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Sample records for del colgajo inguinal

  1. Rescate articular con colgajo anterolateral del muslo

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    F.J. García-Bernal

    2015-06-01

    Full Text Available La preservación del nivel de amputación tanto de la extremidad superior como de la inferior, puede mejorar la función residual y el proceso de rehabilitación protésica de la misma. Ambas van a estar condicionadas por la longitud restante de la extremidad, la presencia o no de articulaciones operativas y la calidad de la cobertura del muñón. Presentamos 2 casos de amputaciones. El primero es un caso agudo de amputación traumática de extremidad superior a la altura del tercio proximal de antebrazo, que asocia avulsión cutánea circular desde el tercio medio del brazo y con articulación de codo conservada. El segundo, es la secuela de una amputación infracondílea de extremidad inferior por osteosarcoma que presenta fístulas cutáneas con drenaje supurativo por osteomielitis en el muñón tibial. En ambos pacientes realizamos cobertura con colgajo anterolateral de muslo anastomosado a la arteria radial en el caso de la extremidad superior, y a la arteria genicular descendente en la extremidad inferior. En los dos casos el postoperatorio transcurrió sin complicaciones, logrando preservar las articulaciones del codo y de la rodilla respectivamente, así como la posterior rehabilitación protésica. Consideramos que el colgajo anterolateral del muslo permite aportar tejido de buena calidad como cobertura del muñón de amputación. Dadas las características del tejido aportado y su volumen, es idóneo tanto para cobertura de defectos agudos como de déficits de almohadillado en casos crónicos.

  2. Aplicaciones clínicas del colgajo en cono

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    W. Calderón

    2014-09-01

    Full Text Available Presentamos nuestra experiencia con el uso de un colgajo previamente descrito, el colgajo denominado en cono por la forma final que obtiene, como la de un barquillo de helado con su bocado. Consta de 2 colgajos acoplados: uno de rotación local y otro un avance en V-Y, ambos fasciocutáneos. Realizamos un análisis retrospectivo de 108 pacientes intervenidos entre 2000 y 2013 por lesiones en diferentes partes del organismo, con edades comprendidas entre los 20 y los 52 años, de los cuales 99 fueron varones, y en los que empleamos este tipo de colgajo. Los defectos cubiertos afectaban a las piernas en el 27% de los casos, tobillos en el 10%, planta del pie en el 9%, al talón en el 8% y a otras localizaciones en el resto de los pacientes. Del total, 80 colgajos tuvieron buena evolución (74%, 11 sufrieron dehiscencia mayor (10,2 %, 13 dehiscencia menor (12% y 4 necrosis (3,7 %. Los resultados confirman que el colgajo en cono es versátil, reproducible, sencillo y seguro de realizar, y permite al cirujano plástico resolver problemas quirúrgicos complejos de forma muy segura y a bajo costo.

  3. Aplicaciones del colgajo frontonasal para la cobertura de defectos nasales

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    M. Pérez

    2015-12-01

    Full Text Available Presentamos una revisión retrospectiva de los pacientes a los cuales se realizó un colgajo frontonasal para la cobertura de defectos nasales intervenidos en la Unidad de Tumores Cutáneos de nuestro Servicio en el periodo comprendido entre enero de 2010 y mayo de 2014. El objetivo es analizar nuestras aplicaciones y resultados además de describir un algoritmo que permita indicar los distintos diseños en función de la localización y el tamaño del defecto a reparar. Empleamos el colgajo frontonasal en 78 pacientes (49 mujeres y 29 varones con un rango de edad de 47 a 92 años (media de 73 años. Creamos un total de 81 defectos, puesto que en 3 casos se resecaron simultáneamente 2 tumoraciones, todos de etiología tumoral (64 carcinomas basocelulares, 16 carcinomas espinocelulares y 1 caso de léntigo maligno melanoma, localizados en el área nasal, con un tamaño mínimo de 12 x 17 mm y máximo de 30 x 35 mm (media de 22 x 25 mm. El periodo de seguimiento fue de entre 2 meses y 4 años (media de 2,5 años. Respecto a las complicaciones observadas, todas ellas menores, hubo 6 casos de necrosis marginal, 8 de dehiscencia parcial de la herida y 1 de cicatrización hipertrófica, tratándose en su mayor parte de varones fumadores. Todos los colgajos sobrevivieron con resultado estético satisfactorio. El colgajo frontonasal permite la cobertura en un sólo tiempo quirúrgico de defectos nasales independientemente de su localización, de hasta 30 x 35 mm en nuestra serie. Se trata de un colgajo seguro y versátil en sus múltiples modificaciones, con unos resultados estéticos satisfactorios. Estas ventajas son de especial importancia en pacientes de edad avanzada como alternativa a técnicas más complejas. Se trata por lo tanto, a nuestro juicio, de una opción a tener en cuenta para la reconstrucción en un único tiempo quirúrgico de defectos nasales.

  4. Drenaje suplementario del sistema venoso superficial en colgajos pediculados Supplementary drainage of superficial venous system in pedicled flaps

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    A. Fernández García

    2012-06-01

    Full Text Available Los colgajos pediculados pueden sufrir edema y congestión debido a que su drenaje a trevés del sistema venoso superfical es imposible y el flujo hacia el sistema profundo a nivel del pedículo es precario. Esta situación suele evolucionar hacia la necrosis parcial o la pérdida total del colgajo en pocas horas. La apertura del sistema venoso superficial permite el drenaje adecuado de los tejidos transferidos y evita estas complicaciones. Este artículo analiza el papel de las anastomosis microquirúrgicas en el sistema venoso superficial de los colgajos pediculados. Esta técnica permite comunicar el sistema venoso superfical de los tejidos transferidos con el sistema venoso superficial del territorio que rodea al defecto. Presentamos los resultados obtenidos con esta técnica en colgajos de perforante en hélice, colgajos miocutáneos, colgajos neurocutáneos y colgajos fasciograsos volteados.The pedicled flaps can suffer edema and congestion due to the impossibility of drainage toward the superficial venous system and the precarious flow via the deep system at the level of the pedicle. The evolution of this situation is usually partial necrosis or total loss of the flap in a few hours. The opening of the venous superficial system achieves an appropriate drainage of the transfered tissues and avoids these complications. In this article we analyze the role of the microsurgical anastomosis at the level of the superficial venous system of pedicled flaps. This technique allows to communicate the superficial venous system of the transfered tissues with the superficial venous system of the territory around the defect. We report the results with this method in propeller perforator flaps, miocutaneous flaps, neurocutaneous flaps and adipofascial turn over flaps.

  5. Reubicación del ombligo al realizar un colgajo TRAM

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    A. Fuente del Campo

    2014-09-01

    Full Text Available Describimos un método simple para reubicar el ombligo en los casos de plicatura abdominal unilateral consecutiva a la rotación de un colgajo TRAM. El ombligo se desplaza a lo largo de una incisión hecha en la aponeurosis anterior del músculo recto abdominal contralateral. Este procedimiento no debilita la musculatura abdominal contralateral, mantiene el ombligo estable, sin estenosis, y evita la formación de cicatrices hipertróficas a su alrededor. Tras este procedimiento los pacientes conservan una resistencia abdominal normal, pudiendo realizar esfuerzo y ejercicio sin manifestar áreas de debilidad.

  6. Complicaciones en el uso del colgajo TRAM pediculado para reconstrucción mamaria por cáncer

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    J.L. López-Robles

    2013-12-01

    Full Text Available Las opciones en reconstrucción mamaria tras tratamiento oncoquirúrgico incluyen el uso de técnicas con implantes, el uso de colgajos autólogos y la combinación de ambos métodos. A nivel internacional, la reconstrucción con tejidos autólogos es el estándar de oro para la reconstrucción mamaria y específicamente, la utilización del colgajo miocutáneo de recto abdominal (colgajo TRAM pediculado es una de las opciones más empleadas. El presente estudio define con qué frecuencia se presentaron complicaciones tras la cirugía con colgajo TRAM pediculado para reconstrucción mamaria por cáncer en el Servicio de Cirugía Plástica y Reconstructiva del Hospital Central Sur de Alta Especialidad (PEMEX de la Cuidad de México (México, en un periodo de estudio de 7 años. Además, se identifican los factores de riesgo que influyeron sobre la aparición de dichas complicaciones. Diseñamos un estudio descriptivo, observacional y retrospectivo, que incluyó a 71 pacientes, de las cuales el 59.15 % presentaron alguna complicación. La mayoría de dichas complicaciones fueron menores (54.9 % y tan solo 3 pacientes presentaron alguna complicación mayor (4.2 %. La complicación del sitio donante del colgajo más frecuente fue la aparición de hernia abdominal (9.86 %. La complicación más frecuente del colgajo y del sitio receptor fue la necrosis grasa parcial (23.94 %. Las únicas complicaciones sistémicas fueron atelectasia y tromboembolismo pulmonar, con 1 caso de cada. En el análisis bivariado, las pacientes fumadoras tuvieron un 40 % más riesgo de presentar una complicación del colgajo en comparación con las no fumadoras (p=0.041. Las pacientes sometidas a radioterapia tuvieron un incremento del 30 % en las complicaciones totales en comparación con las no radiadas (p=0.021. Al comparar el hecho de recibir quimioterapia o no y la presencia de necrosis grasa, el 32 % de las pacientes tuvo esta complicación en comparación con el 10

  7. Colgajos Pediculados en Defectos de Tejidos Blandos en Niños. [Pedicled flaps for coverage of soft-tissue defects in children].

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    Javier Eduardo Nuñez

    2016-02-01

    Full Text Available Introducción: El objetivo de este trabajo es evaluar los resultados obtenidos con la utilización de colgajos pediculados utilizados para la cobertura de defectos de tejidos blandos en los miembros en niños. Material y Métodos: Se evaluaron retrospectivamente 13 niños que sufrieron traumatismo o quemadura de los miembros con pérdida o retracción severa de tejidos blandos, que requirieron de un colgajo pediculado para la adecuada cobertura del defecto, entre el año 2004 y 2013. La edad de los pacientes promedió 7.9 años. El tiempo entre el trauma inicial y la realización del colgajo promedió 39 días. La cobertura se realizó utilizando colgajo sural en cuatro casos, colgajo en isla vasculo-nervioso (Littler en dos casos, colgajo radial en dos casos, colgajo inguinal en tres casos, colgajo abdominal en un caso y colgajo dorsal ancho en un caso. En todos los casos se realizó la reparación o reconstrucción de las lesiones asociadas en el mismo tiempo quirúrgico. Resultados: El seguimiento de los pacientes promedió 19 meses. En los 13 casos se obtuvo buena cobertura del defecto a cubrir. El tiempo de internación promedió 8.1 días. Hubo una infección, una necrosis superficial y dos pacientes con cicatriz hipertrófica. Dos pacientes necesitaron tenolisis y dos zetaplastias. Todos los colgajos realizados en miembro inferior permitieron la vuelta a la actividad deportiva normal. Conclusión: A pesar del creciente número de colgajos libres descriptos para la reconstrucción de tejidos blandos, los colgajos pediculados permiten obtener una adecuada cobertura en la mayoría de estas lesiones en niños, ya que permiten buena cobertura tanto ósea como de tendones y estructuras vasculo-nerviosas, siendo posible la reconstrucción de las lesiones asociadas por debajo de los mismos sin inconvenientes. Entre las desventajas de la utilización de estos colgajos en adultos se nombran la inmovilización del miembro afectado, con una potencial

  8. Aplicaciones del colgajo sural medial en cirugía reconstructiva de cavidad oral y orofaringe

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    Ignacio Zubillaga

    2017-01-01

    Conclusiones: El colgajo de perforantes de la arteria sural medial es una excelente opción en la reconstrucción de defectos de la cavidad oral y la orofaringe, proporcionándonos una adecuada adaptabilidad a la zona receptora y una mínima morbilidad de la zona donante.

  9. Versatilidad del colgajo zigomático de mejilla en la reconstrucción nasal Versatility of cheek zigomatic flap in nose reconstruction

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    J. De Abullarade

    2012-09-01

    Full Text Available Conocemos bien la gran variedad de técnicas quirúrgicas existentes para la reconstrucción nasal, sin embargo está bien contar con una alternativa que permita restituir los tejidos del defecto con un colgajo zigomático de mejilla, que bien manejado, permite la reconstrucción nasal tridimensional y el camuflaje de las cicatrices. En este trabajo, comprobamos la versatilidad del colgajo zigomático de mejilla para la reconstrucción nasal en defectos postcáncer.It is well known the variety of surgical techniques for nasal reconstruction, but it is good to have an alternative that offers restore tissue defect with zygomatic cheek flap, which well managed, allows reaching the threedimensional nasal reconstruction and subsequent camouflage of the scars. In this study we found the versatility of the cheek zigomatic flap in nasal reconstruction post cancer defects.

  10. Utilidad del colgajo frontal en la reconstrucción nasal Usefulness of the forehead flap in the nasal reconstruction

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    Julio César Gálvez Chávez

    2009-03-01

    Full Text Available INTRODUCCIÓN. La nariz constituye el centro estético de la cara y cualquier deformidad en ella afecta de modo importante a la armonía facial. Este estudio tuvo como objetivo caracterizar las experiencias en reconstrucción nasal con colgajo frontal en pacientes con defectos anatómicos de la nariz, como consecuencia fundamentalmente de una cirugía oncológica. MÉTODOS. Se realizó un estudio descriptivo, prospectivo, para caracterizar la experiencia de la reconstrucción nasal con colgajo frontal en pacientes con defectos nasales, atendidos en el Hospital «Hermanos Ameijeiras» y en el Instituto Nacional de Oncología y Radiobiología, entre junio de 1999 y mayo de 2007. RESULTADOS. Destacó que el motivo más frecuente de reconstrucción fue la lesión neoplásica, con igual número de pacientes afectados por carcinoma basocelular y epidermoide. El ala nasal fue la zona más afectada y se presentó recidiva tumoral en 5 pacientes. En todos los casos se pudo crear una cubierta externa al defecto y el diseño oblicuo fue el más utilizado. Se reconstruyó la cubierta interna nasal fundamentalmente con injerto de piel total y el soporte nasal, mayormente con injertos cartilaginosos de la concha auricular. Todos los colgajos frontales se mantuvieron vitales después de su desconexión en el segundo tiempo quirúrgico. El cierre directo de la zona donante fue el más utilizado y en algunos casos se logró con la utilización de expansión tisular. Se realizó un tercer tiempo de remodelación en los pacientes que lo necesitaron. Las complicaciones no afectaron al resultado final de la reconstrucción. CONCLUSIONES. Se demostró la utilidad y vigencia del colgajo frontal en la reconstrucción nasal.ABSTRACT INTRODUCTION. The nose is the aesthetic center of the face and any deformity in it significantly affects facial harmony. This study was aimed at characterizing the experiences in nasal reconstruction with forehead flap in patients with

  11. Versatilidad del colgajo en hacha para reconstrucción de lesiones en punta de dedo Versatility of the hatchet flap for reconstruction of fingertip injuries

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    A. Fernández García

    2008-09-01

    Full Text Available El colgajo en hacha descrito por Emmet, ha sido recientemente aplicado por Tuncali et al. en amputaciones de punta de dedo. Este sencillo colgajo triangular puede ser utilizado tanto en amputaciones transversas como oblicuas. El objetivo del estudio es presentar nuestra experiencia con este versátil colgajo en la reconstrucción de punta de dedo. Incluimos en el estudio 5 pacientes que completaron un periodo de seguimiento de un año. El nivel de amputación fue considerado de acuerdo con la clasificación de Ishikawa. Los pacientes fueron preguntados por la existencia de intolerancia al frío, hipersensibilidad y dolor. Empleamos diferentes diseños del colgajo en hacha que se aplicaron en pacientes pediátricos y adultos con amputaciones múltiples, lesiones del primer dedo del pie o de la mano, de dedos largos y en reconstrucciones con doble colgajo. La media de tamaño del defecto fue 2,2 x 1,4 cm. En todos los pacientes el colgajo aportó almohadillado protector y resultados estéticos. Se observó rigidez articular en un paciente debido a la combinación con un colgajo de dedo cruzado. El objetivo de toda reconstrucción de punta de dedo es proveer cobertura pulpar suficiente al hueso para evitar inestabilidad y pérdida de sensibilidad como consecuencia de la reconstrucción. El colgajo en hacha es una opción versátil y segura para la reconstrucción de punta de dedo. Los diferentes diseños pueden ser usados conforme a nuestras necesidades.The hatchet flap described by Emmet, has been recently applied by Tuncali et al. in fingertip amputations. This single triangular flap can be used in different types of injuries, as transverse and lateral oblique amputations. The aim of our study was to present the authors´ experience with this versatile flap in fingertip reconstruction. Five patients who have completed their 1-year follow-up period were included in the study. The level of amputation was categorized according Ishikawa

  12. Reconstrucción del lóbulo auricular con colgajo bilobulado modificado Earlobe reconstruction with modified bilobed flap

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    F.T. Fidalgo Rodríguez

    2012-03-01

    Full Text Available La ausencia de lóbulo auricular puede deberse a causas congénitas, oncológicas o traumáticas. Esta deformidad con frecuencia constituye una alteración estética facial que precisa de corrección quirúrgica. Se han descrito muchas técnicas para la reconstrucción del lóbulo auricular, sin embargo, algunas requieren varios tiempos quirúrgicos, dejan cicatrices en las regiones adyacentes o incluso pueden requerir injertos cutáneos complementarios. Además es complicado reconstruir la estructura tridimensional del lóbulo. En nuestra práctica, empleamos una nueva variante de colgajo bilobulado para este tipo de reconstrucción.Earlobe absence may be due to congenital, oncologic or traumatic causes. This deformity sometimes constitutes an obvious facial deformity that warrants surgical correction. There are several techniques for reconstructing the earlobe, however, most of them require more than a onestage operation, may leave scars on the cheek or the preauricular or postauricular regions and sometimes require complementary skin grafts. It is difficult to reconstruct the natural and three-dimensional structure of the earlobe. In our practice we use a new type of local flap, with transposition and rotation techniques, based in a bilobed shape flap design.

  13. Ventajas del colgajo frontal expandido para la reconstrucción nasal Advantages of the expanded frontal flap for nasal reconstruction

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    Julio César Gálvez Chávez

    2010-12-01

    Full Text Available INTRODUCCIÓN. Desde 1957 la expansión tisular se ha convertido en una técnica muy utilizada en cirugía reconstructiva, pues permite obtener gran cantidad de tejido blando para corregir defectos cutáneos. En Cuba se ha publicado muy poco sobre la utilización de expansores cutáneos de la región frontal para la reconstrucción nasal. El objetivo de este trabajo fue caracterizar la utilidad del colgajo frontal expandido, para la reconstrucción de defectos nasales distales de espesor total en pacientes con frente corta. MÉTODOS. Se realizó un estudio descriptivo, prospectivo, con pacientes con defectos nasales secundarios a cirugía oncológica, traumatismos y otras causas, a los que se les practicó una reconstrucción nasal con colgajo frontal expandido en el Instituto Nacional de Oncología y Radiobiología y el Hospital «Hermanos Ameijeiras», entre junio de 1999 y mayo de 2007. RESULTADOS. Hubo una ganancia promedio de 1,0 cm en longitud del colgajo frontal expandido con respecto al diseño oblicuo sin expansión. Se logró la reconstrucción de la cubierta cutánea en todos los casos, incluso en los defectos más distales, como los del ala nasal. El cierre de la zona donante siempre fue de forma directa. CONCLUSIONES. Se pudo caracterizar la utilidad del colgajo frontal expandido en la muestra estudiada y se encontró entre sus ventajas fundamentales la ganancia en longitud con respecto a la distancia vertical de la frente. Concordamos con la mayoría de los autores en cuanto a su utilidad, siempre que esté indicado y disponible, y en que es un recurso alternativo cuando existe poco tejido disponible para la reconstrucción de los defectos nasales.INTRODUCTION. From 1957, the tissues expansion has becomes a very used technique in reconstructive surgery, since allows to obtain abundant soft tissue to correct cutaneous defects. In Cuba there aren't much publications on the use of cutaneous expanders of frontal region to nasal

  14. Utilización del colgajo de músculo temporal en cirugía reconstructiva maxilofacial: Revisión de 104 casos Use of the temporalis muscle flap in maxillofacial reconstruction surgery: A review of 104 cases

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    I. Zubillaga Rodríguez

    2004-08-01

    Full Text Available Introducción: el colgajo de músculo temporal ha sido empleado en reconstrucción craneofacial desde hace más de 100 años. El primer caso descrito en la literatura fue publicado por Lentz en 1895. Hoy en día el uso de colgajos locales con músculo temporal parece ser desplazado por el uso de colgajos libres microvascularizados en la reconstrucción craneofacial. En nuestra experiencia dichos colgajos locales constituyen una opción segura en muchos de nuestros pacientes. Objetivos: mostrar nuestras indicaciones y resultados en reconstrucción craneofacial con el empleo del colgajo de músculo temporal. Material y método: análisis retrospectivo de nuestra experiencia con el colgajo de músculo temporal en la última década. Resultados: hemos empleado un total de 108 colgajos miofasciales temporales en pacientes adultos con las siguientes indicaciones: reconstrucción de defectos postmaxilectomía (44; cirugía de base de cráneo (25 incluyendo fosa craneal anterior, media y posterior; cavidad oral y orofaringe (23; tras exenteración orbitaria en pacientes oncológicos (6; anquilosis de ATM (6; secuelas faciales postraumáticas (2; reanimación facial (2. Conclusiones: el colgajo de músculo temporal es una de las primeras opciones en cirugía reconstructiva oncológica craneofacial, de la ATM y base de cráneo. La disección traumática del colgajo y la sutura a tensión predisponen la aparición de complicaciones como necrosis o dehiscencia de la sutura.Abstract: Introduction: Temporalis miofascial flap has been used for craniofacial reconstruction since more than 100 years. The first described case in the medical literature was published by Lentz in 1895. The use of pedicled temporalis muscular flaps in cranial or facial reconstruction seems to be shifted nowadays by microvascular free flaps. Nevertheless, in our experience, this miofascial pedicled flap demonstrates to be a safe option for midfacial and lateral cranial base defects

  15. Reconstrucción total del párpado superior mediante colgajo frontal Whole repair made in the upper eyelid using a frontal flap

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    Yamilé León Rodríguez

    2009-12-01

    Full Text Available Los pacientes que han sido sometidos a resecciones quirúrgicas por cáncer, que han sufrido lesiones por quemaduras de espesor total o traumas avulsivos con pérdida extensa de tejidos que engloban la totalidad del párpado superior, acuden con relativa frecuencia a consulta por presentar la cornea expuesta, y dicha exposición resulta en ulceraciones, cicatriz y ceguera. En estos pacientes se observa una gran insatisfacción por el inconveniente que representa no poder usar una prótesis ocular y algo no menos importante, el gran defecto estético. Se presenta el caso de un paciente del sexo masculino, de 30 años de edad, que sufrió múltiples lesiones por el estallido de un artefacto explosivo, con pérdida total del párpado superior derecho y enucleación ocular. Se le realizó reconstrucción palpebral total mediante el colgajo dermograso frontal y se obtuvieron buenos resultados estéticos.Patients underwent to surgical resections from cancer and whole thickness burn lesions or avulsion traumata with an extent loss of tissues which shape the upper eyelid, came with a relative frequency to consultation due to corneal exposition and this exposition resulting in ulcerations, scar, and blindness. These patients are very unsatisfied because they can not use of an ocular prosthesis, and something less important, the big aesthetic defect. Authors present the case of a male patient aged 30 with multiple lesions from explosion of an explosive artifact with loss of right upper eyelid and ocular enucleation. A total palpebral reconstruction was performed using a frontal dermal fatty flap with good aesthetic results.

  16. Colgajo Sabattini-Abbe en H tumbada para reconstrucción de labio leporino bilateral secundario

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    Juan Márquez-Cañada

    Full Text Available La reconstrucción del labio leporino secundario tiene al colgajo Sabattini-Abbe como una de sus principales herramientas reconstructivas básicas, si bien se han propuesto diferentes modificaciones de la técnica original para lograr una minuciosa reconstrucción de las deformidades secundarias presentes en los pacientes con labio leporino. Presentamos una modificación del colgajo Sabattini-Abbe, el colgajo en H tumbada. Este colgajo modificado incluye un segmento vertical y dos horizontales para restaurar con un solo colgajo, y adhiriéndonos al principio de la Cirugía Plástica de reconstruir lo similar con lo similar, tanto piel como bermellón de las áreas central y laterales del labio superior, las cuales se hallan comúnmente afectadas en los pacientes con labio leporino bilateral secundario.

  17. Cierre de zona donante de colgajo libre radial de antebrazo con colgajo de rotación-avance basado en perforantes cubitales

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    P. Bolado-Gutiérrez

    2013-09-01

    Full Text Available La transferencia libre del colgajo radial de antebrazo se emplea en la práctica clínica habitual en numerosos procedimientos reconstructivos. Sin embargo, también es popular debido a la potencial morbilidad que se genera en la zona donante del colgajo: trastornos vasculares, motores, sensitivos o estéticos. A pesar de haberse realizado numerosas modificaciones tanto en la disección del colgajo como en el cierre del defecto, hasta la actualidad ninguno de los procedimientos empleados ha demostrado paliar completamente estas secuelas. Presentamos nuestra experiencia con la utilización de un colgajo de rotación-avance en V-Y fasciocutáneo basado en los vasos perforantes de la arteria cubital para el tratamiento del defecto resultante de la transferencia libre del colgajo antebraquial radial. Hemos empleado este procedimiento en 7 pacientes con edades comprendidas entre los 30 y los 86 años. Las dimensiones del colgajo radial en el eje longitudinal del antebrazo fueron desde los 4 a los 5,5 cm, con un eje transversal al pedículo vascular desde los 8 a los 10 cm. En todos los casos se conservó la motricidad de antebrazo- muñeca-mano-dedos sin registrarse adherencias a nivel tendinoso. No observamos alteraciones en la fuerza ni en la sensibilidad respecto al preoperatorio en el antebrazo intervenido. Las cicatrices fueron estéticamente aceptables. Concluimos que el colgajo fasciocutáneo de rotación-avance en V-Y basado en perforantes de la arteria cubital aporta numerosas ventajas frente a los injertos cutáneos u otros sustitutos dérmicos, además de ser más barato, con un período de cicatrización más rápido y con un resultado estético superior.

  18. Colgajo perforante tóracodorsal Toracodorsal perforator flap

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    C. Angrigiani

    2006-12-01

    Full Text Available La espalda es una excelente zona dadora de colgajos. El colgajo perforante tóracodorsal basado en ramas cutáneas de la arteria y vena tóracodorsales que perforan el músculo dorsal ancho, es una modifica ción del tradicional colgajo musculocutáneo de dorsal ancho que permite lograr una mayor flexibilidad en su traslado y una disminución de su volumen. Puede emplearse como colgajo libre o en isla. Presentamos su anatomía, disección e indicaciones.Back is an excellent donor site for flaps. The tora codorsal perforator flap, based on cutaneous vessels from toracodorsal artery and vein that pass through Latissimus Dorsi muscle, is a modified conventional musculocutaneous Latissimus Dorsi flap that allows easier movility and a volume reduction. This flap can be used both, free flap or island flap. We present the anatomy, dissection and applica tions of this flap.

  19. Colgajo frontal paramediano de pedículo estrecho para reconstrucción nasal en cáncer de piel

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    Jezabel De Abullarade

    Full Text Available Antecedentes y Objetivos. No se pueden negar los excelentes resultados que el colgajo frontal ofrece en la reconstrucción nasal, por lo que supone una importante herramienta en el arsenal terapéutico del cirujano reconstructivo. El objetivo del presente trabajo es presentar y discutir una modificación de dicho colgajo: el pedículo estrecho del colgajo frontal paramediano, presentando las ventajas que ofrece la modificación del colgajo entre las que destaca el que permite preservar otro potencial colgajo similar para el futuro, en el caso de que éste fuera necesario. Material y método. Analizamos un grupo de pacientes en el que practicamos resección de carcinoma basocelular de piel nasal con limites quirúrgicos negativos por biopsia de congelación, y reconstrucción quirúrgica con elevación de colgajo frontal paramediano con pedículo de 1.5 cm en todos los casos, basado en el hecho de que la arteria supratroclear súperomedial es constante en su borde orbitario .Cerramos el defecto del área donante en la frente mediante sutura directa en todos los casos. Resultados. Operamos con esta técnica a 76 pacientes, 30 mujeres y 46 varones, con una edad media de 59 años. En todos los casos hicimos revisión quirúrgica para autonomización del colgajo, desgrase, cartílago, etc. No hubo necrosis del colgajo en ningún caso. Conclusiones. Comprobamos la utilidad del colgajo frontal de pedículo estrecho y sus ventajas al ser levantado, entre otras, el mantener la integridad del lado contralateral de la frente para otro potencial colgajo frontal paramediano si fuera necesario.

  20. Variabilidad en el diseño y composición del colgajo de perforante de tibial posterior para la reconstrucción de defectos en la pierna Versatility on design and composition of the tibial posterior perforator flap for reconstruction of leg defects

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    C. Laredo Ortiz

    2011-03-01

    Full Text Available Las pérdidas de sustancia en la pierna y fundamentalmente en su tercio inferior, siguen siendo un reto en Cirugía Reconstructiva puesto que los tejidos de vecindad, dañados por el traumatismo o por el edema concomitante, son inadecuados para cubrir hueso, tendones o material de osteosíntesis expuesto. El colgajo propeller o colgajo en hélice es un método elegante y versátil para la cubrir estas pérdidas de sustancia de la extremidad inferior con tejido locorregional no comprometido vascularmente por el traumatismo y/o lesión causante. A diferencia de los colgajos convencionales de rotación o transposición, es posible el cierre directo de la zona donante, lo que ofrece un resultado estético óptimo. Además, la presencia de perforantes más proximales permite usar pastillas musculares y tendinosas en el mismo colgajo para resolver defectos más complejos, convirtiéndose en algo más que una alternativa a los colgajos libres. Presentamos una serie de 43 pacientes para describir las posibilidades reconstructivas que ofrece el colgajo de perforante de arteria tibial posterior en su forma en hélice, en cuanto a la variabilidad del diseño y a su uso como colgajo compuesto, con el fin de minimizar aun más la morbilidad de la zona donante sin el uso de injertos.Lower extremity defects, specially lower third defects, keep being a true challenge in Reconstructive Surgery, since nearness damaged tissues, due to the traumatism or to the concomitant edema, are not suitable for the coverage of bone, tendons or exposed osteosynthesis material. Propeller flap has become an elegant and mobile method for the coverage of this type of lower extremity defects. It provides us with locorregional tissue with not vascular involvement in the traumatism and/or subsequent injury. Unlike conventional rotation or transposition flaps, direct closure of the donor site is possible, offering an optimum aesthetic result. Moreover, the presence of more proximal

  1. Experiencia con el colgajo de Kirschbaum en secuelas de quemaduras cérvico-faciales

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    P. Rossell-Perry

    2014-06-01

    Full Text Available Presentamos nuestra experiencia con el colgajo de Kirschbaum (colgajo en charretera en la corrección de retracciones cicatriciales de la región cervical anterior y del tercio inferior de la cara. Llevamos a cabo un estudio retrospectivo sobre una serie de 63 pacientes con retracciones cicatriciales de la región cervical anterior y del tercio inferior facial, operados por el primer autor entre los años 1996 y 2012 dentro del marco de las campañas quirúrgicas desarrolladas a lo largo del país (Perú en las áreas geográficas con mayor necesidad de atención especializada. En todos los casos empleamos el colgajo en charretera tomado de la región lateral del cuello y de la región deltoidea. Evaluamos a los pacientes mediante el examen físico y la documentación fotográfica obtenida en los periodos pre y postoperatorio. Obtuvimos mejoría en diferentes grados de la limitación funcional de la región cervical y facial en todos los casos operados, con viabilidad total del colgajo en 59 casos (93,65 % y parcial en 4 casos (6,34 % . No hubo ningún caso de pérdida total. Las complicaciones recogidas fueron pocas, principalmente hematomas, 6 casos (9,52 % e infección, 2 casos (3,17 % . Las zonas donantes evolucionaron con cicatriz hipertrófica en 22 de los casos (34,92 % . En conclusión, nuestra experiencia con el uso de esta técnica quirúrgica ha demostrado ser de utilidad en el tratamiento de las secuelas de quemadura con retracción cicatricial cervical y facial, por lo que consideramos que el colgajo de Kirschbaum es seguro y tiene pocas complicaciones.

  2. Efecto del Colgajo Desplazado Coronalmente con y sin Bioacondicionamiento Cementario de Myrciaria Dubia (Camu-Camu) en la Posición Gingival Aparente y Real en Pacientes con Recesión Gingival Clase II de Miller de la Clínica Odontológica. UCSM. Arequipa. 2015

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    Macedo Reynoso, Percy Antonio

    2017-01-01

    La presente investigación tiene por objeto determinar el efecto del colgajo desplazado coronalmente con y sin bioacondicionamiento cementario de Myrciaria Dubia en la posición gingival aparente y real en pacientes con recesión gingival clase II de Miller. Corresponde a un ensayo clínico, randomizado, por ende prospectivo, longitudinal, comparativo y de campo, de nivel cuasi-experimental. Las variables PGA y PGR han sido estudiadas por observación experimental clínica intraoral, una vez en...

  3. Colgajo de perforantes de la arteria colateral cubital inferior para defectos por quemadura eléctrica en fosa cubital

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    González-Alaña, I.; Torrero-López, J.V.; Llop-Adrián, M.; Martín-Playá, P.; Gabilondo Zubizarreta, F.J.

    2014-01-01

    Las quemaduras eléctricas producen lesiones profundas, especialmente las debidas a la entrada y salida de la corriente y al arco voltaico, que pueden dejar expuestas estructuras nobles y afectar áreas de flexo-extensión, como la fosa antecubital. Los defectos resultantes pueden cubrirse mediante colgajos libres o pediculados de brazo y antebrazo. Entre las distintas opciones quirúrgicas, el colgajo medial del brazo evita la interrupción de los ejes vasculares mayores y la secuela en la zona d...

  4. Reconstrucción de defectos amplios en tronco mediante colgajo de perforante en piedra clave

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    J. Aguilera-Sáez

    Full Text Available El colgajo en piedra clave (Keystone Perforator Island Flap KPIF, es un colgajo local fasciocutáneo en isla que no requiere identificación de perforantes, descrito por Behan en 2003, que permite el cierre en un único acto quirúrgico tanto del defecto como de la zona dadora sin precisar, generalmente, autoinjerto cutáneo. Nuestro objetivo es el mostrar la utilidad de este colgajo para la cobertura de defectos amplios en tronco. De los más de 120 casos realizados en nuestro Servicio con esta técnica sin tener en cuenta la localización del problema entre abril de 2011 y abril de 2013, presentamos 5 casos que, tras resección quirúrgica por diferentes etiologías, fueron los que presentaron defectos de cobertura de mayor tamaño en tronco (entre 10 y 25 cm de diámetro máximo que fueron solventados satisfactoriamente mediante el KPIF. En todos obtuvimos un cierre directo tanto de la zona del defecto como de la zona dadora, sin complicaciones durante el acto quirúrgico ni en el postoperatorio, con resultados estéticos óptimos, sin deformidades significativas ni alteraciones funcionales. Creemos que el KPIF es un colgajo óptimo para la cobertura de defectos amplios en el tronco ya que permite cubrir el defecto y hacer un cierre primario de la zona dadora generando poca morbilidad, con un buen resultado estético, con un corto tiempo quirúrgico y con un bajo coste.

  5. Experiencia en reconstrucción auricular en cáncer de piel con colgajo en "quesadilla"

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    C. Gutiérrez Gómez

    Full Text Available La reconstrucción auricular es una de las más difíciles ya que implica reproducir las sofisticadas y delicadas formas del pabellón auricular. Cuando hay que resecar piel en la oreja por un cáncer cutáneo y dejamos expuesto el cartílago, sin pericondrio, suele suceder que al colocar injertos no hay una integración adecuada de los mismos por las caprichosas formas y relieves del pabellón auricular; cuando es necesario resecar el pericondrio estamos obligados a cubrir el defecto con un colgajo y no con un simple injerto. Frente a esta dificultad técnica, diseñamos un colgajo ricamente vascularizado que preserva el cartílago no afectado con una buena cubierta y al mismo tiempo respeta la anatomía de la oreja. Para la cobertura del cartílago auricular anterior usamos un colgajo fasciocutáneo posterior que se asemeja a un plato típico de la cocina mexicana que llamamos "quesadilla", donde el cartílago por su color blanco recuerda el queso y el gran colgajo fasciocutaneo recuerda la tortilla que cubre al queso. Este colgajo incluye la piel enrollada del hélix, que en un segundo tiempo retornará a su lugar de origen anatómico mediante una z-plastía asimétrica. Presentamos, de entre una serie de 13 pacientes con carcinoma de pabellón auricular, 2 casos resueltos mediante esta técnica.

  6. Colgajo de avance en V-Y de gastrocnemio medial basado en perforante para cierre de defectos del tercio medio de la pierna V-Y advancement gastrocnemius perforant based flap for closure of defects of the medial third of the leg

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    V. Spröhnle

    2010-06-01

    Full Text Available Los colgajos de avance en V-Y han sido una alternativa popular para el cierre de heridas profundas, pero su movilidad es limitada. Los colgajos basados en perforantes son especialmente útiles cuando se necesita un mayor avance y cobertura. Diseñamos un colgajo de gastrocnemio que utiliza ambas técnicas para cubrir los defectos del tercio medio y superior de la pierna en sus caras lateral y posterolateral. Evaluamos en forma retrospectiva 5 pacientes con heridas en el tercio medio y superior de la pierna, tratados entre enero de 2005 y septiembre de 2007 en un solo centro y por un mismo cirujano. Todos fueron varones, con un promedio de edad de 48 años y la etiología fue traumática en todos los casos. El vaso perforante se evaluó preoperatoriamente por medio de doppler color en todos los casos. Valoramos telefónicamente la satisfacción del paciente en el postoperatorio tardío. En todos los casos, encontramos los vasos perforantes identificados en el preoperatorio; el tiempo operatorio promedio fue de 1.8 horas. No hubo complicaciones; la cobertura fue exitosa en todos los casos y los pacientes se mostraron satisfechos en la encuesta realizada. El tiempo medio de seguimiento postoperatorio fue de 19 meses. En conclusión, creemos que el colgajo de avance en V-Y de gastrocnemio basado en perforante se presenta como una alternativa segura para el cierre de defectos del tercio medial y superior de la pierna, en un sólo tiempo quirúrgico y con buenos resultados estéticos y funcionales a largo plazo.Advancement V-Y flaps have been a popular choice for closure of deep wounds but their mobility is limited. Perforant based flaps are specially useful when greater advancement and bigger coverage are needed. We designed a gastrocnemius based flap that uses both techniques for covering the defects of the medial third of the leg. We follow a retrospective evaluation of 5 patients that had their wounds in the medial and superior third of the leg

  7. Colgajo de perforantes de la arteria colateral cubital inferior para defectos por quemadura eléctrica en fosa cubital

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    I. González-Alaña

    2014-09-01

    Full Text Available Las quemaduras eléctricas producen lesiones profundas, especialmente las debidas a la entrada y salida de la corriente y al arco voltaico, que pueden dejar expuestas estructuras nobles y afectar áreas de flexo-extensión, como la fosa antecubital. Los defectos resultantes pueden cubrirse mediante colgajos libres o pediculados de brazo y antebrazo. Entre las distintas opciones quirúrgicas, el colgajo medial del brazo evita la interrupción de los ejes vasculares mayores y la secuela en la zona donante es discreta. Sin embargo, su uso está poco extendido por considerarse un colgajo de difícil disección debido a la variabilidad anatómica de las arterias colaterales cubitales superior e inferior que lo irrigan. Presentamos la cobertura para un defecto secundario a quemadura eléctrica en la fosa antecubital mediante un colgajo medial del brazo basado en las ramas perforantes de la arteria colateral cubital inferior. Aunque confirmamos en este caso la variabilidad vascular, la disección resultó sencilla y el resultado estético y funcional fue excelente.

  8. Obliteración de fracturas de seno frontal con colgajos pediculados

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    J. Pefaure

    2014-03-01

    Full Text Available El compromiso del seno frontal con fractura de sus paredes es un tipo de lesión infrecuente, en torno al 5-12% de todas las fracturas faciales. Suele asociarse a lesiones intracraneales, oftalmológicas y a otras fracturas máxilofaciales y cuando conlleva fractura de la pared posterior de seno frontal requiere tratamiento inmediato, siendo necesaria la obliteración del seno frontal debido a la comunicación con meninges y lóbulo frontal, con el riesgo infeccioso que ello representa. Tratamos 18 pacientes con traumatismos craneofaciales y fracturas del seno frontal con compromiso de su pared posterior en el periodo comprendido entre 2007 y 2011; 8 mujeres y 10 varones con edades comprendidas entre los 15 y los 64 años. Todos los casos fueron tratados con reducción y osteosíntesis por vía abierta con distintos abordajes y realizamos en todos colgajos pediculados de vecindad. La vitalidad de los colgajos fue del 100% . Certificamos el posicionamiento correcto mediante tomografía axial computarizada. El tratamiento de las fracturas del seno frontal con compromiso de su pared posterior o del conducto nasofrontal requiere obliteración con tejido vascularizado para evitar comunicaciones con la cavidad nasal.

  9. Colgajo lateral de brazo en reconstrucción de la cavidad oral Lateral arm flap in oral cavity reconstruction

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    A. Dean Ferrer

    2008-08-01

    Full Text Available Introducción. La posibilidad de emplear una piel fácilmente plegable ha permitido reconstruir defectos de la cavidad oral consiguiendo una gran funcionalidad. Aunque el colgajo radial es el colgajo que se utiliza con más frecuencia para reconstruir defectos de superficie de la cavidad oral, el colgajo lateral de brazo puede ser de elección en algunas situaciones. Objetivos. El objetivo del presente trabajo es mostrar las ventajas e inconvenientes y nuestras indicaciones y resultados del colgajo lateral de brazo en reconstrucción de defectos de la cavidad oral. Material y método. Se trata de un estudio prospectivo sobre la utilización del colgajo lateral de brazo en la reconstrucción de defectos de la cavidad oral tras cirugía ablativa. Se ha valorado: la viabilidad del colgajo, la morbilidad del lecho donante, la longitud del pedículo, la selección de vasos receptores, las complicaciones y los resultados funcionales de la zona reconstruida. Resultados. Hemos utilizado el colgajo lateral de brazo en 10 pacientes en reconstrucciones primarias tras cirugía ablativa por carcinoma epidermoide de la cavidad oral. Hubo un caso de necrosis por trombosis venosa. El defecto donante se cerró en 8 casos de modo directo y en 2 con un injerto libre de espesor parcial. La longitud media del pedículo ha sido de 8,75 cm. En 9 casos el resultado funcional de los pacientes ha sido satisfactorio. Conclusiones. El colgajo fasciocutáneo lateral de brazo permite la reconstrucción de la cavidad oral consiguiendo buenos resultados funcionales. Además la morbilidad de la zona donante es mínima y puede realizarse cierre directo del defecto cutáneo del brazo en la mayoría de los casos.Introduction. The availability of easily pliable skin has allowed the functional reconstruction of oral cavity defects. Although the radial forearm free flap is the most frequently used flap for the reconstruction of surface defects of the oral cavity, the lateral arm free

  10. Experiencia en reconstrucción de tercio distal de pierna con colgajo libre de músculo gracilis

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    A. Conejero

    2013-09-01

    Full Text Available En los defectos de cobertura distales de la pierna con exposición ósea o articular, la transferencia de tejidos libres es frecuentemente la única opción viable. Se utilizan en el rescate de extremidades inferiores en riesgo por trauma, infección, ulceración, quemaduras y tumores. El colgajo libre de músculo gracilis está descrito en la literatura como una excelente alternativa. El objetivo de este estudio es describir las características de los pacientes y resultados de la utilización del colgajo libre de músculo gracilis en la reconstrucción del tercio distal de la pierna. Se trata de un estudio retrospectivo, observacional, de revisión de archivo clínico y fotográfico de 7 pacientes operados por los autores entre los años 2007-2010, 4 hombres y 3 mujeres con un promedio de edad de 38,5 años. El defecto de cobertura que motivó la cirugía (de hasta de 20 x 6 cm fue secundario a fractura expuesta (tipo III de Gustilo y a osteomielitis crónica. La cobertura del colgajo se hizo en todos los casos con injerto dermo-epidérmico. No hubo complicaciones menores ni mayores del sitio donante ni del receptor, con resultados funcionales y estéticos satisfactorios. El colgajo libre de músculo gracilis es una muy buena alternativa para la reconstrucción distal de pierna con defectos de cobertura en fracturas expuestas y osteomielitis o en úlceras crónicas. Tras el seguimiento, todos nuestros pacientes lograron una cobertura completa y estable en el tiempo.

  11. Colgajo dermoglandular de apoyo en mastopexia con implantes: técnica de la hamaca

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    A. Alí

    2013-12-01

    Full Text Available La ptosis mamaria es consulta frecuente en la práctica del cirujano plástico, y las opciones quirúrgicas para su corrección son múltiples. A pesar de los avances en el tratamiento de esta alteración, los resultados impredecibles y las posibles complicaciones siguen siendo frecuentes, sobre todo cuando se asocia la colocación de implantes mamarios. La dehiscencia de la herida, la exposición del implante y la modificación de la forma de la mama, en especial del polo inferior, pueden estar presentes a corto o largo plazo en las pacientes sometidas a cirugía de pexia mamaria con implantes. Presentamos una nueva técnica quirúrgica para suspensión y protección del polo inferior de la mama a partir de un colgajo dermoglandular de pedículo interno inferior que llamaremos "hamaca". Este colgajo, nos permite mantener más estable la forma de la mama a lo largo del tiempo y brindar así una mayor protección al implante en caso de dehiscencia de la herida.

  12. Colgajo miocutáneo de trapecio bilateral para reconstrucción de región cervical posterior

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    E. Moretti

    Full Text Available La cirugía reconstructiva para la resolución de defectos en la región cervical posterior y occipital muchas veces puede ser un verdadero desafío para los cirujanos plásticos. El colgajo miocutáneo de trapecio es una de las alternativas más utilizadas. En este artículo describimos una variante técnica del colgajo miocutáneo de trapecio basada en un diseño cutáneo bilateral en V-Y, para reconstruir defectos producidos por dehiscencia de heridas con fístula de líquido cefalorraquídeo en región cervical posterior de 2 pacientes de 52 y 72 años, intervenidos quirúrgicamente por hernia discal cervical. Logramos una cobertura total del defecto en ambos casos, con un exitoso aislamiento biológico proporcionado por la importante superficie y volumen brindados por el tercio medio de ambos músculos trapecios. No hubo sufrimiento de los colgajos ni se manifestaron alteraciones en la funcionalidad de los hombros en ambos casos. El cierre del avance en V-Y se hizo sin tensión. En conclusión, si bien existen distintas opciones para reconstruir la región posterior cervical y occipital, este nuevo diseño de colgajo miocutáneo de trapecio es una herramienta segura, de fácil ejecución, reproducible y que conserva la funcionalidad del hombro.

  13. Reconstrucción en linfedema peneano y escrotal secundario a hernia inguinal bilateral gigante Reconstruction in penile and scrotal lymphedema secondary to billateral giant inguinal hernia

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    A. Fernández García

    2009-12-01

    Full Text Available El linfedema peneano y escrotal tiene consecuencias funcionales, estéticas, sociales y psicológicas significativas para el paciente que lo padece. Es una enfermedad infrecuente en los países desarrollados, aunque relativamente prevalente en los países tropicales. Su causa más común es la filariasis, aunque en nuestra práctica diaria se asocia más frecuentemente a cirugía, radioterapia, procesos inflamatorios y neoplásicos. Presentamos un caso singular de linfedema penoescrotal secundario a cirugía por hernia inguinal gigante bilateral que persistía un año después de la intervención. El tratamiento quirúrgico consistió en la exéresis de toda la piel linfedematosa del escroto involucrada y el uso de colgajos de piel escrotal posterior para la cobertura testicular. En un segundo tiempo quirúrgico se llevó a cabo una extirpación total de la piel del pene y del tejido subcutáneo superficial a la fascia de Buck. Empleamos injertos de piel de grosor parcial para cubrir el pene denudado. El resultado estético postoperatorio fue aceptable y los resultados funcionales y psicológicos son satisfactorios para el paciente 3 años después de la cirugía.Lymphedema of the penis and scrotum has important functional, cosmetic, social, psychological consequences for the affected patient. It is a rare disease in the developed countries, although it is relatively frequent in tropical countries. Globally, the most common cause is filariasis, although in our practice it is most frecuently associated to surgery, radiotherapy, inflammatory and neoplasic diseases. We report one rare case of penoscrotal lymphedema due to billateral giant inguinal hernia reconstrction. The lymphedema was persistent one year after the repair of the billateral hernia. The technique of reconstruction consisted of excision of all involved lymphedematous skin of the scrotum, and use of posterior scrotal flaps for testicular coverage. In a second surgical time, a total

  14. Reanimación palpebral con colgajo frontal miofuncional: Caso clínico

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    F. García-García

    2014-06-01

    Full Text Available El párpado es una estructura crítica para la protección y función del globo ocular, y parte primordial en la estética facial. Su reconstrucción está determinada por la extensión de la lesión y el compromiso de las diferentes capas. Siempre se preferirán tejidos loco-regionales debido a su mayor similitud y disposición. Los métodos de reanimación palpebral se pueden dividir en estáticos y dinámicos, considerando a estos últimos como el único medio para restaurar el parpadeo. Presentamos un caso de celulitis orbitaria preseptal con lesión de espesor total del párpado superior y su reconstrucción miofuncional utilizando un colgajo frontal. Este colgajo frontal miocutáneo logró la restauración funcional del párpado comprometido mediante la adición de fibras musculares y permitiendo el fenómeno de reinervación.

  15. Nuestra técnica de colgajo miocutáneo de pectoral mayor para reconstrucción de defectos cervicales

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    Roser García-Avellana

    Full Text Available Resumen Introducción y Objetivos Las técnicas actuales para reconstrucción de cabeza y cuello se basan principalmente en colgajos libres, fasciocutáneos o viscerales según el defecto. La evolución de la microcirugía ha relegado a un segundo plano a los colgajos pediculados. El colgajo miocutáneo pediculado de pectoral mayor ha sido uno de los más empleados hasta que se ha extendido el uso de los colgajos libres. Las desventajas que presenta, tales como su volumen o sus secuelas funcionales y estéticas, son responsables de su desuso actual. Presentamos una modificación de la técnica clásica del pectoral mayor para minimizar sus desventajas. Material y Método Hacemos una descripción técnica de la modificación desarrollada por Márquez-Cañada del colgajo de pectoral mayor para reconstrucción de defectos cervicales y un estudio descriptivo sobre un grupo de pacientes sometidos a la misma. Resultados Recogimos 6 casos, 5 varones y 1 mujer (edad media de 52.5 años, en los que se empleó la técnica descrita. El defecto más frecuente (66.7% fue el faringostoma secundario a laringuectomía total y vaciamiento cervical por carcinoma epidermoide de laringe. Tiempo medio entre intervenciones quirúrgicas de 5 semanas. En 2 casos hubo como complicación serohematoma en zona donante tras el primer tiempo quirúrgico, No hubo pérdida de injertos ni necrosis, fístulas o estenosis secundarias. Resultado estético aceptable; los pacientes conservaron movilidad completa del brazo. Conclusiones Observamos una reducción en el número de complicaciones respecto del uso del pectoral mayor clásico y los colgajos libres Creemos que la modificación técnica que presentamos, por su reproducibilidad y su baja tasa de complicaciones, podría emplearse en reconstrucción de cuello como colgajo de elección en pacientes de alto riesgo, no candidatos a técnicas microquirúrgicas.

  16. Analgesia pós-operatória para procedimentos cirúrgicos ortopédicos de quadril e fêmur: comparação entre bloqueio do compartimento do psoas e bloqueio perivascular inguinal Analgesia postoperatoria para procedimientos quirúrgicos ortopédicos de cadera y fémur: comparación entre bloqueo del compartimiento del psoas y bloqueo perivascular inguinal Postoperative analgesia for orthopedic surgeries of the hip and femur: a comparison between psoas compartment and inguinal paravascular blocks

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2006-12-01

    dos cinco nervos do plexo lombar.JUSTIFICATIVA Y OBJETIVOS: Este estudio evaluó la eficacia de la inyección única de bupivacaína a 0,25% en el compartimiento del psoas o perivascular inguinal a través del estimulador de nervios periféricos para analgesia postoperatoria en pacientes sometidos a intervenciones quirúrgicas ortopédicas. MÉTODO: Cien pacientes recibieron bloqueo del plexo lumbar a través del compartimiento del psoas y fueron comparados con 100 pacientes que recibieron bloqueo del plexo lumbar vía perivascular inguinal, identificados por el estimulador de nervios periféricos con la inyección de 40 mL bupivacaína a 0,25% sin epinefrina. La analgesia en los nervios ilioinguinal, genitofemoral, cutáneo femoral lateral, femoral y obturatorio fue evaluada a las 4, 8, 12, 16, 20 y 24 horas después del final de la intervención quirúrgica. La intensidad del dolor también fue medida en el mismo período. La cantidad de opioides administrada en el postoperatorio fue anotada. En cinco pacientes de cada grupo, un estudio radiográfico con contraste no iónico se realizó para medir la dispersión de la solución anestésica. RESULTADOS: Los nervios ilioinguinal, genitofemoral, cutáneo femoral lateral, femoral y obturatorio fueron bloqueados en 92% de los pacientes en el compartimiento del psoas versus 62% en el bloqueo perivascular inguinal. El bloqueo del plexo lumbar redujo la necesidad de opioides y 42% de los pacientes sometidos al bloqueo del compartimiento del psoas y 36% de los pacientes en el bloqueo inguinal no necesitaron analgésico adicional en el postoperatorio. La duración de la analgesia fue de aproximadamente 21 horas con el bloqueo del compartimiento del psoas y 15 horas en el bloqueo perivascular inguinal. CONCLUSIONES: El bloqueo del compartimiento del psoas y perivascular inguinal es una excelente técnica para la analgesia postoperatoria en intervenciones quirúrgicas ortopédicas reduciendo la necesidad de opioides. Ese

  17. Estudio de fibras colágenas y elásticas del tejido conjuntivo de pacientes con y sin hernia inguinal primaria

    OpenAIRE

    Bórquez M,Pablo; Garrido O,Luis; Manterola D,Carlos; Peña S,Patricio; Schlageter T,Carol; Orellana C,Juan José; Ulloa U,Hugo; Peña R,Juan Luis

    2003-01-01

    There are few studies looking for collagen matrix defects in patients with inguinal hernia. Aim: To study the skin connective tissue in patients with and without inguinal hernia. Patients and methods: Skin from the surgical wound was obtained from 23 patients with and 23 patients without inguinal hernia. The samples were processed for conventional light microscopy. Collagen fibers were stained with Van Giesson and elastic fibers with Weigert stain. Results: Patients without hernia had compact...

  18. Colgajo deltopectoral bilateral para el tratamiento de úlceras por radionecrosis en el cuello: Caso clínico

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    P. Benito Duque

    2006-09-01

    Full Text Available Bakamjian describió el colgajo deltopectoral en 1965, recibiendo inicialmente una gran aceptación en cirugía de cabeza y cuello. Sin embargo, un porcentaje de fallos del 10%-25% descrito por varios autores motivó su progresivo abandono y su sustitución por otras alternativas. Los autores hacen una revisión de la bibliografía, analizando las modificaciones técnicas que han mejorado la viabilidad de este colgajo y describen la capacidad del colgajo deltopectoral elevado bilateralmente para aportar suficiente tejido en el caso de un paciente con defecto bilateral en el cuello secundario a radiodermitis severa. En la actualidad, el colgajo deltopectoral, teniendo en consideración las aportaciones técnicas descritas, puede seguir considerándose como una fuente de tejido con la calidad y fiabilidad idóneas para técnicas de reconstrucción superficial en cabeza y cuello.Bakamjian introduced the deltopectoral skin flap en 1965, and there after it was used extensively for reconstructive surgery of the head and neck. Within the next years, flap failure rates of 20% to 25% were reported, and several alternative methods of reconstruction have supplanted the preeminent position of the deltopectoral flap. This work is a review of the reconstructive experience afforded by several authors and evaluates the technical modifications used to enhance the reliability of this flap. The authors describe the ability of the deltopectoral flap raised bilaterally to provide tissue enough for an extensive irradiated neck, allowing resurfacing a bilateral cutaneous defect after radiation therapy. The deltopectoral flap remains a useful and reliable tissue source for superficial neck reconstruction by implementing several technical modifications.

  19. Liposucción en Cirugía Reparadora (desengrasamiento de colgajos cutáneos y miocutáneos, exéresis de acúmulos grasos y autotransplante de grasa

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    J.Mª Serra Renom

    2013-12-01

    Full Text Available La liposucción es una técnica quirúrgica de gran utilidad para la remodelación de acúmulos grasos y para el desgrasamiento de los colgajos cutáneos, miocutáneos o musculares. Para el desgrasamiento de los colgajos la realizamos después del año de efectuado el colgajo. También la empleamos en acúmulos grasos, en la reconstrucción mamaria postmastectomía, y acúmulos grasos periféricos en la reducción mamaria. Igualmente en el tratamiento de cicatrices deprimidas con prominencia de tejidos vecinos. En zonas deprimidas la realización del autotransplante de grasa nos ha dado buenos resultados.

  20. Etiology of Inguinal Hernias

    DEFF Research Database (Denmark)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    BACKGROUND: The etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias. RESULTS: Lateral a...

  1. Combinación de colgajos locales y libre microvascularizado para reconstrucción del tercio facial inferior tras traumatismo por arma de fuego Combination of local and free microvascularized flaps for reconstruction of the lower third of the face after gunshot injury

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    Laura Villanueva-Alcojol

    2011-12-01

    Full Text Available El traumatismo por arma de fuego en el territorio maxilofacial constituye uno de los mayores retos a los que se enfrenta el cirujano a la hora de la reconstrucción. La diferencia esencial con otro tipo de traumatismos es la severidad de la lesión y la pérdida de tejidos óseos y blandos. Podemos encontrar en la literatura numerosos artículos sobre reconstrucción facial tras extirpación oncológica; sin embargo, hay pocos documentos que discutan la utilización de colgajos locales y libres microvascularizados para reconstrucción de defectos tras traumatismos de alta energía, y los algoritmos terapéuticos para reconstrucción postraumática. En este trabajo se presenta un caso de reconstrucción del tercio inferior facial tras intento de autolisis y se hace una revisión de los principios de tratamiento de este tipo de pacientes.Gunshot wounds to the maxillofacial region are a challenging problem for the surgeon responsible for reconstruction. The essential difference with respect to other injuries is the severity of the lesion and soft and hard tissue loss. Extensive literature exists on facial reconstruction following tumor extirpation, but there are few reports on the use of local flaps and free tissue transfer for the post-traumatic reconstruction of high-energy defects and therapeutic algorithms for post-traumatic reconstruction. The authors report the case of a patient with reconstruction of the lower third of the face after a suicide attempt and review the principles of treatment of these patients.

  2. Inguinal herniorrhaphy in women

    DEFF Research Database (Denmark)

    Bay-Nielsen, Morten; Kehlet, Henrik

    2006-01-01

    Inguinal hernias in women are relatively rare, and an outcome in this specific subgroup of hernias has not been documented in the literature. An analysis was performed using data from the prospective recording of 3,696 female inguinal hernia repairs in the national Danish hernia database, in the 5.......1%) (P=0.001). The reoperation rate was independent of the type of surgical repair. In 41.5% of the reoperations a femoral hernia was found, compared to 5.4% in males. Female inguinal herniorrhaphy is followed by a higher reoperation rate than in males, and is unrelated to the type of repair...

  3. Reconstrucción cervical tras resección de neurofibroma solitario gigante con colgajo anterolateral de muslo

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    Mauricio Mendieta-Espinosa

    Full Text Available Los tumores de cabeza y cuello son un grupo heterogéneo; los neurofibromas pueden originarse de cualquier nervio independientemente de su localización, incluyendo nervios periféricos o intracraneales y se dividen en 4 tipos. Los solitarios son tumores confinados, espontáneos y prácticamente sin ninguna manifestación. Anatómicamente, los neurofibromas del cuello son relativamente raros, con un crecimiento lento e indoloro. Presentamos el caso de un paciente varón de 41 años de edad, remitido a nuestra consulta por presentar neurofibroma solitario gigante en la base del lado izquierdo del cuello, de 10 cm de diámetro, con zona central ulcerada y sangrados intermitentes, adherido a planos profundos, de 30 años de evolución y que había sido tratado en 3 ocasiones con resecciones parciales y cubertura con colgajo acromial. Practicamos resección completa de la tumoración y reconstrucción inmediata con colgajo anterolateral de muslo, logrando la mejoría estético-funcional de la zona cervical y sin complicaciones.

  4. Inguinal syndrome with penoscrotal elephantiasis

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    Aggarwal Kamal

    2002-11-01

    Full Text Available Bilateral inguinal adenitis and penoscrotal elephantiasis are uncommonly encountered presentations of Lymphogranuloma venereum. Herein, we report a male who presented with bilateral inguinal bubos alongwith penoscrotal elephantiasis that developed within 6 months of the primary lesion.

  5. Inguinal metastases from testicular cancer

    DEFF Research Database (Denmark)

    Daugaard, Gedske; Karas, Vladimir; Sommer, Peter

    2006-01-01

    To evaluate the incidence of inguinal metastases in patients with testicular cancer and relapse after initial stage I disease.......To evaluate the incidence of inguinal metastases in patients with testicular cancer and relapse after initial stage I disease....

  6. El reto de las transferencias de colgajos libres en pacientes quemados: ¿cuál es el momento para la cirugía?

    Directory of Open Access Journals (Sweden)

    M.E. Villaverde-Doménech

    Full Text Available La transferencia de colgajos libres es una herramienta fundamental dentro del arsenal reconstructivo para el tratamiento quirúrgico del gran quemado. Durante años ha existido controversia sobre la influencia del momento de la cirugía sobre la tasa de complicaciones, así como el alto riesgo de complicaciones al realizar reconstrucciones con colgajos libres en pacientes quemados. Diseñamos un estudio retrospectivo de las reconstrucciones quirúrgicas mediante colgajos libres realizadas en nuestra Unidad de Quemados del Hospital Universitari y Politecnic La Fe, de Valencia (España en el periodo comprendido entre 2001 y 2013, recogiendo todos los datos relativos al paciente, a la lesión, al procedimiento reconstructivo, a los resultados y relacionando todo ello con el momento en el cual se realizó la cirugía. Para el análisis de los datos y asociaciones entre distintas variables usamos tablas de contingencia y aplicamos el test de independencia de Chi-cuadrado. Exponemos además 2 casos clínicos representativos de la cirugía reconstructiva practicada en pacientes quemados. Recogimos en total datos de 21 procedimientos de reconstrucción mediante colgajo libre en pacientes quemados. En ninguno se realizó reconstrucción primaria inmediata (en los primeros 5 días, mientras que la reconstrucción primaria temprana (entre el día 5 y el 21 se realizó en el 28,57 % de los casos, la primaria intermedia (entre el día 21 y las 6 semanas en el 28,57 %, la secundaria (más de 6 semanas en el 9,5 %, y la cirugía de secuelas en el 33,33 % de los casos. Las tasas de complicaciones mayores y menores fueron respectivamente 19,05 % y 9,5 % . El 50 % de complicaciones mayores ocurrieron en el periodo de reconstrucción primaria temprana, mientras que no registramos ninguna en el periodo primario intermedio. El resto de complicaciones se repartió a partes iguales entre el periodo secundario y la cirugía de secuelas (ambas con el 25 %. No

  7. Colgajo de omento para tratamiento de dehiscencia de herida esternal Omental flap for management of sternal wound dehiscence

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    A. Pérez García

    2013-03-01

    Full Text Available La mediastinitis es una de las complicaciones más graves de la cirugía cardíaca. Aparece en el 0,5-5 % de las esternotomías y esta incidencia es mucho mayor en pacientes diabéticos, obesos, inmunodeprimidos, con enfermedad pulmonar obstructiva crónica (EPOC, etc. Presentamos el caso de una paciente diabética, obesa mórbida, que sufre mediastinitis tras doble by-pass coronario. Para la cobertura del defecto se empleó un colgajo de epiplon tunelizado transdiafragmático. El colgajo omental permite cubrir grandes defectos además de que posee capacidad antimicrobiana y favorece la revascularización tisular. Las características de este colgajo hacen que actualmente deba considerarse como primera elección en pacientes con grandes defectos esternales y trastornos de la inmunidad y la cicatrización.Mediastinitis is one of the most serious complications from cardiac surgery. It is reported to occur in 0'5-5 % of sternotomy incisions, and this incidence is much higher in diabetic patients, obese, immunocompromised, COPD, etc. We report a case of a diabetic and morbid obese woman suffering mediastinitis after double coronary bypass surgery. For the reconstruction a transdiaphragmatic tunnelled omental flap was used. The omentum is useful to cover large defects. It has antiinfective properties and promotes revascularization of neighbouring tissues. Omental flap can be a highly effective treatment for patients with large sternal wounds and immune disorders and wound healing disorders.

  8. Colgajo prefabricado occipital para cobertura de exposición ósea craneal Prefabricated occipital flap to cover craneal bone exposition

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    B. Rivas León

    2010-03-01

    Full Text Available La exposición del cráneo tras un tratamiento quirúrgico oncológico agresivo es un desafió reconstructivo para el cirujano plástico; los defectos pueden variar en dimensiones y complejidad, desde pequeños defectos, que pueden ser cubiertos con injertos dérmicos o colgajos locales, a defectos más extensos que requerirán de un colgajo libre para su cobertura. Presentamos el caso de un varón de 39 años de edad que presentó un defecto biparietal posterior a radioterapia y resección por carcinoma. El defecto fue cubierto con un colgajo prefabricado axial, tomado del área antebraquial e implantado bajo la piel cabelluda occipital, para posteriormente ser llevado al sitio del defecto. El colgajo axial occipital evolucionó satisfactoriamente y logramos cubrir el defecto en su totalidad, sin complicaciones. En conclusión, el colgajo prefabricado occipital aporta suficiente piel cabelluda con patrón vascular axial para cubrir hueso craneal expuesto, cuando no hay una mejor opción cosmética.Cranial bone exposition after an aggressive oncological treatment is a challenge for plastic surgeon; defects can range in size and complexity, from small defects which can be covered only with skin graft or local flaps, to extensive defects that will require a free flap cover. We report a case of a 39 years-old man, who presented soft tissue defect of biparietal area following to radiotherapy and carcinoma resection. This defect was covered by prefabricated axial flap, which was harvest of forearm area and implanted under occipital hair skin and subsequently transported to the defect. The axial occipital flap healed uneventfully with a good outcome; we managed to cover the scalp defect completely without complications. As a conclusion, prefabricated occipital flap provides enough hair skin, with axial vascularity pattern to cover cranial bone exposed, when there is not a better cosmetical option.

  9. Reconstrucción de cuero cabelludo con colgajo libre de omentum Reconstruction of the scalp with a free flap of omentum

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    C. Navarro Cuellar

    2004-08-01

    Full Text Available Los defectos de cuero cabelludo pueden tener una etiología diversa. Resecciones oncológicas, lesiones postraumáticas e infecciosas pueden dar lugar a diferentes defectos en cuanto a tamaño y extensión. Para su reconstrucción disponemos de múltiples técnicas quirúrgicas como colgajos locales, regionales y expansores titulares. No obstante, para defectos extensos los colgajos libres son la única posibilidad reconstructiva. Presentamos el caso de un paciente con carcinomas epidermoides multicéntricos en cuero cabelludo tratado previamente con radioterapia en el que se realizó una resección amplia del cuero cabelludo y fue reconstruído con un colgajo libre de omentum.Scalp defects may have different etiologies. Oncologic resections, postraumatic lesions and infectious wounds may lead to a great variety of defects in size and extension. In order to accomplish the reconstruction we have different surgical techniques such as local and regional flaps and tissue expanders. Nevertheless, for more extensive defects free flaps are the only reconstructive possibility. We present the case of a patient with multicentric squamous cell carcinomas previously with radiotherapy. He underwent wide resection and was reconstructed with an omentum free flap.

  10. Colgajo sural reverso en pacientes pediátricos: experiencia de 6 años Reverse sural flap in pediatric patients: 6 years experience

    Directory of Open Access Journals (Sweden)

    S. De la Cruz Reyes

    2012-12-01

    Full Text Available Entre las técnicas reconstructivas de miembros inferiores se encuentra el colgajo neurocutáneo de flujo reverso utilizando el paquete neurovascular sural, técnica conocida pero con escasa experiencia publicada en infantes. El objetivo de este trabajo es presentar y analizar 10 casos clínicos en los que se utilizó el colgajo sural reverso en pacientes de edad pediátrica. Realizamos un estudio retrospectivo, descriptivo y observacional, que incluye a todos los pacientes menores de 16 años a los que se les realizó una reconstrucción con colgajo sural reverso durante el período comprendido entre marzo del 2004 y abril del 2010 en el Centenario Hospital Miguel Hidalgo de Aguascalientes, México. Se incluyeron 10 casos con una mediana de edad de 10 años (rango de 3 a 15 años, 6 masculinos y 4 femeninos. El mecanismo del trauma en 6 de los casos fue por lesión en motocicleta, en 2 paientes atropello por automóvil, 1 caso por lesión en bicicleta y 1 caso con lesión por proyectil de arma de fuego. Las áreas afectadas fueron región dorsal del pie en 5 casos, región calcánea en 4 casos, y una lesión maleolar externa. La mediana del diámetro de las superficies afectadas fue de de 8.8 cm. Tres pacientes presentaron complicaciones postoperatorias menores, 2 epidermólisis distales y 1 dehiscencia parcial del colgajo. No se presentó ninguna complicación grave ni hubo perdidas de colgajos. Los resultados fueron considerados como favorables en el 100 % de los pacientes al término del seguimiento. La técnica de reconstrucción del miembro inferior, específicamente en el caso de lesiones en pie, con colgajo neurocutáneo sural en isla de flujo reverso es, a nuestro juicio, una opción eficaz de tratamiento también para pacientes pediátricos.Among the lower leg reconstructive techniques, the reverse sural neurocutaneous flap is a well known technical option, with little experience reported in infants. Our aim is the pesentation and

  11. Etiology of Inguinal Hernias

    DEFF Research Database (Denmark)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    BACKGROUND: The etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias. RESULTS: Lateral...... and medial hernias seem to have common as well as different etiologies. A patent processus vaginalis and increased cumulative mechanical exposure are risk factors for lateral hernias. Patients with medial hernias seem to have a more profoundly altered connective tissue architecture and homeostasis compared...... mechanisms why processus vaginalis fails to obliterate in certain patients should also be clarified. Not all patients with a patent processus vaginalis develop a lateral hernia, but increased intraabdominal pressure appears to be a contributing factor....

  12. Colgajos de perforantes de las arterias epigástricas inferiores profunda y superficial Deep and superficial inferior epigastric artery perforator flaps

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    A. R. Gagnon

    2006-12-01

    Full Text Available Con el desarrollo de los colgajos miocutáneos de recto abdominal (TRAM, el abdomen inferior ha sido reconocido como la principal área dadora de tejidos autólogos de alta calidad, especialmente útiles en reconstrucción mamaria. Más recientemente la habilidad para obtener componentes adiposocutáneos similares sin sacrificar el músculo recto ha revolucionado el campo de la Cirugía Reconstructiva. El advenimiento de los colgajos de perforantes ha permitido a los cirujanos plásticos lograr los mismos buenos resultados estéticos que con los colgajos miocutáneos tradicionales, pero con un considerable descenso en la morbilidad del área donante. Con los colgajos de perforantes de la arteria epigástrica inferior profunda (DIEP y de la arteria epigástrica inferior superficial (SIEA, los pacientes han incrementado sus opciones de reconstrucción. Este artículo revisa la anatomía quirúrgica de la pared abdominal relativa a los colgajos SIEA y DIEP. Se explican detalladamente los pasos principales para la preparación preoperatoria, la técnica quirúrgica y los cuidados postoperatorios. Se discuten las ventajas y desventajas y se presen- tan los trucos técnicos que pueden ayudar a mejorar el resultado final. Además se ilustran con ayuda de casos clínicos las indicaciones típicas y atípicas.Following the development of the transverse rectus abdominis myocutaneous (TRAM flap, the lower abdomen has been recognized as a prime source of high quality autogenous tissue, especially useful in breast reconstruction. More recently, the ability to harvest a similar adipocutaneous component without sacrifice of the rectus muscle has revolutionized the field of reconstructive surgery. The advent of perforator flaps has allowed plastic surgeons to achieve the same highly esthetic results as with the former myocutaneous flaps while significantly decreasing the donor site morbidity. With the deep inferior epigastric artery perforator (DIEP flap and

  13. Angiotomografía computerizada, colgajos de perforante, cirujano y OsiriX Computed tomography angiography, perforator flaps, surgeon and OsiriX

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    M. Rodríguez-Vegas

    2013-03-01

    Full Text Available Desde la introducción de la transferencia cutánea basada en perforantes, la angiotomografía computerizada ha emergido como una técnica de gran valor en la planificación preoperatoria de los colgajos de perforante. Sin embargo, parece probable que el aprovechamiento de la técnica sea menor del deseable. Evaluamos, a través de la experiencia en 144 pacientes, la utilidad del visor gratuito de imágenes DICOM OsiriX para Mac en la planificación preoperatoria de los colgajos de perforante con tres objetivos: 1 ampliar los conocimientos actuales relacionados con la aplicación de la angiotomografía computerizada en la planificación preoperatoria de los colgajos de perforante, 2 evaluar la aplicación OsiriX en el post-procesamiento de imágenes en la planificación preoperatoria de colgajos de perforante y 3 evaluar el rendimiento obtenible de la angiotomografía considerando que el postprocesamiento es realizado por un cirujano (no especialista en Radiodiagnóstico. La experiencia permite afirmar que el postprocesamiento de las imágenes DICOM por el cirujano con la aplicación Osirix permite habitualmente evaluar de manera adecuada diversas estructuras y parámetros de gran interés en la cirugía de colgajos de perforante: 1 arteria principal, origen de la perforante, 2 diámetro de arteria y vena/s en el hipotético sitio de anastomosis microquirúrgica, 3 recorrido y patrón de ramificación del pedículo del colgajo, 4 disposición de la perforante en la grasa subcutánea (teórico eje de diseño del colgajo, 5 medición del grosor cutáneo en el punto de perforación de la fascia profunda por la rama perforante (teórico grosor de colgajo, 6 medición de la distancia entre el punto de perforación de la fascia profunda por la rama perforante y el origen de la arteria principal (teórica longitud máxima posible de pedículo y 7 medición del diámetro, en el punto de perforación de la fascia profunda, de la perforante. En

  14. Análisis de controversias en reconstrucción mamaria con colgajo DIEP Analysis of debated uses in mammary reconstruction with DIEP flap

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    C. Casado Sánchez

    2008-12-01

    Full Text Available La reconstrucción mamaria mediante colgajo DIEP (Deep Inferior Epigastric Perforator se encuentra condicionada en muchas ocasiones por características de la paciente o del tratamiento oncológico recibido, de tal forma que diversos grupos de trabajo contraindican este método en caso de existir alguno de esos factores. Nosotros hemos realizado un estudio de los mismos, analizando su impacto sobre la viabilidad del colgajo y su correlación con las complicaciones postoperatorias, para optimizar así su indicación. Los condicionantes analizados son el tabaco, las intervenciones quirúrgicas previas que afecten en alguna medida la pared abdominal, el sobrepeso u obesidad de la paciente, el volumen de la mama contralateral, el tratamiento radioterápico anterior o posterior a la reconstrucción, y finalmente el gasto sanitario que supone. Estas controversias son a su vez las más discutidas en la literatura al respecto. Se valoran los resultados obtenidos tras 55 reconstrucciones mamarias mediante colgajo DIEP entre enero de 2000 y noviembre de 2005, así como los estudios y publicaciones más recientes existentes sobre esta materia. Hemos encontrado una pobre correlación entre los índices de fracaso del colgajo y las controversias estudiadas, determinando así dos contraindicaciones absolutas para que una paciente pudiese beneficiarse de un colgajo DIEP: abdominoplastia previa y radioterapia adyuvante tras reconstrucción inmediata. Los excelentes resultados que se obtienen globalmente, nos llevan a recomendar este colgajo por encima de otras opciones terapéuticas.The use of DIEP (Deep Inferior Epigastric Perforator flap surgery in breast reconstruction is often conditioned by the patient and the oncologic treatment characteristics to such an extent that several working groups advise against this surgical procedure when any of these factors is present. In the study of this interaction, an analysis of its impact on the flap feasibility and its

  15. Convalescence after inguinal herniorrhaphy

    DEFF Research Database (Denmark)

    Bay-Nielsen, M.; Thomsen, H.; Andersen, H.F.

