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Sample records for diaphragmatic hernia repair

  1. Diaphragmatic hernia repair - slideshow

    Science.gov (United States)

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

  2. Laparoscopic repair of diaphragmatic hernia after left ventricular assist device.

    Science.gov (United States)

    Farma, Jeffrey; Leeser, David; Furukawa, Satoshi; Dempsey, Daniel T

    2003-06-01

    This case report describes a patient with a symptomatic diaphragmatic hernia that developed after orthotopic heart transplantation and explantation of a left ventricular assist device. The hernia was repaired laparoscopically, and at 6-month follow-up, she is without evidence of recurrence.

  3. Acute diaphragmatic rupture following open type IV paraesophageal hernia repair.

    Science.gov (United States)

    Reames, Bradley N; Reddy, Rishindra M

    2011-06-01

    Open primary transthoracic repair is a well established treatment for large paraesophageal hernias. The rate of major post-operative complications has been reported to be low, and no cases of acute diaphragmatic injury have previously been reported. Here we present a case of open primary transthoracic repair of a type IV paraesophageal hernia that was complicated by rupture of the left diaphragm in the immediate post-operative period, and was successfully repaired with Gore DualMesh® (W.L Gore and Assoc. Flagstaff, AZ). © JSCR.

  4. Retrosternal (Morgagni) diaphragmatic hernia.

    Science.gov (United States)

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

    2011-08-01

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

  5. Thoracoscopic repair of a large neonatal congenital diaphragmatic hernia using Gerota's fascia.

    Science.gov (United States)

    Fukuzawa, Hiroaki; Tamaki, Akihiko; Takemoto, Jyunkichi; Morita, Keiichi; Endo, Kosuke; Iwade, Tamaki; Yuichi, Okata; Bitoh, Yuko; Yokoi, Akiko; Maeda, Kosaku

    2015-05-01

    A large congenital diaphragmatic hernia needing patch repair has a high risk of recurrence. Thus, managing these large congenital diaphragmatic hernias under thoracoscopy has become a problem. Here, a large congenital diaphragmatic hernia that was repaired using Gerota's fascia under thoracoscopy is reported. In the present case, it was impossible to close the hernia directly under thoracoscopy because the hernia was too large. Gerota's fascia was raised up by the left kidney and used for the repair. The left colon adhering to Gerota's fascia was mobilized, and a large space was made under thoracoscopy. Gerota's fascia was fixed to the diaphragmatic defect. The patient's postoperative course was good, and there was no recurrence. This technique could be one option for repairing a large hernia under thoracoscopy.

  6. Repair of congenital diaphragmatic hernias through umbilical skin incisions.

    Science.gov (United States)

    Uehara, Shuichiro; Usui, Noriaki; Kamiyama, Masafumi; Masahata, Kazunori; Nara, Keigo; Ueno, Takehisa; Soh, Hideki; Oue, Takaharu; Fukuzawa, Masahiro

    2013-05-01

    The use of thoracoscopy and laparoscopy in the treatment of congenital diaphragmatic hernias (CDHs) has been recently reported; however, the use of these procedures still remains controversial due to CO2 insufflation and limited working space. In addition, because of difficult techniques, it has not been widely accepted. Among CDH patients, mild cases whose lung is not hypoplastic, and not associated with persistent pulmonary hypertension of the neonate (PPHN) often develop small defects in the diaphragm that can be repaired using "direct closure." Because direct closure does not require as wide an operative field as that needed for patch closure, we repaired CDH through umbilical skin windows in two neonates with mild CDH to minimize the wounds. With the creation of additional radical small incisions, the surgeries were successfully performed without any intra- or postoperative complications, and the wounds were cosmetically pleasing. The repair of CDHs through umbilical skin windows is a feasible and useful approach in neonates with mild CDH.

  7. Thoracoscopic Patch Repair of Congenital Diaphragmatic Hernia in a Neonate using Spiral Tacks: A Case Report

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    Mario A Riquelme

    2015-07-01

    Full Text Available We present a case of congenital diaphragmatic hernia that was successfully treated with spi-ral tacks using thoracoscopy. A newborn female was diagnosed with a diaphragmatic hernia at 20 weeks of gestation. The defect was surgically repaired by thoracoscopy and primary closure. On postoperative day 25, she developed respiratory distress. Chest x-ray showed a recurrence and was taken to the OR for surgical repair with spiral tacks.

  8. Congenital diaphragmatic hernia: To repair on or off extracorporeal membrane oxygenation?

    NARCIS (Netherlands)

    R. Keijzer (Richard); D.E. Wilschut (Dorien); R.J.M. Houmes (Robert Jan); K. van de Ven (Kees); L. de Jongste-van den Hout (Lieke); I. Sluijter (Ilona); P. Rycus (Peter); N.M.A. Bax (Klaas); D. Tibboel (Dick)

    2012-01-01

    textabstractBackground: Congenital diaphragmatic hernia (CDH) can be repaired on or off extracorporeal membrane oxygenation (ECMO). In many centers, operating off ECMO is advocated to prevent bleeding complications. We aimed to compare surgery-related bleeding complications between repair on or off

  9. Congenital diaphragmatic hernia: To repair on or off extracorporeal membrane oxygenation?

    NARCIS (Netherlands)

    R. Keijzer (Richard); D.E. Wilschut (Dorien); R.J.M. Houmes (Robert Jan); K. van de Ven (Kees); L. de Jongste-van den Hout (Lieke); I. Sluijter (Ilona); P. Rycus (Peter); N.M.A. Bax (Klaas); D. Tibboel (Dick)

    2012-01-01

    textabstractBackground: Congenital diaphragmatic hernia (CDH) can be repaired on or off extracorporeal membrane oxygenation (ECMO). In many centers, operating off ECMO is advocated to prevent bleeding complications. We aimed to compare surgery-related bleeding complications between repair on or off

  10. Right-sided diaphragmatic rupture after repair of a large Morgagni hernia.

    Science.gov (United States)

    Schiergens, T S; Koch, J G; Khalil, P N; Graser, A; Zügel, N P; Jauch, K-W; Kleespies, A

    2015-08-01

    We present a case of a combination of primary and secondary diaphragmatic hernia in a 63-year male patient. For progressive dyspnea and palpitations caused by a large and symptomatic Morgagni hernia resulting in a right-sided enterothorax, an open tension-free mesh repair was performed. The postoperative course was complicated by a secondary hepatothorax through a spontaneous rupture of the right diaphragm. Primary mesh repair of the Morgagni hernia, however, proved to be sufficient. This recurrent herniation might be a consequence of (1) preexisting atrophy of the right diaphragm caused by disposition and/or long-term diaphragmatic dysfunction due to the large hernia, combined with (2) further thinning out of the diaphragm by intraoperative hernia sac resection, and (3) postoperative increase of intra-abdominal pressure.

  11. Use of composite polyester/collagen mesh in the repair of recurrent congenital diaphragmatic hernias

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    Lin C. Wang

    2015-09-01

    Full Text Available Case 1 is an 18 year-old woman with a third recurrence of a left congenital diaphragmatic hernia (CDH. She had previously undergone a primary repair of a recurrence via laparotomy and an additional repair of a second recurrence with PTFE mesh via a thoracotomy. Following her third recurrence she underwent successful laparoscopic repair utilizing composite polyester/collagen (Parietex™ Composite, Covidien, Sofradim, France mesh. Six years following surgery, she has carried a pregnancy to term and has not recurred. Case 2 is a 5 month-old infant who presented with a recurrent right-sided CDH. She initially underwent primary repair via thoracotomy along with a right pneumonectomy at an outside institution. She presented with incarceration of her liver, hepatic venous thrombosis, mediastinal shift, and respiratory distress. She underwent successful repair with composite mesh through a right thoracoabdominal incision. At 8 months post-operatively, she has no evidence of recurrence in spite of the expected mediastinal deviation to the right and right thoracic volume loss as a result of being status post right pneumonectomy. Recurrences occur in a significant number of patients following repair of congenital diaphragmatic hernia, particularly cases in which a mesh implant are utilized. Historically, PTFE has been the product of choice for a diaphragmatic implant by pediatric surgeons. However, this product does not incorporate into surrounding tissues which theoretically places patients at risk for recurrence. Polyester/collagen composite mesh has been used for decades in adults undergoing complex groin and ventral hernia repairs with excellent results. However, its use for congenital diaphragmatic hernias has not been previously described. We present the successful utilization of this product in two cases which were at extremely high risk for future recurrence. Additional investigations should be done and long term follow up regarding application of

  12. Recurrence in a Laparoscopically Repaired Traumatic Diaphragmatic Hernia: Case Report and Literature Review

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    Bhatt

    2016-02-01

    Full Text Available Introduction Traumatic diaphragmatic hernia (TDH develops infrequently following a traumatic diaphragmatic rupture (TDR. As TDR is frequently missed due to lack of sensitive and specific imaging modalities, a high index of suspicion for such injuries is essential, whether immediately posttraumatic, or even decades after the trauma. We describe a rare case of recurrence in a laparoscopically repaired TDH and review the current literature on the same. Case Presentation A 23-year-old male with a history of primary laparoscopic repair of left-sided TDR two years ago presented with symptoms of acute large bowel obstruction. His chest X-ray showed a left-sided pleural effusion and a loop of the bowel in the left hemithorax, but no signs of free gas. An abdominal X-ray (AXR demonstrated massively dilated large bowel with distension of the small bowel. At laparotomy, the obstructing lesion consisted of the large bowel with omentum herniated through the left hemidiaphragm, consistent with a left recurrent/chronic diaphragmatic hernia. The diaphragmatic defect was repaired with interrupted nylon. The patient made an uneventful recovery. Conclusions Recurrence after repair of TDH is a less reported condition (with only two published articles and little is known regarding the factors responsible for this. Laparoscopy is an excellent diagnostic tool, but currently management is probably best performed via an open technique using heavy non-absorbable suture material to prevent recurrence. Long term follow up of these patients should also be considered.

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

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    Lingohr P

    2014-02-01

    Full Text Available Philipp Lingohr,1 Thomas Galetin,2 Boris Vestweber,2 Hanno Matthaei,1 Jörg C Kalff,1 Karl-Heinz Vestweber2 1Department of Surgery, University of Bonn, Bonn, Germany; 2Department of Surgery, Klinikum Leverkusen, Leverkusen, Germany Purpose: Diaphragmatic hernias (DHs are divided into congenital and acquired hernias, most of which are congenital. Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare. For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur. Methods: In 2009, we performed three partial diaphragm replacements in our clinic for repairing DHs using a PERMACOL™ implant. Results: As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax. Conclusion: We see a good indication for diaphragm replacements by using a PERMACOL™ implant for fixing especially DHs with huge hernial gaps and in cases with fragile tissue. Keywords: bilateral diaphragmatic hernia, enterothorax, conventional hernia repair, PERMACOL™, biological implant, diaphragm replacement, mesh repair

  14. Laparoscopic repair of a Morgagni diaphragmatic hernia in a child, using a trans-sternal technique

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    Shah Amar

    2005-01-01

    Full Text Available Laparoscopic repair of Morgagni hernia has been described in adults and children. In the published reports, the crux of the repair consists of suturing the posterior part of the diaphragmatic defect to the undersurface of the sternum or the posterior rectus sheath. The tissue on the undersurface of the sternum is variable is in its nature and may be inadequate for suturing, hence compromising the strength of the repair. A technique that circumvents this problem and offers a strong anatomical repair is described. A Morgagni hernia was diagnosed in a 2-year-old girl with trisomy 21, who presented with recurrent chest infections. She underwent laparoscopic repair of the hernia using three ports. The tissue on the undersurface of the sternum was inadequate for a conventional repair. The procedure was modified as follows: a small transverse incision was made over the lower end of the sternum. Three nonabsorbable mattress sutures were inserted through the sternum, the anterior edge of the diaphragmatic defect, and back through the sternum and tied with extracorporeal knots. The child was discharged home on the second postoperative day. At 6-month follow up, the child was asymptomatic, and had been infection free. A chest radiograph was normal. This is a simple, novel, noninvasive method, which offers a secure anatomical repair and it is not dependent on the adequacy of the tissue on the undersurface of the sternum.

  15. Laparoscopic repair of Morgagni diaphragmatic hernia in infants ...

    African Journals Online (AJOL)

    anterior abdominal wall without excision of the hernia sac is safe and effective ... Department of Pediatric Surgery, Maternity and Children's Hospital, Madinah,. Kingdom of .... mothorax, anterior mediastinal mass, or lung abscess secondary to ...

  16. Delayed traumatic diaphragmatic hernia

    Science.gov (United States)

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

    2016-01-01

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

  17. New approaches to managing congenital diaphragmatic hernia.

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    Ivascu, Felicia A; Hirschl, Ronald B

    2004-06-01

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

  18. Genetics Home Reference: congenital diaphragmatic hernia

    Science.gov (United States)

    ... Home Health Conditions congenital diaphragmatic hernia congenital diaphragmatic hernia Enable Javascript to view the expand/collapse boxes. ... PDF Open All Close All Description Congenital diaphragmatic hernia is a defect in the diaphragm. The diaphragm, ...

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

    Science.gov (United States)

    Chamary, S L; Chamary, V L

    2015-03-01

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

  20. Tube Thoracostomy at the Time of Congenital Diaphragmatic Hernia Repair: Reassessing the Risks and Benefits.

    Science.gov (United States)

    Schlager, Avraham; Arps, Kelly; Siddharthan, Ragavan; Clifton, Matthew S

    2017-03-01

    Postoperative pneumothorax and effusion remain a concern following congenital diaphragmatic hernia (CDH) repair. Despite a recent trend away from intraoperative thoracostomy, few studies have actually compared outcomes with and without a chest tube. Rationale commonly cited for the more minimalistic approach include the presumed low likelihood of postoperative complications, potential risk of patch infection, and prolonged intubation. We evaluate these theories, as well as the implications of intraoperative chest tube (IOCT) placement. We performed a retrospective chart review of 174 patients who underwent CDH repair at our academic children's hospital from 2004 to 2015. We compared incidence of clinically significant pleural events between patients who received an IOCT (n = 49) and those who did not (NIOCT, n = 124). We also evaluated time to extubation and rate of patch infections. Clinically significant pneumothorax or effusion occurred in 28% of NIOCT patients versus 10% of IOCT patients (P = .01). After thoracoscopic repair, time to extubation averaged 5.2 days in IOCT patients, 5.4 days in NIOCT patients with no postoperative complications, and 6.4 days in NIOCT patients requiring postoperative intervention. After open repair, time to extubation averaged 13.8, 13.6, and 22.5 days, respectively. There were no documented patch infections. Chest tube placement during CDH repair is associated with significantly lower incidence of clinically significant pleural complications, does not delay extubation, and results in shorter ventilator times than cases that require postoperative intervention. Patch infections are extremely rare. There is no evidence that chest tube placement increases this risk.

  1. Congenital Diaphragmatic Hernia

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    Tovar Juan A

    2012-01-01

    Full Text Available Abstract Congenital Diaphragmatic Hernia (CDH is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of abdominal contents into the thorax. The lungs are hypoplastic and have abnormal vessels that cause respiratory insufficiency and persistent pulmonary hypertension with high mortality. About one third of cases have cardiovascular malformations and lesser proportions have skeletal, neural, genitourinary, gastrointestinal or other defects. CDH can be a component of Pallister-Killian, Fryns, Ghersoni-Baruch, WAGR, Denys-Drash, Brachman-De Lange, Donnai-Barrow or Wolf-Hirschhorn syndromes. Some chromosomal anomalies involve CDH as well. The incidence is

  2. Laparoscopic Repair of Morgagni Hernia

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    ilker murat arer

    2015-03-01

    Full Text Available Morgagni hernia is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect and make up about 1 % - 5 % of all types of congenital diaphragmatic hernias. Surgical repair of Morgagni hernias is usually indicated when patients are symptomatic and have a high risk of strangulation or incarceration of the contained viscera. 71-year-old male patient admitted to emergency department with a 2-day history of abdominal pain, vomiting and obstipation. Laparoscopic repair for Morgagni hernia was performed. Laparoscopic repair for Morgagni hernia with mesh repair is secure, satisfactory and easily performed. [Cukurova Med J 2015; 40(Suppl 1: 71-74

  3. Repair of diaphragmatic hernia following spinal surgery by laparoscopic mesh application: a case report and review of the literature.

    Science.gov (United States)

    Bini, Roberto; Fontana, Diego; Longo, Alessandro; Manconi, Paolo; Leli, Renzo

    2014-01-01

    We describe the laparoscopic management of diaphragmatic hernia (DH) caused by vertebral pedicle screw displacement. A 58-year-old woman underwent surgery for scoliosis and underwent posterior pedicle screw fixation. In the first postoperative (PO)day, she developed mild dyspnea. An anteroposterior chest radiograph revealed bilateral pleural effusion, which was more pronounced on the left side. A thoracoabdominal computed tomography (CT) scan, performed in the second PO day, revealed a solid mass in the pleural cavity that was associated with screw displacement, which had also entered into the peritoneal cavity without apparent other lesion of hollow and solid viscous. In the third PO day, after the screw was removed, explorative laparoscopy was carried out. We observed herniation of the omentum through a small diaphragmatic tear. Once the absence of visceral injury was confirmed, we reduced the omentum into the abdomen. Then, we repaired the hernia by applying a dual layer polypropylene mesh over the defect with a 3-cm overlap. The remainder of the postoperative period was uneventful. Iatrogenic DH due to a pedicle screw displacement has never been described before. In cases of pleural effusion following spinal surgery, rapid assessment and treatment are crucial. We conclude that a laparoscopic approach to iatrogenic DH could be feasible and effective in a hemodynamically stable patient with negative CT findings because it enables the completion of the diagnostic cascade and the repair of the tear, providing excellent visualization of the abdominal viscera and diaphragmatic tears.

  4. Minimally invasive repair of pectus excavatum in a 17-year-old boy with a history of congenital diaphragmatic hernia and lack of pericardium

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    Stefan M. van der Heide

    2016-06-01

    Full Text Available We reported a 17-year-old boy with very deep asymmetric pectus excavatum and with a history of congenital diaphragmatic hernia repair and hypoplastic left lung. We performed a minimally invasive repair of pectus excavatum as described by Nuss et al., in 1998. We performed a left-sided thoracoscopy, instead of the right-sided according our normal routine, to provide a safe route. We created a substernal tunnel to have a clear definition of the deviant anatomy after congenital diaphragmatic hernia repair. However, we noticed an absence of the pericardium, which, by itself, can increase the risk of cardiac injury in both bar insertion and removal. Instead of the usual right-sided thoracoscopy, we recommend providing a safe view by left-sided thoracoscopy in comparable cases (e.g. congenital diaphragmatic hernia, other cardiac or vascular malformations to reduce the risk of rupture or perforation of cardiac structures.

  5. Delayed recovery due to exaggerated acid, base and electrolyte imbalance in prolonged laparoscopic repair of diaphragmatic hernia

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    Rakesh Garg

    2011-01-01

    Full Text Available The acid, base and electrolyte changes are usually observed in the perioperative settings. We report a case of prolonged laparoscopic repair of left-sided diaphragmatic hernia which involved a lot of tissue handling and fluid replacement leading to acid, base and electrolyte imbalance. A 42-year-old male underwent prolonged laparoscopic repair under general anesthesia. Intraoperatively, surgeon reported that contents of hernia includes bowel along with mesentery, spleen and lot of fatty tissue The blood loss was about 2 L which was replaced with 1 L of colloid and 7.5 L of lactated ringer. Near the end of surgery arterial blood gas analysis revealed metabolic acidosis, hyperkalemia, and hypocalcemia leading to delayed recovery. We conclude prolonged laparoscopic surgery involving lot of tissue handling including gut and fat should be monitored for acid, base, electrolyte imbalance and corrected timely to have uneventful rapid recovery.

  6. Congenital Diaphragmatic Hernia

    Science.gov (United States)

    2012-01-01

    Congenital Diaphragmatic Hernia (CDH) is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of abdominal contents into the thorax. The lungs are hypoplastic and have abnormal vessels that cause respiratory insufficiency and persistent pulmonary hypertension with high mortality. About one third of cases have cardiovascular malformations and lesser proportions have skeletal, neural, genitourinary, gastrointestinal or other defects. CDH can be a component of Pallister-Killian, Fryns, Ghersoni-Baruch, WAGR, Denys-Drash, Brachman-De Lange, Donnai-Barrow or Wolf-Hirschhorn syndromes. Some chromosomal anomalies involve CDH as well. The incidence is < 5 in 10,000 live-births. The etiology is unknown although clinical, genetic and experimental evidence points to disturbances in the retinoid-signaling pathway during organogenesis. Antenatal diagnosis is often made and this allows prenatal management (open correction of the hernia in the past and reversible fetoscopic tracheal obstruction nowadays) that may be indicated in cases with severe lung hypoplasia and grim prognosis. Treatment after birth requires all the refinements of critical care including extracorporeal membrane oxygenation prior to surgical correction. The best hospital series report 80% survival but it remains around 50% in population-based studies. Chronic respiratory tract disease, neurodevelopmental problems, neurosensorial hearing loss and gastroesophageal reflux are common problems in survivors. Much more research on several aspects of this severe condition is warranted. PMID:22214468

  7. Embryology of congenital diaphragmatic hernia.

    Science.gov (United States)

    Kluth, D; Keijzer, R; Hertl, M; Tibboel, D

    1996-11-01

    It is still generally believed that the defect in congenital diaphragmatic hernia results from failure of the so-called pleuroperitoneal canals (PPCs) to close at the end of the embryonic period (8th gestational week). Furthermore, it is assumed that gut could enter the thoracic cavity through this defect, causing compression and finally hypoplasia of the lung. However, this sequence of embryological events has never been studied, and many details even of normal diaphragmatic development are still unknown. Using scanning electron microscopy and a new animal model of congenital diaphragmatic hernia (CDH), the nitrofen rat model, the normal embryology of the diaphragm was reinvestigated and, for the first time, the crucial developmental steps of congenital diaphragmatic hernia formation were studied. The basic results were: (1) In normal development, the PPCs are never wide enough to allow herniation of gut loops. (2) The formation of the defect happens in an early embryonic period. (3) The early ingrowth of liver through the defect is of major importance for the formation of CDH. In another set of experiments, the nitrofen rat model of congenital diaphragmatic hernias was used to study the cellular mechanisms involved during epithelial and mesenchymal growth and differentiation in normal and in abnormal lungs. These results, combined with selected culture techniques (eg, branching morphogenesis and epithelio-mesenchymal interaction) probably open new ways to a better understanding of the mechanisms that finally lead to an abnormal lung in CDH.

  8. Unusual Diaphragmatic Hernias Mimicking Cardiac Masses

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

    2015-01-01

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

  9. Diaphragmatic hernia of Morgagni.

    Science.gov (United States)

    LaRosa, D V; Esham, R H; Morgan, S L; Wing, S W

    1999-04-01

    Most cases of Morgagni hernia are asymptomatic and diagnosed incidentally on routine chest x-ray film, but they may occasionally become symptomatic. Symptomatic Morgagni hernias may present in many different ways, making the diagnosis challenging. We describe a patient with a Morgagni hernia, resulting in intractable nausea and vomiting, give a brief review of symptoms, note the different types of abdominal contents herniated, and describe the methods used to make the diagnosis.

  10. Thoracotomy for Traumatic Diaphragmatic Hernia.

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

    2016-10-01

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

  11. Asymptomatic congenital intrapericardial diaphragmatic hernia and epigastric hernia in the adult.

    Science.gov (United States)

    La Greca, Gaetano; Sofia, Maria; Randazzo, Valentina; Barbagallo, Francesco; Lombardo, Rosario; Soma, Pierfranco; Russello, Domenico

    2007-08-01

    The congenital intrapericardial hernia is a rare kind of diaphragmatic hernia. It is due to an embryologic defect of the central tendon of the diaphragm, often accompanied by other congenital malformations. This work presents a unique case report in the literature of the congenital association between intrapericardial diaphragmatic hernia and epigastric hernia in an adult woman. In spite of herniation of the colon and omentum the patient was completely asymptomatic, requesting surgery for an epigastric hernia for aesthetic reasons. The defect of the diaphragm was sutured and the abdominal wall was repaired with a prosthetic mesh.

  12. Quantitative pulmonary perfusion imaging at 3.0 T of 2-year-old children after congenital diaphragmatic hernia repair: initial results

    Energy Technology Data Exchange (ETDEWEB)

    Zoellner, F.G.; Schad, L.R. [Heidelberg University, Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Mannheim (Germany); Zahn, K. [Heidelberg University, Department of Pediatric Surgery, University Medical Center Mannheim, Mannheim (Germany); Schaible, T. [Heidelberg University, Department of Pediatrics, University Medical Center Mannheim, Mannheim (Germany); Schoenberg, S.O.; Neff, K.W. [Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim (Germany)

    2012-12-15

    To investigate whether dynamic contrast-enhanced MR imaging of the lung following congenital diaphragmatic hernia repair is feasible at 3.0 T in 2-year-old children and whether associated lung hypoplasia (reflected in reduced pulmonary microcirculation) can be demonstrated in MRI. Twelve children with a mean age 2.0 {+-} 0.2 years after hernia repair underwent DCE-MRI at 3.0 T using a time-resolved angiography with stochastic trajectories sequence. Quantification of lung perfusion was performed using a pixel-by-pixel deconvolution approach. Six regions of interest were placed (upper, middle and lower parts of right and left lung) to assess differences in pulmonary blood flow (PBF), pulmonary blood volume (PBV) and mean transit time (MTT) while avoiding the inclusion of larger pulmonary arteries and veins. The difference in PBF and PBV between ipsilateral and contralateral lung was significant (P < 0.5). No significant differences could be detected for the MTT (P = 0.5). DCE-MRI in 2-year-old patients is feasible at 3.0 T. Reduced perfusion in the ipsilateral lung is reflected by significantly lower PBF values compared with the contralateral lung. DCE-MRI of the lung in congenital diaphragmatic hernia can help to characterise lung hypoplasia initially and in the long-term follow-up of children after diaphragmatic repair. (orig.)

  13. Bochdalek Hernia with Adult Diaphragmatic Agenesis

    Directory of Open Access Journals (Sweden)

    Erkan Akar

    2013-10-01

    Full Text Available    Diaphragmatic hernia arises from pleuro-peritoneal membranes inability to close pericardioperitoneal membranes. Diaphragmatic defect may be located in esophageal hiatus (hiatal hernia, nearby the hiatus (paraesophageal, retrosternal (Morgagni or posterolateral (Bochdalek. Congenital diaphragmatic hernias (CDH diagnosed after neonatal period are defined as late presenting CDH. This group of patients consist 5-31% of CDHs and lead to diagnostic difficulties. A case of adult type Bochdalek hernia who was admitted to our clinic with respiratory problems and recognized late with the absence of left diaphragm was discussed in the light of clinical and surgical methods.

  14. Regenerative medicine solutions in congenital diaphragmatic hernia.

    Science.gov (United States)

    De Coppi, Paolo; Deprest, Jan

    2017-06-01

    Congenital diaphragmatic hernia (CDH) remains a major challenge and associated mortality is still significant. Patients have benefited from current therapeutic options, but most severe cases are still associated to poor outcome. Regenerative medicine is emerging as a valid option in many diseases and clinical trials are currently happening for various conditions in children and adults. We report here the advancement in the field which will help both in the understanding of further CDH development and in offering new treatment options for the difficult situations such as repair of large diaphragmatic defects and lung hypoplasia. The authors believe that advancements in regenerative medicine may lead to increase of CDH patients׳ survival. Copyright © 2017. Published by Elsevier Inc.

  15. Imaging of congenital diaphragmatic hernias

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, George A.; Estroff, Judy A. [Harvard Medical School, Department of Radiology, Children' s Hospital Boston, Boston, MA (United States); Atalabi, Omolola M. [Harvard Medical School, Department of Radiology, Children' s Hospital Boston, Boston, MA (United States); The College of Medicine/University College Hospital, Ibadan (Nigeria)

    2009-01-15

    Congenital diaphragmatic hernias are complex and life-threatening lesions that are not just anatomic defects of the diaphragm, but represent a complex set of physiologic derangements of the lung, the pulmonary vasculature, and related structures. Imaging plays an increasingly important role in the care of these infants. Prenatal sonography and MRI have allowed early and accurate identification of the defect and associated anomalies. These tools have also been the key to defining the degree of pulmonary hypoplasia and to predicting neonatal survival and need for aggressive respiratory rescue strategies. In the postnatal period, conventional radiography supplemented by cross-sectional imaging in selected cases can be very useful in sorting out the differential diagnosis of intrathoracic masses, in the detection of associated anomalies, and in the management of complications. Understanding the pathogenesis of diaphragmatic defects, the underlying physiologic disturbances, and the strengths and limitations of current imaging protocols is essential to the effective and accurate management of these complex patients. (orig.)

  16. Incarcerated Diaphragmatic Hernia – Differential Diagnoses

    OpenAIRE

    Bukvić, Nado; Bosak Veršić, Ana; Bačić, Giordano; Gusić, Nadomir; Nikolić, Harry; Bukvić, Frane

    2014-01-01

    The incarceration of diaphragmatic hernia is very rare. We present a case of a four-year old girl who developed the incarceration of left-sided diaphragmatic hernia, who, until then, was completely asymptomatic. This incarceration of the hernia represented a surgical emergency presenting as obstructive ileus and a severe respiratory distress which developed from what appeared to be full health. During a brief pre-operative examination a number of differential diagnoses were sugges...

  17. Intestinal obstruction from diaphragmatic hernia following colonoscopy.

    Science.gov (United States)

    Rustagi, Tarun

    2011-05-01

    Diaphragmatic hernias caused or exacerbated by colonoscopy are rare with only few cases reported. The author reports here an unusual case of herniation and incarceration of the colon into the left thoracic cavity without bowel perforation after an uneventful screening colonoscopy, through an occult focal diaphragmatic weakness from the patient's prior trauma.

  18. Ventral hernia repair

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007661.htm Ventral hernia repair To use the sharing features on this page, please enable JavaScript. Ventral hernia repair is surgery to repair a ventral hernia. ...

  19. Traumatic Diaphragmatic Hernia. A Case Report

    Directory of Open Access Journals (Sweden)

    Daniel Olivera Fajardo

    2015-12-01

    Full Text Available Diaphragmatic trauma is secondary to penetrating injuries and blunt abdominal and thoracic trauma. Traumatic diaphragmatic hernia is an uncommon entity. Its diagnosis poses a real challenge to internists, surgeons and radiologists since it requires a high level of suspicion and appropriate use of diagnostic imaging. Surgical treatment is always needed. For these reasons, we present the case of a patient operated on due to a stab wound to the chest who was subsequently diagnosed with a traumatic diaphragmatic hernia on the left side of the chest. He underwent surgery again and had a successful postoperative recovery.

  20. Congenital posterolateral diaphragmatic hernia : pathophysiological studies and clinical picture

    NARCIS (Netherlands)

    A.P. Bos (Albert)

    1993-01-01

    textabstractCongenital diaphragmatic hernias are classified according to the location of the defect: posterolateral hernia with or without a sac (Bochdalek-type), parasternal hernia through the foramen of Morgagni, central hernia, and diaphragmatic eventration. The so-called hiatal hernia has a diff

  1. Laparoscopic lumbar hernia repair.

    Science.gov (United States)

    Madan, Atul K; Ternovits, Craig A; Speck, Karen E; Pritchard, F Elizabeth; Tichansky, David S

    2006-04-01

    Lumbar hernias are rare clinical entities that often pose a challenge for repair. Because of the surrounding anatomy, adequate surgical herniorraphy is often difficult. Minimally invasive surgery has become an option for these hernias. Herein, we describe two patients with lumbar hernias (one with a recurrent traumatic hernia and one with an incisional hernia). Both of these hernias were successfully repaired laparoscopically.

  2. Non-traumatic diaphragmatic hernia of the liver in an adult:a case repor t

    Institute of Scientific and Technical Information of China (English)

    Hai-Feng Luo; Ting Lei; Hong-Jiang Wang; Guang Tan; Zhong-Yu Wang

    2007-01-01

    magnetic resonance imaging. Diagnostics in congenital diaphragmatic hernia. Radiologe 2006;46:128-132. 13 Leung JW, Coakley FV, Hricak H, Harrison MR, Farmer DL, Albanese CT, et al. Prenatal MR imaging of congenital diaphragmatic hernia. AJR Am J Roentgenol 2000;174:1607-1612. 14 Kays DW. Congenital diaphragmatic hernia and neonatal lung lesions. Surg Clin North Am 2006;86:329-352,ix. 15 Wenstrom KD. Fetal surgery for congenital diaphragmatic hernia. N Engl J Med 2003;349:1887-1888. 16 Eroglu D, Yanik F, Sakallioglu AE, Arikan U, Varan B, Kuscu E. Prenatal diagnosis of bilateral diaphragmatic hernia by fetal sonography. J Obstet Gynaecol Res 2006;32:90-93. 17 Libretti L, Ciriaco P, Carretta A, Melloni G, Puglisi A, Casiraghi M, et al. Endobronchial migration of prosthetic patch after congenital diaphragmatic hernia repair. J Pediatr Surg 2006;41:e65-67. 18 Szavay PO, Drews K, Fuchs J. Thoracoscopic repair of a right-sided congenital diaphragmatic hernia. Surg Laparosc Endosc Percutan Tech 2005;15:305-307. 19 Kato H, Miyazaki T, Kimura H, Faried A, Sohda M, Nakajima M, et al. A novel technique to facilitate laparoscopic repair of large paraesophageal hernias. Am J Surg 2006;191:545-548. 20 Moya FR, Lally KP. Evidence-based management of infants with congenital diaphragmatic hernia. Semin Perinatol 2005;29:112-117.

  3. Diaphragmatic hernia in horse: case report

    Directory of Open Access Journals (Sweden)

    Augusto Jose Savioli de Almeida Sampaio

    2012-12-01

    Full Text Available The diaphragmatic hernia is a rare cause of colic in equine and may be congenital or acquired. The intestine is commonly involved in cases of diaphragmatic hernia, and clinical signs are related to the intestinal segment involved and the extension, obstruction may occur from a simple process to a strangulating. Often, clinical signs are characterized by acute abdominal whit severe pain, dyspnea and tachypnea. The diagnosis of diaphragmatic hernia can be difficult, and in most cases only is established during surgery or at necropsy. This paper reports a diaphragmatic hernia case in a quarter horse stallion, with 14 years of age showing acute abdominal signs. The clinical examination showed tachycardia, tachypnea and absence of intestinal motility. Turbidity, increase of leukocytes and protein was observed in the analysis of peritoneal fluid. Exploratory laparotomy was performed, but due to the presence of hemorrhagic mesentery, intestinal ischemia, and irreducible incarceration of the jejunum in epiploic foramen, euthanasia was decided. Furthermore, at necropsy, was observed a diaphragmatic hernia with presence of the small intestine in the thorax.

  4. Radiographic observation of congenital diaphragmatic hernia

    Energy Technology Data Exchange (ETDEWEB)

    Rhee, Chung Sik [Ewha Women' s University College of Medicine, Seoul (Korea, Republic of)

    1973-12-15

    Five cases of congenital diaphragmatic hernia. Case 1: A female infant, birth weight 2.25 kg, Apgar score 10, normal delivery at 11:33 P.M. on Feb.8, 1972. Lt side congenital diaphragmatic hernia. Case 2: A female infant, birth weight 1.48 kg, Apgar score 5, normal delivery at 11:20 A.M. on Oct.14, 1972. Lt. side congenital diaphragmatic hernia. This infant was twin. this infant's mother was toxemia. Case 3; A 33 years old women was admitted to the our hospital because of Lt.hip joint pain without other symptoms. Date of admission: Jan. 8, 1973. Rt side congenital diaphragmentic hernia. Case 4: A 4 month infant male was admitted to the our hospital because of vomiting, dyspnea and abdominal pain. He had cyanosis intermittently after one month ago. This infant was normal delivered. The family history was not contributory. Date of admission: This infant was normal delivered. The family history was not contributory. Date of admission: Aug. 30, 1971. Rt side congenital diaphragmatic hernia. Case 5: A 13 years old girl was admitted to our hospital because of general weakness without other symptoms. This patient was normal delivered. The family history was not contributory. Date of admission: March. 15, 1973. Lt. side congenital diaphragmentic hernia.

  5. Difficult weaning in delayed onset diaphragmatic hernia

    Directory of Open Access Journals (Sweden)

    Ahmed Syed

    2009-01-01

    Full Text Available Diaphragmatic injuries are relatively rare and result from either blunt or penetrating trauma. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. The clinical signs associated with a diaphragmatic hernia can range from no outward signs to immediately life-threatening respiratory compromise. Establishing the clinical diagnosis of diaphragmatic injuries (DI can be challenging as it is often clinically occult. Accurate diagnosis is critical since missed DI may result in grave sequelae due to herniation and strangulation of displaced intra-abdominal organs. We present a case of polytrauma with rib fracture and delayed appearance of diaphragmatic hernia manifesting as difficult weaning from ventilatory support.

  6. Diaphragmatic hernia: diagnostic approaches with review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Eren, Suat [Department of Radiology, Faculty of Medicine, Atatuerk University, 25240 Erzurum (Turkey)]. E-mail: suateren@atauni.edu.tr; Ciris, Fahri [Department of Radiology, Faculty of Medicine, Atatuerk University, 25240 Erzurum (Turkey)

    2005-06-01

    Because surgical repair is indicated for the treatment of diaphragmatic hernia (DH), preoperative imaging of the diaphragmatic defect, hernia content, and associated complications with other organ's pathologies is important. While various techniques can be used on imaging of DHs, selection of the most effective but the least invasive technique will present the most accurate findings about DH, and will facilitate the management of DH. We reviewed the diaphragmatic hernia types associated with our cases, and we discussed the preferred imaging modalities for different DHs with review of the literature. We evaluated the imaging findings of 21 DH cases. They were Morgagni's hernia (n = 4), Bochdalek hernia (n = 2), iatrogenic DH (n = 4), traumatic DH (n = 6), and hiatal hernia (n = 5). Although its limited findings on DH and indirect findings about the diaphragmatic rupture, plain radiography is firstly preferred technique on DH. We found that ultrasound (US) is a useful tool on DH, on traumatic DH cases especially. Not only it shows diaphragmatic continuity and herniated organs, but also it reveals associated abdominal organ's pathologies. Computed tomography (CT) scan is most effective in many DH cases. It shows the herniated abdominal organs together with complications, such as intestinal strangulation, haemothorax, and rib fractures. We stressed that Multislice CT scan with coronal and sagittal reformatted images is the most effective and useful imaging technique on DH. With high sensitivity for soft tissue, MR imaging may be performed in the selected patients, on the late presenting DH cases or on the cases of the diagnosis still in doubt especially.

  7. Late-presenting congenital diaphragmatic hernia

    Directory of Open Access Journals (Sweden)

    Raashid Hamid

    2014-01-01

    Full Text Available Background: This study was undertaken to highlight the clinical profile, misdiagnosis, surgical treatment,and prognosis of late-presenting congenital diaphragmatic hernia (CDH cases in a tertiary level hospital. Patients and Methods: This retrospective study included all the babies and children >1 month of age with CDH who were admitted in our Hospital (Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India during the period between January 2008 and December 2013. Babies with age <1 month were excluded from the study. Data regarding clinical profile, operative records, and follow-up was reviewed and analysed statistically. Results: A total of 20 patients were included in this study. The clinical picture ranged from respiratory distress (13 patients to non-specific gastrointestinal complaints (5 patients. In two patients, CDH was misdiagnosed as pneumothorax and had got chest tube inserted in other hospitals before referral to this tertiary care centre. In 14 patients chest, X-ray revealed the diagnosis of CDH and in remaining five patients (including the two patients with misdiagnosis further investigations were undertaken to establish the diagnosis. Age ranged from 45 days to 17 years with an average age of 58.9 months. There were 12 male and 8 female patients. In all the 20 patients, surgical procedures were undertaken with the retrieval of herniated contents from the thoracic cavity and repair of the diaphragmatic defect. There was no mortality in our series. All the 20 patients were followed-up for a period ranging from 6 months to 5 years (median 3.1 years. Conclusions: Late-presenting CDH can have diverse clinical presentation. Late diagnosis and misdiagnosis can result in significant morbidity and potential mortality if these cases are not managed properly at an appropriate stage. Outcome is favourable if these patients are expeditiously identified and surgically repaired.

  8. Femoral hernia repair

    Science.gov (United States)

    Femorocele repair; Herniorrhaphy; Hernioplasty - femoral ... During surgery to repair the hernia, the bulging tissue is pushed back in. The weakened area is sewn closed or strengthened. This repair ...

  9. Diaphragmatic hernia masquerading as pleural effusion

    Directory of Open Access Journals (Sweden)

    Z Nalladaru

    2012-01-01

    Full Text Available Rupture of the diaphragm is almost always due to major trauma. We present here an unusual and rare case of late presentation of diaphragmatic hernia after an innocuous injury. The patient was initially misdiagnosed as a left pleural effusion on the basis of chest X-ray and ultrasound findings. Finally, the diagnosis was confirmed on computerized scanning.

  10. Prenatal MR imaging of congenital diaphragmatic hernias: association of MR fetal lung volume with the need for postnatal prosthetic patch repair

    Energy Technology Data Exchange (ETDEWEB)

    Hagelstein, Claudia; Weidner, Meike; Schoenberg, Stefan O.; Buesing, Karen A.; Neff, K.W. [University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim (Germany); Zahn, Katrin [University of Heidelberg, Department of Pediatric Surgery, University Medical Center Mannheim, Mannheim (Germany); Weiss, Christel [University of Heidelberg, Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Mannheim (Germany); Schaible, Thomas [University of Heidelberg, Department of Pediatrics, University Medical Center Mannheim, Mannheim (Germany)

    2015-01-15

    To assess whether the need for postnatal prosthetic patch repair of the diaphragmatic defect in neonates with a congenital diaphragmatic hernia (CDH) is associated with the antenatal measured observed-to-expected magnetic resonance fetal lung volume (o/e MR-FLV). The o/e MR-FLV was calculated in 247 fetuses with isolated CDH. Logistic regression analysis was used to assess the prognostic value of the individual o/e MR-FLV for association with the need for postnatal patch repair. Seventy-seven percent (77 %) of patients with a CDH (190/247) required prosthetic patch repair and the defect was closed primarily in 23 % (57/247). Patients requiring a patch had a significantly lower o/e MR-FLV (27.7 ± 10.2 %) than patients with primary repair (40.8 ± 13.8 %, p < 0.001, AUC = 0.786). With an o/e MR-FLV of 20 %, 92 % of the patients required patch repair, compared to only 24 % with an o/e MR-FLV of 60 %. The need for a prosthetic patch was further influenced by the fetal liver position (herniation/no herniation) as determined by magnetic resonance imaging (MRI; p < 0.001). Fetal liver position, in addition to the o/e MR-FLV, improves prognostic accuracy (AUC = 0.827). Logistic regression analysis based on the o/e MR-FLV is useful for prenatal estimation of the prosthetic patch requirement in patients with a CDH. In addition to the o/e MR-FLV, the position of the liver as determined by fetal MRI helps improve prognostic accuracy. (orig.)

  11. STUDY OF A TYPICAL PRESENTATIONS IN CONGENITAL DIAPHRAGMATIC HERNIA

    Directory of Open Access Journals (Sweden)

    Venkata Ramana

    2015-10-01

    Full Text Available AIM: To study the clinical features and outcome of congenital Diaphragmatic Hernias with atypical presentation in Paediatric age group. Children with Eventration of Diaphragm are also included in the present study. RESULTS : 20 cases of Diaphragmatic Hernia presented with classical presentation, 4 cases with atypical Presentation and a case with recurrent diaphragmatic hernia. Atypical presentations in congenital Diaphragmatic Hernia are Stomach Volvulus and Malrotati on of Midgut with Volvulus Intestine. 3 Cases with atypical presentation succumbed to death. CONCLUSION: Congenital Diaphragmatic Hernias are common on left side and carries good prognosis. Cases with atypical clinical presentation have 75% mortality. Righ t sided Congenital Diaphragmatic Hernias are rare but carries guarded prognosis.

  12. Delayed traumatic diaphragmatic hernia mimicking hydropneumothorax

    Directory of Open Access Journals (Sweden)

    Rachna Wadhwa

    2014-01-01

    Full Text Available Traumatic diaphragmatic hernia (TDH is generally a consequence of thoraco-abdominal trauma. Anaesthetic problems arise due to herniation of abdominal contents into the thoracic cavity causing diaphragmatic dysfunction, lung collapse, mediastinal shift and haemodynamic instability. Diagnosis depends on history, clinical signs and radiological investigations. Sometimes, it may be misdiagnosed as hydropneumothorax due to the presence of air and fluid in the viscera lying in the pleural cavity. We report a case of TDH mimicking hydropneumothorax on radiological investigations and subsequent surgical management, which led to serious complications.

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

    Directory of Open Access Journals (Sweden)

    Rashid Farhan

    2009-01-01

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

  14. Prenatal surgery for congenital diaphragmatic hernia.

    Science.gov (United States)

    Au-Yeung, Jeff Ying-Kit; Chan, Kwong-Leung

    2003-10-01

    Congenital diaphragmatic hernia (CDH) has a mortality rate of up to 77% despite optimal pre- and postnatal care. Fetuses with liver herniation, a low lung-to-head ratio, and an early diagnosis before 24 weeks have a particularly poor prognosis. In utero open repair of these fetuses does not improve patient survival. The PLUG (Plug the Lung Until it Grows) technique was reported to be able to reverse pulmonary hypoplasia in CDH. A foam plug or a titanium clip is used and the trachea can be unplugged using Ex Utero Intrapartum Tracheoplasty (EXIT) at birth. Since hysterotomy causes premature labour, a video-fetoscopic intrauterine technique of tracheal occlusion called Fetendo-PLUG was developed. Compared to those who receive standard postnatal care or fetal tracheal occlusion via open hysterotomy, patients who undergo Fetendo-PLUG are reported to have a higher survival rate of 75% and fewer fetal and maternal complications. A recent refinement is to use a detachable balloon for intratracheal occlusion through a single 5 mm port under real-time ultrasound guidance. Without the need for neck dissection, injury to the recurrent laryngeal nerves and trachea and vocal cord paresis can be minimized. The result of this form of treatment for CDH is promising, but further refinement of fetal instrumentation and development of effective tocolytic drugs are still required.

  15. Congenital diaphragmatic hernia; masquarding as hydropneumothorax

    Directory of Open Access Journals (Sweden)

    RP Yadav

    2014-04-01

    Full Text Available Congenital diaphragmatic hernia occurs in about 1 in 3000 births among which over 90% of the patients will be diagnosed either antenatally or will present with respiratory distress in the first few hours of life and about 5% to 30% of diaphragmatic hernias present beyond the neonatal period. The extent of herniation of abdominal viscera into the thorax may vary, leading to acute or intermittent symptoms. The inappropriate insertion of a chest drain, although relieving the symptoms temporarily, may result in serious consequences by damaging intrathoracic abdominal viscera. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-3, 54-56 DOI: http://dx.doi.org/10.3126/jcmsn.v9i3.10223   

  16. Combined mitral valve replacement associated with the Bentall procedure, diaphragmatic hernia repair and reconstruction of the pectus excavatum in a 26-year-old patient with Marfan syndrome

    Science.gov (United States)

    Stępiński, Piotr; Aboul-Hassan, Sleiman Sebastian; Szymańska, Anna; Marczak, Jakub; Cichoń, Romuald

    2016-01-01

    A 26-year-old man with Marfan syndrome was admitted as an emergency patient with ascending aorta aneurysm, severe mitral and aortic regurgitation, diaphragmatic hernia and pectus excavatum. After completion of diagnostics a combined surgical procedure was performed. PMID:27516786

  17. Inguinal hernia repair - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100027.htm Inguinal hernia repair - series—Normal anatomy To use the sharing ... to slide 4 out of 4 Overview A hernia occurs when part of an organ protrudes through ...

  18. Congenital diaphragmatic hernia-associated pulmonary hypertension.

    Science.gov (United States)

    Harting, Matthew T

    2017-06-01

    Congenital diaphragmatic hernia (CDH) is a complex entity wherein a diaphragmatic defect allows intrathoracic herniation of intra-abdominal contents and both pulmonary parenchymal and vascular development are stifled. Pulmonary pathology and pathophysiology, including pulmonary hypoplasia and pulmonary hypertension, are hallmarks of CDH and are associated with disease severity. Pulmonary hypertension (PH) is sustained, supranormal pulmonary arterial pressure, and among patients with CDH (CDH-PH), is driven by hypoplastic pulmonary vasculature, including alterations at the molecular, cellular, and tissue levels, along with pathophysiologic pulmonary vasoreactivity. This review addresses the basic mechanisms, altered anatomy, definition, diagnosis, and management of CDH-PH. Further, emerging therapies targeting CDH-PH and PH are explored. Published by Elsevier Inc.

  19. Congenital diaphragmatic hernia: Misdiagnosis in adolescence

    Directory of Open Access Journals (Sweden)

    Kadian Yogender

    2009-01-01

    Full Text Available We report 3 cases of congenital diaphragmatic hernia (CDH in the second decade of life which were misdiagnosed on initial presentation. The first case had an iatrogenic gastric injury because of intercostal tube drainage for suspected pleural effusion. The second case was treated for pulmonary tuberculosis for 6 months before being diagnosed as a case of CDH. The third case presented as acute chest pain on the left side. It was treated accordingly for 1 month and was diagnosed as a CDH on a CT scan of the chest when seen by a surgeon.

  20. Acute Intrathoracic Gastric Volvulus due to Diaphragmatic Hernia: A Rare Emergency Easily Overlooked

    Directory of Open Access Journals (Sweden)

    Hyung Hun Kim

    2011-05-01

    Full Text Available Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial torsion in the chest due to either concomitant enlargement of the hiatus or a diaphragmatic hernia. Iatrogenic diaphragmatic hernia can occur after hiatal hernia repair and other surgical procedures, such as nephrectomy, esophagogastrectomy and splenopancreatectomy. We describe a 49-year-old woman who presented to our emergency department with acute moderate epigastric soreness and vomiting. She had undergone extensive gynecologic surgery including splenectomy 1 year before. The chest radiograph obtained in the emergency department demonstrated an elevated gastric air-fluid level in the left lower lung field. An urgent gastroscopy showed twisted structural abnormality of the stomach body. A computed tomography scan demonstrated the distended stomach, located in the left lower hemithorax through a left diaphragmatic defect. Emergent transthoracic repair was performed. Postoperative recovery was uneventful, and the patient did not experience any pain or difficulty with eating.

  1. Semi-automatic lung segmentation of DCE-MRI data sets of 2-year old children after congenital diaphragmatic hernia repair: Initial results.

    Science.gov (United States)

    Zöllner, Frank G; Daab, Markus; Weidner, Meike; Sommer, Verena; Zahn, Katrin; Schaible, Thomas; Weisser, Gerald; Schoenberg, Stefan O; Neff, K Wolfgang; Schad, Lothar R

    2015-12-01

    In congenital diaphragmatic hernia (CDH), lung hypoplasia and secondary pulmonary hypertension are the major causes of death and severe disability. Based on new therapeutic strategies survival rates could be improved to up to 80%. However, after surgical repair of CDH, long-term follow-up of these pediatric patients is necessary. In this, dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) provides insights into the pulmonary microcirculation and might become a tool within the routine follow-up program of CDH patients. However, whole lung segmentation from DCE-MRI scans is tedious and automated procedures are warranted. Therefore, in this study, an approach to semi-automated lung segmentation is presented. Segmentation of the lung is obtained by calculating the cross correlation and the area under curve between all voxels in the data set and a reference region-of-interest (ROI), here the arterial input function (AIF). By applying an upper and lower threshold to the obtained maps and intersecting these, a final segmentation is reached. This approach was tested on twelve DCE-MRI data sets of 2-year old children after CDH repair. Segmentation accuracy was evaluated by comparing obtained automatic segmentations to manual delineations using the Dice overlap measure. Optimal thresholds for the cross correlation were 0.5/0.95 and 0.1/0.5 for the area under curve, respectively. The ipsilateral (left) lung showed reduced segmentation accuracy compared to the contralateral (right) lung. Average processing time was about 1.4s per data set. Average Dice score was 0.7±0.1 for the whole lung. In conclusion, initial results are promising. By our approach, whole lung segmentation is possible and a rapid evaluation of whole lung perfusion becomes possible. This might allow for a more detailed analysis of lung hypoplasia of children after CDH.

  2. Laparoscopic repair of femoral hernia

    OpenAIRE

    Yang, Xue-Fei; Liu, Jia-Lin

    2016-01-01

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

  3. Bochdalek Congenital Diaphragmatic Hernia in an Adult Sheep

    Science.gov (United States)

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

    2016-01-01

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

  4. [The systematization and the etiopathogenicity of diaphragmatic hernias].

    Science.gov (United States)

    Alecu, L

    2001-01-01

    The author, based on up to date published dates, intends to present the classification and ethiopathogeny of the diaphragmatic hernias, except the aesophagic hiatus oms. This is an interesting chapter of the borderline surgery (abdominal and thorax). They are placed on the second position in frequency (after the hiatal hernias) in the diaphragmatic pathology; they are internal hernias, through congenital or obtained holes which allow to abdominal viscera to pass into thorax. They are--in the most cases, even elderly ones-congenital, result of the abnormalities in the embrionary growth of the diaphragm. A special place' is represented by the traumatic hernias.

  5. Bochdalek Congenital Diaphragmatic Hernia in an Adult Sheep.

    Science.gov (United States)

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

    2016-06-01

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

  6. Bochdalek diaphragmatic hernia: not only a neonatal disease

    OpenAIRE

    Mei-Zahav, M; Solomon, M; Trachsel, D; Langer, J.

    2003-01-01

    Aims: To characterise the clinical manifestations of late presenting Bochdalek diaphragmatic hernia (DH), the incidence of misdiagnosis, and prognosis; and to explore the sequence of events that leads to this clinical picture.

  7. High temporal versus high spatial resolution in MR quantitative pulmonary perfusion imaging of two-year old children after congenital diaphragmatic hernia repair

    Energy Technology Data Exchange (ETDEWEB)

    Weidner, M.; Hagelstein, C.; Schoenberg, S.O.; Neff, K.W. [University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Zoellner, F.G.; Schad, L.R. [Heidelberg University, Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Mannheim (Germany); Zahn, K. [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Department of Pediatric Surgery, Mannheim (Germany); Schaible, T. [University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Department of Pediatrics, Mannheim (Germany)

    2014-10-15

    Congenital diaphragmatic hernia (CDH) leads to lung hypoplasia. Using dynamic contrast-enhanced (DCE) MR imaging, lung perfusion can be quantified. As MR perfusion values depend on temporal resolution, we compared two protocols to investigate whether ipsilateral lung perfusion is impaired after CDH, whether there are protocol-dependent differences, and which protocol is preferred. DCE-MRI was performed in 36 2-year old children after CDH on a 3 T MRI system; protocol A (n = 18) based on a high spatial (3.0 s; voxel: 1.25 mm{sup 3}) and protocol B (n = 18) on a high temporal resolution (1.5 s; voxel: 2 mm{sup 3}). Pulmonary blood flow (PBF), pulmonary blood volume (PBV), mean transit time (MTT), and peak-contrast-to-noise-ratio (PCNR) were quantified. PBF was reduced ipsilaterally, with ipsilateral PBF of 45 ± 26 ml/100 ml/min to contralateral PBF of 63 ± 28 ml/100 ml/min (p = 0.0016) for protocol A; and for protocol B, side differences were equivalent (ipsilateral PBF = 62 ± 24 vs. contralateral PBF = 85 ± 30 ml/100 ml/min; p = 0.0034). PCNR was higher for protocol B (30 ± 18 vs. 20 ± 9; p = 0.0294). Protocol B showed higher values of PBF in comparison to protocol A (p always <0.05). Ipsilateral lung perfusion is reduced in 2-year old children following CDH repair. Higher temporal resolution and increased voxel size show a gain in PCNR and lead to higher perfusion values. Protocol B is therefore preferred. (orig.)

