A 77-year-old man injured himself when he fell heavily on the left side of his chest. He had massive subcutaneous emphysema, bleeding, and left hemopneumothorax. He also fractured his seventh through tenth ribs; a fragment of the ninth rib was displaced into the thoracic cavity. The severity of the damage and the patient's pain was assessed using the Abbreviated Injury Scale 1990 (1998 update) as level 3. He was treated with conservative therapy and discharged on the 16 days after the injury. However, the following day, he had acute upper abdominal pain, his blood pressure dropped to 40 s, and he was readmitted. A chest CT showed the transverse colon was prolapsed in the thoracic cavity. The patient was diagnosed as having a delayed traumatic diapharagmatic hernia. A laparoscopic repair was performed. The rupture was classified as a IIIb-type diaphragmatic injury according to the Japanese Association for the Surgery of Trauma's classification system. It is believed that a fragment of a fractured rib that had been displaced in the thoracic cavity ruptured the diaphragm sharply. Since traumatic diapharagmatic hernia rarely occurs, it is relatively difficult to diagnose at the first examination. This condition has a high mortality rate because of the associated injuries. Surgery is the only treatment, but it should only be considered after a second examination. Herein, I report my experience with a case of delayed diaphragmatic hernia repaired by laparoscopic surgery. PMID:22776308
Background Successful obesity surgery often results months later in redundant abdominal skin and subcutaneous tissue. Following open\\u000a obesity surgery, ventral hernias are also common, yet little has been written about the safety of combining panniculectomy\\u000a with ventral hernia repair. We performed a retrospective analysis of a single plastic surgeon’s experience with panniculectomy\\u000a following gastric bypass surgery including both patients undergoing and
Andrew Saxe; Scott Schwartz; Lori Gallardo; Eanas Yassa; Abd Alghanem
Repair of parastomal represents a significant challenge for the hernia surgeon. Repair of these hernias is indicated because of an ill-fitting appliance, cosmetic deformity, inability to maintain proper hygiene and complications from the hernia itself such as incarceration or strangulation. Recent reports in the literature have shown that primary fascial repair can occur in 46% of patients and relocation of
K. A. LeBlanc; D. E. Bellanger; J. M. Whitaker; M. G. Hausmann
Congenital diaphragmatic hernias occur through embryologic defects in the diaphragm. A subset of adults (5-10 %) may present with a congenital hernia undetected during childhood. It requires surgery because of the risk of incarceration. An old lady having vomiting, upper abdominal pain, dyspnoea and retrosternal discomfort was diagnosed with the presence of a large left-sided Bochdalek diaphragmatic hernia and a hypoplastic lung. Laparoscopic repair was performed successfully after adequate preparation. The patient had postoperative respiratory difficulty and needed mechanical ventilation and intensive care for 5 days. She was discharged 8th POD. There was no recurrence in 32 months follow-up, though the hypoplastic left lung never recovered. Laparoscopy is proving to be more beneficial than laparotomy or thoracotomy. The use of a mesh further strengthens the defect and reduces chance of recurrence. PMID:17785133
Palanivelu, Chinnusamy; Rangarajan, Muthukumaran; Senthilkumar, Ramakrishnan; Madankumar, Madhupalayam Velusamy
Objective: To analyze mortality following groin hernia operations. Summary Background Data: It is well known that the incidence of groin hernia in men exceeds the incidence in women by a factor of 10. However, gender differences in mortality following groin hernia surgery have not been explored in detail. Methods: The study comprises all patients 15 years or older who underwent groin hernia repair between January 1, 1992 and December 31, 2005 at units participating in the Swedish Hernia Register (SHR). Postoperative mortality was defined as standardized mortality ratio (SMR) within 30 days, ie, observed deaths of operated patients over expected deaths considering age and gender of the population in Sweden. Results: A total of 107,838 groin hernia repairs (103,710 operations), were recorded prospectively. Of 104,911 inguinal hernias, 5280 (5.1%) were treated emergently, as compared with 1068 (36.5%) of 2927 femoral hernias. Femoral hernia operations comprised 1.1% of groin hernia operations on men and 22.4% of operations on women. After femoral hernia operation, the mortality risk was increased 7-fold for both men and women. Mortality risk was not raised above that of the background population for elective groin hernia repair, but it was increased 7-fold after emergency operations and 20-fold if bowel resection was undertaken. Overall SMR was 1.4 (95% confidence interval, 1.2–1.6) for men and 4.2 (95% confidence interval, 3.2–5.4) for women, in accordance with a greater proportion of emergency operations among women compared with men, 17.0%, versus 5.1%. Conclusions: Mortality risk following elective hernia repair is low, even at high age. An emergency operation for groin hernia carries a substantial mortality risk. After groin hernia repair, women have a higher mortality risk than men due to a greater risk for emergency procedure irrespective of hernia anatomy and a greater proportion of femoral hernia.
Nilsson, Hanna; Stylianidis, Georgios; Haapamaki, Markku; Nilsson, Erik; Nordin, Par
Background Annually approximately 100.000 patients undergo a laparotomy in the Netherlands. About 15,000 of these patients will develop an incisional hernia. Both open and laparoscopic surgical repair have been proven to be safe. However, the most effective treatment of incisional hernias remains unclear. This study, the ‘INCH-trial’, comparing cost-effectiveness of open and laparoscopic incisional hernia repair, is therefore needed. Methods/Design A randomized multi-center clinical trial comparing cost-effectiveness of open and laparoscopic repair of incisional hernias. Patients with a symptomatic incisional hernia, eligible for laparoscopic and open incisional hernia repair. Only surgeons, experienced in both open and laparoscopic incisional hernia repair, will participate in the INCH trial. During incisional hernia repair, a mesh is placed under or on top of the fascia, with a minimal overlap of 5 cm. Primary endpoint is length of hospital stay after an incisional hernia repair. Secondary endpoints are time to full recovery within three months after index surgery, post-operative complications, recurrences, mortality and quality of life. Our hypothesis is that laparoscopic incisional hernia repair comes with a significant shorter hospital stay compared to open incisional hernia repair. A difference of two days is considered significant. One-hunderd-and-thirty-five patients are enrolled in each treatment arm. The economic evaluation will be performed from a societal perspective. Primary outcomes are costs per patient related to time-to-recovery and quality of life. The main goal of the trial is to establish whether laparoscopic incisional hernia repair is superior to conventional open incisional hernia repair in terms of cost-effectiveness. This is measured through length of hospital stay and quality of life. Secondary endpoints are re-operation rate due to post-operative complications or recurrences, mortality and quality of life. Discussion The difference in time to full recovery between the two treatment strategies is thought to be in favor of laparoscopic incisional hernia repair. Laparoscopic incisional hernia repair is therefore expected to be a more cost-effective approach. Trial registration Netherlands Trial register: NTR2808
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.
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.
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
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.
Bensley, Rodney P; Schermerhorn, Marc L; Hurks, Rob; Sachs, Teviah; Boyd, Christopher A; O'Malley, A James; Cotterill, Philip; Landon, Bruce E
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.
Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair.
Milone, Luca; Gumbs, Andrew; Turner, Patricia
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.
Gupta, Amar; Eckstein, Jeremy G.
Laparoscopic hernioplasty is a technique which can present a number of specific complications. This paper reviews the complications that can occur during laparoscopic hernia repair and ways to avoid them; it also describes the surgical technique used successfully in over 1000 cases. Initial experience suggests that complications can be avoided with adequate knowledge, attention to surgical anatomy and the proper technique of laparoscopic hernioplasty. Early recurrences are rare and invariably result from inadequate surgical technique. Inadequate fixation of the mesh, inadequate mesh size, and failure to cover unidentified wall defects (hernias which have never been repaired), are the main causes of early recurrence of hernia. Experience, knowledge of complications and how to avoid them, adequate training and attention to the anatomy of the inguinal region are the most important factors in correcting inguinal hernia successfully by laparoscopy.
Reusch, Marcus; daRosa, Andre L. M.; Carlos, Jose Roberto B.
Introduction Laparoscopic repair of ventral and incisional hernias (LVIHRs) is feasible; however, many facets of this procedure remain poorly defined. The indications, essential technical features and postoperative management should be standardized to optimize outcomes and facilitate training in this promising approach to incisional hernia repair. Methods All patients referred to one surgeon at a tertiary care centre for LVIHR from 1999 to 2004 were analyzed. Patient records were analyzed and perioperative outcomes were documented. Results Of the 69 patients who were referred for management of incisional hernia, 64 underwent LVIHR. The mean age of patients selected for surgery was 61.4 years (28% of patients over age 70 years); their mean body mass index (BMI) was 32.8 kg/m2 and mean American Association of Anaesthetists (ASA) score was 2.5 (52% of patients had an ASA score equal to 3). The mean operating time was 130.7 minutes for a mean abdominal wall defect of 123.9 cm2 and a mean prosthetic mesh size of 344 cm2. Patients with recurrent incisional hernias and previous prosthetic mesh were the most challenging, with a mean BMI of 39 kg/m2, mean operating time of 191 minutes, mean defect of 224 cm2 and mean prosthetic mesh size of 508 cm2. One patient was converted to open surgery and, in 2 patients, small bowel injuries were repaired laparoscopically without adverse sequelae. The mean length of stay was 4.5 days (median 3.0 d). Postoperatively, 78% of patients developed seromas within the residual hernia sac. All seromas were managed nonoperatively; one-half resolved by 7 weeks, and larger seromas persisted for up to 24 weeks. There was an 18.7% rate of minor complications and a 3.1% rate of major complications (no deaths). After a mean follow-up of 7.7 months, 2 recurrent hernias (3.1%) were identified in patients with multiple previous open mesh repairs. Conclusion Although LVIHR may be challenging, it has the potential to be considered a primary approach for most ventral and incisional hernias, regardless of patient status or hernia complexity.
Birch, Daniel W.
Background The project aimed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay\\u000a surgery for groin hernia repair.\\u000a \\u000a \\u000a \\u000a Methods In two centres for short-stay surgery all patients referred for hernia repair were surveyed between August 1999 and January\\u000a 2002. Patients reported on health-related quality of life (SF-36), symptoms (Hernia Symptom Checklist, HSCL) and other indicators\\u000a pre-operatively
E. M. Bitzer; C. Lorenz; S. Nickel; H. Dörning; A. Trojan
Background: Laparoscopic repair is becoming a popular treatment for recurrent inguinal hernia. The true long-term recurrence\\u000a of this method is unknown. Methods: Patients who underwent laparoscopic recurrent inguinal hernia repair at our institution\\u000a were followed up. Patients were interviewed by phone at least 6 months following surgery and examined by the same surgeon.\\u000a Results: Between April 1995 and November 2000,
A. Keidar; S. Kanitkar; A. Szold
Abstract Aim: Natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) is a new approach that allows surgical manipulations and specimen extractions through the natural orifices such as the vagina. There have been limited numbers of cases about the adaptation of NOTES for ventral hernia repairs. Here, we aimed to present two more cases and highlight our technical differences compared with the previously reported instances. Patients and Methods: Two patients (43 and 46 years old; body mass index of 29 and 30?kg/m(2), respectively) were treated with hybrid transvaginal incisional hernia repairs. Two 5-mm abdominal trocars were used to monitor transvaginal access, adhesiolysis, dissection of the hernia, and tuckering of the mesh. A 15-mm transvaginal trocar was used for scope and mesh introduction into the abdomen. Defects were 3-5?cm in diameter. Results: A rigid 5-mm laparoscope was used. The composite synthetic meshes were, respectively, 11 and 13?cm in diameter. These were passed through the vagina without any protection such as a bag or sheath. No conversion or additional port was required. Respective operative times were 120 and 180 minutes, and the patients were discharged uneventfully on the second day. One patient had seroma, which was managed conservatively (aspiration of 20?mL on Day 7). There were no recurrences after 7 and 13 months, respectively. Conclusions: Conventional laparoscopic equipment can be used for hybrid transvaginal incisional hernia repair. An anti-adhesive synthetic mesh can be inserted through the vaginal trocar without protective devices. The main advantage of this technique is to avoid 10-15-mm abdominal trocars, which increase the risk of trocar-site hernias themselves. PMID:24844529
Kayaalp, Cuneyt; Yagci, Mehmet Ali; Soyer, Vural
Background Despite numerous attempts to improve the techniques used for hernia repair, current published series show that recurrence\\u000a rates are as high as 5–20%. The complexity of inguinal anatomy, combined with multiple potential areas of weakness, has contributed\\u000a to the difficulty in preventing recurrences. However, the laparoscopic approach to inguinal herniorrhaphy has allowed clear\\u000a visualization of all preperitoneal fascial planes and
B. Ramshaw; F. Wo Shuler; H. B. Jones; T. D. Duncan; J. White; R. Wilson; G. W. Lucas; E. M. Mason
Background Worldwide, there has been a marked increase in the number of inguinal and femoral hernia repairs performed as day surgery procedures. This study aimed to outline the epidemiology of the procedures for repairing unilateral inguinal and femoral hernia in the Veneto Region, and to analyze the time trends and organizational appropriateness of these procedures. Methods Drawing from the anonymous computerized database of hospital discharge records for the Veneto Region, we identified all unilateral groin hernia repair procedures completed in Veneto residents between 2000 and 2009 at both public and accredited private hospitals. Results A total 141,329 hernias were repaired in the Veneto Region during the decade considered, with an annual rate of 291.2 per 100,000 population for inguinal hernia (IH) repairs and 11.2 per 100,000 population for femoral hernia (FH) repairs. Day surgery was used more for inguinal than for femoral hernia repairs, accounting for 76% and 43% (p0.05), respectively, of all hernia repair procedures completed during the period. The % of other than surgery hospital ordinary admissions (day surgery or ambulatory surgery) during the decade considered rose from 61.7% to 86.7% for IH and from 33.0% to 61.8% for FH. Conclusions In the last decade, the Veneto Region has reduced the rate of ordinary hospital admissions for groin hernia repair with a view to improving the efficiency of the hospital network.
We describe the laparoscopic management of diaphragmatic hernia (DH) caused by vertebral pedicle screw displacement. A 58-year-old woman underwent surgery for scoliosis and underwent posterior pedicle screw fixation. In the first postoperative (PO)day, she developed mild dyspnea. An anteroposterior chest radiograph revealed bilateral pleural effusion, which was more pronounced on the left side. A thoracoabdominal computed tomography (CT) scan, performed in the second PO day, revealed a solid mass in the pleural cavity that was associated with screw displacement, which had also entered into the peritoneal cavity without apparent other lesion of hollow and solid viscous. In the third PO day, after the screw was removed, explorative laparoscopy was carried out. We observed herniation of the omentum through a small diaphragmatic tear. Once the absence of visceral injury was confirmed, we reduced the omentum into the abdomen. Then, we repaired the hernia by applying a dual layer polypropylene mesh over the defect with a 3-cm overlap. The remainder of the postoperative period was uneventful. Iatrogenic DH due to a pedicle screw displacement has never been described before. In cases of pleural effusion following spinal surgery, rapid assessment and treatment are crucial. We conclude that a laparoscopic approach to iatrogenic DH could be feasible and effective in a hemodynamically stable patient with negative CT findings because it enables the completion of the diagnostic cascade and the repair of the tear, providing excellent visualization of the abdominal viscera and diaphragmatic tears.
We describe the laparoscopic management of diaphragmatic hernia (DH) caused by vertebral pedicle screw displacement. A 58-year-old woman underwent surgery for scoliosis and underwent posterior pedicle screw fixation. In the first postoperative (PO)day, she developed mild dyspnea. An anteroposterior chest radiograph revealed bilateral pleural effusion, which was more pronounced on the left side. A thoracoabdominal computed tomography (CT) scan, performed in the second PO day, revealed a solid mass in the pleural cavity that was associated with screw displacement, which had also entered into the peritoneal cavity without apparent other lesion of hollow and solid viscous. In the third PO day, after the screw was removed, explorative laparoscopy was carried out. We observed herniation of the omentum through a small diaphragmatic tear. Once the absence of visceral injury was confirmed, we reduced the omentum into the abdomen. Then, we repaired the hernia by applying a dual layer polypropylene mesh over the defect with a 3-cm overlap. The remainder of the postoperative period was uneventful. Iatrogenic DH due to a pedicle screw displacement has never been described before. In cases of pleural effusion following spinal surgery, rapid assessment and treatment are crucial. We conclude that a laparoscopic approach to iatrogenic DH could be feasible and effective in a hemodynamically stable patient with negative CT findings because it enables the completion of the diagnostic cascade and the repair of the tear, providing excellent visualization of the abdominal viscera and diaphragmatic tears. PMID:24808922
Bini, Roberto; Fontana, Diego; Longo, Alessandro; Manconi, Paolo; Leli, Renzo
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
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.
Background: Incisional hernia is a frequent complication of abdominal surgery. Various types of repair are recommended for incisional\\u000a hernia. Suture and mesh repair are compared in the present study. Method: One hundred seventy one patients with incisional hernia underwent Cardiff repair (far and near sutures with reinforcement\\u000a sutures) which was used as an open suture repair while onlay polypropylene mesh
V. K. Shukla; R. Mongha; N. Gupta; V. S. Chauhan; Æ Puneet
OBJECTIVES: To define a method of primary repair that would minimize hernia recurrence and to report medium-term follow-up of patients who underwent laparoscopic repair of paraesophageal hernia to verify durability of the repair and to assess the effect of inclusion of an antireflux procedure. SUMMARY BACKGROUND DATA: Primary paraesophageal hernia repair was completed laparoscopically in 55 patients. There were five recurrences within 6 months when the sac was not excised (20%). After institution of a technique of total sac excision in 30 subsequent repairs, no early recurrences were observed. METHODS: Inclusion of an antireflux procedure, incidence of subsequent hernia recurrence, dysphagia, and gastroesophageal reflux symptoms were recorded in clinical follow-up of patients who underwent a laparoscopic procedure. RESULTS: Mean length of follow-up was 29 months. Forty-nine patients were available for follow-up, and one patient had died of lung cancer. Mean age at surgery was 68 years. The surgical morbidity rate in elderly patients was no greater than in younger patients. Eleven patients (22%) had symptoms of mild to moderate reflux, and 15 were taking acid-reduction medication for a variety of dyspeptic complaints. All but 2 of these 15 had undergone 360 degrees fundoplication at initial repair. Two patients (4%) had late recurrent hernia, each small, demonstrated by esophagram or endoscopy. CONCLUSIONS: Laparoscopic repair in the medium term appeared durable. The incidence of postsurgical reflux symptoms was unrelated to inclusion of an antireflux procedure. In the absence of motility data, partial fundoplication was preferred, although dysphagia after floppy 360 degrees wrap was rare. With the low morbidity rate of this procedure, correction of symptomatic paraesophageal hernia appears indicated in patients regardless of age. Images Figure 1.
Edye, M B; Canin-Endres, J; Gattorno, F; Salky, B A
Elective surgical repair of an inguinal or femoral hernia is one of the most common surgical procedures. The treatment, however, presents several challenges regarding anaesthesia for the procedure, the postoperative analgesic therapy and convalescence, as well as planning of the procedure. Local, general, and regional anaesthesia are all used for hernia repair, but to different degrees, primarily depending on traditions and whether the institution has specific interest in hernia surgery. Thus, the use of local anaesthesia varies from a few percent in Sweden, 18% in Denmark and up to almost 100% in specialised institutions, dedicated to hernia surgery. The feasibility of local anaesthesia is high, as judged by the rate of conversion to general anaesthesia (< 1%), although intraoperative pain is quite common. The generally low rate of serious complications does not allow firm conclusions, but the rate of less serious complications is lower by local anaesthesia, compared to other anaesthetic techniques. Of special interest is, that the rate of urinary retention can be eliminated by the use of local anaesthesia. Local anaesthesia results, in comparative studies, in a higher degree of patient satisfaction than other anaesthetic techniques. Local anaesthesia also facilitates faster mobilisation and earlier discharge/fulfilment of discharge criteria from post anaesthetic care units than other anaesthetic techniques. Pain after hernia repair is more pronounced at mobilisation or coughing than during rest, and younger patients seem to have more pain than older patients. The pain ceases over time, and it is most pronounced the day after surgery, where two thirds have moderate or severe pain during activity, while one third still have moderate or severe pain after one week, and approximately 10% after 4 weeks. Pain after laparoscopic surgery is less pronounced than after open surgery, while different open repair techniques do not exhibit significant differences. Postoperative pain is best treated with a combination of local analgesia and peripherally acting agents (paracetamol, NSAID or their combination), while opioids should be avoided due to side effects, primarily nausea and sedation. Moderate or severe pain one year postoperatively is seen in 5-12% of patients. There seem to be no difference between different surgical or anaesthetic techniques, but the following factors have been related to a higher rate of chronic pain: previous or subsequent hernia surgery on the same side, young age, pain before surgery, high pain scores in the immediate postoperative period, and postoperative complications and prolonged convalescence. Patients should be informed about the risk of chronic pain, particularly if the hernia is asymptomatic. The duration of convalescence after hernia repair varies considerably, primarily due to variation in recommendations. No documentation is available to support that a prolonged convalescence reduces the risk of recurrence of the hernia, and most specialised institutions recommend immediate return to all usual activities. Pain seems to be the most important cause of prolonged convalescence. From all published consecutive materials with recommendations of short convalescence the mean or median duration is 6-8 days, in contrast to the two to four weeks often seen in randomised comparisons of different surgical techniques. Patients should be informed, that they can immediately resume all activity if pain permits, but also to expect that pain may limit function of activities of daily living during the first postoperative week. Hernia surgery, including treatment of recurrent hernias, can and ought to be performed as day case surgery, irrespective of the chosen anaesthetic technique, as there are no medical or surgical contraindications to this. Social causes may indicate, that overnight stay may be advisable or desirable, preferably in a patient hotel facility. Despite this, the fraction of patients operated in a day-case surgical set-up varies from 6% in France to 83% in US, and in Denmark 60% of patients hav
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
Sartelli, Massimo; Coccolini, Federico; van Ramshorst, Gabrielle H; Campanelli, Giampiero; Mandalà, Vincenzo; Ansaloni, Luca; Moore, Ernest E; Peitzman, Andrew; Velmahos, George; Moore, Fredrick Alan; Leppaniemi, Ari; Burlew, Clay Cothren; Biffl, Walter; Koike, Kaoru; Kluger, Yoram; Fraga, Gustavo P; Ordonez, Carlos A; Di Saverio, Salomone; Agresta, Ferdinando; Sakakushev, Boris; Gerych, Igor; Wani, Imtiaz; Kelly, Michael D; Gomes, Carlos Augusto; Faro, Mario Paulo; Taviloglu, Korhan; Demetrashvili, Zaza; Lee, Jae Gil; Vettoretto, Nereo; Guercioni, Gianluca; Tranà, Cristian; Cui, Yunfeng; Kok, Kenneth Yy; Ghnnam, Wagih M; Abbas, Ashraf El-Sayed; Sato, Norio; Marwah, Sanjay; Rangarajan, Muthukumaran; Ben-Ishay, Offir; Adesunkanmi, Abdul Rashid K; Segovia Lohse, Helmut Alfredo; Kenig, Jakub; Mandalà, Stefano; Patrizi, Andrea; Scibé, Rodolfo; Catena, Fausto
Background. Incarcerated inguinal hernias have been considered a relative contraindication for endoscopic surgery, as its efficacy and safety is as yet unproven. With more experience and improved techniques, management of incarcerated hernias by the endoscopic approach has become possible with decreased patient discomfort and acceptable results. Aim and Objective. To analyze the feasibility and effectiveness of Endoscopic Totally Extraperitoneal repair
V. R. Saggar; R. Sarangi
Background Laparoscopic ventral hernia repair has been demonstrated to be an acceptable and successful technique. Aside from similar,\\u000a albeit fewer, complications compared to open hernia repair, the laparoscopic technique has the additional complication of\\u000a port site hernia to its follow-up criteria. Our initial experience with reduced port surgery in hernias was described as a\\u000a two-port one-stitch repair technique in 2002. We
Erica R. Podolsky; Angela Mouhlas; Andrew S. Wu; Alexander E. Poor; Paul G. Curcillo
Parastomal hernia is a recognised complication following stoma formation, representing a challenging problem to surgeons. At least three approaches for parastomal hernia repair have been described: fascial suture repair, relocation of stoma and local repair with use of mesh. In simple fascial suture repair only open techniques have been described. Relocation of stoma can be complicated with another parastomal hernia at the new site and risk of incisional hernia at the site of previous stoma. Mesh repair can be either open or laparoscopic. The recurrence rate and complications of parastomal hernia repair remain very high. We have invented a simple fascial suture laparoscopic repair of parastomal hernia with the use of the Crochet hook needle (EndoClose). This new technique may result in reduced pain, earlier discharge from hospital and reduced risk of infection as there is no mesh used as well as reduced risk of seroma formation. PMID:23780775
Zia, Khawaja; McGowan, David Ross; Moore, Etienne
From 2007 to date, fi ve boys with bladder exstrophy underwent this pre-emptive treatment of inguinal hernia at our institution. None has developed a recurrence after a median (range) follow-up of 29 (5 – 46) months. This approach avoids any manipulation of the inguinal canal, which is an advantage per se, but may be even more important in children with bladder exstrophy given the relatively high risk of hernia recurrence reported [ 1,2 ] . Furthermore, the presence of a pelvic diastasis makes the pelvic dissection of the cord easier than in normal children with a closed pelvic ring. The same procedure can also possibly be performed in children with a congenital inguinal hernia undergoing other procedures that require dissection of the perivesical space, e.g. ureteric re-implantation or ureterocoele repair. PMID:22455404
Castagnetti, Marco; Rigamonti, Waifro
Abstract. Given the outstanding outcome that prosthetic repair has recently achieved in the repair of inguinal hernia, we wonder whether\\u000a it should be implemented as the gold-standard technique for umbilical hernia repair. We report on 213 adult patients who underwent\\u000a surgery for umbilical hernia at our Day Surgery Unit from June 1992 to January 1998. Criteria for exclusion included problematic
A. Arroyo Sebastián; F. Pérez; P. Serrano; D. Costa; I. Oliver; R. Ferrer; J. Lacueva; R. Calpena
Background Effective repair of hernia is a difficult task. There have been many advances in hernia repair techniques over the past 50 years,\\u000a but new strategies must be considered to enhance the success of herniorrhaphy.\\u000a \\u000a \\u000a \\u000a Discussion At the 30th International Congress of the European Hernia Society, nine experts in hernia repair and experimental mesh evaluation\\u000a participated in a roundtable discussion about today’s unmet
S. Bringman; J. Conze; D. Cuccurullo; J. Deprest; K. Junge; B. Klosterhalfen; E. Parra-Davila; B. Ramshaw; V. Schumpelick
A wide range of diagnoses can present as inguinal hernia. Laparoscopic techniques are being increasingly used in the repair of inguinal hernias and offer the potential benefit of identifying additional pathology. The authors present the first reported case of a hydrocele of the canal of Nuck diagnosed laparoscopically. We review the incidence of identifying additional pathology through laparoscopy for inguinal hernia repair. We suggest that in patients with atypical presenting features of a hernia, the transabdominal preperitoneal, rather than a totally extraperitoneal, approach to groin hernia repair should be considered because of its greater diagnostic potential.
Szczebiot, Lukasz; Cota, Alwyn
The complications of laparoscopic paraesophageal hernia repair at two institutions were reviewed to determine the rate and\\u000a type of complications. A total of 76 patients underwent laparoscopic paraesophageal hernia repair between December 1992 and\\u000a April 1996. Seventy-one of them had fundoplication (6 required a Collis-Nissen procedure). Five patients underwent hernia\\u000a reduction and gastropexy only. There was one conversion to laparotomy.
Thadeus L. Trus; Tim Bax; William S. Richardson; Gene D. Branum; Susan J. Mauren; Lee L. Swanstrom; John G. Hunter
Hernias are a common occurrence with correspondingly huge clinical and economic impacts on the healthcare system. The most common forms of hernia which need to be diagnosed and treated in routine urological work are inguinal and umbilical hernias. With the objective of reconstructing and stabilizing the inguinal canal there are the possibilities of open and minimally invasive surgery and both methods can be performed with suture or mesh repair. Indications for surgery of umbilical hernias are infrequent although this is possible with little effort under local anesthesia. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostics and therapy of inguinal, femoral and umbilical hernias. PMID:23657776
Franz, T; Schwalenberg, T; Dietrich, A; Müller, J; Stolzenburg, J-U
Inguinal hernia repair in infants and babies is a routine operation, but many issues have not been addressed scientifically.\\u000a Thus, it is not known, e.g., if all children with a hernia should be operated on, what is the best timing of surgery, or if\\u000a the operation should be performed with an open approach or laparoscopically. The review is a critical
Lumbar hernias are rare posterolateral abdominal wall defects that may be congenital or acquired. There are two types of lumbar hernia, the superior lumbar hernia through Grynfeltt triangle, and the inferior lumbar hernia through Petit triangle. Many techniques have been described for the surgical repair of lumbar hernias including primary repair, local tissue flaps, and conventional mesh repair. But these open techniques require a large skin incision. We report a case of superior lumbar hernia, which was successfully repaired using a laparoscopic approach.
Nam, Soon Young; Kee, Se Kook
Background: This article reports the results of a multicenter prospective audit of totally extraperitoneal (TEP) inguinal hernia repair\\u000a conducted by the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTC) from May 1995 to August 1996.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: At 29 Swiss centers 1,605 inguinal hernia repairs were performed in 1,186 patients. Half of the repairs were performed by\\u000a operators whose experience consisted
P. Aeberhard; C. Klaiber; A. Meyenberg; A. Osterwalder; J. Tschudi
Hernias are a common occurrence with a correspondingly huge clinical and economic impact on the healthcare system. Parastomal and trocar hernias are rare in routine urological work. The therapy of parastomal hernias remains problematic but basically the surgeon is able to use conventional techniques with suture repair or procedures with mesh implantation. The conventional parastomal hernia repair with mesh can be classified into sublay, onlay and intraperitoneal techniques. Furthermore, a relocation of the stoma is possible. Trocar hernias represent a rare but hazardous complication. Due to the increase in keyhole surgery there is also the danger of a rise in their occurrence. Incisional hernias occur frequently in patients who have undergone laparotomy and for repair different surgical techniques and types of meshes are available. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostic and therapy of parastomal, trocar and incisional hernias. PMID:23695159
Franz, T; Schwalenberg, T; Dietrich, A; Müller, J; Stolzenburg, J-U
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.
Lei, Wenzhang; Huang, Jianpeng; Luoshang, Ciren
Background/Objectives: Despite multiple options for operative repair of parastomal hernia, results are frequently disappointing. We review our experience with parastomal hernia repair. Methods: A retrospective chart review was performed on all patients with parastomal hernia who underwent LAP or open repair at our institution between 1999 and 2006. Information collected included demographics, indication for stoma creation, operative time, length of stay, postoperative complications, and recurrence. Results: Twenty-five patients who underwent laparoscopic or open parastomal hernia repair were identified. Laparoscopic repair was attempted on 12 patients and successfully completed on 11. Thirteen patients underwent open repair. Operative time was 172±10.0 minutes for laparoscopic and 137±19.1 minutes for open cases (P=0.14). Lengths of stay were 3.1±0.4 days (laparoscopic) and 5.1±0.8 days (open), P=0.05. Immediate postoperative complications occurred in 4 laparoscopic patients (33.3%) and 2 open patients (15.4%), P=0.38. Parastomal hernia recurred in 4 laparoscopic patients (33.3%) and 7 open patients (53.8%) after 13.9±4.5 months and 21.4±4.3 months, respectively, P=0.43. Conclusion: Laparoscopic modified Sugarbaker technique in the repair of parastomal hernia affords an alternative to open repair for treating parastomal hernia.
Pauli, Eric M.; Koltun, Walter A.; Haluck, Randy S.; Shope, Timothy R.; Poritz, Lisa S.
Introduction: Although natural orifice transluminal endoscopic surgery promises truly scarless surgery, this has not progressed beyond the experimental setting and a few clinical cases in the field of ventral hernia repair. This is mainly because of the problem of sterilizing natural orifices, which prevents the use of any prosthetic material because of unacceptable risks of infection. Single-incision laparoscopic ventral hernia repair has gained more widespread acceptance by specialized hernia centers. Even so, there is a special subset of patients who are young and/or scar conscious and find any visible scar unacceptable. This study illustrates an innovative way of performing single-incision laparoscopic ventral hernia repair by a transverse suprapubic incision below the pubic hair/bikini line in 2 young male patients who had both umbilical and epigastric hernias as well as attenuated linea alba in the upper abdomen. Case Description: Both patients underwent successful laparoscopic repair, and both were highly satisfied with the procedure, which produced no visible scars on their abdomen. Discussion: Willingness to adopt new innovative procedures, such as single-incision laparoscopic surgery, has allowed modification of the incision site to produce invisible scars and hence become highly attractive to the young and scar-phobic segment of the population.
Turingan, Isidro; Tran, Mai
INTRODUCTION The concept of using a mesh to repair hernias was introduced over 50 years ago. Mesh repair is now standard in most countries and widely accepted as superior to primary suture repair. As a result, there has been a rapid growth in the variety of meshes available and choosing the appropriate one can be difficult. This article outlines the general properties of meshes and factors to be considered when selecting one. MATERIALS AND METHODS We performed a search of the medical literature from 1950 to 1 May 2009, as indexed by Medline, using the PubMed search engine (
Brown, CN; Finch, JG
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.
Lim, Man Sup; Lee, Hae Wan; Yu, Chang Hee
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.
Sigterman, T. A.; Gorissen, Kim J.; Dolmans, Dennis E. J. G. J.
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.
Sarela, Abeezar I.
This paper presents the surgical technique for ventral abdominal hernia repair, including median incisional hernia, umbilical hernia and epigastric hernia. The main stages of the surgical procedure are as follows: pinpointing the parietal defect, insufflation of pneumoperitoneum and placing the trocars, inspection and adhesiolysis of the peritoneal cavity, closure of the defect with extracorporeal transparietal U reverse stitches, preparing the mesh, introducing the mesh in the peritoneal cavity and fixing it with transfascial sutures and tackers. Postop care measures, postop complications and controversies regarding mesh composition and fixation method are also discussed. PMID:21355179
Nicolau, A E
Paraduodenal hernia is an uncommon cause of acute abdominal pain; however, it is the commonest of internal herniation. Computer tomography of the abdomen is diagnostic. Although it is a rare cause of intestinal obstruction, it is estimated that more than half of paraduodenal hernias develop symptoms. We present a case of left paraduodenal hernia that presented with acute abdominal pain and a left upper abdominal mass. Symptoms resolved spontaneously and a planned Laparoscopic repair was performed. The malpositioned small intestine was reduced from the hernia sac and the hernial orifice was closed. The patient made a rapid recovery with no recurrence of symptoms at 3-year follow-up.
Siddika, Arifa; Coleman, Alistair H.L.; Pearson, Thomas E.