    2004-01-01

    leisure activity was 14 days. After 30 days, 6.8 per cent of patients had not resumed employment and 17.0 per cent had not yet resumed strenuous leisure activity. Important reasons for not resuming work and leisure activity were pain (approximately 60 per cent of patients) and wound problems...... incurring a risk of higher reoperation rates. Pain and wound problems remain the most important factors for not resuming work or leisure activity as recommended.......BACKGROUND: Convalescence after inguinal herniorrhaphy is usually 3-4 weeks and is an important outcome parameter of hernia surgery. The aim of this study was to describe in detail the consequences of recommending a short convalescence, including the risk of recurrence. METHODS...

  16. Hernia inguinal laparoscopic surgery

    International Nuclear Information System (INIS)

    Morelli Brum, R. . E mail: raulmorelli@hotmail.com

    2005-01-01

    The purpose of this paper is to enhance treatment of inguinal hernia through a bibliographic study of its main complications and the analysis of a retrospective series of laparoscopic restorations performed by the author in the same private medical care center. From December 1994 through July 2003, ninety-nine patients were operated in 108 procedures.The technique employed was trans-abdominal peritoneal (TAPP)Follow-up covered over 2 years in 80% of patients with a relapse of 2.8%. Main morbidity was neuralgia due to a nerve being trapped, which fact required re-intervention.There was no mortality.The conclusion arrived at is that it is and excellent technique which requires a long learning curve and its main indication would be relapse of conventional surgery, bilateralism, coexistence with another laparoscopic abdominal pathology and doubts concerning contra lateral hernia

  17. Laparoscopic Repair of Inguinal Hernias

    OpenAIRE

    Carter, Jonathan; Duh, Quan-Yang

    2011-01-01

    For patients with recurrent inguinal hernia, or bilateral inguinal hernia, or for women, laparoscopic repair offers significant advantages over open techniques with regard to recurrence risk, pain, and recovery. For unilateral first-time hernias, either laparoscopic or open repair with mesh can offer excellent results. The major drawback of laparoscopy is that the technique requires a significant number of cases to master. For surgeons in group practice, it makes sense to have one surgeon in ...

  18. Experiencia en reconstrucción auricular en cáncer de piel con colgajo en "quesadilla" Experience in auricle reconstruction after skin carcinoma with "quesadilla" flap

    Directory of Open Access Journals (Sweden)

    C. Gutiérrez Gómez

    2008-06-01

    Full Text Available La reconstrucción auricular es una de las más difíciles ya que implica reproducir las sofisticadas y delicadas formas del pabellón auricular. Cuando hay que resecar piel en la oreja por un cáncer cutáneo y dejamos expuesto el cartílago, sin pericondrio, suele suceder que al colocar injertos no hay una integración adecuada de los mismos por las caprichosas formas y relieves del pabellón auricular; cuando es necesario resecar el pericondrio estamos obligados a cubrir el defecto con un colgajo y no con un simple injerto. Frente a esta dificultad técnica, diseñamos un colgajo ricamente vascularizado que preserva el cartílago no afectado con una buena cubierta y al mismo tiempo respeta la anatomía de la oreja. Para la cobertura del cartílago auricular anterior usamos un colgajo fasciocutáneo posterior que se asemeja a un plato típico de la cocina mexicana que llamamos "quesadilla", donde el cartílago por su color blanco recuerda el queso y el gran colgajo fasciocutaneo recuerda la tortilla que cubre al queso. Este colgajo incluye la piel enrollada del hélix, que en un segundo tiempo retornará a su lugar de origen anatómico mediante una z-plastía asimétrica. Presentamos, de entre una serie de 13 pacientes con carcinoma de pabellón auricular, 2 casos resueltos mediante esta técnica.Auricle reconstruction is one of the most difficult techniques because of the sophisticated and delicates forms of the ear. When we need to remove the auricular skin, preserving the cartilage is very important to keep the shape of the auricle. If treating an auricular skin cancer we find an unaffected cartilage, we can use a skin grafting, but in such delicates forms and curves many times it results inappropriate or the lack of pericondrium difficult skin graft integration. When pericondrium is affected, we will need a skin flap to cover de defect. We designed a rich vascularized flap that preserves the unaffected cartilage with an adequate coverage

  19. Colgajo póstero-medial de muslo (adductor: a propósito de un caso Postero-medial thigh flap (adductor flap: case report

    Directory of Open Access Journals (Sweden)

    L. Gómez-Escolar Larrañaga

    2008-12-01

    Full Text Available En pacientes con úlceras masivas o confluentes en la región glútea, puede ser necesaria la amputación de la extremidad inferior y la reconstrucción mediante colgajos totales de muslo para la cobertura del defecto. Esta técnica es muy agresiva y además de las evidentes secuelas físicas que crea puede generar importantes trastornos psíquicos para el paciente. Presentamos el caso de una paciente con una gran úlcera por decúbito en la región isquio-trocantéreosacra en la que se empleó el colgajo Adductor como alternativa a la amputación de la extremidad inferior.Amputation of the lower extremity and total thigh flaps may be necessary for coverage in patients with massive multiple or confluent sores in the buttock region. This is an aggressive technique with important physical and psychological consequences for the patient. The Adductor flap was used as an alternative of the amputation in a patient with a big ischial-trocantericsacral pressure sore.

  20. El colgajo fasciocutáneo dorsal ulnar en quemaduras eléctricas de la mano: un colgajo constante, rápido y seguro

    Directory of Open Access Journals (Sweden)

    Trinidad Delgado-Ruiz

    2016-03-01

    Full Text Available Antecedentes y Objetivos. La extremidad superior es el área más frecuentemente afectada en las quemaduras eléctricas de alto voltaje, con una alta tasa de amputaciones, síndromes compartimentales y defectos de partes blandas que precisan cobertura. La literatura en cuanto a la cirugía reconstructiva de la mano con quemaduras eléctricas es escasa, pero es fundamental en la fase aguda establecer un plan quirúrgico y una cobertura estable de estos frecuentes defectos en mano y muñeca. Pacientes y Método. Empleamos el colgajo fasciocutáneo dorsal ulnar en 3 pacientes con defectos cutáneos en muñeca secundarios a quemaduras eléctricas de alto voltaje, durante la fase aguda de estas lesiones. Resultados. Obtuvimos en todos los casos una cobertura estable y de alta calidad y sin registrar complicaciones relacionadas con el colgajo o con la zona donante. Conclusiones. Debido a la constancia de su pedículo, la rapidez y seguridad de su disección y la preservación de ambos ejes arteriales, el colgajo fasciocutáneo dorsal ulnar es una herramienta de primer uso en la cobertura de los defectos de la mano y de la muñeca tras quemaduras eléctricas de alto voltaje.

  1. Reconstrucción de canto interno y pared lateral nasal con colgajo zigomático de mejilla Reconstructing soft tissue defects at the medial canthus and sidewalls of the nose with cheek zygomatic flap

    Directory of Open Access Journals (Sweden)

    J. de Abullarade

    2009-06-01

    Full Text Available En la reconstrucción del canto interno palpebral y de la pared lateral nasal es importante la continuidad del color, de la textura y del grosor del tejido que vamos a reemplazar. El colgajo zigomático de mejilla es un colgajo de patrón axial que, cuando se diseña adecuadamente, puede seguir los contornos naturales de la cara, como el pliegue nasolabial y el borde del párpado inferior, logrando un reemplazo casi exacto de la calidad de la piel existente y con una reparación realizada en un solo tiempo quirúrgico.In it's important to keep the continuity of colour, texture and thickness of the tissue in a reconstructed nose. The zigomatic cheek flap is an axial pattern flap that, when is properly designed, can follow the natural existing contour lines such as the nasolabial fold and the lower eyelid border. It gets an almost exactly replacement of matching skin quality, in one surgical stage.

  2. Colgajo bilateral de perforantes lumbares para la reconstrucción de un severo defecto tóracolumbar Bilateral lumbar perforator flap in reconstruction of a wide toracolumbar defect

    Directory of Open Access Journals (Sweden)

    P. Benito Duque

    2006-06-01

    Full Text Available En la reconstrucción de los defectos toracolumbares se han empleado numerosas técnicas quirúrgicas. Ocasionalmente se puede utilizar el cierre directo, injertos de piel, colgajos de dorsal ancho volteado y lumbosacro transverso, colgajos de transposición o de rotación tipo random, pero están limitados cuando los tejidos circundantes están radiados o presentan cicatrices por cirugías previas. Igualmente, la extensión del defecto puede hacerlos inviables. Los colgajos de perforantes están especialmente indicados en pacientes con deambulación conservada, haciendo posible el aporte de una gran superficie de piel y tejido subcutáneo bien vascularizado, basado en los vasos perforantes y evitando así el sacrificio de vasos principales o músculos. Presentamos el caso de una paciente con un defecto en la espalda de 17 cm. De diámetro secundario a la resección de un tumor espinocelular con exposición de cuerpos vertebrales, tratado mediante la transposición de dos colgajos basados en las arterias perforantes lumbares asociados a un colgajo de rotación de dorsal ancho miocutáneo.Thoracolumbar defects have been treated by a variety of surgical methods. Primary closure, skin grafting, reverse latissimus dorsi musculocutaneous flap, transverse lumbosacral back flap, local randomly designed rotation, or transposition flaps may be indicated in occasional cases, but there is limited indication for their use in some cases with a wide lesion or when the surrounding tissues have been compromised by previous surgery or irradiation. Perforator flaps are specially indicated for ambulatory patients, in which large amounts of well-vascularized skin and subcutaneous tissue are transfered easily based on one perforator vessel without sacrificing main vessels or muscles. The authors present a patient with a 17 cm wide defect in the midback region and exposed bone after excision of a squamous cell carcinoma, treated by two perforator flaps based on

  3. Colgajo en hacha de tensor de fascia lata para úlceras por presión trocantereas Hatchet-Shaped fascia lata tensor flap for the treatment of trochanteric pressure sores

    Directory of Open Access Journals (Sweden)

    W. Calderón

    2010-12-01

    Full Text Available Las úlceras trocantéreas por presión representan un problema importante a nivel extra e intrahospitalario. Existen múltiples opciones terapéuticas, ya sean colgajos randomizados, musculocutáneos, fasciocutáneos o libres. Presentamos la técnica quirúrgica del colgajo en hacha de tensor de fascia lata para el tratamiento de esta patología. Consiste en el diseño de un colgajo en V con irrigación por su base superior, que contacta con la úlcera por uno de sus extremos, simulando la forma de un hacha. Resecamos la úlcera hasta obtener un lecho vital, resecando además el hueso prominente dicho hasta un plano en que se visualice tejido sano. Levantamos y rotamos el colgajo cubriendo el defecto. Finalmente se realiza el cierre primario en VY sin tensión. La zona donante permite un cierre primario sin tensión. Mantenemos drenajes durante 10 días. Este colgajo permite obtener una buena cobertura para úlceras trocantéreas por decúbito con un adecuado resultado cosmético. Recogemos una casuística de 17 úlceras tratadas mediante el colgajo descrito; como complicaciones se presentaron 3 seromas, resueltos con sistema de cierre con presión negativa externa e interna; 2 casos de dehiscencia de sutura y 2 hematomas resueltos en pabellón de cirugía. Creemos pertinente conocer este colgajo que debe estar siempre presente dentro de las posibilidades terapéuticas para pacientes con úlceras trocantereas por decúbito.The trochanteric pressure sore it´s an important intra and extrahospitalary problem. There are different therapeutic options for this pathology, for example random, musculocutaneous, fasciocutaneous or free flaps. We present the hatchet-shaped fascia lata tensor flap to treat this kind of lesions. We design a V flap with irrigation in the superior base, having one of the extreme in contact with the sore. The shape of the flap is a hatchet. It´s important to get a vital bed resecting affected tissues and prominent bone; then

  4. The Danish Inguinal Hernia database

    DEFF Research Database (Denmark)

    Friis-Andersen, Hans; Bisgaard, Thue

    2016-01-01

    AIM OF DATABASE: To monitor and improve nation-wide surgical outcome after groin hernia repair based on scientific evidence-based surgical strategies for the national and international surgical community. STUDY POPULATION: Patients ≥18 years operated for groin hernia. MAIN VARIABLES: Type and size...... access to their own data stratified on individual surgeons. Registrations are based on a closed, protected Internet system requiring personal codes also identifying the operating institution. A national steering committee consisting of 13 voluntary and dedicated surgeons, 11 of whom are unpaid, handles...... the medical management of the database. RESULTS: The Danish Inguinal Hernia Database comprises intraoperative data from >130,000 repairs (May 2015). A total of 49 peer-reviewed national and international publications have been published from the database (June 2015). CONCLUSION: The Danish Inguinal Hernia...

  5. Reconstrucción de rodilla con doble colgajo de gemelo Knee reconstruction with double gemelar muscular flap

    Directory of Open Access Journals (Sweden)

    C. Márquez Zevallos

    2011-06-01

    Full Text Available Los traumatismos de miembros inferior representan un reto importante para el cirujano plástico en cuanto a su reconstrucción cuando no se dispone de técnicas microquirúrgicas. En el presente trabajo se presentan 2 casos de reconstrucción de rodilla con doble colgajo muscular de gemelo, en los que se demuestra que se pueden utilizar simultáneamente los dos gemelos sin dejar ninguna secuela estética importante ni funcional en la deambulación de los pacientes. Hasta donde podemos conocer, no existe en la literatura nacional ni internacional un reporte de casos con esta aplicación, ya que siempre se ha empelado un solo músculo precisamente por el temor a alterar la función de flexo-extensión del pie.Lower limb traumatism has always been a problem for plastic surgeon when in the moment of the surgical reconstruction we have not microsurgical techniques. In this paper, we present 2 cases of knee reconstruction using a double gemelar muscular flap, showing how is possible the simultaneous use of the two muscles without aesthetic or functional sequels. As we know, there is no national or international report of cases with this muscular reconstruction; it has been usual to use only one muscle, in order to avoid problems in the flexo-extension movements of the foot.

  6. Colgajo lingual para cierre de fístula oronasal: aportación a la técnica Lingual Flap for Closure of Oronasal Fistula: Contribution to the technique

    Directory of Open Access Journals (Sweden)

    Carlos Licéaga-Escalera

    2012-03-01

    Full Text Available La fístula oronasal es la complicación más común posterior a una palatoplastía y frecuentemente requiere de una reparación secundaria. Se ha desarrollado una gran cantidad de técnicas quirúrgicas para su manejo, siendo una de las más populares el colgajo lingual. A pesar de la excelente vascularidad de la lengua, para asegurar la viabilidad del colgajo, éste debe ser manejado con extremo cuidado durante el procedimiento. Con este propósito sugerimos el uso de una platina acrílica en forma de herradura que aporta estabilidad e inmoviliza la lengua durante la cirugía, lo que facilita el procedimiento y ayuda a evitar errores durante el diseño y el levantamiento del colgajo.The oronasal fistula is the most common complication after a palatoplasty and it frequently needs a secondary repair. A great number of surgical techniques have been developed for the management of this condition. The lingual flap is one of the most popular treatments. In spite of the excellent vascularity of the tongue, it must be handled carefully during the procedure to assure the viability of the flap. For this reason we suggest the use of an acrylic slide in the shape of horse-shoe that improves the stability and immobilises the tongue during the surgery. This makes the procedure easier and helps to avoid mistakes during the design and the raising of the flap.

  7. Transferencia microquirúrgica hemipulpar del hallux en la reconstrucción del pulgar

    Directory of Open Access Journals (Sweden)

    José-Manuel Rodríguez-Vegas

    Full Text Available Introducción y Objetivo. La transferencia hemipulpar del hallux permite excelentes reconstrucciones de pulgar porque ofrece tejidos blandos de alta calidad, contorno pulpar casi normal y recuperación sensitiva satisfactoria sin necesidad de reorientación cortical. Además, a diferencia de colgajos locales y regionales, evita la agresión adicional a una mano ya lesionada, optimizando así el período de rehabilitación y el resultado final. El artículo revisa la experiencia del autor en la técnica y compara el procedimiento con otras opciones reconstructivas. Material y Método. Realizamos una revisión retrospectiva de 16 pacientes sometidos a transferencia hemipulpar del hallux en el período 2007-2013. Todos los pacientes fueron varones, con una edad media de 34 años y una alta demanda funcional (trabajadores manuales con traumatismo laboral. La técnica fue indicada en defectos mayores del 50% de la superficie pulpar del pulgar en pacientes sin factores de riesgo asociados relevantes. En 3 de los casos el defecto pulpar asoció un defecto óseo de falange distal de tamaño suficiente para aconsejar la transferencia combinada osteo-pulpar. Resultados. Quince de los 16 colgajos sobrevivieron sin incidencias postoperatorias. Un colgajo sufrió trombosis arterial con retirada del colgajo y cirugía adicional de cobertura. En 2 pacientes se realizó revisión estética del colgajo de manera diferida. Excepto en el caso fallido, todos los pacientes volvieron a su actividad laboral previa con excelente recuperación funcional de la mano. El cierre de la zona donante se realizó mediante cierre directo (12 pacientes o injerto cutáneo (4 pacientes. Ninguno de los pacientes, independientemente del tipo de cierre del defecto en el pie, refirió problemas en la deambulación o apariencia estética del pie. Conclusiones. La reconstrucción de defectos pulpares del pulgar mediante transferencia hemipulpar del hallux permite un excelente resultado

  8. Colgajo libre osteoseptocutáneo de peroné en la reconstrucción primaria de la radionecrosis masiva mandibular Fibular osteoseptocutaneous free flap in the primary reconstruction after massive radionecrosis of the mandible

    Directory of Open Access Journals (Sweden)

    P. Infante Cossío

    2004-06-01

    Full Text Available Resumen: Una de las complicaciones más serias del uso de la radioterapia en el tratamiento del carcinoma epidermoide de la cavidad oral, es la osteorradionecrosis. En este trabajo, presentamos cuatro pacientes afectos de osteorradionecrosis masiva de la mandíbula que habían fracasado inicialmente con medidas conservadoras y que fueron tratados con resección radical y reconstrucción primaria con un colgajo libre osteoseptocutáneo de peroné. El defecto mandibular tras la resección ósea midió una media de 10 cm e incluyó mucosa intraoral, piel o ambos. En dos casos de reconstrucción, se empleó el colgajo libre de peroné con doble paleta para reconstruir defectos extensos intra y extraorales. Se realizaron osteotomías en el peroné vascularizado en todos los casos para recrear el contorno mandibular. Todos los colgajos sobrevivieron completamente. Tres pacientes curaron primariamente con buenos resultados estéticos y funcionales. Una paciente falleció en el primer mes tras la operación por una pancreatitis aguda y fallo renal. En un paciente se han insertado implantes osteointegrados. En nuestra experiencia, el colgajo libre osteoseptocutáneo de peroné puede ser una opción ideal para la reconstrucción en un solo tiempo de defectos complejos mandibulares compuestos en pacientes afectos de osteorradionecrosis masiva.Abstract: Osteoradionecrosis is one of the most serious complications after radiation therapy of squamous carcinoma of the oral cavity. In this article, we report four cases of massive osteoradionecrosis of the mandible, all of whom had failed initial conservative management and treated with radical resection and primary reconstructed with fibular osteoseptocutaneous free flap. Mandible defects after radical resection were around 10 cm long and included intraoral mucosa, skin or both. A doubled-paddle peroneal tissue transfer was used in two cases for reconstruction of an extensive extra- or intraoral defects. The

  9. Lichtenstein versus Onstep for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

    2013-01-01

    Inguinal hernia is a common condition that affects millions of people world-wide every year. In Denmark (population of 5.5 million), more than 10,000 repairs of inguinal hernias are performed annually. The optimal surgical procedure for mesh placement and fixation is still being debated because o...

  10. Reconstrucción de defectos palatinos con el colgajo de músculo buccinador Reconstruction of palatal defects with the buccinator muscle flap

    Directory of Open Access Journals (Sweden)

    M. Cuesta Gil

    2005-08-01

    Full Text Available Los defectos palatinos de un tamaño significativo precisan reconstrucciones con colgajos locales o a distancia para evitar secuelas funcionales importantes, como regurgitación oronasal y rinolalia. El colgajo de músculo buccinador, descrito por Bozola en 1989 para el cierre de fístulas palatinas y reconstrucciones del paladar blando y duro, supone una interesante alternativa terapéutica en este tipo de defectos. En este trabajo presentamos una descripción anatómico-clínica y de la técnica quirúrgica del colgajo miomucoso de buccinador, así como nuestra pequeña casuística de pacientes operados en el Hospital Gregorio Marañón desde el año 2000 al 2004. De un total de 12 pacientes con defectos palatinos que fueron reconstruidos utilizando este colgajo, 4 eran hombres y 8 mujeres. La localización del defecto fue en 5 casos en el paladar duro y en 7 en paladar blando. Se realizaron reconstrucciones primarias tras resecciones oncológicas en 10 casos, mientras que 1 caso ha sido una reconstrucción secundaria tras fracaso de un colgajo temporal y, en otro paciente se utilizó para cubrir un injerto óseo preprotésico. Los resultados estéticos y funcionales fueron excelentes en 10 de los 12 casos. La complicación más frecuente fue la dehiscencia de sutura que se presentó en 5 casos, 3 de los cuáles fueron dehiscencias parciales que se resolvieron espontáneamente y, en los otros 2 casos, se precisó una reintervención. El colgajo de músculo buccinador parece una interesante técnica reconstructiva para defectos palatinos. Constituye un método quirúrgico sencillo, poco agresivo, con mínimas secuelas y buenos resultados. También puede ser empleado para resolver defectos de labio, lengua, mucosa yugal y órbitas, así como en casos de insuficiencia velopalatina.Defects of the palate that are of a significant size require reconstruction with local or distant flaps in order to avoid important functional sequelae such as oronasal

  11. The Danish Inguinal Hernia database.

    Science.gov (United States)

    Friis-Andersen, Hans; Bisgaard, Thue

    2016-01-01

    To monitor and improve nation-wide surgical outcome after groin hernia repair based on scientific evidence-based surgical strategies for the national and international surgical community. Patients ≥18 years operated for groin hernia. Type and size of hernia, primary or recurrent, type of surgical repair procedure, mesh and mesh fixation methods. According to the Danish National Health Act, surgeons are obliged to register all hernia repairs immediately after surgery (3 minute registration time). All institutions have continuous access to their own data stratified on individual surgeons. Registrations are based on a closed, protected Internet system requiring personal codes also identifying the operating institution. A national steering committee consisting of 13 voluntary and dedicated surgeons, 11 of whom are unpaid, handles the medical management of the database. The Danish Inguinal Hernia Database comprises intraoperative data from >130,000 repairs (May 2015). A total of 49 peer-reviewed national and international publications have been published from the database (June 2015). The Danish Inguinal Hernia Database is fully active monitoring surgical quality and contributes to the national and international surgical society to improve outcome after groin hernia repair.

  12. The Danish Inguinal Hernia Database

    Directory of Open Access Journals (Sweden)

    Friis-Andersen H

    2016-10-01

    Full Text Available Hans Friis-Andersen1,2, Thue Bisgaard2,3 1Surgical Department, Horsens Regional Hospital, Horsens, Denmark; 2Steering Committee, Danish Hernia Database, 3Surgical Gastroenterological Department 235, Copenhagen University Hospital, Hvidovre, Denmark Aim of database: To monitor and improve nation-wide surgical outcome after groin hernia repair based on scientific evidence-based surgical strategies for the national and international surgical community. Study population: Patients ≥18 years operated for groin hernia. Main variables: Type and size of hernia, primary or recurrent, type of surgical repair procedure, mesh and mesh fixation methods. Descriptive data: According to the Danish National Health Act, surgeons are obliged to register all hernia repairs immediately after surgery (3 minute registration time. All institutions have continuous access to their own data stratified on individual surgeons. Registrations are based on a closed, protected Internet system requiring personal codes also identifying the operating institution. A national steering committee consisting of 13 voluntary and dedicated surgeons, 11 of whom are unpaid, handles the medical management of the database. Results: The Danish Inguinal Hernia Database comprises intraoperative data from >130,000 repairs (May 2015. A total of 49 peer-reviewed national and international publications have been published from the database (June 2015. Conclusion: The Danish Inguinal Hernia Database is fully active monitoring surgical quality and contributes to the national and international surgical society to improve outcome after groin hernia repair. Keywords: nation-wide, recurrence, chronic pain, femoral hernia, surgery, quality improvement

  13. Rehabilitación implantosoportada en el colgajo libre de peroné Implant-supported rehabilitation using the fibula free flap

    Directory of Open Access Journals (Sweden)

    C. Navarro Cuéllar

    2006-10-01

    Full Text Available El colgajo de peroné ha demostrado ser el más versatil para la reconstrucción oromandibular, gracias a la gran longitud ósea que podemos utilizar y a la posibilidad de incorporar una amplia paleta cutánea para cobertura de tejidos blandos intraorales. El uso de implantes dentales osteointegrados proporciona un importante método terapéutico para la rehabilitación oral de estos pacientes. Los implantes osteointegrados proporcionan la forma más rígida de estabilización protésica para soportar las fuerzas masticatorias. Estos implantes pueden ser insertados de forma inmediata o diferida. A la hora de utilizar el colgajo libre de peroné realizamos la implantología de forma diferida a los 6-12 meses debido a la gran cantidad de material de osteosíntesis necesaria para la fijación del colgajo. Cuatro o seis meses después, cuando el proceso de osteointegración ha ocurrido, los implantes son cargados con una rehabilitación dental. Analizamos 12 casos de reconstrucción mandibular con colgajo libre de peroné y su rehabilitación estética y funcional con implantes osteointegrados y un seguimiento mínimo de 2 años. Se han colocado un total de 56 implantes, presentando todos ellos excepto uno, una correcta osteointegración. Todos estos pacientes han recuperado la función masticatoria, y mejorado de forma considerable la competencia labial, la continencia salival, la pronunciación y la armonía facial.Free fibula flap has proved to be one of the most versatile for oromandibular reconstruction due to the available length of bone and the possibility of incorporating a long skin paddle to cover intraoral soft tissues. The use of osseointegrated dental implants is an important technique for the oral rehabilitation of these patients. Osseointegrated implants provide the most rigid prosthetic stabilization available to withstand masticatory forces.These implants can be placed immediately or in a second time procedure.In our case

  14. Herniorrafia inguinal: Técnica por sobrecapas de Fascia Transversalis

    Directory of Open Access Journals (Sweden)

    José Miguel Goderich Lalán

    1997-08-01

    Full Text Available Se realizó un estudio descriptivo, prospectivo, observacional y longitudinal para evaluar los resultados obtenidos con la aplicación de una técnica de reparación herniaria inguinal (original del autor por sobrecapas de fascia transversalis, en la que se afronta una primera capa de ésta en sutura continua, desde la proyección del tubérculo púbico hasta obliterar el anillo inguinal profundo, después de lo cual se crea una segunda capa al afrontar el arco aponeurótico del transverso a la cintilla iliopubiana. Luego de un seguimiento superior a los 10 años, se comprobó que de 1 475 pacientes sólo hubo recidivas en 1,2 %; éstas fueron más frecuentes en los hombres, en las hernias del tipo indirecto y en los pacientes con más de 45 años. El mayor número de recidivas ocurrió entre el primer y tercer año de operado. Se recomienda introducir esta nueva técnica en la práctica quirúrgica, y cumplir las indicaciones y el proceder señalado por el autorA descriptive, prospective, observational, and longitudinal study was performed to evaluate the results obtained with the application of a technique for the repair of inguinal hernia (the author's original technique by overlayers of fascia transversalis, in which the first layer is copped with the use of continuos suture from the projection of the pubic tubercle until the obliteration of the deep inguinal rign, creating a second layer when copping the aponeurotic arch of the transverse to the iliopubic eminence. After a follow-up longer than 10 years, it was proved that out of 1 475 patients, only 1,2 % presented with recurrences. Relapses were more frequent in males, in indirect hernias and in patients over 45 years of age. The greatest number of recurrences occurred between the first and the third year after the operation. It is recommended to introduce this new technique within the surgical practice and to comply with the indications for the procedure made by the author

  15. Analgesia pós-operatória em cirurgia ortopédica: estudo comparativo entre o bloqueio do plexo lombar por via perivascular inguinal (3 em 1 com ropivacaína e a analgesia subaracnóidea com morfina Analgesia pós-operatoria en cirugía ortopédica: estudio comparativo entre el bloqueo del plexo lombar por vía perivascular inguinal (3 en 1 con ropivacaína y la analgesia subaracnóidea con morfina Postoperative analgesia following orthopedic surgery: a study comparing perivascular lumbar plexus inguinal block with ropivacaine (3 in 1 and spinal anesthesia with morphine

    Directory of Open Access Journals (Sweden)

    Neuber Martins Fonseca

    2003-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo lombar pelo acesso perivascular inguinal, chamado de bloqueio 3 em 1, tem sido utilizado para analgesia pós-operatória. O objetivo deste estudo foi comparar a analgesia pós-operatória do bloqueio 3 em 1 a da morfina subaracnóidea em pacientes submetidos a cirurgias ortopédicas em membro inferior (MI. MÉTODO: Foram estudados 40 pacientes escalados para cirurgia ortopédica de MI, de ambos os sexos, estado físico ASA I e II, com idades entre 15 e 75 anos, distribuídos em 2 grupos (M e BPL. Foi realizada anestesia subaracnóidea em todos os pacientes, em L3-L4 ou L4-L5, com 20 mg de bupivacaína isobárica a 0,5%. No grupo M (n = 20 foi associado 50 µg de morfina ao anestésico local. No grupo BPL (n = 20 foi realizado o bloqueio 3 em 1 ao término da cirurgia, utilizando 200 mg de ropivacaína a 0,5%. Avaliou-se a analgesia e a intensidade da dor às 4, 8, 12, 14, 16, 20 e 24 horas após o término da cirurgia, o nível do bloqueio subaracnóideo, o tempo cirúrgico e as complicações. RESULTADOS: A duração da analgesia no grupo BPL foi de 13,1 ± 2,47, enquanto no grupo M todos os pacientes referiam dor e ausência de bloqueio motor no primeiro instante avaliado (4 horas. Houve falha do bloqueio de um dos 3 nervos em 3 pacientes. A incidência de náusea e prurido foi significativamente maior no grupo M. Quanto à retenção urinária, não houve diferença significante entre os grupos. Não houve depressão respiratória, hipotensão arterial ou bradicardia. A analgesia pós-operatória foi mais efetiva no grupo BPL, comparada ao grupo M às 4, 8, 12,14 e 16 horas. Às 20 e 24 horas não houve diferença significante entre os grupos. CONCLUSÕES: A analgesia pós-operatória proporcionada pelo bloqueio 3 em 1 apresentou efeitos colaterais inferiores à morfina subaracnóidea com tempo de analgesia semelhante.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del plexo lumbar por el acceso

  16. Resterilized Polypropylene Mesh for Inguinal Hernia Repair

    African Journals Online (AJOL)

    2018-04-19

    Apr 19, 2018 ... Conclusion: The use of sterilized polypropylene mesh for the repair of inguinal ... and nonabsorbable materials to reduce the tissue–mesh. INTRODUCTION ... which we have been practicing in our center since we introduced ...

  17. Male Fertility After Inguinal Hernia Mesh Repair

    DEFF Research Database (Denmark)

    Kohl, Andreas Pagh; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    OBJECTIVE:: To determine whether patients who receive an inguinal hernia repair father the same number of children as the background population. BACKGROUND:: Although the effect of inguinal hernia repair on male fertility has previously been investigated through indirect measures, no previous...... studies have evaluated the final measure of male fertility, which is the number of children fathered by patients. METHODS:: Prospectively collected data on 32,621 male patients between the ages of 18 and 55 years who received 1 or more inguinal hernia repairs during the years 1998 to 2012 were found in 5...... hernia repair using Lichtenstein technique or laparoscopic approach did not father fewer children than expected. Thus, inguinal hernia repair using Lichtenstein or laparoscopic approach did not impair male fertility....

  18. Faloplastia mediante colgajo libre microquirúrgio antebraquial radial con doble tunelización: A propósito de un caso Microsurgical penile reconstruction with a radial forearm free-flap and double tubularization: Case report

    Directory of Open Access Journals (Sweden)

    M. Martín Díaz

    2011-06-01

    Full Text Available La reconstrucción del pene sigue siendo uno de los mayores retos de la Cirugía Plástica debido a la complejidad inherente que conlleva el conseguir tanto la forma anatómica como la función urológica del pene. El objetivo ideal del cirujano al realizar una faloplastia incluye la construcción, en una sola etapa, de un pene estéticamente aceptable y con sensibilidad erógena y táctil, que permita al paciente orinar de pie y mantener relaciones sexuales. La multitud existente de colgajos que pueden ser utilizados para la reconstrucción del pene sólo demuestra que ninguna de estas técnicas se considera ideal. Sin embargo, el colgajo radial es el que se utiliza más frecuentemente y es considerado universalmente como la técnica estándar. Las desventajas relativas de la misma son el número más elevado de fístulas que aparecen inicialmente, la cicatriz residual en el antebrazo y las complicaciones urológicas potenciales a largo plazo. Presentamos una reconstrucción de pene realizada mediante un colgajo libre radial antebraquial con un nuevo diseño geométrico bidimensional que permite la creación tridimensional de un neofalo con excelentes resultados estéticos.Reconstruction of penile defects remains one of the greatest challenges in Plastic Surgery because of the inherent complexity of restoring both the anatomical form and the urologic function of the penis. The surgeon's ideal goals in performing a phalloplasty include the construction, in one-stage procedure, of an aesthetic penis with erogenous and tactile sensation, which enables the patient to void while standing and to have sexual intercourse. The multitude of flaps used for phalloplasty only demonstrates that none of these techniques is considered ideal. Still, the radial forearm flap is the most frequently used one and universally considered as the standard technique. The relative disadvantages of this technique are the rather high number of initial fistulas, the residual

  19. Etiology of Inguinal Hernias: A Comprehensive Review

    Directory of Open Access Journals (Sweden)

    Stina Öberg

    2017-09-01

    Full Text Available BackgroundThe etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias.ResultsLateral and medial hernias seem to have common as well as different etiologies. A patent processus vaginalis and increased cumulative mechanical exposure are risk factors for lateral hernias. Patients with medial hernias seem to have a more profoundly altered connective tissue architecture and homeostasis compared with patients with lateral hernias. However, connective tissue alteration may play a role in development of both subtypes. Inguinal hernias have a hereditary component with a complex inheritance pattern, and inguinal hernia susceptible genes have been identified that also are involved in connective tissue homeostasis.ConclusionThe etiology of lateral and medial hernias are at least partly different, but the final explanations are still lacking on certain areas. Further investigations of inguinal hernia genes may explain the altered connective tissue observed in patients with inguinal hernias. The precise mechanisms why processus vaginalis fails to obliterate in certain patients should also be clarified. Not all patients with a patent processus vaginalis develop a lateral hernia, but increased intraabdominal pressure appears to be a contributing factor.

  20. Lidocaine Patch (5%) in Treatment of Persistent Inguinal Postherniorrhaphy Pain

    DEFF Research Database (Denmark)

    Bischoff, Joakim M; Petersen, Marian; Uçeyler, Nurcan

    2013-01-01

    Evidence-based pharmacological treatment options for patients with persistent inguinal postherniorrhaphy pain are lacking.......Evidence-based pharmacological treatment options for patients with persistent inguinal postherniorrhaphy pain are lacking....

  1. Post Operative Pain Control in Inguinal Hernia Repair: Comparison ...

    African Journals Online (AJOL)

    ADMIN

    drug to be used for local wound infiltrations following inguinal hernia repair. Results: A total of 52 ... intramuscularly or via intravenously 2,3. The local ..... suppository and local marcaine injection on inguinal hernia surgery. Arch crit care.

  2. Laparoscopic Inguinal Hernia Repair in a Developing Nation: Short ...

    African Journals Online (AJOL)

    bilateral hernias, and recurrent hernias), there are data demonstrating an ... no reports of laparoscopic inguinal hernia repair from the. Anglophone ... MATERIALS AND METHODS .... inguinal hernia repair has advantages over open repair for.

  3. Recurrence and complications of pediatric inguinal hernia repair ...

    African Journals Online (AJOL)

    complications of inguinal hernia repair in pediatric patients ... surgery. Patients and methods This retrospective study was ... Bilateral inguinal hernia was observed ..... single-blind comparison of laparoscopic versus open repair of pediatric.

  4. Recurrence and Pain after Mesh Repair of Inguinal Hernias

    African Journals Online (AJOL)

    Abstract. Background: Surgery for inguinal hernias has ... repair. Methods: The study was conducted on all inguinal hernia patients operated between 1st. October ... bilateral (1.6%). Only 101 .... Open Mesh Versus Laparoscopic Mesh. Repair ...

  5. Avoiding cord extraction or mobilization during pediatric inguinal ...

    African Journals Online (AJOL)

    inguinal hernia repair: a step midway between conventional ... the left side, and 19 were bilateral. The mean ... The conventional open approach through inguinal inci- sion is the ... using laparoscopy has gained popularity and many studies.

  6. Sequelae of Endoscopic Inguinal Hernia Repair : Incidence, evaluation and management

    NARCIS (Netherlands)

    Burgmans, J.P.J.

    2015-01-01

    The endoscopic preperitoneal technique (TEP) is an appealing inguinal hernia repair technique, theoretically superior to other approaches. In practice some problems remain unsolved. Real incidences of chronic postoperative inguinal pain (CPIP) and other important sequelae of endoscopic hernia repair

  7. Elective division of ilioinguinal nerve in inguinal hernioplasty: remedy for the morbid postoperative inguinal pain

    International Nuclear Information System (INIS)

    Muneeb, M.D.; Baig, M.A.N.

    2017-01-01

    Objective: To compare the postoperative pain in inguinal hernioplasty, by preserving versus wide elective division of ilioinguinal nerve. Study Design: Randomized controlled trial. Place and Duration of Study: Surgical Department, Civil Hospital, Karachi, from January till August 2015. Methodology: All patients of either gender above 15 years of age, undergoing mesh repair for unilateral, reducible inguinal hernia, were included. Patients with recurrent inguinal hernia, bilateral inguinal hernia, and those who will require emergency hernia surgeries like irreducible, obstructed, and strangulated hernia, were excluded. They were randomly assigned 42 into inguinal nerve preservation group (group A) and 42 in division (group B). Postoperative pain was assessed at first day, at discharge and after one month using visual analogue scale. Results: There were a total of 84 patients. Group A patients had median (IQR) pain scores of 5 (1) and 3 (2) as compared to group B pain scores of 4 (2) and 2 (1) at 24 hours of surgery and at discharge, respectively (p <0.05). Median (IQR) postoperative pain score one month after inguinal hernioplasty was 2.5 (1) in group A, while 0.5 (1) in group B (p <0.05). A significant decline in the pain scores were observed in group B from the first day of surgery till one month afterwards (p <0.05). Conclusion: Wide resection of ilioinguinal nerve has a lower frequency of postoperative pain in comparison to the ilioinguinal nerve preservation, in inguinal hernioplasty. (author)

  8. Amyad's hernia while reparing the bilateral inguinal hernia

    OpenAIRE

    Arif Aslaner; Tuğrul Çakır; Umut Rıza Gündüz; Burhan Mayir; Nurullah Bülbüller

    2015-01-01

    Amyand's hernia is the term used for inguinal hernia containing appendix. It is a rare condition and found in 1% of inguinal hernia repairs. Here we report a case of Amyand's hernia in a 61 years old male who was diagnosed with bilateral inguinal hernia. He underwent surgery and bilateral inguinal hernia repair with prosthetic meshes and without appendectomy. The patient was discharged uneventfully. 

  9. Amyad's hernia while reparing the bilateral inguinal hernia

    Directory of Open Access Journals (Sweden)

    Arif Aslaner

    2015-01-01

    Full Text Available Amyand's hernia is the term used for inguinal hernia containing appendix. It is a rare condition and found in 1% of inguinal hernia repairs. Here we report a case of Amyand's hernia in a 61 years old male who was diagnosed with bilateral inguinal hernia. He underwent surgery and bilateral inguinal hernia repair with prosthetic meshes and without appendectomy. The patient was discharged uneventfully. 

  10. Pain related sexual dysfunction after inguinal herniorrhaphy

    DEFF Research Database (Denmark)

    Aasvang, EK; Møhl, Bo; Bay-Nielsen, M

    2006-01-01

    , and sexual dysfunction have only been described sporadically. The aim was therefore to describe these symptoms in a questionnaire study. A nationwide detailed questionnaire study in September 2004 of pain related sexual dysfunction in all men aged 18-40 years undergoing inguinal herniorrhaphy between October......To determine the incidence of pain related sexual dysfunction 1 year after inguinal herniorrhaphy and to assess the impact pain has on sexual function. In contrast to the well-described about 10% risk of chronic wound related pain after inguinal herniorrhaphy, chronic genital pain, dysejaculation...... 2002 and June 2003 (n=1015) based upon the nationwide Danish Hernia Database collaboration. The response rate was 68.4%. Combined frequent and moderate or severe pain from the previous hernia site during activity was reported by 187 patients (18.4%). Pain during sexual activity was reported by 224...

  11. Day case inguinal hernia surgery in Nigerian children: Prospective ...

    African Journals Online (AJOL)

    required readmission into the hospital. Conclusion: Day case inguinal hernia surgery in children is safe and well accepted by patients and parents alike. Health institutions in which children with inguinal hernias still queue for long periods for space on the operation list need to adopt day case surgery for inguinal hernia in ...

  12. Colgajo submental para reconstrucción de defectos oncológicos en cabeza y cuello Submental flap to reconstruct oncologic head and neck defects

    Directory of Open Access Journals (Sweden)

    J. Brunsó Casellas

    2009-08-01

    Full Text Available El colgajo submental es un procedimiento eficaz para la reconstrucción en el territorio maxilofacial. Caracterizado por su delgadez, versatilidad, excelente color y textura y mínima morbilidad en la zona donante, su utilización en lesiones malignas es controvertida, por el riesgo de trasladar enfermedad metastásica cervical a la zona receptora. Material y métodos: Se presentan 3 casos clínicos en los que se ha aplicado en pacientes afectos de un carcinoma epidermoide de cabeza y cuello. Describimos las particularidades anatómicas, y se realiza una revisión de la técnica quirúrgica. Resultados: Fueron óptimos en cuanto a cobertura del defecto, estética y función salvo por una necrosis parcial en uno de ellos. En todos los casos la morbilidad en la zona donante fue mínima. Conclusiones: El colgajo submental es una opción a considerar incluso en pacientes oncológicos sobre todo en los que, por edad avanzada o presentar patología asociada no están indicados procedimientos más agresivos.The submental flap is an effective option for the reconstruction in the maxillofacial territory. Characterized by its thinness, versatility, excellent colour and texture and minimum morbidity in the donor zone, its use in malignant injuries is controverted by the risk of transferring cervical metastasic disease to the receiving zone. Material and methods: we present 3 clinical cases in which it has been used in patients affected by an squamous cell carcinoma of head and neck. In addition, the anatomical particularities are described, and a revision of the surgical technique is made. Results: They were optimal in relation to covering of the defect, aesthetics and function except for a partial necrosis in one of them. In all the cases the morbidity in the donor zone was minimum. Conclusions: The submental flap is an option to consider in oncologic patients, mainly in those whom by advanced age or by the existence of comorbidity advice against the use

  13. Embryologic and anatomic basis of inguinal herniorrhaphy.

    Science.gov (United States)

    Skandalakis, J E; Colborn, G L; Androulakis, J A; Skandalakis, L J; Pemberton, L B

    1993-08-01

    The embryology and surgical anatomy of the inguinal area is presented with emphasis on embryologic and anatomic entities related to surgery. We have presented the factors, such as patent processus vaginalis and defective posterior wall of the inguinal canal, that may be responsible for the genesis of congenital inguinofemoral herniation. These, together with impaired collagen synthesis and trauma, are responsible for the formation of the acquired inguinofemoral hernia. Still, we do not have all the answers for an ideal repair. Despite the latest successes in repair, we, to paraphrase Ritsos, are awaiting the triumphant return of Theseus.

  14. Colgajo de piel en isla con pedículo fasciocutáneo para cuello: caso clínico Island skin flap with fasciocutaneous pedicle for neck reconstruction: case report

    Directory of Open Access Journals (Sweden)

    J.L. Ramón Vera

    2009-06-01

    Full Text Available Los defectos por falta de piel o las secuelas de quemaduras a nivel del cuello presentan gran dificultad de cobertura debido a la escasez de tejidos locales útiles para corregirlos, ya que debemos dar una solución a las graves alteraciones funcionales y estéticas que producen, con un mínimo de secuelas. Presentamos un caso clínico con graves secuelas de quemaduras en cuello que producían retracción importante y que fue resuelto con un colgajo de piel en isla con pedículo fasciosubcutáneo tomado de región subclavicular. Este colgajo presenta irrigación cutánea por medio de arterias cutáneas directas provenientes de la arteria mamaria interna y brinda la oportunidad de solucionar alteraciones a nivel del cuello con gran facilidad para su realización y con mínimas secuelas en la zona donante.Cutaneous defects or burn sequels at the neck level present difficult of covering, due to the poor local tissues, although we should give a solution to the serious functional and aesthetic alterations with minimal sequels. We present a clinical case with burn sequels of the neck that produced important retraction and that was solved whit an island fasciocutaneous pedicle flap from subclavicular region. This flap has skin irrigation supported by the cutaneous arteries coming from the internal mammary artery and gives us the opportunity to solve these alterations at the neck level in an easy way and with minimal sequels in the donor area.

  15. Cobertura radicular mediante la utilización de un injerto subepitelial de tejido conectivo combinado con un colgajo pediculado avanzado coronalmente

    Directory of Open Access Journals (Sweden)

    Antonio Díaz Caballero

    2010-01-01

    Full Text Available Las recesiones gingivales son un hallazgo clínico muy frecuente que ocasionan problemas estéticos, hipersensibilidad dentaria y dificultad para llevar a cabo una correcta higiene oral en los pacientes. Uno de los objetivos de la terapia periodontal es corregir quirúrgicamente las recesiones; se han descrito una variedad de enfoques quirúrgicos como métodos efectivos para cubrir las superficies radiculares expuestas, siendo el injerto libre de tejido conectivo una de las técnicas que hoy en día ofrece un buen porcentaje de éxito y predecibilidad. Se presenta el caso de un paciente con retracción del margen gingival en el maxilar superior derecho; se describe el procedimiento quirúrgico usando una técnica bilaminar empleando un injerto subepitelial de tejido conectivo bajo un colgajo de espesor parcial posicionado coronalmente, y se obtienen buenos resultados estéticos y cobertura radicular.

  16. Laparoscopic inguinal preperitoneal injection--novel technique for inguinal hernia repair: preliminary results of experimental study.

    Science.gov (United States)

    Kozlov, Yury; Novogilov, Vladimir; Rasputin, Andrey; Podkamenev, Alexey; Krasnov, Pavel; Weber, Irina; Solovjev, Alexey

    2012-04-01

    Inguinal hernia repair is the most common procedure in pediatric surgery. Suture techniques for laparoscopic inguinal hernia repair in children are easy to perform and popular with a low recurrence rate. The aim of this study was to evaluate the effect of laparoscopic preperitoneal injection of three-dimensional gel on closing of the inguinal hernia sac (IHS) in laboratory animals. With the animals under general anesthesia, we performed peritoneoscopy in 12 male Chinchilla rabbits weighing 1200-1400 g. The endoscope was introduced into the abdominal cavity, and bilateral deep inguinal rings were identified. A Tuohy needle with the injectable polymeric bulking agent DAM+™ (three-dimensional polyacrylamide gel with silver ions [Argiform(®) from Bioform(®)]) was introduced preperitoneally. The implant was then injected across the entire orifice of the deep inguinal rings and draped over the cord structures. After completion of bilateral repairs, the rabbits were extubated and observed in the animal laboratory. Then the second laparoscopy was performed 6 months later, and the deep inguinal rings were inspected. The postoperative course was uneventful in all the animals. At the second laparoscopy no reopening of the entire orifice of the deep inguinal rings was noted. Accurate placement of the polymeric agent and adequate coverage of the vas deferens were accomplished in all the animals. This study demonstrates that the biopolymeric implant gives good postoperative results and a stable trend of closing the IHS in long-term follow-up. In conclusion, we hope that injectable polymeric bulking agents can be used for treatment of inguinal hernias of pediatric patients after additional animal and human research.

  17. Herniographic appearance of the lateral inguinal fossa

    International Nuclear Information System (INIS)

    Ekberg, O.; Kesek, P.

    1987-01-01

    Herniography frequently reveals clinically undetected groin hernia. Thereby herniography contributes to the clinical work-up in patients with obscure groin pain. However, the distinction between clinically important and unimportant abnormalities within the lateral inguinal fossa can be difficult. This study was therefore designed in order to elucidate the herniographic appearance of the lateral inguinal fossa in patients with obscure groin pain. Herniographic findings were compared with laterality of the patients' symptoms. The lateral umbilical fold was visible in only 47% of the groins. A triangular shaped outpouching from the lateral inguinal fossa and a patent processus vaginalis were found with equal frequency on the left and right side. They were five times as frequent in men as in women. Their presence did not correlate with laterality of the patients' symptoms. Indirect hernias were almost twice as common on the symptomatic side as compared with the asymptomatic side. On the left side they were found twice as often in men as in women while there was no significant sex difference on the right side. Our results show that neither a patent processus vaginalis nor a triangular outpouching from the lateral inguinal fossa correlate with the laterality of the patients' symptoms while true indirect hernias do. (orig.)

  18. Inguinal endometriosis attaching to the round ligament

    International Nuclear Information System (INIS)

    Hagiwara, Y.; Hatori, M.; Kokubun, S.; Moriya, T.; Terada, Y.; Yaegashi, N.; Ehara, S.

    2007-01-01

    We report a case of endometriosis in the right inguinal region, attached to the right round ligament in a 28-year-old woman. At the age of 20, laparoscopic left ovarian cystectomy and pelvic adhesiolysis for endometriosis was carried out. She noticed a right tender groin mass 7 months previously, and the tumour size fluctuated with the menstrual cycle. A poorly circumscribed elastic hard mass, measuring 3 cm in diameter, was palpated in her right inguinal region. Magnetic resonance imaging showed a 2.5 cm x 2.5 cm mass in the right inguinal canal and a 5.4 cm x 6.8 cm mass was seen in the left ovary. The mass enlarged during menstruation. The groin mass was removed, in addition to carrying out laparoscopic ovarian cystectomy. At operation, the groin mass was found to be in continuity with the round ligament of extraperitoneal portion. Histological diagnosis of endometriosis was made in both ovarian and inguinal tumours. After surgery, the pain disappeared completely. Worth mentioning is that MRI clearly showed the change of tumour size depending on the menstrual cycle, which aided in arriving at the correct diagnosis of endometriosis in an unusual location

  19. Peniskarzinom mit exulzerierten Lymphknotenmetastasen links inguinal

    Directory of Open Access Journals (Sweden)

    Presich K

    2003-01-01

    Full Text Available Im Oktober 2001 wurde ein 53jähriger Patient mit ausgedehnten exulzerierten Lymphknotenmetastasen rechts inguinal an einer auswärtigen chirurgischen Abteilung vorgestellt. Im Rahmen der Durchuntersuchung fand sich eine verhärtete, von einem nicht retrahierbaren Präputium verdeckte Glans als mögliches Primum. Eine Circumcision sowie Biopsie aus der Glans ergaben das histologische Ergebnis eines invasiven, schwach verhornenden Plattenepithelkarzinoms mittleren Differenzierungsgrades (G2-G3. In einer Unterbauch-Computertomographie wurde rechts inguinal ein ausgedehnter, ca. 10 cm messender, teils solider, teils nekrotischer Prozeß, bis an die großen Gefäße heranreichend, beschrieben. Die linke Leiste war unauffällig.

  20. Convalescence after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette Astrup; Rosenberg, Jacob; Bisgaard, Thue

    2016-01-01

    . Furthermore, snowball search was performed in reference lists of identified articles. Randomized controlled trials and prospective comparative or non-comparative trials of high quality were included. Trials with ≥100 patients, >18 years of age and manuscripts in English were included. Scoring systems were...... used for assessment of quality. RESULTS: The literature search identified 1039 papers. Thirty-four trials were included in the final review including 14,273 patients. There was overall a large variation in duration of convalescence. Trials using non-restrictive recommendations of 1-2 days or "as soon...... factors for prolonged convalescence extending more than a few days after laparoscopic inguinal hernia repair. CONCLUSIONS: Patients should be recommended a duration of 1-2 days of convalescence after laparoscopic inguinal hernia repair. Short and non-restrictive recommendations may reduce duration...

  1. Complicated childhood inguinal hernias in UITH, Ilorin

    Directory of Open Access Journals (Sweden)

    Kayode T Bamigbola

    2012-01-01

    Full Text Available Background: Complicated inguinal hernias pose a threat to the life of the child as well as increase the morbidity associated with management of an otherwise straightforward condition. The aim of this study was to determine the presentation, treatment and management outcome of complicated inguinal hernias in children. Materials and Methods: A retrospective study of all children 15 years and less managed for complicated inguinal hernia between 2002 and 2010. Data obtained included demographic characteristics, presentation, operative findings and outcome. Results: Complicated hernia rate was 13.9%.There were 41 children, 38 boys (92.7% and 3 girls. Ages ranged between 4 days and 15 years (Median = 90days. Most were infants (48.8%, n = 20 and neonates accounted for 19.5% (n = 8. Median duration of symptoms prior to presentation was 18 h (range = 2-96 h. Seven patients had been scheduled for elective surgery. Hernia was right sided in 68.3% (n = 28. Symptoms included vomiting (68.3%, abdominal distension (34.1% and constipation (4.9%; one patient presented with seizures. In 19 (46.3% patients hernia was reducible while 22(53.7% had emergency surgery. Associated anomalies included undescended testis (12.2%, umbilical hernia (14.6%. Intestinal resection rate was 7.3% and testicular gangrene occurred in 14.6%. Mean duration of surgery was 60.3 ± 26.7 min. Wound infection occurred in six patients (14.6%. Overall complication rate was 24.4%, 30% in infants. The mortality rate was 2.4% (n = 1. Conclusions: Morbidity associated with complicated inguinal hernia is high in neonates and infants. Delayed presentation is common in our setting. Educating the parents as well as primary care physicians on the need for early presentation is necessary.

  2. Reconstrucción de cuero cabelludo con colgajo libre de omentum Reconstruction of the scalp with a free flap of omentum

    OpenAIRE

    C. Navarro Cuellar; F. Riba García; B. Guerra Martínez; R. Pujol Romanya; H. Herencia Nieto; C. Navvarro Vila

    2004-01-01

    Los defectos de cuero cabelludo pueden tener una etiología diversa. Resecciones oncológicas, lesiones postraumáticas e infecciosas pueden dar lugar a diferentes defectos en cuanto a tamaño y extensión. Para su reconstrucción disponemos de múltiples técnicas quirúrgicas como colgajos locales, regionales y expansores titulares. No obstante, para defectos extensos los colgajos libres son la única posibilidad reconstructiva. Presentamos el caso de un paciente con carcinomas epidermoides multicént...

  3. Mastopexia con prótesis: técnica triplanar con colgajo en cola de pez para mamas con pobre calidad de cobertura

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    M. Berrocal-Revueltas

    2013-12-01

    Full Text Available La mastopexia con implantes de silicona, es uno de los procedimientos más frecuentes en la práctica diaria en Cirugía Plástica. Sin embargo, la pobre calidad de la cobertura de las mamas, relacionada con piel estriada, escaso tejido subcutáneo y pérdida del parénquima mamario secundarios a la lactancia prolongada y a la pérdida masiva de peso, son causa del incremento progresivo de resultados insatisfactorios a medio y largo plazo que han sido evaluados, analizados y discutidos por los especialistas. Los resultados insatisfactorios más frecuentes en mastopexia con implantes en posición retromuscular son: doble contorno mamario, asimetrías y desplazamiento de los implantes. Los objetivos del presente estudio son: describir el nuevo método triplanar como alternativa útil para lograr mejores resultados en pacientes con mala calidad de cobertura y analizar los resultados obtenidos con el mismo. Realizamos un estudio observacional, descriptivo, prospectivo, en un grupo de 268 pacientes con diagnóstico de ptosis mamaria con hipotrofia y mala calidad de cobertura por piel estriada, escaso tejido celular subcutáneo y pérdida del parénquima mamario, secundarios a lactancia prolongada y pérdida masiva de peso, entre otros, a las que se les practicó mamoplastia de aumento con implantes de silicona mediante la aplicación del método triplanar descrito por la autora, entre enero del 2004 y enero del 2013 en el Hospital de Bocagrande de Cartagena, Colombia. El diseño de la técnica se basa en los principios de cicatriz vertical descrita por Lassus o Lejour o mediante cicatriz en "J", descrita por la autora. El método triplanar se basa en tres planos de cobertura del implante. Plano I: submuscular, para cubrir los dos tercios superiores del implante. Plano II: colgajo dermoglandular con dos prolongaciones distales triangulares de tejido adiposo, en forma de pez, para cubrir el tercio inferior del implante y el borde libre del m

  4. Anal Canal Cancer: Management of Inguinal Nodes and Benefit of Prophylactic Inguinal Irradiation (CORS-03 Study)

    International Nuclear Information System (INIS)

    Ortholan, Cécile; Resbeut, Michel; Hannoun-Levi, Jean-Michel; Teissier, Eric; Gerard, Jean-Pierre; Ronchin, Philippe; Zaccariotto, Audrey; Minsat, Mathieu; Benezery, Karen; François, Eric; Salem, Naji; Ellis, Steve; Azria, David; Champetier, Cédric; Gross, Emmanuel; Cowen, Didier

    2012-01-01

    Purpose: To evaluate the benefit of prophylactic inguinal irradiation (PII) in anal canal squamous cell carcinoma (ASCC). Methods and Materials: This retrospective study analyzed the outcome of 208 patients presenting with ASCC treated between 2000 and 2004 in four cancer centers of the south of France. Results: The population study included 35 T1, 86 T2, 59 T3, 20 T4, and 8 T stage unknown patients. Twenty-seven patients presented with macroscopic inguinal node involvement. Of the 181 patients with uninvolved nodes at presentation, 75 received a PII to a total dose of 45–50 Gy (PII group) and 106 did not receive PII (no PII group). Compared with the no PII group, patients in the PII group were younger (60% vs. 41% of patients age 2 toxicity of the lower extremity was observed. Conclusion: PII with a dose of 45 Gy is safe and highly efficient to prevent inguinal recurrence and should be recommended for all T3-4 tumors. For early-stage tumors, PII should also be discussed, because the 5-year inguinal recurrence risk remains substantial when omitting PII (about 10%).

  5. Factors Influencing Choice of Inguinal Hernia Repair Technique ...

    African Journals Online (AJOL)

    Background: Inguinal hernia repair surgery is one of the most frequently performed surgical procedures worldwide. This study sought to highlight factors that may influence decisions concerning inguinal hernia repair techniques. Methods: This descriptive crosssectional study was carried out in September 2014 among ...

  6. Irreducible Inguinal Hernias in the Paediatric Age Group | Ezomike ...

    African Journals Online (AJOL)

    BACKGROUND: An inguinal hernia is said to be irreducible when the content fails to return into the peritoneal cavity without surgical intervention. Irreducibility is an ever present risk in untreated inguinal hernias and its management remains an important part of pediatric surgery practice. When a hernia is irreducible ...

  7. Management of persistent postsurgical inguinal pain

    DEFF Research Database (Denmark)

    Werner, Mads U

    2014-01-01

    . Local anesthetic blocks, pharmacological management, and treatment with sensory stimulation methods were presented in seven studies. In spite of shortcomings, the data on surgical management demonstrate that neurectomy with or without mesh removal may provide long-lasting analgesic effects in most...... patients with severe PPP following inguinal hernia repair. The evidence base for other management methods is still fragile, although promising results appear in the neuromodulation studies. CONCLUSIONS: There is a need for improved study designs and, launching of large multicenter collaborative studies...

  8. Inguinal Hernia in Athletes: Role of Dynamic Ultrasound.

    Science.gov (United States)

    Vasileff, William Kelton; Nekhline, Mikhail; Kolowich, Patricia A; Talpos, Gary B; Eyler, Willam R; van Holsbeeck, Marnix

    Inguinal hernia is a commonly encountered cause of pain in athletes. Because of the anatomic complexity, lack of standard imaging, and the dynamic condition, there is no unified opinion explaining its underlying pathology. Athletes with persistent groin pain would have a high prevalence of inguinal hernia with dynamic ultrasound, and herniorrhaphy would successfully return athletes to activity. Case-control study. Level 3. Forty-seven amateur and professional athletes with sports-related groin pain who underwent ultrasound were selected based on history and examination. Patients with prior groin surgery or hip pathology were excluded. Clinical and surgical documentation were correlated with imaging. The study group was compared with 41 age-matched asymptomatic athletes. Ultrasound was positive for hernia with movement of bowel, bladder, or omental tissue anterior to the inferior epigastric vessels during Valsalva maneuver. The 47-patient symptomatic study group included 41 patients with direct inguinal hernias, 1 with indirect inguinal hernia, and 5 with negative ultrasound. Of 42 patients with hernia, 39 significantly improved with herniorrhaphy, 2 failed to improve after surgery and were diagnosed with adductor longus tears, and 1 improved with physical therapy. Five patients with negative ultrasound underwent magnetic resonance imaging and were diagnosed with hip labral tear or osteitis pubis. The 41-patient asymptomatic control group included 3 patients with direct inguinal hernias, 2 with indirect inguinal hernias, and 3 with femoral hernias. Inguinal hernias are a major component of groin pain in athletes. Prevalence of direct inguinal hernia in symptomatic athletes was greater than that for controls ( P < 0.001). Surgery was successful in returning these athletes to sport: 39 of 42 (93%) athletes with groin pain and inguinal hernia became asymptomatic. Persistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic

  9. Análisis de perforantes de la epigástrica inferior profunda con Angio TC 3D, Eco Doppler color y Doppler simple de ultrasonidos en colgajo DIEP: resultados preliminares Analysis of deep inferior epigastric perforating vessels with 3D CT angiography, color Doppler ultrasonography and Doppler in diep flaps: preliminary results

    Directory of Open Access Journals (Sweden)

    J. Castro García

    2008-09-01

    Full Text Available Nuestro objetivo es la validación de la Angio TC tridimensional como herramienta de planificación de los colgajos DIEP, comparándolo con el Doppler de ultrasonidos (US y eco Doppler color. Entre enero de 2006 y marzo de 2007 se realiza en 11 pacientes (13 DIEP un estudio comparativo prospectivo entre el Doppler de US, eco Doppler color y Angio TC con reconstrucción tridimensional, utilizando como dato de referencia los hallazgos intraoperatorios. En dicho proceso se localiza la mejor perforante que pueda servir como pedículo al colgajo DIEP en función de su localización, calibre, trayecto y relaciones anatómicas con respecto al músculo. La Angio TC con reconstrucción tridimensional, demuestra una especificidad del 100% (IC 95% 75.3-100 lo que le convierte en una prueba con un alto valor predictivo positivo y una excelente herramienta en la planificación de los colgajos de perforantes. El eco Doppler color determinó, que tan sólo en un 46,1% (IC 95% 19,2-74,9 de los pacientes, la perforante seleccionada por la prueba de forma preoperatoria, coincidía con la perforante elegida en quirófano. Con el Doppler de US, en un 30,8 % (IC 95% 9,1-61,4 de los colgajos estudiados, coincidía la mejor perforante escogida de forma preoperatoria, con los hallazgos obtenidos tras la disección del colgajo. En el presente estudio, la Angio TC tridimensional se ha mostrado como una técnica con una gran especificidad que proporciona valiosa información, sólo comparable con la disección anatómica y por delante de pruebas como el Doppler de ultrasonidos y el eco Doppler color.The aim of this report, is to validate the Angio-CT technique with three-dimentional reconstruction as a preoperative planning tool, after comparison with Doppler ultrasound and color- Duplex. Between january 2006 and march 2007, we studied 11 consecutive patients (13 DIEP in whom a prospective comparative followed up was performed comparing, the findings observed using

  10. Herniorrafía inguinal: Técnica por sobrecapas de Fascia Transversalis

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    José Miguel Goderich Lalán

    1998-04-01

    Full Text Available Se realizó un estudio descriptivo, prospectivo, observacional y longitudinal para evaluar los resultados obtenidos con la aplicación de una técnica de reparación herniaria inguinal (original del autor por sobrecapas de fascia transversalis, en la que se afronta una primera capa de ésta en sutura continua, desde la proyección del tubérculo púbico hasta obliterar el anillo inguinal profundo, después de lo cual se crea una segunda capa al afrontar el arco aponeurótico del transverso a la cintilla iliopubiana. Luego de un seguimiento superior a los 10 años, se comprobó que de 1 475 pacientes sólo hubo recidivas en 1,2 %; éstas fueron más frecuentes en los hombres, en las hernias del tipo indirecto y en los pacientes con más de 45 años. El mayor número de recidivas ocurrió entre el primer y tercer año de operado. Se recomienda introducir esta nueva técnica en la práctica quirúrgica, y cumplir las indicaciones y el proceder señalado por el autorA descriptive, prospective, observational, and longitudinal study was performed to evaluate the results obtained with the application of a technique for the repair of inguinal hernia (the author's original technique by overlayers of fascia transversalis, in which the first layer is copped with the use of continuos suture from the projection of the pubic tubercle until the obliteration of the deep inguinal rign, creating a second layer when copping the aponeurotic arch of the transverse to the iliopubic eminence. After a follow-up longer than 10 years, it was proved that out of 1 475 patients, only 1,2 % presented with recurrences. Relapses were more frequent in males, in indirect hernias and in patients over 45 years of age. The greatest number of recurrences occurred between the first and the third year after the operation. It is recommended to introduce this new technique within the surgical practice and to comply with the indications for the procedure made by the author

  11. SEGMENTAL EPIDURAL ANAESTHESIA FOR INGUINAL HERNIA REPAIR

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    Sachidanand

    2015-09-01

    Full Text Available BACKGROUND: Epidural anaesthesia is suitable as a sole agent for lower abdominal surgery and surgery on lower limbs. It has some definite advantages over spinal anaesthesia like avoidance of post spinal headache, minimal chances of meningitis, and minimal chances of nausea and vomiting in postoperative period. But administration of conventional dosage of local epidural anaesthetics (15ml and above for surgical anaesthesia frequently results in multiple hemodynamic changes, including decreases in chronotropism, inotro pism, dromotropism, systemic vascular resistance, cardiac output, and myocardial oxygen consumption. The segmental epidural block denotes the use of a small volume enough to block only the segments involved in the field of surgery. AIM: To study the effect iveness of segmental epidural anaesthesia for inguinal hernia repair. DESIGN: R andomized control study. METHODS: 100 pts belonging to ASA PS I & II posted for inguinal hernia repair given 5ml of 0.5% bupivacaine through epidural route at L1 - L2 level and a fter conforming the adequacy and level of analgesia, the surgery was commenced. If the patient complained of pain during needle prick, then injected local anaesthetic (0.5% Bupivacaine with an incremental dosage of 1ml at a time, till the complete onset o f analgesia Pulse Rate and Blood Pressure were recorded at an interval of 1 minute for first 5 minutes and then every 5 minutes till the end of the surgery. Oxygen saturation and ECG monitoring was done continuously. Onset of analgesia, level of analgesia ( P re & post operatively, duration of analgesia, total dosage of local anaesthetic used were recorded. Complications like bradycardia, hypotension, respiratory depression, shivering, nausea and vomiting, sweating and inadvertent dural puncture were recorde d. RESULTS: 53% of patients had excellent quality of analgesia and relaxation. 34% patients had good quality analgesia and relaxation, mild discomfort while handling sac

  12. Neuroendocrine tumor of the inguinal node: A very rare presentation

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    Niharika Bisht

    2017-12-01

    Full Text Available Neuroendocrine tumors are a broad family of tumors arising most commonly in the gastrointestinal tract and the bronchus pulmonary tree. The other common sounds are the parathyroid, pituitary and adrenal gland. Inguinal node as a primary presentation of a neuroendocrine tumor is an extremely rare presentation. We present the case of a 43-year-old-male who presented with the complaints of an inguinal node swelling without any other symptoms and on further evaluation was diagnosed to have a non-metastatic neuroendocrine tumor of the inguinal node. He was treated with a combination of chemotherapy and surgery and is presently awaiting completion chemotherapy.

  13. Presence of Inguinal Hernia in Soccer Players with Osteitis Pubis

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    Ali Eraslan

    2017-11-01

    Conclusion: The study revealed that soccer players with osteitis pubis may have concomitant inguinal hernia, and that osteitis pubis may develop in soccer players who have undergone hernia repair. In addition, more severe osteitis pubis findings on the same side with hernia indicate that the two pathologies occur with common mechanisms. It should not be forgotten that inguinal hernia be considered in the differential diagnosis of osteitis pubis, which it may accompany. Conservative methods are mostly used in the treatment of osteitis pubis, whereas the treatment of inguinal hernia is surgery. If only one entity is diagnosed when both are present, the success of treatment will decrease.

  14. Paravesical gossypiboma following inguinal herniorrhaphy: Laparoscopic retrieval

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    Chao-Chun Huang

    2015-01-01

    Full Text Available Retained surgical sponge (gossypiboma following an inguinal herniorrhaphy is a rare condition and may cause medicolegal problems. Differential diagnosis for the lesion should be made meticulously. We report a case of a 45-year-old man who had a herniorrhaphy about 8 years previously. He presented one episode of painless gross hematuria. Laboratory and imaging studies excluded any significant lesion in the urological organs. Abdominal CT scan demonstrated a heterogeneous neoplasm of 4 cm in size in the left paravesical area that was retrieved laparoscopically. Abdominal CT and clinical suspicion are helpful for diagnosis. Laparoscopy may be used to confirm the diagnosis and to remove the retained surgical gauze, and considered as an alternative therapy for some selected patients.

  15. Comparación entre la reparación abierta con malla y la técnica de Desarda en la hernia inguinal Comparison between open repair with mesh and the Desarda technique in inguinal hernia

    Directory of Open Access Journals (Sweden)

    Pedro Rolando López Rodríguez

    2009-12-01

    Full Text Available INTRODUCCIÓN. Con el presente trabajo se buscó dar respuesta a algunas controversias en torno de la reparación de las hernias inguinales, así como realizar una valoración sobre el dolor posoperatorio y analizar los costos de las técnicas de reparación protésicas y la técnica que refuerza la pared posterior del canal inguinal con una franja aponeurótica pediculada del músculo oblicuo mayor. MÉTODOS. Se realizó un estudio prospectivo aleatorio de 836 pacientes con hernia inguinal, operados entre septiembre del 2001 y diciembre del 2007. A un grupo se le practicó una hernioplastia anterior con malla y al otro la técnica de Mohan P. Desarda, la cual consiste en una herniorrafia sin malla. RESULTADOS. Ambos grupos de pacientes fueron comparables, sin diferencias con respecto a la edad, la localización y el tipo de hernia. El tiempo quirúrgico fue menor en la hernioplastia con malla y no hubo diferencias significativas en cuanto al dolor durante el primer y tercer día del posoperatorio, pero en el grupo de la hernioplastia éste fue superior al quinto día. En tres pacientes hubo rechazo a la malla de polipropileno. CONCLUSIONES. La técnica de Desarda, al no utilizar malla, fue más económica que la hernioplastia con malla; esta diferencia fue estadísticamente significativa.INTRODUCTION: With present paper we gave response to some controversies around the repair of inguinal hernias as well as to make a valuation on postoperative pain and to analyze the costs of prosthetic repair techniques and the technique reinforcing the posterior wall of inguinal channel with a pediculate aponeurotic band of major obliquus muscle. METHODS: A random prospective study was conducted in 836 patients presenting with inguinal hernia, operated on between September, 2001 and December, 2007. A group underwent anterior hernioplasty with mesh and in the other we used Mohan P. Desarda technique, which is a herniorrhaphy without mesh. RESULTS: Both groups

  16. Abdominal blockage of iliohypogastric and ilio-inguinal nerves for ...

    African Journals Online (AJOL)

    South African Journal of Obstetrics and Gynaecology ... The aim of this study was to compare pain relief after caesarean section achieved by an ... and ilio-inguinal (IHII) nerve block with levobupivacaine with that in patients given a placebo.

