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Sample records for hiatal hernia subjects

  1. Hiatal hernia

    MedlinePlus

    ... discomfort are due to the upward flow of stomach acid, air, or bile. ... prevent complications. Treatments may include: Medicines to control stomach acid Surgery to repair the hiatal hernia and prevent ...

  2. Hiatal hernia repair - slideshow

    MedlinePlus

    ... presentations/100028.htm Hiatal hernia repair - series—Normal anatomy To use the sharing features on ... Overview The esophagus runs through the diaphragm to the stomach. It functions to carry food from the mouth ...

  3. Laparoscopic hernioplasty of hiatal hernia

    PubMed Central

    Yang, Xuefei; Hua, Rong; He, Kai; Shen, Qiwei

    2016-01-01

    Laparoscopic surgery is a good choice for surgical treatment of hiatal hernia because of its mini-invasive nature and intraperitoneal view and operating angle. This article will talk about the surgical procedures, technical details, precautions and complications about laparoscopic hernioplasty of hiatal hernia. PMID:27761447

  4. [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.

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

    PubMed

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

    2014-01-01

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

  6. Hiatal hernia on thoracic computed tomography in pulmonary fibrosis.

    PubMed

    Tossier, Céline; Dupin, Clairelyne; Plantier, Laurent; Leger, Julie; Flament, Thomas; Favelle, Olivier; Lecomte, Thierry; Diot, Patrice; Marchand-Adam, Sylvain

    2016-09-01

    Gastro-oesophageal reflux has long been suspected of implication in the genesis and progression of idiopathic pulmonary fibrosis (IPF). We hypothesised that hiatal hernia may be more frequent in IPF than in other interstitial lung disease (ILD), and that hiatal hernia may be associated with more severe clinical characteristics in IPF.We retrospectively compared the prevalence of hiatal hernia on computed tomographic (CT) scans in 79 patients with IPF and 103 patients with other ILD (17 scleroderma, 54 other connective tissue diseases and 32 chronic hypersensitivity pneumonitis). In the IPF group, we compared the clinical, biological, functional, CT scan characteristics and mortality of patients with hiatal hernia (n=42) and without hiatal hernia (n=37).The prevalence of hiatal hernia on CT scan at IPF diagnosis was 53%, similar to ILD associated with scleroderma, but significantly higher than in the two other ILD groups. The size of the hiatal hernia was not linked to either fibrosis CT scan scores, or reduction in lung function in any group. Mortality from respiratory causes was significantly higher among IPF patients with hiatal hernia than among those without hiatal hernia (p=0.009).Hiatal hernia might have a specific role in IPF genesis, possibly due to pathological gastro-oesophageal reflux.

  7. Hiatal Hernia as a Total Gastrectomy Complication.

    PubMed

    Santos, Bruna do Nascimento; de Oliveira, Marcos Belotto; Peixoto, Renata D'Alpino

    2016-01-01

    According to the Brazilian National Institute of Cancer, gastric cancer is the third leading cause of death among men and the fifth among women in Brazil. Surgical resection is the only potentially curative treatment. The most serious complications associated with surgery are fistulas and dehiscence of the jejunal-esophageal anastomosis. Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy. A 76-year-old man was diagnosed with intestinal-type gastric adenocarcinoma. He underwent a total laparoscopic-assisted gastrectomy and D2 lymphadenectomy on May 19, 2015. The pathology revealed a pT4pN3 gastric adenocarcinoma. The patient became clinically stable and was discharged 10 days after surgery. He was subsequently started on adjuvant FOLFOX chemotherapy; however, 9 days after the second cycle, he was brought to the emergency room with nausea and severe epigastric pain. A CT scan revealed a hiatal hernia with signs of strangulation. The patient underwent emergent repair of the hernia and suffered no postoperative complications. He was discharged from the hospital 9 days after surgery. Hiatal hernia is not well documented, and its occurrence in the context of gastrectomy is an infrequent complication.

  8. Hiatal hernia squeezing the heart to flutter.

    PubMed

    Patel, Arpan; Shah, Rushikesh; Nadavaram, Sravanthi; Aggarwal, Aakash

    2014-04-01

    An 80-year-old woman presented to the emergency department with failure to thrive and weakness for 14 days. Medical history was significant for polio. On admission her electrocardiogram showed atrial flutter, and cardiac enzymes were elevated. Echocardiogram revealed a high pulmonary artery pressure, but no other wall motion abnormalities or valvulopathies. Chest x-ray showed a large lucency likely representing a diaphragmatic hernia. Computed tomographic scan confirmed the hernia. Our patient remained in atrial flutter despite rate control, and thereafter surgery was consulted to evaluate the patient. She underwent hernia repair. After surgery, the patient was taken off rate control and monitored for 72 hours; she did not have any episode of atrial flutter and was discharged with follow up in a week showing no arrhythmia. Her flutter was caused directly by the mechanical effect of the large hiatal hernia pressing against her heart, as the flutter resolved after the operation.

  9. Hiatal hernia in a harbor seal (Phoca vitulina) pup.

    PubMed

    Biancani, Barbara; Field, Cara L; Dennison, Sophie; Pulver, Robert; Tuttle, Allison D

    2012-06-01

    A 2-wk-old stranded harbor seal (Phoca vitulina) rescued by Mystic Aquarium showed signs of the presence of a hiatal hernia during rehabilitation. Contrast radiographs of esophagus and stomach revealed an intrathoracic radiodensity that contains filling defects typical of stomach, consistent with gastric rugal folds. Mural thickening was observed at the level of the cardia consistent with a diagnosis of a hiatal hernia. Although clinical improvement was noted with medical therapy and tube feeding, surgical correction of the hiatal hernia was considered necessary for full resolution. However, owing to the animal's low body weight, the corrective hernia surgery was postponed until the body condition improved. The seal needed to be surgically treated for a corneal ulcer, and while anesthetized with isoflurane, the seal became dyspneic and developed cardiac arrhythmias; ultimately cardiac arrest ensued. Resuscitation was unsuccessfully attempted and the seal was euthanized. Necropsy confirmed the radiographic diagnosis and further characterized a paraesophageal hiatal hernia.

  10. Association between Increased Gastric Juice Acidity and Sliding Hiatal Hernia Development in Humans

    PubMed Central

    Kishikawa, Hiroshi; Kimura, Kayoko; Ito, Asako; Arahata, Kyoko; Takarabe, Sakiko; Kaida, Shogo; Kanai, Takanori; Miura, Soichiro; Nishida, Jiro

    2017-01-01

    Objectives Several clinical factors; overweight, male gender and increasing age, have been implicated as the etiology of hiatal hernia. Esophageal shortening due to acid perfusion in the lower esophagus has been suggested as the etiological mechanism. However, little is known about the correlation between gastric acidity and sliding hiatus hernia formation. This study examined whether increased gastric acid secretion is associated with an endoscopic diagnosis of hiatal hernia. Methods A total of 286 consecutive asymptomatic patients (64 were diagnosed as having a hiatal hernia) who underwent upper gastrointestinal endoscopy were studied. Clinical findings including fasting gastric juice pH as an indicator of acid secretion, age, sex, body mass index, and Helicobacter pylori infection status determined by both Helicobacter pylori serology and pepsinogen status, were evaluated to identify predictors in subjects with hiatal hernia. Results Male gender, obesity with a body mass index >25, and fasting gastric juice pH were significantly different between subjects with and without hiatal hernia. The cut-off point of fasting gastric juice pH determined by receiver operating curve analysis was 2.1. Multivariate regression analyses using these variables, and age, which is known to be associated with hiatal hernia, revealed that increased gastric acid secretion with fasting gastric juice pH <2.1 (OR = 2.60, 95% CI: 1.38–4.90) was independently associated with hiatal hernia. Moreover, previously reported risk factors including male gender (OR = 2.32, 95% CI: 1.23–4.35), body mass index >25 (OR = 3.49, 95% CI: 1.77–6.91) and age >65 years (OR = 1.86, 95% CI: 1.00–3.45), were also significantly associated with hiatal hernia. Conclusions This study suggests that increased gastric acid secretion independently induces the development of hiatal hernia in humans. These results are in accordance with the previously reported hypothesis that high gastric acid itself induces

  11. The History of Hiatal Hernia Surgery

    PubMed Central

    Stylopoulos, Nicholas; Rattner, David W.

    2005-01-01

    Objective: This review addresses the historical evolution of hiatal hernia (HH) repair and reports in a chronological fashion the major milestones in HH surgery before the laparoscopic era. Methods: The medical literature and the collections of the History of Medicine Division of the National Library of Medicine were searched. Secondary references from all sources were studied. The senior author's experience and personal communications are also reported. Results: The first report of HH was published in 1853 by Bowditch. Rokitansky in 1855 demonstrated that esophagitis was due to gastroesophageal reflux, and Hirsch in 1900 diagnosed an HH using x-rays. Eppinger diagnosed an HH in a live patient, and Friedenwald and Feldman related the symptoms to the presence of an HH. In 1926, Akerlund proposed the term hiatus hernia and classified HH into the 3 types that we use today. The first elective surgical repair was reported in 1919 by Soresi. The physiologic link between HH and gastroesophageal reflux was made at the second half of the 20th century by Allison and Barrett. In the midst of a physiologic revolution, Nissen and Belsey developed their famous operations. In 1957, Collis published his innovative operation. Thal described his technique in 1965, and in 1967, Hill published his procedure. Many modifications of these procedures were published by Pearson and Henderson, Orringer and Sloan, Rossetti, Dor, and Toupet. Donahue and Demeester significantly improved Nissen's operation, and they were the first to truly understand its physiologic mechanism. Conclusion: Hiatal hernia surgery has evolved from anatomic repair to physiological restoration. PMID:15622007

  12. Laparoscopic Hiatal Hernia Repair in 221 Patients: Outcomes and Experience

    PubMed Central

    Thackeray, Lisa

    2016-01-01

    Background and Objectives: Hiatal hernia is a common condition often associated with symptomatic gastroesophageal reflux disease (GERD). The objectives of this study were to examine the efficacy and safety of laparoscopic hiatal hernia repair (LHHR) with biologic mesh to reduce and/or alleviate GERD symptoms and associated hiatal hernia recurrence. Methods: We retrospectively reviewed consecutive LHHR procedures with biologic mesh performed by a single surgeon from July 2009 to October 2014. The primary efficacy outcome measures were relief from GERD symptoms, as measured according to the GERD–health-related quality-of-life (GERD-HRQL) scale and hiatal hernia recurrence. A secondary outcome measure was overall safety of the procedure. Results: A total of 221 patients underwent LHHR with biologic mesh during the study period, and pre- and postoperative GERD-HRQL studies were available for 172 of them. At baseline (preoperative), the mean GERD-HRQL score for all procedures was 18.5 ± 14.4. At follow-up (mean, 14.5 ± 11.0 months [range, 2.0–56.0]), the score showed a statistically significant decline to a mean of 4.4 ± 7.5 (P < .0001). To date, 8 patients (3.6%, 8/221) have had a documented anatomic hiatal hernia recurrence. However, a secondary hiatal hernia repair reoperation was necessary in only 1 patient. Most complications were minor (dysphagia, nausea and vomiting). However, there was 1 death caused by a hemorrhage that occurred 1 week after surgery. Conclusions: Laparoscopic hiatal hernia repair using biologic mesh, both with and without a simultaneous bariatric or antireflux procedure, is an efficacious and safe therapeutic option for management of hiatal hernia, prevention of recurrence, and relief of symptomatic GERD. PMID:26884676

  13. Relationship of a hiatal hernia to the function of the body of the esophagus and the gastroesophageal junction

    SciTech Connect

    DeMeester, T.R.; Lafontaine, E.; Joelsson, B.E.; Skinner, D.B.; Ryan, J.W.; O'Sullivan, G.C.; Brunsden, B.S.; Johnson, L.F.

    1981-10-01

    One hundred two patients referred to our Esophageal Function Laboratory without endoscopic evidence of esophagitis were divided into two groups on the basis of the presence of a hiatal hernia on endoscopic examination. Fifty-three patients had a hiatal hernia and 49 did not. Both groups and 30 normal volunteer subjects had esophageal manometry and 24 hour esophageal pH monitoring. The incompetency of the cardia in patients with a hiatal hernia was dependent upon loss of components responsible for the antireflux mechanism, mainly a decrease in distal esophageal sphincter pressure and a decrease in the length of the sphincter exposed to the positive-pressure environment of the abdomen. These deficiencies were not related to the presence of a hiatal hernia and were similar to those of patients with an incompetent cardia without a hiatal hernia. Patients with a hiatal hernia and an incompetent cardia had significantly more esophageal exposure to refluxed acid than without a hiatal hernia. On the basis of the number of reflux episodes that lasted 5 minutes or longer and radioisotope transit studies, this increased acid exposure was due to both a loss of competency of the cardia and poor esophageal clearance secondary to the presence of a hiatal hernia. Reduction of the hernia and anchoring the distal esophagus into the abdomen not only may improve the antireflux mechanism, but corrects the clearance abnormality as well. The presence of a hiatal hernia has a detrimental effect on the clearance function of the body of the esophagus and may aggravate the effects of gastroesophageal reflux due to an incompetent cardia.

  14. Surgical Management of Hiatal Hernia in Children with Asplenia Syndrome.

    PubMed

    Miyake, Hiromu; Fukumoto, Koji; Yamoto, Masaya; Nouso, Hiroshi; Kaneshiro, Masakatsu; Koyama, Mariko; Urushihara, Naoto

    2016-09-08

    Purpose Patients with asplenia syndrome (AS) are likely to have upper gastrointestinal tract malformations such as hiatal hernia. This report discusses the treatment of such conditions. Methods Seventy-five patients with AS underwent initial palliation in our institution between 1997 and 2013. Of these, 10 patients had hiatal hernia. Of the patients with hiatal hernia, 6 had brachyesophagus and 7 had microgastria. Results Of the 10 patients with hiatal hernia, 9 underwent surgery in infancy (7 before Glenn operation, 2 after Glenn operation). Two underwent typical Toupet fundoplication, and the other 7 underwent atypical repair including reduction of the stomach. Two patients with atypical repair showed recurrence of hernia and required reoperation. Three patients required reoperation due to duodenal obstruction. Duodenal obstruction occurred due to preduodenal portal vein or abnormal vessels compressing the duodenum. Obstructive symptoms were not seen in any cases preoperatively. Conclusions In patients with hiatal hernia, typical fundoplication is often difficult because most have concomitant brachyesophagus, microgastria, and hypoplasia of the esophageal hiatus. However, we should at least reduce the stomach to the abdominal cavity as early as possible to increase thoracic cavity volume and allow good feeding. Increasing the volume of the thoracic cavity thus makes Glenn and Fontan circulations more stable. Duodenal obstruction secondary to vascular anomalies is also common, so the anatomy in the area near the duodenum should be evaluated pre- and intraoperatively.

  15. Impact of Bariatric Surgery on Hiatal Hernia Repair Outcomes.

    PubMed

    Sutherland, Victoria; Kuwada, Timothy; Gersin, Keith; Simms, Connie; Stefanidis, Dimitrios

    2016-08-01

    Large hiatal hernias are notorious for their high recurrence rates after conventional repair. Recurrence rates have been described to be higher in obese patients due to increased intra-abdominal pressure. We hypothesized that patients who undergo hiatal hernia repair (HHR) with bariatric surgery (BAR) will have a lower hernia recurrence rate when compared to patients who undergo HHR with fundoplication (FP) due to the decrease in intra-abdominal pressure observed with weight loss. This was an Institutional Review Board approved retrospective review. The outcomes of patients who underwent HHR+BAR as well as patients who had HHR+FP only from 2007 to 2014 were reviewed. Patients who had small hiatal hernias (<2 cm), underwent an anterior repair, or had gastropexy only were excluded. The primary outcome was hernia recurrence and reflux resolution. The outcomes of 58 patients who had HHR+BAR were compared with 30 patients with HHR+FP. Hernia recurrence rate for HHR+BAR was 12 per cent, whereas hernia recurrence rate for HHR+FP was 38 per cent (P < 0.01). Reflux resolution for HHR+FP was 78 per cent, whereas reflux improvement rate for HHR+BAR was 84 per cent (P = n.s.). Combining HHR with BAR leads to a lower hernia recurrence rate when compared to patients who undergo HHR with FP.

  16. Twenty to 40 year follow up of infantile hiatal hernia.

    PubMed Central

    Johnston, B T; Carré, I J; Thomas, P S; Collins, B J

    1995-01-01

    The aim of this study was to assess clinical and radiological findings of gastro-oesophageal reflux in adults who were diagnosed as having a hiatal hernia in infancy or early childhood. One hundred and eighteen patients with a minimum age of 20 who were diagnosed as having a hiatal hernia in childhood were interviewed; barium meal examination was performed in 96 of these cases. Ninety four patients had not required surgery for their hernia. The hiatal hernia persisted in 53% of these patients and 46% experienced heartburn at least monthly but in only three was this severe. Heartburn was significantly more common in patients in whom reflux was seen on barium meal. The consumption of antacids was significantly lower (20% v 46%) in patients who responded well to treatment as children. Eighteen of 24 patients who underwent surgery as children experienced heart-burn monthly but in only one patient was this severe. Two patients underwent endoscopy at their request because of symptoms during this follow up. Both had Barrett's oesophagus. In conclusion, despite the persistence of the hiatal hernia in half of the non-surgically treated patients, few complained of significant symptoms. Effective treatment in childhood was associated with a significant reduction in antacid consumption for heartburn as adults. The finding of Barrett's oesophagus in two patients high-lights a possible role for endoscopic screening in this patient group. Images p810-a PMID:7615264

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

    PubMed

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

    2014-10-01

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

  18. Large hiatal hernia in infancy with right intrathoracic stomach along with left sided morgagni hernia.

    PubMed

    Saeed, Uzma; Mazhar, Naveed; Zameer, Shahla

    2014-11-01

    Congenital diaphragmatic hernia is a very common intrathoracic fetal anomaly with Morgagni hernia typically seen on right side anteriorly and Bochdalek hernia on left side posteriorly, because of the protective effects of liver and heart on either side respectively. Hiatal hernias range from herniation of a small portion of stomach into thoracic cavity to herniation of entire stomach into the left thoracic cavity. Very rarely the herniated stomach has been reported in the right thoracic cavity. Early diagnosis and treatment of all diaphragmatic hernias is essential to reduce the associated morbidity and mortality. We present a very rare and interesting case of an 18 months old baby girl with reverse scenarios. She had a large hiatal hernia with right intrathoracic stomach along with a left sided Morgagni hernia in combination.

  19. Severe Hiatal Hernia as a Cause of Failure to Thrive Discovered by Transthoracic Echocardiogram

    PubMed Central

    Moore, Clint J.; Conley, Devan A.; Berry-Cabán, Cristóbal S.

    2016-01-01

    A newborn infant with failure to thrive presented for murmur evaluation on day of life three due to a harsh 3/6 murmur. During the evaluation, a retrocardiac fluid filled mass was seen by transthoracic echocardiogram. The infant was also found to have a ventricular septal defect and partial anomalous pulmonary venous return. Eventually, a large hiatal hernia was diagnosed on subsequent imaging. The infant ultimately underwent surgical repair of the hiatal hernia at a tertiary care facility. Hiatal hernias have been noted as incidental extracardiac findings in adults, but no previous literature has documented hiatal hernias as incidental findings in the pediatric population. PMID:27895952

  20. [Esophageal manometry in patients with sliding hiatal hernia].

    PubMed

    Ramírez Mata, M; Ixtepan, L; Peña Ancira, F; de Ramírez, A F; Villalobos, J J; Campuzano, M

    1979-01-01

    This presents the method to be followed for the valuation of the gastro-esophagic function in patients with sliding hiatal hernia, twenty-one patients with this diagnosis were studied through X-Rays. Besides gastric and esophagic endoscopy, a complete clinical examinations was made to compare the information obtained from the studies, with the direct measurement of the contractions of the esophagus and the lower sphincter through conventional manometric methods. The relationship between the simptoms and the clinical procedures done in the patients were observed as was the usefulness of esophagic manometry to detect not only the direct pressure of the gastro-esophagic sphincter, but also to determine the concurrent motor changes that can occur in patients which show hiatal hernia. The benefit of this studies to decide the therapeutic handling, specially surgical, is discussed.

  1. 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.

  2. Hiatal hernia repair with the use of biologic meshes: a literature review.

    PubMed

    Antoniou, Stavros A; Pointner, Rudolph; Granderath, Frank A

    2011-02-01

    During the past few years, biologic meshes, primarily evolved for routine and complex cases of abdominal wall reconstruction, have been evaluated in clinical cases and experimental models. Although there is published experience on the use of small intestine submucosa and human cadaveric dermis in hiatal hernia repair with encouraging results, porcine dermal collagen (PDC) matrix has not been subject of study to date in this patient population. A systematic review of the literature was conducted, aiming at evaluating the biomechanical characteristics of cross-linked PDC in comparison to synthetic and biologic meshes. Evidence shows that cross-linked PDC is superior to synthetic meshes in terms of incorporation, adhesion formation, and mesh fibrosis; their biodynamic and biotechnical characteristics do not seem to be superior to other bioprosthetic materials according to current data. The clinical and experimental results of cross-linked PDC implants justify their pilot clinical evaluation in hiatal hernia patients.

  3. Surgical treatment of para-oesophageal hiatal hernia.

    PubMed Central

    Rogers, M. L.; Duffy, J. P.; Beggs, F. D.; Salama, F. D.; Knowles, K. R.; Morgan, W. E.

    2001-01-01

    The development of laparoscopic antireflux surgery has stimulated interest in laparoscopic para-oesophageal hiatal hernia repair. This review of our practice over 10 years using a standard transthoracic technique was undertaken to establish the safety and effectiveness of the open technique to allow comparison. Sixty patients with para-oesophageal hiatal hernia were operated on between 1989 and 1999. There were 38 women and 22 men with a median age of 69.5 years. There were 47 elective and 13 emergency presentations. Operation consisted of a left thoracotomy, hernia reduction and crural repair. An antireflux procedure was added in selected patients. There were no deaths among the elective cases and one among the emergency cases. Median follow-up time was 19 months. There was one recurrence (1.5%). Seven patients (12%) required a single oesophagoscopy and dilatation up to 2 years postoperatively but have been asymptomatic since. Two patients (3%) developed symptomatic reflux which has been well controlled on proton-pump inhibitors. Transthoracic para-oesophageal hernia repair can be safely performed with minimal recurrence. PMID:11777134

  4. Hiatal and paraesophageal hernia repair in pediatric patients.

    PubMed

    Garvey, Erin M; Ostlie, Daniel J

    2017-04-01

    Hiatal and paraesophageal hernia (HH/PEH) can be congenital, resulting from embryologic abnormalities/genetic predisposition, or acquired, most commonly after gastroesophageal surgery such as fundoplication. Minimizing circumferential esophageal dissection at the time of Nissen fundoplication has been shown to decrease the risk of acquired HH/PEH from 36.5% to 12.2%. Gastrointestinal, respiratory, and constitutional symptoms, including anemia and failure to thrive, are common with high rates of associated gastroesophageal reflux. Chest x-ray is often abnormal and upper GI confirms the diagnosis. Treatment is surgical with the goal of reducing the hernia contents, excising the hernia sac, closing the crura, and performing an antireflux procedure. The laparoscopic approach is safe and effective. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. The phrenic ampulla: distal esophagus or potential hiatal hernia?

    PubMed

    Lin, S; Brasseur, J G; Pouderoux, P; Kahrilas, P J

    1995-02-01

    The mechanics of phrenic ampullary emptying were analyzed to determine whether this structure functions in a manner similar to the tubular esophagus or a hiatal hernia. Simultaneous videofluoroscopy and intraluminal manometry of the gastroesophageal junction were done during barium swallows in 18 normal volunteers. Esophageal emptying was studied without any external influences, during abdominal compression with a cuff inflated to 100 mmHg, during a Müller maneuver, and after medication with atropine. The key finding of the study was that ampullary emptying was distinct from esophageal bolus transport in several ways: the propagation velocity of the clearing wave was slower, the maximal contact pressures achieved after luminal closure were lower and unaffected by atropine or outflow obstruction, and ampulary emptying was driven by a hydrostatic pressure difference between the ampulla and stomach rather than by a peristaltic contraction. Increased bolus volume slightly enlarged the ampulla. Taken together, these findings suggest that ampullary emptying occurs, in part, as a result of the restoration of esophageal length (presumably by tension from the phrenoesophageal membrane) rather than as a result of an aborally propagated contraction. As such, a normal phrenic ampulla is analogous to a small reducing hiatal hernia. We speculate that overt hernia formation occurs as a result of progressive degeneration of the phrenoesophageal membrane.

  6. Complete Esophageal Obstruction after Endoscopic Variceal Band Ligation in a Patient with a Sliding Hiatal Hernia

    PubMed Central

    Mansour, Munthir; Abdel-Aziz, Yousef; Awadh, Hesham; Shah, Nihar

    2017-01-01

    Complete esophageal obstruction is a rare complication of endoscopic variceal banding, with only 6 cases in the English literature since the introduction of endoscopic variceal banding in 1986. We report a case of complete esophageal obstruction following esophageal banding due to entrapment of part of a sliding hiatal hernia. To our knowledge, our case is one of few with esophageal obstruction post-banding, and the first associated with a hiatal hernia. We recommend caution when performing esophageal banding on patients with a hiatal hernia. PMID:28144613

  7. Is there a common basis between hiatal hernia and hemorrhoidal disease?

    PubMed

    Sahiner, Zeynep; Uzel, Mehmet; Filik, Levent

    2015-05-01

    In this letter-to-editor, we hypothesize that there is a link between hemorrhoidal disease and hiatal hernia. We underline common risk factors for both and present a cross-sectional patient data. Therefore, we emphasize the necessity of new studies to clarify this coincidence. Clinical benefit of establishment of this link is to delay or prevent development of hiatal hernia as a result of appropriate preventive measures. Accordingly, postoperative period of hiatal hernia operations may also be relieved or recurrence risk may also be decreased with this precautions.

  8. Similar symptom patterns in gastroesophageal reflux patients with and without hiatal hernia.

    PubMed

    Antoniou, S A; Koch, O O; Antoniou, G A; Asche, K U; Kaindlstorfer, A; Granderath, F A; Pointner, R

    2013-07-01

    Gastroesophageal reflux disease is a common clinical entity in Western societies. Its association with hiatal hernia has been well documented; however, the comparative clinical profile of patients in the presence or absence of hiatal hernia remains mostly unknown. The aim of the present study was to delineate and compare symptom, impedance, and manometric patterns of patients with and without hiatal hernia. A cumulative number of 120 patients with reflux disease were enrolled in the study. Quality of life score, demographic, symptom, manometric, and impedance data were prospectively collected. Data comparison was undertaken between patients with and without hiatal hernia. A P-value < 0.05 was considered statistically significant. Patients with hiatal hernia tended to be older than patients without hernia (52.3 vs. 48.6 years, P < 0.05), whereas quality of life scores were slightly better for the former (97.0 vs. 88.2, P= 0.005). Regurgitation occurred more frequently in patients without hiatal hernia (78.3% vs. 93.9%, P < 0.05). Otherwise, no differences were found with regard to esophageal and extraesophageal symptoms. However, lower esophageal sphincter pressures (7.7 vs. 10.0 mmHg, P= 0.007) and more frequent reflux episodes (upright, 170 vs. 134, P= 0.01; supine, 41 vs. 24, P < 0.03) were documented for patients with hiatal hernia on manometric and impedance studies. Distinct functional characteristics in patients with and without hiatal hernia may suggest a tailored therapeutic management for these diverse patient groups.

  9. Laparoscopic repair of large hiatal hernia: impact on dyspnoea.

    PubMed

    Zhu, Jacqui C; Becerril, Guillermo; Marasovic, Katy; Ing, Alvin J; Falk, Gregory L

    2011-11-01

    This study aims to examine the impact of laparoscopic repair of large hiatal hernia on dyspnoea severity, respiratory function and quality of life. From 2004 to 2008, 30 consecutive patients with large para-oesophageal hernia defined as >50% of stomach in the intra-thoracic cavity and minimum follow-up of 2 years were included in this study. All patients had a formal respiratory function test 1 week prior and 3 months after their laparoscopic hiatal hernia repair. Patients rated symptom severity and completed a quality-of-life questionnaire [Gastrointestinal Quality of Life Index (GIQLI)] pre-operatively, and post-operatively at 3 months, 6 months and yearly thereafter. There was no hospital mortality, and the morbidity rate was 10%. In 26 patients with pre-operative dyspnoea, 22 had complete resolution while the remaining 4 had improvement of dyspnoea severity post-operatively. The mean dyspnoea severity index reduced from 2.4 to 1.3 (P < 0.001). Overall, there was 1%, 3% and 3% post-operative increase in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO) values for the whole group, none of which reached statistical significance. For patients with resolution or improvement of dyspnoea after laparoscopic repair, no significant change of respiratory function parameters was demonstrated. GIQLI score improved from a pre-operative value of 85.7 to 107.9 post-operatively (P < 0.001). We failed to show a significant change in post-operative respiratory function despite clearly demonstrated improvement of respiratory symptoms. Alternative explanations for reduction of dyspnoea severity should be sought.

  10. Diagnosis of Type-I hiatal hernia: a comparison of high-resolution manometry and endoscopy.

    PubMed

    Khajanchee, Y S; Cassera, M A; Swanström, L L; Dunst, C M

    2013-01-01

    Sliding Type-I hiatal hernia is commonly diagnosed using upper endoscopy, barium swallow or less commonly, esophageal manometry. Current data suggest that endoscopy is superior to barium swallow or esophageal manometry. Recently, high-resolution manometry has become available for the assessment of esophageal motility. This novel technology is capable of displaying spatial and topographic pressure profiles of gastroesophageal junction and crural diaphragm in real time. The objective of the current study was to compare the specificity and sensitivity of high-resolution manometry and endoscopy in the diagnosis of sliding hiatal hernia in patients with gastroesophageal reflux disease. Data were analyzed retrospectively for 83 consecutive patients (61% females, mean age 52 ± 13.2 years) with objective gastroesophageal reflux disease who were considered for laparoscopic antireflux surgery between January 2006 and January 2009 and had preoperative high-resolution manometry and endoscopy. Manometrically, hiatal hernia was defined as separation of the gastroesophageal junction >2.0 cm from the crural diaphragm. Intraoperative diagnosis of hiatal hernia was used as the gold standard. Sensitivity, specificity and likelihood ratios of a positive test and a negative test were used to compare the performance of the two diagnostic modalities. Forty-two patients were found to have a Type-I sliding hiatal hernia (>2 cm) during surgery. Twenty-two patients had manometric criteria for a hiatal hernia by high-resolution manometry, and 36 patients were described as having a hiatal hernia by preoperative endoscopy. False positive results were significantly fewer (higher specificity) with high-resolution manometry as compared with endoscopy (4.88% vs. 31.71%, P= 0.01). There were no significant differences in the false negative results (sensitivity) between the two diagnostic modalities (47.62% vs. 45.24%, P= 0.62). Analysis of likelihood ratios of a positive and negative test

  11. Laparoscopic repair of voluminous symptomatic hiatal hernia using absorbable synthetic mesh.

    PubMed

    Berselli, Mattia; Livraghi, Lorenzo; Latham, Lorenzo; Farassino, Luca; Rota Bacchetta, Gian Luca; Pasqua, Noemi; Ceriani, Ileana; Segato, Sergio; Cocozza, Eugenio

    2015-01-01

    Hiatal hernia is a common disorder and a controversial topic. In symptomatic voluminous hernias laparoscopic surgery and use of mesh can be considered. An initial experience in voluminous hiatal hernia laparoscopic repair using absorbable glycolic acid/trimethylene carbonate synthetic mesh is reported. Retrospective study from an institutional database was performed to analyze laparoscopic hiatal hernia repair using absorbable synthetic mesh from January 2010 to December 2013. All preoperative symptoms and exams were collected and a standardized procedure was performed. Clinical and radiological follow-up was performed. Eight patients underwent laparoscopic repair of hiatal hernia performed by two highly skilled laparoscopic surgeons. One Toupet and seven Nissen fundoplications were tailored. No conversions into laparotomy, neither intraoperative complications nor mortality occurred. After a median follow-up of 23.5 months (range 14 - 44) no mesh complications occurred and all patients are asymptomatic. Two radiological recurrences (25%) were detected. Voluminous symptomatic hiatal hernias can be successfully treated in a high-volume and long-term experienced laparoscopic surgical center by the use of an absorbable synthetic mesh. Further studies and a longer-term follow-up are necessary to confirm this preliminary report.

  12. [Impaired lung function and anemia from large hiatal hernia: a case report].

    PubMed

    Suppa, Marianna; Colzi, Marina; Magnanelli, Elisa; Migliozzi, Elisa; Negri, Silvia; Millarelli, Federica; Coppola, Alessandro

    2013-05-01

    We present the clinical case of a 54 years old man who accessed for dyspnea and severe anemia. After being transfused, he underwent to gastroscopy, which showed an erosive gastritis with large hiatal hernia. The hernia was surgically reduced with laparoscopic hiatoplastic and Nissen-Rossetti fundoplication. In conclusion, dyspnea is not merely a medical competence but also a surgical one.

  13. 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.

  14. De novo hiatal hernia of the gastric tube after sleeve gastrectomy

    PubMed Central

    Amor, Imed Ben; Debs, Tarek; Kassir, Radwan; Anty, Rodolphe; Amor, Virginie Ben; Gugenheim, Jean

    2015-01-01

    Introduction Sleeve gastrectomy (SG) is a frequently used surgical procedure for the treatment of morbid obesity. Several complications of SG have been described; however, de novo hiatal hernia of the gastric tube, as a complication of SG, has not been described in the literature. Presentation of case Here, we report a case of a hiatal hernia 2 years after SG. In the case reported here, the hiatal hernia was associated with weight regain. The mechanisms responsible for the herniation of the pouch are difficult to identify. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass is an effective treatment for this complication. Its management is safe and effective. Discussion Obesity itself is an independent risk factor for hiatal hernia, found preoperatively in more than half of the morbidly obese patients. This predisposition is explained by higher intra-gastric pressure due to intra-abdominal or visceral fat, reduced inferior oesophageal sphincter pressure, and oesophageal motility problems. Conclusion To our knowledge, this is the first described case of hiatal hernia of the gastric tube after SG. PMID:26318133

  15. De novo hiatal hernia of the gastric tube after sleeve gastrectomy.

    PubMed

    Amor, Imed Ben; Debs, Tarek; Kassir, Radwan; Anty, Rodolphe; Amor, Virginie Ben; Gugenheim, Jean

    2015-01-01

    Sleeve gastrectomy (SG) is a frequently used surgical procedure for the treatment of morbid obesity. Several complications of SG have been described; however, de novo hiatal hernia of the gastric tube, as a complication of SG, has not been described in the literature. Here, we report a case of a hiatal hernia 2 years after SG. In the case reported here, the hiatal hernia was associated with weight regain. The mechanisms responsible for the herniation of the pouch are difficult to identify. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass is an effective treatment for this complication. Its management is safe and effective. Obesity itself is an independent risk factor for hiatal hernia, found preoperatively in more than half of the morbidly obese patients. This predisposition is explained by higher intra-gastric pressure due to intra-abdominal or visceral fat, reduced inferior oesophageal sphincter pressure, and oesophageal motility problems. To our knowledge, this is the first described case of hiatal hernia of the gastric tube after SG. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. Struggling with a Gastric Volvulus Secondary to a Type IV Hiatal Hernia

    PubMed Central

    George, Dafnomilis; Apostolos, Pappas V.; Athanasios, Panoutsopoulos; Emmanuel, Lagoudianakis E.; Nikolaos, Koronakis E.; Nikolaos, Panagiotopoulos; Charalampos, Seretis; George, Karanikas; Andreas, Manouras J.

    2010-01-01

    Type IV hiatal hernias are characterized by herniation of the stomach along with associated viscera such as the spleen, colon, small bowel, and pancreas through the esophageal hiatus. They are relatively rare, representing only about 5%–7% of all hernias, and can be associated with severe complications. We report a 71-year-old veteran wrestler who presented to our department with a type IV paraesophageal hernia containing a gastric volvulus and treated successfully with emergency operation. PMID:20981251

  17. Laparoscopic repair of hiatal hernia with mesenterioaxial volvulus of the stomach.

    PubMed

    Inaba, Kazuki; Sakurai, Yoichi; Isogaki, Jun; Komori, Yoshiyuki; Uyama, Ichiro

    2011-04-21

    Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal hernia, volvulus, and gastroesophageal reflux.

  18. 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

  19. Hiatal hernia following total gastrectomy with Roux-en-Y reconstruction.

    PubMed

    Murata, S; Yamazaki, M; Kosugi, C; Hirano, A; Yoshimura, Y; Shiragami, R; Suzuki, M; Shuto, K; Koda, K

    2014-01-01

    Hiatal hernias after total gastrectomy for advanced gastric cancer are very rare. We review a case of a 44-year-old male who presented with dyspnea and chest pain 2 days after total gastrectomy, lower esophagectomy, and splenectomy with retrocolic Roux-en-Y reconstruction approached by a left thoracoabdominal incision for gastric cancer at the cardia. Plain and cross-sectional imaging identified a large hiatal hernia protruding into the right thorax containing left-sided transverse colon and small intestine. Our patient underwent a laparotomy, and after hernia reduction the hiatal defect was repaired by direct suturing. He experienced anastomotic leakage and right pyothorax, but recovered. The potential cause is discussed here and the published literature on this rare complication is reviewed briefly.

  20. Totally laparoscopic gastrectomy for early gastric cancer accompanied by huge hiatal hernia: A case report.

    PubMed

    Hagiwara, Chie; Yajima, Kazuhito; Iwasaki, Yoshiaki; Oohinata, Ryouki; Yuu, Ken; Ishiyama, Satoshi; Amaki, Misato; Nakano, Daisuke; Yamaguchi, Tatsuro; Matsumoto, Hiroshi; Takahashi, Keiichi

    2016-02-01

    We herein present a case in which we used a totally laparoscopic approach for early gastric cancer accompanied by a huge hiatal hernia. An 80-year-old Japanese woman was referred with a chief complaint of dysphagia. A clinical diagnosis of early gastric cancer, T1b (SM) N0M0, stage IA, accompanied by hiatal hernia, was made. Distal gastrectomy with D1 plus lymphadenectomy was carried out. After the gastrectomy, the hernial sac was excised and the hernial orifice was closed. Reconstruction using the Roux-en-Y method was selected. The postoperative course was uneventful and she was discharged on postoperative day 10.

  1. Cameron lesions: an often overlooked cause of iron deficiency anaemia in patients with large hiatal hernias

    PubMed Central

    Kimer, Nina; Schmidt, Palle Nordblad; Krag, Aleksander

    2010-01-01

    Cameron lesions are linear gastric ulcers or erosions on the mucosal folds at the diaphragmatic impression in patients with a large hiatal hernia. The lesions are associated with occult bleeding and development of chronic iron deficiency anaemia, but are often overlooked during routine endoscopy. We present two patients with known hiatal hernias in who repeated endoscopic examinations had not been able to identify a source of bleeding. In both cases, typical Cameron lesions were found either by repeat gastroscopy or by capsule endoscopy. Treatment with high-dose proton pump inhibitor and iron supplement was initiated. PMID:22791730

  2. Suture Cruroplasty Versus Prosthetic Hiatal Herniorrhaphy for Large Hiatal Hernia: A Meta-analysis and Systematic Review of Randomized Controlled Trials.

    PubMed

    Memon, Muhammed Ashraf; Memon, Breda; Yunus, Rossita Mohamad; Khan, Shahjahan

    2016-02-01

    The aim was to conduct a meta-analysis of randomized controlled trials (RCTs) comparing 2 methods of hiatal closure for large hiatal hernia and to evaluate their strengths and flaws. Prospective RCTs comparing suture cruroplasty versus prosthetic hiatal herniorrhaphy for large hiatal hernia were selected by searching PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane Central Register of Controlled Trials published between January 1991 and October 2014. The outcome variables analyzed included operating time, complications, recurrence of hiatal hernia or wrap migration, and reoperation. These outcomes were unanimously decided to be important because they influence the practical approach toward patient management. Random effects model was used to calculate the effect size of both dichotomous and continuous data. Heterogeneity among the outcome variables of these trials was determined by the Cochran's Q statistic and I index. The meta-analysis was prepared in accordance with Preferred Reporting of Systematic Reviews and Meta-Analyses guidelines. Four RCTs were analyzed totaling 406 patients (Suture = 186, Prosthesis = 220). For only 1 of the 4 outcomes, ie, reoperation rate (OR 3.73, 95% CI 1.18, 11.82, P = 0.03), the pooled effect size favored prosthetic hiatal herniorrhaphy over suture cruroplasty. For other outcomes, comparable effect sizes were noted for both groups which included recurrence of hiatal hernia or wrap migration (OR 2.01, 95% CI 0.92, 4.39, P = 0.07), operating time (SMD -0.46, 95% CI -1.16, -0.24, P = 0.19) and complication rates (OR 1.06, 95% CI 0.45, 2.50, P = 0.90). On the basis of our meta-analysis and its limitations, we believe that the prosthetic hiatal herniorrhaphy and suture cruroplasty produces comparable results for repair of large hiatal hernias. In the future, a number of issues need to be addressed to determine the clinical outcomes, safety, and effectiveness of these 2 methods

  3. [Hiatal hernia incarceration during cardiopulmonary bypass in patient with acute aortic dissection--a case report].

    PubMed

    Hasegawa, Y; Saito, T; Horimi, H; Kato, M; Kawashima, T; Fuse, K

    1995-09-01

    A 67-year-old woman was admitted to our hospital under diagnosis of Stanford type A acute aortic dissection. Chest CT showed aortic dissection from the ascending to descending aorta, and large hiatal hernia. Operation was undergone under cardiopulmonary bypass and circulatory arrest with retrograde cerebral perfusion. A graft replacement was carried out from the ascending to transverse arch aorta. After the release of the cross-clamping of aorta, the heart was gradually oppressed anteriorly by extrapericardial mass, so that the patient could not be weaned from the cardiopulmonary bypass. The mass was revealed incarcerated hiatal hernia by ultrasonography. After laparotomy, diaphragm and hiatus were incised, the incarceration was relieved and the diaphgragm was repaired with a Goretex sheet. Then the patient could be weaned from cardiopulmonary bypass. Her postoperative course was uneventful except for acute renal failure, and she was discharged 60 days after the operation. The incarceration of hiatal hernia was thought to be caused by tissue edema and small bleeding during cardiopulmonary bypass. This is the first reported case with the incarceration of hiatal hernia which occurred during cardiopulmonary bypass.

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

    PubMed Central

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

    2014-01-01

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

  5. Diagnosis and treatment of atypical presentations of hiatal hernia following bariatric surgery.

    PubMed

    Flanagin, Brody A; Mitchell, Myrosia T; Thistlethwaite, William A; Alverdy, John C

    2010-03-01

    Bariatric surgery dramatically alters the normal stomach anatomy resulting in a significant incidence of hiatal hernia and gastroesophageal reflux disease. Although the majority of patients remain asymptomatic, many complain of severe heartburn refractory to medical management and additional highly atypical symptoms. Here, we describe the diagnosis and treatment regarding four cases of symptomatic hiatal hernia following bariatric surgery presenting with atypical symptoms in the University Hospital, USA. Four patients presented following laparoscopic Roux-en-Y gastric bypass or duodenal switch/pancreaticobiliary bypass (DS) with disabling and intractable midepigastric abdominal pain characterized as severe and radiating to the jaw, left shoulder, and midscapular area. The pain in all cases was described as paroxysmal and not necessarily associated with eating. All four patients also experienced nausea, vomiting, and failure to thrive at various intervals following laparoscopic bariatric surgery. Routine workup failed to produce any clear mechanical cause of these symptoms. However, complimentary use of multidetector CT and upper gastrointestinal contrast studies eventually revealed the diagnosis of hiatal hernia. Exploration identified the presence of a type I hiatal hernia in all four patients, with the stomach staple lines densely adherent to the diaphragm and parietal peritoneum. Operative intervention led to immediate and complete resolution of symptoms. The presence of a hiatal hernia following bariatric surgery can present with highly atypical symptoms that do not resolve without operative intervention. Recognition of this problem should lead to the consideration of surgery in cases where patients are dependent on artificial nutritional support and whose symptoms are poorly controlled with medication alone.

  6. LAPAROSCOPIC GASTROPEXY FOR CORRECTION OF A HIATAL HERNIA IN A NORTHERN ELEPHANT SEAL (MIROUNGA ANGUSTIROSTRIS).

    PubMed

    Greene, Rebecca; Van Bonn, William G; Dennison, Sophie E; Greig, Denise J; Gulland, Frances M D

    2015-06-01

    A female northern elephant seal (Mirounga angustirostris) weaned pup presented with malnutrition. During rehabilitation, the seal developed regurgitation and reduced lung sounds on auscultation. Radiographs and endoscopy performed under sedation suggested a diaphragmatic hernia. A Type I (or sliding) hiatal hernia was confirmed with a positive contrast upper gastrointestinal study, revealing varying degrees of herniation of the gastric fundus through the diaphragm into the caudal thorax as well as esophageal reflux. The animal was treated preoperatively with an H2 antagonist and antinausea medication. A laparoscopic gastropexy was performed under general anesthesia. The animal recovered well postoperatively and resolution of clinical signs was achieved. The animal was released back into the wild 21 kg above admit weight. To our knowledge, we report here the first surgical correction of a hiatal hernia in a marine mammal.

  7. Hiatal hernia with upside-down stomach. Management of acute incarceration: case presentation and review of literature.

    PubMed

    Gryglewski, Andrzej; Kuta, Marcin; Pasternak, Artur; Opach, Zdzisław; Walocha, Jerzy; Richter, Piotr

    2016-01-01

    Upside-down stomach (UDS) represents the rarest type of hiatal hernia (<5%) and is characterized by herniation of the entire stomach or most gastric portions into the posterior mediastinum. We present here a very rare complication of such a condition which is incarceration of upside-down stomach. A 54 year-old female was admitted to the emergency department presenting signs of acute epigastric pain radiating into thorax. Computed tomography revealed a giant hiatal hernia with incarceration of the gastric trunk. Immediate operation for reduction of the incarcerated stomach and repair of the hiatal defect was performed. The patient was discharged without any complication and was followed up at the surgical outpatient department. The presented case confirms that differentiation of an acute epigastric or intrathoracic pain in adults should always exclude presence of hiatal hernia which in case of incarceration should be treated by prompt surgical management.

  8. The stapled, uncut gastroplasty for hiatal hernia: 24 years' follow-up.

    PubMed

    Demos, N J

    1999-01-01

    A simple, tension-free, in situ gastroplasty was devised in the late 1960s and early 1970s to avoid the recurrences and complications of the Collis and Nissen hiatal hernioplasties. Long-term follow-up has now been completed on 153 patients. For this procedure, the anterior gastric wall is stapled, not cut, and the fundoplication is performed on the cardia and the neoesophagus created by the stapling and is sutured under the diaphragm. A total of 161 patients underwent the stapled, uncut gastroplasty and were followed for up to 24 years. Conditions included reflux in 145, organic stricture in 23, giant hiatal hernia in 14 (with or without obstruction) and collagen esophagus in six. Post-operative tests included subjective symptom evaluation by questionnaire, esophageal manometry and 24-h pH monitoring. Of the total 161 patients, 89 were followed up for 2-10 years and 64 for 1-24 years; seven were lost to follow-up and one died soon after the operation. The stapled, uncut gastroplasty and fundoplication produced 95% excellent and good results (Matthews classification grade I and II). After the procedure, the esophagus was significantly lengthened (from 2.55 +/- 0.96 to 3.2 +/- 0.32 cm; p < 0.001) and sphincter pressure was significantly increased (from 6.35 +/- 3.5 to 27.3 +/- 6.82 mmHg; p < 0.0001). No leakage, bleeding, or 'slipped' recurrence was observed. Only one patient experienced dissolution of the wrap and recurrent symptoms. Aspiration, scleroderma, stricture and short esophagi, post-gastrectomy gastric remnants and hiccups were treated with excellent and good long-term results. The stapled, uncut gastroplasty has universal application with excellent results, not only in typical cases of gastroesophageal reflux, but also in complicated situations such as short esophagus, strictures, or dysperistaltic and aperistaltic esophagus.

  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. © 2014 British Small Animal Veterinary Association.

  10. Laparoscopic repair of large hiatal hernia without prosthetic reinforcement: late results and relevance of anterior gastropexy.

    PubMed

    Poncet, Gilles; Robert, Maud; Roman, Sabine; Boulez, Jean-Claude

    2010-12-01

    Laparoscopic treatment of large hiatal hernias seems to be associated with a high recurrence rate that some authors suggest to bring down by performing prosthetic closure of the hiatus. However, prosthetic repair remains controversial owing to severe and still underestimated complications. The aims of this study were to assess the long-term functional and objective results of laparoscopic treatment without prosthetic patch, and to identify the risk factors of recurrence. From November 1992 to March 2009, 89 patients underwent laparoscopic treatment of a large hiatal hernia without prosthetic patch, involving excision of the hernial sac, cruroplasty, fundoplication, and often anterior gastropexy. The postoperative assessment consisted of a barium esophagram on day 2, an office visit at 2 months with a 24-h pH study, an esophageal manometry, and then a long-term prospective yearly follow-up with a barium esophagram at 2 years. Out of the 89 laparoscopic procedures, four required a conversion (4.4%). Seventy-seven patients underwent a Boerema's anterior gastropexy (86.5%). The morbidity rate was 7.8%, and the mortality rate was nil. Eleven patients (12.3%) were lost to follow-up. We had 91.5% of very good early functional results and 75.3% of good results after a mean follow-up of 57.5 months. Fourteen recurrences of hiatal hernias (15.7%) were identified, four of which (28.6%) occurred early after surgery. Three factors seemed significantly associated with recurrence: the absence of anterior gastropexy (p = 0.0028), the group of younger patients (p = 0.03), and a history of abdominal surgery (p = 0.01). Large hiatal hernias can be treated by laparoscopy without prosthetic patch with a satisfying long-term result. Performing anterior gastropexy seems to significantly reduce the recurrences.

  11. Intraluminal pressure, transmucosal potential difference, and pH studies in the oesophagus of patients before and after Collis repair of a hiatal hernia

    PubMed Central

    Habibulla, K. S.; Collis, J. Leigh

    1973-01-01

    Intraluminal pressure, transmucosal potential difference, and endo-oesophageal pH measurements were studied in patients with hiatal hernia—before and after a hiatal repair. The operation employed is the Collis (1968) repair for uncomplicated hiatal hernia and does not refer to gastroplasty as recommended for peptic stricture (Collis, 1961). Postoperative studies show that the repair approximates the inferior oesophageal sphincter to the hiatus with the production of a single band of raised pressure at the lower end of the oesophagus. This band is similar to that seen in normal subjects and its appearance was associated with cure of the symptoms, abolition of the gastro-oesophageal reflux, and improvement in the function of the inferior oesophageal sphincter and the musculature of the body of the oesophagus. Certain physiological implications of this study are discussed. Images PMID:4724501

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

    PubMed

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

    2014-10-01

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

  13. Short-term results for laparoscopic repair of large paraesophageal hiatal hernias with Gore Bio A® mesh.

    PubMed

    Priego Jiménez, Pablo; Salvador Sanchís, José Luis; Angel, Vicente; Escrig-Sos, Javier

    2014-01-01

    The application of mesh-reinforced hiatal closure has resulted in a significant reduction in recurrence rates in comparison with primary suture repair. One of the most debated issues is the risk of complications related to the use of the prosthesis, such as esophageal erosion and postoperative dysphagia. The aim of this study is to present our short-terms results in the treatment of laparoscopic paraesophageal hiatal hernia (LPHH) with a synthetic polyglycolic acid:trimethylene carbonate mesh (Gore Bio A(®)). From January 2011 to December 2012, 10 patients with large paraesophageal hiatal hernias and hiatal defect over 5 cm were included. Primary simple suture of the crura and additional reinforcement with a Gore Bio A(®) mesh was performed. Hiatal hernia or gastroesophageal reflux disease (GERD) symptoms recurrence, dysphagia and mesh-related complications were investigated. Of the 10 patients undergoing mesh repair, there were 7 women and 3 men with a mean age of 65.5 years. All operations were completed laparoscopically. Median postoperative stay was 3 days. After a median follow-up of 20.3 months, one patient developed a recurrent hiatal hernia (10%). There were no mesh-related complications. The use of Gore Bio A(®) mesh for the laparoscopic repair of large paraesophageal hiatal hernias is safe and with a reasonably low recurrence rate in this short-term study. Additional long-term studies with ample numbers carried out for years will be necessary to see if this synthetic mesh is not only safe but also successful in the prevention of recurrences. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Resorbable Synthetic Mesh Supported With Omentum Flap in the Treatment of Giant Hiatal Hernia

    PubMed Central

    Pérez Lara, F. J.; Marín, R.; del Rey, A.; Oliva, H.

    2014-01-01

    Covering a large hiatal hernia with a mesh has become a basic procedure in the last few years. However, mesh implants are associated with high complication rates (esophageal erosion, perforation, fistula, etc.). We propose using a synthetic resorbable mesh supported with an omental flap as a possible solution to this problem. A 54-year-old female patient with a large hiatal defect (9 cm) was laparoscopically implanted with a synthetic resorbable mesh supported with an omental flap. The surgical procedure was successful and the patient was discharged on postoperative day 2. On a follow-up examination 6 months after surgery, she remained free of relapse or complication signs. Supporting an implanted resorbable mesh with an omental flap may be a solution to the problems posed by large esophageal hiatus defects. However, more studies based on larger patient samples and longer follow-up periods are necessary. PMID:25216419

  15. Approaches to the Diagnosis and Grading of Hiatal Hernia

    PubMed Central

    Kahrilas, Peter J.; Kim, Hyon C.; Pandolfino, John E

    2008-01-01

    Hiatus hernia refers to conditions in which elements of the abdominal cavity, most commonly the stomach, herniate through the esophageal hiatus into the mediastinum. With the most common type (type I or sliding hiatus hernia) this is associated with laxity of the phrenoesophageal membrane and the gastric cardia herniates. Sliding hiatus hernia is readily diagnosed by barium swallow radiography, endoscopy, or manometry when greater than 2 cm in axial span. However, the mobility of the esophagogastric junction precludes the reliable detection of more subtle disruption by endoscopy or radiography. Detecting lesser degrees of axial separation between the lower esophageal sphincter and crural diaphragm can only be reliably accomplished with high resolution manometry, a technique that permits real time localization of these esophagogastric junction components without swallow or distention related artifact. PMID:18656819

  16. The Effect of Laparoscopic Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair on Gastroesophageal Reflux Disease in the Morbidly Obese.

    PubMed

    Samakar, Kamran; McKenzie, Travis J; Tavakkoli, Ali; Vernon, Ashley H; Robinson, Malcolm K; Shikora, Scott A

    2016-01-01

    The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) is controversial. Although concomitant hiatal hernia repair (HHR) at the time of LSG is common and advocated by many, there are few data on the outcomes of GERD symptoms in these patients. The aim of this study was to evaluate the effect of concomitant HHR on GERD symptoms in morbidly obese patients undergoing LSG. A single institution, multi-surgeon, prospectively maintained database was examined to identify patients who underwent LSG and concomitant HHR from December 2010 to October 2013. Patient characteristics, operative details, and postoperative outcomes were analyzed. Standardized patient questionnaires administered both pre- and postoperatively were utilized. Primary endpoints included subjective reflux symptoms and the need for antisecretory therapy. Weight loss was considered a secondary endpoint. Fifty-eight patients were identified meeting inclusion criteria (LSG + HHR), with a mean follow-up of 97.5 weeks (range 44-172 weeks). The mean age of the cohort was 49.5 ± 11.2 years, with 74.1 % being female. Mean preoperative BMI was 44.2 ± 6.6 kg/m(2). Preoperative upper gastrointestinal contrast series was performed in all patients and demonstrated a hiatal hernia in 34.5 % of patients and reflux in 15.5 % of patients. Preoperatively, 44.8 % (n = 26) of patients reported subjective symptoms of reflux and/or required daily antisecretory therapy [Corrected]. After LSG + HHR, 34.6 % of symptomatic patients had resolution of their symptoms off therapy while the rest remained symptomatic and required daily antisecretory therapy; 84.4 % of patients that were asymptomatic preoperatively remained asymptomatic after surgery. New onset reflux symptoms requiring daily antisecretory therapy was seen in 15.6 % of patients who were previously asymptomatic. Post surgical weight loss did not correlate with the presence or resolution of reflux symptoms. Based

  17. Management of large para-esophageal hiatal hernias.

    PubMed

    Collet, D; Luc, G; Chiche, L

    2013-12-01

    Para-esophageal hernias are relatively rare and typically occur in elderly patients. The various presenting symptoms are non-specific and often occur in combination. These include symptoms of gastro-esophageal reflux (GERD) in 26 to 70% of cases, microcytic anemia in 17 to 47%, and respiratory symptoms in 9 to 59%. Respiratory symptoms are not completely resolved by surgical intervention. Acute complications such as gastric volvulus with incarceration or strangulation are rare (estimated incidence of 1.2% per patient per year) but gastric ischemia leading to perforation is the main cause of mortality. Only patients with symptomatic hernias should undergo surgery. Prophylactic repair to prevent acute incarceration should only be undertaken in patients younger than 75 in good condition; surgical indications must be discussed individually beyond this age. The laparoscopic approach is now generally accepted. Resection of the hernia sac is associated with a lower incidence of recurrence. Repair of the hiatus can be reinforced with prosthetic material (either synthetic or biologic), but the benefit of prosthetic repair has not been clearly shown. Results of prosthetic reinforcement vary in different studies; it has been variably associated with four times fewer recurrences or with no measurable difference. A Collis type gastroplasty may be useful to lengthen a foreshortened esophagus, but no objective criteria have been defined to support this approach. The anatomic recurrence rate can be as high as 60% at 12years. But most recurrences are asymptomatic and do not affect the quality of life index. It therefore seems more appropriate to evaluate functional results and quality of life measures rather than to gauge success by a strict evaluation of anatomic hernia reduction.

  18. Gastroscopy in patients with hiatal hernia with and without gastroesophageal mucosal prolapse.

    PubMed

    Gryglewski, Andrzej; Pasternak, Artur; Piech, Krzysztof; Gąsior, Grzegorz; Głowacki, Roman; Bereza, Krzysztof; Walocha, Ewa

    2016-01-01

    There are still many doubts in the literature regarding gastroesophageal mucosal prolapse (GEMP) and its clinical course. We still do not know what determines mucosal wedging in esophagogastric junction, and what is the role of the anatomy of that site. To investigate that problem we performed 120 upper digestive tract endoscopies in which a hiatal hernia was diagnosed. Patients referred to our unit with different complaints most frequently of typical or atypical gastroesophageal (GE) reflux symptoms. The aim of that study was to assess hernia dimensions in patients with and without GEMP diagnosed during endoscopy. Additionally we analyzed the type and prevalence of gastrointestinal symptoms reported by patients to confirm the observation that GEMP symptoms differ from gastroesophageal reflux disease (GERD) symptoms.

  19. An unusual case: a giant paraesophageal hiatal hernia with intrathoracic spleen, preduodenal portal vein, malrotation, and left inferior vena cava.

    PubMed

    Başaklar, A Can; Sönmez, Kaan; Karabulut, Ramazan; Türkyilmaz, Zafer; Moralioğlu, Serdar

    2007-12-01

    A giant paraesophageal hiatal hernia with preduodenal portal vein, nonrotating gut, intrathoracic spleen, and left inferior vena cava has not been reported to date. This set of complex anomalies can have significant clinical implications. Awareness of these anomalies is essential to avoid further complications.

  20. Effect of perfusion of bile salts solutions into the oesophagus of hiatal hernia patients and controls.

    PubMed Central

    Bachir, G S; Collis, J L

    1976-01-01

    Tests of the response to perfusion of the oesophagus were made in 54 patients divided into three groups. Group I consisted of patients with symptomatic hiatal hernia, group II hiatal hernia patients with peptic stricture, and group III normal individuals. Each individual oesophagus was perfused at a rate of 45-65 drops per minute over 25 minutes with six solutions: normal saline, N/10 HCl, taurine conjugates of bile salts in normal saline, taurine conjugates of bile salts in N/10 HCl, glycine conjugates of bile salts in normal saline, and taurine and glycine conjugates in a ratio of 1 to 2 in normal saline. It was found that acidified taurine solutions were more irritating than acid alone. With a 2mM/l solution of taurine in acid, symptoms are produced even in controls. With a 1 mM/l solution of the same conjugates, the majority of normal people feel slight heartburn or nothing, and therefore perfusion into the oesophagus of such a solution could be used as a test for oesophagitis. PMID:941112

  1. Gasless laparoscopic surgery plus abdominal wall lifting for giant hiatal hernia-our single-center experience.

    PubMed

    Yu, Jiang-Hong; Wu, Ji-Xiang; Yu, Lei; Li, Jian-Ye

    2016-12-01

    Giant hiatal hernia (GHH) comprises 5% of hiatal hernia and is associated with significant complications. The traditional operative procedure, no matter transthoracic or transabdomen repair of giant hiatal hernia, is characteristic of more invasion and more complications. Although laparoscopic repair as a minimally invasive surgery is accepted, a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation. The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia. We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution. The GHH was defined as greater than one-third of the stomach in the chest. Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients. Mean age was 67 years. The results showed that there were no conversions to open surgery and no intraoperative deaths. The mean duration of operation was 100 min (range: 90-130 min). One-side pleura was injured in 4 cases (14.8%). The mean postoperative length of stay was 4 days (range: 3-7 days). Median follow- up was 26 months (range: 6-38 months). Transient dysphagia for solid food occurred in three patients (11.1%), and this symptom disappeared within three months. There was one patient with recurrent hiatal hernia who was reoperated on. Two patients still complained of heartburn three months after surgery. Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient. Totally, satisfactory outcome was reported in 88.9% patients. It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible, safe, and effective for the patients who cannot tolerate the pneumoperitoneum.

  2. Hiatal hernia causing extrapericardial tamponade after coronary bypass surgery.

    PubMed

    Papoulidis, Pavlos; Beatty, Jasmine Winter; Dandekar, Uday

    2014-10-01

    Cardiac tamponade is defined as compression of the heart due to accumulation of fluid in the pericardial sac, leading to raised pericardial pressures with haemodynamic compromise. We describe the case of a 76-year old female patient who underwent a routine off-pump coronary artery bypass graft operation and within 48 h developed classic signs of cardiac tamponade. The perioperative echocardiogram and operative findings at re-exploration revealed no clots or fluid collection. A giant hiatus hernia was found to be responsible for the tamponade through extrinsic compression. After insertion of a nasogastric tube and decompression of the stomach, there was a rapid improvement of the clinical picture. The remaining postoperative course was uneventful and the patient was discharged 5 days later, with referral to the general surgeon for further management. We conclude that, in cases of tamponade post-cardiac surgery, extrapericardial pathologies should be considered. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  3. The frequency of true short oesophagus in type II-IV hiatal hernia.