  8. Congenital Diaphragmatic Hernia in a Case of Patau Syndrome: A Rare Association

    Science.gov (United States)

    A, Jain; P, Kumar; A, Jindal; Yk, Sarin

    2015-01-01

    Congenital diaphragmatic hernia (CDH) occurs in 5-10% associated with chromosomal abnormalities like, Pallister Killian syndrome, Trisomy 18, and certain deletions.. Association of CDH with trisomy 13 (Patau syndromes) is very rare. Here, we report such an unusual association, where surgical repair was done, but eventually the case succumbed as a result of multiple fatal co-morbidities. PMID:26034714

  9. Congenital Diaphragmatic Hernia in a Case of Patau Syndrome: A Rare Association

    OpenAIRE

    Jain, A.; P. Kumar; Jindal, A; YK Sarin

    2015-01-01

    Congenital DiaphragmaticHernia (CDH) occurs in 5-10% associated with chromosomal abnormalities like, Pallister Killian syndrome, Trisomy 18, and certain deletions. Association of CDH with trisomy 13 (Patau syndromes) is very rare. Here, we report such an unusual association, where surgical repair was done, but eventually the case succumbed as a result of multiple fatal co-morbidities.

  10. Congenital Diaphragmatic Hernia in a Case of Patau Syndrome: A Rare Association

    Directory of Open Access Journals (Sweden)

    A Jain

    2015-03-01

    Full Text Available Congenital DiaphragmaticHernia (CDH occurs in 5-10% associated with chromosomal abnormalities like, Pallister Killian syndrome, Trisomy 18, and certain deletions. Association of CDH with trisomy 13 (Patau syndromes is very rare. Here, we report such an unusual association, where surgical repair was done, but eventually the case succumbed as a result of multiple fatal co-morbidities.

  11. Congenital Diaphragmatic Hernia in a Case of Patau Syndrome: A Rare Association

    OpenAIRE

    A Jain; Kumar, P.; A Jindal; Yk, Sarin

    2015-01-01

    Congenital DiaphragmaticHernia (CDH) occurs in 5-10% associated with chromosomal abnormalities like, Pallister Killian syndrome, Trisomy 18, and certain deletions. Association of CDH with trisomy 13 (Patau syndromes) is very rare. Here, we report such an unusual association, where surgical repair was done, but eventually the case succumbed as a result of multiple fatal co-morbidities.

  12. Congenital diaphragmatic hernia in a case of patau syndrome: a rare association.

    Science.gov (United States)

    A, Jain; P, Kumar; A, Jindal; Yk, Sarin

    2015-01-01

    Congenital diaphragmatic hernia (CDH) occurs in 5-10% associated with chromosomal abnormalities like, Pallister Killian syndrome, Trisomy 18, and certain deletions.. Association of CDH with trisomy 13 (Patau syndromes) is very rare. Here, we report such an unusual association, where surgical repair was done, but eventually the case succumbed as a result of multiple fatal co-morbidities.

  13. Iatrogenic diaphragmatic hernia in infants: Potentially catastrophic when overlooked

    Directory of Open Access Journals (Sweden)

    Yousef El-Gohary

    2014-11-01

    Full Text Available Acquired diaphragmatic hernias are a rare occurrence. They can result from blunt, penetrating or inadvertent iatrogenic injury. When overlooked they can potentially be catastrophic. We report a case of iatrogenic diaphragmatic hernia in a six-month old infant presenting with acute respiratory distress as a result of strangulated bowel herniating into the left hemithorax caused from a traumatic chest tube insertion in the neonatal period.

  14. Abnormal lung development in congenital diaphragmatic hernia.

    Science.gov (United States)

    Ameis, Dustin; Khoshgoo, Naghmeh; Keijzer, Richard

    2017-06-01

    The outcomes of patients diagnosed with congenital diaphragmatic hernia (CDH) have recently improved. However, mortality and morbidity remain high, and this is primarily caused by the abnormal lung development resulting in pulmonary hypoplasia and persistent pulmonary hypertension. The pathogenesis of CDH is poorly understood, despite the identification of certain candidate genes disrupting normal diaphragm and lung morphogenesis in animal models of CDH. Defects within the lung mesenchyme and interstitium contribute to disturbed distal lung development. Frequently, a disturbance in the development of the pleuroperitoneal folds (PPFs) leads to the incomplete formation of the diaphragm and subsequent herniation. Most candidate genes identified in animal models have so far revealed relatively few strong associations in human CDH cases. CDH is likely a highly polygenic disease, and future studies will need to reconcile how disturbances in the expression of multiple genes cause the disease. Herein, we summarize the available literature on abnormal lung development associated with CDH. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Epidemiology of congenital diaphragmatic hernia in Europe

    DEFF Research Database (Denmark)

    McGivern, Mark R.; Best, Kate E.; Rankin, Judith

    2015-01-01

    reported among 12 155 491 registered births. Of 3131 singleton cases, 353 (10.4%) were associated with a chromosomal anomaly, genetic syndrome or microdeletion, 784 (28.2%) were associated with other major structural anomalies. The male to female ratio of CDH cases overall was 1:0.69. Total prevalence......INTRODUCTION: Published prevalence rates of congenital diaphragmatic hernia (CDH) vary. This study aims to describe the epidemiology of CDH using data from high-quality, population-based registers belonging to the European Surveillance of Congenital Anomalies (EUROCAT). METHODS: Cases of CDH...... for isolated cases (ie, CDH cases that did not occur with any other congenital anomaly). There was significant variation in total and isolated CDH prevalence between registers. The proportion of cases that survived to 1 week was 69.3% (1392 cases) for total CDH cases and 72.7% (1107) for isolated cases...

  16. Hiatal hernia repair - slideshow

    Science.gov (United States)

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

  17. A rare case of morgagni diaphragmatic hernia presenting in pregnancy.

    Science.gov (United States)

    Thomas, Vijy Paul

    2012-08-01

    A case of Morgagni hernia presenting in adulthood is presented. This form of congenital diaphragmatic hernia is rare in itself and is known to present in adulthood in some cases. But presentation after having undergone three surgeries-PDA ligation, appendicectomy and a full term pregnancy followed by LSCS is even rarer. This case is therefore by any yardstick an extremely rare one.

  18. Congenital diaphragmatic hernia : the importance of genetic and environmental factors

    NARCIS (Netherlands)

    M.F. van Dooren (Marieke)

    2004-01-01

    textabstractFor the studies described in this thesis we used a study protocol 'Environmental and Genetic factors in Congenital Diaphragmatic Hernia and Esophageal Atresia', approved by the Institutional Review Board, in collaboration with the parent support groups, 'Stichting Hernia Diafragrnatica'

  19. Nebulized lidocaine and fentanyl before sevoflurane induction of anesthesia in congenital diaphragmatic hernia repair: Prospective double blind randomized study

    Directory of Open Access Journals (Sweden)

    Moustafa Abdelaziz Moustafa

    2015-04-01

    Conclusions: Premedication of infants undergoing CDH repair with nebulized solution containing 4 mg kg−1 lidocaine 1% plus 2 μg kg−1 fentanyl improves the intubating conditions under inhalational sevoflurane induction without muscle relaxation. The studied combination can suppress patients’ hemodynamic changes to intubation.

  20. Anesthesia for Traumatic Diaphragmatic Hernia Associated with Corneal Laceration.

    Science.gov (United States)

    Safaeian, Reza; Hassani, Valiollah; Faiz, Hamid Reza

    2016-09-06

    BACKGROUND Diaphragmatic rupture can be seen in up to 5% of car accidents, and 80%-100% of diaphragmatic hernias are associated with other vital organ injuries. Brain, pelvis, long bones, liver, spleen, and aorta are some other organs that can be severely damaged and need different anesthetic managements. CASE REPORT A 37-year-old male victim of a head-on collision who was suffering diaphragmatic rupture and corneal laceration was prepared for an emergency operation 11 hours after the car accident. Gastric decompression, pre-oxygenation, rapid sequence induction with succinylcholine, immediate use of non-depolarizing muscle relaxant, and mechanical ventilation with low tidal volume after intubation were used in anesthetic management of the patient. CONCLUSIONS Because of the high prevalence of coexisting pathologies with traumatic diaphragmatic hernia, anesthetic management must be tailored to the associated pathologies.

  1. Congenital diaphragmatic hernia: the impact of embryological studies

    OpenAIRE

    1995-01-01

    textabstractIn recent years, a substantial research effort within the specialty of pediatric surgery has been devoted to improving our knowledge of the natural history and pathophysiology of congenital diaphragmatic hernias (CDH) and pulmonary hypoplasia (PH). However, the embryological background has remained elusive because certain events of normal diaphragmatic development were still unclear and appropriate animal models were lacking. Most authors assume that delayed or inhibited closure o...

  2. Laparoscopic mesh repair of parahiatal hernia: a case report.

    Science.gov (United States)

    Lew, Pei Shi; Wong, Andrew Siang Yih

    2013-08-01

    We report a case of a primary parahiatal hernia that was repaired laparoscopically with a composite mesh. A 51-year-old woman presented with vomiting and epigastric pain. CT scan showed a giant paraesophageal hernia with intrathoracic gastric volvulus. Intraoperatively, a diaphragmatic muscular defect was found lateral to an attenuated left crus of the diaphragm, distinct from the normal esophageal hiatus. The defect ring was fibrotic, making a tension-free primary repair difficult. A laparoscopic mesh repair was performed with a composite mesh, which was covered with the hernia sac to prevent potential erosion into the esophagus or stomach. Recovery was uneventful and the patient was discharged on the 5 days postoperatively. She remained asymptomatic at subsequent follow-up. Laparoscopic repair of parahiatal hernia can be safely performed. In circumstances where a large or fibrotic defect prevents a tension-free primary repair, the use of a composite mesh can provide effective repair of the hernia.

  3. Bilateral Morgagni hernias association with left Bochdalek diaphragmatic hernia: a very rare anomaly.

    Science.gov (United States)

    Niramis, Rangsan; Poocharoen, Wannisa; Watanatittan, Sukawat

    2008-10-01

    Morgagni hernia association with Bochdalek diaphragmatic hernia is a very rare congenital anomaly. The authors reported a 2-year-and-2-month-old boy with Down syndrome who has a history of recurrent pneumonia over a one-year period. A chest film of the first admission at 6 months of age revealed only minimal pulmonary infiltration and normal findings of both sides of the diaphragm. The last investigations with chest films and CT scan were suggestive of sequestration of the right lung with left Morgagni and left Bochdalek diaphragmatic hernias. An exploratory laparotomy revealed bilateral Morgagni and left Bochdalek hernias with hernial sacs in all of the diaphragmatic defects. All of the hernial sacs were excised and the diaphragmatic defects were closed with 2-0 silk interruptedly. Postoperative course was uneventful and he was doing well during his follow-up at one year.

  4. Fetoscopic tracheal occlusion for severe congenital diaphragmatic hernia: retrospective study

    Directory of Open Access Journals (Sweden)

    Angélica de Fátima de Assunção Braga

    Full Text Available Abstract Background and objectives: The temporary fetal tracheal occlusion performed by fetoscopy accelerates lung development and reduces neonatal mortality. The aim of this paper is to present an anesthetic experience in pregnant women, whose fetuses have diaphragmatic hernia, undergoing fetoscopic tracheal occlusion (FETO. Method: Retrospective, descriptive study, approved by the Institutional Ethics Committee. Data were obtained from medical and anesthetic records. Results: FETO was performed in 28 pregnant women. Demographic characteristics: age 29.8 ± 6.5; weight 68.64 ± 12.26; ASA I and II. Obstetric: IG 26.1 ± 1.10 weeks (in FETO; 32.86 ± 1.58 (reversal of occlusion; 34.96 ± 2.78 (delivery. Delivery: cesarean section, vaginal delivery. Fetal data: Weight (g in the occlusion and delivery times, respectively (1045.82 ± 222.2 and 2294 ± 553; RPC in FETO and reversal of occlusion: 0.7 ± 0.15 and 1.32 ± 0.34, respectively. Preoperative maternal anesthesia included ranitidine and metoclopramide, nifedipine (VO and indomethacin (rectal. Preanesthetic medication with midazolam IV. Anesthetic techniques: combination of 0.5% hyperbaric bupivacaine (5-10 mg and sufentanil; continuous epidural predominantly with 0.5% bupivacaine associated with sufentanil, fentanyl, or morphine; general. In 8 cases, there was need to complement via catheter, with 5 submitted to PC and 3 to BC. Thirteen patients required intraoperative sedation; ephedrine was used in 15 patients. Fetal anesthesia: fentanyl 10-20 mg.kg-1 and pancuronium 0.1-0.2 mg.kg-1 (IM. Neonatal survival rate was 60.7%. Conclusion: FETO is a minimally invasive technique for severe congenital diaphragmatic hernia repair. Combined blockade associated with sedation and fetal anesthesia proved safe and effective for tracheal occlusion.

  5. Warfarin-Associated Diaphragmatic Hernia: An Unusual Diagnosis

    Directory of Open Access Journals (Sweden)

    Cristina Vilhena

    2015-01-01

    Full Text Available Fetal warfarin syndrome is a consequence of maternal intake of warfarin during pregnancy and comprises a wide range of manifestations, including some typical facial dysmorphologic features. The authors report a case of prenatal ultrasonographic diagnosis of warfarin embryopathy in an obese woman on unsupervised warfarin prophylaxis at the 16th week of gestation. The fetus presented with facial dysmorphism, pectus excavatum, diaphragmatic hernia, and pulmonary hypoplasia. To the best of our knowledge, this is the second reported case of warfarin-associated diaphragmatic hernia.

  6. Anesthesia for Traumatic Diaphragmatic Hernia Associated with Corneal Laceration

    Science.gov (United States)

    Safaeian, Reza; Hassani, Valiollah; Faiz, Hamid Reza

    2016-01-01

    Patient: Male, 37 Final Diagnosis: Diaphragmatic hernia Symptoms: Dyspnea Medication: — Clinical Procedure: CT-scan Specialty: Anesthesiology Objective: Rare co-existance of disease or pathology Background: Diaphragmatic rupture can be seen in up to 5% of car accidents, and 80%–100% of diaphragmatic hernias are associated with other vital organ injuries. Brain, pelvis, long bones, liver, spleen, and aorta are some other organs that can be severely damaged and need different anesthetic managements. Case Report: A 37-year-old male victim of a head-on collision who was suffering diaphragmatic rupture and corneal laceration was prepared for an emergency operation 11 hours after the car accident. Gastric decompression, preoxygenation, rapid sequence induction with succinylcholine, immediate use of non-depolarizing muscle relaxant, and mechanical ventilation with low tidal volume after intubation were used in anesthetic management of the patient. Conclusions: Because of the high prevalence of coexisting pathologies with traumatic diaphragmatic hernia, anesthetic management must be tailored to the associated pathologies. PMID:27595907

  7. Ventilation modalities in infants with congenital diaphragmatic hernia.

    Science.gov (United States)

    Morini, Francesco; Capolupo, Irma; van Weteringen, Willem; Reiss, Irwin

    2017-06-01

    Neonates with congenital diaphragmatic hernia are among the more complex patients to support with mechanical ventilation. They have particular features that add to the difficulties already present in the neonatal patient. A ventilation strategy tailored to the patient's underlying physiology rather than mode of ventilation is a crucial issue for clinicians treating these delicate patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Congenital Diaphragmatic Hernia and Occupational Therapy: A Case Report

    Science.gov (United States)

    Bates, Angela C.

    2011-01-01

    This case report describes occupational therapy (OT) intervention in an outpatient setting and outcomes for a child diagnosed with congenital diaphragmatic hernia (CDH) from 4 to 28 months of age. There is little information on therapy intervention and outcomes of children who have survived. The patient is a white male, born at 35 weeks gestation…

  9. Congenital diaphragmatic hernia candidate genes derived from embryonic transcriptomes

    DEFF Research Database (Denmark)

    Russell, Meaghan K; Longoni, Mauro; Wells, Julie

    2012-01-01

    Congenital diaphragmatic hernia (CDH) is a common (1 in 3,000 live births) major congenital malformation that results in significant morbidity and mortality. The discovery of CDH loci using standard genetic approaches has been hindered by its genetic heterogeneity. We hypothesized that gene expre...

  10. Congenital Diaphragmatic Hernia and Occupational Therapy: A Case Report

    Science.gov (United States)

    Bates, Angela C.

    2011-01-01

    This case report describes occupational therapy (OT) intervention in an outpatient setting and outcomes for a child diagnosed with congenital diaphragmatic hernia (CDH) from 4 to 28 months of age. There is little information on therapy intervention and outcomes of children who have survived. The patient is a white male, born at 35 weeks gestation…

  11. Congenital Diaphragmatic Hernia with Familial Occurrence in a Taiwanese Pedigree

    Directory of Open Access Journals (Sweden)

    Dah-Ching Ding

    2005-10-01

    Full Text Available Congenital diaphragmatic hernia (CDH is a developmental defect that accounts for 8% of all major congenital anomalies and is associated with a high mortality rate despite optimal postnatal treatment. Its etiology is uncertain. We report a case of familial CDH in a Taiwanese family. We believe autosomal recessive inheritance is the possible genetic etiology of CDH in this family.

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

    Science.gov (United States)

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

    2012-10-01

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

  13. [Inguinal and femoral hernia repair].

    Science.gov (United States)

    Geissler, B; Anthuber, M

    2011-05-01

    With an incidence of 200,000 new cases per year in Germany, inguinal hernia has a significant socioeconomic impact. The 2009 guidelines from the European Hernia Society established treatment recommendations. Hernia repair is based on reinforcing the posterior wall of the inguinal canal by suture or mesh repair by an anterior or posterior approach. Lightweight mesh reduces recurrence rates and is the treatment of choice even in primary hernias. Laparoscopic hernia repair is associated with specific risks but is superior in postoperative pain and earlier return to work.

  14. Delayed Presentation of Traumatic Diaphragmatic Hernia: The Evaluation of Surgical Treatment Results

    Directory of Open Access Journals (Sweden)

    Ali Sadrizadeh

    2015-06-01

    Full Text Available Introduction: Diaphragmatic hernia could be caused by congenital disorders, blunt trauma or penetrating injuries. The diagnosis of traumatic diaphragmatic hernia is normally neglected during the first presentation leading to late complications and considerably increased mortality and morbidity among the patients. Materials and Methods: In this retrospective, descriptive study, we reviewed the medical records of patients presented with traumatic diaphragmatic hernia who had undergone surgical operations between 1982-2015 in Ghaem Hospital and Omid Hospital affiliated to Mashhad University of Medical Sciences, Iran. The studied variables included age, gender, clinical symptoms, location of hernia, involved organs, type of imaging modalities, surgical techniques, length of hospital stay, mortality rate and surgical complications. Results: In this study, 38 patients were diagnosed with traumatic diaphragmatic hernia consisting of 28 men and 10 women. In total, 79% and 21% of the patients suffered from penetrating trauma and blunt trauma, respectively. In addition, left-sided, right-sided and bilateral hernias were present in 33%, 4% and 1% of the patients, respectively. The most frequently herniated organ was the stomach, and the most common clinical symptoms were abdominal pain (84% and dyspnea (53%. Initially, chest radiographs were performed on all the patients, and thoracotomy was performed to repair diaphragmatic tears in all the cases (100%. In this study, 3 patients had previously undergone Hartmann’s operation for gangrenous herniated colon, and devolvulation of gastric volvulus had also been performed on 3 patients. The main post-operative complications were reported to be pneumonia and respiratory insufficiency (2 cases, and the mean length of hospital stay was 6 days (5-8 days which was longer (1-2 months in patients with gangrenous bowel (3 patients. Furthermore, no mortality was reported during the course of hospitalization in these

  15. Congenital Diaphragmatic Hernia Presenting in a 7-Day-Old Infant

    Science.gov (United States)

    Schmidt, Luke; Brock, Lee; Fagiana, Angela

    2017-01-01

    A 7-day-old male infant presented to the emergency room after respiratory distress was noted at an outpatient well child check. On exam, he was observed to have tachypnea, increased work of breathing, and decreased breath sounds on the left side of the chest. On chest X-ray, he was found to have a left-sided congenital diaphragmatic hernia. The infant was transported to a tertiary care facility where the defect was repaired without complication. Interestingly, the mother had a history of a normal antenatal ultrasound, completed at 19 + 2 weeks of gestational age. This case report summarizes the challenges of diagnosing late-presenting congenital diaphragmatic hernia, associated malformations, possible etiologies, and prognosis. PMID:28133553

  16. Congenital Diaphragmatic Hernia Presenting in a 7-Day-Old Infant

    Directory of Open Access Journals (Sweden)

    Christopher Rouse

    2017-01-01

    Full Text Available A 7-day-old male infant presented to the emergency room after respiratory distress was noted at an outpatient well child check. On exam, he was observed to have tachypnea, increased work of breathing, and decreased breath sounds on the left side of the chest. On chest X-ray, he was found to have a left-sided congenital diaphragmatic hernia. The infant was transported to a tertiary care facility where the defect was repaired without complication. Interestingly, the mother had a history of a normal antenatal ultrasound, completed at 19 + 2 weeks of gestational age. This case report summarizes the challenges of diagnosing late-presenting congenital diaphragmatic hernia, associated malformations, possible etiologies, and prognosis.

  17. Laparoscopic repair of incisional hernia.

    Science.gov (United States)

    Lau, H; Lee, F; Patil, N G

    2001-09-01

    A 75-year-old man developed an incisional hernia over the upper abdomen following a wedge resection of a gastric stromal tumour in 1996. This is the first published report of a successful repair of an incisional hernia via a laparoscopic intraperitoneal on-lay technique using GORE-TEX DualMesh material in Hong Kong. Compared with conventional open repair of incisional hernia, long incisions and wound tension are avoided using the laparoscopic approach. This translates into a reduced risk of wound-related complications and facilitates recovery. In selected cases, minimally invasive surgery is a safe technique for the repair of incisional hernias.

  18. Video. Laparoscopic repair of congenital bilateral Morgagni hernia.

    Science.gov (United States)

    Khandelwal, Saurabh; Oelschlager, Brant K

    2011-06-01

    Morgagni hernia is a rare type of congenital diaphragmatic hernia found in the anterior aspect of the diaphragm. It typically presents in the pediatric population and rarely is diagnosed in adults. Only 3% of diaphragmatic hernias are the Morgagni type, and only 4% of these are found to present bilaterally. Surgical repair of Morgagni hernia has been performed through various approaches including open, laparoscopic, thoracotomy, and video-assisted thoracoscopic surgery (VATS), all with and without mesh. The optimal method of surgical repair is not known due to the rarity of this condition and the limitations of setting up a prospective, randomized trial to evaluate the different methods. Laparoscopic repair with mesh has been described with good short-term results. Few case reports exist in the world literature describing laparoscopic repair of a bilateral Morgagni hernia with mesh. At the University of Washington, the authors present a video showing their technique for laparoscopic repair of a congenital, bilateral Morgagni type hernia with mesh.

  19. Repair of surgically created diaphragmatic defect in rat with use of a crosslinked porous collagen scaffold

    NARCIS (Netherlands)

    Brouwer, K.M.; Daamen, W.F.; Reijnen, D.; Verstegen, R.H.J.; Lammers, G.; Hafmans, T.G.M.; Wismans, R.G.; Kuppevelt, A.H.M.S.M. van; Wijnen, R.M.H.

    2013-01-01

    Large defects in congenital diaphragmatic hernia are closed by patch repair, which is associated with a high complication risk and reherniation rate. New treatment modalities are warranted. We evaluated the feasibility of using an acellular biodegradable collagen bioscaffold for a regenerative medic

  20. TRAUMATIC DIAPHRAGMATIC HERNIA IN AN INFANT

    Directory of Open Access Journals (Sweden)

    Vaidyam

    2014-02-01

    Full Text Available T raumatic diaphragmatic ruptures are relatively rare , but are increasingly being reported due to their commonness in motor vehicle accidents. This case report is of a one - year old female child similarly injured , who presented very early after the insult , with none of the abdominal symptoms or signs that usual ly point to this diagnosis. This case underscores the fact that clinical scenario in pediatric patients does not always correlate with the degree of severity of injury and also that CT scan of chest is superior to radiographs and ultrasonography in detecti ng early diaphragmatic rupture

  1. Plummer-Vinson syndrome associated with chronic blood loss anemia and large diaphragmatic hernia.

    Science.gov (United States)

    Maleki, Dordaneh; Cameron, Alan J

    2002-01-01

    The coexistence of large diaphragmatic hernia and Plummer-Vinson syndrome in two patients is described. It is proposed that the hernias caused chronic blood loss anemia, and that iron deficiency then resulted in postcricoid web formation.

  2. Laparoscopic repair of congenital pleuroperitoneal hernia using a polypropylene mesh in a dog

    Directory of Open Access Journals (Sweden)

    H.F. Hartmann

    2015-12-01

    Full Text Available ABSTRACT Pleuroperitoneal hernias are the most uncommon type of diaphragmatic hernias in dogs and cats. The treatment of choice is surgery and may involve the use of prosthetic implant through celiotomy. In the current report, laparoscopic repair of a congenital pleuroperitoneal hernia using polypropylene mesh in a dog is described. The surgery was feasible. Appropriate reduction of the hernia was carried out and no complications were noted.

  3. Interparietal hernias after open retromuscular hernia repair.

    Science.gov (United States)

    Carbonell, A M

    2008-12-01

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

  4. Diaphragmatic hernia after right donor and hepatectomy:a rare donor complication of partial hepatectomy for transplantation

    Institute of Scientific and Technical Information of China (English)

    Alan M. Hawxby; David P. Mason; Andrew S. Klein

    2006-01-01

    BACKGROUND: Because of the critical worldwide shortage of cadaveric organ donors, transplant professionals have increasingly turned to living donors. Partial hepatectomy for adult living donor liver transplantation has been performed since the late 1990s. Most often, the complications of living donor hepatectomy have been related to the biliary tract, speciifcally biliary leaks. METHODS: A 54-year-old man underwent donor right hepatectomy for living donor liver transplantation. Three years after liver donation he presented with upper abdominal pain and fullness. Radiographic workup revealed a diaphragmatic hernia of the right hemithorax. RESULTS: After thoracoscopic evaluation of the right hemithorax, diaphragmatic hernia was repaired. Currently the patient remains well several months after the repair with complete resolution of abdominal pain, normal chest X-ray examination demonstrating no recurrence of diaphragmatic hernia, and normal liver functions tests. CONCLUSIONS: Multiple complications of living donor liver transplantation have been described the transplant literature. Diaphragmatic hernia is a formerly-undescribed complication of right donor hepatectomy for transplantation.

  5. Umbilical hernia repair

    Science.gov (United States)

    Umbilical hernia surgery ... and pain-free) for this surgery. If your hernia is small, you may receive spinal, epidural block , ... your belly button. Your surgeon will find your hernia and separate it from the tissues around it. ...

  6. Morgagni-Larrey parasternal diaphragmatic hernia in the adult.

    Science.gov (United States)

    Arráez-Aybar, L A; González-Gómez, C C; Torres-García, A J

    2009-05-01

    With a prevalence of 0.3-0.5/1000 births, congenital diaphragmatic hernia (CDH) remains a serious, poorly understood abnormality with a high mortality rate that cannot always be effectively managed. Its reported frequency in Spain is 0.69%00 with a yearly decreasing trend of 0.10%00 during the period 1980-2006. Up to 5% of cases are incidentally identified in adults undergoing studies for other reasons.We report the case of a 74-year-old woman with vomiting for three months due to parasternal diaphragmatic hernia of Morgagni-Larrey (retrochondrosternal, retrocostoxyphoid, retrosternal, subcostal, substernal or subcostosternal hernia), which allowed us to report an update on this condition in the adult, and on thoracoabdominal diaphragm morphogenesis. It is in the embryology of the diaphragm where an explanation may be found for some morphological changes and clinical manifestations, even though a number of uncertainties remain. We also analyze the extent of controversy persisting on some aspects of surgical treatment (access routes, mesh use, hernial sac reduction). Overall, minimally invasive techniques predominate. We consider laparoscopy the approach of choice for adult patients with parasternal hernia eligible for surgery.

  7. A Morgagni diaphragmatic hernia found after removal of mediastinal tumor.

    Science.gov (United States)

    Kim, Eung-Soo; Kang, Jong-Yael; Pyo, Chang-Hae; Jeon, Eui-Yong

    2008-06-01

    Morgagni hernia is a disease in which the abdominal contents herniate into the thoracic cavity through a congenital parasternal defect of the diaphragm resulting from an increased intra-abdominal pressure. Obesity, pregnancy, and a history of trauma are considered predisposing factors of Morgagni hernia. However, there is slight evidence that trauma has been the factor. Moreover, Morgagni hernia related to an operation has been rarely reported. We report a case of a female patient, whose mediastinal tumor had been removed 6 months prior to her being diagnosed with postoperative Morgagni hernia. There was a satisfactory result after the repair by an upper abdominal incision.

  8. Our Incidence of Diaphragmatic Hernia Detected with MDCT in the Past Two Years

    Directory of Open Access Journals (Sweden)

    Nesrin Atcı

    2015-11-01

    Full Text Available Aim: Diaphragmatic hernia develops as a result of extension of the intraabdominal organs to the thorax from a diaphragmatic defect which may be either a congenital fusion defect or subsequently formed defect(iatrojenic or traumatic. The diagnosis of symptomatic or asymptomatic diaphragmatic hernia can be easily done with the cross-sectional imaging, multidetector computed tomography (MDCT devices our aim in this study is to investigate diaphragmatic hernia incidence diagnosed by MDCT retrospectively. Methods: An experienced radiologist retrospectively evaluated MDCT results of 1000 patients to whom thorax and abdominal computed tomography was done due to chest and abdominal discomfort or trauma during the last 2 years. Results: According to our results, out of 1000 patients, 77 (7.7% patients had different types of diaphragmatic hernia the most common herniation was hiatal hernia which was seen in 54 patients. Congenital diaphragmatic hernia (n=21 and traumatic diaphragmatic hernia (n=2 were observed also. Conclusion: Diaphragmatic hernia diagnosis could be made easily with extensive use of MDCT in which multi-planar imaging can be taken.

  9. Blood vessels and airway development in normal and congenital diaphragmatic hernia lungs

    NARCIS (Netherlands)

    M. Hösgör

    2002-01-01

    textabstractThe phenotypic expression of congenital diaphragmatic hernia results in major difficulties to standardize the treatment and the order of treatment modalities in the individual patient. As a result even today the treatment of patients with congenital diaphragmatic hernia is "trial and

  10. Late return of function after intrathoracic torsion of the spleen in congenital diaphragmatic hernia

    DEFF Research Database (Denmark)

    Thorup, Jørgen Mogens; Pedersen, P V

    1986-01-01

    A case of late presentation of a left posterolateral diaphragmatic hernia in a four-year-old boy is reported. Shortly after incidental diagnosis of the diaphragmatic hernia, he was admitted with acute abdominal symptoms and laparotomy was performed. The stomach, small intestine, part of the colon...

  11. Pain after groin hernia repair

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Nielsen, R

    1998-01-01

    BACKGROUND: The purpose of the study was to provide a detailed description of postoperative pain after elective day-case open inguinal hernia repair under local anaesthesia. METHODS: This was a prospective consecutive case series study. After 500 hernia operations in 466 unselected patients aged 18...... between types of surgery or hernia. CONCLUSION: Pain remained a problem despite the pre-emptive use of opioids, non-steroidal anti-inflammatory drugs and local anaesthesia, irrespective of surgical technique....

  12. [Hernias of the diaphragmatic hiatus: Personal observation].

    Science.gov (United States)

    Perrin-Fayolle, M; Latarjet, M; Lafont, J P

    1977-01-01

    The authors report a new personal observation of hernia of the diaphragm hiatus. It is a rare, benign abnormality, generally asymptomatic, raising the diagnostic problem of posterior mediastinal opacities : pneumoperitoneum, retropneumoperitoneum and even pleuroscopy should enable a diagnostic and hence prevent a thoracotomy.

  13. Endoscopic inguinal hernia repair

    NARCIS (Netherlands)

    M.T.T. Knook

    2002-01-01

    textabstractInguinal hernias are among the oldest surgical challenges, having been recognized by the Egyptians in 1500 BC and Hippocrates in 400 BC. Celsus in 40 AD described Roman surgical practice, including manual hernia reduction for strangulated hernia, truss for reducible hernia and surgery

  14. Endoscopic inguinal hernia repair

    NARCIS (Netherlands)

    M.T.T. Knook

    2002-01-01

    textabstractInguinal hernias are among the oldest surgical challenges, having been recognized by the Egyptians in 1500 BC and Hippocrates in 400 BC. Celsus in 40 AD described Roman surgical practice, including manual hernia reduction for strangulated hernia, truss for reducible hernia and surgery on

  15. Endoscopic inguinal hernia repair

    NARCIS (Netherlands)

    M.T.T. Knook

    2002-01-01

    textabstractInguinal hernias are among the oldest surgical challenges, having been recognized by the Egyptians in 1500 BC and Hippocrates in 400 BC. Celsus in 40 AD described Roman surgical practice, including manual hernia reduction for strangulated hernia, truss for reducible hernia and surgery on

  16. Comparison of Radiography and Ultrasonography for Diagnosis of Diaphragmatic Hernia in Bovines

    Directory of Open Access Journals (Sweden)

    Hakim Athar

    2010-01-01

    Full Text Available The present study was conducted on 101 animals suffering from thoracoabdominal disorders; out of which twenty seven animals (twenty six buffaloes and one cow were diagnosed with diaphragmatic hernia based on clinical signs, radiography, ultrasonography, and left flank laparorumenotomy. Radiography alone confirmed diaphragmatic hernia in 18 cases (66.67% with a sac-like structure cranial to the diaphragm. In 15 animals the sac contained metallic densities while in three cases a sac-like structure with no metallic densities was present. Ultrasonography was helpful in confirming diaphragmatic hernia in 23 cases (85.18% and ultrasonographically reticular motility was evident at the level of 4th/5th intercostal space in all the animals. B+M mode ultrasonography was used for the first time for diagnosis of diaphragmatic hernia in bovines and the results suggested that ultrasonography was a reliable diagnostic modality for diaphragmatic hernia in bovines.

  17. Delayed Presentation of Traumatic Right-Sided Diaphragmatic Hernia after Abdominoplasty

    Directory of Open Access Journals (Sweden)

    Caroline C. Jadlowiec

    2014-01-01

    Full Text Available Traumatic diaphragmatic hernias are rare and challenging to diagnose. Following trauma, diagnosis may occur immediately or in a delayed fashion. It is believed that left traumatic diaphragmatic hernias are more common as a result of the protective right-sided anatomic lie of the liver. If unrecognized, traumatic diaphragmatic injuries are subject to enlarge over time as a result of the normal pressure changes observed between the thoracic and abdominal cavities. Additionally, abrupt changes to the pressure gradients, such as those which occur with positive pressure ventilation or surgical manipulation of the abdominal wall, can act as a nidus for making an asymptomatic hernia symptomatic. We report our experience with a delayed traumatic right-sided diaphragmatic hernia presenting with large bowel incarceration two months after abdominoplasty. In our review of the literature, we were unable to find any reports of delayed presentation of a traumatic right-sided diaphragmatic hernia occurring acutely following abdominoplasty.

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

    Science.gov (United States)

    Putnis, Soni; Wong, April; Berney, Christophe

    2011-12-01

    During totally extraperitoneal (TEP) endoscopic repair of inguinal hernias, it is possible to see the internal opening of the femoral canal. The aim of our study was to determine the incidence of synchronous femoral hernias found in patients undergoing TEP endoscopic inguinal hernia repair. This was a retrospective review of prospectively collected data on 362 consecutive patients who underwent 484 TEP endoscopic inguinal hernia repairs during a 5-year period, May 2005 to May 2010. During surgery, both inguinal and femoral canal orifices were routinely inspected. The presence of unilateral or bilateral inguinal and femoral hernias was recorded and repaired accordingly. There were a total of 362 patients. More males (343, 95%) underwent a TEP hernia repair than females (19, 5%). There were more cases of unilateral (240/362, 66%) than bilateral (122/362, 34%) inguinal hernias. A total of 18 cases of synchronous femoral hernias were found during operation. There was a higher incidence of femoral hernia in females (7/19, 37%) compared to males (11/343, 3%) (P hernias were clinically detectable preoperatively. Females undergoing elective inguinal hernia repair are more likely to have a synchronous femoral hernia than males. We suggest that all women presenting with an inguinal hernia also have a formal assessment of the femoral canal. TEP endoscopic inguinal hernia repair is an ideal approach as both inguinal and femoral orifices can be assessed and hernias repaired simultaneously during surgery.

  19. Nationwide prevalence of groin hernia repair

    DEFF Research Database (Denmark)

    Burcharth, Jakob; Pedersen, Michael; Bisgaard, Thue;

    2013-01-01

    Groin hernia repair is a commonly performed surgical procedure in the western world but large-scaled epidemiologic data are sparse. Large-scale data on the occurrence of groin hernia repair may provide further understanding to the pathophysiology of groin hernia development. This study was undert...... was undertaken to investigate the age and gender dependent prevalence of groin hernia repair....

  20. Region of interest-based versus whole-lung segmentation-based approach for MR lung perfusion quantification in 2-year-old children after congenital diaphragmatic hernia repair

    Energy Technology Data Exchange (ETDEWEB)

    Weis, M.; Sommer, V.; Hagelstein, C.; Schoenberg, S.O.; Neff, K.W. [Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Mannheim (Germany); Zoellner, F.G. [Heidelberg University, Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Mannheim (Germany); Zahn, K. [University of Heidelberg, Department of Paediatric Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Mannheim (Germany); Schaible, T. [Heidelberg University, Department of Paediatrics, University Medical Center Mannheim, Medical Faculty Mannheim, Mannheim (Germany)

    2016-12-15

    With a region of interest (ROI)-based approach 2-year-old children after congenital diaphragmatic hernia (CDH) show reduced MR lung perfusion values on the ipsilateral side compared to the contralateral. This study evaluates whether results can be reproduced by segmentation of whole-lung and whether there are differences between the ROI-based and whole-lung measurements. Using dynamic contrast-enhanced (DCE) MRI, pulmonary blood flow (PBF), pulmonary blood volume (PBV) and mean transit time (MTT) were quantified in 30 children after CDH repair. Quantification results of an ROI-based (six cylindrical ROIs generated of five adjacent slices per lung-side) and a whole-lung segmentation approach were compared. In both approaches PBF and PBV were significantly reduced on the ipsilateral side (p always <0.0001). In ipsilateral lungs, PBF of the ROI-based and the whole-lung segmentation-based approach was equal (p=0.50). In contralateral lungs, the ROI-based approach significantly overestimated PBF in comparison to the whole-lung segmentation approach by approximately 9.5 % (p=0.0013). MR lung perfusion in 2-year-old children after CDH is significantly reduced ipsilaterally. In the contralateral lung, the ROI-based approach significantly overestimates perfusion, which can be explained by exclusion of the most ventral parts of the lung. Therefore whole-lung segmentation should be preferred. (orig.)

  1. Late presentation of congenital diaphragmatic hernia (CDH: A rare case report

    Directory of Open Access Journals (Sweden)

    Narrotam A. Patel

    2014-09-01

    Full Text Available Reporting a rare case of a 17-year-old lady with late presentation of congenital diaphragmatic hernia. She presented with vague abdominal pain and postprandial vomiting. She underwent a diagnostic upper GI scopy with no significant findings. Chest X-ray and barium study for stomach were performed. Then CT scan was performed and showed herniation of bowel loops, mesentery and spleen into the left thoracic cavity through a large defect in the posterolateral aspect of the left hemidiaphgram. After the patient was operated, content reduced and defect was repaired. Thus CDH in adolescence is rare and a high index of suspicion is required.

  2. Groin hernia repair

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Aasvang, Eske

    2005-01-01

    The choice of anesthesia for groin hernia repair is between general, regional (epidural or spinal), and local anesthesia. Existing data from large consecutive patient series and randomized studies have shown local anesthesia to be the method of choice because it can be performed by the surgeon......, does not necessarily require an attending anesthesiologist, translates into the shortest recovery (bypassing the postanesthesia care unit), has the lowest cost, and has the lowest postoperative morbidity regarding risk of urinary retention. Spinal anesthesia has no documented benefits for this small...... scientific data to support the choice of anesthesia, large epidemiologic and nationwide information from databases show an undesirable high (about 10-20%) use of spinal anesthesia and low (about 10%) use of local infiltration anesthesia. Surgeons and anesthesiologists should therefore adjust their anesthesia...

  3. Prenatal interventions for congenital diaphragmatic hernia for improving outcomes.

    Science.gov (United States)

    Grivell, Rosalie M; Andersen, Chad; Dodd, Jodie M

    2015-11-27

    Congenital diaphragmatic hernia (CDH), is an uncommon but severe condition in which there is a developmental defect in the fetal diaphragm, resulting in liver and bowel migrating to the chest cavity and impairing lung development and function for the neonate. This condition can be diagnosed during pregnancy and as such, is potentially amenable to in-utero prenatal intervention. Neonatal surgical repair is possible, but even with early surgical repair and improving neonatal management, neonatal morbidity and mortality is high. Prenatal interventions described to date have included maternal antenatal corticosteroid administration and fetal tracheal occlusion, with both methods aiming to improve lung growth and maturity. However surgical procedures have potential maternal complications, as the uterus and amniotic sac are breached in order to gain access to the fetus. To compare the effects of prenatal versus postnatal interventions for CDH on perinatal mortality and morbidity, longer-term infant outcomes and maternal morbidity, and to compare the effects of different prenatal interventions with each other. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2015) and reference lists of retrieved studies. All published (including those published in abstract form), unpublished, and ongoing randomised controlled trials comparing prenatal and postnatal interventions for fetuses with CDH. Quasi-RCTs were eligible for inclusion but none were identified. Trials using a cross-over design are not eligible for inclusion. Two review authors evaluated trials for inclusion and methodological quality without consideration of their results according to the stated eligibility criteria and extracted data independently. Data were checked for accuracy. We identified 11 studies for potential inclusion. Of those, we included three studies involving 97 women. Two additional studies are ongoing.Two trials examined in-utero fetal tracheal occlusion with

  4. Laparoscopic Repair of Giant Bochdalek Hernia in Adults.

    Science.gov (United States)

    Moser, Federico; Signorini, Franco José; Maldonado, Pablo Sergio; Gorodner, Veronica; Sivilat, Arturo Lopez; Obeide, Lucio Ricardo

    2016-11-01

    Bochdalek hernia is a congenital diaphragmatic defect that results from improper fusion of the septum transversum and the pleuroperitoneal folds. It rarely persists asymptomatic until adulthood. The reported incidence is as low as 0.17%. Surgical repair of the defect can be performed through the abdomen or through the chest, and in both cases open or through laparoscopy/thoracoscopy. We present 2 cases of fully laparoscopic repair of giant Bochdalek hernia in adults. In both cases we used a GORE(®) DUALMESH(®) and we had neither complications nor recurrence. It is worthy of mention that hernia sac was not found in any of the cases. This has been described as a distinct characteristic that confirms diagnosis. Bochdalek hernia in the adult is a rare entity that requires surgical treatment to avoid complications. CT scan of the abdomen and chest with oral and IV contrast is the gold standard for diagnosis.

  5. Non-intubated laparoscopic repair of giant Morgagni’s hernia for a young man

    Science.gov (United States)

    Zhang, Miao; Wang, Heng; Liu, Dong; Pan, Xuefeng; Wu, Wenbin; Hu, Zhengqun

    2016-01-01

    An asymptomatic patient was admitted as his chest photograph and computed tomography scans showed a giant Morgagni’s hernia (MH). And it was repaired by laparoscopic approach under epidural anesthesia without endotracheal intubation. The hernia content of omentum was repositioned back into the abdominal cavity, and the diaphragmatic defect was repaired with composite mesh. Which indicated that non-intubated laparoscopic mesh repair via epidural anesthesia is reliable and satisfactory for MH. PMID:27621903

  6. Autopsy features in a newborn baby affected by a central congenital diaphragmatic hernia.

    Science.gov (United States)

    Bolino, Giorgio; Gitto, Lorenzo; Serinelli, Serenella; Maiese, Aniello

    2015-03-01

    Congenital diaphragmatic hernia is a congenital malformation of the diaphragm, resulting in the herniation of the abdominal organs into the thoracic cavity. The most common types of congenital diaphragmatic hernia are Bochdalek hernia (postero-lateral hernia), Morgagni hernia (anterior defect), and diaphragm eventration (abnormal displacement of part or all of an otherwise intact diaphragm into the chest cavity). Congenital diaphragmatic hernia is a life-threatening pathology in infants, and a major cause of death due to pulmonary hypoplasia and pulmonary hypertension. We present a fatal case of congenital diaphragmatic hernia in a newborn. At the autopsy, a central defect of the diaphragm was found, 8 × 5 cm in size, that led to a herniation of the small intestine, the right lobe of the liver, and the right adrenal gland into the thorax. An esophageal atresia was associated with the congenital diaphragmatic hernia. The lungs showed severe hypoplasia and atelectasia. Physicians should pay attention to a prenatal diagnosis of congenital diaphragmatic hernia in order to prevent newborn fatalities.

  7. Inguinal hernia repair

    OpenAIRE

    1998-01-01

    A hernia usually presents as a painful lump in the groin, often associated with a large strain but it may also be asymptomatic and coincidentally discovered on routine examination. The incidence of hernia increases with age but a large number affected are working men and they can be severely disabled by the condition. Inguinal hernia is a common condition and 763 hernia operations were carried out in Government hospitals in Malta and Gozo during 1997.

  8. Endoscopic inguinal hernia repair

    OpenAIRE

    2002-01-01

    textabstractInguinal hernias are among the oldest surgical challenges, having been recognized by the Egyptians in 1500 BC and Hippocrates in 400 BC. Celsus in 40 AD described Roman surgical practice, including manual hernia reduction for strangulated hernia, truss for reducible hernia and surgery only for pain. The operation was performed via a scrotal incision and the wound was left open for secondary healing to increase scarring. Scar tissue was considered optimal reinforcement of the weak ...

  9. Hepatic fibrosarcoma incarcerated in a peritoneopericardial diaphragmatic hernia in a cat

    Directory of Open Access Journals (Sweden)

    Michael Linton

    2016-03-01

    Full Text Available Case summary A 14-year-old, female neutered domestic shorthair presented for dyspnoea. Thoracic ultrasonography and radiography showed that a heterogeneous mass was present within the pericardial sac, and the mass continued caudally with the mesenteric fat. On CT, the outline of the diaphragm was not continuous and there was an obvious defect with diaphragmatic thickening present at the mid-level of the liver. A pleural effusion and a small-volume pericardial effusion were also present. A ventral midline coeliotomy and median sternotomy revealed a 5 × 6 × 7 cm firm, irregular, tan-coloured soft tissue mass within the pericardial sac attached to both the diaphragmatic defect and liver. The mass was carefully dissected away from the heart and the diaphragmatic defect was repaired with primary closure. Postoperatively, the cat had a persistent pneumothorax that required continuous pleural suction for 41 h. The cat died 44 h postoperatively. Histopathology and immunohistochemistry confirmed the mass to be a hepatic fibrosarcoma incarcerated in a peritoneopericardial diaphragmatic hernia (PPDH. Relevance and novel information This is the first reported case of metaplastic transformation of liver into a sarcoma in a cat with PPDH. In addition, hepatic fibrosarcoma is a rarely reported location for fibrosarcoma in this species.

  10. Laparoscopic morgagni hernia repair using single-site umbilical and full-thickness abdominal wall repair: Technical report of two cases

    Directory of Open Access Journals (Sweden)

    Martin L van Niekerk

    2013-01-01

    Full Text Available Single incision laparoscopic surgery is used in many centres for routine cases such as appendisectomy, splenectomy and cholecystectomy. Morgagni hernias are uncommon and account for 1-2% of all congenital diaphragmatic hernia. We report our first laparoscopic repair of two Morgagni hernias, using a single umbilical incision and full-thickness abdominal wall repair with standard straight laparoscopic instruments. Operative time was short and compared favourably with the laparoscopic repair.

  11. Laparoscopic Morgagni hernia repair using single-site umbilical and full-thickness abdominal wall repair: technical report of two cases.

    Science.gov (United States)

    van Niekerk, Martin L

    2013-01-01

    Single incision laparoscopic surgery is used in many centres for routine cases such as appendectomy, splenectomy and cholecystectomy. Morgagni hernias are uncommon and account for 1-2% of all congenital diaphragmatic hernia. We report our first laparoscopic repair of two Morgagni hernias, using a single umbilical incision and full-thickness abdominal wall repair with standard straight laparoscopic instruments. Operative time was short and compared favourably with the laparoscopic repair.

  12. Concurrent laparoscopic morgagni hernia repair and sleeve gastrectomy.

    Science.gov (United States)

    Chiou, Grace; Tedesco, Maureen; Eisenberg, Dan

    2012-12-01

    The Morgagni-type anterior diaphragmatic hernia is a congenital defect that is a very uncommon hernia presenting in an adult. Surgical repair is usually recommended upon diagnosis and often requires synthetic mesh for a durable, tension-free repair. The use of synthetic mesh concurrently with several of bariatric operations is controversial owing to the potential for mesh infection. In this report we describe a laparoscopic repair of a symptomatic Morgagni hernia with synthetic mesh, concurrently with sleeve gastrectomy, in a morbidly obese man. The patient was a 58-year-old man with a body mass index of 48 kg/m(2) and associated co-morbid conditions that included obstructive sleep apnea, hypertension, hyperlipidemia, impaired fasting glucose, and osteoarthritis. He was diagnosed with Morgagni hernia with exertional dyspnia. He underwent concurrent laparoscopic Morgagni hernia repair with mesh and sleeve gastrectomy. At 2 months after surgery the patient was doing well and tolerating solid foods, and his percentage excess weight loss was 35%. He was exercising regularly and had no exertional dyspnea. Laparoscopy is an attractive approach to performing multiple intra-abdominal procedures concurrently. The Morgagni hernia repair with mesh can be performed safely and effectively using a laparoscopic approach. This can be performed concurrently with bariatric surgery in the morbidly obese.

  13. Review of traumatic diaphragmatic hernia associated with pelvis fractures

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To review the epidemiological feature, clinical and diagnostic data of post-traumatic diaphragmatic hernia (TDH) associated with pelvis fracture reported in recent 10 years.Methods: A 10-year retrospective study was undertaken to analyze the incidence, diagnosis, management, morbidity and mortality of patients with traumatic diaphragmatic hernia associated with pelvis fractures. A total of 46 cases in our country were reviewed.Results: The incidence of TDH associated with pelvis fractures was relatively rare and the diagnosis was often delayed or missed. A total of 72.34% of these patients were diagnosed as TDH associated with pelvis fractures after injury for 36 hours to 1 week. Although the trans-thorax approach was preferred for surgical closure in the acute phase, its mortality still reached 8.51%.Conclusions: TDH associated with pelvis fractures is difficult to be diagnosed because of its varied clinical and radiological signs and the patients may not present with symptoms for a long time after injury. In clinical, a high index of suspicion with appropriate examination is the mainstay of management, which can be helpful in prognosis.

  14. Comorbidity between Klinefelter syndrome and diaphragmatic hernia. A case report

    Directory of Open Access Journals (Sweden)

    Carolina Melendez Valdez

    Full Text Available CONTEXT: Intrathoracic cystic lesions have been diagnosed in a wide variety of age groups, and the increasing use of prenatal imaging studies has allowed detection of these defects even in utero.CASE REPORT: A 17-year-old pregnant woman in her second gestation, at 23 weeks of pregnancy, presented an ultrasound with evidence of a cystic anechoic image in the fet al left hemithorax. A morphological ultrasound examination performed at the hospital found that this cystic image measured 3.7 cm x 2.1 cm x 1.6 cm. Polyhydramnios was also present. At this time, the hypothesis of cystic adenomatoid malformation was raised. Fet al echocardiography showed only a dextroposed heart. Fet al magnetic resonance imaging produced an image compatible with a left diaphragmatic hernia containing the stomach and at least the first and second portions of the duodenum, left lobe of the liver, spleen, small intestine segments and portions of the colon. The stomach was greatly distended and the heart was shifted to the right. There was severe volume reduction of the left lung. Fet al karyotyping showed the chromosomal constitution of 47,XXY, compatible with Klinefelter syndrome. In our review of the literature, we found only one case of association between Klinefelter syndrome and diaphragmatic hernia.CONCLUSIONS: We believe that the association observed in this case was merely coincidental, since both conditions are relatively common. The chance of both events occurring simultaneously is estimated to be 1 in 1.5 million births.

  15. Ipsilateral occult hernias during endoscopic groin hernia repair

    Directory of Open Access Journals (Sweden)

    Jain Mayank

    2008-01-01

    Full Text Available Endoscopic repair of groin hernias allows the surgeon to have a complete view of the groin and pelvis to diagnose occult hernias both ipsilaterally and contralaterally. These occult hernias can then be treated simultaneously and may reduce the incidence of recurrence and persistent symptoms. The authors present four unusual cases where occult hernias were found ipsilaterally during an endoscopic repair. All these occult hernias were treated along with the clinically diagnosed hernia at the same surgery with excellent results and no post-operative morbidity.

  16. A rare case of Bochdalek diaphragmatic hernia with concomitant partial situs inversus

    Directory of Open Access Journals (Sweden)

    Rishabh Jain

    2015-02-01

    Full Text Available Congenital diaphragmatic hernias clinically presenting in adulthood are exceedingly rare lesions, mainly left-sided defect (Bochdalek. Bochdalek hernias most commonly manifest during the patient's first few weeks of life. Diagnosis beyond the first 8 weeks of life is estimated to represent 5-25% of all Bochdalek hernias. Here we have a 32 year old female patient who presented with 10x10 cm diaphragmatic hernia with dextrocardia who was asymptomatic for years. [Int J Res Med Sci 2015; 3(2.000: 494-497

  17. Adult congenital diaphragmatic hernia of the liver: a rare case report

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Congenital diaphragmatic hernia (CDH), which mainly occurs in the newborn or in childhood with severe respiratory distress and high mortality, is rarely found in adult, especially for those uncommon right CDH [1–4]. Whereas, liver as the main hernial

  18. [Morgagni-Larrey diaphragmatic hernia in a 3-month-old child affected by Marfan syndrome].

    Science.gov (United States)

    Laumonerie, P; Mouttalib, S; Edouard, T; Galinier, P

    2015-11-01

    The authors report on a case of diaphragmatic hernia occurring in a 3-month-old child affected by Marfan syndrome. Diagnosis was made on a chest X-ray and cardiac ultrasounds, performed because of the association of poor general condition, failure to thrive, and signs of respiratory distress. As a reminder, we emphasize the association between Marfan disease and diaphragmatic hernias as well as the diagnostic approach to reach an appropriate diagnosis.

  19. Newborn male presented with congenital diaphragmatic hernia and choledochal cyst: A case report

    Directory of Open Access Journals (Sweden)

    Daniel Krebs

    2015-05-01

    Full Text Available Infants with congenital diaphragmatic hernia (CDH have an increased incidence of associated malformations, ranging from 10% to 50% higher than the general population [1–5]. Choedochal cysts, congenital cystic dilations of the biliary tree, are anomalies that have not yet been described in association with CDH. We describe a patient with a left congenital diaphragmatic hernia who was later diagnosed with a choledochal cyst.

  20. Adult congenital diaphragmatic hernia of the liver: a rare case report

    Institute of Scientific and Technical Information of China (English)

    LIU LiGuo; XU YiYao; MAO YiLei; SANG XinTing; YANG ZhiYing; LU Xin; ZHONG ShouXian; HUANG JieFu

    2010-01-01

    @@ Congenital diaphragmatic hernia (CDH), which mainly occurs in the newborn or in childhood with severe respiratory distress and high mortality, is rarely found in adult, especially for those uncommon right CDH [1-4].Whereas, liver as the main hernial content has been reported only in two cases throughout the world [5-6].This is a report of a right-sided congenital diaphragmatic hernia of the liver in a 46-year-old woman.

