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1

Hernia Repair  

MedlinePLUS

... navel. There are two kinds of hernia repair: Traditional (open) hernia repair - The surgeon cuts open the ... less than one or two hours to complete. Traditional hernia repair - In a traditional repair, the surgeon ...

2

Hiatal hernia repair - series (image)  

MedlinePLUS

... backflows from the stomach into the esophagus. Hiatal hernia repair is surgery to repair a bulging of ... abdomen and chest (diaphragm) into the chest (hiatal hernia). Hiatal hernia repair may be recommended when the ...

3

Update: What Is Left for Laparoscopic Hernia Repair?  

Microsoft Academic Search

The risks, benefits and costs of laparoscopic hernia repair are still being debated. According to a current survey on the situation of hernia surgery in Germany in 1996, laparoscopic hernioplasty was done in about 60% of the answering hospitals; about a quarter of all hernia repairs are done laparoscopically. Since April 1993, about 2,700 laparoscopic hernia repairs were done at

R. Bittner; B. Leibl; K. Kraft; J. Schwarz; C.-G. Schmedt

1998-01-01

4

Pregnancy and ventral hernia repair  

Microsoft Academic Search

Summary Reluctance to repair anterior abdominal wall hernias in women of childbearing age is probably unjustified. A unique series is described of 27 women who gave birth to 41 full-term babies following repair of an anterior abdominal wall hernia with no recurrence of the hernia. Nineteen had primary and recurrent umbilical hernias and an incisional hernia in a low transverse

J. Abrahamson; J. Gorman

2000-01-01

5

Efficacy and Tolerability of Intramuscular Dexketoprofen in Postoperative Pain Management following Hernia Repair Surgery.  

PubMed

Objective. To evaluate the safety and efficacy of intramuscular dexketoprofen for postoperative pain in patients undergoing hernia surgery. Methodology. Total 202 patients received single intramuscular injection of dexketoprofen 50?mg or diclofenac 50?mg postoperatively. The pain intensity (PI) was self-evaluated by patients on VAS at baseline 1, 2, 4, 6, and 8 hours. The efficacy parameters were number of responders, difference in PI (PID) at 8?hours, sum of analogue of pain intensity differences (SAPID), and onset and duration of analgesia. Tolerability assessment was done by global evaluation and adverse events in each group. Results. Dexketoprofen showed superior efficacy in terms of number of responders (P = .007), PID at 8?hours (P = .02), and SAPID( 0-8 hours ) (P < .0001). It also showed faster onset of action (42 minutes) and longer duration of action (6.5 hours). The adverse events were comparable in both groups. Conclusion. Single dose of dexketoprofen trometamol 50?mg given intramuscularly provided faster, better, and longer duration of analgesia in postoperative patients of hernia repair surgery than diclofenac 50?mg, with comparable safety. PMID:21716733

Jamdade, P T; Porwal, A; Shinde, J V; Erram, S S; Kamat, V V; Karmarkar, P S; Bhagtani, K; Dhorepatil, S; Irpatgire, R; Bhagat, H; Kolte, S S; Shirure, P A

2011-01-01

6

Efficacy and Tolerability of Intramuscular Dexketoprofen in Postoperative Pain Management following Hernia Repair Surgery  

PubMed Central

Objective. To evaluate the safety and efficacy of intramuscular dexketoprofen for postoperative pain in patients undergoing hernia surgery. Methodology. Total 202 patients received single intramuscular injection of dexketoprofen 50?mg or diclofenac 50?mg postoperatively. The pain intensity (PI) was self-evaluated by patients on VAS at baseline 1, 2, 4, 6, and 8 hours. The efficacy parameters were number of responders, difference in PI (PID) at 8?hours, sum of analogue of pain intensity differences (SAPID), and onset and duration of analgesia. Tolerability assessment was done by global evaluation and adverse events in each group. Results. Dexketoprofen showed superior efficacy in terms of number of responders (P = .007), PID at 8?hours (P = .02), and SAPID 0–8 hours (P < .0001). It also showed faster onset of action (42 minutes) and longer duration of action (6.5 hours). The adverse events were comparable in both groups. Conclusion. Single dose of dexketoprofen trometamol 50?mg given intramuscularly provided faster, better, and longer duration of analgesia in postoperative patients of hernia repair surgery than diclofenac 50?mg, with comparable safety. PMID:21716733

Jamdade, P. T.; Porwal, A.; Shinde, J. V.; Erram, S. S.; Kamat, V. V.; Karmarkar, P. S.; Bhagtani, K.; Dhorepatil, S.; Irpatgire, R.; Bhagat, H.; Kolte, S. S.; Shirure, P. A.

2011-01-01

7

Diaphragmatic hernia repair - series (image)  

MedlinePLUS

... life-threatening situation. The indications for a diaphragmatic hernia repair include: chest X-rays showing diaphragmatic hernia severe breathing difficulty (respiratory distress) shortly after birth ...

8

Intestinal Obstruction After Totally Extraperitoneal Laparoscopic Inguinal Hernia Repair  

PubMed Central

Laparoscopic hernia repair is a frequently performed operation. Although it has many advantages over open inguinal hernia repair, laparoscopic surgery is not without complications. Small bowel obstruction is a complication unique to laparoscopic repair of inguinal hernias. It is reported following transabdominal preperitoneal repairs. We present a case of small bowel incarceration through a peritoneal defect after a totally extraperitoneal inguinal hernia repair. Techniques to avoid this complication are presented. The literature is reviewed. PMID:14974673

Rink, Joanne

2004-01-01

9

Risk of Late-Onset Adhesions and Incisional Hernia Repairs after Surgery  

PubMed Central

BACKGROUND Long-term adhesion-related complications and incisional hernias after abdominal surgery are common and costly. There are few data on the risk of these complications after different abdominal operations. STUDY DESIGN We identified Medicare beneficiaries who underwent endovascular repair of an abdominal aortic aneurysm from 2001–2008 who presumably are not at risk for laparotomy-related complications. We identified all laparoscopic and open operations involving the abdomen, pelvis, or retroperitoneum and categorized them into 5 groups according to invasiveness. We then identified laparotomy-related complications for up to 5 years after the index operation and compared these with the baseline rate of complications in a control group of patients who did not undergo an abdominal operation. RESULTS We studied 85,663 patients, 7,513 (8.8%) of which underwent a laparotomy, including 2,783 major abdominal operations, 709 minor abdominal operations, 963 ventral hernia repairs, 493 retroperitoneal/pelvic operations, and 2,565 laparoscopic operations. Mean age was 76.7 years and 82.0% were male. Major abdominal operations carried the highest risk for adhesion-related complications (14.3% and 25.0% at 2 and 5 years compared with 4.0% and 7.8% for the control group; p < 0.001) and incisional hernias (7.8% and 12.0% compared with 0.6% and 1.2% for the control group; p < 0.001). Laparoscopic operations (4.6% and 10.7% for adhesions, 1.9% and 3.2% for incisional hernias) carried the lowest risk. CONCLUSIONS Late-onset laparotomy-related complications are frequent and their risk extends through 5 years beyond the perioperative period. With the advancement and expansion of laparoscopic techniques and its attendant lower risk for long-term complications, these results can alter the risk-to-benefit profile of various types of abdominal operations and can also strengthen the rationale for additional development of laparoscopic approaches to abdominal operations. PMID:23623220

Bensley, Rodney P; Schermerhorn, Marc L; Hurks, Rob; Sachs, Teviah; Boyd, Christopher A; O'Malley, A James; Cotterill, Philip; Landon, Bruce E

2013-01-01

10

Natural Orifice Translumenal Endoscopic Surgery Inguinal Hernia Repair: A Survival Canine Model  

PubMed Central

Abstract Introduction With over 20 million repairs performed worldwide annually, inguinal hernias represent a significant source of disability and loss of productivity. Natural orifice translumenal endoscopic surgery (NOTES™), as a potentially less invasive form of surgery may reduce postoperative disability and accelerate return to work. The objective of this study was to assess the safety and short-term effectiveness of transgastric inguinal herniorrhaphy using a biologic mesh in a survival canine model. Materials and Methods Under general anesthesia with the animal in trendelenburg position, a gastrostomy was created. A 4?×?6?cm acellular dermal implant was deployed endoscopically across the myopectineal orifice, draped over the cord structures, and secured with Bioglue. Following completion of bilateral repairs the animals were survived for 14 days. At the end of the study period, the animals were euthanized and a necropsy performed. Cultures of a random site within the peritoneal cavity and at the site of implant deployment were obtained. In addition, a visual inspection of the peritoneal cavity was performed. Results All animals thrived postoperatively and did not manifest signs of peritonitis or sepsis at any point. At necropsy accurate placement and adequate myopectineal coverage was confirmed in all subjects. Cultures of a random site within the peritoneal cavity and at the site of implant deployment had no growth. Discussion This study confirms that NOTES-inguinal herniorrhaphy using a biologic implant can be performed safely. In addition, the transgastric technique provided good short-term myopectineal coverage without infectious sequelae. PMID:21457111

Gupta, Amar; Eckstein, Jeremy G.

2011-01-01

11

Laparoscopic Repair of Incidentally Found Spigelian Hernia  

PubMed Central

Background and Objectives: A Spigelian hernia is a rare type of hernia that occurs through a defect in the anterior abdominal wall adjacent to the linea semilunaris. Estimation of its incidence has been reported as 0.12% of all abdominal wall hernias. Traditionally, the method of repair has been an open approach. Herein, we discuss a series of laparoscopic repairs. Methods: Case series and review of the literature. Cases: Three patients are presented. All were evaluated and taken to surgery initially for a different disease process, and all were incidentally found to have a spigelian hernia. These patients underwent laparoscopic repair of their hernias; 2 were repaired intraperitoneally and one was repaired totally extraperitoneally. Two patients initially underwent a mesh repair, while the third had an attempted primary repair. Conclusions: There is evidence that supports the use of laparoscopy for both diagnosis and repair of spigelian hernias. There are also reports of successful repairs both primarily and with mesh. In our experience with the preceding 3 patients, we found that laparoscopic repair of incidentally discovered spigelian hernias is a viable option, and we also found that implantation of mesh, when possible, resulted in satisfactory results and no recurrence. PMID:21902949

Nickloes, Todd; Mancini, Greg; Solla, Julio A.

2011-01-01

12

Laparoscopic hernia repair in 2000  

Microsoft Academic Search

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 hernia repair. 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

A. Fingerhut; B. Millat; N. Bataille; E. Yachouchi; C. Dziri; M.-J. Boudet; A. Paul

2001-01-01

13

Minimally Invasive Spigelian Hernia Repair  

PubMed Central

Introduction: Spigelian hernia is an uncommon ventral hernia characterized by a defect in the linea semilunaris. Repair of spigelian hernia has traditionally been accomplished via an open transverse incision and primary repair. The purpose of this article is to present 2 case reports of incarcerated spigelian hernia that were successfully repaired laparoscopically using Gortex mesh and to present a review of the literature regarding laparoscopic repair of spigelian hernias. Methods: Retrospective chart review and Medline literature search. Results: Two patients underwent laparoscopic mesh repair of incarcerated spigelian hernias. Both were started on a regular diet on postoperative day 1 and discharged on postoperative days 2 and 3. One patient developed a seroma that resolved without intervention. There was complete resolution of preoperative symptoms at the 12-month follow-up. Conclusion: Minimally invasive repair of spigelian hernias is an alternative to the traditional open surgical technique. Further studies are needed to directly compare the open and the laparoscopic repair. PMID:19660230

Baucom, Catherine; Nguyen, Quan D.; Hidalgo, Marco

2009-01-01

14

Evolution of mesh fixation for hernia repair.  

PubMed

Hernia repair remains one of the most common surgical procedures performed around the world. Over the past several decades, in response to various mesh-related complications and coinciding with the influx of laparoscopy into the field of general surgery, numerous advancements have been made in regards to the technology of mesh products being used in hernia repair today. Along these same lines, devices used for mesh fixation have evolved at a similar pace. The goal of this chapter is to review the various materials and methods of mesh fixation being utilized in both ventral and inguinal hernia repair today. PMID:25398127

Webb, David; Stoikes, Nathaniel; Voeller, Guy

2014-11-01

15

Inguinal hernia repair - series (image)  

MedlinePLUS

A hernia occurs when part of an organ protrudes through a weak point or tear in the thin muscular ... Hernia repair may be recommended for: large bulges through a small hole (increased risk of incarceration and ...

16

Richter's hernia after an intraperitoneal mesh repair.  

PubMed

For ventral hernia repair, laparoscopic surgery offers various advantages, including the application of a large mesh using the intraperitoneal approach. However, improper closure of the port site may lead to serious complications. Port-site hernia is a rare outcome of inadequate repair of the fascial or peritoneal layer, and Richter's hernia in a high risk patient, in the presence of an intraperitoneal mesh, is a particularly challenging scenario. Herein, we present a 58-year-old woman who, after a ventral hernia repair, was diagnosed with a small bowel hernia through a 10-mm port site. The patient complained of pain and mild swelling at the port site in the postoperative period, and her symptoms indicated intestinal obstruction. Clinical evaluation and abdominal X-ray confirmed the diagnosis, and early laparoscopic re-exploration and management were the key to a favorable outcome. PMID:25354381

Pandey, Anshuman; Masood, Shakeel; Goel, Vijay Kumar; Gupta, Amit Kumar

2014-11-01

17

Laparoscopic hernia repair: a preliminary report.  

PubMed

Advances in laparoscopic technique have provided the opportunity to perform preperitoneal herniorrhaphy and potentially avoid the morbidity associated with open techniques. From January 1991 to May 1992, two primary surgeons repaired 63 inguinal hernias (42 indirect, 20 direct, 1 femoral) on 48 patients using a standardized laparoscopic technique. The hernia defect was visualized laparoscopically, and the peritoneum anterior to the defect was incised. The hernia sac was dissected from the inguinal canal. The hernia defect was then loosely packed with rolled 1 x 6-inch polypropylene mesh (average number of rolls used was 3.4). A sheet of polypropylene mesh (average 5 x 8 cm) was then placed over the mesh rolls and the hernia defect and anchored with an endostapler. The peritoneum was closed over the mesh sheet with standard laparoscopic clips. There were 44 males and 4 females in the study group. The mean age was 55 years (range, 17-89 years). The mean follow-up was 5.8 months (range, 1-12 months). Thirty-three patients underwent unilateral hernia repair, and 15 patients underwent bilateral hernia repair. Clinically unsuspected contralateral hernias were identified at the time of laparoscopy in seven patients. The mean duration of surgery was 118 minutes (range, 80-165 minutes) for bilateral hernia repair, and 70 minutes (range, 45-100 minutes) for unilateral hernia repair. All patients with laparoscopic hernia repairs were treated on a same-day or less-than-24-hour in-hospital stay. Complications were designated as minor, moderate, or severe. There were 14 minor complications, which included subcutaneous hematomas at the trocar site, scrotal ecchymosis, groin swelling emphysema, and testicular asymmetry.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8476147

Sailors, D M; Layman, T S; Burns, R P; Chandler, K E; Russell, W L

1993-02-01

18

Laparoscopic versus open incisional hernia repair  

Microsoft Academic Search

Background  Incisional hernia is a common complication of abdominal surgery, and it is often a source of morbidity and high costs for\\u000a health care. This is a case-control study to compare laparoscopic versus anterior-open incisional hernia repair.\\u000a \\u000a \\u000a \\u000a Methods  170 patients with incisional hernia were enrolled in this study between September 2001 and December 2004. Of these, 85 underwent\\u000a anterior-open repair (open group:

S. Olmi; A. Scaini; G. C. Cesana; L. Erba; E. Croce

2007-01-01

19

The laparoscopic hiatoplasty with antireflux surgery is a safe and effective procedure to repair giant hiatal hernia  

PubMed Central

Background Although minimally invasive repair of giant hiatal hernias is a very surgical challenge which requires advanced laparoscopic learning curve, several reports showed that is a safe and effective procedure, with lower morbidity than open approach. In the present study we show the outcomes of 13 patients who underwent a laparoscopic repair of giant hiatal hernia. Methods A total of 13 patients underwent laparoscopic posterior hiatoplasty and Nissen fundoplication. Follow-up evaluation was done clinically at intervals of 3, 6 and 12 months after surgery using the Gastro-oesophageal Reflux Health-Related Quality of Life scale, a barium swallow study, an upper gastrointestinal endoscopy, an oesophageal manometry, a combined ambulatory 24-h multichannel impedance pH and bilirubin monitoring. Anatomic recurrence was defined as any evidence of gastric herniation above the diaphragmatic edge. Results There were no intraoperative complications and no conversions to open technique. Symptomatic GORD-HQL outcomes demonstrated a statistical significant decrease of mean value equal to 3.2 compare to 37.4 of preoperative assessment (p?hernia recurrence was recorded in the study group, treated respecting several crucial surgical principles, e.g., complete sac excision, appropriate crural closure, also with direct hiatal defect where possible, and routine use of antireflux procedure. PMID:24401085

2014-01-01

20

[Laparoscopic repair of incisional and ventral hernia].  

PubMed

The application of laparoscopic principles to ventral or incisional hernia repair has recently been shown to be a safe and effective alternative to open procedures. In this study we analyzed our recent experience with laparoscopic incisional-ventral hernia repair. The outcomes of 75 consecutive patients (January 2002 to July 2006) who underwent laparoscopic repair for incisional-ventral hernia were reviewed. Patient's demographics, hernia parameters, and intraoperative and postoperative data were collected. Of the 75 patients, 44 were females and 31 males. Mean age was 59.1 yrs (range 29-80 yrs). Mean BMI was 25.9 (range 19.4-36.7). Twenty-one patients had primary ventral hernias while 54 patients had an incisional hernia. Fifty-three patients had a single defect and 22 patients multiple defects. In 45 cases the incisional hernia was a primary hernia; in 4 cases it was a first recurrence; in 2 cases a 2nd recurrence; and in 3 cases a 3rd recurrence. The mean defect size was 52,7 cm2 (range 4-432). Laparoscopic hernia repair was successfully performed in 71 cases (94.7%). The mean mesh size was 211 cm2 (range 63-694). Mean operating time was 101 min (range 50-220 min). The mean hospital stay was 4.7 days. The postoperative morbidity rate was 14%. After a mean follow-up of 24.6 months (range 7-56) the recurrence rate was 7% (5/71). Laparoscopic repair of incisional-ventral hernias seems to be safe and effective. Medium-term outcomes were promising with a relatively low rate of conversion to open surgery, a low complication rate and a low risk of recurrence. PMID:18709780

Antinori, Armando; Moschella, Francesca; Tomaiuolo, Pasquina M C; Crucitti, Antonio; La Greca, Antonio; Maci, Eliana; Magistrelli, Paolo

2008-01-01

21

Outpatient Adult Inguinal Hernia Repair  

PubMed Central

Repair of adult inguinal hernia has been done on an outpatient basis at our surgical facility for the past six years. In 616 consecutive repairs, complications have been remarkably few: one patient was electively admitted to hospital, two hernias have recurred and one patient needed to be catheterized. Patient acceptance has been enthusiastic. PMID:6741121

Lee, R. Hewlett; Marzoni, Francis A.; Cannon, Walter B.; Trollope, Michael L.

1984-01-01

22

Hernia Surgery: From Guidelines to Clinical Practice  

PubMed Central

INTRODUCTION Over the last 30 years, hernia surgery has developed into an evidence-based practice assisted by the development of guidelines. MATERIALS AND METHODS Prior to 1993, best practice in the UK was a nylon darn repair under general anaesthesia as an in-patient with prolonged recovery. The publication of The Royal College of Surgeons of England (RCSE) Guidelines on Groin Hernia Repair stimulated debate and coincided with the introduction of mesh hernioplasty and laparoscopic techniques. Further evolution of hernia management has occurred to enable the production of the European Hernia Society (EHS) guidelines in 2008. RESULTS The EHS guidelines cover all aspects of abdominal wall surgery including: indications for operation; investigations; organising surgical care; techniques; local anaesthesia; after-care, complications and outcome; and information for patients. CONCLUSIONS Surgeons have many choices when selecting an appropriate hernia operation for an individual patient. The EHS guidelines provide a basis for this decision-making. PMID:19416585

Kingsnorth, Andrew N

2009-01-01

23

Dyspeptic Symptoms after Laparoscopic Large Hiatal Hernia Repair and Primary Antireflux Surgery for Gastroesophageal Reflux Disease: A Comparative Study  

Microsoft Academic Search

Background: Several patients with gastroesophageal reflux disease suffer from functional dyspepsia. After laparoscopic Nissen fundoplication, these symptoms persist in a substantial number of patients. We hypothesized that, due to a higher chance of vagal nerve impairment during extensive hernia sac resection and esophageal mobilization, dyspeptic symptoms are more frequent after laparoscopic large hiatal hernia (types II–IV) repair than after primary

Edgar J. B. Furnée; Werner A. Draaisma; Eric J. Hazebroek; Niels van Lelyveld; André J. P. M. Smout; Ivo A. M. J. Broeders

2010-01-01

24

Laparoscopic repair of recurrent hernias.  

PubMed

The purpose of this study was to evaluate the results of a laparoscopic approach to recurrent inguinal hernia repair which dissected the entire inguinal floor and repaired all potential areas of recurrence without producing tension. Both a transabdominal preperitoneal and a totally extraperitoneal laparoscopic approach were utilized. Ninety recurrent hernias were repaired in 81 patients. The patients had 26 indirect, 36 direct, and 26 pantaloon recurrent hernias of which eight had a femoral component. In all but one patient the primary operations were open anterior repairs. The median follow-up was 14 months, ranging from 1 to 28 months. Patients returned to normal activities in an average of 1 week. The only recurrence observed was in the one patient whose primary repair was laparoscopic. When the entire inguinal floor of the recurrent hernia was redissected and buttressed with mesh, early recurrence was eliminated and recovery was shortened. PMID:7597580

Felix, E L; Michas, C A; McKnight, R L

1995-02-01

25

Robotic Repair of Giant Paraesophageal Hernias  

PubMed Central

Background and Objectives: Giant paraesophageal hernia accounts for 5% of all hiatal hernias, and it is commonly seen in elderly patients with comorbidities. Some series report complication rates up to 28%, recurrence rates between 10% and 25%, and a mortality rate close to 2%. Recently, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) has shown equivocal benefits when used for elective surgeries, whereas for complex procedures, the benefits appear to be clearer. The purpose of this study is to present our preliminary experience in robotic giant paraesophageal hernia repair. Methods: We retrospectively collected data from patients who had a diagnosis of giant paraesophageal hernia and underwent a paraesophageal hernia repair with the da Vinci Surgical System. Results: Nineteen patients (12 women [63.1%]) underwent surgery for giant paraesophageal hernia at our center. The mean age was 70.4 ± 13.9 years (range, 40–97 years). The mean American Society of Anesthesiologists score was 2.15. The mean surgical time and hospital length of stay were 184.5 ± 96.2 minutes (range, 96–395 minutes) and 4.3 days (range, 2–22 days), respectively. Nissen fundoplications were performed in 3 cases (15.7%), and 16 patients (84.2%) had mesh placed. Six patients (31.5%) presented with gastric volvulus, and 2 patients had other herniated viscera (colon and duodenum). There were 2 surgery-related complications (10.5%) (1 dysphagia that required dilatation and 1 pleural injury) and 1 conversion to open repair (partial gastric resection). No recurrences or deaths were observed in this series. Conclusion: In our experience robotic giant paraesophageal hernia repair is not different from the laparoscopic approach in terms of complications and mortality rate, but it may be associated with lower recurrence rates. However, larger series with longer follow-up are necessary to further substantiate our results. PMID:24398199

Seetharamaiah, Rupa; Romero, Rey Jesus; Kosanovic, Radomir; Gallas, Michelle; Verdeja, Juan-Carlos; Rabaza, Jorge

2013-01-01

26

Laparoscopic repair of abdominal wall hernia: one-year experience  

NASA Astrophysics Data System (ADS)

In this study, 101 consecutive laparoscopic transabdominal preperitoneal hernia repairs (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.

Kavic, Michael S.

1993-05-01

27

Conversion to Stoppa Procedure in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair  

PubMed Central

Background and Objectives: Conversion to open surgery is an important problem, especially during the learning curve of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Methods: Here, we discuss conversion to the Stoppa procedure during laparoscopic TEP inguinal hernia repair. Outcomes of patients who underwent conversion to an open approach during laparoscopic TEP inguinal hernia repair between September 2004 and May 2010 were evaluated. Results: In total, 259 consecutive patients with 281 inguinal hernias underwent laparoscopic TEP inguinal hernia repair. Thirty-one hernia repairs (11%) were converted to open conventional surgical procedures. Twenty-eight of 31 laparoscopic TEP hernia repairs were converted to modified Stoppa procedures, because of technical difficulties. Three of these patients underwent Lichtenstein hernia repairs, because they had undergone previous surgeries. Conclusion: Stoppa is an easy and successful procedure used to solve problems during TEP hernia repair. The Lichtenstein procedure may be a suitable option in patients who have undergone previous operations, such as a radical prostatectomy. PMID:23477173

Dirican, Abuzer; Ozgor, Dincer; Gonultas, Fatih; Isik, Burak

2012-01-01

28

Laparoscopic Repair of Incisional and Other Complex Abdominal Wall Hernias  

PubMed Central

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 hernia repair (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. PMID:20740087

Craft, Randall O; Harold, Kristi L

2009-01-01

29

Laparoscopic hernia repair in 2000. Update of the European Association for Endoscopic Surgery (EAES) Consensus Conference in Madrid, June 1994.  

PubMed

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 hernia repair. 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

2001-10-01

30

Initial experience of single port laparoscopic totally extraperitoneal hernia repair: nearly-scarless inguinal hernia repair  

PubMed Central

Purpose In the early 1990's laparoscopic hernioplasty gained popularity worldwide. Thereafter, laparoscopic surgeons have attempted to improve cosmesis using single port surgery. This study aims to introduce and assess the safety and feasibility of single port laparoscopic total extraperitoneal (TEP) hernia repair with a nearly-scarless umbilical incision. Methods Sixty three single port laparoscopic TEP hernia repairs were performed in sixty patients from June 2010 to March 2011 at Incheon St. Mary's Hospital, with the use of a glove single-port device and standard laparoscopic instruments. Demographic and clinical data, intraoperative findings, and postoperative course were reviewed. Results Of the 63 hernias treated, 31 were right inguinal hernias, 26 were left inguinal hernias and 3 were both inguinal hernias. There was one conversion to conventional three port laparoscopic transabdominal preperitoneal hernioplasty. Mean operative time was 62 minutes (range, 32 to 150 minutes). There were no intraoperative complications. Postoperative complications occurred in two cases (wound seroma and urinary retension) and were successfully treated conservatively. Mean hospital stay was 2.15 days. Conclusion Single port laparoscopic TEP hernia repair is safe and feasible. Umbilical incision provides an excellent cosmetic outcome. Prospective randomized studies comparing single port and conventional three port laparoscopic TEP repairs with short-term outcome and long-term recurrence rate are needed for confirmation. PMID:22148127

Kim, Ji Hoon; Kim, Jin Jo; Lee, Yoon Suk

2011-01-01

31

WSES guidelines for emergency repair of complicated abdominal wall hernias  

PubMed Central

Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. PMID:24289453

2013-01-01

32

Planned totally extraperitoneal laparoscopic Spigelian hernia repair.  

PubMed

A Spigelian hernia is a congenital defect in the tranversus aponeurosis fascia. Traditionally, an open anterior hernioplasty was used to repair these defects. Recently, laparoscopic approaches have been described. This report describes the first application of the totally extraperitoneal laparoscopic approach to a planned repair of a Spigelian hernia. The patient was a 62-year-old white female with a reducible left lower quadrant anterior abdominal wall bulge consistent with a Spigelian hernia. At the time of surgery, we exposed the posterior rectus fascia and modified our extraperitoneal inguinal hernia technique by passing the balloon dissector in a more lateral orientation. This created a unilateral preperitoneal space with adequate room for dissection and mesh fixation. The Spigelian defect was easily identified. Its preperitoneal fat contents were reduced, and a 5-mm laparoscopic tacking device was used to secure a piece of prolene mesh. The patient was discharged home with no complications. Placement of the mesh in the preperitoneal space avoids direct interaction of the mesh prosthesis and the intraperitoneal viscera. In conclusion, we find that a laparoscopic totally extraperitoneal approach is technically feasible and advantageous when a Spigelian hernia is diagnosed preoperatively. PMID:11967699

Tarnoff, M; Rosen, M; Brody, F

2002-02-01

33

Laparoscopic repair of a Morgagni hernia  

PubMed Central

We report a case of laparoscopic repair of symptomatic Morgagni hernia (MH) in an adult. A tension-free closure of the defect was carried out using a polypropylene mesh. The recovery was quick and uneventful. Two years after surgery, the patient is doing well. A search of the English-language surgical literature revealed a total of 55 cases of laparoscopic repair of MH reported: 40 in adults and 15 in children. The various modalities of diagnosis, operative techniques, and disease presentation are discussed. PMID:21206651

Sherigar, J. M.; Dalal, A. D.; Patel, J. R.

2005-01-01

34

[Discrepancy between education and clinical guidelines for groin hernia surgery].  

PubMed

Laparoscopic technique for groin hernia surgery has been used increasingly in Denmark during the latest ten years. This tendency is in accordance with both national and international guidelines, which recommend either laparoscopic repair or open repair ad modum Lichtenstein. The surgical training in Denmark has not kept up with this development, and in the surgical curriculum there is a lack of organized training in laparoscopic inguinal hernia surgery. This article discusses this discrepancy and suggests solutions to help solving the problems. PMID:23582066

Andresen, Kristoffer; Achiam, Michael; Rosenberg, Jacob

2013-04-01

35

Paraumbilical hernia repair during cesarean delivery  

PubMed Central

BACKGROUND AND OBJECTIVES: Pregnant women with paraumbilical hernia usually postpone hernia repair until after delivery, but some patients request that it be done during cesarean delivery. Therefore, we evaluated the outcome of combined cesarean delivery and paraumbilical hernia repair in a prospective study at a tertiary referral university hospital. PATIENTS AND METHODS: In a prospective study, we compared the outcome of 48 patients undergoing cesarean delivery combined with paraumbilical hernia repair versus 100 low-risk patients undergoing cesarean delivery alone. The main outcome measures were operation time, blood loss, severity of pain, peripartum complications, hospital stay, hernia recurrence, and patient satisfaction. RESULTS: The combined procedure took significantly longer than cesarean delivery alone (75.2 minutes versus 60.5 minutes, P<.001)). There were no major complications. Wound infection occurred in 6 patients (4.1%). Hospital stay did not differ significantly from those of controls. Pain at the hernia site repair occurred in two patients, and one hernia recurred in the hernia repair group during a mean follow-up period of 22 months (range, 6-36 months). All hernia patients reported that they preferred the combined operation. CONCLUSIONS: Combined cesarean delivery and paraumbilical hernia repair had the advantage of a single incision, single anesthesia, and a single hospital stay while avoiding re-hospitalization for a separate hernia repair. Our results indicate that the combination approach is safe, effective, and well accepted. PMID:19318752

Ghnnam, Wagih M.; Helal, Adel S.; Fawzy, Muhammad; Ragab, Ahmed; Shalaby, Hend; Elrefaay, Ehsan

2009-01-01

36

Clinical usefulness of laparoscopic total extraperitoneal hernia repair for recurrent inguinal hernia  

PubMed Central

Purpose Hernia repair after recurrence is a challenging procedure, and many approaches have been suggested for it. Total extraperitoneal (TEP) hernia repair should be considered in recurrent hernia. This study was conducted for the purpose of investigating the clinical usefulness of laparoscopic TEP hernia repair for recurrent inguinal hernia. Methods Among the 191 patients who underwent TEP hernia repair at these authors' center from June 2006 to January 2010, the bilateral-hernia cases and the patients with a history of previous pelvic surgery were excluded. A total of 19 patients (12.5%) were enrolled in the recurrent-inguinal-hernia group (group R), and 133 patients (87.5%) in the primary-hernia group (group P). Data were investigated retrospectively, based on the medical records. Results The mean operation time was 97 minutes in group R and 99 minutes in group P (>0.05). In group R, no operation modality change occurred, and temporary urinary retention was developed in four patients (21.1%). In group P, on the other hand, operation modality change from TEP to the transabdominal preperitoneal approach was necessary in four patients (3%). Additionally, in group P, 30 patients (22.6%) had temporary urinary retention and six (4.5%) had testicular edema. No recurrence was identified during the follow-up period in both groups (mean follow-up period: 15.8 months for group R and 18.0 months for group P). Conclusion Laparoscopic TEP hernia repair seems to be a safe and useful method for correcting recurrent inguinal hernia. PMID:22066054

Jang, In Sik; Kim, Joo Hyun; Kim, Beum Su; Choi, Sung Il

2011-01-01

37

Single incision laparoscopic surgery transabdominal pre-peritoneal hernia repair – case report  

PubMed Central

Single incision laparoscopic surgery (SILS) minimizes perioperative trauma and allows surgical procedures without a visible scar. Here we present a case in which the transabdominal pre-peritoneal method was used in inguinal hernioplasty using a SILS port. The presented case is part of a new trend in surgery to minimize operative trauma. In 2009, when the operation was conducted, it was an innovative procedure. PMID:23256016

Kurpiewski, Waldemar; ?uba, Magdalena; Szynkarczuk, Rafa?; Grabysa, Rados?aw

2012-01-01

38

Day-surgery inguinal hernia repair in the elderly: single centre experience  

PubMed Central

Background Inguinal hernioplasty is well established as a day-surgery procedure, our purpose is to assess the safeness of this approach in elderly patients. Methods A total of 292 inguinal hernioplasty were performed between June 2009 and February 2013. Patients were divided into 3 groups depending on the age and postoperative complications were compared in these groups. Results Despite of a large number of higher risk (ASA 3-4) patients and a higher rate of comorbidity in older patients, unplanned admission postoperative, symptoms and complications were comparable with those for the younger patients. Conclusions Ambulatory surgery is feasible also in older patients. Age, comorbidity and higher ASA risk should not be a barrier to elective day surgery. PMID:24267293

2013-01-01

39

Simplified preperitoneal Marlex hernia repair.  

PubMed

The routine use of mesh for repair of inguinal hernia has been popularized by Lichtenstein and others. Although preperitoneal placement is more appealing than the onlay technique, the classical approach by Nyhus and Condon is difficult under local anesthesia and denervates the inguinal muscles to some degree. Preperitoneal mesh may become the standard for inguinal hernia as the laparoscopic approach becomes more popular. This report describes the author's first 100 hernia repairs done using a simplified preperitoneal approach under local anesthesia. The preperitoneal space is entered directly through the posterior floor, but a complete covering of the direct, indirect, and femoral spaces is accomplished similar to an open technique. After placement of the mesh, a truly "tension-free" closure of the posterior floor can be accomplished. Patients are discharged home in 1 to 2 hours. Because a standard approach and block are used, the learning curve for this operation should be brief compared with that of the laparoscopic method. The follow-up of this series is short (average: 15 months), but there have been no recurrences or infections. One patient returned to the operating room within 4 hours due to an arterial bleeder in Scarpa's fascia but was discharged that day and had no subsequent problems. Another patient has a postoperative neuralgia probably unrelated to the mesh. Otherwise, there has no complications with the placement of the Marlex mesh. Patients are allowed to return to full activity and work at their discretion. PMID:8488944

Horton, M D; Florence, M G

1993-05-01

40

Primary Lumbar Hernia Repair: The Open Approach  

Microsoft Academic Search

Background: Lumbar hernias arise through posterolateral abdominal wall defects, named inferior triangle (Petit) and superior triangle (Grynfelt). Most of the lumbar hernias are secondary to trauma or previous surgery, while primary lumbar hernias are rare. There are two possible surgical approaches: the anterior approach with lumbar incision and the laparoscopic (transabdominal or totally extraperitoneal) approach. Methods: We present a series

G. Cavallaro; A. Sadighi; M. Miceli; A. Burza; G. Carbone; A. Cavallaro

2007-01-01

41

Umbilical hernia repair  

MedlinePLUS

... discuss your (or your child's) medical history to determine the right amount and type of anesthesia to use. You or your child may be asked to stop eating and drinking 6 hours before surgery. Make sure ...

42

Laparoscopic ventral hernia repair during pregnancy  

Microsoft Academic Search

Background  Laparoscopic ventral hernia repair in comparison to open herniorrhaphy results in reduced length of stay, less post-operative\\u000a pain, earlier return to work, and reduced complications for the repair of complex ventral hernias. The laparoscopic approach\\u000a has been the standard of care for complex or large ventral hernias for non-pregnant patients over the past decade. Despite\\u000a evidence that demonstrates that laparoscopy

P. Y. Wai; J. A. Ruby; K. A. Davis; A. C. Roberts; K. E. Roberts

2009-01-01

43

Sutureless Laparoscopic Ventral Hernia Repair in Obese Patients  

PubMed Central

Background and Objective: Transfascial sutures (TFS) are a standard component of laparoscopic ventral herniorrhaphy (LVHR) that contribute to the durability of repair, but also pain and, resultantly, hospital stay. We sought to examine LVHR without TFS in obese patients with small abdominal wall hernias. Methods: Between September 2002 and December 2007, 174 patients underwent LVHR at Yale-New Haven Hospital. Patients with BMI >30kg/m2 and small primary abdominal wall hernias were eligible for repair without TFS. Correlation between BMI, defect surface area, operative time, and postoperative stay was assessed. Results: Fourteen patients underwent LVHR with no TFS, 2 with normal BMI and recurrent hernia after open repair and 12 with BMI>30 kg/m2 and primary small hernia. Mean age was 38.8 years. The average defect size was 5.3cm2; mean operative time (OT) was 42 minutes. Eleven patients (92%) were discharged home the day of surgery. No infectious or bleeding complications occurred. One patient required chronic pain management, and 8 patients (67%) developed seromas that resorbed spontaneously. There was no hernia recurrence at 7-month follow-up. Conclusion: LVHR is feasible without TFS provided the hernia defect is small. Surgery can be performed on an outpatient basis in obese individuals with minimal postoperative morbidity. PMID:21902966

Akkary, Ehab; Panait, Lucian; Roberts, Kurt; Duffy, Andrew

2011-01-01

44

Laparoscopic total extraperitoneal repair of lumbar hernia  

PubMed Central

Lumbar hernia is a rare surgical entity without a standard method of repair. With advancements in laparoscopic techniques, successful lumbar herniorrhaphy can be achieved by the creation of a completely extraperitoneal working space and secure fixation of a wide posterior mesh. We present a total extraperitoneal laparoendoscopic repair of lumbar hernia, which allowed for minimal invasiveness while providing excellent anatomical identification, easy mobilization of contents and wide secure mesh fixation. A total extraperitoneal method of lumbar hernia repair by laparoscopic approach is feasible and may be an ideal option. PMID:22111086

Lim, Man Sup; Lee, Hae Wan; Yu, Chang Hee

2011-01-01

45

Controversies in laparoscopic repair of incisional hernia  

PubMed Central

Background: Incisional hernias can be a significant problem after open abdominal surgery. Laparoscopic incisional hernia repair (LIHR) is conceptually appealing: a large, abdominal wall re-incision with potential wound-related ill effects is avoided and an intra-peritoneal onlay mesh is expected to provide security that is equivalent to open, retro-muscular mesh repair. As such, LIHR has gained substantial popularity despite sparse, randomised clinical data to compare with conventional, open repair. Aim: To enumerate and discuss important, controversial issues in patient-selection, technique and early post-operative care for LIHR. Materials and Methods: Pragmatic summary of comprehensive review of English language literature, discussion with experts and personal experience. Outcomes: Six important areas of some dispute were identified: 1. Size of abdominal-wall defect that is suitable for LIHR: Generally, defect-diameter > 10 cm is better served by open retromuscular repair with tension-free re-approximation of the edges of the defect. 2. Extent of adhesiolysis: Complete division of adhesions to the anterior abdominal wall may identify sub-clinical “Swiss-cheese” defects but incurs some risk of additional complications. 3. Intra-operative recognition of enterotomy: Possible options are either laparoscopic suture of bowel injury and simultaneous completion of LIHR, or staged LIHR or conversion to open suture-repair. 4. Choice of mesh: “Composite” meshes are regarded as the current standard of care but there is paucity of data regarding potential dangers of intra-peritoneal polypropylene mesh. 5. Technique of mesh-fixation: Trans-parietal sutures are more secure than tacks, with limited data to correlate with post-operative pain. 6. Alarm over post-operative pain: Unlike other advanced laparoscopic operations, the specificity of pain as a marker of intra-abdominal sepsis after LIHR remains unclear. Conclusion: Recognition of and attention to controversial issues will promote increased success of LIHR. PMID:21170220

Sarela, Abeezar I.

2006-01-01

46

Mini-mesh repair for femoral hernia  

PubMed Central

INTRODUCTION Femoral hernia consists only 4% of all primary groin hernias. It is described as “the Bête Noire of Hernias” because of its nature and anatomy which is difficult to understand for the surgeons and tendency to recurrence. Although there is some large series of femoral hernia in the literature, few studies prospectively comparing repair techniques especially for this type of hernia has been published. A new technique named mini-mesh repair is described here. PRESENTATION OF CASE After hernia sac is dissected completely and sent back into the preperitoneal space, femoral canal is exposed. A round or oval shaped patch is prepared in 1.5–2.5 cm in diameter according to the size of the femoral canal. Mesh is secured to the Cooper's ligament with 2/0 polypropylene suture. Eight femoral hernias in 8 patients were repaired with this new technique. Patient satisfaction is very good. One seroma and one limited ecchymosis were recorded. No recurrence was observed in a mean follow-up of 22.4 months. No chronic pain was recorded. DISCUSSION Many techniques for femoral hernia repair have been described to date with a variety of clinical outcomes. Each technique has its own advantages and disadvantages. Mesh repairs without tension seems to be better choices. When the transversalis fascia is healthy and strong in a patient with femoral hernia a large piece of mesh may be unnecessary. The simple technique described in this paper can be a good alternative. It is totally problem-oriented, and the burden of prosthetic material is very limited. CONCLUSION Mini mesh repair may be a good solution for selected patients with femoral hernia. PMID:25105770

Kulacoglu, Hakan

2014-01-01

47

Fasciitis necroticans after elective hernia inguinal surgery.  

PubMed

Necrotising fasciitis is a rare but disastrous complication after elective surgery. We present two patients (both male, 58 and 18 years old) who developed necrotising fasciitis following elective inguinal hernia repair according to Lichtenstein. The importance of both recognition and time interval between symptom occurrence and surgical intervention is illustrated, emphasising the need for immediate action when necrotising fasciitis is suspected. A high index of suspicion of necrotising fasciitis should be maintained when a wound infection is accompanied by disproportional pain, lethargy, or sepsis. Epidermolysis and subcutaneous emphysema are often very late symptoms. Recognition and immediate intervention decrease mortality and morbidity. PMID:24511409

Sigterman, T A; Gorissen, Kim J; Dolmans, Dennis E J G J

2014-01-01

48

Fasciitis Necroticans after Elective Hernia Inguinal Surgery  

PubMed Central

Necrotising fasciitis is a rare but disastrous complication after elective surgery. We present two patients (both male, 58 and 18 years old) who developed necrotising fasciitis following elective inguinal hernia repair according to Lichtenstein. The importance of both recognition and time interval between symptom occurrence and surgical intervention is illustrated, emphasising the need for immediate action when necrotising fasciitis is suspected. A high index of suspicion of necrotising fasciitis should be maintained when a wound infection is accompanied by disproportional pain, lethargy, or sepsis. Epidermolysis and subcutaneous emphysema are often very late symptoms. Recognition and immediate intervention decrease mortality and morbidity. PMID:24511409

Sigterman, T. A.; Gorissen, Kim J.; Dolmans, Dennis E. J. G. J.

2014-01-01

49

Sexual function after Stoppa hernia repair in patients with bilateral inguinal hernia  

PubMed Central

Background: This study was performed to evaluate the effect of Stoppa hernia repair on sexual function of the patients with bilateral inguinal hernia. Methods: In a prospective follow-up study, 50 patients with bilateral inguinal hernia were investigated to assess sexual function before and 1 and 6 months after standardized Stoppa hernioplasty using the International Index of Erectile Function (IIEF) questionnaire. The mean scores obtained on pre- and postoperative visits for all domains of sexual function were analyzed and compared with the Friedman and paired Wilcoxon tests. Results: The mean score of IIEF at the first month after surgery was significantly declined compared to that before surgery and 6 months after surgery (P< 0.001), while the difference between preoperative score and the score at 6 months after surgery was not significant Conclusion: Bilateral inguinal mesh repair with Stoppa technique can decreased sexual activity of the patients at one month after surgery, nevertheless it returns to its initial condition at 6 months after surgery. This suggests that the Stoppa technique does not affect the sexual function of patients with bilateral inguinal hernia.

Jangjoo, Ali; Darabi Mahboub, Mohammad Reza; Mehrabi Bahar, Mostafa; Afzalaghaee, Monavvar; Najib Jalali, Ali; Aliakbarian, Mohsen

2014-01-01

50

Umbilical hernia repair - series (image)  

MedlinePLUS

Umbilical hernias are fairly common. They are obvious at birth and are caused by a small defect in the ... In most cases, by age 3 the umbilical hernia shrinks and closes without treatment. The indications for ...

51

Laparoscopic inguinal hernia repair: a prospective evaluation at Eastern Nepal  

PubMed Central

Introduction Inguinal hernias have been treated traditionally with open methods of herniorrhaphy or hernioplasty. But the trends have changed in the last decade with the introduction of minimal access surgery. Methods This study was a prospective descriptive study in patients presenting to Surgery Department of B. P. Koirala Institute of Health Sciences, Dharan, Nepal with reducible inguinal hernias from January 2011 to June 2012. All patients >18 years of age presenting with inguinal hernias were given the choice of laparoscopic repair or open repair. Those who opted for laparoscopic repair were included in the study. Results There were 50 patients, age ranged from 18 to 71 years with 34 being median age at presentation. In 41 patients, totally extraperitoneal repair was attempted. Of these, 2 (4%) repairs were converted to transabdominal repair and 2 to open mesh repair (4%). In 9 patients, transabdominal repair was done. The median total hospital stay was 4 days (range 3-32 days), the mean postoperative stay was 3.38±3.14 days (range 2-23 days), average time taken for full ambulation postoperatively was 2.05±1.39 days (range 1-10 days), and median time taken to return for normal activity was 5 days (range 2-50 days). One patient developed recurrence (2%). None of the patients who had laparoscopic repair completed complained of neuralgias in the follow-up. Conclusion Laparoscopic repair of inguinal hernias could be contemplated safely both via totally extra peritoneal as well as transperitoneal route even in our setup of a developing country with modifications. PMID:25170385

Shakya, Vikal Chandra; Sood, Shasank; Bhattarai, Bal Krishna; Agrawal, Chandra Shekhar; Adhikary, Shailesh

2014-01-01

52

Laparoscopic total extraperitoneal repair versus anterior preperitoneal repair for inguinal hernia.  

PubMed

Laparoscopic inguinal hernia repair is still not the gold standard for repair although mesh implantation is unequivocally accepted as an integral part of any groin hernia repair. The aim of the study was to compare the results of anterior preperitoneal (APP) mesh repair with totally extra peritoneal (TEP) repair for inguinal hernias. The prospective study was conducted on 241 patients with 247 hernias (from January 2000 to June 2004). Anterior preperitoneal repair was done in 121 patients and 120 patients were subjected to TEP repair. Repair in both groups was done by using Prolene mesh of size 6x4 in. or 6x6 in. intraoperative and postoperative parameters and complications were recorded and the patients were followed up to 1 year post-surgery. For both unilateral and bilateral inguinal hernias, mean operative time was significantly more in patients of TEP repair as compared to APP repair (P<0.001) and significantly more patients had peritoneal tears in the TEP group (P<0.001). Patients undergoing TEP repair, however, had significantly less postoperative pain (P<0.05) and postoperative hospital stay (P<0.05) and return to work was significantly earlier is this group (P<0.01 and P<0.001). There was no difference in the recurrence rate between the two groups. Patients with inguinal hernias undergoing laparoscopic repair recover more rapidly, and have less incidence of postoperative pain. But it takes significantly more time to perform than APP repair and also the incidence of peritoneal tear is higher. PMID:16479362

Sinha, R; Sharma, N; Dhobal, D; Joshi, M

2006-04-01

53

New technique for inguinal hernia repair.  

PubMed

We compared a new fascia transversalis based hernioplasty with mesh repair techniques which leave the fascia transversalis intact. We prospectively randomized 180 consecutive patients with inguinal hernia to undergo one of the three hernia repair techniques. Hernias were repaired either by using the new fascia transversalis repair-Coskun's hernia repair (FTR), based on the plication of fascia using continuous sutures and followed by a second layer of interrupted or continuous sutures between inguinal ligament and conjoint tendon to distribute the tension, or one of the two mesh repair techniques: anterior (Lichtenstein) or posterior (preperitoneal) repair. Parameters such as age, sex, hernia cause, operation time, type of anesthesia, surgeon's seniority, complications, hospital stay and follow-up were evaluated. Recurrence rates were determined through clinical examination. Effect of prostatism, co-morbid disease, operation time, complications and Nyhus type of hernia on recurrences were also analysed. Most patients in each group were operated on under general anesthesia (78% vs. 80% vs. 85% for FTR, Lichtenstein, and preperitoneal repair, respectively) and by surgeons in training (average 78%). Patients were followed up for a median of 36 months. FTR had less complications and an acceptable time for operation whereas preperitoneal repairs needed more seniority, longer operation time, and caused more complications. There were only 3 (1.6%) recurrences, none in the FTR group and two the in Lichtenstein group during first postoperative year. There was no recurrence in preperitoneal repair group. All patients with recurrences had an operation time longer than 60 min and were operated on by surgeons in training. Two patients with recurrences had prostatism symptoms and chronic cough. We conclude that the new FTR is as effective as mesh repair (either anterior or posterior) with an acceptable rate of recurrences, fewer complications, and that it can be performed by the surgeons in training. PMID:15611838

Coskun, F; Ozmen, M M; Moran, M; Ozozan, O

2005-03-01

54

Laparoscopic repair of hernia in children: Comparison between ligation and nonligation of sac  

PubMed Central

Aim: The essence of the current techniques of laparoscopic hernia repair in children is suture ligation of the neck of the hernia sac at the deep ring with or without its transection. Some studies show that during open hernia repair, after transection at the neck it can be left unsutured without any consequence. This study was aimed to see if the same holds true for laparoscopic hernia repair. Materials and Methods: Sixty patients (52 boys and eight girls, 12-144 months) with indirect inguinal hernia were randomized for laparoscopic repair either by transection of the sac alone (Group I) or transection plus suture ligation of sac at the neck (Group II). Outcome was assessed in terms of time taken for surgery, recurrence, and other complications. Result: Thirty-eight hernia units in 28 patients were repaired by transection alone (Group I) and 34 hernia units in 29 patients were repaired by transection and suture ligation (Group II). Three patients were found to have no hernia on laparoscopy. Recurrence rate and other complications were not significantly different in the two groups. All recurrences occurred in hernias with ring size more than 10 mm. Conclusion: Laparoscopic repair of hernia by circumferential incision of the peritoneum at the deep ring is as effective as incision plus ligation of the sac. PMID:24741209

Pant, Nitin; Aggarwal, Satish Kumar; Ratan, Simmi K.

