transplant patients. Treating them in immunosuppressed patients can take months, increasing costs and implying loss of working productivity. Abdominal wall prostheses have not been used in infected immunosuppressed patients because of poor infection control. We evaluated the outcome of the surgical treatment of these patients with polypropylene mesh to shorten the hospitalization time
Ioannis Michel Antonopoulos; William Carlos Nahas; Eduardo Mazzucchi; Affonso Celso Piovesan; Claudio Birolini; Antonio Marmo Lucon
The case reported here is a 32-year-old man with a sudden onset of chest pain and an acute deterioration of lung function.\\u000a An incarcerated Morgagni hernia was diagnosed with a computer tomographic CT scan, and repaired electively via a midline laparotomy.\\u000a Morgagni hernia is a rare type of congenital diaphragmatic hernia, which may not be symptomatic until adulthood when the
Background Mesh graft infection after prosthetic herniarepair is a challenging complication usually treated by mesh removal. The aim\\u000a of this study was to identify risk factors associated with mesh infection and to assess the efficacy of conservative wound\\u000a therapy in preserving an infected mesh.\\u000a \\u000a \\u000a \\u000a \\u000a Methods We performed a retrospective analysis of 476 consecutive patients with incisional hernia who received mesh graft
Stefan Stremitzer; Thomas Bachleitner-Hofmann; Bernhard Gradl; Matthias Gruenbeck; Barbara Bachleitner-Hofmann; Martina Mittlboeck; Michael Bergmann
Our objective was to determine the accuracy of laparoscopic evaluation to detect a contralateral patent processus vaginalis (CPPV) at initial presentation for inguinal hernia (IH) repair and the rate of CPPV relative to age, sex, and initial hernia side. We performed a 5-year retrospective review of 1580 pediatric patients with unilateral IH in which surgeons selectively used laparoscopy to evaluate for a CPPV. There were 1205 boys and 303 girls; 980 (65%) presented with right IH (RIH) and 528 (35%) with left IH (LIH). Laparoscopic evaluation was performed in 459 (47%) patients presenting with RIH and 225 (43%) patients presenting with LIH. Laparoscopic evaluation was positive for CPPV in 32 per cent of patients with RIH and 42 per cent of patients with LIH (P = 0.0168). CPPV was associated with prematurity (P = 0.0003) and age younger than 6 months (P = 0.0001) but not with sex (P = 0.55). The future contralateral occurrence rate was 1.6 per cent and recurrence rate 0.2 per cent. This study supports the accuracy of CPPV evaluation by laparoscopy. Although the rate of CPPV decreases after 6 months of age, girls older than 2 years of age have a significantly higher rate of CPPV than boys, supporting laparoscopic evaluation in older girls. PMID:22196658
Draus, John M; Kamel, Sarah; Seims, Aaron; Rescorla, Frederick J
In spite of modern advances in medical care, the operative mortality of ruptured abdominal aortic aneurysm remains high at 40%-50%. Multiple organ failure is one of the reasons for the high mortality rates. An acute increase in intra-abdominal pressure and abdominal compartment syndrome are common causes of multiple organ failure.It is important to prevent abdominal compartment syndrome to improve the outcome of ruptured abdominal aortic aneurysm. Delayed abdominal closure is effective in preventing abdominal compartment syndrome in patients with ruptured abdominal aortic aneurysm. We successfully achieved delayed abdominal closure using the ventral herniarepair prosthesis for a ruptured abdominal aortic aneurysm, in a straightforward and rapid manner. No infection was seen, secondary closure was readily performed, and wound healing was good. We conclude that our delayed closure technique is useful for the treatment of ruptured abdominal aortic aneurysm. PMID:23328109
Background Pain remains a significant clinical problem after inguinal herniarepair. We prospectively assessed post-surgical pain following\\u000a herniorrhaphy in 1,440 operations with the aim of describing the characteristics and identifying predisposing factors for\\u000a pain.\\u000a \\u000a \\u000a \\u000a Methods Pain quality was assessed with the short-form McGill Pain Questionnaire (SF-MPQ); pain character was estimated as either nociceptive\\u000a or neuropathic in nature.\\u000a \\u000a \\u000a \\u000a Results A total of 38.3% of
S. Massaron; S. Bona; U. Fumagalli; F. Battafarano; U. Elmore; R. Rosati
The occurrence of enteric fistulae after wall repair using a prosthetic mesh is a serious but, fortunately, rare complication. We report the case of a 66-year-old diabetic man who presented with gas gangrene of the abdominal wall due to an intra-abdominal abscess caused by intestinal erosion six years after an incisional herniarepair using a polyester mesh. The aim of this case report is to illustrate the seriousness of enteric fistula after parietal repair using a synthetic material. PMID:20922446
Moussi, A; Daldoul, S; Bourguiba, B; Othmani, D; Zaouche, A
Giant inguinoscrotal hernias present a challenging surgical problem and are associated with high morbidity and mortality. The main difficulty is that of returning herniated viscera to an abdominal cavity accustomed to being empty, also known as loss of domain. In our case, we present laparoscopic component separation as a technique to increase capacity of the abdominal cavity to facilitate closure and reduce postoperative complications in those patients.
Background Prosthetic reinforcement is the gold standard treatment for inguinal hernia and reduces the risk of recurrence. Yet up to\\u000a one-third of patients complain of post-surgical pain due to irritation and inflammation caused by the mesh and the fixation\\u000a materials. Of these patients, 3–4% will experience severe and disabling chronic pain. We performed a prospective multicenter\\u000a clinical study of a self-adhering
G. Champault; A. Torcivia; L. Paolino; W. Chaddad; F. Lacaine; C. Barrat
Background Incisional hernias after laparotomy are a large financial burden for society as well as for the patients suffering from pain\\u000a and limitations of activity over time. The introduction of alloplastic materials such as polypropylene seems to improve the\\u000a results. The question of whether to apply open or laparoscopic implantation of the mesh is of ongoing interest. We compare\\u000a the available
Matthias Kapischke; Tim Schulz; Thorsten Schipper; Jochen Tensfeldt; Amke Caliebe
. This study was undertaken to assess the degree of ubiquity of umbilical hernias (UHs) in Nigerians and to determine if a\\u000a laissez faire approach to the presence of UHs is justified. A prospective evaluation was conducted of the umbilical area of\\u000a 4052 Nigerians living in the vicinity of the Baptist Medical Centre (BMCO) in Ogbomoso, Nigeria. The diameter of
Donald E. Meier; David A. OlaOlorun; Rachael A. Omodele; Sunday K. Nkor; John L. Tarpley
... less time for the inguinal canal to close. Direct inguinal hernia. Direct inguinal hernias are caused by connective tissue degeneration ... weakening of the muscles during the adult years. Direct inguinal hernias occur only in males. The hernia ...
Port site hernia develops through a fascial or peritoneal layer that was inadequate or not repaired. It is a rare complication of laparoscopic surgery which may lead to serious problems. Here, we present a 77-year-old female, diagnosed with a small bowel hernia through a 10-mm port site. We had performed ten cases of laparoscopy-assisted distal gastrectomy before this case. The
An Amyand's hernia refers to the presence of an appendix within an inguinal hernia sac. This uncommon finding occurs in less than 1% of all right side inguinal hernias; to date, this finding has been reported in only 14 patients with left side inguinal hernias. The preoperative diagnosis of this condition is uncommon. We report the 15th case of a left side Amyand's hernia that was diagnosed preoperatively on a contrast enema study as well as the relatively more common right-sided Amyand's hernia diagnosed serendipitously at surgery. PMID:23691419
We present the first reported case of iatrogenic aortocaval fistula due to trochar injury after attempted laparoscopic repair of incisional hernia. It was diagnosed with an x-ray computed tomography and successfully managed with an endovascular-covered stent graft by excluding the fistula. A follow-up computed tomography scan at 3 months did not show any recurrence. PMID:22678342
Background: The treatment of incisional hernia (IH) is a current problem in modern surgery. Many important aspects of incisional herniasurgery are yet to be answered, especially the choice of surgical technique and its adaptation to the individual patient. The aim of this experts' meeting was to resolve some current questions in incisional herniasurgery and to organise an international
M. Korenkov; A. Paul; S. Sauerland; E. Neugebauer; M. Arndt; J. P. Chevrel; F. Corcione; A. Fingerhut; J. B. Flament; M. Kux; A. Matzinger; H. E. Myrvold; A. M. Rath; R. K. J. Simmermacher
The considerable progress, performed for more than 30 years, in paediatric and interventional cardiology, imaging, surgery, anaesthesia and critical care in the congenital heart diseases allowed the survival the adulthood of more than 85 % of the affected children. The univentricular repair in total cavopulmonary connection or Fontan procedure, are realized in three stages, now, before the age of 5 years, with a different physiology after each stage. This point makes anaesthetic care more complicated for a non-cardiac surgery. The precise knowledge of the physiology of the "Fontan" is necessary before proceeding with anaesthesia. It allows to anticipate the pitfalls and to define specific strategies to be applied. PMID:23305872
An otherwise healthy 17-year-old boy presented to the paediatric emergency department with acute severe epigastric pain. An admission abdominal radiograph demonstrated gastric dilation, associated with an elevated left hemidiaphragm. Subsequent barium contrast imaging confirmed the diagnosis of organoaxial acute gastric volvulus (AGV). Emergent exploratory laparoscopy revealed AGV with migration of the stomach, spleen, pancreatic tail, splenic flexure, left kidney and adrenal through a left-sided Bochdalek diaphragmatic hernia. Following careful mobilisation of the displaced structures, a mesh closure of the diaphragmatic defect was performed. The patient's postoperative chest radiograph was unremarkable, and he was discharged on the sixth postoperative day after an uneventful recovery. At 2 months the patient was well and asymptomatic, with normal barium contrast imaging results. PMID:23519514
Thoracoscopic repair is feasible and safe for congenital diaphragmatic hernia (CDH). The operation can be performed with three trocars using carbon dioxide insufflations at a pressure of 4-6 mmHG. From January 2001 to July 2012, we performed thoracoscopic repair for 311 children with CDH including 152 newborns and 159 infants and toddlers. Mean operative time was 75 ± 27 min. HFOV was used in 24 patients. Direct closure of two rims of diaphragmatic hernia was carried out in 175 patients. Closure of two rims of diaphragmatic hernia with the thoracic wall was performed in 136 patients. Prosthetic patches were required in 54 patients. Conversion to open surgery was required in 38 patients (12.2 %). There were no intraoperative deaths. 38 patients died postoperatively (13.5 %). PMID:23999906
Objectives To determine whether a transverse incision is an alternative to a midline incision in terms of incisional hernia incidence,\\u000a surgical site infection, postoperative pain, hospital stay and cosmetics in cholecystectomy.\\u000a \\u000a \\u000a \\u000a Summary background data Incisional hernias after midline incision are commonly underestimated but probably complicate between 2 and 20% of all abdominal\\u000a wall closures. The midline incision is the preferred incision for
A 26-year-old Rwandan male presented with constrictive pericarditis, massive ascites and a giant umbilical hernia that had been asymptomatic for over a decade. Successful pericardiectomy was complicated by prompt incarceration of the abdominal hernia. This unexpected complication was caused by rapid resolution of the ascites due to autodiuresis and subsequent collapse of the hernial orifice. Patients with constrictive pericarditis and massive ascites who are evaluated for pericardiectomy should be carefully examined for the presence of abdominal hernias. If any such hernias are found, perioperative herniarepair should be considered and postoperative diuresis should be undertaken under close observation. PMID:21930673
Rajab, Taufiek Konrad; Maurice, Musoni; Munyana, Jackline; Robinson, Barbara
INTRODUCTION Epigastric hernia is a rare form of ventral abdominal hernia. When neglected it can attain an impressive size causing it un-aesthetic effect in addition to diagnostic difficulties. PRESENTATION OF CASE Presented is a 60-year-old female farmer with a 10-year history of a voluminous mass in the anterior abdominal wall. DISCUSSION Surgery revealed an epigastric hernia presenting as an interparietal hernia. The hernia was an omentocele with a grossly distended hernia sac filled with about 2.5 l of serous fluid. No similar case has been found in the medical literature. CONCLUSION Epigastric hernia can attain voluminous dimensions and present as a non-inguinal interparietal hernia.
Asuquo, Maurice E.; Nwagbara, Victor I.C.; Ifere, Michael O.
In the past decade herniasurgery has been challenged by two new technologies: by laparoscopy, which has attempted to change the traditional open operative techniques, and by prosthetic mesh, which has achieved much lower recurrence rates. The demand by health care providers for increasingly efficient and cost-effective surgery has resulted in modifications to pathways of care to encourage more widespread adoption of day case, outpatient surgery, and local anaesthesia. In addition, the UK National Institute for Clinical Excellence has recommended strategies for bilateral and recurrent hernias. Here, we discuss these strategies and review some neglected aspects of hernia management such as trusses, antibiotic cover, return to work and activity, and emergency surgery. Many of the principles of management apply equally to inguinal and incisional hernias. We recommend that the more difficult and complex of the procedures be referred to specialists. PMID:14615114
... diagnosis is made by physical examination and sometimes ultrasonography or a computed tomography scan. Treatment involves surgery ... computed tomography epididymis inguinal inguinal hernia peritonitis spermatocele ultrasonography umbilical varicocele vas deferens Back to Top Previous: ...
