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Sample records for human incisional hernia

  1. The operation of giant incisional hernia

    DEFF Research Database (Denmark)

    Eriksson, Axelina; Krag, Christen; Jørgensen, Lars Nannestad

    2014-01-01

    Incisional hernia is a common complication to laparotomy impacting negatively on quality of life, risk of emergency surgery and cosmesis. The operation of giant incisional hernia (cross diameter of hernia defect > 20 cm) is a high risk procedure and the surgical techniques are not based on high...

  2. Stomal Closure: Strategies to Prevent Incisional Hernia

    Science.gov (United States)

    Harries, Rhiannon L.; Torkington, Jared

    2018-01-01

    Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or “purse-string” closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias. PMID:29670882

  3. Stomal Closure: Strategies to Prevent Incisional Hernia

    Directory of Open Access Journals (Sweden)

    Rhiannon L. Harries

    2018-04-01

    Full Text Available Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or “purse-string” closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias.

  4. Incisional hernia: new approaches and aspects

    NARCIS (Netherlands)

    D. den Hartog (Dennis)

    2010-01-01

    textabstractThis thesis is about the anatomy, diagnosis, treatment and outcome of incisional hernia. New approaches and aspects are discussed in the following chapters. The following definitions were derived from Butterworth’s medical dictionary 1. A hernia is the protrusion of an internal

  5. Initial experience of laparoscopic incisional hernia repair.

    Science.gov (United States)

    Razman, J; Shaharin, S; Lukman, M R; Sukumar, N; Jasmi, A Y

    2006-06-01

    Laparoscopic repair of ventral and incisional hernia has become increasingly popular as compared to open repair. The procedure has the advantages of minimal access surgery, reduction of post operative pain and the recurrence rate. A prospective study of laparoscopic incisional hernia repair was performed in our center from August 2002 to April 2004. Eighteen cases (n: 18) were performed during the study period. Fifteen cases (n: 15) had open hernia repair previously. Sixteen patients (n: 16) had successful repair of the hernia with the laparoscopic approach and two cases were converted to open repair. The mean hernia defect size was 156cm2. There was no intraoperative or immediate postoperative complication. The mean operating time was 100 +/- 34 minutes (75 - 180 minutes). The postoperative pain was graded as mild to moderate according to visual analogue score. The mean day of discharge after surgery was two days (1 - 3 days). During follow up, three patients (16.7%) developed seroma at the hernia sac which was resolved with conservative management after three weeks. One (5.6%) patient developed recurrence six months after surgery. In conclusion, laparoscopic repair of incisional hernia particularly recurrent hernia has been shown to be safe and effective in our centre. However, careful patient selection and acquiring the necessary advanced laparoscopic surgical skills coupled with the proper use of equipment are mandatory before embarking on this procedure.

  6. Evaluation of human acellular dermis versus porcine acellular dermis in an in vivo model for incisional hernia repair.

    Science.gov (United States)

    Ngo, Manh-Dan; Aberman, Harold M; Hawes, Michael L; Choi, Bryan; Gertzman, Arthur A

    2011-05-01

    Incisional hernias commonly occur following abdominal wall surgery. Human acellular dermal matrices (HADM) are widely used in abdominal wall defect repair. Xenograft acellular dermal matrices, particularly those made from porcine tissues (PADM), have recently experienced increased usage. The purpose of this study was to compare the effectiveness of HADM and PADM in the repair of incisional abdominal wall hernias in a rabbit model. A review from earlier work of differences between human allograft acellular dermal matrices (HADM) and porcine xenograft acellular dermal matrices (PADM) demonstrated significant differences (P strength 15.7 MPa vs. 7.7 MPa for HADM and PADM, respectively. Cellular (fibroblast) infiltration was significantly greater for HADM vs. PADM (Armour). The HADM exhibited a more natural, less degraded collagen by electrophoresis as compared to PADM. The rabbit model surgically established an incisional hernia, which was repaired with one of the two acellular dermal matrices 3 weeks after the creation of the abdominal hernia. The animals were euthanized at 4 and 20 weeks and the wounds evaluated. Tissue ingrowth into the implant was significantly faster for the HADM as compared to PADM, 54 vs. 16% at 4 weeks, and 58 vs. 20% for HADM and PADM, respectively at 20 weeks. The original, induced hernia defect (6 cm(2)) was healed to a greater extent for HADM vs. PADM: 2.7 cm(2) unremodeled area for PADM vs. 1.0 cm² for HADM at 20 weeks. The inherent uniformity of tissue ingrowth and remodeling over time was very different for the HADM relative to the PADM. No differences were observed at the 4-week end point. However, the 20-week data exhibited a statistically different level of variability in the remodeling rate with the mean standard deviation of 0.96 for HADM as contrasted to a mean standard deviation of 2.69 for PADM. This was significant with P < 0.05 using a one tail F test for the inherent variability of the standard deviation. No