2014-01-01

55

Aspects of hernia surgery in Wales.  

PubMed Central

The management of elective inguinal herniorrhaphy in Wales was assessed by means of a postal survey of consultant general surgeons. This included technique of repair, length of inpatient stay, follow-up, use of heparin thromboprophylaxis and advice regarding driving, strenuous activities and work. In all, 54 replies (77%) were received. The views of patients on their surgery was assessed by a questionnaire sent to 80 patients treated on a single surgical unit; 60 replies (75%) were received. Waiting times were relatively short among this group, 67.5% of patients being treated within 6 months of seeking medical advice; 16.25% suffered a complication. All wound infections occurred after discharge and 15% of patients had some groin discomfort 6 months after operation. Accuracy of clinical examination of 50 inguinal hernias by different grades of surgeon was assessed. Consultants were significantly more accurate when compared with house officers (P < 0.001). There is a wide range of repair techniques and postoperative advice practised by consultant general surgeons in Wales. Patients' main complaint was that of a sparsity of postoperative advice, although there also appears to be an appreciable postoperative morbidity. Clinical experience plays a significant role in assessment of the suitability of hernias for surgery. PMID:7598418

Boyce, D. E.; Crosby, D. L.; Shandall, A. A.

1995-01-01

56

Outcome of the patients with chronic mesh infection following open inguinal hernia repair  

PubMed Central

Purpose Hernia repairs are the most common elective abdominal wall procedures performed by general surgeons. The use of a mesh has become the standard for hernia repair surgery. Herein, we discuss a management strategy for chronic mesh infections following open inguinal hernia repair with onlay prosthetic mesh. Methods In this study, 15 patients with chronic mesh infections following open inguinal hernia repairs were included. The medical records of these patients were retrospectively reviewed and information regarding presentation, type of previous hernia repair, type of mesh, operative findings and bacteriological examination results were obtained. In all cases, the infected mesh was removed completely and the patients were treated with antibiotic regimens and local wound care. Results Fifteen mesh removals due to chronic infection were performed between January 2000 and March 2012. The mean interval of hernia repair to mesh removal was 49 months. All patients were followed up for a median period of 62 months (range, 16 to 115 months). In all patients, the infections were resolved successfully and none were persistent or recurrent. However, one patient developed recurrent hernia and one developed nerve injury. Conclusion Chronic mesh infection following hernia repair mandates removal of the infected mesh, which rarely results in hernia recurrence. PMID:23646314

Kocaay, Firat; Orozakunov, Erkinbek; Genc, Volkan; Kepenekci Bayram, Ilknur; Cakmak, Atil; Baskan, Semih; Kuterdem, Ercument

2013-01-01

57

Proceed(TM) Mesh for Laparoscopic Ventral Hernia Repair  

PubMed Central

Background and Objectives: Laparoscopic technique to repair ventral hernia offers advantages over conventional open surgery such as shorter recovery time, decreased pain, and lower recurrence rates. There are a myriad of meshes available for laparoscopic repair of ventral hernias. This study evaluated the outcomes of laparoscopic repair of ventral hernias with Proceed mesh (Ethicon, Somerville, NJ, USA) in a single academic institution. Methods: An institutional review board–approved retrospective review was performed for 100 consecutive patients with ventral hernia who underwent a laparoscopic approach at our institution from August 2006 to February 2009. All patients were operated on by a single surgeon using a standard technique with transabdominal suture fixation and tacks. Results: The study included 100 consecutive patients (57 female and 43 male patients). The mean age was 55 years (range, 16–78 years), and the mean body mass index was 33.3 kg/m2 (range, 19.6–68.9 kg/m2). Of the repairs, 27% were performed for a recurrent hernia. The mean and median size of the defect were 128 cm2 and 119.5 cm2 (range, 4–500 cm2), respectively. To ensure appropriate mesh overlap, the mean size of mesh was 253 cm2 (range, 36–700 cm2). There were 4 conversions. The mean operative time was 117 minutes (range, 35–286 minutes). The mean length of stay was 1.9 days. There were no major abdominal complications. With a mean follow-up period of 50 months (range, 38–68 months), we have not recorded any recurrences. No mesh-related complications have been documented. Conclusions: The laparoscopic approach to ventral hernia repairs using Proceed mesh is associated with a low conversion rate and no major complications. At 50 months of follow-up, the recurrence rate is 0%. There were no mesh-related complications. PMID:24398198

Franklin, Brenton R.; Patel, Ketan M.

2013-01-01

58

Postoperative complications after laparoscopic incisional hernia repair  

Microsoft Academic Search

  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

D. Berger; M. Bientzle; A. Müller

2002-01-01

59

Inguinal hernia repair using local anaesthesia.  

PubMed Central

This is a review of a large and long experience in one hospital with more than 100 000 elective inguinal hernia repairs using local anaesthesia and emphasising the advantages of this type of anaesthetic. Subsections deal briefly with facets of this experience such as age, preoperative assessment, skin incision, the cremaster muscle, the testis, bilateral hernias, hernias in women, short hospital stay, follow-up, return to work and recurrence rates. Considerable emphasis is given to the principles of technique and this is described in detail. Images p[381]-a p[381]-b p[381]-c p[381]-d Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:6391342

Glassow, F.

1984-01-01

60

Learning curve for laparoscopic totally extraperitoneal repair of inguinal hernia  

PubMed Central

Background Laparoscopic totally extraperitoneal (TEP) repair has been accepted as a popular procedure for inguinal hernia repair, but surgeons still encounter technical difficulties owing to unfamiliar pelvic anatomy and limited working space. We sought to estimate the learning curve for laparoscopic TEP repair without supervision. Methods We retrospectively analyzed the medical records of patients scheduled for laparoscopic TEP repair of an inguinal hernia from December 2000 to October 2007. Results We reviewed medical records for 700 patients. The cases were divided into 8 groups: 20 patients each in groups I–V and 200 patients each in groups VI–VIII. No significant difference in demographic characteristics was identified among the groups. The mean duration of surgery significantly decreased (p < 0.001) in relation to experience; it reached a plateau of less than 30 minutes (mean 28 min) after 60 cases. The mean length of stay in hospital was 0.97 days, reaching a plateau after 20 cases. Six patients were converted to other techniques: 1 patient each in groups III and VIII and 4 patients in group VII. Three recurrences were detected; however, 2 were excluded because the patient had bilateral inguinal hernias. Conclusion We estimate the learning curve for laparoscopic TEP repair is 60 cases for a beginner surgeon. The presence of an experienced supervisor during the first 60 cases can help prevent unnecessary complications and shorten the duration of surgery. PMID:22269299

Choi, Yoon Young; Kim, Zisun; Hur, Kyung Yul

2012-01-01

61

Results of Laparoscopic Versus Open Abdominal and Incisional Hernia Repair  

PubMed Central

Background: Incisional hernia is a frequent complication of abdominal surgery. The object of this study was to confirm the safety, efficacy, and feasibility of laparoscopic treatment of abdominal wall defects. Methods: Fifty consecutive laparoscopic abdominal and incisional hernia repairs from September 2001 to May 2003 were compared with 50 open anterior repairs. Results: The 2 groups were not different for age, body mass index, or American Society of Anaesthesiologists scores. Mean operative time was 59 minutes for the laparoscopic group, 164.5 minutes for the open group. Mean hernia diameter was 10.6 cm for the laparoscopic group, 10.5 cm for the open group. Mean length of stay was 2.1 days for the laparoscopic group, 8.1 days for the open group. Complications occurred in 16% of the laparoscopic and 50% of open group. Median follow-up was 9.0 months for the laparoscopic group, 24.5 months for the open group. Recurrence rates were 2% for laparoscopic group and 0% for the open group. Conclusion: Results for laparoscopic abdominal and incisional hernia repair seem to be superior to results for open repair in terms of operative time, length of stay, wound infection, major complications, and overall hospital reimbursement. PMID:15984708

Magnone, Stefano; Erba, Luigi; Bertolini, Aimone; Croce, Enrico

2005-01-01

62

Laparoscopic repair of ventral / incisional hernias  

PubMed Central

Despite its significant prevalence, there is little in the way of evidence-based guidelines regarding the timing and method of repair of incisional hernias. To add to the above is the formidable rate of recurrence that has been seen with conventional tissue repairs of these hernias. With introduction of different prosthetic materials and laparoscopic technique, it was hoped that an improvement in the recurrence and complication rates would be realized. The increasing application of the laparoscopic technique across the world indicates that these goals might indeed be achieved. PMID:21187995

Chowbey, Pradeep K; Sharma, Anil; Mehrotra, Magan; Khullar, Rajesh; Soni, Vandana; Baijal, Manish

2006-01-01

63

Preemptive analgesia with midazolam and diclofenac for hernia repair pain  

Microsoft Academic Search

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 hernia repair surgery 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

2011-01-01

64

Laparoscopic repair of paraesophageal hernias: a Canadian experience  

PubMed Central

Background The surgical approach to paraesophageal hernias (PEH) has changed with the advent of laparoscopic techniques. Variation in both perioperative outcomes and hernia recurrence rates are reported in the literature. We sought to evaluate the short-and intermediate-term outcomes with laparoscopic PEH repair. Methods We performed a retrospective review of patients having laparoscopic repair of PEH between June 1998 and September 2002. We included patients with more than 120 days of follow-up. Results A total of 58 patients with a mean age of 60.4 (standard deviation [SD] 15.0) years had a laparoscopic procedure to repair a primary PEH, as well as adequate follow-up, during the study period. The types of PEH included type II (n = 13), III (n = 44) and IV (n = 1). The most common symptoms were epigastric pain (57%), dysphagia (40%), heartburn (31%) and vomiting (28%). Associated procedures included 56 (96%) Nissen fundoplications and 2 (4%) gastropexies. We closed all crural defects either with or without pledgets, and 2 patients required the use of mesh. There was 1 conversion to open surgery owing to intraoperative bleeding secondary to a consumptive coagulopathy; we observed no other major intraoperative emergencies. Minor or major complications occurred in 15 patients (26%). Late postoperative complications included 1 umbilical hernia. The mean length of stay in hospital was 3.8 (SD 2.5) days. After surgery, 19 patients were completely asymptomatic, and the majority of the remaining patients (83%) described marked symptom improvement. Upper gastrointestinal series performed in symptomatic patients in the postoperative setting identified 5 recurrent paraesophageal hernias (8.6%) and 5 small sliding hernias (9%). Conclusion Laparoscopic repair of PEH is associated with improved long-term symptom relief, low morbidity and acceptable recurrence rates when performed in an experienced centre. PMID:18841230

Boushey, Robin P.; Moloo, Husein; Burpee, Stephen; Schlachta, Christopher M.; Poulin, Eric C.; Haggar, Fatima; Trottier, Daniel C.; Mamazza, Joseph

2008-01-01

65

Postoperative Pain After Laparoscopic Ventral Hernia Repair: a Prospective Comparison of Sutures Versus Tacks  

PubMed Central

Background and Objectives: Mesh fixation in laparoscopic ventral hernia repair typically involves the use of tacks, transabdominal permanent sutures, or both of these. We compared postoperative pain after repair with either of these 2 methods. Methods: Patients undergoing laparoscopic ventral hernia repair at the Mount Sinai Medical Center were prospectively enrolled in the study. They were sorted into 2 groups (1) those undergoing hernia repairs consisting primarily of transabdominal suture fixation and (2) those undergoing hernia repairs consisting primarily of tack fixation. The patients were not randomized. The technique of surgical repair was based on surgeon preference. A telephone survey was used to follow-up at 1 week, 1 month, and 2 months postoperatively. Results: From 2004 through 2005, 50 patients were enrolled in the study. Twenty-nine had hernia repair primarily with transabdominal sutures, and 21 had repair primarily with tacks. Both groups had similar average age, BMI, hernia defect size, operative time, and postoperative length of stay. Pain scores at 1 week, 1 month, and 2 months were similar. Both groups also had similar times to return to work and need for narcotic pain medication. Conclusions: Patients undergoing laparoscopic ventral hernia repair with primarily transabdominal sutures or tacks experience similar postoperative pain. The choice of either of these fixation methods during surgery should not be based on risk of postoperative pain. PMID:18435881

Nguyen, Scott Q.; Buch, Kerri E.; Schnur, Jessica; Weber, Kaare J.; Katz, L. Brian; Reiner, Mark A.; Aldoroty, Robert A.; Herron, Daniel M.

2008-01-01

66

Effectiveness of Lichtenstein repairs in planned treatment of giant inguinal hernia - own experience  

PubMed Central

Introduction Occurrence of giant inguinal hernias is not frequent because of growing medical awareness in the community as well as progress in surgical treatment in this field. Aim To evaluate the effectiveness of repairs using the Lichtenstein technique in scheduled treatment of giant inguinal hernias. Material and methods Between 2006 and 2010 in the Department of Surgery with the Subdepartment of Proctology, Hospital at Solec in Warsaw, 909 repairs of inguinal hernia were performed, including 15 patients (1.65%) with the diagnosis of giant hernia. In 3 cases it was direct inguinal hernia and in 12 cases indirect inguinal hernia. All giant hernias occurred in male patients between 33 and 87 years of age (mean age 65 years old) and developed for many years, median of 14.2 years. All patients underwent scheduled repairs using the tension-free Lichtenstein technique. A non-absorbable polypropylene mesh was used for hernioplasty. Exact Fisher's test (p < 0.01) was used for statistical analysis. Results In all cases contents of the hernial sac consisted of loops of small intestine, colon and omentum. Early complications occurred in 11 patients (73%) in the group of patients with giant hernias, whereas in the remaining group of patients early complications occurred in 53 patients (5.9%). The difference was statistically significant. In the group of patients with giant hernias no recurrence was observed over the observation period ranging from 6 months to 4.5 years. In the remaining group of patients recurrences occurred in 23 patients (2.6%). Conclusions The Lichtenstein technique of repair is effective in management of giant inguinal hernias. A statistically significantly higher percentage of complications was observed in the group of patients with giant hernias as compared to the remaining group of patients with inguinal hernias. Patients with giant hernias require proper preparation for surgery, especially in relation to their respiratory efficiency. PMID:23630552

Kosim, Anna; Kolodziejczak, Malgorzata; Zmora, Jan; Kultys, Ewa

2012-01-01

67

Single Incision Laparoscopic Ventral Hernia Repair  

PubMed Central

Background and Objectives: Laparoscopic ventral hernia repair (LVH) requires several skin incisions for trocar placement. We have developed a single incision approach to LVH repair. The technique was introduced in clinical practice to any consenting patients who were candidates for a standard multi-port laparoscopic hernia repair. A consecutive series of patients was then followed to evaluate feasibility. Methods: Over an 8-month period, 14 patients (9 females, 5 males) underwent LVH repair by an academic surgeon. One of 2 access methods was used in each patient through a single 1.5-cm to 2-cm skin incision. One technique utilized two 5-mm ports with a temporarily placed 11-mm port for mesh insertion. The second technique utilized the SILS port (Covidien, Norwalk, CT). Standard or roticulating laparoscopic instruments were used with both techniques. Results: Range (mean) BMI: 23 to 59 (38), Age: 26 to 73 years (53), Duration: 37 to 87 minutes (57), Defect size: 1cm to 8cm (2), 3 with Swiss-cheese defect hernias. The procedure was successfully performed in all patients. No conversions to a multiple-port approach or to an open procedure were necessary. There were no mortalities, major complications, or recurrences during the mean follow-up period of 4 weeks. Conclusion: Single incision ventral hernia repair is technically feasible, effective, and reproducible. The technique is easy to master, and safe for any patient who is a candidate for laparoscopic ventral hernia repair. Further data collection with long-term follow-up will be needed to ensure equivalent outcomes. There will be demand for this approach by patients for cosmetic reasons, and it may serve as a bridge to natural orifice techniques. PMID:21902968

Love, Katie M.

2011-01-01

68

Mesh infections after laparoscopic inguinal hernia repair.  

PubMed

Several complications like hematoma and seroma have been reported after laparoscopic inguinal hernia repair (LH). Sepsis due to infection of the patch is an uncommon complication. In this retrospective trial, we evaluated three male patients who developed postoperative mesh infection after LH by transabdominal preperitoneal patch (TAPP) technique in two institutions. Diagnosis was confirmed by clinical symptoms, signs, ultrasonography, and computerized tomography (CT), and definitive treatment was provided by removing the mesh. In the first case, mesh infection occurred 10 months after laparoscopic left inguinal hernia repair with TAPP for recurrence. The infection manifested itself as an external fistula at the drain site. The mesh was removed laparoscopically due to persistent suppuration. In the second case, mesh infection occurred 3 months after transabdominal preperitoneal hernia repair on the left. The patch was removed because of the persistent suppuration despite repetitive drainage and lavage. In the third case, mesh infection occurred in 15 days after transabdominal preperitoneal hernia repair on the right. External drainage was performed under CT guidance, but suppuration could not be stopped. Thus the mesh was removed. In three cases, infection could not be stopped after diagnosis despite drainage and antibiotic coverage, and then it was decided to remove the mesh. The meshes were removed under general anesthesia for the first two cases and under local anesthesia for the third one. During the follow-up period, no recurrences were noted. The mesh infections of these three cases, resistant to conservative treatment methods, completely disappeared after mesh removal. PMID:9194276

Avtan, L; Avci, C; Bulut, T; Fourtanier, G

1997-06-01

69

Ventral hernia repair with simultaneous panniculectomy.  

PubMed

The repair of a ventral hernia in an obese patient presents an interesting clinical challenge. We retrospectively reviewed the charts of 55 patients who, over a 12-year period from 1983 to 1995, concomitantly underwent both ventral herniorrhaphy and panniculectomy or abdominoplasty. In six of 55 patients, the hernia was recurrent. Forty-six patients had primary abdominal wall hernias or diastasis recti. Nineteen of 55 patients had weight greater than 200 lbs. This last subset of patients had a significantly higher incidence of complications, such as seroma, cellulitis, and persistent wound drainage. In our 55 patients, we experienced only two hernia recurrences (3.6%) during an average patient follow-up of 53 weeks. From this experience, we believe that simultaneous ventral hernia repair and panniculectomy is a safe and efficacious approach to these two problems so commonly found in the obese patient. Patients with a preoperative weight greater than 200 lbs can be expected to have a greater risk of wound complications. In all cases, the wounds eventually healed with no long-term sequelae. PMID:8712568

Hughes, K C; Weider, L; Fischer, J; Hopkins, J; Antonetti, A; Manders, E K; Dunn, E

1996-08-01

70

Laparoscopic versus open inguinal hernia repair: randomised prospective trial.  

PubMed

Laparoscopic surgery benefits patients because it reduces pain and enables earlier mobilisation. There is concern that laparoscopic hernia repair may enter surgical practice without proper evaluation. We have done a randomised, prospective study comparing laparoscopic and open inguinal hernia repair performed under day-case general anaesthesia. 150 patients were randomised to have laparoscopic (group L) or open (group O) herniorrhaphy. Group L underwent transabdominal stapling of preperitoneal Prolene mesh. Group O underwent open repair, with a tension-free nylon darn. Postoperatively patients completed pain analogue scales eight times over 7 days, and use of analgesia was recorded. Time of return to normal domestic activity and to work was assessed. The groups were similar in age, sex, and body surface area. Self-administered co-proxamol was a median of 18 tablets (1 tablet = 325 mg) in group O (n = 75) and 6 in group L (n = 75, p < 0.001). Overall mean pain analogue score was 3.1 (SD 1.8, n = 70) in group O and 1.8 (SD 1.1, n = 71) in group L (p < 0.0001). Return to normal domestic activity was a median of 7 days in group O (n = 72) and 3 days in group L (n = 73) (p < 0.001). Return to work was a median of 28 days in group O (n = 39) and 14 days in group L (n = 40) (p < 0.002). These data suggest that laparoscopic hernia repair induces less pain than open hernia repair, and enables patients to return to normal activity and work more quickly. PMID:7910272

Stoker, D L; Spiegelhalter, D J; Singh, R; Wellwood, J M

1994-05-21

71

Inguinal hernia developed after radical retropubic surgery for prostate cancer  

PubMed Central

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 hernia repair 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. PMID:24106684

Jeong, Gyu Young; Kim, Seung Han; Lee, Dong Keun

2013-01-01

72

Laparoscopic repair of coexisting prevascular and obturator hernias.  

PubMed

A prevascular femoral hernia is a rare type of femoral hernia in which the neck lies anterior to the femoral vessels. Obturator hernias are unusual herniations through the obturator foramen. There are no reports in the literature of coexisting prevascular and obturator hernias. Although obturator hernias have been treated successfully by laparoscopic techniques, there are no published reports of prevascular hernias treated in this way. We report the first case in the literature of a patient with a prevascular femoral hernia treated successfully by laparoscopic preperitoneal mesh repair in a rare case associated with ipsilateral obturator and classic femoral hernias. Prevascular femoral hernias are rare, potentially difficult to treat and are ideally suited to investigation and repair by laparoscopic means. PMID:23047414

Bunting, David M; Finlay, Ian G

2012-10-01

73

Local and General Anesthesia in the Laparoscopic Preperitoneal Hernia Repair  

PubMed Central

Objective: The extraperitoneal laparoscopic approach (EXTRA) has been shown to be an effective and safe repair for primary (PIH), recurrent (RIH) and bilateral hernia (BIH). There is very little data examining the merits of laparoscopic repair for hernias under local anesthesia. In this paper, we compare EXTRA performed under both general and local anesthesia. Methods: This nonrandomized prospective study was performed selectively on a male population only. Patients with associated pulmonary disease and high risk for general surgery were selected. Patients with recurrence and previous abdominal operations were excluded to decrease confounding variables in the study. A Prolene mesh was used in all patients. Results: Between May 1997 and September 1998, 92 male patients underwent the repair of 107 groin hernias using the EXTRA technique. The procedure was explained to them, and different anesthesia options were given. Fourteen of these repairs were performed under local anesthesia and 93 under general anesthesia. Of the 10 patients who underwent a repair under local anesthesia, there were 8 indirect, 5 direct and 1 pantaloon. The mean age was 53 years. In the group of general anesthesia, the types of hernias repaired were 45 indirect, 30 direct and 11 pantaloon. The mean age was 45 years. The mean follow-up was 15 months. Each patient was sent home the same day. Two peritoneal tears were recorded in the first group. The operative time was longer in the local group (47 ± 11 vs 18 ± 3). None of the patients required conversion to an open technique or change of anesthesia. No recurrences were found in either group. The average time of return to work and regular activity was 3.5 ± 1 and 3 ± 1 days, respectively. Conclusion: There appears to be no significant difference in recurrence and complication rates when the EXTRA is performed under local anesthesia as compared to general. Blunt dissection of the preperitoneal space does not trigger pain and does not require lidocaine injection. The most painful area is the peritoneal reflection over the cord structure. The laparoscopic repair under local anesthesia represents an advantage in the repair of the inguinal hernia, particularly in the population where general anesthesia is contraindicated. PMID:10987398

Ferzli, George

2000-01-01

74

Preperitoneal repair for recurrent inguinal hernia: Laparoscopic and open approach  

Microsoft Academic Search

Background: The aim of this study was to investigate the outcome of preperitoneal repair using laparoscopic (TEP) and open (OPM) approach in recurrent inguinal hernia. Methods: We performed a prospective controlled nonrandomized clinical study in 188 patients with 207 recurrent inguinal hernias over a period of 5 years. TEP repair was employed for 86 repairs, and OPM was used in 121

X. Feliu; G. Torres; X. Viñas; F. Martínez-Ródenas; E. Fernández-Sallent; J. Pie

2004-01-01

75

Demographic and socioeconomic aspects of hernia repair in the United States in 2003.  

PubMed

Data from the National Center for Health Statistics reveals that approximately 800,000 groin hernia repairs were completed in the United States in 2003. More than 90% of these operations involve the use of mesh prosthesis and are performed on an outpatient basis. The two most common groin hernia repair techniques are the Lichtenstein and plug hernioplasties. Economic evaluation of groin hernia surgery demonstrates that the most important component of cost effectiveness is the aggregate time the patient spends in the operating room, recovery room, and the length of his or her overall stay in the facility. PMID:14533902

Rutkow, Ira M

2003-10-01

76

The u and the sushi roll: a conceptual aid for lichtenstein hernia repair.  

PubMed

For surgical trainees, perfecting a systematic approach to open inguinal herniorrhaphy can be complicated by the difficulty of conceptualizing hernias in relationship to the relatively complex anatomy of the inguinal canal. Open inguinal hernia repair is a common general surgery operation and a precise understanding of the operation is essential for residents. We present a systematic approach to this operation that uses the U and sushi roll technique as a conceptual aid to understand inguinal anatomy and a method of hernia repair. PMID:23070414

Yu, Jessica A; Burlew, Clay Cothren

2012-10-01

77

Laparoscopic repair for groin hernias  

Microsoft Academic Search

Laparoscopic inguinal herniorrhaphy was first described by Ger, Schultz, Corbitt, and Filipi in the early 1990s (1-4) and burst upon the surgical scene just after laparoscopic cholecystectomy. It rapidly became popular, and many different techniques for repair were developed. Over the last decade much good work has been done to find which type of laparoscopic repair is best, to determine

Chad J. Davis; Maurice E. Arregui

78

New minimally invasive technique for repairing femoral hernias: 3-D patch device through a femoris approach  

PubMed Central

Background Femoral hernias are less common than inguinal hernias. The use of preformed mesh to repair femoral hernias without tension has become increasingly common. We sought to investigate the safety and feasibility of repairing femoral hernias with a Prolene 3-dimentional (3-D) patch using a femoris approach. Methods We identified all consecutive patients with femoral hernias treated at our centre with a Prolene 3-D patch using a femoris approach in our institution over a 5-year period (2004–2009). We assessed duration of surgery, length of stay in hospital, recurrence, postoperative pain and complications. Results We repaired 73 hernias with this technique during the study period. The mean duration of surgery was 13.1 minutes, most patients were discharged in less than 24 hours, no recurrence was noted, and only minor complications occurred. Conclusion This technique has not only the same advantage of other tension-free repairs, but also the advantages of convenience and shorter duration of surgery. PMID:22630060

Lei, Wenzhang; Huang, Jianpeng; Luoshang, Ciren

2012-01-01

79

Transperitoneal view of the PROLENE hernia system open mesh repair.  

PubMed

The PROLENE Hernia System (PHS), consisting of an onlay and an underlay patch with a connector, has recently been introduced as an option for tension-free open repair of inguinal hernias and is touted for the repair of both direct and indirect hernias. In theory, the underlay is placed either through the internal ring or through the transversalis fascia and is seated in the preperitoneal space. To date, there have been no views of how this underlay is seated after open repair. Our objective was to determine the position and orientation of the underlay patch after open repair. After informed consent, two patients requiring both umbilical and inguinal hernia repairs had their inguinal hernias repaired using the open technique with the PHS. In the first patient, after open inguinal repair, the umbilical hernia was reduced, a 30 degrees laparoscope was placed intraperitoneally, and the underlay patch placed in the retroperitoneal space was visualized through the translucent peritoneum. In the second patient, the umbilical hernia was initially reduced, and the laparoscope was introduced to visualize the creation of the preperitoneal space and placement of the underlay during open repair of the inguinal hernia. As per our hypothesis, we show that the preperitoneal space is successfully created during open repair with the PHS with minimal trauma. More importantly, the underlay is deployed open and contours to the shape of the abdominal wall from the native intra-abdominal pressure, covering regions at risk for future herniation. PMID:16463951

Awad, Samir S; Bruckner, Brian; Fagan, Shawn P

2005-01-01

80

Simultaneous repair of bilateral inguinal hernias under local anesthesia.  

PubMed Central

OBJECTIVE: The authors confirm the advantages of simultaneous repair of bilateral inguinal hernias, indicate that it is feasible to perform the procedure under local anesthesia, and suggest that when an open tension-free technique is used, the results are superior to those of laparoscopic repair of bilateral inguinal hernias. SUMMARY BACKGROUND DATA: Between 1971 and 1995, simultaneous repair of bilateral inguinal hernias were performed in 2953 men. Initially, between 1971 and 1984, patients with indirect hernias underwent the traditional tissue approximation repair. Those with direct hernias had the same procedure, with the repair additionally buttressed by a sheet of Marlex mesh (Davol, Inc., Cronston, RI). Between 1984 and 1995, both direct and indirect hernias were repaired using the open tension-free hernioplasty procedure. METHOD: The 2953 patients underwent simultaneous repair of bilateral inguinal hernias under local anesthesia in a private practice setting in general hospitals. RESULTS: In those cases in which the "tension free" technique was used, patients experienced minimal to mild postoperative pain and had a short recovery period, with a recurrence rate of 0.1%. CONCLUSIONS: Uncomplicated bilateral inguinal hernias in adults are best treated simultaneously. It is feasible to perform the operation under local anesthesia, and when an open tension-free repair is used, postoperative pain and recovery periods are equally comparable with those of laparoscopic repair, although the complication and the recurrence rates are significantly less. Images Figure 1. Figure 2. Figure 3. PMID:8604904

Amid, P K; Shulman, A G; Lichtenstein, I L

1996-01-01

81

Hernia  

MedlinePLUS

... surrounds the muscle. This layer is called the fascia. Which type of hernia you have depends on ... problems. Surgery secures the weakened abdominal wall tissue (fascia) and closes any holes. Most hernias are closed ...

82

A leak too far--gastro-pleural fistula mimicking recurrence of repaired congenital diaphragmatic hernia following fundoplication.  

PubMed

Recurrence rate after a congenital diaphragmatic hernia repair is high especially after a patch repair. Recurrence can be asymptomatic, followed by respiratory or gastrointestinal symptoms and the diagnosis is usually confirmed radiologically. We present an unusual case of radiologically diagnosed recurrent left diaphragmatic hernia but at surgery was found to be a gastro-pleural fistula that occurred as a complication following fundoplication surgery. PMID:24421956

Lakshminarayanan, Bhanumathi; Morgan, Robert David; Platt, Kaye; Lakhoo, Kokila

2013-09-01

83

Laparoscopic Ventral Hernia Repair: Pros and Cons Compared With Open Hernia Repair  

PubMed Central

Background: The purpose of this study was to analyse the surgical techniques, perioperative complications, and recurrence rate of laparocopic ventral hernia repair (LVHR), in comparison with the open ventral hernia repair (OVHR), based on the international literature. Methods: A Medline search of the English literature was performed using the term “laparoscopic ventral hernia repair.” Further articles were found by cross-referencing the references of each main article. Results: Current literature on the topic suggests that LVHR is a safe alternative to the open method with the main advantages being minimal postoperative pain, a shorter convalescence period, and better cosmetic results. Main complications after the laparoscopic approach, such as incidental enterotomy, protracted pain, postoperative seroma, or mesh infection occur at an acceptable rate. Furthermore, most articles favor LVHR versus OVHR in terms of recurrence rate. Conclusions: Although further randomized studies are needed to draw safe conclusions in terms of complications and recurrence, LVHR is fast becoming the standard approach in the repair of abdominal wall hernias. PMID:18435882

Machairas, Anastasios; Patapis, Paul; Liakakos, Theodore

2008-01-01

84

Subsequent abdominal surgery after laparoscopic ventral and incisional hernia repair with an expanded polytetrafluoroethylene mesh: a single institution experience with 72 reoperations  

Microsoft Academic Search

Purpose  Laparoscopic ventral and incisional hernia repair (LVIHR) carries a risk of adhesion formation and can influence subsequent\\u000a abdominal operations (SAOs). We performed a retrospective study of findings during reoperations of patients who had previously\\u000a had an LVIHR by using an expanded polytetrafluoroethylene mesh (DualMesh®; WL Gore, Flagstaff, AZ, USA).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The medical records of all 695 patients who had LVIHR at

E. B. Wassenaar; E. J. P. Schoenmaeckers; J. T. F. J. Raymakers; S. Rakic

2010-01-01

85

Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review  

Microsoft Academic Search

Background  Although a large number of surgeons currently perform endoscopic hernia surgery using a total extraperitoneal (TEP) approach,\\u000a reviews published to date are based mainly on trials that compare laparoscopic transabdominal preperitoneal (TAPP) repair\\u000a with various types of open inguinal hernia repair.\\u000a \\u000a \\u000a \\u000a Methods  A qualitative analysis of randomized trials comparing TEP with open mesh or sutured repair.\\u000a \\u000a \\u000a \\u000a Results  In this review, 4,231 patients

E. Kuhry; R. N. van Veen; H. R. Langeveld; E. W. Steyerberg; J. Jeekel; H. J. Bonjer

2007-01-01

86

Repair of Groin Hernia With Synthetic Mesh  

PubMed Central

Objective To measure the effects of laparoscopic and open placement of synthetic mesh on recurrence and persisting pain following groin hernia repair. Summary Background Data Synthetic mesh techniques are claimed to reduce the risk of recurrence but there are concerns about costs and possible long-term complications, particularly pain. Methods Electronic databases were searched and experts consulted to identify randomized or quasi-randomized trials that compared mesh with non-mesh methods, or laparoscopic with open mesh placement. Individual patient data were sought for each trial. Aggregated data were used where individual patient data were not available. Meta-analyses of hernia recurrence and persisting pain were based on intention to treat. Results There were 62 relevant comparisons in 58 trials. These included 11,174 participants: individual patient data were available for 6,901 patients, supplementary aggregated data for 2,390 patients, and published data for 1883 patients. Recurrence and persisting pain were less after mesh repair (overall recurrences: 88 in 4,426 vs. 187 in 3,795; OR 0.43, 95% CI 0.34–0.55;P < .001) (overall persistent pain: 120 in 2,368 vs. 215 in 1,998; OR 0.36, 95% CI 0.29–0.46;P < .001), regardless of the non-mesh comparator. Whereas the reduction in recurrence was similar after laparoscopic and open mesh placement (OR 1.26, 95% CI 0.76–2.08;P = .36), persistent pain was less common after laparoscopic than open mesh placement (OR 0.64; 95% CI 0.52–0.78;P < .001). Conclusions The use of synthetic mesh substantially reduces the risk of hernia recurrence irrespective of placement method. Mesh repair appears to reduce the chance of persisting pain rather than increase it. PMID:11882753

2002-01-01

87

Changes in the frequencies of abdominal wall hernias and the preferences for their repair: a multicenter national study from Turkey.  

PubMed

Abstract Abdominal wall hernias are a common problem in the general population. A Western estimate reveals that the lifetime risk of developing a hernia is about 2%. (1 - 3) As a result, hernia repairs likely comprise the most frequent general surgery operations. More than 20 million hernias are estimated to be repaired every year around the world. (4) Numerous repair techniques have been described to date however tension-free mesh repairs are widely used today because of their low hernia recurrence rates. Nevertheless, there are some ongoing debates regarding the ideal approach (open or laparoscopic), (5 , 6) the ideal anesthesia (general, local, or regional), (7 , 8) and the ideal mesh (standard polypropylene or newer meshes). (9 , 10.) PMID:25216417

Seker, Gaye; Kulacoglu, Hakan; Oztuna, Derya; Topgül, Koray; Akyol, Cihangir; Cakmak, At?l; Karateke, Faruk; Ozdo?an, Mehmet; Ersoy, Eren; Gürer, Ahmet; Zerbaliyev, Elbrus; Seker, Duray; Yorganc?, Kaya; Pergel, Ahmet; Ayd?n, Ibrahim; Ensari, Cemal; Bilecik, Tuna; Kahraman, Izzettin; Reis, Erhan; Kalayc?, Murat; Canda, Aras Emre; Demira?, Alp; Kesicio?lu, Tu?rul; Malazgirt, Zafer; Gündo?du, Haldun; Terzi, Cem

2014-01-01

88

Mathematical modelling of implant in an operated hernia for estimation of the repair persistence.  

PubMed

This paper presents mathematical modelling of an implanted surgical mesh used in the repair process of the abdominal hernia. The synthetic implant is simulated by a membrane structure. The author provides a material modelling of the implant based on the dense net model appropriate for technical fabrics. The accuracy of the proposed solution is evaluated by comparing the simulations of the dynamic behaviour of the system with the experiments carried out on physical models of implanted mesh. The model can be used to estimate the repair persistence for different mesh materials, fixing systems and different numbers of tacks to be provided during the surgery in order to resist the cough pressure and required action to avoid hernia recurrence. The persistence of the repaired hernia is assessed on the basis of the values of the forces in the tissue-implant joints because the usual form of the repair failure is due to as the joint disconnection or tissue failure. PMID:23808908

Lubowiecka, Izabela

2015-03-01

89

Kugel hernia repair: open "mini-invasive" technique. Personal experience on 620 patients.  

PubMed

A large monoinstitutional series adopting the Kugel retroparietal technique for inguinal hernia surgery is analysed. Our aim is to assess the "mini-invasiveness" of this technique. Six hundred and twenty patients (pts) affected by monolateral inguinal hernia were treated with a preperitoneal alloplasty with a posterior approach (Kugel hernia repair, KHR) between January 2002 and September 2004. The surgical incision extension was 3.5 cm on average (range 2-4.5). The mean operation time was 33 min (range 20-45). Spinal anaesthesia and ambulatory procedure were applied in 595 cases (96%). Postoperative complications affected 20 pts (3%). The postoperative pain was well controlled. No chronic neuropathic pain was registered at follow-up. Patients resumed work after an average of 9 days (range 7-12) from operation. Recurrence rate was 0.8%. Conclusions. The Kugel hernia repair satisfies the standards to be awarded as a "mini-invasive" technique. PMID:16328156

Ceriani, V; Faleschini, E; Bignami, P; Lodi, T; Roncaglia, O; Osio, C; Sarli, D

2005-12-01

90

Current options in inguinal hernia repair in adult patients.  

PubMed

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. PMID:22435019

Kulacoglu, H

2011-07-01

91

Current options in inguinal hernia repair in adult patients  

PubMed Central

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. PMID:22435019

Kulacoglu, H

2011-01-01

92

An innovative repair for a re-recurrence of an incarcerated inguinal hernia.  

PubMed

A patient presented with a recurrent incarcerated inguinoscrotal hernia requiring urgent surgery. The defect was through the gap in the mesh left originally for the cord structures. As a result, a modified funnel repair was performed. An innovative approach was adopted that was best suited to tackling and reducing the risk of recurrence. PMID:25350170

Merali, N; Verma, A; Davies, T

2014-11-01

93

Long-Term Durability and Comfort of Laparoscopic Ventral Hernia Repair  

PubMed Central

Background: Repair of ventral hernias, including primary ventral hernias and incisional ventral hernias, is performed in the United States 90,000 times per year. Open or traditional ventral hernia repairs involve the significant morbidity and expense of a laparotomy and a significant risk of recurrent herniation. Laparoscopic ventral hernia repair (LVHR) may offer a less-invasive alternative with shorter length of hospital stay, fewer cardiopulmonary complications, and low recurrence rates. Methods: 225 patients underwent laparoscopic ventral hernia repairs in which carboxymethylcellulose-sodium hyaluronate coating (Sepramesh, Davol, Providence, RI) was used primarily. All cases were included prospectively from the study period of 2002 through 2009. Patient characteristics were recorded, and follow-up analysis was performed over a period of 42 mo following surgery. Recurrence, reoperations, and all complications were recorded. Mesh awareness and mesh-related pain were assessed using the hernia-specific Carolinas Comfort Scale (CCS) instrument, completed by 72 patients. Results: Over 42 mo of follow-up, 2 ventral hernias have recurred, and no long-term bowel erosion or fistulization has occurred. Little or no mesh-related symptoms were reported, and mean scores for mesh awareness and mesh pain were 3.6 and 3.2, respectively, on a scale from 0–40 (lower scores signify less pain or awareness). Two serious early complications occurred related to intestinal ileus and metal tacks producing intestinal perforation, and this led to a change in the tacking devices used. Conclusions: LVHR with carboxymethylcellulose-sodium hyaluronate coating (Sepramesh) is safe and effective. Complications are rare, the repair is durable, and long-term results are good with rare recurrences, low awareness of mesh, and little pain. Technical lessons include use of at least one transfascial suture and the avoidance of metal tacks for fixation. PMID:23318062

Sasse, Kent C.; Brandt, Jared

2012-01-01

94

A Traumatic Abdominal Wall Hernia Repair: A Laparoscopic Approach  

PubMed Central

Background: Traumatic abdominal wall hernias from blunt trauma usually occur as a consequence of motor vehicle collisions where the force is tangential, sudden, and severe. Although rare, these hernias can go undetected due to preservation of the skin overlying the hernia defect. Open repairs can be challenging and unsuccessful due to avulsion of muscle directly from the iliac crest, with or without bone loss. A laparoscopic approach to traumatic abdominal wall hernia can aid in the delineation of the hernia and allow for a safe and effective repair. Case Description: A 36-year-old female was admitted to our Level 1 trauma center with a traumatic abdominal wall hernia located in the right flank near the iliac crest after being involved in a high-impact motor vehicle collision. Computed tomography and magnetic resonance imaging of the abdomen revealed the presence of an abdominal wall defect that was unapparent on physical examination. The traumatic abdominal wall hernia in the right flank was successfully repaired laparoscopically. One-year follow-up has shown no sign of recurrence. Discussion: A traumatic abdominal wall hernia rarely presents following blunt trauma, but should be suspected following a high-impact motor vehicle collision. Frequently, repair is complicated by the need to have fixation of mesh to bony landmarks (eg, iliac crest). In spite of this challenge, the laparoscopic approach with tension-free mesh repair of a traumatic abdominal wall hernia can be accomplished successfully using an approach similar to that taken for laparoscopic inguinal hernia repair. PMID:23477181

Wilson, Kenneth L.; Rosser, James C.

2012-01-01

95

Impact of operative time and surgeon satisfaction on the long-term outcome of hernia repair  

Microsoft Academic Search

Purpose  The aim of this study was to assess the impact of the degree of difficulty and quality of hernia repair, as perceived by the\\u000a surgeon, and operative time on the reoperation rate.\\u000a \\u000a \\u000a \\u000a Methods  All hernia repairs performed during the period 1994–1995 at the Department of Surgery, University Hospital of Lund, Sweden,\\u000a were recorded prospectively. The degree of difficulty and the degree

G. Sandblom; D. Sevonius; C. Staël von Holstein

2009-01-01

96

Musculature tissue engineering to repair abdominal wall hernia.  

PubMed

Hernia repair is one of the most frequently performed operations in surgical clinics. Tissue engineering provides insights for the treatment of abdominal wall hernias and other disorders involving deficiencies in the musculature. The present review summarizes the mechanisms of muscle development and regeneration and provides an overview of tissue engineering strategies for the construction of muscles. PMID:22188638

Zhang, Lu; Li, Qiong; Qin, Jian; Gu, Yan

2012-04-01

97

Internal hernias after abdominal surgeries: MDCT features  

Microsoft Academic Search

As less-invasive treatments for small bowel obstruction, such as laparoscopic surgery or small incision therapy, have become\\u000a common, there is a growing demand for preoperative assessment of the cause and location of the small bowel obstruction. Thus,\\u000a the role of computed tomography (CT) in the evaluation of small bowel obstruction is expanding. CT imaging of internal hernias\\u000a (IHs) has been

Norio Hongo; Hiromu Mori; Shunro Matsumoto; Yuriko Okino; Ryo Takaji; Eiji Komatsu

98

Simultaneous repair of bilateral inguinal hernias: a prospective, randomized study of open, tension-free versus laparoscopic approach.  

PubMed

No randomized trial exists that specifically addresses the issue of laparoscopic bilateral inguinal hernia repair. The purpose of the present prospective, randomized, controlled, clinical study was to assess short- and long-term results when comparing simultaneous bilateral hernia repair by an open, tension-free anterior approach with laparoscopic "bikini mesh" posterior repair. Forty-three low-risk male patients with bilateral primary inguinal hernia were randomly assigned to undergo either laparoscopic preperitoneal "bikini mesh" hernia repair (TAPP) or open Lichtenstein hernioplasty. There was no difference in operating time between the two groups. The mean cost of laparoscopic hernioplasty was higher (P < 0.001). The intensity of postoperative pain was greater in the open hernia repair group at 24 hours, 48 hours, and 7 days after surgery (P < 0.001), with a greater consumption of pain medication among these patients (P < 0.05). The median time to return to work was 30 days for the open hernia repair group and 16 days for the laparoscopic "bikini mesh" repair group (P < 0.05). Only 1 asymptomatic recurrence (4.3%) was discovered in the open group. The laparoscopic approach to bilateral hernia with "bikini mesh" appears to be preferable to the open Lichtenstein tension-free hernioplasty in terms of the postoperative quality of life and interruption of occupational activity. PMID:11525372

Sarli, L; Iusco, D R; Sansebastiano, G; Costi, R

2001-08-01

99

Proficiency of Surgeons in Inguinal Hernia Repair  

PubMed Central

Objectives: We examined the influence of surgeon age and other factors on proficiency in laparoscopic or open hernia repair. Summary Background Data: In a multicenter, randomized trial comparing open and laparoscopic herniorrhaphies, conducted in Veterans Administration hospitals (CSP 456), we reported significant differences in recurrence rates (RR) for the laparoscopic procedure as a result of surgeons’ experience. We have also reported significant differences in RR for the open procedure related to resident postgraduate year (PGY) level. Methods: We analyzed data from unilateral laparoscopic and open herniorrhaphies from CSP 456 (n = 1629). Surgeon's experience (experienced ?250 procedures; inexperienced <250), surgeon's age, median PGY level of the participating resident, operation time, and hospital observed-to-expected (O/E) ratios for mortality were potential independent predictors of RR. Results: Age was dichotomized into older (?45 years) and younger (<45 years). Surgeon's inexperience and older age were significant predictors of recurrence in laparoscopic herniorrhaphy. The odds of recurrence for an inexperienced surgeon aged 45 years or older was 1.72 times that of a younger inexperienced surgeon. For open repairs, although surgeon's age and operation time appeared to be related to recurrence, only median PGY level of <3 was a significant independent predictor. Conclusion: This analysis demonstrates that surgeon's age of 45 years and older, when combined with inexperience in laparoscopic inguinal herniorrhaphies, increases risk of recurrence. For open repairs, only a median PGY level of <3 was a significant risk factor. PMID:16135920

Neumayer, Leigh A.; Gawande, Atul A.; Wang, Jia; Giobbie-Hurder, Anita; Itani, Kamal M. F.; Fitzgibbons, Robert J.; Reda, Domenic; Jonasson, Olga

2005-01-01

100

Polyester (Parietex) mesh for total extraperitoneal laparoscopic inguinal hernia repair  

Microsoft Academic Search

  Polypropylene mesh is the most commonly used mesh for open and laparoscopic hernia repair 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 hernia repair.\\u000a Between January 2000 and June 2001, 337

B. Ramshaw; F. Abiad; G. Voeller; R. Wilson; E. Mason

2003-01-01

101

Male infertility after endoscopic Totally Extraperitoneal (Tep) hernia repair (Main): rationale and design of a prospective observational cohort study  

PubMed Central

Background To describe the rationale and design of an observational cohort study analyzing the effects of endoscopic Totally Extraperitoneal (TEP) hernia repair on male fertility (MAIN study). Methods and design The MAIN study is an observational cohort study designed to assess fertility after endoscopic TEP hernia repair. The setting is a high-volume single center hospital, specialized in TEP hernia repair. 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 hernia repair (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 hernia repair. 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 hernia repair 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 hernia repair, 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) PMID:22612995

2012-01-01

102

Light weight meshes in incisional hernia repair  

PubMed Central

Incisional hernias remain one of the most common surgical complications with a long-term incidence of 10–20%. Increasing evidence of impaired wound healing in these patients supports routine use of an open prefascial, retromuscular mesh repair. Basic pathophysiologic principles dictate that for a successful long-term outcome and prevention of recurrence, a wide overlap underneath healthy tissue is required. Particularly in the neighborhood of osseous structures, only retromuscular placement allows sufficient subduction of the mesh by healthy tissue of at least 5 cm in all directions. Preparation must take into account the special anatomic features of the abdominal wall, especially in the area of the Linea alba and Linea semilunaris. Polypropylene is the material widely used for open mesh repair. New developments have led to low-weight, large-pore polypropylene prostheses, which are adjusted to the physiological requirements of the abdominal wall and permit proper tissue integration. These meshes provide the possibility of forming a scar net instead of a stiff scar plate and therefore help to avoid former known mesh complications. PMID:21187980

Schumpelick, Volker; Klinge, Uwe; Rosch, Raphael; Junge, Karsten

2006-01-01

103

Polyester (Parietex) mesh for total extraperitoneal laparoscopic inguinal hernia repair: initial experience in the United States.  

PubMed

Polypropylene mesh is the most commonly used mesh for open and laparoscopic hernia repair in the United States. A variety of newly developed polyester mesh products have recently become available. This is the first U.S. multiinstitutional study evaluating the initial experience of polyester mesh use for total extraperitoneal (TEP) laparoscopic inguinal hernia repair. Between January 2000 and June 2001, 337 patients underwent 495 TEP laparoscopic inguinal hernia repairs using polyester mesh. There were 309 men and 28 women in the study, whose average age was 45 years (range, 17-80 years). The average operative time for all cases was 54.3 min (range, 18-157 min). There were no conversions to open repair and no mortality. Complications included 12 seromas/hematomas (six aspirated), chronic pain in three patients, urinary retention in two patients, and one incidence each of the following: epididimitis, prostatitis, hydrocele, and port-site cellulitis. Additionally, one patient had carbon dioxide (CO2) in the Foley bag at the end of the surgery, but a normal cystogram showed no identified bladder injury. There has been one recurrence (0.2%), occurring 4 months after surgery, which was repaired using a transabdominal laparoscopic approach. The mean follow-up period was 11 months (range, 2-22 months). There have been no documented infections of the mesh, and no mesh has been removed. This study documents a favorable initial experience with polyester mesh for TEP laparoscopic inguinal hernia repair. There were no complications related to the mesh. There may be technical and long-term advantages with the use of polyester mesh for laparoscopic inguinal hernia repair. Longer follow-up evaluation and additional studies are warranted to evaluate these potential advantages. PMID:12436235

Ramshaw, B; Abiad, F; Voeller, G; Wilson, R; Mason, E

2003-03-01

104

Early Belgian experience with the Kugel patch inguinal hernia repair.  

