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Sample records for open incisional hernia

  1. Incisional hernia after open resections for colorectal liver metastases – incidence and risk factors

    PubMed Central

    Nilsson, Jan H.; Strandberg Holka, Peter; Sturesson, Christian

    2016-01-01

    Background Incisional hernia is one of the most common complications after laparotomy. The aim of this retrospective study was to investigate incidence, location and risk factors for incisional hernia after open resection for colorectal liver metastases including the use of perioperative chemotherapy and targeted therapy evaluated by computed tomography. Methods Patients operated for colorectal liver metastases between 2010 and 2013 were included. Incisional hernia was defined as a discontinuity in the abdominal fascia observed on computed tomography. Results A total of 256 patients were analyzed in regard to incisional hernia. Seventy-eight patients (30.5%) developed incisional hernia. Hernia locations were midline alone in 66 patients (84.6%) and involving the midline in another 8 patients (10.3%). In multivariate analysis, preoperative chemotherapy >6 cycles (hazard ratio 2.12, 95% confidence interval 1.14–3.94), preoperative bevacizumab (hazard ratio 3.63, 95% confidence interval 1.86–7.08) and incisional hernia from previous surgery (hazard ratio 3.50, 95% confidence interval 1.98–6.18) were found to be independent risk factors. Conclusions Prolonged preoperative chemotherapy and also preoperative bevacizumab were strong predictors for developing an incisional hernia. After an extended right subcostal incision, the hernia location was almost exclusively in the midline. PMID:27154807

  2. Hernias: inguinal and incisional.

    PubMed

    Kingsnorth, Andrew; LeBlanc, Karl

    2003-11-01

    In the past decade hernia surgery has been challenged by two new technologies: by laparoscopy, which has attempted to change the traditional open operative techniques, and by prosthetic mesh, which has achieved much lower recurrence rates. The demand by health care providers for increasingly efficient and cost-effective surgery has resulted in modifications to pathways of care to encourage more widespread adoption of day case, outpatient surgery, and local anaesthesia. In addition, the UK National Institute for Clinical Excellence has recommended strategies for bilateral and recurrent hernias. Here, we discuss these strategies and review some neglected aspects of hernia management such as trusses, antibiotic cover, return to work and activity, and emergency surgery. Many of the principles of management apply equally to inguinal and incisional hernias. We recommend that the more difficult and complex of the procedures be referred to specialists. PMID:14615114

  3. Long-term recurrence and complication rates after incisional hernia repair with the open onlay technique

    PubMed Central

    Andersen, Lars Peter Holst; Klein, Mads; Gögenur, Ismail; Rosenberg, Jacob

    2009-01-01

    Background Incisional hernia after abdominal surgery is a well-known complication. Controversy still exists with respect to the choice of hernia repair technique. The objective of this study was to evaluate the long-term recurrence rate as well as surgical complications in a consecutive group of patients undergoing open repair using an onlay mesh technique. Methods Consecutive patients undergoing open incisional hernia repair with onlay-technique between 01/05/1995 and 01/09/2007 at a single institution were included in the study. For follow-up patients were contacted by telephone, and answered a questionnaire containing questions related to the primary operation, the hernia and general risk factors. Patients were examined by a consultant surgeon in the outpatient clinic or in the patient's home if there was suspicion of an incisional hernia recurrence. Results The study included 56 patients with 100% follow-up. The median follow-up was 35 months (range 4–151). Recurrent incisional hernia was found in 8 of 56 patients (15%, 95% CI: 6–24). The overall complication rate was 13% (95% CI, 4–22). All complications were minor and needed no hospital admission. Conclusion This study with a long follow-up showed low recurrence and complication rates in patients undergoing incisional hernia repair with the open onlay technique. PMID:19400934

  4. Risk of Incisional Hernia after Minimally Invasive and Open Radical Prostatectomy

    PubMed Central

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

    2013-01-01

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

  5. Unusual Complications of Incisional Hernia

    PubMed Central

    Emegoakor, CD; Dike, EI; Emegoakor, FC

    2014-01-01

    Incisional hernia represents a breakdown or loss of continuity of a fascial closure. These hernias are of particular concern not only for the high recurrence rates among them but also for the challenges that follow their repair. It is known to occur in 11-23% of laparotomies. This paper presents two unusual complications of incisional hernia managed by the authors. One ruptured incisional hernia with evisceration of gut and a case of incarcerated gravid uterus in a woman in labour. The case records of the two patients with unusual complications of incisional hernia were pooled and presented to highlight the clinical presentation and management options of this condition. The patient with ruptured hernia and eviscerated gut presented immediately and was resuscitated and the hernia repaired with polypropylene mesh. The patient with incarcerated uterus had caesarean section and mesh repair of the hernia. Incisional hernia can present with unusual complications. The management is very challenging. Good knowledge and skills are required to deal with this condition. PMID:25506498

  6. Unusual complications of incisional hernia.

    PubMed

    Emegoakor, Cd; Dike, Ei; Emegoakor, Fc

    2014-11-01

    Incisional hernia represents a breakdown or loss of continuity of a fascial closure. These hernias are of particular concern not only for the high recurrence rates among them but also for the challenges that follow their repair. It is known to occur in 11-23% of laparotomies. This paper presents two unusual complications of incisional hernia managed by the authors. One ruptured incisional hernia with evisceration of gut and a case of incarcerated gravid uterus in a woman in labour. The case records of the two patients with unusual complications of incisional hernia were pooled and presented to highlight the clinical presentation and management options of this condition. The patient with ruptured hernia and eviscerated gut presented immediately and was resuscitated and the hernia repaired with polypropylene mesh. The patient with incarcerated uterus had caesarean section and mesh repair of the hernia. Incisional hernia can present with unusual complications. The management is very challenging. Good knowledge and skills are required to deal with this condition. PMID:25506498

  7. The INCH-Trial: a multicentre randomized controlled trial comparing the efficacy of conventional open surgery and laparoscopic surgery for incisional hernia repair

    PubMed Central

    2013-01-01

    Background Annually approximately 100.000 patients undergo a laparotomy in the Netherlands. About 15,000 of these patients will develop an incisional hernia. Both open and laparoscopic surgical repair have been proven to be safe. However, the most effective treatment of incisional hernias remains unclear. This study, the ‘INCH-trial’, comparing cost-effectiveness of open and laparoscopic incisional hernia repair, is therefore needed. Methods/Design A randomized multi-center clinical trial comparing cost-effectiveness of open and laparoscopic repair of incisional hernias. Patients with a symptomatic incisional hernia, eligible for laparoscopic and open incisional hernia repair. Only surgeons, experienced in both open and laparoscopic incisional hernia repair, will participate in the INCH trial. During incisional hernia repair, a mesh is placed under or on top of the fascia, with a minimal overlap of 5 cm. Primary endpoint is length of hospital stay after an incisional hernia repair. Secondary endpoints are time to full recovery within three months after index surgery, post-operative complications, recurrences, mortality and quality of life. Our hypothesis is that laparoscopic incisional hernia repair comes with a significant shorter hospital stay compared to open incisional hernia repair. A difference of two days is considered significant. One-hunderd-and-thirty-five patients are enrolled in each treatment arm. The economic evaluation will be performed from a societal perspective. Primary outcomes are costs per patient related to time-to-recovery and quality of life. The main goal of the trial is to establish whether laparoscopic incisional hernia repair is superior to conventional open incisional hernia repair in terms of cost-effectiveness. This is measured through length of hospital stay and quality of life. Secondary endpoints are re-operation rate due to post-operative complications or recurrences, mortality and quality of life. Discussion The difference

  8. 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

  9. The Management of Incisional Hernia

    PubMed Central

    Kingsnorth, Andrew

    2006-01-01

    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

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

    PubMed Central

    2011-01-01

    Background Mesh repair of incisional hernia is superior to the conventional technique. From all available materials for open surgery polypropylene (PP) is the most widely used. Development resulted in meshes with larger pore size, decreased mesh surface and lower weight. The aim of this retrospective non randomized study was to compare the quality of life in the long term follow up (> 72 month) after incisional hernia repair with "light weight"(LW) and "heavy weight"(HW) PP meshes. Methods 12 patients who underwent midline open incisional hernia repair with a HW-PP mesh (Prolene® 109 g/m2 pore size 1.6 mm) between January 1996 and December 1997 were compared with 12 consecutive patients who underwent the same procedure with a LW-PP mesh (Vypro® 54 g/m2, pore size 4-5 mm) from January 1998. The standard technique was the sublay mesh-plasty with the retromuscular positioning of the mesh. The two groups were equal in BMI, age, gender and hernia size. Patients were routinely seen back in the clinic. Results In the long term run (mean follow up 112 ± 22 months) patients of the HW mesh group revealed no significant difference in the SF-36 Health Survey domains compared to the LW group (mean follow up 75 ± 16 months). Conclusions In this study the health related quality of life based on the SF 36 survey after open incisional hernia repair with light or heavy weight meshes is not related to the mesh type in the long term follow up. PMID:21917180

  11. Anatomical repair of large incisional hernias.

    PubMed Central

    Loh, A.; Rajkumar, J. S.; South, L. M.

    1992-01-01

    We present a method of repair for large incisional hernias using lateral relieving incisions of the anterior rectus sheath. This is a modification of the methods previously described by Young (1), Hunter (2) and Maguire and Young (3). There were no recurrences in the 13 patients reviewed. Other methods of repair for large incisional hernias are discussed. Images Figure 2a,b Figure 3a,b Figure 4 Figure 5 PMID:1567126

  12. Management of voluminous abdominal incisional hernia.

    PubMed

    Bouillot, J-L; Poghosyan, T; Pogoshian, T; Corigliano, N; Canard, G; Veyrie, N

    2012-10-01

    Incisional hernia is one of the classic complications after abdominal surgery. The chronic, gradual increase in size of some of these hernias is such that the hernia ring widens to a point where there is a loss of substance in the abdominal wall, herniated organs can become incarcerated or strangulated while poor abdominal motility can alter respiratory function. The surgical treatment of small (<5 cm) incisional hernias is safe and straightforward, by either laparotomy or laparoscopy. For large hernias, surgical repair is often difficult. After reintegration of herniated viscera into the abdominal cavity, the abdominal wall defect must be closed anatomically in order to restore the function to the abdominal wall. Prosthetic reinforcement of the abdominal wall is mandatory for long-term successful repair. There are multiple techniques for prosthetic hernia repair, but placement of Dacron mesh in the retromuscular plane is our preference. PMID:23137643

  13. Laparoscopic Treatment of Subxiphoid Incisional Hernias in Cardiac Transplant Patients

    PubMed Central

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

    2008-01-01

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

  14. The usefulness of laparoscopic hernia repair in the management of incisional hernia following liver transplantation

    PubMed Central

    Hegab, Bassem; Abdelfattah, Mohamed Rabei; Azzam, Ayman; Al Sebayel, Mohamed

    2016-01-01

    INTRODUCTION: The reported incidence of incisional hernia following orthotopic liver transplantation (OLT) varies from 4% to 23%. Postoperative wound complications are less frequent after laparoscopic repair while maintaining low recurrence rates. We present our experience in managing this complication. MATERIALS AND METHODS: Retrospectively, collected data of all patients who underwent liver transplant and developed incisional hernias were analyzed. Patients’ demographic data, anthropometric data, transplantation-related data, and repair-related operative and postoperative data were collected. Risk factors for post-transplant incisional hernia were appraised in our patients. Patients were divided into two groups: Group A included patients who had their incisional hernia repaired through the laparoscopic approach, and Group B included patients who had their incisional hernia repaired through open conventional approach. RESULTS: A total of 488 liver transplantations were performed at our institution between May 2001 and end of December 2012. Thirty-three patients developed incisional hernias after primary direct closure of the abdominal wall with an overall incidence of 6.9%. Hernia repair was done in 25 patients. Follow-up ranged from 6.4 to 106.1 months with a mean of 48.3 ± 28.3 months. All patients were living at the end of the follow up except four patients (16%). Group A included 13 patients, and Group B included 12 patients. The size of defects and operative time did not differ significantly between both the groups. On the other hand, hospital stay was significantly shorter in laparoscopic group. Complication rate following laparoscopic repair was insignificantly different for open repair. CONCLUSION: In experienced hands, laparoscopic incisional hernia repair in post-liver transplant setting proved to be a safe and feasible alternative to open approach and showed superior outcome expressed in shorter hospital stay, with low recurrence and complication

  15. Laparoscopic repair of ventral / incisional hernias

    PubMed Central

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

    2006-01-01

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

  16. Light weight meshes in incisional hernia repair

    PubMed Central

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

    2006-01-01

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

  17. Contraction of Abdominal Wall Muscles Influences Incisional Hernia Occurrence and Size

    PubMed Central

    Lien, Samuel C.; Hu, Yaxi; Wollstein, Adi; Franz, Michael G.; Patel, Shaun P.; Kuzon, William M.; Urbanchek, Melanie G.

    2015-01-01

    Background Incisional hernias are a complication in 10% of all open abdominal operations and can result in significant morbidity. The purpose of this study is to determine if inhibiting abdominal muscle contraction influences incisional hernia formation during laparotomy healing. We hypothesize that reducing abdominal musculature deformation reduces incisional hernia occurrence and size. Study Design Using an established rat model for incisional hernia, a laparotomy through the linea alba was closed with one mid-incision, fast-absorbing suture. Three groups were compared: a SHAM group (SHAM; n = 6) received no laparotomies while the Saline Hernia (SH; n = 6) and Botox Hernia (BH; n = 6) groups were treated once with equal volume saline or Botulinum Toxin (Botox®, Allergan) before the incomplete laparotomy closure. On post-operative day 14, the abdominal wall was examined for herniation and adhesions and contractile forces were measured for abdominal wall muscles. Results No hernias developed in SHAM rats. Rostral hernias developed in all SH and BH rats. Caudal hernias developed in all SH rats, but in only 50% of the BH rats. Rostral hernias in the BH group were 35% shorter and 43% narrower compared to those in the SH group (p < 0.05). The BH group had weaker abdominal muscles compared to the SHAM and SH groups (p < 0.05). Conclusions In our rat model, partial paralysis of abdominal muscles reduces the number and size of incisional hernias. These results confirm abdominal wall muscle contractions play a significant role in the pathophysiology of incisional hernia formation. PMID:25817097

  18. [Technical principles of incisional hernia surgery].

    PubMed

    Dietz, U A; Muysoms, F E; Germer, C T; Wiegering, A

    2016-04-01

    Many publications are available on the best surgical techniques and treatment of incisional hernias with reports of experiences and randomized clinical studies at the two extremes of the evidence scale. The ultimate proof of the best operative technique has, however, not yet been achieved. In practically no other field of surgery are the variability and the resulting potential aims of surgery so great. The aim of surgery is to provide patients with the optimal recommendation out of a catalogue of possibilities from a holistic perspective. This article describes the surgical techniques using meshes for strengthening (in combination with an anatomical reconstruction) and for replacement of the abdominal wall (with bridging of the defect). PMID:26943166

  19. Evolution and advances in laparoscopic ventral and incisional hernia repair

    PubMed Central

    Vorst, Alan L; Kaoutzanis, Christodoulos; Carbonell, Alfredo M; Franz, Michael G

    2015-01-01

    Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparotomies performed in the 20th century. Even though minimally invasive surgery and hernia repair have evolved rapidly, general surgeons have yet to develop the ideal, standardized method that adequately decreases common postoperative complications, such as wound failure, hernia recurrence and pain. The evolution of laparoscopy and ventral hernia repair will be reviewed, from the rectoscopy of the 4th century to the advent of laparoscopy, from suture repair to the evolution of mesh reinforcement. The nuances of minimally invasive ventral and incisional hernia repair will be summarized, from preoperative considerations to variations in intraoperative practice. New techniques have become increasingly popular, such as primary defect closure, retrorectus mesh placement, and concomitant component separation. The advent of robotics has made some of these repairs more feasible, but only time and well-designed clinical studies will tell if this will be a durable modality for ventral and incisional hernia repair. PMID:26649152

  20. Incidence of Ostomy Site Incisional Hernias after Stoma Closure.

    PubMed

    Sharp, Stephen P; Francis, Jacquelyn K; Valerian, Brian T; Canete, Jonathan J; Chismark, A David; Lee, Edward C

    2015-12-01

    This study sought to evaluate the incidence of ostomy site incisional hernias after stoma reversal at a single institution. This is a retrospective analysis from 2001 to 2011 evaluating the following demographics: age, gender, indication for stoma, urgent versus elective operation, time to closure, total follow-up time, the incidence of and reoperation for stoma incisional hernia, diabetes, postoperative wound infection, smoking status within six months of surgery, body mass index, and any immunosuppressive medications. A total of 365 patients were evaluated. The median follow-up time was 30 months. The clinical hernia rate was 19 percent. Significant risk factors for hernia development were age, diabetes, end colostomies, loop colostomies, body mass index >30, and undergoing an urgent operation. The median time to clinical hernia detection was 32 months. Sixty-four percent of patients required surgical repair of their stoma incisional hernia. A significant number of patients undergoing stoma closure developed an incisional hernia at the prior stoma site with the majority requiring definitive repair. These hernias are a late complication after stoma closure and likely why they are under-reported in the literature. PMID:26736162

  1. [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

  2. 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

  3. A novel reconstruction method for giant incisional hernia: Hybrid laparoscopic technique

    PubMed Central

    Ozturk, G; Malya, FU; Ersavas, C; Ozdenkaya, Y; Bektasoglu, H; Cipe, G; Citgez, B; Karatepe, O

    2015-01-01

    BACKGROUND AND OBJECTIVES: Laparoscopic reconstruction of ventral hernia is a popular technique today. Patients with large defects have various difficulties of laparoscopic approach. In this study, we aimed to present a new reconstruction technique that combines laparoscopic and open approach in giant incisional hernias. MATERIALS AND METHODS: Between January 2006 and August 2012, 28 patients who were operated consequently for incisional hernia with defect size over 10 cm included in this study and separated into two groups. Group 1 (n = 12) identifies patients operated with standard laparoscopic approach, whereas group 2 (n = 16) labels laparoscopic technique combined with open approach. Patients were evaluated in terms of age, gender, body mass index (BMI), mean operation time, length of hospital stay, surgical site infection (SSI) and recurrence rate. RESULTS: There are 12 patients in group 1 and 16 patients in group 2. Mean length of hospital stay and SSI rates are similar in both groups. Postoperative seroma formation was observed in six patients for group 1 and in only 1 patient for group 2. Group 1 had 1 patient who suffered from recurrence where group 2 had no recurrence. DISCUSSION: Laparoscopic technique combined with open approach may safely be used as an alternative method for reconstruction of giant incisional hernias. PMID:26622118

  4. Apoptosis-Like Cell Death Induction and Aberrant Fibroblast Properties in Human Incisional Hernia Fascia

    PubMed Central

    Diaz, Ramon; Quiles, Maria T.; Guillem-Marti, Jordi; Lopez-Cano, Manuel; Huguet, Pere; Ramon-y-Cajal, Santiago; Reventos, Jaume; Armengol, Manel; Arbos, Maria A.

    2011-01-01

    Incisional hernia often occurs following laparotomy and can be a source of serious problems. Although there is evidence that a biological cause may underlie its development, the mechanistic link between the local tissue microenvironment and tissue rupture is lacking. In this study, we used matched tissue-based and in vitro primary cell culture systems to examine the possible involvement of fascia fibroblasts in incisional hernia pathogenesis. Fascia biopsies were collected at surgery from incisional hernia patients and non-incisional hernia controls. Tissue samples were analyzed by histology and immunoblotting methods. Fascia primary fibroblast cultures were assessed at morphological, ultrastructural, and functional levels. We document tissue and fibroblast loss coupled to caspase-3 activation and induction of apoptosis-like cell-death mechanisms in incisional hernia fascia. Alterations in cytoskeleton organization and solubility were also observed. Incisional hernia fibroblasts showed a consistent phenotype throughout early passages in vitro, which was characterized by significantly enhanced cell proliferation and migration, reduced adhesion, and altered cytoskeleton properties, as compared to non-incisional hernia fibroblasts. Moreover, incisional hernia fibroblasts displayed morphological and ultrastructural alterations compatible with autophagic processes or lysosomal dysfunction, together with enhanced sensitivity to proapoptotic challenges. Overall, these data suggest an ongoing complex interplay of cell death induction, aberrant fibroblast function, and tissue loss in incisional hernia fascia, which may significantly contribute to altered matrix maintenance and tissue rupture in vivo. PMID:21641387

  5. Repair of subxiphoid incisional hernias with Marlex mesh after median sternotomy.

    PubMed

    Cohen, M J; Starling, J R

    1985-11-01

    Median sternotomy is sometimes complicated by a bifid xiphoid process and an incisional (ventral) hernia in the subxiphoid region. Such hernias often recur after primary suture repair. We recently initiated the use of a polypropylene prosthetic mesh to primarily repair subxiphoid incisional hernias. This report details the results of using this material in 14 patients between January 1980 and December 1983. We also discuss the complex anatomy of the xiphoid region. PMID:4051732

  6. 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

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

    PubMed Central

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

    2013-01-01

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

  8. MMPs/TIMPs and inflammatory signalling de-regulation in human incisional hernia tissues

    PubMed Central

    Guillen-Marti, Jordi; Diaz, Ramon; Quiles, Maria T; Lopez-Cano, Manuel; Vilallonga, Ramon; Huguet, Pere; Ramon-y-Cajal, Santiago; Sanchez-Niubo, Albert; Reventós, Jaume; Armengol, Manel; Arbos, Maria A

    2009-01-01

    Background: Incisional hernia is a common and important complication of laparotomies. Epidemiological studies allude to an underlying biological cause, at least in a subset of population. Interest has mainly focused on abnormal collagen metabolism. However, the role played by other determinants of extracellular matrix (ECM) composition is unknown. To date, there are few laboratory studies investigating the importance of biological factors contributing to incisional hernia development. We performed a descriptive tissue-based analysis to elucidate the possible relevance of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in association with local cytokine induction in human incisional hernia tissues. The expression profiles of MMPs, TIMPs and pro-inflammatory cytokine signalling were investigated in aponeurosis and skeletal muscle specimens taken intraoperatively from incisional hernia (n= 10) and control (n= 10) patients. Semiquantitative RT-PCR, zymography and immunoblotting analyses were done. Incisional hernia samples displayed alterations in the microstructure and loss of ECM, as assessed by histological analyses. Moreover, incisional hernia tissues showed increased MMP/TIMP ratios and de-regulated inflammatory signalling (tumor necrosis factor [TNFA] and interleukin [IL]-6 tended to increase, whereas aponeurosis TNFA receptors decreased). The changes were tissue-specific and were detectable at the mRNA and/or protein level. Statistical analyses showed several associations between individual MMPs, TIMPs, interstitial collagens and inflammatory markers. The increment of MMPs in the absence of a counterbalance by TIMPs, together with an ongoing de-regulated inflammatory signalling, may contribute in inducing a functional defect of the ECM network by post-translational mechanisms, which may trigger abdominal wall tissue loss and eventual rupture. The notable TIMP3 protein down-regulation in incisional hernia fascia may be of pathophysiological

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

    PubMed Central

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

    2013-01-01

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

  10. Repair of Concomitant Incisional and Parastomal Hernias Using a Hybrid Technique: A Series of 32 Patients

    PubMed Central

    Zhu, Xinyong; Tian, Wen; Li, Jiye; Sun, Pengjun; Pei, Lijuan; Wang, Shijie

    2015-01-01

    Background Concomitant incisional and parastomal hernias is a challenging condition. We used a hybrid technique of sublay and onlay to treat patients with this condition. Material/Methods The clinical data of 32 consecutive patients treated from February 2008 to April 2014 for concomitant incisional and parastomal hernias were retrospectively reviewed. The mean diameter was 9 (range 4–13) cm of the incisional hernias, and 6 (range 4.5–8) cm of the parastomal hernias. Results The mean operative time was 247 (range 220–290) min. The mean hospital stay was 20 (range 14–27) days. All surgical wounds healed by primary intention. Seven patients had postoperative seroma and were well managed with puncture and compression. All 32 patients were followed up for a mean of 48 (range 5–68) months. Four patients recurred with parastomal hernias and were treated with secondary surgery. No further recurrence occurred until the last follow-up. Conclusions This hybrid technique of sublay and onlay is only suitable for the repair of complex incisional and parastomal hernias. PMID:26186130

  11. Late post liver transplant protein losing enteropathy: Rare complication of incisional hernia

    PubMed Central

    Evans, Jonathan D; Perera, M Thamara PR; Pal, CY; Neuberger, James; Mirza, Darius F

    2013-01-01

    Development of oedema and hypoproteinaemia in a liver transplant recipient may be the first signs of graft dysfunction and should prompt a full assessment. We report the novel case of a patient who, years after liver transplantation developed a functional blind loop in an incisional hernia, which manifested as oedema and hypoproteinaemia secondary to protein losing enteropathy. After numerous investigations, the diagnosis was made by flurodeoxyglucose positron emmision tomography (FDG-PET) imaging. Surgical repair of the incisional hernia was followed several months later by resolution of the protein loss, and confirmed at a post operative FDG-PET scan at one year. PMID:23885154

  12. Tactical and surgical techniques issues in the surgical treatment of incisional hernias

    PubMed Central

    Gangură, AG; Palade, RŞ

    2014-01-01

    Abstract Within five years, between 2006 and 2011, a total of 368 incisional hernias have been operated in the Surgery Clinic 1, University Emergency Hospital Bucharest. The study followed the morphological and biological parameters, associated pathology, tactics and surgical technique used and postoperative morbidity. The average age of patients was 61.75 years, female sex was predominant (81.25%), and incisional hernias were large and giant in a percentage of 73.37%. Locations were predominantly median (83.42%). Recurrent incisional hernias and multiple relapsed hernias represented 25.54%. Associated pathology was dominated by obesity (51,09%) and cardiovascular disease (37,77%). We have used both methods of tissue procedures (22.83%), and the prosthetic procedures (77.17%). Prosthetic techniques, retro muscle fitting mesh in the rectus abdominis muscle sheath (Rives-Stoppa technique), fitting ov er the fascia and tissue replacement techniques were performed. Immediate postoperative morbidity was represented by seroma (14.13%), prolonged postoperative ileus (8.69%), prolonged hematic drainage (6.52%), and hematoma (1.9%). Late postoperative morbidity was given by granulomas (5.7%) and recurrence of incisional hernias (4.34%). Good and very good results were obtained in the 89.96% of the operated cases. PMID:25408770

  13. Surgical Site Occurrences of Simultaneous Panniculectomy and Incisional Hernia Repair.

    PubMed

    Warren, Jeremy A; Epps, Matthew; Debrux, Cart; Fowler, James L; Ewing, Joseph A; Cobb, William S; Carbonell, Alfredo M

    2015-08-01

    Horizontal panniculectomy (PAN) offers the advantage of wide exposure for hernia repair with elimination of excess skin and adiposity, at the expense of massive subcutaneous flap creation and its attendant risks. We report our experience with ventral hernia repair (VHR) with PAN compared with patients with hernia repair alone. A prospective database was reviewed retrospectively for all patients undergoing open VHR + PAN. A matched cohort of patients without PAN was used for comparison, resulting in 43 study and 43 control patients. Incidence of surgical site occurrences (SSO), surgical site infection (SSI), and recurrence were analyzed. A total of 43 patients underwent PAN + VHR with mesh. Mean body mass index was 34.3 kg/m(2), with 35 per cent having undergone prior bariatric surgery. Repair techniques included retromuscular (74.4%), preperitoneal (11.6%), intraperitoneal (6.9%), onlay (4.6%), and suture (2.3%). Mesh used was polypropylene (76.7%), polyester (18.6%), bioabsorbable (2.3%), and polytetrafluoroethylene (ePTFE) (2.3%). Component separation was performed in 44.2 per cent of patients. There was a significant difference in total SSO between PAN + VHR and VHR alone (46.5% vs 27.9%; P < 0.001), though the difference for individual SSOs was not significant. There was no difference in SSI between groups (16.3% vs 20.9%; P = 0.776). Mean follow-up was 11.4 months, with recurrence rate of 11.6 per cent in the PAN group and 9.3 per cent in the control group (P = 0.725). Panniculectomy at the time of VHR does not increase the incidence of SSI, though higher rates of skin necrosis and cellulitis were seen. There is no difference in recurrence. This approach is a valid option for patients with excessive abdominal panniculus requiring VHR. PMID:26215237

  14. Results of laparoscopic repair of primary and recurrent incisional hernias at a single UK institution.

    PubMed

    Sturt, N Julian H; Liao, Christopher C L; Engledow, Alec H; Menzies, Donald; Motson, Roger W

    2011-04-01

    In this study incisional hernia repairs at a single UK institution between 1994 and 2008 were analyzed with respect to short-term and long-term results. Prospectively collected data were analyzed retrospectively to ascertain outcomes, complications, and recurrences. Two hundred and twenty-seven operations were performed with 35% of the operations being for recurrent hernias. A self-centering suture technique was used. Median operating time was 55 minutes. There were 8 conversions and median hospital stay was 1 night. There were 52 complications (23%) including 3 postoperative bleeds, 3 mesh infections, and 4 small bowel obstructions. Median postoperative follow-up was 53 months. There were 25 recurrences (11%) being detected, a median of 17 months after initial operation. In this large series, laparoscopic incisional hernia repair is safe and is associated with a short hospital stay. Recurrences after repair remain a concern prompting the development of strategies to try and minimize the likelihood of this occurring. PMID:21471798

  15. A case report on management of synergistic gangrene following an incisional abdominal hernia repair in an immunocompromised obese patient

    PubMed Central

    Merali, N.; Almeida, R.A.R.; Hussain, A.