Introduction Parastomal hernia is a frequent complication after enterostomy formation. A repair using prosthetic mesh by way of a laparoscopic or open transabdominal approach is usually recommended, however, other procedures may be done if the repair is to be performed in a contaminated environment or when the abdominal cavity of the patient is difficult to enter due to postsurgical dense adhesion. The components separation method, which was introduced for non-transabdominal and non-prosthetic ventral hernia repair, solves such problems. Case presentation Case 1. A 79-year-old Japanese woman who underwent total cystectomy with ileal conduit for bladder cancer presented with a parastomal hernia, which was repaired using a keyhole technique. Simultaneously, an incisional hernia in the midline was repaired with a prosthetic mesh. One year after her hernia surgery, a recurrence occurred lateral to the stoma, but it was believed to be difficult to enter the peritoneal cavity because of the wide placement of mesh. Therefore, surgery using the components separation method was performed. Case 2. A 72-year-old Japanese man underwent an abdominoperineal resection for rectal cancer. At 5 and 12 months after his operation, a perineal hernia and an incisional hernia in the midline were repaired with prosthesis using a transabdominal approach, respectively. Three years after his rectal surgery, a parastomal hernia developed lateral to the stoma. For the same reason as case 1, surgery using the components separation method was performed. No recurrence was observed in either case as of 40 and 8 months after the last repair, respectively. Conclusion The components separation method is a novel and effective technique for parastomal hernia repair, especially in cases following abdominal polysurgery or midline incisional hernia repairs using large pieces of mesh. To the best of our knowledge, this is the first report in English on the application of the components separation method for parastomal hernia repair.
We present a case of a giant inguinoscrotal hernia that extended almost to the patient's knees. Operative repair was through a standard transverse inguinal incision. No debulking or abdominal enlargement procedure had to be performed. The repair was done with a tension-free, onlay, prosthetic mesh repair.
Coetzee, E.; Price, C.; Boutall, A.
Laparoscopic instead of open surgical repair of inguinal hernias is becoming more frequent. Radiologists may expect different\\u000a postoperative findings depending on the technique used. We studied how radiology had been used postoperatively and what findings\\u000a were encountered after laparoscopic herniorraphy. Postoperative radiologic examinations related to hernia repair of all consecutive\\u000a patients that had had laparoscopic herniorraphy in Malmö University hospital
Martin Larmark; Olle Ekberg; Agneta Montgomery
A 68 year old female presented for elective repair of an abdominal wall hernia. Preoperative CT imaging revealed a right inguinal hernia defect with hernia contents coursing cephalad between the external and internal abdominal oblique muscles. This was consistent with an interstitial inguinal hernia, a rare entity outside of post- traumatic hernias. At operation the hernia contents were reduced laparoscopically. The hernia was then repaired by transitioning to the totally extraperitoneal (TEP) approach using a 15cm X 15cm piece of polyester mesh. The patient had an uneventful recovery. Interstitial hernias are rare, difficult to diagnose and potentially dangerous if left untreated. There is no consensus on the ideal repair of these unique hernias. This represents a minimally invasive repair of an unusual hernia, with a novel approach to diagnose and manage the hernia and its redundant sac. PMID:24950565
Glaser, J; Pearl, J; Wind, G; Sheppard, F
Currently, operative repair of inguinal hernia is most often performed using one of the open mesh procedures or laparoscopic techniques. These newer approaches minimize anatomical dissection critical to the time-honored traditional hernia surgery described by Bassini, Halsted, McVay, Laroque, Shouldice, and other early pioneers. The familiarity with groin anatomy and the technical skill gained in performing these operations is currently missing from present-day surgical residency training. This article reviews 5 classic hernia operations described by the surgeons whose name they bear, with a view toward better understanding the authors' techniques and philosophies. Each of these operations, though considered by some as of historical interest only, offers today's surgeon reliable alternatives when the simple application of mesh by open or laparoscopic technique is inappropriate. (Curr Surg 62:249-252. Published by Elsevier Inc. on behalf of the Association of Program Directors in Surgery.). PMID:15796951
Banks, Shane B; Cotlar, Alvin M
Background Lumbar hernias that occur after surgery are called lumbar incisional hernias. Recently, laparoscopic repair of these hernias\\u000a has been reported with excellent outcomes. This is a retrospective study of our series of patients with lumbar incisional\\u000a hernias.\\u000a \\u000a \\u000a \\u000a Patients and methods We managed 11 patients with lumbar incisional hernias from 1996–2006. All the patients had undergone either nephrectomy or\\u000a pyeloplasty in the
C. Palanivelu; M. Rangarajan; S. J. John; M. V. Madankumar; K. Senthilkumar
Polypropylene mesh when used in laparoscopic ventral hernia repair can produce the worst complication such as enterocutaneous fistula. We report an interesting case of incisional hernia operated with laparoscopic polypropylene mesh hernioplasty who subsequently developed an enterocutaneous fistula 1 month after surgery. A fistulogram showed dye entering into the transverse colon. On exploration, the culprit polypropylene mesh was found to have eroded into the mid-transverse colon causing the fistula. Resection and end-to-end anastomosis of the colon were done with the removal of the mesh. On literature review, polypropylene mesh erosion in to transverse colon is rare.
Sahoo, Manash Ranjan; Bisoi, Suryakanta; Mathapati, Santosh
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.
Kocaay, Firat; Orozakunov, Erkinbek; Genc, Volkan; Kepenekci Bayram, Ilknur; Cakmak, Atil; Baskan, Semih; Kuterdem, Ercument
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-a p-b p-c p-d Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5
BACKGROUND: Recurrences have been a significant problem following hernia repair. Prosthetic materials have been increasingly used in hernia repair to prevent recurrences. Their use has been associated with several advantages, such as less postoperative pain, rapid recovery, low recurrence rates. METHODS: In this retrospective study, 540 tension-free inguinal hernia repairs were performed between August 1994 and December 1999 in 510
George H Sakorafas; Ioannis Halikias; Christos Nissotakis; Nikolaos Kotsifopoulos; Alexios Stavrou; Constantinos Antonopoulos; George A Kassaras
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.
Choi, Yoon Young; Kim, Zisun; Hur, Kyung Yul
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.
Chowbey, Pradeep K; Sharma, Anil; Mehrotra, Magan; Khullar, Rajesh; Soni, Vandana; Baijal, Manish
Background This report reviews our experience with 3530 transabdominal preperitoneal (TAPP) hernia repairs in 3017 patients (513 bilateral)\\u000a over the 7-year period from May 1992 to July 1999. We have continually audited our practice and modified the techniques in\\u000a response.\\u000a \\u000a \\u000a \\u000a Methods Unless contraindicated, laparoscopic TAPP repair is considered the procedure of choice at our institution for all reducible\\u000a inguinal hernias. We initially
S. A. Kapiris; W. A. Brough; C. M. S. Royston; C. O’Boyle; P. C. Sedman
OBJECTIVES Morgagni hernia (MH) is an uncommon type of diaphragmatic hernia. This study aimed to summarize clinically relevant data with respect to MHs in adults. METHODS We performed a retrospective chart review of patients who underwent surgical repair of foramen due to MH at our hospitals between 1996 and 2010. Data were collected on patient demographics, presenting symptoms, modes of diagnosis, surgical procedures, surgery outcomes, recurrence of hernia and follow-up of the patients. RESULTS We included 36 patients with the mean age of 50.2 years. Of these 66.7% (n = 24) were female. Thirty-one patients had MH on the right side and 1 patient had bilateral MH. Most of the patients experienced abdominal symptoms. 72.2% of patients underwent laparotomy (n = 26, 72.2%), (n = 6, 16.7%) thoracotomy (n = 6, 16.7%), and a thoraco-abdominal approach (n = 4, 11.1%). Resection of the hernia sac and insertion of a mesh were not done in any patients. No recurrence occurred. CONCLUSIONS We conclude that preoperative diagnosis and early diagnosis of MH by using laparotomy and thoracotomy is useful for safe and effective repair. Also we suggest that resection of the hernia sac and insertion of a mesh are not necessary.
Aghajanzadeh, Manouchehr; Khadem, Shahram; Khajeh Jahromi, Sina; Gorabi, Hamed Esmaili; Ebrahimi, Hannan; Maafi, Alireza Amir
Single incision laparoscopic surgery is used in many centres for routine cases such as appendectomy, splenectomy and cholecystectomy. Morgagni hernias are uncommon and account for 1-2% of all congenital diaphragmatic hernia. We report our first laparoscopic repair of two Morgagni hernias, using a single umbilical incision and full-thickness abdominal wall repair with standard straight laparoscopic instruments. Operative time was short and compared favourably with the laparoscopic repair. PMID:23519862
van Niekerk, Martin L
Authors with wide experience report that the Shouldice technique for repair of inguinal hernia is very effective. The technique has not gained widespread acceptance or notoriety. For example, the 13th edition of Textbook of Surgery, edited by Sabiston, devotes only one paragraph to this type of herniorrhaphy. Because of the excellent results reported by the Shouldice Clinic, this technique was adopted at the Augusta Veterans Administration Hospital, a teaching hospital of the Medical College of Georgia. Since 1976, a total of 604 Shouldice repairs have been performed by supervised house staff; 468 patients have been followed for up to 8 years and a recurrence rate of 1.3 per cent is reported. Although the follow-up is brief, the Shouldice hernia repair is widely applicable and good results are not dependent on wide experience alone. PMID:3307578
Sisley, J F; Scarborough, C S; Morris, R C; Jennings, W D
Repair of the abdominal wall is the last stage of abdominal surgery; pariet complications, particularly infection, can have serious impact on operative results. While abdominal wound infections are not universally preventable, they are often predictable; the aphorism of Jean Rives (Stoppa, 1999 ) summarizes this sequence: "Infection is the mother of postoperative incisional hernia and infection of the incisional hernia repair is the grand-daughter". Repair of the abdominal wall in a potentially septic milieu requires the solution of an equation involving four variables: mechanism of sepsis, its severity, the surgical approach, and choice of prosthetic material. These interdependent variables potentiate each other, requiring adaptations of surgical strategy that cannot be absolutely determined pre-operatively, even with collegial consultation. PMID:23137642
Background: This study aimed to document the authors' experience with laparoscopic inguinal hernia repair in children. Methods: Ninety-three hernia repairs were performed in 64 children. The neck was closed with a purse string suture by using 4-0 absorbable suture. Results: Ninety-three indirect inguinal hernial sacs were closed in 64 children. Nine percent of children had an ectopic testis. The mean operating time for laparoscopic ring closure was 25 minutes (range, unilateral 21 to 35; bilateral, 28 to 50). The contralateral processus vaginalis was patent in 20% of children. In 24% of children, the final procedure was modified based on the findings of a dilated internal ring. A laparoscopic ilio-pubic tract repair was done in these cases. Laparoscopic mobilization, orchiopexy followed by ilio-pubic tract repair was done in 9% of children. Scrotal swelling occurred in one child. Hydrocoele occurred in one patient. Recurrence rate was 3.1%. Conclusion: Laparoscopic inguinal hernia repair in children can be offered, as it is safe, reproducible, and technically easy for experienced laparoscopic surgeons. Iliopubic tract repair may be added in cases with dilated internal ring. Recurrence following laparoscopic ring closure can be managed with laparoscopic ilio-pubic tract repair. The long-term follow-up of laparoscopic ilio-pubic tract repair is awaited.
Chinnaswamy, Palanivelu; Jani, Kalpesh V.; Parthasarthi, R.; Shetty, Roshan A.; Kavalakat, Alfie Jose; Prakash, Anand
In modern hernia surgery, there are two competing mesh concepts which often lead to controversial discussions, on the one hand the heavyweight small porous model and on the other, the lightweight large porous hypothesis. The present review illustrates the rationale of both mesh concepts and compares experimental data with the first clinical data available. In summary, the lightweight large porous mesh philosophy takes into consideration all of the recent data regarding physiology and mechanics of the abdominal wall and inguinal region. Furthermore, the new mesh concept reveals an optimized foreign body reaction based on reduced amounts of mesh material and, in particular, a significantly decreased surface area in contact with the recipient host tissues by the large porous model. Finally, recent data demonstrate that alterations in the extracellular matrix of hernia patients play a crucial role in the development of hernia recurrence. In particular, long-term recurrences months or years after surgery and implantation of mesh can be explained by the extracellular matrix hypothesis. However, if the altered extracellular matrix proves to be the weak area, the decisive question is whether the amount of material as well as mechanical and tensile strength of the surgical mesh are really of significant importance for the development of recurrent hernia. All experimental evidence and first clinical data indicate the superiority of the lightweight large porous mesh concept with regard to a reduced number of long-term complications and particularly, increased comfort and quality of life after hernia repair. PMID:16293033
Klosterhalfen, Bernd; Junge, Karsten; Klinge, Uwe
INTRODUCTION Lumbar hernia is a rare condition with fewer than 300 cases reported in the literature. It arises through posterolateral abdominal wall defects, named the inferior triangle (Petit) and superior triangle (Grynfelt). It can be congenital or acquired, primary or secondary, peritoneal or extraperitoneal, reducible or complicated. PRESENTATION OF CASE We report a 63 year old female patient who presented to our hospital with a reducible right superior lumbar hernia. She underwent repair with underlay mesh after inversion of the sac and had a smooth postoperative course. DISCUSSION In contrast to the classical procedure the underlay mesh modification saved us from enlarging the defect, and was quick and associated with minimal tissue injury. CONCLUSION Underlay mesh repair for spontaneous lumbar hernia is feasible when the defect is small.
Mismar, Ayman; Al-Ardah, Mahmoud; Albsoul, Nader; Younes, Nidal
An isolated intrapericardial diaphragmatic hernia is very rare. Only 15 cases have been reported, 2 of which are in adults. The defect in the anterior diaphragm allows abdominal contents to enter the pericardial cavity. We report the 16th case--the third in an adult--and its laparoscopic repair. PMID:24384189
Tyagi, Sam; Steele, Justin; Patton, Byron; Fukuhara, Shinichi; Cooperman, Avram; Wayne, Michael
Patient: Male, 60 Final Diagnosis: Iatrogenic intercostal lung hernia Symptoms: — Medication: No medication Clinical Procedure: Surgically cerrected Specialty: Thoracic surgery Objective: Unusual clinical course Background: Iatrogenic intercostal lung hernia is a rare thoracic pathology. Injury of intercostal muscles and costocondral separation during median sternotomy and sternal dehiscence surgery are important factors in the development of hernia. We report for the first time a case of a 60-year-old man with acquired lung hernia after sternal dehiscence surgery, presenting as chest pain and exertional dyspnea. Case Report: A 60-year-old man presented with a 6-week history of progressive exertional dyspnea, particularly following vigorous coughing. Past medical history included slight chronic obstructive pulmonary disease and coronary artery bypass grafting surgery 8 weeks previously, using the left internal mammary artery for the left anterior descending artery via median sternotomy and sternal dehiscence by the Robicsek method. A chest X-ray showed intact sternal and parasternal wires, but the bilateral lung parenchyma appeared normal. A spiral computed tomography scan of the chest found intercostal herniation of the anterior segment of the left upper lobe. The lung hernia was repaired surgically to relieve exertional dyspnea and incarceration, and to improve respiratory function. The postoperative course was uneventful and the patient recovered well. Conclusions: Intercostal lung hernia after median sternotomy and sternal dehiscence surgery is rare, and it has been previously reported on. Preventive techniques include gentle manipulation of the sternal retractor, avoidance of rib fractures, and using a protective method of intercostal arteries and nerves such as Sharma technique. Thoracic surgeons should be aware of this rare complication in sternal dehiscence surgery.
Celik, Sezai; Aydemir, Cuneyt; Gurer, Onur; Is?k, Omer
Incisional hernias occur as frequent as they did 20 years ago even if we use modern technologies in terms of suture. Sutures techniques, either primary repair or applied after failure of primary repair are characterized by high rates of recurrence. Using the hernia mesh has become mandatory in repairing of all types of hernias - inguinal, ventral or incisional. Implantation of the mesh is a relatively well-coded surgical procedure. But surgery is only the first step in the process of healing. Implantation starts a strong response with haematological mechanisms: protein absorption, complement activation, coagulation, platelet activation, neutrophil activation and tissue mechanisms: proliferation, adhesion, fibrosis. Recurrence rates are consistently lower when replacement meshes are used and a variety of meshes have been developed for this purpose. How the mesh is embedded by the human body and how the biomechanical limits of the abdominal wall are restored is still a subject of debate for surgeons. Histopathological studies and progress in design and materials are the only keys to solve this problem. Also pathological studies should determine the right material for personalized repair according to each patient's biology. This paper attempts to analyze the molecular failure factors in incisional hernia surgery, different from errors in surgery procedures. Complications can be avoided or reduced by an appropriate selection of the type of place in a particular case, and by performing a meticulous technique. Incisional hernias are considered at this moment a biological progressive phenomenon, and not only a strictly technical one, a "simple hole in the abdominal wall" that has to be firmly sutured. PMID:23618569
Radu, P; Br?tucu, M; Garofil, D; Pasnicu, C; Iorga, C; Popa, F; Strâmbu, V
Hernia surgery is generally a rewarding task, patient satisfaction is high and the long-term results are generally good. Incisional hernias are more heterogeneous and there is a higher variability of morphologies to be matched with the available therapeutic approaches but the majority of patients are also satisfied with the results. This positive scenario for hernia surgery can be largely attributable to careful preoperative planning, effective surgical techniques and a high degree of standardization. The picture is somewhat clouded by the complications associated with hernia surgery. If complications do arise, the outcome largely depends on how well the surgeon responds. For inguinal and femoral hernias, the risk profile of the patient is crucial to the surgical planning and the wrong operation on the wrong patient can be disastrous. Open procedures have complication risks in common but the question of how best to deal with the nerves has yet to be answered. Endoscopic procedures are an indispensable part of the hernia surgery repertoire and the hernia specialist should be proficient in TEP and TAPP techniques. Ventral and incisional hernias have higher complication rates and the treatment is similar despite differences in etiology and pathophysiology. Although open procedures are better for morphological reconstruction they are accompanied by a higher complication rate. Laparoscopic procedures had a severe complication profile early on but the situation has greatly improved today due to continued refinement of the learning curve. A critical approach to the application of methods and meshes, a deep knowledge of anatomical peculiarities and the careful planning of tactics for dealing with intraoperative problems are the hallmarks of today's good hernia surgeon. PMID:24435828
Dietz, U A; Wiegering, A; Germer, C T
INTRODUCTION Congenital diaphragmatic hernia (CDH) in adults is a relatively rare condition being asymptomatic in the majority of cases. Symptomatic CDH should prompt surgical management because they may lead to intestinal obstruction or severe pulmonary disease. This is the first reported case of a symptomatic CDH complicated with sliding hiatal hernia (SHH). PRESENTATION OF CASE A 65 years old women with reflux and dysphagia was complaining of postprandial paroxysmal dyspnea and epigastric pain radiating to her back. Upper endoscopy diagnosed sliding and para-esophageal diaphragmatic hernia with severe esophagitis. Computed tomography-scan revealed a large Bochdalek hernia at the left diaphragm. DISCUSSION Diagnostic laparoscopy was decided, which confirmed the SHH, but also revealed a CDH defect at the tendonous part of the left diaphragm. The left bundle of the right crus was intact, separating the two hernia components (sliding and congenital). Extensive adhesiolysis was performed, dissecting and separating the stomach away from the diaphragm. Posterior cruroplasty at the esophageal hiatus was performed for the SHH with Nissen fundoplication as antireflux procedure. Primary continuous suture repair was performed for the CDH, reinforced with prosthetic mesh on top. Operative time was 150 min with no morbidity. The patient was discharged home uneventfully the third postoperative day. On 12-months follow-up, she reported no symptoms and improvement in quality of life. CONCLUSION Laparoscopy is a unique method for a precise diagnosis of symptomatic congenital diaphragmatic hernia in adults being also a safe and viable technique for a successful repair at the same time. Experience of advanced laparoscopic surgery is required.
Ayiomamitis, Georgios D.; Stathakis, Panayiotis Ch.; Kouroumpas, Efstratios; Avraamidou, Alexandra; Georgiades, Phivos
Background and Objectives: Morgagni hernias are unusual congenital diaphragmatic hernias that are generally asymptomatic and discovered incidentally. Surgical treatment is indicated once the diagnosis is made. These hernias have traditionally been repaired by the open abdominal or thoracic approaches. We report a case of Morgagni hernia repaired successfully via the laparoscopic approach. Methods and Results: The patient was noted to have a large anteromedial diaphragmatic hernia by chest radiograph and CT imaging. He underwent laparoscopy, during which the hernia was reduced and the defect repaired with mesh placement. We used intracorporeal suture placement to anchor the mesh. The patient recovered uneventfully after a short hospitalization. Conclusions: The laparoscopic approach for repair of Morgagni hernias offers diagnostic advantages as well as the potential for reduced morbidity when compared to laparotomy. We report intracorporeal knot-tying for fixation of the mesh to be a secure and satisfactory means to achieve the laparoscopic repair.
Nguyen, Trung; Nguyen, Dat; Klein, Stanley R.
Results on hernia surgery from numerous centers confirm that tensionless repair with various meshes reduces the complication\\u000a rates and the frequency of recurrences. Some evidence on incisional hernias suggests, however, that the use of mesh seems\\u000a to transfer the onset of recurrences by several years. Persistent pain and other discomfort is also an unpleasant complication\\u000a of otherwise successful surgery in
R. Penttinen; J. M. Grönroos
Background Many centers use local anesthesia for adult inguinal hernia surgery in the setting of day-case surgery. There are no reports\\u000a on, or guidelines for, use of anesthesia for inguinal hernia surgery in adolescents. We describe our initial experience with\\u000a the use of local anesthesia and intravenous sedation for inguinal hernia surgery in adolescents in the setting of a day-surgery\\u000a facility.
O. Olsha; A. Feldman; D. B. Odenheimer; D. Frankel
Introduction A superior lumbar hernia, which is also known as a Grynfeltt hernia, is a rare abdominal wall defect that can be primary or secondary to trauma or orthopedic surgery. The anatomic location of a lumbar hernia makes diagnosis and repair challenging. We successfully repaired a lumbar hernia using a single-incision laparoscopic total extraperitoneal approach. To the best of our knowledge, this is the first report of the use of this surgical technique in the treatment of a primary Grynfeltt hernia. Case presentation A 76-year-old Taiwanese man presented to our hospital with a left lower bulging mass noted for over three months. Abdominal computed tomography revealed a left Grynfeltt hernia. We performed a single-incision laparoscopic total extraperitoneal repair. Our patient was discharged uneventfully on the fourth day after the operation. There was no evidence of recurrence after six months of follow-up. Conclusion A laparoscopic total extraperitoneal repair for a lumbar hernia provides an excellent operative view and minimal invasiveness. The single-incision technique also provides better cosmetic outcomes. Our experience suggests that the single-incision laparoscopic total extraperitoneal approach may be a feasible and safe alterative to conventional approaches in lumbar hernia repair.
The installation of synthetic prosthesis in the repair of the hernial defects of the inguinal region, though it is part of cleaned surgical operations, it needs of an antibacterial prophylaxis for the prevention of the septic complications of the surgical wound and these, compared with complications following hernioplasty by straight suture, have a meaningful morbidity that can outweigh social and economic advantages of the hernioplasties. The Authors' experience is relative to 112 patients submitted to prosthetic hernioplasty by anterior approach (94 cases) and by transabdominal preperitoneal laparoscopy (TAPP) (18 cases) and underwent to "switch prophylaxis" with Levofloxacin using this posologic scheme: 500 mg ev 30 m' before the surgical operation and 500 mg os in seven days following. The evaluation of the surgical wound has never evidenced septic and suppurative complications; only 11 of the 122 surgical wounds (9%) have documented light phlogosis never advanced to evident suppuration. No patients have showed signs of pharmacologic local intolerance; about collateral general effects as sick and diarrhoea are appeared in 5% of patients, but these have been of light entity; an increase of the transaminase, quickly reverted to the suspension of the therapy, has interested 4% of cases. On the basis of these satisfactory results about clinical efficacy on the prophylaxis of the phlogistic complications of the surgical wound, with reduction of the incidence and gravity and in relation to large and complete antibacterial spectrum included Staphylococcus aureus and epidermidis, and about excellent tolerability without collateral effects, the Authors consider to be important the standardized use of this prophylaxis in the prosthetic hernial surgery of the inguinal region. This choice is correlated to the typical pharmacologic characteristics of the Levofloxacin and particularly to the total bioequivalence between endovenous and oral formulation and besides in relation to perseverance, not inferior to 24 hours, of the plasmatic and tissutal concentrations above bactericide IMC on the most part of organic districts, included skin and soft tissue. The assurance of Levofloxacin's employment in the "switch prophylaxis" also is correlated to patient's elevated compliance, above all if he is operated on regimen of "one day surgery", and to a favorable relationship between costs and benefits. PMID:11682967
Angiò, L G; Versaci, A; Rivoli, G; Santagati, C; De Caridi, G; Pacilè, V
Introduction Natural orifice surgery has evolved from a preclinical setting into a common occurrence at the University of California San\\u000a Diego (UCSD). With close to 40 transvaginal cases, we have become comfortable with this technique and are exploring other\\u000a indications. One of the perceived advantages in natural orifice surgery is the potential reduction in the incidence of hernia\\u000a formation. Patients with
G. R. Jacobsen; K. Thompson; A. Spivack; L. Fischer; B. Wong; J. Cullen; J. Bosia; E. Whitcomb; E. Lucas; M. Talamini; S. Horgan
A parastomal hernia is the most common surgical complication following stoma formation. As the field of laparoscopic surgery advances, different laparoscopic approaches to repair of parastomal hernias have been developed. Recently, the Sugarbaker technique has been reported to have lower recurrence rates compared to keyhole techniques. As far as we know, the Sugarbaker technique has not yet been performed in Korea. We herein present a case report of perhaps the first laparoscopic parastomal hernia repair with a modified Sugarbaker technique to be successfully carried out in Korea. A 79-year-old woman, who underwent an abdominoperineal resection for an adenocarcinoma of the rectum 9 years ago, presented with a large parastomal and incisional hernias, and was treated with a laparoscopic repair with a modified Sugarbaker technique. Six months after surgery, follow-up with the patient has shown no evidence of recurrence.
Jeong, Duck Hyoun; Park, Min Geun; Melich, George; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk
In classic literature, knowing that small defects can be repaired primarily in umbilical hernias of adults, mesh repair should be reserved for larger defects. Conventional repair methods have resulted in high rates of recurrence. Therefore, this prospective study investigated the repair techniques in umbilical hernias of adults. The patients who underwent primary umbilical hernia operation between 1998 and 2003 were reviewed. Primary repair was conducted in defects less than 3 cm, whereas larger defects were repaired with polypropylene mesh. Postoperative complications, the length of hospital stay, and recurrence in follow-up were recorded. Of 111 patients, primary repair was carried out on 63 patients, and 48 underwent polypropylene mesh repair. Recurrence rate was significantly higher in the primary repair group (14%) compared with polypropylene mesh repair group (2%). In conclusion, contrary to the general tendency that small defects can be repaired primarily, polypropylene mesh should be used in all umbilical hernias regardless of the size of the defect. PMID:17061669
Eryilmaz, Ramazan; Sahin, Mustafa; Tekelioglu, M Hakan
The iliac crest is a common donor site for autogenous bone grafts. Among the reported complications, lumbar hernias occur infrequently with a reported incidence of 5% to 9%. Surgical repair is advocated secondary to the risk of incarceration or strangulation. Computed tomography is the diagnostic study of choice. Various transabdominal, retroperitoneal, and laparoscopic approaches have been described for the repair of lumbar hernias. We describe a case of successful lumbar incisional hernia repair after iliac crest bone graft harvesting that used prosthetic mesh.
Do, Michael V.; Richardson, William S.
Primary colon carcinoma within an inguinal hernia sac is very rare and most reported cases were found at emergency open surgery for an incarcerated hernia. We report a case of incarcerated sigmoid colon carcinoma diagnosed preoperatively and treated with elective laparoscopic surgery. A 67-year-old man with a 2-year history of swelling of the scrotum and a breast lump was referred to us for surgical treatment of an irreducible left inguinal hernia and a right breast tumor. Blood examination results showed severe anemia. Computed tomography scan and endoscopic biopsy confirmed sigmoid colon carcinoma incarcerated in the left inguinal hernia. Thus, we performed definitive laparoscopic sigmoidectomy and conventional hernia repair for preoperatively diagnosed sigmoid colon carcinoma within an inguinal hernia. PMID:23846798
Kanemura, Takashi; Takeno, Atsushi; Tamura, Shigeyuki; Okishiro, Masatsugu; Nakahira, Shin; Suzuki, Rei; Nakata, Ken; Egawa, Chiyomi; Miki, Hirohumi; Takeda, Yutaka; Kato, Takeshi
. Antibiotic prophylaxis is not routinely given for nonimplant, clean operations, although this view has recently\\u000a been challenged. We have conducted a randomized multicenter, double-blind prospective trial to compare co-amoxiclav with placebo\\u000a in 619 patients undergoing open groin hernia repair. Altogether 563 (91%) patients fulfilled the protocol; 283 received co-amoxiclav\\u000a and 280 placebo. There was no difference between the groups
Eric W. Taylor; Derek J. Byrne; David J. Leaper; Stephan J. Karran; M. Kennedy Browne; Kenneth J. Mitchell
Inguinal herniation of the urinary bladder is an extremely rare occurrence involving less than 5% of inguinal hernias reported in literature. These hernias require a high index of suspicion for their diagnosis and pose significant challenges to the operating surgeon. The majority of these hernias have been repaired by an open technique. We report two cases managed laparoscopically.
Khan, Atif; Beckley, Ian; Dobbins, Brian; Rogawski, Karol M
Background Family history, male gender and age are significant risk factors for inguinal hernia disease. Family history provides evidence for a genetic trait and could explain early recurrence after inguinal hernia repair despite technical advance at least in a subgroup of patients. This study evaluates if age and family history can be identified as risk factors for early recurrence after primary hernia repair. Methods We performed an observational cohort study for 75 patients having at least two recurrent hernias. The impact of age, gender and family history on the onset of primary hernias, age at first recurrence and recurrence rates was investigated. Results 44% (33/75) of recurrent hernia patients had a family history and primary as well as recurrent hernias occurred significantly earlier in this group (p = 0.04). The older the patients were at onset the earlier they got a recurrent hernia. Smoking could be identified as on additional risk factor for early onset of hernia disease but not for hernia recurrence. Conclusion Our data reveal an increased incidence of family history for recurrent hernia patients when compared with primary hernia patients. Patients with a family history have their primary hernias as well as their recurrence at younger age then patients without a family history. Though recurrent hernia has to be regarded as a disease caused by multiple factors, a family history may be considered as a criterion to identify the risk for recurrence before the primary operation.
Laparoscopic paraesophageal hernia repair continues to be one of the most challenging procedures facing the minimally invasive surgeon. A thorough understanding of the tenets of the operation and advanced skills in minimally invasive laparoscopy are needed for long-term freedom from symptomatic and anatomic recurrence. These include complete reduction of the hernia sac from the mediastinum back into the abdomen with careful preservation of the integrity of muscle and peritoneal lining of the crura, aggressive and complete mobilization of the esophagus to the level of the inferior pulmonary vein, clear identification of the gastroesophageal junction to allow accurate assessment of the intraabdominal esophageal length and use of Collis gastroplasty when esophageal lengthening is required for a tension-free intraabdominal repair. Liberal mobilization of the phrenosplenic and phrenogastric attachments substantially increases the mobility of the left limb of the crura, allowing for a tension-free primary closure in a large percentage of patients. The following describes our current approach to laparoscopic paraesophageal hernia repair following a decade of refinement in a high-volume center.
Nason, Katie S.; Levy, Ryan M.; Witteman, Bart P.L.; Luketich, James D.
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
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.
Wilson, Kenneth L.; Rosser, James C.
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.
Machairas, Anastasios; Patapis, Paul; Liakakos, Theodore
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.
Abdominal wall hernia correction is one of the most common surgical procedures. 85,000 hernia operations are performed in Poland each year. Modern techniques of abdominal wall reconstruction utilize surgical implants for fascial defect closure. In the 70s and the 80s of the last century, these techniques gained widespread acceptance among surgeons. Significant improvement of results in terms of recurrences was observed. Treatment of large abdominal wall defects became possible. Three types of surgical implants were developed early: polipropylene (PP), poliethylene (PE) and politetrafluoroethylene (PTFE). Unfortunately, negative effects of implanted material soon became apparent. Excessive native tissues inflammatory response to the implanted material, leading to multiple complications was observed. Recurrences due to fibrosis, chronic regional pain, stiffness of the operation site, intestinal adhesions and fistulas, infertility and infections were reported. In some cases the use of standard synthetic implant was contraindicated. Analyzing drawbacks of the standard hernia implants, the medical industry developed new materials to improve treatment results. The most popular, currently utilized synthetic materials, are presented in this review in the context of clinical results. PMID:24596016
Lukasiewicz, Aleksander; Drewa, Tomasz
In an attempt to find the ideal surgical technique for mesh fixation during laparoscopic total extraperitoneal inguinal hernia repair, we evaluate the use of a synthetic surgical glue (N-butyl-cyanoacrylate-Glubran 2) in an effort to reduce postoperative pain and the complications associated with the use of staples. We have prospectively evaluated 61 consecutive patients (73 hernias) with a minimum follow-up period of 18 months and an average of 29.7 months, without any significant complications present. The majority (59%) only required low dosages of painkillers during the first 24 hours after surgery and have not experienced any cases of chronic pain or recurring hernias in the time period described. On the basis of this initial experience, the use of the surgical glue used to repair inguinal hernias with the laparoscopic total extraperitoneal technique has been proved to be a simple and effective surgical method for mesh fixation. PMID:24887541
Garcia-Vallejo, Luis; Couto-Gonzalez, Ivan; Concheiro-Coello, Pablo; Brea-Garcia, Beatriz; Taboada-Suarez, Antonio
... Liang, an assistant professor of surgery at the University of Texas Health Sciences Center at Houston. An abdominal hernia ... SOURCES: Mike Liang, M.D., assistant professor, surgery, University of Texas Health Sciences Center at Houston; Steven Hodgett, M. ...
Introduction: We evaluated the effect of the postgraduate medical education level (PGY) of surgery residents on recurrence of inguinal hernia, complications, and operative time. Methods: Post hoc analysis was performed on prospectively collected data from a multicenter Veterans Affairs (VA) cooperative study. Men were randomly assigned to open or laparoscopic inguinal hernia repairs with mesh. Surgery residents performed repairs with designated attending surgeons present throughout all procedures. PGY level of the resident was recorded for each procedure. All patients were followed for 2 years for hernia recurrence and complications. PGY levels were grouped as follows: group I = PGY 1 and 2; group II = PGY 3; group III = PGY ? 4; rates of recurrence, complications and mean operative time were compared. Results: A total of 1983 patients underwent hernia repair. group III residents had significantly lower recurrence rates for open repairs when compared with group I (adjusted odds ratio = 0.24, 95% confidence interval [CI], 0.06, 0.997). The recurrence rate was similar among the groups for laparoscopic repair (P > 0.05) Complication rates were not different for either repair (P > 0.05). Mean operative time was significantly shorter for group III compared with group I for both open (?6.6 minutes; 95% CI, ?11.7, ?1.5) and laparoscopic repairs (?12.9 minutes; 95% CI, ?19.8, ?6.0) and between group II and group I for laparoscopic repair (?15.0; 95% CI, ?24.3, ?5.7). Conclusions: Despite the presence of an attending surgeon, open hernia repairs performed by junior residents were associated with higher recurrence rates than those repaired by senior residents. Lower resident level was associated with increased operative time for both open and laparoscopic repair.