PubMed

The Kugel hernia repair is an open but minimally invasive, tension free repair, offering the advantages of a preperitoneal repair without the need for general anaesthesia. We report our initial experience with this technique in 25 inguinal hernia repairs. Operating time averaged 40 +/- 16 min, and one complication, a bladder tear, occurred intra-operatively. Patients were discharged after a median of 2 days and were then seen after 3 weeks and after at least one year. Three weeks postoperatively, there were two superficial skin inflammations and one haematoma. One year post-operatively no recurrences occurred but two patients complained of persistent inguinodynia. The Kugel hernia repair is a relatively new technique with a short operating time and minimal postoperative pain, but a learning curve, comparable to that of TEP has to be overcome in order to reproduce the results of its inventor. PMID:16612912

Hoste, W; Van Nieuwenhove, Y; Vierendeels, T

2006-01-01

105

Minimally invasive tension-free inguinal hernia repair.  

PubMed

With a growing understanding of abdominal wall mechanics and improving surgical technology, inguinal herniorrhaphy has undergone significant advancements in the past 100 years. As primary repair through an anterior approach gave way to the "tension-free" Lichtenstein technique in the later part of the 20th century, hernia recurrence rates fell dramatically. With this fall in recurrence rates, other postoperative factors became the measure of herniorrhaphy technique quality. The reductions of postoperative pain and recovery time have become the basis for comparison between techniques. To that end, the plug and patch methods of Millikan and Rutkow, as well as the Kugel memory recoil mesh repair system, adhere to the philosophy of minimal dissection and suturing. The Prolene Hernia System was similarly created to simplify hernia repair while improving postoperative recovery. The posterior approach to hernia fixation was well-described in the late 1800s. Although generally underused, this technique offered an excellent option for repairing all inguinal hernias, especially incarcerated ones. By combining the perspective of preperitoneal repair with laparoscopic technology, a truly novel option for herniorrhaphy was created. Laparoscopy offers lower recurrence and postoperative complication rates than standard primary open repair, with the potential for a faster and more comfortable recovery than the "tension-free" open repair. PMID:16525968

Klaristenfeld, Daniel D; Mahoney, Eric; Iannitti, David A

2005-01-01

106

[The Lichtenstein inguinal hernia-plasty: a simple and complication-free technique, especially suited for ambulatory surgery].  

PubMed

A consecutive series of 353 patients who underwent Lichtenstein mesh repair for inguinal hernia from the 1st of July 1994 to the 30th of July 1995 were studied. We analysed our indication, technique, complications, follow-up and outcome. Special consideration was given to the advantages and acceptance of day-case surgery. Our results suggest that the Lichtenstein repair should be considered as a new standard procedure, especially outside of hernia centres. PMID:9574219

Metzger, J; Vogelbach, P; Lutz, N; Laidlaw, I

1997-01-01

107

Surgery for Inguinal Hernia in Byzantine Times (A.D. 324–1453): First Scientific Descriptions  

Microsoft Academic Search

The aim of this article is to present the techniques applied by Byzantine physicians for inguinal hernia repair and to note their influence on the development of surgery after that time. A study and analysis of the original texts of the Byzantine medical writers, written in Greek, and containing the now mostly lost knowledge of the ancient Hellenistic and Roman

John G. Lascaratos; Constantine Tsiamis; Alkiviadis Kostakis

2003-01-01

108

Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study  

PubMed Central

OBJECTIVE: To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. BACKGROUND: TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven. PATIENTS AND METHODS: Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon. RESULTS: All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement. CONCLUSION: EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven.

de Araujo, Felipe Brandao Correa; Starling, Eduardo Simao; Maricevich, Marco; Tobias-Machado, Marcos

2014-01-01

109

Perineal hernia extruding into the labium majus after multiple surgeries for pelvic organ prolapse.  

PubMed

A 78-year-old woman presented with a large bulge in the right labium majus. She had a previous history of two anterior and posterior vaginal wall prolapse repairs, a vaginal hysterectomy for uterovaginal prolapse, a sacrospinous ligament fixation for vaginal vault prolapse, and a LeFort partial colpocleisis for recurrent vault prolapse. Magnetic resonance imaging (MRI) revealed an anterior perineal hernia containing small bowel. Surgery was performed to close the pelvic floor defect through a perineal approach, and polypropylene mesh was used as a bolster. The hernial sac contained small bowel with very thin adhesions. Over 6 months of follow-up, there was no recurrence of the hernia or mesh complications. Perineal hernias after gynecological surgeries for benign diseases are rare. The indications for repair and the optimal surgical approach are not well described. PMID:23430077

Moroni, Rafael Mendes; Magnani, Pedro Sérgio; Candido-Dos-Reis, Francisco José; Brito, Luiz Gustavo Oliveira

2013-12-01

110

Parastomal hernia repair with the use of Parietex composite mesh: a technical note.  

PubMed

Parastomal hernia is an incisional hernia related to an abdominal wall stoma. The incidence ranges from 5 to 50% and only 10% of these require surgical treatment. The authors propose an innovative surgical technique for treatment of parastomal hernia. Many kinds of repair for paracolostomal hernias have been proposed: simple fascia repair, stoma relocation and repair with prosthetic devices. We describe a successful local repair and a new approach to treat this defect using a polypropylene mesh. PMID:19694238

Succi, Lino; Ohazuruike, Nnawuihe Luca; Oliveri, Conchita Emanuela; Privitera, Antonino Carlo; Prumeri, Serafina; Politi, Antonino; Randazzo, Giuseppe

2009-01-01

111

Chronic abdominal pain secondary to mesh erosion into ceacum following incisional hernia repair: a case report and literature review.  

PubMed

Incisional hernias following abdominal operations are a common complication. Mesh is frequently employed in repair of these hernias. Mesh migration is an infrequent occurrence. We present the case of transmural mesh migration from the abdominal wall into the ceacum presenting as chronic abdominal pain. Given the popularity of minimally invasive surgery utilizing polypropylene mesh for incisional hernia repair, related complications such as postoperative hematoma and seroma, foreign body reaction, organ injury, infection, mesh rejection and fistula are increasingly being noted. Most of the mesh migrations reported in the literature involve the urinary bladder. We present a case of delayed mesh migration into the ceacum. Mesh migration is a rare and peculiar complication that is rarely reported in the literature. A review of the literature shows that there are no other cases of mesh migration into ceacum several years after open type incisional hernia repair. PMID:24578759

Aziz, Fahad; Zaeem, Misbah

2014-04-01

112

Chronic Abdominal Pain Secondary to Mesh Erosion Into Ceacum Following Incisional Hernia Repair: A Case Report and Literature Review  

PubMed Central

Incisional hernias following abdominal operations are a common complication. Mesh is frequently employed in repair of these hernias. Mesh migration is an infrequent occurrence. We present the case of transmural mesh migration from the abdominal wall into the ceacum presenting as chronic abdominal pain. Given the popularity of minimally invasive surgery utilizing polypropylene mesh for incisional hernia repair, related complications such as postoperative hematoma and seroma, foreign body reaction, organ injury, infection, mesh rejection and fistula are increasingly being noted. Most of the mesh migrations reported in the literature involve the urinary bladder. We present a case of delayed mesh migration into the ceacum. Mesh migration is a rare and peculiar complication that is rarely reported in the literature. A review of the literature shows that there are no other cases of mesh migration into ceacum several years after open type incisional hernia repair. PMID:24578759

Aziz, Fahad; Zaeem, Misbah

2014-01-01

113

Surgery for inguinal hernia in Byzantine times (A.D. 324-1453): first scientific descriptions.  

PubMed

The aim of this article is to present the techniques applied by Byzantine physicians for inguinal hernia repair and to note their influence on the development of surgery after that time. A study and analysis of the original texts of the Byzantine medical writers, written in Greek, and containing the now mostly lost knowledge of the ancient Hellenistic and Roman periods, was undertaken. Two Byzantine physicians, Aetius of Amida (6th century A.D.) and Paul of Aegina (7th century A.D.), described two techniques for confrontation of inguinal hernia, namely the surgical removal of the prolapsed peritoneum and the cauterization of the groin. These methods were probably derived from the texts of earlier Greek surgeons to which they added their own keen observations. The study of Byzantine medical and literary texts proves that the surgical techniques for inguinal hernia were practiced in Byzantine times and influenced later Arabian and European surgery, thus constituting significant roots of surgery. PMID:12925906

Lascaratos, John G; Tsiamis, Constantine; Kostakis, Alkiviadis

2003-10-01

114

Subsequent abdominal surgery after laparoscopic ventral and incisional hernia repair with an expanded polytetrafluoroethylene mesh: a single institution experience with 72 reoperations  

PubMed Central

Purpose Laparoscopic ventral and incisional hernia repair (LVIHR) carries a risk of adhesion formation and can influence subsequent abdominal operations (SAOs). We performed a retrospective study of findings during reoperations of patients who had previously had an LVIHR by using an expanded polytetrafluoroethylene mesh (DualMesh®; WL Gore, Flagstaff, AZ, USA). Methods The medical records of all 695 patients who had LVIHR at our hospital were reviewed. Patients who underwent SAO for various indications were identified (n = 72) and analyzed. Results Seven LVIHR patients (1%) had early SAO (within a few days). In six patients (86%), removal of the mesh was required. Intra-operatively, in all six of these patients with peritonitis, there were no adhesions against the implant identified. Late SAOs (after more than 1 month) were performed in 65 patients (9.4%). Only one patient required acute surgical intervention due to an LVIHR-related adhesion (0.15%). Laparoscopy was performed in 83% and laparotomy in 17% of patients. Adhesions against the implant were present in 83% of patients; in 65%, the adhesions involved omentum only, and in 18%, they involved the bowel. Adhesiolysis was always easy and caused no inadvertent enterotomies. SAOs were devoid of postoperative complications. Conclusions In this largest series of reoperations after LVIHR, the majority of patients had mild or moderate adhesions against the implant. The specific observations that: (1) no relaparoscopies had to be converted, (2) no inadvertent enterotomies were made during adhesiolysis, and (3) SAOs have practically been devoid of peri- and postoperative complications indicate that SAOs can be safely performed after previous LVIHR with DualMesh. PMID:19806422

Schoenmaeckers, E. J. P.; Raymakers, J. T. F. J.; Rakic, S.

2009-01-01

115

Totally extraperitoneal repair of inguinal hernia: techniques and pitfalls of a challenging procedure.  

PubMed

Inguinal hernia repair is the most common procedure performed worldwide in general surgery. Since the turn of the 21st century, the minimally invasive approach and in particular totally extraperitoneal (TEP) repair has gained in popularity. The concept of the TEP approach combines the advantages of anterior tension-free mesh repair (Lichtenstein repair) and the open preperitoneal approach championed by Stoppa. TEP repair uses a prosthetic mesh significantly bigger than in open herniorrhaphy, offering a complete overlap of the myopectineal orifice. TEP repair is a challenging technique with unfamiliar anatomy, a limited operative field, and long learning curve. This article provides an experienced opinion on the practical aspects of the TEP approach. Some of these steps have already been discussed in the surgical literature, while others are the fruit of a personal expertise grasped over the years with more than 1,000 TEP repairs performed. PMID:23064991

Putnis, Soni; Berney, Christophe R

2012-12-01

116

A novel technique of midline mesh repair for umbilical hernia associated with diastasis recti.  

PubMed

Mesh repair has evolved as the gold standard for umbilical hernias. Surgical reconstruction of umbilical hernias in association with diastasis recti has not been discussed in the recent literature. We describe a novel surgical technique of midline mesh repair for this combined lesion. This is a retrospective review of 44 consecutive patients. Forty-four patients underwent surgery for umbilical hernia with diastasis recti between January 2010 and August 2012. All excess skin, subcutaneous tissue, and distracted midline (linea alba) were excised supraumbilically and paraumbilically according to preoperative marking. Surgical repair began with a midline running suture of the posterior rectal sheath. A light prolene mesh was placed retromuscularly into this sheath and anchored in all directions with a distance of about 5 cm from the midline using U-shaped stitches. The anterior rectal fascia was closed with a continuous suture. All information was obtained from the hospital records. The median operative time was 93.3 minutes (28 to 219 minutes). The median length of postoperative hospital stay was 5.9 days (3 to 12 days). There was no major complication. One minimal umbilical skin necrosis was observed. Analgesic medication was required in all patients. Opiods were added in 84.0% of patients on day 1, in 75.0% on day 3, and in 2.3% on day 7. Our novel technique of sublay mesh repair for combined umbilical hernia and diastasis recti is safe and effectively restores the abdominal midline. PMID:24526430

Matei, Ovidio-Angel; Runkel, Norbert

2014-03-01

117

Evaluation of various prosthetic materials and newer meshes for hernia repairs  

PubMed Central

The use of prosthesis has become essential for repair of all hernias since the recurrence rates are consistently lower when they are used. To fulfill this requirement, a variety of newer meshes have been engineered. An ideal prosthesis should be strong, pliable, non-allergenic, inert, non-biodegradable, non-carcinogenic and should stimulate adequate fibroblastic activity for optimum incorporation into the tissues. Prosthesis used for hernia repairs can be non-absorbable, composite (combination of absorbable and non-absorbable fibres) or with an absorbable or a non-absorbable barrier. Surgeons should acquire sufficient knowledge of different types of prosthesis so as to select an appropriate one for a given case. Non-absorbable or composite mesh is recommended for hernia repair where it will not come in contact with the bowel. Prosthesis with a barrier only should be used for intra-abdominal placement to prevent bowel adhesions since it is increasingly difficult to defend the use of a biomaterial that has no adhesion barriers. This review highlghts all these different types of meshes and their appropriate selection for a given hernia repair. Selection of the optimum size and its proper fixation is mandaory. Complications can be avoided or minimized with proper selection of mesh for a given case and by performing the surgery with a meticulous technique. PMID:21187889

Doctor, H G

2006-01-01

118

Resorbable Biosynthetic Mesh for Crural Reinforcement during Hiatal Hernia Repair.  

PubMed

The use of mesh to reinforce crural closure during hiatal hernia repair is controversial. Although some studies suggest that using synthetic mesh can reduce recurrence, synthetic mesh can erode into the esophagus and in our opinion should be avoided. Studies with absorbable or biologic mesh have not proven to be of benefit for recurrence. The aim of this study was to evaluate the outcome of hiatal hernia repair with modern resorbable biosynthetic mesh in combination with adjunct tension reduction techniques. We retrospectively analyzed all patients who had crural reinforcement during repair of a sliding or paraesophageal hiatal hernia with Gore BioA resorbable mesh. Objective follow-up was by videoesophagram and/or esophagogastroduodenoscopy. There were 114 patients. The majority of operations (72%) were laparoscopic primary repairs with all patients receiving a fundoplication. The crura were closed primarily in all patients and reinforced with a BioA mesh patch. Excessive tension prompted a crural relaxing incision in four per cent and a Collis gastroplasty in 39 per cent of patients. Perioperative morbidity was minor and unrelated to the mesh. Median objective follow-up was one year, but 18 patients have objective follow-up at two or more years. A recurrent hernia was found in one patient (0.9%) three years after repair. The use of crural relaxing incisions and Collis gastroplasty in combination with crural reinforcement with resorbable biosynthetic mesh is associated with a low early hernia recurrence rate and no mesh-related complications. Long-term follow-up will define the role of these techniques for hiatal hernia repair. PMID:25264654

Alicuben, Evan T; Worrell, Stephanie G; DeMeester, Steven R

2014-10-01

119

Clinical evaluation of laparoscopic repair of large hiatal hernias with TiMesh.  

PubMed

The use of mesh for laparoscopic repair of large hiatal hernias may decrease recurrence rates in comparison with primary suture repair. The type of mesh material, as well as its size and shape, is still a matter of debate. The aim of this study was to evaluate a lightweight polypropylene mesh (TiMesh) repair of hiatal hernias, with particular reference to symptomatic relief, patient satisfaction and quality of life (QOL). From a prospectively maintained clinical database, 40 consecutive patients were identified who underwent elective laparoscopic hiatal hernia repair with TiMesh between November 2004 and December 2006. QOL and symptom analysis was carried out using Quality of Life in Reflux and Dyspepsia (QOLRAD) and dysphagia questionnaires preoperatively, and postoperatively after 6 weeks, 6 months, and 1 year. The mean age of the patient was 65.2 years (range: 40-93 years). Total complication rate was 7.5%; all complications were treated without residual disability. There was no 30-day mortality. Median hospital stay was 2.7 days (range 2-13 days). Completed questionnaires were obtained from 37 (92.5%) of 40 patients. After 1 year, more than 90% of patients were satisfied with their symptomatic outcome and regarded their surgery as successful. There was a significant improvement in QOL, measured with QOLRAD at all postoperative time-points (P < 0.001). There was no difference between pre- and postoperative dysphagia scores. Laparoscopic repair of large hiatal hernias with TiMesh yields good symptomatic and clinical outcome. Further studies are needed to show whether the use of this lightweight polypropylene mesh is associated with a reduction in recurrence rates after hiatal hernia repair in the longer term. PMID:18959648

Hazebroek, Eric J; Ng, Ada; Yong, David H K; Berry, Hayley; Leibman, Steven; Smith, Garett S

2008-10-01

120

Lichtenstein vs anterior preperitoneal prosthetic mesh placement in open inguinal hernia repair: a prospective, randomized trial.  

PubMed

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 least 2 years (median 82 months, range 24-110 months), 16 were lost to follow-up, and seven died from causes unrelated to the surgery. The average operative time of the Read-Rives repair was 9 min longer than that of the Lichtenstein repair. There were no wound infections, and the frequencies of other short- and long-term complications were low and similar in the two groups. Six patients developed hernia recurrence, five in the Lichtenstein group (4.3%), and one in the Read-Rives group (<1%), ( P=0.21). Both anterior repairs are associated with low postoperative morbidity and recurrence rates. The Lichtenstein repair is technically easier and less time consuming. There is no statistically significant difference in the recurrence rate between the two repairs. PMID:14625698

Muldoon, R L; Marchant, K; Johnson, D D; Yoder, G G; Read, R C; Hauer-Jensen, M

2004-05-01

121

Evaluation of new prosthetic meshes for ventral hernia repair  

Microsoft Academic Search

Background  In hernia repair, particularly laparoscopic hernia repair, 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

2006-01-01

122

Inguinal hernia recurrence following preperitoneal Kugel patch repair.  

PubMed

Three hundred eighty-six preperitoneal inguinal herniorrhaphies using a polypropylene Kugel patch (Davol) were performed in 355 consecutive patients by six surgeons. Variables for recurrence evaluated included age, gender, hernia type, whether the Kugel patch was placed for a primary or recurrent hernia, and the experience of the surgeon. Of 336 patients with long-term follow-up available (18 months to 63 months, median 42 months) 28 recurrences developed 1 to 48 months (mean 16 months) after 366 Kugel patch repairs (7.7%). Recurrence was highest (27.8%) in the subset of patients who had a Kugel patch placed for recurrent inguinal hernias (P < 0.05). Patients with direct primary hernias involving the entire floor had a recurrence rate of 22.7 per cent (P < 0.05). Patient age and gender had no bearing on recurrence. Surgeon experience did play a role, as the recurrence rate was 18.2 per cent during each surgeon's first 36 cases and 2.9 per cent thereafter (P < 0.0005). Surgeons using a preperitoneal Kugel patch for inguinal herniorraphy had a recurrence rate that was unacceptably high. The technique may not be suitable for repair of recurrent inguinal hernias or primary large direct inguinal hernias. Surgeons in this study saw a learning curve of 36 cases. PMID:15011915

Schroder, Donn M; Lloyd, Larry R; Boccaccio, John E; Wesen, Cheryl A

2004-02-01

123

Plasma esterase activities in young and old patients undergoing open inguinal hernia repair  

Microsoft Academic Search

Previous research has shown substantial decrements in enzymes of drug metabolism (esterases) in older patients following fracture neck of femur and hip replacement surgery. The main aim of this study was to examine the effect of open inguinal hernia repair on the activities of four plasma esterases in old and young patients. Seventeen older patients (mean age±S.E.M. was 67.6±1.8) and

Khaled Abou-Hatab; M. Sinead O'Mahony; Sarju Patel; Declan Carey; Kenneth Woodhouse

2000-01-01

124

Retrosternal (Morgagni) diaphragmatic hernia.  

PubMed

This study presents the case of a shih tzu puppy, in which a rare congenital Morgagni diaphragmatic hernia was diagnosed. The diagnosis was based on abdominal and thoracic radiographs, including a contrast study of the gastrointestinal tract, which revealed a co-existing umbilical hernia. Both hernias were repaired by surgery. PMID:22294795

Lojszczyk-Szczepaniak, Anna; Komsta, Renata; Debiak, Piotr

2011-08-01

125

Laparoscopic Incisional Hernia Repair With Fibrin Glue in Select Patients  

PubMed Central

Background and Objective: Laparoscopic treatment of incisional hernias can be performed using different types of fixation devices and prosthesis. We present a case series of 19 patients with incisional hernias with a diameter of <6cm, who underwent laparoscopic repair using Hi-tex dual-side mesh, positioned intraperitoneally, fixed to the abdominal wall by fibrin glue (Tissucol). Methods: Nineteen patients with incisional hernias <6cm in diameter were enrolled in this study and treated laparoscopically with Hi-tex and Tissucol. Surgical complications and patient outcomes were assessed with a clinical follow-up. Results: Laparoscopic repair of incisional hernias by using Hi-tex mesh affixed to the parietal wall with fibrin glue was feasible and easy in patients with parietal defects <6cm in diameter. Mean operating time was 30 minutes. Mean hospital stay was 1.5 days. Almost no postoperative pain, major surgical complications, seroma formation, relapses, or prosthesis infection occurred during a mean follow-up of 20 months. Conclusions: In select patients, Hi-tex mesh affixed using fibrin glue allows laparoscopic repair of incisional hernias with very good patient outcomes, especially in terms of postoperative pain and seroma formation. PMID:20932376

Stefano, Olmi; Luca, Saguatti; Claudio, Pagano; Giuseppe, Vittoria; Enrico, Croce

2010-01-01

126

Perineal hernia, another incisional hernia?  

PubMed

A secondary perineal hernia is a type of incisional hernia of the pelvic floor, occurring after pelvic surgery such as abdominoperineal excision of the rectum and pelvic exenteration. Our aim is to review the available literature on the subject. This report reviews a recently repaired case, followed by a review of the available literature on the presenting condition, concentrating on approaches and methods of repair. Perineal hernias are uncommon, and not many surgeons face them. It is not known if and how these hernias could be prevented. The method and approach of repair should probably be individualized, but we believe that the use of a mesh is important in the repair of such hernias because of the significant tissue defect prevailing in most of the cases, in addition to the unhealthy tissues related to the use of radiotherapy. The laparoscopic approach has been recently utilized and its use is expected to increase. PMID:23133132

Morcos, Basem B; Al-Masri, Mahmoud; Baker, Bilal

2009-06-01

127

Laparoscopic Inguinal Hernia Repair in a Developing Nation: Short-term Outcomes in 103 Consecutive Procedures  

PubMed Central

Background: There are no published data on the outcomes of inguinal hernia repair from the Anglophone Caribbean. To the best of our knowledge, this is the first report of a series of laparoscopic inguinal hernia repairs from the region. Materials and Methods: Data was extracted from a prospectively maintained database of consecutive trans abdominal pre-peritoneal (TAPP) repairs done between June 1, 2005 and May 30, 2012. Perioperative data collected included patient demographics, hernia type, operative technique, duration of surgery, intra-operative details, morbidity, analgesia requirements, and duration of hospitalization. A telephone survey was also performed to identify late recurrences and complications. Descriptive statistics were generated using Statistical Package for Social Sciences (SPSS) Ver 12.0. Results: There were 103 consecutive TAPP procedures in 88 patients at an average age of 35.4 years ± 12.9 (standard deviation; SD) and average body mass index (BMI) of 28.9 Kg/m2 ± 2.23 (SD). The indications were bilateral (30), recurrent unilateral (24), and primary unilateral (49) inguinal hernias. The mean duration of operation was 68.5 minutes (SD ± 10.4; Range: 55-95; Median 65; Mode 65) minutes for unilateral TAPP and 89 minutes (SD ± 7.61; Range: 80-105; Median 90; Mode 90) for bilateral repairs. Post-operatively, 65/70 patients required ?1 dose of parenteral opioid analgesia and 74 (84.1%) patients discontinued oral analgesia within 48 hours of operation. Complications were recorded in six (5.8%) cases and a recurrence in one (0.97%) case after a mean follow-up period of 3.2 years (SD ± 1.8; Range: 0.5-7). Conclusion: Laparoscopic inguinal hernia repair is a safe and effective operation in this setting. PMID:24470844

Cawich, Shamir O.; Mohanty, Sanjib K.; Bonadie, Kimon O.; Simpson, Lindberg K.; Johnson, Peter B.; Shah, Sundeep; Williams, Eric W.

2013-01-01

128

Is unilateral laparoscopic TEP inguinal hernia repair a job half done? The case for bilateral repair  

Microsoft Academic Search

Introduction  Bilateral laparoscopic totally extraperitoneal (TEP) repair of unilateral hernia is conspicuous in published literature by\\u000a its absence. There are no studies or data on the feasibility, advantages or disadvantages of bilateral repair in all cases\\u000a or in any subset of patients with unilateral primary inguinal hernia. The objective of this study is to investigate the feasibility\\u000a of bilateral laparoscopic exploration

Pawanindra Lal; Prejesh Philips; Jagdish Chander; Vinod K. Ramteke

2010-01-01

129

Early results of inguinal hernia repair by the 'mesh plug' technique--first 200 cases.  

PubMed Central

INTRODUCTION: Inguinal hernia repair is the most common surgical procedure performed in the UK. Evidence from several earlier studies suggests that primary inguinal hernia repair 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. PMID:11103156

Fasih, T.; Mahapatra, T. K.; Waddington, R. T.

2000-01-01

130

The current status of biosynthetic mesh for ventral hernia repair.  

PubMed

Although synthetic mesh has dramatically reduced recurrence in elective hernia repair, its use in contaminated surgical fields has been traditionally associated with complications such as wound sepsis, enterocutaneous fistulas, and chronic prosthetic infection. Biologic meshes emerged in the late 1990s with a rapid popularity fueled largely by the demand for an appropriate substitute in lieu of synthetic mesh in these complex cases; however, the high cost and rate of hernia recurrence have tempered the initial enthusiasm. Biosynthetic meshes were developed as a possible cost-effective alternative to both synthetic and tissue-derived products. Using biodegradable polymers instead of animal or cadaver tissue, they provide a temporary scaffold for deposition of proteins and cells necessary for tissue ingrowth, neovascularization, and host integration. Herein we review the current status of biosynthetic meshes for hernia repair. PMID:25396323

Kim, Mimi; Oommen, Bindhu; Ross, Samuel W; Lincourt, Amy E; Matthews, Brent D; Heniford, B Todd; Augenstein, Vedra A

2014-11-01

131

Outcome and cost comparison of laparoscopic transabdominal preperitoneal hernia repair versus Open Lichtenstein technique.  

PubMed

Laparoscopic hernia repair has all the advantages of a tension free repair. This study compares the laparoscopic transabdominal preperitoneal (TAPP) approach with tension-free open hernia repair in terms of operative time, postoperative pain, hospital stay, complications, and cost. Open and TAPP repairs using polypropylene mesh were performed in two groups of 25 male patients. The difference in operative times between the groups was not significant. Mean pain scores (0-100) for the open group were 54.12 +/- 13.06 at 12 hours and 37.24 +/- 11.38 at 24 hours, significantly higher than the corresponding scores of 38.36 +/- 8.21 at 12 hours and 20.92 +/- 8.73 at 24 hours for the TAPP group (P < 0.05). The mean postoperative analgesic dose was 6.72 +/- 2.72 in the TAPP group, which was insignificantly lower than 7.52 +/- 2.00 in the open group. Mean hospital stay was 2.24 +/- 0.97 days in the open group and 1.52 +/- 0.51 in the TAPP group, which was significant (P < 0.05). Twenty patients (80%) in the TAPP group rated themselves highly satisfied with the surgery as compared to 11 patients (44%) in the open group (P < 0.05). There was no recurrence in either group during a mean followup period of 13.5 months (range, 8-28 months). Laparoscopic hernia repair was significantly more expensive than open (1100 US dollars versus 629 US dollars). TAPP repair is superior to open repair in terms of shorter hospital stay, lower postoperative pain, and better patient satisfaction. It is also safe, with no recurrence in a short-term period. This technique will be the operation of choice for the treatment of groin hernia after long-term results have been established in our center. PMID:15245668

Anadol, Ziya A; Ersoy, Emin; Taneri, Ferit; Tekin, Ercüment

2004-06-01

132

Application of patient-reported outcome measures (PROMs) data to estimate cost-effectiveness of hernia surgery in England  

PubMed Central

Objectives To demonstrate potential uses of nationally collected patient-reported outcome measures (PROMs) data to estimate cost-effectiveness of hernia surgery. Design Cost-utility model populated with national PROMs, National Reference Cost and Hospital Episodes Statistics data. Setting Hospitals in England that provided elective inguinal hernia repair surgery for NHS patients between 1 April 2009 and 31 March 2010. Participants Patients >18 years undergoing NHS-funded elective hernia surgery in English hospitals who completed PROMs questionnaires. Main outcome measures Change in quality-adjusted life year (QALY) following surgery; cost per QALY of surgery by acute provider hospital; health gain and cost per QALY by surgery type received (laparoscopic or open hernia repair). Results The casemix-adjusted, discounted (at 3.5%) and degraded (over 25 years) mean change in QALYs following elective hernia repair surgery is 0.826 (95% CI, 0.793–0.859) compared to a counterfactual of no treatment. Patients undergoing laparoscopic surgery show a significantly greater gain in health-related quality of life (EQ-5D index change, 0.0915; 95% CI, 0.0850–0.0979) with an estimated gain of 0.923 QALYS (95% CI, 0.859–0.988) compared to those having open repair (EQ-5D index change, 0.0806; 95% CI, 0.0771–0.0841) at 0.817 QALYS (95% CI, 0.782–0.852). The average cost of hernia surgery in England is £1554, representing a mean cost per QALY of £1881. The mean cost of laparoscopic and open hernia surgery is equivocal (£1421 vs. £1426 respectively) but laparoscopies appear to offer higher cost-utility at £1540 per QALY, compared to £1746 per QALY for open surgery. Conclusions Routine PROMs data derived from NHS patients could be usefully analyzed to estimate health outcomes and cost-effectiveness of interventions to inform decision-making. This analysis suggests elective hernia surgery offers value-for-money, and laparoscopic repair is more clinically effective and generates higher cost-utility than open surgery. PMID:23759893

Coronini-Cronberg, Sophie; Appleby, John; Thompson, James

2013-01-01

133

Prevention of Incisional Hernia after Aortic Aneurysm Repair  

Microsoft Academic Search

Background. Incisional hernia is a common late complication of elective abdominal aneurysm (AAA) repair. This paper describes a technique that could prevent the development of this condition.Methods. Since Jan 2001, a polypropylene mesh has been sutured prophylactically in the pre-peritoneal space during abdominal closure after elective AAA repair.Results. Twenty-eight consecutive elective procedures were performed. One patient died from a myocardial

M Rogers; R McCarthy; J. J Earnshaw

2003-01-01

134

Intestinal resection and multiple abdominal hernia mesh repair: is the combination safe and feasible?  

PubMed

In a highly advanced era from the point of view of instrumental diagnostic resolution it is, however, not always possible to obtain a precise preoperative diagnosis. Surgery is sometimes the only decisive solution. In April 2003, a 62-year-old male patient was referred to us for umbilical hernia, diastasis recti abdominis and left-sided inguinal hernia; he also complained of pain in the mesogastric-hypogastric region. This site presented with a hard, non-mobile, painful tumefaction at both superficial and deep palpation. The patient was submitted to various diagnostic examinations (pancolonoscopy, CT, X-ray of the digestive tract and angiography), but only surgery allowed us to establish the specific nature of the tumefaction. The operation consisted in the en-bloc removal of an abscess mass affecting intestinal loops, caecum and appendix and at the same time in the repair of the hernia components with the use of prosthesis in a potentially contaminated area. The tumefaction had originated following acute appendicitis episodes that had determined adherences between the appendix, caecum and ileal loops (histologically confirmed). There are situations that require surgery in order to be explicitly diagnosed and solved. Furthermore, although the use of prosthetic materials in the treatment of hernias in association with intestinal resection is an extreme case, it has also been reported in the international literature that nowadays there are no real contraindications to the implantation of a prosthesis in a potentially infected area. PMID:15771039

Campanelli, Giampiero; Nicolosi, Filadelfio Massimiliano; Pettinari, Diego; Avesani, Ettore Contessini

2004-01-01

135

SILS Incisional Hernia Repair: Is It Feasible in Giant Hernias? A Report of Three Cases  

PubMed Central

Aim. Three incisional ventral abdominal wall hernias were repaired by placing a 20 × 30?cm composite mesh via single incision of 2?cm. Methods. All three cases had previous operations and presented with giant incisional defects clinically. The defects were repaired laparoscopically via single incision with the placement of a composite mesh of 20 × 30?cm. Nonabsorbable sutures were needed to hang and fix the mesh only in the first case. Double-crown technique was used in all of the cases to secure the mesh to the anterior abdominal wall. Results. The mean operation time was 120 minutes. The patients were mobilized and led for oral intake at the first postoperative day. No morbidity occurred. Conclusion. Abdominal incisional hernias can be repaired via single incision with a mesh application in experienced centers. PMID:21845023

Barbaros, Umut; Demirel, Tugrul; Sumer, Aziz; Deveci, Ugur; Tukenmez, Mustafa; Cansunar, Mehmet Ibrahim; Kalayci, Murat; DInccag, Ahmet; Seven, Ridvan; Mercan, Selcuk

2011-01-01

136

A Contralateral Complication of Extra-peritoneal Laparoscopic Inguinal Hernia Repair  

PubMed Central

A 63 year old female underwent an uncomplicated total extraperitoneal repair of a right direct inguinal hernia. One week later she presented with a strangulated left femoral hernia. We believe the dissection of the extraperitoneal space caused bleeding which tracked down through the femoral canal resulting in a femoral hernia. To date there are no reports of such a complication following total extraperitoneal inguinal hernia repair in the literature. PMID:24945505

Clark, S E; Hanson, M; Jacob, S

2010-01-01

137

Hiatal Hernia Repair with Gore Bio-A Tissue Reinforcement: Our Experience  

PubMed Central

Type I hiatal hernia is associated with gastroesophageal reflux disease (GERD) in 50–90% of cases. Several trials strongly support surgery as an effective alternative to medical therapy. Today, laparoscopic fundoplication is considered as the procedure of choice. However, primary laparoscopic hiatal hernia repair is associated with upto 42% recurrence rate. Mesh reinforcement of the crural closure decreases the recurrence but can lead to complications, above all nonabsorbable ones. We experiment a new totally absorbable mesh by Gore. Case. We present a case of a 65-year-old female patient with a 6-year classic history of GERD. Endoscopy revealed a large hiatal hernia and esophagitis. pH study was positive for acid reflux; esophageal manometry revealed LES intrathoracic dislocation. With laparoscopic approach, the hiatal hernia defect was identified and primarily repaired, by crural closure. Gore Bio-A Tissue Reinforcement was trimmed to fit the defect accommodating the esophagus. Nissen fundoplication was performed. Result. Bio-A mesh was easily placed laparoscopically. It has good handling and could be cut and tailored intraoperatively for optimal adaptation. There were no short-term complications. Conclusion. Crural closure reinforcement can be done readily with this new totally absorbable mesh replaced by soft tissue over six months. However, further data and studies are needed to evaluate long-term outcomes. PMID:24864221

Antonino, Agrusa; Giorgio, Romano; Giuseppe, Frazzetta; Giovanni, De Vita; Silvia, Di Giovanni; Daniela, Chianetta; Giuseppe, Di Buono; Vincenzo, Sorce; Gaspare, Gulotta

2014-01-01

138

[Comparison of various methods of surgical hernia repair].  

PubMed

Over the last 15 years, a number of different procedures for hernia repair have been developed. Apart from the open techniques, with or without the use of a prosthetic mesh or mesh plug, endoscopic procedures such as transabdominal preperitoneal (TAPP), and totally endoscopic preperitoneal (TEPP), hernioplasty are now established operations. In the present paper, the common open surgical procedures are compared with the minimally invasive repairs with regard to practicability, postoperative wound pain and complications, mobilization, recurrence rates and cosmesis. In the view of the authors, the standard method for inguinal hernial repair is the open Lichtenstein procedure or the Rutkow patch and plug method. PMID:15957857

Benz, S; Hopt, U T

2005-05-19

139

Laparoscopic hernia repair in Leicester General Hospital: a prospective audit of 94 patients.  

PubMed Central

Conventional hernia repair is effective in terms of cure but is associated with considerable postoperative pain and delay in return to normal activity. Laparoscopic repair has the potential to reduce pain and speed return to normal activity, but there have been few published reports of the outcome of this operation in the UK. We present a prospective audit of 94 patients who underwent laparoscopic repair. Of the 94 patients, 87 (92.6%) were male and 7 (7.4%) were female. Thirteen of the repairs were bilateral and 12 were recurrent. Two had to be converted to open repair. The mean operating time for unilateral repair was 56 min and for bilateral repair 98 min. Sixty-three patients (67%) were discharged within 24 h and 21 (22.4%) were discharged within 48 h. There were minor complications in 20 patients (21%), eight of whom (8.5%) developed a haematoma. The other minor complications included seromas (2), bruising at the site of the entry port (2), hyperaesthesia in the groin (2), port hernia (1), shoulder tip pain after surgery (3) and postoperative urinary retention (2). Nine (9.5%) patients claimed to have had no pain or discomfort at all; 35 (37.2%) were pain and discomfort free in 2 weeks. Thirty-two (34%) patients returned to normal activities in 2 weeks. With a median follow-up of 8 months 3 (3.2%) recurrences were noted. It is emphasised that this series represents a learning curve and that the operation is developmental. We are now restricting laparoscopic repair to recurrent and bilateral hernias where the technique offers particular advantages. PMID:8712651

Marappan, S.; Veitch, P. S.; Barrie, W. W.; McCulley, S.; Barr, C.

1996-01-01

140

Emergency groin hernia repair: implications in elderly  

PubMed Central

Background Groin hernia is one of the most frequently encountered pathologies occurring in old age and it is often the cause of emergency procedures. In our study we evaluate the impact of emergency procedures in over 75 patients compared to younger patients. Methods We conducted a retrospective study about patients who underwent emergency hernioplasty between September 2007 and January 2013. Bilateral hernias and recurrences were excluded. We divided patients into two groups by age (under and over 75 years old) and then analyzed the early postoperative surgical complications. Results A total of 48 patients were enrolled, 18 were included in under 75 group and 30 in over 75. In the older group we found a higher rate of comorbidity and also a significant higher rate of postoperative complications. Two patients of over 75 group died. Conclusions Our data suggests that a quick diagnosis and elective surgical procedures are desirable in order to avoid the complications that occur in emergency operations. PMID:24267391

2013-01-01

141

Routine hiatal hernia repair in laparoscopic gastric banding.  

PubMed

Laparoscopic gastric banding is now well established as an effective means of obtaining safe, healthy weight loss in the morbidly obese patient population. The procedure has evolved over the years to minimize complications and optimize results. Preoperative patient evaluation includes upper endoscopy to assess the baseline integrity of the stomach and rule out pathology. Upper endoscopy fails to demonstrate the majority of small hiatal hernias in these patients preoperatively. Hiatal hernias are grossly underappreciated in patients with morbid obesity due to the presence of a large distal esophageal fat pad. With post-operative internal weight loss, a small crural defect can become relatively large in a short amount of time. Performing gastric banding without dissecting and repairing the hiatal hernia can lead to incorrect positioning of the gastric band, which is associated with poor weight loss, chronic reflux, and increased complications. Concomitant hiatal hernia repair is felt by the authors to be a necessary component for the correct placement of the gastric band device, which, in turn, provides excellent long-term results to our patients. PMID:21082563

Reich, Jonathan; Strom, Karl; Pasquariello, James; Fresco, Silvia; Barbalinardo, Joseph

2010-10-01

142

Should laparoscopic paraesophageal hernia repair be abandoned in favor of the open approach?  

Microsoft Academic Search

Background: The most appropriate approach to the repair of large paraesophageal hernias remains controversial. Despite early results of excellent outcomes after laparoscopic repair, recent reports of high recurrence require that this approach be reevaluated. Methods: For this study, 60 primary paraesophageal hernias consecutively repaired at one institution from 1990 to 2002 were reviewed. These 25 open transabdominal and 35 laparoscopic

L. E. Ferri; L. S. Feldman; D. Stanbridge; S. Mayrand; L. Stein; G. M. Fried

2005-01-01

143

Focal testicular infarction from laparoscopic inguinal hernia repair.  

PubMed

A 53-year-old Caucasian male underwent laparoscopic total extraperitoneal repair of a right indirect inguinal hernia. Postoperatively, the patient developed right testicular swelling and pain that increased over the course of a week. On examination, the patient was found to have a tender, swollen, high-riding testicle, and testicular torsion was of main concern. Doppler sonography and testicular scan suggested an infarction only to the upper pole of the right testicle. Subsequent exploration of the right testicle revealed a hydrocele and focal ischemia to the upper pole of the right testicle. Intraoperative Doppler study and a urology consultation were obtained with an initial impression of possible intermittent torsion. This report describes a rare complication seen in laparoscopic inguinal hernia repairs. PMID:12166758

Mincheff, Thomas; Bannister, Brooks; Zubel, Paul

2002-01-01

144

Two cases of cystic seroma following mesh incisional hernia repair.  

PubMed

Cystic seromas, or mature fibrous cysts, are rare complications after ventral and incisional hernioplasties employing polypropylene mesh. We analyzed the medical records of patients, whose abdominal-wall hernias were surgically repaired with polypropylene mesh from November 1996 to February 2004 (N=685). Of the 162 patients, who had incisional hernias repaired with the Rives technique (preperitoneal mesh), we detected two patients who developed giant cystic seromas. Both patients underwent surgical resection of the cyst wall. As follow-up care improves for patients undergoing hernioplasties with polypropylene meshes, more cystic seromas are detected, thereby improving our knowledge of the clinical, radiological, and histopathological characteristics of this complication. However, the etiologic factors related to the appearance of this chronic cyst remain uncertain. PMID:16001158

Mayagoitia, Juan Carlos; Almaraz, A; Díaz, C

2006-03-01

145

Ileocutaneous fistula formation following laparoscopic polypropylene mesh hernia repair  

Microsoft Academic Search

.   A rare case of enterocutaneous fistula caused by chronic erosion of polypropylene mesh after laparoscopic repair of a recurrent\\u000a inguinal hernia is described. Successful treatment was achieved by fistulectomy, total resection of the implanted mesh, and\\u000a small-bowel segmental resection. The patient recovered well postoperatively, and at follow-up 18 months later, the herniorrhaphy\\u000a has remained intact. This complication needs to

K. Miller; W. Junger

1997-01-01

146

NOTES ® transgastric abdominal wall hernia repair in a porcine model  

Microsoft Academic Search

Introduction  With approximately 1 million ventral and inguinal hernia repairs performed in the United States each year, even small rates\\u000a of complications translate into large numbers of patients. Less invasive approaches that potentially lower morbidity deserve\\u000a consideration, recognizing there are many technical considerations that currently limit their use. We describe a reproducible\\u000a technique and lessons learned in our laboratory that answer some

D. B. Earle; D. J. Desilets; J. R. Romanelli

2010-01-01

147

[Laparoscopic or conventional repair of inguinal hernia with synthetic mesh?].  

PubMed

Laparoscopic inguinal hernia repair by means of the transabdominal preperitoneal technique (TAPP) was compared with open plug-and-patch-repair (PP) in a prospective study. From September 1992 until July 1994, 86 patients were operated using the TAPP technique; after introduction of PP in August 1994, 105 patients were operated using this technique. From August 1994 until April 1995, 24 more patients wanted the laparoscopic procedure. The two groups were comparable with regard to age, sex and the distribution of hernia types. Eighty-eight (84%) of the PP patients were operated under local anesthesia, while the others chose general anesthesia. The only intraoperative complication was a bleeding from the epigastric vessel in the laparoscopic group. Postoperative complications were three wound hematomas after TAPP (2.2%) and two wound hematomas and one superficial wound infection after PP (2.4%). All complications healed spontaneously. No detectable statistical difference was noted between the two groups with respect to postoperative pain, the consumption of analgetics, duration of hospitalization and reconvalescence. After a median follow-up of 34 months, two recurrences after TAPP (1.4%) and no recurrences after PP has been detected. Based on our experience we prefer PP for inguinal hernia repair in adults because it affords the same patient comfort as TAPP but is less expensive and can be performed under local anesthesia. PMID:9064469

Zieren, J; Zieren, H U; Wenger, F A; Müller, J M

1996-01-01

148

The role of the laparoendoscopic single site totally extraperitoneal approach to inguinal hernia repairs: a review and meta-analysis of the literature  

PubMed Central

Background Laparoendoscopic single site (LESS) surgery may have perceived benefits of reduced visible scarring compared to conventional laparoscopic (LAP) totally extraperitoneal (TEP) hernia repairs. We reviewed the literature to compare LESS TEP inguinal hernia repairs with LAP TEP repairs. Methods We searched electronic databases for research published between January 2008 and January 2012. Results A total of 13 studies reported on 325 patients. The duration of surgery was 40–98 minutes for unilateral hernia and 41–121 minutes for bilateral repairs. Three studies involving 287 patients compared LESS TEP (n = 128) with LAP TEP (n = 159). There were no significant differences in operative duration for unilateral hernias (p = 0.63) or bilateral repairs (p = 0.29), and there were no significant differences in hospital stay (p > 0.99), intraoperative complications (p = 0.82) or early recurrence rates (p = 0.82). There was a trend toward earlier return to activity in the LESS TEP group (p = 0.07). Conclusion Laparoendoscopic single site surgery TEP hernia repair is a relatively new technique and appears to be safe and effective. Advantages, such as less visible scarring, mean patients may opt for LESS TEP over LAP TEP. Further studies with clear definitions of outcome measures and robust follow-up to assess patient satisfaction, return to normal daily activities and recurrence are needed to strengthen the evidence. PMID:24666450

Siddiqui, Muhammad R.S.; Kovzel, Maksym; Brennan, Steven J.; Priest, Oliver H.; Preston, Shaun R.; Soon, Y.

2014-01-01

149

Comparative Study of Inguinal Hernia Repair Rates After Radical Prostatectomy or External Beam Radiotherapy  

SciTech Connect

Purpose: We tested the hypothesis that patients treated for localized prostate cancer with radical prostatectomy (RP) have a higher risk of requiring an inguinal hernia (IH) repair than their counterparts treated with external beam radiotherapy (EBRT). Methods and Materials: Within the Quebec Health Plan database, we identified 6,422 men treated with RP and 4,685 men treated with EBRT for localized prostate cancer between 1990 and 2000, in addition to 6,933 control patients who underwent a prostate biopsy. From among that population, we identified patients who underwent a unilateral or bilateral hernia repair after either RP or EBRT. Kaplan-Meier plots showed IH repair-free survival rates. Univariable and multivariable Cox regression models tested the predictors of IH repair after RP or EBRT. Covariates consisted of age, year of surgery, and Charlson Comorbidity Index. Results: IH repair-free survival rates at 1, 2, 5, and 10 years were 96.8, 94.3, 90.5, and 86.2% vs. 98.9, 98.0, 95.4, and 92.2%, respectively, in RP vs. EBRT patients (log-rank test, p < 0.001). IH repair-free survival rates in the biopsy population were 98.3, 97.1, 94.9, and 90.2% at the same four time points. In multivariable Cox regression models, RP predisposed to a 2.3-fold higher risk of IH repair than EBRT (p < 0.001). Besides therapy type, patient age (p < 0.001) represented the only other independent predictor of IH repair. Conclusions: RP predisposes to a higher rate of IH repair relative to EBRT. This observation should be considered at informed consent.

Lughezzani, Giovanni [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec (Canada); Department of Urology, Vita-Salute San Raffaele University, Milan (Italy); Sun, Maxine [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec (Canada); Perrotte, Paul [Department of Urology, University of Montreal, Montreal, Quebec (Canada); Alasker, Ahmed; Jeldres, Claudio [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec (Canada); Isbarn, Hendrik; Budaeus, Lars [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec (Canada); Martini-clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg (Germany); Lattouf, Jean-Baptiste; Valiquette, Luc; Benard, Francois; Saad, Fred [Department of Urology, University of Montreal, Montreal, Quebec (Canada); Graefen, Markus [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec (Canada); Martini-clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg (Germany); Montorsi, Francesco [Department of Urology, Vita-Salute San Raffaele University, Milan (Italy); Karakiewicz, Pierre I., E-mail: pierre.karakiewicz@umontreal.c [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec (Canada)

2010-12-01

150

Randomised controlled trial of laparoscopic versus open repair of inguinal hernia: early results.  

PubMed Central

OBJECTIVE--To establish the safety, short term outcome, and theatre costs of transabdominal laparoscopic repair of inguinal hernia performed as day surgery. DESIGN--Randomised controlled trial. The control operation was the two layer modified Maloney darn. SETTING--Teaching hospital and district general hospital. SUBJECTS--125 men randomised to laparoscopic or open repair of inguinal hernia. OUTCOME MEASURES--Morbidity, postoperative pain and use of analgesics, quality of life, and theatre costs. Outcome was assessed by questionnaires administered to patients daily for 10 days and at six weeks postoperatively and by outpatient review at six weeks. Return to normal activity was assessed by questionnaire at three months. RESULTS--One vascular complication (2%) occurred in the group that had open repair. Seven complications (12%) including vessel injury and early recurrence arose in the group that had laparoscopic repair (difference in complication rate 10% (95% confidence interval 4% to 18%; P = 0.02). Pain scores and quality of life assessed by the short form 36 showed a significant benefit to the group that had laparoscopic repair in the early postoperative period. Return to normal activity was not significantly different between the two groups. Total theatre costs were higher in the group that had laparoscopic repair (mean cost for laparoscopic repair 850 pounds (622 pounds to 1078 pounds); mean cost for open repair 268 pounds (245 pounds to 292 pounds)). CONCLUSIONS--Because of the greater complication rate and higher theatre costs for laparoscopic repair and the patient outcome preferences expressed, the results of larger trials of clinical and cost effectiveness using recurrence as the primary outcome measure should be known before laparoscopic herniorrhaphy is widely adopted. PMID:7580639

Lawrence, K.; McWhinnie, D.; Goodwin, A.; Doll, H.; Gordon, A.; Gray, A.; Britton, J.; Collin, J.

