Sample records for hernia repair surgery

  1. Morgagni hernia: Repair with a mesh using laparoscopic surgery

    Microsoft Academic Search

    A. Albarracín Marín-Blazquez; M. F. Candel; P. A. Parra; M. Méndez; J. Ródenas; M. J. Rojas; F. Carrión; M. Madrigal

    2004-01-01

    The aim of this study is to present two patients diagnosed with diaphragmatic Morgagni hernia and treated by repairing the hernia defect with a mesh by laparoscopic surgery. We describe the placement of a double-layer mesh anchored with helicoidal staples to repair the hernia defect using laparoscopic surgery. Laparoscopic surgery allows repair of these defects whilst avoiding the disadvantages of

  2. Open Surgery Simulation of Inguinal Hernia Repair

    E-print Network

    Paris-Sud XI, Université de

    their understanding of the spatial relations of the involved anatomy. Keywords. Virtual reality, open surgery of the complex anatomy of the inguinal region, which is crucial for the effective and careful handling in repairing inguinal hernias is understanding the three dimensional spatial relations of the complex anatomy

  3. Laparoscopic repair and groin hernia surgery.

    PubMed

    Crawford, D L; Phillips, E H

    1998-12-01

    Over the past 15 years, laparoscopic herniorrhaphy has made the transition from an experimental to a proven procedure. With increasing laparoscopic skills in the surgical community, many surgeons are now faced with the question of when to recommend laparoscopic herniorrhaphy to their patients. A surgeon's best hernia repair is the one with which they have had the greatest experience. This results in the lowest recurrence and complication rate in his or her hands. Certainly, simple, unilateral hernias and bilateral hernias can be repaired with either anterior or laparoscopic techniques. Many times, laparoscopic herniorrhaphy is too much surgery for a young patient with a unilateral hernia. In such a case, repair is best performed with the patient under local anesthesia. Also, young patients in whom it is advantageous to avoid mesh should not undergo laparoscopic herniorrhaphy. The authors prefer laparoscopic TEP herniorrhaphy in patients with recurrent hernias, bilateral hernias, and unilateral hernias with a suspected contralateral hernia. There is also a consensus that patients with multiple recurrent hernias in whom a preperitoneal repair is appropriate are best served with a laparoscopic repair. Surgeons without advanced laparoscopic skills or without the time to develop the skills necessary to perform laparoscopic herniorrhaphy should consider referring patients with recurrent hernias to surgeons with experience in TEP. TEP is preferable to TAPP because of its lower complication and recurrence rates and in the authors' hands is the "best repair." TAPP should be reserved for patients with prior lower abdominal wall incisions that make the dissection of the peritoneum from the underside of the incision impossible. Patients who cannot tolerate general anesthesia or who have had extensive lower abdominal surgery should not undergo laparoscopic herniorrhaphy. Complication and recurrence rates, although initially higher than traditional repairs, have now fallen to equal or lower levels at centers experienced in laparoscopic techniques. Prospective randomized trials prove that when patients are selected properly and surgeons are adequately trained and proctored, laparoscopic herniorrhaphy can be performed with acceptably low incidences of recurrence and complications. PMID:9927983

  4. Umbilical hernia repair

    MedlinePLUS

    Umbilical hernia repair is surgery to repair an umbilical hernia . An umbilical hernia is a sac (pouch) formed from the inner ... and pain-free) for this surgery. If your hernia is small, you may receive spinal or epidural ...

  5. Hiatal hernia repair - series (image)

    MedlinePLUS

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

  6. Laparoscopic repair of Morgagni hernia

    Microsoft Academic Search

    E. Durak; S. Gur; A. Cokmez; K. Atahan; E. Zahtz; E. Tarcan

    2007-01-01

    Background  Foramen of Morgagni hernias are rare diaphragmatic hernias. They account for 3–5% of all diaphragmatic hernias and the majority\\u000a of the cases are asymptomatic. They are caused by trauma, obesity or pregnancy. With the advancements of laparoscopic surgery,\\u000a laparoscopic repair has become an excellent alternative to open repair for Morgagni hernias. We report five cases of Morgagni\\u000a hernia repaired with

  7. Single incision laparoscopic surgery (SILS) inguinal hernia repair - recent clinical experiences of this novel technique.

    PubMed

    Yussra, Y; Sutton, P A; Kosai, N R; Razman, J; Mishra, R K; Harunarashid, H; Das, S

    2013-01-01

    Inguinal hernia remains the most commonly encountered surgical problem. Various methods of repair have been described, and the most suitable one debated. Single port access (SPA) surgery is a rapidly evolving field, and has the advantage of affording 'scarless' surgery. Single incision laparoscopic surgery (SILS) for inguinal hernia repair is seen to be feasible in both total extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) approaches. Data and peri-operative information on both of these however are limited. We aimed to review the clinical experience, feasibility and short term complications related to laparoscopic inguinal hernia repair via single port access. A literature search was performed using Google Scholar, Springerlink Library, Highwire Press, Surgical Endoscopy Journal, World Journal of Surgery and Medscape. The following search terms were used: laparoscopic hernia repair, TAPP, TEP, single incision laparoscopic surgery (SILS). Fourteen articles in English language related to SILS inguinal hernia repair were identified. Nine articles were related to TEP repair and the remaining 5 to TAPP. A total of 340 patients were reported within these studies: 294 patients having a TEP repair and 46 a TAPP. Only two cases of recurrence were reported. Various ports have been utilized, including the SILS port, Tri-Port and a custom- made port using conventional laparoscopic instruments. The duration of surgery was 40-100 minutes and the average length of hospital stay was one day. Early outcomes of this novel technique show it to be feasible, safe and with potentially better cosmetic outcome. PMID:24217830

  8. Persistent postsurgical pain: evidence from breast cancer surgery, groin hernia repair, and lung cancer surgery.

    PubMed

    Werner, Mads Utke; Bischoff, Joakim Mutahi

    2014-01-01

    The prevalences of severe persistent postsurgical pain (PPP) following breast cancer surgery (BCS), groin hernia repair (GHR), and lung cancer surgery (LCS) are 13, 2, and 4-12 %, respectively. Estimates indicate that 80,000 patients each year in the U.S.A. are affected by severe pain and debilitating impairment in the aftermath of BCS, GHR, and LCS. Data across the three surgical procedures indicate a 35-65 % decrease in prevalence of PPP at 4-6 years follow-up. However, this is outweighed by late-onset PPP, which appears following a pain-free interval. The consequences of PPP include severe impairments of physical, psychological, and socioeconomic aspects of life. The pathophysiology underlying PPP consists of a continuing inflammatory response, a neuropathic component, and/or a late reinstatement of postsurgical inflammatory pain. While the sensory profiles of PPP-patients and pain-free controls are comparable with hypofunction on the surgical side, this seems to be accentuated in PPP-patients. In BCS-patients and GHR-patients, the sensory profiles indicate inflammatory and neuropathic components with contribution of central sensitization. A number of surgical factors including increased duration of surgery, repeat surgery, more invasive surgical techniques, and intraoperative nerve lesion have been associated with PPP. One of the most consistent predictive factors for PPP is high intensity acute postsurgical pain, but also psychological factors including anxiety, catastrophizing trait, depression, and psychological vulnerability have been identified as significant predictors of PPP. The quest to identify improved surgical and anesthesiological techniques to prevent severe pain and functional impairment in patients after surgery continues. PMID:24523139

  9. Umbilical hernia repair - series (image)

    MedlinePLUS

    ... In most cases, by age 3 the umbilical hernia shrinks and closes without treatment. The indications for umbilical hernia repair include: incarcerated (strangulated) umbilical hernia defects not ...

  10. Diaphragmatic hernia repair - series (image)

    MedlinePLUS

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

  11. Laparoscopic Paraesophageal Hernia Repair

    PubMed Central

    Medina, Laura; Peetz, Michael; Ratzer, Erick

    1998-01-01

    Background and Objective: Paraesophageal hernias are uncommon yet potentially lethal conditions. Their repair has now been facilitated by laparoscopic technology. We present a series of 20 patients with paraesophageal hernias repaired laparoscopically. Methods: Twenty patients with paraesophageal hernias had laparoscopic repairs. Eighteen patients had primary repair of their hiatal defect. Two required mesh reinforcement. Fifteen patients had a fundoplication procedure performed concomitantly. Results: Long-term follow-up is available on 17 patients. There was no in-hospital morbidity or mortality. Average length of stay was 2.3 days. One patient recurred in the immediate postoperative period. There were no other recurrences. The only death in the series occurred in the oldest patient 18 days postoperatively. He had been discharged from the hospital and died of cardiac failure. No patients have had complications from a paraesophageal hernia postoperatively. Conclusion: Laparoscopic repair of paraesophageal hernias is possible. Preoperative work-up should include motility evaluation to assess esophageal peristalsis as the majority of these will need a concomitant anti-reflux procedure. This data helps the surgeon to determine whether or not a complete or partial wrap should be done. Repair of the diaphragmatic defect can be accomplished in the majority of patients without the use of prosthetic material with excellent results. PMID:9876752

  12. Inguinal hernia repair - series (image)

    MedlinePLUS

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

  13. Psychological risk factors for chronic post-surgical pain after inguinal hernia repair surgery: A prospective cohort study

    Microsoft Academic Search

    Rachael Powell; Marie Johnston; W. Cairns Smith; Peter M. King; W. Alastair Chambers; Zygmunt Krukowski; Lorna McKee; Julie Bruce

    A significant proportion of patients experience chronic post-surgical pain (CPSP) following inguinal hernia surgery. Psychological models are useful in predicting acute pain after surgery, and in predicting the transition from acute to chronic pain in non-surgical contexts. This is a prospective cohort study to investigate psychological (cognitive and emotional) risk factors for CPSP after inguinal hernia surgery. Participants were asked

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

    PubMed Central

    2014-01-01

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

  15. Laparoscopic repair of a Morgagni hernia

    Microsoft Academic Search

    H. G. Rau; H. M. Schardey; V. Lange

    1994-01-01

    Laparoscopic repair of a diaphragmatic hernia through the right sternocostal foramen of Morgagni in an obese 42-year-old man is described. The indications for surgery were symptoms of strain-induced dyspnea and tightness in the chest. The technique was carried out by incorporating a marlex mesh into the defect and fixing it in place with hernia staples. The patient had an immediate

  16. Robotic Repair of Giant Paraesophageal Hernias

    PubMed Central

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

    2013-01-01

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

  17. Two ports laparoscopic inguinal hernia repair in children.

    PubMed

    Ibrahim, Medhat M

    2015-01-01

    Introduction. Several laparoscopic treatment techniques were designed for improving the outcome over the last decade. The various techniques differ in their approach to the inguinal internal ring, suturing and knotting techniques, number of ports used in the procedures, and mode of dissection of the hernia sac. Patients and Surgical Technique. 90 children were subjected to surgery and they undergone two-port laparoscopic repair of inguinal hernia in children. Technique feasibility in relation to other modalities of repair was the aim of this work. 90 children including 75 males and 15 females underwent surgery. Hernia in 55 cases was right-sided and in 15 left-sided. Two patients had recurrent hernia following open hernia repair. 70 (77.7%) cases were suffering unilateral hernia and 20 (22.2%) patients had bilateral hernia. Out of the 20 cases 5 cases were diagnosed by laparoscope (25%). The patients' median age was 18 months. The mean operative time for unilateral repairs was 15 to 20 minutes and bilateral was 21 to 30 minutes. There was no conversion. The complications were as follows: one case was recurrent right inguinal hernia and the second was stitch sinus. Discussion. The results confirm the safety and efficacy of two ports laparoscopic hernia repair in congenital inguinal hernia in relation to other modalities of treatment. PMID:25785196

  18. Inguinal hernia repair: anaesthesia, pain and convalescence.

    PubMed

    Callesen, Torben

    2003-08-01

    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

  19. WSES guidelines for emergency repair of complicated abdominal wall hernias

    PubMed Central

    2013-01-01

    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

  20. Totally extraperitoneal laparoendoscopic repair of lumbar hernia

    Microsoft Academic Search

    A. K. Meinke

    2003-01-01

    Background: The repair of congenital and acquired lumbar hernias has remained a significant surgical challenge for over three centuries. Transperitoneal laparoendoscopic techniques have been reported that have achieved success in repairing these difficult hernias using a variety of synthetic mesh. Careful review of the surgical literature addressing the repair of lumbar hernia reveals that only fourteen successful cases have been

  1. Analgesic Effect of Bupivacaine on Extraperitoneal Laparoscopic Hernia Repair

    Microsoft Academic Search

    Gary N. Saff; Richard A. Marks; Max Kuroda; Jonathan P. Rozan; Ronnie Hertz

    1998-01-01

    Local anesthetics decrease postoperative pain when placed at the surgical site. Patients benefit from laparo- scopic extraperitoneal hernia repair because this allows earlier mobilization than the more classical open surgical approach The purpose of this study was to determine the pain-sparing efficacy of local anesthetics placed in the pre- peritoneal fascial plane during extraperitoneal laparo- scopic inguinal hernia surgery. Forty-two

  2. Hiatal hernia repair with biologic mesh reinforcement reduces recurrence rate in small hiatal hernias.

    PubMed

    Schmidt, E; Shaligram, A; Reynoso, J F; Kothari, V; Oleynikov, D

    2014-01-01

    The utility of mesh reinforcement for small hiatal hernia found especially during antireflux surgery is unknown. Initial reports for the use of biological mesh for crural reinforcement during repair for defects greater than 5?cm have been shown to decrease recurrence rates. This study compares patients with small hiatal hernias who underwent onlay biologic mesh buttress repair versus those with suture cruroplasty alone. This is a single-institution retrospective review of all patients undergoing repair of hiatal hernia measuring 1-5?cm between 2002 and 2009. The patients were evaluated based on surgical repair: one group undergoing crural reinforcement with onlay biologic mesh and other group with suture cruroplasty only. Seventy patients with hiatal hernia measuring 1-5?cm were identified. Thirty-eight patients had hernia repair with biologic mesh, and 32 patients had repair with suture cruroplasty only. Recurrence rate at 1 year was 16% (5/32) in patients who had suture cruroplasty only and 0% (0/38) in the group with crural reinforcement with absorbable mesh (statistically significant, P?=?0.017). Suture cruroplasty alone appears to be inadequate for hiatal hernias measuring 1-5?cm with significant recurrence rate and failure of antireflux surgery. Crural reinforcement with absorbable mesh may reduce hiatal hernia recurrence rate in small hiatal hernias. PMID:23441634

  3. Perineal hernia repair in dogs.

    PubMed

    Robertson, J J

    1984-05-01

    Old male Collies, Pekingese , Boxers and Boston Terriers are predisposed to perineal hernia. Recurrence is often related to poor surgical technic in the initial repair. With the anesthetized dog in sternal recumbency and the tail tied forward, a curvilinear skin incision is made over the hernia, from the tail base to the midline, ventral to the anus. The hernial sac is opened and its contents reduced. Five stainless-steel sutures are preplaced in the muscles and ligaments of the perineal diaphragm and tied from top to bottom. In cases of failure of the ventral aspect of the repair, the internal obturator muscle can be elevated from the ischial table and used to cover the ventral aspect of the hernia. Postoperative complications are related to infection, self-trauma and straining. PMID:6738509

  4. Laparoscopic fascial suture repair of parastomal hernia

    PubMed Central

    Zia, Khawaja; McGowan, David Ross; Moore, Etienne

    2013-01-01

    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

  5. Hiatal hernia

    MedlinePLUS

    Hernia - hiatal ... over or lying down Swallowing difficulty A hiatal hernia by itself rarely causes symptoms. Pain and discomfort ... from backing up Surgery to repair the hiatal hernia Other measures to reduce symptoms include: Avoiding large ...

  6. Laparoscopic repair of adult Bochdalek's hernia

    PubMed Central

    Husain, Musharraf; Hajini, Firdoos Farooq; Ganguly, Pavitra; Bukhari, Syed

    2013-01-01

    Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring in approximately 1 in 2200–12?500 live births. It is considered to be extremely rare in adults and poses a diagnostic challenge. We present a case of a young man who was diagnosed as a case of congenital Bochdalek's hernia and underwent laparoscopic mesh repair. PMID:23761496

  7. Lymphoma diagnosed at inguinal hernia repair.

    PubMed

    Veal, David R; Hammil, Chet W; Wong, Linda L

    2010-02-01

    Tumors presenting in the inguinal hernia sac are considered to be extremely rare, with the more common neoplasms metastasizing from the gastrointestinal tract, ovary and prostate. We report the case of Mantle cell lymphoma identified in the inguinal hernia sac following hernia repair While the hernia sac appeared normal to the surgeon, evaluation by the pathologist showed subtle gross irregularities, with subsequent histologic and immunochemical diagnosis of Mantle cell lymphoma. Twelve previous cases of a lymphoma diagnosed during hernia repair have been described in the English literature. This is the first report of Mantle cell lymphoma found in the hernia sac. This case illustrates the value of routine microscopic evaluation of hernia sacs found from inguinal/femoral herniorrhaphies, as it may be the primary presentation of an asymptomatic metastatic lymphoma. Additionally it underscores the importance of the surgeon's role in screening hernia sacs if the practice of submitting only macroscopically abnormal specimens for microscopic evaluation is adopted. PMID:20358722

  8. [Hernia surgery in urology: part 1: inguinal, femoral and umbilical hernias - fundamentals of clinical diagnostics and treatment].

    PubMed

    Franz, T; Schwalenberg, T; Dietrich, A; Müller, J; Stolzenburg, J-U

    2013-05-01

    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

  9. [Hernia surgery in urology. Part 2: parastomal, trocar and incisional hernias - fundamentals of clinical diagnostics and treatment].

    PubMed

    Franz, T; Schwalenberg, T; Dietrich, A; Müller, J; Stolzenburg, J-U

    2013-06-01

    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

  10. Single-Incision Laparoscopic Ventral Hernia Repair with Suprapubic Incision

    PubMed Central

    Turingan, Isidro; Tran, Mai

    2013-01-01

    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. PMID:23925028

  11. Laparoscopic ventral hernia repair: a systematic review

    Microsoft Academic Search

    Clarabelle T. Pham; Caryn L. Perera; D. Scott Watkin; Guy J. Maddern

    2009-01-01

    Background  Laparoscopic ventral hernia repair may be an alternative to open mesh repair as it avoids a large abdominal incision, and\\u000a thus potentially reduces pain and hospital stay. This review aimed to assess the safety and efficacy of laparoscopic ventral\\u000a hernia repair in comparison with open ventral hernia repair.\\u000a \\u000a \\u000a \\u000a Method  A systematic review was conducted, with comprehensive searches identifying six randomised controlled

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

    PubMed Central

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

    2014-01-01

    Background: This study was performed to evaluate the effect of Stoppa hernia repair on sexual function of the patients with bilateral inguinal hernia. Methods: In a prospective follow-up study, 50 patients with bilateral inguinal hernia were investigated to assess sexual function before and 1 and 6 months after standardized Stoppa hernioplasty using the International Index of Erectile Function (IIEF) questionnaire. The mean scores obtained on pre- and postoperative visits for all domains of sexual function were analyzed and compared with the Friedman and paired Wilcoxon tests. Results: The mean score of IIEF at the first month after surgery was significantly declined compared to that before surgery and 6 months after surgery (P< 0.001), while the difference between preoperative score and the score at 6 months after surgery was not significant Conclusion: Bilateral inguinal mesh repair with Stoppa technique can decreased sexual activity of the patients at one month after surgery, nevertheless it returns to its initial condition at 6 months after surgery. This suggests that the Stoppa technique does not affect the sexual function of patients with bilateral inguinal hernia. PMID:25405114

  13. Simple repair of a giant inguinoscrotal hernia

    PubMed Central

    Coetzee, E.; Price, C.; Boutall, A.

    2010-01-01

    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. PMID:22096682

  14. A pseudo-TEP repair of an incarcerated obturator hernia

    PubMed Central

    Maricevich, Marco; Farley, David

    2011-01-01

    Introduction Obturator hernia (OH) is a rare condition and difficult to diagnose. While they account for as few as 0.073% of all hernias, mortality can be as high as 70%. The typical clinical presentation for OH is small bowel obstruction. Computed tomography is the diagnostic tool of choice. Surgical repair is mandatory in virtually all cases of OH and traditionally consists of performing an exploratory laparotomy. Presentation of case A 90-year-old female was admitted to our surgical service with signs of small bowel obstruction and a CT scan revealing incarcerated fatty tissue and small bowel within a left OH. Discussion The role of laparoscopic surgery in the management of OH has been limited to elective repairs; most reports detail that the OH was found serendipitously during laparoscopic inguinal hernia operations or other pelvic procedures. A few reports describe the use of laparoscopy to treat OH associated with bowel obstruction in an emergency setting using a TAPP approach. A strict TEP hernia repair is not indicated for all patients with OH, and should rarely be performed in emergency situations given its limitation to assess or resect bowel if necessary. In selected cases, a formal exploratory laparoscopy that is negative for compromised bowel can be safely followed by a TEP repair using the same umbilical access as shown in our patient. Conclusion A 90-year-old female with a small bowel obstruction related to an incarcerated OH was treated effectively with an extraperitoneal laparoscopic approach. PMID:22096757

  15. Sutureless mesh fibrin glue incisional hernia repair

    Microsoft Academic Search

    M. Canziani; F. Frattini; M. Cavalli; S. Agrusti; F. Somalvico; G. Campanelli

    2009-01-01

    Purpose  The aim of this study is to evaluate the usefulness of sutureless incisional open hernia repair with mesh fixation only using\\u000a a fibrin glue sealant.\\u000a \\u000a \\u000a \\u000a Methods  From 2002 to 2007, 40 patients underwent surgical recurrent incisional hernia repair, consisting of a sutureless positioning\\u000a of a retromuscolar-preperitoneal polypropylene stiff mesh, fixed only with 2 ml of human fibrin glue.\\u000a \\u000a \\u000a \\u000a Results  The average hospitalization period

  16. Abdominoplasty repair for abdominal wall hernias.

    PubMed

    Robertson, J Douglas; de la Torre, Jorge I; Gardner, Paul M; Grant, John H; Fix, R Jobe; Vásconez, Luis O

    2003-07-01

    The objectives of abdominal hernial repair are to reconstruct the structural integrity of the abdominal wall while minimizing morbidity. Current techniques include primary closure, staged repair, and the use of prosthetic materials. Techniques for abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. By incorporating these aspects into hernial repairs, the procedures are made safer and the results are improved. The medical records were reviewed of 123 consecutive patients who underwent hernial repair. Seventy-six of these patients underwent a total of 82 herniorrhaphies using an abdominoplasty approach. This included using a transverse lower abdominal incision with or without extending it into an inverted-T incision. The hernial defect was then identified and isolated. Repair was obtained with primary fascial closure and plication, primary fascial approximation and reinforcement with absorbable Vicryl mesh, or placement of permanent mesh with or without fascial approximation. Overall, 8 of 82 hernias recurred. Most complications were minor and could be managed with local wound care only. Major complications included one enterocutaneous fistula, one occurrence of skin flap necrosis requiring operative debridement and skin grafting, and one delayed permanent mesh extrusion 2 years after repair. The abdominoplasty approach isolates the incision from the hernial defect and repair. This technique is safe with a low risk of complications and a low rate of recurrence. It is particularly helpful in obese patients, in patients with multiple hernias, and in those patients with recurrent hernias. PMID:12838119

  17. Symptomatic intercostal lung hernia secondary to sternal dehiscence surgery

    PubMed Central

    Çelik, Sezai; Aydemir, Cüneyt; Gürer, Onur; I??k, Ömer

    2013-01-01

    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. PMID:23826467

  18. Laparoscopic repair of Morgagni hernia with composite mesh in an elderly woman: Report of a case.

    PubMed

    Ikarashi, Masahito; Matsuda, Minoru; Murayama, Isao; Fujii, Masashi; Takayama, Tadatoshi

    2015-05-01

    A 78-year-old woman was admitted to another hospital with vomiting. Chest X-ray showed an abnormal shadow in the lower right lung field, and CT indicated a Morgagni hernia containing the stomach and transverse colon. The patient was transferred to our hospital and underwent laparoscopic surgery. After the hernia contents were repositioned into the abdominal cavity, we repaired the hernia orifice with a prosthetic mesh to achieve a tension-free repair. There were no complications after the surgery, and there has been no recurrence. The patient has remained free of clinical symptoms since 10 months after the surgery. Laparoscopic repair with a prosthetic mesh for Morgagni hernia is a simple and safety procedure for elderly patients. PMID:25913591

  19. [Hernia surgery: the unavoidable era of laparoscopy].

    PubMed

    Inan, I; Morel, P

    2006-06-14

    Optimal treatment of groin hernia is a primary public health concern. The inguinal hernia is associated with dysfunctions of the collagen matrix of genetic or acquired origin. Recurrence rate after hernia surgery without mesh reinforcement is estimated at 10-15%. The use of mesh decreases the risk of recurrence by between 50 and 70%. The open techniques (Lichtenstein and derived) are easy to learn, feasible with local anaesthesia and in outpatient setting but they produce chronic pain and sexual disorders. Laparoscopic surgery produces less acute and chronic pain, allows a faster return to the daily activities and allows better cosmetic results. Well codified and taught, the laparoscopy has an important role to play in hernia surgery today as well as in the future. PMID:16838724

  20. Morgagni hernia treated by reduced port surgery

    PubMed Central

    Kashiwagi, Hiroyuki; Kumagai, Kenta; Nozue, Mutsumi; Terada, Yasushi

    2014-01-01

    INTRODUCTION The laparoscopic repair of a rare diaphragmatic Morgagni hernia using the reduced port approach is described. PRESENTATION OF CASE An 85-year-old female presented with a 2 days history of upper abdominal discomfort and loss of appetite. We diagnosed her condition as a Morgagni hernia by morphological studies and performed laparoscopic mesh placement with a multi-channel port and 12-mm port. This elderly patient had a rapid postoperative recovery. A 2-year follow-up CT showed no recurrence of the hernia. DISCUSSION Recent trends in laparoscopic procedures have been toward minimizing the number of incisions to reduce invasiveness. This case indicated that the reduced port approach can be considered a suitable and safe procedure for treatment of Morgagni hernia. CONCLUSION The reduced port approach is a good indication for Morgagni hernia. PMID:25437681

  1. Laparoscopic repair of postoperative perineal hernia

    Microsoft Academic Search

    J.-L. Dulucq; P. Wintringer; A. Mahajna

    2006-01-01

    Background  Perineal hernia is an uncommon complication following abdominoperineal resection of the rectum. There are only a few reports\\u000a concerning the management of this unusual problem. Various methods of repair have been described, but none of them is well\\u000a established. The purpose of our study is to present our experience and to discuss the pathogenesis and the different surgical\\u000a repair techniques

  2. Laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni

    Microsoft Academic Search

    M. Orita; M. Okino; K. Yamashita; N. Morita; K. Esato

    1997-01-01

    .   A 78-year-old woman is described who presented with a diaphragmatic hernia through the foramen of Morgagni. A definitive\\u000a diagnosis was confirmed by a sagittal view on magnetic resonance imaging prior to surgery. The hernia was repaired laparoscopically\\u000a under an abdominal wall lifting technique without pneumoperitoneum, and her symptoms completely resolved postoperatively with\\u000a no evidence of recurrence. The laparoscopic repair

  3. [Enterocutaneous fistula after Marlex net implantation. A rare complication after incisional hernia repair].

    PubMed

    Seelig, M H; Kasperk, R; Tietze, L; Schumpelick, V

    1995-07-01

    Erosions of intraabdominal hollow viscus are possible complications following reconstructive surgery of the abdominal wall after hernia repair with non-absorbable biomaterials. A rare case of manifestation of a enterocutaneous fistula by chronical erosion of a Marlex mesh after repair of an incisional hernia is presented. Successful treatment was achieved by fistulectomy, small bowel segmental resection and limited resection of the implanted Marlex mesh. PMID:7671764

  4. Inguinal hernia developed after radical retropubic surgery for prostate cancer

    PubMed Central

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

    2013-01-01

    Purpose In this retrospective study, we aimed to compare the clinical characteristics of inguinal hernia developed after radical retropubic surgery for prostate cancer to the hernia without previous radical prostatectomy. Methods Twenty-three patients (group A) who had radical retropubic surgery for prostate cancer underwent laparoscopic or open tension-free inguinal hernia repair from March 2007 to February 2011. Nine hundred and forty patients (group B) without previous radical retropubic surgery received laparoscopic or tension-free open hernia operation. Results Group A was older than group B (mean ± standard deviation, 69.6 ± 7.2 vs. 54.1 ± 16.1; P < 0.001). Right side (73.9%) and indirect type (91.3%) in group A were more prevalent than in group B (51.5% and 69.4%, respectively) with statistic significance (P = 0.020 and P = 0.023). The rate of laparoscopic surgery in group B (n = 862, 91.7%) was higher than in group A (n = 14, 64.3%, P < 0.001). In comparing perioperative variables between the two groups, operative time (49.4 ± 23.5 minutes) and hospital stay (1.9 ± 0.7 days) in group A were longer than in group B (38.9 ± 16.9, 1.1 ± 0.2; P = 0.046 and P < 0.001, respectively) and pain score at 7 days in group A was higher than in group B (3.1 ± 0.7 vs. 2.3 ± 1.0, P < 0.001). Postoperative recurrence rate was not significantly different between the two groups. Conclusion Inguinal hernia following radical retropubic surgery for prostate cancer was predominantly right side and indirect type with statistic significance compared to hernias without previous radical prostatectomy. PMID:24106684

  5. Repair of complex parastomal hernias.

    PubMed

    Hwang, G S; Hanna, M H; Carmichael, J C; Mills, S D; Pigazzi, A; Stamos, M J

    2015-03-01

    Development of parastomal hernias (PH) is very common after stoma formation and carries a risk of subsequent bowel incarceration, obstruction and strangulation. The management of PH remains a challenge for the colorectal surgeon, and there are currently no standardized guidelines for the treatment of PH. Even more difficult is the management of complex parastomal hernias (CPH). We conducted a review of the literature to identify recent developments in the treatment of CPH, including analysis of the use of synthetic and biologic mesh prostheses, method of mesh placement and surgical approach. PMID:25732736

  6. Short-term outcome of single-incision laparoscopic totally extra-peritoneal inguinal hernia repair.

    PubMed

    Wakasugi, Masaki; Akamatsu, Hiroki; Tori, Masayuki; Ueshima, Shigeyuki; Omori, Takeshi; Tei, Mitsuyoshi; Masuzawa, Toru; Nishida, Toshirou

    2013-05-01

    We performed single-incision laparoscopic surgery for totally extra-peritoneal (SILS-TEP) repair using a lightweight mesh fixed by absorbable tacks and without balloon dilation. Thirty-four patients (mean age, 66.5 years) underwent SILS-TEP repair in our hospital between September 2011 and April 2012; 30 patients had unilateral hernia and 4 had bilateral hernias. Mean operative time was 85.6?min for unilateral hernia and 137.7?min for bilateral hernias. All patients underwent successful SILS-TEP repair. Mean hospital stay was 3.4 days. Mean duration of follow-up was 7.1 months. Four seromas were observed, but no recurrences or major complications occurred. SILS-TEP is an economical and useful method for decreasing postoperative complications, such as neuralgia and recurrence, and it could be an attractive approach for inguinal hernia. PMID:23602002

  7. Laparoscopic repair of parastomal and incisional hernias with a modified Sugarbaker technique

    PubMed Central

    Jeong, Duck Hyoun; Park, Min Geun; Melich, George; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk

    2013-01-01

    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. PMID:23741696

  8. Early outcome of incisional hernia repair using polypropylene mesh: A preliminary report

    PubMed Central

    Udo, Isaac A.; Bassey, Emem A.; Abasiattai, Aniekan M.

    2014-01-01

    Background: The use of prosthetics for open repair of incisional hernia is very recent in our practice. We highlight our experience repairing incisional hernias with polypropylene mesh. Patients and Methods: Patients presenting with incisional hernia >5 cm in length or width received open polypropylene mesh repair and were followed for two years. Data obtained included age, sex, primary surgery causing the hernia, the length of the fascial defect and previous attempts at repair. Post-operative wound complications were recorded. The integrity of the scar and patient satisfaction or concerns with the repair was assessed at each visit. Results: Nineteen females with a mean age of 35 years (range 30-54) underwent repair; most arising from obstetric or gynaecological procedures. Sixteen (82.2%) had midline, 2 (10.5) transverse and 1 (5.3) Pfannenstiel scars. One patient had no previous repair (R0), 7 had undergone one repair (R1), 9 had undergone two repairs (R2) and 1 had three previous repairs (R3). The length of fascial defects ranged from 8 to 18 cm and seroma collection and stitch sinus were the common problems encountered. Two (10.5%) recurrences were recorded in two years. Conclusion: Open mesh repair of incisional hernia carries a low risk of infection and recurrence in two years. PMID:25114370

  9. Hiatus Hernia Repair with Bilateral Oesophageal Fixation

    PubMed Central

    Martin, David

    2015-01-01

    Background. Despite advances in surgical repair of hiatus hernias, there remains a high radiological recurrence rate. We performed a novel technique incorporating bilateral oesophageal fixation and evaluated outcomes, principally symptom improvement and hernia recurrence. Methods. A retrospective study was performed on a prospective database of patients undergoing hiatus hernia repair with bilateral oesophageal fixation. Retrospective and prospective quality of life (QOL), PPI usage, and patient satisfaction data were obtained. Hernia recurrence was assessed by either barium swallow or gastroscopy. Results. 87 patients were identified in the database with a minimum of 3 months followup. There were significant improvements in QOL scores including GERD HRQL (29.13 to 4.38, P < 0.01), Visick (3 to 1), and RSI (17.45 to 5, P < 0.01). PPI usage decreased from a median of daily to none, and there was high patient satisfaction (94%). 57 patients were assessed for recurrence with either gastroscopy or barium swallow, and one patient had evidence of recurrence on barium swallow at 45 months postoperatively. There was an 8% complication rate and no mortality or oesophageal perforation. Conclusions. This study demonstrates that our technique is both safe and effective in symptom control, and our recurrence investigations demonstrate at least short term durability. PMID:26065030

  10. Laparoscopic repair of post-abdominoperineal resection hernia: biological mesh and augmentation technique.

    PubMed

    Chelala, E; Declercq, S

    2013-11-16

    Perineal hernias are infrequent complications following abdominoperineal surgeries. These hernias require surgical repair when they become symptomatic by several conventional or reconstructive techniques. The benefits of a full laparoscopic approach and/or the combined approach of a perineal repair of the pelvic floor associated to the laparoscopic placement of a traditional synthetic mesh have been previously demonstrated. In this article, we present the case of a perineal incisional hernia, post-abdominoperineal resection of the rectum after radio chemotherapy, in the neoadjuvant treatment of a rectal adenocarcinoma tumor. An alternative approach, not previously described for the surgical repair of this type of hernia, is presented to assess the feasibility of the suturing repair, and efficacy of a biological acellular porcine collagen implant Permacol(®). A full laparoscopic suturing for the closure of the perineal defect associated to biological mesh reinforcement was successfully undertaken, with good short-term outcomes. PMID:24241325

  11. Comparison of laparoscopic versus open repair of paraesophageal hernia

    Microsoft Academic Search

    Philip R Schauer; Sayeed Ikramuddin; Robert H McLaughlin; Toby O Graham; Adam Slivka; K. K. W Lee; W. H Schraut; J. D Luketich

    1998-01-01

    Background: Recent reports suggest that laparoscopic paraesophageal hernia repair (LPHR) is feasible, but no direct comparisons with the standard open paraesophageal hernia repair (OPHR) have been reported. The purpose of this study was to compare the short-term outcome of LPHR versus OPHR at a single institution.Methods: The operative and postoperative courses of 95 consecutive patients undergoing open or laparoscopic repair

  12. Elective laparoscopic surgery for sigmoid colon carcinoma incarcerated within an inguinal hernia: report of a case.

    PubMed

    Kanemura, Takashi; Takeno, Atsushi; Tamura, Shigeyuki; Okishiro, Masatsugu; Nakahira, Shin; Suzuki, Rei; Nakata, Ken; Egawa, Chiyomi; Miki, Hirohumi; Takeda, Yutaka; Kato, Takeshi

    2014-07-01

    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

  13. Laparoscopic repair of massive inguinal hernia containing the urinary bladder

    PubMed Central

    Khan, Atif; Beckley, Ian; Dobbins, Brian; Rogawski, Karol M

    2014-01-01

    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. PMID:24833832

  14. Single-Incision Laparoscopic Repair of Spigelian Hernia

    PubMed Central

    Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne J.

    2015-01-01

    Introduction: Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair. Methods: From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh. Results: There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m2. An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1–15 months). Conclusions: Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal herniorrhaphy. PMID:25722629

  15. Vesical calculus formation on non-absorbable sutures used for open inguinal hernia repair

    PubMed Central

    Almarzouq, Ahmad; Mahmoud, Akram H.; Ashebu, Samuel D.; Kehinde, Elijah O.

    2014-01-01

    INTRODUCTION Iatrogenic injuries to the urogenital tract are rare, with the bladder being the organ most affected. We describe a case of a vesical calculus that formed on non-absorbable sutures that were used to repair an inguinal hernia. PRESENTATION OF CASE A 45-year-old male presented with frank haematuria and dysuria 2 years following an open left inguinal hernia repair. A CT urography showed a vesical calculus adherent to the left anterio-lateral wall of the bladder. Cystoscopy revealed that the calculus formed on non-absorbable sutures. Cystolapaxy was performed followed by cystoscopic excision of the sutures. The patient's post-operative course was uneventful. DISCUSSION Foreign bodies in the urinary bladder always act as a nidus for formation of a calculus. Iatrogenic bladder injuries are common during hernia repair. It is however rare for sutures used to repair an inguinal hernia to involve the urinary bladder wall. The patient most likely had a full bladder at the time of hernia repair or the bladder was part of the contents of the hernia sac. CONCLUSION This case illustrates the need to ensure that the bladder is empty prior to pelvic surgery and for surgeons to have a good understanding of inguinal anatomy to avoid injuring the contents of the hernia sac. PMID:25308188

  16. Medical effectiveness and safety of conventional compared to laparoscopic incisional hernia repair: A systematic review

    Microsoft Academic Search

    Falk Müller-Riemenschneider; Stephanie Roll; Meik Friedrich; Juergen Zieren; Thomas Reinhold; J.-Matthias Graf von der Schulenburg; Wolfgang Greiner; Stefan N. Willich

    2007-01-01

    Background  Incisional hernias are a common complication following abdominal surgery and represent about 80% of all ventral hernia. In\\u000a uncomplicated postoperative follow-up they develop in about 11% of cases and in up to 23% of cases with wound infections or\\u000a other forms of wound complications. While conventional mesh repair has been the standard of care in the past, the use of

  17. Resolution of prolonged neonatal apnea with hernia repair.

    PubMed

    Yeaton, H L; Mellish, R W

    1983-04-01

    Three cases of hernia repair and simultaneous resolution of prolonged neonatal apnea are reported. An association has been made between vagal overactivity and apnea. Protrusion of a large hernia at times of vagal stimulation is suggested as a possible mechanism resulting in sustained inhibition of the respiratory control center by increasing vagal afferent traffic to this center. Consideration should be given to repair of hernias in the premature infant with neonatal apnea rather than wait for resolution of the apneic episodes. PMID:6854494

  18. Morbidity associated with laparoscopic repair of suprapubic hernias

    Microsoft Academic Search

    Brandon Varnell; Sharon Bachman; Jacob Quick; Michelle Vitamvas; Bruce Ramshaw; Dmitry Oleynikov

    2008-01-01

    BackgroundLaparoscopic suprapubic hernia repair (LSHR) is frequently a technically difficult procedure. This is often due to extensive adhesions from multiple previous operations, the necessary wide pelvic dissection, and adequate mesh coverage with transfascial suture fixation. The aim of the current study was to document the complications and morbidity associated with the repair of suprapubic hernias.

  19. Technique of parastomal hernia repair using synthetic mesh

    Microsoft Academic Search

    Michael E Franks; Ronald L Hrebinko

    2001-01-01

    We describe a reliable and simple technique of parastomal hernia repair using primary fascial repair with synthetic mesh that minimizes the known complications of infection and stomal stenosis while eliminating the need for peritoneal exploration, lysis of adhesions, and relocation of the stoma. We applied this technique to 6 patients (aged 65 to 83 years) with symptomatic, first-time parastomal hernias.

  20. The Role of Fibrin Glue Polypropylene Mesh Fixation in Open Inguinal Hernia Repair

    PubMed Central

    Odobasic, Amer; Krdzalic, Goran; Hodzic, Mirsad; Hasukic, Sefik; Sehanovic, Aida; Odobasic, Ademir

    2014-01-01

    ABSTRACT The aim: of this study was to compare two methods of polypropylene mesh fixation for inguinal hernia repair according to Lichtenstein using fibrin glue and suture fixation. Material and Methods: The study included 60 patients with unilateral inguinal hernia, divided into two groups of 30 patients – Suture fixation and fibrin glue fixation. All patients were analyzed according to: age, gender, body mass index (BMI), indication for surgery–the type, localization and size of the hernia, preoperative level of pain and the type of surgery. Overall postoperative complications and the patient’s ability to return to regular activities were followed for 3 months. Results and discussion: Statistically significant difference in the duration of surgery, pain intensity and complications (p<0.05) were verified between method A, the group of patients whose inguinal hernia was repaired using polypropylene mesh–fibrin glue and method B, where inguinal hernia was repaired with polypropylene mesh using suture fixation. Given the clinical research, this systematic review of existing results on the comparative effectiveness, will help in making important medical decisions about options for surgical treatment of inguinal hernia. Conclusions: The results of this study may impact decision making process for recommendations of methods of treatment by professional associations, making appropriate decisions on hospital procurement of materials, as well as coverage of health funds and insurance. PMID:24937929

  1. Transfascial suture in laparoscopic ventral hernia repair; friend or foe?

    PubMed

    Sahu, Diwakar; Das, Somak; Wani, Majid Rasool; Reddy, Prasanna Kumar

    2015-01-01

    'Suture hernia' is fairly a new and rare type of ventral hernia. It occurs at the site of transfascial suture, following laparoscopic ventral hernia repair (LVHR). Employment of transfascial sutures in LVHR is still debatable in contrast to tackers. Prevention of mesh migration and significant post-operative pain are the pros and cons with the use of transfascial sutures, respectively. We report an unusual case of suture hernia or transfascial hernia, which can further intensify this dispute, but at the same time will provide insight for future consensus. PMID:25883460

  2. Transfascial suture in laparoscopic ventral hernia repair; friend or foe?

    PubMed Central

    Sahu, Diwakar; Das, Somak; Wani, Majid Rasool; Reddy, Prasanna Kumar

    2015-01-01

    ‘Suture hernia’ is fairly a new and rare type of ventral hernia. It occurs at the site of transfascial suture, following laparoscopic ventral hernia repair (LVHR). Employment of transfascial sutures in LVHR is still debatable in contrast to tackers. Prevention of mesh migration and significant post-operative pain are the pros and cons with the use of transfascial sutures, respectively. We report an unusual case of suture hernia or transfascial hernia, which can further intensify this dispute, but at the same time will provide insight for future consensus. PMID:25883460

  3. Simultaneous Prosthetic Mesh Abdominal Wall Reconstruction with Abdominoplasty for Ventral Hernia and Severe Rectus Diastasis Repairs

    PubMed Central

    Cheesborough, Jennifer E.

    2015-01-01

    Background: Standard abdominoplasty rectus plication techniques may not suffice for severe cases of rectus diastasis. In the authors’ experience, prosthetic mesh facilitates the repair of severe rectus diastasis with or without concomitant ventral hernias. Methods: A retrospective review of all abdominal wall surgery patients treated in the past 8 years by the senior author (G.A.D.) was performed. Patients with abdominoplasty and either rectus diastasis repair with mesh or a combined ventral hernia repair were analyzed. Results: Thirty-two patients, 29 women and three men, underwent mesh-reinforced midline repair with horizontal or vertical abdominoplasty. Patient characteristics included the following: mean age, 53 years; mean body mass index, 26 kg/m2; average width of diastasis or hernia, 6.7 cm; and average surgery time, 151 minutes. There were no surgical-site infections and two surgical-site occurrences—two seromas treated with drainage in the office. After an average of 471 days’ follow-up, none of the patients had recurrence of a bulge or a hernia. Conclusions: For patients with significant rectus diastasis, with or without concomitant hernias, the described mesh repair is both safe and durable. Although this operation requires additional dissection and placement of prosthetic mesh in the retrorectus plane, it may be safely combined with standard horizontal or vertical abdominoplasty skin excision techniques to provide an aesthetically pleasing overall result. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. PMID:25539311

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

    PubMed

    Lubowiecka, Izabela

    2015-01-01

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

  5. Laparoscopic spigelian hernia repair: a series of 40 patients.

    PubMed

    Kelly, Michael E; Courtney, Danielle; McDermott, Frank D; Heeney, Anna; Maguire, Donal; Geoghegan, Justin G; Winter, Des C

    2015-06-01

    Spigelian hernias are a rare abdominal wall hernia. The aim of this study was to assess the efficacy and outcomes of patients who underwent a laparoscopic spigelian hernia repair. A retrospective study was performed reviewing all patients who had a laparoscopic spigelian hernia repair. We assessed the success of the procedure including conversion rates, postoperative morbidities, and recurrence rates. Forty patents had a laparoscopic repair. Two thirds (n=25) had an intraperitoneal repair. There was no conversion to open repair. Four patients had postoperative morbidities. At 6-month follow-up all patients were pain free, with 1 recurrence. There is considerable evidence supporting the opinion that laparoscopic repair offers excellent outcomes. This report is the largest series to date, and we advocate that this approach should become the standard of care. PMID:25383942

  6. Current options in inguinal hernia repair in adult patients

    PubMed Central

    Kulacoglu, H

    2011-01-01

    Inguinal hernia is a very common problem. Surgical repair is the current approach, whereas asymptomatic or minimally symptomatic hernias may be good candidate for watchful waiting. Prophylactic antibiotics can be used in centers with high rate of wound infection. Local anesthesia is a suitable and economic option for open repairs, and should be popularized in day-case setting. Numerous repair methods have been described to date. Mesh repairs are superior to "nonmesh" tissue-suture repairs. Lichtenstein repair and endoscopic/laparoscopic techniques have similar efficacy. Standard polypropylene mesh is still the choice, whereas use of partially absorbable lightweight meshes seems to have some advantages. PMID:22435019

  7. Laparoscopic ventral and incisional hernia repair in 407 patients 1 1 No competing interests declared

    Microsoft Academic Search

    B. Todd Heniford; Adrian Park; Bruce J Ramshaw; Guy Voeller

    2000-01-01

    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

  8. New minimally invasive technique of parastomal hernia repair – methods and review

    PubMed Central

    Skoneczny, Pawe?; Przywózka, Alicja; Czy?ewski, Piotr; Bury, Kamil

    2015-01-01

    Introduction Parastomal hernia is described as the most common complication in patients with ostomy. It is reported that its incidence varies from 3% to 39% for colostomies and 0 to 6% for ileostomies. Surgical repair remains the treatment of choice. There are three types of surgical treatment – fascial repair, stoma relocation and repair using prosthetic mesh via a laparoscopic or open approach. Recently there have been several meta-analyses and systematic reviews aiming to compare the results of surgical treatment, and the authors agreed that the quality of evidence precludes firm conclusions. Aim To describe the novel concept of parastomal hernia repair – HyPER/SPHR technique (hybrid parastomal endoscopic re-do/Szczepkowski parastomal hernia repair) and its early results in 12 consecutive cases. Material and methods Twelve consecutive patients were operated on due to parastomal hernia using the new HyPER hybrid technique between June 2013 and May 2014. The patients’ condition was evaluated during the perioperative period, 6 weeks and then every 3 months after surgery. Results After 6 weeks of follow-up we have not observed any mesh-related complications. All 12 patients were examined 3 months and 6 months after repair surgery for evaluation. No recurrence, stoma site infection or stoma-related problems were found. None of the patients complained of pain and none of them needed to be hospitalized again. Reported quality of life on a 0–10 scale after 6 weeks of follow-up was 8 (range: 7–10). Conclusions The HyPER procedure for treatment of parastomal hernias proposed by the authors is a safe and feasible surgical technique with a high patient satisfaction rate and a low number of complications. The hybrid procedure seems to be a promising method for parastomal hernia repair. PMID:25960785

  9. Traumatic Lumbar Hernias: Difficulty with Diagnosis and Repair

    Microsoft Academic Search

    James K. Lukan; Glen A. Franklin; David A. Spain; J. David Richardson

    2000-01-01

    Infrequently encountered, the traumatic lumbar hernia presents a challenge to the surgeon both in diagnosis and management. Repair is often complicated by a lack of viable fascia and a high incidence of associated injuries. The following review considers the natural history of lumbar hernias and their etiologies. Subsequently, the role of computed tomography (CT) in diagnosis is discussed. Finally, the

  10. Risk factors for early recurrence after inguinal hernia repair

    Microsoft Academic Search

    Petra Lynen Jansen; Uwe Klinge; Marc Jansen; Karsten Junge

    2009-01-01

    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

  11. Laparoscopic repair of Morgagni's hernia: An innovative approach

    PubMed Central

    Shah, Rasik S.; Sharma, Pradeep Chandra; Bhandarkar, Deepraj S.

    2015-01-01

    Aim: To review our experience of laparoscopic repair of Morgagni's hernia (MH) using transfascial sutures. Materials and Methods: This is a retrospective review of patients presenting to the first author with the diagnosis of MH over a 15-year period. The variables analyzed included demographic data, clinical presentation, and operative details. Results: In all there were five male with a median age of 2 years. They were asymptomatic and MH was detected incidentally by observing an air-filled density in the right cardiophrenic angle on plain X-ray of the chest. Computed tomography (CT) confirmed the diagnosis in all patients. All patients underwent laparoscopic repair of MH using transfascial sutures. The average operative time was 75 min. Oral feeding was started 6 h after surgery and patients were discharged on either 3rd or 4th postoperative day. Postoperative follow-up X-ray confirmed the intact repair. Conclusions: Laparoscopic repair of MH using transfascial sutures is an easy and effective solution. Multiple horizontal mattress sutures taking full thickness of abdominal wall muscles with the edge of the diaphragm leads to a strong repair. As sutures are tied extracorporeally, the technique is easily reproducible. PMID:25829669

  12. Transthoracic repair of asymptomatic morgagni hernia in an adult.

    PubMed

    Pousios, Dimitrios; Panagiotopoulos, Nikolaos; Piyis, Anastasios; Gourgiotis, Stavros

    2012-10-01

    Morgagni hernia represents a rare type of diaphragmatic hernia which usually occurs on the right side, in the anterior mediastinum. Predisposing factors of Morgagni hernia include pregnancy, obesity or other causes of increased intraabdominal pressure, and a history of trauma. Most of adults diagnosed with a foramen of Morgagni are asymptomatic. We report a case of an overweight 23-year-old asymptomatic patient with a Morgagni hernia incidentally diagnosed on chest x-ray. There was a satisfactory result after the repair by a transthoracic approach. PMID:24082604

  13. Indications and Outcomes of the Components Separation Technique in the Repair of Complex Abdominal Wall Hernias: Experience From the Cambridge Plastic Surgery Department

    PubMed Central

    Adekunle, Shola; Pantelides, Nicholas M.; Hall, Nigel R.; Praseedom, Raaj; Malata, Charles M.