Wilkiemeyer, Mark; Pappas, Theodore N.; Giobbie-Hurder, Anita; Itani, Kamal M. F.; Jonasson, Olga; Neumayer, Leigh A.
Introduction Parastomal hernia occurs in 35%-50% of patients who have had a stoma formed, whether for the digestive tract or the urinary\\u000a tract. There are many repair techniques including primary repair and repair using different types of mesh prosthesis, and\\u000a the surgical approach may be open or laparoscopic. However, all techniques suffer the disadvantage of a high index of hernia\\u000a recurrence.
Gilberto Guzmán-Valdivia; Teresa Soto Guerrero; Hilda Varela Laurrabaquio
Objective: To estimate the prevalence of residual pain 2 to 3 years after hernia surgery, to identify factors associated with its occurrence, and to assess the consequences for the patient. Summary Background Data: Iatrogenic chronic pain is a neglected problem that may totally annul the benefits from hernia repair. Methods: From the population-based Swedish Hernia Register 3000 patients aged 15 to 85 years were sampled from the 9280 patients registered as having undergone a primary groin hernia operation in the year 2000. Of these, the 2853 patients still alive in 2003 were requested to fill in a postal questionnaire. Results: After 2 reminders, 2456 patients (86%), 2299 men and 157 women responded. In response to a question about “worst perceived pain last week,” 758 patients (31%) reported pain to some extent. In 144 cases (6%), the pain interfered with daily activities. Age below median, a high level of pain before the operation, and occurrence of any postoperative complication were found to significantly and independently predict long-term pain in multivariate logistic analysis when “worst pain last week” was used as outcome variable. The same variables, along with a repair technique using anterior approach, were found to predict long-term pain with “pain right now” as outcome variable. Conclusion: Pain that is at least partly disabling appears to occur more often than recurrences. The prevalence of long-term pain can be reduced by preventing postoperative complications. The impact of repair technique on the risk of long-term pain shown in our study should be further assessed in randomized controlled trials.
Franneby, Ulf; Sandblom, Gabriel; Nordin, Par; Nyren, Olof; Gunnarsson, Ulf
Hypothesis Natural orifice transluminal endoscopic surgery (NOTES) has gained widespread interest as a potentially less invasive alternative\\u000a to laparoscopic surgery or, else, an evolution as the next-generation surgery. The main objective of this study was to assess\\u000a the safety of transluminal abdominal wall hernia repair for potential human application by specifically investigating the\\u000a feasibility and challenges of using a transvaginal
D. Lomanto; U. Dhir; J. B. Y. So; W. K. Cheah; M. A. Moe; K. Y. Ho
Sciatic hernia is a rare pelvic floor hernia that occurs through the greater or lesser sciatic foramen. Sciatic hernias often\\u000a present as pelvic pain, particularly in women, and diagnosis can be difficult. Transabdominal and transgluteal operative approaches,\\u000a including laparoscopic repair, have been reported. We show a laparoscopic technique using a plug of human allogeneic dermal\\u000a matrix and lightweight polypropylene extraperitoneal
A. C. Bernard; C. Lee; J. Hoskins; J. Lee; S. Patel; G. Ginn; B. Maley
Background: Recurrence rates after primary repair of ventral and incisional hernias range from 25% to 52%. Recurrence after open surgery is less likely if mesh is used, but the wide fascial dissection and required flap creation increase complication rates. Laparoscopic techniques offer an alternative.Study Design: To assess the safety and efficacy of laparoscopic ventral and incisional herniorrhaphy, we reviewed the
B. Todd Heniford; Adrian Park; Bruce J Ramshaw; Guy Voeller
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.
Sasse, Kent C.; Brandt, Jared
Background The repair of incisional hernias remains a challenge for the general surgeon. Indications for surgery are severe bowel obstruction,\\u000a as well as aesthetic problems. There are various surgical methods to correct these hernias, with varying results. However,\\u000a the gold standard has not yet been found. Both laparoscopic repair and the component separation technique (CTS) have proven\\u000a to be acceptable techniques;
M. M. PoelmanB; B. L. A. M. Langenhorst; J. F. Schellekens; W. H. Schreurs
Summary Since the first hernioplasty performed by Edoardo Bassini in 1884, all surgical reconstruction techniques have suffered from a common defect: tension on the suture line. This represents the main etiologic factor for recurrent hernia. With the introduction of modern prosthetic materials (meshes and plugs) it is possible to perform all hernia repairs without altering the normal anatomy, as well
G. Campanelli; U. Cioffi; R. Cavagnoli; M. Simone; M. Bastazza; P. Bruni; M. Senni Buratti; A. Ruca; K. Berhane; P. Pietri
Parastomal hernia formation is common following formation of an abdominal stoma, with the risk of subsequent incarceration, obstruction and strangulation. Current treatment options include non-operative management, stoma relocation and fascial repair with or without mesh. The purpose of this systematic review was to evaluate the effectiveness and safety of open mesh repair of a parastomal hernia and to compare open non-mesh fascial repair with mesh techniques of parastomal hernia repair. Electronic databases were searched for studies comparing the two surgical techniques in accordance with preferred reporting items for systematic reviews and meta-analyses. The primary outcome of the study was the comparison of recurrence rates of parastomal hernia for each technique. Secondary outcomes included comparison of mortality, wound infection, mesh infection and any other complication. Twenty-seven studies of parastomal hernia repair were included and divided into two subgroups for open mesh repair and non-mesh fascial repair. Non-mesh fascial repair resulted in a high recurrence rate (around 50%). Reported recurrence rates for mesh repair were substantially lower, at 7.9-14.8%, depending on the position of the mesh in relation to the abdominal fascia and the length of follow-up. Morbidity and mortality did not differ significantly between the techniques used to repair a parastomal hernia. This study shows that mesh repair of a parastomal hernia is safe and significantly reduces the rate of recurrence compared with sutured repair, which should only be used in exceptional circumstances. There is insufficient evidence to determine which mesh technique (onlay, sublay or underlay) is most successful in terms of recurrence rates and morbidity. PMID:24448678
Al Shakarchi, J; Williams, J G
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
Objectives: The components separation technique (CST) is a widely described abdominal wall reconstructive technique. There have, however, been no UK reports of its use, prompting the present review. Methods: Between 2008 and 2012, 13 patients who underwent this procedure by a single plastic surgeon (C.M.M.) were retrospectively evaluated. The indications, operative details, and clinical outcomes were recorded. Results: There were 7 women and 6 men in the series with a mean age of 53 years (range: 30-80). Patients were referred from a variety of specialties, often as a last resort. The commonest indication for CST was herniation following abdominal surgery. All operations except 1 were jointly performed with general surgeons (for bowel resection, stoma reversal, and hernia dissection). The operations lasted a mean of 5 hours (range: 3-8 hours). There were no major intra- and postoperative problems, except in 1 patient who developed intra-abdominal compartment syndrome, secondary to massive hemorrhage. All patients were satisfied with the cosmetic improvement in their abdominal contours. None of the patients have developed a clinical recurrence after a mean follow-up of 16 months (range: 3-38 months). Conclusions: The components separation technique is an effective method of treating large recalcitrant hernias but appears to be underutilized in the United Kingdom. The management of large abdominal wall defects requires a multidisciplinary approach, with input across a variety of specialities. Liaison with plastic surgery teams should be encouraged at an early stage and the CST should be more widely considered when presented with seemingly intractable abdominal wall defects.
Adekunle, Shola; Pantelides, Nicholas M.; Hall, Nigel R.; Praseedom, Raaj; Malata, Charles M.
The published recurrence rate after laparoscopic ventral hernia repair is much less than the rate of recurrence via the open\\u000a approach. Studies have demonstrated the safety and efficacy of this procedure but have had relatively young patient populations.\\u000a We present our experience in a significantly older population. A retrospecitve chart review of all patients undergoing a laparoscopic\\u000a ventral hernia repair
Deron J. Tessier; James M. Swain; Kristi L. Harold
Cystic seromas, or mature fibrous cysts, are rare complications after ventral and incisional hernioplasties employing polypropylene\\u000a mesh. We analyzed the medical records of patients, whose abdominal-wall hernias were surgically repaired with polypropylene\\u000a 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\\u000a two patients who
Juan Carlos Mayagoitia; A. Almaraz; C. Díaz
We report on the presentation and management of a patient with herniation of the rectum following a coccygectomy. We used an abdominal approach and careful pelvic dissection to define the defect in the pelvic floor at the site where coccyx used to be. Prolene mesh repair resulted in the reduction of the hernia. To our knowledge, this is the first report on the mesh repair of the coccygeal hernia via an abdominal approach. Images Figure 1 Figure 2
Kumar, A.; Reynolds, J. R.
We report on the presentation and management of a patient with herniation of the rectum following a coccygectomy. We used an abdominal approach and careful pelvic dissection to define the defect in the pelvic floor at the site where coccyx used to be. Prolene mesh repair resulted in the reduction of the hernia. To our knowledge, this is the first report on the mesh repair of the coccygeal hernia via an abdominal approach. PMID:10743431
Kumar, A; Reynolds, J R
Introduction Lumbar hernias are rare defects of the posterolateral abdominal wall. Surgical repair of lumbar hernias is challenging because\\u000a they are bounded inferiorly by the iliac bone, which makes adequate mesh fixation difficult. We demonstrate a method of a\\u000a laparoscopic lumbar hernia repair utilizing bone anchor fixation at the inferior border.\\u000a \\u000a \\u000a \\u000a \\u000a Methods The patient is a 37-year-old male who had been in
Vanessa P. HoGregory; Gregory F. Dakin
Background Emergency repair of incarcerated incisional hernia with associated bowel obstruction in potentially or contaminated field is technically challenging due to edematous, inflamed and friable tissues with occasional need for concurrent bowel resection and carries high rates of post-operative infectious complications. The aim of this study was to retrospectively assess the wound related morbidity of use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. We also describe a new technique of leaving the mesh exposed to heal by secondary intention with granulation tissue. Methods Between 2000 and 2010 a total of 60 patients underwent emergency surgery for incarcerated incisional hernia with associated bowel obstruction with placement of permanent prosthetic mesh. The wound was closed after hernia repair in 55 patients while it was left open to granulate in 5 patients. Results In the group of patients with primary wound closure, 11 patients developed superficial surgical site infection, 5 developed deep wound infection and one patient had cellulitis. These patients were treated with wound debridement and antibiotics. Mesh removal was required in one patient. There were no infections in the group of patients who had their surgical wounds left open. One patient in this group died on the fifth postoperative day from septicemia. Conclusion Use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. in contaminated field is associated with high risk of wound infection.
Introduction: Intrapericardial diaphragmatic hernia is a rare injury. We present a case of an intrapericardial diaphragmatic hernia from blunt trauma. In this report we will review the current literature and also describe the first report of a primary laparoscopic repair of the defect. Case Description: A 38-year-old unrestrained male passenger had blunt chest and abdominal trauma from a motor vehicle collision. Two months later, on a computed tomography scan, he was found to have an intrapericardial diaphragmatic hernia. The defect was repaired primarily through a laparoscopic approach. Discussion: Symptoms of intrapericardial diaphragmatic hernia are chest pain, upper abdominal pain, dysphagia, and dyspnea. Chest computed tomography is the most useful diagnostic test to define the defect. Even when the injury is diagnosed late, laparoscopy can be used for primary and patch repair.
Kuy, SreyRam; Weigelt, John A.
An estimated overall complication rate of approximately ten percent is found in the half million patients who annually undergo groin hernia repair in the United States. Certain features in the operative technique are emphasized which should prevent many of these complications. Intraoperative complications during the groin hernia repair are primarily hemorrhage and injury to the vas deferens, the three nerves in the area, the vascular supply of the testis, and the abdominal and pelvic viscera. Miscellaneous intraoperative complications relate to problems associated with the repair of massive hernias, missed hernia, and the loss of strangulated bowel into the abdominal cavity. Early postoperative complications may be either systemic or local with cardiac and respiratory conditions comprising the former group. The early local complications are primarily wound problems of infection, hematoma formation, and scrotal swelling involving the skin and testis. High ligation in excision of the sac in all hernias, repair of the defect in the plane of its occurrence, and suture of fascia to fascia in the same plane without tension are the basic tenets of inguinal hernia repair which should result in a low incidence of recurrence. The most effective prophylactic measures necessary for the prevention of complications considered are a thorough knowledge of inguinofemoral anatomy, mature surgical judgment, and meticulous surgical technique.
Gaines, Ray D.
Introduction: Laparoscopic giant hiatal hernia (GHH) (> 50% of stomach above the diaphragm) repair is associated with a 12–40% early recurrence rate. We applied specialized laparoscopic maneuvers to address this potential technical compromise.Methods: 43 patients underwent GHH laparoscopic repair (34 virgin, 9 reoperative) with esophageal lengthening. Specific emphasis was placed on meticulous preservation of crural integrity, complete sac excision, routine
Chuong D. Hoang; Paul S. Koh; Paul D. Scott; Jonathan D’ Cunha; Michael A. Maddaus
Para duodenal hernia is among the uncommon and rare causes of intestinal obstruction, but it is the most common type of internal hernia in abdomen and accounts for more than half of cases that do occur. Here, we are reporting a case of right Para duodenal hernia, reduced and repaired laparoscopically. This thirteen year old girl presented to us with features of small bowel obstruction of two days duration. Plain abdominal X-ray showed multiple fluid levels confined to right side of abdomen. A diagnostic laparoscopy was done under General Anaesthesia. Right Para duodenal hernia was found with small bowel confined to the right side between the ascending colon and hepatic flexure of colon. Laparoscopic reduction of contents of the hernia was done starting from the Ileocaecal junction. Hernial opening was closed laparoscopically with nonabsorbable suture. Patient is quite well till date and has had no recurrence of symptoms. PMID:20407574
Bhartia, Vishnu; Kumar, Anil; Khedkar, Indira; Savita, K S; Goel, N
Para duodenal hernia is among the uncommon and rare causes of intestinal obstruction, but it is the most common type of internal hernia in abdomen and accounts for more than half of cases that do occur. Here, we are reporting a case of right Para duodenal hernia, reduced and repaired laparoscopically. This thirteen year old girl presented to us with features of small bowel obstruction of two days duration. Plain abdominal X-ray showed multiple fluid levels confined to right side of abdomen. A diagnostic laparoscopy was done under General Anaesthesia. Right Para duodenal hernia was found with small bowel confined to the right side between the ascending colon and hepatic flexure of colon. Laparoscopic reduction of contents of the hernia was done starting from the Ileocaecal junction. Hernial opening was closed laparoscopically with nonabsorbable suture. Patient is quite well till date and has had no recurrence of symptoms
Bhartia, Vishnu; Kumar, Anil; Khedkar, Indira; Savita, K S; Goel, N
Purpose Laparoscopic mesh repair is an established alternative to the open repair of herniae of the antero-lateral abdominal wall.\\u000a However, a definition in the literature of “recurrence” is lacking. This study reviews the phenomenon of pseudo-recurrence\\u000a in patients who describe recurrent symptoms despite an apparently successful laparoscopic ventral or incisional hernia repair\\u000a (LVIHR).\\u000a \\u000a \\u000a \\u000a \\u000a Methods Cases of LVIHR from 1st January 2004 to
G. H. Tse; B. M. Stutchfield; A. D. Duckworth; A. C. de Beaux; B. Tulloh
Background It has been reported that the laparoscopic repair of paraesophageal hernias is associated with higher complication and recurrence\\u000a rates than the open methods of repair.\\u000a \\u000a \\u000a \\u000a Methods We identified 136 consecutive patients who underwent laparoscopic repair of a paraesophageal hernia between 1993 and 1999.\\u000a Patient demographics and symptom scores for regurgitation, heartburn, chest pain, and dysphagia at presentation and at last\\u000a follow-up
S. G. Mattar; S. P. Bowers; K. D. Galloway; J. G. Hunter; C. D. Smith
The simplicity and good postoperative results of mesh plug repair for groin hernias have been reported in numerous articles.\\u000a We have been performing this procedure in our department for more than 5 years, and the present study was conducted to reexamine\\u000a its clinical outcome from our viewpoint. A total of 224 patients with a collective 244 groin hernias underwent mesh
Tadasu Mori; Shigeo Souda; Riichirou Nezu; Yukinobu Yoshikawa
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
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.
Schoenmaeckers, E. J. P.; Raymakers, J. T. F. J.; Rakic, S.
Inguinal hernia repair and Caesarian section are the two most commonly occurring operations in Africa. Trained surgeons are few, distances between hospitals are large and strangulated hernia is the most common cause of intestinal obstruction. Numerous deaths and cases of permanent disability occur because patients with inguinal hernias requiring elective or urgent surgery are not properly cared for, or they do not actually reach hospital. Operation Hernia was a humanitarian mission between the European Hernia Society and the Plymouth-Takoradi (Ghana) Link conceived specifically to treat and teach groin hernia surgery in the Western region of Ghana. PMID:16912846
Kingsnorth, A N; Oppong, C; Akoh, J; Stephenson, B; Simmermacher, R
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
Objective: Various ventral and incisional hernia repair techniques exist and have largely replaced the open ones. The purpose of this study was to document the 2-port technique and demonstrate that it is feasible, efficient, and safe. To our knowledge, this is the largest report on this topic to date in the English-language literature. Methods: Forty patients with ventral hernias (VH) or incisional hernias (IH) underwent laparoscopic repair with a 2-port technique. The technique involves insertion of one 10-mm to 12-mm balloon port and one 5-mm port, usually on the left side as laterally as possible. A mesh is inserted through the balloon port site and secured to the abdominal wall by using either 4 peripheral or 1 central Prolene suture. Helical fasteners are used to attach the mesh to the abdominal wall. Results: Forty patients with 47 hernias underwent repair. Operating time ranged from 15 minutes to 70 minutes. Early complications were seen in 5 patients and included 1 small bowel enterotomy, 2 small bowel obstructions (SBO) with bowel adhering to the visceral side of the mesh, 1 wound infection, and 1 seroma. Late postoperative complications occurred in 8 patients (20%) who experienced persistent abdominal pain that resolved without any treatment. There was one recurrence during a mean follow-up of 23.5 months. Conclusion: Laparoscopic herniorrhaphy with the 2-port technique offers an efficient, safe, and effective repair for ventral and incisional hernias.
Lethaby, D.; Hill, J.; Gupta, S.; Bradpiece, H.
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
Background and Objectives: Single-incision laparoscopic surgery is gaining popularity among minimally invasive surgeons and is now being applied to a broad number of surgical procedures. Although this technique uses only 1 port, the diameter of the incision is larger than in standard laparoscopic surgery. The long-term incidence of port-site hernias after single-incision laparoscopic surgery has yet to be determined. Methods: All patients who underwent a single-incision laparoscopic surgical procedure from May 2008 through May 2009 were included in the study. Single-incision laparoscopic surgical operations were performed either by a multiport technique or with a 3-trocar single-incision laparoscopic surgery port. The patients were seen at 30 to 36 months' follow-up, at which time they were examined for any evidence of port-site incisional hernia. Patients found to have hernias on clinical examination underwent repairs with mesh. Results: A total of 211 patients met the criteria for inclusion in the study. The types of operations included were cholecystectomy, appendectomy, sleeve gastrectomy, gastric banding, Nissen fundoplication, colectomy, and gastrojejunostomy. We found a port-site hernia rate of 2.9% at 30 to 36 months' follow-up. Conclusion: Port-site incisional hernia after single-incision laparoscopic surgical procedures remains a major setback for patients. The true incidence remains largely unknown because most patients are asymptomatic and therefore do not seek surgical aid.
Rainville, Harvey; Ikedilo, Ojinika; Vemulapali, Pratibha
Perineal hernia in dogs is very problematic and mostly requires surgical reconstruction of the weak pelvic diaphragm. Tissue or synthetic grafts have been used for the correction after failure of the conventional herniorrhaphy. Aim of this clinical trial was to assess the possible use of the autologous tunica vaginalis communis as a free graft for perineal hernia repair in intact male dogs. Seven unilateral and 2 bilateral perineal hernias in nine intact male dogs free from testicular and scrotal neoplasms were included in this study. The median surgical time for unilateral herniorrhaphy was 75 min. The median follow-up time was 13 months. The success of the autografting, based on no recurrence and comfort of the animals during urination and defecation, was found in ten of 11 hernias; giving a success rate of 90.91%. One hernia (9.09%) recurred 10 days after surgery. Histopathological examination of the apposing area between the graft and the adjacent tissue, taken during the repair of the recurred case at day 20, revealed neovascularization and connective tissue ingrowth. In conclusion, the tunica vaginalis autograft can be used for perineal herniorrhaphy in intact male dogs. PMID:23131842
Pratummintra, Kittiya; Chuthatep, Suwicha; Banlunara, Wijit; Kalpravidh, Marissak
Introduction Esophageal hiatal hernias are the most frequent types of internal hernias. This condition involves disturbance of normal functioning of the stomach cardiac mechanism and reflux of the gastric contents to the esophagus. Aim: To evaluate postoperative results in our Clinic and the comparison of these results to data from the literature. Material and methods One hundred and seventy-eight patients underwent surgery due to esophageal hiatal hernia at the Clinic of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland, from 2006 to 2011. All operations were performed using laparoscopy. Fundoplication by means of the Nissen-Rossetti method was carried out in 172 patients while Toupet's and Dor's methods were applied in 4 and 2 patients, respectively. Results Average time of the surgery was 82 min (55–140 min). Conversion was performed in 4 cases. No serious intraoperative complications were noted. In the postoperative period, dysphagia was reported in 20 patients (11.2%). Postoperative wound infection was observed in 1 patient (0.56%). Hernias in the trocar insertion area were reported in 3 patients (1.68%). Ailments recurred in 6 patients. The recurrence of esophageal hiatal hernia was confirmed in 2 patients. Patients with recurrent hernia were re-operated using a laparoscopic approach. Conclusions Laparoscopic surgery is a simple and effective approach for patients with gastroesophageal reflux symptoms due to diaphragmatic esophageal hiatus hernia. The number of complications is lower after laparoscopic procedures than after “open” operations.
Piatkowski, Jacek; Jackowski, Marek
Androgen Insensitivity Syndrome Diagnosed in an Elderly Patient during a Strangulated Inguinal Hernia Repair INTRODUCTION A strangulated inguinal hernia is a common indication for emergency surgery. In comparison, complete testicular feminization is a rare genetic disease that can present with an inguinal hernia because of ectopically positioned testicles. PRESENTATION OF CASE A 70-year-old female was admitted to the emergency service complaining of a painful swelling in the right inguinal region for 1 day. The physical examination indicated a strangulated inguinal hernia and surgery was performed. On exploring the inguinal region, a strangulated indirect inguinal hernia and hard 2 × 3-cm mass were detected. The histopathological examination of the excised mass showed testicular tissue, and complete testicular feminization (CTF) was diagnosed after further examinations. DISCUSSION Androgen insensitivity syndrome (AIS), the most frequent cause of male pseudohermaphroditism. The diagnosis of patients with AIS is usually made at the beginning of the second decade when a healthy person with a female phenotype complains of no menarche. Making a first diagnosis after the 5th decade is extremely rare. CONCLUSION While AIS can be diagnosed in early adulthood, cases might not bediagnosed until the patient is of advanced age.
Arslan, Yusuf; Altintoprak, Fatih; Ozkan, Orhan Veli; Yalk?n, Omer; Gunduz, Yasemin; Kahyaoglu, Zeynep
Cirrhotic patients with umbilical hernia have an increased likelihood of complications following repair. The aim of this study was to assess the outcomes of elective umbilical hernia repair in cirrhotic patients. Fifty patients having uncomplicated umbilical hernia with a cirrhotic liver were studied prospectively. These patients divided into three groups' according to Child-Turcotte-Pugh (CTP) classification. After management of coagulopathy, correction of hypoalbuminaemia and electrolytes imbalance, and control of ascites, all patients underwent elective hernia repair under regional anesthesia. A comparison was made between the three groups as regard the size of the defect in the linea Alba, operative time, postoperative morbidity and mortality, length of hospital stay, time of return to daily life and postoperative changes in liver function tests (LFTs) in relation to the regional anesthesia applied. hernioplasty was done under spinal anesthesia in 13 patients (26%), under epidural anesthesia in 10 patients (20%), under intercostal nerve block in 7 patients (14%), and under local anesthesia in 20 patients (40%). There was an increased safety (less changes in LFTs) in cases done under local anesthesia and intercostal nerve block. The overall complications rate was 30%. There was an increased complications rate towards the decompensated cases. The differences in the mean length of hospital stay and mean time of return to daily life are statistically significant between the three groups. Umbilical hernia recurrence rate was 2% and no mortality was reported in the study groups. PMID:24640861
Lasheen, Adel; Naser, Hatem M; Abohassan, Ahmed
Ventral hernias are a major surgical challenge with complications such as wound separations, infections, and recurrences contributing to patient morbidity. We describe a new adjunctive technique that may be helpful in repairing difficult ventral hernias: it involves using an appropriately chosen, redundant abdominal skin edge that is deepithelialized and used to reinforce the hernia repair. A series of 7 patients aged 23 to 84 years in whom the technique was used is presented. All patients had complete repair of their incisional ventral hernia defects without complications of infection, wound dehiscence, seroma formation, reoperation, or hernia recurrence. Furthermore, patients reported a subjective improvement in performing daily activities. Mean follow-up in this series was 19.2 months, with a range from 15.0 to 26.8 months. Advantages include the redistribution of mechanical tension, reinforcement of the midline site of greatest pressure, elimination of dead space, and staggering of suture lines to prevent direct external contamination of prosthetic material should wound dehiscence occur. PMID:23235368
Hoang, Don; Abitbol, Nathalie; Broer, Niclas; Narayan, Deepak
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.
Cawich, Shamir O.; Mohanty, Sanjib K.; Bonadie, Kimon O.; Simpson, Lindberg K.; Johnson, Peter B.; Shah, Sundeep; Williams, Eric W.
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
A 77 year old woman who presented with an incarcerated hernia of Morgagni was successfully treated without complications. A Medline search (1996 to date) along with cross referencing was done to quantify the number of acute presentations in adults compared to children. Different investigating modalities—for example, lateral chest and abdominal radiography, contrast studies or, in difficult cases, computed tomography or magnetic resonance imaging—can be used to diagnose hernia of Morgagni. The favoured method of repair—laparotomy or laparoscopy—is also discussed. A total of 47 case reports on children and 93 case reports on adults were found. Fourteen percent of children (seven out of 47) presented acutely compared with 12% of adults (12 out of 93). Repair at laparotomy was the method of choice but if uncertain, laparoscopy would be a useful diagnostic tool before attempted repair. Laparoscopic repair was favoured in adults especially in non-acute cases.
Loong, T; Kocher, H
Concomitant mesh repair of large umbilical hernias and abdominoplasty pose a serious risk of devascularizing the umbilical stalk. A technique of placing mesh in a sublay manner, deep to the fascial defect, for an umbilical herniorrhaphy to avoid damage to the deep umbilical perforators during an abdominoplasty is described.
McKnight, Catherine L; Fowler, James L; Cobb, William S; Smith, Dane E; Carbonell, Alfredo M
Introduction This study aims to examine the impact of laparoscopic repair of large hiatal hernia on dyspnoea severity, respiratory function\\u000a and quality of life.\\u000a \\u000a \\u000a \\u000a \\u000a Methods From 2004 to 2008, 30 consecutive patients with large para-oesophageal hernia defined as >50% of stomach in the intra-thoracic\\u000a cavity and minimum follow-up of 2 years were included in this study. All patients had a formal respiratory function
Jacqui C. Zhu; Guillermo Becerril; Katy Marasovic; Alvin J. Ing; Gregory L. Falk
In modern hernia surgery, there are two competing mesh concepts which often lead to controversial discussions, on the one hand the heavyweight small porous model and on the other, the lightweight large porous hypothesis. The present review illustrates the rationale of both mesh concepts and compares experimental data with the first clinical data available. In summary, the lightweight and large
Bernd Klosterhalfen; Karsten Junge; Uwe Klinge
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.
Antonino, Agrusa; Giorgio, Romano; Giuseppe, Frazzetta; Giovanni, De Vita; Silvia, Di Giovanni; Daniela, Chianetta; Giuseppe, Di Buono; Vincenzo, Sorce; Gaspare, Gulotta
Recent studies have noted advantages of laparoscopic over open repair of ventral hernias. Because few reports have involved comparison with traditional repair we report a comparison between laparoscopic and open approaches. We retrospectively reviewed the records of patients undergoing ventral hernia repair over a 28-month period. Patients were grouped into three categories: laparoscopic repair with mesh, open repair with mesh, and open repair without mesh. There were 295 ventral hernia repairs and there was no difference in age, gender, operative complications, or hospital stay between the groups. Mesh and defect size was greater in the laparoscopic group. The overall postoperative complication rate was greater in the open group with mesh. Yet when specific wound complications were analyzed there was no difference between the groups. Furthermore a death occurred in the laparoscopic group from an unrecognized bowel injury. The recurrence rate was greatest in the open repair without mesh group. Finally hospital cost was greatest in the laparoscopic group and third-party reimbursement was better for the open techniques. We were unable to demonstrate a significant advantage to laparoscopic ventral hernia repair. Although many patients with large fascial defects were well served with this approach it may not be a better option for these patients. PMID:11893110
Wright, Byron E; Niskanen, Brian D; Peterson, Debra J; Ney, Arthur L; Odland, Mark D; VanCamp, Joan; Zera, Richard T; Rodriguez, Jorge L
Background: The addition of an antireflux procedure to all giant paraesophageal hernia (PEH) repairs remains controversial. In addition there are no series evaluating the impact of hernia repair and fundoplication on esophageal physiology. This study examines the outcomes of PEH repair with fundoplication and examines the results of preoperative and postoperative motility and pH testing.Methods: An analysis of a data
Lee L Swanstrom; Blair A Jobe; Luke R Kinzie; Karen D Horvath
Background: Polymer mesh has been used to repair incisional hernias with lower recurrence rates than suture repair. A new generation of mesh has been developed with reduced polypropylene mass and increased pore size. The aim of this study was to compare standard mesh with new lightweight mesh in patients undergoing incisional hernia repair. Methods: Patients were randomized to receive lightweight
J. Conze; A. N. Kingsnorth; J. B. Flament; R. Simmermacher; G. Arlt; C. Langer; E. Schippers; M. Hartley; V. Schumpelick
Abstract\\u000a \\u000a Surgeons who favor the laparoscopic repair of groin hernias must limit the additional costs associated with this technique,\\u000a which is not universally acknowledged to be superior to other less expensive open tension-free repairs. This retrospective\\u000a study compared outcome and costs between laparoscopic and open tension-free hernia repair in 320 patients with inguinal hernias.\\u000a Patients underwent either (a) transabdominal preperitoneal
E. A. Papachristou; M. F. Mitselou; N. Finokaliotis
Background Recurrences continue to be seen after repair of inguinal hernias. The repair of these recurrent hernias is a more complex\\u000a and demanding procedure, with a high re-recurrence rate. Definite advantage has been demonstrated with endoscopic repair of\\u000a these hernias.\\u000a \\u000a \\u000a \\u000a Methods The results for this prospective study from January 2003 to December 2006 were evaluated after laparoscopic repair of 65 recurrent\\u000a hernias
Om Tantia; Mayank Jain; Shashi Khanna; Bimalendu Sen
Background This study aimed to examine the recurrence rate and postoperative pain in total extraperitoneal repair (TEP) performed without\\u000a fixation of the mesh and to compare the rates with those for repairs using fixation of mesh.\\u000a \\u000a \\u000a \\u000a Methods A retrospective analysis was conducted over a 3-year period for 929 patients (1,753 hernias) who had undergone TEP. The recurrence\\u000a rate, pain scores at 24 h
Pankaj Garg; Mahesh Rajagopal; Vino Varghese; Mohamed Ismail
Purpose The experience of endoscopic total extraperitoneal (TEP) repair of recurrent inguinal hernia in a major teaching hospital\\u000a is reviewed.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Between 2003 and 2008, 37 consecutive patients underwent 46 TEP repairs for recurrent inguinal hernia. Patient demographics,\\u000a hernia characteristics, operating time, conversion rate, intraoperative, postoperative complications and recurrence were measured.\\u000a Twenty-eight patients had unilateral hernia and nine patients had bilateral hernias.
T. T. Goo; M. Lawenko; W. K. Cheah; C. Tan; D. Lomanto
Background The need for general anesthesia and the cost and pain due to metal staples required for fixing the mesh are the major reported\\u000a disadvantages of laparoscopic total extraperitoneal (TEP) hernia repair. We studied the feasibility and results of TEP done\\u000a under spinal anesthesia with non-fixation of the mesh (SA-NF). This group was compared to TEP done under general anesthesia\\u000a with
M. Ismail; P. Garg
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.
Saisu, Kazuhiro; Tsuru, Nobuo; Homma, Yukio; Ihara, Hiroyuki
Sciatic hernia is a surgical rarity. One such hernia was incidentally diagnosed in a 79-year-old woman who underwent Robot\\u000a assisted laparoscopic radical cystectomy for locally invasive bladder cancer. Intra-operatively, a patent hernia sac was noted\\u000a in the sciatic notch. The hernia was successfully repaired during the same operation by using robot assisted laparoscopic\\u000a technique. This appears to be the first
Iqbal Singh; Jon E. Hudson; Kyle A. Richards; Ashok K. Hemal
Background 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.
Siddiqui, Muhammad R.S.; Kovzel, Maksym; Brennan, Steven J.; Priest, Oliver H.; Preston, Shaun R.; Soon, Y.
We report the cases of two patients diagnosed with Morgagni hernia who presented with nonspecific abdominal symptoms. Both underwent laparoscopic surgery that used a dual-sided mesh, polyvinylidene fluoride (PVDF; Dynamesh IPOM®). The procedures were successful and both patients were discharged with no complications. There was no recurrence in 18 months of follow up.Herein is the report of these cases and a literature review. PMID:24829663
Godazandeh, Gholamali; Mortazian, Meysam
We report the cases of two patients diagnosed with Morgagni hernia who presented with nonspecific abdominal symptoms. Both underwent laparoscopic surgery that used a dual-sided mesh, polyvinylidene fluoride (PVDF; Dynamesh IPOM®). The procedures were successful and both patients were discharged with no complications. There was no recurrence in 18 months of follow up.Herein is the report of these cases and a literature review.
Godazandeh, Gholamali; Mortazian, Meysam
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
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.