    PubMed

    Lugaresi, Marialuisa; Mattioli, Sandro; Aramini, Beatrice; D'Ovidio, Frank; Di Simone, Massimo Pierluigi; Perrone, Ottorino

    2013-02-01

    The misdiagnosis of short oesophagus may occur on recurrence of the hernia after surgery for type II-IV hiatal hernia (HH). The frequency of short oesophagus in type II-IV hernia is undefined. The aim of this study was to assess the frequency of true short oesophagus in patients undergoing surgery for type II-IV hernia. Thirty-four patients with type II-IV hernia underwent minimally invasive surgery. After full isolation of the oesophago-gastric junction, the position of the gastric folds was localized endoscopically and two clips were applied in correspondence. The distance between the clips and the diaphragm (intra-abdominal oesophageal length) was measured. When the intra-abdominal oesophagus was <1.5 cm after oesophageal mobilization, the Collis procedure was performed. After surgery, patients underwent a follow-up, comprehensive of barium swallow and endoscopy. After mediastinal mobilization (median 10 cm), the intra-abdominal oesophageal length was >1.5 cm in 17 patients (4 type II, 11 type III and 2 type IV) and ≤ 1.5 cm in 17 patients (13 type III and 4 type IV hernia). No statistically significant differences were found between patients with intra-abdominal oesophageal length > or ≤ 1.5 cm with respect to symptoms duration and severity. Global results (median follow-up 48 months) were excellent in 44% of patients, good in 50%, fair in 3% and poor in 3%. HH relapse occurred in 3%. True short oesophagus is present in 57% of type III-IV and in none of type II HHs. The intraoperative measurement of the submerged intra-abdominal oesophagus is an objective method for recognizing these patients.

  4. Cardiac complications after laparoscopic large hiatal hernia repair. Is it related with staple fixation of the mesh? -Report of three cases

    PubMed Central

    Fernandez, Maria del Carmen; Diaz, María; López, Fernando; Martí-Obiol, Roberto; Ortega, J.

    2015-01-01

    Introduction Laparoscopic Nissen operation with mesh reinforcement remains being the most popular operation for large hiatal hernia repair. Complications related to mesh placement have been widely described. Cardiac complications are rare, but have a fatal outcome if they are misdiagnosed. Presentation of cases We sought to outline our institutional experience of three patients who developed cardiac complications following a laparoscopic Nissen operation for large hiatal hernia repair. Discussion Laparoscopic hiatoplasty and Nissen fundoplication are safe and effective procedures for the hiatal hernia repair, but they are not exempt from complications. Fixation technique and material used must be taken into account. We have conducted a review of the literature on complications related to these procedures. Conclusion In the differential diagnosis of hemodynamic instability after laparoscopic hiatal hernia repair, cardiac tamponade and other cardiac complications should be considered. PMID:26635954

  5. Denture mis-swallowing in the sliding esophageal hiatal hernia mimics esophageal perforation.

    PubMed

    Chen, Chao-Yang; Lee, Shih-Chun; Chen, Chun-Wen; Chen, Jen-Chih

    2008-08-01

    Mis-swallowing of a foreign body in the esophagus coexisting with sliding hernia might be misdiagnosed as esophageal perforation with mediastinal abscess. We report an 89-year-old woman, bedridden for a long period in a nursing home after a previous cerebrovascular accident, who was sent to our emergency department in a state of sepsis because she had swallowed a radio-opaque partial denture. The retention of the denture as an esophageal foreign body was complicated with mediastinitis and bilateral pleural effusion. The inability of the patient to give a reliable clinical history delayed the diagnosis. This report highlights the difficulty in precisely locating a partial denture because of conflicting radiologic findings and the coexistence of esophageal sliding hernia, all of which led to a misdiagnosis of possible esophageal perforation. A right posterolateral thoracotomy with gastrostomy was performed to remove the lower esophageal foreign body after esophagoscopy failed. The surgical finding of a coincidental sliding esophageal hiatal hernia correlated well with the clinical presentation. Managing such a complicated esophageal foreign body in this elderly patient was challenging.

  6. Large hiatal hernia at chest radiography in a woman with cardiorespiratory symptoms.

    PubMed

    Torres, Daniele; Parrinello, Gaspare; Cardillo, Mauro; Pomilla, Marina; Trapanese, Caterina; Michele, Bellanca; Lupo, Umberto; Schimmenti, Caterina; Cuttitta, Francesco; Pietrantoni, Rossella; Vogiatzis, Danai; Licata, Giuseppe

    2012-11-01

    Hiatal hernia (HH) is a frequent entity. Rarely, it may exert a wide spectrum of clinical presentations mimicking acute cardiovascular events such as angina-like chest pain until manifestations of cardiac compression that can include postprandial syncope, exercise intolerance, respiratory function, recurrent acute heart failure, and hemodynamic collapse. A 69-year-old woman presented to the emergency department complaining of fatigue on exertion, cough, and episodes of restrosternal pain with less than 1 hour of duration. Her medical history only included some episodes of bronchitis and no history of hypertension. The 12-lead electrocardiogram demonstrated sinus rhythm with right bundle-branch block. Laboratory tests, including cardiac troponin I, were within normal reference values. Chest radiography showed no significant pulmonary alterations and revealed in mediastinum a huge abnormal shadow overlapping the right heart compatible with a gastric bubble.The gastroscopy confirmed a large HH. A 2-dimensional transthoracic echocardiogram, using all standard and modified apical and parasternal views, revealed an echolucent mass, compatible with HH, compressing the right atrium. Also, it showed an altered left ventricular relaxation and a mild increase of pulmonary artery pressure (35 mm Hg). Spirometry showed a mild obstruction of the small airways, whereas coronary angiography showed normal coronary arteries. We concluded that the patient's symptomatology was related to the compressive effects of the large hiatal ernia, a neglected cause of cardiorespiratory symptoms. The surgical repair of HH was indicated.

  7. First human magnetic resonance visualisation of prosthetics for laparoscopic large hiatal hernia repair.

    PubMed

    Köhler, G; Pallwein-Prettner, L; Lechner, M; Spaun, G O; Koch, O O; Emmanuel, K

    2015-12-01

    Mesh repair of large hiatal hernias has increasingly gained popularity to reduce recurrence rates. Integration of iron particles into the polyvinylidene fluoride mesh-based material allows for magnetic resonance visualisation (MR). In a pilot prospective case series eight patients underwent surgical repair of hiatal hernias repair with pre-shaped meshes, which were fixated with fibrin glue. An MR investigation with a qualified protocol was performed on postoperative day four and 3 months postoperatively to evaluate the correct position of the mesh by assessing mesh appearance and demarcation. The total MR-visible mesh surface area of each implant was calculated and compared with the original physical mesh size to evaluate potential reduction of the functional mesh surfaces. We documented no mesh migrations or dislocations but we found a significant decrease of MR-visualised total mesh surface area after release of the pneumoperitoneum compared to the original mesh size (mean 78.9 vs 84 cm(2); mean reduction of mesh area = 5.1 cm(2), p < 0.001). At 3 months postoperatively, a further reduction of the mesh surface area could be observed (mean 78.5 vs 78.9 cm(2); mean reduction of mesh area = 0.4 cm(2), p < 0.037). Detailed mesh depiction and accurate assessment of the surrounding anatomy could be successfully achieved in all cases. Fibrin glue seems to provide effective mesh fixation. In addition to a significant early postoperative decrease in effective mesh surface area a further reduction in size occurred within 3 months after implantation.

  8. Lower recurrence rates after mesh-reinforced versus simple hiatal hernia repair: a meta-analysis of randomized trials.

    PubMed

    Antoniou, Stavros A; Antoniou, George A; Koch, Oliver O; Pointner, Rudolph; Granderath, Frank A

    2012-12-01

    Mesh hiatoplasty has been postulated to reduce recurrence rates, it is however prone to esophageal stricture, and early-term and mid-term dysphagia. The present meta-analysis was designed to compare the outcome between mesh-reinforced and primary hiatal hernia repair. The databases of Medline, EMBASE, and the Cochrane Library were searched; only randomized controlled trials entered the meta-analytical model. Anatomic recurrence documented by barium oesophagography was defined as the primary outcome endpoint. Three randomized controlled trials reporting the outcomes of 267 patients were identified. The follow-up period ranged between 6 and 12 months. The weighted mean recurrence rates after primary and mesh-reinforced hiatoplasty were 24.3% and 5.8%, respectively. Pooled analysis demonstrated increased risk of recurrence in primary hiatal closure (odds ratio, 4.2; 95% confidence interval, 1.8-9.5; P=0.001). Mesh-reinforced hiatal hernia repair is associated with an approximately 4-fold decreased risk of recurrence in comparison with simple repair. The long-term results of mesh-augmented hiatal closure remain to be investigated.

  9. Hiatal Hernia

    MedlinePlus

    ... while your surgeon views images from inside your body that are displayed on a video monitor (laparoscopic surgery). Making a few lifestyle changes may help control the signs and symptoms of acid reflux caused ...

  10. Hiatal Hernia

    MedlinePlus

    ... the esophagus is called gastroesophageal reflux disease (GERD). GERD may cause symptoms such as Heartburn Problems swallowing A dry cough ... in people over age 50. If you have symptoms, eating small meals, avoiding certain ... National Institute of Diabetes and Digestive and Kidney Diseases

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

    PubMed Central

    2014-01-01

    Background Although minimally invasive repair of giant hiatal hernias is a very surgical challenge which requires advanced laparoscopic learning curve, several reports showed that is a safe and effective procedure, with lower morbidity than open approach. In the present study we show the outcomes of 13 patients who underwent a laparoscopic repair of giant hiatal hernia. Methods A total of 13 patients underwent laparoscopic posterior hiatoplasty and Nissen fundoplication. Follow-up evaluation was done clinically at intervals of 3, 6 and 12 months after surgery using the Gastro-oesophageal Reflux Health-Related Quality of Life scale, a barium swallow study, an upper gastrointestinal endoscopy, an oesophageal manometry, a combined ambulatory 24-h multichannel impedance pH and bilirubin monitoring. Anatomic recurrence was defined as any evidence of gastric herniation above the diaphragmatic edge. Results There were no intraoperative complications and no conversions to open technique. Symptomatic GORD-HQL outcomes demonstrated a statistical significant decrease of mean value equal to 3.2 compare to 37.4 of preoperative assessment (p < 0.0001). Combined 24-h multichannel impedance pH and bilirubin monitoring after 12 months did not show any evidence of pathological acid or non acid reflux. Conclusion All patients were satisfied of procedure and no hernia recurrence was recorded in the study group, treated respecting several crucial surgical principles, e.g., complete sac excision, appropriate crural closure, also with direct hiatal defect where possible, and routine use of antireflux procedure. PMID:24401085

  12. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients

    PubMed Central

    Garg, Harshit; Vigneshwaran, Balasubiramaniyan; Aggarwal, Sandeep; Ahuja, Vineet

    2017-01-01

    BACKGROUND: The aim of this study was to analyse the impact of hiatal hernia repair (HHR) on gastro-oesophageal reflux disease (GERD) in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: It is a retrospective study involving ten morbidly obese patients with large hiatus hernia diagnosed on pre-operative endoscopy who underwent LSG and simultaneous HHR. The patients were assessed for symptoms of GERD using a Severity symptom score (SS) questionnaire and anti-reflux medications. RESULTS: Of the ten patients, five patients had GERD preoperatively. At the mean follow-up of 11.70 ± 6.07 months after surgery, four patients (80%) showed complete resolution while one patient complained of persistence of symptoms. Endoscopy in this patient revealed resolution of esophagitis indicating that the persistent symptoms were not attributable to reflux. The other five patients without GERD remained free of any symptom attributable to GERD. Thus, in all ten patients, repair of hiatal hernia (HH) during LSG led to either resolution of GERD or prevented any new onset symptom related to GER. CONCLUSION: In morbidly obese patients with HH with or without GERD undergoing LSG, repair of the hiatus hernia helps in amelioration of GERD and prevents any new onset GER. Thus, the presence of HH should not be considered as a contraindication for LSG. PMID:28281472

  13. Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: a case report.

    PubMed

    Siow, Sze Li; Tee, Sze Chee; Wong, Chee Ming

    2015-03-04

    Paraesophageal hernia with intrathoracic mesentericoaxial type of gastric volvulus is a rare clinical entity. The rotation occurs because of the idiopathic relaxation of the gastric ligaments and ascent of the stomach adjacent to the oesophagus through the hiatus defect, while the gastroesophageal junction remains in the abdomen. The open approach remains the gold standard therapy for most patients. Here we report the case of a patient with such a condition who underwent a successful laparoscopic surgery. A literature search revealed that this is the first case report from Southeast Asia. A 55-year-old Chinese woman presented to us with symptoms suggestive of gastric outlet obstruction for one year. A chest radiograph showed an air bubble with air-fluid level in her left thoracic cavity, where a diaphragmatic hernia was initially suspected. A computed tomography scan and barium swallow study demonstrated the presence of a type III paraesophageal hernia with intrathoracic upside-down stomach. A laparoscopy was performed and the herniated stomach was successfully reduced into the abdomen. The mediastinal part of the hernial sac was excised. Adequate intraabdominal length of oesophagus was achieved after resection of the sac and circumferential oesophageal dissection. A lateral releasing incision was made adjacent to the right crus to facilitate crural closure. The diaphragmatic defect and the hiatal closure were covered with a composite mesh. A Toupet fundoplication was performed to recreate the antireflux valve. She had an uneventful recovery. She had no relapse of previous symptoms at her six-month follow-up assessment. Laparoscopic repair of such a condition can be accomplished successfully and safely when it is performed with meticulous attention to the details of the surgical technique.

  14. Efficacy of a proton pump inhibitor given in the early postoperative period to relieve symptoms of hiatal hernia after open heart surgery.

    PubMed

    Hata, Mitsumasa; Shiono, Motomi; Sekino, Hisakuni; Furukawa, Hidekazu; Sezai, Akira; Iida, Mitsuru; Yoshitake, Isamu; Hattori, Tsutomu; Wakui, Shinji; Taoka, Makoto; Negishi, Nanao; Sezai, Yukiyasu

    2006-01-01

    To evaluate the efficacy of a proton pump inhibitor, we retrospectively reviewed patients who underwent gastric fiberscopy (GFS) in the early phase after cardiac surgery. The subjects were 103 patients who underwent GFS for poor appetite, gastric pain, heartburn, or hematemesis after cardiac surgery. We divided the patients into two groups: group I consisted of 49 patients who received an H2-receptor antagonist (ranitidine hydrochloride 300 mg/day), and group II consisted of 54 patients who received a proton pump inhibitor (PPI; sodium rabeprazole 10 mg/day) as prophylactic treatment. The incidence of upper gastrointestinal (GI) disease was compared in the two groups. Gastric fiberscopy confirmed that 82.5% of the patients had type I hiatal hernia. The incidences of gastric pain and heartburn were significantly higher in group I (12.2% and 83.7%) than in group II (0% and 37.0%). Moreover, gastric bleeding occurred in two patients from group I, one [corrected] of whom died of coagulopathy. The incidences of hemorrhagic gastritis, active ulcer, and reflux esophagitis were significantly higher in group I than in group II, at 22.4%, 22.4%, and 24.5% vs 1.9%, 0%, and 7.4%. Early postcardiotomy GFS confirmed a high incidence of type I hiatal hernia. However, the proton pump inhibitor given in the early postoperative period proved more effective than the H2-receptor antagonist for relieving GI symptoms and preventing upper GI disorders after cardiac surgery.

  15. The contribution of hiatal hernia to severe gastroesophageal reflux disease in patients with gastroschisis.

    PubMed

    Tsai, Jacqueline; Blinman, Thane A; Collins, Joy L; Laje, Pablo; Hedrick, Holly L; Adzick, N Scott; Flake, Alan W

    2014-03-01

    A relationship between gastroschisis-associated gastroesophageal reflux (GER) and hiatal hernia (HH) has not been previously reported. In reviewing our experience with gastroschisis-related GER, we noted a surprising incidence of associated HH in patients requiring antireflux procedures. A single center retrospective chart review focused on GER in all gastroschisis patients repaired between January 1, 2000 and December 31, 2012 was performed. Of the 141 patients surviving initial gastroschisis repair and hospitalization, 16 (11.3%) were noted to have an associated HH (12 Type I, 3 Type II, 1 Type III) on upper gastrointestinal series for severe reflux. Ten of the 13 (76.9%) patients who required an antireflux procedure had an associated HH. The time to initiation of feeds was similar in all patients, 19 and 23 days. However, time to full feedings and discharge was delayed until a median of 80 and 96 days, respectively, in HH patients. This study describes a high incidence of associated HH in gastroschisis patients. The presence of large associated HH correlated with severe GER, delayed feeding, requirement for antireflux surgery, and a prolonged hospital stay. Patients with gastroschisis and clinically severe GER should undergo early assessment for associated HH. © 2013.

  16. Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study.

    PubMed

    Tolboom, Robert C; Draaisma, Werner A; Broeders, Ivo A M J

    2016-03-01

    Surgery for refractory gastroesophageal reflux disease (GERD) and hiatal hernia leads to recurrence or persisting dysphagia in a minority of patients. Redo antireflux surgery in GERD and hiatal hernia is known for higher morbidity and mortality. This study aims to evaluate conventional versus robot-assisted laparoscopic redo antireflux surgery, with the objective to detect possible advantages for the robot-assisted approach. A single institute cohort of 75 patients who underwent either conventional laparoscopic or robot-assisted laparoscopic redo surgery for recurrent GERD or severe dysphagia between 2008 and 2013 were included in the study. Baseline characteristics, symptoms, medical history, procedural data, hospital stay, complications and outcome were prospectively gathered. The main indications for redo surgery were dysphagia, pyrosis or a combination of both in combination with a proven anatomic abnormality. The mean time to redo surgery was 1.9 and 2.0 years after primary surgery for the conventional and robot-assisted groups, respectively. The number of conversions was lower in the robot-assisted group compared to conventional laparoscopy (1/45 vs. 5/30, p = 0.035) despite a higher proportion of patients with previous surgery by laparotomy (9/45 vs. 1/30, p = 0.038). Median hospital stay was reduced by 1 day (3 vs. 4, p = 0.042). There were no differences in mortality, complications or outcome. Robotic support, when available, can be regarded beneficial in redo surgery for GERD and hiatal hernia. Results of this observational study suggest technical feasibility for minimal-invasive robot-assisted redo surgery after open primary antireflux surgery, a reduced number of conversions and shorter hospital stay.

  17. Laparoscopic Repair and Percutaneous Endoscopic Gastrostomy to Treat Giant Esophageal Hiatal Hernia with Gastric Obstruction: A Case Report.

    PubMed

    Hamai, Yoichi; Hihara, Jun; Tanabe, Kazuaki; Furukawa, Takaoki; Yamakita, Ichiko; Ibuki, Yuta; Okada, Morihito

    2015-06-01

    We describe a 74-year-old man with repeated aspiration pneumonia who developed gastric obstruction due to giant esophageal hiatal hernia (EHH). We repaired the giant EHH by laparoscopic surgery and subsequently anchored the stomach to the abdominal wall by percutaneous endoscopic gastrostomy (PEG) using gastrofiberscopy. Thereafter, the patient resumed oral intake and was discharged on postoperative day 21. At two years after these procedures, the patient has adequate oral intake and lives at home. Because this condition occurs more frequently in the elderly with comorbidities, laparoscopic surgery contributes to minimally invasive treatment. Furthermore, the procedure combined with concurrent gastropexy via PEG is useful for treating patients who have difficulty swallowing and for preventing recurrent hernia.

  18. Temporal patterns of hiatus hernia recurrence and hiatal failure: quality of life and recurrence after revision surgery.

    PubMed

    Suppiah, A; Sirimanna, P; Vivian, S J; O'Donnell, H; Lee, G; Falk, G L

    2017-04-01

    Antireflux and paraesophageal hernia repair surgery is increasingly performed and there is an increased requirement for revision hiatus hernia surgery. There are no reports on the changes in types of failures and/or the variations in location of crural defects over time following primary surgery and limited reports on the outcomes of revision surgery. The aim of this study is to report the changes in types of hernia recurrence and location of crural defects following primary surgery, to test our hypothesis of the temporal events leading to hiatal recurrence and aid prevention. Quality of life scores following revision surgery are also reported, in one of the largest and longest follow-up series in revision hiatus surgery. Review of a single-surgeon database of all revision hiatal surgery between 1992 and 2015. The type of recurrence and the location of crural defect were noted intraoperatively. Recurrence was diagnosed on gastroscopy and/or contrast study. Quality of life outcomes were measured using Visick, dysphagia, atypical reflux symptoms, satisfaction scores, and Gastrointestinal Quality of Life Index (GIQLI). Two-hundred eighty four patients (126 male, 158 female), median age 60.8(48.2-69.1), underwent revision hiatal surgery. Median follow-up following primary surgery was 122.8(75.3-180.3) and 91.6(40.5-152.5) months after revision surgery. The most common type of hernia recurrence in the early period after primary surgery was 'telescope'(42.9%), but overall, fundoplication apparatus transhiatal migration was consistently the predominant type of recurrence at 1-3 years (54.3%), 3-5 years (42.5%), 5-10 years (45.1%), and >10 years (44.1%). The location of crural defects changed over duration following primary surgery as anteroposterior defects was most common in the early period (45.5% in <1 year) but decreased over time (30.3% at 1-3 years) while anterior defects increased in the long term with 35.9%, 40%, and 42.2% at 3-5 years, 5-10 years, and >10 years

  19. Incarceration of a large cell neuroendocrine carcinoma arising from the proximal stomach with an organoaxial gastric volvulus through an esophageal hiatal hernia: report of a case.

    PubMed

    Iso, Yukihiro; Tagaya, Nobumi; Nemoto, Takehiko; Kita, Junji; Sawada, Tokihiko; Kubota, Keiichi

    2009-01-01

    An 86-year-old woman was admitted to the hospital to undergo an examination for tarry stools. Laboratory tests showed hypoproteinemia and renal dysfunction. Upper gastrointestinal endoscopy demonstrated a type 5 tumor located in the upper body of the stomach. An upper gastrointestinal series and computed tomography revealed an organoaxial gastric volvulus and the dislocation of the proximal stomach through an esophageal hiatal hernia. The preoperative diagnosis was the incarceration of a gastric carcinoma arising from the proximal stomach with an organoaxial gastric volvulus through an esophageal hiatal hernia. A total gastrectomy and hernia repair were performed. A microscopic examination of the surgical specimen revealed a gastric large cell neuroendocrine carcinoma (GLCNEC). The patient was discharged 22 days after the surgery. Although the prognosis of GLCNEC is significantly worse than that of a conventional adenocarcinoma, the patient was doing well without recurrence at 15 months after surgery. The details of this case are reported with some bibliographical comments.

  20. Hiatal hernia and gastroesophageal reflux: Study of collagen in the phrenoesophageal ligament.

    PubMed

    von Diemen, V; Trindade, E N; Trindade, M R M

    2016-11-01

    Gastroesophageal reflux disease (GERD) is defined by the intensity and/or quality of the reflux of gastric or duodenal contents into the esophagus. Surgical treatment of GERD has shown conflicting results and unacceptable recurrence rates, mainly due to herniation of the antireflux valve into the chest. A variety of techniques has been proposed to reduce GERD recurrence, including routine use of prosthesis in cruroplasty. The prevalence of GERD in patients with hiatal hernia (HH) can reach 94 %. It is possible that the phrenoesophageal ligament (POL) engaged in the stabilization of the gastroesophageal junction in the abdomen may be an etiological factor of HH. We conducted a study to evaluate collagen in the constitution of the POL in patients with HH and cadavers without HH. POL samples were collected from 29 patients with HH and GERD (cases) and 32 samples from cadavers without HH (controls). Total collagen was quantified through the Picrosirius red histochemical technique, and type-I and type-III collagens were quantified immunohistochemically using a monoclonal antibody. The stained slides were photographed, and images were quantified by computer software (Image Pro Plus) to count the pixels per field. The mean age was 49.5 (±11.5) years for the cases and 38.5 (±13) years for the controls (p < 0.01). Seventeen cases (58.6 %) and six controls (18.75 %) were female (p < 0.01). The quantity of total (p < 0.01), type-I (p < 0.01), and type-III (p < 0.05) collagens was significantly lower by about 60 % in patients with HH compared with controls. Our data indicate that the composition of POL for patients with GERD and HH includes less total, type-I, and type-III collagens than that of the POL of cadavers without HH. The quality of the POL may be an etiological factor in the development of HH.

  1. Severe Upper Gastrointestinal Hemorrhage from Linear Gastric Ulcers in Large Hiatal Hernias: a Large Prospective Case Series of Cameron Ulcers

    PubMed Central

    Camus, Marine; Jensen, Dennis M.; Ohning, Gordon V.; Kovacs, Thomas O.; Ghassemi, Kevin A.; Jutabha, Rome; Machicado, Gustavo A.; Dulai, Gareth S.; Hines, Joel O.

    2013-01-01

    Background and study aims Cameron ulcers are a rare but clinically significant cause of severe upper gastrointestinal hemorrhage (SUGIH). Our aims were to describe (1) the diagnosis, treatment and outcomes of patients with Cameron ulcers causing hospitalization for SUGIH, (2) the differences between patients with occult vs. overt bleeding and (3) between patients treated surgically and medically. Patients and methods Over the past 17 years, all consecutive patients hospitalized in our two tertiary referral medical centers for severe UGIH or severe obscure GIH and entered into our large prospective databasis were screened for Cameron ulcer diagnosis. Results Cameron ulcers were diagnosed in 25 patients of 3960 patients with SUGIH (0.6%). 21 patients had follow-up (median [IQR] time of 20.4 months [8.5–31.8]). Patients were more often elderly females with chronic anemia, always had large hiatal hernias, and were usually referred for obscure SUGIH. Twelve (57.2%) patients were referred to surgery for rebleeding and recurrent blood loss while treated with high dose of proton pump inhibitors (PPI). 9 (42.8%) other patients continued PPI without any rebleeding during the follow-up. Patients with overt bleeding had significantly more prior hospitalizations for SUGIH, more often stigmata of hemorrhage on ulcers, and more red blood cell transfusions than patients with occult bleeding. However, there was no difference in rebleeding and mortality rates between the two groups. Conclusions Cameron ulcers in large hiatal hernias are an uncommon cause of SUGIH. Most of patients are referred for obscure GIH. The choice of medical vs. surgical therapy should be individualized. PMID:23616128

  2. Long-term results and complications related to Crurasoft(®) mesh repair for paraesophageal hiatal hernias.

    PubMed

    Priego, P; Perez de Oteyza, J; Galindo, J; Carda, P; García-Moreno, F; Rodríguez Velasco, G; Lobo, E

    2017-04-01

    The application of mesh-reinforced hiatal closure has resulted in a significant reduction in recurrence rates in comparison with primary suture repair. However, the use of meshes has not completely extended in all the cases of large paraesophageal hiatal hernias (LPHH) due to the complications related to them. The aim of this study is to present our long-term results and complications related to Crurasoft(®) mesh (Bard) for the treatment of LPHH. From January 2004 to December 2014, 536 consecutive patients underwent open or laparoscopic fundoplication for gastroesophageal reflux disease or LPHH at Ramón y Cajal University Hospital. Primary simple suture of the crura and additional reinforcement with a Crurasoft(®) mesh (Bard) was performed in 93 patients (17.35 %). Radiologic hiatal hernia recurrence and mesh-related complications were investigated. Of the 93 patients undergoing mesh repair, there were 28 male and 65 female with a mean age of 67.27 years (range 22-87 years). Laparoscopic surgery was attended in 88.2 % of the cases, and open surgery in the rest 11.8 %. Mean operative time was 167.05 min (range 90-370 min). Median postoperative stay was 4.79 days (range 1-41 days). Conversion rate was 8.53 % (7 patients). Intraoperative complications were described in 10.75 % (10 patients), but all of them, except in one case, could be managed laparoscopically. Overall postoperative complications rate was 28 %. Early postoperative complications occurred in 11 patients (12 %), respectively, for grades 2 (6 cases), 3b (1 case) and 5 (4 cases) according to the Clavien-Dindo classification. Late postoperative complications occurred in 15 patients (16 %), respectively, for grades 1 (7 cases), 2 (2 cases), 3b (5 cases) and 5 (1 case) according to the Clavien-Dindo classification. Thirty day-mortality rate was 4.3 %. Mortality rate specific associated with the mesh was 1 %. Reoperation rate was 5.4 %. After a median follow-up of 76.33 months (range 3

  3. Recorded lower esophageal pressures as a function of electronic sleeve placement and location of gastric pressure measurement in patients with hiatal hernia.

    PubMed

    Basseri, Benjamin; Pimentel, Mark; Chang, Christopher; Soffer, Edy E; Conklin, Jeffrey L

    2013-10-01

    In high-resolution manometry lower esophageal sphincter pressure (LESP) is measured relative to intragastric pressure, however Gastric Marker™ (GM) location used to determine resting LESP is not well established with hiatal hernia (HH). We test the hypothesis that measured resting LESP varies with HH based on GM location. Subjects with HH ≥ 2 cm were included. The eSleeve™ was adjusted to span only the LES, excluding the crural diaphragm (CD). Resting LESP was determined by placing the GM below and above the CD (in the position yielding the highest resting LESP). Resting pressure across the lower esophageal sphincter (LES) to CD and pressure in the HH relative to subdiaphragmatic intragastric pressure were also measured. HH ≥ 2 cm was present in 98 patients (mean length 2.7 cm). LESP decreased when GM was moved from below the CD into the HH: respiratory minimum LESP 7.5 ± 1.1 to 3.6 ± 0.9 mmHg; P < 0.001, mean LESP 17.7 ± 1.3 to 13.7 ± 1.1 mmHg; P < 0.001. When the eSleeve encompassed the LES and CD, the respiratory minimum pressure was 12.2 ± 0.9 mmHg and mean pressure was 23.9 ± 1.0 mmHg pressure (P < 0.001 for both). Pressure in the hernia pouch was greater than intragastric pressure: respiratory minimum 3.0 ± 0.7 mmHg and mean 9.0 ± 0.8 mmHg (P < 0.001 for both). pH studies showed a trend toward an association between abnormal distal esophagus acid exposure and lower resting LESP. GM placement in the HH produces lower resting LESPs. This may provide a more physiologic representation of LESP in HH.

  4. [Severe kyphosis and esophagus hiatal hernia affected in the levodopa absorption of a patient with Parkinson's disease].

    PubMed

    Chihara, Norio; Yamamoto, Toshiyuki; Lin, Youwei; Tsukamoto, Tadashi; Ogawa, Masafumi; Murata, Miho

    2009-08-01

    An 82 year-old woman with Parkinson's disease complained of a tendency to fall. She has had an extensive kyphosis since she was 66 years old. Over the last 6 months, she has repeatedly fallen. Even though she took anti-parkisonian drugs, she had also developed camptocormia. Her plasma levodopa concentration was analyzed for 4 hrs after administrating an oral dose of levodopa (200 mg) plus carbidopa (20 mg) at the time of fasting. The change in the plasma levodopa concentration showed bimodal peaks. The physical symptoms depended on the plasma concentration and improved twice. Esophageal tortuosity and esophageal hiatal hernia were detected by esophagography and upper gastric endoscopy. Such physical symptoms were speculated to have been caused by the transit disturbance of the drug in the gastrointestinal duct. During a second analysis of the plasma levodopa concentration, the patient was instructed to keep extending her back after consuming the same dose of drugs but with a greater amount of water than in the first analysis. A single and a higher peak were observed for the plasma levodopa concentration, and the physical symptoms, including camptocormia and parkinsonism, were improved. Hunched posture could influence the absorption of antiparkinsonian drugs.

  5. Gastroesophageal pressure gradients in gastroesophageal reflux disease: relations with hiatal hernia, body mass index, and esophageal acid exposure.

    PubMed

    de Vries, Durk R; van Herwaarden, Margot A; Smout, André J P M; Samsom, Melvin

    2008-06-01

    The roles of intragastric pressure (IGP), intraesophageal pressure (IEP), gastroesophageal pressure gradient (GEPG), and body mass index (BMI) in the pathophysiology of gastroesophageal reflux disease (GERD) and hiatal hernia (HH) are only partly understood. In total, 149 GERD patients underwent stationary esophageal manometry, 24-h pH-metry, and endoscopy. One hundred three patients had HH. Linear regression analysis showed that each kilogram per square meter of BMI caused a 0.047-kPa increase in inspiratory IGP (95% confidence interval [CI] 0.026-0.067) and a 0.031-kPa increase in inspiratory GEPG (95% CI 0.007-0.055). Each kilogram per square meter of BMI caused expiratory IGP to increase with 0.043 kPa (95% CI 0.025-0.060) and expiratory IEP with 0.052 kPa (95% CI 0.027-0.077). Each added year of age caused inspiratory IEP to decrease by 0.008 kPa (95% CI -0.015-0.001) and inspiratory GEPG to increase by 0.008 kPa (95% CI 0.000-0.015). In binary logistic regression analysis, HH was predicted by inspiratory and expiratory IGP (odds ratio [OR] 2.93 and 2.62, respectively), inspiratory and expiratory GEPG (OR 3.19 and 2.68, respectively), and BMI (OR 1.72/5 kg/m(2)). In linear regression analysis, HH caused an average 5.09% increase in supine acid exposure (95% CI 0.96-9.22) and an average 3.46% increase in total acid exposure (95% CI 0.82-6.09). Each added year of age caused an average 0.10% increase in upright acid exposure and a 0.09% increase in total acid exposure (95% CI 0.00-0.20 and 0.00-0.18). BMI predicts IGP, inspiratory GEPG, and expiratory IEP. Age predicts inspiratory IEP and GEPG. Presence of HH is predicted by IGP, GEPG, and BMI. GEPG is not associated with acid exposure.

  6. Mechanisms of Barrett's oesophagus (clinical): LOS dysfunction, hiatal hernia, peristaltic defects.

    PubMed

    Roman, Sabine; Kahrilas, Peter J

    2015-02-01

    Barrett's oesophagus, with the potential to develop into oesophageal adenocarcinoma (OAC), is a major complication of gastrooesophageal reflux disease (GORD). However, about 50% of patients developing OAC had no known GORD beforehand. Hence, while GORD symptoms, oesophagitis, and Barrett's have a number of common determinants (oesophagogastric junction (OGJ) incompetence, impaired oesophageal clearance mechanisms, hiatus hernia) they also have some independent determinants. Further, although excess oesophageal acid exposure plays a major role in the genesis of long-segment Barrett's oesophagus there is minimal evidence supporting this for short-segment Barrett's. Hence, these may have unique pathophysiological features as well. Long-segment Barrett's seems to share most, if not all, of the risk factors for oesophagitis, particularly high-grade oesophagitis. However, it is uncertain if OGJ function and acid clearance are more severely impaired in patients with long-segment Barrett's compared to patients with high-grade oesophagitis. With respect to short-segment Barrett's, the acid pocket may play an important pathogenic role. Conceptually, extension of the acid pocket into the distal oesophagus, also known as intra-sphincteric reflux, provides a mechanism or acid exposure of the distal osophageal mucosa without the occurrence of discrete reflux events, which are more likely to prompt reflux symptoms and lead to the development of oesophagitis. Hence, intra-sphincteric reflux related to extension of the acid/no acid interface at the proximal margin of the acid pocket may be key in the development of short segment Barrett's. However, currently this is still somewhat speculative and further studies are required to confirm this. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Mechanisms of Barrett’s esophagus (clinical): LES dysfunction, hiatal hernia, peristaltic defects

    PubMed Central

    Roman, Sabine; Kahrilas, Peter J

    2014-01-01

    Summary Barrett’s esophagus, with the potential to develop into esophageal adenocarcinoma (EAC), is a major complication of gastroesophageal reflux disease (GERD). However, about 50% of patients developing EAC had no known GERD beforehand. Hence, while GERD symptoms, esophagitis, and Barrett’s have a number of common determinants (esophagogastric junction (EGJ) incompetence, impaired esophageal clearance mechanisms, hiatus hernia) they also have some independent determinants. Further, although excess esophageal acid exposure plays a major role in the genesis of long-segment Barrett’s esophagus there is minimal evidence supporting this for short-segment Barrett’s. Hence, these may have unique pathophysiological features as well. Long-segment Barrett’s seems to share most, if not all, of the risk factors for esophagitis, particularly high-grade esophagitis. However, it is uncertain if EGJ function and acid clearance are more severely impaired in patients with long-segment Barrett’s compared to patients with high-grade esophagitis. With respect to short-segment Barrett’s, the acid pocket may play an important pathogenic role. Conceptually, extension of the acid pocket into the distal esophagus, also known as intra-sphincteric reflux, provides a mechanism or acid exposure of the distal esophageal mucosa without the occurrence of discrete reflux events, which are more likely to prompt reflux symptoms and lead to the development of esophagitis. Hence, intra-sphincteric reflux related to extension of the acid/no acid interface at the proximal margin of the acid pocket may be key in the development of short segment Barrett’s. However, currently this is still somewhat speculative and further studies are required to confirm this. PMID:25743453

  8. Cameron lesions in patients with hiatal hernias: prevalence, presentation, and treatment outcome.

    PubMed

    Gray, D M; Kushnir, V; Kalra, G; Rosenstock, A; Alsakka, M A; Patel, A; Sayuk, G; Gyawali, C P

    2015-07-01

    Cameron lesions, as defined by erosions and ulcerations at the diaphragmatic hiatus, are found in the setting of gastrointestinal (GI) bleeding in patients with a hiatus hernia (HH). The study aim was to determine the epidemiology and clinical manifestations of Cameron lesions. We performed a retrospective cohort study evaluating consecutive patients undergoing upper endoscopy over a 2-year period. Endoscopy reports were systematically reviewed to determine the presence or absence of Cameron lesions and HH. Inpatient and outpatient records were reviewed to determine prevalence, risk factors, and outcome of medical treatment of Cameron lesions. Of 8260 upper endoscopic examinations, 1306 (20.2%) reported an HH. When categorized by size, 65.6% of HH were small (<3 cm), 23.0% moderate (3-4.9 cm), and 11.4% were large (≥5 cm). Of these, 43 patients (mean age 65.2 years, 49% female) had Cameron lesions, with a prevalence of 3.3% in the presence of HH. Prevalence was highest with large HH (12.8%). On univariate analysis, large HH, frequent non-steroidal anti-inflammatory drug (NSAID) use, GI bleeding (both occult and overt), and nadir hemoglobin level were significantly greater with Cameron lesions compared with HH without Cameron lesions (P ≤ 0.03). Large HH size and NSAID use were identified as independent risk factors for Cameron lesions on multivariate logistic regression analysis. Cameron lesions are more prevalent in the setting of large HH and NSAID use, can be associated with GI bleeding, and can respond to medical management. © 2014 International Society for Diseases of the Esophagus.

  9. Surgery for Type III-IV hiatal hernia: anatomical recurrence and global results after elective treatment of short oesophagus with open and minimally invasive surgery.

    PubMed

    Lugaresi, Marialuisa; Mattioli, Benedetta; Daddi, Niccolò; Di Simone, Massimo Pierluigi; Perrone, Ottorino; Mattioli, Sandro

    2016-04-01

    Type III-IV hiatal hernia (HH) is associated with a true short oesophagus in more than 50% of cases; dedicated treatment of this condition might be appropriate to reduce the recurrence rate after surgery. A case series of patients receiving surgery for Type III-IV hernia was examined for short oesophagus, and the results were analysed. From 1980 to 1994, 60 patients underwent an open surgical approach, and the position of the oesophago-gastric junction was visually localized; from 1995 to 2013, 48 patients underwent a minimally invasive approach, and the oesophago-gastric junction was objectively localized using a laparoscopic-endoscopic method. The patients underwent a timed clinical-instrumental follow-up that included symptoms assessment, barium swallow and endoscopy. The results were considered to be excellent in the absence of symptoms and oesophagitis; good, if symptoms occurred two to four times a month in the absence of oesophagitis; fair, if symptoms occurred two to four times a week in the presence of hyperaemia, oedema and/or microscopic oesophagitis; and poor, if symptoms occurred on a daily basis in the presence of any grade of endoscopic oesophagitis, HH of any size or type, or the need for antireflux medical therapy. The follow-up time was calculated from the time of surgery to the last complete follow-up. Among the open surgery patients, 78% underwent abdominal fundoplication, 10% the Belsey Mark IV procedure, 8% laparotomic Collis-Nissen fundoplication and 3% the Pearson operation. Among the minimally invasive surgery patients, 44% underwent a laparoscopic floppy Nissen procedure and 56% a left thoracoscopic Collis-laparoscopic Nissen procedure. The postoperative mortality and complication rates were 1.6% (1/60) and 15% for open surgery and 4.1% (2/48) and 12.5% for minimally invasive surgery. A total of 105 patients were followed up for a median period of 96 months. Five relapses occurred after open surgery (5/59, 8%) and two after minimally

  10. Small volume acid reflux in gastroesophageal reflux disease patients with hiatal hernia is only detectable by pH-metry but not by multichannel intraluminal impedance.

    PubMed

    Weigt, J; Malfertheiner, P

    2013-07-01

    Until now, it is uncertain if the so-called pH-only reflux episodes that consist of a pH drop without evidence of retrograde bolus movement in multichannel intraluminal impedance (MII) represent reflux episodes or artifacts. Hiatal hernia (HH) may allow reflux of small volumes to occur that can be detected by pH-metry but not by MII. The aim was to search for a mechanism that can explain pH-only reflux, 20 patients (12 females and 8 males, median age 52 years, interquartile range [IQR]: 40.5-60.75 years) were investigated with MII-pH off PPI. Impedance and pH-metry data were analyzed separately. The differences in detection rate of acid reflux between pH-metry and MII were correlated with the presence of HH. In an in vitro experiment, MII-pH probes were flushed with citric acid in plastic tubes of different size with capillary diameter and diameters of 2.5 mm and 4.5 mm, while recording pH values and impedance. HH was present in six patients and absent in 14 patients. In patients with HH in comparison with patients with absent HH, the difference of acid reflux detection between pH-metry and MII is significantly higher (70%, IQR: 15-88% and 3.6%, IQR: 0-31%, respectively). In vitro all simulated reflux lead to a fall in pH whereas a corresponding decrease in impedance was only recognizable in the 4.5-mm plastic tubes. Acid reflux episodes in patients with HH are more frequently detected by pH-metry than by MII. Small volume reflux that does not lead to a decrease in impedance is the likely explanation for this phenomenon. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  11. [Difficult endoscopic extraction: pneumomediastinum and bilateral pneumothorax after attempted endoscopic extraction of needle incarcerated in hiatal hernia].

    PubMed

    Scamporrino, A; Mongardini, M; Stagnitti, F; Corona, F; Costantini, A; Priore, F M; Tiberi, R; Iannetti, A; Occhigrossi, G

    2002-01-01

    From June 1987 to April 2000, 167 (74%) of 223 patients suspected of swallowing foreign bodies were treated. Hundred-sixty-three were successfully treated endoscopically. The surgery rate was 2.4%. There was failure to remove a tablespoon, a tooth-brush, a dental prostheses with metallic hook, a knitting-needle. The sharp and pointed foreign bodies were 35 (20.9%). Endoscopic removal of sharp and pointed foreign bodies in the upper gastrointestinal tract can be very difficult to manage. The Authors report iatrogenic perforation of esophagus-gastric-fundus in a patient with hiatus hernia who ingested a big knitting-needle in order to suicide. They think that it is absolutely necessary to use special endoscopic equipment during the taking out of foreign-body procedure, especially when pointed and sharp-edge shaped bodies are involved and when there is high risk of iatrogenic lesions.

  12. Unusual Diaphragmatic Hernias Mimicking Cardiac Masses

    PubMed Central

    Kim, Si Hun; Kim, Myoung Gun; Kim, Su Ji; Moon, Jeonggeun; Kang, Woong Chol; Shin, Mi-Seung

    2015-01-01

    Hiatal hernia and Morgagni hernia are sorts of diaphragmatic hernias that are rarely detected on transthoracic echocardiography. Although echocardiographic findings have an important role for differential diagnosis of cardiac masses, we often might overlook diaphragmatic hernia. We report three cases of diaphragmatic hernias having specific features. The first case is huge hiatal hernia that encroaches left atrium with internal swirling flow on transthoracic echocardiography. The second case is a hiatal hernia that encroaches on both atria, incidentally detected on preoperative echocardiography. The third case is Morgagni hernia which encroaches on the right atrium only. So, we need to consider possibility of diaphragmatic hernia when we find a cardiac mass with specific echocardiographic features. PMID:26140154

  13. Results of left thoracoscopic Collis gastroplasty with laparoscopic Nissen fundoplication for the surgical treatment of true short oesophagus in gastro-oesophageal reflux disease and Type III-IV hiatal hernia.

    PubMed

    Lugaresi, Marialuisa; Mattioli, Benedetta; Perrone, Ottorino; Daddi, Niccolò; Di Simone, Massimo Pierluigi; Mattioli, Sandro

    2016-01-01

    Controversy exists regarding surgery for true short oesophagus (TSOE). We compared the results of thoracoscopic Collis gastroplasty-laparoscopic Nissen procedure for the treatment of TSOE with the results of standard laparoscopic Nissen fundoplication. Between 1995 and 2013, the Collis-Nissen procedure was performed in 65 patients who underwent minimally invasive surgery when the length of the abdominal oesophagus, measured intraoperatively after maximal oesophageal mediastinal mobilization, was ≤1.5 cm. The results of the Collis-Nissen procedure were frequency-matched according to age, sex and period of surgical treatment with those of 65 standard Nissen fundoplication procedures in patients with a length of the abdominal oesophagus >1.5 cm. Postoperative mortality and morbidity were evaluated according to the Accordion classification. The patients underwent a timed clinical-instrumental follow-up that included symptoms assessment, barium swallow and endoscopy. Symptoms, oesophagitis and global results were graded according to semi-quantitative scales. The results were considered to be excellent in the absence of symptoms and oesophagitis, good if symptoms occurred two to four times a month in the absence of oesophagitis, fair if symptoms occurred two to four times a week in the presence of hyperaemia, oedema and/or microscopic oesophagitis and poor if symptoms occurred on a daily basis in the presence of any grade of endoscopic oesophagitis, hiatal hernia of any size or type, or the need for antireflux medical therapy. The follow-up time was calculated from the time of surgery to the last complete follow-up. The postoperative mortality rate was 1.5% for the Collis-Nissen and 0 for the Nissen procedure. The postoperative complication rate was 24% for the Collis-Nissen and 7% for Nissen (P = 0.001) procedure. The complication rate for the Collis-Nissen procedure was 43% in the first 32 cases and 6% in the last 33 cases (P < 0.0001). The median follow-up period

  14. Gastroesophageal reflux in laparoscopic sleeve gastrectomy: hiatal findings and their management influence outcome.

    PubMed

    Lyon, A; Gibson, S C; De-loyde, K; Martin, D

    2015-01-01

    Sleeve gastrectomy (SG) has become a definitive treatment for morbid obesity. There is conflicting evidence on the effects of SG on gastroesophageal reflux disease (GERD). The objective of this study was to assess whether taking an aggressive approach to managing hiatal weakness in patients undergoing SG results in an alteration in GERD symptoms. Tertiary public hospital and private hospital, Sydney, Australia. Patients undergoing laparoscopic extended (beginning within 2 cm from pylorus) SG were included. If evidence of weakness was present, an anterior hiatal dissection and tight suture repair was performed. If a hiatus hernia was present, formal repair was undertaken. Patients were questioned and scored on preoperative and postoperative reflux symptom frequency and severity, proton pump inhibitor (PPI) usage, current weight, and satisfaction. A continuous cohort of 262 patients experienced a significant reduction in heartburn frequency (P = .035) and severity (P = .017). Moderate/severe preoperative reflux (Visick score 3 and 4) often improved whether there was a defect requiring repair or not (no repair P = .02, hiatal suture P = .001, hiatus hernia repair P<.001). The severity of symptoms also improved (no repair P = 0.005, hiatal suture P<.001, hiatus hernia repair P< .001). Moderate or severe preexisting gastroesophageal reflux improved for most of our obese patients undergoing an extended SG when hiatal defects were routinely repaired. Moderate to severe preoperative reflux also improved in the average obese patient when there was no hiatal defect to repair. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  15. 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.

  16. Laparoscopic surgery of esophageal hiatus hernia – single center experience

    PubMed Central

    Piątkowski, Jacek; Jackowski, Marek

    2014-01-01

    Introduction Esophageal hiatal hernias are the most frequent types of internal hernias. This condition involves disturbance of normal functioning of the stomach cardiac mechanism and reflux of the gastric contents to the esophagus. Aim: To evaluate postoperative results in our Clinic and the comparison of these results to data from the literature. Material and methods One hundred and seventy-eight patients underwent surgery due to esophageal hiatal hernia at the Clinic of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland, from 2006 to 2011. All operations were performed using laparoscopy. Fundoplication by means of the Nissen-Rossetti method was carried out in 172 patients while Toupet's and Dor's methods were applied in 4 and 2 patients, respectively. Results Average time of the surgery was 82 min (55–140 min). Conversion was performed in 4 cases. No serious intraoperative complications were noted. In the postoperative period, dysphagia was reported in 20 patients (11.2%). Postoperative wound infection was observed in 1 patient (0.56%). Hernias in the trocar insertion area were reported in 3 patients (1.68%). Ailments recurred in 6 patients. The recurrence of esophageal hiatal hernia was confirmed in 2 patients. Patients with recurrent hernia were re-operated using a laparoscopic approach. Conclusions Laparoscopic surgery is a simple and effective approach for patients with gastroesophageal reflux symptoms due to diaphragmatic esophageal hiatus hernia. The number of complications is lower after laparoscopic procedures than after “open” operations. PMID:24729804

  17. Inguinal Hernia

    MedlinePlus

    ... for hernias are Open hernia repair. During an open hernia repair, a health care provider usually gives a patient local anesthesia in the abdomen with sedation; however, some patients may have sedation ...

  18. Cameron Ulcer Causing Severe Anemia in a Patient with Diaphragmatic Hernia

    PubMed Central

    Gupta, Prashant; Suryadevara, Madhu; Das, Avash; Falterman, James

    2015-01-01

    Patient: Female, 51 Final Diagnosis: Cameron’s ulcer Symptoms: — Medication: — Clinical Procedure: Endoscopy Specialty: Gastroenterology and Hepatology Objective: Rare co-existance of disease or pathology Background: Cameron lesions are linear gastric erosions on the mucosal folds at the diaphragmatic impressions found in patients with large hiatal hernias. While usually asymptomatic, hiatal hernias can result in serious sequelae, as this case report will clearly illustrate. Cameron lesions are clinically significant because of their ability to cause significant acute, chronic, or obscure gastrointestinal bleeding, often requiring blood transfusions. Case Report: In this report, we present the case of a 51-year-old white woman who originally presented to the Emergency Department with complaints of a runny nose, dry cough, generalized weakness, and muscle cramping ascribed to a viral infection. However, closer examination revealed substantial pallor with pale conjunctiva prompting further workup that revealed substantial anaemia. Upon further inquiry of her past medical history, she revealed the need for previous blood transfusions, and meticulous review of her medical record indicated a previous diagnosis of hiatal hernia with the presence of Cameron lesions based on esophagogastroduodenoscopy 2 years prior. Conclusions: This case emphasizes the need for a high index of suspicion for Cameron lesions as a causative agent of substantial blood loss in patients with hiatal hernias after other common causes of gastrointestinal bleeding have been ruled out. PMID:26467083

  19. 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

  20. Bladder hernia.

    PubMed

    Nicola, Massimiliano; De Luca, Francesco

    2006-06-01

    Bladder hernia is a rare condition, but crural herniation of the bladder into the scrotum is very rare. A case of bladder hernia presenting with urological symptoms is described. A 71-year-old man presented to the urological ward complaining for persistent frequency and nocturia associated with loss offorce and decrease of caliber of the urinary stream and the presence of a large mass of the right scrotum. An IVP (intra venous pyelography) showed a large herniation of the bladder through the right inguinal canal into the scrotum. An inguinal incision was made and a crural hernia was identified. The hernia sac, containing bowel and bladder, was dissectedfreefrom the spermatic cord and the testis and the hernia defect was repaired.

  1. Epigastric Hernia.

    PubMed

    Suarez Acosta, Carlos Enrique; Romero Fernandez, Esperanza; Calvo Manuel, Elpidio

    2015-08-01

    Epigastric hernia is a common condition, mostly asymptomatic although sometimes their unusual clinical presentation still represents a diagnostic dilemma for clinician. The theory of extra tension in the epigastric region by the diaphragm is the most likely theory of epigastric hernia formation. A detailed history and clinical examination in our thin, elderly male patient who presented with abdominal pain and constipation of 5 days of evolution was crucial in establishing a diagnosis. Noninvasive radiologic modalities such as ultrasonographic studies in the case of our patient can reliably confirm the diagnosis of epigastric hernia.

  2. [Diaphragmatic hernia].

    PubMed

    Osmak, Liliana; Cougard, Patrick

    2003-10-15

    A diaphragmatic hernia is the protrusion of abdominal contents into the thoracic cavity, via a hole in the diaphragm, which either presence or size is abnormal. Congenital hernias are rare and often diagnosed at birth. Adults are diagnosed accidentally. Symptoms can be digestive or respiratory, and the risk of volvulus calls for surgery. Diaphragmatic ruptures are seen more often, and are a consequence of violent thoraco-abdominal trauma, or penetrating wound. They should be treated surgically in emergency, but the operation can be delayed if they are not diagnosed at once. Videosurgery has been used more and more often recently to treat diaphragmatic hernias.

  3. Femoral hernia

    MedlinePlus

    ... or strain. Sometimes, the first symptoms are: Sudden groin pain Abdominal pain Nausea Vomiting This may mean that ... present with the hernia. If you feel sudden pain in your groin, a piece of intestine may be stuck in ...

  4. Umbilical Hernia

    MedlinePlus

    ... complicated umbilical hernia with liver cirrhosis and ascites. International Journal of Surgery. 2014;12:181. Cameron JL, et al. In: Current Surgical Therapy. 11th ed. Philadelphia, Pa.: Saunders Elsevier; ...

  5. Paraesophageal hernia with incarceration of the gastric antrum and duodenal bulb: a case report

    PubMed Central

    2013-01-01

    Background In cases of esophageal hernia, incarceration of peritoneal organs other than the stomach is rare. Case presentation An 84-year-old female was admitted to our institution with a complaint of nausea and vomiting. Abdominal computed tomography revealed an esophageal hiatal hernia with incarceration of the gastric antrum and duodenal bulb. Gastrofluorography under gastroendoscopy confirmed prolapse of the antrum and duodenal bulb into the esophageal hernial sac. Although gastroendoscopy guided repositioning of the prolapsed organs was successful, reprolapse occurred immediately. Therefore, surgical treatment was indicated. The gastric antrum and duodenal bulb were associated with a paraesophageal hernia. Therefore, they were repositioned, and passage from the duodenal bulb to the descending portion of the duodenum was improved. Conclusion We report a rare case of paraesophageal hernia with incarceration of the gastric antrum and duodenal bulb. PMID:24207166

  6. Hernias (For Parents)

    MedlinePlus

    ... usually required within a few days to prevent development of another incarcerated hernia. The most serious type of hernia is a strangulated hernia, in which the normal blood supply is cut off from the trapped tissue. ...

  7. Transfusion-Dependent Anaemia: An Overlooked Complication of Paraoesophageal Hernias

    PubMed Central

    Smith, Garett S.

    2014-01-01

    Introduction. A paraoesophageal hernia (PH) may be one reason for iron-deficiency anaemia (IDA) but is often overlooked as a cause. We aimed to assess the incidence and resolution of transfusion-dependent IDA in patients presenting for hiatal hernia surgery. Methods. We analysed a prospective database of patients undergoing laparoscopic hiatal repair in order to identify patients with severe IDA requiring red cell/iron transfusion. Results. Of 138 patients with PH managed over a 4-year period, 7 patients (5.1%; M : F 2 : 5; median age 62 yrs (range 57–82)) with IDA requiring red cell/iron transfusion were identified. Preoperatively, 3/7 patients underwent repetitive and unnecessary diagnostic endoscopic investigations prior to surgery. Only 2/7 ever demonstrated gastric mucosal erosions (Cameron ulcers). All patients were cured from anaemia postoperatively. Discussion. PH is an important differential diagnosis in patients with IDA, even those with marked anaemia and no endoscopically identifiable mucosal lesions. Early recognition can avoid unnecessary additional diagnostic endoscopies. Laparoscopic repair is associated with low morbidity and results in resolution of anaemia. PMID:27379280

  8. A new experimental method for hiatal reinforcement using connective tissue patch transfer.

    PubMed

    Vereczkei, A; Varga, G; Tornoczky, T; Papp, A; Horvath, Ö P

    2012-07-01

    The closure of a large hiatal hernia still represents a challenge for the surgeon. Mesh reinforcement of a hiatoplasty generally decreases recurrence rate. An artificial mesh is cheaper compared with a biologic one, but has a higher complication rate. Our aim was to introduce a new biologic reinforcement method with less expenses. During organ donation for transplantation, tissue islets from pericardium and fascia lata were cryopreserved in a tissue bank. Later, the grafts were transplanted on the diaphragm of mongrel dogs. After 1, 3, and 6 months, the animals were sacrificed, and the transplanted patches were macroscopically and microscopically examined. There were no macroscopic signs of inflammation, abcedation, or significant adhesion formation. The grafts were well recognizable, with palpable thickening and moderate shrinkage. Microscopically, an organization process with fibrosis, neovascularization, and peritoneal integration could be observed. Reinforcement of a hiatoplasty with connective tissue transfer either with cryopreserved or autologous tissue is a good option. This is a cheap and easy method, which should also be tested in human interventions. © 2011 Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  9. Incarcerated Pediatric Hernias.

    PubMed

    Abdulhai, Sophia A; Glenn, Ian C; Ponsky, Todd A

    2017-02-01

    Indirect inguinal hernias are the most commonly incarcerated hernias in children, with a higher incidence in low birth weight and premature infants. Contralateral groin exploration to evaluate for a patent processus vaginalis or subclinical hernia is controversial, given that most never progress to clinical hernias. Most indirect inguinal hernias can be reduced nonoperatively. It is recommended to repair them in a timely fashion, even in premature infants. Laparoscopic repair of incarcerated inguinal hernia repair is considered a safe and effective alternative to conventional open herniorrhaphy. Other incarcerated pediatric hernias are extremely rare and may be managed effectively with laparoscopy. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Para-oesophageal and parahiatal hernias in an Asian acute care tertiary hospital: an underappreciated surgical condition

    PubMed Central

    Koh, Ye Xin; Ong, Lester Wei Lin; Lee, June; Wong, Andrew Siang Yih

    2016-01-01

    INTRODUCTION The prevalence of hiatal hernias and para-oesophageal hernias (PEHs) is lower in Asian populations than in Western populations. Progressive herniation can result in giant PEHs, which are associated with significant morbidity. This article presents the experience of an Asian acute care tertiary hospital in the management of giant PEH and parahiatal hernia. METHODS Surgical records dated between January 2003 and January 2013 from the Department of Surgery, Changi General Hospital, Singapore, were retrospectively reviewed. RESULTS Ten patients underwent surgical repair for giant PEH or parahiatal hernia during the study period. Open surgery was performed for four patients with giant PEH who presented emergently, while elective laparoscopic repair was performed for six patients with either giant PEH or parahiatal hernia (which were preoperatively diagnosed as PEH). Anterior 180° partial fundoplication was performed in eight patients, and mesh reinforcement was used in six patients. The electively repaired patients had minimal or no symptoms during presentation. Gastric volvulus was observed in five patients. There were no cases of mortality. The median follow-up duration was 16.3 months. There were no cases of mesh erosion, complaints of dysphagia or recurrence of PEH in all patients. CONCLUSION Giant PEH and parahiatal hernia are underdiagnosed in Asia. Most patients with giant PEH or parahiatal hernia are asymptomatic; they often present emergently or are incidentally diagnosed. Although surgical outcomes are favourable even with a delayed diagnosis, there should be greater emphasis on early diagnosis and elective repair of these hernias. PMID:26778633

  11. Combined paraesophageal hernia repair and partial longitudinal gastrectomy in obese patients with symptomatic paraesophageal hernias.

    PubMed

    Rodriguez, John H; Kroh, Matthew; El-Hayek, Kevin; Timratana, Poochong; Chand, Bipan

    2012-12-01

    Obesity is a risk factor for gastroesophageal reflux disease and hiatal hernia. Studies have demonstrated poor symptom control in obese patients undergoing fundoplication. The ideal operation remains elusive. However, addressing both obesity and the anatomic abnormality should be the goal. This study retrospectively identified 19 obese (body mass index [BMI], >30 kg/m(2)) and morbidly obese (BMI, >40 kg/m(2)) patients who presented between December 2007 and November 2011 for management of large or recurrent paraesophageal hernia. All the patients underwent a combined primary paraesophageal hernia repair and longitudinal gastrectomy. Charts were retrospectively reviewed to collect preoperative, operative, and short-term postoperative results. Quantitative data were analyzed using Student's t test and qualitative data with χ(2) testing. Laparoscopy was successful for all 19 patients. The mean preoperative BMI was 37.8 ± 4.1 kg/m(2), and the mean operative time was 236 ± 80 min. Preoperative endoscopy showed that 5 patients who had undergone prior fundoplication experienced anatomic failures, whereas the remaining 14 patients had type 3 and one type 4 paraesophageal Hernia. Mesh was used to reinforce the hiatus in 15 of the 19 cases. The postoperative complications included pulmonary embolism (n = 1) and pulmonary decompensation (n = 2) due to underlying chronic obstructive pulmonary disease. The mean hospital stay was 5.3 ± 3 days. Upper gastrointestinal esophagography was performed for all the patients, with no short-term recurrence of paraesophageal hernia. Weight loss was seen for all the patients during the first month, with a mean BMI drop of 2.7 ± 1 kg/m(2). All the patients experienced near to total resolution of their preoperative symptoms within the first month. Combined laparoscopic paraesophageal hernia repair and longitudinal gastrectomy offer a safe and feasible approach for the management of large or recurrent paraesophageal

  12. Paraesophageal Hernia Repair With Partial Longitudinal Gastrectomy in Obese Patients

    PubMed Central

    Rodriguez, John; El-Hayek, Kevin; Brethauer, Stacy; Schauer, Philip; Zelisko, Andrea; Chand, Bipan; O'Rourke, Colin; Kroh, Matthew

    2015-01-01

    Background and Objectives: Treatment of gastroesophageal reflux disease (GERD) with hiatal hernia in obese patients has proven difficult, as studies demonstrate poor symptom control and high failure rates in this patient population. Recent data have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes. Methods: We retrospectively reviewed 28 obese and morbidly obese patients who presented from December 2007 through July 2013 with large or recurrent type 3 or 4 paraesophageal hernia. All of the patients underwent combined paraesophageal hernia repair and partial longitudinal gastrectomy. Charts were retrospectively reviewed, and the patients were contacted to determine symptomatic relief. Results: Mean preoperative body mass index was 38.1 ± 4.9 kg/m2. Anatomic failure of prior fundoplication occurred in 7 patients (25%). The remaining 21 had primary paraesophageal hernia, 3 of which were type 4. Postoperative complications included pulmonary embolism (n = 1), pulmonary decompensation (n = 2), and wound infection (n = 1). Mean hospital stay was 5 ± 3 days. Upper gastrointestinal esophagogram was performed in 21 patients with no immediate recurrence or staple line dehiscence. Mean excess weight loss was 44 ± 25%. All of the patients surveyed experienced near to total resolution of their preoperative symptoms within the first month. At 1 year, symptom scores decreased significantly. At 27 months, however, there was a mild increase in the scores. Return of severe symptoms occurred in 2 patients, both of whom underwent conversion to gastric bypass. Conclusions: Combined laparoscopic paraesophageal hernia repair with longitudinal partial gastrectomy offers a safe, feasible approach to the management of large or recurrent paraesophageal hernia in well-selected obese and morbidly obese patients. Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required

  13. Spontaneous Transomental Hernia

    PubMed Central

    Lee, Seung Hun

    2016-01-01

    A transomental hernia through the greater or lesser omentum is rare, accounting for approximately 4% of internal hernias. Transomental hernias are generally reported in patients aged over fifty. In such instances, acquired transomental hernias are usual, are commonly iatrogenic, and result from surgical interventions or from trauma or peritoneal inflammation. In rare cases, such as the one described in this study, internal hernias through the greater or lesser omentum occur spontaneously as the result of senile atrophy without history of surgery, trauma, or inflammation. A transomental hernia has a high postoperative mortality rate of 30%, and emergency diagnosis and treatment are critical. We report a case of a spontaneous transomental hernia of the small intestine causing intestinal obstruction. An internal hernia with strangulation of the small bowel in the lesser sac was suspected from the image study. After an emergency laparotomy, a transomental hernia was diagnosed. PMID:26962535

  14. [Laparoscopic treatment of para-esophageal hernias].