    2013-01-01

    Objectives: The components separation technique (CST) is a widely described abdominal wall reconstructive technique. There have, however, been no UK reports of its use, prompting the present review. Methods: Between 2008 and 2012, 13 patients who underwent this procedure by a single plastic surgeon (C.M.M.) were retrospectively evaluated. The indications, operative details, and clinical outcomes were recorded. Results: There were 7 women and 6 men in the series with a mean age of 53 years (range: 30-80). Patients were referred from a variety of specialties, often as a last resort. The commonest indication for CST was herniation following abdominal surgery. All operations except 1 were jointly performed with general surgeons (for bowel resection, stoma reversal, and hernia dissection). The operations lasted a mean of 5 hours (range: 3-8 hours). There were no major intra- and postoperative problems, except in 1 patient who developed intra-abdominal compartment syndrome, secondary to massive hemorrhage. All patients were satisfied with the cosmetic improvement in their abdominal contours. None of the patients have developed a clinical recurrence after a mean follow-up of 16 months (range: 3-38 months). Conclusions: The components separation technique is an effective method of treating large recalcitrant hernias but appears to be underutilized in the United Kingdom. The management of large abdominal wall defects requires a multidisciplinary approach, with input across a variety of specialities. Liaison with plastic surgery teams should be encouraged at an early stage and the CST should be more widely considered when presented with seemingly intractable abdominal wall defects. PMID:24058718

  14. Safety and Efficacy of Laparoendoscopic Single-Site Surgery for Abdominal Wall Hernias

    PubMed Central

    2012-01-01

    Background: Laparoendoscopic single-site surgery has rapidly progressed from the animal laboratory to clinical use since mass production of multichannel ports began in 2007. Indeed, it has now been shown to be feasible and safe for many commonly performed operations. Methods: This study cohort comprised 22 unselected patients with abdominal wall hernias of varying types: multiply recurrent inguinal (n=2), suprapubic (n=1), ventral/incisional (n=17), and parastomal hernias (n=2), who underwent laparoendoscopic single-site ventral hernia repair between December 2009 and February 2011. Standard dissecting instruments and a 52cm/5.5mm/30°angle laparoscope were used. Results: Patients included 14 men and 8 women, with a median age of 56 (range, 32 to 78) years and a mean body mass index of 31.5±4.7kg/m2. The mean mesh size was 460cm2 (range, 225 to 884cm2). Mean operation time was 125 minutes for ventral/incisional hernias and 270 minutes for parastomal hernias. No conversions to multiport or open surgeries were necessary. There was no mortality or morbidity, and no recurrence at 6- to 18-month follow-up. The mean satisfaction score was 2.7 (range, 2 to 3) with no patients reporting dissatisfaction with the procedure. Conclusion: This series, though relatively small, represents a diverse group of patients with varying abdominal wall hernias, including parastomal hernias. These successful laparoendoscopic single-site surgeries, with no complications, demonstrate safety and efficacy, albeit in a specialized hernia center. This study is a prelude to the eventual validation of laparoendoscopic single-site hernia surgery with prospective randomized controlled trials. PMID:23477172

  15. Complications of groin hernia repair: their prevention and management.

    PubMed

    Gaines, R D

    1978-03-01

    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. PMID:691083

  16. Outcome of abdominal wall hernia repair with Permacol™ biologic mesh.

    PubMed

    Cheng, Amy W; Abbas, Maher A; Tejirian, Talar

    2013-10-01

    The use of biologic mesh in abdominal wall operations has gained popularity despite a paucity of outcome data. We aimed to review the experience of a large healthcare organization with Permacol™. A retrospective study was conducted of patients who underwent abdominal hernia repair with Permacol™ in 14 Southern California hospitals. One hundred ninety-five patients were analyzed over a 4-year period. Operations included ventral/incisional hernia repairs, ostomy closures, parastomal hernia repairs, and inguinal hernia repairs. In 50 per cent of the patients, Permacol™ was used to reinforce a primary fascial repair and in 50 per cent as a fascial bridge. The overall complication rate was 39.5 per cent. The complication rate was higher in patients with infected versus clean wounds, body mass index (BMI) 40 kg/m(2) or greater versus BMI less than 40 kg/m(2), in patients with prior mesh repair, and when mesh was used as a fascial bridge. With a mean follow-up of 2.1 years, morbid obesity was associated with a higher recurrence. To date this is the largest study on the use of Permacol™ in abdominal wall hernia repair. In our patient population undergoing heterogeneous operations with a majority of wounds as Class II or higher, use of Permacol™ did not eliminate wound morbidity or prevent recurrence, especially in morbidly obese patients. PMID:24160785

  17. Anaesthesia for a Rare Case of Down’s Syndrome with Morgagni’s Hernia Undergoing Laparoscopic Repair

    PubMed Central

    Marulasiddappa, Vinay

    2015-01-01

    Morgagni’s hernia is a type of congenital diaphragmatic hernia and it is rare in children. The association between Down’s syndrome and Morgagni’s hernia in children is also rare. Laparoscopic repair is a preferred surgical approach than open surgical procedures as laparoscopy offers a bilateral view of Morgagni’s hernia, minimal tissue damage and a faster recovery. When children with Down’s syndrome and associated Morgagni’s hernia present for laparoscopic repair, they pose several complex challenges to the anaesthetist due to the involvement of multiple organ systems, difficulties in airway management and effects of laparoscopic surgery on the organ systems. Therefore, such children need a very careful anaesthetic plan, including a thorough preoperative assessment and preparation for a successful perioperative outcome.

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

    PubMed Central

    de Araújo, Felipe Brandão Corrêa; Starling, Eduardo Simão; Maricevich, Marco; Tobias-Machado, Marcos

    2014-01-01

    OBJECTIVE: To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. BACKGROUND: TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven. PATIENTS AND METHODS: Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon. RESULTS: All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement. CONCLUSION: EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven. PMID:25336820

  19. Totally extraperitoneal inguinal hernia repair during extraperitoneal laparoscopic radical prostatectomy: Report of a case

    PubMed Central

    Wakasugi, Masaki; Yamamoto, Yoshiyuki; Jo, Sayaka; Takada, Shingo; Matsumiya, Kiyomi; Tori, Masayuki; Akamatsu, Hiroki

    2014-01-01

    Introduction The incidence of prostate cancer is increasing, and inguinal hernias are common in the age group of men with prostate cancer. Furthermore, inguinal hernias are now considered to be one of the long-term complications of radical prostatectomy. In this report, we present our experience with the performance of totally extraperitoneal inguinal hernia repair (TEP) along with extraperitoneal laparoscopic radical prostatectomy (ELRP). Presentation of case A 66-year-old man with prostate cancer and bilateral inguinal hernias was admitted to our hospital for surgery. He had a history of right inguinal hernioplasty without mesh placement and ascending colon diverticulitis. With a diagnosis of prostate cancer and bilateral inguinal hernia, concomitant TEP after ELRP was safely performed. Discussion TEP combined with ELRP appears to be a rational procedure and easy to perform. The incidence of complications related to either TEP or ELRP might not be increased. TEP combined with ELRP might be safely performed for recurrent inguinal hernia after non-mesh hernioplasty. Conclusion TEP combined with ELRP might be of use in prostate cancer patients with inguinal hernias. PMID:25528036

  20. Combined epigastric hernia repair and mini-abdominoplasty. Case report

    PubMed Central

    Roberto, Grella; Sergio, Razzano; Rossella, Lamberti; Biagio, Trojaniello; Francesco, D’Andrea; Francesco, Nicoletti Giovanni

    2014-01-01

    The objectives of abdominal hernia repair are to restore the structural integrity of the abdominal wall. Current techniques include primary closure, staged repair and the use of prosthetic materials. Techniques for mini-abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. We report a case of epigastric hernia repair through a transverse lower abdominal incision with the resection of excess of skin. Our purpose is to evaluate the results of the procedure by incorporating these aspects into an epigastric hernia repair, we found out that the procedures are made safer and the results are improved. Proper indication and details of the technique are described. PMID:25667986

  1. Laparoscopic repair of Morgagni-Larrey hernia in a child

    Microsoft Academic Search

    Mario Lima; Marcello Dòmini; Michele Libri; Antonino Morabito; Giovanni Tani; Remigio Dòmini

    2000-01-01

    Primary laparoscopic repair of Morgagni-Larrey hernia has been described in adult patients but not in children. This is the first report of primary laparoscopic correction in the pediatric age group without using a prosthesis. A Morgagni-Larrey hernia was found incidentally in a 3-year-old-girl. Laparoscopic correction of the defect was performed. After 6 months the patient is doing well. The chest

  2. Reduction of the complication rate in Liechtenstein hernia repair

    Microsoft Academic Search

    E. Just; X. Botet; S. Martínez; D. Escolà; I. Moreno; E. Duque

    2010-01-01

    BackgroundInguinal hernia is one of the most common pathologies in the surgical setting. The introduction of the Lichtenstein technique in 1989 (tension-free hernioplasty with polypropylene mesh) represented one of the most significant breakthroughs in the treatment of this condition since Bassini’s hernia repair. The aim of this study was to know the most significant predictive variables of complications in Lichtenstein

  3. Delayed repair for traumatic abdominal wall hernia: is it safe?

    Microsoft Academic Search

    I. Sall; H. El Kaoui; S. M. Bouchentouf; A. Ait Ali; A. Bounaim; A. Hajjouji; H. Baba; M. Fahssi; A. Alhyane; A. Zentar; K. Sair

    2009-01-01

    Abdominal wall hernias after trauma have been recognized for more than a century, with the first case reported as occurring\\u000a after a fall. Traumatic abdominal wall hernias (TAWHs) after blunt trauma are uncommon. The timing of definitive repair, early\\u000a or delayed, is not clear. We report a case on TAWH and mesenteric avulsion, highlighting the reasons for immediate or delayed

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

    PubMed

    Matei, Ovidio-Angel; Runkel, Norbert

    2014-03-01

    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

  5. Transcutaneous laparoscopic hernia repair in children: a prospective review of 275 hernia repairs with minimum 2-year follow-up

    Microsoft Academic Search

    Sanjeev Dutta; Craig Albanese

    2009-01-01

    Background  Inguinal hernia in children is traditionally repaired through a groin incision by dissecting the hernia sac from the spermatic\\u000a cord and suture ligating its base. A laparoscopic modification of this procedure involves placement of a transcutaneous suture\\u000a around the neck of the sac through a 2-mm stab incision under visualization with an umbilically placed 2.7-mm 30o lens. We reviewed the

  6. Incidence of Port-Site Incisional Hernia After Single-Incision Laparoscopic Surgery

    PubMed Central

    Rainville, Harvey; Ikedilo, Ojinika; Vemulapali, Pratibha

    2014-01-01

    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. PMID:24960483

  7. Resorbable biosynthetic mesh for crural reinforcement during hiatal hernia repair.

    PubMed

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

    2014-10-01

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

  8. Regeneration of abdominal wall aponeurosis: new dimension in Marlex peritoneal sandwich repair of incisional hernia.

    PubMed

    Matapurkar, B G; Bhargave, A; Dawson, L; Sonal, B

    1999-05-01

    Loss of abdominal wall substance is a major cause of incisional hernia formation. It makes repair of this iatrogenic human ailment a difficult surgical problem. The abdominal wall substance loss has compelled the world's surgical community dealing with this condition to substantiate the repair with extra material such as skin, fascia, wire mesh, and lately biocompatible synthetic mesh. Even though the synthetic mesh is compatible and well tolerated by body tissues, it is not without complications. Regenerative repair in the region of the abdominal wall with substance loss is probably the best repair if it can be achieved. With reasonable success in animal experiments and the positive regenerative capacity of stem cells to transform the peritoneum into an aponeurotic layer, the new technique using a Marlex peritoneal sandwich for repair of large incisional hernias was attempted but was not reported in the article published in the World Journal of Surgery in 1991. The present study is based on experiments on seven mongrel dogs. A suitable embryonal segment of autogenous peritoneum was excised and transferred to the rectus sheath region. The gross appearance of the grafted membrane 3 months after operation revealed tough, thick tissue formation. The histology confirmed the presence of collagen fiber tissue in layers similar to the aponeurosis in the grafted peritoneal membrane. The use of this regeneration in the Marlex peritoneal sandwich technique of repair of large incisional hernias and the scientific rationale of tissue regeneration by desired metaplasia is discussed. PMID:10085391

  9. Repair of Parastomal Hernias with Biologic Grafts: A Systematic Review

    Microsoft Academic Search

    Nicholas Jonathan Slater; Bibi M. E. Hansson; Otmar R. Buyne; Thijs Hendriks; Robert P. Bleichrodt

    2011-01-01

    Background  Biologic grafts are increasingly used instead of synthetic mesh for parastomal hernia repair due to concerns of synthetic\\u000a mesh-related complications. This systematic review was designed to evaluate the use of these collagen-based scaffolds for\\u000a the repair of parastomal hernias.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Studies were retrieved after searching the electronic databases MEDLINE, EMBASE and Cochrane CENTRAL. The search terms ‘paracolostomy’,\\u000a ‘paraileostomy’, ‘parastomal’, ‘colostomy’, ‘ileostomy’,

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

    PubMed Central

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

    2013-01-01

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

  11. Deepithelialized flap closure: an adjunct to complex ventral hernia repairs.

    PubMed

    Hoang, Don; Abitbol, Nathalie; Broer, Niclas; Narayan, Deepak

    2013-08-01

    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

  12. Single-Port Laparoscopic Parastomal Hernia Repair with Modified Sugarbaker Technique

    PubMed Central

    Turingan, Isidro; Zajkowska, Marta; Tran, Kim

    2014-01-01

    Introduction: Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery. Materials and Methods: All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, “inline” and “chopsticks” to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh. Results: Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m2 did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm2 with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months. Conclusion: Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care. PMID:24680140

  13. [Surgery of inguinal and femoral hernia in the elderly].

    PubMed

    Spirch, S; Martella, B; Militello, C; Nistri, R; De Santis, L; Ciardo, L; Dalla Vecchia, D; Perelda, F; Reale, F; Sarri, C; Volpin, E; Terranova, O

    1997-01-01

    Old people are continuously increasing in frequency but age is not a significant factor to value the operative risk in hernia surgery. From June 1985 to December 1996, 189 patients, aged > 80-year, were submitted to hernia surgery. No complications were noted when elective surgery was performed. Emergent procedure was undertaken in 7% of the patients major perioperative complications and one death were registered in this group of patients. Mean hospital stay has decreased in the period of the study: was 2.2 days in the last two years. Local anesthesia permitted a day surgery procedure in 60% of cases. PMID:10392186

  14. Clinical presentation and operative repair of hernia of Morgagni

    PubMed Central

    Loong, T; Kocher, H

    2005-01-01

    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. PMID:15640427

  15. Concomitant sublay mesh repair of umbilical hernia and abdominoplasty.

    PubMed

    McKnight, Catherine L; Fowler, James L; Cobb, William S; Smith, Dane E; Carbonell, Alfredo M

    2012-01-01

    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. PMID:24294023

  16. Single port laparoscopic repair of paediatric inguinal hernias: Our experience at a secondary care centre

    PubMed Central

    Kumar, Ameet; Ramakrishnan, T S

    2013-01-01

    BACKGROUND: Congenital inguinal hernias are a common paediatric surgical problem and herniotomy through a groin incision is the gold standard. Over the last 2 decades minimally invasive surgery (MIS) has challenged this conventional surgery. Over a period, MIS techniques have evolved to making it more minimally invasive – from 3 to 2 and now single port technique. All studies using single port technique are from tertiary care centres. We used a modification of the technique described by Ozgediz et al. and reviewed the clinical outcome of this novel procedure and put forth our experience at a secondary level hospital. MATERIALS AND METHODS: Prospective review of 37 hernias in 31 children (29 male and 2 female) (8 months - 13 years) performed laparoscopically by a single surgeon at a single centre between September 2007 and June 2010. Under laparoscopic guidance, the internal ring was encircled extraperitoneally using a 2-0 non-absorbable suture and knotted extraperitoneally. Data analyzed included operating time, ease of procedure, occult patent processus vaginalis (PPV), complications, and cosmesis. RESULTS: Sixteen right (52%), 14 left (45%) and 1 bilateral hernia (3%) were repaired. Five unilateral hernias (16.66%), all left, had a contralateral PPV that was repaired (P = 0.033). Mean operative time for a unilateral and bilateral repair were 13.20 (8–25) and 20.66 min (17 -27 min) respectively. Only one of the repairs (2.7%) recurred and another had a post operative hydrocoele (2.7%). One case (2.7%) needed an additional port placement due to inability to reduce the contents of hernia completely. There were no stitch abscess/granulomas, obvious spermatic cord injuries, testicular atrophy, or nerve injuries. CONCLUSION: Single port laparoscopic inguinal hernia repair can be safely done in the paediatric population. It permits extension of benefits of minimal access surgery to patients being managed at secondary level hospitals with limited resources. The advantage of minimal instrumentation and avoidance of intracorporeal knotting makes it a feasible technique for a secondary care centre. PMID:23626413

  17. Initial outcomes of laparoscopic paraesophageal hiatal hernia repair with mesh.

    PubMed

    Gebhart, Alana; Vu, Steven; Armstrong, Chris; Smith, Brian R; Nguyen, Ninh T

    2013-10-01

    The use of mesh in laparoscopic paraesophageal hiatal hernia repair (LHR) may reduce the risk of late hernia recurrence. The aim of this study was to evaluate initial outcomes and recurrence rate of 92 patients who underwent LHR reinforced with a synthetic bioabsorbable mesh. Surgical approaches included LHR and Nissen fundoplication (n = 64), LHR without fundoplication (n = 10), reoperative LHR (n = 9), LHR with a bariatric operation (n = 6), and emergent LHR (n = 3). The mean length of hospital stay was 2 ± 3 days (range, 1 to 30 days). There were no conversions to open laparotomy and no intraoperative complications. One of 92 patients (1.1%) required intensive care unit stay. The 90-day mortality was zero. Minor complications occurred in 3.3 per cent, major complications in 2.2 per cent, and late complications in 5.5 per cent of patients. There were no perforations or early hernia recurrence. The 30-day reoperation rate was 1.1 per cent. For patients with available 1-year follow-up, the overall recurrence rate was 18.5 per cent with a mean follow-up of 30 months (range, 12 to 51 months). LHR repair with mesh is associated with low perioperative morbidity and no mortality. The use of bioabsorbable mesh appears to be safe with no early hiatal hernia recurrence or late mesh erosion. Longer follow-up is needed to determine the long-term rate of hernia recurrence associated with LHR with mesh. PMID:24160791

  18. Incisional Hernia Classification Predicts Wound Complications Two Years after Repair.

    PubMed

    Baucom, Rebeccah B; Ousley, Jenny M; Oyefule, Omobolanle O; Stewart, Melissa K; Holzman, Michael D; Sharp, Kenneth W; Poulose, Benjamin K

    2015-07-01

    Classification of ventral hernias (VHs) into categories that impact surgical outcome is not well defined. The European Hernia Society (EHS) classification divides ventral incisional hernias by midline or lateral location. This study aimed to determine whether EHS classification is associated with wound complications after VH repair, indicated by surgical site occurrences (SSOs). A retrospective cohort study of patients who underwent VH repair at a tertiary referral center between July 1, 2005 and May 30, 2012, was performed. EHS classification, comorbidities, and operative details were determined. Primary outcome was SSO within two years, defined as an infection, wound dehiscence, seroma, or enterocutaneous fistula. There were 538 patients included, and 51.5 per cent were female, with a mean age of 54.2 ± 12.4 years and a mean body mass index of 32.4 ± 8.6 kg/m(2). Most patients had midline hernias (87.0%, n = 468). There were 47 patients (8.7%) who had a lateral hernia, and 23 patients (4.3%) whose repair included both midline and lateral components. Overall rate of SSO was 39 per cent (n = 211) within two years. The rate of SSO by VH location was: 39 per cent (n = 183) for midline, 23 per cent (n = 11) for lateral, and 74 per cent (n = 17) for VHs with midline and lateral components (P = <0.001). Patients whose midline hernia spanned more than one EHS category also had a higher rate of SSOs (P = 0.001). VHs are often described by transverse dimension alone, but a more descriptive classification system offers a richness that correlates with outcomes. PMID:26140887

  19. Gravid uterus in an umbilical hernia.

    PubMed

    Mbuagbaw, Lawrence C E; Morfaw, Frederick L I

    2012-01-01

    Umbilical hernias large enough to contain a gravid uterus are rare. We report a case of a woman with prolapse of a gravid uterus through a previously repaired umbilical hernia. Our plans for elective surgery with caesarean section and hernia repair were foiled by poor compliance. The hernia was repaired during an emergency caesarean section. We provide details of her management and briefly review the literature on umbilical hernias and pregnancy. Surgical management offers an opportunity for hernia repair and can ensure a safe delivery for the mother and child. PMID:22811943

  20. The lightweight and large porous mesh concept for hernia repair

    Microsoft Academic Search

    Bernd Klosterhalfen; Karsten Junge; Uwe Klinge

    2005-01-01

    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

  1. Anti-reflux surgery

    MedlinePLUS

    ... Mark IV) fundoplication; Toupet fundoplication; Thal fundoplication; Hiatal hernia repair; Endoluminal fundoplication ... surgery, your surgeon will: First repair the hiatal hernia, if present. This involves tightening the opening in ...

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

    PubMed Central

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

    2014-01-01

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

  3. Hiatal hernia repair with gore bio-a tissue reinforcement: our experience.

    PubMed

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

    2014-01-01

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

  4. Inguinal hernia repair: are the results from a general hospital comparable to those from dedicated hernia centres?

    PubMed Central

    Cheong, Kai Xiong; Lo, Hong Yee; Neo, Jun Xiang Andy; Appasamy, Vijayan; Chiu, Ming Terk

    2014-01-01

    INTRODUCTION We aimed to report the outcomes of inguinal hernia repair performed at Tan Tock Seng Hospital and compare them with those performed at dedicated hernia centres. METHODS We retrospectively analysed the medical records and telephone interviews of 520 patients who underwent inguinal hernia repair in 2010. RESULTS The majority of the patients were male (498 [95.8%] men vs. 22 [4.2%] women). The mean age was 59.9 ± 15.7 years. Most patients (n = 445, 85.6%) had unilateral hernias (25.8% direct, 64.3% indirect, 9.9% pantaloon). The overall recurrence rate was 3.8%, with a mean time to recurrence of 12.0 ± 8.6 months. Risk factors for recurrence included contaminated wounds (odds ratio [OR] 50.325; p = 0.004), female gender (OR 8.757; p = 0.003) and pantaloon hernias (OR 5.059; p = 0.013). Complication rates were as follows: chronic pain syndrome (1.2%), hypoaesthesia (5.2%), wound dehiscence (0.4%), infection (0.6%), haematoma/seroma (4.8%), urinary retention (1.3%) and intraoperative visceral injury (0.6%). Most procedures were open repairs (67.7%), and laparoscopic repair constituted 32.3% of all the inguinal hernia repairs. Open repairs resulted in longer operating times than laparoscopic repairs (86.6 mins vs. 71.6 mins; p < 0.001), longer hospital stays (2.7 days vs. 0.7 days; p = 0.020) and a higher incidence of post-repair hypoaesthesia (6.8% vs. 1.8%; p = 0.018). However, there were no significant differences in recurrence or other complications between open and laparoscopic repair. CONCLUSION A general hospital with strict protocols and teaching methodologies can achieve inguinal hernia repair outcomes comparable to those of dedicated hernia centres. PMID:24763834

  5. Timing of repair of congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation support

    Microsoft Academic Search

    David L. Sigalet; Anne Tierney; Vincent Adolph; Therese Perreault; Neil Finer; Robert Hallgren; Jean-Martin Laberge

    1995-01-01

    Treatment of congenital diaphragmatic hernia (CDH) has undergone a revolutionary change in philosophy, from previous urgent repair to the present practice of stabilization and delayed repair. However, when extracorporeal membrane oxygenation (ECMO) is required, many people believe that the risk of postoperative pulmonary hypertension (PPHN) mandates hernia repair while on ECMO. This report details the experience in two ECMO centers

  6. A simple technique of laparoscopic full-thickness anterior abdominal wall repair of retrosternal (Morgagni) hernias

    Microsoft Academic Search

    Georges Azzie; Kiki Maoate; Spencer Beasley; Wilhelm Retief; Arie Bensoussan

    2003-01-01

    Background\\/Purpose: Previous reports of laparoscopic repair of Morgagni hernias in children have involved relatively complex laparoscopic techniques. This report describes a simpler method of repair that we have applied to 4 children. Methods: Four children with retrosternal (Morgagni) hernias underwent primary laparoscopic repair by placement of interrupted synthetic nonabsorbable sutures through the full-thickness of the anterior abdominal wall, incorporating the

  7. Comparison of three different mesh materials in tension-free inguinal hernia repair: prolene versus Vypro versus surgisis.

    PubMed

    Puccio, F; Solazzo, M; Marciano, P

    2005-01-01

    Using mesh or a synthetic prosthesis during tension-free inguinal hernia repair has been shown to be safe and effective. We compared the final outcome in treating inguinal hernia in 45 patients using three different prosthetic materials: 15 patients underwent tension-free inguinal hernia repair using Prolene (polypropylene) mesh, 15 using Vypro (polyglactin and polypropylene) mesh, and 15 with Surgisis-a new bioactive material derived from porcine small intestinal submucosa. The aim of this study was to evaluate the safety and efficacy of tension-free inguinal repair using Surgisis, comparing it with conventional prosthetic materials. From January 2003 to December 2003, 45 male patients underwent Lichtenstein inguinal hernia repair. Median follow-up was 12 months, with a range of 1-16 months. Each patient underwent ultrasound evaluation of the inguinal region 1 month after surgery. All the procedures were completed under local anesthesia. There were no intraoperative complications, and all patients were discharged home the same day of surgery. No recurrent hernias and wound infections were observed in our post-operative follow-up period. Postoperative pain (visual analog score) and discomfort were lower in patients with Surgisis mesh. There was no statistically significant difference between the groups in terms of overall early and late complications; however, there was a tendency toward a higher incidence of pain and discomfort in Vypro and Prolene group. The median time to full recovery was significantly shorter in the Surgisis group. Surgisis mesh seems to be a promising new prosthetic material for hernia repair. Long-term follow-up is necessary to confirm these preliminary results. PMID:16463943

  8. Preincisional Treatment to Prevent Pain After Ambulatory Hernia Surgery

    Microsoft Academic Search

    D. Janet Pavlin; Karen D. Horvath; Edward G. Pavlin; Kristien Sima

    2003-01-01

    We designed this study as a randomized comparison of postoperative pain after inguinal hernia repair in pa- tients treated with triple preincisional analgesic ther- apy versus standard care. Triple therapy consisted of a nonsteroidal antiinflammatory, a local anesthetic field block, and an N-methyl-d-aspartate inhibitor before in- cision. The treatment group (n 17) received rofecoxib, 50 mg PO, a field block

  9. Ileocutaneous fistula formation following laparoscopic polypropylene mesh hernia repair

    Microsoft Academic Search

    K. Miller; W. Junger

    1997-01-01

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

  10. Laparoscopic repair of complicated umbilical hernia with Strattice Laparoscopic™ reconstructive tissue matrix

    PubMed Central

    Tsuda, Shawn

    2014-01-01

    INTRODUCTION Complex hernias continue to present a challenge. Surgical techniques for repair are carefully considered to reduce risk for complications. Laparoscopic repairs improve postoperative infection rates, and placement of biologic mesh decreases mesh infection rates. However, laparoscopic repairs using biologic mesh is generally challenging due to difficulty with maneuverability. PRESENTATION OF CASE We present a case of a complex ventral hernia that was laparoscopically repaired using a new FDA cleared laparoscopic biologic graft. The patient had multiple comorbidities, including obesity, hepatitis C, endocarditis secondary to IV drug use, tobacco smoking, bilateral inguinal hernia, and recurrent umbilical hernia. The recurrent hernia was larger, irreducible, and discolored compared to original defect. The patient underwent laparoscopic repair with primary closure and reinforcement with Strattice™ Tissue Matrix Laparoscopic (LifeCell Corporation, Branchburg, NJ). At nine months postoperative, the patient had no evidence of recurrence, infection, or chronic pain, demonstrating early success from the surgical management. DISCUSSION Presence of multiple comorbidities and incarcerated recurrent hernia increase risk for complications during and/or after hernia repair. Considering these factors, laparoscopic repair with Strattice Laparoscopic and defect closure was a reasonable technique for repair. CONCLUSION Laparoscopic suture repair reinforced with biologic dermal tissue matrix was successfully performed during a complex hernia repair. PMID:25437666

  11. Transthoracic repair of an incarcerated diaphragmatic hernia using hexamethylene diisocyanate cross-linked porcine dermal collagen (Permacol).

    PubMed

    Gooch, Benn; Smart, Neil; Wajed, Saj

    2012-03-01

    It is the general surgeon who commonly repairs paraesophageal hernias nowadays, and they are repaired laparoscopically, making the performance of thoracotomy relatively rare. Whether to use prosthetic materials to repair the hiatus is still under debate, as is the question of which material to use, if any. We report a case of a 38-year-old man who had a large, incarcerated paraesophageal hernia. He had a past history of extensive abdominal surgery for exomphalos, which rendered any abdominal surgical approach a high-risk procedure. We therefore decided to proceed with thoracotomy and repair of the hiatus with hexamethylene diisocyanate (HMDI) cross-linked porcine dermal collagen. He made a good recovery with no complications. PMID:22419182

  12. Laparoscopic repair of a rare acquired abdominal intercostal hernia

    PubMed Central

    Dan, Dilip; Ramraj, Parasram; Solomon, Verin; Ramnarine, Malini; Kawal, Trudy; Bascombe, Nigel; Naraynsingh, Vijay

    2014-01-01

    INTRODUCTION An acquired abdominal intercostal hernia (AIH) is a very rare and sporadically reported entity. Most cases of AIH are secondary to major trauma and the treatment of choice is surgical repair. PRESENTATION OF CASE We present the case of a 58-year-old man who presented with a painless intercostal swelling, which started after previous penetrating trauma to the same area. Radiological assessment was done with CT scan and the hernia was repaired with a laparoscopic approach using mesh. DISCUSSION AIH is a rare entity and trauma has an integral role in the pathophysiology. Surgical repair is the treatment of choice, however, due to the paucity of cases, there is no established method of choice for such repair. We present the first reported case in the Caribbean, which was repaired with the laparoscopic approach. CONCLUSION Although AIH is a rare condition, the pathophysiology seems relatively straightforward and the use of CT scan is recommended to confirm the diagnosis. The laparoscopic approach, with all its established benefits, appears to be a safe and feasible option in its management. PMID:25460469

  13. What is a Certified Hernia Center? The Example of the German Hernia Society and German Society of General and Visceral Surgery

    PubMed Central

    Köckerling, Ferdinand; Berger, Dieter; Jost, Johannes O.

    2014-01-01

    To date, the scientific definition “hernia center” does not exist and this term is being used by hospitals and private institutions as a marketing instrument. Hernia surgery has become increasingly more complex over the past 25?years. Differentiated use of the various techniques in hernia surgery has been adopted as a “tailored approach” program and requires intensive engagement with, and extensive experience of, the entire field of hernia surgery. Therefore, there is a need for hernia centers. A basic requirement for a credible certification process for hernia centers involves definition of requirements and its verification by hernia societies and/or non-profit organizations that are interested in assuring the best possible quality of hernia surgery. At present, there are two processes for certification of hernia centers by hernia societies or non-profit organizations. PMID:25593950

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

    SciTech Connect

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

    2010-12-01

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

  15. Incarcerated obturator hernia–laparoscopic repair with intraoperative view of the corona mortis

    PubMed Central

    Ramser, Michaela; Messmer, Anna Sarah; Zbinden, Isabella; Von Holzen, Urs; Nebiker, Christian Andreas

    2014-01-01

    Obturator hernias are a rare form of abdominal wall hernias. We present a case of a patient with an obturator hernia diagnosed by the classical signs of lower abdominal pain, a positive Howship–Romberg sign (painful internal rotation of the hip) and a computed tomography scan showing a herniated loop of small bowel. During the emergency laparoscopic hernia repair (transabdominal preperitoneal approach) a variant vessel, the corona mortis, was detected. PMID:25157088

  16. Acute Osteomyelitis of the Symphysis Pubis after Inguinal Hernia Surgery

    PubMed Central

    Tekin, Recep; Ceylan Tekin, Rojbin; Ceylan Cevik, Figen; Cevik, Remzi

    2015-01-01

    Osteomyelitis of pubic symphysis is infectious inflammatory condition of the symphysis pubis and rare complication of surgery around inguinal and groin region. It should be kept in mind in the differential diagnosis of lower pelvic pain and should be sought in cases of pelvic insufficiency fractures. Herein, we present a case of a 55-year-old man with osteomyelitis of the symphysis pubis following inguinal hernia surgery for diagnosis and management of this rare condition. PMID:25973280

  17. Symptomatic internal hernias after laparoscopic bariatric surgery

    Microsoft Academic Search

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

    2005-01-01

    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

  18. A Systematic Review of Outcomes Following Repair of Complex Ventral Incisional Hernias With Biologic Mesh

    PubMed Central

    Ferzoco, Stephen J.

    2013-01-01

    Repair of contaminated/infected ventral incisional hernias is marked by high rates of recurrence, complications, and/or explantation of synthetic mesh. Biologic mesh products are recommended for repair to permit reconstruction and reduce complications. A systematic review of PubMed, EMBASE, and Cochrane databases identified English-language articles reporting postoperative outcomes (e.g., hernia recurrence, infection, mesh explantation) in patients undergoing contaminated/infected ventral incisional herniorrhaphy. Eleven studies met inclusion criteria and contained quantitative outcome data. All were retrospective chart reviews of biologic mesh use (mostly human acellular dermal matrix). Hernia recurrence and wound infection rates were highly variable and inconsistently reported across studies. Mesh explantation was rarely reported. Outcome variability is likely owing to heterogenous patient populations, surgical technique variations, and follow-up duration. Biologic mesh use in contaminated/infected herniorrhaphy was marked by low reported rates of secondary surgeries for infected mesh removal. Data from large, well-controlled, prospective trials with biologic mesh products are needed. PMID:24229031

  19. Pros and cons of tacking in laparoscopic hernia repair.

    PubMed

    Reynvoet, Emmelie; Berrevoet, Frederik

    2014-11-01

    Present available fixation devices in laparoscopic hernia repair include transfascial sutures, (permanent or absorbable) tacks, and fibrin or synthetic sealants, all of which have advantages and disadvantages. Tack fixation has been applied since the introduction of laparoscopic inguinal and ventral hernia repair during the end of the 1980s and the beginning of the 1990s, respectively. However, although this type of penetrating fixation offers a reliable method to keep the mesh in place, several negative aspects have been highlighted in recent years. Permanent metallic fixation devices such as helical titanium tacks (Protack™ ) provide greater fixation strength than absorbable fixation devices (AbsorbaTack™, Permasorb™, or SorbaFix™), but as the titanium tacks remain in the body permanently, they have been associated with serious adverse events. Dense adhesion formation and erosion of tacks in hollow viscera have been reported as well as the formation of so-called "tack hernias." However, the most clinically important negative aspect might be the increased acute and chronic postoperative pain. As pain and quality of life, rather than recurrence rate, gained the attention of clinicians, researchers, and patients, recent developments have been focusing on different types of absorbable materials. However, studies that investigated these issues comparing different tack materials for mesh fixation did not show any benefit from any type of fixation. Despite the postoperative short- and long-term sequellae, tack fixation is still the most widely applied technique for laparoscopic mesh fixation. PMID:25433227

  20. Analysing the benefits of laparoscopic hernia repair compared to open repair: A meta-analysis of observational studies

    PubMed Central

    Salvilla, Sarah A; Thusu, Sundeep; Panesar, Sukhmeet S

    2012-01-01

    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. PMID:23248436

  1. Laparoscopic Hernia Repair With 3-Millimeter Instruments: A Point of Technique and Illustrative Case Video.

    PubMed

    Kassir, Radwan; Tiffet, Olivier; Bourbon, Michel; Meyer, Alberto; Gugenheim, Jean; Debs, Tarek; Amor, Imed Ben; Blanc, Pierre

    2015-08-01

    The repair of inguinal hernia has been a controversial issue in surgical practice since its conception. The article demonstrates that use of 3 mm instruments can be incorporated in Laparoscopic hernia repair. The second aim of this article is that use of TAP block (Transverse abdominal plane block) without curare is efficient, safe and reproducible. PMID:25975780

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

    Microsoft Academic Search

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

    1998-01-01

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

  3. [Chronic fistulating wound infection after Lichtenstein repair of inguinal hernia, caused by a small colony variant of Staphylococcus aureus].

    PubMed

    Göring, H; Waldner, H; Emmerling, P; Abele-Horn, M

    2001-04-01

    We report a case of chronic wound infection (abscess, fistula) after a Lichtenstein repair of inguinal hernia. After surgical treatment (mesh explantation), a small-colony variant (SCV) of Staphylococcus aureus was cultured microbiologically. SCV represent subpopulations of Staphylococcus aureus which are associated with chronic infections and which respond poorly to usual treatment regimes. In this case surgery and specific antibiotic treatment with flucloxacillin and rifampicin were successful. PMID:11357538

  4. Laparoscopic Hernia Repair versus Open Herniotomy in Children: A Controlled Randomized Study

    PubMed Central

    Shalaby, Rafik; Ibrahem, Refaat; Shahin, Mohamed; Yehya, Abdelaziz; Abdalrazek, Mohamed; Alsayaad, Ibrahim; Shouker, Maged Ali

    2012-01-01

    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. PMID:23326656

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

    PubMed Central

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

    2013-01-01

    Introduction: Bowel injury during laparoscopic surgery is a rare but serious complication. A Bovie injury to the bowel can cause delayed perforation of the viscus, thus increasing the possibility of a preventable morbidity. Patients presenting with perforation peritonitis within 24 hours and up to 2 to 3 weeks after laparoscopic Bovie injury to the bowel have been reported in the literature. Case Description: A 74-year-old woman underwent a laparoscopic ventral hernia mesh repair. Intraoperatively, a small area of superficial Bovie injury to the small bowel was repaired with Lembert sutures and tissue glue. Postoperatively, the patient recovered well, but she presented with perforation peritonitis 3 months after surgery. An exploratory laparotomy showed a jejunal perforation in the same area that was injured with cautery and repaired during the previous surgery. The patient was only using inhaled steroids for asthma on and off but had a remote history of chemotherapy and radiation for colorectal cancer. Conclusion: Bovie injury to the bowel has a hidden depth, causing a slow transmural tissue necrosis, and it might also impair local healing and eventually lead to perforation. Thus, the patient may present later than the usual period for wound healing and remodeling as previously reported. Given the disastrous consequence, it is imperative to perform a good surgical repair of even a minor Bovie injury to the bowel. This is the first report of a delayed presentation (>1 month) of a Bovie injury of the bowel. PMID:24018096

  6. Single-Port Onlay Mesh Repair of Recurrent Inguinal Hernias after Failed Anterior and Laparoscopic Repairs

    PubMed Central

    Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne J.

    2015-01-01

    Background and Objectives: Despite the exponential increase in the use of laparoscopic inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, a growing number of patients are presenting with recurrent hernias after conventional anterior and laparoscopic repairs have failed. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair of these hernias. Methods: Patients referred with two or more recurrences of inguinal hernia underwent SIL-IPOM from November 1, 2009, to June 24, 2014. A 2.5-cm infraumbilical incision was made, and an SIL port was placed intraperitoneally. Modified dissection techniques were used: chopstick and inline dissection, 5.5-mm/52-cm/30° angled laparoscope, and conventional straight dissecting instruments. The peritoneum was incised above the pubic symphysis, and dissection was continued laterally and proximally, raising the inferior flap below the previous extraperitoneal mesh while reducing any direct, indirect, femoral, or cord lipoma before placement of antiadhesive mesh, which was fixed to the pubic ramus, as well as superiorly, with nonabsorbable tacks before the inferior border was fixed with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh. Results: Nine male patients underwent SIL-IPOM. Their mean age was 53 years and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes, with a hospital stay of 1 day. The umbilical scar length was 23 mm at the 6-week follow-up. There were no intra-/postoperative complications, port-site hernias, chronic groin pain, or recurrence of the hernia during a mean follow-up of 24 months. Conclusion: Inguinal hernias recurring after two or more failed conventional anterior and laparoscopic repairs can be safely and efficiently treated with SIL-IPOM. PMID:25848186

  7. Repair of giant abdominal hernias: does the type of prosthesis matter?

    PubMed

    Diaz, Jose J; Gray, Brian W; Dobson, Jean M; Grogan, Eric L; May, Addison K; Miller, Richard; Guy, Jeffrey; O'Neill, Patrick; Morris, John A

    2004-05-01

    Closure of the abdominal wall after trauma or major surgery may be difficult due to visceral edema or fascial weakness; thus, the risk of developing a ventral hernia (VH) is high. Commonly, these hernias are repaired using a prosthetic mesh. Complications following mesh repair can develop. We hypothesize that the type of prosthetic material affects outcome. This is a retrospective chart review of patients admitted from 1996 to 2002 undergoing VH (> or = 20 x 10 cm) repair with prosthetic mesh. Data collected included age, sex, and race. Patients were stratified by prosthetic material as follows: Gore-Tex (GR), Marlex + Gore-Tex (MG), Marlex (MR), and Marlex + Vicryl (MV). For the purpose of clinical analysis, the groups were collapsed into subgroups: Gore-Tex exposure (GT) or non-Gore-Tex exposure (NG). Outcome measures were hernia recurrence (HR), wound infection (WI), and fistula formation (FF). Statistical analysis utilized chi2 test and Fisher's exact test. There were 55 VH repairs in 37 patients. The mean age was 43.9 (+/- 16.3), males out-numbered females 22 (59.5%) to 15 (40.5%). The majority of the patients were Caucasian (29; 78.4%). There were 30 trauma patients (81.1%), and 7 general surgery patients (18.9%). The HR for the study (n = 55) was 20 (36.4%), the WI was 17 (30.9%), and the FF was 3 (5.5%). GR group (6; 66.7%) had a significant higher wound IF rate than MR group (8; 26.7%) (Chi P = 0.02, Fisher P = 0.047). All other group comparisons (HR, WI, and FF) were N.S. The Gore-Tex versus non-Gore-Tex subgroup comparison results were as follows: GT (n = 18) had a WI 8 (44.4%), HR 6 (33.3%), and FF 0 (0%). NG (n = 37) had a WI 9 (24.3%), HR 14 (37.8%), and a FF 3 (8.1%). There was a trend toward a higher wound infection in the GT versus NG, but it did not reach statistical significance. We conclude that 1) the wound infection rate was higher in the Gore-Tex versus the Marlex group (Chi P = 0.02, Fisher P = 0.047). Wound infection in the presence of Gore-Tex usually mandates the removal of the mesh resulting in a hernia recurrence. 2) There was a trend toward a higher wound infection in the GT (44.4%) versus NG (24.3%), but it did not reach statistical significance. PMID:15156946

  8. Laparoscopic repair of Morgagni hernia by artificial pericardium patch in an adult obese patient

    PubMed Central

    Li, Shuhai; Liu, Xiaochuan; Wang, Hao; Feng, Mingxiang; Tan, Lijie

    2015-01-01

    Background Morgagni hernia is a kind of rare congenital diaphragmatic hernia. We reported a case of Morgagni hernia repaired successfully with artificial pericardium patch via the laparoscopic approach. Methods The patient was admitted with a 3-month history of postprandial nausea and vomiting, and accompanied by epigastric pain. Computed tomography (CT) scans showed a large anteromedial diaphragmatic hernia. The hernial contents were reduced back into the abdominal cavity and the diaphragmatic defect was repaired with artificial pericardium patch by laparoscopic intracorporeal suture. Results We achieved satisfactory intracorporeal repair of this large diaphragmatic defect. The patient had excellent recovery and started on oral diet on the first postoperative day, and then was discharged just two days after operation. Conclusions The minimally invasive advantage of laparoscopic approach offers a secure, reliable and satisfactory way to confirm the diagnosis and achieve the repair of non-complicated Morgagni hernia. PMID:25973243

  9. The “Inside-out” Technique for Hernia Repair with Mesh Underlay

    PubMed Central

    Berhanu, Aaron E.

    2015-01-01

    Background: An improved method for mesh repair of ventral/incisional hernias after component separation is presented. The use of a Carter-Thomason suture passer (Cooper Surgical, http://www.coopersurgical.com) allows for safe passage of preplaced sutures on the mesh from within the abdominal cavity through the anterior rectus sheath. This “inside-out” method makes the underlay of mesh fast and easy by improving visualization and control of sharp instruments as they are passed through the abdominal cavity. Preplacement of sutures circumferentially on the mesh also improves the distribution of tension around the repair, which may ultimately reduce the risk of hernia recurrence. Methods: The “inside-out” technique was performed on 23 patients at a single tertiary academic medical center from November 2011 to February 2014. We have followed these patients for a median of 24.5 months to assess for postoperative complications and hernia recurrence. Results: We report an acceptable hernia recurrence rate (2 of 23 = 8.7%). One recurrence was observed in a patient who underwent repair of a recurrent ventral hernia and the other had significant loss of domain requiring an inlay mesh. Conclusions: The “inside-out” technique for ventral hernia repair with a mesh underlay after component separation using a Carter-Thomason suture passer is easy, safe, and reliable. We have observed no hernia recurrence in patients who underwent repair for a primary ventral hernia with an underlay technique. PMID:26180723

  10. Laparoscopic Repair of a Morgagni-Larrey Hernia: Report of Three Cases

    Microsoft Academic Search

    Turgut Ipek; Ediz Altinli; Serdar Yuceyar; Suphan Erturk; Erhun Eyuboglu; Tarik Akcal

    2002-01-01

    .  \\u000a Morgagni-Larrey hernia is a rare type of diaphragmatic hernia, the diagnosis of which is made incidentally by routine chest\\u000a X-ray film. We describe a technique for the laparoscopic repair of Morgagni-Larrey hernia which was successfully performed\\u000a in three adult patients; two women and one man. Two of the patients were asymptomatic and had herniation of only omentum into\\u000a the

  11. A novel approach to extraction of incarcerated omentum and mesh insertion in laparoscopic ventral hernia repair

    Microsoft Academic Search

    Kyle A. Perry; Keith W. Millikan; Wendy W. Huang; Jonathan A. Myers

    2008-01-01

    During laparoscopic ventral hernia repair (LVHR), it is not always possible to reduce incarcerated omentum through a tight\\u000a defect and it may tear or require transection within the abdomen. This leaves an ischemic mass of tissue within the hernia\\u000a sac which can cause pain, infection, or the appearance of hernia recurrence postoperatively. We describe a technique which\\u000a allows extraction of

  12. Situs inversus totalis: giant hiatal hernia repair by laparoscopic Collis gastroplasty and Nissen fundoplication

    Microsoft Academic Search

    C. D. Hoang; Y. G. Bakman; S. Ikramuddin; M. A. Maddaus

    2004-01-01

    We report the repair of a giant hiatal hernia by laparoscopic Collis gastroplasty and Nissen fundoplication in a patient with situs inversus totalis, highlighting the unique anatomic challenges in this case. The 52-year old female patient had Kartagener’s syndrome, a giant hiatal hernia, and a history of chronic severe gastroesophageal reflux disease with uncontrolled regurgitation. The laparoscopic procedure was accomplished

  13. GOALS-incisional hernia: a valid assessment of simulated laparoscopic incisional hernia repair.

    PubMed

    Vaillancourt, Marilou; Ghaderi, Iman; Kaneva, Pepa; Vassiliou, Melina; Kolozsvari, Nicoleta; George, Ivan; Sutton, F Erica; Seagull, F Jacob; Park, Adrian E; Fried, Gerald M; Feldman, Liane S

    2011-03-01

    The Global Operative Assessment of Laparoscopic Skills (GOALS) is a valid and reliable measure of basic, non-procedure-specific laparoscopic skills. GOALS-incisional hernia (GOALS-IH) was developed to evaluate performance of laparoscopic incisional hernia repair (LIHR). The purpose of this study was to assess the validity and reliability of GOALS-IH during LIHR simulation. GOALS-IH assesses 7 domains with a maximum score of 35. A total of 12 experienced surgeons and 10 novices performed LIHR on the Surgical Abdominal Wall simulator. Performance was assessed by a trained observer and by self-assessment using GOALS-IH, basic GOALS and a visual analog scale (VAS) for overall competence. Both interrater reliability and internal consistency were high (.76 and .95 respectively). Experienced surgeons had higher mean GOALS-IH scores than novices (32.3 ± 2 versus 22.7 ± 5). There was excellent correlation between GOALS-IH and other measures of performance (GOALS r = .93 and VAS r = .93). GOALS-IH is easy to use, valid and reliable for assessment of simulated LIHR. PMID:21216811

  14. Mesh fixation alternatives in laparoscopic ventral hernia repair.

    PubMed

    Muysoms, Filip E; Novik, Bengt; Kyle-Leinhase, Iris; Berrevoet, Frederik

    2012-12-01

    Since the introduction of laparoscopic ventral hernia repair, there has been an ongoing dispute over the optimal method of fixating the mesh against the abdominal wall. In general, one could say that the more penetrating the fixation used, the stronger the fixation, but at the cost of increased acute postoperative pain. The occurrence of chronic pain in some patients has led to the search for less permanent penetrating fixation, but without risking a less stable mesh fixation and increased recurrences due to shift or shrinkage of the mesh. Avoiding transfascial sutures by using a double crown of staples has been proposed and recently absorbable fixation devices have been developed. Some surgeons have proposed fixation with glue to reduce the number of staples, or even eliminate them entirely. The continuously increasing multitude of marketed meshes and fixating devices leads to unlimited options in mesh fixation combination and geometry. Therefore, we will never be able to get a clear view on the benefits and pitfalls of every specific combination. Clearance of the anterior abdominal wall from peritoneal fatty tissue and correct positioning of the mesh with ample overlap of the hernia defect are possibly as important as the choice of mesh and fixation. Other topics that are involved in successful outcomes but not addressed in this article are adequate training in the procedure, appropriate selection of patients, and careful adhesiolysis to minimize accidental visceral injuries. PMID:23225589

  15. The Use of Nontreated Mosquito-Net Mesh Cloth for a Tension Free Inguinal Hernia Repair: Our Experience

    PubMed Central

    Oribabor, Felix O; Amao, Oluwasegun A; Akanni, Saheed O; Fatidinu, Samuel O

    2015-01-01

    Introduction: The prohibitive costs and scarcity of the imported prosthetic mesh for hernioplasty, has prevented its widespread use in most developing countries. We then set out to ascertain the outcome, complications (undue pain, wound infection, recurrence, and mesh extrusion) and cost implications in the use of a nontreated mosquito-net for inguinal hernioplasty. Materials and Methods: A prospective study of all consecutive adult patients with uncomplicated inguinal hernia who were admitted for open herniorrhaphy between January 2012 and December, 2013 at the Federal Medical Centre, Ido – Ekiti, South West, Nigeria. A sheet of the nontreated mosquito-net mesh 10 cm ? 8 cm, autoclaved, a day prior to surgery was used for each patient's hernia repair. The operation sites were exposed and examined 3rd and 6th postoperative days. Findings were documented for analysis. Result: A total of 130 adult patients were recruited for this study of which 115 of the patients were males and 15 were females. Forty-four (41.53%) had inguinal hernia and 76 (58.46%) of them had inguinoscrotal hernia. They all had successful repair and were followed-up for complications for a period of 6 weeks to 6 months at the surgical out-patient department. Conclusion: Locally-sourced and autoclaved mosquito-net mesh is an effective alternative for hernioplasty especially in situations where commercial mesh is not readily available or affordable. PMID:25838767

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

    PubMed

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

    2011-09-01

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

  17. A Critical Review of Biologic Mesh Use in Ventral Hernia Repairs under Contaminated Conditions

    PubMed Central

    Primus, Frank E.; Harris, Hobart W.