  17. Chronic Post Inguinal Herniorraphy Pain: Prevalence and Risk Factors

    African Journals Online (AJOL)

    Keywords: Chronic Pain, Inguinal Hernia Repair, Pain,. Surgery. Ann Afr ... operator's experience and method used though a special interest is ... Bilateral hernia. 4. Repair due to .... after Laparoscopic and Open Mesh Repair of. Groin Hernia.

  18. Analgesia and sedation practices for incarcerated inguinal hernias in children.

    Science.gov (United States)

    Al-Ansari, Khalid; Sulowski, Christopher; Ratnapalan, Savithiri

    2008-10-01

    In this study, the use of medications for analgesia and/or sedation for incarcerated inguinal hernia reductions in the emergency department was analyzed. A retrospective chart review was conducted for all patients presenting to a pediatric emergency department with incarcerated inguinal hernia from 2002 to 2005. A total of 99 children presented with incarcerated hernias during the study period. The median age was 11 months. Forty-four percent of children received medication for the procedure, of them 75% received parenteral and 25% oral or intranasal medications. Forty-five percent of children who received medication went through at least 1 hernia reduction attempt initially without medications. More than half the children with incarcerated inguinal hernias did not receive any medication for pain and/or sedation prior to hernia reduction. Guidelines for medication use for children with incarcerated inguinal hernias need to be developed.

  19. Comparison of elective inguinal node irradiation techniques in anal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Ji Hye; Seong, Jin Sil; Keum, Ki Chang; Lee, Chang Geol; Koom, Woong Sub [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    To compare photon thunderbird with deep match (technique 1) with 3-field technique with electron inguinal boost (technique 2) in acute skin toxicity, toxicity-related treatment breaks and patterns of failure in elective inguinal radiation therapy (RT) for curative chemoradiation in anal cancer. Seventeen patients treated between January 2008 and September 2010 without evidence of inguinal and distant metastasis were retrospectively reviewed. In 9 patients with technique 1, dose to inguinal and whole pelvis area was 41.4 to 45 Gy and total dose was 59.4 Gy. In 8 patients with technique 2, doses to inguinal, whole pelvis, gross tumor were 36 to 41.4 Gy, 36 to 41.4 Gy, and 45 to 54 Gy, respectively. The median follow-up period was 27.6 and 14.8 months in group technique 1 and 2, respectively. The incidences of grade 3 radiation dermatitis were 56% (5 patients) and 50% (4 patients), dose ranges grade 3 dermatitis appeared were 41.4 to 50.4 Gy and 45 to 54 Gy in group technique 1 and 2, respectively (p = 0.819). The areas affected by grade 3 dermatitis in 2 groups were as follow: perianal and perineal areas in 40% and 25%, perianal and inguinal areas in 0% and 50%, and perianal area only in 60% and 25%, respectively (p = 0.196). No inguinal failure has been observed. Photon thunderbird with deep match technique and 3-field technique with electron inguinal boost showed similar incidence of radiation dermatitis. However, photon thunderbird with deep match seems to increase the possibility of severe perineal dermatitis.

  20. Hospital Costs Associated With Laparoscopic and Open Inguinal Herniorrhaphy

    OpenAIRE

    Spencer Netto, Fernando; Quereshy, Fayez; Camilotti, Bruna G.; Pitzul, Kristen; Kwong, Josephine; Jackson, Timothy; Penner, Todd; Okrainec, Allan

    2014-01-01

    Purpose: The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy. Methods: A prospectively maintained database was used to identify patients who underwent elective inguinal herniorrhaphy from April 2009 to March 2011. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. The main outcomes were operatin...

  1. Two Ports Laparoscopic Inguinal Hernia Repair in Children

    OpenAIRE

    Ibrahim, Medhat M.

    2015-01-01

    Introduction. Several laparoscopic treatment techniques were designed for improving the outcome over the last decade. The various techniques differ in their approach to the inguinal internal ring, suturing and knotting techniques, number of ports used in the procedures, and mode of dissection of the hernia sac. Patients and Surgical Technique. 90 children were subjected to surgery and they undergone two-port laparoscopic repair of inguinal hernia in children. Technique feasibility in relation...

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

    Directory of Open Access Journals (Sweden)

    Recep Tekin

    2015-01-01

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

  3. Comparison of elective inguinal node irradiation techniques in anal cancer

    International Nuclear Information System (INIS)

    Cha, Ji Hye; Seong, Jin Sil; Keum, Ki Chang; Lee, Chang Geol; Koom, Woong Sub

    2011-01-01

    To compare photon thunderbird with deep match (technique 1) with 3-field technique with electron inguinal boost (technique 2) in acute skin toxicity, toxicity-related treatment breaks and patterns of failure in elective inguinal radiation therapy (RT) for curative chemoradiation in anal cancer. Seventeen patients treated between January 2008 and September 2010 without evidence of inguinal and distant metastasis were retrospectively reviewed. In 9 patients with technique 1, dose to inguinal and whole pelvis area was 41.4 to 45 Gy and total dose was 59.4 Gy. In 8 patients with technique 2, doses to inguinal, whole pelvis, gross tumor were 36 to 41.4 Gy, 36 to 41.4 Gy, and 45 to 54 Gy, respectively. The median follow-up period was 27.6 and 14.8 months in group technique 1 and 2, respectively. The incidences of grade 3 radiation dermatitis were 56% (5 patients) and 50% (4 patients), dose ranges grade 3 dermatitis appeared were 41.4 to 50.4 Gy and 45 to 54 Gy in group technique 1 and 2, respectively (p = 0.819). The areas affected by grade 3 dermatitis in 2 groups were as follow: perianal and perineal areas in 40% and 25%, perianal and inguinal areas in 0% and 50%, and perianal area only in 60% and 25%, respectively (p = 0.196). No inguinal failure has been observed. Photon thunderbird with deep match technique and 3-field technique with electron inguinal boost showed similar incidence of radiation dermatitis. However, photon thunderbird with deep match seems to increase the possibility of severe perineal dermatitis.

  4. Association Between Thoracic Aortic Disease and Inguinal Hernia

    OpenAIRE

    Olsson, Christian; Eriksson, Per; Franco?Cereceda, Anders

    2014-01-01

    Background The study hypothesis was that thoracic aortic disease (TAD) is associated with a higher?than?expected prevalence of inguinal hernia. Such an association has been reported for abdominal aortic aneurysm (AAA) and hernia. Unlike AAA, TAD is not necessarily detectable with clinical examination or ultrasound, and there are no population?based screening programs for TAD. Therefore, conditions associated with TAD, such as inguinal hernia, are of particular clinical relevance. Methods and ...

  5. Prosthetic Mesh Repair for Incarcerated Inguinal Hernia

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    Cihad Tatar

    2016-08-01

    Full Text Available Background: Incarcerated inguinal hernia is a commonly encountered urgent surgical condition, and tension-free repair is a well-established method for the treatment of noncomplicated 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

  6. Inguinal hernia recurrence: Classification and approach

    Directory of Open Access Journals (Sweden)

    Campanelli Giampiero

    2006-01-01

    Full Text Available 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.

  7. Un nuevo enfoque quirúrgico realizado en la herniorrafía inguinal A new surgical approach in inguinal herniorraphy

    Directory of Open Access Journals (Sweden)

    Pedro López Rodríguez

    2004-06-01

    Full Text Available Se describe la experiencia con la técnica de reparación de la hernia en la cual la pared posterior del canal inguinal se fortalece con una franja fija de la aponeurosis del oblicuo externo para producir una pared posterior fuerte y fisiológicamente activa; en un estudio retrospectivo en el Hospital General Docente “Enrique Cabrera” en Ciudad de La Habana. Se presenta un primer corte de los primeros 56 pacientes operados entre de mayo de 2001 hasta el mes de mayo de 2003, ambos inclusive; los cuales se han seguido por consulta. Todos los pacientes fueron intervenidos de manera ambulatoria, con anestesia local; ninguno presentó dolor posoperatorio y sólo hubo un hematocele temprano y un granuloma tardío y no se ha encontrado recurrencia. La operación es fácil de realizar, no requirió de malla y ofrece resultados equivalentes con aquellos reportados con mallaThe experience with the hernia repair technique, in which the posterior wall of the inguinal canal is strengthened with a fix band of the aponeurosis of the external oblique muscle to produce a strong and physiologically active posterior wall is described in a retrospective study conducted at “Enrique Cabrera” General Hospital, in Havana City. A first cut-off of the first 56 patients operated on from May 2001 to May 2003, including both, that have been followed up, is presented. All the patients underwent ambulatory surgery with local anesthesia. No patient had postoperative pain and only one presented an early hematocele and late granuloma. Recurrence has not been found. The operation is easy, it does not require any mesh and its results are equivalent to those reported with mesh

  8. Implante con el sistema de reparación herniaria inguinal de prolene (Prolene hernia system

    Directory of Open Access Journals (Sweden)

    José Goderich Lalán

    2002-04-01

    Full Text Available Se realizó un estudio clinicodescriptivo y prospectivo del seguimiento de 21 pacientes a los que se les realizó implante sistema de reparación herniaria inguinal de prolene en hernias inguinales, reproducidas entre el 15 de octubre de 1998 y el 31 de marzo de 1999, con el objetivo de evaluar sus resultados. En todos los casos se utilizó el método de cirugía de corta estadía, anestesia local y sedación o espinal y antibioticoterapia profiláctica. En el seguimiento a muy corto plazo no se reportan recidivas y ninguna complicación posoperatoria. Más de la mitad de los pacientes había recibido más de 2 operaciones. La media de edad fue 49 años y el sexo predominante el masculino. La técnica que se utilizó para implante fue la recomendada por los fabricantesA clinical descriptive and prospective study of the follow-up of 21 patients who received implant of the Prolene inguinal hernia repair system in inguinal hernias reproduced between October l5th, 1998, and March 31st, 1999, was conducted aimed at evaluating the results. The short-stay surgery method, local anesthesia and sedation, or spinal anesthesia and prophylactic antibiotic therapy were used in all cases. No relapses or postoperative complications were reported in a very short-term follow-up. More than half of the patients had undergone more than 2 operations. Average age was 49 and there was a predominance of males. The technique used for the implant was the one recommended by the manufacturers

  9. Reconstrucción mamaria mediante colgajo transverso miocutáneo de gracilis: evaluación de resultados y estudio comparativo

    Directory of Open Access Journals (Sweden)

    V. Yuste-Benavente

    2014-06-01

    Full Text Available El uso de tejido abdominal representa una de las primeras líneas de actuación en reconstrucción mamaria con tejido autólogo. En aquellas pacientes en las que no está disponible, el colgajo miocutáneo transverso de gracilis (TMG representa una opción válida para la creación de una nueva mama. Presentamos una serie de 10 casos de reconstrucción mamaria con TMG con el objetivo de evaluar esta opción quirúrgica. Para ello, administramos a las pacientes intervenidas un cuestionario sobre calidad de la reconstrucción y de la zona donante y valoramos además: la duración promedio de la intervención, el periodo promedio de ingreso hospitalario, las complicaciones sufridas en el área donante y en la mama reconstruida. Para poder comparar los resultados obtenidos con esta técnica, recogimos también los mismos datos en las pacientes sometidas a reconstrucción mamaria con colgajo de músculo dorsal ancho, una alternativa a la reconstrucción con tejido abdominal ampliamente extendida. Exponemos los resultados de la comparación, que obtuvieron resultados superiores en los ítems referentes al aspecto de la mama reconstruida con el colgajo TMG.

  10. Outcome of laproscopic totally extraperitoneal hernioplasty for inguinal hernia

    International Nuclear Information System (INIS)

    Hanif, H.; Memon, S.H.

    2015-01-01

    Background: Hernioplasty for Inguinal hernia is one of the commonest operations performed in general surgical wards. More recently, interest has waxed and waned regarding the minimally invasive approach to hernioplasty. This study was carried out to assess the management outcome of minimally invasive hernioplasty (Totally extra-peritoneal approach) as the treatment of choice for uncomplicated (incomplete and reducible) inguinal hernia. Method: In this quasi experimental study patients aged between 14-83 years who were otherwise fit and willing for total extra-peritoneal laparoscopic repair were recruited prospectively over a 10 month period. Thirty-seven such patients were operated and followed up in the hernia clinics. Six cases were later excluded for lack of proper follow-up. Results: The typical patient was middle-aged male with right-sided inguinal hernia. Mean operating time was 53.3 minutes. No conversion was undertaken; however, there was one case of small bowel injury that went unrecognized on-table but necessitated subsequent laparotomy. Overall morbidity was 13.5 percentage. Mean length of hospitalization was 2.89 days. Mean duration to normal routine life was 9.25 days. Overall, 70.9 percentage of patients expressed satisfaction with the surgery. Conclusion: Totally extra-peritoneal mesh repair is a new and safe technique for hernioplasty with acceptable rates of morbidity and it is procedure of choice for recurrent and bilateral inguinal hernias and also used as alternate to open hernioplasty for uncomplicated (incomplete and reducible) inguinal hernia. (author)

  11. Acute testicular ischemia caused by incarcerated inguinal hernia.

    Science.gov (United States)

    Orth, Robert C; Towbin, Alexander J

    2012-02-01

    Acute testicular ischemia caused by an incarcerated inguinal hernia usually affects infants. There are few reports of diagnosis using US, and the effect of long-standing reducible hernias on testicular growth in infants and children is unknown. The objectives of this study were to determine the incidence of testicular ischemia secondary to an incarcerated inguinal hernia at scrotal sonography and to determine the effect on testicular size at diagnosis. A hospital database was used to locate scrotal sonography examinations documenting an inguinal hernia, and images were reviewed for signs of testicular ischemia. Testicular volumes were compared using the Wilcoxon signed rank test. A total of 147 patients were identified with an inguinal hernia (age 1 day to 23 years, average 6 years). Ten patients (6.8%) had associated testicular ischemia (age 3 weeks to 6 months, average 9 weeks) and showed a statistically significant increase in ipsilateral testicular size compared to the contralateral testicle (P = 0.012). Patients without testicular ischemia did not show a significant difference in testicular size, regardless of patient age. An incarcerated inguinal hernia should be considered as a cause of acute testicular ischemia in infants younger than 6 months of age.

  12. Unusual Initial Presentation of Herpes Simplex Virus as Inguinal Lymphadenopathy

    Directory of Open Access Journals (Sweden)

    Sarah A. Fleming

    2015-01-01

    Full Text Available Genital herpes simplex virus (HSV infections are a common cause of inguinal lymphadenopathy. However, surgical excision of enlarged inguinal nodes is almost never performed to initially diagnose genital herpes simplex virus, due to the distinct external presentation of genital herpetic vesicles that usually occur with the first symptoms of infection. Therefore, the histologic and immunophenotypic features of HSV-associated inguinal lymphadenopathy are unfamiliar to most pathologists. The current report describes the lymph node pathology of two immunocompetent patients, whose initial HSV diagnosis was established through surgical excision of enlarged inguinal lymph nodes. Histologic examination showed features consistent with viral lymphadenopathy, including florid follicular hyperplasia, monocytoid B-cell hyperplasia, and paracortical hyperplasia without extensive necrosis. Immunohistochemical stains for HSV antigens, using polyclonal anti-HSV I and II antibodies, demonstrate strong immunoreactivity for HSV in a small number of cells in the subcapsular sinuses, especially in areas with monocytoid B-cell hyperplasia. Rare scattered HSV-positive cells also are identified in paracortical areas and germinal centers. We conclude that an initial diagnosis of genital HSV infection may be established by inguinal lymph node biopsy.

  13. Patient-Related Risk Factors for Recurrence After Inguinal Hernia Repair

    DEFF Research Database (Denmark)

    Burcharth, Jakob; Pommergaard, Hans-Christian; Bisgaard, Thue

    2015-01-01

    patient demographics, hernia characteristics, connective tissue composition and degradation, habits and social relations, and conditions related to inguinal hernia recurrence. Results. From a total of 5061 records screened, we included 40 observational studies enrolling 720 651 inguinal hernia procedures...

  14. Pain and functional impairment 6 years after inguinal herniorrhaphy

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Bay-Nielsen, Morten; Kehlet, Henrik

    2006-01-01

    2002 and June 2003 (n=1015) based upon the nationwide Danish Hernia Database collaboration. The response rate was 68.4%. Combined frequent and moderate or severe pain from the previous hernia site during activity was reported by 187 patients (18.4%). Pain during sexual activity was reported by 224...... and subsequent sexual dysfunction represent a clinically significant problem in about 3% of younger male patients with a previous inguinal herniorrhaphy. Intraoperative nerve damage and disposition to other chronic pain conditions are among the most likely pathogenic factors.......To determine the incidence of pain related sexual dysfunction 1 year after inguinal herniorrhaphy and to assess the impact pain has on sexual function. In contrast to the well-described about 10% risk of chronic wound related pain after inguinal herniorrhaphy, chronic genital pain, dysejaculation...

  15. Type V Collagen is Persistently Altered after Inguinal Hernia Repair

    DEFF Research Database (Denmark)

    Lorentzen, L; Henriksen, N A; Juhl, P

    2018-01-01

    BACKGROUND AND AIMS: Hernia formation is associated with alterations of collagen metabolism. Collagen synthesis and degradation cause a systemic release of products, which are measurable in serum. Recently, we reported changes in type V and IV collagen metabolisms in patients with inguinal...... elective cholecystectomy served as controls (n = 10). Whole venous blood was collected 35-55 months after operation. Biomarkers for type V collagen synthesis (Pro-C5) and degradation (C5M) and those for type IV collagen synthesis (P4NP) and degradation (C4M2) were measured by a solid-phase competitive...... assay. RESULTS: The turnover of type V collagen (Pro-C5/C5M) was slightly higher postoperatively when compared to preoperatively in the inguinal hernia group (P = 0.034). In addition, the results revealed a postoperatively lower type V collagen turnover level in the inguinal hernia group compared...

  16. Bilateral inguinal hernia repair: laparoscopic or open approach?

    Science.gov (United States)

    Feliu, X; Clavería, R; Besora, P; Camps, J; Fernández-Sallent, E; Viñas, X; Abad, J M

    2011-02-01

    The aim of this study was to investigate outcomes in the treatment of bilateral inguinal hernia, comparing the laparoscopic totally extraperitoneal (TEP) and open tension-free mesh repair (LICHT) approaches. We performed a prospective controlled non randomized clinical study in 128 patients with bilateral inguinal hernia over a period of 3 years. LICHT was used in 106 cases (53 patients) while TEP was employed in 150 cases (75 patients). The main outcome measurements were: recurrence rate, operating time, hospital stay and postoperative complications. There were three recurrences (2.3%): two in the LICHT group (3.8%) and one (1.3%) in the TEP group P = NS. The TEP procedure was faster than LICHT repair (48.8 ± 10.8 vs. 70.4 ± 11.2 min) P approach is an effective option for the treatment of bilateral inguinal hernia when performed by experienced surgeons.

  17. Laparoscopic approach to incarcerated inguinal hernia in children.

    Science.gov (United States)

    Kaya, Mete; Hückstedt, Thomas; Schier, Felix

    2006-03-01

    The purpose of this study was to describe the laparoscopic approach to incarcerated inguinal hernia in children. After unsuccessful manual reduction, 29 patients (aged 3 weeks to 7 years; median, 10 weeks; 44 boys, 15 girls) with incarcerated inguinal hernia underwent immediate laparoscopy. The hernial content was reduced in a combined technique of external manual pressure and internal pulling by forceps. The bowel was inspected, and the hernia was repaired. In all patients, the procedure was successful. No conversion to the open approach was required. Immediate laparoscopic herniorrhaphy in the same session was added. No complications occurred. Laparoscopy allowed for simultaneous reduction under direct visual control, inspection of the incarcerated organ, and definitive repair of the hernia. Technically, it appears easier than the conventional approach because of the internal inguinal ring being widened by intraabdominal carbon dioxide insufflation. The hospital stay is shorter.

  18. Imaging findings of angiomyxolipoma of the spermatic cord mimicking inguinal hernia

    NARCIS (Netherlands)

    Cho, H.S.; Woo, J.Y.; Hong, H.S.; Yang, I.; Lee, Y.; Jung, A.Y.; Yang, D.H.; Kim, J.W.

    2013-01-01

    We report the case in a 72-year-old man who presented with a right inguinal mass and with a one month history that was initially interpreted as an inguinal hernia. Ultrasonography (US) and computed tomography (CT) demonstrated a right inguinal mass, including myxoid and fat component, extending from

  19. Toxic shock syndrome following inguinal hernia repair: a rare condition

    Directory of Open Access Journals (Sweden)

    Rohit Prasad Yadav

    2014-01-01

    Full Text Available A 25-year-old man developed fulminant multisystem failure 28 hours after elective repair of an inguinal hernia. Toxic shock syndrome (TSS was diagnosed. The patient recovered fully with supportive care in ICU, antibiotics, and IV human immunoglobin . To the best of our knowledge, only one case of TSS following inguinal hernia repair have ever been previously published. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 57-59 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9689

  20. An animal model to train Lichtenstein inguinal hernia repair

    DEFF Research Database (Denmark)

    Rosenberg, J; Presch, I; Pommergaard, H C

    2013-01-01

    , thus complicating the procedure if operation should be done in the inguinal canal. The chain of lymph nodes resembles the human spermatic cord and can be used to perform Lichtenstein's hernia repair. RESULTS: This experimental surgical model has been tested on two adult male pigs and three adult female...... pigs, and a total of 55 surgeons have been educated to perform Lichtenstein's hernia repair in these animals. CONCLUSIONS: This new experimental surgical model for training Lichtenstein's hernia repair mimics the human inguinal anatomy enough to make it suitable as a training model. The operation...

  1. Colgajo dermoglandular de apoyo en mastopexia con implantes: técnica de la hamaca

    OpenAIRE

    A. Alí; C. Zuleta-Bechara; V. Vassaro

    2013-01-01

    La ptosis mamaria es consulta frecuente en la práctica del cirujano plástico, y las opciones quirúrgicas para su corrección son múltiples. A pesar de los avances en el tratamiento de esta alteración, los resultados impredecibles y las posibles complicaciones siguen siendo frecuentes, sobre todo cuando se asocia la colocación de implantes mamarios. La dehiscencia de la herida, la exposición del implante y la modificación de la forma de la mama, en especial del polo inferior, pueden estar prese...

  2. CT and US findings of ovarian torsion within an incarcerated inguinal hernia.

    Science.gov (United States)

    Hyun, Park Mee; Jung, Ah Young; Lee, Yul; Yang, Ik; Yang, Dae Hyun; Hwang, Ji-Young

    2015-02-01

    Inguinal hernia is relatively common in children. Although inguinal hernia is not frequently encountered in girls in comparison to boys, there are occasional cases of uterine or ovarian herniation in female indirect inguinal hernia. Incarcerated ovary in hernia sac has the risk of torsion and strangulation. We present an 8-year-old girl with painful mass in her left groin. With computed tomography (CT) and ultrasonography (US), we made the diagnosis of ovarian strangulation within an incarcerated inguinal hernia. Since ultrasound is primarily used for evaluation of groin mass, CT findings of an incarcerated inguinal hernia is rarely reported.

  3. Surgical management of chronic pain after inguinal hernia repair

    DEFF Research Database (Denmark)

    Aasvang, E; Kehlet, H

    2005-01-01

    BACKGROUND: Chronic pain after inguinal hernia repair is an adverse outcome that affects about 12 per cent of patients. Principles of treatment have not been defined. This review examines neurectomy and mesh or staple removal as possible treatments. METHOD: A literature search was carried out using...

  4. Ectopic decidual reaction mimicking inguinal lymphoma on ultrasound

    DEFF Research Database (Denmark)

    Lorentzen, C.; Prangsgaard, Tina; Lorentzen, Torben

    2014-01-01

    Ectopic decidual reaction has been described in various intraperitoneal locations. We present a case of unusual ectopic decidual reaction in the groin mimicking inguinal lymphoma on ultrasound in a pregnant woman. This case contributes evidence illustrating the variability of the clinical...... presentation of ectopic decidual reaction....

  5. Incidence of inguinal hernia in children with congenital cerebral palsy

    DEFF Research Database (Denmark)

    Reimers, J I; Latocha, J E

    1990-01-01

    The incidence of inguinal hernia among 247 children with cerebral palsy was ascertained. During the first year of life, 20 of the 153 boys developed hernia, as did one of the 94 girls. Among boys with birthweights of 1000 to 2000g the incidence was 31 per cent, which is twice the rate for normal...

  6. Robotic Inguinal Hernia Repair: Technique and Early Experience.

    Science.gov (United States)

    Arcerito, Massimo; Changchien, Eric; Bernal, Oscar; Konkoly-Thege, Adam; Moon, John

    2016-10-01

    Laparoscopic inguinal hernia repair has been shown to have multiple advantages compared with open repair such as less postoperative pain and earlier resume of daily activities with a comparable recurrence rate. We speculate robotic inguinal hernia repair may yield equivalent benefits, while providing the surgeon added dexterity. One hundred consecutive robotic inguinal hernia repairs with mesh were performed with a mean age of 56 years (25-96). Fifty-six unilateral hernias and 22 bilateral hernias were repaired amongst 62 males and 16 females. Polypropylene mesh was used for reconstruction. All but, two patients were completed robotically. Mean operative time was 52 minutes per hernia repair (45-67). Five patients were admitted overnight based on their advanced age. Regular diet was resumed immediately. Postoperative pain was minimal and regular activity was achieved after an average of four days. One patient recurred after three months in our earlier experience and he was repaired robotically. Mean follow-up time was 12 months. These data, compared with laparoscopic approach, suggest similar recurrence rates and postoperative pain. We believe comparative studies with laparoscopic approach need to be performed to assess the role robotic surgery has in the treatment of inguinal hernia repair.

  7. Ilio inguinal block: do we know the correct dose?

    African Journals Online (AJOL)

    Adele

    TRAVEL FELLOWSHIP. Introduction. Although Ilio-inguinal nerve blocks are commonly used, the dose advocated varies between 0.3-0.5ml/kg. Despite these doses a failure rate of up to 20-30% has been described using the standard technique. These failures may be due to inadequate understanding of the anatomy, faulty ...

  8. Chronic Post Inguinal Herniorraphy Pain: Prevalence and Risk Factors

    African Journals Online (AJOL)

    Background: Inguinal hernia is a common surgical condition. Whereas complications associated with hernia repair are well documented, chronic postoperative groin pain has received less attention. Objective: To review the frequency and associated risk factors for chronic post herniorrhaphy groin pain at a tertiary urban ...

  9. Metastatic Carcinoma Of The BreastWith Inguinal Lymph Node ...

    African Journals Online (AJOL)

    To report two cases of advanced breast carcinoma with metastases to the inguinal lymph nodes in two Nigerian women. The University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Two Nigerian women, one aged 40 years with an invasive lobular carcinoma of the right breast, and the other aged 48 yearswith ...

  10. Two Ports Laparoscopic Inguinal Hernia Repair in Children

    Directory of Open Access Journals (Sweden)

    Medhat M. Ibrahim

    2015-01-01

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

  11. Ultrasound-guided nerve block for inguinal hernia repair

    DEFF Research Database (Denmark)

    Bærentzen, Finn; Maschmann, Christian; Jensen, Kenneth

    2012-01-01

    Open inguinal hernia repair in adults is considered a minor surgical procedure but can be associated with significant pain. We aimed to evaluate acute postoperative pain management in male adults randomized to receive an ultrasound-guided ilioinguinal and iliohypogastric nerve block administered...

  12. Efficacy of local anaesthesia in repair of inguinal hernia

    International Nuclear Information System (INIS)

    Rafiq, M.K.; Sultan, B.; Malik, M.A.; Khan, K.; Abbasi, M.A.

    2017-01-01

    Local anaesthesia has been identified as the most favourable anaesthesia for elective inguinal hernia repair with respect to complication rate, cost effectiveness and overall patients' satisfaction. This study was conducted to determine the efficacy of local anaesthesia in inguinal hernia in terms of pain relief, wound infection and hospital stay. Methods: In this randomized controlled trial (RCT), 60 patients with inguinal hernia were included at the General Surgical 'B' Unit, Ayub Teaching Hospital Abbottabad. Results: The day-case rates were significantly higher when patients underwent surgery under LA compared to GA (82.6 percent versus 42.6 percent). The incidence of urinary retention was higher in the GA group (p<0.05). There were 17 (2.9 percent) re-admissions overall. The reasons for re-admission included haematoma (n=6), severe pain (n=4), infection (n=3), fainting (n=2) and urinary retention (n=2). Conclusion: This study demonstrates that local anaesthesia for inguinal hernia repair has better efficacy as compared to general anaesthesia. (author)

  13. Mesh Plug Repair of Inguinal Hernia; Single Surgeon Experience

    Directory of Open Access Journals (Sweden)

    Ahmet Serdar Karaca

    2013-10-01

    Full Text Available Aim: Mesh repair of inguinal hernia repairs are shown to be an effective and reliable method. In this study, a single surgeon%u2019s experience with plug-mesh method performs inguinal hernia repair have been reported. Material and Method: 587 patients with plug-mesh repair of inguinal hernia, preoperative age, body / mass index, comorbid disease were recorded in terms of form. All of the patients during the preoperative and postoperative hernia classification of information, duration of operation, antibiotics, perioperative complications, and later, the early and late postoperative complications, infection, recurrence rates and return to normal daily activity, verbal pain scales in terms of time and postoperative pain were evaluated. Added to this form of long-term pain ones. The presence of wound infection was assessed by the presence of purulent discharge from the incision. Visual analog scale pain status of the patients was measured. Results: 587 patients underwent repair of primary inguinal hernia mesh plug. One of the patients, 439 (74% of them have adapted follow-ups. Patients%u2019 ages ranged from 18-86. Was calculated as the mean of 47±18:07. Follow-up period of the patients was found to be a minimum of 3 months, maximum 55 months. Found an average of 28.2±13.4 months. Mean duration of surgery was 35.07±4.00 min (min:22mn-max:52mn, respectively. When complication rates of patients with recurrence in 2 patients (0.5%, hematoma development (1.4% in 6 patients, the development of infection in 11 patients (2.5% and long-term groin pain in 4 patients (0.9% appeared. Discussion: In our experience, the plug-mesh repair of primary inguinal hernia repair safe, effective low recurrence and complication rates can be used.

  14. Inguinodynia in patients submitted to conventional inguinal hernioplasty.

    Science.gov (United States)

    Dias, Bruno Garcia; Santos, Marcelo Protásio Dos; Chaves, Ana Barbara DE Jesus; Willis, Mariana; Gomes, Marcio Couto; Andrade, Fernandes Tavares; Melo, Valdinaldo Aragão DE; Santos, Paulo Vicente Dos

    2017-01-01

    to evaluate the incidence of chronic pain and its impact on the quality of life of patients submitted to inguinal hernioplasty using the Lichtenstein technique. this was a descriptive, cross-sectional study of patients operated under spinal anesthesia from February 2013 to February 2015 and who had already completed six postoperative months. We questioned patients about the presence of chronic inguinal pain and, if confirmed, invited them to a consultation in which we assessed the pain and its impact on quality of life. out of 158 patients submitted to the procedure, we identified 7.6% as having inguinodynia. Of these, there was an impact on the quality of life in 25%. the incidence of inguinodynia after hernioplasty with repercussion in quality of life was similar to the one of found in the world literature. avaliar a incidência de dor crônica e o seu impacto na qualidade de vida de pacientes submetidos à hernioplastia inguinal pela técnica de Lichtenstein. trata-se de estudo transversal descritivo, de pacientes operados de hérnia inguinal pela técnica de Lichtenstein sob anestesia raquidiana, no período de fevereiro de 2013 a fevereiro de 2015, e que já haviam completado seis meses de pós-operatório. Os pacientes foram questionados sobre a presença de dor inguinal crônica e, caso confirmada, convidados a uma consulta na qual foi feita análise da qualidade da dor e seu impacto na qualidade de vida. do total de 158 pacientes submetidos ao procedimento, 7,6% foram identificados como portadores de inguinodinia. Destes, houve impacto na qualidade de vida em 25%. observou-se incidência de inguinodinia pós-hernioplastia com repercussão na qualidade de vida semelhante à literatura mundial.

  15. Cierre de una fístula oroantral usando cemento óseo y un colgajo de mucosa yugal Closure of an oroantral fistula using bone cement and a jugal mucosa flap

    Directory of Open Access Journals (Sweden)

    Beatriz Ágreda Moreno

    2012-03-01

    Full Text Available Una fístula oroantral es una solución de continuidad patológica entre el seno maxilar y la cavidad oral, producida frecuentemente tras una extracción dentaria, en la mayoría de los casos, del primer o segundo molar. El síntoma más común que provoca es una sinusitis aguda, que evolucionará a la cronicidad si la fístula permanece. El diagnóstico se realiza mediante endoscopia transalveolar, ortopantografía o tomografía computarizada dental. Su cierre quirúrgico es necesario cuando la fístula tiene más de 3 mm, o no sella por sí misma en 3 semanas. Existen, para ello, varias técnicas, usando distintos materiales y colgajos, cuyo fin es ocluir, tanto el defecto óseo, como el mucoso, para solucionar así a la vez la fístula y el problema sinusal.The oroantral fistula is a solution of pathological continuity between the maxillary sinus and the oral cavity, frequently produced after a teeth extraction in most of cases of the first or second molars. The commonest symptom provoked is an acute sinusitis evolving to chronicity if the fistula remains. The diagnosis is made by transalveolar, orthopantography or dental computerized tomography. Its surgical closure is necessary when the fistula has more than 3 mm or not seal by itself in three weeks. For it, there are some techniques using different materials and flaps where its objective is to occlude the bone defect as well as the mucous one thus solving the fistula and the sinus problem.

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

    Science.gov (United States)

    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.

  17. Anatomía arterial de los colgajos musculares de extensor carpi radialis longus y extensor carpi radialis brevis para su uso en transferencia muscular funcional libre Arterial anatomy of the extensor carpi radialis longus and extensor carpi radialis brevis muscle flaps related to its use in free functioning muscle transfer

    Directory of Open Access Journals (Sweden)

    A. Rodríguez Lorenzo

    2008-09-01

    Full Text Available El objetivo de este trabajo es documentar el aporte arterial y el patrón vascular intramuscular de los músculos Extensor Carpi Radialis Longus (ECRL y Extensor Carpi Radialis Brevis (ECRB para analizar su utilización como colgajos libres en transferencia muscular funcional para reanimación facial. Realizamos un estudio anatómico en 29 brazos humanos en fresco. Las técnicas de inyección utilizadas fueron la modificada de oxido de plomo y gelatina en 11 cadáveres y la de inyección pulsátil de látex color en 18. Disecamos los músculos ECRL y ECRB y sus pedículos, los fotodocumentamos y radiografiamos valorando los resultados en función del patrón vascular intramuscular, relaciones anatómicas, calibres y longitud de pedículos. Encontramos dos patrones vasculares diferentes en las 29 disecciones siguiendo la clasificación de Mathes y Nahai de la anatomía vascular de los músculos (en función del número de pedículos vasculares y su dominancia: Tipo I( 37,9% ECRL y 20,7% ECRB y Tipo II(62,1% del ECRL y 79,3% del ECRB. El pedículo principal del ECRL (de diámetro medio 1,73 mm y longitud de pedículo media de 32,32 mm es en el 100% de los casos rama de la arteria recurrente radial y el pedículo principal del ECRB (de diámetro medio 1,11 mm y longitud de pedículo media de 27,77 mm es rama de la arteria radial en el 68,9% de los casos y de la arteria recurrente radial en el 31,1% de los casos. Concluimos que El ECRL y ECRB presentan dos tipos de patrones vasculares: tipo I y tipo II, siendo más frecuente en nuestro trabajo el tipo II, que hacen que ambos puedan ser transferidos como colgajos libres por su pedículo principal. Ambos músculos presentan un tamaño, contorno, contenido fascial importante para el anclaje de suturas y una longitud de pedículo y calibre vascular adecuados para su transferencia microvascular libre en reanimación facial. De los dos, el más realizable como colgajo libre es el ECRB ya que la relaci

  18. Dysejaculation after laparoscopic inguinal herniorrhaphy: a nationwide questionnaire study

    DEFF Research Database (Denmark)

    Bischoff, Joakim Mutahi; Linderoth, Gitte; Aasvang, Eske Kvanner

    2012-01-01

    or genitals during sexual activity was reported by 88 patients (10.9%), and 19 patients (2.4%) reported that the pain had impaired their sexual activity to a moderate or severe degree. Older patients and patients with longer follow-up had lower prevalence of pain during sexual activity. CONCLUSIONS......BACKGROUND: Dysejaculation and pain from the groin and genitals during sexual activity represent a clinically significant problem in up to 4% of younger males after open inguinal herniorrhaphy. The aim of this questionnaire study is to assess the prevalence of dysejaculation and pain during sexual...... activity after laparoscopic inguinal herniorrhaphy on a nationwide basis. METHODS: The study population comprised all men aged 18-50 years registered in the Danish Hernia Database (n = 1,671) who underwent primary laparoscopic herniorrhaphy between January 1, 1998 and November 30, 2009. Questionnaires...

  19. Association between thoracic aortic disease and inguinal hernia.

    Science.gov (United States)

    Olsson, Christian; Eriksson, Per; Franco-Cereceda, Anders

    2014-08-21

    The study hypothesis was that thoracic aortic disease (TAD) is associated with a higher-than-expected prevalence of inguinal hernia. Such an association has been reported for abdominal aortic aneurysm (AAA) and hernia. Unlike AAA, TAD is not necessarily detectable with clinical examination or ultrasound, and there are no population-based screening programs for TAD. Therefore, conditions associated with TAD, such as inguinal hernia, are of particular clinical relevance. The prevalence of inguinal hernia in subjects with TAD was determined from nation-wide register data and compared to a non-TAD group (patients with isolated aortic stenosis). Groups were balanced using propensity score matching. Multivariable statistical analysis (logistic regression) was performed to identify variables independently associated with hernia. Hernia prevalence was 110 of 750 (15%) in subjects with TAD versus 29 of 301 (9.6%) in non-TAD, P=0.03. This statistically significant difference remained after propensity score matching: 21 of 159 (13%) in TAD versus 14 of 159 (8.9%) in non-TAD, PTAD, OR 1.8 (1.1 to 2.8), P=0.015. The prevalence of inguinal hernia (15%) in TAD is higher than expected in a general population and higher in TAD, compared to non-TAD. TAD is independently associated with hernia in multivariable analysis. Presence or history of hernia may be of importance in detecting TAD, and the association warrants further study. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  20. Pediatric inguinal hernia repair-a critical appraisal

    DEFF Research Database (Denmark)

    Rosenberg, J.

    2008-01-01

    Inguinal hernia repair in infants and babies is a routine operation, but many issues have not been addressed scientifically. Thus, it is not known, e.g., if all children with a hernia should be operated on, what is the best timing of surgery, or if the operation should be performed with an open a...... approach or laparoscopically. The review is a critical discussion of these and other issues in pediatric herniorrhaphy pointing out the need for further research Udgivelsesdato: 2008/4...

  1. Exodoncia atraumática e implante post exodoncia sin colgajo combinado con injerto gingival libre

    OpenAIRE

    García Linares, Sixto; Yon Guerrero, Helen

    2010-01-01

    Presentamos un caso donde se describe la técnica de exodoncia atraumática, colocación de un implante post exodoncia y cierre por primera intención mediante un injerto gingival libre. El uso de implantes post exodoncia necesita varias condiciones para poder realizarse, entre ellas: paredes óseas conservadas, hueso alveolar más allá del ápice mayor a 4 mm. , margen gingival conservado, ausencia de fístula, etc. El injerto gingival libre permite una cicatrización por primera intención n...

  2. Inguinal hernia repair in the Amsterdam region 1994-1996.

    Science.gov (United States)

    Schoots, I G; van Dijkman, B; Butzelaar, R M; van Geldere, D; Simons, M P

    2001-03-01

    In the Netherlands, approximately 30,000 inguinal hernia repairs are performed yearly. At least 15% are for recurrence. New procedures are being introduced creating discussion on which technique is the best. Currently it is not possible to choose on evidence alone because of the long follow-up that is needed. In 1996 an inventory was taken of all inguinal hernia repairs that were performed in the Amsterdam region (9 hospitals). These results were compared with the results from a similar study performed in 1994. Major changes in treatment strategy were noted. The Bassini repair was replaced by Shouldice and Lichtenstein techniques. There was a significant increase in the use of prostheses for both primary and recurrent inguinal hernias. There was no significant decrease in the percentage of operations performed for recurrent hernia from 19.5% to 16.8%. However, there was a significant decrease in operations performed for early recurrences (5.1%-3.4%) (p = 0.05). These results suggest that the Shouldice and Lichtenstein repairs may be superior to the Bassini repair in terms of early hernia recurrence.

  3. Minimal access surgery of pediatric inguinal hernias: a review.

    Science.gov (United States)

    Saranga Bharathi, Ramanathan; Arora, Manu; Baskaran, Vasudevan

    2008-08-01

    Inguinal hernia is a common problem among children, and herniotomy has been its standard of care. Laparoscopy, which gained a toehold initially in the management of pediatric inguinal hernia (PIH), has managed to steer world opinion against routine contralateral groin exploration by precise detection of contralateral patencies. Besides detection, its ability to repair simultaneously all forms of inguinal hernias (indirect, direct, combined, recurrent, and incarcerated) together with contralateral patencies has cemented its role as a viable alternative to conventional repair. Numerous minimally invasive techniques for addressing PIH have mushroomed in the past two decades. These techniques vary considerably in their approaches to the internal ring (intraperitoneal, extraperitoneal), use of ports (three, two, one), endoscopic instruments (two, one, or none), sutures (absorbable, nonabsorbable), and techniques of knotting (intracorporeal, extracorporeal). In addition to the surgeons' experience and the merits/limitations of individual techniques, it is the nature of the defect that should govern the choice of technique. The emerging techniques show a trend toward increasing use of extracorporeal knotting and diminishing use of working ports and endoscopic instruments. These favor wider adoption of minimal access surgery in addressing PIH by surgeons, irrespective of their laparoscopic skills and experience. Growing experience, wider adoption, decreasing complications, and increasing advantages favor emergence of minimal access surgery as the gold standard for the treatment of PIH in the future. This article comprehensively reviews the laparoscopic techniques of addressing PIH.

  4. An inguinal hernia sac tumor of extrahepatic cholangiocarcinoma origin

    Directory of Open Access Journals (Sweden)

    Yamazaki Hidehiro

    2006-03-01

    Full Text Available Abstract Background Metastatic hernia sac tumor from biliary malignancy is extremely rare with only one such case previously reported. We herein report an additional case of extrahepatic cholangiocarcinoma presenting as a hernia sac tumor. Case presentation A 78-year-old man presented with an irreducible right inguinal hernia associated with a firm tumor, 2.0 cm in diameter. A computed tomography scan demonstrated a soft tissue density mass with heterogeneous enhancement within the right inguinal canal. The patient underwent a hernia repair and the hernia sac tumor was resected. Histological examination of the tumor revealed a metastatic adenocarcinoma suggesting the tumor was of pancreato-biliary origin. Further investigation using imaging studies disclosed a primary tumor in the upper bile duct. The patient died of the disease nine months after the resection. Conclusion Hernia sac tumors should be considered when an irreducible, growing mass appears within an inguinal hernia. Computed tomography may be useful for the early detection of hernia sac tumors from undiagnosed intra-abdominal malignancies.

  5. Collagen and elastic fibers of skin connective tissue in patients with and without primary inguinal hernia

    OpenAIRE

    Bórquez M, Pablo; Garrido O, Luis; Manterola D, Carlos; Peña S, Patricio; Schlageter T, Carol; Orellana C, Juan José; Ulloa U, Hugo; Peña R, Juan Luis

    2003-01-01

    There are few studies looking for collagen matrix defects in patients with inguinal hernia. Aim: To study the skin connective tissue in patients with and without inguinal hernia. Patients and methods: Skin from the surgical wound was obtained from 23 patients with and 23 patients without inguinal hernia. The samples were processed for conventional light microscopy. Collagen fibers were stained with Van Giesson and elastic fibers with Weigert stain. Results: Patients without hernia had compact...

  6. Glue versus suture for mesh fixation in inguinal hernia repair.

    Science.gov (United States)

    Chandrasekar, Shruthi; Jeyakumar, S; Ganapathy, Tharun

    2018-03-22

    Inguinal hernia is one of the most common surgical problem presenting to the surgical OPD. Surgery is the mainstay of treatment for inguinal hernia today. Surgery for inguinal hernia has undergone a great evolution over a period of several centuries. Lichenstein's tension free hernioplasty is the one of the first surgeries taught to a surgical resident. The main aim of surgeries in this era is to give the best possible results with the least possible pain, scar and time. This has given rise to so many modifications to the classical Lichenstein's procedure and also to laparoscopic hernioplasty. Pain after inguinal hernia surgery is found to be debilitating and altering the quality of life in several patients, which has been attributed to the traumatic fixation of the mesh with sutures. This has paved way to the development of various atraumatic methods of fixation, tissue glue is one such development. Hence this study, to compare traumatic and atraumatic methods of mesh fixation in inguinal hernia repair. The aim of this study was to compare suture fixation versus tissue glue fixation of the mesh in inguinal hernia repair. Primary objective was to compare the immediate and chronic post-operative pain. Secondary objective was to compare the time taken for the procedure by the two methods in use and also to compare the presence of any complications. and methodology: This study was done in the General Surgery department of XXX hospital, medical college and research centre, kattangulathur after Ethics committee clearance. It is a single blinded study. The study was done on 51 patients consenting for the study and meeting the inclusion criterias from the period of March 2016 to August 2017 out of which 26 were selected for glue mesh fixation and 25 for suture mesh fixation according to simple randomization. The suture group patients underwent classical Lichenstein's tension free hernioplasty and the glue group underwent Lichenstein's hernioplasty with glue where dots of

  7. Cono extendido, nueva variante técnica en la cirugía de la hernia inguinal Extended cone a new technical variant in the inguinal hernia surgery

    Directory of Open Access Journals (Sweden)

    Hiram Rodríguez Blanco

    2011-06-01

    Full Text Available INTRODUCCIÓN. El tratamiento de la hernia inguinal continúa siendo un tema controvertido y no existe un punto común de acción en cuanto a la modalidad terapéutica que se emplea. Con el desarrollo de las técnicas protésicas la controversia continúa a pesar de las demostradas ventajas de estas. El objetivo de este estudio fue evaluar los primeros casos intervenidos quirúrgicamente mediante la técnica del cono extendido, una modificación de las técnicas clásicas de Liechtenstein y Rutkow. MÉTODOS. Se realizó un estudio prospectivo lineal en 45 pacientes operados mediante una técnica protésica denominada cono extendido. Los pacientes fueron operados en un período de 2 años en la Clínica Multiperfil de Luanda (Angola y para clasificarlos se utilizó la clasificación de Gilbert modificada. RESULTADOS. Hubo un predominio del sexo masculino. La localización más frecuente fue la región inguinal derecha. Predominaron los pacientes clasificados de grado III según la clasificación de Gilbert. Hubo 6 complicaciones menores y hasta el momento no han ocurrido recidivas. CONCLUSIONES. La técnica del cono extendido es una opción más para el tratamiento de los pacientes que presenten hernias inguinales de grado III y VI de la clasificación de Gilbert.INTRODUCTION. The treatment of the inguinal hernia remains being a controversial subject and there is not a common point of action as regards the therapeutic modality used. With the development of the prosthetic techniques the controversy remains despite their demonstrated advantages. The objective of present study was to assess the first cases operated on with the extended cone technique a modification of the classic Liechtenstein's and Rutkow's techniques. METHODS. A linear and prospective study was conducted in 45 patients operated on by a prosthetic technique called extended cone. The patients were operated on in a period of two years in the Multiprofile Clinic of Luanda (Angola and

  8. Validation of newly developed physical laparoscopy simulator in transabdominal preperitoneal (TAPP) inguinal hernia repair.

    Science.gov (United States)

    Nishihara, Yuichi; Isobe, Yoh; Kitagawa, Yuko

    2017-12-01

    A realistic simulator for transabdominal preperitoneal (TAPP) inguinal hernia repair would enhance surgeons' training experience before they enter the operating theater. The purpose of this study was to create a novel physical simulator for TAPP inguinal hernia repair and obtain surgeons' opinions regarding its efficacy. Our novel TAPP inguinal hernia repair simulator consists of a physical laparoscopy simulator and a handmade organ replica model. The physical laparoscopy simulator was created by three-dimensional (3D) printing technology, and it represents the trunk of the human body and the bendability of the abdominal wall under pneumoperitoneal pressure. The organ replica model was manually created by assembling materials. The TAPP inguinal hernia repair simulator allows for the performance of all procedures required in TAPP inguinal hernia repair. Fifteen general surgeons performed TAPP inguinal hernia repair using our simulator. Their opinions were scored on a 5-point Likert scale. All participants strongly agreed that the 3D-printed physical simulator and organ replica model were highly useful for TAPP inguinal hernia repair training (median, 5 points) and TAPP inguinal hernia repair education (median, 5 points). They felt that the simulator would be effective for TAPP inguinal hernia repair training before entering the operating theater. All surgeons considered that this simulator should be introduced in the residency curriculum. We successfully created a physical simulator for TAPP inguinal hernia repair training using 3D printing technology and a handmade organ replica model created with inexpensive, readily accessible materials. Preoperative TAPP inguinal hernia repair training using this simulator and organ replica model may be of benefit in the training of all surgeons. All general surgeons involved in the present study felt that this simulator and organ replica model should be used in their residency curriculum.

  9. [The transrectus sheath preperitoneal procedure: a safe, effective and cheap surgical approach to inguinal hernia?

    NARCIS (Netherlands)

    Prins, M.W.; Voropai, D.A.; Laarhoven, C.J.H.M. van; Akkersdijk, W.L.

    2013-01-01

    The main complication of surgery for inguinal hernia is chronic postoperative pain. This is often reported following the Lichtenstein procedure. A new, open surgical technique for the repair of inguinal hernia has been developed. This procedure is called the transrectus sheath preperitoneal

  10. Direct and Recurrent Inguinal Hernias are Associated with Ventral Hernia Repair

    DEFF Research Database (Denmark)

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

    2013-01-01

    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...

  11. Hypogonadism and man’s infertility at patients with indirect inguinal hernia after hernioplasty

    Directory of Open Access Journals (Sweden)

    I. S. Sobennikov

    2014-11-01

    Full Text Available The article estimates hydrologic status and fertility prognosis of 35 year-old reproductive age men with unilateral inguinal hernioplasty in past history from the system syndrome-based approach perspective to the etiology and pathogenesis of indirect inguinal hernia and hypogonadism.

  12. Hypogonadism and man’s infertility at patients with indirect inguinal hernia after hernioplasty

    Directory of Open Access Journals (Sweden)

    I. S. Sobennikov

    2012-01-01

    Full Text Available The article estimates hydrologic status and fertility prognosis of 35 year-old reproductive age men with unilateral inguinal hernioplasty in past history from the system syndrome-based approach perspective to the etiology and pathogenesis of indirect inguinal hernia and hypogonadism.

  13. Impact of occupational mechanical exposures on risk of lateral and medial inguinal hernia requiring surgical repair

    DEFF Research Database (Denmark)

    Vad, Marie Vestergaard; Frost, Poul; Bay-Nielsen, Morten

    2012-01-01

    We undertook a register-based cohort study to evaluate exposure-response relations between cumulative occupational mechanical exposures, and risk of lateral and medial inguinal hernia repair.......We undertook a register-based cohort study to evaluate exposure-response relations between cumulative occupational mechanical exposures, and risk of lateral and medial inguinal hernia repair....

  14. [Hidradenocarcinoma of the heel associated with inguinal metastases].

    Science.gov (United States)

    Labbardi, W; Hali, F; Marnissi, F; Cribier, B; Chiheb, S

    Hidradenocarcinoma is a rare malignant tumour involving the sweat glands. It classically arises de novo, only rarely resulting from pre-existing hidradenoma. The literature contains few reports of lymph node metastasis in this tumour. We report a case of a patient with hidradenocarcinoma of the heel associated with inguinal node metastases. We report the case of a 64-year-old patient with a history of chronic smoking, who in the last two years developed a painless nodule in his right heel, with no prior injury, and which gradually increased in size to become an ulcerated tumour. Physical examination revealed a rounded tumour mass, ulcerated in the centre, and associated with multiple inguinal adenopathies. Histological and immunohistochemical examination was suggestive of hidradenocarcinoma. The patient had undergone extensive local excision with inguinal lymphadenectomy. Histological examination showed infiltration of lymph nodes by the tumour with capsular rupture. Radiotherapy was subsequently given. The outcome was good without recurrence after 34 months of follow-up. Hidradenocarcinoma is a rare malignant tumour. Diagnosis is based on histological and immunohistochemical examination. However, hidradenocarcinoma may on occasion be difficult to differentiate from hidradenoma, a benign tumour, hence the interest of complete surgical resection with safety margins even in the absence of cytological malignancy. Local recurrences are common. The occurrence of lymph node metastasis during hidradenocarcinoma has been described only rarely in the literature. Such metastases usually occur after tumour resection. The specific features of our case are the rarity of lymph node metastases in hidradenocarcinoma coupled with the fact that these metastases were discovered upon diagnosis of the primary tumour. Copyright © 2017. Published by Elsevier Masson SAS.

  15. Sigmoid colon cancer in an incarcerated left inguinal hernia

    OpenAIRE

    González González, Daniel Alfredo; Tarigo, Nicolás

    2017-01-01

    Resumen: El cáncer de colon como contenido de una hernia inguinal es una situación infrecuente. Pocos casos se han reportado en la literatura. Habitualmente ocurre en hernias inguinales izquierdas y es el colon sigmoides su contenido. La palpación de una tumoración en una hernia que previamente no existía y la aparición de sintomatología intestinal orientan el diagnóstico. El colon por enema constituye el examen paraclínico por excelencia para su confirmación. El tratamiento quirúrgico se imp...

  16. A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia.

    LENUS (Irish Health Repository)

    O'Reilly, Elma A

    2012-05-01

    Laparoscopic inguinal hernia repair (LIHR), using a transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) technique, is an alternative to conventional open inguinal hernia repair (OIHR). A consensus on outcomes of LIHR when compared with OIHR for primary, unilateral, inguinal hernia has not been reached.

  17. Outpatient repair for inguinal hernia in elderly patients: still a challenge?

    Science.gov (United States)

    Palumbo, Piergaspare; Amatucci, Chiara; Perotti, Bruno; Zullino, Antonio; Dezzi, Claudia; Illuminati, Giulio; Vietri, Francesco

    2014-01-01

    Elective inguinal hernia repair as a day case is a safe and suitable procedure, with well-recognized feasibility. The increasing number of elderly patients requiring inguinal hernia repair leads clinicians to admit a growing number of outpatients. The aim of the current study was to analyze the outcomes (feasibility and safety) of day case treatment in elderly patients. Eighty patients >80 years of age and 80 patients ≤55 years of age underwent elective inguinal hernia repairs under local anesthesia. There were no mortalities or major complications in the elderly undergoing inguinal herniorraphies as outpatients, and only one unanticipated admission occurred in the younger age group. Elective inguinal hernia repair in the elderly has a good outcome, and age alone should not be a drawback to day case treatment. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  18. Prevalence of Inguinal Hernia in Adult Men in the Ashanti Region of Ghana.

    Science.gov (United States)

    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.

  19. Risk factors for inguinal hernia in women: a case-control study. The Coala Trial Group.

    Science.gov (United States)

    Liem, M S; van der Graaf, Y; Zwart, R C; Geurts, I; van Vroonhoven, T J

    1997-11-01

    Potential risk factors for inguinal hernia in women were investigated and the relative importance of these factors was quantified. In women, symptomatic but nonpalpable hernias often remain undiagnosed. However, knowledge on this subject only concerns hernia and operation characteristics, which have been obtained by review of case series. Virtually nothing is known about risk factors for inguinal hernia. The authors performed a hospital-based case-control study of 89 female patients with an incident inguinal hernia and 176 age-matched female controls. Activity since birth with two validated questionnaires was measured and smoking habits, medical and operation history, Quetelet index (kg/m2), and history of pregnancies and deliveries were recorded. Response for cases was 81% and for controls 73%. Total physical activity was not associated with inguinal hernia (univariate odds ratio (OR) = 0.8, 95% confidence interval (CI) 0.6-1.1), but high present sports activities was associated with less inguinal hernia (multivariate OR = 0.2, 95% CI 0.1-0.7). Obesity (Quetelet index > 30) was also protective for inguinal hernia (OR = 0.2, 95% CI 0.04-1.0). Independent risk factors were positive family history (OR = 4.3, 95% CI 1.9-9.7) and obstipation (OR = 2.5, 95% CI 1.0-6.7). In particular, smoking, appendectomy, other abdominal operations, and multiple deliveries were not associated with inguinal hernia in females. The protective effect of present sports activity may be explained by optimizing the resistance of the abdominal musculature protecting the relatively small inguinal weak spot in the female. The individual predisposition for inguinal hernia may be quantified by these risk factors, and, with this in mind, the authors advise that further evaluation might be needed for the patient with unexplained inguinal pain.

  20. Reconstrucción de la subunidad estética de la ceja con un colgajo temporal en isla de cuero cabelludo

    Directory of Open Access Journals (Sweden)

    J. Gaona Silva

    Full Text Available La reconstrucción de las cejas juega un papel importante en la Cirugía Reconstructiva facial, debido a que la ausencia o deformidad de las mismas altera la expresión y las características de la cara, ejerciendo una influencia poderosa en la apariencia de la región periorbitaria, así como en el aspecto y en la autoestima de los pacientes. Describimos una técnica quirúrgica basada en el empleo de un colgajo temporal en isla de cuero cabelludo para la reconstrucción de la subunidad estética de la ceja y presentamos 3 casos de pacientes con defectos alopécicos de las cejas reconstruidos mediante dicha técnica.

  1. Colgajo de nuca para reconstrucción de lesiones en cuero cabelludo Retalho de nuca para reconstrução de lesões de couro cabeludo Nape flap for scalp lessions reconstruction

    Directory of Open Access Journals (Sweden)

    L.F. Dos Santos

    2010-09-01

    Full Text Available Un total de 16 pacientes de sexo masculino y edades comprendidas entre los 20 y los 35 años de edad, fueron sometidos a Cirugía Reconstructiva con colgajo pediculado de nuca, entre los años 2000 y 2003 en el Servicio de Cirugía Plástica del hospital Agamenon Magalháes de Recife, Pernambuco (Brasil, para tratamiento de lesiones inflamatorias crónicas de origen micótico en cuero cabelludo y en 1 caso, por lesión secundaria a quemadura eléctrica con necrosis de cuero cabelludo y exposición ósea, todas ellas en la región occipital. El tiempo de hospitalización osciló entre los 3 a 4 días. Se identificaron 3 casos de necrosis de punta del colgajo en la región retroauricular, de tamaño entre 0,5 a 1 cm, que cicatrizaron por segunda intención. No hubo ningún caso de de infección o necrosis del pedículo. La técnica que proponemos presentó ventajas para la corrección quirúrgica de este tipo de lesiones en un solo tiempo quirúrgico y el cierre directo de la lesión con un buen resultado cosmético. Como desventajas, identificamos 3 casos de incremento del área alopécica y, en algunos casos, cicatrización hipertrófica que sin embargo, en opinión de los pacientes, no comprometió su calidad de vida.Dezesseis pacientes do sexo masculino com idade entre 20 e 35 anos foram submetidos a Cirurgia Reconstrutiva com retalho pediculado de nuca, entre 2000 e 2003, no Serviço de Cirurgia Plástica do Hospital Agamenon Magalhães, Recife, Pernambuco, Brasil, para tratamento de lesões inflamatórias crônicas de origem micótica e um caso de lesão secundária a queimadura elétrica com necrose de couro cabeludo e exposição óssea, todos em região occipital. O tempo de internamento variou entre 3 e 4 dias. Foram identificados três casos de necrose de ponta de retalho, em região retroauricular, medindo entre 0,5 cm e 1 cm, que cicatrizaram por segunda intenção. Não houve qualquer caso de infecção ou necrose pedicular. A t

  2. Route to neo-inguinal canal: Our experience

    Directory of Open Access Journals (Sweden)

    J Jacob Swaroop Anand

    2011-01-01

    Full Text Available Aim: The objective of this study was to stress the importance and value of this route to neo-inguinal canal creation for undescended testis management laparoscopically. Materials and Methods: Data from the Department of Paediatric Surgery, Coimbatore Medical College, was taken. Retrospective study was undertaken for the period 2004 to 2008. Here the surgical technique and outcome of the treatment are recorded for children aged 1 year to 12 years. Results: A total of 126 children underwent laparoscopic stage II surgery by this route (medial to the medial umbilical ligament. Right-sided undescended testis (UDT was present in 76 (60% patients. Left-sided UDT was present in 45 (35% patients. Bilateral UDT was present in 5 (5% patients. There were 90 (71% patients aged less than 2 years and 36 (29% patients aged more than 2 years. The eldest patient was 12 years of age. The overall hospital stay was 1 day. There were no complications seen in the follow-up. In all cases, the testis could not be brought down in a single stage. Conclusion: Creation of neo-inguinal canal medial to the medial umbilical ligament and just lateral to the bladder has the advantage of gaining more length on the vessels and vas to bring the testis to scrotum. The laparoscopic management of undescended testis in stage II by this innovative new route is simple, less complicated and well tolerated.

  3. Laparoscopic inguinal hernia repair: review of 6 years experience.

    Science.gov (United States)

    Vanclooster, P; Smet, B; de Gheldere, C; Segers, K

    2001-01-01

    Since 6 years, the totally extraperitoneal laparoscopic hernia repair has become our procedure of choice to manage inguinal hernia in adult patients, especially for bilateral hernias and recurrences after classical anterior repair. Between March 1993 and March 1999, 976 patients underwent 1259 hernia repairs by an endoscopic total extraperitoneal approach. A large polypropylene prosthesis (15 x 15 cm) is placed and covers all potential defects. Follow-up on patients ranged from 6 to 79 months (mean, 39 months). Per- and postoperative morbidity and complications were acceptable (8.4%) and included conversion to open surgery (0.4%), bleedings (0.3%), urinary retention (4.2%), seromas (2.7%), neuralgias (0.2%), vague persistent groin discomfort (0.4%), orchitis (0.08%) and sigmoido-cutaneous fistula (0.08%). Recurrence rate so far is 0.1%. This retrospective study shows that the totally extraperitoneal repair for inguinal hernia should have a promising future because of low morbidity and low recurrence rate.

  4. The epidemiology and risk factors for recurrence after inguinal hernia surgery.

    Science.gov (United States)

    Burcharth, Jakob

    2014-05-01

    Recurrence after inguinal hernia surgery is a considerable clinical problem, and several risk factors of recurrence such as surgical technique, re-recurrence, and family history have been identified. Non-technical patient related factors that influence the risk of recurrence after inguinal hernia surgery are sparsely studied. The purpose of the studies included in this PhD thesis, was to describe the epidemiologic characteristics of inguinal hernia occurrence and recurrence, as well as investigating the patient related risk factors leading to recurrence after inguinal hernia surgery. Four studies were included in this thesis. Study 1: The study was a nationwide register-based study combining the Civil Registration System and the Danish National Hospital Register during a five-year period. We included a total of 46,717 persons operated for a groin hernia from the population of 5,639,885 people (2,799,105 males, 2,008,780 females). We found that 97% of all groin hernia repairs were inguinal hernias and 3% femoral hernias. Data showed that inguinal hernia surgery peaked during childhood and old age, whereas femoral hernia surgery increased throughout life. Study 2: Using data from the Danish Hernia Database (DHDB), we included all male patients operated for elective primary inguinal hernia during a 15-year period (n = 85,314). The overall inguinal hernia reoperation rate was 3.8%, and subdivided into indirect inguinal hernias and direct inguinal hernias, the reoperation rates were 2.7% and 5.2%, respectively (p thesis have studies the natural history of groin hernias on a nationwide basis; have identified the epidemiologic distribution of groin hernias and the non-technical risk factors associated with recurrence. Data showed that non-technical patient-related risk factors have great impact on the risk of recurrence after inguinal hernia surgery. The reason to why inguinal hernias recur is most likely multifactorial and lies in the span of technical and non

  5. Adenocarcinoma arising at a colostomy site with inguinal lymph node metastasis: report of a case.

    Science.gov (United States)

    Iwamoto, Masayoshi; Kawada, Kenji; Hida, Koya; Hasegawa, Suguru; Sakai, Yoshiharu

    2015-02-01

    Inguinal lymph node metastasis from adenocarcinoma arising at a colostomy site is extremely rare, and the significance of surgical resection for metastatic inguinal lymph nodes has not been established. An 82-year-old woman who had undergone abdominoperineal resection 27 years earlier was admitted to our hospital complaining of bleeding from a colostomy. Physical examination revealed that a tumor at the colostomy site directly invaded into the peristomal skin, and that a left inguinal lymph node was firm and swollen. Positron emission tomography/computed tomography scan demonstrated accumulation of (18)F-fluorodeoxy glucose into both the colostomy tumor and the left swollen inguinal lymph node, while there was no evidence of metastasis to liver or lungs. She underwent open left hemicolectomy with wide local resection of the colostomy, and dissection of left inguinal lymph nodes. Histological diagnosis was a moderately differentiated adenocarcinoma that directly invaded into the surrounding skin and metastasized to the left inguinal lymph node. The patient has been followed up for >5 years without any sign of recurrence. In general, inguinal lymph node metastasis from colorectal cancers is regarded as a systemic disease with a poor prognosis, and so systemic chemotherapy and radiotherapy, but not surgical lymph node dissection, are recommended. Considering the lymphatic drainage route in the present case, inguinal lymph node metastasis does not represent a systemic disease but rather a sentinel nodal metastasis from adenocarcinoma at a colostomy site. Surgical dissection of metastatic inguinal lymph nodes should be considered to enable a favorable prognosis in the absence of distant metastasis to other organs. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. Persistent Mullerian duct syndrome presenting as an inguinal hernia : A case report

    Directory of Open Access Journals (Sweden)

    Amit Dangi

    2016-10-01

    Full Text Available A brief report of persistent mullerian duct syndrome (PMDS with 46XY karyotype which is one of the rarest variety of disorders of sexual differentiation (DSD accounting only 5% cases of all is being presented. A 21 years old male with left inguinal hernia and absent right testis presented in surgical outdoor and was operated. On exploration female genital organs like uterus and fallopian tubes along with contralateral testis were present in left inguinal canal as a content of sliding left inguinal hernia.

  7. [A giant myxoid leiomyoma mimicking an inguinal hernia].

    Science.gov (United States)

    Huszár, Orsolya; Zaránd, Attila; Szántó, Gyöngyi; Juhász, Viktória; Székely, Eszter; Novák, András; Molnár, Béla Ákos; Harsányi, László

    2016-03-06

    Leiomyoma is a rare, smooth muscle tumour that can occur everywhere in the human body. The authors present the history of a 60-year-old female, who had a giant, Mullerian type myxoid leiomyoma in the inguinal region mimicking acute abdominal symptoms. After examination the authors removed the soft tissue mass in the right femoral region reaching down in supine position to the middle third of the leg measuring 335 × 495 × 437 mm in greatest diameters in weight 33 kg. Reconstruction of the tissue defect was performed using oncoplastic guidelines. During the follow-up time no tumour recurrence was detected and the quality of life of the patient improved significantly.

  8. Sonography in the postoperative evaluation of laparoscopic inguinal hernia repair.

    Science.gov (United States)

    Furtschegger, A; Sandbichler, P; Judmaier, W; Gstir, H; Steiner, E; Egender, G

    1995-09-01

    We evaluated the use of sonography as a means of assessing hernial occlusion and possible postoperative changes such as hematomas or seromas in the inguinal and scrotal regions after 1139 laparoscopic repairs of hernias between August 1992 and November 1994. Changes after laparoscopic hernia repair were found in 307 patients (27%). Hematomas or seromas were seen in 132 patients, protrusion of the prosthetic mesh in 17, mesh infection in two, and small bowel entrapment in an insufficient peritoneal suture in two. Recurrences were diagnosed correctly in six patients, mobile preperitoneal lipomas in five. Sonography is useful in the evaluation of complications after laparoscopic hernia repair, including recurrent hernia. In the absence of symptoms, sonography is not indicated.

  9. Inflammatory myofibroblastic tumor of inguinal lymph nodes, simulating lymphoma

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    Akansha Gandhi

    2015-01-01

    Full Text Available Multiple enlarged lymph nodes in an elderly female patient can have varied etiologies as well as histologic pictures. We are presenting the case of a 53-year-old female who presented with inguinal lymphadenopathy with fever, which was clinically misconstrued as lymphoma. Cytology could not exclude a lymphoma. Histology led to the unusual diagnosis of inflammatory myofibroblastic tumor of lymph node in this case. Inflammatory myofibroblastic tumor of the lymph node is a rare, distinctive reactive proliferative pattern in the lymph node which involves proliferation of the connective tissue elements of the lymph node, admixed with lymphocytes, plasma cells, eosinophils, and histiocytes. Multiple etiologic agents have been suggested in existing literature. Despite extensive search, no definite attributable cause could be sought. It is now widely accepted that inflammatory pseudotumor of the lymph node is a non-neoplastic proliferation which has a benign clinical course and excellent prognosis after surgical resection.

  10. Concomitant inguinal endometriosis and groin hernia – Case report

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    Daniel Ion

    2017-12-01

    Full Text Available Endometriosis is a condition which affects women during their reproductive age. We present the case of a 42 years old Caucasian nulliparous woman accusing in the last three months a painful bulging mass in the right groin. The patient reported that the mass increases in size during prolonged standing and lifting of heavyweights. In addition, the inguinal pain was exacerbated during ovulation. The patient underwent surgery, during which wide excision of the nodule was performed. Furthermore, both direct and indirect hernia sacs were found and dissected, the content was reduced and the sacs were excised. Four months after the surgery, the patient was free of symptoms and had no signs of recurrence.

  11. Estudio comparativo entre el uso de N – 2 butilcianoacrilato modificado y Vicryl 4 – 0 para el cierre de colgajos en cirugía de terceros molares Inferiores retenidos

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    José Ignacio Serrano

    2014-12-01

    , quinto y octavo día postquirúrgico. Resultados: Los resultados arrojados por el estudio demuestran una gran efectividad en la disminución del dolor postquirúrgico y en la reducción de la dehiscencia de los colgajos al utilizar técnicas adhesivas de sutura a base de cianoacrilatos (Glubran2.

  12. Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy

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    Hala Saad Abdel-Ghaffar

    2017-01-01

    Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.

  13. Pain during sexual activity before and after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette A; Rosenberg, Jacob

    2015-01-01

    during sexual activity was a risk factor for postoperative pain during sexual activity. METHODS: A prospective questionnaire study before and 6 months after hernia repair was conducted. Men (age 18-85 years) undergoing laparoscopic inguinal hernia repair were included. RESULTS: In total, 160 men were......BACKGROUND: Sexual life may be impaired by pain during sexual activity in patients with inguinal hernia. On the other hand, inguinal hernia repair has also been reported to cause sexual dysfunction in terms of pain during sexual activity and ejaculation. The primary aim of this study...... was to estimate the prevalence of pain during sexual activity before and after laparoscopic inguinal hernia repair, and the secondary, to describe pain location, frequency of pain during sexual activity, and to which degree sexual life was affected by the pain. Furthermore, to examine whether preoperative pain...

  14. "Laparoscopic excision of a large ovarian cyst herniating into the inguinal canal: a rare presentation".

    Science.gov (United States)

    Machado, Norman Oneil; Machado, Lovina S M; Al Ghafri, Wadha

    2011-08-01

    Inguinal hernia repair is one of the most common operation in surgical practice. Despite its common occurrence, hernia often poses a surgical dilemma even for a skilled surgeon. The unexpected hernial content constitutes one of these cases. Although the often-reported, unusual contents of a hernia sac include ovary, fallopian tube, vermiform appendix, Meckel diverticulum, and urinary bladder, the herniation of a large ovarian cyst into the inguinal canal has been hardly reported. Majority of the ovarian cysts are asymptomatic or present with vague lower abdominal pain, whereas the presentation of a large ovarian cyst as an inguinolabial swelling as in our patient is extremely rare. We present here one of the few reported cases of a laparoscopic excision of a large ovarian cyst herniating into the inguinal canal and discuss the pathogenesis of an ovarian cyst as hernial content, the advantages and concerns of a laparoscopic approach in resecting large ovarian cysts, and simultaneous management of the inguinal hernia.

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

    OpenAIRE

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

    2014-01-01

    Background and Objectives: Laparoscopic preperitoneal hernia repair with mesh has been reported to result in improved patient outcomes. However, there are few published data on the use of a totally extraperitoneal (TEP) approach. The purpose of this study was to present our experience and evaluate early outcomes of TEP inguinal hernia repair with self-adhesive mesh. Methods: This cohort study was a retrospective review of patients who underwent laparoscopic TEP inguinal hernial repair from Ap...

  16. Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis

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    Jun Wang

    2015-02-01

    Full Text Available Conventional meta-analyses have shown inconsistent results for the efficacy of various treatments of varicoceles. Therefore, we performed a multiple-treatment meta-analysis to assess the effectiveness and safety of 10 methods of varicocelectomy and embolization/sclerotherapy. We systematically reviewed 35 randomized controlled trials and observational studies, from 1966 to August 5, 2013, which compared any of the following treatments for varococeles: laparoscopic, retroperitoneal, open inguinal and subinguinal varicocelectomy, microsurgical subinguinal and inguinal varicocelectomy, percutaneous venous embolization, Tauber antegrade sclerotherapy, retrograde sclerotherapy and expectant therapy (no treatment. Inguinal and subinguinal microsurgery, open inguinal, laparoscopic varicocelectomy showed a significant advantage over expectant therapy in terms of pregnancy rates (odds ratio (OR: 3.48, 2.68, 2.92 and 2.90, respectively. Compared with retroperitoneal open surgery, inguinal microsurgery showed an improvement of sperm density (mean difference (MD: 10.60, 95% confidence interval (CI: 1.92-19.60 and sperm motility (MD: 9.09, 95% CI: 4.88-13.30. Subinguinal and inguinal microsurgery outperformed retroperitoneal open surgery in terms of recurrence (OR: 0.05, 0.06 respectively. Tauber antegrade sclerotherapy and subinguinal microsurgery were associated with the lowest risk of hydrocele formation. The odds of overall complication, compared with retroperitoneal open varicocelectomy, were lowest for inguinal microsurgery (OR = 0.07, 95% CI: 0.02-0.19, followed by subinguinal microsurgery (OR = 0.09, 95% CI: 0.02-0.19. Inguinal and subinguinal micro-varicocelectomy had the highest pregnancy rates, significant increases in sperm parameters, with low odds of complication. These results warrant additional properly conducted randomized controlled clinical studies with larger sample sizes.