Over half of the cases of congenital diaphragmatic hernia are picked up prenatally. Prenatal assessment aims to rule out associated anomalies and to make an individual prognosis. Prediction of outcome is based on measurements of lung size and vasculature as well as on liver herniation. A subset of fetuses likely to die in the postnatal period is eligible for a
Jan A. Deprest; Kypros Nicolaides; Eduard Gratacos
Endoscopic techniques are commonly used for many different types of surgery. It is claimed that videoendoscopic procedures have the advantage of being less traumatic and of offering higher postoperative patient comfort than conventional open techniques. The extent of tissue trauma can be evaluated on the basis of the inflammatory response observed in the wake of surgery. Available studies that have
R. Schwab; S. Eissele; U. B. Brückner; F. Gebhard; H. P. Becker
BACKGROUND The purpose of this study was to compare tissue incorporation and adhesion characteristics of a novel fenestrated versus nonfenestrated crosslinked porcine dermal matrix (CPDM) (Bard CollaMend) in a porcine model of ventral herniarepair. STUDY DESIGN Bilateral abdominal wall defects were created in 24 Yucatan minipigs, resulting in 48 defects, which were allowed to mature for 21 days. Twelve defects were repaired with fenestrated CPDM using a preperitoneal technique, 12 with fenestrated CPDM using an intraperitoneal technique, 12 with nonfenestrated CPDM using a preperitoneal technique, and 12 with nonfenestrated CPDM using an intraperitoneal technique. Half of the animals in the intraperitoneal group were euthanized after 1 month, and the other half after 3 months. Similarly, half of the animals in the preperitoneal group were euthanized after 1 month, and the other half after 6 months. Biomechanical testing and histologic evaluation were performed. RESULTS Intraperitoneal placement of the CPDM products resulted in significantly greater adhesed area compared with preperitoneal placement (p < 0.05). Tissue ingrowth into preperitoneal fenestrated and nonfenestrated CPDM resulted in significantly greater incorporation strengths after 6 months compared with 1 month (p = 0.03 and p < 0.0001). Histologic analysis showed significantly greater cellular infiltration, extracellular matrix deposition, and neovascularization, with less fibrous encapsulation through the center of the fenestrations compared with all other sites evaluated, including nonfenestrated grafts. CONCLUSIONS Histologic findings revealed increased tissue incorporation at fenestration sites compared with nonfenestrated grafts regardless of implant location or time in vivo. However, preperitoneal placement resulted in greater incorporation strength, less adhesed area, and lower adhesion scores compared with intraperitoneal placement for both fenestrated and nonfenestrated CPDM.
Jenkins, Eric D; Melman, Lora; Deeken, Corey R; Greco, Suellen C; Frisella, Margaret M; Matthews, Brent D
Bilateral congenital diaphragmatic hernia (CDH) is a rare birth defect, with a poor prognosis. We describe a case of bilateral CDH discovered while repairing the right sided CDH. Diaphragmatic defect was repaired and a silo was applied on the abdominal wound to avoid abdominal compartment syndrome. The patient however died postoperatively due to severe pulmonary hypertension. PMID:23061036
Dhua, Anjan Kumar; Aggarwal, Satish K; Mathur, Nb; Sethi, Gr
We describe an effective surgical technique in primary repair of the spinal dura during minimally invasive spine surgery (MISS). Objective. Minimally invasive spine surgery includes the treatment of intradural lesions, and proper closure of the dura is necessary. However, primary dural closure can be difficult due to the restricted space of MIS retractors and the availability of appropriate surgical instrumentation. Methods. We describe the use of a needle already used in the pediatric neurosurgical arena that can facilitate easier and safer closure of spinal dura through MISS retractors in two illustrative intradural cases. Results and Discussion. The primary dural closure technique is described and patient demographics are included. The instruments specifically used for the intradural closure through MIS retractor systems include (1) 4-0 Surgilon braided nylon (Covidien, Dublin, Ireland) with a CV-20 taper 1/2 circle, 10?mm diameter needle; (2) Scanlan (Saint Paul, MN, USA) dura closure set. Conclusion. Successful primary dural repair can be performed on primary and incidental durotomies during minimally invasive spinal surgery. We describe the novel use of a 10?mm diameter needle to help surgeons safely and efficiently close the dura with more ease than previously described.
Haque, Raqeeb M.; Hashmi, Sohaib Z.; Ahmed, Yousef; Ogden, Alfred T.; Fessler, Richard
A 45-year-old man presented to our clinic requesting evaluation for surgical treatment of chronic low back pain of more than 20 years duration. He was diagnosed with 3-level lumbar spondylolysis at L3–5. Direct repair using the pedicle screw and hook-rod system was conducted for all three levels. After the surgery, his low back pain completely disappeared. Six months later, he felt discomfort and heard a metallic sound as he twisted his trunk. Computed tomography and radiography indicated that the hook head for L3 and the screw head for L4 were interfering with each other, causing the sound. We confirmed bony union at L3 and removed the L3 system. Surgeons should be aware of such complications if direct repair using a pedicle screw and hook-rod system is conducted for multilevel spondylolysis.
A 45-year-old man presented to our clinic requesting evaluation for surgical treatment of chronic low back pain of more than 20 years duration. He was diagnosed with 3-level lumbar spondylolysis at L3-5. Direct repair using the pedicle screw and hook-rod system was conducted for all three levels. After the surgery, his low back pain completely disappeared. Six months later, he felt discomfort and heard a metallic sound as he twisted his trunk. Computed tomography and radiography indicated that the hook head for L3 and the screw head for L4 were interfering with each other, causing the sound. We confirmed bony union at L3 and removed the L3 system. Surgeons should be aware of such complications if direct repair using a pedicle screw and hook-rod system is conducted for multilevel spondylolysis. PMID:23607020
Ophthalmic surgery currently utilizes suture materials to repair wounds created during eye operations. Although effective, suture-based techniques can result in complications that further impair the patient's vision, such as retinal detachment and scleral perforation associated with strabismus (eye muscle) surgery. Two techniques currently under development avoid sutures altogether, yielding similar strength results, reduced operating time, and simpler methods of repair. The first of these techniques employs a light-activated scaffold-enhanced protein solder to re-adhere the tissue. The second technique utilizes commercially available bioadhesives that have been scaffold-enhanced to improve their handling characteristics. A comparison of these two techniques is given. Initial tensile strength results show a higher strength of repair when a scaffold is utilized, with significantly less variations within each experimental group. Repairs formed using the scaffold-enhanced cyanoacrylate adhesives were the strongest. The tensile strength of extraocular muscle-to-sclera adhesions was 72% stronger than cyanoacrylate alone (4.2 +/- 0.2 N vs. 2.4 +/- 0.4 N) and 78% stronger than native tissue (2.3 +/- 0.4 N). Sclera-to-sclera adhesions were 60% stronger than adhesions formed with cyanoacrylate alone (3.9 +/- 0.2 N vs. 2.5 +/- 0.4 N), while the tensile strength of extraocular muscle-to-extraocular muscle adhesions were 81% of native extraocular muscle tensile strength (5.6 +/- 0.2 N vs. 6.2 +/- 0.3 N), and 50% stronger than adhesions formed using cyanoacrylate alone (3.6 +/- 0.4 N). The data analysis and resulting conclusions favor the less invasive adhesive technique as an alternative for tissue reattachment during ophthalmic procedures. Future experiments will examine the optimization of application parameters and detail tensile strength time course studies. PMID:15133935
Hoffman, Grant T; Soller, Eric C; Bloom, Jeffrey N; Duffy, Mark T; Heintzelman, Douglas L; McNally-Heintzelman, Karen M
We report the rare case of a pregnant woman who had undergone Roux-en-Y gastric bypass 8 months previously, and now presented\\u000a with subacute small bowel obstruction secondary to internal herniation of some of the proximal Roux limb into the lesser sac\\u000a through the transverse mesocolon rent, which was widely spread apart. At laparoscopy, the hernia contents were reduced and\\u000a the
Femoral hernia is a rare surgical entity in the paediatric age group. The diagnosis is still a challenging issue. The aim of our study was to review our experience with femoral hernias in children during the past 21 years. We reviewed retrospectively the medical records of all patients who underwent femoral herniarepair in our institution between 1980 and 2000. Thirty-eight
Introduction An internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery. Although they are considered as a rare cause of intestinal obstruction, paraduodenal hernias are the most common type of congenital hernias. Methods A literature search using PubMed was performed to identify all published cases of left paraduodenal hernia (LPDH). Results In Literature search between 1980 and 2012 using PubMed revealed only 44 case reports before the present one. Median age was 47 years (range 18 – 82 years). Nearly 50% reported previous mild symptoms. Two-third of patients required emergency surgery in form of laparotomy or laparoscopic repair. Reduction of hernia contents with widening or suture repair of the hernia orifice were the most common standards in surgical management of LPDH. Conclusion Intestinal obstruction secondary to internal hernias is a rare presentation. High index of suspicion and preoperative imaging are essential to make an early diagnosis in order to improve outcome.
Background\\/PurposeIn 1995, we developed laparoscopic percutaneous extraperitoneal closure (LPEC) to treat inguinal hernias in children. This study evaluated LPEC's safety, efficacy, and reliability in 3 hospitals.
Surgical meshes today represent a group of implants mainly used for herniarepair. Modern herniasurgery is no longer imaginable\\u000a without the application of these special biomaterials leading to millions of implantations each year worldwide. Because clinical\\u000a trials are insufficient to evaluate the distinct effects of modified mesh materials in regard to tissue biocompatibility and\\u000a functionality, a basic understanding of
Marcel Binnebösel; Klaus T. von Trotha; Petra Lynen Jansen; Joachim Conze; Ulf P. Neumann; Karsten Junge
Purpose The repair of groin hernias with local anesthesia has gained popularity. Two main methods have been described for local anesthesia. This study was aimed at comparing percutaneous truncular ilioinguinal-iliohypogastric block and step-by-step infiltration technique by using cadaver dissections. Methods The study was performed on an adult male cadaver by using blue dye injection. A percutaneous nerve block simulation was done on right side and the dye was given in between the internal oblique and transversus muscles. On the left side, a skin incision was deepened and the dye was injected under the external oblique aponeurosis. Following the injections, stained areas were investigated superficially and within the deeper tissues with dissection. Results There was a complete superficial staining covering the iliohypogastric and ilioinguinal nerves in the inguinal floor at both sides. On the right side, intraabdominal observation showed a wide and intense peritoneal staining, while almost no staining was seen on the left side. Preperitoneal dissection displayed a massive staining including testicular vascular pedicule and vas deferens on the right side. The dye solution also infiltrated the area of the femoral nerve prominently. On the contrary, a very limited staining was seen on the left. Conclusion It may not always be easy to keep the percutaneous block within optimum anatomical limits without causing adverse events. A step-by-step infiltration technique under direct surgical vision seems to be safer than percutaneous inguinal block for patients undergoing inguinal herniarepair.
Ergul, Zafer; Esmer, Ali Firat; Sen, Tulin; Akkaya, Taylan; Elhan, Alaittin
BACKGROUND The objective of this study was to evaluate the biomechanical characteristics and histologic remodeling of crosslinked (Peri-Guard, Permacol) and non-crosslinked (AlloDerm, Veritas) biologic meshes over a 12 month period using a porcine model of incisional herniarepair. STUDY DESIGN Bilateral incisional hernias were created in 48 Yucatan minipigs and repaired after 21 days using an underlay technique. Samples were harvested at 1, 6, and 12 months and analyzed for biomechanical and histologic properties. The same biomechanical tests were conducted with de novo (time 0) meshes as well as samples of native abdominal wall. Statistical significance (p < 0.05) was determined using 1-way analysis of variance with a Fisher's least significant difference post-test. RESULTS All repair sites demonstrated similar tensile strengths at 1, 6, and 12 months and no significant differences were observed between mesh materials (p > 0.05 in all cases). The strength of the native porcine abdominal wall was not augmented by the presence of the mesh at any of the time points, regardless of de novo tensile strength of the mesh. Histologically, non-crosslinked materials showed earlier cell infiltration (p < 0.01), extracellular matrix deposition (p < 0.02), scaffold degradation (p < 0.05), and neovascularization (p < 0.02) compared with crosslinked materials. However, by 12 months, crosslinked materials showed similar results compared with the non-crosslinked materials for many of the features evaluated. CONCLUSIONS The tensile strengths of sites repaired with biologic mesh were not impacted by very high de novo tensile strength/stiffness or mesh-specific variables such as crosslinking. Although crosslinking distinguishes biologic meshes in the short-term for histologic features, such as cellular infiltration and neovascularization, many differences diminish during longer periods of time. Characteristics other than crosslinking, such as tissue type and processing conditions, are likely responsible for these differences.
Deeken, Corey R; Melman, Lora; Jenkins, Eric D; Greco, Suellen C; Frisella, Margaret M; Matthews, Brent D
Introduction Cases of right paraduodenal hernia and superior mesenteric artery syndrome have been reported separately, but their occurrence in combination has not been reported. Case presentation A 46-year-old Japanese man who had never undergone laparotomy was admitted to our hospital due to an acute abdomen. An enhanced multidetector-row computed tomography scan of our patient showed a cluster of small intestines with ischemic change in his right lateral abdominal cavity. Emergency surgery was subsequently performed, and strangulation of the distal jejunum along with incidental right paraduodenal hernia was found. His necrotic ileum was resected, and the jejunum encapsulated by the sac was repaired manually without reduction. Three days after the operation, however, our patient developed vomiting. An upper gastrointestinal series revealed a straight line cut-off sign on the third portion of his duodenum. A second enhanced multidetector-row computed tomography scan showed that he had a lower aortomesenteric angle and a shorter aortomesenteric distance compared to his condition before his right paraduodenal hernia was surgically repaired. We strongly suspected that the right paraduodenal herniarepair may have induced superior mesenteric artery syndrome. On the 21st post-operative day, duodenojejunostomy was performed because conservative management had failed. Conclusions In this case, enhanced multidetector-row computed tomography, which permits reconstructed multiplanar imaging, helped us to visually identify these diseases easily. It is important to recognize that surgical repair of a right paraduodenal hernia may cause superior mesenteric artery syndrome.
Background / Aim: Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in our region. The setting is the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria during a period when prosthetic mesh was not readily available. Patients and Methods: All the women who presented with incisional hernia between 1996 and 2005 were prospectively studied using a standard form to obtain information on pre-hernia (index) operations and possible predisposing factors. They all had open surgical repair and were followed up for 18–60 months. Results: Forty-four women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/44 (59.1%), emergency exploratory laparotomy 6/44 (13.6%), and elective surgeries 12/44 (27.3%). Major associated risk factors were the use of wrong suture materials for fascia repair, midline incisions, wound sepsis, and overweight. Conclusion: For elective surgeries, reduction of weight should be encouraged when appropriate, and transverse incisions are preferred. Absorbable sutures, especially chromic catgut, should be avoided in fascia closure. Antibiotics should be used for complicated obstetric cases.