    2013-01-01

    Purpose We used an evidence-based approach to determine if the promotions and claims of superiority of biologic mesh over synthetic mesh use in ventral hernia repairs (VHRs) under contaminated conditions were sound and valid. Methods We searched the Medline database to specifically identify review articles relating to biologic mesh and VHR and critically reviewed these studies using an evidence-based approach. Results For the past forty-five years, four clinical reviews and one systematic review have included biologic meshes as part of a larger discussion on available prosthetics for VHR. All reviews supported biologic mesh use, especially in the setting of contaminated fields. Yet the primary literature included in these reviews and served as the basis for these conclusions consisted entirely of case series and case reports, which have the lowest level of evidence in determining scientific validity. Furthermore the FDA has neither cleared nor approved this particular use. Conclusions The cumulative data regarding biologic mesh use in VHRs under contaminated conditions does not support the claim that it is better than synthetic mesh used under the same conditions. The highly promoted and at least moderately utilized practice of placing biologic mesh in contamination is being done outside of the original intended use, and a re-evaluation of or possible moratorium on biologic mesh use in hernia surgery is seriously warranted. Alternatively, an industry-sponsored national registry of patients in whom ventral hernia repairs involved biologic mesh would substantively add to our understanding regarding how these intriguing biomaterials are being used and their overall clinical efficacy. PMID:23296600

  18. Laparoscopic features and repair of a combined left Spigelian hernia and left Morgagni diaphragmatic hernia.

    PubMed

    Chamary, S L; Chamary, V L

    2015-03-01

    Both Spigelian and Morgagni hernias cause serious morbidity so early diagnosis and timely treatment are necessary. These two types of hernia are more commonly found on the right side of patients. They are rare individually in adults and even rarer in combination. So far, an association between the two hernias has only been reported on the right. We describe the first case of a Spigelian hernia and a Morgagni hernia in a 62-year-old woman, both occurring on the left side. Our accompanying video describes several laparoscopic features that will help lead to early detection and diagnosis. PMID:25723678

  19. Repair of congenital diaphragmatic hernia after weaning from extracorporeal membrane oxygenation

    Microsoft Academic Search

    Vincent Adolph; Helene Flageole; Therese Perreault; Anne Johnston; Luong Nguyen; Sami Youssef; Frank Guttman; Jean-Martin Laberge

    1995-01-01

    Stabilization and delayed operation for patients with congenital diaphragmatic hernia (CDH) is now widely accepted. When preoperative extracorporeal membrane oxygenation (ECMO) is needed, most centers have CDH repaired on ECMO to minimize the risk of postoperative deterioration. The authors adopted a policy of weaning from ECMO before repair in an effort to avoid hemorrhagic risks. They reviewed their experience with

  20. Pitfalls in retromuscular mesh repair for incisional hernia: The importance of the “fatty triangle”

    Microsoft Academic Search

    J. Conze; A. Prescher; U. Klinge; M. Saklak; V. Schumpelick

    2004-01-01

    Open retromuscular mesh repair has become a standard procedure in incisional hernia repair. This technique led to a significant decrease of recurrences. Recurrences after this technique typically occur at the upper mesh border and are a result of the technical complexity of reaching the postulated underlay of 5 cm in the region of the linea alba. We performed an anatomical study

  1. Laparoscopic umbilical hernia repair in a cirrhotic patient with a peritoneovenous shunt.

    PubMed

    Umemura, Akira; Suto, Takayuki; Sasaki, Akira; Fujita, Tomohiro; Endo, Fumitaka; Wakabayashi, Go

    2015-05-01

    A 62-year-old Japanese woman who had developed massive cirrhotic ascites was referred to our hospital for a peritoneovenous shunt implant. However, CT examination revealed an umbilical hernia that had not been observed before the peritoneovenous shunt was implanted. We decided to perform laparoscopic umbilical hernia repair to keep carbon dioxide from flowing backward into the central circulatory system. We first clamped the catheter and set the upper limit of the pneumoperitoneum pressure to 6?mmHg. The central venous pressure was also measured simultaneously. Mesh was then applied over the hernia and fixed by the double-crown technique. Finally, 1000-mL physiological saline was infused into the abdominal cavity while the pneumoperitoneum was slowly released. In this case, we safely performed laparoscopic umbilical hernia repair while making some alterations, specifically catheter clamping, reducing pneumoperitoneum pressure, monitoring central venous pressure, and infusing physiological saline. PMID:25418015

  2. Abdominal ventral hernia repair with current biological prostheses: an experimental large animal model.

    PubMed

    Stanwix, Matthew G; Nam, Arthur J; Hui-Chou, Helen G; Ferrari, Jonathan P; Aberman, Harold M; Hawes, Michael L; Keledjian, Kaspar M; Jones, Luke S; Rodriguez, Eduardo D

    2011-04-01

    Biologic prostheses have emerged to address the limitations of synthetic materials for ventral hernia repairs; however, they lack experimental comparative data. Fifteen swine were randomly assigned to 1 of 3 bioprosthetic groups (DermaMatrix, AlloDerm, and Permacol) after creation of a full thickness ventral fascial defect. At 15 weeks, host incorporation, hernia recurrence, adhesion formation, neovascularization, inflammation, and biomechanical properties were assessed. No animals had hernia recurrence or eventration. DermaMatrix and Alloderm implants demonstrated more adhesions, greater inflammatory infiltration, and more longitudinal laxity, but near identical neovascularization and tensile strength to Permacol. We found that porcine acellular dermal products (Permacol) contain following essential properties of an ideal ventral hernia repair material: low inflammation, less elastin and stretch, lower adhesion rates and cost, and more contracture. The addition of lower cost xenogeneic acellular dermal products to the repertoire of available acellular dermal products demonstrates promise, but requires long-term clinical studies to verify advantages and efficacy. PMID:21042180

  3. Laparoscopic Repair of Large Bladder Herniation Presenting as an Inguinal Hernia

    PubMed Central

    Lee, Jong Yeon; Chang, In Ho; Choe, Jung Won; Park, Sang Ho; Ryu, Jae Hyung; Lee, Dong Min; Ryu, Young Woo; Lim, Song Won

    2013-01-01

    The bladder is involved in 1% to 3% of all hernia cases. We report a case of a large paraperitoneal bladder hernia (BH) in a 59-year-old man who had a palpable scrotal mass. Several techniques and approaches have been described for managing BHs. We performed a laparoscopic partial cystectomy and herniorrhaphy. This is the first case report on the repair of a large BH by use of a laparoscopic technique in Korea. PMID:23550233

  4. Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis

    Microsoft Academic Search

    K. Junge; R. Rosch; U. Klinge; R. Schwab; Ch. Peiper; M. Binnebösel; F. Schenten; V. Schumpelick

    2006-01-01

    The aim of this study was to analyze and evaluate the long-term recurrence rate and risk factors for inguinal hernia recurrence\\u000a in patients treated by the Shouldice suture repair. A total of 293 hernias treated by Shouldice suture technique in 1992 were\\u000a studied retrospectively. After a 10-year follow-up, 15 potential risk factors for recurrence were assessed in 142 patients\\u000a undergoing

  5. Operation for repair of obstructed substernocostal (Morgagni) hernia

    Microsoft Academic Search

    K Moghissi

    1981-01-01

    A complicated case of large substernocostal hernia in a 67-year-old man is described. A new surgical approach via upper laparotomy which can be extended by a lower median sternotomy, allowing complete access to the hernia was tried successfully and the patient's recovery was uneventful.

  6. Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials.

    PubMed

    Gillern, Suzanne; Bleier, Joshua I S

    2014-12-01

    Parastomal hernia is a prevalent problem and treatment can pose difficulties due to significant rates of recurrence and morbidities of the repair. The current standard of care is to perform parastomal hernia repair with mesh whenever possible. There exist multiple options for mesh reinforcement (biologic and synthetic) as well as surgical techniques, to include type of repair (keyhole and Sugarbaker) and position of mesh placement (onlay, sublay, or intraperitoneal). The sublay and intraperitoneal positions have been shown to be superior with a lower incidence of recurrence. This procedure may be performed open or laparoscopically, both having similar recurrence and morbidity results. Prophylactic mesh placement at the time of stoma formation has been shown to significantly decrease the rates of parastomal hernia formation. PMID:25435825

  7. Pain and convalescence following laparoscopic ventral hernia repair.

    PubMed

    Eriksen, Jens Ravn

    2011-12-01

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

  8. Significant improvement of biocompatibility of polypropylene mesh for incisional hernia repair by using poly-?-caprolactone nanofibers functionalized with thrombocyte-rich solution

    PubMed Central

    Plencner, Martin; Prosecká, Eva; Rampichová, Michala; East, Barbora; Buzgo, Matej; Vysloužilová, Lucie; Hoch, Ji?í; Amler, Evžen

    2015-01-01

    Incisional hernia is the most common postoperative complication, affecting up to 20% of patients after abdominal surgery. Insertion of a synthetic surgical mesh has become the standard of care in ventral hernia repair. However, the implementation of a mesh does not reduce the risk of recurrence and the onset of hernia recurrence is only delayed by 2–3 years. Nowadays, more than 100 surgical meshes are available on the market, with polypropylene the most widely used for ventral hernia repair. Nonetheless, the ideal mesh does not exist yet; it still needs to be developed. Polycaprolactone nanofibers appear to be a suitable material for different kinds of cells, including fibroblasts, chondrocytes, and mesenchymal stem cells. The aim of the study reported here was to develop a functionalized scaffold for ventral hernia regeneration. We prepared a novel composite scaffold based on a polypropylene surgical mesh functionalized with poly-?-caprolactone (PCL) nanofibers and adhered thrombocytes as a natural source of growth factors. In extensive in vitro tests, we proved the biocompatibility of PCL nanofibers with adhered thrombocytes deposited on a polypropylene mesh. Compared with polypropylene mesh alone, this composite scaffold provided better adhesion, growth, metabolic activity, proliferation, and viability of mouse fibroblasts in all tests and was even better than a polypropylene mesh functionalized with PCL nanofibers. The gradual release of growth factors from biocompatible nanofiber-modified scaffolds seems to be a promising approach in tissue engineering and regenerative medicine. PMID:25878497

  9. Significant improvement of biocompatibility of polypropylene mesh for incisional hernia repair by using poly-?-caprolactone nanofibers functionalized with thrombocyte-rich solution.

    PubMed

    Plencner, Martin; Prosecká, Eva; Rampichová, Michala; East, Barbora; Buzgo, Matej; Vysloužilová, Lucie; Hoch, Ji?í; Amler, Evžen

    2015-01-01

    Incisional hernia is the most common postoperative complication, affecting up to 20% of patients after abdominal surgery. Insertion of a synthetic surgical mesh has become the standard of care in ventral hernia repair. However, the implementation of a mesh does not reduce the risk of recurrence and the onset of hernia recurrence is only delayed by 2-3 years. Nowadays, more than 100 surgical meshes are available on the market, with polypropylene the most widely used for ventral hernia repair. Nonetheless, the ideal mesh does not exist yet; it still needs to be developed. Polycaprolactone nanofibers appear to be a suitable material for different kinds of cells, including fibroblasts, chondrocytes, and mesenchymal stem cells. The aim of the study reported here was to develop a functionalized scaffold for ventral hernia regeneration. We prepared a novel composite scaffold based on a polypropylene surgical mesh functionalized with poly-?-caprolactone (PCL) nanofibers and adhered thrombocytes as a natural source of growth factors. In extensive in vitro tests, we proved the biocompatibility of PCL nanofibers with adhered thrombocytes deposited on a polypropylene mesh. Compared with polypropylene mesh alone, this composite scaffold provided better adhesion, growth, metabolic activity, proliferation, and viability of mouse fibroblasts in all tests and was even better than a polypropylene mesh functionalized with PCL nanofibers. The gradual release of growth factors from biocompatible nanofiber-modified scaffolds seems to be a promising approach in tissue engineering and regenerative medicine. PMID:25878497

  10. [Complicated umbilical hernia in patients with decompensated liver cirrhosis. Concept for risk reduction of repair].

    PubMed

    Koscielny, A; Hirner, A; Kaminski, M

    2010-03-01

    Umbilical hernia repair is often accompanied by complications in patients with liver cirrhosis and ascites. In recent years we have been using the following concept for treating umbilical hernias in such patients: repair of the hernia by direct sutures and concomitant implantation of two large bore Robinson drainage tubes until the wound healing was completed within the next postoperative 10-14 days. During this time the reconstruction of the abdominal wall is in our opinion as robust that the ascites no longer represents a risk. Preconditions to perform this procedure were the best medicamentous treatment of ascites as ever possible and the perioperative administration of prophylactic antibiotics like gyrase inhibitors to avoid spontaneous bacterial peritonitis. Over a period of 10 years (01.01.1997-31.12.2006) we operated on 22 patients suffering from liver cirrhosis and ascites because of a complicated umbilical hernia (incarceration, irreponibility, skin ulceration, leackage of ascites). One group of patients (n=10) was treated by umbilical hernia repair with the concomitant implantation of two drainage tubes and the other group (n=12) by umbilical hernia repair without draining off the ascites. Morbidity and mortality were compared in both groups in a retrospective analysis. The postoperative morbidity could be reduced from 25% to 10% by using the drainage tubes as well as the rate of recurrent hernias in the drainage group. Due to these experiences we use the concept as standard in such patients and would like to recommend it further. However, we would like to initiate a prospective, randomized, at best multicenter trial for further validation. PMID:19812906

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

    PubMed Central

    Teng, Tze Yeong; Lau, Cheryl Chien-Li

    2014-01-01

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

  12. Magnetic Resonance–Visible Meshes for Laparoscopic Ventral Hernia Repair

    PubMed Central

    Pallwein-Prettner, Leo; Koch, Oliver Owen; Luketina, Ruzica Rosalia; Lechner, Michael; Emmanuel, Klaus

    2015-01-01

    Background and Objectives: We aimed to evaluate the first human use of magnetic resonance–visible implants for intraperitoneal onlay repair of incisional hernias regarding magnetic resonance presentability. Methods: Ten patients were surgically treated with intraperitoneally positioned superparamagnetic flat meshes. A magnetic resonance investigation with a qualified protocol was performed on postoperative day 1 and at 3 months postoperatively to assess mesh appearance and demarcation. The total magnetic resonance–visible mesh surface area of each implant was calculated and compared with the original physical mesh size to evaluate potential reduction of the functional mesh surfaces. Results: We were able to show a precise mesh demarcation, as well as accurate assessment of the surrounding tissue, in all 10 cases. We documented a significant decrease in the magnetic resonance–visualized total mesh surface area after release of the pneumoperitoneum compared with the original mesh size (mean, 190 cm2 vs 225 cm2; mean reduction of mesh area, 35 cm2; P < .001). At 3 months postoperatively, a further reduction of the surface area due to significant mesh shrinkage could be observed (mean, 182 cm2 vs 190 cm2; mean reduction of mesh area, 8 cm2; P < .001). Conclusion: The new method of combining magnetic resonance imaging and meshes that provide enhanced signal capacity through direct integration of iron particles into the polyvinylidene fluoride base material allows for detailed mesh depiction and quantification of structural changes. In addition to a significant early postoperative decrease in effective mesh surface area, a further considerable reduction in size occurred within 3 months after implantation. PMID:25848195

  13. Modified tension-free mesh repair used in rare case of Littre’s hernia

    PubMed Central

    Duysenovich, Raimkhanov Aidar; Zhaksybekvich, Aimagambetov Meyirbek; Bakytbekovich, Omarov Nazarbek; Yermukhambetovichzhan, Zhagniyev Zhandos

    2015-01-01

    Introduction Meckel’s diverticulum is found at the antimesenteric border of the ileum, usually located from 30 to 90 cm from the ileocecal valve. Meckel’s diverticulum complications, such as bowel obstruction, diverticulitis, hemorrhage and rarely, hernias containing a Meckel’s diverticulum (Littre’s Hernia) required surgical intervention. Case presentation We introduce the case report of 77-year-old man with inguinal hernia containing Meckel’s diverticulum operated by the modified tension-free mesh repair. Discussion Although Meckel’s diverticulum is a relatively common anomaly, herniation of these embryological remnants is an exceedingly rare event. It can be difficult to diagnose Littre’s hernia before operation. Conclusion The important thing is not to hesitate to perform diverticulectomy, to avoid complications of the patient in the future. PMID:26036457

  14. Laparoscopic umbilical hernia repair in the presence of extensive paraumbilical collateral veins: a case report.

    PubMed

    Lases, Seilenna S; Eker, Hasan H; Pierik, Engelbertus G J M; Klitsie, Pieter J; de Goede, Barry; Peeters, Mark P F M Vrancken; Kazemier, Geert; Lange, Johan F

    2011-12-01

    A patient with an umbilical hernia presenting with collateral veins in the abdominal wall and umbilicus is a case that every hernia surgeon has to deal with occasionally. Several underlying diseases have been described to provoke collateral veins in the abdominal wall. However, the treatment strategy should be uniform. We herein report a case of a successful laparoscopic umbilical hernia repair in a patient with collateral veins in the abdominal wall and umbilicus. A 63-year-old man was referred to the surgical outpatient clinic with a large symptomatic umbilical hernia and collateral veins in the abdominal wall, secondary to an occlusion of both common iliac veins. Because of collateral veins in the umbilicus and the size of the hernial defect, he was offered laparoscopic hernia repair without compromising these veins. Because of the extensive abdominal wall collaterals, duplex sonography vein mapping was performed preoperatively to mark a safe collateral-free area for trocar introduction. The defect was repaired by mesh prosthesis. PMID:22146185

  15. Outcome of abdominal wall hernia repair with biologic mesh: Permacol™ versus Strattice™.

    PubMed

    Cheng, Amy W; Abbas, Maher A; Tejirian, Talar

    2014-10-01

    The use of biologic mesh in abdominal wall operations has gained popularity despite a paucity of outcome data. Numerous biologic products are available with virtually no clinical comparison studies. A retrospective study was conducted to compare patients who underwent abdominal wall hernia repair with Permacol™ (crosslinked porcine dermis) and Strattice™ (noncrosslinked porcine dermis). Of 270 reviewed patients, 195 were implanted with Permacol™ and 75 with Strattice™. Ventral hernia repairs comprised the majority (85% for Permacol, 97% for Strattice™). Postoperative infection rate was lower in the Strattice™ group (5 vs 21%, P < 0.01). In the Permacol™ group only, the overall complication rates were significantly higher in patients with infected versus clean wounds (55 vs 35%, P < 0.05) and in obese patients (body mass index 40 kg/m(2) or greater [57 vs 34%], P < 0.01). Short-term complication and recurrence rates were higher when mesh was used as a fascial bridge: 51 versus 28 per cent for Permacol™, 58 versus 20 per cent for Strattice™. The hernia recurrence was similar in both groups. In this review of patients undergoing abdominal hernia repair with biologic mesh, Strattice™ mesh was associated with a lower short-term complication rate compared with Permacol™, but the hernia recurrence rate was similar. PMID:25264647

  16. Laparoscopic inguinal hernia repair in children using the percutaneous internal ring suturing technique – own experience

    PubMed Central

    Patkowski, Dariusz

    2014-01-01

    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). PMID:24729810

  17. Dual-sided composite mesh repair of hiatal hernia: Our experience and a review of the Chinese literature

    PubMed Central

    Zhang, Wei; Tang, Wei; Shan, Cheng-Xiang; Liu, Sheng; Jiang, Zhi-Guo; Jiang, Dao-Zhen; Zheng, Xiang-Min; Qiu, Ming

    2013-01-01

    AIM: To summarize our experience in the application of Crurasoft® for antireflux surgery and hiatal hernia (HH) repair and to introduce the work of Chinese doctors on this topic. METHODS: Twenty-one patients underwent HH repair with Crurasoft® reinforcement. Gastroesophageal reflux disease (GERD) and HH-related symptoms including heartburn, regurgitation, chest pain, dysphagia, and abdominal pain were evaluated preoperatively and 6 mo postoperatively. A patient survey was conducted by phone by one of the authors. Patients were asked about “recurrent reflux or heartburn” and “dysphagia”. An internet-based Chinese literature search in this field was also performed. Data extracted from each study included: number of patients treated, hernia size, hiatorrhaphy, antireflux surgery, follow-up period, recurrence rate, and complications (especially dysphagia). RESULTS: There were 8 type?I, 10 type II and 3 type III HHs in this group. Mean operative time was 119.29 min (range 80-175 min). Intraoperatively, length and width of the hiatal orifice were measured, (4.33 ± 0.84 and 2.85 ± 0.85 cm, respectively). Thirteen and eight Nissen and Toupet fundoplications were performed, respectively. The intraoperative complication rate was 9.52%. Despite dysphagia, GERD-related symptoms improved significantly compared with those before surgery. The recurrence rate was 0% during the 6-mo follow-up period, and long-term follow-up disclosed a recurrence rate of 4.76% with a mean period of 16.28 mo. Eight patients developed new-onset dysphagia. The Chinese literature review identified 12 papers with 213 patients. The overall recurrence rate was 1.88%. There was no esophageal erosion and the rate of dysphagia ranged from 0% to 24%. CONCLUSION: The use of Crurasoft® mesh for HH repair results in satisfactory symptom control with a low recurrence rate. Postoperative dysphagia continues to be an issue, and requires more research to reduce its incidence. PMID:24023497

  18. Peritoneal colon cancer metastasis to bilateral inguinal hernia repair sites: report of a case.

    PubMed

    Kudou, Michihiro; Murayama, Yasutoshi; Konishi, Hirotaka; Morimura, Ryo; Komatsu, Shuhei; Shiozaki, Atsushi; Kuriu, Yoshiaki; Ikoma, Hisashi; Kubota, Takeshi; Nakanishi, Masayoshi; Ichikawa, Daisuke; Fujiwara, Hitoshi; Okamoto, Kazuma; Sakakura, Chouhei; Kojima, Osamu; Otsuji, Eigo

    2015-08-01

    We report a rare case of peritoneal metastasis from colon cancer being found in the bilateral sites of inguinal hernia repair. The patient was an 85-year-old man who underwent colonoscopy for a positive fecal occult blood test, with a subsequent diagnosis of ascending colon cancer. He had undergone mesh plug repair for bilateral inguinal hernias at another hospital 6 years previously. We performed laparoscopy-assisted right hemi-colectomy and found nodes in the bilateral scars from the inguinal hernioplasty. Biopsy confirmed that both of the nodes were peritoneal metastasis, leading to the assumption that cancer cells disseminated within the abdominal cavity had been implanted at the repair sites, although the mechanism for this was unclear. A relationship between inflammation and peritoneal metastasis has been reported; thus, we speculated that local inflammation resulting from chronic stimulus of mesh plugs and peritoneal trauma caused peritoneal metastasis at the repair sites. PMID:25319214

  19. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair

    Microsoft Academic Search

    M. A. Memon; N. J. Cooper; B. Memon; M. I. Memon; K. R. Abrams

    2003-01-01

    Background: The aim was to conduct a meta-analysis of the randomized evidence to determine the relative merits of laparoscopic (LIHR) and open (OIHR) inguinal hernia repair. Methods: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified all randomized clinical trials that compared OIHR and LIHR and were published in the English language between January

  20. Experience with abdominal wall closure for patients with congenital diaphragmatic hernia repaired on ECMO

    Microsoft Academic Search

    Jay J Schnitzer; Colin S Kikiros; Billie L Short; Ann O'Brien; Kathryn D Anderson; Kurt D Newman

    1995-01-01

    Congenital diaphragmatic hernia (CDH) and its attendant lack of abdominal domain can create major technical challenges with respect to diaphragmatic and abdominal wall reconstruction, especially in seriously ill infants who require extracorporeal membrane oxygenation (ECMO). The authors reviewed the medical records of all infants with CDH repaired on ECMO at their institution (group 1, 15 patients), and compared them with

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

    Microsoft Academic Search

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

    2001-01-01

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

  2. [Repair of a huge Bochdalek hernia by direct suture and mesh reconstruction].

    PubMed

    Sato, Hiroki; Yamashita, Kazuki; Waki, Naohisa; Kawai, Hiroshi; Ishizaki, Masahiro; Nishi, Hideyuki

    2014-12-01

    A 72-year-old man presented with complaints of sudden abdominal pain and vomiting. After a thorough examination, the patient was diagnosed with a left-sided Bochdalek hernia with strangulation of the stomach and spleen. The impaction was cleared by drainage of the stomach contents by a nasogastric tube;then, surgical repair through thoracic approach was performed. The herinia port size was large, and the defect of diaphragm was successfully repaired by both direct closure and mesh reconstruction. PMID:25434538

  3. Case report and review of lumbar hernia

    PubMed Central

    Walgamage, Thilan B.; Ramesh, B.S.; Alsawafi, Yaqoob

    2014-01-01

    Lumbar hernias are uncommon and about 300 cases have been reported till date. They commonly occur due to trauma, surgery and infection. They are increasingly being reported after motor vehicle collision injuries. However, spontaneous lumbar hernias are rare and are reported infrequently. It is treated with different surgical approaches and methods. We report a case of primary spontaneous lumbar hernia which was repaired by transperitonial laparoscopic approach using Vypro (polypropylene/polyglactin) mesh and covered with a peritoneal flap. PMID:25555145

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

    PubMed

    Köhler, G

    2014-08-01

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

  5. [The history of treatment of groin hernia].

    PubMed

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

    2008-01-01

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

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

    Microsoft Academic Search

    Eugene S. Wiener; Robert J. Touloukian; Bradley M. Rodgers; Jay L. Grosfeld; Edwin I. Smith; Moritz M. Ziegler; Arnold G. Coran

    1996-01-01

    The members of the Section on Surgery of the American Academy of Pediatrics were surveyed to determine the practice of North American pediatric surgeons in infants with inguinal hernia (IH). Case-scenario multiple-choice-design questionnaires regarding hernias and hydroceles were sent to all members of the Surgical Section, and responses were received from 292 (50%). In healthy full-term infant boys with asymptomatic

  7. Outcomes of Laparoscopic versus Open Fascial Component Separation for Complex Ventral Hernia Repair.

    PubMed

    Ng, Nathaniel; Wampler, Mallory; Palladino, Humberto; Agullo, Francisco; Davis, Brian R

    2015-07-01

    Ventral hernia recurrence rates have improved with advancements in technique. Open and laparoscopic fascial component separation techniques improve recurrence rates by allowing a tension free closure. This study examines laparoscopic component separation (LCS) and open component separation (OCS) techniques in the repair of complex ventral hernias and compares factors affecting patient outcomes. A retrospective chart review of patients who underwent ventral hernia repair with LCS and OCS was conducted between 2009 and 2013. Patient characteristics and outcomes were documented. Hernia recurrence was determined using physical exam and computed tomography if physical exam was equivocal. Univariate and multivariate analyses were performed. Ten patients underwent LCS and 38 underwent OCS. The rate of wound infection in the LCS group was 20 per cent versus 50 per cent in the OCS group. The overall rate of recurrence after LCS was 20 per cent, and 26 per cent in the OCS group. For body mass index > 30, the recurrence rate was 20 per cent in the LCS group and 29 per cent (P = 0.5) in the open group. The use of LCS demonstrates a trend in the reduction of hernia recurrence and wound infection overall and in patients with body mass index > 30 compared with OCS. PMID:26140893

  8. Outcomes for incisional hernia repair in patients undergoing concomitant surgical procedures.

    PubMed

    Altom, Laura K; Graham, Laura A; Gray, Stephen H; Snyder, Christopher W; Vick, Catherine C; Hawn, Mary T

    2012-02-01

    The safety and efficacy of performing concomitant surgical procedures with an incisional hernia repair (IHR) is not well understood. There are conflicting reports on the outcomes for permanent mesh implantation in the setting of clean-contaminated procedures. The purpose of this study was to review the effect of concomitant surgical procedures on IHR outcomes. This is a retrospective multisite cohort of patients undergoing elective IHR at 16 Veterans Affairs hospitals from 1998 to 2002. Concomitant procedure status, hernia characteristics, and operative details were determined using physician-abstracted operative notes. Hernia outcomes of recurrence and mesh explantation were determined from the medical chart. ?(2) tests, Kaplan-Meier curves, and Cox regression were used to evaluate the effects of concomitant status on hernia outcomes. Of the 1495 elective IHRs, 75 (4.8%) were same site and 56 (3.8%) different site concomitant procedures. At median follow-up of 69.3 months (range 19.1-98.3), 33.6 per cent of patients had a recurrence, mesh explantation, or both. Permanent mesh placement was less likely among concomitant procedures as compared with nonconcomitant procedures (P < 0.0001). Adjusted Cox proportional hazards models of hernia outcomes resulted in an increased hazard for recurrence among same site clean procedures (Hazard Ratio (HR) = 1.8, P = 0.03) and an increased hazard for mesh explantation among same site clean-contaminated procedures (HR = 8.4, P = 0.002). Concomitant same site procedures are significantly associated with adverse hernia outcomes as compared with isolated IHR or IHR with other site concomitant procedures. The high failure rate of hernia repairs among same site concomitant procedures should be taken into account during the surgical decision-making process. PMID:22369837

  9. Bilateral prevascular herniae – A rare complication of aorto-uniiliac endovascular abdominal aortic aneurysm repair and femoro-femoral bypass

    PubMed Central

    Obinwa, Obinna; Canning, Caitriona; O’Donohoe, Martin

    2015-01-01

    A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency aorto-uniiliac EVAR and femoro-femoral bypass for a ruptured abdominal aortic aneurysm is presented. Primary repair of the herniae was achieved using a preperitoneal approach. The case emphasises a safe approach to dealing with this rare complication. PMID:25890122

  10. Medial Versus Traditional Approach to US-guided TAP Blocks for Open Inguinal Hernia Repair

    ClinicalTrials.gov

    2012-04-30

    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

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

    PubMed

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

    2014-11-01

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

  12. A laparoscopic high anterior resection for sigmoid cancer with extraction through incarcerated left inguinal hernia repaired with Permacol mesh.

    PubMed

    Carr, William Reginald Joseph; O'Dair, Graham

    2012-01-01

    A 65-year-old man presented to the general surgical outpatients with an incarcerated left inguinal hernia. Initial investigations revealed an iron deficiency anaemia that was investigated with a colonoscopy and gastroscopy. This revealed a sigmoid cancer and the staging CT scan confirmed a tumour incarcerated in the sac of the left inguinal hernia. We proceeded with a laparoscopic high anterior resection using the inguinal hernia as the extraction site. The hernia was repaired using Permacol mesh. No postoperative complications occurred. PMID:23001089

  13. Bone Anchor Fixation in Abdominal Wall Reconstruction: A Useful Adjunct in Suprapubic and Para-iliac Hernia Repair.

    PubMed

    Blair, Laurel J; Cox, Tiffany C; Huntington, Ciara R; Ross, Samuel W; Kneisl, Jeffrey S; Augenstein, Vedra A; Heniford, B Todd

    2015-07-01

    Suprapubic hernias, parailiac or flank hernias, and lumbar hernias are difficult to repair and are associated with high-recurrence rates owing to difficulty in obtaining substantive overlap and especially mesh fixation due to bone being a margin of the hernia. Orthopedic suture anchors used for ligament reconstruction have been used to attach prosthetic material to bony surfaces and can be used in the repair of these hernias where suture fixation was impossible. A prospective, single institution study of ventral hernia repairs involving bone anchor mesh fixation was performed. Demographics, operative details, and outcomes data were collected. Twenty patients were identified, with a mean age 53 (range: 35-70 years) and mean body mass index 28.4 kg/m(2) (range 21-38). Ten lumbar, seven suprapubic, and three parailiac hernias were studied. The majority were recurrent hernias (n = 13), with one to seven previously failed repairs. The mean hernia defect size was very large (270 cm(2); range: 56-832 cm(2)) with average mesh size of 1090 cm(2) (range 224-3640 cm(2)). Both Mitek GII (Depuy, Raynham, MA) and JuggerKnot 2.9-mm (Biomet, Biomedical Instruments, Warsaw, IN) anchors were used, with an average of four anchors/case (range: 1-16). Mean operative time was 218 minutes (120-495). There were three minor complications, no operative mortality, and no recurrences during an average follow-up of 24 months. Pelvic bone anchors permit mesh fixation in high-recurrence areas not amenable to traditional suture fixation. The ability to safely and effectively use bone anchor fixation is an essential tool in complex open ventral hernia repair. PMID:26140889

  14. Umbilical hernias and cirrhose.

    PubMed

    Dokmak, S; Aussilhou, B; Belghiti, J

    2012-10-01

    Umbilical hernia (UH) is the most frequent abdominal wall complication of ascites in cirrhotic patients. Treatment to control ascites, which mainly consists of repeated paracentesis or transjugular intrahepatic portosystemic shunt (TIPS), is mandatory; otherwise the risk of hernia recurrence is very high. Nowadays, surgical portosystemic shunts are rarely performed. Classically, hernia repair was offered only to patients with symptomatic UH, but presently, even if the hernia is minimally symptomatic, there is tendency to perform elective repair to avoid emergency surgery for complications associated with very high mortality and morbidity rates (rupture and strangulation). If liver transplantation is indicated, treatment of UH can be performed simultaneously, unless the hernia is highly symptomatic or complicated or if the waiting time on the transplantation list is long. During repair, necrotic skin tissue should be excised; the use of prosthetic material (if the defect is large) is possible with a low risk of infection as long as ascites is sterile. The advantage of laparoscopic repair of large UH is to avoid any skin incision (precluding ascitic fluid leak) and avoid exposing prosthetic mesh to necrotic infected tissue. If the defect is small, UH repair can be performed under local anesthesia. PMID:23122832

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

    PubMed

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

    2012-08-01

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

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

    PubMed

    Dixon, Steven; Sharma, Mitesh; Holtham, Stephen

    2014-01-01

    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

  17. Conventional mesh repair of a giant iatrogenic bilateral diaphragmatic hernia with an enterothorax

    PubMed Central

    Lingohr, Philipp; Galetin, Thomas; Vestweber, Boris; Matthaei, Hanno; Kalff, Jörg C; Vestweber, Karl-Heinz

    2014-01-01

    Purpose Diaphragmatic hernias (DHs) are divided into congenital and acquired hernias, most of which are congenital. Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare. For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur. Methods In 2009, we performed three partial diaphragm replacements in our clinic for repairing DHs using a PERMACOL™ implant. Results As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax. Conclusion We see a good indication for diaphragm replacements by using a PERMACOL™ implant for fixing especially DHs with huge hernial gaps and in cases with fragile tissue. PMID:24600251

  18. Strangulation of the stomach and the transverse colon following laparoscopic esophageal hiatal hernia repair

    PubMed Central

    Ko?ci?ski, Tomasz; Malinger, Stanis?aw; Szmeja, Jacek; Monkiewicz, Micha?; Drews, Micha?

    2012-01-01

    The authors present a 32-year-old male patient with incarceration of a recurrent esophageal hiatal hernia after laparoscopic repair. A life-threatening strangulation of the stomach and the transverse colon occurred within a few days after the operation. Relapse of hiatal hernias amounts to almost half of early complications characteristic for the laparoscopic approach. General recommendations regarding surgical technique as well as perioperative care have been proposed in order to decrease the risk of relapse. Also, routine contrast radiology on the first or second day following the laparoscopic operation facilitates early diagnosis of relapse of hiatal hernia with emergent reoperation. This may result in decreased morbidity and improved overall outcome of the treatment. PMID:23362434

  19. Strangulation of the stomach and the transverse colon following laparoscopic esophageal hiatal hernia repair.

    PubMed

    Hermann, Jacek; Ko?ci?ski, Tomasz; Malinger, Stanis?aw; Szmeja, Jacek; Monkiewicz, Micha?; Drews, Micha?

    2012-12-01

    The authors present a 32-year-old male patient with incarceration of a recurrent esophageal hiatal hernia after laparoscopic repair. A life-threatening strangulation of the stomach and the transverse colon occurred within a few days after the operation. Relapse of hiatal hernias amounts to almost half of early complications characteristic for the laparoscopic approach. General recommendations regarding surgical technique as well as perioperative care have been proposed in order to decrease the risk of relapse. Also, routine contrast radiology on the first or second day following the laparoscopic operation facilitates early diagnosis of relapse of hiatal hernia with emergent reoperation. This may result in decreased morbidity and improved overall outcome of the treatment. PMID:23362434

  20. Successful utilization of a video-assisted thoracic approach to repair morgagni's hernia: Report of a case

    Microsoft Academic Search

    Shinji Akamine; Katsunobu Kawahara; Akihiro Nakamura; Takao Takahashi; Satoshi Yamamoto; Hiroyoshi Ayabe; Masao Tomita

    1995-01-01

    We describe herein the successful utilization of a video-assisted thoracic surgical approach to repair Morgagni's hernia. The patient was a 62-year-old woman in whom a routine chest X-ray had revealed an asymptomatic mass, which was presumed to be a pericardial lipoma or Morgagni's hernia. The video-assisted thoracic surgical approach was combined with a right submammary minithoracotomy to successfully repair the

  1. Outcomes Following Placement of Non–Cross-Linked Porcine-Derived Acellular Dermal Matrix in Complex Ventral Hernia Repair

    PubMed Central

    Golla, Dinakar; Russo, Carly C.

    2014-01-01

    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

  2. Outcomes following placement of non-cross-linked porcine-derived acellular dermal matrix in complex ventral hernia repair.

    PubMed

    Golla, Dinakar; Russo, Carly C

    2014-01-01

    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

  3. A case of incarcerated umbilical hernia in an adult treated by laparoscopic surgery.

    PubMed

    Tsushimi, Takaaki; Mori, Hirohito; Nagase, Takashi; Harada, Takasuke; Ikeda, Yoshitaka

    2015-01-01

    A 42-year-old, obese woman was admitted to our hospital 3 h after the sudden development of abdominal pain. Her umbilical region was swollen and she was diagnosed with incarceration of an umbilical hernia by computed tomography. Although we tried, we were unable to reduce the hernia with a manipulative procedure. We decided to perform an emergency laparoscopy. Once general anesthesia was induced, we achieved hernia reduction. From a laparoscopic view, the portion of strangulated small intestine was neither necrotic nor perforated. The size of the hernial orifice was ?2 × 2 cm, and thus, we selected a 12 × 12 cm composite mesh to cover the hernia defect by at least 5 cm in all directions. The surgical procedure was uneventful and the total operation time was 112 min. The patient recovered uneventfully and was discharged on postoperative day 9. She remains free of recurrence 20 months after surgery. PMID:25672973

  4. Analysis of Risk Factors for the Development of Incisional and Parastomal Hernias in Patients after Colorectal Surgery

    PubMed Central

    Song, In Ho; Ha, Heon-Kyun; Choi, Sang-Gi; Jeon, Byeong Geon; Kim, Min Jung

    2012-01-01

    Purpose The purpose of this study was to evaluate the overall rate and risk factors for the development of an incisional hernia and a parastomal hernia after colorectal surgery. Methods The study cohort consisted of 795 consecutive patients who underwent open colorectal surgery between 2005 and 2007 by a single surgeon. A retrospective analysis of prospectively collected data was performed. Results The overall incidence of incisional hernias was 2% (14/690). This study revealed that the cumulative incidences of incisional hernia were 1% at 12 months and 3% after 36 months. Eighty-six percent of all incisional hernias developed within 3 years after a colectomy. The overall rate of parastomal hernias in patients with a stoma was 6.7% (7/105). The incidence of parastomal hernias was significantly higher in the colostomy group than in the ileostomy group (11.9% vs. 0%; P = 0.007). Obesity, abdominal aortic aneurysm, American Society of Anesthesiologists score, serum albumin level, emergency surgery and postoperative ileus did not influence the incidence of incisional or parastomal hernias. However, the multivariate analysis revealed that female gender and wound infection were significant risk factors for the development of incisional hernias female: P = 0.009, wound infection: P = 0.041). There were no significant factors related to the development of parastomal hernias. Conclusion Our results indicate that most incisional hernias develop within 3 years after a colectomy. Female gender and wound infection were risk factors for the development of an incisional hernia after colorectal surgery. In contrast, no significant factors were found to be associated with the development of a parastomal hernia. PMID:23346508

  5. Impact of mesh positioning on foreign body reaction and collagenous ingrowth in a rabbit model of open incisional hernia repair

    Microsoft Academic Search

    M. Binnebösel; C. D. Klink; J. Otto; J. Conze; P. L. Jansen; M. Anurov; V. Schumpelick; K. Junge

    2010-01-01

    Background  Incisional hernia remains as one of the most common surgical complications. Different mesh techniques are used in 75–80% of\\u000a hernia repair. The aim of this study was to evaluate the dependence of mesh positioning and the type of mesh implanted on\\u000a foreign body reaction and collagenous ingrowth.\\u000a \\u000a \\u000a \\u000a Materials and methods  In 24 male Chinchilla rabbits, an incisional hernia repair was performed

  6. Synthetic mesh repair for incisional hernia treatment in high-risk patients for surgical site occurrences.

    PubMed

    Köhler, Gernot; Weitzendorfer, Michael; Kalcher, Veronika; Emmanuel, Klaus

    2015-04-01

    Patients with incisional hernias (IH) and risk factors for surgical site occurrences (SSOs) such as defined comorbidities and/or potential contaminations are considered to be treated with bioprosthetics. A retrospective analysis of consecutive patients who had undergone elective IH repair with synthetic mesh materials between 2009 and 2013 was conducted. Only patients who were classified into Grades II and III according to the classification of the Ventral Hernia Working Group (VHWG) were considered for the study. Primary outcome parameter was the incidence of SSO. The relationships among demographics, hernia characteristics, surgical technique, and SSOs were also evaluated. Overall, 108 patients were included (Grade II: 68, Grade III: 40). SSO was identified in 14 patients. Having two or more comorbidities (P = 0.04), an open sublay technique (P = 0.005), duration of operation (P = 0.02), larger hernia defects (P = 0.001), and using larger mesh sizes (P = 0.01) were associated with significantly higher rates of SSO. Affiliation to VHWG Grading II or III showed no impact on SSO occurrence. Synthetic mesh repair both in an "open sublay" and laparoscopic intraperitoneal technique is safe regarding patients with risk factors for SSO. The recommendations of the VHWG must be declined and a modification of the grading system is warranted overlooking a more liberal use of synthetic meshes. PMID:25831186

  7. Telephone Follow-Up by a Midlevel Provider After Laparoscopic Inguinal Hernia Repair Instead of Face-to-Face Clinic Visit

    PubMed Central

    Hwa, Kimberly; Wren, Sherry M.

    2015-01-01

    Background and Objectives: The need for more cost- and time-efficient provision of medical care has prompted an interest in remote or telehealth approaches to delivery of health care. We present a study examining the feasibility and outcomes of implementation of a telephone follow-up program for laparoscopic inguinal hernia repair. Methods: This is a retrospective review of consecutive patients who prospectively agreed to undergo telephone follow-up after laparoscopic inguinal hernia repair instead of standard face-to-face clinic visits. Patients received a telephone call from a dedicated physician assistant 2 to 3 weeks after surgery and answered a predetermined questionnaire. A face-to-face clinic visit was scheduled based on the results of the call or on patient request. Results: Of 62 patients who underwent surgery, all agreed to telephone follow-up instead of face-to-face clinic visits. Their mean round-trip distance to the hospital was 122 miles. Fifty-five patients (88.7%) successfully completed planned telephone follow-up. Three patients (4.8%) were lost to follow-up, and 4 (6.5%) were erroneously scheduled for a clinic appointment. Of the 55 patients who were reached by telephone, 50 (90.9%) were satisfied and declined an in-person clinic visit. Five patients (9.1%) returned for a clinic appointment based on concerns raised during the telephone call. Of these, 1 was found to have an early hernia recurrence and 1 had a seroma. Conclusion: Telephone follow-up by a midlevel provider after laparoscopic inguinal hernia repair is feasible and effective and is well received by patients. PMID:25848178

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

    PubMed Central

    2013-01-01

    Background Anterior open treatment of the inguinal hernia with a tension-free mesh has reduced the incidence of hernia recurrence. The Lichtenstein procedure is the current reference technique for inguinal hernia treatment. Chronic pain has become the main postoperative complication after surgical inguinal hernia repair, especially following Lichtenstein. Preliminary experiences with a soft mesh positioned in the preperitoneal space (PPS) by transinguinal preperitoneal (TIPP) or total extraperitoneal (TEP) technique, showed promising results considering the reduction of postoperative chronic pain. Evolution of surgical innovations for inguinal hernia repair led to an open, direct approach with preperitoneal mesh position, such as TIPP. Based on the TIPP procedure, another preperitoneal repair has been recently developed, the transrectus sheath preperitoneal (TREPP) mesh repair. Methods The ENTREPPMENT trial is a multicentre randomized clinical trial. Patients will be randomly allocated to anterior inguinal hernia repair according to the TREPP mesh repair or TIPP procedure. All patients with a primary unilateral inguinal hernia, eligible for operation, will be invited to participate in the trial. The primary outcome measure will be the number of patients with postoperative chronic pain. Secondary outcome measures will be serious adverse events (SAEs), including recurrence, hemorrhage, return to daily activities (for example work), operative time and hospital stay. Alongside the trial health status, an economic evaluation will be performed. To demonstrate that inguinal hernia repair according to the TREPP technique reduces the percentage of patients with postoperative chronic pain from 12% to <6%, a sample size of 800 patients is required (two-sided test, ??=?0.05, 80% power).The ENTREPPMENT trial aims to evaluate the TREPP and TIPP procedures from patients’ perspective. It is hypothesized that the TREPP technique may reduce the number of patients with any form of postoperative chronic pain by 50% compared to the TIPP procedure. Trial registration Current Controlled Trials: ISRCTN18591339 PMID:23452397

  9. Symposium on the management of inguinal hernias: 4. The Shouldice technique: a canon in hernia repair

    PubMed Central

    Bendavid, Robert

    1997-01-01

    Controversy exists on the merits of the various approaches to inguinal repair. Evolution of the classic open repair has culminated in the Shouldice repair. Challenges from newcomers, namely, tension-free repair and laparoscopy, are being examined. These two techniques have a number of disadvantages: the presence of foreign bodies (prostheses) and their implication in cases of infection; the cost of prosthetic material, which is no longer negligible (particularly with expanded polytetrafluoroethylene); and problems of safety in that the laparoscopic approach is no longer a dependable asset except in the hands of a highly specialized and dextrous operator. Still, complications occur with laparoscopic repair that should not be associated with a surgical procedure that is considered benign, safe and cost-effective. Surgeons must recognize the pertinent facts and decide according to their conscience which method of repair to use. PMID:9194781

  10. Development of a clinical trial to determine whether watchful waiting is an acceptable alternative to surgical repair for patients with oligosymptomatic incisional hernia: study protocol for a randomized controlled trial

    PubMed Central

    2012-01-01

    Background Incisional hernia is a frequent complication in abdominal surgery. This article describes the development of a prospective randomized clinical trial designed to determine whether watchful waiting is an acceptable alternative to surgical repair for patients with oligosymptomatic incisional hernia. Methods/Design This clinical multicenter trial has been designed to compare watchful waiting and surgical repair for patients with oligosymptomatic incisional hernia. Participants are randomized to watchful waiting or surgery and followed up for two years. The primary efficacy endpoint is pain/discomfort during normal activities as a result of the hernia or hernia repair two years after enrolment, as measured by the hernia-specific Surgical Pain Scales (SPS). The target sample size of six hundred thirty-six patients was calculated to detect non-inferiority of the experimental intervention (watchful waiting) in the primary endpoint. Sixteen surgical centers will take part in the study and have submitted their declaration of commitment giving the estimated number of participating patients per year. A three-person data safety monitoring board will meet annually to monitor and supervise the trial. Discussion To date, we could find no published data on the natural course of incisional hernias. To our knowledge, watchful waiting has never been compared to standard surgical repair as a treatment option for incisional hernias. A trial to compare the outcome of the two approaches in patients with oligosymptomatic incisional hernias is urgently needed to provide data that can facilitate the choice between treatment options. If watchful waiting was equal to surgical repair, the high costs of surgical repair could be saved. The design for such a trial is described here. This multicenter trial will be funded by the German Research Foundation (DFG). The ethics committee of the Charité has approved the study protocol. Approval has been obtained from ten study sites at time of this submission. The electronic Case Report Forms have been created. The first patient was to be randomized November 14th, 2011. An initiation meeting took place in Berlin January 9th, 2012. Trial Registration ClinicalTrials.gov: NCT01349400 PMID:22314130

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

    PubMed

    Strange, Paul S

    2003-01-01

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

  12. Transabdominal laparoscopic inguinal hernia repair: is there a place for biological mesh?

    Microsoft Academic Search

    F. Agresta; N. Bedin

    2008-01-01

    Aim  An ideal mesh should produce minimal foreign-body reaction and be compatible with human tissue. Studies focusing on these\\u000a aspects indicate that a biological mesh acts as a scaffold for hernia repair. In this paper, we retrospectively evaluate a\\u000a consecutive series of patients who underwent laparoscopic transabdominal pre-peritoneal (TAPP) hernioplasty using a biological\\u000a mesh—Surgisis—fixed with fibrin glue, focusing on the feasibility

  13. The impact of pain on daily activities following open mesh inguinal hernia repair

    Microsoft Academic Search

    E. Staal; S. W. Nienhuijs; M. E. Keemers-Gels; C. Rosman; L. J. A. Strobbe

    2008-01-01

    Background  In groin hernia repair studies, chronic pain is a frequently used primary endpoint. However, its impact on daily life activities\\u000a has been less investigated. Such an outcome is relevant for the patient and surgeon and cannot be extrapolated out of pain\\u000a scores. The Pain Disability Index (PDI), a questionnaire wherein patients rate their impairment, could reveal the consequences\\u000a of pain.

  14. Human acellular dermal matrix for ventral hernia repair reduces morbidity in transplant patients

    Microsoft Academic Search

    M. B. Brewer; E. M. Rada; M. L. Milburn; N. H. Goldberg; D. P. Singh; M. Cooper; R. P. Silverman

    2011-01-01

    Purpose  Organ transplantation is widely accepted as the treatment of choice for native organ failure. Due to required immunosuppression,\\u000a however, organ recipients are prone to wound infections, incisional hernias, and fascial dehiscence. These complications are\\u000a especially dangerous in this patient population, as they can compromise the survival of the transplanted organ. Various methods\\u000a have been employed to repair ventral and incisional

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

    Microsoft Academic Search

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

    2001-01-01

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

  16. A prospective randomised trial comparing mesh types and fixation in totally extraperitoneal inguinal hernia repairs.

    PubMed

    Cristaudo, Adam; Nayak, Arun; Martin, Sarah; Adib, Reza; Martin, Ian

    2015-05-01

    The totally extraperitoneal (TEP) approach for surgical repair of inguinal hernias has emerged as a popular technique. We conducted a prospective randomised trial to compare patient comfort scores using different mesh types and fixation using this technique. Over a 14 month period, 146 patients underwent 232 TEP inguinal hernia repairs. We compared the comfort scores of patients who underwent these procedures using different types of mesh and fixation. A non-absorbable 15 × 10 cm anatomical mesh fixed with absorbable tacks (Control group) was compared with either a non-absorbable 15 × 10 cm folding slit mesh with absorbable tacks (Group 2), a partially-absorbable 15 × 10 cm mesh with absorbable tacks (Group 3) or a non-absorbable 15 × 10 cm anatomical mesh fixed with 2 ml fibrin sealant (Group 4). Outcomes were compared at 1, 2, 4 and 12 weeks using the Carolina Comfort Scale (CCS) scores. At 1, 2, 4 and 12 weeks, the median global CCS scores were low for all treatment groups. Statistically significant differences were seen only for median CCS scores and subscores with the use of partially-absorbable mesh with absorbable tacks (Group 3) at weeks 2 and 4. However, these were no longer significant at week 12. In this study, the TEP inguinal hernia repair with minimal fixation results in low CCS scores. There were no statistical differences in CCS scores when comparing types of mesh, configuration of the mesh or fixation methods. PMID:25845302

  17. Congenital diaphragmatic hernia: Survival treated with very delayed surgery, spontaneous respiration, and no chest tube

    Microsoft Academic Search

    J. T. Wung; R. Sahni; S. T. Moffitt; E. Lipsitz; C. J. H. Stolar

    1995-01-01

    This report suggests that stabilization of the intrauterine to extrauterine transitional circulation combined with a respiratory care strategy that avoids pulmonary overdistension, takes advantage of inherent biological cardiorespiratory mechanics, and very delayed surgery for congenital diaphragmatic hernia results in improved survival and decreases the need for extracorporeal membrane oxygenation (ECMO). This retrospective review of a 10-year experience in which the

  18. A Preclinical Evaluation of Alternative Synthetic Biomaterials for Fascial Defect Repair Using a Rat Abdominal Hernia Model

    PubMed Central

    Ulrich, Daniela; Edwards, Sharon L.; White, Jacinta F.; Supit, Tommy; Ramshaw, John A. M.; Lo, Camden; Rosamilia, Anna; Werkmeister, Jerome A.; Gargett, Caroline E.

    2012-01-01

    Introduction Fascial defects are a common problem in the abdominal wall and in the vagina leading to hernia or pelvic organ prolapse that requires mesh enhancement to reduce operation failure. However, the long-term outcome of synthetic mesh surgery may be unsatisfactory due to post-surgical complications. We hypothesized that mesh fabricated from alternative synthetic polymers may evoke a different tissue response, and provide more appropriate mechanical properties for hernia repair. Our aim was to compare the in vivo biocompatibility of new synthetic meshes with a commercial mesh. Methods We have fabricated 3 new warp-knitted synthetic meshes from different polymers with different tensile properties polyetheretherketone (PEEK), polyamide (PA) and a composite, gelatin coated PA (PA+G). The rat abdominal hernia model was used to implant the meshes (25×35 mm, n?=?24/ group). After 7, 30, 60, 90 days tissues were explanted for immunohistochemical assessment of foreign body reaction and tissue integration, using CD31, CD45, CD68, alpha-SMA antibodies. The images were analysed using an image analysis software program. Biomechanical properties were uniaxially evaluated using an Instron Tensile® Tester. Results This study showed that the new meshes induced complex differences in the type of foreign body reaction over the time course of implantation. The PA, and particularly the composite PA+G meshes, evoked a milder early inflammatory response, and macrophages were apparent throughout the time course. Our meshes led to better tissue integration and new collagen deposition, particularly with the PA+G meshes, as well as greater and sustained neovascularisation compared with the PP meshes. Conclusion PA, PA+G and PEEK appear to be well tolerated and are biocompatible, evoking an overlapping and different host tissue response with time that might convey mechanical variations in the healing tissue. These new meshes comprising different polymers may provide an alternative option for future treatment of fascial defects. PMID:23185528

  19. Laparoscopic surgery of inguinal hernias in children—Initial experience

    Microsoft Academic Search

    Felix Schier

    2000-01-01

    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

  20. Bacterial clearance of biologic grafts used in hernia repair: an experimental study

    PubMed Central

    Harth, K. C.; Broome, A.-M.; Jacobs, M. R.; Blatnik, J. A.; Zeinali, F.; Bajaksouzian, S.