Byrd, Jim F.; Agee, Neal; Nguyen, Phuong H.; Heath, Jessica J.; Lau, Kwan N.; McKillop, Iain H.; Sindram, David; Martinie, John B.
In laparoscopic ventral hernia repair a mesh is inserted and anchored intraperitoneally to the abdominal wall. Currently, a variety of fixation methods are being used. As a primary goal the ideal fixation method should contribute to preventing recurrences. It should also be associated with less pain, and should prevent adhesion formation, mesh migration, and shrinkage but without contributing to infection, fistula, or seroma. In this review we evaluate the evidence for using each type of available fixation device. A systematic search of the literature, including human as well as animal studies, identified 17 different fixation methods. Their role with regard to effect on major end-points in laparoscopic ventral hernia repair including postoperative pain, infection, seroma formation, adhesions, fixation strength, strength of ingrowth, shrinkage, bowel fistulas, and hernia recurrence, is described in detail. No gold standard exists currently. The vast majority of published results are based on uncontrolled series with short or incomplete follow-up. In this review only three randomized controlled trials were identified. PMID:24700224
Harsløf, Sanne Shiroma; Wara, Pål; Friis-Andersen, Hans
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 , 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.
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.
Ozben, Volkan; Ozveri, Emel
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
Laparoscopic parastomal hernia repair has become a viable option to overcome the challenges that face the hernia surgeon. Multiple techniques have been described over the last 5 years, one of which is the lateralizing “sling” technique, first described by Sugarbaker in1980. In this study, we report the technique and our early results with the laparoscopic modified Sugarbaker repair of parastomal hernias after ileal conduit.
BACKGROUND: The purpose of this study is to compare the difference of incidence of post-operative complications, operative time, length of stay and recurrence of patients undergoing laparoscopic or open repair of their ventral/incisional hernia a meta-analytic technique for observational studies. MATERIALS AND METHODS: A literature search was performed using Medline, PubMed, Embase and Cochrane databases for studies reported between 1998 and 2009 comparing laparoscopic and open surgery for the treatment of ventral (incisional) hernia. This meta-analysis of all the observational studies compared the post-operative complications recurrence rate and length of stay. The random effects model was used. Sensitivity and heterogeneity were analysed. RESULTS: Analysis of 15 observational studies comprising 2452 patients qualified for meta-analysis according to the study's inclusion criteria. Laparoscopic surgery was attempted in 1067 out of 2452. The results showed that the length of stay (odds ratio [OR], – 1.00; 95% confidence interval [CI], – 1.09 to – 0.91; P < 0.00001) and operative time (OR, 59.33; 95% CI, 58.55 to 60.11; P < 0.00001) was significantly lower in the laparoscopic group. The results also showed that there was a significant reduction in the formation of abscesses (OR, 0.38; 95% CI, 0.16 to 0.92; P = 0.03) and wound infections (OR, 0.49; 95% CI, 0.29 to 0.82; P = 0.007) post-operatively. There is a trend which indicates that the recurrence of the hernia using laparoscopic repair versus open repair was overall lower with the laparoscopic repair (OR, 0.48; 95% CI, 0.22 to 1.04; P = 0.06), however, this was not significant. CONCLUSION: Laparoscopic incisional hernia repair was associated with a reduced length of stay, operative time and lower incidence of abscess and wound infection post-operatively. This study also highlights the benefit of using observational studies as a form of research and its value as a tool in answering questions where large sample sizes of patient groups would be impossible to accumulate in a reasonable length of time.
Salvilla, Sarah A; Thusu, Sundeep; Panesar, Sukhmeet S
Repair of a large abdominal wall incisional hernia is a difficult surgical problem with recurrence being a common complication. In addition, other complications such as hematomas, seromas, and sinus formation result from the use of foreign material. A new technique to obviate these complications was used in 60 patients with large incisional hernias repaired over the last 15 years. Marlex®
B. G. Matapurkar; Arun Kumar Gupta; Anil Kumar Agarwal
To determine whether surgical repair of congenital diaphragmatic hernia (CHD) results in improvement in respiratory mechanics, we measured respiratory system compliance in nine patients (five survivors and four nonsurvivors) before and after operation. In all nine infants, CHD was diagnosed within 6 hours of life, and surgical repair was through an abdominal approach after a period of stabilization. Measurements were made noninvasively, using the passive expiratory flow-volume technique. In only one of the nine infants did compliance immediately improve after surgical repair, and in another it showed no change. Both of these infants survived, with an uneventful postoperative course. In the remaining seven infants, however, postoperative compliance immediately decreased to 10% to 77% from the preoperative value. The four infants with more than 50% decrease in compliance died with increasing hypoxemia and acidosis. These results suggest that respiratory mechanics in CHD, far from improving, frequently deteriorate as a result of repair of the hernia. The role of urgent surgery in this malformation should be reevaluated. PMID:3625415
Sakai, H; Tamura, M; Hosokawa, Y; Bryan, A C; Barker, G A; Bohn, D J
Abdominal wall hernias, in particular inguinal hernias are the most frequently encountered entity in general surgery. Consequently, the socio-economic burden results from the in-hospital phase itself and to a considerable extent from the convalescence period. In addition to the surgical procedure and the occupation of the patient there are two factors of particular significance influencing the aftercare: the post-operative pain and the given recommendations for postoperative strain. Next to patient-factor adapted operative procedures it is therefore essential, to offer a standardized pain management and recommendations for postoperative strain. Currently there is no conclusion, whether the minimally invasive techniques will be established as the "Gold-standard", particularly from an economic point of view and the introduction of the DRG in Switzerland. PMID:22198934
Matz, Daniel; Kirchhoff, Philipp
The acid, base and electrolyte changes are usually observed in the perioperative settings. We report a case of prolonged laparoscopic repair of left-sided diaphragmatic hernia which involved a lot of tissue handling and fluid replacement leading to acid, base and electrolyte imbalance. A 42-year-old male underwent prolonged laparoscopic repair under general anesthesia. Intraoperatively, surgeon reported that contents of hernia includes bowel along with mesentery, spleen and lot of fatty tissue The blood loss was about 2 L which was replaced with 1 L of colloid and 7.5 L of lactated ringer. Near the end of surgery arterial blood gas analysis revealed metabolic acidosis, hyperkalemia, and hypocalcemia leading to delayed recovery. We conclude prolonged laparoscopic surgery involving lot of tissue handling including gut and fat should be monitored for acid, base, electrolyte imbalance and corrected timely to have uneventful rapid recovery.
Garg, Rakesh; Punj, Jyotsna; Pandey, Ravindra; Darlong, Vanlal
Background. Laparoscopic hernia repair in infancy and childhood is still debatable. The objective of this study is to compare laparoscopic assisted hernia repair versus open herniotomy as regards operative time, hospital stay, postoperative hydrocele formation, recurrence rate, iatrogenic ascent of the testis, testicular atrophy, and cosmetic results. Patients and Methods. Two hundred and fifty patients with inguinal hernia were randomized into two equal groups. Group A was subjected to laparoscopic inguinal hernia repair. Group B was subjected to open herniotomy. The demographic data were matched between both groups. Assessment of the testicular volume and duplex assessment in preoperative, early, and late postoperative periods were done. Results. All cases were completed successfully without conversion. The mean operative time for group A was 7.6 ± 3.5 minutes, 9.2 ± 4.6 minutes and 11.4 ± 2.7 minutes, for unilateral hernia, unilateral hernia in obese child, and bilateral hernia, respectively. The recurrence rate was 0.8% in group A, whereas in group B the recurrence rate was 2.4%. Conclusion. Laparoscopic hernia repair by RN is an effective line of hernia repair. It resulted in marked reduction of operative time, low rate of recurrence, no testicular atrophy, no iatrogenic ascent of the testis, and excellent cosmetic results.
Shalaby, Rafik; Ibrahem, Refaat; Shahin, Mohamed; Yehya, Abdelaziz; Abdalrazek, Mohamed; Alsayaad, Ibrahim; Shouker, Maged Ali
Objectives To illustrate urological complications of laparoscopic inguinal hernia repair and discuss their management.\\u000a \\u000a \\u000a \\u000a Patients Between April 2002 and February 2004, four men (aged 38–63 years) were treated for serious complications 2 days to 11 years\\u000a after unilateral (1 patient) or bilateral (3 patients) laparoscopic inguinal hernioplasty.\\u000a \\u000a \\u000a \\u000a \\u000a Results In all cases (extra and intraperitoneal bladder injury, purulent urocystitis due to mesh-erosion of the bladder, secondary\\u000a retroperitoneal
A. Kocot; E. W. Gerharz; H. Riedmiller
For years, surgical dictum has posited that permanent synthetic mesh is contraindicated in the repair of a hernia in a contaminated field. Numerous investigators, however, have demonstrated the acceptably low morbidity associated with the use of heavy-weight polypropylene mesh in clean-contaminated and contaminated fields. Recently, experience utilizing more modern, light-weight polypropylene mesh constructs in contaminated fields has grown considerably. The time has come to critically reevaluate the unfounded fear of utilizing permanent synthetic mesh in contaminated fields, as we will review the data speaking to the safety of mesh in these contaminated fields. PMID:24035085
Carbonell, Alfredo M; Cobb, William S
In our series of 710 consecutive laparoscopic total-extra-peritoneal hernia repairs over a period of 10 years (2001–2010), the authors report a rare case of delayed mesh infection developing 7 years postoperatively. A 56-year-old patient presented with diarrhoea and fullness in right iliac fossa region. Radiological imaging confirmed a floating mesh in a fluid-containing cavity. Subsequent exploration revealed a large preperitoneal cavity containing 550 ml of pus with a floating mesh in it. The mesh was removed and the patient was discharged after making a good recovery.
Samee, Abdus; Adjepong, Samuel; Pattar, Jay
Inguinal hernia repair and Caesarian section are the two most commonly occurring operations in Africa. Trained surgeons are\\u000a few, distances between hospitals are large and strangulated hernia is the most common cause of intestinal obstruction. Numerous\\u000a deaths and cases of permanent disability occur because patients with inguinal hernias requiring elective or urgent surgery\\u000a are not properly cared for, or they
A. N. Kingsnorth; C. Oppong; J. Akoh; B. Stephenson; R. Simmermacher
Minimal inflammation of tissues can occur following skin closure with a foreign material. This foreign body reaction can lead to granuloma formation. We report the case of a middle-aged man who, having undergone laparoscopic surgery and had the port site wounds closed with skin glue, was detected to have a non-healing wound. A crystal mass protruding from the incision site was confirmed histologically as a chronic granulomatous reaction to skin glue. A foreign body granulomatous reaction to skin glue has not been described in the literature. PMID:24700107
Ihedioha, U; Panteleimonitis, S; Mann, C; Finch, G J
Background Prosthetic reinforcement is now routine in the management of inguinal and incisional hernia, and it significantly reduces\\u000a the risk of recurrence. After surgery, chronic pain is often attributed to the characteristics of the mesh and to the method\\u000a of fixation in the wound, with a potential risk of nerve or muscle injuries.\\u000a \\u000a \\u000a \\u000a Aim To evaluate the properties of a new “self
G. Champault; C. Polliand; F. Dufour; M. Ziol; L. Behr
Traumatic lumbar hernia (TLH) is a rare presentation. Traditionally, these have been repaired via an open approach. Recurrence can be a problem due to the often limited tissue available for mesh fixation at the inferior aspect of the hernia defect. We report the successful use of bone suture anchors placed in the iliac crest during transperitoneal laparoscopy for mesh fixation to repair a recurrent TLH. This technique may be particularly useful after previous failed attempts at open TLH repair. PMID:20803044
Links, D J R; Berney, C R
The policy of elective repair of umbilical hernia in cirrhotic ascitic patients has long been a subject of debate and is still a major health problem. This study evaluated the role and outcome of elective mesh repair of umbilical hernia in cirrhotic ascitic patients, compared with the conventional two layers fascial repair technique. Forty cases with a small to medium sized umbilical hernia defects in ascitic cirrhotic patients were divided into two groups (GI & GII) of 20 patients each. After proper control of ascites in both groups, patients in GI were subjected to elective umbilical hernia onlay mesh repair. In GII, hernias were managed by conventional two layers fascial repair. In GI, transient early postoperative ascitic fluid leakage occurred in 3 (15%) cases and mild superficial wound infection in 5 (25%) cases which was controlled by antibiotics. Two (10%) cases developed hernia recurrence during follow up period. In GII, ascitic leakage occurred in 6 (30%) cases that responded well to conservative management except only one case needed re-exploration and repair reenforcement. Drainage was significantly less than in GI in amount (P<0.05) and duration (P<0.01), wound infection occurred in 3 (15%) cases but were superficial and controlled conservatively. Recurrence occurred in 7 cases (35%). Elective mesh repair of umbilical hernia with ascites in cirrhotic patients proved to be a safe, simple and effective technique with perioperative antibiotics and proper aseptic procedure. PMID:18431993
Youssef, Youssef Farouk; El Ghannam, Maged
Perineal hernia is a recognized but uncommon complication following proctectomy. Emergency presentations of this hernia are very rare and are not well described in the literature. We present the case of an 81-year-old lady who presented with small bowel obstruction with strangulation secondary to a perineal hernia 2 years after abdominoperineal resection for carcinoma of the rectum. At laparotomy, a small bowel resection was required and a biological mesh was used to repair the perineal defect.
Fallis, Simon A.; Taylor, Lewis H.; Tiramularaju, R.M.R.
... that should be studied, as was in this patient. She underwent coronary studies prior to any decision being made about the ... us probably about 20 minutes to rewarm the patient and get a confirmatory transesophageal echo study to show that our repair worked. I’m ...
A spigelian hernia is a protrusion through an anterior abdominal wall defect along the linea semilunaris. The traditional method of repair consists of an open surgical technique requiring a lengthy abdominal incision to allow visualization of the defect. However, with the emergence and availability of laparoscopic techniques, a minimally invasive approach is feasible. Only eight prior case reports have documented emergent laparoscopic repair of a spigelian hernia. We describe the first successful laparoscopic repair of a spigelian hernia in an emergent setting at our institution.
Barker, Reid; Gill, Richdeep S.; Brar, Avneet S.; Birch, Daniel W.; Karmali, Shahzeer
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.
Amirlak, Bardia; Gerdes, Jodi; Puri, Varun; Fitzgibbons, Robert J.
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.
Background Today, the laparoscopic approach is a stan- dard procedure for the repair of incisional hernias. How- ever, the direct contact of visceral organs with mesh material is a major issue. Patients and methods This prospective observational study presents the data of 344 patients treated for incisional and parastomal hernias with a new mesh made of polyvi- nylidene Xuoride (PVDF;
D. Berger; M. Bientzle
OBJECTIVE: The authors provide an assessment of mechanisms leading to hernia recurrence after laparoscopic and traditional preperitoneal herniorrhaphy to allow surgeons using either technique to achieve better results. SUMMARY BACKGROUND DATA: The laparoscopic and traditional preperitoneal approaches to hernia repair are analogous in principle and outcome and have experienced a similar evolution over different time frames. The recurrence rate after preperitoneal herniorrhaphy should be low (< 2%) to be considered a viable alternative to the most successful methods of conventional herniorrhaphy. METHODS: Experienced surgeons supply specifics regarding the mechanisms of recurrence and technical measures to avoid hernia recurrence when using the preperitoneal prosthetic repair. Videotapes of laparoscopic herniorrhaphy in 13 patients who subsequently experienced a recurrence also are used to determine technical causes of recurrence. RESULTS: Factors leading to recurrence include surgeon inexperience, inadequate dissection, insufficient prosthesis size, insufficient prosthesis overlap of hernia defects, improper fixation, prosthesis folding or twisting, missed hernias, or mesh lifting secondary to hematoma formation. CONCLUSIONS: The predominant factor in successful preperitoneal hernia repair is adequate dissection with complete exposure and coverage of all potential groin hernia sites. Hematoma mesh lifting and inadequate lateral inferior and medial inferior mesh fixation represent the most common causes of recurrence for surgeons experienced in traditional or laparoscopic preperitoneal hernia repair.
Lowham, A S; Filipi, C J; Fitzgibbons, R J; Stoppa, R; Wantz, G E; Felix, E L; Crafton, W B
The aim of the current prospective study was to show the results of a new type of medium-weight monofilament polypropylene mesh covered with a hydrogel barrier on the visceral side. Between July 2011 and April 2013 prospectively collected data on 30 consecutive patients who underwent abdominal wall hernia repair using a medium-weight mesh covered with carboxymethylcellulose-sodiumhyaluronate coating (Ventralight™ ST mesh, Davol Inc, Subsidary of C. R. Bard, Inc. Warwick, RI) were analyzed. Out of these patients, those who had a follow-up of at least 12 months were selected. Short- and long-term outcomes were described. Meanwhile, registration continues up to completion of a series with 100 included patients. A total of 17 patients were selected (men/women ratio 11/6). Median follow-up was 12 months (range 12-21). Mean hernia diameter was 7 cm x 5 cm (craniocaudal x laterolateral) (range 1.5 x 1.5 to 20 x 15). Mean length of hospital stay was 6.1 days. Postoperative Visual Analogue Scale (VAS) at last follow-up was significantly lower than the preoperative VAS (P = 0.017) There were no intraoperative complications. Four patients (23%) developed minor complications. Two patients had mild discomfort, another two patients developed a seroma. No recurrences were observed. This intermediate study shows good results using a biofilm coated mesh and confirm the positive results obtained in the Sasse clinical trial. PMID:23982980
Tollens, Tim; Topal, Halit; Ovaere, Sander; Beunis, Anthony; Vermeiren, Koen; Aelvoet, Chris
In principle, hernias should always be managed surgically. In the event of an acute incarceration, the patient must be referred to hospital immediately, since the condition is lifethreatening. The decision as the type of surgical procedure is made on an individual basis, with preference being given to mesh implantation, which has a clearly reduced recurrence rate. Laparoscopic (expensive) repairs require general anesthesia, and usually a stay in hospital. Open procedures are increasingly being done on an outpatient basis under local anesthesia. The implantation of a mesh is associated with a quicker resumption of normal activities by the patient. PMID:17615716
Braun, C; Imdahl, A
Lumbar hernias are difficult to repair due to their proximity to bone and inadequate surrounding tissue to buttress the repair. We analyzed the outcome of patients undergoing a novel retromuscular lumbar hernia repair technique. The repair was performed in ten patients using a polypropylene or polytetrafluoroethylene mesh placed in an extraperitoneal, retromuscular position with at least 5 cm overlap of the hernia defect. The mesh was fixed with circumferential, transfascial, permanent sutures and inferiorly fixed to the iliac crest by suture bone anchors. Five hernias were recurrent, and five were incarcerated; seven were incisional hernias, and three were posttraumatic. Back and abdominal pain was the most common presenting symptom. Mean hernia size was 227 cm(2) (60-504) with a mesh size of 620 cm(2) (224-936). Mean operative time was 181 min (120-269), with a mean blood loss of 128 ml (50-200). Mean length of stay was 5.2 days (2-10), and morphine equivalent requirement was 200 mg (47-460). There were no postoperative complications or deaths. After a mean follow-up of 40 months (3-99) there have been no recurrences. Our sublay repair of lumbar hernias with permanent suture fixation is safe and to date has resulted in no recurrences. Suture bone anchors ensure secure fixation of the mesh to the iliac crest and may eliminate a common area of recurrence. PMID:15365883
Carbonell, A M; Kercher, K W; Sigmon, L; Matthews, B D; Sing, R F; Kneisl, J S; Heniford, B T
Scrotal haematoma and oedema are the most frequent complications of scrotal surgery and are associated with high morbidity. Through early postoperative compression on the scrotal sac these complications can be avoided. Compression can be assured by the following simple surgical method independent of the quality of the postoperative care: extending the scrotal sac over the abdominal wall and fixing it with skin sutures under tension at the lower abdominal wall over a pile of gauzes. This method was shown to be effective after hernia repair of scrotal hernias but also seems promising for other scrotal surgery. PMID:22431825
Wilms, Miriam C; Hellmold, Peter
The aim of this study was to compare mesh placement in front of the fascia transversalis and behid the fascia transversalis via inguinal incision. We evaluated the results of 106 inguinal hernia cases treated with polypropylene mesh applied via the anterior approach between December 2004 and January 2010. Using the anterior approach, the mesh was placed preperitoneally behind the fascia transversalis in 51 of the patients, whereas in the other 55 patients the mesh was placed in front of the fascia transversalis. Mean duration of surgery was shorter in the patients in which the mesh was placed behind the fascia transversalis (60 min vs. 75 min) (P?0.05). In all, 8 patients (7.5%) had postoperative complications, including hematoma (n?=?4), seroma (n?=?2), scrotal edema (n?=?1), and orchitis (n?=?1). There weren't any significant differences in the complication rate between the 2 groups of patients (P?>?0.05). During a mean 44-month follow-up period (range: 12-72 months), no recurrence was observed. In conclusion, there weren't any significant differences between the 2 methods of inguinal hernia repair, other than the duration of surgery. PMID:24891776
Bülbüller, Nurullah; Cetinkaya, Ziya; Kirkil, Cüneyt; Ayten, Refik; Aygen, Erhan; Girgin, Mustafa; Ilhan, Yavuz Selim
Inguinal hernia repair is one of the most frequently performed surgical procedures in infants and young children. This prospective comparative study was conducted with initial experience in the department of pediatric surgery, Dhaka Shishu (children) hospital during the period of July 2007 to August 2008. We enrolled 62 children undergoing surgery for inguinal hernia, of which 30 underwent laparoscopic procedure (bilateral in 21, unilateral 9) and 32 open procedures (bilateral in 5, unilateral in 27). Mean±SD patient age was 5.92±2.11 months in laparoscopic group and 6.63±2.64 months in open group (p=0.264), 3 months to 5 years in both groups. Patients were studied under variables of operative time, duration of postoperative hospital stay & post operative complications. During laparoscopy a contralateral patent processus vaginalis of ?2cm was noted and repaired peroperatively in 18 out of 27 children (66%), who were initially diagnosed as unilateral hernia. For unilateral repair mean±SD operative time was significantly longer in Group A (62.63±52.75) minutes compares to the Group B (29.37±9.40), p<0.001. On the contrary, for bilateral repair Mean±SD operative time was comparable between the two groups (64.65±49.70) minutes for laparoscopy & (35.65±11.53 minutes) for open herniotomy & P=0.01, that was not remarkably significant. The mean±SD post operative length of hospital stay (in hours) 36.00±32.7 hours in Group A compared to 29.97±11.82 hours in Group B which was not statically significant (p=0.342). The mean±SD follow up was 24.5±10.5 months in laparoscopic group (Group A) & 22.5±10.5 months in open group (Group B), p=0.251. Regarding post operative complication, in this study, contra lateral metachronous inguinal hernia (CMIH) manifested in none of the patient out of 27 (total unilateral repaired number) patients in laparoscopic group but contrary to this in open group 2 patients out of 27 had developed CMIH & p value was <0.05, which is statistically significant. There were 2 cases of scrotal hydrocele out of 30, observed in Group A whereas 1 case out of 32 in Group B, p=0.49, which was statistically insignificant. The scrotal hydrocele was lasted only for 2 days & resolved spontaneously. About recurrence after operation, our study noted that, 1 case (3.3%) out of 30 in laparoscopic group and 2 cases (6%) out of 32 in open surgery group had developed recurrent inguinal hernia in about one year follow up where p value was 0.459, & it was statistically insignificant. In this study, none of the patient had developed post operative testicular atrophy (due to any vas or vascular injury) or testicular ascend. So, overall this study result implies that, Laparoscopic herniotomy might be a safe and effective option as open herniotomy for the treatment of inguinal hernia in children but which one would be superior or best option it requires a large series of randomized trial. PMID:23715341
Saha, N; Biswas, I; Rahman, M A; Islam, M K
The advent of mesh devices allowed for tension-free inguinal hernia repairs and a subsequent reduction in the rate of recurrences.\\u000a In 1993, Rutkow and Robbins introduced the plug-and-patch repair method whereby the hernia defect is filled with a mesh plug.\\u000a This new procedure led to new technique-specific complications. Here, we report the case of a man who presented with obstructive
D. J. Lo; K. Y. Bilimoria; C. M. Pugh
Background Though the occurrence of postoperative seroma after incisional hernia repair using mesh reinforcement is very common, little\\u000a is known about the genesis of seroma formation. The aim of this study was to determine the characteristics of drainage liquid\\u000a as a potential predictor for the development of seroma after incisional hernia mesh repair. Furthermore, the characteristics\\u000a of drainage liquid were compared
C. D. KlinkM; M. Binnebösel; A. H. Lucas; A. Schachtrupp; U. Klinge; V. Schumpelick; K. Junge
Background There are many different meshes available for laparoscopic repair of ventral hernias. A relatively new product is the Proceed\\u000a mesh with a bioresorbable layer against the bowels and a polypropylene layer against the abdominal wall. There are, however,\\u000a no human data available. The aim of this study was to evaluate the feasibility and outcome after laparoscopic ventral hernia\\u000a repair using
J. Rosenberg; J. Burcharth
Background Seroma are common early postoperative complications encountered in laparoscopic inguinal hernia repair. Previous anecdotal\\u000a evidence from our surgical practice suggested a lower incidence of postoperative seroma formation with direct hernia repairs\\u000a when the lax transversalis fascia (TF) is inverted by tacking to the pubic ramus. We undertook a study to investigate whether\\u000a TF inversion in this way reduces the incidence
V. M. Reddy; C. D. Sutton; L. Bloxham; G. Garcea; S. S. Ubhi; G. S. Robertson
. We evaluated the true incidence of seroma formation after laparoscopic repair of incisional hernia with polytetrafluoroethylene\\u000a (PTFE) patch. In a prospective study, 20 patients who underwent laparoscopic repair of incisional hernia with PTFE were evaluated\\u000a clinically and with ultrasound examination for seroma formation up to the 90th postoperative day. Seroma was diagnosed clinically\\u000a in only 35% of cases, while ultrasound
S. Susmallian; G. Gewurtz; T. Ezri; I. Charuzi
Introduction Abdominal wall defects and incisional hernias represent a challenging problem. Currently, several commercially available biologic\\u000a prostheses are used clinically for hernia repair. We compared the performance and efficacy of two non-crosslinked meshes in\\u000a ventral hernia repair to two crosslinked prostheses in a rodent model.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Animals were divided into 12 groups (4 matrix types and 3 termination time-points per matrix). A
L. E. de Castro Brás; S. Shurey; P. D. Sibbons
Background The laparoscopic approach has emerged in the search for a surgical technique to decrease the morbidity associated with conventional\\u000a repair of ventral hernias. In this study we aimed to compare the results of our open and laparoscopic ventral hernia repairs\\u000a prospectively.\\u000a \\u000a \\u000a \\u000a Methods Between January 2001 and October 2005, a total of 46 patients diagnosed with ventral hernias (primary and incisional) who
U. Barbaros; O. Asoglu; R. Seven; Y. Erbil; A. Dinccag; U. Deveci; S. Ozarmagan; S. Mercan
Objective: This report depicts the feasibility of the concomitant repair of a large direct inguinal hernia with mesh by using the intraperitoneal onlay approach after extra-peritoneal laparoscopic radical prostatectomy. Methods: A 66-year-old man with localized adenocarcinoma of the prostate was referred for laparoscopic radical prostatectomy. The patient also had a 4-cm right, direct inguinal hernia, found on physical examination. To minimize the risk of infection of the mesh, an extraperitoneal laparoscopic prostatectomy was performed in the standard fashion after which transperitoneal access was obtained for the hernia repair. The hernia repair was completed by reduction of the hernia sac, followed by prosthetic mesh onlay. In this fashion, the peritoneum separated the prostatectomy space from the mesh. A single preoperative and postoperative dose of cefazolin was administered. Results: The procedure was completed with no difficulty. Total operative time was 4.5 hours with an estimated blood loss of 450 mL. The final pathology revealed pT2cN0M0 prostate cancer with negative margins. No infectious or bowel complications occurred. At 10-month follow-up, no evidence existed of recurrence of prostate cancer or the hernia. Conclusion: Concomitant intraperitoneal laparoscopic mesh hernia repair and extraperitoneal laparoscopic prostatectomy are feasible. This can decrease the risk of potential infectious complications by separating the mesh from the space of Retzius where the prostatectomy is performed and the lower urinary tract is opened.
Knoll, Abraham; Teixeira, Julio A.
Nonstrangulating indirect scrotal hernias were corrected in two 4-week-old Percheron foals by a laparoscopic technique. After laparoscopic reduction of herniated nonstrangulated small intestine each testes was retracted through the vaginal ring. The ligament of the tail of the epididymis was transected by electrocautery. The testicular vessels and nerves were isolated by cautery of the mesenteric portion of the mesorchium and then ligated. Staples were used to close the opening of the inguinal canal by apposing the peritoneal edges of the vaginal ring. Resection of umbilical stalk remnants via celiotomy performed in one foal after laparoscopic observation of enlargement of the right umbilical artery and urachus. No complications or recurrence of herniation had occurred 16 weeks after surgery. PMID:8879113
Klohnen, A; Wilson, D G
Although the clinical picture of discogenic sciatica is well known already in the ancient world, it is not until 1933 that WJ Mixter and JS Barr provide the correct pathogenetic interpretation and suggest surgery as the treatment of choice. The work of the American Authors was however based on the knowledge acquired during the previous centuries starting with Domenico Cotugno, who first suggested the neurogenic nature of sciatica (1764) and later with the neurologists of the french school Valleix, Lasègue, Dejerine, Sicard who elucidated the semeiology and debated in detail the etiopathogenesis of the condition. The german pathologists Schmorl and Andrae (1927-29) are to be credited for their contribution to the pathology of intervertebral disc, recognizing the frequency and degenerative (not neoplastic) nature of nucleus pulposus herniation. Surgery of disc herniation starts with Oppenheim and Krause (1909). Mixter and Barr used laminectomy and a transdural route although a more limited approach to the spinal canal had already been proposed by the italian Bonomo (1902), unknown to many. Love, of the Mayo Clinic (1937-39) introduced the extradural/interlaminar approach while Caspar and Yasargil (1977) applied the concepts of microsurgery to the procedure. The latest advances are represented by percutaneous and endoscopic techniques. PMID:9835099
Brunori, A; De Caro, G M; Giuffrè, R
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.
Hay, J M; Boudet, M J; Fingerhut, A; Poucher, J; Hennet, H; Habib, E; Veyrieres, M; Flamant, Y
INTRODUCTION: Ventral hernias are common and repair with mesh has been shown to reduce recurrence. However, synthetic mesh is associated with a risk of infection. Biologic mesh is an alternative that may be less susceptible to infection. Typically, the sublay position is preferred for mesh placement but this technique takes longer and has not been shown to have a lower recurrence rate than an onlay mesh. The aim of this study was to evaluate the outcome of complex ventral hernia repair using a porcine non-cross-linked biologic mesh onlay. METHODS: A retrospective chart review was performed of all patients that had a ventral hernia repair with biologic mesh from January 2009 to March 2012. The operative procedure in all patients was an open repair with primary fascial closure (if possible) with or without external oblique component separation and porcine biologic mesh onlay. RESULTS: There were 22 patients that had a ventral hernia repair, 19 primary and 3 recurrent. The majority were men, had hernia grade 3 or 4, and developed the hernia after an esophagectomy or gastrectomy for cancer. All but one had primary closure with a porcine biologic mesh onlay. One patient was bridged for loss of domain. A bilateral external oblique component separation was added in 16 patients (73 %). The median hospital stay was 7 days. There were two superficial wound infections, one with exposed mesh, but no patient required mesh removal. A seroma requiring intervention developed in 6 patients (27 %) and resolved with pig-tail drainage. At a median follow-up of 7 months, there has been no hernia recurrence apart from the patient that was bridged. CONCLUSIONS: Porcine non-cross-linked biologic mesh overlay has excellent short-term results in patients at increased risk for mesh infection. No patient required mesh removal, and there have been no recurrent hernias in patients with primary fascial closure. Biologic bridging is not effective for long-term abdominal wall reconstruction. PMID:23400527
Alicuben, E T; Demeester, S R
Background: Type III paraesophageal hernias are diaphragmatic defects with the risk of serious complications. High recurrence rates associated with primary suture repair are significantly improved with the use of a tension-free repair with prosthetic mesh. However, mesh in the hiatus is associated with multiple complications. A bioengineered material from donated human tissue offers an attractive alternative material for hernia repair. This report is on the first series of laparoscopic type III paraesophageal hernia repairs with acellular dermal allografts (AlloDerm, Lifecell Corporation, Branchburg, NJ) in 11 patients with follow-up evaluation. Methods: From August 2003 to June 2004, 11 patients underwent laparoscopic repair of type III paraesophageal hernias with acellular dermal allografts. Patients were evaluated postoperatively with a symptoms questionnaire and barium esophagram. Results: All patients were available for follow-up; however, 2 refused a barium esophagram. Average length of hospital stay was 3 days. Follow-up evaluation was at a mean interval of 1 year. Postoperatively, 9 of 11 patients reported no symptoms. Barium esophagram revealed one recurrence in an asymptomatic patient. Conclusion: Type III paraesophageal hernia can be laparoscopically repaired successfully with acellular dermal allografts.
Wisbach, Gordon; Peterson, Todd
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.
Kitamura, Riley K.; Choi, Jacqueline; Lynn, Elizabeth
Abstract\\u000a \\u000a \\u000a Background. The use of prosthetic materials in tension-free incisional hernia repairs has diminished reherniation rates markedly; however,\\u000a infection, intestinal fistulization, and seroma formation have been reported after repairs. Use of the Rives-Stoppa procedure\\u000a for incisional hernia repair, in which the prosthesis is placed between the rectus abdominis muscle and the posterior sheath,\\u000a may reduce occurrence of these problems.\\u000a \\u000a \\u000a \\u000a \\u000a Methods
J. Bauer; M. Harris; S. Gorfine; I. Kreel
Giant paraesophageal hernias (PEHs) are associated with progression of symptoms in up to 45 per cent of patients. Recently, many series have reported that laparoscopic repair of PEH is technically feasible, effective, and safe. A retrospective review of the University of Athens tertiary care hospitals patient database and the patient medical records identified 45 patients who underwent elective repair of a giant PEH between 2002 and 2009. Elective laparoscopic repair of a giant PEH was attempted in 45 patients who were treated with Gore-Tex dual mesh with or without Nissen fundoplication. They all had a mesh repair. Intraoperative complications included one pulmonary embolism and one recurrent hernia. The use of a mesh seems to be effective in the treatment of large hernias. It appears to offer the benefit of a shorter hospital stay and a quicker recovery. PMID:22472400
Stavropoulos, George; Flessas, Ioannis I; Mariolis-Sapsakos, Theodoros; Zagouri, Flora; Theodoropoulos, George; Toutouzas, Konstantinos; Michalopoulos, Nikolaos V; Triantafyllopoulou, Ioanna; Tsamis, Dimitrios; Spyropoulos, Basilios G; Zografos, George C
A 2-day-old Thoroughbred intact female was presented for a large subcutaneous swelling in the right inguinal region. Surgical repair was performed using a double layer polypropylene mesh. To the authors' knowledge, there have been no previous reports of surgical repair of congenital body wall hernias with polypropylene mesh in foals. PMID:19721780
Moorman, Valerie J; Jann, Henry W
A 2-day-old Thoroughbred intact female was presented for a large subcutaneous swelling in the right inguinal region. Surgical repair was performed using a double layer polypropylene mesh. To the authors’ knowledge, there have been no previous reports of surgical repair of congenital body wall hernias with polypropylene mesh in foals.