  1. A Triad of Congenital Diaphragmatic Hernia, Meckel’s Diverticulum, and Heterotopic Pancreas

    Directory of Open Access Journals (Sweden)

    Parkash Mandhan

    2014-01-01

    Full Text Available Congenital diaphragmatic hernia is a common developmental anomaly encountered by paediatric surgeons. It is known to be associated with extradiaphragmatic malformations, which include cardiac, renal, genital, and chromosomal abnormalities. Herein, we report a newborn born with concurrent congenital diaphragmatic hernia, Meckel’s diverticulum, and heterotopic pancreatic tissue. This is the first case report of such a triad with description of possible mechanisms of the development.

  2. Diaphragmatic hernia complicated with intestinal obstruction with colon perforation after surgery for esophageal cancer: a case report

    Institute of Scientific and Technical Information of China (English)

    Chao Sun; Hongcan Shi; Kang Wang

    2012-01-01

    We reported a case of diaphragmatic hernia complicated with intestinal obstruction with colon perforation after surgery for esophageal cancer. In this case, the conservative treatment took too long, which delayed the diagnosis and treatment and resulted in colon perforation. After computed tomography confirmed the diagnosis, an emergency operation was performed. During the operation, we found colon perforation. Because pollution of thoracic cavity was serious, we performed proximal end colon neostomy. The patient recovered and discharged with active treatment 35 days after operation. We consider surgical repair of the diaphragmatic hernia is recommended to avoid the potentially disastrous complications, such as strangulation or perforation of the herniated contents, which can threaten the life of the patient if diagnosis is delayed.

  3. Laparoscopic Inguinal Hernia Repair

    Science.gov (United States)

    ... hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. ... is a technique to fix tears in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). ...

  4. Revisional laparoscopic parastomal hernia repair.

    Science.gov (United States)

    Zacharakis, Emmanouil; Shalhoub, Joseph; Selvapatt, Nowlan; Darzi, Ara; Ziprin, Paul

    2008-01-01

    We herein report a laparoscopically performed re-do operation on a patient who had previously undergone a laparoscopic parastomal hernia repair. We describe the case of a 71-year-old patient who presented within 3 months of her primary laparoscopic parastomal hernia repair with recurrence. On relaparoscopy, dense adhesions to the mesh were found, and the mesh had migrated into the hernia sac. This had allowed loops of small bowel to herniate into the sac. The initial part of the procedure involved the lysis of adhesions. A piece of Gore-Tex DualMesh with a central keyhole and a radial slit was cut so that it could provide at least 3 cm to 5 cm of overlap of the fascial defect. The tails of the mesh were wrapped around the bowel, and the mesh was secured to the margins of the hernia with circumferential metal tacking and 4 transfascial sutures. The patient remains in satisfactory condition and no recurrence or any surgery-related problem has been observed during 8 months of follow-up. Revisional laparoscopic repair of parastomal hernias seems feasible and has been shown to be safe and effective in this case. The success of this approach depends on longer follow-up reports and standardization of the technical elements.

  5. Congenital Diaphragmatic Hernia Following Usage of Lithium Carbonate; Is Lithium a Teratogen?

    Directory of Open Access Journals (Sweden)

    Seyed-Abdollah Mousavi

    2010-03-01

    Full Text Available Background:Lithium is used mainly for the treatment of Bipolar Disorder (BD. Case reports and several retrospective studies have demonstrated possible teratogenicity, but the data in different studies is inconclusive. The risk for cardiovascular malformations, particularly Ebsteins anomaly and other congenital abnormalities have been reported. Case Presentation:A 25-year-old gravida 1, para 1 woman at 38 weeks of gestation was admitted for an elective caesarean section. She had a history of BP for which she was treated with lithium 600mg q12h in the first trimester of pregnancy. There was no familial history of birth defects, any antenatal infection or exposure to any other medications, alcohol, smoking, or X-rays. A baby boy (3500g was born. After 2 to 3 hours respiratory distress clinical picture and chest radiograph suggested diagnosis of congenital diaphragmatic hernia. Repair of his diaphragm was preformed and patient discharged after 12 days. Conclusion:Lithium probably produces a defect in normal development of the diaphragm and may pose specific risk for an anomaly known as congenital diaphragmatic hernia (CDH.

  6. Laparoscopic repair of postoperative perineal hernia.

    LENUS (Irish Health Repository)

    Ryan, Stephen

    2010-01-01

    Perineal hernias are infrequent complications following abdominoperineal operations. Various approaches have been described for repair of perineal hernias including open transabdominal, transperineal or combined abdominoperineal repairs. The use of laparoscopic transabdominal repair of perineal hernias is not well-described. We present a case report demonstrating the benefits of laparoscopic repair of perineal hernia following previous laparoscopic abdominoperineal resection (APR) using a nonabsorbable mesh to repair the defect. We have demonstrated that the use of laparoscopy with repair of the pelvic floor defect using a non absorbable synthetic mesh offers an excellent alternative with many potential advantages over open transabdominal and transperineal repairs.

  7. Long-term follow-up of congenital diaphragmatic hernia.

    Science.gov (United States)

    Hollinger, Laura E; Harting, Matthew T; Lally, Kevin P

    2017-06-01

    Increased survival of patients with congenital diaphragmatic hernia has created a unique cohort of children, adolescent, and adult survivors with complex medical and surgical needs. Disease-specific morbidities offer the opportunity for multiple disciplines to unite together to provide long-term comprehensive follow-up, as well as an opportunity for research regarding late outcomes. These children can exhibit impaired pulmonary function, altered neurodevelopmental outcomes, nutritional insufficiency, musculoskeletal changes, and specialized surgical needs that benefit from regular monitoring and intervention, particularly in patients with increased disease severity. Below we aim to characterize the specific challenges that these survivors face as well as present an algorithm for a multidisciplinary long-term follow-up program. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Umbilical and epigastric hernia repair.

    Science.gov (United States)

    Muschaweck, Ulrike

    2003-10-01

    The repair of umbilical and epigastric hernias still represents a challenge to surgeons. Although a common and relatively simple procedure, there is no exact protocol today on how the repair should be done. The Mayo technique and its alterations could not stand the test of time: a recurrence rate of 20% and higher is not acceptable for any surgical procedure. Although there is no consensus opinion, one thing is clear: the importance of an anatomic repair without tension and without an artificial enlargement of the defect. In 1987 Lichtenstein reported on 6321 cases of herniorraphy with a tension free repair, and in 1994 Stuart reemphasized that special importance in his editorial in the Lancet. A newer study from Brancato and coworkers in Italy also states the advantage of a tension-free prosthetic repair in 16 patients with epigastric hernia. We have gone even further and recommend a tailored-to-the-patient repair using a customized polypropylene mesh and a one-layer running suture. The advantages should be obvious: no artificial creation of an even bigger than original defect, a completely tension-free repair, and little to no recurrence of the hernia. Our results clearly prove that assumption. Moreover, the procedure is extremely safe and complications are very rare and minor. We conclude that using a mesh plug in a customized tension-free repair of umbilical and epigastric hernia shows many advantages over the commonly used methods. And we finally conclude with the words of Albert Einstein: "The only source of knowledge is experience."

  9. Groin hernia repair in young males: mesh or sutured repair?

    DEFF Research Database (Denmark)

    Bisgaard, T; Bay-Nielsen, M; Kehlet, H

    2010-01-01

    Large-scale data for the optimal inguinal hernia repair in younger men with an indirect hernia is not available. We analysed nationwide data for risk of reoperation in younger men after a primary repair using a Lichtenstein operation or a conventional non-mesh hernia repair....

  10. The value of fetal ultrasonography and magnetic resonance imaging in the assessment of diaphragmatic hernias; O valor da ultra-sonografia e da ressonancia magnetica fetal na avaliacao das hernias diafragmaticas

    Energy Technology Data Exchange (ETDEWEB)

    Amim, Bruno [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil). Curso de Pos-graduacao em Radiologia]. E-mail: brunoamim@gmail.com; Werner Junior, Heron; Daltron, Pedro Augusto; Antunes, Erika; Fazecas, Tatiana; Rodrigues, Leise; Domingues, Romeu Cortes [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil); Guerra, Fernando [Instituto Fernandes Figueira, Rio de Janeiro, RJ (Brazil); Marchiori, Edson [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil); Gasparetto, Emerson Leandro [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil)

    2008-01-15

    To demonstrate the relevance of ultrasonography and magnetic resonance imaging findings in the prenatal characterization and prognostic evaluation in cases of congenital diaphragmatic hernia. Materials And Methods: Fourteen pregnant women (mean gestational age = 28.7 weeks) who had undergone ultrasonography for suspicion of fetuses with congenital diaphragmatic hernia were assessed by means of magnetic resonance imaging on a 1.5 tesla equipment, following the standard protocol. Two radiologists evaluated the images and the findings were defined by consensus. Results: Twelve fetuses had left diaphragmatic hernia and two, right diaphragmatic hernia. Ultrasonography showed the fetal liver inside the thorax of five fetuses (three with left diaphragmatic hernia, and two with right diaphragmatic hernia) and magnetic resonance imaging in eight fetuses (six with left diaphragmatic hernia, and two with right diaphragmatic hernia). Stomach and small bowel loop herniation was observed in all of the fetuses with left diaphragmatic hernia (n = 12) at both magnetic resonance imaging and ultrasonography. Eight fetuses (seven with left diaphragmatic hernia and one with right diaphragmatic hernia) survived after surgical treatment. Conclusion: Ultrasonography and magnetic resonance imaging are complementary imaging methods in the evaluation of congenital diaphragmatic hernia. Magnetic resonance imaging is a helpful diagnostic method complementary to ultrasonography for evaluation of the fetal liver positioning, considering its relevance as a prognostic factor in cases of congenital diaphragmatic hernia. (author)

  11. Nationwide prevalence of groin hernia repair.

    Directory of Open Access Journals (Sweden)

    Jakob Burcharth

    Full Text Available INTRODUCTION: Groin hernia repair is a commonly performed surgical procedure in the western world but large-scaled epidemiologic data are sparse. Large-scale data on the occurrence of groin hernia repair may provide further understanding to the pathophysiology of groin hernia development. This study was undertaken to investigate the age and gender dependent prevalence of groin hernia repair. METHODS: In a nationwide register-based study, using data from the Civil Registration System covering all Danish citizens, we established a population-based cohort of all people living in Denmark on December 31(st, 2010. Within this population all groin hernia repairs during the past 5 years were identified using data from the ICD 10(th edition in the Danish National Hospital Register. RESULTS: The study population covered n = 5,639,885 persons. During the five years study period 46,717 groin hernia repairs were performed (88.6% males, 11.4% females. Inguinal hernias comprised 97% of groin hernia repairs (90.2% males, 9.8% females and femoral hernias 3% of groin hernia repairs (29.8% males, 70.2% females. Patients between 0-5 years and 75-80 years constituted the two dominant groups for inguinal hernia repair. In contrast, the age-specific prevalence of femoral hernia repair increased steadily throughout life peaking at age 80-90 years in both men and women. CONCLUSION: The age distribution of inguinal hernia repair is bimodal peaking at early childhood and old age, whereas the prevalence of femoral hernia repair increased steadily throughout life. This information can be used to formulate new hypotheses regarding disease etiology with regard to age and gender specifications.

  12. Percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia: Review of three cases.

    Science.gov (United States)

    Zouari, M; Jallouli, M; Bendhaou, M; Zitouni, H; Mhiri, R

    2015-12-01

    Morgagni hernias are uncommon, accounting for only 1-2% of all congenital diaphragmatic hernia. Minimally invasive surgery is today the gold standard treatment. We present a technique using percutaneous suturing and single-site umbilical laparoscopic repair of Morgagni hernia in three children. Recovery was uneventful in all three patients. There was no recurrence and the chest radiograph remained normal during the postoperative follow-up. The percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia is an easy and effective alternative to standard laparoscopic repair.

  13. Treatment and Controversies in Paraesophageal Hernia Repair

    Directory of Open Access Journals (Sweden)

    P. Marco eFisichella

    2015-04-01

    Full Text Available Background: Historically all paraesophageal hernias were repaired surgically, today intervention is reserved for symptomatic paraesophageal hernias. In this review, we describe the indications for repair and explore the controversies in paraesophageal hernia repair, which include a comparison of open to laparoscopic paraesophageal hernia repair, the necessity of complete sac excision, the routine performance of fundoplication, and the use of mesh for hernia repair.Methods: We searched Pubmed for papers published between 1980 and 2015 using the following keywords: hiatal hernias, paraesophageal hernias, regurgitation, dysphagia, gastroesophageal reflux disease, aspiration, GERD, endoscopy, manometry, pH monitoring, proton pump inhibitors, anemia, iron deficiency anemia, Nissen fundoplication, sac excision, mesh, mesh repair. Results: Indications for paraesophageal hernia repair have changed, and currently symptomatic paraesophageal hernias are recommended for repair. In addition, it is important not to overlook iron-deficiency anemia and pulmonary complaints, which tend to improve with repair. Current practice favors a laparoscopic approach, complete sac excision, primary crural repair with or without use of mesh, and a routine fundoplication.

  14. Diaphragmatic Hernias: A Cause of Unilateral Loss of The Cardiophrenic Sinus Angle

    Directory of Open Access Journals (Sweden)

    Elcin Zan

    2014-12-01

    Full Text Available Aim: Cardiophrenic space is the most basal portion of the mediastinum and surrounded by heart, diaphragm and chest wall. Cardiophrenic space full with fatty tissue shows a sharp angles. However, some space-occupying lesions, infections, inflammations and diaphragmatic herniation can be the cause of the blunt cardiophrenic sinus angle. The aim of this study is to determine the incidence of loss of the cardiophrenic sinus angle due to diaphragmatic hernias. Material and Method: Nine hundred eighty three consecutive chest MDCTs performed at our department were evaluated for the presence of one-sided increased cardiophrenic fat tissue. Two hundred patients who had blunting in the cardiophrenic (right or left sinus were included in the study. Density measurements proved the presence of adipose tissue in the cardiophrenic sinus in all patients. The relationship between age, gender and right or left sided atelectasis and associated diaphragmatic hernias were statistically analyzed. Results: One hundred and seven patients were female (53.5% and ninety three (46.5% were male. 28% of patients had diaphragmatic hernia. 31% of females and 24% of males had diaphragmatic hernia. Incidence of the Morgagni hernia was 14.5% and it was significantly higher in females than in males (p

  15. [Late-presenting congenital diaphragmatic hernia: a possible cause of sudden respiratory distress in children

    Science.gov (United States)

    Aita, J F; Zanolla, G R; Barcelos, A; Nascimento, L; Knebel, R; Verney, Y

    1999-01-01

    OBJECTIVE: To emphasize that congenital defects of the diaphragm should be considered in the differential diagnosis of sudden onset of respiratory distress in children. MATHOD: Two illustrative cases of children (aged 2 years) with late presenting congenital diaphragmatic hernia who developed sudden respiratory distress and were managed at the University Hospital of Santa Maria are reported. The medical literature was reviewed to identify cases reports and other articles related to late presenting congenital diaphragmatic hernia. A computerized search was performed using the MEDLINE data base to identify papers published within the last 25 years. RESULTS: In both cases the initial clinical examination and plain chest X-rays were misinterpreted as another pleuropulmonary disease like pneumothorax/pneumatoceles. One of the children underwent to emergency chest tube placement without clinical improvement. The absence of respiratory symptoms that could justify this kind of pathology motivated a more careful investigation, involving fiberoptical endoscopy and intestinal seriography. This subsequent investigation revealed that the cause was late-presenting congenital diaphragmatic hernia. CONCLUSION: Although many congenital diaphragmatic hernias that present late have a history of chronic respiratory symptoms, some of them present with acute symptoms. A higher degree of attention is required to avoid confusion with other intrathoracic conditions, such as pneumatoceles and pneumothorax, if an incorrect diagnosis is to be avoided. Misinterpretation of the radiographs is likely if the possibility of a congenital diaphragmatic hernia is not considered, and may result in increased morbidity. Gastric atony may occur in the early postoperative period.

  16. Umbilical Hernia Repair with Proceed Ventral Patch

    Directory of Open Access Journals (Sweden)

    Salati Sajad Ahmad

    2014-07-01

    Full Text Available Umbilical hernia is one the commonest surgical lesions and there is a variety of methods available for its repair. Proceed Ventral Patch is a recent and novel innovation in hernia management and we present a successful management of umbilical hernia in a 45 years old obese patient with this technique

  17. Rol de la TC multicorte en las hernias diafragmáticas: Ensayo iconográfico Role of Multislice Computed Tomography in the evaluation of diaphragmatic hernias: Pictorial essay

    Directory of Open Access Journals (Sweden)

    Mario G. Santamarina

    2009-12-01

    Full Text Available Las hernias diafragmáticas consisten en la migración de estructuras abdominales hacia el tórax a través de un defecto del diafragma. Ellas pueden tener origen congénito (de Morgagni y de Bochdalek o adquirido, incluyendo las traumáticas o no traumáticas (del hiato, defectos diafragmáticos posteriores. Debido a que en algunas hernias diafragmáticas está indicada la reparación quirúrgica, los métodos de diagnóstico por imágenes cumplen un rol fundamental. La TC multicorte, con su capacidad multiplanar y posibilidad de efectuar cortes finos, nos permite valorar y caracterizar adecuadamente el defecto diafragmático y sus complicaciones. En este ensayo iconográfico realizamos un breve repaso de la embriología y anatomía del diafragma, revisamos los distintos tipos de hernias diafragmáticas y la utilidad de la TC multicorte.Diaphragmatic hernias are characterized by the migration of abdominal structures into the chest through a diaphragmatic defect. These may have either a congenital etiology (e.g., Morgagni and Bochdalek, or an acquired etiology, including traumatic and nontraumatic hernias (hiatal, posterior diaphragmatic defects. Since a surgical repair is indicated in certain types of hernias, imaging diagnostic methods play a key role. Multislice Computed Tomography (MSCT allows multiplanar views and thin section evaluation, thus providing a useful tool for the assessment and characterization of the diaphragmatic defect and its complications. In this pictorial essay we briefly review the diaphragm anatomy and embryology, the different types of diaphragmatic hernias and the role of MSCT.

  18. [A case of strangulated congenital diaphragmatic hernia with necrosis and rupture of the colon and herniation into a left hemithorax in an adult (author's transl)].

    Science.gov (United States)

    Sarris, M; Georgoulis, J; Gatos, M; Dariotis, A

    This is a case report of a successful repair of congenital diaphragmatic hernia in a 48 years old male that contained the transverse colon which was strangulated and ruptured in the left thoracic cavity. It was approached in two stages. First through a laparotomy the proximal part of the transverse colon was divided. The side going to the hernial sac was sutured and the proximal stump was anastomosed to the descending colon. In a second stage, two days later, through a felt thoracotomy the strangulated and ruptured colon was resected and the distal stump of the transverse colon was sutured and the hernia repaired.

  19. Fetal Stomach Position Predicts Neonatal Outcomes in Isolated Left-Sided Congenital Diaphragmatic Hernia.

    Science.gov (United States)

    Basta, Amaya M; Lusk, Leslie A; Keller, Roberta L; Filly, Roy A

    2016-01-01

    We sought to determine the relationship between the degree of stomach herniation by antenatal sonography and neonatal outcomes in fetuses with isolated left-sided congenital diaphragmatic hernia (CDH). We retrospectively reviewed neonatal medical records and antenatal sonography of fetuses with isolated left CDH cared for at a single institution (2000-2012). Fetal stomach position was classified on sonography as follows: intra-abdominal, anterior left chest, mid-to-posterior left chest, or retrocardiac (right chest). Ninety fetuses were included with 70% surviving to neonatal discharge. Stomach position was intra-abdominal in 14% (n = 13), anterior left chest in 19% (n = 17), mid-to-posterior left chest in 41% (n = 37), and retrocardiac in 26% (n = 23). Increasingly abnormal stomach position was linearly associated with an increased odds of death (OR 4.8, 95% CI 2.1-10.9), extracorporeal membrane oxygenation (ECMO; OR 5.6, 95% CI 1.9-16.7), nonprimary diaphragmatic repair (OR 2.7, 95% CI 1.4-5.5), prolonged mechanical ventilation (OR 5.9, 95% CI 2.3-15.6), and prolonged respiratory support (OR 4.0, 95% CI 1.6-9.9). All fetuses with intra-abdominal stomach position survived without substantial respiratory morbidity or need for ECMO. Fetal stomach position is strongly associated with neonatal outcomes in isolated left CDH. This objective tool may allow for accurate prognostication in a variety of clinical settings. © 2015 S. Karger AG, Basel.

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

    National Research Council Canada - National Science Library

    Bunting, David; Szczebiot, Lukasz; Cota, Alwyn

    2013-01-01

    A wide range of diagnoses can present as inguinal hernia. Laparoscopic techniques are being increasingly used in the repair of inguinal hernias and offer the potential benefit of identifying additional pathology...

  1. Laparoscopic repair of a bilateral internal inguinal hernia with supravesical hernia – a case report

    Science.gov (United States)

    Kawaguchi, Tsutomu; Itoh, Tadao; Yoshii, Kazuhiro; Otsuji, Eigo

    2015-01-01

    Introduction Supravesical hernia is an exceptional subtype of internal inguinal hernia, and it is located between the median umbilical ligament and the medial umbilical ligament. The hernia is classified as two types: internal supravesical hernia and external supravesical hernia. Presentation of case Herein we report a rare case of external supravesical hernia successfully treated by laparoscopic procedure. The patient who complained right inguinal protrusion and mild frequent urination was diagnosed as right inguinal hernia and potential of left inguinal hernia using computed tomography. He underwent laparoscopic bilateral hernia repair, and intraoperative findings revealed right external supravesical hernia and left internal inguinal hernia. Discussion Laparoscopic hernia repair may make it possible to avoid overlooking of internal hernia such as supravesical hernia. Moreover it was possible to cover the hernia orifice and dissected layer of the dorsal site of urine bladder using bilateral approach in the current case. Conclusion In conclusions, laparoscopic hernia repair might be a surgical option for supravesical hernia. PMID:26263448

  2. [Complications of inguinal hernia repair].

    Science.gov (United States)

    Forte, A; D'Urso, A; Gallinaro, L S; Lo Storto, G; Bosco, M R; Vietri, F; Beltrami, V

    2002-03-01

    It's shown by literature and confirmed by Author's experience that, on account of the excellent results, prosthetic repair of inguinal hernia is more effective than "conventional" (Bassini, Mc Vay, Shouldice). Between January 1993 and December 2000 were observed 875 patients with inguinal hernia (814 monolateral, 61 bilateral); all patients underwent a Lichtenstein repair both in the primary version and in its variations (internal ring plastic, trasversalis plicate, plug repair). The patients were discharged from hospital within 24 hours after surgery in 90% of cases. No important intraoperative complications were observed; the patients restarting work varied from 3 to 15 days after the discharging in relation to patient anxiety, onset of complications and to the type of work. The complications observed were: urine retention (1.6%), superficial haematoma (1.3%), superficial infection (1%), wound suppuration (0.5%), serous effusion (0.7%), postsurgery pain (2.1%), scrotal edema (1.7%), persistent inguinal neuralgia (0.6), local hypoesthesia (4.3%), ischemical orchitis (0.1%), recurrence (0.2%). In conclusion Authors assert that "tension free" repair allows optimal results both for the surgery point (easiness of the technique, repeatability, less invasivity, scanty incident of recurrences, low frequency of postoperative complications) and in economic terms, allowing an early mobilization of the patients. A further improvement would be obtained with more care in surgical and patient management, with more excellent results.

  3. Intrathoracic intestinal diverticulum in a late presenting congenital bilateral diaphragmatic hernia: a case report

    Science.gov (United States)

    2013-01-01

    Introduction Hernias comprise 3% of all defects of the diaphragm. Bilateral hernias are extremely rare and usually occur in children. Here we present a case report of a bilateral Morgagni-Larrey diaphragmatic hernia with an intrathoracic intestinal diverticulum and late presentation. To the best of our knowledge this is the first report of this type. Case presentation A 37-year-old Hispanic man was admitted to our emergency department with a 4-day history of obstipation, abdominal pain, distension, nausea, and vomiting. During the initial evaluation, chest and abdominal X-rays were performed, which revealed intestinal displacement into his right and left hemithorax. During laparotomy, a Morgagni-Larrey hernia with a sac was found. His small bowel with a large diverticulum, transverse colon, descending colon, and epiploic fat were herniated into his thorax. Tissues were returned to his abdominal cavity and the hernia defects were corrected with running non-absorbable sutures. He had no postoperative complications. Conclusions Bilateral congenital diaphragmatic hernias remain extremely rare. However, they should be considered in adult patients with intestinal obstruction even when respiratory symptoms are absent. This is the first description of a patient with a prolapsed intestinal diverticulum and bilateral diaphragmatic hernias. PMID:24377864

  4. Congenital diaphragmatic hernia in neonate: A retrospective study about 28 observations

    Directory of Open Access Journals (Sweden)

    Rachid Khemakhem

    2012-01-01

    Full Text Available Objective: Our purpose was to review our experience with congenital diaphragmatic hernia emphasizing diagnosis, management, and outcome. Study Design: We conducted a retrospective review of all cases of babies with congenital diaphragmatic hernia diagnosed and treated in our centre from 1998 to 2010. Results: There were 28 congenital diaphragmatic hernia cases, 13 girls and 15 boys with a mean weight birth of 3 kg. Three patients (10, 6% of cases died within a few hours after admission. In the remaining cases, surgery was performed after a stabilization period of 2 days. The diaphragmatic defect was sitting in the posterolateral left in 23 cases and right in 2 cases. Its dimensions were on average 4,5 cm, tow cases of agenesis of the cupola were seen and required the placement of gortex prosthesis. The remaining cases are treated by direct closure of defect. Postoperative course was marked by an early death in context of respiratory distress in six cases and later with sepsis in tow cases. The outcome was favourable in 17 cases (60, 7%, despite the occurrence of sepsis in four cases and evisceration in two cases. Conclusions: Congenital diaphragmatic hernia remains a serious disease with high mortality and morbidity despite advances in prenatal diagnosis and neonatal resuscitation.

  5. Laparoscopic Ventral and Incisional Hernia Repair

    NARCIS (Netherlands)

    Wassenaar, E.B.

    2009-01-01

    Ventral and incisional hernia repair is one of the most frequently performed operations in daily surgical practice. Laparoscopic ventral and incisional hernia repair (LVIHR) is gaining increasing adoption in surgical practice. It has theoretical advantages but improvements in technique can still be

  6. Pain characteristics after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette A; Strandfelt, Pernille; Rosenberg, Jacob;

    2011-01-01

    Previous studies have shown different pain characteristics in different types of laparoscopic operations, but pain pattern has not been studied in detail after laparoscopic inguinal hernia repair. To optimise preoperative patient information and postoperative analgesic treatment the present study...... investigated postoperative pain in terms of time course, pain intensity and individual pain components during the first 4 days after transabdominal preperitoneal hernia repair (TAPP)....

  7. Mechanical Bowel Obstruction as a Late Presentation of Traumatic Diaphragmatic Hernia

    Directory of Open Access Journals (Sweden)

    Igor Hernández Toboso

    2012-05-01

    Full Text Available Traumatic diaphragmatic hernia is a rare entity that occurs only in 0.3 to 1, 6% of all abdominal trauma, being blunt or penetrating. It is sometimes lately diagnosed. The case of a 35 years old male patient with a history of 5 cm stab wound in the lower back of the left hemithorax 5 years before admission is presented. He attended medical care for colic abdominal pain and signs of intestinal obstruction without previous abdominal surgical history. The patient underwent surgery and a left diaphragmatic hernia in left complicated location was found. The patient presented a favorable outcome.

  8. Stomach in Contact with the Bladder: A Sonographic Sign of Left Congenital Diaphragmatic Hernia.

    Science.gov (United States)

    Aiello, Horacio; Meller, César; Vázquez, Lucía; Otaño, Lucas

    2016-01-01

    The evaluation of the characteristics of the fetal stomach should be part of every routine prenatal ultrasound after 11 weeks. A position that has not been previously described in the literature is the stomach in contact with the bladder. We describe 6 cases with the ultrasonographic finding of the stomach in contact with the bladder, all of them in fetuses with left-sided congenital diaphragmatic hernia. Even though the reasons for this striking position of the stomach are not clear, our series highlights the fact that the visualization of the stomach in contact with the bladder may be a specific sonographic marker of congenital diaphragmatic hernia. © 2015 S. Karger AG, Basel.

  9. Convalescence after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

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

    2016-01-01

    BACKGROUND: Duration of convalescence after inguinal hernia repair is of major socio-economic interest and an often reported outcome measure. The primary aim was to perform a critical analysis of duration of convalescence from work and activity and secondary to identify risk factors for unexpected...... prolonged convalescence after laparoscopic inguinal hernia repair. METHODS: A qualitative systematic review was conducted. PubMed, Embase and the Cochrane database were searched for trials reporting convalescence after laparoscopic inguinal hernia repair in the period from January 1990 to January 2016...... 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...

  10. Diagnosis and management of fetal intrapericardial Morgagni diaphragmatic hernia with massive pericardial effussion.

    Science.gov (United States)

    Antiñolo, Guillermo; De Agustin, Juan Carlos; Losada, Antonio; Marenco, Maria Luisa; Garcia-Diaz, Lutgardo; Morcillo, Juan

    2010-02-01

    Herniation of the liver into the fluid-filled pericardial sac resulting in a thoracic mass is a particularly rare form of Morgagni hernia (congenital diaphragmatic hernia of Morgagni). We report an early antenatal diagnosis of congenital diaphragmatic hernia of Morgagni with pericardium effussion at 21 weeks' gestation. Two pericardiocentesis were performed at 21 and 22 4/7 weeks' gestation because of recurrence of pericardial effussion. Regular ultrasound assessments showed progressive herniation of the liver to practically fill the right hemithorax. An ex utero intrapartum treatment procedure was performed at 37 weeks' gestation to rescue maximum intrathoracic space for ventilation of the remaining functional lung tissue and to establish an airway for postnatal support. After birth, the patient successfully underwent early correction of the hernia. Postoperative course was uneventful, and the newborn girl was discharged 18 days later without complications and is currently doing well.

  11. ONSTEP versus laparoscopy for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

    2015-01-01

    INTRODUCTION: The optimal repair of inguinal hernias remains controversial. It is recommended that an inguinal hernia be repaired using a mesh, either with a laparoscopic or an open approach. In Denmark, the laparoscopic approach is used in an increasing number of cases. The laparoscopic repair has...... clinical trial described in this protocol is to evaluate chronic pain after inguinal hernia repair using the ONSTEP method versus the laparoscopic approach. METHODS: This study is designed as a non-inferiority, two-arm, multicentre, randomised clinical trial, with a 1:1 allocation to ONSTEP or laparoscopic...

  12. ONSTEP versus laparoscopy for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

    2015-01-01

    INTRODUCTION: The optimal repair of inguinal hernias remains controversial. It is recommended that an inguinal hernia be repaired using a mesh, either with a laparoscopic or an open approach. In Denmark, the laparoscopic approach is used in an increasing number of cases. The laparoscopic repair has...... clinical trial described in this protocol is to evaluate chronic pain after inguinal hernia repair using the ONSTEP method versus the laparoscopic approach. METHODS: This study is designed as a non-inferiority, two-arm, multicentre, randomised clinical trial, with a 1:1 allocation to ONSTEP or laparoscopic...

  13. Sepsis risk factors in infants with congenital diaphragmatic hernia.

    Science.gov (United States)

    Levy, Michaël; Le Sache, Nolwenn; Mokhtari, Mostafa; Fagherazzi, Guy; Cuzon, Gaelle; Bueno, Benjamin; Fouquet, Virginie; Benachi, Alexandra; Eleni Dit Trolli, Sergio; Tissieres, Pierre

    2017-12-01

    Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly and remains among the most challenging ICU-managed disease. Beside severe pulmonary hypertension, lung hypoplasia and major abdominal surgery, infective complications remain major determinants of outcome. However, the specific incidence of sepsis as well as associated risk factors is unknown. This prospective, 4-year observational study took place in the pediatric intensive care and neonatal medicine department of the Paris South University Hospitals (Le Kremlin-Bicêtre, France), CDH national referral center and involved 62 neonates with CDH. During their ICU stay, 28 patients (45%) developed 38 sepsis episodes. Ventilator-associated pneumonia (VAP: 23/38; 31.9 VAP per 1000 days of mechanical ventilation) and central line-associated blood stream infections (CLABSI: 5/38; 5.5 per 1000 line days) were the most frequently encountered infections. Multivariate analysis showed that gestational age at birth and intra-thoracic position of liver were significantly associated with the occurrence of sepsis. Infected patients had longer duration of mechanical and noninvasive ventilation (16.2 and 5.8 days, respectively), longer delay to first feeding (1.2 days) and a longer length of stay in ICU (23 days), but there was no difference in mortality. Healthcare-associated infections, and more specifically VAP, are the main infective threat in children with CDH. Sepsis has a significant impact on the duration of ventilator support and ICU length of stay but does not impact mortality. Low gestational age and intra-thoracic localization of the liver are two independent risk factors associated with sepsis.

  14. Prenatal Diagnosis and Management for Congenital Intrapericardial Diaphragmatic Hernia with Massive Cardiac Effusion: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Ching-Chang Hsieh

    2015-03-01

    Full Text Available Congenital intrapericardial diaphragmatic hernia with massive pericardial effusion is a rare type of Morgagni hernia. Since 1980, there have been only 16 reported cases. We report on the imaging features of such a case that was diagnosed in utero. The prognosis of congenital intrapericardial diaphragmatic hernia is better than the other types of congenital diaphragmatic hernia, but lung hypoplasia due to compression by the pericardial effusion is not uncommon. Early intervention and treatment should be given to improve the perinatal outcome once the prenatal diagnosis has been made. We have summarized current diagnostic methods and management for this rare phenotype, after reviewing previous case reports and articles relating to the intervention for congenital diaphragmatic hernia.

  15. Congenital diaphragmatic hernia with(out) ECMO: impaired development at 8 years.

    NARCIS (Netherlands)

    Madderom, M.J.; Toussaint, L.; Cammen-van Zijp, M.H. van der; Gischler, S.J.; Wijnen, R.M.H.; Tibboel, D.; Ijsselstijn, H.

    2013-01-01

    OBJECTIVE: To evaluate developmental and social-emotional outcomes at 8 years of age for children with congenital diaphragmatic hernia (CDH), treated with or without neonatal extracorporeal membrane oxygenation (ECMO) between January 1999 and December 2003. DESIGN: Cohort study with structural prosp

  16. Inhalation of nitric oxide as a treatment of pulmonary hypertension in congenital diaphragmatic hernia

    DEFF Research Database (Denmark)

    Henneberg, S W; Jepsen, S; Andersen, P K;

    1995-01-01

    Congenital diaphragmatic hernia (CDH) still has a mortality risk of around 40%. The concomitant pulmonary hypoplasia and the persistent pulmonary hypertension are of major prognostic importance. The use of a selective pulmonary vasodilator may revert this vicious circle that is fatal to many chil...... treatment fails, and it may in some cases prove to be an alternative to ECMO....

  17. Congenital diaphragmatic hernia with(out) ECMO: impaired development at 8 years.

    NARCIS (Netherlands)

    Madderom, M.J.; Toussaint, L.; Cammen-van Zijp, M.H. van der; Gischler, S.J.; Wijnen, R.M.H.; Tibboel, D.; Ijsselstijn, H.

    2013-01-01

    OBJECTIVE: To evaluate developmental and social-emotional outcomes at 8 years of age for children with congenital diaphragmatic hernia (CDH), treated with or without neonatal extracorporeal membrane oxygenation (ECMO) between January 1999 and December 2003. DESIGN: Cohort study with structural

  18. Diaphragmatic hernia and right-sided heart enlargement in a Florida manatee (Trichechus manatus latirostris).

    Science.gov (United States)

    Gerlach, Trevor J; de Wit, Martine; Landolfi, Jennifer A

    2012-10-01

    Postmortem evaluation of a Florida manatee (Trichechus manatus latirostris) revealed cold stress lesions and previous watercraft trauma that included broken ribs, a diaphragmatic hernia, an enlarged vena cava, and right-sided cardiomegaly. We discuss these findings and present a possible pathogenesis for the cardiomegaly.

  19. Cardiac defect with diaphragmatic hernia and left lung agenesis--heart disease and other anomalies.

    Science.gov (United States)

    Palma, G; Giordano, R; Russolillo, V; Vosa, C

    2010-10-01

    This report describes a rare case of left pulmonary agenesis associated with congenital diaphragmatic hernia and congenital heart disease in a 2-year-old child with pulmonary hypertension. We performed direct radical correction of the congenital heart defect. The postoperative course was challenging but without major complications.

  20. Inhalation of nitric oxide as a treatment of pulmonary hypertension in congenital diaphragmatic hernia

    DEFF Research Database (Denmark)

    Henneberg, S W; Jepsen, S; Andersen, P K

    1995-01-01

    Congenital diaphragmatic hernia (CDH) still has a mortality risk of around 40%. The concomitant pulmonary hypoplasia and the persistent pulmonary hypertension are of major prognostic importance. The use of a selective pulmonary vasodilator may revert this vicious circle that is fatal to many chil...

  1. Psychological outcome and quality of life in children born with congenital diaphragmatic hernia

    NARCIS (Netherlands)

    Peetsold, M.; Huisman, J.; Hofman, V.E.; Heij, H.A.; Raat, H.; Gemke, R.J.B.J.

    2009-01-01

    OBJECTIVE: To assess psychological and social functioning as well as health-related quality of life and its early determinants in children born with congenital diaphragmatic hernia (CDH). DESIGN: Cross-sectional follow-up study. SETTING: Outpatient clinic of a tertiary care hospital. PARTICIPANTS: T

  2. Congenital diaphragmatic hernia associated with duplication of 11q23-qter.

    NARCIS (Netherlands)

    M. Klaassens (Merel); D.A. Scott; M.F. van Dooren (Marieke); R. Hochstenbach; H.J.F.M.M. Eussen (Bert); W.W. Cai; R-J.H. Galjaard (Robert-Jan); C. Wouters (Cokkie); M. Poot; J.A.M. Laudij (Jacqueline); B. Lee (Brendan); D. Tibboel (Dick); J.E.M.M. de Klein (Annelies)

    2006-01-01

    textabstractCongenital diaphragmatic hernia (CDH) is a relatively common birth defect with a high mortality. Although little is known about its etiology, there is increasing evidence for a strong genetic contribution. Both numerical and structural chromosomal abnormalities have been described in pat

  3. Psychological outcome and quality of life in children born with congenital diaphragmatic hernia

    NARCIS (Netherlands)

    Peetsold, M.; Huisman, J.; Hofman, V.E.; Heij, H.A.; Raat, H.; Gemke, R.J.B.J.

    2009-01-01

    OBJECTIVE: To assess psychological and social functioning as well as health-related quality of life and its early determinants in children born with congenital diaphragmatic hernia (CDH). DESIGN: Cross-sectional follow-up study. SETTING: Outpatient clinic of a tertiary care hospital. PARTICIPANTS: T

  4. The Pathogenesis of Pulmonary Hypoplasia in Congenital Diaphragmatic Hernia: A continuing quest

    NARCIS (Netherlands)

    R.B. van Loenhout (Rhiannon)

    2012-01-01

    textabstractCongenital diaphragmatic hernia or CDH is a developmental defect of the diaphragm that allows abdominal organs, such as intestines and liver, to herniate into the thoracic cavity during lung development. CDH has a prevalence of 1 in 2000 – 3000 newborns and accounts for approximately 8%

  5. Inhalation of nitric oxide as a treatment of pulmonary hypertension in congenital diaphragmatic hernia

    DEFF Research Database (Denmark)

    Henneberg, Steen Winther; Jepsen, S; Andersen, P K

    1995-01-01

    Congenital diaphragmatic hernia (CDH) still has a mortality risk of around 40%. The concomitant pulmonary hypoplasia and the persistent pulmonary hypertension are of major prognostic importance. The use of a selective pulmonary vasodilator may revert this vicious circle that is fatal to many...

  6. Congenital diaphragmatic hernia associated with duplication of 11q23-qter.

    NARCIS (Netherlands)

    M. Klaassens (Merel); D.A. Scott; M.F. van Dooren (Marieke); R. Hochstenbach; H.J.F.M.M. Eussen (Bert); W.W. Cai; R-J.H. Galjaard (Robert-Jan); C. Wouters (Cokkie); M. Poot; J.A.M. Laudij (Jacqueline); B. Lee (Brendan); D. Tibboel (Dick); J.E.M.M. de Klein (Annelies)

    2006-01-01

    textabstractCongenital diaphragmatic hernia (CDH) is a relatively common birth defect with a high mortality. Although little is known about its etiology, there is increasing evidence for a strong genetic contribution. Both numerical and structural chromosomal abnormalities have been described in pat

  7. Chronic pain after childhood groin hernia repair

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Kehlet, Henrik

    2007-01-01

    BACKGROUND: In contrast to the well-described 10% risk of chronic pain affecting daily activities after adult groin hernia repair, chronic pain after childhood groin hernia repair has never been investigated. Studies of other childhood surgery before the age of 3 months suggest a risk of increased...... pain responsiveness later in life, but its potential relationship to chronic pain in adult life is unknown. METHODS: This was a nationwide detailed questionnaire study of chronic groin pain in adults having surgery for a groin hernia repair before the age of 5 years (n = 1075). RESULTS: The response...

  8. Perinatal Factors Associated with Poor Neurocognitive Outcome in Early School Age Congenital Diaphragmatic Hernia Survivors

    Science.gov (United States)

    Benjamin, Jennifer R.; Gustafson, Kathryn E.; Smith, P. Brian; Ellingsen, Kirsten M.; Tompkins, K. Brooke; Goldberg, Ronald N.; Cotten, C. Michael; Goldstein, Ricki F.

    2013-01-01

    Objective Determine predictors of neurocognitive outcome in early school age congenital diaphragmatic hernia (CDH) survivors. Study design Prospective study of infants with CDH at Duke University Medical Center. Neurocognitive delay (NCD) at school age (4 to 7 years) was defined as a score < 80 in any of the following areas: Verbal Scale IQ, Performance Scale IQ, Expressive Language, or Receptive Language. Logistic regression, Fisher’s exact, and the Wilcoxon rank sum test were used to examine the relationship between NCD at early school age and 6 demographic and 18 medical variables. Results Of 43 infants with CDH, twenty seven (63%) survived to hospital discharge, and 16 (59%) returned for school age testing at a median age of 4.9 years. Seven (44%) of the children evaluated had NCD. Patch repair (p=0.01), extracorporeal membrane oxygenation (ECMO; p=0.02), days on ECMO (p=0.01), days of mechanical ventilation (p=0.049), and post-operative use of inhaled nitric oxide (p=0.02) were found to be associated with NCD at early school age. Conclusions CDH survivors are at risk for neurocognitive delay persisting into school age. Perinatal factors such as patch repair and ECMO treatment may aid in identifying CDH survivors at high risk for continued learning difficulties throughout childhood. PMID:23583126

  9. Transthoracic Repair of Asymptomatic Morgagni Hernia in an Adult

    OpenAIRE

    2011-01-01

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

  10. Congenital Diaphragmatic Hernia and Growth to 12 Years.

    Science.gov (United States)

    Leeuwen, Lisette; Mous, Daphne S; van Rosmalen, Joost; Olieman, Joanne F; Andriessen, Laura; Gischler, Saskia J; Joosten, Koen F M; Wijnen, Rene M H; Tibboel, Dick; IJsselstijn, Hanneke; Spoel, Marjolein

    2017-08-01

    Growth problems are reported in patients with congenital diaphragmatic hernia during the first years of life. However, it is unknown if poor growth persists during childhood. We therefore evaluated growth of patients longitudinally until 12 years of age. This prospective study included 172 patients (43 treated with extracorporeal membrane oxygenation [ECMO]) born from 1999 to 2014. Z scores of height-for-age (HFA), weight-for-height, and distance-to-target height were calculated at 6 months of age and at 1, 2, 5, 8, and 12 years of age. Data were analyzed by using general linear models. At 1 year of age, the mean weight-for-height z score had declined in ECMO (-1.30, 95% confidence interval: -1.62 to -0.97) and non-ECMO patients (-0.72, 95% confidence interval: -0.91 to -0.54; P < .05). Thereafter in ECMO patients, the mean HFA z score deteriorated between 1 (-0.43, 95% confidence interval: -0.73 to -0.13) and 5 years of age (-1.08, 95% confidence interval: -1.38 to -0.78; P < .01). In non-ECMO patients, the mean HFA z score deteriorated between 2 (-0.35, 95% confidence interval: -0.53 to -0.17) and 5 years of age (-0.56, 95% confidence interval: -0.75 to -0.37; P = .002). At 12 years of age, the mean HFA z score was still less than the norm in both groups: ECMO (-0.67, 95% confidence interval: -1.01 to -0.33) versus non-ECMO (-0.49, 95% confidence interval: -0.77 to -0.20; P < .01). Adjusting for target height improved the mean height z scores but did not bring them to normal range. Poor linear growth persisted at 12 years of age. The pattern of early deterioration of weight gain followed by a decline in linear growth is suggestive of inadequate nutrition during infancy. Therefore, nutritional assessment and intervention should be started early and should be continued during childhood. Copyright © 2017 by the American Academy of Pediatrics.

  11. Enhanced expression of vascular endothelial growth factor in lungs of newborn infants with congenital diaphragmatic hernia and pulmonary hypertension

    NARCIS (Netherlands)

    S.M.K. Shehata; W.J. Mooi (Wolter); T. Okazaki (Tadaharu); I. El-Banna; H.S. Sharma (Hari); D. Tibboel (Dick)

    1999-01-01

    textabstractBACKGROUND: Pulmonary hypoplasia accompanied by pulmonary hypertension resistant to treatment is an important feature of congenital diaphragmatic hernia (CDH). The pathogenesis of the pulmonary vascular abnormalities in CDH remains to be elucidated at the mo

  12. Pain characteristics after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette A; Strandfelt, Pernille; Rosenberg, Jacob;

    2011-01-01

    Previous studies have shown different pain characteristics in different types of laparoscopic operations, but pain pattern has not been studied in detail after laparoscopic inguinal hernia repair. To optimise preoperative patient information and postoperative analgesic treatment the present study...

  13. 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...... of long-term complications such as persisting pain and impairment of sexual function. The Onstep approach is a newer type of groin hernia repair with promising preliminary results in terms of very few cases of chronic pain and recurrences. This protocol describes a randomised clinical trial the objective...... of which is to evaluate chronic pain and sexual dysfunction after inguinal hernia repair using the Lichtenstein repair compared with the Onstep approach....

  14. 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...... of which is to evaluate chronic pain and sexual dysfunction after inguinal hernia repair using the Lichtenstein repair compared with the Onstep approach....... of long-term complications such as persisting pain and impairment of sexual function. The Onstep approach is a newer type of groin hernia repair with promising preliminary results in terms of very few cases of chronic pain and recurrences. This protocol describes a randomised clinical trial the objective...

  15. Laparoscopic transabdominal extraperitoneal repair of lumbar hernia

    Directory of Open Access Journals (Sweden)

    Sharma A

    2005-01-01

    Full Text Available Lumbar hernias need to be repaired due to the risk of incarceration and strangulation. A laparoscopic intraperitoneal approach in the modified flank position causes the intraperitoneal viscera to be displaced medially away from the hernia. The creation of a wide peritoneal flap around the hernial defect helps in mobilization of the colon, increased length of margin is available for coverage of mesh and more importantly for secure fixation of the mesh under vision to the underlying fascia. Laparoscopic lumbar hernia repair by this technique is a tensionless repair that diffuses total intra-abdominal pressure on each square inch of implanted mesh. The technique follows current principles of hernia repair and appears to confer all benefits of a minimal access approach.

  16. Chronic pain after inguinal hernia repair

    OpenAIRE

    2008-01-01

    : BACKGROUND: Chronic post herniorrhaphy groin pain is defined as pain lasting > 6 months after surgery, which is one of the most important complication occurring after inguinal hernia repair, occurs with greater frequency than previously thought. Chronic groin pain is one of the most significant complications following inguinal hernia repair, and majority of chronic pain has been attributed to ilioinguinal nerve entrapment. Various other factors are involved in development of...

  17. Umbilical hernia repair - series (image)

    Science.gov (United States)

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

  18. Inguinal hernia repair: toward Asian guidelines.

    Science.gov (United States)

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

    2015-02-01

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

  19. Umbilical Hernia Repair: Analysis After 934 Procedures.

    Science.gov (United States)

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

    2015-09-01

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

  20. A growing animal model for neonatal repair of large diaphragmatic defects to evaluate patch function and outcome

    Science.gov (United States)

    Joyeux, Luc; Pranpanus, Savitree; Van der Merwe, Johannes; Verbeken, Eric; De Vleeschauwer, Stephanie; Gayan-Ramirez, Ghislaine; Deprest, Jan

    2017-01-01

    Objectives We aimed to develop a more representative model for neonatal congenital diaphragmatic hernia repair in a large animal model, by creating a large defect in a fast-growing pup, using functional pulmonary and diaphragmatic read outs. Background Grafts are increasingly used to repair congenital diaphragmatic hernia with the risk of local complications. Growing animal models have been used to test novel materials. Methods 6-week-old rabbits underwent fiberoptic intubation, left subcostal laparotomy and hemi-diaphragmatic excision (either nearly complete (n = 13) or 3*3cm (n = 9)) and primary closure (Gore-Tex patch). Survival was further increased by moving to laryngeal mask airway ventilation (n = 15). Sham operated animals were used as controls (n = 6). Survivors (90 days) underwent chest X-Ray (scoliosis), measurements of maximum transdiaphragmatic pressure and breathing pattern (tidal volume, Pdi). Rates of herniation, lung histology and right hemi-diaphragmatic fiber cross-sectional area was measured. Results Rabbits surviving 90 days doubled their weight. Only one (8%) with a complete defect survived to 90 days. In the 3*3cm defect group all survived to 48 hours, however seven (78%) died later (16–49 days) from respiratory failure secondary to tracheal stricture formation. Use of a laryngeal mask airway doubled 90-day survival, one pup displaying herniation (17%). Cobb angel measurements, breathing pattern, and lung histology were comparable to sham. Under exertion, sham animals increased their maximum transdiaphragmatic pressure 134% compared to a 71% increase in patched animals (p<0.05). Patched animals had a compensatory increase in their right hemi-diaphragmatic fiber cross-sectional area (p<0.0001). Conclusions A primarily patched 3*3cm defect in growing rabbits, under laryngeal mask airway ventilation, enables adequate survival with normal lung function and reduced maximum transdiaphragmatic pressure compared to controls. PMID:28358826

  1. ONSTEP versus laparoscopy for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

    2015-01-01

    a learning curve of about 50-100 cases and decreases chronic pain, but slightly increases the risk of serious complications compared with open mesh repairs. Therefore, a simpler kind of operation is needed. The ONSTEP technique is a possible solution to this problem. The objective of the present randomised......INTRODUCTION: The optimal repair of inguinal hernias remains controversial. It is recommended that an inguinal hernia be repaired using a mesh, either with a laparoscopic or an open approach. In Denmark, the laparoscopic approach is used in an increasing number of cases. The laparoscopic repair has...... clinical trial described in this protocol is to evaluate chronic pain after inguinal hernia repair using the ONSTEP method versus the laparoscopic approach. METHODS: This study is designed as a non-inferiority, two-arm, multicentre, randomised clinical trial, with a 1:1 allocation to ONSTEP or laparoscopic...

  2. ONSTEP versus laparoscopy for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

    2015-01-01

    INTRODUCTION: The optimal repair of inguinal hernias remains controversial. It is recommended that an inguinal hernia be repaired using a mesh, either with a laparoscopic or an open approach. In Denmark, the laparoscopic approach is used in an increasing number of cases. The laparoscopic repair has...... a learning curve of about 50-100 cases and decreases chronic pain, but slightly increases the risk of serious complications compared with open mesh repairs. Therefore, a simpler kind of operation is needed. The ONSTEP technique is a possible solution to this problem. The objective of the present randomised...... clinical trial described in this protocol is to evaluate chronic pain after inguinal hernia repair using the ONSTEP method versus the laparoscopic approach. METHODS: This study is designed as a non-inferiority, two-arm, multicentre, randomised clinical trial, with a 1:1 allocation to ONSTEP or laparoscopic...

  3. Laparoscopic repair of left lumbar hernia after laparoscopic left nephrectomy.

    Science.gov (United States)

    Gagner, Michel; Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

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

  4. Laparoscopic repair of large incisional hernias.

    Science.gov (United States)

    Parker, Harris H; Nottingham, James M; Bynoe, Raymond P; Yost, Michael J

    2002-06-01

    Incisional hernias after abdominal operations are a significant cause of long-term morbidity and have been reported to occur in 3 to 20 per cent of laparotomy incisions. Traditional primary suture closure repair is plagued with up to a 50 per cent recurrence rate. With the introduction of prosthetic mesh repair recurrence decreased, but complications with mesh placement emerged ushering in the development of laparoscopic incisional herniorrhaphy. The records of patients who underwent laparoscopic incisional hernia repair between June 1, 1995 and September 1, 2001 were reviewed. Patient demographics, hernia defect size, recurrence, operative time, and procedure-related complications were evaluated. Fifty patients (22 male and 28 female, mean age 57 years with range of 24-83) were scheduled for laparoscopic incisional hernia repair between June 1, 1995 and September 1, 2001. The average patient was obese with a mean body mass index of 35.8 kg/m2 (range 16-57 kg/m2). Two patients (4%) had primary ventral hernias. Forty-eight patients (96%) had incisional hernias with 22 (46%) of these previously repaired with prosthetic mesh. Mean defect size was 206.1 cm2 (range 48-594 cm2). The average mesh size was 510.2 cm2 (range 224-1050 cm2). Gore-Tex DualMesh and Bard Composite Mesh were used in 84 and 16 per cent of the repairs, respectively. Mean operating time was 97 minutes. There were no deaths. Complications were seen in 12 per cent patients (six occurrences) and included two small bowel enterotomies, a symptomatic seroma requiring aspirate, a mesh reaction requiring a short course of intravenous antibiotics, and trocar site pain (two patients). There were no recurrences during a mean follow-up of 41 months (range 3-74 months). We conclude that laparoscopic incisional herniorrhaphy offers a safe and effective repair for large primary and recurrent ventral hernia with low morbidity.

  5. Seizure attack and Morgagni diaphragmatic hernia: incidental diagnosis or direct correlation?

    Science.gov (United States)

    Zisa, Monica; Pulvirenti, Elia; Toro, Adriana; Mannino, Maurizio; Reale, Giulio; Di Carlo, Isidoro

    2011-03-01

    Asymptomatic Morgagni hernia can be discovered in adults as an incidental finding or because of acute gastrointestinal symptoms. We report a case of a 76-year-old man with an incidental diagnosis of seizure attack. Obesity and the increased abdominal pressure caused by abdominal muscles contraction during seizure could have contributed to the clinical presentation. The omentum, small bowel, and transverse colon were found in the right side of the chest using an open transabdominal approach. The hernia sac was excised and the diaphragmatic defect closed by direct suturing. The postoperative period was uneventful and the shortness of breath attributed to obesity disappeared.

  6. Late occurrence of a congenital diaphragmatic hernia complicating pregnancy: A case report

    Directory of Open Access Journals (Sweden)

    Jyoti Singh

    2012-12-01

    Full Text Available Diaphragmatic hernia complicating pregnancy is rare and results in a high fetal and maternal mortality particularly if early surgical intervention is not undertaken. A very high degree of suspicion in needed for diagnosis as the symptoms produced by this hernia are seen in normal pregnancy also. We present here a patient with CDH who became acutely symptomatic for the first time during the pregnancy and was managed successfully. [Int J Reprod Contracept Obstet Gynecol 2012; 1(1.000: 47-49

  7. [Clinical case--voluminous diaphragmatic hernia--surgically acute abdomen: diagnostic and therapeutical challenges].