    PubMed

    Collet, D; Wagner, T; Sa Cunha, A; Rault, A; Masson, B

    2006-10-01

    This retrospective study aims at analyzing the functional results obtained in patients operated by laparoscopy for a para-esophageal hernia. From 1994 to 2004, 38 patients underwent a laparoscopic procedure for a symptomatic para-esophageal hiatal hernia of at least 3/4 of the proximal stomach: 27 females and 11 males, mean age 65 years (extreme: 22-84). There was no case on emergency, 4 patients had have at least one episode of intrathoracic volvulus. The operation consisted in gastric reduction into the abdominal cavity, excision of the sac, suture of the crura reinforced with a mesh in 6 patients and the construction of a gastric wrap. A postoperative barium swallow was performed on POD 3 in order to confirm the anatomical result. Mean operating time was 157 minutes (75-480), no case was converted into laparotomy. Four postoperative complications were observed (morbidity 10.8%): one gastric perforation diagnosed on POD 1, 2 severe dysphagias linked to the wrap, and one atelectasia. There was no death in this series. Functional results were evaluated by the mean of a questionnaire in 33 patients who had a follow up more than 6 months. Thirty-three questionnaires have been sent, 3 patients were lost and one was dead. Among the 29 patients analyzed, 14 were very satisfied, 11 were satisfied and 3 were deceived by the operation. Best results are obtained in patients with GERD, dysphagia or postprandial cardiothoracic symptoms. These results compared to the published data allow us to discuss about indications of surgery, the necessity to removal the hernia sac, and the advantages to reinforce the crura by the mean of a non absorbable mesh.

  15. Inguinal hernia (image)

    MedlinePlus

    Inguinal hernia is the result of an organ, usually bowel, protruding through a weak point or tear in the thin muscular abdominal wall. Inguinal hernias can restrict blood supply to the bowel herniated ...

  16. Umbilical hernia repair - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100105.htm Umbilical hernia repair - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Hernia A.D.A.M., Inc. is accredited by ...

  17. Retrosternal (Morgagni) diaphragmatic hernia

    PubMed Central

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

    2011-01-01

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

  18. Survey on ventral hernias: surgeon indications, contraindications, and management of large ventral hernias.

    PubMed

    Evans, Karen Kim; Chim, Harvey; Patel, Ketan M; Salgado, Christopher J; Mardini, Samir

    2012-04-01

    Repair of ventral hernias constitutes one of the most common surgical procedures. Although an abundance of data exists on objective outcome measures, very little information exists on subjective measures of surgeon preference and patient satisfaction in surgical management of ventral hernias. Moreover, there are minimal data on indications for elective repair of ventral hernias. Two questionnaires were sent to a population of general and plastic surgeons active in hernia surgery. The first of these aimed at gathering information from surgeons about their indications and contraindications for repair of ventral hernias. The second survey was aimed at determining surgeons' perception of patient satisfaction with repair of large ventral hernias (greater than 15 cm width). Five hundred sixty-eight surgeons responded to the first survey and 336 responded to the second survey. The most common indications for elective repair of abdominal wall hernias were generalized pain (68.7%) and cosmesis (54.6%), whereas the most common contraindications were morbid obesity (43.3%), American Society of Anesthesiologists Class III or IV (35.4%), and enterocutaneous fistula (33.1%). The majority of surgeons do not routinely repair large abdominal wall hernias in asymptomatic patients, but 31.6 per cent do repair asymptomatic large hernias. Most surgeons reported that the majority of patients had resolution of pain and subjective impression of improved cosmesis after surgery. This study demonstrates uniform indications and contraindications for surgical repair of ventral hernias among surgeons as well as surgeons' perception of improvements in satisfaction of most patients after surgery. Future studies will focus on comparing surgeon and patient satisfaction.

  19. Operation hernia: humanitarian hernia repairs in Ghana.

    PubMed

    Sanders, D L; Kingsnorth, A N

    2007-10-01

    Ghana has a high incidence of inguinal hernias and the healthcare system is unable to deliver an adequate repair rate. This results in morbidity and mortality and has a knock-on effect on the local economy. A project has been set up to try and reduce the burden of these hernias by establishing Africa's first Hernia Centre. This is supported by structured visits by European surgeons to the centre. In October 2006, a team of four surgeons, two specialist registrars, one hernia nurse specialist, and three nurses was assembled in order to open the Hernia Centre, which will provide a base for the delivery of hernia services in the West of Ghana. A 2-year teaching programme has been formulated, tailored to the needs of local surgeons and nurses, with the aim of developing an integrated team that will initially deliver up to 50 hernia repairs each month. It is planned that the centre will be supported by structured periodic visits from surgeons and nurses based in Plymouth, the European Hernia Society, and any other volunteers wishing to support the link.

  20. Primary lumbar hernia: A rarely encountered hernia

    PubMed Central

    Sundaramurthy, Sharada; Suresh, H.B.; Anirudh, A.V.; Prakash Rozario, Anthony

    2015-01-01

    Introduction Lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. Presentation may be misleading and diagnosis often missed. An imaging study forms an indispensable aid in the diagnosis and surgery is the only treatment option. Presentation of case A 42 year old male presented with history of pain in lower back of 4 years duration and was being treated symptomatically over 4 years with analgesics and physiotherapy. He had noticed a swelling over the left side of his mid-back and consequently on examination was found to have a primary acquired lumbar hernia arising from the deep superior lumbar triangle of Grynfelt. Diagnosis was confirmed by Computed Tomographic imaging. Discussion A lumbar hernia may be primary or secondary with only about 300 cases of primary lumbar hernia reported in literature. Lumbar hernias manifest through two possible defects in the posterior abdominal wall, the superior being more common. Management remains surgical with various techniques emerging over the years. The patient at our center underwent an open sublay mesh repair with excellent outcome. Conclusion A surgeon may encounter a primary lumbar hernia perhaps once in his lifetime making it an interesting surgical challenge. Sound anatomical knowledge and adequate imaging are indispensable. Inspite of advances in minimally invasive surgery, it cannot be universally applied to patients with lumbar hernia and management requires a more tailored approach. PMID:26812667

  1. Treating and Preventing Sports Hernias

    MedlinePlus

    ... Close ‹ Back to Healthy Living Treating and Preventing Sports Hernias If you play ice hockey, tennis or ... for the most commonly misdiagnosed groin pain—a sports hernia. A sports hernia often results from overuse ...

  2. Bochdalek's hernia in adults.

    PubMed

    Bujanda, L; Larrucea, I; Ramos, F; Muñoz, C; Sánchez, A; Fernández, I

    2001-02-01

    Bochdalek's hernia is a congenital hernia of the diaphragm, which is manifested in the early years of life. Its diagnosis is difficult and is based on barium studies. We present an adult patient with Bochdalek's hernia who exhibited a gastric volvulus. The patient had a history of intermittent abdominal pains. In this article, we analyze the diagnostic and therapeutic procedures, laying special emphasis on the importance of early diagnosis in the prevention of complications.

  3. European Hernia Society classification of parastomal hernias.

    PubMed

    Śmietański, M; Szczepkowski, M; Alexandre, J A; Berger, D; Bury, K; Conze, J; Hansson, B; Janes, A; Miserez, M; Mandala, V; Montgomery, A; Morales Conde, S; Muysoms, F

    2014-02-01

    A classification of parastomal hernias (PH) is needed to compare different populations described in various trials and cohort studies, complete the previous inguinal and ventral hernia classifications of the European Hernia Society (EHS) and will be integrated into the EuraHS database (European Registry of Abdominal Wall Hernias). Several members of the EHS board and invited experts gathered for 2 days to discuss the development of an EHS classification of PH. The discussions were based on a literature review and critical appraisal of existing classifications. The classification proposal is based on the PH defect size (small is ≤5 cm) and the presence of a concomitant incisional hernia (cIH). Four types were defined: Type I, small PH without cIH; Type II, small PH with cIH; Type III, large PH without cIH; and Type IV, large PH with cIH. In addition, the classification grid includes details about whether the hernia recurs after a previous PH repair or whether it is a primary PH. Clinical validation is needed in the future to assess if the classification allows us to differentiate the treatment strategy and if the classification impacts outcome in these different subgroups. A classification of PH divided into subgroups according to size and cIH was formulated with the aim of improving the ability to compare different studies and their results.

  4. Levator hiatal area as a risk factor for cystocele recurrence after surgery: a prospective study.

    PubMed

    Vergeldt, T F M; Notten, K J B; Weemhoff, M; van Kuijk, S M J; Mulder, F E M; Beets-Tan, R G; Vliegen, R F A; Gondrie, E T C M; Bergmans, M G M; Roovers, J P W R; Kluivers, K B

    2015-07-01

    To investigate whether increased levator hiatal area, measured preoperatively, was independently associated with anatom-ical cystocele recurrence 12 months after anterior colporrhaphy. Multicentre prospective cohort study. Nine teaching hospitals in the Netherlands. Women planned for conventional anterior colporrhaphy without mesh. Women underwent physical examination, translabial three-dimensional (3D) ultrasound and magnetic resonance imaging (MRI) prior to surgery. At 12 months after surgery the physical examination was repeated. Women with and without anatomical cystocele recurrence were compared to assess the association with levator hiatal area on 3D ultrasound, levator hiatal area on MRI, and potential confounding factors. The receiver operating characteristic (ROC) curve was created to quantify the discriminative ability of using levator hiatal area to predict anatomical cystocele recurrence. Of 139 included women, 76 (54.7%) had anatomical cystocele recurrence. Preoperative stage 3 or 4 and increased levator hiatal area during Valsalva on ultrasound were significantly associated with cystocele recurrence, with odds ratios of 3.47 (95% confidence interval, 95% CI 1.66-7.28) and 1.06 (95% CI 1.01-1.11) respectively. The area under the ROC curve was 0.60 (95% CI 0.51-0.70) for levator hiatal area during Valsalva on ultrasound, and 0.65 (95% CI 0.55-0.71) for preoperative Pelvic Organ Prolapse Quantification (POP-Q) stage. Increased levator hiatal area during Valsalva on ultrasound prior to surgery and preoperative stage 3 or 4 are independent risk factors for anatomical cystocele recurrence after anterior colporrhaphy; however, increased levator hiatal area as the sole factor for predicting anatomical cystocele recurrence after surgery shows poor test characteristics. © 2015 Royal College of Obstetricians and Gynaecologists.

  5. Impact of hernias on peritoneal dialysis technique survival and residual renal function.

    PubMed

    Balda, Sagrario; Power, Albert; Papalois, Vassilios; Brown, Edwina

    2013-01-01

    We evaluated the effect of hernias and their surgical or conservative management on peritoneal dialysis (PD) technique survival and residual renal function. This 10-year single-center retrospective case-control study (January 2001 - January 2011) compared patient survival, PD technique survival, and residual renal function in patients with a history of abdominal hernias and in a control cohort matched for age and PD vintage. Of 73 hernias identified in 63 patients (mean age: 55 years; 63% men), umbilical hernias were the most frequent (40%), followed by inguinal (33%), incisional, and epigastric hernias. Some hernias were surgically repaired before (n = 10) or at the time of PD catheter insertion (n = 11), but most (71%) were diagnosed and managed after initiation of PD. Overall, 49 of 73 (67%) hernias were treated surgically. In 53% of subjects, early postoperative dialysis was not needed; only 7 patients required temporary hemodialysis. The occurrence of a hernia and its treatment did not significantly affect residual renal function. After a hernia diagnosis or repair, 86% of patients were able to continue with PD. ♢ The incidence of abdominal hernia and hernia management in patients on PD do not significantly influence residual renal function or PD technique survival. Timely management of hernias is advisable and does not preclude continuation with PD as a dialysis modality.

  6. Laparoscopic repair of femoral hernia

    PubMed Central

    Yang, Xue-Fei

    2016-01-01

    Laparoscopic repair of inguinal hernia is mini-invasive and has confirmed effects. Femoral hernia could be repaired through the laparoscopic procedures for inguinal hernia. These procedures have clear anatomic view in the operation and preoperatively undiagnosed femoral hernia could be confirmed and treated. Lower recurrence ratio was reported in laparoscopic procedures compared with open procedures for repair of femoral hernia. The technical details of laparoscopic repair of femoral hernia, especially the differences to laparoscopic repair of inguinal hernia are discussed in this article. PMID:27826574

  7. Synchronous femoral hernias diagnosed during endoscopic inguinal hernia repair.

    PubMed

    Putnis, Soni; Wong, April; Berney, Christophe

    2011-12-01

    During totally extraperitoneal (TEP) endoscopic repair of inguinal hernias, it is possible to see the internal opening of the femoral canal. The aim of our study was to determine the incidence of synchronous femoral hernias found in patients undergoing TEP endoscopic inguinal hernia repair. This was a retrospective review of prospectively collected data on 362 consecutive patients who underwent 484 TEP endoscopic inguinal hernia repairs during a 5-year period, May 2005 to May 2010. During surgery, both inguinal and femoral canal orifices were routinely inspected. The presence of unilateral or bilateral inguinal and femoral hernias was recorded and repaired accordingly. There were a total of 362 patients. More males (343, 95%) underwent a TEP hernia repair than females (19, 5%). There were more cases of unilateral (240/362, 66%) than bilateral (122/362, 34%) inguinal hernias. A total of 18 cases of synchronous femoral hernias were found during operation. There was a higher incidence of femoral hernia in females (7/19, 37%) compared to males (11/343, 3%) (P < 0.001). None of the femoral hernias were clinically detectable preoperatively. Females undergoing elective inguinal hernia repair are more likely to have a synchronous femoral hernia than males. We suggest that all women presenting with an inguinal hernia also have a formal assessment of the femoral canal. TEP endoscopic inguinal hernia repair is an ideal approach as both inguinal and femoral orifices can be assessed and hernias repaired simultaneously during surgery.

  8. Incisional hernia repair.

    PubMed

    Millikan, Keith W

    2003-10-01

    Incisional ventral hernias are a common problem encountered by surgeons, with over 100,000 repairs being performed annually in the United States. Although many predisposing factors for incisional ventral hernia are patient-related, some factors such as type of primary closure and materials used may reduce the overall incidence of incisional ventral hernia. With the advent of prosthetic meshes being used for incisional ventral hernia repair, the recurrence rate has dropped to approximately 10%. More recently, with the development of prosthetic mesh that is now safe to place intraperitoneally, the recurrence rate has dropped to under 5%. The current controversies that exist for incisional ventral hernia repair are which approach to use (open versus laparoscopic) and what type of fixation (partial- versus full-thickness abdominal muscular/fascial wall) is necessary to stabilize the position of the mesh while tissue ingrowth occurs. During the next decade the answers to these controversies should be available in the surgical literature.

  9. Laparoscopic treatment of Bochdalek hernia without the use of a mesh.

    PubMed

    Brusciano, L; Izzo, G; Maffettone, V; Rossetti, G; Renzi, A; Napolitano, V; Russo, G; Del Genio, A

    2003-09-01

    Bochdalek hernia is a rare pathology. The preoperative diagnosis is difficult, and few reports are available regarding its treatment. Herein we report the case of a 25-year-old woman referred for symptoms of dyspepsia, dysphagia, and thoracic pain exacerbated by pregnancy. Preoperative radiography, EGD, and CT scan revealed a paraesophageal hiatal hernia. Laparoscopic exploration showed the complete thoracic migration of the stomach through a left posterolateral diaphragmatic foramen. The diagnosis of a Bochdalek hernia was then made. The diaphragmatic defect was repaired without inserting a prosthesis, using five separate non-reabsorbable stitches (Rieder technique). The procedure was completed with a Nissen-Rossetti fundoplication. The duration of the procedure was 150 min. Hospital stay was 12 days. There were no complications. Postoperative Gastrografin radiography of the esophagus and stomach showed a normal-shaped fundoplication and confirmed the subdiaphragmatic location of the stomach. We conclude that the laparoscopic approach represents the gold standard for the diagnosis and treatment of Bochdalek hernia and any associated complications.

  10. Iatrogenic diaphragmatic hernia following laparoscopic left colectomy for splenic flexure cancer An unusual complication.

    PubMed

    Dell'Abate, Paolo; Bertocchi, Elisa; Dalla Valle, Raffaele; Viani, Lorenzo; Del Rio, Paolo; Sianesi, Mario

    2016-11-03

    Iatrogenic diaphragmatic hernia following laparoscopic left colectomy for splenic flexure cancer. An unusual complication Diaphragmatic hernias are a migration of abdominal structures into the thorax via a diaphragmatic defect; they may be classified as congenital or acquired and acquired hernias can be hiatal, traumatic or iatrogenic, generally complications of thoracic or abdominal surgery. We report a case of iatrogenic diaphragmatic hernia after a laparoscopic left colectomy for splenic flexure tumor; to our knowledge, in literature this case is the first reported. A 51-years-old woman was readmitted to our Hospital on 11th post-operative day for bowel occlusion and a CT - scan revealed left diaphragmatic herniation with fluid dilatation of the small bowel that appeared in the left hemithorax. Laparoscopic surgery resolution was decided and after the reduction of the small bowel in the abdomen we closed the defect using two direct absorbable auto-block hemi-continuous sutures that were covered by a synthetic absorbable mesh. Probably we didn't notice a minimal injury of the left diaphragm caused by ultrasonic scalpel and we can suppose that this delay in presentation may be a result of the gradual enlargement of a microscopic lesion. Patient's gas exchanges were good during surgery and during post-operative course.

  11. Obturator hernia - MRI image.

    PubMed

    Vitone, Louis; Joel, Abraham; Masters, Andrew; Lea, Simon

    2013-08-01

    Obturator hernia although considered a rare entity is the most frequently encountered pelvic floor hernia. Since the first published report in the 18th century, their unusual and unfamiliar clinical presentation still represents a diagnostic dilemma for the modern day clinician. A detailed history and clinical examination in our thin, elderly female patient who presented with intermittent small bowel obstruction and symptoms of right obturator nerve compression with a positive Howship-Romberg sign was crucial in establishing a diagnosis. Sophisticated radiologic modalities such as MRI as shown below in the case of our patient can reliably confirm the diagnosis of obturator hernia.

  12. Recurrent groin hernia

    PubMed Central

    Cox, P. J.; Leach, R. D.; Ellis, Harold

    1981-01-01

    One hundred consecutive recurrences following repair of inguinal hernias have been studied; 62 were direct, 30 indirect, 7 pantaloon and one a femoral hernia. Half the indirect recurrences occurred within a year of repair and probably represented failure to detect a small indirect sac. Later indirect recurrences probably represented failure to repair the internal ring. Nine of the direct hernias were medial funicular recurrences and represented failure to anchor the darn medially. The rest of the direct recurrences were attributable to tissue insufficiency and could probably have been averted by larger tissue bites. Recurrences following inguinal herniorrhaphy remain an all too common problem but can be reduced by meticulous surgical technique. PMID:7339602

  13. Left Aberrant Gastric Vein Causing Isolated Left Hepatic Portal Venous Gas Secondary to an Incarcerated Diaphragmatic Hernia

    PubMed Central

    Mittal, Kartik; Anandpara, Karan; Dey, Amit K.; Kedar, Pradnya; Hira, Priya; Kale, Sunita

    2015-01-01

    Summary Background Hepatic portal venous gas (HPVG) is an ominous radiological sign suggestive of underlying intestinal sepsis, infection or trauma. Portal pneumatosis secondary to gastric pathologies is rare. Case Report We report a rare case of a 34-year-old man who presented with acute epigastric pain and vomiting, diagnosed to have an incarcerated diaphragmatic hernia causing gastric pneumatosis and resultant portal venous gas. Conclusions Our case highlights an unusual presentation of gastric pneumatosis secondary to an incarcerated hiatal hernia with resultant portal venous gas involving only the left lobe of the liver. An aberrant left gastric vein was responsible for this phenomenon in our case. A sound understanding of anatomical variants is thus crucial to radiological diagnosis. PMID:26251676

  14. Interparietal hernias after open retromuscular hernia repair.

    PubMed

    Carbonell, A M

    2008-12-01

    The retromuscular or sublay repair of ventral hernias, popularized by Rives and Stoppa, requires that a layer of tissue be reapproximated dorsal to the mesh to separate the bowel from the prosthetic. This is the first report of two patients who developed bowel obstruction resulting from interparietal incarceration between the posterior rectus sheath and the prosthetic graft through a defect in this dorsal layer. Both patients underwent open retromuscular hernia repair, one with lightweight polypropylene mesh, the other with human acellular dermal matrix. Postoperatively (day 3 and day 42, respectively), the patients developed signs of bowel obstruction. Computed tomography demonstrated the herniation of the small bowel into the potential space between the prosthesis and the posterior rectus sheath. The first patient underwent successful laparoscopic repair, while the second patient had an open operation to reduce the incarcerated bowel and repair the defect. In the patient convalescing from an uneventful retromuscular hernia repair who develops signs and symptoms of a bowel obstruction, there should be a high index of suspicion that an interparietal hernia may have formed, with the small bowel herniated into the surgically created space between the prosthetic and the posterior rectus sheath.

  15. Diaphragmatic hernia following oesophagectomy for oesophageal cancer – Are we too radical?

    PubMed Central

    Argenti, F.; Luhmann, A.; Dolan, R.; Wilson, M.; Podda, M.; Patil, P.; Shimi, S.; Alijani, A.

    2016-01-01

    Background Diaphragmatic herniation (DH) of abdominal contents into the thorax after oesophageal resection is a recognised and serious complication of surgery. While differences in pressure between the abdominal and thoracic cavities are important, the size of the hiatal defect is something that can be influenced surgically. As with all oncological surgery, safe resection margins are essential without adversely affecting necessary anatomical structure and function. However very little has been published looking at the extent of the hiatal resection. We aim to present a case series of patients who developed DH herniation post operatively in order to raise discussion about the ideal extent of surgical resection required. Methods We present a series of cases of two male and one female who had oesophagectomies for moderately and poorly differentiated adenocarcinomas of the lower oesophagus who developed post-operative DH. We then conducted a detailed literature review using Medline, Pubmed and Google Scholar to identify existing guidance to avoid this complication with particular emphasis on the extent of hiatal resection. Discussion Extended incision and partial resection of the diaphragm are associated with an increased risk of postoperative DH formation. However, these more extensive excisions can ensure clear surgical margins. Post-operative herniation can be an early or late complication of surgery and despite the clear importance of hiatal resection only one paper has been published on this subject which recommends a more limited resection than was carried out in our cases. Conclusion This case series investigated the recommended extent of hiatal dissection in oesophageal surgery. Currently there is no clear guidance available on this subject and further studies are needed to ascertain the optimum resection margin that results in the best balance of oncological parameters vs. post operative morbidity. PMID:27158485

  16. Ventral hernia repair

    MedlinePlus

    ... Philadelphia. PA: Elsevier Saunders; 2014:539-545. Nagle AP, Soper NJ. Laparoscopic ventral hernia repair. In: Khatri ... Support Get email updates Subscribe to RSS Follow us Disclaimers Copyright Privacy Accessibility Quality Guidelines Viewers & Players ...

  17. 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 ...

  18. Diaphragmatic hernia repair - slideshow

    MedlinePlus

    ... presentations/100014.htm Diaphragmatic hernia repair - series—Normal anatomy To use the sharing ... Overview The chest cavity includes the heart and lungs. The abdominal cavity includes the liver, the stomach, ...

  19. Femoral hernia repair

    MedlinePlus

    ... medicine to relax you . Your surgeon makes a cut (incision) in your groin area. The hernia is ... wall. At the end of the repair, the cuts are stitched closed. In laparascopic surgery: The surgeon ...

  20. Recurrent inguinal hernia.

    PubMed Central

    Postlethwait, R W

    1985-01-01

    An analysis of 584 operations for recurrent inguinal hernia was made in an attempt to determine the cause of the recurrence based on the anatomic findings. The recurrence was indirect in 300, direct in 241, and various other in 43 operations. The causes of the indirect recurrences appeared to be an unrecognized hernia, incomplete dissection or improper ligation of the sac, failure to narrow the cord, or inadequate reconstruction of the internal ring. No cause for the diffuse direct recurrences was apparent. Of the 241 hernias in Hesselbach's triangle, 144 were small localized defects, usually (112) just lateral to the symphysis. These were considered to be caused by the cutting action of a suture placed under tension. On the basis of these findings, suggestions are made for primary inguinal hernia operations. PMID:4073990

  1. Hernia Surgical Mesh Implants

    MedlinePlus

    ... The surgeon makes several small incisions in the abdomen that allow surgical tools into the openings to repair the hernia. Laparoscopic surgery can be performed with or without surgical mesh. Open Repair - The surgeon makes an incision near the ...

  2. Bilateral Hernias in the Female

    PubMed Central

    Glassow, Frank

    1969-01-01

    An experience with 216 bilateral hernias in female patients is reviewed. The condition is rare, occurring only once in every 250 patients admitted for a hernia repair. Bilateral primary indirect inguinal hernias were the most frequent type. Bilateral primary femoral hernias were quite rare while bilateral primary direct inguinal hernias were even more uncommon. Other rare bilateral combinations are briefly described. The incidence in children is given. Etiological factors are discussed, emphasizing the strong posterior wall of the inguinal canal in females. Two per cent of patients developed a recurrent hernia; one per cent of hernias recurred. No recurrence following a bilateral primary indirect inguinal hernia repair and no “femoral” recurrence following inguinal repair were recorded. PMID:5348491

  3. [New aspects in hernia surgery].

    PubMed

    Lammers, B J; Goretzki, P E; Otto, T

    2005-07-01

    In the last 10 years in Germany we have seen a lot of hernia repairs using mesh.Meta-analysis shows the advantages of using meshes in hernia surgery; recurrence rates in inguinal hernia surgery are less than 3% in studies. There is some discussion about minimally invasive surgery in Germany.In incisional hernia surgery there is no discussion about using meshes. The role of minimally invasive surgery has not yet been defined.

  4. Diaphragmatic hernia during pregnancy: a case report with a review of the literature from the past 50 years.

    PubMed

    Chen, Yue; Hou, Qiannan; Zhang, Zhu; Zhang, Jian; Xi, Mingrong

    2011-07-01

    Diaphragmatic hernia is a rare complication during pregnancy. Only 30 reports have been published on this subject in English between 1959 and 2009. Due to misdiagnoses and management delays, diaphragmatic hernia usually presents itself as a life-threatening emergency. Here, we present a case report of a patient with a traumatic diaphragmatic hernia who became acutely symptomatic during pregnancy. The diaphragmatic hernia was managed successfully, and we describe the presentation, management and outcome of this case. We also present a review of all of the reported cases of diaphragmatic hernias complicating pregnancy that have been published in English during the past 50 years.

  5. 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

  6. Assessment of Abdominal Muscle's Maximal Force of Contraction Using Surface EMG in Inguinal Hernia Patients

    PubMed Central

    Sreenath, G. S.; Subramanian, Senthil Kumar

    2016-01-01

    Introduction Reduction in abdominal muscle’s strength has been implicated in the development of inguinal hernia. Patients with inguinal hernia on one side are shown to be at higher risk of developing inguinal hernia on the other side. Aim To assess the abdominal muscle strength in inguinal hernia subjects using surface Electromyography (EMG) and compare it with healthy controls. Materials and Methods This is a cross-sectional study involving only male subjects. Abdominal (Inguinal) hernia subjects without any known complications were recruited from surgery department and the accompanying healthy individuals were taken as control (Control, n=44, inguinal hernia subjects, n=43). The subjects were asked to perform maximal contraction for three seconds targeting external and internal oblique muscles of right and left sides separately. Motor unit potentials were recorded using surface EMG for individual muscles on both sides during maximal contraction. The maximum amplitude of the motor unit potentials obtained was considered as the strength of the respective muscle. Results In control group, there was no significant difference in strength of external and internal oblique muscles between the two sides. Strength of external and internal oblique muscles of both herniated and unaffected side was reduced in inguinal hernia subjects as compared to healthy controls. Further, the muscle strength of herniated side was less as compared to unaffected side in the inguinal hernia subjects. Conclusion Abdominal muscle strength is reduced in hernia subjects and even the apparently normal side strength is less as compared to controls. This should be considered while performing corrective surgeries in inguinal hernia subjects. PMID:28208924

  7. Clinical Manifestations of Huge Diaphragmatic Hernias.

    PubMed

    Lesiński, Jan; Zielonka, Tadeusz M; Kaszyńska, Aleksandra; Wajtryt, Olga; Peplińska, Krystyna; Życińska, Katarzyna; Wardyn, Kazimierz A

    2017-07-06

    Translocation of abdominal organs into the thoracic cavity may cause dyspnea, heart disorders, and gastric symptoms. Diaphragmatic hernias can cause diagnostic difficulties, since both clinical and radiological symptoms might imitate different disorders. In these cases computed tomography of the chest is the method of choice. The aim of this study was to assess clinical manifestations, risk factors, and prognosis in patients with huge diaphragmatic hernias with displacement of abdominal organs into the thorax, depending on the action taken. We carried out a retrospective study using data of patients hospitalized in the years 2012-2016. Ten patients were qualified for the study (8 women and 2 men). The mean age of the subjects was 86.5 ± 10.5 years. Thirty percent of the hernias were post-traumatic. All of the patients reported cardiovascular or respiratory symptoms. Upper gastrointestinal symptoms occurred in half of the patients. Twenty percent of patients underwent surgery with a positive outcome, while 30% of patients, who were not qualified for surgery due to numerous co-morbidities, died. The main risk factors predisposing to the occurrence of large diaphragmatic hernias were the following: old age, female gender, and thoracic cage deformities.

  8. Abdominal hernias: Radiological features

    PubMed Central

    Lassandro, Francesco; Iasiello, Francesca; Pizza, Nunzia Luisa; Valente, Tullio; Stefano, Maria Luisa Mangoni di Santo; Grassi, Roberto; Muto, Roberto

    2011-01-01

    Abdominal wall hernias are common diseases of the abdomen with a global incidence approximately 4%-5%. They are distinguished in external, diaphragmatic and internal hernias on the basis of their localisation. Groin hernias are the most common with a prevalence of 75%, followed by femoral (15%) and umbilical (8%). There is a higher prevalence in males (M:F, 8:1). Diagnosis is usually made on physical examination. However, clinical diagnosis may be difficult, especially in patients with obesity, pain or abdominal wall scarring. In these cases, abdominal imaging may be the first clue to the correct diagnosis and to confirm suspected complications. Different imaging modalities are used: conventional radiographs or barium studies, ultrasonography and Computed Tomography. Imaging modalities can aid in the differential diagnosis of palpable abdominal wall masses and can help to define hernial contents such as fatty tissue, bowel, other organs or fluid. This work focuses on the main radiological findings of abdominal herniations. PMID:21860678

  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. Hiatus hernia and heartburn

    PubMed Central

    Gillison, E. W.; Capper, W. M.; Airth, G. R.; Gibson, M. J.; Bradford, I.

    1969-01-01

    The symptoms in a group of 80 patients with a pure sliding hiatus hernia were investigated using the pyloric regulation test (Capper, Airth, and Kilby, 1966). It was found that there was a high correlation between the symptoms of heartburn and the reflux of duodenal barium into the stomach. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5 PMID:5810968

  11. Sports Hernia (Athletic Pubalgia)

    MedlinePlus

    ... injury. A sports hernia is a strain or tear of any so tissue (muscle, tendon, ligament) in the lower abdomen or groin ... sports activity. In some patients the tissues will tear again during sports and ... that attaches the inner thigh muscles to the pubis is cut. The tendon will ...

  12. 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

  13. Lesser omental hernia after total colectomy: report of a case.

    PubMed

    Konishi, Takanori; Morita, Yasuhiro; Takanishi, Kijuro; Nitta, Jun; Matsumoto, Jun; Miyazaki, Masaru

    2014-07-01

    Lesser omental hernia is a rare type of hernia that can cause intestinal obstruction. To our knowledge, there are only 16 documented cases of lesser omental hernia, including the present case. The subject of this case report was a 42-year-old man with a history of total colectomy for colon perforation caused by Crohn's disease 15 years earlier, who presented with epigastralgia and vomiting. Abdominal computed tomography (CT) revealed a distended bowel loop ventral to the stomach and convergence of mesenteric vessels at the lesser curvature of the stomach. Based on a diagnosis of intestinal obstruction caused by a lesser omental hernia, he underwent emergency surgery, which revealed a 150-cm jejunal segment herniating through a 5-cm defect in the lesser omentum from the retrogastric space. We reduced the herniated loop and closed the hernial orifice successfully. We describe the characteristic CT findings, which allowed us to make the preoperative diagnosis, and speculate how the past total colectomy, in which the gastrocolic ligament was isolated and the transverse colon was resected, probably caused by this hernia. This case serves to demonstrate that lesser omental hernia could be a postoperative complication of total colectomy.

  14. Terminal ileum gangrene secondary to a type IV paraesophageal hernia.

    PubMed

    Hsu, Ching Tsai; Hsiao, Po Jen; Chiu, Chih Chien; Chan, Jenq Shyong; Lin, Yee Fung; Lo, Yuan Hung; Hsiao, Chia Jen

    2016-02-28

    Type IV paraesophageal hernia (PEH) is very rare, and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type IV PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in PubMed. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type IV PEH with incarceration of only the terminal ileum.

  15. Terminal ileum gangrene secondary to a type IV paraesophageal hernia

    PubMed Central

    Hsu, Ching Tsai; Hsiao, Po Jen; Chiu, Chih Chien; Chan, Jenq Shyong; Lin, Yee Fung; Lo, Yuan Hung; Hsiao, Chia Jen

    2016-01-01

    Type IV paraesophageal hernia (PEH) is very rare, and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type IV PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in PubMed. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type IV PEH with incarceration of only the terminal ileum. PMID:26937153

  16. Single-center ventral hernia repair with porcine dermis collagen implant.

    PubMed

    Boules, M; Strong, A T; Corcelles, R; Haskins, I N; Ilie, R; Wathen, C; Froylich, D; Sharma, G; Rodriguez, J; Rosenblatt, S; El-Hayek, K; Kroh, M

    2017-09-20

    This study aims to evaluate the outcomes and utilization of porcine acellular dermal collagen implant (PADCI) during VHR at a large tertiary referral center. Records of 5485 patients who underwent VIHR from June 1995 to August 2014 were retrospectively reviewed to identify patients >18 years of age who had VIHR with PADCI reinforcement. Use of multiple mesh reinforcement products, inguinal hernias, and hiatal hernias were exclusion criteria. The primary outcome was hernia recurrence, and secondary outcomes were early complications and surgical site occurrences (SSOs). Uni- and multivariate analyses assessed risk factors for recurrence after PADCI reinforced VIHR. There were 361 patients identified (54.5% female, mean age of 56.7 ± 12.5 years, and mean body mass index (BMI) of 33.0 ± 9.9 kg/m(2)). Hypertension (49.5%), diabetes (24.3%), and coronary artery disease (14.4%) were the most common comorbidities, as was active smoking (20.7%). Most were classified as American Association of Anesthesiologists (ASA) Class 3 (61.7%). Hernias were distributed across all grades of the ventral hernia working group (VHWG) grading system: grade I 93 (25.7%), grade II 51 (14.1%), grade III 113 (31.3%), and grade IV 6 (1.6%). Most VIHR were performed from an open approach (96.1%), and were frequently combined with concomitant surgical procedures (47.9%). Early postoperative complications (first 30 days) were reported in 39.0%, with 71 being SSO. Of the 19.7% of patients with SSO, there were 31 who required procedural intervention. After a mean follow-up of 71.5 ± 20.5 months, hernia recurrence was documented in 34.9% of patients. Age and male gender were predictors of recurrence on multivariate analysis. To the best of our knowledge, this is the largest retrospective single institutional study evaluating PADCI to date. Hernias repaired with PADCI were frequently in patients undergoing concomitant operations. Reinforcement with PADCI may be considered a temporary

  17. Treatment of "hernia" in the writings of Celsus (first century AD).

    PubMed

    Papavramidou, Niki S; Christopoulou-Aletras, Helen

    2005-10-01

    Descriptions concerning "hernia" can be found from the early historical years, and its treatment was a subject mentioned by numerous physicians of Antiquity, such as Hippocrates and Praxagoras of Kos. Yet, Aulus Cornelius Celsus, a famous doctor and encyclopedist of the first century AD, was among the first to propose surgical treatment and carry it out successfully, according to his accounts. Many physicians attempted to treat several types of "hernia" before him, but more "scientific" information with details and complete descriptions could be found only in Celsus' work. In his book De Medicina, Celsus described eight types of "hernia": bronchocele, umbilical hernia, intestinal and omental hernias, hydrocele, varicocele, sarcocele (hernia carnosa), and inguinal hernia. Among them, some retain their ancient nomenclature up to now, although others have acquired gradually different terminology or are not recognized by physicians today as "hernias" (e.g. , bronchocele). For each type of "hernia", Celsus provided his readers with an extremely detailed, well reasoned description of the execution of surgical procedures accompanied usually with pre- and postoperative instructions. His innovations particularly concerned ligature of the vessels. He recommended that an injured vessel be tied in two places with lint threads and then cut between the ties. Other pre- and postoperative practices, such as sterilization and bandaging of the incised area, were elements that helped in the advances of medicine, and some of them still exist in modern medicine.

  18. [Morgagni hernia causing cardiac tamponade].

    PubMed

    S Breinig; Paranon, S; Le Mandat, A; Galinier, P; Dulac, Y; Acar, P

    2010-10-01

    Morgagni hernia is a rare malformation (3% of diaphragmatic hernias). This hernia is usually asymptomatic in children. We report on a case revealed by an unusual complication. Severe cyanosis was due to right-to-left atrial shunt through the foramen ovale assessed by 2D echocardiography. Diagnosis of the Morgagni hernia was made with CT scan. The intrathoracic liver compressed the right chambers of the heart causing tamponade. Cardiac compression was reversed after surgery and replacement of the liver in the abdomen. Six months after the surgery, the infant was symptom-free with normal size right chambers of the heart.

  19. Bilateral Inguinal Hernias Containing Ovaries

    PubMed Central

    Basrur, Gurudutt Bhaskar

    2015-01-01

    Inguinal hernias are rare in females. The authors report a case of bilateral inguinal hernias in a 10-year-old female. On exploration, the patient was found to be having a sliding hernia containing incarcerated ovary as contents on both sides. Peroperatively the contents were reduced, the sac was transfixed at its base and the redundant sac was excised. The repair of this form of hernias is more difficult because of adhesions between the contents and the wall of the sac and risk of damage during dissection. A description of this clinical presentation in the pre operative assessment and operative management are discussed in this report. PMID:25918632

  20. Abdominal wall hernias-A local manifestation of systemically impaired quality of the extracellular matrix.

    PubMed

    Henriksen, Nadia A; Mortensen, Joachim H; Lorentzen, Lea; Ågren, Magnus S; Bay-Jensen, Anne C; Jorgensen, Lars N; Karsdal, Morten A

    2016-07-01

    Throughout life, inguinal hernia develops in approximately every fourth man, some of whom develop multiple hernias. If patients at risk of developing multiple hernias could be identified by a serologic biomarker, treatment might be able to be tailored and improved. Evidence suggests that abdominal wall hernia formation is associated with altered collagen metabolism. The aim of this study was to evaluate biomarkers for type IV and V collagen turnover in patients with multiple hernias and control subjects without hernia. Venous blood was collected from 88 men (mean age, 62 years) with a history of more than 3 hernia repairs and 86, age-matched men without hernias. Biomarkers for synthesis of collagen type IV (P4NP) and type V (P5CP) as well as breakdown (C4M and C5M) were measured in serum by validated, solid-phase, competitive assays. Collagen turnover was indicated by the ratio between the biomarker for synthesis and breakdown. Type IV collagen turnover was 1.4-fold increased in patients with multiple hernias compared to control subjects (P < .001), whereas type V collagen turnover was 1.7-fold decreased (P < .001). Diagnostic power of P5CP was 0.83 (95%C.I.:0.77-0.89), P < .001. Patients with multiple hernias exhibit increased turnover of type IV collagen and a decreased turnover of type V collagen, demonstrating systemically altered collagen turnover. Biomarkers for type V collagen turnover may be used to identify patients at risk for or with multiple hernias. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Prosthetic Mesh Repair for Incarcerated Inguinal Hernia

    PubMed Central

    Tatar, Cihad; Tüzün, İshak Sefa; Karşıdağ, Tamer; Kızılkaya, Mehmet Celal; Yılmaz, Erdem

    2016-01-01

    Background: Incarcerated inguinal hernia is a commonly encountered urgent surgical condition, and tension-free repair is a well-established method for the treatment of non-complicated cases. However, due to the risk of prosthetic material-related infections, the use of mesh in the repair of strangulated or incarcerated hernia has often been subject to debate. Recent studies have demonstrated that biomaterials represent suitable materials for performing urgent hernia repair. Certain studies recommend mesh repair only for cases where no bowel resection is required; other studies, however, recommend mesh repair for patients requiring bowel resection as well. Aim: The aim of this study was to compare the outcomes of different surgical techniques performed for strangulated hernia, and to evaluate the effect of mesh use on postoperative complications. Study Design: Retrospective cross-sectional study. Methods: This retrospective study was performed with 151 patients who had been admitted to our hospital’s emergency department to undergo surgery for a diagnosis of incarcerated inguinal hernia. The patients were divided into two groups based on the applied surgical technique. Group 1 consisted of 112 patients treated with mesh-based repair techniques, while Group 2 consisted of 39 patients treated with tissue repair techniques. Patients in Group 1 were further divided into two sub-groups: one consisting of patients undergoing bowel resection (Group 3), and the other consisting of patients not undergoing bowel resection (Group 4). Results: In Group 1, it was observed that eight (7.14%) of the patients had wound infections, while two (1.78%) had hematomas, four (3.57%) had seromas, and one (0.89%) had relapse. In Group 2, one (2.56%) of the patients had a wound infection, while three (7.69%) had hematomas, one (2.56%) had seroma, and none had relapses. There were no statistically significant differences between the two groups with respect to wound infection, seroma

  2. 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

  3. Contemporary hernia smartphone applications (apps).

    PubMed

    Connor, K; Brady, R R W; de Beaux, A; Tulloh, B

    2014-08-01

    Smartphone technology and downloadable applications (apps) have created an unprecedented opportunity for access to medical information and healthcare-related tools by clinicians and their patients. Here, we review the current smartphone apps in relation to hernias, one of the most common operations worldwide. This article presents an overview of apps relating to hernias and discusses content, the presence of medical professional involvement and commercial interests. The most widely used smartphone app online stores (Google Play, Apple, Nokia, Blackberry, Samsung and Windows) were searched for the following hernia-related terms: hernia, inguinal, femoral, umbilical, incisional and totally extraperitoneal. Those with no reference to hernia or hernia surgery were excluded. 26 smartphone apps were identified. Only 9 (35 %) had named medical professional involvement in their design/content and only 10 (38 %) were reviewed by consumers. Commercial interests/links were evident in 96 % of the apps. One app used a validated mathematical algorithm to help counsel patients about post-operative pain. There were a relatively small number of apps related to hernias in view of the worldwide frequency of hernia repair. This search identified many opportunities for the development of informative and validated evidence-based patient apps which can be recommended to patients by physicians. Greater regulation, transparency of commercial interests and involvement of medical professionals in the content and peer-review of healthcare-related apps is required.

  4. Ventral incisional hernia recurrence.

    PubMed

    Clark, J L

    2001-07-01

    During the period October 1993 to December 1996, 31 patients were operated on by the author for primary or recurrent ventral incisional hernia (VIH). Three patients were excluded from analysis because their records were unavailable for review. The median age of the 28 remaining patients at their initial procedure was 57.5 years (range, 37-78 years). The repair was performed with interrupted O-Ethibond sutures in all but 3 cases where Prolene suture was used secondary to noniatrogenic contamination or recurrent hernia. There were no unplanned enterotomies in the entire series and prophylactic intravenous antibiotics were used in all cases. The only significant complications were skin hyperemia after five repairs in 3 patients who were treated empirically with intravenous antibiotics, and 1 patient who had an antibiotic-associated rash. There were no 30-day mortalities. Prolene mesh was used exclusively in all repairs performed with mesh. Seven of these repairs (25%) were for recurrent VIH. Three of these seven patients had previous mesh repairs. Six of these seven patients who presented with recurrent VIH had a mesh repair and four developed a recurrence. Five of seven were active smokers, with one having severe obstructive lung disease. Four of seven related significant occupational lifting. Of the 21 patients having initial repair of VIH, mesh was used in 8 (38%). After a median follow-up of 13 months, there were 2 recurrent hernias (25%). The remaining 13 patients had primary closure of their hernias. After median follow-up of 25 months, there were 5 recurrences (38%). A total of 34 VIH repairs were performed on these 28 patients, of which 13 were for recurrent hernias. Five of thirteen (38%) of the mesh repairs for recurrent VIH failed. The median body mass index (BMI) for the 13 patients having primary repair was 26.4, and that for all 21 cases having mesh repair was 28.8. Patients with recurrent VIH frequently recur despite use of mesh, avoidance of

  5. Internal hernias: a brief review.

    PubMed

    Salar, O; El-Sharkawy, A M; Singh, R; Speake, W

    2013-06-01

    Hernias are very familiar to a core surgical trainee in the setting of clinics and the surgical assessment unit. By definition, a hernia is an abnormal protrusion of a viscus from one compartment to another. In clinic, they are visible lumps, exhibiting a cough reflex often with a well definable history making them readily identifiable. In the acute setting, they are the third commonest cause of small bowel obstruction in the developed world. Ventral and inguinal hernias account for the majority of these with only a small proportion due to internal hernias. This article aims to educate the core surgical trainee on the anatomy and distinguishing clinical features of these rare but important types of internal abdominal hernias.

  6. Mesh materials and hernia repair

    PubMed Central

    Elango, Santhini; Perumalsamy, Sakthivel; Ramachandran, Krishnakumar; Vadodaria, Ketankumar

    2017-01-01

    Hernia incidence has been observed since ancient time. Advancement in the medical textile industry came up with the variety of mesh materials to repair hernia, but none of them are without complications including recurrence of hernia. Therefore individuals once developed with the hernia could not lead a healthy and comfortable life. This drawn attention of surgeons, patients, researchers and industry to know the exact mechanism behind its development, complications and recurrence. Recent investigations highlighted the role of genetic factors and connective tissue disorders being the reason for the development of hernia apart from the abnormal pressure that is known to develop during other disease conditions. This review discusses different mesh materials, their advantages and disadvantages and their biological response after its implantation. PMID:28840830

  7. 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

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

    PubMed

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

    2011-05-01

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

  9. Two-criteria optimisation problem for ventral hernia repair.

    PubMed

    Szymczak, Czesław; Lubowiecka, Izabela; Szepietowska, Katarzyna; Tomaszewska, Agnieszka

    2017-05-01

    Two-criteria optimisation problem related to laparoscopic ventral hernia repair is formulated in this paper. An optimal implant from a given set and its orientation is sought. The implant is subjected to kinematic extortions due to a patient's body movement and intra-abdominal pressure. The first criterion of the optimisation problem deals with the reaction force in the implant fastener, while the deflection of the implant constitutes the second criterion. A two-stage optimization procedure is proposed and the optimal solution is determined with the aid of minimization of an additional objective function. Numerical examples for typical locations of hernia are provided.

  10. Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing post-prostatectomy hernia.

    PubMed

    Marien, Tracy; Taouli, Bachir; Telegrafi, Shpetim; Babb, James S; Lepor, Herbert

    2012-12-01

    What's known on the subject? and What does the study add? Some studies have evaluated preoperative and intraoperative examination for inguinal hernias and their repair, noting a decrease in the rate of post-prostatectomy hernias. However, this did not eradicate post-prostatectomy hernias, indicating that this method probably missed subclinical hernias. Other studies looked at prophylactic procedures to prevent the formation of inguinal hernias at the time of prostatectomy and showed a decrease in the rate of postoperative hernias. To our knowledge this is the only series evaluating a multi-modal approach with magnetic resonance imaging, ultrasonography and examination to identify all clinical and subclinical hernias and repair them at the time of prostatectomy. This approach only subjects those patients at risk for symptomatic hernias to an additional procedure and decreases the post-prostatectomy hernia rate to <1%. • To assess if a comprehensive evaluation to diagnose clinical and subclinical hernias and repair of these hernias at the time of open radical retropubic prostatectomy (ORRP) decreases the incidence of clinical inguinal hernias (IHs) after ORRP. • Between 1 July 2007 and 31 July 2010, 281 consecutive men underwent ORRP by a single surgeon. • Of these men, 207 (74%) underwent comprehensive preoperative screening for IH, which included physical examination, upstanding ultrasonography and magnetic resonance imaging. • Between 12 and 24 months after ORRP, 178 (86%) of these men completed a questionnaire designed to capture development of clinical IHs. • Of the 178 evaluable patients, 92 (52%) were diagnosed preoperatively with IH by at least one diagnostic modality. • Forty-one and 51 of the men had bilateral or unilateral IHs, respectively for a total of 133 IHs. • No preoperative factor was significantly associated with the presence of an IH before prostatectomy. • No groin subjected to IH repair (IHR) at the time of ORRP developed a

  11. Delayed diaphragmatic hernia: an unusual complication of tube thoracostomy.

    PubMed

    Ozpolat, Berkant; Doğan, Orhan Veli; Yücel, Ertan

    2009-11-01

    The nature of a tube thoracostomy -a blind maneuver- renders it subject to complications. Nevertheless, it is very uncommon to create a diaphragmatic hernia with this procedure. Herein, we present the occurrence of this complication after six months under emergency conditions that was treated by thoracotomy.

  12. Obturator hernia: A diagnostic challenge

    PubMed Central

    Kulkarni, Sanjeev R.; Punamiya, Aditya R.; Naniwadekar, Ramchandra G.; Janugade, Hemant B.; Chotai, Tejas D.; Vimal Singh, T.; Natchair, Arafath

    2013-01-01

    INTRODUCTION Obturator hernia is an extremely rare type of hernia with relatively high mortality and morbidity. Its early diagnosis is challenging since the signs and symptoms are non specific. PRESENTATION OF CASE Here in we present a case of 70 years old women who presented with complaints of intermittent colicky abdominal pain and vomiting. Plain radiograph of abdomen showed acute dilatation of stomach. Ultrasonography showed small bowel obstruction at the mid ileal level with evidence of coiled loops of ileum in pelvis. On exploration, Right Obstructed Obturator hernia was found. The obstructed Intestine was reduced and resected and the obturator foramen was closed with simple sutures. Postoperative period was uneventful. DISCUSSION Obturator hernia is a rare pelvic hernia and poses a diagnostic challenge. Obturator hernia occurs when there is protrusion of intra-abdominal contents through the obturator foramen in the pelvis. The signs and symptoms are non specific and generally the diagnosis is made during exploration for the intestinal obstruction, one of the four cardinal features. Others are pain on the medial aspect of thigh called as Howship Rombergs sign, repeated attacks of Intestinal Obstruction and palpable mass on the medial aspect of thigh. CONCLUSION Obturator hernia is a rare but significant cause of intestinal obstruction especially in emaciated elderly woman and a diagnostic challenge for the Doctors. CT scan is valuable to establish preoperative diagnosis. Surgery either open or laproscopic, is the only treatment. The need for the awareness is stressed and CT scan can be helpful. PMID:23708307

  13. Sonographic imaging of Spigelian hernias

    PubMed Central

    Kołaczyk, Katarzyna; Lubiński, Jan; Bojko, Stefania; Gałdyńska, Maria; Bernatowicz, Elżbieta

    2012-01-01

    The aim of the work was to present clinical material referring to rarely occurring abdominal cavity hernias in semilunar line – Spigelian hernias diagnosed with the help of ultrasound. Material and methods In the period from 1995 to 2001 785 anterior abdominal wall hernias were diagnosed including 11 Spigelian hernias (1.4%) diagnosed in 10 patients (7 women and 3 men) aged from 38 to 65 years old (average age 48). Eight patients complained of spastic pain in abdomen, in 5 of them it was accompanied by bloating and sometimes loud peristalsis. All the patients had been observing the mentioned symptoms from 2 to 5 years. Each of them had had colonoscopy and abdominal cavity ultrasound examination performed, some of them even three times. In 3 women with uterine fibroid the uterus was removed which did not eliminate the symptoms. The ultrasound examination of the abdominal integument was performed mainly with the use of linear transducers of the frequency of 7–12 MHz; in obese patients also convex transducers were used (3,5–6 MHz). Each examination of abdominal integument included the assessment of the following areas: linea alba from xiphoid process to pubic symphysis including umbilicus, both semilunar lines from costal margins to pubic bones, and also inguinal areas. Moreover, all types of postoperative scars were examined. Each hernia was assessed in terms of size (the greatest dimension), hernia sac contents, width of the ring and reducibility under the compression of the transducer. Moreover, cough test and Valsalva's maneuver were performed. Generally, the examination was performed in a standing position. Results In 9 patients hernias were localized unilaterally, in one patient bilaterally. In 7 cases the hernia sac contained small bowel, in 2 cases the preperitoneal and omental fat, and in 2 cases preperitoneal fat only. Eight patients presenting with clinical symptoms underwent operative repair. Conclusion Ultrasound examination is beneficial in

  14. Amyand’s hernia: A review

    PubMed Central

    Ivashchuk, Galyna; Cesmebasi, Alper; Sorenson, Edward P.; Blaak, Christa; Tubbs, Shane R.; Loukas, Marios

    2014-01-01

    Amyand’s hernia is defined as when the appendix is trapped within an inguinal hernia. While the incidence of this type of hernia is rare, the appendix may become incarcerated within Amyand’s hernia and lead to further complications such as strangulation and perforation. Incarceration of the appendix most commonly occurs within inguinal and femoral hernias, but may arise to a lesser extent in incisional and umbilical hernias. Incarcerated appendix has been reported in a variety of ventral abdominal and inguinal locations, yet its indistinct clinical presentation represents a diagnostic challenge. This paper reviews the literature on incarceration of the appendix within inguinal hernias and discusses current approaches to diagnosis and treatment of Amyand’s hernia and complications that may arise from incarceration of the appendix within the hernia. PMID:24473371

  15. Laparoscopic repair of parastomal hernia

    PubMed Central

    Yang, Xuefei; He, Kai; Hua, Rong; Shen, Qiwei

    2017-01-01

    Parastomal hernia is one of the most common long-term complications after abdominal ostomy. Surgical treatment for parastomal hernia is the only cure but a fairly difficult field because of the problems of infection, effects, complications and recurrence. Laparoscopic repair operations are good choices for Parastomal hernia because of their mini-invasive nature and confirmed effects. There are several major laparoscopic procedures for parastomal hernioplasty. The indications, technical details and complications of them will be introduced and discussed in this article. PMID:28251124

  16. 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

  17. A genome-wide association study identifies four novel susceptibility loci underlying inguinal hernia

    PubMed Central

    Jorgenson, Eric; Makki, Nadja; Shen, Ling; Chen, David C.; Tian, Chao; Eckalbar, Walter L.; Hinds, David; Ahituv, Nadav; Avins, Andrew

    2015-01-01

    Inguinal hernia repair is one of the most commonly performed operations in the world, yet little is known about the genetic mechanisms that predispose individuals to develop inguinal hernias. We perform a genome-wide association analysis of surgically confirmed inguinal hernias in 72,805 subjects (5,295 cases and 67,510 controls) and confirm top associations in an independent cohort of 92,444 subjects with self-reported hernia repair surgeries (9,701 cases and 82,743 controls). We identify four novel inguinal hernia susceptibility loci in the regions of EFEMP1, WT1, EBF2 and ADAMTS6. Moreover, we observe expression of all four genes in mouse connective tissue and network analyses show an important role for two of these genes (EFEMP1 and WT1) in connective tissue maintenance/homoeostasis. Our findings provide insight into the aetiology of hernia development and highlight genetic pathways for studies of hernia development and its treatment. PMID:26686553

  18. Laparoscopic repair of recurrent hernias.

    PubMed

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

    1995-02-01

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

  19. A rare case of Spigelian hernia combined with direct and indirect inguinal hernias.

    PubMed

    Kılıç, Murat Özgür; Değirmencioğlu, Gürkan; Dener, Cenap

    2017-01-01

    Spigelian hernia is a rare type of ventral hernias with nonspecific symptoms and signs. Therefore, its diagnosis is often difficult and requires more clinical attention. Although intermittent abdominal swelling and pain are the main symptoms, Spigelian hernias can be sometimes asymptomatic and are discovered incidentally at the operation. In some cases, these hernias can be associated with other abdominal wall hernias, therefore a detailed physical examination of the patients is necessary to avoid mistakes in diagnosis. Herein, we report an interesting and educational case of Spigelian hernia with accompanying ipsilateral both direct and indirect inguinal hernias in a male patient treated by open surgical repair with use of polypropylene mesh.

  20. Female Gender and Diabetes Mellitus Increase the Risk of Recurrence after Laparoscopic Incisional Hernia Repair

    PubMed Central

    McDermott, FD; Coleman, M; Ahmed, Z; Bunni, J; Bunting, D; Elshaer, M; Evans, V; Kimble, A; Kostalas, M; Page, G; Singh, J; Szczebiot, L; Wienand-Barnett, S; Wilkins, A; Williams, O; Newell, P

    2015-01-01

    Background Laparoscopic hernia repair is used widely for the repair of incisional hernias. Few case studies have focussed on purely ‘incisional’ hernias. This multicentre series represents a collaborative effort and employed statistical analyses to provide insight into the factors predisposing to recurrence of incisional hernia after laparoscopic repair. A specific hypothesis (ie, laterality of hernias as well as proximity to the xyphoid process and pubic symphysis predisposes to recurrence) was also tested. Methods This was a retrospective study of all laparoscopic incisional hernias undertaken in six centres from 1 January 2004 to 31 December 2010. It comprised a comprehensive review of case notes and a follow-up using a structured telephone questionnaire. Patient demographics, previous medical/surgical history, surgical procedure, postoperative recovery, and perceived effect on quality of life were recorded. Repairs undertaken for primary ventral hernias were excluded. A logistic regression analysis was then fitted with recurrence as the primary outcome. Results A total of 186 cases (91 females) were identified. Median follow-up was 42 months. Telephone interviews were answered by 115/186 (62%) of subjects. Logistic regression analyses suggested that only female sex (odds ratio (OR) 3.53; 95% confidence interval (CI) 1.39–8.97) and diabetes mellitus (3.54; 1–12.56) significantly increased the risk of recurrence. Position of the defect had no statistical effect. Conclusions These data suggest an increased risk of recurrence after laparoscopic incisional hernia repair in females and subjects with diabetes mellitus. These data will help inform surgeons and patients when considering laparoscopic management of incisional hernias. We recommend a centrally hosted, prospectively maintained national/international database to carry out additional research. PMID:25723687

  1. Athlete's hernia--a true, early direct inguinal hernia: diagnosis, pathophysiology, and surgical treatment.

    PubMed

    Chernyavsky, Victoriya S; Davidov, Tomer; Trooskin, Stanley Z; Boyarsky, Andrew

    2011-11-01

    Athlete's hernia (AH) is an activity limiting condition that presents as chronic inguinal pain in elite athletes. The diagnosis involves a thorough history and physical examination and can be aided by ultrasound interrogation of the groin. Operative treatment with a direct tissue repair of the inguinal floor successfully alleviates symptoms and allows for full return to activity. A retrospective analysis of patients with the diagnosis of AH from January 1998 to May 2010 who underwent operative repair was reviewed. Patients were evaluated based on age, gender, sport, time to presentation, subjective and objective physical findings, imaging findings, operative findings, length of follow-up, and return to activity. Ninety-six patients (6 females) with a median age of 22.6 years were evaluated. In the majority of these patients, operative exploration revealed a wide external ring with separation of the fibers of the external oblique aponeurosis and an unprotected and bulging transverses abdominis aponeurosis, very akin to an early direct inguinal hernia. The mean initial follow-up time was 6 weeks at which point all but two of the patients were able to resume their full level of activity without restrictions. The diagnosis of AH, although somewhat elusive, can be easily established with a high degree of suspicion after doing a thorough history and physical exam augmented with ultrasonography. AH is equivalent to an early direct inguinal hernia found in young athletes and can be surgically corrected allowing return to full activity.

  2. Lymphoma Diagnosed at Inguinal Hernia Repair

    PubMed Central

    Veal, David R; Hammill, Chet W

    2010-01-01

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

  3. Laparoscopic repair of adult Bochdalek's hernia

    PubMed Central

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

    2013-01-01

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

  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 hernia...

  5. 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 hernia...

  6. Sliding indirect hernia containing both ovaries.

    PubMed

    Fowler, Carol L

    2005-09-01

    Although sliding indirect inguinal hernias containing the ipsilateral ovary and fallopian tube are not uncommon in infant girls, sliding hernias containing both ovaries are rare. This report describes a large indirect inguinal hernia in a 1-year-old infant girl that contained the left uterine fundus, left bladder ear, as well as both ovaries and fallopian tubes.

  7. Mini Totally Extra-Peritoneal Repair of Inguinal Hernia with All 5 mm Ports: An Innovative "555 Technique".

    PubMed

    Gupta, Manish K; Muley, Kiran Kumar; Bethanbhatla, Murali Krishna; Nanavati, Juhil D; Manish, Kumar; Sarangi, Rathindra

    2017-03-01

    Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. We have innovated a "555 Technique" for completing Mini TEP repair of inguinal hernia by using all three 5 mm ports. Sixty-one consecutive patients were subjected for TEP repair of inguinal hernia by our innovative "555 Technique" since October 2014. A simple "Manish Retractor" is devised to make extra-peritoneal space with 5 mm trocar. Fifty-nine cases were men and 2 cases were women. The mean age of patients was 44.6 years (range 23-82 years). Out of 61 cases, 27 were indirect inguinal hernia (23 unilateral, 4 bilateral), 32 direct inguinal hernia (21 unilateral, 11 bilateral), 1 femoral hernia, and 1 obturator hernia. One patient of indirect inguinal hernia had sliding hernia with sigmoid colon. Sixty cases were successfully operated by "555 Technique." There was conversion to trans-abdominal pre-peritoneal repair (TAPP) in 1 case. The average time for insertion of 5 mm trocar in preperitoneal space by our technique was 150 seconds. No complications were noted on 6 months follow-up. Small infra-umbilical scar was cosmetically more acceptable to patients. "555 Technique" is a feasible option without compromising the principles of TEP repair for inguinal hernia. Innovation of simple "Manish Retractor" is the key in completing Mini TEP repair. This technique is simple, less invasive, less morbid, and cost effective as it avoids dependence over costly Hasson trocar with better cosmetic results.