Moorman, Valerie J.; Jann, Henry W.
Prosthetic repair of inguinal hernias has low recurrence and infection rates in practice. However, surgical site infection is still a potential complication. A limited number of cases have been reported to date describing late-onset deep mesh infection following prosthetic repairs. We herein report a new case of postherniorrhaphy infection with a very late onset. PMID:20941982
Genç, V; Ensari, C; Ergul, Z; Kulacoglu, H
Background and Objectives: The contemporary results of open incisional and ventral hernia repair are unsatisfactory because of high recurrence rates and morbidity levels. Laparoscopic repair of ventral and incisional hernias (LIVH) can be accomplished in a simple, reproducible manner while dramatically lowering recurrence rates and morbidity. Methods: One hundred consecutive patents underwent laparoscopic repair of their ventral and incisional hernias over a 27-month period. Composix mesh and Composix E/X mesh (Davol Inc., Cranston, RI) were utilized for the repairs. Transfixion sutures were not used. Results: All repairs were completed laparoscopically. No conversions to open techniques were necessary. No postoperative infections have been observed. One recurrent hernia was identified and subsequently repaired with the same technique. Conclusions: LIVH can be accomplished with a dramatic reduction in recurrence rates and morbidity. The technique for this repair is still in a state of evolution. The construction and handling characteristics of this particular type of mesh have allowed us to eliminate transfixion sutures and to simplify the repair technique while maintaining a very low recurrence rate.
Geis, W. Peter; Grover, Gary
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.
Kumar, Rakesh; Hazrah, Priya; Bal, Sabyasachi
Three infants were studied by echo planar imaging after repair of congenital diaphragmatic hernias. Total lung volume and individual lung volumes were estimated using echo planar imaging. In the two patients with left sided hernias, the right lung was more than twice as large as the left. The patient with a right sided hernia had developed emphysema on the right side, and the right lung was twice as large as the left when estimated by echo planar imaging. Echo planar imaging studies took less than five minutes to perform and no sedation was required. Images Fig 1 Fig 2
O'Callaghan, C; Chapman, B; Coxon, R; Howseman, A; Jaroszkiewicz, G; Stehling, M; Mansfield, P; Milner, A D; Swarbrick, A; Small, P
Background Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is as efficacious as the open Lichtenstein procedure, can\\u000a be learned with proper training, and causes less postoperative pain, better cosmesis, and earlier return to work. The one\\u000a major factor preventing the widespread acceptance of TEP is the requirement for general anesthesia (GA). In contrast, open\\u000a hernia is performed using local or regional
Pawanindra Lal; P. Philips; K. N. Saxena; R. K. Kajla; J. Chander; V. K. Ramteke
The use of prosthetic mesh has become the standard of care in the management of hernias because of its association with a\\u000a low rate of recurrence. However, despite its use, recurrence rates of 1% have been reported in primary inguinal repair and\\u000a rates as high as 15% with ventral hernia repair. When dealing with difficult recurrent hernias, the two-layer prosthetic
J. M. Treviño; M. E. Franklin; K. R. Berghoff; J. L. Glass; E. J. Jaramillo
AIM: To investigate the use of the V-Loc wound closure device for transabdominal preperitoneal hernia repair. METHODS: We performed conventional transabdominal preperitoneal hernia repair in 19 patients, including one single incisional case using V-Loc. Except for the use of V-Loc for peritoneal closure, the procedures were the same as those used in conventional techniques. RESULTS: Although the operators included 2 residents who have no experience in laparoscopic herniorrhaphy and intracorporeal suture, the operations were completed. We believe that V-Loc is especially suitable for inexperienced surgeons and the use of V-Loc reduces the operative time by a small amount but reduces operator stress significantly. CONCLUSION: We conclude that V-Loc is the ideal peritoneal closure device for transabdominal preperitoneal hernia repair.
Takayama, Satoru; Nakai, Nozomu; Shiozaki, Midori; Ogawa, Ryo; Sakamoto, Masaki; Takeyama, Hiromitsu
Background: Hiatal hernia (HH) is closely associated with morbid obesity. There is controversy over the need for preoperative imaging before laparoscopic adjustable gastric band placement. The aim of this study is to determine the predictive value of preoperatively diagnosing HH with upper gastrointestinal (UGI) series imaging. Methods: A retrospective review of a single surgeon's experience with laparoscopic adjustable gastric band placements was performed. All patients received a preoperative UGI series. The decision to perform an HH repair at the time of gastric banding was based on intraoperative findings. Each patient's UGI study was compared with the operative report. Patients' outpatient records were also reviewed for subjective reflux symptoms or use of antireflux medications. Results: Of 146 patients, 63 (43%) had intraoperative findings consistent with an HH and underwent repair. Of these, only 32 (50%) had a preoperative UGI study that showed an HH (positive predictive value, 50%). Of the 83 patients who did not have an intraoperative HH, only 51 (61%) had a congruent UGI (negative predictive value, 62%). No correlation was found between patient-reported symptoms and either radiologic or intraoperative findings. Conclusions: UGI series have poor positive and negative predictive values in preoperatively diagnosing HH. In addition, subjective patient symptoms and the need for antireflux medication did not correlate with either radiologic or intraoperative findings of HH. Our results suggest that direct operative diagnosis is a more accurate method of detecting HH.
Broucek, Joseph R.; Ritter, Lane A.; Francescatti, Amanda B.; Smith, Claire H.; Luu, Minh B.; Autajay, Khristi M.
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.
Delossantos, Aubrey I; Rodriguez, Neil L; Patel, Paarun; Franz, Michael G; Wagner, Christopher T
Laparoscopic incisional and ventral hernia (LVIH) repair is becoming more popular throughout the world. Although individual series have presented their own information, few data have been collected to identify the risk of the most serious complication, enterotomy. A literature review has identified this to occur in 1.78% of patients who undergo this procedure. Large bowel injury represents only 8.3% of these injuries. Eighty-two percent of the time, these injuries will be recognized and repaired. In the majority of published series in which this occurred, the hernia repair was completed with a laparoscopically placed prosthesis, as only 43% were converted to the open procedure. Complications related to this approach are infrequent. The mortality rate of this operation was noted to be 0.05%. However, if an enterotomy occurred, it increased to 2.8%. A recognized enterotomy was associated with a mortality rate of 1.7%, but an unrecognized enterotomy had a rate of 7.7%. Careful technique and close inspection of the intestine at the completion of the adhesiolysis and the herniorrhaphy is recommended. If the hernia repair proceeds as planned following repair of enterotomy, continuation of antibiotics and the placement of an antimicrobial impregnated prosthesis are recommended. More study is necessary before firm recommendations can be made, as the majority of these events are most likely unreported. Safety concerns may require postponement of the hernia repair if an enterotomy occurs.
Elieson, Melvin Joseph; Corder, James M.
The long term neurodevelopmental outcome was assessed in 23 survivors born with congenital diaphragmatic hernia who had been managed by an elective delay in surgical repair after a period of stabilisation. This cohort was treated in one neonatal surgical unit between 1983 and 1989 by a single team of surgeons and anaesthetists. All children underwent comprehensive neurological, developmental, and anthropometric assessment at a mean age of 56 (range 18-94) months. Two children (9%) had major disability (one with hemiplegia and one with a lower limb monoplegia) and two further children had minor disabilities (one had partial sightedness and squint, the other squint only). The mean developmental quotient (DQ) for the group was 108 (SD 10.8) and none had developmental delay (defined as DQ < 70). Infants who had spent more time in hospital, or had had a longer duration of ventilation, tended to have lower weights and lower occipitofrontal circumference centiles in later childhood. Preoperative stabilisation and delayed surgery for congenital diaphragmatic hernia is not associated with an impaired neurodevelopmental outcome.
Davenport, M; Rivlin, E; D'Souza, S W; Bianchi, A
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
Background. The exact nature of learning curve of totally extraperitoneal inguinal hernia and the number required to master this technique remain controversial. Patients and Methods. We present a retrospective review of a single surgeon experience on patients who underwent totally extraperitoneal inguinal hernia repair. Results. There were 42 hernias (22 left- and 20 right-sided) in 39 patients with a mean age of 48.8 ± 15.1 years. Indirect, direct, and combined hernias were present in 18, 12, and 12 cases, respectively. The mean operative time was 55.1 ± 22.8 minutes. Peritoneal injury occurred in 9 cases (21.4%). Conversion to open surgery was necessitated in 7 cases (16.7%). After grouping of all patients into two groups as cases between 1–21 and 22–42, it was seen that the majority of peritoneal injuries (7 out of 9, 77.8%, P = 0.130) and all conversions (P = 0.001) occurred in the first 21 cases. Conclusions. Learning curve of totally extraperitoneal inguinal hernia repair can be divided into two consequent steps: immediate and late. At least 20 operations are required for gaining anatomical knowledge and surgical pitfalls based on the ability to perform this operation without conversion during immediate phase.
Hasbahceci, Mustafa; Basak, Fatih; Acar, Aylin
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.
Background: Repairing large hiatal hernias using mesh has been shown to reduce recurrence. Drawbacks to mesh include added time to place and secure the prosthesis as well as complications such as esophageal erosion. We used a laparoscopic technique for repair of hiatal hernias (HH) >5cm, incorporating primary crural repair with onlay fixation of a synthetic polyglycolicacid:trimethylene carbonate (PGA:TMC) absorbable tissue reinforcement. The purpose of this report is to present short-term follow-up data. Methods: Patients with hiatal hernia types I-III and defects >5cm were included. Primary closure of the hernia defect was performed using interrupted nonpledgeted sutures, followed by PGA:TMC mesh onlay fixed with absorbable tacks. A fundoplication was then performed. Evaluation of patients was carried out at routine follow-up visits. Outcomes measured were symptoms of gastroesophageal reflux disease (GERD), or other symptoms suspicious for recurrence. Patients exhibiting these complaints underwent further evaluation including radiographic imaging and endoscopy. Results: Follow-up data were analyzed on 11 patients. Two patients were male; 9 were female. The mean age was 60 years. The mean length of follow-up was 13 months. There were no complications related to the mesh. One patient suffered from respiratory failure, one from gas bloat syndrome, and another had a superficial port-site infection. One patient developed a recurrent hiatal hernia. Conclusions: In this small series, laparoscopic repair of hiatal hernias >5cm with onlay fixation of PGA:TMC tissue reinforcement has short-term outcomes with a reasonably low recurrence rate. However, due to the preliminary and nonrandomized nature of the data, no strong comparison can be made with other types of mesh repairs. Additional data collection is warranted.
Singh, Tejinder P.; Dunnican, Ward J.; Binetti, Brian R.
Background The repair of incisional hernias remains a challenge for the general surgeon. Indications for surgery are severe bowel obstruction, as well as aesthetic problems. There are various surgical methods to correct these hernias, with varying results. However, the gold standard has not yet been found. Both laparoscopic repair and the component separation technique (CTS) have proven to be acceptable techniques; however, they are not always suitable for resolving the more complicated abdominal wall defects, i.e. after open-abdomen treatment or fascial necrosis. In our hospital, we developed a new onlay technique which we have evaluated in the following research. Patients and methods During a period of 10 years (1996–2007), 101 patients with an incisional hernia were corrected with the new onlay technique. A Marlex mesh of dimensions at least 10 × 20 cm was used, overlapping the fascia by at least 5 cm on each side. This mesh was stapled onto the fascia with skin staples. Of the 101 patients, there were 45 men and 56 women, with a mean age of 55 years. Nine patients died and 13 were lost during follow-up. Of the remaining 79 patients, eight refused to participate. The mean follow-up time was 64 months (normal distribution, standard deviation [SD] 34 months). This cohort of 101 patients was studied retrospectively. Results Seventy-one of the 101 patients were evaluated at our out-patient clinic. For 24 patients (25%), the operation was for a recurrence after an incisional hernia correction in the past. Twenty-one patients (20%) had an open-abdomen treatment in their medical history. The surgical procedure was technically possible in all patients and the mean operation time was 63 min. The median admission time was 4.5 days (quartiles 3–6.25). The mean follow-up time was 64 months (SD 35 months). A seroma was reported in 27 of 101 patients (27%) and a wound infection in 22 patients (21%), of which seven patients had to be re-operated. Only if a patient was evaluated at our out-patient clinic could reherniation have been scored; this occurred in 11 of 71 patients (16%). Conclusion This technique is an effective and simple procedure to correct incisional hernias with acceptable complication rates and is feasible even in the more complicated hernias.
Langenhorst, B. L. A. M.; Schellekens, J. F.; Schreurs, W. H.
Background Abdominal closure in the presence of enterocutaneous fistula, stoma or infection can be challenging. A single-surgeon’s experience of performing components separation abdominal reconstruction and reinforcement with mesh in the difficult abdomen is presented. Methods Medical records from patients undergoing components separation and reinforcement with hernia mesh at Royal Liverpool Hospital from 2009 to 2012 were reviewed. Patients were classified by the Ventral Hernia Working Group (VHWG) grading system. Co-morbidities, previous surgeries, specific type of reconstruction technique, discharge date, complications and hernia recurrence were recorded. Results Twenty-three patients’ (15 males, 8 females) notes were reviewed. Median age was 57 years (range 20-76 years). Median follow-up at the time of review was 17 months (range 2-48 months). There were 13 grade III hernias and 10 grade IV hernias identified. Synthetic mesh was placed to reinforce the abdomen in 6 patients, cross-linked porcine dermis was used in 3, and a Biodesign® Hernia Graft was placed in 14. Complications included wound infection (13%), superficial wound dehiscence (22%), seroma formation (22%) and stoma complications (9%). To date, hernias have recurred in 3 patients (13%). Conclusions Components separation and reinforcement with biological mesh is a successful technique in the grade III and IV abdomen with acceptable rate of recurrence and complications.
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.
von Ahnen, Thomas; von Ahnen, Martin; Schardey, Hans
Introduction Percutaneous internal ring suturing (PIRS) is a method of laparoscopic herniorrhaphy, i.e. percutaneous closure of the internal inguinal ring under the control of a telescope placed in the umbilicus. Aim To evaluate the usefulness of the PIRS technique. Material and methods Fifty-five children (39 girls and 16 boys) underwent surgery using this method in our institution between 2008 and 2010. Results In 10 cases the presence of an open inguinal canal on the opposite side was also noted during surgery, and umbilical hernia was recognized in 2 patients. In 5 cases it was necessary to convert to the open surgery because of the inability to continue the laparoscopic procedure. In 1 case, male pseudohermaphroditism was diagnosed during surgery. Recurrent inguinal hernia required a conventional method of surgery in 1 child. Other children did not exhibit the characteristics of hernia recurrence. The inguinal canals were followed up with postoperative ultrasound examination in 29 children. In 23 children, the ultrasound examination showed no dilatation of the inguinal canal. In the other 6 children dilatation of the inguinal canal or the presence of fluid within the inguinal canal was observed during ultrasound. In 6 children symptoms such as swelling and soreness around the inguinal canal developed within 3 to 6 months after surgery. Conclusions Inguinal hernia surgery using the PIRS procedure is an alternative, effective, minimally invasive method of surgery. Visualization of the peritoneal cavity allows for detection of other abnormalities, as well as for performing other procedures during the same session (such as closing the contralateral inguinal canal or umbilical hernia surgery).
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
Background The treatment of ventral hernias is still a subject of debate. The affixing of a prosthesis and the subsequent introduction of laparoscopic treatment have reduced complications and recurrences. The high incidence of seromas and high costs remain open problems. Methods At our Department between January 2008 and December 2011, 87 patients (43 over 65 years), out of a total of 132, with defects of wall whose major axis was less than 10 cm, or minor and multiple defects (Swiss-cheese defect) on an axis not exceeding 12 cm underwent laparoscopic ventral hernia repair (LVHR) with primary and transparietal closure of the hernial defect. Through small incisions in the skin we proceeded to close the parietal defect with sutures tied outside. Then the mesh was fixed as usual with double row of stitches and an overlap of 3-5cm. Results In all patients, 43 of them elderly, surgery was successfully conducted. The juxtaposition of the edges of the hernial defect has not been time consuming and has not developed new complications. The postoperative course was uneventful, with discharge on the third day, except in 5 patients. Were observed only small gaps and not the formation of large seromas. There were no infections wall. We do not have relapses, but some small and asymptomatic solutions continuously up to 2 cm at the sonographic study. In elderly patients the absence of dead space and the feeling of greater stability of the wall, early mobilization and pain control have facilitated the post-operative course. Conclusions The positioning of sutures transcutaneous is simple and effective, the reduced incidence of seromas and the greater stability of the wall suggest to adopt this procedure fully. The possibility to close the margins of the defect may allow to change the size and setting of the mesh, since the absence of dead space allows to download physiologically tensions of the wall.
Purpose To describe the anesthetic concerns and management options in an infant with acute viral bronchiolitis who required emergency\\u000a surgery.\\u000a \\u000a \\u000a \\u000a Clinical features A 12-week-old infant presented to the emergency department with an incarcerated right inguinal hernia. The history was complicated\\u000a by concurrent acute bronchiolitis. As the hernia was irreducible, emergency surgery was required. General endotracheal anesthesia,\\u000a following a rapid sequence induction, was
Robin G. Cox
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
Koning, Giel G; de Schipper, Hans JP; Oostvogel, Henk JM; Verhofstad, Michiel HJ; Gerritsen, Pieter G; van Laarhoven, Kees CJHM; Vriens, Patrick WHE
Chylothorax is a recognized cause of morbidity after repair of congenital diaphragmatic hernia (CDH). Management may include prolonged hospitalization with cessation of enteral feedings, repeated aspiration, chest tube drainage, total parenteral nutrition, and introduction of a medium chain triglyceride (MCT) diet as the effusion resolves. The authors report that the successful deployment of octreotide, a somatostatin analogue, hastened resolution of
Anju Goyal; Nicola P Smith; Edwin C Jesudason; Steve Kerr; Paul D Losty
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
Introduction The main risk factors for inguinal hernia are male sex and increasing age. Complications of inguinal hernia include strangulation, intestinal obstruction, and infarction. Recurrence can occur after surgery. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of elective treatments for primary unilateral, primary bilateral, and recurrent inguinal hernia in adults? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations, such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 24 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: expectant management, open mesh repair, open suture repair, totally extraperitoneal (TEP) laparoscopic repair, and transabdominal preperitoneal (TAPP) laparoscopic repair.
Flank incisions may be associated with flank hernias, which may be complicated with incarceration and strangulation. Furthermore,\\u000a they may cause a significant limitation of the patient’s quality of life.\\u000a \\u000a In the period 1997-2006 we performed 15 flank hernia repairs with a prosthetic mesh implantation. From 1997 to 2001 hernias\\u000a were managed with a standardized mesh implantation through the initial flank
Jürgen Zieren; Charalambos Menenakos; Kasra Taymoorian; Jochen M. Müller
Background The use of prosthetic materials for the repair of paraesophageal hiatal hernia (PEH) may lead to esophageal stricture and\\u000a perforation. High recurrence rates after primary repair have led surgeons to explore other options, including various bioprostheses.\\u000a However, the long-term effects of these newer materials when placed at the esophageal hiatus are unknown. This study assessed\\u000a the anatomic and histologic characteristics
K. M. Desai; S. Diaz; I. G. Dorward; E. R. Winslow; M. C. La Regina; V. Halpin; N. J. Soper
INTRODUCTION Local anaesthetic inguinal hernia repair may be technically demanding. There are minimal data regarding the outcomes of local anaesthetic hernia repair by trainees in comparison with consultants. PATIENTS AND METHODS All consecutive local anaesthetic repairs performed by trainees and one consultant over a 9-year period were reviewed. Operation time, volume of local anaesthetic used, early and long-term complications were assessed. A postal survey was conducted to assess chronic groin pain and satisfaction rates. RESULTS A total of 369 repairs were reviewed of which 265 repairs were performed by the consultant and 104 by trainees. The male-to-female ratio was 25:1 and the median age of the study group was 61 years (range, 18–93 years). The volume of local anaesthetic used was significantly higher for trainees than the consultant (42 ml versus 69 ml; P = 0.03). The operative time for the consultant and the trainees was 35 min and 40 min (P = 0.8). The day-case rate was higher for the consultant than the trainees (84% versus 69%; P = 0.02). Three patients operated by trainees required conversion to a general anaesthetic repair. No difference was noted in chronic groin pain (consultant 28% versus trainees 32%; P = 0.52) on the postal survey. The median follow-up was 5 years (range, 2–7 years). CONCLUSIONS Local anaesthetic inguinal hernia repair can be performed safely by surgical trainees under consultant supervision with minimal short- and long-term morbidity. A large volume dilute solution of Lignocaine and Marcaine is recommended when hernia repair is undertaken by trainees.
Sanjay, P; Woodward, A
Background Repair of complex incisional hernias poses a major challenge.\\u000a \\u000a \\u000a \\u000a Aim The aim of this study was to review the outcomes of the modified Rives-Stoppa repair of complex incisional hernias using a\\u000a synthetic prosthesis.\\u000a \\u000a \\u000a \\u000a Methods We reviewed patients undergoing a modified Rives-Stoppa repair of complex incisional hernias from 1990 to 2003. Patients were\\u000a followed through clinic visits and mailed questionnaires. Follow-up data were
Corey W. Iqbal; Tuan H. Pham; Anthony Joseph; Jane Mai; Geoffrey B. Thompson; Michael G. Sarr
Background: Bassini’s repair and the Lichtenstein’s tension free mesh hernioplasty are commonly used hernia repair techniques and yet there is no unison as to which is the best technique. Our hospital being in a rural setup and catering to majority of poor patients who are daily wagers, open hernia repairs are commonly done. This study was undertaken to compare the technique and post-operative course so as to determine the best suitable of the two procedures for them. Materials and Methods: A comparative randomized study was conducted on a total of 70 patients with inguinal hernia and were operated upon by either of technique and followed up. Outcome of both the techniques were analyzed and compared with other similar studies. Results: Study involved 35 each of Modified Bassini’s Repair (MBR) and Lichtenstein’s Mesh Repair (LMR), over a period of 18 months. MBR took more operating time than LMR. Commonest complication in both the groups was seroma formation. There were two recurrences in the MBR group and none in LMR group. Conclusion: LMR was comparatively better than MBR due to its simplicity, less dissection and early ambulation in the post-operative period and with no recurrence, in our study.
N., Naveen; R., Srinath
Background: Bassini's repair and the Lichtenstein's tension free mesh hernioplasty are commonly used hernia repair techniques and yet there is no unison as to which is the best technique. Our hospital being in a rural setup and catering to majority of poor patients who are daily wagers, open hernia repairs are commonly done. This study was undertaken to compare the technique and post-operative course so as to determine the best suitable of the two procedures for them. Materials and Methods: A comparative randomized study was conducted on a total of 70 patients with inguinal hernia and were operated upon by either of technique and followed up. Outcome of both the techniques were analyzed and compared with other similar studies. Results: Study involved 35 each of Modified Bassini's Repair (MBR) and Lichtenstein's Mesh Repair (LMR), over a period of 18 months. MBR took more operating time than LMR. Commonest complication in both the groups was seroma formation. There were two recurrences in the MBR group and none in LMR group. Conclusion: LMR was comparatively better than MBR due to its simplicity, less dissection and early ambulation in the post-operative period and with no recurrence, in our study. PMID:24701491
N, Naveen; R, Srinath
The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency. PMID:24368923
Naraynsingh, Vijay; Cawich, Shamir O; Maharaj, Ravi; Dan, Dilip
The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency.
Cawich, Shamir O.; Maharaj, Ravi; Dan, Dilip
Background Laparoscopic incisional hernia repair (LIHR) is a common procedure requiring advanced laparoscopic skills. This study aimed\\u000a to develop a procedure-specific tool to assess the performance of LIHR and to evaluate its reliability and validity.\\u000a \\u000a \\u000a \\u000a \\u000a Methods The Global Operative Assessment of Laparoscopic Skills-Incisional Hernia (GOALS-IH) is a 7-item global rating scale developed\\u000a by experts to evaluate the steps of LIHR (placement of
Iman Ghaderi; Marilou Vaillancourt; Gideon Sroka; Pepa A. Kaneva; Melina C. Vassiliou; Ian Choy; Allan Okrainec; F. Jacob Seagull; Erica Sutton; Ivan George; Adrian Park; Rita Brintzenhoff; Dimitrios Stefanidis; Gerald M. Fried; Liane S. Feldman
Background Repair for umbilical and epigastric hernia is a minor and common surgical procedure. Early outcomes are not well documented.\\u000a \\u000a \\u000a \\u000a Methods All patients ?18 years operated on for umbilical or epigastric hernia in Denmark during a 2-year period (2005–2006) were analysed\\u000a according to hospital stay, risk of readmission, complications, and mortality <30 days after operation. Patients with acute\\u000a operations and patients having an umbilical
T. Bisgaard; H. Kehlet; M. Bay-Nielsen; M. G. Iversen; J. Rosenberg; L. N. Jørgensen
Background Today, the laparoscopic approach is a standard procedure for the repair of incisional hernias. However, the direct contact\\u000a of visceral organs with mesh material is a major issue.\\u000a \\u000a \\u000a \\u000a Patients and methods This prospective observational study presents the data of 344 patients treated for incisional and parastomal hernias with\\u000a a new mesh made of polyvinylidene fluoride (PVDF; Dynamesh IPOM®) between May 2004
D. Berger; M. Bientzle
Objective: Laparoscopic repair of ventral incisional hernias is feasible and safe. Polypropylene mesh is often preferred because of its ease of handling and lower cost. Complications like adhesion and fistula formation can occur. The goal of this study was to determine whether bowel adhesions and their attendant complications could be prevented by interposition of omentum. Methods: Thirty patients underwent laparoscopic ventral incisional hernias repair with polypropylene mesh. Omentum was always positioned over the loops of bowel for protection. At a mean follow-up of 14 months, 20 patients underwent ultrasonic examination using the previously described visceral slide technique to detect adhesions. Results: The mean size of the hernias in the study was 50.3 cm2, and the mean size of the mesh applied was 275 cm2. Thirteen patents (65%) had no sonographically detectable adhesions. Five patients demonstrated adhesions between the mesh and omentum, 1 patient developed adhesions between the left lobe of the liver and the mesh, and only 1 case of bowel adhesion to the edge of the mesh was found. Conclusion: Laparoscopic ventral incisional hernias repair with polypropylene mesh and omental interposition is not associated with visceral adhesions in the majority of patients. Polypropylene mesh can be used safely when adequate omental coverage is available.
Bingener, Juliane; Chopra, Shailendra; Schwesinger, Wayne H.
Titanium and its alloys are used worldwide in surgery. The favorable characteristics that make this material desirable for implantation are corrosion resistance and biocompatibility. Concerning hernia repair, a mesh modification has been developed using titanium layering of a polypropylene mesh implant, which is said to lead to an improved biocompatibility compared to commercially available mesh materials. To analyze the pure effect of titanium coating, two different mesh structures were studied using a standardized animal model. The titanium-coated monofilamentous, large porous, and lightweight mesh made of polypropylene and coated with titanium (PP+T) was compared to a pure polypropylene mesh manufactured with a similar structure and amount of material serving as a control (PP). In Sprague-Dawley rats, mesh samples were placed in a subcutaneuous position. Then 56, 84, and 182 days after mesh implantation, three animals from each group were sacrificed for morphological observations (amount of inflammatory and connective tissue formation, percentages of proliferating and apoptotic cells, percentage of macrophages). Both mesh modifications investigated showed an overall good biocompatibility. Macroscopic clinical observation after implantation of up to 182 days was uneventful. The tissue response to the PP as well as to the PP+T mesh was characterized by a moderate inflammatory tissue reaction limited to the perifilamentary region as is known for low weight, large porous, and monofilamentous mesh structures. No significant improvement of biocompatibility was found when analyzing the effect of titanium coating compared to the pure polypropylene mesh structure. PMID:15583967
Junge, K; Rosch, R; Klinge, U; Saklak, M; Klosterhalfen, B; Peiper, C; Schumpelick, V
Abdominal Muscles/Ultrasonography; Adult; Ambulatory Surgical Procedures; Anesthetics, Local/Administration & Dosage; Ropivacaine/Administration & Dosage; Ropivacaine/Analogs & Derivatives; Hernia, Inguinal/Surgery; Humans; Nerve Block/Methods; Pain Measurement/Methods; Pain, Postoperative/Prevention & Control; Ultrasonography, Interventional
The repair of incisional hernias with the use of prosthetic biomaterials is the standard of care today. There are different prosthetic biomaterials that can be used to repair incisional hernias. These materials can be divided into products that are single component or a combination. Incisional hernia repair using the intraperitoneal implantation of a prosthesis requires mesh with impervious properties. This is preliminary study with a new composite non resorbable mesh in polyethylene terephthalate-polyurethane (HI-TEX PARP MP) used for incisional hernia repair in intraperitoneal implantation. This mesh has one permeable side in polyethylene terephthalate (PET) for rapid tissue fixation and another side in polyurethane (PEU), hydrophobic in order to avoid cell penetration. This is a preliminary study of medical records of 24 patients (17 women and 7 men) in whom intraperitoneal placement of composite prosthetics in polyethylene terephthalate-polyurethane (HI-TEX PARP MP) was used between September 2004 and September 2006. The incisional hernias were recurrent in 8 patients. The underside of the mesh was placed in direct contact with the visceral peritoneum, whereas the upper side made contact with the subcutaneous tissue. No intraoperative complications occurred. Postoperatively, 1 had seromas, 1 had phlegmon of the wound without removing prosthetics. There was 1 death but not dependent of the surgical performance. The follow-up, was 12 months (range 1 month-2 years); none had discomfort; only one patient had recurrence. Intraperitoneal placement of HI-TEX PARP MP has several advantages over other techniques including minimal adhesions, a decreased risk of infection and recurrences. In addition this mesh is more economics than the other prosthetics in use. PMID:18035015
Bove, A; Pungente, S; Corradetti, L; Bongarzoni, G; Palone, G; Corbellini, L
BACKGROUND--In utero surgery was used to correct a surgically induced model of congenital diaphragmatic hernia (CDH) in premature and term lambs, resulting in an improvement in lung mechanics at birth. METHODS--The differences between the in utero "patch" repair method and the "silo" repair method were assessed in 55 lambs by measuring the static respiratory system compliance (CST,RS) at birth in term (approximately 145 day) and in premature (128 day) animals. RESULTS--Both methods resulted in similar improvements in CST,RS in term lambs, but in premature lambs only the silo method produced an increase in compliance. Comparisons of specific compliance related to length or birth weight did not alter these findings; however, corrections related to lung weight or a measure of lung volume showed there was no difference between any experimental groups in either term or premature lambs. CONCLUSIONS--These findings suggest that there was no difference in the intrinsic compliance of the lung tissue between normal, unrepaired and repaired animals, and that the differences in respiratory system compliance measured at birth may be due primarily to differences in lung size. The silo repair method appears to provide an earlier improvement in CST,RS than the patch repair method.
Parsons, D. W.; Ford, W. D.; Cool, J. C.; Martin, A. J.; Staugas, R. E.; Kennedy, J. D.
Background. To evaluate the use, indications, and short-term outcomes for human acellular dermis. Methods. We retrospectively reviewed patients having human acellular dermis placed for ventral hernia repair from January 2008 through October 2009. Demographic information, operative details, and outcomes of patients with and without recurrences were compared; a P value <0.05 was considered significant. Results. 115 patients met inclusion criteria. The average age was 60 years (range, 24–89). The technique of repair included primary repair with overlay of mesh in 76%, bridge repair in 13%, and underlay in 11%. Average cost of mesh per operation was $3,709 (range $191–10,630). Open repairs were performed in 90% of patients with addition of component separation in 12%. At an average of 13 months, 58 patients were available for followup (50%), with a 47% recurrence rate. The morbidity rate was 48% and the mortality rate was 2%. Technique of repair was the only significant risk factor for recurrence with bridge repairs associated with a higher rate of recurrence (P < 0.05). Conclusions. The use of biologic grafts for ventral hernia repair is becoming more popular especially in clean cases. Although followup is limited, there remains a high recurrence rate associated with the use of human acellular dermis.
Hope, William W.; Griner, Devan; Adams, Ashley; Hooks, W. Borden; Clancy, Thomas V.
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
In an attempt to reduce the high recurrence rate after repair of parastomal hernia, a technique was devised in which non-absorbable mesh was used to provide a permanent closure of the gap between the emerging bowel and abdominal wall. Seven patients were treated during the period 1990-1992. Five-year follow-up has given disappointing results, with recurrent hernia in 29% of cases and serious complications, including obstruction and dense adhesions to the intra-abdominal mesh, in 57% and a mesh-related abscess in 15% of cases. This study highlights a dual problem--failure of a carefully sutured mesh to maintain an occlusive position, and complications of the mesh itself. The poor results obtained with this technique together with the disappointing results with other methods described in the literature confirms that parastomal hernia presents a continuing challenge. PMID:9682640
Morris-Stiff, G; Hughes, L E
In an attempt to reduce the high recurrence rate after repair of parastomal hernia, a technique was devised in which non-absorbable mesh was used to provide a permanent closure of the gap between the emerging bowel and abdominal wall. Seven patients were treated during the period 1990-1992. Five-year follow-up has given disappointing results, with recurrent hernia in 29% of cases and serious complications, including obstruction and dense adhesions to the intra-abdominal mesh, in 57% and a mesh-related abscess in 15% of cases. This study highlights a dual problem--failure of a carefully sutured mesh to maintain an occlusive position, and complications of the mesh itself. The poor results obtained with this technique together with the disappointing results with other methods described in the literature confirms that parastomal hernia presents a continuing challenge. Images Figure 1 Figure 2
Morris-Stiff, G.; Hughes, L. E.