Agbakwuru, EA; Olabanji, JK; Alatise, OI; Okwerekwu, RO; Esimai, OA
The use of prosthetic meshes in incisional herniasrepairs is now very attractive, particularly for wide fascial defects; nevertheless the presence of a foreign body and placement technique may be responsible for complications sometimes leading to failure. To evaluate technical problems and complications in incisional herniasurgery the authors reviewed their 5 year experience in 70 patients; 39 mesh repairs and 31 direct sutures of the abdominal wall were performed. Local complications (fistulas, wound hematoma or infections) were more frequent in the former group; PTFE meshes showed a lower resistance to infections, particularly in diabetics, and in three patients partial or total removal was mandatory. Prosthetic meshes showed a marked reduction of recurrences in incisional herniasurgery, but their use leads to more local complications than direct repair; the authors believe that mesh placement must be evaluated for every single patient and not used as a routine procedure. PMID:9297143
Garavello, A; Tuccimei, U; Sadighi, A; Belardi, A; Remedi, M; Antonellis, D
One major problem for patients with myelomeningocele (MMC) is fecal incontinence. To prevent this problem, fetal surgery for repair of MMC has been recently undertaken. The strategy behind this surgery is to allow normal development of anal sphincter muscles. The purpose of this study was to determine whether fetal surgery for repair of MMC allows normal development of anal sphincter muscles. Myelomeningocele was surgically created in fetal sheep at 75 days of gestation. At 100 days of gestation, fetal surgery for repair of the MMC lesion was performed. Three repair methods were used: standard neurosurgical repair (4 fetal sheep), covering the MMC lesion with Alloderm (2 fetal sheep), and covering the MMC lesion with Gore-Tex (2 fetal sheep). After the sheep were delivered (140 days of gestation), external and internal anal sphincter muscles were analyzed histopathologically. In control fetal sheep (not repaired) anal sphincter muscles did not develop normally. In contrast, in fetal sheep that underwent repair of the MMC, the external and internal anal sphincter muscles developed normally. Histopathologically, in the external sphincter muscles, muscle fibers were dense. In the internal sphincter muscles, endomysial spaces were small, myofibrils were numerous, and fascicular units were larger than those in unrepaired fetal sheep. There was no difference in muscle development for the repair methods. Fetal surgery for repair of MMC allows normal development of anal sphincter muscles. PMID:14689212
Yoshizawa, Jyoji; Sbragia, Lourenco; Paek, Bettina W; Sydorak, Roman M; Yamazaki, Yoji; Harrison, Michael R; Farmer, Diana L
Background Conventional open herniorrhaphy in children has been reported to have 0.3–3.8% recurrence and 5.6–30% postoperative contralateral\\u000a hernia rates. We developed a unique technique to achieve completely extraperitoneal ligation of PPV without any skip areas\\u000a under laparoscopic control. This report introduces our technique and results compared with the cut-down herniorrhaphy.\\u000a \\u000a \\u000a \\u000a Methods A consecutive series of 1,585 children with inguinal hernia\\/hydrocele (1996–2006) was
We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of the acute swelling and subcutaneous haematoma. The indication for surgery was the potential for visceral strangulation or ischaemia with the patient describing discomfort on coughing. At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis. A modified prolene mesh herniarepair was performed after reconstructing the inguinal ligament and canal in layers.To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal. Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries. PMID:20537142
Biswas, Seema; Vedanayagam, Maria; Hipkins, Gabrielle; Leather, Andrew
Late into the 19th century, treatment for inguinal hernias consisted of repositioning the hernia with trusses or using 'softening agents' such as warm herbal baths and moist bandages. Surgical resection or cauterisation, often combined with hemicastration, was only considered for cases ofstrangulated hernia that could not be repositioned. Bassini (1844-1924) is credited with developing the precursor to the modern inguinal hernia operation at the end of the 19th century. Bassini's essential discovery was that the transverse fascia plays a key role in the pathophysiology of inguinal hernias. Bassini's operation, consisting of complete incision of the transverse fascia and reconstruction of the inguinal floor, was considered the gold standard for nearly a century. One problem with the conventional Bassini operation was the tension applied to tissues, which led to a high rate of recurrence. Although Bassini's operation has now become obsolete, current surgical approaches still centre on fortification of the inguinal floor. This tension-free repair now uses synthetic mesh that is positioned using an open anterior approach, laparoscopic surgery, or a preperitoneal technique. PMID:17500346
Thorough knowledge of anatomy, appropriate preoperative planning, and reliance on the principles of herniarepair ensure successful outcomes. There are many options for repair, including technique and mesh choice. The hernia surgeon should be well versed in the open and laparoscopic approaches and apply them based on the individual clinical presentation. Long-term outcomes related to suprapubic, subxiphoid, and lateral herniarepairs are limited; however, open and laparoscopic repairs using wide mesh overlap and adequate fixation have acceptable outcomes and recurrence rates. Future research will likely focus on comparative studies based on patient factors, techniques, mesh, and cost. PMID:24035079
Prosthetic mesh is now used routinely in inguinal herniarepairs, although its fixation is thought to be a potential cause of chronic groin pain. The Parietene ProGrip™ (TYCO Healthcare) mesh, which is semi-resorbable and incorporates self-fixing properties, has been shown to provide satisfactory repair in open surgery. We describe the use of this mesh in TAPP herniarepair, which has not previously been reported in the literature. A prospective study of 29 patients showed a mean operative time to be 47.6 min, with 96% of patients discharged home on the day of surgery or the day after. Visual analog pain scales (out of 10) reduced from 4 preoperatively to 0 at 6 months, and only 1 patient suffered a minor wound complication. The use of this mesh in transabdominal preperitoneal herniarepair is therefore feasible, safe, and may reduce postoperative pain.
Kosai, Nik; Sutton, Paul Anthony; Evans, Jonathan; Varghese, Joseph
Many thousand laparotomy incisions are created each year and the failure rate for closure of these abdominal wounds is between 10–15%, creating a large problem of incisional hernia. In the past many of these hernias have been neglected and treated with abdominal trusses or inadequately managed with high failure rates. The introduction of mesh has not had a significant impact because surgeons are not aware of modern effective techniques which may be used to reconstruct defects of the abdominal wall. This review will cover recent advances in incisional herniasurgery which affect the general surgeon, and also briefly review advanced techniques employed by specialist surgeons in anterior abdominal wall surgery.
IntroductionThe purpose of this study was to evaluate the long-term complications of surgical site infection (SSI) in the colorectal population, specifically its association with incisional hernia and small bowel obstruction.
Bryce W. Murray; Daisha J. Cipher; Thai Pham; Thomas Anthony
Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery causes great controversy regarding the choice of procedure for perforated duodenal ulcer. In this study the safety and efficacy of laparoscopic surgery was evaluated, different types of procedures were described and early outcomes in comparison with open surgery were assessed. In addition
The management of a large proboscoid umbilical hernia presents challenging problems to the surgeon. As children and parents are concerned with the appearance of the actual hernia they are also intensely interested in the postsurgical result. Presented is a simple one-stage umbilicoplasty that allows repair of the fascial defect and the management of the redundant skin in such a way as to produce a "scarless" and natural-appearing umbilicus. PMID:3681620
Purpose: The aim of this study was to evaluate secondary operations using a posterior sagittal approach in patients with fecal incontinence and impaction after primary repair of anorectal malformations. Methods: Twenty patients (14 boys, 6 girls) who had previous failed surgery for imperforate anus underwent secondary operations. The indications for surgery included fecal incontinence (n = 16) and fecal impaction
Background Although it is now generally accepted that patients should be advised to quit smoking before surgery, the effect of low-intensive\\u000a smoking cessation intervention, both on preoperative smoking behavior and on risk reduction, remains unclear. Our objective\\u000a was to study the effect on perioperative smoking behavior and on postoperative wound infection of different types of low-intensive\\u000a intervention before herniotomy.\\u000a \\u000a \\u000a \\u000a Methods Between October
Incisional hernias are a real problem in abdominal surgery and occur in up to 18% of patients undergoing surgery. Simple sutures or so-called anatomical processes lead to recurrence in up to 50% of cases. Performance of an alloplastic procedure decreases relapse rate to 10%, down from 12%. Popularized in Europe by Rives and Stoppa, the sublay mesh repair technique has proven very effective, with low recurrence rates (0% -23%) and minimal complications. In our clinic we have been using this technique for about 10 years, adding some changes that we consider beneficial to the further evolution of the patient and especially to obtaining a strong abdominal wall, equally functional in terms of bio-mechanics. During the study period, we recorded a total of 45 patients with abdominal incisional hernias operated by this technique. All patients were operated on by the same surgical team. No patients required surgical reintervention. Our results show that the Rives-Stoppa technique is an effective method for repairing incisional hernias. Complications and recurrence rates are comparable with the results of other techniques. PMID:23464769
Strâmbu, V; Radu, P; Br?tucu, M; Garofil, D; Iorga, C; Iorga, R; Popa, F
The incidence of Intraabdominal Hypertension (IAH) and Abdominal Compartment Syndrome (ACS) is underestimated within the surgery of large size parietal-abdominal defects, with the maximum transverse diameter above 10 cm, being considered the main risk factor for the development of intra abdominal hypertension, together with ventilatory restraint under 60% and obesity. Intraabdominal hypertension has a prevalence of at least 50% among critical patients and was identified as an independent life-threatening risk factor.However, doctors do not evaluate it properly and do not realize the potential lethal consequences of untreated intraabdominal hypertension. These consequences may be abdominal compartment syndrome, followed by multiple organ dysfunction and even patient death. The paper intends to highlight the importance of the early recognition of this pathology, as a key factor in the correct management of these complications. PMID:23790795
Acting as a pneumatic tissue expander, progressive preoperative pneumoperitoneum (PPP) pressurizes the abdomen to prepare patients with giant hernias and loss of domain for herniarepair. We review our experience with PPP. Between 2006 and 2008, a prospective hernia database revealed nine patients who underwent PPP prior to herniarepair. Mean patient age was 54 years (41-68) and mean BMI was 31.3 kg/m2 (25.2-36.5). Patients had prophylactic vena cava filters and intraperitoneal catheters placed. Over a mean 22.4 days (7-64), patients received 7.6 (3-13) injections of air. PPP complications included death from pulmonary mycetoma (1), deep venous thrombosis and acute renal failure (1), port infection (1), kinked catheter requiring reoperation (1). Seven patients underwent successful herniarepair; open ventral (6) and laparoscopic inguinal (1). Defect size averaged 387 cm2 (110-980) with a mesh size of 420 cm (180-1200). Operative time averaged 256 minutes (175-330) with a mean blood loss of 157 ml (50-500). Post-herniarepair length of stay was 10.3 days (4-22). Herniarepair complications included ventricular tachycardia (1) and hernia recurrence (1). PPP has an acceptable risk, and for patients with large hernias and loss of domain, it may be a useful adjunct prior to definitive herniarepair. PMID:19545099
Mcadory, R Stephen; Cobb, William S; Carbonell, Alfredo M
Emergent repair of umbilical hernias in cirrhotic patients is associated with a high risk for morbidity and mortality. We propose a new technique, umbilical paracentesis, for reduction of incarcerated hernias in the patient with ascites. Under ultrasound guidance, removal of ascitic fluid from the umbilical hernia sac can reduce the local pressure and thereby allow for easy hernia reduction, thus avoiding the need for an emergent operation. PMID:24132449
Russell, Katie W; Mone, Mary C; Scaife, Courtney L
We report a case of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery. Endovascular repair was successfully used as the treatment for this patient and studies have shown this to be a safe alternative to surgery. PMID:23526110
Chest-wall hernia is a very unusual pathological event. The Authors report a singular diagnostic case of chest-wall hernia, miming rib tumor. Instrumental diagnostic tools and surgical treatment is reported. Finally patient's follow-up is discussed. PMID:11515457
Monaco, M; Barone, M; Carditello, A; Barresi, P; Sibilio, M; Pavia, R; Mondello, B
We present a personal experience with 750 children suffering from obstetrical brachial plexus palsy. The related surgery is described, including early microsurgical nerve reconstruction and secondary procedures including tendon and muscle transfers. The clinical examination, indications and timing for surgery, technical details of primary and secondary operations and the possible outcome are discussed. Both clinical and research work need an
We report a parapubic hernia in a 54-year-old patient following radical retropubic prostatectomy. This complication can occur when the musculotendinous insertions of the rectus abdominis muscle are divided from the pubis. Bowel contents herniate over the pubic crest and can be misdiagnosed as an incisional or inguinal hernia. Successful repair depends on closure of the entire defect. Elective repair necessitates the use of prosthetic mesh. PMID:7985326
Full-thickness tears of the rotator cuff are common, but there is no clear consensus regarding indications for rotator cuff surgery. Because some patients with full-thickness rotator cuff tears who are asymptomatic or symptomatic can be successfully treated nonoperatively, clinical outcome studies of rotator cuff repair should describe the subjects in detail to allow appropriate interpretation of the results. However, we hypothesized the indications for surgery are poorly described in outcome studies of rotator cuff surgery. We undertook a detailed literature review over 11 years of six major orthopaedic journals to assess whether the indications for surgery were described adequately in studies of rotator cuff repair. Eighty-six papers fit the criteria for the study and were reviewed. Limitations of activities of daily living (31%), failure of nonoperative treatment (52%), duration of nonoperative treatment (26%), and history of nocturnal pain (16%) were reported in a minority of papers overall. The patients’ characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair. It is important for these factors to be considered and reported because, without this information, the reasons for and results of rotator cuff repair are difficult to interpret. Level of Evidence: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Koulouvaris, Panagiotis; Chu, Samuel K.; Levy, Bruce A.