    2015-01-01

    Introduction We present a case on conservative management of salvaging the mesh in an immunocompromised morbidly obese patient, who developed a synergistic gangrene infection following a primary open mesh repair of an incisional hernia. Presentation of case Our patient presented with a surgical wound infection, comorbidities were Chronic Lymphoblastic Leukemia (CLL), Body Mass Index (BMI) of 50, hypertension and diet controlled type-2 diabetes. In surgery, wide necrotic wound debridement, early and repetitive wound drainages with the use of a large pore polypropylene mesh and a detailed surgical follow up was required. High dose intravenous broad-spectrum antibiotic treatment and Negative Pressure Wound Therapy (NPWT) was administrated in combination with adopting a multidisciplinary approach was key to our success. Discussion Stoppa Re et al. complied a series of 360 ventral hernia mesh repairs reporting an infection rate of 12% that were managed conservatively. However, our selective case is unique within current literature, being the first to illustrate mesh salvage in a morbid obese patient with CLL. Recent modifications in mesh morphology, such as lower density, wide pores, and lighter weight has led to considerable improvements regarding infection avoidance. Conclusion This case has demonstrated how a planned multidisciplinary action can produce prosperous results in a severely obese immunocompromised patient with an SSI, following an incisional hernia repair. PMID:26322822

  16. Surgical mesh for ventral incisional hernia repairs: Understanding mesh design.

    PubMed

    Rastegarpour, Ali; Cheung, Michael; Vardhan, Madhurima; Ibrahim, Mohamed M; Butler, Charles E; Levinson, Howard

    2016-01-01

    Surgical mesh has become an indispensable tool in hernia repair to improve outcomes and reduce costs; however, efforts are constantly being undertaken in mesh development to overcome postoperative complications. Common complications include infection, pain, adhesions, mesh extrusion and hernia recurrence. Reducing the complications of mesh implantation is of utmost importance given that hernias occur in hundreds of thousands of patients per year in the United States. In the present review, the authors present the different types of hernia meshes, discuss the key properties of mesh design, and demonstrate how each design element affects performance and complications. The present article will provide a basis for surgeons to understand which mesh to choose for patient care and why, and will explain the important technological aspects that will continue to evolve over the ensuing years. PMID:27054138

  17. [Abdominal wall closure by incisional hernia and herniation after laparostoma].

    PubMed

    Mischinger, H-J; Kornprat, P; Werkgartner, G; El Shabrawi, A; Spendel, S

    2010-03-01

    As hernias and abdominal wall defects have a variety of etiologies each with its own complications and comorbidities in various constellations, efficient treatment requires patient-oriented management. There is no recommended standard treatment and the very different clinical pictures demand an individualized interdisciplinary approach. Particularly in the case of complicated hernias, the planning of the operation should focus on the problems posed by the individual patient. Treatment mainly depends on the etiology of the hernia, immediate or long-term complications and the efficiency of individual repair techniques. Abdominal wall repair for recurrent herniation requires direct closure of the fascia generally using the sublay technique with a lightweight mesh. It is still unclear whether persistent inflammation, mesh dislocation, fistula formation or other long-term complications are due to certain materials or to the surgical technique. With mesh infections it has been shown to be advantageous to remove a polytetrafluoroethylene (PTFE) mesh, while the combination of systemic and local treatment appears to suffice for a polypropylene or polyester mesh. Heavier meshes in the sublay position or plastic reconstruction with autologous tissue are indicated as substitutes for the abdominal wall for giant hernias, repeated recurrences and large abdominal wall defects. A laparostoma is increasingly more often created to treat septic intra-abdominal processes but is very often responsible for a complicated hernia. If primary repair of the abdominal wall is not an option, resorbable material or split skin is used for coverage under the auspices of a planned hernia repair. PMID:20145901

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

    PubMed Central

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

    2014-01-01

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

  19. 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

  20. Reconstruction of the Abdominal Wall in Anatomical Plans. Pre- and Postoperative Keys in Repairing “Cold” Incisional Hernias

    PubMed Central

    POPA, FLORINA; ROSCA, OANA; GEORGESCU, ALEXANDRU; CANNISTRA, CLAUDIO

    2016-01-01

    Background and aims The clinical results of the vertical “vest-over-pants” Mayo repair were evaluated, and the risk factors for incisional hernia recurrence were studied. The purpose of this study is to point out the importance of reducing pre and post operative risk factors in the incisional hernia repair process in order to achieve a physiologically normal abdominal wall. Methods Twenty patients diagnosed with incisional hernia underwent an abdominal reconstruction procedure using the Mayo (Paletot) technique at Bichat Claude Bernard Hospital between 2005 and 2015. All procedures were performed by a single surgeon and all patients were pre-operatively prepared, identifying all coexisting conditions and treating them accordingly before undergoing surgery. Results All patients underwent at least one surgical operation before the hernia repair procedure and a quarter had experienced at least three, prior to this one. Nine patients had a body mass index of >30 kg/m2. Additional risk factors and comorbidities included obesity in 45%, diabetes mellitus in 10%, smoking in 55%, and high blood pressure in 40%. Hernia defect width was from 3 cm (25% F) to 15 cm (5% M) of which nine patients (45%) had a 10 cm defect. Most of the patients had an average hospitalization of 7 days. The patients were carefully monitored and were called on periodic consultations after 3, 6, and 12 months from the moment of the procedure. Patient feedback regarding hernia recurrence and complaints about the scar were noted. Physical examination is essential in determining the hernia recurrence therefore the scar was examined for any abnormalities that may have occurred, which was defined as any palpable or detected fascial defect located within seven centimeters of the hernia repair. Post-operative complications: seroma formation, wound hematoma, superficial and deep wound infection, recurrences and chronic pain were followed and no complications were registered during the follow-up period

  1. Delayed onset seroma formation 'opting out' at 5 years after ventral incisional hernia repair.

    PubMed

    Mohamed, Mohamed; Elmoghrabi, Adel; Shepard, William Reid; McCann, Michael

    2016-01-01

    We present a case of delayed onset seroma formation presenting 5 years after ventral incisional hernia repair (VIHR) with mesh. The patient presented with several months of progressive abdominal fullness and eventual spontaneous drainage from a prior abdominal surgical incision site. Surgical drainage was performed with evolvement of mesh infection. After 5 months of conservative management, the patient remained symptomatic and continued to show evidence of infection. Subsequently, she underwent mesh explantation and definitive repair with complex abdominal wall reconstruction. To the best of our knowledge, this case represents the longest delay in the onset of seroma formation post-VIHR, reported in the literature. PMID:27095812

  2. A multicenter randomized controlled trial evaluating the effect of small stitches on the incidence of incisional hernia in midline incisions

    PubMed Central

    2011-01-01

    Background The median laparotomy is frequently used by abdominal surgeons to gain rapid and wide access to the abdominal cavity with minimal damage to nerves, vascular structures and muscles of the abdominal wall. However, incisional hernia remains the most common complication after median laparotomy, with reported incidences varying between 2-20%. Recent clinical and experimental data showed a continuous suture technique with many small tissue bites in the aponeurosis only, is possibly more effective in the prevention of incisional hernia when compared to the common used large bite technique or mass closure. Methods/Design The STITCH trial is a double-blinded multicenter randomized controlled trial designed to compare a standardized large bite technique with a standardized small bites technique. The main objective is to compare both suture techniques for incidence of incisional hernia after one year. Secondary outcomes will include postoperative complications, direct costs, indirect costs and quality of life. A total of 576 patients will be randomized between a standardized small bites or large bites technique. At least 10 departments of general surgery and two departments of oncological gynaecology will participate in this trial. Both techniques have a standardized amount of stitches per cm wound length and suture length wound length ratio's are calculated in each patient. Follow up will be at 1 month for wound infection and 1 year for incisional hernia. Ultrasound examinations will be performed at both time points to measure the distance between the rectus muscles (at 3 points) and to objectify presence or absence of incisional hernia. Patients, investigators and radiologists will be blinded during follow up, although the surgeon can not be blinded during the surgical procedure. Conclusion The STITCH trial will provide level 1b evidence to support the preference for either a continuous suture technique with many small tissue bites in the aponeurosis only or for

  3. Measurement of intra-abdominal pressure in large incisional hernia repair to prevent abdominal compartmental syndrome

    PubMed Central

    ANGELICI, A.M.; PEROTTI, B.; DEZZI, C.; AMATUCCI, C.; MANCUSO, G.; CARONNA, R.; PALUMBO, P.

    2016-01-01

    Introduction The repair of large incisional hernias may occasionally lead to a substantial increase in intra-abdominal pressure (IAP), and rarely to abdominal compartmental syndrome (ACS) with subsequent respiratory, vascular, and visceral complications. Measurement of the IAP has recently become a common practice in monitoring critical patients, even though such measurements were obtained in the early 1900s. Patients and Methods A prospective study involving 54 patients undergoing elective abdominal wall gap repair (mean length, 17.4 cm) with a tension-free technique after incisional hernia was conducted. The purpose of the study was to determine whether or not urinary pressure for indirect IAP measurement is a reliable method for the early identification of patients with a higher risk of developing ACS. IAP measurements were performed using a Foley catheter connected to a HOLTECH® medical manometer. IAP values were determined pre-operatively, after anesthetic induction, upon patient awakening, upon patient arrival in the ward after surgery, and 24 h after surgery before removing the catheter. All patients were treated by the same surgical team using a prosthetic composite mesh (PARIETEX®). Results Incisional hernia repair caused an increase in the mean IAP score of 2.68 mmHg in 47 of 54 patients (87.04%); the IAP was decreased in two patients (3.7%) and remained equal in five patients before and 24 h after surgery (9.26%). FEV-1, measured 24 h after surgery, increased in 50 patients (92.6%), remained stable in two patients (3.7%), and decreased in two patients (3.7%). The mean increase in FEV-1 was 0.0676 L (maximum increase = 0.42 L and minimum increase = 0.01 L) in any patient who developed ACS. Conclusions Measurement of urinary bladder pressure has been shown to be easy to perform and free of complications. Measurement of urinary bladder pressure can also be a useful tool to identify patients with a higher risk of developing ACS. PMID:27142823

  4. CRITICAL ANALYSIS OF EXPERIMENTAL MODEL FOR STUDY OF ADHESIONS AFTER INCISIONAL HERNIAS INDUCED IN RATS’ AND REPAIR OF ABDOMINAL WALL WITH DIFFERENT BIOMATERIALS

    PubMed Central

    SERIGIOLLE, Leonardo Carvalho; BARBIERI, Renato Lamounier; GOMES, Helbert Minuncio Pereira; RODRIGUES, Daren Athiê Boy; STUDART, Sarah do Valle; LEME, Pedro Luiz Squilacci

    2015-01-01

    Background: Adhesions induced by biomaterials experimentally implanted in the abdominal cavity are basically studied by primary repair of different abdominal wall defects or by the correction of incisional hernias previously performed with no precise definition of the most appropriate model. Aim: To describe the adhesions which occur after the development of incisional hernias, before the prosthesis implantation, in an experimental model to study the changes induced by different meshes. Methods: Incisional hernias were performed in 10 rats with hernia orifices of standardized dimensions, obtained by the median incision of the abdominal wall and eversion of the defect edges. Ten days after the procedure adhesions of abdominal structures were found when hernias were repaired with different meshes. Results: The results showed hernia sac well defined in all rats ten days after the initial procedure. Adhesions of the greater omentum occurred in five animals of which two also showed adhesions of small bowel loops besides the omentum, and another two showed liver adhesions as well as the greater omentum, numbers with statistical significance by Student's t test (p<0.05). Conclusion: Although it reproduces the real clinical situation, the choice of experimental model of incisional hernia repair previously induced implies important adhesions, with possible repercussions in the evaluation of the second operation, when different implants of synthetic materials are used. PMID:26537141

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

    PubMed Central

    Plencner, Martin; East, Barbora; Tonar, Zbyněk; Otáhal, Martin; Prosecká, Eva; Rampichová, Michala; Krejčí, Tomáš; Litvinec, Andrej; Buzgo, Matej; Míčková, Andrea; Nečas, Alois; Hoch, Jiří; 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-ε-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

  6. Development and Validation of a Risk Stratification Score for Ventral Incisional Hernia after Abdominal Surgery: Hernia Expectation Rates iN Intra-Abdominal Surgery (The HERNIA Project)

    PubMed Central

    Goodenough, Christopher J; Ko, Tien C; Kao, Lillian S; Nguyen, Mylan T; Holihan, Julie L; Alawadi, Zeinab; Nguyen, Duyen H; Gonzalez, Juan Ramon; Arita, Nestor T; Roth, J Scott; Liang, Mike K

    2015-01-01

    Background Ventral incisional hernias (VIH) develop in up to 20% of patients following abdominal surgery. No widely applicable pre-operative risk-assessment tool exists. We aim to develop and validate a risk-assessment tool to predict VIH following abdominal surgery. Study Design A prospective study of all patients undergoing abdominal surgery was conducted at a single institution from 2008-2010. Variables were defined in accordance with the National Surgical Quality Improvement Project. VIH was determined through clinical and radiographic evaluation. A multivariate Cox proportional hazard model was built from a development cohort (2008-2009) to identify predictors of VIH. The HERNIAscore was created by converting the hazards ratios (HR) to points. The predictive accuracy was assessed on the validation cohort (2010) using a receiver operator characteristic curve and calculating the area under the curve (AUC). Results Of 625 patients followed for a median of 41(0.3-64 months), 93(13.9%) developed a VIH. The training cohort (n=428, VIH=70,16.4%) identified four independent predictors: laparotomy (HR 4.77, 95%CI 2.61-8.70) or hand-assisted laparoscopy (HR=4.00, 95% CI 2.08-7.70), COPD (HR=2.35; 95%CI 1.44-3.83), and BMI≥25 (HR=1.74; 95% CI 1.04-2.91). Factors that were not predictive included age, gender, ASA score, albumin, immunosuppression, prior surgery, and suture material/technique. The predictive score had an AUC=0.77(95%CI0.68-0.86) using the validation cohort (n=197, VIH=23,11.6%). Using the HERNIAscore--HERNIAscore=4*Laparotomy+3*HAL+1*COPD+1* BMI≥25--three classes stratified the risk of VIH: Class I (0-3 points):5.2%, Class II (4-5 points):19.6%, and Class III (6 points):55.0%. Conclusions The HERNIAscore accurately identifies patients at increased risk for VIH. While external validation is needed, this provides a starting point to counsel patients and guide clinical decisions. Increasing the use of laparoscopy, weight-loss programs, community smoking

  7. [Results of ventral hernia repair: comparison of suture repair with mesh implantation (onlay vs sublay) using open and laparoscopic approach--prospective, randomized, multicenter study].

    PubMed

    Wéber, György; Horváth, Ors Péter

    2002-10-01

    Incisional hernias is a frequent complication following abdominal surgery, it develops in 11-20% of patients who had laparotomies. Different operative techniques are used for repair but results are often poor. In the absence of valid scientific data, there is no general agreement on the best surgical treatment. To provide evidence based surgery a nation-wide multi-center, prospective, randomized study is set up. The present study compares suture and mesh repairs in different positions, using open and laparoscopic approach to define standard indication for the treatment of incisional hernias. The study was started in March, 2002, with 23 surgical departments participating. Each report about 100 patients with incisional hernia repair. The 2300 consecutive patients (who are 18 to 70 years old) with primary incisional hernia or first recurrent umbilical hernia are randomized. Patients are divided in two groups. If the hernia is between 5-25 cm2 (Group I) they are selected at random either for prosthetic (sublay) or suture repair. In patients with a hernia larger than 25 cm2 (Group II) mesh is implanted at random as either sublay or onlay position using a computer randomization program. After a short learning period, in Group II the laparoscopic approach will also be randomized. Postoperative outcome, complications and recurrence are recorded. The study will run for five years. All collected data are sent to the coordinating center via internet to be entered into database. PMID:12474512

  8. Malignant peritoneal mesothelioma in a patient with intestinal fistula, incisional hernia and abdominal infection: A case report

    PubMed Central

    HONG, SEN; BI, MIAO-MIAO; ZHAO, PING-WEI; WANG, XU; KONG, QING-YANG; WANG, YONG-TAO; WANG, LEI

    2016-01-01

    Malignant mesothelioma is a rare type of cancer, most commonly associated with exposure to asbestos. Mesothelioma of the peritoneum, the membrane lining the abdominal cavity, is extremely rare. The current study reports the case of a 60-year-old female who presented with intestinal fistula, recurrent incisional hernia and abdominal infection, with no history of asbestos exposure, and was diagnosed with clear cell MPM. Computed tomography scans of the abdomen revealed extensive small bowel adhesions and massive peritoneal effusion. Histological examination of biopsy specimens indicated a diagnosis of malignant peritoneal mesothelioma with clear cell morphology. A laparotomy was performed, with subsequent resection of the bowel with fistula. Follow-up examination performed at 1-year post-surgery revealed that the patient was alive and in generally good health. PMID:26998119

  9. Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature.

    PubMed

    Suwa, Katsuhito; Okamoto, Tomoyoshi; Yanaga, Katsuhiko

    2016-07-01

    The laparoscopic technique for repairing ventral and incisional hernias (VIH) is now well established. However, several issues related to laparoscopic VIH repair, such as the high recurrence rate for hernias with large fascial defects and in extremely obese patients, are yet to be resolved. Additional problems include seroma formation, mesh bulging/eventration, and non-restoration of the abdominal wall rigidity/function with only bridging of the hernial orifice using standard laparoscopic intraperitoneal onlay mesh repair (sIPOM). To solve these problems, laparoscopic fascial defect closure with IPOM reinforcement (IPOM-Plus) has been introduced in the past decade, and a few studies have reported satisfactory outcomes. Although detailed techniques for fascial defect closure and handling of the mesh have been published, standardized techniques are yet to be established. We reviewed the literature on IPOM-Plus in the PubMed database and identified 16 reports in which the recurrence rate, incidence of seroma formation, and incidence of mesh bulging were 0-7.7, 0-11.4, and 0 %, respectively. Several comparison studies between sIPOM and IPOM-Plus seem to suggest that IPOM-Plus is associated with more favorable surgical outcomes; however, larger-scale studies are essential. PMID:26198897

  10. Laparoscopic Versus Open Umbilical Hernia Repair

    PubMed Central

    Gonzalez, Rodrigo; Mason, Edward; Duncan, Titus; Wilson, Russell

    2003-01-01

    Background: The use of prosthetic material for open umbilical hernia repair has been reported to reduce recurrence rates. The aim of this study was to compare outcomes after laparoscopic versus open umbilical hernia repair. Methods: We reviewed all umbilical hernia repairs performed from November 1995 to October 2000. Demographic data, hernia characteristics, and outcomes were compared. Results: Of the 76 patients identified, 32 underwent laparoscopic repair (LR), 24 primary suture repairs (PSR), and 20 open repairs with mesh (ORWM). Preoperative characteristics were similar between groups. Hernia size was similar between LR and ORWM groups, and both were larger than that in the PSR group. ORWM compared with the other techniques resulted in longer operating time, more frequent use of drains, higher complication rates, and prolonged return to normal activities (RTNA). The length of stay (LOS) was longer in the ORWM than in the PSR group. When compared with ORWM, LR resulted in lower recurrence rates. LR resulted in fewer recurrences in patients with previous repairs and hernias larger than 3 cm than in both open techniques. Conclusions: LR results in faster RTNA, and lower complication and recurrence rates compared with those in ORWM. Patients with larger hernias and previous repairs benefit from LR. PMID:14626398

  11. Telerobotic laparoscopic repair of incisional ventral hernias using intraperitoneal prosthetic mesh.

    PubMed

    Ballantyne, Garth H; Hourmont, Katherine; Wasielewski, Annette

    2003-01-01

    Laparoscopic ventral hernia repair shortens the length of hospital stay and achieves low rates of hernia recurrence. The inherent difficulties of performing advanced laparoscopy operations, however, have limited the adoption of this technique by many surgeons. We hypothesized that the virtual operative field and hand-like instruments of a telerobotic surgical system could overcome these limitations. We present herein the first 2 reported cases of telerobotic laparoscopic ventral hernia repair with mesh. The operations were accomplished with the da Vinci telerobotic surgical system. The hernia defects were repaired with dual-sided, expanded polytetrafluoroethylene (ePTFE) mesh. The mesh was secured in place with 8 sutures that were passed through the abdominal wall, and 5-mm surgical tacks were placed around the circumference of the mesh. The 2 operations were accomplished with total operative times of 120 and 135 minutes and total operating room times of 166 and 180 minutes, respectively. The patients were discharged home on postoperative days 1 and 4. The surgeon sat in an ergonomically comfortable position at a computer console that was remote from the patient. Immersion of the surgeon within the 3-dimensional virtual operative field expedited each stage of these procedures. The articulation of the wristed telerobotic instruments greatly facilitated reaching the anterior abdominal cavity near the abdominal wall. This report indicates that telerobotic laparoscopic ventral hernia repair is feasible and suggests that telepresence technology facilitates this procedure. PMID:12722992

  12. Telerobotic Laparoscopic Repair of Incisional Ventral Hernias Using Intraperitoneal Prosthetic Mesh

    PubMed Central

    Hourmont, Katherine; Wasielewski, Annette

    2003-01-01

    Laparoscopic ventral hernia repair shortens the length of hospital stay and achieves low rates of hernia recurrence. The inherent difficulties of performing advanced laparoscopy operations, however, have limited the adoption of this technique by many surgeons. We hypothesized that the virtual operative field and hand-like instruments of a telerobotic surgical system could overcome these limitations. We present herein the first 2 reported cases of telerobotic laparoscopic ventral hernia repair with mesh. The operations were accomplished with the da Vinci telerobotic surgical system. The hernia defects were repaired with dual-sided, expanded polytetrafluoroethylene (ePTFE) mesh. The mesh was secured in place with 8 sutures that were passed through the abdominal wall, and 5-mm surgical tacks were placed around the circumference of the mesh. The 2 operations were accomplished with total operative times of 120 and 135 minutes and total operating room times of 166 and 180 minutes, respectively. The patients were discharged home on postoperative days 1 and 4. The surgeon sat in an ergonomically comfortable position at a computer console that was remote from the patient. Immersion of the surgeon within the 3-dimensional virtual operative field expedited each stage of these procedures. The articulation of the wristed telerobotic instruments greatly facilitated reaching the anterior abdominal cavity near the abdominal wall. This report indicates that telerobotic laparoscopic ventral hernia repair is feasible and suggests that telepresence technology facilitates this procedure. PMID:12722992

  13. A Risk Model and Cost Analysis of Incisional Hernia After Elective, Abdominal Surgery Based Upon 12,373 Cases

    PubMed Central

    Fischer, John P.; Basta, Marten N.; Mirzabeigi, Michael N.; Bauder, Andrew R.; Fox, Justin P.; Drebin, Jeffrey A.; Serletti, Joseph M.; Kovach, Stephen J.

    2016-01-01

    Objectives: Incisional hernia (IH) remains a common, highly morbid, and costly complication. Modest progress has been realized in surgical technique and mesh technology; however, few advances have been achieved toward understanding risk and prevention. In light of the increasing emphasis on prevention in today's health care environment and the billions in costs for surgically treated IH, greater focus on predictive risk models is needed. Methods: All patients undergoing gastrointestinal or gynecologic procedures from January 1, 2005 to June 1, 2013, within the University of Pennsylvania Health System were identified. Comorbidities and operative characteristics were assessed. The primary outcome was surgically treated IH after index procedures. Patients with prior hernia, less than 1-year follow-up, or emergency surgical procedures were excluded. Cox hazard regression modeling with bootstrapped validation, risk factor stratification, and assessment of model performance were conducted. Results: A total of 12,373 patients with a 3.5% incidence of surgically treated IH (follow-up 32.2 ± 26.6 months) were identified. The cost of surgical treatment of IH and management of associated complications exceeded $17.5 million. Notable independent risk factors for IH were ostomy reversal (HR = 2.76), recent chemotherapy (HR = 2.04), bariatric surgery (HR = 1.78), smoking history (HR = 1.74), liver disease (HR = 1.60), and obesity (HR = 1.96). High-risk patients (20.6%) developed IH compared with 0.5% of low-risk patients (C-statistic = 0.78). Conclusions: This study demonstrates an internally validated preoperative risk model of surgically treated IH after 12,000 elective, intra-abdominal procedures to provide more individualized risk counseling and to better inform evidence-based algorithms for the role of prophylactic mesh. PMID:26465784

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

    PubMed

    Plencner, Martin; Prosecká, Eva; Rampichová, Michala; East, Barbora; Buzgo, Matej; Vysloužilová, Lucie; Hoch, Jiří; 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-ε-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

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

    PubMed Central

    Plencner, Martin; Prosecká, Eva; Rampichová, Michala; East, Barbora; Buzgo, Matej; Vysloužilová, Lucie; Hoch, Jiří; 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-ε-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

  16. Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14 618 Patients

    PubMed Central

    Bosanquet, David C.; Ansell, James; Abdelrahman, Tarig; Cornish, Julie; Harries, Rhiannon; Stimpson, Amy; Davies, Llion; Glasbey, James C. D.; Frewer, Kathryn A.; Frewer, Natasha C.; Russell, Daphne; Russell, Ian; Torkington, Jared

    2015-01-01

    Background The incidence of incisional hernias (IHs) following midline abdominal incisions is difficult to estimate. Furthermore recent analyses have reported inconsistent findings on the superiority of absorbable versus non-absorbable sutures. Objective To estimate the mean IH rate following midline laparotomy from the published literature, to identify variables that predict IH rates and to analyse whether the type of suture (absorbable versus non-absorbable) affects IH rates. Methods We undertook a systematic review according to PRISMA guidelines. We sought randomised trials and observational studies including patients undergoing midline incisions with standard suture closure. Papers describing two or more arms suitable for inclusion had data abstracted independently for each arm. Results Fifty-six papers, describing 83 separate groups comprising 14 618 patients, met the inclusion criteria. The prevalence of IHs after midline incision was 12.8% (range: 0 to 35.6%) at a weighted mean of 23.7 months. The estimated risk of undergoing IH repair after midline laparotomy was 5.2%. Two meta-regression analyses (A and B) each identified seven characteristics associated with increased IH rate: one patient variable (higher age), two surgical variables (surgery for AAA and either surgery for obesity surgery (model A) or using an upper midline incision (model B)), two inclusion criteria (including patients with previous laparotomies and those with previous IHs), and two circumstantial variables (later year of publication and specifying an exact significance level). There was no significant difference in IH rate between absorbable and non-absorbable sutures either alone or in conjunction with either regression analysis. Conclusions The IH rate estimated by pooling the published literature is 12.8% after about two years. Seven factors account for the large variation in IH rates across groups. However there is no evidence that suture type has an intrinsic effect on IH rates

  17. Incisional Reinforcement in High-Risk Patients

    PubMed Central

    Feldmann, Timothy F.; Young, Monica T.; Pigazzi, Alessio

    2014-01-01

    Hernia formation after surgical procedures continues to be an important cause of surgical morbidity. Incisional reinforcement at the time of the initial operation has been used in some patient populations to reduce the risk of subsequent hernia formation. In this article, reinforcement techniques in different surgical wounds are examined to identify situations in which hernia formation may be prevented. Mesh use for midline closure, pelvic floor reconstruction, and stoma site reinforcement is discussed. Additionally, the use of retention sutures, closure of the open abdomen, and reinforcement after component separation are examined using current literature. Although existing studies do not support the routine use of mesh reinforcement for all surgical incisions, certain patient populations appear to benefit from reinforcement with lower rates of subsequent hernia formation. The identification and characterization of these groups will guide the future use of mesh reinforcement in surgical incisions. PMID:25435823

  18. 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

  19. Current Trends in Laparoscopic Ventral Hernia Repair

    PubMed Central

    Patapis, Paul; Zavras, Nick; Tzanetis, Panagiotis; Machairas, Anastasios

    2015-01-01

    Background and Objectives: The purpose of this study was to analyze the surgical technique, postoperative complications, and possible recurrence after laparoscopic ventral hernia repair (LVHR) in comparison with open ventral hernia repair (OVHR), based on the international literature. Database: A Medline search of the current English literature was performed using the terms laparoscopic ventral hernia repair and incisional hernia repair. Conclusions: LVHR is a safe alternative to the open method, with the main advantages being minimal postoperative pain, shorter recovery, and decreased wound and mesh infections. Incidental enterotomy can be avoided by using a meticulous technique and sharp dissection to avoid thermal injury. PMID:26273186

  20. Laparoscopic repair of abdominal wall hernia: one-year experience

    NASA Astrophysics Data System (ADS)

    Kavic, Michael S.