Background The aim of this prospective, randomized, single-blinded clinical trial was to compare the incidence of chronic pain after\\u000a 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\\u000a is a serious problem. The techniques of dissection, mesh fixation, and
Stefan Schopf; Thomas von Ahnen; Martin von Ahnen; Hans Schardey
Abstract Repair of complex ventral hernias frequently results in postoperative complications. This study assessed postoperative outcomes in a consecutive cohort of patients with ventral hernias who underwent herniorrhaphy using components separation techniques and reinforcement with non-cross-linked intact porcine-derived acellular dermal matrix (PADM) performed by a single surgeon between 2008 and 2012. Postoperative outcomes of interest included incidence of seroma, wound infection, deep-vein thrombosis, bleeding, and hernia recurrence determined via clinical examination. Of the 47 patients included in the study, 25% were classified as having Ventral Hernia Working Group grade 1 risk, 62% as grade 2, 2% as grade 3, and 11% as grade 4; 49% had undergone previous ventral hernia repair. During a mean follow-up of 31 months, 3 patients experienced hernia recurrence, and 9 experienced other postoperative complications: 4 (9%) experienced deep-vein thrombosis; 3 (6%), seroma; 2 (4%), wound infection; and 2 (4%), bleeding. The use of PADM reinforcement following components separation resulted in low rates of postoperative complications and hernia recurrence in this cohort of patients undergoing ventral hernia repair. PMID:24833145
Golla, Dinakar; Russo, Carly C
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
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
Traumatic abdominal wall hernias (TAWHs) are rare. They can arise from either high or low impact trauma and can be associated with significant associated injury. We present the case of a 27-year-old male involved in a high-impact road traffic accident resulting in a TAWH. He sustained significant disruption to the abdominal wall and sustained injuries to the thoracic cage. Operative management was undertaken with a porcine dermal collagen mesh, using a bridge technique.
Davey, Simon R.; Smart, Neil J.; Wood, James J.; Longman, Robert J.
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; Oyen, Ole M
Complex ventral hernias represent a significant challenge to surgeons. We hypothesized that a wide underlay technique in combination with a novel biologic mesh would result in repair with a low recurrence rate. Medical records of patients undergoing ventral herniorrhaphy with XenMatrix biologic mesh were evaluated. All patients were evaluated for hernia recurrence both immediately and after 2 to 3 years. There were 57 patients included in the study. The overall recurrence rate was 7.2 per cent; however, all recurrences were early and were likely technical failures. The average duration of follow-up was 30.6 months with no further recurrences after the early technical failures. The average number of previous recurrences was 1.5. Fascial closure was obtained over the mesh in 84 per cent of patients, with component separation being necessary in 36 per cent of patients. Lack of fascial reapproximation over the mesh was associated with early recurrence (0 vs 55%, P < 0.0001). Complex ventral hernias can be repaired with a low recurrence rate. Our technique in combination with the XenMatrix biologic mesh provides for durable repair. Whenever possible, the fascia should be closed above the underlay mesh, because this technique provides a more durable repair than using the mesh as a "fascial bridge". PMID:21337869
Byrnes, Matthew C; Irwin, Eric; Carlson, Dana; Campeau, Amy; Gipson, Jonathon C; Beal, Alan; Croston, J Kevin
The use of biomaterial meshes in the repair of incisional abdominal wall hernias is now widely accepted internationally. The introduction of synthetic meshes to achieve tension-free repair has led to a satisfactory reduction in the recurrence rate to less than 10%. However, the use of such biomaterials can result in the occurrence of undesirable complications such as increased risk of infection, seromas, restriction of the abdominal wall and failure caused by mesh shrinkage. Additionally, at the time of writing there is much discussion concerning the potential risk of a persistent foreign body reaction directly associated with the meshes with regard to possible malignant transformation. As such, the trend seems to be toward the use of lighter meshes utilizing less non-absorbable material. One particular novel mesh theoretically capable of guaranteeing the necessary mechanical stability uses 70% less biomaterial. Against this background, we report a central mesh recurrence through the mesh following incisional hernia repair with a Marlex mesh. To our knowledge, this is the first description of a central mesh recurrence, and we discuss a possible mechanism with particular emphasis on the required abdominal wall forces both physiologically and after incisional hernia repair. PMID:11759806
Langer, C; Neufang, T; Kley, C; Liersch, T; Becker, H
This prospective study was conducted at a tertiary care teaching hospital in South India over a period of 7 years and included 90 patients with incisional hernia (n?=?90; 76 females and 14 males), operated over 2 years (January 2004 to December 2005), and followed-up for 5 years postoperatively (2005-2009). As per the surgical unit preference, patients underwent different methods of hernia repair-onlay mesh repair (n?=?45, 50 %), underlay mesh repair (n?=?18, 20 %), and anatomical repair (i.e., without mesh) (n?=?27, 30 %). Parameters studied included seroma formation, wound infection, postoperative pain, and hernia recurrence. Although the first two parameters were statistically not significant, postoperative pain was found to be more in patients who underwent an underlay repair. A significant difference in the hernia recurrence rate was observed between mesh repair and anatomical repair groups. Hence, we conclude that all incisional hernias should be repaired with a mesh (meshplasty). PMID:24426451
Kumar, Vikram; Rodrigues, Gabriel; Ravi, Chandni; Kumar, Sampath
The present study has been designed to compare the intensity of postoperative pain in children by wound infiltration with levobupivacaine with that provided by paracetamol administration per rectaly. This intervention study was carried out at the department of paediatric surgery, Mymensingh Medical College Hospital, Mymensingh and Dhaka Medical College Hospital, Dhaka, during the period of January 2009 to September 2010. A total of 120 patients were included in this study. Among them 60 patients in Group A (study group) where post incisional wound infiltration with levobupivacain after inguinal herniotomy before skin closure was done and 60 patients in Group B (control group) where paracetamol was given per rectally after induction of anaesthesia. Both groups were followed up post operatively for 23 hours. The intensity of post operative pain relief following inguinal hernia repair in children by wound infiltration with levobupivacaine is significantly higher than rectal administration of paracetamol. PMID:22828535
Bari, M S; Haque, N; Talukder, S A; Chowdhury, L H; Islam, M A; Zahid, M K; Hassanuzzaman, S M; Alam, M M
INTRODUCTION Bochdalek's diaphragmatic hernia (BDH) rarely developed symptomatic in adulthood but mostly required an operation. In adult BDH cases, long-term residing of the massive intraabdominal organs in the thoracic cavity passively causes loss of domain for abdominal organs (LOD). PRESENTATION OF CASE A 63-year-old man presented at our institution complaining of sudden left upper quadrant abdominal pain. Chest radiography showed a hyperdense lesion containing bowel gas in the left pleural space. Computed tomography revealed a dilated bowel above the diaphragm and intestinal obstruction suggestive of gangrenous changes. These findings were consistent with the diagnosis of incarcerated BDH and an emergency laparotomy was performed. Operative findings revealed the hypoplastic lung, lack of hernia sac, and location of the diaphragmatic defect, which indicated that his hernia was true congenital. Organs were reduced into the abdominal cavity, and large defect of the diaphragm was repaired with combination of direct vascular closure and intraperitoneal onlay mesh reinforcement using with expanded polytetrafluoroethylene (ePTFE) mesh. On the postoperative day 1, the patient fell into the shock and was diagnosed to have abdominal compartment syndrome (ACS). Conservative therapies were administered, but resulted in gastropleural fistula and pleural empyema, which required an emergency surgery. Mesh extraction and fistulectomy were performed. DISCUSSION A PubMed search for the case of ACS after repair of the adult BDH revealed only three cases, making this very rare condition. CONCLUSION In dealing with adult BDH, possible post-repair ACS should be considered.
Suzuki, Toshiaki; Okamoto, Tomoyoshi; Hanyu, Ken; Suwa, Katsuhito; Ashizuka, Shuichi; Yanaga, Katsuhiko
Ureterosciatic hernia (USH) is a rarely described entity and is an extremely rare cause of refractory flank pain. We report the diagnostic dilemma, and sequential endourological and finally the successful robotic management of one such symptomatic USH in an elderly woman who had presented with ipsilateral refractory flank pain, hydroureteronephrosis, and compromised renal function. We have also reviewed the current literature regarding the etiopathogenesis, presentation, diagnosis, and management of USHs. To the best of our knowledge, this is the first such case to describe the robotic-assisted laparoscopic management of a case of USH.
Singh, Iqbal; Patel, Bhavin; Hemal, Ashok K.
. 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
Background Anchoring the mesh in laparoscopic totally extraperitoneal groin hernia repair (TEP) with human fibrin glue has theoretical\\u000a advantages. However, these have been supported and reported previously only in animal studies. Before the initiation of large\\u000a patient trials, the authors wanted to confirm the feasibility, assess the costs, and rule out any flagrant short- and long-term\\u000a adverse effects of fibrin glue
B. Novik; S. Hagedorn; U.-B. Mörk; K. Dahlin; S. Skullman; J. Dalenbäck
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
Laparoscopic ventral hernia repair (LVHR) is now widely performed. One of the most common complications of this procedure is seroma. Most seromas usually form anterior to the mesh and resolve with conservative management. In rare cases, some patients develop a pseudoneoperitoneum deep to the mesh which actively secretes fluid, forming a collection. We present a group of seven patients with persistent seroma posterior to the mesh and a possible treatment algorithm. PMID:18259834
Tsereteli, Z; Ramshaw, B; Ramaswamy, A
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
Laparoscopic ventral hernia repair (LVHR) is now widely performed. One of the most common complications of this procedure\\u000a is seroma. Most seromas usually form anterior to the mesh and resolve with conservative management. In rare cases, some patients\\u000a develop a pseudoneoperitoneum deep to the mesh which actively secretes fluid, forming a collection. We present a group of\\u000a seven patients with
Z. Tsereteli; B. Ramshaw; A. Ramaswamy
Chylothorax is a recognized cause of morbidity after repair of congenital diaphragmatic hernia (CDH). Management may include prolonged hospitalization with cessation of enteral feedings, repeated aspiration, chest tube drainage, total parenteral nutrition, and introduction of a medium chain triglyceride (MCT) diet as the effusion resolves. The authors report that the successful deployment of octreotide, a somatostatin analogue, hastened resolution of a postoperative chylothorax in a newborn infant with CDH. PMID:12891519
Goyal, Anju; Smith, Nicola P; Jesudason, Edwin C; Kerr, Steve; Losty, Paul D
Background: The aim was to determine whether systemic antibiotic prophylaxis prevented wound infection after of abdominal wall hernia with mesh. Method: This was a systematic review of the available literature identified from multiple database using the terms 'hernia' and 'antibiotic prophylaxis'. Randomized placebo-controlled trials of antibiotic prophylaxis in abdominal wall mesh hernia repair with explicitly defined wound infection criteria and
T. J. Aufenacker; M. J. W. Koelemay; D. J. Gouma; M. P. Simons
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
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.
Purpose: The aim of this study was to document the authors' experience with laparoscopy in the treatment of inguinal hernia in girls and boys. Methods: The internal inguinal ring was closed with 1 or 2 stitches of 4-0 monofilamentous material. Two 2-mm needle holders were inserted through the inferolateral abdominal wall. The laparoscope was advanced through the umbilicus. A total
Aim The aim of this retrospective study is to compare the immediate and long-term postoperative outcomes of Lichtenstein and Kugel repair of inguinal hernia. Methods From 1996 to 2006, 219 consecutive patients underwent inguinal hernia repair - 92 using a standard Lichtenstein repair and 127 with a Kugel patch. Patient characteristics, length of postoperative hospital stay and complication rates were assessed by retrospective review of the notes. Recurrence and chronic groin pain were assessed by postal questionnaire (with a follow up by telephone interview for non-responders). Patients with symptoms or an apparent groin swelling were reassessed by one of the authors (BD). Results There were 214 men and 5 women. Patients ranged from 18 to 87 years of age (mean 54 years). Seventy two percent of postal questionnaires were returned. Following telephone calls the overall response rate was 80%. The mean follow up period was 60 months (range: 9 – 132 months). Immediate complications were similar in both groups. The recurrence rates were 1.1% for Lichtenstein repair and 6.3% for Kugel patch (p= 0.09). None of the patients in the Lichtenstein group and 1.6% of patients in Kugel patch group complained of severe chronic pain in inguinal region. Conclusion There was no significant difference in the immediate complication rates between the two groups. Although recurrence and chronic groin pain rates are higher with Kugel repair, this was not statistically significant.
Dasari, Bobby; Grant, Lorraine; Irwin, Terry
Background Biologic grafts used in ventral hernia repair are derived from various sources and undergo different post-tissue-harvesting processing, handling, and sterilization techniques. It is unclear how these various characteristics impact graft response in the setting of contamination. We evaluated four materials in an infected hernia repair animal model using fluorescence imaging and quantitative culture studies. Methods One hundred seven rats underwent creation of a chronic hernia. They were then repaired with one synthetic polyester control material (n = 12) and four different biologic grafts (n = 24 per material). Biologic grafts evaluated included Surgisis (porcine small intestinal submucosa), Permacol (crosslinked porcine dermis), Xenmatrix (noncrosslinked porcine dermis), and Strattice (noncrosslinked porcine dermis). Half of the repairs in each group were inoculated with Staphylococcus aureus at 104 CFU/ml and survived for 30 days without systemic antibiotics. Animals then underwent fluorescence imaging and quantitative bacterial studies. Results All clean repairs remained sterile. Rates of bacterial clearance were as follows: polyester synthetic 0%, Surgisis 58%, Permacol 67%, Xenmatrix 75%, and Strattice 92% (P = 0.003). Quantitative bacterial counts had a similar trend in bacterial clearance: polyester synthetic 1 × 106 CFU/g, Surgisis 4.3 × 105 CFU/g, Permacol 1.7 × 103 CFU/g, Xenmatrix 46 CFU/g, and Strattice 31 CFU/g (P = 0.001). Fluorescence imaging was unable to detect low bacterial fluorescence counts observed on bacterial studies. Conclusion Biologic grafts, in comparison to synthetic material, are able to clear a Staphylococcus aureus contamination; however, they are able to do so at different rates. Bacterial clearance correlated to the level of residual bacterial burden observed in our study. Post-tissue-harvesting processing, handling, and sterilization techniques may contribute to this observed difference in ability to clear bacteria.
Harth, K. C.; Broome, A.-M.; Jacobs, M. R.; Blatnik, J. A.; Zeinali, F.; Bajaksouzian, S.
Congenital lumbar hernia (CLH) is a rare anomaly with only 45 cases reported in the English-language literature. This paper describes nine patients with CLH treated in our unit. Unusual features included the relatively high incidence of inferior lumbar hernia, presentation at the age of 6 years in one case, and an association with hydrometrocolpos and anorectal malformation, which is hitherto unreported. In seven patients the hernia could be repaired successfully. One patients' parents refused surgery for the CLH after treatment of a hydrometrocolpos and another died of fulminant pneumonia before the operation. Early operation is the treatment of choice, and repair with local tissues is preferable. The need for prosthetic material arises when the size of the defect is large. A successful operation offers a good quality of life. PMID:10663870
Wakhlu, A; Wakhlu, A K
Summary In the last 10 years, in Italy a rapid evolution has occurred from the “traditional” herniorraphies (Bassini, Shouldice) toward\\u000a prosthetic techniques and outpatient procedures under local anesthesia are now most commonly preferred. Since october 1992\\u000a we have adopted a personal modification of the sutureless mesh repair, which we call held in mesh repair. Basic steps of this\\u000a technique are: the
F. Corcione; G. Cristinzio; M. Maresca; U. Cascone; G. Titolo; G. Califano
. To solve the problem of limited abdominal cavity in cases of giant inguino-scrotal hernias, a new technique is described,\\u000a aiming, while repairing the hernia, to provide a larger abdominal cavity into which the hernial contents can be replaced without\\u000a compromising respiratory and cardiac functions.The idea of this technique is to create a midline abdominal wall defect to\\u000a increase the
N. I. EL-Dessouki
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
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.
Eriksen, MH; Bulut, O
A minimally invasive component separation may lead to a dynamic abdominal wall after hernia repair, with reduced complications. We present early results of our patients undergoing this technique. Five patients were selected for open midline repairs; three with chronic infections, one with a prior midline skin graft, and one who desired a primary, tension-free repair. These three males and two females had a mean age of 50.8 +/- 21.1 years and body mass index of 30.9 +/- 6.2. The mean number of previous abdominal operations was 7 +/- 3.4 and previous attempted hernia repairs were 4 +/- 2.7. All patients had a midline laparotomy with lysis of adhesions. An endoscopic component separation was then performed bilaterally. Drains were left in the dissection bed. All patients had the midline closed; four received biologic mesh underlays. Mean operative time was 227 minutes +/- 49. Mean length of stay (LOS) was 9.2 days +/- 3.6. Early median follow-up was 6 months (range 0.25-9). Two patients required postop transfusions, and two patients had mild complications of the midline wound (hematoma, infection). To date, one recurrence was diagnosed by CT scan. Early evaluation of adopting the minimally invasive (MIS) component separation demonstrates minimal complications and good initial outcomes. PMID:19655600
Bachman, Sharon L; Ramaswamy, Archana; Ramshaw, Bruce J
The formation of an appendico-cutaneous fistula is rare. Few case reports have been published; most describe the formation of a fistula after appendicitis. Here we describe the case of a 79-year-old woman presenting with an appendico-cutaneous fistula after groin hernia repair. She was referred to our outpatient department with a painful mass in the right groin. An ultrasound showed a fluid containing mass. Incision and drainage was performed. After 9 weeks she was referred again with a persisting open wound. Fistulogram and CT scan showed a fistuleous tract involving the appendix. Wound culture showed Escherichia coli. Diagnostic laparoscopy showed an appendix stuck to the ventral wall of the abdomen without any sign of previous infection. After an appendectomy, pathological investigation revealed an appendix sana. After operation, the fistula persisted due to a polypropylene plug from the previous groin hernia correction. The (infected) plug was removed and the fistula healed. PMID:23921697
Wijers, Olivier; Conijn, Anne; Wiese, Hans; Sjer, Mike
\\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
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.
Satishkumar, Rohan; Sankar, Sriram; Yurko, Yuliya; Lincourt, Amy; Shipp, John; Heniford, B. Todd; Vertegel, Alexey
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
Prolene (polypropylene) mesh is a useful material for technically difficult repairs of abdominal wall hernias. In this study, two insertion techniques were used and compared. The first method, in which 2-cm wide strips of mesh were cut perpendicular to the main part, pulled through the musculoperitoneal layer and anchored to the anterior fascial layer, was abandoned after use in 10 patients because of complications. The second method, using circumferential horizontal mattress sutures to anchor the mesh, gave satisfactory results in the 40 patients in whom it was used. There were no deaths, and complications were few and easily dealt with. PMID:6704821
McDonald, S; Gagic, N
Introduction Paraesophageal hernia (PEH) repair is a technically challenging operation. These patients are typically older and have more\\u000a co-morbidities than patients undergoing anti-reflux operations for gastroesophageal reflux disease (GERD), and these factors\\u000a are usually cited as the reason for worse outcomes for PEH patients. Clinically, it would be useful to identify potentially\\u000a modifiable variables leading to improved outcomes.\\u000a \\u000a \\u000a \\u000a Methods We performed a
Anirban Gupta; David Chang; Kimberley E. Steele; Michael A. Schweitzer; Jerome Lyn-Sue; Anne O. Lidor
Purpose The aim of this study was to identify potential parameters as predictors for seroma formation after incisional hernia mesh\\u000a repair.\\u000a \\u000a \\u000a \\u000a \\u000a Methods The incidence of postoperative seroma was determined prospectively in 37 patients who underwent incisional hernia repair with\\u000a lightweight polypropylene-polyglactin composite mesh (Vypro-II®). Postoperative seroma manifestation was related to patient characteristics (gender, age, BMI, comorbidity, nicotine abuse)\\u000a and to preoperative serum
C. D. Klink; M. Binnebösel; A. H. Lucas; A. Schachtrupp; J. Grommes; J. Conze; U. Klinge; U. Neumann; K. Junge
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.
Pott, Peter P.; Schwarz, Markus L. R.; Gundling, Ralf; Nowak, Kai; Hohenberger, Peter; Roessner, Eric D.
Introduction: Adhesion formation following abdominal wall hernia repair with prosthetic mesh may lead to intestinal obstruction and enterocutaneous fistula. Physical barriers, namely, human amniotic membrane (HAM) or Seprafilm (Genzyme, Cambridge, Mass., USA), a bio-absorbable, translucent membrane composed of carboxymethylcellulose and hyaluronic acid, have been reported to prevent postsurgical intra-abdominal adhesions. Objective: Evaluating the effect of HAM and Seprafilm in preventing
A. Szabo; M. Haj; I. Waxsman; A. Eitan
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
Background The objective of the study was to reassess the efficacy of the open onlay technique for repair of major incisional hernias,\\u000a utilizing the modern adjuncts of components separation and fibrin sealant to reduce the principal complications of seroma\\u000a and recurrence. Major incisional hernias were defined as >10 cm transverse diameter.\\u000a \\u000a \\u000a \\u000a Methods A prospective audit was applied to 116 patients undergoing open
Andrew N. Kingsnorth; M. Kamran Shahid; Aby J. Valliattu; Robert A. Hadden; Christine S. Porter
Introduction. In adipose tissue healing, angiogenesis is stimulated by adipose-derived stromal stem cells (ASCs). Ventral hernia repair (VHR) patients are at high risk for wound infections. We hypothesize that ASCs from VHR patients are less vasculogenic than ASCs from healthy controls. Methods. ASCs were harvested from the subcutaneous fat of patients undergoing VHR by the component separation technique and from matched abdominoplasty patients. RNA and protein were harvested on culture days 0 and 3. Both groups of ASCs were subjected to hypoxic conditions for 12 and 24 hours. RNA was analyzed using qRT-PCR, and protein was used for western blotting. ASCs were also grown in Matrigel under hypoxic conditions and assayed for tubule formation after 24 hours. Results. Hernia patient ASCs demonstrated decreased levels of VEGF-A protein and vasculogenic RNA at 3 days of growth in differentiation media. There were also decreases in VEGF-A protein and vasculogenic RNA after growth in hypoxic conditions compared to control ASCs. After 24 hours in hypoxia, VHR ASCs formed fewer tubules in Matrigel than in control patient ASCs. Conclusion. ASCs derived from VHR patients appear to express fewer vasculogenic markers and form fewer tubules in Matrigel than ASCs from abdominoplasty patients, suggesting decreased vasculogenic activity. PMID:24757684
Lisiecki, Jeffrey; Rinkinen, Jacob; Eboda, Oluwatobi; Peterson, Jonathan; De La Rosa, Sara; Agarwal, Shailesh; Dimick, Justin; Varban, Oliver A; Cederna, Paul S; Wang, Stewart C; Levi, Benjamin
Introduction De Garengeot first described the presence of the appendix within a femoral hernia in 1731. Case presentation We report the case of a 66-year-old Caucasian woman who presented with acute appendicitis within an incarcerated femoral hernia. This is the first reported case of de Garengeot's hernia in the Balkan area. Conclusions Appropriate management without incurring any delay for radiological imaging can be promising for an uneventful postoperative course. The treatment of choice of this disease entity is emergency surgery and consists in simultaneous appendectomy through the hernia incision and primary hernia repair. In patients with large hernia defects or in older people the use of mesh for repairing the hernia defect can be an excellent choice.
During laparoscopic repair of ventral hernia, optimal fixation of the prosthetic mesh to the abdominal wall includes transfascial fixation with sutures in addition to fixation with a stapling, clipping, or tacking device. With the current methods, intracorporeal passage grasping and retrieval of sutures from the abdominal cavity are technically difficult. The reason for this difficulty is the lack of three-dimensional visual feedback during conventional laparoscopy. An easier method is needed. A new method using T-shaped anchors (T-anchors) is described. A T-anchor is a horizontal bar made of rigid titanium that is attached to a vertical limb made of monofilament suture. T-anchors are deployed in pairs, through a needle, and are tied over a musculofascial bridge to achieve transfascial fixation of the mesh to the abdominal wall. This method eliminates the need for intracorporeal grasping and retrieval of the sutures. PMID:16034505
Kumar, S S
The article presents an experience with application of tension-free plasty of the anterior abdominal wall using reticular endoprostheses. New endoprostheses of Reperen are developed and applied, a method of sutureless fixation of polypropylene net in the abdominal wall tissues is proposed when performing plasty for great ventral hernias. Advantages of new methods are shown compared with analogs both in selective and in emergency surgery, in different age groups of patients. The direct and long-term postoperative results and parameters of quality of life are investigated. PMID:21137266
Parshikov, V V; Medvedev, A P; Samsonov, A A; Romanov, R V; Samsonov, A V; Gradusov, V P; Petrov, V V; Khodak, V A; Baburin, A B
A 79-year-old woman presented with a huge, asymptomatic, balloon-like abdomen, which gradually developed after polypropylene mesh repair of an incisional hernia following a median laparotomy. Additional CT showed a huge cyst measuring 20 x 24 cm which seemed to originate from the anterior abdominal wall and lacked communication with the inner abdominal space. Subsequently an explorative laparotomy was performed. The content of the cyst consisted of dark brown serosanguineous material. The inferior portion was firmly affixed to the mesh. The entire cyst, except for the part fixed to the mesh, was excised followed by an abdominoplasty. Histological examination showed aspecific signs of inflammation due to a foreign body, and haemorrhagic material without epithelial lining. The diagnosis 'giant pseudocyst' was established. Etiologically, this condition is probably related to postoperative formation of a seroma, which is a well-known complication after mesh repair, especially when a polypropylene mesh is used. Postoperative formation of a haematoma might be a causative factor as well. Former literature reports 11 cases of such giant cyst formation after mesh repair ofhernias. In one study a prevalence of 0.45% is mentioned. This complication may be an underreported phenomenon. PMID:18320949
Hoefkens, M F; Vles, W J
Background The ultrasound-guided transverse abdominis plane block (TAPB) reduces postoperative pain after laparoscopic abdominal surgery. But, its effect post laparoscopic totally extraperitoneal hernia repair (TEP) is not clear. In this study, we evaluated the analgesic effect of ultrasound-guided TAPB in TEP. Methods In this prospective, randomized study, forty adult patients (ASA I-II) scheduled for a TEP under general anesthesia were studied. In the TAPB group (n = 20), an ultrasound-guided bilateral TAPB was performed with 0.375% ropivacaine 15 ml on each side after the induction of general anesthesia. The control group (n = 20) did not have TAPB performed. Fentanyl 50 µg was repeatedly injected as per the patient's request in the recovery room. Pain scores at rest and on coughing were assessed postoperatively in the recovery room (20 min, at discharge) and at 4, 8, and 24 hours after surgery. Results In the recovery room, pain scores (numeric rating scale, 0-10) at postoperative 20 min were lower in the TAPB group (3.9 ± 1.6, 4.9 ± 1.8) than the control group (6.9 ± 1.6, 8.0 ± 1.6) at rest and on coughing. Also, pain scores upon discharge from the recovery room were lower in the TAPB group (3.2 ± 1.2, 4.2 ± 1.5) than the control group (5.3 ± 1.6, 6.5 ± 1.8) at rest and on coughing. Conclusions The ultrasound-guided TAPB in patients that had undergone TEP reduced postoperative pain scores and the fentanyl requirement in the recovery room. Also, pain scores on coughing were reduced until postoperative 8 hours.
Kim, Mun Gyu; Ok, Si Young; Kim, Sang Ho; Lee, Se-Jin; Park, Sun-Young; Lee, Su Myung; Jung, Bo-Il
An 80-year-old woman presented to the emergency department with failure to thrive and weakness for 14 days. Medical history was significant for polio. On admission her electrocardiogram showed atrial flutter, and cardiac enzymes were elevated. Echocardiogram revealed a high pulmonary artery pressure, but no other wall motion abnormalities or valvulopathies. Chest x-ray showed a large lucency likely representing a diaphragmatic hernia. Computed tomographic scan confirmed the hernia. Our patient remained in atrial flutter despite rate control, and thereafter surgery was consulted to evaluate the patient. She underwent hernia repair. After surgery, the patient was taken off rate control and monitored for 72 hours; she did not have any episode of atrial flutter and was discharged with follow up in a week showing no arrhythmia. Her flutter was caused directly by the mechanical effect of the large hiatal hernia pressing against her heart, as the flutter resolved after the operation. PMID:24238486
Patel, Arpan; Shah, Rushikesh; Nadavaram, Sravanthi; Aggarwal, Aakash
RESUMEN Presentamos dos pacientes con tratamiento laparoscópico de una hernia de Morgagni. Este es un defecto congénito en el diafragma anterior poco frecuente, que puede ser asintomático o causar síntomas dependiendo del contenido herniario. El tratamiento quirúrgico puede ser a cielo abierto por vía torácica o transabdominal, pero el abordaje laparoscópico también permite su reparación, tanto cuando es simple como
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Incisional hernias occur in up to 11 per cent of patients undergoing abdominal surgery. Up to 50 per cent of these patients with hernias will require repeat operative procedures. Management of these hernias have focused primarily on tensile strength of the mesh material, have not addressed currently used materials, and have not compared the strength of these repairs with each other. Forty-nine adult Sprague-Dawley rats had an incisional hernia created by removing a portion of their abdominal wall that was then repaired primarily, using either a composite mesh, Dual mesh (Gore-Tex), or polypropylene mesh. Six weeks after the repair, the rats were euthanized. Hydrostatic distension of the abdominal cavity was performed to compare bursting strength of each repair. Wound tensile strength was assessed and compared. Tissue samples were also taken to compare repair types for incorporation of prosthetic materials. The gross weight of the animals subjected to hydrostatic distention was equivalent between groups, as was the volume required prior to failure of the repair. There was a trend toward improved tensile strength of the Prolene mesh repair, which had a lower average inflammatory and fibrosis score on histology. Overall, the type of mesh used for repair does not seem to impact significantly the strength of the repair when assessed 6 weeks postoperatively. Choice of prosthetic material to repair the hernia should be made based on economics and handling characteristics alone. Prolene mesh has satisfactory strength with the least amount of inflammation and fibrosis. PMID:17674950
Lucha, Paul A; Briscoe, Crystal; Brar, Harpreet; Schneider, James J; Butler, Ralph E; Jaklic, Beth; Francis, Michael
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
Giant pseudocyst formation of the anterior abdominal wall, following on-lay polypropylene mesh repair for incisional hernia is an under reported complication. We report an unusual case of a 56-year-old female who underwent a polypropylene mesh repair of incisional hernia 2 years back. Subsequently she developed a giant pseudocyst of the anterior abdominal wall, which was occupying the whole of the abdomen from the xiphisternum to the pubic bone, and over both the flanks. Over a period of one year, the cyst had defied multiple attempts at aspiration. The patient underwent a laparoscopic drainage of the collection with piecemeal excision of the entire cyst wall. Histopathology of the cyst wall revealed necrotic material with intervening areas of hemorrhage. No epithelial lining was seen. There has been no recurrence in the two years of follow-up. Conclusion: giant pseudocyst of the anterior abdominal wall is a rare complication following mesh repair of an incisional hernia. Such pseudocysts can be managed successfully by laparoscopic procedures. PMID:16136392
Mehrotra, Prateek K; Ramachandran, C S; Goel, Deep; Arora, Vijay
Chylothorax, a known complication of surgery for Congenital Diaphragmatic hernia, can sometimes be resistant to treat. Octeriotide (Somatostatin analogue) can be useful in this situation. However, the dose and schedule of Octeriotide therapy in neonates is not well established. We report two cases of resistant chylothorax following surgery for congenital diaphragmatic hernia which were successfully managed by using an escalating infusion of octeriotide. The literature on the subject is also reviewed.
Jarir, Rawia A.; Rahman, Sajjad ur; Bassiouny, Ibrahim El Sayed
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.
Katkhouda, Namir; Mavor, Eli; Friedlander, Melanie H.; Mason, Rodney J.; Kiyabu, Milton; Grant, Steven W.; Achanta, Kranti; Kirkman, Erlinda L.; Narayanan, Krishna; Essani, Rahila
Lumbar hernias, namely transiliac hernias, are not frequent events and are almost always associated with bone graft harvesting from the iliac crest. We describe a case of transiliac hernia 10 years after bone graft harvest, the patient presenting with right colon incarceration. Diagnosis was made by CT scan. The hernia was repaired with a composite polypropylene-PTFE mesh (Bard(®)). PMID:24269126
Kunin, N; Gancel, C-H; Foret, A; Gayet, C; Letoquart, J-P; Daaboul, M
Introduction Frequent complications in incisional hernia surgery are re-herniation, wound infection and seroma formation. The use of subatmospheric\\u000a pressure dressings such as the vacuum-assisted closure (VAC) device has been shown to be an effective way to accelerate healing\\u000a of various wounds. Here, we describe the application of the VAC device as a postoperative dressing to prevent seroma formation\\u000a after open incisional
M. López-Cano; M. Armengol-Carrasco
Background Biologic implants have been recommended for reinforcement in routine and challenging hernia repair. However, experimental\\u000a and clinical studies have reported adverse effects (e.g., slow implant integration and pronounced foreign body reaction).\\u000a To evaluate the impact of different material processing methods (cross-linking vs. non-cross-linking of collagen) and implant\\u000a design, four different biologic hernia implants were compared directly in experimental intraperitoneal onlay
A. H. Petter-Puchner; R. H. Fortelny; K. Silic; J. Brand; S. Gruber-Blum; H. Redl
The purpose of the current prospective study was to confirm the results of our previous study on the use of the Ventralight™ ST mesh. In this study we also evaluated a pre-attached positioning system. Between July 2011 and October 2013 prospectively collected data of 61 consecutive patients who underwent a laparoscopic ventral hernia repair were analyzed. Short- and long-term outcomes were described. A total of 61 patients were treated in this period (men/women ratio 44/17). Overall median follow-up was 7 months (range 2-29). There were 30 patients with a follow-up of at least 12 months. Mean hernia diameter was 6 x 5 cm (craniocaudal x laterolateral) (range 1.5 x 1.5 to 20 x 15 cm). Overall mean length of hospital stay was 4.4 days. Postoperative visual analog scale (VAS) at last follow-up was significantly lower than the preoperative VAS (3.01 vs 0.68; P = 0.011) There were no intraoperative complications. In the whole group, only 6 patients (10%) showed minor complications. Four patients had mild discomfort, another 2 patients developed a clinically significant seroma. The complication rate in the subgroup with a follow-up of at least 1 year was 13%. No recurrences were observed. This study confirms our preliminary findings on the use of this mesh. The optional positioning system offers a significantly more quick and proper mesh positioning. PMID:24574018
Tollens, Tim; Topal, Halit; Vermeiren, Koen; Aelvoet, Chris
Background An incisional hernia is a frequent complication of abdominal surgery. The repair of incisional hernias comes with a high risk\\u000a of reherniation and serious complications. With the introduction of mesh repair, recurrence rates have decreased and subsequent\\u000a clinical outcomes have improved. Whereas further research needs to be done to improve complication rates and recurrence, the\\u000a focus has now been placed
M. M. PoelmanJ; J. F. Schellekens; B. L. A. M. Langenhorst; W. H. Schreurs
Polypropylene mesh is widely used for the reconstruction of incisional hernias that cannot be closed primarily. Several techniques have been advocated to implant the mesh. The objective of this study was to evaluate, retrospectively, early and late results of three different techniques, onlay, inlay, and underlay. The records of 53 consecutive patients with a large midline incisional hernia — 25
T. S. de Vries Reilingh; D. van Geldere; BLAM Langenhorst; D. de Jong; G. J. van der Wilt; H. van Goor; R. P. Bleichrodt
INTRODUCTION Internal abdominal hernias are infrequent but an increasing cause of bowel obstruction still often underdiagnosed. Among adults its usual causes are congenital anomalies of intestinal rotation, postsurgical iatrogenic, trauma or infection diseases. PRESENTATION OF CASE We report the case of a 63-year-old woman with history of chronic constipation. The patient was hospitalized for two days with acute abdominal pain, abdominal distension and inability to eliminate flatus. The X-ray and abdominal computerized tomography scan (CT scan) showed signs of intestinal obstruction. Exploratory laparotomy performed revealed a trans-mesenteric hernia containing part of the transverse colon. The intestine was viable and resection was not necessary. Only the hernia was repaired. DISCUSSION Internal trans-mesenteric hernia constitutes a rare type of internal abdominal hernia, corresponding from 0.2 to 0.9% of bowel obstructions. This type carries a high risk of strangulation and even small hernias can be fatal. This complication is specially related to trans-mesenteric hernias as it tends to volvulize. Unfortunately, the clinical diagnosis is rather difficult. CONCLUSION Trans-mesenteric internal abdominal hernia may be asymptomatic for many years because of its nonspecific symptoms. The role of imaging test is relevant but still does not avoid the necessity of exploratory surgery when clinical features are uncertain.