    2011-01-01

    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. PMID:21298542

  1. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia

    Microsoft Academic Search

    Jacobus W. A. Burger; Roland W. Luijendijk; Wim C. J. Hop; Jens A. Halm; Emiel G. G. Verdaasdonk; Johannes Jeekel

    2004-01-01

    OBJECTIVE: The objective of this study was to determine the best treatment\\u000a of incisional hernia, taking into account recurrence, complications,\\u000a discomfort, cosmetic result, and patient satisfaction. BACKGROUND:\\u000a Long-term results of incisional hernia repair are lacking. Retrospective\\u000a studies and the midterm results of this study indicate that mesh repair is\\u000a superior to suture repair. However, many surgeons are still performing\\u000a suture

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

    PubMed Central

    Eriksen, MH; Bulut, O

    2014-01-01

    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

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

    PubMed

    Eriksen, Mh; Bulut, O

    2014-01-01

    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

  4. Tension free open inguinal hernia repair using an innovative self gripping semi-resorbable mesh

    PubMed Central

    Chastan, Philippe

    2006-01-01

    Aims: Inguinal hernia repair according to Lichtenstein technique has become the most common procedure performed by general surgeons. Heavy weight polypropylene meshes have been reported to stimulate inflammatory reaction responsible for mesh shrinkage when scar tissue evolved. Additionally, some concerns remain regarding the relationship between chronic pain and mesh fixation technique. In order to reduce those drawbacks, we have developed a new mesh for anterior tension free inguinal hernia repair which exhibits self-gripping absorbable properties. Materials and Methods: 52 patients (69 hernias) were prospectivly operated with this mesh (SOFRADIM-France) made of low-weight isoelastic large pores knitted fabric which incorporated resorbable micro hooks that provides self gripping properties to the mesh during the first months post-implantation. The fixation of the mesh onto the tissues is significantly facilitated. The mesh is secured around the cord with a self gripping flap. After complete tissular ingrowth and resorption of the PLA hooks, the low-weight (40 g/m2) polypropylene mesh insures the long term wall reinforcement. Results: Peroperativly, no complication was reported, the mesh was easy to handle and to fix. Discharge was obtained at Day 1. No perioperative complication occurred, return to daily activities was obtained at Day 5.5. At one month, no neurological pain or other complications were described. Conclusions: Based on the first results of this clinical study, this unique concept of low density self gripping mesh should allows an efficient treatment of inguinal hernia. It should reduce postoperative complications and the extent of required suture fixation, making the procedure more reproducible PMID:21187984

  5. Are current techniques of inguinal hernia repair optimal? A survey in the United Kingdom.

    PubMed

    Morgan, M; Reynolds, A; Swan, A V; Beech, R; Devlin, H B

    1991-11-01

    Data was collected on the techniques currently employed in adult inguinal hernia repair by means of a postal questionnaire to consultants in four Regional Health Authorities in England. Questionnaires were returned by 240 consultants (85%). This identified a considerable range in methods of repair, with a Moloney nylon darn being the sole method used by 35% of consultants, and the Shouldice technique, either alone or in combination with other methods, being used by 20%. Overall, 51% employ a subcuticular suture for skin closure, and traditional skin sutures are used by 31%. There was no association between consultant's date of qualification or subspecialty and type of repair. Consultants qualifying after 1969 are most likely to use a subcuticular suture. Some 14% of all consultants and 19% of those qualifying since 1969 employ a Shouldice procedure and a subcuticular suture. PMID:1759760

  6. A rare case of mesh infection 3 years after a laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.

    PubMed

    Jalilvand, Anahita; Sarker, Sharfi; Fisichella, Piero M

    2015-04-01

    Late complications after a laparoscopic inguinal hernia repair are extremely rare and have only recently entered into the literature. One such late complication is mesh infection, of which there have been a handful of cases reported in the literature. Mesh infections occurring many years after inguinal hernia repairs are not only of significance because they are not well documented in the literature, and the pathogenesis and risk factors contributing to their development are not well understood. This report details a rare case of mesh infection 3 years after a laparoscopic totally extraperitoneal inguinal hernia repair, describes our management of the condition, highlights the current options for management, and attempts to define its pathophysiology. PMID:25187073

  7. Two cross-linked porcine dermal implants in a single patient undergoing hernia repair

    PubMed Central

    Linz, Luke A; Burke, Leandra H; Miller, Lisa A

    2013-01-01

    A 50-year-old woman with a history of multiple recurrent incisional hernias and multiple comorbidities received two different porcine dermal implants during the same procedure due to the availability of products in stock. At 3.5?months following this procedure, the patient developed a secondary hernia inferior and lateral to the site of previous surgery. Both the implants were biopsied and sent for pathological evaluation. One implant was compliant and well integrated while the other was non-compliant and exhibited extensive foreign body reaction. In this case report, we examine the differences between the two porcine implants that may have caused them to react so differently in the same subject under the same conditions. PMID:23345480

  8. Challenges of giant ventral hernia repair in children in an African tertiary care center with limited resources

    Microsoft Academic Search

    O. D. Osifo; A. C. Efobi

    2009-01-01

    Objective  The objective of this study is to report the challenges and outcome of giant ventral abdominal hernia repair in infants\\/children\\u000a in a tertiary care center in Africa.\\u000a \\u000a \\u000a \\u000a Design  A retrospective analysis of infants\\/children who had a repair of giant ventral abdominal hernia between January 1998 and December\\u000a 2007 at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, was carried

  9. Splenic torsion after congenital diaphragmatic hernia repair: case report and review of the literature.

    PubMed

    Mehta, Anupama; Vana, Paul Geoffrey; Glynn, Loretto

    2013-03-01

    Wandering spleen with torsion, a rare clinical diagnosis, was found to be the cause of chronic abdominal pain in an 11-year-old female with a history of congenital diaphragmatic hernia repaired at three days of age. Doppler ultrasound revealed patent vessels with splenomegaly, and computed tomography (CT) showed an absence of the spleen in the left subphrenic space with torsion at the splenic hilum. Due to the chronicity of pain and risk of ischemia from torsion, open splenopexy with Vicryl mesh was performed. This case report/review of the literature discusses the rarity of this condition, and the importance of timely diagnosis and intervention. PMID:23480945

  10. Laparoscopic ventral hernia repair using expanded polytetrafluoroethylene–polyester mesh compound

    Microsoft Academic Search

    M. Farrakha

    2006-01-01

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

  11. Combination of Liechtenstein Repair with Herniorrhaphy in Open Inguinal Hernia Repair- A Prospective Observational Single Center Study

    PubMed Central

    Pukar, Mahesh

    2014-01-01

    Context: This study is about documentation of a technique which includes a combination of both hernioplasty and Herniorrhaphy, and its outcome in terms of recurrence rate and postoperative complications. It also compares the outcome of this method with routinely used techniques reported in the literature. Materials and Methods: LR with Herniorrhaphy was performed in the patients admitted with inguinal hernia under concerned surgeon. Their follow-up was assessed after 12 months. Incidences of recurrence rate and other postoperative complications like painful scar, atrophy of testis, urinary retention, hematoma, sinus and infection were noted and compared with other techniques of repair from published data. Statistical Analysis: was carried out by calculating the mean, standard deviation (SD), percentage and incidence rates. Results: LR with Herniorrhaphy performed in 475 patients showed recurrence rate of <<0.01% (n=1) and very low incidences of other postoperative complications like painful scar (0.01%, n=5), sinus (0%, n=0), atrophy of testis (0%, n=0), retention of urine (0.01%, n=6), hematoma (<<0.01%, n=1) and infection (0%, n=0); as compared to published data with different techniques. Conclusion: LR with Herniorrhaphy can be used for open inguinal hernia repair as the gold standard procedure as it has got low recurrence rate and other postoperative complications as compared to other techniques. However, the result of this study is based on the data from a single center, thus we recommend multicentric trials to test the efficacy of this technique. PMID:25478390

  12. Left Sided Hydro-pneumothorax in a Operated Case of Left Diaphragmatic Hernia Repair: A Diagnostic Dilemma

    PubMed Central

    Hombalkar, Narendra Narayan; Dalvi, Santosh Bhimrao; Gurav, Prakash Dattatray

    2015-01-01

    Diaphragmatic hernia in adults often presents with overlapping respiratory and abdominal symptoms. They may be simple diaphragmatic eventrations or undiagnosed Bochdalek’s hernias or may even be of post traumatic variety. Diaphragmatic hernias may be asymptomatic, present only with respiratory symptoms, or may present with obstruction and strangulation of involved bowel loops with faeco-pneumothorax. The index case was operated for open diaphragmatic hernia repair six years back and admitted for breathlessness with absence of abdominal signs and symptoms. Patient subsequently developed hydro-pneumothorax during conservative management. Emergency laparotomy revealed a gastric ulcer which perforated into the left chest giving rise to hydro-pneumothorax. In present study we would like to report how this unusual presentation led to dilemma in diagnosis and surgical intervention thus increasing the morbidity and mortality of the patient at our institute. PMID:26023591

  13. The Role of Antibiotic Prophylaxis in Prevention of Wound Infection After Lichtenstein Open Mesh Repair of Primary Inguinal Hernia

    PubMed Central

    Aufenacker, Theo J.; van Geldere, Dirk; van Mesdag, Taco; Bossers, Astrid N.; Dekker, Benno; Scheijde, Edo; van Nieuwenhuizen, Roos; Hiemstra, Esther; Maduro, John H.; Juttmann, Jan-Willem; Hofstede, Diederik; van Der Linden, Cunera T. M.; Gouma, Dirk J.; Simons, Maarten P.

    2004-01-01

    Objective: To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair. Summary Background Data: A recent Cochrane meta-analysis (2003) concluded that “antibiotic prophylaxis for elective inguinal hernia repair cannot be firmly recommended or discarded.” Methods: Patients with a primary inguinal hernia scheduled for Lichtenstein repair were randomized to a preoperative single dose of 1.5 g intravenous cephalosporin or a placebo. Patients with recurrent hernias, immunosuppressive diseases, or allergies for the given antibiotic were excluded. Infection was defined using the Centers for Disease Control and Prevention criteria. Results: We included 1040 patients in the study between November 1998 and May 2003. According to the intention-to-treat principle, 1008 patients were analyzed. There were 8 infections (1.6%) in the antibiotic prophylaxis group and 9 (1.8%) in the placebo group (P = 0.82). There was 1 deep infection in the antibiotic prophylaxis group and 2 in the placebo group (P = 0.57). Statistical analysis showed an absolute risk reduction of 0.19% (95% confidence interval, ?1.78%–1.40%) and a number needed to treat of 520 for the total number of infections. For deep infection, the absolute risk reduction is 0.20% (95% confidence interval, ?0.87%–0.48%) with a number needed to treat of 508. Conclusions: A low percentage (1.7%) of wound infection after Lichtenstein open mesh inguinal (primary) hernia repair was found, and there was no difference between the antibiotic prophylaxis or placebo group. The results show that, in Lichtenstein inguinal primary hernia repair, antibiotic prophylaxis is not indicated in low-risk patients. PMID:15570201

  14. Laparoscopically assisted repair of an acute traumatic diaphragmatic hernia

    PubMed Central

    Safdar, G; Slater, R; Garner, J P

    2013-01-01

    A 60-year-old man with chronic obstructive pulmonary disease and a heavy smoker and drinker presented to the emergency department with left-sided thoracoabdominal pain after falling down the stairs. Initial clinical findings were left-sided chest tenderness with no clinical evidence of subcutaneous emphysema. Twenty-four hours later the patient's respiratory distress increased—repeat chest X-ray showed a left gastrothorax indicative of a ruptured left hemi diaphragm. Diagnostic laparoscopy in the supine position via an umbilical port confirmed the presence of the stomach, spleen and splenic flexure of the colon in the left chest. Laparoscopic reduction of the stomach and colon was performed, but a small upper midline incision was required to reduce the spleen without injury. The diaphragmatic tear was repaired by direct open suture. The patient required a brief period of postoperative ventilation via a tracheostomy. The patient remained well at a 3-month follow-up visit. PMID:23813999

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

    PubMed Central

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

    2012-01-01

    Background Hernia repair is the most common surgical procedure in the world. Augmentation with synthetic meshes has gained importance in recent decades. Most of the published work about hernia meshes focuses on the surgical technique, outcome in terms of mortality and morbidity and the recurrence rate. Appropriate biomechanical and engineering terminology is frequently absent. Meshes are under continuous development but there is little knowledge in the public domain about their mechanical properties. In the presented experimental study we investigated the mechanical properties of several widely available meshes according to German Industrial Standards (DIN ISO). Methodology/Principal Findings Six different meshes were assessed considering longitudinal and transverse direction in a uni-axial tensile test. Based on the force/displacement curve, the maximum force, breaking strain, and stiffness were computed. According to the maximum force the values were assigned to the groups weak and strong to determine a base for comparison. We discovered differences in the maximum force (11.1±6.4 to 100.9±9.4 N/cm), stiffness (0.3±0.1 to 4.6±0.5 N/mm), and breaking strain (150±6% to 340±20%) considering the direction of tension. Conclusions/Significance The measured stiffness and breaking strength vary widely among available mesh materials for hernia repair, and most of the materials show significant anisotropy in their mechanical behavior. Considering the forces present in the abdominal wall, our results suggest that some meshes should be implanted in an appropriate orientation, and that information regarding the directionality of their mechanical properties should be provided by the manufacturers. PMID:23071685

  16. Assessment of Pain and Quality of Life in Lichtenstein Hernia Repair Using a New Monofilament PTFE Mesh: Comparison of Suture vs. Fibrin-Sealant Mesh Fixation

    PubMed Central

    Fortelny, René H.; Petter-Puchner, Alexander H.; Redl, Heinz; May, Christopher; Pospischil, Wolfgang; Glaser, Karl

    2014-01-01

    Background: Inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become the gold standard in open inguinal hernia repair. Despite the low recurrence rates, pain and discomfort remain a problem for a large number of patients. The aim of this study was to compare suture fixation vs. fibrin sealing by using a new monofilament PTFE mesh, i.e., the Infinit® mesh by W. L. Gore & Associates. Methods: This study was designed as a controlled prospective single-center two-cohort study. A total of 38 patients were enrolled and operated in Lichtenstein technique either standard suture mesh fixation or fibrin-sealant mesh fixation were used as described in the TIMELI trial. Primary outcome parameters were postoperative complications with the new mesh (i.e., seroma, infection), pain, and quality of life evaluated by the VAS and the SF-36 questionnaire. Secondary outcome was recurrence assessed by ultrasound and physical examination. Follow-up time was 1?year. Results: Significantly, less postoperative pain was reported in the fibrin-sealant group compared to the suture group at 6?weeks (P?=?0.035), 6?months (P?=?0.023), and 1 year (P?=?0.011) postoperatively. Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay were seen in the fibrin-sealant group. Conclusion: Fibrin-sealant mesh fixation in Lichtenstein hernioplasty effectively reduces acute and chronic postoperative pain. Monofilament, macro-porous, knitted PTFE meshes seem to be a practicable alternative to commonly used polypropylene meshes in open inguinal hernia repair. PMID:25593969

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

    PubMed

    Lubowiecka, Izabela

    2015-01-01

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

  18. Early results of a randomised trial comparing Prolene and VyproII-mesh in endoscopic extraperitoneal inguinal hernia repair (TEP) of recurrent unilateral hernias.

    PubMed

    Heikkinen, T; Wollert, S; Osterberg, J; Smedberg, S; Bringman, S

    2006-03-01

    The purpose of this study was to compare a lightweight mesh to a standard polypropylene hernia mesh in endoscopic extraperitoneal hernioplasty in recurrent hernias. A total of 140 men with recurrent unilateral inguinal hernias were randomised to a totally extraperitoneal endoscopic hernioplasty (TEP) with Prolene or VyproII in a single-blinded multi-center trial. The randomisation and all data handling were performed through the Internet. 137 patients were operated as allocated. Follow-up was completed in 88% of the patients. The median operation times were 55 (24-125) min and 53.5 (21-123) min for the Prolene and VyproII groups, respectively. The meshes had comparable results in the surgeon's assessment of the handling of the mesh, return to work, return to daily activities, complications, postoperative pain and quality of life during the first 8 weeks of rehabilitation, except in General Health (GH) SF-36, where the VyproII-group had a significantly better score (P=0.045). The use of Prolene and VyproII-meshes in endoscopic repair of recurrent inguinal hernia seems to result in similar short-term outcomes and quality of life. PMID:16088358

  19. [Morgagni's hernia: Report of a case treated by videolaparoscopy].

    PubMed

    Roussy, Guillermo; Maldonado, Pablo; Alcaraz, Álvaro; Moser, Federico; Obeide, Lucio

    2015-03-01

    Morgagni's hernia is a rare congenital disorder, usually asymptomatic, but may cause respiratory or gastrointestinal symptoms. We reviewed the clinical findings of a patient with a Morgagni's hernia, diagnosed and treated in our department. The Morgagni's hernia caused various symptoms in our patient and surgery was performed via laparoscopy. A chest CT-scan established the diagnosis. The hernial defect was closed with a synthetic mesh. Our patients had an uneventful postoperative recovery. We believe that the laparoscopic approach is an effective way of repairing Morgagni's hernia. PMID:26076516

  20. Richter's hernia.

    PubMed

    Agrawal, Shefali; Daruwala, Cherag

    2013-01-01

    Richter's hernia is associated with rapid onset of gangrene and a high mortality. We report a case of a strangulated inguinal Richter's hernia of the cecum requiring a laparotomy and bowel resection. Due to the misleading clinical presentation, a high index of suspicion, particularly in patients with a history of laparoscopic surgery, will minimize delay in diagnosis. PMID:23601775

  1. Open Onlay Mesh Repair for Major Abdominal Wall Hernias with Selective Use of Components Separation and Fibrin Sealant

    Microsoft Academic Search

    Andrew N. Kingsnorth; M. Kamran Shahid; Aby J. Valliattu; Robert A. Hadden; Christine S. Porter

    2008-01-01

    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

  2. Double rolling and center hitch technique for laparoscopic ventral hernia repair

    PubMed Central

    Ali, Asfar; Bhatia, Parveen; Kalhan, Sudhir; Khetan, Mukund; John, Suviraj; Bindal, Vivek

    2013-01-01

    BACKGROUND: Intraperitoneal onlay mesh repair is an established modality to treat large ventral hernias. Various techniques of laying the mesh are utilized. We present the Double Rolling and Center Hitch technique to lay a large intraperitoneal onlay mesh. OBJECTIVE: The aim of the study is to devise and adopt a method to reduce the difficulty in manoeuvring a large mesh inside the peritoneal cavity. It should also help in correct placement of mesh and decrease the operative time. MATERIALS AND METHODS: The DRACH technique was used in eighteen patients with large ventral hernias between May 2010 and September 2011. The Mesh size used was 15x20cm and more (considered to be large mesh). RESULTS: All the procedures were completed successfully. Mesh handling was significantly easier with the DRACH technique. The average mesh deployment time (MDT) was 15mins. In all cases the mesh was adequately centred with a margin of 3-5cm from the defect. CONCLUSION: The DRACH technique can be employed to lay large intraperitoneal meshes in order to reduce the handling difficulties associated with large meshes, and to aid in better placement of meshes so as to centered over the defect. PMID:23741119

  3. Functional cine MRI of the abdomen for the assessment of implanted synthetic mesh in patients after incisional hernia repair: initial results

    Microsoft Academic Search

    Tanja Fischer; Roland Ladurner; Alexander Gangkofer; Thomas Mussack; Maximilian Reiser; Andreas Lienemann

    2007-01-01

    The aim of our study was to develop a method that allows the vizualiation and evaluation of implanted mesh in patients after\\u000a incisional hernia repair with MRI. Furthermore, we assessed problems typically related with mesh implantation like adhesions\\u000a and muscular atrophy. We enrolled 28 patients after incisional hernia repair. In 10 patients mesh implantation was done by\\u000a laparoscopy (expanded polytetrafluoroethylene=ePTFE

  4. A MATERIAL COST-MINIMIZATION ANALYSIS FOR HERNIA REPAIRS AND MINOR PROCEDURES DURING A SURGICAL MISSION IN THE DOMINICAN REPUBLIC

    PubMed Central

    Cavallo, Jaime A.; Ousley, Jenny; Barrett, Christopher D.; Baalman, Sara; Ward, Kyle; Borchardt, Malgorzata; Thomas, J. Ross; Perotti, Gary; Frisella, Margaret M.; Matthews, Brent D.

    2013-01-01

    INTRODUCTION Expenditures on material supplies and medications constitute the greatest per capita costs for surgical missions. We hypothesized that supply acquisition at nonprofit organization (NPO) costs would lead to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for hernia repairs and minor procedures during a surgical mission in the Dominican Republic (DR). METHODS Items acquired for a surgical mission were uniquely QR-coded for accurate consumption accounting. Both NPO and US academic institution unit costs were associated with each item in an electronic inventory system. Medication doses were recorded and QR-codes for consumed items were scanned into a record for each sampled procedure. Mean material costs and cost savings ± SDs were calculated in US dollars for each procedure type. Cost-minimization analyses between the NPO and the US academic institution platforms for each procedure type ensued using a two-tailed Wilcoxon matched-pairs test with ?=0.05. Item utilization analyses generated lists of most frequently used materials by procedure type. RESULTS The mean cost savings of supply acquisition at NPO costs for each procedure type were as follows: $482.86 ± $683.79 for unilateral inguinal hernia repair (IHR, n=13); $332.46 ± $184.09 for bilateral inguinal hernia repair (BIHR, n=3); $127.26 ± $13.18 for hydrocelectomy (HC, n=9); $232.92 ± $56.49 for femoral hernia repair (FHR, n=3); $120.90 ± $30.51 for umbilical hernia repair (UHR, n=8); $36.59 ± $17.76 for minor procedures (MP, n=26); and $120.66 ± $14.61 for pediatric inguinal hernia repair (PIHR, n=7). CONCLUSION Supply acquisition at NPO costs leads to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for IHR, HC, UHR, MP, and PIHR during a surgical mission to DR. Item utilization analysis can generate minimum-necessary material lists for each procedure type to reproduce cost-savings for subsequent missions. PMID:24162140

  5. Internal hernias in pregnant women with history of gastric bypass surgery: Case series and review of literature

    PubMed Central

    Leal-González, Raúl; De la Garza-Ramos, Rafael; Guajardo-Pérez, Horacio; Ayala-Aguilera, Fernando; Rumbaut, Roberto

    2012-01-01

    INTRODUCTION Gastric bypass surgery is the most common obesity surgery procedure in women. Decreased weight loss favors fertility and leads to pregnancy sometimes just months after surgery, raising the risk of developing gastric bypass-related complications during pregnancy, including the formation of internal hernias. PRESENTATION OF CASE The first patient presented at 37 weeks of gestation with abdominal pain, nausea and vomiting. X-ray revealed multiple air-fluid levels and absence of gas in colon. She underwent a cesarean section and exploratory laparotomy without complications. A Petersen's space internal hernia was found. The second patient presented at 25 weeks of gestation with abdominal pain and nausea. X-ray revealed multiple air–fluid levels and a “U-shaped” intestinal loop. She underwent exploratory laparotomy with reduction of an internal hernia also in Petersen's space. DISCUSSION Pregnant patients with internal hernias after gastric bypass are usually of young age and with a several-day history of abdominal pain. Surgical exploration is safe and should not be delayed. The literature review showed that maternal death (9%) and fetal death (13.6%) rates are considerably high. CONCLUSION The possibility of an internal hernia should always be considered in pregnant women with history of gastric bypass who present with abdominal pain, in order to prevent catastrophic outcomes such as maternal and/or fetal death. PMID:23108170

  6. Pericardial cyst in a 2-year-old Maine Coon cat following peritoneopericardial diaphragmatic hernia repair.

    PubMed

    Hodgkiss-Geere, Hannah M; Palermo, Valentina; Liuti, Tiziana; Philbey, Adrian W; Marques, Ana

    2015-04-01

    A pericardial cyst developed in a 2-year-old male neutered Maine Coon cat following surgery for an incidentally diagnosed congenital peritoneopericardial diaphragmatic hernia. The cyst caused no clinical signs in the cat, although clinical findings included positional right-sided cardiac tamponade and compression of thoracic structures, associated with a cardiac arrhythmia and axis deviation on electrocardiography. Extensive assessment of the cyst included radiography, echocardiography, computed tomography, exploratory thoracotomy, electrocardiography, histopathology and fluid analysis. Surgical removal of the cyst was curative, and the arrhythmia and axis deviation resolved. This report details case management from initial diagnosis to long-term follow-up, adding to the limited body of literature available on feline pericardial cysts. This is also the first report to associate cardiac arrhythmia with a pericardial cyst. PMID:24966244

  7. Massive mesenteric ischemia resulting from a giant strangulated umbilical hernia.

    PubMed

    Testini, Mario; Marzaioli, Rinaldo; Gurrado, Angela; Lissidini, Germana; Piccinni, Giuseppe

    2007-01-01

    Hernia repair is the most commonly practiced operation in the departments of surgery in developed countries. Huge abdominal hernias are uncommon in western civilization. We present a rare case of a 73-year-old woman with a diagnosis at admission of intestinal obstruction caused by a giant strangulated umbilical hernia. At the clinical and radiological examination, the patient showed an enormous strangulated umbilical hernia with acute abdomen, atrial fibrillation, and pulmonary subedema. Emergency laparotomy showed a huge peritoneal umbilical sac containing massive mesenteric ischemia starting from 40 cm after the Treitz ligament and extended to the right colonic flexure. A near-total resection of the small bowel, a right colectomy with double terminal stomas, and a direct hernia repair without prosthetic mesh were performed. Twenty days after the operation, the patient was discharged and begun domiciliary total parenteral nutrition, and 24 months after surgical treatment she is still alive. PMID:18399102

  8. Cost-effectiveness of primary abdominal wall hernia repair in a 364-bed provincial hospital of Spain

    Microsoft Academic Search

    R. de Miguel Ibañez; S. A. Nahban Al Saied; J. Alonso Vallejo; J. M. Rodríguez Canales; C. Blanco Prieto; F. Escribano Sotos

    Purpose  Primary abdominal hernia is a prevalent condition that weighs heavily on human and financial health-care resources (e.g.,\\u000a 1.12% of the total budget of our hospital in 2008). Tension-free hernioplasty is the standard repair procedure, but the anesthetic\\u000a technique varies, including local anesthesia with sedation (Lsed), regional (Reg), and general (Gen) anesthesia. As the cost–outcome\\u000a relation of different anesthetic options has

  9. In vivo evaluation of a new composite mesh (10% polypropylene\\/90% poly- l -lactic acid) for hernia repair

    Microsoft Academic Search

    Keitaro Tanaka; Didier Mutter; Harutaka Inoue; Véronique Lindner; George Bouras; Antonello Forgione; Joël Leroy; Marc Aprahamian; Jacques Marescaux

    2007-01-01

    The increasing use of mesh insertion for groin hernia repair is dashed by a worrying prevalence of chronic pain frequently\\u000a related as a reaction to the biomaterial implantation. Thus, new biocompatible prosthesis, designed as a composite material\\u000a associating polypropylene (PP) and long-term absorbable material, are now under development. In the present study, the typical\\u000a commercially available Prolene mesh has been

  10. Respiratory physiopathology in surgical repair for large incisional hernias of the abdominal wall 1 1 No competing interests declared

    Microsoft Academic Search

    Gabriele Munegato; Renato Brandolese

    2001-01-01

    Background:The computerized noninvasive measurement of respiratory mechanics enables new prospects in the study of respiratory physiopathology in surgical repair of large incisional hernias.Study design:We studied 10 patients with COPD ventilated with a Servo Ventilator 900C. We measured inspiratory flow by means of a pneumotacograph, the volume by integrating the flow signal, and esophageal and airway opening pressure by means of

  11. Persistent extracellular matrix remodelling at the interface to polymers used for hernia repair.

    PubMed

    Junge, K; Rosch, R; Bialasinski, L; Klinge, U; Klosterhalfen, B; Schumpelick, V

    2003-01-01

    On the one hand, recurrence rates and postoperative complications following hernia repair are supposed to be influenced by the kind of mesh material used. On the other hand, an impaired collagen metabolism and cleavage within connective tissue has been suggested as decisive factor in the pathogenesis of recurrent hernia formation. The aim of our study was, therefore, to analyze the impact of commonly used mesh materials on quality of collagen deposition, expression of collagenases (matrix metalloproteinases; MMP-1/MMP-13), and specific tissue inhibitors of MMPs (TIMPs) in an animal study. Four different mesh materials were used (Prolene = polypropylene, Mersilene = polyester, and Vypro and Vypro II = combinations of polypropylene and polyglactin) and implanted as abdominal wall replacement in 60 male Wistar rats. Mesh samples were explanted after 3, 21, and 90 days and investigated using immunohistochemistry (expression of MMP-1/MMP-13 and TIMP-1) and cross-polarization microscopy (percentage of collagen type III to overall collagen). Besides an insufficient collagen composition with an increased percentage of collagen type III, we found a complex expression of collagenases and their inhibitors combined with a persistent chronic foreign-body reaction even 90 days after implantation. Except for TIMP-1 expression, which was significantly related to a lowered amount of inflammatory (r = -0.980, p = 0.02) and connective tissue formation (r = -0.951, p = 0.049), there was no relation to the expression of collagenases (MMP-1/MMP-13) with regard to the amount of inflammatory and connective tissue formation despite partly significant differences between implanted polymers. PMID:14593234

  12. Predictors of incisional hernia after robotic assisted radical prostatectomy.

    PubMed

    Chennamsetty, Avinash; Hafron, Jason; Edwards, Luke; Pew, Scott; Poushanchi, Behdod; Hollander, Jay; Killinger, Kim A; Coffey, Mary P; Peters, Kenneth M

    2015-01-01

    Introduction. To explore the long term incidence and predictors of incisional hernia in patients that had RARP. Methods. All patients who underwent RARP between 2003 and 2012 were mailed a survey reviewing hernia type, location, and repair. Results. Of 577 patients, 48 (8.3%) had a hernia at an incisional site (35 men had umbilical), diagnosed at (median) 1.2 years after RARP (mean follow-up of 5.05 years). No statistically significant differences were found in preoperative diabetes, smoking, pathological stage, age, intraoperative/postoperative complications, operative time, blood loss, BMI, and drain type between patients with and without incisional hernias. Incisional hernia patients had larger median prostate weight (45 versus 38 grams; P = 0.001) and a higher proportion had prior laparoscopic cholecystectomy (12.5% (6/48) versus 4.6% (22/480); P = 0.033). Overall, 4% (23/577) of patients underwent surgical repair of 24 incisional hernias, 22 umbilical and 2 other port site hernias. Conclusion. Incisional hernia is a known complication of RARP and may be associated with a larger prostate weight and history of prior laparoscopic cholecystectomy. There is concern about the underreporting of incisional hernia after RARP, as it is a complication often requiring surgical revision and is of significance for patient counseling before surgery. PMID:25709645

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

    PubMed Central

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

    2014-01-01

    Background: Caudal analgesia is the most commonly used technique providing intra- and postoperative analgesia for various pediatric infraumbilical surgical procedures but with the disadvantage of short duration of action after single injection. Caudal dexamethasone and magnesium could offer significant analgesic benefits. We compared the analgesic effects and side-effects of dexamethasone or magnesium added to caudal ropivacaine in pediatric patients undergoing inguinal hernia repair. Materials and Methods: A total of 105 (1-6 years) were randomly assigned into three groups in a double-blinded manner. After a standardized sevoflurane in oxygen anesthesia, each patient received a single caudal dose of ropivacaine 0.15% 1.5 mL/kg combined with either magnesium 50 mg in normal saline 1 mL (group RM), dexamethasone 0.1 mg/kg in normal saline 1 mL (group RD), or corresponding volume of normal saline (group R) according to group assignment. Postoperative analgesia, use of analgesics, and side-effects were assessed during the first 24 h. Results: Addition of magnesium or dexamethasone to caudal ropivacaine significantly prolonged analgesia duration 8 (5-11) h and 12 (8-16) h, respectively compared with 4 (3-5) h with the use of ropivacaine alone. The incidence of postoperative rescue analgesia was significantly higher in group R compared with groups RM and RD. The time to 1st analgesic dose was significantly longer in groups RM and RD (500 ± 190 and 730 ± 260 min) respectively compared with group R (260 ± 65 min). Group R patients achieved significantly higher Children's Hospital of Eastern Ontario Pain Scale and Faces Legs Activity Cry Consolability scores (4th hourly) compared with groups RM and RD patients (8th and 12th hourly, respectively). Conclusion: The addition of dexamethasone or magnesium to caudal ropivacaine significantly prolonged the duration of postoperative analgesia in children undergoing inguinal hernia repair. Also the time to 1st analgesic dose was longer and the need for rescue postoperative analgesic was reduced and without increase in incidence of side effects. PMID:25886097

  14. [A new method for plastic repair of the inguinal canal in treating inguinal hernias].

    PubMed

    Zhebrovski?, V V; Toskin, K D; Babanin, A A; Vorovski?, S N; Kisliakov, V V; Naima, A A

    1995-01-01

    An analysis of the 20-years experience with treatment of inguinal hernias is presented. Patients with "light" forms of inguinal hernias and with a good condition of the posterior wall, inconsiderable widening of the deep opening of the inguinal canal can be successfully treated by Martynov's and Girard's methods. In complicated forms of the inguinal hernia it is necessary to strengthen the posterior wall of the inguinal canal, in cases with big recurrent and repeatedly recurring hernias it must be completely reconstructed, often with the help of alloplasty. A method of alloplasty of the inguinal canal is proposed for complicated forms of inguinal hernias. Operations were made on 62 patients, recurrent hernias were noted in 2 patients (3.4%). Another method of operations is proposed used in men of young and middle age excluding traumas of elements of the spermatic cord. Operations were performed on 111 patients, recurrences were noted in 2 of them (2%). PMID:8743798

  15. Repairing facial injury with refining plastic surgery techniques.

    PubMed

    Zhao, Donghong; Li, Jiang; Wang, Kehua; Guo, Xiaoping; Lang, Yuhong; Peng, Lijun; Wang, Qin; Li, Yamin

    2012-11-01

    The purpose of this study was to evaluate the refining plastic surgery techniques for repairing facial surface injury. For this purpose, 82 patients with facial surface injury were recruited in the study. All wounds were repaired by refining plastic surgery techniques. The wounds were processed by fine wound excision and plastic surgery repair technique. The deep tissue fracture and dislocation were sutured and reduced using 8-0 absorbable suture and the skin wounds were sutured using 8-0 cosmetic suture. The facial injuries showed good rates of healing with fine debridement and fine recovering. The minimum scarring was observed and good cosmetic effect was achieved. We conclude that refining plastic surgery techniques including fine debridement and fine recovering are ideal for the reconstruction of facial injuries. PMID:22610701

  16. Surgical Treatment of a Parastomal Hernia

    PubMed Central

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

    2011-01-01

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

  17. Biologic hernia implants in experimental intraperitoneal onlay mesh plasty repair: the impact of proprietary collagen processing methods and fibrin sealant application on tissue integration

    Microsoft Academic Search

    A. H. Petter-Puchner; R. H. Fortelny; K. Silic; J. Brand; S. Gruber-Blum; H. Redl

    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

  18. Prevention of Surgical Site Infection After Open Prosthetic Inguinal Hernia Repair: Efficacy of Parenteral Versus Oral Prophylaxis with Amoxicillin-Clavulanic Acid in a Randomized Clinical Trial

    Microsoft Academic Search

    Mehmet A. Kuzu; Selçuk Hazinedaro?lu; ?ükrü Dolalan; Nam?k Özkan; Samet Yalç?n; A. Bülent Erkek; Hatem Mahmoudi; Acar Tüzüner; Atilla H. Elhan; Ercümet Kuterdem

    2005-01-01

    The aim of this prospective study was to compare the efficacy of oral versus parenteral prophylactic amoxicillin–clavulanic acid for preventing surgical site infection after open prosthetic mesh repair of inguinal hernia. A total of 480 inguinal-hernia patients were randomly assigned to two groups. Group I (n = 240) received 1.313 g oral amoxicillin–clavulanic acid 2 hours before operation, and group

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

    PubMed Central

    2013-01-01

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

  20. Laparoscopic Hernia: Umbilical-Pubis Length Versus Technical Difficulty

    PubMed Central

    Blanc, Pierre; Kassir, Radwan; Atger, Jérôme

    2014-01-01

    Laparoscopic hernia repair is more difficult than open hernia repair. The totally extraperitoneal procedure with 3 trocars on the midline is more comfortable for the surgeon. We studied the impact of the length between the umbilicus and the pubis on the totally extraperitoneal procedure (95 hernias operated on in 70 patients). This length did not influence the totally extraperitoneal procedure in this study. Background: The laparoscopic repair of hernias is considered to be difficult especially for the totally extra-peritoneal technique (TEP) due to a limited working space and different appreciation of the usual anatomical landmarks seen through an anterior approach. The aim of our study has been to answer a question: does the umbilical-pubic distance, which influences the size of the mesh, affect the TEP technique used in the treatment of inguinal hernias? Methods: From January 2001 to May 2011, the umbilical-pubic (UP) distance was measured with a sterile ruler graduated in centimeters in all patients who underwent a symptomatic inguinal hernia by the TEP technique in two hernia surgery centers. The sex, age, BMI, hernia type, UP distance, operation time, hospital stay and complications were prospectively examined based on the medical records. Results: Seventy patients underwent 95 inguinal hernia repairs by the TEP technique. The umbilical-pubic distance average was 14 cm (10 to 22) and a 25 kg/m2 (16–30) average concerning the body mass index (BMI). Seventy percent of patients were treated on an outpatient basis. The postoperative course was very simple. There was no recurrence of hernia within this early postoperative period. Conclusion: The umbilical-pubic distance had no influence on the production of TEP with 3 trocars on the midline in this study. PMID:25392661

  1. Prospective comparison of local, spinal, and general types of anaesthesia regarding oxidative stress following Lichtenstein hernia repair.

    PubMed

    Kulacoglu, H; Ozdogan, M; Gurer, A; Ersoy, Eren P; Onder Devay, A; Duygulu Devay, S; Gulbahar, O; Gogkus, S

    2007-01-01

    As a tension-free repair technique, Lichtenstein operation has gained great popularity worldwide during the last decade. Expert centres do this technique using local anaesthesia in nearly 95 % of cases. However, general anaesthesia is used in many hospitals, while regional anaesthesia is preferred in some centres. To date, no study has compared different types of anesthesia in respect of inflammatory response and oxidative stress specifically. The objective of this prospective study was to compare local, spinal and general types of anesthesia regarding their effects on inflammatory response and oxidative stress in Lichtenstein hernia repair. Lichtenstein hernia repair causes only a mild oxidative stress. While total WBC and neutrophil count responses fade away after 24 hours in patients who are operated under local anaesthesia, these changes in spinal and general types of anaesthesia cases stay valid at 24th hour. Spinal anaesthesia is seen to be more advantageous than local and general types of anaesthesia when C-reactive protein as an acute phase marker is considered. Total antioxidant status shows minor alterations in three types of anaesthesia, however, general anaesthesia seems to be the least reliable among them. Overall, local and spinal anaesthesia methods can be accepted as better alternatives in comparison with general anaesthesia in regard to oxidative stress (Tab. 2, Ref. 25). Full Text (Free, PDF) www.bmj.sk. PMID:18203536

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

    PubMed Central

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

    2012-01-01

    Introduction With an average incidence rate of 11%, chronic pain is considered the most serious complication of inguinal hernioplasty after surgical site infection. One of the proposed solutions to this problem is to use tissue adhesive for mesh fixation, which helps prevent nerve and tissue damage. Aim The goal of this study was to compare mesh fixation with the use of sutures vs. adhesive in Lichtenstein's inguinal hernia repair in a randomized, double-blind one-center study. Material and methods The study group consisted of 41 males with primary inguinal hernia undergoing Lichtenstein's repair (20 – adhesive; 21 – suture) and remaining in follow-up from July 2008 to November 2010. Randomization took place during the operation. The follow-up was performed by one surgeon (blinded) according to a pre-agreed schedule; the end-of-study unblinding was performed during the last follow-up visit, usually 16 months postoperatively. Results In 1 patient from the “adhesive” group, a recurrence was observed one year after the initial repair. The early postoperative pain was less intense in this group. In later postoperative periods the method of mesh fixation had no influence on the pain experienced by the patient. Other complications were not correlated with the method of mesh fixation. Conclusions In this randomized, one-center double-blind clinical study of males with primary inguinal hernia it has been show during follow-up that the use of Glubran 2 cyanoacrylate adhesive for mesh implant fixation yields similar recurrence and chronic pain rates as the classical suture technique. In the early postoperative period, the pain reported by these patients was relatively weaker; patients undergoing adhesive mesh fixation experienced a quicker return to daily household activities. PMID:23256009

  3. Comparative study between Levobupivacaine and Bupivacaine for hernia surgery in the elderly

    PubMed Central

    2012-01-01

    Background The inguinal hernia is one of the most common diseases in the elderly. Treatment of this type of pathology is exclusively surgical and relies almost always on the use of local anesthesia. While in the past hernia surgery was carried out mainly by general anesthesia, in recent years there has been growing emphasis on the role of local anesthesia. Methods The aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine compared with that of bupivacaine. Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty. Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity. The study was conducted from April 2010 to May 2012. We collected data of forty male patients, aged between 73 and 85 years, who underwent inguinal hernioplasty with local anesthesia for the first time. Results Minimal pain is the same in both groups. Mild pain was more frequent in the group who used bupivacaine, moderate pain was slightly more frequent in the group who used levobupivacaine, and the same for intense pain. It is therefore evident how Bupivacaine is slightly less preferred after four and twenty four hours, while the two drugs seem to have the same effect at a distance of twelve and forty-eight hours. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. The request for an analgesic was slightly higher in patients receiving levobupivacaine. Conclusions After considering all these elements, we can conclude that the clinical efficacy of levobupivacaine and racemic bupivacaine are essentially similar, when used under local intervention of inguinal hernioplasty. PMID:23173755

  4. Incarcerated recurrent Amyand's hernia.

    PubMed

    Quartey, Benjamin; Ugochukwu, Obinna; Kuehn, Reed; Ospina, Karen

    2012-10-01

    Amyand's hernia is a rarity and a recurrent case is extremely rare. A 71-year-old male with a previous history of right inguinal hernia repair presented to the emergency department with a 1-day history of pain in the right groin. A physical examination revealed a nonreducible right inguinal hernia. A computed tomography scan showed a 1.3-cm appendix with surrounding inflammation within a right inguinal hernia. An emergent right groin exploration revealed an incarcerated and injected non-perforated appendix and an indirect hernia. Appendectomy was performed through the groin incision, and the indirect hernia defect was repaired with a biological mesh (Flex-HD). We hereby present this unique case - the first reported case of recurrent Amyand's hernia and a literature review of this anatomical curiosity. PMID:23248506

  5. Strength of tissue attachment to mesh after ventral hernia repair with synthetic composite mesh in a porcine model

    Microsoft Academic Search

    S. Majercik; V. Tsikitis; D. A. Iannitti

    2006-01-01

    Background  A prospective animal study involving 12 female swine aimed to measure the strength of tissue attachment to composite mesh\\u000a at various time points after laparoscopic ventral hernia repair in a porcine model.\\u000a \\u000a \\u000a \\u000a Methods  Each animal had two 10 16-cm sheets of polypropylene\\/expanded polytetrafluoroethylene (ePTFE) composite mesh laparoscopically\\u000a affixed to the abdominal wall with a helical tacking device. No transfascial sutures were

  6. Early biocompatibility of crosslinked and non-crosslinked biologic meshes in a porcine model of ventral hernia repair

    PubMed Central

    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.

    2013-01-01

    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. PMID:21222009

  7. Ovarian Hernia: A rarity.

    PubMed

    Malik, Kamran A; Al Shehhi, Ruqaiya M; Al Qadhi, Hani; Al Kalbani, Moza; Al Harthy, Abdullah

    2012-05-01

    Ovarian hernias are extremely rare. The prevalence of ovaries and fallopian tubes in operable inguinal hernias is only about 2.9%. We report here an unusual case of an ovary in a hernia sac in an adult female. She presented with symptoms and signs of an incarcerated left inguinal hernia. The left ovary contained a haemorrhagic cyst and, along with the left fallopian tube and broad ligament, these were found in the sac. She underwent a left ovarian cystectomy and the inguinal hernia was repaired with mesh. PMID:22548143

  8. Minimally Invasive Component Separation Results in Fewer Wound-Healing Complications than Open Component Separation for Large Ventral Hernia Repairs

    PubMed Central

    Ghali, Shadi; Turza, Kristin C; Baumann, Donald P; Butler, Charles E

    2014-01-01

    BACKGROUND Minimally invasive component separation (CS) with inlay bioprosthetic mesh (MICSIB) is a recently developed technique for abdominal wall reconstruction that preserves the rectus abdominis perforators and minimizes subcutaneous dead space using limited-access tunneled incisions. We hypothesized that MICSIB would result in better surgical outcomes than would conventional open CS. STUDY DESIGN All consecutive patients who underwent CS (open or minimally invasive) with inlay bioprosthetic mesh for ventral hernia repair from 2005 to 2010 were included in a retrospective analysis of prospectively collected data. Surgical outcomes including wound-healing complications, hernia recurrences, and abdominal bulge/laxity rates were compared between patient groups based on the type of CS repair: MICSIB or open. RESULTS Fifty-seven patients who underwent MICSIB and 50 who underwent open CS were included. The mean follow-ups were 15.2±7.7 months and 20.7±14.3 months, respectively. The mean fascial defect size was significantly larger in the MICSIB group (405.4±193.6 cm2 vs. 273.8±186.8 cm2; p =0.002). The incidences of skin dehiscence (11% vs. 28%; p=0.011), all wound-healing complications (14% vs. 32%; p=0.026), abdominal wall laxity/bulge (4% vs. 14%; p=0.056), and hernia recurrence (4% vs. 8%; p=0.3) were lower in the MICSIB group than in the open CS group. CONCLUSIONS MICSIB resulted in fewer wound-healing complications than did open CS used for complex abdominal wall reconstructions. These findings are likely attributable to the preservation of paramedian skin vascularity and reduction in subcutaneous dead space with MICSIB. MICSIB should be considered for complex abdominal wall reconstructions, particularly in patients at increased risk of wound-healing complications. PMID:22521439

  9. Local Anesthesia in Open Inguinal Hernia Repair Improves Postoperative Quality of Life Compared to General Anesthesia: A Prospective, International Study.

    PubMed

    Huntington, Ciara R; Wormer, Blair A; Cox, Tiffany C; Blair, Laurel J; Lincourt, Amy E; Augenstein, Vedra A; Heniford, B Todd

    2015-07-01

    The choice of general (GA) versus local anesthesia (LA) in open inguinal hernia repair (OIHR) has a substantial financial impact and may influence clinical outcomes. Our study compares postoperative quality of life (QOL) in patients undergoing OIHR under LA versus GA. A cooperative prospective study from centers in 10 countries was performed through the International Hernia Mesh Registry from 2007 to 2012. QOL was compared at one, six, 12, and 24 months for LA versus GA with univariate and multivariate analysis controlling for known confounding variables. Of 1128 patients who underwent OIHR, 585(52%) used GA and 533(48%) used LA. Most were male (92%) with unilateral (94%), primary (91%) repairs with a mean age 57 ± 16 years. There was no difference (P > 0.05) in age, gender, operative time, mesh size, length of stay, infection, recurrence, reoperation, or death. Multivariate analysis demonstrated significant QOL differences between groups: GA had higher odds of discomfort at one and six months [odds ratio (OR) 3.3, 2.0], movement limitation at one and six months (OR 3.5, 2.8), and mesh sensation at one and 12 months (OR 2.9, 1.8). Overall, patients undergoing OIHR under LA had improved postoperative QOL in the short and long term compared with GA. PMID:26140891

  10. Minimal Incision Scar-Less Open Umbilical Hernia Repair in Adults – Technical Aspects and Short-Term Results

    PubMed Central

    Zachariah, Sanoop K.; Kolathur, Najeeb Mohamed; Balakrishnan, Mahesh; Parakkadath, Arun Joseph

    2014-01-01

    Background: There is no gold standard technique for umbilical hernia (UH) repair. Conventional open UH repair often produces an undesirable scar. Laparoscopic UH repair requires multiple incisions beyond the umbilicus, specialized equipments, and expensive tissue separating mesh. We describe our technique of open UH repair utilizing a small incision. The technique was derived from our experience with single incision laparoscopy. We report the technical details and short-term results. Methods: This is a retrospective analysis of the first 20 patients, who underwent minimal incision scar-less open UH repair, from June 2011 to February 2014. A single intra-umbilical curved incision was used to gain access to the hernia sac. Primary suture repair was performed for defects up to 2?cm. Larger defects were repaired using an onlay mesh. In patients with a BMI of 30?kg/m2 or greater, onlay mesh hernioplasty was performed irrespective of the defect size. Results: A total of 20 patients, 12 males and 8 females underwent the procedure. Mean age was 50 (range 29–82) years. Mean BMI was 26.27 (range 20.0–33.1) kg/m2. Average size of the incision was 1.96 range (1.5–2.5) cm. Mesh hernioplasty was done in nine patients. Eleven patients underwent primary suture repair alone. There were no postoperative complications associated with this technique. Average postoperative length of hospital stay was 3.9 (range 2–10) days. Mean follow-up was 29.94?months (2?weeks to 2.78?years). On follow-up there was no externally visible scar in any of the patients. There were no recurrences on final follow-up. Conclusion: This technique provides a similar cosmetic effect as obtained from single port laparoscopy. It is easy to perform, safe, offers good cosmesis, does not require incisions beyond the umbilicus, and cost effective, with encouraging results on short-term follow-up. Further research is needed to assess the true potential of the technique and the long-term results. PMID:25593956

  11. Outcomes of the fascial component separation technique with synthetic mesh reinforcement for repair of complex ventral incisional hernias in the morbidly obese

    Microsoft Academic Search

    Michael Moore; Timothy Bax; Mark MacFarlane; M. Shane McNevin

    2008-01-01

    IntroductionComplex ventral incisional hernias (VIH) in the morbidly obese remain a difficult management problem for the general surgeon. Multiple methods of repair with variable rates of success are described. The outcomes and techniques of a fascial component separation technique with synthetic mesh reinforcement in the morbidly obese are described.

  12. A selective sac extraction method: another minimally invasive procedure for inguinal hernia repair in children: a technical innovation with satisfactory surgical and cosmetic results

    Microsoft Academic Search

    Hitoshi Ikeda; Masahiro Hatanaka; Makoto Suzuki; Junko Fujino; Kazunori Tahara; Yuki Ishimaru

    2009-01-01

    PurposeTo achieve satisfactory surgical and cosmetic results with minimal surgical invasiveness without laparoscopic assistance in childhood inguinal hernia repair, a novel technique, the selective sac extraction method (SSEM), was devised. The technical feasibility of this method was retrospectively examined.

  13. Posthemipelvectomy hernia.

    PubMed

    Die Trill, J; Madrid, J M Fernández; Ferrero, E; Igea, J; Torres, A; Gómez, J L; Medina, I; Canales, C; Perea, F; Carda, P; García Villanueva, A; Die Goyanes, A

    2005-12-01

    We report the case of a white male who underwent a classic hemipelvectomy due to a femur fibrosarcoma with inguinal metastases, which 33 years later, developed into a posthemipelvectomy hernia in the amputation stump that impaired the use of his Canadian prosthesis. The hernia was repaired with a polypropylene mesh in a subaponeurotic position. A seroma was drained in the postoperative and it was only 2 months after the operation that he could use his prosthesis with any difficulty. A year after the operation, the hernia had not recurred. Only seven similar cases have been published, and there are only four cases with details of their correction, two with a mesh as was our case, and the rest with a primary suture of the aponeurotic borders. A brief review of the bibliography is given on this subject. PMID:15912261

  14. Acquired umbilical hernias in four captive polar bears (Ursus maritimus).

    PubMed

    Velguth, Karen E; Rochat, Mark C; Langan, Jennifer N; Backues, Kay

    2009-12-01

    Umbilical hernias are a common occurrence in domestic animals and humans but have not been well documented in polar bears. Surgical reduction and herniorrhaphies were performed to correct acquired hernias in the region of the umbilicus in four adult captive polar bears (Ursus maritimus) housed in North American zoos. Two of the four bears were clinically unaffected by their hernias prior to surgery. One bear showed signs of severe discomfort following acute enlargement of the hernia. In another bear, re-herniation led to acute abdominal pain due to gastric entrapment and strangulation. The hernias in three bears were surgically repaired by debridement of the hernia ring and direct apposition of the abdominal wall, while the large defect in the most severely affected bear was closed using polypropylene mesh to prevent excessive tension. The cases in this series demonstrate that while small hernias may remain clinically inconsequential for long periods of time, enlargement or recurrence of the defect can lead to incarceration and acute abdominal crisis. Umbilical herniation has not been reported in free-ranging polar bears, and it is suspected that factors such as body condition, limited exercise, or enclosure design potentially contribute to the development of umbilical hernias in captive polar bears. PMID:20063824

  15. Evaluation of fenestrated and non-fenestrated biologic grafts in a porcine model of mature ventral incisional hernia repair

    PubMed Central

    Jenkins, E. D.; Melman, L.; Deeken, C. R.; Greco, S. C.; Frisella, M. M.; Matthews, B. D.