  7. Incidence of Incisional Hernia after Cesarean Delivery

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Krebs, Lone; Ladelund, Steen

    2014-01-01

    OBJECTIVE: To estimate the incidence of incisional hernias requiring surgical repair after cesarean delivery over a 10-year period. METHODS: This population- and register-based cohort study identified all women in Denmark with no history of previous abdominal surgery who had a cesarean delivery...... the inclusion period. The cumulated incidence of a hernia repair within 10 years after a cesarean delivery was 0.197% (95% CI 0.164-0.234%). The risk of a hernia repair was higher during the first 3 years after a cesarean delivery, with an incidence after 3 years of 0.157% (95% CI 0.127-0.187%). CONCLUSIONS...

  8. Surgical treatment for giant incisional hernia

    DEFF Research Database (Denmark)

    Eriksson, A; Rosenberg, J; Bisgaard, T

    2014-01-01

    INTRODUCTION: Repair for giant incisional hernias is a challenge due to unacceptable high morbidity and recurrence rates. Several surgical techniques are available, but all are poorly documented. This systematic review was undertaken to evaluate the existing literature on repair for giant...... % with a wide range between studies of 4-100 %. The mortality ranged from 0 to 5 % (median 0 %) and recurrence rate ranged from 0 to 53 % (median 5 %). Study follow-up ranged from 15 to 97 months (median 36 months). Mesh repair should always be used for patients undergoing repair for a giant hernia......, and the sublay position may have advantages over onlay positioning. To avoid tension, it may be advisable to use a mesh in combination with a component separation technique. Inlay positioning of the mesh and repair without a mesh should be avoided. CONCLUSIONS: Evidence to optimise repair for giant hernias...

  9. Preperitoneal approach to parastomal hernia with coexistent large incisional hernia.

    Science.gov (United States)

    Egun, A; Hill, J; MacLennan, I; Pearson, R. C

    2002-03-01

    OBJECTIVE: To assess the outcome of preperitoneal mesh repair of complex incisional herniae incorporating a stoma and large parastomal hernia. METHODS: From 1994 to 1998, symptomatic patients who had repair of combined incisional hernia and parastomal hernia were reviewed. Body mass index, co-morbidity, length of hospital stay, patient satisfaction and outcomes were recorded. RESULTS: Ten patients (seven females and three males), mean age 62 (range 48-80) years underwent primary repair. All had significant comorbidities (ASA grade 3) and mean body mass index was 31.1 (range 20-49). Median hospital stay was 15 (range 8-150) days. Complications were of varying clinical significance (seroma, superficial infection, major respiratory tract infection and stomal necrosis). There were no recurrences after a mean follow up of 54 (range 22-69) months. CONCLUSION: The combination of a parastomal hernia and generalised wound dehiscence is an uncommon but difficult problem. The application of the principles of low-tension mesh repair can provide a satisfactory outcome and low recurrence rate. This must be tempered by recognition of the potential for significant major postoperative complication.

  10. A STUDY ON INCISIONAL HERNIA FOLLOWING OBSTETRICS AND GYNAECOLOGICAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Sumathi Ravikumar

    2016-12-01

    Full Text Available BACKGROUND The term ventral hernia encompasses incisional, epigastric, paraumbilical, spigelian and traumatic hernias. This is a hernia that protrudes through defect in an abdominal wound. With evolution of modern surgery and rapid increase in the number of abdominal operations performed, incisional hernias have risen in frequency and this hernia seems to be more common in females following obstetric and gynaecological surgeries. This study undertaken to stress the problem of incisional hernias in females occurring after obstetric and gynaecological surgeries. The aim of the study is to- 1. Study the incidence and prevalence of incisional hernias following obstetrics and gynaecological surgeries in KAPV Government Medical College, Tiruchirappalli. 2. Study aetiological factors for incisional hernia following obstetric and gynaecological surgeries. 3. Analyse preventive measures. 4. Analyse the problems in females, which led to incisional hernia. MATERIALS AND METHODS 178 cases of incisional hernia admitted in KAPV Government Medical College, Tiruchirappalli, during the period of 2 years from June 2014 to May 2016. The cases analysed according to age, previous history, type of incision, suture material used and associated comorbidities. RESULTS Maximum age affected is between 50 to 59 years and with 10 years of surgery. Incidence more following LSCS with midline incision. Incidence more with the usage of absorbable suture material. Postoperative wound infection and anaemia were leading associated factors for incisional hernia. CONCLUSION The incidence of incisional hernia is more common in females especially in obese and multiparous woman. The incidence is more after LSCS and puerperal sterilisation. Onlay reinforced mesh repair using Prolene mesh have given good results. Prolene mesh appears to be best tolerated by body tissues. The use of closed suction drain have significantly reduced the postoperative wound infection.