Crispin-Trebejo, Brenda; Robles-Cuadros, Maria Cristina; Orendo-Velasquez, Edwin; Andrade, Felipe P.
Surgical procedures for hernia surgery are usually performed using prosthetic meshes. In spite of all the improvements in these biomaterials, the perfect match between the prosthesis and the implant site has not been achieved. Thus, new designs of surgical meshes are still being developed. Previous to implantation in humans, the validity of the meshes has to be addressed, and to date experimental studies have been the gold standard in testing and validating new implants. Nevertheless, these procedures involve long periods of time and are expensive. Thus, a computational framework for the simulation of prosthesis and surgical procedures may overcome some disadvantages of the experimental methods. The computational framework includes two computational models for designing and validating the behaviour of new meshes, respectively. Firstly, the beam model, which reproduces the exact geometry of the mesh, is set to design the weave and determine the stiffness of the surgical prosthesis. However, this implies a high computational cost whereas the membrane model, defined within the framework of the large deformation hyperelasticity, is a relatively inexpensive computational tool, which also enables a prosthesis to be included in more complex geometries such as human or animal bodies. PMID:23167618
Hernández-Gascón, B; Espés, N; Peña, E; Pascual, G; Bellón, J M; Calvo, B
. Laparoscopic repair of abdominal wall hernias has been introduced recently to treat both spontaneous and incisional hernias\\u000a with reported good results. In the Mafraq and Al Jaziera Hospitals in the United Arab Emirates, 18 patients have been treated\\u000a using the laparoscopic technique. These cases included 11 incisional hernias, 5 spontaneous paraumbilical hernias, and 2 combined\\u000a incisional and paraumbilical hernias.
Mesh hiatoplasty has been postulated to reduce recurrence rates, it is however prone to esophageal stricture, and early-term and mid-term dysphagia. The present meta-analysis was designed to compare the outcome between mesh-reinforced and primary hiatal hernia repair. The databases of Medline, EMBASE, and the Cochrane Library were searched; only randomized controlled trials entered the meta-analytical model. Anatomic recurrence documented by barium oesophagography was defined as the primary outcome endpoint. Three randomized controlled trials reporting the outcomes of 267 patients were identified. The follow-up period ranged between 6 and 12 months. The weighted mean recurrence rates after primary and mesh-reinforced hiatoplasty were 24.3% and 5.8%, respectively. Pooled analysis demonstrated increased risk of recurrence in primary hiatal closure (odds ratio, 4.2; 95% confidence interval, 1.8-9.5; P=0.001). Mesh-reinforced hiatal hernia repair is associated with an approximately 4-fold decreased risk of recurrence in comparison with simple repair. The long-term results of mesh-augmented hiatal closure remain to be investigated. PMID:23238375
Antoniou, Stavros A; Antoniou, George A; Koch, Oliver O; Pointner, Rudolph; Granderath, Frank A
The Rives repair for ventral/incisional (V/I) hernias involves sublay mesh placement requiring retrorectus dissection and transfascial stitches. Chevrel described a repair by onlaying mesh after a unique primary fascial closure. Although Chevrel fixated mesh to the anterior fascia with sutures, he used fibrin glue for fascial closure reinforcement. We describe an onlay technique with mesh fixated to the anterior fascia solely with fibrin glue without suture fixation. From January 2010 to January 2012, 50 patients underwent a V/I hernia onlay technique with fibrin glue mesh fixation. Records were reviewed for technical details, demographics, mesh characteristics, and postoperative outcomes. Primary fascial closure with interrupted permanent suture was done with or without myofascial advancement flaps. Onlay polypropylene mesh was placed providing 8 cm of overlap. Fibrin glue was applied over the prosthesis and subcutaneous drains were placed. Mean age was 62.4 years. Mean body mass index was 30.1 kg/m(2). Average mesh size was 14.5 cm × 19.1 cm. Mean operative time was 144.4 minutes (range, 38 to 316 minutes). Mean discharge was postoperative Day 2.9 (range, 0 to 15 days). Morbidity included eight seromas, one hematoma, and three wound infections. Seventeen patients required components separation. Mean follow-up was 19.5 months with no recurrences. This is the first series describing fibrin glue alone for mesh fixation for V/I hernia repair. It allows for immediate prosthesis fixation to the anterior fascia. Early results are promising. Potential advantages include less operative time, less technical difficulty, and less long-term pain. A prospective trial is needed to evaluate this approach. PMID:24165253
Stoikes, Nathaniel; Webb, David; Powell, Ben; Voeller, Guy
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.
Dabrowiecki, Stanislaw; Pierscinski, Stanislaw
Purpose Biologic meshes have unique physical properties as a result of manufacturing techniques such as decellularization, crosslinking, and sterilization. The purpose of this study is to directly compare the biocompatibility profiles of five different biologic meshes, AlloDerm® (non-crosslinked human dermal matrix), PeriGuard® (crosslinked bovine pericardium), Permacol® (crosslinked porcine dermal matrix), Strattice® (non-crosslinked porcine dermal matrix), and Veritas® (non-crosslinked bovine pericardium), using a porcine model of ventral hernia repair. Methods Full-thickness fascial defects were created in 20 Yucatan minipigs and repaired with the retromuscular placement of biologic mesh 3 weeks later. Animals were euthanized at 1 month and the repair sites were subjected to tensile testing and histologic analysis. Samples of unimplanted (de novo) meshes and native porcine abdominal wall were also analyzed for their mechanical properties. Results There were no significant differences in the bio-mechanical characteristics between any of the mesh-repaired sites at 1 month postimplantation or between the native porcine abdominal wall without implanted mesh and the mesh-repaired sites (P > 0.05 for all comparisons). Histologically, non-crosslinked materials exhibited greater cellular infiltration, extracellular matrix (ECM) deposition, and neovascularization compared to crosslinked meshes. Conclusions While crosslinking differentiates biologic meshes with regard to cellular infiltration, ECM deposition, scaffold degradation, and neovascularization, the integrity and strength of the repair site at 1 month is not significantly impacted by crosslinking or by the de novo strength/stiffness of the mesh.
Melman, L.; Jenkins, E. D.; Hamilton, N. A.; Bender, L. C.; Brodt, M. D.; Deeken, C. R.; Greco, S. C.; Frisella, M. M.; Matthews, B. D.
INTRODUCTION The NHS is required to collect data from patient reported outcome measures (PROMs) for inguinal hernia surgery. We explored the use of one such measure, the Carolinas Comfort Scale® (CCS), to compare long-term outcomes for patients who received two different types of mesh. The CCS questionnaire asks about mesh sensation, pain and movement limitations, and combines the answers into a total score. PATIENTS AND METHODS A total of 684 patients were treated between January 2007 and August 2008 and were followed up in November 2009. RESULTS Data on 215 patients who met the inclusion criteria were available (96 patients who received Surgipro™ mesh and 119 who received Parietene™ Progrip™ mesh). Recurrence rates were similar in the Surgipro™ group (2/96, 2.1%) and Progrip™ group (3/118, 2.5%) (Fisher's exact test = 1.0). Chronic pain occurred less frequently in the Surgipro™ group (11/95, 11.6%) than in the Progrip™ group (22/118, 18.6%) (p<0.157). Overall, 90% of CCS total scores indicated a good outcome (scores of 10 or less out of 115). A principal component analysis of the CCS found that responses clustered into two subscales: ‘mesh sensation’ and ‘pain+movement limitations’. The Progrip™ group had a slightly higher mesh sensation score (p<0.051) and similar pain+movement limitations scores (p<0.120). CONCLUSIONS In this study of quality of life outcomes related to different mesh types, the CCS subscales were more sensitive to differences in outcome than the total CCS score for the whole questionnaire. Future research should consider using the CCS subscales rather than the CCS total score.
Zaborszky, Andras; Gyanti, Rita; Barry, John A; Saxby, Brian K; Bhattacharya, Panchanan; Hasan, Fazal A
Background Chronic pain may be a long-term problem related to operative trauma and mesh material in Lichtenstein hernioplasty.\\u000a \\u000a \\u000a \\u000a Study design Inguinal hernioplasty was performed under local anesthesia in 228 patients (232 hernias) in day-case surgery by the same surgeon\\u000a and exactly by the same surgical technique. The patients were randomized to receive either a partly absorbable polypropylene–polyglactin\\u000a mesh (Vypro IIR 50 g\\/m2, 79
Incisional hernias represent one of the most frequent complications of abdominal surgery. The incidence is probably underestimated. The pathogenesis is complex and not fully understood, implying patient-related factors (i.e., collagen biochemistry, obesity, age) as well as technical factors, including, among others, wound infection, suture material, and types of incisions and closures. In this paper, the first of two, the authors
Elie Yahchouchy-Chouillard; Tamer Aura; Olivier Picone; Jean-Charles Etienne; Abe Fingerhut
BackgroundDiaphragmatic reconstruction remains a challenging problem. There is limited information concerning the use of small intestinal submucosa (SIS) in congenital diaphragmatic hernia repair. A canine model was used to evaluate the use of a SIS patch in diaphragmatic reconstruction.
John A. Sandoval; Derek Lou; Scott A. Engum; Lisa M. Fisher; Christine M. Bouchard; Mary M. Davis; Jay L. Grosfeld
Sacroperineal hernia is an uncommon complication following sacrectomy. We review previous techniques of repair and report a simple method of reconstructing the operative defect using polypropylene mesh. This case has been without complication or repeat herniation at six years follow-up. PMID:10983262
Lehto, S A; Vakharia, M R; Fernando, T L; Mohler, D G
Introduction: Adhesions to mesh/tacks in laparoscopic ventral hernia repair are often cited as reasons not to adopt its evidence-based superiority over conventional open methods. This pilot study assessed the occurrence of adhesions to full-sized Polypropylene and Gore-tex DualMesh Plus meshes and the possibility for adhesion prevention using fibrin sealant. Methods: Two 10-cm to 15-cm pieces of mesh were placed and fixed laparoscopically in pigs (25kg to 55kg). Group I: 2 animals with Polypropylene mesh on one side and DualMesh on other side. Group II: 2 animals with DualMesh on each side with fibrin sealant applied to the periphery of mesh and staples to one side. Group III: 1 animal with 2 pieces of Polypropylene mesh with fibrin sealant applied to the entire mesh. All animals underwent laparoscopy 3 months later to assess the extent of adhesions, and full-thickness specimens were removed for histological evaluation. Results: More Polypropylene mesh was involved in adhesions than DualMesh. However, with the DualMesh involved in adhesions, more of the surface area was involved in forming adhesions than with Polypropylene mesh. None of the implanted DualMesh had visceral adhesions, while 2 out of 3 Polypropylene meshes had adhesions to both the liver and spleen but none to the bowel. Implanted Polypropylene mesh with fibrin sealant had no adhesions. DualMesh had shrunk more significantly than Polypropylene mesh. Histological evaluation showed absence of acute inflammatory response, significantly more chronic inflammatory response to DualMesh compared to Polypropylene and complete mesothelialization with both meshes. There was extensive collagen deposition between Polypropylene mesh fibers, while fibrosis occurred on both sides of DualMesh with synovial metaplasia over its peritoneal surface akin to encapsulation. Conclusions: DualMesh caused fewer omental and visceral adhesions than Polypropylene mesh did. Fibrin sealant eliminated adhesions to DualMesh and prevented adhesions to Polypropylene mesh when applied over the entire surface. These results support our current use of DualMesh and fibrin sealant in LVHR.
Saliba, Lucia; Chandratnam, Edward; Turingan, Isidro; Hawthorne, Wayne
Lung hypoplasia is central to the poor prognosis of babies with congenital diaphragmatic hernia (CDH). Prolapse of abdominal organs through a diaphragmatic defect has traditionally been thought to impair lung growth by compression. The precise developmental biology of CDH remains unresolved. Refractory to fetal correction, lung hypoplasia in CDH may instead originate during embryogenesis and before visceral herniation. Resolving these conflicting hypotheses may lead to reappraisal of current clinical strategies. Genetic studies in murine models and the fruitfly, Drosophila melanogaster are elucidating the control of normal respiratory organogenesis. Branchless and breathless are Drosophila mutants lacking fibroblast growth factor (FGF) and its cognate receptor (FGFR), respectively. Sugarless and sulphateless mutants lack enzymes essential for heparan sulphate (HS) biosynthesis. Phenotypically, all these mutants share abrogated airway branching. Mammalian organ culture and transgenic models confirm the essential interaction of FGFs and HS during airway ramification. Embryonic airway development (branching morphogenesis) occurs in a defined spatiotemporal sequence. Unlike the surgically-created lamb model, the nitrofen rat model permits investigation of embryonic lung growth in CDH. Microdissecting embryonic lung primordia from the nitrofen CDH model and normal controls, we demonstrated that disruption of stereotyped airway branching correlates with and precedes subsequent CDH formation. To examine disturbed branching morphogenesis longitudinally, we characterised a system that preserves lung hypoplasia in organ culture. We tested FGFs and heparin (an HS analogue) as potential therapies on normal and hypoplastic lungs. Observing striking differences in morphological response to FGFs between normal and hypoplastic lung primordia, we postulated abnormalities of FGF/HS signalling in the embryonic CDH lung. Evaluating this hypothesis further, we examined effects of an HS-independent growth factor (epidermal growth factor, EGF) on hypoplastic lung development. Visible differences in morphological response indicate an intrinsic abnormality of hypoplastic lung primordia that may involve shared targets of FGFs and EGE. These studies indicate that lung hypoplasia precedes diaphragmatic hernia and may involve disturbances of mitogenic signalling pathways fundamental to embryonic lung development. What does this imply for human CDH? Fetal surgery may be 'too little, too late' to correct an established lung embryopathy. In utero growth factor therapy may permit antenatal lung rescue. Prevention of the birth defect by preconceptual prophylaxis may represent the ultimate solution. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 6
Jesudason, E. C.
One hundred consecutive recurrences following repair of inguinal hernias have been studied; 62 were direct, 30 indirect, 7 pantaloon and one a femoral hernia. Half the indirect recurrences occurred within a year of repair and probably represented failure to detect a small indirect sac. Later indirect recurrences probably represented failure to repair the internal ring. Nine of the direct hernias were medial funicular recurrences and represented failure to anchor the darn medially. The rest of the direct recurrences were attributable to tissue insufficiency and could probably have been averted by larger tissue bites. Recurrences following inguinal herniorrhaphy remain an all too common problem but can be reduced by meticulous surgical technique.
Cox, P. J.; Leach, R. D.; Ellis, Harold
Background\\/Purpose: Neonates with large congenital diaphragmatic hernias (CDH) require prosthetic patch closure of the defect because of the paucity of native diaphragmatic tissue. As the child grows, patch separation can occur necessitating reoperation. Use of vascularized autologous tissue may decrease the incidence of reherniation as tissue incorporation and growth may be improved. The authors report our early experience using a
R. M. Sydorak; W. Hoffman; H. Lee; C. D. Yingling; M. Longaker; J. Chang; B. Smith; M. R. Harrison; C. T. Albanese
Summary Several well tolerated materials are currently available for the treatment of hernias. Polyester (Dacron) and polypropylene (PPL) are currently the most frequently used materials. Experimental work has highlighted the biological response of laboratory animals treated with a range of prostheses. Authors agree that an inflammatory response rarely occurs, although materials generate a range of responses. In the years 1996–2000,
A. Coda; F. Botto-Micca; F. Quaglino; G. Ramellini
Background Laparoscopic ventral hernia repair (LVHR) for morbidly obese patients with a body mass index (BMI) exceeding 35 kg\\/m2 has not been well investigated.\\u000a \\u000a \\u000a \\u000a Methods Hernia recurrence was evaluated by surveillance computed tomography. A p value less than 0.05 was considered significant.\\u000a \\u000a \\u000a \\u000a Results Between 2003 and 2006, LVHR was attempted for 27 patients with a BMI exceeding 35 kg\\/m2. There was one conversion
I. Raftopoulos; A. P. Courcoulas
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
Early Postoperative and One Year Results of a Randomized Controlled Trial Comparing the Impact of Extralight Titanized Polypropylene Mesh and Traditional Heavyweight Polypropylene Mesh on Pain and Seroma Production in Laparoscopic Hernia Repair (TAPP)
Background Today the main goals of inguinal hernia repair are maximum postoperative comfort and a minimal rate of chronic pain. This\\u000a randomized trial compares these parameters after laparoscopic hernia repair (TAPP) using an extralight titanized polypropylene\\u000a mesh (ELW group) TiMesh® 16 g\\/m2 without any fixation with those using a standard heavyweight mesh (HW) Prolene 90 g\\/m2 fixed in a standardized way with two
R. Bittner; C.-G. Schmedt; B. J. Leibl; J. Schwarz
Diaphragmatic, lumbar, and extra-thoracic hernias are well-described complications of blunt trauma. However, in the absence of an immediate indication for surgery in the injured patient, early recognition of these hernias can be a diagnostic challenge and delayed presentation is common. Upon diagnosis, surgical repair is necessary secondary to the high morbidity and mortality associated with herniation and strangulation of abdominal organs. Surgical treatment of these hernias is evolving and a variety of options are available to the surgeon. This article will provide a historical overview of post-traumatic diaphragmatic and multi-cavity hernias, and a review of the literature addressing key issues of diagnosis and management. PMID:17939410
Crandall, Marie; Popowich, Daniel; Shapiro, Michael; West, Michael
Background High Frequency electrical Stimulation (HFS) of the skin induces enhanced brain responsiveness expressed as enhanced Event-Related Potential (ERP) N1 amplitude to stimuli applied to the surrounding unconditioned skin in healthy volunteers. The aim of the present study was to investigate whether this enhanced ERP N1 amplitude could be a potential marker for altered cortical sensory processing in patients with persistent pain after surgery. Materials and Methods Nineteen male patients; 9 with and 10 without persistent pain after inguinal hernia repair received HFS. Before, directly after and thirty minutes after HFS evoked potentials and the subjective pain intensity were measured in response to electric pain stimuli applied to the surrounding unconditioned skin. Results The results show that, thirty minutes after HFS, the ERP N1 amplitude observed at the conditioned arm was statistically significantly larger than the amplitude at the control arm across all patients. No statistically significant differences were observed regarding ERP N1 amplitude between patients with and without persistent pain. However, thirty minutes after HFS we did observe statistically significant differences of P2 amplitude at the conditioned arm between the two groups. The P2 amplitude decreased in comparison to baseline in the group of patients with pain. Conclusion The ERP N1 effect, induced after HFS, was not different between patients with vs. without persistent pain. The decreasing P2 amplitude was not observed in the patients without pain and also not in the previous healthy volunteer study and thus might be a marker for altered cortical sensory processing in patients with persistent pain after surgery.
van den Broeke, Emanuel N.; Koeslag, Lonneke; Arendsen, Laura J.; Nienhuijs, Simon W.; Rosman, Camiel; van Rijn, Clementina M.; Wilder-Smith, Oliver H. G.; van Goor, Harry
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.
Elliot, David; Giesen, Thomas
Purpose Following surgical repair of congenital diaphragmatic hernia (CDH), chylothorax can be present in 7–28% of the cases. It has\\u000a been associated with prenatal diagnosis, the use of ECMO and prosthetic patches during reparatory surgery. The objective is\\u000a to present a neonatal unit experience in handling this complication and the search for predictive factors for its appearance\\u000a in our patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods A
Alejandro Zavala; José-Manuel Campos; Cecilia Riutort; Ilona Skorin; Loreto Godoy; Miriam Faunes; Javier Kattan
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).
Coccygectomy is a rarely used treatment for coccygodynia because of its high failure rate and various complications, such as bowel herniation, as seen in our patient. The limited number of literature articles available on coccygectomy discussed the few successes but failed to mention the complications and treatment of such. As a result of coccygectomy, our patient suffered from bowel herniation, unsuccessfully treated twice with prosthetic mesh. Bilateral gluteus maximus muscle flaps plicated in the midline reduced our patient's hernia successfully. This procedure appears to be an effective treatment for this postcoccygectomy complication. PMID:9207665
Zook, N L; Zook, E G
Thoracoscopic repair is feasible and safe for congenital diaphragmatic hernia (CDH). The operation can be performed with three trocars using carbon dioxide insufflations at a pressure of 4-6 mmHG. From January 2001 to July 2012, we performed thoracoscopic repair for 311 children with CDH including 152 newborns and 159 infants and toddlers. Mean operative time was 75 ± 27 min. HFOV was used in 24 patients. Direct closure of two rims of diaphragmatic hernia was carried out in 175 patients. Closure of two rims of diaphragmatic hernia with the thoracic wall was performed in 136 patients. Prosthetic patches were required in 54 patients. Conversion to open surgery was required in 38 patients (12.2%). There were no intraoperative deaths. 38 patients died postoperatively (13.5%). PMID:23999906
Liem, Nguyen Thanh
The study assessed the need for revision surgery and the relating factors in alveolar cleft autogenous bone grafting in patients with complete cleft. It was a retrospective study carried out in 2009. The medical records of the 54 patients with alveolar cleft who underwent autogenous bone grafting in the maxillofacial department in Shariati Hospital from 2005 to 2008 were studied. The patients' age, sex, cleft type, age at palatal and alveolar clefts repair, tooth missing, surgery turn, and presence of orthodontic treatment were assessed. The patients' alveolar bone height was evaluated from their postoperative and follow-up panoramic radiographs. In general, 41% (n = 22) of patients needed revision surgery. Among all patients, 20 (37%) had secondary bone grafting and 34 (63%) had tertiary bone grafting. For 77% of the secondary unilateral clefts and 71% of bilateral ones, the remaining bone was at least three-fourths of the normal. Logistic regression model controlling for grafting time, surgery turn, orthodontic supervision, and age at palatal cleft closure showed that orthodontic treatment is associated with a lower need for revision surgery (odds ratio = 0.3; 95% confidence interval, 0.1-1.0). In conclusion, although alveolar cleft bone grafting is necessary for the reconstruction of the complete clefts, all these patients must be under the supervision of orthodontists to benefit from the surgical treatment. PMID:22421832
Shirani, Gholamreza; Abbasi, Amir Jalal; Mohebbi, Simin Zahra
Over half of the cases of congenital diaphragmatic hernia are picked up prenatally. Prenatal assessment aims to rule out associated anomalies and to make an individual prognosis. Prediction of outcome is based on measurements of lung size and vasculature as well as on liver herniation. A subset of fetuses likely to die in the postnatal period is eligible for a
Jan A. Deprest; Kypros Nicolaides; Eduard Gratacos
We describe an effective surgical technique in primary repair of the spinal dura during minimally invasive spine surgery (MISS). Objective. Minimally invasive spine surgery includes the treatment of intradural lesions, and proper closure of the dura is necessary. However, primary dural closure can be difficult due to the restricted space of MIS retractors and the availability of appropriate surgical instrumentation. Methods. We describe the use of a needle already used in the pediatric neurosurgical arena that can facilitate easier and safer closure of spinal dura through MISS retractors in two illustrative intradural cases. Results and Discussion. The primary dural closure technique is described and patient demographics are included. The instruments specifically used for the intradural closure through MIS retractor systems include (1) 4-0 Surgilon braided nylon (Covidien, Dublin, Ireland) with a CV-20 taper 1/2 circle, 10?mm diameter needle; (2) Scanlan (Saint Paul, MN, USA) dura closure set. Conclusion. Successful primary dural repair can be performed on primary and incidental durotomies during minimally invasive spinal surgery. We describe the novel use of a 10?mm diameter needle to help surgeons safely and efficiently close the dura with more ease than previously described.
Haque, Raqeeb M.; Hashmi, Sohaib Z.; Ahmed, Yousef; Ogden, Alfred T.; Fessler, Richard
Vascular injury as a complication of disc surgery was first reported in 1945 by Linton and White. It is a rare but potentially fatal complication. The high mortality rate (40–100%) is attributed to a combination of rapid blood loss and the failure to recognise the cause of the deteriorating patient. Early diagnosis and treatment is essential. Treatment has traditionally been by open vascular surgical repair, however with modern imaging and endovascular techniques, minimally invasive treatment should be considered first line in patients who are stable. We present the case of a 51-year-old woman who sustained common iliac artery injury during lumbar spinal surgery that was treated successfully using a covered stent.
Raja, J.; McFarland, R.; Belli, A. M.
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 extracorporeal membrane oxygenation (ECMO) invariably increased mortality. The authors reviewed the charts of 119 infants who had high-risk CDH treated between 1981 and 1994. They were divided into two groups: those that suffered cardiopulmonary arrest (CA, n = 21) before CDH repair or ECMO cannulation; and those that did not (NCA, N = 98). The authors compared mortality rate, ventilatory parameters, duration of, and complications on ECMO, as well as length of hospitalization between groups. Twenty-one infants suffered CA before initiation of ECMO support or CDH repair. Three infants (14%) suffered CA before arrival at our institution; seven (33%) after, and 11 (53%) both before and after arrival. There was no difference between the CA and NCA groups in terms of birth weight, gestational age, race and gender mix, or pregnancy and delivery complications. Five-minute Apgar scores were significantly lower in the CA group compared with the NCA group (4.6 v 5.7, P = .04). The CA group also had significantly worse "best postductal" blood gas and ventilatory parameters. There was no significant difference in length of hospitalization, time from admission to ECMO cannulation or CDH repair, or incidence of complications while on ECMO between the two groups. CA cases were more likely to require ECMO support (76% v 48%, P = .02) and to stay on ECMO for a more prolonged period than NCA cases (5.8 v 3.8 days, P = NS). However, there was no significant difference in overall survival between CA and NCA cases (43% v 51%, P = NS). Cardiopulmonary arrest before repair of CDH or ECMO cannulation is not a univariate independent predictor of mortality and therefore should not preclude these high-risk infants from maximum intensive care therapy, including ECMO cannulation. PMID:9247211
Courcoulas, A P; Reblock, K K; Rowe, M I; Ford, H R
This report presents the case of an 84-year-old woman who developed tetanus 3 days after the resection of a gangrenous small intestine caused by obturator hernia incarceration. The diagnosis of tetanus was clinically made after the appearance of generalized spastic contractions with opisthotonus. Clostridium tetani organisms residing in the gastrointestinal tract were presumed to have been endogenously inoculated into the strangulated intestine, where it produced tetanospasmin, causing tetanus. The patient successfully recovered after aggressive intensive care. There have been 16 case reports of tetanus occurring after gastrointestinal surgical procedures. Primary care physicians should thus be aware of the fact that, although extremely rare, C. tetani residing in the gastrointestinal tract can provide a possible endogenous source of tetanus infection. PMID:22037939
Mori, Mitsuo; Iida, Haruyasu; Miki, Keita; Tsugane, Eiji; Sasaki, Miwako; Nagayama, Rintaro; Noguchi, Takaaki; Manabe, Haruki; Ohta, Fumihito; Iimura, Yuzuru
An otherwise healthy 17-year-old boy presented to the paediatric emergency department with acute severe epigastric pain. An admission abdominal radiograph demonstrated gastric dilation, associated with an elevated left hemidiaphragm. Subsequent barium contrast imaging confirmed the diagnosis of organoaxial acute gastric volvulus (AGV). Emergent exploratory laparoscopy revealed AGV with migration of the stomach, spleen, pancreatic tail, splenic flexure, left kidney and adrenal through a left-sided Bochdalek diaphragmatic hernia. Following careful mobilisation of the displaced structures, a mesh closure of the diaphragmatic defect was performed. The patient's postoperative chest radiograph was unremarkable, and he was discharged on the sixth postoperative day after an uneventful recovery. At 2 months the patient was well and asymptomatic, with normal barium contrast imaging results. PMID:23519514
Hadjittofi, Christopher; Matter, Ibrahim; Eyal, Ori; Slijper, Nadav
Introduction The homeostatic intracellular repair response (HIR2) is an endogenous beneficial pathway that eliminates damaged mitochondria and dysfunctional proteins in response to stress. The underlying mechanism is adaptive autophagy. The purpose of this study was to determine whether the HIR2 response is activated in the heart in patients undergoing cardiac surgery and to assess whether it is associated with the duration of ischemic arrest and predicted surgical outcome. Methods Autophagy was assessed in 19 patients undergoing coronary artery bypass or valve surgery requiring cardiopulmonary bypass (CPB). Biopsies of the right atrial appendage obtained before initiation of CPB and after weaning from CPB were analyzed for autophagy by immunoblotting for LC3, Beclin-1, Atg5-12, and p62. Changes in p62, a marker of autophagic flux, were correlated with duration of ischemia and with the mortality/morbidity risk scores obtained from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (v2.73). Results Heart surgery was associated with a robust increase in autophagic flux indicated by depletion of LC3-I, LC3-II, Beclin-1, and Atg5-12; the magnitude of change for each of these factors correlated significantly with changes in the flux marker p62. Moreover, changes in p62 correlated directly with cross clamp time and inversely with the mortality/morbidity risk scores. Conclusion These findings are consistent with preclinical studies indicating that HIR2 is cardioprotective, and reveal that it is activated in patients in response to myocardial ischemic stress. Strategies designed to amplify HIR2 during conditions of cardiac stress may have therapeutic utility and represent an entirely new approach to myocardial protection in patients undergoing heart surgery.
Jahania, Salik M.; Sengstock, David; Vaitkevicius, Peter; Andres, Allen; Ito, Bruce R.; Gottlieb, Roberta A.; Mentzer, Robert M.
Biological meshes are biomaterials consisting of extracellular matrix that are used in surgery particularly for hernia treatment, thoracic wall reconstruction, or silicone implant-based breast reconstruction. We hypothesized that combination of extracellular matrices with autologous mesenchymal stem cells used for hernia repair would result in increased vascularization and increased strength of incorporation. We cultured autologous adipose-derived stem cells harvested from the inguinal region of Wistar rats on cross-linked and noncross-linked porcine extracellular matrices. In 24 Wistar rats, a standardized 2?×?4?cm fascial defect was created and repaired with either cross-linked or noncross-linked grafts enriched with stem cells. Non-MSC-enriched grafts were used as controls. The rats were sacrificed at 3 months of age. The specimens were examined for the strength of incorporation, vascularization, cell invasion, foreign body reaction, and capsule formation. Both materials showed cellular ingrowth and neovascularization. Comparison of both tested groups with the controls showed no significant differences in the capsule thickness, foreign body reaction, cellularization, or vascularization. The strength of incorporation of the stem cell-enriched cross-linked extracellular matrix specimens was higher than in acellular specimens, but this result was statistically nonsignificant. In the noncross-linked extracellular matrix, the strength of incorporation was significantly higher in the stem cell group than in the acellular group. Seeding of biological meshes with stem cells does not significantly contribute to their increased vascularization. In cross-linked materials, it does not ensure increased strength of incorporation, in contrast to noncross-linked materials. Owing to the fact that isolation and seeding of stem cells is a very complex procedure, we do not see sufficient benefits for its use in the clinical setting. PMID:24304366
Mestak, Ondrej; Matouskova, Eva; Spurkova, Zuzana; Benkova, Kamila; Vesely, Pavel; Mestak, Jan; Molitor, Martin; Pombinho, Antonio; Sukop, Andrej
In a large number of cases, post-traumatic diaphragmatic hernias (PTDH) are a consequence of occult diaphragmatic injuries associated with penetrating abdominal trauma. We present a case of a 26-year-old male patient who, 2 months prior to the current admission, sustained a non-penetrating stab wound to the left anterior chest below the nipple. Upon presentation the patient complained of epigastric pain radiated to the left shoulder, and nausea and vomiting. The chest X-ray, and abdominal and thoracic CT scan were inconclusive. The patient was sutured and discharged. The laparoscopic approach was selected as a diagnostic and minimally invasive therapeutic method. The suspected diagnosis of PTDH was confirmed. The herniated organs (transverse colon, small bowel loops, and greater omentum) were reduced, and the diaphragmatic defect was sutured by placing 3 non-resorbable 2.0 knots. The suture was reinforced with a composite mesh affixed with resorbable clips. Postoperative period was uneventful, and the patient was discharged 4 days later. PMID:19601469
Nicolau, A E; Gheju, I; Micu, B; Kitkani, A; Iftimie, I; Dinescu, G; Mirea, L; Ungureanu, R
Traumatic abdominal wall hernia is a rare clinical entity despite the high incidence of blunt abdominal trauma. In children, traumatic abdominal wall injury can occur even after minor trauma without any associated intra-abdominal injury. We report a case of Spigelian hernia due to a handlebar injury in a male child of 9 years, who came for treatment 5 weeks after the injury. Ultrasonography confirmed the clinical diagnosis of traumatic Spigelian hernia. The case was taken up for open surgery and anatomical repair was done with prolene. The patient had an uneventful postoperative course. PMID:24426630
Thakur, Sudhir Kumar; Gupta, Salabh; Goel, Saurabh
Introduction An internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery. Although they are considered as a rare cause of intestinal obstruction, paraduodenal hernias are the most common type of congenital hernias. Methods A literature search using PubMed was performed to identify all published cases of left paraduodenal hernia (LPDH). Results In Literature search between 1980 and 2012 using PubMed revealed only 44 case reports before the present one. Median age was 47 years (range 18 – 82 years). Nearly 50% reported previous mild symptoms. Two-third of patients required emergency surgery in form of laparotomy or laparoscopic repair. Reduction of hernia contents with widening or suture repair of the hernia orifice were the most common standards in surgical management of LPDH. Conclusion Intestinal obstruction secondary to internal hernias is a rare presentation. High index of suspicion and preoperative imaging are essential to make an early diagnosis in order to improve outcome.
Introduction. Femoral hernias are at high risk of strangulation due to the narrow femoral canal and femoral ring. This can lead to symptoms of obstruction or strangulation requiring emergency surgery and possible bowel resection. To our knowledge, there is only one previous published report of bilateral strangulated femoral hernia. We present our case of this phenomenon. Case Report. An 86-year-old woman presented with symptoms of small bowel obstruction. Examination revealed two tender lumps in the area of the femoral triangle. CT scan revealed bilateral femoral hernias. Both hernias were repaired and a small bowel resection on the right side was performed with side to side anastomosis. She made an uneventful recovery. Conclusion. Bilateral femoral hernias are a rare occurrence with only one reported case of bilateral strangulation. Our case highlights the importance of meticulous history taking and clinical examination as any delay in diagnosis will increase the risk of mortality and morbidity for the patient. Hernias should always be considered as a cause if one presents with symptoms of abdominal pain or obstruction.