Purpose: The aim of this study was to investigate the incidence of contralateral patent processus vaginalis (PPV) in children with inguinal hernia using direct laparoscopic inspection. Methods: This study evaluates the incidence and size of contralateral PPVs in 143 children (96 boys, 47 girls) with clinically unilateral indirect inguinal hernia who underwent laparoscopic herniarepair. During repair, the contralateral internal
Background: Muscle weakness, particularly of shoulder external rotation, is common after rotator cuff repairsurgery. Neuromuscular electrical stimulation has been shown to be an effective adjunct in the enhancement of muscle recruitment. Hypothesis: Shoulder external rotation peak force can be enhanced by neuromuscular electrical stimulation after rotator cuff repairsurgery. Study Design: Controlled laboratory study. Methods: Thirty-nine patients (20 men,
Michael M. Reinold; Leonard C. Macrina; Kevin E. Wilk; Jeffrey R. Dugas; E. Lyle Cain; James R. Andrews
Purpose This is so far the largest series of recurrences after laparoscopic inguinal herniarepair.\\u000a \\u000a \\u000a \\u000a Methods Video documents of 1,071 laparoscopic inguinal herniarepairs were retrospectively studied with respect to the affected side,\\u000a anatomical appearance, gender, history and time interval between operation and recurrence. Only indirect, clinically manifest\\u000a hernias were included.\\u000a \\u000a \\u000a \\u000a Results Recurrences occurred in 32 children (3%), 26 boys and 6
In cases of painful complex hammertoe deformity, there is no single approach that can be used in all circumstances. If conservative care fails, surgical management may include interphalangeal joint arthroplasty, arthrodesis, and/or plantar plate repair. The best and most pragmatic surgical plan must be patient-centered, taking the age, activity level, expectations of the patient, and precise etiology of the hammertoe deformity into account. PMID:22727377
The first description diaphragmatic hernia appeared in 1575. In 1848, Bochdalek described congenital diaphragmatic hernia (CDH) occurring through a posterolateral defect. Successful surgical treatment of CDH in an infant was first performed in 1902, whereas the first neonate operated within 24 hours of life was reported in 1946. However, early surgery did not improve survival rates and the mortality was
Chest pain Heartburn , worse when bending over or lying down Swallowing difficulty A hiatal hernia by itself ... symptoms include: Avoiding large or heavy meals Not lying down or bending over right after a meal ...
INTRODUCTION Traumatic abdominal wall hernia (TAWH) is a rare entity. Most cases occur in children, following an injury from the bicycle handle bar. In adults, it usually results from road traffic accidents (RTA). We present one of the largest reported cases of TAWH following RTA managed by delayed mesh repair. PRESENTATION OF CASE A 35 yr old obese male with RTA was diagnosed with TAWH with 19 cm × 15 cm defect in left flank. As there were no intra abdominal injuries and overlying skin was abraded, he was planned for elective repair after 6 months. On exploration a defect of 30 cm × 45 cm was found extending from midline anteriorly to 8 cm short of midline posteriorly in transverse axis and costal margin to iliac crest in craniocaudal axis. After restoration of bowel into abdominal cavity, primary closure or even approximation of muscular defect was not possible thus a mesh closure using 60 cm × 60 cm prolene mesh in subcutaneous plane was done. After 4 months follow up, patient is healthy and has no recurrence. DISCUSSION Emergent surgical management of TAWH is usually favoured due to high incidence of associated intra abdominal injuries. Delayed repair may be undertaken in selected cases. CONCLUSION TAWH, although rare, should be suspected in cases of RTA with abdominal wall swellings. With time, the hernia defect may enlarge and muscles may undergo atrophy making delayed repair difficult.
Background We sought to determine the efficacy of sutures, human fibrin glue and N-butyl-2-cyanoacrylate for mesh fixation in patients undergoing the plug and mesh procedure for groin hernia. Methods A total of 156 patients with 167 inguinal hernias (11 bilateral) underwent a plug and mesh procedure and were randomly assigned to received either sutures (n = 59 hernias), human fibrin glue (n = 52) or N-butyl-2-cyanoacrylate (n = 56) for mesh fixation. Results The overall morbidity rate was 38.98% in the suture group, 9.62% in the fibrin glue group and 10.71% in the N-butyl-2-cyanoacrylate group (suture v. fibrin glue, p < 0.001; suture v. N-butyl-2-cyanoacrylate, p < 0.001). There was no significant difference in morbidity between the fibrin glue and N-butyl-2-cyanoacrylate groups. Overall, short-term morbidity was significantly higher in the suture group (27.12%) than in the fibrin glue (9.62%, p = 0.01) or N-butyl-2-cyanoacrylate (8.93%, p = 0.004) groups, but there was no significant difference between the fibrin glue and N-butyl-2-cyanoacrylate groups. There was no significant difference between the groups in terms of mean postoperative stay (32.6 h in the suture group v. 30.8 h in the fibrin glue group v. 32.0 h in the N-butyl-2-cyanoacrylate group) or mean time to return to work (20.4 d in the suture group v. 20.3 d in the fibrin glue group v. 19.8 d in the N-butyl-2-cyanoacrylate group). Overall, long-term morbidity was significantly higher in the suture group (11.86%) than in the fibrin glue (0%, p = 0.001) or N-butyl-2-cyanoacrylate (1.78%, p = 0.03) groups. There was no recurrence in any of the groups. Two cases (3.39%) of chronic groin pain were reported in patients in the suture group. A sensation of extraneous body was reported in 5 (8.47%) patients who received sutures and in 1 (1.78%) patient in the N-butyl-2-cyanoacrylate group; there were no reported cases in the fibrin glue group (suture v. fibrin glue, p = 0.01; suture v. N-butyl-2-cyanoacrylate, p = 0.03; fibrin glue v. N-butyl-2-cyanoacrylate, p = 0.30). Conclusion The use of human fibrin glue or N-butyl-2-cyanoacrylate is better tolerated than sutures in tension-free inguinal open repair using the plug and mesh technique in terms of overall immediate results, and there is a better trend in the long-term data.
Esophageal hiatal hernia was diagnosed in 11 young Chinese Shar-Pei dogs between October 1985 and July 1991. The dogs ranged in age from 2 to 11 months and included 3 females and 8 males. The most common clinical signs were regurgitation, vomiting, and hypersalivation. Physical examination was normal in 6 dogs; abnormal physical examination findings in the other 5 dogs included fever, dehydration, hypersalivation, and pulmonary wheezes and crackles. Laboratory evaluation was significant only for neutrophilia in 5 dogs. A diagnosis of hiatal hernia was made on the basis of survey thoracic radiographic and/or barium esophagram findings of displacement of the esophagogastric junction and stomach into the thoracic cavity; the diagnosis was confirmed by surgery in 9 dogs and at necropsy in 2 dogs. Megaesophagus (n = 7), gastroesophageal reflux (n = 4), and esophageal hypomotility (n = 1) were additional findings in some dogs. Aspiration pneumonia was diagnosed in 7 of the dogs. Medical therapies formulated for the therapy of presumed reflux esophagitis generally failed to resolve the clinical signs associated with the hiatal hernia. Hiatal herniae were surgically repaired in 9 of the Shar-Peis by various combinations of diaphragmatic crural apposition, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and left fundic tube gastropexy. Eight of the animals survived surgery, six of which have been asymptomatic since surgery (19 to 36 months). The megaesophagus, esophageal hypomotility, and bronchopneumonia resolved in all of these dogs. PMID:8246209
Callan, M B; Washabau, R J; Saunders, H M; Kerr, L; Prymak, C; Holt, D
Aims Open herniotomy with or without hernioscopy has been performed in our unit for a decade. Since 2005 the laparoscopic repair\\u000a was also introduced. The aims of this study were: (1) to compare detection rates for direct visualization of the contralateral\\u000a deep inguinal ring via the known sac using a 70° scope and via umbilical 30° laparoscopy and (2) to compare
Anindya Niyogi; Arpan S. Tahim; William J. Sherwood; Diane De Caluwe; Nicholas P. Madden; Robin M. Abel; Munther J. Haddad; Simon A. Clarke
París, F., Tarazona, V., Casillas, M., Blasco, E., Cantó, A., Pastor, J., and Acosta, A. (1973).Thorax, 28, 631-636. Hernia of Morgagni. Nine patients with Margagni's hernia of the diaphragm are reported, seven of whom have been operated on. Four patients had gastrointestinal symptoms, two respiratory symptoms, and one retrosternal pain; the other two were asymptomatic. In the first case the diagnosis was made at the time of thoracotomy, in the other eight it was suggested by radiological studies. The standard midline epigastric incision was used for repair in four cases and thoracotomy in two; the last patient was operated on through a preperitoneal subxiphoid route. This route has the advantage of not requiring a wide incision of peritoneum. Images
Paris, F.; Tarazona, V.; Casillas, M.; Blasco, E.; Canto, A.; Pastor, J.; Acosta, A.
In recent years scarless surgery (axillo-bilateral-breast aproach [ABBA], natural orifice transluminal endoscopic surgery [NOTES], single-port surgery) has gained importance in order to improve postoperative outcome in laparoscopic surgery. As part of this effort minilaparoscopic surgery might be a suitable alternative concerning cosmetic outcome without implementing a completely new technique. Due to the definition minilaparoscopic surgery is based on instruments which reduce the total length of trocar incisions to less than 2.5 cm. Nevertheless the total number of incisions is similar to conventional laparoscopic techniques. Most recent indications for minilaparoscopic surgery are cholecystectomy, appendectomy, hernia and colorectal surgery. This article describes the technical aspects and feasibility of minilaparoscopic cholecystectomy and transabdominal preperitoneal herniarepair (TAPP).While the trocar positions remain in the original setting the laparoscopic surgeon benefits from experience gained in conventional laparoscopic surgery. Although the cosmetic outcome is not comparable to single-port surgery, in the author's opinion minilaparoscopic surgery is a useful alternative in scarless surgery due to the fact that it is easy to adapt without establishing a completely new technique. PMID:21424297
Background This study reports medium-term outcomes of laparoscopic incisional herniarepair.\\u000a \\u000a \\u000a \\u000a Study Design Laparoscopic repair was performed on 721 patients with ventral hernia. After adhesiolysis the defect was closed with no. 1\\u000a polyamide suture or loop. This was followed by reinforcement with intraperitoneal onlay repair with a bilayered mesh.\\u000a \\u000a \\u000a \\u000a Results Laproscopic repair of ventral hernia was performed on 613 females and 108 males.
C. Palanivelu; K. V. Jani; P. Senthilnathan; R. Parthasarathi; M. V. Madhankumar; V. K. Malladi
Many thousand laparotomy incisions are created each year and the failure rate for closure of these abdominal wounds is between 10-15%, creating a large problem of incisional hernia. In the past many of these hernias have been neglected and treated with abdominal trusses or inadequately managed with high failure rates. The introduction of mesh has not had a significant impact because surgeons are not aware of modern effective techniques which may be used to reconstruct defects of the abdominal wall. This review will cover recent advances in incisional herniasurgery which affect the general surgeon, and also briefly review advanced techniques employed by specialist surgeons in anterior abdominal wall surgery. PMID:16719992
Introduction The treatment of hernias remains controversial, with multiple prosthetic meshes being exalted for a variety of their characteristics.\\u000a In the event of incarcerated\\/strangulated hernias and other potentially contaminated fields the placement of prosthetic material\\u000a remains controversial because of increased risk of recurrence and infection. Porcine small intestinal submucosa mesh (Surgisis,\\u000a Cook Bloomington, IN) has been demonstrated safe and feasible in
Morris E. Franklin; Jorge M. Trevińo; Guillermo Portillo; Itzel Vela; Jeffrey L. Glass; John J. González
Background: Muscle weakness, particularly of shoulder external rotation, is common after rotator cuff repairsurgery. Neuromuscular electrical stimulation has been shown to be an effective adjunct in the enhancement of muscle recruitment.Hypothesis: Shoulder external rotation peak force can be enhanced by neuromuscular electrical stimulation after rotator cuff repairsurgery.Study Design: Controlled laboratory study.Methods: Thirty-nine patients (20 men, 19 women) who
Michael M. Reinold; Leonard C. Macrina; Kevin E. Wilk; Jeffrey R. Dugas; E. Lyle Cain; James R. Andrews
... of hernia tends to be more common in women in their 50s or 60s. Complications For children, complications ... a> Guidelines for sites linking to MayoClinic.com Advertisement ... heart health in just 10 minutes a day Heartburn, ulcers, IBS? ...
Objective: To determine the nature of and to compare the inflammatory responses induced by (1) endovascular and (2) conventional abdominal aortic aneurysm (AAA) repair. Material and Methods: Twelve consecutive patients undergoing elective infrarenal AAA repair were prospectively studied. Seven patients were selected for endovascular procedures (the EAAA group); five patients underwent open surgery (the OAAA group). Three control patients undergoing
Cécile Galle; Viviane De Maertelaer; Serge Motte; Ling Zhou; Patrick Stordeur; Jean-Pierre Delville; Rong Li; José Ferreira; Michel Goldman; Paul Capel; Jean-Claude Wautrecht; Olivier Pradier; Jean-Pierre Dereume
A 75-year-old woman presented with a painful abdominal lump. Clinically and sonographically it was diagnosed as an abscess. Surgical exploration revealed a Spigelian hernia with Richter's type of strangulation. The strangulated portion of the ileum had perforated, leading to abscess formation. PMID:10659490
The aim of lumbar disc herniation surgery is the removal of herniated disc material (HDM) and complete decompression of the nerve root. As some patients present with residual HDM, we examined the ability of intraoperative ultrasound (IOUS) to detect this material. Between February 2006 and June 2007, we used IOUS in 30 patients undergoing surgery for lumbar disc herniation. They
Cerebrospinal fluid (CSF) leak is a complication that may occur after translabyrinthine (translab) acoustic neuroma (AN) removal. The aim of this study is to verify the incidence of CSF leak using two techniques for dural defect closure in translab AN surgery and present a new technique for dural repair. A retrospective study was held, reviewing charts of 34 patients in a tertiary neurotologic referral center. Out of these 34 patients that underwent translab AN excision in a 1-year period, 18 had their dural defect repaired using only abdominal fat graft and 16 using synthetic dura substitute (SDS) plus abdominal fat tissue. One patient (5.5%) in the first group had CSF leak and 1 (6.2%) in the second group had CSF leak postoperatively. Our data suggest that there are no significant differences in CSF leak rates using both techniques, although studies in a larger series must be undertaken to conclude it. We believe that the development of some points in the new technique for dural repair can achieve better results and reduce the CSF leak incidence in the translabyrinthine acoustic neuroma surgery in the near future. PMID:24083124
Netto, Aloysio Augusto Tahan de Campos; Colafęmina, José Fernando; Centeno, Ricardo Silva
Hypothesis: The emergence of endovascular abdominal aortic aneurysm (AAA) repair may negatively impact the open AAA experience of general surgery residents. Methods: Prospectively collected data on general and vascular surgery resident training in AAA repair for a 5-year period (1997 to 2001) at a single institution were retrospectively reviewed. Five general surgery residents and one vascular resident completed training yearly.