  17. A case report of fallopian tube into inguinal canal in patient with unicorn uretus

    OpenAIRE

    Maryam Asgharnia; Ziba Zahiri; Fariba Mirblouk; Fatemeh Hosseinzadeh; seyedeh Fatemeh Dalil Heirati

    2014-01-01

    Introduction: Presence of the ovary, fallopian tube and uterus within an inguinal canal is a rare condition in women of reproductive age. Case report: In this report we present a 31-year-old female with 5 years primary infertility who was admitted for infertility evaluation. We described a patient with unicornuate uterus without rudimentary horn and the left fallopian tube within the left inguinal canal diagnosed through laparoscopy. Conclusion: The surgeon who works on infertility may encoun...

  18. Dedifferentiated retroperitoneal liposarcoma presenting as right inguinal hernia: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Myung; Lee, Su Lim; Ku, Young Mi [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of); Choi, Moon Hyung [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2016-01-15

    Retroperitoneal liposarcomas usually present as painless, slow-growing abdominal masses. When masses grow large enough to compress surrounding structures, symptoms may occur. Retroperitoneal liposarcoma clinically manifesting as inguinal hernia is a very rare entity; only 11 cases have been reported. Herein, we present radiographic features of a 37-year-old male with a painless palpable mass in the right groin that was identified as dedifferentiated retroperitoneal liposarcoma herniated through the right inguinal canal.

  19. Satisfacción en pacientes con reconstrucción mamaria con colgajo D.I.E.P. Patient’s satisfaction after diep flap reconstruction

    Directory of Open Access Journals (Sweden)

    E. Cabrera Sánchez

    2006-09-01

    Full Text Available La reconstrucción mamaria tras mastectomía se realiza primordialmente para proporcionar calidad de vida a la paciente. Este estudio se desarrolló para valorar la satisfacción y calidad de vida de las pacientes reconstruidas mediante colgajo D.I.E.P. (Deep Inferior Epigastric Perforator y evaluar el resultado estético de la reconstrucción. Treinta y tres pacientes, de 51 reconstrucciones mamarias con colgajo DIEP realizadas entre enero de 2000 y noviembre de 2004 fueron preguntadas acerca de aspectos generales relativos a la cirugía, imagen corporal y sensación subjetiva. El resultado de imagen corporal fue evaluado por dos observadores externos, un cirujano plástico y una enfermera, además de por la propia paciente. Para valorar la reconstrucción mamaria, se utilizó una escala de 4 puntos. La satisfacción general de nuestro estudio fue más elevada que la observada en estudios precedentes. Hemos conseguido una valoración alta en simetría, dentro de los parámetros objetivos y en integridad corporal entre los subjetivos. Hemos encontrado una correlación alta entre las respuestas de los observadores comparada con las respuestas de las propias pacientes. Por último, hemos visto una fuerte correlación entre integridad corporal y satisfacción generalBreast reconstructions after breast cancer surgery are primarily performed to improve patient’s quality of life. This study investigates patient’s satisfaction and quality of life with breast reconstruction after deep inferior epigastric perforator (D.I.E.P. flap surgery and to evaluate the aesthetic result of the breast reconstruction. Thirty-three patiens, from fifty-one DIEP breast reconstruction made between january 2000 and december 2004 were answered about three questionnaires concerning to general aspect, body image, and subjective sensation. The body image outcome was also evaluated by one plastic surgeon and a nurse. The panel evaluated breast reconstruction on 4 subescales

  20. Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: case report of a rare complication

    OpenAIRE

    Moore, John B; Hasenboehler, Erik A

    2007-01-01

    Abstract Background Ischemic orchitis is an established complication after open inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the laparoscopic approach has not been reported. Case presentation The patient was a thirty-three year-old man who presented with bilateral direct inguinal hernias, right larger than left. He was a thin, muscular male with a narrow pelvis who underwent bilateral extraperitoneal mesh laparoscopic inguinal hernia repair. The case was compli...

  1. An inguinal hernia with cryptorchidism with a Leydig cell tumor in an elderly man: A case report

    Directory of Open Access Journals (Sweden)

    Toru Zuiki

    2017-01-01

    Conclusion: The combination of laparoscopic and anterior approaches facilitated the surgical treatment of an unusual inguinal hernia with cryptorchidism. The resected ectopic testis should undergo thorough histopathologic examination.

  2. Retirada de implantes mamarios y corrección simultánea con colgajo dermoglandular inferior: técnica de mastopexia con autoprótesis

    Directory of Open Access Journals (Sweden)

    A. Rancati

    2014-09-01

    Full Text Available Los cirujanos plásticos nos enfrentamos cada vez con más frecuencia en nuestra consulta a pacientes que desean o necesitan retirar sus implantes mamarios. Algunas de estas pacientes rechazan la idea de un reemplazo protésico, pero son exigentes con el resultado cosmético postoperatorio. Describimos la técnica empleada en 68 casos consecutivos y los resultados que hemos obtenido al tratar las secuelas en la mama tras la retirada de los implantes, fundamentalmente una disminución de volumen asociada a ptosis y excedente cutáneo. Esta técnica se basa en la extracción de los implantes y correccion mamaria simultanea con colgajo dermoglandular inferior que denominamos "autoprotesis" asociado a injerto graso simultáneo. Los resultados logran mejorar la forma, proyección y conificacion de la mama tras la retirada de los implantes, con un alto grado de satisfacción por parte de las pacientes.

  3. The role of surgical expertise with regard to chronic postoperative inguinal pain (CPIP) after Lichtenstein correction of inguinal hernia: a systematic review.

    Science.gov (United States)

    Lange, J F M; Meyer, V M; Voropai, D A; Keus, E; Wijsmuller, A R; Ploeg, R J; Pierie, J P E N

    2016-06-01

    The aim of this study was to evaluate whether a relation exists between surgical expertise and incidence of chronic postoperative inguinal pain (CPIP) after inguinal hernia repair using the Lichtenstein procedure . CPIP after inguinal hernia repair remains a major clinical problem despite many efforts to address this problem. Recently, case volume and specialisation have been found correlated to significant improvement of outcomes in other fields of surgery; to date these important factors have not been reviewed extensively enough in the context of inguinal hernia surgery. A systematic literature review was performed to identify randomised controlled trials reporting on the incidence of CPIP after the Lichtenstein procedure and including the expertise of the surgeon. Surgical expertise was subdivided into expert and non-expert. In a total of 16 studies 3086 Lichtenstein procedures were included. In the expert group the incidence of CPIP varied between 6.9 and 11.7 % versus an incidence of 18.1 and 39.4 % in the non-expert group. Due to the heterogeneity between groups no statistical significance could be demonstrated. The results of this evaluation suggest that an association between surgical expertise and CPIP is highly likely warranting further analysis in a prospectively designed study.

  4. Inguinal lymph node as the only evidence of progressive lung cancer

    Directory of Open Access Journals (Sweden)

    Zafer Kocak

    2008-09-01

    Full Text Available Abstact: Tumours that metastasise to groin nodes most frequently originate in genital and reproductive organs, skin, rectum or anus, or urinary bladder1,2. However, rare cases of inguinal metastases from tumours above the diaphragm have been reported2-5 and only three of them had an inguinal metastasis which was recognised antemortem and reported in detail in the English medical literature3-5. The primary tumours of these cases were malignant mesothelioma, salivary duct and breast carcinoma. In this paper, we report a case of carcinoma of the lung metastatic to an inguinal lymph node as the only evidence of progressive lung cancer. Resumo: Os tumores que metastizam para os gânglios inguinais têm frequentemente origem nos órgãos genitais e reprodutores, na pele, no recto ou ânus, ou na bexiga1,2. Há, no entanto, algumas descrições de casos raros de metástases inguinais de tumores localizados acima do diafragma2-5, e apenas três destes apresentavam uma metástase inguinal reconhecida antes da morte. Estes casos estão detalhadamente descritos na literatura médica de língua inglesa3-5. Os tumores primários destes casos eram mesotelioma maligno e carcinomas do conduto salivar e da mama. Descrevemos um caso de carcinoma do pulmão que metastizou para gânglio inguinal, como única evidência de cancro do pulmão progressivo. Key-words: Non-small cell lung carcinoma, inguinal lymph node, metastasis, disease progression, Palavras-chave: Carcinoma do pulmão de não pequenas células, gânglio inguinal, metástase, progressão da doença

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

    Science.gov (United States)

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

    2014-10-01

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

  6. Inguinal Abnormalities in Male Patients with Acetabular Fractures Treated Using an Ilioinguinal Exposure

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    Reza Firoozabadi

    2015-09-01

    Full Text Available Purpose: Surgeons performing an ilioinguinal exposure for acetabular fracture surgery need to be aware of aberrant findings such as inguinal hernias and spermatic cord lesions. The purpose of this study is to report these occurrences in a clinical series of adult males undergoing acetabular fracture fixation and a series of adult male cadavers. The secondary aim is to characterize these abnormalities to aid surgeons in detecting these abnormalities preoperatively and coordinating a surgical plan with a general surgeon.Methods: Clinical study- Retrospective review of treated acetabular fractures through an ilioinguinal approach. Incidence of inguinal canal and spermatic cord abnormalities requiring general surgery consultation were identified. Corresponding CT scans were reviewed and radiographic characteristics of the spermatic cord abnormalities and/or hernias were noted.Cadaveric study- 18 male cadavers dissected bilaterally using an ilioinguinal exposure. The inguinal canal and the contents of the spermatic cord were identified and characterized.Results: Clinical Study- 5.7% (5/87 of patients had spermatic cord lesion and/or inguinal hernia requiring general surgical intervention. Preoperative pelvic CT scan review identified abnormalities noted intraoperatively in four of the five patients. Cord lipomas visualized as enlargements of the spermatic cord with homogeneous density. Hernias visualized as enlarged spermatic cords with heterogeneous density. Cadaver Study- 31% (11/36 of cadavers studied had spermatic cord and/or inguinal canal abnormalities. Average cord diameter in those with abnormalities was 24.9 mm (15-28 compared to 16 mm (11-22 in normal cords, which was statistically significant.Conclusion: The clinical and cadaveric findings emphasize the importance of understanding inguinal abnormalities and the value of detecting them preoperatively. The preoperative pelvic CT scans were highly sensitive in detecting inguinal abnormalities.

  7. The role of peripheral afferents in persistent inguinal postherniorrhaphy pain

    DEFF Research Database (Denmark)

    Wijayasinghe, N; Ringsted, T K; Bischoff, J M

    2016-01-01

    ) in the medial aspect of the inguinal region that triggers pain upon minimal pressure. As TPs may play a role in the pathophysiology of PIPP, the aim of this trial was to investigate the analgesic effects of local anaesthetic TP-blockade. METHODS: A randomized, double-blind, placebo-controlled, crossover trial......-algometry) and quantitative sensory testing (pressure pain thresholds, thermal detection/pain thresholds, supra-threshold heat perception), before and after the TP-blockade. RESULTS: The median (95% CI) reduction in pain was 63% (44.1 to 73.6%) after bupivacaine compared with 36% (11.6 to 49.7%; P=0.003) after placebo....... Significant increases in cool detection (P=0.01) and pressure pain thresholds (P=0.009) with decreases in supra-threshold heat pain perception (P=0.003) were seen after bupivacaine only. In four out of six volunteers, increased thermal and evoked-pain thresholds after bupivacaine compared with placebo...

  8. Cirugía de la hernia inguinal en la tercera edad: ambulatoria y con hospitalización corta Inguinal hernia surgery in third age patients: ambulatory and with a short hospitalization

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    Pablo Gonzalo Pol Herrera

    2011-03-01

    Full Text Available INTRODUCCIÓN. La cirugía de la enfermedad herniaria de la pared abdominal, y en especial de la hernia inguinofemoral, ha sufrido un incremento pero en realidad su prevalencia se desconoce. El objetivo de este estudio fue valorar el resultado del tratamiento quirúrgico de la hernia de la región inguinofemoral en los pacientes de la tercera edad atendidos en el Hospital General Docente «Dr. Enrique Cabrera». MÉTODOS. Se realizó un estudio en 1 093 pacientes de la tercera edad operados de hernia inguinofemoral entre enero de 1999 y diciembre del 2008, en el Hospital General Docente «Dr. Enrique Cabrera». En todos los casos se ofreció al paciente la alternativa de ser operado de forma ambulatoria o con corta estadía. También se incluyeron los pacientes operados de urgencia. De entre los pacientes operados de forma electiva se excluyeron los que padecían enfermedades asociadas, cardiopulmonares o tromboembólicas de tipo ASA-III (clasificación de la American Society of Anesthesiologists. RESULTADOS. La mayor incidencia de la hernia inguinal se encontró en las edades de 60-69 años (59,3 %. La hernia inguinal derecha, indirecta, apareció con mayor frecuencia. La técnica quirúrgica anatómica de Desarda fue la más aplicada en la hernia inguinal, y la técnica protésica de Lichtenstein, con el 32 %, le siguió en frecuencia. Hubo un total de 20 recidivas (1,8 %. Se aplicó anestesia local en el 75,4 % de los pacientes, de forma ambulatoria en el 76,4 %. El total de complicaciones fue de 78 (7,1 %. CONCLUSIONES. El tratamiento quirúrgico de las hernias inguinofemorales, de forma ambulatoria o con corta hospitalización, es un procedimiento adecuado en pacientes de la tercera edad, ya que aumenta la comodidad de los pacientes, disminuye el riesgo de infección hospitalaria, reduce las listas de espera y los costos hospitalarios.INTRODUCTION. The surgery of hernial disease of abdominal wall and especially of the inguinofemoral hernia

  9. Cellular Angiofibroma Presenting as an Inguinal Subcutaneous Mass: a Case Report and Review of the Literature.

    Science.gov (United States)

    Schiebel, Frank; Cassim, R

    2016-01-01

    Cellular angiofibroma is a rare benign mesenchymal tumor that occurs in the inguinal and vulvovaginal region. We report a case of the tumor occurring in the right inguinal region of a 64 old male and a review of the current literature. A 64 year old male veteran was referred to our general surgery service with an incidentally discovered right inguinal mass on a computerized tomography scan. The scan was performed to follow a history of prostate cancer that had been treated with brachytherapy. Magnetic resonance imaging of the lesion helped confirm that the mass did not represent a hernia or an undescended testicle. Surgical resection revealed encapsulated, yellowish, pink tissue measuring 6.5 x 5 x 3.5 cm. Microscopically, the sections showed densely fibrous to loose and focally fibromyxoid background of oval to spindle-shaped cells with a few scattered plasma cells and mast cells. Based upon the clinical, histologic, and immunohistochemical findings, the lesion was classified as a cellular angiofibroma. Cellular angiofibroma of the inguinal region is a rare benign encapsulated tumor.It should be considered in the differential diagnosis of a male with an inguinal mass proven not to be a hernia or undescended testicle.

  10. Pitfalls in the diagnosis and management of inguinal lymphogranuloma venereum: important lessons from a case series.

    Science.gov (United States)

    Oud, Emerentiana Veronica; de Vrieze, Nynke Hesselina Neeltje; de Meij, Arjan; de Vries, Henry John C

    2014-06-01

    Current lymphogranuloma venereum (LGV) guidelines mainly focus on anorectal infections. Inguinal LGV infections have been rare in the current epidemic among men who have sex with men (MSM), but might require a different approach not yet recommended in current guidelines for the treatment and diagnosis of LGV. We describe 4 inguinal LGV cases. Three MSM developed inguinal LGV infection several weeks after a previous consultation, of which two had received azithromycin after being notified for LGV. Three failed the recommended 21 days doxycycline treatment. These inguinal LGV cases highlight 3 pitfalls in the current standard management of LGV: (1) Urethral chlamydia infections in MSM can be caused by LGV biovars that in contrast to non-LGV biovars require prolonged antibiotic therapy. (2) The recommended one gram azithromycin contact treatment seems insufficient to prevent established infections. (3) Inguinal LGV may require prolonged courses of doxycycline, exceeding the currently advised 21 days regimen. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Lack of association between inguinal hernia and abdominal aortic aneurysm in a population-based male cohort

    DEFF Research Database (Denmark)

    Henriksen, N A; Sorensen, L T; Jorgensen, L N

    2013-01-01

    Previous studies have reported a higher prevalence of inguinal hernia in patients with abdominal aortic aneurysm (AAA). The aim of this study was to explore the association between inguinal hernia and AAA in a large population-based cohort of men who had screening for AAA....

  12. A Low-Cost Teaching Model of Inguinal Canal: A Useful Method to Teach Surgical Concepts in Hernia Repair

    Science.gov (United States)

    Ansaloni, Luca; Catena, Fausto; Coccolini, Frederico; Ceresoli, Marco; Pinna, Antonio Daniele

    2014-01-01

    Objectives: Inguinal canal anatomy and hernia repair is difficult for medical students and surgical residents to comprehend. Methods: Using low-cost material, a 3-dimensional inexpensive model of the inguinal canal was created to allow students to learn anatomical details and landmarks and to perform their own simulated hernia repair. In order to…

  13. Amyand's hernia masquerading inguinal abscess complicated with appendico-cutaeneous fistula in an infant with Hirschsprung's disease

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    Ruzaimie Noor

    2017-06-01

    Full Text Available A normal or diseased vermiform appendix located inside the inguinal hernia is called Amyand's hernia (AH. The incidence of appendicitis in Amyand's hernia is rare. The appendicitis per se is uncommon disease in infancy. We reported an extremely rare case of undiagnosed right Amyand's hernia mimicking inguinal abscess complicated with appendico-cutaneous fistula in total colonic Hirschsprung's Disease.

  14. A capsaicin (8%) patch in the treatment of severe persistent inguinal postherniorrhaphy pain

    DEFF Research Database (Denmark)

    Bischoff, Joakim M; Ringsted, Thomas K; Petersen, Marian

    2014-01-01

    BACKGROUND: Persistent pain after inguinal herniorrhaphy is a disabling condition with a lack of evidence-based pharmacological treatment options. This randomized placebo-controlled trial investigated the efficacy of a capsaicin 8% cutaneous patch in the treatment of severe persistent inguinal...... postherniorrhaphy pain. METHODS: Forty-six patients with persistent inguinal postherniorrhaphy pain were randomized to receive either a capsaicin 8% patch or a placebo patch. Pain intensity (Numerical Rating Scale [NRS 0-10]) was evaluated under standardized conditions (at rest, during movement, and during pressure....... The primary outcome was comparisons of summed pain intensity differences (SPIDs) between capsaicin and placebo treatments at 1, 2 and 3 months after patch application (significance level P placebo treatments, was observed at 1 month after...

  15. Sexual dysfunction after inguinal hernia repair with the Onstep versus Lichtenstein technique

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Fonnes, Siv

    2017-01-01

    BACKGROUND: Sequelae after inguinal hernia repair include pain-related impairment of sexual function. Pain during intercourse can originate from the scar, scrotum, penis, or during ejaculation. The aim of this study was to investigate if the Onstep technique resulted in better results than...... the Lichtenstein technique regarding pain-related impairment of sexual function. METHODS: This study was part of the randomized ONLI trial (NCT01753219, Onstep versus Lichtenstein for inguinal hernia repair). Separate reporting of pain-related impairment of sexual function was planned before the study start......, with a separate sample size calculation. Participants were randomized to the Onstep or Lichtenstein technique for repair of their primary inguinal hernia and followed up at 6 months postoperative with the use of a questionnaire specific for pain-related impairment of sexual function. RESULTS: A total of 259...

  16. Academic Performance in Adolescence after Inguinal Hernia Repair in Infancy: A Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Hansen, Tom G; Pedersen, Jacob K; Henneberg, Steen Winther

    2011-01-01

    for inguinal hernia repair in infancy and subsequent academic performance. METHODS:: Using Danish birth cohorts from 1986-1990, we compared the academic performance of all children who had undergone inguinal hernia repair in infancy to a randomly selected, age-matched 5% population sample. Primary analysis...... compared average test scores at ninth grade adjusting for sex, birth weight, and paternal and maternal age and education. Secondary analysis compared the proportions of children not attaining test scores between the two groups. RESULTS:: From 1986-1990 in Denmark, 2,689 children underwent inguinal hernia...... repair in infancy. A randomly selected, age-matched 5% population sample consists of 14,575 individuals. Although the exposure group performed worse than the control group (average score 0.26 lower; 95% CI, 0.21-0.31), after adjusting for known confounders, no statistically significant difference (-0...

  17. Treatment for incarcerated indirect hernia with "Cross-Internal Ring" inguinal oblique incision in children.

    Science.gov (United States)

    Yan, Xue-Qiang; Yang, Jun; Zheng, Nan-Nan; Kuang, Hou-Fang; Duan, Xu-Fei; Bian, Hong-Qiang

    2017-01-01

    This study aims to evaluate the utility of the "Cross-Internal Ring" inguinal oblique incision for the surgical treatment of incarcerated indirect hernia (IIH) complicated with severe abdominal distension. Patients of IIH complicated with severe abdominal distension were reviewed retrospectively. All patients received operation through the "Cross-Internal Ring" inguinal oblique incision. There were totally 13 patients were included, male to female ratio was 9-4. The time for patients to resume oral feeding varying from 2 to 5 days after operation, no complications include delayed intestinal perforation, intra-abdominal abscess, and incision infection happened. Average postoperative hospital stay was 5.2 days. All cases were followed up for 6-18 months. No recurrence or iatrogenic cryptorchidism happened. "Cross-Internal Ring" inguinal oblique incision is a simple, safe, and reliable surgical method to treat pediatric IIH complicated with severe abdominal distension.

  18. Treatment for incarcerated indirect hernia with “Cross-Internal Ring” inguinal oblique incision in children

    Directory of Open Access Journals (Sweden)

    Xue-Qiang Yan

    2017-01-01

    Full Text Available Background: This study aims to evaluate the utility of the “Cross-Internal Ring” inguinal oblique incision for the surgical treatment of incarcerated indirect hernia (IIH complicated with severe abdominal distension. Materials and Methods: Patients of IIH complicated with severe abdominal distension were reviewed retrospectively. All patients received operation through the “Cross-Internal Ring” inguinal oblique incision. Results: There were totally 13 patients were included, male to female ratio was 9-4. The time for patients to resume oral feeding varying from 2 to 5 days after operation, no complications include delayed intestinal perforation, intra-abdominal abscess, and incision infection happened. Average postoperative hospital stay was 5.2 days. All cases were followed up for 6–18 months. No recurrence or iatrogenic cryptorchidism happened. Conclusion: “Cross-Internal Ring” inguinal oblique incision is a simple, safe, and reliable surgical method to treat pediatric IIH complicated with severe abdominal distension.

  19. Vaginocutaneous fistula and inguinal abcess presented 6 years after tension-free vaginal tape sling

    Directory of Open Access Journals (Sweden)

    Ali Feyzullah Sahin

    2013-06-01

    Full Text Available Surgical treatment of female stress urinary incontinence (SUI has become very pop- ular after respectable success with minimal invasive surgeries. This is the first report of long term vaginocutaneous fistula (VCF plus inguinal abcess after tension-free vaginal tape (TVT. A 67 year-old woman with vaginal discharge lasting more than 3 years complained with a painful swelling in the left inguinal area for the last three months. She had a medical history of TVT sling procedure for SUI six years ago. She had no history of pelvic surgery, cancer treatment or pelvic irradiation before or after TVT sling. No urethrovaginal or vesicovaginal fistula was found in physical examination and cystocopy. MRI showed a vaginocutenaous fistula and inguinal abcess. This case highlights the need for a high index of suspicion for VCF after TVT.

  20. Combined Partial Penectomy With Bilateral Robotic Inguinal Lymphadenectomy Using Near-infrared Fluorescence Guidance.

    Science.gov (United States)

    Sávio, Luís Felipe; Panizzutti Barboza, Marcelo; Alameddine, Mahmoud; Ahdoot, Michael; Alonzo, David; Ritch, Chad R

    2018-03-01

    To describe our novel technique for performing a combined partial penectomy and bilateral robotic inguinal lymphadenectomy using intraoperative near-infrared (NIR) fluorescence guidance with indocyanine green (ICG) and the DaVinci Firefly camera system. A 58-year-old man presented status post recent excisional biopsy of a 2-cm lesion on the left coronal aspect of the glans penis. Pathology revealed "invasive squamous cell carcinoma of the penis with multifocal positive margins." His examination was suspicious for cT2 primary and his inguinal nodes were cN0. He was counseled to undergo partial penectomy with possible combined vs staged bilateral robotic inguinal lymphadenectomy. Preoperative computed tomography scan was negative for pathologic lymphadenopathy. Before incision, 5 mL of ICG was injected subcutaneously beneath the tumor. Bilateral thigh pockets were then developed simultaneously and a right, then left robotic modified inguinal lymphadenectomy was performed using NIR fluorescence guidance via the DaVinci Firefly camera. A partial penectomy was then performed in the standard fashion. The combined procedure was performed successfully without complication. Total operative time was 379 minutes and total robotic console time was 95 minutes for the right and 58 minutes to the left. Estimated blood loss on the right and left were 15 and 25 mL, respectively. A total of 24 lymph nodes were retrieved. This video demonstrates a safe and feasible approach for combined partial penectomy and bilateral inguinal lymphadenectomy with NIR guidance using ICG and the DaVinci Firefly camera system. The combined robotic approach has minimal morbidity and avoids the need for a staged procedure. Furthermore, use of NIR guidance with ICG during robotic inguinal lymphadenectomy is feasible and may help identify sentinel lymph nodes and improve the quality of dissection. Further studies are needed to confirm the utility of NIR guidance for robotic sentinel lymph node

  1. Unusual metachronous isolated inguinal lymph node metastasis from adenocarcinoma of the sigmoid colon

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    Parodo Giuseppina

    2011-10-01

    Full Text Available Abstract This study aimed to describe an unusual case of metachronous isolated inguinal lymph nodes metastasis from sigmoid carcinoma. A 62-year-old man was referred to our department because of an obstructing sigmoid carcinoma. Colonoscopy showed the obstructing lesion at 30 cm from the anal verge and abdominal CT revealed a sigmoid lesion infiltrating the left lateral abdominal wall. The patient underwent a colonic resection extended to the abdominal wall. Histology showed an adenocarcinoma of the colon infiltrating the abdominal wall with iuxtacolic nodal involvement. Thirty three months after surgery abdominal CT and PET scan revealed a metastatic left inguinal lymph node involvement. The metastatic lymph node was found strictly adherent to the left iliac-femoral artery and encompassing the origin of the left inferior epigastric artery. Histology showed a metachronous nodal metastasis from colonic adenocarcinoma. Despite metastastic involvement of inguinal lymph node from rectal cancer is a rare but well known clinical entity, to the best of our knowledge, this is the first report of inguinal metastasis from a carcinoma of the left colon. Literature review shows only three other similar reported cases: two cases of inguinal metastasis secondary to adenocarcinoma of the cecum and one case of axillary metastasis from left colonic carcinoma. A metastatic pathway through superficial abdominal wall lymphatic vessels could be possible through the route along the left inferior epigastric artery. The solitary inguinal nodal involvement from rectal carcinoma could have a more favorable prognosis. In the case of nodal metastasis to the body surface lymph nodes from colonic carcinoma, following the small number of such cases reported in the literature, no definitive conclusions can be drawn.

  2. Current practices of laparoscopic inguinal hernia repair: a population-based analysis.

    Science.gov (United States)

    Trevisonno, M; Kaneva, P; Watanabe, Y; Fried, G M; Feldman, L S; Andalib, A; Vassiliou, M C

    2015-10-01

    The selection of a laparoscopic approach for inguinal hernias varies among surgeons. It is unclear what is being done in actual practice. The purpose of this study was to report practice patterns for treatment of inguinal hernias among Quebec surgeons, and to identify factors that may be associated with the choice of operative approach. We studied a population-based cohort of patients who underwent an inguinal hernia repair between 2007 and 2011 in Quebec, Canada. A generalized linear model was used to identify predictors associated with the selection of a laparoscopic approach. 49,657 inguinal hernias were repaired by 478 surgeons. Laparoscopic inguinal hernia repair (LIHR) was used in 8 % of all cases. LIHR was used to repair 28 % of bilateral hernias, 10 % of recurrent hernias, 6 % of unilateral hernias, and 4 % of incarcerated hernias. 268 (56 %) surgeons did not perform any laparoscopic repairs, and 11 (2 %) surgeons performed more than 100 repairs. These 11 surgeons performed 61 % of all laparoscopic cases. Patient factors significantly associated with having LIHR included younger age, fewer comorbidities, bilateral hernias, and recurrent hernias. An open approach is favored for all clinical scenarios, even for situations where published guidelines recommend a laparoscopic approach. Surgeons remain divided on the best technique for inguinal hernia repair: while more than half never perform LIHR, the small proportion who perform many use the technique for a large proportion of their cases. There appears to be a gap between the best practices put forth in guidelines and what surgeons are doing in actual practice. Identification of barriers to the broader uptake of LIHR may help inform the design of educational programs to train those who have the desire to offer this technique for certain cases, and have the volume to overcome the learning curve.

  3. Transumbilical endoscopic surgery for incarcerated inguinal hernias in infants and children.

    Science.gov (United States)

    Zhou, Xuewu; Peng, Lei; Sha, Yongliang; Song, Daiqiang

    2014-01-01

    To describe transumbilical laparoscopic herniorrhaphy after unsuccessful attempted manual reduction of incarcerated inguinal hernias in infants and children. In our two hospitals, two-trocar transumbilical endoscopic surgery (TUES) is the standard technique used to repair incarcerated inguinal hernias in infants and children. Seventeen patients (aged 8months to 2.5years; median, 15months; 15 boys, 2 girls) with incarcerated inguinal hernias underwent urgent laparoscopy after unsuccessful attempted manual reduction. Two 3- or 5-mm trocars were inserted into the abdomen through two intraumbilical incisions, under laparoscopic guidance. The hernia was reduced by combined external manual pressure and internal pulling with bowel forceps. After inspection of the bowel, a round needle with a 2-0 nonabsorbable suture was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The hernial orifice was closed with an extraperitoneal purse-string suture around the internal inguinal ring, and tied with an intraperitoneal knot. A similar procedure was performed on the contralateral side if the processus vaginalis was patent. The TUES procedure was successful in all patients. No conversions to open surgery were required. The mean operating time was 30min (range, 25-40min). All patients were discharged on the second postoperative day. No complications such as postoperative bleeding, hydrocele, or scrotal edema were observed. The mean follow-up period was 15months. No cases of testicular atrophy, hypotrophy, or hernia recurrence were reported. Our preliminary experience with using TUES for the treatment of incarcerated inguinal hernias in infants and children had satisfactory outcomes. This technique appeared to be safe, effective, and reliable, and had excellent cosmetic results. Published by Elsevier Inc.

  4. Two-trocar needlescopic approach to incarcerated inguinal hernia in children.

    Science.gov (United States)

    Shalaby, Rafik; Shams, Abdul Moniem; Mohamed, Soliman; el-Leathy, Mohamed; Ibrahem, Medhat; Alsaed, Gamal

    2007-07-01

    Many studies described the safety and effectiveness of laparoscopy in the treatment of inguinal hernia in children. Needlescopic techniques have been recently used in repairing inguinal hernias, which made this type of surgery more cosmetic and less invasive. However, few reports have described its role in the treatment of incarcerated inguinal hernia. The aim of this study was to assess the feasibility and outcome of needlescopy in the treatment of incarcerated inguinal hernia in children. A total of 250 children, comprising 190 boys and 60 girls, who presented with incarcerated inguinal hernia were analyzed. Their ages ranged from 6 months to 6 years (mean age, 2 years). In 170 (68%) cases, manual reduction was successful. One hundred of these patients were subjected to definitive surgery in the same day, whereas the remaining 70 patients were subjected to needlescopy 1 to 3 days later. In 80 (32%) cases, external manual reduction was unsuccessful. These children were subjected to urgent needlescopic reduction and herniorrhaphy. The incarcerated herniae were easily reduced and the contents thoroughly inspected under direct vision. Then the hernia was repaired in the same setting. In all patients, there was no need to convert the procedure to an open approach. Immediate needlescopic herniorrhaphy in the same session was added without significant increase in operative time. The mean operative time is 10 minutes. There were no intraoperative complications. The study showed that needlescopic approach to incarcerated inguinal hernia in children is feasible, safe, easy, and preferable to the open surgery. In addition to reduction of incarcerated hernial contents under direct vision, it allows definitive treatment of hernial defect at the same time without significant increase in operative time and hospital stay.

  5. Endometriosis presenting as inguinal mass attached to the extra pelvic part of round ligament

    International Nuclear Information System (INIS)

    Ibrahim, N.T.

    2013-01-01

    Endometriosis attached to extra pelvic part of the round ligament is rare. Preoperative diagnosis is difficult but history and presentation may guide to diagnosis which is confirmed on histology. A woman aged 29 years presented with painful right inguinal mass whose intensity of pain and size changed with menstrual cycle. Physical examination revealed right inguinal hard, fixed mass measuring 2*2 cm. Ultrasound, computed tomography, and fine needle aspiration cytology were normal therefore, excision of the mass was done along with histology which,confirmed endometriosis; simultaneous laparoscopy was performed which showed peritoneal endometriosis too. (author)

  6. A case report of fallopian tube into inguinal canal in patient with unicorn uretus

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    Maryam Asgharnia

    2014-11-01

    Full Text Available Introduction: Presence of the ovary, fallopian tube and uterus within an inguinal canal is a rare condition in women of reproductive age. Case report: In this report we present a 31-year-old female with 5 years primary infertility who was admitted for infertility evaluation. We described a patient with unicornuate uterus without rudimentary horn and the left fallopian tube within the left inguinal canal diagnosed through laparoscopy. Conclusion: The surgeon who works on infertility may encounter such unexpected intraoperative findings, and must call attention to these findings.

  7. Laparoscopic appendicectomy for suspected mesh-induced appendicitis after laparoscopic transabdominal preperitoneal polypropylene mesh inguinal herniorraphy

    Directory of Open Access Journals (Sweden)

    Jennings Jason

    2010-01-01

    Full Text Available Laparoscopic inguinal herniorraphy via a transabdominal preperitoneal (TAPP approach using Polypropylene Mesh (Mesh and staples is an accepted technique. Mesh induces a localised inflammatory response that may extend to, and involve, adjacent abdominal and pelvic viscera such as the appendix. We present an interesting case of suspected Mesh-induced appendicitis treated successfully with laparoscopic appendicectomy, without Mesh removal, in an elderly gentleman who presented with symptoms and signs of acute appendicitis 18 months after laparoscopic inguinal hernia repair. Possible mechanisms for Mesh-induced appendicitis are briefly discussed.

  8. Corrección de cicatrices postraqueostomía mediante doble colgajo adipofascial opuesto Double opposite adipofascial flap for the correction of post-tracheostomy scars

    Directory of Open Access Journals (Sweden)

    S. Llanos

    2012-12-01

    Full Text Available La traqueostomía es un procedimiento frecuentemente para asegurar una vía aérea permeable en casos de intubación prolongada, trauma facial severo y neoplasias de cabeza y cuello. Tras la extubación, el defecto se deja cerrar por segunda intención con el resultado de una cicatriz defectuosa, de pobre resultado estético y con frecuentes alteraciones funcionales asociadas, como por ejemplo disfagia. Se han descrito muchas técnicas para la corrección de estas cicatrices, sin embargo, algunas no corrigen los defectos funcionales y otras requieren una gran disección y movilización de los tejidos. Proponemos una técnica basada en dos colgajos adipofasciales de base opuesta y dependientes de circulación random realizada en 7 pacientes con cicatriz defectuosa postraqueostomía con buenos resultados estéticos y funcionales.Tracheostomy is a frequently used procedure to secure a viable airway in cases such as prolonged intubation, facial trauma and head and neck cancer. After decannulation, the defect is left to heal by secondary intention resulting in a poor aesthetic and functional outcome. Many techniques have been described to correct this defects, however they don´t correct functional defect and some of them require large and complex dissections and manipulation of subdermal tissues. In order to correct these defects we present a technique using a doble opposite adipofascial flap based on random irrigation. This technique has been used in 7 patients with good aesthetical and functional results.

  9. Topographic distribution of inguinal lymph nodes metastasis: significance in determination of treatment margin for elective inguinal lymph nodes irradiation of low pelvic tumors

    International Nuclear Information System (INIS)

    Wang, C.J.; Chin, Y.Y.; Leung, Stephen Wan; Chen, H.C.; Sun, L.M.; Fang, F.M.

    1996-01-01

    Purpose: To study the distribution of gross inguinal lymph node metastasis and, in particular, its correlation with major pelvic bony structures on a simulation film. Methods and Materials: Thirty-seven cases of low pelvic tumors having gross inguinal lymph node metastasis that were treated with radiation therapy between November 1987 and December 1992 were segregated for study. The patient's nodes were palpated and marked with lead wire before the simulation film was taken. The geometric center of the usually round or elliptical node on the film was assumed to be the origin of the previously uninfested node. A total of 84 such labeled nodes was obtained from these 37 cases. These centers were transferred to and mapped collectively on a new simulation film showing major pelvic bony structures of left hemipelvis and upper femur. Results: Distribution of gross inguinal lymph nodes was found confined to the following area, as related to major pelvic bony structure: laterally, just abutting the tangential line that passes through lateral border of the femoral head; medially: 3 cm away from the body's midline axis; superiorly: 1 cm below the line that joins both upper borders of the femoral head; inferiorly: 2.5 cm below the low borders of ischial tuberosity. According to this rectangular boundary, three nodes were out of field, nine nodes near the border less than 1 cm margin. This area adequately covered 86% (72 of 84) of the studied nodes. Conclusion: Distribution study is important in determining the treatment margin. In general, an additional 1-2 cm beyond the area described above is the recommended treatment margin for elective inguinal lymph nodes irradiation with high confidence level of coverage.

  10. Comparison of efficacy of spinal anaesthesia and sub-fascial local anaesthetic inguinal field block for open inguinal hernia repair-a single institutional experience

    International Nuclear Information System (INIS)

    Shafique, N.; Rashid, H.U.; Raja, M.I.; Saeed, M.

    2015-01-01

    The use of local anaesthetic for open inguinal hernia surgery has long been restricted to specialist centres. This study aimed to compare the efficacy of spinal anaesthesia and sub-fascial local anaesthetic (LA) for performing open hernia repair and at the same time provide better post op pain relief and early mobilization. Methods: In this randomized clinical trial, 62 male patients aged 16-72 were randomly allocated to two groups. Group A received mixture of 20ml 0.5% bupivacain, 20ml 2% lignocaine with adrenaline, 20ml normal saline (N/S), 3 ml NaHCO/sub 3/ sub-fascially for Local anaesthetic (LA) inguinal field block, while Group B received Spinal Anaesthesia (SA) with 0.5% Bupivacaine. Comparison was made in terms of Visual Analogue Score (VAS) recorded intra-operatively at 0 and 30 minutes and post operatively at 2, 4 and 12 hours at rest and on movement. Need for rescue analgesia and total analgesic consumption in both groups were calculated. Interval to pain free ambulation as well as procedural and anaesthesia related complications were compared. Results: Mean VAS in the intraoperative period were significantly high in Group A (p-value 0.011) at the start of operation and at 30 minutes (p-value <0.001). However, it did not correlate with patient satisfaction as 90% of patients in Group A successfully underwent the procedure without need for supplemental analgesia. VAS scores at rest and on movement/cough were comparable in the post op period at 2, 4 and 12 hours in both groups. Interval to pain free ambulation was significantly low in Group A (p-value 0.0012). Conclusion: Sub facial LA inguinal field block provides effective anaesthesia with optimum post op analgesia, prompt recovery and fewer systemic side effects compared to SA and can safely be used for routine open inguinal hernia surgery. (author)

  11. Minilaparoscopic technique for inguinal hernia repair combining transabdominal pre-peritoneal and totally extraperitoneal approaches.

    Science.gov (United States)

    Carvalho, Gustavo L; Loureiro, Marcelo P; Bonin, Eduardo A; Claus, Christiano P; Silva, Frederico W; Cury, Antonio M; Fernandes, Flavio A M

    2012-01-01

    Endoscopic surgical repair of inguinal hernia is currently conducted using 2 techniques: the totally extraperitoneal (TEP) and the transabdominal (TAPP) hernia repair. The TEP procedure is technically advantageous, because of the use of no mesh fixation and the elimination of the peritoneal flap, leading to less postoperative pain and faster recovery. The drawback is that TEP is not performed as frequently, because of its complexity and longer learning curve. In this study, we propose a hybrid technique that could potentially become the gold standard of minimally invasive inguinal hernia surgery. This will be achieved by combining established advantages of TEP and TAPP associated with the precision and cosmetics of minilaparoscopy (MINI). Between January and July 2011, 22 patients were admitted for endoscopic inguinal hernia repair. The combined technique was initiated with TAPP inspection and direct visualization of a minilaparoscopic trocar dissection of the preperitoneum space. A10-mm trocar was then placed inside the previously dissected preperitoneal space, using the same umbilical TAPP skin incision. Minilaparoscopic retroperitoneal dissection was completed by TEP, and the surgical procedure was finalized with intraperitoneal review and correction of the preperitoneal work. The minilaparoscopic TEP-TAPP combined approach for inguinal hernia is feasible, safe, and allows a simple endoscopic repair. This is achieved by combining features and advantages of both TAPP and TEP techniques using precise and sophisticated MINI instruments. Minilaparoscopic preperitoneal dissection allows a faster and easier creation of the preperitoneal space for the TEP component of the procedure.

  12. Inguinal hernia repair among men in relation to occupational mechanical exposures and lifestyle factors

    DEFF Research Database (Denmark)

    Vad, Marie Vestergaard; Frost, Poul; Rosenberg, Jacob

    2017-01-01

    showed lower HRs for both repair types. Leisure-time physical activity and smoking status were not related to any of the outcomes. CONCLUSIONS: Assuming a causal relationship, the results suggest that around 30% of all first-time lateral inguinal hernia repairs in the highest exposure category would...

  13. Postoperative nausea and vomiting (PONV) in outpatient repair of inguinal hernia.

    Science.gov (United States)

    Palumbo, Piergaspare; Usai, Sofia; Amatucci, Chiara; Pulli, Valentina Taurisano; Illuminati, Giulio; Vietri, Francesco; Tellan, Guglielmo

    2018-01-01

    Nausea and vomiting are among the most frequent complications following anesthesia and surgery. Due to anesthesia seems to be primarily responsible for post operative nausea and vomiting (PONV) in Day Surgery facilities, the aim of the study is to evaluate how different methods of anesthesia could modify the onset of postoperative nausea and vomiting in a population of patients undergoing inguinal hernia repair. Ninehundredten patients, aged between 18 and 87 years, underwent open inguinal hernia repair. The PONV risk has been assessed according to Apfel Score. Local anesthetic infiltration, performed by the surgeon in any cases, has been supported by and analgo-sedation with Remifentanil in 740 patients; Fentanyl was used in 96 cases and the last 74 underwent deep sedation with Propofol . Among the 910 patients who underwent inguinal hernia repair, PONV occurred in 68 patients (7.5%). Among patients presenting PONV, 29 received Remifentanil, whereas 39 received Fentanyl. In the group of patients receiving Propofol, no one presented PONV. This difference is statistically significant (p < .01). Moreover, only 50 patients of the total sample received antiemetic prophylaxis, and amongst these, PONV occurred in 3 subjects. Compared to Remifentanil, Fentanyl has a major influence in causing PONV. Nonetheless, an appropriate antiemetic prophylaxis can significantly reduce this undesirable complication. Key words: Day Surgery, Fentanyl, Inguinal, Hernia repair, Nausea, Vomiting.

  14. Sutures for inguinal herniorrhaphy--a comparison of monofilaments with PTFE.

    Science.gov (United States)

    Cahill, J.; Northeast, A. D.; Jarret, P. E.; Leach, R. D.

    1989-01-01

    Polybutester (Novafil, Davis & Geck) and expanded polytetrafluoroethylene PTFE (Gore-tex, W L Gore) were compared with nylon (Ethilon, Ethicon UK) for elective inguinal herniorrhaphy. PTFE had the best handling characteristics, but is expensive, and increased wound sepsis attended its use. Polybutester had significantly better handling characteristics, and is an attractive alternative to nylon for hernia repair. PMID:2705719

  15. Femoral hernia, a rare complication following deep inguinal lymph node dissection

    DEFF Research Database (Denmark)

    Muus Steffensen, Signe; Ahm Sørensen, Jens

    2015-01-01

    A 72-year-old woman underwent complete deep inguinal lymph node dissection on her right side subsequent to metastasis from malignant melanoma. On the second postoperative day, the patient reported of nausea and vomiting. She presented with a mass in the resected area that gradually increased...

  16. A 5‑year Review of Darning Technique of Inguinal Hernia Repair

    African Journals Online (AJOL)

    modes of presentation,[8,9] and in many hospitals where the experience ... will be ideal. This study aims to present our experience with the use of the. Darning technique for repair of inguinal hernia in a Nigerian ... Study Design: A descriptive retrospective study ... site infection was the most common complication occurring in.

  17. Incarcerated inguinal hernia management in children: 'a comparison of the open and laparoscopic approach'.

    Science.gov (United States)

    Mishra, Pankaj Kumar; Burnand, Katherine; Minocha, Ashish; Mathur, Azad B; Kulkarni, Milind S; Tsang, Thomas

    2014-06-01

    To compare the outcomes of management of incarcerated inguinal hernia by open versus laparoscopic approach. This is a retrospective analysis of incarcerated inguinal hernina in a paediatric surgery centre involving four consultants. Manual reduction was attempted in all and failure was managed by emergency surgery. The laparoscopy group had 27 patients. Four patients failed manual reduction and underwent emergency laparoscopic surgery. Three of them had small bowel strangulation which was reduced laparoscopically. The strangulated bowel was dusky in colour initially but changed to normal colour subsequently under vision. The fourth patient required appendectomy for strangulated appendix. One patient had concomitant repair of umbilical hernia and one patient had laparoscopic pyloromyotomy at the same time. One patient had testicular atrophy, one had hydrocoele and one had recurrence of hernia on the asymptomatic side. The open surgery group had 45 patients. Eleven patients had failed manual reduction requiring emergency surgery, of these two required resection and anastomosis of small intestine. One patient in this group had concomitant repair of undescended testis. There was no recurrence in this group, one had testicular atrophy and seven had metachronous hernia. Both open herniotomy and laparoscopic repair offer safe surgery with comparable outcomes for incarcerated inguinal hernia in children. Laparoscopic approach and hernioscopy at the time of open approach appear to show the advantage of repairing the contralateral patent processus vaginalis at the same time and avoiding metachronous inguinal hernia.

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

    Science.gov (United States)

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

    2013-01-01

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

  19. Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: Are there differences in the outcome?

    Science.gov (United States)

    Köckerling, F; Jacob, D; Wiegank, W; Hukauf, M; Schug-Pass, C; Kuthe, A; Bittner, R

    2016-03-01

    To date, there are no prospective randomized studies that compare the outcome of endoscopic repair of primary versus recurrent inguinal hernias. It is therefore now attempted to answer that key question on the basis of registry data. In total, 20,624 patients were enrolled between September 1, 2009, and April 31, 2013. Of these patients, 18,142 (88.0%) had a primary and 2482 (12.0%) had a recurrent endoscopic repair. Only patients with male unilateral inguinal hernia and with a 1-year follow-up were included. The dependent variables were intra- and postoperative complications, reoperations, recurrence, and chronic pain rates. The results of unadjusted analyses were verified via multivariable analyses. Unadjusted analysis did not reveal any significant differences in the intraoperative complications (1.28 vs 1.33%; p = 0.849); however, there were significant differences in the postoperative complications (3.20 vs 4.03%; p = 0.036), the reoperation rate due to complications (0.84 vs 1.33%; p = 0.023), pain at rest (4.08 vs 6.16%; p primary versus recurrent male unilateral inguinal hernia showed significant differences to the disadvantage of the recurrent operation. Therefore, endoscopic repair of recurrent inguinal hernias calls for particular competence on the part of the hernia surgeon.

  20. External Genital Abnormalities and Inguinal Hernia among Males of Children Nurseries, North West of Iran

    Directory of Open Access Journals (Sweden)

    Hossein Haratipour

    2016-02-01

    Full Text Available Background Abnormalities of external genitalia in male children nurseries and inguinal hernia are the most common congenital disorders in children. We aimed to determine prevalence rate of inguinal hernia and other genital among children nurseries, in Shahrood-Iran. Materials and Methods In this descriptive cross-sectional study, we examined 920 children nurseries boys. Physical examination of children was performed in presence of a parent in a warm room in supine and upright position with and without Valsalva maneuver. A written consent was obtained from parents before examination. Past medical history and history of surgery on inguinal and genital area was taken. Examination was performed 2 interns who were trained about genital system examination.   Results A total of 920 children nurseries boys aged 3 to 6 years were examined which were detected in 88 children and prevalence rate of these abnormalities were 9.6%. The prevalence of abnormalities in the children under study were as follows: Inguinal hernia (5.1%, cryptorchidism (2.1%, Hydrocele (1.5%, hypospadias (0.4%, Varicocele (0.1%, micropenis (0.4%. Conclusion Regarding to relatively high prevalence rate of these abnormalities and low level of people knowledge, seem screening systems for diagnosis and appropriate treatment of these abnormalities to be necessary.

  1. Determinants of a short convalescence after laparoscopic transabdominal preperitoneal inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette Astrup; Strandfelt, Pernille; Forsberg, Gert

    2012-01-01

    Evidence-based recommendations for the expected duration of convalescence after laparoscopic groin hernia repair are not available, and objective reasons for prolonged convalescence are not clear. Our main aim was to establish the expected duration of convalescence using preoperative...... recommendations to the patient and to identify the limiting factors for early (postoperative) resumption of normal activities after laparoscopic transabdominal preperitoneal inguinal herniorraphy (TAPP)....

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

    Science.gov (United States)

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

    2016-03-01

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

  3. Early-onset inguinal hernia as risk factor for schizophrenia or related psychosis: a nationwide register-based cohort study.

    Science.gov (United States)

    Melkersson, Kristina; Wernroth, Mona-Lisa

    2017-10-01

    In an earlier interview study, we found that more men with familial schizophrenia had undergone inguinal hernia operation, than men with sporadic schizophrenia. However, there are no other studies published specifically on inguinal hernia and schizophrenia. Therefore, the aim of this study was to carry out a Swedish register-based cohort study on the association between inguinal hernia and schizophrenia or related psychosis. Data from the Total Population- and Medical Birth-Registers were used to create a cohort of all individuals born in Sweden 1987-1999 (n=1 406 168). The cohort individuals were linked with the In- and Out-patient Registers and followed from birth to 2015 to identify onset of schizophrenia, schizoaffective disorder and inguinal hernia. Cox proportional hazards regression models were used to assess the association between inguinal hernia before age 13 and risk of developing schizophrenia or schizoaffective disorder during a follow-up from age 13. Inguinal hernia before age 13 was identified in 21 095 individuals, and during the follow-up in total 1314 individuals developed schizophrenia or schizoaffective disorder. The risk of schizophrenia or schizoaffective disorder was higher among individuals with inguinal hernia before age 13, than among individuals without such a diagnosis, especially among the men [adjusted hazard ratio (95% confidence interval); all: 1.44 (1.01-2.06), p=0.0452, men: 1.46 (1.01-2.12), p=0.0460, women: 0.56 (0.14-2.27), p=0.4173]. This study shows that early-onset inguinal hernia is associated with increased risk of developing schizophrenia or schizoaffective disorder, especially in men. Such an association may point to a common biological basis for the development of inguinal hernia and schizophrenia or related psychosis.

  4. Laparoendoscopic single-site extraperitoneal inguinal hernia repair: initial experience in 10 patients.

    Science.gov (United States)

    Do, Minh; Liatsikos, Evangelos; Beatty, John; Haefner, Tim; Dunn, Ian; Kallidonis, Panagiotis; Stolzenburg, Jens-Uwe

    2011-06-01

    Recent technical advances and a trend toward laparoscopic single incision surgery have led us to explore the feasibility of laparoendoscopic single-site (LESS) hernia repair. We present our technique and initial experience with LESS extraperitoneal inguinal hernia repair in 10 consecutive men with unilateral inguinal hernias. Age range was 43.7 (28-64) years. Mean body mass index was 28 (range 24-30). Six were left inguinal hernias. There were six indirect and four direct hernias. Three patients had undergone previous open appendectomy. Incarcerated or bilateral hernias were excluded from our initial series. All cases were performed by three surgeons who were experienced in conventional totally extraperitoneal laparoscopic hernia repair as well as experienced in LESS. A literature review of current single-port inguinal hernia repair data is also presented. The mean operative time was 53 minutes (range 45-65  min). The average length of skin incision was 2.8  cm (range 2.3-3.2  cm). No drain was necessary in any of the patients, while no recordable bleeding was observed. There were no intraoperative or immediate postoperative complications. Hospitalization period was 2 days for all patients. After a limited follow-up of 1 month, there have been no recurrences and no complaints of testicular pain. The results of the current series compare favorably with those found in a literature review. LESS extraperitoneal inguinal hernia repair is both feasible and safe, although more technically demanding than its conventional laparoscopic counterpart. Although the cosmetic result with the former approach may prove superior, there are standing questions regarding the complications and long-term outcome. Randomized and if possible blinded trials that compare conventional and single-incision laparoscopic hernia repair may help to distinguish the most advantageous technique.

  5. [Non-incarcerated inguinal hernia in children: operation within 7 days not necessary].

    Science.gov (United States)

    Timmers, L; Hamming, J F; Oostvogel, H J M

    2005-01-29

    To assess the necessity to operate on non-incarcerated inguinal hernia in children within 7 days of diagnosis. Retrospective. Data on 360 children, 0-10 years old (104 girls and 256 boys) who were operated on for inguinal hernia between 1 January 1993-31 December 2001 at the St. Elisabeth Hospital in Tilburg, the Netherlands, were collected from the medical records. These data included sex, age, interval between diagnosis and repair, recurrence, incarceration, length of hospitalisation and complications. In the group of 113 children 0-1 years old, 137 inguinal hernias were repaired, ofwhich 16 were incarcerated on presentation. The interval between diagnosis and repair was known in 93 of 121 cases: 37 hernias were repaired within 7 days and 56 at a later stage. In the latter group, there was one case of secondary incarceration (1.8%; 95% CI: 0-5.4). The number needed to treat was 56. In the group of 247 children 1-10 years old, 269 inguinal hernias were repaired, of which 8 were primarily incarcerated. The interval between diagnosis and repair was known in 208 of 261 cases: 34 hernias were repaired within 7 days and 174 at a later stage. In the latter group, 3 hernias incarcerated secondarily (1.7%; 95% CI: 0-3.7). The number needed to treat was 58. In the group of non-incarcerated hernias 1 complication occurred, in the group of incarcerated hernias none. The mean length of hospitalisation of children with non-incarcerated hernia was 0.85 days, and of children with incarcerated hernia 2.4 days. In children with a non-incarcerated inguinal hernia who are waiting for an operation, the risk of secondary incarceration and complications is 2% which we do not think is enough reason to carry out an elective hernia-repair procedure within 7 days.

  6. The initial experience of introducing the Onstep technique for inguinal hernia repair in a general surgical department

    DEFF Research Database (Denmark)

    Andresen, K; Burcharth, Jakob Hornstrup Frølunde; Rosenberg, J

    2015-01-01

    BACKGROUND AND AIMS: A new technique for the repair of inguinal hernia, called Onstep, has been described. This technique places the mesh in the preperitoneal space medially and between the internal and external oblique muscles laterally. The Onstep technique has not yet been described outside...... repair. Inguinal Pain Questionnaire results: 95.5% reported no pain or pain that was easily ignored. CONCLUSIONS: It seems from this study that the Onstep technique is a safe method for inguinal hernia repair regarding perioperative and postoperative complications. The postoperative pain seems...

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

    Science.gov (United States)

    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.

  8. Epithelioid malignant mesothelioma of tunica vaginalis with deciduoid features: An unusual malignancy clinically masquerading an inguinal hernia

    Directory of Open Access Journals (Sweden)

    Sharique Ahmed

    2012-01-01

    Full Text Available Paratesticular/scrotal and inguinal canal mass lesions in elderly patients may pose a diagnostic challenge to both the surgeon as well as the pathologist. In most cases, these represent hernial sacs with their contents, and true neoplasms like lipomas, rhabdomyosarcomas, and fibrous pseudotumors are infrequent. Malignant mesotheliomas arising from the tunica layers are rare cause of inguinal and paratesticular tumors. Herein, we report a case of an elderly patient who presented with an inguinal hernia which pathologically had features of deciduoid malignant mesothelioma.

  9. Hernias inguinales bilaterales operadas con anestesia local mediante hernioplastia de Lichtenstein Bilateral inguinal hernias operated on with local anesthesia by Lichtenstein hernioplasty

    Directory of Open Access Journals (Sweden)

    Bárbaro Agustín Armas Pérez

    2009-03-01

    Full Text Available INTRODUCCIÓN. La hernioplastia inguinal bilateral libre de tensión de Lichtenstein es una posibilidad real de tratamiento en pacientes con hernia inguinal bilateral. Este método es en esencia menos costoso para el paciente, la institución y la economía en general, y permite una reincorporación rápida a la sociedad, por lo cual en el presente estudio se presentaron los resultados de este protocolo de tratamiento, con la finalidad de evaluar su efectividad. MÉTODOS. Se realizó un estudio descriptivo transversal con los primeros 38 pacientes operados con la técnica de Lichtenstein mediante anestesia local (técnica combinada de Braun y de Shleider. Los pacientes fueron operados de forma ambulatoria entre enero de 2001 y diciembre del 2007. Se dio el alta en la tarde, si la operación fue en la mañana; y al amanecer del día siguiente, si se operó en la tarde, con el objetivo de evitar la equimosis declive con la movilización precoz. RESULTADOS. Cuatro de los pacientes presentaban hernias recurrentes. El material protésico más empleado fue el polipropileno (86,9 %. Las complicaciones alcanzaron el 9,1 % (referidas no a los 38 pacientes, sino a las 76 hernioplastias; y después de un seguimiento que osciló entre 1 y 36 meses, se presentó un rechazo al material protésico (1,3 % y una recidiva (1,3 %. CONCLUSIONES. Se concluyó que este procedimiento es aplicable a las hernias bilaterales, ya que el estrés, los costos institucionales y las molestias del paciente se reducen, con lo cual demuestra su eficacia.INTRODUCTION. Lichtenstein's tension free bilateral inguinal hernioplasty is a real possibility for treating patients with bilateral inguinal hernia. This method is essentially less expensive for the patient, the institution and the economy in general, and it allows a fast reincorporation to society. Therefore, the results of this treatment protocol were included in the present study aimed at evaluating its effectiveness. METHODS

  10. Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration

    Directory of Open Access Journals (Sweden)

    Aleksandra Gavrilovska-Brzanov

    2016-02-01

    CONCLUSIONS: Between children undergoing inguinal hernia repair, local wound infiltration insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not overwhelming. Caudal block provides longer analgesia, however complications are rather common.

  11. [Study of collagen and elastic fibers of connective tissue in patients with and without primary inguinal hernia].

    Science.gov (United States)

    Bórquez, Pablo; Garrido, Luis; Manterola, Carlos; Peña, Patricio; Schlageter, Carol; Orellana, Juan José; Ulloa, Hugo; Peña, Juan Luis

    2003-11-01

    There are few studies looking for collagen matrix defects in patients with inguinal bernia. To study the skin connective tissue in patients with and without inguinal bernia. Skin from the surgical wound was obtained from 23 patients with and 23 patients without inguinal bernia. The samples were processed for conventional light microscopy. Collagen fibers were stained with Van Giesson and elastic fibers with Weigert stain. Patients without hernia had compact collagen tracts homogeneously distributed towards the deep dermis. In contrast, patients with hernia had zones in the dermis with thinner and disaggregated collagen tracts. Connective tissue had a lax aspect in these patients. Collagen fiber density was 52% lower in patients with hernia, compared to subjects without hernia. No differences in elastic fiber density or distribution was observed between groups. Patients with inguinal bernia have alterations in skin collagen fiber quality and density.

  12. Evaluation of outcome of totally extra peritoneal laparoscopic inguinal hernia repair with lichtenstein open repair

    International Nuclear Information System (INIS)

    Ahmed, I.; Dian, A.; Azam, U.F.; Khan, M.

    2015-01-01

    The objective of this study was to evaluate outcome of total extraperitoneal laparoscopic inguinal hernia repair with Lichtenstein open repair in terms of postoperative pain. Study Design: Quasi experimental study. Place and Duration of Study: Surgical unit l Rawalpindi and Allied hospitals from January to June 2012. Patients and Methods: Sixty patients, with unilateral, primary, inguinal hernia were alternately allocated to undergo either total extraperitoneal (TEP) laparoscopic repair of inguinal hernia or Lichtenstein tension free, mesh repair of inguinal hernia. Pain scores at 12, 24, and 48 hours and at 7 days of follow up were noted using a visual analogue scale. Total number of intravenous injections of Diclofenac Sodium requested by the patient for pain relief was also noted. Results: At 12 hours after surgery, the mean pain scores in the TEP group were 3.1 ± 1.8 and in the Lichtenstein group they were 4.2 ± 2.1 (p 0.031). At 24 hours after surgery, the scores were 2.3 ± 1.5 and 3.1 ± 1.9 for the TEP and Lichtenstein groups, respectively (p = 0.026). At 48 hours after surgery, the mean pain scores in the TEP group were 1.5 ± 1.1 while in the Lichtenstein group they were 2.0 ± 1.6 (p = 0.041). At 7 days after surgery, the scores were 0.3 ± 0.5 in the TEP group and 0.4 ± 0.8 in the Lichtenstein group (0.137). The mean number of injection of Diclofenac Sodium required by the TEP and Lichtenstein groups was 3.1 ± 1.6 and 5.8 ± 2.2, respectively (p = 0.011). Conclusion: Less postoperative pain and requirement for analgesics were reported by patients who underwent total extraperitoneal laparoscopic repair of inguinal hernia as compared to those who underwent inguinal hernia repair by Lichtenstein tension free mesh hernioplasty. (author)

  13. [The quality of patient care under the German DRG system using as example the inguinal hernia repair].

    Science.gov (United States)

    Rudroff, C; Schweins, M; Heiss, M M

    2008-02-01

    The DRG system in Germany was introduced to improve and at the same time simplify the reimbursement of costs in German hospitals. Cost effectiveness and economic efficiency were the declared goals. Structural changes and increased competition among different hospitals were the consequences. The effect on the qualitiy of patient care has been discussed with some concern. Furthermore, doubts have been expressed about the correct representation of the various diagnoses and treatments in the coding system and the financial revenue. Inguinal hernia repair serves as an example to illustrate some common problems with the reimbursement in the DRG system. Virtual patients were grouped using a "Web Grouper" and analysed using the cost accounting from the G-DRG-Browser of the InEK. Additionally, the reimbursement for ambulant hernia repair was estimated. The DRG coding did not differentiate the various operative procedures for inguinal hernia repair. They all generated the same revenues. For example, the increased costs for bilateral inguinal hernia repair are not represented in the payment. Furthermore, no difference is made between primary and recurrent inguinal hernia. In the case of a short-term hospital stay, part of the revenue is retained. In the case of ambulatory treatment of inguinal hernia, the reimbursement is by far not a real compensation for the actual costs. The ideal patient in the DRG system suffers from a primary inguinal hernia, undergoes an open hernia repair without mesh, and remains for 2-3 days in hospital. Minimally invasive procedures, repair of bilateral inguinal hernia and ambulant operation are by far less profitable--if at all. The current revenues for inguinal hernia repair require improvement and adjustment to reality in order to accomplish the goals which the DRG system in Germany aims at.

  14. Long-term follow-up after mesh removal and selective neurectomy for persistent inguinal postherniorrhaphy pain

    DEFF Research Database (Denmark)

    Bischoff, J M; Enghuus, Casper Nørskov; Werner, M U

    2013-01-01

    PURPOSE: Persistent inguinal pain, influencing daily activities, is seen in about 5 % of patients following inguinal herniorrhaphy. Surgical treatment of patients with persistent postherniorrhaphy pain has been associated with pain relief and improvement in functional status. However, the detailed...... and functional ability when comparing preoperative and postoperative assessments. RESULTS: Pain intensities (average, maximum, and during activity) were significantly lower at all time points during follow-up compared to preoperative values (p ...

  15. Lymphatic mapping inguinal and sentinel lymph node biopsy in anal canal cancers to avoid prophylactic inguinal irradiation; Le marquage lymphatique et la biopsie du ganglion sentinelle inguinal dans les cancers du canal anal pour eviter l'irradiation inguinale prophylactique

    Energy Technology Data Exchange (ETDEWEB)

    Bobin, J.Y. [Centre Hospitalier Universitaire Lyon-Sud, Service de Chirurgie Oncoloque, 69 - Pierre-Benite (France); Gerard, J.P.; Chapet, O.; Romestaing, P. [Centre Hospitalier Universitaire Lyon-Sud, Dept. de Radiotherapie et Oncologie, 69 - Pierre-Benite (France); Isaac, S. [Centre Hospitalier Universitaire Lyon-Sud, Dept. d' Anatomopathologie, 69 - Pierre-Benite (France)

    2003-11-01

    Thirty-five patients with clinically N0 cancers of the canal anal, 33 epidermoid carcinomas et 2 melanomas were histologically staged with inguinal sentinel lymphode biopsy (ISN). With the combined technique, blue dye and radiocolloid the ISN was identified in 100 % of the cases. The ISN was invaded in 7 cases/33 for epidermoid tumors and 2/2 for melanomas. After 18 months of follow-up, no inguinal recurrence could be seen in ISN pN0 cases. In conclusion, ISN biopsy is a reliable procedure to stage anal,, canal cancers. It should prevent unnecessary prophylactic inguinal irradiation for pN0 ISN. Inguinal irradiation is only indicated in pN1 ISN. (author)

  16. An Incarcerated Colon Inguinal Hernia That Perforated into the Scrotum and Exhibited an Air-Fluid Level

    Directory of Open Access Journals (Sweden)

    Seisuke Ota

    2015-01-01

    Full Text Available There are few reports of a transverse colon inguinal hernia; furthermore, an inguinal hernia perforating the scrotum is rare. Here we report the case of a 79-year-old man who died after developing an incarcerated colon inguinal hernia that perforated the scrotum and exhibited an air-fluid level. The patient was referred to our hospital in November 2011 with a complaint of inability to move. Physical examination revealed an abnormally enlarged left scrotum and cold extremities. He reported a history of gastric cancer that was surgically treated more than 30 years ago. His white blood cell count and C-reactive protein level were elevated. Abdominal and inguinal computed tomography revealed that his transverse colon was incarcerated in the left inguinal canal. Free air and air-fluid level were observed around the transverse colon, suggestive of a perforation. The patient and his family refused any surgical intervention; therefore, he was treated with sultamicillin tosilate hydrate and cefotiam hydrochloride. However, he succumbed to panperitonitis 19 days after admission. The findings from this case indicate that the transverse colon can perforate into an inguinal hernia sac.

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

    Directory of Open Access Journals (Sweden)

    Emin Kose

    2017-01-01

    Full Text Available 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.

  18. [The transrectus sheath preperitoneal procedure: a safe, effective and cheap surgical approach to inguinal hernia?].

    Science.gov (United States)

    Prins, M W Wiesje; Voropai, D A Dasha; van Laarhoven, C J H M Kees; Akkersdijk, Willem L

    2013-01-01

    The main complication of surgery for inguinal hernia is chronic postoperative pain. This is often reported following the Lichtenstein procedure. A new, open surgical technique for the repair of inguinal hernia has been developed. This procedure is called the transrectus sheath preperitoneal procedure (TREPP). At TREPP a lightweight mesh with a ring made of memory metal is introduced into the preperitoneal space through the transrectus sheath. The first results of this operative technique are very promising: short operation time, short learning curve and not many patients with chronic postoperative pain. In a randomised, multi-centre study which will start mid-2013 (ISRCTN18591339), the TREPP procedure is compared with the transinguinal preperitoneal procedure. The primary outcome measure of this study is chronic postoperative pain.

  19. An extraneural primary anaplastic ependymoma at the subcutaneous inguinal region: Report of a rare case

    Directory of Open Access Journals (Sweden)

    Hamide Sayar

    2015-01-01

    Full Text Available Ependymomas commonly arise in the central nervous system. Extraneural presentation is quite rare. Herein, we describe a primary extraneural ependymoma in a young female. The mass was located in the right inguinal area. The cut surface of the 7.5 mm × 6.5 mm × 4.5 mm sized tumor was brownish-yellow in color. Histologically, it was hypercellular exhibiting pseudorosette or rosette formations and some papillary structures. Mitosis was counted as high as 10 per 10 high power fields. Neither necrosis nor vascular endothelial proliferation within the tumor was observed. Tumor cells showed strong glial fibrillary acidic protein immunoreactivity. On epithelial membrane antigen, intracytoplasmic dot-like immunostaining was observed. This is the first report presenting a primary extraneural anaplastic ependymoma arising in the inguinal subcutaneous region.

  20. An extraneural primary anaplastic ependymoma at the subcutaneous inguinal region: Report of a rare case.

    Science.gov (United States)

    Sayar, Hamide; Ersen, Ayca; Kurtul, Neslihan; Yazar, Mehmet Fatih; Balakan, Ozan

    2015-01-01

    Ependymomas commonly arise in the central nervous system. Extraneural presentation is quite rare. Herein, we describe a primary extraneural ependymoma in a young female. The mass was located in the right inguinal area. The cut surface of the 7.5 mm × 6.5 mm × 4.5 mm sized tumor was brownish-yellow in color. Histologically, it was hypercellular exhibiting pseudorosette or rosette formations and some papillary structures. Mitosis was counted as high as 10 per 10 high power fields. Neither necrosis nor vascular endothelial proliferation within the tumor was observed. Tumor cells showed strong glial fibrillary acidic protein immunoreactivity. On epithelial membrane antigen, intracytoplasmic dot-like immunostaining was observed. This is the first report presenting a primary extraneural anaplastic ependymoma arising in the inguinal subcutaneous region.

  1. Academic Performance in Adolescence after Inguinal Hernia Repair in Infancy: A Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Hansen, Tom G; Pedersen, Jacob K; Henneberg, Steen W

    2011-01-01

    for inguinal hernia repair in infancy and subsequent academic performance. METHODS:: Using Danish birth cohorts from 1986-1990, we compared the academic performance of all children who had undergone inguinal hernia repair in infancy to a randomly selected, age-matched 5% population sample. Primary analysis...... found no evidence that a single, relatively brief anesthetic exposure in connection with hernia repair in infancy reduced academic performance at age 15 or 16 yr after adjusting for known confounding factors. However, the higher test score nonattainment rate among the hernia group could suggest...... repair in infancy. A randomly selected, age-matched 5% population sample consists of 14,575 individuals. Although the exposure group performed worse than the control group (average score 0.26 lower; 95% CI, 0.21-0.31), after adjusting for known confounders, no statistically significant difference (-0...

  2. Ligation of lymph vessels for the treatment of recurrent inguinal lymphoceles following lymphadenectomy

    DEFF Research Database (Denmark)

    Toyserkani, Navid Mohamadpour; Nielsen, Henrik Toft; Bakholdt, Vivi

    2016-01-01

    BACKGROUND: Recurrent lymphocele following groin dissection is generally a self-limiting condition, but in a few cases, the lymphocele persists and for this, there are not many options. Few reports have proposed the efficacy of lymph vessel ligation with patent blue as a vessel locator. We have......, and their data was retrieved from electronic patient records. RESULTS: In total, eight patients had this procedure performed for a total of ten inguinal regions. In all regions, leaking lymph vessels were easily found by the blue color and a median of 3 (range 1-5 vessels) vessels per region were ligated using...... and had the procedure performed again with immediate effect. CONCLUSIONS: Ligation of lymph vessels for the treatment of recurrent inguinal lymphoceles appears to be an appropriate treatment modality that is both quick and easy to perform with minimum risk, and in most cases, it results in immediate...

  3. Sertoli cell tumor arising in a cryptorchid testis presenting as a content of inguinal hernial sac

    Directory of Open Access Journals (Sweden)

    Kusuma Venkatesh

    2016-01-01

    Full Text Available Sertoli cell tumors (SCTs are rare tumors accounting for <1% of all testicular tumors. Here, we report a rare case of SCT in a 60-year-old man presenting as a painless swelling in the right groin since childhood. Clinically, he presented with right-sided inguinal hernia with absence of the right testis. He had normal left testis and had no gynecomastia or infertility. The specimen of hernial sac showed testis with a 1.6 cm × 1.5 cm nodular mass having gray tan-cut surface. Histopathologically, the testis showed atrophy and the nodular portion showed tumor cells arranged in tubular and microcystic pattern, with no solid pattern or necrosis. The diagnosis of SCT was confirmed with immunohistochemical staining for inhibin which showed fine granular cytoplasmic positivity. Cryptorchid testis having SCT and presenting as a content of inguinal hernia is a rare occurrence.

  4. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Kehlet, H

    2001-01-01

    To evaluate the feasibility and safety of unmonitored local anesthesia (ULA) for elective open inguinal hernia repair, we made a prospective, consecutive data collection from 1000 operations on primary and recurrent hernias. Follow-up consisted of a questionnaire 1 mo after surgery and retrieval...... from the electronic patient data management system. In 921 ASA Group I and II and 79 ASA Group III and IV patients, the median age was 60 yr (range, 18-95 yr). ULA was converted to general anesthesia in 5 of 1000 cases, and 961 patients were discharged on the day of surgery after 95 min (median...... anesthesia, day-case setup, or both, primarily because of intraoperative pain (n = 74; 7.8%). We conclude that open inguinal hernia repair can be conducted under ULA, regardless of comorbidity, with a small rate of deviation from day-case setup and minimal morbidity. It provides a safe alternative to other...