    2013-01-01

    Introduction The purpose of this study is to compare the tissue incorporation of a novel fenestrated and non-fenestrated crosslinked porcine dermal matrix (CPDM) (CollaMend™, Davol Inc., Warwick, RI) in a porcine model of ventral hernia repair. Methods Bilateral abdominal wall defects were created in 12 Yucatan minipigs and repaired with a preperitoneal or intraperitoneal technique 21 days after hernia creation. Animals were randomized to fenestrated or non-fenestrated CPDM for n = 6 pieces of each graft in the preperitoneal or intraperitoneal location. All animals were sacrificed at 1 month. Adhesion characteristics and graft contraction/growth were measured by the Garrard adhesion grading scale and transparent grid overlay. Histological analysis of hematoxylin and eosin (H&E)-stained slides was performed to assess graft incorporation. Tissue incorporation strength was measured by a T-peel tensile test. The strength of explanted CPDM alone and de novo CPDM was measured by a uniaxial tensile test using a tensiometer (Instron, Norwood, MA) at a displacement rate of 0.42 mm/s. Statistical significance (P < 0.05) was determined for histological analysis using a Kruskal–Wallis non-parametric test with a Bonferroni correction, and for all other analyses using a two-way analysis of variance (ANOVA) with a Bonferroni post-test or a Kruskal–Wallis non-parametric test with a Dunn’s post-test. Results Intraperitoneal placement of fenestrated CPDM resulted in a significantly higher area of adhesions and adhesion score compared to the preperitoneal placement of fenestrated CPDM (P < 0.05). For both preperitoneal and intraperitoneal placement, histological findings demonstrated greater incorporation of the graft due to the fenestrations. No significant differences were detected in the uniaxial tensile strengths of the graft materials alone, either due to the graft type (non-fenestrated vs. fenestrated) or due to the placement location (preperitoneal vs. intraperitoneal). The incorporation strength (T-peel force) was significantly greater for fenestrated compared to non-fenestrated CPDM when placed in the preperitoneal location (P < 0.01). The incorporation strength was also significantly greater for fenestrated CPDM placed in the preperitoneal location compared to fenestrated CPDM placed in the intraperitoneal location (P < 0.05). Conclusions Fenestrations in CPDM result in greater tissue incorporation strength and lower adhesion area and score when placed in the preperitoneal location. Fenestrations in CPDM allow for greater tissue incorporation without accelerating graft degradation. Fenestrations may be placed in CPDM while still allowing adequate graft strength for intraperitoneal and preperitoneal hernia repairs at 1 month in a porcine model. PMID:20549274

  16. Thalassemia and heart surgery: aortic valve repair after endocarditis.

    PubMed

    Raffa, Giuseppe Maria; Mularoni, Alessandra; Di Gesaro, Gabriele; Vizzini, Giovanni; Cipolla, Tommaso; Pilato, Michele

    2015-01-01

    Outcome after heart valve surgery in patients affected by thalassemia is an unreported issue and to the best of our knowledge only 7 cases have been described in the literature. Heart valve disease is commonly encountered in thalassemia patients and heart valve replacement carries high risk of prosthesis complications including thrombosis and embolization despite optimal anticoagulation management. We report a successful long-term outcome after a case of aortic valve repair after mycotic valve endocarditis. PMID:25555980

  17. Analysis of post-surgical pain after inguinal hernia repair: a prospective study of 1,440 operations

    Microsoft Academic Search

    S. Massaron; S. Bona; U. Fumagalli; F. Battafarano; U. Elmore; R. Rosati

    2007-01-01

    Background  Pain remains a significant clinical problem after inguinal hernia repair. We prospectively assessed post-surgical pain following\\u000a herniorrhaphy in 1,440 operations with the aim of describing the characteristics and identifying predisposing factors for\\u000a pain.\\u000a \\u000a \\u000a \\u000a Methods  Pain quality was assessed with the short-form McGill Pain Questionnaire (SF-MPQ); pain character was estimated as either nociceptive\\u000a or neuropathic in nature.\\u000a \\u000a \\u000a \\u000a Results  A total of 38.3% of

  18. Hydrocele repair

    MedlinePLUS

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

  19. In vivo evaluation of a new composite mesh (10% polypropylene/90% poly-L-lactic acid) for hernia repair.

    PubMed

    Tanaka, Keitaro; Mutter, Didier; Inoue, Harutaka; Lindner, Véronique; Bouras, George; Forgione, Antonello; Leroy, Joël; Aprahamian, Marc; Marescaux, Jacques

    2007-06-01

    The increasing use of mesh insertion for groin hernia repair is dashed by a worrying prevalence of chronic pain frequently related as a reaction to the biomaterial implantation. Thus, new biocompatible prosthesis, designed as a composite material associating polypropylene (PP) and long-term absorbable material, are now under development. In the present study, the typical commercially available Prolene mesh has been compared to two new meshes designed with 3-fold less PP, either alone (light PP) or associated with poly-L-lactic acid (PP-PLA) accounting for 90% of the mesh weight. These PP-mesh variants were implanted in an extraperitoneal position within the abdominal wall of 90 rats. Mesh adhesion and size were determined at autopsy 2, 4 and 8 weeks after implantation (10 animals per group) and morphometric parameters of the host tissues by light microscopy. Prolene and light PP-meshes presented intra-corporeal shrinkage and tissue adhesion, both more pronounced with light-PP, whilst PP-PLA meshes were not affected in spite of a strongest fibrosis. In contrast to Prolene and even more with light PP meshes, inflammation and cell-mediated immune responses were reduced without occurrence of angiogenesis or oedema. All these findings advocate together for a better tolerance of this new composite biomaterial, more likely due to a low macrophage response that appeared statistically correlated to the absence of mesh shrinkage and to a decreased adhesion to the tissue. On the basis of these experimental observations, it could be expected that the better tolerance of this composite biomaterial may avoid both long-term pain and recurrence when used as plug in groin hernia repair. PMID:17243000

  20. A self-adhering mesh for inguinal hernia repair: preliminary results of a prospective, multicenter study

    Microsoft Academic Search

    G. Champault; A. Torcivia; L. Paolino; W. Chaddad; F. Lacaine; C. Barrat

    Background  Prosthetic reinforcement is the gold standard treatment for inguinal hernia and reduces the risk of recurrence. Yet up to\\u000a one-third of patients complain of post-surgical pain due to irritation and inflammation caused by the mesh and the fixation\\u000a materials. Of these patients, 3–4% will experience severe and disabling chronic pain. We performed a prospective multicenter\\u000a clinical study of a self-adhering

  1. Inguinal hernia repair with beta glucan-coated mesh: results at two-year follow up

    Microsoft Academic Search

    G. Champault; C. Barrat

    2005-01-01

    In a prospective study, 115 patients with a mean age of 55 years, presenting a primary or recurrent hernia were treated with a beta glucan-coated polypropylene mesh (Glucamesh). Fifty-eight underwent a Lichtenstein procedure and 57 had a laparoscopic procedure (TEP\\/TAPP). Oat beta glucan is an entirely natural plant product that eliminates the risk of viral or prion contamination associated with the

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

    PubMed Central

    Alshkaki, Giath

    2013-01-01

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

  3. Placement of a non-cross-linked porcine-derived acellular dermal matrix during preperitoneal laparoscopic inguinal hernia repair.

    PubMed

    Alshkaki, Giath

    2013-01-01

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

  4. Treatment of giant hiatal hernia by laparoscopic Roux-en-Y gastric bypass

    PubMed Central

    Duinhouwer, Lucia E.; Biter, L. Ulas; Wijnhoven, Bas P.; Mannaerts, Guido H.

    2015-01-01

    Introduction Obesity is a risk factor for hiatal hernia. In addition, much higher recurrence rates are reported after standard surgical treatment of hiatal hernia in morbidly obese patients. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective surgical treatment for morbid obesity and is known to effectively control symptoms of gastroesophageal reflux (GERD). Case presentation Two patients suffering from giant hiatal hernias where a combined LRYGB and hiatal hernia repair (HHR) with mesh was performed are presented in this paper. There were no postoperative complications and at 1 year follow-up, there was no sign of recurrence of the hernia. Discussion The gold standard for all symptomatic reflux patients is still surgical correction of the paraesophageal hernia, including complete reduction of the hernia sac, resection of the sac, hiatal closure and fundoplication. However, HHR outcome is adversely affected by higher BMI levels, leading to increased HH recurrence rates in the obese. Conclusion Concomitant giant hiatal hernia repair with LRYGB appears to be safe and feasible. Moreover, LRYGB plus HHR appears to be a good alternative for HH patients suffering from morbid obesity as well than antireflux surgery alone because of the additional benefit of significant weight loss and improvement of obesity related co-morbidity. PMID:25723747

  5. Pericardiectomy causing abdominal hernia incarceration.

    PubMed

    Rajab, Taufiek Konrad; Maurice, Musoni; Munyana, Jackline; Robinson, Barbara

    2011-12-01

    A 26-year-old Rwandan male presented with constrictive pericarditis, massive ascites and a giant umbilical hernia that had been asymptomatic for over a decade. Successful pericardiectomy was complicated by prompt incarceration of the abdominal hernia. This unexpected complication was caused by rapid resolution of the ascites due to autodiuresis and subsequent collapse of the hernial orifice. Patients with constrictive pericarditis and massive ascites who are evaluated for pericardiectomy should be carefully examined for the presence of abdominal hernias. If any such hernias are found, perioperative hernia repair should be considered and postoperative diuresis should be undertaken under close observation. PMID:21930673

  6. Biocompatibility of prosthetic meshes in abdominal surgery

    Microsoft Academic Search

    Marcel Binnebösel; Klaus T. von Trotha; Petra Lynen Jansen; Joachim Conze; Ulf P. Neumann; Karsten Junge

    2011-01-01

    Surgical meshes today represent a group of implants mainly used for hernia repair. Modern hernia surgery is no longer imaginable\\u000a without the application of these special biomaterials leading to millions of implantations each year worldwide. Because clinical\\u000a trials are insufficient to evaluate the distinct effects of modified mesh materials in regard to tissue biocompatibility and\\u000a functionality, a basic understanding of

  7. Improving Outcomes in Hernia Repair by the Use of Light Meshes—A Comparison of Different Implant Constructions Based on a Critical Appraisal of the Literature

    Microsoft Academic Search

    Dirk Weyhe; Orlin Belyaev; Christophe Müller; Kirsten Meurer; Karl-Heinz Bauer; Georgios Papapostolou; Waldemar Uhl

    2007-01-01

    Background  Despite convincing advantages offered by meshes, their use in hernia surgery remains controversial because of fears concerning\\u000a the long-term effects of their implantation. To improve biocompatibility, a large variety of newly developed light meshes\\u000a has been introduced to the market.\\u000a \\u000a This overview of the literature aimed to establish whether absolute material reduction (g per implanted mesh), use of absorbable\\u000a components,

  8. A De Garengeot Hernia masquerading as a strangulated femoral hernia

    PubMed Central

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

    2014-01-01

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

  9. Magnetic resonance imaging and abdominal wall hernias in aortic surgery 1 1 No competing interests declared

    Microsoft Academic Search

    Mario Musella; Francesco Milone; Massimo Chello; Pierluigi Angelini; Raffaele Jovino

    2001-01-01

    BACKGROUND:The aim of this study was to evaluate the incidence of abdominal wall hernias (AWH) in patients operated on for abdominal aortic aneurysm (AAA) compared with patients treated for aortoiliac occlusive disease. The efficacy of MRI in early diagnosis of AWH also was studied.STUDY DESIGN:One hundred fourteen patients operated for either AAA (51 patients, group A) or aortoiliac occlusive disease

  10. Acute incarcerated external abdominal hernia

    PubMed Central

    Yang, Xue-Fei

    2014-01-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surgery in some cases to achieve minimally invasive treatment. However, strict adherence to the indications and contraindications is still required. PMID:25489584

  11. Acute incarcerated external abdominal hernia.

    PubMed

    Yang, Xue-Fei; Liu, Jia-Lin

    2014-11-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surgery in some cases to achieve minimally invasive treatment. However, strict adherence to the indications and contraindications is still required. PMID:25489584

  12. Biomechanical and Histologic Evaluation of Fenestrated and Nonfenestrated Biologic Mesh in a Porcine Model of Ventral Hernia Repair

    PubMed Central

    Jenkins, Eric D; Melman, Lora; Deeken, Corey R; Greco, Suellen C; Frisella, Margaret M; Matthews, Brent D

    2013-01-01

    BACKGROUND The purpose of this study was to compare tissue incorporation and adhesion characteristics of a novel fenestrated versus nonfenestrated crosslinked porcine dermal matrix (CPDM) (Bard CollaMend) in a porcine model of ventral hernia repair. STUDY DESIGN Bilateral abdominal wall defects were created in 24 Yucatan minipigs, resulting in 48 defects, which were allowed to mature for 21 days. Twelve defects were repaired with fenestrated CPDM using a preperitoneal technique, 12 with fenestrated CPDM using an intraperitoneal technique, 12 with nonfenestrated CPDM using a preperitoneal technique, and 12 with nonfenestrated CPDM using an intraperitoneal technique. Half of the animals in the intraperitoneal group were euthanized after 1 month, and the other half after 3 months. Similarly, half of the animals in the preperitoneal group were euthanized after 1 month, and the other half after 6 months. Biomechanical testing and histologic evaluation were performed. RESULTS Intraperitoneal placement of the CPDM products resulted in significantly greater adhesed area compared with preperitoneal placement (p < 0.05). Tissue ingrowth into preperitoneal fenestrated and nonfenestrated CPDM resulted in significantly greater incorporation strengths after 6 months compared with 1 month (p = 0.03 and p < 0.0001). Histologic analysis showed significantly greater cellular infiltration, extracellular matrix deposition, and neovascularization, with less fibrous encapsulation through the center of the fenestrations compared with all other sites evaluated, including nonfenestrated grafts. CONCLUSIONS Histologic findings revealed increased tissue incorporation at fenestration sites compared with nonfenestrated grafts regardless of implant location or time in vivo. However, preperitoneal placement resulted in greater incorporation strength, less adhesed area, and lower adhesion scores compared with intraperitoneal placement for both fenestrated and nonfenestrated CPDM. PMID:21356487

  13. Mesenchymal stem cells seeded on cross-linked and noncross-linked acellular porcine dermal scaffolds for long-term full-thickness hernia repair in a small animal model.

    PubMed

    Mestak, Ondrej; Matouskova, Eva; Spurkova, Zuzana; Benkova, Kamila; Vesely, Pavel; Mestak, Jan; Molitor, Martin; Pombinho, Antonio; Sukop, Andrej

    2014-07-01

    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

  14. [The surgery of laparoceles. The postoperative complications].

    PubMed

    Garavello, A; Tuccimei, U; Sadighi, A; Belardi, A; Remedi, M; Antonellis, D

    1997-05-01

    The use of prosthetic meshes in incisional hernias repairs is now very attractive, particularly for wide fascial defects; nevertheless the presence of a foreign body and placement technique may be responsible for complications sometimes leading to failure. To evaluate technical problems and complications in incisional hernia surgery the authors reviewed their 5 year experience in 70 patients; 39 mesh repairs and 31 direct sutures of the abdominal wall were performed. Local complications (fistulas, wound hematoma or infections) were more frequent in the former group; PTFE meshes showed a lower resistance to infections, particularly in diabetics, and in three patients partial or total removal was mandatory. Prosthetic meshes showed a marked reduction of recurrences in incisional hernia surgery, but their use leads to more local complications than direct repair; the authors believe that mesh placement must be evaluated for every single patient and not used as a routine procedure. PMID:9297143

  15. Complications of mesh devices for intraperitoneal umbilical hernia repair: a word of caution.

    PubMed

    Muysoms, F E; Bontinck, J; Pletinckx, P

    2011-08-01

    Several mesh devices for the treatment of umbilical and other small ventral hernias have become available in recent years. These meshes have a dual layer consisting of a permanent or temporary barrier against adhesion formation between the viscera and the intraperitoneally exposed part of the mesh. We have seen several patients with serious late complications of these meshes placed intraperitoneally. Some of these patients needed small bowel resection and mesh removal. Others developed a recurrence because of improper deployment of the mesh in the intraperitoneal position. We think that, if preperitoneal deployment of such mesh devices is possible, this should be the preferred position, notwithstanding the fact that these meshes have a dual layer. There is a complete lack of convincing data on these mesh devices in the medical literature. No long-term data have been published, and, for three of the four mesh devices available, no publications on their use in humans were found. We think that surgeons adopting innovative mesh devices should register and follow their patients prospectively, at least until there are enough published studies with sufficiently large patient samples, acceptable follow up times, and favourable outcomes. PMID:20556448

  16. Mycobacterium chelonae causing chronic wound infection and abdominal incisional hernia.

    PubMed

    Verghese, Susan; Agrawal, Parag; Benjamin, Santosh

    2014-01-01

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

  17. The management of abdominal wall hernias – in search of consensus

    PubMed Central

    Bury, Kamil; ?mieta?ski, Maciej

    2015-01-01

    Introduction Laparoscopic repair is becoming an increasingly popular alternative in the treatment of abdominal wall hernias. In spite of numerous studies evaluating this technique, indications for laparoscopic surgery have not been established. Similarly, implant selection and fixation techniques have not been unified and are the subject of scientific discussion. Aim To assess whether there is a consensus on the management of the most common ventral abdominal wall hernias among recognised experts. Material and methods Fourteen specialists representing the boards of European surgical societies were surveyed to determine their choice of surgical technique for nine typical primary ventral and incisional hernias. The access method, type of operation, mesh prosthesis and fixation method were evaluated. In addition to the laparoscopic procedures, the number of tackers and their arrangement were assessed. Results In none of the cases presented was a consensus of experts obtained. Laparoscopic and open techniques were used equally often. Especially in the group of large hernias, decisions on repair methods were characterised by high variability. The technique of laparoscopic mesh fixation was a subject of great variability in terms of both method selection and the numbers of tackers and sutures used. Conclusions Recognised experts have not reached a consensus on the management of abdominal wall hernias. Our survey results indicate the need for further research and the inclusion of large cohorts of patients in the dedicated registries to evaluate the results of different surgical methods, which would help in the development of treatment algorithms for surgical education in the future. PMID:25960793

  18. [Testing of implants used in the correction of abdominal wall defects in hernia surgery].

    PubMed

    Ninger, V; Sákra, L; Havlícek, K; Rothröckel, P

    2000-09-01

    The aim of this study is experimental testing of various kinds of meshes. They are used for correction of abdominal wall defects during operations of hernias (especially by the laparoscopic technique). The following implants were tested: Goretex, Prolen, Mersilen and Vicryl. Each of them represents one group of artificial materials (nonabsorbable, monofilaments multifilament, absorbable) which are usually used. Semiabsorbable materials were not tested because they are not usually used. The objects of testing were firstly constant quality of implants lasting in the time and secondly the reaction of tissues after implantation of those materials. PMID:11109329

  19. [Use of meshendoprostheses with diamond-like carbon coating in abdominal hernias surgery].

    PubMed

    Kulikovski?, V F; Soloshenko, A V; Iarosh, A L; Dolzhikov, A A; Kolpakov, A Ia; Karpachev, A A; Bitenskaia, E P; Molchanova, A S

    2015-01-01

    It is presented the results of implantation of meshendoprostheses with and without carbon coating for surgical treatment of abdominal hernias in experiment and clinical practice. It was shown that diamond-like carbon coating minimizes primary tissue reaction against foreign material and provides complete implant's biological integration into subcutaneous connective tissue as are active encapsulation with connective tissue. Suggested meshendoprostheses with diamond-like carbon coating decrease local inflammatory reaction in operated area and thereby reduce number of exudative complications in early postoperative period. PMID:26031953

  20. Ureterosciatic hernia.

    PubMed

    Ritschel, S; Heimbach, D; Schoeneich, G

    1996-10-01

    We report on a patient with a hydronephrosis of the left kidney caused by an ureterosciatic hernia. Curlicue formation is a characteristic sign in urography. In case of symptomatic sciatic hernia the hernia should be treated by operation. PMID:8936636

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

    PubMed Central

    2012-01-01

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

  2. Inguinal Hernias

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program discusses inguinal hernias including the anatomy of the abdomen, symptoms, the benefits and risks of surgery, and what to expect after the procedure. This resource is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: This tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

  3. Functional cine MRI and transabdominal ultrasonography for the assessment of adhesions to implanted synthetic mesh 5–7 years after laparoscopic ventral hernia repair

    Microsoft Academic Search

    N. B. Zinther; P. Wara; H. Friis-Andersen

    2010-01-01

    Background  Laparoscopic ventral hernia repair (LVHR) has gained worldwide acceptance, due to its minimally invasive character, feasibility\\u000a and low rate of complications. Animal experiments have shown marked adhesions to the intraperitoneal mesh (IPM), the clinical\\u000a consequences being unclear. This study aimed to describe the extension of adhesions to the mesh, 5–7 years after LVHR, using\\u000a two validated non-invasive radiologic methods.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Real-time transabdominal

  4. Incisional Hernia in Women: Predisposing Factors and Management Where Mesh is not Readily Available

    PubMed Central

    Agbakwuru, EA; Olabanji, JK; Alatise, OI; Okwerekwu, RO; Esimai, OA

    2009-01-01

    Background / Aim: Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in our region. The setting is the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria during a period when prosthetic mesh was not readily available. Patients and Methods: All the women who presented with incisional hernia between 1996 and 2005 were prospectively studied using a standard form to obtain information on pre-hernia (index) operations and possible predisposing factors. They all had open surgical repair and were followed up for 18–60 months. Results: Forty-four women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/44 (59.1%), emergency exploratory laparotomy 6/44 (13.6%), and elective surgeries 12/44 (27.3%). Major associated risk factors were the use of wrong suture materials for fascia repair, midline incisions, wound sepsis, and overweight. Conclusion: For elective surgeries, reduction of weight should be encouraged when appropriate, and transverse incisions are preferred. Absorbable sutures, especially chromic catgut, should be avoided in fascia closure. Antibiotics should be used for complicated obstetric cases. PMID:21483511

  5. [Surgical treatment of ventral hernia].

    PubMed

    Helgstrand, Frederik; Rosenberg, Jacob; Jørgensen, Lars Nannestad; Kehlet, Henrik; Bisgaard, Thue

    2010-06-28

    The evidence for choice of surgical technique in ventral hernia treatment is poor. The outcomes have so far been associated with high recurrence rates and significant morbidity. Data from the Danish Ventral Hernia Database show large variations in the surgical approach. On the basis of a consensus meeting, agreement on a national strategy for ventral hernia surgery in Denmark is proposed in order to facilitate future interpretation of the outcomes. PMID:20654289

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

    PubMed

    Deprest, Jan; De Coppi, Paolo

    2012-02-01

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

  7. Medium-term follow-up confirms the safety and durability of laparoscopic ventral hernia repair with PTFE

    Microsoft Academic Search

    George M Eid; Jose M Prince; Samer G Mattar; Giselle Hamad; Sayeed Ikrammudin; Philip R Schauer

    2003-01-01

    BackgroundVentral abdominal wall hernias are common lesions and may be associated with life-threatening complications. The application of laparoscopic principles to the treatment of ventral hernias has reduced recurrence rates from a range of 25% to 52% to a range of 3.4% to 9%. In this study, we review our experience and assess the clinical outcome of patients who have undergone

  8. Vascular dysfunction after repair of coarctation of the aorta: impact of early surgery

    Microsoft Academic Search

    Marcello de Divitiis; Carlo Pilla; Mia Kattenhorn

    2002-01-01

    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

  9. Histologic and Biomechanical Evaluation of Crosslinked and Non-Crosslinked Biologic Meshes in a Porcine Model of Ventral Incisional Hernia Repair

    PubMed Central

    Deeken, Corey R; Melman, Lora; Jenkins, Eric D; Greco, Suellen C; Frisella, Margaret M; Matthews, Brent D

    2013-01-01

    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. PMID:21435917

  10. Laparoscopic treatment of Morgagni-Larrey hernia: technical details and report of a series.

    PubMed

    Percivale, Andrea; Stella, Mattia; Durante, Valentino; Dogliotti, Luca; Serafini, Giovanni; Saccomani, Giovanni; Pellicci, Riccardo

    2005-06-01

    Three patients with Morgagni-Larrey hernia were admitted to the surgical department between August 2000 and September 2003 with slight chest pain and dyspnea. Laparoscopic repair of the diaphragmatic hernia was performed using a tension-free closure of the defects with either Vicryl-Prolene or dual facing mesh fixed by Prolene extracorporeal knots and Endostitch devices. The patients were discharged on postoperative day 5 without complications. Mean follow-up has been 23 months (range, 15-36 months) and no recurrence or morbidity related to the procedure has been seen. Laparoscopic repair of Morgagni-Larrey hernia represents an attractive alternative to open surgery. The benefits are gentle and easy manipulation of the content of the sac, reduced surgical trauma, and rapid and uneventful recovery. PMID:15954834

  11. Surgical Resection and Scarification for Chronic Seroma Post-Ventral Hernia Mesh Repair

    PubMed Central

    Vasilakis, Vasileios; Cook, Kristin; Wilson, Dorian

    2014-01-01

    Patient: Male, 52 Final Diagnosis: Seroma Symptoms: Abdominal discomfort • abdominal mass Medication: — Clinical Procedure: Excision and evacuation of the complex seroma Specialty: Surgery Objective: Unusual or unexpected effect of treatment Background: The aim of this report is to present a new surgical approach in the definitive management of challenging cases of abdominal wall seroma following herniorrhaphy with mesh. Case Report: We describe the case of a 56-year-old male with a 4-year history of a complex abdominal wall seroma. He had undergone fluid aspiration twice without success. On physical examination, the mass was supraumbilical and measured 15×10 cm. Computer tomography (CT) scan revealed a complex encapsulated formation overall measuring 10.1×17.3×17.3 cm in AP, transverse, and craniocaudal dimensions, respectively. In this case complete resection was not safe due to the anatomic relationship of the posterior aspect of the pseudocapsule and the mesh. Intraoperatively, the anterior and lateral aspects of the pseudocapsule were resected and an argon beam was used to scarify the residual posterior pseudocapsule and prevent recurrence. This technique was successful in preventing reaccumulation of the seroma. Conclusions: Capsulectomy and scarification of the remnant pseudocapsule is an acceptable and safe surgical option for complex chronic abdominal wall seromas. PMID:25430512

  12. Prevention of adhesion formation with use of sodium hyaluronate–based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh—A randomized, controlled study

    Microsoft Academic Search

    Glen D. Hooker; Brian M. Taylor; David K. Driman

    1999-01-01

    Background: There is a high incidence of adhesions after ventral hernia repair with polypropylene mesh. Hyaluronic acid (HA)–based membrane has been shown to reduce the incidence of adhesions in the absence of prosthetic mesh. The purpose of this study was to determine the effect of HA membrane on the quantity and grade of adhesions and its effect on strength of

  13. [Use of Permacol in complicated incisional hernia].

    PubMed

    Armellino, Mariano Fortunato; De Stefano, Guglielmo; Scardi, Francesco; Forner, Anna Lucia; Ambrosino, Francesco; Bellotti, Roberto; Robustelli, Umberto; De Stefano, Giovanni

    2006-01-01

    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

  14. Inguinal hernia repair with beta glucan-coated mesh: Prospective multicenter study (115 cases)—Preliminary results

    Microsoft Academic Search

    C. Barrat; F. Seriser; R. Arnoud; P. Trouette; G. Champault

    2004-01-01

    Prosthetic reinforcement is now routine in the management of inguinal hernia, and it significantly reduces the risk of recurrence. However, there may be postoperative pain and discomfort of late onset, the intensity of which appears to be related to the rigidity of the material and its ability to integrate with tissues. We have evaluated the results of implantation with beta

  15. Emergency Open Incarcerated Hernia Repair with a Biological Mesh in a Patient with Colorectal Liver Metastasis Receiving Chemotherapy and Bevacizumab Uncomplicated Wound Healing

    PubMed Central

    Giakoustidis, Alexandros; Morrison, Dawn; Giakoustidis, Dimitrios

    2014-01-01

    Bevacizumab is a humanized monoclonal antibody targeting vascular endothelial growth factor (VEGF), often used in combinational chemotherapy regimens for the treatment of patients with colorectal liver metastases. However adverse events have been attributed to the use of bevacizumab including gastrointestinal perforations, thrombotic events, hypertension, bleeding, and wound healing complications. 53-year-old male, with a history of colorectal cancer with liver metastasis, receiving a combination of cytotoxic chemotherapy (FOLFIRI, irinotecan with fluorouracil and folinic acid) with bevacizumab presented as an emergency with an incarcerated incisional hernia. The last administration of chemotherapy and bevacizumab had taken place 2 weeks prior to this presentation. As the risk of strangulation of the bowel was increased, a decision was made to take the patient to theatre, although the hazard with respect to wound healing, haemorrhage, and infection risk was high due to the recent administration of chemotherapy with bevacizumab. The patient underwent an open repair of the incarcerated recurrent incisional hernia with placement of a biological mesh, and the postoperative recovery was uncomplicated with no wound healing or bleeding problems. PMID:25614840

  16. Hiatal Hernia

    MedlinePLUS

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

  17. Inguinal Hernia

    MedlinePLUS

    Listen Español Text Size Email Print Share Inguinal Hernia Article Body If you notice a small lump ... the scrotum, you may have discovered an inguinal hernia. This condition, which is present in up to ...

  18. In children undergoing umbilical hernia repair is rectus sheath block effective at reducing post-operative pain? Best evidence topic (bet).

    PubMed

    Rajwani, Kapil M; Butler, Sarah; Mahomed, Anies

    2014-12-01

    A best evidence topic was constructed according to a structured protocol. The question addressed was: In children undergoing umbilical hernia repair is a rectus sheath block (RSB) better than local anaesthetic infiltration of the surgical site, at reducing post-operative pain? From a total of 34 papers, three studies provided the best available evidence on this topic. One randomised clinical trial showed RSB had a better analgesic effect in the immediate post-operative period. In another randomised trial opioid consumption in the peri-operative period was found to be significantly lower in patients administered RSB. These improvements in pain and analgesia consumption need to be balanced against the expertise, training, equipment required, time implications and complications of performing a RSB. PMID:25463042

  19. Laparoscopic Ventral Hernia Repair

    MedlinePLUS

    ... Foundation Newsroom SAGES Mission Statement SAGES Resource Guide Leadership SAGES Board of Governors Committee Chairs and Co- ... Training Jeff Ponsky Master Educator Excellence in Medical Leadership The Brandeis Meetings SAGES 2016 Meeting Information 2016 ...

  20. Image-Guided Techniques Improve the Short-Term Outcome of Autologous Osteochondral Cartilage Repair Surgeries

    PubMed Central

    Devlin, Steven M.; Hurtig, Mark B.; Waldman, Stephen D.; Rudan, John F.; Bardana, Davide D.; Stewart, A. James

    2013-01-01

    Objective: Autologous osteochondral cartilage repair is a valuable reconstruction option for cartilage defects, but the accuracy to harvest and deliver osteochondral grafts remains problematic. We investigated whether image-guided methods (optically guided and template guided) can improve the outcome of these procedures. Design: Fifteen sheep were operated to create traumatic chondral injuries in each knee. After 4 months, the chondral defect in one knee was repaired using (a) conventional approach, (b) optically guided method, or (c) template-guided method. For both image-guided groups, harvest and delivery sites were preoperatively planned using custom-made software. During optically guided surgery, instrument position and orientation were tracked and superimposed onto the surgical plan. For the template-guided group, plastic templates were manufactured to allow an exact fit between template and the joint anatomy. Cylindrical holes within the template guided surgical tools according to the plan. Three months postsurgery, both knees were harvested and computed tomography scans were used to compare the reconstructed versus the native pre-injury joint surfaces. For each repaired defect, macroscopic (International Cartilage Repair Society [ICRS]) and histological repair (ICRS II) scores were assessed. Results: Three months after repair surgery, both image-guided surgical approaches resulted in significantly better histology scores compared with the conventional approach (improvement by 55%, P < 0.02). Interestingly, there were no significant differences found in cartilage surface reconstruction and macroscopic scores between the image-guided and the conventional surgeries.

  1. JAMA Patient Page: Abdominal Hernia

    MedlinePLUS

    JAMA PATIENT PAGE Abdominal Hernia Common abdominal hernias Inguinal hernia Indirect inguinal hernia Direct inguinal hernia Intestinal loop Umbilical annulus Peritoneum Peritoneum Abdominal wall Intestinal ...

  2. Laparoscopic treatment of type III and IV hiatal hernia – authors’ experience

    PubMed Central

    Grzesiak-Kuik, Agata; P?dziwiatr, Micha?; Budzy?ski, Andrzej

    2014-01-01

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

  3. Early laparotomy wound failure as the mechanism for incisional hernia formation

    PubMed Central

    Xing, Liyu; Culbertson, Eric J.; Wen, Yuan; Franz, Michael G.

    2015-01-01

    Background Incisional hernia is the most common complication of abdominal surgery leading to reoperation. In the United States, 200,000 incisional hernia repairs are performed annually, often with significant morbidity. Obesity is increasing the risk of laparotomy wound failure. Methods We used a validated animal model of incisional hernia formation. We intentionally induced laparotomy wound failure in otherwise normal adult, male Sprague-Dawley rats. Radio-opaque, metal surgical clips served as markers for the use of x-ray images to follow the progress of laparotomy wound failure. We confirmed radiographic findings of the time course for mechanical laparotomy wound failure by necropsy. Results Noninvasive radiographic imaging predicts early laparotomy wound failure and incisional hernia formation. We confirmed both transverse and craniocaudad migration of radio-opaque markers at necropsy after 28 d that was uniformly associated with the clinical development of incisional hernias. Conclusions Early laparotomy wound failure is a primary mechanism for incisional hernia formation. A noninvasive radiographic method for studying laparotomy wound healing may help design clinical trials to prevent and treat this common general surgical complication. PMID:23036516

  4. Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use? 1 1 No competing interests declared

    Microsoft Academic Search

    Claudio Birolini; Edivaldo Massazo Utiyama; Aldo Junqueira Rodrigues; Dario Birolini

    2000-01-01

    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

  5. Atypical right diaphragmatic hernia (hernia of Morgagni), spigelian hernia and epigastric hernia in a patient with Williams syndrome: a case report

    PubMed Central

    2009-01-01

    Introduction Williams syndrome is rare genetic disorder resulting in neurodevelopmental problems. Hernias of the foramen of Morgagni are rare diaphragmatic hernias and they mostly present on the right side, in the anterior mediastinum. They are usually asymptomatic and are difficult to diagnose, especially in patients with learning disabilities. Case presentation This 49-year-old woman with Williams syndrome, cognitive impairment and aortic stenosis presented to physicians with right-sided chest pain. She had previously undergone repair of her right spigelian and epigastric hernia. Her abdominal examination was unremarkable. Chest X-ray suggested right-sided diaphragmatic hernia and pleural effusion for which she received treatment. The computed tomography scan showed a diaphragmatic hernia with some collapse/consolidation of the adjacent lung. Furthermore, the patient had aortic stenosis and was high risk for anaesthesia (ASA grade 3). She underwent successful laparoscopic repair of her congenital diaphragmatic hernia leading to a quick and uneventful postoperative recovery. Conclusion These multiple hernias suggest that patients with Williams syndrome may have some connective tissue disorder which makes them prone to develop hernias especially associated with those parts of the body which may have intracavity pressure variations like the abdomen. Diaphragmatic hernia may be the cause of chest pain in these patients. A computed tomography scan helps in early diagnosis, and laparoscopic repair helps in prevention of further complications, and leads to quick recovery especially in patients with learning disabilities. In the presence of significant comorbidities, a less invasive operative procedure with quick recovery becomes advisable. PMID:19128471

  6. Trocar site hernia after laparoscopic colectomy: a case report and literature review.

    PubMed

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

    2011-01-01

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

  7. Sellar repair with fibrin sealant and collagen fleece after endoscopic endonasal transsphenoidal surgery

    Microsoft Academic Search

    Paolo Cappabianca; Luigi Maria Cavallo; Vinicio Valente; Immacolata Romano; Alfonso Iodice D'Enza; Felice Esposito; Enrico de Divitiis

    2004-01-01

    ObjectiveTo determine, in patients undergoing sellar repair after endoscopic endonasal transsphenoidal surgery, the clinical efficacy of a combination of fibrin sealant\\/collagen fleece compared to the use of fibrin sealant or collagen fleece alone, in preventing CSF-related (cerebrospinal fluid) postoperative complications.

  8. Intestinal obstruction secondary to left paraduodenal hernia

    PubMed Central

    Gusz, John R.; Wright, Lauren M.

    2015-01-01

    An internal hernia—congenital or acquired—is a protrusion of bowel through an opening in the peritoneum or mesentery. Internal hernias are the etiology of <2% of intestinal obstructions, with paraduodenal hernias being the most common type of congenital internal hernia. We report a case of a left paraduodenal hernia (LPDH) combined with partial small bowel obstruction in a 69-year-old male with recurrent abdominal pain of 2 years duration and no previous abdominal surgeries. An abdominal computed tomography scan showed an agglomeration of small bowel loops in the left upper quadrant but failed to yield a clear diagnosis. Surgical intervention provided definitive diagnosis and treatment of the LPDH. We additionally review the literature regarding anatomy, pathogenesis, diagnosis and treatment of this uncommon hernia. Intestinal obstruction secondary to an internal hernia is a rare entity; however, delayed diagnosis and surgical intervention may result in significant morbidity and mortality. PMID:26188474

  9. The role of TGF-?1 as a determinant of foreign body reaction to alloplastic materials in rat fibroblast cultures: comparison of different commercially available polypropylene meshes for hernia repair

    Microsoft Academic Search

    Dirk Weyhe; Peter Hoffmann; Orlin Belyaev; Kirsten Mros; Christophe Muller; Waldemar Uhl; Frank Schmitz

    2007-01-01

    BackgroundAnimal experiments on hernia repair demonstrated better biocompatibility of light-weight polypropylene meshes. However, implanted medical devices trigger a variety of adverse tissue responses, such as inflammation, fibrosis, infection and thrombosis, but the mechanisms involved in such responses remain largely unknown. This study aimed to determine the effect of transforming growth factor ?1 (TGF-?1) on host tolerance by quantification of foreign

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed

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

    2014-01-01

    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

  12. Obturator Hernia: A Rare Case of Acute Mechanical Intestinal Obstruction

    PubMed Central

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

    2013-01-01

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

  13. A rare case of a groin hernia: the Hesselbach's hernia.

    PubMed

    van den Heuvel, B; Munoz Brands, R M; Beuerle, E Y; Dwars, B J

    2015-06-01

    A 61-year-old woman presented with pain in the left groin. The pain radiated from the groin to the knee. At physical examination, a non-reducible swelling was found lateral to the femoral vessels. A CT-scan showed herniation of fatty tissue through the lacuna musculorum. A laparoscopic repair was carried out. A large adipose structure was found herniating through the lacuna musculorum and originating from the Bogros area. It ran along the iliopsoas muscle, suppressing the femoral cutaneous nerve. The tissue was reduced and excised, and a polypropylene mesh was placed to cover the defect. Inguinal hernias are categorized as medial, lateral or femoral hernias. We describe a case in which a hernia through the lacuna musculorum was found, which is very rare and referred to as a Hesselbach's hernia. PMID:23929498

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

    PubMed Central

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

    2014-01-01

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

  15. Umbilical hernia

    MedlinePLUS

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

  16. Incisional hernia involving the neobladder: technical considerations to avoid complications.

    PubMed

    Katkoori, Devendar; Jayathillake, Anuradha; Eldefrawy, Ahmed; Manoharan, Murugesan

    2009-01-01

    The management of incisional hernia following radical cystectomy (RC) and neobladder diversion poses a special challenge. Mesh erosion into the neobladder is a potential complication of hernia repair in this setting. We describe our experience and steps to avoid this complication. Three patients developed incisional hernias following RC involving the neobladder. The incisional hernias were repaired by the same surgeon. A systematic dissection and repair of the hernias with an onlay dual-layer mesh (made of polyglactin and polypropylene) was carried out. The critical steps were placing the polyglactin side of the mesh deeper and positioning of an omental flap anterior to the neobladder. The omental flap adds a protective layer that prevents adhesions between the neobladder and abdominal wall, and prevents erosion of the mesh into the fragile neobladder wall. All of these patients had received two cycles of neoadjuvant chemotherapy prior to RC. The time duration from RC to the repair of hernia was 7, 42, and 54 months. No intraoperative injury to the neobladder or other complication was noted during hernia repair. The patients were followed after hernia repair for 20, 22, and 42 months with no recurrence, mesh erosion, or other complications. Careful understanding and attention to details of the technique can minimize the risk of complications, especially incisional hernia recurrence, injury to the neobladder, and erosion of mesh into the neobladder wall. PMID:19578707

  17. Sports Hernia (Athletic Pubalgia)

    MedlinePLUS

    ... by the American Academy of Orthopaedic Surgeons. Sports Hernia (Athletic Pubalgia) A sports hernia is a painful, so tissue injury that occurs ... direction or intense twisting movements. Although a sports hernia may lead to a traditional, abdominal hernia, it ...

  18. Chylous ascites following repair of exomphalos major--a report.

    PubMed

    Debnath, Bidyut; Biswas, Sumitra Kumar

    2010-08-01

    In cases of giant omphalocele anterior abdominal wall is so poorly developed that primary closure is not possible without excessive tension. The simplest of innovative strategies in such a situation is to provide epithellalisation of sac with secondary closure of ensuing ventral hernia at a later date. Postsurgical chylous ascites is a known entity and it usually responds with supportive therapy. Chylous ascites as a complication of reparative surgery of exomphalos is rare. Here a case of complete resolution of chylous ascites following conservative therapy who underwent a repair of ventral hernia as a sequela to non-operative treatment of giant omphalocele is reported. PMID:21404749

  19. Muscle hernias of the leg: A case report and comprehensive review of the literature

    PubMed Central

    Nguyen, Jesse T; Nguyen, Jenny L; Wheatley, Michael J; Nguyen, Tuan A

    2013-01-01

    A case involving a retired, elderly male war veteran with a symptomatic peroneus brevis muscle hernia causing superficial peroneal nerve compression with chosen surgical management is presented. Symptomatic muscle hernias of the extremities occur most commonly in the leg and are a rare cause of chronic leg pain. Historically, treating military surgeons pioneered the early documentation of leg hernias observed in active military recruits. A focal fascial defect can cause a muscle to herniate, forming a variable palpable subcutaneous mass, and causing pain and potentially neuropathic symptoms with nerve involvement. While the true incidence is not known, the etiology has been classified as secondary to a congenital (or constitutional) fascial weakness, or acquired fascial defect, usually secondary to direct or indirect trauma. The highest occurrence is believed to be in young, physically active males. Involvement of the tibialis anterior is most common, although other muscles have been reported. Dynamic ultrasonography or magnetic resonance imaging is often used to confirm diagnosis and guide treatment. Most symptomatic cases respond successfully to conservative treatment, with surgery reserved for refractory cases. A variety of surgical techniques have been described, ranging from fasciotomy to anatomical repair of the fascial defect, with no consensus on optimal treatment. Clinicians must remember to consider muscle hernias in their repertoire of differential diagnoses for chronic leg pain or neuropathy. A comprehensive review of muscle hernias of the leg is presented to highlight their history, occurrence, presentation, diagnosis and treatment. PMID:24497767

  20. What should be the management policy for asymptomatic inguinal hernias?

    PubMed

    Bagshaw, Philip F

    2015-03-27

    Elective surgical repair was the general policy for the treatment of asymptomatic and minimally symptomatic inguinal hernias, based on reducing the risks of possible future bowel obstruction or visceral strangulation. Two randomised controlled trials in 2006 suggested that an alternative policy of "watchful waiting" was safe and appropriate. As a result, some health authorities in the UK withdrew funding for elective surgical repair for asymptomatic hernias in 2010. The long-term follow-up results of these two trials, however, showed high rates of surgery in the watchful waiting arms due to the development of symptoms. Two recent studies have called the watchful waiting policy into question on the basis of cost-effectiveness, quality of life and mortality data. The current article shows the results of an Official Information Act request of the New Zealand Ministry of Health and the 20 District Health Boards on their current policies for the management of such hernias. The results show a range of policies, with two District Health Boards employing watchful waiting, seven with policies or health pathways that can restrict or deny access to treatment, and all District Health Boards required to comply with Ministry of Health performance indicators. It is concluded that, at least with some District Health Boards, patients with asymptomatic and minimally symptomatic inguinal hernias are given a lower priority for surgical treatment than they might merit on clinical grounds. Further research is needed to formulate appropriate policy for the management of this common disorder, and should perhaps be extended to cover other similarly common conditions. PMID:25820507

  1. [Groin hernia in the patients receiving CAPD].

    PubMed

    Smieta?ski, Maciej; Renke, Marcin; Bigda, Justyna; Smieta?ska, Irmina; Wujtewicz, Maria; Rutkowski, Boles?aw; Sledzi?ski, Zbigniew

    2005-01-01

    Continuous ambulatory peritoneal dialysis (CAPD) is a popular way of treatment of the patients with renal failure. There were 1365 patients on CAPD in Poland in the year 2001. Higher frequency of groin and abdominal hernias was reported in those patients. 10% of dialysed patients developed hernia in the first five years of the therapy. The main problems of hernia repair in the CAPD patients are: increased pressure in abdominal cavity caused by dialysate volume, higher risk of peritonitis, poor prognosis in the complicated cases temporarily or permanently converted to hemodialysis (HD) and the insufficiency of healing process. Complications accorded to hernia repair are the third most often reason of conversion to HD. Conducted studies on hernia repair did not lead to the introduction of the world standard. Authors propose to introduce an unified protocol to improve treatment results. Main guidelines of hernia treatment in CAPD patients are: 1) consultation of the surgeon cooperating with dialysis center in qualification to CAPD, and in the case of hernia symptoms in CAPD patients, 2) application of tension-free methods (PHS recommended), 3) administration of antibiotic prophylaxis, 4) application of local or epidural anesthesia, 5) no necessity of discontinuation of CAPD procedures. PMID:16529069

  2. Hernia, Mesh, and Topical Antibiotics, Especially Gentamycin: Seeking the Evidence for the Perfect Outcome…

    PubMed Central

    Kulacoglu, Hakan

    2015-01-01

    Inguinal hernia repair is a clean surgical procedure and surgical site infection (SSI) rate is generally below 2%. Antibiotic prophylaxis is not routinely recommended, but it may be a good choice for institutions with high rates of wound infection (>5%). Typical prophylaxis is the intravenous application of first or second-generation cephalosporins before the skin incision. However, SSI rate remains more than 2% in many centers in spite of intravenous antibiotic prophylaxis. Even a 1% SSI rate may be unacceptable for the surgeons who specifically deal with hernia surgery. A hernia center targets to be a center of excellence not only in respect of recurrence rate but also for other postoperative outcomes, therefore a further measure is required for an excellent result regarding infection control. Topical gentamycin application in combination with preoperative single-dose intravenous antibiotic may be a useful to obtain this perfect outcome. Data about this subject are not complete and high-grade evidence has not been cumulated yet. Prospective randomized controlled trials can make our knowledge more solid about this subject and help the surgeons who seek perfect outcome regarding infection control in inguinal hernia surgery. PMID:25699259

  3. The management of incisional hernia.

    PubMed

    Kingsnorth, Andrew

    2006-05-01

    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. PMID:16719992

  4. An atypical lateral hernia and concomitant inguinal and umbilical hernias in a patient with polycystic kidney disease and an intracranial aneurysm - a combined approach of clinical and radiological investigation, endoscopic hernia repair, and anatomical cadaver model documentation and a systematic review of the literature.

    PubMed

    Veréb-Amolini, László; Betschart, Thomas; Kiss, Emilia; Ullrich, Oliver; Wildi, Stefan; Eppler, Elisabeth

    2015-01-01

    Atypical hernias are difficult to diagnose due to their rarity and often unspecific symptoms. In the literature there exist hints to peri-inguinal hernias, i.e. direct lateral hernia, but most of them are forms of Spigelian hernias. Since the majority were described during the first half of the past century or even earlier, only very few cases have been documented using modern diagnostic techniques. We report a unique case of a 51 year old patient presenting with an atypical inguinal hernia with concomitant inguinal and umbilical hernias in combination with cystic kidney disease and intracranial aneurysm. The atypical position of the hernia was assumed from clinical inspection, ultrasound and CT scan and verified during pre-peritoneoscopy. Using an anatomical cadaver dissection approach, we followed the unusual position of the hernia through the abdominal wall below the aponeurosis of the external oblique muscle. After a thorough literature search, we assume that the present hernia containing a hernial sac has not been documented before, especially not in such a multidisciplinary approach comprising radiological, surgical and anatomical localisation and endoscopic treatment in a patient with a clinical situation being aggravated by large cystic kidneys leading to dialysis-dependency. Rare hernias have been described as being often associated with concomitant inguinal or other hernias, a predisposition for the male gender and a pathogenic mechanism related to other soft tissue defects such as cystic kidney disease or cranial aneurysm. Thus, we consider this a unique case that has not been documented in this constellation previously, which may increase the awareness for these rare hernias. PMID:25763300

  5. Concomitant tricuspid valve repair in patients with minimally invasive mitral valve surgery

    PubMed Central

    Pfannmüller, Bettina; Davierwala, Piroze; Hirnle, Gregor; Borger, Michael A.; Misfeld, Martin; Garbade, Jens; Seeburger, Joerg; Mohr, Friedrich W.

    2013-01-01

    Background The aim of this study was to investigate the 10-year Leipzig experience with minimally invasive mitral valve (MIMV) surgery in combination with tricuspid valve (TV) surgery. Methods Between January 2002 and December 2011, a total of 441 patients with mitral valve (MV) dysfunction and concomitant TV regurgitation (TR) underwent MIMV surgery at the Leipzig Heart Center. The mean age was 68.7±10.0 years, mean LVEF was 56.7%±13.1% and 184 patients (41.7%) were male. The Average logEuroSCORE was 8.3%±7.2%, and patients had an average follow-up of 3.4±2.4 years. Results Pre-discharge echocardiography showed no or mild mitral regurgitation (MR) in 95.1% and no or mild TR in 84.1%. Overall 30-day mortality was 4.3% with nineteen deaths. Five-year survival was 77.2%±2.5%. Five-year freedom from TV-related reoperation was 91.0%±1.8%. Conclusions Our 10-year experience show that MIMV surgery in combination with TV surgery can be performed routinely with good peri- and post-operative results. Our observations support current recommendations to perform concomitant TV repair, particularly if tricuspid annular dilation is present. PMID:24349978

  6. Comparison of Cross-linked and Non–Cross-linked Acellular Porcine Dermal Scaffolds for Long-term Full-Thickness Hernia Repair in a Small Animal Model

    PubMed Central

    Mestak, Ondrej; Spurkova, Zuzana; Benkova, Kamila; Vesely, Pavel; Hromadkova, Veronika; Miletin, Jakub; Juzek, Robert; Molitor, Martin; Sukop, Andrej

    2014-01-01

    Background: This study compared the strength of incorporation and biocompatibility of 2 porcine-derived grafts (cross-linked and non–cross-linked) in a rat hernia model. Methods: A standardized 2 × 4 cm2 fascial defect was created in 30 Wistar rats and repaired with either a cross-linked or a non–cross-linked graft. The rats were killed 3, 6, and 12 months later. The strength of incorporation, vascularization, cellular invasion, foreign body reaction, and capsule formation were evaluated. Results: Both graft materials showed cellular ingrowth and neovascularization by 3 months postimplantation. The average level of cellularization was significantly higher in the non–cross-linked grafts than in the cross-linked grafts at 6 months (2 vs 1; P = .029). Vascularization was significantly higher in the non–cross-linked grafts than in the cross-linked grafts at 6 months postimplantation (2 vs 1; P = .029) and insignificant at 3 months (2 vs 1.75; P = .311) and 12 months (1 vs 0.67; P = 1). The maximum load and breaking strength of both biomaterials increased during the study period. Overall, the strength of incorporation of the non–cross-linked grafts increased from 3 months (0.75 MPa) to 12 months (3.06 MPa) postimplantation. The strength of incorporation of the cross-linked grafts also increased from 3 months (0.59 MPa) to 12 months (1.58 MPa) postimplantation. Conclusions: The results of our study suggest that non–cross-linked grafts may be slightly more biocompatible and allow a more rapid and higher degree of cellular penetration and vascularization, resulting in stronger attachment to the tissues. PMID:24966996

  7. Endovascular stenting of abdominal aortic aneurysm in patients unfit for elective open surgery. Eurostar group. EUROpean collaborators registry on Stent-graft Techniques for abdominal aortic Aneurysm Repair.