    Science.gov (United States)

    Dumitrescu, D; Savlovschi, C; Borcan, R; Pantu, H; Serban, D; Gradinaru, S; Smarandache, G; Trotea, T; Branescu, C; Musat, L; Comandasu, M; Priboi, M; Baldir, M; Sandolache, B; Oprescu, S

    2011-01-01

    We present the case of a 58-year old male patient admitted in the surgery section of the University Emergency Hospital of Bucharest and diagnosed with acute abdomen. The minimal clinical-paraclinical investigation (i.e., thorax-pulmonary Xray, biological probes) raises questions as to the differentiated diagnosis and other associated diseases, also suggesting the existence of voluminous diaphragmatic hernia. The CT thorax-abdomen examination confirms the diaphragmatic hernia suspicion, with intra-thorax ascent of the colon up to the anterior C4 level, but does not explain the abdominal suffering; thus we suspected a biliary ileus or acute appendicitis. Medial laparotomy was imperative. Intrasurgically peritonitis was noticed located by gangrenous acute apendicitis, perforated, with coprolite, for which apendictomy and lavage-drainage pf the peritoneal cavity was performed. Post-surgical status: favourable to recovery.

  8. [A case of right pulmonary hypoplasia with congenital diaphragmatic hernia and dextrocardia].

    Science.gov (United States)

    Andou, A; Shimizu, N; Okabe, K; Date, H; Teramoto, S

    1992-10-01

    Chest X-ray of a 28-year-old woman revealed an abnormal shadow in the right lower lung field and dextrocardia, for which detailed investigation was performed. Since the CT number of the tumor shadow corresponded to that of the liver on chest CT, diaphragmatic hernia of the liver was suspected, and was confirmed by MRI and angiography of the abdomen. In addition, the pulmonary artery and vein were hypoplastic, and angiography of the pulmonary artery demonstrated pulmonary hypoplasia. This case was considered to have primary pulmonary hypoplasia, because the dextrocardia was considered to have occurred secondary to pulmonary hypoplasia and the diaphragmatic hernia of the liver was not sufficiently large to cause pulmonary hypoplasia. Pulmonary hypoplasia first diagnosed in adulthood is rare, with a clinical course and roentgenographic appearance differing from those of pulmonary hypoplasia in children.

  9. Management of a Patient With Tetralogy of Fallot, Congenital Diaphragmatic Hernia, and Complete Left Lung Agenesis.

    Science.gov (United States)

    Labovsky, Kristen; Hoffman, George; Scott, John

    2016-07-01

    We describe the rare case of an infant with congenital diaphragmatic hernia, unilateral lung agenesis, and unpalliated single-ventricle physiology. Infants with congenital diaphragmatic hernia and parallel circulation are at risk for maldistribution of systemic and pulmonary blood flow. Optimal perioperative management should include an assessment of the ratio of pulmonary to systemic blood flow (Qp:Qs). Traditionally, arterial and systemic venous oxygen (SvO2) saturations are needed to calculate Qp:Qs. However, in this case, SvO2 measurement was not feasible. On the basis of a previously described relationship, we used 2-site near-infrared spectroscopy to calculate a near-infrared spectroscopy-derived SvO2, which was then used to estimate Qp:Qs and guide goal-directed interventions.

  10. Current concepts on the pathogenesis and etiology of congenital diaphragmatic hernia.

    Science.gov (United States)

    Greer, John J

    2013-11-01

    This review outlines research that has advanced our understanding of the pathogenesis and etiology of congenital diaphragmatic hernia (CDH). The majority of CDH cases involve incomplete formation of the posterolateral portion of the diaphragm, clinically referred to as a Bochdalek hernia. The hole in the diaphragm allows the abdominal viscera to invade the thoracic cavity, thereby impeding normal lung development. As a result, newborns with CDH suffer from a combination of severe pulmonary hypoplasia and pulmonary hypertension. Despite advances in neonatal intensive care, mortality and serious morbidity remain high. Systematic studies using rat and transgenic mouse models in conjunction with analyses of human tissue are providing insights into the embryological origins of the diaphragmatic defect associated with CDH and abnormalities of developmentally regulated signaling cascades.

  11. Repair of umbilical and epigastric hernias.

    Science.gov (United States)

    Earle, David B; McLellan, Jennifer A

    2013-10-01

    Umbilical and epigastric hernias are primary midline defects that are present in up to 50% of the population. In the United States, only about 1% of the population carries this specific diagnosis, and only about 11% of these are repaired. Repair is aimed at symptoms relief or prevention, and the patient's goals and expectations should be explicitly identified and aligned with the health care team. This article details some relevant and interesting anatomic issues, reviews existing data, and highlights some common and important surgical techniques. Emphasis is placed on a patient-centered approach to the repair of umbilical and epigastric hernias.

  12. Open preperitoneal groin hernia repair with mesh

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    A systematic review was conducted and reported according to the PRISMA statement. PubMed, Cochrane library and Embase were searched systematically. Studies were included if they provided clinical data with more than 30 days follow up following repair of an inguinal hernia with an open preperitoneal mesh......Background For the repair of inguinal hernias, several surgical methods have been presented where the purpose is to place a mesh in the preperitoneal plane through an open access. The aim of this systematic review was to describe preperitoneal repairs with emphasis on the technique. Data sources...

  13. 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

  14. Risk of Morbidity, Mortality, and Recurrence After Parastomal Hernia Repair

    DEFF Research Database (Denmark)

    Helgstrand, Frederik; Rosenberg, Jacob; Kehlet, Henrik

    2013-01-01

    Surgical outcome results after repair for parastomal hernia are sparsely reported and based on small-scale studies.......Surgical outcome results after repair for parastomal hernia are sparsely reported and based on small-scale studies....

  15. Outcome of laparoscopic inguinal hernia repair in a South African ...

    African Journals Online (AJOL)

    Outcome of laparoscopic inguinal hernia repair in a South African private practice setting. ... South African Journal of Surgery ... hernia recurrence, chronic pain and technique preference if they had previously undergone an open repair.

  16. 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

  17. [Delayed discovery of congenital diaphragmatic hernia: diagnostic difficulties. A report of two cases].

    Science.gov (United States)

    Coste, C; Jouvencel, P; Debuch, C; Argote, C; Lavrand, F; Feghali, H; Brissaud, O

    2004-08-01

    Delayed revelation of congenital diaphragmatic hernias (CDH) is not uncommon and can represent 5-30% of total CDHs. Time before diagnosis may be prolonged, sometimes to the adult period. Respiratory and gastrointestinal symptoms are frequent but not specific. The clinical presentation of delayed CDH may thus mislead the practitioner. Diagnosis can be approached and/or confirmed by plain radiography. Outcome is usually favorable after surgery. We report two cases of delayed CDH and we discuss the difficulty of diagnosis.

  18. Inguinal hernia repair: anaesthesia, pain and convalescence

    DEFF Research Database (Denmark)

    Callesen, Torben

    2003-01-01

    Elective surgical repair of an inguinal or femoral hernia is one of the most common surgical procedures. The treatment, however, presents several challenges regarding anaesthesia for the procedure, the postoperative analgesic therapy and convalescence, as well as planning of the procedure. Local......, general, and regional anaesthesia are all used for hernia repair, but to different degrees, primarily depending on traditions and whether the institution has specific interest in hernia surgery. Thus, the use of local anaesthesia varies from a few percent in Sweden, 18% in Denmark and up to almost 100......% in specialised institutions, dedicated to hernia surgery. The feasibility of local anaesthesia is high, as judged by the rate of conversion to general anaesthesia (

  19. Concurrent Mesh Repair of a Morgagni and Umbilical Hernia during a Laparoscopic Sleeve Gastrectomy in a Morbidly Obese Individual

    Directory of Open Access Journals (Sweden)

    N.R Kosai

    2016-10-01

    Full Text Available Morgagni Hernia is a rare form of diaphragmatic hernia. It is mainly asymptomatic and often identified incidentally during surgery. Tension-free synthetic mesh repair is the preferred treatment modality. However, the use of synthetic mesh concurrently during a clean-contaminated surgery such as sleeve gastrectomy remains controversial due to the remote possibility of mesh infection. A middle-aged female 2 with BMI of 47 Kg/m was admitted electively for laparoscopic sleeve gastrectomy with concurrent umbilical hernia repair. Intra-operatively, a left Morgagni Hernia containing omentum and a segment of transverse colon was noted. She underwent a laparoscopic sleeve gastrectomy and simultaneous laparoscopic tension-free composite mesh repair of both Morgagni and umbilical hernia. Outpatient review three months later revealed excess weight loss of almost 30% with no recurrence of either hernia. In conclusion, the advantages of concurrent hernia repair during bariatric surgery outweigh the risk of mesh infection and should be performed to prevent future risk of visceral herniation and strangulation. Laparoscopic mesh repair of a Morgagni Hernia and umbilical hernia in the setting of an electively planned sleeve gastrectomy is feasible, effective and safe in the hands of a trained laparoscopic surgeon.

  20. Total Extraperitoneal Preperitoneal Laparoscopic Hernia Repair Using Spinal Anesthesia

    OpenAIRE

    Molinelli, Bruce M.; Tagliavia, Alfonso; Bernstein, David

    2006-01-01

    Background: Laparoscopic herniorrhaphy is a well-debated approach to inguinal hernia repair. Multiple technical and outcome variables have been compared with those of traditional open inguinal hernia repairs. One of these variables is the choice of anesthesia. To date, no reports describe the use of spinal anesthesia for laparoscopic hernia repairs. We present herein a review of our experience with spinal anesthesia for the total extraperitoneal preperitoneal laparoscopic hernia repair (TEP)....

  1. Total Extraperitoneal Preperitoneal Laparoscopic Hernia Repair Using Spinal Anesthesia

    OpenAIRE

    2006-01-01

    Background: Laparoscopic herniorrhaphy is a well-debated approach to inguinal hernia repair. Multiple technical and outcome variables have been compared with those of traditional open inguinal hernia repairs. One of these variables is the choice of anesthesia. To date, no reports describe the use of spinal anesthesia for laparoscopic hernia repairs. We present herein a review of our experience with spinal anesthesia for the total extraperitoneal preperitoneal laparoscopic hernia repair (TEP)....

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

    Science.gov (United States)

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

    2011-04-21

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

  3. Predictors of prognosis in neonates with congenital diaphragmatic hernia: experience of 12 years

    Directory of Open Access Journals (Sweden)

    Catarina Granjo Morais

    2017-01-01

    Full Text Available Introduction: Congenital diaphragmatic hernia (CDH is a severe malformation, displaying relevant mortality and morbidity rates in newborns.Aim: To characterize clinically and demographically all neonatal cases of CDH admitted to a level III Neonatal Intensive Care Unit during a 12-year period and to evaluate the predictive value of baseline characteristics on mortality and morbidity at discharge.Methods: Maternal/infant clinical and electronic records were ret-rospectively reviewed. All neonates with posterolateral CDH admitted between January 2003 and December 2014 were included.Results: Fifty-three newborns were included. Overall mortality during hospitalization was 22/53 (41.5%. Clinical characteristics associated with mortality were the presence of intrathoracic liver (p = 0.005, intrathoracic stomach (p = 0.015, elevated arterial pCO2 or lower pH values at admission (respectively, p = 0.001 and p < 0.001, pre-ductal oxygen saturation < 85% at admission (p = 0.012 and surgical repair with prosthetic patch (p = 0.041. Morbidity at discharge was reported in 7 (22.6% survivors. Stomach herniation and sepsis were associated with higher morbidity (respectively, p = 0.012 and p = 0.029. In a logistic regression, patch repair was the only variable with predictive value for death during hospitalization, with an odds ratio (OR of 15 (95% CI 0.98-228.9, and intrathoracic stomach was a predictor of morbidity at discharge (OR = 15.7, 95% CI 1.4-174.2.Conclusion: Structural characteristics, namely defect size and presence of intrathoracic stomach, remain the primary determinants of neonatal prognosis in CDH. Although post-natal approaches have progressively proven their value in increasing survival and improving management of high-risk cases, future researches should continue focusing on the definition of foetal anatomical markers of severity and prenatal treatment of CDH.

  4. Correction of congenital diaphragmatic hernia in utero VIII: Response of the hypoplastic lung to tracheal occlusion.

    Science.gov (United States)

    Harrison, M R; Adzick, N S; Flake, A W; VanderWall, K J; Bealer, J F; Howell, L J; Farrell, J A; Filly, R A; Rosen, M A; Sola, A; Goldberg, J D

    1996-10-01

    Most fetuses with congenital diaphragmatic hernia (CDH) diagnosed before 24 weeks' gestation die despite optimal postnatal care. In fetuses with liver herniation into the chest, prenatal repair has not been successful. In the course of exploring the pathophysiology of CDH and its repair in fetal lambs, the authors found that obstructing the normal egress of fetal lung fluid enlarges developing fetal lungs, reduces the herniated viscera, and accelerates lung growth, resulting in improved pulmonary function after birth. They developed and tested experimentally a variety of methods to temporarily occlude the fetal trachea, allow fetal lung growth, and reverse the obstruction at birth. The authors applied this strategy of temporary tracheal occlusion in eight human fetuses with CDH and liver herniation at 25 to 28 weeks' gestation. With ongoing experimental and clinical experience, the technique of tracheal occlusion evolved from an internal plug (two patients) to an external clip (six patients), and a technique was developed for unplugging the trachea at the time of birth (Ex Utero Intrapartum Tracheoplasty [EXIT]). Two fetuses had a foam plug placed inside the trachea. The first showed dramatic lung growth in utero and survived; the second (who had a smaller plug to avoid tracheomalacia) showed no demonstrable lung growth and died at birth. Two fetuses had external spring-loaded aneurysm clips placed on the trachea; one was aborted due to tocolytic failure, and the other showed no lung growth (presumed leak) and died 3 months after birth. Four fetuses had metal clips placed on the trachea. All showed dramatic lung growth in utero, with reversal of pulmonary hypoplasia documented after birth. However, all died of nonpulmonary causes. Temporary occlusion of the fetal trachea accelerates fetal lung growth and ameliorates the often fatal pulmonary hypoplasia associated with severe CDH. Although the strategy is physiologically sound and technically feasible, complications

  5. Pericardial Window Formation Complicated by Intrapericardial Diaphragmatic Hernia

    Directory of Open Access Journals (Sweden)

    Jeremy Docekal

    2014-01-01

    Full Text Available In rare circumstances, a diaphragmatic defect may allow for herniation of intra-abdominal contents into the pericardial space. These occurrences are exceedingly rare and may be due to trauma or congenital defects of the septum transversum or as the result of surgical procedures. We describe a 73-year-old female who presented with cardiac and abdominal symptoms one month after undergoing a subxiphoid pericardioperitoneal window for treatment and evaluation of a symptomatic pericardial effusion.

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

    Science.gov (United States)

    Marulasiddappa, Vinay

    2015-01-01

    Morgagni’s hernia is a type of congenital diaphragmatic hernia and it is rare in children. The association between Down’s syndrome and Morgagni’s hernia in children is also rare. Laparoscopic repair is a preferred surgical approach than open surgical procedures as laparoscopy offers a bilateral view of Morgagni’s hernia, minimal tissue damage and a faster recovery. When children with Down’s syndrome and associated Morgagni’s hernia present for laparoscopic repair, they pose several complex challenges to the anaesthetist due to the involvement of multiple organ systems, difficulties in airway management and effects of laparoscopic surgery on the organ systems. Therefore, such children need a very careful anaesthetic plan, including a thorough preoperative assessment and preparation for a successful perioperative outcome. PMID:26155537

  7. Enhanced recovery after giant ventral hernia repair

    DEFF Research Database (Denmark)

    Jensen, K K; Brøndum, T L; Harling, H.

    2016-01-01

    PURPOSE: Giant ventral hernia repair is associated with a high risk of postoperative morbidity and prolonged length of stay (LOS). Enhanced recovery (ERAS) measures have proved to lead to decreased morbidity and LOS after various surgical procedures, but never after giant hernia repair. The current....... Pain, nausea and fatigue were registered prospectively in all patients treated according to ERAS, as well as continuous measurement of transcutaneous capillary oxygen saturation. Postoperative morbidity and LOS were compared between patients treated according to ERAS and a historic group treated...

  8. Tension free femoral hernia repair with plug

    Institute of Scientific and Technical Information of China (English)

    Milivoje Vukovi; Neboja Moljevi; Sinia Crnogorac

    2013-01-01

    Objective: To investigate the conventional technique involves treatment of femoral hernia an approximation inguinal ligament to pectineal ligament. In technique which uses mesh closure for femoral canal without tissue tension. Method: A prospective study from January 01. 2007-May 30. 2009. We analyzed 1 042 patients with inguinal hernia, of which there were 83 patients with 86 femoral hernia. Result: Femoral hernias were present in 7.96% of cases. Males were 13 (15.66%) and 70 women (84.34%). The gender distribution of men: women is 1:5.38. Urgent underwent 69 (83%), and the 14 election (17%) patients. Average age was 63 years, the youngest patient was a 24 and the oldest 86 years. Ratio of right: left hernias was 3.4:1. With bilateral femoral hernias was 3.61% of cases. In 7 patients (8.43%) underwent femoral hernia repair with 9 Prolene plug. Conclusions: The technique of closing the femoral canal with plug a simple. The plug is made from monofilament material and is easily formed. This technique allows the reduction of recurrence and can be used safely, quickly and easily in elective and emergency situations.

  9. Lumbar hernia repaired using a new technique.

    Science.gov (United States)

    Di Carlo, Isidoro; Toro, Adriana; Sparatore, Francesca; Corsale, Giuseppe

    2007-01-01

    Lumbar hernia is uncommon and occurs in Grynfeltt's triangle on the left side, more frequently in men than in women. Acquired lumbar hernias are the result of iliac crest bone harvest or blunt trauma and seat belt injuries in road accidents. Many surgical options have been reported for repairing this hernia through primary closure of the defect or through use of aponeurotic or prosthetic materials. The Dowd technique is the technique most often used. The authors describe a patient with posttraumatic inferior triangle lumbar hernia who underwent laparoscopy and, 10 days later, laparotomy. Both procedures failed. Finally, a novel lumbotomic surgical approach was used, involving the Dowd technique and prosthetic mesh. The patient was free of recurrence 3 months after the procedure.

  10. Radiologic investigation after laparoscopic inguinal hernia repair

    Energy Technology Data Exchange (ETDEWEB)

    Larmark, Martin; Ekberg, Olle [Department of Diagnostic Radiology, Malmoe University Hospital, 205 02, Malmoe (Sweden); Montgomery, Agneta [Department of Surgery, Malmoe University Hospital, 205 02, Malmoe (Sweden)

    2003-12-01

    Laparoscopic instead of open surgical repair of inguinal hernias is becoming more frequent. Radiologists may expect different postoperative findings depending on the technique used. We studied how radiology had been used postoperatively and what findings were encountered after laparoscopic herniorraphy. Postoperative radiologic examinations related to hernia repair of all consecutive patients that had had laparoscopic herniorraphy in Malmoe University hospital between 1992 and 1998 were retrospectively evaluated. A total of 538 groins were included, 3.9% (n=21) of these were postoperatively examined with ultrasound (n=10), herniography (n=7), plain abdominal films (n=2), CT (n=1), or fistulography (n=1). Significant findings were found in five groins, namely, one sinus tract, two hematomas, one small bowel obstruction, and one recurrence of hernia. Four insignificant seromas were found. The characteristics of the findings and pitfalls are described. Symptoms resulting in radiologic examination are rare after laparoscopic herniorraphy. The radiologist must be familiar with the spectrum of such findings. (orig.)

  11. The Onstep Method for Inguinal Hernia Repair

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Andresen, Kristoffer

    2016-01-01

    Inguinal hernia repair is one of the most common surgical procedures and several different surgical techniques are available. The Onstep method is a new promising technique. The technique is simple with a number of straightforward steps. This paper provides a full description of the technique...

  12. The use of biological meshes in diaphragmatic defects – An evidence-based review of the literature

    Directory of Open Access Journals (Sweden)

    Stavros Athanasios Antoniou

    2015-10-01

    Full Text Available The widespread use of meshes for hiatal hernia repair has emerged in the era of laparoscopic surgery, although sporadic cases of mesh augmentation of traumatic diaphragmatic rupture have been reported. The indications for biologic meshes in diaphragmatic repair are ill defined. This systematic review aims to investigate the available evidence on the role of biologic meshes in diaphragmatic rupture and hiatal hernia repair. Limited data from sporadic case reports and case series have demonstrated that repair of traumatic diaphragmatic rupture with biologic mesh is safe technique in both the acute or chronic setting. High level evidence demonstrates short-term benefits of biologic mesh augmentation in hiatal hernia repair over primary repair, although adequate long-term data are not currently available. Long-term follow-up data suggest no benefit of hiatal hernia repair using porcine small intestine submucosa over suture repair. The effectiveness of different biologic mesh materials on hernia recurrence requires further investigation.

  13. A novel EFNB1 mutation (c.712delG) in a family with craniofrontonasal syndrome and diaphragmatic hernia.

    Science.gov (United States)

    Hogue, Jacob; Shankar, Suma; Perry, Hazel; Patel, Reena; Vargervik, Karin; Slavotinek, Anne

    2010-10-01

    We report on the occurrence of congenital diaphragmatic hernia in a family with craniofrontonasal syndrome found to have a previously unreported mutation in EFNB1. The female proband presented with hypertelorism, telecanthus, bifid nasal tip, widow's peak, frontal bossing, and a widened metopic suture. Her father was noted to have hypertelorism, telecanthus, widow's peak, and a history of pectus carinatum. He was found to have a previously unreported mutation in exon 5 of EFNB1 predicted to cause premature protein truncation. The parents of the proband previously had a female fetus with congenital diaphragmatic hernia. The occurrence of congenital diaphragmatic hernia, phenotypic differences between males and females, and utility of molecular testing in craniofrontonasal syndrome are demonstrated.

  14. Laparoscopic lumbar hernia repair in a child with lumbocostovertebral syndrome.

    Science.gov (United States)

    Jones, Sarah L; Thomas, Iona; Hamill, James

    2010-02-01

    Lumbocostovertebral syndrome is the association of a congenital lumbar hernia with rib and vertebral anomalies. We report the first case of a laparoscopic repair of a lumbar hernia in a child with lumbocostovertebral syndrome. Laparoscopic lumbar hernia repair appears to be safe and feasible in children.

  15. Time-Trend Analysis of Pulmonary and Diaphragmatic Functionality in Patients with Diaphragmatic Palsy or with Chronic Diaphragmatic Hernia after Surgical Treatment.

    Science.gov (United States)

    Rapicetta, Cristian; Voltolini, Luca; Lococo, Filippo; Vecchioni, Ilaria; Tenconi, Sara; Paci, Masimiliano; Ricchetti, Tommaso; Rossi, Marcello; Gotti, Giuseppe

    2016-12-01

    Background The aim of this study was to assess long-term pulmonary and diaphragmatic function in two cohorts of patients: the first one affected by diaphragmatic palsy (DP) who underwent plication reinforced by rib-fixed mesh and the second one affected by chronic diaphragmatic hernia (TDH) who underwent surgical reduction and direct suture. Materials and Methods From 1996 to 2011, 10 patients with unilateral DP and 6 patients with TDH underwent elective surgery. Preoperative and long-term (12 months) follow-up assessments were completed in all patients, including pulmonary function tests (PFTs) with diffusion of the lung for carbon monoxide (DLCO), measure of maximum inspiratory pressure (MIP) assessed both in standing and in supine positions, blood gas analysis, chest computed tomographic (CT) scan, and dyspnea score. The Pearson chi-square test, Fisher exact test, and Student t-test were applied when indicated. Results At long-term (12 months) postoperative follow-up, patients operated for DP showed a significant improvement in terms of forced expiratory volume in 1 second (FEV1%) (+ 18.2%, p TDH group, only the levels of Po 2 were found to be significantly higher in the postoperative assessment (+ 8.3 mm Hg, p = 0.04). Although MIP increased in both the groups after surgery, a persistent and significant decrease of MIP was detected in TDH group when comparing the levels assessed in supine position with those measured in the standing position (p TDH group by a factor of 0.33 (p = 0.175). Conclusion In patients who underwent surgery for DP, good long-term results may be predicted in terms of pulmonary flows, volumes, and DLCO. Conversely, in patients who underwent elective surgery for chronic TDH, a persistent overall restrictive pattern, lower MIP values in supine position, and paradoxical motion could be expected.

  16. Developments in inguinal hernia repair

    NARCIS (Netherlands)

    Voorbrood, C.E.H.

    2016-01-01

    Performing inguinal hernia surgery in a high volume clinic allows for gaining expertise and achieving considerable experience and knowledge. This results in the recognition of benefits of tailored treatment, selection of patients, and structured aftercare rendering improvement of patients' outcome a

  17. Developments in inguinal hernia repair

    NARCIS (Netherlands)

    Voorbrood, C E H

    2016-01-01

    Performing inguinal hernia surgery in a high volume clinic allows for gaining expertise and achieving considerable experience and knowledge. This results in the recognition of benefits of tailored treatment, selection of patients, and structured aftercare rendering improvement of patients´ outcome a

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

    Science.gov (United States)

    Callesen, Torben

    2003-08-01

    Elective surgical repair of an inguinal or femoral hernia is one of the most common surgical procedures. The treatment, however, presents several challenges regarding anaesthesia for the procedure, the postoperative analgesic therapy and convalescence, as well as planning of the procedure. Local, general, and regional anaesthesia are all used for hernia repair, but to different degrees, primarily depending on traditions and whether the institution has specific interest in hernia surgery. Thus, the use of local anaesthesia varies from a few percent in Sweden, 18% in Denmark and up to almost 100% in specialised institutions, dedicated to hernia surgery. The feasibility of local anaesthesia is high, as judged by the rate of conversion to general anaesthesia (thirds have moderate or severe pain during activity, while one third still have moderate or severe pain after one week, and approximately 10% after 4 weeks. Pain after laparoscopic surgery is less pronounced than after open surgery, while different open repair techniques do not exhibit significant differences. Postoperative pain is best treated with a combination of local analgesia and peripherally acting agents (paracetamol, NSAID or their combination), while opioids should be avoided due to side effects, primarily nausea and sedation. Moderate or severe pain one year postoperatively is seen in 5-12% of patients. There seem to be no difference between different surgical or anaesthetic techniques, but the following factors have been related to a higher rate of chronic pain: previous or subsequent hernia surgery on the same side, young age, pain before surgery, high pain scores in the immediate postoperative period, and postoperative complications and prolonged convalescence. Patients should be informed about the risk of chronic pain, particularly if the hernia is asymptomatic. The duration of convalescence after hernia repair varies considerably, primarily due to variation in recommendations. No documentation is

  19. Recessive and dominant mutations in retinoic acid receptor beta in cases with microphthalmia and diaphragmatic hernia.

    Science.gov (United States)

    Srour, Myriam; Chitayat, David; Caron, Véronique; Chassaing, Nicolas; Bitoun, Pierre; Patry, Lysanne; Cordier, Marie-Pierre; Capo-Chichi, José-Mario; Francannet, Christine; Calvas, Patrick; Ragge, Nicola; Dobrzeniecka, Sylvia; Hamdan, Fadi F; Rouleau, Guy A; Tremblay, André; Michaud, Jacques L

    2013-10-01

    Anophthalmia and/or microphthalmia, pulmonary hypoplasia, diaphragmatic hernia, and cardiac defects are the main features of PDAC syndrome. Recessive mutations in STRA6, encoding a membrane receptor for the retinol-binding protein, have been identified in some cases with PDAC syndrome, although many cases have remained unexplained. Using whole-exome sequencing, we found that two PDAC-syndrome-affected siblings, but not their unaffected sibling, were compound heterozygous for nonsense (c.355C>T [p.Arg119(∗)]) and frameshift (c.1201_1202insCT [p.Ile403Serfs(∗)15]) mutations in retinoic acid receptor beta (RARB). Transfection studies showed that p.Arg119(∗) and p.Ile403Serfs(∗)15 altered RARB had no transcriptional activity in response to ligands, confirming that the mutations induced a loss of function. We then sequenced RARB in 15 subjects with anophthalmia and/or microphthalmia and at least one other feature of PDAC syndrome. Surprisingly, three unrelated subjects with microphthalmia and diaphragmatic hernia showed de novo missense mutations affecting the same codon; two of the subjects had the c.1159C>T (Arg387Cys) mutation, whereas the other one carried the c.1159C>A (p.Arg387Ser) mutation. We found that compared to the wild-type receptor, p.Arg387Ser and p.Arg387Cys altered RARB induced a 2- to 3-fold increase in transcriptional activity in response to retinoic acid ligands, suggesting a gain-of-function mechanism. Our study thus suggests that both recessive and dominant mutations in RARB cause anophthalmia and/or microphthalmia and diaphragmatic hernia, providing further evidence of the crucial role of the retinoic acid pathway during eye development and organogenesis.

  20. Cardiac dysfunction in congenital diaphragmatic hernia: Pathophysiology, clinical assessment, and management.

    Science.gov (United States)

    Patel, Neil; Kipfmueller, Florian

    2017-06-01

    Cardiac dysfunction is an important consequence of pulmonary hypertension in congenital diaphragmatic hernia and a determinant of disease severity. Increased afterload leads to right ventricular dilatation and diastolic dysfunction. Septal displacement and dysfunction impair left ventricular function, which may also be compromised by fetal hypoplasia. Biventricular failure contributes to systemic hypotension and hypoperfusion. Early and regular echocardiographic assessment of cardiac function and pulmonary artery pressure can guide therapeutic decision-making, including choice and timing of pulmonary vasodilators, cardiotropes, ECMO, and surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Late presentation of congenital diaphragmatic hernia in patients with cystic fibrosis.

    Science.gov (United States)

    Goetz, Danielle M; Burns, Cartland; Segura, Bradley J; Weiner, Daniel J

    2010-04-01

    Late presentation of congenital diaphragmatic hernia (CDH) is unusual, especially in patients with cystic fibrosis (CF). To our knowledge, cases of CDH in CF patients and the combined effects on lung function have not been previously described. Here we report two cases of late presenting CDH in CF patients and describe effects on lung function. Late presentation of CDH in CF patients can cause gastrointestinal or respiratory symptoms and requires a high index of suspicion as well as proper interpretation of imaging. In patients with CF and CDH, lung function abnormalities could include obstructive, restrictive defects, or combined defects.

  2. Neonatal diabetes mellitus and congenital diaphragmatic hernia: coincidence or concurrent etiology?

    Directory of Open Access Journals (Sweden)

    Topiol Emmanuelle S

    2012-07-01

    Full Text Available Abstract Neonatal diabetes mellitus (NDM is a rare metabolic disorder, affecting approximately 1 in 500,000 live births. The management of NDM is challenging, as the benefits of controlling hyperglycemia must be balanced with the risks of iatrogenic hypoglycemia. NDM occurs in both permanent and transient forms, which have been genetically and phenotypically well characterized. Herein, we present the previously unreported combination of transient NDM (TNDM and congenital diaphragmatic hernia (CDH. In addition to reviewing the management and genetics of NDM we discuss the potential for overlapping genetic or embryologic abnormalities to explain the concurrence of CDH and NDM.

  3. Congenital diaphragmatic hernia is part of the new 15q24 microdeletion syndrome.

    Science.gov (United States)

    Van Esch, Hilde; Backx, Liesbeth; Pijkels, Elly; Fryns, Jean-Pierre

    2009-01-01

    The recurrent microdeletion 15q24 syndrome is rare with only 5 cases reported thus far. Here we describe an additional patient with this deletion, presenting with many features common to this syndrome, including developmental delay, loose connective tissue, digital and genital anomalies and a distinct facial gestalt. Interestingly, in addition, this patient has a large congenital diaphragmatic hernia, as was described in one other patient with a 15q24 microdeletion, indicating that this feature might be part of the syndrome. Chromosome 15q24 has a highly polymorphic architecture that is prone to genomic rearrangements underlying this novel microdeletion syndrome.

  4. Congenital diaphragmatic hernia, Meckel′s diverticulum and malrotation in a 3-month-old infant

    Directory of Open Access Journals (Sweden)

    Laxman Basani

    2016-01-01

    Full Text Available Congenital diaphragmatic hernia (CDH is a common developmental anomaly that usually presents in the neonatal period. It is known to be associated with cardiac, renal, genital and chromosomal anomalies. Late presentation of CDH (beyond 1-month of age is seen in 13% of the cases. Malrotation is reported in 42% of CDH cases. We report a case of a 3-month-old infant with concurrent CDH, Meckel′s diverticulum and malrotation. This is the first case report of such an association in an infant.

  5. Combination of congenital cleft lip and palate with congenital diaphragmatic hernia: a severe disease course

    Institute of Scientific and Technical Information of China (English)

    LI Yang; XIONG Wan-lin; SHI Bing

    2006-01-01

    @@ Congenital cleft lip and palate (CLP) is the most common birth defect now in China. The incidence is 1.62‰ according to the data (1988-1992) provided by the National Center for Birth Defects Monitoring.1 It is also one of the congenital anomalies that have excellent prognosis. But severe complications may occur in the cases accompanied some other deformities. Here we report a case of death caused by left-sided posterolateral congenital diaphragmatic hernia (CDH), type Bochdalek, after the cleft operation.

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

    Science.gov (United States)

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

    2015-03-01

    Totally extra-peritoneal (TEP) inguinal hernia repair allows identification and repair of incidental non-inguinal groin hernias. We assessed the prevalence of incidental hernias during TEP inguinal hernia repair and identified the risk factors for incidental hernias. Consecutive patients undergoing TEP repair from May 2005 to November 2012 were the study cohort. Inspection for ipsilateral femoral, obturator and rarer varieties of hernia was undertaken during TEP repair. Patient characteristics and operative findings were recorded on a prospectively collected database. A total of 1,532 TEP repairs were undertaken in 1,196 patients. Ninety-three patients were excluded due to incomplete data, leaving 1,103 patients and 1,404 hernias for analyses (1,380 male; 802 unilateral and 301 bilateral repairs; median age, 59 years). Among the 37 incidental hernias identified (2.6% of cases), the most common type of incidental hernia was femoral (n=32, 2.3%) followed by obturator (n=2, 0.1%). Increasing age was associated with an increased risk of incidental hernia, with a significant linear trend (p60 years of age was 4.0% vs 1.4% for those aged hernias were found in 29.2% of females vs 2.2% of males, (phernia in those with a recurrent inguinal hernia was 3.0% vs 2.6% for primary repair (p=0.79). Incidental hernias during TEP inguinal hernia repair were found in 2.6% of cases and, though infrequent, could cause complications if left untreated. The risk of incidental hernia increased with age and was significantly higher in patients aged >60 years and in females.

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

    Science.gov (United States)

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

    2011-08-01

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

  8. Outcomes After Emergency Versus Elective Ventral Hernia Repair

    DEFF Research Database (Denmark)

    Helgstrand, Frederik; Rosenberg, Jacob; Kehlet, Henrik;

    2013-01-01

    BACKGROUND: Early surgical results after emergency repairs for the most frequent ventral hernias (epigastric, umbilical, and incisional) are not well described. Thus, the aim of present study was to investigate early results and risk factors for poor 30-day outcome after emergency versus elective...... repair for ventral hernias. METHODS: All patients undergoing epigastric, umbilical, or incisional hernia repair registered in the Danish Hernia Database during the period 1 January 2007 to 31 December 2010 were included in the prospective study. Follow-up was obtained through administrative data from...... significantly more patients with concomitant bowel resection after emergency repairs than after elective repairs (p 2-7 cm, and repair for a primary hernia (vs recurrent hernia) (all p ...

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

    Saggar, V R; Sarangi, R

    2007-02-01

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

  11. Endoscopic totally extraperitoneal repair of bilateral inguinal hernias

    NARCIS (Netherlands)

    M.T.T. Knock (M. T T); W.F. Weidema (Wibo); L.P. Stassen (Laurents); R.U. Boelhouwer (Roelof Ubbo); C.J. van Steensel (C.)

    1999-01-01

    textabstractBackground: Recurrence rates associated with bilateral inguinal hernia repair with a giant prosthesis (Stoppa procedure) are low. Endoscopic totally extraperitoneal bilateral inguinal hernia repair with a giant prosthesis combines the low recurrence rate of the Stoppa repair and the adva

  12. Scarless laparoscopic repair of epigastric hernia in children

    OpenAIRE

    2015-01-01

    Background Despite the small size of the incision, the scar left by open repair of epigastric hernia in children is unaesthetic. Few laparoscopic approaches to epigastric hernia repair have been previously proposed, but none has gain wide acceptance from pediatric surgeons. In this study, we present our experience with a scarless laparo- scopic approach using a percutaneous suturing technique for epigastric hernia repair in children. Methods Ten consecutive patients presenting with ep...

  13. Laparoscopic repair of Morgagni hernia in an adult: use of a porcine small intestine submucosa biocompatible prosthesis.

    Science.gov (United States)

    Puglisi, Francesco; Capuano, Palma; Iambrenghi, Onofrio Caputi; Armenise, Nicola; Carlucci, Francesco; Memeo, Maurizio; Memeo, Riccardo; Martines, Gennaro

    2009-01-01

    Morgagni hernia is a rare cause of diaphragmatic hernia. There are few reports of laparoscopic repair in the literature. Tension-free hernia closure with synthetic mesh reduces recurrence but occasionally results in complications, such as visceral stricture, erosion or perforation. We report a case of successful laparoscopic repair of a very large symptomatic Morgagni hernia in a 78-year-old patient, treated by positioning a gradually resorbable mesh made from porcine SIS (Surgisis Soft Tissue Graft device--Cook Inc, Bloomington, Ind). After surgery, the patient reported an immediate, marked improvement in clinical symptoms. During the postoperative course, pleural and pericardial leakage occurred. The pleural leakage was immediately drained with thoracentesis, and the pericardial leakage was treated conservatively. No other complications occurred after patient discharge. One year later, the patient was in very good general condition. No recurrence was documented with abdominal CT scan, which also demonstrated connective tissue proliferation that was progressively replacing the prosthesis. Laparoscopic repair is a safe, efficacious procedure for the treatment of diaphragmatic hernia, and presents all the advantages of minimally invasive surgery. The use of new types of material featuring marked biocompatibility and gradual reabsorbability characteristics offers considerable benefits.

  14. Congenital massive hiatus hernia type IV; initial experience with laparoscopic repair in young infant.

    Science.gov (United States)

    Bataineh, Z A; Rousan, L A; Abu Baker, A; Wahdow, H; Kiwan, R N; Saleem, M M

    2014-06-01

    Congenital massive hiatus hernia (CMHH) is an uncommon disorder during childhood. It can be associated with grave complications especially if presented in the highest grade; type IV, when the hernia contains other intra-peritoneal organ beside the stomach through a large hiatus defect. The insidious form of clinical presentation can be deceptive in diagnosis and may mimic congenital diaphragmatic hernia or other chest pathologies. The basic principle of surgical repair is to reduce the herniated organs, excise the hernia sac, and repair the crural defect and to add anti-reflux procedure with or without gastropexy. Traditionally, this has been done by open approach. Nowadays, the minimally invasive approach is the preferred method of treatment. A sixteen-month-old boy with history of recurrent respiratory symptoms was diagnosed with CMHH type IV for which laparoscopic repair was performed. Few reports in using minimally invasive technique in the management of CMHH in the pediatric age group are present in the literature, to the best of our knowledge type IV had never been described in young infants. We present a new case repaired by laparoscope in a young infant with CMHH type IV from the Middle East.

  15. Left posterolateral strangulated congenital diaphragmatic hernia in children: About a case at the Charles de Gaulle Paediatric Teaching Hospital in Ouagadougou (Burkina Faso).

    Science.gov (United States)

    Bandré, Emile; Wandaogo, Albert; Ouedraogo, Isso; Napon, Madina; Béré, Bernadette; Kabré, Yvette; Lamita Tapsoba, Toussaint Wend; Ouédraogo, Francis Somkieta

    2015-01-01

    Late presentation of congenital diaphragmatic hernia is uncommon. It poses considerable diagnostic challenges when it strangulates. The authors report a case of a left posterolateral strangulated congenital diaphragmatic hernia in a 5-year-old child diagnosed at the stage of acute intestinal occlusion with intestinal necrosis and managed successfully. A strangulated congenital diaphragmatic hernia should be suspected in the case of an association of sudden-onset respiratory and digestive manifestations with no sign of trauma or specific pulmonary history. It then requires an antero posterior thoracic X-ray or, even better, a thoracic-abdominal scan to confirm the diagnosis.

  16. Left posterolateral strangulated congenital diaphragmatic hernia in children: About a case at the Charles de Gaulle Paediatric Teaching Hospital in Ouagadougou (Burkina Faso

    Directory of Open Access Journals (Sweden)

    Emile Bandré

    2015-01-01

    Full Text Available Late presentation of congenital diaphragmatic hernia is uncommon. It poses considerable diagnostic challenges when it strangulates. The authors report a case of a left posterolateral strangulated congenital diaphragmatic hernia in a 5-year-old child diagnosed at the stage of acute intestinal occlusion with intestinal necrosis and managed successfully. A strangulated congenital diaphragmatic hernia should be suspected in the case of an association of sudden-onset respiratory and digestive manifestations with no sign of trauma or specific pulmonary history. It then requires an antero posterior thoracic X-ray or, even better, a thoracic-abdominal scan to confirm the diagnosis.

  17. Congenital diaphragmatic hernia with concurrent aplasia of the pericardium in a foal.

    Science.gov (United States)

    Tăbăran, Alexandru-Flaviu; Nagy, Andras Laszlo; Cătoi, Cornel; Morar, Iancu; Tăbăran, Alexandra; Mihaiu, Marian; Bolfa, Pompei

    2015-12-30

    In veterinary medicine congenital abnormalities of the diaphragm and pericardium are rare, idiopathic malformations, being reported mainly in dogs. This report documents an unusual case of developmental defects in a foal consisting of diaphragmatic hernia concurrent with pericardial aplasia. Following a normal delivery, a full term, female Friesian stillborn foal with the placenta was presented for necropsy. External morphological examination indicated a normally developed foal. At necropsy, a large oval defect (approximately 20 × 15 cm in size) was observed in the left-dorsal side of the diaphragm (left lumbocostal triangle). This defect allowed the intestinal loops, spleen and partially the liver to translocate into the thorax. The loops of the left ascending colon, including the pelvic flexure and partially the small intestine covered the cranial and dorsal posterior parts of the heart due to the complete absence of the left pericardium. The remaining pericardium presented as a white, semi-transparent strip, partially covering the right side of the heart. The left lung and the main bronchus were severely hypoplastic to approximately one-fifth the size of their right homologue. The intermediate part of the liver, containing mainly the enlarged quadrate lobe was translocated in the thorax, severely enlarged and showed marked fibrosis. Histologically in the herniated lobes we diagnosed hepatic chronic passive congestion, telangiectasia and medial hypertrophy of blood vessels. Concomitant malformation involving diaphragmatic hernia and pericardial aplasia in horses have not been previously reported. Moreover, this is the first case describing pericardial aplasia in horse.

  18. Chronic Pain after Inguinal Hernia Repair

    OpenAIRE

    2014-01-01

    Background. Chronic postherniorrhaphy groin pain is defined as pain lasting >6 months after surgery, which is one of the most important complications occurring after inguinal hernia repair, which occurs with greater frequency than previously thought. Material and Methods. Patients undergoing elective inguinal hernioplasty in Victoria Hospital from November 2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for followup at end of ...

  19. Congenital diaphragmatic hernia interval on chromosome 8p23.1 characterized by genetics and protein interaction networks

    DEFF Research Database (Denmark)

    Longoni, Mauro; Hansen, Kasper Lage; Russell, Meaghan K.

    2012-01-01

    Chromosome 8p23.1 is a common hotspot associated with major congenital malformations, including congenital diaphragmatic hernia (CDH) and cardiac defects. We present findings from high‐resolution arrays in patients who carry a loss (n = 18) or a gain (n = 1) of sub‐band 8p23.1. We confirm a regio...

  20. Short term and long term health related quality of life after congenital anorectal malformations and congenital diaphragmatic hernia

    NARCIS (Netherlands)

    M.J. Poley (Marten); E.A. Stolk (Elly); D. Tibboel (Dick); J.C. Molenaar; J.J. van Busschbach (Jan)

    2004-01-01

    textabstractAIMS: To examine short term and long term health related quality of life (HRQoL) of survivors of congenital anorectal malformations (ARM) and congenital diaphragmatic hernia (CDH), and to compare these patients' HRQoL with that of the general population. METHODS: HRQoL

  1. Congenital diaphragmatic hernia in Smith-Magenis syndrome: a possible locus at chromosome 17p11.2.

    Science.gov (United States)

    Sanford, E F; Bermudez-Wagner, K; Jeng, L J B; Rauen, K A; Slavotinek, Anne M

    2011-11-01

    We report on a 7-month-old girl with Smith-Magenis syndrome (SMS) due to a 4.76-Mb deletion of 17p12-17p11.2 detected by array comparative genomic hybridization. She was also affected with a left-sided congenital diaphragmatic hernia (CDH) and cardiac anomalies including an atypical atrioventricular canal defect and a cleft mitral valve. To our knowledge, this is the first reported case of a patient with both SMS and CDH. There are numerous chromosomal regions in which duplications, deletions, inversions, or translocations have been associated with CDH, but none have previously been reported at or close to 17p11.2. We discuss candidate genes for the diaphragmatic defect in this patient. Our case demonstrates that it is important to consider the possibility of SMS in non-isolated cases of diaphragmatic hernia.

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

    Science.gov (United States)

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

    2013-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Saud Al-Subaie

    2015-01-01

    Conclusion: We were able to obtain an accurate diagnosis of an appendix within a long-standing irreducible femoral hernia through diagnostic laparoscopy followed by transabdominal preperitoneal (TAPP approach for hernia repair. We would like to underline the usefulness of laparoscopy as a valuable tool in the diagnosis and treatment of this unusual presentation of groin hernias.

  4. Single-Incision Laparoscopic Repair of Spigelian Hernia

    Science.gov (United States)

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

    2015-01-01

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

  5. Laparoscopic repair of a Morgagni hernia

    Directory of Open Access Journals (Sweden)

    Sherigar J

    2005-01-01

    Full Text Available We report a case of laparoscopic repair of symptomatic Morgagni hernia (MH in an adult. A tension-free closure of the defect was carried out using a polypropylene mesh. The recovery was quick and uneventful. Two years after surgery, the patient is doing well. A search of the English-language surgical literature revealed a total of 55 cases of laparoscopic repair of MH reported: 40 in adults and 15 in children. The various modalities of diagnosis, operative techniques, and disease presentation are discussed.

  6. Laparoscopic Incisional Hernia Repair in Obese Patients

    Science.gov (United States)

    2005-01-01

    Background and Objectives: Laparoscopic incisional hernia repair is coming to the forefront as a preferred method of repair due to the advantages offered by minimally invasive techniques. To evaluate safety and feasibility of this approach in obese patients when performed by a general surgeon trained in basic laparoscopy with no prior experience in this technique, we reviewed our early experience in the first 18 patients. Methods: All patients with incisional hernias presenting to a single surgeon from 2000 to 2002 were offered laparoscopic repair. Patients were informed about the limited experience of the surgeon in this particular field. Those who consented were repaired laparoscopically using a standard 4-port technique, one 12-mm port and three 5-mm ports. All patients with body mass index ≥30 were included in this review. A retrospective review of the data included demographics, operative time, blood loss, hospital stay, postoperative complications, and patient satisfaction. Results: Nineteen laparoscopic repairs were completed in 18 patients. No conversions to open repair were necessary. All patients were females except for 2. All hernia sacs were left in place, some of which were empty while others required extensive lysis of adhesions to release sac contents. Mean fascial defect was 102.5 cm2. One defect was closed primarily without mesh, while the rest were closed using Composix mesh in 1 and Dual Plus Gore-Tex mesh in the rest. Three patients were discharged from the recovery room. Mean follow-up was 24 months. No wound or mesh infections occurred. Eight patients had no complications. Eight patients had asymptomatic seromas. Two patients had hematomas; none of them required drainage. One patient had nonspecific dizziness. One patient presented with bowel obstruction secondary to early recurrence (within a week). The repair was salvaged laparoscopically. Upon evaluation by telephone calls, all patients indicated extreme satisfaction with the results

  7. Primary Combined Latissimus Dorsi and Serratus Anterior Flap Repair of Right-Sided Congenital Diaphragmatic Agenesis in a Neonate

    Science.gov (United States)

    Samuel, Madan; Parapurath, Rajiv

    2016-01-01

    Large diaphragmatic defects can be repaired with latissimus dorsi and serratus anterior muscle flaps. We report the first successful primary repair of complete congenital diaphragmatic agenesis using a combination of autologous living bio-tissue and synthetic mesh in a neonate born in the NMC Specialty Hospital in Dubai, United Arab Emirates, in May 2014. Poor Apgar scores, a scaphoid abdomen and absent breath sounds over the right hemithorax were observed at birth. Chest and abdominal X-rays revealed a diaphragmatic hernia. The neonate was stabilised using high-frequency oscillatory ventilation, nitric oxide and sildenafil. The right diaphragm was reconstructed using combined latissimus dorsi and serratus anterior muscle flaps reinforced by a flexible composite mesh. At 12 months old, the infant had normal respiratory function and the diaphragm was intact. No disabilities of the shoulder or scapula were observed. This case indicates that a combination of living tissue and synthetic mesh can be used to reconstruct a functional diaphragm with efficient pleuroperitoneal separation. PMID:26909223

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

    Science.gov (United States)

    Kavic, Michael S.

    1993-05-01

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

  9. Chronic Pain after Inguinal Hernia Repair.

    Science.gov (United States)

    Manangi, Mallikarjuna; Shivashankar, Santhosh; Vijayakumar, Abhishek

    2014-01-01

    Background. Chronic postherniorrhaphy groin pain is defined as pain lasting >6 months after surgery, which is one of the most important complications occurring after inguinal hernia repair, which occurs with greater frequency than previously thought. Material and Methods. Patients undergoing elective inguinal hernioplasty in Victoria Hospital from November 2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for followup at end of six months. Detailed preoperative, intraoperative, and postoperative details of cases were recorded according to proforma. The postoperative pain and pain at days two and seven and at end of six months were recorded on a VAS scale. Results. Chronic pain at six-month followup was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7% of patients with preoperative pain developed chronic pain. Preemptive analgesia failed to show statistical significance in development of chronic pain (P = 0.079). Nerve injury was present in 22 of cases; it was found that nerve injury significantly affected development of chronic pain (P = 0.001). On multivariate analysis, it was found that development of chronic pain following hernia surgery was dependent upon factors like preoperative pain, type of anesthesia, nerve injury, postoperative local infiltration, postoperative complication, and most importantly the early postoperative pain. Conclusions. In the present study, we found that chronic pain following inguinal hernia repair causes significant morbidity to patients and should not be ignored. Preemptive analgesia and operation under local anesthesia significantly affect pain. Intraoperative identification and preservation of all inguinal nerves are very important. Early diagnosis and management of chronic pain can remove suffering of the patient.

  10. Case report: Morgagni hernia.

    Science.gov (United States)

    Rogers, Frederick B; Rebuck, Jill A

    2006-03-01

    The case reported here is a 32-year-old man with a sudden onset of chest pain and an acute deterioration of lung function. An incarcerated Morgagni hernia was diagnosed with a computer tomographic CT scan, and repaired electively via a midline laparotomy. Morgagni hernia is a rare type of congenital diaphragmatic hernia, which may not be symptomatic until adulthood when the patient presents with acute symptoms or incarceration.

  11. The clinical effects of closure of the hernia gap after laparoscopic ventral hernia repair:

    DEFF Research Database (Denmark)

    Christoffersen, Mette W; Westen, Mikkel; Assadzadeh, Sami;

    2014-01-01

    outcomes are patient-rated cosmesis and hernia-specific quality of life. METHODS: A randomised, controlled, double-blinded study is planned. Based on power calculation, we will include 40 patients in each arm. Patients undergoing elective laparoscopic umbilical, epigastric or umbilical trocar-site hernia......INTRODUCTION: Closure of the hernia gap in laparoscopic ventral hernia repair before mesh reinforcement has gained increasing acceptance among surgeons despite creating a tension-based repair. Beneficial effects of this technique have been reported sporadically, but no evidence is available from...... randomised controlled trials. The primary purpose of this paper is to compare early post-operative activity-related pain in patients undergoing laparoscopic ventral hernia repair with closure of the gap with patients undergoing standard laparoscopic ventral hernia repair (non-closure of the gap). Secondary...

  12. A rare case of delayed presentation of congenital diaphragmatic hernia with gastric volvulus

    Directory of Open Access Journals (Sweden)

    Bajrang Tak

    2016-05-01

    Full Text Available A Bochdalek hernia is a posterior congenital defect of the diaphragm, usually on the left hemidiaphragm, caused by a lack of closure of the pleuroperitoneal canal between the eighth and tenth week of fetal life during the embryonic development. It typically presents in the neonatal period with severe respiratory failure. Here we present a 28 year old man with history of episodes of severe dyspnea, pain in epigastric region who arrived to the emergency room, having tachypnoea with oxygen saturation 80% on room air. During his medical work-up we incidentally found gastric volvulus with diaphragmatic hernia. It was managed with reduction of the herniated and rotated stomach and spleen back to the peritoneal cavity and closed the defect by open approach. This type of hernia is uncommon in adults. In this age group, there are two different clinical presentations: asymptomatic patients who are diagnosed incidentally when abdominal organs are found in the thorax in a chest X-ray, and symptomatic patients due to side effects of incarceration, strangulation, hemorrhage and visceral perforation in the chest cavity. [Int J Res Med Sci 2016; 4(5.000: 1749-1751

  13. Calcitonin gene-related peptide expression is altered in pulmonary neuroendocrine cells in developing lungs of rats with congenital diaphragmatic hernia

    NARCIS (Netherlands)

    H. IJsselstijn (Hanneke); N. Hung; J.C. de Jongste (Johan); D. Tibboel (Dick); E. Cutz

    1998-01-01

    textabstractCongenital diaphragmatic hernia (CDH) is associated with high neonatal mortality from lung hypoplasia and persistent pulmonary hypertension. Pulmonary neuroendocrine cells (PNEC) produce calcitonin gene-related peptide (CGRP), a potent vasodilator. We previo

  14. Hernia diagfragmática congénita derecha en el Hospital Universitario de Santander Right congenital diaphragmatic hernia at the Hospital Universitario de Santander

    Directory of Open Access Journals (Sweden)

    Julio César Mantilla

    2010-08-01

    Full Text Available Introducción: La hernia diafragmática del lado derecho es una variable poco frecuente de los defectos congénitos diafragmáticos que permiten el paso del contenido abdominal a la cavidad torácica, causando graves trastornos en el desarrollo pulmonar fetal. Objetivo: Describir las características patológicas encontradas en la autopsia perinatal de un paciente con Hernia diafragmática congénita derecha en el Hospital Universitario de Santander. Caso clínico: Neonato de 35 semanas de gestación con diagnóstico prenatal de Hernia Diafragmática Congénita, quien fallece minutos después de su nacimiento debido a insuficiencia respiratoria aguda. En los hallazgos de autopsia se encuentra ausencia de la mayor parte del hemidiafragma derecho, herniación del contenido abdominal al tórax y una severa hipoplasia pulmonar. Conclusion: La Hernia diafragmática congénita del lado derecho se asocia con alta mortalidad neonatal y los hallazgos encontrados en el presente caso se correlacionan con los graves defectos estructurales pulmonares que se describen en otros casos reportados en la literatura. Salud UIS 2010; 42: 133-138Introduction: The congenital diaphragmatic hernia of the right side is the least common type of the congenital diaphragmatic defects which allows the passage of abdominal contents to the thoracic cavity, causing serious disorders on lung development. Objective: To describe the pathological features found in perinatal autopsy of a patient with Congenital Diaphragmatic Hernia of the right side at the Hospital Universitario de Santander. Case report: 35 weeks gestation neonate with prenatal diagnosis of congenital diaphragmatic hernia, who died due to acute respiratory failure. In the autopsy be found a severe pulmonary hypoplasia and in the microscopic examination, the pulmonary alveoli collapsed. Conclusion: The congenital diaphragmatic hernia of the right side is associated with high neonatal mortality and the findings in

  15. Posterolateral Bochdalek diaphragmatic hernia in adults Hernia diafragmática posterolateral de Bochdalek en el adulto

    Directory of Open Access Journals (Sweden)

    José Maximiliano Garófano-Jerez

    2011-09-01

    Full Text Available Bochdalek hernias (BHs are produced in the posterolateral area of the diaphragm. They are generally congenital, appearing in childhood, but are also detected in asymptomatic adult patients seeking medical attention for other reasons. Computed tomography (CT or magnetic resonance imaging (MRI is used for the correct diagnosis of the hernia type and for its localization, facilitating its management and the choice of treatment. We describe three cases of Bochdalek hernia, two on the right side and one bilateral, which was larger on the right than left side. All of these hernias contained only omental fat. In one patient, the right kidney was adjacent to the diaphragmatic defect but remained within the abdomen. The patients showed no symptoms and were not surgically treated. Examination by multi-slice CT with the possibility of coronal and sagittal reconstruction should be considered the standard method for diagnosing this entity. MRI in T1 is highly valuable to evaluate fat-containing chest lesions. The incidental finding of BH in asymptomatic adults is increasing, thanks to the wider application of new imaging techniques.Las hernias de Bochdalek se producen a través de la zona posterolateral del diafragma. Generalmente son congénitas y se presentan en la infancia, pero pueden verse también en la edad adulta en pacientes asintomáticos, que consultan por patologías diversas. El uso de tomografía computarizada o resonancia magnética permite el diagnóstico correcto del tipo y localización de la hernia, lo cual facilitará su manejo y la elección del tratamiento. Presentamos 3 casos clínicos, dos tenían una hernia de Bochdalek derecha, y, el otro caso es bilateral, siendo mayor la situada en el lado derecho. En todos nuestros casos, el contenido ha sido únicamente grasa omental. No obstante, en uno de ellos, el riñón derecho se situaba adyacente al defecto diafragmático, pero dentro del abdomen. Debido a la ausencia de sintomatolog

  16. 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.