1995-01-01

151

Laparoscopic repair of a Littre’s hernia with porcine dermal collagen implant (Permacol)  

Microsoft Academic Search

Background  Littre’s hernia was originally defined as “the presence of a Meckel’s diverticulum in any hernia sac” by Rieke in 1841. It\\u000a is a rare finding at any age,\\u0009 and its true incidence is unknown. The conventional treatment for Littre’s hernia is wedge\\u000a resection of the diverticulum and repair of the hernia from within the sac. However, the advent of laparoscopic

N. Smart; A. Immanuel; M. Mercer-Jones

2007-01-01

152

Laparoscopic Repair of a Ureteric Sciatic Hernia: Report of a Case  

PubMed Central

Ureteric sciatic hernias are extremely rare. Here we report a case of a 78-year-old woman presented with colicky left abdominal pain. Computed tomography revealed a ureteric sciatic hernia, and drip infusion pyelography revealed dilated left ureter with herniation of the ureter into the sciatic foramen. The hernia was successfully repaired laparoscopically. We have described the diagnosis and management of the patient, followed by a review of the literature on sciatic hernias. PMID:24778894

Saisu, Kazuhiro; Tsuru, Nobuo; Homma, Yukio; Ihara, Hiroyuki

2014-01-01

153

Evaluation of Composite Mesh for Ventral Hernia Repair  

PubMed Central

Introduction: Composite mesh prostheses incorporate the properties of multiple materials for ventral hernia repair. This study evaluated a polypropylene/ePTFE composite mesh with a novel internal polydioxanone (PDO) absorbable ring. Methods: Composite mesh was placed intraperitoneally in 16 pigs through an open laparotomy and explanted at 2, 4, 8, and 12 weeks. Intraabdominal adhesions were measured laparoscopically. Host tissue in-growth was assessed histologically and tensiometrically. Degradation of the internal PDO ring component was also measured tensiometrically. Appropriate statistical tests were used, and P?.05 indicated significance. Results: No adhesions were formed in 50% of the grafts explanted at 8 weeks and 25% of grafts explanted at 12 weeks. There were significantly more vascular structures at 8 weeks, 73.5±28, compared with 2 weeks, 6.75±2 (P?.01). The T-peel force at the mesh-host tissue interface was not significantly different among time points. The absorbable PDO ring underwent complete degradation by 12 weeks. Conclusions: This composite mesh was associated with minimal intraabdominal adhesions, progressive in-growth of host tissues, and complete degradation of a novel internal PDO ring that aided mesh positioning. This composite hernia mesh showed a favorable performance in a porcine model of open ventral hernia repair. PMID:21985713

Byrd, Jim F.; Agee, Neal; Nguyen, Phuong H.; Heath, Jessica J.; Lau, Kwan N.; McKillop, Iain H.; Sindram, David; Martinie, John B.

2011-01-01

154

Laparoscopic partially extraperitoneal (PEP) mesh repair for laterally placed ventral and incisional hernias.  

PubMed

Laparoscopic mesh repair is becoming an increasingly popular method of ventral and incisional hernia repair. Entrapment neuropathy is a recognised complication when tacks are used to fix the mesh, particularly below the inguinal ligament and laterally in the abdominal wall. We describe a novel method of ventral hernia repair, which employs transabdominal extra-peritoneal dissection to create a pocket for mesh placement with complete avoidance of tacks in the postero-lateral abdominal wall. This technique is particularly useful for incisional hernias arising through old stoma wounds or appendicectomy incisions, and for Spigelian and lumbar hernias. PMID:24710242

Brady, Richard R W; Ventham, Nicholas T; De Beaux, Andrew C; Tulloh, Bruce

2014-06-01

155

Relaparoscopic Treatment of Recurrences after Previous Laparoscopic Inguinal Hernia Repair  

PubMed Central

Background. Relaparoscopic treatment of inguinal hernia recurrences has become a relatively new concept with favourable results. The purpose of this study was to examine a series of relaparoscopic repair, present technical experiences, and the clinical outcomes in this subset of patients. Patients and Methods. The medical records of five patients who underwent relaparoscopic repair (TAPP or TEP) for a recurrence between March 2005 and September 2012 were retrospectively reviewed. Results. All the patients were male with a mean age of 45 years. Technical failures in the previous repairs were the main factors contributing to recurrences. In two re-TEP cases with no previous mesh fixation, the old mesh remained on the peritoneal side during preperitoneal dissection and this greatly facilitated surgical manipulation. The mean operative time was 93?min (range, 45–120?min). There were no conversions, no intraoperative complications, and no morbidity or rerecurrence after a mean follow-up period of 17 months (range, 7–24 months). Conclusion. Relaparoscopic repair appears to be safe and effective in the treatment of recurrent inguinal hernia and repeated TEP could be a simpler approach than expected in the presence of no prior mesh fixation. PMID:24379974

Ozben, Volkan; Ozveri, Emel

2013-01-01

156

A Cost and Profit Analysis of Hernia Surgery  

PubMed Central

The vast majority of surgeons who are in the active practice of their particular field have little time to evaluate their individual practices from a “business perspective.” This fact is critical to the future of any entity that is engaged in the delivery of goods and services. Without such an analysis, few businesses will continue to function in such a manner that ensures the financial viability of that enterprise. We have attempted to accumulate the available data to analyze the practice of surgery as it relates to the cost and profit of hernia repairs. Given this information, it is easily extrapolated into other procedures, open or laparoscopic, that are performed by the general surgeon. The herniorraphy analysis indicates that one cannot hope to generate enough income to rely upon a financially successful business. The information presented should be considered a national average and not specific to an individual practice situation. It is meant to serve as a template for which each surgeon can (and must) evaluate his or her own practice profitability. PMID:10694077

LeBlanc, Zinda Z.

1999-01-01

157

Transabdominal pre-peritoneal mesh in inguinal hernia repair in elderly: end point of our experience  

PubMed Central

Background Aim of this study is to present our standardized laparoscopic transabdominal preperitoneal hernia repair (TAPP) technique, and to study our experience in the elderly as far as concerns preoperative and postoperative variables. Methods We described our standardized TAPP technique according with Stuttgart technique [1], and we evalutated our team's experience in TAPP inguinal hernia repair in elderly (> 65 yrs) and in young patients (< 65 yrs). Results We retrospectively reviewed our Surgery Division's experience about TAPP; we included in our study 185 patients. The sample was subdivided in two groups: TAPP Group (< 65 years patients) and TAPPe Group (> 65 years patients). TAPP Group was composed by 154 patients and TAPPe Group of 31 patients. According with literature, in this subgroup recurrence rate (3,2%), early and delayed complications and mean operative time (86 min). There were no major vascular or intestinal complications. At the moment follow-up is 31 months. There were no incisional hernias on umbilical trocar. Mean satisfaction rate was excellent also in elderly patients. Conclusions According with literature, in our experience TAPP technique is a safe and feasible procedure, even in elderly patients. PMID:24266979

2013-01-01

158

Perineal hernia repair with acellular dermal graft and suture anchor fixation.  

PubMed

Perineal hernia is an infrequent complication of abdominoperineal resection, but can be problematic. Multiple surgical approaches to the repair of perineal hernia have been described, including abdominal, perineal, and combined methods; most feature the use of a prosthetic mesh. We report a case wherein a large perineal hernia was reduced via an abdominal approach, and then repaired by the placement of an acellular dermal graft (DermaMatrix) fixated anteriorly directly to the pubis with Mitek suture anchors. PMID:20490587

Kathju, S; Lasko, L-A; Medich, D S

2011-06-01

159

Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair  

Microsoft Academic Search

Background: Posterior cruroplasty repair of a large paraesophageal hiatus hernia has a higher than desirable rate of recurrence attributable to the inexorable cyclic negative intrathoracic pressure of respiration and positive intraabdominal pressure produced by straining, physical exertion, and coughing. To reduce the risk of recurrence after repair of a large hiatus hernia and intrathoracic stomach, we have used posterior cruroplasty

Mark A. Carlson; Robert E. Condon; Kirk A. Ludwig; William J. Schulte

1998-01-01

160

Symptomatic internal hernias after laparoscopic bariatric surgery  

Microsoft Academic Search

Background: The aim of this study was to describe the occurrence and clinical characteristics of symptomatic internal hernias (IH) after laparoscopic bariatric procedures. Methods: We conducted a retrospective review of cases of IH after 1,064 laparoscopic gastric bypasses (LGB) and biliopancreatic diversions with duodenal switch (LBPD-DS) performed from September 1998 to August 2002. Results: We documented 35 cases of IH

E. Comeau; M. Gagner; W. B. Inabnet; D. M. Herron; T. M. Quinn; A. Pomp

2005-01-01

161

Incisional Hernia Repair in Renal Transplantation Patients  

Microsoft Academic Search

Introduction: Abdominal wall dehiscence in renal transplantation patients risks the survival of the transplanted organ. No\\u000a clear treatment algorithm exists in the literature for this group of patients. Methods: Between 1992 and 2001, the Division\\u000a of Plastic Surgery at the University of Maryland treated 41 of 2499 renal transplant patients. Based on a retrospective review\\u000a of these patients, an algorithm

Edward N. Li; Ronald P. Silverman; Nelson H. Goldberg

2005-01-01

162

Delayed Presentation of a Bowel Bovie Injury After Laparoscopic Ventral Hernia Repair  

PubMed Central

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. PMID:24018096

Gayagoy, Jennifer; Chaudhary, Sushant; Kolachalam, Ramachandra B.

2013-01-01

163

[Prosthetic repair of inguino-crural hernia using Rives technique].  

PubMed

The authors report their experience with Rives procedure, a prosthetic repair of groin hernias using preperitoneal sutured mesh by parainguinal access. This operation is not technically easy to perform and is usually done out of necessity in cases with higher risk of recurrence because of systemic factors of chronic abdominal high pressure and/or of local factors of risk, when there are contraindications to operations like Stoppa procedure. Our series report 38 patients operated upon on 5 years, with incidence of 5.8% overall hernias repaired in the same period. 33 are males, 5 females, with average age of 60.5 years. Mean time required for the operation is 94 minutes (range 55'-130'). About postoperative complications we complain of one testicular atrophy, but none infections. Follow-up range is 9-50 months (average 23.2 months) for 30 patients operated more than one year ago. All but one were revisited after almost 12 months. No recurrences were detected. PMID:9148203

Coda, A; Ferri, F; Filippa, C; Mattio, R; Bona, A; Tonello, P; Benedetto, C

1997-03-01

164

Laparoscopic Mesh Versus Open Preperitoneal Mesh Versus Conventional Technique for Inguinal Hernia Repair  

PubMed Central

Objective To evaluate the influence of the laparoscopic technique in hernia repair regarding time to full recovery and return to work, complications, recurrence rate, and economic aspects. Summary Background Data Several studies have shown advantages in terms of less pain and faster recovery after laparoscopic hernia repair, whereas others have not, and the cost-effectiveness has been questioned. The laparoscopic technique must be thoroughly compared with the open procedures before its true place in hernia surgery can be defined. Methods Six hundred thirteen male patients aged 40 to 75 years were randomized to the conventional procedure, preperitoneal mesh placed by the open technique, or laparoscopic preperitoneal mesh (TAPP). Follow-up was after 7 days, 8 weeks, and 1 year. Results Of 613 patients undergoing surgery, 604 (98.5%) were followed for 1 year. Patients who underwent TAPP gained full recovery after 18.4 days, compared with 24.2 days for open mesh (p < 0.001) and 26.4 days for the conventional procedure (p < 0.001). Patients who underwent TAPP returned to work after 14.7 days, compared with 17.7 days for open mesh (p = 0.05) and 17.9 days for the conventional procedure (p = 0.04). They also had significantly less restriction in physical activities after 7 days. The TAPP procedure was more expensive, mainly as a result of longer surgical time and equipment costs, even after compensation for earlier return to work. Complications were more common in the TAPP group, with a varying pattern between the groups. Four recurrences in the conventional, 11 in the open mesh, and 4 in the TAPP group were recorded after 1 year (p = n.s.). Conclusion The laparoscopic technique results in both shorter time to full recovery and shorter time to return to work, at the price of substantially increased costs. PMID:10450737

Johansson, Bo; Hallerback, Bengt; Glise, Hans; Anesten, Bengt; Smedberg, Sam; Roman, Jonas

1999-01-01

165

Tension-free inguinal hernia repair: a retrospective study of 3000 cases in one center.  

PubMed

The tension-free anterior repair of inguinal hernia using a mesh, initially described by Zagdoun in 1959 and perfectly described by Lichtenstein, was used as a basis for the technique we adapted 17 years ago. The purpose of this study was to retrospectively assess the clinical long-term results of this modified tension-free technique. Three thousand inguinal hernias were operated by the same surgeon. The Lichtenstein technique modifications were the nature and the enlarged size of the mesh (polyester-Parietex, 13 x 9 cm) and the fixation method (staples). Complications, pain, and recurrence were carefully reported on a standardized file. Immediate complications were rare and always minor: hematomas and parietal abscesses. With a mean follow-up of 8 years, 48 cases of persisting pains (2%) coming from nervous irritation were reported, and only 12 recurrences (0.5%) were detected more than 10 years after surgery. Based on follow-up of these 3000 hernias, the results of this study exhibit a very low rate of recurrence (0.5%). This technique seems to be easy, painless, safe, and effective. PMID:15912901

Chastan, Philippe

2005-01-01

166

[Inguinal hernia repair with marlex mesh in a preperitoneal site using the classical inguinal access].  

PubMed

Following a brief review of the main method of prosthetic repair used for inguinal hernia: Lichtenstein, Stoppa, Rives, etc, the authors propose an original technique consisting in the placement of a marlex patch below the trasversalis fascia, in a pre-peritoneal site, using a classical inguinal access route. The prosthesis is fitted round the spermatic funicle and fixed with a single stitch to the pubis and with a few others, in resorbable material, to the posterior face of the trasversalis fascia. Above it, plastic surgery is performed to bring the triple stratum closer to the reflexio of the inguinal ligament. The prosthesis is kept in place by positive abdominal pressure. The method outlined here has been used in 71 cases of primary or recurrent inguinal hernia. Follow-up lasted for 1-24 months and showed the low morbidity (4.5%) due to sepsis of the surgical wound, which did not require reoperation, and only 1 case of recurrent hernia which was probably caused by the incorrect positioning of the prosthesis. PMID:8247277

Battistini, G; Castrati, G; Fiorone, E; Cannici, F; Sommariva, S

1993-07-01

167

Allograft AlloDerm® tissue for laparoscopic transabdominal preperitoneal groin hernia repair: A case report  

PubMed Central

INTRODUCTION Synthetic mesh is the prosthetic material used for most inguinal hernioplasties. However, when left in contact with intra-abdominal viscera, it often becomes associated with infection and migration, particularly in irradiated tissues, contaminated fields, immunosuppressed individuals, and patients with intestinal obstruction or fistula. AlloDerm® Regenerative Tissue Matrix (LifeCell Corporation, Branchburg, NJ) is derived from human cadaver skin and may be associated with fewer visceral adhesions and more durability in infected fields than synthetic mesh. PRESENTATION OF CASE We report the first case in which AlloDerm was used in a laparoscopic transabdominal preperitoneal repair of a multiple recurrent right inguinal hernia, a left femoral hernia, and an umbilical hernia in the same patient. Use of AlloDerm greatly enhanced the maneuverability during laparoscopic hernia repair due to its pliability and strength and eliminated the need to cover the prosthetic with peritoneum. DISCUSSION Previous pelvic radiation and multiple previous groin repairs can render the peritoneum friable, resulting in obstacles to successful closure. AlloDerm is a reasonable choice for groin hernia repairs when such factors are present. CONCLUSION The long-term durability of AlloDerm for laparoscopic groin hernia repairs is yet to be determined, but based on current data it seems prudent to use this technique in laparoscopic repair of complex groin hernias where infection is suspected or inadequate prosthetic coverage with peritoneum is anticipated. PMID:24780773

Amirlak, Bardia; Gerdes, Jodi; Puri, Varun; Fitzgibbons, Robert J.

2014-01-01

168

Long term outcome and quality of life after open incisional hernia repair - light versus heavy weight meshes  

PubMed Central

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 hernia repair with "light weight"(LW) and "heavy weight"(HW) PP meshes. Methods 12 patients who underwent midline open incisional hernia repair 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 hernia repair with light or heavy weight meshes is not related to the mesh type in the long term follow up. PMID:21917180

2011-01-01

169

Laparoscopic ventral hernia repair with the Goretex Dualmesh: long-term results and review of the literature  

Microsoft Academic Search

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 hernia repair using an intraperitoneal Goretex Dualmesh with a 3–5-cm mesh\\u000a overlap secured with

Ph. Topart; L. Ferrand; F. Vandenbroucke; P. Lozac’h

2005-01-01

170

Single incision approach to totally extraperitoneal inguinal hernia repair  

PubMed Central

Introduction Nowadays the vast majority of inguinal hernia repairs are laparoscopically assisted. Single incision laparoscopy aims to accelerate recovery and provide a better cosmetic outcome after the operation. Aim To present our own modification of the totally extraperitoneal (TEP) procedure with a single incision and without a multiport, and compare the results with those obtained in the classic three-trocar TEP method. Material and methods The study group comprised 61 males. The first group consisted of 35 males who underwent single incision videoscopic alloplasty TEP. The second group comprised 26 males who underwent videoscopic alloplasty using the classic approach. The study assessed the time of operation, complications and postoperative pain based on the VAPS scale. Results The operation time in the first group was statistically longer compared with the time in the second group. The assessment of differences in postoperative pain in both the examined groups on the first and seventh day after the operation was considered statistically insignificant. In both the studied groups there was no recurrence of hernia established on the first and seventh day after the operation. Conclusions The reduced number of incisions in the TEP method with a single incision approach without a multiport involves a decrease in the number of postoperative scars, and thus offers a better cosmetic outcome compared with the classic TEP procedure. The time of TEP operation performed with a single incision approach without a multiport is statistically longer than the duration of the classic laparoscopic TEP procedure. PMID:25097687

Bialecki, Jacek T.; Kolomecki, Krzysztof

2014-01-01

171

Outcomes of the open mesh repair of large incisional hernias using an intraperitoneal composite mesh: our experience with 100 cases.  

PubMed

Incisional hernia repair sometimes requires intraperitoneal implantation of a mesh. This becomes necessary when the hernia opening is large, in particular, in patients with a low abdominal wall surface/wall defect surface (AWS/WDS) ratio, in large boundary incisional hernias where the proximity to bone structures or cartilage often complicates retromuscular mesh implantation and in multi-recurrent incisional hernias that are sometimes characterised by an actual loss of abdominal wall tissue. The authors report on the results of a series of 100 incisional hernias treated between 1999 and 2006 using the open technique to implant an intraperitoneal mesh (Parietex Composite). Mean follow-up time was 42 months (range 12-96 months). The mean wall defect surface was 95 cm(2) (range 60-210 cm(2)). Twelve percent of patients suffered minor complications: 5 seromas (5%), 3 haematomas (3%) and 4 parietal suppurations (4%). No mesh had to be removed. The recurrence rate was 6%. At 6 months after surgery, no patient lamented pain or discomfort due to foreign body sensation. None of these patients presented intestinal occlusion or enterocutaneous fistulae. In conclusion, it is our opinion that the mesh should be implanted in direct contact with the viscera only where absolutely necessary, i.e., when it cannot be implanted in the retromuscular area without creating excessive parietal tension. Our experience with PC mesh, over the short-to-medium term, was positive. Naturally, further studies are required to evaluate long-term biocompatibility. PMID:20845102

Ammaturo, Carmine; Bassi, Uberto Andrea; Bassi, Gaspare

2010-08-01

172

Post-laparoscopic mesh in post-menopausal umbilical hernia repair: a case series.  

PubMed

We evaluated the efficacy and safety of the use of a composite PTFE/polypropylene patch, Ventralex (Davol Inc., C.R. Bard, Inc., RI, USA), to repair, concurrent with laparoscopy, umbilical hernia in 51 postmenopausal women. After laparoscopy, patients were submitted to the hernia repair by a patch intraperitoneally placed behind the hernia. Primary outcomes included complication rates, while hernia recurrence was the secondary outcome. Patient age range was 58 ± 4.3 years, the size of patches was small in 17.6% of women, medium in 68.7% and large in 13.7%. Seventy-six percent of patients had an ASA I-II score, the mean operating time for hernia repair was 7 ± 2 minutes with 15 cc of related blood loss, with 1.8 days of hospital stay. The visual analogue scale was 0-3 for 62.7%, 4-6 for 27.5% and 7-10 for 9.8% of women. All laparoscopic and umbilical hernia repair terminated without any further intra or postoperative complications, with 36 months of follow-up; none of the patients showed recurrences. Combining laparoscopy and intraperitoneal mesh repair appears to be indicated for umbilical hernia treatment in post-menopausal patients undergoing laparoscopy, resulting in a safe and easy procedure, with short hospital stay and fast dismissal, with no major morbidity or recurrence. PMID:21247250

Tinelli, Andrea; Malvasi, Antonio; Manca, Corrado; Alemanno, Giovanni; Bettocchi, Stefano; Benhidjeb, Tahar

2011-09-01

173

Oligosymptomatic vs. symptomatic incisional hernias—who benefits from open repair?  

Microsoft Academic Search

Introduction  Incisional hernias are one of the most often complications in abdominal surgery and therefore present a significant surgical\\u000a and socioeconomic problem. To date, incisional hernias are always an indication for surgery, regardless of the patient’s symptoms.\\u000a However, it remains unclear to what extent the surgery actually results in symptomatic improvement and whether a relevant\\u000a risk of incarceration exists. The purpose

Johannes Christian Lauscher; Stefanie Rieck; Jan C. Loh; Jörn Gröne; Heinz J. Buhr; Jörg-Peter Ritz

2011-01-01

174

Repair of Giant Midline Abdominal Wall Hernias: “Components Separation Technique” versus Prosthetic Repair  

PubMed Central

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. PMID:17372669

van Goor, H.; Charbon, J. A.; Rosman, C.; Hesselink, E. J.; van der Wilt, G. J.; Bleichrodt, R. P.

2007-01-01

175

Laparoscopic paraesophageal hernia repair: quality of life outcomes in the elderly.  

PubMed

Paraesophageal hernias (PEH) occur when there is herniation of the stomach through a dilated hiatal aperture. These hernias occur more commonly in the elderly, who are often not offered surgery despite the failure of medical treatment to address mechanical symptoms and life-threatening complications. The aim of this study was to assess the impact of laparoscopic repair of PEH on quality of life in an elderly population. Data were collected prospectively on 35 consecutive patients aged >70 years who had laparoscopic repair of a symptomatic PEH between December 2001 and September 2005. The change in quality of life was assessed using a validated questionnaire, the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD), and by patient interviews. Patients were assessed preoperatively, and at 6 weeks, 6 months, 12 months, 1 year, and 2 years postoperatively. Mean patient age was 77 years (range 70-85); mean American Society of Anesthesiologists class was 2.7 (range 1-3). There were 28 women and 7 men. There was one readmission for acute reherniation, which required open revision. Total complication rate was 17.1%. All complications were treated without residual disability. There was no 30-day mortality, and median hospital stay was 3 days (range 2-14). Completed questionnaires were obtained in 30 of 35 patients (85.7%). There was a significant improvement in quality of life, as measured with QOLRAD, at all postoperative time points (P < 0.001). Laparoscopic PEH repair can be performed with acceptable morbidity in symptomatic patients refractory to conservative treatment and is associated with a significant improvement in quality of life. Our data support elective repair of symptomatic PEH in the elderly, a population who may not always be referred for a surgical opinion. PMID:18459987

Hazebroek, E J; Gananadha, S; Koak, Y; Berry, H; Leibman, S; Smith, G S

2008-01-01

176

Costing anaesthetic practice. An economic comparison of regional and general anaesthesia for varicose vein and inguinal hernia surgery.  

PubMed

A computerised database of operating theatre activity was used to estimate the costs of regional and general anaesthesia for varicose vein and inguinal hernia surgery. Data retrieved for each procedure included the anaesthetic technique and drugs used, and the duration of anaesthesia, surgery and recovery. The costs of anaesthetic drugs and disposables, salary costs of the anaesthetic personnel and maintenance costs for anaesthetic equipment were considered. Drugs and disposables accounted for approximately 25% of the total cost of an anaesthetic. Anaesthetic times were 5 min longer for regional anaesthesia, but recovery times were 10 min shorter following regional anaesthesia for varicose vein surgery. Staff costs were dependent on the length of time each staff member spent with the patient. Although the number of cases was small, provision of a field block and sedation for inguinal hernia repair was considerably cheaper than other anaesthetic techniques. PMID:11069339

Kendell, J; Wildsmith, J A; Gray, I G

2000-11-01

177

A new approach for transversalis fascia reinforcement in Lichtenstein's inguinal hernia repair.  

PubMed

Operations undertaken for inguinal hernia repair are the most common elective surgical procedures. According to the current guidelines, Lichtenstein's tension-free method is the gold standard for elective hernia operations. The most common types of implanted mesh are polypropylene and composite mesh. We herein present Lichtenstein's operation using a biological hemostatic mesh (Tachosil) used for transversalis fascia reinforcement, and our results after a 3-year follow-up period for 52 patients implanted with Tachosil mesh are reported. According to our results, the biological mesh can be safely implanted during hernia repair with the same recurrence rate and lower postoperative pain and complications compared to hernia repair with polypropylene mesh implantation. PMID:22718088

Arslani, Nuhi; Gajzer, Borut; Papeš, Dino; Rajkovi?, Zoran; Altarac, Silvio; Zore, Zvonimir; Filipovi?-Zore, Irina

2013-02-01

178

How Lichtenstein hernia repair affects abdominal and anal resting pressures: a controlled clinical study  

PubMed Central

Purpose: Inguinal hernia repair is the most common surgical procedure performed by general surgeons worldwide. The Lichtenstein tension-free hernioplasty was first introduced in 1984 and evolved through 1988. Today it is the gold standard in hernia repair. The objective of this study was to determine if intra-abdominal and anal pressures changed in patients with inguinal hernias after Lichtenstein hernioplasties were performed. Materials and methods: A sample of 103 individuals, 92.2% of whom were male (n = 95) and 7.8% of whom were female (n = 8), aged 38.38 ± 14.03 years was used. The sample was divided into two groups: those with inguinal hernia (n = 53) and those without hernia (n = 50), who served as controls. Anal and abdominal manometric measurements were taken from each control patient at baseline and from each study patient before and after surgical repair. Results: Data analysis revealed differentiation of abdominal and anal pressures between the controls, the study patients before operation, and the study patients after operation. The average [SD] abdominal pressure was -2.58 mmHg [5.35] before hernia repair and 2.33 mmHG [3.62] after repair. The average [SD] abdominal pressure in the control group was 1.16 mmHg [1.96]. Conclusions: The Lichtenstein tension-free hernioplasty causes increases in abdominal and anal pressures, but this increase is not of a pathological level. PMID:24600490

Peker, Kemal; Isik, Arda; Inal, Abdullah; Demiryilmaz, Ismail; Yilmaz, Ismayil; Emiroglu, Mustafa

2014-01-01

179

Bulging of the Mesh After Laparoscopic Repair of Ventral and Incisional Hernias  

PubMed Central

Background and Objectives: To investigate the prevalence, diagnosis, clinical significance, and treatment strategies for bulging in the area of laparoscopic repair of ventral hernia that is caused by mesh protrusion through the hernia opening, but with intact peripheral fixation of the mesh and actually a still sufficient repair. Methods: Medical records of all 765 patients who underwent laparoscopic ventral hernia repair were reviewed, and all patients with a swelling in the repaired area were identified and analyzed. Results: Twenty-nine patients were identified. They all underwent a computed tomography assessment. Seventeen patients (2.2% of the total group) had a hernia recurrence; in an additional 12 patients (1.6%), radiologic examinations indicated only bulging of the mesh but no recurrence. Bulging was associated with pain in 4 patients who underwent relaparoscopy and got a new, larger mesh tightly stretched over the entire previous repair. Eight asymptomatic patients decided on “watchful waiting.” All patients remained symptom free during a median follow-up of 22 months. Conclusion: Symptomatic bulging, though not a recurrence, requires a new repair and must be considered as an important negative outcome of laparoscopic ventral hernia repair. In asymptomatic patients, “watchful waiting” seems justified. PMID:21605519

Wassenaar, Eelco B.; Raymakers, Johan T. F. J.; Rakic, Srdjan

2010-01-01

180

Shouldice inguinal hernia repair in the male adult: the gold standard? A multicenter controlled trial in 1578 patients.  

PubMed Central

BACKGROUND: Hernia repair is the second most frequently performed operation in France and in the United States, the prevalence being 36 for every 1000 males. Lowering the recurrence rate by 1% would mean 1000 fewer operations for hernia repair per year in France. METHODS: Between 1983 and 1989, 1578 adult males with a total of 1706 nonrecurrent inguinal hernias were prospectively and randomly allotted to undergo either a Bassini's repair, Cooper's ligament, or Shouldice repair with polypropylene or a Shouldice repair with stainless steel for determination of which technique was associated with the lowest recurrence rate. Fifty-nine hernia repairs were withdrawn after inclusion. Of the 1647 remaining hernias, 52.2% were indirect, 25.6% were direct, and 23.2% were combined. Patients were seen every 6 months for 3 years and then every year. Median follow-up was 5 years 8 months (range, 3 months-8.5 years). RESULTS: At 8.5 years, 5.6% of hernias were lost to follow-up. Ninety-seven hernia repairs failed, 50% during the first 2 years. The actuarial recurrence rate was 7.94% at 8.5 years. The Shouldice repair (stainless steel or polypropylene) was associated with fewer recurrences (6.1%) than either the Bassini's (8.6%) or Cooper's ligament repair (11.2%) technique (p < 0.001). This difference remained significant even when the maximal bias test was used. Fewer recurrences (5.9%) were observed with the stainless steel wire Shouldice repair than with polypropylene version (6.5%), but the difference was not significant. CONCLUSIONS: Shouldice hernia repair provides the patient with the best chances of nonrecurrence regardless of the anatomical type of hernia. The Shouldice hernia repair should be the gold standard for inguinal hernia repair in men and serves as the basis for comparison with all other techniques, be they prosthetic or laparoscopic. PMID:8526578

Hay, J M; Boudet, M J; Fingerhut, A; Poucher, J; Hennet, H; Habib, E; Veyrieres, M; Flamant, Y

1995-01-01

181

Surgical physiology of inguinal hernia repair - a study of 200 cases  

PubMed Central

Background Current inguinal hernia operations are generally based on anatomical considerations. Failures of such operations are due to lack of consideration of physiological aspects. Many patients with inguinal hernia are cured as a result of current techniques of operation, though factors that are said to prevent hernia formation are not restored. Therefore, the surgical physiology of inguinal canal needs to be reconsidered. Methods A retrospective study is describer of 200 patients operated on for inguinal hernia under local anaesthesia by the author's technique of inguinal hernia repair. Results The posterior wall of the inguinal canal was weak and without dynamic movement in all patients. Strong aponeurotic extensions were absent in the posterior wall. The muscle arch movement was lost or diminished in all patients. The movement of the muscle arch improved after it was sutured to the upper border of a strip of the external oblique aponeurosis (EOA). The newly formed posterior wall was kept physiologically dynamic by the additional muscle strength provided by external oblique muscle to the weakened muscles of the muscle arch. Conclusions A physiologically dynamic and strong posterior inguinal wall, and the shielding and compression action of the muscles and aponeuroses around the inguinal canal are important factors that prevent hernia formation or hernia recurrence after repair. In addition, the squeezing and plugging action of the cremasteric muscle and binding effect of the strong cremasteric fascia, also play an important role in the prevention of hernia. PMID:12697071

Desarda, Mohan P

2003-01-01

182

Successful repair of a diaphragmatic hernia through a pericardial window with acellular dermal matrix.  

PubMed

A successful placement of a transabdominal pericardial window is associated with diaphragmatic hernia. In this paper, we present the case of a 5-month-old ex-31-weeks-premature baby who developed a symptomatic diaphragmatic hernia following a chronic pericardial effusion who was treated successfully with a laparoscopic transabdominal pericardial window. Laparoscopy and a pericardial window were used to manage the symptomatic effusion that developed following a bilateral thoracotomy and median sternotomy for the patient's massive hygroma. The patient was followed before and after pericardial drainage with a serial examination, chest radiography, and echocardiography. In addition, computerized tomography was also used for long-term follow-up following the repair of the hernia. An acellular dermal matrix was utilized for patching the hernia with a laparotomy. The abdominal approach in both operations offered direct access to the pericardial space and hernia, thereby avoiding previously operated thoraces. A subsequent follow-up at 9 months following the creation of the window suggested a recurrent tamponade physiology. Plain radiographs and an echocardiogram showed herniation into the pericardial sac. The hernia was operatively reduced and repaired with an acellular dermal matrix. Recovery and subsequent followup at 1 year revealed no hernia, full symptom resolution, and no recurrence of the pericardial effusion. A pericardial window is an effective approach for the management of chronic pericardial effusion. Diaphragmatic herniation through a pericardial window can be successfully repaired with an acellular dermal matrix. PMID:17570794

Bruen, Kevin; Downey, Earl

2007-06-01

183

Incarcerated internal hernia within a huge irreducible parastomal hernia with intestinal obstruction: a rare case report of "hernia within hernia"  

PubMed Central

We report an incarcerated internal hernia in a huge irreducible parastomal hernia-"hernia within hernia." A 70-year-old obese woman with diabetes who underwent an abdomino-perineal resection 20 years ago was admitted to our hospital with 20 years history of a huge irreducible bulge, 25 cm in diameter. An internal hernia due to an adhesive band extending from the sac wall to proximal colon was found in the parastomal hernia sac during an emergency laparotomy. We cut off the distal colon and relocated the colostomy stoma. The patient was discharged uneventfully 2 weeks after the surgery and was readmitted to have a further laparoscopic hernia repair 8 months later. Unfortunately, an unrecognized enterotomy occurred during the secondary surgery that led to an additional laparotomy during which the mesh was not contaminated by the bowel contents and was kept in place. At 22-month follow-up, there were no evidences of recurrence. PMID:22977766

Wu, Yu-lian; Wu, Dan

2012-01-01

184

A new technique for laparoscopic hernia repair using fibrin sealant.  

PubMed

The purpose of this study was to evaluate whether an adequate prosthetic mesh fixation in laparoscopic preperitoneal inguinal hernia repair can be achieved with fibrin sealant (FS) (Tisseel trade mark, Hyland/Immuno Div., Baxter Healthcare Corp., Deerfield, IL, USA), and compare it with stapled fixation. The use of staples for prosthetic mesh fixation in laparoscopic preperitoneal hernia repair is associated with a small but significant number of complications, mainly nerve injury and hematomas. An alternative method of fixation should be as efficient as staples in preventing graft migration. An experimental study was conducted using swine models to compare the efficacy of polypropylene mesh fixation with FS to that achieved with staples and to non-fixed mesh grafts in the preperitoneal groin area. Twenty-five female pigs were used in the study. In each pig, a prosthetic mesh was placed laparoscopically in the groin area bilaterally and fixed with either FS, staples, or left without fixation. The pigs were killed after 12 days. The following outcome measures were evaluated: macroscopic findings including graft alignment and motion, tensile strength between the grafts and surrounding tissues, and histologic findings (fibrous reaction and inflammatory response). The procedures were completed laparoscopically in 49 sites. FS was used to fix 18 grafts; 16 with staples, and 15 were not fixed. No significant difference was noted in graft motion between the FS and staple groups. The non-fixed grafts had a median motion of 5 mm (range: 0 to 10 mm), significantly more than the FS fixed (p<0.01) and stapled grafts (p<0.001). No significant difference was noted in median tensile strength between the FS and staples groups (0.955 Kg vs. 1.03 Kg, respectively) compared with 0.46 Kg in the non-fixed group (p<0.01). FS triggered a significantly stronger fibrous reaction and inflammatory response than those observed in the staples and control groups. An adequate mesh fixation in the extraperitoneal inguinal area can be accomplished using FS, based on our experimental evidence. The FS is equivalent to fixation achieved by staples and superior to no fixation. Soft fixation with FS prevents graft migration and avoids complications associated with use of staples. PMID:15455316

Katkhouda, Namir

2004-01-01

185

Suture Versus Tack Fixation of Mesh in Laparoscopic Umbilical Hernia Repair  

PubMed Central

Background and Objectives: Mesh fixation in laparoscopic umbilical hernia repair is poorly studied. We compared postoperative outcomes of laparoscopic umbilical hernia repair in suture versus tack mesh fixation. Methods: Patients who underwent laparoscopic umbilical hernia repair were separated by method of mesh fixation: sutures versus primarily tacks. Medical history and follow-up data were collected through medical records. The primary outcome of this study was the recurrence rates of hernias. Postoperative major and minor complications, such as surgical site infection, small-bowel obstruction, and seroma formation, were regarded as secondary outcomes. Additionally, a telephone interview was conducted to assess postoperative pain, recovery time, and overall patient satisfaction. Results: Eighty-six patients were identified: 33 in the suture group and 53 in the tacks group. The number of emergent cases was increased in the tacks group (6 vs 0; P = .022). Mean follow-up time was 2.7 years for both groups. Documented postoperative follow-up was obtained in 29 (90%) suture group and 31 (58%) tacks group patients. Hernia recurrence occurred in 3 and 2 patients in the sutures and tacks groups, respectively (P was not significant). No differences were found in secondary outcomes, including subjective outcomes from telephone interviews, between groups. Conclusions: There are no differences in postoperative complication rates in suture versus tack mesh fixation in laparoscopic umbilical hernia repair. PMID:24398197

Kitamura, Riley K.; Choi, Jacqueline; Lynn, Elizabeth

2013-01-01

186

Outcomes of the open mesh repair of large incisional hernias using an intraperitoneal composite mesh: our experience with 100 cases  

Microsoft Academic Search

Incisional hernia repair sometimes requires intraperitoneal implantation of a mesh. This becomes necessary when the hernia\\u000a opening is large, in particular, in patients with a low abdominal wall surface\\/wall defect surface (AWS\\/WDS) ratio, in large\\u000a boundary incisional hernias where the proximity to bone structures or cartilage often complicates retromuscular mesh implantation\\u000a and in multi-recurrent incisional hernias that are sometimes characterised

Carmine AmmaturoUberto; Uberto Andrea Bassi; Gaspare Bassi

2010-01-01

187

A questionnaire study on the surgeons' preferences for inguinal hernia repair after a decade.  

PubMed

During the 20th century, hernia repair trend changed several times. A very interesting competition has been going on between the opponents of Lichtenstein and laparoscopic repairs. We recently questioned the same issue by the same method to see if laparoscopic hernia repair found more opponents and preference rate in surgeons and physicians in Ankara, Turkey. In general 88.9% of the respondents preferred open repair, while only 11.1% chose laparoscopy. The majority of the participants who preferred an open repair stated that it was a better known technique to choice. Almost half considered local anaesthesia an advantage. Laparoscopic repair was mainly preferred for its advantages of less pain and early return to work. When three consecutive surveys among the same population in Ankara in 1997, 2001 and 2007 were compared the laparoscopic repair preference rates did not show a statistical difference (9.1%, 16.1% and 11.1% respectively). PMID:19889278

Genc, Volkan; Ensari, Cemal; Kulacoglu, Hakan; Ersoy, Eren; Ergul, Zafer

2009-11-01

188

Trends in the utilization of inguinal hernia repair techniques: a population-based study  

PubMed Central

Background The use of inguinal hernia repair techniques in the community setting is poorly understood. Methods A retrospective review of all inguinal hernia repairs performed on adult residents of Olmsted County, MN, from 1989 to 2008 was performed through the Rochester Epidemiology Project. Results A total of 4,433 inguinal hernia repairs among 3,489 individuals were reviewed. Non–mesh-based repairs predominated in the late 1980s (94% in 1989), declined throughout the 1990s (40% in 1996), and are rarely used nowadays (4% in 2008). Open mesh-based repairs comprised 21% in 1990, peaked in 2001 with 72%, and declined to 55% in 2008. The adoption of laparoscopic repairs began in 1992 (6%) and has increased steadily to 41% in 2008 (P < .001). Conclusions Although non–mesh-based repairs, once the predominant method, have been supplanted by open mesh-based techniques, nowadays the use of laparoscopic inguinal hernia repair techniques has increased substantially to nearly equal that of open mesh-based techniques. PMID:22221993

Zendejas, Benjamin; Ramirez, Tatiana; Jones, Trahern; Kuchena, Admire; Martinez, Jaime; Ali, Shahzad M.; Lohse, Christine M.; Farley, David R.

2013-01-01

189

A Randomized Comparison of the Early Outcome of Stapled and Unstapled Techniques of Laparoscopic Total Extraperitoneal Inguinal Hernia Repair  

PubMed Central

Objective: The need for stapling is a relative drawback of laparoscopic hernia repairs because it adds to the complications and costs. The safety of unstapled repairs as a viable alternative lacks validation, due to the dearth of analogous comparative trials. Methods: Patients were randomized to undergo either stapled or unstapled total extraperitoneal hernia repairs. The groups were matched for age and the type of hernia repaired. Pain scores, intraoperative complications, postoperative complications, postoperative recovery, and long-term outcomes (ie, groin pain, paraesthesias, testicular atrophy, and recurrence) were studied. Results: The incidence of complications, pain scores, pain trends, hospital stay, return to activity, and long-term outcomes were comparable. No recurrence has been noted at a median follow-up of 23 months in 63 hernias repaired in 49 patients. Conclusion: Unstapled laparoscopic hernia repair scores are equivalent to their stapled counterparts with respect to recurrence and complications. PMID:16381354

Kumar, Rakesh; Hazrah, Priya; Bal, Sabyasachi

2005-01-01

190

Fiber-reinforced dermis graft for ventral hernia repair.  

PubMed

Ventral hernia repair (VHR) continues to be a challenge for surgeons. Poor long-term durability of the commonly-used human acellular dermal matrix (HADM) grafts often results in VHR failure and reherniation. We hypothesized that fiber-reinforcement will improve the mechanical properties of HADM grafts and maintain these properties after enzymatic degradation. We designed a reinforced HADM (r-HADM) graft comprised of HADM and a small amount (~10wt% or 56g/m(2)) of 2-0 monofilament polypropylene. We evaluated the failure and fatigue biomechanics of r-HADM grafts and HADM controls, before and after 8h of in vitro enzymatic degradation, in ball-burst and planar biaxial testing modes (n=6-11/group/test). Fiber-reinforcement improved time-zero failure properties of HADM. While enzymatic degradation resulted in a significant reduction in nearly all mechanical properties and frequent premature failure of HADM, key sub-failure parameters and cyclic dilatational strain were maintained in r-HADM, with no sample having premature failure. These data show that fiber-reinforcement improves biomechanical properties and imparts mechanical durability to r-HADM during enzymatic degradation. Our findings suggest that fiber-reinforcement may be a strategy to mitigate the loss of HADM graft mechanical properties after in vivo implantation, and thereby limit VHR bulging and improve outcomes. PMID:24704969

Sahoo, Sambit; DeLozier, Katherine R; Dumm, Rochelle A; Rosen, Michael J; Derwin, Kathleen A

2014-06-01

191

Laparoscopic repair of obturator bladder hernia: a case report and review of the literature.  

PubMed

Hernias through the obturator foramen are rare and are difficult to diagnose. They usually appear in elderly women, have an atypical presentation, and are associated with high mortality. The most frequently compromised organ is the small bowel. Hernias that involve the small bowel are often associated with intestinal obstruction and secondary necrosis. Several techniques and approaches have been described for management. We present a case of bladder hernia through the obturator foramen that we repaired laparoscopically by placing a mesh plug, a management option we find safe, fast, and effective. PMID:18211207

Velásquez-López, Juan G; Gil, Federico Gaviria; Jaramillo, Federico Escobar

2008-02-01

192

Testicular fate after incarcerated hernia repair and\\/or orchiopexy performed in patients under 6 months of age  

Microsoft Academic Search

This study assessed testicular viability after 476 inguinal procedures performed in 338 infants under 6 months of age, between 1974 and 1993. One hundred twenty-one elective hernia repairs (contralateral explorations) were compared with 355 hernia repairs complicated by incarceration and\\/or orchiopexy. Clinical examination of 323 testes in the early postoperative period showed 20 atrophic testes. Since January 1994, 71 of

L. Walc; J. Bass; S. Rubin; M. Walton

1995-01-01

193

Self-gripping Covidien™ ProGrip™ mesh versus polypropylene mesh in open inguinal hernia repair: multicenter short term results.  

PubMed

The purpose of this study was to compare clinical outcomes following sutureless ProGrip™ mesh repair to traditional Lichtenstein repair with polypropylene mesh secured with sutures. Data were collected prospectively and were analyzed for 57 male and 3 female patients with 60 inguinal hernias. All patients included underwent open surgical repair for inguinal hernia with polypropylene mesh or ProGrip mesh. In our two centres study sixty patients were operated; 30 were treated with Lichtenstein repair with polypropylene mesh (L group) and 30 with ProGrip mesh (P group) with or without fixation. The primary parameter measured was intensity of postoperative pain using visual analogue scale (VAS); other outcomes included assessment of early and late complication. VAS was assessed in 7 days and 4 months of the postoperative period. Our results show that VAS scored at the 7th postoperative day was 1.5 for the ProGrip mesh versus 4.4 in Lichtenstein repair group. The difference between groups was statistically significant (P=0.001). Surgery duration was significantly shorter in the P group (24.9 vs. 58.3 min; P=0.001). No recurrence was observed at 3 months in both groups. The 3-months follow-up has shown that time necessary to return to daily routine activity was significantly lower in the P group during the (P=0.001). Surgery duration, early and late postoperative, pain and return to daily routine activity rates were significantly reduced with self-gripping ProGrip mesh compared to Lichtenstein repair with polypropylene mesh. PMID:24485340

Yilmaz, A; Yener, O; Kaynak, B; Yi?itba?i, R; Demir, M; Burcu, B; Aksoy, F

2013-01-01

194

Experience with 300 laparoscopic inguinal hernia repairs with up to 3 years follow-up.  

PubMed Central

The long-term results of 300 laparoscopic inguinal hernia repairs are reported with 11 cases followed up more than 3 years, 104 cases more than 2 years, and 225 cases more than 1 year. There were five early failures owing to the use of too small a piece of mesh. There have been no long-term recurrences. The results indicate that transabdominal preperitoneal laparoscopic mesh repair of hernias is a satisfactory technique with a low recurrence rate and a low major complication rate (4%). Patients have found the procedure to be remarkably pain free and 51% have taken no analgesics after discharge from hospital. Of the patients, 78% returned to work within 2 weeks of the operation. These results suggest that laparoscopic hernia repair can be performed safely with excellent long-term results. PMID:8540657

Davies, N. M.; Dunn, D. C.; Appleton, B.; Bevington, E.

1995-01-01

195

Pain and convalescence following laparoscopic ventral hernia repair.  

PubMed

Severe pain is usual after laparoscopic ventral hernia repair (LVHR). Mesh fixation with titanium tacks may play a key role in the development of acute and chronic pain and alternative fixation methods should therefore be investigated. This PhD thesis was based on three studies and aimed too: 1) assess the intensity and impact of postoperative pain by detailed patient-reported description of pain and convalescence after LVHR (Study I), 2) evaluate the feasibility of fibrin sealant (FS) for mesh fixation in an experimental pig model (Study II), and 3) investigate FS vs. tacks for mesh fixation in LVHR in a randomised, double-blinded, clinical controlled study with acute postoperative pain as the primary outcome (Study III). In Study I - a prospective descriptive study - 35 patients were prospectively included and underwent LVHR. Scores of pain, quality of life, convalescence, fatigue, and general well-being were obtained from each patient. Follow-up was six months. Average pain from postoperative day (POD) 0-2 and POD 0-6 measured on a 0-100 mm visual analogue scale (VAS) was 61 and 48, respectively. Pain scores reached preoperative values at POD 30. The incidence of severe chronic pain was 7%. No parameter predicted postoperative pain significantly. Significant correlations were found between pain, and general well-being (rS= -0.8, p < 0.001), satisfaction (rS= -0.67, p < quality of life score (rS= -0.63, p < 0.001) six months postoperatively. Patients resumed normal daily activity at POD 14. In Study II - a randomised experimental study in pigs - nine pigs were operated laparoscopically with insertion of two different meshes fixed with either FS or tacks. All pigs were euthanized on POD 30. The primary outcome parameter was strength of ingrowth between the mesh and the anterior abdominal wall. A mechanical peel test was performed for each tissue sample. The secondary outcome parameters were grade and strength of adhesions to the mesh, shrinkage and displacement/folding of the mesh and histological parameters. All nine pigs survived without complications until sacrifice. No meshes were displaced from their initial position at autopsy, but in two cases mesh folding was observed. No significant difference in strength of ingrowth was found between different fixation methods or mesh types. Furthermore, no significant difference was found in grade or strength of adhesions or any histological parameters. In Study III - a randomised, controlled, double-blinded, multicenter trial - 40 patients with umbilical hernia defects between 1.5-5 cm, were randomly assigned to receive FS or titanium tacks for mesh fixation in LVHR. Patients, care givers and those assessing the outcomes were blinded to group assignment. The primary outcome was average pain from POD 0-2 (VAS score). Secondary outcome parameters were fatigue, general well-being and time to resume normal daily activity. Follow-up was one month for all. Patients in the FS group reported significantly less pain at POD 0-2 (median VAS 38 (range 6-98) vs. 60 (18-96), p = 0.01). Absolute VAS score difference between groups was 20 mm (95% CI 4-35 mm) at activity, and 19 mm (95% CI 3-34 mm) at rest. Patients in the FS group reported significantly less discomfort from POD 0-2 and POD 0-10, compared with the tack group. No significant difference was found in fatigue score between groups. No significant difference in hospital stay, hernia diameter, or morphine consumption in the post anesthesia care unit was found between groups. Patients in the FS group resumed normal daily activity at POD 7 (1-66) versus POD 18 (1-95) in the tack group (p = 0.03). No recurrences were observed. No adverse events or side effects were observed. No significant differences in predefined complications were found between groups. In conclusion, pain is a significant clinical problem after LVHR with impact on general well-being, quality of life and patient satisfaction. This issue must have first priority in future ventral hernia repair research. It is now documented, that the simple application of fi

Eriksen, Jens Ravn

2011-12-01

196

Porcine incisional hernia model: Evaluation of biologically derived intact extracellular matrix repairs.  