  5. Amyand′s hernia masquerading as a strangulated inguinal hernia: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Shahbaz Habib Faridi

    2014-01-01

    Full Text Available We report a rare case of a 62-year-old male who presented to surgical emergency department with the complaints of sudden onset pain and swelled in the right inguinal region with nausea, vomiting and abdominal distension. There was a history of a reducible swelling in the right inguino-scrotal region for the last 1 year. Based on history, clinical examination and investigations a provisional diagnosis of right-sided strangulated inguinal hernia was made and patient was planned for an emergency surgery. On the exploration, the hernial sac revealed a gangrenous vermiform appendix and the diagnosis of Amyand′s hernia was made. Appendectomy was performed through the same incision, and hernial repair was done using a polypropylene mesh.

  6. Condrossarcoma de ramo púbico superior simulando hérnia inguinal

    Directory of Open Access Journals (Sweden)

    Fabio Terabe

    Full Text Available Primary pelvic tumors are relatively rare, representing no more than 5% of primary bone tumors. We presented a case of a chondrosarcoma of the superior pubic ramus initially managed as an inguinal hernia and then operated under oncological principles. Special attention is attributed to the importance for the correct diagnosis and surgical treatment given the low efficacy of adjuvant treatments for this type of neoplasia.

  7. Diagnosis and Surgical Management of Male Pelvic, Inguinal, and Testicular Pain.

    Science.gov (United States)

    Belanger, Gabriel V; VerLee, Graham T

    2016-06-01

    Pain occurs in the male genitourinary organs as for any organ system in response to traumatic, infectious, or irritative stimuli. A knowledge and understanding of chronic genitourinary pain can be of great utility to practicing nonurologists. This article provides insight into the medical and surgical management of subacute and chronic pelvic, inguinal, and scrotal pain. The pathophysiology, diagnosis, and medical and surgical treatment options of each are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. [The ultrasound semiotics of uncomplicated wound healing after inguinal mesh plastics].

    Science.gov (United States)

    Kharitonov, S V; Ziniakova, M V

    2012-01-01

    Dynamic ultrasound (US) investigation was performed in 89 patients operated on inguinal hernia with the use of meshes of various type. The US scanning proved to be a highly informative means of visualization, allowing the objective postoperative assessment of muscular and aponeurotic structures as well as the implant form and position. The study showed, that the mesh implantation was always accompanied by the exudative tissue reaction, which was determined by the physico-chemical characteristics of the implant.

  9. Postoperative urinary retention after inguinal hernia repair: a single institution experience.

    Science.gov (United States)

    Blair, A B; Dwarakanath, A; Mehta, A; Liang, H; Hui, X; Wyman, C; Ouanes, J P P; Nguyen, H T

    2017-12-01

    Inguinal hernia repair is a common general surgery procedure with low morbidity. However, postoperative urinary retention (PUR) occurs in up to 22% of patients, resulting in further extraneous treatments.This single institution series investigates whether patient comorbidities, surgical approaches, and anesthesia methods are associated with developing PUR after inguinal hernia repairs. This is a single institution retrospective review of inguinal hernia from 2012 to 2015. PUR was defined as patients without a postoperative urinary catheter who subsequently required bladder decompression due to an inability to void. Univariate and multivariate logistic regressions were performed to quantify the associations between patient, surgical, and anesthetic factors with PUR. Stratification analysis was conducted at age of 50 years. 445 patients were included (42.9% laparoscopic and 57.1% open). Overall rate of PUR was 11.2% (12% laparoscopic, 10.6% open, and p = 0.64). In univariate analysis, PUR was significantly associated with patient age >50 and history of benign prostatic hyperplasia (BPH). Risk stratification for age >50 revealed in this cohort a 2.49 times increased PUR risk with lack of intraoperative bladder decompression (p = 0.013). At our institution, we found that patient age, history of BPH, and bilateral repair were associated with PUR after inguinal hernia repair. No association was found with PUR and laparoscopic vs open approach. Older males may be at higher risk without intraoperative bladder decompression, and therefore, catheter placement should be considered in this population, regardless of surgical approach.

  10. Feasibility study of natural orifice transluminal endoscopic surgery inguinal hernia repair.

    Science.gov (United States)

    Sherwinter, Danny A; Eckstein, Jeremy G

    2009-07-01

    A potentially less-invasive technique, transluminal surgery, may reduce or eliminate pain and decrease time to full return of activities after abdominal operations. Inguinal hernia repair is perfectly suited to the transgastric endoscopic approach and has not been previously reported. Our purpose was to evaluate the feasibility of transgastric bilateral inguinal herniorrhaphy (BIH). Feasibility study with a nonsurvival canine model. Under general anesthesia, male mongrel dogs weighing 20 to 30 kg had a dual-channel endoscope introduced into the peritoneal cavity over a percutaneously placed guidewire. An overtube with an insufflation channel was used. Peritoneoscopy was performed, and bilateral deep and superficial inguinal rings were identified. The endoscope was removed, premounted with a 4 x 6 cm acellular human dermal implant and then readvanced intraperitoneally through the overtube. The implant was then deployed across the entire myopectineal orifice and draped over the cord structures. Bioglue was then applied endoscopically, and the implant was attached to the peritoneum. After completion of bilateral repairs, the animals were killed and necropsy performed. Five dogs underwent pure natural orifice transluminal endoscopic surgery (NOTES) intraperitoneal onlay mesh (IPOM) BIH. Accurate placement and adequate myopectineal coverage was accomplished in all subjects. At necropsy no injuries to the major structures were noted but Bioglue misapplication with contamination of unintended sites did occur. Our study involved only a small number of subjects in nonsurvival experiments, and no gastric closure was used. Many of the characteristics of inguinal hernia repair are especially well suited to the transgastric approach. The repair is in line with the transgastric endoscope vector, bilateral defects are adjacent, and the IPOM technique does not require significant manipulation or novel instrumentation.

  11. Clinical Outcome Following Infra-Inguinal Percutaneous Transluminal Angioplasy for Critical Limb Ischemia

    International Nuclear Information System (INIS)

    Matsagas, Miltiadis I.; Rivera, Marco A.; Tran, Tan; Mitchell, Adam; Robless, Peter; Davies, Alun H.; Geroulakos, George

    2003-01-01

    Objective: The aim of this study was to assess the efficacy and durability of infra-inguinal PTA in patients with CLI, in terms of clinical outcome. Design:Retrospective study of 50 consecutive patients with CLI that were exclusively treated by infra-inguinal PTA. Methods: The indications for intervention were rest pain in seven (14%) patients,non-healing ulcers in 27 (54%), and gangrenous lesions in 16 (32%).Thirty-three (66%) of these patients presented with a single arterial lesion, and the remaining 17 (34%) with multilevel arterial lesions.Kaplan-Meier analysis was used to assess survival, patency,limb-salvage rates, and amputation-free survival. Results: A total of 67 endovascular procedures were performed and 59 (88.1%) of them were considered to be technically successful. The median follow-up period was 12 months (interquartilerange: 17 months). The 30-day mortality was 4%, while the cumulative survival rates at 12, 24, and 36 months were 73%, 67%, and 59%,respectively. The cumulative primary patency rates at 12 and 24 months were 63% and 52%, respectively, and remained unchanged thereafter.The estimated secondary patency rate was 72% at 36 months. There was only one below-knee amputation in the patients that were treated exclusively with infra-inguinal PTA. The cumulative amputation-free survival at the same period was estimated at 60%. Conclusions: Infra-inguinal PTA had a good early and late outcome in this series of patients with a limited life expectancy.These results are comparable to historical results of surgical revascularization in the treatment of CLI. There is need for a randomized study to determine the primary optimal interventional approach for patients with CLI

  12. Ultrasonographic and clinical findings of inguinal hernia containing the ovary or omentum in girls

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Su Mi; Chai, Jee Won [Dept. of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of)

    2016-09-15

    To characterize the ultrasonographic and clinical findings of inguinal hernia containing the ovary or omentum in girls. We studied 46 girls (49 cases) who were diagnosed with inguinal hernia on ultrasonography between March 2009 and December 2015. The ultrasonographic findings were retrospectively analyzed with respect to location, age at detection, contents of hernia, diameter of the canal of Nuck, and incidence of reducibility, incarceration and strangulation. The clinical findings included the number of cases that underwent operation, contents of hernia discovered during operation, and duration between ultrasonographic diagnosis and operation. The two groups in which inguinal hernia contained the ovary and omentum were statistically compared. Of the 49 cases, the contents of hernia were the ovary or tube in 14 cases, omentum in 32 cases, and bowel in 3 cases. The ovarian herniation group was significantly younger (10.1 months vs. 4.9 years, p < 0.001), had a lower incidence of reducibility (n = 3 vs. n = 29, p < 0.001), higher incidence of incarceration (n = 4 vs. n = 0, p = 0.006), and a shorter duration between ultrasonographic diagnosis and operation (5.7 days vs. 55.8 days, p = 0.032) than the omental herniation group. The ovarian herniation group was younger, had a lower incidence of reducibility, higher incidence of incarceration, and a shorter duration between ultrasonographic diagnosis and operation.

  13. Laparoscopic Pediatric Inguinal Hernia Repair: Overview of "True Herniotomy" Technique and Review of Current Evidence.

    Science.gov (United States)

    Feehan, Brendan P; Fromm, David S

    2017-05-01

    Inguinal hernia repair is one of the most commonly performed operations in the pediatric population. While the majority of pediatric surgeons routinely use laparoscopy in their practices, a relatively small number prefer a laparoscopic inguinal hernia repair over the traditional open repair. This article provides an overview of the three port laparoscopic technique for inguinal hernia repair, as well as a review of the current evidence with respect to visualization and identification of hernias, recurrence rates, operative times, complication rates, postoperative pain, and cosmesis. The laparoscopic repair presents a viable alternative to open repair and offers a number of benefits over the traditional approach. These include superior visualization of the relevant anatomy, ability to assess and repair a contralateral hernia, lower rates of metachronous hernia, shorter operative times in bilateral hernia, and the potential for lower complication rates and improved cosmesis. This is accomplished without increasing recurrence rates or postoperative pain. Further research comparing the different approaches, including standardization of techniques and large randomized controlled trials, will be needed to definitively determine which is superior. Copyright© South Dakota State Medical Association.

  14. Impact of using prophylactic antibiotic on prevention of wound infection in inguinal herniorrhaphy

    International Nuclear Information System (INIS)

    Akhtar, K.; Khan, Z.; Bhatti, A.M.; Mahmood, K.

    2015-01-01

    To compare the effect of antibiotic prophylaxis with placebo in prevention of wound infection amongst patients undergoing clean open inguinal herniorrhaphy (without mesh). Study Design: Randomized Controlled Trial. Place and Duration of Study: Pakistan Air Force Hospital, Faisal Base Karachi from October 2009 to November 2011. Material and Methods: One hundred and fifty patients undergoing inguinal herniorrhaphy were included and randomly assigned to one of the two groups using random numbers table. Group A patients were given intravenous antibiotic while those in Group B were given equal volume of normal saline just before the induction of anaesthesia. Patients from both groups were observed for the presence of wound infection. Results: Total seven cases (4.7%) of surgical site infection were detected; two cases (2.7%) occurred in group A whereas five cases (6.7%) occurred in group B. The low frequency of post-operative wound infection was seen in group A as compared to group B but the difference was statistically insignificant. Conclusion: Antibiotic prophylaxis has no significant effect on prevention of wound infection in inguinal herniorrhaphy. (author)

  15. Athletes with inguinal disruption benefit from endoscopic totally extraperitoneal (TEP) repair.

    Science.gov (United States)

    Roos, M M; Bakker, W J; Goedhart, E A; Verleisdonk, E J M M; Clevers, G J; Voorbrood, C E H; Sanders, F B M; Naafs, D B; Burgmans, J P J

    2018-06-01

    Inguinal disruption, a common condition in athletes, is a diagnostic and therapeutic challenge. The aim of this study was to evaluate the effect of endoscopic totally extraperitoneal (TEP) repair in athletes with inguinal disruption, selected through a multidisciplinary, systematic work-up. An observational, prospective cohort study was conducted in 32 athletes with inguinal disruption. Athletes were assessed by a sports medicine physician, radiologist and hernia surgeon and underwent subsequent endoscopic TEP repair with placement of polypropylene mesh. The primary outcome was pain reduction during exercise on the numeric rating scale (NRS) 3 months postoperatively. Secondary outcomes were sports resumption, physical functioning and long-term pain intensity. Patients were assessed preoperatively, 3 months postoperatively and after a median follow-up of 19 months. Follow-up was completed in 30 patients (94%). The median pain score decreased from 8 [interquartile range (IQR) 7-8] preoperatively to 2 (IQR 0-5) 3 months postoperatively (p disruption, selected through a multidisciplinary, systematic work-up, benefit from TEP repair.

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

    Science.gov (United States)

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

    1991-01-01

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

  17. Ultrasonographic and clinical findings of inguinal hernia containing the ovary or omentum in girls

    International Nuclear Information System (INIS)

    Shin, Su Mi; Chai, Jee Won

    2016-01-01

    To characterize the ultrasonographic and clinical findings of inguinal hernia containing the ovary or omentum in girls. We studied 46 girls (49 cases) who were diagnosed with inguinal hernia on ultrasonography between March 2009 and December 2015. The ultrasonographic findings were retrospectively analyzed with respect to location, age at detection, contents of hernia, diameter of the canal of Nuck, and incidence of reducibility, incarceration and strangulation. The clinical findings included the number of cases that underwent operation, contents of hernia discovered during operation, and duration between ultrasonographic diagnosis and operation. The two groups in which inguinal hernia contained the ovary and omentum were statistically compared. Of the 49 cases, the contents of hernia were the ovary or tube in 14 cases, omentum in 32 cases, and bowel in 3 cases. The ovarian herniation group was significantly younger (10.1 months vs. 4.9 years, p < 0.001), had a lower incidence of reducibility (n = 3 vs. n = 29, p < 0.001), higher incidence of incarceration (n = 4 vs. n = 0, p = 0.006), and a shorter duration between ultrasonographic diagnosis and operation (5.7 days vs. 55.8 days, p = 0.032) than the omental herniation group. The ovarian herniation group was younger, had a lower incidence of reducibility, higher incidence of incarceration, and a shorter duration between ultrasonographic diagnosis and operation

  18. Comparative Study of Fibrin Sealent versus Use of Tackers in Inguinal Hernia Repair

    Directory of Open Access Journals (Sweden)

    Wasim Qadir Kar

    2015-09-01

    Full Text Available Purpose: To determine role and benefit of fibrin glue over tackers for mesh fixation in laparoscopic inguinal hernia repair. Backgroud: Mesh fixation by tackers may lead to many complications peroperatively like bleeding, increased hospital stay and overall more cost and later on chronic groin pain. Material and Methods: 60 inguinal hernia with age more than 18 years were taken and were divided in two groups; 30 patient group who underwent TAPP and 30 patient group who underwent TEPP. In 15 patients in both groups tackers were used and in other half fibrin glue was used for fixation of mesh using a 3mm catheter (Duplotip: Baxter Healthcare, which fits the Tisseel syringe. Results: The use of fibrin sealent has a distinct advantage in laparoscopic treatment of inguinal hernias compared with use of tackers as a method of mesh fixation. The use of fibrin sealant reduces the risk of post- and intraoperative complications, such as bleeding, seroma, chronic pain, has a lower incidence of postoperative neuralgia and provides an early faster return to social life. The recurrence rates do not vary much, but the operative time is slightly longer if the preparation time of the fibrin sealant is taken into consideration. In our study, we found a marginal difference in the cost of the two groups, fibrin sealant and stapled tackers. [Cukurova Med J 2015; 40(3.000: 457-465

  19. Amyand’s Hernia – Vermiform Appendix in an Inguinal Hernia: A Rare Finding

    Directory of Open Access Journals (Sweden)

    Prakash Kumar Sahoo

    2017-10-01

    Full Text Available A variety of surprises may spring up when the sac is opened in an inguinal hernia. Omentum, bowel diverticulum, ovary, fallopian tube, urinary bladder, large bowel, Meckel’s diverticulum or foreign bodies being the varied contents of a hernia sac. The presence of vermiform appendix in the hernia sac in an inguinal hernia is a rare finding. This condition has been named as “Amyand’s Hernia” in the honour of an English surgeon, Claudius Amyand. A diagnosis preoperatively is difficult and is most often made intraoperatively. We report here a 52-year-old patient who presented with acute intestinal obstruction due to an obstructed right sided inguinal hernia. A diagnosis of Amyand’s hernia was confirmed when on exploration appendix along with a part of ascending colon was found to be content of the sac along with a few loops of small bowel. The contents were reduced after checking the viability and Bassini’s repair was done. The patient had an uneventful postoperative period.

  20. Resident postgraduate year does not influence rate of complications following inguinal herniorrhaphy.

    Science.gov (United States)

    Renteria, Oswaldo; Mokdad, Ali A; Imran, Jonathan; Huerta, Sergio

    2017-11-01

    Previous data indicate that patients who undergo surgery with a postgraduate year 3 (PGY-3) resident as the junior surgeon have a lower rate of recurrence compared with PGY-1 and PGY-2 after an open inguinal herniorrhaphy. Lower PGY level was also associated with increased operative time. We hypothesize that when controlling for surgeon, technique, and hernia type, the outcomes for inguinal herniorrhaphy are the same independent of PGY level. A retrospective review of all open unilateral inguinal hernia repairs done by residents who assisted the same senior surgeon at the Veterans Affairs North Texas Health Care System was performed. Seven hundred fifty-two open unilateral inguinal hernia were identified: mean patient age = 60.6 ± 12.7 y; mean body mass index = 27.0 ± 10.8 kg/m 2 ; American Society of Anesthesia III-IV = 51%; and Nyhus type 2 = 44.7%, 3a = 41.6%, and 3b = 13.7%. Residents involved were PGY-1 (17.2%), PGY-2/3 (71.1%), and PGY-4/5 (11.7%). Postoperative complications for intern, junior (PGY-2 and PGY-3), and senior residents (PGY-4 and PGY-5) were 4%, 9%, and 6%, respectively (P = 0.14). Compared to interns, junior residents finished the operation 3.9 min faster (95% confidence interval = -7.5, -0.3). There was no time difference between interns and senior residents completing the operations after controlling for hernia type. Logistic regression did not identify PGY level as an independent predictor of complications or recurrence. There was a slight decrease in operative time when the repair was done with junior-level residents. PGY level did not influence outcomes for open, unilateral inguinal herniorrhaphy when controlled for hernia type and technique. Published by Elsevier Inc.

  1. Cross-sectional study to identify staphylococcal species isolated from teat and inguinal skin of different-aged dairy heifers.

    Science.gov (United States)

    Adkins, P R F; Dufour, S; Spain, J N; Calcutt, M J; Reilly, T J; Stewart, G C; Middleton, J R

    2018-04-01

    The purpose of this study was to describe the prevalence and distribution of staphylococcal species on the teat and inguinal skin of dairy heifers across the various stages of the heifer life cycle. The cross-sectional study included 106 Holstein heifers with an age range of 0 d to 27 mo that were selected from 11 different groups, based on housing type and age, on a single dairy operation. A composite swabbing sample including all 4 teats and a second composite sample including both inguinal regions of each heifer were collected using gas-sterilized electrostatic dusters (Swiffers; Procter and Gamble, Cincinnati, OH). Swabbing samples were mixed with 10 mL of sterile saline, agitated, and cultured on mannitol salt agar plates. At 24 h, plates were read and up to 10 staphylococcal colonies were saved for further analysis. Staphylococcal isolates were speciated using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or PCR amplification and partial sequencing of rpoB or tuf. The prevalence of staphylococci was compared between the inguinal and teat regions using the chi-squared or Fisher's exact test, as applicable. Logistic regression models were used to investigate the relationship between a heifer's age (treated as a quantitative continuous variable) and the probability of isolating a given staphylococcal species from a given body site (inguinal region or teats). Overall, the most common species identified were Staphylococcus haemolyticus followed by Staphylococcus chromogenes, Staphylococcus xylosus, Staphylococcus devriesei, and Staphylococcus sciuri. Staphylococcus aureus was more prevalent on the teat than in the inguinal region, whereas Staphylococcus arlettae was more prevalent in the inguinal region than on the teat. All other staphylococcal species were as likely to be found on the teat skin as the inguinal region skin. Isolation from the inguinal and teat skin was associated with age for Staphylococcus agnetis, S. chromogenes

  2. Hernioplastia inguinal de Lichtenstein: la mejor opción Lichtenstein’s inguinal hernioplasty: the best choicev

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    Oscar Duménigo Arias

    2007-03-01

    Full Text Available Las hernias inguinales son un problema frecuente de salud que afecta a ambos sexos en todas las edades. A pesar de la frecuencia de su reparación quirúrgica, los cirujanos aún no logran resultados perfectos y el índice de recurrencias es humillante. Se estudiaron 136 pacientes a los cuales se les realizó hernioplastia de Lichtenstein entre el 2001 y 2003, y que estuvieron bajo seguimiento médico durante 3 a 5 años con el objetivo de determinar la efectividad de dicha técnica. La muestra estuvo constituida fundamentalmente por varones mayores de 45 años, en quienes predominaron las hernias del lado derecho, de los tipos 2 y 4 según la clasificación de Gilbert modificada por Rutkow y Robbins y de causa primaria en el 83,12 % de los casos. Más de la mitad de los procedimientos se realizó con anestesia local y el material protésico más empleado fue el polipropileno. El 79,87 % de los pacientes se operó de forma ambulatoria y el índice de complicaciones fue de 5,85 %. Hasta la fecha sólo hemos tenido una recurrencia (0,65 %. Los resultados obtenidos con la técnica de Lichtenstein fueron eficaces, con baja morbilidad y recidiva a corto plazo mínima

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

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    Gerritsen Pieter G

    2009-09-01

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

  4. Herniorrafia inguinal em crianças: valor da anestesia local associada Inguinal hernia repair in children: importance of local anesthesia association

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    José Guilherme Minossi

    2002-07-01

    Full Text Available OBJETIVO: Descrever uma técnica de anestesia local no tratamento de hérnias inguinais em crianças. MÉTODO: Foram operadas 48 crianças com hérnias inguinais sob anestesia local na Santa Casa de Misericórdia de Cerqueira César, SP, sendo 34 do sexo masculino e 14 do sexo feminino, com idades entre 3 meses e 12 anos. Apenas quatro crianças tinham hérnia bilateral. A anestesia local foi realizada com lidocaína a 1% na dose de 5 mg/kg de peso através do bloqueio dos nervos abdominogenitais próximos à espinha ilíaca ântero-superior, à altura do anel inguinal externo e na pele ao redor da incisão. A sedação foi feita com cetamina na dose de 1 a 2 mg/kg e diazepam 0,2 a 0,4 mg/kg de peso. RESULTADOS: Todas as cirurgias puderam ser realizadas com tranqüilidade com este método, com exceção de uma criança em que o bloqueio não foi efetivo e a anestesia complementada com inalação de halogenado, sob máscara. Como complicações pós-operatórias, ocorreram três hematomas, sendo um de parede e dois em bolsa escrotal, todos com boa evolução. CONCLUSÕES: O uso da anestesia local associada à sedação é procedimento simples e seguro para realizar herniorrafias inguinais em crianças.AIM: To describe an anesthetic technique, as well as the results of surgical treatment of the inguinal hernia in children. PATIENTS/METHODS: Forty-eight patients were submitted to inguinal hernia repair under local anesthesia at "Santa Casa de Misericórdia de Cerqueira César", State of São Paulo, Brazil. There were 34 male and 14 female patients, range from 3 months to 12 years old. Local anesthesia was performed with a dose of 5 mg/kg body weight of 1% lidocaine through iliohypogastric and ilioinguinal nerve blocks, medially to the anterior superior iliac spine, and at level of the pubic tubercle. Sedation was done with an association of ketamine (1 to 2 mg/kg and diazepam (0,2 to 0,4 mg/kg. RESULTS: In all patients except one the procedure was

  5. Rescate de colgajo muscular de trapecio con isla cutánea en paciente lesionado medular que precisa rehabilitación inmediata Rescue of a pedicled trapezious muscle flap with skin paddle in a patient with spinal cord injury who needded inmediate rehabilitation

    Directory of Open Access Journals (Sweden)

    J.M. Arévalo Velasco

    2011-12-01

    Full Text Available La terapia por presión negativa (subatmosférica es una modalidad no invasiva de tratamiento que hoy en día está incluida en el arsenal terapéutico de cualquier Servicio no sólo de Cirugía Plástica, sino también de Cirugía General, Cirugía Vascular y Traumatología. Se puede aplicar en el tratamiento de heridas tanto crónicas como agudas más o menos complejas, con el fin de evitar aumentar el tiempo y el número de curas necesarias y además el realizar cirugías que conlleven una elevada morbilidad para el paciente. Presentamos el caso de un paciente con cuadro depresivo secundario a la mala evolución clínica sufrida tras el desarrollo de una lesión medular transversa D4 ASIA C (incompleta de causa iatrogénica postquirúrgica (vertebroplastia-fusión vertebral por aplastamiento vertebral D3-D4, en el que tras más de 6 meses de evolución tórpida de una úlcera dorsal alta, se realizó un colgajo de músculo trapecio pediculado con paleta cutánea para cobertura del defecto, en cuyo postoperatorio inmediato sufrió, de nuevo iatrogénicamente, una pérdida parcial de dicha paleta y un seroma importante en la zona dadora. Consideramos de interés este caso porque la aplicación de terapia de presión negativa empleando el sistema VAC® nos permitió: 1 Minimizar la pérdida de tejido del colgajo. 2 Disminuir el número de curas semanales hasta 1 ó 2. 3 Disminuir también el tiempo empleado en cada cura. 4 Que el paciente pudiera desplazarse en su silla de ruedas con dos sistemas VAC® portátiles hasta el gimnasio para no abandonar su programa de rehabilitación. 5 Que ante una evolución rápida e inesperada, el paciente experimentara una notable mejoría clínica de su estado depresivo-ansioso y 6 La colocación final de un sistema VAC-VIA® de última generación sobre los autoinjertos, para que el paciente pudiera continuar su tratamiento de terapia ocupacional y fisioterápico de extremidades superiores. Consideramos las

  6. Long-term quality of life and outcomes following robotic assisted TAPP inguinal hernia repair.

    Science.gov (United States)

    Iraniha, Andrew; Peloquin, Joshua

    2018-06-01

    Laparoscopic TAPP inguinal hernia repair is an established alternative to open hernia repair, which offers equivalent outcomes with less postoperative pain and faster recovery. Unfortunately, it remains technically challenging, requiring advanced laparoscopic skills which have limited its popularity among surgeons. The robotic platform has the potential to overcome these challenges. The objective of this study was to examine the long-term quality of life and outcomes following robotic assisted TAPP inguinal hernia repair, since these data have not been reported up to now. From October 2012 to October 2015, 159 inguinal hernias in 82 consecutive patients were repaired with 3D mesh (BARD) using da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). The patients' demographics and intraoperative data were documented. Patients were seen 2 and 6 weeks after the surgery and the complications were recorded. Patients were assessed 6 weeks after the surgery by a survey using a universal pain assessment tool to document their post-operative pain, narcotic use and time of return to work and exercise. A modified short form 12 (SF 12) was also sent out to the patients 12-36 months after the surgery to measure their health-related quality of life prior to surgery and at the 12- to 36-month follow-up, and to document any evidence of recurrence. Postoperative health-related quality of life scores were compared to the pre-operative baseline quality of life scores using the unpaired t test. Over the course of 3 years, 159 robotic assisted TAPP inguinal hernia repair were performed in 82 patients, 73 men and 9 women by one surgeon as an outpatient basis. The mean age was 53 and mean body mass index was 26. There were no intraoperative complications or conversions. The average operative time was 99 min. Four patients developed urinary retention post-operatively and one patient developed postoperative bowel obstruction requiring laparoscopic lysis of adhesion with no

  7. An international consensus algorithm for management of chronic postoperative inguinal pain.

    Science.gov (United States)

    Lange, J F M; Kaufmann, R; Wijsmuller, A R; Pierie, J P E N; Ploeg, R J; Chen, D C; Amid, P K

    2015-02-01

    Tension-free mesh repair of inguinal hernia has led to uniformly low recurrence rates. Morbidity associated with this operation is mainly related to chronic pain. No consensus guidelines exist for the management of this condition. The goal of this study is to design an expert-based algorithm for diagnostic and therapeutic management of chronic inguinal postoperative pain (CPIP). A group of surgeons considered experts on inguinal hernia surgery was solicited to develop the algorithm. Consensus regarding each step of an algorithm proposed by the authors was sought by means of the Delphi method leading to a revised expert-based algorithm. With the input of 28 international experts, an algorithm for a stepwise approach for management of CPIP was created. 26 participants accepted the final algorithm as a consensus model. One participant could not agree with the final concept. One expert did not respond during the final phase. There is a need for guidelines with regard to management of CPIP. This algorithm can serve as a guide with regard to the diagnosis, management, and treatment of these patients and improve clinical outcomes. If an expectative phase of a few months has passed without any amelioration of CPIP, a multidisciplinary approach is indicated and a pain management team should be consulted. Pharmacologic, behavioral, and interventional modalities including nerve blocks are essential. If conservative measures fail and surgery is considered, triple neurectomy, correction for recurrence with or without neurectomy, and meshoma removal if indicated should be performed. Surgeons less experienced with remedial operations for CPIP should not hesitate to refer their patients to dedicated hernia surgeons.

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

    Science.gov (United States)

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

    2015-05-01

    The totally extraperitoneal (TEP) approach for surgical repair of inguinal hernias has emerged as a popular technique. We conducted a prospective randomised trial to compare patient comfort scores using different mesh types and fixation using this technique. Over a 14 month period, 146 patients underwent 232 TEP inguinal hernia repairs. We compared the comfort scores of patients who underwent these procedures using different types of mesh and fixation. A non-absorbable 15 × 10 cm anatomical mesh fixed with absorbable tacks (Control group) was compared with either a non-absorbable 15 × 10 cm folding slit mesh with absorbable tacks (Group 2), a partially-absorbable 15 × 10 cm mesh with absorbable tacks (Group 3) or a non-absorbable 15 × 10 cm anatomical mesh fixed with 2 ml fibrin sealant (Group 4). Outcomes were compared at 1, 2, 4 and 12 weeks using the Carolina Comfort Scale (CCS) scores. At 1, 2, 4 and 12 weeks, the median global CCS scores were low for all treatment groups. Statistically significant differences were seen only for median CCS scores and subscores with the use of partially-absorbable mesh with absorbable tacks (Group 3) at weeks 2 and 4. However, these were no longer significant at week 12. In this study, the TEP inguinal hernia repair with minimal fixation results in low CCS scores. There were no statistical differences in CCS scores when comparing types of mesh, configuration of the mesh or fixation methods. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  9. Surgical repair of incarcerated inguinal hernia in children: laparoscopic or open?

    Science.gov (United States)

    Nah, S A; Giacomello, L; Eaton, S; de Coppi, P; Curry, J I; Drake, D P; Kiely, E M; Pierro, A

    2011-01-01

    The management of Incarcerated Inguinal Hernia (IIH) in children is challenging and may be associated with complications. We aimed to compare the outcomes of laparoscopic vs. open repair of IIH. With institutional ethical approval (09SG13), we reviewed the notes of 63 consecutive children who were admitted to a single hospital with the diagnosis of IIH between 2000 and 2008. Data are reported as median (range). Groups were compared by chi-squared or t-tests as appropriate. · Open repair (n=35): There were 21 children with right and 14 with left IIH. 2 patients also had contralateral reducible inguinal hernia. Small bowel resection was required in 2 children. · Laparoscopic repair (n=28): All children had unilateral IIH (19 right sided, 9 left sided). 15 children (54%) with no clinical evidence of contralateral hernia, had contralateral patent processus vaginalis at laparoscopy, which was also repaired. The groups were similar with regard to gender, age at surgery, history of prematurity, interval between admission and surgery, and proportion of patients with successful preoperative manual reduction. However, the duration of operation was longer in the laparoscopy group (p=0.01). Time to full feeds and length of hospital stay were similar in both groups. Postoperative follow-up was 3.5 months (1-36), which was similar in both groups. 5 patients in the group undergoing open repair had serious complications: 1 vas transaction, 1 acquired undescended testis, 2 testicular atrophy and 1 recurrence. The laparoscopic group had a single recurrence. Open repair of incarcerated inguinal hernia is associated with serious complications. The laparoscopic technique appears safe, avoids the difficult dissection of an oedematous sac in the groin, allows inspection of the reduced hernia content and permits the repair of a contralateral patent processus vaginalis if present. © Georg Thieme Verlag KG Stuttgart · New York.

  10. A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty.

    Science.gov (United States)

    Desmet, Matthias; Vermeylen, Kris; Van Herreweghe, Imré; Carlier, Laurence; Soetens, Filiep; Lambrecht, Stijn; Croes, Kathleen; Pottel, Hans; Van de Velde, Marc

    The role of a fascia iliaca compartment block (FICB) for postoperative analgesia after total hip arthroplasty (THA) remains questionable. High-dose local anesthetics and a proximal injection site may be essential for successful analgesia. High-dose local anesthetics may pose a risk for local anesthetic systemic toxicity. We hypothesized that a high-dose longitudinal supra-inguinal FICB is safe and decreases postoperative morphine consumption after anterior approach THA. We conducted a prospective, double blind, randomized controlled trial. Patients scheduled for THA were randomized to group FICB (longitudinal supra-inguinal FICB with 40-mL ropivacaine 0.5%) or group C (control, no block). Standard hypothesis tests (t test or Mann-Whitney U test, χ test) were performed to analyze baseline characteristics and outcome parameters. The primary end point of the study was total morphine (mg) consumption at 24 hours postoperatively. Serial total and free ropivacaine serum levels were determined in 10 patients. After obtaining ethical committee approval and written informed consent, 88 patients were included. Mean (SD) morphine consumption at 24 hours postoperatively was reduced in group FICB compared to group C: 10.25 (1.64) mg versus 19.0 (2.4) mg (P = 0.004). Using a mean dose of 2.6-mg/kg ropivacaine (range, 2-3.4 mg/kg), none of the patients had total or free ropivacaine levels above the maximum tolerated serum concentration. We conclude that a high-dose longitudinal supra-inguinal FICB reduces postoperative morphine requirements after anterior approach THA.Clinical Trials Registry: EU Clinical Trials Register. www.clinicaltrialsregister.eu #2014-002122-12.

  11. Aligning incentives in the management of inguinal hernia: the impact of the payment model.

    Science.gov (United States)

    Devarajan, Karthik; Rogers, Loni; Smith, Paul; Schwaitzberg, Steven D

    2012-09-01

    The Affordable Care Act has stimulated discussion to find feasible, alternate payment models. Adopting a global payment (GP) mechanism may dampen the high number of procedures incentivized by the fee-for-service (FFS) system. The evolving payment mechanism should reflect collaboration between surgeon and system goals. Our aim was to model and perform simulation of a GP system for hernia care and its impact on cost, revenue, and physician reimbursement in an integrated health care system. The results of the 2006 Watchful Waiting (WW) vs Repair of Inguinal Hernia in Minimally Symptomatic Men trial was used as a clinical model for the natural history and progression of inguinal hernia disease Simulations were built using 2009 financial and clinical data from the Cambridge Health Alliance to model costs and revenues in managing care for a 4-year cohort of inguinal hernia patients; FFS, FFS-WW, and the GP-WW were modeled. To build this GP model, surgeons were paid a constant $500 per patient whether herniorrhaphy was performed or not. Compared with the actual combined physician and hospital revenue under the current FFS model ($308,820), implementing the FFS-WW system for 4 years for 139 hernia patients decreased hospital and physician revenues by $93,846 and $19,308, respectively. This resulted in a total savings of $113,154 for the payors only. In contrast, when using WW methodology within a GP model, system savings of $69,174 were observed after 4 years, with preservation of physician and hospital income. Collaboration to achieve shared savings can be accomplished by pooling physician and hospital revenue in order to meet the goals of all parties. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Spinal anesthesia is safe in laparoscopic total extraperitoneal inguinal hernia repair. A retrospective clinical trial.

    Science.gov (United States)

    Yildirim, Dogan; Hut, Adnan; Uzman, Sinan; Kocakusak, Ahmet; Demiryas, Suleyman; Cakir, Mikail; Tatar, Cihad

    2017-12-01

    Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is an effective and safe method for the treatment of inguinal hernia. There are very few studies on regional anesthesia methods in TEP surgery. To compare TEP inguinal hernia repair performed when the patient was treated under spinal anesthesia (SA) with that performed under general anesthesia (GA). All total of 80 patients were studied between December 2015 and March 2017. Hyperbaric bupivacaine and fentanyl were used for SA, to achieve a sensorial level of T3. Propofol, sevoflurane, rocuronium, fentanyl, and tracheal intubation were used for GA. Intraoperative events related to SA, surgical times, intra- and postoperative complications, and pain scores were recorded. The mean operative time in the SA TEP group was 70.2 ±6.7 min, which was significantly longer than the mean operative time in the GA TEP group of 67.2 ±6.2 min (p < 0.038). The mean pain scores in the SA TEP group were 0.23 ±0.42 at the first hour, 1.83 ±0.64 at 6 h and 1.28 ±0.45 at 24 h. These scores were significantly lower than the corresponding scores of 5.18 ±0.84 (p < 0.001), 2.50 ±0.55 (p < 0.001) and 1.58 ±0.55 in the GA TEP group. Generally, patients were more satisfied with SA than GA (p < 0.004). Spinal anesthesia TEP is significantly less painful in the early postoperative period, leading to earlier ambulation than GA TEP. Additionally, SA TEP results in significantly less need for analgesics and better patient satisfaction results. SA TEP seems to be a better alternative than the existing GA TEP.

  13. Wound infiltration with ropivacaine and bupivacaine for pain after inguinal herniotomy

    DEFF Research Database (Denmark)

    Erichsen, C J; Vibits, H; Dahl, J B

    1995-01-01

    In a double-blind, randomized study, 32 patients scheduled for elective inguinal herniotomy under general anaesthesia received subcutaneous infiltration with 40 ml ropivacaine 2.5 mg/ml or bupivacaine. Postoperative pain intensity was assessed repeatedly for 24 hours at rest, during cough...... and movement on a visual analogue scale (VAS) and by means of pressure algometry. No differences between pain intensities or wound tenderness were found between the groups. The demand for analgesics was similar in the two groups. We conclude that incisional ropivacaine is as effective as bupivacaine...

  14. Repair of inguinal hernia: a comparison between extraperitoneal laparoscopy and Lichtenstein open surgery

    Directory of Open Access Journals (Sweden)

    Tavassoli A

    2010-06-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: The inguinal hernia is a common disorder in general surgery. Different methods have been described for repair of these hernias. In modern methods, synthetic mesh is used to cover the wall defect and the most known method is Lichtenstein surgical repair. The laparoscopic totally extra peritoneal procedure (TEP is a newer technique of repairing hernia. The aim of this study is to compare the outcomes of totally extraperitoneal laparoscopic inguinal hernia repair versus Lichtenstein open repair in patients with inguinal hernia."n"nMethods: Among 50 patients, 25 cases underwent Lichtenstein procedure and 25 patients underwent TEP technique for repairing primary unilateral inguinal hernia. Findings during the operation have been recorded and the 12-months follow-up of patients in different views was performed through a questionnaire and then the results were compared."n"nResults: The operation duration, the rate of complications and frequency of recurrence were similar in two groups; but the hospital stay, postoperative pain, chronic groin pain and the required time to return to normal activity were significantly lower in patients who underwent the TEP method compared to the patients who underwent the

  15. [Inguinal hernia repair: results of randomized clinical trials and meta-analyses].

    Science.gov (United States)

    Slim, K; Vons, C

    2008-01-01

    This evidence-based review of the literature aims to answer two questions regarding inguinal hernia repair: 1. should a prosthetic patch be used routinely? 2. Which approach is better - laparoscopic or open surgery? After a comprehensive search of electronic databases we retained only meta-analyses (n=14) and/or randomised clinical trials (n=4). Review of this literature suggests with a good level of evidence that prosthetic hernia repair is the gold standard; the laparoscopic approach has very few proven benefits and may involve more serious complications when performed outside expert centers. The role of laparoscopy for the repair of bilateral or recurrent hernias needs better evaluation.

  16. Persistent Müllerian duct syndrome with transverse testicular ectopia presenting as an incarcerated inguinal hernia.

    Science.gov (United States)

    Kaul, A; Srivastava, K N; Rehman, S M F; Goel, V; Yadav, V

    2011-12-01

    The presence of both of the testes in one scrotal sac is one of the very rare presentations of testicular ectopia, which is known as transverse testicular ectopia (TTE) and is also known as crossed testicular ectopia. The presence of the uterus and fallopian tubes in a normally virilized male is termed as persistent Müllerian duct syndrome (PMDS). We report a case of an adult male who had a unique combination of both TTE and PMDS presenting as an incarcerated inguinal hernia.

  17. Short convalescence after inguinal herniorrhaphy with standardised recommendations: duration and reasons for delayed return to work

    DEFF Research Database (Denmark)

    Callesen, T; Klarskov, B; Bech, K

    1999-01-01

    inguinal herniorrhaphy under local anaesthesia. One day convalescence for light/moderate and three weeks for strenuous physical activity was recommended. MAIN OUTCOME MEASURE: Duration of absence from work or main recreational activity. RESULTS: Overall median absence (including the day of operation) was 6...... the general practitioner in 12. Pain was the main cause of impairment of activities of daily living. CONCLUSION: Well-defined recommendations for convalescence may, together with improved management of postoperative pain, shorten convalescence; they are essential in the evaluation of effects of different...

  18. Laporoscopic Surgery as the Gold Standard Surgery for Inguinal Hernia in Children

    Directory of Open Access Journals (Sweden)

    Elena Yu. Dyakonova

    2018-01-01

    Full Text Available Inguinal hernia in children is one of the most common diseases requiring surgical treatment. There are two methods of surgical interventions for inguinal hernia in children: open and laparoscopic. In international clinical practice, open hernia repair is widely used due to the simplicity of the technique which does not require special tools. However, the percentage of complications and relapse frequency remain high when open hernia repair is performed. The article presents the analysis of the treatment results in 209 children with strangulated inguinal hernia who underwent open and laparoscopic surgery in the period from 2003 to 2014. The open hernia repair (Krasnobaev or Martynov technique was performed in 89 children. The following complications were registered: edema of the spermatic cord — in 34 patients, non-viable loop of the intestine — in 2; one child had a vermicular appendix with signs of striation in the hernial sac, 4 patients — a vermiform appendix with signs of inflammation. In 6 cases the contents of the hernial sac included the strand of the greater omentum, in 1 — the strand of the greater omentum with signs of acute ischemia. In 12 children, the hernial protrusion was absorbed to the abdominal, and therefore no revision was required. In 1 patient, the early postoperative period was complicated by peritonitis due to bowel wall necrosis. Laparoscopic hernioplasty was performed in 120 pediatric patients. The contents of the hernial sac in 86 cases included a loop of the small intestine, in 7 — an appendix and a site of the caecum, in 15 — the ovary and fallopian tubes, in 5 — the strand of the greater omentum. In 14 children, unobliterated internal inguinal rings previously not diagnosed were detected when examining the abdomen. Simultaneous appendectomy was performed when the cecum and the appendix were strangulated. Laparoscopic techniques omitting the disadvantages of an open repair method make it possible to

  19. Physicomechanical evaluation of polypropylene, polyester, and polytetrafluoroethylene meshes for inguinal hernia repair.

    Science.gov (United States)

    Deeken, Corey R; Abdo, Michael S; Frisella, Margaret M; Matthews, Brent D

    2011-01-01

    For meshes to be used effectively for hernia repair, it is imperative that engineers and surgeons standardize the terminology and techniques related to physicomechanical evaluation of these materials. The objectives of this study were to propose standard techniques, perform physicomechanical testing, and classify materials commonly used for inguinal hernia repair. Nine meshes were evaluated: 4 polypropylene, 1 polyester, 1 polytetrafluoroethylene, and 3 partially absorbable. Physical properties were determined through image analysis, laser micrometry, and density measurements. Biomechanical properties were determined through suture retention, tear resistance, uniaxial, and ball burst testing with specimens tested in 2 different orientations. A 1-way ANOVA with Tukey's post-test or a t-test were performed, with p INFINIT (WL Gore & Associates) did not resist tearing as effectively as the others. All meshes exhibited supraphysiologic burst strengths except INFINIT and ULTRAPRO. Significant differences exist between the physicomechanical properties of polypropylene, polyester, polytetrafluoroethylene, and partially absorbable mesh prostheses commonly used for inguinal hernia repair. Orientation of the mesh was also shown to be critical for the success of meshes, particularly those demonstrating anisotropy. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Inguinal hernia repair: totally preperitoneal laparoscopic approach versus Stoppa operation: randomized trial of 100 cases.

    Science.gov (United States)

    Champault, G G; Rizk, N; Catheline, J M; Turner, R; Boutelier, P

    1997-12-01

    In a prospective randomized trial comparing the totally preperitoneal (TPP) laparoscopic approach and the Stoppa procedure (open), 100 patients with inguinal hernias (Nyhus IIIA, IIIB, IV) were followed over a 3-year period. Both groups were epidemiologically comparable. In the laparoscopic group, operating time was significantly longer (p = 0.01), but hospital stay (3.2 vs. 7.3 days) and delay in return to work (17 vs. 35 days) were significantly reduced (p = 0.01). Postoperative comfort (less pain) was better (p = 0.001) after laparoscopy. In this group, morbidity was also reduced (4 vs. 20%; p = 0.02). The mean follow-up was 605 days, and 93% of the patients were reviewed at 3 years. There were three (6%) recurrences after TPP, especially at the beginning of the surgeon's learning curve, versus one for the Stoppa procedure (NS). For bilateral hernias, the authors suggest the use of a large prosthesis rather than two small ones to minimize the likelihood of recurrence. In the conditions described, the laparoscopic (TPP) approach to inguinal hernia treatment appears to have the same long-term recurrence rate as the open (Stoppa) procedure but a real advantage in the early postoperative period.

  1. The Comparison of Lichtenstein Procedure with and without Mesh-Fixation for Inguinal Hernia Repair

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    Feyzullah Ersoz

    2016-01-01

    Full Text Available Aim. Although inguinal hernia repair is the most frequently performed surgical procedure in the world, the best repair method has not gained acceptance yet. The ideal repair must be safe, simple, and easy to perform and require minimal dissection which provides enough exploration, maintain patient’s comfort in the early stage, and also be cost-effective, reducing operation costs, labor loss, hospital stay, and recurrence. Materials and Methods. There were eighty-five patients between the ages of 18 and 75, diagnosed with inguinal hernia in our clinic. Lichtenstein procedure for hernia repair was performed under spinal anesthesia in all patients. Forty-two patients had the standard procedure and, in 43 patients, the polypropylene mesh was used without fixation. All patients were examined and questioned on the 7th day of the operation in terms of pain, scrotal edema, and the presence of seroma and later on in the 6th postoperative month in terms of paresthesia, neuropraxia, and recurrence by a single physician. Results. Operative time and pain scores in the nonfixation group were significantly lower, without any increase in rates of recurrence. Conclusion. Based on these findings, in Lichtenstein hernia repair method, nonfixation technique can be used safely with better results.

  2. Laparoscopic repair of incarcerated inguinal hernia. A safe and effective procedure to adopt in children.

    Science.gov (United States)

    Esposito, C; Turial, S; Alicchio, F; Enders, J; Castagnetti, M; Krause, K; Settimi, A; Schier, F

    2013-04-01

    The purpose of our retrospective study was to describe the efficacy and the advantages of laparoscopic approach to treat incarcerated inguinal hernia (IIH) in pediatric patients. In a 2-year period, 601 children underwent a laparoscopic inguinal hernia repair, 46 (7.6 %) of them presented an IIH. Our study will be focused on these 46 patients: 30 boys and 16 girls (age range 1 month-8 years). Twenty-one/46 hernias (45.6 %) were reduced preoperatively and then operated laparoscopically (RH), 25/46 (54.4 %) were irreducible and they were operated directly in laparoscopy (IRH). We have no conversions in our series. The length of surgery in RH group was in median 23 min and in IRH group was in median 30 min. Hospital stay was variable between 6 h and 3 days (median 36 h).With a minimum follow-up of 14 months, we had 2/46 recurrences (4.3 %). The laparoscopic approach to IIH appears easy to perform from the technical point of view. The 3 main advantages of laparoscopic approach are that all edematous tissue are surgically bypassed and the cord structures are not touched; the reduction is performed under direct visual control, and above all, an inspection of the incarcerated organ is performed at the end of procedure.

  3. Laparoscopic surgery in the treatment of incarcerated indirect inguinal hernia in children.

    Science.gov (United States)

    Yin, Yiyu; Zhang, Hongwei; Zhang, Xiang; Sun, Fang; Zou, Huaxin; Cao, Hui; Wen, Cheng

    2016-12-01

    We aimed to explore the feasibility and the safety of the laparoscopic surgery for incarcerated indirect inguinal hernia (IIH) in children. From January 2012 to December 2014, 64 children were enrolled into this study. All 64 patients received laparoscopic surgery and we reviewed their perioperative and postoperative follow-up studies. In addition, we enrolled 60 cases of children who received traditional surgery of IIH administered through minimally invasive surgery as the control group. Results from the present study showed that the mean operation time for the laparoscopic group was 41.5 min (range, 15-80 min) which was significantly shorter than the control group. Nine cases developed incarcerated intestine necrosis, expanded umbilical incision and parallel resection anastomosis. They received laparoscopic hernia sac high ligation. Only 5 cases developed scrotum edema after the surgery. The postoperative length of the stay ranged from 2 to 7 days (average, 3.2). The postoperative follow-up was from 6 months to 1 year and no relapse or secondary testicular atrophy was observed in the laparoscopic group. The operation time, incidence of postoperative complications and length of stay in the laparoscopic group were decreased compared to the control group, and differences were statistically significant (Pincarcerated inguinal hernia is safe and feasible and produced better results compared with the alternative.

  4. The Usefulness of International Cooperation in the Repair of Inguinal Hernias in Sub-Saharan Africa.

    Science.gov (United States)

    Gil, José; Rodriguez, J M; Gil, E; Hernández Agúera, Q; González, F M; García, J A; Balsalobre, M D; Tortosa, J A; Hernández Palazón, D; Diallo, A B; Parrilla, P

    2015-11-01

    The burden of disease and mortality associated with inguinal hernia in Africa, especially in sub-Saharan Africa, is very high. The purpose of this study is to show that International Cooperation work in the field of hernia repair is effective; it minimizes the delay in hernia repairs in the targeted population, and can prevent a large number of disability-adjusted life years (DALYs). As a part of an International Cooperation program, a total of 990 black patients with inguinal hernias were studied, in whom hernioplasty was performed using polypropylene mesh. The type of hernia and surgical technique were studied. Indicators of scientific and technical quality, indicators of efficiency and of effectiveness were analyzed. The results on the usefulness of interventions were calculated as avoided DALYs. Surgery was performed on 926 patients with a total of 1033 hernia repairs. 87.2 % of the repairs were made with mesh. There was no mortality in the series, complications were minor, and 85.7 % of patients remained less than 24 h in the center. There was a 2.8 % of recurrence, with a follow-up 58.7 % of the patients in the first year. 5014 DALYs were avoided, and the average of the avoided DALYs per patient was of 5.41. Hernia repair with mesh in low development countries is a procedure with low morbidity and high effectiveness that can prevent a large number of DALYs.

  5. Clinical Implantation with the novel D-13 prosthesis for inguinal hernioplasty: A retrospective cohort study.

    Science.gov (United States)

    Gao, Peng-Zhi; Li, Ming; Yu, Ying-Jian; Hao, Xiang-Dong; Li, Wu-Zi; Rong, Ya-Jun; Zheng, Zhi-Gang; Meng, Ning

    2015-05-01

    Using a mesh to repair inguinal hernias is now a standard procedure that is widely accepted as superior to primary suture repair. Although a variety of meshes are available, individual meshes may have their own unattractive features. This retrospective study examines the efficacy of our originally designed D-13 prosthesis, which is used in patients with inguinal hernias. A total of 305 patients who underwent a herniorrhaphy between January 2009 and March 2011 were included in this study. The recurrent rate, chronic pain and feeling of a foreign body were examined at a 3-year follow-up. The D-13 prosthesis, made from clear polypropylene monofilament mesh, was originally designed by the first author of this study and constructed with the upper and lower pieces of polypropylene mesh having different shapes and sizes. Both pieces are linked together by a connector. The mesh is well tolerated. At a 3-year follow-up, only two patients had a foreign body sensation at the operative site, and three patients had recurrent hernias. The unique design of the D-13 prosthesis with two pieces of mesh provided encouraging long-term outcome for hernia recurrence, chronic pain and the feeling of a foreign body. Copyright © 2015 IJS Publishing Group Limited. All rights reserved.

  6. Inguinal hernia repair with tension-free hernioplasty under local anesthesia

    International Nuclear Information System (INIS)

    Gao, Jia-Sen; Wang, Zhen-Jun; Zhao, Bo; Ma Song Zhang; Pang, Guo-Yi; Na, Dong-Ming; Zhang Yu-Dong

    2009-01-01

    To evaluate the use of local anesthesia in tension-free hernioplasty in a local hospital. The study took place at Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China during the period from January 2007 to May 2008. All 110 patients who had undergone inguinal hernia repair with mesh under local anesthesia were included in the study. To increase the homogeneity of the sample, we excluded umbilical hernia repairs, parastomal hernia repairs, non-elective procedures, procedures not involving mesh, and repairs performed concurrently with another surgical procedure. We performed a retrospective review of all 110 patients' data. The average operating time was 45 minutes (30-70 minutes), and the average hospital stay was 3-4 days. There was no postoperative mortality in this study. No surgical site infection occurred. Two patients (18%) that suffered from a moderate scrotal hematoma had recovered after extract injection therapy was applied. The duration of incisional pain was 2-3 days, and no patient required post-operative analgesia. During the follow-up, no recurrence occurred. The use of local anesthesia in inguinal hernia repair with tension-free hernioplasty is a safe and effective alternative for inpatient treatment. (aothor)

  7. Amyand's hernia-a vermiform appendix presenting in an inguinal hernia: a case series

    Directory of Open Access Journals (Sweden)

    Pavlidis Theodoros

    2011-09-01

    Full Text Available Abstract Introduction A vermiform appendix in an inguinal hernia, inflamed or not, is known as Amyand's hernia. Here we present a case series of four men with Amyand's hernia. Case presentations We retrospectively studied 963 Caucasian patients with inguinal hernia who were admitted to our surgical department over a 12-year period. Four patients presented with Amyand's hernia (0.4%. A 32-year-old Caucasian man had an inflamed vermiform appendix in his hernial sac (acute appendicitis, presenting as an incarcerated right groin hernia, and underwent simultaneous appendectomy and Bassini suture hernia repair. Two patients, Caucasian men aged 36 and 43 years old, had normal appendices in their sacs, which clinically appeared as non-incarcerated right groin hernias. Both underwent a plug-mesh hernia repair without appendectomy. The fourth patient, a 25-year-old Caucasian man with a large but not inflamed appendix in his sac, had a plug-mesh hernia repair with appendectomy. Conclusion A hernia surgeon may encounter unexpected intraoperative findings, such as Amyand's hernia. It is important to be prepared and apply the appropriate treatment.

  8. Reconstrucción de la subunidad estética de la ceja con un colgajo temporal en isla de cuero cabelludo Aesthetic reconstruction of the eyebrow unit using a temporal island scalp flap

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    J. Gaona Silva

    2010-09-01

    Full Text Available La reconstrucción de las cejas juega un papel importante en la Cirugía Reconstructiva facial, debido a que la ausencia o deformidad de las mismas altera la expresión y las características de la cara, ejerciendo una influencia poderosa en la apariencia de la región periorbitaria, así como en el aspecto y en la autoestima de los pacientes. Describimos una técnica quirúrgica basada en el empleo de un colgajo temporal en isla de cuero cabelludo para la reconstrucción de la subunidad estética de la ceja y presentamos 3 casos de pacientes con defectos alopécicos de las cejas reconstruidos mediante dicha técnica.Eyebrow reconstruction plays an important role in facial Reconstructive Surgery. Absence or deformity of the eyebrows alter the expression and other features in the face exerting a powerful influence in the appearance of the periorbital region, so in the aspect as well as in the self-esteem of the patients. This paper describes the use of a temporal island scalp flap technique to reconstruct the eyebrow unit and we present 3 patients who underwent eyebrows reconstruction with this technique.

  9. Sparing Saphenous Vein During Inguinal Lymphadenectomy in Patients with Vulvar Cancer: A Single Center Experience of 10 Years

    Directory of Open Access Journals (Sweden)

    Mustafa Özat

    2011-12-01

    CONCLUSIONS: The preservation of saphenous vein during inguinal lymphadenectomy reduces the incidence of short-term and long-term complications without affecting the risk of local recurrence. Depending on the experience of the surgeon, the surgical strategy should be individualized and optimized for each patient with vulvar cancer.

  10. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

    DEFF Research Database (Denmark)

    Miserez, M; Peeters, E; Aufenacker, T

    2014-01-01

    in bold). CONCLUSIONS: Despite the fact that the Working Group responsible for it tried to represent most kinds of surgeons treating inguinal hernias, such general guidelines inevitably must be fitted to the daily practice of every individual surgeon treating his/her patients. There is no doubt...

  11. Preparation of a nano- and micro-fibrous decellularized scaffold seeded with autologous mesenchymal stem cells for inguinal hernia repair

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2017-02-01

    Full Text Available Yinlong Zhang,1,* Yuanyuan Zhou,1,* Xu Zhou,2,* Bin Zhao,1,* Jie Chai,1 Hongyi Liu,1 Yifei Zheng,1 Jinling Wang,3 Yaozong Wang,4 Yilin Zhao2 1Medical College, Xiamen University, 2Department of Oncology and Vascular Intervention Radiology, 3Department of Emergency, 4Department of Orthopaedics, Zhongshan Hospital, Xiamen University, Xiamen, People’s Republic of China *These authors contributed equally to this work Abstract: Prosthetic meshes used for hernioplasty are usually complicated with chronic pain due to avascular fibrotic scar or mesh shrinkage. In this study, we developed a tissue-engineered mesh (TEM by seeding autologous bone marrow-derived mesenchymal stem cells onto nanosized fibers decellularized aorta (DA. DA was achieved by decellularizing the aorta sample sequentially with physical, mechanical, biological enzymatic digestion, and chemical detergent processes. The tertiary structure of DA was constituted with micro-, submicro-, and nanosized fibers, and the original strength of fresh aorta was retained. Inguinal hernia rabbit models were treated with TEMs or acellular meshes (AMs. After implantation, TEM-treated rabbit models showed no hernia recurrence, whereas AM-treated animals displayed bulges in inguinal area. At harvest, TEMs were thicker, have less adhesion, and have stronger mechanical strength compared to AMs (P<0.05. Moreover, TEM showed better cell infiltration, tissue regeneration, and neovascularization (P<0.05. Therefore, these cell-seeded DAs with nanosized fibers have potential for use in inguinal hernioplasty. Keywords: nanobiomaterial, tissue engineering, inguinal hernia, hernioplasty, decellularized aorta 

  12. Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases.

    Science.gov (United States)

    Lambertz, A; Schälte, G; Winter, J; Röth, A; Busch, D; Ulmer, T F; Steinau, G; Neumann, U P; Klink, C D

    2014-10-01

    Inguinal hernia repair is the most frequently performed surgical procedure in infants and children. Especially in premature infants, prevalence reaches up to 30% in coincidence with high rates of incarceration during the first year of life. These infants carry an increased risk of complications due to general anesthesia. Thus, spinal anesthesia is a topic of growing interest for this group of patients. We hypothesized that spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants even at high risk and cases of incarceration. Between 2003 and 2013, we operated 100 infants younger than 6 months with inguinal hernia. Clinical data were collected prospectively and retrospectively analyzed. Patients were divided into two groups depending on anesthesia procedure (spinal anesthesia, Group 1 vs. general anesthesia, Group 2). Spinal anesthesia was performed in 69 infants, and 31 infants were operated in general anesthesia, respectively. In 7 of these 31 infants, general anesthesia was chosen because of lumbar puncture failure. Infants operated in spinal anesthesia were significantly smaller (54 ± 4 vs. 57 ± 4 cm; p = 0.001), had a lower body weight (4,047 ± 1,002 vs. 5,327 ± 1,376 g; p emergent incarcerated hernia repairs were performed in spinal anesthesia (p = 0.429). Spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants, especially in high-risk premature infants and in cases of hernia incarceration.

  13. Inguinal Hernia

    Science.gov (United States)

    ... Healthy Living Healthy Living Healthy Living Nutrition Fitness Sports Oral Health Emotional Wellness Growing Healthy Sleep Safety & Prevention Safety & Prevention Safety and Prevention Immunizations ...

  14. Inguinal Hernia

    Science.gov (United States)

    ... Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Acid Reflux (GER & GERD) in Children & Teens Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Acid Reflux (GER & GERD) in Infants Definition & ...

  15. Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia: the first 1,000 patients.

    Science.gov (United States)

    Lange, J F M; Lange, M M; Voropai, D A; van Tilburg, M W A; Pierie, J P E N; Ploeg, R J; Akkersdijk, W L

    2014-08-01

    After the introduction of mesh in inguinal hernia repair, the focus to improve surgical technique has changed from recurrence to chronic postoperative inguinal pain. At present, the most common surgical techniques are the Lichtenstein hernioplasty and total extraperitoneal procedure. Both techniques have their own specific disadvantages, with regard to potential nerve damage and the necessity of general anesthesia, respectively. The goal of this study was to evaluate the results of a new technique in which the inguinal nerves are not at risk, and in which general anesthesia is not needed: trans rectus sheath extraperitoneal procedure (TREPP). Between 2006 and 2010, a total of 1,000 patients were treated for inguinal hernia with TREPP. A questionnaire concerning pain, sensibility changes, patient satisfaction, and recurrence was sent to all patients. The questionnaire was completed by 932 patients. Almost 90% of patients had not experienced any pain since the surgical procedure; 8% of patients reported experiencing some pain, but less than preoperatively; and 2% of patients reported an increase in pain postoperatively. Recurrence occurred in 1 and 3% were unsure about this. Reduced sensibility of the scar, scrotum, and upper leg was reported by 12.4, 1.4, and 1.5%, respectively. Overall, 97.4% of patients were satisfied with the results of the surgical procedure. The time period in which TREPP was performed was not associated with any of the outcome measures. TREPP has proven to be a feasible new technique for inguinal hernia repair, with excellent results, justifying a randomized controlled trial in which TREPP should be compared with standard techniques.

  16. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair

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    Venkatraman R

    2016-01-01

    Full Text Available Rajagopalan Venkatraman, Ranganathan Jothi Abhinaya, Ayyanar Sakthivel, Govindarajan Sivarajan Department of Anaesthesia, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India Background and aim: Transversus abdominis plane block (TAP block is a novel procedure to provide postoperative analgesia following inguinal hernia surgery. The utilization of ultrasound has greatly augmented the success rate of this block and additionally avoiding complications. The aim of our study was to gauge the analgesic efficacy of ultrasound-guided TAP block in patients undergoing unilateral inguinal hernia repair. Materials and methods: Sixty patients scheduled for elective inguinal hernia repair were selected for the study. At the end of the surgical procedure, they were randomly divided into two groups. Ultrasound-guided TAP block was performed with 20 mL of ropivacaine 0.2% (group A or normal saline (group B. Visual analog scale (VAS scores were used to assess pain. Paracetamol was given if VAS >3 and tramadol was used when VAS >6. Patients were monitored for VAS scores and total analgesic consumption for the 24-hour period. Results: The TAP block with ropivacaine (group A reduced VAS scores at 4, 6, and 12 hours. There was no distinction in VAS scores at 0, 2, and 24 hours between the two groups. The duration of analgesia for TAP block with ropivacaine lasted for 390 minutes. Total analgesics consumption was also significantly reduced in group A than group B. No complication was reported to TAP block in both the groups. Conclusion: The ultrasound-guided TAP block provides good postoperative analgesia, reduces analgesic requirements, and provides good VAS scores with fewer complications following inguinal hernia surgery. Keywords: inguinal hernia repair, postoperative analgesia, ropivacaine, transversus abdominis block, ultrasound

  17. Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: case report of a rare complication.

    Science.gov (United States)

    Moore, John B; Hasenboehler, Erik A

    2007-11-07

    Ischemic orchitis is an established complication after open inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the laparoscopic approach has not been reported. The patient was a thirty-three year-old man who presented with bilateral direct inguinal hernias, right larger than left. He was a thin, muscular male with a narrow pelvis who underwent bilateral extraperitoneal mesh laparoscopic inguinal hernia repair. The case was complicated by pneumoperitoneum which limited the visibility of the pelvic anatomy; however, the mesh was successfully deployed bilaterally. Cautery was used to resect the direct sac on the right. The patient was discharged the same day and doing well with minimal pain and swelling until the fourth day after surgery. That night he presented with sudden-onset pain and swelling of his right testicle and denied both trauma to the area and any sexual activity. Ultrasound of the testicle revealed no blood flow to the testicle which required exploration and subsequent orchiectomy. Ischemic orchitis typically presents 2-3 days after inguinal hernia surgery and can progress to infarction. This ischemic injury is likely due to thrombosis of the venous plexus, rather than iatrogenic arterial injury or inappropriate closure of the inguinal canal. Ultrasound/duplex scanning of the postoperative acute scrotum can help differentiate ischemic orchitis from infarction. Unfortunately, testicular torsion cannot be ruled out and scrotal exploration may be necessary. Although ischemic orchitis, atrophy, and orhiectomy are uncommon complications, all patients should be warned of these potential complications and operative consent should include these risks irrespective of the type of hernia or the surgical approach.

  18. Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: case report of a rare complication

    Directory of Open Access Journals (Sweden)

    Moore John B

    2007-11-01

    Full Text Available Abstract Background Ischemic orchitis is an established complication after open inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the laparoscopic approach has not been reported. Case presentation The patient was a thirty-three year-old man who presented with bilateral direct inguinal hernias, right larger than left. He was a thin, muscular male with a narrow pelvis who underwent bilateral extraperitoneal mesh laparoscopic inguinal hernia repair. The case was complicated by pneumoperitoneum which limited the visibility of the pelvic anatomy; however, the mesh was successfully deployed bilaterally. Cautery was used to resect the direct sac on the right. The patient was discharged the same day and doing well with minimal pain and swelling until the fourth day after surgery. That night he presented with sudden-onset pain and swelling of his right testicle and denied both trauma to the area and any sexual activity. Ultrasound of the testicle revealed no blood flow to the testicle which required exploration and subsequent orchiectomy. Conclusion Ischemic orchitis typically presents 2–3 days after inguinal hernia surgery and can progress to infarction. This ischemic injury is likely due to thrombosis of the venous plexus, rather than iatrogenic arterial injury or inappropriate closure of the inguinal canal. Ultrasound/duplex scanning of the postoperative acute scrotum can help differentiate ischemic orchitis from infarction. Unfortunately, testicular torsion cannot be ruled out and scrotal exploration may be necessary. Although ischemic orchitis, atrophy, and orhiectomy are uncommon complications, all patients should be warned of these potential complications and operative consent should include these risks irrespective of the type of hernia or the surgical approach.

  19. Does surgeon volume matter in the outcome of endoscopic inguinal hernia repair?

    Science.gov (United States)

    Köckerling, F; Bittner, R; Kraft, B; Hukauf, M; Kuthe, A; Schug-Pass, C

    2017-02-01

    For open and endoscopic inguinal hernia surgery, it has been demonstrated that low-volume surgeons with fewer than 25 and 30 procedures, respectively, per year are associated with significantly more recurrences than high-volume surgeons with 25 and 30 or more procedures, respectively, per year. This paper now explores the relationship between the caseload and the outcome based on the data from the Herniamed Registry. The prospective data of patients in the Herniamed Registry were analyzed using the inclusion criteria minimum age of 16 years, male patient, primary unilateral inguinal hernia, TEP or TAPP techniques and availability of data on 1-year follow-up. In total, 16,290 patients were enrolled between September 1, 2009, and February 1, 2014. Of the participating surgeons, 466 (87.6 %) had carried out fewer than 25 endoscopic/laparoscopic operations (low-volume surgeons) and 66 (12.4 %) surgeons 25 or more operations (high-volume surgeons) per year. Univariable (1.03 vs. 0.73 %; p = 0.047) and multivariable analysis [OR 1.494 (1.065-2.115); p = 0.023] revealed that low-volume surgeons had a significantly higher recurrence rate compared with the high-volume surgeons, although that difference was small. Multivariable analysis also showed that pain on exertion was negatively affected by a lower caseload <25 [OR 1.191 (1.062-1.337); p = 0.003]. While here, too, the difference was small, the fact that in that group there was a greater proportion of patients with small hernia defect sizes may have also played a role since the risk in that group was higher. In this analysis, no evidence was found that pain at rest [OR 1.052 (0.903-1.226); p = 0.516] or chronic pain requiring treatment [OR 1.108 (0.903-1.361); p = 0.326] were influenced by the surgeon volume. As confirmed by previously published studies, the data in the Herniamed Registry also demonstrated that the endoscopic/laparoscopic inguinal hernia surgery caseload impacted the outcome. However

  20. Short-term outcome after Onstep versus Lichtenstein technique for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, K; Burcharth, J; Fonnes, S

    2015-01-01

    was to investigate if there were differences in early postoperative pain during the first 10 days between the Onstep and the Lichtenstein technique. METHODS: This was a double-blinded, randomized clinical trial conducted in five surgical departments in Denmark, from April 2013 to June 2014. Eligible participants...... for this study were male patients, >18 years, with a primary inguinal hernia. Experimental treatment in this study was the Onstep technique, which was compared with the Lichtenstein repair. Primary outcome was postoperative pain during the first 10 days following surgery. Secondary outcomes included duration...... of surgery, period for return to normal daily activities (days), and recurrence. Randomization was done in blocks and stratified on centers. Participants and study personnel handling questionnaires and analysis were blinded to the allocation. RESULTS: In total, 290 participants were randomized. We found...

  1. Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Blocks for Persistent Inguinal Postherniorrhaphy Pain

    DEFF Research Database (Denmark)

    Bischoff, Joakim Mutahi; Koscielniak-Nielsen, Zbigniew J; Kehlet, Henrik

    2012-01-01

    -guided blocks of the ilioinguinal and iliohypogastric nerves with lidocaine.Methods:A randomized, double-blind, placebo-controlled, crossover trial in 12 patients with severe persistent inguinal postherniorrhaphy pain, including a control group of 12 healthy controls, was performed. Assessments included pain...... was used. Outcomes were changes in pain ratings, sensory mapping, and QST compared with preblock values. Lidocaine responders were a priori defined by a pain reduction of =80% after lidocaine block and =25% after placebo block, nonresponders by pain reduction of 25% after placebo block.Results:One of 12...... pain patients was a lidocaine responder, 6 patients were nonresponders, and 5 patients were placebo responders. No consistent QST changes were observed in patients after the lidocaine block. In 10 of 12 healthy controls, a cool hypoesthesia area developed in the groin after the lidocaine block...

  2. ANESTESIA REGIONAL PARA HERNIORRAFIA INGUINAL EM PACIENTE PORTADOR DE CARDIOMIOPATIA HIPERTROFICA ASSIMETRICA: RELATO DE CASO.

    OpenAIRE

    Immich, Liége Caroline; Specht, Fabiana; Magro, Priscila Sartoretto Dal; Miranda Jr, Vasco

    2017-01-01

    Resumen Introdução: A cardiomiopatia hipertrófica assimétrica é uma doençade hipertrofia de ventrículo esquerdo e do septo interventricular. Há aumento da obstrução de saída do ventrículo esquerdo, da força contrátil; diminuição do volume diastólico final do ventrículo esquerdo e da resistência vascular periférica aumentando o consumo de oxigênio com risco de isquemia subendocárdica e arritmias. Relato de paciente portador de cardiomiopatia assimétrica submetido à herniorrafia inguinal aber...

  3. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery

    DEFF Research Database (Denmark)

    Joshi, G P; Rawal, N; Kehlet, H

    2012-01-01

    BACKGROUND: Open inguinal hernia repair is associated with moderate postoperative pain, but optimal analgesia remains controversial. The aim of this systematic review was to evaluate the available literature on the management of pain after open hernia surgery. METHODS: Randomized studies......, in English, published between January 1966 and March 2009, assessing analgesic and anaesthetic interventions in adult open hernia surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases. In addition to published evidence, clinical practice was taken into account to ensure...... and increased time to home-readiness compared with regional anaesthesia. CONCLUSION: Field block with, or without wound infiltration, either as a sole anaesthetic/analgesic technique or as an adjunct to general anaesthesia, is recommended to reduce postoperative pain. Continuous local anaesthetic infusion...

  4. A child of Williams-Beuren syndrome for inguinal hernia repair: Perioperative management concerns

    Directory of Open Access Journals (Sweden)

    Sangeeta Deka

    2016-01-01

    Full Text Available Williams-Beuren syndrome, commonly known as Williams syndrome (WS, is a multi-organ disorder. The principal anomalies of the syndrome are developmental delay, unusual craniofacial dysmorphic features, and cardiovascular anomalies such as valvular or supravalvular aortic stenosis, pulmonary artery stenosis, and coronary insufficiency. Sudden cardiac death during minor procedures even in the absence of gross cardiovascular pathology is the most dreaded complication in these patients. A 7-year-old child with WS was posted for left-sided inguinal hernia repair under general anesthesia. Our article describes the uneventful perioperative course of the patient and highlights the concerns and complications that may be an integral part with the syndrome.

  5. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy.