  11. Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

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    Avinash Chennamsetty

    2015-01-01

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

  12. Post incisional hernia in dogs and cats

    OpenAIRE

    Raiser, Alceu Gaspar

    1999-01-01

    A hérnia pós-incisão foi analisada quanto à prevalência e protocolo terapêutico em nove cães e seis gatos cadastrados no Hospital Veterinário da Universidade Federal de Santa Maria, RS, Brasil. Os animais apresentaram peritonite localizada que foi tratada com reposição hidroeletrolítica, antibioticoterapia, irrigação abundante da cavidade abdominal e debridamento cirúrgico. Todos tiveram evolução favorável.The case records of nine dogs and six cats with post-incisional hernia were managed by ...

  13. Abdominal muscle function and incisional hernia

    DEFF Research Database (Denmark)

    Jensen, K K; Kjaer, M; Jorgensen, L N

    2014-01-01

    PURPOSE: Although ventral incisional hernia (VIH) repair in patients is often evaluated in terms of hernia recurrence rate and health-related quality of life, there is no clear consensus regarding optimal operative treatment based on these parameters. It was proposed that health-related quality...... of life depends largely on abdominal muscle function (AMF), and the present review thus evaluates to what extent AMF is influenced by VIH and surgical repair. METHODS: The PubMed and EMBASE databases were searched for articles following a systematic strategy for inclusion. RESULTS: A total of seven...... studies described AMF in relation to VIH. Five studies examined AMF using objective isokinetic dynamometers to determine muscle strength, and two studies examined AMF by clinical examination-based muscle tests. CONCLUSION: Both equipment-related and functional muscle tests exist for use in patients...

  14. Comparison of two surgical techniques in large incisional hernias

    Directory of Open Access Journals (Sweden)

    Mustafa Sit

    2014-03-01

    Full Text Available Objectives: Incisional hernias occur from incisions of previous abdominal operations. It is an often complication of abdominal interventions. Prevalence of incisional hernias is approximately 2.9% and 3.6% in vertical midline incisions and transverse incisions, respectively. Incisional hernias cause morbidity and loss of manpower. The only treatment option is surgery. We aimed to compare surgical methods of incisional hernias and discuss the postoperative data in this retrospective report. Methods: We retrospectively analyzed the data of 54 patients with large incisional hernias operated between 2007 and 2011. Results: We compared age, chronic diseases (e.g. Chronic obstructive pulmonary disease, diabetes mellitus,which may cause postoperative recurrence, gender, personal factors, such as patients undergoing incisional hernia repair mesh over solid fascia less or over than 5 cm with the placement of decolation; recurrence, the development of postoperative seroma, receiving postoperative drainage and postoperative length of hospital stay were compared. While the recurrence rate of less than 5 cm above the decolation; seroma development, no significant difference in length of hospital stay and drain times to get. Conclusion: In conclusion, we think that recurrence rate should be reduced by dissection of 5 cm intact fascia and grafting in incisional hernias of anterior abdominal wall. J Clin Exp Invest 2014; 5 (1: 36-39

  15. Mucinous ovarian tumour presenting as a ruptured incisional hernia.

    LENUS (Irish Health Repository)

    Toomey, D

    2012-10-01

    We describe an ovarian borderline tumour that presented as an acute deterioration in an incisional hernia secondary to intraperitoneal mucin accumulation. The differential diagnosis associated with hernial sac contents and options for opportunistic diagnosis are discussed. This case raises awareness of potential serious diagnoses that may be overlooked during emergent hernia repair.

  16. Full - Term Pregnancy In An Incisional Hernia - A Case Report ...

    African Journals Online (AJOL)

    ... made and the fascia should be closed with non-absorbable sutures (mass closure) in order to avoid occurrence of incisional hernias. Emergency operations in the abdomen including caesarian section, surgical principles should always be observed. Keywords: Full-term pregnancy, Abdominal incision, hernia, prevention.

  17. Incisional abdominal hernia repair with concomitant abdominoplasty: Maintaining umbilical viability

    OpenAIRE

    Robert Phan; Elan Kaplan; Jemma K. Porrett; Yik-Hong Ho; Warren M. Rozen

    2018-01-01

    Introduction: Abdominoplasty and abdominal hernia repair are often carried out in two-stage procedures, and those describing single-stage surgery require careful dissection to preserve often only partial blood supply to the umbilicus to maintain its viability. This paper aims to describe the surgical method of laparoscopic umbilical hernia repair in association with abdominoplasty. Case presentation: A patient presents with an incisional hernia at a previous periumbilical port site of size 14...