PubMed

We compared fascial wounds repaired with non-cross-linked intact porcine-derived acellular dermal matrix versus primary closure in a large-animal hernia model. Incisional hernias were created in Yucatan pigs and repaired after 3 weeks via open technique with suture-only primary closure or intraperitoneally placed porcine-derived acellular dermal matrix. Progressive changes in mechanical and biological properties of porcine-derived acellular dermal matrix and repair sites were assessed. Porcine-derived acellular dermal matrix-repaired hernias of additional animals were evaluated 2 and 4 weeks post incision to assess porcine-derived acellular dermal matrix regenerative potential and biomechanical changes. Hernias repaired with primary closure showed substantially more scarring and bone hyperplasia along the incision line. Mechanical remodeling of porcine-derived acellular dermal matrix was noted over time. Porcine-derived acellular dermal matrix elastic modulus and ultimate tensile stress were similar to fascia at 6 weeks. The biology of porcine-derived acellular dermal matrix-reinforced animals was more similar to native abdominal wall versus that with primary closure. In this study, porcine-derived acellular dermal matrix-reinforced repairs provided more complete wound healing response compared with primary closure. PMID:24555008

Monteiro, Gary A; Delossantos, Aubrey I; Rodriguez, Neil L; Patel, Paarun; Franz, Michael G; Wagner, Christopher T

2013-01-01

197

Unusual cause of pneumomediastinum in a laparoscopic extraperitoneal inguinal hernia repair.  

PubMed

Pneumomediastinum is an extremely rare complication after laparoscopic inguinal hernia repair. Very few cases have been reported in the surgical literature to date and most reports indicate pneumoperitoneum from the transabdominal preperitoneal approach as a causative factor. This case report describes a patient in whom an elective total extraperitoneal inguinal hernia repair was complicated by a pneumomediastinum without concomitant pneumoperitoneum, and identifies the tracking of air along the anterior extraperitoneal space and endothoracic fascia as a cause. Previous case reports were reviewed and possible etiologies are discussed. PMID:25348336

Teng, Tze Yeong; Lau, Cheryl Chien-Li

2014-01-01

198

A novel approach for salvaging infected prosthetic mesh after ventral hernia repair  

Microsoft Academic Search

Background  Salvaging infected prosthetic material after ventral hernia repair 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 hernia repair. One patient with a remote history of methicillin-resistant

J. A. Trunzo; J. L. Ponsky; J. Jin; C. P. Williams; M. J. Rosen

2009-01-01

199

Clinical predictors of operative complexity in laparoscopic ventral hernia repair: a prospective study  

Microsoft Academic Search

Background  Because of uncertainties about the complexity of laparoscopic ventral hernia repair for varying patient populations, surgeons\\u000a may be reluctant to perform this procedure. This study aimed to delineate the risk factors that can be identified in the preoperative\\u000a setting predictive of longer operative times and complexity in laparoscopic ventral hernia repair.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Patient demographics including body mass index (BMI), comorbidities, previous

Eric D. JenkinsVictoria; Victoria H. Yom; Lora Melman; Richard A. Pierce; Richard B. Schuessler; Margaret M. Frisella; J. Christopher Eagon; L. Michael Brunt; Brent D. Matthews

2010-01-01

200

Unusual cause of pneumomediastinum in a laparoscopic extraperitoneal inguinal hernia repair  

PubMed Central

Pneumomediastinum is an extremely rare complication after laparoscopic inguinal hernia repair. Very few cases have been reported in the surgical literature to date and most reports indicate pneumoperitoneum from the transabdominal preperitoneal approach as a causative factor. This case report describes a patient in whom an elective total extraperitoneal inguinal hernia repair was complicated by a pneumomediastinum without concomitant pneumoperitoneum, and identifies the tracking of air along the anterior extraperitoneal space and endothoracic fascia as a cause. Previous case reports were reviewed and possible etiologies are discussed. PMID:25348336

Teng, Tze Yeong; Lau, Cheryl Chien-Li

2014-01-01

201

Evolution of hernia repair: a salute to Professor Piero Pietri  

Microsoft Academic Search

.   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 \\

L. Nyhus

2001-01-01

202

The preperitoneal approach and prosthetic buttress repair for recurrent hernia. The evolution of a technique.  

PubMed

Repair of recurrent groin hernias is associated with a high incidence of repeat recurrences (2-19%). Reported herein is a 10-year experience of the management of recurrent groin hernias through the use of the preperitoneal approach with the addition of a reinforcing prosthetic mesh buttress. Two hundred and three recurrent groin hernias in 195 patients (192 men, three women) were treated between July 1975 and October 1986. The preperitoneal approach to the inguinal region was performed under regional anesthesia to define the nature of the recurrent hernia. Initial experience in a randomized trial between the use of local endogenous tissue repair versus endogenous repair with a prosthetic polypropylene mesh buttress demonstrated superiority of the latter in reducing repeat recurrences of anatomically defined direct or combined recurrent hernias. Pure indirect and femoral recurrences did not mandate mesh reinforcement. Long-term follow-up was available for 115 hernias (56%) in 102 patients (52.3%) over a period of 6 months to 10 years. Eight patients had repeat recurrences a mean of 30 +/- 22 months after repair. Six recurrences (four direct, two indirect) occurred in an early experience, when no mesh was used. Two recurrences (one indirect and one lateral to the mesh) representing 1% of all hernias (1.7% of those followed-up) have occurred after routine use of the mesh buttress, with the last re-recurrence seen in December 1982. Three ventral hernias (1.5%) occurred at the wound of entry, but none have occurred since placement of the mesh was modified to cover this wound. There were five (2.5%) wound infections and one (0.5%) hydrocele with no re-recurrences. It is concluded that the preperitoneal approach to recurrent groin hernias, together with the appropriate use of a reinforcing mesh buttress, is safe, allows anatomic definition of the hernial defect, and is followed by few repeated recurrences. The evolution of this approach during the last 10 years has made it the procedure of choice for the management of all recurrent groin hernias at the University of Illinois College of Medicine. PMID:3196094

Nyhus, L M; Pollak, R; Bombeck, C T; Donahue, P E

1988-12-01

203

The preperitoneal approach and prosthetic buttress repair for recurrent hernia. The evolution of a technique.  

PubMed Central

Repair of recurrent groin hernias is associated with a high incidence of repeat recurrences (2-19%). Reported herein is a 10-year experience of the management of recurrent groin hernias through the use of the preperitoneal approach with the addition of a reinforcing prosthetic mesh buttress. Two hundred and three recurrent groin hernias in 195 patients (192 men, three women) were treated between July 1975 and October 1986. The preperitoneal approach to the inguinal region was performed under regional anesthesia to define the nature of the recurrent hernia. Initial experience in a randomized trial between the use of local endogenous tissue repair versus endogenous repair with a prosthetic polypropylene mesh buttress demonstrated superiority of the latter in reducing repeat recurrences of anatomically defined direct or combined recurrent hernias. Pure indirect and femoral recurrences did not mandate mesh reinforcement. Long-term follow-up was available for 115 hernias (56%) in 102 patients (52.3%) over a period of 6 months to 10 years. Eight patients had repeat recurrences a mean of 30 +/- 22 months after repair. Six recurrences (four direct, two indirect) occurred in an early experience, when no mesh was used. Two recurrences (one indirect and one lateral to the mesh) representing 1% of all hernias (1.7% of those followed-up) have occurred after routine use of the mesh buttress, with the last re-recurrence seen in December 1982. Three ventral hernias (1.5%) occurred at the wound of entry, but none have occurred since placement of the mesh was modified to cover this wound. There were five (2.5%) wound infections and one (0.5%) hydrocele with no re-recurrences. It is concluded that the preperitoneal approach to recurrent groin hernias, together with the appropriate use of a reinforcing mesh buttress, is safe, allows anatomic definition of the hernial defect, and is followed by few repeated recurrences. The evolution of this approach during the last 10 years has made it the procedure of choice for the management of all recurrent groin hernias at the University of Illinois College of Medicine. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. PMID:3196094

Nyhus, L M; Pollak, R; Bombeck, C T; Donahue, P E

1988-01-01

204

Giant inguinoscrotal hernia repaired by lichtensteins technique without loss of domain -a case report.  

PubMed

Giant inguinal hernia is a formidable surgical problem. It is defined as inguinal hernia extending up to mid thigh or below in standing position. Giant inguinal hernia is usually associated with compromised quality of life due to sexual discomfort and constant weight bearing. It is a challenge for the operating surgeon since it is rare. It may require multistage repair with recurrence being common. A 45-year-old male patient presented with Giant inguinal hernia and compromised quality of life due to pain and sexual discomfort. Lichtenstein's polypropylene mesh repair was done after reducing the sac contents (omentum and transverse colon) with partial omentectomy. There was no loss of intra-abdominal domain. Postoperative period was uneventful. In literature many techniques are available to increase the intra-abdominal cavity (a) Creating progressive preoperative pneumoperitoneum (b) Creation of ventral wall defect (c) surgical debulking of hernia contents. Recurrence is prevented by reconstruction of the abdominal wall using Marlex mesh and a Tensor fasciae lata flap. Laparoscopic repair is associated with more recurrence. Lichtenstein's technique is one of the preferred treatments. PMID:25386483

Hn, Dinesh; Kumar Cd, Jagadish; N, Shreyas

2014-09-01

205

Giant Inguinoscrotal Hernia Repaired by Lichtensteins Technique Without Loss of Domain -A Case Report  

PubMed Central

Giant inguinal hernia is a formidable surgical problem. It is defined as inguinal hernia extending up to mid thigh or below in standing position. Giant inguinal hernia is usually associated with compromised quality of life due to sexual discomfort and constant weight bearing. It is a challenge for the operating surgeon since it is rare. It may require multistage repair with recurrence being common. A 45-year-old male patient presented with Giant inguinal hernia and compromised quality of life due to pain and sexual discomfort. Lichtenstein’s polypropylene mesh repair was done after reducing the sac contents (omentum and transverse colon) with partial omentectomy. There was no loss of intra-abdominal domain. Postoperative period was uneventful. In literature many techniques are available to increase the intra-abdominal cavity (a) Creating progressive preoperative pneumoperitoneum (b) Creation of ventral wall defect (c) surgical debulking of hernia contents. Recurrence is prevented by reconstruction of the abdominal wall using Marlex mesh and a Tensor fasciae lata flap. Laparoscopic repair is associated with more recurrence. Lichtenstein’s technique is one of the preferred treatments. PMID:25386483

HN, Dinesh; N, Shreyas

2014-01-01

206

Integrating a novel shape memory polymer into surgical meshes to improve device performance during laparoscopic hernia surgery  

NASA Astrophysics Data System (ADS)

About 600,000 hernia repair surgeries are performed each year. The use of laparoscopic minimally invasive techniques has become increasingly popular in these operations. Use of surgical mesh in hernia repair has shown lower recurrence rates compared to other repair methods. However in many procedures, placement of surgical mesh can be challenging and even complicate the procedure, potentially leading to lengthy operating times. Various techniques have been attempted to improve mesh placement, including use of specialized systems to orient the mesh into a specific shape, with limited success and acceptance. In this work, a programmed novel Shape Memory Polymer (SMP) was integrated into commercially available polyester surgical meshes to add automatic unrolling and tissue conforming functionalities, while preserving the intrinsic structural properties of the original surgical mesh. Tensile testing and Dynamic Mechanical Analysis was performed on four different SMP formulas to identify appropriate mechanical properties for surgical mesh integration. In vitro testing involved monitoring the time required for a modified surgical mesh to deploy in a 37°C water bath. An acute porcine model was used to test the in vivo unrolling of SMP integrated surgical meshes. The SMP-integrated surgical meshes produced an automated, temperature activated, controlled deployment of surgical mesh on the order of several seconds, via laparoscopy in the animal model. A 30 day chronic rat model was used to test initial in vivo subcutaneous biocompatibility. To produce large more clinical relevant sizes of mesh, a mold was developed to facilitate manufacturing of SMP-integrated surgical mesh. The mold is capable of manufacturing mesh up to 361 cm2, which is believed to accommodate the majority of clinical cases. Results indicate surgical mesh modified with SMP is capable of laparoscopic deployment in vivo, activated by body temperature, and possesses the necessary strength and biocompatibility to function as suitable ventral hernia repair mesh, while offering a reduction in surgical operating time and improving mesh placement characteristics. Future work will include ball-burst tests similar to ASTM D3787-07, direct surgeon feedback studies, and a 30 day chronic porcine model to evaluate the SMP surgical mesh in a realistic hernia repair environment, using laparoscopic techniques for typical ventral hernia repair.

Zimkowski, Michael M.

207

Chronic Pain after Laparoscopic Transabdominal Preperitoneal Hernia Repair: A Randomized Comparison of Light and Extralight Titanized Polypropylene Mesh  

PubMed Central

Background The aim of this prospective, randomized, single-blinded clinical trial was to compare the incidence of chronic pain after laparoscopic transabdominal preperitoneal hernia repair (TAPP) using a 35-g/m2 titanized polypropylene mesh and a 16-g/m2 titanized polypropylene mesh. The reported incidence of chronic pain in patients who underwent laparoscopic hernia repair is a serious problem. The techniques of dissection, mesh fixation, and the mesh material used have all been identified as being part of the problem. Excellent biocompatibility through a unique combination of a lightweight open porous polypropylene mesh covered with a covalent-bonded titanium layer has been claimed. The aim of this study was to find out whether the titanium surface alone or the difference in material load between the two available meshes influences clinical outcomes. Methods Three hundred eighty patients with 466 inguinal hernias were operated on between 2002 and 2006 with the laparoscopic transabdominal preperitoneal (TAPP) technique. Mesh fixation with staples was carried out routinely. After the dissection was completed just prior to the implantation of the mesh, patients were randomized into two groups. In Group A, 250 (53.6%) inguinal hernias were repaired with a 35-g/m2 titanized polypropylene mesh, and in Group B, 216 (46.4%) inguinal hernias were repaired with a 16-g/m2 titanized polypropylene mesh. The primary outcome was chronic pain 3 years after surgery. The degree of pain was determined using a visual analog scale (VAS) with a range from 0 to 10. The secondary outcome was the rate of recurrence. Results The postoperative period of observation was at least 3 years for every patient. In both groups, 90% of the patients could be questioned and examined clinically: in Group A (Light), 5.3% of the patients and in Group B (Extralight), 1.5% of the patients suffered from chronic pain. Chronic pain was significantly more common in Group A than in Group B (p = 0.037). There was no difference with respect to the rate of recurrence: for Group A it was 3.1% and for Group B it was 2.6% (p = 0.724). Conclusions Chronic pain is not very common in patients who have had their inguinal hernias repaired with titanium-covered polypropylene mesh. Reducing the material load from 35 to 16 g/m2 seems to further improve the biocompatibility of these meshes, thus improving the clinical outcome by reducing chronic pain to a rare event. The role of staples in causing chronic pain following inguinal hernia repair may be overestimated. There was no evidence supporting the notion that the use of the 16-g/m2 titanized meshes is associated with increased recurrence rates. PMID:21103989

von Ahnen, Thomas; von Ahnen, Martin; Schardey, Hans

2010-01-01

208

[Our experience with totally extraperitoneal technique of laparoscopic inguinal hernia repaires modifi ed by Stolzenburg].  

PubMed

Introduction: Two current types of laparoscopic inguinal hernia repair are known: the TransAbdominal PrePeritoneal (TAPP) and the Totally ExtraPeritoneal (TEP) method. The mesh is placed in the preperitoneal space (sublay). Usually during TAPP method we fix the mesh with tacks or staples. In case of TEP fixation it is not necessary because the intraabdominal pressure keeps the implant in position. There is no significant difference between the two methods in terms of recurrence. The advantage of TEP is that the abdominal cavity remains intact, hence reduces the risk of intraabdominal injuries and adhesions. It is unnecessary to use special stapler or tacker. Materials and Methods: Our team performed 50 TEP procedures in male patients with uni- or bilateral inguinal hernias in the period 2011-2013. We prepared the mesh in a special way according to Stolzenburg and placed it to the subfunicular area. We did not apply additional fixation (tacks, stitches) and drainage. Mean hospital stay was 1 day. We allowed complete physical activity 10-12 days after surgery. Results: No recurrence was observed during the 2 years of follow-up. The mean operating time was 70 minutes. We performed conversion in 3 cases (Lichtenstein 2, TAPP 1). In one case there was an injury of the inferior epigastric artery. In two cases we have detected neuralgia in the postoperative period. Conclusions: After the learning curve the TEP method can be used safely with good functional results. The technique of mesh positioning reduces the risk of complications and provides cost-effectiveness. PMID:24873769

Kesser?, Balázs; Kecskédi, Bence; Polányi, Csaba; Réti, András; Saftics, György; Völgyi, Réka; Kovács, Béla; Tenke, Péter; Ender, Ferenc; Vörös, Attila

2014-06-01

209

Laparoscopic mesh repair of inguinal hernia using a preperitoneal approach: a preliminary report.  

PubMed

From October 1990 to December 1991, we performed 61 laparoscopic preperitoneal mesh repairs of inguinal hernias on 52 patients, including 22 direct, 38 indirect, and one femoral hernias. The laparoscopic technique employs the same principles as open preperitoneal mesh repair of replacing and reinforcing attenuated transversalis fascia. After entering the peritoneal cavity through the umbilicus, the preperitoneal space is entered by excising the hernia sac. The preperitoneal space is bluntly dissected and the transversalis fascia exposed. For a direct or recurrent hernia, the defect in the transversalis fascia is closed with a pursestring or running suture without tension. For an indirect hernia, the internal ring is tightened with an interrupted suture. Next a piece of mesh approximately 2.5 x 4.5 inches is trimmed to fit over the internal ring, the testicular vessels, and spermatic cord laterally, Hesselbach's triangle medially, and Cooper's ligament inferiorly, which covers potential sites for a new hernia or recurrence. The mesh (Prolene or Marlex) is then sutured with 3-0 vicryl to the transversalis fascia and transversus abdominis aponeurosis superior-medially, to the iliopubic tract or Cooper's ligament inferiorly, and to the transversalis fascia and transversus abdominis lateral to the internal inguinal ring. Upon completion of the tensionless repair, the peritoneum is reapproximated. Compared with the open procedure, laparoscopic repair reduces postoperative pain and shortens convalescence. No lifting restrictions are imposed on the patient. We have had three minor complications and no recurrences to date, but follow-up is too short to make firm conclusions. PMID:1341501

Arregui, M E; Davis, C J; Yucel, O; Nagan, R F

1992-03-01

210

The Tilburg double blind randomised controlled trial comparing inguinal hernia repair according to Lichtenstein and the transinguinal preperitoneal technique  

PubMed Central

Background Anterior open treatment of the inguinal hernia with a tension free mesh has reduced the incidence of recurrence and direct postoperative pain. The Lichtenstein procedure rules nowadays as reference technique for hernia treatment. Not recurrences but chronic pain is the main postoperative complication in inguinal hernia repair after Lichtenstein's technique. Preliminary experiences with a soft mesh placed in the preperitoneal space showed good results and less chronic pain. Methods The TULIP is a double-blind randomised controlled trial in which 300 patients will be randomly allocated to anterior inguinal hernia repair according to Lichtenstein or the transinguinal preperitoneal technique with soft mesh. All unilateral primary inguinal hernia patients eligible for operation who meet inclusion criteria will be invited to participate in this trial. The primary endpoint will be direct postoperative- and chronic pain. Secondary endpoints are operation time, postoperative complications, hospital stay, costs, return to daily activities (e.g. work) and recurrence. Both groups will be evaluated. Success rate of hernia repair and complications will be measured as safeguard for quality. To demonstrate that inguinal hernia repair according to the transinguinal preperitoneal (TIPP) technique reduces postoperative pain to <10%, with ? = 0,05 and power 80%, a total sample size of 300 patients was calculated. Discussion The TULIP trial is aimed to show a reduction in postoperative chronic pain after anterior hernia repair according to the transinguinal preperitoneal (TIPP) technique, compared to Lichtenstein. In our hypothesis the TIPP technique reduces chronic pain compared to Lichtenstein. Trial registration ISRCTN 93798494 PMID:19781069

Koning, Giel G; de Schipper, Hans JP; Oostvogel, Henk JM; Verhofstad, Michiel HJ; Gerritsen, Pieter G; van Laarhoven, Kees CJHM; Vriens, Patrick WHE

2009-01-01

211

Congenital massive hiatus hernia type IV; initial experience with laparoscopic repair in young infant.  

PubMed

Congenital massive hiatus hernia (CMHH) is an uncommon disorder during childhood. It can be associated with grave complications especially if presented in the highest grade; type IV, when the hernia contains other intra-peritoneal organ beside the stomach through a large hiatus defect. The insidious form of clinical presentation can be deceptive in diagnosis and may mimic congenital diaphragmatic hernia or other chest pathologies. The basic principle of surgical repair is to reduce the herniated organs, excise the hernia sac, and repair the crural defect and to add anti-reflux procedure with or without gastropexy. Traditionally, this has been done by open approach. Nowadays, the minimally invasive approach is the preferred method of treatment. A sixteen-month-old boy with history of recurrent respiratory symptoms was diagnosed with CMHH type IV for which laparoscopic repair was performed. Few reports in using minimally invasive technique in the management of CMHH in the pediatric age group are present in the literature, to the best of our knowledge type IV had never been described in young infants. We present a new case repaired by laparoscope in a young infant with CMHH type IV from the Middle East. PMID:24497129

Bataineh, Z A; Rousan, L A; Abu Baker, A; Wahdow, H; Kiwan, R N; Saleem, M M

2014-06-01

212

Radical Prostatectomy in Patients with Previous Groin Hernia Repair Using Synthetic Nonabsorbable Mesh  

Microsoft Academic Search

Objective: Identification of patients in whom the perineal route is the optimal approach to perform radical prostatectomy. Material and Methods: During 1992–1999, 376 patients with prostate cancer underwent radical perineal prostatectomy. Four patients were identified in whom the perineal approach was indicated because of previous bilateral groin hernia repair using synthetic meshes. In addition, 1 patient underwent perineal prostatectomy elsewhere

Holger Borchers; Bernhard Brehmer; Hein van Poppel; Gerhard Jakse

2001-01-01

213

Patient awareness and symptoms from an incisional hernia.  

PubMed

Abstract Incisional hernia is a common postoperative complication following open abdominal surgery with incidence varying between 3% and 20%. (1) Approximately half of all incisional hernias are diagnosed within 1 year following surgery. In the United Kingdom alone, about 10,000 incisional hernia repairs are performed annually. Incisional hernia repairs are generally elective with emergency repair due to incarceration or strangulation constituting about 15% of repairs. (1) Incisional hernia repair is not a low-risk operation and generally has relatively poor results due to chronic postoperative pain and high recurrence rates. (2 - 3) Little has been published on patients' awareness of incisional hernia following open abdominal surgery. Moreover, there are very few publications on indications for incisional hernia repair and on the natural course of such hernias. The literature suggests that symptoms and complaints usually presented by patients include pain, discomfort, cosmetic complaints, skin problems, incarceration, strangulation, functional disability, and pulmonary dysfunction. (4 - 6) The aim of this study was to investigate whether patients were aware that they had a hernia. In addition, we sought to determine symptoms for those who knew that they had an incisional hernia. PMID:24833146

Ah-Kee, Elliott Yann; Kallachil, Thomas; O'Dwyer, Patrick J

2014-01-01

214

Comparison of the outcomes between laparoscopic totally extraperitoneal repair and prolene hernia system for inguinal hernia; review of one surgeon's experience  

PubMed Central

Purpose To compare the outcomes between laparoscopic total extraperitoneal (TEP) repair and prolene hernia system (PHS) repair for inguinal hernia. Methods A retrospective analysis of 237 patients scheduled for laparoscopic TEP or PHS repair of groin hernia from 2005 to 2009 was performed. Results The mean age was 52.3 years in TEP group and 55.7 years in PHS group. Of 119 TEP cases, 98 were indirect inguinal hernia, 15 direct type, 5 femoral hernia and 1 complex hernia; Of 118 PHS cases, 100 indirect, 18 direct type. All in TEP group were performed under general anesthesia and 64% of PHS group were performed under spinal or epidural anesthesia. Preoperatively, 10 cases of recurrent inguinal hernia were involved in our study (4 in TEP, 6 in PHS group). The mean operative time was similar in both groups (74.8 in TEP, 71.2 in PHS group), however mean hospital stay (1.6 days in TEP, 3.2 days in PHS group, P = 0.018) and mean usage of analgesics (0.54 times in TEP, 2.03 times in PHS group, P < 0.01), complications (36 cases in TEP, 6 cases in PHS group, P < 0.01) showed statistical differences. There is only 1 case of postoperative recurrence inguinal hernia in PHS group but it has no statistical significance (P = 0.314). Conclusion Compared to PHS repair, laparoscopic TEP repair has some advantages; shorter hospital stay, less frequent need of analgesics; as well as more postoperative complications such as hematoma, seroma, scrotal swelling. PMID:22324045

Choi, Yoon Young; Han, Sun Wook; Bae, Sang Ho; Kim, Sung Yong; Hur, Kyung Yul

2012-01-01

215

Regeneration of Abdominal Wall Aponeurosis: New Dimension in Marlex Peritoneal Sandwich Repair of Incisional Hernia  

Microsoft Academic Search

.   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

1999-01-01

216

Ventral hernia repair using allogenic acellular dermal matrix in a swine model  

Microsoft Academic Search

Background This study was designed to assess the long-term efficacy of allogenic acellular dermal matrix (ADM) used as an interpositional graft for ventral hernia repair in a swine model. Methods We created 12×4-cm full-thickness abdominal wall defects in 22 Yucatan miniature pigs. The defect was repaired with either two 6×4-cm pieces of AlloDerm (acellular dermal matrix processed from pig skin

R. P. Silverman; E. N. Li; L. H. Holton; K. T. Sawan; N. H. Goldberg

2004-01-01

217

Sports Hernia Treatment  

PubMed Central

Background: The minimal repair technique for sports hernias repairs only the weak area of the posterior abdominal wall along with decompressing the genitofemoral nerve. This technique has been shown to return athletes to competition rapidly. This study compares the clinical outcomes of the minimal repair technique with the traditional modified Bassini repair. Hypothesis: Athletes undergoing the minimal repair technique for a sports hernia would return to play more rapidly compared with athletes undergoing the traditional modified Bassini repair. Methods: A retrospective study of 28 patients who underwent sports hernia repair at the authors’ institution was performed. Fourteen patients underwent the modified Bassini repair, and a second group of 14 patients underwent the minimal repair technique. The 2 groups were compared with respect to time to return to sport, return to original level of competition, and clinical outcomes. Results: Patients in the minimal repair group returned to sports at a median of 5.6 weeks (range, 4-8 weeks), which was significantly faster compared with the modified Bassini repair group, with a median return of 25.8 weeks (range, 4-112 weeks; P = 0.002). Thirteen of 14 patients in the minimal repair group returned to sports at their previous level, while 9 of 14 patients in the Bassini group were able to return to their previous level of sport (P = 0.01). Two patients in each group had recurrent groin pain. One patient in the minimal repair group underwent revision hernia surgery for recurrent pain, while 1 patient in the Bassini group underwent hip arthroscopy for symptomatic hip pain. Conclusion: The minimal repair technique allows athletes with sports hernias to return to play faster than patients treated with the modified Bassini. PMID:24427419

Economopoulos, Kostas J.; Milewski, Matthew D.; Hanks, John B.; Hart, Joseph M.; Diduch, David R.

2013-01-01

218

[Median incisional hernias and coexisting parastomal hernias : new surgical strategies and an algorithm for simultaneous repair].  

PubMed

The co-occurrence of incisional and parastomal hernias (PSH) remains a surgical challenge. Standardized treatment guidelines are missing, and the patients concerned require an individualized surgical approach. The laparoscopic techniques can be performed with incised and/or stoma-lateralizing flat meshes with intraperitoneal onlay placement. The purely laparoscopic and laparoscopic-assisted approaches with 3-D meshes offer advantages regarding the complete coverage of the edges of the stomal areas and the option of equilateral or contralateral stoma relocation in cases of PSH, which are difficult to handle due to scarring, adhesions, and large fascial defects >?5 cm with intestinal hernia sac contents. A relevant stoma prolapse can be relocated by tunnel-like preformed 3-D meshes and shortening the stoma bowel. The positive effect on prolapse prevention arises from the dome of the 3-D mesh, which is directed toward the abdominal cavity and tightly fits to the bowel. In cases of large incisional hernias (>?8-10 cm in width) or young patients with higher physical demands, an open abdominal wall reconstruction in sublay technique is required. Component separation techniques that enable tension-free ventral fascial closure should be preferred to mesh-supported defect bridging methods. The modified posterior component separation with transversus abdominis release (TAR) and the minimally invasive anterior component separation are superior to the original Ramirez technique with respect to wound morbidity. By using 3-D textile implants, which were specially designed for parastomal hernia prevention, the stoma can be brought out through the lateral abdominal wall without increased risk of parastomal hernia or prolapse development. An algorithm for surgical treatment, in consideration of the complexity of combined hernias, is introduced for the first time. PMID:24823998

Köhler, G

2014-08-01

219

Impact of randomized trials on the application of endoscopic techniques for inguinal hernia repair in the netherlands  

Microsoft Academic Search

Background  One year after publication of a Dutch prospective trial randomizing patients with inguinal hernias to either endoscopic or\\u000a open repair, a questionnaire was sent to all Dutch surgeons to evaluate the impact of this trial on the application of endoscopic\\u000a inguinal hernia repair in the Netherlands.\\u000a \\u000a \\u000a \\u000a Methods  All 780 registered Dutch surgeons were surveyed. The performance of endoscopic inguinal hernia repair,

M. T. T. Knook; L. P. S. Stassen; H. J. Bonjer

2001-01-01

220

Laparoscopic repair of incisional and ventral hernias with the new type of meshes: randomized control trial  

PubMed Central

Introduction Laparoscopic incisional and ventral hernia repair (LIVHR) was first reported by Le Blanc and Booth in 1993. Many studies are available in the literature that have shown that laparoscopic repair of incisional and ventral hernia is preferred over open repair because of lower recurrence rates (less than 10%), less wound morbidity, less pain, and early return to work. Aim To identify the long-term outcomes between the different types of meshes and two techniques of mesh fixation, i.e., tacks (method Double crown) and transfascial polypropylene sutures. Material and methods A total of 92 patients underwent LIVHR at our department between January 2009 and August 2012. The hernias were umbilical in 26 patients, paraumbilical in 15 patients and incisional in 51 patients. All patients admitted for LIVHR were randomized to either group I (tacker fixation of ePTFE meshes) or group II (suture fixation of meshes with nitinol frame) using computer-generated random numbers with block randomization and sealed envelopes for concealed allocation. Results The mean mesh fixation time was significantly higher in the tacker fixation group (117 ±15 min vs. 72 ±6 min, p < 0.01). There were no conversions in either group. The median postoperative hospital stay was 3.5 ±1.5 days. All patients were followed up at 1, 3, 6, 12 and every 6 months thereafter postoperatively. There were 5 recurrences in the study population. In group I there were 4 patients with recurrence, and only 1 patient in the group with meshes with a nitinol frame. Conclusions Meshes of the new generation with a nitinol framework can significantly improve laparoscopic ventral hernia repair. The fixation of these meshes is very simple using 3–4 transfascial sutures. The absence of shrinkage of these meshes makes the probability of recurrence minimal. Absence of tackers allows postoperative pain to be minimized. We consider that these new meshes can significantly improve laparoscopic ventral hernia repair. PMID:25097679

Grubnik, Aleksandra V.; Vorotyntseva, Kseniya O.

2014-01-01

221

Short- and long-term outcomes of incarcerated inguinal hernias repaired by Lichtenstein technique  

PubMed Central

Introduction The use of tension-free inguinal hernia repair techniques using commercially available implants is now rather common. However, it is widely accepted that the use of biomaterials should be limited to non-infected surgical fields. As such, most current studies pertain to the application of various implants during the surgical repair of uncomplicated hernias. Aim To compare the short- and long-term outcomes of incarcerated inguinal hernia repair using the Lichtenstein or Bassini technique. Material and methods Between 1997 and 2012, 107 patients were operated on an emergency basis due to the incarceration of inguinal hernias – 105 subjects were included for further analysis in our study. Results Postoperative complications were observed in 13 out of the 84 (15.5%) patients subjected to Lichtenstein repair. In 9 of these patients (10.7%), morbidity was associated with the surgical wound. In 2 cases (2.4%), a small inflammatory infiltration was observed and resolved within a few days. Serous fluid accumulation within the wound was observed in 3 patients (3.6%), but the fluid was successfully drained by puncture. Finally, hematoma formed in 4 cases (4.8%). In total, 4 complications (19%) were recorded in the group of 21 patients who were operated on with the Bassini technique. In 3 of these cases (14.3%), the complications were related to suppuration of the surgical wound. Conclusions Polypropylene mesh may be safely implanted during the repair of incarcerated hernia and this approach is reflected by satisfactory long-term outcomes. PMID:25097686

Wysocki, Andrzej; Strzalka, Marcin; Budzynski, Piotr

2014-01-01

222

[Anterolateral hernias of the abdomen].  

PubMed

Anterolateral hernias of the abdomen group together umbilical, epigastric, and spigelian hernias and diastasis of the abdominal rectus. In spigelian hernias, 90% are located in the subumbilical region at the Monro line. They are asymptomatic in 90% of cases. The risk of strangulation is 10%-25% and requires surgical treatment. A herniorrhaphy is sufficient if the ring is less than 2 cm in diameter. Beyond 2 cm, open or celioscopic mesh repair is necessary. The risk of recurrence is less than 2%. Umbilical hernias result from progressive enlargement of the umbilical ring. The risk of strangulation is higher than 10%. The morbidity and mortality rate reaches 15% in large strangulated hernias. All umbilical hernias should therefore be treated surgically. If their diameter is under 2 cm, a simple herniorrhaphy can be done; otherwise mesh repair is required. In the cirrhosis patient, hernia treatment is part of the ascites treatment. The indication for surgery depends on liver function. Epigastric hernias are most often symptomatic: 80% have a ring smaller than 25 mm and 20% are multifocal. The risk of strangulation is low. If the ring is less than 20 mm, these hernias can be treated by herniorrhaphy. Recurrence is frequent - more than 10% - and always difficult to treat. Diastasis of the recti does not lead to complication, and treatment is not necessary. Cosmetic surgery can be used to manage diastasis. PMID:18065914

Mathonnet, M; Mehinto, D

2007-01-01

223

Tension-Free Inguinal Hernia Repair: TEP Versus Mesh-Plug Versus Lichtenstein  

PubMed Central

Objective To compare laparoscopic hernioplasty with two open tension-free hernia repairs. Summary Background Data Laparoscopic hernioplasty is associated with a short rehabilitation, but it is a technically difficult procedure. It is unclear if it has advantages over the technically easier open tension-free herniorrhaphy. Methods Two hundred ninety-nine men 30 to 75 years old were randomized to undergo laparoscopic totally extraperitoneal hernioplasty (TEP), open operation with mesh-plug and patch, or Lichtenstein’s operation. Results Two hundred ninety-four (98%) patients were followed for 19.8 ± 8.6 months. Over 90% of the patients in all groups were operated in day surgery; the rest of the patients were all discharged within 24 hours. Postoperative pain (visual analog score) was lower in the patients undergoing TEP than in those undergoing Lichtenstein and mesh-plug procedures. The median sick-leave period was 5 days in the TEP group, 7 days in the mesh-plug group, and 7 days in the Lichtenstein group. The median time to full recovery was significantly shorter in the TEP group compared to the other two groups. There were no major complications. Two recurrences were found in the TEP group and two in the mesh-plug group. Conclusions Laparoscopic hernioplasty is superior to tension-free open herniorrhaphy in terms of postoperative pain and rehabilitation. PMID:12496542

Bringman, Sven; Ramel, Stig; Heikkinen, Timo-Jaakko; Englund, Tord; Westman, Bo; Anderberg, Bo

2003-01-01

224

Impact of the mesh fixation technique on operation time in laparoscopic repair of ventral hernias  

Microsoft Academic Search

Background  Fixation of the prosthesis is one of the critical components of laparoscopic repair of ventral and incisional hernia (LRVIH).\\u000a The impact of the fixation technique used on operative time has never been analyzed. We compared the duration of the operation\\u000a according to the fixation technique used in a series of 138 patients with primary umbilical hernia.\\u000a \\u000a \\u000a \\u000a Methods  All patients underwent a

E. B. Wassenaar; J. T. F. J. Raymakers; S. Rakic

2008-01-01

225

Totally extraperitoneal repair of inguinal hernia: Sir Ganga Ram Hospital technique  

PubMed Central

Laparoscopic approach for hernia has evolved rapidly over the past decade. We adopted the TEP repair early as we believe in preserving the sanctity of the coelomic cavity. Once well versed with the approach we have found it an efficient and cost effective method for groin hernia repair. Endoscopic totally extraperitoneal hernia repair is a technically demanding procedure. Indepth anatomical knowledge, training and advanced technical skill is needed for the surgeon to perform this procedure. To make the procedure cost effective and prevent hernia recurrences, we have modified and innovated to simplify the procedure. This modification which we have named the SGRH technique, innovates by creating the preperitoneal working space with the help of an indigenous glove finger balloon. A rolled mesh makes placement and fixation easier in the limited working space. The mesh is unrolled on the peritoneal surface (floor), a manouver which is technically simpler. On desufflation the mesh comes to appose the Fruchad's orifice covering all potential hernial sites. With the modified SGRH technique we have found TEP to be safe, cost effective, reproducible and without significant complications. PMID:21187989

Chowbey, Pradeep K; Khullar, Rajesh; Sharma, Anil; Soni, Vandana; Baijal, Manish

2006-01-01

226

Laparoscopic mesh repair of a Morgagni hernia using the double-crown technique: A case study.  

PubMed

We report a case of Morgagni hernia in which the patient underwent laparoscopic mesh repair. A 65-year-old woman presented with an abnormal shadow in the right lower lung field on a routine medical checkup. CT showed that the transverse colon passed between the liver and abdominal wall, and herniated into the thoracic cavity. Simple closure was precluded by the large hernial orifice. We therefore performed laparoscopic repair using a Parietex Optimized Composite Mesh. The double-crown technique was used to fix the margin of the mesh to the region around the hernial orifice. Our procedure for repair of a Morgagni hernia with a large hernial orifice is safe and minimally invasive, and it may effectively prevent recurrence. PMID:25354379

Kaida, Takeshi; Ikeda, Atsushi; Shimoda, Hirofumi; Sako, Hiroyuki; Uchida, Hiroshi; Wada, Masahiro; Ikeda, Ken; Okusawa, Seijiro; Watanabe, Masahiko

2014-11-01

227

[The history of treatment of groin hernia].  

PubMed

Hernia (Greek kele/hernios--bud or offshoot) was present in the human history from its very beginning. The role of surgery was restricted to the treatment of huge umbilical and groin hernias and life-threatening incarcerated hernias. The treatment of groin hernia can be divided into five eras. The oldest epoch was ancient era from ancient Egypt to 15th century. The Egyptian Papirus of Ebers contains description of a hernia: swelling that comes out during coughing. Most essential knowledge concerning hernias in ancient times derives from Galen. This knowledge with minor modifications was valid during Middle Ages and eventually in the Renaissance the second era of hernia treatment began. Herniology flourished mainly due to many anatomical discoveries. In spite of many important discoveries from 18th to 19th century the treatment results were still unsatisfactory. Astley Coooper stated that no disease treated surgically involves from surgeon so broad knowledge and skills as hernia and its many variants. Introduction of anesthesia and antiseptic procedures constituted the beginning of modern hernia surgery known as era of hernia repair under tension (19th to middle 20th century). Three substantial rules were introduced to hernia repair technique: antiseptic and aseptic procedures. high ligation of hernia sac and narrowing of the internal inguinal ring. In spite of the progress the treatment results were poor. Recurrence rate during four years was ca. 100% and postoperative mortality gained even 7%. The treatment results were satisfactory after new surgical technique described by Bassini was implemented. Bassini introduced the next rule of hernia repair ie. reconstruction of the posterior wall of inguinal canal. The next landmark in inguinal hernia surgery was the method described by Canadian surgeon E. Shouldice. He proposed imbrication of the transverse fascia and strengthening of the posterior wall of inguinal canal by four layers of fasciae and aponeuroses of oblique muscles. These modifications decreased recurrence rate to 3%. The next epoch in the history of hernia surgery lasting to present days is referred to as era of tensionless hernia repair. The tension of sutured layers was reduced by incisions of the rectal abdominal muscle sheath or using of foreign materials. The turning point in hernia surgery was discovery of synthetic polymers by Carothers in 1935. The first tensionless technique described by Lichtenstein was based on strengthening of the posterior wall of inguinal canal with prosthetic material. Lichtenstein published the data on 1,000 operations with Marlex mesh without any recurrence in 5 years after surgery. Thus fifth rule of groin hernia repair was introduces--tensionless repair. Another treatment method was popularized by Rene Stoppa, who used Dacron mesh situated in preperitoneal space without fixing sutures. Fist such operation was performed in 1975, and reported recurrence rates were quite low (1.4%). The next type of repair procedure was sticking of a synthetic plug into inguinal canal. Lichtenstein in 1968 used Marlex mesh plug (in shape of a cigarette) in the treatment of inguinal and femoral hernias. The mesh was fixated with single sutures. The next step was introduction of a Prolene Hernia System which enabled repair of the tissue defect in three spaces: preperitoneal, above transverse fascia and inside inguinal canal. Laproscopic treatment of groin hernias began in 20th century. The first laparoscopic procedure was performed by P. Fletcher in 1979. In 1990 Schultz plugged inguinal canal with polypropylene mesh. Later such methods like TAPP and TEP were introduced. The disadvantages of laparoscopic approach were: high cost and risk connected with general anesthesia. In conclusion it may be stated that history of groin hernia repair evolved from life-saving procedures in case of incarcerated hernias to elective operations performed within the limits of 1 day surgery. PMID:19140492

Legutko, Janusz; Pach, Rados?aw; Solecki, Rafa?; Matyja, Andrzej; Kulig, Jan

2008-01-01

228

Hernia survey of the Section on Surgery of the American Academy of Pediatrics  

Microsoft Academic Search

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

1996-01-01

229

Randomized Prospective Study of Totally Extraperitoneal Inguinal Hernia Repair: Fixation Versus No Fixation of Mesh  

PubMed Central

Background: Fixation of the mesh during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase postoperative pain and lead to an increased risk of complications. We questioned whether elimination of fixation of the mesh during TEP inguinal hernia repair leads to decreased postoperative pain or complications, or both, without an increased rate of recurrence. Methods: A randomized prospective single-blinded study was carried out in 40 patients who underwent laparoscopic TEP inguinal hernia repair with (Group A=20) or without (Group B=20) fixation of the mesh. Results: Patients in whom the mesh was not fixed had shorter hospital length of stay (8.3 vs 16.0 hours, P=0.01), were less likely to be admitted to the hospital (P=0.001), used less postoperative narcotic analgesia in the PACU (P=0.01), and were less likely to develop urinary retention (P=0.04). No significant differences occurred in the level of pain, time to return to normal activity, or the difficulty of the operation between the 2 groups. No hernia recurrences were observed in either group (follow-up range, 6 to 30 months, median=19). Conclusions: Elimination of tack fixation of mesh during laparoscopic TEP inguinal hernia repair significantly reduces the use of postoperative narcotic analgesia, hospital length of stay, and the development of postoperative urinary retention but does not lead to a significant reduction in postoperative pain. Eliminating tacks does not lead to an increased rate of recurrence. PMID:17575757

Koch, Cody A.; Greenlee, Susan M.; Larson, Dirk R.; Harrington, Jeffrey R.

2006-01-01

230

Recurrences in Laparoscopic Incisional Hernia Repairs: A Personal Series and Review of the Literature  

PubMed Central

Objective: Laparoscopic repair of incisional ventral hernias with ePTFE mesh continues to evolve, with variable reporting of surgical techniques and outcomes. This report of 34 cases discusses, with a literature review of laparoscopic incisional hernia repair, specific factors associated with three recurrences. Methods: Retrospective analysis and review of the literature. Results: Thirty-two patients (16 female, 16 male), under-went 34 laparoscopic repairs: average age–54 years (27-80), average weight–207 lbs (100-300). Nineteen patients (62%) were undergoing first time repairs, 38% were redo cases and 5 cases (14%) involved previous mesh. Operating times averaged 101 minutes (45-220), and average length of stay was 1.9 days (0.6 days excluding 5 patients who required readmission), with 13 patients (38%) being discharged same-day. Two patients developed cellulitis (6%) treated without patch removal. Two enterotomies occurred (6%) both requiring patch removal. Five patients required readmission (14%), and one patient died postoperative day 29 secondary to end-stage liver disease. Three recurrences developed (9%): one secondary to missed enterotomy with reoperation, patch removal and hernia recurrence; one due to omission of suspension suture fixation; and one recurrence developed in a section of the intact old previous incision that extended beyond the original patch. Follow up has averaged 20 months (4-36). Conclusions: The laparoscopic repair of ventral and incisional hernias utilizing transabdominal placement of ePTFE patch can achieve excellent results with low morbidity in comparison with open surgical approaches. In reviewing the experience of other investigators, adequate fixation of the mesh, extension to cover the entire previous incision and standardizing the placement interval of the sutures are critical to the success of the repair. PMID:10694076

Voeller, Guy

1999-01-01

231

Cholecystocutaneous fistula: an unusual complication of a para-umbilical hernia repair.  

PubMed

This case describes a 94-year-old woman who presented 2?years postsutured para-umbilical hernia repair with a painful black lump protruding through her scar with blood stained discharge. This was initially thought to be either ischaemic bowel secondary to strangulated incisional hernia or a large organised haematoma. An urgent CT scan was performed following which the patient passed two large calculi and bile-stained fluid spontaneously through the wound, making the diagnosis somewhat clearer. The scan revealed an incisional hernia containing the gallbladder and two large calculi at the skin surface and an incidental large caecal cancer with surrounding lymphadenopathy. Frail health and the incidental finding of a colon cancer rendered invasive surgical management inappropriate. Therefore, she was managed conservatively with antibiotics. A catheter was inserted into the fistula tract to allow free drainage and alleviate pressure-related symptoms. The patient was discharged following a multidisciplinary team discussion. PMID:24862413

Dixon, Steven; Sharma, Mitesh; Holtham, Stephen

2014-01-01

232

Bupivacaine-enhanced small intestinal submucosa biomaterial as a hernia repair device.  

PubMed

Management of post-surgical pain following herniorrhaphy remains a clinical challenge and novel methods to deliver analgesic compounds could be of great benefit. Because there is great interest in the use of natural biomaterials for hernia repair, we investigated the biocompatibility of a natural biomaterial, porcine small intestinal submucosa (SIS), which was impregnated with bupivacaine (SIS-B) via immersion in a solution of poly(lactic-co-glycolic acid) (PLGA). Groups of Sprague Dawley rats underwent surgical creation of a ventral abdominal wall defect with subsequent repair using either SIS or SIS-B. Analysis of serial blood samples showed peak bupivacaine levels (83?ng/mL) were achieved 16?h after implantation of SIS-B. One month after surgery, the rats were euthanized and implant sites harvested for mechanical strength testing and histological analysis. At the time of necropsy, adhesion extent and tenacity was greater in SIS-B rats, with 90% of SIS-B rats have adhesion to the implant site compared to only 75% of SIS rats. Microscopically, SIS implant sites were characterized by small amounts of residual SIS surrounded by mild-to-moderate chronic inflammation. In contrast, rats treated with SIS-B, residual SIS-B was surrounded by a ring of acute inflammatory cells and an outer ring of chronic inflammatory cells, possibly due to bupivacaine or residual PLGA. Mechanical strength testing of the harvested implant sites showed no significant (p???0.05) difference between SIS and SIS-B implants. In summary, bupivacaine is readily elaborated from SIS-B; and impregnation of SIS with bupivacaine does not substantially alter the biocompatibility of the biomaterial or its mechanical strength following implantation. PMID:21680611

Suckow, Mark A; Wolter, William R; Fecteau, Chris; Labadie-Suckow, Susan M; Johnson, Chad

2012-08-01

233

A new tension-free technique for the repair of umbilical hernia, using the Prolene Hernia System--early results from 48 cases.  

PubMed

Tension-free repair using the Prolene Hernia System (PHS) has been widely adopted for inguinal hernias with excellent results. In our department, a new technique for umbilical hernia repair, using the PHS, has been developed. Between 2000 and 2002, 48 patients underwent tension-free umbilical hernia repair, using the PHS. There were 20 male and 28 female patients, with a mean age of 54 years. The preperitoneal space was dissected to accumulate the underlay patch of the PHS. The onlay patch was placed on the anterior rectus sheath and the connector in the umbilical ring. The median operating time was 35 min (range, 28-40). Postoperative pain was minimal, and there were no complications associated with the mesh, except a seroma, which required needle aspiration. There were no recurrences after a median follow-up of 13 months (1-24). Our early results indicate that the described tension-free technique could become the standard treatment for umbilical hernia repair, but long-term results are required to establish the efficacy of the procedure. PMID:12690534

Perrakis, E; Velimezis, G; Vezakis, A; Antoniades, J; Savanis, G; Patrikakos, V

2003-12-01

234

Tensile strength and adhesion formation of mesh fixation systems used in laparoscopic incisional hernia repair  

Microsoft Academic Search

Background  Mesh tearoff from the tissue is the most common reason for hernia recurrence after hernia surgery involving the use of a synthetic\\u000a mesh. Various fixation systems were critically compared in terms of their retention strength and the formation of adhesions.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  In a prospective study with 25 Sprague–Dawley rats, two pieces of Parietex composite meshes measuring 2 × 3 cm were fixed\\u000a intraperitoneally in

Christian Hollinsky; Thomas Kolbe; Ingrid Walter; Anja Joachim; Simone Sandberg; Thomas Koch; Thomas Rülicke; Albert Tuchmann

2010-01-01

235

Death by late-presenting Bochdalek hernia in infant soon after congenital cardiac repair.  

PubMed

Congenital diaphragmatic hernia (CDH) presenting beyond the neonatal period is commonly perceived to be rare. With reported frequencies of 2.6% to 20% of all CDH, it may be an overlooked cause of mortality. Variable symptomatology makes its diagnosis challenging. We report the sudden death of a 3-month-old patient shortly after hospital discharge following congenital heart surgery. Autopsy findings associated the patient's demise with migrated abdominal contents in the chest through a Bochdalek hernia defect. No indications of CDH existed before hospital discharge. Relevant issues pertaining to congenital heart disease, CDH, and importance of autopsy in this context are discussed. PMID:23799739

Chau, Destiny; Srour, Habib; Rolf, Cristin; O'Connor, William; Cumbermack, Kristopher; Bezold, Lou; Kozik, Deborah; Plunkett, Mark; Murphy, Thomas J; Hessel, Eugene

2013-04-01

236

Laparoscopic repair of incisional hernia in solid organ-transplanted patients: the method of choice?  