  17. REAPPRAISAL OF DARNING METHOD OF INGUINAL HERNIA REPAIR

    OpenAIRE

    2014-01-01

    OBJECTIVE: To evaluate the darning method of inguinal hernia repair with polypropylene. MATERIAL AND METHODS: 125 Patient of unilateral or bilaterally inguinal hernia were admitted. After thorough investigations, all patients were operated for hernia repair by standard procedure using no-1 polypropylene. Patients were operated under spinal, general anesthesia or local anesthesia. Patients were followed up at one week, four weeks and six months after operation for wound hea...

  18. Tumescent local anesthetic technique for inguinal hernia repairs

    OpenAIRE

    2014-01-01

    Purpose We evaluated the adequacy and feasibility of a tumescent solution containing lidocaine and bupivacaine for inguinal hernia repairs. Methods The medical records of 146 consecutive inguinal hernia patients with 157 hernia repairs using the tumescent local anesthesia technique performed by a single surgeon between September 2009 and December 2013 were retrospectively reviewed. Results The mean operation time (±standard deviation) and hospital stay were 64.5 ± 17.6 minutes and 2.7 ± 1.5 d...

  19. Nerve-identifying inguinal hernia repair : A surgical anatomical study

    NARCIS (Netherlands)

    Wijsmuller, A. R.; Lange, J. F. M.; Kleinrensink, G. J.; van Geldere, D.; Simons, M. P.; Huygen, F. J. P. M.; Jeekel, J.; Lange, J. F.

    2007-01-01

    Background: Pain syndromes of somatic and neuropathic origin are considered to be the main causes of chronic pain after open inguinal hernia repair. Nerve-identification during open hernia repair is suggested to be associated with less postoperative chronic pain. The aim of this study was to define

  20. Reoperation versus clinical recurrence rate after ventral hernia repair

    DEFF Research Database (Denmark)

    Helgstrand, Frederik; Rosenberg, Jacob; Kehlet, Henrik

    2012-01-01

    OBJECTIVE:: To compare the clinical recurrence rate with reoperation rate for recurrence after ventral hernia repair. BACKGROUND:: Reoperation is often used as an outcome measure after ventral hernia repair, but it is unknown whether reoperation rate reflects the overall clinical risk for recurre...

  1. Iatrogenic gastric fistula due to inappropriate placement of intercostal drainage tube in a case of traumatic diaphragmatic hernia.

    Directory of Open Access Journals (Sweden)

    Rege S

    2001-04-01

    Full Text Available A 26-year-old, 30 weeks primigravida presented with a gastric fistula through a left intercostal drain, which was inserted for drainage of suspected haemopneumothorax following minor trauma. It was confirmed to be a diaphragmatic hernia, with stomach and omentum as its contents. On exploratory laparotomy, disconnection of the tube and fistulous tract, with reduction of herniated contents and primary suturing of stomach was carried out. Diaphragmatic reconstruction with polypropylene mesh was also carried out. Post-operative recovery was uneventful with full lung expansion by 3rd postoperative day. Patient was asymptomatic at follow-up 6 months.

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

    Science.gov (United States)

    Kulacoglu, Hakan; Alptekin, Alp

    2011-01-01

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

  3. Randomized trial comparing the Prolene Hernia System, mesh plug repair and Lichtenstein method for open inguinal hernia repair.

    NARCIS (Netherlands)

    Nienhuijs, S.W.; Oort, I.M. van; Keemers-Gels, M.E.; Strobbe, L.J.; Rosman, C.

    2005-01-01

    BACKGROUND: Most surgeons favour the use of a mesh for open inguinal hernia repair as it has a low recurrence rate. Procedures used most frequently are the Lichtenstein method, mesh plug repair and the Prolene Hernia System. The choice of technique may be influenced by the effects on postoperative p

  4. Budd-chiari syndrome caused by diaphragmatic hernia of the liver: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Song, Jae Min; Yoon, Jung Won; Kim, Jae Wook; Chung, Woo Kyoung; Chung, Hee Sun; Kim, Joo Hyung; Choi, Jun Ho; Kim, Seung Ho [Armed Forces Capital Hospital, Seongnam (Korea, Republic of)

    2007-01-15

    Budd-Chiari syndrome is an uncommon disorder, and it is caused by obstruction of the hepatic venous out-flow or inferior vena cava above the hepatic vein. It may result from a large number of conditions, including primary congenital obstructions of the hepatic veins or inferior vena cava by webs or bands. Secondary causes include trauma, polycythemia vera, chronic leukemia, pregnancy, tumors and use of oral contraceptives. No definitive etiologic factors have been identified in two thirds of all cases. We recently experienced a case of Budd-Chiari syndrome caused by diaphragmatic hernia in 21-year-old man. Postoperative follow up CT showed normal venous flow after reintroduction of the liver into the abdominal cavity and closure of the diaphragm defect.

  5. Traumatic diaphragmatic hernia associated with pelvic fractures: a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Dou Wu; Qiang Liu; Junchang Cheng; Shufeng Han

    2005-01-01

    Objective: To review the epidemiological feature, clinical, and diagnostic data of post-traumatic diaphragmatic hernia (TDH) associated with pelvic fractures patients reported in recent 10 years. Methods: One case of delayed presentation of TDH after pelvic fractures taken place one month later was present, with a review on the literature of this kind of patients in our country. Results:The incidence of TDH associated with pelvic fractures was relatively rare, and the diagnosis were often delayed or missed. Although the trans-thorax approach was preferred for surgical closure in the acute phase, its mortality was 8.51%. Conclusion: TDH associated with pelvic fractures is difficult to diagnose because of their varied clinical and radiological signs and the patients may not present with symptoms for a long time following the injury. In clinical, a high index of suspicion with appropriate examination is the mainstays of management,which can also increase the prognosis.

  6. Design of a flexible fetoscopy manipulation system for congenital diaphragmatic hernia.

    Science.gov (United States)

    Yao, Wei; Elangovan, Hariprashanth; Nicolaides, Kypros

    2014-01-01

    Recent advancements in fetal surgery have proven that tracheal occlusion in fetuses with congenital diaphragmatic hernia is an effective way to prevent the occurrence of pulmonary hypoplasia. A novel flexible fetoscope with a parallel mechanism structure of a thumbstick to carry on the fetal tracheal balloon occlusion by the targeting and manipulation of the fetal endoscope at a high standard of quick response and dexterity is proposed in this paper. This design is compared with a commercial rigid fetoscope in terms of operation timing and reduced stress to the fetus at neck level. Experiments using a phantom have demonstrated that the flexible fetoscope has a better dexterity and is able to perform stable tracheoscopy and balloon inflation at different levels of the trachea, with the help of a fiberoptic camera.

  7. Congenital diaphragmatic hernia may be associated with 17q12 microdeletion syndrome.

    Science.gov (United States)

    Goumy, Carole; Laffargue, Fanny; Eymard-Pierre, Eléonore; Kemeny, Stéphen; Gay-Bellile, Mathilde; Gouas, Laetiti; Gallot, Denis; Francannet, Christine; Tchirkov, Andrei; Pebrel-Richard, Céline; Vago, Philippe

    2015-01-01

    Microdeletions of 17q12 encompassing TCF2 are associated with maturity-onset of diabetes of the young type 5, cystic renal disease, pancreatic atrophy, Mullerian aplasia in females and variable cognitive impairment. We report on a patient with a de novo 17q12 microdeletion, 1.8 Mb in size, associated with congenital diaphragmatic hernia (CDH). The 5-year-old male patient presented multicystic renal dysplasia kidneys, minor facial dysmorphic features and skeletal anomalies, but neither developmental delay nor behavioral abnormalities. CDH has been previously associated with the 17q12 microdeletion syndrome only in one prenatal case. The present study reinforces the hypothesis that CDH is part of the phenotype for 17q12 microdeletion and that 17q12 encompasses candidate(s) gene(s) involved in diaphragm development. We suggest that PIGW, a gene involved in an early step of GPI biosynthesis, could be a strong candidate gene for CDH.

  8. Laparoscopic Repair of Morgagni Hernia: Three-Case Presentation and the Literature

    Directory of Open Access Journals (Sweden)

    Gholamali Godazandeh

    2016-01-01

    Full Text Available Introduction. Morgagni hernia is a rare form of congenital diaphragmatic hernia. Case Presentation. We present three cases of Morgagni hernia with GI symptoms treated by laparoscopic surgery. Discussion. Hernial sac was excised in two cases and left in situ in one case. There was no recurrence in symptoms after 30 months from surgery.

  9. Controversies in laparoscopic repair of incisional hernia

    Directory of Open Access Journals (Sweden)

    Sarela Abeezar

    2006-01-01

    Full Text Available Background: Incisional hernias can be a significant problem after open abdominal surgery. Laparoscopic incisional hernia repair (LIHR is conceptually appealing: a large, abdominal wall re-incision with potential wound-related ill effects is avoided and an intra-peritoneal onlay mesh is expected to provide security that is equivalent to open, retro-muscular mesh repair. As such, LIHR has gained substantial popularity despite sparse, randomised clinical data to compare with conventional, open repair. Aim: To enumerate and discuss important, controversial issues in patient-selection, technique and early post-operative care for LIHR. Materials and Methods: Pragmatic summary of comprehensive review of English language literature, discussion with experts and personal experience. Outcomes: Six important areas of some dispute were identified: 1. Size of abdominal-wall defect that is suitable for LIHR: Generally, defect-diameter > 10 cm is better served by open retromuscular repair with tension-free re-approximation of the edges of the defect. 2. Extent of adhesiolysis: Complete division of adhesions to the anterior abdominal wall may identify sub-clinical "Swiss-cheese" defects but incurs some risk of additional complications. 3. Intra-operative recognition of enterotomy: Possible options are either laparoscopic suture of bowel injury and simultaneous completion of LIHR, or staged LIHR or conversion to open suture-repair. 4. Choice of mesh: "Composite" meshes are regarded as the current standard of care but there is paucity of data regarding potential dangers of intra-peritoneal polypropylene mesh. 5. Technique of mesh-fixation: Trans-parietal sutures are more secure than tacks, with limited data to correlate with post-operative pain. 6. Alarm over post-operative pain: Unlike other advanced laparoscopic operations, the specificity of pain as a marker of intra-abdominal sepsis after LIHR remains unclear. Conclusion : Recognition of and attention to

  10. Congenital diaphragmatic hernia: neonatal outcomes following referral to a paediatric surgical centre.

    LENUS (Irish Health Repository)

    Chukwu, J

    2012-02-01

    Congenital diaphragmatic hernia (CDH) is a rare malformation observed in approximately 1 in 3000 live births. Estimates of postnatal survival range from 50 to 70% despite advances in neonatal care. Antenatal diagnosis is associated with termination of pregnancy in 25-50% pregnancy internationally which may not be reflective of the Irish population. We aimed to evaluate the mortality of infants with CDH who survived to admission in a tertiary referral paediatric hospital between 1996 and 2007. The Hospital In-Patient Enquiry system was used to determine the number of neonatal referrals for CDH to OLHSC between 1996 and 2007. Mortality, sex distribution, length of patient stay and the number of cases per year were examined. 141 neonates with CDH were over 12 years with approximately 12 referrals per annum of which 82 (58%) were male and 59 (42%) female. The average length of stay in the hospital was 33 (range 0-364) days. Overall 71% of the patients survived to discharge. In the first epoch (1996-2001) survival was 63% compared with 78% in the later epoch (2002-7). The overall survival for neonates with CDH presenting to OLCHC during the 12 year-period was 71% although this improved to 78% in recent epoch. Further study of associated congenital anomalies, number of terminations of pregnancy, complexity of the diaphragmatic defect and degree of pulmonary hypertension are required to compare this population with other international centres.

  11. Radiological Diagnosis of Congenital Diaphragmatic Hernia in 17th Century Korean Mummy

    Science.gov (United States)

    Kim, Yi-Suk; Lee, In Sun; Jung, Go-Un; Kim, Myeung Ju; Oh, Chang Seok; Yoo, Dong Su; Lee, Won-Joon; Lee, Eunju; Cha, Soon Chul; Shin, Dong Hoon

    2014-01-01

    Congenital diaphragmatic hernia (CDH) is a birth defect of the diaphragm resulting in pulmonary sequelae that threaten the lives of infants. In computed tomography (CT) images of a 17th century middle-aged male mummy (the Andong mummy), we observed that the abdominal contents had protruded into the right thoracic cavity through the diaphragmatic defect, accompanied by a mediastinal shift to the left. On autopsy, the defect in the right posterolateral aspect of the diaphragm was reconfirmed, as was the herniation of the abdominal organs. The herniated contents included the right lobe of the liver, the pyloric part of the stomach, a part of the greater omentum, and the right colic flexure connecting the superior part of the ascending colon and the right part of the transverse colon. Taking our CT and autopsy results together, this case was diagnosed as the Bochdalek-type CDH. Herein we make the first ever report of a CT-assisted diagnosis of a pre-modern historical case of CDH. Our results show the promising utility of this modality in investigations of mummified human remains archaeologically obtained. PMID:24988465

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

    Science.gov (United States)

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

    2015-01-01

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

  13. Candidate genes for congenital diaphragmatic hernia from animalmodels: sequencing of fog2 and pdgfra reveals rare variants indiaphragmatic hernia patients

    Energy Technology Data Exchange (ETDEWEB)

    Bleyl, S.B.; Moshrefi, A.; Shaw, G.M.; Saijoh, Y.; Schoenwolf,G.C.; Pennacchio, L.A.; Slavotinek, A.M.

    2007-05-11

    Congenital diaphragmatic hernia (CDH) is a common, lifethreatening birth defect. Although there is strong evidence implicatinggenetic factors in its pathogenesis, few causative genes have beenidentified, and in isolated CDH, only one de novo, nonsense mutation hasbeen reported in FOG2 in a female with posterior diaphragmaticeventration. We report here that the homozygous null mouse for the Pdgfragene has posterolateral diaphragmatic defects and thus is a model forhuman CDH. We hypothesized that mutations in this gene could cause humanCDH. We sequenced PDGFRa and FOG2 in 96 patients with CDH, of which 53had isolated CDH (55.2 percent), 36 had CDH and additional anomalies(37.5 percent), and 7 had CDH and known chromosome aberrations (7.3percent). For FOG2, we identified novel sequence alterations predictingp.M703L and p.T843A in two patients with isolated CDH that were absent in526 and 564 control chromosomes respectively. These altered amino acidswere highly conserved. However, due to the lack of available parental DNAsamples we were not able to determine if the sequence alterations were denovo. For PDGFRa, we found a single variant predicting p.L967V in apatient with CDH and multiple anomalies that was absent in 768 controlchromosomes. This patient also had one cell with trisomy 15 on skinfibroblast culture, a finding of uncertain significance. Although ourstudy identified sequence variants in FOG2 and PDGFRa, we have notdefinitively established the variants as mutations and we found noevidence that CDH commonly results from mutations in thesegenes.

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

    Science.gov (United States)

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

    2014-01-01

    The utility of mesh reinforcement for small hiatal hernia found especially during antireflux surgery is unknown. Initial reports for the use of biological mesh for crural reinforcement during repair for defects greater than 5 cm have been shown to decrease recurrence rates. This study compares patients with small hiatal hernias who underwent onlay biologic mesh buttress repair versus those with suture cruroplasty alone. This is a single-institution retrospective review of all patients undergoing repair of hiatal hernia measuring 1-5 cm between 2002 and 2009. The patients were evaluated based on surgical repair: one group undergoing crural reinforcement with onlay biologic mesh and other group with suture cruroplasty only. Seventy patients with hiatal hernia measuring 1-5 cm were identified. Thirty-eight patients had hernia repair with biologic mesh, and 32 patients had repair with suture cruroplasty only. Recurrence rate at 1 year was 16% (5/32) in patients who had suture cruroplasty only and 0% (0/38) in the group with crural reinforcement with absorbable mesh (statistically significant, P = 0.017). Suture cruroplasty alone appears to be inadequate for hiatal hernias measuring 1-5 cm with significant recurrence rate and failure of antireflux surgery. Crural reinforcement with absorbable mesh may reduce hiatal hernia recurrence rate in small hiatal hernias. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  16. Mini-mesh repair for femoral hernia

    National Research Council Canada - National Science Library

    Kulacoglu, Hakan

    2014-01-01

    Femoral hernia consists only 4% of all primary groin hernias. It is described as "the Bête Noire of Hernias" because of its nature and anatomy which is difficult to understand for the surgeons and tendency to recurrence...

  17. Pain following the repair of an abdominal hernia

    DEFF Research Database (Denmark)

    Hansen, Mark Berner; Andersen, Kenneth Geving; Crawford, Michael Edward

    2010-01-01

    Pain and other types of discomfort are frequent symptoms following the repair of an abdominal hernia. After 1 year, the incidence of light to moderate pain following inguinal hernia repair is as high as 10% and 2% for severe disabling chronic pain. Postoperative chronic pain not only affects......, psychosocial characteristics, and surgical procedures) related to the postoperative pain conditions. Furthermore, the mechanisms for both acute and chronic pain are presented. We focus on inguinal hernia repair, which is the most frequent type of abdominal hernia surgery that leads to chronic pain. Finally...... the individual patient, but may also have a great impact on relatives and society, and may be a cause of concern for the responsible surgeon. This paper provides an overview of the anatomy, surgical procedures, and disposing factors (age, gender, ethnicity, genotype, previous hernia repair, pain prior to surgery...

  18. REAPPRAISAL OF DARNING METHOD OF INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Pawan

    2014-05-01

    Full Text Available OBJECTIVE: To evaluate the darning method of inguinal hernia repair with polypropylene. MATERIAL AND METHODS: 125 Patient of unilateral or bilaterally inguinal hernia were admitted. After thorough investigations, all patients were operated for hernia repair by standard procedure using no-1 polypropylene. Patients were operated under spinal, general anesthesia or local anesthesia. Patients were followed up at one week, four weeks and six months after operation for wound healing and complications. RESULTS: Out of 125 patients, ranging in age from 18 to 85 Years, 90 patients (72% were given spinal anesthesia, 28 Patients, (22.4% were operated under general anesthesia, 7 patients under local anesthesia. Patients were discharged from the hospital after 4 days. 20 Patients were above 50 yr. who were operated under spinal anesthesia were catheterized to prevent urinary retentions. Recurrence rate was 1.6% CONCLUSION: Darning methods of inguinal hernia repair with polypropylene is a safe and cheaper method of hernia repair

  19. Acceptable nationwide outcome after paediatric inguinal hernia repair

    DEFF Research Database (Denmark)

    Bisgaard, Thue; Kehlet, H; Oehlenschlager, J;

    2014-01-01

    PURPOSE: The primary objective was to describe 30-day outcomes after primary inguinal paediatric hernia repair. METHODS: Prospectively collected data from the National Patient Registry covering a 2-year study period 1 January 2005 to 31 December 2006 were collected. Unexpected outcomes were defined...... was not associated with the inguinal hernia repair. The usual technique was a simple sutured plasty (96.5 %). Emergency repair was performed in 54 patients (2.2 %) mainly in children between 0 and 2 years (79.6 %). During the 1 year follow-up, reoperation for recurrent inguinal hernia was performed in 8 children...... after elective repair (recurrence rate 0.3 %). Paediatric repairs were for most parts performed in surgical public hospitals, and most departments performed less than 10 inguinal hernia repairs within the 2 years study period. CONCLUSION: These nationwide results are acceptable with low numbers...

  20. Radiographic findings in late-presenting congenital diaphragmatic hernia: helpful imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Muzzafar, Sofia; Swischuk, Leonard E.; Jadhav, Siddharth P. [University of Texas Medical Branch, Department of Pediatric Radiology, Galveston, TX (United States)

    2012-03-15

    Imaging findings in delayed presentation of congenital diaphragmatic hernia can be confusing and misleading, resulting in a delay in diagnosis. To evaluate the often puzzling plain film findings of late-presenting CDH in an effort to determine whether any of the findings could be helpful in arriving at an early diagnosis. We reviewed and documented the plain film findings and clinical data in eight patients seen during the last 20 years with late-presenting CDH. IRB exempt status was obtained in this study. There were five boys and three girls. The age range was 4 months to 12 years with a mean of 2.4 years. Five children presented with acute respiratory problems while three presented with acute abdominal pain. Two children presented with both respiratory and abdominal findings and one also presented with hematemesis. Two children had radiographic findings that were not difficult to analyze while the remaining six had findings that posed initial diagnostic problems. Although not common, late-presenting CDH can result in confusing plain film radiographic findings and a delay in diagnosis. We found that the most important finding in analyzing these radiographs is in evaluating the location and position of the gastric bubble with the more common left-side hernias. (orig.)

  1. The confused identity of Cantrell's pentad: ectopia cordis is related either to thoracoschisis or to a diaphragmatic hernia with an omphalocele.

    Science.gov (United States)

    Davies, Belinda R; Duran, Marco

    2003-01-01

    To find out if Cantrell's pentad is a single entity, four cases of ectopia cordis were studied and compared with cases in the literature. Our cases had the heart outside the thorax and had two to four other features of the association. In one case the thoracic organs had apparently escaped through a diaphragmatic hernia into an omphalocele, and in the others via a thoracoschisis with an abdominal defect, either a supraumbilical hernia or a gastroschisis. According to these cases and those from the literature, it is proposed that there are two major mechanisms leading to ectopia cordis: (1) a reversed diaphragmatic hernia in the case of a large diaphragmatic defect and an omphalocele, and (2) through a sterno-costal defect, with gastroschisis or a supraumbililical abdominal defect. As omphaloceles and major diaphragmatic defects are probably pathogenetically distinct from thoraco- and thoracogastroschisis, it is important to distinguish these groups of anomalies, rather than be concerned as to their relationship with Cantrell's pentad.

  2. Non-traumatic trans-diaphragmatic intercostal hernia and cor pulmonale in a patient with poorly controlled obstructive sleep apnoea.

    Science.gov (United States)

    Mehdi, Syed Basharath; Madi, Salem; Sudworth, Jordan

    2016-10-28

    Trans-diaphragmatic intercostal hernia is a rare entity. Patient with multiple medical comorbidities, including obstructive sleep apnoea, presents with shortness of breath, leg oedema and a bulging swelling through the right chest wall. CT shows partial herniation of the right lung and liver through intercostal space and an echocardiogram reveals right heart failure. He was treated initially with continuous positive airway pressure with poor response and subsequently treated with adaptive servo ventilation with much better symptomatic relief and treatment tolerance.

  3. Richter hernia: surgical anatomy and technique of repair.

    Science.gov (United States)

    Skandalakis, Panagiotis N; Zoras, Odyseas; Skandalakis, John E; Mirilas, Petros

    2006-02-01

    Richter hernia (partial enterocele) is the protrusion and/or strangulation of only part of the circumference of the intestine's antimesenteric border through a rigid small defect of the abdominal wall. The first case was reported in 1606 by Fabricius Hildanus. The first definition of partial enterocele was given by August Gottlieb Richter in 1785. Sir Frederick Treves discriminated it from Littre hernia (hernia of the Meckel diverticulum). More often these hernias are diagnosed in the sixth and seventh decades of life. They comprise 10 per cent of strangulated hernias. Their common sites are the femoral ring, inguinal ring, and at incisional trauma. The most-often entrapped part of the bowel is the distal ileum, but any part of the intestinal tube may be incarcerated. These hernias progress more rapidly to gangrene than other strangulated hernias, and obstruction is less frequent. The gold standard technique for repair is the preperitoneal approach, followed by laparotomy and resection if perforation is suspected.

  4. CHRONIC PAIN AFTER INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Suresh

    2014-09-01

    Full Text Available : BACKGROUND: Chronic post herniorrhaphy groin pain is defined as pain lasting > 6 months after surgery, which is one of the most important complication occurring after inguinal hernia repair, occurs with greater frequency than previously thought. Chronic groin pain is one of the most significant complications following inguinal hernia repair, and majority of chronic pain has been attributed to ilioinguinal nerve entrapment. Various other factors are involved in development of chronic pain. MATERIAL AND METHODS: Patients undergoing elective inguinal hernioplasty in Victoria hospital from November2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for follow up at end of six months. A detailed preoperative, intraoperative and post-operative details of cases were recorded according to proforma. The postoperative pain and pain at two, seven days and at end of six months were recorded on a VAS scale. RESULTS: Chronic pain at six month follow up was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7 % of patients with preoperative pain developed chronic pain. Patients with significant preoperative pain had higher chances of developing chronic pain (p<.0001. Preemptive analgesia failed to show statistical significance in development of chronic pain (p=0.079. Nerve injury were present in 22 of cases it was found that nerve injury significantly affected development of chronic pain (p=0.001.Post-operative infiltration of local anesthesia was practiced in 16.3 % of cases and it was found that local infiltration at incision site significantly reduced incidence of chronic pain (p=0.001.Postoperative complications in the form of hematoma, seroma or infection was present in 8.5 % of cases. It was found that post-operative complication not only increased early post-operative pain

  5. COMPARATIVE STUDY OF LICHTENSTEIN VERSUS DESARDA REPAIR FOR INGUINAL HERNIA

    Directory of Open Access Journals (Sweden)

    Sowmya

    2015-12-01

    Full Text Available BACKGROUND Inguinal hernia repair is the most frequently performed operation in any general surgical unit. The Bassini’s, Shouldice and other tissue-based techniques are still being acceptable for primary inguinal hernia repair. Desarda’s technique is originally a tissue based hernia repair using an undetached strip of external oblique aponeurosis to strengthen the posterior wall of the inguinal canal. The aim of the present study was to compare Lichtenstein hernia repair and Desarda herniorrhaphy. METHODS A total of 40 patients with primary unilateral inguinal hernia were subjected either to Desarda herniorrhaphy or Lichtenstein hernioplasty. The patients were followed in terms of recurrence rate, post-operative complications, convalescence, chronic pain and cost effectiveness. RESULTS During the followup all patients had either mild or moderate pain, but the pain intensity was more in Lichtenstein repair compared to Desarda repair in the immediate postoperative period. In Lichenstein repair patients had chronic groin pain even at the end of one year, but none of the patients in Desarda repair had chronic groin pain. Complications such as seroma and wound infection were less in Desarda repair. Time taken to resume normal activities was significantly less in case of Desarda herniorrhaphy; however, there was no recurrence observed in both the groups during the followup period. Average cost incurred for Desarda repair was significantly less than Lichtenstein repair. CONCLUSION Lichtenstein method of hernia repair is simple and safe. But the mesh prosthesis has its drawbacks. Desarda hernia repair is based on physiological principles and the results are good with less convalescence period and fewer recurrences and no chronic groin pain. It is more cost effective.

  6. The prevalence of umbilical and epigastric hernia repair

    DEFF Research Database (Denmark)

    Burcharth, J; Pedersen, M.S.; Pommergaard, H C;

    2015-01-01

    PURPOSE: Umbilical and epigastric hernia repair are common surgical procedures; however, the nationwide gender and age-specific prevalence of these repairs is unknown, and this knowledge could form the basis for new studies. METHODS: A nationwide register-based study covering all people living...... in Denmark on December 31st, 2010 was performed. Within this population all umbilical and epigastric hernia repairs from January 1st, 2006 to December 31st, 2010 were identified using data from the Danish National Hospital Register, and 5-year prevalence estimates were calculated. RESULTS: The study...... population covered 5,639,885 persons (49 % males). A total of 10,107 patients (68 % males) were operated for an umbilical hernia and 2412 patients (55 % males) were operated for an epigastric hernia. The age-specific 5-year prevalence differed for both hernia types. The highest 5-year prevalence of umbilical...

  7. The search for ideal hernia repair; mesh materials and types.

    Science.gov (United States)

    Bilsel, Yilmaz; Abci, Ilker

    2012-01-01

    Hernia surgery continues to draw the attention of surgeons, patients, and the industry. This strong interest has driven the establishment of professional medical societies with the sole purpose of furthering the understanding of hernias and hernia repair. In the more than 100 years of development, industry has played a major role in advancing the technology to perfect the performance of hernia repair with the hope of establishing the "best" technique and its associated technology. However, with the development of newer prosthetics and approaches to hernia repair, many surgeons do not fully understand the properties of the available prosthetics. The goal of this review is to highlight the different types of meshes in an effort to clarify to surgeons what types of materials are available to them and how to select an appropriate one for a given case.

  8. A Rare Case of Laparoscopic Repair of Simultaneously Occurring Morgagni and Paraesophageal Hernias.

    Science.gov (United States)

    Zhou, Zu-Li; Li, Hao; Li, Jian-Feng; Liu, Yan-Guo; Wang, Chong; Wang, Jun

    2016-01-01

    Simultaneously occurring Morgagni hernia and paraesophageal hernia is an extremely rare clinical condition with only six case reports in the English-language literature and only two laparoscopic repair reports. We report a 73-year-old woman with both Morgagni hernia and paraesophageal hernia who underwent successful laparoscopic repair of the hernia defects using transabdominal wall suturing. The laparoscopic operation can provide excellent exposure and repair the hernia defect easily with minimal invasiveness and fewer complications. This case report reported the concurring Morgagni and paraesophageal hernias and validated the feasibility of laparoscopic repair both hernias simultaneously.

  9. Indications for incisional hernia repair: An international questionnaire among hernia surgeons

    NARCIS (Netherlands)

    J. Nieuwenhuizen (Jeroen); G.J. Kleinrensink (Gert Jan); W.C.J. Hop (Wim); J. Jeekel (Hans); J.F. Lange (Johan)

    2008-01-01

    textabstractBackground: Incisional hernia repair can be a significant challenge for both surgeon and patient. Despite the growing amount of literature describing various methods of surgical techniques, little has been published regarding the natural course of incisional hernia and the opinions about

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

    Science.gov (United States)

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

    2014-08-01

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

  11. Nationwide Prospective Study of Outcomes after Elective Incisional Hernia Repair

    DEFF Research Database (Denmark)

    Helgstrand, Frederik; Rosenberg, Jacob; Kehlet, Henrik

    2013-01-01

    BACKGROUND: Incisional hernia repair is a frequent surgical procedure, but perioperative risk factors and outcomes have not been prospectively assessed in large-scale studies. The aim of this nationwide study was to analyze surgical risk factors for early and late outcomes after incisional hernia...

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

    Although mesenterioaxial gastric volvulus is an uncom-mon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesente-rioaxial intrathoracic gastric volvulus, which was success-fully treated with laparoscopic repair of the diaphrag-matic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gas-trointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparo-scopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundopli-cation. This case highlights the feasibility and effective-ness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be use-ful for preventing postoperative recurrence of hiatal her-nia, volvulus, and gastroesophageal reflux.

  13. Current developments in hernia repair; meshes, adhesives, and tacking.

    Science.gov (United States)

    Powell, Benjamin S; Voeller, Guy R

    2010-10-01

    Open and laparoscopic hernia surgery continues to evolve with new products allowing surgeons multiple choices in treating their patients. The evolution towards tension-free techniques in dealing with hernias requires that today's surgeons know the options available in meshes as well as fixation methods in order to have the best outcomes. In recent years, there has been a rapid expansion in the number of meshes available. Currently, there are numerous uncoated, coated, and biologic meshes in production that can be used in hernia repair. This paper will focus on the latest developments in coated meshes that allow for intra-abdominal placement as well as the different types of biologic meshes and their typical uses. Tacking devices for laparoscopic hernia repair now come in titanium as well as absorbable devices. AbsorbaTack™ (Covidien, Norwalk, CT) and Sorbafix™ (Davol, Warwick, RI) are two of the newest absorbable tacking devices thought to possibly benefit patients with decreased pain and long-term complications as compared with their titanium counterparts. Adhesives continue to be used more and more for hernia repair, especially in inguinal and paraesophageal hernia repairs. Tissucol™/Tisseel™ (Baxter, Deerfield, IL) and Evicel™ (Ethicon, Somerville, NJ) are two types of fibrin glues that are available for use in hernia repair. Practitioners using these biologic adhesives think there is less pain compared with tacking.

  14. Anesthetic management of Morgagni hernia repair in an elderly woman.

    Science.gov (United States)

    Nama, Rajnish K; Butala, Bina P; Shah, Veena R; Patel, Hiren R

    2015-01-01

    Adult onset congenital diaphragmatic hernia (CDH) is uncommon but not rare. Morgagni hernia is a rare variant of CDH. The defect tends to be small and patients may remain asymptomatic and diagnosed incidentally. When these patients become symptomatic, they usually present with gastrointestinal and cardiorespiratory symptoms or sometimes as an emergency due to obstruction or strangulation of herniated viscera. Chest radiograph, computed tomography scan, and magnetic resonance imaging are the imaging modalities used for diagnosis of CDH. Cardiopulmonary compromise due to mass effect of hernial contents on lungs, heart and great vessels, and obstruction or strangulation of herniated viscera poses the special challenge before anesthesiologists. Our patient was diagnosed to have Morgagni hernia, at the age of 72 years and underwent laparotomy for the same. This case highlights the key feature of the successful anesthetic management of adult onset CDH.

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

    African Journals Online (AJOL)

    complications of inguinal hernia repair in pediatric patients who underwent ... were complications such as pain, wound infection, and fever. Results. In this study ... incidence of recurrence within 1 year after the surgery .... Treatment strategy of.

  16. Post operative pain control in inguinal hernia repair: comparison of ...

    African Journals Online (AJOL)

    Post operative pain control in inguinal hernia repair: comparison of tramadol versus ... Log in or Register to get access to full text downloads. ... postoperative pain control effects and cost effectiveness of Tramadol versus Bupivaaine in wound ...

  17. Reoperation Rates for Laparoscopic vs Open Repair of Femoral Hernias in Denmark

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Bisgaard, Thue; Kehlet, Henrik

    2014-01-01

    IMPORTANCE: In Denmark approximately 10 000 groin hernias are repaired annually, of which 2% to 4% are femoral hernias. Several methods for repair of femoral hernias are used including sutured repair and different types of mesh repair with either open or laparoscopic techniques. The use of many...... laparoscopic vs open femoral hernia repair, analyzing data from a nationwide database. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted. Data on femoral hernia repairs registered in the Danish Hernia Database from January 1998 until February 2012 were extracted and analyzed. All...... repairs were followed in the database and analyzed for reports of reoperation, which were used as a proxy for recurrence. Femoral hernia recurrence and inguinal hernia occurrence after the index repair were analyzed. EXPOSURE: Repair of a femoral hernia. MAIN OUTCOMES AND MEASURES: Reoperation...

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

    Science.gov (United States)

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

    2017-04-01

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

  19. Fibrin sealant for mesh fixation in laparoscopic umbilical hernia repair

    DEFF Research Database (Denmark)

    Eriksen, J R; Bisgaard, T; Assaadzadeh, S;

    2013-01-01

    Fibrin sealant for mesh fixation has significant positive effects on early outcome after laparoscopic ventral hernia repair (LVHR) compared with titanium tacks. Whether fibrin sealant fixation also results in better long-term outcome is unknown.......Fibrin sealant for mesh fixation has significant positive effects on early outcome after laparoscopic ventral hernia repair (LVHR) compared with titanium tacks. Whether fibrin sealant fixation also results in better long-term outcome is unknown....

  20. The Anterior Preperitoneal Approach for Repair of Complex Inguinal Hernias

    Directory of Open Access Journals (Sweden)

    Safa Onel

    2014-08-01

    Results: A total of 40 patients (Male:32, Female:8 underwent hernia repair with our technique during the study period. The mean age was (+/-SD 44+/-6.8 years. Four patients had giant direct hernia,12 patients had giant inguino-scrotal hernia, 14 patients had recurrent and 10 patients had femoral hernia. 4 patients were underwent emergent surgery due to incarceration. The mean operation time was (+/-SD 61+/-11 min. There was no recurrence with the mean follow-up time of 7+/-2.2 years. Cnclusion: Our surgical technique allows to repair all types of inguinal hernia with one piece of prolene mesh by covering all potential defects. [Cukurova Med J 2014; 39(4.000: 822-828

  1. Laparoscopic and open incisional hernia repair: A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Mehmet Zafer Sabuncuoğlu

    2015-07-01

    Full Text Available As the number of major surgical procedures has increased in recent years, so there has been an increase in incisional hernias. With gained experience and new materials, laparoscopic repair of incisional hernia is now applied. This study was aimed to compare the results of incisional hernia repair with the open surgery or laparoscopic approach at the only centre in the region for laparoscopic incisional hernia repair. A total of 55 cases of incisional hernia at the General Surgery Clinic of SDU between November 2012 and 2014 were underwent laparoscopic ventral hernia repair (L-VHR and conventional incisional hernia repair (C-VHR. From the L-VHR group 6 cases and from the C-VHR 9 cases were excluded from the study, as they did not meet the inclusion criteria or did not wish to participate in the study. The two techniques were compared in respect of operative time, length of hospital stay, postoperative pain scores, complications and recurrence. A total of 40 cases of incisional hernia repair were evaluated. The mean follow-up period was found as 12.75±4.19 months. No difference was determined between the characteristics of the patients due to age, body mass index, American Society of Anesthesiologists (ASA score, comorbidities, hernia size, and follow-up. In the laparoscopic repair group, the postoperative pain scores, complication rates and duration of hospital stay were found significantly superior to those of the open technique group. While there was no mortality seen and wound complications as a morbidity were 0 % in the L-VHR (n = 0 and 20 % in C-VHR group (n = 4. In the comparison of mean operative time, the duration of surgery was significantly shorter in the laparoscopic repair group (67.25±19.23 min compared to the open technique group (91.50±24.87 min (p=0.001. Laparoscopic repair was associated with less postoperative pain (4.35±1.03 vs 5.60±1.31, p=0.002, lesser postoperative complications (5% vs. 35%, p=0.044, and shorter

  2. Study of a new method for inguinal hernia repair

    Directory of Open Access Journals (Sweden)

    Noori M.

    2007-11-01

    Full Text Available Background: Inguinal hernia accounts for about 80% of all hernias and are the most common surgical procedure done in infants. There are different methods for repairing of inguinal hernia such as tissue repair; rate of recurrence by this method is 1-3%. The purpose of this study was to introduce new method for this surgery and assessing recurrence and complications.Methods: This was a semi clinical trial. 174 patients were considered after five years. (During 1998-2002. In this method after removing of hernia's sac, the floor of inguinal canal was torn in two layers continuously. One of them was torn from cooper ligament to fascia transversalis and the other one was torn from inguinal ligament to conjoint tendon and finally the fascia of external muscle was torn on spermatic cord. The patients were assessed by a questionnaire composed of two sections; one about the site of inguinal hernia and age of patients and the other was composed of questions about complication and recurrence of surgery. Data was compared to other conventional tissue repair using Z test. Results: The mean age of patients were 28-48 years, 164(94% were males and 10(5/7% were females, 59(34% of patients had left inguinal hernia (56 male and 3 female, 92(52% had right inguinal hernia (88 male and 4 female and 23(13% had bilateral inguinal hernia (20 male and 3 female. Two patients (1/1% had recurrence two years after surgery and no complication were seen after 5 years. Conclusions: There were no significant difference between methods of surgery (1/1% recurrence and other conventional tissue repair methods (1-3% recurrence. More long evaluation is required to recommend this fast and simple method for routine repair of inguinal hernias.

  3. Open femoral hernia repair: one skin incision for all

    Directory of Open Access Journals (Sweden)

    El-Masry Nabil S

    2009-11-01

    Full Text Available Abstract Background Femoral hernias are relatively uncommon, however they are the most common incarcerated abdominal hernia, with strangulation of a viscus carrying significant mortality. Classically three approaches are described to open femoral hernia repair: Lockwood's infra-inguinal, Lotheissen's trans-inguinal and McEvedy's high approach. Each approach describes a separate skin incision and dissection to access the femoral sac. The decision as to which approach to adopt, predominantly dependent on the suspicion of finding strangulated bowel, is often a difficult one and in our opinion an unnecessary one. Methods We propose a technique for open femoral hernia repair that involves a single skin incision 1 cm above the medial half of the inguinal ligament that allows all of the above approaches to the hernia sac depending on the operative findings. Thus the repair of simple femoral hernias can be performed from below the inguinal ligament. If found, inguinal hernias can be repaired. More importantly, resection of compromised bowel can be achieved by accessing the peritoneal cavity with division of the linea semilunaris 4 cm above the inguinal ligament. This avoids compromise of the inguinal canal, and with medial retraction of the rectus abdominis muscle enables access to the peritoneal cavity and compromised bowel. Discussion This simple technique minimises the preoperative debate as to which incision will allow the best approach to the femoral hernia sac, allow for alteration to a simple inguinal hernia repair if necessary, and more importantly obviate the need for further skin incisions if compromised bowel is encountered that requires resection.

  4. [Intrathoracic kidney in a newborn with breathing difficulty syndrome secondary to congenital diaphragmatic hernia].

    Science.gov (United States)

    Urdaneta-Carruyo, Eliexer; Méndez-Parra, Alexander; Palencia-Molina, María Alejandra; Urdaneta-Contreras, Adriana; Urdaneta-Morales, Aubin

    2004-01-01

    Congenital diaphragmatic hernia (CDH) is found frequently in from 0.17 to 0.57 among 1000 newborns and is associated with intrathoracic kidney (IK) in 0.25%. The objective of the present work was to describe both present pathologies in a newborn and to review the literature in this respect. male newborns, who presented tachypnea sudden and persistent for the first 24 h of life. For the that was physical exam, we included breathing difficult, (eight points of Silverman's) and cyanosis; initial arterial gases: hypoxemia and hypocapnia (acute respiratory failure type I); thorax X-ray; increase of bronchial plot and of parahiliary density; normal lungs, pleuro-peritoneal membrane and solid mass superimposed on heart silhouette were observed and confirmed by echocardiogram. Computed axial tomography (CAT) revealed left kidney and part of spleen inside thorax, beside inferior lobe of left lung. Immediately, the patient was mechanically ventilated and after 2 days, was operated surgically for correction of CDH and descent of left kidney. After surgical intervention, initial symtomatology disappeared and evolution was satisfactory. The present case illustrates how the kidney on occasion can emigrate due to congenital default to the thorax of the wall of the diaphragm and be a casual discovery at the moment of radiologic exploration.

  5. Correlation between lung scintigraphy and long-term outcome in survivors of congenital diaphragmatic hernia.

    Science.gov (United States)

    Okuyama, Hiroomi; Kubota, Akio; Kawahara, Hisayoshi; Oue, Takaharu; Kitayama, Yasuhiro; Yagi, Makoto

    2006-09-01

    Lung scintigraphy has been used to evaluate the degree of pulmonary hypoplasia in infants with congenital diaphragmatic hernia (CDH). However, the relationship between lung scintigraphy and long-term outcome of CDH remains unclear. The aim of this study is to determine whether lung scintigraphy correlates with long-term pulmonary morbidity and nutritional status in survivors of CDH. Consecutive 31 survivors of CDH were enrolled in this study. The initial scan was performed at 1-2 months when the patients were ready for discharge and the follow-up scan was performed following an approximately 1-year interval. The regional ventilation and perfusion were evaluated using (133)Xe-inhalation and intravenous (99m)Tc-MAA injection, respectively. The ventilation and perfusion of the ipsilateral lung was expressed as a percentage of that of the contralateral lung. Physical growth at 1 and 2 years, and pulmonary morbidity were reviewed from medical records. The ventilation and perfusion of the ipsilateral lung at the follow-up scan increased significantly from those at the initial scan. Ten patients had pulmonary morbidity. The ventilation and perfusion of the ipsilateral lung was significantly lower in the patients with pulmonary morbidity compared to the patients without pulmonary morbidity. The initial ventilation and perfusion of the ipsilateral lung were strongly correlated with body weight at 1 and 2 years (ventilation: R = 0.503, P lung scintigraphy is useful to predict long-term pulmonary morbidity and poor nutritional status in survivors of CDH.

  6. Stomach position versus liver-to-thoracic volume ratio in left-sided congenital diaphragmatic hernia.

    Science.gov (United States)

    Cordier, Anne-Gaël; Cannie, Mieke M; Guilbaud, Lucie; De Laveaucoupet, Jocelyne; Martinovic, Jéléna; Nowakowska, Dorota; Milejska-Lewandowska, Malgorzata; Rodó, Carlota; Viaris de Lesegno, Benjamin; Votino, Carmela; Senat, Marie-Victoire; Jani, Jacques C; Benachi, Alexandra

    2015-01-01

    To describe a new grading method for stomach position (SP) in fetuses with left-sided congenital diaphragmatic hernia (L-CDH) using ultrasound and to correlate SP to liver position and to liver-to-thoracic cavity volume ratio (LiTR) using magnetic resonance imaging. SP were graded at the level of the 4-chamber view as following: grade 1-to-4 for stomach not visualised, visualised anteriorly at the apex of the heart, stomach showing abdominal structures anteriorly and stomach with its larger part posterior to the level of the atrial-ventricular heart valves, respectively. The LiTR was calculated and correlated to SP using the Mann-Whitney U test. Seventy-four fetuses were included. Median LiTR for grade 1 SP was 0% and was not different from median LiTR for grade 2 SP (0%, p=NS). Median LiTR for grade 3 SP was 14.9% and was significantly higher than for grade 2 SP (p<0.001). Similarly, median LiTR for grade 4 SP was 20.7% and was significantly higher than for grade 3 SP (p<0.05). When SP was grade 1 or 2, liver was intra-abdominal in 21 (84%) out of 25 fetuses while it was always intrathoracic for SP 3 or 4. In L-CDH, SP as described represents a simple indirect measurement of intrathoracic position and quantification of liver.

  7. Maternal hyperoxygenation test in fetuses undergoing FETO for severe isolated congenital diaphragmatic hernia.

    Science.gov (United States)

    Done, E; Allegaert, K; Lewi, P; Jani, J; Gucciardo, L; Van Mieghem, T; Gratacos, E; Devlieger, R; Van Schoubroeck, D; Deprest, J

    2011-03-01

    To predict neonatal survival and pulmonary hypertension by measurement of fetal pulmonary artery reactivity to maternal hyperoxygenation in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO). Thirty-eight fetuses underwent FETO at around 28 weeks' gestation and the balloon was removed at 34 weeks in most cases. We performed a hyperoxygenation test and measured the lung-to-head ratio of each fetus before and after each procedure. Outcome measures were neonatal survival, occurrence of pulmonary hypertension and its response to inhaled nitric oxide (iNO). Fetuses that survived had a larger increase in lung size and decrease of resistance in the first branch of the main pulmonary artery than did those that died. Both measures were also predictive of pulmonary hypertension unresponsive to iNO. The hyperoxygenation test and lung-to-head ratio were both best predictive for neonatal survival when measured following removal of the balloon (P FETO, pulmonary vascular reactivity in relation to oxygen and lung size are independent predictors of neonatal survival and pulmonary hypertension. The hyperoxygenation test merits further study in expectantly managed cases. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

  8. Use of renal near-infrared spectroscopy measurements in congenital diaphragmatic hernia patients on ECMO.

    Science.gov (United States)

    Lau, Patricio E; Cruz, Stephanie; Garcia-Prats, Joseph; Cuevas, Milenka; Rhee, Christopher; Cass, Darrell L; Horne, Sarah E; Lee, Timothy C; Welty, Stephen E; Olutoye, Oluyinka O

    2017-05-01

    This study tests the hypothesis that renal tissue oxygen saturation as measured by Near Infrared Spectroscopy (NIRS) would correlate with urine output in neonates with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO). Between 2012 and 2015, neonates with CDH were enrolled as part of a comprehensive study that provided renal/cerebral/abdominal NIRS monitoring for the duration of ECMO support. Continuous NIRS measurements, mean arterial pressure, and urine output were recorded. Periods of anuria (NU), adequate urine output >1ml/kg/h (AU), and low urine output 76% as highly predictive of adequate urine output (AUC=0.96). MAP was significantly lower only in anuric patients, 36.42±10.26, compared to patients with AU and LU - 42.99±5.25 and 42.85±7.4, respectively (p<0.001). Renal NIRS measurements correlate with urine production. Lower values are noted as urine output declines and precedes a decline in MAP. Renal NIRS may have promise as a non-invasive means of determining adequacy of renal perfusion and urine output in neonates with complex fluid shifts. IIb. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Early neonatal echocardiographic findings in an experimental rabbit model of congenital diaphragmatic hernia

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    P.H. Manso

    2015-03-01

    Full Text Available This study aimed to demonstrate that congenital diaphragmatic hernia (CDH results in vascular abnormalities that are directly associated with the severity of pulmonary hypoplasia and hypertension. These events increase right ventricle (RV afterload and may adversely affect disease management and patient survival. Our objective was to investigate cardiac function, specifically right ventricular changes, immediately after birth and relate them to myocardial histological findings in a CDH model. Pregnant New Zealand rabbits underwent the surgical procedure at 25 days of gestation (n=14. CDH was created in one fetus per horn (n=16, and the other fetuses were used as controls (n=20. At term (30 days, fetuses were removed, immediately dried and weighed before undergoing four-parameter echocardiography. The lungs and the heart were removed, weighed, and histologically analyzed. CDH animals had smaller total lung weight (P<0.005, left lung weight (P<0.005, and lung-to-body ratio (P<0.005. Echocardiography revealed a smaller left-to-right ventricle ratio (LV/RV, P<0.005 and larger diastolic right ventricle size (DRVS, P<0.007. Histologic analysis revealed a larger number of myocytes undergoing mitotic division (186 vs 132, P<0.05 in CDH hearts. Immediate RV dilation of CDH hearts is related to myocyte mitosis increase. This information may aid the design of future strategies to address pulmonary hypertension in CDH.

  10. Does overnight birth influence treatment or outcome in congenital diaphragmatic hernia?

    Science.gov (United States)

    Mills, Jessica L A; Lin, Yi; MacNab, Ying C; Skarsgard, Erik D

    2010-01-01

    We examined the effect of overnight birth on treatment and outcome (including initial cardiorespiratory stabilization) in newborns with congenital diaphragmatic hernia (CDH). CDH births between May 2005 and May 2008 were abstracted from a national CDH database. Overnight birth was defined as occurring between 8 PM and 8 AM. Patient characteristics, treatment, and outcomes were compared between birth time groups, including the subset of infants in whom a prenatal diagnosis of CDH had been made. Of 132 cases evaluated, 106 (80%) survived. Forty-nine babies (37%) were born overnight. Eighty-five infants (64%) with a prenatal diagnosis were evenly distributed between the birth time cohorts. Survival to discharge, surgical management, duration of mechanical ventilation, and length of hospital stay were comparable between the risk-matched (SNAP-II score) birth time groups. Overnight birth did predict a lower rate of cesarean section deliveries (P = 0.03). Escalation of ventilator mode, inability to achieve/maintain blood gas targets, development of pneumothorax, and need for extracorporeal membrane oxygenation were all considered "stabilization failures." Overnight birth predicted a failure to maintain or improve pH to within target range (P = 0.008). Overnight birth did not adversely affect outcome in this birth time comparison of newborns with CDH. Thieme Medical Publishers.

  11. Tracheomegaly: a complication of fetal endoscopic tracheal occlusion in the treatment of congenital diaphragmatic hernia

    Energy Technology Data Exchange (ETDEWEB)

    McHugh, Kieran; Afaq, Asim; Roebuck, Derek J. [Great Ormond Street Hospital for Children, Radiology Department, London (United Kingdom); Broderick, Nigel [Nottingham University Hospitals, Radiology Department, Nottingham (United Kingdom); Gabra, Hany O.; Elliott, Martin J. [Great Ormond Street Hospital for Children, Department of Cardiothoracic Surgery, London (United Kingdom)

    2010-05-15

    Fetal endoscopic tracheal occlusion (FETO) is a promising treatment for severe congenital diaphragmatic hernia, a condition that carries significant morbidity and mortality. It is hypothesised that balloon occlusion of the fetal trachea leads to an improvement in lung growth and development. The major documented complications of FETO to date are related to preterm delivery. To report a series of five infants who developed tracheomegaly following FETO. Review of all children referred with tracheomegaly to the paediatric intensive care and tracheal service at two referral centres. Five neonates presented with features of respiratory distress shortly after birth and were subsequently found to have marked tracheomegaly. Two neonates had tracheomalacia in addition. There are no previous reports in the literature describing tracheomalacia, or more specifically, tracheomegaly, as a consequence of FETO. We propose that the particularly compliant fetal airway is at risk of mechanical damage from in utero balloon occlusion. This observation of a new problem in this cohort suggests a thorough evaluation of the trachea should be performed in children who have had FETO in utero. It may be that balloon occlusion of the trachea earlier in utero (before 26 weeks' gestation) predisposes to this condition. (orig.)

  12. Prediction of postnatal outcomes in congenital diaphragmatic hernia using MRI signal intensity of the fetal lung.

    Science.gov (United States)

    Terui, K; Omoto, A; Osada, H; Hishiki, T; Saito, T; Sato, Y; Nakata, M; Komatsu, S; Ono, S; Yoshida, H

    2011-04-01

    Prognostic prediction in prenatally diagnosed congenital diaphragmatic hernia (CDH) is needed. The aim of the study was to evaluate magnetic resonance imaging (MRI) signal intensity of the fetal lung as a predictor of prognosis in CDH. The subjects consisted of 12 fetuses with prenatally diagnosed CDH, who were treated soon after the birth in our institution. They all underwent MRI at 29 to 37 weeks of gestation. The ratio of the lung signal intensity to the spinal fluid signal intensity (L/SF) was calculated using region-of-interest analysis of T2-weighted images. The relationship between L/SF and clinical data was then examined. L/SF were significantly larger in survivors compared with deaths (0.815 vs 0.614, P<0.05). In survivors, L/SF significantly correlated with duration of tracheal intubation (rs=-0.938, P<0.01). L/SF is a unique factor to predict the survival prognosis and likely to quantify the degree of pulmonary hypoplasia in CDH.

  13. Long-term neurodevelopmental outcomes of congenital diaphragmatic hernia survivors not treated with extracorporeal membrane oxygenation.