W. Charles Sternberg III; John W. York; Michael S. Conners III; Samuel R. Money
Traumatic ventral herniae are uncommon. The authors present a patient with traumatic intermuscular hernia in the anterior abdominal wall. Early recognition and differentiation from haematoma is important. In this case, the overlying intact muscle layer masked the classical clinical signs. The incision should be adequate and all internal organs carefully examined. Primary repair is usually possible.
Because surgical repair is indicated for the treatment of diaphragmatic hernia (DH), preoperative imaging of the diaphragmatic defect, hernia content, and associated complications with other organ's pathologies is important. While various techniques can be used on imaging of DHs, selection of the most effective but the least invasive technique will present the most accurate findings about DH, and will facilitate
A case of a central diaphragmatic hernia diagnosed prenatally is reported. The prenatal sonographic findings included central herniation of most of the liver into the chest and hydrops. The hernia was successfully repaired. However, the infant died secondary to respiratory distress syndrome.
B. R. Gross; C. D'Agostino; C. V. Coren; B. P. Petrikovsky
The etiology of congenital diaphragmatic hernia (CDH) is unknown. Phenotypic patterns of CDH defects provide clues about normal diaphragm development and the pathophysiology of CDH. We report a case of a patient who was diagnosed with CDH postnatally and was found on imaging to have simultaneous Bochdalek and Morgagni hernias on the right side. During the operative repair of these
Eric B. Jelin; Tyson N. Kim; Nirmal Nathan; Doug Miniati
Background: Abdominal wall defects secondary to hernias, trauma or disease are a common problem in surgery. Complications of closing these defects with synthetic meshes include foreign body reactions, infection, and adhesions to abdominal viscera. To minimize these problems, several acellular dermis derived collagen products are being used clinically for tissue replacement\\/reconstruction and repair of abdominal wall defects, including both animal
Background: Both totally extraperitoneal (TEP) and preperitoneal (PPOR) approaches involve the placement of prosthetic material preperitoneally. As the prosthetic material overlies the femoral artery and vein, we aimed to assess its effect on the velocity and the diameter of the artery and vein, using colour Doppler ultrasonography in both approaches. Methods: Eighty patients with unilateral groin hernia were prospectively randomised
M. M. Ozmen; N. Ozalp; B. Zulfikaroglu; P. Soydinc; I. Ziraman; S. Hengirmen
We report the case of a 4-year-old girl treated by a laparoscopic transabdominal preperitoneal (TAPP) technique with polypropylene\\u000a mesh in whom a primary contralateral hernia was found and repaired, closing the orifice with a suture. This 4-year-old female\\u000a had a medical history of clubfoot treated by surgery during her first year of age, ureteral reimplantation because of stenosis,\\u000a and laparoscopic
A. Weber-Sanchez; P. Weber-Alvarez; D. Garteiz-Martinez
A new method of treatment of postoperative ventral hernias was developed. During surgery under control over intraabdominal pressure hernial defect is closed with special devices for closure of wound margins. Plastic repair with local tissues in the form of duplication with uninterruptedly-recurrent suture (1st variant) or by contact method ("in join") with auto- or alloplasty on suture line (2nd variant) are performed when intraabdominal pressure doesn't change. If intraabdominal pressure increases, closure of the wound is stopped and polypropylene net or autodermal transplant (3rd variant) are sutured to margins of the wound. One hundred and sixty-eight patients with postoperative ventral hernias underwent surgeries with this method. Control group consisted of 110 patients. Recurrence of hernia was seen in 33 (30%) patients. There were no recurrences in the study group after the 2nd and 3rd variant of the surgery. In the 1st variant recurrence was seen in 6% cases. The method is recommended for surgical departments. Device immobilization permits to decrease tension in sutured tissue, creates optimal conditions for wound closure and prevents suture insufficiency. PMID:13677984
An 85-year-old woman presented with sudden onset of generalised abdominal pain and absolute constipation for 4 d. On examination she had a distended abdomen. Plain abdominal radiograph revealed a gas filled viscous within the left upper quadrant. Subsequent computed tomography suggested caecal volvulus herniated through a left diaphragmatic hernia. The patient underwent reduction of the internal hernia, right hemicolectomy and mesh repair of the diaphragmatic hernia. Postoperative recovery was uneventful. Histology revealed a Dukes' A colonic cancer within the caecum. Herniation of caecal volvulus through a diaphragmatic hernia is a very rare condition and may have been precipitated by the colonic tumour. PMID:24137523
Bhogal, Ricky Harminder; Maleki, Kambiz; Patel, Rajan
An 85-year-old woman presented with sudden onset of generalised abdominal pain and absolute constipation for 4 d. On examination she had a distended abdomen. Plain abdominal radiograph revealed a gas filled viscous within the left upper quadrant. Subsequent computed tomography suggested caecal volvulus herniated through a left diaphragmatic hernia. The patient underwent reduction of the internal hernia, right hemicolectomy and mesh repair of the diaphragmatic hernia. Postoperative recovery was uneventful. Histology revealed a Dukes’ A colonic cancer within the caecum. Herniation of caecal volvulus through a diaphragmatic hernia is a very rare condition and may have been precipitated by the colonic tumour.
Bhogal, Ricky Harminder; Maleki, Kambiz; Patel, Rajan
Neonates with inguinal hernia face a relatively high risk of incarcerated hernia and bowel obstruction and this therefore\\u000a requires surgical treatment. Complications following general anesthesia even for minor surgery are more common in low birth\\u000a weight neonates than in term neonates. Caudal epidural anesthesia without adjunct general anesthesia has been recommended\\u000a for neonates to reduce the risk of postoperative complications.
... The lung tissue on the affected side is compressed, fails to grow normally, and is unable to expand after birth. As the child begins to breathe, cry, and swallow, air enters the intestines that are protruding into the ...
Objective: Our study focuses on the long term result of open surgery and endovascular abdominal aortic aneurysm repair (EVAR) using the Zenith stentgraft. Patients and Methods: A total of 237 patients underwent elective abdominal aortic aneurysm (AAA) repair between April 1999 and December 2006. Nineteen patients underwent EVAR, whereas 218 patients underwent open surgery. The mean follow-up time for EVAR group was 73.8 ± 49 months (range; 25–150 months), and 69.7 ± 46 months (range; 1–156 months) for open surgery group. Results: One open surgery patient (1/218, 0.46%) died of aspiration pneumonia, whereas all the EVAR patients survived the operation. Remote complications requiring reintervention occurred in 8 patients (8/174, 4.6%) in open surgery group. Six EVAR patients (6/19, 31.6%) developed late aneurysm expansion, among whom four patients (4/19, 21.1%) required reinterventions after 3 or more years postoperatively. The need for reintervention persisted even at 11 years after initial EVAR. There was no significant intergroup difference in late mortality. Conclusions: There was no statistically significant intergroup difference in early and long term mortality. Complications requiring reinterventions, however, were more frequent in EVAR than in open surgery, especially in the late period. Long term follow-up is mandatory for comparison of the clinical results between open surgery and EVAR.
The authors report their experience with the laparoscopic treatment of recurrent inguinal hernia in children. Between April\\u000a 1993 and January 1998, 225 boys aged 8 months to 14 years (mean 4.4 years) were treated laparoscopically for a hydrocele,\\u000a spermatic-cord cyst, or hernia. Ten boys had recurrent inguinal hernias after conventional surgery, in one case bilateral.\\u000a The technique requires 3 trocars:
Orchidopexy; Inguinal orchidopexy; Orchiopexy; Repair of undescended testicle; Cryptorchidism repair ... year of life without medical treatment. Undescended testicle repairsurgery is recommended for patients whose testicles do ...
Diaphragmatic defects in cats are common and most frequently occur as a result of trauma. Congenital diaphragmatic defects include peritoneopericardial hernias, hiatal hernias and, infrequently, true diaphragmatic, or pleuroperitoneal, hernias. Only three reports of feline pleuroperitoneal hernias could be found in the veterinary literature. All of these cats presented for evaluation of respiratory distress and two were managed successfully with surgery. This report describes the incidental diagnosis and successfully surgical treatment of a pleuroperitoneal hernia in a cat. It highlights the fact that pleuroperitoneal hernias may not always be symptomatic and that they may not be as rare as previously considered. PMID:19477669
Cariou, Matthieu P L; Shihab, Nadia; Kenny, Patrick; Baines, Stephen J
Purpose In this prospective, randomized, double-blind study, our aim was to compare the analgesic efficacy of the semi-blind approach of transversus abdominis plane (TAP) block with a placebo block in patients undergoing unilateral inguinal herniarepair. Methods After receiving hospital ethical committee approval and informed patient consents, American Society of Anesthesiologists (ASA) I–III patients aged 18–80 were enrolled in the study. Standard anesthesia monitoring was applied to all patients. After premedication, spinal anesthesia was administered to all patients with 3.5 mL heavy bupivacaine at the L3-L4 subarachnoid space. Patients were randomly allocated into 2 groups. Group I (n = 32) received a placebo block with 20 mL saline, Group II (n = 32) received semi-blind TAP block with 0.25% bupivacaine in 20 mL with a blunt regional anesthesia needle into the neurofascial plane via the lumbar triangle of Petit near the midaxillary line before fascial closure. At the end of the operation, intravenous (IV) dexketoprofen was given to all patients. The verbal analog scale (VAS) was recorded at 2, 4, 6, 12, and 24 hours postoperatively. Paracetamol IV was given to patients if their VAS score > 3. A rescue analgesic of 0.05 mg/kg morphine IV was applied if VA S > 3. Total analgesic consumption and morphine requirement in 24 hours were recorded. Results TAP block reduced VAS scores at all postoperative time points (P < 0.001). Postoperative analgesic and morphine requirement in 24 hours was significantly lower in group II (P < 0.01). Conclusion Semi-blind TAP block provided effective analgesia, reducing total 24-hour postoperative analgesic consumption and morphine requirement in patients undergoing elective unilateral inguinal herniarepair.
Salman, A Ebru; Yetisir, Fahri; Yurekli, Banu; Aksoy, Mustafa; Yildirim, Murat; Kilic, Mehmet
Some minimally invasive techniques have been introduced to decrease morbidity related to standard laparoscopic procedures. One such approach is laparoendoscopic single-site surgery (LESS), which can also be applied for transvesical surgery. The aim of the study was to present our initial clinical experience of using this technique for transvesical vesicovaginal fistula (VVF) repair. In August 2011, we carried out the LESS repair of a 3-mm in diameter vesicovaginal fistula on a 72-year-old woman, who failed the conservative treatment with Foley placement. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (4-channel, TriPort+, Olympus Winter&IBE GMBH) via a 1.5-cm incision made 2 cm above the pubic symphysis. A standard 10-mm optic and straight laparoscopic instruments were used. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with running absorbable V-Loc (Covidien, Norwalk, CT, USA) suture. Ureteral catheters were left for 5 days and the Foley catheter for 14 days. The operative time was 170 min. The blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a 6-month follow-up the patient reported no involuntary discharge of urine into the vagina. Diagnostic scans revealed no presence of VVF and laboratory examination results were all within the normal range. Although substantial development of the instruments and skills is needed, the transvesical LESS vesicovaginal fistula repair appeared to be feasible and safe. Nevertheless, further experience and observations are necessary. PMID:23362433
Roslan, Marek; Markuszewski, Marcin M; Bagi?ska, Joanna; Krajka, Kazimierz
A 2-year-old dog was presented with a 3-month history of increasing respiratory effort and rate, inappetence, and lethargy. Chest radiographs demonstrated significant pleural effusion, which was consistent with chyle on biochemical and cytological evaluations. Further diagnostic evaluation, including a thoracic computed tomographic scan, revealed a peritoneopericardial diaphragmatic hernia (PPDH) resulting in a large, fat-attenuating mass within the pericardium. The dog was taken to surgery for repair of the PPDH, pericardectomy, and cisterna chyli ablation. Rapid and permanent resolution of the chylothorax occurred postoperatively. This is the first reported case of chylothorax secondary to PPDH. PMID:19411649
Schmiedt, Chad Weber; Washabaugh, Kate F; Rao, Deepa B; Stepien, Rebecca L
We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of
Seema Biswas; Maria Vedanayagam; Gabrielle Hipkins; Andrew Leather
Background A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women across Africa and Asia. There are numerous challenges associated with providing fistula repair services in developing countries, including limited availability of operating rooms, equipment, surgeons with specialized skills, and funding from local or international donors to support surgeries and subsequent post-operative care. Finding ways of providing services in a more efficient and cost-effective manner, without compromising surgical outcomes and the overall health of the patient, is paramount. Shortening the duration of urethral catheterization following fistula repairsurgery would increase treatment capacity, lower costs of services, and potentially lower risk of healthcare-associated infections among fistula patients. There is a lack of empirical evidence supporting any particular length of time for urethral catheterization following fistula repairsurgery. This study will examine whether short-term (7 day) urethral catheterization is not worse by more than a minimal relevant difference to longer-term (14 day) urethral catheterization in terms of incidence of fistula repair breakdown among women with simple fistula presenting at study sites for fistula repair service. Methods/Design This study is a facility-based, multicenter, non-inferiority randomized controlled trial (RCT) comparing the new proposed short-term (7 day) urethral catheterization to longer-term (14 day) urethral catheterization in terms of predicting fistula repair breakdown. The primary outcome is fistula repair breakdown up to three months following fistula repairsurgery as assessed by a urinary dye test. Secondary outcomes will include repair breakdown one week following catheter removal, intermittent catheterization due to urinary retention and the occurrence of septic or febrile episodes, prolonged hospitalization for medical reasons, catheter blockage, and self-reported residual incontinence. This trial will be conducted among 512 women with simple fistula presenting at 8 study sites for fistula repairsurgery over the course of 24 months at each site. Discussion If no major safety issues are identified, the data from this trial may facilitate adoption of short-term urethral catheterization following repair of simple fistula in sub-Saharan Africa and Asia. Trial registration ClinicalTrials.gov Identifier NCT01428830.