    1993-05-01

    In this study, 101 consecutive laparoscopic transabdominal preperitoneal hernia repairs (LTPR) were performed in 62 patients by a single surgeon. The series was begun in April 1991, and involved repair of 49 direct, 41 indirect, 4 femoral, 3 umbilical, 3 sliding, and 1 incisional hernias. Twelve cases were bilateral, eleven hernias were incarcerated, and fifteen hernias were recurrent. There were no intraoperative complications, and none of the procedures required conversion to open surgery. Patients experienced the following postoperative complications: transient testicular pain (1), transient anterior thigh paresthesias (2), urinary retention requiring TURP (1), and hernia recurrences (2). Follow up has ranged from 4 - 15 months and initial results have been encouraging.

  1. A randomised, multi-centre, prospective, double blind pilot-study to evaluate safety and efficacy of the non-absorbable Optilene® Mesh Elastic versus the partly absorbable Ultrapro® Mesh for incisional hernia repair

    PubMed Central

    2010-01-01

    Background Randomised controlled trials with a long term follow-up (3 to 10 years) have demonstrated that mesh repair is superior to suture closure of incisional hernia with lower recurrence rates (5 to 20% versus 20 to 63%). Yet, the ideal size and material of the mesh are not defined. So far, there are few prospective studies that evaluate the influence of the mesh texture on patient's satisfaction, recurrence and complication rate. The aim of this study is to evaluate, if a non-absorbable mesh (Optilene® Mesh Elastic) will result in better health outcomes compared to a partly absorbable mesh (Ultrapro® Mesh). Methods/Design In this prospective, randomised, double blind study, eighty patients with incisional hernia after a midline laparotomy will be included. Primary objective of this study is to investigate differences in the physical functioning score from the SF-36 questionnaire 21 days after mesh insertion. Secondary objectives include the evaluation of the patients' daily activity, pain, wound complication and other surgical complications (hematomas, seromas), and safety within six months after intervention. Discussion This study investigates mainly from the patient perspective differences between meshes for treatment of incisional hernias. Whether partly absorbable meshes improve quality of life better than non-absorbable meshes is unclear and therefore, this trial will generate further evidence for a better treatment of patients. Trial registration NCT00646334 PMID:20624273

  2. Open repair of large abdominal wall hernias with and without components separation; an analysis from the ACS-NSQIP database

    PubMed Central

    Desai, Nirav K.; Leitman, I. Michael; Mills, Christopher; Lavarias, Valentina; Lucido, David L.; Karpeh, Martin S.

    2016-01-01

    Background Components separation technique emerged several years ago as a novel procedure to improve durability of repair for ventral abdominal hernias. Almost twenty-five years since its initial description, little comprehensive risk adjusted data exists on the morbidity of this procedure. This study is the largest analysis to date of short-term outcomes for these cases. Methods The ACS-NSQIP database identified open ventral or incisional hernia repairs with components separation from 2005 to 2012. A data set of cohorts without this technique, matched for preoperative risk factors and operative characteristics, was developed for comparison. A comprehensive risk-adjusted analysis of outcomes and morbidity was performed. Results A total of 68,439 patients underwent open ventral hernia repair during the study period (2245 with components separation performed (3.3%) and 66,194 without). In comparison with risk-adjusted controls, use of components separation increased operative duration (additional 83 min), length of stay (6.4 days vs. 3.8 days, p < 0.001), return to the OR rate (5.9% vs. 3.6%, p < 0.001), and 30-day morbidity (10.1% vs. 7.6%, p < 0.001) with no increase in mortality (0.0% in each group). Conclusions Components separation technique for large incisional hernias significantly increases length of stay and postoperative morbidity. Novel strategies to improve short-term outcomes are needed with continued use of this technique. PMID:27158489

  3. Hernia

    MedlinePlus

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

  4. Hernia

    MedlinePlus

    ... of a hernia. Sometimes, hernias occur with: Heavy lifting Straining while using the toilet Any activity that ... Extra weight Fluid in the abdomen ( ascites ) Heavy lifting Peritoneal dialysis Poor nutrition Smoking Overexertion Undescended testicles

  5. Chronic pain after open inguinal hernia repair.

    PubMed

    Nikkolo, Ceith; Lepner, Urmas

    2016-01-01

    Following the widespread use of mesh repairs, recurrence rates after inguinal hernia surgery have become acceptable and focus has shifted from recurrence to chronic pain. Although pain can be controlled with analgesics, chronic postsurgical pain is a major clinical problem, which can significantly influence the patient's quality of life. The rate of chronic pain after inguinal hernia mesh repair can reach 51.6%. The reasons for posthernioplasty chronic pain are often unclear. It has been linked to nerve injury and nerve entrapment, but there is also association between the rate of chronic pain and the type of mesh used for hernia repair. As there are >160 meshes available in the market, it is difficult to choose a mesh whose usage would result in the best outcome. Different mesh characteristics have been studied, among them weight of mesh has probably gained the most attention. The choice of adequate therapy for chronic groin pain after inguinal hernia repair is controversial. The European Hernia Society recommends that a multidisciplinary approach at a pain clinic should be considered for the treatment of chronic postoperative pain. Although surgical treatment of chronic posthernioplasty pain is limited because of the lack of relevant research data, resection of entrapped nerves, mesh removal in the case of mesh related pain or removal of fixation sutures can be beneficial for the patient with severe pain after inguinal hernia surgery. One drawback of published studies is the lack of consensus over definition of chronic pain, which makes it complicated to compare the results of different studies and to conduct meta-analyses and systematic reviews. Therefore, a uniform definition of chronic pain and its best assessment methods should be developed in order to conduct top quality multicenter randomized trials. Further research to develop meshes with optimal parameters is of vital importance and should be encouraged. PMID:26567717

  6. Hybrid technique for postoperative ventral hernias – own experience

    PubMed Central

    Okniński, Tomasz; Pawlak, Jacek

    2015-01-01

    Introduction There are many techniques which may be involved in abdominal hernia repair, from classical to tension-free. Treatment of complicated hernias has undergone evolution. Many surgeons consider the laparoscopic method as a method of choice for incisional hernia repair. Sometimes miniinvasive repair of complicated hernia is not so easy to perform. We are convinced that selected patients may benefit from combined open and laparoscopic techniques. Aim To present the operating technique and early results of treatment of 15 patients operated on using the 3 hybrid technique. Material and methods Fifteen patients suffering from recurrent incisional hernias underwent the hybrid technique for their repair between June 2012 and April 2015. The hybrid technique was performed using synthetic meshes in 14 cases and a biological implant in 1 case. Results The early postoperative period was uncomplicated in all cases. Within a maximum follow-up period of 32 months, two deep wound infections were observed. Conclusions The hybrid technique may be used in patients with recurrent incisional hernias. PMID:26865889

  7. [Intervention-specific complications of hernia surgery].

    PubMed

    Dietz, U A; Wiegering, A; Germer, C T

    2014-02-01

    Hernia surgery is generally a rewarding task, patient satisfaction is high and the long-term results are generally good. Incisional hernias are more heterogeneous and there is a higher variability of morphologies to be matched with the available therapeutic approaches but the majority of patients are also satisfied with the results. This positive scenario for hernia surgery can be largely attributable to careful preoperative planning, effective surgical techniques and a high degree of standardization. The picture is somewhat clouded by the complications associated with hernia surgery. If complications do arise, the outcome largely depends on how well the surgeon responds. For inguinal and femoral hernias, the risk profile of the patient is crucial to the surgical planning and the wrong operation on the wrong patient can be disastrous. Open procedures have complication risks in common but the question of how best to deal with the nerves has yet to be answered. Endoscopic procedures are an indispensable part of the hernia surgery repertoire and the hernia specialist should be proficient in TEP and TAPP techniques. Ventral and incisional hernias have higher complication rates and the treatment is similar despite differences in etiology and pathophysiology. Although open procedures are better for morphological reconstruction they are accompanied by a higher complication rate. Laparoscopic procedures had a severe complication profile early on but the situation has greatly improved today due to continued refinement of the learning curve. A critical approach to the application of methods and meshes, a deep knowledge of anatomical peculiarities and the careful planning of tactics for dealing with intraoperative problems are the hallmarks of today's good hernia surgeon. PMID:24435828

  8. National results after ventral hernia repair.

    PubMed

    Helgstrand, Frederik

    2016-07-01

    Ventral hernia repairs are among the most frequently performed surgical procedures. The variations of repair techniques are multiple and outcome has been unacceptable. Despite the high volume, it has been difficult to obtain sufficient data to provide evidence for best practice. In order to monitor national surgical quality and provide the warranted high volume data, the first national ventral hernia register (The Danish Ventral Hernia Database) was established in 2007 in Denmark. The present study series show that data from a well-established database supported by clinical examinations, patient files, questionnaires, and administrative data makes it possible to obtain nationwide high volume data and to achieve evidence for better outcome in a complex surgical condition as ventral hernia. Due to the high volume and included variables on surgical technique, it is now possible to make analyses adjusting for a variety of surgical techniques and different hernia specifications. We documented high 30-day complications and recurrence rates for both primary and secondary ventral hernias in a nationwide cohort. Furthermore, recurrence found by clinical examination was shown to exceed the number of patients undergoing reoperation for recurrence by a factor 4-5. The nationwide adjusted analyses proved that open mesh and laparoscopic repair for umbilical and epigastric hernias does not differ in 30-day outcome or in risk of recurrence. There is a minor risk reduction in early complications after open sutured repairs. However, the risk for a later recurrence repair is significantly higher after sutured repairs compared with mesh repairs. The study series showed that large hernia defects and open re-pairs were independent predictors for 30-day complications after an incisional hernia repair. Open procedures and large hernia defects were independent risk factors for a later recurrence re-pair. However, patients with large defects (> 15 cm) seemed to benefit from an open mesh

  9. Incisional hernioplasty with Mersilene.

    PubMed

    Wantz, G E

    1991-02-01

    Thirty large incisional abdominal hernias (myoaponeurotic defects greater than 10 centimeters) were successfully repaired by a technique of incisional hernioplasty which implants a large Mersilene (polyester fiber) prosthesis in the space between the abdominal muscles and the peritoneum. The prosthesis extends far beyond the borders of the myoaponeurotic defect, and is solidly held in place by intra-abdominal pressure and later by fibrous ingrowth. The prosthesis protects against recurrence in two ways. First, it prevents peritoneal eventration by adhering to the visceral sac and rendering it indistensible. Second, the prosthesis unites and consolidates the abdominal wall. Consequently, the procedure uniquely exploits the very force which caused the hernia to prevent a recurrence. A prosthesis of Mersilene is essential for success because it is supple and elastic enough to conform freely to the curvatures of the visceral sac, has the necessary grainy texture to grip the peritoneum and prevent slippage and is reactive enough to induce a rapid fibroblastic response to ensure fixation. PMID:1989116

  10. VOLUME CALCULATION OF RATS' ORGANS AND ITS APPLICATION IN THE VALIDATION OF THE VOLUME RELATION BETWEEN THE ABDOMINAL CAVITY AND THE HERNIAL SAC IN INCISIONAL HERNIAS WITH "LOSS OF ABDOMINAL DOMAIN"

    PubMed Central

    de ARAÚJO, Luz Marina Gonçalves; SERIGIOLLE, Leonardo Carvalho; GOMES, Helbert Minuncio Pereira; RODRIGUES, Daren Athiê Boy; LOPES, Carolina Marques; LEME, Pedro Luiz Squilacci

    2014-01-01

    Background The calculation of the volume ratio between the hernia sac and the abdominal cavity of incisional hernias is based on tomographic sections as well as the mathematical formula of the volume of the ellipsoid, which allows determining whether this is a giant hernia or there is a "loss of domain". As the images used are not exact geometric figures, the study of the volume of two solid organs of Wistar rats was performed to validate these calculations. Aim To correlate two methods for determining the volume of the kidney and spleen of rats, comparing a direct method of observation of the volume with the mathematical calculation of this value. Methods The volume of left kidney, geometrically more regular, and spleen, with its peculiar shape, of ten animals was established in cubic centimeters after complete immersion in water with the aid of a beaker graduated in millimeters. These values ​​were compared with those obtained by calculating the same volume with a specific mathematical formula: V = 4/3 × π × (r1 x r2 x r3). Data were compared and statistically analyzed by Student's t test. RESULTS: Although the average volume obtained was higher through the direct method (1.13 cm3 for the left kidney and 0.71 cm3 for the spleen) than the values ​​calculated with the mathematical formula (0.81 cm3 and 0.54 cm3), there were no statistically significant differences between the values ​​found for the two organs (p>0.05). Conclusion There was adequate correlation between the direct calculation of the volume of the kidney and spleen with the result of mathematical calculation of these values ​​in the animals' studies. PMID:25184766

  11. Endoscopic extraperitoneal repair of a Grynfeltt hernia.

    PubMed

    Postema, R R; Bonjer, H J

    2002-04-01

    There are three types of lumbar hernia: congenital, acquired, and incisional hernias. Acquired hernia can appear in two forms: the inferior (Petit) type and the superior type, first described by Grynfeltt in 1866. We report endoscopic extraperitoneal repair of a Grynfeltt hernia. A 46-year-old woman presented with a painful swelling in the left lumbar region that had caused her increasing discomfort. The diagnosis of Grynfeltt's hernia was made, and she underwent surgery. With the patient in a left-side decubitus position, access to the extraperitoneal space was gained by inserting a 10-mm inflatable balloon trocar just anteriorly to the midaxillary line between the 12th rib and the superior iliac crest through a muscle-splitting incision into the extraperitoneal space. After the balloon trocar had been removed a blunt-tip trocar was inserted. Using two 5-mm trocars, one above and another below the 10-mm port in the midaxillary line, the hernia could be reduced. A polypropylene mesh graft was introduced through the 10-mm trocar and tacked with spiral tackers. The patient could be discharged the next day after requiring only minimal analgesics. At this writing, 2 (1/2) years after the operation, there is no sign of recurrence. This Grynfeltt hernia could safely be treated using the extraperitoneal approach, which obviates opening and closing the peritoneum, thereby reducing operative time and possibly postoperative complications. PMID:11972231

  12. Stratification of Surgical Site Infection by Operative Factors and Comparison of Infection Rates after Hernia Repair

    PubMed Central

    Olsen, Margaret A.; Nickel, Katelin B.; Wallace, Anna E.; Mines, Daniel; Fraser, Victoria J.; Warren, David K.

    2015-01-01

    Objective The National Healthcare Safety Network does not risk adjust surgical site infection (SSI) rates after hernia repair by operative factors. We investigated whether operative factors are associated with risk of SSI after hernia repair. Design Retrospective cohort study. Patients Commercially-insured enrollees aged 6 months–64 years with ICD-9-CM procedure or CPT-4 codes for inguinal/femoral, umbilical, and incisional/ventral hernia repair procedures from 1/1/2004–12/31/2010. Methods SSIs within 90 days after hernia repair were identified by ICD-9-CM diagnosis codes. Chi-square and Fisher’s exact tests were used to compare SSI incidence by operative factors. Results A total of 119,973 hernia repair procedures were included in the analysis. The incidence of SSI differed significantly by anatomic site, with rates of 0.45% (352/77,666) for inguinal/femoral, 1.16% (288/24,917) for umbilical, and 4.11% (715/17,390) for incisional/ventral hernia repair. Within anatomic sites, the incidence of SSI was significantly higher for open versus laparoscopic inguinal/femoral (0.48% [295/61,142] versus 0.34% [57/16,524], p=0.020) and incisional/ventral (4.20% [701/16,699] versus 2.03% [14/691], p=0.005) hernia repairs. The rate of SSI was higher following procedures with bowel obstruction/necrosis than procedures without obstruction/necrosis for open inguinal/femoral (0.89% [48/5,422] versus 0.44% [247/55,720], p<0.001) and umbilical (1.57% [131/8,355] versus 0.95% [157/16,562], p<0.001), but not incisional/ventral hernia repair (4.01% [224/5,585] versus 4.16% [491/11,805], p=0.645). Conclusions The incidence of SSI was highest after open procedures, incisional/ventral repairs, and hernia repairs with bowel obstruction/necrosis. Our findings suggest that stratification of hernia repair SSI rates by some operative factors may be important to facilitate accurate comparison of SSI rates between facilities. PMID:25695175

  13. Five-Year Follow-Up of Patients Undergoing Laparoscopic or Open Groin Hernia Repair

    PubMed Central

    Wright, David; Paterson, Caron; Scott, Neil; Hair, Alan; O’Dwyer, Patrick J.

    2002-01-01

    Objective To compare laparoscopic with open hernia repair in a randomized clinical trial at a median follow-up of 5 years. Summary Background Data Follow-up of patients in clinical trials evaluating laparoscopic hernia repair has been short. Methods Of 379 consecutive patients admitted for surgery under the care of one surgeon, 300 were randomized to totally extraperitoneal hernia repair or open repair, with the open operation individualized to the patient’s age and hernia type. All patients, both randomized and nonrandomized, were followed up by clinical examination annually by an independent observer. Results Recurrence rates were similar for both randomized groups. In 1 of the 79 nonrandomized patients, a recurrent hernia developed. Groin or testicular pain was the most common symptom on follow-up of randomized patients. The most common reason for reoperation was development of a contralateral hernia, which was noted in 9% of patients; 11% of all patients died on follow-up, mainly as a result of cardiovascular disease or cancer. Conclusions These data show a similar outcome for laparoscopic and open hernia repair, and both procedures have a place in managing this common problem. PMID:11882754

  14. [Lumbar hernia].

    PubMed

    Teiblum, Sandra Sofie; Hjørne, Flemming Pii; Bisgaard, Thue

    2010-03-22

    Lumbar hernia is a rare condition. Lumbar hernia should be considered a rare differential diagnosis to unexplained back pain. Symptoms are scarce and diffuse and can vary with the size and content of the hernia. As there is a 25% risk of incarceration, operation is indicated even in asymptomatic hernias. We report a case of lumbar hernia in a woman with a slow growing mass in the lumbar region. She presented with pain and a computed tomography confirmed the diagnosis. She underwent open surgery and fully recovered with recurrence within the first half year. PMID:20334799

  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. A Comparative Analysis Between Laparoscopic and Open Ventral Hernia Repair at a Tertiary Care Center

    PubMed Central

    DAVIES, STEPHEN W.; TURZA, KRISTIN C.; SAWYER, ROBERT G.; SCHIRMER, BRUCE D.; HALLOWELL, PETER T.

    2012-01-01

    Laparoscopic ventral hernia repair reportedly yields lower postoperative complications than open repair. We hypothesized that patients undergoing laparoscopic repair would have lower postoperative infectious outcomes. Also, certain preoperative patient characteristics and preoperative hernia characteristics are hypothesized to increase complication risk in both groups. All ventral hernia repairs performed at University of Virginia from January 2004 to January 2006 were reviewed. Primary outcomes included wound healing complications and hernia recurrence. Categorical data were analyzed with χ2 and Fisher’s exact tests. Continuous variables were evaluated with independent t tests and Mann-Whitney U tests. Multivariable logistic regression was performed. A total of 268 repairs (110 open, 158 laparoscopic) were evaluated. Patient and hernia characteristics were similar between groups, though the percents of wound contamination (5.4% vs 0.6%; P = 0.02) and simultaneous surgery (7.2% vs 0%; P = 0.001) were greater in the open procedures. Univariate analysis also revealed that open cases had a greater incidence of postoperative superficial surgical site infection (SSI) (30.0% vs 10.7%; P < 0.0001). Multivariable analysis revealed that both diabetes and open repair were associated with an increased risk of superficial SSI (P = 0.019; odds ratio = 3.512; 95% confidence interval = 1.229–10.037 and P = 0.001; odds ratio = 4.6; 95% confidence interval = 1.9–11.2, respectively). Laparoscopic ventral hernia repair yielded lower rates of postoperative superficial SSI than open surgery. Other pre-operative patient characteristics and preoperative hernia characteristics, with the exception of diabetes, were not found to be associated with an increased risk of postoperative complications. PMID:22856497

  17. 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

  18. Recurrent incisional hernia, enterocutaneous fistula and loss of the substance of the abdominal wall: plastic with organic prosthesis, skin graft and VAC therapy. Clinical case.

    PubMed

    Nicodemi, Sara; Corelli, Sergio; Sacchi, Marco; Ricciardi, Edoardo; Costantino, Annarita; Di Legge, Pietro; Ceci, Francesco; Cipriani, Benedetta; Martellucci, Annunziata; Santilli, Mario; Orsini, Silvia; Tudisco, Antonella; Stagnitti, Franco

    2015-01-01

    Surgical wounds dehiscence is a serious post-operatory complication, with an incidence between 0.4% and 3.5%. Mortality is more than 45%. Complex wounds treatment may require a multidisciplinary management. VAC Therapy could be an alternative treatment regarding complex wound. VAC therapy has been recently introduced on skin's graft tissue management reducing skin graft rejection. The use of biological prosthesis has been tested in a contaminated field, better than synthetic meshes, which often need to be removed. The Permacol is more resistant to degradation by proteases due to its cross-links. Surgery is still considered the best treatment for digestive fistula. A 58 years old obese woman come to our attention, she was operated for an abdominal hernia. She had a post-operatory entero-cutaneous fistula. She was submitted to bowel resection, the anastomosis has been tailored and the hernia of the abdominal wall has been repaired with biological mesh for managing such condition. She had a wound dehiscence with loss of substance and the exposure of the biological prosthesis, nearly 20 cm diameter. She was treated first with antibiotic therapy and simple medications. In addiction, antibiotic therapy was necessary late associated to 7 months with advanced medications allowed a small reduction's defect. Because of its, treatment went on for two more months using VAC therapy. Antibiotic's therapy was finally suspended. The VAC therapy allowed the reduction of the gap, between skin and subcutaneous tissue, and the defect's size preparing a suitable ground for the skin graft. The graft, managed with the vac therapy, was necessary to complete the healing process. PMID:25953007

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

    PubMed Central

    2013-01-01

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

  20. A Large Single-Center Experience of Open Lateral Abdominal Wall Hernia Repairs.

    PubMed

    Patel, Puraj P; Warren, Jeremy A; Mansour, Roozbeh; Cobb, William S; Carbonell, Alfredo M

    2016-07-01

    Lateral abdominal wall hernias may occur after a variety of procedures, including anterior spine exposure, urologic procedures, ostomy closures, or after trauma. Anatomically, these hernias are challenging and require a complete understanding of abdominal wall, interparietal and retroperitoneal, anatomy for successful repair. Mesh placement requires extensive dissection of often unfamiliar planes, and its fixation is difficult. We report our experience with open mesh repair of lateral abdominal wall hernias. A retrospective review of a prospectively maintained database was performed to identify patients with a classification of lateral abdominal wall hernia who underwent an open repair. A total of 61 patients underwent open lateral hernia repairs. Mean patient age was 58 years (range 25-78), with a mean body mass index of 32 kg/m(2) (range 19.0-59.1). According to the European Hernia Society classification, defects were located subcostal (L1, 14 patients), flank (L2, 33 patients), iliac (L3, 11 patients), and lumber (L4, 3 patients). Mean defect size was 78.6 cm(2), with a mean greatest single dimension of 9.2 cm (range 2-25 cm). Retromuscular or interparietal repair was performed in 50.8 per cent, preperitoneal in 41.0 per cent, intraperitoneal in 6.6 per cent, and onlay in 1.6 per cent. The rate of surgical site occurrence was 49.2 per cent, primarily seroma and surgical site infection rate was 13.1 per cent. With a mean follow-up of 15.4 months, seven patients (11.5%) have documented recurrence. Synthetic mesh reconstruction of lateral wall hernias is challenging. Our experience demonstrates the safety and success of repair using synthetic mesh primarily in the retromuscular, interparietal, or preperitoneal planes. PMID:27457859

  1. The effect of incisional infiltration of bupivacaine upon pain and respiratory function following open cholecystectomy.