    Science.gov (United States)

    Jones, Lisa J; Craven, Paul D; Lakkundi, Anil; Foster, Jann P; Badawi, Nadia

    2015-06-09

    With improvements in neonatal intensive care, more preterm infants are surviving the neonatal period and presenting for surgery in early infancy. Inguinal hernia is the most common condition requiring early surgery, appearing in 38% of infants whose birth weight is between 751 grams and 1000 grams. Approximately 20% to 30% of otherwise healthy preterm infants having general anaesthesia for inguinal hernia surgery at a postmature age have at least one apnoeic episode within the postoperative period. Research studies have failed to adequately distinguish the effects of apnoeic episodes from other complications of extreme preterm gestation on the risk of brain injury, or to investigate the potential impact of postoperative apnoea upon longer term neurodevelopment. In addition to episodes of apnoea, there are concerns that anaesthetic and sedative agents may have a direct toxic effect on the developing brain of preterm infants even after reaching postmature age. It is proposed that regional anaesthesia may reduce the risk of postoperative apnoea, avoid the risk of anaesthetic-related neurotoxicity and improve neurodevelopmental outcomes in preterm infants requiring surgery for inguinal hernia at a postmature age. To determine if regional anaesthesia reduces postoperative apnoea, bradycardia, the use of assisted ventilation, and neurological impairment, in comparison to general anaesthesia, in preterm infants undergoing inguinal herniorrhaphy at a postmature age. The following databases and resources were searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2015, Issue 2), MEDLINE (December 2002 to 25 February 2015), EMBASE (December 2002 to 25 February 2015), controlled-trials.com and clinicaltrials.gov, reference lists of published trials and abstracts published in Pediatric Research and Pediatric Anesthesia. Randomised and quasi-randomised controlled trials of regional (spinal, epidural, caudal) versus general anaesthesia, or

  6. Transversus Abdominis Plane Versus Ilioinguinal and Iliohypogastric Nerve Blocks for Analgesia Following Open Inguinal Herniorrhaphy

    Directory of Open Access Journals (Sweden)

    Anatoli Stav

    2016-07-01

    Full Text Available Objectives We hypothesized that preoperative (pre-op ultrasound (US-guided posterior transversus abdominis plane block (TAP and US-guided ilioinguinal and iliohypogastric nerve block (ILI+IHG will produce a comparable analgesia after Lichtenstein patch tension-free method of open inguinal hernia repair in adult men. The genital branch of the genitofemoral nerve will be blocked separately. Methods This is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 166 adult men were randomly assigned to one of three groups: a pre-op TAP group, a pre-op ILI+IHG group, and a control group. An intraoperative block of the genital branch of the genitofemoral nerve was performed in all patients in all three groups, followed by postoperative patient-controlled intravenous analgesia with morphine. The pain intensity and morphine consumption immediately after surgery and during the 24 hours after surgery were compared between the groups. Results A total of 149 patients completed the study protocol. The intensity of pain immediately after surgery and morphine consumption were similar in the two “block” groups; however, they were significantly decreased compared with the control group. During the 24 hours after surgery, morphine consumption in the ILI+IHG group decreased compared with the TAP group, as well as in each “block” group versus the control group. Twenty-four hours after surgery, all evaluated parameters were similar. Conclusion Ultrasound-guided ILI+IHG provided better pain control than US-guided posterior TAP following the Lichtenstein patch tension-free method of open inguinal hernia repair in men during 24 hours after surgery. (ClinicalTrials.gov number: NCT01429480.

  7. Is intra-operative gamma probe detection really necessary for inguinal sentinel lymph node biopsy?

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira Filho, Renato Santos de; Santos, Ivan Dunshe Abranches Oliveira; Ferreira, Lydia Massako; Almeida, Fernando Augusto de; Simoes, Milvia Maria; Enokihara, Silvia; Barbieri, Antonio; Tovo Filho, Reinaldo [Universidade Federal de Sao Paulo (UNIFESP - EPM), SP (Brazil). Disciplina de Cirurgia Plastica

    2000-11-01

    Sentinel node (SN) biopsy has changed the surgical treatment of malignant melanoma. The literature has emphasized the importance of gamma probe detection (GPD) of the SN. Our objective was to evaluate the efficacy of patent blue dye (PBD) and GPD for SN biopsy in different lymphatic basins. Patients with cutaneous malignant melanoma in stages I and II were submitted to biopsy of the SN, identified by PBD and GPD, as part of a research project. Patients were seen at Hospital Sao Paulo by a multidisciplinary group (Plastic Surgery Tumor Branch, Nuclear Medicine and Pathology). 64 patients with localized malignant melanoma were studied. The median age was 46.5 years. The primary tumor was located in the neck, trunk or extremities. Preoperative lymphoscintigraphy, lymphatic mapping with PBD and intraoperative GPD were performed on all patients. The SN was examined by conventional and immuno-histological staining. If the SN was not found or contained micrometastases, only complete lymphadenectomy was performed. The SN was identified by PBD if it was blue-stained, and by GPD if demonstrated activity five times greater than the adipose tissue of the neighborhood. Seventy lymphatic basins were explored. Lymphoscintigraphy showed ambiguous drainage em 7 patients. GPD identified the SN in 68 basins (97%) and PBD in 53 (76%). PBD and GPD identified SN in 100% of the inguinal basins. For the remaining basins both techniques were complementary. A metastatic SN was found in 10 basins. Three patients with negative SN had recurrence (median follow-up=11 months). Although both GPD and PBD are useful and complementary, PBD alone identified the SN in 100% of the inguinal lymphatic basins. (author)

  8. Is intra-operative gamma probe detection really necessary for inguinal sentinel lymph node biopsy?

    International Nuclear Information System (INIS)

    Oliveira Filho, Renato Santos de; Santos, Ivan Dunshe Abranches Oliveira; Ferreira, Lydia Massako; Almeida, Fernando Augusto de; Simoes, Milvia Maria; Enokihara, Silvia; Barbieri, Antonio; Tovo Filho, Reinaldo

    2000-01-01

    Sentinel node (SN) biopsy has changed the surgical treatment of malignant melanoma. The literature has emphasized the importance of gamma probe detection (GPD) of the SN. Our objective was to evaluate the efficacy of patent blue dye (PBD) and GPD for SN biopsy in different lymphatic basins. Patients with cutaneous malignant melanoma in stages I and II were submitted to biopsy of the SN, identified by PBD and GPD, as part of a research project. Patients were seen at Hospital Sao Paulo by a multidisciplinary group (Plastic Surgery Tumor Branch, Nuclear Medicine and Pathology). 64 patients with localized malignant melanoma were studied. The median age was 46.5 years. The primary tumor was located in the neck, trunk or extremities. Preoperative lymphoscintigraphy, lymphatic mapping with PBD and intraoperative GPD were performed on all patients. The SN was examined by conventional and immuno-histological staining. If the SN was not found or contained micrometastases, only complete lymphadenectomy was performed. The SN was identified by PBD if it was blue-stained, and by GPD if demonstrated activity five times greater than the adipose tissue of the neighborhood. Seventy lymphatic basins were explored. Lymphoscintigraphy showed ambiguous drainage em 7 patients. GPD identified the SN in 68 basins (97%) and PBD in 53 (76%). PBD and GPD identified SN in 100% of the inguinal basins. For the remaining basins both techniques were complementary. A metastatic SN was found in 10 basins. Three patients with negative SN had recurrence (median follow-up=11 months). Although both GPD and PBD are useful and complementary, PBD alone identified the SN in 100% of the inguinal lymphatic basins. (author)

  9. Costs and cost-effectiveness of pediatric inguinal hernia repair in Uganda.

    Science.gov (United States)

    Eeson, Gareth; Birabwa-Male, Doreen; Pennington, Mark; Blair, Geoffrey K

    2015-02-01

    Surgically treatable diseases contribute approximately 11% of disability-adjusted life years (DALYs) worldwide yet they remain a neglected public health priority in low- and middle-income countries (LMICs). Pediatric inguinal hernia is the most common congenital abnormality in newborns and a major cause of morbidity and mortality yet elective repair remains largely unavailable in LMICs. This study is aimed to determine the costs and cost-effectiveness of pediatric inguinal hernia repair (PIHR) in a low-resource setting. Medical costs of consecutive elective PIHRs were recorded prospectively at two centers in Uganda. Decision modeling was used to compare two different treatment scenarios (adoption of PIHR and non-adoption) from a provider perspective. A Markov model was constructed to estimate health outcomes under each scenario. The robustness of the cost-effectiveness results in the base case analysis was tested in one-way and probabilistic sensitivity analysis. The primary outcome of interest was cost per DALY averted by the intervention. Sixty-nine PIHRs were performed in 65 children (mean age 3.6 years). Mean cost per procedure was $86.68 US (95% CI 83.1-90.2 USD) and averted an average of 5.7 DALYs each. Incremental cost-effectiveness ratio was $12.41 per DALY averted. The probability of cost-effectiveness was 95% at a cost-effectiveness threshold of $35 per averted DALY. Results were robust to sensitivity analysis under all considered scenarios. Elective PIHR is highly cost-effective for the treatment and prevention of complications of hernia disease even in low-resource settings. PIHR should be prioritized in LMICs alongside other cost-effective interventions.

  10. The efficacy of laparoscopic examination of the internal inguinal ring in children.

    Science.gov (United States)

    Grossmann, P A; Wolf, S A; Hopkins, J W; Paradise, N F

    1995-02-01

    The ability of physicians to identify a patent processus vaginalis by laparoscopic examination of the internal ring is now well established, but the efficacy on patient outcome is not. The authors reviewed their experience to determine the effect of diagnostic laparoscopy of the internal ring on the management of children with inguinal hernias. The records of 150 children who underwent inguinal surgery were reviewed--75 before (group 1) and 75 after (group 2) pediatric laparoscopy was introduced into the authors' practice. The children in group 1 were selected for unilateral or bilateral surgery based on history, age, sex, side of presentation, and parental preference. For group 2, laparoscopy was an additional option offered to appropriate patients. Laparoscopy was performed in 43 group 2 patients, using an infraumbilical site. The minimum follow-up period was 2 years for group 1 and 1 year for group 2. The mean ages for groups 1 and 2 were 41.2 and 39.7 months, respectively. There were 61 boys and 14 girls in each group. The percentages of right (R), left (L), and bilateral (B) findings, based on clinical observation, were 56.0 (R), 29.3 (L), and 14.7 (B) for group 1, and 58.7 (R), 26.6 (L), and 14.7 (B) for group 2. The incidence of bilateral surgical exploration was similar for the two groups (group 1, 58.6%; group 2, 61.3%). The addition of laparoscopy significantly lowered the incidence of negative explorations (group 1, 16.0%; group 2, 2.6%; P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Influencia del deporte de impacto en la disfunción del suelo pélvico en la mujer activa

    OpenAIRE

    Santesteban López, Leyre

    2014-01-01

    Antecedentes: la pubalgia o dolor púbico (inguinal) ocurre principalmente en futbolistas y atletas corredores. Los mecanismos responsables son gestos repetitivos, cambios repentinos de ritmo, velocidad y dirección, giros bruscos. Las estructuras involucradas son el aductor largo, recto del abdomen, iliopsoas y sínfisis del pubis. Objetivos: Revisar la evidencia científica en relación a las pruebas clínicas exploratorias y programas de tratamiento conservador y preventivo más adecuados para...

  12. Immunohistochemical evaluation of fibrillar components of the extracellular matrix of transversalis fascia and anterior abdominal rectus sheath in men with inguinal hernia

    Directory of Open Access Journals (Sweden)

    Rogério De Oliveira Gonçalves

    Full Text Available OBJECTIVE: to evaluate the role of fibrillar extracellular matrix components in the pathogenesis of inguinal hernias. METHODS: samples of the transverse fascia and of the anterior sheath of the rectus abdominis muscle were collected from 40 men aged between 20 and 60 years with type II and IIIA Nyhus inguinal hernia and from 10 fresh male cadavers (controls without hernia in the same age range. The staining technique was immunohistochemistry for collagen I, collagen III and elastic fibers; quantification of fibrillar components was performed with an image analysis processing software. RESULTS: no statistically significant differences were found in the amount of elastic fibers, collagen I and collagen III, and the ratio of collagen I / III among patients with inguinal hernia when compared with subjects without hernia. CONCLUSION: the amount of fibrillar extracellular matrix components did not change in patients with and without inguinal hernia.

  13. MYOMA OF THE ROUND LIGAMENT MIMICKING THE CLINICAL APPEARANCE OF THE INGUINAL HERNIA – A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Aleš Pišek

    2004-12-01

    Full Text Available Background. Myomas are the most frequent gynecological tumors. They first occur during puberty; however, they are most frequent among aged between 35 and 50. In this age group their incidence is 15–20%. They are rare after menopause. The majority of myomas arise in the uterus, but they may arise from other extrauterine sites such as the fallopian tubes, ovaries, round ligament, ligamentum latum, sacrouterine ligament, vagina and even the urethra. Most authors agree that there are numerous causes for the occurrence of myomas; however, they have not yet been clearly proven. They however agree that the myomas appear most frequently in the reproductive age, when the ovarian hormone levels are high and they diminish after menopause. They equally agree that the risk factors for the clinically significant myomas are nulliparity, obesity, a positive family history of myomas and African racial origin.Patients and methods. A 43-year-old patient was referred to our institution for operative treatment by her personal gynaecologist who clinically and sonografically verified a solid tumor situated to the right side of the uterus. The size of the tumor was that of a newborn’s head. The patient, however, had been observing a reponible inguinal hernia the size of a female fist for a period of four years. A solid tumor (22×6×7 cm arising from the right round ligament, was remowed during surgery. Half of its size was situated in the inguinal canal thus mimicking the clinical appearance of the inguinal hernia. After the tumor was removed the inner door of the inguinal canal closed by itself, no surgical repair was necessary. On histological examination the tumor was classified as a leiomyoma.Conclusions. Although the leiomyoma of the round ligament is the most frequent tumor of that region it is a rare gynecological tumor. The described case is especially interesting due to the unusual position of the tumor. It was situated partly intraabdominally and partly

  14. Inguinal hernia vs. arthritis of the hip in sporting adolescents--case report and review of the literature.

    Science.gov (United States)

    Holzheimer, R G; Gresser, U

    2007-07-26

    Chronic pain in the hip, groin or thigh can be caused by a wide spectrum of diseases posing extended diagnostic problems. We describe the case of a 10-years old child with chronic pain in the groin with gait restriction for more than six months without successful classification and treatment. The girl suffered from heavy pain in the groin after a sporting contest which forced her to walk with walking sticks and to avoid climbing stairs. Within six months she was examined by pediatric, orthopedic, pediatric surgery, pediatric orthopedic, radiology, pediatric rheumatology specialists. Working diagnoses were transient synovitis (coxitis fugax), arthritis, streptococcal arthritis, Morbus Perthes, rheumatic fever, rheumatoid arthritis. She was treated with antibiotics and ibuprofen in high dosage. Repeated laboratory tests and imaging studies (ultrasound, x-rays, magnetic resonance imaging) of the hip and pelvis did not support any of these diagnoses. Six months after beginning of the complaints the girl was presented by her mother to our institution. The physical examination showed a sharp localized pain in the groin, just in the region of the inguinal ligament with otherwise free hip movement. There was no visible inguinal hernia. The family history for hernia was positive. After infiltration of the ilioinguinal nerve the girl had a complete long-lasting disappearance of pain and gait disturbance. This led to the diagnosis of inguinal hernia with nerve entrapment. After hernia repair and neurolysis/neurectomy there was a continuous state of disappearance of pain and gait disturbances. To avoid such a diagnostic dilemma one should always discuss all possible causes. Non-visible inguinal hernia may be more common in females than previously thought. Nerve entrapment as a cause of groin pain has been well described. The relationship of the start of complaints with sporting activity, a positive family history for inguinal hernia, a lack of signs of inflammation and bone

  15. Ultrasound-guided transversus abdominis plane block in combination with ilioinguinal-iliohypogastric block in a high risk cardiac patient for inguinal hernia repair: a case report

    OpenAIRE

    BARISIN, STJEPAN; DUZEL, VIKTOR; SAKIC, LIVIJA

    2015-01-01

    Background and Purpose: A high risk cardiac patient, ASA IV, was planned for inguinal hernia repair. Since general anaesthesia presented a high risk, anaesthesia was conducted with a transversus abdominis plane (TAP) in combination with ilioinguinal-iliohypogastric (ILIH) block. Material and Methods: A 70-year old male patient with severe CAD and previous LAD PTCA, AVR, in situ PPM and severe MR and TR 3+, was planned for elective inguinal hernia repair. The preoperative ECH...

  16. Different types of mesh fixation for laparoscopic repair of inguinal hernia: A protocol for systematic review and network meta-analysis with randomized controlled trials.

    Science.gov (United States)

    Wei, Kongyuan; Lu, Cuncun; Ge, Long; Pan, Bei; Yang, Huan; Tian, Jinhui; Cao, Nong

    2018-04-01

    Laparoscopic inguinal hernia repair has become a valid option for repair of an inguinal hernia. Due to there are several types of mesh fixation for laparoscopic repair of inguinal hernia. The study aims to assess and compare the efficacy of different types of mesh fixation for laparoscopic repair of inguinal hernia using network meta-analysis. We will systematically search PubMed, EMBASE the Cochrane library, and Chinese Biomedical Literature Database from their inception to March 2018. Randomized controlled trials (RCTs) that compared the effect of different types of mesh fixation for laparoscopic inguinal hernia repair will be included. The primary outcomes are chronic groin pain, incidence risk of hernia recurrence, and complications. Risk of bias assessment of the included RCTs will be conducted using to Cochrane risk of bias tool. A network meta-analysis will be performed using WinBUGS 1.4.3 software and the result figures will be generated using R x64 3.1.2 software and STATA V.12.0 software. Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess the quality of evidence. The results of this study will be published in a peer-reviewed journal. Our study will generate evidence of laparoscopic repair of mesh fixation for adult patients with inguinal hernia and provide suggestions for clinical practice or guideline.

  17. Uso del regenerador dérmico Integra® como material de relleno para el tratamiento de defectos del contorno corporal Use of Integra® dermal regeneration template in deep tissue planes for contour defects treatment

    Directory of Open Access Journals (Sweden)

    P. A. Gómez Morell

    2007-09-01

    Full Text Available En el tratamiento de los defectos de contorno corporal se usan múltiples productos biológicos y/o sintéticos. Cuando el volumen no es grande, los autores plantean el uso del regenerador dérmico Integra® eliminando previamente su capa superficial de silicona frente a los inconvenientes que presenta el uso de otros materiales de relleno en Cirugía Plástica (reabsorción variable, intolerancia, infección, granulomas, calcificación, etc. Dicho producto acaba transformándose en neodermis del propio paciente, bien tolerada. Presentamos dos casos con defectos a nivel frontal (postraumático y en tórax anterior (secuelas de reconstrucción tras mastectomía respectivamente, en los que se colocó Integra® en bolsillos profundos y doblado sobre sí mismo para aumentar su volumen. Los resultados son previsibles, con mínima reabsorción y además son duraderos, con seguimiento a los 6 y 12 meses. Los autores recomiendan el uso del regenerador dérmico en volúmenes moderados y/o pequeños, considerando que en grandes volúmenes es preferible el uso del colgajos autólogos y/o colgajos más prótesis.In the treatment of body contour defects we can use many biological and synthetic products. They have many inconvenient effects as variable reabsortion, intolerance, infection, granulomas, calcification, etc. In moderate defects, the authors propose the use of modificated Integra® dermal regeneration template without the superficial silicone layer. Two patients are reported, one with a traumatic frontal defect and another with a depression in the anterior thorax after postmastectomy breast reconstruction post mastectomy. In both we put Integra® into a subcutaneous pocket and we bent it to increase lamina volume. Results are predictable, permanent, with minimal reabsortion after 6 and 12 months follow up. Integra® will be autologous neodermis. The authors recommend the dermal regeneration template for small or medium defects; in large defects they

  18. Appendicitis in De Garengeot's Hernia Presenting as a Nontender Inguinal Mass: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    K. Ahmed

    2014-01-01

    Full Text Available Introduction. De Garengeot first described a femoral hernia containing the appendix in 1731. Appendicitis occurring in this rare clinical setting represents a challenge in diagnosis and management. Case Presentation. We present the case of a 71-year-old male with a three-day history of a nontender inguinal mass. Computed tomography (CT suggested a femoral hernia. Intraoperatively, the hernia sac was noted to contain a perforated appendix. Discussion. This is an infrequently reported clinical scenario and only the 14th reported case in peer-reviewed literature which includes preoperative CT images. Our case adds to previously reported low sensitivity of CT for diagnosing De Garengeot’s hernia. Furthermore, unlike our case the vast majority of previous reports noted a painful inguinal swelling. Conclusion. Perforated appendicitis in a femoral hernia is an extremely uncommon presentation. However, consideration should be given to De Garengeot’s hernia in patients with a groin mass, even if nontender.

  19. As in Real Estate, Location Is What Matters: A Case Report of Transplant Ureteral Obstruction Due to an Inguinal Hernia.

    Science.gov (United States)

    Bugeja, Ann; Clark, Edward G; Sood, Manish M; Ali, Sohrab N

    2018-01-01

    Kidney allograft dysfunction is common and often reversible but can lead to allograft loss if not promptly evaluated. Transplant ureteral obstruction in an inguinal hernia is a rare cause of allograft dysfunction, but early recognition may prevent allograft loss. We present a case of a man with acute kidney allograft dysfunction who received a deceased donor kidney transplant 6 years earlier for end-stage kidney disease secondary to polycystic kidney disease. Abdominal ultrasounds revealed hydronephrosis without full visualization of the transplant ureter. Abdominal computed tomography revealed moderate hydronephrosis of the transplant kidney due to obstructed herniation of the transplant ureter in a right inguinal hernia. A stent was inserted into the transplant ureter to prevent further allograft dysfunction and facilitate hernia repair. Transplant ureteral obstruction is a rare cause of acute kidney allograft dysfunction, and its detection can be challenging. The recognition of transplant ureteral obstruction is vital to timely management for preventing allograft loss.

  20. Elective Inguinal Node Irradiation in Early-Stage T2N0 Anal Cancer: Prognostic Impact on Locoregional Control

    Energy Technology Data Exchange (ETDEWEB)

    Zilli, Thomas, E-mail: Thomas.Zilli@hcuge.ch [Department of Radiation Oncology, Geneva University Hospital, Geneva (Switzerland); Betz, Michael [Department of Radiation Oncology, Geneva University Hospital, Geneva (Switzerland); Radiation Oncology Institute, Hirslanden Lausanne, Lausanne (Switzerland); Bieri, Sabine [Department of Radiation Oncology, Geneva University Hospital, Geneva (Switzerland); Ris, Frederic; Roche, Bruno [Department of Surgery, Geneva University Hospital, Geneva (Switzerland); Roth, Arnaud D. [Oncosurgery Unit, Geneva University Hospital, Geneva (Switzerland); Allal, Abdelkarim S. [Department of Radiation Oncology, Geneva University Hospital, Geneva (Switzerland); Department of Radiation Oncology,Hôpital Fribourgeois, Fribourg (Switzerland)

    2013-09-01

    Purpose: To evaluate the influence of elective inguinal node radiation therapy (INRT) on locoregional control (LRC) in patients with early-stage T2N0 anal cancer treated conservatively with primary RT. Methods and Materials: Between 1976 and 2008, 116 patients with T2 node-negative anal cancer were treated curatively with RT alone (n=48) or by combined chemoradiation therapy (CRT) (n=68) incorporating mitomycin C and 5-fluorouracil. Sixty-four percent of the patients (n=74) received elective INRT. Results: Over a median follow-up of 69 months (range, 4-243 months), 97 (84%) and 95 patients (82%) were locally and locoregionally controlled, respectively. Rates for 5-year actuarial local control, LRC, cancer-specific, and overall survival for the entire population were 81.7% ± 3.8%, 79.2% ± 4.1%, 91.1% ± 3.0%, and 72.1% ± 4.5%, respectively. The overall 5-year inguinal relapse-free survival was 92.3% ± 2.9%. Isolated inguinal recurrence occurred in 2 patients (4.7%) treated without INRT, whereas no groin relapse was observed in those treated with INRT. The 5-year LRC rates for patients treated with and without INRT and with RT alone versus combined CRT were 80.1% ± 5.0% versus 77.8% ± 7.0% (P=.967) and 71.0% ± 7.2% versus 85.4% ± 4.5% (P=.147), respectively. A trend toward a higher rate of grade ≥3 acute toxicity was observed in patients treated with INRT (53% vs 31%, P=.076). Conclusions: In cases of node-negative T2 anal cancer, the inguinal relapse rate remains relatively low with or without INRT. The role of INRT in the treatment of early-stage anal carcinoma needs to be investigated in future prospective trials.

  1. Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years.

    Science.gov (United States)

    Dulucq, Jean-Louis; Wintringer, Pascal; Mahajna, Ahmad

    2009-03-01

    Two revolutions in inguinal hernia repair surgery have occurred during the last two decades. The first was the introduction of tension-free hernia repair by Liechtenstein in 1989 and the second was the application of laparoscopic surgery to the treatment of inguinal hernia in the early 1990s. The purposes of this study were to assess the safety and effectiveness of laparoscopic totally extraperitoneal (TEP) repair and to discuss the technical changes that we faced on the basis of our accumulative experience. Patients who underwent an elective inguinal hernia repair at the Department of Abdominal Surgery at the Institute of Laparoscopic Surgery (ILS), Bordeaux, between June 1990 and May 2005 were enrolled retrospectively in this study. Patient demographic data, operative and postoperative course, and outpatient follow-up were studied. A total of 3,100 hernia repairs were included in the study. The majority of the hernias were repaired by TEP technique; the repair was done by transabdominal preperitoneal (TAPP) repair in only 3%. Eleven percent of the hernias were recurrences after conventional repair. Mean operative time was 17 min in unilateral hernia and 24 min in bilateral hernia. There were 36 hernias (1.2%) that required conversion: 12 hernias were converted to open anterior Liechtenstein and 24 to laparoscopic TAPP technique. The incidence of intraoperative complications was low. Most of the patients were discharged at the second day of the surgery. The overall postoperative morbidity rate was 2.2%. The incidence of recurrence rate was 0.35%. The recurrence rate for the first 200 repairs was 2.5%, but it decreased to 0.47% for the subsequent 1,254 hernia repairs According to our experience, in the hands of experienced laparoscopic surgeons, laparoscopic hernia repair seems to be the favored approach for most types of inguinal hernias. TEP is preferred over TAPP as the peritoneum is not violated and there are fewer intra-abdominal complications.

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

    OpenAIRE

    Alshkaki, Giath

    2013-01-01

    This retrospective chart review evaluated outcomes following laparoscopic inguinal herniorrhaphies with non–cross-linked intact porcine-derived acellular dermal matrix (PADM) by one surgeon in a community teaching facility hospital. Mesh was sutured and/or tacked in the preperitoneal space. Postoperative visits were scheduled at 2 weeks, 3 months, and 6 months, and then at 6-month intervals up to 2 years. PADM was placed in 14 male patients (mean age, 41.1 years). Seven patients had bilateral...

  3. LAPAROSCOPIC TEP VERSUS OPEN HERNIOPLASTY: A COMPARATIVE STUDY OF EXTRAPERITONEAL TENSION FREE MESH REPAIRS IN INGUINAL HERNIA

    OpenAIRE

    Rehan Sabir; Sadiq; Shadan

    2015-01-01

    Inguinal hernia repair is now one of the most commonly performed general surgical procedures in practice. 'Tension - free repair' is the procedure of choice . [ 1 ] due to its low recurrence rate, these tension - free repair procedures can be roughly categorized into two groups: laparoscopic and open anterior approach. TEP is accepted as the most ideal method because it can avoid entry into the peritoneal cavity, which can cause intraperitoneal compli...

  4. Adrenal cortical heterotopia in an inguinal hernia sac of an adult: A case report and literature review

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    Sarah S. Kassaby, MD

    2017-06-01

    Full Text Available Ectopic adrenal cortical tissue is not an infrequent incidental finding during abdominal and inguinal operations in infants; however, it is a rare finding in adults with only a few case reports described in the literature. We report a case of adrenal heterotopia as an incidental finding in a hernia sac from a 56 year-old man. We review the literature and discuss the importance of recognizing this rare finding.

  5. Confirmed inguinal lymphogranuloma venereum genovar L2c in a man who had sex with men, Slovenia, 2015.

    Science.gov (United States)

    Matičič, Mojca; Klavs, Irena; Videčnik Zorman, Jerneja; Vidmar Vovko, Darja; Kogoj, Rok; Keše, Darja

    2016-01-01

    A laboratory-confirmed lymphogranuloma venereum (LGV) case in Slovenia was reported in 2015, in a human immunodeficiency virus (HIV)-negative man presenting with inguinal lymphadenopathy. He reported unprotected insertive anal intercourse with two male partners in Croatia. Variant L2c of Chlamydia trachomatis was detected in clinical samples. Although the patient was eventually cured, the recommended treatment regimen with doxycycline had to be prolonged.

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

    Science.gov (United States)

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

    2014-04-01

    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. We retrospectively analysed the medical records and telephone interviews of 520 patients who underwent inguinal hernia repair in 2010. 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 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. A general hospital with strict protocols and teaching methodologies can achieve inguinal hernia repair outcomes comparable to those of dedicated hernia centres.

  7. Self-adhesive mesh for Lichtenstein inguinal hernia repair. Experience of a single center.

    Science.gov (United States)

    Tarchi, P; Cosola, D; Germani, P; Troian, M; De Manzini, N

    2014-06-01

    Lichtenstein tension-free mesh repair is the most frequently performed procedure for inguinal hernioplasty. In the past surgery aimed to control recurrences. Nowadays it is important to avoid postoperative chronic pain and thus several studies have examined the potential role of meshes in causing postoperative pain. The purpose of this study was to retrospectively assess the early and long-term results after Lichtenstein tension-free repair using a self-adhesive mesh (Parietex ProgripTM - Covidien, Germany) in a single center. The study enrolled 211 patients, 199 males (94.3%) and 12 females (5.7%), mean age 62 years (28-90 years), between January 2008 and December 2011. Of these, 206 had primary inguinal hernias while 5 were recurrences following previous tension repair. Ten different general surgeons, including residents, performed Lichtenstein hernia repair using a 12 x 8-cm Parietex ProgripTM mesh. In 88.1% of patients no additional fixation was used, while in 11.9% a single 2-0 polypropylene stitch was placed on the pubic bone. A 1-10 visual analog scale (VAS) was used to assess postoperative pain, evaluating it at 1 week, 1 month and 12, 24 and 36 months. Local paresthesia was assessed at same intervals. Any pain sensation lasting longer than 3 months postoperatively, or requiring injection of analgesics was defined as chronic pain. Mean operating time was 64.1 minutes (SD ± 21.14). There were no intraoperative complications. Early postoperative complications included hematoma-seroma (5.7% cases), superficial wound infection (1%), urinary retention (0.5%), and scrotal swelling (1%). The main follow-up period was 3 years, although patients operated between 2009 and 2011 underwent a shorter follow-up. At one-year follow-up, 17 patients reported groin discomfort, but did not require analgesics. Three patients reported moderate pain, requiring occasional use of oral analgesics, and 2 of these described a discontinuous pain mainly during movement. One patient

  8. Low Spigelian hernia in a 6-year-old boy presenting as an incarcerated inguinal hernia: a case report

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    Christianakis Efstratios

    2009-01-01

    Full Text Available Abstract Introduction Lower Spigelian hernia is a very rare entity. The clinical findings are similar to those of inguinal hernias and in many cases may be misdiagnosed. In the literature, only a few references to this entity have been reported in children. To the best of our knowledge, this is the first case report of a lower Spigelian hernia in a child who presented with an acute painful scrotum. Case presentation We discuss the case of a 6-year-old Greek boy who presented to our emergency department complaining of severe pain in the left inguinal area and scrotum. The acute painful swelling started suddenly, without any obvious cause. The initial diagnosis was incarcerated inguinal hernia which was reduced with difficulty. Five days later, the patient still experienced mild pain during palpation and he was operated on. During the operation, a large lower Spigelian hernia was revealed and reconstructed. Conclusion Although Spigelian hernias are rare in children and difficult to diagnose, physicians should be aware of them and include them in the differential diagnosis.

  9. Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration.

    Science.gov (United States)

    Gavrilovska-Brzanov, Aleksandra; Kuzmanovska, Biljana; Kartalov, Andrijan; Donev, Ljupco; Lleshi, Albert; Jovanovski-Srceva, Marija; Spirovska, Tatjana; Brzanov, Nikola; Simeonov, Risto

    2016-03-15

    The aim of this study is to evaluate anesthesia and recovery profile in pediatric patients after inguinal hernia repair with caudal block or local wound infiltration. In this prospective interventional clinical study, the anesthesia and recovery profile was assessed in sixty pediatric patients undergoing inguinal hernia repair. Enrolled children were randomly assigned to either Group Caudal or Group Local infiltration. For caudal blocks, Caudal Group received 1 ml/kg of 0.25% bupivacaine; Local Infiltration Group received 0.2 ml/kg 0.25% bupivacaine. Investigator who was blinded to group allocation provided postoperative care and assessments. Postoperative pain was assessed. Motor functions and sedation were assessed as well. The two groups did not differ in terms of patient characteristic data and surgical profiles and there weren't any hemodynamic changes between groups. Regarding the difference between groups for analgesic requirement there were two major points - on one hand it was statistically significant p < 0.05 whereas on the other hand time to first analgesic administration was not statistically significant p = 0.40. There were significant differences in the incidence of adverse effects in caudal and local group including: vomiting, delirium and urinary retention. Between children undergoing inguinal hernia repair, local wound infiltration insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not overwhelming. Caudal block provides longer analgesia, however complications are rather common.

  10. Comparison of post-operative wound infection after inguinal hernia repair with polypropylene mesh and polyester mesh

    International Nuclear Information System (INIS)

    Mughal, M.A.; Ahmed, M.; Sajid, M.T.; Mustafa, Q.U.A.; Shukr, I.; Ahsan, J.

    2012-01-01

    Objective: To compare post operative wound infection frequency after inguinal hernia repair with polypropylene and polyester mesh using standard Lichtenstein hernioplasty technique. Study Design: Randomized controlled trial. Place and Duration: This study was conducted at general surgery department CMH/MH Rawalpindi from 8th April 2007 to 1st Jan 2008 over a period of 09 months. Patients and Materials: Sixty patients received through outpatient department with diagnosis of inguinal hernia satisfying inclusion/exclusion criteria were included. Patients were divided into two groups randomly. Group 1 included those patients in whom polypropylene mesh was used while group II patients were implanted with polyester mesh. Demographic as well as data concerning post operative wound infection was collected and analyzed. Results: Fifty seven patients (95%) were males while remaining (05%) were females. Mean age in group I was 41.17+-9.99 years while in group II was 41.47+-9.79 years (p=0.907). One patient (3.3%) in each group developed wound infection diagnosed by clinical evidence of pain at wound site, redness, induration and purulent discharge. Conclusion: There is no difference in post operative wound infection rate after inguinal Lichtenstein hernioplasty using either polypropylene or polyester mesh. (author)

  11. Transperitoneal rectus sheath block and transversus abdominis plane block for laparoscopic inguinal hernia repair: A novel approach.

    Science.gov (United States)

    Nagata, Jun; Watanabe, Jun; Nagata, Masato; Sawatsubashi, Yusuke; Akiyama, Masaki; Tajima, Takehide; Arase, Koichi; Minagawa, Noritaka; Torigoe, Takayuki; Nakayama, Yoshifumi; Horishita, Reiko; Kida, Kentaro; Hamada, Kotaro; Hirata, Keiji

    2017-08-01

    A laparoscopic approach for inguinal hernia repair is now considered the gold standard. Laparoscopic surgery is associated with a significant reduction in postoperative pain. Epidural analgesia cannot be used in patients with perioperative anticoagulant therapy because of complications such as epidural hematoma. As such, regional anesthetic techniques, such as ultrasound-guided rectus sheath block and transversus abdominis plane block, have become increasingly popular. However, even these anesthetic techniques have potential complications, such as rectus sheath hematoma, if vessels are damaged. We report the use of a transperitoneal laparoscopic approach for rectus sheath block and transversus abdominis plane block as a novel anesthetic procedure. An 81-year-old woman with direct inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal repair. Epidural anesthesia was not performed because anticoagulant therapy was administered. A Peti-needle™ was delivered through the port, and levobupivacaine was injected though the peritoneum. Surgery was performed successfully, and the anesthetic technique did not affect completion of the operative procedure. The patient was discharged without any complications. This technique was feasible, and the procedure was performed safely. Our novel analgesia technique has potential use as a standard postoperative regimen in various laparoscopic surgeries. Additional prospective studies to compare it with other techniques are required. © 2017 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  12. Pregnancy, parturition, parity and position in the family. Any influence on the development of paediatric inguinal hernia/hydrocele?

    Science.gov (United States)

    Irabor, D O; Ogundoyin O O; Ogunlana, D I

    2014-01-01

    To see if pre-partum factors have a relationship to the development of inguinal hernia in children. A prospective study on children with hernia. On first contact, the affected child was examined and data like the age, sex, weight, blood group, the diagnosis, side of the lesion and other co-morbid conditions was recorded. The mother filled a questionnaire about her age, parity, illness during pregnancy, her mode of delivery and the patient's position in the family. There were 104 patients from 103 mothers, their ages ranged from 13 days to 14 years with the highest incidence in the 1-4 age group. The sex ratio was overwhelmingly male (M:F ratio was 38:1). Right sided hernias were predominant. Only 7% had a family history. The peak age group of the mothers was 26-32 years and about 33% of the mothers had some illness during pregnancy. The birth positions of the patients showed that majority of them were either 1st or 2nd born children. Women of ages 26-32 likelyto have children with inguinal hernia. Malaria during pregnancy is unlikely to have a role to play. 1st and 2nd born male children have a higher chance of having inguinal hernia.

  13. Differences in gaze behaviour of expert and junior surgeons performing open inguinal hernia repair.

    Science.gov (United States)

    Tien, Tony; Pucher, Philip H; Sodergren, Mikael H; Sriskandarajah, Kumuthan; Yang, Guang-Zhong; Darzi, Ara

    2015-02-01

    Various fields have used gaze behaviour to evaluate task proficiency. This may also apply to surgery for the assessment of technical skill, but has not previously been explored in live surgery. The aim was to assess differences in gaze behaviour between expert and junior surgeons during open inguinal hernia repair. Gaze behaviour of expert and junior surgeons (defined by operative experience) performing the operation was recorded using eye-tracking glasses (SMI Eye Tracking Glasses 2.0, SensoMotoric Instruments, Germany). Primary endpoints were fixation frequency (steady eye gaze rate) and dwell time (fixation and saccades duration) and were analysed for designated areas of interest in the subject's visual field. Secondary endpoints were maximum pupil size, pupil rate of change (change frequency in pupil size) and pupil entropy (predictability of pupil change). NASA TLX scale measured perceived workload. Recorded metrics were compared between groups for the entire procedure and for comparable procedural segments. Twenty-five cases were recorded, with 13 operations analysed, from 9 surgeons giving 630 min of data, recorded at 30 Hz. Experts demonstrated higher fixation frequency (median[IQR] 1.86 [0.3] vs 0.96 [0.3]; P = 0.006) and dwell time on the operative site during application of mesh (792 [159] vs 469 [109] s; P = 0.028), closure of the external oblique (1.79 [0.2] vs 1.20 [0.6]; P = 0.003) (625 [154] vs 448 [147] s; P = 0.032) and dwelled more on the sterile field during cutting of mesh (716 [173] vs 268 [297] s; P = 0.019). NASA TLX scores indicated experts found the procedure less mentally demanding than juniors (3 [2] vs 12 [5.2]; P = 0.038). No subjects reported problems with wearing of the device, or obstruction of view. Use of portable eye-tracking technology in open surgery is feasible, without impinging surgical performance. Differences in gaze behaviour during open inguinal hernia repair can be seen between expert and junior surgeons and may have

  14. The analgesic effect of Magnesium Sulfate in postoperative pain of inguinal hernia repair

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    Mehraein A

    2007-08-01

    Full Text Available Background: Magnesium Sulfate (MgSO4 has been used as a pharmacologic agent in different situations for many years in the treatment of tachyarrhythmias, myocardial ischemia, preeclampsia, and tocolysis among others. The analgesic effect of MgSO4 for postoperative pain has been used since the 1990s. Postoperative pain is one of the most common complications in the perioperative period and can result in serious consequences in different organs if left untreated. Inguinal herniorrhaphy is among the most common surgeries and is almost always accompanied by severe pain. The object of this study is to determine the effect of a pre-induction infusion of MgSO4 on the reduction of postsurgical pain after herniorrhaphy. Methods: This double-blind, randomized clinical trial included 105 ASA class I and class II herniorrhaphy patients at Shariati Hospital in years 2004 and 2005. For statistical analysis, the 2 and T tests were used. The patients were divided into three groups based on block randomization. Patients in the following groups received: Group A, 200 ml of normal saline infusion (placebo; Group B, 25 mg/kg MgSO4 in 200 ml of normal saline; Group C, 50 mg/kg MgSO4 in 200 ml of normal saline. All groups were infused twenty minutes before induction of anesthesia using identical methods and dosage in all three groups. Heart rate and mean arterial pressure (MAP at pre- and postintubation and so at skin incision time were charted. Visual analog scale (VAS pain score, nausea, vomiting and the amount of morphine used before recovery room discharge and in six, twelve and twenty-four hours after recovery discharge was recorded. Results: The average age for the different groups was as follows: Group A: 33.6, Group B: 37.37, Group C: 32.74. Nausea and vomiting between the case and control groups were not statistically different (60% vs. 71.4%, p=0.0499, nor was the amount of Morphine used. On recovery room discharge, the VAS scores were 8.1, 7.2, and 5

  15. Romboplastia múltiple en cirugía de rescate del cáncer de cabeza y cuello

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    Orlando R Expósito Reyes

    Full Text Available La romboplastia de Limberg es una técnica quirúrgica útil en la reparación de defectos faciales. Se presenta un paciente de 55 años de edad, de procedencia rural que acude a consulta de cirugía de cabeza y cuello por presentar lesión persistente de tres meses de evolución. Esta se localizaba en la región temporo-frontal derecha, ulcerada y dolorosa y provocaba molestias físicas y estéticas. Se realizó resección quirúrgica y biopsia que informó carcinoma basocelular con bordes de sección libres de lesión y quedó un defecto circular de aproximadamente 8 cm de diámetro. El tamaño y localización de esta lesión en un área poco extensible hizo imposible el cierre borde a borde, fue necesario diseñar la triple plastia de Limberg que requiere de tres colgajos concéntricos de piel de las regiones del cuero cabelludo, preauricular y frontal, seguido del decolado, transposición y sutura de los mismos sin comprometer su irrigación. La triple plastia de Limberg demuestra su vigencia en la reparación del defecto temporo-frontal y posibilita el resultado oncoplástico esperado.

  16. Resultados del tratamiento quirúrgico de los tumores malignos del párpado inferior Results of the surgical treatment of malignant tumors of the lower eyelid

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    Roberto Frías Banqueris

    2008-06-01

    Full Text Available INTRODUCCIÓN. Es objetivo de este trabajo describir el tratamiento quirúrgico de las lesiones malignas localizadas en el párpado inferior, de extensión mayor del 25 % y propagación a los cantos mediales y externo. MÉTODOS. Un equipo multidisciplinario del Hospital «Celia Sánchez Manduley» (Manzanillo realizó un estudio descriptivo y prospectivo entre enero de 2001 y diciembre de 2006. Se seleccionaron para el estudio 19 pacientes que cumplieron con los criterios de inclusión, que fueron valorados previamente por el equipo multidisciplinario, y que dieron su consentimiento informado de participar en la investigación. Se describieron variables como edad, sexo, técnica quirúrgica empleada, localización, resultado anatomopatológico, complicaciones y resultado final. A los pacientes se les daría seguimiento durante un mínimo de 5 años. RESULTADOS. Se encontró un ligero predominio del sexo masculino y de edades por encima de los 50 años. La resección del tumor en cuña, seguida de la reconstrucción por técnica de colgajo de mejilla de Mustardé, fue la técnica de elección. El 79 % de los tumores resultó ser del tipo carcinoma basocelular. La necrosis parcial del colgajo y el hematoma fueron las complicaciones más frecuentes. Los pacientes se han mantenido en consulta de seguimiento, sin recidiva ni persistencia tumoral. CONCLUSIONES. El tratamiento quirúrgico por técnica de Mustardé combinada con otras técnicas y realizado por un equipo multidisciplinario es ideal para la cirugía del cáncer del párpado inferior.INTRODUCTION. The objective of this paper is to describe the surgical treatment of the malignant lesions localized in the lower eyelid with an extension over 25 % and propagation to the medial and external edges. METHODS. A multidisciplinary team of «Celia Sánchez Manduley» Hospital (Manzanillo conducted a descriptive and prospective study from January 2001 to December 2006. 19 patients that fulfilled the

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

    Science.gov (United States)

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

    2010-07-01

    Bilateral laparoscopic totally extraperitoneal (TEP) repair of unilateral hernia is conspicuous in published literature by its absence. There are no studies or data on the feasibility, advantages or disadvantages of bilateral repair in all cases or in any subset of patients with unilateral primary inguinal hernia. The objective of this study is to investigate the feasibility of bilateral laparoscopic exploration for all unilateral cases followed by laparoscopic TEP in all cases and to compare complications, recurrence rates, postoperative pain, patient satisfaction, and return to work retrospectively with a similar number of age-matched retrospective controls. One hundred fifty TEP operations were performed in 75 patients (group A) prospectively and were compared with 75 unilateral TEP operations (group B) in age-matched controls done previously by the same surgeon. All cases were performed under general anesthesia, and TEP repair was performed using three midline ports. All uncomplicated patients were discharged at 24 h, in keeping with departmental policy. Of 75 patients (group A), 25 (33.3%) were clinically diagnosed with bilateral hernia and the rest (50, 66.66%) with unilateral hernia. The distribution of the 25 bilateral cases was 11 bilateral direct and 14 bilateral indirect inguinal hernias. The distribution of the 75 age-matched controls (group B) was all unilateral hernia, of which 47 were right-sided and 28 were left-sided. There were 23 direct hernias and 52 indirect hernias among the control group. The mean operative time for all 150 cases was 76.66 +/- 15.92 min. The operative time in the control group (unilateral hernias) was 66.16 +/- 12.44 min, whereas the operative time in the test group (bilateral repair) was 87.2 +/- 11.32 min. The operative time in the bilateral group was significantly higher, by 21.04 min or 31.88% (p = 0.000). The operative time in the true unilateral group was 82.45 +/- 9.38 min, whereas the operative time in the former

  18. Myocarditis exacerbation in a child undergoing inguinal hernioplasty after viral infection

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    Simić Dušica

    2009-01-01

    Full Text Available Introduction Immunosuppressive effects of general anesthesia and surgery could have unexpected consequences in a child with recent infection. The incidence of myocarditis in childhood is unknown. Case outline During general anesthesia for inguinal hernia repair, a seven-year-old boy suddenly developed heart failure. Clinical presentation included hypotension, pulmonary edema, drop in hemoglobin oxygen saturation, ST segment elevation and premature ventricular contractions. Homodynamic stability and adequate oxygenation were achieved with dopamine and furosemide. Preoperative history, physical examination and complete blood count were unremarkable. Moderate cardiomegaly and pulmonary edema were present on chest radiography. Diminished left ventricular contractility found on echocardiography increased troponin I and CK-MB levels suggested myocardial injury. Increased C-reactive protein with lymphocytosis suggested inflammation as its cause. Parents failed to report rubella 10 days before the operation. A clinical diagnosis of myocarditis as a complication of rubella was based on increased titer of IgM to rubella. With intravenous immunoglobulin, corticosteroids and symptomatic treatment for heart failure, his condition improved and ejection fraction reached 68 % one month after operation. Conclusion In future, we need protocols with instructions for pediatric patients undergoing elective surgery and anesthesia after viral infections.

  19. General anesthesia plus ilioinguinal nerve block versus spinal anesthesia for ambulatory inguinal herniorrhapy

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    Lucía Vizcaíno-Martínez

    2014-01-01

    Full Text Available Objective: The aim was to evaluate general anesthesia (GA plus ilioinguinal nerve block (IIB versus spinal anesthesia (SA in patients scheduled for ambulatory inguinal hernia repair regarding pain management, anesthesia recovery and reducing potential complications. Materials and Methods: A double-blind, prospective, randomized, controlled study in patients American Society of Anesthesiologists I-III randomized into two groups: GA plus IIB group, induction of anesthesia with propofol, maintenance with sevoflurane, airway management with laryngeal mask allowing spontaneous ventilation and ultrasound-guided IIB; SA group, patients who underwent spinal block with 2% mepivacaine. The study variables were pain intensity, assessed by visual analog scale, analgesic requirements until hospital discharge, time to ambulation and discharge, postoperative complications-related to both techniques and satisfaction experienced. Results: Thirty-two patients were enrolled; 16 patients in each group. The differences regarding pain were statistically significant at 2 h of admission (P < 0.001 and at discharge (P < 0.001 in favor of the GA plus ilioinguinal block group. In addition in this group, analgesic requirements were lower than SA group (P < 0.001, with times of ambulation and discharge significantly shorter. The SA group had a higher tendency to develop complications and less satisfaction. Conclusion: General anesthesia plus IIB is better than SA regarding postoperative analgesia, time to mobilization and discharge, side-effect profile and satisfaction experienced by the patients.

  20. Quantitative analysis of collagen and elastic fibers in the transversalis fascia in direct and indirect inguinal hernia Análise quantitativa do colágeno e de fibras elásticas na fascia transversal de pacientes com hernia inguinal direta e indireta

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    Aldo Junqueira Rodrigues Junior

    2002-01-01

    Full Text Available PURPOSE: Our previous studies demonstrated structural and quantitative age-related changes of the elastic fibers in transversalis fascia, which may play a role in inguinal hernia formation. To verify whether there were differences in the extracellular matrix between direct and indirect inguinal hernia, we studied the amount of collagen and elastic fibers in the transversalis fascia of 36 male patients with indirect inguinal hernia and 21 with direct inguinal hernia. MATERIAL AND METHODS: Transversalis fascia fragments were obtained during surgical intervention and underwent histological quantitative analysis of collagen by colorimetry and analysis of elastic fibers by histomorphometry. RESULTS: We demonstrated significantly lower amounts of collagen and higher amounts of elastic fibers in transversalis fascia from patients with direct inguinal hernia compared to indirect inguinal hernia patients. The transversalis fascia from direct inguinal hernia patients showed structural changes of the mature and elaunin elastic fibers, which are responsible for elasticity, and lower density of oxytalan elastic fibers, which are responsible for resistance. These changes promoted loss of resiliency of the transversalis fascia. CONCLUSION: These results improve our understanding of the participation of the extracellular matrix in the genesis of direct inguinal hernia, suggesting a relationship with genetic defects of the elastic fiber and collagen synthesis.OBJETIVO: Estudos prévios nossos demonstraram alterações estruturais e quantitativas de fibras elásticas na fascia transversal com o envelhecimento, tendo papel na gênese da hérnia inguinal. Com o objetivo de verificar diferenças na matriz extracellular da fascia transversal de pacientes com hernia inguinal direta e indireta, quantificamos o colágeno e as fibras elásticas na fascia transversal de 36 pacientes masculinos com hernia inguinal indireta e 21 pacientes masculinos com hernia inguinal

  1. Reparación quirúrgica de fístula traqueocutánea y de cicatriz postraqueotomía mediante colgajo dermograso de rotación Reparação cirúrgica de fístula traqueocutânea e de cicatriz pós-traqueostomia com rotação de retalho dermoadiposo Surgical repair of tracheocutaneous fistulae and postracheotomy scar using a dermoadipose turn-over flap

    Directory of Open Access Journals (Sweden)

    F. Passos da Rocha

    2009-03-01

    Full Text Available La fístula traqueocutánea y la retracción cicatricial son las complicaciones postraqueotomía más frecuentes. El objetivo del presente trabajo es el presentar una técnica quirúrgica de fácil ejecución para la reparación de los defectos estéticos y funcionales creados por estas patologías. Presentamos el caso de un varón de 61 años que había sufrido traqueotomía. Tras la decanulación, la cicatrización cursó con retracción, adherencia a planos profundos y aparición de fístula traqueocutánea. El cierre de la fístula se hizo reparando el defecto funcional mediante la técnica de rotación de colgajos dermograsos en "hoja de libro", logrando el cierre del área de retracción y reparando el defecto estético. La retracción cutáneo-hipodérmica es un defecto inestético, incómodo y estigmatizante. Las fístulas traqueocutáneas con escape de aire son desagradables tanto desde el punto de vista funcional como estético. El método que presentamos logró corregir la fístula y la depresión provocada por la traqueotomía mediante un procedimiento simple, rápido y efectivo. Este método evita las dificultades encontradas en otras técnicas y garantiza la corrección funcional y estética empleando un método simple con baja morbilidad.Tracheocutaneous fistulas and scar retraction are frequent complications of the tracheotomy. The objective of the present manuscript is to present an easy execution surgical technique to restore tracheocutaneous fistula and cutaneous retraction. We present the clinical case of a 61 years old man who had suffered tracheotomy. After decannulation, the scar became retracted and adhered to deep tissues, developing into a tracheocutaneous fistula. The fistula was closed repairing the functional defect and a turn-over hinge flap of dermoadipose tissue was used to fill the retracted area, correcting the aesthetic abnormality. Correction of cicatricial retraction and of tracheocutaneous fistula using the

  2. Peces del Noroeste del Ecuador

    OpenAIRE

    Barriga, Ramiro

    1994-01-01

    La ictiofauna del occidente del Ecuador es poco conocida. Los peces del noroccidente son diferentes a los del suroccidente del Ecuador. 34 familias y 82 especies fueron colectadas que equivale al 11 % de las especies de peces continentales registradas en el Ecuador. Icteogeográficamente se sabe que la costa ecuatoriana posee dos provincias: la del Pacifico Norte y la del Guayas, se determinó que el límite de las dos provincias es el río Santiago ya que las especies del mencionado río so...

  3. The exploration of medical resources utilization among inguinal hernia repair in Taiwan diagnosis-related groups.

    Science.gov (United States)

    Yan, Yu-Hua; Kung, Chih-Ming; Chen, Yi

    2017-11-09

    This study centered on differences in medical costs, using the Taiwan diagnosis-related groups (Tw-DRGs) on medical resource utilization in inguinal hernia repair (IHR) in hospitals with different ownership to provide suitable reference information for hospital administrators. The 2010-2011 data for three hospitals under different ownership were extracted from the Taiwan National Health Insurance claims database. A retrospective method was applied to analyze the age, sex, length of stay, diagnosis and surgical procedure code, and the change in financial risk of medical costs in IHR cases after introduction of Tw-DRGs. The study calculated the cost using Tw-DRG payment principles, and compared it with estimated inpatient medical costs calculated using the fee-for-service policy. There were 723 IHR cases satisfying the Tw-DRGs criteria. Cost control in the medical care corporation hospital (US$764.2/case) was more efficient than that in the public hospital (US$902.7/case) or nonprofit proprietary hospital (US$817.1/case) surveyed in this study. For IHR, anesthesiologists in the public hospital preferred to use general anesthesia (86%), while those in the two other hospitals tended to administer spinal anesthesia. We also discovered the difference in anesthesia cost was high, at US$80.2/case on average. Because the Tw-DRG-based reimbursement system produces varying hospital costs, hospital administrators should establish a financial risk assessment system as early as possible to improve healthcare quality and financial management efficiency. This would then benefit the hospital, patient, and Bureau of National Health Insurance.

  4. Inguinal hernia repair in day surgery: the role of MAC (Monitored Anesthesia Care) with remifentanil

    Science.gov (United States)

    USAI, S.; AMATUCCI, C.; PEROTTI, B.; RUGGERI, L.; ILLUMINATI, G.; TELLAN, G.

    2017-01-01

    Background The extension of indications for procedures in a Day Surgery (DS) setting has led to changes in the anesthetic and surgical treatment of Inguinal Hernias (IH). According to the recommendations of the European Hernia Society, the treatment of IH in DS units should be performed under Monitored Anesthesia Care (MAC). Patients and methods 960 patients underwent IH repairs over a period of 24 months. The patients were randomly divided into two groups: R (remifentanil) and F (fentanyl); the group F was considered as a control group. The exclusion criteria in both group were: morbid obesity (BMI>40 or BMI>35 in association with high blood pressure or diabetes); coagulopathy; OSAS (obstructive sleep apnea syndrome) with AHI >10; cardiovascular, respiratory, renal, hepatic or metabolic disease; history of substances abuse; GERD-related esophagitis (gastro-esophageal reflux disease); chronic analgesic use; allergy to local anesthetic and ASA>III. Patients reported their level of pain on a verbal numeric scale (VNS), with scores ranging from 0 to 10. For each patient systolic and diastolic blood pressure (SBP and DBP), mean arterial pressure (MAP), heart rate (HR) and peripheral oxygen saturation (SpO2) were recorded. The results are presented as the mean value ± standard deviations; statistical analysis was performed using Student’s t-test. Results Amongst the 960 procedures, complications or side effects related to the anesthetic techniques didn’t occur; no procedure-related complications requiring mechanical ventilation support were reported. Our research focused on evaluating remifentanil effectiveness in pain control and its impact on hemodynamic stability and respiratory function. There was a significant difference between the two groups with regard to the VNS. Conclusions Remifentanil, is an excellent drug for pain control during intra-operative procedures, that allows an optimal hemodynamic stability for IH repairs in a DS setting, due to its

  5. The exploration of medical resources utilization among inguinal hernia repair in Taiwan diagnosis-related groups

    Directory of Open Access Journals (Sweden)

    Yu-Hua Yan

    2017-11-01

    Full Text Available Abstract Background This study centered on differences in medical costs, using the Taiwan diagnosis-related groups (Tw-DRGs on medical resource utilization in inguinal hernia repair (IHR in hospitals with different ownership to provide suitable reference information for hospital administrators. Methods The 2010–2011 data for three hospitals under different ownership were extracted from the Taiwan National Health Insurance claims database. A retrospective method was applied to analyze the age, sex, length of stay, diagnosis and surgical procedure code, and the change in financial risk of medical costs in IHR cases after introduction of Tw-DRGs. The study calculated the cost using Tw-DRG payment principles, and compared it with estimated inpatient medical costs calculated using the fee-for-service policy. Results There were 723 IHR cases satisfying the Tw-DRGs criteria. Cost control in the medical care corporation hospital (US$764.2/case was more efficient than that in the public hospital (US$902.7/case or nonprofit proprietary hospital (US$817.1/case surveyed in this study. For IHR, anesthesiologists in the public hospital preferred to use general anesthesia (86%, while those in the two other hospitals tended to administer spinal anesthesia. We also discovered the difference in anesthesia cost was high, at US$80.2/case on average. Conclusions Because the Tw-DRG-based reimbursement system produces varying hospital costs, hospital administrators should establish a financial risk assessment system as early as possible to improve healthcare quality and financial management efficiency. This would then benefit the hospital, patient, and Bureau of National Health Insurance.

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

    International Nuclear Information System (INIS)

    Lughezzani, Giovanni; Sun, Maxine; Perrotte, Paul; Alasker, Ahmed; Jeldres, Claudio; Isbarn, Hendrik; Budaeus, Lars; Lattouf, Jean-Baptiste; Valiquette, Luc; Benard, Francois; Saad, Fred; Graefen, Markus; Montorsi, Francesco; Karakiewicz, Pierre I.

    2010-01-01

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

  7. Mesh fixation in endoscopic inguinal hernia repair: evaluation of methodology based on a systematic review of randomised clinical trials.

    Science.gov (United States)

    Lederhuber, Hans; Stiede, Franziska; Axer, Stephan; Dahlstrand, Ursula

    2017-11-01

    The issue of mesh fixation in endoscopic inguinal hernia repair is frequently debated and still no conclusive data exist on differences between methods regarding long-term outcome and postoperative complications. The quantity of trials and the simultaneous lack of high-quality evidence raise the question how future trials should be planned. PubMed, EMBASE and the Cochrane Library were searched, using the filters "randomised clinical trials" and "humans". Trials that compared one method of mesh fixation with another fixation method or with non-fixation in endoscopic inguinal hernia repair were eligible. To be included, the trial was required to have assessed at least one of the following primary outcome parameters: recurrence; surgical site infection; chronic pain; or quality-of-life. Fourteen trials assessing 2161 patients and 2562 hernia repairs were included. Only two trials were rated as low risk for bias. Eight trials evaluated recurrence or surgical site infection; none of these could show significant differences between methods of fixation. Two of 11 trials assessing chronic pain described significant differences between methods of fixation. One of two trials evaluating quality-of-life showed significant differences between fixation methods in certain functions. High-quality evidence for differences between the assessed mesh fixation techniques is still lacking. From a socioeconomic and ethical point of view, it is necessary that future trials will be properly designed. As small- and medium-sized single-centre trials have proven unable to find answers, register studies or multi-centre studies with an evident focus on methodology and study design are needed in order to answer questions about mesh fixation in inguinal hernia repair.

  8. Early assessment of bilateral inguinal hernia repair: A comparison between the laparoscopic total extraperitoneal and Stoppa approaches

    Directory of Open Access Journals (Sweden)

    Edivaldo Massazo Utiyama

    2016-01-01

    Full Text Available Background: The present clinical trial was designed to compare the results of bilateral inguinal hernia repair between patients who underwent the conventional Stoppa technique and laparoscopic total extraperitoneal repair (LTE with a single mesh and without staple fixation. Patients and Methods: This controlled, randomised clinical trial was conducted at General Surgery and Trauma of the Clinics Hospital, Medical School, the University of São Paulo between September 2010 and February 2011. Totally, 50 male patients, with a bilateral inguinal hernia, older than 25 years were considered eligible for the study. The following parameters were analysed during the early post-operative period: (1 The intensity of surgical trauma, operation time, C-reactive protein (CRP levels, white blood cell count, bleeding and pain intensity; (2 quality of life assessment; and (3 post-operative complications. Results: LTE procedure was longer than the Stoppa procedure (134.6 min ± 38.3 vs. 90.6 min ± 41.3; P 0.05. There was no difference in pain during the 1st and 7th post-operative, physical functioning, physical limitation, the impact of pain on daily activities, and the Carolinas Comfort Scale during the 7th and 15th post-operative (P > 0.05. Complications occurred in 88% of Stoppa group (22 patients and 64% in LTE group (16 patients (P < 0.05. Conclusion: The comparative study between the Stoppa and LTE approaches for the bilateral inguinal hernia repair demonstrated that: (1 The LTE approach showed less surgical trauma despite the longer operation time; (2 Quality of life during the early post-operative period were similar; and (3 Complication rates were higher in the Stoppa group.

  9. Cost-effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphy. Coala trial group.

    Science.gov (United States)

    Liem, M S; Halsema, J A; van der Graaf, Y; Schrijvers, A J; van Vroonhoven, T J

    1997-12-01

    To determine the cost-effectiveness of laparoscopic inguinal hernia repair. Laparoscopic inguinal hernia repair seems superior to open techniques with respect to short-term results. An issue yet to be studied in depth remains the cost-effectiveness of the procedure. As part of a multicenter randomized study in which >1000 patients were included, a cost-effectiveness analysis from a societal point of view was performed. After informed consent, all resource costs, both in and outside the hospital, for patients between August 1994 and July 1995 were recorded prospectively. Actual costs were calculated in a standardized fashion according to international guidelines. The main measures used for the evaluation of inguinal hernia repair were the number of averted recurrences and quality of life measured with the Short Form 36 questionnaire. Resource costs were recorded for 273 patients, 139 in the open and 134 in the laparoscopic group. Both groups were comparable at baseline. Average total hospital costs were Dfl 1384.91 (standard deviation: Dfl 440.15) for the open repair group and Dfl 2417.24 (standard deviation: Dfl 577.10) for laparoscopic repair, including a disposable kit of Dfl 676. Societal costs, including costs for days of sick leave, were lower for the laparoscopic repair and offset the hospital costs by Dfl 780.83 (75.6%), leaving the laparoscopic repair Dfl 251.50 more expensive (Dfl 4665 versus Dfl 4916.50). At present, the recurrence rate is 2.6% lower after laparoscopic repair. Thus, 38 laparoscopic repairs, costing an additional Dfl 9,557, prevent the occurrence of one recurrent hernia. Quality of life was better after laparoscopic repair. A better quality of life in the recovery period and the possibility of replacing parts of the disposable kit with reusable instruments may result in the laparoscopic repair becoming dominantly better--that is, less expensive and more effective from a societal perspective.

  10. Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report.

    Science.gov (United States)

    St-Onge, Eric; MacIntyre, Ian G; Galea, Anthony M

    2015-12-01

    To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy.

  11. Pre-operative Spermatic Cord Ultrasonography Helps to Reduce the Incidence of Metachronous Inguinal Hernia in Boys

    Directory of Open Access Journals (Sweden)

    Shoujiang Huang

    2018-06-01

    Full Text Available Background/purpose: Thickening of the spermatic cord is a clinical sign of an inguinal hernia. We therefore tested whether pre-operative spermatic cord ultrasonography could reduce the incidence of metachronous inguinal hernia (MIH.Methods: Boys under 2 years old with an initial unilateral inguinal hernia were enrolled in this study. In whom the width of the asymptomatic-sided spermatic cord was ≥0.5 cm, these patients underwent contralateral groin exploration. Age at initial operation, weight, initial operation side, the sonographic width of the spermatic cord, the operative findings and presence of MIH were recorded, and the relationship among them was studied. Boys in the US group underwent an open herniorrhaphy with pre-operative ultrasound examination; the non-US group included boys who did not undergo a pre-operative ultrasound examination. A receiver operator curve (ROC analysis was performed to evaluated predictive value of the sonographic width of the spermatic cord for contralateral hernia.Results: A total of 24 months' follow-up data were obtained from 1,793 boys (US group 1,162, non-US group 631. In the US group, the width of the hernia-sided spermatic cord (0.75 ± 0.18 cm was larger than the normal side (0.37 ± 0.05 cm, P < 0.001. And the width of normal side spermatic cord had no significant difference between the groups regarding other factors such as age and weight. In whom the width of the asymptomatic-sided spermatic cord was ≥0.5 cm, the corresponding incidence of CIH was 86.4% (57/66. The width of the spermatic cord predicted the presence of contralateral hernia with ROC area under the curve = 0.943 (95% CI = 0.919–0.966. The total incidence of MIH was 4.1% (74/1793. The incidence of MIH in the US group was 2.2% (25/1162 much lower than 7.8% (49/631 in the non-US group (P < 0.001. If the width of the asymptomatic-sided spermatic cord was 0.5 cm and 0.54 cm, the corresponding sensitivity was 0.682 and 0

  12. Flap Lymphedema after Successful Reconstruction of the Chronic Inguinal Wound with a Vertical Rectus Abdominis Flap (VRAM

    Directory of Open Access Journals (Sweden)

    Yalcin Kulahci

    2012-07-01

    Full Text Available The reconstruction of extensive and complex wounds represents a challenging problem for reconstructive surgeon. The reconstructive options to provide cover-age following debridment of these complicated wounds are local, distant flaps, or freetissue transfer. Vertical rectus abdominis flaps have been used succes-sully to repair defects in the groin, hip, perineal, trunk, and breast regions. We encountered flap lymphedema after successful reconstruction of the chronic in-guinal wound with a vertical rectus abdominis (VRAM flap. As far as were able to ascertain, there is no report in the literature related to flap lymphedema.

  13. Difficulties and Problematic Steps in Teaching the Onstep Technique for Inguinal Hernia Repair, Results from a Focus Group Interview

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Laursen, Jannie; Rosenberg, Jacob

    2016-01-01

    technique for inguinal hernia repair, seen from the instructor's point of view. Methods. We designed a qualitative study using a focus group to allow participants to elaborate freely and facilitate a discussion. Participants were surgeons with extensive experience in performing the Onstep technique from...... course should preferably have experience with other types of hernia repairs. If trainees are inexperienced, the training setup should be a traditional step-by-step programme. A training setup should consist of an explanation of the technique with emphasis on anatomy and difficult parts of the procedure...

  14. Assessing the impact of short-term surgical education on practice: a retrospective study of the introduction of mesh for inguinal hernia repair in sub-Saharan Africa.

    Science.gov (United States)

    Wang, Y T; Meheš, M M; Naseem, H-R; Ibrahim, M; Butt, M A; Ahmed, N; Wahab Bin Adam, M A; Issah, A-W; Mohammed, I; Goldstein, S D; Cartwright, K; Abdullah, F

    2014-08-01

    Inguinal hernia repair is the most common general surgery operation performed globally. However, the adoption of tension-free hernia repair with mesh has been limited in low-income settings, largely due to a lack of technical training and resources. The present study evaluates the impact of a 2-day training course instructing use of polypropylene mesh for inguinal hernia repair on the practice patterns of sub-Saharan African physicians. A surgical training course on tension-free mesh repair of hernias was provided to 16 physicians working in rural Ghanaian and Liberian hospitals. Three physicians were requested to prospectively record all their inguinal hernia surgeries, performed with or without mesh, during the 14-month period following the training. Demographic variables, diagnoses, and complications were collected by an independent data collector for mesh and non-mesh procedures. Surgery with mesh increased significantly following intervention, from near negligible levels prior to the training to 8.1 % of all inguinal hernia repairs afterwards. Mesh repair accounted for 90.8 % of recurrent hernia repairs and 2.9 % of primary hernia repairs after training. Overall complication rates between mesh and non-mesh procedures were not significantly different (p = 0.20). Three physicians who participated in an intensive education course were routinely using mesh for inguinal hernia repair 14 months after the training. This represents a significant change in practice pattern. Complication rates between patients who underwent inguinal hernia repairs with and without mesh were comparable. The present study provides evidence that short-term surgical training initiatives can have a substantial impact on local healthcare practice in resource-limited settings.

  15. Efficacy and tolerance of lysine clonixinate versus paracetamol/codeine following inguinal hernioplasty.

    Science.gov (United States)

    de los Santos, A R; Di Girolamo, G; Martí, M L

    1998-01-01

    In this study lysine clonixinate, a nonsteroidal antiinflammatory agent with selective inhibition of cyclooxygenase-2 and 5-lipooxygenase in in vitro and in vivo pharmacodynamic studies, was evaluated in a prospective, randomized, double-blind, double-dummy clinical study versus paracetamol/codeine, in 151 patients with pain following inguinal hernioplasty. Patients were treated with one 125 mg tablet of lysine clonixinate or paracetamol/codeine (500 mg + 30 mg) administered at fixed doses every 4 h during 2 days. Controls were carried out 1, 2 and 4 h after the first intake of day 1 and day 2. Each control included assessment of pain at rest, when coughing, sitting and upon moderate pressure. Both treatment groups (lysine clonixinate, 77 patients and paracetamol/codeine, 74 patients) were comparable in terms of demographic and baseline pain intensities. Spontaneous pain was reduced significantly in both treatment groups from the 1st-h control. The following values were recorded in the lysine clonixinate group during day 1: baseline: 6.86 +/- 1.24; 1st h: 4.49 +/- 1.77; 2nd h: 2.96 +/- 1.74; 4th h: 2.23 +/- 1.51. The following values for the same group during day 2 were: predose: 1.70 +/- 1.64; 1st h: 1.16 +/- 1.17; 2nd h: 0.78 +/- 1.06; 4th h: 0.63 +/- 1.05. The paracetamol/codeine group revealed the following values: day 1: baseline: 6.72 +/- 1.22; 1st h: 4.57 +/- 1.72; 2nd h: 2.97 +/- 1.68; 4th h: 2.47 +/- 1.68 and day 2: predose: 2.02 +/- 1.57; 1st h: 1.32 +/- 1.23; 2nd h: 0.82 +/- 0.99; 4th h: 0.66 +/- 0.89. Reduction of pain induced by coughing, sitting and pressure showed similar behavior patterns. No significant differences between both treatment groups were encountered in terms of analgesic efficacy. Incidence of adverse effects was significantly higher in the paracetamol/codeine group (X2: p lysine clonixinate group four out of 77 patients showed side effects but these did not require treatment discontinuation.

  16. Inguinal Hernia Repair Using Self-adhering Sutureless Mesh: Adhesix™: A 3-Year Follow-up with Low Chronic Pain and Recurrence Rate.

    Science.gov (United States)

    Tabbara, Malek; Genser, Laurent; Bossi, Manuela; Barat, Maxime; Polliand, Claude; Carandina, Sergio; Barrat, Christophe

    2016-02-01

    To review our experience and outcomes after inguinal hernia repair using the lightweight self-adhering sutureless mesh "Adhesix™" and demonstrate the safety and efficacy of this mesh. This is a 3-year retrospective study that included 143 consecutive patients who underwent 149 inguinal hernia repairs at our department of surgery. All hernias were repaired using a modified Lichtenstein technique. Preoperative, perioperative, and postoperative data were prospectively collected. Incidence of chronic pain, postoperative complications, recurrence, and patient satisfaction were assessed three years postoperatively by conducting a telephone survey. We had 143 patients with a mean age of 58 years (17-84), who underwent 149 hernia repairs using the Adhesix™ mesh. Ninety-two per cent (131 patients) were males. Only 10 patients (7%) had a postoperative pain for more than three years. In our series, neither age nor gender was predictive of postoperative pain. Only one patient had a hematoma lasting for more than one month and only four patients (2.8%) had a recurrence of their hernia within three years of their initial surgery. Ninety per cent of the patient expressed their satisfaction when surveyed three years after their surgery. In conclusion, the use of the self-adhering sutureless mesh for inguinal hernia repair has been proving itself as effective as the traditional mesh. Adhesix™ is associated with low chronic pain rate, recurrence rate, and postoperative complications rate, and can be safely adopted as the sole technique for inguinal hernia repair.

  17. Do guidelines influence results in inguinal hernia treatment? A descriptive study of 2,535 hernia repairs in one teaching hospital from 1994 to 2004

    NARCIS (Netherlands)

    Aufenacker, T. J.; Schmits, S. P.; Gouma, D. J.; Simons, M. P.

    2009-01-01

    BACKGROUND: The Onze Lieve Vrouwe Gasthuis (OLVG) hospital is a large district teaching hospital with a residency programme for general surgery. Since 1998, inguinal hernia (IH) repairs in this hospital were performed according to the preliminary "evidence-based guidelines" concerning IH repair. The

  18. Inguinal hernia in stage M0 prostate cancer: a comparison of incidence in men treated with and without radical retropubic prostatectomy--an analysis of 1105 patients

    DEFF Research Database (Denmark)

    Stranne, Johan; Hugosson, Jonas; Iversen, Peter

    2005-01-01

    To analyze the incidence of inguinal hernia (IH) in a large group of patients with nonmetastatic prostate cancer who were treated nonoperatively, and to compare it with the incidence in a subset of patients who had undergone radical retropubic prostatectomy (RRP). IH has been reported in 12% to 2...