Nikolopoulos, Ioannis; Oderuth, Eshan; Ntakomyti, Eleni; Kald, Bengt
Gastrogastric fistula (GGF) is a known complication of gastric bypass surgery. Revisional surgery for GGF repair can be technically\\u000a challenging. We describe our experience with endoscopic repair of small GGFs. A retrospective review was performed to identify\\u000a patients in whom symptomatic GGF was repaired endoscopically at our institution between September 2004 and September 2008.\\u000a At endoscopy, the fistulous margins were
Atul Bhardwaj; Robert N. Cooney; Andrew Wehrman; Ann M. Rogers; Abraham Mathew
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.
Brouwer, Katrien M; Wijnen, Rene M; Reijnen, Daphne; Hafmans, Theo G; Daamen, Willeke F; van Kuppevelt, Toin H
An inguinal hernia containing appendix is termed an Amyand's hernia. It is an uncommon and rare condition estimated to be found in approximately 1 % of adult inguinal hernia repairs. Depending on the extent of inflammation in the hernia sac and obstruction of hernia, clinical presentation can vary. We report a case of Amyand's hernia in a 22-year-old male who presented with history of right inguinal hernia for 6 months duration. Operation revealed hernia sac containing inflamed appendix hence appendectomy was performed. PMID:24426651
Mishra, Vivek Kumar; Joshi, Prarthan; Shah, Jigar Vipul; Agrawal, Chintan; Sharma, Dhaval; Aggarwal, Kuldeep
Purpose: The authors reviewed their experience in the management of CDH after the introduction of early high-frequency oscillatory ventilation (HFOV) during the preoperative stabilization period and delayed CDH repair.Methods: This is a retrospective analysis of 24 consecutive infants with CDH treated at University of California, Irvine Medical Center (UCIMC) during a 36-month period from January 1993 to December 1996.Results: Two
Cynthia Reyes; Lynn K Chang; Feizal Waffarn; Halleh Mir; M. James Warden; Jack Sills
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)
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
Abstract Introduction: Ventral hernias may be primary or incisional and classified as midline ventral hernias (MVHs) or non-MVHs (NMVHs). NMVHs are rarer, and their laparoscopic management is technically challenging because of varied anatomic locations, differences in patient positioning at time of surgery, and lack of adequate lateral space for mesh fixation, compounded by the proximity of major organs and bony landmarks. A retrospective review of all the NMVHs operated on in a clinical unit is presented. Subjects and Methods: One hundred eighty-three cases met the criteria of ventral hernia, with 25 cases (13.66%) as NMVH. These NMVHs included lumbar (n=5), suprapubic (n=7), iliac (n=10), and subcostal (n=3). Univariate and multivariate analyses were done using SPSS version 19 software (IBM, Armonk, NY). Continuous data were analyzed using the Mann-Whitney U test/t test, and categorical data were analyzed using the chi-squared test. A P value of ?.05 was considered significant. Results: Demographic profile and presentation were similar in all groups. One case each had seromuscular intestinal injury in the iliac group (P=.668), splenic injury in the lumbar group, and liver injury in the subcostal group (P=.167). In the iliac group there was 1 patient with hematoma (P=.668), whereas seroma was seen in 1 lumbar group patient and 2 iliac group patients (P=.518). Persistent cough impulse was seen in 1 case each in the iliac and lumbar groups (P=.593). One case in the iliac group recurred after primary surgery (P=.668). Conclusions: NMVHs have a similar spectrum of difficulty and complication profile as those of laparoscopic MVH repairs. Laparoscopic repair of a non-midline hernia is technically challenging but definitely feasible. The incidence of complications and recurrence rate might be more than those for MVHs, but its actual validation needs a much larger comparative study having a longer follow-up. PMID:24918940
Lal, Romesh; Sharma, Deborshi; Hazrah, Priya; Kumar, Pawan; Borgharia, Saurabh; Agarwal, Abhinav
Introduction Cases of right paraduodenal hernia and superior mesenteric artery syndrome have been reported separately, but their occurrence in combination has not been reported. Case presentation A 46-year-old Japanese man who had never undergone laparotomy was admitted to our hospital due to an acute abdomen. An enhanced multidetector-row computed tomography scan of our patient showed a cluster of small intestines with ischemic change in his right lateral abdominal cavity. Emergency surgery was subsequently performed, and strangulation of the distal jejunum along with incidental right paraduodenal hernia was found. His necrotic ileum was resected, and the jejunum encapsulated by the sac was repaired manually without reduction. Three days after the operation, however, our patient developed vomiting. An upper gastrointestinal series revealed a straight line cut-off sign on the third portion of his duodenum. A second enhanced multidetector-row computed tomography scan showed that he had a lower aortomesenteric angle and a shorter aortomesenteric distance compared to his condition before his right paraduodenal hernia was surgically repaired. We strongly suspected that the right paraduodenal hernia repair may have induced superior mesenteric artery syndrome. On the 21st post-operative day, duodenojejunostomy was performed because conservative management had failed. Conclusions In this case, enhanced multidetector-row computed tomography, which permits reconstructed multiplanar imaging, helped us to visually identify these diseases easily. It is important to recognize that surgical repair of a right paraduodenal hernia may cause superior mesenteric artery syndrome.
Left paraduodenal hernia (LPDH) is a retrocolic internal hernia of congenital origin that develops through the fossa of Landzert, and extends into the descending mesocolon and left portion of the transverse mesocolon. It carries significant overall risk of mortality, yet delay in diagnosis is not unusual due to subtle and elusive features. Familiarisation with the embryological and anatomical features of this rare hernia is essential for surgical management. This is especially important with respect to vascular anatomy as major mesenteric vessels form intimate relationships with the ventral rim and anterior portion of the hernia. As an illustrative case, we describe our experience with a striking example of LPDH, particularly focusing on the inherent diagnostic challenges and associated critical vascular anatomy. We advocate the role of diagnostic laparoscopy; however caution that decision to safely proceed with laparoscopic repair must occur only with confident identification of the vascular anatomy involved. PMID:24792018
Cundy, Thomas P; Di Marco, Aimee N; Hamady, Mohamad; Darzi, Ara
The aim of the study was to evaluate whether the surgical treatment reserved for the ilioinguinal, iliohypogastric and genital branches of the genitofemoral nerves, during open hernia mesh repair, is effective in reducing chronic post-operative pain. A multicentre prospective study involving 11 Italian Institutions led to the recruitment of 973 cases of hernioplasty. All surgeons were asked to report whether or not each nerve had been identified and preserved or divided. The main endpoint of the study was the evaluation of moderate-severe chronic pain at 6 months and 1 year. Overall, presence of groin pain at 6 months and 1 year follow-up was 9.7% and 4.1%, respectively. Pain was mild in 7.9% and moderate-to-severe in 2.1% at 6 months, and mild in 3.6% and moderate-to-severe in 0.5% at 1 year. Univariate and multivariate analysis showed that lack of identification of nerves is significantly correlated with presence of chronic pain, the risk of developing inguinal pain increasing with the number of nerves not detected. Likewise, division of nerves was clearly correlated with presence of chronic pain. The present findings indicate that identification and preservation of nerves during open inguinal hernia repair reduce chronic incapacitating groin pain. PMID:16729606
Alfieri, Sergio; Rotondi, Fabio; Di Miceli, Dario; Di Giorgio, Andrea; Ridolfini, Marco Pericoli; Fumagalli, Uberto; Salzano, Antonio; Prete, Francesco Paolo; Spadari, Antonio
BACKGROUND The objective of this study was to evaluate the biomechanical characteristics and histologic remodeling of crosslinked (Peri-Guard, Permacol) and non-crosslinked (AlloDerm, Veritas) biologic meshes over a 12 month period using a porcine model of incisional hernia repair. STUDY DESIGN Bilateral incisional hernias were created in 48 Yucatan minipigs and repaired after 21 days using an underlay technique. Samples were harvested at 1, 6, and 12 months and analyzed for biomechanical and histologic properties. The same biomechanical tests were conducted with de novo (time 0) meshes as well as samples of native abdominal wall. Statistical significance (p < 0.05) was determined using 1-way analysis of variance with a Fisher's least significant difference post-test. RESULTS All repair sites demonstrated similar tensile strengths at 1, 6, and 12 months and no significant differences were observed between mesh materials (p > 0.05 in all cases). The strength of the native porcine abdominal wall was not augmented by the presence of the mesh at any of the time points, regardless of de novo tensile strength of the mesh. Histologically, non-crosslinked materials showed earlier cell infiltration (p < 0.01), extracellular matrix deposition (p < 0.02), scaffold degradation (p < 0.05), and neovascularization (p < 0.02) compared with crosslinked materials. However, by 12 months, crosslinked materials showed similar results compared with the non-crosslinked materials for many of the features evaluated. CONCLUSIONS The tensile strengths of sites repaired with biologic mesh were not impacted by very high de novo tensile strength/stiffness or mesh-specific variables such as crosslinking. Although crosslinking distinguishes biologic meshes in the short-term for histologic features, such as cellular infiltration and neovascularization, many differences diminish during longer periods of time. Characteristics other than crosslinking, such as tissue type and processing conditions, are likely responsible for these differences.
Deeken, Corey R; Melman, Lora; Jenkins, Eric D; Greco, Suellen C; Frisella, Margaret M; Matthews, Brent D
The aim of our study was to evaluate the pharmaco- kinetics and pharmacodynamics of ropivacaine in ilioinguinal-iliohypogastric blocks (IIB). After ethics committee approval and informed consent, 80 male adults scheduled for inguinal hernia repair were en- rolled and randomized into four groups. After induc- tion of general anesthesia, an IIB was performed double blinded in Groups 1, 2, and 3
Hinnerk Wulf; Frank Worthmann; Hagen Behnke
Hepatic pulmonary fusion is a rare malformation associated with right congenital diaphragmatic hernia (CDH), often only discovered during surgical repair of the defect. Fourteen previous cases have been reported in the literature. We describe a case of a full term male newborn with prenatal ultrasound diagnosis of right CDH who underwent a thoracoscopy converted to a thoracotomy, due to this rare aforementioned intraoperative incidental finding. We reviewed the previous reported literature, especially focusing on the chosen surgical approach, concluding that an early and appropriate preoperative imaging investigation may be crucial for the best management of these kinds of patients. PMID:23324869
Olenik, D; Codrich, D; Gobbo, F; Travan, L; Zennaro, F; Dell'Oste, C; Bussani, R; Schleef, J
Background—Patients with repaired coarctation are at increased risk of hypertension and cardiovascular disease despite successful repair. We studied the function of conduit arteries in upper and lower limbs of patients late after successful coarctation repair and its relation to age at surgery. Methods and Results—Flow-mediated dilatation (FMD) and the dilatation after sublingual nitroglycerin (NTG, 25 mg) were measured by using
Marcello de Divitiis; Carlo Pilla; Mia Kattenhorn
Prosthetic mesh is now used routinely in inguinal hernia repairs, although its fixation is thought to be a potential cause of chronic groin pain. The Parietene ProGrip™ (TYCO Healthcare) mesh, which is semi-resorbable and incorporates self-fixing properties, has been shown to provide satisfactory repair in open surgery. We describe the use of this mesh in TAPP hernia repair, which has not previously been reported in the literature. A prospective study of 29 patients showed a mean operative time to be 47.6 min, with 96% of patients discharged home on the day of surgery or the day after. Visual analog pain scales (out of 10) reduced from 4 preoperatively to 0 at 6 months, and only 1 patient suffered a minor wound complication. The use of this mesh in transabdominal preperitoneal hernia repair is therefore feasible, safe, and may reduce postoperative pain.
Kosai, Nik; Sutton, Paul Anthony; Evans, Jonathan; Varghese, Joseph
Prosthetic mesh is now used routinely in inguinal hernia repairs, although its fixation is thought to be a potential cause of chronic groin pain. The Parietene ProGrip™ (TYCO Healthcare) mesh, which is semi-resorbable and incorporates self-fixing properties, has been shown to provide satisfactory repair in open surgery. We describe the use of this mesh in TAPP hernia repair, which has not previously been reported in the literature. A prospective study of 29 patients showed a mean operative time to be 47.6 min, with 96% of patients discharged home on the day of surgery or the day after. Visual analog pain scales (out of 10) reduced from 4 preoperatively to 0 at 6 months, and only 1 patient suffered a minor wound complication. The use of this mesh in transabdominal preperitoneal hernia repair is therefore feasible, safe, and may reduce postoperative pain. PMID:22022105
Kosai, Nik; Sutton, Paul Anthony; Evans, Jonathan; Varghese, Joseph
Polypropylene mesh repair is the gold standard for primary inguinal hernia and incisional hernia. Wound infection and small bowel fistulas are contraindications to polypropylene mesh repair. In addition, synthetic meshes are known to cause severe peritoneal adhesions and enteric fistulas if located close to the bowel. Porcine intestinal submucosa has been used successfully in experimental studies in dogs and rats to repair large abdominal wall defects. A new porcine dermal collagen graft has been used in man for groin hernia repair, incisional hernia repair and other surgical procedures without complications. We describe 6 cases of complicated incisional hernia operated in emergency using porcine dermal collagen grafts. In one woman the incisional hernia was associated with an enterovaginal fistula. Three cases presented severe wound infections, two of which related to a previous polypropylene mesh repair, while another had an irreducible recurrent incisional hernia and one woman presented complete evisceration. None of the patients had postoperative or porcine-graft-related complications. Over a follow-up period of 3-24 months we have had no recurrence or wound infection. The results of these few cases confirm the safety and efficacy of the porcine dermal collagen mesh also in incisional hernia repair. PMID:17069192
Armellino, Mariano Fortunato; De Stefano, Guglielmo; Scardi, Francesco; Forner, Anna Lucia; Ambrosino, Francesco; Bellotti, Roberto; Robustelli, Umberto; De Stefano, Giovanni
A 1-yr-old male leopard (Panthera pardus) presented for intermittent anorexia, emaciation, and generalized muscle wasting. Plain radiographs, ultrasonography, and esophageal endoscopy led to a diagnosis of diaphragmatic eventration with probable concurrent hiatal hernia. An exploratory laparotomy confirmed both diagnoses, and surgical repair and stabilization were performed. After surgery, the leopard was maintained on small liquid meals for 4 days, with a gradual return to normal diet over 2 wk. By 4 wk after surgery, the leopard was eating well and gaining weight, and it showed no recurrence of clinical signs for 2 yr subsequently, becoming mildly obese. PMID:11237147
Kearns, K S; Jones, M P; Bright, R M; Toal, R; DeNovo, R; Orosz, S
Many thousand laparotomy incisions are created each year and the failure rate for closure of these abdominal wounds is between 10–15%, creating a large problem of incisional hernia. In the past many of these hernias have been neglected and treated with abdominal trusses or inadequately managed with high failure rates. The introduction of mesh has not had a significant impact because surgeons are not aware of modern effective techniques which may be used to reconstruct defects of the abdominal wall. This review will cover recent advances in incisional hernia surgery which affect the general surgeon, and also briefly review advanced techniques employed by specialist surgeons in anterior abdominal wall surgery.
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.
Al-Khudari, Samer; Succar, Eric; Ghanem, Tamer; Gardner, Glendon M.
The diagnosis of spigelian hernia presents greater difficulties than its treatment. The clinical presentation varies, depending on the contents of the hernial sac and the degree and type of herniation. The pain, which is the most common symptom, varies and there is no typical pain of spigelian hernia. Findings to facilitate diagnosis are palpable hernia and a palpable hernial orifice.
Background Although it is now generally accepted that patients should be advised to quit smoking before surgery, the effect of low-intensive\\u000a smoking cessation intervention, both on preoperative smoking behavior and on risk reduction, remains unclear. Our objective\\u000a was to study the effect on perioperative smoking behavior and on postoperative wound infection of different types of low-intensive\\u000a intervention before herniotomy.\\u000a \\u000a \\u000a \\u000a Methods Between October
L. T. Sørensen; U. Hemmingsen; T. Jørgensen
Erosion of small intestine with necrotising fasciitis of over lying abdominal wall after expanded poly-tetrafluoroethylene mesh implantation: A rare complication after laparoscopic incisional hernia repair
Complications such as bowel erosions, enterocutaneous fistulae are rare with the use of expandedpoly-tetrafluoroethylene (ePTFE) mesh in laparoscopic incisional hernia repair (LIHR). This unusual case patient presented to us with necrotising fasciitis of overlying anterior abdominal wall with peritonitis withsepticaemia and underwent aLIHR6 weeks before, which has not been reported till yet. We report a case of LIHR, presented to us with necrotising fasciitis of overlying anterior abdominal wall, peritonitis and septicaemia which was managed by small bowel segmental resection and exteriorisation of the ends, debridement of overlying anterior abdominal wall and maximum resection of implanted mesh. This case is unusual secondary to long experience with ePTFE mesh and the lack of published cases similar to this one. A brief review of relevant literature has been included in the article. We recommend pre-peritoneal placement of dual mesh fixed preferably by trans-abdominal polypropylene suture in LIHR.
Shrivastava, Ashish; Gupta, Akshara; Gupta, Achal; Shrivastava, Jyoti
Lumbar hernia is one of the rare cases that most surgeons are not exposed to. Hence the diagnosis can be easily missed. This leads to delay in the treatment causing increased morbidity. We report a case of lumbar hernia in a middle-aged woman. It was misdiagnosed as lipoma by another surgeon. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Clinical and MRI findings were correlated to reach the diagnosis. We also highlight the types, the process of diagnosis and the surgical repair of lumbar hernias. We wish to alert our fellow surgeons to keep the differential diagnosis of the lumbar hernia in mind before diagnosing any lumbar swelling as lipoma. PMID:24810439
Ahmed, Syed Tausif; Ranjan, Rajeeva; Saha, Subhendu Bikas; Singh, Balbodh
Primary ventral and even small incisional hernias have historically been repaired by primary closure; however, data proves that use of mesh can significantly reduce hernia recurrence. Here we report clinical outcomes at one year using the International Hernia Mesh Registry following the use of a three-dimensional tissue-separating mesh device (Proceed Ventral Patch™, Ethicon, Somerville, NJ). This ongoing prospective multi-center registry collects preoperative, perioperative, and postoperative outcome data including adverse events at 1, 6, 12, and 24 months. Patient-reported outcomes are collected including a hernia-specific questionnaire. A total of 234 patients (72.1% male, 27.9% female) from 13 sites in the United States and Europe were enrolled. Mean age and BMI were 52.2 (SD 15.0) and 29.2 kg/m2 (SD 5.2), respectively. Hernia types: umbilical 67.1%, epigastric 11.5%, small incisional including trocar 21.3%. Preoperatively 46.9% and 38.3% of patients reported symptomatic pain and movement scores, respectively. At 1 year, these were significantly reduced to 8.9% and 5.0%, respectively (p < 0.001). At 12 months hernia recurrence was 3.0% (95% CI, 1.2% to 6.1%), seroma (2.1%), infection (2.1%) with other events being less than 1%. These results indicate repair using this device led to significant improvement in pain and movement limitations and were associated with low complication and recurrence rates. PMID:24574019
Tollens, Tim; Mitchell, Jenny; Jones, Peter; Berrevoet, Frederik
Background The purported advantage of lightweight large-pore meshes is improved biocompatibility that translates into lesser postoperative\\u000a pain and earlier rehabilitation. However, there are concerns of increased hernia recurrence rate. We undertook a prospective\\u000a randomized clinical trial to compare early and late outcome measures with the use of a lightweight (Ultrapro) mesh and heavyweight\\u000a (Prolene) mesh in endoscopic totally extraperitoneal (TEP) groin
P. K. Chowbey; N. Garg; A. Sharma; R. Khullar; V. Soni; M. Baijal; T. Mittal
Background: Despite being one of the most exact indications, laparoscopic treatment of eventrations and ventral hernias is barely known\\u000a among the array of laparoscopic techniques.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: A total of 60 patients were assigned at random over a 3-year period to two homogeneous groups to be operated on for major\\u000a ventral hernias with mesh. Half of them were operated upon laparoscopically
M. A. Carbajo; J. C. Martín del Olmo; J. I. Blanco; C. de la Cuesta; M. Toledano; F. Martin; C. Vaquero; L. Inglada
INTRODUCTION Cryptorchidism is characterized by the extra-scrotal position of the testis. The surgical community has little to no knowledge of cryptorchid testis in adults apart from of pediatric surgeons. Therefore, we sought to describe this unusual cause of inguinal hernia. PRESENTATION OF CASE A 50-year-old man was referred with a inguinal hernia. Diagnosis of cryptorchidism was made during surgery, as the patient underwent an operation for repair of his left inguinal hernia. The testicle was non-viable and a left testicle was resected. Histopathology report confirmed a atrophic testis without testicular germ cell tumor (TGCT). DISCUSSION This is an extremely rare case of cryptorchidism revealed in an adult. The patient remained asymptomatic for 50 years. Most studies have concluded that there is a direct correlation between how long the testis was subjected to a cryptorchid position and TGCT incidence. The recommended age of surgical correction is before the age of 2 years. In our case, we did not find correlation between the time of surgery and risk of TGCT. Histopathology report confirmed the presence of leydig cells, seminiferous tubule and Sertoli cells without TGCT. Very little is known about link between cryptorchidism and TGCT. The correct diagnosis of inguinal hernia is usually made during an inguinal hernia repair. CONCLUSION The surgeon must always be alert to the possibility of cryptorchid testis during a surgical exploration of an inguinal hernia. In suspected cases, laparoscopy ultrasonographic, CT scan and laparoscopy evaluation may be helpful in diagnosing of this atypical inguinal hernia before surgery.
Kassir, Radwan; Dubois, Joelle; Berremila, Sid-Ali; Baccot, Sylviane; Boueil-Bourlier, Alexia; Tiffet, Olivier
Background: Wound infection and sepsis leading to incisional hernia development are common after emergency colonic operations. Later on, while being operated on to correct an incisional hernia, most of these patients will need colonic resection or bowel continuity reestablishment. Simultaneous treatment of incisional hernias in patients with colostomy or colonic disease remains a difficult challenge, considering the reluctance of most
Claudio Birolini; Edivaldo Massazo Utiyama; Aldo Junqueira Rodrigues; Dario Birolini
Symptomatic perineal hernias following abdomino-perineal excision of rectum have been reported to occur uncommonly. We present the case of a 79-year-old gentleman who developed a perineal hernia after laparoscopic-assisted extralevator abdomino-perineal excision (ELAPE) of the rectum. Despite initial myocutaneous flap repair, there was further symptomatic recurrence. Magnetic resonance imaging demonstrated non-compromised bowel extending beneath the gracilis flap with extension into the adductor compartment of the left thigh. Given the recurrent nature, a rectus flap repair was performed and after 15 months, he remains hernia free. There is currently no consensus as to the optimal operative technique in the prevention and management of these hernias; however, primary reconstruction at the time of ELAPE may be preferable. Symptomatic perineal hernias can be severely debilitating and require operative repair. We suggest that surgical options should be discussed and carried out with the input of a Plastic surgeon.
Patel, Rikesh K.; Sayers, Adele E.; Gunn, James
Background: Umbilical hernia repair, a common day-case surgery procedure in children, is associated with a significant postoperative pain. The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath infiltration and caudal block. The rectus sheath block may offer improved pain relief following umbilical hernia repair with no undesired effects such as lower limb motor weakness or urinary retention seen with caudal block which might delay discharge from the hospital. Ultrasound guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. The aim of this case series is to assess the post rectus sheath block pain relief in pediatric patients coming for umbilical surgery. Methods: Twenty two (22) children (age range: 1.5-8 years) scheduled for umbilical hernia repair were included in the study. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 5-16 MHz 50 mm linear probe. An ultrasound-guided posterior rectus sheath block of both rectus abdominis muscles (RMs) was performed (total of 44 punctures). An in-plain technique using Stimuplex A insulated facet tip needle 22G 50mm. Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia by means of the modified CHEOPS scale were evaluated. Results: ultrasonograghic visualization of the posterior sheath was possible in all patients. The ultrasound guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia except for one patient who postoperatively required morphine 0.1 mg/kg intravenously. There were no complications. Conclusions: Ultrasound guidance enables performances of an effective rectus sheath block for umbilical hernia. Use of the Stimuplex A insulated facet tip needle 22G 50mm provides easy, less traumatic skin and rectus muscle penetration and satisfactory needle visualiza.
Alsaeed, Abdul Hamid; Thallaj, Ahmed; Khalil, Nancy; AlMutaq, Nada; Aljazaeri, Ayman
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.
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
Introduction Combined 24-h multichannel intralumenal impedance–pH monitoring (MII-pH) is gaining popularity as a diagnostic tool for gastroesophageal\\u000a reflux. Since the surgical reduction of hiatal hernias and creation of a fundoplication anatomically restores the gastroesophageal\\u000a reflux barrier, one would assume that it effectively stops all reflux regardless of composition. Our aim is to evaluate the\\u000a results of routine MII-pH testing in successful
Brittany N. Arnold; Christy M. Dunst; Angi B. Gill; Trudie A. Goers; Lee L. Swanström
Introduction: Endoscopic repair was introduced for use with inguinal hernia therapy more than 10 years ago. The technique as well as the\\u000a indications for this method are debated, however. As a borderline inguinal hernia situation, the scrotal hernia in particular\\u000a evokes vehement objections to an endoscopic procedure because of the anticipated problems and complications in dissecting\\u000a the extended hernia sac.
B. J. Leibl; C.-G. Schmedt; K. Kraft; M. Ulrich; R. Bittner
We report a rare case of obstructed right inguinal hernia caused by ingested stones. A 2 year-old boy from Northern Thailand was transferred to our hospital with low-grade fever, vomiting, and acute painful swelling at his right hemiscrotum for one day. The physical examination revealed marked enlargement with inflammation in his right hemiscrotum. The radiological findings showed huge number of stones in the right hemiscrotum. At surgery, the content of hernia sac was ascending colon, which was full of hard masses. With the help of additional lower transverse abdominal incision, the obstructed segment was successfully reduced and revealed a perforation. Most of the stones were removed through the perforation. The colonic wound was primarily repaired and both incisions were primarily closed. Although he developed post-operative wound infection, the boy had uneventfully recovered. The psychological exploration in this "stone pica" revealed no other psychological disorders. PMID:24841026
Sookpotarom, Paiboon; Ariyawatkul, Kansuda; Paramagul, Py; Sakulisariyaporn, Chanin; Stimanont, Thaniya; Vejchapipat, Paisarn
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
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.
Melman, L.; Jenkins, E. D.; Hamilton, N. A.; Bender, L. C.; Brodt, M. D.; Deeken, C. R.; Greco, S. C.; Frisella, M. M.
Context Surgical repair of the ruptured distal biceps brachaii tendon is an effective treatment in injured patients. Timing of surgery is considered an important factor when managing these patients. Objective To compare our outcomes after distal biceps tendon acute (at 4 weeks or less) or chronic (greater than 4 weeks) repair. Design Cohort study. Setting Clinical practice. Patients or Other Participants Of 18 patients in a tertiary practice who underwent distal biceps repair, 12 and 6 underwent acute or chronic repair, respectively. The average durations from injury to surgery were 15.3 (range, 9 to 25) and 50.1 (range, 29 to 75) days for the acute and chronic groups, respectively. Intervention(s) Distal biceps tendon repair. Main Outcome Measure(s) Disabilities of the Arm, Shoulder and Hand (DASH) scoring, range of motion, and clinical and radiographic complications. Results No differences were noted between the groups in DASH scoring or range of motion. No complications occurred, and radiographic outcomes were satisfactory, without evidence of heterotopic ossification in any patients. Conclusions Secure repair of a distal biceps tendon injury may yield similar results, whether it is performed in the acute or chronic setting.
Anakwenze, Oke A; Baldwin, Keith; Abboud, Joseph A
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.
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
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
Of the different eras in the evolution of hernia surgery one of the most intriguing is the late eighteenth century, when surgeon/anatomists first began to publish their studies of the abdominal wall and the inguinal and femoral canals. It became known as the age of dissection, and many of the surgical successes of subsequent periods can be traced back to the anatomical knowledge gained from 1750 to 1800. These fifty years also served as the all-important transition era from text-only hernia treatises to lavishly illustrated monographs. The works of Percivall Pott, Jean Louis Petit, D. August Gottlieb Richter, Don Antonio de Gimbernat, and Pieter Camper were among the most influential hernia-related tomes of this time. Biographies of these five surgeons and extracts from their writings are presented in this article. PMID:14533901
Rutkow, Ira M
... never gets worse and never has a significant impact on health or life. Prevention It is difficult to prevent a hiatal hernia. However, you can reduce your risk by maintaining a healthy weight and not smoking. To prevent hernia associated with increased abdominal pressure, ...
Vascular injury as a complication of disc surgery was first reported in 1945 by Linton and White. It is a rare but potentially\\u000a fatal complication. The high mortality rate (40–100%) is attributed to a combination of rapid blood loss and the failure to\\u000a recognise the cause of the deteriorating patient. Early diagnosis and treatment is essential. Treatment has traditionally\\u000a been
P. Skippage; J. Raja; R. McFarland; A. M. Belli
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.
The first description diaphragmatic hernia appeared in 1575. In 1848, Bochdalek described congenital diaphragmatic hernia (CDH) occurring through a posterolateral defect. Successful surgical treatment of CDH in an infant was first performed in 1902, whereas the first neonate operated within 24 hours of life was reported in 1946. However, early surgery did not improve survival rates and the mortality was
P. PuriT; T. Wester
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.
Munhoz, Alexandre Mendonca; Montag, Eduardo; Arruda, Eduardo Gustavo; Sturtz, Gustavo; Gemperli, Rolf
Enteric fistulas are a rare but serious complication following the repair of an incisional hernia using a prosthesis. We report the case of a 52-year-old man who developed an enterocolocutaneus fistula after incisional hernia repair with intra-abdominal polyester mesh. This case shows that one may want to avoid placing the parietal prostheses in direct contact with intestinal loops.
V. Ott; Y. Groebli; R. Schneider
Acellular dermal matrices are integrally involved in the majority of expander-implant reconstructions and complex hernia repairs today, and they are now making their way into secondary aesthetic breast surgery. The number of revisional breast surgery cases has continued to increase as the materials and repair techniques have improved. The aesthetic outcome bar is constantly being raised, and the complexity of patient deformities often requires additional tissues to achieve a successful repair. The most common complications in breast augmentation are reviewed, along with indications and some current repair techniques, general principles, and specific caveats to help plastic surgeons deal with these complex and challenging patient problems utilizing acellular dermal matrices. PMID:23096964
Small bowel perforation caused by direct blunt trauma to an inguinal hernia has rarely been reported. In this report, we present a patient with terminal ileum perforation after direct blunt trauma to an inguinal hernia region. Both perforation and hernia repair were managed surgically in the same stage. This case demonstrates that leaving an inguinal hernia unrepaired may lead to dangerous outcomes, such as intestinal strangulation and perforation. Inguinal hernias with intestinal perforation need urgent surgical intervention. It is possible to repair the intestinal perforation and inguinal hernia in the same operation. PMID:19214649
Ersoz, F; Arikan, S; Ozcan, O; Sentatar, E
Acute appendicitis involving the hernia sac is infrequent but well-documented in medical literature. In most instances, it occurs within the right inguinal (Amyand’s hernia) or right femoral hernia (de Garengeot hernia). The diagnosis is always mistaken for incarcerated groin hernia. During surgery, the appendix itself, either perforated or strangulated, is most commonly encountered within the hernia sac. In very rare occasions, only appendiceal pus is found in the hernia sac. In this paper, we report the case of a 90-year-old woman with acute appendicitis and a tender mass in the right groin. Typical findings of acute appendicitis by computed tomography (CT) and incarcerated femoral hernia with groin cellulitis misled us into preoperative diagnosis of strangulated femoral hernia. Acute phlegmonous inflammation of the incarcerated femoral hernia sac containing pus only and acute suppurative appendicitis were found intraoperatively. This case presents a rare complication of acute appendicitis and the first report of CT-documented appendiceal pus-contained femoral hernia. Knowledge of this rare condition is helpful in establishing preoperative diagnosis and patient management decisions.
Hsiao, Tien-Fa; Chou, Yenn-Hwei
Aortic injuries represent a rare but life-threatening complication of spinal surgery. Perforation of the aorta due to pedicle screw penetration or misplacement can lead to immediate bleeding with hemodynamic instability or to pseudoaneurysm development with delayed risk of rupture, which can occur weeks to months later. Recently, thoracic endovascular aortic repair (TEVAR) in aortic trauma has contributed to a reduction of both mortality and morbidity. The literature on this subject is reviewed. PMID:23294480
Carmignani, Amedeo; Lentini, Salvatore; Acri, Edvige; Vazzana, Giovanni; Campello, Mauro; Volpe, Pietro; Acri, Ignazio E; Spinelli, Francesco
PURPOSE A proportion of patients have fecal incontinence secondary to a full-thickness rectal prolapse that fails to resolve following prolapse repair. This multicenter, prospective study assessed the use of sacral nerve stimulation for this indication.METHODS Patients had to have more than or equal to four days with fecal incontinence per 21-day period more than one year after surgery. They had to have
Michael E. D. Jarrett; Klaus E. Matzel; Michael Stösser; Cor G. M. I. Baeten; Michael A. Kamm
INTRODUCTION Traumatic abdominal wall hernia (TAWH) is a rare entity. Most cases occur in children, following an injury from the bicycle handle bar. In adults, it usually results from road traffic accidents (RTA). We present one of the largest reported cases of TAWH following RTA managed by delayed mesh repair. PRESENTATION OF CASE A 35 yr old obese male with RTA was diagnosed with TAWH with 19 cm × 15 cm defect in left flank. As there were no intra abdominal injuries and overlying skin was abraded, he was planned for elective repair after 6 months. On exploration a defect of 30 cm × 45 cm was found extending from midline anteriorly to 8 cm short of midline posteriorly in transverse axis and costal margin to iliac crest in craniocaudal axis. After restoration of bowel into abdominal cavity, primary closure or even approximation of muscular defect was not possible thus a mesh closure using 60 cm × 60 cm prolene mesh in subcutaneous plane was done. After 4 months follow up, patient is healthy and has no recurrence. DISCUSSION Emergent surgical management of TAWH is usually favoured due to high incidence of associated intra abdominal injuries. Delayed repair may be undertaken in selected cases. CONCLUSION TAWH, although rare, should be suspected in cases of RTA with abdominal wall swellings. With time, the hernia defect may enlarge and muscles may undergo atrophy making delayed repair difficult.
Yadav, Siddharth; Jain, Sunil K.; Arora, Jainendra K.; Sharma, Piyush; Sharma, Abhinav; Bhagwan, Jai; Goyal, Kaushal; Sahoo, Bhabani S.
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