    Science.gov (United States)

    Frisk, Virginia; Jakobson, Lorna S; Unger, Sharon; Trachsel, Daniel; O'Brien, Karel

    2011-07-01

    Although there has been a marked improvement in the survival of children with congenital diaphragmatic hernia (CDH) in the past 2 decades, there are few reports of long-term neurodevelopmental outcome in this population. The present study examined neurodevelopmental outcomes in 10- to 16-year-old CDH survivors not treated with extracorporeal membrane oxygenation (ECMO). Parents of 27 CDH survivors completed questionnaires assessing medical problems, daily living skills, educational outcomes, behavioral problems, and executive functioning. Fifteen CDH survivors and matched full-term controls completed standardized intelligence, academic achievement, phonological processing, and working memory tests. Non-ECMO-treated CDH survivors demonstrated high rates of clinically significant difficulties on standardized academic achievement measures, and 14 of the 27 survivors had a formal diagnosis of specific learning disability, attention deficit hyperactivity disorder, or developmental disability. Specific problems with executive function, cognitive and attentional weaknesses, and social difficulties were more common in CDH patients than controls. Perioperative hypocapnia was linked to executive dysfunction, behavioral problems, lowered intelligence, and poor achievement in mathematics. Non-ECMO-treated CDH survivors are at substantial risk for neurodevelopmental problems in late childhood and adolescence. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Prolonged use of pancuronium bromide and sensorineural hearing loss in childhood survivors of congenital diaphragmatic hernia.

    Science.gov (United States)

    Cheung, P Y; Tyebkhan, J M; Peliowski, A; Ainsworth, W; Robertson, C M

    1999-08-01

    Sensorineural hearing loss (SNHL) is a significant neurologic morbidity in survivors of neonatal congenital diaphragmatic hernia (CDH), with a reported incidence of up to 60%. In a historical cohort study of 37 neonates with CDH, we investigated the use of pancuronium bromide (PB) and common ototoxic drugs during the neonatal period and their relationship to SNHL in childhood survivors. Survivors with SNHL (n = 23) had significantly higher cumulative dose of PB administered during the neonatal illness than survivors without SNHL (n = 14). The cumulative dose and duration of PB use significantly correlated (r = 0.66-0.81) and independently predicted (adjusted r (2) = 0.42-0.64) the greatest intensity (in decibels) and the widest band (lowest frequency in hertz) loss of SNHL. No differences were identified between survivors with and without SNHL regarding demographic and neonatal characteristics (including oxygenation and ventilation variables and the cumulative dose and duration of therapy with aminoglycosides, vancomycin, and furosemide), although survivors with SNHL had received a modestly higher cumulative dose of ethacrynic acid than survivors without SNHL. Although we show that prolonged administration of PB during the neonatal period is associated with SNHL in childhood survivors of CDH, further multicenter studies are required to investigate the possible etiologies of SNHL in this high-risk population.

  15. Lumbar hernia: surgical anatomy, embryology, and technique of repair.

    Science.gov (United States)

    Stamatiou, Dimitrios; Skandalakis, John E; Skandalakis, Lee J; Mirilas, Petros

    2009-03-01

    Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a defect of the posterolateral abdominal wall. Barbette was the first, in 1672, to suggest the existence of lumbar hernias. The first case was reported by Garangeot in 1731. Petit and Grynfeltt delineated the boundaries of the inferior and superior lumbar triangles in 1783 and 1866, respectively. These two anatomical sites account for about 95 per cent of lumbar hernias. Approximately 20 per cent of lumbar hernias are congenital. The rest are either primarily or secondarily acquired. The most common cause of primarily acquired lumbar hernias is increased intra-abdominal pressure. Secondarily acquired lumbar hernias are associated with prior surgical incisions, trauma, and abscess formation. During embryologic development, weakening of the area of the aponeuroses of the layered abdominal muscles that derive from somitic mesoderm, which invades the somatopleure, may potentially lead to lumbar hernias. Repair of lumbar hernias should be performed as early as possible to avoid incarceration and strangulation. The classic repair technique uses the open approach, where closure of the defect is performed either directly or using prosthetic mesh. The laparoscopic approach, either transabdominal or extraperitoneal, is an alternative.

  16. Perineal hernia: surgical anatomy, embryology, and technique of repair.

    Science.gov (United States)

    Stamatiou, Dimitrios; Skandalakis, John E; Skandalakis, Lee J; Mirilas, Petros

    2010-05-01

    Perineal hernia is the protrusion into the perineum of intraperitoneal or extraperitoneal contents through a congenital or acquired defect of the pelvic diaphragm. The first case was reported by de Garangeot in 1743. Perineal hernias may occur anteriorly or posteriorly to the superficial transverse perineal muscles. Congenital perineal hernia is a rare entity. Failure of regression of the peritoneal cul de sac of the embryo is considered a predisposing factor for hernia formation. Acquired perineal hernias are primary or secondary. Primarily acquired perineal hernias are caused by factors associated with increased intra-abdominal pressure. They are more common in females as a result of the broader female pelvis and the attenuation of the pelvic floor during pregnancy and childbirth. Secondarily acquired perineal hernias are incisional hernias associated with extensive pelvic operations such as abdominoperineal resection of the anorectum and pelvic exenteration. Pain in the perineal area, intestinal obstruction, topical skin erosion, and difficulty with urination necessitate the surgical repair of a perineal hernia. This can be accomplished through transabdominal, perineal, or combined abdominoperineal approaches. The defect in the muscles of the pelvic diaphragm may be closed either with direct suturing or by using autogenous tissues or synthetic mesh.

  17. Right cranial lung lobe torsion after a diaphragmatic rupture repair in a Jack Russell terrier

    Directory of Open Access Journals (Sweden)

    Terzo E

    2008-03-01

    Full Text Available Abstract A seven-year-old male Jack Russell terrier was presented with a history of coughing, generalised weakness and lethargy 10 days after an abdominal coeliotomy to repair a large diaphragmatic rupture. Thoracic radiographs demonstrated a soft tissue mass in the midcaudal right thoracic cavity. Ultrasonographic studies, bronchoscopy and subsequent exploratory thoracotomy confirmed a diagnosis of a right cranial lung lobe torsion (LLT, with an anomalous caudodorsal displacement of the affected lobe. LLT should be considered as a differential diagnosis for respiratory tract disease following diaphragmatic rupture repair.

  18. Laparoscopic repair of hiatal hernias: Experience after 200 consecutive cases

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    Bjelović Miloš

    2014-01-01

    Full Text Available Introduction. Repair of hiatal hernias has been performed traditionally via open laparotomy or thoracotomy. Since first laparoscopic hiatal hernia repair in 1992, this method had a growing popularity and today it is the standard approach in experienced centers specialized for minimally invasive surgery. Objective. In the current study we present our experience after 200 consecutive laparoscopic hiatal hernia repairs. Methods. A retrospective cohort study included 200 patients who underwent elective laparoscopic hiatal hernia repair at the Department for Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2004 to December 2013. Results. Hiatal hernia types included 108 (54% patients with type I, 30 (15% with type III, 62 (31% with giant paraesophageal hernia, while 27 (13.5% patients presented with a chronic gastric volvulus. There were a total of 154 (77% Nissen fundoplications. In 26 (13% cases Nissen procedure was combined with esophageal lengthening procedure (Collis-Nissen, and in 17 (8.5% Toupet fundoplications was performed. Primary retroesophageal crural repair was performed in 164 (82% cases, Cleveland Clinic Foundation suture modification in 27 (13.5%, 4 (2% patients underwent synthetic mesh hiatoplasty, 1 (0.5% primary repair reinforced with pledgets, and 4 (2% autologous fascia lata graft reinforcement. Poor result with anatomic and symptomatic recurrence (indication for revisional surgery was detected in 5 patients (2.7%. Conclusion. Based on the result analysis, we found that laparoscopic hiatal hernia repair was a technically challenging but feasible technique, associated with good to excellent postoperative outcomes comparable to the best open surgery series.

  19. Strangulated Morgagni’s Hernia: A Rare Diagnosis and Management

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    Malav Modi

    2016-01-01

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

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

    Science.gov (United States)

    Mate, Ajay; Rege, Samir

    2016-01-01

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

  1. Laparoscopic Morgagni hernia repair: how I do it.

    Science.gov (United States)

    Park, Adrian; Doyle, Courtney

    2014-10-01

    Surgical repair of Morgagni hernias is recommended given their historically high risk of incarceration. Traditionally, such repair has been undertaken via laparotomy or thoracotomy or more recently, thoracoscopically or laparoscopically using mesh. Here, we describe a laparoscopic approach to the management of Morgagni hernias achieving a primary tissue repair without mesh implantation. This technique allows for the general benefits of minimally invasive surgery, such as less postoperative pain, reduced wound complications, decreased duration of the hospital stay, as well as offering an alternative to mesh implantation and its associated potential complications.

  2. Biology of biological meshes used in hernia repair.

    Science.gov (United States)

    Novitsky, Yuri W

    2013-10-01

    Successful repair of most hernias requires the use of a prosthetic implant for reinforcement of the defect. Because of the need for prosthetic implants to resist infections as well to support repairs in contaminated or potentially contaminated fields, biological meshes have been developed to take the place of nondegradable synthetic meshes in cases where mesh infection is of high concern. The ideal is a biological matrix that resists infection while providing durable reinforcement of a hernia repair. This article reviews the validity of assumptions that support the purported notion of the biological behavior of biological meshes.

  3. Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study

    DEFF Research Database (Denmark)

    Jess, P; Schultz, Karen; Bendtzen, K

    2000-01-01

    To see if the inflammatory responses during and after laparoscopic and open inguinal hernia repairs differed.......To see if the inflammatory responses during and after laparoscopic and open inguinal hernia repairs differed....

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

    Directory of Open Access Journals (Sweden)

    Grella Roberto

    2015-01-01

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

  5. An animal model to train Lichtenstein inguinal hernia repair

    DEFF Research Database (Denmark)

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

    2013-01-01

    PURPOSE: Inguinal hernia repair is a common surgical procedure, and the majority of operations worldwide are performed ad modum Lichtenstein (open tension-free mesh repair). Until now, no suitable surgical training model has been available for this procedure. We propose an experimental surgical...... training model for Lichtenstein's procedure on the male and female pig. METHODS: In the pig, an incision is made 1 cm cranially to the inguinal sulcus where a string of subcutaneous lymph nodes is located and extends toward the pubic tubercle. The spermatic cord is located in a narrow sulcus in the pig...... 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...

  6. Standardized measurement of quality of life after incisional hernia repair

    DEFF Research Database (Denmark)

    Jensen, Kristian K; Henriksen, Nadia A; Harling, Henrik

    2014-01-01

    repair. The aim of this systematic review was to analyze existing standardized methods to measure quality of life after incisional hernia repair. DATA SOURCES: A PubMed and Embase search was carried out together with a cross-reference search of eligible papers, giving a total of 26 included studies...

  7. Incisional, epigastric and umbilical hernia repair using the Prolene Hernia System: describing a novel technique.

    Science.gov (United States)

    Khera, Goldie; Berstock, David A

    2006-08-01

    The Prolene Hernia System (PHS) is already widely in use in the United Kingdom for inguinal hernias. We describe the novel technique of using the three-in-one design of the PHS (Ethicon Endo-Surgery, Bracknell, UK) for repairing incisional, epigastric and umbilical herniae. This is a three-dimensional device and consists of an onlay patch, a tubular connector and an underlay patch. We recommend a four 'corner' suturing of the underlay patch under vision (and then) through the full thickness of abdominal wall layers to ensure a flat underlay mesh. These four sutures flatten out the underlay patch and can be tied or removed with equal effect. The sutures are placed at 3, 6, 9 and 12 o'clock, which simplifies the procedure and ensures that the underlay lays correctly and is corrugation-free and tension-free, thereby providing a two-layer repair for those herniae with a high rate of recurrence.

  8. Spigelian hernia: surgical anatomy, embryology, and technique of repair.

    Science.gov (United States)

    Skandalakis, Panagiotis N; Zoras, Odyseas; Skandalakis, John E; Mirilas, Petros

    2006-01-01

    Spigelian hernia (1-2% of all hernias) is the protrusion of preperitoneal fat, peritoneal sac, or organ(s) through a congenital or acquired defect in the spigelian aponeurosis (i.e., the aponeurosis of the transverse abdominal muscle limited by the linea semilunaris laterally and the lateral edge of the rectus muscle medially). Mostly, these hernias lie in the "spigelian hernia belt," a transverse 6-cm-wide zone above the interspinal plane; lower hernias are rare and should be differentiated from direct inguinal or supravescical hernias. Although named after Adriaan van der Spieghel, he only described the semilunar line (linea Spigeli) in 1645. Josef Klinkosch in 1764 first defined the spigelian hernia as a defect in the semilunar line. Defects in the aponeurosis of transverse abdominal muscle (mainly under the arcuate line and more often in obese individuals) have been considered as the principal etiologic factor. Pediatric cases, especially neonates and infants, are mostly congenital. Embryologically, spigelian hernias may represent the clinical outcome of weak areas in the continuation of aponeuroses of layered abdominal muscles as they develop separately in the mesenchyme of the somatopleura, originating from the invading and fusing myotomes. Traditionally, repair consists of open anterior herniorraphy, using direct muscle approximation, mesh, and prostheses. Laparoscopy, preferably a totally extraperitoneal procedure, or intraperitoneal when other surgical repairs are planned within the same procedure, is currently employed as an adjunct to diagnosis and treatment of spigelian hernias. Care must be taken not to create iatrogenic spigelian hernias when using laparoscopy trocars or classic drains in the spigelian aponeurosis.

  9. Emergency repair of Morgagni hernia with partial gastric volvulus: our approach.

    Science.gov (United States)

    Razi, Kasra; Light, Duncan; Horgan, Liam

    2016-08-31

    Morgagni hernias are a rare form of congenital diaphragmatic hernias, thus there is paucity in literature about the diagnosis and management of the condition. We report an 83-year-old woman who presented with vomiting and a metabolic acidosis with a previous computed tomography diagnosis of Bochdalek's hernia. Diagnostic laparoscopy revealed a Morgagni hernia containing transverse colon, greater curvature of the stomach and a partial gastric volvulus. The hernia was reduced with the sac untouched, and the defect was closed with a composite mesh using tac fixation. The operation was done successfully in 45 minutes with no complications.

  10. Emergency inguinal hernia repair under local anesthesia: a 5-year experience in a teaching hospital

    OpenAIRE

    2016-01-01

    Background Local anesthesia (LA) has been reported to be the best choice for elective open inguinal hernia repair because it is cost efficient, with less post-operative pain and enables more rapid recovery. However, the role of LA in emergency inguinal hernia repair is still controversial. The aim of this study is to investigate the safety and effectiveness of LA in emergency inguinal hernia repair. Methods All patients underwent emergency inguinal hernia repair in our hospital between Januar...

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

    Science.gov (United States)

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

    2012-08-01

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

  12. Prolene Hernia System in the Tension-Free Repair of Primary Inguinal Hernias

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    Jayesh Gohel

    2012-06-01

    Full Text Available Objective: The aim of this study was to determine the feasibility of using the Prolene (polypropylene Hernia System for open tension-free repair on inguinal hernias, and study the results in terms of operation time, patient comfort, hospital stay, return to normal activity and postoperative complications. Material and Methods: From February 2002 through April 2003, we performed 50 open tension-free hernia repairs on 47 patients (46 men, 1 woman with a mean age of 55.8 years. There were 26 right and 18 left hernias, and 3 were bilateral. Of these, 39 were direct, 10 were indirect and 1 was femoral type. All were primary hernias. Results: The duration of surgery averaged 35 minutes (range 20 to 90 min. There was no perioperative mortality. Four patients developed mild self-limiting neuralgias. There were no subcutaneous wound infections, no haematomas, no seromas and no testicular atrophy. The average duration of postoperative hospitalisation was 3.5 days. The length of follow-up ranged from 1 month to 15 months (mean= 6.24 months. We have had no recurrences so far. Conclusion: The Prolene Hernia System is a novel approach in the management of inguinal hernias, with encouraging initial results. Its long-term efficacy needs to be studied with larger, prospective double-blind randomized trials, with longer follow-up. [National J of Med Res 2012; 2(3.000: 302-305

  13. Scar endometriosis developing after an umbilical hernia repair with mesh.

    Science.gov (United States)

    Majeski, James; Craggie, James

    2004-05-01

    A 44-year-old female was initially evaluated for a 3-cm umbilical hernia, which developed after a laparoscopic myomectomy performed seven years prior. The umbilical hernia was repaired using a synthetic mesh. Eight months after the umbilical hernia repair, the patient returned with chronic pain in a 3-cm raised mass originating from the umbilical hernia repair incision. The mass and mesh were surgically removed. The umbilical fascial defect was repaired with a primary fascia-to-fascia closure and the umbilicus was reconstructed from adjacent skin. The mass was found histologically to be endometriosis and fascial scarring with a foreign body reaction to synthetic mesh. Umbilical endometriosis developed either from peritoneal endometrial seeding from a laparoscopic myomectomy or from metaplasia of multipotential cells, which developed into endometriosis due to inflammatory stimulation by the synthetic mesh. Synthetic mesh probably should be avoided in the surgical repair of a laparoscopically caused umbilical hernia in a premenopausal female especially if there is a history of pelvic endometriosis.

  14. 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...... 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...

  15. Laparoscopic Repair of Sportman's Hernia - The Trinidad Experience.

    Science.gov (United States)

    Gopeesingh, Anyl; Dan, Dilip; Naraynsingh, Vijay; Hariharan, Seetharaman; Seetahal, Shiva

    2014-01-01

    Sportman's hernia: (Athletic pubalgia) is an uncommon and poorly understood condition afflicting athletic individuals. Sufferers complain of chronic groin pain and often present diagnostic dilemmas to physicians and physiotherapists. We present a series of cases illustrating the varying presentations of sportman's hernia and diagnostic approaches that can be utilized to exclude common differentials. We also describe laparoscopic mesh repair as an effective treatment option for this condition.

  16. RESULTS OF INGUINAL HERNIA REPAIRS PERFORMED UNDER LOCAL ANESTHSEIA

    OpenAIRE

    2001-01-01

    Aim: The aim of this study was to investigate the results of inguinal hernia repairs performed under local anesthesia with respect to operation duration, hospitalization period, postoperative complications, need for analgesics, and duration for recovery to normal life style. Material and Methods: Patients admitted to our hospital between January 1998 to January 2001 with diagnose of inguinal hernia were involved in this study. Of these patients whose with cardiovasculary and respiratory prob...

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

    Science.gov (United States)

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

    2015-01-01

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

  18. The Surgical Results of Onlay Mesh Repair for Incisional Hernia

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    Bülent Kaya

    2012-10-01

    Full Text Available Aim: İncisional hernia after abdominal surgery is an important problem. We aimed to evaluate the longterm recurrence rate as well as surgical complications in patients operated with onlay mesh repair technique for incisional hernia. Material and Method: We studied a serial of 139 patients retrospectively, operated due to incisional hernia in between January 2001 to November 2009 in Vakıf Gureba Training and Research Hospital General Surgery Department. The patient’s age, sex, location and size of the defect, operation findings, duration of hospitalization, early and late complications and recurrences were recorded. Result: There were 56 men and 83 women inour serial. The mean age was 55 (age range, 30-85 years. The most commonincisions that hernia had been developed were upper midline incision (51 patients and lower midline incision (37 patients. The size of the hernia defect was 0-5 cm in 118 patients , 6-10 cm in 5 patients 11-15 cm in 12 patients, and above 15 cm in 4 patients. The postoperative complications were wound infection in 22 patients, seroma in 12 patients. The mean duration of hospital stay was 4.53 (range 1-10 days. The recurrence was detected in 6 patients. Discussion: It seems to be that onlay mesh repair is safe and effective technique for incisional hernia repair.

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

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    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.

  20. Local Fetal Lung Renin-Angiotensin System as a Target to Treat Congenital Diaphragmatic Hernia

    Science.gov (United States)

    Nogueira-Silva, Cristina; Carvalho-Dias, Emanuel; Piairo, Paulina; Nunes, Susana; Baptista, Maria J; Moura, Rute S; Correia-Pinto, Jorge

    2012-01-01

    Antenatal stimulation of lung growth is a reasonable approach to treat congenital diaphragmatic hernia (CDH), a disease characterized by pulmonary hypoplasia and hypertension. Several evidences from the literature demonstrated a possible involvement of renin-angiotensin system (RAS) during fetal lung development. Thus, the expression pattern of renin, angiotensin-converting enzyme, angiotensinogen, type 1 (AT1) and type 2 (AT2) receptors of angiotensin II (ANGII) was assessed by immunohisto-chemistry throughout gestation, whereas the function of RAS in the fetal lung was evaluated using fetal rat lung explants. These were morphometrically analyzed and intracellular pathway alterations assessed by Western blot. In nitrofen-induced CDH model, pregnant rats were treated with saline or PD-123319. In pups, lung growth, protein/DNA ratio, radial saccular count, epithelial differentiation and lung maturation, vascular morphometry, right ventricular hypertrophy and overload molecular markers, gasometry and survival time were evaluated. Results demonstrated that all RAS components were constitutively expressed in the lung during gestation and that ANGII had a stimulatory effect on lung branching, mediated by AT1 receptor, through p44/42 and Akt phosphorylation. This stimulatory effect on lung growth was mimicked by AT2-antagonist (PD-123319) treatment. In vivo antenatal PD-123319 treatment increased lung growth, ameliorated indirect parameters of pulmonary hypertension, improved lung function and survival time in nonventilated CDH pups, without maternal or fetal deleterious effects. Therefore, this study demonstrated a local and physiologically active RAS during lung morphogenesis. Moreover, selective inhibition of AT2 receptor is presented as a putative antenatal therapy for CDH. PMID:22113494

  1. Neurotrophins expression is decreased in lungs of human infants with congenital diaphragmatic hernia

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    O'Hanlon LD

    2014-02-01

    Full Text Available Lynn D O'Hanlon, Sherry M Mabry, Ikechukwu I EkekezieChildren's Mercy Hospitals/University of Missouri-Kansas City School of Medicine, Department of Pediatrics, Section of Neonatal-Perinatal Medicine, Kansas City, MO, USAObjectives: To evaluate neurotrophin (NT (nerve growth factor [NGF], NT-3, and brain-derived neurotrophic factor [BDNF] expression in autopsy lung tissues of human congenital diaphragmatic hernia (CDH infants versus that of infants that expired with: 1 "normal" lungs (controls; 2 chronic lung disease (CLD; and 3 pulmonary hypertension (PPHN.Hypothesis: NT expression will be significantly altered in CDH lung tissue compared with normal lung tissue and other neonatal lung diseases.Study design: Immunohistochemical studies for NT proteins NGF, BDNF, and NT-3 were applied to human autopsy neonatal lung tissue samples.Subject selection: The samples included a control group of 18 samples ranging from 23-week gestational age to term, a CDH group of 15 samples, a PPHN group of six samples, and a CLD group of 12 samples.Methodology: The tissue samples were studied, and four representative slide fields of alveoli/saccules and four of bronchioles were recorded from each sample. These slide fields were then graded (from 0 to 3 by three blinded observers for intensity of staining.Results: BDNF, NGF, and NT-3 immunostaining intensity scores were significantly decreased in the CDH lung tissue (n=15 compared with normal neonatal lung tissue (n=18 (P<0.001. The other neonatal pulmonary diseases that were studied, CLD and PPHN, were much less likely to be affected and were much more variable in their neurotrophin expression.Conclusion: NT expression is decreased in CDH lungs. The decreased expression of NT in CDH lung tissue may suggest they contribute to the abnormality in this condition.Keywords: nerve growth factor, NGF, brain-derived neurotrophic factor, BDNF, neurotrophin-3, NT-3, chronic lung disease, persistent pulmonary hypertension, lung

  2. Physical activity, fitness, and dyspnea perception in children with congenital diaphragmatic hernia.

    Science.gov (United States)

    Turchetta, Attilio; Fintini, Danilo; Cafiero, Giulia; Calzolari, Armando; Giordano, Ugo; Cutrera, Renato; Morini, Francesco; Braguglia, Annabella; Bagolan, Pietro

    2011-10-01

    We assessed whether physical activity could influence the performance and perception of dyspnea in children who were operated on for high risk congenital diaphragmatic hernia (CDH). We hypothesized that CDH children with normal activity would have better lung function and exercise performance level when compared to sedentary CDH subjects. We studied 18 children (11 males and 7 females, mean age 6.6 ± 2.6 years) who were surgically corrected. All children underwent physical examination, ECG at rest, and a maximal exercise stress test on a treadmill to measure the duration of exercise, maximal heart rate and blood pressure, maximal oxygen uptake (VO(2)  max and VO(2)  ml/kg/min). Lung function testing to measure forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV(1) ), and peak expiratory flow (PEF) was also performed. Following the stress test, the Dalhousie dyspnea and effort scale was shown to children as a pictorial panel with three groups of increasing (from 1 to 7) levels of effort perception, throat discomfort, and chest dyspnea. Children were divided into group A (sedentary) and group B (regular physical participation). There was no difference in CDH severity between the two groups. Group A had a statistically significant lower duration of exercise (P < 0.01), maximal oxygen consumption (VO(2)  max P < 0.0001), VO(2)  ml/kg/min (P < 0.001), higher throat closing feeling (P < 0.004), chest dyspnea (P < 0.001), and effort perception (P < 0.04) compared to group B. No differences were found in lung function tests. In conclusion, our data may suggest that children with a history of CDH who are active maintain a higher level of performance with less perception of dyspnea and effort.

  3. Late-presenting congenital diaphragmatic hernia in children: a literature review

    Energy Technology Data Exchange (ETDEWEB)

    Baglaj, Maciej [Wroclaw Medical University, Department of Pediatric Surgery, Wroclaw (Poland); Dorobisz, Urszula [Wroclaw Medical University, Department of Radiology, Wroclaw (Poland)

    2005-05-01

    This is a review of 122 articles published until December 2003 that describe 349 children with late-presenting postero-lateral congenital diaphragmatic hernia (CDH). Data regarding pre-operative diagnostic work-up were adequately reported in 177 patients with left CDH and in 41 with a right-sided defect. Chest radiography was the only diagnostic study in 92 (51.9%) children from the former group and in 17 (43.9%) from the latter group. In other patients, diagnostic work-up encompassed various combinations of two or more imaging modalities. Apart from chest radiography, contrast study of the upper gastrointestinal tract was the most frequently performed imaging modality. In 88 (25.2%) children, initial radiographic features of CDH were misinterpreted. Pneumothorax and pleural effusion were the most common initial findings. Analysis of the hernial content in this group of patients has shown that herniation of the stomach, spleen or omentum should be regarded as risk factors for misdiagnosis of left CDH, whereas for right CDH, the risk factor is the presence of liver in the chest. Late-presenting CDH may pose a significant diagnostic problem because of the great variability of radiographic appearance. Chest radiography following passage of a nasogastric tube and contrast studies of the gastrointestinal tract seem to be the most useful investigations for the diagnosis of left CDH. For patients with right CDH, owing to the high probability of liver herniation, a chest radiograph with liver scintigraphy or CT seems to be the best diagnostic option. (orig.)

  4. BMP4 and LGL1 are Down Regulated in an Ovine Model of Congenital Diaphragmatic Hernia

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    Heather eEmmerton-Coughlin

    2014-11-01

    Full Text Available Background/Purpose: The molecular pathophysiology of lung hypoplasia in congenital diaphragmatic hernia (CDH remains poorly understood. The Wnt signaling pathway and downstream targets, such as bone morphogenetic proteins (BMP 4 and other factors such as late gestation lung protein 1 (LGL1, are essential to normal lung development. Nitrofen-induced hypoplastic CDH rodent lungs demonstrate down regulation of the Wnt pathway including BMP4 and reduced LGL1 expression. The aim of the current study was to examine the molecular pathophysiology associated with a surgically induced CDH in an ovine model. Methods: Left thoracotomy was performed at 80 days in 14 fetal sheep; CDH was created in 7 experimental animals. Lungs were harvested at 136 days (term=145d. Lung weight and mean terminal bronchiole density (MTBD were measured to determine the degree of pulmonary hypoplasia. Quantitative real time PCR was undertaken to analyze Wnt2, Wnt7b, BMP4 and LGL1 mRNA expression. Results: Total lung weight was decreased while MTBD was increased in the CDH group (p<0.05, confirming pulmonary hypoplasia. BMP4 and LGL1 mRNA was significantly reduced in CDH lungs (p<0.05. Wnt2 mRNA was decreased, although not significantly (p<0.06. Conclusions: For the first time, down regulation of BMP4 and Lgl1 are reported in an ovine CDH model. In contrast to other animal models, these changes are persistent to near term. These findings suggest that mechanical compression from herniated viscera may play a more important role in causing pulmonary hypoplasia in CDH, rather than a primary defect in lung organogenesis.

  5. Developmental outcomes of children with congenital diaphragmatic hernia: a multicenter prospective study.

    Science.gov (United States)

    Wynn, Julia; Aspelund, Gudrun; Zygmunt, Annette; Stolar, Charles J H; Mychaliska, George; Butcher, Jennifer; Lim, Foong-Yen; Gratton, Teresa; Potoka, Douglas; Brennan, Kate; Azarow, Ken; Jackson, Barbara; Needelman, Howard; Crombleholme, Timothy; Zhang, Yuan; Duong, Jimmy; Arkovitz, Marc S; Chung, Wendy K; Farkouh, Christiana

    2013-10-01

    To determine developmental outcomes and associated factors in patients with congenital diaphragmatic hernia (CDH) at 2 years of age. This is a multicenter prospective study of a CDH birth cohort. Clinical and socioeconomic data were collected. Bayley Scales of Infant Development (BSID-III) and Vineland Adaptive Behavior Scales (VABS-II) were performed at 2 years of age. BSID-III and VABS-II assessments were completed on 48 and 49 children, respectively. The BSID-III mean cognitive, language, and motor scores were significantly below the norm mean with average scores of 93 ± 15, 95 ± 16, and 95 ± 11. Ten percent (5/47) scored more than 2 standard deviations below the norm on one or more domains. VABS-II scores were similar to BSID-III scores with mean communication, daily living skills, social, motor, adaptive behavior scores of 97 ± 14, 94 ± 16, 93 ± 13, 97 ± 10, and 94 ± 14. For the BSID-III, supplemental oxygen at 28 days, a prenatal diagnosis, need for extracorporeal membrane oxygenation (ECMO) and exclusive tube feeds at time of discharge were associated with lower scores. At 2 years of age, history of hospital readmission and need for tube feeds were associated with lower scores. Lower socioeconomic status correlated with lower developmental scores when adjusted for significant health factors. CDH patients on average have lower developmental scores at 2 years of age compared to the norm. A need for ECMO, oxygen at 28 days of life, ongoing health issues and lower socioeconomic status are factors associated with developmental delays. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Congenital diaphragmatic hernia prevents absorption of distal air space fluid in late-gestation rat fetuses.

    Science.gov (United States)

    Folkesson, Hans G; Chapin, Cheryl J; Beard, Lamonta L; Ertsey, Robert; Matthay, Michael A; Kitterman, Joseph A

    2006-03-01

    We hypothesized that congenital diaphragmatic hernia (CDH) may decrease distal air space fluid absorption due to immaturity of alveolar epithelial cells from a loss of the normal epithelial Na+ transport, as assessed by amiloride and epithelial Na+ channel (ENaC) and Na-K-ATPase expression, as well as failure to respond to endogenous epinephrine as assessed by propranolol. Timed-pregnant dams were gavage fed 100 mg of nitrofen at 9.5-day gestation to induce CDH in the fetuses, and distal air space fluid absorption experiments were carried out on 22-day gestation (term) fetuses. Controls were nitrofen-exposed fetuses without CDH. Absorption of distal air space fluid was measured from the increase in 131I-albumin concentration in an isosmolar, physiological solution instilled into the developing lungs. In controls, distal air space fluid absorption was rapid and mediated by beta-adrenoceptors as demonstrated by reversal to fluid secretion after propranolol. Normal lung fluid absorption was also partially inhibited by amiloride. In contrast, CDH fetuses continued to show lung fluid secretion, and this secretion was not affected by either propranolol or amiloride. CDH lungs showed a 67% reduction in alpha-ENaC and beta-ENaC expression, but no change in alpha1-Na-K-ATPase expression. These studies demonstrate: 1) CDH delays lung maturation with impaired distal air space fluid absorption secondary to inadequate Na+ uptake by the distal lung epithelium that results in fluid-filled lungs at birth with reduced capacity to establish postnatal breathing, and 2) the main stimulus to lung fluid absorption in near-term control fetuses, elevated endogenous epinephrine levels, is not functional in CDH fetuses.

  7. Comparison between late-presenting and isolated neonatal congenital diaphragmatic hernias

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    Christos Plataras

    2011-01-01

    Full Text Available Purpose: Late-presenting posterolateral congenital diaphragmatic hernias (CDH are anatomically similar to isolated neonatal CDH but are diagnosed and treated after the first month of life. We aim to characterise the clinical manifestations and short-term postoperative course of this entity and compare it with isolated CDH of the neonatal period. Materials and Methods: In the 30-year period from 1980 to 2010, 116 children with CDH were treated at the Aghia Sophia Children′s Hospital, Athens, Greece. Twenty-three (19% of these children were late-presenting cases, being diagnosed between the ages of 1 month and 4 years. Ninety-three were neonatal cases, of whom 22 (24% were excluded due to severe associated anomalies, leaving 71 cases of isolated neonatal CDH. We compared these two groups of patients with regard to preoperative symptoms, postoperative hospital stay, time to complete feeding, overall complication rate, and reoperation rate. Results: Isolated neonatal cases presented more often with acute respiratory symptoms (n=25; P= 0.016 and failure to thrive (n= 38; P= 0.03. Late-presenting cases presented more often with chronic respiratory symptoms (n=14;P= 0.0044 or gastrointestinal symptoms (n=12; P= 0.006. Thirty-five cases with minor or serious complications were reported in the neonatal group, whereas only five complications were observed in the late-presenting group (P= 0.028. We did not record any recurrences or reoperations in the late-presenting group, but we had two recurrences and three reoperations in the neonatal group. Time to full feeds and postoperative hospital stay was shorter in the late-presenting group. Conclusions: Our data demonstrate differences between the two groups in preoperative symptoms and short-term postoperative complications and short-term outcome. Late-presenting cases of CDH had a greater number of chronic symptoms preoperatively, more favorable postoperative outcomes, and less recurrences and reoperations.

  8. VEGF receptor expression decreases during lung development in congenital diaphragmatic hernia induced by nitrofen

    Energy Technology Data Exchange (ETDEWEB)

    Sbragia, L. [Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil, Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Nassr, A.C.C. [Departamento de Hidrobiologia do Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos, São Carlos, SP, Brasil, Departamento de Hidrobiologia do Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos, São Carlos, SP (Brazil); Gonçalves, F.L.L. [Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil, Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Schmidt, A.F. [Pediatrics House Office, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH, USA, Pediatrics House Office, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Zuliani, C.C. [Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP (Brazil); Garcia, P.V. [Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, Campinas, SP, Brasil, Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, Campinas, SP (Brazil); Gallindo, R.M. [Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil, Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Pereira, L.A.V. [Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, Campinas, SP, Brasil, Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, Campinas, SP (Brazil)

    2014-02-17

    Changes in vascular endothelial growth factor (VEGF) in pulmonary vessels have been described in congenital diaphragmatic hernia (CDH) and may contribute to the development of pulmonary hypoplasia and hypertension; however, how the expression of VEGF receptors changes during fetal lung development in CDH is not understood. The aim of this study was to compare morphological evolution with expression of VEGF receptors, VEGFR1 (Flt-1) and VEGFR2 (Flk-1), in pseudoglandular, canalicular, and saccular stages of lung development in normal rat fetuses and in fetuses with CDH. Pregnant rats were divided into four groups (n=20 fetuses each) of four different gestational days (GD) 18.5, 19.5, 20.5, 21.5: external control (EC), exposed to olive oil (OO), exposed to 100 mg nitrofen, by gavage, without CDH (N-), and exposed to nitrofen with CDH (CDH) on GD 9.5 (term=22 days). The morphological variables studied were: body weight (BW), total lung weight (TLW), left lung weight, TLW/BW ratio, total lung volume, and left lung volume. The histometric variables studied were: left lung parenchymal area density and left lung parenchymal volume. VEGFR1 and VEGFR2 expression were determined by Western blotting. The data were analyzed using analysis of variance with the Tukey-Kramer post hoc test. CDH frequency was 37% (80/216). All the morphological and histometric variables were reduced in the N- and CDH groups compared with the controls, and reductions were more pronounced in the CDH group (P<0.05) and more evident on GD 20.5 and GD 21.5. Similar results were observed for VEGFR1 and VEGFR2 expression. We conclude that N- and CDH fetuses showed primary pulmonary hypoplasia, with a decrease in VEGFR1 and VEGFR2 expression.

  9. Local fetal lung renin-angiotensin system as a target to treat congenital diaphragmatic hernia.

    Science.gov (United States)

    Nogueira-Silva, Cristina; Carvalho-Dias, Emanuel; Piairo, Paulina; Nunes, Susana; Baptista, Maria J; Moura, Rute S; Correia-Pinto, Jorge

    2012-03-27

    Antenatal stimulation of lung growth is a reasonable approach to treat congenital diaphragmatic hernia (CDH), a disease characterized by pulmonary hypoplasia and hypertension. Several evidences from the literature demonstrated a possible involvement of renin-angiotensin system (RAS) during fetal lung development. Thus, the expression pattern of renin, angiotensin-converting enzyme, angiotensinogen, type 1 (AT₁) and type 2 (AT₂) receptors of angiotensin II (ANGII) was assessed by immunohisto-chemistry throughout gestation, whereas the function of RAS in the fetal lung was evaluated using fetal rat lung explants. These were morphometrically analyzed and intracellular pathway alterations assessed by Western blot. In nitrofen-induced CDH model, pregnant rats were treated with saline or PD-123319. In pups, lung growth, protein/DNA ratio, radial saccular count, epithelial differentiation and lung maturation, vascular morphometry, right ventricular hypertrophy and overload molecular markers, gasometry and survival time were evaluated. Results demonstrated that all RAS components were constitutively expressed in the lung during gestation and that ANGII had a stimulatory effect on lung branching, mediated by AT₁ receptor, through p44/42 and Akt phosphorylation. This stimulatory effect on lung growth was mimicked by AT₂-antagonist (PD-123319) treatment. In vivo antenatal PD-123319 treatment increased lung growth, ameliorated indirect parameters of pulmonary hypertension, improved lung function and survival time in nonventilated CDH pups, without maternal or fetal deleterious effects. Therefore, this study demonstrated a local and physiologically active RAS during lung morphogenesis. Moreover, selective inhibition of AT₂ receptor is presented as a putative antenatal therapy for CDH.

  10. [Azoospermia and a history of inguinal hernia repair in adult].

    Science.gov (United States)

    Khodari, M; Ouzzane, A; Marcelli, F; Yakoubi, R; Mitchell, V; Zerbib, P; Rigot, J-M

    2015-10-01

    Inguinal hernia repair is one of the most performed surgeries in the world. It is recognized that any surgery of the pelvic floor may represent a risk factor of male infertility. Retrospective study of patients with azoospermia and a history of adult inguinal hernia repair surgery and referred to our center between January 1990 and January 2011 for infertility. Among 69 azoospermia patients with history of adult inguinal hernia repair surgery, 60 patients underwent surgical extraction of sperm that was successful in 75% (45/60). Positive extraction rate decreases in the subgroup of patients with risk factors for infertility (61.4%) as well as in the group with bilateral inguinal hernia (67.9%). There was no statistically significant difference in the positive rate of sperm retrieval according to surgical technique or according to the use of polypropylene mesh (P>0.05). The obstruction of the vas deferens due to an inguinal hernia repair was a potential iatrogenic cause of male infertility that was rare and underestimated. The influence of using a polypropylene mesh was not clearly demonstrated. The management of these patients is based on prevention in order to identify patients with risk factors of infertility in order to propose a presurgery cryopreservation of sperm. 5. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Current status of laparoscopic inguinal hernia repair in Denmark

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Bay-Nielsen, M

    2008-01-01

    BACKGROUND: Laparoscopic inguinal hernia repair is becoming more common in many countries, but the quality of care, experience of the operating surgeon, and details of the surgical technique are not known in detail on a national level in Denmark. In a period of expanding surgical volume for lapar......BACKGROUND: Laparoscopic inguinal hernia repair is becoming more common in many countries, but the quality of care, experience of the operating surgeon, and details of the surgical technique are not known in detail on a national level in Denmark. In a period of expanding surgical volume...... for laparoscopic inguinal hernia repair, it is important to know the typical indications for surgery, re-operation rates, details of surgical technique, and status of surgical training on a national level in order to rationalize interventions to improve outcome. METHODS: Data from the National Hernia Database...... for the last 8 years regarding laparoscopic inguinal hernia repair were used in combination with questionnaire data obtained from all surgical units in Denmark. The questionnaire included issues such as the number of operating surgeons in the department, number of residents training in the laparoscopic...

  12. [Laparoscopic inguinal hernia repair "IPOM" with Dual-Mesh].

    Science.gov (United States)

    Catani, M; De Milito, R; Materia, A; Chiaretti, M; Spaziani, E; Manili, G; Simi, M

    2003-01-01

    The authors report their experience on laparoscopic hernioplasty using the Intraperitoneal Onlay Mesh Repair (IPOM) in 56 patients. 34 patients had a bilateral hernia, 6 of which were recurrent and 22 had a monolateral hernia, of which 9 had recurrent hernia. Overall, a total of 90 hernias were treated. The hernia repair was performed utilizing "GORE-TEX DualMesh Plus biomaterial with holes" in the first 32 cases and the latest "...Corduroy" type in the remaining 24 cases. The prostheses were fixed with titanium spiral tacks (Protack, AutoSuture, Tyco Healthcare). No intraoperative complications occurred and no conversion was necessary. Five minor post-operative complications (5.5%), 2 seromas and 3 transient paresthesias, were observed. Four patients (7.1%) needed analgesics after the first 24 hours. Mean hospital stay was 36 hours, with a minimum of 24 and a maximum of 48. Mean resumption of normal activity was 8 days with return to work within two weeks. At an average 18 months follow-up, 3 recurrences were recorded (3.3%). The results of this study as well as the meta-analysis of the series presented in the Literature, indicate that the IPOM may be a feasible, safe and effective procedure in the treatment of recurrent and bilateral hernias or when a hernia repair is performed during other laparoscopic procedures. The IPOM has infact been shown to be faster and easier than the other more commonly performed laparoscopic hernioplasties (TAPP and TEP). These data may also suggest to utilize this technique in particular cases of primitive hernia such as very active young males or heavy duty workers. However the limited series and the short follow-up ask for randomized prospective long term studies to definitely ascertain the true incidence of recurrence and therefore the effectiveness of this attractive procedure.

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

    Directory of Open Access Journals (Sweden)

    Takeshi Matsutani

    2016-01-01

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

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

    Science.gov (United States)

    Nomura, Tsutomu; Matsuda, Akihisa; Takao, Yoshimune

    2016-01-01

    Purpose. To evaluate the feasibility, safety, and effectiveness of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using a memory-ring patch (Polysoft™ mesh). Patients and Methods. Between April 2010 and March 2013, a total of 76 inguinal hernias underwent TAPP repair using Polysoft mesh in 67 adults under general anesthesia. Three different senior resident surgeons performed TAPP repair under the instruction of a specialist surgeon. Nine patients had bilateral hernias. The 76 hernias included 37 indirect inguinal hernias, 29 direct hernias, 1 femoral hernia, 1 pantaloon hernia (combined direct/indirect inguinal hernia), and 8 recurrent hernias after open anterior hernia repair. The immediate postoperative outcomes as well as the short-term outcomes (mainly recurrence and incidence of chronic pain) were studied. Results. There was no conversion from TAPP repair to anterior open repair. The mean operation time was 109 minutes (range, 40–132) for unilateral hernia repair. Scrotal seroma was diagnosed at the operation site in 5 patients. No patient had operation-related orchitis, testicle edema, trocar site infection, or chronic pain during follow-up. Conclusions. The use of Polysoft mesh for TAPP inguinal hernia repair does not seem to adversely affect the quality of repair. The use of this mesh is therefore feasible and safe and may reduce postoperative pain. PMID:27635414

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

    Science.gov (United States)

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

    2014-10-01

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

  16. INTRAOPERATIVE PNEUMOTHORAX COMPLICATING TOTALLY EXTRAPERITONEAL INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Charulatha

    2015-07-01

    Full Text Available Laparoscopic inguinal hernia repair compared with open procedure is associated with reduced recurrence rate and earlier return to work. [1,2] Though insufflation of carbon dioxide is limited to preperitoneal space, higher insufflation pressures and longer operative times have been associated with pneumothorax and pneumomediastinum even during totally extra peritoneal patchplasty (TEP . [3] We present a patient who developed pneumothorax due to inadvertent peritoneal tear during hernial sac dissection that resolved with conservative management in the postoperative period. This case report highlights the importance of peritoneal tear closure before proceeding with the rest of the procedure during extra peritoneal inguinal hernia repair.

  17. 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

  18. Components separation technique combined with a double-mesh repair for large midline incisional hernia repair

    NARCIS (Netherlands)

    M. Bröker (Mirelle); E. Verdaasdonk (Emiel); T.M. Karsten (Thomas)

    2011-01-01

    textabstractBackground The surgical treatment of large midline incisional hernias remains a challenge. The aim of this report is to present the results of a new technique for large midline incisional hernia repair which combines the components- separation technique with a double-prostheticmesh repai

  19. [First case report in Mexico of a diaphragmatic hernia, by Agustín Arellano in 1839].

    Science.gov (United States)

    de León, Fernando Chico-Ponce; Nieto-Zermeño, Jaime

    2007-01-01

    Reports on partial lacking of the diaphragm and diaphragmatic hernia date to seventeenth century reports. In 1939 Arellano published in Mexico, a necropsy case of diaphragmatic hernia with holoprosencephaly and cyclocephaly. Agustín Arellano's was the the fifth or sixth report ever published worldwide and his manuscript was reported nine years before Bochdalek's publication. Before 1839, in the Americas, there is no other existing report describing this type of pathology, and we can safely assume Arellano's work was the first of its kind in the Western hemisphere. It is well known that, at the time, the quality ofscientific publications of this Mexican medical researcher could be compared to the level of any medical publication in the developed world. It is worth noting that the Journal were Arellano's work was published, named "Periodico de la Academia de Médicina de Mégico (sic), "founded and directed by Dr. Manuel Carpio in 1836, is the direct precursor of the present-day "Gaceta Médica de México" the oldest current medical journal in the Americas.

  20. Pulmonary transcriptome analysis in the surgically induced rabbit model of diaphragmatic hernia treated with fetal tracheal occlusion.

    Science.gov (United States)

    Engels, Alexander C; Brady, Paul D; Kammoun, Molka; Finalet Ferreiro, Julio; DeKoninck, Philip; Endo, Masayuki; Toelen, Jaan; Vermeesch, Joris R; Deprest, Jan

    2016-02-01

    Congenital diaphragmatic hernia (CDH) is a malformation leading to pulmonary hypoplasia, which can be treated in utero by fetal tracheal occlusion (TO). However, the changes of gene expression induced by TO remain largely unknown but could be used to further improve the clinically used prenatal treatment of this devastating malformation. Therefore, we aimed to investigate the pulmonary transcriptome changes caused by surgical induction of diaphragmatic hernia (DH) and additional TO in the fetal rabbit model. Induction of DH was associated with 378 upregulated genes compared to controls when allowing a false-discovery rate (FDR) of 0.1 and a fold change (FC) of 2. Those genes were again downregulated by consecutive TO. But DH+TO was associated with an upregulation of 157 genes compared to DH and controls. When being compared to control lungs, 106 genes were downregulated in the DH group and were not changed by TO. Therefore, the overall pattern of gene expression in DH+TO is more similar to the control group than to the DH group. In this study, we further provide a database of gene expression changes induced by surgical creation of DH and consecutive TO in the rabbit model. Future treatment strategies could be developed using this dataset. We also discuss the most relevant genes that are involved in CDH.

  1. Chromosome 8p23.1 deletions as a cause of complex congenital heart defects and diaphragmatic hernia.

    Science.gov (United States)

    Wat, Margaret J; Shchelochkov, Oleg A; Holder, Ashley M; Breman, Amy M; Dagli, Aditi; Bacino, Carlos; Scaglia, Fernando; Zori, Roberto T; Cheung, Sau Wai; Scott, Daryl A; Kang, Sung-Hae Lee

    2009-08-01

    Recurrent interstitial deletion of a region of 8p23.1 flanked by the low copy repeats 8p-OR-REPD and 8p-OR-REPP is associated with a spectrum of anomalies that can include congenital heart malformations and congenital diaphragmatic hernia (CDH). Haploinsufficiency of GATA4 is thought to play a critical role in the development of these birth defects. We describe two individuals and a monozygotic twin pair discordant for anterior CDH all of whom have complex congenital heart defects caused by this recurrent interstitial deletion as demonstrated by array comparative genomic hybridization. To better define the genotype/phenotype relationships associated with alterations of genes on 8p23.1, we review the spectrum of congenital heart and diaphragmatic defects that have been reported in individuals with isolated GATA4 mutations and interstitial, terminal, and complex chromosomal rearrangements involving the 8p23.1 region. Our findings allow us to clearly define the CDH minimal deleted region on chromosome 8p23.1 and suggest that haploinsufficiency of other genes, in addition to GATA4, may play a role in the severe cardiac and diaphragmatic defects associated with 8p23.1 deletions. These findings also underscore the importance of conducting a careful cytogenetic/molecular analysis of the 8p23.1 region in all prenatal and postnatal cases involving congenital defects of the heart and/or diaphragm.

  2. Chromosome 8p23.1 Deletions as a Cause of Complex Congenital Heart Defects and Diaphragmatic Hernia

    Science.gov (United States)

    Wat, Margaret J.; Shchelochkov, Oleg A.; Holder, Ashley M.; Breman, Amy M.; Dagli, Aditi; Bacino, Carlos; Scaglia, Fernando; Zori, Roberto T.; Cheung, Sau Wai; Scott, Daryl A.; Kang, Sung-Hae Lee

    2009-01-01

    Recurrent interstitial deletion of a region of 8p23.1 flanked by the low copy repeats 8p-OR-REPD and 8p-OR-REPP is associated with a spectrum of anomalies that can include congenital heart malformations and congenital diaphragmatic hernia (CDH). Haploinsufficiency of GATA4 is thought to play a critical role in the development of these birth defects. We describe two individuals and a monozygotic twin pair discordant for anterior CDH all of whom have complex congenital heart defects caused by this recurrent interstitial deletion as demonstrated by array comparative genome hybridization. To better define the genotype/phenotype relationships associated with alterations of genes on 8p23.1, we review the spectrum of congenital heart and diaphragmatic defects that have been reported in individuals with isolated GATA4 mutations and interstitial, terminal, and complex chromosomal rearrangements involving the 8p23.1 region. Our findings allow us to clearly define the CDH minimal deleted region on chromosome 8p23.1 and suggest that haploinsufficiency of other genes, in addition to GATA4, may play a role in the severe cardiac and diaphragmatic defects associated with 8p23.1 deletions. These findings also underscore the importance of conducting a careful cytogenetic/molecular analysis of the 8p23.1 region in all prenatal and postnatal cases involving congenital defects of the heart and/or diaphragm. PMID:19606479

  3. Dietary vitamin A intake below the recommended daily intake during pregnancy and the risk of congenital diaphragmatic hernia in the offspring

    NARCIS (Netherlands)

    Beurskens, L.W.J.E.; Schrijver, L.H.; Tibboel, D.; Wildhagen, M.F.; Knapen, M.F.C.M.; Lindemans, J.; Vries, de J.H.M.; Steegers-Theunissen, R.P.M.

    2013-01-01

    BACKGROUND Vitamin A has been related to the etiology of congenital diaphragmatic hernia (CDH). We performed a case-control study to investigate whether maternal dietary vitamin A intake is related to CDH in the offspring. METHODS Thirty-one pregnancies diagnosed with CDH and 46 control pregnancies

  4. Congenital diaphragmatic hernia and chromosome 15q26: determination of a candidate region by use of fluorescent in situ hybridization and array-based comparative genomic hybridization

    NARCIS (Netherlands)

    M. Klaassens (Merel); C. Wouters (Cokkie); M.F. van Dooren (Marieke); H.J.F.M.M. Eussen (Bert); H. Douben (Hannie); J.E.M.M. de Klein (Annelies); A.T. den Dekker (Alexander); C. Lee; P.K. Donahoe; D. Tibboel (Dick); R-J.H. Galjaard (Robert-Jan); N.N.T. Goemaere (Natascha); B.A. Oostra (Ben); R.R. de Krijger (Ronald); J. Wauters (Jan)

    2005-01-01

    textabstractCongenital diaphragmatic hernia (CDH) has an incidence of 1 in 3,000 births and a high mortality rate (33%-58%). Multifactorial inheritance, teratogenic agents, and genetic abnormalities have all been suggested as possible etiologic factors. To define candidate regions

  5. Laparoscopic Repair of a Right Paraduodenal Hernia

    OpenAIRE

    Bittner, James G; Edwards, Michael A.; Harrison, Steven J.; Li, Kelvin; Karmin, Paul N.; Mellinger, John D.

    2009-01-01

    Background and Objectives: Right paraduodenal hernia (PDH) results from a primitive gut malrotation. The resultant jejunal mesenteric defect posterior to the superior mesenteric vessels allows decompressed jejunum to herniate retroperitoneally. PDH make up 53% of all internal hernias, but account for only 0.2% to 5.8% of all cases of intestinal obstruction. In addition, PDH exhibits male and left-sided predominance. Ours is the second report to describe the preoperative diagnosis and totally ...

  6. Umbilical hernia in cirrhotic patients: outcome of elective repair.

    Science.gov (United States)

    Lasheen, Adel; Naser, Hatem M; Abohassan, Ahmed

    2013-12-01

    Cirrhotic patients with umbilical hernia have an increased likelihood of complications following repair. The aim of this study was to assess the outcomes of elective umbilical hernia repair in cirrhotic patients. Fifty patients having uncomplicated umbilical hernia with a cirrhotic liver were studied prospectively. These patients divided into three groups' according to Child-Turcotte-Pugh (CTP) classification. After management of coagulopathy, correction of hypoalbuminaemia and electrolytes imbalance, and control of ascites, all patients underwent elective hernia repair under regional anesthesia. A comparison was made between the three groups as regard the size of the defect in the linea Alba, operative time, postoperative morbidity and mortality, length of hospital stay, time of return to daily life and postoperative changes in liver function tests (LFTs) in relation to the regional anesthesia applied. hernioplasty was done under spinal anesthesia in 13 patients (26%), under epidural anesthesia in 10 patients (20%), under intercostal nerve block in 7 patients (14%), and under local anesthesia in 20 patients (40%). There was an increased safety (less changes in LFTs) in cases done under local anesthesia and intercostal nerve block. The overall complications rate was 30%. There was an increased complications rate towards the decompensated cases. The differences in the mean length of hospital stay and mean time of return to daily life are statistically significant between the three groups. Umbilical hernia recurrence rate was 2% and no mortality was reported in the study groups.

  7. Nationwide study of early outcomes after incisional hernia repair

    DEFF Research Database (Denmark)

    Bisgaard, T; Kehlet, H; Bay-Nielsen, M B;

    2009-01-01

    BACKGROUND: There are no nationwide studies on early outcomes after incisional hernia repair. METHODS: This study included all patients aged 18 years or more who had surgery for incisional hernia in Denmark between 1 January 2005 and 31 December 2006, and analysed clinical outcomes within 30 days...... of surgery. Patients having acute operations and those whose hernia repair was secondary to other procedures were excluded. RESULTS: Of a total of 2896 incisional hernia repairs (1872 open, 1024 laparoscopic), 2754 (95.1 per cent) were for primary hernia and 142 (4.9 per cent) for recurrence. The median...... hospital stay was 1 (range 0-88) day (open, 1 day; laparoscopic, 2 days); 10.0 per cent stayed for more than 6 days. Some 11.2 per cent of patients were readmitted (open, 10.1 per cent; laparoscopic, 13.1 per cent). Major complications were observed in 3.5 per cent (open, 2.8 per cent; laparoscopic, 4...