PubMed

Due to immunosuppressive (IS) therapy, incisional hernias are overrepresented in the organ-transplanted (Tx) population with larger defects, a high rate of recurrence, and a tendency toward more seromas and infectious problems. Thirty-one Tx/IS patients with a control group of 70 non-IS patients with incisional hernia (6/7 recurrences) were included in a prospective interventional study. Both cohorts were treated with laparoscopic ventral hernia repair (LVHR). Follow-up time and rate was 37 months and 95%. One hundred LVHR's were completed as there was one conversion in the Tx/IS group. No late infections or mesh removals occurred. Recurrence rates were 9.7% vs. 4.2% (P = 0.37) and the overall complication rates were 19% vs. 27% (P = 0.80). The Tx/IS group had a higher mesh-protrusion rate (29% vs. 13%, P = 0.09), but also larger hernias. Polycystic kidney disease was overrepresented in the Tx cohort (44% of kidney-Tx). Incisional hernias in Tx/IS patients may be treated by LVHR with the same low complication rate and recurrence rate as non-IS patients. By LVHR, the highly problematic seroma/infection problems encountered in Tx/IS patients treated by conventional open technique seem almost eliminated. The minimally invasive procedure seems particularly rational in the Tx/Is population and should be the method of choice. (ClinicalTrials.gov number: NCT00455299, date: 5 May 2006). PMID:24684675

Lambrecht, Jan R; Skauby, Morten; Trondsen, Erik; Vaktskjold, Arild; Øyen, Ole M

2014-07-01

237

Laparoscopic Repair of a Spigelian Hernia: A Case Report and Literature Review  

PubMed Central

Background: We present a case in which laparoscopy was both diagnostic and therapeutic in a patient with a spigelian hernia. Case Report: A 35-year-old man was referred to the General Surgery Service for evaluation of right lower quadrant abdominal pain of approximately 6 months. The pain was not disabling but was a constant discomfort. The patient did not have any significant past medical or surgical history, and the physical examination was significant only for an area of focal tenderness in the right lower quadrant. Ultrasound and CT scans of the patient's abdomen were unremarkable. A laparoscopic exploration of the area revealed a defect in the area of semilunar and semicircular lines consistent with a spigelian hernia. The patient underwent a laparoscopic herniorrhaphy with placement of a polypropylene mesh. Conclusion: This case illustrates the role of laparoscopy in the diagnosis and treatment of spigelian hernias. PMID:15347117

Singh, Niten N.; Zagorski, Stanley M.; Sawyer, Michael A. J.

2004-01-01

238

Study protocol for a randomized controlled trial for anterior inguinal hernia repair: transrectus sheath preperitoneal mesh repair compared to transinguinal preperitoneal procedure  

PubMed Central

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 hernia repair, 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 hernia repair 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 hernia repair 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 hernia repair 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 PMID:23452397

2013-01-01

239

Role of prophylactic antibiotics in open inguinal hernia repair: a randomised study.  

PubMed

To study the role of prophylactic antibiotics in open inguinal hernia repair. A total of 200 patients were included, they were randomised in two groups. Group 1 was given prophylactic dose of inj amoxy-clav while group 2 was given placebo only. Results were compared and Data analysed using the Chi-square test. Complications in both the groups were compared. Rate of serous discharge and seroma formation was 1% and 22% respectively in group 1 while 2% and 26% in group 2 also the rate of erythema and stitch abscess were 1% and none in group 1 and 2% and 1% in group 2 respectively. On statistical analysis these differences were not significant. Addition of prophylactic antibiotics in elective open inguinal hernia repair has no significant benefit over placebo although larger studies are required to prepare some uniform guidelines. PMID:22654329

Goyal, Amit; Garg, Rajeev; Jenaw, R K; Jindal, D K

2011-06-01

240

Small intestinal submucosa for laparoscopic repair of large paraesophageal hiatal hernias: a preliminary report.  

PubMed

Laparoscopic repair of large paraesophageal hiatal hernias is associated with several areas of contention. One of these is primary repair of the esophageal hiatus versus repair with the use of a prosthetic mesh material. Those who favor primary repair are concerned because of the risk of erosion of the prosthesis into surrounding viscera. Those who favor hiatal closure with the aid of a prosthetic mesh are concerned because of the relatively high rate of reherniation of the repair. A biodegradable mesh composed of small intestinal submucosa (SIS ES Cook Surgical, Bloomington, IN) may resolve the concerns of the opposing points of view. It has been shown in animal studies to maintain strength while it is gradually resorbed and replaced by native host tissue. Since April of 2000, 12 (8 female, 4 male) patients have had laparoscopic repair of large paraesophageal hiatal hernias with hiatal closure accomplished with this material. Nine of these 12 patients have had barium studies at six months post-procedure and seven at one year. No failures demonstrated. PMID:12931295

Strange, Paul S

2003-01-01

241

Biomaterials for abdominal wall hernia surgery and principles of their applications  

Microsoft Academic Search

This article focuses special attention on the porosity, cellular permeability and molecular permeability of biomaterials and their effect on infection, host tissue incorporation and seroma formation when mesh is used for the repair of abdominal wall hernias. Furthermore, the general principles of the application of biomaterials, regardless of the technique used for their employment, is discussed.

P. K. Amid; A. G. Shulman; I. L. Lichtenstein; M. Hakakha

1994-01-01

242

Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair  

Microsoft Academic Search

  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

2002-01-01

243

Laparoscopic incisional and ventral hernia repair: Complications—how to avoid and handle  

Microsoft Academic Search

Complications will occur with any operative procedure. The possibility of this must be considered for laparoscopic incisional and ventral hernia repair (LIVH) as well. The most commonly reported of these include: intraoperative intestinal injury (1–3.5%), infection involving the prosthetic biomaterial (0.7–1.4%), seromas (2.6–100%), postoperative ileus (1–8%), and persistent postoperative pain (1–2%). The incidence of enterotomy can be reduced by careful

K. A. LeBlanc

2004-01-01

244

Preliminary experience with new bioactive prosthetic material for repair of hernias in infected fields  

Microsoft Academic Search

.   Surgisis (Cook Surgical, Bloomington, Ind., USA) is a new four-ply bioactive, prosthetic mesh for hernia repair derived from\\u000a porcine small-intestinal submucosa. It is a naturally occurring extracellular matrix which is easily absorbed, supports early\\u000a and abundant new vessel growth, and serves as a template for the constructive remodeling of many tissues. As such, we believe\\u000a that Surgisis mesh is

M. E. Franklin Jr; J. J. Gonzalez Jr; R. P. Michaelson; J. Glass; D. Chock

2002-01-01

245

Functional impairment and complaints following incisional hernia repair with different polypropylene meshes  

Microsoft Academic Search

.   The influence of mesh material on the clinical outcome of hernia repair has often been neglected, although recent studies\\u000a have clearly demonstrated the importance of mesh properties for integration in the abdominal wall. Of particular significance\\u000a are the amount of mesh material and the pore size. In the following study, patients received different mesh types with distinct\\u000a amounts of

G. Welty; U. Klinge; B. Klosterhalfen; R. Kasperk; V. Schumpelick

2001-01-01

246

KETAMINE HAS NO PRE-EMPTIVE ANALGESIC EFFECT IN CHILDREN UNDERGOING INGUINAL HERNIA REPAIR  

Microsoft Academic Search

Previous studies have suggested that ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, provides a pre-emptive analgesic effect and pre-emptive analgesia improves postoperative pain management. The aim of this study was to determine the effict of pre-incisional vs. post-incisional intravenous low dose of racemic ketamine in postoperative pain in children undergoing inguinal hernia repair. Seventy-five children aged 1-6 years who were scheduled

M. E. Darabi; S. M. Mireskandari; M. Sadeghi; P. Salamati; E. Rahimi

247

Classification of biomaterials and their related complications in abdominal wall hernia surgery  

Microsoft Academic Search

Summary  The value of the use of biomaterials for the repair of abdominal wall hernias is gaining increasing recognition. The use of\\u000a synthetic mesh to achieve a tension-free repair has resulted in a significant reduction in postoperative pain, in length of\\u000a the recovery period, and in the number of recurrences. However, certain physical properties of biomaterials can lead to undesirable\\u000a consequences.

P. K. Amid

1997-01-01

248

Abdominal hernia repair with a decellularized dermal scaffold seeded with autologous bone marrow-derived mesenchymal stem cells.  

PubMed

Surgeons usually use synthetic polymer meshes for abdominal wall hernia repair. However, synthetic polymer meshes exhibit a lack of growth and related complications. In this study, we produced a tissue-engineered patch for abdominal hernia repair. Autologous bone-marrow-derived mesenchymal stem cells (BMSCs) were isolated and proliferated in vitro; decellularized dermal scaffolds (DSs) were prepared using enzymatic process; and then BMSCs were seeded onto the DSs for the construction of tissue-engineered patches. Under general anesthesia, rabbits underwent creation of abdominal wall defects and which were repaired with BMSC-seeded DSs, acellular DSs, and skin sutures only, respectively. Animals were sacrificed after 2 months for assessing the histological and gross examination. Abdominal hernias were absent in animals repaired with cell-seeded group, and abdominal hernias or bulges appeared in all animals repaired with acellular group. All the animals that were not repaired died within 10 days. The cell-seeded implants were thicker and indicated good angiogenesis compared with that of the acellular implants, both in histological and gross examination. The tissue-engineered patches prepared with BMSCs seeding on DSs can be used for abdominal wall hernia repair. PMID:21899574

Zhao, Yilin; Zhang, Zhigang; Wang, Jinling; Yin, Ping; Zhou, Jianyin; Zhen, Maochuan; Cui, Wugeng; Xu, Gang; Yang, Donghai; Liu, Zhongchen

2012-03-01

249

Mesh fixation compared with nonfixation in transabdominal preperitoneal laparoscopic inguinal hernia repair.  

PubMed

This study was conducted to compare laparoscopic inguinal hernia repair with or without mesh fixation regarding recurrence rate and duration of operation time. A sample of 73 patients who underwent laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair from January 2002 to January 2010 were derived from the medical records of university hospitals including Ekbatan, Beasat, and Shaheed Beheshti, as well as private hospitals. MERSILENE™ Mesh (Johnson & Johnson Medical GmbH, Norderstedt, Germany) fixation was performed for 23 cases and polypropylene mesh without fixation for the rest. The recurrence rate was followed in both groups for two years. The patients ages were from 7 to 64 years, 70 patients (95%) were male. Operation time for mesh fixation and nonfixation was 68.09 and 21.10 minutes, respectively (P < 0.001). Two recurrences occurred in the mesh fixation group versus no recurrence in the nonfixation group (P = 0.096). The results of this study revealed that laparoscopic TAPP inguinal hernia repair without mesh fixation is safe and feasible with no increase in recurrence rate. In addition, it offers a significantly shorter operation time than TAPP mesh fixation. However, we need more evidence based on randomized clinical trials to compare the benefits and harm of the two methods. PMID:23975444

Amirzargar, Mohammad Ali; Mohseni, Maede; Poorolajal, Jalal

2013-09-01

250

Totally extra-peritoneal repair of inguinal hernia by a glove-balloon: technical innovation.  

PubMed

Totally extra-peritoneal (TEP) laparoscopic repair of an inguinalhernia involves the creation of an extra-peritoneal space by blunt dissection or the use of commercial balloons. This new technique demonstrates the use of a device to create this extra-peritoneal space, without the need for any commercial balloons. The extra-peritoneal space was created using a glove-balloon. A total of 107 consecutive TEP repairs were carried out using the glove-balloon technique, these included ten bilateral and 17 recurrent inguinal hernias. This method is simple, cost-effective and easy to teach. PMID:17849960

Ullah, M Z; Bhargava, A; Jamal-Hanjani, M; Jacob, S

2007-08-01

251

Repair of an inguinoscrotal hernia containing the urinary bladder: a case report  

PubMed Central

Introduction Cases of patients with inguinoscrotal hernia containing the urinary bladder are very rare. These patients usually present with frequent episodes of urinary tract infection, difficulty in walking, pollakisuria and difficulty in initiating micturition because of incarceration of the urinary bladder into the scrotum. Case presentation We describe the case of an 80-year-old Caucasian man with an incarcerated urinary bladder into the scrotum who underwent surgical repair with mesh. Conclusions Diagnosis of such cases often requires not only clinical examination but also specialized radiological examinations to show the ectopic position of the urinary bladder. Surgical repair in these patients is a real challenge for surgeons. PMID:22448739

2012-01-01

252

Comparison of PTFE, pericardium bovine and fascia lata for repair of incisional hernia in rat model, experimental study.  

PubMed

Incisional hernia is a frequent complication of abdominal surgery developing in 11-20 % of patients undergoing an abdominal operation. Regarding morbidity and loss of manpower, incisional hernias continue to be a fundamental problem for surgeons. In this experimental study, three commonly used mesh materials (Goretex PTFE; Tutoplast Fascia lata; Tutopatch Pericardium bovine) were compared according to effectiveness, strength, adhesion formation, histological changes, and early complications. Three groups, each consisting of 14 rats, have been formed as group A: polytetrafluoroethylene (PTFE), group B: pericardium bovine and group C: fascia lata. Evaluations were achieved at the end of the first and second postoperative week, respectively. Adhesion formation, wound maturation, bursting pressure, and tensile strength were evaluated. No statistically significant difference regarding adhesion formation was observed between groups although adhesion formation was less significant in PTFE and pericardium bovine groups than in the fascia lata group. Bursting pressure and tensile strength values were significantly higher in PTFE group than in the fascia lata group ( P<0.05). No statistically significant difference was observed between groups regarding wound maturation. In this experimental model, PTFE and pericardium bovine were found to be superior to fascia lata in abdominal wall repair. PMID:12612797

Kapan, S; Kapan, M; Goksoy, E; Karabicak, I; Oktar, H

2003-03-01

253

Use of a bioprosthetic mesh in complex hernia repair: early results from a French multicenter pilot study.  

PubMed

Background. Implantation of synthetic meshes for reinforcement of abdominal wall hernias can be complicated by mesh infection, which often requires mesh explantation. The risk of mesh infection is increased in a contaminated environment or in patients who have comorbidities such as diabetes or smoking. The use of biological prostheses has been advocated because of their ability to resist infection. Initial results, however, have shown high hernia recurrence rates and wound occurrences. The objective of the present study is to evaluate early and mid-term outcomes in the largest French series that included 43 consecutive complex abdominal hernias repaired with biological prostheses. Materials and methods. Retrospective observational study of a prospective collected data bank. Patient demographics, history of previous repairs, intraoperative findings and degree of contamination, associated procedures, postoperative prosthetic-related complications, and long-term results were retrospectively reviewed. Results. There were 25 (58%) incisional, 14 parastomal, and 4 midline hernia repairs. Hernias were considered "clean" (n = 5), "clean-contaminated" (n = 19), "contaminated" (n = 12), or "dirty" (n = 7). Wound-related morbidity occurred in 17 patients; 4 patients needed reoperation for cutaneous necrosis or abscess. Smoking was the only risk factor associated with wound complication (P = .022). No postoperative wound events required removal of the prosthesis. There were 4 hernia recurrences (9%). A previous attempt at repair (P = .018) and no complete fascia closure (P = .033) were associated with hernia recurrence. Conclusions. This study demonstrated that the use of bioprothesis in complex hernia repair allowed successful single-stage reconstruction. Wound-related complications were frequent. Cost-benefit analyses are important to establish the validity of these findings. PMID:24496103

Lupinacci, Renato Micelli; Gizard, Anne Sophie; Rivkine, Emmanuel; Debove, Clotilde; Menegaux, Fabrice; Barrat, Christophe; Wind, Philippe; Trésallet, Christophe

2014-12-01

254

Regenerative medicine for congenital diaphragmatic hernia: regeneration for repair.  

PubMed

Regenerative medicine has developed recently as a new field of science aiming at restoring organ and tissue damage through the use of autologous constructs. Cellular therapies and relatively simple tissue engineering reconstructions have recently been successfully applied into patients. For babies born with congenital diaphragmatic hernia, regenerative medicine may play a role both in developing a myogenic patch capable of restoring muscle function and promoting regeneration of hypoplastic lungs that characterised those patients. The latter is particularly attractive because it may change the long-term outcome of those children. We aim here to discuss recent advancement in the field, looking in particular at the future clinical prospective of those exciting therapeutic strategies. PMID:23114980

De Coppi, Paolo; Deprest, Jan

2012-10-01

255

Mesh erosion into caecum following laparoscopic repair of inguinal hernia (TAPP): a case report and literature review.  

PubMed

Repair of inguinal hernia is the most commonly performed surgical procedure. Both open and laparoscopic methods are accepted modalities of surgical treatment. Transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) are the two types of laparoscopic repair of the inguineal hernia. The main advantages of laparoscopic repair, as compared to open repair, are a shorter hospital stay and a quicker recovery to normal activities. However, laparoscopic repairs are associated with a higher incidence of visceral and vascular injuries. One particular complication is the migration and erosion of mesh into the adjacent viscera. Although the total numbers of cases are small, compared to the total numbers of inguinal hernia repairs, they are important, as they often presented with a diagnostic dilemma. Most of the mesh migrations reported in the literature involves the urinary bladder. In this paper, we present a case of erosion of mesh into the caecum. The patient (a 66-year-old male) underwent TAPP repair of a right inguinal hernia in 1996 with polypropelene mesh. He also underwent an open appendicectomy in 1980. During the laparoscopic repair, he was found to have multiple intra-abdominal adhesions. He presented with intermittent diarrhea, for which he was investigated, and a benign caecal lesion was found. He was initially managed conservatively. However, his symptoms persisted and he underwent a right hemicolectomy in February 2006 in our hospital. The offending lesion was found to be the prolene mesh having eroded into the caecum. PMID:17907986

Goswami, Rup; Babor, Mohammed; Ojo, Akinyede

2007-10-01

256

Body image and health locus of control among male patients with incisional hernias  

Microsoft Academic Search

Incisional hernias form after surgery through incision sites and can enlarge over time. Relations between body image (BI) and health locus of control (HLC) were investigated in male patients undergoing evaluation for incisional hernia repair (n=32) and non-hernia controls (n=34). Analyses revealed that patients with incisional hernias reported significantly less satisfaction with general appearance and appearance of the mid-torso than

Emily L. Hiatt; Robert L. Collins; Nicholas J. Pastorek; Charles F. Bellows

2009-01-01

257

Chemotherapy-induced enterocutaneous fistula after perineal hernia repair using a biological mesh: a case report  

PubMed Central

This is the first reported case of an enterocutaneous fistula as a late complication to reconstruction of the pelvic floor with a Permacol™ mesh after a perineal hernia. A 70-year-old man had a reconstruction of the pelvic floor with a biological mesh because of a perineal hernia after laparoscopic abdominoperineal resection. Nine months after the perineal hernia operation, the patient had multiple metastases in both lungs and liver. The patient underwent chemotherapy, including bevacizumab, irinotecan, calcium folinate, and fluorouracil. Six weeks into chemotherapy, the patient developed signs of sepsis and complained of pain from the right buttock. Ultrasound examination revealed an abscess, which was drained, guided by ultrasound. A computed tomography scan showed a subcutaneous abscess cavity located in the right buttock with communication to the small bowel. Operative findings confirmed a perineal fistula from the distal ileum to perineum. A resection of the small bowel with primary anastomosis was performed. The postoperative course was complicated by fluid and electrolyte disturbances, but the patient was stabilized and finally discharged to a hospice for terminal care after 28 days of hospital stay. It seems that hernia repairs with biological meshes have lower erosion and infection rates compared with synthetic meshes, and so far, evidence suggests that biological grafts are safe and effective in the treatment of pelvic floor reconstruction. There have been no reports of enteric fistulas after pelvic reconstruction with biological meshes. However, the development of intestinal fistulas after chemotherapy with bevacizumab has been described in the literature. Our case report supports this association between bevacizumab and fistula formation among rectal cancer patients, as symptoms of a fistula started only 6 weeks into bevacizumab treatment but approximately 12 months after the perineal hernia operation, even after pelvic reconstruction using a biological mesh and without local recurrence. PMID:24489478

Eriksen, MH; Bulut, O

2014-01-01

258

Use of a dynamic self-regulating prosthesis (P.A.D.) in inguinal hernia repair: our first experience in 214 patients.  

PubMed

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

2009-01-01

259

Evaluation of the Antimicrobial Activity of Lysostaphin-Coated Hernia Repair Meshes?  

PubMed Central

Bacterial infections by antibiotic-resistant Staphylococcus aureus strains are among the most common postoperative complications in surgical hernia repair 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 hernia repair 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 hernia repair meshes. PMID:21709102

Satishkumar, Rohan; Sankar, Sriram; Yurko, Yuliya; Lincourt, Amy; Shipp, John; Heniford, B. Todd; Vertegel, Alexey

2011-01-01

260

Comparison of PTFE, pericardium bovine and fascia lata for repair of incisional hernia in rat model, experimental study  

Microsoft Academic Search

  \\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

2003-01-01

261

Abdominal adiposity is the main determinant of the C-reactive response to injury in subjects undergoing inguinal hernia repair  

PubMed Central

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 hernia repair 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 hernia repair 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. PMID:23391158

2013-01-01

262

Trends in emergent inguinal hernia surgery in Olmsted County, MN: a population-based study  

PubMed Central

Background Evidence suggests that watchful waiting of inguinal hernias (IH) is safe because the risk of acute strangulation requiring an emergent repair is low. However, population-based incidence rates are lacking, and it is unknown whether the incidence of emergent inguinal hernia repairs (IHR) has changed over time. Study design A retrospective review of all IHR performed on adult residents of Olmsted County, Minnesota from 1989 to 2008 was performed using the Rochester epidemiology project, a record-linkage system that covers more than 97 % of the population (2010 US Census = 146,466). Incidence rates/100,000 person-years were calculated, and trends over time were evaluated using Poisson regression. Results A total of 4,026 IHR were performed on 3,599 patients; 136 repairs (3.8 %) were emergent. Of these, 19 patients (14 %) had bowel resection and three (2 %) died within 30 days of the repair. Rates/100,000 person-years yielded an overall incidence of 7.6 for emergent IHR and 200.0 for elective IHR. Emergent IHR rates increased with age. Overall emergent IHR rates declined from 18.2 to 12.4 in men and from 6.4 to 2.4 in women from 1989 to 2008 (p > 0.05). Older age, obesity, a high ASA risk score, a femoral and/or a recurrent hernia were more likely to be associated with an emergent IHR (all p ? 0.05). Conclusion The incidence of emergent IHR is low. This risk has decreased over the past 20 years. However, patients who are either ?70 years old, obese, with a high ASA score, or with a femoral or recurrent hernias are more likely to require an emergent IHR and could benefit from elective operative intervention if deemed adequate surgical candidates. PMID:22695978

Hernandez-Irizarry, R.; Zendejas, B.; Ramirez, T.; Moreno, M.; Ali, S. M.; Lohse, C. M.

2013-01-01

263

Symptomatic Morgagni Hernia Misdiagnosed As Chilaiditi Syndrome  

PubMed Central

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. PMID:21691487

Vallee, Phyllis A.

2011-01-01

264

A calcified foreign body in the bladder after laparoscopic inguinal hernia repair.  

PubMed

In this paper, we report an exceedingly rare complication after laparoscopic inguinal hernioplasty. A 57-year-old man was submitted to transurethral resection of the prostate followed by laparoscopic "bikini mesh" hernia repair. One year later, he presented with miccional irritative symptoms. Ultrasonography showed a vesical intraluminal foreign body and computerized tomography revealed a calcified foreign body on the anterior bladder wall. On reoperation, it was noted that there occurred mesh transfixation of the bladder. The lateral segments were removed and the patient recovered uneventfully. This is a, thus far, unpublished complication of this technique. PMID:17541491

Lopes, R I; Dias, A R; Lopes, S I; Cordeiro, M D; Barbosa, C M; Lopes, R N

2008-02-01

265

Laparoscopic ventral hernia repair using expanded polytetrafluoroethylene–polyester mesh compound  

Microsoft Academic Search

Background  Many biomaterials and composites have been used in clinical and experimental laparoscopic ventral hernia repair. The ideal\\u000a prosthesis should allow firm binding to the abdominal wall without adhesion to the bowel.\\u000a \\u000a \\u000a \\u000a Methods  A compound prosthesis was made by circumferentially suturing a Gore-Tex mesh as visceral interface to a smaller polyester\\u000a mesh as parietal interface, and it was used in 46 laparoscopic

M. Farrakha

2006-01-01

266

Paraesophageal hernia repair followed by cardiac tamponade caused by ProTacks.  

PubMed

We describe a case of cardiac tamponade caused by ProTacks Autosuture used for mesh fixation during a laparoscopic Nissen operation with giant paraesophageal hernia repair. Perforations of the posterior descendent artery and epicardial vein of the right ventricle were caused by ProTacks used for Parietex Composite Mesh fixation. Protruding ProTacks were secured from inside the pericardiac sac with a synthetic vascular patch during emergency sternotomy. Quick and multidisciplinary cooperation ended with emergency cardiothoracic procedure saving the patient's life and preventing further damage to the heart muscle and its vessels. PMID:23006720

Makarewicz, Wojciech; Jaworski, ?ukasz; Bobowicz, Maciej; Roszak, Krzysztof; Jaroszewicz, Krzysztof; Rogowski, Jan; Jastrz?bski, Tomasz; Ja?kiewicz, Janusz

2012-10-01

267

Preperitoneal repair (open posterior approach) for recurrent inguinal hernias previously treated with Lichtenstein tension-free hernioplasty  

PubMed Central

Background: The repair of recurrent inguinal hernias after prosthetic mesh repair is usually diffucult due to considerable technical challenge and complications. There is also a greater risk of developing further recurrence. The aim of this study was to investigate the outcome of preperitoneal repair (open posterior approach) for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty. Methods: We performed a prospective clinical study in 44 patients having recurrent inguinal hernias the period 2002- 2008. Preperitoneal repair was performed on all patients who have had Lichtenstein tension-free hernioplasty previously. The age, gender, operating time, hospital stay, postoperative complication rates and recurrence rates of patients were evaluated. Results: There were no serious intraoperative complications. There were 36 men and 9 women in the study, whose average age was 38.45 (25-68) years. The average operative time and hospital stay were 44.56 (30-120) min and 1.6 (1-3) days, respectively. Complications included 4.5 % seromas, 4.5 % hematomas and urinary retention in 9.09 % patients. Follow-up to date is 1-90 months (range, median 40 months). Conclusions: We concluded that the preperitoneal repair (open posterior approach) in recurrent inguinal hernias after Lichtenstein tension-free hernioplasty is a safe and efficient method with low complication and rerecurrence rates. PMID:20596268

Karatepe, O; Acet, E; Altiok, M; Adas, G; Cak?r, A; Karahan, S

2010-01-01

268

Mesh-Based Transperineal Repair of a Perineal Hernia After a Laparoscopic Abdominoperineal Resection  

PubMed Central

A perineal hernia (PH) is formed by a protrusion of intra-abdominal viscera through a defect in the pelvic floor. This is a rare complication after a conventional abdominoperineal resection (APR). However, the risk of a PH may be increased after a laparoscopic resection because this technique can cause fewer postoperative adhesions, predisposing the small bowel to sliding down toward the pelvis. However, only a few case reports describe the transperineal approach for the repair of a PH after a laparoscopic APR. We present a case of a PH after a laparoscopic APR; the PH was repaired with synthetic mesh by using a transperineal approach. A transperineal approach using a mesh to reconstruct the pelvic floor is less invasive and more effective. We suggest that this technique should probably be the first choice for treating an uncomplicated PH that occurs after a laparoscopic APR.

Lee, Taek-Gu

2014-01-01

269

Mechanical Properties of Mesh Materials Used for Hernia Repair and Soft Tissue Augmentation  

PubMed Central

Background Hernia repair 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 hernia repair, 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. PMID:23071685

Pott, Peter P.; Schwarz, Markus L. R.; Gundling, Ralf; Nowak, Kai; Hohenberger, Peter; Roessner, Eric D.

2012-01-01

270

Small Bowel Obstruction and Internal Hernias during Pregnancy after Gastric Bypass Surgery  

Microsoft Academic Search

Small bowel obstruction (SBO) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. Internal hernia (IH)\\u000a a potential problem associated with RYGB, can have severe consequences if not diagnosed. We present two cases of SBO due to\\u000a IH during pregnancy after laparoscopic RYGB (LRYGB). Both patients underwent an antecolic, antegastric LRYGB. In both patients\\u000a a Petersen’s type IH was

Gonzalo M. Torres-Villalobos; Todd A. Kellogg; Daniel B. Leslie; Gintaras Antanavicius; Rafael S. Andrade; Bridget Slusarek; Tracy L. Prosen; Sayeed Ikramuddin

2009-01-01

271

Cardiac arrest before repair or extracorporeal membrane oxygenation cannulation does not increase the mortality rate associated with congenital diaphragmatic hernia  

Microsoft Academic Search

Despite recent advances in the management of high-risk congenital diaphragmatic hernia (CDH), mortality remains high. Deaths occur later because infants with inadequate pulmonary parenchyma are treated aggressively but eventually succumb to respiratory failure. In an attempt to identify absolute predictors of mortality the authors examined retrospectively their experience with CDH to determine if cardiac arrest before repair or initiation of

Anita P Courcoulas; Kimberly K Reblock; Marc I Rowe; Henri R Ford

1997-01-01

272

Behaviour of orthotropic surgical implant in hernia repair due to the material orientation and abdomen surface deformation.  

PubMed

Surgical implants used in hernia repair reveal isotropic as well as orthotropic properties. In particular, its orthotropy, in relation to the different range of typical deformations observed in different directions and zones of abdomen surface due to the patients' life activities, has a significant influence on the extreme junction forces in the mesh-tissue connections and hence the repair persistence. The finite element model of the orthotropic implant was developed, and the junction forces in the connections of tissue and mesh were studied. The kinematical extortions representing the abdomen surface deformations identified in specific zones of hernia placement were applied to the model. The sensitive analysis was applied to specify the influence of the orthotropy (implant orientation) direction to the repair persistence. Due to the anisotropy of the human abdomen and also the different range of deformations observed in different areas of abdomen surface, the behaviour of the implant differs significantly depending on the hernia placement and the implant orientation. Especially, it is observed in the values of the implant-tissue junction forces which determinate considerably the repair persistence. The provided results and conclusions may be useful in some clinical recommendations for implantation of orthotropic surgical mesh specifying the hernia placement as well as the orthotropic implant orientation. This can also be considered in the design of new synthetic implants with more physiologic tissue-like properties also taking into account the human abdomen anisotropy. PMID:23627312

Lubowiecka, Izabela

2015-02-01

273

Neonatal minimally invasive surgery for congenital diaphragmatic hernias: a multicenter study using thoracoscopy or laparoscopy  

Microsoft Academic Search

Background  Minimally invasive surgery (MIS) for late-presenting congenital diaphragmatic hernia (CDH) has been described previously,\\u000a but few neonatal cases of CDH have been reported. This study aimed to report the multicenter experience of these rare cases\\u000a and to compare the laparoscopic and thoracoscopic approaches.\\u000a \\u000a \\u000a \\u000a Methods  Using MIS procedures, 30 patients (16 boys and 14 girls) from nine centers underwent surgery for CDH

Cindy Gomes Ferreira; Olivier Reinberg; François Becmeur; Hossein Allal; Pascal De Lagausie; Hubert Lardy; Paul Philippe; Manuel Lopez; François Varlet; Guillaume Podevin; Jürgen Schleef; Max Schlobach

2009-01-01

274

Effective operative training in hernia repair for junior surgery residents  

Microsoft Academic Search

\\u000a Zusammenfassung  GRUNDLAGEN: Das Erlernen operativ-technischer Fähigkeiten ist ein wichtiger Bestandteil der chirurgischen Ausbildung und kann\\u000a nur durch persönliche Erfahrung und Training erreicht werden. Wachsender Kostendruck und die Einführung von Arbeitszeitbegrenzungen\\u000a führt zunehmend zu kritischen Diskussionen über die, für die chirurgische Ausbildung benötigte, zusätzliche Operationszeit.\\u000a Daher ist es notwendig neue Strategien zu entwickeln um Operationszeiten zu verkürzen ohne die chirurgische Ausbildung zu

C. Justinger; J. Mikneviciute; J. Schuld; M. K. Schilling

2011-01-01

275

Office Based Anesthesia and Surgery  

MedlinePLUS

... From the simple removal of a mole to breast augmentation/reduction, liposuction, hernia repairs or knee arthroscopies, a rapidly growing number of surgeries are being performed in doctors’ offices rather than ...

276

Prolene hernia system compared with mesh plug technique: a prospective study of short- to mid-term outcomes in primary groin hernia repair.  

PubMed

Two types of anterior tension-free hernioplasty, prolene hernia system (PHS) repair and mesh plug technique (MPT), were introduced to Taiwan in 2001. This study compared the short- to mid-term outcomes following primary groin hernia repair with PHS and MPT. From January 2001 to December 2003, 393 patients with 426 primary groin hernias were operated on by a single surgeon using MPT (n=192) and PHS (n=234). Baseline perioperative details and follow-up information were compared. Demographic characteristics of both groups were similar. The laterality, types of anesthesia, postoperative stay, postoperative wound pain scores, wound complications and days to return to activities of daily life were equally distributed between the two groups. However, the distribution of Gilbert types in the PHS group was shifted a little to the right compared with that of the MPT group. PHS repair had longer operative time (34+/-17 vs 25+/-9 minutes, p<0.01). No recurrence was noted in both groups during the follow-up from 5 to 41 months. Chronic non-disabling groin pains were noted in 2.8% (6/218) of patients in the PHS group and 8.9% (14/175) in the MPT group (p=0.01). Our results show that both PHS and MPT repairs can be performed with short operation time, minor wound pain and quick return to activities of daily life without short- to mid-term recurrences, but postoperatively the MPT group had higher incidence of chronic non-disabling groin pain. Although the MPT is less invasive, the additional protective patch in the preperitoneal space of the PHS may provide a further safeguard against recurrences, especially for those patients with attenuated inguinal floor. Long-term follow-up is needed. PMID:15703858

Huang, C S; Huang, C C; Lien, H H

2005-05-01

277

Bilateral Retrovascular Femoral Hernia  

PubMed Central

A 34-year-old woman with cystic fibrosis presented with bilateral femoral hernias, which were found to be retrovascular at operation. The hernias were not amenable to conventional open or laparoscopic repair, and were repaired using pre-peritoneal mesh inserted deep to transversalis fascia. The anatomical basis and management of uncommon variants of femoral hernia are discussed. PMID:18634743

Papanikitas, Joseph; Sutcliffe, Robert P; Rohatgi, Ashish; Atkinson, Simon

2008-01-01

278

Biomechanical analyses of prosthetic mesh repair in a hiatal hernia model.  

PubMed

Recurrence rate of hiatal hernia can be reduced with prosthetic mesh repair; however, type and shape of the mesh are still a matter of controversy. The purpose of this study was to investigate the biomechanical properties of four conventional meshes: pure polypropylene mesh (PP-P), polypropylene/poliglecaprone mesh (PP-U), polyvinylidenefluoride/polypropylene mesh (PVDF-I), and pure polyvinylidenefluoride mesh (PVDF-S). Meshes were tested either in warp direction (parallel to production direction) or perpendicular to the warp direction. A Zwick testing machine was used to measure elasticity and effective porosity of the textile probes. Stretching of the meshes in warp direction required forces that were up to 85-fold higher than the same elongation in perpendicular direction. Stretch stress led to loss of effective porosity in most meshes, except for PVDF-S. Biomechanical impact of the mesh was additionally evaluated in a hiatal hernia model. The different meshes were used either as rectangular patches or as circular meshes. Circular meshes led to a significant reinforcement of the hiatus, largely unaffected by the orientation of the warp fibers. In contrast, rectangular meshes provided a significant reinforcement only when warp fibers ran perpendicular to the crura. Anisotropic elasticity of prosthetic meshes should therefore be considered in hiatal closure with rectangular patches. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 102B: 1485-1495, 2014. PMID:24599834

Alizai, Patrick Hamid; Schmid, Sofie; Otto, Jens; Klink, Christian Daniel; Roeth, Anjali; Nolting, Jochen; Neumann, Ulf Peter; Klinge, Uwe

2014-10-01

279

[Injury of the femoral vein--a complication in inguinal hernia surgery].  

PubMed

In a 21-year-old patient with recurrence of the right-sided inguinal hernia the right femoral vein was injured during the operative repair. The vein had to be reconstructed by the use of the right saphena vein and anticoagulative therapy was begun. Since the coagulation parameters were satisfactory the haematoma was produced in the operative wound and had to be evacuated through the second operation. The next operative course was without complications and the patient with healed operative wound was discharged from the hospital at the 13th hospitalization day. PMID:8768949

Popovic, J; Hut'an, M

1996-01-01

280

Comparison of Lichtenstein and laparoscopic transabdominal preperitoneal repair of recurrent inguinal hernias.  

PubMed

The aim of our study was the comparative analysis of the results of two surgical methods: tension-free repair by the Lichtenstein technique and laparoscopic transabdominal preperitoneal (TAPP) repair. In total 52 patients with recurrent inguinal hernia were randomly assigned to the two groups: Lichtenstein (28 patients) and TAPP (24 patients). Comparisons between these groups were done by several preoperative, intraoperative, and postoperative factors. For postoperative factors both short-term and long-term results were considered. Average operation time for Lichtenstein group was 59.6 +/- 9.9 minutes, compared with 64.4 +/- 8.4 minutes for TAPP patients (P = 0.068). In TAPP patients there was less pain in the postoperative period (P = 0.002) and fewer sick-leave days (13.4 +/- 1.7 versus 17.5 +/- 2.6 days; P < 0.001) and, correspondingly, faster recovery. In the Lichtenstein group a total of 4 postoperative complications (infection, hematoma, seroma, urinary retention) were observed, compared with 8 in the TAPP group (P = 0.19). Statistically significant difference was only by urinary retention (0 for Lichtenstein, 4 for TAPP; P = 0.039). There were no cases of hernia recurrence observed during the followup. Chronic pain developed in 5 patients from the Lichtenstein group (17.9%) and 2 patients from the TAPP group (8.3%; P = 0.28) more than 1 year after the operation; 4 Lichtenstein patients (14.3%) and 1 TAPP patient (4.2%; P = 0.23) more than 2 years after the operation; and 3 Lichtenstein patients (10.7%) and 1 TAPP patient (4.2%; P = 0.36) more than 3 years after the operation. For the treatment of recurrent inguinal hernias, which are developed after use of conventional (nonmesh) methods, the first choice should be given to the laparoscopic method, especially for young, physically active, nonobese patients, and if there are any contraindications for the laparoscopy, the Lichtenstein approach should be recommended. PMID:22216702

Demetrashvili, Z; Qerqadze, V; Kamkamidze, G; Topchishvili, G; Lagvilava, L; Chartholani, T; Archvadze, V

2011-01-01

281

A laparoscopic intraperitoneal onlay mesh technique for the repair of an indirect inguinal hernia.  

PubMed Central

OBJECTIVE: This study was done (1) to determine whether congenital indirect inguinal hernias in male pigs could be repaired by placing a polypropylene mesh prosthesis over the defect intra-abdominally, (2) to measure the incidence of adhesions between intra-abdominal viscera and the prosthesis with and without the adhesion barrier oxidized regenerated cellulose, (3) to determine the incidence of other complications, and (4) to assess the effect on fertility. SUMMARY BACKGROUND DATA: Several techniques for laparoscopic inguinal herniorrhaphy are currently being evaluated to determine whether there are advantages over conventional inguinal herniorrhaphy. Perhaps the most controversial is the intraperitoneal onlay mesh procedure (IPOM). Its advantage is its simplicity (in that the repair is accomplished by placing a prosthesis over the hernia defect intra-abdominally, avoiding a groin dissection). Its disadvantage is the potential for complications because the prosthesis is in contact with the intra-abdominal viscera. METHODS: In male pigs, polypropylene mesh alone or polypropylene mesh plus the adhesion barrier oxidized regenerated cellulose (composite prosthesis) was fixed to the peritoneum surrounding the hernia defect. In phase 1 (6-week follow-up), two groups of 13 pigs each underwent herniorrhaphy at laparotomy or laparoscopy. In phase 2 (7.1-month follow-up), 21 pigs underwent laparoscopic herniorrhaphy. RESULTS: All IPOM herniorrhaphies were successful. The prostheses adhered most frequently to the bladder, followed by small bowel, peritoneum, and cord structures. Prosthetic erosion into these organs was not observed. Laparoscopically placed prostheses in phases 1 and 2 had significantly less surface covered by adhesions (13% +/- 13% and 19% +/- 27%, respectively) and a lower adhesion tenacity grade (1.5 +/- 0.9 and 1.3 +/- 1.1, respectively) than those placed at laparotomy (44% +/- 27% and 2.5 +/- 0.7, respectively; p < 0.01). In phase 1, a histologic evaluation of laparoscopically placed specimens demonstrated significantly thinner above-mesh fibrotic tissue compared with the prostheses implanted at laparotomy (p < 0.04). In either phase, the use of the adhesion barrier did not produce any histologic difference between the polypropylene alone and the composite prosthesis. Fertility studies were performed in phase 2 and showed no adverse effects caused by either prosthesis. CONCLUSIONS: This study demonstrated that the intraperitoneal placement of a polypropylene prosthesis was an effective technique for indirect inguinal herniorrhaphy in a pig. Furthermore, with laparotomy, the addition of oxidized regenerated cellulose significantly decreased the rate of adhesion formation to the prosthesis. However, oxidized regenerated cellulose would appear to have no value when used with a prosthesis placed laparoscopically. Images Figure 1. Figure 2. Figure 5. Figure 5. PMID:8129485

Fitzgibbons, R J; Salerno, G M; Filipi, C J; Hunter, W J; Watson, P

1994-01-01

282

Evaluation of ECHO PS Positioning System in a Porcine Model of Simulated Laparoscopic Ventral Hernia Repair  

PubMed Central

Purpose. Operative efficiency improvements for laparoscopic ventral hernia repair (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. PMID:23762628

Hanna, Erin M.; Voeller, Guy R.; Roth, J. Scott; Scott, Jeffrey R.; Gagne, Darcy H.; Iannitti, David A.

2013-01-01

283

The use of composite meshes in laparoscopic repair of abdominal wall hernias: are there differences in biocompatibily?  

Microsoft Academic Search

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

2009-01-01

284

Computed tomographic measurements of mesh shrinkage after laparoscopic ventral incisional hernia repair with an expanded polytetrafluoroethylene mesh  

Microsoft Academic Search

Background  The potential for shrinkage of intraperitoneally implanted meshes for laparoscopic repair of ventral and incisional hernia\\u000a (LRVIH) remains a concern. Numerous experimental studies on this issue reported very inconsistent results. Expanded polytetrafluoroethylene\\u000a (ePTFE) mesh has the unique property of being revealed by computed tomography (CT). We therefore conducted an analysis of\\u000a CT findings in patients who had previously undergone LRVIH

Ernst J. P. Schoenmaeckers; Steef B. A. van der Valk; Huib W. van den Hout; Johan F. T. J. Raymakers; Srdjan Rakic

2009-01-01

285

Enhancement of ropivacaine caudal analgesia using dexamethasone or magnesium in children undergoing inguinal hernia repair  

PubMed Central

Background: Caudal analgesia is the most commonly used technique providing intra- and postoperative analgesia for various pediatric infraumbilical surgical procedures but with the disadvantage of short duration of action after single injection. Caudal dexamethasone and magnesium could offer significant analgesic benefits. We compared the analgesic effects and side-effects of dexamethasone or magnesium added to caudal ropivacaine in pediatric patients undergoing inguinal hernia repair. Materials and Methods: A total of 105 (1-6 years) were randomly assigned into three groups in a double-blinded manner. After a standardized sevoflurane in oxygen anesthesia, each patient received a single caudal dose of ropivacaine 0.15% 1.5 mL/kg combined with either magnesium 50 mg in normal saline 1 mL (group RM), dexamethasone 0.1 mg/kg in normal saline 1 mL (group RD), or corresponding volume of normal saline (group R) according to group assignment. Postoperative analgesia, use of analgesics, and side-effects were assessed during the first 24 h. Results: Addition of magnesium or dexamethasone to caudal ropivacaine significantly prolonged analgesia duration 8 (5-11) h and 12 (8-16) h, respectively compared with 4 (3-5) h with the use of ropivacaine alone. The incidence of postoperative rescue analgesia was significantly higher in group R compared with groups RM and RD. The time to 1st analgesic dose was significantly longer in groups RM and RD (500 ± 190 and 730 ± 260 min) respectively compared with group R (260 ± 65 min). Group R patients achieved significantly higher Children's Hospital of Eastern Ontario Pain Scale and Faces Legs Activity Cry Consolability scores (4th hourly) compared with groups RM and RD patients (8th and 12th hourly, respectively). Conclusion: The addition of dexamethasone or magnesium to caudal ropivacaine significantly prolonged the duration of postoperative analgesia in children undergoing inguinal hernia repair. Also the time to 1st analgesic dose was longer and the need for rescue postoperative analgesic was reduced and without increase in incidence of side effects.

Yousef, Gamal T.; Ibrahim, Tamer H.; Khder, Ahmed; Ibrahim, Mohamed

2014-01-01

286

Use of Fibrin Sealant for Prosthetic Mesh Fixation in Laparoscopic Extraperitoneal Inguinal Hernia Repair  

PubMed Central

Objective To evaluate the efficacy of mesh fixation with fibrin sealant (FS) in laparoscopic preperitoneal inguinal hernia repair and to compare it with stapled fixation. Summary Background Data Laparoscopic hernia repair involves the fixation of the prosthetic mesh in the preperitoneal space with staples to avoid displacement leading to recurrence. The use of staples is associated with a small but significant number of complications, mainly nerve injury and hematomas. FS (Tisseel) is a biodegradable adhesive obtained by a combination of human-derived fibrinogen and thrombin, duplicating the last step of the coagulation cascade. It can be used as an alternative method of fixation. Methods A prosthetic mesh was placed laparoscopically into the preperitoneal space in both groins in 25 female pigs and fixed with either FS or staples or left without fixation. The method of fixation was chosen by randomization. The pigs were killed after 12 days to assess early graft incorporation. The following outcome measures were evaluated: macroscopic findings, including graft alignment and motion, tensile strength between the grafts and surrounding tissues, and histologic findings (fibrous reaction and inflammatory response). Results The procedures were completed laparoscopically in 49 sites. Eighteen grafts were fixed with FS and 16 with staples; 15 were not fixed. There was no significant difference in graft motion between the FS and stapled groups, but the nonfixed mesh had significantly more graft motion than in either of the fixed groups. There was no significant difference in median tensile strength between the FS and stapled groups. The tensile strength in the nonfixed group was significantly lower than the other two groups. FS triggered a significantly stronger fibrous reaction and inflammatory response than in the stapled and control groups. No infection related to method of fixation was observed in any group. Conclusion An adequate mesh fixation in the extraperitoneal inguinal area can be accomplished using FS. This method is mechanically equivalent to the fixation achieved by staples and superior to nonfixed grafts. Biologic soft fixation with FS will prevent early graft migration and will avoid the complications associated with staple use. PMID:11141220

Katkhouda, Namir; Mavor, Eli; Friedlander, Melanie H.; Mason, Rodney J.; Kiyabu, Milton; Grant, Steven W.; Achanta, Kranti; Kirkman, Erlinda L.; Narayanan, Krishna; Essani, Rahila

2001-01-01

287

Randomized clinical trial comparing inguinal hernia repair with Lichtenstein technique using non-absorbable or partially absorbable mesh. Preliminary report  

PubMed Central

Introduction The Lichtenstein technique is currently considered the “gold standard” of open, anterior inguinal hernia repair. It is not free, however, of adverse effects, which may be caused by the implemented synthetic material. Aim Determination the influence of the mesh employed on treatment results including immediate complications, return to everyday activities, chronic pain occurrence and hernia recurrence. Material and methods Tension-free hernia repair using the Lichtenstein technique was performed in all the 59 patients randomized to trial groups. Group P with heavyweight polypropylene mesh contained 34 patients; group V with lightweight, partially absorbable mesh (polypropylene/polyglactin 910) consisted of 25 people. Controlled, scheduled follow-up appointments took place after the 7th day and the 3rd and 6th month. Patients were clinically assessed and pain intensity was determined on an analogue-visual scale. Results No statistically significant influence of the type of mesh on the risk of early complications, severe pain intensity, the length of hospital stay, time of recovery, or patients’ satisfaction with treatment was observed. After 6 months also no statistically significant differences were observed between groups with regard to recurrence rate (P 3.4% vs. V 4.0%), chronic pain (P 5.9% vs. V 4.0%) and ailments such as “foreign body presence” (V vs. P, OR = 0.30, 95% CI 0.077-1.219, p = 0.093) incidence, although their probability was 70% lower for V mesh. Conclusions The preliminary results confirm the effectiveness of the Lichtenstein technique for hernia repair with both types of meshes. It appears that use of a partially absorbable mesh is connected with lower risk of postoperative complications, but the final results require multicentre trials in a larger series of patients. PMID:23255981

Szczepanik, Andrzej B.; Misiak, Andrzej; Wroblewski, Tadeusz

2011-01-01

288

The economic impact of laparoscopic inguinal hernia repair: results of a double-blinded, prospective, randomized trial.  

PubMed

For this study, 66 patients with a preoperative diagnosis of unilateral primary inguinal hernia were randomized to undergo laparoscopic totally extra peritoneal (TEP), laparoscopic transabdominal (TAPP), or open inguinal hernia repair with polypropylene mesh (Lichtenstein type). Both the operative team caring for the patient postoperatively and the patient were blinded to the operative approach by placement of a large dressing covering the abdomen, which was not removed until postoperative day 3. The patients recorded their pain level on a visual analog pain scale daily. Medication usage also was recorded. All patients were seen at 7-day intervals until they returned to work. The patients were interviewed during their postoperative visits by an investigator blinded to the operative approach and questioned regarding their ability to return to work and their pain levels. The average number of lost work days in all the groups was 12, and there was no significant difference between the three groups (p = 0.074). The average operating time for the TAPP procedure was 59 min, less than the time required to complete either the TEP or the Lichtenstein approach, which had equivalent operative times (p = 0.027). The material cost was significantly lower for the Lichtenstein repair (1,200 dollars less) than for either of the laparoscopic approaches, a saving primarily related to consumable operating room supplies. The TEP repair costs were minimally higher than those for the TAPP repair (125 dollars more). No significant differences were noted in the postoperative pain scales, and the use of postoperative oral analgesics was equivalent. The higher operative costs noted for the laparoscopic hernia repairs were not offset by a shortened convalescence. Postoperative pain appears to be equivalent regardless of the operative approach chosen and is easily managed with oral analgesics. PMID:17235721

Butler, Ralph E; Burke, Rachel; Schneider, James J; Brar, Harpreet; Lucha, Paul A

2007-03-01

289

Rare variant of inguinal hernia, interparietal hernia and ipsilateral abdominal ectopic testis, mimicking a spiegelian hernia. Case report.  