    PubMed

    Russell, W C; Ramsay, A H; Fletcher, D R

    1993-10-01

    A controlled, prospective, double-blind trial of wound infiltration with bupivacaine in elective open cholecystectomy was performed to determine if this was an effective method of pain relief and reduced respiratory complications. Additionally, dextran was added to the bupivacaine in an attempt to prolong the effect. The solutions used were, bupivacaine alone 0.25% (n = 14), bupivacaine 0.25% with dextran 70 (n = 16) and saline (n = 16) as a control. To determine the effect of each solution, the subjects were assessed for pain perception and respiratory function before and after surgery. Pain was assessed using a visual analogue scale and narcotic usage, and respiratory function was assessed by spirometry, chest X-rays and arterial blood gases. The study did not demonstrate any objective improvement in either pain relief or respiratory function. This may reflect inadequate infiltration by the surgeons in the study or that infiltration should have been performed prior to incision. PMID:7506020

  2. Cure of inguinal hernias with large preperitoneal prosthesis: Experience of 2,312 cases.

    PubMed

    Alexandre, J H; Bouillot, J L; Dupin, P; Aouad, K; Bethoux, J P

    2006-09-01

    It is clear that the recurrence rates after nonprosthetic methods for the repair of inguinal hernias, like McVay, Bassini or Shouldice techniques, are high (6-10%). Since 20 years, we are convinced, in the GREPA-EHS group, about the advantages of the use of a prosthetic mesh in majority of patients for repairs of primary or recurrent inguinal hernias and incisional hernias. We describe our typical technique for the cure of all inguinal hernias. We place a large supple mesh, by open inguinal route, posterior to the transversalis fascia and anterior to the peritoneum. We have made a double modification in the initial technique of Rives - the use of a very large unsplit prosthesis (15 × 17 cm) and the parietalization of the spermatic cord helped by a wide opening of the Fruchaud's orifice by diversion of the epigastric vessels. The positioning of the mesh is about the same as in the TEP technique but with the advantages of reduction in the vital laparoscopic risks and reinforcement of the wall by a short tension-free McVay technique.For this prospective study, we repaired 2,312 consecutive hernias in 1,828 patients, 284 of which were recurrent. We present our results in terms of quality of repairs, recurrence rates (0.4%), morbidity rate (8%), and mortality rate (0.8%).This technique involves the placement by an open incisional route of a large preperitoneal sheet of mesh for initial treatment of all inguinal hernias - including scrotal, giant or femoral - to ensure a definitive solid muscular wall, even for recurrent hernias. PMID:21187983

  3. Single incision laparoscopic spigelian hernia repair--an approach with standard instrumentarium.

    PubMed

    Peterko, Ana Car; Kirac, Iva; Cugura, Jaksa Filipović; Bekavac-Beslin, Miroslav

    2013-09-01

    Spigelian hernia is a rare type of abdominal wall ventral hernia caused by defect in the spigelian fascia and presented with pain and/or palpable mass. This diagnosis is an indication for surgical procedure due to the high risk of incarceration. There are two surgical approaches (open and laparoscopic), both using two methods of repair (mesh-free primary closure and tension-free mesh repair), depending on the hernia ring size. We present a case of a 62-year-old woman with a palpable mass localized in the left spigelian hernia belt, verified by ultrasonography as a spigelian hernia. A single incision intra-abdominal laparoscopic approach with a tension-free underlay mesh-repair technique was used to treat the condition. Operating time was 40 minutes and the procedure was completed without complications. Postoperative recovery was uneventful as well as 1-week and 2-month follow up. To our knowledge, this is the first report of spigelian hernia repair by single incision laparoscopic surgery. Although this approach is more demanding in comparison to multiport laparoscopy, it proved to be safe and feasible for experienced laparoscopic team. Besides cosmetic improvement, the single incision approach reduces to minimum the risk of bleeding, organ injury and incisional postoperative hernia. To determine optimal indications and limits of this approach, further data collection and follow up are required. PMID:24558773

  4. Two port laparoscopic ventral hernia mesh repair: an innovative technical advancement.

    PubMed

    Mehrotra, Prateek K; Ramachandran, C S; Arora, Vijay

    2011-01-01

    Ventral hernia is a common surgical problem. The traditional open surgical repair has the disadvantage of excessive morbidity, long hospital stay and high recurrence rates. Laparoscopic ventral hernia repair (LVHR) is gaining acceptance but there is no standardized technique for the repair of these hernias. We have introduced an innovative technique of 2-port laparoscopic mesh repair for ventral and incisional hernias. Between January 2002 and September 2008, 168 patients underwent the 2-port repair of ventral hernias at our institution, with Bard polypropylene mesh in 162 cases and Gore-tex expanded polytetrafloroethylene mesh in 6 patients. The average size of the defects was 10.2 cm (6.6-24.8 cm). Mean operating time was 61.4 min (48-102 min). The mean post-operative hospital stay was 1.2 days. Prolonged ileus over one day occurred in 22 patients while 6 patients had urinary retention in the post-operative period. There were 6 recurrences (3.94%) in the mean follow up period of 42 months (6-62 months). Seroma formation occurred in 5.3% cases but all of them subsided within 6 weeks without any active intervention. In conclusion we recommend that the 2-port LVHR is a technically sound procedure which is less invasive and with comparable complication rates to the 3 or 4 port hernia repair. PMID:20934544

  5. [Laparoscopic repair of abdominal wall hernias].

    PubMed

    Bezsilla, János

    2010-10-01

    Repair of abdominal wall defects is a challenge for all general surgeons and a variety of methods have been described in the past. Traditionally, primary suture repair was shown to have a high recurrence rate in long-term follow-up studies. Herniorrhaphies that apply a large prosthetic mesh are appear to have a lower failure rate, but extensive dissection of soft tissue contributes to an increased incidence of wound infections and wound-related complications. The method of laparoscopic incisional hernia repair was developed in the early 1990s. This technique is based on the same physical and surgical principles as the open underlay procedure. The laparoscopic intraperitoneal onlay mesh (IPOM) technique and mesh materials were developed further in subsequent years, and there have been numerous reports on successful use of the IPOM technique even for extremely large hernia openings in obese and elderly patients. Reduced surgical trauma and lower infection and recurrence rates are key advantages of the minimally invasive repair. Therefore, this operation has increased in popularity promising shorter hospital stay, improved outcome, and fewer complications than traditional open procedures. PMID:20965866

  6. ADULT ABDOMINAL WALL HERNIA IN IBADAN

    PubMed Central

    Ayandipo, O.O; Afuwape, O.O; Irabor, D.O; Abdurrazzaaq, A.I.

    2015-01-01

    Background: Abdominal wall hernias are very common diseases encountered in surgical practice. Groin hernia is the commonest type of abdominal wall hernias. There are several methods of hernia repair but tension-free repair (usually with mesh) offers the least recurrent rate. Aim: To describe the clinical profile of anterior abdominal wall hernias and our experience in the surgical management of identified hernias Method: The project was a retrospective study of all patients with abdominal wall hernia presenting into surgical divisions of University College Hospital Ibadan during a 6 year period (January 2008 to December 2013). Relevant information was retrieved from their case notes and analysed. Results: The case records of 1215 (84.7%) patients out of 1435 were retrieved. Elective surgery was done in 981(80.7%) patients while 234 (19.3%) patients had emergency surgery. There were 922 (84.8%) groin hernias and post-operative incisional hernia accounted for 9.1% (111) of the patients. About half (49.1%) of those with incisional hernia were post obstetric and gynaecologic procedure followed by post laparotomy incisional hernias 16 (14%) and others (23.5%). The ratio of inguinal hernia to other types in this study is 3:1. Hollow viscus resection and emergency surgery were predictors of wound infection statistically significant in predicting wound infection (P < 0.001). Peri-operative morbidity/mortality at 28 days post operation was documented in 113 patients (12.1%). One year recurrence rate of groin hernia was 2.1%. Conclusion: The pattern of presentation and management of anterior wall hernias are still the same compared with the earlier study in this hospital. New modality of treatment should be adopted as the standard choice of care. Abdominal wall hernias are very common clinical presentation. Modified Bassini repair was the preferred method of repair due to its simplicity. Mesh repair is becoming more common in recent time but high cost and initial non

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

    PubMed Central

    Bury, Kamil; Śmietański, 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

  8. Hiatal hernia

    MedlinePlus

    Treatment can relieve most symptoms of hiatal hernia. ... may include: Pulmonary (lung) aspiration Slow bleeding and iron deficiency anemia (due to a large hernia) Strangulation (closing off) of the hernia

  9. Minimally Invasive Spigelian Hernia Repair

    PubMed Central

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

    2009-01-01

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

  10. Open preperitoneal versus anterior approach for recurrent inguinal hernia: a randomized study

    PubMed Central

    2012-01-01

    Background Inguinal herniorrhaphy remains one of the most common general surgical operations, with approximately 15% performed for recurrence. The repair of the resulting recurrent hernia is a daunting task because of already weakened tissues and obscured and distorted anatomy. The aim of this study is to compare the posterior preperitoneal versus anterior tension-free approach for repair of unilateral recurrent inguinal hernia regarding complications and early recurrence. Methods 120 Patients in this study were divided randomly into 2 main groups; Group A patients were subjected to posterior preperitoneal approach and those of group B were subjected to conventional anterior tension-free repair. 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 was 1.2 days and 4.7, the mean time to return work was 8.2 and 11.2 days and the mean time off from work was 9.4 and 15.9 days in group A and B respectively. The maximum follow-up period was 48 months and the minimum was 14 months with a mean value as 37.11 ± 5.14 months. Only 2 recurrences (3.3%) in group A and 4 cases (6.25%) in group B were seen. The final pain score per patient and the overall complication rate were higher in group B. Conclusions The open preperitoneal repair offers the advantages of low recurrence rate and allows covering all potential defects with one piece of mesh and is far superior to the anterior approach. Trial Registration ACTRN12611000337976 PMID:23110701

  11. Hiatal Hernia After Open versus Minimally Invasive Esophagectomy: A Systematic Review and Meta-analysis.

    PubMed

    Oor, J E; Wiezer, M J; Hazebroek, E J

    2016-08-01

    Hiatal hernia (HH) is an infrequent yet potentially life-threatening complication after esophagectomy. Several studies have reported the incidence of this complication after both open and minimally invasive esophagectomy (MIE). This meta-analysis aimed to determine the pooled incidence of HH after both types of esophagectomy and, importantly, to provide insight in the outcome of subsequent HH repair. A systematic search was performed of the PubMed, Embase, CINAHL, and Cochrane databases. Article selection was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. Articles describing the incidence of HH after different open and minimally invasive techniques were included. Only when five or more comparable studies reported on the same outcome were data pooled. The incidence of postoperative HH and the outcome of HH repair were analyzed. Twenty-six studies published between 1985 and 2015 were included, describing a total of 6058 patients who underwent esophagectomy, of whom 240 were diagnosed with a postoperative HH. The pooled incidence of symptomatic HH after MIE was 4.5 %, compared to a pooled incidence of 1.0 % after open esophagectomy. 11 studies reported on the outcome of HH repair in 125 patients. A pooled morbidity rate after HH repair of 25 % was found. During follow-up, a pooled recurrence rate of 14 % was reported in 11 of the included studies. The pooled incidence of HH after MIE is higher compared to open esophagectomy. Most importantly, surgical repair of these HHs is associated with a high morbidity rate. Both radiologists and surgeons should be aware of this rare yet potentially life-threatening complication. PMID:26926480

  12. A case of a colocutaneous fistula: A rare complication of mesh migration into the sigmoid colon after open tension-free hernia repair

    PubMed Central

    Al-Subaie, Saud; Al-Haddad, Mohanned; Al-Yaqout, Wadha; Al-Hajeri, Mufarrej; Claus, Christiano

    2015-01-01

    Introduction The Lichtenstein technique is commonly used in inguinal hernia repair and a polypropylene mesh is the most frequently used mesh. Mesh migration into the colon has been rarely reported in the literature. Here we report a case of a colocutaneous fistula that developed following delayed mesh migration into the sigmoid colon. Presentation of case A 52-year-old man undergone Lichtenstein repair for left direct inguinal herniain 2008. Three years later, he presented complaining of rectal bleeding and concurrent bloody discharge from the hernia repair scar. Colonoscopy identified an internal fistulous orifice with intraluminal extrusion of the polypropylene mesh. Furthermore, abdominal ultrasound revealed a fistulous tract extending from the sigmoid colon to the anterior abdominal wall, and a fistulogram confirmed the findings. Open sigmoidectomy and resection of the abdominal wall with the fistula tract was performed, and BIO-A® tissue reinforcement meshwas placed. His postoperative course was unremarkable and was discharged on postoperative day 3. Discussion Mesh migration after mesh inguinal hernia repair is unpredictable. A previous report has presented complications related to prosthetics in hernia repair, such as infection, contraction, rejection, and, rarely, mesh migration.Mesh migration may occur as an early or late complication after hernioplasty. Conclusion During hernia repair, the surgeon should carefully check for a sliding hernia, which may contain the sigmoid colon within the sac, because failure to identify this hernia may lead to direct contact between the mesh and the colon, which may cause pressure necrosis and fistula formation followed by mesh migration. PMID:26209758

  13. Umbilical hernia

    MedlinePlus

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

  14. 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

  15. Comparison of Porcine Small Intestinal Submucosa versus Polypropylene in Open Inguinal Hernia Repair: A Systematic Review and Meta-Analysis

    PubMed Central

    Nie, Xin; Xiao, Dongdong; Wang, Wenyue; Song, Zhicheng; Yang, Zhi; Chen, Yuanwen; Gu, Yan

    2015-01-01

    Background A systematic review and meta-analysis was performed in randomized controlled trials (RCTs) to compare porcine small intestinal submucosa (SIS) with polypropylene in open inguinal hernia repair. Method Electronic databases MEDLINE, Embase, and the Cochrane Library were used to compare patient outcomes for the two groups via meta-analysis. Result A total of 3 randomized controlled trials encompassing 200 patients were included in the meta-analysis. There was no significant difference in recurrence (P = 0.16), hematomas (P = 0.06), postoperative pain within 30 days (P = 0.45), or postoperative pain after 1 year (P = 0.12) between the 2 groups. The incidence of discomfort was significantly lower (P = 0.0006) in the SIS group. However, the SIS group experienced a significantly higher incidence of seroma (P = 0.03). Conclusions Compared to polypropylene, using SIS in open inguinal hernia repair is associated with a lower incidence of discomfort and a higher incidence of seroma. However, well-designed larger RCT studies with a longer follow-up period are needed to confirm these findings. PMID:26252895

  16. [Perineal hernia].

    PubMed

    Mandarano, R; Giorgi, G; Venturini, N; Mancini, E; Natale, A; Tiburzi, C

    1999-01-01

    The authors base this study on a case of perineal hernia referred to their attention. In the light of the scant international literature on this subject, they focus on the topographical anatomy of the pelvic floor in order to gain a clearer understanding of this pathology, as well as their classification into median, lateral, anterior and posterior forms. Above all, the authors draw attention to the importance of the differential diagnosis of perineal hernia from Bartholin cysts or vulvar tumours in relation to anterior perineal hernia, and perianal abscesses in relation to posterior hernia. They underline the value of ultrasonography or TAC during the diagnostic procedure. Lastly, they examine the channels of aggression for this type of hernia which may be abdominal, perianal or combined (abdominal and peri-anal), as well as the repair techniques used, varying from direct suture with non-absorbable material to the use of prolene mesh or flaps if the hernia breech is very large. PMID:10528488

  17. 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

  18. A case of de Garengeot hernia: the feasibility of laparoscopic transabdominal preperitoneal hernia repair

    PubMed Central

    Al-Subaie, Saud; Mustafa, Hatem; Al-Sharqawi, Noura; Al-Haddad, Mohanned; Othman, Feras

    2015-01-01

    Introduction de Garengeot hernia is described as the presence of an appendix in a femoral hernia. This rare hernia usually presents with both diagnostic and therapeutic dilemmas. Presentation of case We report a case of a 59 year-old woman with a one-year history of a right irreducible femoral hernia. She underwent diagnostic laparoscopy with an intraoperative diagnosis of de Garengeot hernia. This was followed by a laparoscopic transabdominal preperitoneal (TAPP) approach for hernia repair. Discussion The long-standing presentation of de Garengeot hernia is seldomly reported in literature. There has been no standard approach of treatment for de Garengeot hernias described, possibly due to the rarity of this condition. The unusual presentation of the hernia prompted us to undergo a diagnostic laparoscopy first, during which the appendix was seen incarcerated in a femoral hernia sac. We were easily able to proceed for a laparoscopic TAPP approach for hernia repair without the need for conversion to an open repair. Conclusion We were able to obtain an accurate diagnosis of an appendix within a long-standing irreducible femoral hernia through diagnostic laparoscopy followed by transabdominal preperitoneal (TAPP) approach for hernia repair. We would like to underline the usefulness of laparoscopy as a valuable tool in the diagnosis and treatment of this unusual presentation of groin hernias. PMID:26432998

  19. Mesh fixation methods in open inguinal hernia repair: a protocol for network meta-analysis and trial sequential analysis of randomised controlled trials

    PubMed Central

    Ge, Long; Tian, Jin-hui; Li, Lun; Wang, Quan; Yang, Ke-hu

    2015-01-01

    Introduction Randomised clinical trials (RCTs) have been used to compare and evaluate different types of mesh fixation usually employed to repair open inguinal hernia. However, there is no consensus among surgeons on the best type of mesh fixation method to obtain optimal results. The choice often depends on surgeons’ personal preference. This study aims to compare different types of mesh fixation methods to repair open inguinal hernias and their role in the incidences of chronic groin pain, risk of hernia recurrence, complications, operative time, length of hospital stay and postoperative pain, using Bayesian network meta-analysis and trial sequential analysis of RCTs. Methods and analysis A systematic search will be performed using PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Biomedical Literature Database (CBM) and Chinese Journal Full-text Database, to include RCTs of different mesh fixation methods (or fixation vs no fixation) during open inguinal hernia repair. The risk of bias in included RCTs will be evaluated according to the Cochrane Handbook V.5.1.0. Standard pairwise meta-analysis, trial sequential analysis and Bayesian network meta-analysis will be performed to compare the efficacy of different mesh fixation methods. Ethics and dissemination Ethical approval and patient consent are not required since this study is a meta-analysis based on published studies. The results of this network meta-analysis and trial sequential analysis will be submitted to a peer-reviewed journal for publication. Protocol registration number PROSPERO CRD42015023758. PMID:26586326

  20. Laparoscopic Repair of Left Lumbar Hernia After Laparoscopic Left Nephrectomy

    PubMed Central

    Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

    Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair. PMID:21333197

  1. Abdominal wall hernias in the setting of cirrhosis.

    PubMed

    Belghiti, J; Durand, F

    1997-01-01

    In cirrhotic patients, umbilical hernias occur almost exclusively when longstanding ascites is present. Umbilical hernias expose cirrhotic patients to potentially life-threatening complications such as strangulation (which can be precipitated by rapid removal of ascitic fluid) and rupture (which is usually preceded by cutaneous ulcerations on the surface of the hernia). In cirrhotic patients, prevention of umbilical hernias is based on prevention of ascites. When prevention has failed, medical treatment of ascites should be first attempted. In patients in whom medical treatment is effective, and after ascites has disappeared, surgical treatment of umbilical hernia can be safely performed in most cases. In patients in whom medical treatment is ineffective and who develop refractory ascites, treatment strategy for umbilical hernia depends on the presence or absence of indication for liver transplantation. In patients who are candidates for liver transplantation, careful local care with pressure bandage must be performed until transplantation. Herniorrhaphy must be performed at the time of transplantation. In patients with refractory ascites, and who are not candidates for transplantation, portocaval shunt, transjugular intrahepatic portocaval shunt (both followed by surgical herniorrhaphy when ascites has disappeared) or concomitant peritoneo-venous shunt and herniorrhaphy should be considered. In contrast to umbilical hernias, groin hernias are not markedly influenced by ascites. However, ascites is a major risk factor for surgery. Therefore, surgical repair should not be recommended in patients with ascites and poor liver function. In cirrhotic patients with incisional hernia, prosthetic devices should be avoided because of the high risk of bacterial infection. PMID:9308126

  2. Umbilical hernia repair

    MedlinePlus

    Umbilical hernia repair is surgery to repair an umbilical hernia . An umbilical hernia is a sac (pouch) formed from the ... the hole or weak spot caused by the umbilical hernia. Your surgeon may also lay a piece ...

  3. Hiatal hernia

    MedlinePlus

    ... Chest pain Heartburn , worse when bending over or lying down Swallowing difficulty A hiatal hernia by itself ... symptoms include: Avoiding large or heavy meals Not lying down or bending over right after a meal ...

  4. 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

  5. Management of Giant Ventral Hernia by Polypropylene Mesh and Host Tissue Barrier: Trial of Simplification

    PubMed Central

    Ammar, Samir A.

    2009-01-01

    Background Surgical management of giant ventral hernias is a surgical challenge due to limited abdominal cavity. This study evaluates management of giant ventral hernias using polypropylene mesh and host tissue barrier after suitable preoperative preparation. Methods In the period from January 2005 and January 2007, 35 patients with giant ventral hernias underwent hernia repair. After careful preoperative preparation, repair was done using polypropylene mesh. The mesh was separated from the viscera by a small part of the hernia sac and the greater omentum. Results The average age of the patients was 52. Twenty patients had post-operative incisional and 15 had para-umbilical hernias. The mean hernia defect size was 16.8 cm. Mean body mass index was 33. Follow up ranged from 18-36 months. No patient required ventilation after operation. Recurrent seroma, which responded to repeated aspiration, was experienced in 4 patients. Minor wound infection was observed in 5 patients. Small hernia recurrence occurred in one patient. Conclusion The use of polypropylene and host tissue barrier after suitable preoperative preparation is relatively simple, safe, and reliable surgical solution to the problem of giant ventral hernia. Keywords Hernia repair; Giant ventral hernia; Polypropylene mesh PMID:22461873

  6. Laparoscopic repair of an incarcerated femoral hernia

    PubMed Central

    Pillay, Yagan

    2015-01-01

    Introduction A femoral hernia is a rare, acquired condition, which has been reported in less than 5% of all abdominal wall hernias, with a female to male ratio of 4:1. Presentation of case We report a case in a female patient who had a previous open inguinal herniorrhaphy three years previously. She presented with right sided groin pain of one month duration. Ultrasound gave a differential diagnosis of a recurrent inguinal hernia or a femoral hernia. A transabdominal preperitoneal repair was performed and the patient made an uneventful recovery. Discussion Laparoscopic repair of a femoral hernia is still in its infancy and even though the outcomes are superior to an open repair, open surgery remains the standard of care. The decision to perform a laparoscopic trans abdominal preperitoneal (TAPP) repair was facilitated by the patient having previous open hernia surgery. The learning curve for laparoscopic femoral hernia repair is steep and requires great commitment from the surgeon. Once the learning curve has been breached this is a feasible method of surgical repair. This is demonstrated by the fact that this case report is from a rural hospital in Canada. Conclusion Laparoscopic femoral hernia repair involves more time and specialized laparoscopic skills. The advantages are a lower recurrence rate and lower incidence of inguinodynia. PMID:26581083

  7. Laparoscopic Versus Open Preperitoneal Mesh Repair of Inguinal Hernia: an Integrated Systematic Review and Meta-analysis of Published Randomized Controlled Trials.

    PubMed

    Sajid, Muhammad Shafique; Caswell, Jennifer; Singh, Krishna K

    2015-12-01

    The objective of this article is to systematically analyse the randomized, controlled trials comparing open (OPPR) versus laparoscopic (LPPR) preperitoneal mesh repair of inguinal hernia. Randomized, controlled trials comparing OPPR versus LPPR of inguinal hernia were analysed systematically using RevMan®, and combined outcomes were expressed as odds ratio (OR) and standardized mean difference (SMD). Ten randomized trials evaluating 1286 patients were retrieved from the electronic databases. There were 606 patients in the OPPR repair group and 680 patients in the LPPR group. There was significant heterogeneity among trials (p < 0.0001). Therefore, in the random effects model, LPPR was associated with longer operative time and relatively lesser postoperative pain in the case of the trans-abdominal preperitoneal approach. Statistically, both OPPR and LPPR were equivalent in terms of developing chronic groin pain, recurrence and postoperative complications. OPPR of inguinal hernia is associated with shorter operative time and comparable with LPPR (both total extraperitoneal and trans-abdominal preperitoneal approaches) in terms of risk of chronic groin pain, recurrence and complications. PMID:27011548

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

    PubMed Central

    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

  9. Laparoscopy for Hemoperitoneum After Traditional Inguinal Hernia Repair

    PubMed Central

    Kasamatsu, Hajime; Fujita, Sadanori; Mori, Hiroshi

    2002-01-01

    Hemoperitoneum after inguinal hernia repair, with the exception of laparoscopic herniorrhaphy, is extremely rare. No other case of hemoperitoneum after traditional open inguinal hernia repair has been reported in the English-language literature. A 39-year-old woman had undergone inguinal hernia repair with the Bassini repair technique. Lower abdominal pain and anemia occurred on postoperative day 1. Laparoscopy was performed and revealed hemoperitoneum caused as a complication of inguinal hernia repair. The abdominal cavity was thoroughly washed with saline solution, and the aspirated blood was processed and reinfused. Laparoscopy for hemoperitoneum as a complication after inguinal hernia repair was very useful for both diagnosis and treatment. PMID:12166761

  10. Recurrence and pseudorecurrence after laparoscopic ventral hernia repair: predictors and patient-focused outcomes.

    PubMed

    Carter, Stacey A; Hicks, Stephanie C; Brahmbhatt, Reshma; Liang, Mike K

    2014-02-01

    Laparoscopic ventral hernia repair (LVHR) is gaining popularity as an option to repair abdominal wall hernias. Bulging after repair remains common after this technique. This study evaluates the incidence and factors associated with bulging after LVHR. Between 2000 and 2010, 201 patients underwent LVHR at two affiliated institutions. Patients who developed recurrence or pseudorecurrence (seroma or eventration) were analyzed with univariate and multivariate analyses to identify predictors of these complications. Of the 201 patients who underwent LVHR, 40 (19.9%) patients developed a seroma, 63 (31.3%) patients had radiographically proven eventration, and 25 (12.4%) patients had a hernia recurrence. On multivariate analysis, seromas were associated with number of prior ventral hernia repairs, surgical site infections, and prostate disease. Mesh eventration was associated with hernia size and surgical technique. Tissue eventration was associated with primary hernias and surgical technique. Hernia recurrence was associated with incisional hernias and mesh type used. Recurrence and pseudorecurrence are important complications after LVHR. Large hernia size, infections, and surgical technique are important clinical factors that affect outcomes after LVHR. PMID:24480213

  11. Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery

    PubMed Central

    2013-01-01

    Background Previous meta-analyses have had conflicting conclusions regarding the differences between laparoscopic and open techniques in patients with Crohn’s Disease. The objective of this meta-analysis was to compare outcomes in patients with Crohn’s disease undergoing laparoscopic or open surgical resection. Methods A literature search of EMBASE, MEDLINE, The Cochrane Central Register of Controlled Trials and the US National Institute of Health’s Clinical Trials Registry was completed. Randomized clinical trials and non-randomized comparative studies were included if laparoscopic and open surgical resections were compared. Primary outcomes assessed included perioperative complications, recurrence requiring surgery, small bowel obstruction and incisional hernia. Results 34 studies were included in the analysis, and represented 2,519 patients. Pooled analysis showed reduced perioperative complications in patients undergoing laparoscopic resection vs. open resection (Risk Ratio 0.71, 95% CI 0.58 – 0.86, P = 0.001). There was no evidence of a difference in the rate of surgical recurrence (Rate Ratio 0.78, 95% CI 0.54 – 1.11, P = 0.17) or small bowel obstruction (Rate Ratio 0.63, 95% CI 0.28 – 1.45, P = 0.28) between techniques. There was evidence of a decrease in incisional hernia following laparoscopic surgery (Rate Ratio 0.24, 95% CI 0.07 – 0.82, P = 0.02). Conclusions This is the largest review in this topic. The results of this analysis are based primarily on non-randomized studies and thus have significant limitations in regards to selection bias, confounding, lack of blinding and potential publication bias. Although we found evidence of decreased perioperative complications and incisional hernia in the laparoscopic group, further randomized controlled trials, with adequate follow up, are needed before strong recommendations can be made. PMID:23705825

  12. Laparoscopic Repair of Ventral Hernias

    PubMed Central

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

    2003-01-01

    Objective: To evaluate the efficacy and safety of laparoscopic repair of ventral hernias. Summary Background Data: The recurrence rate after standard repair of ventral hernias may be as high as 12-52%, and the wide surgical dissection required often results in wound complications. Use of a laparoscopic approach may decrease rates of complications and recurrence after ventral hernia repair. Methods: Data on all patients who underwent laparoscopic ventral hernia repair (LVHR) performed by 4 surgeons using a standardized procedure between November 1993 and October 2002 were collected prospectively (85% of patients) or retrospectively. Results: LVHR was completed in 819 of the 850 patients (422 men; 428 women) in whom it was attempted. Thirty-four percent of completed LVHRs were for recurrent hernias. The patient mean body mass index was 32; the mean defect size was 118 cm2. Mesh, averaging 344 cm2, was used in all cases. Mean operating time was 120 min, mean estimated blood loss was 49 mL, and hospital stay averaged 2.3 days. There were 128 complications in 112 patients (13.2%). One patient died of a myocardial infarction. The most common complications were ileus (3%) and prolonged seroma (2.6%). During a mean follow-up time of 20.2 months (range, 1-94 months), the hernia recurrence rate was 4.7%. Recurrence was associated with large defects, obesity, previous open repairs, and perioperative complications. Conclusion: In this large series, LVHR had a low rate of conversion to open surgery, a short hospital stay, a moderate complication rate, and a low risk of recurrence. PMID:14501505

  13. [Traumatic Spigelian hernia. Elective extraperitoneal laparoscopic repair].