  8. Wandering Spleen and Organoaxial Gastric Volvulus after Morgagni Hernia Repair: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Noemi Cantone

    2016-01-01

    Full Text Available Wandering spleen and gastric volvulus are two rare entities that have been described in association with congenital diaphragmatic hernia. The diagnosis is difficult and any delay can result in ischemia and necrosis of both organs. We present a case of a 13-year-old girl, previously operated on for anterior diaphragmatic hernia and intrathoracic gastric volvulus, that presented to our service for a subdiaphragmatic gastric volvulus recurrence associated with a wandering spleen. In this report we reviewed the literature, analyzing the clinical presentation, diagnostic assessment, and treatment options of both conditions, in particular in the case associated with diaphragmatic hernia.

  9. Incisional hernia recurrence following 'vest-over-pants' or vertical mayo repair of primary hernias of the midline

    NARCIS (Netherlands)

    R.W. Luijendijk; M.H.M. Lemmen (M. H M); W.C.J. Hop (Wim); J.C.J. Wereldsma

    1997-01-01

    textabstractA series of 68 primary midline incisional hernias with a vertical Mayo repair was evaluated retrospectively. Patients without documented hernia recurrence following this repair were invited for physical examination. Life- table methods were used for statistical analysis. The 1-, 3-, 5-,

  10. Childhood Morgagni hernia: report of two cases

    Directory of Open Access Journals (Sweden)

    Kamal Nain Rattan

    2017-01-01

    Full Text Available Morgagni diaphragmatic hernia is a rare congenital anomaly to be seen in the pediatric age group. We are reporting two cases of Morgagni hernia, which presented with non-specific symptoms and posed a diagnostic dilemma. One of the patients was 10 years old and associated with asplenia and Down’s syndrome; the second case presented as isolated Morgagni hernia in an 8 month baby. The diagnosis was confirmed with radiography and computed chest tomography. Both cases were managed successfully with surgical repair of the diaphragmatic defect through trans-abdominal approach.

  11. 先天性膈疝的诊断与治疗%Diagnosis and treatment of congenital diaphragmatic hernia

    Institute of Scientific and Technical Information of China (English)

    刘文英

    2016-01-01

    先天性膈疝(CDH)是由于单侧或双侧膈肌发育缺损导致腹腔内脏器疝入胸腔的一种先天畸形性疾病.由于常合并有不同程度的肺发育不良和其他异常,肺发育不良的程度决定了手术治疗的效果,改善肺发育不良是治疗的关键问题.通过B超等可以产前做出早期诊断,并可以帮助判断预后及选择更好的手术时机,腔镜手术具有微创优势,是治疗CDH的趋势.%Congenital diaphragmatic hernia(CDH) is one of the critical congenital malformations disease which caused the defects of the diaphragmatic hernia,the hernia of the abdominal viscera into the thoracic cavity and the dysplasia of the lung because of the abnormal development of the embryo.The degree of pulmonary hypoplasia determined the curative effect of surgical treatment,so it is a key problem to improve the condition of pulmonary hypoplasia in treatment of CDH.Now it is feasible to make early prenatal diagnosis,predict outcomes and select the best operative opportunity of CDH with ultrasonography.It is a trend to treat CDH with endoscopic surgery of the minimally invasive operation.This article focuses on the latest diagnostics,treatment and new research progress of CDH,and summarized as follows.

  12. Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias.

    Science.gov (United States)

    Newcomb, W L; Polhill, J L; Chen, A Y; Kuwada, T S; Gersin, K S; Getz, S B; Kercher, K W; Heniford, B T

    2008-10-01

    Obesity may be the most predominant risk factor for recurrence following ventral hernia repair. This is secondary to significantly increased intra-abdominal pressures, higher rates of wound complications, and the technical difficulties encountered due to obesity. Medically managed weight loss prior to surgery is difficult. One potential strategy is to provide a surgical means to correct patient weight prior to hernia repair. After institutional review board approval, we reviewed the medical records of all patients who underwent gastric bypass surgery prior to the definitive repair of a complex ventral hernia at our medical center. Twenty-seven morbidly obese patients with an average of 3.7 (range 1-10) failed ventral hernia repairs underwent gastric bypass prior to definitive ventral hernia repair. Twenty-two of the gastric bypasses were open operations and five were laparoscopic. The patients' average pre-bypass body mass index (BMI) was 51 kg/m2 (range 39-69 kg/m2), which decreased to an average of 33 kg/m2 (range 25-37 kg/m2) at the time of hernia repair at a mean of 1.3 years (range 0.9-3.1 years) after gastric bypass. Seven patients had hernia repair at the same time as their gastric bypass (four sutured, three biologic mesh), all of which recurred. Of the 27 patients, 19 had an open hernia repair and eight had a laparoscopic repair. Panniculectomy was performed concurrently in 15 patients who had an open repair. Prior to formal hernia repair, one patient required an urgent operation to repair a hernia incarceration and a small-bowel obstruction 11 months after gastric bypass. The average hernia and mesh size was 203 cm2 (range 24-1,350 cm2) and 1,040 cm2 (range 400-2,700 cm2), respectively. There have been no recurrences at an average follow-up of 20 months (range 2 months-5 years). Gastric bypass prior to staged ventral hernia repair in morbidly obese patients with complex ventral hernias is a safe and definitive method to effect weight loss and facilitate a

  13. Congenital heart anomaly in newborns with congenital diaphragmatic hernia: a single-center experience.

    Science.gov (United States)

    Ruano, R; Javadian, P; Kailin, J A; Maskatia, S A; Shamshirsaz, A A; Cass, D L; Zamora, I J; Sangi-Haghpeykar, H; Lee, T C; Ayres, N A; Mehollin-Ray, A; Cassady, C I; Fernandes, C; Welty, S; Belfort, M A; Olutoye, O O

    2015-06-01

    To evaluate the impact of the presence of a congenital heart anomaly (CHA) and its potential contribution to morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). In this retrospective cohort study, prenatal and postnatal data of all newborns diagnosed with CDH between January 2004 and December 2012 in a single center were reviewed. Cases were classified into two groups: those with 'isolated' CDH and those with both CDH and CHA. Patients with CHA were further subclassified into those with a major or minor CHA based on the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) scoring systems. Patients with associated non-cardiac anomalies, including 'syndromic cases', were excluded from the analysis. Primary and secondary outcomes were survival up to 1 year of age and a need for extracorporeal membrane oxygenation (ECMO), respectively. Of the 180 infants with CDH, 41 were excluded because of the presence of non-cardiac associated anomalies, 118 had isolated CDH and 21 had CDH with CHA (16 with minor and five with major CHA). Receiver-operating characteristics curve analysis demonstrated that the best cut-off for survival was when the score for CHA was ≤ 2 for both RACHS-1 (area under the curve (AUC), 0.74 (P = 0.04); sensitivity, 80.0%; specificity, 87.5%) and STS-EACTS (AUC, 0.83 (P = 0.03); sensitivity, 100%; specificity, 87.5%). Survival rate at 1 year was significantly lower in those with CHD and a major CHA (40.0%; P = 0.04) than in those with isolated CDH (77.1%) and those with CDH and a minor CHA (81.3%). We found no significant differences among the groups with regard to the need for ECMO. In general, a milder form of CHA does not appear to have a negative impact on the survival of infants with CDH. However, mortality appears to be significantly higher in infants with CDH and a major form of CHA. The scoring systems

  14. Bilateral Morgagni Hernia: Primary Repair without a Mesh

    Directory of Open Access Journals (Sweden)

    Vassilios Papanikolaou

    2008-07-01

    Full Text Available We present a case of bilateral Morgagni hernia in a 68-year-old male with an intermittent history of progressive onset of breath shortness and occasional cardiac arrhythmias. Diagnosis was made by clinical examination and the findings in a plain chest radiograph and was confirmed by computed tomography scan. The patient was operated electively and subjected to a transabdominal approach. A bilateral subcostal incision revealed a large right side anterior diaphragmatic defect with a hernia containing the ascending colon, the majority of the transverse colon and a huge amount of omentum. Also a second smaller defect was found on the left side with no hernia inside. After large bowel and omentum had been taken down to the peritoneal cavity, both defects were primarily closed using interrupted nylon sutures without the use of a mesh. The patient recovered very well, had an uneventful postoperative course and was released on the 5th postoperative day. 15-month follow-up failed to reveal any signs of recurrence.

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

    NARCIS (Netherlands)

    M. Sartelli (Massimo); F. Coccolini (Federico); G.H. van Ramshorst (Gabrielle); G. Campanelli (Giampiero); V. Mandala; L. Ansaloni (Luca); E.E. Moore (Ernest); A. Peitzman (Andrew); G.C. Velmahos (George ); F.A. Moore (Fredrick); A. Leppaniemi (Ari); C.C. Burlew (Clay); W.L. Biffl (Walter); K. Koike (Kaoru); Y. Kluger (Yoram); G.P. Fraga (Gustavo); C.A. Ordonez (Carlos); S. Di Saverio (Salomone); F. Agresta; B. Sakakushev (Boris); I. Gerych (Igor); I. Wani (Imtiaz); M.D. Kelly (Michael ); C.A. Gomes (Carlos); M.P. Faro Jr (Mario); K. Taviloglu (Korhan); Z. Demetrashvili (Zaza); J.G. Lee (Jeong ); N. Vettoretto (Nereo); G. Guercioni (Gianluca); C. Tranà (Cristian); Y. Cui (Yijun); K.Y.Y. Kok (Kenneth); W.M. Ghnnam (Wagih); A.E.S. Abbas (Ashraf El-Sayed); N. Sato (Norio); S. Marwah (Sanjay); M. Rangarajan (Muthukumaran); O. Ben-Ishay (Offir); A.R.K. Adesunkanmi (Abdul Rashid); H.A. Segovia Lohse (Helmut); J. Kenig (Jakub); V. Mandalà (Vincenzo); A. Patrizi (Andrea); R. Scibé (Rodolfo); F. Catena (Fausto)

    2013-01-01

    textabstractEmergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergenc

  16. Reliable and valid assessment of Lichtenstein hernia repair skills

    DEFF Research Database (Denmark)

    Carlsen, Charlotte Green; Lindorff-Larsen, K; Funch-Jensen, P

    2013-01-01

    PURPOSE: Lichtenstein hernia repair is a common surgical procedure and one of the first procedures performed by a surgical trainee. However, formal assessment tools developed for this procedure are few and sparsely validated. The aim of this study was to determine the reliability and validity...

  17. Functional outcome after laparoscopic and open incisional hernia repair

    NARCIS (Netherlands)

    H.H. Eker (Hasan); D. den Hartog (Dennis); W.E. Tuinebreijer (Wim); G.J. Kleinrensink (Gert Jan); H.J. Stam (Henk); J.F. Lange (Johan)

    2010-01-01

    textabstractAbstract: Background: The debate about the advantages of laparoscopic versus open incisional hernia repair is still ongoing. The primary outcomes of already published studies are mainly recurrence, pain and quality of life. Data on postoperative abdominal wall function after these corre

  18. Concomitant sublay mesh repair of umbilical hernia and abdominoplasty

    OpenAIRE

    2012-01-01

    Concomitant mesh repair of large umbilical hernias and abdominoplasty pose a serious risk of devascularizing the umbilical stalk. A technique of placing mesh in a sublay manner, deep to the fascial defect, for an umbilical herniorrhaphy to avoid damage to the deep umbilical perforators during an abdominoplasty is described.

  19. 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...

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

    NARCIS (Netherlands)

    M. Sartelli (Massimo); F. Coccolini (Federico); G.H. van Ramshorst (Gabrielle); G. Campanelli (Giampiero); V. Mandala; L. Ansaloni (Luca); E.E. Moore (Ernest); A. Peitzman (Andrew); G.C. Velmahos (George ); F.A. Moore (Fredrick); A. Leppaniemi (Ari); C.C. Burlew (Clay); W.L. Biffl (Walter); K. Koike (Kaoru); Y. Kluger (Yoram); G.P. Fraga (Gustavo); C.A. Ordonez (Carlos); S. Di Saverio (Salomone); F. Agresta; B. Sakakushev (Boris); I. Gerych (Igor); I. Wani (Imtiaz); M.D. Kelly (Michael ); C.A. Gomes (Carlos); M.P. Faro Jr (Mario); K. Taviloglu (Korhan); Z. Demetrashvili (Zaza); J.G. Lee (Jeong ); N. Vettoretto (Nereo); G. Guercioni (Gianluca); C. Tranà (Cristian); Y. Cui (Yijun); K.Y.Y. Kok (Kenneth); W.M. Ghnnam (Wagih); A.E.S. Abbas (Ashraf El-Sayed); N. Sato (Norio); S. Marwah (Sanjay); M. Rangarajan (Muthukumaran); O. Ben-Ishay (Offir); A.R.K. Adesunkanmi (Abdul Rashid); H.A. Segovia Lohse (Helmut); J. Kenig (Jakub); V. Mandalà (Vincenzo); A. Patrizi (Andrea); R. Scibé (Rodolfo); F. Catena (Fausto)

    2013-01-01

    textabstractEmergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergenc

  1. Burst strength of laparoscopic and open hernia repair.

    Science.gov (United States)

    Brockman, J B; Patterson, N W; Richardson, W S

    2004-03-01

    There are few reports of overall strength of laparoscopic and open incisional hernia repair. After anesthesia, a 2-inch circular defect was made in the abdominal wall of 28 female swine. Gore-Tex DualMesh Biomaterial (W. L. Gore & Associates, Flagstaff, AZ) was used for all repairs. Sixteen animals underwent open repair and 12 underwent laparoscopic repair. Burst strength was detected within 2 weeks and at 6 weeks by euthanizing the animals and insufflating the abdominal cavity with water while measuring the intraabdominal pressure until it could no longer be pressurized. Three events occurred after insufflation: rupture around patch (R), dissection from insufflation or pressure monitoring sites (D), or rectal prolapse (P). Failure after open early repair occurred at 289 (range 219-388) mmHg with 7-R, 1-P and late 289 (196-343) mmHg with 1-R, 6-P. Failure after laparoscopic early repair occurred at 259 (191-388) mmHg with 4-R, 1-P, 1-D and late 291 (140-330) mmHg with 2-R, 1-P, 3-D. Late groups were less likely to rupture. Both hernia repairs are durable at early and late periods. Tissue ingrowth adds to repair strength. We could not show that one repair was stronger than the other. Nonetheless, laparoscopic repair tended to degrade by dissection, which was our highest pressure event.

  2. Repair of diaphragmatic injury and placement of tube thoracostomy during right upper quadrant peritonectomy.

    Science.gov (United States)

    Ozgul, Nejat; Basaran, Derman; Boyraz, Gokhan; Salman, M Coskun

    2016-01-01

    Patients with advanced or recurrent ovarian cancer often have metastatic disease in the upper abdominal region, especially to the right hemidiaphragm, which requires diaphragmatic resection in order to achieve optimal cytoreduction. The aim of this surgical video is to demonstrate repair of a diaphragmatic injury and placement of tube thoracostomy during right upper quadrant peritonectomy in a patient with recurrent ovarian cancer. This is the case of a 45-year-old woman presented with platinum sensitive recurrent ovarian cancer. Abdomen computed tomography also confirmed peritoneal carcinomatosis and pelvic recurrent mass. HIPEC was administered after complete cytoreduction including bilateral upper quadrant peritonectomy, during which diaphragmatic injury occurred near the central tendon and pleural cavity was entered. We inserted a chest tube through the 6th intercostal space in the anterior axillary line in order to prevent postoperative massive pleural effusion. Diaphragmatic defect was closed primarily after the tube placement. The chest tube was withdrawn on the third postoperative day and the patient was discharged on postoperative day 25 without any complications. The central tendon of diaphragm is the most vulnerable part for lacerations. Diaphragmatic repairs could be performed by various techniques; interrupted or continuous, locking or non-locking sutures, with either permanent or absorbable materials. In our view, all of the techniques provide similar results and surgeons can choose any of them as long as they are comfortable with the procedure. In most cases, these lacerations can be repaired primarily without necessitating tube thoracostomy. However, performance of HIPEC can cause massive pleural effusions which can lead to significant pulmonary morbidity. Therefore, retrograde placement of the chest tube under direct vision is quite straightforward when the diaphragm is opened.

  3. Diaphragmatic rupture with right colon and small intestine herniation after blunt trauma: a case report

    Directory of Open Access Journals (Sweden)

    Muroni Mirko

    2010-08-01

    Full Text Available Abstract Introduction Traumatic diaphragmatic hernias are an unusual presentation of trauma, and are observed in about 10% of diaphragmatic injuries. The diagnosis is often missed because of non-specific clinical signs, and the absence of additional intra-abdominal and thoracic injuries. Case presentation We report a case of a 59-year-old Italian man hospitalized for abdominal pain and vomiting. His medical history included a blunt trauma seven years previously. A chest X-ray showed right diaphragm elevation, and computed tomography revealed that the greater omentum, a portion of the colon and the small intestine had been transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy, at which time the colon and small intestine were reduced back into the abdomen and the diaphragm was repaired. Conclusions This was a unusual case of traumatic right-sided diaphragmatic hernia. Diaphragmatic ruptures may be revealed many years after the initial trauma. The suspicion of diaphragmatic rupture in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only curative treatment for diaphragmatic hernias. Prosthetic patches may be a good solution when the diaphragmatic defect is severe and too large for primary closure, whereas primary repair remains the gold standard for the closure of small to moderate sized diaphragmatic defects.

  4. Littre hernia: surgical anatomy, embryology, and technique of repair.

    Science.gov (United States)

    Skandalakis, Panagiotis N; Zoras, Odyseas; Skandalakis, John E; Mirilas, Petros

    2006-03-01

    Littre hernia is the protrusion of a Meckel diverticulum through a potential abdominal opening. Alexis de Littre (1700) reported ileal diverticula and attributed them to traction. August Gottlieb Richter (1785) defined them as preformed, and Johann Friedrich Meckel (1809) postulated their embryologic origin. Sir Frederic Treves (1897) distinguished between Littre and Richter hernia (partial enterocele). Embryologically, Meckel diverticulum is the persistent intestinal part of the omphaloenteric duct through which the midgut communicates with the umbilical vesicle until the fifth week. It is found at the antimesenteric border of the ileum, usually located 30 to 90 cm from the ileocecal valve, measuring 3 to 6 cm in length and 2 cm in diameter. Usual sites of Littre hernia are: inguinal (50%), umbilical (20%), and femoral (20%). Meckel diverticulum may be accompanied in the sac by the ileal loop to which it is attached; rarely, it may undergo incarceration or strangulation, necrosis, and perforation. In children, it is mostly found in umbilical hernias, and the diverticulum is more prone to adhere to the sac. Repair of Littre hernia consists of resection of the diverticulum and herniorraphy; in perforated cases, care must be taken to not contaminate the hernia field.

  5. First laparoscopic totally extraperitoneal repair of Laugier's hernia: a case report.

    Science.gov (United States)

    Ates, M; Dirican, A; Kose, E; Isik, B; Yilmaz, S

    2013-02-01

    An atypical femoral hernia developing through the lacunar ligament is called Laugier's hernia. Preoperative diagnosis of these atypical hernias is very difficult because of their rarity and similar clinical appearance to conventional femoral hernias. A 52-year-old female presented with right groin swelling. During laparoscopic totally extraperitoneal (TEP) inguinal hernia repair, a hernia sac through an opening in the lacunar ligament was diagnosed and repaired with mesh covering the inguinal floor. The surgeon should be alert to the possibility of an atypical femoral hernia when examining patients with inguinal hernias. A laparoscopic approach should be chosen instead of a conventional approach for the treatment of femoral hernias because of its high diagnostic and therapeutic capacity for all types of femoral hernia, including Laugier's.

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

    Science.gov (United States)

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

    2013-10-01

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

  7. Is Pooled Data Analysis of Ventral and Incisional Hernia Repair Acceptable?

    OpenAIRE

    2015-01-01

    Purpose In meta-analyses and systematic reviews comparing laparoscopic with open repair of ventral hernias, data on umbilical, epigastric, and incisional hernias are pooled. Based on data from the Herniamed Hernia Registry, we aimed to investigate whether the differences in the therapy and treatment results justified such an approach. Methods Between 1st September 2009 and 31st August 2013, 31,664 patients with a ventral hernia were enrolled in the Herniamed Hernia Registry. The im...

  8. Laparoscopic repair of strangulated Morgagni hernia

    OpenAIRE

    2007-01-01

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

  9. Laparoscopic repair of strangulated Morgagni hernia

    Directory of Open Access Journals (Sweden)

    Kelly Michael D

    2007-10-01

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

  10. Tailored Approach in Inguinal Hernia Repair – Decision Tree Based on the Guidelines

    OpenAIRE

    2014-01-01

    The endoscopic procedures TEP and TAPP and the open techniques Lichtenstein, Plug and Patch, and PHS currently represent the gold standard in inguinal hernia repair recommended in the guidelines of the European Hernia Society, the International Endohernia Society, and the European Association of Endoscopic Surgery. Eighty-two percent of experienced hernia surgeons use the “tailored approach,” the differentiated use of the several inguinal hernia repair techniques depending on the findings of ...

  11. A Contralateral Complication of Extra-peritoneal Laparoscopic Inguinal Hernia Repair

    Directory of Open Access Journals (Sweden)

    Jacob S

    2010-03-01

    Full Text Available A 63 year old female underwent an uncomplicated total extraperitoneal repair of a right direct inguinal hernia. One week later she presented with a strangulated left femoral hernia. We believe the dissection of the extraperitoneal space caused bleeding which tracked down through the femoral canal resulting in a femoral hernia. To date there are no reports of such a complication following total extraperitoneal inguinal hernia repair in the literature.

  12. Hernia diafragmática paraesternal de Morgagni-Larrey en adulto Morgagni-Larrey parasternal diaphragmatic hernia in the adult

    Directory of Open Access Journals (Sweden)

    L. A. Arráez-Aybar

    2009-05-01

    Full Text Available Con una prevalencia de 0,3-0,5/1.000 nacimientos, la hernia diafragmática congénita (HDC sigue siendo una anomalía grave, no bien entendida, alta mortalidad y tratamiento no siempre efectivo. En España se ha informado de una frecuencia del 0,69%oo con una tendencia decreciente en el periodo 1980-2006 del 0,10%oo por año. No obstante, hasta un 5% se diagnostican en adultos durante la realización de un reconocimiento por otra causa. Presentamos un cuadro de vómitos de tres meses de evolución en una mujer de 74 años por hernia diafragmática paraesternal de Morgagni-Larrey (retrocondroesternal, retrocostoxifoidea, retroesternal, subcostal, subesternal o subcostoesternal, que nos ha permitido realizar una actualización de esta patología en adultos y de la morfogénesis del diafragma toracoabdominal. Es en la embriología del diafragma donde encontramos explicación de algunas de sus alteraciones morfológicas y características clínicas, si bien persisten aspectos confusos de la misma. También analizamos el grado de controversia que persiste en algunos aspectos de su tratamiento quirúrgico (vías de acceso, uso o no de mallas y reducción o no del saco herniario. Por lo general priman las técnicas mínimamente invasivas. Consideramos el abordaje laparoscópico como de elección en pacientes adultos con hernia paraesternal candidatos a la cirugía.With a prevalence of 0.3-0.5/1000 births, congenital diaphragmatic hernia (CDH remains a serious, poorly understood abnormality with a high mortality rate that cannot always be effectively managed. Its reported frequency in Spain is 0.69%oo with a yearly decreasing trend of 0.10%oo during the period 1980-2006. Up to 5% of cases are incidentally identified in adults undergoing studies for other reasons. We report the case of a 74-year-old woman with vomiting for three months due to parasternal diaphragmatic hernia of Morgagni-Larrey (retrochondrosternal, retrocostoxyphoid, retrosternal

  13. Extracorporeal Membrane Oxygenation Cannula Malposition in the Azygos Vein in a Neonate with Right-Sided Congenital Diaphragmatic Hernia

    Directory of Open Access Journals (Sweden)

    Seung Jun Choi

    2016-05-01

    Full Text Available Malposition of the extracorporeal membrane oxygenation (ECMO venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.

  14. Laparoscopic intraperitoneal onlay mesh repair of incisional hernia.

    Science.gov (United States)

    Tsimoyiannis, E C; Tassis, A; Glantzounis, G; Jabarin, M; Siakas, P; Tzourou, H

    1998-10-01

    Improvements in laparoscopic techniques and equipment have engendered many new intraabdominal procedures. Laparoscopic hernioplasty was used in 11 patients with 12 incisional abdominal hernias. All repairs were made with an intraperitoneal onlay patch of expanded polytef Gore-Tex DualMesh Biomaterial. The patch was secured by whole-thickness sutures, tied subcutaneously through stab holes, and staples between the sutures to cover the hernia defect without excision of the hernia sac. There were three postoperative complications: one seroma, one hematoma, and one infection. These complications successfully healed without reoperation. No recurrence was observed during a follow-up of 8-21 months (average 15 months). It is concluded that laparoscopic incisional hernioplasty using the new Gore-Tex DualMesh Biomaterial, which is securely sutured and stapled on the abdominal wall, is a promising minimally invasive procedure. Continued follow-up is necessary to determine the long-term results.

  15. Challenges in the management of early versus late presenting congenital diaphragmatic hernia in a poor resource setting

    Directory of Open Access Journals (Sweden)

    Abubakar Auwal

    2011-01-01

    Full Text Available Background: Despite the advances in management, congenital diaphragmatic hernia (CDH has continued to pose a significant challenge to paediatric surgeons. This is amplified in a setting like ours where there is a dearth of facilities to cope with the problem of CDH. This study was undertaken to highlight the peculiarities of the management of CDH in a poor resource setting. Methods: All confirmed cases of CDH were prospectively documented from 2003 till date. Results: Seven children were treated from 2003 till date. The diaphragmatic defect was on the left side in six (83.8% and on the right side in one (17.7%. All the patients had primary closure of the defect without patch via an abdominal approach. The three patients presenting at birth died while the remaining four patients survived. Conclusion: With inadequate neonatal intensive care facilities, the severe early presenting CDH has a dismal prognosis. In contrast, the late presenting CDH poses more diagnostic challenges; but once identified and appropriate treatment instituted, it has an excellent prognosis. We recommend that physicians should include CDH in the differential diagnosis of patients with birth asphyxia and in patients with chronic respiratory symptoms with failure to thrive.

  16. Intestinal obstruction caused by a strangulated Morgagni hernia in an adult patient.

    Science.gov (United States)

    Barut, Ibrahim; Tarhan, Omer Ridvan; Cerci, Celal; Akdeniz, Yusuf; Bulbul, Mahmut

    2005-08-01

    A Morgagni hernia is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect. The reported incidence of congenital diaphragmatic hernias is estimated to be 1 in between 2000 to 5000 births. Morgagni hernias comprise 2% of diaphragmatic hernias. Most Morgagni hernias are found and repaired in children, but 5% are found in adults. They are usually asymptomatic and often found incidentally on chest radiography. Symptoms of these hernias are attributable to the herniated viscera. Morgagni hernias containing bowel may require repair on presentation because of the risk of incarceration. We present a case of an incarcerated and strangulated Morgagni hernia in a 71-year-old woman admitted to our clinic for abdominal pain and symptoms of intestinal obstruction. The diagnosis was made preoperatively by chest radiography, sonography, and computed tomography. Emergent laparotomy was performed, with the herniated transverse colon and omentum reduced into the abdomen. The diaphragmatic defect was repaired, followed by resection of the strangulated omentum. In conclusion, a Morgagni hernia may cause intestinal obstruction. Routine radiographic studies are usually sufficient to arrive at the diagnosis, but a CT scan and sonography may be necessary. Laparotomy is appropriate for the management of symptomatic adult patients with Morgagni hernias, particularly those with findings of intestinal strangulation, with laparoscopic treatment an alternative approach in selected cases.

  17. Transabdominal preperitoneal laparoscopic approach for incarcerated inguinal hernia repair

    Science.gov (United States)

    Yang, Shuo; Zhang, Guangyong; Jin, Cuihong; Cao, Jinxin; Zhu, Yilin; Shen, Yingmo; Wang, Minggang

    2016-01-01

    Abstract To investigate the efficacy, key technical points, and complication management of the transabdominal preperitoneal (TAPP) approach for incarcerated inguinal hernia repair. Seventy-three patients with incarcerated inguinal hernias underwent TAPP surgery in our department between Jan 2010 and Dec 2015. A retrospective review was performed by analyzing the perioperative data from these patients. The operation was successfully completed in all 73 patients. Operation time was 54.0 ± 18.8 minutes (range, 35–100 minutes). Length of stay was 3.9 ± 1.1 days (range, 3–9 days). There was 1 case of incisional infection, 32 cases of seroma, and 3 cases of postoperative pain during follow-up. All patients recovered after the appropriate treatment. No recurrence or fistula was observed. The TAPP approach represents a safe and effective technique for incarcerated inguinal hernia repair because of its potential in assessment of hernia content and decreasing incisional infection rate. However, it requires experienced surgeons to ensure safety with special attention paid to the key technical points as well as complication management. PMID:28033260

  18. Results of AlloDerm use in abdominal hernia repair.

    Science.gov (United States)

    Misra, S; Raj, P K; Tarr, S M; Treat, R C

    2008-06-01

    AlloDerm (decellularized human cadaveric dermis) is increasingly being used for tissue reconstruction and hernia repairs. This article presents the results of AlloDerm use in treating abdominal wall hernias by analyzing all patients who underwent repair with AlloDerm at our institution. A series of 70 consecutive patients starting in October 2003 with abdominal wall hernia repair using AlloDerm was studied. This study began as a retrospective chart review, which included subsequent postoperative follow-up. SPSS version 11.5 was used for statistical analysis, and parametric tests were conducted. Various technical variables (type of AlloDerm placement, mesh-suture technique, suture type) and nontechnical variables (steroids use, obesity, smoking status, diabetes, prior surgeries, number of comorbidities) were evaluated. Of 70 study patients, 31 were men and 39 were women, with a mean age of 58 (range 25-88) years. Fifty-six patients (80%) had no complications, whereas 14 (20%) suffered one or more complications. Of those patients with complications, there was one rejection, two infections, and 14 hernia recurrences. The overall complication rate was 24%. Of patients with hernia recurrences, one had the initial repair with AlloDerm implant of 1.8-mm thickness (ultrathick). The 14 patients with recurrences include three who had a prior AlloDerm repair with ultrathick implant. Two of these three patients reported abdominal wall protrusion, and one had a recurrence between two pieces of AlloDerm used in the initial repair. Of these 14 patients, nine had subsequent repair of their recurrence with synthetic mesh, and four had subsequent repair with AlloDerm with satisfactory outcomes; one patient was yet to have a repair at the time of this paper. Recurrence rates with ultrathick and thick AlloDerm were 23% and 6%, respectively. None of the patients who were on steroid therapy had complications. Mesh-suture technique had no effect on recurrence. Type of placement was

  19. Synchronous Morgagni and Bochdalek Hernias: A Case Report of a Unique Approach to a Rare Finding

    Directory of Open Access Journals (Sweden)

    Schlager

    2016-06-01

    Full Text Available Introduction Multiple unilateral congenital diaphragmatic hernias (CDH are extremely rare, described only five times in the medical literature. Concurrent ipsilateral Bochdalek and Morgagni hernias are rarer still with only two cases previously described. In all reported cases of multiple concurrent defects, the hernias were repaired in an open fashion, either via a thoracotomy or laparotomy with both of the two combined Bochdalek and Morgagni hernias repaired via laparotomy. Case Presentation In this case report we have a 2-day-old who developed respiratory distress and on CT scan was found to have a congenital diaphragmatic hernia (CDH or eventration. This patient is ideal for this case report because he meets a lot of the previously established criteria for minimally invasive repair of congenital diaphragmatic hernias - minimal respiratory compromise, no congenital heart defects - and he has synchronous defects which have very rarely been seen before. Here we present the first reported case of concurrent ipsilateral Bochdalek and Morgagni hernias repaired in a one-stage minimally invasive fashion, approaching the Bochdalek hernia thoracoscopically and the Morgagni laparoscopically. The patient had a quick recovery post-operatively and he continues to do well. Conclusions From this experience, we argue that in the right circumstances a completely minimally invasive approach can be taken for synchronous congenital diaphragmatic hernias.

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

    OpenAIRE

    2016-01-01

    Purpose. To evaluate the feasibility, safety, and effectiveness of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using a memory-ring patch (Polysoft™ mesh). Patients and Methods. Between April 2010 and March 2013, a total of 76 inguinal hernias underwent TAPP repair using Polysoft mesh in 67 adults under general anesthesia. Three different senior resident surgeons performed TAPP repair under the instruction of a specialist surgeon. Nine patients had bilateral hernias...

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

    Science.gov (United States)

    Bringman, S; Holmberg, H; Österberg, J

    2016-06-01

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

  2. 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...... the Medline and Ovid databases. Keywords were 'pain; chronic', 'herniorrhaphy; inguinal', 'neurectomy' and similar words. Article references were cross-checked for additional references. Articles were reviewed for data on surgical treatment of chronic pain after hernia repair. RESULTS: Neurectomy...... of the ilioinguinal, iliohypogastric, genitofemoral or lateral femoral cutaneous nerve was described in 14 papers. Overall, a favourable outcome was reported. However, the methodological quality was poor in all studies in respect of preoperative diagnostic criteria and treatment, intraoperative success in identifying...

  3. Compartment Syndrome Following Directly Repair of Hernia of Anterior Tibialis

    Directory of Open Access Journals (Sweden)

    Yuan-Ta Li

    2015-01-01

    Full Text Available We present a case of a patient with hernia of anterior tibialis who was treated operatively. Muscle herniation through a fascial defect is rare, which requires repair of fascial defects. We performed a simple closure of fascial defect. A fasciotomy was proceeded to complication of acute compartment syndrome developed after the operation. The sequelae as weakness of dorsiflexion of ankle and big toe were present.

  4. Surgical tension pneumothorax during laparoscopic repair of massive hiatus hernia: a different situation requiring different management

    National Research Council Canada - National Science Library

    Phillips, S; Falk, G L

    2011-01-01

    During laparoscopic repair of massive hiatus hernia, surgical dissection can breach the parietal pleura allowing insufflating carbon dioxide to rapidly expand the pleural space, causing a tension pneumothorax...

  5. A COMPARATIVE STUDY BETWEEN LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR AND TOTAL EXTRAPERITONEAL REPAIR OF INGUINAL HERNIA

    Directory of Open Access Journals (Sweden)

    Narendra

    2016-05-01

    Full Text Available BACKGROUND Groin hernia surgeries have come a long way since knowledge of modern surgery. Among them laparoscopic hernia repair is the advanced and better method in terms of less pain and speedy recovery. AIMS AND OBJECTIVES To compare and assess the outcome between laparoscopic transabdominal preperitoneal repair and total extraperitoneal repair of inguinal hernia. 1. To compare the duration of procedure between two techniques. 2. To assess the complications encountered (Intraoperative and postoperative. 3. To evaluate the post-operative pain. MATERIALS AND METHODS 40 cases of groin hernia admitted in Sri Siddhartha Medical College, Tumkur, between 2013 and 2015 randomly picked for TAPP and TEP surgeries, assigning 20 for each, prospective analysis made results compared and evaluated using Fischer’s test and Chisquare test. RESULTS Comparatively TEP repair took more operative time and TAPP repair had more post-operative pain. CONCLUSION No major complications seen in both procedures. Laparoscopy repair has long learning curve, which demands skills. TEP is more technically demanding and takes more time than TAPP, but with postoperative pain in comparison.

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

    Science.gov (United States)

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

    2012-12-01

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

  7. Total Extraperitoneal Hernia Repair: Residency Teaching Program and Outcome Evaluation.

    Science.gov (United States)

    Garofalo, Fabio; Mota-Moya, Pau; Munday, Andrew; Romy, Sébastien

    2017-01-01

    Total extraperitoneal (TEP) hernia repair has been shown to offer less pain, shorter postoperative hospital stay and earlier return to work when compared to open surgery. Our institution routinely performs TEP procedures for patients with primary or recurrent inguinal hernias. The aim of this study was to show that supervised senior residents can safely perform TEP repairs in a teaching setting. All consecutive patients treated for inguinal hernias by laparoscopic approach from October 2008 to June 2012 were retrospectively analyzed from a prospective database. A total of 219 TEP repairs were performed on 171 patients: 123 unilateral and 48 bilateral. The mean patient age was 51.6 years with a standard deviation (SD) of ± 15.9. Supervised senior residents performed 171 (78 %) and staff surgeons 48 (22 %) TEP repairs, respectively. Thirty-day morbidity included cases of inguinal paresthesias (0.4 %, n = 1), umbilical hematomas (0.9 %, n = 2), superficial wound infections (0.9 %, n = 2), scrotal hematomas (2.7 %, n = 6), postoperative urinary retentions (2.7 %, n = 6), chronic pain syndromes (5 %, n = 11) and postoperative seromas (6.7 %, n = 14). Overall, complication rates were 18.7 % for staff surgeons and 19.3 % for residents (p = 0.83). For staff surgeons and residents, mean operative times for unilateral hernia repairs were 65 min (SD ± 18.9) and 77.6 min (SD ± 29.8) (p = 0.043), respectively, while mean operative times for bilateral repairs were 115 min (SD ± 40.1) and 103.6 (SD ± 25.9) (p = 0.05). TEP repair is a safe procedure when performed by supervised senior surgical trainees. Teaching of TEP should be routinely included in general surgery residency programs.

  8. Minimally invasive repair of Morgagni hernia - A multicenter case series.

    Science.gov (United States)

    Lamas-Pinheiro, R; Pereira, J; Carvalho, F; Horta, P; Ochoa, A; Knoblich, M; Henriques, J; Henriques-Coelho, T; Correia-Pinto, J; Casella, P; Estevão-Costa, J

    2016-01-01

    Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.

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

    Science.gov (United States)

    Reynvoet, Emmelie; Berrevoet, Frederik

    2014-11-01

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

  10. [Laparoscopic incisional hernia repair as first therapeutic choice].

    Science.gov (United States)

    Verbo, A; Petito, L; Pedretti, G; Manno, A; Rizzo, G; Masi, A; Coco, C

    2005-08-01

    Incisional hernias are one of the most frequent complications of open abdominal surgery. Historically, the best results have been obtained with the open rives-stoppa approach. This is done by fixing a large piece of prosthetic mesh behind the rectus muscle. Laparoscopic approach allows similar mesh placement with minimal dissection and lower recurrence rate compared to the open mesh repair. Between October 2001 to September 2003, 75 consecutive patients were scheduled to undergo laparoscopic incisional hernia repair with ePTFE mesh (Gore-Tex Dualmesh Plus). Postoperative complications were recorded and analysed. Most were obese affected by multiple wall defects Conversion to open surgery was required in 1 case Postoperative complications occurred 13.3%. Recurrence occurred in one only case. The key to the success of this procedure is avoidance of complications. The laparoscopic approach is safe, effective and relatively complication-free option in the management of patients presenting with a first time or recurrent incisional hernia and recommended as the treatment of choice.

  11. 胎儿先天性膈疝MRI诊断的探讨%MRI diagnosis of fetal congenital diaphragmatic hernia

    Institute of Scientific and Technical Information of China (English)

    董素贞; 朱铭; 钟玉敏; 张弘

    2009-01-01

    目的 探讨MRI在胎儿先天性膈疝诊断中的应用价值.方法 14名孕妇,孕龄16~39周.产前常规行超声(US)检查怀疑胎儿先天性膈疝后在24-48 h内行MR检查,采用二维快速平衡稳态采集(2D FIESTA)序列、单次激发快速自旋回波(SSFSE)序列以及快速反转恢复运动抑制(FIRM)序列,行胎儿颅脑、胸、腹部常规及胸腹部重点冠状面、矢状面及横断面扫描,将产前MRI、US表现与出生后影像表现或手术(13例胎儿)、引产后尸体解剖(1例胎儿)结果对照.结果 12例为单胎,2例为双胎之一.膈疝位于左侧12例,右侧2例.随访结果与产前MRI诊断完全一致,产前US误诊2例、漏诊2例.12例左侧疝中1例为左胸部被巨大结肠占据,1例仅整个胃泡疝入,5例仅部分肠管疝入,5例整个胃泡和部分肠管同时疝入;2例右侧疝中1例仅部分肠管疝入,1例为肝脏部分和部分肠管同时疝入.结论 MRI对胎儿先天性膈疝诊断具有较高的应用价值.%Objective To explore the diagnostic value of MRI on fetal congenital diaphragmatic hernia(CDH).Methods Fourteen pregnant women with gestation from 16 to 39 weeks were studied with a 1.5 T superconductive MR unit within 24 to 48 hours after ultrasound studies.Fast-imaging employing steady-state acquisition(FIESTA),single-shot fast spin echo(SSFSE)and T_1-weighted fast inversion recovery motion insensitive(FIRM)sequences were employed on the axial,coronal and sagittal planes of the fetal brain,thorax and abdomen,especially the thorax.Prenatal US and MR imaging findings were compared with postnatal diagnoses(13 fetuses)or autopsy(1 fetus).US,MR imaging and surgery were used for postnatal evaluation.Results Fourteen pregnant women(12 with a single fetus and 2 with twin fetuses)were studied.There were 12 fetuses(in 2 cases,being one of twins)with a left-sided and 2 with right-sided diaphragmatic hernias.For all cases,the prenatal MRI diagnosis Was correct when compared with

  12. Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias

    DEFF Research Database (Denmark)

    Christoffersen, Mette W; Helgstrand, Frederik; Rosenberg, Jacob;

    2015-01-01

    and risk of chronic pain in small primary ventral hernias. METHODS: A cohort study with questionnaire and clinical follow-up was conducted. Patients with primary, elective, open mesh or sutured repair for a small umbilical or epigastric hernia (≤ 2 cm) were included. RESULTS: One thousand three hundred......BACKGROUND: Mesh repair reduces the risk of reoperation for recurrence in patients with primary ventral hernias. However, reoperation for recurrence underestimates total recurrence (reoperation + clinical) and mesh reinforcement may induce chronic pain. This study investigated the total recurrence......-term risk of recurrence after repair for small ventral hernias without increased risk of chronic pain....

  13. A modified laparoscopic hernioplasty (TAPP) is the standard procedure for inguinal and femoral hernias: a retrospective 17-year analysis with 1,123 hernia repairs.

    Science.gov (United States)

    Peitsch, Werner K J

    2014-02-01

    Laparoscopic and endoscopic procedures generally are accepted for repair of primary and recurrent hernias that follow conventional (anterior) repair. This report discusses transabdominal preperitoneal (TAPP) for incarcerated hernias, scrotal hernias, and hernias after radical prostatectomy, as well as hernia recurrences after TAPP and totally extraperitoneal (TEP) procedures (complex hernias). Studies with long-term results of hernia recurrences are missing. This study aimed to determine hernia recurrence rates for adults after a modified TAPP procedure. The records of patients who had hernia repair surgery at a general hospital 2, 7, 12, and 17 years earlier were analyzed. Living patients were requested to complete a questionnaire to complement information from their hospital records. A retrospective analysis was undertaken that included 5,764 patients who had undergone hernia repair surgery 2-17 years earlier at a single large center. Between 1993 and 2009, a modified TAPP procedure was performed for 5,764 patients (median age, 59.1 years) to repair 6,776 hernias (93.9% of all hernia repairs), including 6,126 primary hernias (87.4%) and 884 recurrent hernias (12.6%). These included 994 complicated hernias (14.2%) closed by a modified TAPP (89.3% of all femoral hernias, 85.9% of scrotal hernias, 79.1% of incarcerated hernias, and 92.7% of hernias after radical prostatectomy). Limited financial and staff resources did not permit a quantitative follow-up study within a reasonable time of all 5,764 patients who had hernia surgery 2-18 years earlier. To obtain quantitative results of hernia recurrences after a modified TAPP, the patients were divided into four subgroups and requested to complete a questionnaire. These four patient subgroups whose surgeries had been performed 2 years earlier (241 patients with 277 hernias), 7 years earlier (285 patients with 376 hernias), 12 years earlier (401 patients with 544 hernias), and 17 years earlier (181 patients with 222

  14. Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure.

    Science.gov (United States)

    Lambrecht, J R; Vaktskjold, A; Trondsen, E; Øyen, O M; Reiertsen, O

    2015-06-01

    Supposing divergent aetiology, we found it interesting to investigate outcomes between primary (PH) versus incisional (IH) hernias. In addition, we wanted to analyse the effect of defect closure and mesh fixation techniques. 37 patients with PH and 70 with IH were enrolled in a prospective cohort-study, treated with laparoscopic ventral hernia repair (LVHR) and randomised to ± transfascial sutures. In addition, we analysed results from a retrospective study with 36 PH and 51 IH patients. Mean follow-up time was 38 months in the prospective study and 27 months in the retrospective study. 35 % of PH's and 10 % of IH's were recurrences after previous suture repair. No late infections or mesh removals occurred. Recurrence rates in the prospective study were 0 vs. 4.3 % (p = 0.55) and the complication rates were 16 vs. 27 % (p = 0.24) in favour of the PH cohort. The IH group had a mesh protrusion rate of 13 vs. 5 % in the PH group (p = 0.32), and significantly (p hernias and adhesion score, longer operating time (100 vs. 79 min) and admission time (2.8 vs. 1.6 days). Closure of the hernia defect did not influence rate of seroma, pain at 2 months, protrusion or recurrence. An overall increased complication rate was seen after defect closure (OR 3.42; CI 1.25-9.33). With PH, in comparison to IH treated with LVHR, no differences were observed regarding recurrence, protrusion or complication rates. Defect closure (raphe), when using absorbable suture, did not benefit long-term outcomes and caused a higher overall complication rate. (ClinicalTrials.gov number: NCT00455299).

  15. Nationwide prospective study on readmission after umbilical or epigastric hernia repair

    DEFF Research Database (Denmark)

    Helgstrand, F; Jørgensen, L N; Rosenberg, J;

    2013-01-01

    The primary aim of the present study was to investigate risk factors for readmission after elective umbilical and epigastric hernia repair and secondarily to evaluate causes for readmission.......The primary aim of the present study was to investigate risk factors for readmission after elective umbilical and epigastric hernia repair and secondarily to evaluate causes for readmission....

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

    Science.gov (United States)

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

    2015-08-01

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

  17. Postoperative Comparison In Open Vs. Laparoscopic Ventral Hernia Repair In Obese Patients

    Directory of Open Access Journals (Sweden)

    Dogaru Iuliana

    2017-02-01

    Full Text Available Introduction: Obesity is an important problem in our society. Recent studies shows that laparoscopic ventral hernia repair has advantages in obese patients comparing with the standard open approach. This study wants to compare length of stay (LOS, hospitalization costs (HC and operative time (OT in laparoscopic and open ventral hernia repair.

  18. Emergency repair of inguinal hernia in the premature infant is associated with high direct medical costs

    NARCIS (Netherlands)

    J. Verhelst (Joost); B. de Goede (Barry); B.J.H. van Kempen (Bob); H.R. Langeveld-Benders (Hester); M.J. Poley (Marten); G. Kazemier (Geert); J. Jeekel (Hans); R.M.H. Wijnen (René); J.F. Lange (Johan)

    2015-01-01

    textabstractPurpose: Inguinal hernia repair is frequently performed in premature infants. Evidence on optimal management and timing of repair, as well as related medical costs is still lacking. The objective of this study was to determine the direct medical costs of inguinal hernia, distinguishing b

  19. 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....

  20. Pain after totally extraperitoneal (TEP) hernia repair might fade out within a year

    NARCIS (Netherlands)

    Burgmans, J. P J; Schouten, N.; Clevers, G. J.; Verleisdonk, E. J M M; Davids, P. H P; Voorbrood, C. E H; Simmermacher, R. K J; Van Dalen, T.

    2015-01-01

    Background: The incidence of chronic pain after endoscopic hernia repair varies between 1 and 16 %. Studies regarding the course of pain in time after the operation are scarce. Methods: 473 male patients ≥18 years of age, scheduled for totally extraperitoneal (TEP) hernia repair (Prolene® mesh) betw

  1. Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair

    DEFF Research Database (Denmark)

    Kokotovic, Dunja; Bisgaard, Thue; Helgstrand, Frederik

    2016-01-01

    Importance: Prosthetic mesh is frequently used to reinforce the repair of abdominal wall incisional hernias. The benefits of mesh for reducing the risk of hernia recurrence or the long-term risks of mesh-related complications are not known. Objective: To investigate the risks of long......-term recurrence and mesh-related complications following elective abdominal wall hernia repair in a population with complete follow-up. Design, Setting, and Participants: Registry-based nationwide cohort study including all elective incisional hernia repairs in Denmark from January 1, 2007, to December 31, 2010....... Exposures: Hernia repair using mesh performed by either open or laparoscopic techniques vs open repair without use of mesh. Main Outcomes and Measures: Five-year risk of reoperation for recurrence and 5-year risk of all mesh-related complications requiring subsequent surgery. Results: Among the 3242...

  2. Patient profiles and outcomes following repair of irreducible and reducible Ventral Wall Hernias.

    Science.gov (United States)

    Danzig, M R; Stey, A M; Yin, S S; Qiu, S; Divino, C M

    2016-04-01

    The belief that irreducible hernias are repaired less successfully and with higher morbidity drives patients to seek elective repair. The aims of this study were threefold. First, this study sought to compare characteristics of patients undergoing irreducible and reducible ventral hernia repair. Second, to compare morbidity rates. Third, to determine which factors, including irreducibility, might be associated with recurrence. This observational study was a retrospective review of 252 consecutive ventral hernia patients divided into two cohorts: 101 patients who underwent repair of an irreducible ventral hernia, and 152 patients underwent repair of a reducible ventral hernia. The mean follow-up time was approximately 4 years in both groups. Patients undergoing repair of irreducible hernias had higher median BMI (31 vs. 27 kg/m2, p = 0.005), had their hernias longer (median 34 months compared to 12 months, p = 0.043), had more defects on average (mean 1.8 vs. 1.4, p hernia size (p = 0.821), nor the location of hernia (p = 0.261) differed significantly between the two groups. Morbidity rates, including rates of surgical site infection, obstruction, and recurrence, did not differ significantly; nor did recurrence-free survival (RFS) distributions. Risk factors for hernia recurrence on multivariate analysis included the repaired hernia being itself recurrent (HR = 2.06, 95% CI = 1.07-3.99, p = 0.031), the occurrence of post-operative surgical site infection (HR = 5.10, 95% CI = 2.18-11.91, p hernias did not have statistically significant differences in morbidity. Recurrence was not observed to be associated with irreducibility but was found to be associated with other post-operative complications.

  3. Quality of life following component separation versus standard open ventral hernia repair for large hernias.

    Science.gov (United States)

    Klima, David A; Tsirline, Victor B; Belyansky, Igor; Dacey, Kristian T; Lincourt, Amy E; Kercher, Kent W; Heniford, B Todd

    2014-04-01

    Component separation (CS) has become a viable alternative to repair large ventral defects when the fascia cannot be reapproximated. However, the impact of transecting the external oblique to facilitate closure of the abdomen on quality of life (QOL) has yet to be investigated. The study goal was to investigate QOL and outcomes after standard open ventral hernia repair (OVHR) versus CS for large ventral hernias. Prospective data for all CSs were reviewed and compared with matched OVHR controls. All defects were 100 to 1000 cm2 in size and repaired with mesh. Comorbidities, complications, outcomes, and Carolinas Comfort Scale (CCS) scores, were reviewed. Seventy-four CS patients were compared with 154 patients undergoing standard OVHR with similar defect sizes. Age (56.7±13.0 vs. 54.7 ± 12.3 years, P = .26), defect sizes (299 ± 160 vs. 304 ± 210 cm2, P = .87), and BMI (32.7 ± 6.9 vs. 34.2 ± 9.0 kg/m2, P = .26) were similar in both groups, respectively. There were no differences in major postoperative complications (P = .22), mesh infections (P = 1.00), wound infections (P = .07), or hernia recurrence (P = .09), but wound breakdown increased after CS (10% vs. 1%, P < .001) as did seroma interventions (15% vs. 4%, P = .005). Postoperative CCS scores were similar at 1 month (P = .82) and 1 year (P = .14). In the first comparative study of its kind, it is found that patient undergoing CS with mesh reinforcement had equal short- and long-term QOL outcomes compared with similar patients who underwent standard OVHR. Whereas wound breakdown and seroma formation are higher, the overall complication, mesh infection, and recurrence rates are similar.

  4. Inguinodynia following Lichtenstein tension-free hernia repair: A review

    Institute of Scientific and Technical Information of China (English)

    Abdul Hakeem; Venkatesh Shanmugam

    2011-01-01

    Chronic Groin Pain (Inguinodynia) following inguinal hernia repair is a significant, though under-reported problem.Mild pain lasting for a few days is common following mesh inguinal hernia repair.However, moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological.The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors.The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves.Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain, as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved.Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair, use of heavyweight vs lightweight mesh and mesh fixation with sutures vs glue.Though there is no convincing evidence favouring one over the other, lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients.Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain, though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation.Both nonsurgical and surgical options have been tried for chronic groin pain, with their consequent risks of analgesic sideeffects, recurrent pain, recurrent hernia and significant sensory loss.By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre- and post-herniorraphy.

  5. Cumulative incidence and registry validation of groin hernia repair in a 34-year nationwide cohort

    DEFF Research Database (Denmark)

    Burcharth, Jakob; Liljekvist, Mads Svane; Pommergaard, Hans-Christian

    2016-01-01

    INTRODUCTION: The purpose of this study was to present a nationwide cumulative incidence and an age-specific incidence rate of groin hernia repair as well as to evaluate the validity of inguinal and femoral hernia operation codes in the Danish National Patient Registry (DNPR). METHODS: All persons...... registered with inguinal hernia operations in the DNPR who had been operated for an inguinal hernia was 100% (95% CI: 96-100%) and 91.3% (95% CI: 83-96%) for femoral hernia operations. CONCLUSIONS: The incidence rate of groin hernia operations peaked at the 0-1 year age group in males and at the 3-4-year age...... group in females. Furthermore, the validation of the DNPR showed very high positive predictive values for both inguinal hernia operations and femoral hernia operations. FUNDING: none. TRIAL REGISTRATION: not relevant....

  6. Poorly understood and often miscategorized congenital umbilical cord hernia: an alternative repair method.

    Science.gov (United States)

    İnce, E; Temiz, A; Ezer, S S; Gezer, H Ö; Hiçsönmez, A

    2017-06-01

    Umbilical cord hernia is poorly understood and often miscategorized as "omphalocele minor". Careless clamping of the cord leads to iatrogenic gut injury in the situation of umbilical cord hernia. This study aimed to determine the characteristics and outcomes of umbilical cord hernias. We also highlight an alternative repair method for umbilical cord hernias. We recorded 15 cases of umbilical cord hernias over 10 years. The patients' data were retrospectively reviewed, and preoperative preparation of the newborn, gestational age, birth weight, other associated malformations, surgical technique used, enteral nutrition, and length of hospitalization were recorded. This study included 15 neonates with umbilical cord hernias. The mean gestational age at the time of referral was 38.2 ± 2.1 umbilical cord hernia, the body folds develop normally and form the umbilical ring. The double purse-string technique is easy to apply and produces satisfactory cosmetic results in neonates with umbilical cord hernias.

  7. Cumulative incidence and registry validation of groin hernia repair in a 34-year nationwide cohort

    DEFF Research Database (Denmark)

    Burcharth, Jakob; Liljekvist, Mads Svane; Pommergaard, Hans-Christian;

    2016-01-01

    INTRODUCTION: The purpose of this study was to present a nationwide cumulative incidence and an age-specific incidence rate of groin hernia repair as well as to evaluate the validity of inguinal and femoral hernia operation codes in the Danish National Patient Registry (DNPR). METHODS: All persons...... registered with inguinal hernia operations in the DNPR who had been operated for an inguinal hernia was 100% (95% CI: 96-100%) and 91.3% (95% CI: 83-96%) for femoral hernia operations. CONCLUSIONS: The incidence rate of groin hernia operations peaked at the 0-1 year age group in males and at the 3-4-year age...... group in females. Furthermore, the validation of the DNPR showed very high positive predictive values for both inguinal hernia operations and femoral hernia operations. FUNDING: none. TRIAL REGISTRATION: not relevant....