PubMed

We report a case in which the combination of an interparietal inguinal hernia and ipsilateral ectopic testicle mimicked a spigelian hernia. The patient was a 22-day-old boy who presented with a reducible mass that extended from the right lumbar region to the iliac fossa region. The right testis was palpable in the right lumbar region. Ultrasonography and magnetic resonance imaging revealed that a small bowel had herniated through the inguinal region below the external oblique aponeurosis. Surgery was performed when the patient was 23 months old. Laparoscopic examination to identify the hernia orifice revealed that it was the deep inguinal ring, and the testicular vessels and the vas deferens passed beneath the hernia sac. An inguinal incision was made, and a hernia sac was observed passing through the deep inguinal ring and extending superiorly below the aponeurosis. The testis was found in the hernia sac. Traditional inguinal herniorrhaphy and traditional orchidopexy were performed, and the postoperative course was uneventful. It is difficult to understand the surgical anatomy of interparietal hernias, but once the surgical anatomy is understood, surgical repair is simple. We report the case with a review of the literature and also emphasize that laparoscopic exploration is helpful during surgery. PMID:23868739

Hirabayashi, Takeshi; Ueno, Shigeru

2013-07-01

290

Surgical management of sportsman's hernia in professional soccer players.  

PubMed

Soccer players frequently experience acute and chronic groin pain. Sportsman's hernia is a common injury in professional soccer players, that causes inguinal pain. The authors discuss their experience with the management of sportsman's hernia in professional soccer players competing in national and international competition in a retrospective review of prospectively collected data. Between March 2004 and December 2009, seventy-one professional soccer players were surgically treated for sportsman's hernia. Average age at surgery was 24 years, and average duration of symptoms from onset to surgical repair was 11 months. Conservative treatment improved symptoms temporarily or to some extent in 18 athletes. All athletes underwent a bilateral open hernia repair with concurrent adductor tendon release. Average follow-up was 4 years, and average time to return to competitive sport was 4 months. At final follow-up, 95% of soccer players were still active, 48 at the same level and 19 at a lower level. Four athletes had stopped their careers because of another injury (n=2) or recurrence (n=2). Sportsman's hernia is a potentially career-ending injury in professional soccer players. Conservative management is often unsuccessful. An open surgical hernia repair combined with an adductor longus tenotomy relieves the symptoms caused by a sportsman's hernia and restores activity in 95% of athletes. This study offers insight into the management of sportsman's hernia and offers a successful treatment to salvage the careers of professional soccer players. PMID:22955404

Messaoudi, Nouredin; Jans, Christophe; Pauli, Steven; Van Riet, Roger; Declercq, Geert; Van Cleemput, Marc

2012-09-01

291

Total costs of laparoscopic and lichtenstein inguinal hernia repairs: a randomized prospective study.  

PubMed

In a prospective, randomized study, laparoscopic (n = 20) and Lichtenstein (n = 18) inguinal hernia repairs were compared in relation to operative time, operative costs, hospital stay, postoperative pain, return to work, patient satisfaction, complications, and total costs. All the operations were performed with the patient under general anesthesia. The median operative times in the laparoscopic and Lichtenstein groups were 71.5 (range, 43-140) and 45 (16-83) min, respectively (p < 0.001). Postoperative pain and use of analgesics was less in the laparoscopic group. The median time to return to work was 14 (8-26) days in the laparoscopic group and 19 (5-40) days in the Lichtenstein group. More complications occurred in the Lichtenstein group. The median of the operative costs, in U.S. dollars, was $1,395 and $878, respectively, and the median total costs (including community expenses resulting from lost workdays) were $4,796 in the laparoscopic and $5,320 in the Lichtenstein groups. PMID:9116938

Heikkinen, T; Haukipuro, K; Leppälä, J; Hulkko, A

1997-02-01

292

No-mesh Inguinal Hernia Repair with Continuous Absorbable Sutures: A Dream or Reality? (A Study of 229 Patients)  

PubMed Central

Background/Aim The author has published results from two series based on his new technique of inguinal hernia repair. Interrupted sutures with a nonabsorbable material were used for repairs in both theses series. The author now describes the results of repairs done with continuous absorbable sutures. Materials and Methods This is a prospective study of 229 patients having 256 hernias operated from December 2003 to December 2006. An undetached strip of the external oblique aponeurosis was sutured between the inguinal ligament and the muscle arch to form the new posterior wall. Continuous sutures were taken with absorbable suture material (Monofilament Polydioxanone Violet). Data of hospital stay, complications, ambulation, recurrences, and pain were recorded. Follow-up was done until June 2007. Results A total of 224 (97.8%) patients were ambulatory within 6-8 h (mean: 6.42 h) and they attained free ambulation within 18-24 h (mean: 19.26 h). A total of 222 (96.4%) patients returned to work within 6-14 days (mean: 8.62 days) and 209 (91.26%) patients had one-night stays in the hospital. A total of 216 (94.3%) patients had mild pain for 2 days. There were four minor complications, but no recurrence or incidence of chronic groin pain. Patients were followed up for a mean period of 24.28 months (range: 6-42 months). Conclusions The results of this study correlate well with the author's previous publications. Continuous suturing saves operative time and one packet of suture material. The dream of every surgeon to give recurrence-free inguinal hernia repair without leaving any foreign body inside the patient may well become a reality in future. PMID:19568520

Desarda, Mohan P.

2008-01-01

293

Repair of giant subcostal hernia using porcine acellular dermal matrix (Strattice(TM)) with bone anchors and pedicled omental flap coverage: a case report  

PubMed Central

Introduction Giant abdominal wall hernias represent a major challenge to the hernia surgeon in practice today. Of the common abdominal wall hernias, those located in the subcostal region are among the most difficult to repair, and have historically been plagued by higher recurrence rates than other locations, such as the midline. No technique has been identified as the clearly superior choice for hernias of this type. Case presentation We report a successful repair of a giant, multiply recurrent subcostal hernia with loss of domain in a 45-year-old obese Caucasian man. This was accomplished in a novel fashion, using a porcine acellular dermal matrix (Strattice™) as the floor of the repair, which was fixed to the costal margin using orthopedic bone anchors (Mitek™), then covered with a pedicled omental flap to eliminate dead space and facilitate a more rapid revascularization of the porcine acellular dermal matrix implant. Conclusions This case emphasizes the need for a thorough understanding of the challenges of the specific type of hernia defect encountered, as well as knowledge of any available techniques that may be adjunctively employed to enhance the chances of achieving a successful result. PMID:24215723

2013-01-01

294

Simultaneous adenomectomy and preperitoneal repair of inguinal hernias by a single incision with the application of polypropylene mesh.  

PubMed

Preperitoneal inguinal herniorraphy in conjuction with other pelvic procedures has been described in the literature, but it has not gained wide popularity mainly due to the high recurrence rate. Recently, there has been a resurgence of interest in the preperitoneal repair of inguinal hernias with the application of mesh on the deficiency of the inguinal wall using the method commonly known as the Stoppa procedure. We evaluated the results and complications of 22 patients who underwent open surgical prostatectomy (adenomectomy) and simultaneous preperitoneal application of polypropylene mesh. Nineteen (86.4%) patients suffered from unilateral inguinal hernia whereas the remaining 3 (13.6%) had bilateral protrusions. Primary hernias only and not recurrences were included in our series. The median clinical follow-up was 20.4 months (range 9-50 months). The hernioplasty itself prolonged the whole procedure for only a few minutes and it did not affect the patients' hospitalization time (mean 6.7 days). Wound infection with subsequent development of cutaneous fistula occurred in one patient (4.5%) and treated conservatively. During follow-up one recurrence (4.5%) at the side of the previous repair of the left inguinal hernia was recorded; the protrusion was insignificant and left untreated. In all but one patient (21/22, 95.5%), the surgical results were excellent. In our experience, simultaneous transvesical adenomectomy and mesh preperitoneal hernioplasty is a convenient and safe procedure which can easily be performed by urologists in just a few minutes. The procedure which is both cost and time effective for the surgeon, achieves long-lasting beneficial results for the vast majority of patients. PMID:14620277

Filiadis, I; Hastazeris, K; Tsimaris, I; Papadopoulos, A; Kakoulidis, S; Stavropoulos, N E

2003-01-01

295

Surgical Treatment of a Parastomal Hernia  

PubMed Central

Purpose Parastomal hernia is a major complication of an intestinal stoma. This study was performed to compare the results of various operative methods to treat parastomal hernias. Methods Results of surgical treatment for parastomal hernias (postoperative recurrence, complications and postoperative hospital stays) were surveyed in 39 patients over an 11-year period. The patients enrolled in this study underwent surgery by a single surgeon to exclude surgeon bias. Results Seventeen patients were male, and twenty-two patients were female. The mean age was 65.9 years (range, 36 to 86 years). The stomas were 35 sigmoid-end-colostomies (90%), 2 loop-colostomies (5%), and 2 double-barrel-colostomies. Over half of the hernias developed within two years after initial formation. Stoma relocation was performed in 8 patients, suture repair in 14 patients and mesh repair in 17 patients. Seven patients had recurrence of the hernia, and ten patients suffered from complications. Postoperative complications and recurrence were more frequent in stoma relocation than in suture repair and mesh repair. Emergency operations were performed in four patients (10.3%) with higher incidence of complications but not with increased risk of recurrence. Excluding emergency operations, complications of relocations were not higher than those of mesh repairs. Postoperative hospital stays were shortest in mesh repair patients. Conclusion In this study, mesh repair showed low recurrence and a low complication rate with shorter hospital stay than relocation methods, though these differences were not statistically significant. Further studies, including randomized trials, are necessary if more reliable data on the surgical treatment of parastomal hernias are to be obtained. PMID:21980587

Heo, Seung Chul; Oh, Heung-Kwon; Song, Yoon Suk; Seo, Mi Sun; Choe, Eun Kyung; Ryoo, Seungbum

2011-01-01

296

The Glubran 2 glue for mesh fixation in Lichtenstein's hernia repair: a double-blind randomized study  

PubMed Central

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 hernia repair 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. PMID:23256009

D?browiecki, Stanis?aw; Pier?ci?ski, Stanis?aw

2012-01-01

297

Incidence of Incisional Hernia after Cesarean Delivery: A Register-Based Cohort Study  

PubMed Central

Objective To estimate the incidence of incisional hernias requiring surgical repair after cesarean delivery over a 10-year period. Methods This population- and register-based cohort study identified all women in Denmark with no history of previous abdominal surgery who had a cesarean delivery between 1991 and 2000. The cohort was followed from their first until 10 years after their last cesarean delivery within the inclusion period or until the first of the following events: hernia repair, death, emigration, abdominal surgery, or cesarean delivery after the inclusion period. For women who had a hernia repair, hospital records regarding the surgery and previous cesarean deliveries were tracked and manually analyzed to validate the relationship between hernia repair and cesarean delivery. Data were analyzed with a competing risk analysis that included each cesarean delivery. Results We identified 57,564 women who had had 68,271 cesarean deliveries during the inclusion period. During follow-up, 134 of these women had a hernia requiring repair. Of these 68 (51% [95% CI 42–60%]) were in a midline incision although the transverse incision was the primary approach at cesarean delivery during the inclusion period. The cumulated incidence of a hernia repair within 10 years after a cesarean delivery was 0.197% (95% CI 0.164–0.234%). The risk of a hernia repair was higher during the first 3 years after a cesarean delivery, with an incidence after 3 years of 0.157% (95% CI 0.127–0.187%). Conclusions The overall risk of an incisional hernia requiring surgical repair within 10 years after a cesarean delivery was 2 per 1000 deliveries in a population in which the transverse incision was the primary approach at cesarean delivery. PMID:25268746

Aabakke, Anna J. M.; Krebs, Lone; Ladelund, Steen; Secher, Niels J.

2014-01-01

298

Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials  

PubMed Central

Objective: The objective of this article is to systematically analyse the randomized, controlled trials comparing transinguinal preperitoneal (TIPP) and Lichtenstein repair (LR) for inguinal hernia. Methods: Randomized, controlled trials comparing TIPP vs LR were analysed systematically using RevMan® and combined outcomes were expressed as risk ratio (RR) and standardized mean difference. Results: Twelve randomized trials evaluating 1437 patients were retrieved from the electronic databases. There were 714 patients in the TIPP repair group and 723 patients in the LR group. There was significant heterogeneity among trials (P < 0.0001). Therefore, in the random effects model, TIPP repair was associated with a reduced risk of developing chronic groin pain (RR, 0.48; 95% CI, 0.26, 0.89; z = 2.33; P < 0.02) without influencing the incidence of inguinal hernia recurrence (RR, 0.18; 95% CI, 0.36, 1.83; z = 0.51; P = 0.61). Risk of developing postoperative complications and moderate-to-severe postoperative pain was similar following TIPP repair and LR. In addition, duration of operation was statistically similar in both groups. Conclusion: TIPP repair for inguinal hernia is associated with lower risk of developing chronic groin pain. It is comparable with LR in terms of risk of hernia recurrence, postoperative complications, duration of operation and intensity of postoperative pain. PMID:24759818

Sajid, Muhammad S.; Craciunas, L.; Singh, K.K.; Sains, P.; Baig, M.K.

2013-01-01

299

Laparoscopic Treatment of Subxiphoid Incisional Hernias in Cardiac Transplant Patients  

PubMed Central

Background: Symptomatic subxiphoid incisional hernias present difficult surgical problems, especially in immuno-suppressed cardiac transplant patients. Here, we describe the laparoscopic repair of subxiphoid incisional hernias in patients with a history of cardiac transplantation. Methods: Four patients with subxiphoid hernias who had previously undergone heart transplantation were identified from a prospective database. Each underwent a laparoscopic repair with mesh implantation. Results: Three patients had a previous open repair. The mean age was 62.5 years, an average of 64.3 months after transplantation. At the time of surgery, all patients were immunosuppressed, and each had a subxiphoid, poststernotomy incisional hernia. Gore dual mesh was used in 2 patients, while Parietex mesh was used in 2. Mean operative time was 122 minutes, and all were completed laparoscopically. The mean length of stay was 6.5 days, and the mean defect size was 286.25 cm2. There was a significant correlation between hernia size and length of stay (P=0.037). Postoperatively, one patient (25%) developed pulmonary edema, and 1 patient (25%) had a prolonged ileus. Conclusion: Symptomatic subxiphoid incisional hernias are a challenging surgical problem in patients with a history of sternotomy. Laparoscopic repair is safe and effective in immunosuppressed patients who have previously undergone cardiac transplantation. PMID:18765049

Popescu, Wanda M.; Duffy, Andrew J.; Bell, Robert L.

2008-01-01

300

[Anesthesia for non-cardiac surgery after Fontan repair].  

PubMed

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

Mauriat, P; Tafer, N

2013-01-01

301

Effectiveness of mesh hernioplasty in incarcerated inguinal hernias  

PubMed Central

Introduction The use of mesh is still controversial in patients undergoing emergency incarcerated hernia repair, mostly because of potential infectious complications. Aim The main aim of this study was to assess the efficacy of tension-free methods in treating incarcerated inguinal hernias (IIH), with and without intestine resection. The secondary aim was to establish an algorithm on how to proceed with incarcerated hernias. Material and methods A retrospective analysis of patients who underwent surgery due to an inguinal hernia at the First Department of General Surgery Jagiellonian University Medical College in Krakow, in the period 1999–2009. Operative methods included Lichtenstein, Robbins-Rutkow and Prolene Hernia System. The rate of postoperative complications was compared in patients who underwent elective and emergency surgery. Results The study group consisted of 567 patients (546 male) age 19–91 years. In this group 624 hernias were treated using the three tension-free techniques – 295 using the Lichtenstein method, 236 using PHS and 93 using the RR technique. Out of the 561 operations 89.9% were elective. No correlation (p > 0.05) was found between the type of surgery and such complications as postoperative pain duration and intensity, fever, micturation disorders, wound healing disorders, testicle hydrocoele, testicle atrophy, spermatic cord cyst, sexual dysfunction, wound dehiscence, wound suppuration, seroma, haematoma and hernia recurrence. Conclusions Mesh repairs can be safely performed while operating due to an IIH. The use of a synthetic implant, in emergency IIH repairs, does not increase the rate of local complications. Synchronous, partial resection of the small intestine, due to intestinal necrosis, is not a contraindication to use mesh.

Kamtoh, Georges; Kibil, Wojciech; Matyja, Andrzej; Solecki, Rafal; Banas, Bartlomiej; Kulig, Jan

2014-01-01

302

Treatment of unfavourable results of flexor tendon surgery: Ruptured repairs, tethered repairs and pulley incompetence  

PubMed Central

As primary repair of divided flexor tendons becomes more common, secondary tendon surgery becomes largely that of the complications of primary repair, namely ruptured and adherent repairs. These occur with an incidence of each in most reported series world-wide of around 5%, with these problems having changed little in the last two decades, despite strengthening our suture repairs. Where the primary referral service is less well-developed, and as a more occasional occurrence where primary treatment is the routine, the surgeon faces different problems. Patients arrive at a hand unit variable, but longer, times after the primary insult, having had no, or bad, previous treatment. Sometimes the situation is the same, viz. an extended finger with no active flexion, but now no longer amenable to primary repair. Frequently, it is much more complex as a result of injuries to the other tissues of the digit and, also, as a result of the unaided healing process within the digit in the presence of an inactive flexor system. We present our experience in dealing with ruptured repairs, tethered repairs and pulley incompetence. PMID:24459333

Elliot, David; Giesen, Thomas

2013-01-01

303

Hydrocele repair  

MedlinePLUS

... Sometimes they form when there is also a hernia (an abnormal bulging of tissue) present. Hydroceles are ... muscle wall with stitches. This is called a hernia repair. Sometimes the surgeon uses a laparoscope to ...

304

Repair of massive inguinal hernia with loss of abdominal domain using laparoscopic component separation technique  

PubMed Central

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. PMID:24964420

Hamad, Ahmed; Marimuthu, Kanagaraj; Mothe, Bhavani; Hanafy, Magdi

2013-01-01

305

[Perineal hernia: an undescribed complication following operative repair of vault vaginal prolaps].  

PubMed

The presented case reports the treatment of a 80-year-old V gravida IV para suffering from a large perineal hernia and rectocele after vaginal hysterectomy and subsequently performed threefold colpocleisis due to recurrent vault vaginal prolaps.[nl]Since perioperative morbidity and mortality of geriatric patients differ not significantly from thoses of younger women age should not be used as an argument to withhold elderly organ preserving operative strategies with low recurrence rates. PMID:14981567

Bussen, D; Broscheit, J; Bussen, S; Kenn, W; Fuchs, K-H; Sailer, M

2004-02-01

306

Open versus laparoscopic incisional hernia repair: something different from a meta-analysis  

Microsoft Academic Search

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

2008-01-01

307

Surgical management of inguinal hernia.  

PubMed

The Lichtenstein repair is now the gold standard for open hernia repairs. This repair is easier to learn and easy to implement for the average general surgeon. Open mesh repairs are not the end-all in hernia operations, however, and surgeons must retain the knowledge for open tissue-based procedures. Laparoscopic inguinal hernia repair is a safe alternative to open repair for inguinal hernias but is much more operator dependent. Open mesh repair has a lower recurrence rate when compared with TEP or TAPP repairs for less experienced laparoscopists. Laparoscopic repair has a quicker return to work, is associated with less postoperative pain, and has a better cosmetic result. It is more difficult to learn, however, and hospital costs are higher. Surgeons need to look at their own numbers and experience to decide which approach is better given the clinical situation based on their proficiency with the various techniques. PMID:17163110

Reuben, Brian; Neumayer, Leigh

2006-01-01

308

Impact of the establishment of a specialty hernia referral center.  

PubMed

Background. Creating a surgical specialty referral center requires a strong interest, expertise, and a market demand in that particular field, as well as some form of promotion. In 2004, we established a tertiary hernia referral center. Our goal in this study was to examine its impact on institutional volume and economics. Materials and methods. The database of all hernia repairs (2004-2011) was reviewed comparing hernia repair type and volume and center financial performance. The ventral hernia repair (VHR) patient subset was further analyzed with particular attention paid to previous repairs, comorbidities, referral patterns, and the concomitant involvement of plastic surgery. Results. From 2004 to 2011, 4927 hernia repairs were performed: 39.3% inguinal, 35.5% ventral or incisional, 16.2% umbilical, 5.8% diaphragmatic, 1.6% femoral, and 1.5% other. Annual billing increased yearly from 7% to 85% and averaged 37% per year. Comparing 2004 with 2011, procedural volume increased 234%, and billing increased 713%. During that period, there was a 2.5-fold increase in open VHRs, and plastic surgeon involvement increased almost 8-fold, (P = .004). In 2005, 51 VHR patients had a previous repair, 27.0% with mesh, versus 114 previous VHR in 2011, 58.3% with mesh (P < .0001). For VHR, in-state referrals from 2004 to 2011 increased 340% while out-of-state referrals jumped 580%. In 2011, 21% of all patients had more than 4 comorbidities, significantly increased from 2004 (P = .02). Conclusion. The establishment of a tertiary, regional referral center for hernia repair has led to a substantial increase in surgical volume, complexity, referral geography, and financial benefit to the institution. PMID:24733063

Williams, Kristopher B; Belyansky, Igor; Dacey, Kristian T; Yurko, Yuliya; Augenstein, Vedra A; Lincourt, Amy E; Horton, James; Kercher, Kent W; Heniford, B Todd

2014-12-01

309

Placement of a Non–Cross-Linked Porcine-Derived Acellular Dermal Matrix During Preperitoneal Laparoscopic Inguinal Hernia Repair  

PubMed Central

This retrospective chart review evaluated outcomes following laparoscopic inguinal herniorrhaphies with non–cross-linked intact porcine-derived acellular dermal matrix (PADM) by one surgeon in a community teaching facility hospital. Mesh was sutured and/or tacked in the preperitoneal space. Postoperative visits were scheduled at 2 weeks, 3 months, and 6 months, and then at 6-month intervals up to 2 years. PADM was placed in 14 male patients (mean age, 41.1 years). Seven patients had bilateral hernias. One patient required intraoperative conversion to open herniorrhaphy based on diagnostic laparoscopy findings. PADM sizes were 6 × 10 to 12 × 16 cm; mean operative time was 102 minutes. All patients were discharged on the day of surgery and resumed full activity. This treatment approach was effective, with no recurrence or complications during a median follow-up period of 18 months (range, 13–25 months). PMID:23701148

Alshkaki, Giath

2013-01-01

310

Advantages of new materials in fascia transversalis reinforcement for inguinal hernia repair  

Microsoft Academic Search

Purpose  We investigated whether new absorbable materials can be used in the treatment of inguinal hernia with the same efficacy as\\u000a the traditionally used polypropylene.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We compared local tissue inflammation and fibrous reaction, postoperative complications (bleeding, wound haematoma, wound\\u000a infection) and postoperative recovery time (time of mobilisation) in rats (Fischer strain) after implantation of a polypropylene\\u000a mesh (PPM) (Prolene, Ethicon, Bracknell,

N. Arslani; L. Patrlj; M. Kopljar; Z. Rajkovi?; S. Altarac; D. Papeš; D. Štritof

2010-01-01

311

Single-incision laparoscopic trans-abdominal pre-peritoneal mesh hernia repair: a feasible approach  

Microsoft Academic Search

Background  Single-incision laparoscopic surgery (SILS) is aimed at improving the cosmetic outcome following surgery. If the incision\\u000a is made through the umbilicus, the surgery is almost ‘scarless.’ This is increasingly being used for laparoscopic cholecystectomy\\u000a with good cosmetic results without compromising the safety of the operation. The challenge of this surgery lies in manipulating\\u000a instruments within the limitations of the closely

S. H. Rahman; B. J. John

2010-01-01

312

Sciatic hernia clinically mimicking obturator hernia, missed by ultrasonography: case report.  

PubMed

Sciatic hernia is a rare pelvic floor hernia that occurs through the greater or lesser sciatic foramen. Sciatic hernias often present as pelvic pain, particularly in women, and diagnosis can be difficult. Sciatic hernia is one of the rarest forms of internal hernia, which can present as signs and symptoms of small bowel obstruction, swelling in the respective gluteal region or pelvic pain. Transabdominal and transgluteal operative approaches, including laparoscopic repair, have been reported. We present a case of left-sided sciatic hernia with incarcerated small bowel as its contents. The hernia was missed by ultrasonography and plain abdominal radiography, but the clinical features were suggestive of an obturator hernia. PMID:21935810

Rather, Shiraz Ahmad; Dar, Tanveer Iqbal; Malik, Aijaz Ahmad; Parray, Fazal Q; Ahmad, Mukhtar; Asrar, Syed

2011-05-01

313

The treatment of Spigelian hernia with the Prolene Hernia System: notes on techniques.  

PubMed

Spigelian hernia repair techniques use prostheses both in the traditional and the videolaparoscopic approach; only in selected cases direct suturing of the parietal defect is performed. The aim of this study is to describe a technique that uses a device proposed specifically for inguinal hernias, but which has not yet been described in the literature, namely the Prolene Hernia System (P.H.S.). Our personal experience consists of 7 cases (5 females and 2 males; mean age: 58 years) operated on from January 2002 to May 2003. Four patients were operated on in the ordinary hospitalisation regime with selective spinal anaesthesia and three patients were treated in the day surgery setting with local anaesthesia. With this technique, the underlay patch is positioned in an adequately prepared preperitoneal space and the onlay patch above the internal oblique muscle, while the connector acts as a plug positioned in the parietal defect. The method has proved simple, safe, and fast. It causes minimal discomfort to the patient in terms of postoperative pain and allows rapid rehabilitation. Moreover, it can also be performed in the day surgery setting. The authors conclude that the P.H.S. Spigelian hernia repair technique is a valid alternative to any of the other methods used to date. PMID:15152521

Licheri, Sergio; Pisano, Giuseppe; Pintus, Michele; Erdas, Enrico; Martinasco, Luca; Pomata, Mariano; Daniele, Giovanni Maria

2004-01-01

314

A De Garengeot Hernia masquerading as a strangulated femoral hernia  

PubMed Central

INTRODUCTION De Garengeot hernia is a rare occurrence whereby an appendix is found in a femoral hernia sac. It is rarer still to find an acutely inflamed appendix manifesting itself as a strangulated femoral hernia. This case is important to report as it highlights the diagnostic difficulty this particular condition presents to an emergency surgeon. PRESENTATION OF CASE We report the case of an 86 year old female who was found to have a De Garengeot hernia containing a necrotic appendix. A retrograde appendicectomy was performed to prevent peritoneal contamination. The hernia defect was repaired using a standard repair with non-absorbable suture. DISCUSSION De Garengeot's hernia is a rare occurrence, is often unexpected and tends to be diagnosed intra-operatively. Pre-operative diagnosis remains difficult and it will often masquerade as a strangulated femoral hernia. In stable patients, where there is a diagnostic uncertainty CT scanning is a useful adjunct and may allow a laparoscopic approach to be undertaken in the absence of appendicitis. CONCLUSION A De Garengeot's hernia should be considered as a differential diagnosis in patients presenting with clinical signs of a strangulated femoral hernia. It is often an incidental finding during an emergency operation. Although mesh repairs in the presence of appendicitis have been reported, the safest approach remains a primary suture repair. PMID:25194597

Hussain, A.; Slesser, A.A.P.; Monib, S.; Maalo, J.; Soskin, M.; Arbuckle, J.

2014-01-01

315

Mechanical behaviour of the implant used in human hernia repair under physiological loads.  

PubMed

In laparoscopic operations of abdominal hernias some recurrences still take place, even when applying a surgical mesh. This is usually caused by a failure of the connection between the tissue and the implant. The study deals with the influence of an implant's orientation on forces in joints, which connect the mesh to human tissues. In the paper, the implant is modelled as a membrane structure within framework of the Finite Element Method. Two models are analysed: in the first one interaction between the mesh and a fascia is taken into account, in the second this interaction is not considered. Computations are conducted for two different material types of the implants: one with isotropic properties and second one with orthotropic properties. The models are validated by comparing dynamic numerical analysis with experimental outcomes, where load was simulating intraabdominal pressure during postoperative cough. Due to displacements of joints during activities like bending sideways or torsion of an abdomen, influence of kinematic extortions on forces in the joints is analysed. The outcome shows that position of the orthotropic implants is crucial and may strongly change the level of forces in the joints. PMID:24215128

Szepietowska, Katarzyna; Lubowiecka, Izabela

2013-01-01

316

A Multicentric Comparison of Transabdominal versus Totally Extraperitoneal Laparoscopic Hernia Repair using PARIETEX® Meshes  

PubMed Central

The authors report a series of 1972 inguinal hernias treated between 1993 and 1997 by the insertion of a PARIETEX® mesh via either a transabdominal-preperitoneal (TAPP) (1290 procedures) or a totally extraperitoneal TEP approach (682 procedures). Pain scores were equivalent in both groups, while the hospital stay and time to return to normal activity was lower in the TEP group than in the TAPP group (p<0.001). In both groups, the average incidence of the total reported events (complications) was around 10% with no statistical difference. This ratio seemed to compare favorably to previously published reports. Chronic pain was extremely rare (0.6% and 0.7% in the TAPP and TEP groups, respectively). Whatever the approach was, sepsis was also very rare (1/1526 laparoscopic procedures). These findings illustrate the local tolerance of the mesh. Recurrence rates were below 1% with no statistical difference between groups. This retrospective study demonstrates the clinically apparent local tolerance of this type of mesh. Prospective and long-term clinical results will be necessary to demonstrate that the optimized short-term tolerance of PARIETEX® mesh will influence the long term functional results. PMID:10917122

Benchetrit, S.; Debaert, M.; Detruit, B.; Dufilho, A.; Gaujoux, D.; Lagoutte, J.; Leon, L. Martin Saint; d'Escurac, X. Pavis; Rico, E.; Sorrentino, J.; Therin, J.

2000-01-01

317

Heparinized collagen scaffolds with and without growth factors for the repair of diaphragmatic hernia  

PubMed Central

A regenerative medicine approach to restore the morphology and function of the diaphragm in congenital diaphragmatic hernia is especially challenging because of the position and flat nature of this organ, allowing cell ingrowth primarily from the perimeter. Use of porous collagen scaffolds for the closure of surgically created diaphragmatic defects in rats has been shown feasible, but better ingrowth of cells, specifically blood vessels and muscle cells, is warranted. To stimulate this process, heparin, a glycosaminoglycan involved in growth factor binding, was covalently bound to porous collagenous scaffolds (14%), with or without vascular endothelial growth factor (VEGF; 0.4 µg/mg scaffold), hepatocyte growth factor (HGF; 0.5 µg/mg scaffold) or a combination of VEGF + HGF (0.2 + 0.5 µg/mg scaffold). All components were located primarily at the outside of scaffolds. Scaffolds were implanted in the diaphragm of rats and evaluated after 2 and 12 weeks. No herniations or eventrations were observed, and in several cases, growth factor-substituted scaffolds showed macroscopically visible blood vessels at the lung site. The addition of heparin led to an accelerated ingrowth of blood vessels at 2 weeks. In all scaffold types, giant cells and immune cells were present primarily at the liver side of the scaffold, and immune cells and individual macrophages at the lung side; these cell types decreased in number from week 2 to week 12. The addition of growth factors did not influence cellular response to the scaffolds, indicating that further optimization with respect to dosage and release profile is needed. PMID:23867845

Brouwer, Katrien M; Wijnen, Rene M; Reijnen, Daphne; Hafmans, Theo G; Daamen, Willeke F; van Kuppevelt, Toin H

2013-01-01

318

The effect of ultrapro or prolene mesh on postoperative pain and well-being following endoscopic Totally Extraperitoneal (TEP) hernia repair (TULP): study protocol for a randomized controlled trial  

PubMed Central

Background The purpose of this study was to describe the rationale and design of a randomized controlled trial analyzing the effects of mesh type (Ultrapro versus Prolene mesh) on postoperative pain and well-being following an endoscopic Totally Extraperitoneal (TEP) repair for inguinal hernias (short: TULP trial). Methods and design The TULP trial is a prospective, two arm, double blind, randomized controlled trial to assess chronic postoperative pain and quality of life following implantation of a lightweight (Ultrapro) and heavyweight (Prolene) mesh in endoscopic TEP hernia repair. The setting is a high-volume single center hospital, specializing in TEP hernia repair. All patients are operated on by one of four surgeons. Adult male patients (?18?years of age) with primary, reducible, unilateral inguinal hernias and no contraindications for TEP repair are eligible for inclusion in the study. The primary outcome is substantial chronic postoperative pain, defined as moderate to severe pain persisting???3?months postoperatively (Numerical Rating Scale, NRS 4–10). Secondary endpoints are the individual development of pain until three years after the TEP procedure, the quality of life (QoL), recurrence rate, patient satisfaction and complications. Discussion Large prospective randomized controlled studies with a long follow-up evaluating the incidence of chronic postoperative pain following implantation of lightweight and heavyweight mesh in endoscopic (TEP) hernia repair are limited. By studying the presence of pain and quality of life, but also complications and recurrences in a large patient population, a complete efficiency and feasibility assessment of both mesh types in TEP hernia repair will be performed. Trial registration The TULP study is registered in the Dutch Trial Register (NTR2131) PMID:22676248

2012-01-01

319

Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair  

Microsoft Academic Search

Background  The purpose of this study was to characterize the adhesion characteristics of absorbable- and nonabsorbable-barrier-coated\\u000a meshes and to report adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Under an IRB-approved protocol, patients undergoing laparoscopic re-exploration after prior intraperitoneal mesh placement\\u000a were prospectively graded intraoperatively for adhesion tenacity (0-4), adhesion surface area (0 = 0%, 10 = 100%), and ratio\\u000a of adhesiolysis time

Eric D. Jenkins; Victoria Yom; Lora Melman; L. Michael Brunt; J. Christopher Eagon; Margaret M. Frisella; Brent D. Matthews

2010-01-01

320

Laparoscopic repair of inguinal hernias using an intraperitoneal onlay mesh technique and a Parietex composite mesh fixed with fibrin glue (Tissucol). Personal technique and preliminary results  

Microsoft Academic Search

Introduction  Laparoscopic repair of inguinal hernias is usually achieved by totally extraperitoneal (TEP) or transabdominal preperitoneal\\u000a (TAPP) techniques. The intraperitoneal onlay mesh (IPOM) could be an interesting alternative as it is much easier to perform\\u000a and faster to execute. This technique is subject to correct selection of indications and to demonstration of its safety.\\u000a \\u000a \\u000a \\u000a Materials and methods  From January 2003 to January

Stefano Olmi; Alberto Scaini; Luigi Erba; Aimone Bertolini; Enrico Croce

2007-01-01

321

Mycobacterium chelonae causing chronic wound infection and abdominal incisional hernia.  

PubMed

Mycobacterium chelonae is a rapidly growing mycobacterium that is found all over the environment, including sewage and tap water. They are important species associated with chronic non-healing wounds. We report a case in a 41 year old female patient who underwent multiple surgeries for an ovarian cyst, tubo-ovarian abscesses with peritonitis and a repair of an abdominal incisional hernia. PMID:24943783

Verghese, Susan; Agrawal, Parag; Benjamin, Santosh

2014-01-01

322

Randomized, controlled, blinded trial of Tissucol\\/Tisseel for mesh fixation in patients undergoing Lichtenstein technique for primary inguinal hernia repair: rationale and study design of the TIMELI trial  

Microsoft Academic Search

Background  Complications associated with sutured mesh fixation following open groin hernia repair have prompted surgeons to evaluate\\u000a methods of atraumatic fixation such as the use of human fibrin glue. Small trials with Tissucol\\/Tisseel fibrin glue (Baxter\\u000a Healthcare, Deerfield, IL, USA) have shown promising results that warrant further investigation.\\u000a \\u000a \\u000a \\u000a Methods  TIMELI (Tissucol\\/Tisseel for MEsh fixation in LIchtenstein hernia repair) is an international, controlled,

G. Campanelli; G. Champault; M. Hidalgo Pascual; A. Hoeferlin; A. Kingsnorth; J. Rosenberg; M. Miserez

2008-01-01

323

Inguinal Hernia  

MedlinePLUS

... Conditions > Abdominal > Inguinal Hernia Health Issues Listen Inguinal Hernia Article Body If you notice a small lump ... the scrotum, you may have discovered an inguinal hernia. This condition, which is present in up to ...

324

A combined Richter's and de Garengeot's hernia  

PubMed Central

INTRODUCTION de Garengeot's hernia is very rare. Richter's hernia is responsible for 10% of acute strangulated hernias. PRESENTATION OF CASE A 91-year-old woman with three days of abdominal distention was found on computed tomogram to have an incarcerated femoral hernia. Operation revealed a de Garengeot's hernia combined with a Richter's hernia of small bowel. Primary repair was performed along with appendectomy. DISCUSSION We discuss these rare hernias, not previously reported in combination, and options for management. CONCLUSION Combined de Garengeot's and Richter's hernias are rare, represent a significant diagnostic challenge, and should be repaired urgently to prevent ischemic bowel, or limit contamination if ischemia is already present. Use of computed tomography will likely lead to increased pre-operative diagnosis of this rare entity. PMID:25194599

Le, Hau D.; Odom, Stephen R.; Hsu, Albert; Gupta, Alok; Hauser, Carl J.

2014-01-01

325

Understanding noninguinal abdominal hernias in the athlete.  

PubMed

Abdominal hernias are common with over 20 million hernia repairs performed worldwide. Inguinal hernias are the most common type of hernia. Inguinal and sports hernia have been discussed at length in recent literature, and therefore, they will not be addressed in this article. The noninguinal hernias are much less common but do occur, and knowledge of these hernias is important when assessing the athlete with abdominal pain. Approximately 25% of abdominal wall hernias are noninguinal, and new data show the order of frequency as umbilical, epigastric, incisional, femoral, and all others (i.e., Spigelian, obturator, traumatic). Return-to-play guidelines need to be tailored to the athlete and the needs of their sport. Using guidelines similar to abdominal strain injuries can be a starting point for the treatment plan. Laparoscopic repair is becoming more popular because of safety and efficacy, and it may lead to a more rapid return to play. PMID:24614421

Cabry, Robert J; Thorell, Erik; Heck, Keith; Hong, Eugene; Berkson, David

2014-01-01

326

Laparoscopic extraperitoneal repair of inguinofemoral herniation.  

PubMed

This report describes my group's experience with repairing 100 direct and indirect inguinal hernias using a solely extraperitoneal, laparoscopic prosthetic procedure. No unusual complications were noted and all patients were discharged on the day of or the day following surgery and resumed normal activities within one week. The surgical technique is outlined, with attention given to general guidelines performing this minimally invasive repair procedure. PMID:8050020

McKernan, J B

1993-08-01

327

A less invasive surgery for rotator cuff tear: Mini-open repair  

Microsoft Academic Search

As a less invasive surgery of the shoulder, the mini-open repair was carried out from March 1997 through December 1998 in 22 patients (mini-open repair group) for all types of rotator cuff tears, except massive tears. A transacromial skin incision about 3 cm long was made. The anterior deltoid was split along its muscle fibers, and an anterior acromioplasty was

Yukihiko Hata; Satoru Saitoh; Narumichi Murakami; Hiroshi Seki; Yukio Nakatsuchi; Kunio Takaoka

2001-01-01

328

Laparoscopic treatment of inguinal hernias. A personal approach.  

PubMed

Laparoscopic hernia repair has suffered from a lack of careful anatomical appreciation and the application of sound surgical principles. Key anatomical landmarks which must be clearly identified in every hernia repair are Cooper's ligament, the umbilical artery and the epigastric vessels. The preperitoneal transabdominal mesh repair is the technique advocated by the authors. Between January 1991 and February 1993, 180 hernias were repaired. One hernia has recurred. Morbidity was minimal, with no major complication. The hospital stay was 1.3 days and the majority of patients returned rapidly to full activity. The best indications for laparoscopic hernia repair are recurrent hernias, a large hernia in patients with a weak muscular abdominal wall and bilateral hernias, for which the technique is considered ideal. PMID:8050019

Katkhouda, N; Mouiel, J

1993-08-01

329

The Totally Extraperitoneal Method versus Lichtenstein's Technique for Inguinal Hernia Repair: A Systematic Review with Meta-Analyses and Trial Sequential Analyses of Randomized Clinical Trials  

PubMed Central

Background Lichtenstein's technique is considered the reference technique for inguinal hernia repair. Recent trials suggest that the totally extraperitoneal (TEP) technique may lead to reduced proportions of chronic pain. A systematic review evaluating the benefits and harms of the TEP compared with Lichtenstein's technique is needed. Methodology/Principal Findings The review was performed according to the ‘Cochrane Handbook for Systematic Reviews’. Searches were conducted until January 2012. Patients with primary uni- or bilateral inguinal hernias were included. Only trials randomising patients to TEP and Lichtenstein were included. Bias evaluation and trial sequential analysis (TSA) were performed. The error matrix was constructed to minimise the risk of systematic and random errors. Thirteen trials randomized 5404 patients. There was no significant effect of the TEP compared with the Lichtenstein on the number of patients with chronic pain in a random-effects model risk ratio (RR 0.80; 95% confidence interval (CI) 0.61 to 1.04; p?=?0.09). There was also no significant effect on number of patients with recurrences in a random-effects model (RR 1.41; 95% CI 0.72 to 2.78; p?=?0.32) and the TEP technique may or may not be associated with less severe adverse events (random-effects model RR 0.91; 95% CI 0.73 to 1.12; p?=?0.37). TSA showed that the required information size was far from being reached for patient important outcomes. Conclusions/Significance TEP versus Lichtenstein for inguinal hernia repair has been evaluated by 13 trials with high risk of bias. The review with meta-analyses, TSA and error matrix approach shows no conclusive evidence of a difference between TEP and Lichtenstein on the primary outcomes chronic pain, recurrences, and severe adverse events. PMID:23349689

Koning, G. G.; Wetterslev, J.; van Laarhoven, C. J. H. M.; Keus, F.

2013-01-01

330

Risk of Incisional Hernia after Minimally Invasive and Open Radical Prostatectomy  

PubMed Central

Purpose The number of radical prostatectomies has increased. Many urologists have shifted from the open surgical approach to minimally invasive techniques. It is not clear whether the risk of post-prostatectomy incisional hernia varies by surgical approach. Materials and Methods In the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset we identified men age 66 and older who had minimally invasive (MIRP) or open radical prostatectomy (ORP) for prostate cancer diagnosed 2003–2007. The main outcome was incisional hernia repair identified in Medicare claims following prostatectomy. We also examined the frequency of umbilical, inguinal and other hernia repairs. Results We identified 3,199 patients who had MIRP and 6,795 who had open radical prostatectomy ORP. The frequency of incisional hernia repair was 5.3% (median follow-up 3.1 years) in the MIRP group and 1.9% (median follow-up 4.4 years) in the ORP group, corresponding to incidence rates of 16.1 and 4.5 per 1000 person-years for MIRP and ORP, respectively. Compared with ORP, MIRP was associated with a more than 3-fold increased risk of incisional hernia repair, controlling for patient and disease characteristics (adjusted hazard ratio 3.39, 95% CI, 2.63–4.38, p <0.0001). MIRP was associated with an attenuated but increased risk of any hernia repair compared with ORP (adjusted hazard ratio 1.48, 95% CI 1.29–1.70, p <0.0001). Conclusions MIRP was associated with a significantly increased risk of incisional hernia compared with ORP. This is a potentially remediable complication of prostate cancer surgery that warrants increased vigilance with respect to surgical technique. PMID:23688847

Carlsson, Sigrid V.; Ehdaie, Behfar; Atoria, Coral L.; Elkin, Elena B.; Eastham, James A.

2013-01-01

331

Strangulated lesser sac hernia.  

PubMed

Internal hernias account for less than 1% of acute mechanical bowel obstruction. Because of their rarety, they are often not considered in the clinical or radiologic diagnosis of bowel obstruction; diagnosis is often delayed, and is most often made at the time of surgery. We present images obtained during the management of a strangulated transomental internal hernia; computerized tomography permitted timely preoperative diagnosis and specifically adapted surgical therapy. PMID:22424797

Guinier, D; Tissot, O

2012-06-01

332

Percutaneous ilioinguinal-iliohypogastric nerve block or step-by-step local infiltration anesthesia for inguinal hernia repair: what cadaveric dissection says?  

PubMed Central

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 hernia repair. PMID:22200042

Ergul, Zafer; Esmer, Ali Firat; Sen, Tulin; Akkaya, Taylan; Elhan, Alaittin

2011-01-01

333

Antenatal management of isolated congenital diaphragmatic hernia today and tomorrow: ongoing collaborative research and development. Journal of Pediatric Surgery Lecture.  

PubMed

The diagnosis of congenital diaphragmatic hernia should be made prenatally in virtually all cases where routine maternal ultrasonography is available. At that time, the prognosis can be predicted based on whether it is isolated and assessment of lung size and/or the position of the liver. Prenatal intervention may be offered in those selected fetuses that have a predicted poor outcome. The aim of this procedure is to reverse the key determinant of survival-pulmonary hypoplasia. Percutaneous fetal endoscopic tracheal occlusion by a balloon is a minimally invasive procedure that has been shown safe and yields a 50% survival rate in severe cases. The outcome can be predicted by the gestational age at birth, the lung size before and after balloon placement, and whether the balloon has been removed prenatally. Currently, the added value of prenatal intervention is being investigated in the Tracheal Occlusion To Accelerate Lung Growth trial ((TOTAL); a European and North American collaboration). Future developments may include better prediction of outcome by more complex algorithms reflecting combinations of prenatal predictors, gene expression profiling to reflect lung development and response to tracheal occlusion, and alternative prenatal strategies for salvaging the worst cases. Fetuses with severe hypoplasia usually require postnatal operative repair using prosthetic patches, and tissue engineering offers the potential for ex utero culture. PMID:22325377

Deprest, Jan; De Coppi, Paolo

2012-02-01

334

Obturator hernia: a diagnostic challenge.  

PubMed

We describe a case of an 82-year-old lady with groin pain secondary to an obturator hernia. She was a diagnostic challenge, and 6 years passed before the obturator hernia was discovered. She presented to hospital with symptoms of bowel obstruction, and a computer tomography (CT) scan of her pelvis revealed an incarcerated obturator hernia. Her surgical management included reinforcement of the obturator foramen with sutures. A recurrence of the obturator hernia 2 years later required an extra-peritoneal mesh repair of the defect in the obturator foramen with a good outcome. PMID:18636223

Pandey, R; Maqbool, A; Jayachandran, N

2009-02-01

335

Uncommon content in congenial inguinal hernia  

PubMed Central

Although sliding indirect inguinal hernias containing the ipsilateral ovary and fallopian tube are not uncommon in infant girls, sliding hernias containing uterus with both ovaries and fallopian tubes are extremely rare. At surgery, a 5-month-old infant girl was found to have an indirect hernia in which the uterus and fallopian tubes were sliding components with a wide deep inguinal ring.

Harjai, Man Mohan

2014-01-01

336

Delayed Failure after Endoscopic Staple Repair of an Anterior Spine Surgery Related Pharyngeal Diverticulum  

PubMed Central

We present a rare complication of endoscopic staple repair of a pharyngeal diverticulum related to prior anterior cervical spine surgery. A 70-year-old male developed a symptomatic pharyngeal diverticulum 2 years after an anterior cervical fusion that was repaired via endoscopic stapler-assisted diverticulectomy. He initially had improvement of his symptoms after the stapler-assisted approach. Three years later, the patient presented with dysphagia and was found to have erosion of the cervical hardware into the pharyngeal lumen at the site of the prior repair. We present the first reported case of late hardware erosion into a pharyngeal diverticulum after endoscopic stapler repair. PMID:24454395

Al-Khudari, Samer; Succar, Eric; Ghanem, Tamer; Gardner, Glendon M.

2013-01-01

337

Experience in the Management of Eighty-Two Newborns With Congenital Diaphragmatic Hernia Treated With High-Frequency Oscillatory Ventilation and Delayed Surgery Without the Use of Extracorporeal Membrane Oxygenation  

Microsoft Academic Search

The aim of this study is to analyze neonatal outcome of isolated congenital diaphragmatic hernia and to identify prenatal and postnatal prognosis-related factors. A retrospective single institution series from January 2000 to November 2005 of isolated congenital diaphragmatic hernia neonates was reviewed. Respiratory-care strategy was early high-frequency oscillatory ventilation, nitric oxide in pulmonary hypertension, and delayed surgery after respiratory and

Valérie Datin-Dorriere; Elizabeth Walter-Nicolet; Véronique Rousseau; Pierre Taupin; Alexandra Benachi; Sophie Parat; Philippe Hubert; Yan Revillon; Delphine Mitanchez

2008-01-01

338

[Treatment of inguinal hernia with the Prolene Hernia System (P.H.S.)].  

PubMed

Among the several techniques available for the treatment of inguinal hernia, the Prolene Hernia System (P.H.S.) has gained widespread acceptance over the past few years. This is an original prosthetic device that combines, in a single step, what other techniques offer separately, namely an underlay patch (preperitoneal placement), an onlay patch (subfascial placement) and a connector that joins them together and works as a plug. The aims of this study were to specify the indications and the technique of this method and to evaluate its efficacy in our experience. From January 1999 to July 2003 we performed 156 inguinal herniorraphies with the P.H.S. in 152 patients (143 male, 9 female; mean age 62.4 years). One hundred and thirty-six cases were primary hermias (mainly types III, IV and VI according to the Rutkow and Robbins classification) and 18 were recurrences (mainly type R3 according to the Campanelli classification). In 56.5% of cases the operations were performed in the day surgery setting, 37.5% as ordinary admissions and 6% as emergency procedures. Locoregional (62.5%) or local (34.2%) anaesthesia were mainly given. Early postoperative complications (7%) were 7 haematomas and 4 seromas. In 125 patients with a follow-up of at least 6 months, the late postoperative complications included 4 cases of persistent inguinocrural pain among the primary hernias (3.7%) and a new recurrence among the recurring hernias. The Authors believe that hernia repair with the P.H.S. is a valid choice comparable to the other common techniques but they suggest its use particularly in primary hernias with major relaxation of the posterior inguinal wall of the inguinal canal or of the entire myopectineal orifice. PMID:15038658

Licheri, Sergio; Erdas, Enrico; Martinasco, Luca; Pisano, Giuseppe; Pomata, Mariano; Daniele, Giovanni Maria

2004-01-01

339

[Diaphragmatic hernia complicated with diaphragmatic resection by automatic stapling device].  