    PubMed

    Moreno-Egea, Alfredo; Campillo-Soto, Alvaro; Girela-Baena, Enrique; Torralba-Martínez, José Antonio; Corral de la Calle, Miquel; Aguayo-Albasini, José Luis

    2006-01-01

    Traumatic Spigelian hernia is rare. These hernias are usually treated in the same admission through open surgery. We present a case of Spigelian hernia in a high anatomical location following injury, with a cutaneous lesion and preperitoneal hematoma. Delayed parietal repair was performed through extraperitoneal laparoscopy. Elective laparoscopic repair in this case avoided surgery in an injured area, providing clear cosmetic advantages to the patient. We describe a modification to the classical approach to facilitate access to high-lying Spigelian defects. PMID:16426535

  14. 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

  15. 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

  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. Laparoscopic Repair of Paraesophageal Hernias

    PubMed Central

    Borao, Frank; Squillaro, Anthony; Mansson, Jonas; Barker, William; Baker, Thomas

    2014-01-01

    Background and Objectives: Laparoscopy has quickly become the standard surgical approach to repair paraesophageal hernias. Although many centers routinely perform this procedure, relatively high recurrence rates have led many surgeons to question this approach. We sought to evaluate outcomes in our cohort of patients with an emphasis on recurrence rates and symptom improvement and their correlation with true radiologic recurrence seen on contrast imaging. Methods: We retrospectively identified 126 consecutive patients who underwent laparoscopic repair of a large paraesophageal hernia between 2000 and 2010. Clinical outcomes were reviewed, and data were collected regarding operative details, perioperative and postoperative complications, symptoms, and follow-up imaging. Radiologic evidence of any size hiatal hernia was considered to indicate a recurrence. Results: There were 95 female and 31 male patients with a mean age (± standard deviation) of 71 ± 14 years. Laparoscopic repair was completed successfully in 120 of 126 patients, with 6 operations converted to open procedures. Crural reinforcement with mesh was performed in 79% of patients, and 11% underwent a Collis gastroplasty. Fundoplications were performed in 90% of patients: Nissen (112), Dor (1), and Toupet (1). Radiographic surveillance, obtained at a mean time interval of 23 months postoperatively, was available in 89 of 126 patients (71%). Radiographic evidence of a recurrence was present in 19 patients (21%). Reoperation was necessary in 6 patients (5%): 5 for symptomatic recurrence (4%) and 1 for dysphagia (1%). The median length of stay was 4 days. Conclusion: Laparoscopic paraesophageal hernia repair results in an excellent outcome with a short length of stay when performed at an experienced center. Radiologic recurrence is observed relatively frequently with routine surveillance; however, many of these recurrences are small, and few patients require correction of the recurrence. Furthermore, these

  18. Hernias (For Parents)

    MedlinePlus

    ... with them. Hernias in kids can be treated (hernia repair is the one of the most common surgeries ... intestine that is caught and squeezed in the groin area may block the passage of food though ...

  19. Laparoscopic Ventral Hernia Repair

    MedlinePlus

    ... the likelihood of a hernia including persistent coughing, difficulty with bowel movements or urination, or frequent need for straining. What are the Advantages of Laparoscopic Ventral Hernia Repair? Keep reading... Page 1 of 2 1 2 » Brought to ...

  20. Robotic inguinal hernia repair.

    PubMed

    Escobar Dominguez, Jose E; Gonzalez, Anthony; Donkor, Charan

    2015-09-01

    Inguinal hernias have been described throughout the history of medicine with many efforts to achieve the cure. Currently, with the advantages of minimally invasive surgery, new questions arise: what is going to be the best approach for inguinal hernia repair? Is there a real benefit with the robotic approach? Should minimally invasive hernia surgery be the standard of care? In this report we address these questions by describing our experience with robotic inguinal hernia repair. PMID:26153353

  1. Amyand’s Hernia: Case Report -Current Dilemma in Diagnosis and Management

    PubMed Central

    Samuel, Vasanth Mark; Kodiatte, Thomas; Gaikwad, Pranay

    2015-01-01

    Amyand’s hernia is an extremely rare condition, often misdiagnosed as a strangulated inguinal hernia, in which the inguinal hernial sac contains the vermiform appendix. It is often a surgical surprise. The reported incidence is approximately 1% of all adult inguinal hernia cases. Acute appendicitis in the Amyand’s hernia is even less common. We report a rare presentation of acute appendicitis associated with Amyand’s hernia managed by en masse reduction of the hernia followed by laparoscopic appendicectomy and open Lichtenstein’s tension free inguinal hernioplasty. PMID:25859489

  2. Two Ports Laparoscopic Inguinal Hernia Repair in Children

    PubMed Central

    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

  3. 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

  4. Congenital diaphragmatic hernia.

    PubMed

    Tovar, Juan A

    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

  5. Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair Using Memory-Ring Mesh: A Pilot Study

    PubMed Central

    Nomura, Tsutomu; Matsuda, Akihisa; Takao, Yoshimune

    2016-01-01

    Purpose. To evaluate the feasibility, safety, and effectiveness of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using a memory-ring patch (Polysoft™ mesh). Patients and Methods. Between April 2010 and March 2013, a total of 76 inguinal hernias underwent TAPP repair using Polysoft mesh in 67 adults under general anesthesia. Three different senior resident surgeons performed TAPP repair under the instruction of a specialist surgeon. Nine patients had bilateral hernias. The 76 hernias included 37 indirect inguinal hernias, 29 direct hernias, 1 femoral hernia, 1 pantaloon hernia (combined direct/indirect inguinal hernia), and 8 recurrent hernias after open anterior hernia repair. The immediate postoperative outcomes as well as the short-term outcomes (mainly recurrence and incidence of chronic pain) were studied. Results. There was no conversion from TAPP repair to anterior open repair. The mean operation time was 109 minutes (range, 40–132) for unilateral hernia repair. Scrotal seroma was diagnosed at the operation site in 5 patients. No patient had operation-related orchitis, testicle edema, trocar site infection, or chronic pain during follow-up. Conclusions. The use of Polysoft mesh for TAPP inguinal hernia repair does not seem to adversely affect the quality of repair. The use of this mesh is therefore feasible and safe and may reduce postoperative pain.

  6. Incarcerated recurrent Amyand's hernia

    PubMed Central

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

    2012-01-01

    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

  7. JAMA Patient Page: Abdominal Hernia

    MedlinePlus

    ... an operation. Umbilical hernia Abdominal wall Intestinal loop Peritoneum Skin Peritoneum Umbilical annulus SYMPTOMS The first symptom of a ... vomiting, or constipation. Inguinal hernia Indirect inguinal hernia Peritoneum Deep inguinal ring Inguinal canal Superficial inguinal ring ...

  8. Inguinal hernia repair: toward Asian guidelines.

    PubMed

    Lomanto, Davide; Cheah, Wei-Keat; Faylona, Jose Macario; Huang, Ching Shui; Lohsiriwat, Darin; Maleachi, Andy; Yang, George Pei Cheung; Li, Michael Ka-Wai; Tumtavitikul, Sathien; Sharma, Anil; Hartung, Rolf Ulrich; Choi, Young Bai; Sutedja, Barlian

    2015-02-01

    Groin hernias are very common, and surgical treatment is usually recommended. In fact, hernia repair is the most common surgical procedure performed worldwide. In countries such as the USA, China, and India, there may easily be over 1 million repairs every year. The need for this surgery has become an important socioeconomic problem and may affect health-care providers, especially in aging societies. Surgical repair using mesh is recommended and widely employed in Western countries, but in many developing countries, tissue-to-tissue repair is still the preferred surgical procedure due to economic constraints. For these reason, the development and implementation of guidelines, consensus, or recommendations may aim to clarify issues related to best practices in inguinal hernia repair in Asia. A group of Asian experts in hernia repair gathered together to debate inguinal hernia treatments in Asia in an attempt to reach some consensus or develop recommendations on best practices in the region. The need for recommendations or guidelines was unanimously confirmed to help overcome the discrepancy in clinical practice between countries; the experts decided to focus mainly on the technical aspects of open repair, which is the most common surgery for hernia in our region. After the identification of 12 main topics for discussion (indication, age, and sex; symptomatic and asymptomatic hernia: type of hernia; type of treatment; hospital admission; preoperative care; anesthesia; surgical technique; perioperative care; postoperative care; early complications; and long-term complications), a search of the literature was carried out according to the five levels of the Oxford Classification of Evidence and the four grades of recommendation. PMID:25598054

  9. Simultaneous repair of bilateral inguinal hernias under local anesthesia.

    PubMed Central

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

    1996-01-01

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

  10. Repair of Postoperative Abdominal Hernia in a Child with Congenital Omphalocele Using Porcine Dermal Matrix.

    PubMed

    Lambropoulos, V; Mylona, E; Mouravas, V; Tsakalidis, C; Spyridakis, I; Mitsiakos, G; Karagianni, P

    2016-01-01

    Introduction. Incisional hernias are a common complication appearing after abdominal wall defects reconstruction, with omphalocele and gastroschisis being the most common etiologies in children. Abdominal closure of these defects represents a real challenge for pediatric surgeons with many surgical techniques and various prosthetic materials being used for this purpose. Case Report. We present a case of repair of a postoperative ventral hernia occurring after congenital omphalocele reconstruction in a three-and-a-half-year-old child using an acellular, sterile, porcine dermal mesh. Conclusion. Non-cross-linked acellular porcine dermal matrix is an appropriate mesh used for the reconstruction of abdominal wall defects and their postoperative complications like large ventral hernias with success and preventing their recurrence. PMID:27110247

  11. Repair of Postoperative Abdominal Hernia in a Child with Congenital Omphalocele Using Porcine Dermal Matrix

    PubMed Central

    Mylona, E.; Tsakalidis, C.; Spyridakis, I.; Mitsiakos, G.; Karagianni, P.

    2016-01-01

    Introduction. Incisional hernias are a common complication appearing after abdominal wall defects reconstruction, with omphalocele and gastroschisis being the most common etiologies in children. Abdominal closure of these defects represents a real challenge for pediatric surgeons with many surgical techniques and various prosthetic materials being used for this purpose. Case Report. We present a case of repair of a postoperative ventral hernia occurring after congenital omphalocele reconstruction in a three-and-a-half-year-old child using an acellular, sterile, porcine dermal mesh. Conclusion. Non-cross-linked acellular porcine dermal matrix is an appropriate mesh used for the reconstruction of abdominal wall defects and their postoperative complications like large ventral hernias with success and preventing their recurrence. PMID:27110247

  12. Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia.

    PubMed

    Taylor, D C; Meyers, W C; Moylan, J A; Lohnes, J; Bassett, F H; Garrett, W E

    1991-01-01

    There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. Groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the public tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symptoms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, including inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months. PMID:1831010

  13. Sports hernia and femoroacetabular impingement in athletes: A systematic review

    PubMed Central

    Munegato, Daniele; Bigoni, Marco; Gridavilla, Giulia; Olmi, Stefano; Cesana, Giovanni; Zatti, Giovanni

    2015-01-01

    AIM: To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes. METHODS: PubMed, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism. RESULTS: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone (89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries. CONCLUSION: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy. PMID:26380829

  14. Fibrin Sealant: A Review of the History, Biomechanics, and Current Applications for Prosthetic Fixation in Hernia Repair.

    PubMed

    Watson, Jefferson Tyler; Webb, David L; Stoikes, Nathaniel F N; Voeller, Guy R

    2015-11-01

    The role of surgical adhesives in hernia repair has continued to evolve. The purpose of this chapter is to review the role of fibrin sealant and its application in general surgery for mesh fixation, specifically the history, biomechanics, and clinical utilization. The utilization of fibrin sealant for repair of groin hernias, both open and laparoscopic, ventral hernias, and hiatal hernias will be discussed. PMID:26696538

  15. [Diagnosis and surgical therapy of hiatal hernia].

    PubMed

    Koch, O O; Köhler, G; Antoniou, S A; Pointner, R

    2014-08-01

    Using the usual diagnostic tools like barium swallow examination, endoscopy, and manometry, we are able to diagnose a hiatal hernia, but it is not possible to predict the size of the hernia opening or, respectively, the size of the hiatal defect. At least a correlation can be expected if the gastroesophageal junction is endoscopically assessed in a retroflexed position, and graded according to Hill. So far, it is not possible to come to a clear conclusion how the hiatal closure during hiatal hernia repair should be performed. There is no consensus on using a mesh, and when using a mesh which type or shape should be used. Further studies including long-term results on this issue are necessary. However, it seems obvious to make the decision depending on certain conditions found during operation, and not on preoperative findings. PMID:24647816

  16. 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

  17. Parastomal hernias after radical cystectomy and ileal conduit diversion

    PubMed Central

    Donahue, Timothy F.

    2016-01-01

    Parastomal hernia, defined as an "incisional hernia related to an abdominal wall stoma", is a frequent complication after conduit urinary diversion that can negatively impact quality of life and present a clinically significant problem for many patients. Parastomal hernia (PH) rates may be as high as 65% and while many patients are asymptomatic, in some series up to 30% of patients require surgical intervention due to pain, leakage, ostomy appliance problems, urinary obstruction, and rarely bowel obstruction or strangulation. Local tissue repair, stoma relocation, and mesh repairs have been performed to correct PH, however, long-term results have been disappointing with recurrence rates of 30%–76% reported after these techniques. Due to high recurrence rates and the potential morbidity of PH repair, efforts have been made to prevent PH development at the time of the initial surgery. Randomized trials of circumstomal prophylactic mesh placement at the time of colostomy and ileostomy stoma formation have shown significant reductions in PH rates with acceptably low complication profiles. We have placed prophylactic mesh at the time of ileal conduit creation in patients at high risk for PH development and found it to be safe and effective in reducing the PH rates over the short-term. In this review, we describe the clinical and radiographic definitions of PH, the clinical impact and risk factors associated with its development, and the use of prophylactic mesh placement for patients undergoing ileal conduit urinary diversion with the intent of reducing PH rates. PMID:27437533

  18. Parastomal hernias after radical cystectomy and ileal conduit diversion.

    PubMed

    Donahue, Timothy F; Bochner, Bernard H

    2016-07-01

    Parastomal hernia, defined as an "incisional hernia related to an abdominal wall stoma", is a frequent complication after conduit urinary diversion that can negatively impact quality of life and present a clinically significant problem for many patients. Parastomal hernia (PH) rates may be as high as 65% and while many patients are asymptomatic, in some series up to 30% of patients require surgical intervention due to pain, leakage, ostomy appliance problems, urinary obstruction, and rarely bowel obstruction or strangulation. Local tissue repair, stoma relocation, and mesh repairs have been performed to correct PH, however, long-term results have been disappointing with recurrence rates of 30%-76% reported after these techniques. Due to high recurrence rates and the potential morbidity of PH repair, efforts have been made to prevent PH development at the time of the initial surgery. Randomized trials of circumstomal prophylactic mesh placement at the time of colostomy and ileostomy stoma formation have shown significant reductions in PH rates with acceptably low complication profiles. We have placed prophylactic mesh at the time of ileal conduit creation in patients at high risk for PH development and found it to be safe and effective in reducing the PH rates over the short-term. In this review, we describe the clinical and radiographic definitions of PH, the clinical impact and risk factors associated with its development, and the use of prophylactic mesh placement for patients undergoing ileal conduit urinary diversion with the intent of reducing PH rates. PMID:27437533

  19. Athletic pubalgia (sports hernia).

    PubMed

    Litwin, Demetrius E M; Sneider, Erica B; McEnaney, Patrick M; Busconi, Brian D

    2011-04-01

    Athletic pubalgia or sports hernia is a syndrome of chronic lower abdomen and groin pain that may occur in athletes and nonathletes. Because the differential diagnosis of chronic lower abdomen and groin pain is so broad, only a small number of patients with chronic lower abdomen and groin pain fulfill the diagnostic criteria of athletic pubalgia (sports hernia). The literature published to date regarding the cause, pathogenesis, diagnosis, and treatment of sports hernias is confusing. This article summarizes the current information and our present approach to this chronic lower abdomen and groin pain syndrome. PMID:21419964

  20. A Traumatic Abdominal Wall Hernia Repair: A Laparoscopic Approach

    PubMed Central

    Wilson, Kenneth L.; Rosser, James C.

    2012-01-01

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

  1. Sportsman hernia; the review of current diagnosis and treatment modalities

    PubMed Central

    Paksoy, Melih; Sekmen, Ümit

    2016-01-01

    Groin pain is an important clinical entity that may affect a sportsman’s active sports life. Sportsman’s hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman’s hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman’s hernia at our hospital between 2011–2014, in light of current literature. PMID:27436937

  2. Sportsman hernia; the review of current diagnosis and treatment modalities.

    PubMed

    Paksoy, Melih; Sekmen, Ümit

    2016-01-01

    Groin pain is an important clinical entity that may affect a sportsman's active sports life. Sportsman's hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman's hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman's hernia at our hospital between 2011-2014, in light of current literature. PMID:27436937

  3. Laparoscopic Inguinal Hernia Repair

    MedlinePlus

    ... Some hernia repairs are performed using a small telescope known as a laparoscope. If your surgeon has ... in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). Laparoscopic repair offers a ...

  4. Handlebar hernia in children.

    PubMed

    Mitchell, P J; Green, M; Ramesh, A N

    2011-05-01

    Handlebar hernia is a rare form of traumatic abdominal wall hernia usually occurring in children. As the name suggests, it results from the blunt impact of a handlebar after a fall from a bicycle. A classic case is described of such a hernia occurring in a 14-year-old boy who presented with minimal external signs of injury, but was found to have significant traumatic disruption to the abdominal wall musculature and peritoneum, requiring surgical repair. A review of the English literature found only 25 cases of handlebar hernias in children less than 16 years of age. The average age is 9 years, and two-thirds of cases occur in boys. The frequency of associated visceral injury is low. The majority of reported cases were managed with surgical exploration and simple suture repair. Despite minimal signs on examination, the history should raise suspicion of significant underlying muscular disruption. PMID:21098798

  5. Umbilical hernia repair - series (image)

    MedlinePlus

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

  6. Umbilical hernia in patients with liver cirrhosis: A surgical challenge

    PubMed Central

    Coelho, Julio C U; Claus, Christiano M P; Campos, Antonio C L; Costa, Marco A R; Blum, Caroline

    2016-01-01

    Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites. Due to the enormous intraabdominal pressure secondary to the ascites, umbilical hernia in these patients has a tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge. Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, such as wound infection, evisceration, ascites drainage, and peritonitis. Intermittent paracentesis, temporary peritoneal dialysis catheter or transjugular intrahepatic portosystemic shunt may be necessary to control ascites. Hernia repair is indicated in patients in whom medical treatment is effective in controlling ascites. Patients who have a good perspective to be transplanted within 3-6 mo, herniorrhaphy should be performed during transplantation. Hernia repair with mesh is associated with lower recurrence rate, but with higher surgical site infection when compared to hernia correction with conventional fascial suture. There is no consensus on the best abdominal wall layer in which the mesh should be placed: Onlay, sublay, or underlay. Many studies have demonstrated several advantages of the laparoscopic umbilical herniorrhaphy in cirrhotic patients compared with open surgical treatment. PMID:27462389

  7. Umbilical hernia in patients with liver cirrhosis: A surgical challenge.

    PubMed

    Coelho, Julio C U; Claus, Christiano M P; Campos, Antonio C L; Costa, Marco A R; Blum, Caroline

    2016-07-27

    Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites. Due to the enormous intraabdominal pressure secondary to the ascites, umbilical hernia in these patients has a tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge. Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, such as wound infection, evisceration, ascites drainage, and peritonitis. Intermittent paracentesis, temporary peritoneal dialysis catheter or transjugular intrahepatic portosystemic shunt may be necessary to control ascites. Hernia repair is indicated in patients in whom medical treatment is effective in controlling ascites. Patients who have a good perspective to be transplanted within 3-6 mo, herniorrhaphy should be performed during transplantation. Hernia repair with mesh is associated with lower recurrence rate, but with higher surgical site infection when compared to hernia correction with conventional fascial suture. There is no consensus on the best abdominal wall layer in which the mesh should be placed: Onlay, sublay, or underlay. Many studies have demonstrated several advantages of the laparoscopic umbilical herniorrhaphy in cirrhotic patients compared with open surgical treatment. PMID:27462389

  8. 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

  9. Gastric dilatation and volvulus in a brachycephalic dog with hiatal hernia.

    PubMed

    Aslanian, M E; Sharp, C R; Garneau, M S

    2014-10-01

    A brachycephalic dog was presented with an acute onset of retching and abdominal discomfort. The dog had a chronic history of stertor and exercise intolerance suggestive of brachycephalic airway obstructive syndrome. Radiographs were consistent with a Type II hiatal hernia. The dog was referred and within hours of admission became acutely painful and developed tympanic abdominal distension. A right lateral abdominal radiograph confirmed gastric dilatation and volvulus with herniation of the pylorus through the hiatus. An emergency exploratory coeliotomy was performed, during which the stomach was derotated, and an incisional gastropexy, herniorrhaphy and splenectomy were performed. A staphylectomy was performed immediately following the exploratory coeliotomy. The dog recovered uneventfully. Gastric dilatation and volvulus is a potentially life-threatening complication that can occur in dogs with Type II hiatal hernia and should be considered a surgical emergency. PMID:24871205

  10. 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

  11. Laparoscopic hernia repair--when is a hernia not a hernia?

    PubMed

    Bunting, David; Szczebiot, Lukasz; Cota, Alwyn

    2013-01-01

    A wide range of diagnoses can present as inguinal hernia. Laparoscopic techniques are being increasingly used in the repair of inguinal hernias and offer the potential benefit of identifying additional pathology. The authors present the first reported case of a hydrocele of the canal of Nuck diagnosed laparoscopically. We review the incidence of identifying additional pathology through laparoscopy for inguinal hernia repair. We suggest that in patients with atypical presenting features of a hernia, the transabdominal preperitoneal, rather than a totally extraperitoneal, approach to groin hernia repair should be considered because of its greater diagnostic potential. PMID:24398212

  12. Laparoscopic Hernia Repair—When Is a Hernia Not a Hernia?

    PubMed Central

    Szczebiot, Lukasz; Cota, Alwyn

    2013-01-01

    A wide range of diagnoses can present as inguinal hernia. Laparoscopic techniques are being increasingly used in the repair of inguinal hernias and offer the potential benefit of identifying additional pathology. The authors present the first reported case of a hydrocele of the canal of Nuck diagnosed laparoscopically. We review the incidence of identifying additional pathology through laparoscopy for inguinal hernia repair. We suggest that in patients with atypical presenting features of a hernia, the transabdominal preperitoneal, rather than a totally extraperitoneal, approach to groin hernia repair should be considered because of its greater diagnostic potential. PMID:24398212

  13. Anterior preperitoneal repair of extremely large inguinal hernias: An alternative technique☆☆☆

    PubMed Central

    Koning, Giel G.; Vriens, Patrick W.H.E.

    2011-01-01

    INTRODUCTION Standard open anterior inguinal hernia repair is nowadays performed using a soft mesh to prevent recurrence and to minimalize postoperative chronic pain. To further reduce postoperative chronic pain, the use of a preperitoneal placed mesh has been suggested. In extremely large hernias, the lateral side of the mesh can be insufficient to fully embrace the hernial sac. We describe the use of two preperitoneal placed meshes to repair extremely large hernias. This ‘Butterfly Technique’ has proven to be useful. Hernias were classified according to hernia classification of the European Hernia Society (EHS) during operation. Extremely large indirect hernias were repaired by using two inverted meshes to cover the deep inguinal ring both medial and lateral. Follow up was at least 6 months. VAS pain score was assessed in all patients during follow up. Outcomes of these Butterfly repairs were evaluated. Medical drawings were made to illustrate this technique. A Total of 689 patients underwent anterior hernia repair 2006–2008. PRESENTATION OF CASE Seven male patients (1%) presented with extremely large hernial sacs. All these patients were men. Mean age 69.9 years (range: 63–76), EHS classifications of hernias were all unilateral. Follow up was at least 6 months. Recurrence did not occur after repair. Chronic pain was not reported. Discussion Open preperitoneal hernia repair of extremely large hernias has not been described. The seven patients were trated with this technique uneventfully. No chronic pain occurred. CONCLUSION The Butterfly Technique is an easy and safe alternative in anterior preperitoneal repair of extremely large inguinal hernias. PMID:22288042

  14. Laparoscopic Total Extraperitoneal Hernia Repair Outcomes

    PubMed Central

    Bresnahan, Erin R.

    2016-01-01

    Background and Objectives: Laparoscopic inguinal hernia repair has become increasingly popular as an alternative to open surgery. The purpose of this study was to evaluate the safety and effectiveness of the laparoscopic total extraperitoneal procedure with the use of staple fixation and polypropylene mesh. Methods: A retrospective chart review examined outcomes of 1240 laparoscopic hernia operations in 783 patients, focusing on intraoperative and early postoperative complications, pain, and time until return to work and normal physical activities. Results: There were no intraoperative complications in this series; 106 patients experienced early postoperative complications across 8 evaluated categories: urinary retention (4.1%), seroma (3.0%), testicular/hemiscrotal swelling (1.9%), testicular atrophy (0%), hydrocele (0.6%), mesh infection (0.1%), and neurological symptoms (transient, 1.0%; persistent, 0.2%). Patients used an average of 5.6 Percocet pills after the procedure, and mean times until return to work and normal activities, including their routine exercise regimen, were 3.0 and 3.8 days, respectively. Conclusion: Complication rates and convalescence times were considered equivalent or superior to those found in other studies assessing both laparoscopic and open techniques. The usage of multiple Endostaples did not result in increased neurologic complications in the early postoperative period when compared with findings in the literature. In the hands of an experienced surgeon, total extraperitoneal repair is a safe, effective alternative to open inguinal hernia repair. PMID:27493471

  15. Inguinal hernia - discharge

    MedlinePlus

    You or your child had surgery to repair an inguinal hernia caused by a weakness in the abdominal wall in your groin area. You or your child probably had general (asleep and pain-free) or spinal or epidural (numb from the waist down) anesthesia. If ...

  16. Femoral hernia repair

    MedlinePlus

    ... bulges out of a weak spot in the groin. Usually this tissue is part of the intestine. ... Your surgeon makes a cut (incision) in your groin area. The hernia is ... wall. This repairs the weakness in the wall. At the end ...

  17. Ventral hernia repair

    MedlinePlus

    You will probably receive general anesthesia (asleep and pain-free) for this surgery. If your hernia is small, you may receive a spinal or epidural block and medicine to relax you. You will be awake, but pain-free. Your surgeon will make a surgical cut in ...