  8. Giant congenital diaphragmatic hernia in an adult

    PubMed Central

    2014-01-01

    Bochdalek hernia is the most common type of congenital diaphragmatic hernia. It appears frequently in infants but rarely in adults. We present the case of a 50-year-old female han patient with tremendous left-sided congenital posterolateral diaphragmatic hernia (Bochdalek hernia) who also has a pair of supernumerary breasts and pulmonary hypoplasia of the lower-left lobe. The patient had an experience of misdiagnosis and she was treated for bronchitis for one year until being admitted to our hospital. This case study emphasizes the rare presentation of Bochdalek hernia in adults and the necessity of high clinical attention to similar cases. PMID:24512974

  9. Laparoscopic repair of abdominal incisional hernia

    PubMed Central

    Yang, Xue-Fei

    2016-01-01

    Abdominal incisional hernia is a common complication after open abdominal operations. Laparoscopic procedures have obvious mini-invasive advantages for surgical treatment of abdominal incisional hernia, especially to cases with big hernia defect. Laparoscopic repair of incisional hernia has routine mode but the actual operations will be various according to the condition of every hernia. Key points of these operations include design of the position of trocars, closure of defects and fixation of meshes. The details of these issues and experiences of perioperative evaluation and treatment will be talked about in this article. PMID:27761446

  10. An Unusual Trocar Site Hernia after Prostatectomy

    PubMed Central

    2016-01-01

    Trocar site hernias are rare complications after laparoscopic surgery but most commonly occur at larger trocar sites placed at the umbilicus. With increased utilization of the laparoscopic approach the incidence of trocar site hernia is increasing. We report a case of a trocar site hernia following an otherwise uncomplicated robotic prostatectomy at a 12 mm right lower quadrant port. The vermiform appendix was incarcerated within the trocar site hernia. Subsequent appendectomy and primary repair of the hernia were performed without complication. PMID:27648335

  11. Materials characterization of explanted polypropylene hernia mesh: Patient factor correlation.

    PubMed

    Smith, Sarah E; Cozad, Matthew J; Grant, David A; Ramshaw, Bruce J; Grant, Sheila A

    2016-02-01

    This study quantitatively assessed polypropylene (PP) hernia mesh degradation and its correlation with patient factors including body mass index, tobacco use, and diabetes status with the goal of improving hernia repair outcomes through patient-matched mesh. Thirty PP hernia mesh explants were subjected to a tissue removal process followed by assessment of their in vivo degradation using Fourier transform infrared, differential scanning calorimetry, and thermogravimetric analysis analyses. Results were then analyzed with respect to patient factors (body mass index, tobacco use, and diabetes status) to determine their influence on in vivo hernia mesh oxidation and degradation. Twenty of the explants show significant surface oxidation. Tobacco use exhibits a positive correlation with modulated differential scanning calorimetry melt temperature and exhibits significantly lower TGA decomposition temperatures than non-/past users. Chemical and thermal characterization of the explanted meshes indicate measurable degradation while in vivo regardless of the patient population; however, tobacco use is correlated with less oxidation and degradation of the polymeric mesh possibly due to a reduced inflammatory response.

  12. New injectable elastomeric biomaterials for hernia repair and their biocompatibility.

    PubMed

    Skrobot, J; Zair, L; Ostrowski, M; El Fray, M

    2016-01-01

    Complications associated with implantation of polymeric hernia meshes remain a difficult surgical challenge. We report here on our work, developing for the first time, an injectable viscous material that can be converted to a solid and elastic implant in vivo, thus successfully closing herniated tissue. In this study, long-chain fatty acids were used for the preparation of telechelic macromonomers end-capped with methacrylic functionalities to provide UV curable systems possessing high biocompatibility, good mechanical strength and flexibility. Two different systems, comprising urethane and ester bonds, were synthesized from non-toxic raw materials and then subjected to UV curing after injection of viscous material into the cavity at the abdominal wall during hernioplasty in a rabbit hernia model. No additional fixation or sutures were required. The control group of animals was treated with commercially available polypropylene hernia mesh. The observation period lasted for 28 days. We show here that artificially fabricated defect was healed and no reherniation was observed in the case of the fatty acid derived materials. Importantly, the number of inflammatory cells found in the surrounding tissue was comparable to these found around the standard polypropylene mesh. No inflammatory cells were detected in connective tissues and no sign of necrosis has been observed. Collectively, our results demonstrated that new injectable and photocurable systems can be used for minimally invasive surgical protocols in repair of small hernia defects.

  13. Meshless treatment of open inguinal hernia repair: a prospective study

    PubMed Central

    Kassab, Paulo; Franciulli, Ettore Ferrari; Wroclawski, Carolina Kassab; Ilias, Elias Jirjoss; Castro, Osvaldo Antônio Prado; Malheiros, Carlos Alberto

    2013-01-01

    ABSTRACT Objective: To evaluate two types of meshless open inguinal repair and to evaluate the recurrence rate. Methods: We operated on sequentially 98 men and 15 women with 144 unilateral or bilateral inguinal hernias between December 1988 and April 2007. The surgeries were performed by two experienced surgeons and divided into two groups: Bassini or McVay reconstructive surgery techniques. Bassini type reinforcements were employed for Nyhus II and IIIB with minor destruction of the posterior wall. Patients with Nyhus type IIIA, type IIIB with major destruction of the fascia transversalis, and type IIIC were subjected to the McVay technique. Results: Seventy-five hernias were corrected using the McVay technique. Only two recurrences (2.67%) were observed in this group. For group Bassini, two recurrences for 69 hernias (2.89%) were observed (p=0.658). Mean age for the recurrent group was 56 years. No differences were observed between the ages of males and females (52 years). Conclusions: Non-mesh repair in inguinal hernia can be safely used if performed by experienced surgeons. PMID:23843059

  14. 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

  15. Perineal hernia repair in dogs.

    PubMed

    Robertson, J J

    1984-05-01

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

  16. Direct and recurrent inguinal hernias are associated with ventral hernia repair: a database study.

    PubMed

    Henriksen, Nadia A; Sorensen, Lars T; Bay-Nielsen, Morten; Jorgensen, Lars N

    2013-02-01

    A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal hernias as opposed to patients with indirect inguinal hernias. The aim of the present study was to assess whether direct or recurrent inguinal hernias are associated with an elevated rate of ventral hernia surgery. In the nationwide Danish Hernia Database, a cohort of 92,457 patients operated on for inguinal hernias was recorded from January 1998 until June 2010. Eight-hundred forty-three (0.91 %) of these patients underwent a ventral hernia operation between January 2007 and June 2010. A multivariate logistic regression analysis was applied to assess an association between inguinal and ventral hernia repair. Direct (Odds Ratio [OR] = 1.28 [95 % CI, 1.08-1.51]) and recurrent (OR = 1.76, [95 % CI, 1.39-2.23]) inguinal hernias were significantly associated with ventral hernia repair after adjustment for age, gender, and surgical approach (open or laparoscopic). Patients with direct and recurrent inguinal herniation are more prone to ventral hernia repair than patients with indirect inguinal herniation. This is the first study to show that herniogenesis is associated with type of inguinal hernia.

  17. Parastomal hernias -- clinical study of therapeutic strategies.

    PubMed

    Târcoveanu, E; Vasilescu, A; Cotea, E; Vlad, N; Palaghia, M; Dănilă, N; Variu, M

    2014-01-01

    Parastomal hernias are parietal defects adjacent to the stomasite, after ileostomy and colostomy. Their incidence is variable and they are generally underestimated. Between 2001 and 2010 at the First Surgical Clinic Iasi, we treated 861 incisional hernias, of which there were 31 parastomal hernias in 26 patients (3%), 5 of which were recurrent parastomal hernias. Parastomal hernias have been explored clinically, through imaging and intraoperatively.Because our experience and literature review have demonstrated that a mesh repair is a safe procedure in the treatment of parastomal hernia, in 2010 we initiated a prospective randomized trial on the use of prophylactic polypropylene mesh at the time of stoma formation to reduce the risk of parastomal hernia. We enrolled in the study 20 patients with mesh implanted at the primary operation and 22 patients without mesh. The inclusion criteria were: patients with low rectal cancer, stage II-III, irradiated, obese, with a history of hernias, patients who do physical work. Most parastomal hernias were asymptomatic; only six cases with parastomal hernias required emergency surgical treatment. We performed local tissue repair in 16 cases (4 cases with recurrent parastomal hernia, stoma relocation in one case), sublay mesh repair in 15 cases (one case with recurrent parastomal hernia; stoma relocation in 5 cases). Postoperative morbidity registered included 4 wound infections (one case after mesh repair which required surgical reintervention) and stoma necrosis in one case with strangulation parastomal hernia with severe postoperative evolution and death. After local tissue repair recurrences were seen in 6 cases, after mesh repair we registered recurrence only in one case and no relapse after the relocation of the stoma. The patients with prophylactic mesh at the time of stoma formation to reduce the risk of parastomal hernia were followed for a median of 20 months(range 12 to 28 months) by clinical examination and ultrasound

  18. Diaphragmatic hernia: an unusual presentation

    PubMed Central

    Shah, Neha; Fernandes, Roland; Thakrar, Amit; Rozati, Hamoun

    2013-01-01

    A 53-year-old lady presented to A&E with a 3-day history of severe epigastric pain and vomiting. This was preceded by a 3-month history of generalised abdominal discomfort, early satiety and increasing shortness of breath. A CT scan showed a left-sided posterior diaphragmatic defect. Urgent repair of the hernia showed herniation of three-quarter of the stomach, half of the transverse colon, the 13 cm spleen and the pancreas in the chest. There were no postoperative complications. Traumatic diaphragmatic hernias are known to be a complication of major trauma. However, the patient in this case report presented acutely, after mild physical trauma related to using a rowing machine. This exercise, when not performed correctly can raise intra-abdominal pressure. It is plausible that this trauma, although mild, was sufficient in causing the lady's diaphragmatic hernia. This case would suggest that the trauma required to cause a diaphragmatic hernia need not be as severe as originally thought. PMID:23616319

  19. Minilaparoscopy For Inguinal Hernia Repair

    PubMed Central

    Malcher, Flavio; Cavazzola, Leandro Totti; Araujo, Guilherme D. E.; Silva, José Antônio Da Cunha E.; Rao, Prashanth; Iglesias, Antonio Carlos

    2016-01-01

    Background and Objectives: Inguinal hernia repair is among the most common procedures performed worldwide and the laparoscopic totally extraperitoneal (TEP) approach is a recognized and effective surgical technique. Although technically advantageous because of the option of no mesh fixation and no need for creation of a peritoneal flap resulting, in less postoperative pain and faster recovery, TEP has not achieved the popularity it deserves, mainly because of its complexity and steep learning curve. Minilaparoscopy was first described in the 1990s and has recently gained significantly from better instrumentation that may increase TEP's effectiveness and acceptance. We performed a prospective study, to analyze the outcomes of minilaparoscopy in pain and operative time when compared to the conventional laparoscopic technique in hernia repair. Methods: Fifty-eight laparoscopic inguinal hernia repairs were performed: 36 by traditional laparoscopic technique and 22 by minilaparoscopic instruments (mini). A study protocol was applied prospectively for data collection. Variables analyzed were early postoperative pain (at hour 6 after procedure), pain at discharge, use of on-demand analgesics, and operative time. Results: The mini group presented reduced early postoperative pain and operative time. The present study also suggests less postoperative pain at discharge with mini procedures, although this difference was not statistically significant. No difference between the groups regarding on-demand use of analgesics was found. Conclusions: This study corroborates findings in previously published papers that have shown the feasibility of minilaparoscopy in laparoscopic TEP hernia repair and its benefits regarding postoperative pain, operative time, and aesthetic outcomes. PMID:27777499

  20. False esophageal hiatus hernia caused by a foreign body: A fatal event

    PubMed Central

    Lu, Ya-Ping; Yao, Ming; Zhou, Xu-Yan; Huang, Bing; Qi, Wei-Bo; Chen, Zhi-Heng; Xu, Long-Sheng

    2014-01-01

    Foreign body ingestion is a common complaint in gastrointestinal clinics. It is usually not difficult to diagnose because most of the patients report a definitive history of accidental foreign body ingestion. However, in rare cases, patients do not have a clear history. Thus, the actual condition of the patient is difficult to diagnosis or is misdiagnosed; consequently, treatment is delayed or the wrong treatment is administered, respectively. This report describes a fatal case of esophageal perforation caused by an unknowingly ingested fishbone, which resulted in lower esophageal necrosis, chest cavity infection, posterior mediastinum fester, and significant upper gastrointestinal accumulation of blood. However, his clinical symptoms and imaging data are very similar with esophageal hiatal hernia. Unfortunately, because the patient was too late in consulting a physician, he finally died of chest infection and hemorrhage caused by thoracic aortic rupture. First, this case report underlines the importance of immediate consultation with a physician as soon as symptoms are experienced so as not to delay diagnosis and treatment, and thus avoid a fatal outcome. Second, diagnostic imaging should be performed in the early stage, without interference by clinical judgment. Third, when computed tomography reveals esophageal hiatus hernia with stomach incarceration, posterior mediastinal hematoma, and pneumatosis caused by esophageal, a foreign body should be suspected. Finally, medical professionals are responsible for making people aware of the danger of foreign body ingestion, especially among children, those who abuse alcohol, and those who wear dentures, particularly among the elderly, whose discriminability of foreign bodies is decreased, to avoid dire consequences. PMID:25339840

  1. Incidental Non-Inguinals Hernias in Totally Extra-Peritoneal Hernia Repair

    PubMed Central

    Old, OJ; Kulkarni, SR; Hardy, TJ; Slim, FJ; Emerson, LG; Bulbulia, RA; Whyman, MR

    2015-01-01

    Introduction Totally extra-peritoneal (TEP) inguinal hernia repair allows identification and repair of incidental non-inguinal groin hernias. We assessed the prevalence of incidental hernias during TEP inguinal hernia repair and identified the risk factors for incidental hernias. Materials and Methods Consecutive patients undergoing TEP repair from May 2005 to November 2012 were the study cohort. Inspection for ipsilateral femoral, obturator and rarer varieties of hernia was undertaken during TEP repair. Patient characteristics and operative findings were recorded on a prospectively collected database. Results A total of 1,532 TEP repairs were undertaken in 1,196 patients. Ninety-three patients were excluded due to incomplete data, leaving 1,103 patients and 1,404 hernias for analyses (1,380 male; 802 unilateral and 301 bilateral repairs; median age, 59 years). Among the 37 incidental hernias identified (2.6% of cases), the most common type of incidental hernia was femoral (n=32, 2.3%) followed by obturator (n=2, 0.1%). Increasing age was associated with an increased risk of incidental hernia, with a significant linear trend (p<0.01). The risk for patients >60 years of age was 4.0% vs 1.4% for those aged <60 years (p<0.01). Incidental hernias were found in 29.2% of females vs 2.2% of males, (p<0.0001). Risk of incidental hernia in those with a recurrent inguinal hernia was 3.0% vs 2.6% for primary repair (p=0.79). Conclusions Incidental hernias during TEP inguinal hernia repair were found in 2.6% of cases and, though infrequent, could cause complications if left untreated. The risk of incidental hernia increased with age and was significantly higher in patients aged >60 years and in females. PMID:25723688

  2. Incidental non-inguinals hernias in totally extra-peritoneal hernia repair.

    PubMed

    Old, O J; Kulkarni, S R; Hardy, T J; Slim, F J; Emerson, L G; Bulbulia, R A; Whyman, M R; Poskitt, K R

    2015-03-01

    Totally extra-peritoneal (TEP) inguinal hernia repair allows identification and repair of incidental non-inguinal groin hernias. We assessed the prevalence of incidental hernias during TEP inguinal hernia repair and identified the risk factors for incidental hernias. Consecutive patients undergoing TEP repair from May 2005 to November 2012 were the study cohort. Inspection for ipsilateral femoral, obturator and rarer varieties of hernia was undertaken during TEP repair. Patient characteristics and operative findings were recorded on a prospectively collected database. A total of 1,532 TEP repairs were undertaken in 1,196 patients. Ninety-three patients were excluded due to incomplete data, leaving 1,103 patients and 1,404 hernias for analyses (1,380 male; 802 unilateral and 301 bilateral repairs; median age, 59 years). Among the 37 incidental hernias identified (2.6% of cases), the most common type of incidental hernia was femoral (n=32, 2.3%) followed by obturator (n=2, 0.1%). Increasing age was associated with an increased risk of incidental hernia, with a significant linear trend (p<0.01). The risk for patients >60 years of age was 4.0% vs 1.4% for those aged <60 years (p<0.01). Incidental hernias were found in 29.2% of females vs 2.2% of males, (p<0.0001). Risk of incidental hernia in those with a recurrent inguinal hernia was 3.0% vs 2.6% for primary repair (p=0.79). Incidental hernias during TEP inguinal hernia repair were found in 2.6% of cases and, though infrequent, could cause complications if left untreated. The risk of incidental hernia increased with age and was significantly higher in patients aged >60 years and in females.

  3. Primary prevascular and retropsoas hernias: incidence of rare abdominal wall hernias.

    PubMed

    Powell, B S; Lytle, N; Stoikes, N; Webb, D; Voeller, G

    2015-06-01

    To describe the incidence and treatment of prevascular and retropsoas hernias in a large-volume general surgery practice. Femoral hernias are considered uncommon with an incidence between 2 and 8 % of groin hernias. There are no large studies describing the subtypes of femoral hernias or retropsoas hernias, and therefore no reported incidence or standardized treatment recommendations for these hernias exist. This study is a retrospective review of all patients undergoing total extraperitoneal (TEP) laparoscopic herniorrhaphy between August 1993 and December 2011. A single surgeon performed all the repairs. Demographics and patient outcomes were reported. 2,436 patients underwent 3,242 TEP repairs. The subtypes were: indirect 1,523 (46.9 %), direct 1,473 (45.4 %), femoral 156 (4.8 %), obturator 35 (1.1 %), prevascular 25 (0.77 %), Spigelian 20 (0.61 %), retropsoas 3 (0.09 %). Prevascular hernias accounted for 16 % of femoral hernias. Patients with prevascular hernias had a mean age of 70.3 years and were all male. 13 of the 25 patients (52 %) with prevascular hernias had other associated defects and four (16 %) of the patients had prevascular hernias as a recurrence from a prior hernia operation. There were three patients with retropsoas hernias that only would not have been seen from an anterior open approach. There are no intraoperative complications or known recurrences from this study group. Prevascular and retropsoas hernias are uncommon, but have a higher incidence than previously believed. Prevascular hernias tend to be associated with older age and other defects. The diagnosis and management of these hernias are readily achieved using the laparoscopic TEP approach.

  4. Acute management of a unilateral incarcerated Spigelian hernia in a patient with bilateral Spigelian hernias.

    PubMed

    Vannahme, M; Monkhouse, S J W

    2013-09-01

    Spigelian hernias were first described by Joseph Klinkosch in the 18th century, and have since posed a diagnostic and surgical problem owing to their non-specific presentation and rarity. While the management of unilateral hernias is fairly well described in today's literature, bilateral Spigelian hernias are very rare. We describe the emergency management of a patient with bilateral Spigelian hernias, diagnosed on computed tomography.

  5. Occult hernias detected by laparoscopic totally extra-peritoneal inguinal hernia repair: a prospective study.

    PubMed

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

    2011-08-01

    One distinct advantage of laparoscopic inguinal hernia repair is the opportunity for clear visualization of the direct, indirect, femoral, obturator and other groin spaces. The aim of this study was to examine/assess the potential of the laparoscopic totally extraperitoneal (TEP) inguinal hernia repair method in detecting unexpected additional hernias. Patients who underwent an elective inguinal hernia repair, in the department of abdominal surgery at the institute of laparoscopic surgery (ILS, Bordeaux, France) between September 2003 and July 2005 were enrolled prospectively in the study. The patients' demographic data, operative, postoperative course and outpatient follow-up were studied. A total of 337 laparoscopic inguinal hernia repairs were performed in 263 patients. Of these, 189 patients had unilateral hernia (109 right and 80 left) and 74 patients had bilateral hernias. Indirect hernias were the most common, followed by direct and then femoral hernias. There were 218 male patients and 45 female patients with a mean age of 60 ± 15 years. There were 44 unexpected hernias: 6 spegilian hernias, 19 obturator hernias and another 19 femoral hernias. Two patients were converted to transabdominal preperitoneal (TAPP) due to surgical difficulties. There were no major intraoperative complications in all patients except for three cases of bleeding arising from the inferior epigastric artery. Only one patient had postoperative bleeding and was re-operated on several hours after the hernia repair. No recurrence occurred in the present series. The laparoscopic inguinal hernia repair approach allows viewing of the entire myopectineal orifice, facilitating repair of any unexpected hernias and thereby reducing the chance of recurrence.

  6. Hernia fibroblasts lack β-estradiol induced alterations of collagen gene expression

    PubMed Central

    2006-01-01

    Background Estrogens are reported to increase type I and type III collagen deposition and to regulate Metalloproteinase 2 (MMP-2) expression. These proteins are reported to be dysregulated in incisional hernia formation resulting in a significantly decreased type I to III ratio. We aimed to evaluate the β-estradiol mediated regulation of type I and type III collagen genes as well as MMP-2 gene expression in fibroblasts derived from patients with or without history of recurrent incisional hernia disease. We compared primary fibroblast cultures from male/female subjects without/without incisional hernia disease. Results Incisional hernia fibroblasts (IHFs) revealed a decreased type I/III collagen mRNA ratio. Whereas fibroblasts from healthy female donors responded to β-estradiol, type I and type III gene transcription is not affected in fibroblasts from males or affected females. Furthermore β-estradiol had no influence on the impaired type I to III collagen ratio in fibroblasts from recurrent hernia patients. Conclusion Our results suggest that β-estradiol does not restore the imbaired balance of type I/III collagen in incisional hernia fibroblasts. Furthermore, the individual was identified as an independent factor for the β-estradiol induced alterations of collagen gene expression. The observation of gender specific β-estradiol-dependent changes of collagen gene expression in vitro is of significance for future studies of cellular response. PMID:17010202

  7. Incarceration of a colonoscope in an inguinal hernia: Case report and literature review

    PubMed Central

    Tan, Victoria Ping-Yi; Lee, Yuk Tong; Poon, Jensen Tung Chung

    2013-01-01

    Incarceration of an endoscope in an inguinal hernia may occur during the course of routine colonoscopy. The incarceration may occur on insertion or withdrawal and frequently the hernia is not suspected prior to the colonoscopy. Most commonly, a left sided inguinal hernia is involved, however right inguinal hernias may be implicated in subjects with altered anatomy post abdominal surgery. Incarceration of an endoscope in an inguinal hernia has been seldom reported in the literature which is likely to be related to under reporting. A range of techniques have been suggested by various authors over the last four decades to manage this unusual complication of colonoscopy. These techniques include utilizing fluoroscopy, manual external pressure and/or the fitting of a cap onto the tip of the colonoscope to facilitate colonoscopic navigation. The authors present a case report of incarceration of the colonoscope on withdrawal in an unsuspected left inguinal hernia with a review of the literature on the management of this colonoscopic complication. A management strategy is suggested. PMID:23772270

  8. Groin hernia subtypes are associated in patients with bilateral hernias: a 14-year nationwide epidemiologic study.

    PubMed

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian; Rosenberg, Jacob

    2015-07-01

    To investigate the relation between groin hernia subtypes in patients operated for bilateral hernias. With data from the Danish Hernia Database, we identified all patients operated for primary groin hernias from 1998 to 2012. Within this cohort all patients that were bilaterally operated were analyzed. Risk factors for bilateral groin hernia operation as well as the relationship between groin hernia subtypes bilaterally, were analyzed using multivariate Cox proportional hazards analysis and Kappa statistics. A total of 108, 775 persons with primary groin hernia repair (89.9% males) were registered, and of those were 12,041 persons operated bilaterally (94.9% males). Females and males operated for a unilaterally direct inguinal hernia (DIH) had increased Hazard Ratios (HR) of 3.85 (CI 95% 2.14-6.19) and 4.46 (CI 95% 2.57-7.88) of being contralaterally operated for a DIH. Females and males operated for a unilaterally indirect inguinal hernia (IIH) had HRs of 6.93 (CI 95% 3.66-13.11) and 1.89 (CI95% 1.24-2.88) for being contralaterally operated for an IIH. The same tendency was seen for femoral hernias. All hernia subtypes were bilaterally associated in both genders and the hernia subtypes could be localized manifestations of generalized conditions or inheritable traits instead of localized defects.

  9. Amyand's hernia in infant: a rare entity.

    PubMed

    Upadhyaya, V D; Kumar, V; Srivastava, P; Gangopadhyaya, A N

    2009-01-01

    The chance of vermiform appendix lying with in a hernial sac is 1% or less and is known as Amyand's hernia and it is very rare in infant and neonate. Till date, only twenty cases had been reported in English literature. We are reporting a rare case of Amyand's hernia where appendix was present in right inguinal sac of non-obstructed inguinal hernia in a seven month old male infant during operation. The appendectomy was done along with right inguinal herniotomy. In most of the reported cases, appendix was inflamed or perforated, expect in one case where appendix was not inflamed but patient presented with inguinal hernia. This case is reported because of the rarity of Amyand's hernia in infant, the appendix was not inflamed, hernia was not obstructed, and whether in such types of cases appendix should be preserved or not.

  10. Microlaparoscopic hernia repair in children: initial experiences.

    PubMed

    Turial, Salmai; Saied, Ahmad; Schier, Felix

    2011-12-01

    This study reports the authors' experience with the exclusive use of 2-mm instrument sets and small diameter scopes in 100 children undergoing microlaparoscopic herniorrhaphy. This prospective study was designed as a pilot feasibility study; all data related to patients and procedures were prospectively collected. A pneumoperitoneum was established, and 1.7 to 2 mm 0° or 30° scopes were introduced for visualization. Exclusively 2-mm instruments were used. This study included 100 children (aged 15 days to 11 years, median age 2.3 years) undergoing microlaparoscopic hernia repair. A total of 140 hernias were treated. The average operative time for the microlaparoscopically experienced surgeon was 16 minutes for bilateral inguinal hernia and 12 minutes for unilateral hernias. All procedures were completed microlaparoscopically. Hernia recurrence was observed in 2 patients. Based on the authors' early experience, it is found that microlaparoscopic hernia repair in children seems to be a safe and feasible procedure.

  11. [Inguinofemoral hernia: multicenter study of surgical techniques].

    PubMed

    Porrero, José L; Sánchez-Cabezudo, Carlos; Bonachía, Oscar; López-Buenadicha, Adolfo; Sanjuánbenito, Alfonso; Hidalgo, Manuel

    2005-07-01

    The present study was performed by the Spanish Association of surgeons through its abdominal wall and sutures section. The aim was to determine the current situation of inguinofemoral hernias in Spain and was based on an anonymous multicenter study with the participation of various national hospitals. Fifty general surgery departments in distinct surgical centers throughout Spain responded to an anonymous survey in 2000. The survey gathered data on anesthetic features, surgical techniques and complications in the treatment of inguinofemoral hernias. Sixty-six percent of hospital centers had a specific abdominal wall unit and 24% performed laparoscopic hernia surgery. Prosthetic techniques (especially Lichtenstein) were the most frequently used in the treatment of primary inguinal hernia (72%) and recurrent hernia (100%). The most frequently used prosthetic material was polypropylene mesh (76%). Only 28% of the departments surveyed performed anatomic techniques in the repair of primary inguinal hernia (Shouldice and Bassini). The most frequent treatment for femoral hernia was the Lichtenstein "plug" (78%). Sixty-eight percent of the centers surveyed performed regional anesthesia, 18% used general anesthesia and only 14% used local anesthesia with sedation. Severe complications were found in 20% of departments. Clinical postoperative follow-up was performed in 96% of the centers and telephone follow-up was used in 4%. The recurrence rate was 1.2% for primary inguinal hernia, 2.7% for recurrent inguinal hernia and 0.3% for femoral hernia. In Spain the most commonly used surgical technique in the treatment of inguinal hernia is Lichtenstein hernioplasty under spinal anesthesia and with polypropylene prosthesis. The Lichtenstein plug is the most commonly used technique in the treatment of femoral hernia.

  12. Acute Scrotum Caused by Hernia Sac Torsion.

    PubMed

    Fukui, Shinji; Aoki, Katsuya; Shimada, Keiji; Samma, Shoji

    2016-03-01

    A 9-year-old boy was referred to us with an acute pain attack of the left scrotal contents. Ultrasonography showed a normal blood supply to the left testis, suggesting an incarcerated left inguinal hernia. Surgical exploration did not demonstrate an incarcerated left inguinal hernia. After exploration of the left testis, a dark red pedunculated cystic mass, separate from the left testis, was found to be twisted. Immunohistochemical studies of the excised cyst demonstrated torsion of the hernia sac of the peritoneum. In conclusion, we encountered a case of acute scrotum which was probably caused by torsion of the hernia sac.

  13. 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

  14. Acute pancreatitis secondary to incarcerated paraesophageal hernia.

    PubMed

    Kafka, N J; Leitman, I M; Tromba, J

    1994-05-01

    Paraesophageal hiatus hernia can be a morbid and even lethal condition. Although many complications from this entity have been described, they almost always involve gastric incarceration and its related complications. Occasionally, the transverse colon or spleen may be involved in the hernia, causing additional symptoms. An unusual case of paraesophageal hiatus hernia involving incarceration of the pylorus, proximal duodenum, and pancreatic head is described. The patient's presentation, operative management, and perioperative course are discussed to emphasize the importance of early elective repair of paraesophageal hiatus hernia before the development of such occurrences.

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

    PubMed

    Chamary, S L; Chamary, V L

    2015-03-01

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

  16. Laparoscopic Features and Repair of a Combined left Spigelian Hernia and left Morgagni Diaphragmatic Hernia

    PubMed Central

    Chamary, SL

    2015-01-01

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

  17. 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

  18. Laparoscopic management of Spigelian hernia.

    PubMed

    Novell, F; Sanchez, G; Sentis, J; Visa, J; Novell, J; Novell Costa, F

    2000-12-01

    Spigelian hernia (SH) is an uncommon abdominal wall hernia. Its clinical symptoms are not characteristic, and the preoperative diagnosis is often difficult because SH can simulate the symptoms of more classical lower quadrant abdominal diseases. We report a case of SH in an 80-year-old woman that was complicated by incarceration and diagnosed by physical examination and ultrasound. At the time of presentation, she had an abdominal mass that was soft and occasionally painful, and aggravated by movements that increase intraabdominal pressure. Laparoscopic examination of the abdominal cavity identified the incarcerate jejunum ansae. The defect was a large opening in the peritoneum along the lateral margin of the rectus abdominis muscle. After dissection of the intestinal adhesions, a prosthetic polypropylene mesh was introduced and fixed with staples into the lateral abdominal wall. There were no postoperative complications. We conclude that the laparoscopic approach is a feasible alternative to the conventional open technique that is easy, safe, and allows excellent operative visualization.

  19. [Diagnosis of hernia using peritoneography].

    PubMed

    Wrazidlo, W; Karl, E L; Koch, K

    1989-06-01

    Peritoneography was performed in 1200 patients with ill-defined complaints concerning the abdominal wall, the groin or the pelvic floor. The purpose was to exclude or demonstrate the presence of a hernia. Amongst 750 patients, abnormalities were found in 53.5%. The examination was also carried out post-operatively in order to demonstrate possible recurrences which were not clinically obvious. Amongst 450 patients, a recurrence or a contra lateral hernia was demonstrated in 44%. These results show that a recurrence can only be demonstrated or excluded with certainty by means of peritoneography. The radiological examination is technically straightforward, can be carried out in a few minutes on an out patient basis and is simple for the patient.

  20. Designing a ventral hernia staging system.

    PubMed

    Petro, C C; O'Rourke, C P; Posielski, N M; Criss, C N; Raigani, S; Prabhu, A S; Rosen, M J

    2016-02-01

    The absence of a standardized classification scheme for ventral hernias hinders comparisons within the literature, indirectly delaying meaningful discussions regarding technique. We aimed to generate a comprehensive staging system that stratifies patients by risk of developing wound morbidity and hernia recurrence. Our prospective database of all ventral hernia repairs (2006-2013) was reviewed with no exclusion based on technique or prosthetic. The presence of patient comorbidities, contamination and hernia dimensions-width/location on computed topography-was evaluated to identify variables most closely associated with surgical site occurrence (SSO) and recurrence. Predicted odds ratios and relative hazards, for SSO and recurrence, respectively, were used to partition patients into stages corresponding with increasing levels of risk. Hernia width (OR 2.24, HR 1.73) and the presence of contamination (OR 1.81, HR 2.04) were most significantly associated with increased risk of SSO and recurrence, while hernia location and the presence of comorbidities were not. Stage I hernias are <10 cm/clean and associated with low SSO and recurrence risk. Stage II hernias are 10-20 cm/clean or <10 cm contaminated and carry an intermediate risk of SSO and recurrence. Stage III hernias are either ≥10/contaminated or any hernia ≥20 cm, and these are associated with high SSO and recurrence risk. Stages I-III carry a concordance index of 0.67 for SSO and 0.61 for recurrence. Hernia width and wound class can be used to stratify patients into stages (I-III) with increasing risk of wound morbidity and recurrence. This can be the foundation for future inclusion and exclusion criteria.

  1. Prediction of contralateral inguinal hernias in children: a prospective study of 357 unilateral inguinal hernias.

    PubMed

    Hoshino, M; Sugito, K; Kawashima, H; Goto, S; Kaneda, H; Furuya, T; Hosoda, T; Masuko, T; Ohashi, K; Inoue, M; Ikeda, T; Tomita, R; Koshinaga, T

    2014-06-01

    Previously, we established a pre-operative risk scoring system to predict contralateral inguinal hernia in children with unilateral inguinal hernias. The current study aimed to verify the usefulness of our pre-operative scoring system. This was a prospective study of patients undergoing unilateral inguinal hernia repair from 2006 to 2009 at a single institution. Gender, age at initial operation, birth weight, initial operation side, and the pre-operative risk score were recorded. We analyzed the incidence of contralateral inguinal hernia, risk factors, and the usefulness of our pre-operative risk scoring system. The follow-up period was 36 months. We used forward multiple logistic regression analysis to predict contralateral hernia. Of the 372 patients who underwent unilateral hernia repair, 357 (96.0 %) were completely followed-up for 36 months, and 23 patients (6.4 %) developed a contralateral hernia. Left-sided hernia (OR = 5.5, 95 %, CI = 1.3-24.3, p = 0.023) was associated with an increased risk of contralateral hernia. The following covariates were not associated with contralateral hernia development: gender (p = 0.702), age (p = 0.215), and birth weight (p = 0.301). The pre-operative risk score (cut-off point = 4.5) of the patients with a contralateral hernia was significantly higher, compared with the patients without a contralateral hernia using the area under the receiver operating characteristic curve (p = 0.024). Using multivariate analysis, we confirmed usefulness of our pre-operative scoring system and initial side of the inguinal hernia, together, for the prediction of contralateral inguinal hernia in children.

  2. Parastomal hernia repair. An update.

    PubMed

    Wara, P

    2011-04-01

    Repair of parastomal hernia remains controversial. Open suture repair of the fascial defect or stoma resiting are both associated with high morbidity and unacceptably high recurrence rates and are no longer recommended for routine use. Mesh repair appears to provide the best results. Following the first anectodal reports there are accumulating evidence that laparoscopic mesh repair is feasible and has a promising potential in the management of parastomal hernia. Two laparoscopic techniques have emerged, the use of a mesh with a slit and a central keyhole and a mesh without a slit, the latter often termed as a modified Sugarbaker. Published series, however, are observational and often with a short length of follow-up. Most series suffer from small sample size and controlled trials are lacking. The limited data, therefore, make it difficult to draw conclusions. At present none of the methods of open or laparoscopic mesh repair has proved superior. In spite of this laparoscopic repair has gained increasing acceptance. A polypropylene based mesh with an anti-adhesive layer covering the visceral side seems to be applicable using the keyhole technique with a slit as well as the modified Sugarbaker technique. A PTFE mesh should preferably be used with the modified Sugarbaker technique. If a PTFE mesh is used with the keyhole technique parastomal hernia is likely to recur.

  3. De Garengeot hernia: an uncommon presentation of acute appendicitis.

    PubMed

    Vos, Cornelis G; Mollema, Robbert; Richir, Milan C

    2017-02-01

    We present a case of a 78-year-old female patient with an uncommon presentation of acute appendicitis. She was found to have a perforated appendicitis which developed in a femoral hernia sack. An appendix present in a femoral hernia is called a De Garengeot Hernia, which is a rare form of femoral hernia. Clinical presentation, diagnosis and management are discussed.

  4. 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

  5. Anatomy essentials for laparoscopic inguinal hernia repair.

    PubMed

    Yang, Xue-Fei; Liu, Jia-Lin

    2016-10-01

    Laparoscopic inguinal hernia repair is performed more and more nowadays. The anatomy of these procedures is totally different from traditional open procedures because they are performed from different direction and in different space. The important anatomy essentials for laparoscopic inguinal hernia repair will be discussed in this article.

  6. Anatomy essentials for laparoscopic inguinal hernia repair

    PubMed Central

    Yang, Xue-Fei

    2016-01-01

    Laparoscopic inguinal hernia repair is performed more and more nowadays. The anatomy of these procedures is totally different from traditional open procedures because they are performed from different direction and in different space. The important anatomy essentials for laparoscopic inguinal hernia repair will be discussed in this article. PMID:27826575

  7. Diaphragmatic Hernia After Pediatric Liver Transplant.

    PubMed

    Kirnap, Mahir; Akdur, Aydincan; Ozcay, Figen; Soy, Ebru; Coskun, Mehmet; Moray, Gokhan; Haberal, Mehmet

    2015-10-01

    Diaphragmatic hernia is an unusual complication after pediatric liver transplant. Nearly half of bowel obstruction cases, which require surgical intervention in liver transplant patients, are caused by diaphragmatic hernia. The smaller patients are at risk for higher rates of diaphragmatic complication after pediatric liver transplant, but diaphragmatic hernia has not been reported as a unique occurrence. Here, we report 3 cases of diaphragmatic hernia after liver transplant and discuss the possible contributing factors. Diaphragmatic hernia should nevertheless be added to the list of potential complications after liver transplant in the pediatric population. Pediatric transplant physicians and surgeons should be aware of this complication so that it is recognized promptly in both acute and nonacute settings and appropriate action is taken.

  8. Are there any predictive factors of metachronous inguinal hernias in children with unilateral inguinal hernia?

    PubMed

    Jallouli, M; Yaich, S; Dhaou, M B; Yengui, H; Trigui, D; Damak, J; Mhiri, R

    2009-12-01

    This study was done to identify risk factors for metachronous manifestation of contralateral inguinal hernia in children with unilateral inguinal hernia. This is a retrospective study of 565 patients with inguinal hernia during a nine-year period at a single institution. Age, sex, and side of the hernia at presentation were recorded. The incidence of metachronous inguinal hernia and its risk factors were analyzed. Of 565 children, 62 (11%) were presented with synchronous bilateral hernias. Of the remaining 503, a metachronous contralateral hernia developed in 22 (4.4%). The age at hernia repair of the patients with contralateral manifestation (18 ± 3.67 months; mean ± SD), was significantly younger than observed in the control patients (34 ± 1.34 months; p = 0.000). There was no significant difference between the groups in other factors such as the age at hernia presentation, the initial side of the hernia, birth weight. and the percentage of patients who had experienced incarceration. We believe that the incidence is still too low to recommend routine contralateral exploration. Therefore, infants younger than 18 months appear to be a higher-risk subpopulation and should receive closer follow-up over this time period.

  9. Traumatic lumbar hernias: do patient or hernia characteristics predict bowel or mesenteric injury?

    PubMed

    Mellnick, Vincent M; Raptis, Constantine; Lonsford, Chad; Lin, Michael; Schuerer, Douglas

    2014-06-01

    Traumatic lumbar hernias are rare but important injuries to diagnose in blunt abdominal trauma, both because of delayed complications of the hernia itself and because of well-documented association with bowel and mesenteric injuries. No study to our knowledge has determined whether specific features of the hernia-size of the wall defect, inferior or superior location, or the side of the hernia-bear any predictive value on the presence of underlying bowel and mesenteric injury. A retrospective query of the radiology information system yielded 21 patients with lumbar hernias which were diagnosed on CT. These were reviewed by three radiologists to confirm the presence of an acute lumbar hernia and to determine the size and location of the hernia. The patients' medical records were reviewed to determine the presence of operatively confirmed bowel and/or mesenteric injuries, which occurred in 52 % of patients. A significant (p < 0.001) difference was found in the frequency of bowel and/or mesenteric injury with hernia defects greater than 4.0 cm (100 %) and those less than 4.0 cm (17 %). Larger hernias also resulted in more procedures (p = 0.042) and a trend towards longer ICU stay, but no difference in injury severity score (ISS) or overall hospital stay. No significant difference was seen in the frequency of bowel and/or mesenteric injuries based on side or location of the hernia, though distal colonic injuries were more commonly seen with left-sided hernias (50 %) compared to right-sided hernias (18 %). Although based on a small patient population, these results suggest that larger traumatic lumbar hernias warrant particularly close evaluation for an underlying bowel and/or mesenteric injury.

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

    PubMed

    Hirabayashi, Takeshi; Ueno, Shigeru

    2013-07-20

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

  11. 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

  12. The inheritance of groin hernia: a systematic review.

    PubMed

    Burcharth, J; Pommergaard, H C; Rosenberg, J

    2013-04-01

    Groin hernia has been proposed to be hereditary; however, a clear hereditary pattern has not been established yet. The purpose of this review was to analyze studies evaluating family history and inheritance patterns and to investigate the possible heredity of groin hernias. A literature search in the MEDLINE and Embase databases was performed with the following search terms: genetics, heredity, multifactorial inheritance, inheritance patterns, sibling relations, family relations, and abdominal hernia. Only English human clinical or register-based studies describing the inheritance of groin hernias, family history of groin hernias, or familial accumulation of groin hernias were included. Eleven studies evaluating 37,166 persons were included. The overall findings were that a family history of inguinal hernia was a significant risk factor for the development of a primary hernia. A family history of inguinal hernia showed a tendency toward increased hernia recurrence rate and significantly earlier recurrence. The included studies did not agree on the possible inheritance patterns differing between polygenic inheritance, autosomal dominant inheritance, and multifactorial inheritance. Furthermore, the studies did not agree on the degree of penetrance. The literature on the inheritance of groin hernias indicates that groin hernia is most likely an inherited disease; however, neither the extent of familial accumulation nor a clear inheritance pattern has yet been found. In order to establish whether groin hernias are accumulated in certain families and to what extent, large register studies based on hernia repair data or clinical examinations are needed. Groin hernia repair (inguinal and femoral hernia) is among the most commonly performed gastrointestinal surgical procedures [1]. Emergency groin hernia surgery is associated with increased mortality, increased patient-related morbidity, and increased hospital stay compared with elective groin hernia procedures [2, 3

  13. Inguinal hernia recurrence: Classification and approach

    PubMed Central

    Campanelli, Giampiero; Pettinari, Diego; Cavalli, Marta; Avesani, Ettore Contessini

    2006-01-01

    The authors reviewed the records of 2,468 operations of groin hernia in 2,350 patients, including 277 recurrent hernias updated to January 2005. The data obtained - evaluating technique, results and complications - were used to propose a simple anatomo-clinical classification into three types which could be used to plan the surgical strategy: Type R1: first recurrence ‘high,’ oblique external, reducible hernia with small (<2 cm) defect in non-obese patients, after pure tissue or mesh repairType R2: first recurrence ‘low,’ direct, reducible hernia with small (<2 cm) defect in non-obese patients, after pure tissue or mesh repairType R3: all the other recurrences - including femoral recurrences; recurrent groin hernia with big defect (inguinal eventration); multirecurrent hernias; nonreducible, linked with a controlateral primitive or recurrent hernia; and situations compromised from aggravating factors (for example obesity) or anyway not easily included in R1 or R2, after pure tissue or mesh repair. PMID:21187986

  14. 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.

  15. Laparoscopic Repair of Incidentally Found Spigelian Hernia

    PubMed Central

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

    2011-01-01

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

  16. Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences.

    PubMed

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian; Bisgaard, Thue; Rosenberg, Jacob

    2014-01-01

    The purpose of this study was to establish the risk of recurrence after direct and indirect inguinal hernia operation in a large-scale female population and to establish the relationship between the type of hernia at the primary and recurrent procedure. Using data from the Danish Hernia Database (DHDB), a cohort was generated: all females operated on electively for a primary inguinal hernia by either Lichtenstein’s technique or laparoscopy from 1998 to 2012. Within this prospectively collected cohort, the hernia type at the primary procedure (direct inguinal hernia (DIH), indirect inguinal hernia (IIH), combination hernia), the hernia type at the recurrent procedure (DIH, IIH, combination hernia, femoral hernia), anesthesia type, and time from primary procedure to reoperation were registered. A total of 5,893 females with primary elective inguinal hernia operation on in the study period (61 % IIH, 37 % DIH, 2 % combined hernias) were included with a median follow-up time of 72 months (range 0 to 169). A total of 305 operations for suspected recurrences were registered (61 % inguinal recurrences, 38 % femoral recurrences, 1 % no hernias), which corresponded to an overall reoperation rate of 5.2 %. All femoral recurrences occurred after a previous open anterior operation. The crude reoperation rate after primary DIH operation was 11.0 %, 3.0 % after primary IIH operation and 0.007 % after combined hernia operation (p < 0.001). The multivariate adjusted analysis found that DIH at primary operation was a substantial risk factor for recurrence with a hazard ratio of 3.1 (CI 95 % 2.4–3.9) compared with IIH at primary operation (p < 0.001), and that laparoscopic operation gave a lower risk of recurrence with a hazard ratio of 0.57 (CI 95 % 0.43–0.75) compared with Lichtenstein’s technique (p < 0.001). The risk of femoral recurrence was correlated to operation for DIH with a hazard ratio of 2.4 (CI 95 % 1.7–3.5) compared with operation for IIH. In a

  17. Risk factors for early recurrence after inguinal hernia repair

    PubMed Central

    2009-01-01

    Background Family history, male gender and age are significant risk factors for inguinal hernia disease. Family history provides evidence for a genetic trait and could explain early recurrence after inguinal hernia repair despite technical advance at least in a subgroup of patients. This study evaluates if age and family history can be identified as risk factors for early recurrence after primary hernia repair. Methods We performed an observational cohort study for 75 patients having at least two recurrent hernias. The impact of age, gender and family history on the onset of primary hernias, age at first recurrence and recurrence rates was investigated. Results 44% (33/75) of recurrent hernia patients had a family history and primary as well as recurrent hernias occurred significantly earlier in this group (p = 0.04). The older the patients were at onset the earlier they got a recurrent hernia. Smoking could be identified as on additional risk factor for early onset of hernia disease but not for hernia recurrence. Conclusion Our data reveal an increased incidence of family history for recurrent hernia patients when compared with primary hernia patients. Patients with a family history have their primary hernias as well as their recurrence at younger age then patients without a family history. Though recurrent hernia has to be regarded as a disease caused by multiple factors, a family history may be considered as a criterion to identify the risk for recurrence before the primary operation. PMID:20003183

  18. New approaches to managing congenital diaphragmatic hernia.

    PubMed

    Ivascu, Felicia A; Hirschl, Ronald B

    2004-06-01

    A number of new techniques have been studied for managing newborns with congenital diaphragmatic hernia and respiratory insufficiency. Among these have been the techniques of delayed approach to the repair of the diaphragmatic hernia; permissive hypercapnia; nitric oxide and surfactant administration; intratracheal pulmonary ventilation; liquid ventilation; perfluorocarbon-induced lung growth; and lung transplantation. These interventions are at various stages of development and evaluation of effectiveness. All, however, are being explored in the hopes of improving outcome in patients with congenital diaphragmatic hernia who continue to have significant morbidity and mortality in the newborn period.

  19. Colocutaneous Fistula after Open Inguinal Hernia Repair

    PubMed Central

    Kallis, Panayiotis; Koronakis, Nikolaos; Hadjicostas, Panayiotis

    2016-01-01

    The plug-and-patch technique is frequently used for the open repair of inguinal hernias; however, serious complications may arise on rare occasions. We present the case of a 69-year-old patient who presented with a colocutaneous fistula with the sigmoid colon 9 years after the repair of a left sliding inguinal hernia with the plug-and-patch technique. The patient underwent sigmoidectomy and excision of the fistulous track. He was discharged on postoperative day 5 and had an uneventful recovery. Although such complications are reported rarely, the surgeon must be aware of them when deciding upon the method of hernia repair. PMID:27738544

  20. [Spontaneous pulmonary hernia: report of a case].

    PubMed

    Petour Gazitúa, Felipe; Pérez Velásquez, Javiera; Quintanilla Guidobono, Felipe; Chehade, Jeanne Marie

    2015-10-13

    Pulmonary hernia is a protrusion of lung tissue through a defect in the chest wall. Its origin can be congenital or acquired; spontaneous presentation is the least frequent. We report a case of spontaneous intercostal pulmonary hernia with a brief description of the disease. In this case, the patient developed a hematoma in the left hemithorax associated to pain at the base of the left hemithorax after a Valsalva's maneuver. The images obtained by thoracic CT scan revealed the existence of a left intercostal hernia. After radiological diagnosis, surgical treatment of the defect was performed with good results.

  1. Diaphragmatic hernia in Denys-Drash syndrome

    SciTech Connect

    Devriendt, K.; Deloof, E.; Moerman, P.

    1995-05-22

    We report on a newborn infant with male pseudohermaphroditism and glomerular lesions (Denys-Drash syndrome) but without Wilms tumor. A constitutional heterozygous mutation in the WT1 gene ({sup 366} Arg to His) was identified. In addition the child had a large diaphragmatic hernia, so far not described in Denys-Drash syndrome. The expression of the WT1 gene in pleural and abdominal mesothelium and the occurrence of diaphragmatic hernia in transgenic mice with a homozygous WT1 deletion strongly suggests that the diphragmatic hernia in this patient is part of the malformation pattern caused by WT1 mutations. 21 refs., 4 figs.

  2. 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

  3. [Incarcerated and strangulated hernias--surgical approach and management].

    PubMed

    Mauch, J; Helbling, C; Schlumpf, R

    2000-01-01

    Acute symptomatic groin hernias with potential or definite ischemia represent a special group of all the groin hernias. The method of choice to treat these hernias has to fulfill the following criteria: 1. Easy reduction of the hernia sac and its contents without causing damage. 2. Good exposure and easy access for possible resection. 3. Safe hernia repair through the same access. According to our experience with 44 incarcerated and strangulated groin hernias operated between 1993 and 1997 and after a literature review, we took the following procedure as our routine: Posterior approach and mesh repair. We do not use a meshgraft only in the presence of colonic necrosis or peritonitis.

  4. Obstructive Uropathy Secondary to Uretero-inguinal Hernia

    PubMed Central

    Hong, Lih En; Tan, Chrismin; Li, Jordan

    2015-01-01

    Uretero-inguinal hernia in patients with native kidneys is rare. We report a case of an 84-year-old man who was diagnosed with obstructive uropathy secondary to uretero-inguinal hernia, with no past history of herniorrhaphy or congenital genitourinary malformation. Uretero-inguinal hernias are predominantly indirect inguinal hernias and may be paraperitoneal or extraperitoneal. Computed tomography (CT) is a non-invasive diagnostic tool for uretero-inguinal hernia. Herniorrhaphy is indicated in all cases of uretero-inguinal hernia to prevent obstructive uropathy. PMID:26180656

  5. Laparoscopic totally extra-peritoneal hernia repair for bilateral Spigelian hernias and coincident inguinal hernia: A case report.

    PubMed

    Matsui, Shimpei; Nitori, Nobuhiro; Kato, Ayu; Ikeda, Yoshifumi; Kiatagwa, Yuko; Hasegawa, Hirotoshi; Okabayashi, Koji; Tsuruta, Masashi; Kitajima, Masaki

    2016-01-01

    Spigelian hernia (SH) is a rare ventral hernia occurring near the lateral border of the rectus muscle. The treatment remains controversial and depends on institutional expertise. Although laparoscopic surgery is a good adaptation for the repair of ventral hernias, only a few cases have been reported in the literature. Here, we report a case of totally extra-peritoneal (TEP) repair for bilateral SHs. A 74-year-old Japanese man presented with asymptomatic bulges in the right lower abdominal quadrant. On physical examination, the bulges were located to the right of the lateral border of the abdominal rectus muscle and the right inguinal region in an upright position. We diagnosed right SH and coincident homonymous ipsilateral inguinal hernia (IH) by abdominal computed tomography and planned a curative operation by laparoscopy. By first laparoscopic exploration, we found an asymptomatic SH to the left of the lateral border of the abdominal rectus muscle and performed TEP repair for all hernias. The second laparoscopic exploration after fixing the mesh in place revealed that the orifice of the right SH was scarred and stiffened by repeated prolapse. We finally eliminated the sac by ligation because of a fear causing of reduction en masse of the SH. The use of laparoscopy simplified the diagnosis and facilitates the subsequent repair of the hernia. TEP approach is the ideal treatment for the simultaneous laparoscopic repair of SH and IH. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  6. Gallstone ileus in an 'asymptomatic' parastomal hernia.

    PubMed

    Jayamanne, H; Brown, J; Stephenson, B M

    2016-09-01

    Parastomal hernias are common and often asymptomatic. We report the first known case in which later, acute symptoms developed owing to gallstone ileus in a sac containing both omentum and small bowel. Urgent computed tomography established the diagnosis.

  7. Single incision endoscopic surgery for lumbar hernia.

    PubMed

    Kawaguchi, Masahiko; Ishikawa, Norihiko; Shimizu, Satsuki; Shin, Hisato; Matsunoki, Aika; Watanabe, Go

    2011-01-01

    Single Incision Endoscopic Surgery (SIES) has emerged as a less invasive surgery among laparoscopic surgeries, and this approach for incisional hernia was reported recently. This is the first report of SIES for an incisional lumbar hernia. A 66-year-old Japanese woman was referred to our institution because of a left flank hernia that developed after left iliac crest bone harvesting. A 20-mm incision was created on the left side of the umbilicus and all three trocars (12, 5, and 5 mm) were inserted into the incision. The hernial defect was 14 × 9 cm and was repaired with intraperitoneal onlay mesh and a prosthetic graft. The postoperative course was uneventful. SIES for lumbar hernia offers a safe and effective outcome equivalent compared to laparoscopic surgery. In addition, SIES is less invasive and has a cosmetic benefit.

  8. Prosthetic mesh materials used in hernia surgery.

    PubMed

    Sanders, David L; Kingsnorth, Andrew N

    2012-03-01

    It is estimated that 20 million prosthetic meshes are implanted each year worldwide. It is clear that the evolution of meshes is not yet complete and the ideal mesh is yet to be found. There is a vast array of prosthetics available for hernia repair. This review outlines the properties of available meshes and the evidence to be considered when choosing a prosthetic for hernia repair.

  9. Distinct Presentations of Hernia of Umbilical Cord

    PubMed Central

    Mirza, Bilal; Ali, Waqas

    2016-01-01

    Hernia of umbilical cord is a well-known entity which presents with herniation of small bowel into the proximal part of umbilical cord. It has very good prognosis after surgical repair. Occasionally, it can have distinct presentations and varied malformations at the umbilicus which have bearing on the course of treatment and final outcome. Herein, we describe various presentations and malformations associated with hernia of umbilical cord. Embryological extrapolation is attempted for the malformations at umbilicus. PMID:27896161

  10. Distinct Presentations of Hernia of Umbilical Cord.

    PubMed

    Mirza, Bilal; Ali, Waqas

    2016-01-01

    Hernia of umbilical cord is a well-known entity which presents with herniation of small bowel into the proximal part of umbilical cord. It has very good prognosis after surgical repair. Occasionally, it can have distinct presentations and varied malformations at the umbilicus which have bearing on the course of treatment and final outcome. Herein, we describe various presentations and malformations associated with hernia of umbilical cord. Embryological extrapolation is attempted for the malformations at umbilicus.

  11. [Treatment of paracolostomic hernias using polypropylene mesh].

    PubMed

    Grigoriuk, A A; Ishchenko, V N; Matveev, A V; Kovalev, V A; Krasnobaev, A E; Stuzhin, S A

    2015-01-01

    It was analyzed the results of treatment of 23 patients with large paracolostomic hernias. Twenty patients underwent colostomy suturing and hernial ring Onlay-plasty with polypropylene mesh without tension. Onlay-plasty of hernial ring with own tissues and polypropylene mesh and colostomy reconstruction outside of implant were performed in 3 patients. Onlay-alloplasty with polypropylene mesh "PROLENE" is effective method of treatment of postoperative paracolostomic ventral hernias with colostomy closing as well as with its reconstruction outside of implant.

  12. Surgical Treatment of Paraesophageal Hernias: A Review.

    PubMed

    Andolfi, Ciro; Jalilvand, Anahita; Plana, Alejandro; Fisichella, P Marco

    2016-10-01

    The management of paraesophageal hernia (PEH) can be challenging due to the lack of consensus regarding indications and principles of operative treatment. In addition, data about the pathophysiology of the hernias are scant. Therefore, the goal of this review is to shed light and describe the classification, pathophysiology, clinical presentation, and indications for treatment of PEHs, and provide an overview of the surgical management and a description of the technical principles of the repair.

  13. Laparoscopic repair of recurrent groin hernias.

    PubMed

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

    1994-06-01

    Between November 1991 and May 1993, 54 recurrent groin hernias were laparoscopically repaired in 50 patients. Forty-eight were men and two were women. Forty-six recurrent hernias were unilateral and four bilateral. Twenty-five were direct, 19 indirect, 10 pantaloon, and two had a femoral component. In only 10 patients was the contralateral side normal. In 27 patients, the other side had been previously repaired, and in 13 they had a new contralateral hernia. A transabdominal preperitoneal technique was used to dissect and repair the entire floor in all patients. A single sheet of polypropylene mesh was used in the repair of the women patients, and a double-buttress technique with the first sheet slitted for the cord was used for the men. Patients were examined every 3 months for the first year and at 6-month intervals thereafter. Follow-up ranged from 1 to 18 months with a mean of 8 months. No patient was lost to follow-up, and no recurrence was observed. Patients returned to normal activity in an average of 1 week. Seroma, which resolved spontaneously, was the most common complication. The overall short-term results suggested that a laparoscopic mesh buttressed repair of recurrent groin hernias is technically feasible and can eliminate early rerecurrence of the hernia so commonly seen after repair of recurrent hernias.

  14. Umbilical Hernia Repair: Analysis After 934 Procedures.

    PubMed

    Porrero, José L; Cano-Valderrama, Oscar; Marcos, Alberto; Bonachia, Oscar; Ramos, Beatriz; Alcaide, Benito; Villar, Sol; Sánchez-Cabezudo, Carlos; Quirós, Esther; Alonso, María T; Castillo, María J

    2015-09-01

    There is a lack of consensus about the surgical management of umbilical hernias. The aim of this study is to analyze the medium-term results of 934 umbilical hernia repairs. In this study, 934 patients with an umbilical hernia underwent surgery between 2004 and 2010, 599 (64.1%) of which were evaluated at least one year after the surgery. Complications, recurrence, and the reoperation rate were analyzed. Complications were observed in 5.7 per cent of the patients. With a mean follow-up time of 35.5 months, recurrence and reoperation rates were 3.8 per cent and 4.7 per cent, respectively. A higher percentage of female patients (60.9 % vs 29 %, P = 0.001) and a longer follow-up time (47.4 vs 35 months, P = 0.037) were observed in patients who developed a recurrence. No significant differences were observed between complications and the reoperation rate in patients who underwent Ventralex(®) preperitoneal mesh reinforcement and suture repair; however, a trend toward a higher recurrence rate was observed in patients with suture repair (6.5 % vs 3.2 %, P = 0.082). Suture repair had lower recurrence and reoperation rates in patients with umbilical hernias less than 1 cm. Suture repair is an appropriate procedure for small umbilical hernias; however, for larger umbilical hernias, mesh reinforcement should be considered.

  15. Internal abdominal hernia: Intestinal obstruction due to trans-mesenteric hernia containing transverse colon

    PubMed Central

    Crispín-Trebejo, Brenda; Robles-Cuadros, María Cristina; Orendo-Velásquez, Edwin; Andrade, Felipe P.

    2014-01-01

    INTRODUCTION Internal abdominal hernias are infrequent but an increasing cause of bowel obstruction still often underdiagnosed. Among adults its usual causes are congenital anomalies of intestinal rotation, postsurgical iatrogenic, trauma or infection diseases. PRESENTATION OF CASE We report the case of a 63-year-old woman with history of chronic constipation. The patient was hospitalized for two days with acute abdominal pain, abdominal distension and inability to eliminate flatus. The X-ray and abdominal computerized tomography scan (CT scan) showed signs of intestinal obstruction. Exploratory laparotomy performed revealed a trans-mesenteric hernia containing part of the transverse colon. The intestine was viable and resection was not necessary. Only the hernia was repaired. DISCUSSION Internal trans-mesenteric hernia constitutes a rare type of internal abdominal hernia, corresponding from 0.2 to 0.9% of bowel obstructions. This type carries a high risk of strangulation and even small hernias can be fatal. This complication is specially related to trans-mesenteric hernias as it tends to volvulize. Unfortunately, the clinical diagnosis is rather difficult. CONCLUSION Trans-mesenteric internal abdominal hernia may be asymptomatic for many years because of its nonspecific symptoms. The role of imaging test is relevant but still does not avoid the necessity of exploratory surgery when clinical features are uncertain. PMID:24880799

  16. Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care.

    PubMed

    Poulose, B K; Roll, S; Murphy, J W; Matthews, B D; Todd Heniford, B; Voeller, G; Hope, W W; Goldblatt, M I; Adrales, G L; Rosen, M J

    2016-04-01

    Wide variation in care and costs exists regarding the management of abdominal wall hernias, with unproven benefit for many therapies. This work establishes a specialty society-based solution to improve the quality and value of care delivered to hernia patients during routine clinical management on a national scale. The Americas Hernia Society Quality Task Force was charged by the Americas Hernia Society leadership to develop an initiative that utilizes the concepts of continuous quality improvement (CQI). A disease-based registry was created to collect information for CQI incorporating real-time outcome reporting, patient reported outcomes, stakeholder engagement, and collaborative learning methods to form a comprehensive quality improvement effort. The Americas Hernia Society Quality Collaborative (AHSQC) was formed with the mission to provide health care professionals real-time information for maximizing value in hernia care. The initial disease areas selected for CQI were incisional and parastomal hernias with ten priorities encompassing the spectrum of care. A prospective registry was created with real-time analytic feedback to surgeons. A data assurance process was implemented to ensure maximal data quality and completeness. Four collaborative meetings per year were established to meet the goals of the AHSQC. As of the fourth quarter 2014, the AHSQC includes nearly 2377 patients at 38 institutions with 82 participating surgeons. The AHSQC has been established as a quality improvement initiative utilizing concepts of CQI. This ongoing effort will continually refine its scope and goals based on stakeholder input to improve care delivered to hernia patients.