    PubMed

    Laheij, R J; van Marrewijk, C J

    2000-09-01

    Endovascular aneurysm repair is useful for patients who are judged unfit for surgery. We investigated the outcome of endovascular repair of abdominal aortic aneurysm in patients fit and unfit for surgery. The 1-year cumulative survival for patients unfit for surgery and patients unfit for general anaesthesia was 20% and 23%, respectively. The overall health status of patients was an important predictor of survival after endovascular repair. The risks of endovascular aneurysm repair might, therefore, exceed that of non-operative management. Caution should be used when advising these patients about endovascular repair. PMID:11022935

  8. Perioperative clinical decision-making in surgery for mitral valve repair.

    PubMed

    Naqvi, T Z

    2007-04-01

    Echocardiography has played a critical role in the progress in mitral valve reconstructive surgery which was revolutionized as ''the French correction'' by Alain Carpentier in the mid 1980s. Mitral regurgitation (MR) is the most challenging valvular heart disease throughout the world and is related to rheumatic etiology in the underdeveloped world and to degenerative etiology in the Western world. Echocardiography plays an integral role in the management of patients with significant MR. This includes evaluation and follow-up during the medical management phase of MR to intraoperative mitral valve repair and post operative follow-up, using a combination of transthoracic echocardiography and transesophageal echocardiography. Newer developments include evaluation by transthoracic and transesophageal three-dimensional echocardiography. This review summarizes role of echocardiography in diagnosis, therapy and follow-up of patients with clinically significant MR. Discussion will focus on mitral valve repair for degenerative MR of myxomatous etiology and functional and ischemic MR. PMID:17342039

  9. A rare nonincisional lateral abdominal wall hernia

    PubMed Central

    Kim, Dong-Ju

    2015-01-01

    A 68-year-old woman presented a rare lateral abdominal wall hernia. Three month before admission to Chungbuk National University Hospital, she found a large protruding mass measuring 8 cm in diameter in the midaxillary line just below the costal margin upon heavy coughing. She had no history of abdominal trauma, infection, or operation previously. The mass was easily reduced manually or by position change to left lateral decubitus. CT scan showed a defect of the right transversus abdominis muscle and internal oblique muscle at the right flank with omental herniation. Its location is different from that of spigelian hernia or lumbar hernia. The peritoneal lining of the hernia sac was smooth and there was no evidence of inflammation or adhesion. The hernia was successfully repaired laparoscopically using Parietex composite mesh with an intraperitoneal onlay mesh technique. The patient was discharged uneventfully and did not show any evidence of recurrence at follow-up visits. PMID:25692123

  10. Epigastric and umbilical hernia; work relatedness and return to work.

    PubMed

    Mehrdad, Ramin; Sadeghniiat Haghighi, Khosro; Naseri Esfahani, Amir Hossein

    2013-01-01

    Abdominal wall hernia is common but reliable scientific data about its work relatedness is very limited and inconsistent. In this paper, a less common type of abdominal wall hernia in a 30 year old male worker is presented with recurrence after first surgery when he returned to work. In contrast with almost all kinds of hernia, a lifelong limitation for heavy lifting was recommended. It seems that contrary to popular belief, work relatedness of abdominal wall hernia is seriously doubtful, although conclusive evidences are not enough. It is preferable to make decisions cautiously for return to heavy duties of work after surgery of large umbilical, umbilical & epigastric or incisional hernia, while avoiding recommendations for long days off work after surgery of any hernia. PMID:23641412

  11. Combined complex open heart surgery and infra-renal aortic aneurysm repair.

    PubMed

    Corso, Ricardo B; Atik, Fernando A; Faber, Cristiano N; Succi, Guilherme M; Santos, Linda M C; Succi, Fabiana M P; Caneo, Luiz Fernando

    2008-06-01

    The optimal management of patients with combined ischemic and/or valvular heart disease and abdominal aortic aneurysm is still a matter of debate. A 60-year-old woman presented with a large infra-renal aortic aneurysm. Preoperative workup revealed ischemic cardiomyopathy and aortic regurgitation. She was submitted to one-stage aneurysm repair and complex heart surgery. Postoperatively, she developed mediastinal bleeding, transient renal dysfunction, pulmonary edema and superficial wound infection. She was discharged home about a month later without residual problems. PMID:17433478

  12. Management of a giant inguinoscrotal hernia with an ulcerated base in a patient with cardiac disease

    PubMed Central

    Turner, E Jane H; Malhas, Amar; Chisti, Imran; Oke, Tayo

    2010-01-01

    Giant inguinal herniae pose a surgical challenge, though not uncommon in the developing world they are a rare presentation in the UK. We present a patient with cardiac disease who presented with a giant inguino-scrotal hernia complicated by a bleeding scrotal ulcer. We describe his medical management and the surgical repair of the hernia and refashioning of his scrotum. PMID:24946352

  13. Successful laparoscopic management of an incarcerated obturator hernia

    PubMed Central

    Lynch, Noel P.; Corrigan, Mark A.; Kearney, David E.; Andrews, Emmet J.

    2013-01-01

    Obturator hernia is a rare pelvic hernia that occurs primarily in multiparous, elderly (>70 years of age), thin females. This case highlights the successful laparoscopic mesh repair of an incarcerated obturator hernia in an octogenarian. The authors report a case of an incarcerated obturator hernia in an elderly female with subsequent high-grade small bowel and its successful laparoscopic operative management. A review of the relevant literature was also performed following a search on the online literature databases such as PUBMED and EMBASE. Laparoscopic mesh repair of the incarcerated obturator hernia and an ipsilateral femoral hernia found incidentally was successfully performed. A review of the literature showed a significant burden of morbidity and mortality associated with obturator hernias. Laparoscopic mesh repair has been previously shown to be a safe therapeutic modality. Small bowel obstruction and leg pain in a thin elderly lady should arouse suspicion for an incarcerated obturator hernia. Laparoscopic management of an incarcerated obturator hernia is a feasible and safe therapeutic option. PMID:24964456

  14. Perforated sigmoid diverticulitis in a lumbar hernia after iliac crest bone graft - a case report

    PubMed Central

    2014-01-01

    Background The combination of perforated diverticulitis in a lumbar hernia constitutes an extremely rare condition. Case presentation We report a case of a 66 year old Caucasian woman presenting with perforated sigmoid diverticulitis localized in a lumbar hernia following iliac crest bone graft performed 18 years ago. Emergency treatment consisted of laparoscopic peritoneal lavage. Elective sigmoid resection was scheduled four months later. At the same time a laparoscopic hernia repair with a biologic mesh graft was performed. Conclusion This case shows a very seldom clinical presentation of lumbar hernia. Secondary colonic resection and concurrent hernia repair with a biologic implant have proven useful in treating this rare condition. PMID:25051974

  15. Biomechanical evaluation of three fixation modalities for preperitoneal inguinal hernia repair: a 24-hour postoperative study in pigs

    PubMed Central

    Guérin, Gaëtan; Bourges, Xavier; Turquier, Frédéric

    2014-01-01

    Purpose Tacks and sutures ensure a strong fixation of meshes, but they can be associated with pain and discomfort. Less invasive methods are now available. Three fixation modalities were compared: the ProGrip™ laparoscopic self-fixating mesh; the fibrin glue Tisseel™ with Bard™ Soft Mesh; and the SorbaFix™ absorbable fixation system with Bard™ Soft Mesh. Materials and methods Meshes (6 cm ×6 cm) were implanted in the preperitoneal space of swine. Samples were explanted 24 hours after surgery. Centered defects were created, and samples (either ten or eleven per fixation type) were loaded in a pressure chamber. For each sample, the pressure, the mesh displacement through the defect, and the measurements of the contact area were recorded. Results At all pressures tested, the ProGrip™ laparoscopic self-fixating mesh both exhibited a significantly lower displacement through the defect and retained a significantly higher percentage of its initial contact area than either the Bard™ Soft Mesh with Tisseel™ system or the Bard™ Soft Mesh with SorbaFix™ absorbable fixation system. Dislocations occurred with the Bard™ Soft Mesh with Tisseel™ system and with the Bard™ Soft Mesh with SorbaFix™ absorbable fixation system at physiological pressure (,225 mmHg). No dislocation was recorded for the ProGrip™ laparoscopic self-fixating mesh. Conclusion At 24 hours after implantation, the mechanical fixation of the ProGrip™ laparoscopic self-fixating mesh was found to be significantly better than the fixation of the Tisseel™ system or the SorbaFix™ absorbable fixation system. PMID:25525396

  16. Tennis elbow surgery - discharge

    MedlinePLUS

    ... surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... had surgery to repair a tendon in your elbow . The surgeon made a cut (incision) over the ...

  17. Comparison of contracture, adhesion, tissue ingrowth, and histologic response characteristics of permanent and absorbable barrier meshes in a porcine model of laparoscopic ventral hernia repair

    Microsoft Academic Search

    C. R. Deeken; B. D. Matthews

    Purpose  The objective of this study was to determine the mesh contracture, adhesion, tissue ingrowth, and histologic characteristics\\u000a of a novel absorbable barrier mesh (Ventrio™ ST Hernia Patch) compared to existing permanent (Ventrio™ Hernia Patch) and absorbable barrier meshes (Sepramesh™ IP Composite and PROCEED™ Surgical Mesh).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Standard laparoscopic technique was utilized to bilaterally implant meshes in 20 female Yorkshire pigs (n = 5

  18. Possibilities and limits in the treatment of congenital diaphragmatic hernia

    PubMed Central

    Georgescu, R; Chiu?u, L; Neme?, R; Georgescu, I; Stoica, A; Georgescu, E

    2014-01-01

    Abstract Aim: to establish a therapeutic strategy that will improve the prognosis and increase the survival rate in congenital diaphragmatic hernia. Material and method: 14 congenital diaphragmatic hernias (incidence 1/1597 live births, 12 boys and 2 girls with a sex ratio of 6/1, 10 term infants and 4 preterm first degree, 11 natural births and 3 by caesarean section) admitted to the Clinic of Pediatric Surgery Craiova, in a 5-year period (2007-2012), were analyzed from the therapeutic point of view. The "tension free" primary suture was the main surgical procedure to repair the diaphragmatic defect in all cases, preceded by a period of preoperative resuscitation and stabilization (2.8 days on average). Results: We registered a survival rate of 64.29% and a postoperative mortality rate of 35.71%. Conclusions: delayed surgery preceded by a period of the preoperative respiratory resuscitation and stabilization (24-72 hours on average) significantly reduced postoperative mortality and increased the survival rate. PMID:25408771

  19. The treatment of breast cancer in one day surgery. A four year experience.

    PubMed

    Tirone, Andrea; Cesaretti, Manuela; Vuolo, Giuseppe; Gaggelli, Ilaria; Guarnieri, Alfredo; Piccolomini, Alessandro; Verre, Luigi; Savelli, Vinno; Varrone, Fabrizio; D'Onofrio, Pasquale; Di Bella, Caterina; Carli, Antonio Ferdinando

    2013-01-01

    The number of short-stay surgery procedures has progressively increased since the concept of short-stay surgery was first introduced. Initially this type of surgery was reserved for patients undergoing inguinal hernia repair, proctological surgery, and various minor procedures. Careful patient selection makes it possible to apply one-day surgery to other surgical specialties including breast cancer surgery. Reducing the length of hospital stay lowers health care costs, and shortens waiting lists. The most important benefits for patients are a more rapid return to work and positive psychological effects. Exclusion criteria for one-day surgery are the lack of home care, excessive distance from place of treatment and the presence of any concomitant pathology that is a contraindication to this type of surgery. We report our experience in oncological surgery of the breast in one-day surgery. PMID:23698193

  20. Transabdominal Approach in the Surgical Management of Morgagni Hernia

    Microsoft Academic Search

    Mehmet Yilmaz; Burak Isik; Sacit Coban; Gokhan Sogutlu; Cengiz Ara; Vedat Kirimlioglu; Sezai Yilmaz; Cuneyt Kayaalp

    2007-01-01

    Purpose  Morgagni hernias are uncommon diaphragmatic hernias that are generally asymptomatic, and so far only limited data have been\\u000a reported. The objective of this retrospective study was to evaluate the outcome of patients presenting with a complicated\\u000a Morgagni hernia and who undergo a transabdominal repair.\\u000a \\u000a \\u000a \\u000a Methods  Between September 1999 and October 2005, 11 patients with Morgagni hernia were operated on in our

  1. Thoracic endovascular aortic repair versus open surgery for type-B chronic dissection.

    PubMed

    Roselli, Eric E

    2015-02-01

    An aging population, increased awareness, high-resolution imaging, and improving access to care all mean that more people are being diagnosed with acute aortic dissection. A better understanding of the role of initial medical therapy, improved surgical techniques, and the addition of endovascular approaches to the treatment algorithm, have resulted in more patients surviving the acute phase of disease. During the chronic phase, patients with residual dissection are challenged by the competing risks of reoperation or death. Open repair for chronic type-B dissection can be performed safely but is a relatively morbid operation. For this reason, surgery is often postponed until patients develop very late complications. Despite encouraging results for thoracic endovascular aortic repair of acute type-B dissection, chronic type-B dissection poses unique challenges that make application of endovascular technology more difficult. As our understanding of the disease and its natural history evolves, the ways in which these 2 methods of treatment complement each other need to be better understood. The benefits and limitations of each therapy, and how and when to apply each in the setting of chronic distal dissection, are discussed. PMID:25726076

  2. Amyand hernia with appendicitis

    PubMed Central

    Yagnik, Vipul D.

    2011-01-01

    The term Amyand hernia refers to presence of appendix within inguinal hernia. The incidence of having a normal appendix within inguinal hernia is about 1%, whereas the finding of appendicitis in the inguinal hernia is only 0.1%. PMID:24765286

  3. Fatal Diaphragmatic Hernia following Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report and Literature Review

    PubMed Central

    Saito, Tomoko; Chiba, Tetsuhiro; Ogasawara, Sadahisa; Inoue, Masanori; Wakamatsu, Toru; Motoyama, Tenyu; Kanogawa, Naoya; Suzuki, Eiichiro; Ooka, Yoshihiko; Tawada, Akinobu; Matsubara, Hisahiro; Yokosuka, Osamu

    2015-01-01

    An 81-year-old man was admitted to our hospital because of right quadrant abdominal pain. On admission, his liver function was Child-Pugh grade C (10 points). Computed tomography (CT) revealed a diaphragmatic herniation of bowel loops into the right thoracic cavity, accompanied by pleural effusion. Although diaphragmatic hernia was successfully repaired by emergency surgery, he died of liver failure 23 days after the surgery. A retrospective reading of CT images revealed the presence of diaphragmatic injury after radiofrequency ablation (RFA) which had been conducted 33 months before the development of diaphragmatic hernia. Of importance, the lesion of the diaphragmatic injury was located on the estimated needle track of RFA for hepatocellular carcinomas in segment 5 and segment 5/8, but not adjacent to their ablation areas. Subsequently, diaphragmatic perforation had been observed 24 months before admission. This suggests that diaphragmatic hernia caused by RFA is not necessarily due to thermal damage of ablation and is possibly life-threatening, at least in some patients with an impaired liver function.

  4. Intrathoracic gastric perforation: a late complication of an unknown postpartum recurrent hiatal hernia.

    PubMed

    Lococo, Filippo; Cesario, Alfredo; Meacci, Elisa; Granone, Pierluigi

    2012-08-01

    Diaphragmatic hernias occurring during pregnancy are an uncommon event. In very rare occasions, the clinical situation can suddenly worsen due to obstruction, torsion or infarction of the herniated viscera. Here, we describe a challenging case of a post-partum diaphragmatic hiatus hernia complicated by intrathoracic gastric perforation. A 23-year old woman was admitted at our hospital with a syndrome characterized by epigastralgy, dyspnoea and fever. She had previously undergone a laparoscopic antireflux surgery for hiatus hernia (6 years before) and a recent (4 months) unremarkable vaginal delivery. Due to the persistence of a pelvic pain after the delivery, she had been taking pain-killers as a self-administered medication. A CT scan showed a massive left pleural effusion and a complete herniation of the stomach into the left hemithorax. After placing a chest drainage and removing up to 3000 ml of brownish purulent fluid, a repeat CT scan (with water soluble contrast swallow) showed a leak at the level of the stomach. At surgery, we observed a complete intrathoracic herniation through a large diaphragmatic hiatal defect and a small well-defined gastric ulcer. A primary repair of both the stomach and the diaphragm was performed. We take the opportunity presented by this report to briefly discuss the patho-physiological mechanisms underlying this unusual complication. PMID:22611183

  5. Fatal Diaphragmatic Hernia following Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report and Literature Review.

    PubMed

    Saito, Tomoko; Chiba, Tetsuhiro; Ogasawara, Sadahisa; Inoue, Masanori; Wakamatsu, Toru; Motoyama, Tenyu; Kanogawa, Naoya; Suzuki, Eiichiro; Ooka, Yoshihiko; Tawada, Akinobu; Matsubara, Hisahiro; Yokosuka, Osamu

    2015-01-01

    An 81-year-old man was admitted to our hospital because of right quadrant abdominal pain. On admission, his liver function was Child-Pugh grade C (10 points). Computed tomography (CT) revealed a diaphragmatic herniation of bowel loops into the right thoracic cavity, accompanied by pleural effusion. Although diaphragmatic hernia was successfully repaired by emergency surgery, he died of liver failure 23 days after the surgery. A retrospective reading of CT images revealed the presence of diaphragmatic injury after radiofrequency ablation (RFA) which had been conducted 33 months before the development of diaphragmatic hernia. Of importance, the lesion of the diaphragmatic injury was located on the estimated needle track of RFA for hepatocellular carcinomas in segment 5 and segment 5/8, but not adjacent to their ablation areas. Subsequently, diaphragmatic perforation had been observed 24 months before admission. This suggests that diaphragmatic hernia caused by RFA is not necessarily due to thermal damage of ablation and is possibly life-threatening, at least in some patients with an impaired liver function. PMID:26120308

  6. Spontaneous rupture of umbilical hernia in pregnancy: a case report.

    PubMed

    Ahmed, Adamu; Stephen, Garba; Ukwenya, Yahaya

    2011-07-01

    A 28 year old woman presented with a spontaneous rupture of an umbilical hernia in her seventh month of pregnancy. She had four previous unsupervised normal deliveries. There was no history of trauma or application of herbal medicine on the hernia. The hernia sac ruptured at the inferior surface where it was attached to the ulcerated and damaged overlying skin. There was a gangrenous eviscerated small bowel. The patient was resuscitated and the gangrenous small bowel was resected and end to end anastomosis done. The hernia sac was excised and the 12 cm defect repaired. Six weeks later, she had spontaneous vaginal delivery of a live baby. We advocate that large umbilical hernias should be routinely repaired when seen in women of child bearing age. PMID:22043438

  7. Colonic carcinoma presenting as strangulated inguinal hernia: report of two cases and review of the literature.

    PubMed

    Slater, R; Amatya, U; Shorthouse, A J

    2008-09-01

    Inguinal hernia and colonic carcinoma are common surgical conditions, yet carcinoma of the colon occurring within an inguinal hernia sac is rare. Of 25 reported cases, only one was a perforated sigmoid colon carcinoma in an inguinal hernia. We report two cases of sigmoid colon carcinoma, one of which had locally perforated. Each presented within a strangulated inguinal hernia. Oncologically correct surgery in these patients presents a technical challenge. PMID:18798013

  8. Mesh Or Patch for Hernia on Epigastric and Umbilical Sites (MORPHEUS trial): study protocol for a multi-centre patient blinded randomized controlled trial

    PubMed Central

    2014-01-01

    Background Evidence is accumulating that, similar to other ventral hernias, umbilical and epigastric hernias must be mesh repaired. The difficulties involved in mesh placement and in mesh-related complications could be the reason many small abdominal hernias are still primary closed. In laparoscopic repair, a mesh is placed intraperitoneally, while the most common procedure is open surgery is pre-peritoneal mesh placement. A recently developed alternative method is the so-called patch repair, in this approach a mesh can be placed intraperitoneally through open surgery. In theory, such patches are particularly suitable for small hernias due to a reduction in the required dissection. This simple procedure is described in several studies. It is still unclear whether this new approach is associated with an equal risk of recurrence and complications compared with pre-peritoneal meshes. The material of the patch is in direct contact with intra-abdominal organs, it is unknown if this leads to more complications. On the other hand, the smaller dissection in the pre-peritoneal plane may lead to a reduction in wound complications. Methods/Design 346 patients suffering from an umbilical or epigastric hernia will be included in a multi-centre patient-blinded trial, comparing mesh repair with patch repair. Randomisation will take place for the two operation techniques. The two devices investigated are a flat pre-peritoneal mesh and a Proceed Ventral Patch®. Stratification will occur per centre. Post-operative evaluation will take place after 1, 3, 12 and 24 months. The number of complications requiring treatment is the primary endpoint. Secondary endpoints are Verbal Descriptor Scale (VDS) pain score and VDS cosmetic score, operation duration, recurrence and costs. An intention to treat analysis will be performed. Discussion This trial is one of the first in its kind, to compare different mesh devices in a randomized controlled setting. The results will help to evaluate mesh repair for epigastric an umbilical hernia, and find a surgical method that minimizes the complication rate. Trial registration Netherlands Trail Registration (NTR) www.trialregister.nl 2010 NTR2514 NL33995.060.10 PMID:24884770

  9. Eye muscle repair - discharge

    MedlinePLUS

    ... Lazy eye repair - discharge; Strabismus repair - discharge; Extraocular muscle surgery - discharge ... You or your child had eye muscle repair surgery to correct eye muscle ... term for crossed eyes is strabismus. Children most often ...

  10. Management of acute paraesophageal hernia

    Microsoft Academic Search

    Mohammed Bawahab; Philip Mitchell; Neal Church; Estifanos Debru

    2009-01-01

    Background  Acute paraesophageal hernia is a surgical emergency presenting with sudden chest or abdominal pain, dysphagia, vomiting, retching\\u000a or significant anemia. Severe cases can present with respiratory failure or systemic sepsis. This can be due to gastric volvulus,\\u000a incarceration, strangulation, severe bleeding or perforation. Traditionally this has been treated with an open surgery. The\\u000a purpose of this study is to develop

  11. Iliac crest bone graft donor site hernia: not so uncommon

    PubMed Central

    Prabhu, Raghunath; Kumar, Nawin; Shenoy, Rajgopal

    2013-01-01

    A 73-year-old man, who had undergone fracture fixation of humerus with LCP plating and bone grafting, presented again with a peri-implant fracture after 1?year. A repeat surgery was contemplated and replating was performed with tricortical bone graft harvested from the iliac crest. In the postoperative period the patient developed a tender swelling at the graft site with nausea and abdominal discomfort. It was managed conservatively thinking it to be a haematoma at the graft site. In the following 2?days his symptoms worsened. A CT abdomen showed the herniation of caecum from the bone graft donor site with obstruction. The patient was taken up for emergency surgical repair, the caecum was reduced and polypropylene mesh hernioplasty was performed. The patient recovered well without recurrence in the follow-up period. Iliac crest bone graft site hernia is not so uncommon and care has to be taken while harvesting. PMID:23761618

  12. Paraesophageal hernia.

    PubMed

    Oleynikov, Dmitry; Jolley, Jennifer M

    2015-06-01

    The treatment of PEHs is challenging. They tend to occur in patients in their 60s and 70s with multiple medical problems and a variety of associated symptoms. Detailed preoperative evaluation is crucial to determining a safe and effective strategy for repair in the operating room. Laparoscopic PEH repair has shown to be advantageous compared with conventional open repair with regard to hospital stay, recovery time, and decreased complications. Although some results indicate there are higher recurrence rates in laparoscopic PEH repair, the clinical significance of these recurrences has not yet been determined. In order to maximize the efficacy of this procedure, modifications have emerged, such as performing a fundoplication and using an absorbable mesh onlay to reinforce the cruroplasty. Althoughmoreprospective, randomized studies are needed to support the superior results of these surgical adjuncts, laparoscopic PEH repair with an antireflux procedure and absorbable mesh should be the current standard of care. PMID:25965129

  13. Gastroschisis repair

    MedlinePLUS

    Abdominal wall defect repair ... back into the belly. The opening in the wall of the belly will be repaired, if possible. ... after surgery. Inflammation of tissues that line the wall of the abdomen and cover the abdominal organs ...

  14. Metastatic ovarian carcinoma presenting as an incarcerated femoral hernia

    PubMed Central

    Beecher, Suzanne M.; O’Leary, Donal Peter; McLaughlin, Ray

    2015-01-01

    Introduction Incarcerated femoral hernias usually contain a simple loop of bowel. Occasionally other abdominal structures may be found within the hernial sac. Rarely femoral hernias may contain metastatic tumour deposits. Presentation of case We report the case of an 82 year old lady with a background of ovarian carcinoma, who presented with acute small bowel obstruction and an irreducible right groin mass. CT imaging revealed an incarcerated loop of small bowel within a femoral hernia sac. The patient proceeded to theatre for hernia repair. Upon opening the hernial sac an adherent incarcerated small bowel loop was discovered. Interestingly, the sac itself was lined with metastatic deposits, which were later histologically proven to be ovarian in origin. The sac was reduced and the hernia was repaired. The patient’s post-operative course was uneventful. Discussion As abdominal wall hernias communicate with the abdominal cavity there is the potential for malignant cells to seed the peritoneal lining of the hernia sac. If the sac also contains bowel wall, this may become involved in the tumour mass. This may result in small bowel incarceration & obstruction. Conclusion In cases, where there is a known intra-abdominal malignancy & the presence of an incarcerated hernia, there should be a high index of suspicion for the presence of tumour within the hernial contents. PMID:25931301

  15. A novel suture technique for distal aorta-graft anastomosis in aortic aneurysm repair surgery: diagonal basting stitch.

    PubMed

    Cagli, Kerim; Cicek, Omer Faruk; Lafci, Gokhan

    2015-05-01

    We describe a novel suture technique of distal anastomosis between the graft and the aorta in ascending aortic aneurysm repair surgery. In this technique, the aortic graft is positioned inside the distal aortic lumen with an overlapping segment and circumferential or back wall part only diagonal basting stitches are performed without use of Teflon pledgets, strips, or bioadhesives. This new technique establishes a secure anastomosis line, shortens anastomosis time, and avoids the use of foreign materials. PMID:25733219

  16. A peculiar variety of indirect inguinal hernia (juxtacordal indirect inguinal hernia)

    PubMed Central

    Alkhateeb, Harith M.; Aljanabi, Thaer J.

    2015-01-01

    Background Indirect inguinal hernias are usually congenital, forming a sac in the core of the spermatic cord covered by the internal spermatic, cremasteric, and external spermatic fasciae1?3. Direct inguinal hernias are acquired; the sac lies beside/behind the cord1?3. A rare third type is a combination of indirect and direct sacs on both sides of inferior epigastric vessels1?3. We describe a rare fourth type, juxtacordal indirect oblique inguinal hernia (Fig. 1), in which the sac emerges through a weakness in the deep inguinal ring, lateral to inferior epigastric vessels, and passes into the inguinal canal beside and in contact with the cord but outside of its covering fasciae. Objective Describes a very rare variety of inguinal hernia. Design Case reports. Setting Tikrit Teaching Hospital/Salahuddin/Iraq. Participants: and presentation The first case; a 5-year-old male with right inguinal hernia, the second case; a 25-year-old man with right inguinal hernia, the third case; a 60-year-old man with right inguinal hernia. Interventions Surgery has been done electively for all. Results and discussion Because the sac emerges through the deep inguinal ring and passes through the inguinal canal, it is an indirect type and because it passes beside the spermatic cord we call it juxtacordal hernia. Because of the thick extraperitoneal fat layer over the sac, we think this hernia is acquired. Conclusions Knowing this type of hernia might reduce the risk of inferior epigastric vessels injury and lower the rate of recurrence. PMID:26052435

  17. Totally extraperitoneal endoscopic (TEP) treatment of sportsman's hernia.

    PubMed

    Paajanen, Hannu; Syvähuoko, Ismo; Airo, Ilari

    2004-08-01

    Sportsman's hernia is a term used to describe a weakness or disruption of is a term used to describe the musculotendinous part of the posterior inguinal wall, which causes persistent groin pain in athletes. A video-assisted placement of extraperitoneal synthetic mesh to support the damaged area may heal this injury. Forty-one male athletes at an elite level (mean age 27 +/- 7.1 years) with chronic groin pain, which was resistant to conservative therapy, were referred to surgery by sports clinics or club doctors. The majority of the patients were soccer (58%) or ice hockey players (27%) at a professional level. A 10 x 15 cm polypropylene mesh was placed into the preperitoneal space using a totally extraperitoneal video-assisted technique. The severity of pain, and the time to return to sports, were determined after 1 month and after the mean follow-up of 4 years. On operation, no macroscopic abnormality was found in 24 patients (58%), obvious musculotendinous tear was present in 10 patients, and muscle asymmetry was present in 7 patients. All except 2 patients (95%) returned to their sport activities after 1 month of convalescence. No immediate or long-term complications were associated with the operation. The placement of a retropubic mesh was safe and a mini-invasive method to repair sportsman's hernia and chronic groin pain of athletes. PMID:15472551

  18. Fast Absorbing Gut Suture versus Cyanoacrylate Tissue Adhesive in the Epidermal Closure of Linear Repairs Following Mohs Micrographic Surgery

    PubMed Central

    Kim, June; Cool, Alicia J.; Hanlon, Allison M.; Leffell, David J.

    2015-01-01

    Background: Cyanoacrylate topical adhesives and fast absorbing gut sutures are increasingly utilized by dermatologic surgeons as they provide satisfactory surgical outcomes while eliminating an additional patient visit for suture removal. To date, no head-to-head studies have compared the wound healing characteristics of these epidermal closure techniques in the repair of facial wounds after Mohs micrographic surgery. Objective: To compare the cosmetic outcome of epidermal closure by cyanoacrylate topical adhesive with fast absorbing gut suture in linear repairs of the face following Mohs micrographic surgery. Methods: Fourteen patients with wound length greater than 3cm who underwent Mohs micrographic surgery for nonmelanoma skin cancer of the face were enrolled in this randomized right-left comparative study. Following placement of dermal sutures, half of the wound was randomly selected for closure with cyanoacrylate and the contralateral side with fast absorbing gut suture. Using photographs from the three-month postoperative visit, six blinded individuals rated the overall cosmetic outcome. Results: The present study shows no significant difference in cosmetic outcomes between cyanoacrylate and fast absorbing gut suture for closure of linear facial wounds resulting from Mohs micrographic surgery. Cyanoacrylate tissue adhesive may not be as effective in achieving optimal cosmesis for wounds on the forehead or of longer repair lengths. The majority of patients did not have a preference for wound closure techniques, but when a preference was given, cyanoacrylate was significantly favored over sutures. Conclusion: Cyanoacrylate tissue adhesive and fast absorbing gut suture both result in comparable aesthetic outcomes for epidermal closure of linear facial wounds following Mohs micrographic surgery. Consideration should be given to factors such as need for eversion, hemostasis, and wound tension when selecting an epidermal wound closure method. (ClinicalTrials.gov, Identifier: NCT01298167, http://clinicaltrials.gov/show/NCT01298167). PMID:25741400

  19. ABDOMINAL INCISIONS IN GENERAL SURGERY: A REVIEW

    PubMed Central

    2007-01-01

    There is this wrong notion that the only standard abdominal incision is the midline incision. Cases have been seen in which an abdominal incision extends from the xyphoid process to the symphysis pubis just to remove a perforated appendix! It is also not unusual to see a groin incision together with a lower abdominal incision for an obstructed inguinal hernia repair that “slipped” back into the abdominal cavity during preparation for surgery. Even though the trend nowadays in surgery is to opt for laparoscopic and mini-incision surgery, the basic rule in surgery is to have an incision that will be comfortable for the surgeon and provide adequate access to the area of pathology. PMID:25161434

  20. Myocardial perfusion abnormalities in patients occurring more than 1 year after successful univentricular (Fontan surgery) and biventricular repair (complete repair of tetralogy of Fallot).

    PubMed

    Priyadarshini, A; Saxena, Anita; Patel, Chetan; Paul, Vinod K; Lodha, Rakesh; Airan, Balram

    2013-04-01

    The outcome of children born with cyanotic congenital heart disease has markedly improved over the years. Follow up is recommended for most post-operated cases as complications may occur over long term. One of the complications is the development of ventricular dysfunction, often seen after a successful Fontan surgery (or one of its modifications) for single ventricle. The aim of this study was to determine the prevalence of myocardial perfusion abnormalities in the ventricular myocardium of asymptomatic patients, older than 8 years of age, who had earlier undergone either a univentricular palliation (modified Fontan procedure) or a biventricular repair for tetralogy of Fallot, more than a year ago. All eligible patients underwent screening electrocardiogram (to rule out rhythm disturbance) and echocardiography. Patients with ventricular ejection fraction of more than 50 % by echocardiography were included. Enrolled patients were subjected to gated stress-rest myocardial perfusion imaging using Technitium-99m tetrofosmin single photon emission-computerized tomography (SPECT). Ventricular ejection fraction was also calculated from gated rest study. For the Fontan group, we also analyzed data to see if the morphology of the systemic ventricle would make a difference as far as myocardial perfusion was concerned. Twenty-six patients were enrolled (11 had undergone Fontan surgery and 15 had complete repair of tetralogy of Fallot). Seven of 11 patients in the Fontan group had myocardial perfusion defects (63.6 %) as against none in the repaired tetralogy of Fallot group (p < 0.001). The ejection fraction was within normal range in both the groups; it was statistically higher in the post tetralogy of Fallot repair group (p < 0.04). There were two subgroups in the post Fontan group depending on the morphology of systemic ventricle-left (4 patients) and non-left (7 patients). Higher number and larger size of perfusion defects were present in the non-left ventricular systemic ventricle morphology as compared with left ventricular morphology, but this difference did not reach statistical significance. Myocardial perfusion defects are common in patients who have undergone univentricular repair more than one year ago in contrast to patients who had a biventricular repair for tetralogy of Fallot. In the Fontan group, the morphology of the systemic ventricle was not predictive of prevalence of perfusion defect. PMID:23064840

  1. Adult right-sided Bochdalek hernia with ileo-cecal appendix: Almeida-Reis hernia

    PubMed Central

    Costa Almeida, C.E.; Reis, Luis S.; Almeida, Carlos M. Costa

    2013-01-01

    INTRODUCTION Bochdalek hernia is one of the most common congenital abnormalities manifested in infants. In the adult is a rarity, with a prevalence of 0.17–6% of all diaphragmatic hernias. Right-sided Bochdalek hernias containing colon are even more rare, with no case described in the literature with ileo-cecal appendix. PRESENTATION OF CASE The authors present a case of a right-sided Bochdalek hernia in an adult female of 49 years old, presented with severe respiratory failure. During laparotomy for hernia correction, were found in an intrathoracic position the cecum and ileo-cecal appendix, the right colon and the transverse colon. DISCUSSION Although useful in patient evaluation, clinical history and physical examination are not helpful in making diagnosis because of their nonspecific character. CT scan is the most accurate exam for making diagnosis. Most of the times there is no hernial sac. Surgery is the treatment of choice, and it is always indicated even if asymptomatic. In general suture of the defect is possible. Due to patient's weak respiratory function we chose laparotomy by Kocher incision. CONCLUSION Being the first case of a right-sided Bochdalek hernia in the adult with a herniated ileo-cecal appendix, we name it Almeida-Reis hernia. PMID:23872263

  2. Establishment of a Clinically Relevant Ex Vivo Mock Cataract Surgery Model for Investigating Epithelial Wound Repair in a Native Microenvironment.

    PubMed

    Walker, Janice L; Bleaken, Brigid M; Wolff, Iris M; Menko, A Sue

    2015-01-01

    The major impediment to understanding how an epithelial tissue executes wound repair is the limited availability of models in which it is possible to follow and manipulate the wound response ex vivo in an environment that closely mimics that of epithelial tissue injury in vivo. This issue was addressed by creating a clinically relevant epithelial ex vivo injury-repair model based on cataract surgery. In this culture model, the response of the lens epithelium to wounding can be followed live in the cells' native microenvironment, and the molecular mediators of wound repair easily manipulated during the repair process. To prepare the cultures, lenses are removed from the eye and a small incision is made in the anterior of the lens from which the inner mass of lens fiber cells is removed. This procedure creates a circular wound on the posterior lens capsule, the thick basement membrane that surrounds the lens. This wound area where the fiber cells were attached is located just adjacent to a continuous monolayer of lens epithelial cells that remains linked to the lens capsule during the surgical procedure. The wounded epithelium, the cell type from which fiber cells are derived during development, responds to the injury of fiber cell removal by moving collectively across the wound area, led by a population of vimentin-rich repair cells whose mesenchymal progenitors are endogenous to the lens(1). These properties are typical of a normal epithelial wound healing response. In this model, as in vivo, wound repair is dependent on signals supplied by the endogenous environment that is uniquely maintained in this ex vivo culture system, providing an ideal opportunity for discovery of the mechanisms that regulate repair of an epithelium following wounding. PMID:26132117

  3. Medical and regenerative solutions for congenital diaphragmatic hernia: a perinatal perspective.

    PubMed

    Deprest, Jan; Gucciardo, Leonardo; Eastwood, Patrice; Zia, Silvia; Jimenez, Julio; Russo, Francesca; Lesage, Flore; Lewi, Liesbeth; Sampaolesi, Maurilio; Toelen, Jaan

    2014-06-01

    In the EU-27, 2,100 babies with congenital diaphragmatic hernia (CDH) are born annually. CDH is fatal in 30% of them. Experimental fetal surgery in severe cases results in a survival rate of 50 to 60% at its best. Failure is due to insufficient lung growth, persistent pulmonary hypertension or prematurity induced by the procedure. For nonsurvivors alternative strategies are required. Survivors undergo anatomical repair, but large diaphragmatic defects are closed using a patch. At present the used materials are less than ideal, mainly because of recurrence and chest deformation. To overcome the above limitations, alternative medical therapies (pharmacologic or cell therapy) that are more potent and less invasive are needed. Also a more functional postnatal repair may be possible when using novel scaffolds or engineered constructs. We see a prominent place for autologous amniotic fluid-derived stem cells for these novel strategies, which could be prenatally harvested following appropriate patient selection by noninvasive imaging. PMID:24937193

  4. Acquired Abdominal Intercostal Hernia: A Case Report and Literature Review

    PubMed Central

    Tripodi, Giuseppe

    2014-01-01

    Acquired abdominal intercostal hernia (AAIH) is a rare disease phenomenon where intra-abdominal contents reach the intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. We discuss a case of a 51-year-old obese female who arrived to the emergency room with a painful swelling between her left 10th rib and 11th rib. She gave a history of a stab wound to the area 15 years earlier. A CT scan revealed a fat containing intercostal hernia with no diaphragmatic defect. An open operative approach with a hernia patch was used to repair this hernia. These hernias are difficult to diagnose, so a high clinical suspicion and thorough history and physical exam are important. This review discusses pathogenesis, clinical presentation, complications, and appropriate treatment strategies of AAIH. PMID:25197605

  5. Erosion and perforation of colon by synthetic mesh in a recurrent paracolostomy hernia

    Microsoft Academic Search

    A. Aldridge; J. Simson

    2001-01-01

    .   Parastomal hernia, particularly when recurrent, presents a troublesome problem to the surgeon. Since the late 1970s, prosthetic-mesh\\u000a repairs have been used increasingly, though, as yet, there is no consensus on the best technique of repair. We report a case\\u000a of failure of a polypropylene-mesh repair of a recurrent parastomal hernia, complicated by erosion of the mesh edge into the

  6. Relationship Between Hiatal Hernia and Inguinal Hernia

    Microsoft Academic Search

    Leonardo De Luca; Pietro Di Giorgio; Giuseppe Signoriello; Enrico Sorrentino; Giuseppe Rivellini; Emilia D' Amore; Bruno De Luca; Joseph A. Murray

    2004-01-01

    Several theories explain the development of hiatal hernia (HH). Since inguinal hernia (IH) is due to abdominal wall herniation, we hypothesized that if HH is caused by an excessive “push” from increased intraabdominal pressure, there would be a greater than chance association between HH and IH. The aim of this prospective case–control study was to determine the relationship between HH,

  7. Massive paraumbilical hernia: not all is as it seems.

    PubMed

    Chisholm, J; Dean, N R

    2011-06-01

    We discuss the management of an otherwise healthy obese patient who presented with a massive paraumbilical hernia extending into a large lymphoedematous abdominal apron. After anaesthetic assessment and abdominal computed tomography (CT), the patient underwent an elective operation. The hernia was dissected free of the heavy lymphoedematous apron with the aid of orthopaedic pins and a motorised patient lifter. Despite the size of the hernia, the primary defect was found to be relatively small and easy to reduce. The defect was repaired with a sublay Proceed(®) mesh and skin closure was achieved primarily. The patient had an uneventful post-operative course and gained significant improvement in her mobility. PMID:20221840

  8. Hiatal hernia in a harbor seal (Phoca vitulina) pup.

    PubMed

    Biancani, Barbara; Field, Cara L; Dennison, Sophie; Pulver, Robert; Tuttle, Allison D

    2012-06-01

    A 2-wk-old stranded harbor seal (Phoca vitulina) rescued by Mystic Aquarium showed signs of the presence of a hiatal hernia during rehabilitation. Contrast radiographs of esophagus and stomach revealed an intrathoracic radiodensity that contains filling defects typical of stomach, consistent with gastric rugal folds. Mural thickening was observed at the level of the cardia consistent with a diagnosis of a hiatal hernia. Although clinical improvement was noted with medical therapy and tube feeding, surgical correction of the hiatal hernia was considered necessary for full resolution. However, owing to the animal's low body weight, the corrective hernia surgery was postponed until the body condition improved. The seal needed to be surgically treated for a corneal ulcer, and while anesthetized with isoflurane, the seal became dyspneic and developed cardiac arrhythmias; ultimately cardiac arrest ensued. Resuscitation was unsuccessfully attempted and the seal was euthanized. Necropsy confirmed the radiographic diagnosis and further characterized a paraesophageal hiatal hernia. PMID:22779241

  9. [Life with hiatal hernias and reflux disease. An historical synthesis and an update].

    PubMed

    Rossetti, M

    1993-01-01

    By long experience with the problems on hiatal hernias and reflux the author summarizes and analyzes errors and progress in development, interpretation, diagnostic methods and treatment. After the pioneer work done by Akerlund 1926 the hiatal hernia was a sometimes dangerous surgical target. It remained for a long time a gastroenterological prima donna, responsible of all sorts of symptoms. Thoracal or abdominal approach and repair were high risk procedures with logically bad results. After a long way of mistakes and researches hiatal hernias remain a concomitant factor of reflux disease and an important cause of mechanical complications and anemia by para-oesophageal and mixed forms. The studies about pathogenesis and consequences of the reflux are extensive and important in the second half of our century. The treatment of reflux disease was for a long time preponderantly surgical, since 1970 increasingly pharmacological. By critical review of many methods and technics the author describes the birth of fundoplication 1955, the standard procedure with the anterior wall, and analyzes the actual indications despite the long list of efficient drugs. The mixed or para-oesophageal forms of hiatal hernia remain always a surgical problem. The method of choice is here a double gastropexy with fundoplication after regulated partial closure of the big hiatus communis by abdominal approach. The choice of the surgical procedure and the quality of results depend of the school and competence of the surgeon. The rarity of the indication to surgery (nowadays between conventional and, perhaps, mini invasive possibilities) is a problem for the training-program of the young surgeons of the new generation. PMID:8109810

  10. Characterization of the Mechanical Strength, Resorption Properties, and Histologic Characteristics of a Fully Absorbable Material (Poly-4-hydroxybutyrate—PHASIX Mesh) in a Porcine Model of Hernia Repair

    PubMed Central

    Deeken, Corey R.; Matthews, Brent D.

    2013-01-01

    Purpose. Poly-4-hydroxybutyrate (P4HB) is a naturally derived, absorbable polymer. P4HB has been manufactured into PHASIX Mesh and P4HB Plug designs for soft tissue repair. The objective of this study was to evaluate mechanical strength, resorption properties, and histologic characteristics in a porcine model. Methods. Bilateral defects were created in the abdominal wall of n = 20 Yucatan minipigs and repaired in a bridged fashion with PHASIX Mesh or P4HB Plug fixated with SorbaFix or permanent suture, respectively. Mechanical strength, resorption properties, and histologic characteristics were evaluated at 6, 12, 26, and 52 weeks (n = 5 each). Results. PHASIX Mesh and P4HB Plug repairs exhibited similar burst strength, stiffness, and molecular weight at all time points, with no significant differences detected between the two devices (P > 0.05). PHASIX Mesh and P4HB Plug repairs also demonstrated significantly greater burst strength and stiffness than native abdominal wall at all time points (P < 0.05), and material resorption increased significantly over time (P < 0.001). Inflammatory infiltrates were mononuclear, and both devices exhibited mild to moderate granulation tissue/vascularization. Conclusions. PHASIX Mesh and P4HB Plug demonstrated significant mechanical strength compared to native abdominal wall, despite significant material resorption over time. Histological assessment revealed a comparable mild inflammatory response and mild to moderate granulation tissue/vascularization. PMID:23781348

  11. Diagnosis and Surgical Treatment of Morgagni Hernia: Report of Three Cases

    Microsoft Academic Search

    Ibrahim Can Kurkcuoglu; Atilla Eroglu; Nurettin Karaoglanoglu; P?nar Polat; Ahmet A. Balik; Celal Tek?nbas

    2003-01-01

    Morgagni hernia is a rare congenital disorder, which is usually asymptomatic, but may cause respiratory or gastrointestinal\\u000a symptoms. We reviewed the clinical findings of three patients with a Morgagni hernia, diagnosed and treated in our department\\u000a between 1997 and 2000. The Morgagni hernia caused various symptoms in all three patients and surgery was performed via posterolateral\\u000a thoracotomy in two, and

  12. Biocompatibility and tissue integration of a novel shape memory surgical mesh for ventral hernia: in vivo animal studies.

    PubMed

    Zimkowski, Michael M; Rentschler, Mark E; Schoen, Jonathan A; Mandava, Nageswara; Shandas, Robin

    2014-07-01

    Approximately 400,000 ventral hernia repair surgeries are performed each year in the United States. Many of these procedures are performed using laparoscopic minimally invasive techniques and employ the use of surgical mesh. The use of surgical mesh has been shown to reduce recurrence rates compared to standard suture repairs. The placement of surgical mesh in a ventral hernia repair procedure can be challenging, and may even complicate the procedure. Others have attempted to provide commercial solutions to the problems of mesh placement, but these have not been well accepted by the clinical community. In this article, two versions of shape memory polymer (SMP)-modified surgical mesh, and unmodified surgical mesh, were compared by performing laparoscopic manipulation in an acute porcine model. Also, SMP-integrated polyester surgical meshes were implanted in four rats for 30-33 days to evaluate chronic biocompatibility and capacity for tissue integration. Porcine results show that the modified mesh provides a controlled, temperature-activated, automated deployment when compared to an unmodified mesh. In rats, results indicate that implanted SMP-modified meshes exhibit exceptional biocompatibility and excellent integration with surrounding tissue with no noticeable differences from the unmodified counterpart. This article provides further evidence that an SMP-modified surgical mesh promises reduction in surgical placement time and that such a mesh is not substantially different from unmodified meshes in chronic biocompatibility. PMID:24327401

  13. Gastric outlet obstruction with an elevated serum pancreatic lipase secondary to an infraumbilical hernia.

    PubMed

    Ranasinghe, W Kb; Smith, M

    2013-10-01

    We report the case of a 68-year-old woman who presented with symptoms and signs of gastric outlet obstruction with a history of a ventral hernia. Clinical examination revealed a large ventral hernia with visible peristalsis of the herniated viscera. Initial serum biochemistry revealed a markedly elevated lipase level and deranged renal function. Computed tomography demonstrated an infraumbilical hernia with herniation of the stomach through the ventral defect and distortion of the pancreatic anatomy. The hernia was reduced operatively and repaired, leading to an uneventful recovery. PMID:24112485

  14. Frozen Elephant Trunk Repair for Descending Thoracic Aortic Dissection in a Man with a Hostile Left Pleural Cavity

    PubMed Central

    Kent, William D.T.; Manjunath, Adarsh

    2014-01-01

    The frozen elephant trunk procedure is a hybrid, single-staged alternative to conventional surgery for repairing diffuse pathologic conditions of the thoracic aorta. This approach is particularly advantageous in patients who have pathologic conditions of the left side of the chest, because the descending thoracic aorta can be repaired without entering a hostile pleural cavity. We present the case of a 67-year-old man who had undergone repair of acute type A aortic dissection. He presented with aneurysmal dilation of the descending thoracic aorta secondary to chronic dissection, a large acute dissection of the proximal ascending aorta, and a large paraesophageal hernia that made him a poor candidate for conventional, 2-staged open aortic repair. We describe the hybrid frozen elephant trunk technique that we used to repair the aorta, and its broader advantages. PMID:24955060

  15. Hernia of Morgagni

    Microsoft Academic Search

    V. Tarazona; M. Casillas; E. Blasco; A. Cantó; J. Pastor; A. Acosta

    1973-01-01

    París, F., Tarazona, V., Casillas, M., Blasco, E., Cantó, A., Pastor, J., and Acosta, A. (1973).Thorax, 28, 631-636. Hernia of Morgagni. Nine patients with Margagni's hernia of the diaphragm are reported, seven of whom have been operated on. Four patients had gastrointestinal symptoms, two respiratory symptoms, and one retrosternal pain; the other two were asymptomatic. In the first case the

  16. Recent Advances and Developments in Neural Repair and Regeneration for Hand Surgery

    PubMed Central

    Chimutengwende-Gordon, Mukai; Khan, Wasim

    2012-01-01

    End-to-end suture of nerves and autologous nerve grafts are the ‘gold standard’ for repair and reconstruction of peripheral nerves. However, techniques such as sutureless nerve repair with tissue glues, end-to-side nerve repair and allografts exist as alternatives. Biological and synthetic nerve conduits have had some success in early clinical studies on reconstruction of nerve defects in the hand. The effectiveness of nerve regeneration could potentially be increased by using these nerve conduits as scaffolds for delivery of Schwann cells, stem cells, neurotrophic and neurotropic factors or extracellular matrix proteins. There has been extensive in vitro and in vivo research conducted on these techniques. The clinical applicability and efficacy of these techniques needs to be investigated fully. PMID:22431954

  17. [Traumatic diaphragmatic hernia].

    PubMed

    Plekhanov, A N

    2012-01-01

    Historical and statistical data on traumatic diaphragmatic hernias are presented. It was shown that frequency of occurrence of the pathology in question was dependent on principal causes of its development, anatomic features of diaphragmatic hernias and mechanisms of damage of the diaphragm. In the article the author notes that the worsening of criminogenic situation, increased number of road and traffic accidents were principal causes of the development of diaphragmatic hernias. Special place in the review is given to strangulated diaphragmatic hernias. The basic diagnostic methods for this pathology are radiological investigation, computed tomography and ultrasonic scanning. In addition, the methods of treatment, prognosis of the development of diaphragmatic hernias, complications included, are presented. PMID:23227757

  18. Comparison of different ADM materials in breast surgery.

    PubMed

    Cheng, Angela; Saint-Cyr, Michel

    2012-04-01

    This is a brief review of the history of the role of acellular dermal matrices in breast reconstruction surgery, with a summary of several currently available products, including a table of comparisons. Key features, including biologic tissue source, surgical preparation, sterility, polarity, contraindications, shelf life, and cost, are examined. A paucity of data exists to directly compare AlloDerm®, DermaMatrix®, Strattice™, Permacol™, DermACELL, FlexHD®, SurgiMend®, and ALLOMAX™ for breast reconstruction; most studies relate to hernia repair. An ideal acellular dermal matrix product is still unavailable but the information provided in this review should facilitate a breast surgeons decision-making process. PMID:22482358

  19. Obturator hernia: anatomy, embryology, diagnosis, and treatment.

    PubMed

    Petrie, Alison; Tubbs, R Shane; Matusz, Petru; Shaffer, Kitt; Loukas, Marios

    2011-07-01

    An obturator hernia is an infrequent but significant cause of intestinal obstruction. The incidence of obturator hernias is between 0.05 and 1.4% of all hernias. The mortality rate can be as high as 70% when acutely incarcerated due to the difficulty in diagnosis and delay in surgical treatment Three progressive stages of obturator herniation have been classified and can be one of three different varieties depending on the pathway the herniated sac follows. Knowledge of the anatomy and pathogenesis of obturator herniation is essential in diagnosis and treatment. The most common clinical presentation is intestinal obstruction (90%) and this is often seen in elderly, emaciated, multiparous women with predisposing conditions. Other classic signs, though not always present include obturator neuralgia, the Howship-Romberg sign and the Hannington-Kiff sign. Computed tomography scan is the most favored diagnostic imaging method. The abdominal surgical approach is most preferred when a diagnosis is uncertain and laparoscopy should be employed in elective early surgeries. This aim of this article is to review the diagnosis and treatment of obturator hernia by describing the anatomy, embryology, clinical presentation, diagnosis, and management currently in use. Increased awareness and proper management of this condition will result in decreased morbidity and mortality. PMID:21322061

  20. Traumatic abdominal wall hernia: a case report.

    PubMed

    Bansal, Somendra; Vyas, Kailash C

    2015-04-01

    Traumatic abdominal wall hernias are rare injuries despite the high incidence of blunt abdominal traumas. The mechanism of this injury includes a sudden increase in intra-abdominal pressure and extensive shear forces applied to the abdominal wall. We report a case of traumatic hernia of the anterior abdominal wall in a 42-year-old woman presented with blunt injury of the upper abdomen. She was attacked by a bull. She had a clinically evident abdominal fascial disruption with intact skin and was hemodynamically stable. The presence of localized pain, bruising and a reducible swelling or a cough impulse suggested the diagnosis. An emergency mesh repair of the defect was performed, and she recovered well. PMID:25972694

  1. Chronic pain after surgery: pathophysiology, risk factors and prevention.

    PubMed

    Reddi, Danielle; Curran, Natasha

    2014-04-01

    Interest in chronic pain after surgery has grown since the finding that more than a fifth of patients attending chronic pain clinics cite surgery as the cause for their chronic pain. The problem is not limited to major surgery; even common minor procedures such as hernia repair have a significant risk of chronic pain. Surgical technique can influence the development of chronic postsurgical pain (CPSP) and techniques to minimise nerve injury should be used where possible. Central nervous system changes contribute to the development of persistent pain following surgical trauma and nerve injury. Pharmacological agents that interrupt the mechanisms contributing to central sensitisation may be helpful in reducing the incidence of CPSP. Psychosocial factors are also important in the development of chronic pain and should be addressed as part of a holistic approach to perioperative care. PMID:24572639

  2. [Traumatic lung hernia].