  18. Sports Hernia Treatment

    PubMed Central

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

    2013-01-01

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

  19. Personalized identification of abdominal wall hernia meshes on computed tomography.

    PubMed

    Pham, Tuan D; Le, Dinh T P; Xu, Jinwei; Nguyen, Duc T; Martindale, Robert G; Deveney, Clifford W

    2014-01-01

    An abdominal wall hernia is a protrusion of the intestine through an opening or area of weakness in the abdominal wall. Correct pre-operative identification of abdominal wall hernia meshes could help surgeons adjust the surgical plan to meet the expected difficulty and morbidity of operating through or removing the previous mesh. First, we present herein for the first time the application of image analysis for automated identification of hernia meshes. Second, we discuss the novel development of a new entropy-based image texture feature using geostatistics and indicator kriging. Third, we seek to enhance the hernia mesh identification by combining the new texture feature with the gray-level co-occurrence matrix feature of the image. The two features can characterize complementary information of anatomic details of the abdominal hernia wall and its mesh on computed tomography. Experimental results have demonstrated the effectiveness of the proposed study. The new computational tool has potential for personalized mesh identification which can assist surgeons in the diagnosis and repair of complex abdominal wall hernias. PMID:24184112

  20. Section 17. Laparoscopic and minimal incisional donor hepatectomy.

    PubMed

    Choi, YoungRok; Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk

    2014-04-27

    Living donor hepatectomy is now a well-established surgical procedure. However, a large abdominal incision is still required, which results in a large permanent scar, especially for a right liver graft. This report reviews our techniques of minimally invasive or minimal incisional donor hepatectomy using a transverse incision.Twenty-five living donors underwent right hepatectomy with a transverse incision and 484 donors with a conventional incision between April 2007 and December 2012. Among the donors with a transverse incision, two cases were totally laparoscopic procedures using a hand-port device; 11 cases were laparoscopic-assisted hepatectomy (hybrid technique), and 14 cases were open procedures using a transverse incision without the aid of the laparoscopic technique. Currently, a hybrid method has been exclusively used because of the long operation time and surgical difficulty in totally laparoscopic hepatectomy and the exposure problems for the liver cephalic portion during the open technique using a transverse incision.All donors with a transverse incision were women except for one. Twenty-four of the grafts were right livers without middle hepatic vein (MHV) and one with MHV. The donors' mean BMI was 21.1 kg/m. The median operation time was 355 minutes, and the mean estimated blood loss was 346.1±247.3 mL (range, 70-1200). There was no intraoperative transfusion. These donors had 29 cases of grade I [14 pleural effusions (56%), 11 abdominal fluid collections (44%), 3 atelectasis (12%), 1bile leak (4%)], 1 case of grade II (1 pneumothorax) and two cases of grade III complications; two interventions were needed because of abdominal fluid collections by Clavien-Dindo classification. Meanwhile, donors with a conventional big incision, which included the Mercedes-Benz incision or an inverted L-shaped incision, had 433 cases of grade I, 19 cases of grade II and 18 cases of grade III complications. However, the liver enzymes and total bilirubin of all donors

  1. Clinical Conundrum: Killian-Jamieson Diverticulum with Paraesophageal Hernia.

    PubMed

    Bock, Jonathan M; Knabel, Michael J; Lew, Daniel A; Knechtges, Paul M; Gould, Jon C; Massey, Benson T

    2016-08-01

    Killian-Jamieson diverticulum is a outpouching of the lateral cervical esophageal wall adjacent to the insertion of the recurrent laryngeal to the larynx and is much less common in clinical practice than Zenkers Diverticulum. Surgical management of Killian-Jamieson diverticulum requires open transcervical diverticulectomy due to the proximity of the recurrent laryngeal nerve to the base of the pouch. We present a case of a Killian-Jamieson diverticulum associated with a concurrent large type III paraesophageal hernia causing significant solid-food dysphagia, post-prandial regurgitation of solid foods, and chronic cough managed with open transcervical diverticulectomy and laparoscopic paraesophageal hernia repair with Nissen fundoplication. PMID:26753928

  2. Obesity increases the odds of acquiring and incarcerating noninguinal abdominal wall hernias.

    PubMed

    Lau, Briana; Kim, Hanjoo; Haigh, Philip I; Tejirian, Talar

    2012-10-01

    The current data available describing the relationship of obesity and abdominal wall hernias is sparse. The objective of this study was to investigate the current prevalence of noninguinal abdominal wall hernias and their correlation with body mass index (BMI) and other demographic risk factors. Patients with umbilical, incisional, ventral, epigastric, or Spigelian hernias with or without incarceration were identified using the regional database for 14 hospitals over a 3-year period. Patients were stratified based on their BMI. Univariate and multivariate analyses were performed to distinguish other significant risk factors associated with the hernias. Of 2,807,414 patients, 26,268 (0.9%) had one of the specified diagnoses. Average age of the patients was 52 years and 61 per cent were male. The majority of patients had nonincarcerated umbilical hernias (74%). Average BMI was 32 kg/m2. Compared with patients with a normal BMI, the odds of having a hernia increased with BMI: BMI of 25 to 29.9 kg/m2 odds ratio (OR) 1.63, BMI of 30 to 39.9 kg/m2 OR 2.62, BMI 40 to 49.9 kg/m2 OR 3.91, BMI 50 to 59.9 kg/m2 OR 4.85, and BMI greater than 60 kg/m2 OR 5.17 (P<0.0001). Age older than 50 years was associated with a higher risk for having a hernia (OR, 2.12; 95% [CI], 2.07 to 2.17), whereas female gender was associated with a lower risk (OR, 0.53; 95% CI, 0.52 to 0.55). Those with incarcerated hernias had a higher average BMI (32 kg/m2 vs 35 kg/m2; P<0.0001). Overall, BMI greater than 40 kg/m2 showed an increased chance of incarceration, and a BMI greater than 60 kg/m2 had the highest chance of incarceration, OR 12.7 (P<0.0001). Age older than 50 years and female gender were also associated with a higher risk of incarceration (OR, 1.28; 95% CI, 1.02 to 1.59 and OR, 1.80; CI, 1.45 to 2.24). Increasing BMI and increasing age are associated with a higher prevalence and an increased risk of incarceration of noninguinal abdominal wall hernias. PMID:23025954

  3. Quality of life in patients undergoing inguinal hernia repair.

    PubMed Central

    Lawrence, K.; McWhinnie, D.; Jenkinson, C.; Coulter, A.

    1997-01-01

    Inguinal hernia repair is one of the most common surgical procedures undertaken in the NHS. Despite this, no previous work has examined quality of life in this patient group. This study examines quality of life preoperatively and at 3 and 6 months postoperatively in 140 patients undergoing inguinal hernia repair in the context of a randomised controlled trial of laparoscopic versus open hernia repair. Surgery was undertaken on a day case basis, and quality of life was assessed using the Short Form 36 (SF36). In the initial phase of the study, 57% of those screened for suitability met the study inclusion criteria and were randomised. No significant differences were found between laparoscopic and open hernia repair in terms of quality of life at 3 and 6 months postoperatively. No difference was found between 3 and 6 month scores, suggesting that patients had already made a good recovery by 3 months. A significant improvement was found between preoperative and postoperative scores, with the greatest change arising on dimensions assessing pain, physical function, and role limitation owing to physical restriction. After standardising for age, sex, and social class, a comparison of the hernia patients to population norms for the SF36 was consistent with improvement from preoperative to postoperative assessment. This study has demonstrated the improvement in quality of life in patients undergoing elective inguinal hernia repair by experienced surgeons on a day case basis. It has also demonstrated the feasibility of assessing quality of life using generic measures in this patient group. Further work in this area is required. Ultimately, the priority given to elective inguinal hernia repair will depend on how the demonstrated benefits compare with those derived from other elective surgical procedures. PMID:9038494

  4. Transient left paraduodenal hernia.

    PubMed

    Ovali, Gulgun Yilmaz; Orguc, Sebnem; Unlu, Murat; Pabuscu, Yuksel

    2005-09-01

    A 52-year-old woman with acute deterioration of recurrent abdominal pain was admitted to the hospital. Spiral computed tomography (CT) of abdomen was performed. A left paraduodenal hernia was identified on CT. There was no clinical sign or imaging finding suggesting intestinal obstruction or mesenteric ischemia. She refused surgical intervention since her pain was intermittant and decreasing. On the fifth day of hospitalization the patient's pain resolved completely and the follow-up CT demonstrated regression of the herniation. PMID:15994059

  5. Groin hernia repair by laparoscopic techniques: current status and controversies.

    PubMed

    Arregui, Maurice E; Young, Susan B

    2005-08-01

    Laparoscopic hernia repair remains controversial, and its position in current hernia surgery remains in flux. In this article we attempt to put the laparoscopic approach in perspective by describing the rationale for its development. We summarize studies comparing it with open repairs, including recent publications, meta-analyses, and systematic reviews; and we then contrast the data with recent findings of the United States Veterans Affairs Cooperative study 456. We discuss the current and future status of the laparoscopic approach to inguinal hernia repair and present an update of our own laparoscopic totally extraperitoneal technique without mesh fixation. From 1994 to 2004 we performed 314 hernia repairs on 224 patients with no intraoperative complications, no conversions to an open procedure, and no mortality. Thirty (14%) minor postoperative complications occurred. There were three herniated lipomas (preperitoneal fat) but no true peritoneal reherniations. We evaluate critical points of laparoscopic hernia repair including extensive preperitoneal dissection, mesh configuration, size and fixation, cost reduction, and the learning curve. PMID:15983713

  6. [Congenital lumbar hernia].

    PubMed

    Peláez Mata, D J; Alvarez Muñoz, V; Fernández Jiménez, I; García Crespo, J M; Teixidor de Otto, J L

    1998-07-01

    Hernias in the lumbar region are abdominal wall defects that appear in two possible locations: the superior lumbar triangle of Grynfelt-Lesshaft and the inferior lumbar triangle of Petit. There are 40 cases reported in the pediatric literature, and only 16 are considered congenital, associated with the lumbocostovertebral syndrome and/or meningomyelocele. A new case is presented. A premature newborn with a mass in the left flank that increases when the patient cries and reduces easily. The complementary studies confirm the diagnosis of lumbar hernia and reveal the presence of lumbocostovertebral syndrome associated. At the time of operation a well defined fascial defect at the superior lumbar triangle of Grynfelt-Lesshaft is primarily closed. The diagnosis of lumbar hernia is not difficult to establish but it is necessary the screening of the lumbocostovertebral syndrome. We recommend the surgical treatment before 12 months of age; the objective is to close the defect primarily or to use prosthetic material if necessary. PMID:12602034

  7. Delayed traumatic diaphragmatic hernia

    PubMed Central

    Lu, Jing; Wang, Bo; Che, Xiangming; Li, Xuqi; Qiu, Guanglin; He, Shicai; Fan, Lin

    2016-01-01

    Abstract Background: Traumatic diaphragmatic hernias (TDHs) are sometimes difficult to identify at an early stage and can consequently result in diagnostic delays with life-threatening outcomes. It is the aim of this case study to highlight the difficulties encountered with the earlier detection of traumatic diaphragmatic hernias. Methods: Clinical data of patients who received treatment for delayed traumatic diaphragmatic hernias in registers of the First Affiliated Hospital of Xi’an Jiaotong University from 1998 to 2014 were analyzed retrospectively. Results: Six patients were included in this study. Left hemidiaphragm was affected in all of them. Most of the patients had a history of traffic accident and 1 a stab-penetrating injury. The interval from injury to developing symptoms ranged from 2 to 11 years (median 5 years). The hernial contents included the stomach, omentum, small intestine, and colon. Diaphragmatic injury was missed in all of them during the initial managements. All patients received operations once the diagnosis of delayed TDH was confirmed, and no postoperative mortality was detected. Conclusions: Delayed TDHs are not common, but can lead to serious consequences once occurred. Early detection of diaphragmatic injuries is crucial. Surgeons should maintain a high suspicion for injuries of the diaphragm in cases with abdominal or lower chest traumas, especially in the initial surgical explorations. We emphasize the need for radiographical follow-up to detect diaphragmatic injuries at an earlier stage. PMID:27512848

  8. Laparoscopic paracolostomy hernia mesh repair.

    PubMed

    Virzí, Giuseppe; Giuseppe, Virzí; Scaravilli, Francesco; Francesco, Scaravilli; Ragazzi, Salvatore; Salvatore, Ragazzi; Piazza, Diego; Diego, Piazza

    2007-12-01

    Paracolostomy hernia is a common occurrence, representing a late complication of stoma surgery. Different surgical techniques have been proposed to repair the wall defect, but the lowest recurrence rates are associated with the use of mesh. We present the case report of a patient in which laparoscopic paracolostomy hernia mesh repair has been successfully performed. PMID:18097321

  9. Laparoscopic Hernia Repair and Bladder Injury

    PubMed Central

    Bhoyrul, Sunil; Mulvihill, Sean J.

    2001-01-01

    Background: Bladder injury is a complication of laparoscopic surgery with a reported incidence in the general surgery literature of 0.5% and in the gynecology literature of 2%. We describe how to recognize and treat the injury and how to avoid the problem. Case Reports: We report two cases of bladder injury repaired with a General Surgical Interventions (GSI) trocar and a balloon device used for laparoscopic extraperitoneal inguinal hernia repair. One patient had a prior appendectomy; the other had a prior midline incision from a suprapubic prostatectomy. We repaired the bladder injury, and the patients made a good recovery. Conclusion: When using the obturator and balloon device, it is important to stay anterior to the preperitoneal space and bladder. Prior lower abdominal surgery can be considered a relative contraindication to extraperitoneal laparoscopic hernia repair. Signs of gas in the Foley bag or hematuria should alert the surgeon to a bladder injury. A one- or two-layer repair of the bladder injury can be performed either laparoscopically or openly and is recommended for a visible injury. Mesh repair of the hernia can be completed provided no evidence exists of urinary tract infection. A Foley catheter is placed until healing occurs. PMID:11394432

  10. Vesicocutaneous fistula after sliding hernia repair

    PubMed Central

    Mittal, Varun; Kapoor, Rakesh; Sureka, Sanjoy

    2016-01-01

    Sliding inguinal hernias are usually direct inguinal hernias containing various abdominal viscera. The incidence of bladder forming a part of an inguinal hernia, called as “scrotal cystocele,” is 1–4%. The risk of bladder injury is as high as 12% when repairing this type of hernia. This case report emphasizes this aspect in a 65-year-old man who presented with urinary leak through the scrotal wound following right inguinal hernia repair. PMID:26941501

  11. Sampson's Artery Hemorrhage after Inguinal Hernia Repair: Second Case Reported

    PubMed Central

    Adjei Boachie, Joseph

    2016-01-01

    Sampson artery is normally obliterated in postembryonic development. In rare cases it can remain patent and complicate a routine outpatient herniorrhaphy when severed. This is the second reported case in the available English literature of hemoperitoneum due to bleeding from a patent Sampson's artery following an open inguinal hernia repair. PMID:27247822

  12. Sampson's Artery Hemorrhage after Inguinal Hernia Repair: Second Case Reported.

    PubMed

    Adjei Boachie, Joseph; Smith-Singares, Eduardo

    2016-01-01

    Sampson artery is normally obliterated in postembryonic development. In rare cases it can remain patent and complicate a routine outpatient herniorrhaphy when severed. This is the second reported case in the available English literature of hemoperitoneum due to bleeding from a patent Sampson's artery following an open inguinal hernia repair. PMID:27247822

  13. [A brief history of the inguinal hernia operation in adults].

    PubMed

    Bekker, J; Keeman, J N; Simons, M P; Aufenacker, Th J

    2007-04-21

    Late into the 19th century, treatment for inguinal hernias consisted of repositioning the hernia with trusses or using 'softening agents' such as warm herbal baths and moist bandages. Surgical resection or cauterisation, often combined with hemicastration, was only considered for cases ofstrangulated hernia that could not be repositioned. Bassini (1844-1924) is credited with developing the precursor to the modern inguinal hernia operation at the end of the 19th century. Bassini's essential discovery was that the transverse fascia plays a key role in the pathophysiology of inguinal hernias. Bassini's operation, consisting of complete incision of the transverse fascia and reconstruction of the inguinal floor, was considered the gold standard for nearly a century. One problem with the conventional Bassini operation was the tension applied to tissues, which led to a high rate of recurrence. Although Bassini's operation has now become obsolete, current surgical approaches still centre on fortification of the inguinal floor. This tension-free repair now uses synthetic mesh that is positioned using an open anterior approach, laparoscopic surgery, or a preperitoneal technique. PMID:17500346

  14. Amyand's Hernia: Rare Presentation of a Common Ailment

    PubMed Central

    Singhal, Sanjeev; Singhal, Anu; Negi, Sanjay Singh; Tugnait, Rahul; Arora, Pankaj Kumar; Tiwari, Bishwanath; Malik, Pawan; Gupta, Lav; Bimal, Amit; Gupta, Abhishek; Gupta, Rahul; Chouhan, Pushkar; Singh, ChandraKant

    2015-01-01

    Inguinal hernia with vermiform appendix as content is known as Amyand's hernia. It is a rare entity but we encountered four cases within six months. A 52-year-old female had high grade fever and evidence of inflammatory pathology involving the ileocaecal region. She was initially managed conservatively and subsequently underwent exploratory laparatomy. The appendix was perforated and herniating in the inguinal canal. Appendectomy was done with herniorrhaphy without mesh placement. A 74-year-old male with bilateral inguinal hernia, of which, the right side was more symptomatic, underwent open exploration. Operative findings revealed a lipoma of the sac and a normal appearing appendix as content. Contents were reduced without appendectomy and mesh hernioplasty was performed. A 63-year-old male with an obstructed right sided hernia underwent emergency inguinal exploration which revealed edematous caecum and appendix as content without any inflammation. Contents were reduced without any resection. Herniorrhaphy was performed without mesh placement. A 66-year-old male with an uncomplicated right inguinal hernia underwent elective surgery. The sac revealed an appendix with adhesions at the neck. Contents were reduced after adhesiolysis and hernioplasty was performed with mesh placement. Emphasis is made to the rarity of disease, variation in presentation, and difference in treatment modalities depending upon the state of appendix. PMID:26576304

  15. 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

  16. CONGENITAL DIAPHRAGMATIC HERNIA

    PubMed Central

    Adams, Burton E.

    1954-01-01

    Treatment of congenital diaphragmatic hernia in infants is a matter of semi-emergency and should be done as soon as adequate preparations can be made because sometimes fatal complications develop swiftly. In preoperative preparation there is great advantage in thorough decompression of the abdominal viscera, stomach, bowel and bladder. As to operation, the author believes the abdominal approach has most to recommend it. In the postoperative period, continued gastric suction for a brief time, parenteral administration of fluids and use of a Mistogen tent with a high moist oxygen content will facilitate rapid recovery. ImagesFigure 1. PMID:13209363

  17. Combined usage with intraperitoneal and incisional ropivacaine reduces pain severity after laparoscopic cholecystectomy

    PubMed Central

    Liu, Dan-Shu; Guan, Feng; Wang, Bin; Zhang, Tian

    2015-01-01

    Postoperative pain is the main obstacle for safely rapid recovery of patients undergoing laparoscopic cholecystectomy (LC). In this study, we systemically evaluated the analgesic efficacy of intraperitoneal and incisional ropivacaine injected at the end of the LC. A total of 160 patients, scheduled for elective LC, were allocated into four groups. Group Sham received intraperitoneal and incisional normal saline (NS). Group IC received incisional ropivacaine and intraperitoneal NS. Group IP received incisional NS and intraperitoneal ropivacaine. Group ICP received intraperitoneal and incisional ropivacaine. At the end of the surgery, ropivacaine was injected into the surgical bed through the right subcostal port and infiltrated at the four ports. Dynamic pain by a visual analogue scale (VAS) and cumulative morphine consumption at 2 h, 6 h, 24 h, and 48 h postoperatively, as well as incidence of side-effects over 48 h after LC was recorded. Compared with those in group Sham, the time of post-anesthesia care unit (PACU) stay, dynamic VAS score (VAS-D) 2 h and 6 h postoperatively, cumulative morphine consumption 6 h and 24 h postoperatively, and incidence of nausea and vomiting 48 h after LC in group IC and ICP were less (P<0.05). Furthermore, intraperitoneal and incisional ropivacaine exerts more powerful analgesic effect than single usage with intraperitoneal or incisional ropivacaine (P<0.05). No patients exhibited signs of local anesthetic toxicity. In conclusion, intraperitoneal and incisional ropivacaine might facilitate PACU transfer and effectively and safely reduce pain intensity after LC. PMID:26885228

  18. Management of Septic Open Abdomen in a Morbid Obese Patient with Enteroatmospheric Fistula by Using Standard Abdominal Negative Pressure Therapy in Conjunction with Intrarectal One

    PubMed Central

    Yetisir, Fahri; Salman, A. Ebru; Acar, Hasan Zafer; Özer, Mehmet; Aygar, Muhittin; Osmanoglu, Gokhan

    2015-01-01

    Introduction. Management of open abdomen (OA) with enteroatmospheric fistula (EAF) in morbid obese patient with comorbid disease is challenging. We would like to report the management of septic OA in morbid obese patient with EAF which developed after strangulated recurrent giant incisional hernia repair. We would also like to emphasize, in this case, the conversion of EAF to ileostomy by the help of second Negative Pressure Therapy (NPT) on ostomy side, and the chance of new EAF occurrence was reduced with intrarectal NPT. Case Presentation. 62-year-old morbid obese woman became an OA patient with EAF after strangulated recurrent giant hernia. EAF was converted to ostomy with pezzer drain by the help of second NPT on ostomy. Colonic distention was reduced with the third NPT application via rectum. Abdominal reapproximation anchor (ABRA) system was used for delayed abdominal closure. Conclusions. Using the 2nd NPT on ostomy side may help in the maturation of the ostomy created in a difficult condition in an open abdomen. Using the 3rd NPT through rectum may decrease the chance of EAF formation by reducing the pressure difference between intraluminal pressure and extraluminal pressure in hollow viscera. PMID:26779360

  19. The Usefulness of the Endonasal Incisional Approach for the Treatment of Nasal Bone Fracture

    PubMed Central

    Kim, Hyo Seong; Suh, Hyeun Woo; Ha, Ki Young; Kim, Boo Yeong

    2012-01-01

    Background Among all facial fractures, nasal bone fractures are the most common, and they have been reduced by closed reduction (CR) for a long time. But several authors have reported suboptimal results when using CR, and the best method of nasal bone reduction is still being debated. We have found that indirect open reduction (IOR) through an endonasal incisional approach is a useful method for more accurate reduction of the nasal bone. Methods A retrospective chart review was performed of 356 patients who underwent reduction of a nasal bone fracture in our department from January, 2006, to July, 2011. We treated 263 patients with IOR. We assessed patients' and doctors' satisfaction with surgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing to mucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsal augmentation rhinoplasty. Results According to the analysis of the satisfaction scores, both patients and doctors were significantly more satisfied in the IOR group than the CR group (P<0.05). Mucosal injury with nasal bleeding occurred much less in the IOR group (5.3%) than the CR group (12.9%). Dorsal augmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them (31/34) showed satisfaction with the outcomes. Conclusions IOR enables surgeons to manipulate the bony fragment directly through the endonasal incisional approach. However, we propose that CR is the proper technique for patients under 16 and for those with comminuted nasal bone fractures because submucosal dissection in IOR can damage the growth or circulation of nasal bone. PMID:22783528

  20. Incarcerated diaphragmatic hernia--differential diagnoses.

    PubMed

    Bukvić, Nado; Versić, Ana Bosak; Bacić, Giordano; Gusić, Nadomir; Nikolić, Harry; Bukvić, Frane

    2014-12-01

    The incarceration of diaphragmatic hernia is very rare. We present a case of a four-year-old girl who developed the incarceration of left-sided diaphragmatic hernia, who, until then, was completely asymptomatic. This incarceration of the hernia represented a surgical emergency presenting as obstructive ileus and a severe respiratory distress which developed from what appeared to be full health. During a brief pre-operative examination a number of differential diagnoses were suggested. Along with the laboratory blood analysis (complete blood count and acid-base balance) a plain thoracic and abdominal radiography was done (babygram). After that, through an inserted nasal-gastric tube, barium meal of the upper gastrointestinal tract was done, showing abdominal organs in the left half of the thorax and a significant shift of the mediastinum to the right. With an urgent upper medial laparotomy we accessed the abdominal cavity and made the correct diagnosis. An opening was shown in the rear part of the left hemi-diaphragm with thickened and edematous edges, approx. 6 cm in diameter with incarcerated content. The incarcerated abdominal organs (stomach, transversal colon, small intestine and spleen) gradually moved into the abdominal cavity. The opening was closed with nonresorptive sutures (TiCron) size 2-0 with aprevious control and ventilated expansion of the well-developed left lung. In postoperative course the acid-base balance quickly recovered, as well as the general state of the patient and radiography showed a good expansion and lucency of the lung parenchyma and a return of the mediastinum into the middle part of the thorax. PMID:25842758

  1. Sports Hernia: Misdiagnosed Muscle Strain

    MedlinePlus

    ... Manipulative Treatment Becoming a DO Video Library Misdiagnosed Muscle Strain Can Be A Pain Page Content If ... speeds, sports hernias are frequently confused with common muscle strain ,” says Michael Sampson, DO, who practices in ...

  2. Endoscopic incisional therapy for benign esophageal strictures: Technique and results

    PubMed Central

    Samanta, Jayanta; Dhaka, Narendra; Sinha, Saroj Kant; Kochhar, Rakesh

    2015-01-01

    Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy (EIT). A proper delineation of the stricture anatomy is a prerequisite. A host of electrocautery and mechanical devices may be used, the most common being the use of needle knife, either standard or insulated tip. The technique entails radial incision and cutting off of the stenotic rim. Adjunctive therapies, to prevent re-stenosis, such as balloon dilatation, oral or intralesional steroids or argon plasma coagulation can be used. The common strictures where EIT has been successfully used are Schatzki’s rings (SR) and anastomotic strictures (AS). Short segment strictures (< 1 cm) have been found to have the best outcome. When compared with routine balloon dilatation, EIT has equivalent results in treatment naïve cases but better long term outcome in refractory cases. Anecdotal reports of its use in other types of strictures have been noted. Post procedure complications of EIT are mild and comparable to dilatation therapy. As of the current evidence, incisional therapy can be used for management of refractory AS and SR with relatively short stenosis (< 1 cm) with good safety profile and acceptable long term patency. PMID:26722613

  3. Endoscopic incisional therapy for benign esophageal strictures: Technique and results.

    PubMed

    Samanta, Jayanta; Dhaka, Narendra; Sinha, Saroj Kant; Kochhar, Rakesh

    2015-12-25

    Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy (EIT). A proper delineation of the stricture anatomy is a prerequisite. A host of electrocautery and mechanical devices may be used, the most common being the use of needle knife, either standard or insulated tip. The technique entails radial incision and cutting off of the stenotic rim. Adjunctive therapies, to prevent re-stenosis, such as balloon dilatation, oral or intralesional steroids or argon plasma coagulation can be used. The common strictures where EIT has been successfully used are Schatzki's rings (SR) and anastomotic strictures (AS). Short segment strictures (< 1 cm) have been found to have the best outcome. When compared with routine balloon dilatation, EIT has equivalent results in treatment naïve cases but better long term outcome in refractory cases. Anecdotal reports of its use in other types of strictures have been noted. Post procedure complications of EIT are mild and comparable to dilatation therapy. As of the current evidence, incisional therapy can be used for management of refractory AS and SR with relatively short stenosis (< 1 cm) with good safety profile and acceptable long term patency. PMID:26722613

  4. Simultaneous Extraperitoneal Laparoscopic Radical Prostatectomy and Intraperitoneal Inguinal Hernia Repair With Mesh

    PubMed Central

    Knoll, Abraham; Teixeira, Julio A.