  17. Endoscopic TEP inguinal hernia repair in the management of occult obturator and femoral hernias.

    PubMed

    Rath, Alok; Bhatia, Parveen; Kalhan, Sudhir; John, Suviraj; Khetan, Mukund; Bindal, Vivek; Ali, Asfar; Singh, Rahul

    2014-08-01

    The gold standard technique for the repair of groin hernias has always been a controversial issue. Richard Ger introduced the endoscopic approach for the repair of groin hernias in 1991.The endoscopic technique follows the basic principle of preperitoneal placement of a polypropylene mesh over the myopectineal orifice. During the course of dissection of the preperitoneal space, occult obturator and femoral hernias were discovered. Patients who underwent endoscopic totally extraperitoneal repair of inguinal hernias over a period of 2 years were included in this retrospective study. A total of 305 cases of groin hernias were operated in 208 patients over a period of 2 years from January 2010 to January 2012 in a single institution. Eleven synchronous clinically occult obturator hernias were found in 8 patients (3.84%) and 5 synchronous clinically occult femoral hernias were found in 5 patients (2.40%) during repair. Preoperative and perioperative findings were discordant in quite a few cases. Preperitoneal dissection discovered coincidental occult hernias in 6.25% of patients.

  18. Symposium on the management of inguinal hernias: 3. Laparoscopic groin hernia surgery: the TAPP procedure

    PubMed Central

    Litwin, Demetrius E.M.; Pham, Quynh N.; Oleniuk, Fredrick H.; Kluftinger, Andreas M.; Rossi, Ljubomir

    1997-01-01

    Objective To describe the technique and results of laparoscopic transabdominal preperitoneal (TAPP) hernia repair. Design A case series, with a detailed description of the operative technique. Setting A university affiliated hospital. Patients A consecutive series of 554 patients (494 male, 60 female) who underwent laparoscopic hernia repair in a single institution. The mean follow-up was 14 months. Interventions Laparoscopic TAPP hernia repair was performed in almost all patients. Simple closure was performed in a patient with a strangulated hernia, and a mesh-based repair was used in a patient with bilateral obturator hernias. Main outcome measures Complications and recurrence. Results The laparoscopic TAPP repair was successful in 550 of the 554 patients who underwent 632 hernia repairs. Conversion was necessary in 4 patients. Complications were infrequent and there were no recurrences. Only 3.4% of patients were lost to follow-up. The most frequent complications were urinary retention (27) and hematoma and seroma (38) in the early postoperative period. Neuralgia (11) and hydrocele (10) also occurred. Mesh infection occurred in only 1 patient and port-site hernias in 3 patients. There was 1 death from an acute myocardial infarction. Conclusion Laparoscopic TAPP hernia repair is associated with an exceedingly low recurrence rate and an acceptable complication rate. PMID:9194780

  19. Aetiology of femoral hernias revisited: bilateral femoral hernia in a young male (two cases).

    PubMed

    Kochupapy, R T; Ranganathan, G; Dias, S; Shanahan, D

    2013-01-01

    Bilateral femoral hernias are less common in men than in women and rare in young adults. Only one case of a bilateral femoral hernia in a young man has been reported in the literature before. Three main theories have been postulated for femoral hernias. The theory that they are an acquired disease is the most accepted due to the common occurrence of such hernias in multiparous women but the theory lacks enough evidence. We report two cases in young men. Anatomical variations in the femoral canal could be the primary aetiological factor in these patients. A unilateral femoral hernia in young men with acquired aetiological factors requires a clinical examination of the opposite side.

  20. Which mesh for hernia repair?

    PubMed Central

    Brown, CN; Finch, JG

    2010-01-01

    INTRODUCTION The concept of using a mesh to repair hernias was introduced over 50 years ago. Mesh repair is now standard in most countries and widely accepted as superior to primary suture repair. As a result, there has been a rapid growth in the variety of meshes available and choosing the appropriate one can be difficult. This article outlines the general properties of meshes and factors to be considered when selecting one. MATERIALS AND METHODS We performed a search of the medical literature from 1950 to 1 May 2009, as indexed by Medline, using the PubMed search engine (). To capture all potentially relevant articles with the highest degree of sensitivity, the search terms were intentionally broad. We used the following terms: ‘mesh, pore size, strength, recurrence, complications, lightweight, properties’. We also hand-searched the bibliographies of relevant articles and product literature to identify additional pertinent reports. RESULTS AND CONCLUSIONS The most important properties of meshes were found to be the type of filament, tensile strength and porosity. These determine the weight of the mesh and its biocompatibility. The tensile strength required is much less than originally presumed and light-weight meshes are thought to be superior due to their increased flexibility and reduction in discomfort. Large pores are also associated with a reduced risk of infection and shrinkage. For meshes placed in the peritoneal cavity, consideration should also be given to the risk of adhesion formation. A variety of composite meshes have been promoted to address this, but none appears superior to the others. Finally, biomaterials such as acellular dermis have a place for use in infected fields but have yet to prove their worth in routine hernia repair. PMID:20501011

  1. A peculiar variety of indirect inguinal hernia (juxtacordal indirect inguinal hernia)

    PubMed Central

    Alkhateeb, Harith M.; Aljanabi, Thaer J.

    2015-01-01

    Background Indirect inguinal hernias are usually congenital, forming a sac in the core of the spermatic cord covered by the internal spermatic, cremasteric, and external spermatic fasciae1−3. Direct inguinal hernias are acquired; the sac lies beside/behind the cord1−3. A rare third type is a combination of indirect and direct sacs on both sides of inferior epigastric vessels1−3. We describe a rare fourth type, juxtacordal indirect oblique inguinal hernia (Fig. 1), in which the sac emerges through a weakness in the deep inguinal ring, lateral to inferior epigastric vessels, and passes into the inguinal canal beside and in contact with the cord but outside of its covering fasciae. Objective Describes a very rare variety of inguinal hernia. Design Case reports. Setting Tikrit Teaching Hospital/Salahuddin/Iraq. Participants: and presentation The first case; a 5-year-old male with right inguinal hernia, the second case; a 25-year-old man with right inguinal hernia, the third case; a 60-year-old man with right inguinal hernia. Interventions Surgery has been done electively for all. Results and discussion Because the sac emerges through the deep inguinal ring and passes through the inguinal canal, it is an indirect type and because it passes beside the spermatic cord we call it juxtacordal hernia. Because of the thick extraperitoneal fat layer over the sac, we think this hernia is acquired. Conclusions Knowing this type of hernia might reduce the risk of inferior epigastric vessels injury and lower the rate of recurrence. PMID:26052435

  2. Life-threatening Petersen's hernia following open Beger's procedure

    PubMed Central

    Goh, Yan Li; Haworth, Alexander; Wilson, Jeremy; Magee, Conor J.

    2016-01-01

    Petersen's hernia (an internal hernia between the transverse mesocolon and Roux limb following Roux-en-Y reconstruction) is well described following laparoscopic gastric bypass surgery. We describe a Petersen-type hernia in a patient who had undergone complex open upper gastrointestinal surgery for chronic pancreatitis. PMID:26994105

  3. Hernia

    MedlinePlus

    ... lifting heavy objects. In time, the most common complaint is a bump that is sore and growing. ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  4. Hernias

    MedlinePlus

    ... heavy objects diarrhea or constipation persistent coughing or sneezing pregnancy These types of strain on their own ... a persistent cough from a cold or you sneeze a lot because of allergies , see your doctor ...

  5. Hernias

    MedlinePlus

    ... and exercise program if you think you are overweight or obese. Make fruits, veggies, and whole grains ... to lift something that's heavy, bend from your knees, not at your waist, or don't lift ...

  6. Mesh Inguinal Hernia Repair and Appendectomy in the Treatment of Amyand's Hernia with Non-Inflamed Appendices

    PubMed Central

    Kose, Emin; Sisik, Abdullah

    2017-01-01

    Amyand's hernia is defined as protrusion of the vermiform appendix in an inguinal hernia sac. It is a rare entity with variable clinical presentation from normal vermiform appendix to abscess formation due to perforation of acute appendicitis. Although surgical treatment includes appendectomy and hernia repair, appendectomy in the absence of an inflamed appendix and use of a mesh in cases of appendectomy remain to be controversial. The aim of this study was to review the experience of mesh inguinal hernia repair plus appendectomy performed for Amyand's hernia with noninflamed appendices. There were five male patients with a mean age of 42.4 ± 16.1 years in this retrospective study in which Amyand's hernia was treated with mesh inguinal hernia repair plus appendectomy for noninflamed appendices. Patients with acute appendicitis and perforated vermiform appendix were excluded. There were four right sided and one bilateral inguinal hernia. Postoperative courses were uneventful. During the follow-up period (14.0 ± 7.7 months), there was no inguinal hernia recurrence. Mesh inguinal hernia repair with appendectomy can be performed for Amyand's hernia in the absence of acute appendicitis. However, presence of fibrous connections between the vermiform appendix and the surrounding hernia sac may be regarded as a parameter to perform appendectomy. PMID:28194430

  7. Single-incision laparoscopic repair of Spigelian hernia.

    PubMed

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

    2015-01-01

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

  8. Single-Incision Laparoscopic Repair of Spigelian Hernia

    PubMed Central

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

    2015-01-01

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

  9. Review article: appendicitis in groin hernias.

    PubMed

    Meinke, Alan K

    2007-10-01

    To review the clinical presentation, outcome and causes of acute appendicitis presenting within a groin hernia. A comprehensive review of the past 70 years of English language surgical literature was conducted pertaining to acute appendicitis presenting within an inguinal or femoral hernia. Thirty-four reports describing 45 patients were reviewed to determine age, position, gender, pathologic stage at presentation, causal suppositions, and clinical outcomes. Hernial appendicitis presented as an inguinal abscess or a tender inguinal mass, often in the femoral position, and most commonly at the extremes of age. It was almost never recognized preoperatively, and, because of the sequestered nature of the inflammatory process, presented with few classic systemic signs or symptoms suggestive of acute appendicitis. Advanced pathologic stage and death correlated with the patient's age, delay in presentation, and delay in recognition. Evaluation of an inguinal abscess or a nonreducible tender groin hernia presenting in a patient at the extremes of age, should include computed tomography to rule out an occult acute appendicitis within the hernia, as systemic signs and symptoms of appendicitis are rarely evident. The condition appears to be caused by inflammatory adhesions caused by appendicitis occurring within an enlarged hernial orifice rather than appendicitis caused by external compression of the appendix base. Early recognition of this unique presentation of appendicitis allows trans-hernial appendectomy and immediate herniorraphy. Delayed diagnosis requires drainage of abscess with appendectomy and interval hernia repair.

  10. Grynfelt hernia: case report and literature review.

    PubMed

    Cesar, D; Valadão, M; Murrahe, R J

    2012-02-01

    Back lumbar hernia is a rare abdominal wall defect that usually presents spontaneously after trauma or lumbar surgery or, less frequently, during infancy (congenital). Few reports have been published in the literature describing primary lumbar hernia. A general surgeon will have the opportunity to repair only one or a few lumbar hernia cases in his/her lifetime. We report a case of a healthy 50-year-old man, with no previous surgeries or history of trauma, who presented to the outpatient department with abdominal discomfort, pain, and a sensation of a growing mass on his lower left back for 4 years. CT scan of the abdomen showed a mass in the left posterolateral abdominal wall. Specifically, a herniation of retroperitoneal fat between the erector spinae muscle group and internal oblique muscles through aponeurosis of the transversalis muscle (Grynfeltt hernia). The patient underwent a small lumbotomy, polypropylene mesh was placed and he recovered well. Although many techniques have been described for the surgical management of such hernias, none of them can be recommended as the preferred method. Our impression, however, is that the open approach, with a small lumbotomy, seems to be easy, safe and presents good postoperative recovery.

  11. Traumatic abdominal hernia complicated by necrotizing fasciitis.

    PubMed

    Martínez-Pérez, Aleix; Garrigós-Ortega, Gonzalo; Gómez-Abril, Segundo Ángel; Martí-Martínez, Eva; Torres-Sánchez, Teresa

    2014-11-01

    Necrotizing fasciitis is a critical illness involving skin and soft tissues, which may develop after blunt abdominal trauma causing abdominal wall hernia and representing a great challenge for physicians. A 52-year-old man was brought to the emergency department after a road accident, presenting blunt abdominal trauma with a large non-reducible mass in the lower-right abdomen. A first, CT showed abdominal hernia without signs of complication. Three hours after ICU admission, he developed hemodynamic instability. Therefore, a new CT scan was requested, showing signs of hernia complication. He was moved to the operating room where a complete transversal section of an ileal loop was identified. Five hours after surgery, he presented a new episode of hemodynamic instability with signs of skin and soft tissue infection. Due to the high clinical suspicion of necrotizing fasciitis development, wide debridement was performed. Following traumatic abdominal wall hernia (TAWH), patients can present unsuspected injuries in abdominal organs. Helical CT can be falsely negative in the early moments, leading to misdiagnosis. Necrotizing fasciitis is a potentially fatal infection and, consequently, resuscitation measures, wide-spectrum antibiotics, and early surgical debridement are required. This type of fasciitis can develop after blunt abdominal trauma following wall hernia without skin disruption.

  12. Adult Bochdalek hernia with bowel incarceration.

    PubMed

    Hung, Yeh-Huang; Chien, Yu-Hon; Yan, Sheng-Lei; Chen, Ming-Feng

    2008-10-01

    Bochdalek hernias are rare in adults. We report 2 cases of Bochdalek hernia with bowel obstruction. The first case was a 74-year-old male patient who suffered from abdominal pain and chest tightness for 1 day. Chest radiography indicated a mass-like lesion above the left diaphragm. The pain could not be relieved by nasogastric tube decompression for 12 hours. We arranged computed tomography, which revealed a dilated bowel above the diaphragm and intestinal obstruction with gangrenous change. The patient received emergency laparotomy, and a Bochdalek hernia was detected during the operation. The second case was a 75-year-old female patient who suffered from chest tightness and dyspnea for about 1 week. Chest X-ray and magnetic resonance imaging revealed herniation of small and large bowels at the right posterior aspect of the thoracic cavity. She received transthoracic repair of diaphragmatic hernia, recovered, and was discharged 15 days later. We recommend that adult Bochdalek hernia should be considered in the differential diagnosis of bowel obstruction.

  13. 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.

  14. Giant Inguinal Herniae Managed by Primary Repair: A Case Series

    PubMed Central

    Anand, Madhur; Naku, Narang; Hajong, Debobratta; Singh, K Lenish

    2017-01-01

    Giant inguinal hernia are usually found in developing countries due to delay in seeking medical attention. The management of such hernias may sometimes require procedures to increase the intra-peritoneal capacity prior to the repair of the giant hernia. Otherwise patients may develop abdominal compartment syndrome leading to various unwanted complications. Primary repair of giant hernias are possible in some cases without having significant post-operative complications. In this present case series, we have managed a total of four patients of giant inguinal hernia by primary repair without much post-operative complications. PMID:28384934

  15. An 81-year-old gentleman with symptomatic Bochdalek hernia

    PubMed Central

    Rajput, Mohammed Zak; Fisichella, Piero Marco

    2013-01-01

    An 81-year-old gentleman with congenital polycystic kidney disease presented to his primary care physician with dysphagia, gastroesophageal reflux refractory to medical management, and 11.25 kg weight loss in a 6 mo-period. A barium swallow misdiagnosed a paraesophageal hernia for a Bochdalek hernia. Herein, we highlight how a Bochdalek hernia may be disregarded in the differential diagnosis and how providers can resort to a more common diagnosis, a paraesophageal hernia, which is more frequently encountered in old age and whose radiologic appearance might mimic a Bochdalek hernia. PMID:23894690

  16. An 81-year-old gentleman with symptomatic Bochdalek hernia.

    PubMed

    Rajput, Mohammed Zak; Fisichella, Piero Marco

    2013-07-27

    An 81-year-old gentleman with congenital polycystic kidney disease presented to his primary care physician with dysphagia, gastroesophageal reflux refractory to medical management, and 11.25 kg weight loss in a 6 mo-period. A barium swallow misdiagnosed a paraesophageal hernia for a Bochdalek hernia. Herein, we highlight how a Bochdalek hernia may be disregarded in the differential diagnosis and how providers can resort to a more common diagnosis, a paraesophageal hernia, which is more frequently encountered in old age and whose radiologic appearance might mimic a Bochdalek hernia.

  17. Systemic and local collagen turnover in hernia patients.

    PubMed

    Henriksen, Nadia A

    2016-07-01

    Hernia formation is a multifactorial disease involving important endogenous factors possibly affected by exogenous factors. Alterations in collagen composition seem to contribute to abdominal wall hernia formation, possibly related to increased collagen breakdown. The collagen composition appears altered in fascial tissue but also in skin biopsies, suggesting that the collagen alterations are systemic. More pronounced collagen alterations are found in patients with hernia recurrences. Hypothetically, primary inguinal hernias are formed due to a systemic predisposition to altered connective tissue, whereas impaired healing influences on the development of incisional hernias and hernia recurrences. The overall objective of this thesis was to investigate the collagen turnover systemically and locally in patients with primary inguinal hernia, multiple hernias and incisional hernia. In a systematic literature review, a total of 55 original articles were reviewed evaluating connective tissue alterations in patients with abdominal wall hernias. Patients with inguinal and incisional hernias exhibit a decreased type I to III collagen ratio in fascia and skin biopsies with the most pronounced alterations found in patients with direct inguinal hernia and hernia recurrence. An increased level of MMP-2 was reported in patients with inguinal hernias. In a nationwide study from the Danish Hernia Database, 92,283 patients with an inguinal hernia repair were identified from January 1998 until June 2010. A total of 843 patients were also registered with a ventral hernia repair. Direct (OR = 1.28 [95% C.I. 1.08-1.51]) and recurrent (OR = 1.76 [95% C.I. 1.39-2.23]) inguinal hernia repairs were significantly associated with ventral hernia repair compared to indirect inguinal hernia repair after adjustment for gender, age and surgical approach. In a multivariable subgroup analysis, direct and recurrent inguinal hernia repair were associated with primary ventral hernia surgery, whereas

  18. Laparoscopic inguinal hernia repair by the hook method in emergency setting in children presenting with incarcerated inguinal hernia.

    PubMed

    Chan, Kin Wai Edwin; Lee, Kim Hung; Tam, Yuk Him; Sihoe, Jennifer Dart Yin; Cheung, Sing Tak; Mou, Jennifer Wai Cheung

    2011-10-01

    The development of laparoscopic hernia repair has provided an alternative approach to the management of incarcerated inguinal hernia in children. Different laparoscopic techniques for hernia repair have been described. However, we hereby review the role of laparoscopic hernia repair using the hook method in the emergency setting for incarcerated inguinal hernias in children. A retrospective review was conducted of all children who presented with incarcerated inguinal hernia and underwent laparoscopic hernia repair using the hook method in emergency setting between 2004 and 2010. There were a total of 15 boys and 1 girl with a mean age of 30 ± 36 months (range, 4 months to 12 years). The hernia was successfully reduced after sedation in 7 children and after general anesthesia in 4 children. In 5 children, the hernia was reduced by a combined manual and laparoscopic-assisted approach. Emergency laparoscopic inguinal hernia repair using the hook method was performed after reduction of the hernia. The presence of preperitoneal fluid secondary to recent incarceration facilitated the dissection of the preperitoneal space by the hernia hook. All children underwent successful reduction and hernia repair. The median operative time was 37 minutes. There was no postoperative complication. The median hospital stay was 3 days. At a median follow-up of 40 months, there was no recurrence of the hernia or testicular atrophy. Emergency laparoscopic inguinal hernia repair by the hook method is safe and feasible. Easier preperitoneal dissection was experienced, and repair of the contralateral patent processus vaginalis can be performed in the same setting. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. A rare variant of inguinal hernia: Cryptorchid testis at the age of 50 years. Etiopathogenicity, prognosis and management

    PubMed Central

    Kassir, Radwan; Dubois, Joelle; Berremila, Sid-Ali; Baccot, Sylviane; Boueil-Bourlier, Alexia; Tiffet, Olivier

    2014-01-01

    INTRODUCTION Cryptorchidism is characterized by the extra-scrotal position of the testis. The surgical community has little to no knowledge of cryptorchid testis in adults apart from of pediatric surgeons. Therefore, we sought to describe this unusual cause of inguinal hernia. PRESENTATION OF CASE A 50-year-old man was referred with a inguinal hernia. Diagnosis of cryptorchidism was made during surgery, as the patient underwent an operation for repair of his left inguinal hernia. The testicle was non-viable and a left testicle was resected. Histopathology report confirmed a atrophic testis without testicular germ cell tumor (TGCT). DISCUSSION This is an extremely rare case of cryptorchidism revealed in an adult. The patient remained asymptomatic for 50 years. Most studies have concluded that there is a direct correlation between how long the testis was subjected to a cryptorchid position and TGCT incidence. The recommended age of surgical correction is before the age of 2 years. In our case, we did not find correlation between the time of surgery and risk of TGCT. Histopathology report confirmed the presence of leydig cells, seminiferous tubule and Sertoli cells without TGCT. Very little is known about link between cryptorchidism and TGCT. The correct diagnosis of inguinal hernia is usually made during an inguinal hernia repair. CONCLUSION The surgeon must always be alert to the possibility of cryptorchid testis during a surgical exploration of an inguinal hernia. In suspected cases, laparoscopy ultrasonographic, CT scan and laparoscopy evaluation may be helpful in diagnosing of this atypical inguinal hernia before surgery. PMID:24892247

  20. Results of the simultaneous bilateral inguinal hernia repair by the Lichtenstein technique.

    PubMed

    Maciel, Gustavo Sasso Benso; Simões, Romeo Lages; do Carmo, Felipe Poubel Timm; Garcia, Julio William Rangel; Paulo, Danilo Nagib Salomão

    2013-01-01

    To analyze the results of bilateral inguinal hernia repairs by the Lichtenstein technique. We studied the charts of 59 patients who underwent elective simultaneous bilateral inguinal hernia repair between 2003 and 2007. We analyzed: gender, age, weight, operative time, length of hospital stay, Nyhus classification, complications in the immediate and late postoperative periods, and recurrence. These data were submitted to descriptive statistical analysis. Of the 59 patients, 95% were men. Age ranged from 40 to 60 years; weight, from 50 to 103 kg; operative time, from 60 to 80 minutes; and the length of stay, from one to six days. Thirty patients had type IIIB hernias; nine, type II; ten, type IIIA; seven, type IV; one, type II on the left and type IIIB on the right; one, type IIIA on the right and IIIB on the left; and one, type IIIA on the right and type II on the left. In the immediate postoperative period, pain was the most important manifestation, in 30.5% of subjects. In 94.92% of cases there were no complications. There were two cases of inguinodinia and one of burning pain in the surgical site. There was one recurrence 29 months after the procedure. Simultaneous bilateral inguinal hernia repair by Lichtenstein technique was safe and effective, with a low rate of complications, short hospital stay, and only one case of recurrence at an average of 48 months follow-up.

  1. Laparoscopic Repair of Internal Transmesocolic Hernia of Transverse Colon

    PubMed Central

    Kishiki, Tomokazu; Mori, Toshiyuki; Hashimoto, Yoshikazu; Matsuoka, Hiroyoshi; Abe, Nobutsugu; Masaki, Tadahiko; Sugiyama, Masanori

    2015-01-01

    Introduction. Internal hernias are often misdiagnosed because of their rarity, with subsequent significant morbidity. Case Presentation. A 61-year-old Japanese man with no history of surgery was referred for intermittent abdominal pain. CT suggested the presence of a transmesocolic internal hernia. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We found internal herniation of the small intestine loop through a defect in the transverse mesocolon, without any strangulation of the small intestine. We were able to complete the operation laparoscopically. The patient's postoperative course was uneventful and the patient was discharged on postoperative day 6. Discussion. Transmesocolic hernia of the transverse colon is very rare. Transmesocolic hernia of the sigmoid colon accounts for 60% of all other mesocolic hernias. Paraduodenal hernias are difficult to distinguish from internal mesocolic transverse hernias. We can rule out paraduodenal hernias with CT. Conclusion. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We report a case of a transmesocolic hernia of the transverse colon with intestinal obstruction that was diagnosed preoperatively and for which laparoscopic surgery was performed. PMID:26246930

  2. Outcomes of Lichtenstein hernioplasty for primary and recurrent inguinal hernia.

    PubMed

    Beltrán, Marcelo A; Cruces, Karina S

    2006-12-01

    The Lichtenstein hernioplasty for the repair of primary inguinal hernia in male patients is well established and constitutes the current gold standard. However a gold standard technique for the repair of recurrent inguinal hernia has not been established. The aim of this study was to analyze the outcomes of Lichtenstein hernioplasty for the repair of primary inguinal hernia and recurrent inguinal hernia, applying for that purpose the Qualitative and Quantitative Measurement Instrument (QQMI). We studied 75 recurrent inguinal hernia patients and 287 primary inguinal hernia patients with a follow-up period ranging from 60 to 107 months. The final QQMI score demonstrated that most patients in both groups reached scores between 8 and 11 points, with a significant difference in the maximum score (11 points) favoring primary hernia patients. All evaluated parameters showed better outcomes in primary hernia patients. Applying the QQMI, we have demonstrated that the outcomes of Lichtenstein hernioplasty are not similar between primary and recurrent inguinal hernia; there is a tendency toward better outcomes for primary inguinal hernia patients, although the Lichtenstein hernioplasty stands as a safe option for repair of recurrent inguinal hernias.

  3. Prognostic factors of congenital diaphragmatic hernia accompanied by cardiovascular malformation.

    PubMed

    Takahashi, Shigehiro; Sago, Haruhiko; Kanamori, Yutaka; Hayakawa, Masahiro; Okuyama, Hiroomi; Inamura, Noboru; Fujino, Yuji; Usui, Noriaki; Taguchi, Tomoaki

    2013-08-01

    Congenital diaphragmatic hernia is associated with cardiovascular malformation. Many prognostic factors have been identified for isolated congenital diaphragmatic hernia; however, reports of concurrent congenital diaphragmatic hernia and cardiovascular malformation in infants are limited. This study evaluated congenital diaphragmatic hernia associated with cardiovascular malformation in infants. Factors associated with prognosis for patients were also identified. This retrospective cohort study was based on a Japanese survey of congenital diaphragmatic hernia patients between 2006 and 2010. Frequency and outcome of cardiovascular malformation among infants with congenital diaphragmatic hernia were examined. Severity of congenital diaphragmatic hernia and cardiovascular malformation were compared as predictors of mortality and morbidity. Cardiovascular malformation was identified in 76 (12.3%) of 614 infants with congenital diaphragmatic hernia. Mild cardiovascular malformation was detected in 19 (33.9%) and severe cardiovascular malformation in 37 (66.1%). Their overall survival rate at discharge was 46.4%, and the survival rate without morbidity was 23.2%. Mortality and morbidity at discharge were more strongly associated with severity of cardiovascular malformation (adjusted OR 7.69, 95%CI 1.96-30.27; adjusted OR 7.93, 95%CI 1.76-35.79, respectively) than with severity of congenital diaphragmatic hernia. The prognosis for infants with both congenital diaphragmatic hernia and cardiovascular malformation remains poor. Severity of cardiovascular malformation is a more important predictive factor for mortality and morbidity than severity of congenital diaphragmatic hernia. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  4. Laparoscopic inguinal hernia repair: is the enthusiasm justified?

    PubMed

    Cooper, S S; McAlhany, J C

    1997-01-01

    One surgeon repaired 72 inguinal hernias in 61 patients by a transabdominal preperitoneal laparoscopic placement of prosthetic mesh. There were 58 male and 3 female patients; the mean age was 47.9 years. Thirty-six unilateral inguinal hernias (either direct or indirect), 11 bilateral inguinal hernias, 12 recurrent inguinal hernias, and 2 unilateral pantaloon inguinal hernias were repaired. There were no operative mortalities. The mean follow-up was 21 months, with a range of 6 to 42 months. Ten hernia recurrences (13.8%) were documented 3 to 24 months postoperatively (mean, 12 months). There were six direct hernia recurrences, two indirect hernia recurrences, and two recurrences of recurrent hernia repairs. Thirteen patients (21.3%) experienced morbidity: seromas in eight, a hematoma in one, an ileus in one, hematuria in one, and neuropathy in two. In our opinion, the significant morbidity and early recurrence rate of a laparoscopic inguinal hernia repair are unacceptable. Enthusiasm for laparoscopic technique to repair inguinal hernias is not justified if similar morbidity and recurrence rates are documented within the surgical community.

  5. Strangulation of chronic transdiaphragmatic intercostal hernia.

    PubMed

    Kao, Peiyu; Fang, Hsin-Yuan; Lu, Ting-Yu; Hsu, Shih-Chao; Chen, Chien-Kuang; Chen, Pin-Ru

    2014-06-01

    Transdiaphragmatic intercostal hernia (TIH) caused by violent coughing is a rare clinical diagnosis. Most patients diagnosed with TIH have a chronic condition consisting of a hernia that can be reduced completely by surgical intervention. Our patient presented with acute abdomen resulting from mechanical bowel obstruction secondary to an incarcerated hernia. Acute TIH presents a diagnostic challenge because of its rarity and lack of specific signs or symptoms in the differential diagnosis of acute abdomen. We recommend performing diagnostic computed tomography (CT) early if there is suspicion of TIH. Surgical intervention is always needed. Surgical intervention was complicated in this case, necessitating both transthoracic and abdominal exposure to resect the ischemic bowel segment. Nonetheless, the patient recovered uneventfully.

  6. Diaphragmatic Hernia Masquerading as a Pulmonary Metastasis

    PubMed Central

    Appiah, S; Tcherveniakov, P; Krysiak, P

    2015-01-01

    Iatrogenic injury accounts for the second most common cause of acquired diaphragmatic hernias after penetrating trauma. An increased incidence of these hernias has been observed with the widespread use of laparoscopic surgery. We present the case of a 65-year-old woman who initially underwent sigmoid resection for an adenocarcinoma and a subsequent liver resection for metastasis. She was noted to have a left lower lobe pulmonary nodule on surveillance computed tomography, for which she underwent a mini-thoracotomy for a planned resection. At the time of surgery, the pulmonary nodule was discovered to be a diaphragmatic hernia, most probably of iatrogenic origin. We discuss the difficulty in diagnosis given her history and the location of such a lesion. PMID:25723679

  7. Bilateral inguinal hernias: simultaneous or sequential repair?

    PubMed Central

    Stott, M. A.; Sutton, R.; Royle, G. T.

    1988-01-01

    Two hundred and forty four patients underwent either simultaneous bilateral inguinal hernia repair (n = 122) or unilateral inguinal hernia (n = 122) repair at a general hospital between January 1971 and December 1981. The two groups of patients were matched for age and sex. Both groups had a similar overall incidence of post-operative complications and in both groups the duration of post-operative stay and duration of operating time were similar. Chest infections developed in 12 patients after bilateral repair and in 3 patients after unilateral repair (P less than 0.02). All patients were assessed prospectively from 4 to 15 years after operation, when no significant difference in the number of recurrent hernias was found. Our results suggest that simultaneous bilateral inguinal herniorrhaphy is economical in terms of both operating time and duration of hospital stay, and that this economy is not bought at a cost of increased short term morbidity or long-term recurrence rate. PMID:3200778

  8. Strangulated Morgagni's Hernia: A Rare Diagnosis and Management

    PubMed Central

    Mate, Ajay; Rege, Samir

    2016-01-01

    Morgagni hernia is a rare type of congenital diaphragmatic hernia. It accounts for only 3% of all diaphragmatic hernias. The defect is small and hernia being asymptomatic in the majority presents late in adulthood. Obstruction or incarceration in Morgagni hernia is uncommon. We report a rare occurrence of strangulated Morgagni hernia. A 40-year-old gentleman presented to our emergency department with features of intestinal obstruction. Computed tomography of the chest and abdomen showed a strangulated right Morgagni hernia. An exploratory laparotomy was performed with resection of the ischemic bowel segment with anastomosis and a primary repair of the diaphragmatic defect. Postoperative recovery was uneventful and asymptomatic at follow-up. PMID:27891284

  9. Ureteral inguinal hernia: an uncommon trap for general surgeons

    PubMed Central

    Yahya, Zarif; Al-habbal, Yahya; Hassen, Sayed

    2017-01-01

    Inguinal hernias involving the ureter, a retroperitoneal structure, is an uncommon phenomenon. It can occur with or without obstructive uropathy, the latter posing a trap for the unassuming general surgeon performing a routine inguinal hernia repair. Ureteral inguinal hernia should be included as a differential when a clinical inguinal hernia is diagnosed concurrently with unexplained hydronephrosis, renal failure or urinary tract infection particularly in a male. The present case describes a patient with a known ureteroinguinal hernia who proceeded to having a planned hernia repair and ureteric protection. The case is a reminder that when faced with an unexpected finding such an indirect sliding inguinal hernia, extreme care should be taken to ensure that no structures are inadvertently damaged and that a rare possibility is the entrapment of the ureter in the inguinal canal. PMID:28275027

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

    PubMed

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

    2013-05-01

    Hernias are a common occurrence with correspondingly huge clinical and economic impacts on the healthcare system. The most common forms of hernia which need to be diagnosed and treated in routine urological work are inguinal and umbilical hernias. With the objective of reconstructing and stabilizing the inguinal canal there are the possibilities of open and minimally invasive surgery and both methods can be performed with suture or mesh repair. Indications for surgery of umbilical hernias are infrequent although this is possible with little effort under local anesthesia. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostics and therapy of inguinal, femoral and umbilical hernias.

  11. 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.

  12. [Hernia surgeons of Scutari, Istanbul].

    PubMed

    Sahillioglu, H

    1998-01-01

    The Ottoman capital was constituted of four judicial regions (mevleviyet, molla kursusu): Istanbul (within the citywalls), Galata (the Roumelian side of Bosphorous from Kasimpasha to Rumelifeneri), Eyup (western bank of the Golden Horn and Scutari. Since one judicial court did not suffice for this spacious area, each region was subdivided into districts (niyabets) called Mamure and Cedide where a large collection of records registered chronologically were reserved at the law court archives. I have studied 168 judicial records of Scutari. Among them, a document with the record number of 139, attracted my attention because of its interesting content. In view of this document of the 17th century, a physician could not be blamed or legally responsible for a risky operation if the patient had given his consent in advance. In this case, the patient was a man called Yanni from Agriboz Island. He was suffering from inguinal hernia. The healer was a woman called Saliha Sultan binti Kupeli, a Coptic, who practiced as a surgeon. Since some risk is inherent in medical operations, a contract was made between the patient and the surgeon, while the consent was given in case of any legal actions for damages. Therefore the surgeon was in need of a guarantee which was to be stated in the contract and confirmed by the judge (kadi). This article gives examples of this kind of case.

  13. Visceral adhesions to hernia prostheses.

    PubMed

    Gaertner, W B; Bonsack, M E; Delaney, J P

    2010-08-01

    To report our experience with abdominal adhesion formation to various synthetic and biologic prosthetic materials in a rat ventral hernia model. A total of 14 prostheses, nine synthetic, four biologic, and one bioresorbable, were evaluated in the rat. Two synthetic prostheses had bioresorbable coatings and one consisted of synthetic and bioresorbable materials woven together. The model involved the removal from the midline of a 2.5 x 2.5-cm segment of full-thickness ventral abdominal wall with the test prosthetic material sewed into the defect, thus, exposing the viscera directly to one surface of the prosthesis. There were four or more rats in each group. Adhesions were assessed at autopsy 7 days after operation or later. The results were expressed as the percentage area of prosthesis surface involved. All 14 of the tested prosthetic materials induced adhesions. Vicryl Mesh and the four biologic varieties had lesser overall adhesion coverage than the bare synthetic prostheses. Sepramesh developed the least adhesion coverage (15%). The two synthetic materials with bioresorbable coatings had smaller areas involved compared to bare synthetic prostheses. All of the tested prostheses attracted adhesions. Biologic prostheses had smaller areas of coverage compared to synthetic prostheses. Barrier surfaces on synthetic meshes were associated with a much lesser extent of adhesion involvement.

  14. [Prosthetic material in incisional hernia surgery].

    PubMed

    López-Cano, Manuel; Barreiro Morandeira, Francisco

    2010-09-01

    There are different designs of prosthesis for use in the repair of incisional hernia, and it is often difficult to choose the most appropriate. The biological behaviour of the material must be a key part in the selection, although this behaviour will vary depending on what materials are available. A proper understanding of the relationship of the material with the abdominal wall dynamics is another important factor in this selection. Finally we need a stable repair without long term side effects. This paper analyses the prostheses more commonly available for incisional hernia surgery in the non-emergency situation.

  15. Prolene hernia system, ultrapro hernia system and 3D patch devices in the treatment of inguinal, femoral, umbilical and small incisional hernias in outpatient surgery.

    PubMed

    Dabić, D; Cerović, S; Azanjaç, B; Marić, B; Kostić, I

    2010-01-01

    The employment of a diversity of prosthetic materials and several types of mesh different in construction is opening a new chapter in hernia surgery and tension-free techniques are becoming a "golden standard" for repairing abdominal wall defects, whereas the conventional methods, i.e., the tension techniques are performed on young patients having small direct, indirect, or femoral hernias. The aim of this retrospective study is to present the results of using Prolene Hernia System (PHS), Ultrapro Hernia System (UHS) and 3D Patch (3DP) devices in the treatment of inguinal, femoral, umbilical and small incisional hernias in outpatient surgery. From January 2006 to January 2009, 70 patients were operated on for abdominal wall hernias (54 inguinal, 4 femoral, 8 umbilical and 4 small incisional hernias) using PHS, UHS and 3DP devices. All the patients underwent surgery under local infiltrative anaesthesia. All the surgical operations were performed by a single surgeon, 19 of them in the General Hospital and 51 in a private polyclinic. The mean size of the hernia defect in the inguinal, femoral and umbilical hernias was 2.5 cm (1-4 cm), while in the incisional hernias it was 4.5 cm (3-6 cm). The mean operating time was 2.4 hrs (2-6 hrs). There were no requirement for urinary drains. The mean follow-up was 18 months (0-36 months). The incidence of infection, chronic pain and recurrence was 0%. Three of the patients had complications: seroma in one patient with an incisional hernia and hematoma in two patients after inguinal hernia repair. The employment of PHS, UHS and 3DP devices, which have not yet been widely accepted in our hospitals, has had outstanding results in outpatient surgery. In addition, the type of anaesthesia and the 3D mesh construction prepare the way for a short hospital stay, smooth recovery and a swift return to normal activity.

  16. [Principles of the management of adult inguinal hernia--recommendations by the European Hernia Society].

    PubMed

    Wéber, György

    2010-10-01

    The European Hernia Society (EHS) presented the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the management of inguinal hernia from diagnosis to aftercare. These have been developed by a Working Group consisting of expert surgeons with representatives of 14 member countries of the EHS. The Guidelines are evidence-based and, when necessary, a consensus of all members was reached. The Guidelines have been reviewed by a Steering Committee as well. Before finalisation, feedback from the relevant national hernia societies was obtained. The Guidelines can be used to adjust local protocols, training purposes as well as quality control. In order to keep them updated the next revision will be published in 2012. A short update of new high-level evidence will be provided by the Working Group during the EHS annual congress until the next revision.

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

    PubMed

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

    2013-06-01

    Hernias are a common occurrence with a correspondingly huge clinical and economic impact on the healthcare system. Parastomal and trocar hernias are rare in routine urological work. The therapy of parastomal hernias remains problematic but basically the surgeon is able to use conventional techniques with suture repair or procedures with mesh implantation. The conventional parastomal hernia repair with mesh can be classified into sublay, onlay and intraperitoneal techniques. Furthermore, a relocation of the stoma is possible. Trocar hernias represent a rare but hazardous complication. Due to the increase in keyhole surgery there is also the danger of a rise in their occurrence. Incisional hernias occur frequently in patients who have undergone laparotomy and for repair different surgical techniques and types of meshes are available. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostic and therapy of parastomal, trocar and incisional hernias.

  18. INFLUENCE OF TOBACCO, ALCOHOL AND DIABETES ON THE COLLAGEN OF CREMASTER MUSCLE IN PATIENTS WITH INGUINAL HERNIAS

    PubMed Central

    MÓDENA, Sérgio Ferreira; CALDEIRA, Eduardo José; PERES, Marco Antonio O; ANDREOLLO, Nelson Adami

    2016-01-01

    ABSTRACT Background: New findings point out that the mechanism of formation of the hernias can be related to the collagenous tissues, under activity of aggressive agents such as the tobacco, alcohol and diabetes. Aim: To analyze the collagen present in the cremaster muscle in patients with inguinal hernias, focusing the effect of tobacco, alcohol, and diabetes. Methods: Fifteen patients with inguinal hernia divided in three groups were studied: group I (n=5) was control; group II (n=5) were smokers and/or drinkers; and group III (n=5) had diabetes mellitus. All subjects were underwent to surgical repair of the inguinal hernias obeying the same pre, intra and postoperative conditions. During surgery, samples of the cremaster muscle were collected for analysis in polarized light microscopy, collagen morphometry and protein. Results: The area occupied by the connective tissue was higher in groups II and III (p<0.05). The collagen tissue occupied the majority of the samples analyzed in comparison to the area occupied by muscle cells. The content of total protein was higher in groups II and III compared to the control group (p<0.05). Conclusion: The tobacco, alcohol and diabetes cause a remodel the cremaster muscle, leading to a loss of support or structural change in this region, which may enhance the occurrences and damage related to inguinal hernias. PMID:28076473

  19. Multi-directional mechanical analysis of synthetic scaffolds for hernia repair.

    PubMed

    Est, Savannah; Roen, Madeleine; Chi, Tingying; Simien, Adrian; Castile, Ryan M; Thompson, Dominic M; Blatnik, Jeffrey A; Deeken, Corey R; Lake, Spencer P

    2017-02-09

    Hernias remain one of the most common ailments to affect men and women worldwide. Surgical mesh materials were first used to reinforce hernia defects during surgery in the late 1950s (Laker, n.d.). Today, there are well over 50 prosthetic meshes available for hernia repair (Brown and Finch, 2010; Bryan et al., 2014; Hope and El-hayek, 2014). With the multitude of available options, surgeons are faced with the challenging task of optimizing mesh selection for each patient. If the mechanics of the mesh are not compatible with the surrounding tissue, mismatch can occur, which can lead to complications such as mesh failure and/or hernia recurrence. Unfortunately, many aspects of synthetic mesh mechanics remain poorly described. Therefore, the purpose of this study was to provide a more complete mechanical analysis of a variety of commercially available prosthetic meshes for hernia repair, including evaluation of meshes in a variety of orientations. Twenty different meshes were subjected to biaxial tensile tests at both 90° and 45° orientations, and results were analyzed for relative strength, strain behavior, and anisotropy. Peak tension and strain values varied dramatically across all mesh types for all directions, ranging between 4.08 and 25.74N/cm and -5% to 10% strain. Anisotropy ratios for the evaluated meshes ranged from 0.33 to 1.89, demonstrating a wide range in relative direction-dependence of mesh mechanics. While further study of prosthetic meshes and better characterization of properties of the human abdominal wall are needed, results of this study provide valuable data that may aid clinicians in optimizing mesh selection for specific patients and repair conditions.

  20. A retrospective study of inguinal hernia in 35 dogs.

    PubMed

    Waters, D J; Roy, R G; Stone, E A

    1993-01-01

    Inguinal hernia was associated with trauma in five dogs and was considered nontraumatic in 30 dogs. There were 11 males, 13 intact females, and six spayed females with nontraumatic inguinal hernia. Six dogs had bilateral hernias. Five dogs were younger than 4 months at the time of diagnosis. In 11 older dogs with nontraumatic inguinal hernia, the hernias were identified less than 7 days before surgical repair; in 14 older dogs, the hernias had been recognized for 1 to 60 months. Clinical signs in dogs without small intestinal incarceration were usually limited to a visible or palpable mass without pain or systemic illness. Herniorrhaphy approaches included inguinal, midline with contralateral ring evaluation, and celiotomy with or without inguinal exposure. Fat and omentum were the most common hernial contents. Small intestine was within the hernias of 12 dogs. Six dogs had nonviable small intestine. Postoperative complications included two incisional infections, one incisional dehiscence, two cases of peritonitis and sepsis associated with bowel leakage after intestinal resection and anastomosis, and one hernia recurrence. The overall prevalence of postoperative complications was 17%, and the mortality rate was 3%. Vomiting for 2 to 6 days was predictive of nonviable small intestine. Dogs younger than 2 years were at 11 times greater risk for nonviable small intestine than dogs older than 2 years. Four of five dogs with nontraumatic inguinal hernia and nonviable small intestine were intact males, whereas none of 13 intact females were affected. Only one of 14 dogs with longstanding hernias had nonviable small intestine.

  1. [Inguinal hernia repair by the tension free technique of Lichtenstein].

    PubMed

    Prywiński, S; Zomrowski, L; Kapała, A; Mackiewicz, Z

    1997-01-01

    Failure rate in standard groin hernia repair varies from 3 to 10%. Polypropylene mesh implantation based on Lichtenstein "tension free" method in 1986 year reduced the failure rate to less than 1%. From Feb. '95 to Dec.'96, 115 patients were operated on with 127 groin hernias repair. The average age of patients was 58 years 52 direct hernias, 74 indirect hernias and 1 pantaloon hernia have been diagnosed in examined material, 101 primary repairs and 26 repairs of recurrent hernia have been performed. The operations were performed in subarachnoid anaesthesia--66 patients, in general anaesthesia--11 patients in local anaesthesia--38 patients. After having opened the inguinal canal estimated the type of its wall defect. In case of direct hernia the sac usually was invaginated by absorbing suture. In case of indirect hernia sac was cut and peritoneal cavity left opened. The patch made of polypropylene monofilament mesh (size 6 x 8 cm) was sewn with "tension free" method under spermatic funiculus. As a complication 6 patients had haematomas in operating wounds. Four of the patients had wound infections. One of these patients was operated again and the patch was removed. The patients had no recurrence of hernia during the previous 10.6 months of observation. We haven't confirmed recurrence in examined material, yet it was too short time to estimate the efficiency of repair. The proposed way of groin hernia repair is easy and simple in every-day surgery practice.

  2. Abdominal wall hernia and pregnancy: a systematic review.

    PubMed

    Jensen, K K; Henriksen, N A; Jorgensen, L N

    2015-10-01

    There is no consensus as to the treatment strategy for abdominal wall hernias in fertile women. This study was undertaken to review the current literature on treatment of abdominal wall hernias in fertile women before or during pregnancy. A literature search was undertaken in PubMed and Embase in combination with a cross-reference search of eligible papers. We included 31 papers of which 23 were case reports. In fertile women undergoing sutured or mesh repair, pain was described in a few patients during the last trimester of a subsequent pregnancy. Emergency surgery of incarcerated hernias in pregnant women, as well as combined hernia repair and cesarean section appears as safe procedures. No major complications were reported following hernia repair before or during pregnancy. The combined procedure of elective cesarean section and abdominal wall hernia repair was reported in 102 patients without major complications. The literature on abdominal wall hernia and pregnancy is sparse. Abdominal wall hernia repair with suture or mesh may cause pain in the last trimester of a subsequent pregnancy. Hernia repair in conjunction with cesarean section appear as the optimal treatment of a pregnant patient with a symptomatic abdominal wall hernia.

  3. Inguinal hernias associated with a single strenuous event.

    PubMed

    Williamson, J S; Jones, H G; Radwan, R R; Rasheed, A

    2016-10-01

    There is debate regarding the role of physical activity and, in particular, a single strenuous event (SSE) in the development of inguinal hernia. This study aims to identify the incidence and associated features of hernias perceived to be due to a single strenuous event and to compare their features with published guidelines. All consecutive patients surgically treated for primary inguinal hernia at a single NHS trust between April 2010 and April 2011 were identified and contacted to participate in a questionnaire. Clinical details from operative records and case notes were compared with patients' responses to identify features of their presentation attributable to a single strenuous event according to previously published guidelines. Three hundred and thirty five eligible patients were contacted with a response rate of 292 (87 %). 41/292 (14 %) of patients reported an SSE associated with the onset of their hernia. Only 2 of 41 (5 %) patients reporting a hernia associated with SSE met published criteria for association of the hernia with SSE, and this represented less than 1 % of all patients treated for inguinal hernia at a single centre in a 1-year period. The relationship between physical activity and development of inguinal hernia is under debate; however, we find that inguinal hernia that can be attributed to SSE is a rare event, despite the fact that many patients present with acute symptoms. Updated guidelines for the assessment of 'cause' in industrial claims for the association of hernia with workplace activity are required.

  4. A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain.

    PubMed

    Tanaka, E Y; Yoo, J H; Rodrigues, A J; Utiyama, E M; Birolini, D; Rasslan, S

    2010-02-01

    Preoperative progressive pneumoperitoneum (PPP) is a safe and effective procedure in the treatment of large incisional hernia (size > 10 cm in width or length) with loss of domain (LIHLD). There is no consensus in the literature on the amount of gas that must be insufflated in a PPP program or even how long it should be maintained. We describe a technique for calculating the hernia sac volume (HSV) and abdominal cavity volume (ACV) based on abdominal computerized tomography (ACT) scanning that eliminates the need for subjective criteria for inclusion in a PPP program and shows the amount of gas that must be insufflated into the abdominal cavity in the PPP program. Our technique is indicated for all patients with large or recurrent incisional hernias evaluated by a senior surgeon with suspected LIHLD. We reviewed our experience from 2001 to 2008 of 23 consecutive hernia surgical procedures of LIHLD undergoing preoperative evaluation with CT scanning and PPP. An ACT was required in all patients with suspected LIHLD in order to determine HSV and ACV. The PPP was performed only if the volume ratio HSV/ACV (VR = HSV/ACV) was >or=25% (VR >or= 25%). We have performed this procedure on 23 patients, with a mean age of 55.6 years (range 31-83). There were 16 women and 7 men with an average age of 55.6 years (range 31-83), and a mean BMI of 38.5 kg/m(2) (range 23-55.2). Almost all patients (21 of 23 patients-91.30%) were overweight; 43.5% (10 patients) were severely obese (obese class III). The mean calculated volumes for ACV and HSV were 9,410 ml (range 6,060-19,230 ml) and 4,500 ml (range 1,850-6,600 ml), respectively. The PPP is performed by permanent catheter placed in a minor surgical procedure. The total amount of CO(2) insufflated ranged from 2,000 to 7,000 ml (mean 4,000 ml). Patients required a mean of 10 PPP sessions (range 4-18) to achieve the desired volume of gas (that is the same volume that was calculated for the hernia sac). Since PPP sessions were performed

  5. Twelve years of experience treating Spigelian hernia.

    PubMed

    Polistina, Francesco A; Garbo, Greta; Trevisan, Paolo; Frego, Mauro

    2015-03-01

    A Spigelian hernia (SH) is an acquired ventral hernia that most commonly occurs in the Spigelian belt. Patients may experience pain or a bulge in the abdominal area, but in most cases there are no symptoms. If left untreated the hernia may become strangulated, which could lead to bowel obstruction. We reviewed 28 surgical patients with SH between January 2002 and December 2013. We evaluated the incidence of complications, recurrences, and the length of hospital stay with comorbidities, body mass index, clinical presentation, and operative techniques. The 28 patients included 10 males and 18 females, with a mean age of 67 years. Seven patients (26.9%) received emergency operations, and the remaining patients received elective operations. An "open-direct" operative approach was used in 16 cases and a laparoscopic approach in 12. The overall complication rate was 7.6% and the recurrence rate was 3.8% with a median follow-up of 3 years. The median hospital stay was 1 day (range, 1-7). Only the presence of local complications at diagnosis showed a significant impact on length of hospital stay. None of the considered variables had a significant impact on hernia recurrence. No differences were noted among the operative techniques, wound infections, complications rate, and length of hospital stay. Laparoscopy seems to cause more early postoperative pain that reverses in about 2 weeks. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Day-case laparoscopic hernia repair.

    PubMed

    Evans, D S; Ghaneh, P; Khan, I M

    1996-10-01

    Some 114 patients (median age 52 years) underwent laparoscopic hernia repair as a day-case procedure. Twenty-one patients had bilateral and 11 recurrent hernias. Some 113 patients underwent transabdominal preperitoneal mesh repair but one required conversion to open operation. Mean operating time was 24 min for unilateral and 38 min for bilateral repair. In an operating session of 3.5 h, up to five patients (mean 4.4) underwent surgery and as many as seven hernias were repaired. More than 10 per cent of patients were found to have a previously undiagnosed hernia on the opposite side. A total of 111 patients were discharged home on the day of surgery. Major complications included one omental bleed and one small bowel obstruction. Seroma was the commonest minor complication and occurred in 7 per cent of patients. More than 35 per cent of patients needed no postoperative analgesia. To date there has been one recurrence (follow-up range 2-18 months).

  7. Laparoscopic repair of strangulated Morgagni hernia

    PubMed Central

    Kelly, Michael D

    2007-01-01

    A 73 year old man presented with vomiting and pain due to a strangulated Morgagni hernia containing a gastric volvulus. Laparoscopic operation allowed reduction of the contents, excision of necrotic omentum and the sac, with mesh closure of the large defect. A brief review of the condition is presented along with discussion of the technique used. PMID:17935621

  8. 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 Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... contents. This generic type of device includes the umbilical truss. (b) Classification. Class I (general...

  9. 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 Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... contents. This generic type of device includes the umbilical truss. (b) Classification. Class I (general...

  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 Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... contents. This generic type of device includes the umbilical truss. (b) Classification. Class I (general...

  11. A consecutive series of 235 epigastric hernias.

    PubMed

    Ponten, J E H; Leenders, B J M; Charbon, J A; Nienhuijs, S W

    2015-10-01

    Epigastric herniation is a common, though not always symptomatic condition. It is likely, that in accordance to the tension-free principles for other hernias, epigastric hernia repair should be mesh based. Patients from two large hospitals were investigated retrospectively if they were operated on an epigastric hernia for the past 6 years. Follow-up was completed with a postal questionnaire. A total of 235 patients (50 % male) were operated. Sixty-eight patients were operated with mesh and 167 patients with suture repair. Forty-six patients were loss-to follow-up (19.6 %). In the mesh operated patients the recurrence rate was 10.9 % (n = 6) compared to 14.9 % (n = 20) in the suture repair group. Cox-regression analysis showed an increased risk for recurrence in the suture repair group (odds ratio 1.43; 95 % CI 0.56-3.57; p = 0.44). Operation time for mesh repair (47 min) was significantly longer compared to suture repair (29 min) (p < 0.0001). Thirty-seven patients had previous or other anterior wall hernias. A total of 51 patients smoked and 14 patients had diabetes mellitus. Fourteen patients used steroids and 22 patients suffered from a chronic lung disease. Subgroup analysis showed a significant difference for pain in patients in which re-operation for a recurrence occurred (p = 0.004). This is one of the largest reported series on solely epigastric hernias. A recurrence occurred more often after sutured repair compared to mesh repair. No differences in chronic pain was seen between mesh and suture repaired patients. Male:female ratio of 1:1, which is different from the 3:1 ratio found in previous older smaller studies, could be more reliable.

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

    PubMed Central

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

    2014-01-01

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

  13. Amyand's hernia in elderly patients: diagnostic, anesthetic, and perioperative considerations.

    PubMed

    Yang, Weiping; Tao, Zongyuan; Chen, Hao; Li, Qinyu; Chu, Peiguo G; Yen, Yun; Qiu, Weihua

    2009-01-01

    The presence of a vermiform appendix in an inguinal hernia sac is termed as Amyand's hernia. Although rare, mistakes in diagnosis and treatment can cause catastrophic results. Charts of patients with inguinal hernia were reviewed, and four cases of Amyand's hernia were confirmed. The clinical presentation, anesthetic, and perioperative management of Amyand's hernia were further analyzed. The mean age of patients was over 70 years, and all were males. None of the patients were diagnosed preoperatively. All the patients had little abdominal complaint only with a right inguinal mass and dragging sensation for several hours. Due to the short time after incarceration and significant cardiovascular and pulmonary comorbidities, manual reduction was attempted first in three patients. With complete preoperative evaluation and careful perioperative support, all patients underwent appendectomy and Bassini's hernia repair through a groin incision. Based on age-related organ failure and associated chronic medical illnesses of geriatric patients, the difficulties in the diagnosis and treatment are also summarized and analyzed.

  14. Rare small bowel obstruction: Right paraduodenal hernia. Case report

    PubMed Central

    Manfredelli, Simone; Andrea, Zitelli; Stefano, Pontone; Giovanni, Leonetti; Maria, Marcantonio; Angelo, Forte; Alberto, Angelici; Renato, Mancini

    2013-01-01

    INTRODUCTION Paraduodenal hernia (paramesocolic hernia), a rare congenital anomaly due to a midgut malrotation during fetal development, is recognized as the most frequent internal hernias. Two variants have been described: left and right, the latter less common than the first one. PRESENTATION OF CASE We report a right paraduodenal hernia case in a 86 years old female patient who developed an acute bowel obstruction syndrome. Final diagnosis was achieved by imaging techniques as abdomen X-ray and CT and confirmed only after surgical operation. DISCUSSION Surgical approach was via median laparotomy, consisting in hernia reduction, replacement and stitching of the bowel in its anatomical orientation, and fixing of the posterior wall defect. At 15 months follow-up from surgical procedure the patient is asymptomatic. CONCLUSION Paraduodenal hernia is a rare pathology but its involvement in bowel obstruction syndrome should be always taken into account during diagnostic process. PMID:23500746

  15. An unusual presentation of an incarcerated Spigelian hernia.

    PubMed

    Peeters, Karen; Huysentruyt, Frederik; Delvaux, Peter

    2016-11-29

    Spigelian hernias are rare hernias, occurring through a defect in the Spigelian aponeurosis. Like other hernias, they may contain abdominal contents but are more likely to be incarcerated due to the small size of the fascial defect. Multiple intra-abdominal organs have reportedly been found in Spigelian hernias. A search of the literature showed only nine reported cases in which an appendix has been found within a Spigelian hernia. We present a patient with a history of lower abdominal pain since 10 weeks with a large intra-abdominal mass in the right iliac fossa. Due to abscess formation with spontaneous evacuation through the abdominal wall, drainage and incision were performed and the patient was treated with broad-spectrum antibiotics. An explorative laparoscopy after six weeks showed an incarcerated appendix in a Spigelian hernia.

  16. Endoscopic totally extraperitoneal (TEP) hernia repair for inguinal disruption (Sportsman's hernia): rationale and design of a prospective observational cohort study (TEP-ID-study)

    PubMed Central

    Voorbrood, C E H; Goedhart, E; Verleisdonk, E J M M; Sanders, F; Naafs, D; Burgmans, J P J

    2016-01-01

    Introduction Chronic inguinal pain is a frequently occurring problem in athletes. A diagnosis of inguinal disruption is performed by exclusion of other conditions causing groin pain. Up to now, conservative medical management is considered to be the primary treatment for this condition. Relevant large and prospective clinical studies regarding the treatment of inguinal disruption are limited; however, recent studies have shown the benefits of the totally extraperitoneal patch (TEP) technique. This study provides a complete assessment of the inguinal area in athletes with chronic inguinal pain before and after treatment with the TEP hernia repair technique. Methods and analysis We describe the rationale and design of an observational cohort study for surgical treatment with the endoscopic TEP hernia repair technique in athletes with a painful groin (inguinal disruption). The study is being conducted in a high-volume, single centre hospital with specialty in TEP hernia repair. Patients over 18 years, suffering from inguinal pain for at least 3 months during or after playing sports, and whom have not undergone previous inguinal surgery and have received no benefit from physiotherapy are eligible for inclusion. Patients with any another cause of inguinal pain, proven by physical examination, inguinal ultrasound, X-pelvis/hip or MRI are excluded. Primary outcome is reduction in pain after 3 months. Secondary outcomes are pain reduction, physical functioning, and resumption of sport (in frequency and intensity). Ethics and dissemination An unrestricted research grant for general study purposes was assigned to the Hernia Centre. This study itself is not directly subject to the above mentioned research grant or any other financial sponsorship. We intend to publish the outcome of the study, regardless of the findings. All authors will give final approval of the manuscript version to be published. PMID:26739740

  17. Thoracotomy for Traumatic Diaphragmatic Hernia.

    PubMed

    Fangbiao, Zhang; Chunhui, Zheng; Chun, Zhao; Hongcan, Shi; Xiangyan, Zhang; Shaosong, Tu

    2016-10-01

    The aim of this retrospective study is to review our experience in the diagnosis and role of thoracotomy for traumatic diaphragmatic hernia (TDH). Between January 2008 and June 2014, 23 patients from Yangzhou Medical College (Yangzhou China) and Lishui Center Hospital (Lishui China), who underwent thoracotomy for TDH, were analyzed. The clinical features, imaging findings, operative findings, and outcome of treatment in these patients are presented. There were 23 patients (18 males and 5 females) who underwent surgical procedures due to TDH. The median age of the patients was 43.2 years (range, 15-68 years). The cause of rupture was penetrating trauma in 1 (4.3 %) patient and blunt trauma in 22 (95.7 %) patients. The TDH was left sided in 21 patients and right sided in two patients. The diagnosis was made by chest X-ray (n = 2) and chest or abdominal CT (n = 13) and at thoracotomy based on a high index of suspicion (n = 8). Associated injuries were seen in 21 patients (91.3 %). Twenty-two patients underwent thoracotomy, and one underwent thoracotomy with laparotomy. The mean operating time was 112 min (range, 60-185 min) and the mean blood loss was 116 mL (range, 20-400 mL). The most common herniated organs were the omentum (n = 15), stomach (n = 14), spleen (n = 11), colon (n = 10), small bowel (n = 2), and liver (n = 1). All diaphragmatic defects were repaired using interrupted prolene sutures. The overall mortality rate was 4.3 % (n = 1). The diagnosis of TDH is easily missed or delayed. Chest X-ray and computer tomography (CT), especially chest and abdominal CT, are useful in the diagnosis of diaphragmatic ruptures, and thoracotomy is an effective and successful treatment for TDH.

  18. Inguinal hernia as a presentation of testicular feminization.

    PubMed

    Gibor, Udit; Ohana, Eric; Elena, Dubilet; Kirshtein, Boris

    2015-08-01

    We present a case of a 20-year-old female who was admitted to our department for an elective inguinal hernia repair. An oval-shaped mass was found in the hernia sac during the surgery that was suspected to be an ovary. Histological examination revealed testicular tissue. Further evaluation confirmed testicular feminization. She underwent laparoscopic orchiectomy and hernia repair from the contralateral side 3 months later.

  19. [Treatment of large postoperative hernias using intraperitoneal meshes].