An internal hernia may be either congenital or acquired. The reported incidence of such hernias is 1–2%. In rare cases, internal hernias are the cause of small bowel obstruction, with a reported incidence of 0.2–0.9%. Transmesocolic hernia of the ascending colon is especially rare. We report a case of transmesocolic hernia of the ascending colon with intestinal obstruction diagnosed preoperatively. A 91-year-old Japanese female was admitted to our hospital with abdominal distention and vomiting of 3 days duration. She had no past history of any abdominal surgery. Abdominal examination revealed distention and tenderness in the right iliac fossa. Abdominal computed tomography revealed ileus in the sac at the left side of the ascending colon and dilatation of the oral side of the intestine. We diagnosed a transmesocolic hernia of the ascending colon with intestinal obstruction and performed emergency surgery. At the time of operation, there was internal herniation of ileal loops through a defect in the ascending mesocolon, without any strangulation of the small bowel. The contents were reduced and the tear in the ascending mesocolon was closed. The postoperative course was uneventful and the patient was discharged 14 days after surgery. In conclusion, preoperative diagnosis of bowel obstruction caused by a congenital mesocolic hernia remains difficult despite the techniques currently available, so it is important to consider the possibility of a transmesocolic hernia when diagnosing a patient with ileus with no past history of abdominal surgery.
The presence of the appendix in an inguinal hernia sac has been referred to as Amyand’s hernia. Vermiform appendix located in an external hernia sac is not an uncommon condition, and the incidence of these cases is approximately 1%. In Amyand’s hernias, appendices are frequently found in the hernia sac; but an incarceration particularly on the left side is a very unusual sight. In this report we present 32-year-old male with Amyand’s hernia on the left side.
BACKGROUND:: Fertility preservation is important for women of reproductive age with cervical cancer. The underlying reasons behind suboptimal reproductive results after successful fertility-preserving surgery have not yet been fully revealed. OBJECTIVE:: The objective of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer. METHODS:: We conducted interviews with women with cervical cancer who underwent radical trachelectomy using a Grounded Theory methodology with a theoretical framework of symbolic interactionism. RESULTS:: Our findings articulate a process in which feminine identity is first threatened by a diagnosis of cancer, then repaired by fertility preservation with radical trachelectomy, and finally reconstructed after the surgery, through interactions with self, others, and external events in women with cervical cancer. Feeling incomplete as a woman because of the loss of the uterus was a critical factor in the women's feeling that their feminine identity was threatened. Thus, fertility preservation was significant for these women. The meaning of fertility preservation varied among the women, and their life perspectives were therefore distinct after the surgery. CONCLUSIONS:: Women with cervical cancer who undergo radical trachelectomy experience an identity transformation process, and child bearing is not the only expected outcome of fertility preservation. IMPLICATIONS FOR PRACTICE:: Nurses should coordinate care through the cancer trajectory. Understanding the identity transformation process helps nurses to assess patients' needs and provide appropriate individual care. PMID:23486357
Background: The aim of the present study was to assess the role of the referral pattern and the timing of the surgical procedure on outcome after reconstructive surgery for bile duct injury (BDI). Summary Background Data: BDI after laparoscopic cholecystectomy remains a major problem in current surgical practice. Controversy exists about the influence of previous interventions before referral and the timing of repair on outcome. Methods: Of 500 patients referred to a tertiary center, 151 patients (30.2%) underwent reconstructive surgery for BDI. The influence of referral pattern was analyzed by defining patients as primary and secondary referred patients. The influence of timing of repair was investigated by categorizing 3 groups of patients: A, acute repair; B, delayed repair; and C, late repair. Results: Hospital mortality was zero. Perioperative complications occurred in 29 patients (19.2%): in 26.4% in secondary referred patients and 7.9% in primary referred patients (P = 0.04). Perioperative complications occurred in group A in 33.3%, in group B in 15.6%, and in group C in 22.5% (P = 0.22). Postoperative strictures occurred significantly more often in patients operated in the acute phase (P < 0.01) and in secondary referred patients (P = 0.03). A multivariate analysis identified 3 independent negative predictive factors for outcome: extended injury in the biliary tree (odds ratio = 3.70; confidence interval, 1.32–10.34), secondary referral (odds ratio = 4.35; confidence interval, 1.12–16.76), and repair in the acute phase after injury (odds ratio = 5.44; confidence interval, 1.2–24.43). Conclusions: Reconstructive surgery for the treatment of BDI is associated with acceptable morbidity and no mortality. Extended injury to the bile duct, referral to a tertiary center after therapeutic interventions, and acute repair are independent negative predictors on outcome after reconstructive surgery for BDI.
de Reuver, Philip R.; Grossmann, Irene; Busch, Olivier R.; Obertop, Huug; van Gulik, Thomas M.; Gouma, Dirk J.
PurposeLaparoscopic inguinal hernia inversion and ligation (LIHIL) is a method of herniarepair in which the hernia sac is inverted into the peritoneal cavity and subsequently ligated and excised. Since 2003, 5 surgeons at our institution have been performing LIHIL in girls.
Aaron M. Lipskar; Samuel Z. Soffer; Richard D. Glick; Nelson G. Rosen; Marc A. Levitt; Andrew R. Hong
A patient with vascular type Ehlers-Danlos syndrome developed a large abdominal intercostal hernia secondary to coughing.\\u000a The tissue friability and associated risks for arterial ruptures and visceral perforations in these patients make herniarepair\\u000a challenging. The hernia was successfully treated using a novel approach.
In an effort to determine the cost effectiveness of rotator cuff repairsurgery in workers' compensation patients, a financial analysis of 50 consecutive patients with a “successful” result was performed. Treatment cots were analyzed from the date of initial injury through all evaluations, diagnostic studies, surgical reconstruction, physical therapy and work hardening. Additionally, all workers' compensation payments and the cost
Background: Coarctation of the aorta accounts for almost 5% of all congenital cardiac malformations, and it is usually treated by open surgical procedures. Despite the excellent primary results, many patients may develop anastomotic pseudo-aneurysms, associated with considerable morbidity and mortality rates. We investigated the role of endovascular repair as an alternative to open re-do surgery on the descending aorta. Methods:
Luca Botta; Vincenzo Russo; Guido Oppido; Marzia Rosati; Francesco Massi; Luigi Lovato; Roberto Di Bartolomeo; Rossella Fattori
Improved laparoscopic techniques have engendered many new gastrointestinal and other intracavity abdominal procedures. Groin hernias have also been repaired with the assistance of the laparoscope via both transperitoneal and properitoneal approaches, but less emphasis has been placed upon repair of hernias of the anterior abdominal wall. A technique for the transperitoneal, laparoscopic repair of anterior abdominal wall hernias using a
Philip S. Barie; Charles A. Mack; William A. Thompson
... Lazy eye repair - discharge; Strabismus repair - discharge; Extraocular muscle surgery - discharge ... You or your child had eye muscle repairsurgery to correct eye ... term for crossed eyes is strabismus. Children usually receive ...
Purpose: We evaluated the operative results of our treatment for multiple aortic aneurysms by means of a hybrid procedure consisting of a combination of conventional surgical maneuvers and simultaneous or sequential endovascular aortic repair (EVAR). Materials and Methods: From August 1998 to April 2007, a total of 15 patients, 11 men and 4 women, ranging in age from 62 to 78 years, were treated with hybrid procedures for multiple aortic aneurysms. The pathology of these patients were, atherosclerotic aneurysm in 12 patients, atherosclerotic aneurysm associated with chronic dissection in 2 and type III chronic dissection in 1 patient. The distribution of aneurysmal locations were as follows: 5 patients had aneurysms at the arch and descending aorta, 1 had at the arch and thoracoabdominal aorta, 6 at the descending and abdominal aorta. Two patients with chronic dissection had simultaneous abdominal aortic aneurysms. In all except 1 of the 7 patients who had abdominal aortic aneurysm, we performed abdominal aneurysmectomy and EVAR simultaneously. In 7 patients, EVAR was performed sequentially after graft replacement surgery. In 2 patients, EVAR was the initial procedure followed by conventional surgery. The mean interval between first and second stage procedures was approximately 4 months. Results: One patients died of methicillin resistant Staphylococcus aureus pneumonia 3 months after the simultaneous procedure, all others were discharged and survive. In particular, no major EVAR linked complication was observed in the follow-up period (range 3 to 91 months, mean 46 months). Conclusion: The hybrid procedure for the treatment of multiple aortic aneurysmal disease is less invasive compared to conventional staged surgery and the outcome in terms of mortality and morbidity in hospital as well as long-term follow-up are satisfactory.
Rotator cuff tears are a common cause of shoulder pain and dysfunction. After surgical repair, there is a significant re-tear rate (25%-90%). The aim of this study was to determine the primary mode of mechanical failure for rotator cuffs repaired with suture anchors at the time of revision rotator cuff repair. We prospectively followed 342 consecutive torn rotator cuffs, repaired
Although blunt abdominal trauma is frequent, traumatic abdominal wall hernias (TAWH) are rare. We describe a large TAWH with associated intra-abdominal lesions that were caused by high-energy trauma. The diagnosis was missed by clinical examination but was subsequently revealed by a computed tomography (CT) scan. Repair consisted of an open anatomical reconstruction of the abdominal wall layers with reinforcement by an intraperitoneal composite mesh. The patient recovered well and the results of a post-operative CT scan are presented. PMID:20440527
den Hartog, D; Tuinebreijer, W E; Oprel, P P; Patka, P
Intrapericardial diaphragmatic hernia (IDH) is the rarest type of adult diaphragmatic hernia. Only 28 cases have been reported. Indirect blunt trauma has been implicated in most cases, but one resulted from a stab wound to the anterior chest. Patients presented immediately or up to 20 years following trauma with symptoms of intermittent bowel obstruction, including one with strangulation, or cardiac dysfunction, including dyspnea, palpitations, and two patients with cardiac tamponade. Physical findings included bowel sounds in the chest, decreased heart and lung sounds, and an absent point of maximal cardiac impulse. Chest roentgenography usually revealed supradiaphragmatic gas shadows suggestive of bowel in the chest. Thorough examination of both anteroposterior and lateral chest roentgenograms and barium gastrointestinal series may provide positive diagnosis of anterior diaphragmatic hernia, and fluoroscopy after induced pneumoperitoneum may establish its pericardial involvement. Celiotomy is the preferred approach to surgical repair of IDH. Since the symptoms referable to adult IDH can be incapacitating or life threatening, herniorrhaphy should be performed promptly upon diagnosis, with expectation of an uneventful recovery and negligible recurrence rate. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4.
Meng, R L; Straus, A; Milloy, F; Kittle, C F; Langston, H
To assess the frequency and reasons for truss prescription, we surveyed 437 general practitioners collaborating with the surgical department of the Kantonsspital Winterthur and all members of the Swiss Association of Orthotists. 59% of the general practitioners answered. For 85% of them trusses are obsolete. Based on the data of the orthotists, an estimated 1740 trusses are issued in Switzerland annually (250 per million population). In Switzerland approximately 16,000 hernia operations are performed annually. Therefore, 11% of hernia patients are supplied with a truss rather than referred for a consultant surgical opinion. Patients can be divided into groups, one that wears the truss only for a short time in order to delay surgery for medical or occupational reasons and another group, especially elderly patients, that wears the truss permanently. Poor hernia control and pain, hernia incarceration, or dissatisfaction with the uncomfortable truss are reasons for referral to a surgeon. In our personal experience with 14 patients, all judged their situation after the operation better than with the truss. Our study confirms that despite advances in herniasurgery and in the use of regional and local anesthesia trusses are often prescribed. PMID:12430061
Gastric leaks represent serious complications of bariatric surgery. With the increasing popularity and performance of bariatric procedures, the incidence of leaks and associated complications are expected to increase. Minimally invasive natural orifice surgery represents a novel and promising approach to gastric leak management, especially for morbidly obese patients who are at much higher risk from open or laparoscopic surgical procedures. The present article reports two cases of the safe and successful use of the EndoGastric Solutions StomaphyX™ device to alter the flow of gastric contents and repair gastric leaks resulting from bariatric revision surgery. Both patients were at a high risk and could not undergo another open or laparoscopic surgery to correct the leaks that were not healing. The StomaphyX procedures lasted approximately 30 min, were performed without any complications, and resulted in the resolution of the gastric leaks in both patients.