    2005-01-01

    Objective: This report depicts the feasibility of the concomitant repair of a large direct inguinal hernia with mesh by using the intraperitoneal onlay approach after extra-peritoneal laparoscopic radical prostatectomy. Methods: A 66-year-old man with localized adenocarcinoma of the prostate was referred for laparoscopic radical prostatectomy. The patient also had a 4-cm right, direct inguinal hernia, found on physical examination. To minimize the risk of infection of the mesh, an extraperitoneal laparoscopic prostatectomy was performed in the standard fashion after which transperitoneal access was obtained for the hernia repair. The hernia repair was completed by reduction of the hernia sac, followed by prosthetic mesh onlay. In this fashion, the peritoneum separated the prostatectomy space from the mesh. A single preoperative and postoperative dose of cefazolin was administered. Results: The procedure was completed with no difficulty. Total operative time was 4.5 hours with an estimated blood loss of 450 mL. The final pathology revealed pT2cN0M0 prostate cancer with negative margins. No infectious or bowel complications occurred. At 10-month follow-up, no evidence existed of recurrence of prostate cancer or the hernia. Conclusion: Concomitant intraperitoneal laparoscopic mesh hernia repair and extraperitoneal laparoscopic prostatectomy are feasible. This can decrease the risk of potential infectious complications by separating the mesh from the space of Retzius where the prostatectomy is performed and the lower urinary tract is opened. PMID:15984719

  5. Laparoscopic Repair of Inguinal Hernia Using Surgisis Mesh and Fibrin Sealant

    PubMed Central

    2006-01-01

    Objective: We tested the hypothesis that laparoscopic inguinal herniorrhaphy using Surgisis mesh secured with fibrin sealant is an effective long-term treatment for repair of inguinal hernia. This case series involved 38 adult patients with 51 inguinal hernias treated in a primary care center. Methods: Between December 2002 and May 2005, 38 patients with 45 primary and 6 recurrent inguinal hernias were treated with laparoscopic repair by the total extra-peritoneal mesh placement (TEP) technique using Surgisis mesh secured into place with fibrin sealant. Postoperative complications, incidence of pain, and recurrence were recorded, as evaluated at 2 weeks, 6 weeks, 1 year, and with a follow-up questionnaire and telephone interview conducted in May and June 2005. Results: The operations were successfully performed on all patients with no complications or revisions to an open procedure. Average follow-up was 13 months (range, 1 to 30). One hernia recurred (second recurrence of unilateral direct hernia), indicating a 2% recurrence rate. Conclusions: Laparoscopic repair of inguinal hernia using Surgisis mesh secured with fibrin sealant can be effectively used to treat primary, recurrent, direct, indirect, and bilateral inguinal hernias in adults without complications and minimal recurrence within 1-year of follow-up. PMID:17575758

  6. Components separation in complex ventral hernia repair: surgical technique and post-operative outcomes.

    PubMed

    Ross, Samuel W; Oommen, Bindhu; Heniford, B Todd; Augenstein, Vedra A

    2014-03-01

    There are over 350,000 ventral hernia repairs (VHR) performed in the United States annually and a variety of laparoscopic and open surgical techniques are described and utilized. Complex ventral hernias such as recurrent hernias, those with infected mesh, open wounds, coexisting enteric fistulas, parastomal hernias, and massive hernias-especially those with loss of abdominal domain-require sophisticated repair techniques. Many of these repairs are performed via an open approach. Ideally, the aim is to place mesh under the fascia with a large overlap of the defect and obtain primary fascial closure. However, it is often impossible to bring together fascial edges in very large hernias. Component separation is an excellent surgical technique in selected patients which involves release of the different layers of the abdominal wall and in turn helps accomplish primary fascial approximation. The posterior rectus sheath, external oblique or the transverse abdominis fascia can be cut and allows for closure of fascia in a tension free manner in a majority of patients. In this chapter we describe the various techniques for component separation, indications for use, how to select an appropriate type of release and post-operative outcomes. PMID:24700223

  7. Milestones in the history of hernia surgery: prosthetic repair.

    PubMed

    Read, Raymond C

    2004-02-01

    Billroth (1878) envisaged prostheses before Bassini's sutured cure (1887). Phelps (1894) reinforced with silver coils. Metals were replaced by plastic (Aquaviva 1944). Polypropylene (Usher 1962), resisting infection, became popular. Usher instituted tensionless, overlapping preperitoneal repair. Spermatic cord was parietalized, to obviate keyholing. Stoppa (1969) championed the sutureless Cheatle-Henry approach encasing the peritoneum. His technique, "La grande prosthese de renforcement du sac visceral" (GPRVS), was adopted by laparoscopists. Newman (1980) and Lichtenstein (1986) pioneered subaponeurotic positioning. Kelly (1898) inserted a plug into the femoral canal; Lichtenstein and Shore (1974) followed. Gilbert (1987) plugged the internal ring, and Robbins and Rutkow (1993) treated all groin herniae thus. Incisional herniation has been controlled by prefascial, retrorectus prosthetic placement (Rives-Flament 1973). ePTFE (Sher et al. 1980) is useful intraperitoneally, since it evokes few adhesions. Here, laparoscopy (Ger 1982) is competitive. Beginning in 1964 (Wirtschafter and Bentley), experimental and clinical studies have shown herniation may be associated with aging and genetic or acquired (smoking, etc.) systemic disease of connective tissue. These data, with prospective trials, all but mandate tensionless prosthetic repair. PMID:14586774

  8. 21 CFR 876.5970 - Hernia support.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hernia support. 876.5970 Section 876.5970 Food and... GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5970 Hernia support. (a) Identification. A hernia... contents. This generic type of device includes the umbilical truss. (b) Classification. Class I...

  9. 21 CFR 876.5970 - Hernia support.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hernia support. 876.5970 Section 876.5970 Food and... GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5970 Hernia support. (a) Identification. A hernia... contents. This generic type of device includes the umbilical truss. (b) Classification. Class I...

  10. 21 CFR 876.5970 - Hernia support.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hernia support. 876.5970 Section 876.5970 Food and... GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5970 Hernia support. (a) Identification. A hernia... contents. This generic type of device includes the umbilical truss. (b) Classification. Class I...

  11. Abdominal wall herniae and their underlying pathology

    PubMed Central

    Upchurch, Emma; Al-Akash, Musallam

    2016-01-01

    We describe a case of pseudomyxoma peritonei presenting as a strangulated inguinal hernia. We review the current literature regarding the incidence of underlying pathology in patients presenting with abdominal wall herniae and discuss the need for histological assessment of the hernia sac in selected patients. We highlight the importance of assessing for and being aware of significant underlying pathology in certain patients. PMID:26855074

  12. Do large hiatal hernias affect esophageal peristalsis?

    PubMed Central

    Roman, Sabine; Kahrilas, Peter J; Kia, Leila; Luger, Daniel; Soper, Nathaniel; Pandolfino, John E

    2013-01-01

    Background & Aim Large hiatal hernias can be associated with a shortened or tortuous esophagus. We hypothesized that these anatomic changes may alter esophageal pressure topography (EPT) measurements made during high-resolution manometry (HRM). Our aim was to compare EPT measures of esophageal motility in patients with large hiatal hernias to those of patients without hernia. Methods Among 2000 consecutive clinical EPT, we identified 90 patients with large (>5 cm) hiatal hernias on endoscopy and at least 7 evaluable swallows on EPT. Within the same database a control group without hernia was selected. EPT was analyzed for lower esophageal sphincter (LES) pressure, Distal Contractile Integral (DCI), contraction amplitude, Contractile Front Velocity (CFV) and Distal Latency time (DL). Esophageal length was measured on EPT from the distal border of upper esophageal sphincter to the proximal border of the LES. EPT diagnosis was based on the Chicago Classification. Results The manometry catheter was coiled in the hernia and did not traverse the crural diaphragm in 44 patients (49%) with large hernia. Patients with large hernias had lower average LES pressures, lower DCI, slower CFV and shorter DL than patients without hernia. They also exhibited a shorter mean esophageal length. However, the distribution of peristaltic abnormalities was not different in patients with and without large hernia. Conclusions Patients with large hernias had an alteration of EPT measurements as a consequence of the associated shortened esophagus. However, the distribution of peristaltic disorders was unaffected by the presence of hernia. PMID:22508779

  13. [Congenital lumbar hernia and bilateral renal agenesis].

    PubMed

    Barrero Candau, R; Garrido Morales, M

    2007-04-01

    We report a new case of congenital lumbar hernia. This is first case reported of congenital lumbar hernia and bilateral renal agenesis. We review literature and describe associated malformations reported that would be role out in every case of congenital lumbar hernia. PMID:17650728

  14. Preperitoneal Surgery Using a Self-Adhesive Mesh for Inguinal Hernia Repair

    PubMed Central

    Oguntodu, Olakunle F.; Rodriguez, Francisco; Rassadi, Roozbeh; Haley, Michael; Shively, Cynthia J.; Dzandu, James K.

    2014-01-01

    Background and Objectives: Laparoscopic preperitoneal hernia repair with mesh has been reported to result in improved patient outcomes. However, there are few published data on the use of a totally extraperitoneal (TEP) approach. The purpose of this study was to present our experience and evaluate early outcomes of TEP inguinal hernia repair with self-adhesive mesh. Methods: This cohort study was a retrospective review of patients who underwent laparoscopic TEP inguinal hernial repair from April 4, 2010, through July 22, 2014. Data assessed were age, sex, body mass index (BMI), hernia repair indications, hernia type, pain, paresthesia, occurrence (bilateral or unilateral), recurrence, and patient satisfaction. Descriptive and regression analyses were performed. Results: Six hundred forty patients underwent laparoscopic preperitoneal hernia surgery with self-adhesive mesh. The average age was 56 years, nearly all were men (95.8%), and the mean BMI was 26.2 kg/m2. Cases involved primary hernia more frequently than recurrent hernia (94% vs 6%; P < .05). After surgery, 92% of the patients reported no more than minimal pain, <1% reported paresthesia, and 0.2% had early recurrence. There were 7 conversions to an open procedure. The patients had no adverse reactions to anesthesia and no bladder injury. Postoperative acute pain or recurrence was not explained by demographics, BMI, or preoperative pain. There were significant associations of hernia side, recurrence, occurrence, and sex with composite end points. Nearly all patients (98%) were satisfied with the outcome. Conclusion: The use of self-adhesive, Velcro-type mesh in laparoscopic TEP inguinal hernia repair is associated with reduced pain; low rates of early recurrence, infection, and hematoma; and improved patient satisfaction. PMID:25587212

  15. Spinal hernia tissue autofluorescence spectrum.

    PubMed

    Varanius, Darius; Terbetas, Gunaras; Vaitkus, Juozas V; Vaitkuviene, Aurelija

    2013-02-01

    The laser intervertebral disc decompression may provide appropriate relief in properly selected patients with contained disc herniations. The present investigation aims to characterise intervertebral disc material by autofluorescence induced by laser light. Degeneration of the intervertebral disc is associated with progressive biochemical changes in disc material. Percutaneous laser disc decompression has become rather popular for the treatment of lumbar disc herniation, but there are problems in the selection of patients. For this purpose, recognition of the disc composition is necessary. We propose a new type of spectroscopic investigation. It is advantageous to the characterization of intervertebral disc material. Intervertebral disc specimens were removed during open surgery from different disc locations. Preoperative patients' MRI was evaluated using the Pfirrmann disc degeneration and Komori scale for migrating of herniated nucleus pulposus. Adjacent slices of stained disc sections were evaluated by histology/histochemistry and autofluorescence spectra. Comparison of the MRI, spectral, histological and histochemical data was performed. The MRI Komori scale correlated with the histology Boos degeneration index. In the histochemistry, collagens other than collagens I and II of the disc were distinguished with best positive correlation coefficient (0.829) and best negative one (-0.904) of proteoglycans of sequester to Boos index. A correlation of the IV Gaussian component of the hernia spectra with the Boos index was established. The Gaussian component correlation with different collagen types and proteoglycan was determined for the disc and sequester. "Autofluorescence-based diagnosis" refers to the evaluation of disc degeneration by histological and histochemical evaluation; it can provide additional data on the degeneration of an intervertebral disc. PMID:22389123

  16. Grynfelt-Lesshaft hernia a case report and review of the literature

    PubMed Central

    Ploneda-Valencia, C.F.; Cordero-Estrada, E.; Castañeda-González, L.G.; Sainz-Escarrega, V.H.; Varela-Muñoz, O.; De la Cerda-Trujillo, L.F.; Bautista-López, C.A.; López-Lizarraga, C.R.

    2016-01-01

    Introduction Lumbar hernia account for less than 2% of al abdominal hernias, been the Grynfelt-Lesshaft's hernia (GLH) more frequent than the others. With approximately 300 cases published in the literature, the general surgeon may have the chance of treat it ones in their professional life. Case report A 42-years old male with human immunodeficiency virus and Diabetes Mellitus presented to the outpatient clinic with a GLH. Preoperative classified as a type “A” lumbar hernia an open approach was scheduled. We performed a Sandwich technique with a sublay and onlay ULTRAPRO® mesh fixed with PDS® II suture without complications and discharged the patient 24-h after. After six months, the patient denied any complication. Discussion Primary (spontaneous) lumbar hernias represent 50–60% of all GLH. The preoperative classification of a lumbar hernia is mandatory to propose the best surgical approach. According to the classification of Moreno-Egea A et al., the best technique for our patient was an open approach. The Sandwich technique has demonstrated good outcomes in the management of the GLH. Conclusion The surgical approach should be according to the classification proposed and to the experience of the surgeon. The Sandwich technique has good outcomes. PMID:27144007

  17. Grynfeltt Hernia: A Deceptive Lumbar Mass with a Lipoma-Like Presentation

    PubMed Central

    Zadeh, Jonathan R.; Buicko, Jessica L.; Patel, Chetan; Kozol, Robert; Lopez-Viego, Miguel A.

    2015-01-01

    The Grynfeltt-Lesshaft hernia is a rare posterior abdominal wall defect that allows for the herniation of retro- and intraperitoneal structures through the upper lumbar triangle. While this hernia may initially present as a small asymptomatic bulge, the defect typically enlarges over time and can become symptomatic with potentially serious complications. In order to avoid that outcome, it is advisable to electively repair Grynfeltt hernias in patients without significant contraindications to surgery. Due to the limited number of lumbar hernioplasties performed, there has not been a large study that definitively identifies the best repair technique. It is generally accepted that abdominal hernias such as these should be repaired by tension-free methods. Both laparoscopic and open techniques are described in modern literature with unique advantages and complications for each. We present the case of an unexpected Grynfeltt hernia diagnosed following an attempted lipoma resection. We chose to perform an open repair involving a combination of fascial approximation and dual-layer polypropylene mesh placement. The patient's recovery was uneventful and there has been no evidence of recurrence at over six months. Our goal herein is to increase awareness of upper lumbar hernias and to discuss approaches to their surgical management. PMID:26697256

  18. Grynfeltt Hernia: A Deceptive Lumbar Mass with a Lipoma-Like Presentation.

    PubMed

    Zadeh, Jonathan R; Buicko, Jessica L; Patel, Chetan; Kozol, Robert; Lopez-Viego, Miguel A

    2015-01-01

    The Grynfeltt-Lesshaft hernia is a rare posterior abdominal wall defect that allows for the herniation of retro- and intraperitoneal structures through the upper lumbar triangle. While this hernia may initially present as a small asymptomatic bulge, the defect typically enlarges over time and can become symptomatic with potentially serious complications. In order to avoid that outcome, it is advisable to electively repair Grynfeltt hernias in patients without significant contraindications to surgery. Due to the limited number of lumbar hernioplasties performed, there has not been a large study that definitively identifies the best repair technique. It is generally accepted that abdominal hernias such as these should be repaired by tension-free methods. Both laparoscopic and open techniques are described in modern literature with unique advantages and complications for each. We present the case of an unexpected Grynfeltt hernia diagnosed following an attempted lipoma resection. We chose to perform an open repair involving a combination of fascial approximation and dual-layer polypropylene mesh placement. The patient's recovery was uneventful and there has been no evidence of recurrence at over six months. Our goal herein is to increase awareness of upper lumbar hernias and to discuss approaches to their surgical management. PMID:26697256

  19. When is surgery necessary for a groin hernia?

    PubMed

    Berliner, S D

    1990-01-01

    Hernias are one of the most common causes of symptoms in the groin. Surgery is needed for all femoral and indirect inguinal hernias to prevent incarceration and strangulation. Asymptomatic direct hernias can be observed if they are not enlarging. Atypical symptoms in a patient with a hernia must be evaluated to exclude other disease. Fortunately, most groin hernias can be repaired electively. PMID:2296562

  20. [Management of umbilical hernia in cirrhotic patients].

    PubMed

    Loriau, J; Manaouil, D; Mauvais, F

    2002-06-01

    The treatment of umbilical hernia in the setting of cirrhosis poses unique and specific management problems due to the pathophysiology of cirrhotic ascites. The high intra-abdominal pressures generated by ascites when applied to areas of parietal weakness are the cause of hernia formation and enlargement. Successful surgical treatment depends on minimization or elimination of ascites. Umbilical rupture and hernia strangulation are the most life-threatening complications of umbilical hernia with ascites and they demand urgent surgical intervention. In non-emergency situations, medical therapy to control ascites should precede hernia repair. When ascites is refractory to medical therapy, treatment will vary depending on whether transplantation is an option. In liver transplantation candidates, hernia repair can be performed at the end of the transplantation procedure. If transplanation is not envisaged, concomitant treatment of both ascites and hernia is best achieved by placement of a peritoneo-venous shunt at the time of the parietal repair. PMID:12391663

  1. Proficiency of Surgeons in Inguinal Hernia Repair

    PubMed Central

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

    2005-01-01

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

  2. Comparison of pre- vs. post-incisional caudal bupivacaine for postoperative analgesia in unilateral pediatric herniorrhaphy: A double-blind randomized clinical trial

    PubMed Central

    Sajedi, Parvin; Yaraghi, Ahmad; Zadeh, Mohammad Taher Dehdari

    2011-01-01

    Introduction: This study was designed to evaluate the pre- vs. post-incisional analgesic efficacy of bupivacaine administered caudally in children undergoing unilateral hernia repair. Methods: Fifty children aged 6 months to 6 years were included in the study. Children were divided blindly between the two groups to receive pre- vs. post-incisional caudal bupivacaine. The preincisional group received 1 ml/kg of 0.125% bupivacaine caudally after induction of anesthesia and the postincisional group received the same dose caudally at the end of surgery. Heart rate, SaO2, end tidal CO2, and noninvasive arterial blood pressure were recorded every 10 min. The duration of surgery, extubation time, and duration of recovery period were also recorded. The pain scores were measured with using an Oucher chart in the recovery room, 2, 4, 6, 12, and 24 h after surgery. Time to first analgesia, numbers of supplementary analgesics required by each child in a 24-h period and total analgesic consumptions were recorded. Any local and systemic complications were recorded. Quantitative data were compared using a two-tailed t-test. Sex distribution and frequency of acetaminophen consumption were measured using χ2 test. P < 0.05 was considered statistically significant. Results: The Oucher pain scale at 4, 6, 12, and 24 h after surgery, the total analgesic consumption and the numbers of demand for supplemental acetaminophen were lower statistically in preincisional group (P < 0.05). Extubation time and duration were higher in preincisional group (P < 0.05). Mean changes of heart rates were statistically lower during the anesthesia period and recovery time in preincisional group (P < 0.05). Conclusion: Preincisional caudal analgesia with a single injection of 0.125% bupivacaine is more effective than the postincisional one for postoperative pain relief and analgesic consumption in unilateral pediatric herniorrhaphy. PMID:21804795

  3. Intrathoracic Hernia after Total Gastrectomy

    PubMed Central

    Tashiro, Yoshihiko; Murakami, Masahiko; Otsuka, Koji; Saito, Kazuhiko; Saito, Akira; Motegi, Kentaro; Date, Hiromi; Yamashita, Takeshi; Ariyoshi, Tomotake; Goto, Satoru; Yamazaki, Kimiyasu; Fujimori, Akira; Watanabe, Makoto; Aoki, Takeshi

    2016-01-01

    Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation.

  4. Paraduodenal hernia and jejunal diverticulosis.

    PubMed

    Goodney, Philip P; Pindyck, Frank

    2004-02-01

    A case of left-sided paraduodenal hernia and jejunal diverticulosis is described in 75-year-old man who presented with chronic intermittent abdominal pain, weight loss, and anemia. A brief review of the epidemiology, pathogenesis, and clinical presentation displays the variety of symptoms associated with these rare conditions. PMID:14731138

  5. Outcome of four years experience in laparoscopic ventral hernia repair

    PubMed Central

    Kumar, Dileep; Khan, Hina; Qureshi, Muhammad Shamim

    2015-01-01

    Objective: To find out the short term outcomes of laparoscopic ventral hernia repair (LVHR) during the last four years. Methods: It was a descriptive and prospective case series of 53 consecutive patients out of 107 at Department of General Surgery, Jinnah Post Graduate Medical Center, Unit II, Karachi, from January 2009 to December 2012. These patients were admitted through out patient department with complain of lump, pain and discomfort. Most of the patients were obese. All patients were clinically examined and baseline investigations done. Fifty three (49.5%) patients underwent laparoscopic repair with mesh placement and remaining 54 by open surgical repair. Results: Among 53 patients, mean age was 46 years range (30 - 55). While females were 33(62.2%) and males 20(37.7%). We observed variety of hernias, in which midline and epigastric hernia were predominant. The commonest symptom was lump and dragging sensation. The duration of symptoms ranged between 6 months to one year. About 53 patients (49.5%) had laparoscopic repair with mesh placement. Average hospital stay was two days. Out of 53 patients, 4 (7.5%) had cellulitis at trocar site, seroma in 2(3.7%), 2(3.7%) patient complained of persistent pain postoperatively, port site minor infection was in 2(3.7%) patients, while conversion to open approach was done in 2 (3.7%), postoperative ileus was observed in one (1.8%) patients. Conclusions: This study provides the evidence that, laparoscopic repair with mesh placement in ventral hernia is safe and effective approach compared to open surgical procedure. It has a low complication rate, less hospital stay and low recurrence. PMID:26430444

  6. FIXING JEJUNAL MANEUVER TO PREVENT PETERSEN HERNIA IN GASTRIC BYPASS

    PubMed Central

    MURAD-JUNIOR, Abdon José; SCHEIBE, Christian Lamar; CAMPELO, Giuliano Peixoto; de LIMA, Roclides Castro; MURAD, Lucianne Maria Moraes Rêgo Pereira; dos SANTOS, Eduardo Pachu Raia; RAMOS, Almino Cardoso; VALADÃO, José Aparecido

    2015-01-01

    Background : Among Roux-en-Y gastric bypass complications is the occurrence of intestinal obstruction by the appearance of internal hernias, which may occur in Petersen space or the opening in mesenteric enteroenteroanastomosis. Aim : To evaluate the efficiency and safety in performing a fixing jejunal maneuver in the transverse mesocolon to prevent internal hernia formation in Petersen space. Method : Two surgical points between the jejunum and the transverse mesocolon, being 5 cm and 10 cm from duodenojejunal angle are made. In all patients was left Petersen space open and closing the opening of the mesenteric enteroenteroanastomosis. Results : Among 52 operated patients, 35 were women (67.3%). The age ranged 18-63 years, mean 39.2 years. BMI ranged from 35 to 56 kg/m2 (mean 40.5 kg/m2). Mean follow-up was 15.1 months (12-18 months). The operative time ranged from 68-138 min. There were no intraoperative complications, and there were no major postoperative complications and no reoperations. The hospital stay ranged from 2-3 days. During the follow-up, no one patient developed suspect clinical presentation of internal hernia. Follow-up in nine patients (17.3%) showed asymptomatic cholelithiasis and underwent elective laparoscopic cholecystectomy. During these procedures were verified the Petersen space and jejunal fixation. In all nine, there was no herniation of the jejunum to the right side in Petersen space. Conclusion : The fixation of the first part of the jejunum to left side of the transverse mesocolon is safe and effective to prevent internal Petersen hernia in RYGB postoperatively in the short and medium term. It may be interesting alternative to closing the Petersen space. PMID:26537279

  7. Tailored approach in inguinal hernia repair - decision tree based on the guidelines.

    PubMed

    Köckerling, Ferdinand; Schug-Pass, Christine

    2014-01-01

    The endoscopic procedures TEP and TAPP and the open techniques Lichtenstein, Plug and Patch, and PHS currently represent the gold standard in inguinal hernia repair recommended in the guidelines of the European Hernia Society, the International Endohernia Society, and the European Association of Endoscopic Surgery. Eighty-two percent of experienced hernia surgeons use the "tailored approach," the differentiated use of the several inguinal hernia repair techniques depending on the findings of the patient, trying to minimize the risks. The following differential therapeutic situations must be distinguished in inguinal hernia repair: unilateral in men, unilateral in women, bilateral, scrotal, after previous pelvic and lower abdominal surgery, no general anesthesia possible, recurrence, and emergency surgery. Evidence-based guidelines and consensus conferences of experts give recommendations for the best approach in the individual situation of a patient. This review tries to summarize the recommendations of the various guidelines and to transfer them into a practical decision tree for the daily work of surgeons performing inguinal hernia repair. PMID:25593944

  8. 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

  9. [Idiopathic Lumbar Hernia: A Case Report].