    PubMed

    Trojanowski, Piotr; Witczak, Witold; Najdecki, Marek; Stanowski, Edward

    2007-05-01

    Most common hernias among men and women are inguinal hernias (75-80%) and postoperative (incisional) hernias (8-10%). Management of large incisional hernias (hernia gate bigger than 10 cm) both primary and recurrent could be an encounter for a surgeon. In surgical repair of large hernia use of synthetic materials (mesh) is being prefered. Using mesh can significantly decrease recurrence rate (<10%), compare to operations without synthetic grafts where risk of recurrence can reach 50%. One of the methods of surgical treatment of large abdominal hernias is intraperitoneal placing of implants. For such purpose complex meshes (multi-layered) should be used to prevent adhesion of the mesh to the intestines and avoid dangerous complications such as migration of the mesh through the tissues, perforation of the urine bladder, small and large intestine, forming fistulas and blocking intestines. Presentation of own experience in dealing with patients with large postoperative abdominal hernias using composite meshes: Bard--Composix Mesh, Parietex--Composite Sofradim and Proceed Ethicon. Since 2003 to 2006 were performed 7 surgical repairs of large abdominal hernia via an open aproach. 3 male, 4 female, average age 47 years old. Every hernia gate was wider than 15 cm. Bard mesh was used three times, Sofradim and Ethicon two times. Mesh was implanted without tension with single sutures and overlap of more than 5 cm from the edge of the hernia gate. Mesh was separated from intestines with greater momentum if it was possible. Anticoagulant and antibiotic preventive therapies were applied as a rule. Average time of operation was 140 minutes; average time of postoperative hospitalization was 8 days. Only one case was complicated with seroma which was treated with transcutaneous punctures with good result. (1) Surgical treatment of large abdominal hernia using composite mesh (intraperitoneal). in selected cases has good results. (2) The limiting factor of using presented method is

  20. Internal hernias: surgeons dilemma-unravelled by imaging.

    PubMed

    Murali Appavoo Reddy, Uma Devi; Dev, Bhawna; Santosham, Roy

    2014-08-01

    Internal hernias may present as intestinal obstruction and account for 0.5 to 4.1 % of all cases. Clinical diagnosis of internal hernias is often difficult and thus imaging studies plays an important role in the early diagnosis. It is vital for the radiologist to be familiar with the various types of internal hernias and their radiological features so that prompt diagnosis and early intervention can be made.

  1. Fatal necrotizing fasciitis following elective inguinal hernia repair.

    PubMed

    Sistla, S C; Sankar, G; Sistla, S

    2011-02-01

    Necrotizing soft tissue infections (NSTIs) following elective hernia repair are extremely uncommon, though they can occur following emergency surgery for complicated hernias. They are also usually seen in individuals with impaired immunity. We report a case of fatal necrotizing fasciitis following elective hernia repair in an otherwise healthy young patient. A high index of suspicion is required to diagnose this condition early, as it is difficult to differentiate it from superficial surgical site infection.

  2. Obstructed Groin Hernia in a Tropical African Population

    PubMed Central

    Ajao, Oluwole G.

    1979-01-01

    In a 15-month period, at the University College Hospital, Ibadan, 44 cases of obstructed hernia were treated by emergency operation. More than 94 percent were inguinal, but femoral hernia was not common. The ratio of females to males was 1:6.4, and more than 68 percent of hernias occurred on the right side. The youngest patient was two weeks old. One incarcerated hernial sac contained an ileoileal intussusception and a segment of sigmoid colon. PMID:529309

  3. Incisional and port-site hernias following robotic colorectal surgery.

    PubMed

    Harr, Jeffrey N; Juo, Yen-Yi; Luka, Samuel; Agarwal, Samir; Brody, Fred; Obias, Vincent

    2016-08-01

    The association between extraction site location, robotic trocar size, and the incidence of incisional hernias in robotic colorectal surgery remain unclear. Laparoscopic literature reports variable rates of incisional hernias versus open surgery, and variable rates of trocar site hernias. However, conclusions from these studies are confusing due to heterogeneity in closure techniques and may not be generalized to robotic cases. This study evaluates the effect of extraction site location on incisional hernia rates, as well as trocar hernia rates in robotic colorectal surgery. A retrospective review of multiport and single incision robotic colorectal surgeries from a single institution was performed. Patients underwent subtotal, segmental, or proctocolectomies, and were compared based on the extraction site through either a muscle-splitting (MS) or midline (ML) incision. Hernias were identified by imaging and/or physical exam. Demographics and risk factors for hernias were assessed. Groups were compared using a multivariate logistic regression analysis. The study included 259 colorectal surgery patients comprising 146 with MS and 113 with ML extraction sites. Postoperative computed tomograms were performed on 155 patients (59.8 %) with a mean follow-up of 16.5 months. The overall incisional hernia rate was 5.8 %. A significantly higher hernia rate was found among the ML group compared to the MS group (12.4 vs. 0.68 %, p < 0.0001). Of the known risk factors assessed, only increased BMI was associated with incisional hernias (OR 1.18). No trocar site hernias were found. Midline extraction sites are associated with a significantly increased rate of incisional hernias compared to muscle-splitting extraction sites. There is little evidence to recommend fascia closure of 8-mm trocar sites.

  4. Congenital mesenteric hernia in neonates: Still a dilemma

    PubMed Central

    Mandhan, Parkash; Alshahwani, Noora; Al-Balushi, Zainab; Arain, Anwar

    2015-01-01

    Congenital transmesenteric hernia in neonates is a rare cause of intestinal obstruction with devastating outcomes and still remains a challenge to diagnose pre-operatively. Patients are often managed with emergency surgical exploration and may need bowel resection. We present 2 neonates with small bowel obstruction secondary to strangulated transmesenteric hernia through a congenital defect in the small bowel mesentery, which were managed successfully. We have also reviewed the literature about congenital transmesenteric hernia in neonates. PMID:26612129

  5. Occult hernias and bilateral endoscopic total extraperitoneal inguinal hernia repair: is there a need for prophylactic repair? : Results of endoscopic extraperitoneal repair over a period of 10 years.

    PubMed

    Saggar, V R; Sarangi, R

    2007-02-01

    An advantage of the endoscopic total extraperitoneal approach over the conventional hernia repair is detection of an unsuspected, asymptomatic hernia on the contralateral side. A high incidence of occult contralateral hernias has been reported in the literature. However, few studies have examined the incidence of development of a hernia on the healthy side evaluated previously during an endoscopic unilateral hernia repair. This study aims to evaluate the incidence of development of a contralateral hernia after a previous bilateral exploration. The need for a prophylactic contralateral repair is also addressed. We retrospectively reviewed the results of 822 endoscopic total extraperitoneal inguinal hernia repairs done in 634 patients over a period of 10 years from May 1993 to 2003. Incidence of hernia undetected clinically and during previous contralateral repair was assessed over a follow up period ranging from 10 to 82 months. About 7.97% of bilateral hernias were clinically occult hernias. Only 1.12% of unilateral hernia repairs (who had undergone a contralateral evaluation at surgery) subsequently developed a hernia on the other side. The endoscopic approach to inguinal hernia repair is an excellent tool to detect and treat occult contralateral hernias. The incidence of hernia occurring at the contralateral side after a previous bilateral exploration is low, hence a prophylactic repair on the contralateral side is not recommended on a routine basis.

  6. Incisional hernia in the elderly: risk factors and clinical considerations.

    PubMed

    Caglià, Pietro; Tracia, Angelo; Borzì, Laura; Amodeo, Luca; Tracia, Lucio; Veroux, Massimiliano; Amodeo, Corrado

    2014-01-01

    Ventral incisional hernia is a common complication of abdominal surgery. The marked improvements in medical technology and healthcare, lead to an increasing number of elderly patients to take advantage of even complex surgical procedures. The objective of this literature review was to analyze the risk factors for ventral incisional hernia in elderly patients and to identify measures that might decrease the incidence of this complication. An analysis of the surgical literature was performed using the search engines EMBASE, Cochrane Library, and PubMed with particular reference to elderly patients using the keywords: abdominal hernia, wound dehiscence, incisional hernia, incidence, trocar site hernia, and hernia prevention. In our opinion the risk factors for incisional hernia should be separately considered. First those related to the patients and to the abdominal surgery and, in addition, those related to the surgery of the abdominal wall defects. Reparative surgery of the abdominal wall, to date uniquely characterized by the use of the mesh, should be considered an additional risk factor for the occurrence of incisional hernia. However, the low incarceration risk, the risk of recurrence, the relevant rate of postoperative pain and discomfort and complications associated with mesh repair, as small bowel obstruction, mesh infection, and entero-cutaneous fistula, suggest that the general indication for surgical treatment of incisional hernias, in a symptomatic or oligosymptomatic elderly patients, should be critically reconsidered in order to avoid unnecessary surgery. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  7. Ruptured abdominal aneurysm disguised as an incarcerated inguinal hernia.

    PubMed

    Colpaert, J; Willaert, B; Van Molhem, Y

    2017-01-31

    An incarcerated inguinal hernia is a textbook example of a basic and straightforward diagnosis. In rare cases, an incarcerated hernia may be a symptom of more complex underlying pathology. In this case report a patient with a ruptured abdominal aortic aneurysm presented with an incarcerated left inguinal hernia. Only two other cases have been reported with a stable patient at initial presentation. The diagnosis was suspected when blood seeping next to the internal inguinal ring was detected, and an urgent ultrasound in the operating room confirmed the diagnosis. Whether or not patients with an inguinal hernia are more at risk for an AAA remains unclear.

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

    PubMed

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

    2009-06-30

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

  9. Type 4 appendiceal diverticulum within a de Garengeot hernia

    PubMed Central

    Coveney, E

    2016-01-01

    A de Garengeot hernia is defined as an incarcerated femoral hernia containing the vermiform appendix. We describe the case of a patient with a type 4 appendiceal diverticulum within a de Garengeot hernia and delineate valuable learning points. A 76-year-old woman presented with a 2-week history of a non-reducible painless femoral mass. Outpatient ultrasonography demonstrated a 36mm × 20mm smooth walled, multiloculated, partially cystic lesion anterior to the right inguinal ligament in keeping with an incarcerated femoral hernia. Intraoperatively, the appendix was found to be incarcerated in the sac of the femoral hernia and appendicectomy was performed. Histopathology demonstrated no evidence of inflammation in the appendix. However, an incidental appendiceal diverticulum was identified. It is widely recognised that a de Garengeot hernia may present with concomitant appendicitis, secondary to raised intraluminal pressure in the incarcerated appendix. Appendiceal diverticulosis is also believed to develop in response to raised pressure in the appendix and may therefore develop secondary to incarceration in a de Garengeot hernia. To our knowledge, only one such case has been described in the literature. A de Garengeot hernia is a rare entity, which poses significant diagnostic challenges. A high index of clinical suspicion is necessary as these hernias are at particularly high risk of perforation and so prompt surgical management is paramount. PMID:27269437

  10. Increasing Body Mass Index Is Inversely Related to Groin Hernias.

    PubMed

    Ravanbakhsh, Samine; Batech, Michael; Tejirian, Talar

    2015-10-01

    Few studies describe the relationship between obesity and groin hernias. Our objective was to investigate the correlation between body mass index (BMI) and groin hernias in a large population. Patients with the diagnosis of inguinal or femoral hernia with and without incarceration or strangulation were identified using the Kaiser Permanente Southern California regional database including 14 hospitals over a 7-year period. Patients were stratified by BMI. There were 47,950 patients with a diagnosis of a groin hernia--a prevalence of 2.28 per cent. Relative to normal BMI (20-24.9 kg/m(2)), lower BMI was associated with an increased risk for hernia diagnosis. With increasing BMI, the risk of incarceration or strangulation increased. Additionally, increasing age, male gender, white race, history of hernia, tobacco use history, alcohol use, and higher comorbidity index increased the chance of a groin hernia diagnosis. Complications were higher for women, patients with comorbidities, black race, and alcohol users. Our study is the largest to date correlating obesity and groin hernias in a diverse United States population. Obesity (BMI ≥ 30 kg/m(2)) is associated with a lower risk of groin hernia diagnosis, but an increased risk of complications. This inverse relationship may be due to limitations of physical exam in obese patients.

  11. Endometriosis in a spigelian hernia sac: an unexpected finding.

    PubMed

    Moris, Demetrios; Michalinos, Adamantios; Vernadakis, Spiridon

    2015-01-01

    Describes the existence of endometrioma in a spigelian hernia sac. Spigelian Hernia is a rare ventral hernia, presenting difficulties in diagnosis and carrying a high incarceration and obstruction risk. Endometriomas occur due to implantation of endometrial cells into a surgical wound, most often after a cesarean delivery. A 37-year-old woman presented to our department with persistent abdominal pain, exacerbating during menses, and vomiting for 2 days. Physical examination revealed a mass-like lesion in the border between the left-upper and left-lower quadrant. Ultrasound examination was inconclusive and a computed tomography scan of the abdomen revealed an abdominal wall mass. During surgery, a spigelian hernia was found 5 to 7 cm above a previous cesarean incision. Tissue like "chocolate cysts" was present at the hernia sac. Hernia was repaired while tissue was excised and sent for histological examination that confirmed the diagnosis. Spigelian hernia is a hernia presenting difficulties in diagnosis and treatment. Endometrioma in a spigelian hernia sac is a rare diagnosis, confirmed only histologically. Clinical suspicion can be posed only through symptoms and thorough investigation.

  12. Bochdalek Congenital Diaphragmatic Hernia in an Adult Sheep

    PubMed Central

    Williams, R. D.; Katz, M. G.; Fargnoli, A. S.; Kendle, A. P.; Mihalko, K. L.; Bridges, C. R.

    2016-01-01

    Summary Congenital diaphragmatic hernia (CDH) is a rare condition. The aetiology of CDH is often unclear. In our case, a hollow mass was noted on MRI. Cardiac ejection fraction was diminished (47.0%) compared to 60.5% (average of 10 other normal animals, P < 0.05). The final diagnosis of congenital diaphragmatic hernia (Bochdalek type) was made when the sheep underwent surgery. The hernia was right-sided and contained the abomasum. Lung biopsy demonstrated incomplete development with a low number of bronchopulmonary segments and vessels. The likely cause of this hernia was genetic malformation. PMID:26293994

  13. Bochdalek Congenital Diaphragmatic Hernia in an Adult Sheep.

    PubMed

    Williams, R D; Katz, M G; Fargnoli, A S; Kendle, A P; Mihalko, K L; Bridges, C R

    2016-06-01

    Congenital diaphragmatic hernia (CDH) is a rare condition. The aetiology of CDH is often unclear. In our case, a hollow mass was noted on MRI. Cardiac ejection fraction was diminished (47.0%) compared to 60.5% (average of 10 other normal animals, P < 0.05). The final diagnosis of congenital diaphragmatic hernia (Bochdalek type) was made when the sheep underwent surgery. The hernia was right-sided and contained the abomasum. Lung biopsy demonstrated incomplete development with a low number of bronchopulmonary segments and vessels. The likely cause of this hernia was genetic malformation.

  14. Bilateral Morgagni Hernia: A Unique Presentation of a Rare Pathology

    PubMed Central

    Richardson, Randy

    2016-01-01

    Morgagni hernia is an unusual congenital herniation of abdominal content through the triangular parasternal gaps of the anterior diaphragm. They are commonly asymptomatic and right-sided. We present a case of a bilateral Morgagni hernia resulting in delayed growth in a 10-month-old boy. The presentation was unique due to its bilateral nature and its symptomatic compression of the mediastinum. Diagnosis was made by 3D reconstructed CT angiogram. The patient underwent medical optimization until he was safely able to tolerate laparoscopic surgical repair of his hernia. Upon laparoscopy, the CT findings were confirmed and the hernia was repaired. PMID:27403367

  15. Made in Italy for hernia: the Italian history of groin hernia repair.

    PubMed

    Negro, Paolo; Gossetti, Francesco; Ceci, Francesca; D'Amore, Linda

    2016-01-01

    The history of groin hernia surgery is as long as the history of surgery. For many centuries doctors, anatomists and surgeons have been devoted to this pathology, afflicting the mankind throughout its evolution. Since ancient times the Italian contribution has been very important with many representative personalities. Authors, investigators and pioneers are really well represented. Every period (the classic period, the Middle Age, the Renaissance and the post-Renaissance) opened new perspectives for a better understanding. During the 18th century, more information about groin anatomy, mainly due to Antonio Scarpa, prepared the Bassini revolution. Edoardo Bassini developed the first modern anatomically based hernia repair. This procedure spread worldwide becoming the most performed surgical technique. After World War II synthetic meshes were introduced and a new era has begun for hernia repair, once again with the support of Italian surgeons, first of all Ermanno Trabucco. But Italian contribution extends also to educational, with the first national school for abdominal wall surgery starting in Rome, and to Italian participation and support in international scientific societies. Authors hereby wish to resume this long history highlighting the "made in Italy" for groin hernia surgery. Bassini, Groin hernia, History, Prosthetic repair.

  16. A prospective study of 1000 hernias: results of the Plymouth Hernia Service.

    PubMed Central

    Kingsnorth, A. N.; Bowley, D. M. G.; Porter, C.

    2003-01-01

    BACKGROUND: A hernia service within a general hospital was prospectively evaluated to establish whether evidence-based protocols could deliver results comparable to those reported from specialist hernia clinics. METHODS: Protocols were devised according to established models. With the support of a nurse specialist, 1015 patients with inguinal hernia were treated. Quality-of-life analysis was undertaken using the Short Form 36. RESULTS: Patients ranged in age from 16-98 years (median, 56 years). Ambulatory day-case surgery was achieved in 820 patients (81%), with local anaesthesia in 891 (88%). Wound infection occurred in 10 patients (0.98%). Wound haematoma requiring surgical intervention occurred in three patients. Two patients formed wound seromas that settled spontaneously. One patient developed ischaemic orchitis resulting in testicular atrophy. At 5 days after operation, 91% of patients had returned to normal activity. At 1 year, 7 patients (0.7%) had pain sufficient to limit normal activity or employment. There were 8 recurrences (0.78%) at a median follow-up of 2.5 years. Quality-of-life was enhanced at 1 year postoperatively. CONCLUSION: A protocol-driven hernia service within a general hospital can provide patient outcomes comparable to specialist hernia clinics. PMID:12585625

  17. De Garengeot's hernia: an unusual right groin mass due to acute appendicitis in an incarcerated femoral hernia.

    PubMed

    Salkade, Parag R; Chung, Alexander Y F; Law, Y M

    2012-10-01

    The presence of an acutely inflamed vermiform appendix in a femoral hernia sac is extremely rare; the condition is termed De Garengeot's hernia. Here we describe an elderly patient for whom preoperative computed tomography aided the diagnosis of this rare entity. This Chinese woman had presented with a painful right groin mass. The patient successfully underwent an emergency appendicectomy and primary femoral hernia repair. Once diagnosed, it is imperative to follow key surgical principles to limit the spread of infection.

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

    PubMed

    Callesen, Torben

    2003-08-01

    Elective surgical repair of an inguinal or femoral hernia is one of the most common surgical procedures. The treatment, however, presents several challenges regarding anaesthesia for the procedure, the postoperative analgesic therapy and convalescence, as well as planning of the procedure. Local, general, and regional anaesthesia are all used for hernia repair, but to different degrees, primarily depending on traditions and whether the institution has specific interest in hernia surgery. Thus, the use of local anaesthesia varies from a few percent in Sweden, 18% in Denmark and up to almost 100% in specialised institutions, dedicated to hernia surgery. The feasibility of local anaesthesia is high, as judged by the rate of conversion to general anaesthesia (< 1%), although intraoperative pain is quite common. The generally low rate of serious complications does not allow firm conclusions, but the rate of less serious complications is lower by local anaesthesia, compared to other anaesthetic techniques. Of special interest is, that the rate of urinary retention can be eliminated by the use of local anaesthesia. Local anaesthesia results, in comparative studies, in a higher degree of patient satisfaction than other anaesthetic techniques. Local anaesthesia also facilitates faster mobilisation and earlier discharge/fulfilment of discharge criteria from post anaesthetic care units than other anaesthetic techniques. Pain after hernia repair is more pronounced at mobilisation or coughing than during rest, and younger patients seem to have more pain than older patients. The pain ceases over time, and it is most pronounced the day after surgery, where two thirds have moderate or severe pain during activity, while one third still have moderate or severe pain after one week, and approximately 10% after 4 weeks. Pain after laparoscopic surgery is less pronounced than after open surgery, while different open repair techniques do not exhibit significant differences. Postoperative

  19. Anterior Tension-Free Repair of Recurrent Inguinal Hernia Under Local Anesthesia

    PubMed Central

    Gianetta, Ezio; Cuneo, Sonia; Vitale, Bruno; Camerini, Giovanni; Marini, Paola; Stella, Mattia

    2000-01-01

    Objective To describe a 7-year experience with recurrent inguinal hernia repair performed mainly with tension-free mesh or plug technique under local anesthesia through the anterior approach, and to evaluate the safety and effectiveness of this method of treatment. Methods One hundred forty-five elective and 1 emergency herniorrhaphies for recurrent groin hernia were performed in 141 subjects (134 men and 7 women) with a mean age of 65 years (range 30–89). Concomitant medical and surgical problems were present in 73% and 8% of subjects, respectively. In 28 instances, the relapsed hernia had already been operated on once or twice for recurrence. A traditional hernioplasty had been previously performed in the vast majority of cases (136). Tension-free mesh or plug techniques through an anterior approach under local anesthesia were performed in 144 reoperations. Preperitoneal mesh repair and general or spinal anesthesia were used in all but one case when herniorrhaphy was performed during simultaneous operations. Results Mean hospital stay after surgery was 1.5 days (range 3 hours–14 days). No perioperative deaths occurred in this series. General complications were one case of acute intestinal bleeding and two cases of urinary retention. Local complications consisted of eight (5.5%) minor complications and one case of orchitis (0.7%) followed by testicular atrophy. In no instance was postoperative neuralgia or chronic pain reported. Two re-recurrences occurred. Conclusions Given the low complication rate in this and other reported series and the absence of surgical or general complications described after preperitoneal open or laparoscopic repair and after general and spinal anesthesia, anterior mesh repair under local anesthesia seems to be a low-cost surgical technique that can be safely and effectively used even in a teaching hospital for the treatment of the majority of patients with recurrent groin hernias. PMID:10636113

  20. Linea arcuate hernia disguised as Pfannenstiel incision's hernia: a case report and a systemic literature review

    PubMed Central

    Vincelli, Veronica; Marazzi, Cesare; Posabella, Alberto; Steiger, Aurore

    2017-01-01

    We report a rare case of a 46-year-old woman 2 weeks after a cesarean section with Pfannenstiel incision, who presented at the Emergency Department with a significant abdominal pain accompanied by two episodes of vomiting. After that a clinical examination and an abdominal computed tomography scan were completed, a visceral herniation through Pfannenstiel incision was suspected. The indication of surgical exploration was clear. Finally, the laparotomy revealed a linea arcuata hernia with a hernia of the small intestine. After a reduction of the hernia sac, the defect was repaired and no mesh was placed. An antibiotic treatment with co-amoxicillin for 1 week during the recovery was prescribed. The patient recovered uneventfully and could be discharged by postoperative day 7. PMID:28069882

  1. Incisional Hernia Following Ventriculoperitoneal Shunt Positioning.

    PubMed

    Bonatti, Matteo; Vezzali, Norberto; Frena, Antonio; Bonatti, Giampietro

    2016-06-01

    Incisional hernia represents a rare complication after ventriculoperitoneal shunt positioning due to failure of the fascial suture in the site of abdominal entrance of ventriculoperitoneal catheter. Clinical presentation can be extremely variable, according to patient's performance status, herniated material constitution (i.e. mesenteric fat, bowel loops or both) and complication occurrence (e.g. strangulation or intestinal obstruction). Early diagnosis is fundamental in order to surgically repair the defect and prevent further complications. We present the case of a paucisymptomatic incisional hernia following ventriculoperitoneal shunt positioning. Diagnosis was made by means of ultrasound and confirmed by means of computed tomography. The patient was successfully managed by means of surgical repositioning of herniated loop and re-suture.

  2. Incisional Hernia Following Ventriculoperitoneal Shunt Positioning

    PubMed Central

    Bonatti, Matteo; Vezzali, Norberto; Frena, Antonio; Bonatti, Giampietro

    2016-01-01

    Incisional hernia represents a rare complication after ventriculoperitoneal shunt positioning due to failure of the fascial suture in the site of abdominal entrance of ventriculoperitoneal catheter. Clinical presentation can be extremely variable, according to patient’s performance status, herniated material constitution (i.e. mesenteric fat, bowel loops or both) and complication occurrence (e.g. strangulation or intestinal obstruction). Early diagnosis is fundamental in order to surgically repair the defect and prevent further complications. We present the case of a paucisymptomatic incisional hernia following ventriculoperitoneal shunt positioning. Diagnosis was made by means of ultrasound and confirmed by means of computed tomography. The patient was successfully managed by means of surgical repositioning of herniated loop and re-suture. PMID:27761180

  3. What is inside the hernia sac?

    PubMed Central

    Virgínia, Ana Araújo; Santos, Cláudia; Contente, Helena; Branco, Cláudia

    2016-01-01

    Most ovarian inguinal hernias occur in children and are frequently associated with congenital genitalia defects. The authors present the case of a multiparous 89-year-old woman, without any genitalia defect, who was brought to the emergency department with an irreducible inguinal hernia. The patient was proposed for emergency surgery during which we encountered an ovary and a fallopian tube inside the hernial sac. An oophorosalpingectomy and a Lichtenstein procedure were carried out and the postoperative period was uneventful. This case shows that, even though it is rare, a hernial sac may contain almost any intra-abdominal organ, including those least frequent such as the appendix, an ovary or the fallopian tubes. PMID:27511751

  4. Outcomes of an innovative training course in laparoscopic hernia repair.

    PubMed

    Light, D; Bawa, S; Gallagher, P; Horgan, L

    2017-07-06

    INTRODUCTION The Ethicon™ laparoscopic inguinal groin hernia training (LIGHT) course is an educational course based on three days of teaching on laparoscopic hernia surgery. The first day involves didactic lectures with tutorials. The second day involves practical cadaveric procedures in laparoscopic hernia surgery. The third day involves direct supervision by a consultant surgeon during laparoscopic hernia surgery on a real patient. We reviewed our outcomes for procedures performed on real patients on the final day of the course for early complications and outcomes. METHODS A retrospective study was undertaken of patients who had laparoscopic hernia surgery as part of the LIGHT course from 2013 to 2015. A matched control cohort of patients who had elective laparoscopic hernia surgery over the study period was identified. These patients had their surgery performed by the same consultant general surgeons involved in delivering the course. All patients were followed up at 6 weeks postoperatively. RESULTS A total of 60 patients had a laparoscopic inguinal hernia repair and 23 patients had a laparoscopic ventral hernia repair during the course. The mean operative time for laparoscopic inguinal hernia repair was 48 minutes for trainees (range 22-90 minutes) and 35 minutes for consultant surgeons (range 18-80 minutes). There were no intraoperative injuries or returns to theatre in either group. All the patients operated on during the course were successfully performed as daycase procedures. The mean operative time for laparoscopic ventral hernia repair was 64 minutes for trainees (range 40-120 minutes) and 51 minutes for consultant surgeons (range 30-130 minutes). CONCLUSIONS The outcomes of patients operated on during the LIGHT course are comparable to procedures performed by a consultant. Supervised operating by trainees is a safe and effective educational model in hernia surgery.

  5. 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

  6. [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.

  7. Rare presentation of spontaneous acquired diaphragmatic hernia.

    PubMed

    Gupta, Shweta; Bali, Roseleen Kaur; Das, Kamanasish; Sisodia, Anula; Dewan, R K; Singla, Rupak

    2011-01-01

    Spontaneous acquired diaphragmatic hernia without any apparent history of trauma is a very rare condition and is very difficult to diagnose. We present a case of a 21-year-old male who presented with abdominal pain for one month and four episodes of vomiting for one day. Clinical suspicion, chest radiography with nasogastric tube in situ and computed tomography (CT) confirmed the diagnosis. The diaphragmatic defect was repaired surgically. The patient had an uneventful post-operative recovery.

  8. [Spigelian hernia: clinical, diagnostic and therapeutical aspects].

    PubMed

    Versaci, A; Rossitto, M; Centorrino, T; Barbera, A; Fonti, M T; Broccio, M; Ciccolo, A

    1998-01-01

    The Authors describing a case of Spigelian hernia observed point out clinical, diagnostic and therapeutic considerations about this rare pathology of abdominal wall. They specify the anatomic characteristics of the region and underline as any diagnostic difficulties are by passed by use of USG and TC imaging for formulation of correct preoperative diagnosis. They confirm as surgical treatment by a correct access isn't different by a normal hernioplasty and guarantee the long term surgical outcome.

  9. Thoracic kidney associated with congenital diaphragmatic hernia.

    PubMed

    Rattan, Kamal N; Rohilla, Seema; Narang, Rajat; Rattan, Simmi K; Maggu, Sarita; Dhaulakhandi, Dhara B

    2009-09-01

    We report three cases of ectopic thoracic (or superior ectopic) kidney; one in a neonate and two in 6-month-old children, associated with congenital diaphragmatic hernia. In all cases the diagnosis was made during surgery and confirmed by intravenous pyelography, sonography and magnetic resonance imaging in the postoperative period. Because of the rarity of this condition we report these cases together with a wide review of the published reports.

  10. Laparoscopic repair of inguinal hernia in adults

    PubMed Central

    Yang, Xue-Fei

    2016-01-01

    Laparoscopic repair of inguinal hernia is mini-invasive and has confirmed effects. The procedures include intraperitoneal onlay mesh (IPOM) repair, transabdominal preperitoneal (TAPP) repair and total extraperitoneal (TEP) repair. These procedures have totally different anatomic point of view, process and technical key points from open operations. The technical details of these operations are discussed in this article, also the strategies of treatment for some special conditions. PMID:27867954

  11. 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

  12. Female 'groin' hernia: totally extraperitoneal (TEP) endoscopic repair seems the most appropriate treatment modality.

    PubMed

    Schouten, N; Burgmans, J P J; van Dalen, T; Smakman, N; Clevers, G J; Davids, P H P; Verleisdonk, E J M M; Elias, S G; Simmermacher, R K J

    2012-08-01

    About 30% of all female 'groin' hernias are femoral hernias, although often only diagnosed during surgery. A Lichtenstein repair though, as preferred treatment modality according to guidelines, would not diagnose and treat femoral hernias. Totally extraperitoneal (TEP) hernia repair, however, offers the advantage of being an appropriate modality for the diagnosis and subsequent treatment of both inguinal and femoral hernias. TEP therefore seems an appealing surgical technique for women with groin hernias. This study included all female patients ≥ 18 years operated for a groin hernia between 2005 and 2009. A total of 183 groin hernias were repaired in 164 women. TEP was performed in 85% of women; the other 24 women underwent an open anterior (mesh) repair. Peroperatively, femoral hernias were observed in 23% of patients with primary hernias and 35% of patients with recurrent hernias. There were 30 cases (18.3%) of an incorrect preoperative diagnosis. Peroperatively, femoral hernias were observed in 17.3% of women who were diagnosed with an inguinal hernia before surgery. In addition, inguinal hernias were found in 24.0% of women who were diagnosed with a femoral hernia preoperatively. After a follow-up of 25 months, moderate to severe (VAS 4-10) postoperative pain was reported by 8 of 125 patients (6.4%) after TEP and 5 of 23 patients (21.7%) after open hernia repair (P = 0.03). Five patients had a recurrent hernia, two following TEP (1.4%) and three following open anterior repair (12.5%, P = 0.02). Two of these three patients presented with a femoral recurrence after a previous repair of an inguinal hernia. Femoral hernias are common in women with groin hernias, but not always detected preoperatively; this argues for the use of a preperitoneal approach. TEP hernia repair combines the advantage of a peroperative diagnosis and subsequent appropriate treatment with the known good clinical outcomes.

  13. Transdiaphragmatic intercostal hernia: imaging aspects in three cases.

    PubMed

    Macedo, Ana Carolina Sandoval; Kay, Fernando Uliana; Terra, Ricardo Mingarini; Campos, José Ribas Milanez de; Aranha, André Galante Alencar; Funari, Marcelo Buarque de Gusmão

    2013-01-01

    Transdiaphragmatic intercostal hernia is uncommon and mostly related to blunt or penetrating trauma. We report three similar cases of cough-induced transdiaphragmatic intercostal hernia, highlighting the anatomic findings obtained with different imaging modalities (radiography, ultrasonography, CT, and magnetic resonance) in each of the cases.

  14. 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.

  15. Factors associated with lumbar disc hernia recurrence after microdiscectomy.

    PubMed

    Camino Willhuber, G; Kido, G; Mereles, M; Bassani, J; Petracchi, M; Elizondo, C; Gruenberg, M; Sola, C

    2017-09-09

    Lumbar disc hernias are a common cause of spinal surgery. Hernia recurrence is a prevalent complication. To analyse the risk factors associated with hernia recurrence in patients undergoing surgery in our institution. Lumbar microdiscectomies between 2010 and 2014 were analysed, patients with previous surgeries, extraforaminales and foraminal hernias were excluded. Patients with recurrent hernia were the case group and those who showed no recurrence were the control group. 177 patients with lumbar microdiscectomy, of whom 30 experienced recurrence (16%), and of these 27 were reoperated. Among the risk factors associated with recurrence, we observed a higher rate of disc height, higher percentage of spinal canal occupied by the hernia and presence of degenerative facet joint changes; we observed no differences in sex, body mass index or age. Previous studies show increased disc height and young patients as possible factors associated with recurrence. In our series we found that the higher rate of disc height, the percentage of spinal canal occupied by the hernia and degenerative facet joint changes were associated with hernia recurrence. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. 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

  17. Current options in local anesthesia for groin hernia repairs.

    PubMed

    Kulacoglu, Hakan; Alptekin, Alp

    2011-01-01

    Inguinal hernia repair is one of the most common procedures in general surgery. All anesthetic methods can be used in inguinal hernia repairs. Local anesthesia for groin hernia repair had been introduced at the very beginning of the last century, and gained popularity following the success reports from the Shouldice Hospital, and the Lichtenstein Hernia Institute. Today, local anesthesia is routinely used in specialized hernia clinics, whereas its use is still not a common practice in general hospitals, in spite of its proven advantages and recommendations by current hernia repair guidelines. In this review, the technical options for local anaesthesia in groin hernia repairs, commonly used local anaesthetics and their doses, potential complications related to the technique are evaluated. A comparison of local, general and regional anesthesia methods is also presented. Local anaesthesia technique has a short learning curve requiring simple training. It is easy to learn and apply, and its use is in open anterior repairs a nice way for health care economics. Local anesthesia has been shown to have certain advantages over general and regional anesthesia in inguinal hernia repairs. It is more economic and requires a shorter time in the operating room and shorter stay in the institution. It causes less postoperative pain, requires less analgesic consumption; avoids nausea, vomiting, and urinary retention. Patients can mobilize and take oral liquids and solid foods much earlier. Most importantly, local anesthesia is the most suitable type of anesthesia in elder, fragile patients and patients with ASA II-IV scores.

  18. [Results of surgical treatment of postoperative abdominal hernia].

    PubMed

    Belokonev, V I; Pushkin, S Iu

    2000-09-01

    There were examined 525 patients with postoperative abdominal hernia, in 47.3% of them big, vast and giant hernia was revealed. There were operated 436 patients using local tissues with duplicature formation--according to Mayo, Sapezhko, Napalkov and Yanov method.

  19. [Unusual ischemic cord compression by discal hernia (author's transl)].

    PubMed

    Vergeret, J; Noble, Y; Barat, M; Guérin, J; Arné, L

    The discal hernia are unfrequent in dorsal localization and neurological appearances are deceptive. We report a case with amyotrophic and fasciculations developing a progressive spinal cord amyotrophy aspect. The complementary investigations (gaz myelography and spinal angiography) show the discal hernia in T11-T12 which was operated successfully. The vascular factor role is discussed about semiologic and pathogenic view.

  20. Do not overlook an umbilical cord hernia before clamping.

    PubMed

    Cizmeci, Mehmet Nevzat; Kanburoglu, Mehmet Kenan; Akelma, Ahmet Zulfikar; Tatli, Mustafa Mansur

    2013-08-01

    An umbilical cord hernia is a rare midline abdominal defect. These masses may be easily overlooked at birth, which may result in an intestinal injury due to careless proximal application of the cord clamp. Herein, we present a newborn infant with an umbilical cord hernia who was managed by primary closure of the lesion.

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

    PubMed

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

    2009-12-01

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

  2. Fecally loaded inguinoscrotal hernia masquerading as testicular mass.

    PubMed

    Morgan, Robert David; Wallace, Sophie; Zein, Abdulhalim Al; D'Costa, Horace

    2011-10-01

    An 88-year-old man presented with clinical signs suggestive of a testicular mass. The initial ultrasound examination was inconclusive however regional computed tomography eloquently distinguished a large indirect inguinoscrotal hernia with a hernia sac containing a loop of fecally loaded sigmoid colon.

  3. Diaphragmatic Hernia after Transhiatal Esophagectomy for Esophageal Cancer

    PubMed Central

    Kim, Dohun; Kim, Si-Wook; Hong, Jong-Myeon

    2016-01-01

    Diaphragmatic hernia was found in a patient who had undergone transhiatal esophagectomy for early esophageal cancer. Chest X-ray was not helpful, but abdominal or chest computed tomography was useful for accurate diagnosis. Primary repair through thoracotomy was performed and was found to be feasible and effective. However, long-term follow-up is required because hernia recurrence is common. PMID:27525243

  4. [Rare complication of a post-traumatic left diaphragmatic hernia].

    PubMed

    Aissa, A; Hassine, A; Hajji, H; Ben Salah, K; Morjène, A; Alouini, R

    2013-12-01

    Diaphragmatic hernia is a post-traumatic lesion specific trauma that may go unnoticed. The left hemidiaphragm is the most frequently affected. The diagnosis is then made at the occasion of a complication, especially gastric volvulus. The authors report the case of a young man aged 26 years old with a gastric volvulus on post-traumatic diaphragmatic hernia diagnosed by CT.

  5. Transdiaphragmatic intercostal hernia: imaging aspects in three cases*

    PubMed Central

    Macedo, Ana Carolina Sandoval; Kay, Fernando Uliana; Terra, Ricardo Mingarini; de Campos, José Ribas Milanez; Aranha, André Galante Alencar; Funari, Marcelo Buarque de Gusmão

    2013-01-01

    Transdiaphragmatic intercostal hernia is uncommon and mostly related to blunt or penetrating trauma. We report three similar cases of cough-induced transdiaphragmatic intercostal hernia, highlighting the anatomic findings obtained with different imaging modalities (radiography, ultrasonography, CT, and magnetic resonance) in each of the cases. PMID:24068274

  6. De Garengeot's hernia: our experience of three cases and literature review

    PubMed Central

    Akbari, Khalid; Wood, Claire; Hammad, Ahmed; Middleton, Simon

    2014-01-01

    Groin hernia is a common surgical presentation and nearly half of the femoral hernias present acutely with strangulation. The hernia sac usually contains omentum or small bowel. Rarely, the appendix can herniate into the femoral canal. De Garengeot's hernia is the term used to describe the presence of appendicitis in the femoral hernia. Hernia explorations are performed by surgical trainees and encountering a De Garengeot's hernia can be challenging to manage. We report our experience of three cases of this rare entity and a literature review to improve our understanding for optimum management. PMID:25080546

  7. The Burnia: Laparoscopic Sutureless Inguinal Hernia Repair in Girls.

    PubMed

    Novotny, Nathan M; Puentes, Maria C; Leopold, Rodrigo; Ortega, Mabel; Godoy-Lenz, Jorge

    2017-04-01

    Laparoscopic inguinal hernia repair in children is in evolution. Multiple methods of passing the suture around the peritoneum at the level of the internal inguinal ring exist. Cauterization of the peritoneum at the internal ring is thought to increase scarring and decrease recurrence. We have employed a sutureless, cautery only, laparoscopic single port repair of inguinal hernias and patent processus vaginalis (PPV) in girls. After institutional ethical review was obtained, a retrospective review of sutureless laparoscopic inguinal hernia repairs in girls by 4 surgeons at separate institutions was performed. Patient demographics, intraoperative findings, and postoperative outcomes were recorded and analyzed. The technique involves an umbilical 30° camera and either a separate 3 mm stab incision in the midclavicular line or a 3 mm Maryland grasper placed next to the camera, and the distal most portion of the hernia sac is grasped and pulled into the abdomen and cauterized obliterating the sac. Eighty inguinal hernias were repaired using this technique in 67 girls between July 2009 and September 2015. The ages and weights ranged from 1 month to 16 years and from 2 to 69 kg, respectively. There was one conversion to open approach because an incarcerated ovary was too close to the ring. A single umbilical incision was utilized in 85%. Fifty-seven percent patients had hernias on the right whereas 42% had hernias on the left. Of the patients with presumed unilateral hernias, 22 patients were found to have PPV and were treated through the same incisions, 17/22 were found during a contralateral hernia surgery and 5/22 were found incidentally during appendectomy. Average operative time for unilateral and bilateral hernias was 22 minutes (5-38 minutes) and 31 minutes (11-65 minutes), respectively. No patient required a hospital stay because of the hernia repair. At an average of 25 months follow-up (1.6-75 months), there were no recurrences. The only complication was

  8. Ultrasound Prenatal Diagnosis of Inguinal Scrotal Hernia and Contralateral Hydrocele

    PubMed Central

    Massaro, G.; Sglavo, G.; Cavallaro, A.; Pastore, G.; Nappi, C.; Di Carlo, C.

    2013-01-01

    Fetal inguinal scrotal hernia is a rare condition resulting in an abnormal embryonic process of the tunica vaginalis. We report a case of ultrasound prenatal diagnosis of inguinal scrotal hernia associated with contralateral hydrocele in a woman at 37 weeks of gestation, referred to our clinic for a scrotal mass. Differential diagnosis includes hydrocele, teratoma, hemangiomas, solid tumours of testis, bowel herniation, and testicular torsion. Bowel peristalsis is an important ultrasound sign and it allowed us to make diagnosis of inguinal scrotal hernia. Diagnosis was confirmed at birth and a laparoscopic hernia repair was performed without complications on day 10. During surgery, a bilateral defect of canal inguinal was seen and considered as the cause of scrotal inguinal hernia and contralateral hydrocele observed in utero. PMID:24455356

  9. Acquired Abdominal Intercostal Hernia: A Case Report and Literature Review

    PubMed Central

    Tripodi, Giuseppe

    2014-01-01

    Acquired abdominal intercostal hernia (AAIH) is a rare disease phenomenon where intra-abdominal contents reach the intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. We discuss a case of a 51-year-old obese female who arrived to the emergency room with a painful swelling between her left 10th rib and 11th rib. She gave a history of a stab wound to the area 15 years earlier. A CT scan revealed a fat containing intercostal hernia with no diaphragmatic defect. An open operative approach with a hernia patch was used to repair this hernia. These hernias are difficult to diagnose, so a high clinical suspicion and thorough history and physical exam are important. This review discusses pathogenesis, clinical presentation, complications, and appropriate treatment strategies of AAIH. PMID:25197605

  10. Costs of inguinal hernia repair associated with using different medical devices in the Czech Republic.

    PubMed

    Marešová, Petra; Peteja, Matus; Lerch, Milan; Zonca, Pavel; Kuca, Kamil

    2016-01-01

    Inguinal hernia repair is one of the most frequently carried out operations worldwide. The purpose of this article is to analyze the costs of hernia repair and to specify the loss or profit made under the conditions in the Czech Republic with respect to the currently used medical devices and approaches. This article is based on the Drummond and O'Brien methodology, which specifically determines the content of direct and indirect costs in health services. The costs of operations during the period 2010-2014 were specified for a total of 746 patients. The cost details are described for four patients who represent the use of different types of medical devices. The procedure was a laparoscopic surgery in all cases. The total costs of inguinal hernia repairs (as per 2015 currency conversion rate) are €1,248,579; only part is covered from public funds, resulting in a loss of €218,359 for the hospital. The obtained data indicate that this operation is unprofitable for hospitals under the present conditions. The loss in the subject facility amounts to 17% of the total cost, which is the cost incurred by the hospital in the Czech Republic. The study conducted in the Czech Republic refers to different economic results when using various medical device types. So the medical device selection depends on advantages or disadvantages for the patients, as well as on the cost effectiveness for the hospital.

  11. Costs of inguinal hernia repair associated with using different medical devices in the Czech Republic

    PubMed Central

    Marešová, Petra; Peteja, Matus; Lerch, Milan; Zonca, Pavel; Kuca, Kamil

    2016-01-01

    Objective Inguinal hernia repair is one of the most frequently carried out operations worldwide. The purpose of this article is to analyze the costs of hernia repair and to specify the loss or profit made under the conditions in the Czech Republic with respect to the currently used medical devices and approaches. Methods This article is based on the Drummond and O’Brien methodology, which specifically determines the content of direct and indirect costs in health services. The costs of operations during the period 2010–2014 were specified for a total of 746 patients. The cost details are described for four patients who represent the use of different types of medical devices. The procedure was a laparoscopic surgery in all cases. Results The total costs of inguinal hernia repairs (as per 2015 currency conversion rate) are €1,248,579; only part is covered from public funds, resulting in a loss of €218,359 for the hospital. The obtained data indicate that this operation is unprofitable for hospitals under the present conditions. The loss in the subject facility amounts to 17% of the total cost, which is the cost incurred by the hospital in the Czech Republic. Conclusion The study conducted in the Czech Republic refers to different economic results when using various medical device types. So the medical device selection depends on advantages or disadvantages for the patients, as well as on the cost effectiveness for the hospital. PMID:27822052

  12. The economic analysis of two treatment procedures for incisional hernias - alloplastic versus tissular

    PubMed Central

    Mavrodin, C; Pariza, G; Ion, D; Ciurea, M

    2014-01-01

    Incisional hernias are a common complication of abdominal surgery. Research shows that their incidence reaches 10%-11% of the total number of patients subject to laparotomy. Recurrent hernias are the main complication of eventrations and its rate ranges from 5 to 54%, depending on both the surgical procedure used and the follow-up methods. The goal of this study is the comparative cost analysis of two procedures used in the treatment of event rations, tissular versus alloplastic, the former, leading very often to recurrence requiring a new surgical intervention. The analysis comprised 156 cases of surgeries performed for incisional hernia in 2007 in the clinic of Surgery III, SUUB (Bucharest University Emergency Hospital). Tissular procedures were used in 42 cases and prosthetic procedures in 114 cases. The medium-term postoperative follow-up has revealed 17 relapses (40.4%) in the tissular batch and no relapse in the batch where parietal prosthesis was used. If the short-term costs of the tissular procedures are low as compared with the prosthetic procedures, on the medium-term the costs increase by 24.35% due to the high rate of relapses of tissular procedures. Therefore, the tissular procedure must be abandoned due to the high rate of relapse, as this drives additional costs required for the alloplastic repair of the abdominal parietal defects in a subsequent surgical intervention. PMID:24653765

  13. Performance of simulated laparoscopic incisional hernia repair correlates with operating room performance.

    PubMed

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

    2011-01-01

    the role of simulation for training in procedures such as laparoscopic incisional hernia repair (LIHR) is unknown. The purpose of this study was to determine whether performance in simulated LIHR correlates with operating room (OR) performance. subjects performed LIHR in the University of Maryland Surgical Abdominal Wall (SAW) simulator and the OR. Trained observers used a LIHR-specific global rating scale (Global Operative Assessment of Laparoscopic Skills-Incisional Hernia) to assess performance. Global Operative Assessment of Laparoscopic Skills-Incisional Hernia includes 7 domains (trocar placement, adhesiolysis, mesh sizing, mesh positioning, mesh fixation, knowledge and autonomy in instrument use, and overall competence). The correlation between simulator and OR performance was assessed using the Pearson coefficient. fourteen surgeons from 2 surgical departments participated. Experienced surgeons (n = 9) were defined as attending surgeons and minimally invasive surgury (MIS) fellows, and novice surgeons (n = 5) were general surgery residents (postgraduate years 3-5). The correlation between performance in the OR and the simulator for the entire group was .87 (95% confidence interval, .63-.96; P < .001). there was an excellent correlation between LIHR performance in the simulator and clinical LIHR. This suggests that performance in the SAW simulator may predict performance in the operating room. 2011 Elsevier Inc. All rights reserved.

  14. Location of recurrent groin hernias at TEP after Lichtenstein repair: a study based on the Swedish Hernia Register.

    PubMed

    Bringman, S; Holmberg, H; Österberg, J

    2016-06-01

    To investigate which type of hernia that has the highest risk of a recurrence after a primary Lichtenstein repair. Male patients operated on with a Lichtenstein repair for a primary direct or indirect inguinal hernia and with a TEP for a later recurrence, with both operations recorded in the Swedish Hernia Register (SHR), were included in the study. The study period was 1994-2014. Under the study period, 130,037 male patients with a primary indirect or direct inguinal hernia were operated on with a Lichtenstein repair. A second operation in the SHR was registered in 2236 of these patients (reoperation rate 1.7 %). TEP was the chosen operation in 737 in this latter cohort. The most likely location for a recurrence was the same as the primary location. If the recurrences change location from the primary place, we recognized that direct hernias had a RR of 1.51 to having a recurrent indirect hernia compared to having a direct recurrence after an indirect primary hernia repair. Recurrent hernias after Lichtenstein are more common on the same location as the primary one, compared to changing the location.

  15. [Is the presence of an asymptomatic inguinal hernia enough to justify repair?].

    PubMed

    Metzger, Jürg

    2015-11-11

    The risk of strangulation in case of a inguinal hernia is low. Patients with a symptomatic inguinal hernia should undergo an operation. Morbidity and mortality in inguinal hernia surgery are very rare. There is also non-conservative treatment of inguinal hernias. Trusses should no longer be recommended. Watchful waiting is an option for men with minimally symptomatic or asymptomatic inguinal hernias. But patients must be informed that there is a high risk of becoming symptomatic.

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

    PubMed Central

    Blanc, Pierre; Kassir, Radwan; Atger, Jérôme

    2014-01-01

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

  17. Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias.

    PubMed

    Newcomb, W L; Polhill, J L; Chen, A Y; Kuwada, T S; Gersin, K S; Getz, S B; Kercher, K W; Heniford, B T

    2008-10-01

    Obesity may be the most predominant risk factor for recurrence following ventral hernia repair. This is secondary to significantly increased intra-abdominal pressures, higher rates of wound complications, and the technical difficulties encountered due to obesity. Medically managed weight loss prior to surgery is difficult. One potential strategy is to provide a surgical means to correct patient weight prior to hernia repair. After institutional review board approval, we reviewed the medical records of all patients who underwent gastric bypass surgery prior to the definitive repair of a complex ventral hernia at our medical center. Twenty-seven morbidly obese patients with an average of 3.7 (range 1-10) failed ventral hernia repairs underwent gastric bypass prior to definitive ventral hernia repair. Twenty-two of the gastric bypasses were open operations and five were laparoscopic. The patients' average pre-bypass body mass index (BMI) was 51 kg/m2 (range 39-69 kg/m2), which decreased to an average of 33 kg/m2 (range 25-37 kg/m2) at the time of hernia repair at a mean of 1.3 years (range 0.9-3.1 years) after gastric bypass. Seven patients had hernia repair at the same time as their gastric bypass (four sutured, three biologic mesh), all of which recurred. Of the 27 patients, 19 had an open hernia repair and eight had a laparoscopic repair. Panniculectomy was performed concurrently in 15 patients who had an open repair. Prior to formal hernia repair, one patient required an urgent operation to repair a hernia incarceration and a small-bowel obstruction 11 months after gastric bypass. The average hernia and mesh size was 203 cm2 (range 24-1,350 cm2) and 1,040 cm2 (range 400-2,700 cm2), respectively. There have been no recurrences at an average follow-up of 20 months (range 2 months-5 years). Gastric bypass prior to staged ventral hernia repair in morbidly obese patients with complex ventral hernias is a safe and definitive method to effect weight loss and facilitate a

  18. [Clinical anatomy of the esophagogastric junction].

    PubMed

    Tănase, M; Aldea, A S

    2012-01-01

    The esophagogastric junction is a controversial anatomical area, due to its sphincteric mechanism which does not show an obvious anatomical basis. The aim of this study is to investigate the anatomical components that endoscopically indicate the mucosal esophagogastric junction in hiatal hernia patients. The esophagogastric junction was investigated in 27 hiatal hernia patients undergoing surgery. Hiatal hernia is an extension of the stomach situated between the esophagogastric junction and the diaphragmatic indentation. The following types of hiatal hernia were found: sliding hiatal hernia (type I) in 4 patients (14.81%), rolling hiatal hernia (type II) in 2 (7.4%), mixed hiatal hernia (type III) in 12 (44.44%), type IV hiatal hernia in 4 (14.81%) and recurrent hiatal hernia in 5 (18.51%). Of the 27 hiatal hernia patients, 8 (29.6%) were operated using classical procedures: laparotomy--6 (75%) and laparoscopic surgery--2 (25%). The angle of His cannot be used for marking the mucosal esophagogastric junction due to the severe damage of the lower esophageal sphincter in hiatal hernia patients. The squamocolumnar junction is displaced in hiatal hernia patients and was not an option for the study group. The distal end of the esophageal longitudinal palisading vessels needs medication (proton pump inhibitors that reduce the gastric acid production), in order to enhance the visibility of these vessels. The proximal end of gastric longitudinal mucosal folds proved to be the most reliable site to identify endoscopically the mucosal esophagogastric junction. The anatomical structure of the esophagogastric junction differs in hiatal hernia patients and these peculiarities are very important in surgery.

  19. Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost

    PubMed Central

    Wellwood, James; Sculpher, Mark J; Stoker, David; Nicholls, Graham J; Geddes, Cathy; Whitehead, Anne; Singh, Rameet; Spiegelhalter, David

    1998-01-01

    Objective: To compare tension-free open mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic hernia repair under general anaesthetic. Design: A randomised controlled trial of 403 patients with inguinal hernias. Setting: Two acute general hospitals in London between May 1995 and December 1996. Subjects: 400 patients with a diagnosis of groin hernia, 200 in each group. Main outcome measures: Time until discharge, postoperative pain, and complications; patients’ perceived health (SF-36), duration of convalescence, and patients’ satisfaction with surgery; and health service costs. Results: More patients in the open group (96%) than in the laparoscopic group (89%) were discharged on the same day as the operation (χ2=6.7; 1 df; P=0.01). Although pain scores were lower in the open group while the effect of the local anaesthetic persisted (proportional odds ratio at 2 hours 3.5 (2.3 to 5.1)), scores after open repair were significantly higher for each day of the first week (0.5 (0.3 to 0.7) on day 7) and during the second week (0.7 (0.5 to 0.9)). At 1 month there was a greater improvement (or less deterioration) in mean SF-36 scores over baseline in the laparoscopic group compared with the open group on seven of eight dimensions, reaching significance on five. For every activity considered the median time until return to normal was significantly shorter for the laparoscopic group. Patients randomised to laparoscopic repair were more satisfied with surgery at 1 month and 3 months after surgery. The mean cost per patient of laparoscopic repair was £335 (95% confidence interval £228 to £441) more than the cost of open repair. Conclusion: This study confirms that laparoscopic hernia repair has considerable short term clinical advantages after discharge compared with open mesh hernioplasty, although it was more expensive. Key messages In the 4 hours after surgery laparoscopic hernia repair with general anaesthesia causes more pain

  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.

  1. Umbilical hernias: the cost of waiting.

    PubMed

    Strosberg, David S; Pittman, Matthew; Mikami, Dean

    2017-02-01

    Umbilical hernias are well described in the literature, but its impact on health care is less understood. The purpose of this study was to investigate the effect of non-operative management of umbilical hernias on cost, work absenteeism, and resource utilization. The Truven Health Database, consisting of 279 employers and over 3000 hospitals, was reviewed for all umbilical hernia patients, aged 18-64 who were enrolled in health plans for 12 months prior to surgery and 12 months after surgery. Patients were excluded if they had a recurrence or had been offered a "no surgery" approach within 1 year of the index date. The remaining patients were separated into surgery (open or laparoscopic repair) or no surgery (NS). Post-cost analysis at 90 and 365 days and estimated days off from work were reviewed for each group. The non-surgery cohort had a higher proportion of females and comorbidity index. Adjusted analysis showed significantly higher 90 and 365 costs for the surgery group (p < 0.0001), though the cost difference did decrease over time. NS group had significantly higher estimated days of health-care utilization at both the 90 (1.99 vs. 3.58 p < 0.0001) and 365 (8.69 vs. 11.04 p < 0.0001) day post-index mark. A subgroup analysis demonstrated laparoscopic repair had higher costs compared to open primarily due to higher index procedure costs (p < 0.05). Though the financial costs were found to be higher in the surgery group, the majority of these were due to the surgery itself. Significantly higher days of health-care utilization and estimated days off work were experienced in the NS group. It is our belief that early operative intervention will lead to decreased costs and resource utilization.

  2. Age and sex-based distribution of lumbar multifidus muscle atrophy and coexistence of disc hernia: an MRI study of 2028 patients.

    PubMed

    Ekin, Elif Evrim; Kurtul Yıldız, Hülya; Mutlu, Harun

    2016-01-01

    We aimed to investigate the prevalence of lumbar multifidus muscle (LMM) atrophy in patients having mechanical low back pain with and without disc hernia. In total, 2028 lumbar magnetic resonance imaging scans of low back pain patients (age range, 18-88 years) were re-evaluated retrospectively. LMM atrophy was visually assessed in axial sections of L4-L5 and L5-S1 levels. LMM atrophy prevalence at both levels was significantly higher in subjects ≥40 years compared with younger adults (P < 0.001). LMM atrophy was significantly more frequent in women than in men (P < 0.001). Among patients with low back pain without hernia, LMM atrophy was significantly more frequent than normal muscle (n=559 vs. n=392; P < 0.001). Frequency of LMM atrophy in low back pain patients without disc hernia was 13%. Hernia was more frequent in patients with LMM atrophy compared with patients without atrophy (P < 0.001). LMM atrophy is more common in women; its prevalence and severity are observed to increase with advancing age, and disc hernia is found more frequently in individuals with LMM atrophy.

  3. Observations on oesophageal length.

    PubMed Central

    Kalloor, G J; Deshpande, A H; Collis, J L

    1976-01-01

    The subject of oesophageal length is discussed. The great variations in the length of the oesophagus in individual patients is noted, and the practical use of its recognition in oesophageal surgery is stressed. An apprasial of the various methods available for this measurement is made; this includes the use of external chest measurement, endoscopic measurement, and the measurement of the level of the electrical mucosal potential change. Correlative studies of these various methods are made, and these show a very high degree of significance. These studies involved simultaneous measurement of external and internal oesophageal length in 26 patients without a hiatal hernia or gastro-oesophageal length in 26 patients without a hiatal hernia or gastro-oesophageal reflux symptoms, 42 patients with sliding type hiatal hernia, and 17 patients with a peptic stricture in association with hiatal hernia. The method of measuring oesophageal length by the use of the external chest measurement, that is, the distance between the lower incisor teeth and the xiphisternum, measured with the neck fully extended and the patient lying supine, is described in detail, its practical application in oesophageal surgery is illustrated, and its validity tested by internal measurements. The findings of this study demonstrate that the external chest measurement provides a mean of assessing the true static length of the oesophagus, corrected for the size of the individual. Images PMID:941114

  4. Laparoscopic ventral hernia repair: a community hospital experience.

    PubMed

    Saiz, A A; Willis, I H; Paul, D K; Sivina, M

    1996-05-01

    From October 1993 to April 1994, laparoscopic ventral hernia repair was performed on 10 patients, all of whom had a history of failed ventral hernia repair and at least two prior ventral hernia repair procedures. Patients presented with complaints of abdominal discomfort, painful mass at the hernia site, or vague abdominal discomfort. No operative deaths occurred. Two patients had minor complications: a seroma at the repair site, which resolved spontaneously, and a superficial wound infection at a trochar site, which responded to an oral cephalosporin. Six patients were discharged within 24 hours of surgery and one patient was operated on as an outpatient and discharged the same day. Follow-up of all patients ranged from 10 to 17 months. No evidence of hernia recurrence has been noted. Some recurrent ventral hernias are amenable to laparoscopic repair, and this technique may be preferable in some patients, especially those who have had an earlier failed open repair with mesh. We do not advocate use of our technique for the first repair of a ventral hernia. Long-term follow-up is still needed to determine recurrence rates compared with conventional open techniques.

  5. A prospective study of bilateral inguinal hernia repair.

    PubMed Central

    Serpell, J. W.; Johnson, C. D.; Jarrett, P. E.

    1990-01-01

    A prospective study of outcome after inguinal hernia repair in patients undergoing simultaneous repair of bilateral hernias (n = 31), sequential repair of bilateral hernias (n = 5), and unilateral hernia repair (n = 75) is reported. There were no differences in wound complications, post-operative respiratory complications, or other adverse effects in the three groups. Operating time was similar in the unilateral and bilateral simultaneous repairs (median 55 min), but was longer (100 min) for the combination of two sequential repairs. Hospital stay was shortest for patients undergoing unilateral repair (2 days) but was less with bilateral simultaneous repair (4 days) than after two sequential repairs (total of 6 days). There were 12 (11%) wound complications of which five (5%) were infections. There was no difference in complication rate between unilateral and bilateral hernia repair. Postoperative recovery was assessed prospectively and was recorded at 1 month. There was no difference between unilateral and bilateral simultaneous repairs in the number of days before the patient was able to climb stairs easily, drive a car or return to work. The duration of the requirement for analgesia was similar in each group. We conclude that bilateral simultaneous hernia repair can be carried out with no greater morbidity than a unilateral repair, and the return to normal activity is as rapid. Bilateral hernias should be repaired simultaneously rather than sequentially. PMID:2221764

  6. A review of available prosthetics for ventral hernia repair.

    PubMed

    Shankaran, Vidya; Weber, Daniel J; Reed, R Lawrence; Luchette, Fred A

    2011-01-01

    To review mesh products currently available for ventral hernia repair and to evaluate their efficacy in complex repair, including contaminated and reoperative fields. Although commonly referenced, the concept of the ideal prosthetic has never been fully realized. With the development of newer prosthetics and approaches to the ventral hernia repair, many surgeons do not fully understand the properties of the available prosthetics or the circumstances that warrant the use of a specific mesh. A systematic review of published literature from 1951 to June of 2009 was conducted to identify articles relating to ventral hernia repairs and the use of prosthetics in herniorrhaphy. Important differences exist between the synthetics, composites, and biologic prosthetics used for ventral hernia repair in terms of mechanics, cost, and the ideal situation in which each should be used. The use of synthetic mesh remains an appropriate solution for most ventral hernia repairs. Laparoscopic ventral hernia repair has created a niche for both expanded polytetrafluoroethylene and composite mesh, as they are suited to intraperitoneal placement. Preliminary studies have demonstrated that the newer biologic prosthetics are reasonable options for hernia repair in contaminated fields and for large abdominal wall defects; however, more studies need to be done before advocating the use of these biologics in other settings.

  7. Dynamic intermittent strain can rapidly impair ventral hernia repair.

    PubMed

    Kallinowski, Friedrich; Baumann, Elena; Harder, Felix; Siassi, Michael; Mahn, Axel; Vollmer, Matthias; Morlock, Michael M

    2015-11-26

    Ventral hernia repair fails frequently despite advanced mesh inserting surgery. A model for dynamic intermittent straining (DIS) of ventral hernia repairs was developed. The influence of phospholipids, position, overlap, fixation and tissue quality of various meshes on the durability of hernia repair was studied. DIS comprises the repetition of submaximal impacts delivered via a hydraulically driven plastic containment. Pig tissues simulate a ventral hernia with a standardized 5cm defect. Commercially available meshes strengthened with tacks, glue and sutures were used to bridge this defect in an underlay (IPOM) or sublay (retromuscular) position starting with a 5cm overlap in all directions. We tested 35 different ways of ventral hernia repair with up to 425 submaximal intermittent dynamic impacts until mesh dislocation occurred 10 times or a maximum of 4000 impacts each were withstood. The likelihood of a failing repair was related to the mesh, the lubricants, the position, the overlap, the fixation and the tissue quality. Most meshes dislocated easily and required fixation. One of the meshes tested was stable without fixation with a 5cm overlap and failed after reducing the overlap. Phospholipids exerted a strong influence on the biomaterial tested. The sublay position was about 10% more durable in comparison to the IPOM position. DIS revealed distinct degrees of stability with primarily stable, intermediate and primarily unstable repairs. Based on the DIS results available, the currently used ventral hernia repair options can be classified. In the future, DIS investigations can improve the durability of hernia repair.