PubMed

Nowadays, a diaphragmatic lesion is sometimes resected with use of an automatic stapling device, especially through video-assisted thoracoscopic procedure. We herein report 2 patients with a diaphragmatic hernia after diaphragmatic resection by automatic stapling devices. Etiology and cause of postoperative diaphragmatic hernia are discussed. Diaphragmatic resection by mechanical stapler was performed for thymic epithelial tumor recurring at the diaphragmatic pleura in both patients: 48-year-old man and 72-year-old woman. The former patient underwent a right diaphragmatic resection (3×4 cm in size) with a cartridge of mechanical stapler. Computed tomography (CT) and magnetic resonance imaging showed asymptomatic right diaphragmatic hernia 2 months after surgery. No symptom and progression occurred 8 years later. The latter patient underwent a right diaphragmatic resection (6×7 cm in size) with 2 cartridges of mechanical stapler. Diaphragmatic hernia advanced 7 months after surgery and required surgical intervention. Diaphragmatic repair was successful with the use of 8×6 cm expanded polytetrafluoroethylene patch. Surgical stump after diaphragmatic resection with automatic stapling device is easy to rupture during diaphragmatic movement synchronized with respiratory movement. Diaphragmatic resection with use of stapling device, which is a simple procedure, should be contraindicated. PMID:25292370

Minegishi, Kentaro; Nakano, Tomoyuki; Shibano, Tomoki; Maki, Mitsuru; Mitsuda, Sayaka; Yamamoto, Shinichi; Tetsuka, Kenji; Tsubochi, Hiroyoshi; Hasegawa, Tsuyoshi; Endo, Shunsuke

2014-10-01

340

Hiatal Hernia  

MedlinePLUS

A hiatal hernia is a condition in which the upper part of the stomach bulges through an opening in the diaphragm. ... into the esophagus. When you have a hiatal hernia, it's easier for the acid to come up. ...

341

Laparoscopic bridging vs. anatomic open reconstruction for midline abdominal hernia mesh repair [LABOR]: single-blinded, multicenter, randomized, controlled trial on long-term functional results  

PubMed Central

Background Re-approximation of the rectal muscles along the midline is recommended by some groups as a rule for incisional and ventral hernia repairs. The introduction of laparoscopic repair has generated a debate because it is not aimed at restoring abdominal wall integrity but instead aims just to bridge the defect. Whether restoration of the abdominal integrity has a real impact on patient mobility is questionable, and the available literature provides no definitive answer. The present study aims to compare the functional results of laparoscopic bridging with those of re-approximation of the rectal muscle in the midline as a mesh repair for ventral and incisional abdominal defect through an “open” access. We hypothesized that, for the type of defect suitable for a laparoscopic bridging, the effect of an anatomical reconstruction is near negligible, thus not a fixed rule. Methods and design The LABOR trial is a multicenter, prospective, two-arm, single-blinded, randomized trial. Patients of more than 60 years of age with a defect of less than 10 cm at its greatest diameter will be randomly submitted to open Rives or laparoscopic defect repair. All the participating patients will have a preoperative evaluation of their abdominal wall strength and mobility along with volumetry, respiratory function test, intraabdominal pressure and quality of life assessment. The primary outcome will be the difference in abdominal wall strength as measured by a double leg-lowering test performed at 12 months postoperatively. The secondary outcomes will be the rate of recurrence and changes in baseline abdominal mobility, respiratory function tests, intraabdominal pressure, CT volumetry and quality of life at 6 and 12 months postoperatively. Discussion The study will help to define the most suitable treatment for small-medium incisional and primary hernias in patients older than 60 years. Given a similar mid-term recurrence rate in both groups, if the trial shows no differences among treatments (acceptance of the null-hypothesis), then the choice of whether to submit a patient to one intervention will be made on the basis of cost and the surgeon’s experience. Trial registration Current Controlled Trials ISRCTN93729016 PMID:24165473

2013-01-01

342

The Effect of Neuromuscular Electrical Stimulation of the Infraspinatus on Shoulder External Rotation Force Production After Rotator Cuff Repair Surgery  

Microsoft Academic Search

Background: Muscle weakness, particularly of shoulder external rotation, is common after rotator cuff repair surgery. 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 repair surgery. 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

343

Littre's hernia in a paediatric patient.  

PubMed

Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract that is generally asymptomatic and manifests only in a specific way when complications exist. Littre's hernia is a rare complication of MD . The definition of Littre's hernia is based upon the protrusion of a MD through a potential abdominal opening accompanied in some cases by incarceration, inflammation, or necrosis. The most common site of Littre's hernia is the inguinal canal, usually on the right. It is difficult to diagnose before surgery. We report a 4-month-old boy with Littre's hernia, including join with incarcerated hernia in the left side. PMID:25323188

Qin, Daorui; Liu, Guochang; Wang, Zhe

2014-01-01

344

Hammertoe surgery: arthroplasty, arthrodesis or plantar plate repair?  

PubMed

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

Kernbach, Klaus J

2012-07-01

345

Laparoscopic trans-peritoneal hernioplasty (TAPP) is useful for obturator hernias: report of a Case.  

PubMed

A 71-year-old female presented to our hospital due to pain from the right hip joint to the lower abdomen. The pain had suddenly appeared and spontaneously disappeared more than 10 times during the past 2 years. She had visited many hospitals, but remained undiagnosed. The patient underwent a computed tomography (CT) scan of the pelvis, and a soft tissue shadow was seen between the external obturator and pectineal muscles. She was diagnosed with a right obturator hernia and underwent elective repair by laparoscopic trans-peritoneal hernioplasty (TAPP). 1 year has passed since the surgery, without any recurrence of the abdominal pain. Obturator hernias are rare, and most cases are found as incarcerated hernias. It is rare to find an obturator hernia without intestinal obstruction, or with the recurrent pain as in our case. We herein report a case in which an obturator hernia was undiagnosed and intermittent pain was experienced for 2 years prior to TAPP, which appears to have successfully treated the hernia. PMID:23975587

Otowa, Yasunori; Kanemitsu, Kiyonori; Sumi, Yasuo; Nakamura, Tetsu; Suzuki, Satoshi; Kuroda, Daisuke; Kakeji, Yoshihiro

2014-11-01

346

Laparoscopic treatment of type III and IV hiatal hernia - authors' experience  

PubMed Central

Introduction There are four types of hiatal hernias, and diagnosis is established on the basis of gastroscopy in the majority of cases. Type III represents a mixed type in which the abdominal esophagus as well as the gastric cardia and fundus protrude into the thorax through the pathologically widened esophageal hiatus. Type IV, the so-called upside down stomach, can be considered an evolutionary form of type III, and refers to herniation of nearly the whole stomach (except for the cardia and pylorus) into the thorax. Types III and IV of hiatal hernias represent a group of rare diaphragmatic defects; thus, most centers do not possess considerable experience in their treatment. Frequently, laparoscopic treatment is implemented, although, according to some authors, conversion to laparotomy, thoracotomy, or thoracolaparotomy is necessary in selected cases. Aim To analyze the outcomes of laparoscopic treatment of the largest hiatal hernias, i.e. type III and IV hernias. Material and methods A total of 25 patients diagnosed with type III and IV hiatal hernia were included in further analysis. Results As many as 19 out of 25 patients (76%) assessed the outcome of the surgery as evidently positive and reported marked improvement in the quality of life. Conclusions The laparoscopic technique constitutes an excellent and safe method of repair of even the most complex defects in the esophageal hiatus. Therefore, the minimally invasive technique combined with an anti-reflux procedure should be the method of choice in patients with type III and IV hernia. PMID:25097681

Grzesiak-Kuik, Agata; Pedziwiatr, Michal; Budzynski, Andrzej

2014-01-01

347

The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: Midterm analysis of 400 cases  

Microsoft Academic Search

Background  The authors describe a minimally invasive treatment of moderate to large incisional and ventral hernia defects using Parietex\\u000a composite mesh.\\u000a \\u000a \\u000a \\u000a Methods  All defects are closed laparoscopically or through a minilaparotomy using sutures, and the composite mesh is fixed intraperitonally\\u000a using transabdominal fixation with nonabsorbable sutures to avoid the use of staple or tack fixation, which has been associated\\u000a with various complications,

E. Chelala; M. Thoma; B. Tatete; A. C. Lemye; M. Dessily; J. L. Alle

2007-01-01

348

A rare case report of appendix and cecum in the sac of left inguinal hernia (left Amyand's hernia)  

PubMed Central

This case is a rare aspect of left inguinal hernia. The patient was a 60-years old man with left scrotal mass since childhood. In the operating room, the hernia sac was opened which included cecum and appendix that is called left Amyand‘s hernia. The patient underwent herniorrhaphy with Lichtenstein repair. PMID:23483809

Anbara, Taha; Foroutankia, Raheleh

2012-01-01

349

Trocar Site Hernia after Laparoscopic Colectomy: A Case Report and Literature Review  

PubMed Central

Background. Trocar Site Hernia (TSH) is defined as an incisional hernia which occurs after minimally invasive surgery on the trocar incision site.In 2004 Tonouchi classified trocar site hernias into 3 types: Early onset type; Late onset type; Special type. Case Report. We report the case of a 76-year old woman that underwent an emergency explorative laparotomy on the 10th p.o. day after a laparoscopic left hemicolectomy. Surgery showed a small bowel herniation through the 12?mm trocar incision site; the intestinal loop appeared necrotic and had to be resected, and the hernia orifice was repaired. We carried out a review of literature about this topic. Discussion. The clinical onset of a trocar site hernia is usually early, occurring within the 30th post operative day and it is caused by the omentum or small bowel entrapment into the trocar orifice. The clinical presentation is insidious, with progression to an acute abdomen, and an emergency surgical approach is often required. Conclusions. TSH is a severe complication of operative laparoscopy especially with large-bore trocar ports. The incidence of TSH resulting from our review ranges from 0.007% to 22% with an average of 1.85%. Prevention of TSH appears to be more effective when trocar insertion through the abdominal wall is tangential, the closure of both the fascia and the peritoneum is performed if the incision is greater than 7?mm, the suture of extra umbilical port site is performed under laparoscopic vision. PMID:22084774

Pamela, Delmonaco; Roberto, Cirocchi; Francesco, La Mura; Umberto, Morelli; Carla, Migliaccio; Vincenzo, Napolitano; Stefano, Trastulli; Eriberto, Farinella; Daniele, Giuliani; Angelo, Desol; Diego, Milani; Micol Sole, Di Patrizi; Alessandro, Spizzirri; Maurizio, Bravetti; Vito, Sciannameo; Nicola, Avenia; Francesco, Sciannameo

2011-01-01

350

Histologic and biomechanical evaluation of a novel macroporous polytetrafluoroethylene knit mesh compared to lightweight and heavyweight polypropylene mesh in a porcine model of ventral incisional hernia repair  

PubMed Central

Purpose To evaluate the biocompatibility of heavyweight polypropylene (HWPP), lightweight polypropylene (LWPP), and monofilament knit polytetrafluoroethylene (mkPTFE) mesh by comparing biomechanics and histologic response at 1, 3, and 5 months in a porcine model of incisional hernia repair. Methods Bilateral full-thickness abdominal wall defects measuring 4 cm in length were created in 27 Yucatan minipigs. Twenty-one days after hernia creation, animals underwent bilateral preperitoneal ventral hernia repair with 8 × 10 cm pieces of mesh. Repairs were randomized to Bard®Mesh (HWPP, Bard/Davol, http://www.davol.com), ULTRAPRO® (LWPP, Ethicon, http://www.ethicon.com), and GORE®INFINIT Mesh (mkPTFE, Gore & Associates, http://www.gore.com). Nine animals were sacrificed at each timepoint (1, 3, and 5 months). At harvest, a 3 × 4 cm sample of mesh and incorporated tissue was taken from the center of the implant site and subjected to uniaxial tensile testing at a rate of 0.42 mm/s. The maximum force (N) and tensile strength (N/cm) were measured with a tensiometer, and stiffness (N/mm) was calculated from the slope of the force-versus-displacement curve. Adjacent sections of tissue were stained with hematoxylin and eosin (H&E) and analyzed for inflammation, fibrosis, and tissue ingrowth. Data are reported as mean ± SEM. Statistical significance (P < 0.05) was determined using a two-way ANOVA and Bonferroni post-test. Results No significant difference in maximum force was detected between meshes at any of the time points (P > 0.05 for all comparisons). However, for each mesh type, the maximum strength at 5 months was significantly lower than that at 1 month (P < 0.05). No significant difference in stiffness was detected between the mesh types or between timepoints (P > 0.05 for all comparisons). No significant differences with regard to inflammation, fibrosis, or tissue ingrowth were detected between mesh types at any time point (P > 0.09 for all comparisons). However, over time, inflammation decreased significantly for all mesh types (P < 0.001) and tissue ingrowth reached a slight peak between 1 and 3 months (P = 0.001) but did not significantly change thereafter (P > 0.09). Conclusions The maximum tensile strength of mesh in the abdominal wall decreased over time for HWPP, LWPP, and mkPTFE mesh materials alike. This trend may actually reflect inability to adequately grip specimens at later time points rather than any mesh-specific trend. Histologically, inflammation decreased with time (P = 0.000), and tissue ingrowth increased (P = 0.019) for all meshes. No specific trends were observed between the polypropylene meshes and the monofilament knit PTFE, suggesting that this novel construction may be a suitable alternative to existing polypropylene meshes. PMID:21279663

Melman, L.; Jenkins, E. D.; Hamilton, N. A.; Bender, L. C.; Brodt, M. D.; Deeken, C. R.; Greco, S. C.; Frisella, M. M.

2013-01-01

351

Risk of continuing planned surgery after endovascular repair of subclavian artery injury: a case report  

PubMed Central

Endovascular repair with covered stents has been widely used to treat subclavian and axillary artery injuries and has produced promising early results. The possibility of a thromboembolism occurring in cerebral arteries during an endovascular procedure should be a cause for concern. In the case of endovascular management of arterial traumas, a prompt and sufficient period for check-up of the patient's neurological signs is needed, even if it requires postponing elective intervention for the patient's safety. We report a rare case of liver transplantation immediately after endovascular repair of an iatrogenic subclavian arterial injury to describe the risk of continuing planned surgery without neurologic assessment. PMID:25237452

Kwon, O-Sun; Kim, Won-Sung; Hong, Jung-Min; Cho, Hyun-Jun

2014-01-01

352

Small bowel obstruction caused by sigmoid mesocolic hernia  

PubMed Central

Internal hernia is an unusual cause of small bowel obstruction and classified several types according to locations. Sigmoid mesocolic hernia is an uncommon condition and among others intramesosigmoid hernia was rarely reported in the literature. We report the case of a 49-year-old female with a rare type of congenital internal hernia, through the mesosigmoid, causing small bowel obstruction. She suffered from obstructive symptoms but with no previous history of laparotomy. The diagnosis of internal hernia was suggested by computed tomography, but the type of internal hernia was confirmed by laparoscopic exploration. She underwent laparoscopic detachment of peritoneal attachment comprising hernia sac without defect repair. The postoperative course was uneventful and the patient is free from symptoms and recurrence. This report presents a case of intrasigmoid hernia managed successfully by the laparoscopic approach and shows another surgical technique according to hernia types. PMID:24876507

Yang, Chunseok; Kim, Daedong

2014-01-01

353

Abdominal closure reinforcement by using polypropylene mesh functionalized with poly-?-caprolactone nanofibers and growth factors for prevention of incisional hernia formation.  

PubMed

Incisional hernia affects up to 20% of patients after abdominal surgery. Unlike other types of hernia, its prognosis is poor, and patients suffer from recurrence within 10 years of the operation. Currently used hernia-repair meshes do not guarantee success, but only extend the recurrence-free period by about 5 years. Most of them are nonresorbable, and these implants can lead to many complications that are in some cases life-threatening. Electrospun nanofibers of various polymers have been used as tissue scaffolds and have been explored extensively in the last decade, due to their low cost and good biocompatibility. Their architecture mimics the natural extracellular matrix. We tested a biodegradable polyester poly-?-caprolactone in the form of nanofibers as a scaffold for fascia healing in an abdominal closure-reinforcement model for prevention of incisional hernia formation. Both in vitro tests and an experiment on a rabbit model showed promising results. PMID:25031534

Plencner, Martin; East, Barbora; Tonar, Zbyn?k; Otáhal, Martin; Prosecká, Eva; Rampichová, Michala; Krej?í, Tomáš; Litvinec, Andrej; Buzgo, Matej; Mí?ková, Andrea; Ne?as, Alois; Hoch, Ji?í; Amler, Evžen

2014-01-01

354

Abdominal closure reinforcement by using polypropylene mesh functionalized with poly-?-caprolactone nanofibers and growth factors for prevention of incisional hernia formation  

PubMed Central

Incisional hernia affects up to 20% of patients after abdominal surgery. Unlike other types of hernia, its prognosis is poor, and patients suffer from recurrence within 10 years of the operation. Currently used hernia-repair meshes do not guarantee success, but only extend the recurrence-free period by about 5 years. Most of them are nonresorbable, and these implants can lead to many complications that are in some cases life-threatening. Electrospun nanofibers of various polymers have been used as tissue scaffolds and have been explored extensively in the last decade, due to their low cost and good biocompatibility. Their architecture mimics the natural extracellular matrix. We tested a biodegradable polyester poly-?-caprolactone in the form of nanofibers as a scaffold for fascia healing in an abdominal closure-reinforcement model for prevention of incisional hernia formation. Both in vitro tests and an experiment on a rabbit model showed promising results. PMID:25031534

Plencner, Martin; East, Barbora; Tonar, Zbynek; Otahal, Martin; Prosecka, Eva; Rampichova, Michala; Krejci, Tomas; Litvinec, Andrej; Buzgo, Matej; Mickova, Andrea; Necas, Alois; Hoch, Jiri; Amler, Evzen

2014-01-01

355

De Garengeot's hernia: diagnosis and surgical management of a rare type of femoral hernia  

PubMed Central

De Garengeot's hernia is quite rare and is a femoral hernia that contains a vermiform appendix and can present as a painful, tender swelling or an asymptomatic lump. We present the case of a 70-year-old patient who presented to our surgical unit after being referred for diagnostic imaging of an asymptomatic groin lump which was found to be a De Garengeot's hernia. She had an open repair of her femoral hernia and laparoscopic appendicectomy. Her post-operative stay was uneventful. De Garengeot's hernia is rare; however, imaging is usually required to make a diagnosis preoperatively. Management is usually surgical with simultaneous repair of the femoral hernia and appendicectomy. PMID:24876373

Ramsingh, Jason; Ali, Ahmad; Cameron, Caroline; Al-Ani, Ahmed; Hodnett, Robert; Chorushyj, Catriona

2014-01-01

356

Risk Factors for Readmission and Revision Surgery Following Rotator Cuff Repair  

Microsoft Academic Search

Risk factors for revision surgery and hospitalization following rotator cuff repair (RCR) have not been clearly identified.\\u000a We hypothesized patient factors and surgeon and hospital volume independently contribute to the risk of readmission within\\u000a 90 days and revision RCR within one year. Using the SPARCS database, we included patients undergoing primary RCR in New York\\u000a State between 1997 and 2002. These

Seth L. Sherman; Stephen Lyman; Panagiotis Koulouvaris; Andrew Willis; Robert G. Marx

2008-01-01

357

Indications for Surgery in Clinical Outcome Studies of Rotator Cuff Repair  

Microsoft Academic Search

Full-thickness tears of the rotator cuff are common, but there is no clear consensus regarding indications for rotator cuff\\u000a surgery. Because some patients with full-thickness rotator cuff tears who are asymptomatic or symptomatic can be successfully\\u000a treated nonoperatively, clinical outcome studies of rotator cuff repair should describe the subjects in detail to allow appropriate\\u000a interpretation of the results. However, we

Robert G. Marx; Panagiotis Koulouvaris; Samuel K. Chu; Bruce A. Levy

2009-01-01

358

Obturator Hernia: A Rare Case of Acute Mechanical Intestinal Obstruction  

PubMed Central

Obturator hernia is a rare type of pelvic hernia which generally occurs in elderly patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common symptom is strangulation combined with mechanical intestinal obstruction. PMID:23738179

Yucel, Ahmet Fikret; Pergel, Ahmet; Sahin, Dursun Ali

2013-01-01

359

Variations of urinary bladder and the urogenital fatty fascial compartment with different filling of the bladder are notable factors relevant to hernia repair-related bladder injury.  

PubMed

The present study investigated bladder and urogenital fatty fascial compartment (UFFC) variations during bladder filling in an attempt to identify other possible causes of hernia repair-related bladder injury besides mesh migration. The study included 30 patients scheduled for abdominal computed tomography (CT) scan for nonhernia diseases. Sixty-four-slice CT scan was performed immediately after urination and no more than 30 minutes later. Three-dimensional images were constructed by two independent experienced readers. The empty bladder was triangular in shape, narrow in the front and broad in the rear. Its vertex deviated from midline of the abdominal wall in 11 cases (36.7%).With normal filling, it appeared as an irregular oval shape. Only two cases (6.7%) of empty bladder extended inside Hesselbach's triangle. However, this area was occupied to some extent in all cases during bladder filling (P = 0.003). The UFFC formed a molar-like structure in cross-section. In three dimensions, it appeared as an inverted V-shaped structure from the front. In the lateral view it appeared as a spoon that contained the bladder. UFFC volume increased from 61.85 ± 6.23 to 139.23 ± 5.29 cm(3) with bladder filling (P < 0.0001). The UFFC can be clearly identified by CT scanning or three-dimensional reconstruction. The considerable spatial variation of the UFFC and movement and deformation of the mesh within this area may be related to bladder injury. PMID:23336656

Jiang, Zhi-Peng; Wang, Dong-Ye; Lai, Dong-Ming; Zhou, Quan-Bo; Zhang, Yu-Chao; Yang, Bin; Chen, Shuang

2013-02-01

360

[Transperitoneal technique of preperitoneal mesh implantation in laparoscopic hernioplasty of direct and indirect inguinal hernias].  

PubMed

The method of transperitoneal application of a large polypropylene-mesh in the preperitoneal space for laparoscopic inguinal hernia repair is described. The own experiences with a total number of 64 inguinal hernias are presented. The technique takes the principle of conventional hernia repair into account and appears to be a safe and effective way to repair indirect and direct inguinal uni- or bilateral hernias. During a mean follow-up of 24 weeks one recurrence occurred resulting from an inadequate application of the mesh. The technique presented is effective for laparoscopic inguinal hernia repair with low morbidity. Long-term follow-up is needed to determine late recurrence rate. PMID:8203171

Germer, C T; Albrecht, D; Butz, C; Spröder, J; Wondzinski, A; Häring, R

1994-01-01

361

Omental whirl associated with bilateral inguinal hernia: a case report  

PubMed Central

Introduction Torsion of the omentum is a rare cause of abdominal pain. It is clinically similar to common causes of acute surgical abdomen and is often diagnosed during surgery. Inguinal hernia is a common condition but not frequently related with torsion of the omentum. Case presentation A 40-year-old Caucasian man came to our emergency department with abdominal pain of the left quadrant and abdominal distension for 2 days. His medical history included an untreated left inguinal hernia in the last year. Computed tomography revealed densification of mesocolon with left omentum “whirl” component and other signs of omental torsion. During an exploratory laparoscopy, a wide twist of his omentum with necrotic alterations that extended to the bilateral inguinal hernial content was observed. Omentectomy and surgical repair of bilateral inguinal hernia were performed. Conclusions Torsion of the omentum is a rare entity and usually presents a diagnostic challenge. The use of abdominal computed tomography can help diagnosing torsion of the omentum preoperatively and, thus, prevents a surgical approach. Nonetheless, some cases of torsion of the omentum require surgical repair. Accordingly, a laparoscopic approach is minimally invasive and efficient in performing omentectomy. PMID:24985935

2014-01-01

362

The Effect of Neuromuscular Electrical Stimulation of the Infraspinatus on Shoulder External Rotation Force Production After Rotator Cuff Repair Surgery  

Microsoft Academic Search

Background: Muscle weakness, particularly of shoulder external rotation, is common after rotator cuff repair surgery. 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 repair surgery.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

2008-01-01

363

Umbilical hernia  

MedlinePLUS

An umbilical hernia is an outward bulging (protrusion) of the lining of the abdomen or part of the abdominal organ(s) through ... An umbilical hernia in an infant occurs when the muscle through which the umbilical cord passes does not close completely after ...

364

Management of giant inferior triangle lumbar hernia (Petit's triangle hernia): A rare complication following delayed breast reconstruction with extended latissimus dorsi myocutaneous flap  

PubMed Central

INTRODUCTION Lumbar triangle hernia after breast reconstruction with latissimus dorsi flap (LDMF) is a very rare complication and few cases were previously described. Muscle mobilization and iatrogenic fascia defect are related etiologic factors. PRESENTATION OF CASE The authors describe a rare case of lumbar hernia in a 58-year-old woman who underwent delayed left breast reconstruction with LDMF. Two months after surgery, a progressive symptomatic lower left lumbar bulge was observed. The CT scan confirmed the diagnosis and delineated an 18 cm lumbar defect filled with lower and large bowel. At operation, the defect was exposed and the hernia sac reduced. In order to obtain stability, the remained local muscle and fascia flaps were mobilized into the defect. Additional strength was achieved with a two-layer closure of prosthetic mesh (intra/extra peritoneal). The patient is currently in the 10th postoperative year of hernia repair and satisfactory lumbar wall contour was achieved. Neither the recurrence of lumbar hernia nor symptoms compliance was noted. DISCUSSION Lumbar hernia is an uncommon complication of LDMF harvest. Although it is a rare disease, general and plastic surgeons must be on alert to avoid complications and misdiagnosis. Seroma differential diagnosis is important in order to avoid bowel perforation due to aspiration. Defect reconstruction is necessary with a muscular and fascia flaps mobilization and synthetic mesh in order to obtain a stable repair. CONCLUSION The knowledge of this rare post-operative complication following delayed breast reconstruction is crucial to its surgical management. Early surgical intervention is warranted in order to avoid severe complications. PMID:24794025

Munhoz, Alexandre Mendonca; Montag, Eduardo; Arruda, Eduardo Gustavo; Sturtz, Gustavo; Gemperli, Rolf

2014-01-01

365

Porcine Dermal Collagen Graft in Complicated Incisional Hernia  

Microsoft Academic Search

Several techniques for the repair of abdominal-wall defects and incisional hernia have been described. Primary repair, with\\u000a or without discharge incision on the rectus muscle sheath, and other closure techniques such as aponeurotic flap, myocutaneous\\u000a flap, skin or fascial graft, are still associated with high recurrence rates, especially in complicated incisional hernias.

Mariano Fortunato Armellino; Guglielmo De Stefano; Giovanni Bartone; Giovanni De Stefano

366

[Laparoscopic management of a congenital diaphragmatic hernia].  

PubMed

Morgagni diaphragmatic hernia is a birth defect whose presentation in adults is rare. Diagnosis is usually made as an incidental finding through image studies; infrequently, patients may present with symptoms such as dyspnea or retrosternal pain. Open surgical repair has been the preferred management method of symptomatic presentation. In this paper we present the case of a 42 year-old-male with symptoms of retrosternal pain and dyspnea. Diaphragmatic hernia diagnosis was made ??by CT and it was managed by laparoscopic repair of the diaphragmatic hernia. PMID:25275848

Núñez García, Edgar; Arriola Sánchez, Jorge; Sánchez Jauredini, Gabriel; Baley Spindel, Isaac

2014-01-01

367

Is It Possible to Eliminate Sutures in Open (Lichtenstein Technique) and Laparoscopic (Totally Extraperitoneal Endoscopic) Inguinal Hernia Repair? A Randomized Controlled Trial With Tissue Adhesive (n-Hexyl-?-Cyanoacrylate).  

PubMed

Background. The morbidity linked to the use of sutures in inguinal hernioplasty is well known. Tissue adhesives may be an alternative, so as to be able to improve levels of postoperative comfort, but clinical experience using them is limited. The aim of this study is to evaluate the efficiency of cyanoacrylate as a substitute for sutures in the treatment of inguinal hernias. Patients. Randomized clinical trial in abdominal wall unit. A total of 208 patients were operated upon for inguinal hernias of which 102 were unilateral hernias via open surgery using the Lichtenstein technique, randomized to receive prolene sutures (n = 52) or n-hexyl-?-cyanoacrylate glue (n = 50) and 106 were patients with bilateral inguinal hernias operated upon via totally extraperitoneal laparoscopy and randomized to receive either tackers (n = 54) or glue (n = 52). Main Outcome Measures. The primary endpoints were pain and recurrence. Secondary endpoints were operating time, postoperative morbidity, pain, and analgesic consumption. Results. No morbidity associated with the use of the glue existed. The use of glue significantly reduced the mean of surgical time (12 minutes in open surgery, 13 minutes in laparoscopic surgery), pain, and analgesics consumption, both via the open and laparoscopic approaches (P < .001). After 1 year the adhesive did not change the recurrence rate in either of the approaches. The economic analysis shows potential yearly savings of 123 916.3 Euros. Conclusions. Substituting sutures with glue (n-hexyl-?-cyanoacrylate) in open or laparoscopic inguinal hernioplasty is safe with less postoperative pain and the same possibilities of recurrence. PMID:24398761

Moreno-Egea, Alfredo

2014-12-01

368

Efficacy of tramadol as a preincisional infiltration anesthetic in children undergoing inguinal hernia repair: a prospective randomized study  

PubMed Central

Background Preincisional local anesthetic infiltration at the surgical site is a therapeutic option for postoperative pain relief for pediatric inguinal hernia. Additionally, tramadol has been used as an analgesic for postoperative pain in children. Recently, the local anesthetic effects of tramadol have been reported. The aim of this study was to determine both the systemic analgesic and the local anesthetic effects of tramadol and to determine how it differs from bupivacaine when administered preincisionally. Methods Fifty-two healthy children, aged 2–7 years, who were scheduled for elective herniorrhaphy were randomly allocated to receive either preincisional infiltration at the surgical site with 2 mg/kg tramadol (Group T, n=26) or 0.25 mL/kg 0.5% bupivacaine (Group B, n=26). At the time of anesthetic administration, perioperative hemodynamic parameters were recorded. The pain assessments were performed 10 minutes after the end of anesthesia and during the first 6-hour period, using pain scores. The time of first dose of analgesia and need for additional analgesia were recorded. Results Between T and B groups, the anesthesia time, perioperative hemodynamic changes, and pain scores were not statistically different. However, in group B, the postoperative analgesic requirement was higher than in group T. Conclusion Tramadol shows equal analgesic effect to bupivacaine and decreases additional analgesic requirement, when used for preincisional infiltration anesthesia in children undergoing inguinal herniorrhaphy. PMID:25285011

Numano?lu, Kemal Var?m; Ayo?lu, Hilal; Er, Duygu Tatl?Ebubekir

2014-01-01

369

Hernias (For Parents)  

MedlinePLUS

... get your child the appropriate medical care. About Hernias When part of an organ or tissue in ... it bulges and becomes a hernia. Types of Hernias There are different types of hernias, and each ...

370

Sports Hernia (Athletic Pubalgia)  

MedlinePLUS

... by the American Academy of Orthopaedic Surgeons. Sports Hernia (Athletic Pubalgia) A sports hernia is a painful, so tissue injury that occurs ... direction or intense twisting movements. Although a sports hernia may lead to a traditional, abdominal hernia, it ...

371

Obturator hernia: A diagnostic challenge  

PubMed Central

INTRODUCTION Obturator hernia is an extremely rare type of hernia with relatively high mortality and morbidity. Its early diagnosis is challenging since the signs and symptoms are non specific. PRESENTATION OF CASE Here in we present a case of 70 years old women who presented with complaints of intermittent colicky abdominal pain and vomiting. Plain radiograph of abdomen showed acute dilatation of stomach. Ultrasonography showed small bowel obstruction at the mid ileal level with evidence of coiled loops of ileum in pelvis. On exploration, Right Obstructed Obturator hernia was found. The obstructed Intestine was reduced and resected and the obturator foramen was closed with simple sutures. Postoperative period was uneventful. DISCUSSION Obturator hernia is a rare pelvic hernia and poses a diagnostic challenge. Obturator hernia occurs when there is protrusion of intra-abdominal contents through the obturator foramen in the pelvis. The signs and symptoms are non specific and generally the diagnosis is made during exploration for the intestinal obstruction, one of the four cardinal features. Others are pain on the medial aspect of thigh called as Howship Rombergs sign, repeated attacks of Intestinal Obstruction and palpable mass on the medial aspect of thigh. CONCLUSION Obturator hernia is a rare but significant cause of intestinal obstruction especially in emaciated elderly woman and a diagnostic challenge for the Doctors. CT scan is valuable to establish preoperative diagnosis. Surgery either open or laproscopic, is the only treatment. The need for the awareness is stressed and CT scan can be helpful. PMID:23708307

Kulkarni, Sanjeev R.; Punamiya, Aditya R.; Naniwadekar, Ramchandra G.; Janugade, Hemant B.; Chotai, Tejas D.; Vimal Singh, T.; Natchair, Arafath

2013-01-01

372

Inguinal Bladder Hernia: Four Case Analyses  

PubMed Central

A study of four cases presenting as inguinal bladder hernia was performed based on a review of the clinical presentation, circumstances of diagnostics, and surgical management. The mean age of patients was 66.5 years. Presenting symptoms included lower urinary tract symptoms (LUTS; three cases) and decrease in scrotal size after voiding (one case). The diagnostic circumstances were incidental finding during investigation for urethral stricture (one case), preoperative discovery on the basis of decrease in scrotal size after voiding (one case), perioperative discovery during standard herniorrhaphy (one case), and peritoneal effusion secondary to bladder injury in the early postoperative period. All patients were managed successfully by replacement of the bladder in its original position and inguinal herniorrhaphy, the Lichtenstein technique (two cases), Shouldice repair (one case), or modified Bassini repair (one case) through the same inguinal incision. For one patient, bladder injury was diagnosed at the time of inguinal herniorrhaphy and repair was promptly made. For another, bladder injury was discovered only at surgical abdominal exploration. Surgical repair led to the resolution of signs and urologic symptoms in all but one patient who needed medical therapy for residual LUTS. An awareness of this possibility on the part of general surgeons should guide preoperative evaluation and therapy appropriately. Even if the preoperative diagnosis is missed, a perioperative diagnosis is crucial to avoid bladder injury during surgery. PMID:23671403

Moufid, Kamal; Touiti, Driss; Mohamed, Lezrek

2013-01-01

373

Inguinal bladder hernia: four case analyses.  

PubMed

A study of four cases presenting as inguinal bladder hernia was performed based on a review of the clinical presentation, circumstances of diagnostics, and surgical management. The mean age of patients was 66.5 years. Presenting symptoms included lower urinary tract symptoms (LUTS; three cases) and decrease in scrotal size after voiding (one case). The diagnostic circumstances were incidental finding during investigation for urethral stricture (one case), preoperative discovery on the basis of decrease in scrotal size after voiding (one case), perioperative discovery during standard herniorrhaphy (one case), and peritoneal effusion secondary to bladder injury in the early postoperative period. All patients were managed successfully by replacement of the bladder in its original position and inguinal herniorrhaphy, the Lichtenstein technique (two cases), Shouldice repair (one case), or modified Bassini repair (one case) through the same inguinal incision. For one patient, bladder injury was diagnosed at the time of inguinal herniorrhaphy and repair was promptly made. For another, bladder injury was discovered only at surgical abdominal exploration. Surgical repair led to the resolution of signs and urologic symptoms in all but one patient who needed medical therapy for residual LUTS. An awareness of this possibility on the part of general surgeons should guide preoperative evaluation and therapy appropriately. Even if the preoperative diagnosis is missed, a perioperative diagnosis is crucial to avoid bladder injury during surgery. PMID:23671403

Moufid, Kamal; Touiti, Driss; Mohamed, Lezrek

2013-01-01

374

Laparoscopic extraperitoneal treatment of inguinal hernias in adults. A series of 200 cases.  

PubMed

Laparoscopic repair of 200 inguinal hernias by the preperitoneal approach is described. The technique uses a large mesh either of polypropylene or of ePTFE-Goretex. The average duration of the procedure was 45 minutes for unilateral hernias and 71 minutes for bilateral hernias. Postoperative pain was minimal and complications rare (no infection, one deep vein thrombosis). The mean duration of hospital stay was 44 hours. At a maximum follow-up of 22 months only one hernia has recurred. This technique of hernia repair has the advantage of minimal postoperative pain and early return to work with minimal recurrence of the hernia. PMID:8050021

Begin, G F

1993-08-01

375

Muscle hernias of the leg: A case report and comprehensive review of the literature  

PubMed Central

A case involving a retired, elderly male war veteran with a symptomatic peroneus brevis muscle hernia causing superficial peroneal nerve compression with chosen surgical management is presented. Symptomatic muscle hernias of the extremities occur most commonly in the leg and are a rare cause of chronic leg pain. Historically, treating military surgeons pioneered the early documentation of leg hernias observed in active military recruits. A focal fascial defect can cause a muscle to herniate, forming a variable palpable subcutaneous mass, and causing pain and potentially neuropathic symptoms with nerve involvement. While the true incidence is not known, the etiology has been classified as secondary to a congenital (or constitutional) fascial weakness, or acquired fascial defect, usually secondary to direct or indirect trauma. The highest occurrence is believed to be in young, physically active males. Involvement of the tibialis anterior is most common, although other muscles have been reported. Dynamic ultrasonography or magnetic resonance imaging is often used to confirm diagnosis and guide treatment. Most symptomatic cases respond successfully to conservative treatment, with surgery reserved for refractory cases. A variety of surgical techniques have been described, ranging from fasciotomy to anatomical repair of the fascial defect, with no consensus on optimal treatment. Clinicians must remember to consider muscle hernias in their repertoire of differential diagnoses for chronic leg pain or neuropathy. A comprehensive review of muscle hernias of the leg is presented to highlight their history, occurrence, presentation, diagnosis and treatment. PMID:24497767

Nguyen, Jesse T; Nguyen, Jenny L; Wheatley, Michael J; Nguyen, Tuan A

2013-01-01

376

Laparoscopic totally extraperitoneal repair without suprapubic port: comparison with conventional totally extraperitoneal repair  

PubMed Central

Purpose We have treated 24 patients through laparoscopic totally extraperitoneal (TEP) repair without suprapubic port by using reliability and reducing the invasiveness of two surgery. This study is aimed to assess the safety and feasibility of the TEP repair without suprapubic port compared to conventional TEP repair. Methods From September 2007 to 11 May 2010, we compared two groups that suffer from inguinal hernias. One is comprised of 24 patients who were treated without suprapubic port laparoscopic totally extraperitoneal repair (Group A), and the other is comprised of 100 patients who were treated with conventional laparoscopic totally extraperitoneal repair (Group B). Data regarding patient demographics (sex, age, site of hernia, and the type of hernia), operating time, postoperative hospital stay, the use of analgesics, and complications were prospectively collected. Results There was no significant difference noted between two groups in relation to sex, age, site, and the type of hernia. The mean operating time and postoperative hospital stay was longer for the Group B (62.9 minutes, 3.55 days) than for the Group A (59.0 minutes, 2.54 days) (P = 0.389, P < 0.001). Postoperative urinary retention, seroma, wound infection were respectively 4.2%, 8.3%, 0% in Group A, and 12.0%, 8.0%, 7% in group B. There was difference between the two groups, but not statistical significance. Group B used more analgesics than Group A (0.33 vs. 0.48), but it wasn't significant statistically (P = 0.234). Conclusion Although prospective randomized studies with long-term follow-up evaluation are needed to confirm our study between laparoscopic totally extraperitoneal repair without suprapubic-port and conventional laparoscopic totally extraperitoneal repair, our method have some advantages in postoperative pain, urinary retention, operating time, postoperative hospital stay, and cosmetic effect. PMID:22066055

Kwon, Ki-Hwak; Han, Won-Kon

2011-01-01

377

A Small, 4-Degree-Of-Planar Freedom Robot for Artery Cross Clamping during Minimally Invasive Aorta Repair Surgery  

Microsoft Academic Search

Abdominal aortic aneurysm (AAA) is one of the most common diseases in old people and accounts for nearly 15,000 deaths each year. The most long-standing approach of AAA treatment is open surgery, at which large incisions are necessary. Drawbacks of open surgery lead to minimally invasive surgery (MIS) of aortic repair, whose main problem is that cross-clamping process is too

Pedram Pahlavan; Siamak Najarian; Ali Abouei; Majid Moini; Salman Dehkhoda

2011-01-01

378

Inguinal hernia: preperitoneal placement of a memory-ring patch by anterior approach. Preliminary experience.  

PubMed

The aim of this prospective study was to set up and evaluate a technique allowing, by the mean of a memory ring, easy placement of the patch in the preperitoneal space (PPS), directly via the hernia orifice, so as to associate the advantages of the preperitoneal patch, anterior approach and minimally invasive surgery. The memory-ring patch was made by basting a PDS cord around a 14 x 7.5 cm oval shaped polypropylene mesh. The hernia sac was dissected, blunt dissection of the PPS was carried out through the hernia orifice and the patch was introduced in the PPS via the orifice. Spreading of the patch in the PPS was facilitated by the memory-ring. One hundred and twenty nine hernias, classified as Nyhus Type IIIa, IIIb and IV, were operated on 126 patients; 11 were big pantaloon or sliding hernias. The anesthesia was spinal in 116 cases and local in 10 cases. There were three benign postoperative complications (2.3%) related to the hernia repair. Ninety six percent of the patients were evaluated with a mean follow up of 24.5 months (12-42). Two recurrences (1.6%) occurred, 7 patients (5.6%) felt some degree of light pain, but not any case of disabling pain was observed. This technique offers many advantages. It is tension-free and almost sutureless. The patch is placed in the PPS through the hernia orifice without any remote opening in the abdominal wall. The patch applied directly to the deep surface of the fascia reinforces the weak inguinal area by restoring the normal anatomic disposition. The good preliminary results are encouraging and justify further randomized evaluation. PMID:16758150

Pélissier, E P

2006-06-01

379

Hiatal hernia  

MedlinePLUS

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 ...

380

Novel in Vitro Model for Assessing Susceptibility of Synthetic Hernia Repair Meshes to Staphylococcus aureus Infection Using Green Fluorescent Protein-Labeled Bacteria and Modern Imaging Techniques  

PubMed Central

Abstract Background Mesh infection complicating hernia repair is a major cause of patient morbidity and results in substantial healthcare expenditures. The various constructs of prosthetic mesh may alter the ability of bacteria to attach and form a biofilm. Few data exist evaluating biofilm formation. Using the Maestro in-Vivo Imaging System (CRi, Inc., Woburn, MA) to detect green fluorescent protein (GFP)-expressing Staphylococcus aureus, we studied the ability of synthetic mesh to withstand bacterial biofilm formation in an in vitro model. Methods We included four meshes: Polypropylene (PP), polypropylene/expanded PTFE (PX), compressed PTFE (cPTFE), and polyester/polyethylene glycol and collagen hydrogel (PE). Five samples of each mesh were exposed to GFP-expressing S. aureus for 18?h at 37°C. Next, green fluorescence was measured using the Maestro Imaging System, with the results expressed in relative fluorescence units (RFU), subtracting the fluorescence of uninfected mesh (control). Each mesh subsequently underwent sonication and quantitative culture of the released bacteria, with the results expressed in colony-forming units (CFU). Analysis of variance was performed to compare the mean values for the different meshes. Results There was a statistically significant difference in bacterial fluorescence for the four meshes: PE (49.9?±?25.5 [standard deviation] RFU), PX (30.8?±?9.4 RFU), cPTFE (10.1?±?4.0 RFU), and PP (5.8?±?7.5 RFU)(p?=?0.001). Bacterial counts also were significantly different: PE (2.2?×?108 CFU), PX (8.6?×?107 CFU), cPTFE (3.7?×?107 CFU), and PP (9.1?×?107 CFU)(p?

Halaweish, Ihab; Harth, Karem; Broome, Ann-Marie; Voskerician, Gabriela; Jacobs, Michael R.

2010-01-01

381

Airway management: A comparative study in cleft lip and palate repair surgery in children  

PubMed Central

Background: Cleft lip with or without palate is one of the common congenital malformations. Aim: To evaluate the per-operative complications of anesthesia, a comparative study was conducted in children using the endotracheal tubes available in the Institute so that the complications can be averted in future procedures. Materials and Methods: The rural population of Tripura, India. Result: Awareness was generated and the incidence of repair surgeries of cleft lip and palate was thus increased considerably in Dr. B. R. Ambedkar Memorial Teaching Hospital, Agartala, Tripura. Conclusion: The RAE tube has been found to be the choicest one and at a minimal risk for maintaining patients’ patent airway and other related complications.

Sen, Jayashree; Sen, Bitan

2014-01-01

382

JAMA Patient Page: Abdominal Hernia  

MedlinePLUS

... movement • Cystic fibrosis and chronic lung infections • Previous abdominal surgery COMPLICATIONS A hernia may result in entrapment of other organs (such as the bladder or colon) or nerves, producing constipation or problems with ... of the abdominal cavity) needing surgical removal of part of the ...

383

Amyand's hernia with a periappendicular abscess.  

PubMed

We present a rare case of a perforated vermiform appendix presenting as a strangulated inguinal hernia. An 89-year-old man presented to the surgical assessment unit with a 1-week history of progressively worsening abdominal pain, fever and a tender mass in the right iliac fossa. A diagnosis of strangulated inguinal hernia was made. Intraoperatively, a perforated appendix and a pus-filled sac were found. An appendicectomy and a Bassini repair of the hernia were performed with a satisfactory postoperative outcome. In the majority of cases Amyand's hernia is an intraoperative finding and its management depends on the extent of appediceal disease. In cases of perforated appendix with periappendiceal abscess within the hernial sac, an appedicectomy with Bassini's repair is recommended. PMID:24777080

Oremule, Babatunde; Ashrafi, Mohammed Hayat

2014-01-01

384

Incisional Hernia in Obese Patients  

Microsoft Academic Search

Incisional hernia is one of the most frequent complications of abdominal surgery [1,2]. Different aetiologies have been hypothesized, including patient factors such as older age, cancer, diabetes, malnutrition,\\u000a chronic steroid therapy, and wound factors such as lower midline incision, re-incision and wound infections [3,4]. In abdominal surgery, by far, obesity has long been recognised as one of the most relevant

Luigi Angrisani; Michele Lorenzo; Pier Paolo Cutolo

385

Bochdalek hernia in a symptomatic adult.  

PubMed

Bochdalek hernias usually present in neonates with respiratory failure, need to be operated early and are associated with a high mortality. We describe an adult patient who came to the emergency department with nonspecific recurrent chest and abdominal pain. A computed tomography scan showed a large posterolateral diaphragmatic defect and an oversized spleen. The hernia was repaired by a thoracoabdominal approach and Gore-Tex patch. Congenital diaphragmatic hernias are rare and are associated with nonspecific symptoms in adults. With suspicious chest or abdominal radiographs, a computed tomography scan is essential to plan an individualized surgical intervention. PMID:25087794

Herling, Anique; Makhdom, Fahd; Al-Shehri, Abdullah; Mulder, David S

2014-08-01

386

[The use of prostheses in recurrent hernias].  

PubMed

The use of inert plastic (Prolene mesh, 0,027 inches in thickness fournited by Ethicon) as preperitoneal prosthesis in repair of incisional hernias and inguinal hernia recurrencies has been investigated in 28 patients operated upon then 1977 to 1984. In 9 patients the inguinal approach was used with one recurrence (11%). In 9 patients the posterior approach through a midline incision has been used with two recurrences (22%). In 10 patients with incisional hernias there was only one recurrence (10%). Total recurrences rate was 14%. Most recurrences occur in patients operated from 1977 to 1980 (40%). Patients operated in the last period from 1980 to 1984 had no recurrences. PMID:6529507

Tanzini, G; Setacci, C; Piccolotti, T; Salvestrini, F; Palasciano, G; Papi, F; Calfa, C

1984-12-30

387

Successful laparoscopic management of an incarcerated obturator hernia  

PubMed Central

Obturator hernia is a rare pelvic hernia that occurs primarily in multiparous, elderly (>70 years of age), thin females. This case highlights the successful laparoscopic mesh repair of an incarcerated obturator hernia in an octogenarian. The authors report a case of an incarcerated obturator hernia in an elderly female with subsequent high-grade small bowel and its successful laparoscopic operative management. A review of the relevant literature was also performed following a search on the online literature databases such as PUBMED and EMBASE. Laparoscopic mesh repair of the incarcerated obturator hernia and an ipsilateral femoral hernia found incidentally was successfully performed. A review of the literature showed a significant burden of morbidity and mortality associated with obturator hernias. Laparoscopic mesh repair has been previously shown to be a safe therapeutic modality. Small bowel obstruction and leg pain in a thin elderly lady should arouse suspicion for an incarcerated obturator hernia. Laparoscopic management of an incarcerated obturator hernia is a feasible and safe therapeutic option. PMID:24964456

Lynch, Noel P.; Corrigan, Mark A.; Kearney, David E.; Andrews, Emmet J.

2013-01-01

388

The economic analysis of two treatment procedures for incisional hernias - alloplastic versus tissular.  

PubMed

Incisional hernias are a common complication of abdominal surgery. Research shows that their incidence reaches 10%-11% of the total number of patients subject to laparotomy. Recurrent hernias are the main complication of eventrations and its rate ranges from 5 to 54%, depending on both the surgical procedure used and the follow-up methods. The goal of this study is the comparative cost analysis of two procedures used in the treatment of event rations, tissular versus alloplastic, the former, leading very often to recurrence requiring a new surgical intervention. The analysis comprised 156 cases of surgeries performed for incisional hernia in 2007 in the clinic of Surgery III, SUUB (Bucharest University Emergency Hospital). Tissular procedures were used in 42 cases and prosthetic procedures in 114 cases. The medium-term postoperative follow-up has revealed 17 relapses (40.4%) in the tissular batch and no relapse in the batch where parietal prosthesis was used. If the short-term costs of the tissular procedures are low as compared with the prosthetic procedures, on the medium-term the costs increase by 24.35% due to the high rate of relapses of tissular procedures. Therefore, the tissular procedure must be abandoned due to the high rate of relapse, as this drives additional costs required for the alloplastic repair of the abdominal parietal defects in a subsequent surgical intervention. PMID:24653765

Mavrodin, C M; Pariza, G; Ion, D; Ciurea, M

2014-03-15

389

The economic analysis of two treatment procedures for incisional hernias - alloplastic versus tissular  

PubMed Central

Incisional hernias are a common complication of abdominal surgery. Research shows that their incidence reaches 10%-11% of the total number of patients subject to laparotomy. Recurrent hernias are the main complication of eventrations and its rate ranges from 5 to 54%, depending on both the surgical procedure used and the follow-up methods. The goal of this study is the comparative cost analysis of two procedures used in the treatment of event rations, tissular versus alloplastic, the former, leading very often to recurrence requiring a new surgical intervention. The analysis comprised 156 cases of surgeries performed for incisional hernia in 2007 in the clinic of Surgery III, SUUB (Bucharest University Emergency Hospital). Tissular procedures were used in 42 cases and prosthetic procedures in 114 cases. The medium-term postoperative follow-up has revealed 17 relapses (40.4%) in the tissular batch and no relapse in the batch where parietal prosthesis was used. I