  8. Robotic repair of a large abdominal intercostal hernia: a case report and review of literature.

    Science.gov (United States)

    Wang, Stephani C; Singh, Tejinder P

    2017-06-01

    Abdominal intercostal hernia is an uncommon phenomenon, reported in few case reports and small case series. If left untreated, it can lead to strangulation and visceral ischemia. Prompt diagnosis and appropriate surgical intervention are thus critical to prevent resulting morbidity. We present a 50-year-old woman with a large abdominal intercostal hernia after an open nephrectomy. She underwent a successful robotic repair of the hernia with mesh placement. Through the presentation, we would like to raise awareness of intercostal hernia as a complication of open nephrectomy and significance of early diagnosis in avoiding potential morbidity. We also performed a review of literature especially focusing on acquired abdominal intercostal hernia secondary to prior surgery. Although intercostal hernias can be difficult to repair secondary to the size and location, adequate visualization and surgical planning are critical to successful repair.

  9. Pain and convalescence following laparoscopic ventral hernia repair

    DEFF Research Database (Denmark)

    Eriksen, Jens Ravn

    satisfaction. This issue must have first priority in future ventral hernia repair research. It is now documented, that the simple application of fibrin glue instead of titanium tacks for mesh fixation in LVHR of defects ...) assess the intensity and impact of postoperative pain by detailed patient-reported description of pain and convalescence after LVHR (Study I), 2) evaluate the feasibility of fibrin sealant (FS) for mesh fixation in an experimental pig model (Study II), and 3) investigate FS vs. tacks for mesh fixation...

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

    Science.gov (United States)

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

    2015-01-01

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

  11. A Case of Morgagni Hernia Resulting with Respiratory Arrest

    Directory of Open Access Journals (Sweden)

    Cavit Çöl

    2011-05-01

    Full Text Available Morgagni’s hernia is seen at a rate of 3-4% among all diaphragmatic hernias. It develops from a defect in the pleuroperitoneal membrane. Herniation of the omentum is seen most commonly, that of the colon frequently, and herniation of small bowel and stomach is seen rarely. When being examined due to anemia and dyspnea, a 53-year-old male patient suffered from a respiratory arrest and was hence intubated and placed under treatment at the intensive care unit. On radiological examination, a giant diaphragmatic hernia was observed bilaterally, more marked on the right side. On laparotomy, especially on the right side, the caecum, the ascending colon, the transverse colon, the appendix, the omentum and part of the small bowel was seen to be herniated. Primary diaphragmatic repair + right hemicolectomy + end-to-end ileo-transversostomy was performed. We have reported this case because it was a giant hernia which caused respiratory arrest.

  12. Congenital diaphragmatic hernia: The role of multi-institutional collaboration and patient registries in supporting best practice.

    Science.gov (United States)

    Lally, Pamela A; Skarsgard, Erik D

    2017-06-01

    Among congenital malformations, congenital diaphragmatic hernia (CDH) is distinguished by its relatively low occurrence rate, need for resource intensive, integrated multidisciplinary care, and widespread variation in practice and outcome. Although randomized controlled trials (RCTs) are considered the gold standard for generating evidence, they are poorly suited to the study of a condition like CDH due to challenges in illness severity adjustment, unpredictability in clinical course and the impact limitations of studying a single intervention at a time. An alternative to RCTs for comparative effectiveness research for CDH is the patient registry, which aggregates multi-institutional condition-specific patient level data into a large CDH-specific database for the dual purposes of collaborative research and quality improvement across participating sites. This article discusses patient registries from the perspective of structure, data collection and management, and privacy protection that guide the use of registry data to support collaborative, multidisciplinary research. Two CDH-specific registries are described as illustrative examples of the "value proposition" of registries in improving the evidence basis for best practices for CDH. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Stomach position in prediction of survival in left-sided congenital diaphragmatic hernia with or without fetoscopic endoluminal tracheal occlusion.

    Science.gov (United States)

    Cordier, A-G; Jani, J C; Cannie, M M; Rodó, C; Fabietti, I; Persico, N; Saada, J; Carreras, E; Senat, M-V; Benachi, A

    2015-08-01

    To investigate the value of fetal stomach position in predicting postnatal outcome in left-sided congenital diaphragmatic hernia (CDH) with and without fetoscopic endoluminal tracheal occlusion (FETO). This was a retrospective review of CDH cases that were expectantly managed or treated with FETO, assessed from May 2008 to October 2013, in which we graded, on a scale of 1-4, stomach position on the four-chamber view of the heart with respect to thoracic structures. Logistic regression analysis was used to investigate the effect of management center (Paris, Brussels, Barcelona, Milan), stomach grading, observed-to-expected lung area-to-head circumference ratio (O/E-LHR), gestational age at delivery, birth weight in expectantly managed CDH, gestational ages at FETO and at removal and period of tracheal occlusion, on postnatal survival in CDH cases treated with FETO. We identified 67 expectantly managed CDH cases and 47 CDH cases that were treated with FETO. In expectantly managed CDH, stomach position and O/E-LHR predicted postnatal survival independently. In CDH treated with FETO, stomach position and gestational age at delivery predicted postnatal survival independently. In left-sided CDH with or without FETO, stomach position is predictive of postnatal survival. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  14. Assessment of lung development in isolated congenital diaphragmatic hernia using signal intensity ratios on fetal MR imaging.

    Science.gov (United States)

    Balassy, Csilla; Kasprian, Gregor; Brugger, Peter C; Weber, Michael; Csapo, Bence; Herold, Christian; Prayer, Daniela

    2010-04-01

    To investigate developmental changes in the apparently unaffected contralateral lung by using signal intensity ratios (SIR) and lung volumes (LV), and to search for correlation with clinical outcome. Twenty-five fetuses (22-37 weeks' gestation) were examined. Lung/liver signal intensity ratios (LLSIR) were assessed on T1-weighted and T2-weighted sequences for both lungs, then together with LV compared with age-matched controls of 91 fetuses by using the U test. Differences in LLSIRs and lung volumes were correlated with neonatal outcomes. LLSIRs in fetuses with congenital diaphragmatic hernia (CDH) were significantly higher in both lungs on T1-weighted images and significantly lower on T2-weighted images, compared with normals (p < 0.05), increasing on T2-weighted imaging and decreasing on T1-weighted imaging during gestation. Total LV were significantly smaller in the CDH group than in controls (p < 0.05). No significant differences in LLSIR of the two lungs were found. Outcomes correlated significantly with total LV, but not with LLSIR. Changes in LLSIR seem to reflect developmental impairment in CDH; however, they provide no additional information in predicting outcome. LV remains the best indicator on fetal MR imaging of neonatal survival in isolated, left-sided CDH.

  15. Assessment of lung development in isolated congenital diaphragmatic hernia using signal intensity ratios on fetal MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Balassy, Csilla; Kasprian, Gregor; Weber, Michael; Herold, Christian; Prayer, Daniela [Medical University of Vienna, Department of Radiology, Vienna (Austria); Brugger, Peter C. [Medical University of Vienna, Centre of Anatomy and Cell Biology, Vienna (Austria); Csapo, Bence [Medical University of Vienna, Department of Obstetrics and Gyneocology, Vienna (Austria)

    2010-04-15

    To investigate developmental changes in the apparently unaffected contralateral lung by using signal intensity ratios (SIR) and lung volumes (LV), and to search for correlation with clinical outcome. Twenty-five fetuses (22-37 weeks' gestation) were examined. Lung/liver signal intensity ratios (LLSIR) were assessed on T1-weighted and T2-weighted sequences for both lungs, then together with LV compared with age-matched controls of 91 fetuses by using the U test. Differences in LLSIRs and lung volumes were correlated with neonatal outcomes. LLSIRs in fetuses with congenital diaphragmatic hernia (CDH) were significantly higher in both lungs on T1-weighted images and significantly lower on T2-weighted images, compared with normals (p < 0.05), increasing on T2-weighted imaging and decreasing on T1-weighted imaging during gestation. Total LV were significantly smaller in the CDH group than in controls (p < 0.05). No significant differences in LLSIR of the two lungs were found. Outcomes correlated significantly with total LV, but not with LLSIR. Changes in LLSIR seem to reflect developmental impairment in CDH; however, they provide no additional information in predicting outcome. LV remains the best indicator on fetal MR imaging of neonatal survival in isolated, left-sided CDH. (orig.)

  16. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males

    DEFF Research Database (Denmark)

    Bay-Nielsen, M; Nilsson, E; Nordin, P;

    2004-01-01

    males operated on for an indirect inguinal hernia with a Lichtenstein mesh repair, Shouldice or Marcy (annulorrhaphy) repair. METHODS: This was a postal questionnaire study carried out within the Danish and Swedish Hernia Database Collaboration. Some 2612 patients responded (response rate 80.9 per cent...... it as worse after than before surgery, and 56.6 per cent stated that it interfered with social activities. CONCLUSION: Chronic pain is common after primary inguinal hernia repair in young males, but there is no difference in the pain associated with open mesh and non-mesh repair....

  17. Combining autologous ventral hernia repair using component separation with DIEP breast reconstruction

    Directory of Open Access Journals (Sweden)

    Louis de Weerd

    2015-12-01

    Full Text Available Concern about flap viability and abdominal wall integrity would normally exclude a patient with a large ventral midline hernia from having a breast reconstruction with a deep inferior epigastric perforator (DIEP flap. Ventral hernia repair using the abdominoplasty approach has been reported before. The abdominoplasty flap would normally be discarded. This article presents a unique case of a patient with a large incisional midline hernia who had a combined procedure of autologous hernia repair using component separation technique and DIEP breast reconstruction. The indications for DIEP breast reconstruction are therewith expanded.

  18. Laparoscopic vs open incisional hernia repair a randomized clinical trial

    NARCIS (Netherlands)

    H.H. Eker (Hasan); B.M. Hansson; M. Buunen (Mark); I.M.C. Janssen (Ignace); R.E.G.J.M. Pierik (Robert); W.C.J. Hop (Wim); H.J. Bonjer (Jaap); J. Jeekel (Hans); J.F. Lange (Johan)

    2013-01-01

    textabstractImportance: Incisional hernia is the most frequent surgical complication after laparotomy. Up to 30% of all patients undergoing laparotomy develop an incisional hernia. Objective: To compare laparoscopic vs open ventral incisional hernia repairwith regard to postoperative pain and

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

    DEFF Research Database (Denmark)

    Tolver, Mette A; Rosenberg, Jacob

    2015-01-01

    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...... 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...

  20. Laparoscopic repair of a bilateral internal inguinal hernia with supravesical hernia – a case report

    OpenAIRE

    2015-01-01

    Introduction: Supravesical hernia is an exceptional subtype of internal inguinal hernia, and it is located between the median umbilical ligament and the medial umbilical ligament. The hernia is classified as two types: internal supravesical hernia and external supravesical hernia. Presentation of case: Herein we report a rare case of external supravesical hernia successfully treated by laparoscopic procedure. The patient who complained right inguinal protrusion and mild frequent urination ...

  1. Ultrapro hernia system for inguinal hernia repair%腹股沟疝 UHS 手术

    Institute of Scientific and Technical Information of China (English)

    陈吉彩; 陈晓曦

    2014-01-01

    Ultrapro hernia dystem ( UHS) is a bilayer polypropylene mesh which is composed of an anterior layer , a posterior layer and a connector .The posterior layer is placed between the transversalis fascia and peritoneum ( preperitoneal space ) and covers the myopectineal orifice , for repairing the preperitoneal space.By fixing of the anterior layer between the inguinal ligament and pubic tubercle , the posterior wall of the inguinal canal could be strengthened .The connector , which filled the abdominal wall defect and fixed layers, could prevent from recurrence caused by displacement of mesh .Double repairment of the posterior wall of the inguinal canal and the preperitoneal space by using UHS could significantly reduce the recurrence of inguinal hernia maximally .%超普疝修补装置( ULTRAPRO Hernia System, UHS)由上片、下片和中间连接柱构成。下片位于腹膜与腹横筋膜之间(腹膜前间隙),覆盖整个肌耻骨孔,起到了腹膜前间隙修补的作用;将上片分别固定于腹股沟韧带和耻骨结节,加强腹股沟管后壁;中间连接柱既充填了疝环缺损,又连接和稳定了上、下片,可防止网片移位造成的复发。 UHS同时对腹膜前间隙和腹股沟管后壁进行双重修补,理论上最大限度地减少了腹股沟疝的复发。

  2. Primary fascial closure with laparoscopic ventral hernia repair: systematic review.

    Science.gov (United States)

    Nguyen, Duyen H; Nguyen, Mylan T; Askenasy, Erik P; Kao, Lillian S; Liang, Mike K

    2014-12-01

    Laparoscopic ventral hernia repair (LVHR) has grown in popularity. Typically, this procedure is performed with a mesh bridge technique that results in high rates of seroma, eventration (bulging), and patient dissatisfaction. In an effort to avoid these complications, there is growing interest in the role of laparoscopic primary fascial closure with intraperitoneal mesh placement. This systematic review evaluated the outcomes of closure of the central defect during LVHR. A literature search of PubMed, Cochrane databases, and Embase was conducted using PRISMA guidelines. MINORS was used to assess the methodologic quality. Primary outcome was hernia recurrence. Secondary outcomes were surgical-site infection, seroma formation, bulging, and patient-centered items (satisfaction, chronic pain, functional status). Eleven studies were identified, eight of which were case series (level 4 data). Three comparative studies examined the difference between closure and nonclosure of the fascial defect during laparoscopic ventral incisional hernia repairs (level 3 and 4 data). These studies suggested that primary fascial closure (n = 138) compared to nonclosure (n = 255) resulted in lower recurrence rates (0-5.7 vs. 4.8-16.7 %) and seroma formation rates (5.6-11.4 vs. 4.3-27.8 %). Follow-up periods for both groups were similar (1-108 months). Only one study evaluated patient function and clinical bulging. It showed better outcomes with primary fascial closure. Closure of the central defect during LVHR resulted in less recurrence, bulging, and seroma than nonclosure. Patients with closure were more satisfied with the results and had better functional status. The quality of the data was poor, however. A randomized controlled trial to evaluate the role of closure of the central defect during LVHR is warranted.

  3. 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 of the pr......A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal hernias as opposed to patients with indirect inguinal hernias. The aim...... of the present study was to assess whether direct or recurrent inguinal hernias are associated with an elevated rate of ventral hernia surgery....

  4. Open, intraperitoneal, ventral hernia repair: lessons learned from laparoscopy.

    Science.gov (United States)

    Ponsky, Todd A; Nam, Arthur; Orkin, Bruce A; Lin, Paul P

    2006-03-01

    Recent literature suggests that laparoscopic repair of ventral hernias may have very low recurrence rates. However, laparoscopy may not be feasible in certain situations. We describe an open technique that uses the tension-free retrofascial principles of laparoscopic repair without the need for subcutaneous flaps. Through an incision in the hernia, the peritoneum is entered and adhesions are taken down. A piece of DualMesh (W.L. Gore & Associates, Inc, Newark, Del) is trimmed to fit with a 5-cm circumferential overlap. A vertical incision is made in the mid portion of the mesh. The mesh is fixed in an intraperitoneal retrofascial position using GORE-TEX sutures (W.L. Gore & Associates, Inc). The sutures are brought through the abdominal wall using a laparoscopic suture passer and tied into place on one side of the mesh. That side is then tacked to the posterior fascia with a spiral tacking device. The other side is sutured into place in a similar fashion and then tacked to the fascia by passing the spiral tacking device through the incision in the mesh. The mesh incision is closed with a running GORE-TEX suture. The overlying tissues are closed in layers.

  5. Stratification of surgical site infection by operative factors and comparison of infection rates after hernia repair.

    Science.gov (United States)

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

    2015-03-01

    To investigate whether operative factors are associated with risk of surgical site infection (SSI) after hernia repair. Retrospective cohort study. Patients Commercially insured enrollees aged 6 months-64 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure or Current Procedural Terminology, fourth edition, codes for inguinal/femoral, umbilical, and incisional/ventral hernia repair procedures from January 1, 2004, through December 31, 2010. SSIs within 90 days after hernia repair were identified by diagnosis codes. The χ2 and Fisher exact tests were used to compare SSI incidence by operative factors. A total of 119,973 hernia repair procedures were analyzed. The incidence of SSI differed significantly by anatomic site, with rates of 0.45% (352/77,666) for inguinal/femoral, 1.16% (288/24,917) for umbilical, and 4.11% (715/17,390) for incisional/ventral hernia repair. Within anatomic sites, the incidence of SSI was significantly higher for open versus laparoscopic inguinal/femoral (0.48% [295/61,142] vs 0.34% [57/16,524], P=.020) and incisional/ventral (4.20% [701/16,699] vs 2.03% [14/691], P=.005) hernia repairs. The rate of SSI was higher following procedures with bowel obstruction/necrosis than procedures without obstruction/necrosis for open inguinal/femoral (0.89% [48/5,422] vs 0.44% [247/55,720], P<.001) and umbilical (1.57% [131/8,355] vs 0.95% [157/16,562], P<.001), but not incisional/ventral hernia repair (4.01% [224/5,585] vs 4.16% [491/11,805], P=.645). The incidence of SSI was highest after open procedures, incisional/ventral repairs, and hernia repairs with bowel obstruction/necrosis. Stratification of hernia repair SSI rates by some operative factors may facilitate accurate comparison of SSI rates between facilities.

  6. Laparoscopic repair of Morgagni′s hernia: An innovative approach

    Directory of Open Access Journals (Sweden)

    Rasik S Shah

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  8. A 22-Week-Old Fetus with Nager Syndrome and Congenital Diaphragmatic Hernia due to a Novel SF3B4 Mutation.

    Science.gov (United States)

    Castori, Marco; Bottillo, Irene; D'Angelantonio, Daniela; Morlino, Silvia; De Bernardo, Carmelilia; Scassellati Sforzolini, Giovanna; Silvestri, Evelina; Grammatico, Paola

    2014-08-01

    Nager syndrome, or acrofacial dysostosis type 1 (AFD1), is a rare multiple malformation syndrome characterized by hypoplasia of first and second branchial arches derivatives and appendicular anomalies with variable involvement of the radial/axial ray. In 2012, AFD1 has been associated with dominant mutations in SF3B4. We report a 22-week-old fetus with AFD1 associated with diaphragmatic hernia due to a previously unreported SF3B4 mutation (c.35-2A>G). Defective diaphragmatic development is a rare manifestation in AFD1 as it is described in only 2 previous cases, with molecular confirmation in 1 of them. Our molecular finding adds a novel pathogenic splicing variant to the SF3B4 mutational spectrum and contributes to defining its prenatal/fetal phenotype.

  9. Traumatic lumbar hernia repair: a laparoscopic technique for mesh fixation with an iliac crest suture anchor.

    Science.gov (United States)

    Links, D J R; Berney, C R

    2011-12-01

    Traumatic lumbar hernia (TLH) is a rare presentation. Traditionally, these have been repaired via an open approach. Recurrence can be a problem due to the often limited tissue available for mesh fixation at the inferior aspect of the hernia defect. We report the successful use of bone suture anchors placed in the iliac crest during transperitoneal laparoscopy for mesh fixation to repair a recurrent TLH. This technique may be particularly useful after previous failed attempts at open TLH repair.

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

    OpenAIRE

    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...

  11. DESARDA’S NO MESH REPAIR VERSUS LICHTENSTEIN’S OPEN MESH REPAIR OF INGUINAL HERNIA: A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Zaheer

    2015-09-01

    Full Text Available BACKGROUND : The tissue - based techniques are still acceptable for primary inguinal hernia repair according to the European Hernia Society guidelines. Desarda’s no mesh technique, introduced in 2001, is a hernia repair method using an undetached strip of external oblique Apo neurosis . This study compared outcomes after hernia repair with Desarda (D and mesh - based Lichtenstein (L techniques. METHODS : A total of 100 patients were randomly assigned to the D or L group (50 each. The primary outcomes measured were post - operative pain ( D ay1 and day 7, mean hospital stay (in days, return to basic activity (in days and recurrence. RESULTS : During the follow - up, no recurrences were observed in each group (p = 1.000. Average duration of the Desarda’s repair was 65.64 minutes, while the Lichtenstein repair lasted for 65.76 minutes. Mean VAS on 1 st post - operative day was significantly less in Desarda’s repair (2.86 than Lichenstein’s repair (3.50, (p=0.0004. Mean hospital stay was less in Desarda’s repair (2.58 days versus Lichtenstein’s repair (3.90 days p=0.0001. Return to basic physical activity was earlier in Desarda’s repair (7.04 days than Lichenstein’s repair (11.30 days, (p=<0.0001. However there was no recurrence in either group in 18 months follow up. CONCLUSIONS : The Desarda’s and Lichtenstein’s methods of primary inguinal hernia repair do not differ in the means of procedure complexity, surgery time and complication profile. However the return to basic physical activity was earlier in Desarda’s repair. Desarda’s no mesh repair is equally safe and more cost effective than Lichtenstein’s repair. The technique may potentially increase the number of tissue - based methods a vailable for treating inguinal hernias.

  12. 婴幼儿先天性膈疝的X线及CT表现%X-ray and CT features of congenital diaphragmatic hernia in infant

    Institute of Scientific and Technical Information of China (English)

    代燕增; 周朝理

    2012-01-01

    目的 探讨先天性膈疝的影像学诊断价值.方法 回顾性分析13例经X线胸部平片、钡餐或钡灌肠造影及CT检查而诊断为先天性膈疝,其中8例经手术证实.结果 胸腹膜裂孔疝X线胸腹部平片表现为患侧胸腔内见含气肠襻,钡餐或钡灌肠造影显示小肠或结肠疝入胸腔内;食管裂孔疝X线胸腹部平片表现为心膈角处透亮影或无异常,钡餐显示胃疝入胸腔内或见三环征;胸骨后疝X线胸腹部平片表现为心膈角处见含气或无气肿块影,钡餐显示胃及小肠位置及形态正常,钡灌肠造影显示结肠疝入胸骨后方心膈角处.而CT二维重建成像均可显示膈肌缺损的大小、部位及疝入胸腔内的脏器形态.胸腹膜裂孔疝6例,食管裂孔疝5例,胸骨后疝2例,其中位于左侧10例,右侧3例.结论 联合合理运用影像学检查对婴幼儿先天性膈疝具有很高的诊断价值,为临床手术治疗提供重要的依据.%Objective To investigate imaging value in diagnosing congenital diaphragmatic hernia in infants. Methods 13 cases with congenital diaphragmatic hernia confirmed by X-ray, barium meal or barium enema examination and CT examination were ana-lysed retrospectively. In which 8 cases were confirmed by operation. Results The pleuroperitoneal hernia,X-ray showed gas intesti-nal loops at disordered ipsilateral chest, barium meal or barium enema examination showed the small intestine or colon herniated into the chest cavity; the esophageal hiatal hernia, X-ray showed cardiac septal corner translucent shadow or without abnormal, barium meal showed the stomach herniated into the chest cavity, or the three-ring sign; the morgagni hernia,X-ray showed masses at the cardiac septal corner with gas or without gas inside the masses, barium meal showed the location and morphology of the stomach and small intestine to be normal, barium enema examination showed colon herniated into the chest behind the heart and diaphragm cor

  13. Laparoscopic Repair Reduces Incidence of Surgical Site Infections for All Ventral Hernias

    Science.gov (United States)

    Arita, Nestor A.; Nguyen, Mylan T.; Nguyen, Duyen H.; Berger, Rachel L.; Lew, Debbie F.; Suliburk, James T.; Askenasy, Erik P.; Kao, Lillian S.; Liang, Mike K.

    2014-01-01

    Background The role of laparoscopic repair of ventral hernias remains incompletely defined. We hypothesize that laparoscopy, compared to open repair with mesh, decreases surgical site infection (SSI) for all ventral hernia types. Methods MEDLINE, EMBASE, and Cochrane databases were reviewed to identify studies evaluating outcomes of laparoscopic versus open repair with mesh of ventral hernias and divided into groups (primary or incisional). Studies with high risk of bias were excluded. Primary outcomes of interest were recurrence and SSI. Fixed effects model was used unless significant heterogeneity, assessed with the Higgins I-square (I2), was encountered. Results There were five and fifteen studies for primary and incisional cohorts. No difference was seen in recurrence between laparoscopic and open repair in the two hernia groups. SSI was more common with open repair in both hernia groups: primary (OR 4.17, 95%CI [2.03–8.55]) and incisional (OR 5.16, 95%CI [2.79–9.57]). Conclusions Laparoscopic repair, compared to open repair with mesh, decreases rates of SSI in all types of ventral hernias with no difference in recurrence. This data suggests that laparoscopic approach may be the treatment of choice for all types of ventral hernias. PMID:25294541

  14. Antenatal use of bosentan and/or sildenafil attenuates pulmonary features in rats with congenital diaphragmatic hernia

    Institute of Scientific and Technical Information of China (English)

    María de Lourdes Lemus-Varela; Amed Soliz; Belinda Claudia Gómez-Meda; Ana Lourdes Zamora-Perez; José Manuel Ornelas-Aguirre; Valery Melnikov; Blanca Miriam Torres-Mendoza

    2014-01-01

    Background: Lung hypoplasia, pulmonary persistent hypertension of the newborn and its morphological changes are the main features in congenital diaphragmatic hernia (CDH). This study was undertaken to investigate if antenatal use of sildenafi l and/or bosentan attenuates vascular remodeling, promotes branching, and improves alveolarization in experimental nitrofeninduced CDH. Methods: Nitrofen (100 mg) was gavage-fed to pregnant rats at post conception day (PCD) 9 to induce CDH. The rats were randomized to 5 groups: 1) control; 2) nitrofen; 3) nitrofen+sildenafil 100 mg/kg per day at PCD 16-20; 4) nitrofen+bosentan 30 mg/kg per day, at PCD 16-20, and 5) nitrofen+bosentan+sildenafil, same doses and administration days. After cesarean delivery, the offsprings were sacrifi ced. The diaphragmatic defect and pulmonary hypoplasia were identifi ed, and the lungs were dissected. Arterial wall thickness, bronchiolar density and alveolarization were assessed. Results: The offsprings with CDH were characterized by severe pulmonary hypoplasia (lung weight-to-body weight ratio: 0.0263 [95% confidence interval (CI) 0.0242-0.0278)] in the nitrofen group versus 0.0385 (95% CI 0.0355-0.0424) in the control group (P=0.0001). Pulmonary arterial wall thickness was decreased to 3.0 (95% CI 2.8-3.7) μm in the nitrofen+sildenafil group versus 5.0 (95% CI 4.1-4.9) μm in the nitrofen group (P=0.02). Terminal bronchioles increased to 13.7 (95% CI 10.7-15.2) μm in the nitrofen+bosentan group in contrast to 8.7 (95% CI 7.2-9.4) μm in the nitrofen group (P=0.002). More significant differences (P=0.0001) were seen in terminal bronchioles in the nitrofen+sildenafil+bosentan group than in the nitrofen group [14.0 (95% CI 12.5-15.4) μm versus 8.5 (95% CI 7.1-9.3) μm]. Pulmonary arterial wall thickness was also decreased in the former group. Conclusions: In this rat model, antenatal treatment with sildenafi l attenuates vascular remodeling. Bosentan promotes the development of terminal

  15. 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.

  16. Laparoscopic Total Extraperitoneal (TEP) Inguinal Hernia Repair Using 3-dimensional Mesh Without Mesh Fixation.

    Science.gov (United States)

    Aliyazicioglu, Tolga; Yalti, Tunc; Kabaoglu, Burcak

    2017-08-01

    Approximately one fifth of patients suffer from inguinal pain after laparoscopic total extraperitoneal (TEP) inguinal hernia repair. There is existing literature suggesting that the staples used to fix the mesh can cause postoperative inguinal pain. In this study, we describe our experience with laparoscopic TEP inguinal hernia surgery using 3-dimensional mesh without mesh fixation, in our institution. A total of 300 patients who had undergone laparoscopic TEP inguinal hernia repair with 3-dimensional mesh in VKV American Hospital, Istanbul from November 2006 to November 2015 were studied retrospectively. Using the hospital's electronic archive, we studied patients' selected parameters, which are demographic features (age, sex), body mass index, hernia locations and types, duration of operations, preoperative and postoperative complications, duration of hospital stays, cost of surgery, need for analgesics, time elapsed until returning to daily activities and work. A total of 300 patients underwent laparoscopic TEP hernia repair of 437 inguinal hernias from November 2006 to November 2015. Of the 185 patients, 140 were symptomatic. Mean duration of follow-up was 48 months (range, 6 to 104 mo). The mean duration of surgery was 55 minutes for bilateral hernia repair, and 38 minutes for unilateral hernia repair. The mean duration of hospital stay was 0.9 day. There was no conversion to open surgery. In none of the cases the mesh was fixated with either staples or fibrin glue. Six patients (2%) developed seroma that were treated conservatively. One patient had inguinal hernia recurrence. One patient had preperitoneal hematoma. One patient operated due to indirect right-sided hernia developed right-sided hydrocele. One patient had wound dehiscence at the umbilical port entry site. Chronic pain developed postoperatively in 1 patient. Ileus developed in 1 patient. Laparoscopic TEP inguinal repair with 3-dimensional mesh without mesh fixation can be performed as safe as

  17. Partial duplication of 13q31.3-q34 and deletion of 13q34 associated with diaphragmatic hernia as a sole malformation in a fetus

    DEFF Research Database (Denmark)

    Jønch, Aia E; Larsen, Lise G; Pouplier, Susanne;

    2012-01-01

    the pregnancy after the finding of diaphragmatic hernia by ultrasound scan, which was also confirmed by autopsy of the fetus. Subsequently chromosome analysis, fluorescence in situ hybridization (FISH), and array comparative genomic hybridization (array CGH) was carried out on fetal tissue. The chromosome...... analysis revealed additional material on chromosome 13, which was shown to be from the same chromosome, by FISH analysis. Array CGH demonstrated a partial duplication and a small deletion at the distal long arm of chromosome 13. The parents had normal karyotypes. This is the first case of a de novo pure...

  18. 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

    Because of the high number of patients with chronic pain following inguinal hernia repair, a new, simple and safe method of repair is needed. Onstep is a new type of inguinal hernia repair that might be able to reduce postoperative acute and chronic pain. The aim of this study was to investigate...... 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...... between the groups regarding early postoperative pain or minor postoperative complications. Four patients had a recurrence within the first 10 days of follow-up, one patient in the Lichtenstein group and three patients in the Onstep group, p = 0.30. The Onstep technique for inguinal hernia repair was safe...

  19. Seroma after laparoscopic repair of hernia with PTFE patch: is it really a complication?

    Science.gov (United States)

    Susmallian, S; Gewurtz, G; Ezri, T; Charuzi, I

    2001-09-01

    We evaluated the true incidence of seroma formation after laparoscopic repair of incisional hernia with polytetrafluoroethylene (PTFE) patch. In a prospective study, 20 patients who underwent laparoscopic repair of incisional hernia with PTFE were evaluated clinically and with ultrasound examination for seroma formation up to the 90th postoperative day. Seroma was diagnosed clinically in only 35% of cases, while ultrasound examination revealed the presence of seroma in 100% of patients. Ultrasound examination is a reliable tool for diagnosis of early or delayed postoperative seroma formation following laparoscopic repair of incisional hernia with Gore-Tex Dualmesh.

  20. Chronic complaints after simple sutured repair for umbilical or epigastric hernias may be related to recurrence

    DEFF Research Database (Denmark)

    Westen, Mikkel; Christoffersen, Mette W; Jorgensen, Lars N

    2014-01-01

    PURPOSE: Umbilical and epigastric hernia repairs are minor, but are commonly conducted surgical procedures. Long-term results have only been sparsely investigated. Our objective was to investigate the risk of chronic complaints after a simple sutured repair for small umbilical and epigastric...... hernias. METHODS: A retrospective cohort study with a 5-year questionnaire and clinical follow-up was conducted. Patients undergoing primary elective, open non-mesh umbilical or epigastric sutured hernia repair were included. Patients completed a structured questionnaire regarding chronic complaints...

  1. Emergent Laparoscopic Repair of a Spigelian Hernia: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Reid Barker

    2013-01-01

    Full Text Available A spigelian hernia is a protrusion through an anterior abdominal wall defect along the linea semilunaris. The traditional method of repair consists of an open surgical technique requiring a lengthy abdominal incision to allow visualization of the defect. However, with the emergence and availability of laparoscopic techniques, a minimally invasive approach is feasible. Only eight prior case reports have documented emergent laparoscopic repair of a spigelian hernia. We describe the first successful laparoscopic repair of a spigelian hernia in an emergent setting at our institution.

  2. Is pooled data analysis of ventral and incisional hernia repair acceptable?

    Directory of Open Access Journals (Sweden)

    Ferdinand eKöckerling

    2015-05-01

    Full Text Available AbstractPurpose: In meta-analyses and systematic reviews comparing laparoscopic with open repair of ventral hernias, data on umbilical, epigastric and incisional hernias are pooled. Based on data from the Herniamed Registry, we aimed to investigate whether the differences in the therapy and treatment results justified such an approach.Methods: Between 1 September 2009 and 31 August 2013, 31,664 patients with a ventral hernia were enrolled in the Herniamed Hernia Registry. The implicated hernias included 16,206 umbilical hernias, 3,757 epigastric hernias, and 11,701 incisional hernias. Data on the surgical techniques, postoperative complication rates and one-year follow-up results were subjected to statistical analysis.Results: The laparoscopic IPOM technique was used significantly more often for incisional hernia than for epigastric hernia, 31.3 % vs. 24.0 %, respectively, and was used for 12.9 % of umbilical hernias (p < 0.0001. Likewise, the open technique with suturing of defect was used significantly more often for umbilical hernia than for epigastric hernia, 56.1 % vs. 35.4 %, respectively, and was used for 12.5 % of incisional hernias (p < 0.0001. The postoperative complication rates of 3.2 % for umbilical hernia and 3.5 % for epigastric hernia were significantly lower than for incisional hernia, at 9.2 % (p < 0.0001. That was also true for the reoperation rates due to postoperative complications, of 1.0 % vs. 1.2 % vs. 4.2 % (p < 0.0001. The one-year follow-up revealed significantly higher recurrence rates as well as rates of chronic pain needing treatment of 6.3 % and 7.9 %, respectively, for incisional hernia, compared with 4.1 % and 4.3 %, respectively, for epigastric hernia, and 2 % and 1.9 %, respectively, for umbilical hernia (p < 0.0001.Conclusion: Since significant differences were identified in the therapy and outcome between umbilical, epigastric and incisional hernias, scientific studies should be conducted only for a single

  3. Causes of recurrence in laparoscopic inguinal hernia repair

    Directory of Open Access Journals (Sweden)

    Kukleta Jan

    2006-01-01

    Full Text Available Aim: The analysis of possible mechanisms of repair failure is a necessary instrument and the best way to decrease the recurrence rate and improve the overall results. Avoiding historical errors and learning from the reported pitfalls and mistakes helps to standardize the relatively new laparoscopic techniques of trans-abdominal preperitoneal and total extraperitoneal. Materials and Methods: The video tapes of all primary laparoscopic repairs done by the author that led to recurrence were retrospectively analyzed and compared with findings at the second laparoscopic repair. A review of the available cases of recurrences occurring between 1994 and 2003 is the basis of this report. Summary: Adequate mesh size, porosity of mesh material, slitting of the mesh, correct and generous dissection of preperitoneal space and wrinkle-free placement of the mesh seem to be the more important factors in avoiding recurrence rather than strength of the material or strong penetrating fixation. Special attention should be paid to preperitoneal lipoma as a possible overlooked herniation or potential future pseudorecurrence despite nondislocated correctly positioned mesh. Conclusion: Laparoscopic hernia repair is a complex but very efficient method in experienced hands. To achieve the best possible results, it requires an acceptance of a longer learning curve, structured well-mentored training and high level of standardization of the operative procedure.

  4. FIELD BLOCK FOR INGUINAL HERNIA REPAIR- A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Shivakumar

    2013-01-01

    Full Text Available ABSTRACT: BACKGROUND AND OBJECTIVES: Present clinical study was conducted to evaluate advantages of field block for inguinal her nia repair, with respect to duration and quality of analgesia, haemodynamic stability, and s peed of recovery by using 1% lidocaine with adrenaline. METHODS: Study was conducted on 50 patients posted for elective ingu inal hernia repair. Field block was instituted with 1% lidocaine with adrenaline with mean volume of 35.48 ml to block ilioinguinal, iliohypogastric, genital b ranch of genitofemoral nerve with subcutaneous infiltration. Patients were observed f or duration and quality of analgesia. Haemodynamic stability with PR, systolic and diasto lic BP. Post anaesthesia recovery was assessed by using “criteria for fast track eligibil ity for ambulatory anaesthesia” after the surgery. Duration of analgesia was assessed with su bjective complaint of pain (duration of onset of analgesia till the subjective complaint of pain. RESULTS: In the present study, the quality of analgesia was excellent in 72% of cases, good in 16 %, fair in 8% and poor in 4%. The mean duration of analgesia was 201.02 min (160 min to 28 0 min. All patients were haemodynamically stable throughout the surgery. Usi ng fast tract eligibility criteria for recovery all the patient had a score of 12 at 0 min and all o f them had score of > 12 at 15 min and 30 min and were ready to be shifted toward from the OR byp assing the post anaesthesia recovery room. CONCLUSION: Thus field block for inguinal hernia repair is a saf e technique, that provides excellent quality and prolonged analgesia, w ith rapid recovery and minimal to nil complications.

  5. Late mesh rejection as a complication to transabdominal preperitoneal laparoscopic hernia repair

    DEFF Research Database (Denmark)

    Hofbauer, C; Andersen, P V; Juul, P;

    1998-01-01

    BACKGROUND: The use of a mesh in transabdominal preperitoneal laparoscopic hernia repair (TAPP) caries the risk of late rejection or infectious complications related to the mesh. The aim of this study was to describe the extent of these complications. METHODS: We performed a retrospective study...... repair had been done. CONCLUSION: Late mesh rejection is a potential complication of TAPP and has to be considered when choosing the surgical method of hernia repair....... of 500 consecutive patients with TAPP for inguinal hernia. RESULTS: Late mesh rejection was observed in three patients at 5-19 months after surgery. The mesh was removed via a suprapubic midline incision. At 3-4 month's follow-up, none of the patients had recurrence of the hernia, even though no hernia...

  6. PROSPECTIVE STUDY ON DARNING AND LICHTENSTEIN MESH HERNIOPLASTY (LMH IN INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Affin

    2016-01-01

    Full Text Available INTRODUCTION Prospective study on Darning and Lichtenstein Mesh Hernioplasty in Inguinal Hernia Repair is a study of 61 cases of inguinal hernias which were treated by either open Inguinal hernia mesh repair (Lichtenstein or darning repair. The study was conducted with an objective to compare the effectiveness of these procedures and complications if any. 61 cases of inguinal hernia admitted in Yenepoya Medical College Hospital, Mangalore were selected on the basis of the non-probability (prospective sampling method. All patients with uncomplicated direct and indirect hernias treated by darning or mesh repair were included. After preoperative preparation they were randomly chosen for darning or mesh repair. The age/sex incidence, mode of presentation, precipitating factors, surgical treatment and postoperative complications were all evaluated and compared with standard published literature. The total number of postoperative complications was reported in 13.9% patients, complications was high after Mesh repair when compared to Darning. Seroma was the most common complication followed by funiculitis and wound infection. There was one recurrence each noted till date in the two groups under study. Darn repair is equally effective and much less costly treatment for inguinal hernia than mesh repair which had more risk of infection.

  7. Characterization of ventral incisional hernia and repair using shear wave elastography.

    Science.gov (United States)

    Chaudhry, Anuj; Fernandez-Moure, Joseph S; Shajudeen, Peer Shafeeq; Van Eps, Jeffrey L; Cabrera, Fernando J; Weiner, Bradley K; Dunkin, Brian J; Tasciotti, Ennio; Righetti, Raffaella

    2017-04-01

    To assess the integrity of hernia repair, imaging modalities such as computed tomography or ultrasound (US) are commonly used. Neither modality has currently the capacity to simultaneously image the mesh and quantify a prosthetic and surrounding tissue stiffness. In this pilot study, we hypothesize that US shear wave elastography (SWE) can be used to identify a polyester mesh and a biologic graft and to assess their stiffness noninvasively in a rat model of bridging hernia repair. Lewis rats underwent hernia creation and repair with Parietex or Strattice at 30 d. After 3 mo, the animals were euthanized, and the Young's Modulus was measured using SWE. Three-dimensional reconstructions of the hernia pre- and post-repair were performed using in-house image processing algorithms. SWE was capable of accurate and real-time assessment and diagnosis of the hernia defects in vivo. Young's Modulus of Parietex meshes and Strattice grafts as estimated from the shear wave elastograms were found to be statistically different from each other (P < 0.05). Accurate three-dimensional reconstructions of the hernia defects pre- and post-repair were generated. In this study, we demonstrate the feasibility of using US SWE to detect ventral hernias and evaluate mesh repair in vivo. Our results indicate that the presence of a hernia and repair can be reliably visualized by SWE and three dimensionally reconstructed. Thus, this technique may provide both structural and functional information regarding the hernia and the repair. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Mesh repair of hernias of the abdominal wall

    OpenAIRE

    2003-01-01

    textabstractA hernia of the abdominal wall is a permanent or intermittent protrusion of abdominal contents outside the abdominal cavity through a defect in the abdominal wall. Approximately 75% of all hernias occur in the inguinal region. Other types of hernias of the ventral abdominal wall are incisional, umbilical, epigastric and Spigelian hernia. In chapter 1 an overview of hernias of the abdominal wall is described. The incidence, clinical implications and treatment options and their comp...

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

    NARCIS (Netherlands)

    J.W.A. Burger (Jacobus); R.W. Luijendijk; W.C.J. Hop (Wim); J.A. Halm (Jens); E.G. Verdaasdonk; J. Jeekel (Hans)

    2004-01-01

    textabstractOBJECTIVE: The objective of this study was to determine the best treatment of incisional hernia, taking into account recurrence, complications, discomfort, cosmetic result, and patient satisfaction. BACKGROUND: Long-term results of incisional hernia repair are lacking.

  10. Evaluation of Neonatal Lung Volume Growth by Pulmonary Magnetic Resonance Imaging in Patients with Congenital Diaphragmatic Hernia.

    Science.gov (United States)

    Schopper, Melissa A; Walkup, Laura L; Tkach, Jean A; Higano, Nara S; Lim, Foong Yen; Haberman, Beth; Woods, Jason C; Kingma, Paul S

    2017-09-01

    To evaluate postnatal lung volume in infants with congenital diaphragmatic hernia (CDH) and determine if a compensatory increase in lung volume occurs during the postnatal period. Using a novel pulmonary magnetic resonance imaging method for imaging neonatal lungs, the postnatal lung volumes in infants with CDH were determined and compared with prenatal lung volumes obtained via late gestation magnetic resonance imaging. Infants with left-sided CDH (2 mild, 9 moderate, and 1 severe) were evaluated. The total lung volume increased in all infants, with the contralateral lung increasing faster than the ipsilateral lung (mean ± SD: 4.9 ± 3.0 mL/week vs 3.4 ± 2.1 mL/week, P = .005). In contrast to prenatal studies, the volume of lungs of infants with more severe CDH grew faster than the lungs of infants with more mild CDH (Spearman's ρ=-0.086, P = .01). Although the contralateral lung volume grew faster in both mild and moderate groups, the majority of total lung volume growth in moderate CDH came from increased volume of the ipsilateral lung (42% of total lung volume increase in the moderate group vs 32% of total lung volume increase in the mild group, P = .09). Analysis of multiple clinical variables suggests that increased weight gain was associated with increased compensatory ipsilateral lung volume growth (ρ = 0.57, P = .05). These results suggest a potential for postnatal catch-up growth in infants with pulmonary hypoplasia and suggest that weight gain may increase the volume growth of the more severely affected lung. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Foetoscopic endotracheal occlusion (FETO) for severe isolated left-sided congenital diaphragmatic hernia: single center Polish experience.

    Science.gov (United States)

    Kosinski, Przemyslaw; Wielgos, Miroslaw

    2017-07-04

    To present early experience with foetoscopic endotracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH) in a new center in Poland. This was a prospective study in singleton pregnancies with CDH treated by FETO between 2014 and 2016 in the Medical University of Warsaw, Poland. FETO was carried out at 25.6-30.1 (median 27.7) weeks' gestation in 28 consecutive cases of isolated left-sided CDH with observed over expected lung area to head circumference ratio (o/e LHR) of 20.7-22.6 (median 18.9). Neonatal survival rate was 46.4% (13/28) at the time of discharge. The median o/e LHR the day before balloon removal was 33.4 (19.7-57.5) and median gestational age at delivery was 34.7 (29.0-38.1) weeks. Comparison of the survivors and perinatal deaths showed no significant differences in median gestational age at FETO or median o/e LHR before FETO, but higher median gestational age at delivery (35.9, range 32.7-38.1 weeks vs. 33.2, range 29.0-37.7 weeks; p = .007) and o/e LHR before balloon removal (33.7, range 28.3-57.5 vs. 30.9, range 19.7-37.5; p = .017). FETO was implemented successfully in Poland and the survival rate (46.4%) is similar to that reported in other centers. Important determinants of survival were gestational age at delivery and pulmonary response to FETO. The rate of preterm prelabor rupture of membranes (PPROM) in our series is similar to the larger series treated with FETO in the pioneering centers of this technique.

  12. STOPPA’S REPAIR FOR INGUINAL HERNIA: STILL AN IDEAL PROCEDURE

    Directory of Open Access Journals (Sweden)

    Durganna

    2015-08-01

    Full Text Available BACKGROUND : Inguinal hernia repairs are commonly performed operations. GPRVS is one of the methods . Also known as Stoppa s repair uses large prosthetic mesh placed in preperitoneal plane covering both the hernial orifices i . e ., it covers the whole Myopectineal Orifice Bilaterally. Stoppas repair is use full in cases of bilateral hernias, recurrent and multi recurrent hernias, unilateral hernias where risk of recurrence is more i . e. , When associated with COPD, BPH, Poor abdominal tone and previous surgery. Purpose of present study is to know the role of Stoppa s repair in management of inguinal hernias especialy Bilateral , recurrent and unilateral hernias which are at the risk of recu rrence. METHODS: Study done in victoria hospital attached toBangalore medical college and research centre . 250 cases were included for stoppa s repair. Bilateral hernias , recurrent hernias, unilateral hernias with one or more risk factors for recurrence and femoral hernias . Demographic data such as age, gender, occupation, smoking, symptoms as well as comorbid conditions such as chronic obstructive pulmonary disease, prostatism, and recurrence were collected. Duration of surgery was also noted. Complications such as seroma, hematoma, orchitis, and wound infection were recorded. Duration of hospital stay was recorded. Chronic groin pain and recurrences in each group were also recorded. RESULTS: Out of 250 patients 225 had bilateral inguinal hernia and 25 unila teral inguinal hernia , 48 were recurrent and 7 were re recurrent hernia. All the patients were males with age group between 21 to 80 years. All the patients had swelling in the groin region 43.3 % of patients had associated pain. Direct hernia was common v ariety in this study as mean age in the study was more than 40 yrs. Most of the patients had one or the other risk factor for recurrence smoking was most common 76.6% . O ther risk factors are COPD , BPH , Poor abdominal tone, previous surgery

  13. A STUDY OF POSTOPERATIVE COMPLICATIONS FOLLOWING OPEN MESH INGUINAL HERNIA REPAIR

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    Abdul Kalam

    2016-09-01

    Full Text Available BACKGROUND Inguinal hernia is the most common type of hernia. Inguinal region consists of deep inguinal ring, inguinal canal and superficial inguinal ring, which make the region weak and susceptible to hernia. 65% of inguinal hernias are indirect hernias and 35% direct hernias. Hernioplasty is the strengthening of posterior wall of inguinal canal. It can be done either with the help of mesh repair or darning. Hernioplasty is indicated in recurrent hernia cases, inguinal hernia with weak abdominal muscle tone where mesh plasty is preferred and inguinal hernia with good muscle tone where darning can be done. In mesh repair, posterior wall (Lichtenstein repair of inguinal canal is strengthened by a Prolene or Marlex mesh. Over time, fibroblasts and capillaries grow over the mesh converting it into a thick sheath strengthening the posterior wall. Complications which can be encountered postsurgery are pain, bleeding, urinary retention, scrotal swelling, abdominal distension, seroma and wound infections, chronic pain, keloid and testicular atrophy. MATERIALS AND METHODS  The study was conducted in the Department of General Surgery, Travancore Medical College, Kollam.  The study was done from January 2015 to January 2016.  One hundred cases were identified and were chosen for the study. INCLUSION CRITERIA 1. Inguinal hernia cases treated by open mesh repair. EXCLUSION CRITERIA 1. Other types of inguinal hernia repair. RESULTS All the cases studied belonged to male sex. In our study, age group twenty to forty years amounted to sixty one cases followed by age group forty to sixty years, which amounted to twenty eight cases. Age group zero to twenty years amounted to six cases and age group more than sixty years amounted to five cases. In the study group, seventy two cases were indirect inguinal hernias and twenty eight cases were direct inguinal hernias. Based on the complications encountered, pain at the site was the commonest complaint, which

  14. Laparoscopic ventral hernia repair using a two (5-mm) port technique.

    Science.gov (United States)

    Abir, Farshad; Eisenberg, Dan; Bell, Robert

    2005-01-01

    High recurrence rates have been documented after primary repair of incisional hernias. Laparoscopic ventral and incisional hernia repairs have been performed with very low rates of recurrence. We have modified the standard technique of laparoscopic repair in patients with small incisional and ventral hernias. The purpose of this study was to document the technique utilizing only two 5-mm ports and demonstrate that it is safe, effective, and feasible. Three patients with small incisional or ventral hernias were examined. The standard laparoscopic ventral hernia repair technique was modified as follows: two 5-mm ports were inserted on opposite sides of the defect. The defects ranged from 2.5 cm to 4 cm in size. Expanded polytetrafluoroethylene mesh (DualMesh, WL Gore, Flagstaff, AZ) was used to cover the hernia defect, overlapping the defect margins circumferentially by 3 cm. The mesh diameter ranged from 8.5 cm to 10 cm. The mesh was inserted through a 5-mm skin incision site and affixed into position with transfascial sutures and spiral tacks. The operative time ranged from 53 minutes to 57 minutes. All patients were discharged home the day of surgery and reported minimal postoperative pain. Follow-up ranged from 6 months to 1 year; all patients were doing well without recurrence. Laparoscopic repair of ventral or incisional hernias can be performed using only two 5-mm ports. This technique can be done on an outpatient basis in a safe, timely fashion.

  15. A novel technique of lumbar hernia repair using bone anchor fixation.

    Science.gov (United States)

    Carbonell, A M; Kercher, K W; Sigmon, L; Matthews, B D; Sing, R F; Kneisl, J S; Heniford, B T

    2005-03-01

    Lumbar hernias are difficult to repair due to their proximity to bone and inadequate surrounding tissue to buttress the repair. We analyzed the outcome of patients undergoing a novel retromuscular lumbar hernia repair technique. The repair was performed in ten patients using a polypropylene or polytetrafluoroethylene mesh placed in an extraperitoneal, retromuscular position with at least 5 cm overlap of the hernia defect. The mesh was fixed with circumferential, transfascial, permanent sutures and inferiorly fixed to the iliac crest by suture bone anchors. Five hernias were recurrent, and five were incarcerated; seven were incisional hernias, and three were posttraumatic. Back and abdominal pain was the most common presenting symptom. Mean hernia size was 227 cm(2) (60-504) with a mesh size of 620 cm(2) (224-936). Mean operative time was 181 min (120-269), with a mean blood loss of 128 ml (50-200). Mean length of stay was 5.2 days (2-10), and morphine equivalent requirement was 200 mg (47-460). There were no postoperative complications or deaths. After a mean follow-up of 40 months (3-99) there have been no recurrences. Our sublay repair of lumbar hernias with permanent suture fixation is safe and to date has resulted in no recurrences. Suture bone anchors ensure secure fixation of the mesh to the iliac crest and may eliminate a common area of recurrence.

  16. The laparoscopic repair of a morgagni hernia in a child.

    Science.gov (United States)

    Ra, Yong Joon; Huh, Up; Lee, Sang-Gwon; Je, Hyung Gon

    2011-02-01

    A 12-year-old female presented with the abnormal findings on the chest PA. The chest CT revealed a retrosternal defect of the diaphragm and a fatty opacity in the pleural cavity, resulting in a diagnosis of Morgagni hernia. It was decided to undergo a laparoscopic surgery. The retrosternal defect of the diaphragm measuring 3.5 cm in diameter was found, through which a portion of the greater omentum and the fatty tissue connected with the falciform ligament were herniated into the pleural cavity. The greater omentum was pushed back into the peritoneal cavity and the fatty tissue connected with falciform ligament was excised. The mediastinal pleura was plicated and the defect of the diaphragm was repaired primarily. Immediately after the operation, the patient developed a right pneumothorax for which a chest tube was inserted. She was discharged at the post-operative third day without any further complications.

  17. Strangulated ileostomy evisceration following lateralizing mesh repair of parastomal hernia.

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    Ramly, E P; Crosslin, T; Orkin, B; Popowich, D

    2016-04-01

    Parastomal hernia formation and ostomy prolapse are relatively common complications of intestinal ostomy construction. Underlay mesh placement with lateralization of the stoma limb appears to be the method of repair with the lowest recurrence rate. Prophylaxis of new stomas with mesh is advocated by many authors. We report the case of an 81-year-old man with chronic steroid-dependent COPD who presented to the emergency department with strangulated small bowel evisceration 9 days following completion abdominal colectomy, and creation of an end ileostomy reinforced with intraperitoneal mesh. This rare complication was related to this patient's risk factors for poor healing including poor nutrition, age, chronic COPD and coughing and steroid dependence with immunosuppression.

  18. Use of mesh in laparoscopic paraesophageal hernia repair

    DEFF Research Database (Denmark)

    Müller-Stich, Beat P.; Kenngott, Hannes G.; Gondan, Matthias;

    2015-01-01

    Introduction. Mesh augmentation seems to reduce recurrences following laparoscopic paraesophageal hernia repair (LPHR). However, there is an uncertain risk of mesh-associated complications. Risk-benefit analysis might solve the dilemma. Materials and Methods. A systematic literature search...... was performed to identify randomized controlled trials (RCTs) and observational clinical studies (OCSs) comparing laparoscopic mesh-augmented hiatoplasty (LMAH) with laparoscopic mesh-free hiatoplasty (LH) with regard to recurrences and complications. Random effects meta-analyses were performed to determine...... potential benefits of LMAH. All data regarding LMAH were used to estimate risk of mesh-associated complications. Risk-benefit analysis was performed using a Markov Monte Carlo decision-analytic model. Results. Meta-analysis of 3 RCTs and 9 OCSs including 915 patients revealed a significantly lower...

  19. Symptomatic Morgagni Hernia Misdiagnosed As Chilaiditi Syndrome

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    Vallee, Phyllis A

    2011-02-01

    Full Text Available Chilaiditi syndrome, symptomatic interposition of bowel beneath the right hemidiaphragm, is uncommon and usually managed without surgery. Morgagni hernia is an uncommon diaphragmatic hernia that generally requires surgery. In this case a patient with a longstanding diagnosis of bowel interposition (Chilaiditi sign presented with presumed Chilaiditi syndrome. Abdominal computed tomography was performed and revealed no bowel interposition; instead, a Morgagni hernia was found and surgically repaired. Review of the literature did not reveal similar misdiagnosis or recommendations for advanced imaging in patients with Chilaiditi sign or syndrome to confirm the diagnosis or rule out other potential diagnoses. [West J Emerg Med. 2011;12(1:121-123.

  20. Totally extra-peritoneal repair for acute incarcerated femoral hernia with intestinal obstruction

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    Guowei Kim

    2017-01-01

    Conclusion: This modification of the TEP repair technique for the acutely incarcerated and obstructed femoral hernia serves to minimise potential contamination by keeping the pre-peritoneal plane strictly separate from the intra-peritoneal space.