  19. Gânglio inguinal como única evidência de cancro progressivo do pulmão

    Directory of Open Access Journals (Sweden)

    Zafer Kocak

    2008-09-01

    Full Text Available Resumo: Os tumores que metastizam para os gânglios inguinais têm frequentemente origem nos órgãos genitais e reprodutores, na pele, no recto ou ânus, ou na bexiga 1,2. Há, no entanto, algumas descrições de casos raros de metástases inguinais de tumores localizados acima do diafragma2−5, e apenas três destes apresentavam uma metástase inguinal reconhecida antes da morte. Estes casos estão detalhadamente descritos na literatura médica de língua inglesa3−5. Os tumores primários destes casos eram mesotelioma maligno e carcinomas do conduto salivar e da mama. Descrevemosum caso de carcinoma do pulmão que metastizou para gânglio inguinal, como única evidência de cancro do pulmão progressivo.Rev Port Pneumol 2008; XIV (5: 709-713 Abstact: Tumours that metastasise to groin nodes most frequently originate in genital and reproductive organs, skin, rectum or anus, or urinary bladder 1,2. However, rare cases of inguinal metastases from tumours above the diaphragm have been reported 2−5 and only three of them had an inguinal metastasis which was recognised antemortem and reported in detail in the English medical literature 3−5. The primary tumours of these cases were malignant mesothelioma, salivary duct and breast carcinoma. In this paper, we report a case of carcinoma of the lung metastatic to an inguinal lymph node as the only evidence of progressive lung cancer.Rev Port Pneumol 2008; XIV (5: 709-713 Palavras-chave: Carcinoma do pulmão de não pequenas células, gânglio inguinal, metástase, progressão da doença, Key-words: Non-small cell lung carcinoma, inguinal lymph node, metastasis, disease progression

  20. Diagnostic Laparoscopy as Decision Tool for Re-recurrent Inguinal Hernia Treatment Following Open Anterior and Laparo-Endoscopic Posterior Repair

    Directory of Open Access Journals (Sweden)

    Ferdinand Köckerling

    2017-05-01

    Full Text Available IntroductionThe guidelines of the international hernia societies recommend posterior repair in laparo-endoscopic technique for recurrent inguinal hernia after open anterior mesh repair and, conversely, open anterior repair for recurrence after laparo-endoscopic primary repair. Even when these guidelines are followed, already 1 year after repair a re-recurrence rate of 1–2% must be expected, with that rate rising further in the subsequent years. Accordingly, increasingly more patients with re-recurrence after anterior and posterior mesh implantation must be treated, which constitutes a problem that to date has been investigated in only very few studies. Hence, there are no well-founded recommendations. This paper now presents a number of case reports aimed at identifying the role of explorative laparoscopy as decision tool for re-recurrent inguinal hernia treatment.Patients and methodsBased on three case reports the role of explorative laparoscopy as decision tool for re-recurrent inguinal hernia treatment is presented below.ResultsIn all the three cases described explorative laparoscopy played a key role as decision tool when deciding how best to treat re-recurrence after anterior and posterior inguinal hernia repair. In one case severe adhesions after robotic prostatectomy and in another case correct placement of the mesh in the posterior plane, adhesions from the cecum to the groin region and no definitive finding of a re-recurrence resulted in an open repair. In the third case, an insufficient laparoscopic posterior mesh placement made the re-recurrent TAPP procedure relatively easy.ConclusionExplorative laparoscopy is an important decision tool for re-recurrent inguinal hernia treatment to minimize the risks of the procedure for the patients.

  1. Technical success of the ultrasound-guided supra-inguinal fascia iliaca compartment block in older children and adolescents for hip arthroscopy.

    Science.gov (United States)

    Eastburn, Elizabeth; Hernandez, Maria A; Boretsky, Karen

    2017-11-01

    Hip arthroscopic surgery is performed on older pediatric patients. Fascia iliaca compartment block has proven efficacy in providing analgesia following hip surgery and can be performed with target location of local anesthetic below or above the inguinal ligament. The reported success of ultrasound-guided infra-inguinal fascia iliaca compartment block is lower when compared to traditional landmark technique, while the reliability of supra-inguinal fascia iliaca compartment block is unreported. The primary aim was to report the results in obtaining sensory changes in the distribution of the femoral and lateral femoral cutaneous nerves following supra-inguinal fascia iliaca compartment block in patients undergoing arthroscopic hip surgery. Secondary outcomes are the ability to find echogenic landmarks and to report pain scores and opioid consumption. We reviewed the electronic medical record and regional anesthesia database of patients receiving ultrasound-guided fascia iliaca compartment block for arthroscopic hip surgery. Sensory changes to the femoral and lateral femoral cutaneous nerves were determined. Identification of echogenic landmarks was quantified. Pain scores and opioid consumption were determined. Seventeen patients of mean age 15.4 years old (SD 1.3; range 13-17 years) were included. Sensory changes to both the femoral and lateral femoral cutaneous nerves occurred in 94% of patients (95% CI: 82%-100%). The average volume of ropivacaine 0.2% was 0.53 mL/Kg (SD 0.11 mL/Kg). Echogenic landmarks were identified in all patients. Pain scores and opioid consumption were generally low. A supra-inguinal location for the deposition of local anesthetic when performing fascia iliaca nerve block for hip surgery is reliable in anesthetizing the femoral and lateral femoral cutaneous nerves and should encourage investigation into the clinical efficacy. © 2017 John Wiley & Sons Ltd.

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

    Science.gov (United States)

    Módena, Sérgio Ferreira; Caldeira, Eduardo José; Peres, Marco Antonio O; Andreollo, Nelson Adami

    2016-01-01

    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. To analyze the collagen present in the cremaster muscle in patients with inguinal hernias, focusing the effect of tobacco, alcohol, and diabetes. 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. The area occupied by the connective tissue was higher in groups II and III (ptabaco, o álcool e o diabete. Avaliar o colágeno presente no músculo cremaster em pacientes com hérnias inguinais enfocando o efeito do tabaco, álcool e diabete. Foram estudados 15 pacientes com hérnias inguinais divididos em: grupo I (n=5) controles; grupo II (n=5) indivíduos fumantes e/ou etilistas; e grupo III (n=5) indivíduos que apresentavam diabete melito. Todos foram submetidos à correção cirúrgica das hérnias inguinais obedecendo às mesmas condições pré, intra e pós-operatórias. Durante o procedimento cirúrgico, amostras do músculo cremaster foram coletadas para análises em microscopia de luz polarizada, morfometria do colágeno e de proteínas. A área ocupada por tecido conjuntivo foi maior nos grupos II e III (ptabaco, o álcool e o diabete ocasionam remodelação no músculo cremaster, levando à perda de suporte ou alteração estrutural nesta região, podendo intensificar as ocorrências e os danos relacionados às hérnias inguinais.

  3. Inguinal pain syndrome. The influence of intraoperative local administration of 0.5% bupivacaine on postoperative pain control following Lichtenstein hernioplasty. A prospective case-control study.

    Science.gov (United States)

    Cybułka, Bartosz

    2017-04-30

    With current technological advancement and availability of synthetic materials used in inguinal hernia repair, a recurrence after first intervention is not a common and important adverse event. On the other hand, however, some patients complain about chronic pain of the operated site after surgeries using a polypropylene mesh. Many patients are constrained to a prolonged use of analgesics and increased frequency of control visits, which may eventually result in loss of trust in the operator. Every surgical intervention is associated with the risk of immediate or delayed complications. Genitofemoral neuralgia is associated with dysfunction of peripheral nerves passing through the inguinal canal or the surrounding tissue and it is a chronic, troublesome and undesired complication of an inguinal hernia repair. The possibility of minimizing chronic inguinal pain by proper management during herniorraphy should be considered in all cases of an inguinal canal reconstruction. The aim of the study was to investigate whether an intraoperative injection of 0.5% bupivacaine into the operated site (preemptive analgesia) has an influence on the postoperative pain assessed on the day of operation as well as the 1st and 2nd postoperative day after Lichtenstein hernioplasty of an inguinal, scrotal or recurrent hernia. In the studied population, we attempted to identify risk factors affecting pain level after surgical repair of an inguinal, scrotal or recurrent hernia. During the period between December 2015 and May 2016, 133 patients with preoperative diagnosis of an inguinal (81.95%, n=109), scrotal (13.53%, n=18) or recurrent hernia (4.51%, n=6) underwent an elective intervention and were randomly allocated to the group, which intraoperatively received 20 mL of 0.5% bupivacaine locally in selected anatomical points of the inguinal canal. In the group with preoperative diagnosis of an inguinal hernia, this intervention was applied in 56.88% of cases (n=62). In the case of scrotal

  4. Primary amelanotic malignant melanoma of the male urethra with inguinal lymph node metastasis successfully controlled by nivolumab: A case report

    Directory of Open Access Journals (Sweden)

    Takashi Tokita

    2018-05-01

    Full Text Available We report a rare case of primary amelanotic malignant melanoma of the male urethra. A 65-year-old man with a urethral mass was referred to our hospital. A pathological diagnosis of a biopsy specimen revealed malignant melanoma. Thereafter, the patient underwent partial penectomy. The histopathological diagnosis was amelanotic malignant melanoma of the urethra. The patient had received DAV-Feron in an adjuvant setting; however, PET-CT revealed multiple metastasis. After receiving more than 10 cycles of nivolumab, the accumulation of FDG was no longer observed on PET-CT. The patient is currently free from recurrence at 20 months after nivolumab treatment. Keywords: Melanoma, Urethral neoplasm, Inguinal lymphadenectomy, Nivolumab

  5. Coagulation, inflammatory, and stress responses in a randomized comparison of open and laparoscopic repair of recurrent inguinal hernia

    DEFF Research Database (Denmark)

    Rahr, H B; Bendix, J; Ahlburg, P

    2006-01-01

    BACKGROUND: In previous comparisons of inflammatory and stress responses to open (OR) and laparoscopic (LR) hernia repair, all operations were performed under general anesthesia. Since local anesthesia is widely used for OR, a comparison of this approach with LR seemed relevant. METHODS: Patients...... with recurrent inguinal hernia were randomized to OR under local anesthesia (n = 30) or LR under general anesthesia (n = 31). The magnitude of the surgical trauma was assessed by measuring markers of coagulation (prothrombin fragment 1 + 2), endothelial activation (von Willebrand factor), inflammation...... [leukocytes, interleukin-6, -8 and -10, granulocyte macrophage colony-stimulating factor, and C-reactive protein (CRP)], and endocrine stress (cortisol) in blood collected before operation, 4 h postincision, and on postoperative day 2. RESULTS: Leukocyte counts and interleukin-6 and CRP levels increased...

  6. A randomized comparison of physical performance following laparoscopic and open inguinal hernia repair. The Coala Trial Group.

    Science.gov (United States)

    Liem, M S; van der Graaf, Y; Zwart, R C; Geurts, I; van Vroonhoven, T J

    1997-01-01

    Return to normal activity after laparoscopic inguinal hernia repair has been reported to occur sooner than after conventional repair. As part of a randomized study, the ability of patients to return to normal activity was assessed by measuring abdominal muscular performance with an exercise test. In addition, patients completed a questionnaire concerning activities of daily life (ADL) and were asked when they returned to normal activities. All patients were given similar instructions for resumption of activities. Patients who had a laparoscopic repair returned to normal activities sooner (6 versus 10 days; P = 0.0003). One week after operation, these patients were able to perform more repetitions of both exercise (14 versus two straight leg raises; 16 versus seven curled sit ups; both P < 0.0001) and their ADL scores were significantly better (89 versus 72; P = 0.0001). Laparoscopic hernia repair results in a quicker recovery.

  7. Efficacy of tramadol as a preincisional infiltration anesthetic in children undergoing inguinal hernia repair: a prospective randomized study

    Directory of Open Access Journals (Sweden)

    Numanoğlu KV

    2014-09-01

    Full Text Available Kemal Varim Numanoğlu,1 Hilal Ayoğlu,2 Duygu Tatli,1 Ebubekir Er11Department of Pediatric Surgery, 2Department of Anesthesiology, Faculty of Medicine, Bülent Ecevit University, Kozlu, Zonguldak, TurkeyBackground: Preincisional local anesthetic infiltration at the surgical site is a therapeutic option for postoperative pain relief for pediatric inguinal hernia. Additionally, tramadol has been used as an analgesic for postoperative pain in children. Recently, the local anesthetic effects of tramadol have been reported. The aim of this study was to determine both the systemic analgesic and the local anesthetic effects of tramadol and to determine how it differs from bupivacaine when administered preincisionally.Methods: Fifty-two healthy children, aged 2–7 years, who were scheduled for elective herniorrhaphy were randomly allocated to receive either preincisional infiltration at the surgical site with 2 mg/kg tramadol (Group T, n=26 or 0.25 mL/kg 0.5% bupivacaine (Group B, n=26. At the time of anesthetic administration, perioperative hemodynamic parameters were recorded. The pain assessments were performed 10 minutes after the end of anesthesia and during the first 6-hour period, using pain scores. The time of first dose of analgesia and need for additional analgesia were recorded.Results: Between T and B groups, the anesthesia time, perioperative hemodynamic changes, and pain scores were not statistically different. However, in group B, the postoperative analgesic requirement was higher than in group T.Conclusion: Tramadol shows equal analgesic effect to bupivacaine and decreases additional analgesic requirement, when used for preincisional infiltration anesthesia in children undergoing inguinal herniorrhaphy.Keywords: bupivacaine, postoperative analgesia, pain scores

  8. Open versus robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair: a multicenter matched analysis of clinical outcomes.

    Science.gov (United States)

    Gamagami, R; Dickens, E; Gonzalez, A; D'Amico, L; Richardson, C; Rabaza, J; Kolachalam, R

    2018-04-26

    To compare the perioperative outcomes of initial, consecutive robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair (IHR) cases with consecutive open cases completed by the same surgeons. Multicenter, retrospective, comparative study of perioperative results from open and robotic IHR using standard univariate and multivariate regression analyses for propensity score matched (1:1) cohorts. Seven general surgeons at six institutions contributed 602 consecutive open IHR and 652 consecutive R-TAPP IHR cases. Baseline patient characteristics in the unmatched groups were similar with the exception of previous abdominal surgery and all baseline characteristics were comparable in the matched cohorts. In matched analyses, postoperative complications prior to discharge were comparable. However, from post discharge through 30 days, fewer patients experienced complications in the R-TAPP group than in the open group [4.3% vs 7.7% (p = 0.047)]. The R-TAPP group had no reoperations post discharge through 30 days of follow-up compared with five patients (1.1%) in the open group (p = 0.062), respectively. Multivariate logistic regression analysis which demonstrated patient age > 65 years and the open approach were risk factors for complications within 30 days post discharge in the matched group [age > 65 years: odds ratio (OR) = 3.33 (95% CI 1.89, 5.87; p open approach: OR = 1.89 (95% CI 1.05, 3.38; p = 0.031)]. In this matched analysis, R-TAPP provides similar postoperative complications prior to discharge and a lower rate of postoperative complications through 30 days compared to open repair. R-TAPP is a promising and reproducible approach, and may facilitate adoption of minimally invasive repairs of inguinal hernias.

  9. Lymphoscintigraphy of a patient with secondary leg lymphoedema provides evidence for the existence of axillo-inguinal anastomotic pathways

    International Nuclear Information System (INIS)

    Peter, D.T.; Piller, N.B.; Goodear, M.

    1999-01-01

    Full text: The aim of treatment for lymphoedema is to open collateral pathways to allow lymph to pass any blocked or restricted region and to move across watershed areas. These areas and drainage territories have been postulated by Foldi and Kubic. Some groups have stated that in over 400 lymphoscintigrams they have not been able to corroborate tracer collateral pathways. However, we have been able to demonstrate the existence of axillo-inguinal anastomotic pathways. A 37-year-old female presented with leg oedema subsequent to a total abdominal hysterectomy and radiotherapy Lymphoscintigraphy was requested to assess lymphatic drainage of both legs to assist optimization of treatment. 99 Tc m -antimony trisulphide colloid was injected at each of four sites intra-dermally, in the first inter-digital space and latero-dorsal areas of each foot. Anterior images, these being from the feet to above the liver, were then performed at 40, 85, 180 and 307 min post-injection. From 40 min, and continuing throughout the study, isotope distribution representing dermal diffusion was seen throughout both limbs up to and including the pelvic area. Tracer was first observed in the axillary region at 85 min and at that time clear superficial anastomotic pathways were observable. The axillary nodes continued to appear throughout the rest of the study. As important as it was to localize the areas of dermal diffusion and lymphatic pathways in the lower limbs, the most significant discovery in this instance was the confirmation of the axillo-inguinal anastomotic pathways previously postulated by Foldi and Kubic. This should help to increase the confidence of those professionals involved in the treatment of lymphoedema

  10. Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature.

    Science.gov (United States)

    Wauschkuhn, Constantin Aurel; Schwarz, Jochen; Boekeler, Ulf; Bittner, Reinhard

    2010-12-01

    Advantages and disadvantages of open and endoscopic hernia surgery are still being discussed. Until now there has been no study that evaluated the advantages and disadvantages of bilateral hernia repair in a large number of patients. Our prospectively collected database was analyzed to compare the results of laparoscopic bilateral with laparoscopic unilateral hernia repair. We then compared these results with the results of a literature review regarding open and laparoscopic bilateral hernia repair. From April 1993 to December 2007 there were 7240 patients with unilateral primary hernia (PH) and 2880 patients with bilateral hernia (5760 hernias) who underwent laparoscopic transabdominal preperitoneal patch plastic (TAPP). Of the 10,120 patients, 28.5% had bilateral hernias. Adjusted for the number of patients operated on, the mean duration of surgery for unilateral hernia repair was shorter than that for bilateral repair (45 vs. 70 min), but period of disability (14 vs. 14 days) was the same. Adjusted for the number of hernias repaired, morbidity (1.9 vs. 1.4%), reoperation (0.5 vs. 0.43%), and recurrence rate (0.63 vs. 0.42%) were similar for unilateral versus bilateral repair, respectively. The review of the literature shows a significantly shorter time out of work after laparoscopic bilateral repair than after the bilateral open approach. Simultaneous laparoscopic repair of bilateral inguinal hernias does not increase the risk for the patient and has an equal length of down time compared with unilateral repair. According to literature, recovery after laparoscopic repair is faster than after open simultaneous repair. Laparoscopic/endoscopic inguinal hernia repair of bilateral hernias should be recommended as the gold standard.

  11. Laparoscopic versus open inguinal hernia repair in patients with obesity: an American College of Surgeons NSQIP clinical outcomes analysis.

    Science.gov (United States)

    Froylich, Dvir; Haskins, Ivy N; Aminian, Ali; O'Rourke, Colin P; Khorgami, Zhamak; Boules, Mena; Sharma, Gautam; Brethauer, Stacy A; Schauer, Phillip R; Rosen, Michael J

    2017-03-01

    The laparoscopic approach to inguinal hernia repair (IHR) has proven beneficial in reducing postoperative pain and facilitating earlier return to normal activity. Except for indications such as recurrent or bilateral inguinal hernias, there remains a paucity of data that specifically identities patient populations that would benefit most from the laparoscopic approach to IHR. Nevertheless, previous experience has shown that obese patients have increased wound morbidity following open surgical procedures. The aim of this study was to investigate the effect of a laparoscopic versus open surgical approach to IHR on early postoperative morbidity and mortality in the obese population using the National Surgical Quality Improvement Program (NSQIP) database. All IHRs were identified within the NSQIP database from 2005 to 2013. Obesity was defined as a body mass index ≥30 kg/m 2 . A propensity score matching technique between the laparoscopic and open approaches was used. Association of obesity with postoperative outcomes was investigated using an adjusted and unadjusted model based on clinically important preoperative variables identified by the propensity scoring system. A total of 7346 patients met inclusion criteria; 5573 patients underwent laparoscopic IHR, while 1773 patients underwent open IHR. On univariate analysis, obese patients who underwent laparoscopic IHR were less likely to experience a deep surgical site infection, wound dehiscence, or return to the operating room compared with those who underwent an open IHR. In both the adjusted and unadjusted propensity score models, there was no difference in outcomes between those who underwent laparoscopic versus open IHR. The laparoscopic approach to IHR in obese patients has similar outcomes as an open approach with regard to 30-day wound events. Preoperative risk stratification of obese patients is important to determining the appropriate surgical approach to IHR. Further studies are needed to investigate the

  12. Refinamientos en la reconstrucción del tercio superior auricular con la técnica de Davis: Estudio anatómico y serie clínica Refinements on reconstruction of auricular upper pole defects with Davi's technique: Anatomical study and clinical series

    Directory of Open Access Journals (Sweden)

    S. Llanos

    2009-06-01

    Full Text Available Los defectos del tercio superior auricular son un desafío reconstructivo. Están descritas diferentes técnicas quirúrgicas para este fin con resultados a veces desfavorables Realizamos un estudio anatómico en cadáveres frescos que mostró la presencia constante de un pedículo neurovascular que penetra la raíz del hélix. Mostramos la localización y los diámetros de los vasos. Basándonos en este estudio anatómico, presentamos una serie de 10 casos consecutivos tratados por el autor principal. Analizamos la etiología, técnica quirúrgica, complicaciones y resultado a largo plazo. La técnica del autor introduce refinamientos a la técnica de Davis, el cual usa un colgajo condrocutáneo de concha auricular basado en la rama superior de la arteria temporal superficial y un colgajo cutáneo axial de base superior basado en la arteria retroauricular, para crear el nuevo hélix auricular superior. El aspecto posterior de este colgajo condrocutáneo se cubre con un injerto de piel total. En un segundo tiempo empleamos una zetaplastia de la base del hélix que nos dará una mejor forma. El estudio anatómico demostró la presencia de un pedículo neurovascular que penetra la raíz del hélix. La serie clínica está compuesta por 8 defectos postraumáticos, una quemadura eléctrica y un tumor de piel. Todos los colgajos condrocutáneos de concha auricular sobrevivieron comprobándose la seguridad del pedículo del hélix. Dos colgajos retroauriculares presentaron sufrimiento vascular transitorio distal, uno de ellos con recuperación completa y otro con necrosis distal mínima. Dos casos sufrieron pérdida parcial del injerto de piel total. Durante el desarrollo de la serie descubrimos algunos detalles de la técnica quirúrgica, que ahora discutimos en el artículo. Todos los pacientes recuperaron el contorno auricular, obteniendo los mejores resultados en aquellos en los que se aplicaron los refinamientos descritos. En conclusión, creemos

  13. Value and efficiency of sentinel lymph node diagnostics in patients with penile carcinoma with palpable inguinal lymph nodes as a new multimodal, minimally invasive approach

    Energy Technology Data Exchange (ETDEWEB)

    Luetzen, Ulf; Zuhayra, Maaz; Marx, Marlies; Zhao, Yi [University Hospital Schleswig Holstein, Campus Kiel, Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, Kiel (Germany); Colberg, Christian; Knuepfer, Stephanie; Juenemann, Klaus-Peter; Naumann, Carsten Maik [University Hospital Schleswig Holstein, Campus Kiel, Department of Urology and Pediatric Urology, Kiel (Germany); Baumann, Rene [University Hospital Schleswig Holstein, Campus Kiel, Department of Radio Oncology, Kiel (Germany); Kaehler, Katharina Charlotte [University Hospital Schleswig Holstein, Campus Kiel, Department of Dermatology, Venerology and Allergology, Kiel (Germany)

    2016-12-15

    The international guidelines recommend sentinel lymph node biopsy (SLNB) for lymph node staging in penile cancer with non-palpable inguinal lymph nodes (LN) but it is not recommended with palpable inguinal LN. The aim of this study was to evaluate the reliability and morbidity of SLNB in combination with an ultrasound-guided resection of suspect inguinal LNs as a new multimodal, minimally invasive staging approach in these patients. We performed SLNB in 26 penile cancer patients with 42 palpable inguinal LNs. Prior to the combined staging procedures the patients underwent an ultrasound examination of the groins as well as planar lymphatic drainage scintigraphy and SPECT/CT scans. During the surgical procedure, the radioactive-labelled sentinel lymph nodes and, in addition, sonographically suspect LNs, were resected under ultrasound guidance. Follow-up screening was done by ultrasound examination of the groins according to the guidelines of the European Association of Urology. Nineteen groins of 42 preoperatively palpable inguinal findings were histologically tumor-positive. SLNB alone showed lymphogenic metastases in 14 groins. Sonography revealed five further metastatic groins, which would not have been detected during SLNB due to a tumor-related blockage of lymphatic drainage or a so-called re-routing of the tracer. During follow-up, none of the 28 groins with tumor-negative LN status showed any LN recurrence in this combined investigation technique. The median follow-up period was 46 (24 to 92) months. Morbidity of this procedure was low at 4.76 % in relation to the number of groins resp. 7.69 % in relation to the number of patients. The results show that this combined procedure is a reliable multimodal diagnostic approach for treatment of penile cancer patients with palpable inguinal LNs. It is associated with low morbidity rates. SLNB alone would lead to a significantly higher false-negative rate in these patients. The encouraging results of this work can

  14. Resultados de los primeros casos de craneoplastia con tela de titanio y colgajo galeal bipediculado postraumatismo craneano Resultados dos primeiros casos da cranioplastia com tela de titânio e retalho galeal bipediculado pós-trauma crânio-encefálico Results of first cases of craneoplasty with titanium mesh and galeal bipediculated flap after craneal trauma

    Directory of Open Access Journals (Sweden)

    L. Dos Santos Fonseca

    2010-03-01

    Full Text Available La causa más frecuente de una solución de continuidad de los huesos de la calota craneana es un traumatismo craneoencefálico grave. La reparación de la misma es lo que conocemos como craneoplastia. El objetivo de nuestro artículo es presentar nuestros primeros resultados de craneoplastia con tela de titanio y colgajo galeal bipediculado. A través de un estudio retrospectivo, descriptivo, tipo serie de casos, relatamos los resultados de nuestra experiencia en craneoplastia con tela de titanio y colgajo sobre 10 pacientes operados entre Enero y Octubre de 2007, tras valoración con Tomografía Computerizada, de los cuales el 90% fueron de sexo masculino y con una edad media de 29,9 años. El tiempo medio de internamiento hospitalario fue de 10,3 días. Tuvimos un caso de complicación y una reintervención por desplazamiento de la tela de titanio a los 4 meses. Todos los pacientes quedaron satisfechos con los resultados. Como conclusión, la craneoplastia con tela de titanio asociada a colgajo galeal bipediculado es un procedimiento eficaz y viable dentro de la red pública hospitalaria.A falta de continuidade entre ossos da calota craniana é mais frequentemente causada por trauma crânio-encefálico grave. A reparação dessas deformidades é conhecida como cranioplastia. Objetivo: Avaliar os resultados dos primeiros casos da cranioplastia com tela de titânio e retalho galeal bipediculado. Por meio de estudo retrospectivo, descritivo, tipo série de casos, relatam-se os resultados de cranioplastia com tela de titânio e retalho a que 10 pacientes foram submetidos, entre Janeiro a Outubro de 2007, após avaliação por tomografia computadorizada, sendo 90% do sexo masculino, com média de idade de 29,9 anos. O tempo médio de internamento foi de 10,3 dias. Houve uma complicação e uma reoperação por deslocamento da tela após quatro meses. Todos os pacientes ficaram satisfeitos com os resultados. Conclusão: A cranioplastia com tela de

  15. Mesh fixation with glue versus suture for chronic pain and recurrence in Lichtenstein inguinal hernioplasty.

    Science.gov (United States)

    Sun, Ping; Cheng, Xiang; Deng, Shichang; Hu, Qinggang; Sun, Yi; Zheng, Qichang

    2017-02-07

    Chronic pain following mesh-based inguinal hernia repair is frequently reported, and has a significant impact on quality of life. Whether mesh fixation with glue can reduce chronic pain without increasing the recurrence rate is still controversial. To determine whether tissue adhesives can reduce postoperative complications, especially chronic pain, with no increase in recurrence rate, compared with sutures for mesh fixation in Lichtenstein hernia repair. We searched the following electronic databases with no language restrictions: the Cochrane Central Register of Controlled Trials (CENTRAL; issue 4, 2016) in the Cochrane Library (searched 11 May 2016), MEDLINE Ovid (1986 to 11 May 2016), Embase Ovid (1986 to 11 May 2016), Science Citation Index (Web of Science) (1986 to 11 May 2016), CBM (Chinese Biomedical Database), CNKI (China National Knowledge Infrastructure), VIP (a full-text database in China), Wanfang databases. We also checked reference lists of identified papers (included studies and relevant reviews). We included all randomised and quasi-randomised controlled trials comparing glue versus sutures for mesh fixation in Lichtenstein hernia repair. Cluster-RCTs were also eligible. Two review authors extracted data and assessed the risk of bias independently. Dichotomous outcomes were expressed as odds ratio (OR) with 95% confidence intervals (CI). Continuous outcomes were expressed as mean differences (MD) with 95% CIs. Twelve trials with a total of 1932 participants were included in this review. The overall postoperative chronic pain in the glue group was reduced by 37% (OR 0.63, 95% CI 0.44 to 0.91; 10 studies, 1418 participants, low-quality evidence) compared with the suture group. However, the results changed when we conducted subgroup analysis with regard to the type of mesh. Subgroup analysis of included studies using lightweight mesh showed the reduction of chronic pain was less profound and insignificant (OR 0.77, 95% CI 0.50 to 1.17). Subgroup

  16. Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on the role of type of repair

    DEFF Research Database (Denmark)

    Bisgaard, Thue; Bay-Nielsen, M.; Kehlet, H.

    2008-01-01

    the surgical strategy and results after recurrent inguinal hernia repairs. METHODS: Prospective recording of all primary and subsequent recurrent inguinal hernia repairs from January 1, 1998 to December 31, 2005, in the national Danish Hernia Database, using the reoperation rate as a proxy for recurrence...... = 1124) was significantly reduced after laparoscopic operation for recurrence (1.3% (95% CI: 0.4-3.0)) compared with open repairs for recurrence (Lichtenstein 11.3% (8.2-15.2), nonmesh 19.2% (14.0-25.4), mesh (non-Lichtenstein) 7.2% (4.0 - 11.8)). After primary nonmesh (n = 616), non-Lichtenstein mesh (n...... = 277), and laparoscopic repair (n = 100) there was no significant difference in re-reoperation rates between a laparoscopic repair and all open techniques of repair for recurrence. CONCLUSION: Laparoscopic repair is recommended for reoperation of a recurrence after primary open Lichtenstein repair...

  17. Ruptured Hemorrhagic Ovarian Cyst Presenting as an Incarcerated Inguinal Hernia in an Adult Female: A Rare Clinical Scenario of a Common Surgical Emergency

    Directory of Open Access Journals (Sweden)

    Priyadarshan Anand Jategaonkar

    2013-01-01

    Full Text Available Embryoanatomical peculiarities are responsible for low occurrence of inguinal hernias in females. Amongst them, ovarian hernias are rarer. They are commonly noticed in children. An attending surgeon commonly faces diagnostic and operative dilemmas in managing these overtly “simple-looking” clinical scenarios. Although ovarian cysts are one of the common contents of the sac, we report a case of adult incarcerated ovarian hernia who presented with a ruptured hemorrhagic ovarian cyst. This differential should be kept in mind while treating an adult female with painful inguinal swelling. As far our knowledge goes, such case with ruptured ovarian cyst presenting as an incarcerated hernia in an emergency scenario has not been reported as yet.

  18. Double autologous lymph node transplantation (ALNT) at the level of the knee and inguinal region for advanced lymphoedema of the lower limb (elephantiasis).

    Science.gov (United States)

    Gómez Martín, C; Murillo, C; Maldonado, A A; Cristóbal, L; Fernández-Cañamaque, J L

    2014-02-01

    Primary lower-limb lymphoedema is a chronic, progressive and debilitating condition with a difficult management, especially in advanced cases (elephantiasis). Recently, autologous lymph node transplantation (ALNT) appears to be a promising treatment for extremity lymphoedema. A case of a double ALNT for an advanced primary lower-limb lymphoedema is here reported: a contralateral inguinal lymph node flap was transferred to the knee and, in a second surgery, a thoracic lymph node flap was transplanted to the inguinal region. Clinical outcomes at 5 months postoperatively are very satisfactory with reduction in limb circumferences and improvement in skin quality and social impairment. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  19. The inguinal lymphadenectomy in the management of penile cancer in Costa Rica, the experience of a center between the years 2003 to 2012

    International Nuclear Information System (INIS)

    Vasquez Chaves, Laura Leticia

    2013-01-01

    The neoplasm of the penis has been a disease few frequent and without studies to indicate which is the reality of patients with epidermoid cell carcinoma of the penis that are subjected to inguinal lymphadenectomy. The results of this disease as regards the healing and complications derived from the surgical procedure are described by means of a retrospective design based on review of clinical records. The management of epidermoid cell carcinoma of the penis is analyzed to determine the characteristics of patients and the results of the inguinal lymphadenectomy between the year 2003 and the year 2012 in a hospital in Costa Rica. Men diagnosed with epidermoid cell carcinoma of the penis has been the population to which the study was performed after resection of the primary tumor [es

  20. A comparative study on trans-umbilical single-port laparoscopic approach versus conventional repair for incarcerated inguinal hernia in children

    OpenAIRE

    Jun, Zhang; Juntao, Ge; Shuli, Liu; Li, Long

    2016-01-01

    Purpose: The purpose of this study is to determine whether singleport laparoscopic repair (SLR) for incarcerated inguinal hernia in children is superior toconventional repair (CR) approaches. Method: Between March 2013 and September 2013, 126 infants and children treatedwere retrospectively reviewed. All the patients were divided into three groups. Group A (48 patients) underwent trans-umbilical SLR, group B (36 patients) was subjected to trans-umbilical conventional two-port laparoscopic rep...

  1. Lichtenstein Mesh Repair (LMR) v/s Modified Bassini’s Repair (MBR) + Lichtenstein Mesh Repair of Direct Inguinal Hernias in Rural Population – A Comparative Study

    Science.gov (United States)

    Patil, Santosh M; Kumar, Ashok; Kumar, Kuthadi Sravan; Mithun, Gorre

    2016-01-01

    Introduction Lichtenstein’s tension free mesh hernioplasty is the commonly done open technique for inguinal hernias. As our hospital is in rural area, majority of patients are labourers, open hernias are commonly done. The present study was done by comparing Lichtenstein Mesh Repair (LMR) v/s Modified Bassini’s repair (MBR) + Lichtenstein mesh repair (LMR) of direct Inguinal Hernias to compare the technique of both surgeries and its outcome like postoperative complications and recurrence rate. Materials and Methods A comparative randomized study was conducted on patients reporting to MNR hospital, sangareddy with direct inguinal hernias. A total of fifty consecutive patients were included in this study of which, 25 patients were operated by LMR and 25 patients were operated by MBR+LMR and followed up for a period of two years. The outcomes of the both techniques were compared. Results Study involved 25 each of Lichtenstein’s mesh repair (LMR) and modified bassini’s repair (MBR) + LMR, over a period of 2 years. The duration of surgery for lichtenstein mesh repair is around 34.56 min compared to LMR+MBR, which is 47.56 min which was statistically significant (p-value is MBR group in POD 1, but not statistically significant (p-value is 0.0949) and from POD 7 the pain was almost similar in both groups. The recurrence rate is 2% for LMR and 0% for MBR+LMR. Conclusion LMR+MBR was comparatively better than only LMR in all direct inguinal hernias because of low recurrence rate (0%) and low postoperative complications, which showed in our present study. PMID:27042517

  2. Lichtenstein Mesh Repair (LMR) v/s Modified Bassini's Repair (MBR) + Lichtenstein Mesh Repair of Direct Inguinal Hernias in Rural Population - A Comparative Study.

    Science.gov (United States)

    Patil, Santosh M; Gurujala, Avinash; Kumar, Ashok; Kumar, Kuthadi Sravan; Mithun, Gorre

    2016-02-01

    Lichtenstein's tension free mesh hernioplasty is the commonly done open technique for inguinal hernias. As our hospital is in rural area, majority of patients are labourers, open hernias are commonly done. The present study was done by comparing Lichtenstein Mesh Repair (LMR) v/s Modified Bassini's repair (MBR) + Lichtenstein mesh repair (LMR) of direct Inguinal Hernias to compare the technique of both surgeries and its outcome like postoperative complications and recurrence rate. A comparative randomized study was conducted on patients reporting to MNR hospital, sangareddy with direct inguinal hernias. A total of fifty consecutive patients were included in this study of which, 25 patients were operated by LMR and 25 patients were operated by MBR+LMR and followed up for a period of two years. The outcomes of the both techniques were compared. Study involved 25 each of Lichtenstein's mesh repair (LMR) and modified bassini's repair (MBR) + LMR, over a period of 2 years. The duration of surgery for lichtenstein mesh repair is around 34.56 min compared to LMR+MBR, which is 47.56 min which was statistically significant (p-value is MBR group in POD 1, but not statistically significant (p-value is 0.0949) and from POD 7 the pain was almost similar in both groups. The recurrence rate is 2% for LMR and 0% for MBR+LMR. LMR+MBR was comparatively better than only LMR in all direct inguinal hernias because of low recurrence rate (0%) and low postoperative complications, which showed in our present study.

  3. Anorectal and inguinal lymphogranuloma venereum among men who have sex with men in Amsterdam, The Netherlands: trends over time, symptomatology and concurrent infections.

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    de Vrieze, Nynke Hesselina Neeltje; van Rooijen, Martijn; Schim van der Loeff, Maarten Franciscus; de Vries, Henry John C

    2013-11-01

    To examine lymphogranuloma venereum (LGV) trends over time among men who have sex with men (MSM) visiting the Amsterdam sexually transmitted infection (STI) clinic; to investigate anal LGV symptomatology; and to examine the positivity and characteristics of anorectal and inguinal LGV. We included MSM consultations from whom a swab (from anorectum, bubo or an genital ulcer) was taken for Chlamydia trachomatis (Ct) screening. Anorectal swabs were taken from all MSM who reported receptive anorectal intercourse in the preceding 6 months. Ct positive samples were further tested with a pmpH PCR to identify L-genovars. Patient symptoms, clinical and anoscopic inflammatory signs, and STI co-infections were noted; Gram-stained anorectal mucosal smears were examined. Between January 2005 and June 2012, 48 570 consultations among MSM were conducted. In 3628/35 650 visits, anorectal Ct infections were diagnosed, including 411 anal LGV (1.2%). Moreover, 65/1649 genital ulcer swabs were Ct positive; 10 were inguinal LGV (0.6%) Since January 2011 a significant increase in the positivity of LGV occurred (p<0.0001). 89 (27.2%) anorectal LGV cases were asymptomatic. HIV prevalence among anorectal LGV cases was significantly higher (p=0.008) than among inguinal LGV cases. STI co-morbidity in anorectal LGV cases remained invariably high during the study period. Since January 2011, LGV positivity in MSM consultations in Amsterdam has risen significantly. The great majority comprise anal LGV; inguinal LGV is rare. Anal LGV is asymptomatic in a quarter of cases. In all MSM with anal Ct infections LGV should be excluded, irrespective of symptoms or inflammatory signs.

  4. A New Proposal for Learning Curve of TEP Inguinal Hernia Repair: Ability to Complete Operation Endoscopically as a First Phase of Learning Curve

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    Mustafa Hasbahceci

    2014-01-01

    Full Text Available Background. The exact nature of learning curve of totally extraperitoneal inguinal hernia and the number required to master this technique remain controversial. Patients and Methods. We present a retrospective review of a single surgeon experience on patients who underwent totally extraperitoneal inguinal hernia repair. Results. There were 42 hernias (22 left- and 20 right-sided in 39 patients with a mean age of 48.8±15.1 years. Indirect, direct, and combined hernias were present in 18, 12, and 12 cases, respectively. The mean operative time was 55.1±22.8 minutes. Peritoneal injury occurred in 9 cases (21.4%. Conversion to open surgery was necessitated in 7 cases (16.7%. After grouping of all patients into two groups as cases between 1–21 and 22–42, it was seen that the majority of peritoneal injuries (7 out of 9, 77.8%, P=0.130 and all conversions (P=0.001 occurred in the first 21 cases. Conclusions. Learning curve of totally extraperitoneal inguinal hernia repair can be divided into two consequent steps: immediate and late. At least 20 operations are required for gaining anatomical knowledge and surgical pitfalls based on the ability to perform this operation without conversion during immediate phase.

  5. A feasibility of single-incision laparoscopic percutaneous extraperitoneal closure for treatment of incarcerated inguinal hernia in children: our preliminary outcome and review of the literature.

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    Murase, Naruhiko; Uchida, Hiroo; Seki, Takashi; Hiramatsu, Kiyoshi

    2016-02-01

    The purpose of this study is to examine the feasibility of single-incision laparoscopic percutaneous extraperitoneal closure (LPEC) for incarcerated inguinal hernia (IIH) repair. 6 single-incision LPEC procedures were performed for IIH repair and 60 procedures were performed for reducible inguinal hernia (RIH) in the same period of time in one hospital. The laparoscope and one pair of grasping forceps were placed through the same umbilical incision. In IIH repair, the herniated organ was gently pulled using the grasping forceps with external manual pressure. If it was difficult to reduce the herniated organ with one pair of forceps, another pair of forceps were inserted through a multi-channel port without extending the umbilical incidion. Using the LPEC needle, the hernia orifice was closed extraperitoneally. We performed a retrospective analysis to compare the outcomes of single-incision LPEC for IIH repair or reducible inguinal hernia. All procedures were completed by single-incision without open conversion. A multi-channel port with another pair of forceps was needed in three cases. The operation time and the length of stay were significantly longer with IIH repair than with RIH repair. There were no major complications and there was no evidence of early recurrence in any patient. In conclusion, single-incision LPEC with a multi-channel port is feasible and safe for IIH repair.

  6. Potencial del Agua del suelo

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    Bustamante Heliodoro

    1986-12-01

    Full Text Available La energía potencial del agua presenta diferencias de un punto del suelo a otro; esas diferencias son las que originan el movimiento del agua de acuerdo a la tendencia universal de la materia en el sentido de moverse de donde la energía potencial es mayor a donde dicha energía es menor. En el suelo el agua en consecuencia se mueve hacia donde su energía decrece hasta lograr su estado de equilibrio. Se desprende entonces que la cantidad de energía potencial absoluta contenida en el agua, no es importante por sí misma, sino por su relación con la energía en diferentes lugares dentro del suelo. El concepto Potencial de agua del suelo es un criterio para esta energía.

  7. A Comparison of Three Different Volumes of Levobupivacaine for Caudal Block in Children Undergoing Orchidopexy and Inguinal Hernia Repair.

    Science.gov (United States)

    Marjanovic, Vesna; Budic, Ivana; Stevic, Marija; Simic, Dusica

    2017-01-01

    The aim of this study was to compare the efficacy of 3 different volumes of 0.25% levobupivacaine caudally administered on the effect of intra- and postoperative analgesia in children undergoing orchidopexy and inguinal hernia repair. Forty children, aged 1-7 years, American Society of Anesthesiologists (ASA) physical status I and II, were randomized into 3 different groups according to the applied volumes of 0.25% levobupivacaine: group 1 (n = 13): 0.6 mL∙kg-1; group 2 (n = 10): 0.8 mL∙kg-1; and group 3 (n = 17): 1.0 mL∙kg-1. The age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage, and addition of intraoperative fentanyl were compared among the groups. The time to first use of the analgesic and the number of patients who required analgesic 24 h after surgery in the time intervals within 6 h, between 6 and 12 h, and between 12 and 24 h postoperatively were evaluated among the groups. Statistical analyses were performed with a Dunnett t test, ANOVA, or Kruskal-Wallis test and χ2 test. Logistic regression analysis was used in order to examine predictive factors on duration of postoperative analgesia. Age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage, and addition of intraoperative fentanyl were similar among the groups. The time to first analgesic use did not differ among the groups, and logistic regression modelling showed that using the 3 different volumes of levobupivacaine had no predictive influence on duration of postoperative analgesia. The numbers of patients who required analgesics within 6 h (3/2/3), between 6 and 12 h (3/1/3), and between 12 and 24 h (1/0/2) after surgery were similar among the groups. The 3 different volumes of 0.25% levobupivacaine provided the same quality of intra- and postoperative pain relief in pediatric patients undergoing orchidopexy and inguinal hernia repair. © 2017 S. Karger AG, Basel.

  8. Evaluation of a single-dose of intravenous magnesium sulphate for prevention of postoperative pain after inguinal surgery

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    Shashi Kiran

    2011-01-01

    Full Text Available This study was undertaken to study efficacy of single dose of intravenous magnesium sulphate to reduce post-operative pain in patients undergoing inguinal surgery. One hundred patients undergoing inguinal surgery were divided randomly in two groups of 50 each. The patients of magnesium sulphate group (Group-I received magnesium sulphate 50 mg/kg in 250 ml of isotonic sodium chloride solution IV whereas patients in control group (Group-II received same volume of isotonic sodium chloride over 30 minutes preoperatively. Anaesthesia was induced with propofol (2 mg/kg and pethidine (1 mg/kg. Atracurium besylate (0.5 mg/kg was given to facilitate insertion of LMA. Pain at emergence from anaesthesia and 2, 4, 6, 12 and 24 hours after surgery was evaluated. The timing and dosage of rescue analgesic during first 24 hrs after operation was noted. Pain in postop period was significantly lower in magnesium sulphate group in comparison to control group at emergence from anaesthesia and 2, 4, 6, 12 and 24 hrs postop [1.86 vs. 1.96 (P=0.138, 1.22 vs. 1.82 (P=0.001, 1.32 vs. 1.88 (P=0.000, 2.74 vs. 3.84 (P=0.000, 1.36 vs. 2.00 (P=0.000 and 0.78 vs 1.30 (P=0.000, respectively]. Patients in group-I were more sedated as compared to group-II [sedation score 1.86 vs. 1.40 (P=0.000]. Rescue analgesia requirement postoperatively in first 4, 8 and 16 hrs was significantly lower in patients of group-1 than in group- II [1.9 vs. 3.8 (P<0.05, 25.50 vs. 52.50 (P<0.05 and 0.000 vs. 7.5 (P<0.05]. Preoperative magnesium sulphate infusion decreases postop pain and requirement of rescue analgesia.

  9. Tratamento de linfocele inguinal pós-operatória com injeção de cola de fibrina: relato de caso Treatment of postoperative inguinal lymphocele with fibrin glue injection: case report

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    Priscila Nunes Boaventura

    2007-06-01

    Full Text Available O paciente desenvolveu linforragia na região inguinal direita, depois de ponte aorto-bifemoral com enxerto de dácron®. Não respondeu ao tratamento conservador com cuidados locais e compressão. Foi realizado exame de ultra-sonografia Doppler, que evidenciou grande linfocele (6,4 x 3,36 x 6,1 cm, tratada pelo esvaziamento da loja por aspiração e injeção de cola de fibrina (1,6 mL em seu interior. O paciente se recuperou sem intercorrências e sem recidiva, após 3 meses de seguimento.The patient developed lymphatic drainage in the right groin after an aortobifemoral bypass with Dacron® graft. Conservative treatment with local wound care and compression was unsuccessful. Duplex scan showed a 6.4 x 3.36 x 6.1 cm lymphocele, which was treated by aspiration and injection of fibrin glue (1.6 mL. The patient recovered uneventfully and without recurrence after a 3-month follow-up.

  10. Trauma inguinal penetrante com formação de fístula arteriovenosa e pseudoaneurisma: relato de caso

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    Frederico Michelino de Oliveira

    2015-12-01

    Full Text Available Resumo Os autores apresentam um relato de caso de vítima de acidente de trabalho com ferimento penetrante em região inguinal direita com peça metálica em espiral, que evoluiu com fístula arteriovenosa da artéria femoral profunda com a veia femoral profunda associado a pseudoaneurisma envolvendo essas estruturas e a veia femoral comum. As fístulas arteriovenosas ocorrem frequentemente após traumas e a associação com pseudoaneurisma é fato raro, devendo ser tratadas precocemente após seu diagnóstico. O ultrassom duplex é atualmente o exame mais utilizado para a avaliação inicial e a arteriografia, o padrão ouro para diagnóstico. No paciente em questão foi realizado tratamento convencional com abordagem cirúrgica direta, sutura arterial e ligaduras venosas. Entretanto, nos dias atuais a cirurgia endovascular e a compressão guiada por ultrassom são métodos terapêuticos que têm sido utilizados com sucesso. O paciente evoluiu sem intercorrência, recebendo alta para acompanhamento ambulatorial com preservação do membro.

  11. Subcutaneous inguinal white adipose tissue is responsive to, but dispensable for, the metabolic health benefits of exercise.

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    Peppler, Willem T; Townsend, Logan K; Knuth, Carly M; Foster, Michelle T; Wright, David C

    2018-01-01

    Exercise training has robust effects on subcutaneous inguinal white adipose tissue (iWAT), characterized by a shift to a brown adipose tissue (BAT)-like phenotype. Consistent with this, transplantation of exercise-trained iWAT into sedentary rodents activates thermogenesis and improves glucose homeostasis, suggesting that iWAT metabolism may contribute to the beneficial effects of exercise. However, it is yet to be determined if adaptations in iWAT are necessary for the beneficial systemic effects of exercise. To test this, male C57BL/6 mice were provided access to voluntary wheel running (VWR) or remained as a cage control (SED) for 11 nights after iWAT removal via lipectomy (LIPX) or SHAM surgery. We found that SHAM and LIPX mice with access to VWR ran similar distances and had comparable reductions in body mass, increased food intake, and increased respiratory exchange ratio (RER). Further, VWR improved indexes of glucose homeostasis and insulin tolerance in both SHAM and LIPX mice. The lack of effect of LIPX in the response to VWR was not explained by compensatory increases in markers of mitochondrial biogenesis and thermogenesis in skeletal muscle, epididymal white adipose tissue, or interscapular brown adipose tissue. Together, these data demonstrate that mice with and without iWAT have comparable adaptations to VWR, suggesting that iWAT may be dispensable for the metabolic health benefits of exercise.

  12. Understanding the Inguinal Sinus in Sheep (Ovis aries—Morphology, Secretion, and Expression of Progesterone, Estrogens, and Prolactin Receptors

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    Graça Alexandre-Pires

    2017-07-01

    Full Text Available Post-parturient behavior of mammalian females is essential for early parent–offspring contact. After delivery, lambs need to ingest colostrum for obtaining the related immunological protection, and early interactions between the mother and the lamb are crucial. Despite visual and auditory cues, olfactory cues are decisive in lamb orientation to the mammary gland. In sheep, the inguinal sinus is located bilaterally near the mammary gland as a skin pouch (IGS that presents a gland that secretes a strong-smelling wax. Sheep IGS gland functions have many aspects under evaluation. The objective of the present study was to evaluate sheep IGS gland functional aspects and mRNA transcription and the protein expression of several hormone receptors, such as progesterone receptor (PGR, estrogen receptor 1 (ESR1, and 2 (ESR2 and prolactin receptor (PRLR present. In addition, another aim was to achieve information about IGS ultrastructure and chemical compounds produced in this gland. All hormone receptors evaluated show expression in IGS during the estrous cycle (follicular/luteal phases, pregnancy, and the post-partum period. IGS secretion is rich in triterpenoids that totally differ from the surrounding skin. They might be essential substances for the development of an olfactory preference of newborns to their mothers.

  13. Gender-related differences of inguinal hernia and asymptomatic patent processus vaginalis in term and preterm infants.

    Science.gov (United States)

    Burgmeier, Christine; Dreyhaupt, Jens; Schier, Felix

    2015-03-01

    The aim of this study was to analyze the gender-related differences of inguinal hernia (IH) and patent processus vaginalis (PPV) in term and preterm infants. Over a nine-year-period 411 infants underwent laparoscopic herniorrhaphy within the first six months of life. 246 term (191 male; 55 female) and 165 preterm (118 male; 47 female) infants were included in this retrospective study. Initial presentation of IH and intraoperative anatomical findings of PPV were reviewed. We found that term boys (58.6%) and girls (58.2%) predominantly presented with right-sided IH whereas preterm boys (36.4%) and girls (44.7%) mostly presented with bilateral IH. Female babies had a higher incidence of initial left-sided IH. Term and preterm girls with initial left-sided hernia were found to have highest incidence of PPV. Male term babies with initial left-sided IH were found to have the lowest incidence of PPV (25.0%). The highest incidence of PPV in male was found in preterm boys with either left- or right-sided IH. Incidence and laterality of IH and PPV differ between term and preterm girls and boys. In open hernia repair decision concerning contralateral groin exploration should consider term/preterm birth as well as gender. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Comparison of the Effects of Fentanyl and Midazolam as a Premedication in Children Undergoing Inguinal Hernial Surgery

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    MH Abdollahi

    2011-04-01

    Full Text Available Introduction: Premedication with midazolam can occasionally result in increased pediatric anxiety. In this study, we compared the effects of intravenous midazolam and fentanyl as pediatric premedication in children posted for inguinal hernia surgery. Methods: In this double blind randomized clinical trial study, sixty pediatric patients were randomly allocated to two study groups. Anesthesia was similar in both groups. Sedation score by Richmond agitation sedation scale was repeatedly measured on arrival to the preoperative part of the operating room, during drug administration, separation of the child from parent for transfer to the operating room, induction of anesthesia, time of transfer to the recovery room and discharge from the recovery room. Post-operative nausea and vomiting was also recorded. The collected data was analyzed with SPSS 15 and P value<0.05 was considered meaningful. Results: Baseline characteristics of the two study groups were similar. Mean RASS at separation of patients from parents; the time between the study drug administrations till separation from parents, induction of anesthesia and end of operation and need for additional drug during separation was significantly lower in the midazolam group. Opioid need in the fentanyl group was higher. Other findings were similar in the two groups. Conclusion: Use of fentanyl instead of midazolam as a premedication is not a priority in children posted for surgery.

  15. del alcoholismo

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    Rodrigo Arias Duque

    2005-01-01

    Full Text Available Desde el punto de vista farmacológico, es importante comprender qué es el alcohol y cómo actúa en el organismo. No existe una causa simple, sino una interacción complicada de factores neuroquímicos, fisiológicos, psicológicos y sociales que originan y desarrollan esta grave enfermedad fármaco-dependiente. La acción psicofisiológica y farmacodinámica del alcohol es fundamentalmente depresiva, por la reducción de la transmisión sináptica en el sistema nervioso humano. Es un hecho conocido que el consumo excesivo de alcohol causa una disfunción aguda y crónica del cerebro, produciendo trastornos en el sistema nervioso central, presentando alteraciones en la memoria y en las funciones intelectuales como cálculo, comprensión y aprendizaje. A nivel hepático tiene lugar, en su mayoría, el metabolismo del alcohol, produciéndose un hígado graso alcohólico, aumentando el tamaño, terminando en necrosis e inflamación grave del hígado; esto se llama hepatitis alcohólica, y si se sigue consumiendo alcohol se desarrollará la cirrosis. El alcohol también ha estado relacionado con alteraciones del miocardio; se ha constatado en animales de experimentación sanos que tanto la velocidad de contracción del músculo cardiaco y su máxima tensión disminuyen en presencia del alcohol, como consecuencia, la fuerza de cada contracción y el aumento de presión en el ventrículo izquierdo son menores, perdiendo eficacia el corazón como bomba.

  16. Reconstrucción de una pérdida parcial del pabellón auricular por trauma

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    Denia Morales Navarro

    Full Text Available La posición expuesta de la oreja la hace vulnerable a muchos tipos de lesiones, entre las que se encuentran los traumas. Nuestro propósito es presentar un caso clínico en el que se realizó la reconstrucción de una pérdida parcial del pabellón auricular por trauma. Acude al cuerpo de guardia del Hospital Universitario “General Calixto García” un paciente masculino de 42 años refiriendo haber perdido un fragmento de oreja en una riña. Se decide realizar hemostasia y fijación mediante puntos de sutura del pabellón auricular remanente a la región temporal, previa incisión en la zona. A los 3 meses del evento traumático se reevalúa con fines de realizar la planificación preoperatoria reconstructiva. Se decide la realizarla mediante injerto de cartílago costal colocado en forma de “bolsillo” en la región temporal. Al mes de esta última intervención quirúrgica se realiza, bajo anestesia local, la liberación de la región auricular, el avance de un colgajo temporal y la colocación de un injerto libre de piel en la cara posterior del área reconstruida. Se observa una excelente evolución posoperatoria. El paciente refirió una gran satisfacción por los resultados estéticos obtenidos. En este caso se empleó una secuencia diagnóstica y terapéutica, según elección de los cirujanos involucrados, ante un defecto traumático parcial del pabellón auricular en sus tercios superior y medio. Este tipo de secuela traumática requirió el empleo de procederes quirúrgicos en varios tiempos operatorios que garantizaran un buen aporte sanguíneo de los tejidos y adecuados resultados estéticos finales.

  17. Culturas del Mundo

    DEFF Research Database (Denmark)

    Benwell, Ann Fenger; Costa, Alberto; Waehle, Espen

    2006-01-01

    ’Culturas del mundo. Colecciones del Museo Nacional de Dinamarca’ with Ann Fenger Benwell in Culturas del Mundo. Colecciones del Museo Nacional de Dinamarca, ed. Silvia Sauquet, Fundación "la Caixa", Barcelona 2006, pp. 31-39......’Culturas del mundo. Colecciones del Museo Nacional de Dinamarca’ with Ann Fenger Benwell in Culturas del Mundo. Colecciones del Museo Nacional de Dinamarca, ed. Silvia Sauquet, Fundación "la Caixa", Barcelona 2006, pp. 31-39...

  18. Burden of congenital inguinal hernia and hydrocele in northern and southern Nigeria: An opportunity for awareness creation

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    Musa Ibrahim

    2014-01-01

    Full Text Available Background: Nigeria, with a population of >150 million people in which half of the population are children encounters challenges in paediatric surgery practice in rural areas. There are paediatric surgeons in Nigeria, but majority practice in tertiary health facilities in cities. The poor rural dwellers have little or no access to such highly trained specialists. Hence, children with congenital and acquired paediatric surgical pathologies including anterior abdominal wall defects not only grow up with these diseases to adulthood, they are also exposed to various health hazards posed by unqualified personnel. Therefore, we are evaluating the burden of congenital inguinal hernia/hydrocele in northern and southern Nigeria for awareness creation and the way forward. Materials and Methods: Data obtained from organised free hernia missions to the rural populace from northern and southern Nigeria by the West African Collage of Surgeons in 2010 and Kano State Government in 2013 was analysed. Results: A total of 811 patients aged from 3 months (0.25 years to 35 years was screened and found to have congenital hernia and/or hydrocele from the two centres. 171 (21.1% were successfully operated, while the remaining 640 (78.9% could not benefit from a surgical procedure during the missions. There were n = 46 (26.9% patients with various forms of genital mutilations/and or surgical mismanagements among the operated patients. Conclusion: The burden of congenital anterior abdominal wall defects among Nigerian children is high. A little effort could bring succor and create awareness among this group of people.

  19. A low-protein, high-carbohydrate diet increases browning in perirenal adipose tissue but not in inguinal adipose tissue.

    Science.gov (United States)

    Pereira, Mayara P; Ferreira, Laís A A; da Silva, Flávia H S; Christoffolete, Marcelo A; Metsios, George S; Chaves, Valéria E; de França, Suélem A; Damazo, Amílcar S; Flouris, Andreas D; Kawashita, Nair H

    2017-10-01

    The aim of this study was to evaluate the browning and origin of fatty acids (FAs) in the maintenance of triacylglycerol (TG) storage and/or as fuel for thermogenesis in perirenal adipose tissue (periWAT) and inguinal adipose tissue (ingWAT) of rats fed a low-protein, high-carbohydrate (LPHC) diet. LPHC (6% protein, 74% carbohydrate) or control (C; 17% protein, 63% carbohydrate) diets were administered to rats for 15 d. The tissues were stained with hematoxylin and eosin for histologic analysis. The content of uncoupling protein 1 (UCP1) was determined by immunofluorescence. Levels of T-box transcription factor (TBX1), PR domain containing 16 (PRDM16), adipose triacylglycerol lipase (ATGL), hormone-sensitive lipase, lipoprotein lipase (LPL), glycerokinase, phosphoenolpyruvate carboxykinase (PEPCK), glucose transporter 4, β 3 -adrenergic receptor (AR), β 1 -AR, protein kinase A (PKA), adenosine-monophosphate-activated protein kinase (AMPK), and phospho-AMPK were determined by immunoblotting. Serum fibroblast growth factor 21 (FGF21) was measured using a commercial kit (Student's t tests, P diet increased FGF21 levels by 150-fold. The presence of multilocular adipocytes, combined with the increased contents of UCP1, TBX1, and PRDM16 in periWAT of LPHC-fed rats, suggested the occurrence of browning. The contents of β 1 -AR and LPL were increased in the periWAT. The ingWAT showed higher ATGL and PEPCK levels, phospho-AMPK/AMPK ratio, and reduced β 3 -AR and PKA levels. These findings suggest that browning occurred only in the periWAT and that higher utilization of FAs from blood lipoproteins acted as fuel for thermogenesis. Increased glycerol 3-phosphate generation by glyceroneogenesis increased FAs reesterification from lipolysis, explaining the increased TG storage in the ingWAT. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. The efficacy of laparoscopic intracorporeal linear suture technique as a strategy for reducing recurrences in pediatric inguinal hernia.

    Science.gov (United States)

    Lee, S R; Choi, S B

    2017-06-01

    Pediatric laparoscopic herniorrhaphy has rare complications, but recurrence might occur. The purpose of this manuscript is to evaluate the efficacy of linear suture technique of laparoscopic pediatric herniorrhaphy in reducing recurrences. Laparoscopic surgery was performed on 2223 pediatric patients (under 10 years old) from September 2012 to December 2014 in Damsoyu Hospital, Seoul, Republic of Korea. The causes of recurrence were investigated case by case. The patients were categorized into two groups according to the suture method used in closing the hernia orifice: Group 1 (purse-string suture, 1009 patients) and Group 2 (linear suture, 1214 patients). There were 1413 (63.6%) male and 810 (36.4%) female patients. Mean age was 30.5 ± 29.2 months. A significantly higher proportion of male patients, contralateral patent processus vaginalis, and less proportion of recurrence were observed in Group 2. There were ten cases of recurrence in Group 1 because the internal ring suture could not endure the tension. One recurrence occurred in Group 2. The suture technique and age were found to be a significant risk factor for recurrence. Linear suture technique had a lower recurrence rate (odds ratio = 0.07, with 95% confidence interval 0.01-0.53, and p = 0.004). Purse-string suture technique causes significantly higher occurrence of hernia recurrences than linear suture technique. Linear suture technique can reduce recurrence by increasing the endurance to tension around the internal ring by distributing pressure to a wider area along the linear suture line. Linear suture technique can effectively reduce recurrence in pediatric inguinal herniorrhaphy.

  1. Effect of cooled hyperbaric bupivacaine on unilateral spinal anesthesia success rate and hemodynamic complications in inguinal hernia surgery.

    Science.gov (United States)

    Tomak, Yakup; Erdivanli, Basar; Sen, Ahmet; Bostan, Habib; Budak, Ersel Tan; Pergel, Ahmet

    2016-02-01

    We hypothesized that cooling hyperbaric bupivacaine from 23 to 5 °C may limit the intrathecal spread of bupivacaine and therefore increase the success rate of unilateral spinal anesthesia and decrease the rate of hemodynamic complications. A hundred patients scheduled for elective unilateral inguinal hernia surgery were randomly allocated to receive 1.8 ml of 0.5 % hyperbaric bupivacaine intrathecally at either 5 °C (group I, n = 50) or at 23 °C (group II, n = 50). Following spinal block at the L2-3 interspace, the lateral decubitus position was maintained for 15 min. Unilateral spinal anesthesia was assessed and confirmed at 15 and 30 min. The levels of sensory and motor block on the operative side were evaluated until complete resolution. The rate of unilateral spinal anesthesia at 15 and 30 min was significantly higher in group I (p = 0.015 and 0.028, respectively). Hypotensive events and bradycardia were significantly rarer in group I (p = 0.014 and 0.037, respectively). The density and viscosity of the solution at 5 °C was significantly higher than at 23 °C (p < 0.0001). Compared with group II, sensory block peaked later in group I (17.4 vs 12.6 min) and at a lower level (T9 vs T7), and two-segment regression of sensory block (76.4 vs 84.3 min) and motor block recovery was shorter (157.6 vs 193.4 min) (p < 0.0001). Cooling of hyperbaric bupivacaine to 5 °C increased the density and viscosity of the solution and the success rate of unilateral spinal anesthesia, and decreased the hemodynamic complication rate.

  2. Postoperative analgesic efficacy of ultrasound-guided ilioinguinal-iliohypogastric nerve block compared with medial transverse abdominis plane block in inguinal hernia repair: A prospective, randomised trial.

    Science.gov (United States)

    Bhatia, Nidhi; Sen, Indu Mohini; Mandal, Banashree; Batra, Ankita

    2018-03-29

    Analgesic efficacy of ultrasound-guided transverse abdominis plane block, administered a little more medially, just close to the origin of the transverse abdominis muscle has not yet been investigated in patients undergoing unilateral inguinal hernia repair. We hypothesised that medial transverse abdominis plane block would provide comparable postoperative analgesia to ilioinguinal-iliohypogastric nerve block in inguinal hernia repair patients. This prospective, randomised trial was conducted in 50 ASA I and II male patients≥18 years of age. Patients were randomised into two groups to receive either pre-incisional ipsilateral ultrasound-guided ilioinguinal-iliohypogastric nerve block or medial transverse abdominis plane block, with 0.3ml/kg of 0.25% bupivacaine. Our primary objective was postoperative 24-hour analgesic consumption and secondary outcomes included pain scores, time to first request for rescue analgesic and side effects, if any, in the postoperative period. There was no significant difference in the total postoperative analgesic consumption [group I: 66.04mg; group II: 68.33mg (P value 0.908)]. Time to first request for rescue analgesic was delayed, though statistically non-significant (P value 0.326), following medial transverse abdominis plane block, with excellent pain relief seen in 58.3% patients as opposed to 45.8% patients in ilioinguinal-iliohypogastric nerve block group. Medial transverse abdominis plane block being a novel, simple and easily performed procedure can serve as an useful alternative to ilioinguinal-iliohypogastric nerve block for providing postoperative pain relief in inguinal hernia repair patients. Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  3. Ultrasound-guided transversus abdominis plane block in patients undergoing open inguinal hernia repair: 0.125% bupivacaine provides similar analgesic effect compared to 0.25% bupivacaine.

    Science.gov (United States)

    Erdoğan Arı, Dilek; Yıldırım Ar, Arzu; Karadoğan, Firdevs; Özcabı, Yetkin; Koçoğlu, Ayşegül; Kılıç, Fatih; Akgün, Fatma Nur

    2016-02-01

    To evaluate the effectiveness of 0.125% bupivacaine compared to 0.25% bupivacaine for ultrasound-guided transversus abdominis plane (TAP) block in patients undergoing open inguinal hernia repair. Randomized, double-blind study. Educational and research hospital. Forty adult patients of American Society of Anesthesiologists physical status I-III undergoing elective primary unilateral open inguinal hernia repair under spinal anesthesia. Patients in group I received 20 mL of 0.25% bupivacaine, whereas patients in group II received 20 mL of 0.125% bupivacaine for TAP block at the end of the surgery. Pain intensity was assessed at rest and during coughing using 10-cm visual analog scale score at 5, 15, 30, and 45 minutes and 1, 2, 4, 6, 12, and 24 hours after TAP block. Morphine consumption and time to first morphine requirement were recorded. Visual analog scale scores at rest and during coughing were not significantly different between groups at all time points measured. Twenty-four hours of morphine consumption (7.72±7.33 mg in group I and 6.06±5.20 mg in group II; P=.437) and time to first morphine requirement (182.35±125.16 minutes in group I and 143.21±87.28 minutes in group II; P=.332) were not different between groups. 0.125% Bupivacaine provides similar analgesic effect compared to 0.25% bupivacaine for ultrasound-guided TAP block in patients undergoing open inguinal hernia repair. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Patient-reported opioid analgesic requirements after elective inguinal hernia repair: A call for procedure-specific opioid-administration strategies.

    Science.gov (United States)

    Mylonas, Konstantinos S; Reinhorn, Michael; Ott, Lauren R; Westfal, Maggie L; Masiakos, Peter T

    2017-11-01

    A better understanding of the analgesia needs of patients who undergo common operative procedures is necessary as we address the growing opioid public health crisis in the United States. The aim of this study was to evaluate patient experience with our opioid prescribing practice after elective inguinal hernia repairs. A prospective, observational study was conducted between October 1, 2015, and September 30, 2016, in a single-surgeon, high-volume, practice of inguinal hernia operation. Adult patients undergoing elective inguinal herniorrhaphy under local anesthesia with intravenous sedation were invited to participate. All patients were prescribed 10 opioid analgesic tablets postoperatively and were counseled to reserve opioids for pain not controlled by nonopioid analgesics. Their experience was captured by completing a questionnaire 2 to 3 weeks postoperatively during their postoperative visit. A total of 185 patients were surveyed. The majority of the participants were males (177, 95.7%) and ≥60 years old (96, 51.9%). Of the 185 patients, 159 (85.9%) reported using ≤4 opioid tablets; 110 patients (59.5%) reported that they used no opioid analgesics postoperatively. None of the patients was taking opioids within 7 days of their postoperative appointment. Of the 147 patients who were employed, 111 (75.5%) reported missing ≤3 work days, 57 of whom (51.4%) missed no work at all. Patients who were employed were more likely to take opioid analgesics postoperatively (P = .049). Patients who took no opioid analgesics experienced less maximum (P require any opioid analgesics, and nearly all of those who thought that they did need opioids used reserved.

  5. How to Surgically Remove the Permanent Mesh Ring after the Onstep Procedure for Alleviation of Chronic Pain following Inguinal Hernia Repair

    DEFF Research Database (Denmark)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

    2016-01-01

    -month follow-up, the patient was free of pain, without a recurrence. It is advised to wait some months after the initial hernia repair before removing the ring, since the mesh needs time to become well integrated into the surrounding tissue. The operation is safe and easy to perform, which is demonstrated......A promising open inguinal hernia operation called Onstep was developed in 2005. The technique is without sutures to the surrounding tissue, causing minimal tension. A specific mesh is used with a memory recoil ring in the border, which may cause pain superficial to the lateral part of the mesh...

  6. Importancia de la reconstrucción volumétrica y del pliegue glúteo en los parapléjicos con úlceras isquiáticas Enis Sarmiento IV Importance of volume and gluteal fold reconstruction in paraplegic patients with ischial ulcers type Enis Sarmiento IV

    Directory of Open Access Journals (Sweden)

    E. Revelo Jirón

    2011-06-01

    Full Text Available Los parapléjicos rehabilitados son propensos a sufrir úlceras isquiáticas como complicación más frecuente. Cuando estas úlceras tienen compromiso óseo, su tratamiento solo puede ser quirúrgico. Bajo estas condiciones los colgajos miocutáneos locales son parte de la solución. En el artículo presentamos una serie personal de 10 pacientes parapléjicos rehabilitados con úlceras isquiáticas reconstruidas utilizando un colgajo miocutáneo en isla de la porción inferior del glúteo mayor transferido a través de un túnel subcutáneo. Ninguno de los pacientes de nuestro grupo de estudio sufrió recidiva y todos han tenido una buena evolución a largo plazo. La aportación principal del presente trabajo es hacer hincapié en respetar en estos casos 3 principios utilizados en Cirugía Estética: las incisiones quirúrgicas deben efectuarse en los pliegues naturales para evitar secuelas estético-funcionales; debemos dejar mínimas cicatrices y obtener una restauración volumétrica corporal. En ese sentido pensamos que el diseño de los colgajos debe respetar rigurosamente la orientación del pliegue glúteo y aportar un buen almohadillado para reconstruir el capital volumétrico de la zona glútea; además es primordial dejar pocas cicatrices para no aumentar los riesgos locales debido a la falta de trofismo de la piel. De esta manera, creemos que se evitan las recidivas y las complicaciones.Paraplegic patients, during their rehabilitation period, usually develop ischial ulcers as the most common complication. When there is bone involvement only the surgical approach can be successful. Myocutaneous flaps are part of this approach. We present a sample of 10 paraplegic patients under rehabilitation suffering ischial ulcers that were handled with myocutaneous island flaps obtained from the lower bundles of gluteus maximus and transferred though a subcutaneous tunnel. All these patients have had a long term good evolution with no recurrences

  7. Teaching three-dimensional surgical concepts of inguinal hernia in a time-effective manner using a two-dimensional paper-cut.

    Science.gov (United States)

    Mann, B D; Seidman, A; Haley, T; Sachdeva, A K

    1997-06-01

    Because inguinal hernia repair is difficult for third-year students to comprehend, a 2-dimensional paper-cut was developed to teach the concepts of inguinal hernia in a time-effective manner before students' observation of herniorrhaphy in the operating room. Using Adobe Illustrator 5.5 for MacIntosh, a 2-dimensional inexpensively printed paper-cut was created to allow students to perform their own simulated hernia repair before observing surgery. The exercise was performed using a no.15 scalpel or an iris scissors and was evaluated by comparing 10-question pre-tests and post-tests. Seventy-five students performed the exercise, most completing it within 15 minutes. The mean pre-test score was 7.4/10 and the mean post-test score was 9.1/10. Students performing the paper-cut reported better understanding when observing actual herniorrhaphy. A 2-dimensional paper-cut ("surgical origami") may be a time-effective method to prepare students for the observation of hernia repair.

  8. Prediction of emergence agitation using withdrawal reaction following rocuronium injection in preschool-aged patients undergoing inguinal herniorrhaphy: a preliminary exploratory observational trial.

    Science.gov (United States)

    Kim, Dae Hee; Roh, Go Un; Lee, Young Bok; Choi, Chang Ik; Lee, Jae Moon; Chae, Yun Jeong

    2018-01-01

    The development of emergence agitation (EA) is associated with several factors including age, preoperative anxiety, postoperative pain, anesthesia method, and surgery type. No studies have investigated whether the withdrawal reaction following rocuronium injection can predict the occurrence of EA. Therefore, we investigated this relationship in preschool-aged children undergoing inguinal herniorrhaphy, and which grade of withdrawal reaction is appropriate for identifying patients at risk of experiencing EA. A total of 40 patients were enrolled in this study. During anesthesia induction, the withdrawal reaction after loss of consciousness following rocuronium injection was assessed using a 4-point scale. After surgery, EA was assessed using the Watcha scale. There was a correlation between withdrawal reaction and EA on admission to the postanesthesia care unit (PACU). Patients with a severe withdrawal reaction (grade 3) showed a significantly higher incidence of severe EA requiring medication on admission to the PACU. The findings of this preliminary exploratory observational study suggest that it is possible for withdrawal movement following rocuronium injection during anesthesia induction to reflect pain sensitivity of pediatric patients, which in turn may be useful in identifying those at risk of severe EA on admission to the PACU among preschool children undergoing inguinal herniorrhaphy. Further studies with a larger sample size are required to validate these findings. The exact correlation between pain reaction following rocuronium injection and postoperative pain or pain-related phenomenon should be elucidated.

  9. Reducing morbidity with surgical adhesives following inguinal lymph node dissections for the treatment of malignant skin tumors

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    Stollwerck, Peter. L.