Sandifer syndrome is an unusual combination of gastroesophageal reflux with or without hiatal hernia and torticollis. It can be considered to be part of an expanded syndrome of unusual presentation of gastroesophageal reflux. After successful surgical repair of the gastroesophageal reflux and the hiatus hernia, there is a gradual but permanent disappearance of the torticollis. An infant with this extremely rare syndrome is presented along with a review of the related literature. PMID:8165756
The iliac crest has become an often used site for autogenous bone graft, because of the easy access it affords. One of the less common complications that can occur after removal is a graft-site hernia. It was first reported in 1945 (see the work by Oldfield, 1945). We report a case of iliac crest bone hernia in a 53-year-old male who was admitted for elective resection of a pseudarthrosis and reconstruction of the left femur with iliac crest bone from the right side. One and a half months after initial surgery, the patient presented with increasing abdominal pain and signs of bowel obstruction. A CT scan of the abdominal cavity showed an obstruction of the small bowel caused by the bone defect of the right iliac crest. A laparoscopy showed a herniation of the small bowel. Due to collateral vessels of the peritoneum caused by portal hypertension, an IPOM (intraperitoneal onlay-mesh) occlusion could not be performed. We performed a conventional ventral herniarepair with an onlay mesh. The recovery was uneventful. PMID:22084778
The iliac crest has become an often used site for autogenous bone graft, because of the easy access it affords. One of the less common complications that can occur after removal is a graft-site hernia. It was first reported in 1945 (see the work by Oldfield, 1945). We report a case of iliac crest bone hernia in a 53-year-old male who was admitted for elective resection of a pseudarthrosis and reconstruction of the left femur with iliac crest bone from the right side. One and a half months after initial surgery, the patient presented with increasing abdominal pain and signs of bowel obstruction. A CT scan of the abdominal cavity showed an obstruction of the small bowel caused by the bone defect of the right iliac crest. A laparoscopy showed a herniation of the small bowel. Due to collateral vessels of the peritoneum caused by portal hypertension, an IPOM (intraperitoneal onlay-mesh) occlusion could not be performed. We performed a conventional ventral herniarepair with an onlay mesh. The recovery was uneventful.
... surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... had surgery to repair a tendon in your elbow. The surgeon made a cut (incision) over the ...
Purpose Long-term results of inguinal herniarepair with the Prolene Hernia System (PHS) in our regional training hospital were retrospectively\\u000a analysed. Research was conducted in an identical cohort of patients previously investigated for short-term results.\\u000a \\u000a \\u000a \\u000a \\u000a Methods One-hundred and fifty-eight patients (217 inguinal hernias) treated with the PHS were traced and included. Patients were invited\\u000a to visit the outpatient clinic for a brief
D. FarajJ; J. P. Ruurda; J. G. Olsman; H. J. A. A. van Geffen
The outcome of children born with cyanotic congenital heart disease has markedly improved over the years. Follow up is recommended for most post-operated cases as complications may occur over long term. One of the complications is the development of ventricular dysfunction, often seen after a successful Fontan surgery (or one of its modifications) for single ventricle. The aim of this study was to determine the prevalence of myocardial perfusion abnormalities in the ventricular myocardium of asymptomatic patients, older than 8 years of age, who had earlier undergone either a univentricular palliation (modified Fontan procedure) or a biventricular repair for tetralogy of Fallot, more than a year ago. All eligible patients underwent screening electrocardiogram (to rule out rhythm disturbance) and echocardiography. Patients with ventricular ejection fraction of more than 50 % by echocardiography were included. Enrolled patients were subjected to gated stress-rest myocardial perfusion imaging using Technitium-99m tetrofosmin single photon emission-computerized tomography (SPECT). Ventricular ejection fraction was also calculated from gated rest study. For the Fontan group, we also analyzed data to see if the morphology of the systemic ventricle would make a difference as far as myocardial perfusion was concerned. Twenty-six patients were enrolled (11 had undergone Fontan surgery and 15 had complete repair of tetralogy of Fallot). Seven of 11 patients in the Fontan group had myocardial perfusion defects (63.6 %) as against none in the repaired tetralogy of Fallot group (p < 0.001). The ejection fraction was within normal range in both the groups; it was statistically higher in the post tetralogy of Fallot repair group (p < 0.04). There were two subgroups in the post Fontan group depending on the morphology of systemic ventricle-left (4 patients) and non-left (7 patients). Higher number and larger size of perfusion defects were present in the non-left ventricular systemic ventricle morphology as compared with left ventricular morphology, but this difference did not reach statistical significance. Myocardial perfusion defects are common in patients who have undergone univentricular repair more than one year ago in contrast to patients who had a biventricular repair for tetralogy of Fallot. In the Fontan group, the morphology of the systemic ventricle was not predictive of prevalence of perfusion defect. PMID:23064840
An adult alpaca was presented because of abdominal pain and was diagnosed with an intestinal obstruction. The putative diagnosis at surgery was an intestinal obstruction caused by peritonitis and intra-abdominal adhesions. The cause of the inflammation was not determined at that time. The alpaca died soon after surgery from post-surgical complications and a peritoneopericardial diaphragmatic hernia that was not diagnosed until necropsy. PMID:21250957
Foster, D M; Chinnadurai, S K; Nutt, J N; Pandiri, A; Linder, K E; Alley, M L; Smith, G W
Although abnormal collagen metabolism has been ascribed an important role in the high recurrence rates after surgical herniarepair, knowledge on tissue sampled in the region affected by inguinal hernias is poor. In the present study, we determined collagen type I and type III in the skin of adult patients with indirect and direct inguinal hernias by both immunohistochemistry and
U. Klinge; H. Zheng; Z. Si; V. Schumpelick; R. S. Bhardwaj; L. Muys; B. Klosterhalfen
Trusses are not usually used in management of inguinal hernia of the very low birth weight infant. A potential benefit of this therapy is maintenance of hernia reduction, thus delaying operative repair until the infant is larger and healthier. We designed a safe and effective truss with supplies found in most neonatal intensive care units. PMID:7595774
Giant exomphalos containing liver as its major component and with visceroabdominal disproportion presents difficult management options to a paediatric surgeon. At Starship Children’s Hospital, we deal with these with primary skin closure, if possible, followed by staged repair of the ventral hernia beginning in the 2nd year of life. During the closure of a ventral hernia, we encountered major hepatic
Chronic pain after surgery is recognised as an important post-operative complication; recent studies have shown up to 30% of patients reporting persistent pain following mastectomy and inguinal herniarepair. No large-scale studies have investigated the epidemiology of chronic pain at two operative sites following coronary artery bypass grafting (CABG). This paper reports the follow-up of a cohort of 1348 patients
J Bruce; N Drury; A. S Poobalan; R. R Jeffrey; W. C. S Smith; W. A Chambers
Objective To discuss the difficulties in dealing with infected or exposed ventral hernia mesh, and to illustrate one solution using an autogenous abdominal wall reconstruction technique. Summary Background Data The definitive treatment for any infected prosthetic material in the body is removal and substitution. When ventral hernia mesh becomes exposed or infected, its removal requires a solution to prevent a subsequent hernia or evisceration. Methods Eleven patients with ventral hernia mesh that was exposed, nonincorporated, with chronic drainage, or associated with a spontaneous enterocutaneous fistula were referred by their initial surgeons after failed local wound care for definitive management. The patients were treated with radical en bloc excision of mesh and scarred fascia followed by immediate abdominal wall reconstruction using bilateral sliding rectus abdominis myofascial advancement flaps. Results Four of the 11 patients treated for infected mesh additionally required a bowel resection. Transverse defect size ranged from 8 to 18 cm (average 13 cm). Average procedure duration was 3 hours without bowel repair and 5 hours with bowel repair. Postoperative length of stay was 5 to 7 days without bowel repair and 7 to 9 days with bowel repair. Complications included hernia recurrence in one case and stitch abscesses in two cases. Follow-up ranges from 6 to 54 months (average 24 months). Conclusions Removal of infected mesh and autogenous flap reconstruction is a safe, reliable, and one-step surgical solution to the problem of infected abdominal wall mesh.
The aim of this study was to present and discuss the anatomical basis of internal hernias thanks to our clinical experience of 14 cases. Internal hernias are uncommon cases of acute intestinal obstruction when a viscera protrudes through an intraperitoneal orifice, remaining inside the peritoneal cavity. It excludes iatrogenic post surgical hernias. From an anatomical point of view, three kinds of orifices may be interested. The orifice may be normal: epiploic or omental (Winslow's) foramen, or abnormal through a pathologic transomental hole realizing an internal prolapsus or procidentia, without sac. Or this orifice may be a paranormal peritoneal fossa (para duodenal or retrocaecal) acting as a trap for the bowel: these hernias possess a sac and are considered as true hernias. The clinical diagnosis is always difficult. CT scan can be useful confirming the obstruction and leads to an urgent operation. This retrospective study evaluates diagnosis, management and follow-up according to the type of anatomical orifice and delay of surgery. PMID:17487440
Introduction Progressive preoperative pneumoperitoneum (PPP) is used to prepare incisional hernias with loss of domain (IHLD) operations.\\u000a The aim of the present study was to analyze the effect of PPP on peritoneal volume [measured using a new computed tomography\\u000a (CT)-based method] and respiratory function.\\u000a \\u000a \\u000a \\u000a \\u000a Methods From July 2004 to July 2008, 19 patients were included in a prospective, observational study. The volumes
C. Sabbagh; F. Dumont; D. Fuks; T. Yzet; P. Verhaeghe; J.-M. Regimbeau
Background We designed a technique of pure minilaparoscopic hernia sac transaction and ligation to repair primary inguinal hernias in\\u000a children and young adults.\\u000a \\u000a \\u000a \\u000a Methods Between September 2003 and December 2004, 83 patients with primary inguinal hernia were treated surgically with minilaparoscopic\\u000a herniorrhaphy. The mean patient age was 6.8 years. Before the operation there were synchronous bilateral hernias in 2 (2.4%)\\u000a patients, left
Yao Chou Tsai; Chia Chang Wu; Stephen Shei Dei Yang
We report the case of a 68-year-old woman who presented with symptoms and signs of gastric outlet obstruction with a history of a ventral hernia. Clinical examination revealed a large ventral hernia with visible peristalsis of the herniated viscera. Initial serum biochemistry revealed a markedly elevated lipase level and deranged renal function. Computed tomography demonstrated an infraumbilical hernia with herniation of the stomach through the ventral defect and distortion of the pancreatic anatomy. The hernia was reduced operatively and repaired, leading to an uneventful recovery. PMID:24112485
Background In our communities there are large numbers of longstanding external hernias that remain untreated. This paper describes the\\u000a epidemiological characteristics of these hernias. The data is expected to provide guidelines for sustained national and international\\u000a efforts to reduce the burden of hernia by performing large-scale elective herniarepairs.\\u000a \\u000a \\u000a \\u000a Method Between January 1998 and December 2007, a simple pro-forma was designed and
M. Ohene-Yeboah; F. Abantanga; J. Oppong; B. Togbe; B. Nimako; M. Amoah; R. Azorliade
A Bochodalek hernia is rarely seen in adults. An 18-year-old man was referred to our institute with the chief complaint of\\u000a a sudden onset of left subcostal pain, nausea, and vomiting. A radiograph and a computed tomographic scan of the chest revealed\\u000a a Bochodalek hernia. Emergency surgery was thus performed. The herniated organs were put back into the peritoneal cavity
Umbilical hernia is a common finding in cirrhotic patients with ascites. Spontaneous disruption of the hernia and attendant discharge of ascitic fluid is an unusual and rarely reported complication in these patients and is associated with an overall mortality rate of nearly 30%. During the 5-year period 1977-1982, nine patients with hepatic cirrhosis and ascites were treated for spontaneous rupture of an umbilical hernia. Ascites was attributed to alcoholic cirrhosis in all cases and was present for an average of 21 months prior to rupture. In two cases, failed peritoneovenous shunts resulted in reaccumulation of massive ascites. Initial management included sterile occlusive dressings, fluid repletion, and intravenous antibiotic administration. Herniarepair was performed an average of 4.2 days after rupture. General anesthesia was used in eight cases and local anesthesia in one case. In one instance, the hernia became incarcerated and required urgent repair. Postoperative complications, including wound infection and colonic dilatation, occurred separately in two patients (22%). One patient died of hepatic failure 28 days after operation, for an overall mortality rate of 11%. Surviving patients have been followed for an average of 8 months, and most have done well. Spontaneous rupture of umbilical hernia in patients with ascites occurs uncommonly. Operative management is indicated uniformly and can be conducted safely when the patient's condition has stabilized. The prognosis is favorable for patients with good hepatic reserve.
Lemmer, J H; Strodel, W E; Knol, J A; Eckhauser, F E
Introduction Internal hernia within the falciform ligament is exceedingly rare. A literature search revealed only 14 cases of internal herniation of the small bowel through a congenital defect of the falciform ligament, most of which were found intra-operatively. Case presentation A 77-year-old Japanese woman presented to our emergency department with sudden hematemesis, occurring at least four to five times over a 12-hour period. No ulcer or gastrointestinal bleeding was detected on gastroendoscopy. A 40mm mass in the inferior lobe of the right lung was found on a chest X-ray, and our patient’s symptoms were therefore initially ascribed to aspirated blood from lung tumor-associated hemoptysis. However, our patient continued to show signs of severe abdominal pain and decreased urine output despite aggressive hydration, leading her examining physicians to search for a possibly severe, occult abdominal pathology. On emergent computed tomography imaging, we found an acute strangulated internal hernia within the falciform ligament. Diagnosis was made by helical computed tomography, permitting rapid surgical intervention. Conclusions Our findings on computed tomography imaging assisted with the pre-operative diagnosis and enabled us to make a rapid surgical intervention. Early diagnosis may help preclude significant strangulation with unnecessary resection.