    PubMed

    Marsico, Giovanni Antonio; Boasquevisque, Carlos Henrique Ribeiro; Loureiro, Gustavo Lucas; Marques, Rodrigo Felipe; Clemente, Antonio Miraldi

    2011-01-01

    Traumatic lung herniation is an unusual clinical problem. We present a case of a large left post-traumatic lung hernia on the left, anterior, second intercostal space following blunt chest trauma. An important factor in the etiology of these lesions is the relative lack of muscular support of the anterior part of the chest. This report describes the diagnosis and management of a post-traumatic lung hernia. PMID:21537748

  3. Emergent Endovascular vs. Open Surgery Repair for Ruptured Abdominal Aortic Aneurysms: A Meta-Analysis

    PubMed Central

    Qin, Chuan; Chen, Lin; Xiao, Ying-bin

    2014-01-01

    Objectives To systematically review studies comparing peri-operative mortality and length of hospital stay in patients with ruptured abdominal aortic aneurysms (rAAAs) who underwent endovascular aneurysm repair (EVAR) to patients who underwent open surgical repair (OSR). Methods The Medline, Cochrane, EMBASE, and Google Scholar databases were searched until Apr 30, 2013 using keywords such as abdominal aortic aneurysm, emergent, emergency, rupture, leaking, acute, endovascular, stent, graft, and endoscopic. The primary outcome was peri-operative mortality and the secondary outcome was length of hospital stay. Results A total of 18 studies (2 randomized controlled trials, 5 prospective studies, and 11 retrospective studies) with a total of 135,734 rAAA patients were included. rAAA patients who underwent EVAR had significantly lower peri-operative mortality compared to those who underwent OSR (overall OR?=?0.62, 95% CI?=?0.58 to 0.67, P<0.001). rAAA patients with EVAR also had a significantly shorter mean length of hospital stay compared to those with OSR (difference in mean length of stay ranged from ?2.00 to ?19.10 days, with the overall estimate being ?5.25 days (95% CI?=??9.23 to ?1.26, P?=?0.010). There was no publication bias and sensitivity analysis showed good reliability. Conclusions EVAR confers significant benefits in terms of peri-operative mortality and length of hospital stay. There is a need for more randomized controlled trials to compare outcomes of EVAR and OSR for rAAA. PMID:24498112

  4. Strangulated small bowel obstruction secondary to a transmesosigmoid hernia.

    PubMed

    Bandawar, Mayur Satish; Nayak, Praveen; Shaikh, Irfan Abubakar; Sakthivel, M S; Yadav, Thakur Deen

    2014-04-01

    Internal hernias are an infrequent cause of small bowel obstruction with transmesosigmoid herniation being very rare, especially in patients with no history of abdominal surgery or trauma. Early surgical intervention is important in acute presentation to reduce the high morbidity and mortality rates associated with this disease. PMID:24891782

  5. A cost–utility analysis of treatment options for inguinal hernia in 1,513,008 adult patients

    Microsoft Academic Search

    N. Stylopoulos; G. S. Gazelle; D. W. Rattner

    2003-01-01

      Background: The controversial issue of the cost-effectiveness of laparoscopic inguinal hernia repair is examined, employing\\u000a a decision analytic method. Materials and methods: The NSAS, NHDS (National Center for Health Statistics), HCUP-NIS (Agency\\u000a for Healthcare Research and Quality) databases and 51 randomized controlled trials were analyzed. The study group constituted\\u000a of a total of 1,513,008 hernia repairs. Projection of the clinical,

  6. Strangulated intestinal obstruction secondary to a typical obturator hernia: a case report with literature review.

    PubMed

    Cai, Xiaoyan; Song, Xiangyang; Cai, Xiujun

    2012-01-01

    Obturator hernia is a rare pelvic hernia with incidence of 1%. It's a significant cause of intestinal obstruction in emaciated elderly women. Delayed diagnosis and surgical intervention contributed to its relatively high morbidity and mortality. We present a typical case of obturator hernia with positive Howship-Romberg sign and Hannington-Kiff sign. The diagnosis was confirmed by spiral CT preoperatively. During the emergency laparotomy, the incarcerated intestine was reduced and removed. Obturator foramen was repaired by simple suture. The patient recovered uneventfully and no recurrence occurred during the follow-up. The obturator hernia should be included in the differential diagnosis if clinically suspected. Early diagnosis and prompt surgical treatment are essential to reduce the morbidity and mortality associated with obturator hernia. PMID:22408570

  7. Strangulated Intestinal Obstruction Secondary to a Typical Obturator Hernia: A Case Report with Literature Review

    PubMed Central

    Cai, Xiaoyan; Song, Xiangyang; Cai, Xiujun

    2012-01-01

    Obturator hernia is a rare pelvic hernia with incidence of 1%. It's a significant cause of intestinal obstruction in emaciated elderly women. Delayed diagnosis and surgical intervention contributed to its relatively high morbidity and mortality. We present a typical case of obturator hernia with positive Howship-Romberg sign and Hannington-Kiff sign. The diagnosis was confirmed by spiral CT preoperatively. During the emergency laparotomy, the incarcerated intestine was reduced and removed. Obturator foramen was repaired by simple suture. The patient recovered uneventfully and no recurrence occurred during the follow-up. The obturator hernia should be included in the differential diagnosis if clinically suspected. Early diagnosis and prompt surgical treatment are essential to reduce the morbidity and mortality associated with obturator hernia. PMID:22408570

  8. Hybrid repair of a very late, post-aortic coarctation surgery thoracic aneurysm: a case report

    PubMed Central

    2012-01-01

    Introduction Local aneurysms after surgical repair of coarctation of the aorta occur mainly in patients surgically treated by Dacron patch plasty during adulthood. The management of these patients is always problematic, with frequent complications and increased mortality rates. Percutaneous stent-graft implantation avoids the need for surgical reintervention. Case presentation We report a case involving the hybrid treatment by stent-graft implantation and transposition of the left subclavian artery to the left common carotid artery of an aneurysmal dilatation of the thoracic aorta that occurred in a 64-year-old Caucasian man, operated on almost 40?years earlier with a Dacron patch plasty for aortic coarctation. Our patient presented to our facility for evaluation with back pain and shortness of breath after minimal physical effort. A physical examination revealed stony dullness to percussion of the left posterior thorax, with no other abnormalities. The results of chest radiography, followed by contrast-enhanced computed tomography and aortography, led to a diagnosis of giant aortic thoracic aneurysm. Successful treatment of the aneurysm was achieved by percutaneous stent-graft implantation combined with transposition of the left subclavian artery to the left common carotid artery. His post-procedural recovery was uneventful. Three months after the procedure, computed tomography showed complete thrombosis of the excluded aneurysm, without any clinical signs of left lower limb ischemia or new onset neurological abnormalities. Conclusions Our patient’s case illustrates the clinical outcomes of surgical interventions for aortic coarctation. However, the very late appearance of a local aneurysm is rather unusual. Management of such cases is always difficult. The decision-making should be multidisciplinary. A hybrid approach was considered the best solution for our patient. PMID:22935451

  9. Pulmonary Hernia in a Two-Year-Old Child

    PubMed Central

    Walters, Bryan S.; Agnoni, Alysia A.; Coppola, Christopher P.; Scorpio, Ronald J.; Kennedy, Alfred P.

    2014-01-01

    Pulmonary hernia, also known as lung herniation or intercostal herniation, is best explained as the lung parenchyma protruding beyond the confines of the thoracic wall. This rare finding can be classified as congenital or acquired. Acquired pulmonary herniations are often the complication of blunt or penetrating trauma to the chest wall. This report describes a two-year-old male who fell onto a rigid post, striking his left lower chest. Imaging studies demonstrated a small pneumothorax as well as pulmonary herniation. The patient underwent a diagnostic thoracoscopy and repair of a pulmonary hernia within the 7th intercostal space without complication. In this case report, we aim to add to the limited body of existing literature on the surgical management of pulmonary hernias. PMID:25328752

  10. Treatment of Morbid Obesity and Hiatal Paraesophageal Hernia by Laparoscopic Roux-en-Y Gastric Bypass

    Microsoft Academic Search

    Jose Luis Salvador-Sanchis; David Martinez-Ramos; Ana Herfarth; Isabel Rivadulla-Serrano; Miguel Ibañez-Belenguer; Jane S. Hoashi

    2010-01-01

    Obesity has been proven to be a significant independent risk factor for hiatal hernia. In morbidly obese patients, the usual\\u000a techniques to improve gastroesophageal reflux after hiatal hernia repair could have poorer outcomes than in the general population.\\u000a Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been demonstrated to be an effective procedure in controlling symptoms\\u000a and complications of gastroesophageal reflux in

  11. An irreducible left scrotal hernia containing a sigmoid colon tumor (adenocarcinoma) – Case report

    PubMed Central

    Gna?, Jaros?aw; Bulsa, Marek; Czaja-Bulsa, Gra?yna

    2014-01-01

    INTRODUCTION In relation to all inguinal hernias, large irreducible scrotal hernias are quite rare, while such hernias containing colon tumors in the sac have so far been described in fewer than 30 cases. PRESENTATION OF CASE A 61-year-old patient was admitted for a planned surgery because of a large irreducible left-sided scrotal hernia. Intraoperatively, a large tumor of the sigmoid colon was found in the hernial sac. In a histopathological examination it was diagnosed as adenocarcinoma. A palliative operation was performed and he was referred to further systemic and palliative treatment (because of numerous coexisting liver metastases). DISCUSSION Until now, only about 30 cases of colon tumor in inguinal hernia sac have been reported. CONCLUSION It should be remembered that even the most obvious preoperative diagnosis may be verified intraoperatively. PMID:24988210

  12. Genetics Home Reference: Congenital diaphragmatic hernia

    MedlinePLUS

    ... literature OMIM Genetic disorder catalog Conditions > Congenital diaphragmatic hernia On this page: Description Genetic changes Inheritance Diagnosis ... definitions Reviewed September 2013 What is congenital diaphragmatic hernia? Congenital diaphragmatic hernia is a defect in the ...

  13. Laparoendoscopic Single-Site Herniorrhaphy After Gynecologic Surgery

    PubMed Central

    Su, Hsuan; Huang, Lulu; Han, Chien-Min; Huang, Kuan-Gen; Yen, Chih-Feng

    2014-01-01

    Background and Objectives: Increased interest in laparoendoscopic single-site surgery has instigated research into trials of novel techniques. The procedure we propose may potentially improve patient satisfaction and cosmetic results while diminishing the incidence of trocar-site herniation. We report our initial experience with laparoendoscopic single-site totally extraperitoneal herniorrhaphy for postoperative incisional hernia to determine the procedure's feasibility and safety. Methods: Three patients with incisional hernias after gynecologic surgery underwent laparoendoscopic single-site totally extraperitoneal procedures. We evaluated the patients' preoperative and postoperative condition, as well as the details of their original surgery. We performed the procedure through a 2-cm umbilical incision followed by mesh insertion and transabdominal suture placement in all patients. Results: Laparoendoscopic single-site totally extraperitoneal herniorrhaphy was completed in 80 to 120 minutes. No intraoperative complications were encountered, and surgical blood loss was minimal. The duration of hospital stay ranged from 2 to 4 days. One patient had a postoperative wound infection. The patients have shown no sign of recurrence at 9 months' follow-up. Conclusion: Laparoendoscopic single-site totally extraperitoneal herniorrhaphy appears to be feasible and safe. It may be performed with readily available instruments, although further experience and practice are warranted for a more efficient repair. The procedure has similar advantages to a multiport laparoscopic totally extraperitoneal procedure but yields better cosmetic results. More studies are needed to assess the long-term benefits and complications of this procedure. PMID:25392616

  14. Well-differentiated papillary mesothelioma manifesting in a hernia sac.

    PubMed

    Val-Bernal, José Fernando; Mayorga, Marta; Val, Daniel; Garijo, María Francisca

    2014-09-01

    Well-differentiated papillary mesothelioma (WDPM) is a tumor of uncertain malignant potential that usually occurs as a multifocal lesion of the female peritoneum, and is incidentally found at the time of surgery. We present here a multifocal case that had arisen from the lining of a hernia sac. To our knowledge, only four cases of this event have been previously described. A review of the five cases reported, including our case, revealed that the mean age of the patients was 56.6±8.35 years. There was predominance in men (4:1). In four cases, the lesion was incidental. Most tumors were found in inguinal hernias. Four cases presented with gross abnormalities in the hernia sac. All the five patients were alive with no evidence of WDPM after a mean follow-up of 38.6 months. Extensive sampling of this rare lesion helps to rule out an epithelial malignant mesothelioma and prevents overtreatment. PMID:24860916

  15. Obturator hernia: A case report and review of the literature?

    PubMed Central

    Hodgins, Nicholas; Cieplucha, Krzysztof; Conneally, Padhraic; Ghareeb, Essam

    2013-01-01

    INTRODUCTION An obturator hernia is a rare condition but is associated with the highest mortality of all abdominal wall hernias. Early surgical intervention is often hindered by clinical and radiological diagnostic difficulty. The following case report highlights these diagnostic difficulties, and reviews the current literature on management of such cases. PRESENTATION OF CASE We present the case of an 86-year-old lady who presented with intermittent small bowel obstruction, clear hernial orifices, and right medial thigh pain. Pre-operative CT imaging was suggestive of an obstructed right femoral hernia. However, intra-operatively the femoral canal was clear and an obstructed hernia was found passing through the obturator foramen lying between the pectineus and obturator muscles in the obturator canal. DISCUSSION Obturator hernias are notorious for diagnostic difficulty. Patients often present with intermittent bowel obstruction symptoms due to a high proportion exhibiting Richter's herniation of the bowel. Hernial sacs can irritate the obturator nerve within the canal, manifesting as medial thigh pain, and often no hernial masses can be detected on clinical examination. Increasing speed of diagnosis through early CT imaging has been shown to reduce the morbidity and mortality associated with obturator hernias. However, over-reliance on CT findings should be cautioned, as imaging and operative findings may not always correlate. CONCLUSION A high suspicion for obturator hernia should be maintained when assessing a patient presenting with bowel obstruction particularly where intermittent symptoms or medial thigh pain are present. Rapid clinical and appropriate radiological assessment, followed by early surgery is critical to successful treatment. PMID:23973903

  16. Esophageal hiatal hernia in three exotic felines--Lynx lynx, Puma concolore, Panthera leo.

    PubMed

    Hettlich, Bianca F; Hobson, H Phil; Ducoté, Julie; Fossum, Theresa W; Johnson, James H

    2010-03-01

    Hiatal hernia was diagnosed in three exotic felines-lynx (Lynx lynx), cougar (Puma concolore), and lion (Panthera leo). All cats had a history of anorexia. Thoracic and abdominal radiographs showed evidence of a soft tissue mass within the caudal mediastinum suggestive of a hiatal hernia in all animals. A barium esophagram was performed in one case. All animals underwent thoracic or abdominal surgery for hernia reduction. Surgical procedures included: intercostal thoracotomy with herniorrhaphy and esophagopexy (lynx and cougar), and incisional gastropexy (lion). Concurrent surgical procedures performed were gastrotomy for gastric foreign body removal and jejunostomy tube placement. Clinical signs related to the hiatal hernia disappeared after surgery and recurrence of signs was not reported for the time of follow-up. PMID:20722259

  17. Recurrent inguinal hernia in a preschool girl treated laparoscopically with a preperitoneal transabdominal technique and polypropylene mesh: an alternative in complex cases.

    PubMed

    Weber-Sanchez, A; Weber-Alvarez, P; Garteiz-Martinez, D

    2012-02-01

    We report the case of a 4-year-old girl treated by a laparoscopic transabdominal preperitoneal (TAPP) technique with polypropylene mesh in whom a primary contralateral hernia was found and repaired, closing the orifice with a suture. This 4-year-old female had a medical history of clubfoot treated by surgery during her first year of age, ureteral reimplantation because of stenosis, and laparoscopic cholecystectomy because of hydrocholecystis. She had recurrence 1 year after a conventional inguinal herniorraphy and was treated by the TAPP technique with polypropylene mesh. A primary contralateral hernia was found and repaired, and the orifice was closed with a suture. The child's acceptance of the procedure was good, and the postoperative evolution was uneventful, requiring minimal analgesia in the first 24 h. She was discharged the following day. Two years later, there have been no recurrences, and the girl is developing and carrying out activities in a normal way. The open technique remains the gold standard for hernioplasty in children, but laparoscopy may be an option, and it is possible that in some special cases, the use of mesh to reinforce the inguinal wall using the TAPP technique, although it is controversial, may be justified. PMID:20803043

  18. Collagen-coated Vicryl mesh is not a suitable material for repair of diaphragmatic defects.

    PubMed

    Ramadwar, R H; Carachi, R; Young, D G

    1997-12-01

    Encouraged by the results in abdominal wall defects, the authors used the collagen-coated Vicryl mesh (CCVM) in repair of diaphragmatic defects in two patients. In a patient with recurrent diaphragmatic hernia, CCVM was used to reinforce the anterior abdominal muscle flap. The hernia recurred after 8 months. In another patient, it was used to repair a large diaphragmatic defect. This patient had a recurrence of the hernia in 10 weeks. The results suggestthat CCVM is not a good material for repairing the diaphragmatic defect. However, it can be used to reinforce other types of repairs. PMID:9434003

  19. Physiology in Medicine: physiological basis of diaphragmatic dysfunction with abdominal hernias-implications for therapy.

    PubMed

    Koo, Patrick; Gartman, Eric J; Sethi, Jigme M; McCool, F Dennis

    2015-01-15

    An incisional hernia is a common complication after abdominal surgery. Complaints of dyspnea in this population may be attributed to cardiopulmonary dysfunction or deconditioning. Large abdominal incisional hernias, however, may cause diaphragm dysfunction and result in dyspnea, which is more pronounced when standing (platypnea). The use of an abdominal binder may alleviate platypnea in this population. We discuss the link between diaphragm dysfunction and the lack of abdominal wall integrity and how abdominal wall support partially restores diaphragm function. PMID:25377882

  20. Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial

    PubMed Central

    Saber, Aly; Hokkam, Emad N.; Ellabban, Goda M.

    2015-01-01

    INTRODUCTION: The repair of the recurrent hernia is a daunting task because of already weakened tissues and distorted anatomy. Open posterior preperitoneal approach gives results far superior to those of the anterior approach. Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with advantages of a minimally invasive approach. The present work aimed at comparing these three approaches for repair of recurrent inguinal hernia regarding complications and early recurrence. MATERIALS AND METHODS: A total of 180 patients were divided randomly into three equal groups: A, B, and C. Group A patients were subjected to open posterior preperitoneal approach , those of group B were subjected to transinguinal anterior tension-free repair and group C patients were subjected to TAPP. The primary end point was recurrence and the secondary end points were time off from work, postoperative pain, scrotal swelling, and wound infections. RESULTS: The mean hospital stay, the mean time to return to work and the mean time off from work were less in group C then A and B. Chronic postoperative pain was observed in eight patients in group A (13.33%), in 18 patients in group B (30%) and six patients in group C (10%). The overall complication rate was 19.7% in both groups A and C and 34.36% in group B. CONCLUSION: In recurrent inguinal hernia, the laparoscopic and open posterior approaches are equally effective in term of operative outcome. The open preperitoneal hernia repair is inexpensive, has a low recurrence rate. Postoperative recovery is short and postoperative pain is minimal. This approach gives results far superior to those of the commonly used anterior approach. However, while laparoscopic hernia repair requires a lengthy learning curve and is difficult to learn and perform, it has advantages of less post-operative pain, early recovery with minimal hospital stay, low post-operative complications and recurrence. Trial Registration ACTRN12613001050741 PMID:25883452

  1. Watching for Complications

    MedlinePLUS

    ... a hernia, most eventually require surgical repair. Inguinal Hernia The most common hernia is called an inguinal ... and painful, and immediate surgery is necessary. Umbilical Hernia Another area where the muscle may not close ...

  2. Giant inguinoscrotal hernia: case report and management principles.

    PubMed

    Tahir, Mohammad; Ahmed, Faiz U; Seenu, V

    2008-12-01

    We present a case of a giant inguinoscrotal hernia reaching up to the patient's knees. It was only partially reducible but was not associated with any other complications. It was treated by an inguinal incision and the reduction of contents aided by a small midline infra-umbilical incision. The hernial sac contained loops of small bowel along with its mesentery, appendix, cecum and ascending colon. The defect was repaired using prolene mesh. PMID:19059158

  3. Cardiac response and complications during endovascular repair of abdominal aortic aneurysms: A concurrent comparison with open surgery

    Microsoft Academic Search

    Philippe W. M. Cuypers; Martin Gardien; Jacob Buth; Jan Charbon; Cathinka H. Peels; Wim Hop; Robert J. F. Laheij

    2001-01-01

    Purpose: The purpose of this study was to assess and to compare perioperative changes in left ventricular function and the incidence of adverse cardiac events in two groups of patients with abdominal aortic aneurysms, one during endovascular aneurysm repair (EAR) and the other during open aneurysm repair (OAR). Methods: One hundred twenty consecutive patients who underwent EAR (49 patients) or

  4. Traumatic abdominal wall hernia associated with small bowel injury-case report.

    PubMed

    Constantin, Vlad; Carâp, Alexandru; Bobic, Simona; Albu, M?d?lina; Nica, Elvira; Socea, Bogdan

    2015-04-01

    Traumatic abdominal wall hernias (TAWHs) are rare. Their diagnosis is mostly clinical and can be overlooked in the setting of trauma and distracting injuries or they can be misinterpreted as parietal hematomas. Associated lesions can influence decision making regarding time of operation and surgical technique. Our case highlights the management of a high-energy TAWH that associates a small bowel traumatic lesion. Surgical repair of TAWHs should follow general hernia repair principles. Further exploration of surgical options is necessary for a consensus to be reached. PMID:25972687

  5. Varicoceles, Hernias, and Hydroceles

    Microsoft Academic Search

    Ross Bauer; Barry A. Kogan

    \\u000a Varicoceles, hernias, and hydroceles are three common presenting complaints seen by urologists. Varicoceles are found in about\\u000a 15% of the adolescent population. Varicoceles are easy to diagnose on physician examination by a primary care provider and\\u000a are almost always asymptomatic. Treatment is needed only to improve fertility, which is not an issue for most teens. Further,\\u000a semen analysis is difficult

  6. Mitral Valve Repair Surgery

    MedlinePLUS Videos and Cool Tools

    ... ll answer our opinions here based on the knowledge gained at this center. If you’d let ... I think that’s a very important point of knowledge, particularly as it goes to experience and available ...

  7. Laparoscopic treatment of paraesophageal and mixed diaphragmatic hernias. Report of two cases.

    PubMed

    Gelmini, R; Andreotti, A; Saviano, M

    2007-06-01

    Hiatal hernias are classified into 3 types: sliding hernia (type I), paraesophageal hernia (type II) and mixed hernia (type III), that is a combination of type I and II. The paraesophageal and mixed hernias represent about 5-10% of the surgically treated hiatal hernias. The surgical treatment of the paraesophageal and mixed hernias is unavoidable because of the high risk of severe complications and it has to be considered in a high percentage of cases. The most important technical difficulty in the video-laparoscopic treatment is represented by the hugeness of the hernial defect and by the challenging reduction of the stomach into the abdomen. A cautious dissection of hernial sac and diaphragmatic cruses as well as a careful crural repair make the video-laparoscopic procedure feasible. The operative times are not prolonged and the results are similar to the open technique ones. In literature, the incidence of both intra and postoperative complications doesn't exhibit statistically significant differences between laparoscopic and open techniques. Because of the complexity of the laparoscopic procedure, the minimally invasive access has to be reserved to surgeons who are well trained in those techniques. In this paper we describe 2 cases: one of paraesophageal hernia and the other of mixed hernia which were video-laparoscopically treated with the help, in the second case, of a Gore-Tex mesh. In both cases the technical results were positive. Intra and postoperative complications didn't occur and, one year after the surgical procedure, both patients were in good health and recurrence-free. PMID:17519845

  8. Laparoscopic Treatment of Ventral Abdominal Wall Hernias: Preliminary Results in 100 Patients

    PubMed Central

    Martín del Olmo, Juan Carlos; Blanco, Jose Ignacio; de la Cuesta, Carmen; Martín, Fernando; Toledano, Miguel; Perna, Christiam; Vaquero, Carlos

    2000-01-01

    Objective: The laparoscopic treatment of eventrations and ventral hernias has been little used, although these hernias are well suited to a laparoscopic approach. The objective of this study was to investigate the usefulness of a laparoscopic approach in the surgical treatment of ventral hernias. Methods: Between January 1994 and July 1998, a series of 100 patients suffering from major abdominal wall defects were operated on by means of laparoscopic techniques, with a mean postoperative follow-up of 30 months. The mean number of defects was 2.7 per patient, the wall defect was 93 cm2 on average. There were 10 minor hernias (<5 cm), 52 medium-size hernias (5-10 cm), and 38 large hernia (>10 cm). The origin of the wall defect was primary in 21 cases and postsurgical in 79. Three access ports were used, and the defects were covered with PTFE Dual Mesh measuring 19 × 15 cm in 54 cases, 10 x 15 cm in 36 cases, and 12 × 8 cm in 10 cases. An additional mesh had to be added in 21 cases. In the last 30 cases, PTFE Dual Mesh Plus with holes was employed. Results: Average surgery time was 62 minutes. One procedure was converted to open surgery, and only one patient required a second operation in the early postoperative period. Minor complications included 2 patients with abdominal wall edema, 10 seromas, and 3 subcutaneous hematomas. There were no trocar site infections. Two patients developed hernia relapse (2%) in the first month after surgery and were reoperated with a similar laparoscopic technique. Oral intake and mobilization began a few hours after surgery. The mean stay in hospital was 28 hours. Conclusions: Laparoscopic technique makes it possible to avoid large incisions, the placement of drains, and produces a lower number of seromas, infections and relapses. Laparoscopic access considerably shortens the time spent in the hospital. PMID:10917121

  9. [Laparotomy closure - do we know how?(Guideline of the European Hernia Society)].

    PubMed

    East, B; Muysoms, F E

    2015-02-01

    The recurrence rate of surgical treatment of incisional hernia is high. The material and surgical technique used to close the abdominal wall following every surgery contribute as important risk factors in incisional hernia formation. However, by optimising abdominal wall closure, many patients can be spared from developing this type of complication. The European Hernia Society has established a Guidelines Development Group with a goal to research the literature and write a series of recommendations of how to close the abdomen and minimize the risk of incisional hernia in accordance with the principles of evidence-based medicine. To decrease the incidence of incisional hernias, the following is recommended: To utilise a non-midline approach to a laparotomy whenever possible. To perform a continuous suturing technique using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique. To perform the small bites technique with a suture to wound length (SL/WL) ratio at least 4/1. Not to close the peritoneum separately. To avoid rapidly resorbable materials. To consider using a prophylactic mesh in high-risk patients. To use the smallest trocar size adequate for the procedure and closing the fascial defect if trocars larger or equal to 10 mm are used in laparoscopic surgery. Key words: incisional hernia laparotomy laparotomy closure suturing material. PMID:25659254

  10. Diagnosis of a Strangulated Laparoscopic Incisional Hernia with Point-of-Care Ultrasonography

    PubMed Central

    Argintaru, Niran; Al-Den, Ahmed; Chenkin, Jordan

    2015-01-01

    The use of point-of-care ultrasound for the diagnosis of bowel obstructions and hernias is becoming increasingly common in the emergency department (ED). Using a relatively rare case of an incisional port hernia, we demonstrate the ultrasound findings of a strangulated hernia causing a partial small bowel obstruction. A 46-year-old female presented four days following a laparoscopic surgery complaining of abdominal pain, nausea and lack of bowel movements. There was a palpable mass in the left lower quadrant under the 12mm trocar port incision. ED point-of-care ultrasound revealed herniated akinetic loops of bowel through her laparoscopy incision. This is the first case report to describe the use of point-of-care ultrasound for the diagnosis of a strangulated incisional port hernia at the bedside. PMID:25987928

  11. Unusual Diaphragmatic Hernias Mimicking Cardiac Masses

    PubMed Central

    Kim, Si Hun; Kim, Myoung Gun; Kim, Su Ji; Moon, Jeonggeun; Kang, Woong Chol; Shin, Mi-Seung

    2015-01-01

    Hiatal hernia and Morgagni hernia are sorts of diaphragmatic hernias that are rarely detected on transthoracic echocardiography. Although echocardiographic findings have an important role for differential diagnosis of cardiac masses, we often might overlook diaphragmatic hernia. We report three cases of diaphragmatic hernias having specific features. The first case is huge hiatal hernia that encroaches left atrium with internal swirling flow on transthoracic echocardiography. The second case is a hiatal hernia that encroaches on both atria, incidentally detected on preoperative echocardiography. The third case is Morgagni hernia which encroaches on the right atrium only. So, we need to consider possibility of diaphragmatic hernia when we find a cardiac mass with specific echocardiographic features. PMID:26140154

  12. Obturator Hernia with Ureteral Entrapment

    PubMed Central

    Izzo, Matteo; Regusci, Luca; Fasolini, Fabrizio

    2014-01-01

    Obturator hernia of the ureter is uncommon. Computed tomography of a 77-year-old woman with sudden-onset lower left abdominal pain and urinary symptoms showed an obturator hernia with ureteral entrapment. Obturator hernia is a diagnostic challenge because the hernial mass is very insidious. It should be suspected in emaciated, multiparous, elderly women presenting with unexplained pain in the groin, hip, thigh or knee. High levels of clinical suspicion of high-risk patients and recourse to investigation by computed tomography are important, as delay in diagnosis and treatment is associated with increased morbidity and mortality. PMID:24926229

  13. Site-specific prolapse surgery. II. Vaginal paravaginal repair augmented with either synthetic mesh or remodelling xenograft

    Microsoft Academic Search

    Richard I. Reid; Kehui Luo

    2011-01-01

    Introduction and hypothesis  This study aims to answer the question, “Does tissue augmentation improve the mechanical repair of displacement cystourethrocoele?”\\u000a \\u000a \\u000a \\u000a Methods  A retrospective cohort study comparing 108 bridging graft vaginal paravaginal repairs (89 tissue-inductive xenografts and\\u000a 19 polypropylene mesh) to 59 native tissue historical controls was conducted. Main outcome measures were same-site prolapse\\u000a recurrence and time to failure. Initial reliability was evaluated

  14. Richter’s Hernia and Sir Frederick Treves: An Original Clinical Experience, Review, and Historical Overview

    PubMed Central

    Steinke, Wolfgang; Zellweger, René

    2000-01-01

    Objective To describe the clinical recognition, pathology, and management of Richter’s hernia and to review the relevant literature of the past 400 years. Summary Background Data The earliest known reported case of Richter’s hernia occurred in 1598 and was described by Fabricius Hildanus. The first scientific description of this particular hernia was given by August Gottlob Richter in 1778, who presented it as “the small rupture.” In 1887, Sir Frederick Treves gave an excellent overview on the topic and proposed the title “Richter’s hernia.” To his work—a cornerstone to modern understanding—hardly any new aspects can be added today. Since then, only occasional case reports or small series of retrospectively collected Richter’s hernias have been published. Methods The authors draw on their experience with 18 prospectively collected cases treated in the ICRC Lopiding Hospital for War Surgery in northern Kenya between February and December 1998 and review the relevant literature of the past 400 years. Results The classic features of Richter’s hernia were confirmed in all case studies of patients: only part of the circumference of the bowel is entrapped and strangulated in the hernial orifice. The involved segment may rapidly pass into gangrene, yet signs of intestinal obstruction are often absent. The death rate in the authors’ collective was 17%. Conclusion Richter’s hernia is a deceptive entity whose high death rate can be reduced by accurate diagnosis and early surgery. Considering the increasing incidence at laparoscope insertion sites, awareness of this special type of hernia with its misleading clinical appearance is important and of general interest. PMID:11066144

  15. Congenital diaphragmatic hernia in a case of patau syndrome: a rare association.

    PubMed

    A, Jain; P, Kumar; A, Jindal; Yk, Sarin

    2015-01-01

    Congenital diaphragmatic hernia (CDH) occurs in 5-10% associated with chromosomal abnormalities like, Pallister Killian syndrome, Trisomy 18, and certain deletions.. Association of CDH with trisomy 13 (Patau syndromes) is very rare. Here, we report such an unusual association, where surgical repair was done, but eventually the case succumbed as a result of multiple fatal co-morbidities. PMID:26034714

  16. Trevira mesh: a promising new implant for the treatment of abdominal hernias

    Microsoft Academic Search

    Jürgen Zieren; Folkert Maecker; Heiko Neuss; Jochen M. Müller

    2002-01-01

    Background: Trevira (polyethylene terephthalate) has been in clinical use for more than 20 years, serving as implant material with minimal foreign body reaction for the replacement of the cruciate ligaments of the knee. An animal (pig) trial was performed to ascertain whether a Trevira mesh offers any advantages over currently employed meshes like Prolene for abdominal hernia repair. Methods: In

  17. Congenital Diaphragmatic Hernia in a Case of Patau Syndrome: A Rare Association

    PubMed Central

    A, Jain; P, Kumar; A, Jindal; Yk, Sarin

    2015-01-01

    Congenital diaphragmatic hernia (CDH) occurs in 5-10% associated with chromosomal abnormalities like, Pallister Killian syndrome, Trisomy 18, and certain deletions.. Association of CDH with trisomy 13 (Patau syndromes) is very rare. Here, we report such an unusual association, where surgical repair was done, but eventually the case succumbed as a result of multiple fatal co-morbidities.

  18. Congenital Diaphragmatic Hernia

    PubMed Central

    2012-01-01

    Congenital Diaphragmatic Hernia (CDH) is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of abdominal contents into the thorax. The lungs are hypoplastic and have abnormal vessels that cause respiratory insufficiency and persistent pulmonary hypertension with high mortality. About one third of cases have cardiovascular malformations and lesser proportions have skeletal, neural, genitourinary, gastrointestinal or other defects. CDH can be a component of Pallister-Killian, Fryns, Ghersoni-Baruch, WAGR, Denys-Drash, Brachman-De Lange, Donnai-Barrow or Wolf-Hirschhorn syndromes. Some chromosomal anomalies involve CDH as well. The incidence is < 5 in 10,000 live-births. The etiology is unknown although clinical, genetic and experimental evidence points to disturbances in the retinoid-signaling pathway during organogenesis. Antenatal diagnosis is often made and this allows prenatal management (open correction of the hernia in the past and reversible fetoscopic tracheal obstruction nowadays) that may be indicated in cases with severe lung hypoplasia and grim prognosis. Treatment after birth requires all the refinements of critical care including extracorporeal membrane oxygenation prior to surgical correction. The best hospital series report 80% survival but it remains around 50% in population-based studies. Chronic respiratory tract disease, neurodevelopmental problems, neurosensorial hearing loss and gastroesophageal reflux are common problems in survivors. Much more research on several aspects of this severe condition is warranted. PMID:22214468

  19. Successful surgical management of ruptured umbilical hernias in cirrhotic patients.

    PubMed

    Chatzizacharias, Nikolaos A; Bradley, J Andrew; Harper, Simon; Butler, Andrew; Jah, Asif; Huguet, Emmanuel; Praseedom, Raaj K; Allison, Michael; Gibbs, Paul

    2015-03-14

    Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual, but potentially life-threatening complication, with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical repair. Management options include primary surgical repair with or without concomitant portal venous system decompression for the control of the ascites. We present a retrospective analysis of our centre's experience over the last 6 years. Our cohort consisted of 11 consecutive patients (median age: 53 years, range: 36-63 years) with advanced hepatic cirrhosis and refractory ascites. Appropriate patient resuscitation and optimisation with intravenous fluids, prophylactic antibiotics and local measures was instituted. One failed attempt for conservative management was followed by a successful primary repair. In all cases, with one exception, a primary repair with non-absorbable Nylon, interrupted sutures, without mesh, was performed. The perioperative complication rate was 25% and the recurrence rate 8.3%. No mortality was recorded. Median length of hospital stay was 14 d (range: 4-31 d). Based on our experience, the management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible without the use of transjugular intrahepatic portosystemic shunt routinely in the preoperative period, provided that meticulous patient optimisation is performed. PMID:25780312

  20. Successful surgical management of ruptured umbilical hernias in cirrhotic patients

    PubMed Central

    Chatzizacharias, Nikolaos A; Bradley, J Andrew; Harper, Simon; Butler, Andrew; Jah, Asif; Huguet, Emmanuel; Praseedom, Raaj K; Allison, Michael; Gibbs, Paul

    2015-01-01

    Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual, but potentially life-threatening complication, with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical repair. Management options include primary surgical repair with or without concomitant portal venous system decompression for the control of the ascites. We present a retrospective analysis of our centre’s experience over the last 6 years. Our cohort consisted of 11 consecutive patients (median age: 53 years, range: 36-63 years) with advanced hepatic cirrhosis and refractory ascites. Appropriate patient resuscitation and optimisation with intravenous fluids, prophylactic antibiotics and local measures was instituted. One failed attempt for conservative management was followed by a successful primary repair. In all cases, with one exception, a primary repair with non-absorbable Nylon, interrupted sutures, without mesh, was performed. The perioperative complication rate was 25% and the recurrence rate 8.3%. No mortality was recorded. Median length of hospital stay was 14 d (range: 4-31 d). Based on our experience, the management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible without the use of transjugular intrahepatic portosystemic shunt routinely in the preoperative period, provided that meticulous patient optimisation is performed. PMID:25780312

  1. Image-Guided Techniques Improve the Short-term Outcome of Autologous Osteochondral Cartilage Repair Surgeries -An

    E-print Network

    Stewart, James

    operated to create traumatic chondral injuries in each knee. After four months, the chondral defect in one surface of the knee are injuries frequently en- countered in clinical practice (1) (2). Due knee was repaired using a: (A) conventional ap- proach, (B) optically-guided method, or (C) template

  2. Intravesical pressure: A new prognostic indicator in congenital diaphragmatic hernia

    PubMed Central

    Abraham, Mohan K.; Viswanath, Naveen; Ramakrishnan, P.; Bindu, S.; Kedari, P.; Naaz, Aisha; Rahman, Lukman O. Abdur; Nasir, Abdulrasheed A.; Sharon, Mohan; Shivji, R.; Sasidharan, P.

    2011-01-01

    Aims: To evaluate the usefulness of intravesical pressure as a prognostic indicator in congenital diaphragmatic hernia. Material and Methods: In 25 cases, bladder pressure was measured intraoperatively during repair. Results: Cases were divided into three groups according to the intravesical pressure. Group 1: pressure <10 cm (n.9), Group 2: 10–15 cm (n.11) and Group 3: >15 cm (n.5). Number of ventilated days was tabulated against these groups. Median number of ventilated days for Group 1, with the lowest pressure, was 3 days, while that for Group 2 was 5 and for Group 3, with the highest pressure, was 10 days. This was significant, with a P-value of 0.016. Conclusion: Measurement of intravesical pressure is a reliable prognostic indicator in newborns with congenital diaphragmatic hernia. It also helps in predicting postoperative ventilatory requirement. PMID:22121309

  3. Associated malformations in Morgagni hernia

    Microsoft Academic Search

    Murat Kemal Cigdem; Abdurrahman Onen; Hanifi Okur; Selcuk Otcu

    2007-01-01

    Morgagni hernia (MH) is a congenital herniation of the abdominal organs through the subcostosternal portion of the diaphragm.\\u000a It is a rare type of diaphragmatic hernia that has been associated with other congenital anomalies. The purpose of this clinical\\u000a review was to determine the incidence of associated anomalies in patients with MH at a major pediatric referral center. The\\u000a medical

  4. Incarceration of the hepatic lobe in incisional hernia: A case report

    PubMed Central

    Eken, Huseyin; Isik, Arda; Buyukakincak, Sercan; Yilmaz, Ismayil; Firat, Deniz; Cimen, Orhan

    2015-01-01

    Introduction Incisional hernias are abnormal peritoneal outward pouch-like protrusions that develop due to defects that arise as a result of the disruption of the fascia's continuity after abdominal surgery. Presentation of case A 77-year-old female patient presented to the emergency department of our hospital with complaints of abdominal swelling, abdominal pain, nausea and vomiting. The patient was recommended for surgery. It was decided that the primary fascia closure and onlay patch was the most appropriate approach. Discussion When the defect in the abdominal wall grows, the functionality of the related abdominal wall is disrupted thereby eliminating the dynamic structure of the abdominal wall. Incisional hernias lead to a significant number of job losses and morbidity and negatively affect quality of life. Moreover, the formations in the hernia pouch might lead to higher risk of strangulation and dysfunction. Conclusion Subcutaneous herniation of the left lobe of the liver passing through the abdominal wall is a very rare condition.

  5. 21 CFR 876.5970 - Hernia support.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5970 Hernia support. (a) Identification. A hernia support is a...

  6. 21 CFR 876.5970 - Hernia support.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5970 Hernia support. (a) Identification. A hernia support is a...

  7. 21 CFR 876.5970 - Hernia support.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5970 Hernia support. (a) Identification. A hernia support is a...

  8. 21 CFR 876.5970 - Hernia support.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5970 Hernia support. (a) Identification. A hernia support is a...

  9. 21 CFR 876.5970 - Hernia support.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5970 Hernia support. (a) Identification. A hernia support is a...

  10. Wide range force feedback for catheter insertion mechanism for use in minimally invasive mitral valve repair surgery

    NASA Astrophysics Data System (ADS)

    Ahmadi, Roozbeh; Sokhanvar, Saeed; Packirisamy, Muthukumaran; Dargahi, Javad

    2009-02-01

    Mitral valve regurgitation (MR) is a condition in which heart's mitral valve does not close tightly, which allows blood to leak back into the left atrium. Restoring the dimension of the mitral-valve annulus by percutaneous intervention surgery is a common choice to treat MR. Currently, this kind of open heart annuloplasty surgery is being performed through sternotomy with cardiomyopathy bypass. In order to reduce trauma to the patient and also to eliminate bypass surgery, robotic assisted minimally invasive surgery (MIS) procedure, which requires small keyhole incisions, has a great potential. To perform this surgery through MIS procedure, an accurate computer controlled catheter with wide-range force feedback capabilities is required. There are three types of tissues at the site of operation: mitral leaflet, mitral annulus and left atrium. The maximum allowable applied force to these three types of tissue is totally different. For instance, leaflet tissue is the most sensitive one with the lowest allowable force capacity. For this application, therefore, a wide-range force sensing is highly required. Most of the sensors that have been developed for use in MIS applications have a limited range of sensing. Therefore, they need to be calibrated for different types of tissue. The present work, reports on the design, modeling and simulation of a novel wide-range optical force sensor for measurement of contact pressure between catheter tip and heart tissue. The proposed sensor offers a wide input range with a high resolution and sensitivity over this range. Using Micro-Electro-Mechanical-Systems (MEMS) technology, this sensor can be microfabricated and integrated with commercially available catheters.

  11. Emergency liver transplant in patient with Child-Pugh class C cirrhosis and strangulated umbilical hernia.

    PubMed

    Chaudhary, Abhideep; Daga, Sachin; Goyal, Neerav; Ramaswamy, Vasudevan Karisangal; Agarwal, Shaleen; Pareek, Shishir; Ray, Ramdip; Wadhawan, Manav; Gupta, Subash

    2013-02-01

    The authors report the case of a patient who presented with small bowel obstruction while awaiting liver transplant for Child-Pugh class C cirrhosis. He underwent emergency liver transplant with resection of the small bowel after the obstruction did not improve with conservative management. The authors believe this is the first case of successful emergency liver transplant with resection of the small bowel in a patient with decompensated Child-Pugh class C liver cirrhosis and strangulated umbilical hernia. This case suggests the possibility of improved outcomes of emergency hernia repair in patients with liver cirrhosis when small bowel resection is combined with liver transplant. PMID:23190414

  12. Treatment of idiopathic intracranial hypertension with gastric bypass surgery.

    PubMed

    Levin, Adriane A; Hess, Donald; Hohler, Anna D

    2015-01-01

    Idiopathic intracranial hypertension (IIH) is defined by elevated intracranial pressure and associated headaches, changes in vision and pulsatile tinnitus, among other symptoms. It occurs most frequently in young, obese women. Gastric bypass surgery has been used to treat morbid obesity and its comorbidities, and IIH has recently been considered among these indications. We present a case report of a 29-year-old female with a maximum BMI of 50.3 and a 5-year history of severe headaches and moderate papilledema due to IIH. She also developed migraine headaches. After a waxing and waning course and various medical treatments, the patient underwent laparoscopic Roux-en-Y gastric bypass surgery with anterior repair of hiatal hernia. Dramatic improvement in IIH headaches occurred by 4 months postprocedure and was maintained at 1 year, when she reached her weight plateau with a BMI of 35. Presurgery migraines persisted. This adds to the small number of case reports and retrospective analyses of the successful treatment of IIH with gastric bypass surgery, and brings this data from the surgical literature into the neurological domain. It offers insight into an early time course for symptom resolution, and explores the impact of weight-loss surgery on migraine headaches. This treatment modality should be further investigated prospectively to analyze the rate of headache improvement with weight loss, the amount of weight loss needed for clinical improvement, and the possible correlation with improvement in papilledema. PMID:24579748

  13. [Perineal incisional hernia following rectal resection. Diagnostic and management].

    PubMed

    Villar, F; Frampas, E; Mirallié, E; Potiron, L; Villet, R; Lehur, P-A

    2003-05-01

    Postoperative perineal hernia is a rare complication following abdominoperineal excision of the rectum. We report four cases illustrating its clinical presentation and modern management. Surgical technique for rectal excision and perineal closure, making of an epiplooplasty, postoperative infection may contribute to the occurrence of this complication. Mesh repair through an anterior open or laparoscopic abdominal approach is one of the surgical options if not contraindicated by age and/or general condition. Perineal or combined approaches can also be selected to solve this difficult problem. PMID:12853021

  14. A transmesenteric congenital internal hernia presenting in an adult

    PubMed Central

    Edwards, Hellen McK; Al-Tayar, Haytham

    2013-01-01

    Congenital internal hernias (CIAHs) are a rare cause of small bowel obstruction in adults. We present a case of transmesenteric CIAH in a 32-year-old male. The clinical examination and computed tomography scan were interpreted as intestinal obstruction, and only an emergency laparotomy revealed that 1 m of small bowel herniated through a 2 cm defect in the mesentery of the transverse colon. Repair of the defect was performed using interrupted suturing, and the patient was discharged after 4 days without sequelae. PMID:24968431

  15. Stenosis of the small intestine after reduction of strangulated Littre hernia in an infant.

    PubMed

    Višnji?, S; Car, A; Kralj, R

    2013-04-01

    Herniation and incarceration of a Meckel's diverticulum in a hernial sac-Littre hernia-is a relatively uncommon surgical emergency. Segmental stenosis of small intestine after hernia reduction and consecutive intestinal obstruction is a similarly rare emergency. The combination of both these disorders is extremely uncommon at any age and especially during infancy. The obvious rarity of the condition, its subtle diagnostic features, the potentially ominous course of events and the age of patient indicate early surgery as a life-saving solution. PMID:21789653

  16. Morgagni hernia diagnosed by MRI

    Microsoft Academic Search

    Noriki Kamiya; Kohei Yokoi; Naoto Miyazawa; Shoichi Hishinuma; Yoshiro Ogata; Nobuhito Katayama

    1996-01-01

    We herein present a patient with Morgagni hernia which was diagnosed by magnetic resonance imaging (MRI). The patient had a progressively enlarging mass in the right cardiophrenic angle on chest roentgenogram. On computed tomography (CT) scans, the mass was revealed to have fat density and therefore was suspected to be either a lipoma or liposarcoma. MRI clearly demonstrated that the

  17. Left diaphragmatic hernia after pneumonectomy.

    PubMed

    Piraccini, E; Agnoletti, V; Corso, R M; Chanis-Vargas, J; Gaetani, S; Gambale, G

    2010-01-01

    Patients undergoing pneumonectomy can suffer by cardiovascular and respiratory postoperative complications that can affect patient's outcome by increasing morbidity and mortality. We describe a diaphragmatic hernia occurring after pneumonectomy. with late presentation and with epidural analgesia confusing the scenario suggesting that anesthesiologists should remain aware on this complication even in the late post operative period. PMID:23439328

  18. Regarding extremely large inguinal hernias with a contribution of two cases.

    PubMed

    Kovachev, L S; Paul, A P; Chowdhary, P; Choudhary, P; Filipov, E T

    2010-04-01

    We report two men of ages 62 and 80 years, respectively, with giant inguinoscrotal hernias. They were operated with a single-stage repair by two approaches, extended preperitoneal of Nyhus and an inguinal method. After hernia content reduction, a policaproamide antimicrobial mesh Ampoxen (MEDICA SA, Sandanski, Bulgaria) with dimensions 20 x 30 cm was inserted by using Stoppa's technique. An additional inguinal reinforcement with other mesh patch was done on the external aponeurosis hernial defect. Synchronous orchiectomy and transscrotal drainage of both patients was performed. The first patient suffering from umbilical hernia was also operated at the same stage. He was prepared by preoperative pneumoperitoneum. The second patient, due to scrotal skin cellulitis with ulceration, was operated without pneumoperitoneum preparation. The latter created easier mobilization and reduction of the hernial content. The sizable mesh dimensions allowed, to some degree, an acceptable level of intra-abdominal pressure after the repair. These hernias demand interdisciplinary teamwork and their treatment has to be adapted to the individual condition of the patient using all therapeutic options. PMID:19495921

  19. [Laparoscopic treatment of abdominal wall hernias: prosthesis material comparison].