    2016-01-01

    Full Text Available Background: Inguinal lymph node dissection (ILND is associated with a high rate of morbidity. To evaluate the clinical benefit of surgical adhesives to reduce complications in patients undergoing ILND, we compared the use of TissuGlu Surgical Adhesive and ARTISS fibrin sealant with a control population. Material and methods: We conducted a retrospective analysis of patients undergoing ILND for metastatic malignant skin tumors at one hospital, Fachklinik Hornheide (Münster, Germany, from January 2011 through September 2013, assessing 137 patients with a total of 142 procedures. Results: Complications occurred in 22/60 procedures in the TissuGlu group (TG, in 8/17 in the ARTISS group (AG, and in 29/65 in the control group (CG. Prolonged drainage and seroma were recorded in four (23.5%, and 26 (40% respectively (non-significant. TG showed less extended drainage vs. CG (p=0.082. Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000. With regard to wound infection, there was a 15% reduction in TG and 74% increase in AG group. Revision surgery was reduced by 36% in TG and increased by 54% in AG. Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000. Mean total post-operative drain volume was lower in TG and AG vs. CG (p<0.001 among groups, CG vs. TG p<0.001, CG vs. AG p<0.001. The mean body mass index (BMI was significantly higher in patients with complications, 29.4±5.8 vs. 25.3±4.1 (p=0.000.Conclusion: The use of TissuGlu in our ILND patients was associated with a reduction in post-operative wound related complications and the need for revision surgeries compared to the control group. Daily drainage was significantly lower within the first 7 post-operative days with the use of ARTISS, but the benefit was lost due to the higher occurrence of wound infection and revision surgery. BMI above 29 is a risk factor for complications following ILND.(Level of evidence: level IV, retrospective case study

  10. Il dono del racconto

    DEFF Research Database (Denmark)

    Polito, Paola

    1998-01-01

    L'articolo indaga a vari livelli strutturali del romanzo "Il coraggio del pettirosso" (rete metaforica, dialogismo diegetico, dialogismo come fenomeno di voce, strategie discorsive messe in atto dalla voce narrante, stile colloquiale) la complessa realizzazione testuale del genere narrativo...

  11. Laparoscopic Inguinal Hernia Repair

    Science.gov (United States)

    ... surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery. It is recommended that you shower the night before or morning of the operation with an antibiotic soap. After midnight the night before the operation, ...

  12. del cambio

    Directory of Open Access Journals (Sweden)

    Alejandro Canales

    2006-01-01

    Full Text Available El artículo analiza las propuestas y los compromisos en materia de cobertura y de financiamiento en el periodo 2000-2006. En particular, revisa las modificaciones y los ajustes de los tres principales documentos en los que se expresaron las iniciativas: el de la Asociación Nacional de Universidades e Instituciones de Educación Superior, el del equipo de la transición y el programa sectorial. Los resultados muestran que las cifras de atención a la demanda educativa e inversión quedaron lejos de las metas autoimpuestas por el gobierno federal y que será necesario realizar mayores esfuerzos para atender tales desafíos.

  13. Open reduction and internal fixation of osteoporotic acetabular fractures through the ilio-inguinal approach: use of buttress plates to control medial displacement of the quadrilateral surface.

    Science.gov (United States)

    Peter, Robin E

    2015-01-01

    The number of acetabular fractures in the geriatric population requiring open reduction and internal fixation is increasing. Fractures with medial or anterior displacement are the most frequent types, and via the ilio-inguinal approach buttress plates have proved helpful to maintain the quadrilateral surface or medial acetabular wall. Seven to ten hole 3.5 mm reconstruction plates may be used as buttress plates, placed underneath the usual pelvic brim plate. This retrospective study presents our results with this technique in 13 patients at a minimum follow-up of 12 months (average, 31 months). 85% of the patients had a good result. The early onset of post-traumatic osteoarthritis necessitated total hip arthroplasty in two patients (15%) at 12 and 18 months follow-up, respectively. This treatment option should be considered in the surgeon's armamentarium when fixing these challenging cases. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. How to Surgically Remove the Permanent Mesh Ring after the Onstep Procedure for Alleviation of Chronic Pain following Inguinal Hernia Repair

    Directory of Open Access Journals (Sweden)

    Stina Öberg

    2016-01-01

    Full Text Available A promising open inguinal hernia operation called Onstep was developed in 2005. The technique is without sutures to the surrounding tissue, causing minimal tension. A specific mesh is used with a memory recoil ring in the border, which may cause pain superficial to the lateral part of the mesh for slender patients. The aim of this study was to illustrate an easy procedure that alleviates/removes the pain. A male patient had persistent pain six months after the Onstep operation and therefore had a ring removal operation. The procedure is presented as a video and a protocol. At the eleven-month follow-up, the patient was free of pain, without a recurrence. It is advised to wait some months after the initial hernia repair before removing the ring, since the mesh needs time to become well integrated into the surrounding tissue. The operation is safe and easy to perform, which is demonstrated in a video.

  15. Prediction of emergence agitation using withdrawal reaction following rocuronium injection in preschool-aged patients undergoing inguinal herniorrhaphy: a preliminary exploratory observational trial

    Directory of Open Access Journals (Sweden)

    Kim DH

    2018-01-01

    Full Text Available Dae Hee Kim,1 Go Un Roh,2 Young Bok Lee,3 Chang Ik Choi,3 Jae Moon Lee,3 Yun Jeong Chae1 1Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, 2Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, 3Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea Purpose: The development of emergence agitation (EA is associated with several factors including age, preoperative anxiety, postoperative pain, anesthesia method, and surgery type. No studies have investigated whether the withdrawal reaction following rocuronium injection can predict the occurrence of EA. Therefore, we investigated this relationship in preschool-aged children undergoing inguinal herniorrhaphy, and which grade of withdrawal reaction is appropriate for identifying patients at risk of experiencing EA. Methods: A total of 40 patients were enrolled in this study. During anesthesia induction, the withdrawal reaction after loss of consciousness following rocuronium injection was assessed using a 4-point scale. After surgery, EA was assessed using the Watcha scale. Results: There was a correlation between withdrawal reaction and EA on admission to the postanesthesia care unit (PACU. Patients with a severe withdrawal reaction (grade 3 showed a significantly higher incidence of severe EA requiring medication on admission to the PACU. Conclusion: The findings of this preliminary exploratory observational study suggest that it is possible for withdrawal movement following rocuronium injection during anesthesia induction to reflect pain sensitivity of pediatric patients, which in turn may be useful in identifying those at risk of severe EA on admission to the PACU among preschool children undergoing inguinal herniorrhaphy. Further studies with a larger sample size are required to validate these findings. The exact correlation between pain

  16. Iliohypogastric/ilioinguinal nerve block in inguinal hernia repair for postoperative pain management: comparison of the anatomical landmark and ultrasound guided techniques

    Directory of Open Access Journals (Sweden)

    Abdurrahman Demirci

    2014-10-01

    Full Text Available Objectives:The purpose of this study is to compare the efficacy of iliohypogastric/ilioinguinal nerve blocks performed with the ultrasound guided and the anatomical landmark techniques for postoperative pain management in cases of adult inguinal herniorrhaphy.Methods:40 patients, ASA I-II status were randomized into two groups equally: in Group AN (anatomical landmark technique and in Group ultrasound (ultrasound guided technique, iliohypogastric/ilioinguinal nerve block was performed with 20 ml of 0.5% levobupivacaine prior to surgery with the specified techniques. Pain score in postoperative assessment, first mobilization time, duration of hospital stay, score of postoperative analgesia satisfaction, opioid induced side effects and complications related to block were assessed for 24 h postoperatively.Results:VAS scores at rest in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p < 0.01 or p < 0.001. VAS scores at movement in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p < 0.001 in all time points. While duration of hospital stay and the first mobilization time were being found significantly shorter, analgesia satisfaction scores were found significantly higher in ultrasound Group (p < 0.05, p < 0.001, p < 0.001 respectively.Conclusion:According to our study, US guided iliohypogastric/ilioinguinal nerve block in adult inguinal herniorrhaphies provides a more effective analgesia and higher satisfaction of analgesia than iliohypogastric/ilioinguinal nerve block with the anatomical landmark technique. Moreover, it may be suggested that the observation of anatomical structures with the US may increase the success of the block, and minimize the block-related complications.

  17. La superaci??n del modelo del ??ngel del hogar:

    OpenAIRE

    Hurtado Mu??oz, M??nica

    2012-01-01

    La Tesis Doctoral titulada "La superaci??n del modelo del "??ngel del hogar". Recuperaci??n de la escritora Leonor Canalejas y Fustegueras (1869-1945)" aborda, en primer lugar, un an??lisis sociol??gico de las circunstancias que rodearon a la mujer espa??ola en el cambio de siglo en el ??mbito social y educativo, en un intento de esclarecer las caracter??sticas propias del contexto en el que la mujer accede a la intelectualidad en general y a la literatura en particular. Esta parte concluye q...

  18. Iliohypogastric/ilioinguinal nerve block in inguinal hernia repair for postoperative pain management: comparison of the anatomical landmark and ultrasound guided techniques

    Directory of Open Access Journals (Sweden)

    Abdurrahman Demirci

    2014-09-01

    Full Text Available Objectives: The purpose of this study is to compare the efficacy of iliohypogastric/ilioinguinal nerve blocks performed with the ultrasound guided and the anatomical landmark techniques for postoperative pain management in cases of adult inguinal herniorrhaphy. Methods: 40 patients, ASA I–II status were randomized into two groups equally: in Group AN (anatomical landmark technique and in Group ultrasound (ultrasound guided technique, iliohypogastric/ilioinguinal nerve block was performed with 20 ml of 0.5% levobupivacaine prior to surgery with the specified techniques. Pain score in postoperative assessment, first mobilization time, duration of hospital stay, score of postoperative analgesia satisfaction, opioid induced side effects and complications related to block were assessed for 24 h postoperatively. Results: VAS scores at rest in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p < 0.01 or p < 0.001. VAS scores at movement in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p < 0.001 in all time points. While duration of hospital stay and the first mobilization time were being found significantly shorter, analgesia satisfaction scores were found significantly higher in ultrasound Group (p < 0.05, p < 0.001, p < 0.001 respectively. Conclusion: According to our study, US guided iliohypogastric/ilioinguinal nerve block in adult inguinal herniorrhaphies provides a more effective analgesia and higher satisfaction of analgesia than iliohypogastric/ilioinguinal nerve block with the anatomical landmark technique. Moreover, it may be suggested that the observation of anatomical structures with the US may increase the success of the block, and minimize the block-related complications. Resumo: Objetivo: Comparar a eficácia de bloqueios dos nervos ílio-hipogástrico/ilioinguinal feitos com a técnica guiada por

  19. Učinak pregabalina na kroničnu bol i kvalitetu života nakon operacije preponske kile [The effect of pregabalin on a chronic pain and the quality of life after inguinal hernia surgery

    OpenAIRE

    Lončarić-Katušin, Mirjana

    2015-01-01

    The development of chronic postoperative pain after the inguinal hernia surgery can have a significant impact on reducing the quality of life correlated to health in the late as well as the early postoperative period. Drugs from the gabapentinoid group are considered a possible, important supplement in a multimodal approach to the treatment of acute postoperative pain and the prevention of its development into a chronic postoperative pain, all in order to improve the quality of...

  20. Ethnicity-related differences in inguinal canal dimensions between African and Caucasian populations and their potential impact on the mesh size for open and laparoscopic groin hernia repair in low-resource countries in Africa.

    Science.gov (United States)

    Mitura, Kryspin; Kozieł, Sławomir; Pasierbek, Michał

    2018-03-01

    Access to surgery in Africa is significantly limited. Treatment outcomes in Africa differ significantly compared to those achieved in Europe or the US. Therefore, to popularise tension-free repair, it is essential to determine the economically justified mesh size for the African population. To conduct anthropometric evaluation of the inguinal canal in African and European patients to determine its potential consequences for the mesh size for open and laparoscopic hernia repair. The measurements were made in 44 adult males in Africa (group I) and were compared to measurements in 45 consecutive Caucasian males (group II). The mean age of patients was respectively 48.3 and 51.2 years. There was no statistically significant difference in the internal ring diameter between groups (2.2 vs. 2.1 cm; p = 0.58). The distance between the pubic tubercle and the inferomedial border of the internal inguinal ring was significantly shorter in group I (3.8 vs. 5.1 cm; p < 0.001). A similar difference was found in the length of transverse arch aponeurosis (2.9 vs. 4.0 cm; p < 0.001). The distance between the pubic tubercle and anterior superior iliac spine in group I was approximately 2 cm shorter on each side (10.0 vs. 11.8 cm; p < 0.001). The anatomical differences in inguinal dimensions between Central African and European populations support the potential need to adjust the standard size of synthetic mesh used for hernia repair to the needs of local populations. The significantly smaller dimensions of the inguinal canal in African males may allow the use of smaller meshes.

  1. RIVES AND LICHTENSTEIN REPAIR IN INGUINAL HERNIA- A COMPARISON OF POSTOPERATIVE COMPLICATIONS TO KNOW WHETHER RIVES REPAIR IS AS SAFE AS THE GOLD STANDARD LICHTENSTEIN REPAIR

    Directory of Open Access Journals (Sweden)

    John S. Kurien

    2018-02-01

    Full Text Available BACKGROUND Hernia repair surgeries underwent a lot of modifications over time. These modifications were an attempt to reduce the recurrence rate and post-operative complications. Current techniques for Inguinal hernia show similar recurrence rate. Therefore, recurrence is no longer the main issue discussed when considering improving the current standards for groin hernia repair. Post-surgical chronic pain presents a major, largely unrecognized clinical problem. Consequently, there is a need to not only decrease an extensive dissection in the inguinal canal but also to minimize the interaction between the mesh and major surrounding structures. As a result, placing a mesh in the preperitoneal space is a viable option. Likewise, studies have shown that return to normal activity and return to work is comparatively quicker in Rives. In this study I am comparing the post op period complications in Rives and Lichtenstein hernia surgeries to know whether Rives is superior to Lichtenstein’s repair. MATERIALS AND METHODS After obtaining approval for the study from Institutional Review Board, written informed consent from 100 male patients planning to undergo elective hernia repair surgery at the General Surgery wards in Government Medical College, Kottayam & who were willing to participate in the study were obtained and randomly allocated into two groups, 50 undergoing Rives hernia repair & 50 Lichtenstein hernia repair. The patients were evaluated and followed up according to the protocol. In early postop period, patients were assessed for pain using a numeric rating scale. Complications like haematoma, seroma, wound infection and early recurrence were compared. Chronic inguinal pain/Inguinodynia is a significant, though under reported problem. Moderate to severe pain persisting more than 3 months should be considered pathological. Inguinodynia, if present was assessed using a numerical scale. Another parameter that was assessed was testicular atrophy

  2. PRE-OPERATIVE HAIR REMOVAL WITH TRIMMERS AND RAZORS AND ITS IMPACT ON SURGICAL SITE INFECTIONS IN ELECTIVE INGUINAL HERNIA REPAIR

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    John S. Kurien

    2018-02-01

    Full Text Available BACKGROUND Despite major advances in infection control interventions, health care-associated infections (HAI remain a major public health problem and patient safety threat worldwide. The global data suggests that the SSI incidence rate varies from 0.5 to 20% depending upon the type of operation and underlying patient status. Several factors preoperative, intraoperative & postoperative, determine the occurrence of surgical site infections, Preoperative hair removal is considered as a risk for the development of surgical site infections. The objective of the study is to find out the difference in the incidence of surgical site infections in patients undergoing pre-operative hair removal by shaving with Razor blades and hair trimmers prior to elective inguinal hernia surgery. MATERIALS AND METHODS Written informed consent from 160 patients with no significant comorbidities planning to undergo elective inguinal hernia surgery at the general surgery wards in Government Medical College Kottayam and who were willing to participate in the study were to be obtained. 80 of them to undergo pre-operative hair removal with hair trimmers and 80 to undergo preoperative hair removal by shaving with razor blades on the day prior to the surgery randomised into two groups. During their stay in the postoperative ward the surgical wounds of the patients were examined daily for the development of erythema, pain, discharge, induration and gaping of the wound. The daily findings were noted down till the patient was discharged from the ward. The patients were again reassessed 2 weeks later, when they came for review in the Surgery OPD after their discharge from the ward; finally the patients were examined on the 30th day post-surgery to look for the clinical features of surgical site infections. RESULTS Out of the total 160 patients who were studied, 29 (18.1% of them had post-operative infection within 30 days, in the form of erythema, induration, discharge and gaping

  3. Effect of addition of dexamethasone to ropivacaine on post-operative analgesia in ultrasonography-guided transversus abdominis plane block for inguinal hernia repair: A prospective, double-blind, randomised controlled trial.

    Science.gov (United States)

    Sharma, Uma Datt; Prateek; Tak, Himani

    2018-05-01

    Ultrasonography (USG)-guided transversus abdominis plane (TAP) block is an abdominal field block with high efficacy. This study was undertaken with the aim of determining the effect of the addition of dexamethasone to 0.5% ropivacaine on post-operative analgesia in USG-guided TAP block for inguinal hernia repair. A double-blind randomised control study was conducted on sixty patients posted for inguinal hernia repair with the American Society of Anesthesiologists physical Status I or II, who were allocated two groups of 30 each. Patients in Group RS received 0.5% ropivacaine (20 ml) and normal saline (2 ml) whereas patients in Group RD received 0.5% ropivacaine (20 ml) and dexamethasone (2 ml, i.e., 8 mg), in USG-guided TAP Block on the same side, after repair of inguinal hernia under spinal anaesthesia. Visual analogue scale (VAS) scores, time for request of first analgesia and total tramadol consumption in first 24 h were compared. Unpaired Student's t -test and Mann-Whitney U-test were performed using SPSS 23 Software. Patients in Group RD had significantly lower VAS scores as compared to Group RS from 4 th to 12 th h, postoperatively. Duration of analgesia was significantly more in Group RD (547.50 [530,530] min) when compared with Group RS (387.50 [370,400] min) ( P consumption.

  4. The use of self-gripping (Progrip™) mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair: a prospective feasibility and long-term outcomes study.

    Science.gov (United States)

    Bresnahan, Erin; Bates, Andrew; Wu, Andrew; Reiner, Mark; Jacob, Brian

    2015-09-01

    The use of self-gripping mesh during laparoscopic TEP inguinal hernia repairs may eliminate the need for any additional fixation, and thus reduce post-operative pain without the added concern for mesh migration. Long-term outcomes are not yet prospectively studied in a controlled fashion. Under IRB approval, from January 2011-April 2013, 91 hernias were repaired laparoscopically with self-gripping mesh without additional fixation. Patients were followed for at least 1 year. Demographics and intraoperative data (defect location, size, and mesh deployment time) are recorded. VAS is used in the recovery room (RR) to score pain, and the Carolinas Comfort Scale ™ (CCS), a validated 0-5 pain/quality of life (QoL) score where a mean score of >1.0 means symptomatic pain, is employed at 2 weeks and at 1 year. Morbidities, narcotic usage, days to full activity and return to work, and CCS scores are reported. Sixty two patients, with 91 hernias repaired with self-gripping mesh, completed follow-up at a mean time period of 14.8 months. Seventeen hernias were direct defects (average size 3.0 cm). Mesh deployment time was 193.7 s. RR pain was 1.1/10 using a VAS. Total average oxycodone/acetaminophen (5 mg/325 mg) usage = 5.0 tablets, days to full activity was 1.6, and return to work was 4.2 days. Thirteen small asymptomatic seromas were palpated without any recurrences or groin tenderness, and all seromas resolved by the 6 month visit. Transient testis discomfort was reported in five patients. Urinary retention was 3.2%. Mean CCS™ scores at the first visit for groin pain laying, bending, sitting, walking, and step-climbing were 0.2, 0.5, 0.4, 0.3, and 0.3, respectively. At the first post op visit, 4.8% had symptomatic pain (CCS > 1). At 14.8 months, no patients reported symptomatic pain with CCS scores for all 62 patients averaging 0.02, (range 0-0.43). There are no recurrences thus far. Self-gripping mesh can be safely used during laparoscopic TEP inguinal hernia repairs

  5. Acerca del moho

    Science.gov (United States)

    El moho forma parte del medio ambiente natural. Afuera del hogar, el moho juega un papel en la naturaleza al desintegrar materias organicas tales como las hojas que se han caido o los arboles muertos. El moho puede crecer adentro del hogar cuando las espor

  6. Del bit al qubit

    OpenAIRE

    Torras Font, Josep

    2011-01-01

    Aquest document pretén donar una visió del desenvolupament dels computadors electrònics i dels components que els han fet possibles. Dintre de les opcions de futur en computació, també intenta donar una visió de les bases en que es fonamenta la computació quàntica.

  7. PKA-RIIB Deficiency Induces Brown Fatlike Adipocytes in Inguinal WAT and Promotes Energy Expenditure in Male FVB/NJ Mice.

    Science.gov (United States)

    Su, Jing; Wu, Wei; Huang, Shan; Xue, Ruidan; Wang, Yi; Wan, Yun; Zhang, Lv; Qin, Lang; Zhang, Qiongyue; Zhu, Xiaoming; Zhang, Zhaoyun; Ye, Hongying; Wu, Xiaohui; Li, Yiming

    2017-03-01

    Obesity has become the most common metabolic disorder worldwide. Promoting brown adipose tissue (BAT) and beige adipose tissue formation, and therefore, a functional increase in energy expenditure, may counteract obesity. Mice lacking type IIβ regulatory subunit of adenosine 3',5' cyclic monophosphate (cAMP)-dependent protein kinase A (PKA-RIIB) display reduced adiposity and resistance to diet-induced obesity. PKA-RIIB, encoded by the Prkar2b gene, is most abundant in BAT and white adipose tissue (WAT) and in the brain. In this study, we show that mice lacking PKA-RIIB have increased energy expenditure, limited weight gain, and improved glucose metabolism. PKA-RIIB deficiency induces brownlike adipocyte in inguinal WAT (iWAT). PKA-RIIB deficiency also increases the expression of uncoupling protein 1 and other thermogenic genes in iWAT and primary preadipocytes from iWAT through a mechanism involving increased PKA activity, which is represented by increased phosphorylation of PKA substrate, cAMP response element binding protein, and P38 mitogen-activated protein kinase. Our study provides evidence for the role of PKA-RIIB deficiency in regulating thermogenesis in WAT, which may potentially have therapeutic implications for the treatment of obesity and related metabolic disorders. Copyright © 2017 by the Endocrine Society.

  8. Jarak antara Saraf Femoralis dan Arteri Femoralis pada Daerah Lipat Inguinal Orang Dewasa dengan Menggunakan Pencitraan Ultrasonografi untuk Panduan Letak Penyuntikan Blokade Saraf Femoralis

    Directory of Open Access Journals (Sweden)

    Nur Intan Nasution

    2015-12-01

    Full Text Available The femoral nerve block is one the peripheral nerve block methods that are used to falicitate lower extremity surgical procedures. The advantages of femoral nerve block include an effective perioperative analgesia with minimum systemic side effects, lower dosage of opioids, early mobilization and cost effective. This study aimed to measure the distance from the mid point of the femoral nerve to the mid point of the femoral artery at the level of inguinal crease of adults with ultrasound guidance that will determine the success rate of femoral nerve block. A descriptive analytic study involving 43 volunteer subjects aged 18–60 years was performed at the Anesthesiology and Intensive Care Department of the Faculty of Medicine, Universitas Padjadjaran and Central Operating Theatre (COT of Dr. Hasan Sadikin General Hospital Bandung between September and October 2014. Statistical analysis are using Mann-Whitney test and independent t-test. Results showed that the average distance from the mid point of the femoral nerve to the mid point of the femoral artery in male was 1.075±0.13 cm and in female was 1.069±0.13 cm. This study conclude that the average distance of femoral artery to the femoral nerve is 1.07 cm lateral to the femoral artery.

  9. Algunas aclaraciones acerca del conocimiento del singular.

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    Carlos Llano Cifuentes

    2013-11-01

    Full Text Available Llano tries to explain the main purpose of El Conocimiento del Singular, showing how the individuals about which the book is concerned are basically human individuals: people as decision makers.

  10. Psicodrama del duelo.

    OpenAIRE

    José Antonio Espina Barrio; Marisol Filgueira Bouza

    1997-01-01

    La pérdida de rituales agrava y alarga la reacción del duelo. Se define el Psicodrama Antropológico y su intervención en el proceso del duelo. El Psicodrama Focal del Duelo es una psicoterapia breve centrada en el proceso de Duelo. Se comentan varios casos y resultados. Se concluye con un programa sencillo para el duelo en Atención Primaria.

  11. Fractura triple del complejo suspensorio del hombro

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    Eraclio Delgado Rifá

    2015-06-01

    Full Text Available El complejo suspensorio del hombro es una estructura sumamente importante, compuesta por un anillo de huesos y tejidos blandos. Las lesiones aisladas de este complejo anatómico son frecuentes y no afectan su estabilidad. La interrupción doble conduce a la inestabilidad de esta estructura y usualmente requiere tratamiento quirúrgico. La triple interrupción, por su parte, es sumamente rara y es encontrada en casos de trauma de alta energía a menudo en asociación con otras lesiones. Se presenta una triple lesión del complejo suspensorio del hombro en un paciente de 46 años de edad, con una fractura de la glenoides, del acromion tipo III de Kuhn y de la coracoides tipo II de Ogawa. En este caso, la fractura del acromion fue tratada con fijación percutánea con alambres de Kirschner, por tener asociado lesiones de partes blandas que contraindicaron la reducción abierta. La fractura de la glenoides y de la apófisis coracoides fueron tratadas conservadoramente. Después de 6 meses de evolución, el paciente tuvo un resultado funcional aceptable, con una abducción de 90 grados, los 30 grados de rotación externa y 70 de rotación interna, además asintomático y consolidación de todas las fracturas. A pesar de ser catalogada de una lesión grave del cinturón escapular y estar asociada a otras lesiones se obtuvo un resultado satisfactorio al final del tratamiento.

  12. Vigencia del Darwinismo

    OpenAIRE

    Lessa, Enrique P

    2009-01-01

    En este ensayo se presenta una revisión histórica del signifcado y legado del darwinismo, con énfasis en el último siglo. La principal conclusión es que la visión darwiniana de la evolución, con las modifcaciones requeridas para dar cuenta de los grandes desarrollos de la disciplina, se ha impuesto y mantiene vigencia en nuestros días. En particular, el papel del azar, la evolución como proceso de “descendencia con modifcación” a lo largo de diversas ramas del árbol de la vida, el pensamiento...

  13. Systematic training model for teaching, development and training of instructors in inguinal hernia treatment using the Lichtenstein technique. Hernia campaign 2014 & 2015.

    Science.gov (United States)

    Lazzarini-Mendes, Carlos José; Pacheco, Adhemar Monteiro; Destro, Bárbara Bozzoli; Tamaro, Caroline; Nogueira, Fábio Antonio Del Picchia DE Araújo; Chen, David; Reinpold, Wolfgang; Bruscagin, Vitor; Roll, Sergio; Silva, Rodrigo Altenfelder

    2016-01-01

    to evaluate the method of training and continuing education of 18 surgeons in 2014, and 28 surgeons in 2015, in the Holy Homes of Ribeirao Preto, Araraquara, Franca and San Carlos of São Paulo, in the performance of Lichtenstein inguinal herniorrhaphy, tutored by the Faculty of Medical Sciences of the São Paulo Holy Home and the organization HERNIA HELP - "Hernia Repair for the Underserved". the training was tutored and systematized through an active methodology of teaching and learning, aiming to offer competence, skills and attitudes, measured by a previously validated Qualification Form, qualifying leaders in trainees' improvement. in 2014 the outcomes were: the difficulty of the case, direction, incision, dissection, mesh preparation, mesh cutting, mesh setting, closing, instruments, respect to tissues, flow, time and motion, and performance, all presented change in the general rating (p=0.000002); there was greater confidence in the execution of the procedure in 80% of trainees, considered "very valuable" in 93.3% of the interventions. In 2015, 28 surgeons were trained by ten surgeons previously qualified in 2014. The nerve identification rate, a relevant time the Lichtenstein technique, was 95.5% for the Iliohypogastric, 98.5% for the ilioinguinal and 89.4% for the genital branch of the genitofemoral nerve. the applied teaching method is possible, reproducible, reliable and valid. The joint efforts offer enormous opportunity of directed education, reaching underserved populations, revealing the great teacher-student social responsibility. avaliar resultados do método de treinamento e educação continuada de 18 cirurgiões, em 2014, e 28 cirurgiões, em 2015, nas Santas Casas de Ribeirão Preto, Araraquara, Franca e São Carlos do Estado de São Paulo, na realização da Herniorrafia Inguinal à Lichtenstein, tutorados pela Faculdade de Ciências Médicas da Santa Casa de São Paulo e pela organização HERNIA HELP - "Hernia Repair for the Underserved

  14. The DQB1 *03:02 HLA haplotype is associated with increased risk of chronic pain after inguinal hernia surgery and lumbar disc herniation.

    Science.gov (United States)

    Dominguez, Cecilia A; Kalliomäki, Maija; Gunnarsson, Ulf; Moen, Aurora; Sandblom, Gabriel; Kockum, Ingrid; Lavant, Ewa; Olsson, Tomas; Nyberg, Fred; Rygh, Lars Jørgen; Røe, Cecilie; Gjerstad, Johannes; Gordh, Torsten; Piehl, Fredrik

    2013-03-01

    Neuropathic pain conditions are common after nerve injuries and are suggested to be regulated in part by genetic factors. We have previously demonstrated a strong genetic influence of the rat major histocompatibility complex on development of neuropathic pain behavior after peripheral nerve injury. In order to study if the corresponding human leukocyte antigen complex (HLA) also influences susceptibility to pain, we performed an association study in patients that had undergone surgery for inguinal hernia (n=189). One group had developed a chronic pain state following the surgical procedure, while the control group had undergone the same type of operation, without any persistent pain. HLA DRB1genotyping revealed a significantly increased proportion of patients in the pain group carrying DRB1*04 compared to patients in the pain-free group. Additional typing of the DQB1 gene further strengthened the association; carriers of the DQB1*03:02 allele together with DRB1*04 displayed an increased risk of postsurgery pain with an odds risk of 3.16 (1.61-6.22) compared to noncarriers. This finding was subsequently replicated in the clinical material of patients with lumbar disc herniation (n=258), where carriers of the DQB1*03:02 allele displayed a slower recovery and increased pain. In conclusion, we here for the first time demonstrate that there is an HLA-dependent risk of developing pain after surgery or lumbar disc herniation; mediated by the DRB1*04 - DQB1*03:02 haplotype. Further experimental and clinical studies are needed to fine-map the HLA effect and to address underlying mechanisms. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  15. A comparative study on trans-umbilical single-port laparoscopic approach versus conventional repair for incarcerated inguinal hernia in children

    Directory of Open Access Journals (Sweden)

    Zhang Jun

    2016-01-01

    Full Text Available Purpose: The purpose of this study is to determine whether singleport laparoscopic repair (SLR for incarcerated inguinal hernia in children is superior toconventional repair (CR approaches. Method: Between March 2013 and September 2013, 126 infants and children treatedwere retrospectively reviewed. All the patients were divided into three groups. Group A (48 patients underwent trans-umbilical SLR, group B (36 patients was subjected to trans-umbilical conventional two-port laparoscopic repair (TLR while the conventional open surgery repair (COR was performed in group C (42 patients. Data regarding the operating time, bleeding volume, post-operative hydrocele formation, testicular atrophy, cosmetic results, recurrence rate, and duration of hospital stay of the patients were collected. Result: All the cases were completed successfully without conversion. The mean operative time for group A was 15 ± 3.9 min and 24 ± 7.2 min for unilateral hernia and bilateral hernia respectively, whereas for group B, it was 13 ± 6.7 min and 23 ± 9.2 min. The mean duration of surgery in group C was 35 ± 5.2 min for unilateral hernia. The recurrence rate was 0% in all the three groups. There were statistically significant differences in theoperating time, bleeding volume, post-operative hydrocele formation, cosmetic results and duration hospital stay between the three groups (P < 0.001. No statistically significant differences between SLR and TLR were observed except the more cosmetic result in SLR. Conclusion: SLR is safe and effective, minimally invasive, and is a new technology worth promoting.

  16. A comparative study on trans-umbilical single-port laparoscopic approach versus conventional repair for incarcerated inguinal hernia in children.

    Science.gov (United States)

    Jun, Zhang; Juntao, Ge; Shuli, Liu; Li, Long

    2016-01-01

    The purpose of this study is to determine whether singleport laparoscopic repair (SLR) for incarcerated inguinal hernia in children is superior toconventional repair (CR) approaches. Between March 2013 and September 2013, 126 infants and children treatedwere retrospectively reviewed. All the patients were divided into three groups. Group A (48 patients) underwent trans-umbilical SLR, group B (36 patients) was subjected to trans-umbilical conventional two-port laparoscopic repair (TLR) while the conventional open surgery repair (COR) was performed in group C (42 patients). Data regarding the operating time, bleeding volume, post-operative hydrocele formation, testicular atrophy, cosmetic results, recurrence rate, and duration of hospital stay of the patients were collected. All the cases were completed successfully without conversion. The mean operative time for group A was 15 ± 3.9 min and 24 ± 7.2 min for unilateral hernia and bilateral hernia respectively, whereas for group B, it was 13 ± 6.7 min and 23 ± 9.2 min. The mean duration of surgery in group C was 35 ± 5.2 min for unilateral hernia. The recurrence rate was 0% in all the three groups. There were statistically significant differences in theoperating time, bleeding volume, post-operative hydrocele formation, cosmetic results and duration hospital stay between the three groups (P < 0.001). No statistically significant differences between SLR and TLR were observed except the more cosmetic result in SLR. SLR is safe and effective, minimally invasive, and is a new technology worth promoting.

  17. Effect of addition of dexamethasone to ropivacaine on post-operative analgesia in ultrasonography-guided transversus abdominis plane block for inguinal hernia repair: A prospective, double-blind, randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Uma Datt Sharma

    2018-01-01

    Full Text Available Background and Aims: Ultrasonography (USG-guided transversus abdominis plane (TAP block is an abdominal field block with high efficacy. This study was undertaken with the aim of determining the effect of the addition of dexamethasone to 0.5% ropivacaine on post-operative analgesia in USG-guided TAP block for inguinal hernia repair. Methods: A double-blind randomised control study was conducted on sixty patients posted for inguinal hernia repair with the American Society of Anesthesiologists physical Status I or II, who were allocated two groups of 30 each. Patients in Group RS received 0.5% ropivacaine (20 ml and normal saline (2 ml whereas patients in Group RD received 0.5% ropivacaine (20 ml and dexamethasone (2 ml, i.e., 8 mg, in USG-guided TAP Block on the same side, after repair of inguinal hernia under spinal anaesthesia. Visual analogue scale (VAS scores, time for request of first analgesia and total tramadol consumption in first 24 h were compared. Unpaired Student's t-test and Mann–Whitney U-test were performed using SPSS 23 Software. Results: Patients in Group RD had significantly lower VAS scores as compared to Group RS from 4th to 12th h, postoperatively. Duration of analgesia was significantly more in Group RD (547.50 [530,530] min when compared with Group RS (387.50 [370,400] min (P < 0.001. The demand for intravenous tramadol was significantly low in Group RD (223.33 ± 56.83 mg as compared to Group RS (293.33 ± 25.71 mg (P < 0.001. Conclusion: Addition of dexamethasone to ropivacaine in USG-guided TAP block significantly reduces post-operative pain and prolongs the duration of post-operative analgesia, thereby reducing analgesic consumption.

  18. La luz del origen del universo

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    Casas, Alberto

    2015-10-01

    Full Text Available Penzias and Wilson discovered the cosmic microwave background, a luminous echo of the Big Bang, in 1965. The amount of information encoded in this relic of the early universe is truly extraordinary. At present, the most precise data about the origin and structure of the universe comes from the study of this primordial light, the full potential of which has yet to be explored.En 1965 se descubrió el fondo de radiación de microondas, un eco luminoso de la Gran Explosión (Big Bang. La cantidad de información contenida en esta reliquia del universo primitivo es verdaderamente extraordinaria. En la actualidad los datos más precisos sobre el origen y estructura del universo provienen del estudio de esta luz primigenia, que aún no ha sido explorada en todo su potencial.

  19. Efficacy of ropivacaine by the concentration of 0.25%, 0.5%, and 0.75% on surgical performance, postoperative analgesia, and patient’s satisfaction in inguinal hernioplasty: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Su YL

    2015-09-01

    Full Text Available Yinglan Su, Zhongjun Zhang, Yaoxian Zhang, Hanwei Li, Wei Shi Anesthesia Department, The Shenzhen People’s Hospital, The Secondary Clinical Medical College of Jinan University, Shenzhen, Guangdong, People’s Republic of China Background: The purpose of this study was to evaluate the use of different concentrations of ropivacaine in ultrasound-guided regional anesthesia with regard to postoperative analgesic and patient’s satisfaction in elderly patients undergoing inguinal hernioplasty in the People’s Republic of China. Methods: A total of 60 patients (>75 years of age who scheduled inguinal hernioplasty at the Shenzhen People’s Hospital from December 2013 to March 2015 were randomly assigned to three groups: 0.25% ropivacaine (n=20, 0.5% ropivacaine (n=20, and 0.75% ropivacaine (n=20. Ultrasound-guided regional anesthesia was performed before every surgery. Non-invasive blood pressure and heart rate were recorded before the operation, during the first 5 minutes of the surgical procedure, and 5 minutes after the operation of the patients, and compared between the groups. Incidence of adverse reactions, postoperative Visual Analog Scale score, and analgesic effect were also recorded and analyzed. Results: The surgical procedure and anesthesia was performed successfully in all patients. Patients with high-dose ropivacaine (0.5% and 0.75% in ultrasound-guided regional anesthesia exhibited lower arterial pressure and lower heart rate during the operation when compared to low-dose group. The interquartile range of Visual Analog Scale scores in both group C (0.75% ropivacaine and group B (0.5% ropivacaine were significantly lower (P<0.05 than in group A (0.25% ropivacaine. Accordingly, the interquartile range of satisfactory scores in both group C (0.75% ropivacaine and group B (0.5% ropivacaine were significantly higher (P<0.05 than in group A (0.25% ropivacaine. More cases in high-dose groups reported abnormal skin sensation; however, it

  20. Archivo del Duelo

    OpenAIRE

    Ferrera, Tamara

    2010-01-01

    Photos taken from the Archive of Mourning following the March 11 terrorist attacks El Archivo del Duelo. Creación de un archivo etnográfico de los Atentados del 11 de marzo en Madrid. Ministerio de Educación y Ciencia HUM2005-03490.

  1. Displasias del seno

    Directory of Open Access Journals (Sweden)

    Ernesto Andrade Valderrama

    1971-04-01

    Full Text Available En general, las Displasias no se presentan antes de la iniciación del estímulo Gonadal y tienden a desaparecer con el climaterio. Se definen entonces como las afecciones benignas del Seno, de origen endocrino.

  2. La crisi del diritto del lavoro

    Directory of Open Access Journals (Sweden)

    Alessandro Garilli

    2012-01-01

    Full Text Available Riassunto - L’Autore ripercorre in chiave critica l’evoluzione delle politiche legislative in materia di lavoro, alla luce dell’attuale fase di crisi economico finanziaria. Nell’esaminare i principali interventi normativi attuati da inizio secolo, l’Autore mette in evidenza le scelte di metodo e gli elementi di continuità che accomunano i vari provvedimenti, individuandoli nell’affannosa ricerca del punto di equilibrio tra flessibilità e garantismo. La riflessione si chiude con alcuni interrogativi sulle ultime linee di riforma del mercato del lavoro e con l’auspicio che, anche al cospetto delle imprescindibili ragioni dell’economia, il diritto del lavoro possa continuare a svolgere il proprio tradizionale ruolo di disciplina di tutela della persona.   Abstract - The author analyzes, with a critically oriented approach, the development of the employment law, in the light of the current economic and financial crisis. In examining the main regulatory measures implemented since the beginning of the century, the author highlights the methodological choices and the elements of continuity that unite the various measures, focusing them in a hard research of a point of balance between flexibility and security. The discussion concludes with some questions about the last lines of the reform of the labor market and with the hope that, even in the face of compelling reasons of economy, labor law can continue to play its traditional role of governing the protection of person.

  3. OBJETIVO DEL DESARROLLO DEL MILENIO 7

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    Margarita M. Pérez O.

    2013-10-01

    Full Text Available Los Objetivos de Desarrollo del Milenio, también conocidos como los Objetivos del Milenio, constituyeron las metas finales que aprobaron los dirigentes mundiales, 189 jefes de estado y de gobierno en la Cumbre del Milenio de las Naciones Unidas celebrada en Nueva York en el año 2000, en la cual los Estados miembros de la organización reafirmaron su compromiso de luchar por un mundo en el que el desarrollo sostenible y la eliminación de la pobreza tuvieran máxima prioridad1 . En la cumbre se definió la Declaración del Milenio, la cual detalla los objetivos, principios, valores, metas y acciones para erradicar la pobreza Mundial hacia el año 2015, todos ellos ratificados con alto interés y acción estratégica de carácter global, como marco para la medición de los progresos en materia de desarrollo.

  4. Elementos del sistema electoral del Congreso Mexicano

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    Aldo Medina García

    2013-08-01

    Full Text Available El presente artículo es un estudio de los componentes del sistema electoral, diseñado por el legislador mexicano para integrar al parlamento federal. Estudio desarrollado a sabiendas de la importancia que reviste el sistema electoral como un medio que permite a los ciudadanos convertir su voto expresado en las urnas en escaños a favor de determinado candidato o partido. En dicho análisis tomamos en cuenta la evolución constitucional del sistema electoral mexicano, la participación de las fuerzas minoritarias en la integración del Senado y de la Cámara de Diputados, la división que se hace del territorio en circunscripciones electorales, la barrera electoral que se fija a los partidos políticos para acceder a la representación en el Parlamento, la fórmula de asignación que se aplica a la votación obtenida, para finalmente concluir que el sistema electoral mexicano es esencialmente mayoritario aun cuando se vista de proporcional.

  5. ANÁLISIS RETROSPECTIVO DEL CARDINOMA CUTÁNEO TIPO BASOCELULAR Y ESCAMOCELULAR EN BOGOTÁ - C0LOMBIA: EPIDEMIOLOGÍA, PREVENCIÓN Y TRATAMIENTO

    Directory of Open Access Journals (Sweden)

    Óscar Iván Barón Estrada

    2009-01-01

    Full Text Available Antecedentes. El carcinoma cutáneo no melanoma del tipo basocelular (CBC y escamocelular (CEC, tiene tasas de incidencia cercanas al 13 por ciento y es el más prevalente en la población blanca. Trae elevada morbilidad para el paciente y altos costos para el sistema de salud, y aunque es la neoplasia maligna mas frecuentemente diagnosticada, en Colombia sólo se tienen estadísticas en instituciones oncológicas, haciendo énfasis principalmente en melanomas. Entre los principales factores de riesgo se encuentra la exposición a los RUVB, tipo de piel, la radiación, el virus del papiloma humano (HPV y su tratamiento incluye medicación tópica, crioterapia, electrofulguración y cirugía. Objetivo. Analizar algunas características epidemiológicas del cáncer cutáneo (CBC - CEC en nuestro medio, estableciendo similitudes y diferencias respecto a la literatura actual. Material y métodos. En la clínica San Pedro Claver se revisaron 202 historias clínicas de pacientes con diagnóstico confirmado de CBC O CEC de 2004 a 2006 en un estudio retrospectivo de serie de casos y se analizaron las variables más comunes como el tipo de lesión, su ubicación, tamaño, patrón histológico y tratamiento. Resultados. Ingresaron en el estudio 112 pacientes, de los cuales cerca del 60 por ciento eran hombres, con una edad media de 69.5 años. El 90 por ciento de las lesiones se localizaban en cara (mejillas, párpados, nariz. Del 70 por ciento de las lesiones que correspondían a CBC el tipo histológico más frecuente fue sólido nodular y del 22 por ciento de lesiones que correspondían a CEC, el moderadamente diferenciado de célula grande fue el más común. Las lesiones tuvieron un tamaño promedio de 2 cm y los procedimientos quirúrgicos más usados fueron resección más injerto (44.1%, seguido de resección más colgajo local (23.5%. El 5 por ciento de los pacientes tenían lesiones previas y uno de cada cuatro tuvo algún tipo de reca

  6. Comprehensive MRA of the lower limbs including high-resolution extended-phase infra-inguinal imaging with gadobenate dimeglumine: Initial experience with inter-individual comparison to the blood-pool contrast agent gadofosveset trisodium

    International Nuclear Information System (INIS)

    Christie, A.; Chandramohan, S.; Roditi, G.

    2013-01-01

    Aim: To compare extended-phase imaging using an extracellular space contrast agent, gadobenate dimeglumine, to imaging with a blood-pool contrast agent, gadofosveset, for magnetic resonance angiography. Materials and methods: A lower-limb magnetic resonance angiography (MRA) protocol (dynamic crural, three-station bolus chase, and infra-inguinal high resolution) designed for blood-pool agent imaging was adapted for use with the extracellular agent, gadobenate dimeglumine, primarily by using a triphasic injection protocol. Ten patients scanned with gadofosveset were compared to 10 patients scanned with gadobenate. The dynamic, bolus chase, and high-resolution images were scored for quality on a Likert scale (from 1–5). Signal- and contrast-to-noise ratios were analysed, and Mann–Whitney U statistical analysis performed. Results: There was no significant difference for the dynamic imaging or the aorto-iliac station of the bolus chase. Infra-inguinal bolus chase images were higher quality (p < 0.05 Mann–Whitney U test) with gadobenate. Signal analysis confirmed lower signal and contrast for venous imaging on the high spatial resolution acquisitions with gadobenate; however, this allowed improved arterial conspicuity. Conclusion: Extended-phase imaging using an extracellular space contrast agent is feasible and provides image quality to equal imaging with a blood-pool contrast agent.

  7. Comparison of efficacy of transversus abdominis plane block and iliohypogastric/ilioinguinal nerve block for postoperative pain management in patients undergoing inguinal herniorrhaphy with spinal anesthesia: a prospective randomized controlled open-label study.

    Science.gov (United States)

    Okur, Onur; Tekgul, Zeki Tuncel; Erkan, Nazif

    2017-10-01

    The purpose of this study was to compare the effects of lateral abdominal transversus abdominis plane block (TAP block) and iliohypogastric/ilioinguinal nerve block (IHINB) under ultrasound guidance for postoperative pain management of inguinal hernia repair. Secondary purposes were to compare the complication rates of the two techniques and to examine the effects of TAP block and IHINB on chronic postoperative pain. This was a prospective randomized controlled open-label study. After approval of the Research Ethics Board, a total of 90 patients were allocated to three groups of 30 by simple randomized sampling as determined with a priori power analysis. Peripheral nerve blocks (TAP block or IHINB) were administered to patients following subarachnoid block according to their allocated group. Patient pain scores, additional analgesic requirements and complication rates were recorded periodically and compared. Pain scores were significantly lower in the study groups (p block group [GT] 266.6 ± 119.7 min; IHINB group [GI] 247.2 ± 128.7 min; and control group [GC] 79.1 ± 66.2 min; p block or IHINB for patients undergoing inguinal herniorrhaphy reduces the intensity of both acute and chronic postoperative pain and additional analgesic requirements.

  8. Castillo del Real. Olocau

    OpenAIRE

    AUÑÓN VALLEJO, JONATAN

    2012-01-01

    El objetivo que se quiere alcanzar con este proyecto es el de realizar un estudio lo más cercano posible del Catillo del Real, de manera que se pueda conocer su origen, su evolución a lo largo de la historia, así como las diferentes técnicas y sistemas constructivos utilizados en su construcción. Auñón Vallejo, J. (2011). Castillo del Real. Olocau. http://hdl.handle.net/10251/14244. Archivo delegado

  9. La Representabilidad del Genocidio

    OpenAIRE

    Cardona González, Lorena

    2012-01-01

    El presente artículo intenta hacer una aproximación histórica y analítica al fenómeno del Genocidio, sus implicaciones sociales y culturales que dieron como resultado la reformulación analítica y conceptual de hechos que hasta entonces superaban el conocimiento y la moral humana. De este modo, se hace un trayecto histórico de la paulatina aparición del asesinato masivo como practica de Estado, enmarcado en las experiencias del genocidio armenio y el alemán. A su vez, se hace una mirada sobre ...

  10. Significado presente del CSIC

    OpenAIRE

    Garrido Gallardo, Miguel Angel

    2000-01-01

    Not available

    Este artículo, elaborado en 1999, ofrece una panorámica de la realidad del Consejo Superior de Investigaciones Científicas en la actualidad. Repasa su organización, su volumen de publicaciones, sus indicadores de productividad, su capacidad de obtener recursos y, en suma, su lugar en el conjunto del sistema español de Ciencia y Tecnología, considerado en sí mismo y en relación con la Universidad. Como conclusión del repaso de datos, se afirma que, aunque la fó...

  11. Tratamiento del pie equino

    OpenAIRE

    Robles, Fernanda

    2012-01-01

    El pie equino varo es una patología frecuente en los pacientes con Encefalopatía crónica no evolutiva (ECNE).Se observó que existe una mayor frecuencia en el sexo masculino. Se realizó un estudio descriptivo, comparativo y secundario, durante el periodo de septiembre del 2006 a septiembre del 2011, con un total de 125 pacientes con Ecne, de los cuales se encontraron 101 con pie equino varo congénito. Objetivo: observar los resultados obtenidos en la rehabilitación del pie equino, en niños de ...

  12. Del Pasadismo al Futurismo

    OpenAIRE

    Agudo-Martínez, M. J.

    2003-01-01

    Uno de los habituales prejuicios a la hora de abordar el análisis del movimiento futurista, al igual que sucede con el constructivismo, es la consideración del contexto político en el que se desarrollaron ambas vanguardias. Sin embargo, y dejando a un lado un enfoque del arte con finalidad política de signo diverso, habría que insistir en el hecho de que posiblemente sean tanto el futurismo italiano como el constructivismo ruso, los movimientos que con mayor entusiasmo se manifestaron, en un ...

  13. Ritidoplastia: sutura del sistema SMAS-Platisma e importancia de la filosofía de la naturalidad

    Directory of Open Access Journals (Sweden)

    R. Goulart Jr.

    2013-06-01

    Full Text Available La ritidoplastia ha pasado por incontables cambios técnicos en relación a los colgajos cutáneos o a los musculares involucrados en el procedimiento. Inicialmente solo se realizaba la tracción de la piel con resultados muy variables; con el tiempo y con un mejor conocimiento de la anatomía facial, los resultados han evolucionado hasta la estandarización de la tracción de las estructuras faciales que en la actualidad es mucho más muscular, realizando sobre la piel solamente el ajuste de la cobertura al nuevo contorno facial. El objetivo de este artículo es demostrar la eficacia de la sutura simple del sistema SMAS-Platisma y la importancia de considerar una filosofía de la naturalidad que será la base de una técnica moderna de ritidoplastia. Revisamos un total de 617 pacientes, todas de sexo femenino, que se sometieron a ritidoplastia simple o combinada con otras cirugías en el periodo comprendido entre enero de 1992 a diciembre del 2010. La edad osciló entre los 37 y 75 años. Las cirugías combinadas incluyeron: reducción mamaria, mastopexia, abdominoplastia, implantes mamarios, cirugía de los párpados, rinoplastia, liposucción, cirugía vascular y cirugías ginecológicas. El número de pacientes en las que solo se realizó la ritidoplastia fue 326. Los índices de complicaciones estuvieran entre el 0,16 % y 1,13 % con relación a cada complicación estudiada, siendo el total del 4,03 %. El estudio retrospectivo mostró la eficiencia de la sutura simple del sistema SMAS-Platisma y los resultados naturales que se pueden obtener incluso con las cirugías combinadas. Todas las pacientes quedaron satisfechas con los resultados y consideramos que los índices de complicaciones estuvieron en niveles aceptables. A nuestro juicio, la ritidoplastia, por encima de otras cirugías estéticas, necesita de una rutina técnica eficiente y de un concepto filosófico basado en la más pura naturalidad, que necesita ser independiente de las

  14. Preferencias del Turista

    Directory of Open Access Journals (Sweden)

    Jose Luis Leiva Olivencia

    2015-01-01

    Full Text Available Actualmente existen aplicaciones orientadas al turismo basadas en realidad aumentada, pero no integran técnicas de recomendación. Este articulo describe RAMCAT (Realidad Aumentada Móvil Contextual Aplicada al Turismo un modelo de guía turística, que recomienda puntos de interés, teniendo en cuenta factores como preferencias personales y atributos contextuales. Se presentan los componentes teóricos de la arquitectura propuesta, así como sus características, destacando la integración de diferentes sistemas de recomendación, que permiten añadir nuevos motores en el futuro. El articulo se centra en describir sus funcionalidades y el modulo correspondiente al sistema de recomendación basado en el perfil del turista. Otra característica importante del sistema propuesto es la retroalimentación del mismo mediante calificaciones del turista y su trazabilidad.

  15. Carta del Editor

    Directory of Open Access Journals (Sweden)

    Luis Eladio Proaño

    2015-01-01

    Full Text Available La millonaria contratación del futbolista David Beckham, un fenómeno del mercado, ha provocado cuestionamientos a los que se busca respuesta. Es tema de análisis el por qué el betseller "Harry Potter" ha causado tanta conmoción en la opinión pública. Respecto al periodista cibernético, se señalan los contornos del presente y atisban las posibilidades del futuro de esta nueva profesión. El tratamiento de los mitos de la prensa, los temores de la Ley mordaza venezolana y la brutalidad de los video juegos e Internet son temas de enorme interés. Se comenta las pocas veces que la prensa reflexiona sobre la comunicación corporal y la anorexia.

  16. Los muertos del Floreanismo

    Directory of Open Access Journals (Sweden)

    Enrique Ayala Mora

    2008-06-01

    Full Text Available El artículo analiza el crimen político durante las primeras décadas de vida de la República del Ecuador. Específicamente centra su estudio en el período dominado por la figura de Juan José Flores, primer presidente del Ecuador. La inestabilidad política, la precariedad de las alianzas entre las élites regionales, la crisis económica generada por las guerras de Independencia, las conspiraciones y la violencia que caracterizaron al período de surgimiento de las repúblicas andinas hicieron del crimen político un “vicio de nacimiento”. El asesinato del general Antonio José de Sucre, la muerte de los miembros de la sociedad El Quiteño Libre, el homicidio de Juan Otamendi, entre otros, hicieron patente esta característica.

  17. Niveles del aprendizaje organizacional

    OpenAIRE

    Garzón Castrillón, Manuel Alfonso

    2005-01-01

    En la propuesta de modelo de aprendizaje organizacional (AO), la segunda variable se denomina niveles del aprendizaje organizacional ; los niveles de aprendizaje que contemplamos para nuestra investigación son: individual, de equipo, organizacional e interorganizacional.

  18. La escritura del Yo

    Directory of Open Access Journals (Sweden)

    Patricio Landaeta Mardones

    2013-11-01

    Full Text Available Si la creación de una imagen fidedigna del mundo fue la condición de la conquista cognitiva y económica de la tierra, las imágenes mediáticas circulan hoy en día a la manera de un montaje que organiza los sujetos como elementos de un territorio. En esta presentación abordaremos el cruce entre estos dos hechos, entre la escritura del mundo y la de los sujetos, a partir de la idea de Fabulación para mostrar otra escritura del mundo y del yo, leyendo textos e imágenes de la Primera buena Corónica y Buen Gobierno de Felipe Guaman Poma de Ayala.

  19. Consideraciones alrededor del Libro del Almismo, el Libro del Pensar.

    Directory of Open Access Journals (Sweden)

    MartaLucía Tamayo Fernandez

    1999-12-01

    Full Text Available

    La doctora MarthaLucía Tamayo comparte muchas inquietudes alrededor del Libro del Almismo, el Libro del Pensar; de dónde salió ese nombre; de juntar en medicina y en genética a tres escritores como lo son Jorge Luis Borges, Macedonio Fernández y Julio Cortázar. Su conferencia dice así:

    El término almismo fue ideado por Macedonio Fernández porque defendía mucho el ensimismamiento y el pensamiento hacia el interior, mirar hacia adentro; cada uno somos un “sí mismo” que nos hace diferentes aunque al mismo tiempo podemos ser iguales. Todos tenemos esa parte interior que la medicina debe trabajar y que no puede olvidar.

    “El Libro del Almismo, el libro del pensar” nos lleva a replantear y a repensar un poco la medicina que queremos, una medicina vuelta a pensar.

    Quiero contarles la historia de cómo se llegó a este libro y por qué y para qué se sigue trabajando en estos temas: Después de mi internado y de un trabajo un poco triste de rural, volví al Instituto de Genética y a la Universidad Javeriana en donde encontré al doctor Bernal y un espacio que estaba buscando para esa medicina diferente que quería, con un grupo de personas que me permitía no sólo ver la medicina sino ver muchas otras cosas más; había espacio para la literatura, para Mafalda, para hablar de niños, de locos, había incluso tiempo para hablar de medicina dentro del golf, de carros antiguos y de todo eso fui aprendiendo.

    Eso era lo que estaba buscando. Una medicina que diera espacios diferentes, que fuera más humanizada. Rápidamente me ubiqué y me quedé! No me arrepiento en lo absoluto de haberme quedado porque fue, ha sido y sigue siendo, una experiencia enriquecedora, de muchas vivencias importantes. Sabía exactamente dónde estaba y sabía que había que seguir rápido y había que trabajar muchos aspectos de esa medicina que estábamos buscando y de esa genética especial.

    Rápidamente empezamos a trabajar

  20. Actualidad del relativismo cultural

    OpenAIRE

    Sánchez Durá, Nicolás

    2013-01-01

    Este ensayo tiene tres propósitos. En primer lugar, propone examinar las relaciones entre etnocentrismo y relativismo. El etnocentrismo puede tomar tres formas distintas: a saber, la de una universalidad impostada, la del exotismo y la de un particularismo narcisista exacerbado. El relativismo cultural es una postura que asume la inconmensurabilidad de los conceptos y valores que deben ser considerados como válidos dentro de las imágenes del mundo definidas. En segundo lugar, se argumenta que...

  1. el Valle del Cauca

    Directory of Open Access Journals (Sweden)

    Carlos Humberto Ortiz

    2007-01-01

    Full Text Available Este artículo se enfoca en la identi- ficación de aquellos factores estructurales que explican la pérdida de dinamismo económico de largo plazo en Colombia y, en particular, en el Valle del Cauca. Se examina la competitividad del Valle en relación con Colombia y con el resto del mundo. Se cuestiona la insistencia en una estrategia exportadora como dinamizadora del desarrollo económico. Se identifica que una gran parte de la población está excluida de los beneficios del desarrollo económico. Para construir un modelo de desarrollo que incluya a esta población se recomienda recuperar la senda de la industrialización, invertir en el capital humano (educación de alta calidad, salud, salubridad y nutrición, e invertir en infraestructura. La participación del Estado en estas inversiones sociales es necesaria para disminuir la desigualdad y aumentar el crecimiento económico.

  2. Espectroscopia del Cometa Halley

    Science.gov (United States)

    Naranjo, O.; Fuenmayor, F.; Ferrin, L.; Bulka, P.; Mendoza, C.

    1987-05-01

    Se reportan observaciones espectroscópicas del cometa Halley. Los espectros fueron tomados usando el espectrógrafo del telescopio reflector de 1 metro del Observatorio Nacional de Venezuela. Se utilizó óptica azul, con una red de difracción de 600 lineas/min, obteniéndose una dispersión de 74.2 A/mm y una resolución de 2.5 A, en el rango espectral de 3500 a 6500 A. Seis placas fueron tomadas con emulsión IIa-O y dos con IIa-D. Los tiempos de exposición fueron entre 10 y 150 minutos. El cometa se encontraba entre 0.70 y 1.04 UA del Sol, y entre 1.28 y 0.73 UA de la Tierra. Las emisiones más prominentes en el espectro, son las del CN, C2, y C3. Otras emisiones detectadas corresponden a CH, NH2 y Na. Los espectros muestran un fuerte continuo, indicando un contenido significativo de polvo. Se detectó mayor intensidad del contínuo, en la dirección anti solar, lo cual es evidencia de la cola de polvo.

  3. Inventario nacional del uso actual del agua

    OpenAIRE

    Oficina Nacional de Evaluación de Recursos Naturales

    1984-01-01

    Establece como se emplea el agua en el Perú, teniendo en cuenta el tipo de uso, consuntivo y no consuntivo, discriminando según sea el destino: agrícola, pecuario, poblacional,industrial, minero, energético y pesquero, así como su localización geográfica; ello con la finalidad de que sirva de información básica para la planificación del desarrollo.

  4. Gerencia del cuidado-gerencia del servicio

    Directory of Open Access Journals (Sweden)

    Marta Palmet Jiménez

    2016-01-01

    Full Text Available La gerencia de este siglo debe estar plenamente identificada con la administración para planear, organizar, decidir y obtener resultados definidos, evaluados y alcanzados a través de las personas. Para poder gerenciar el cuidado se debe saber administrar. El objetivo de enfermería es cuidar; el objetivo de la gerencia es la conducción de la producción de bienes o servicios en las organizaciones. La gerencia del cuidado implica: motivación, creatividad, responsabilidad y ética por parte del cuidador y de quien cuida, claridad de actitud frente al ser y al qué hacer por parte del cuidador. Se puede concluir que la gerencia (administración, el cuidado (producto de calidad, el servicio (valor intangible, querer servir son un trinomio que deben ir de la mano de manera integrada para el logro de los objetivos propuestos por la organización de salud y de enfermería.

  5. Reconstrucción del complejo areola-pezón: revisión de 60 casos Nipple-areola complex reconstruction: revision of 60 cases

    Directory of Open Access Journals (Sweden)

    R. Fernández García

    2007-06-01

    Full Text Available La creación del complejo areola-pezón, CAP, constituye el último tiempo de la reconstrucción mamaria, transformando la reconstrucción del montículo mamario en una mama. Debemos considerar pues la reconstrucción de la areola y el pezón, como la culminación de la reconstrucción de la mama. Existen numerosas técnicas descritas para la reconstrucción del CAP. El objetivo de este estudio es determinar el grado de satisfacción psicológica de las pacientes tras la misma. El presente estudio fue diseñado como una revisión clínica retrospectiva de 60 pacientes. Tras la revisión de las historias clínicas, las pacientes fueron entrevistadas procediéndose a la realización del cuestionario. El aspecto a cambiar más deseado fue la falta/pérdida de proyección del pezón. No obstante, el 22% de las pacientes respondieron que no cambiarían nada acerca de su reconstrucción. La satisfacción acerca de la reconstrucción del montículo mamario fue excelente o buena para el 68%, normal para el 23% y pobre para el 9%. En cambio, para la reconstrucción del complejo areola-pezón fue excelente o buena para el 50%, normal para el 45% y pobre para el 5%. No se encontraron diferencias significativas entre las diferentes técnicas en función del tiempo transcurrido entre el momento de la mastectomía y el tercer tiempo de la reconstrucción (p=0,06. La técnica de la donación contralateral de pezón fue la que ofreció una mayor satisfacción (2,67 puntos y proyección (7,23 puntos. A pesar de las diferencias en sus medias, no se demostró ninguna diferencia estadísticamente significativa. Teniéndo en cuenta la técnica usada para la reconstrucción de la areola, la técnica de la donación-injerto de piel inguinal fue la que ofreció mayor satisfacción (3 puntos y coloración (8,57 puntos. El estudio estadístico objetivó diferencias estadísticamente significativas (p=0,01. Entre las distintas técnicas de reconstrucción del pezón no

  6. Determinantes del ingreso y del gasto corriente de los hogares

    OpenAIRE

    Muñoz C., Manuel

    2004-01-01

    Este ensayo de investigación empírica analiza los determinantes del ingreso y del gasto en los hogares colombianos. Utilizando un modelo del ciclo de vida con datos de la encuesta de hogares de 1994 y 1995, muestra que el comportamiento del ingreso está afectado principalmente por las características demográficas del hogar y los rasgos socio ocupacionales de sus miembros. El comportamiento del gasto está determinado ante todo por el ingreso y, en menor medida, por las características sociales...

  7. Las fluctuaciones del nivel del mar durante el Cuaternario

    OpenAIRE

    Pousa, Jorge Lorenzo; Isla, Federico Ignacio; Schnack, Enrique Jorge

    2002-01-01

    Los cambios del nivel del mar han ejercido una fuerte influencia en la evolución del planeta y en la historia de la humanidad. En una escala de tiempo geológico, las variaciones de los niveles oceánicos han dejado un registro ampliamente distribuido en la forma de depósitos sedimentarios. El descenso del nivel del mar durante la Ultima Glaciación, que alcanzó unos 120 metros hace 18.000 años, permitió la emergencia del estrecho de Bering y la migración humana desde Eurasia hacia América. Se e...

  8. La imagen del pase.

    Directory of Open Access Journals (Sweden)

    Hernando Bernal.

    1999-11-01

    Full Text Available A partir de un texto del poeta Octavio Paz llamado «La imagen», se busca proseguir la equivalencia entre las imágenes de la poesía y la función que ellas tienen para el poeta, y el fantasma fundamental y su función para el analizante que está en el momento del pase. Se parte de la idea de que la poesía busca entrar en el ser así como el psicoanálisis tiene como finalidad apuntar al corazón del ser del sujeto. Se hace entonces una distinción del concepto de «ser» para el psicoanálisis, haciendo alusión también al discurso de la filosofía. Esclarecido el sentido de lo que es el «ser» para el psicoanálisis, se aborda de lleno – entre otras cosas, relacionadas con la experiencia del pase específicamente- la equivalencia entre la definición que hace Octavio Paz de «La Imagen» y el momento del pase en el análisis de un sujeto, imagen que, al igual que el mito para la filosofía, las leyes para la ciencia y el matema para el psicoanálisis, se constituyen en los instrumentos con los que cada una de estas disciplinas horadan en lo real.

  9. The efficacy of the semi-blind approach of transversus abdominis plane block on postoperative analgesia in patients undergoing inguinal hernia repair: a prospective randomized double-blind study

    Directory of Open Access Journals (Sweden)

    Salman AE

    2013-01-01

    Full Text Available A Ebru Salman,1 Fahri Yetisir,2 Banu Yürekli,3 Mustafa Aksoy,1 Murat Yildirim,2 Mehmet Kiliç21Anesthesiology and Reanimation Department, 2General Surgery Department, Atatürk Research and Training Hospital, Ankara, Turkey; 3Endocrinology Department, Bozyaka Research and Training Hospital, Izmir, TurkeyPurpose: In this prospective, randomized, double-blind study, our aim was to compare the analgesic efficacy of the semi-blind approach of transversus abdominis plane (TAP block with a placebo block in patients undergoing unilateral inguinal hernia repair.Methods: After receiving hospital ethical committee approval and informed patient consents, American Society of Anesthesiologists (ASA I–III patients aged 18–80 were enrolled in the study. Standard anesthesia monitoring was applied to all patients. After premedication, spinal anesthesia was administered to all patients with 3.5 mL heavy bupivacaine at the L3-L4 subarachnoid space. Patients were randomly allocated into 2 groups. Group I (n = 32 received a placebo block with 20 mL saline, Group II (n = 32 received semi-blind TAP block with 0.25% bupivacaine in 20 mL with a blunt regional anesthesia needle into the neurofascial plane via the lumbar triangle of Petit near the midaxillary line before fascial closure. At the end of the operation, intravenous (IV dexketoprofen was given to all patients. The verbal analog scale (VAS was recorded at 2, 4, 6, 12, and 24 hours postoperatively. Paracetamol IV was given to patients if their VAS score > 3. A rescue analgesic of 0.05 mg/kg morphine IV was applied if VAS > 3. Total analgesic consumption and morphine requirement in 24 hours were recorded.Results: TAP block reduced VAS scores at all postoperative time points (P < 0.001. Postoperative analgesic and morphine requirement in 24 hours was significantly lower in group II (P < 0.01.Conclusion: Semi-blind TAP block provided effective analgesia, reducing total 24-hour postoperative analgesic

  10. del Estado Aragua

    Directory of Open Access Journals (Sweden)

    Joselys Cintia Zerpa

    2008-01-01

    Full Text Available Diagnostica la situación actual de los bienes que conforman al patrimonio histórico-cultural del Municipio Zamora, Estado Aragua, Venezuela. La Investigación es descriptiva y de campo, comprendió la elaboración de un inventario de los bienes inmuebles, festividades religiosas y manifestaciones artesanales del municipio. Se estudiaron la condición física y uso actual de estos bienes y los planes y proyectos existentes. Analizó el marco normativo que los rige. Se obtuvo la opinión de los representantes de organismos públicos relacionados con la actividad turística del Municipio, de los visitantes, cronistas e historiadores. Aportes: La mayoría de los bienes se encuentran en buen estado de conservación, Las manifestaciones culturales, festividades y la artesanía se desarrollan periódicamente pero no son aprovechadas turísticamente, Se determinó que existe un marco normativo para tales bienes y No existen propuestas actuales referentes a estos bienes. Se reflejó el interés de los sectores institucional y privado para la incorporación de estos bienes a la oferta turística del Municipio y del Estado

  11. APOSTILLAS ACERCA DEL POSTRABAJO

    Directory of Open Access Journals (Sweden)

    Arturo Torrecilla

    2000-01-01

    Full Text Available El más reciente debate en torno al postrabajo transforma la herencia de los dos ciclos que le precedieron desde los años setenta. El primero se correspondía con la crítica de la división social y técnica de labores informada por una filosofía de la alienación o bien por una rectificación de la arquitectónica marxista pero salvaguardando la promesa laborista del buen trabajo. El segundo ciclo hacía eco del rechazo a las cadenas de montaje fordistas y se abría al horizonte de la abolición del trabajo salarial, manteniendo sin embargo el abolengo del sujeto unitario de la historia. La presente escena asume una densidad mayor, producto del encuentro entre las nuevas tecnologías informacionales, las discusiones en el ámbito de la sociología y la antropología, de la tecnología y la ciencia, junto al dueto que inaugura el posmodernismo.

  12. Apostillas acerca del postrabajo

    Directory of Open Access Journals (Sweden)

    Arturo Torrecilla

    2000-04-01

    Full Text Available El más reciente debate en torno al postrabajo transforma la herencia de los dos ciclos que le precedieron desde los años setenta. El primero se correspondía con la crítica de la división social y técnica de labores informada por una filosofía de la alienación o bien por una rectificación de la arquitectónica marxista pero salvaguardando la promesa laborista del buen trabajo. El segundo ciclo hacía eco del rechazo a las cadenas de montaje fordistas y se abría al horizonte de la abolición del trabajo salarial, manteniendo sin embargo el abolengo del sujeto unitario de la historia. La presente escena asume una densidad mayor, producto del encuentro entre las nuevas tecnologías informacionales, las discusiones en el ámbito de la sociología y la antropología, de la tecnología y la ciencia, junto al dueto que inaugura el posmodernismo.

  13. La universidad del futuro

    Directory of Open Access Journals (Sweden)

    FERNANDO SANCÉN CONTRERAS

    2013-01-01

    Full Text Available El trabajo señala la necesidad de reconstruir la Universidad, dado el dinamismo que muestra la ciencia y la sociedad, pues trae consigo cambios sustanciales en la visión del mundo y en el aumento del poder del hombre sobre la naturaleza. Se analizan los supuestos epistemológicos de la universidad tradicional y se propone una nueva explicación del conocimiento humano, enfatizando el conocimiento científico. Postula una docencia fundada en las propiedades de la ciencia, cuyo método inductivo basado en los paradigmas vigentes: analítico, crítico, pragmático, ofrece una herramienta para la docencia, la investigación y la difusión de la cultura. Se propone una educación centrada en el sujeto que se hace a sí mismo (etopoiética y que insiste en el proceso de auto-creación del individuo y de la sociedad.

  14. Significado presente del CSIC

    Directory of Open Access Journals (Sweden)

    Garrido Gallardo, Miguel Angel

    2000-05-01

    Full Text Available Not available

    Este artículo, elaborado en 1999, ofrece una panorámica de la realidad del Consejo Superior de Investigaciones Científicas en la actualidad. Repasa su organización, su volumen de publicaciones, sus indicadores de productividad, su capacidad de obtener recursos y, en suma, su lugar en el conjunto del sistema español de Ciencia y Tecnología, considerado en sí mismo y en relación con la Universidad. Como conclusión del repaso de datos, se afirma que, aunque la fórmula del CSIC, como organismo nacional e interdisciplinario, no es la única posible, la organización del Estado de las Autonomías, así como la evaluación de los datos con que se cuenta, la hacen vivamente recomendable. No hay, pues, sino que seguir con su desarrollo.

  15. Dalt del tren

    Directory of Open Access Journals (Sweden)

    Jaume Subirana

    2001-11-01

    Full Text Available Ens consta que la saviesa popular hi toca més del que a aquest temps d’enquestes, telèfons mòbils i targetes de crèdit li ve de gust admetre, per això em fa gràcia, en veure la pausada però continuada intrusió de la cultura catalana a Internet, recordar les cançons de quan era petit: “Dalt del tren, tots anem-hi dalt del tren, hi ha lloc per tota la gent”, dèiem, i “El tren pinxo de Banyoles és el més bonic que hi ha, ple de llaunes i cassoles i barrets de capellà”. I resulta que per una vegada a la vida hem pujat, efectivament, dalt del tren que passava per l’estació de Catalunya i en cinc anys hem passat de gairebé res a prou pàgines amb un contingut, a més, apreciable i, sobretot, a un petit teixit de persones i institucions que han entès la importància de la revolució comunicativa que Internet representa i que hi teixeixen i projecten webs amb el convenciment dels conversos.

  16. Las carreras del futuro

    Directory of Open Access Journals (Sweden)

    Luis Piscoya Hermoza

    2011-07-01

    Full Text Available La primera década del siglo XXI ha estado signada por un énfasis en los estudiosde prospectiva, los mismos que, a partir de procesos de complejizacióny articulación de la sociedad planetaria como son la digitalización, el progresivodeterioro del medio ambiente, la necesidad del cambio de la matriz energéticay la globalización del mercado, han ensayado hipótesis para identificar lastendencias que se fortalecerán y profundizarán durante las próximas décadas.Desde el punto de vista metodológico, existen muchas maneras de clasificarlaspara conceptualizarlas y entenderlas mejor. Sin embargo, considerando lanaturaleza de esta edición nos proponemos enfocar directamente aquellas queestán estrechamente ligadas a la formación universitaria.Naturalmente, no pensamos que estamos ante tendencias inevitables en lamedida que epistemológicamente la creencia en leyes históricas deterministases insostenible y la práctica social nos muestra que la construcción del futuroes nuestra responsabilidad