  8. Amyand hernia: Case report and review of the literature

    PubMed Central

    Morales-Cárdenas, Adrián; Ploneda-Valencia, César Felipe; Sainz-Escárrega, Victor Hugo; Hernández-Campos, Alvaro Cuauhtemoc; Navarro-Muñiz, Eliseo; López-Lizarraga, Carlos René; Bautista-López, Carlos Alfredo

    2015-01-01

    Introduction Amyand Hernia is a rare disease seen in approximately 1% of all hernias, complications of it, like acute appendicitis, or perforated appendicitis are even more rare, about 0.1%. Its diagnosis is very difficult in the pre-operative period; it is usually an incidental finding. Presentation of case This paper describes the case of a forty-year-old male patient, which was presented to the outpatient clinic of surgery with an incarcerated right side inguinal hernia without any signs of ischemic complications. He was admitted, and an hernioplasty was performed, as an incidental finding we encountered an Amyand hernia treated without appendectomy and placement of a prosthetic mesh without any complications. Discussion This disease represents a very challenging diagnosis, seven years ago the standardization of management had already been established; in this case we encountered a type 1 Amyand's Hernia so we performed a standard tension free hernioplasty without complications. Conclusion Amyand hernia is a rare condition, which represents two of the most common diseases a general surgeon has to face. Standardization of treatment is still ongoing and more prospective studies need to be done. This case demonstrates that this pathology must remain in the mind of the surgeons especially in the event of a strangulated hernia and offer a comprehensive review. PMID:25941568

  9. Sportsman’s hernia? An ambiguous term

    PubMed Central

    Dimitrakopoulou, Alexandra; Schilders, Ernest

    2016-01-01

    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

  10. Genetic aspects of human congenital diaphragmatic hernia

    PubMed Central

    Pober, BR

    2010-01-01

    Congenital diaphragmatic hernia (CDH) is a common major malformation affecting 1/3000–1/4000 births, which continues to be associated with significant perinatal mortality. Much current research is focused on elucidating the genetics and pathophysiology contributing to CDH to develop more effective therapies. The latest data suggest that many cases of CDH are genetically determined and also indicate that CDH is etiologically heterogeneous. The present review will provide a brief summary of diaphragm development and model organism work most relevant to human CDH and will primarily describe important human phenotypes associated with CDH and also provide recommendations for diagnostic evaluation of a fetus or infant with CDH. PMID:18510546

  11. Tissue engineering in congenital diaphragmatic hernia.

    PubMed

    Fauza, Dario O

    2014-06-01

    Engineered diaphragmatic repair is emblematic of perinatal regenerative medicine and of the fetal tissue engineering concept. The alternative of a cellularized graft for the repair of a congenital diaphragmatic defect in the neonatal period is both biologically justifiable by the mechanisms behind diaphragmatic hernia recurrence as well as an ideal match for fetal mesenchymal stem cell-based constructs. It has been among the most developed experimental pursuits in neonatal tissue engineering, of which clinical application should be forthcoming. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Genetic causes of congenital diaphragmatic hernia

    PubMed Central

    Wynn, Julia; Yu, Lan; Chung, Wendy K.

    2014-01-01

    Congenital diaphragmatic hernia (CDH) is a moderately prevalent birth defect that, despite advances in neonatal care, is still a significant cause of infant death, and surviving patients have significant morbidity. The goal of ongoing research to elucidate the genetic causes of CDH is to develop better treatment and ultimately prevention. CDH is a complex developmental defect that is etiologically heterogeneous. This review summarizes the recurrent genetic causes of CDH including aneuploidies, chromosome copy number variants, and single gene mutations. It also discusses strategies for genetic evaluation and genetic counseling in an era of rapidly evolving technologies in clinical genetic diagnostics. PMID:25447988

  13. Retroperitoneal vascular malformation mimicking incarcerated inguinal hernia.

    PubMed

    Dubey, Indu Bhushan; Sharma, Anuj; Singh, Ajay Kumar; Mohanty, Debajyoti

    2011-01-01

    A 30-year-old man presented to the Department of Surgery with a painful groin swelling on right side. Exploration revealed a reddish-blue hemangiomatous mass in the scrotum extending through inguinal canal into the retroperitoneum. On further dissection swelling was found to be originating from right external iliac vein. The swelling was excised after ligating all vascular connections. The histopathological examination of excised mass confirmed the diagnosis of venous variety of vascular malformation. This is the first reported case of vascular malformation arising from retroperitoneum and extending into inguinoscrotal region, presenting as incarcerated inguinal hernia.

  14. Spigelian hernias: repair and outcome for 81 patients.

    PubMed

    Larson, David W; Farley, David R

    2002-10-01

    Spigelian hernia is a rare partial abdominal wall defect. The frequent lack of physical findings along with vague associated abdominal complaints makes the diagnosis elusive. A retrospective review of Mayo Clinic patients was performed to find all patients who had undergone surgical repair of a Spigelian hernia from 1976 to 1997. Patients were scrutinized for presentation, work-up, therapy, and outcome. The goal of this study was to obtain long-term outcome. The study was set in a tertiary referral center. There were 76 patients in whom 81 Spigelian hernias were repaired. Symptoms most commonly included an intermittent mass (n = 29), pain (n = 20), pain with a mass (n = 22), and bowel obstruction (n = 5). Five patients were asymptomatic. Preoperative imaging was performed in 21 patients and correctly diagnosed the hernia in 15. Spigelian hernias were repaired by primary suture closure (n = 75), mesh (n = 5), and laparoscopic (n = 1) techniques. Eight patients (10%) required emergent operations. Thirteen hernias (17%) were found to be incarcerated at the time of the operation. Overall mean follow-up for the 76 patients was 8 years, with three hernia recurrences identified. Spigelian hernia is rare and requires a high index of suspicion given the lack of consistent symptoms and signs. An astute physician may couple a proper history and physical examination with preoperative imaging to secure the diagnosis. Mesh and laparoscopic repairs are viable alternatives to the durable results of standard primary closure. Given the high rate of incarceration/strangulation, the diagnosis of Spigelian hernia is an indication for surgical repair.

  15. Combined laparoscopic and open extraperitoneal approach to scrotal hernias.

    PubMed

    Ferzli, G S; Rim, S; Edwards, E D

    2013-04-01

    Laparoscopic repair of scrotal hernias is often a difficult endeavor to successfully complete. The longstanding nature of these hernias often results in significant adhesions and anatomic distortion of the inguinal floor. These two issues make reduction of the hernia arduous and subsequent reinforcement of the parietal sac difficult. We have previously described techniques to increase the chances of success when attempting laparoscopic repair of scrotal hernias. Here, we describe some of those techniques as well as a combined laparoscopic and open approach to achieve a robust preperitoneal repair of incarcerated scrotal hernias when the usual totally extraperitoneal approach does not work. We performed a retrospective review of 1890 TEP hernia repairs we performed from 1990 to 2010. Rate of conversion to an open approach or a combined laparoscopic and open approach was examined. Incidence of complications or recurrences was assessed over a 12-month follow-up period. Among the 1890 TEP repairs, 94 large scrotal hernias were identified. Of these, nine cases (9.5 %) required conversion to an open procedure due to an incarcerated and indurated omentum. Three were completed with a conventional open preperitoneal whereas six patients (6.4 %) underwent repair with the combined approach. In this group, no recurrences or complications were found over a 12-month period. In cases where a large scrotal hernia may be difficult or dangerous to reduce laparoscopically, immediate conversion to an open repair may not be necessary. A combined laparoscopic and open approach can greatly assist in the visualization and dissection of the preperitoneal space, thereby facilitating reduction of the hernia and placement of the mesh.

  16. Postoperative interstitial hernia as a cause of obscure incisional wound site pain.

    PubMed

    Modrzejewski, Andrzej; Smietański, Maciej

    2012-03-01

    An interstitial hernia is one in which the hernia sac is located between the layers of the abdominal wall. The analysis of contemporary literature shows that interstitial hernias are most often seen in children as a type of inguinal hernia and often accompany undescended testis. The hernia sac is usually located between the external-oblique and internal-oblique muscles in a lateral-cephalic direction. The authors present 3 cases of interstitial hernia found during laparoscopic exploration of the front abdominal wall done due to incisional wound site pain. No previous diagnosis of hernia was considered in all the cases. Hernias were found as complications of appendectomy and wound healing after radiotherapy of uterine and cervical cancer. In conclusion, in obscure wound site pain, the presence of an interstitial postoperative hernia should be considered as a possible reason for the complaint. Laparoscopic examination of the anterior abdominal wall during adhesiolysis in patients with abdominal pain enables proper diagnosis and treatment.

  17. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era.

    PubMed

    Esposito, Ciro; Escolino, Maria; Turrà, Francesco; Roberti, Agnese; Cerulo, Mariapina; Farina, Alessandra; Caiazzo, Simona; Cortese, Giuseppe; Servillo, Giuseppe; Settimi, Alessandro

    2016-08-01

    The surgical repair of inguinal hernia and hydrocele is one of the most common operations performed in pediatric surgery practice. This article reviews current concepts in the management of inguinal hernia and hydrocele based on the recent literature and the authors׳ experience. We describe the principles of clinical assessment and anesthetic management of children undergoing repair of inguinal hernia, underlining the differences between an inguinal approach and minimally invasive surgery (MIS). Other points discussed include the current management of particular aspects of these pathologies such as bilateral hernias; contralateral patency of the peritoneal processus vaginalis; hernias in premature infants; direct, femoral, and other rare hernias; and the management of incarcerated or recurrent hernias. In addition, the authors discuss the role of laparoscopy in the surgical treatment of an inguinal hernia and hydrocele, emphasizing that the current use of MIS in pediatric patients has completely changed the management of pediatric inguinal hernias. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Unusual findings in inguinal hernia surgery: Report of 6 rare cases

    PubMed Central

    Ballas, K; Kontoulis, Th; Skouras, Ch; Triantafyllou, A; Symeonidis, N; Pavlidis, Th; Marakis, G; Sakadamis, A

    2009-01-01

    Background and aim: To present our experience with unexpected findings during hernia surgery, either unusual hernial contents or pathologic entities, like neoplastic masses, masquerading as a hernia. Patients and methods: We studied retrospectively 856 patients with inguinal hernia who were admitted to our surgical department over a 9-year period. In addition, our study included patients complaining of inguinal protrusion, even without a definitive diagnosis of inguinal hernia upon admission. Results: Five patients presented with unusual hernial contents. Three of them had a vermiform appendix in their sac. Acute appendicitis (Amyands hernia) was found in only one case. One patient had epiploic appendagitis related with a groin hernia. Moreover, an adult woman was diagnosed with ovarian and tubal inguinal hernia. Finally, we report a case of a massive extratesticular intrascrotal lipoma, initially misdiagnosed as a scrotal hernia. Conclusion: a hernia surgeon may encounter unexpected intraoperative findings. It is important to be prepared to detect them and apply the appropriate treatment. PMID:19918306

  19. Recessive and Dominant Mutations in Retinoic Acid Receptor Beta in Cases with Microphthalmia and Diaphragmatic Hernia

    PubMed Central

    Srour, Myriam; Chitayat, David; Caron, Véronique; Chassaing, Nicolas; Bitoun, Pierre; Patry, Lysanne; Cordier, Marie-Pierre; Capo-Chichi, José-Mario; Francannet, Christine; Calvas, Patrick; Ragge, Nicola; Dobrzeniecka, Sylvia; Hamdan, Fadi F.; Rouleau, Guy A.; Tremblay, André; Michaud, Jacques L.

    2013-01-01

    Anophthalmia and/or microphthalmia, pulmonary hypoplasia, diaphragmatic hernia, and cardiac defects are the main features of PDAC syndrome. Recessive mutations in STRA6, encoding a membrane receptor for the retinol-binding protein, have been identified in some cases with PDAC syndrome, although many cases have remained unexplained. Using whole-exome sequencing, we found that two PDAC-syndrome-affected siblings, but not their unaffected sibling, were compound heterozygous for nonsense (c.355C>T [p.Arg119∗]) and frameshift (c.1201_1202insCT [p.Ile403Serfs∗15]) mutations in retinoic acid receptor beta (RARB). Transfection studies showed that p.Arg119∗ and p.Ile403Serfs∗15 altered RARB had no transcriptional activity in response to ligands, confirming that the mutations induced a loss of function. We then sequenced RARB in 15 subjects with anophthalmia and/or microphthalmia and at least one other feature of PDAC syndrome. Surprisingly, three unrelated subjects with microphthalmia and diaphragmatic hernia showed de novo missense mutations affecting the same codon; two of the subjects had the c.1159C>T (Arg387Cys) mutation, whereas the other one carried the c.1159C>A (p.Arg387Ser) mutation. We found that compared to the wild-type receptor, p.Arg387Ser and p.Arg387Cys altered RARB induced a 2- to 3-fold increase in transcriptional activity in response to retinoic acid ligands, suggesting a gain-of-function mechanism. Our study thus suggests that both recessive and dominant mutations in RARB cause anophthalmia and/or microphthalmia and diaphragmatic hernia, providing further evidence of the crucial role of the retinoic acid pathway during eye development and organogenesis. PMID:24075189

  20. Inguinal endometriosis or irreducible hernia? A difficult preoperative diagnosis.

    PubMed

    Miranda, L; Settembre, A; Capasso, P; Piccolboni, D; De Rosa, N; Corcione, F

    2001-03-01

    Two cases of endometriosis infiltrating the round ligament and associated with an inguinal hernia are presented. The initial diagnosis was irreducible hernia, since this rare association often causes unusual preoperative symptoms and diagnostic problems. Diagnosis is frequently made by histologic examination. Surgery is the treatment of choice both for hernia and for endometriosis, and is locally curative. However, in a fertile woman with a painful mass in the inguinal region the possibility of endometriosis should be considered, and if suspected at inguinal exploration a laparoscopy should be made to rule out the presence of intraperitoneal endometriosis.

  1. Testicular atrophy as a consequence of inguinal hernia repair.

    PubMed

    Reid, I; Devlin, H B

    1994-01-01

    Testicular atrophy is an uncommon but well recognized complication of inguinal hernia repair and one that frequently results in litigation. A series of ten cases of testicular atrophy occurring after hernia repair in nine patients is presented. Identifiable risk factors were present in eight instances. Surgeons should make careful enquiries as to previous groin or scrotal surgery and, when indicated, warn the patient before surgery of the increased risk of testicular atrophy. Overzealous dissection of a distal hernia sac, dislocation of the testis from the scrotum into the wound and concomitant scrotal surgery should all be avoided.

  2. 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

  3. [Incarcerated scrotal hernia in a gelding (author's transl)].

    PubMed

    Breukink, H J; Németh, F; van Dieten, J S

    1980-03-15

    The clinical examination, anaesthesia and surgery in a gelding with an incarcerated scrotal hernia are described. The results of examination of the blood at regular intervals are shown in a table. Surgery was performed without enterectomy. The postoperation course was uneventful. It is concluded that the possibility of scrotal hernia should be borne in mind, even in geldings with colic. The incarcerated portion of the small intestine is usually found to be the jejuno-ileal junction. The anaesthesiological and surgical features of equine scrotal hernia are discussed.

  4. Obturator hernia: An uncommon cause of small bowel obstruction

    PubMed Central

    Shreshtha, S

    2016-01-01

    A 70 year old lady presented to surgery emergency with small bowel obstruction without any obvious etiology. On exploration she was found to have an obstructed obturator hernia, which is a rare pelvic hernia with an incidence of 0.07-1.4% of all intra-abdominal hernias. Diagnosis is often delayed until laparotomy for bowel obstruction. Strangulation is frequent and mortality remains high (25%). Early diagnosis and surgical treatment contributes greatly to reduce the mortality and morbidity rates. A variety of techniques have been described, however surgical repair has not been standardized. It is an important diagnosis to be considered in elderly patients with intestinal obstruction. PMID:27763487

  5. Congenital and acquired umbilical hernias: examination and treatment.

    PubMed

    Summers, Anthony

    2014-03-01

    Many adults and children with painful swellings to the abdomen present to emergency departments (EDs) and are diagnosed with umbilical hernia. Some of these patients require urgent surgery because the hernia has become incarcerated or strangulated, while others can be discharged home safely. This article explains what an umbilical hernia is and what causes it, and discusses how the abdomen should be examined. The article also reviews potential management techniques in EDs and how nurse practitioners can explain the condition to the patients concerned.

  6. Point-of-Care Ultrasound Identification of an Abdominal Hernia.

    PubMed

    Alfonzo, Michael; von Reinhart, Anna; Riera, Antonio

    2017-08-01

    Pediatric emergency medicine physicians may be able to use point-of-care ultrasound (POCUS) as a tool to evaluate abdominal wall masses. We present a case of a 2-month-old infant with a lower abdominal mass identified as a hernia sac by POCUS. It was initially thought to represent a Spigelian-type abdominal wall hernia but subsequently determined to be an unusual presentation of an inguinal hernia with testicular entrapment. We review each of these diagnoses in addition to relevant POCUS findings.

  7. Sonographic prevalence of groin hernias and adductor tendinopathy in patients with femoroacetabular impingement.

    PubMed

    Naal, Florian D; Dalla Riva, Francesco; Wuerz, Thomas H; Dubs, Beat; Leunig, Michael

    2015-09-01

    Femoroacetabular impingement (FAI) is a common debilitating condition that is associated with groin pain and limitation in young and active patients. Besides FAI, various disorders such as hernias, adductor tendinopathy, athletic pubalgia, lumbar spine affections, and others can cause similar symptoms. To determine the prevalence of inguinal and/or femoral herniation and adductor insertion tendinopathy using dynamic ultrasound in a cohort of patients with radiographic evidence of FAI. Case series; Level of evidence, 4. This retrospective study consisted of 74 patients (36 female and 38 male; mean age, 29 years; 83 symptomatic hips) with groin pain and radiographic evidence of FAI. In addition to the usual diagnostic algorithm, all patients underwent a dynamic ultrasound examination for signs of groin herniation and tendinopathy of the proximal insertion of the adductors. Evidence of groin herniation was found in 34 hips (41%). There were 27 inguinal (6 female, 21 male) and 10 femoral (9 female, 1 male) hernias. In 3 cases, inguinal and femoral herniation was coexistent. Overall, 5 patients underwent subsequent hernia repair. Patients with groin herniation were significantly older than those without (33 vs 27 years, respectively; P = .01). There were no significant differences for any of the radiographic or clinical parameters. Tendinopathy of the proximal adductor insertion was detected in 19 cases (23%; 11 female, 8 male). Tendinopathy was coexistent with groin herniation in 8 of the 19 cases. There were no significant differences for any of the radiographic or clinical parameters between patients with or without tendinopathy. Patients with a negative diagnostic hip injection result were more likely to have a concomitant groin hernia than those with a positive injection result (80% vs 27%, respectively). Overall, 38 hips underwent FAI surgery with satisfactory outcomes in terms of score values and subjective improvement. The results demonstrate that groin

  8. A modified laparoscopic hernioplasty (TAPP) is the standard procedure for inguinal and femoral hernias: a retrospective 17-year analysis with 1,123 hernia repairs.

    PubMed

    Peitsch, Werner K J

    2014-02-01

    Laparoscopic and endoscopic procedures generally are accepted for repair of primary and recurrent hernias that follow conventional (anterior) repair. This report discusses transabdominal preperitoneal (TAPP) for incarcerated hernias, scrotal hernias, and hernias after radical prostatectomy, as well as hernia recurrences after TAPP and totally extraperitoneal (TEP) procedures (complex hernias). Studies with long-term results of hernia recurrences are missing. This study aimed to determine hernia recurrence rates for adults after a modified TAPP procedure. The records of patients who had hernia repair surgery at a general hospital 2, 7, 12, and 17 years earlier were analyzed. Living patients were requested to complete a questionnaire to complement information from their hospital records. A retrospective analysis was undertaken that included 5,764 patients who had undergone hernia repair surgery 2-17 years earlier at a single large center. Between 1993 and 2009, a modified TAPP procedure was performed for 5,764 patients (median age, 59.1 years) to repair 6,776 hernias (93.9% of all hernia repairs), including 6,126 primary hernias (87.4%) and 884 recurrent hernias (12.6%). These included 994 complicated hernias (14.2%) closed by a modified TAPP (89.3% of all femoral hernias, 85.9% of scrotal hernias, 79.1% of incarcerated hernias, and 92.7% of hernias after radical prostatectomy). Limited financial and staff resources did not permit a quantitative follow-up study within a reasonable time of all 5,764 patients who had hernia surgery 2-18 years earlier. To obtain quantitative results of hernia recurrences after a modified TAPP, the patients were divided into four subgroups and requested to complete a questionnaire. These four patient subgroups whose surgeries had been performed 2 years earlier (241 patients with 277 hernias), 7 years earlier (285 patients with 376 hernias), 12 years earlier (401 patients with 544 hernias), and 17 years earlier (181 patients with 222

  9. Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure.

    PubMed

    Lambrecht, J R; Vaktskjold, A; Trondsen, E; Øyen, O M; Reiertsen, O

    2015-06-01

    Supposing divergent aetiology, we found it interesting to investigate outcomes between primary (PH) versus incisional (IH) hernias. In addition, we wanted to analyse the effect of defect closure and mesh fixation techniques. 37 patients with PH and 70 with IH were enrolled in a prospective cohort-study, treated with laparoscopic ventral hernia repair (LVHR) and randomised to ± transfascial sutures. In addition, we analysed results from a retrospective study with 36 PH and 51 IH patients. Mean follow-up time was 38 months in the prospective study and 27 months in the retrospective study. 35 % of PH's and 10 % of IH's were recurrences after previous suture repair. No late infections or mesh removals occurred. Recurrence rates in the prospective study were 0 vs. 4.3 % (p = 0.55) and the complication rates were 16 vs. 27 % (p = 0.24) in favour of the PH cohort. The IH group had a mesh protrusion rate of 13 vs. 5 % in the PH group (p = 0.32), and significantly (p < 0.01) larger hernias and adhesion score, longer operating time (100 vs. 79 min) and admission time (2.8 vs. 1.6 days). Closure of the hernia defect did not influence rate of seroma, pain at 2 months, protrusion or recurrence. An overall increased complication rate was seen after defect closure (OR 3.42; CI 1.25-9.33). With PH, in comparison to IH treated with LVHR, no differences were observed regarding recurrence, protrusion or complication rates. Defect closure (raphe), when using absorbable suture, did not benefit long-term outcomes and caused a higher overall complication rate. (ClinicalTrials.gov number: NCT00455299).

  10. Diaphragmatic hernia mimicking hydropneumothorax: common error in emergency department

    PubMed Central

    Magu, Sarita; Agarwal, Shalini; Jain, Nitin; Dalal, Nityasha

    2013-01-01

    Detection of diaphragmatic hernia in the acute setting is problematic and diagnosing diaphragmatic hernia as hydropneumothorax is not an uncommon mistake. We present a series of four such cases diagnosed over a 7-year period, from December 2004 to January 2011 and analyse them for how this mistake can be avoided. In case of all the patients reported by us the initial radiographs were technically compromised because the patient could not be positioned properly. Also they were examined by non-radiologists. We feel that treating surgeons in emergency department tend to overdiagnose pneumothorax as it is a life-threatening condition. We feel that in the appropriate setting suspicion of diaphragmatic hernia should be raised in patients having fractured ribs associated with homogenous opacity, which cannot be differentiated from the diaphragm. Evidence of loculation of hydropneumothorax in the appropriate setting should also raise the possibility of diaphragmatic hernia. PMID:23907963

  11. Laparoscopic Repair of a Traumatic Intrapericardial Diaphragmatic Hernia

    PubMed Central

    Kuy, SreyRam; Weigelt, John A.

    2014-01-01

    Introduction: Intrapericardial diaphragmatic hernia is a rare injury. We present a case of an intrapericardial diaphragmatic hernia from blunt trauma. In this report we will review the current literature and also describe the first report of a primary laparoscopic repair of the defect. Case Description: A 38-year-old unrestrained male passenger had blunt chest and abdominal trauma from a motor vehicle collision. Two months later, on a computed tomography scan, he was found to have an intrapericardial diaphragmatic hernia. The defect was repaired primarily through a laparoscopic approach. Discussion: Symptoms of intrapericardial diaphragmatic hernia are chest pain, upper abdominal pain, dysphagia, and dyspnea. Chest computed tomography is the most useful diagnostic test to define the defect. Even when the injury is diagnosed late, laparoscopy can be used for primary and patch repair. PMID:24960502

  12. Gallstone ileus in an ‘asymptomatic’ parastomal hernia

    PubMed Central

    Jayamanne, H; Brown, J

    2016-01-01

    Parastomal hernias are common and often asymptomatic. We report the first known case in which later, acute symptoms developed owing to gallstone ileus in a sac containing both omentum and small bowel. Urgent computed tomography established the diagnosis. PMID:27241611

  13. Incisional bladder hernia following appendectomy: report of a case.

    PubMed

    Sasaki, Shin; Miura, Emi; Nakayama, Hiroshi; Watanabe, Toshiyuki

    2014-10-01

    We herein report the case of a 68-year-old male who presented with a few years' history of swelling at the scar of an appendectomy, which he had undergone nearly 40 years earlier, and which was associated with radiating pain towards the penis when he pushed on the swelling. The scar was located in the right lower quadrant of the abdomen. Abdominal sonography and a computed tomography (CT) scan demonstrated the presence of an incisional bladder hernia, and surgery was performed. The herniated bladder was successfully replaced into the preperitoneal space, and the orifice was covered with a polypropylene mesh. Most bladder hernias develop in the inguinal and/or femoral region, and an incisional bladder hernia is extremely rare, especially after abdominal surgery. To our knowledge, this is the fourth report of an incisional bladder hernia following abdominal surgery.

  14. Congenital hernia of cord: an often misdiagnosed entity

    PubMed Central

    Raju, Rubin; Satti, Mohamed; Lee, Quoc; Vettraino, Ivana

    2015-01-01

    Congenital hernia of the cord, also known as umbilical cord hernia, is an often misdiagnosed and under-reported entity, easily confused with a small omphalocele. It is different from postnatally diagnosed umbilical hernias and is believed to arise from persistent physiological mid-gut herniation. Its incidence is estimated to be 1 in 5000. Unlike an omphalocele, it is considered benign and is not linked with chromosomal anomalies. It has been loosely associated with intestinal anomalies, suggesting the need for a complete fetal anatomical ultrasound evaluation. We present a case of a fetal umbilical cord hernia diagnosed in a 28-year-old woman at 21 weeks gestation. The antenatal and intrapartum courses were uncomplicated. It was misdiagnosed postnatally as a small omphalocele, causing unwarranted anxiety in the parents. Increased awareness and knowledge of such an entity among health professionals is important to prevent unwarranted anxiety from misdiagnosis, and inadvertent bowel injury during cord clamping at delivery. PMID:25899514

  15. Tumescent local anesthetic technique for inguinal hernia repairs

    PubMed Central

    Chyung, Ju Won; Kwon, Yujin; Cho, Dong Hui; Lee, Kyung Bok; Park, Sang Soo; Yoon, Jin; Jang, Yong Seog

    2014-01-01

    Purpose We evaluated the adequacy and feasibility of a tumescent solution containing lidocaine and bupivacaine for inguinal hernia repairs. Methods The medical records of 146 consecutive inguinal hernia patients with 157 hernia repairs using the tumescent local anesthesia technique performed by a single surgeon between September 2009 and December 2013 were retrospectively reviewed. Results The mean operation time (±standard deviation) and hospital stay were 64.5 ± 17.6 minutes and 2.7 ± 1.5 days. The postoperative complication rate was 17.8%. There were four cases of recurrences (2.5%) at a mean follow-up of 24 ± 14 months. Conclusion Our results suggest that local anesthesia with the tumescent technique is an effective and safe modality for inguinal hernia repairs. PMID:25485241

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

    PubMed Central

    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. Simultaneous Umbilical Hernia Repair with Transumbilical Ventriculoperitoneal Shunt Placement.

    PubMed

    Montalbano, Michael J; Loukas, Marios; Oakes, W Jerry; Tubbs, R Shane

    2017-01-01

    Recently, placement of a ventriculoperitoneal shunt via a transumbilical approach has been reported. Herein, we report the repair of an umbilical hernia via the same incision and introduction of the distal end of a ventricultoperitoneal shunt into the peritoneal cavity in 3 patients. A case illustration is included. Both hernia repair and placement of the distal end of the ventriculoperitoneal shunt were uncomplicated in our small case series. To our knowledge, simultaneous repair of an umbilical hernia followed by transumbilical shunt placement has not been reported. As umbilical hernias are so common in infants, this finding, based on our experience, should not exclude placement of peritoneal tubing in the same setting. © 2017 S. Karger AG, Basel.

  18. [Fetal magnetic resonance imaging evaluation of congenital diaphragmatic hernia].

    PubMed

    Sebastià, C; Garcia, R; Gomez, O; Paño, B; Nicolau, C

    2014-01-01

    A diaphragmatic hernia is defined as the protrusion of abdominal viscera into the thoracic cavity through a normal or pathological orifice. The herniated viscera compress the lungs, resulting in pulmonary hypoplasia and secondary pulmonary hypertension, which are the leading causes of neonatal death in patients with congenital diaphragmatic hernia. Congenital diaphragmatic hernia is diagnosed by sonography in routine prenatal screening. Although magnetic resonance imaging is fundamentally used to determine whether the liver is located within the abdomen or has herniated into the thorax, it also can provide useful information about other herniated structures and the degree of pulmonary hypoplasia. The aim of this article is to review the fetal magnetic resonance findings for congenital diaphragmatic hernia and the signs that enable us to establish the neonatal prognosis when evaluating pulmonary hypoplasia.

  19. Pantaloon Hernia: Obstructed Indirect Component and Direct Component with Cryptorchidism.

    PubMed

    Kariappa, Mohan Kumar; Harihar, Vivek; Kothudum, Ashwini Rajareddy; Hiremath, Vivekanand Kedarlingayya

    2016-01-01

    Cryptorchidism is a condition in which one or both testes have not passed down into the scrotal sac. It is categorized as true undescended testis in which testes are present in the normal path of descent, and as ectopic testis, in which testes are present at abnormal site. Common complications of cryptorchidism are testicular torsion, subfertility, inguinal hernia, and testicular cancer. Here we present a rare case of pantaloon hernia of obstructed indirect component and direct component with cryptorchidism.

  20. Pantaloon Hernia: Obstructed Indirect Component and Direct Component with Cryptorchidism

    PubMed Central

    Kariappa, Mohan Kumar; Hiremath, Vivekanand Kedarlingayya

    2016-01-01

    Cryptorchidism is a condition in which one or both testes have not passed down into the scrotal sac. It is categorized as true undescended testis in which testes are present in the normal path of descent, and as ectopic testis, in which testes are present at abnormal site. Common complications of cryptorchidism are testicular torsion, subfertility, inguinal hernia, and testicular cancer. Here we present a rare case of pantaloon hernia of obstructed indirect component and direct component with cryptorchidism. PMID:27579208

  1. Traumatic right diaphragmatic hernia in children: Diagnostic difficulties

    PubMed Central

    Ndour, O.; Mustapha, H.; Ndoye, N. A.; Faye Fall, A. L.; Ngom, G.; Ndoye, M.

    2015-01-01

    Traumatic right diaphragmatic hernia is rare in children. Its diagnosis can be difficult in the acute phase of trauma because its signs are not specific, especially in a poly trauma context. We report two cases of traumatic right diaphragmatic hernia following a blunt thoraco-abdominal trauma, highlighting some difficulties in establishing an early diagnosis and the need for a high index of suspicion. PMID:25659563

  2. Small bowel strangulation due to peritoneopericardial diaphragmatic hernia

    PubMed Central

    2014-01-01

    A 75-year-old Korean man was referred to our hospital with cramping abdominal pain. His chest X-ray showed an abnormal air shadow above the diaphragm, and computed tomography showed an abdominal viscera in the pericardium. We performed surgery and confirmed peritoneopericardial diaphragmatic hernia with small bowel strangulation. Postoperative course was uneventful. Peritoneopericardial diaphragmatic hernia is very rare in humans, so we report the case with a literature review. PMID:24694166

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

    PubMed Central

    2013-01-01

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

  4. Tissue Expanders in Skin Deficient Ventral Hernias Utilizing Component Separation

    PubMed Central

    Molinar, Vanessa E.; Molinar, Alonso; Palladino, Humberto

    2015-01-01

    Summary: Skin deficient complex ventral hernias are complicated surgical cases that have multimodal approaches. There is no current consensus on the management of those patients who also have concomitant stomas or enterocutaneous fistula. We present 2 cases in which the senior authors were able to apply tissue expanders above and between the abdominal wall in patients with an enterocutaneous fistula or stoma. After expansion and final closure, the patients did not experience recurrent hernias. PMID:26893988

  5. Role of Sonography in Clinically Occult Femoral Hernias.

    PubMed

    Brandel, David W; Girish, Gandikota; Brandon, Catherine J; Dong, Qian; Yablon, Corrie; Jamadar, David A

    2016-01-01

    The purpose of this article is to evaluate the diagnostic accuracy of sonography in clinically occult femoral hernias and to describe our sonographic technique. The clinical and imaging data for 93 outpatients referred by general surgeons, all of whom underwent sonographic evaluation and surgery, were reviewed retrospectively. Of these, 55 patients who underwent surgical exploration for groin hernias within 3 months of sonography and met all inclusion criteria were included in the study. The sonographic technique involves using the pubic tubercle as an osseous landmark to identify and appropriately visualize the femoral canal. The Valsalva maneuver is then used to differentiate the movement of normal fat (a potential pitfall) from true herniation in the femoral canal. Surgical findings were used as the reference standard by which sonographic results were judged. Two-by-two contingency tables were used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value. In these 55 patients, surgery revealed 15 femoral hernias. Eight femoral hernias occurred in women, and 7 occurred in men. For diagnosing femoral hernias, sonography demonstrated sensitivity of 80%, specificity of 88%, a positive predictive value of 71%, and a negative predictive value of 92%. True-positive cases of femoral hernias have a sonographic appearance of a hypoechoic sac with speckled internal echoes. When examining during the Valsalva maneuver, a femoral hernia passes deep to the inguinal ligament, expands the femoral canal, displacing the normal canal fat, and effaces the femoral vein. Sonography can exclude femoral hernias with high confidence in light of its exceptional negative predictive value. With attention to technique and imaging criteria, the diagnostic accuracy of sonography can be enhanced.

  6. Is laparoscopic inguinal hernia repair more effective than open repair?

    PubMed

    O, Aly; A, Green; M, Joy; H, Wong C; Al-Kandari A; S, Cheng; M, Malik

    2011-05-01

    To systematically review randomized controlled trials, (RCT) evidence comparing Lichtenstein to total extraperitoneal (TEP) hernia repair in terms of clinical and cost effectiveness. Case series. The study was conducted at University of Abderdeen, U.K. A comprehensive online literature search was undertaken using databases such as MEDLINE, PubMed, EMBASE and Springerlink. Studies were then shortlisted according to the selection criteria (RCT with over 100 subject and English language publications from 1995 onwards) and appraised using the SIGN Methodology Checklist. A metaanalysis of the data was also performed using RevMan software. Analysis of reported data shows that TEP has less postoperative pain and return to work than Lichtenstein method. Operation time is shown to be longer in the TEP but this difference is shortened with increasing surgeon experience. The meta-analysis of the data on complications shows that there are no significant differences between the two types of procedures. TEP causes more short-term recurrences which are attributed to the learning curve effect. Longterm recurrence rates on the other hand show no significant differences. At present TEP is slightly more expensive than Lichtenstein repair. Both TEP and Lichtenstein repair are clinically effective procedures. The choice between them should be made on a case-by-case basis; which depends on the patients' preference and characteristics such as age, work and health status.

  7. Sir Ganga Ram Hospital classification of groin and ventral abdominal wall hernias

    PubMed Central

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

    2006-01-01

    Background: Numerous classifications for groin and ventral hernias have been proposed over the past five to six decades. The old, simple classification of groin hernia in to direct, inguinal and femoral components is no longer adequate to understand the complex pathophysiology and management of these hernias. The most commonly followed classification for ventral hernias divide them into congenital, acquired, incisional and traumatic, which also does not convey any information regarding the predicted level of difficulty. Aim: All the previous classification systems were based on open hernia repairs and have their own fallacies particularly for uncommon hernias that cannot be classified in these systems. With the advent of laparoscopic/ endoscopic approach, surgical access to the hernia as well as the functional anatomy viewed by the surgeon changed. This change in the surgical approach and functional anatomy opened the doors for newer classifications. The authors have thus proposed a classification system based on the expected level of intraoperative difficulty for endoscopic hernia repair. Classification: In the proposed classification higher grades signify increasing levels of expected intraoperative difficulty. This functional classification grades groin hernias according to the: a) Pre -operative predictive level of difficulty of endoscopic surgery, and b) Intraoperative factors that lead to a difficult repair. Pre operative factors include multiple or pantaloon hernias, recurrent hernias, irreducible and incarcerated hernias. Intraoperative factors include reducibility at operation, degree of descent of the hernial sac and previous hernia repairs. Hernial defects greater than 7 cm in diameter are categorized one grade higher. Conclusion: Though there have been several classification systems for groin or inguinal hernias, none have been described for total classification of all ventral hernias of the abdomen. The system proposed by us includes all abdominal wall

  8. 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. PMID:27635414

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

    PubMed

    Matsutani, Takeshi; Nomura, Tsutomu; Hagiwara, Nobutoshi; Matsuda, Akihisa; Takao, Yoshimune; Uchida, Eiji

    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.

  10. Herniamed: an internet-based registry for outcome research in hernia surgery.

    PubMed

    Stechemesser, B; Jacob, D A; Schug-Paß, C; Köckerling, F

    2012-06-01

    Despite the high frequency of hernia surgery procedures and continuous improvements, thanks to new hernia meshes and fixation techniques, in Germany, for example, the recurrence rate and rate of chronic inguinal pain after inguinal surgery are more than 10% far too high. Introduction of a hernia register in Denmark led to a significant reduction in the recurrence rate. The aim of a hernia registry as an application-oriented outcome research tool is to monitor and evaluate (concomitant research) how the knowledge gleaned from evidence-based science is implemented in the everyday clinical setting and, ultimately, investigate its effectiveness (outcome research). The new Internet-based English- and German-language registry for the entire spectrum of inpatient and outpatient hernia surgery is designed to improve the quality of patient care and provide valid data on outcome research. Via the Internet, all relevant patient data (comorbidities, previous operations, staging, specific surgical technique, medical devices used, perioperative complications and follow-up data) can be entered into the registry database. The participating hospitals and surgeons can at any time view their own data by means of an evaluation statistics tool. The outcome research project Herniamed focuses on inguinal hernias, umbilical hernias, incisional hernias, epigastric hernias, parastomal hernias and hiatus hernias. The online-based outcome research registry meets the most stringent data protection criteria. With the Internet-based English- and German-language hernia register, a new instrument is now available for outcome research in hernia surgery.

  11. Lichtenstein, prolene hernia system, and UltraPro Hernia System for primary inguinal hernia repair: one-year outcome of a prospective randomized controlled trial.

    PubMed

    Magnusson, J; Nygren, J; Thorell, A

    2012-06-01

    The optimal technique for open inguinal hernia repair is yet to be determined. Three hundred and nine male patients [median of 60 years (range, 31-75)] undergoing primary open inguinal hernia repair in local anesthesia and day-care surgery were randomly allocated to operation with the Lichtenstein technique (L), Prolene Hernia System (PHS), or UltraPro Hernia System (UHS). [Median (IQR)] There were no differences in operating time [47 (40-58) vs. 50 (40-57) and 50 (42-56) min in groups L, PHS, and UHS, respectively], intra- or postoperative complications, time until return to normal workload (8 (4-14) vs. 9 (4-14), and 8 (4-14) days) or occurrence of chronic pain at 12 months (15 vs. 12, and 13 patients). Self-reported physical quality of life (SF-36) was reduced compared to matched controls preoperatively and increased similarly to levels not different from controls in all groups at 12 months postoperatively. There was one recurrence in each group during the follow-up period. The Lichtenstein technique, PHS, and UHS seem all acceptable approaches for open inguinal hernia repair in local anesthesia and day-care surgery regarding perioperative course, rehabilitation, complications, recurrence rates, development of chronic groin pain, and improvement in quality of life after 12 months. However, due to reduced costs and lack of need for the exploration of the preperitoneal space, the Lichtenstein technique should be recommended as first choice.

  12. [Case report: Occlusion and intestinal necrosis by obturator hernia].

    PubMed

    Palacios-Zertuche, Jorge Tadeo; Guerrero-Hernández, Armando de Jesús; Salinas-Domínguez, Rogelio; Muñoz-Maldonado, Gerardo Enrique

    2016-12-16

    Obturator hernia is a rare variety of abdominal hernia, it accounts for 0.07%-1.0% of all hernias, and occurs most often in women of advanced age and multiparous. A 78-year-old female was admitted to the Emergency Department due to nausea, vomiting, complaints of abdominal discomfort and obstipation for the last 7 days. Abdominal CT scan showed dilated small bowel loops and multiple air-fluid levels near to a small bowel loop obturator hernia, between external obturator and pectineus muscle. Emergency laparotomy was performed and during the surgery, loop of small intestine was revealed herniated into the obturator foramen, 130cm from the angle of Treitz. Necrosis of small intestine was found, without perforation. Resection of the 10cm affected jejunal segment was performed and a side-to-side bowel anastomosis was fashioned. Also simple suture closure of obturator foramen was performed. Obturator hernia is relatively rare. However physicians should keep it in mind and have clinical suspicion for obturator hernia as a cause of intestinal obstruction in female, elderly and multiparous patients in order to make an appropriate diagnosis and avoid bowel ischaemia. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  13. Intestinal Obstruction due to Bilateral Strangulated Femoral Hernias

    PubMed Central

    Nikolopoulos, Ioannis; Oderuth, Eshan; Ntakomyti, Eleni; Kald, Bengt

    2014-01-01

    Introduction. Femoral hernias are at high risk of strangulation due to the narrow femoral canal and femoral ring. This can lead to symptoms of obstruction or strangulation requiring emergency surgery and possible bowel resection. To our knowledge, there is only one previous published report of bilateral strangulated femoral hernia. We present our case of this phenomenon. Case Report. An 86-year-old woman presented with symptoms of small bowel obstruction. Examination revealed two tender lumps in the area of the femoral triangle. CT scan revealed bilateral femoral hernias. Both hernias were repaired and a small bowel resection on the right side was performed with side to side anastomosis. She made an uneventful recovery. Conclusion. Bilateral femoral hernias are a rare occurrence with only one reported case of bilateral strangulation. Our case highlights the importance of meticulous history taking and clinical examination as any delay in diagnosis will increase the risk of mortality and morbidity for the patient. Hernias should always be considered as a cause if one presents with symptoms of abdominal pain or obstruction. PMID:25057426

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

    PubMed

    Gaines, R D

    1978-03-01

    An estimated overall complication rate of approximately ten percent is found in the half million patients who annually undergo groin hernia repair in the United States. Certain features in the operative technique are emphasized which should prevent many of these complications.Intraoperative complications during the groin hernia repair are primarily hemorrhage and injury to the vas deferens, the three nerves in the area, the vascular supply of the testis, and the abdominal and pelvic viscera. Miscellaneous intraoperative complications relate to problems associated with the repair of massive hernias, missed hernia, and the loss of strangulated bowel into the abdominal cavity.Early postoperative complications may be either systemic or local with cardiac and respiratory conditions comprising the former group. The early local complications are primarily wound problems of infection, hematoma formation, and scrotal swelling involving the skin and testis. High ligation in excision of the sac in all hernias, repair of the defect in the plane of its occurrence, and suture of fascia to fascia in the same plane without tension are the basic tenets of inguinal hernia repair which should result in a low incidence of recurrence.The most effective prophylactic measures necessary for the prevention of complications considered are a thorough knowledge of inguinofemoral anatomy, mature surgical judgment, and meticulous surgical technique.

  15. Online patient resources for hernia repair: analysis of readability.

    PubMed

    Vargas, Christina R; Chuang, Danielle J; Lee, Bernard T

    2014-07-01

    The limited functional health literacy of a significant portion of the adult US population negatively affects their access to appropriate online health information about hernia repair surgery. The National Institutes of Health and American Medical Association recommend that patient-directed content should be written at a sixth-grade reading level. This study aims to evaluate readability of the most frequently used Internet resources for patient information about hernia repair relative to average American literacy. A web search for "hernia repair surgery" was performed, and the top 12 Web sites were identified. Relevant articles (n=102) with patient-directed content immediately available from the main sites were downloaded. The 12 most popular consumer magazines in circulation were also identified, and using the same method, the first 10 articles were downloaded from each magazine's Web site for comparison. Readability was assessed using 10 established analyses. A t-test was used to compare the average grade level of hernia repair and magazine articles for each readability test. Web-based information about hernia repair had an overall average reading grade level of 13.6. All 102 articles were above the recommended sixth-grade reading level; these were significantly more difficult to read than the comparison group of articles from popular magazines. Online patient-directed information about hernia repair uniformly exceeds the recommended reading level and may be too difficult to be understood by a large portion of the US population. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Chronic diaphragmatic hernia in 34 dogs and 16 cats.

    PubMed

    Minihan, Anne C; Berg, John; Evans, Krista L

    2004-01-01

    Medical records of 34 dogs and 16 cats undergoing surgical repair of diaphragmatic hernia of >2 weeks' duration were reviewed, and long-term follow-up information was obtained. The most common clinical signs were dyspnea and vomiting; however, many of the animals were presented for nonspecific signs such as anorexia, lethargy, and weight loss. Thoracic radiographs revealed evidence of diaphragmatic hernia in only 66% of the animals, and additional imaging tests were often needed to confirm the diagnosis. Thirty-six hernias were repaired through a midline laparotomy; 14 required a median sternotomy combined with a laparotomy. In 14 animals, division of mature adhesions of the lungs or diaphragm to the herniated organs was necessary to permit reduction of the hernia. Fourteen animals required resection of portions of the lungs, liver, or intestine. All hernias were sutured primarily without the use of tissue flaps or mesh implants. Twenty-one of the animals developed transient complications in the postoperative period; the most common of these was pneumothorax. The mortality rate was 14%. Thirty-four (79%) of the animals that were discharged from the hospital had complete resolution of clinical signs, and none developed evidence of recurrent diaphragmatic hernia during the follow-up period. Nine were lost to follow-up.

  17. Comparative Study of Prolene Hernia System and Lichtenstein Method for Open Inguinal Hernia Repair

    PubMed Central

    Badkur, Mayank

    2015-01-01

    Background Prolene Hernia System (PHS) is a bi-layered polypropylene mesh with a connector that combines the anterior and posterior inguinal hernia repair, but still not very popular in this part of the country. Hence a prospective & randomized comparative study was undertaken to compare PHS with the already popular Lichtenstein Hernia Repair (LHR) and determine the post-operative outcome. Materials and Methods Total 67 inguinal hernia repairs were randomly assigned to either PHS or LHR method, and data was collected regarding various outcome measures like duration of surgery, post-operative pain, requirement of analgesia, return to normal activity, and early and late complications. Results Mean duration of surgery was significantly higher for PHS group than LHR group (65.4 min vs 51.26 min, p-value <0.0001). Significant difference was noted between the PHS and LHR group in terms of moderate to severe post-operative pain (15.15% vs 41.18%,p-value 0.018), time of requirement of analgesia (3.7 vs 4.6 days, p-value 0.024), and time to return to normal activity (2.7 vs 3.4 days, p-value 0.023), all in favour of the former technique. No intra-operative complication was noted in either of the groups. 5 patients had early complications in PHS group and 6 in LHR group, but this was statistically not significant. The average time of follow-up for the study was 7.8 month, ranging from 1 to 18 months. Chronic inguinal pain was noted in 1 and 2 patients respectively in PHS and LHR group, again statistically not significant. No recurrence was noted in both the groups till the time of follow-up. Conclusion PHS is a safe and better alternative to the time honored Lichtenstein hernia repair with the added advantage of strengthening whole of myopectineal orifice, and virtually eliminating any risk of recurrence. PMID:26266158

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

    PubMed Central

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

    2014-01-01

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

  19. Gallstone ileus obstructing within an incarcerated lumbar hernia: an unusual presentation of a rare diagnosis.

    PubMed

    Ziesmann, Markus Tyler; Alotaiby, Nouf; Al Abbasi, Thamer; Rezende-Neto, Joao B

    2014-12-03

    We describe an unusual case of a 74-year-old woman who presented with signs and symptoms of small-bowel obstruction and a clinically appreciable, irreducible, left-sided lumbar hernia associated with previous iliac crest bone graft harvesting. Palpation of the hernia demonstrated a small, firm mass within the loops of herniated bowel. CT scanning recognised an intraluminal gallstone at the transition point, establishing the diagnosis of gallstone ileus within an incarcerated lumbar hernia. The proposed explanatory mechanism is that of a gallstone migrating into an easily reducible hernia containing small bowel causing obstruction at the hernia neck by a ball-valve mechanism, resulting in proximal bowel dilation and thus hernia incarceration; it remains unclear when the stone entered the hernia, and whether it enlarged in situ or prior to entering the enteral tract. This is only the second reported instance in the literature of an intraluminal gallstone causing hernia incarceration.

  20. Gallstone ileus obstructing within an incarcerated lumbar hernia: an unusual presentation of a rare diagnosis

    PubMed Central

    Ziesmann, Markus Tyler; Alotaiby, Nouf; Abbasi, Thamer Al; Rezende-Neto, Joao B

    2014-01-01

    We describe an unusual case of a 74-year-old woman who presented with signs and symptoms of small-bowel obstruction and a clinically appreciable, irreducible, left-sided lumbar hernia associated with previous iliac crest bone graft harvesting. Palpation of the hernia demonstrated a small, firm mass within the loops of herniated bowel. CT scanning recognised an intraluminal gallstone at the transition point, establishing the diagnosis of gallstone ileus within an incarcerated lumbar hernia. The proposed explanatory mechanism is that of a gallstone migrating into an easily reducible hernia containing small bowel causing obstruction at the hernia neck by a ball-valve mechanism, resulting in proximal bowel dilation and thus hernia incarceration; it remains unclear when the stone entered the hernia, and whether it enlarged in situ or prior to entering the enteral tract. This is only the second reported instance in the literature of an intraluminal gallstone causing hernia incarceration. PMID:25471112

  1. Gallbladder torsion resulting in gangrenous cholecystitis within a parastomal hernia: Findings on unenhanced CT

    PubMed Central

    Rosenblum, Jessica K.; Dym, R. Joshua; Sas, Norman; Rozenblit, Alla M.

    2013-01-01

    Gallbladder torsion is a rare cause of acute gangrenous cholecystitis; its occurrence within an abdominal hernia has not been previously reported. We present such a case occurring within a parastomal hernia and imaged with unenhanced CT. PMID:24421934

  2. Genetic Factors in Congenital Diaphragmatic Hernia

    PubMed Central

    Holder, A. M.; Klaassens, M.; Tibboel, D.; de Klein, A.; Lee, B.; Scott, D. A.

    2007-01-01

    Congenital diaphragmatic hernia (CDH) is a relatively common birth defect associated with high mortality and morbidity. Although the exact etiology of most cases of CDH remains unknown, there is a growing body of evidence that genetic factors play an important role in the development of CDH. In this review, we examine key findings that are likely to form the basis for future research in this field. Specific topics include a short overview of normal and abnormal diaphragm development, a discussion of syndromic forms of CDH, a detailed review of chromosomal regions recurrently altered in CDH, a description of the retinoid hypothesis of CDH, and evidence of the roles of specific genes in the development of CDH. PMID:17436238

  3. Congenital diaphragmatic hernia-associated pulmonary hypertension.

    PubMed

    Harting, Matthew T

    2017-06-01

    Congenital diaphragmatic hernia (CDH) is a complex entity wherein a diaphragmatic defect allows intrathoracic herniation of intra-abdominal contents and both pulmonary parenchymal and vascular development are stifled. Pulmonary pathology and pathophysiology, including pulmonary hypoplasia and pulmonary hypertension, are hallmarks of CDH and are associated with disease severity. Pulmonary hypertension (PH) is sustained, supranormal pulmonary arterial pressure, and among patients with CDH (CDH-PH), is driven by hypoplastic pulmonary vasculature, including alterations at the molecular, cellular, and tissue levels, along with pathophysiologic pulmonary vasoreactivity. This review addresses the basic mechanisms, altered anatomy, definition, diagnosis, and management of CDH-PH. Further, emerging therapies targeting CDH-PH and PH are explored. Published by Elsevier Inc.

  4. Abnormal lung development in congenital diaphragmatic hernia.

    PubMed

    Ameis, Dustin; Khoshgoo, Naghmeh; Keijzer, Richard

    2017-06-01

    The outcomes of patients diagnosed with congenital diaphragmatic hernia (CDH) have recently improved. However, mortality and morbidity remain high, and this is primarily caused by the abnormal lung development resulting in pulmonary hypoplasia and persistent pulmonary hypertension. The pathogenesis of CDH is poorly understood, despite the identification of certain candidate genes disrupting normal diaphragm and lung morphogenesis in animal models of CDH. Defects within the lung mesenchyme and interstitium contribute to disturbed distal lung development. Frequently, a disturbance in the development of the pleuroperitoneal folds (PPFs) leads to the incomplete formation of the diaphragm and subsequent herniation. Most candidate genes identified in animal models have so far revealed relatively few strong associations in human CDH cases. CDH is likely a highly polygenic disease, and future studies will need to reconcile how disturbances in the expression of multiple genes cause the disease. Herein, we summarize the available literature on abnormal lung development associated with CDH. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Regenerative medicine solutions in congenital diaphragmatic hernia.

    PubMed

    De Coppi, Paolo; Deprest, Jan

    2017-06-01

    Congenital diaphragmatic hernia (CDH) remains a major challenge and associated mortality is still significant. Patients have benefited from current therapeutic options, but most severe cases are still associated to poor outcome. Regenerative medicine is emerging as a valid option in many diseases and clinical trials are currently happening for various conditions in children and adults. We report here the advancement in the field which will help both in the understanding of further CDH development and in offering new treatment options for the difficult situations such as repair of large diaphragmatic defects and lung hypoplasia. The authors believe that advancements in regenerative medicine may lead to increase of CDH patients׳ survival. Copyright © 2017. Published by Elsevier Inc.

  6. De Garengeot's Hernia: Two Case Reports with Correct Preoperative Identification of the Vermiform Appendix in the Hernia

    PubMed Central

    Imtiaz, Muhammad Rafiz; Nnajiuba, Henry; Samlalsingh, Suzette; Ojo, Akinyede

    2016-01-01

    We present two cases of incarcerated de Garengeot's hernia. This anatomical phenomenon is thought to occur in as few as 0.5% of femoral hernia cases and is a rare cause of acute appendicitis. Risk factors include a long pelvic appendix, abnormal embryological bowel rotation, and a large mobile caecum. In earlier reports operative treatment invariably involves simultaneous appendicectomy and femoral hernia repair. Both patients were correctly diagnosed preoperatively with computed tomography (CT). Both had open femoral hernia repair, one with appendectomy and one with the appendix left in situ. Both patients recovered without complications. Routine diagnostic imaging modalities such as ultrasonography and standard CT have previously shown little success in identifying de Garengeot's hernia preoperatively. We believe this to be the first documented case of CT with concurrent oral and intravenous contrast being used to confidently and correctly diagnose de Garengeot's hernia prior to surgery. We hope that this case report adds to the growing literature on this condition, which will ultimately allow for more detailed case-control studies and systematic reviews in order to establish gold-standard diagnostic studies and optimal surgical management in future. PMID:28070438

  7. A Survey of Fuzzy Logic and Applications

    DTIC Science & Technology

    1994-01-01

    Amount of Heat to be Applied ............... 21 10. Symptoms of Patients With Hiatal Hernia ............................................. 35 11. Symptoms...patients numbered 1 through 57 all have hiatal hernia , while the others, numbered 58 through 107, suffer from gallstones. In Tables 10 and 11, which list...least 20 lb in 6 mos.) 11. Persistence of pain (at least 1 month in length). Table 10. Symptoms of Patients With Hiatal Hernia Patient Symptoms 1 0 1

  8. Contemporary thoughts on the management of Spigelian hernia.

    PubMed

    Webber, V; Low, C; Skipworth, R J E; Kumar, S; de Beaux, A C; Tulloh, B

    2017-06-01

    Spigelian hernias are said to be a rare condition of the elderly population, usually arising below the arcuate line. Local experience has led us to challenge these commonly held beliefs. Operations for Spigelian hernia from 2006-2016 were identified from the Edinburgh Lothian Surgical Audit computerised database and case notes were reviewed. One hundred and one patients underwent surgery for 107 Spigelian hernias in the 10-year period. The female-to-male ratio was 2:1. Ages ranged from 32 to 88 with a median of 64 years. Sixty-five operations were done open and 42 were laparoscopic. Twelve of the 27 for which the precise anatomic location was recorded were situated above the arcuate line. Twenty-nine hernias had small defects and comprised interstitial fat only with no peritoneal sac. Ages in this group ranged from 32 to 80 (median = 48 years). All presented with intermittent local pain and/or swelling, although in three patients the hernias were impalpable. Those three also underwent ultrasound, CT and/or laparoscopy, but the hernias were only identified after open surgical exploration. The remaining 78 cases had peritoneal sacs of varying size with defects up to 9 cm across, and all were identified on imaging and/or laparoscopy. Ages ranged from 38 to 88 (median = 67 years; p < 0.01). Eighteen patients presented as emergencies and all were in this group. Spigelian hernias may be more common than we think and are probably under-diagnosed. They commonly arise above the arcuate line. We describe three clinical stages: Stage 1 hernias are those without peritoneal sacs and tend to arise in younger patients, can be difficult to diagnose and may not seen at laparoscopy. Stages 2 and 3 hernias arise in older patients, do have peritoneal sacs, are visible at laparoscopy and are more likely to present as emergencies. Stage three hernias are too large for laparoscopic repair. The differences between stages likely reflect the natural history of the condition, which

  9. Pericecal hernia manifesting as a small bowel obstruction successfully treated with laparoscopic surgery

    PubMed Central

    Ogami, Takuya; Honjo, Hirotaka; Kusanagi, Hiroshi

    2016-01-01

    A pericecal hernia is a type of internal hernia, which rarely causes small bowel obstruction (SBO). At our institution, a 92-year-old man presented with vomiting and abdominal pain. He was conservatively treated with a diagnosis of SBO. After 2 weeks of copious drainage output, he was taken to the operating room. Laparoscopy revealed a pericecal hernia that was successfully reduced. We conclude that laparoscopic surgery is an effective way to treat SBOs secondary to pericecal hernias. PMID:26933000

  10. Cystogram with dumbbell shaped urinary bladder in a sliding inguinal hernia.

    PubMed

    Mahadevappa, Basant; Suresh, Sumanth Channapatna; Natarajan, K; Thomas, Joseph

    2009-01-01

    Sliding inguinal hernias present with various symptoms and these are usually direct inguinal hernias containing various abdominal viscera. Case reports and series have been published with various organs and rare organs being part of the hernia. Urinary bladder is a known content of sliding hernias. This case report emphasizes this aspect in a picturesque manner and the importance of radiological investigations for pre-surgical evaluation.

  11. Asymptomatic extraperitoneal inguinoscrotal hernia involving ureter: A case presentation and review of the literature

    PubMed Central

    Falidas, Evangelos; Gourgiotis, Stavros; Veloudis, George; Exarchou, Elena; Vlachos, Konstantinos; Villias, Constantinos

    2015-01-01

    An inguinoscrotal hernia is a common disorder that usually contains intraperitoneal organs (small intestine, colon, appendix, ovaries). Extraperitoneal ureteral herniation into an inguinoscrotal hernia is a rare condition and often associated with congenital abnormalities or postoperative anatomic changes. A high index of suspicion is needed in order to avoid intraoperative ureteric injuries. We herein report the case of a ureteric herniation into an inguinoscrotal hernia incidentally found during a scheduled hernia repair. PMID:26604607

  12. Discal hernia in children and teenagers: medical, surgical and recovery treatment.

    PubMed

    Burnei, G; Gavriliu, S; Vlad, C; Georgescu, Ileana; Hurmuz, Lucia; Hodorogea, D

    2006-01-01

    Lumbar disc hernia represents a rare situation for the physician. The first intervention in disc hernia was performed during the '40. The rate of surgery needing lumbar hernia is about 1-2%. Lumbar disc hernia in children and teenagers has 4 main causes: familial history, trauma, congenital malformation of the spine and disc degeneration. The symptoms in young patients are dominated by local or ischiadic irradiated pain, but neurological discrepancies rarely occur.

  13. Bochdalek hernia presenting with initial local fat infiltration of the thoracic cavity in a leukemic child.

    PubMed

    Kang, Zhen; Min, Xiangde; Wang, Liang

    2017-03-01

    Local fat infiltration of the thoracic cavity is a rare initial presentation of Bochdalek hernia. We report a case of Bochdalek hernia in a child with leukemia that demonstrated initial local fat infiltration of the thoracic cavity on computed tomography scan and progressed to an obvious diaphragmatic hernia on subsequent follow-up. We suggest that initial local fat infiltration of the thoracic cavity on computed tomography scan may indicate a potential diaphragmatic hernia.

  14. Prevalence of Inguinal Hernia in Adult Men in the Ashanti Region of Ghana.

    PubMed

    Ohene-Yeboah, Michael; Beard, Jessica H; Frimpong-Twumasi, Benjamin; Koranteng, Adofo; Mensah, Samuel

    2016-04-01

    Inguinal hernia is thought to be common in rural Ghana, though no recent data exist on hernia prevalence in the country. This information is needed to guide policy and increase access to safe hernia repair in Ghana and other low-resource settings. Adult men randomly selected from the Barekese sub-district of Ashanti Region, Ghana were examined by surgeons for the presence of inguinal hernia. Men with hernia completed a survey on demographics, knowledge of the disease, and barriers to surgical treatment. A total of 803 participants were examined, while 105 participants completed the survey. The prevalence of inguinal hernia was 10.8 % (95 % CI 8.0, 13.6 %), and 2.2 % (95 % CI 0, 5.4 %) of participants had scars indicative of previous repair, making the overall prevalence of treated and untreated inguinal hernia 13.0 % (95 % CI 10.2, 15.7 %). Prevalence of inguinal hernia increased with age; 35.4 % (95 % CI 23.6, 47.2 %) of men aged 65 and older had inguinal hernia. Untreated inguinal hernia was associated with lower socio-economic status. Of those with inguinal hernia, 52.4 % did not know the cause of hernia. The most common reason cited for failing to seek medical care was cost (48.2 %). Although inguinal hernia is common among adult men living in rural Ghana, surgical repair rates are low. We propose a multi-faceted public health campaign aimed at increasing access to safe hernia repair in Ghana. This approach includes a training program of non-surgeons in inguinal hernia repair headed by the Ghana Hernia Society and could be adapted for use in other low-resource settings.