    PubMed

    Biondi, A; Tropea, A; Monaco, N; Musmeci, G; Basile, G; Basile, F

    2011-12-01

    Hernia is due to abdominal wall weakening. This allows the contents of the abdomen to protrude from normal boundaries. Hernias are repaired by implanting a sterile surgical mesh to strengthen the weakened abdominal wall. Aim of this study is to compare the results obtained by bard Composix® L/P mesh or Dualmesh Plus Gore® implanting. The mesh has various beneficial characteristics. It is a reinforcing material for the abdominal wall, even when in the direct contact with the intestinal tract does not cause adhsion problems. The use of biocompatible materials is necessary in laparoscopic hernia repair. e-PTFE prosthesis and Dual Mesh® were the first to be used for laparoscopic treatment of the abdominal wall defects. These prosthesis are the result of many improvements, actually they are 1-mm thick and the two surfaces have different characteristics. Compound meshes are composed by e-PTFE and polypropylene with different percentage of the two materials and methods of interactions. The incidence of early complications were poor in relation to both types of implants, only seroma cases e-PTFE treated showed a prevalence of complication, in agreement with literature. About relapses in our experience we found that e-PTFE cases were predominantly. Dual Mesh® has better adaptability than Bard Composix®, which allows easier placement of the prosthesis as well as a better adaptation to the wall surface. The Bard Composix®, thanks to rigidity due to the polypropylene component has better handling than the Dual Mesh®, as it promotes a rapid and easy deployment of the prosthesis inside the abdominal cavity, favoring its positioning. The use of both prosthesis depends also on the experience specific to each operator, moreover, a rigorous surgical technique remains fundamental for the application of the mesh used. PMID:22233661

  20. The role of n-butyl-2-cyanoacrylate in the repair of traumatic diaphragmatic injuries

    PubMed Central

    Bas, Gurhan; Ozkan, Orhan Veli; Alimoglu, Orhan; Eryilmaz, Ramazan; Sahin, Mustafa; Okan, Ismail; Cevikbas, Ugur

    2015-01-01

    Diaphragmatic injuries either by blunt or penetrating trauma require prompt surgical intervention and are often exigent to repair. N-butyl-2-cyanoacrylate (n-butyl-2-CA) is a tissue adhesive which has gained wide application in many areas of surgery including emergency. To repair the extensive injuries of the diaphragm it may be necessary the use of synthetic mesh by fixing it with sutures or staples. The use of tissue adhesives may circumvent the potential problems associated with mesh fixation. This study aimed to evaluate the efficacy and safety of tissue adhesives usage for mesh fixation in diaphragmatic injury repair. Twenty-four rats were divided into 3 groups each of them containing 8 rats. A 1- cm diaphragmatic defect was created in all rats. The defect was repaired by polypropylene suture in Group I, by mesh fixed with sutures in group II and by mesh fixed with n-butyl-2-CA in group III. The rats were sacrificed after 1 month. The episode of hernia and the adhesions were assessed by adhesion density score. Also, the abscess and inflammation in the repaired tissue were evaluated microscopically. The Kruskal-Wallis test was performed for the histopathological analysis. No diaphragmatic hernia was detected in any group. While Group III had higher adhesion density scores than group I (P: 0.027), there were no differences between group III and II (P: 0.317) and group II and I (P = 0.095) regarding adhesion density scores. The inflammation grade was higher in group III than group I and II (P < 0.001) and was higher in group II than group I (P < 0.05). There was no differences between each groups, concerning microabcsess formation (P > 0.05). Repair of traumatic diaphragmatic injury in penetrating wound, with polypropylene mesh fixed by n-butyl-2-CA in rats appears to be as efficacious and safe as conventional methods in early period. However, further experimental and clinical study are needed to compare the long-term results of adhesive mesh repair with those of the traditional sutured techniques. PMID:26131179

  1. The role of n-butyl-2-cyanoacrylate in the repair of traumatic diaphragmatic injuries.

    PubMed

    Bas, Gurhan; Ozkan, Orhan Veli; Alimoglu, Orhan; Eryilmaz, Ramazan; Sahin, Mustafa; Okan, Ismail; Cevikbas, Ugur

    2015-01-01

    Diaphragmatic injuries either by blunt or penetrating trauma require prompt surgical intervention and are often exigent to repair. N-butyl-2-cyanoacrylate (n-butyl-2-CA) is a tissue adhesive which has gained wide application in many areas of surgery including emergency. To repair the extensive injuries of the diaphragm it may be necessary the use of synthetic mesh by fixing it with sutures or staples. The use of tissue adhesives may circumvent the potential problems associated with mesh fixation. This study aimed to evaluate the efficacy and safety of tissue adhesives usage for mesh fixation in diaphragmatic injury repair. Twenty-four rats were divided into 3 groups each of them containing 8 rats. A 1- cm diaphragmatic defect was created in all rats. The defect was repaired by polypropylene suture in Group I, by mesh fixed with sutures in group II and by mesh fixed with n-butyl-2-CA in group III. The rats were sacrificed after 1 month. The episode of hernia and the adhesions were assessed by adhesion density score. Also, the abscess and inflammation in the repaired tissue were evaluated microscopically. The Kruskal-Wallis test was performed for the histopathological analysis. No diaphragmatic hernia was detected in any group. While Group III had higher adhesion density scores than group I (P: 0.027), there were no differences between group III and II (P: 0.317) and group II and I (P = 0.095) regarding adhesion density scores. The inflammation grade was higher in group III than group I and II (P < 0.001) and was higher in group II than group I (P < 0.05). There was no differences between each groups, concerning microabcsess formation (P > 0.05). Repair of traumatic diaphragmatic injury in penetrating wound, with polypropylene mesh fixed by n-butyl-2-CA in rats appears to be as efficacious and safe as conventional methods in early period. However, further experimental and clinical study are needed to compare the long-term results of adhesive mesh repair with those of the traditional sutured techniques. PMID:26131179

  2. Acute management of a unilateral incarcerated spigelian hernia in a patient with bilateral spigelian hernias

    PubMed Central

    Monkhouse, SJW

    2013-01-01

    Spigelian hernias were first described by Joseph Klinkosch in the 18th century, and have since posed a diagnostic and surgical problem owing to their non-specific presentation and rarity. While the management of unilateral hernias is fairly well described in today’s literature, bilateral Spigelian hernias are very rare. We describe the emergency management of a patient with bilateral Spigelian hernias, diagnosed on computed tomography. PMID:24025275

  3. Meningocele repair

    MedlinePLUS

    ... Myelodysplasia repair; Spinal dysraphism repair; Meningomyelocele repair; Neural tube defect repair; Spina bifida repair ... hydrocephalus, the doctor may put a shunt (plastic tube) in their brain to drain the extra fluid ...

  4. Abdominal Hernias Complicating Continuous Ambulatory Peritoneal Dialysis

    Microsoft Academic Search

    John P. O’Connor; Russell J. Rigby; Ian R. Hardie; Darryl R. Wall; Russell W. Strong; Peter W. H. Woodruff; James J. B. Petrie

    1986-01-01

    Twenty-five percent of all CAPD patients reviewed in this study developed abdominal hernias. Eleven hernias (32.4%) occurred at the catheter insertion site, 17.6% were inguinal, 26.5% were epigastric and umbilical and 23.5 % occurred at the site of previous abdominal incisions. The risk of developing a hernia was significantly greater in patients over 40 years of age, women of parity

  5. Internal hernias: anatomical basis and clinical relevance

    Microsoft Academic Search

    O. Armstrong; A. Hamel; B. Grignon; J. Peltier; O. Hamel; E. Letessier; J. C. Le Neel; R. Robert; J. M. Rogez

    2007-01-01

    The aim of this study was to present and discuss the anatomical basis of internal hernias thanks to our clinical experience\\u000a of 14 cases. Internal hernias are uncommon cases of acute intestinal obstruction when a viscera protrudes through an intraperitoneal\\u000a orifice, remaining inside the peritoneal cavity. It excludes iatrogenic post surgical hernias. From an anatomical point of\\u000a view, three kinds

  6. Diagnosis of Congenital Diaphragmatic Hernia

    Microsoft Academic Search

    Mieke Cannie; Jacques Jani

    \\u000a With advances in ultrasound technology, congenital diaphragmatic hernia (CDH) is easily diagnosed prenatally. In contrast,\\u000a prenatal prognostication remains a challenge. In view of the current availability of fetal therapy this becomes even more\\u000a important. To date, one of the most studied markers is the lung-area to head circumference ratio and has been shown in large\\u000a studied to be predictive of

  7. Transthoracic approach in surgical management of Morgagni hernia

    Microsoft Academic Search

    Dalokay K?l?ç; Ayd?n Nadir; Egemen Döner; ?evket Kavukçu; Murat Akal; Nezih Özdemir; Hadi Akay; ?lker Ökten

    2001-01-01

    Objective: Morgagni hernia is an uncommon type of diaphragmatic hernias. Numerous approaches have been described and, particularly the significance of laparatomy has been emphasized as an operative technique. We present our experience on patients with Morgagni hernia operated on via transthoracic approach in our department. Materials and methods: Between January 1986 and March 2000, 16 patients with Morgagni hernia were

  8. Transthoracic approach in surgical management of Morgagni hernia

    Microsoft Academic Search

    Dalokay Kilic; Aydin Nadir; Egemen Doner; Murat Akal; Nezih Ozdemir; Hadi Akay; Ilker Okten

    Objective: Morgagni hernia is an uncommon type of diaphragmatic hernias. Numerous approaches have been described and, particularly the significance of laparatomy has been emphasized as an operative technique. We present our experience on patients with Morgagni hernia operated on via transthoracic approach in our department. Materials and methods: Between January 1986 and March 2000, 16 patients with Morgagni hernia were

  9. Morgagni hernia in a patient with Morquio syndrome

    Microsoft Academic Search

    T. Z. Nursal; M. Atli; V. Kaynaroglu

    2000-01-01

    Summary Morgagni hernia is a type of congenital diaphragmatic hernia which constitutes 2–6% of congenital diaphragmatic hernia cases. Morquio syndrome, a type of lysosomal hydrolase deficiency, results in keratan sulphate accumulation and skeletal dystrophy. Other anomalies such as cardiac anomalies and trisomy 21 may accompany the Morquio syndrome; however Morgagni hernia has not been previously reported with this syndrome. A

  10. Introducing the Proceed Ventral Patch as a new device in surgical management of umbilical and small ventral hernias: preliminary results.

    PubMed

    Tollens, Tim; Struyve, David; Aelvoet, Chris; Vanrijkel, Jean Pierre

    2010-04-01

    Surgical treatment of umbilical and small ventral hernias ranges from a simple suture repair to the placement of large intra-abdominal or retromuscular meshes. Several articles report a lower incidence of recurrence after mesh repair, whether this is positioned onlay, retromuscular, or intraperitoneally. Often, a simple suture repair fails in the longterm, whereas a laparoscopic or retromomuscular approach seems too extensive for these rather small hernias. In between those two treatment options exists a go-between repair that carries the idea of posterior repair without being so aggressive in its approach. In this study, the authors examined a new device called the Proceed Ventral Patch (PVP) (Ethicon, Inc., Sommerville, NJ, USA). It is a self-expanding, partially absorbable, flexible laminate mesh device that allows an easy, quick and minimal invasive, tension-free, and standardized approach to umbilical hernia treatment. No data nor publication exist on this new device. Reported herein is our early and first experience with this novel technique. PMID:20437352

  11. Strangulated umbilical hernia in a child.

    PubMed Central

    Vyas, I. D.; MacKinnon, A. E.

    1983-01-01

    We describe a case of strangulated umbilical hernia in a girl aged 5 years. She presented with an acute inflammatory lesion at the umbilicus which was initially thought to be due to cellulitis with possible abscess formation. Exploration revealed an umbilical hernia containing necrotic greater omentum. PMID:6657544

  12. Fetal stabilization for antenatally diagnosed diaphragmatic hernia

    Microsoft Academic Search

    Sachiyo Suita; Tomoaki Taguchi; Takeshi Yamanouchi; Kouji Masumoto; Keiko Ogita; Masatoshi Nakamura; Hideki Nakayama; Toshiro Hara; Kiyomi Tsukimori; Hitoo Nakano; Tomoo Kanna; Shousuke Takahashi

    1999-01-01

    Background\\/Purpose: Infants with congenital diaphragmatic hernia have pulmonary hypoplasia resulting in persistent pulmonary hypertension of neonates (PPHN), which is the main contributor to both high mortality and morbidity. The pulmonary artery bed in patients with congenital diaphragmatic hernia (CDH) is underdeveloped and is very sensitive to slight stimuli. It is, therefore, vital to avoid any factors that might increase pulmonary

  13. A Case of Nonalcoholic Steatohepatitis and Small Intestinal Bacterial Overgrowth with Peripheral Edema Caused by Intestinal Bypass Surgery and Relieved by Repair

    PubMed Central

    Sung, Young Kyung; Gwak, Geum Youn; Choi, Moon Seok; Koh, Kwang Chul; Paik, Seung Woon; Yoo, Byung Chul

    2012-01-01

    Intestinal bypass surgery, particularly jejuno-ileal bypass surgery, performed for the purpose of weight reduction may cause an unexpected exacerbation of nonalcoholic steatohepatitis (NASH). Here, we report a case of NASH caused by small intestinal bacterial overgrowth, which developed after jejuno-colic bypass surgery and resolved dramatically after surgical correction. PMID:23170161

  14. Sciatic hernia mimicking perianal abscess in a cirrhotic patient.

    PubMed

    Andraus, Wellington; Haddad, Luciana Bertocco de Paiva; Ferro, Oscar Cavalcante; D'Albuquerque, Luiz Augusto Carneiro

    2012-01-01

    Abdominal hernias are very frequent in cirrhotic patients with ascites. The hernias usually present as umbilical, inguinal, incisional, or femoral. However, these patients can also develop uncommon hernias such as pelvic hernias because of pelvic floor weakness and high abdominal pressure due to ascites. We present the first case of a cirrhotic patient with ascites that developed a giant sciatic hernia mimicking a perianal abscess. PMID:23150732

  15. Salvage hypospadias repairs

    PubMed Central

    Sripathi, V.; Satheesh, M.; Shubha, K.

    2008-01-01

    Aim: Review of our experience and to develop an algorithm for salvage procedures in the management of hypospadias cripples and treatment of urethral strictures following hypospadias repair. Methods: This is a retrospective review of hypospadias surgeries over a 41-month period. Out of a total 168 surgeries, 20 were salvage/re-operative repairs. In three children a Duplay repair was feasible, while in four others a variety of single-stage repairs could be done. The repair was staged in seven children – buccal mucosal grafts (BMGs) in five, buccal mucosal tube in one, and skin graft in one. Five children with dense strictures were managed by dorsal BMG inlay grafting in one, vascularized tunical onlay grafting on the ventrum in one, and a free tunical patch in one. Three children were treated by internal urethrotomy and stenting for four weeks with a poor outcome. Results: The age of children ranged from 1.5–15 years (mean 4.5). Follow-up ranged from 3 months to 3.5 years. Excellent results were obtained in 10 children (50%) with a well-surfaced erect penis and a slit-like meatus. Glans closure could not be achieved and meatus was coronal in three. Two children developed fistulae following a Duplay repair and following a staged BMG. Three repairs failed completely – a composite repair broke down, a BMG tube stenosed with a proximal leak, and a stricture recurred with loss of a ventral free tunical graft. Conclusions: In salvage procedures performed on hypospadias cripples, a staged repair with buccal mucosa as an inlay in the first stage followed by tubularization 4–6 months later provides good results. A simple algorithm to plan corrective surgery in failed hypospadias cases and obtain satisfactory results is devised. PMID:20011495

  16. Cleft lip repair - series (image)

    MedlinePLUS

    ... palate repair, tissue from the back of the mouth (pharynx) may be taken to add tissue to the deficient soft palate (this is called a pharyngeal flap). Occasionally more than one surgery is required for complete palate closure.

  17. Anesthetic implications of laparoscopic surgery.

    PubMed Central

    Cunningham, A. J.

    1998-01-01

    Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease. PMID:10604786

  18. Sports Hernia/Athletic Pubalgia

    PubMed Central

    Larson, Christopher M.

    2014-01-01

    Context: Sports hernia/athletic pubalgia has received increasing attention as a source of disability and time lost from athletics. Studies are limited, however, lacking consistent objective criteria for making the diagnosis and assessing outcomes. Evidence Acquisition: PubMed database through January 2013 and hand searches of the reference lists of pertinent articles. Study Design: Review article. Level of Evidence: Level 5. Results: Nonsurgical outcomes have not been well reported. Various surgical approaches have return-to–athletic activity rates of >80% regardless of the approach. The variety of procedures and lack of outcomes measures in these studies make it difficult to compare one surgical approach to another. There is increasing evidence that there is an association between range of motion–limiting hip disorders (femoroacetabular impingement) and sports hernia/athletic pubalgia in a subset of athletes. This has added increased complexity to the decision-making process regarding treatment. Conclusion: An association between femoroacetabular impingement and athletic pubalgia has been recognized, with better outcomes reported when both are managed concurrently or in a staged manner. PMID:24587864

  19. Obstructive Uropathy Secondary to Uretero-inguinal Hernia

    PubMed Central

    Hong, Lih En; Tan, Chrismin; Li, Jordan

    2015-01-01

    Uretero-inguinal hernia in patients with native kidneys is rare. We report a case of an 84-year-old man who was diagnosed with obstructive uropathy secondary to uretero-inguinal hernia, with no past history of herniorrhaphy or congenital genitourinary malformation. Uretero-inguinal hernias are predominantly indirect inguinal hernias and may be paraperitoneal or extraperitoneal. Computed tomography (CT) is a non-invasive diagnostic tool for uretero-inguinal hernia. Herniorrhaphy is indicated in all cases of uretero-inguinal hernia to prevent obstructive uropathy.

  20. Amyand's hernia: Our experience in the laparoscopic era

    PubMed Central

    Sahu, Diwakar; Swain, Sudeepta; Wani, Majid; Reddy, Prasanna Kumar

    2015-01-01

    Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment. PMID:25883458

  1. Amyand's hernia: Our experience in the laparoscopic era.

    PubMed

    Sahu, Diwakar; Swain, Sudeepta; Wani, Majid; Reddy, Prasanna Kumar

    2015-01-01

    Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment. PMID:25883458

  2. Leiomyoma mimicking an incarcerated inguinal hernia: A rare complication of laparoscopic hysterectomy

    PubMed Central

    Apestegui, Carlos; Tamer, Saadallah; Ciccarelli, Olga; Bonaccorsi-Riani, Eliano; Marbaix, Etienne; Lerut, Jan

    2011-01-01

    A 52-year-old, obese, female patient was referred for a right inguinal mass, which appeared seven months after a laparoscopic hysterectomy, which was performed because of myomatosis. Despite several examinations, including ultrasound, computed tomography (CT)-Scan, positron emission tomography (PET)-CT, and ultrasound-guided biopsy, the diagnosis remained unclear until surgical exploration, which disclosed a well-encapsulated solid tumour corresponding to a fibrotic leiomyoma. Spilling of leiomyoma cells is a rare and unusual complication of laparoscopic surgery. Tumour development in the inguinal canal after laparoscopic gynaecological surgery should be kept in mind in the differential diagnosis of inguinal hernia and other uncommon pathologies. PMID:21523240

  3. A double blind randomized controlled trial comparing primary suture closure with mesh augmented closure to reduce incisional hernia incidence

    PubMed Central

    2013-01-01

    Background Incisional hernia is the most frequently seen long term complication after laparotomy causing much morbidity and even mortality. The overall incidence remains 11-20%, despite studies attempting to optimize closing techniques. Two patient groups, patients with abdominal aortic aneurysm and obese patients, have a risk for incisional hernia after laparotomy of more than 30%. These patients might benefit from mesh augmented midline closure as a means to reduce incisional hernia incidence. Methods/design The PRImary Mesh Closure of Abdominal Midline Wound (PRIMA) trial is a double-blinded international multicenter randomized controlled trial comparing running slowly absorbable suture closure with the same closure augmented with a sublay or onlay mesh. Primary endpoint will be incisional hernia incidence 2 years postoperatively. Secondary outcomes will be postoperative complications, pain, quality of life and cost effectiveness. A total of 460 patients will be included in three arms of the study and randomized between running suture closure, onlay mesh closure or sublay mesh closure. Follow-up will be at 1, 3, 12 and 24 months with ultrasound imaging performed at 6 and 24 months to objectify the presence of incisional hernia. Patients, investigators and radiologists will be blinded throughout the whole follow up. Disccusion The use of prosthetic mesh has proven effective and safe in incisional hernia surgery however its use in a prophylactic manner has yet to be properly investigated. The PRIMA trial will provide level 1b evidence whether mesh augmented midline abdominal closure reduces incisional hernia incidence in high risk groups. Trial registration Clinical trial.gov NCT00761475. PMID:24499111

  4. Anencephaly with diaphragmatic hernia in sibs

    Microsoft Academic Search

    T J David; V M Parker; C A Illingworth

    1979-01-01

    Two sibs who both had anencephaly and diaphragmatic hernia are reported. The type of diaphragmatic defect seen in anencephaly may differ from the defect seen in other babies. It is important to perform a necropsy in anencephaly.

  5. CT diagnosis of hernia of Morgagni

    Microsoft Academic Search

    Donald Fagelman; James G. Caridi

    1984-01-01

    A single case of hernia of Morgagni diagnosed by computed tomography (CT) is presented. CT is an accurate, noninvasive method of evaluating this entity and can replace many of the other imaging modalities previously employed.

  6. A primer on wound healing in colorectal surgery in the age of bioprosthetic materials.

    PubMed

    Lundy, Jonathan B

    2014-12-01

    Wound healing is a complex, dynamic process that is vital for closure of cutaneous injuries, restoration of abdominal wall integrity after laparotomy closure, and to prevent anastomotic dehiscence after bowel surgery. Derangements in healing have been described in multiple processes including diabetes mellitus, corticosteroid use, irradiation for malignancy, and inflammatory bowel disease. A thorough understanding of the process of healing is necessary for clinical decision making and knowledge of the current state of the science may lead future researchers in developing methods to enable our ability to modulate healing, ultimately improving outcomes. An exciting example of this ability is the use of bioprosthetic materials used for abdominal wall surgery (hernia repair/reconstruction). These bioprosthetic meshes are able to regenerate and remodel from an allograft or xenograft collagen matrix into site-specific tissue; ultimately being degraded and minimizing the risk of long-term complications seen with synthetic materials. The purpose of this article is to review healing as it relates to cutaneous and intestinal trauma and surgery, factors that impact wound healing, and wound healing as it pertains to bioprosthetic materials. PMID:25435821

  7. Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias.

    PubMed

    DiBello, J N; Moore, J H

    1996-09-01

    Despite a reported incidence of up to 11 percent of incisional/ventral hernias following celiotomies, there is no universally applicable preventive or reconstructive technique in practice. Among patients undergoing repair of ventral incisional herniation, the reported recurrence rates are typically in the 30- to 50-percent range. This study concentrates on the patient with a large, recurrent abdominal incisional hernia in whom conventional surgical repair has failed. We report our recent 4-year experience with the use of "components separation" of the myofascial layers of the abdominal wall for repair of these recurrent herniations. During 4-year period, 35 patients with large, recurrent ventral hernias underwent repair by the same surgeon (J. H. M.) using the method described below. Abdominal defects as large as 875 cm2 were repaired, with a median defect size of 255 cm2. The repair was based on the compound flap of the rectus muscle with its attached internal oblique-transversus abdominus muscle with advancement to the midline to recreate the linea alba. Any repairs that were attenuated were supported with either ePTFE (8.6 percent) or Vicryl mesh (34 percent). The study group consisted of 35 patients, 34 percent male and 66 percent female; mean age was 55 years. Length of follow-up ranged from 1 to 43 months, with a mean follow-up of 22 months. Overall recurrence rate for herniation was 8.5 percent (3/35). Additional complications, namely seroma, wound infection, and hematoma, occurred at rates of 2.8, 5.7, and 5.7 percent, respectively. There were no mortalities. The compound flap of the rectus and internal oblique-transversus can be advanced medially to recreate the linea alba to provide dynamic, stable support for defects as large as 875 cm2. A recurrence rate of 8.5 percent was achieved in a relatively high-risk population with acceptable morbidity and no mortalities. In our 4-year experience, the sliding rectus abdominus myofascial flap has proved to be a safe and effective tool for dealing with patients in whom conventional means of repair have failed. PMID:8700983

  8. A promising new device for the prevention of parastomal hernia.

    PubMed

    Hoffmann, Henry; Oertli, Daniel; Soysal, Savas; Zingg, Urs; Hahnloser, Dieter; Kirchhoff, Philipp

    2015-06-01

    Parastomal hernia (PSH) is the most frequent long-term stoma complication with serious negative effects on quality of life. Surgical revision is often required and has a substantial morbidity and recurrence rate. The development of PSH requires revisional surgery with a substantial perioperative morbidity and high failure rate in the long-term follow-up. Prophylactic parastomal mesh insertion during stoma creation has the potential to reduce the rate of PSH, but carries the risk of early and late mesh-related complications such as infection, fibrosis, mesh shrinkage, and/or bowel erosion. We developed a new stomaplasty ring (KORING), which is easy to implant, avoids potential mesh-related complications, and has a high potential of long-term prevention of PSH. Here we describe the technique and the first use. PMID:25432883

  9. Biological mesh for abdominal wall hernia synthetic mesh multidrug-resistant Pseudomonas aeruginosa infection: Report of a case

    Microsoft Academic Search

    George Peppas; Marinos C. Makris; Matthew E. Falagas

    2011-01-01

    The use of biological mesh for the treatment of synthetic mesh-related infections in patients who undergo ventral hernia repair\\u000a has been considered over the past few years. Removal of the infected synthetic mesh, which may be required in such cases,\\u000a can result in recurring herniation. Biological implants have thus been recently used for the reconstruction of the existing\\u000a defect. We

  10. Foramen of Morgagni hernia: changes in diagnosis and treatment

    Microsoft Academic Search

    Peter C Minneci; Katherine J Deans; Peter Kim; Douglas J Mathisen

    2004-01-01

    BackgroundForamen of Morgagni hernias are uncommon diaphragmatic hernias for which there are limited reported data. The purpose of this study is to report a recent case series of foramen of Morgagni hernias in the context of new diagnostic and treatment modalities.

  11. Foramen of Morgagni Hernia: Changes in Diagnosis and Treatment

    Microsoft Academic Search

    Peter C. Minneci; Katherine J. Deans; Peter Kim; Douglas J. Mathisen

    Background. Foramen of Morgagni hernias are uncom- mon diaphragmatic hernias for which there are limited reported data. The purpose of this study is to report a recent case series of foramen of Morgagni hernias in the context of new diagnostic and treatment modalities. Methods. A retrospective chart review was performed over a 15-year period, from 1987 to 2001. Twelve patients

  12. Retrosternal hernia (Morgagni) with colonic perforation due to incarceration

    Microsoft Academic Search

    Özden Çakmak; Osman Pektas; Didem Baskin

    1990-01-01

    Retrosternal (Morgagni) hernias in children are usually asymptomatic or may be associated with mild respiratory distress or gastrointestinal symptoms. Incarceration of bowel in a retrosternal hernia is unusual. This report describes a complete colonic obstruction with incarceration and perforation in a Morgagni hernia.

  13. [Clinical case--voluminous diaphragmatic hernia--surgically acute abdomen: diagnostic and therapeutical challenges].

    PubMed

    Dumitrescu, D; Savlovschi, C; Borcan, R; Pantu, H; Serban, D; Gradinaru, S; Smarandache, G; Trotea, T; Branescu, C; Musat, L; Comandasu, M; Priboi, M; Baldir, M; Sandolache, B; Oprescu, S

    2011-01-01

    We present the case of a 58-year old male patient admitted in the surgery section of the University Emergency Hospital of Bucharest and diagnosed with acute abdomen. The minimal clinical-paraclinical investigation (i.e., thorax-pulmonary Xray, biological probes) raises questions as to the differentiated diagnosis and other associated diseases, also suggesting the existence of voluminous diaphragmatic hernia. The CT thorax-abdomen examination confirms the diaphragmatic hernia suspicion, with intra-thorax ascent of the colon up to the anterior C4 level, but does not explain the abdominal suffering; thus we suspected a biliary ileus or acute appendicitis. Medial laparotomy was imperative. Intrasurgically peritonitis was noticed located by gangrenous acute apendicitis, perforated, with coprolite, for which apendictomy and lavage-drainage pf the peritoneal cavity was performed. Post-surgical status: favourable to recovery. PMID:22165067

  14. The ACGME case log: General surgery resident experience in pediatric surgery

    PubMed Central

    Gow, Kenneth W.; Drake, F. Thurston; Aarabi, Shahram; Waldhausen, John H.

    2014-01-01

    Background General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. Methods The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989–1990 to 2010–2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989–90 to AY1993–94), Period II (AY1994–95 to AY1998–99), Period III (AY1999–00 to AY2002–03), Period IV (AY2003–04 to AY2006–07), and Period V (AY2007–08 to AY2010–11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05. Results Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. Conclusions GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. PMID:23932601

  15. Herniation of the gallbladder within a hernia of the abdominal wall associated with Mirizzi Syndrome.

    PubMed

    Paolino, LA; Millan, M; Bossi, M; Champault, G; Barrat, C

    2011-01-01

    A gallbladder incarcerated hernia associated with Mirizzi syndrome is a very rare entity and to our knowledge this is the first case ever described in literature. An 85-year-old man presented at the emergency department with a tender right upper quadrant mass. Computed Tomography (CT) revealed the presence of a gallbladder lithiasis with signs of acute cholecystitis, herniated through the abdominal wall with an associated Mirizzi syndrome. Laparoscopic cholecystectomy and repair of the abdominal wall defect were performed. The patient recovered very well and the postoperative period was uneventful. PMID:24950574

  16. Herniation of the gallbladder within a hernia of the abdominal wall associated with Mirizzi Syndrome

    PubMed Central

    Paolino, LA; Millan, M; Bossi, M; Champault, G; Barrat, C

    2011-01-01

    A gallbladder incarcerated hernia associated with Mirizzi syndrome is a very rare entity and to our knowledge this is the first case ever described in literature. An 85-year-old man presented at the emergency department with a tender right upper quadrant mass. Computed Tomography (CT) revealed the presence of a gallbladder lithiasis with signs of acute cholecystitis, herniated through the abdominal wall with an associated Mirizzi syndrome. Laparoscopic cholecystectomy and repair of the abdominal wall defect were performed. The patient recovered very well and the postoperative period was uneventful. PMID:24950574

  17. Traumatic diaphragmatic hernia. Occult marker of serious injury.

    PubMed Central

    Meyers, B F; McCabe, C J

    1993-01-01

    OBJECTIVE: Recent experience with traumatic diaphragmatic hernias at the Massachusetts General Hospital was reviewed to identify pitfalls in the diagnosis and treatment of this injury. SUMMARY BACKGROUND DATA: Traumatic diaphragmatic disruption is a common injury and a marker of severe trauma. It occurs in 5% of hospitalized automobile accident victims and 10% of victims of penetrating chest trauma. Numerous reports describe splenic rupture in 25% of patients with blunt diaphragmatic rupture, liver lacerations in 25%, pelvic fracture in 40%, and thoracic aortic tears in 5%. Diaphragmatic rupture is a predictor of serious associated injuries which, unfortunately, is itself often occult. METHODS: A chart review of all patients admitted to the Trauma Service with traumatic diaphragmatic hernias was undertaken for the period of January 1982 to June 1992. RESULTS: Data on 68 patients sustaining blunt (n = 25) and penetrating (n = 43) diaphragmatic rupture or laceration were presented. The diagnosis was made preoperatively in only 21 (31%). Associated injuries were frequent in those injured by either blunt or penetrating trauma. Sixty-six patients underwent repair, 54 (82%) through a laparotomy alone and 12 (18%) with the addition of a thoracotomy. There were five (7.4%) deaths that were caused by coagulopathy, hemorrhagic shock, multisystem organ failure, and pulmonary embolism. Complications were twice as frequent in the blunt-trauma group and included abscess, pneumonia, and the sequelae of closed head injuries. CONCLUSIONS: The recognition of diaphragmatic rupture is important because of the frequency and severity of associated injuries. The difficulties in reaching the diagnosis require an aggressive search in patients at risk. Images Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. PMID:8257229

  18. Integrating a novel shape memory polymer into surgical meshes decreases placement time in laparoscopic surgery: an in vitro and acute in vivo study.

    PubMed

    Zimkowski, Michael M; Rentschler, Mark E; Schoen, Jonathan; Rech, Bryan A; Mandava, Nageswara; Shandas, Robin

    2013-09-01

    About 600,000 hernia repair surgeries are performed each year; recently, 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 study, 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. Results indicate surgical mesh modified with SMP is capable of laparoscopic deployment in vivo, activated by body temperature. This suggests a reduction in surgical operating time and improved mesh placement characteristics is possible with SMP-integrated surgical meshes. PMID:23412974

  19. Holt-Oram syndrome and diaphragmatic hernia associate with paracentric inversion of chromosome 8

    SciTech Connect

    Eswara, M.S.; Batanian, J.R. [St. Louis Univ., MO (United States)

    1994-09-01

    Holt-Oram syndrome (HOS) consists of congenital heart disease, usually atrial septal defect, along with thumb anomalies and occasionally more extensive limb defects. Inheritance is autosomal dominant. Previous reports have associated HOS with cytogenetic abnormalities on chromosomes 4, 14 and 20. Recently a linkage study has suggested a HOS locus on chromosome 12. We describe another case of HOS with a de novo cytogenetic abnormality. On prenatal ultrasound, IUGR, oligohydramnios and left diaphragmatic hernia were noted. Following delivery, patient was placed on extra-corporeal membrane oxygenation because of severe lung hypoplasia; diaphragmatic hernia was repaired with mesh graft. He expired on day 17 of life. On exam, he had subtle dysmorphic features with hypotelorism and abnormal folding of the ear lobes. He had bilateral radial aplasia, aplasia of thumbs, index and middle fingers, along with the metacarpals. On autopsy he was found to have atrial septal defect of the ostium secundum type, right side aortic arch with vascular ring formation, bicuspid pulmonic valve and severe lung hypoplasia worse on the left. Cytogenetic analysis on blood and skin showed 48,XX,inv(8)(q24.2q13). Chromosome fragility study was negative. Parental chromosomes were normal. Our observation of inv(8)q with HOS and diaphragmatic hernia may indicate genetic heterogeneity with this condition. Regulation of morphogenesis is likely under the control of a hierarchy of genes; multiple loci for conditions such as HOS would not be surprising.

  20. Effect of mesh type, surgeon and selected patients’ characteristics on the treatment of inguinal hernia with the Lichtenstein technique. Randomized trial

    PubMed Central

    Szczepanik, Andrzej B.; Wróblewski, Tadeusz

    2013-01-01

    Introduction Though not entirely free of complications, the Lichtenstein technique is still considered the “gold standard” for inguinal hernia repair due to the low recurrence rate. Aim In our study we determined the effect of mesh type, surgeon and selected patients’ characteristics on treatment results. The latter were determined by the frequency of early complications, recovery time and return to normal activities, chronic pain and hernia recurrence. Material and methods Tension-free hernia repair with the Lichtenstein technique was performed in 149 male patients aged 20-89 years randomized to two trial groups. One group comprised 76 patients with heavyweight non-absorbable polypropylene mesh (HW group) and the other included 73 patients with lightweight partially absorbable mesh (LW group). The control schedule follow-up took place on the 7th day as well as in the 3rd and 6th month after the operation. Statistical analysis was performed with multi-factor regression models. Results In the LW group patients returned to normal activity faster (p = 0.031), experienced less intensive chronic pain (p = 0.01) and expressed higher treatment satisfaction (p = 0.024) than the patients from the HW group. The type of mesh had an insignificant influence on the risk of early complications and hernia recurrence. Statistically significant differences were observed however with regard to surgeon, type and hernia duration, patient's general condition and body mass. Conclusions Both types of mesh are equally effective for prevention of hernia recurrence. Lightweight partially absorbable meshes are more beneficial to patients than the heavyweight non-absorbable type. The surgeon and patients’ characteristics have a significant impact on the treatment outcome. PMID:23837093

  1. Hiatal hernia in pediatric patients: laparoscopic versus open approaches

    PubMed Central

    Namgoong, Jung-Man; Kim, Seong-Chul; Hwang, Ji-Hee

    2014-01-01

    Purpose The aim of this study was to evaluate the surgical outcomes of laparoscopic approach for hiatal hernia (HH) in pediatric patients. Methods This was a retrospective study of 33 patients younger than 18 years who underwent an operation for HH between January 1999 and December 2012. Results The HH symptoms were various and included regurgitation, vomiting, weight loss, cough, hoarseness, and cyanosis. Among the 33 patients, there were 25 sliding types, 1 paraesophageal type, and 7 mixed types. Open surgery (OS) and laparoscopic surgery (LS) were used in 16 and 17 patients, respectively. There were no statistically significant differences in sex, age, or body weight between the groups. The median operating time was longer in the LS group (150 minutes; range, 90-250 minutes vs. 125 minutes; range, 66-194 minutes; P = 0.028). Time to oral intake was shorter in the LS group than in the OS group (1 day; range, 1-3 days vs. 2 days; range, 1-7 days; P = 0.001) and time to full feeding was shorter in the LS group than in the OS group (6 days; range, 3-16 days vs. 10 days; range, 3-33 days; P = 0.048). There were no differences in length of hospital stay and complications between the two groups. There was no perioperative mortality or recurrence of HH. Conclusion A good surgical outcome for laparoscopic correction of HH was seen in pediatric patients. PMID:24851228

  2. Surgery in osteogenesis imperfecta.

    PubMed

    Cole, W G

    1995-01-01

    An analysis of 266 operations on 63 patients with osteogenesis imperfecta, mostly type III and IV, showed that about half had corrections of skeletal deformities and internal splinting with intramedullary stainless steel rods. The remaining operations were for other orthopaedic procedures as well as non-orthopaedic procedures such as hernia repairs. There were no major anaesthetic or post-operative complications. Mild pyrexia was common but without the features of malignant hyperpyrexia. Correction of long deformities and internal splintage of the bones with non-expanding rods effectively reduced the fracture rate but deformities and fractures recurred as the epiphyses grew off the ends of the rods. Expanding rods provided continuing splintage during growth but could not be used in children with very narrow or very fragile bones. PMID:15612377

  3. Preservation of Facial Nerve Function Repaired by Using Fibrin Glue-Coated Collagen Fleece for a Totally Transected Facial Nerve during Vestibular Schwannoma Surgery.

    PubMed

    Choi, Kyung-Sik; Kim, Min-Su; Jang, Sung-Ho; Kim, Oh-Lyong

    2014-04-01

    Recently, the increasing rates of facial nerve preservation after vestibular schwannoma (VS) surgery have been achieved. However, the management of a partially or completely damaged facial nerve remains an important issue. The authors report a patient who was had a good recovery after a facial nerve reconstruction using fibrin glue-coated collagen fleece for a totally transected facial nerve during VS surgery. And, we verifed the anatomical preservation and functional outcome of the facial nerve with postoperative diffusion tensor (DT) imaging facial nerve tractography, electroneurography (ENoG) and House-Brackmann (HB) grade. DT imaging tractography at the 3rd postoperative day revealed preservation of facial nerve. And facial nerve degeneration ratio was 94.1% at 7th postoperative day ENoG. At postoperative 3 months and 1 year follow-up examination with DT imaging facial nerve tractography and ENoG, good results for facial nerve function were observed. PMID:25024825

  4. Chest wall repair in Poland syndrome: complex single-stage surgery including Vertical Expandable Prosthetic Titanium Rib stabilization--a case report.

    PubMed

    Lieber, Justus; Kirschner, Hans Joachim; Fuchs, Jörg

    2012-03-01

    Various surgical techniques have been described for repair of chest wall defects in Poland syndrome. We describe the case of a 16-year-old boy who underwent autologous rib transposition after sternal osteotomy. Chest wall stabilization was achieved using a combination of K-wires and Vertical Expandable Prosthetic Titanium Rib (Synthes GmbH, Freiburg, Germany). Reconstruction of the soft tissue defect was accomplished by combined latissimus dorsi muscle flap and Permacol patch (Covidien Deutschland GmbH, Neustadt, Germany). This approach might be considered an effective 1-stage treatment option of this condition in postpubescent boys. PMID:22424369

  5. Magnetic resonance imaging of Morgagni hernia

    Microsoft Academic Search

    Bradford A. Yeager; Gwen E. Guglielmi; Mark L. Schiebler; Warren B. Gefter; Herbert Y. Kressel

    1987-01-01

    A case of a Morgagni hernia is demonstrated by magnetic resonance imaging (MRI). The correct diagnosis was facilitated by the ability to image directly the anteromedial diaphragmatic defect in the coronal and sagittal planes. The findings from MRI, computed tomography, and radiographic studies are correlated.

  6. Traumatic Diaphragmatic Hernia or Something Else?

    PubMed Central

    Thakur, Nagarjuna; Kumar, Narender; G, Prashanth; Mohammed, Shoukatulla

    2014-01-01

    Subcutaneous emphysema (SCE) mimicking diaphragmatic hernia on X-ray is hitherto unreported and this case has been presented with the aim to alert the clinician about this unusual presentation of SCE to avert undue panic and initiate appropriate evaluation and management. This case also reemphasizes the importance of a thorough clinical examination, which probably could have revealed the subcutaneous emphysema earlier. PMID:26023504

  7. The strangulated umbilical hernia of Queen Caroline.

    PubMed

    Ellis, Harold

    2014-11-01

    One of the lessons we learn from medical history is how great the improvement has been in the management of commonplace surgical emergencies. Less than three hundred years ago, the Queen of England, in her healthy middle age, died of a straightforward strangulated umbilical hernia. PMID:26012198

  8. Functional and morphological evaluation of different polypropylene-mesh modifications for abdominal wall repair

    Microsoft Academic Search

    B. Klosterhalfen; U. Klinge; V. Schumpelick

    1998-01-01

    Modern surgical hernia repair depends increasingly on synthetic meshes for the reconstruction of the abdominal wall. Despite the undisputed advantages of the polypropylene (PP) meshes currently available (Marlex®, Prolene®), reports of complications after implantation are increasing. Although, serious complications such as perforation and fistula formation are rare, minor and local complaints such as seromas, misfeelings and a decreased abdominal wall

  9. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery†.

    PubMed

    Etz, Christian D; Weigang, Ernst; Hartert, Marc; Lonn, Lars; Mestres, Carlos A; Di Bartolomeo, Roberto; Bachet, Jean E; Carrel, Thierry P; Grabenwöger, Martin; Schepens, Marc A A M; Czerny, Martin

    2015-06-01

    Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most devastating complication. The aim of this position paper is to provide physicians with broad information regarding spinal cord blood supply, to share strategies for shortening intraprocedural spinal cord ischaemia and to increase spinal cord tolerance to transitory ischaemia through detection of ischaemia and augmentation of spinal cord blood perfusion. This study is meant to support physicians caring for patients in need of any kind of thoracic or thoracoabdominal aortic repair in decision-making algorithms in order to understand, prevent or reverse ischaemic SCI. Information has been extracted from focused publications available in the PubMed database, which are cohort studies, experimental research reports, case reports, reviews, short series and meta-analyses. Individual chapters of this position paper were assigned and after delivery harmonized by Christian D. Etz, Ernst Weigang and Martin Czerny. Consequently, further writing assignments were distributed within the group and delivered in August 2014. The final version was submitted to the EJCTS for review in September 2014. PMID:25991554

  10. Single incision laparoscopic surgery in general surgery: a review

    PubMed Central

    Greaves, N; Nicholson, J

    2011-01-01

    Single incision laparoscopic surgery (SILS) is a rapidly developing field that may represent the future of laparoscopic surgery. The major advantage of SILS over standard laparoscopic surgery is in cosmesis, with surgery becoming essentially scarless if the incision is hidden within the umbilicus. Only one incision is required so the risk of potential complications like port site hernias, haematomas and wound infection is reduced. The trade-off for this is a technically more challenging procedure with different underlying principles to that of traditional laparoscopic surgery. A wide variety of new equipment has been developed to support SILS and the range of procedures that are amenable to the technique is increasing. To date most of the published data relating to SILS are in the form of case series, with the first large randomised controlled trials due to be completed by the end of 2012. The existing evidence suggests that SILS is similar to standard laparoscopic surgery in terms of complication rates, completion rates and post-operative pain scores. However, the duration of SILS is longer than equivalent laparoscopic procedures. This article discusses SILS with regard to its applications in general surgery and reviews the evidence currently available. PMID:21929912

  11. Videoscope-assisted cardiac surgery

    PubMed Central

    Chen, Robert Jeen-Chen

    2014-01-01

    Videoscope-assisted cardiac surgery (VACS) offers a minimally invasive platform for most cardiac operations such as coronary and valve procedures. It includes robotic and thoracoscopic approaches and each has strengths and weaknesses. The success depends on appropriate hardware setup, staff training, and troubleshooting efficiency. In our institution, we often use VACS for robotic left-internal-mammary-artery takedown, mitral valve repair, and various intra-cardiac operations such as tricuspid valve repair, combined Maze procedure, atrial septal defect repair, ventricular septal defect repair, etc. Hands-on reminders and updated references are provided for reader’s further understanding of the topic. PMID:24455172

  12. Clinicopathologic Significance of Excision Repair Cross-Complementation 1 Expression in Patients Treated With Breast-Conserving Surgery and Radiation Therapy

    SciTech Connect

    Goyal, Sharad, E-mail: goyalsh@umdnj.ed [Department of Radiation Oncology, Cancer Institute of New Jersey, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Parikh, Rahul R.; Green, Camille; Schiff, Devora B.S. [Department of Radiation Oncology, The Cancer Institute of New Jersey, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Moran, Meena S. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States); Yang Qifeng [Department of Radiation Oncology, The Cancer Institute of New Jersey, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Department of Breast Surgery, Qilu Hospital/Shandong University (China); Haffty, Bruce G. [Department of Radiation Oncology, Cancer Institute of New Jersey, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, NJ (United States)

    2010-03-01

    Purpose: The excision repair cross-complementation 1 (ERCC1) enzyme plays a rate-limiting role in the nucleotide excision repair pathway and is associated with resistance to platinum-based chemotherapy in cancers of the head and neck and the lung. The purpose of this study was to evaluate the clinicopathologic and prognostic significance of ERCC1 expression in a cohort of early-stage breast cancer patients treated with breast conservation therapy. Methods and Materials: Paraffin specimens from 504 women with early-stage breast cancer treated with breast conservation therapy were constructed into tissue microarrays. The array was stained for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) and ERCC1. This was then correlated with clinicopathologic factors and outcomes data. Results: ERCC-1 expression was evaluable in 366 cases (72%). In this group, 32% and 38% of patients received adjuvant chemotherapy and hormonal therapy, respectively. Increased ERCC-1 expression was found to be correlated with ER positivity (p < 0.005), lower T stage (p < 0.017), nodal negativity (p < 0.013), age >50 (p < 0.006), reduced use of adjuvant chemotherapy (p < 0.02), and increased use of adjuvant hormonal therapy (p < 0.004). ERCC1 expression did not correlate with locoregional recurrence-free survival, distant metastasis-free survival, cause-specific survival, or overall survival. In patients who were both ERCC1-negative and -positive, the use of chemotherapy predicted for worse distant metastasis-free survival (p = 0.05 and p = 0.07, respectively) but not cause-specific survival or overall survival. Conclusions: Although ERCC1 expression did not predict for outcome measures in this dataset, overexpression correlated with favorable prognostic factors such as ER positivity, lower T stage, nodal negativity, and age >50. To our knowledge, this is the first study investigating ERCC1 expression in patients receiving adjuvant radiation therapy for breast cancer.

  13. Gastric volvulus through a Morgagni hernia: multidetector computed tomography diagnosis

    Microsoft Academic Search

    Bruno Coulier; Bernard Broze

    2008-01-01

    Hernia through the foramen of Morgagni (HM) is uncommon in adults, accounting for only 3% of all treated diaphragmatic hernias.\\u000a We report a very rare case of acute gastric volvulus producing within this type of hernia. It was found in an 81-year-old\\u000a man presenting with symptoms of acute gastric outlet obstruction. The diagnosis was first suspected on plain abdominal and

  14. Hernia of Umbilical Cord: Report of Three Unusual Cases

    PubMed Central

    Mirza, Bilal; Mirza, Afzal; Hashim, Imran; Saleem, Muhammad

    2015-01-01

    Congenital hernia of umbilical cord is a less frequent entity in newborns and occasionally associated with other maladies. Herein, we report three unusual cases of hernia of umbilical cord. First case was associated with in-utero evisceration of entire small bowel through the presumably ruptured hernia of umbilical cord and other two cases had associated patent vitellointestinal duct (PVID). All of the cases were managed successfully.

  15. Hernia of umbilical cord: report of three unusual cases.

    PubMed

    Mirza, Bilal; Mirza, Afzal; Hashim, Imran; Saleem, Muhammad

    2015-01-01

    Congenital hernia of umbilical cord is a less frequent entity in newborns and occasionally associated with other maladies. Herein, we report three unusual cases of hernia of umbilical cord. First case was associated with in-utero evisceration of entire small bowel through the presumably ruptured hernia of umbilical cord and other two cases had associated patent vitellointestinal duct (PVID). All of the cases were managed successfully. PMID:26034710

  16. Outcome of atrial fibrillation after mitral valve repair

    Microsoft Academic Search

    Jean F. Obadia; Mazen el Farra; Olivier H. Bastien; Michel Lièvre; Yvan Martelloni; Jean F. Chassignolle

    1997-01-01

    Objective: The aim of the study was to evaluate the prognostic factors for return to sinus rhythm after mitral valve repair. Method: One hundred ninety-one patients underwent surgery for mitral valve repair, including 142 procedures for valve repair only (74%). The patients with preoperative atrial fibrillation (50.5%) were older, clinically more symptomatic, and had a greater degree of left atrial

  17. Fascicular Phrenic Nerve Neurotization for Restoring Physiological Motion in a Congenital Diaphragmatic Hernia Reconstruction With a Reverse Innervated Latissimus Dorsi Muscle Flap.

    PubMed

    Horta, Ricardo; Henriques-Coelho, Tiago; Costa, Joana; Estevão-Costa, José; Monteiro, Diana; Dias, Mariana; Braga, José; Silva, Alvaro; Azevedo, Inês; Amarante, José Manuel

    2015-08-01

    Congenital diaphragmatic hernia is a severe developmental anomaly characterized by the malformation of the diaphragm. An innervated reversed latissimus dorsi flap reconstruction for recurrent congenital diaphragmatic hernia has been described as an alternative to prosthetic patch repair to achieve pleuroperitoneal separation. However, there is very little supporting scientific data; therefore, there is no real basic understanding of the condition of the phrenic nerve in the absence of diaphragmatic muscle or even the neurotization options for restoring neodiaphragmatic muscle motion. We have reviewed the literature regarding phrenic nerve anatomy and neurotization options, and to our knowledge, this is the first time that the application of a fascicular repair is being described where the continuity of one remaining fascicle of the diaphragm has been preserved close to the phrenic nerve distal division. The procedure was undertaken in a 3 year-old boy, with the diagnosis of congenital large posteromedial diaphragmatic hernia and dependence of mechanical ventilation in consequence of severe bronchopulmonary dysplasia.The phrenic nerve divides itself into several terminal branches, usually three, at the diaphragm level, or just above it. This allows the selective coaptation of separate fascicular branches. In the case described, videofluoroscopy evaluation showed no evidence of paradoxical neodiaphragmatic motion, with synchronous contraction movements and intact pleura-peritoneal separation. The child is now asymptomatic and shows improvement of his previous restrictive pulmonary disease.We believe that fascicular repair can achieve some reinnervation of the flap without jeopardizing the potential of diaphragmatic function by contraction of reminiscent native diaphragm. PMID:26101982

  18. Prediction of outcome in congenital diaphragmatic hernia

    Microsoft Academic Search

    A. Numanoglu; C. Morrison; H. Rode

    1998-01-01

    The case records of 59 patients with congenital diaphragmatic hernia (CDH) who presented between 1984 and 1997 were studied\\u000a retrospectively. Included in the study were infants born with CDH who required respiratory support within the first 6 h of\\u000a life. Twenty-three were excluded from the study for various reasons; 36 were enrolled in the study; the male-to-female ratio\\u000a was 18:18.

  19. The use of a subfascial vicryl mesh buttress to aid in the closure of massive ventral hernias following damage-control laparotomy.

    PubMed

    Tobias, Adam M; Low, David W

    2003-09-01

    Damage control laparotomy for life-threatening abdominal conditions has gained wide acceptance in the management of exsanguinating trauma patients as well as septic patients with acute abdomen. Survivors considered too ill to undergo definitive abdominal wall closure are temporized, often with skin grafting on granulated viscera. These maneuvers compromise the integrity of the anterior abdominal wall and result in a subset of patients with loss of abdominal domain and massive, debilitating ventral hernias. A retrospective review was conducted of 21 such patients (16 men, five women) who underwent elective abdominal wall reconstruction at the Hospital of the University of Pennsylvania between November of 1998 and October of 2000. The purpose of this study was to report the authors' experience with these complex abdominal wall reconstructions. A double-layer, subfascial Vicryl mesh buttress was used in all repairs to aid in reestablishing abdominal wall integrity. The mean hernia size was 813 cm2 (range, 75 to 1836 cm2), and the average interval to definitive repair was 24.4 months (range, 3 weeks to 11 years). Mean follow-up was 13.5 months (range, 1 month to 40 months). Twenty patients (95 percent) had successful ventral hernia repair. Four patients with massive hernias (924 to 1836 cm2) required submuscular Marlex mesh implantation. Two patients (10 percent) developed abdominal compartment syndrome that required surgical decompression. One patient (5 percent) developed an incisional hernia at a prior colostomy site. Four patients (19 percent) had superficial skin dehiscence that healed secondarily with daily wound care. There were no mesh infections. In most cases, successful single-stage repair of large ventral hernias following damage control laparotomy can be achieved using a subfascial Vicryl mesh buttress in combination with other established reconstructive techniques. Massive defects exceeding 900 cm2 typically require permanent mesh implantation to achieve fascial closure and to minimize the risk of postoperative abdominal compartment syndrome and recurrent herniation. This technique represents an improved solution to a complicated problem and optimizes the aesthetic and functional outcome for these debilitated patients. PMID:12960857

  20. [Laparotomy closure and incisional hernia prevention - what are the surgical requirements?].

    PubMed

    Höer, J; Fischer, L; Schachtrupp, A

    2011-02-01

    In the light of an incisional hernia incidence of between 10 and 20 % that remains constantly high in spite of modifications of suture materials and suture techniques, intensified scientific efforts aiming at incisional hernia prevention are -required. This article reviews the scientific results dealing with incisional hernia incidence, time of manifestation, risk factors and the influence of suture material and suture technique. A lack of evidence-based data and no current consensus concerning the ideal material and technique to close laparotomies has to be mentioned. To encourage a novel approach to incisional hernia -prevention, the results of experimental studies which demonstrate the negative effects of conventional laparotomy closure on the abdominal wall are discussed. Histology and additionally -laser-fluorescence angiography reveal the weak-en-ing of abdominal wall structures and abdominal wall perfusion after directly suturing the -incisional edges. Additionally, inadequate suture -tension has an influence on collagen quantity and quality in the healing incision. Further investigations with a suture simulator have made clear that surgical sutures vary widely in precision and reproducibility of suture tension when completed only under visual and tactile control. As suture tension dynamics cannot be measured due to the lack of adequate devices, an implantable sensor has been developed that reveals a loss of suture tension of up to 60 % of the initial tension in the first 2 hours after completion of laparotomy closure. These results have led to the development and experimental use of a bridging closure with a tension-banding technique. This technique has almost no influence on abdominal wall per-fusion, leaves the architecture and dynamics of the abdominal wall intact, and results in a favour-able ultra-structural composition of collagen and a mechanically stable laparotomy healing after 15 months. Measures to prevent incisional hernia formation - which is in fact the post-operative complication in surgery most frequently leading to re-operation - require intensified research activities. Success will only be achieved if the development of -unconventional closure techniques is encouraged and the beaten path of suturing the incisional edges is discarded. PMID:21279924