    PubMed

    Tsujino, Takuya; Inamoto, Teruo; Matsunaga, Tomohisa; Uchimoto, Taizo; Saito, Kenkichi; Takai, Tomoaki; Minami, Koichiro; Takahara, Kiyoshi; Nomi, Hayahito; Azuma, Haruhito

    2015-11-01

    A 68-year-old woman, complained of an indolent lump about 60 × 70 mm in size in the left lower back. We conducted a computed tomography scan, which exhibited a hernia of Gerota'sfascia-commonly called superior lumbar hernia. In the right lateral position, the hernia contents were observed to attenuate, hence only closure of the hernial orifice was conducted by using Kugel patch, without removal of the hernia sack. Six months after the surgery, she has had no relapse of the hernia. Superior lumbar hernia, which occurs in an anatomically brittle region in the lower back, is a rare and potentially serious disease. The urologic surgeon should bear in mind this rarely seen entity. PMID:26699890

  10. Uncommon content in congenial inguinal hernia.

    PubMed

    Harjai, Man Mohan

    2014-10-01

    Although sliding indirect inguinal hernias containing the ipsilateral ovary and fallopian tube are not uncommon in infant girls, sliding hernias containing uterus with both ovaries and fallopian tubes are extremely rare. At surgery, a 5-month-old infant girl was found to have an indirect hernia in which the uterus and fallopian tubes were sliding components with a wide deep inguinal ring. PMID:25336812

  11. Mesh tuck repair of ventral hernias of the abdomen: a new, simplified technique for sublay herniorrhaphy.

    PubMed

    East, J M

    2007-12-01

    There is biomechanical advantage to placing mesh in the retro-myofascial plane for repair of ventral abdominal hernias. Intra-abdominal pressure applied to the periphery of the mesh increases apposition to the abdominal wall rather than causing distraction and this translates, in general, into lower recurrence rates than after "inlay" and "onlay" mesh placement. Traditionally, retro-myofascial mesh is placed in the pre-peritoneal or retro-muscular space. Both traditional techniques require extensive dissection and placement of large sheets of mesh which can cause symptomatic impairment of abdominal wall compliance. Pre-peritoneal dissection can be particularly tedious due to pathological adherence of peritoneum to the posterior abdominal wall in longstanding primary and incisional hernias. In the technique described, mesh is tucked into the retro-myofascial plane without any dissection into pre-peritoneal, retro-muscular or peritoneal spaces. The operation is less tedious, takes less time to perform, can often be done under local anaesthesia, demands less mesh and achieves similar recurrence rates to traditional retro-myofascial mesh repairs. Sixty-one operations have been performed by the author using this technique, with a recurrence rate of 8.2% after 13 years to 3 months of follow-up (median, 3.75 years) and 9.3% if patients with less than one year of follow-up are excluded Factors predisposing to recurrence after mesh repair of ventral hernias are numerous and complex. A fair comparison of recurrence rates between this technique and traditional retro-myofascial repairs requires a randomized controlled trial but the crude recurrence rate for this operation falls well within the range reported for traditional repairs from other studies. PMID:18646495

  12. Recurrent spigelian hernia: a case report.

    PubMed

    Losanoff, Julian E; Richman, Bruce W; Jones, James W

    2003-02-01

    Only seven cases of spigelian hernia recurrence have been previously reported. We report the case of a 75-year-old male patient who presented with extremely large hernia after four unsuccessful suture repairs over 12 years. The abdominal wall defect was repaired with Marlex mesh. The advantage of using prosthetic mesh in both primary and recurrent spigelian hernia is supported by recent clinical research data indicating a generalized collagen metabolism disorder in patients with primary and recurrent hernia. Mesh repair allows for tension-free anatomic restoration of distorted tissues associated with repair failures. PMID:12641349

  13. Obturator hernia of the fallopian tube.

    PubMed

    Karasaki, Takahiro; Nakagawa, Tassei; Tanaka, Nobutaka

    2013-06-01

    Obturator hernia of the fallopian tube is extremely rare. Multidetector computed tomography of a 43-year-old nulliparous woman with sudden onset lower right abdominal pain showed a low-density mass in the right obturator canal suspected of being an obturator hernia of the uterine adnexa. She was diagnosed as having an incarcerated obturator hernia of the fallopian tube at operation and treated with prosthetic mesh. Obturator hernia of the fallopian tube is very rare, and all cases reported in the literature were localized on the right side, perhaps due to the lesser mobility of the left than the right fallopian tube. PMID:22990633

  14. Hybrid Approaches for Complex Parastomal Hernia Repair.

    PubMed

    Zhang, Heng; Xie, Jia-Ming; Miao, Jian-Qing; Wu, Hao-Rong

    2016-01-01

    Parastomal hernia is one of the major complications of colostomy with high occurrence. From October 2011 to November 2014, a retrospective study was conducted by analyzing and following up data of 16 patients suffering from parastomal hernia who underwent a hybrid technique repair. The safety and efficacy of the hybrid technique for parastomal hernia repair was investigated in terms of complications. All cases were operated successfully and had no major immediate postoperative complications other than mild abdominal pain in 5 cases. No long-term postoperative complications were reported in the follow-up. The authors found hybrid technique to be safe and effective for parastomal hernia repair with fewer complications. PMID:26787038

  15. Massive hiatus hernia complicated by jaundice

    PubMed Central

    Furtado, Ruelan V.; D'Netto, Trevor J.; Hook, Henry C.; Falk, Gregory L.; Vivian, SarahJayne

    2015-01-01

    Giant para-oesophageal hernia may include pancreas with pancreatic complication and rarely jaundice. Repair is feasible and durable by laparoscopy. Magnetic resonance cholangiopancreatography is diagnostic. PMID:26246452

  16. Current options in umbilical hernia repair in adult patients

    PubMed Central

    Kulaçoğlu, Hakan

    2015-01-01

    Umbilical hernia is a rather common surgical problem. Elective repair after diagnosis is advised. Suture repairs have high recurrence rates; therefore, mesh reinforcement is recommended. Mesh can be placed through either an open or laparoscopic approach with good clinical results. Standard polypropylene mesh is suitable for the open onlay technique; however, composite meshes are required for laparoscopic repairs. Large seromas and surgical site infection are rather common complications that may result in recurrence. Obesity, ascites, and excessive weight gain following repair are obviously potential risk factors. Moreover, smoking may create a risk for recurrence. PMID:26504420

  17. Minimally invasive surgical technique integrating multiple procedures with large specimen extraction via inguinal hernia orifice

    PubMed Central

    Mani, Vishnu R.; Ahmed, Leaque

    2015-01-01

    While laparoscopic surgery can be performed using small skin incisions, any resected specimen must still be able to fit through these opening. For procedures, such as cholecystectomies and appendectomies, this is not usually a problem; however, for large specimens such as bowel or large tumors, this becomes problematic. Currently, the standard technique is to attempt piecemeal removal of the specimen or enlarge one of the laparoscopic incisions, effectively creating a mini laparotomy. Creating a larger incision adds many of the drawbacks of open laparotomy and should be avoided whenever possible. In this article, we present a new technique of combining the repair of an inguinal hernia, umbilical hernia with a duodenal tumor resection in order to extract the specimen through the inguinal hernia orifice. PMID:26703927

  18. Laparoscopic treatment of acute small bowel obstruction due to left paraduodenal hernia: A case report and literature review

    PubMed Central

    Zizzo, Maurizio; Smerieri, Nazareno; Barbieri, Italo; Lanaia, Andrea; Bonilauri, Stefano

    2016-01-01

    Introduction Internal hernia is a pathological condition resulting from abnormal protrusion of abdominal viscera through an opening in the intraperitoneal recesses of the abdominal cavity. Small bowel obstruction due to internal hernia is not common (0.25–0.9% of cases). The most common group is that of paraduodenal hernias (53%), of which the left-sided one is the most common type (75%). Presentation of case We report a case of a 43 year-old man with a history of recurrent abdominal pain, who was hospitalized because of an episode of acute small bowel obstruction. He had no previous surgery. Computed tomography revealed an encapsulated circumscribed cluster of jejunal loops in the left upper quadrant, near the ligament of Treitz, and the hernia orifice was adjacent to the left side of the inferior mesenteric vessels. Emergency laparoscopic surgery was performed: the small bowel was found completely herniated under the inferior mesenteric vessels. It was gradually reduced and the hernia space was closed with a running suture. The patient was discharged on the fourth day without complications. Conclusion Left paraduodenal hernia is a rare cause of small bowel obstruction that should be taken into account in a patient with a history of recurrent abdominal pain or intestinal obstruction, and no previous surgery. Computed tomography is the standard for a correct diagnosis. Surgery is treatment of choice, because it reduces the risk of emergency and complications associated to hernia. Laparoscopic approach is feasible and effective, also in emergency situation. PMID:26826933

  19. The effect of incisional negative pressure therapy on wound complications after acetabular fracture surgery.

    PubMed

    Reddix, Robert N; Leng, Xiaoyan Iris'; Woodall, James; Jackson, Benjamin; Dedmond, Barnaby; Webb, Lawrence X

    2010-01-01

    The purpose of the study was to determine if the use of incisional negative pressure therapy affected the rate of wound complications after acetabular fracture surgery. Between August 1996 to April 2005, 301 patients were found to have had an operatively treated acetabular fracture. There were 235 patients who had placement of incisional vacuum-assisted closure (VAC) who had three (1.27%) deep wound infections and one (0.426%) wound dehiscence. There were 66 consecutive patients who were available in the 5 years preceding the usage of the incisional VAC who had four (6.06%) deep wound infections and two (3.03%) wound dehiscences. This is less than the published infection rate of 4% for patients undergoing operative treatment of acetabular fractures and less than the authors' rate of 6.15% in the time period before the use of the incisional negative pressure wound therapy (p=.0414). The use of incisional negative pressure wound therapy significantly decreases perioperative wound complications after acetabular fracture surgery. PMID:20727304

  20. Comparison of two antimicrobial regimens on the prevalence of incisional infections after colic surgery.

    PubMed

    Durward-Akhurst, S A; Mair, T S; Boston, R; Dunkel, B

    2013-03-16

    Appropriate durations of perioperative antimicrobial therapy following exploratory coeliotomy in horses are controversial, and with the rising prevalence of multiresistant bacteria there is a strong incentive to use antimicrobials for the shortest time possible. Following exploratory coeliotomies, incisional infections are an important cause of morbidity in horses and could be influenced by the duration of systemic antimicrobial therapy. The aim of this study was to investigate whether 72 hours of perioperative antimicrobial therapy is as effective as 120 hours at preventing the development of postoperative incisional infections. Horses undergoing exploratory coeliotomy at two referral hospitals were assigned randomly into Group 1 (receiving 72 hours of perioperative antimicrobial therapy) and Group 2 (receiving 120 hours of perioperative antimicrobial therapy). Only horses recovering from surgery and surviving for >120 hours were included in the study. Ninety-two horses met the criteria for inclusion in the study, 42 in Group 1 and 50 in Group 2. The overall incisional complication rate was 42.2 per cent, and no significant difference in the number of incisional complications in the two groups was identified. Results of the study suggest that there is no benefit in using 120 hours over 72 hours of perioperative antimicrobial therapy to prevent incisional infections. PMID:23268187

  1. Obturator hernia: A diagnostic challenge

    PubMed Central

    Tokushima, Midori; Aihara, Hidetoshi; Tago, Masaki; Tomonaga, Motosuke; Sakanishi, Yuta; Yoshioka, Tsuneaki; Hyakutake, Masaki; Kyoraku, Itaru; Sugioka, Takashi; Yamashita, Shu-ichi

    2014-01-01

    Patient: Female, 90 Final Diagnosis: Obturator hernia Symptoms: Epigastric pain • vomiting Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Challenging differential diagnosis Background: Obturator hernia (OH) can be difficult to diagnose because it shows only nonspecific signs and symptoms. Although pain in a lower limb caused by compression of the obturator nerve by the hernia in the obturator canal (Howship-Romberg sign) is a characteristic sign, its presence is rather rare. Case Report: We herein describe the case of a 90-year-old woman with an OH that was difficult to diagnose because of her slight abdominal signs and symptoms on admission and subtle abdominal computed tomography (CT) findings. Although the CT images revealed the presence of an OH, this finding was overlooked because it contained only a part of the small intestine wall, which is called the Richter type. Fortunately, her condition improved dramatically with only conservative treatment. Conclusions: Although early diagnosis is essential to reduce morbidity and mortality, OH can be a diagnostic challenge even with abdominal CT. PMID:25006359

  2. Laparoscopic repair of paraesophageal hernia.

    PubMed Central

    Willekes, C L; Edoga, J K; Frezza, E E

    1997-01-01

    OBJECTIVE: The purpose of this report is to describe the authors' technique for the laparoscopic repair of paraesophageal hernias and the outcome in their series of patients. METHODS: Thirty patients underwent elective laparoscopic repair of paraesophageal hernias. All were pure type II paraesophageal hernias as defined by upper gastrointestinal contrast studies. All operations were performed by a single surgeon (JKE) assisted by five different chief surgical residents. The authors have used various prototypes of a laparoscopic utility belt to reduce the physician requirement to the surgeon and a first assistant. The operative setup and specific techniques of the repair are described and illustrated. A concomitant anti-reflux procedure was performed in the last 23 patients. RESULTS: Satisfactory repair using video-laparoscopic techniques was achieved in all cases. There were no deaths. Complications occurred in 8 of 30 patients. Postoperative gastroesophageal reflux developed in three of the first seven patients in whom fundoplication was not performed. Three consecutive patients had left lower lobe atelectasis believed to be related to endotracheal tube displacement during the passage of the bougie. One patient had postoperative dysphagia. There was one case of major deep venous thrombosis with pulmonary embolism. Twenty-eight of 30 patients were discharged home by postoperative day 3. Twenty-four of 30 patients had returned to normal activity by the time of their first postoperative office visit 1 week after surgery. Images Figure 9. Figure 10. PMID:8998118

  3. 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

  4. 21 CFR 876.5970 - Hernia support.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hernia support. 876.5970 Section 876.5970 Food and Drugs 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...

  5. [Neonatal occlusion due to a lumbar hernia].

    PubMed

    Hunald, F A; Ravololoniaina, T; Rajaonarivony, M F V; Rakotovao, M; Andriamanarivo, M L; Rakoto-Ratsimba, H

    2011-10-01

    A Petit lumbar hernia is an uncommon hernia. Congenital forms are seen in children. Incarceration may occur as an unreducible lumbar mass, associated with bilious vomiting and abdominal distention. Abdominal X-ray shows sided-wall bowel gas. In this case, reduction and primary closure must be performed as emergency repair. PMID:21868206

  6. 21 CFR 876.5970 - Hernia support.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hernia support. 876.5970 Section 876.5970 Food and Drugs 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...

  7. Periappendicular Abscess Presenting within an Inguinal Hernia

    PubMed Central

    Loberant, Norman; Bickel, Amitai

    2015-01-01

    The presence of the appendix within an inguinal hernia is a rare finding. We present the case of an elderly woman who developed appendicitis within an inguinal hernia, complicated by a supervening periappendicular abscess. She was successfully treated with a combination of antibiotics and percutaneous drainage. PMID:26605128

  8. Liver scan in traumatic right hemidiaphragmatic hernia

    SciTech Connect

    Suzuki, Y.

    1985-01-01

    Liver imaging was performed in two patients with traumatic right hemidiaphragmatic hernia. It has elucidated the cause of obliteration of the right hemidiaphragmatic shadow on the chest x-ray. These cases are illustrative of the usefulness of liver imaging in the diagnosis of traumatic right hemidiaphragmatic hernia as well as hepatic injury.

  9. Morgagni hernia: A rare case report and review of literature.

    PubMed

    Pattnaik, Manoj Kumar; Sahoo, Sarada Prasanna; Panigrahy, Sameer Kumar; Nayak, Kalyani Bala

    2016-01-01

    Morgagni hernias (MHs) are rare and constitute about 2% of all diaphragmatic hernias. Although uncommon, it has potential for considerable morbidity if the diagnosis is missed. An elderly woman with known history of chronic asthma and constipation presented to us with vague right-sided chest pain. General physical examination was unremarkable and coincidentally diagnosed to have diabetes mellitus. Chest roentgenogram posteroanterior view revealed a right paracardiac opacity and right lateral view showed the opacity in the peridiaphragmatic area of anterior mediastinum. Computed tomographic scan of the chest and abdomen revealed a right-sided MH containing omental fat. Standard right posterolateral thoracotomy was done, and there was a rent at the medial end of the xiphoid process with hernia sac containing the omentum, which was compressing adjacent lungs and heart. The sac was opened; redundant omentum was resected, and rent closed with intercostal muscle with prolene. MH being rare must be addressed with appropriate investigation to prevent unnecessary morbidity and mortality. PMID:27578938

  10. Morgagni hernia: A rare case report and review of literature

    PubMed Central

    Pattnaik, Manoj Kumar; Sahoo, Sarada Prasanna; Panigrahy, Sameer Kumar; Nayak, Kalyani Bala

    2016-01-01

    Morgagni hernias (MHs) are rare and constitute about 2% of all diaphragmatic hernias. Although uncommon, it has potential for considerable morbidity if the diagnosis is missed. An elderly woman with known history of chronic asthma and constipation presented to us with vague right-sided chest pain. General physical examination was unremarkable and coincidentally diagnosed to have diabetes mellitus. Chest roentgenogram posteroanterior view revealed a right paracardiac opacity and right lateral view showed the opacity in the peridiaphragmatic area of anterior mediastinum. Computed tomographic scan of the chest and abdomen revealed a right-sided MH containing omental fat. Standard right posterolateral thoracotomy was done, and there was a rent at the medial end of the xiphoid process with hernia sac containing the omentum, which was compressing adjacent lungs and heart. The sac was opened; redundant omentum was resected, and rent closed with intercostal muscle with prolene. MH being rare must be addressed with appropriate investigation to prevent unnecessary morbidity and mortality. PMID:27578938

  11. Early clinical outcomes following laparoscopic inguinal hernia repair.

    PubMed

    Tolver, Mette Astrup

    2013-07-01

    Laparoscopic inguinal hernia repair (TAPP) has gained increasing popularity because of less post-operative pain and a shorter duration of convalescence compared with open hernia repair technique (Lichtenstein). However, investigation of duration of convalescence with non-restrictive recommendations, and a procedure-specific characterization of the early clinical outcomes after TAPP was lacking. Furthermore, optimization of the post-operative period with fibrin sealant versus tacks for fixation of mesh, and the glucocorticoid dexamethasone versus placebo needed to be investigated in randomized clinical trials. The objective of this PhD thesis was to characterize the early clinical outcomes after TAPP and optimize the post-operative period. The four studies included in this thesis have investigated duration of convalescence and procedure-specific post-operative pain and other early clinical outcomes after TAPP. Furthermore, it has been shown that fibrin sealant can improve the early post-operative period compared with tacks, while dexamethasone showed no advantages apart from reduced use of antiemetics compared with placebo. Based on these findings, and the existing knowledge, 3-5 days of convalescence should be expected when 1 day of convalescence is recommended and future studies should focus on reducing intraabdominal pain after TAPP. Fibrin sealant can optimize the early clinical outcomes but the risk of hernia recurrence and chronic pain needs to be evaluated. Dexamethasone should be investigated in higher doses. PMID:23809977

  12. Current trends in laparoscopic groin hernia repair: A review.

    PubMed

    Pahwa, Harvinder Singh; Kumar, Awanish; Agarwal, Prerit; Agarwal, Akshay Anand

    2015-09-16

    Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques of repair have also evolved. A PubMed and COCHRANE database search was accomplished in this regard to establish the current status of laparoscopic inguinal hernia repair in view of recent published literature. Published literature support that laparoscopic hernia repair is best suited for recurrent and bilateral inguinal hernia although it may be offered for primary inguinal hernia if expertise is available. PMID:26380826

  13. Current trends in laparoscopic groin hernia repair: A review

    PubMed Central

    Pahwa, Harvinder Singh; Kumar, Awanish; Agarwal, Prerit; Agarwal, Akshay Anand

    2015-01-01

    Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques of repair have also evolved. A PubMed and COCHRANE database search was accomplished in this regard to establish the current status of laparoscopic inguinal hernia repair in view of recent published literature. Published literature support that laparoscopic hernia repair is best suited for recurrent and bilateral inguinal hernia although it may be offered for primary inguinal hernia if expertise is available. PMID:26380826

  14. First Case Report of Acute Renal Failure After Mesh-Plug Inguinal Hernia Repair in a Kidney Transplant Recipient

    PubMed Central

    Veroux, Massimiliano; Ardita, Vincenzo; Zerbo, Domenico; Caglià, Pietro; Palmucci, Stefano; Sinagra, Nunziata; Giaquinta, Alessia; Veroux, Pierfrancesco

    2016-01-01

    Abstract Acute renal failure due to ureter compression after a mesh-plug inguinal repair in a kidney transplant recipient has not been previously reported to our knowledge. A 62-year-old man, who successfully underwent kidney transplantation from a deceased donor 6 years earlier, was admitted for elective repair of a direct inguinal hernia. The patient underwent an open mesh-plug repair of the inguinal hernia with placement of a plug in the preperitoneal space. We did not observe the transplanted ureter and bladder during dissection of the inguinal canal. Immediately after surgery, the patient became anuric, and a graft sonography demonstrated massive hydronephrosis. The serum creatinine level increased rapidly, and the patient underwent an emergency reoperation 8 hours later. During surgery, we did not identify the ureter but, immediately after plug removal, urine output increased progressively. We completed the hernia repair using the standard technique, without plug interposition, and the postoperative course was uneventful with complete resolution of graft dysfunction 3 days later. Furthermore, we reviewed the clinical features of complications related to inguinal hernia surgery. An increased risk of urological complications was reported recently in patients with a previous prosthetic hernia repair undergoing kidney transplantation, mainly due to the mesh adhesion to surrounding structures, making the extraperitoneal dissection during the transplant surgery very challenging. Moreover, older male kidney transplant recipients undergoing an inguinal hernia repair may be at higher risk of graft dysfunction due to inguinal herniation of a transplanted ureter. Mesh-plug inguinal hernia repair is a safe surgical technique, but this unique case suggests that kidney transplant recipients with inguinal hernia may be at higher risk of serious urological complications. Surgeons must be aware of the graft and ureter position before proceeding with hernia repair. A prompt

  15. 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

  16. 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

  17. ULTRAPRO Hernia System versus lichtenstein repair in treatment of primary inguinal hernias: a prospective randomized controlled study.

    PubMed

    Karateke, Faruk; Ozyazici, Sefa; Menekse, Ebru; Özdogan, Hatice; Kunt, Mevlüt; Bozkurt, Hilmi; Bali, İlhan; Özdogan, Mehmet

    2014-01-01

    The Lichtenstein repair has been recommended as the gold standard for inguinal hernia repair. However, postoperative discomfort still constitutes a concern and an area for improvement. New mesh materials have been continuously introduced to achieve this goal. The goal of the present study was to investigate the outcomes of ULTRAPRO Hernia System (UHS) compared with Lichtenstein mesh repair. A total of 99 male patients with primary unilateral inguinal hernia were included in the study during the period of September 2010-January 2012. Patients with body mass index>30, comorbid diseases, and anesthetic risk of ASA-III and ASA-IV were excluded. The patients were randomly allocated to operation with the Lichtenstein technique (group L) or UHS. Demographics, operative and postoperative/recovery data, and short- and medium-term outcomes of the patients were recorded. A total of 50 patients in group L and 49 patients in group UHS were analyzed. The median follow-up time for the study was 33 months. There were no significant differences regarding demographics, complications, and rehabilitation between the groups. Overall, there was a prolonged operation time in the UHS group compared with the L group (UHS: 53.7±5.7 minutes; L: 44.5±5.5 minutes; P<0.001). UHS may provide results similar to those for the Lichtenstein technique in open repair of inguinal hernias regarding perioperative course, complications, recovery, and recurrence rates. However, because of reduced costs and the lack of need for the exploration of the preperitoneal space, we conclude that the Lichtenstein technique should be recommended as the first choice. PMID:25058771

  18. Parastomal Hernia Repair and Reinforcement: The Role of Biologic and Synthetic Materials

    PubMed Central

    Gillern, Suzanne; Bleier, Joshua I. S.

    2014-01-01

    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

  19. Sportsman's hernia? An ambiguous term.

    PubMed

    Dimitrakopoulou, Alexandra; Schilders, Ernest

    2016-04-01

    Groin pain is common in athletes. Yet, there is disagreement on aetiology, pathomechanics and terminology. A plethora of terms have been employed to explain inguinal-related groin pain in athletes. Recently, at the British Hernia Society in Manchester 2012, a consensus was reached to use the term inguinal disruption based on the pathophysiology while lately the Doha agreement in 2014 defined it as inguinal-related groin pain, a clinically based taxonomy. This review article emphasizes the anatomy, pathogenesis, standard clinical assessment and imaging, and highlights the treatment options for inguinal disruption. PMID:27026822

  20. The role of hiatus hernia in GERD.

    PubMed Central

    Kahrilas, P. J.

    1999-01-01

    Increased esophageal acid exposure in gastroesophageal reflux disease has several potential causes, some related primarily to physiological dysfunction of the LES and others related to anatomic distortion of the gastroesophageal junction as occurs with hiatus hernia. One attractive feature of implicating hiatal hernias in the pathogenesis of reflux disease is that, like reflux disease, axial hernias become more common with age and obesity. However, the importance of hiatus hernia is obscured by imprecise definition and an all-or-none conceptualization that has led to wide variation in estimates of prevalence among normal or diseased populations. There are at least three potentially significant radiographic features of a hiatus hernia: axial length during distention, axial length at rest, and competence of the diaphragmatic hiatus. Although any or all of these features may be abnormal in a particular instance of hiatus hernia, each is of different functional significance. Grouping all abnormalities of the gastroesophageal junction as "hiatus hernia" without detailing the specifics of each case defies logic. Mechanistically, the gastroesophageal junction must protect against reflux both in static and dynamic conditions. During abrupt increases in intra-abdominal pressure, the crural diaphragm normally serves as a "second sphincter," and this mechanism is substantially impaired in individuals with a gaping hiatus. Large, non-reducing hernias also impair the process of esophageal emptying, thereby prolonging acid clearance time following a reflux event (especially while in the supine posture). These anatomically-determined functional impairments of the gastroesophageal junction lead to increased esophageal acid exposure. Thus, although hiatus hernia may or may not be an initiating factor at the inception of reflux disease, it clearly can act as a sustaining factor accounting for the frequently observed chronicity of the disease. PMID:10780571

  1. Advances in prenatal diagnosis and treatment of congenital diaphragmatic hernia.

    PubMed

    Shue, Eveline H; Miniati, Doug; Lee, Hanmin

    2012-06-01

    Congenital diaphragmatic hernia (CDH) is a common birth anomaly. Absence or presence of liver herniation and determination of lung-to-head ratio are the most accurate predictors of prognosis for fetuses with CDH. Though open fetal CDH repair has been abandoned, fetal endoscopic balloon tracheal occlusion promotes lung growth in fetuses with severe CDH. Although significant improvements in lung function have not yet been shown in humans, reversible or dynamic tracheal occlusion is promising for select fetuses with severe CDH. This article reviews advances in prenatal diagnosis of CDH, the experimental basis for tracheal occlusion, and its translation into human clinical trials. PMID:22682380

  2. De Garengeot hernia: a forgotten rare entity?

    PubMed Central

    Madiha, Ahmedi; Rares, Hard; Abdus, Samee

    2014-01-01

    We report the case of a 79-year-old woman who presented with an increasingly painful lump in her right groin for 24 h. An incidental femoral hernia was detected on her CT scan nearly 8 months ago while investigating her medical conditions. However, its management was deferred on account of ongoing medical illness. Exploration of the lump revealed a gangrenous appendix strangulated within the femoral canal (de Garengeot hernia). The hernia was repaired primarily after appendicectomy. The patient was discharged after making an uneventful recovery. PMID:24722706

  3. Laparoscopic total extraperitoneal repair of lumbar hernia

    PubMed Central

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

    2011-01-01

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

  4. [Pubic osteotomy in obturator gliding hernia].

    PubMed

    Fritz, T; Teklote, J; Kraus, T

    1997-12-01

    Hernias of the obturator foramen are rare. They are described mostly in elderly female patients in poor health. Often the correct diagnosis is stumbled upon as a result of surprising intraoperative findings. Surgical therapy is indicated often by the clinical symptoms of an incarcerated hernia. Herniation of the entire urinary bladder with hemorrhagic infarction has never been described before. For an anatomical reduction of the hernia it was necessary to resect the superior pubic ramus. For plastic reconstruction a marlex mesh was used. PMID:9483360

  5. Symptomatic Morgagni Hernia Misdiagnosed As Chilaiditi Syndrome

    PubMed Central

    Vallee, Phyllis A.

    2011-01-01

    Chilaiditi syndrome, symptomatic interposition of bowel beneath the right hemidiaphragm, is uncommon and usually managed without surgery. Morgagni hernia is an uncommon diaphragmatic hernia that generally requires surgery. In this case a patient with a longstanding diagnosis of bowel interposition (Chilaiditi sign) presented with presumed Chilaiditi syndrome. Abdominal computed tomography was performed and revealed no bowel interposition; instead, a Morgagni hernia was found and surgically repaired. Review of the literature did not reveal similar misdiagnosis or recommendations for advanced imaging in patients with Chilaiditi sign or syndrome to confirm the diagnosis or rule out other potential diagnoses. PMID:21691487

  6. [Anatomy and mechanism of inguinal hernias].

    PubMed

    Flament, J B; Avisse, C; Delattre, J F

    1997-02-01

    Anterior abdominal wall presents a weak point between the pelvic bone and the muscular arch of transverse and internal oblique muscles. This myo-pectineal orifice, crossed by the inguinal ligament is closed by the transversalis fascia. All groin hernias, inguinal directs, indirects or femoral, result from a defect of the transversalis fascia. They have two causes. Congenital hernias result from a persisting peritoneo-vaginal canal. Acquired hernias result from a progressive weakening of the transversalis fascia depending on connective tissue insufficiency and increase of intra-abdominal pressure. PMID:9122597

  7. 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

  8. 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

  9. Genetics Home Reference: congenital diaphragmatic hernia

    MedlinePlus

    ... Center: Congenital Diaphragmatic Hernia University of Michigan Health System These resources from MedlinePlus offer information about the diagnosis and management of various health conditions: Diagnostic Tests Drug Therapy ...

  10. Large Hiatal Hernia Compressing the Heart.

    PubMed

    Matar, Andrew; Mroue, Jad; Camporesi, Enrico; Mangar, Devanand; Albrink, Michael

    2016-02-01

    We describe a 41-year-old man with De Mosier's syndrome who presented with exercise intolerance and dyspnea on exertion caused by a giant hiatal hernia compressing the heart with relief by surgical treatment. PMID:26704030