  15. Some aspects of the epidemiology of external hernias in Kumasi, Ghana.

    PubMed

    Ohene-Yeboah, M; Abantanga, F; Oppong, J; Togbe, B; Nimako, B; Amoah, M; Azorliade, R

    2009-10-01

    In our communities there are large numbers of longstanding external hernias that remain untreated. This paper describes the epidemiological characteristics of these hernias. The data is expected to provide guidelines for sustained national and international efforts to reduce the burden of hernia by performing large-scale elective hernia repairs. Between January 1998 and December 2007, a simple pro-forma was designed and used to record, in a prospective manner, the age, sex of patient and anatomical site of all external hernias seen and operated on both as emergencies and non-emergencies. These were patients who presented to a single general and paediatric surgeon at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. A total of 2,506 patients were studied, of which 1,930 were male and 576 female, giving a male:female ratio of 3.4:1. Inguinal hernia was seen in 1,766 patients: 1,613 males and 153 females, a male:female ratio of 10.5:1. Children 4 years old or younger accounted for 20.9% of inguinal hernias. Femoral hernia was seen in 79 patients: 70 females and 9 males. These groin hernias were diagnosed in 1,845 patients, accounting for 73.6% of all patients. Incisional hernia was diagnosed in 380 patients (15.2%): 179 males and 201 females-a male:female ratio of 1:1.1. These two hernia types (groin and incisional) were seen in 2,225 patients, representing 88.8% of all the patients studied. All other hernias studied, including para-umbilical, umbilical and epigastric, were seen in 281 patients, representing 11.2% of the hernias studied. The epidemiology of external hernias seen and treated in our hospital is no different from that of hernias in other communities. Sustained efforts at elective repair will reduce the vast numbers of untreated accumulated hernias in our communities and thus prevent unnecessary morbidity and mortality.

  16. Management of a large abdominal aortic aneurysm in conjunction with a massive inguinal hernia.

    PubMed

    Wartman, Sarah M; Woo, Karen; Brewer, Michael; Weaver, Fred A

    2017-04-04

    The majority of inguinal hernias that are concomitant with abdominal aortic aneurysms (AAA) are clinically insignificant. However, management of AAA associated with a complex hernia can be challenging. We report a case of a 72-year-old male with a 7 cm AAA and a massive inguinal hernia involving loss of abdominal domain. Using a multidisciplinary approach, a staged hybrid endovascular and open repair of the AAA was performed followed by hernia repair.

  17. Natural history of endoscopically detected hiatus herniae at late follow-up.

    PubMed

    Ahmed, Syeda Khadijah; Bright, Tim; Watson, David I

    2017-10-09

    Hiatus herniae are commonly seen at endoscopy. Many patients with a large hiatus hernia are endoscoped for symptoms associated with the hernia and many of these will progress to surgical treatment. However, little is known about the natural history of small to medium size hiatus herniae, and their risk of progressing to a larger hernia requiring surgery. This study aims to determine the need for subsequent surgery in these patients. A retrospective audit of the endoscopy database at Flinders Medical Centre and the Repatriation General Hospital in Adelaide, South Australia for the 2-year period 2002-2003 was performed to identify all patients with a hiatus hernia. Patients under the age of 65 and with a sliding hiatus hernia <5 cm in length were selected for this study, and sent a questionnaire which determines the long-term (>10 years) outcome of these herniae. Small- to medium-sized hiatus herniae (<5 cm length) were found at 10% of endoscopies performed. In this group, 38% had reflux as the indication for endoscopy. 1.5% subsequently progressed to anti-reflux surgery or hiatus hernia repair. Thirty-nine percent reported being on proton pump inhibitors for symptom control. No patients required emergency surgical repair of their hiatus hernia. While patients with small- to medium-sized sliding hiatus hernia commonly have symptomatic reflux, an acute problem requiring emergency surgery is unlikely over long-term follow-up. © 2017 Royal Australasian College of Surgeons.

  18. Laparoscopic Repair of Morgagni Hernia: Three-Case Presentation and the Literature

    PubMed Central

    Godazandeh, Gholamali

    2016-01-01

    Introduction. Morgagni hernia is a rare form of congenital diaphragmatic hernia. Case Presentation. We present three cases of Morgagni hernia with GI symptoms treated by laparoscopic surgery. Discussion. Hernial sac was excised in two cases and left in situ in one case. There was no recurrence in symptoms after 30 months from surgery. PMID:27957378

  19. Technical refinement of mini-laparoscopic hernia repair in infants and children.

    PubMed

    Tsai, Y-C; Da Lin, C; Chueh, S-C

    2015-08-01

    In large, long-term series of laparoscopic pediatric groin hernia repairs, the recurrence rate is commonly higher compared with the open herniotomy. Thus, we refined our laparoscopic technique from a simple hernia sac ligation into combined posterior wall repair for pediatric groin hernias. Between March 2010 and March 2013, 41 consecutive infants and children with primary inguinal hernia were treated surgically with our refined mini-laparoscopic hernia technique. The mean patient age was 4.5 years. Before hernia repair, there were synchronous bilateral hernias in 4 (9.7 %), left inguinal hernias in 14 (34.2 %) and right inguinal hernias in 23 (56.1 %). The mini-laparoscopic hernia repair was carried out with three 3.5 mm trocar ports including 3 mm telescope and 3 mm instruments. Totally 61 repairs were performed. The mean follow-up period was 12 months. The mean operation time was 45 min. None of the repaired groin hernias had a recurrence or procedure-related complication during the period of follow-up. None of them experienced a chronic pain postoperatively. To date there was no scrotal or testicular complication detected by regular ultrasonographic follow-up. Our refined laparoscopic technique is a safe and effective method in the management of groin hernias in infants and children with a minimal early recurrence rate.

  20. Initial results of the National Registry of Incisional Hernia.

    PubMed

    Pereira, José Antonio; López-Cano, Manuel; Hernández-Granados, Pilar; Feliu, Xavier

    2016-12-01

    The aim of this study was to the data from the National Registry of Incisional Hernia (EVEREG) to determine the reality of the treatment of this condition in Spain. EVEREG is an online prospective database which has been functioning since July 2012; operations for incisional hernia are anonymously recorded. Up to March 2015, 4501 hernias from 95 of the 113 participating hospitals were registered. The mean age of the patients was 62.7, and 56.5% were women, with a mean BMI of 30.2kg/m(2); 29.8% presented a high surgical risk (ASA III-V). A total of 93.7% were scheduled surgeries, 88.3% open surgery and 22.2% were recurrent incisional hernias. There were 66.9% hernias after a midline laparotomy, and 81.4% of a transverse diameter of less than 10cm. A mesh was used in 96.2% of cases. Postoperative stay was 5.3 days and 29.1% presented a complication, with a mortality of 0.8%. After a median follow-up of 7.7 months a high rate of recurrence was detected (20.7% per year), especially in hernias that were operated on after a previous repair (18.1% primary vs. 30.6% recurrent; P=.004). the EVEREG registry is a useful tool to know the current situation of incisional hernia treatment. Analysis of the data shows several points that could be improved: a low rate of follow-up and high recurrence rate. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. [A Case of Abdominal Wall Hernia Rupture during Bevacizumab Treatment].

    PubMed

    Sugimoto, Satoshi; Miyazaki, Yasuaki; Hirose, Sou; Michiura, Toshiya; Fujita, Shigeo; Yamabe, Kazuo; Miyazaki, Satoru; Nagaoka, Makio

    2015-11-01

    A 78 -year-old man with rectal cancer underwent abdominoperineal resection of the rectum. In the postoperative period, the patient experienced wound infection, leading to an abdominal wall hernia. Two years following surgery, a rise in the serum CEA level was seen. A metastatic tumor was detected in the right lung on chest CT. VATS right lung inferior lobe segmental resection was performed. After lobectomy, the serum CEA level continued to increase. Another metastatic tumor was detected in the right lung on chest CT. Chemotherapy with capecitabine, oxaliplatin, and bevacizumab was commenced. The erosive part of the abdominal wall scar hernia extended during the nine weeks of chemotherapy. The chemotherapy was then discontinued. In the follow-up CT scan, a right pleural recurrence, local recurrence in the pelvis, and a liver metastasis were detected. Chemotherapy was re-introduced 3 years after surgery. The erosive part of the abdominal wall hernia again began to spread with chemotherapy recommencement. Four months after restarting chemotherapy, the hernia ruptured, with a loop of the small intestine protruding out of it. The patient covered this with a sheet of vinyl and was taken by the ambulance to our hospital. The erosive part of the abdominal wall hernia had split by 10 cm, and a loop of the small intestine was protruding. As ischemia of the small intestine was not observed, we replaced it into the abdominal cavity, and performed a temporary suture repair of the hernia sac. Following this, bevacizumab was discontinued, and the erosive part reduced. We performed a radical operation for abdominal wall scar hernia repair 11 weeks after the discontinuation of bevacizumab.

  2. Management of strangulated abdominal wall hernias with mesh; early results

    PubMed Central

    Ozbagriacik, Mustafa; Bas, Gurhan; Basak, Fatih; Sisik, Abdullah; Acar, Aylin; Kudas, Ilyas; Yucel, Metin; Ozpek, Adnan; Alimoglu, Orhan

    2015-01-01

    OBJECTIVE: Surgery for abdominal wall hernias is a common procedure in general surgery practice. The main causes of delay for the operation are comorbid problems and patient unwillingness, which eventually, means that some patients are admitted to emergency clinics with strangulated hernias. In this report, patients who admitted to the emergency department with strangulated adominal wall hernias are presented together with their clinical management. METHODS: Patients who admitted to our clinic between January 2009 and November 2011 and underwent emergency operation were included in the study retrospectively. Demographic characteristics, hernia type, length of hospital stay, surgical treatment and complications were assessed. RESULTS: A total 81 patients (37 female, 44 male) with a mean age of 52.1±17.64 years were included in the study. Inguinal, femoral, umbilical and incisional hernias were detected in 40, 26, 9 and 6 patients respectively. Polypropylene mesh was used in 75 patients for repair. Primary repair without mesh was used in six patients. Small bowel (n=10; 12.34%), omentum (n=19; 23.45%), appendix (n=1; 1.2%) and Meckel’s diverticulum (n=1; 1.2%) were resected. Median length of hospital stay was 2 (1–7) days. Surgical site infection was detected in five (6.2%) patients. No significant difference was detected for length of hospital stay and surgical site infection in patients who had mesh repair (p=0.232 and 0.326 respectively). CONCLUSION: The need for bowel resection is common in strangulated abdominal wall hernias which undergo emergency operation. In the present study, an increase of morbidity was seen in patients who underwent bowel resection. No morbidity was detected related to the usage of prosthetic materials in repair of hernias. Hence, we believe that prosthetic materials can be used safely in emergency cases. PMID:28058336

  3. Obturator hernia: A case report and review of the literature.

    PubMed

    Hodgins, Nicholas; Cieplucha, Krzysztof; Conneally, Padhraic; Ghareeb, Essam

    2013-01-01

    An obturator hernia is a rare condition but is associated with the highest mortality of all abdominal wall hernias. Early surgical intervention is often hindered by clinical and radiological diagnostic difficulty. The following case report highlights these diagnostic difficulties, and reviews the current literature on management of such cases. We present the case of an 86-year-old lady who presented with intermittent small bowel obstruction, clear hernial orifices, and right medial thigh pain. Pre-operative CT imaging was suggestive of an obstructed right femoral hernia. However, intra-operatively the femoral canal was clear and an obstructed hernia was found passing through the obturator foramen lying between the pectineus and obturator muscles in the obturator canal. Obturator hernias are notorious for diagnostic difficulty. Patients often present with intermittent bowel obstruction symptoms due to a high proportion exhibiting Richter's herniation of the bowel. Hernial sacs can irritate the obturator nerve within the canal, manifesting as medial thigh pain, and often no hernial masses can be detected on clinical examination. Increasing speed of diagnosis through early CT imaging has been shown to reduce the morbidity and mortality associated with obturator hernias. However, over-reliance on CT findings should be cautioned, as imaging and operative findings may not always correlate. A high suspicion for obturator hernia should be maintained when assessing a patient presenting with bowel obstruction particularly where intermittent symptoms or medial thigh pain are present. Rapid clinical and appropriate radiological assessment, followed by early surgery is critical to successful treatment. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Obturator hernia: A case report and review of the literature☆

    PubMed Central

    Hodgins, Nicholas; Cieplucha, Krzysztof; Conneally, Padhraic; Ghareeb, Essam

    2013-01-01

    INTRODUCTION An obturator hernia is a rare condition but is associated with the highest mortality of all abdominal wall hernias. Early surgical intervention is often hindered by clinical and radiological diagnostic difficulty. The following case report highlights these diagnostic difficulties, and reviews the current literature on management of such cases. PRESENTATION OF CASE We present the case of an 86-year-old lady who presented with intermittent small bowel obstruction, clear hernial orifices, and right medial thigh pain. Pre-operative CT imaging was suggestive of an obstructed right femoral hernia. However, intra-operatively the femoral canal was clear and an obstructed hernia was found passing through the obturator foramen lying between the pectineus and obturator muscles in the obturator canal. DISCUSSION Obturator hernias are notorious for diagnostic difficulty. Patients often present with intermittent bowel obstruction symptoms due to a high proportion exhibiting Richter's herniation of the bowel. Hernial sacs can irritate the obturator nerve within the canal, manifesting as medial thigh pain, and often no hernial masses can be detected on clinical examination. Increasing speed of diagnosis through early CT imaging has been shown to reduce the morbidity and mortality associated with obturator hernias. However, over-reliance on CT findings should be cautioned, as imaging and operative findings may not always correlate. CONCLUSION A high suspicion for obturator hernia should be maintained when assessing a patient presenting with bowel obstruction particularly where intermittent symptoms or medial thigh pain are present. Rapid clinical and appropriate radiological assessment, followed by early surgery is critical to successful treatment. PMID:23973903

  5. Laparoscopic Repair of Congenital Diaphragmatic Hernia in Adults

    PubMed Central

    Kumar, Satendra; Afaque, Yusuf; Bhartia, Abhishek Kumar; Bhartia, Vishnu Kumar

    2016-01-01

    Background, Aims, and Objectives. Congenital diaphragmatic hernia typically presents in childhood but in adults is extremely rare entity. Surgery is indicated for symptomatic and asymptomatic patients who are fit for surgery. It can be done by laparotomy, thoracotomy, thoracoscopy, or laparoscopy. With the advent of minimal access techniques, the open surgical repair for this hernia has decreased and results are comparable with early recovery and less hospital stay. The aim of this study is to establish that laparoscopic repair of congenital diaphragmatic hernia is a safe and effective modality of surgical treatment. Materials and Methods. A retrospective study of laparoscopic diaphragmatic hernia repair done during May 2011 to Oct 2014. Total n = 13 (M/F: 11/2) cases of confirmed diaphragmatic hernia on CT scan, 4 cases Bochdalek hernia (BH), 8 cases of left eventration of the diaphragm (ED), and one case of right-sided eventration of the diaphragm (ED) were included in the study. Largest defect found on the left side was 15 × 6 cm and on the right side it was 15 × 8 cm. Stomach, small intestine, transverse colon, and omentum were contents in the hernial sac. The contents were reduced with harmonic scalpel and thin sacs were usually excised. The eventration was plicated and hernial orifices were repaired with interrupted horizontal mattress sutures buttressed by Teflon pieces. A composite mesh was fixed with nonabsorbable tackers. All patients had good postoperative recovery and went home early with normal follow-up and were followed up for 2 years. Conclusion. The laparoscopic repair is a safe and effective modality of surgical treatment for congenital diaphragmatic hernia in experienced hands. PMID:28074156

  6. Open tension free repair of inguinal hernias; the Lichtenstein technique

    PubMed Central

    Sakorafas, George H; Halikias, Ioannis; Nissotakis, Christos; Kotsifopoulos, Nikolaos; Stavrou, Alexios; Antonopoulos, Constantinos; Kassaras, George A

    2001-01-01

    Background Recurrences have been a significant problem following hernia repair. Prosthetic materials have been increasingly used in hernia repair to prevent recurrences. Their use has been associated with several advantages, such as less postoperative pain, rapid recovery, low recurrence rates. Methods In this retrospective study, 540 tension-free inguinal hernia repairs were performed between August 1994 and December 1999 in 510 patients, using a polypropylene mesh (Lichtenstein technique). The main outcome measure was early and late morbidity and especially recurrence. Results Inguinal hernia was indirect in 55 % of cases (297 patients), direct in 30 % (162 patients) and of the pantaloon (mixed) type in 15 % (81 patients). Mean patient age was 53.7 years (range, 18 – 85). Follow-up was completed in 407 patients (80 %) by clinical examination or phone call. The median follow-up period was 3.8 years (range, 1 – 6 years). Seroma and hematoma formation requiring drainage was observed in 6 and 2 patients, respectively, while transient testicular swelling occurred in 5 patients. We have not observed acute infection or abscess formation related to the presence of the foreign body (mesh). In two patients, however, a delayed rejection of the mesh occurred 10 months and 4 years following surgery. There was one recurrence of the hernia (in one of these patients with late mesh rejection) (recurrence rate = 0.2 %). Postoperative neuralgia was observed in 5 patients (1 %). Conclusion Lichtenstein tension-free mesh inguinal hernia repair is a simple, safe, comfortable, effective method, with extremely low early and late morbidity and remarkably low recurrence rate and therefore it is our preferred method for hernia repair since 1994. PMID:11696246

  7. Surgical approach for recurrent inguinal hernias: a Nationwide Cohort Study.

    PubMed

    Öberg, S; Andresen, K; Rosenberg, J

    2016-12-01

    Guidelines recommend that the reoperation of a recurrent inguinal hernia should be by the opposite approach (anterior-posterior) than the primary repair. However, the level of evidence supporting the guidelines is partially low. The purpose of this study was to compare re-reoperation rates between repairs performed according to the guidelines with the ones performed against it. This cohort study was based on the Danish Hernia Database, including 4344 patients with two inguinal hernia repairs in the same groin. Four groups were compared as follows: Lichtenstein-Lichtenstein vs. Lichtenstein-Laparoscopy, and Laparoscopy-Laparoscopy vs. Laparoscopy-Lichtenstein. The outcome was re-reoperation rates, which were compared by crude rates, cumulated rates, and hazard ratios. There was no difference in the re-reoperation rates when the primary repair was laparoscopic, regardless of the type of reoperation. However, Lichtenstein-Lichtenstein had a significantly higher re-reoperation rate compared with Lichtenstein-Laparoscopy (crude rate 8.7 vs. 3.1 %, p value <0.0005; Hazard Ratio 2.46, 95 % CI 1.76-3.43). Further analysis showed that the higher risk of re-reoperation for Lichtenstein-Lichtenstein was only seen if the primary hernia was medial. A primary Lichtenstein repair of a primary medial hernia should be reoperated with a laparoscopic repair. A primary Lichtenstein repair of a primary lateral hernia can be reoperated with either a Lichtenstein or a laparoscopic repair according to surgeon's choice. For a primary laparoscopic operation, the method of repair of a recurrent hernia did not affect the re-reoperation rate.

  8. The feasibility of laparoscopic management of incarcerated obturator hernia.

    PubMed

    Liu, Jing; Zhu, Yilin; Shen, Yingmo; Liu, Sujun; Wang, Minggang; Zhao, Xuefei; Nie, Yusheng; Chen, Jie

    2017-02-01

    Obturator hernia (OH), a rare cause of acute small bowel obstruction, requires immediate surgical intervention to prevent serious complications and mortality. We assessed the safety and efficacy of laparoscopic surgery in patients with incarcerated OH presenting with acute abdomen in an emergency setting. Data pertaining to patients diagnosed with incarcerated OH between 2011 and April 2015 at our hospital were reviewed. Patients' characteristics, operation details and postoperative outcomes were retrospectively analyzed. All ten patients diagnosed with incarcerated obturator hernia during the reference period were females (average age 72.1 ± 11.8 years; average weight 44.1 ± 6.9 kg; average body mass index 17.8 ± 2.1 kg/m(2); average operating time 63 ± 15 min; average hospital stay 6.2 ± 6.6 days). Twelve occult hernias, including six contralateral OHs, two ipsilateral femoral hernias and two bilateral femoral hernias were detected in six patients (60 %), which were simultaneously repaired after laparoscopic exploration. Nine patients (90 %) were successfully treated with synthetic mesh by laparoscopic technique. Only one case required intraoperative conversion to open surgery due to strangulated intestine with perforation. Wound infection was reported in one patient who had undergone bowel resection, but with an eventual complete recovery. Postoperative period was uneventful in the other nine patients. No recurrence or complications were reported on follow-up (mean duration of follow-up: 6-54 months). In this study, laparoscopic technique was associated with a reduced duration of hospital stay and fewer complications. In addition to being a safe and minimally invasive strategy, it allowed for simultaneous diagnosis and treatment of occult hernias during the same procedure. The approach may be a better option for the treatment of incarcerated OH and occult hernias in selected patients.

  9. Laparoscopic treatment of Spiegel hernia by total extraperitoneal (TEP) approach.

    PubMed

    Filip, S; Dragomirescu, C; Copăescu, C

    2014-01-01

    Spiegelian hernia is a rare type of ventral abdominal hernia. Surgical treatment is recommended due to the high risk of complications. Laparoscopic treatment is preferred to open repair, by means of intraperitoneal or extraperitoneal mesh placement, either by transperitoneal(TAPP) or by total extraperitoneal (TEP) approach. Total extraperitoneal approach is rarely reported in the literature. To evaluate the results of laparoscopic repair of Spiegelhernia by total extraperitoneal approach. We prospectively studied the patients operated on for Spiegel hernia between October 2009 and March 2013 by laparoscopic TEP approach at Ponderas Hospital. Data regarding symptoms, sex, preoperative work-up,surgical technique, hospital stay and outcome of the procedure were analysed. Follow-up of the patients was achieved at 1week, 1 month, 6 months and yearly postoperatively and patients were evaluated for recurrence, chronic pain, mesh infection, time to reinsertion to normal activities and overall patient satisfaction score. We have treated 4 patients with Spiegel hernia by laparoscopic TEP repair, with mean age 55.25 years (range 50-64), sex ratio 1 (2 2); all patients were symptomatic, all cases had left sided hernias, the surgical intervention was elective in all cases. Mean hospital stay was 1.5 days (range1- 2 days). There was only one postoperative complication ina patient with asymptomatic seroma, with remission in 1 month. There were no recurrences, no mesh infection, no chronic pain or other morbidity at a mean follow-up of 25 months (range 12-53 months). The overall satisfaction score was maximal (5) in all cases. Spiegelian hernias are rare but surgery is mandatory because of the risk of complications like incarceration and strangulation. In the presented experience, laparoscopic total extraperitoneal approach proved to be an efficient technique,reproducible, with excellent results for Spiegel hernia treated electively. Celsius.

  10. "Amyand's Hernia" – Pathophysiology, Role of Investigations and Treatment

    PubMed Central

    SINGAL, Rikki; GUPTA, Samita

    2011-01-01

    ABSTRACT Background: In the present era, appendicitis and hernia are common problems but their presentations in different positions are rare to be seen. It is difficult to make diagnose pre-operatively of contents as appendicitis in obstructed hernia. The term "Amyand's hernia" was lost in the literature and we are describing its pathophysiology and management. The aggravating factors are: complex injuries related to hernia (size, degree of sliding, multiplicity, etc.), patient characteristics (age, activity, respiratory disease, dysuria, obesity, constipation). If not treated in the earliest stages then it can lead to significant morbidity and mortality. Existing literature describes almost exclusively its pathophysiology, investigations and treatment. Material and Methods: We have focused on clinical presentation, radiological investigations and management of "Amyand's hernia". In literature, there is still confusion regarding investigations and treatment. We are presenting such rare entity managed in time without encountering any post-operative complications. Results: Ultrasonography and Computed Tomography are useful tests but clinical correlation is necessary in incarcerated appendix. Regarding treatment, it is clear that if appendix is inflamed then it should be removed, but we concluded that if appendix is found to be normal in obstructed hernia then it should also be removed due to possible later inflammation. Conclusion: If the appendix found in the hernial sac is inflamed then chances of mortality increase. Although emergency surgery is indicated in all obstructed hernias, morbidity and mortality can be decreased if operated on time. Early recognition and its awareness, along with good surgical technique in such cases are keys to success when dealing with this problem. PMID:22879848

  11. Quality of life following component separation versus standard open ventral hernia repair for large hernias.

    PubMed

    Klima, David A; Tsirline, Victor B; Belyansky, Igor; Dacey, Kristian T; Lincourt, Amy E; Kercher, Kent W; Heniford, B Todd

    2014-04-01

    Component separation (CS) has become a viable alternative to repair large ventral defects when the fascia cannot be reapproximated. However, the impact of transecting the external oblique to facilitate closure of the abdomen on quality of life (QOL) has yet to be investigated. The study goal was to investigate QOL and outcomes after standard open ventral hernia repair (OVHR) versus CS for large ventral hernias. Prospective data for all CSs were reviewed and compared with matched OVHR controls. All defects were 100 to 1000 cm2 in size and repaired with mesh. Comorbidities, complications, outcomes, and Carolinas Comfort Scale (CCS) scores, were reviewed. Seventy-four CS patients were compared with 154 patients undergoing standard OVHR with similar defect sizes. Age (56.7±13.0 vs. 54.7 ± 12.3 years, P = .26), defect sizes (299 ± 160 vs. 304 ± 210 cm2, P = .87), and BMI (32.7 ± 6.9 vs. 34.2 ± 9.0 kg/m2, P = .26) were similar in both groups, respectively. There were no differences in major postoperative complications (P = .22), mesh infections (P = 1.00), wound infections (P = .07), or hernia recurrence (P = .09), but wound breakdown increased after CS (10% vs. 1%, P < .001) as did seroma interventions (15% vs. 4%, P = .005). Postoperative CCS scores were similar at 1 month (P = .82) and 1 year (P = .14). In the first comparative study of its kind, it is found that patient undergoing CS with mesh reinforcement had equal short- and long-term QOL outcomes compared with similar patients who underwent standard OVHR. Whereas wound breakdown and seroma formation are higher, the overall complication, mesh infection, and recurrence rates are similar.

  12. Severe left diaphragmatic hernia limits size of fetal left heart more than does right diaphragmatic hernia.

    PubMed

    Byrne, F A; Keller, R L; Meadows, J; Miniati, D; Brook, M M; Silverman, N H; Moon-Grady, A J

    2015-12-01

    To assess whether severity of congenital diaphragmatic hernia (CDH) correlates with the degree of left heart hypoplasia and left ventricle (LV) output, and to determine if factors leading to abnormal fetal hemodynamics, such as compression and reduced LV preload, contribute to left heart hypoplasia. This was a retrospective cross-sectional study of fetuses at 16-37 weeks' gestation that were diagnosed with CDH between 2000 and 2010. Lung-to-head ratio (LHR), liver position and side of the hernia were determined from stored ultrasound images. CDH severity was dichotomized based on LHR and liver position. The dimensions of mitral (MV) and aortic (AV) valves and LV were measured, and right and left ventricular outputs were recorded. In total, 188 fetuses with CDH were included in the study, 171 with left CDH and 17 with right CDH. Fetuses with severe left CDH had a smaller MV (Z = -2.24 ± 1.3 vs -1.33 ± 1.08), AV (Z = -1.39 ± 1.21 vs -0.51 ± 1.05) and LV volume (Z = -4.23 ± -2.71 vs -2.08 ± 3.15) and had lower LV output (26 ± 10% vs 32 ± 10%) than those with mild CDH. MV and AV in fetuses with right CDH (MV, Z = -0.83 ± 1.19 and AV, Z = -0.71 ± 1.07) were larger than those in fetuses with left CDH, but LV outputs were similarly diminished, regardless of hernia side. Severe dextroposition and abnormal liver position were associated independently with smaller left heart, while LHR was not. The severity of left heart hypoplasia correlates with the severity of CDH. Altered fetal hemodynamics, leading to decreased LV output, occurs in both right- and left-sided CDH, but the additional compressive effect on the left heart is seen only when the hernia is left-sided. Improved knowledge of the physiology of this disease may lead to advances in therapy and better risk assessment for use in counseling affected families. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  13. Sutureless onlay hernia repair: a review of 97 patients.

    PubMed

    Shahan, Charles P; Stoikes, Nathaniel F; Webb, David L; Voeller, Guy R

    2016-08-01

    Repair of large ventral/incisional (V/I) hernias is a common problem. Outside of recurrence, other factors such as wound complications and mesh infection can create significant morbidity. Chevrel described the premuscular repair and later modified it by using glue over the midline closure. We previously described our onlay technique using fibrin glue alone in a small case series. The aim of this study is to review the largest case series of sutureless onlay V/I hernia repair whereby mesh is fixated with fibrin glue alone for complex ventral hernias, and how the technique has evolved. All patients who underwent onlay V/I hernia repair over a 3-year period were reviewed. Patient demographics, operative details, complications, and follow-up were reviewed. In total, 97 patients were included. 54.6 % were female, with a mean age of 57.3 years. Mean BMI was 32.2. 23(23.7 %) patients had diabetes. 90 (92.8 %) of the operations were for incisional hernias, 3 (3.1 %) primary ventral hernias, 2 (2.1 %) flank hernias, and 2 (2 %) complex abdominal wall reconstruction. 88 (90.7 %) of the cases were performed on an elective basis. 77 (77.3 %) cases were classified as clean, 21 (21.6 %) clean-contaminated, and 1 (1.0 %) contaminated. The mean defect size was 150 cm(2). Mean follow-up was 386 days, and maximum was 3.1 years. There were 21 (21.6 %) seromas, 4 (4.1 %) wound infections, 7 (7.4 %) had skin necrosis, and 9 (9.3 %) required re-operation due to a complication. At 3 years, there have been no recurrences or mesh explants. The sutureless onlay V/I hernia repair with fibrin glue fixation has proven to be durable with a comparable complication profile to other techniques. The most common sequela, seroma, is easily managed in the outpatient setting. This sutureless technique is an effective option for onlay hernia repair that may provide several advantages over traditional suture techniques.

  14. A new accurate method of physical examination for differentiation of inguinal hernia types.

    PubMed

    Tromp, Wouter G; van den Heuvel, Baukje; Dwars, Boudewijn J

    2014-05-01

    It is generally stated that preoperative differentiation between indirect and direct inguinal hernias by physical examination is inaccurate and irrelevant. With the expansion of the laparoscopic technique, new relevance has emerged. Laparoscopic correction of an indirect hernia is more challenging and time consuming than laparoscopic correction of a direct hernia. Preoperative knowledge concerning the type of hernia informs the laparoscopic surgeon about the required expertise and the expected operative time, and this knowledge is useful for training programs and management. The authors therefore developed a new accurate and easy method of physical examination to differentiate types of inguinal hernia. A prospective study was conducted to determine the accuracy of this new method that combines physical examination with a hand-held Doppler device (not ultrasound) to differentiate types of inguinal hernia. This prospective diagnostics study consisted of two consecutive parts. Each part included 100 consecutive patients presenting with an inguinal hernia. The inguinal occlusion test was used to differentiate the types of inguinal hernia during physical examination in the first part of the study. A hand-held Doppler device was used for adequate localization of the epigastric vessels in addition to the occlusion test in the second part of the study. Preoperative remarks were compared with findings during laparoscopic inguinal hernia repair. The McNemar symmetry χ (2) test was used for statistical evaluation The first part of the study showed a preoperative accuracy of 35 % for direct inguinal hernias and 86 % for indirect inguinal hernias (p < 0.001). The second part of the study showed a preoperative accuracy of 79 % for direct inguinal hernias and 93 % for indirect inguinal hernias (p < 0.001) CONCLUSION: The inguinal occlusion test combined with the use of a handheld Doppler device is accurate in distinguishing direct and indirect inguinal hernias and provides

  15. [Azoospermia and a history of inguinal hernia repair in adult].

    PubMed

    Khodari, M; Ouzzane, A; Marcelli, F; Yakoubi, R; Mitchell, V; Zerbib, P; Rigot, J-M

    2015-10-01

    Inguinal hernia repair is one of the most performed surgeries in the world. It is recognized that any surgery of the pelvic floor may represent a risk factor of male infertility. Retrospective study of patients with azoospermia and a history of adult inguinal hernia repair surgery and referred to our center between January 1990 and January 2011 for infertility. Among 69 azoospermia patients with history of adult inguinal hernia repair surgery, 60 patients underwent surgical extraction of sperm that was successful in 75% (45/60). Positive extraction rate decreases in the subgroup of patients with risk factors for infertility (61.4%) as well as in the group with bilateral inguinal hernia (67.9%). There was no statistically significant difference in the positive rate of sperm retrieval according to surgical technique or according to the use of polypropylene mesh (P>0.05). The obstruction of the vas deferens due to an inguinal hernia repair was a potential iatrogenic cause of male infertility that was rare and underestimated. The influence of using a polypropylene mesh was not clearly demonstrated. The management of these patients is based on prevention in order to identify patients with risk factors of infertility in order to propose a presurgery cryopreservation of sperm. 5. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Laparoscopic Incisional Hernia Repair With Fibrin Glue in Select Patients

    PubMed Central

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

    2010-01-01

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

  17. Definitive Surgical Treatment of Infected or Exposed Ventral Hernia Mesh

    PubMed Central

    Szczerba, Steven R.; Dumanian, Gregory A.

    2003-01-01

    Objective To discuss the difficulties in dealing with infected or exposed ventral hernia mesh, and to illustrate one solution using an autogenous abdominal wall reconstruction technique. Summary Background Data The definitive treatment for any infected prosthetic material in the body is removal and substitution. When ventral hernia mesh becomes exposed or infected, its removal requires a solution to prevent a subsequent hernia or evisceration. Methods Eleven patients with ventral hernia mesh that was exposed, nonincorporated, with chronic drainage, or associated with a spontaneous enterocutaneous fistula were referred by their initial surgeons after failed local wound care for definitive management. The patients were treated with radical en bloc excision of mesh and scarred fascia followed by immediate abdominal wall reconstruction using bilateral sliding rectus abdominis myofascial advancement flaps. Results Four of the 11 patients treated for infected mesh additionally required a bowel resection. Transverse defect size ranged from 8 to 18 cm (average 13 cm). Average procedure duration was 3 hours without bowel repair and 5 hours with bowel repair. Postoperative length of stay was 5 to 7 days without bowel repair and 7 to 9 days with bowel repair. Complications included hernia recurrence in one case and stitch abscesses in two cases. Follow-up ranges from 6 to 54 months (average 24 months). Conclusions Removal of infected mesh and autogenous flap reconstruction is a safe, reliable, and one-step surgical solution to the problem of infected abdominal wall mesh. PMID:12616130

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

    PubMed Central

    Turingan, Isidro; Tran, Mai

    2013-01-01

    Introduction: Although natural orifice transluminal endoscopic surgery promises truly scarless surgery, this has not progressed beyond the experimental setting and a few clinical cases in the field of ventral hernia repair. This is mainly because of the problem of sterilizing natural orifices, which prevents the use of any prosthetic material because of unacceptable risks of infection. Single-incision laparoscopic ventral hernia repair has gained more widespread acceptance by specialized hernia centers. Even so, there is a special subset of patients who are young and/or scar conscious and find any visible scar unacceptable. This study illustrates an innovative way of performing single-incision laparoscopic ventral hernia repair by a transverse suprapubic incision below the pubic hair/bikini line in 2 young male patients who had both umbilical and epigastric hernias as well as attenuated linea alba in the upper abdomen. Case Description: Both patients underwent successful laparoscopic repair, and both were highly satisfied with the procedure, which produced no visible scars on their abdomen. Discussion: Willingness to adopt new innovative procedures, such as single-incision laparoscopic surgery, has allowed modification of the incision site to produce invisible scars and hence become highly attractive to the young and scar-phobic segment of the population. PMID:23925028

  19. Does inguinal hernia repair have an effect on sexual functions?

    PubMed Central

    Sonbahar, Bilgehan Çağdaş; Bora, Gül; Özalp, Necdet; Kara, Cengiz

    2016-01-01

    Introduction The aim of this study is to evaluate sexual functions which are affected by inguinal hernias and may change after hernia repair surgery. Material and methods A total of 47 patients who underwent Lichtenstein tension-free anterior repair and inguinal hernia surgery were evaluated in terms of erectile function, intercourse function, sexual desire, overall satisfaction and orgasm satisfaction using the International Index of Erectile function questionnaire (IIEF) scoring system before surgery and in the first and sixth months after surgery. Parameters evaluated with the IIEF score before the surgery and in the first and sixth months after surgery were compared statistically using the Wilcoxon test. Results The average age of patients was 46.2 ±11.2 years (range: 22–67). It was determined that all scores, apart from sexual desire (p = 0.08), significantly increased in the postoperative first and sixth months compared to the preoperative period. It was measured that the preoperative sexual desire score increased significantly in the postoperative sixth month (p <0.001). A significant score was also detected when all scores in the postoperative sixth month were compared to the postoperative first month. Conclusions Inguinal hernia surgery positively affects sexual functions compared to the preoperative period. The improvement in sexual parameters in addition to the benefits of hernia removal and presence of no significant postoperative complications indicates that this surgery is useful and safe. PMID:27551560

  20. [Clinical use of a new method of inguinal hernia repair].

    PubMed

    Shkvarkovskiy, I V; Moskaliuk, O P; Grebeniuk, V I; Yakobchuk, S A; Rusak, O B

    2015-02-01

    Surgery is the only treatment for inguinal hernias. The use of allografts has reduced the number recurrences of hernias to 3-14%. However, in any form of alloplasty around implantat develops tissue reaction that causes a number of specific complications. At present, researchers found that in 45-59% of cases of inguinal allogernioplasty leads to a significant disruption of spermatogenic and hormonal functions of the testicle. On the basis of the Surgical Department № 1 (Chernivtsi Emergency Hospital) 61 patients (main group) underwent surgery according to the proposed method (patent of Ukraine for useful model № 81728). The control group included 63 male patients from 19 to 61 years old who underwent inguinal hernia repair by I.L. Lichtenstein. Postoperative recovery periods examined basal activity and disability, pain intensity, the presence of specific complications, length of postoperative hospital stay days, recurrences of hernias. In order to assess reproductive disorders studied the state of blood circulation to the testicular arteries, testicular volume and the level of sex hormones. The prevention of polymeric implant to contact with the components of the spermatic cord reduces the inflammatory response to the structure of the inguinal canal, and the reproductive organs, which leads to a reduction of pain. Also accelerated social and labor rehabilitation of patients, blood circulation is preserved in the testicle and male hormones in the postoperative period. The proposed method prevents the development of recurrences of hernias through the elimination of the deep inguinal ring as one of the weaknesses of the anterior abdominal wall.

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

    PubMed

    Klosterhalfen, Bernd; Junge, Karsten; Klinge, Uwe

    2005-01-01

    In modern hernia surgery, there are two competing mesh concepts which often lead to controversial discussions, on the one hand the heavyweight small porous model and on the other, the lightweight large porous hypothesis. The present review illustrates the rationale of both mesh concepts and compares experimental data with the first clinical data available. In summary, the lightweight large porous mesh philosophy takes into consideration all of the recent data regarding physiology and mechanics of the abdominal wall and inguinal region. Furthermore, the new mesh concept reveals an optimized foreign body reaction based on reduced amounts of mesh material and, in particular, a significantly decreased surface area in contact with the recipient host tissues by the large porous model. Finally, recent data demonstrate that alterations in the extracellular matrix of hernia patients play a crucial role in the development of hernia recurrence. In particular, long-term recurrences months or years after surgery and implantation of mesh can be explained by the extracellular matrix hypothesis. However, if the altered extracellular matrix proves to be the weak area, the decisive question is whether the amount of material as well as mechanical and tensile strength of the surgical mesh are really of significant importance for the development of recurrent hernia. All experimental evidence and first clinical data indicate the superiority of the lightweight large porous mesh concept with regard to a reduced number of long-term complications and particularly, increased comfort and quality of life after hernia repair.

  2. The argument for lightweight polypropylene mesh in hernia repair.

    PubMed

    Cobb, William S; Kercher, Kent W; Heniford, B Todd

    2005-03-01

    The development of polypropylene prosthetics revolutionized surgery for the repair of abdominal wall hernias. A tension-free mesh technique has drastically reduced recurrence rates for all hernias compared to tissue repairs and has made it possible to reconstruct large ventral defects that were previously irreparable. The repair of abdominal wall defects is one of the most commonly performed general surgical procedures, with over 1 million polypropylene implants inserted each year. Surprisingly, little research has been performed to investigate the interaction of abdominal wall forces on a ventral hernia repair or the required amount or strength of the foreign-body material necessary for an adequate hernia repair. The long-term consequences of implantable polypropylene prosthetics are not without concern. The body generates an intense inflammatory response to the prosthetic that results in scar plate formation, increased stiffness of the abdominal wall, and shrinkage of the biomaterial. Reducing the density of polypropylene and creating a ''light weight'' mesh theoretically induces less foreign-body response, results in improved abdominal wall compliance, causes less contraction or shrinkage of the mesh, and allows for better tissue incorporation. A review of the laboratory data and short-term clinical follow-up is reviewed to provide a strong basis or argument for the use of ''light weight'' prosthetics in hernia surgery.

  3. Amyand's Hernia with Appendicitis: A Case Report and Integrative Review

    PubMed Central

    Feitosa Cavalcante, Jéssica; Melo Teixeira Batista, Hermes; Cavalcante Pita Neto, Ivo; Fernandes Frutuoso, Jairo; Rodrigues Pinheiro, Woneska; Maria Pinheiro Bezerra, Italla; de Abreu, Luiz Carlos; de Menezes Silveira, Gylmara Bezerra

    2015-01-01

    Introduction. Inguinal hernia is a common disorder with an estimated prevalence of 1.2% of the entire population and it is 12 times more common in males. Objective. To describe a case of appendix with signs of inflammation in the hernia sac, condition that is rare and difficult to diagnose, and to perform literature review, describing the most relevant aspects and the main controversies. Method. Report of a case and search in PubMed on June 1, 2015, using the terms “Appendix” [MeSH term] AND “hernia, inguinal” [MeSH term]. Results. The search resulted in 38 articles in total, and after deleting the articles that were not part of the inclusion criteria, there were 26 case reports remaining. Discussion. The search resulted in a total of 38 articles and after deleting the articles that were not part of the inclusion criteria, there were 26 case reports remaining. Conclusion. Amyand's hernia is a rare and difficult to diagnose condition, being commonly found occasionally in surgical procedures. It should be remembered in the presence of cases of incarcerated hernia, due to its possible complications if not diagnosed. PMID:26640737

  4. The Case of Huge Pure Lipoma of the Spermatic Cord Misdiagnosed as Inguinal Hernia.

    PubMed

    Jo, Dong In; Choi, Sang Kyu; Kim, Soon Heum; Kim, Cheol Keun; Chung, Hong; Kim, Hong Sup

    2017-07-01

    Clinically, pure spermatic-cord lipoma has not been recognized as a disease entity but regarded as an incidental finding at the time of hernia repair, because it presents groin symptoms and clinical findings indistinguishable from those of inguinal hernia. We report the successful treatment of case of huge pure spermatic-cord lipoma originally misdiagnosed as inguinal hernia. The patients had tumor excision without orchiectomy. Symptoms improved without any complication. In patients with inguinal hernia symptoms, pure spermatic-cord lipoma should be recognized as a significant clinical entity, and differential diagnosis should be achieved using ultrasonography and computed tomography to avoid unnecessary hernia repair.

  5. Long-term quality of life after hernioplasty using a Prolene hernia system in adult inguinal hernia.

    PubMed

    Yener, O; Aksoy, F; Güzel, P; Bölük, S; Dağ, E; Atak, T

    2012-02-01

    Most surgeons favour the use of a mesh for open inguinal hernia repair as it has a low recurrence rate. Procedures used most frequently are the Lichtenstein method, mesh plug repair and the Prolene hernia system (PHS). The choice of technique may be influenced by effects on postoperative pain and quality of life. In this retrospective study, results from inguinal hernia repair with the PHS in a regional training hospital were analysed. Thirty primary inguinal hernias were treated with PHS. The primary endpoint was the recurrence rate. Secondary endpoints were short-term and long-term complications. Pain was evaluated by use of a visual analog scale (VAS, 0-100), and a short-form 36-item questionnaire was used to assess postoperation quality of life. All patients visited the outpatient clinic for a physical examination (100% follow up). After a median follow up of 8 years, one patient was diagnosed with recurrent herniation (3.3%). Three self-limited wound discharge (10%), and one haematoma needing surgical evacuation (3.3%) were diagnosed. Two patients (6.6%) suffered from persistent pain (VAS > 40). Average VAS score was 21 (0-80) 8 years after surgery. In a regional training hospital, primary inguinal hernias were treated with low recurrence and few complications by use of the PHS.

  6. Diagnosis of inguinal hernia by prone- vs. supine-position computed tomography.

    PubMed

    Miyaki, A; Yamaguchi, K; Kishibe, S; Ida, A; Miyauchi, T; Naritaka, Y

    2017-08-10

    The aim of this study was to investigate the efficacy of prone-position computed tomography (CT) for detecting and classifying inguinal hernia relative to supine-position CT before laparoscopic inguinal hernia repair. Seventy-nine patients who underwent laparoscopic transabdominal preperitoneal repair of inguinal hernia were enrolled in this prospective study. Patients diagnosed with inguinal hernia by physical examination underwent abdominal CT in the supine and prone positions for preoperative assessment. The anatomy of the right and left inguinal regions was confirmed during the surgery and compared with the preoperative CT findings. The 79 cases included 87 operated lesions and 71 non-operated contralateral inguinal sites. Of the 84 clinical hernias, inguinal hernia was detected significantly more frequently on prone-position CT images (84, 100%) than on supine-position CT images (55, 65.5%). In addition, the inguinal hernia type was determined with significantly greater accuracy on prone-position CT images (96.4%) than on supine-position CT images (58.3%). Twenty-two occult hernias were detected by laparoscopy. The detection rate and accuracy for determining the type of occult hernia were significantly greater when using prone-position CT images [19 of 22 lesions (86.4%) and 77.3%, respectively] than when using supine-position CT images [8 of 22 lesions (36.4%) and 27.3%, respectively]. Prone-position CT is adequate for detecting and classifying inguinal hernia and for evaluating occult hernia.

  7. [Amyand's hernia and complicated appendicitis; case presentation and surgical treatment choice].

    PubMed

    García-Cano, Eugenio; Martínez-Gasperin, José; Rosales-Pelaez, César; Hernández-Zamora, Valeria; Montiel-Jarquín, José Álvaro; Franco-Cravioto, Fernando

    2016-01-01

    A caecal appendix within an inguinal hernia, with or without appendicitis, is defined as Amyand's hernia. In 1% of inguinal hernias an appendix without inflammation can be found, however, the prevalence of appendicitis in a hernia sac is only 0.08-0.13%. Male of 43 years old, began two days before admission with pain in the right inguinal region. He was scheduled for surgery due to a complication of a right inguinal hernia. The surgical findings were Amyand's hernia, necrotic spermatic cord, and perforated appendix. Surgical repair was performed with a favourable outcome, and he was discharged on the fourth postoperative day. Most of Amyand's hernia exhibit characteristics of incarcerated or strangulated inguinal hernia. Even acute appendicitis or perforated appendix within the hernia sac does not reflect specific symptoms or signs, therefore, a preoperative clinical diagnosis of Amyand's hernia is difficult to achieve. In our case, the patient had perforated appendicitis, developing necrosis of the spermatic cord. Orchiectomy, appendectomy, and inguinal hernia repair was performed without placing mesh. Due to the controversy on the use of mesh in contaminated abdominal wall defects, it was not indicated here, due to the high risk of wound infection and appendicular fistula. An extremely rare condition is presented, with a surgical choice that led to a favourable outcome. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  8. Review of stoma site and midline incisional hernias after stoma reversal.

    PubMed

    Nguyen, Mylan T; Phatak, Uma R; Li, Linda T; Hicks, Stephanie C; Moffett, Jennifer M; Arita, Nestor A; Berger, Rachel L; Kao, Lillian S; Liang, Mike K

    2014-08-01

    The incidence of incisional hernias after stoma reversal is not well reported. The aim of this study was to systematically review the literature reporting data on incisional hernias after stoma reversal. We evaluated both the incidence of stoma site and midline incisional hernias. A systematic review identified studies published between January 1, 1980, and December 31, 2012, reporting the incidence of incisional hernia after stoma reversal at either the stoma site or at the midline incision (in cases requiring laparotomy). Pediatric studies were excluded. Assessment of risk of bias, detection method, and essential study-specific characteristics (follow-up duration, stoma type, age, body mass index, and so forth) was done. Sixteen studies were included in the analysis; 1613 patients had 1613 stomas formed. Fifteen studies assessed stoma site hernias and five studies assessed midline incisional hernias. The median (range) incidence of stoma site incisional hernias was 8.3% (range 0%-33.9%) and for midline incisional hernias was 44.1% (range 8.7%-58.1%). When evaluating only studies with a low risk of bias, the incidence for stoma site incisional hernias is closer to one in three and for midline incisional hernias is closer to one in two. Stoma site and midline incisional hernias are significant clinical complications of stoma reversals. The quality of studies available is poor and heterogeneous. Future prospective randomized controlled trials or observational studies with standardized follow-up and outcome definitions/measurements are needed. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Evaluation of port site hernias, chronic pain and recurrence rates after laparoscopic ventral hernia repair: a monocentric long-term study.

    PubMed

    Liot, Emilie; Bréguet, Romain; Piguet, Valérie; Ris, Frédéric; Volonté, Francesco; Morel, Philippe

    2017-09-01

    The aim of this study was to evaluate hernia appearance at the trocar site after laparoscopic treatment of primary or incisional ventral hernias using an intraperitoneal prosthetic mesh. Chronic pain at the trocar site and primary hernia recurrence were also evaluated. Two-hundred and twenty-six consecutive patients who underwent a standardized laparoscopic hernia repair for primary or incisional ventral hernia at our centre between January 2000 and December 2008 were included. All patients had clinical and radiological examinations. Primary end points were port site hernia and the occurrence of chronic trocar site pain. Secondary end point was primary hernia recurrence. Seventy-eight patients were excluded: 6 declined to participate, 48 were unreachable, and 24 did not meet the inclusion criteria (nine underwent a single site laparoscopic approach, ten died of unrelated disease, three were unable to visit the hospital and two had relocated). After exclusion, 148 remained in our study. Mean follow-up was 49 ± 12.6 months. Mean age at the time of surgery was 60 years (range, 28-83) In total, 504 port sites were clinically and radiologically evaluated, and only one (0.02%) had secondary herniation. Three patients (2.0%) had a recurrent hernia, and 14 (9.5%) had developed chronic pain at time of assessment. Nine patients (6.1%) were re-operated for the recurrent hernia before the follow-up evaluation. The overall recurrence rate is, therefore, 8.1%. Only two minor complications and no major complications occurred after surgery. No mortality was observed. Laparoscopic repair for primary or incisional ventral hernias is a safe surgical approach, with low rates of hernia recurrence and a low morbidity rate. When fascial closure is maintained for 10 mm port sites, the incidence of port site hernias is very low. Five millimetre ports do not require closure.

  10. [Prospects of hernia and abdominal wall surgery in China].

    PubMed

    Tang, J X; Huang, L; Li, S J; Hu, X C

    2017-01-01

    In recent 20 years, hernia and abdominal wall surgery has made great progress in China. However, what we've done still leaves much to be desired. Related guidelines of hernia disease had been conducted, but China is short of multi-center, prospective, and large-sample research evidence. These guidelines are still with low evidence level, and contents need additional modified to well meet Chinese real situation. In terms of treatment of inguinal and abdominal wall incisional hernia, some consensus has been reached from certain key issues globally, but further exploration are still needed. To stand at top of the world, we are a long distance. We should not only strengthen training and quality control but also establish patient registration system and overall management process.

  11. [Diaphragmatic hernia caused by penetrating injury: emergency laparoscopic reconstruction].

    PubMed

    González-Rapado, L; Collera-Rodríguez, S A; Pérez-Esteban, M; Alfonso, O; Ramírez-Barba, E J

    1997-01-01

    To inform a patient with penetrating thoracic trauma and diaphragm injury that produced stomach herniation, being reduced the hernia and repaired the injury by laparoscopy though abdominal route with excellent result. 17-years-old male, hemodynamically stable with penetrating injury in the fifth left intercostal space, at the level of the middle auxiliary line, pneumothorax and left diaphragmatic hernia. Treatment. A pleurostomy tube was inserted. By laparoscopy 600 mL of free blood in abdominal cavity were aspired, the stomach hernia was reduced and the diaphragmatic repair was performed with nylon 3-0 running suture. The evolution was excellent, being integrated to his work at the twentieth postoperative day. Our case supports that laparoscopic surgery is at therapeutic alternative in select cases of trauma.

  12. Relationship between posterior pharyngeal pouch and hiatus hernia

    PubMed Central

    Smiley, T. B.; Caves, P. K.; Porter, D. C.

    1970-01-01

    The formation of posterior pharyngeal pouches is generally attributed to dysfunction of the cricopharyngeal sphincter. The reason for this dysfunction and its exact nature have not been established. Observations in the Royal Victoria Hospital, Belfast, suggested that an association exists between pharyngeal pouch and hiatus hernia. Barium studies performed in patients with a pharyngeal pouch using a described technique demonstrated the presence of a hiatus hernia in 32 out of 34 patients. Illustrative case histories and a review of published work on cricopharyngeal function are provided to support our conclusions that gastro-oesophageal reflux is the primary factor leading to cricopharyngeal dysfunction, with the formation of a pharyngeal pouch in some cases. Several possible criticisms of this theory are discussed and the need for further investigation in patients with a pharyngeal pouch is emphasized. The management of patients with a pharyngeal pouch and hiatus hernia is briefly outlined. Images PMID:5494681

  13. Recurrent Congenital Diaphragmatic Hernia in Ehlers-Danlos Syndrome

    SciTech Connect

    Lin, I.C.; Ko, S.F.; Shieh, C.S.; Huang, C.F.; Chien, S.J.; Liang, C.D.

    2006-10-15

    Ehlers-Danlos syndrome (EDS) includes a group of connective tissue disorders with abnormal collagen metabolism and a diverse clinical spectrum. We report two siblings with EDS who both presented with congenital diaphragmatic hernia (CDH). The elder sister suffered from recurrent diaphragmatic hernia twice and EDS was overlooked initially. Echocardiography as well as contrast-enhanced magnetic resonance angiography (MRA) showed dilatation of the pulmonary artery, and marked elongation and tortuosity of the aorta and its branches. A diagnosis of EDS was eventually established when these findings were coupled with the clinical features of hyperelastic skin. Her younger brother also had similar features. This report emphasizes that EDS may present as CDH in a small child which could easily be overlooked. Without appropriate surgery, diaphragmatic hernia might occur. Echocardiographic screening is recommended in patients with CDH. Contrast-enhanced MRA can be helpful in delineation of abnormally tortuous aortic great vessels that are an important clue to the early diagnosis of EDS.

  14. Tissucol application in dermolipectomy and incisional hernia repair.

    PubMed

    Fernández Lobato, R; García Septiem, J; Ortega Deballon, P; Martín Lucas, F J; Ruíz de Adana, J C; Limones Esteban, M

    2001-01-01

    Biological adhesives have a lot of applications in surgical procedures. Here we present a prospective study with the aim of analyzing results of the application of Tissucol between the muscle layers and subcutaneous tissue after incisional hernia repair with polypropylene mesh and associated dermolipectomy. We assess clinical and technical parameters, local morbidity, and hospital stay. Fifty-six patients were divided into two groups. Patients with whom we used fibrin glue were older, with more obesity (P < 0.005) with associated diseases, and their incisional hernias were larger and more complicated to repair. Patients in the Tissucol group developed less local morbidity (hematomas or abscesses; P < 0.01), had a shorter mean hospital stay (P < 0.01), and required less wound care. The use of Tissucol improves the results of surgical repair of large abdominal incisional hernias repaired by mesh placement and dermolipectomy, and it decreases global morbidity and hospital stay are reduced.

  15. [Some aspects of surgical treatment of postoperative ventral hernia].

    PubMed

    Lukomskiĭ, G I; Shulutko, A M; Antropova, N V; Moiseev, A Iu; El-Said, A Kh

    1995-01-01

    The results of surgical treatment of of 392 patients with postoperative ventral hernia are discussed. The algorithm of treatment of patients with large hernias was developed. Special preoperative management by dosed pneumocompression in an antioverload costume makes it possible to avoid menacing complications after the operation, which are caused by increased intraabdominal pressure. Test for tolerance to increase of intraabodominal pressure allowed prognostication of the character of the operative intervention: with or without decrease of the volume of the abdominal cavity (autoplasty or alloplasty, respectively). Prevention of wound complications consisted in control of infection, improvement of operative techniques, and use of modern surgical instruments. The prevention of recurrent hernias should be directed at correct choice of the method of plastics and removal of wound complications.

  16. Prospective analysis of ventral hernia repair using the Ventralight™ ST hernia patch.

    PubMed

    Tollens, Tim; Topal, Halit; Ovaere, Sander; Beunis, Anthony; Vermeiren, Koen; Aelvoet, Chris

    2013-09-01

    The aim of the current prospective study was to show the results of a new type of medium-weight monofilament polypropylene mesh covered with a hydrogel barrier on the visceral side. Between July 2011 and April 2013 prospectively collected data on 30 consecutive patients who underwent abdominal wall hernia repair using a medium-weight mesh covered with carboxymethylcellulose-sodiumhyaluronate coating (Ventralight™ ST mesh, Davol Inc, Subsidary of C. R. Bard, Inc. Warwick, RI) were analyzed. Out of these patients, those who had a follow-up of at least 12 months were selected. Short- and long-term outcomes were described. Meanwhile, registration continues up to completion of a series with 100 included patients. A total of 17 patients were selected (men/women ratio 11/6). Median follow-up was 12 months (range 12-21). Mean hernia diameter was 7 cm x 5 cm (craniocaudal x laterolateral) (range 1.5 x 1.5 to 20 x 15). Mean length of hospital stay was 6.1 days. Postoperative Visual Analogue Scale (VAS) at last follow-up was significantly lower than the preoperative VAS (P = 0.017) There were no intraoperative complications. Four patients (23%) developed minor complications. Two patients had mild discomfort, another two patients developed a seroma. No recurrences were observed. This intermediate study shows good results using a biofilm coated mesh and confirm the positive results obtained in the Sasse clinical trial.

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

    PubMed

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

    2011-03-01

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

  18. Impact of the establishment of a specialty hernia referral center.

    PubMed

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

    2014-12-01

    Creating a surgical specialty referral center requires a strong interest, expertise, and a market demand in that particular field, as well as some form of promotion. In 2004, we established a tertiary hernia referral center. Our goal in this study was to examine its impact on institutional volume and economics. The database of all hernia repairs (2004-2011) was reviewed comparing hernia repair type and volume and center financial performance. The ventral hernia repair (VHR) patient subset was further analyzed with particular attention paid to previous repairs, comorbidities, referral patterns, and the concomitant involvement of plastic surgery. From 2004 to 2011, 4927 hernia repairs were performed: 39.3% inguinal, 35.5% ventral or incisional, 16.2% umbilical, 5.8% diaphragmatic, 1.6% femoral, and 1.5% other. Annual billing increased yearly from 7% to 85% and averaged 37% per year. Comparing 2004 with 2011, procedural volume increased 234%, and billing increased 713%. During that period, there was a 2.5-fold increase in open VHRs, and plastic surgeon involvement increased almost 8-fold, (P = .004). In 2005, 51 VHR patients had a previous repair, 27.0% with mesh, versus 114 previous VHR in 2011, 58.3% with mesh (P < .0001). For VHR, in-state referrals from 2004 to 2011 increased 340% while out-of-state referrals jumped 580%. In 2011, 21% of all patients had more than 4 comorbidities, significantly increased from 2004 (P = .02). The establishment of a tertiary, regional referral center for hernia repair has led to a substantial increase in surgical volume, complexity, referral geography, and financial benefit to the institution. © The Author(s) 2014.

  19. Doxycycline administration improves fascial interface in hernia repair.

    PubMed

    Tharappel, Job C; Bower, Curtis E; Whittington Harris, Jennifer; Ramineni, Sandeep K; Puleo, David A; Roth, J Scott

    2014-08-01

    Despite improvements in ventral hernia repair techniques, their recurrence rates are unacceptably high. Increased levels of matrix metalloproteinases (MMPs) and reduced collagen-1 to -3 ratios are implicated in incisional hernia formation. We have recently shown doxycycline treatment for 4 wk after hernia repair reduced MMP levels, significantly increased collagen-1 to -3 ratios, and increased tensile strength of repaired interface fascia. However, this increase was not statistically significant. In this study, we extended treatment duration to determine whether this would impact the tensile strength of the repaired interface fascia. Thirty-two male Sprague-Dawley rats underwent incision hernia creation and subsequent repair with polypropylene mesh. The animals received either saline (n = 16) or doxycycline (n = 16) beginning from 1 day before hernia repair until the end of survival time of 6 wk (n = 16) or 12 wk (n = 16). Tissue samples were investigated for MMPs and collagen subtypes using Western blot procedures, and tensiometric analysis was performed. At both 6 and 12 wk after hernia repair, the tensiometric strength of doxycycline-treated mesh to fascia interface (MFI) tissue showed a statistically significant increase when compared with untreated control MFI. In both groups, collagen-1, -2, and -3 ratios were remarkably increased in doxycycline-treated MFI. At 6 wk, the doxycycline-treated MFI group showed a significant decrease in MMP-2, an increase in MMP-3, and no change in MMP-9. At 12 wk, MMP-9 showed a remarkable reduction, whereas MMP-2 and -3 protein levels increased in the doxycycline-treated MFI group. Doxycycline administration results in significantly improved strength of repaired fascial interface tissue along with a remarkable increase in collagen-1, -2, and -3 ratios. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Symptomatic intercostal lung hernia secondary to sternal dehiscence surgery.

    PubMed

    Celik, Sezai; Aydemir, Cüneyt; Gürer, Onur; Işık, Omer

    2013-01-01

    Patient: Male, 60Final Diagnosis: Iatrogenic intercostal lung herniaSymptoms: -Medication: No medicationClinical Procedure: Surgically cerrectedSpecialty: Thoracic surgery. Unusual clinical course. Iatrogenic intercostal lung hernia is a rare thoracic pathology. Injury of intercostal muscles and costocondral separation during median sternotomy and sternal dehiscence surgery are important factors in the development of hernia. We report for the first time a case of a 60-year-old man with acquired lung hernia after sternal dehiscence surgery, presenting as chest pain and exertional dyspnea. A 60-year-old man presented with a 6-week history of progressive exertional dyspnea, particularly following vigorous coughing. Past medical history included slight chronic obstructive pulmonary disease and coronary artery bypass grafting surgery 8 weeks previously, using the left internal mammary artery for the left anterior descending artery via median sternotomy and sternal dehiscence by the Robicsek method. A chest X-ray showed intact sternal and parasternal wires, but the bilateral lung parenchyma appeared normal. A spiral computed tomography scan of the chest found intercostal herniation of the anterior segment of the left upper lobe. The lung hernia was repaired surgically to relieve exertional dyspnea and incarceration, and to improve respiratory function. The postoperative course was uneventful and the patient recovered well. Intercostal lung hernia after median sternotomy and sternal dehiscence surgery is rare, and it has been previously reported on. Preventive techniques include gentle manipulation of the sternal retractor, avoidance of rib fractures, and using a protective method of intercostal arteries and nerves such as Sharma technique. Thoracic surgeons should be aware of this rare complication in sternal dehiscence surgery.