Background The incidence of incisional hernia after midline laparotomies ranges from 10 to 20%. The recurrence rate after this hernia\\u000a surgery varies from 25 to 52% using autogenous tissue. The use of prosthetic meshes can decrease the postoperative hernia\\u000a recurrence by up to 10%. The aim of this prospective randomized clinical study was to analyze and compare the results of three
Traumatic diaphragmatic hernia secondary to diaphragmatic injury is a recognized complication following trauma. It is frequently unrecognized in acute trauma, and delayed presentations with complications are not uncommon.We report the case of a 12-year-old boy presenting in respiratory distress 1 year after blunt abdominal trauma. A chest radiograph demonstrated dilated bowel loops in the left hemithorax mimicking tension pneumothorax. At emergency laparotomy, dilated sigmoid colon was found in the left hemithorax. The hernia was reduced, and a noncongenital diaphragmatic defect was repaired.Although well described in patients with congenital diaphragmatic hernia, tension gastrothorax-colothorax has not been well characterized in traumatic diaphragmatic hernia. We present the second reported pediatric case and discuss the diagnostic workup, operative approach, and postoperative course of this unusual condition. PMID:20386417
Complex knee ligament injuries are characterized by simultaneous rupture of the anterior cruciate ligament (ACL) and/or the posterior cruciate ligament (PCL) and at least one collateral ligament. Isolated injury to the medial collateral ligament (MCL) and PCL have a high healing capacity and can be treated conservatively in many cases. Ruptures of the MCL can also be treated conservatively in complex injuries if the cruciate ligaments are reconstructed. Ruptures of the lateral structures usually need surgical reconstruction. Indications for acute surgical repair include meniscus dislocation, entrapment of collateral ligament portions in the joint, knee dislocation with severe knee instability, and displaced bony avulsions. The anatomy of the knee ligaments must be carefully respected in surgical reconstruction. Acute repair of collateral ligament injuries is possible only in the first 2 weeks after trauma. Acute arthroscopy is indicated only in combination with reconstructive surgery. PMID:19430762
Surgical site infections are common, so effective antibiotic concentrations at the sites of infection, i.e., in the interstitial fluid (ISF), are required. The aim of this study was to evaluate contemporary perioperative prophylactic dosing of cefazolin by determining plasma and subcutaneous ISF concentrations in patients undergoing elective/semielective abdominal aortic aneurysm (AAA) open repairsurgery. This was a prospective pharmacokinetic study in a tertiary referral hospital. Cefazolin (2 g) was administered as a 3-min slow bolus 30 min prior to incision in 12 enrolled patients undergoing elective/semielective AAA open repairsurgery. Serial blood, urine, and ISF (via microdialysis) samples were collected and analyzed using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Cardiac output was determined using pulse waveform contours with Vigileo. The recruited patients had a median (interquartile range) age of 70 (66 to 76) years and weight of 88 (81 to 95) kg. The median (interquartile range) terminal volume of distribution was 0.14 (0.11 to 0.15) liter/kg, total clearance was 0.05 (0.03 to 0.06) liter/h, and minimum observed unbound concentration was 5.7 (5.4 to 8.1) mg/liter. The penetration of unbound drug from plasma to ISF was 85% (78% to 106%). We found correlations present, albeit weak, between cefazolin clearance and cardiac output (r2 = 0.11) and urinary creatinine clearance (r2 = 0.12). In conclusion, we found that a single 2-g dose of cefazolin administered 30 min before incision provides plasma and ISF concentrations in excess of the likely MICs for susceptible pathogens in patients undergoing AAA open repairsurgery.
Douglas, Alexandra; Udy, Andrew A.; Wallis, Steven C.; Jarrett, Paul; Stuart, Janine; Lassig-Smith, Melissa; Deans, Renae; Roberts, Michael S.; Taraporewalla, Kersi; Jenkins, Jason; Medley, Gregory; Lipman, Jeffrey; Roberts, Jason A.
Surgical site infections are common, so effective antibiotic concentrations at the sites of infection, i.e., in the interstitial fluid (ISF), are required. The aim of this study was to evaluate contemporary perioperative prophylactic dosing of cefazolin by determining plasma and subcutaneous ISF concentrations in patients undergoing elective/semielective abdominal aortic aneurysm (AAA) open repairsurgery. This was a prospective pharmacokinetic study in a tertiary referral hospital. Cefazolin (2 g) was administered as a 3-min slow bolus 30 min prior to incision in 12 enrolled patients undergoing elective/semielective AAA open repairsurgery. Serial blood, urine, and ISF (via microdialysis) samples were collected and analyzed using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Cardiac output was determined using pulse waveform contours with Vigileo. The recruited patients had a median (interquartile range) age of 70 (66 to 76) years and weight of 88 (81 to 95) kg. The median (interquartile range) terminal volume of distribution was 0.14 (0.11 to 0.15) liter/kg, total clearance was 0.05 (0.03 to 0.06) liter/h, and minimum observed unbound concentration was 5.7 (5.4 to 8.1) mg/liter. The penetration of unbound drug from plasma to ISF was 85% (78% to 106%). We found correlations present, albeit weak, between cefazolin clearance and cardiac output (r(2) = 0.11) and urinary creatinine clearance (r(2) = 0.12). In conclusion, we found that a single 2-g dose of cefazolin administered 30 min before incision provides plasma and ISF concentrations in excess of the likely MICs for susceptible pathogens in patients undergoing AAA open repairsurgery. PMID:21859939
Douglas, Alexandra; Udy, Andrew A; Wallis, Steven C; Jarrett, Paul; Stuart, Janine; Lassig-Smith, Melissa; Deans, Renae; Roberts, Michael S; Taraporewalla, Kersi; Jenkins, Jason; Medley, Gregory; Lipman, Jeffrey; Roberts, Jason A
Three cases with lesions in the right aortic arch (RAA) are presented. For two patients, whose RAA contained a retroesophageal segment, the primary treatment was total arch replacement (TAR) for acute type A dissection or severe arch angulation with thoracic endovascular aneurysm repair (TEVAR) as second-stage surgery. The third patient, who had RAA with mirror image branching, underwent supra-aortic bypass followed by TEVAR. There was no operative mortality, but the condition of two patients who underwent TAR was complicated by bilateral recurrent nerve palsy, which can be critical. The combination of TEVAR and supra-aortic bypass might thus be preferable for patients with RAA.
PURPOSE: The purpose of this study was to evaluate surgical residents' educational experience related to ventral hernias. METHODS: A 16-question survey was sent to all program coordinators to distribute to their residents. Consent was obtained following a short introduction of the purpose of the survey. Comparisons based on training level were made using ?(2) test of independence, Fisher's exact, and Fisher's exact with Monte Carlo estimate as appropriate. A p value <0.05 was considered significant. RESULTS: The survey was returned by 183 residents from 250 surgical programs. Resident postgraduate year (PG-Y) level was equivalent among groups. Preferred techniques for open ventral hernia varied; the most common (32 %) was intra-abdominal placement of mesh with defect closure. Twenty-two percent of residents had not heard of the retrorectus technique for herniarepair, 48 % had not performed the operation, and 60 % were somewhat comfortable with and knew the general categories of mesh prosthetics products. Mesh choices, biologic and synthetic, varied among the different products. The most common type of hernia education was teaching in the operating room in 87 %, didactic lecture 69 %, and discussion at journal club 45 %. Number of procedures, comfort level with open and laparoscopic techniques, indications for mesh use and technique, familiarity and use of retrorectus repair, and type of hernia education varied significantly based on resident level (p < 0.05). CONCLUSION: Exposure to hernia techniques and mesh prosthetics in surgical residency programs appears to vary. Further evaluation is needed and may help in standardizing curriculums for herniarepair for surgical residents. PMID:23644776
Hope, W W; O'Dwyer, B; Adams, A; Hooks, W B; Kotwall, C A; Clancy, T V
Introduction The surgical treatment of large ventral hernias with accompanying contamination is challenging. We have reviewed our institution's\\u000a experience with single-staged repair of complex ventral hernias in the setting of contamination.\\u000a \\u000a \\u000a \\u000a Methods We retrospectively reviewed the medical records of all patients who underwent ventral herniarepairs in the setting of a contaminated\\u000a field. Pertinent details included baseline demographics, reason for contamination, operative
D. I. Alaedeen; J. Lipman; D. Medalie; M. J. Rosen
We report a pediatric baseball player having both a fracture of the posterior ring apophysis and spondylolysis. He was presented to a primary care physician complaining of back pain and leg pain. Despite conservative treatment for 3 months, the pain did not subside. He was referred to our clinic, and surgical intervention was carried out. First, a bony fragment of the caudal L5 apophyseal ring was removed following fenestration at the L5-S interlaminal space, bilaterally: and decompression of the bilateral S1 nerve roots was confirmed. Next, pseudoarthrosis of the L5 pars was refreshed and pedicle screws were inserted bilaterally. A v-shaped rod was inserted beneath the L5 spinous process, which stabilized the pars defects. After the surgery, back pain and leg pain completely disappeared. In conclusion, the v-rod technique is appropriate for the spondylolysis direct repairsurgery, especially, in case the loose lamina would have a partial laminotomy.
Abnormal systemic collagen metabolism is thought to dispose to the development of hernias. Studies have shown that a reduced type-I/III collagen ratio predisposes to the development of hernias. Patient groups with reduced type-I/III collagen ratio and consequently increased risk of herniation include patients with Ehlers-Danlos, Marfans syndrome, osteogenesis imperfecta, cutis laxa, and patients with abdominal aortic aneurysms, colonic diverticula or stress urinary incontinence. Looking ahead, the perspective may be individualization of the operative technique for patients with a hernia, depending on their collagen profile. PMID:18940165
The physical and clinical features of a number of laser energy sources presently being used in plastic and endonasal surgery, such as the Nd:YAG, KTP, Ho:YAG, Er:YAG and CO2 lasers, are emphasized. Particular attention is paid to the Nd:YAG laser and to an Nd:YAG laser-powered quartz laser scalpel.
Abstract Poly-4-hydroxybutyrate (P4HB) is a thermoplastic, linear polyester, produced by recombinant fermentation, that can be converted into a wide range of resorbable medical devices. P4HB fibers are exceptionally strong, and can be designed to provide prolonged strength retention in vivo. In 2007, the FDA cleared a monofilament suture made from P4HB for general soft tissue approximation and/or ligation. Subsequently, surgical mesh devices for herniarepair, tendon and ligament repair, and plastic and reconstructive surgery have been introduced for clinical use. This review describes the unique properties of P4HB, its clinical applications, and potential uses that are under development. PMID:23979121
Morgagni hernias are uncommon congenital diaphragmatic deficiencies that may remain asymptomatic till adulthood. We report a case of Morgagni hernia presenting with subacute bowel obstruction in a bilateral lung transplant recipient. This diaphragmatic deficiency was not evident during bilateral lung transplantation surgery via clamshell incision. To our knowledge this is the first report of a congenital defect evident after lung
C. H. Wigfield; R. Birla; T. Butt; B. Jaques; J. Lordan; S. Barnard; S. Schueler
Incisional hernia is a very rare complication after hemipelvectomy. Very few references are reported in the literature. A\\u000a rare case of post hemipelvectomy incisional hernia is presented with a unique method of reconstruction using a combination\\u000a of monofilament polypropylene mesh and a de-epithelialized skin flap in such a way that it provided double breasting of dermal\\u000a flaps.
De Garengeot's hernia is a rare condition of acute appendicitis in an incarcerated femoral hernia. A 65-year-old woman was admitted to the emergency room with a 3-day history of a painful and non-reducible mass in her right groin. The patient underwent emergency surgery. At exploration, an acute appendicitis in an incarcerated femoral hernia was identified, likely prediagnosed by computed tomography. The postoperative period was uneventful. In De Garengeot's hernia, early diagnosis is important to reduce the morbidity rate. The surgical approach should be designed according to the condition of the patient, the anatomical position of the appendix vermiformis, and the likelihood of complications. PMID:21431837
Single-port endo-laparoscopic surgery has gained support in the surgical community because it is perceived to offer a better postoperative outcome as it requires only a single incision. We write this prospective observational study to ascertain the feasibility and safety of this technique in patients otherwise requiring two operations. Five patients who underwent double procedures with a single-port device were reviewed: Case 1, a transabdominal preperitoneal herniarepair and gastric wedge resection; Case 2, cholecystectomy and diaphragmatic herniarepair; Case 3, oophorectomy and incisional herniarepair; Case 4, anterior resection of the rectum and hepatic segmentectomy; and Case 5, left adrenalectomy and cholecystectomy. Patient demographics, type of port used, operative time, complications and incision length were collected. Mean operative time for the cases ranged from 100 to 315?min. Incision length for the single-port device was 2?cm. In Case 2, an additional 5-mm port was used and an intraoperative complication involving a laceration of the liver occurred during the suturing of the gallbladder fundus. An additional 8-cm lower abdominal incision (Pfannenstiel) was required in Case 4 to complete the colonic anastomosis and for specimen retrieval. Single-port endo-laparoscopic surgery is a feasible and safe technique for approaching double procedures. It drastically reduces the number of scars that a double procedure creates, and if difficulty arises, another port can always be added to ease the operation. It can also potentially reduce the number of admissions and anesthesia that a patient undergoes. PMID:23879412
Kim, Guowei; Lomanto, Davide; Lawenko, Michael M; Lopez-Gutierrez, Javier; Lee-Ong, Alembert; Iyer, Shridhar Ganpathi; Cheah, Wei Keat; So, Jimmy Bok Yan; Tsang, Charles Bih Shiou; Fong, Yoke Fai
We report a case of neglected, strangulated, inguinal hernia in a middle-aged male, which presented as a scrotal fecal fistula.\\u000a This is the first such case reported in an adult. The patient was treated by resection and anastamosis of the ileum, local\\u000a debridement of the scrotum and Shouldice repair for the inguinal defect.
A 3.5-year-old border collie was presented for routine ovariohysterectomy. A preoperative physical examination revealed no abnormalities, but, under anesthesia, the patient became dyspneic and cyanotic. Plain radiography indicated the presence of a diaphragmatic hernia. The herniated structures were returned to the abdomen and the diaphragmatic defect was surgically repaired. PMID:11467188
Biliary complications have great importance for liver transplant recipients because of affecting long-term prognosis. In rare situations, an internal hernia of the Roux-en-Y loop cause graft injury. A 42-year-old woman with a history of living donor liver transplantation 6 years ago presented with prolonged graft injury during the past 6 months. She suddenly developed ileus of the small bowel with internal hernia through the defect of the mesentery around the Roux-en-Y limb of the hepaticojejunostomy. Emergent surgery was performed to reduce the hernia and volvulus; also the mesenteric rent was closed with interrupted suture of silk. Internal hernia of the small bowel after liver transplantation is rare but causes graft injury due to associated biliary complications and rapid deterioration of patient's condition.
Fraternal twins with identical left-sided foramen of Morgagni hernias are described. The occurrence of this rare type of congenital diaphragmatic hernia in twins suggests that genetic factors play a role in the formation of this lesion.
Stanley T. Lau; Stephen S. Kim; Daniel J. Ledbetter; Patrick J. Healey