  18. Incisional hernia after upper abdominal surgery: A randomised controlled trial of midline versus transverse incision

    NARCIS (Netherlands)

    J.A. Halm (Jens); H. Lip (Harm); P.I.M. Schmitz (Paul); J. Jeekel (Hans)

    2009-01-01

    textabstractObjectives: To determine whether a transverse incision is an alternative to a midline incision in terms of incisional hernia incidence, surgical site infection, postoperative pain, hospital stay and cosmetics in cholecystectomy. Summary background data: Incisional hernias after midline

  19. Incisional hernia prevention and use of mesh. A narrative review.

    Science.gov (United States)

    Hernández-Granados, Pilar; López-Cano, Manuel; Morales-Conde, Salvador; Muysoms, Filip; García-Alamino, Josep; Pereira-Rodríguez, José Antonio

    2018-02-01

    Incisional hernias are a very common problem, with an estimated incidence around 15-20% of all laparotomies. Evisceration is another important problem, with a lower rate (2.5-3%) but severe consequences for patients. Prevention of both complications is an essential objective of correct patient treatment due to the improved quality of life and cost savings. This narrative review intends to provide an update on incisional hernia and evisceration prevention. We analyze the current criteria for proper abdominal wall closure and the possibility to add prosthetic reinforcement in certain cases requiring it. Parastomal, trocar-site hernias and hernias developed after stoma closure are included in this review. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. 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...

  1. Incisional hernia prevention using a cyanoacrilate-fixed retrofascial mesh.

    Science.gov (United States)

    Hoyuela, Carlos; Juvany, Montserrat; Trias, Miquel; Ardid, Jordi; Martrat, Antoni

    2018-01-01

    The rate of incisional hernia in high-risk patients (obesity, cancer, etc.) is high, even in laparoscopic surgery. The aim of this study is to evaluate the safety of the use of cyanoacrylate fixed prophylactic meshes in the assistance incision in overweight or obese patients undergoing laparoscopic colorectal surgery. A prospective, non-randomized cohort study of patients undergoing elective laparoscopic resection for colorectal cancer between January 2013 and March 2016 was performed. Those with a body mass index greater than 25kg / m 2 were evaluated to implant a prophylactic meshes fixed with cyanoacrylate (Histoacryl®) as reinforcement of the assistance incision. 52 patients were analyzed (mean body mass index: 28.4±2kg / m 2 ). Prophylactic meshes was implanted in 15 patients. The time to put the mesh in place was always less than 5minutes. There was no significant difference in wound infection rate (12% vs. 10%). No mesh had to be explanted. Although the mean follow-up was shorter (14.1±4 vs. 22.3±9 months), there were no incisional hernia in the mesh group. On the other hand, in the non-mesh group, 1 acute evisceration (2.7%) and 4 incisional hernia of the assistance incision were observed (10.8%). There were no significant differences between groups regarding trocar incisional hernia (6.6 vs. 5.4%). The implantation of a reinforcement prophylactic mesh in overweight or obese patients undergoing laparoscopic colorectal surgery is safe and seems to reduce the short-term rate of incisional hernia. Fixation with cyanoacrylate is a rapid method that facilitates the procedure without additional complications. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Prevention of Incisional Hernias after Open Abdomen Treatment

    Directory of Open Access Journals (Sweden)

    Frederik Berrevoet

    2018-02-01

    Full Text Available Management of a patient with an open abdomen is difficult, and the primary closure of the fascial edges is essential to obtain the best patient outcome, regardless of the initial etiology of the open abdomen. The use of temporary abdominal closure devices is nowadays the gold standard to have the highest closure rates with mesh-mediated fascial traction as the proposed standard of care. However, the incidence of incisional hernias, although much more controlled than when leaving an abdomen open, is high and reaches up to 65%. As shown for other high-risk patient subgroups, such as obese patients, patients with an abdominal aneurysm, and patients with former -ostomy sites, the prevention of incisional hernias might be key to further optimize patient outcomes after open abdomen treatment. In this overview, current available modalities to decrease the incidence of incisional hernia are discussed. Most of these preventive options have been shown effective in giant ventral hernia repair and might work effectively in this patient cohort with open abdomen as well.

  3. Use of biologic mesh at ostomy takedown to prevent incisional hernia: A case series

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    Sepehr Lalezari

    Full Text Available Introduction: Incisional hernias are a relatively common occurrence after ostomy takedown with a incidence of 30–35%. The use of biologic mesh offers a means to bolster the stoma incision site with a lower risk of infection than synthetic mesh. Methods: This study represents a retrospective chart review of six patients who underwent stoma takedown and had biologic mesh placed in the retrorectus position during repair from March 2015 until March 2016. Results: There has been a zero-rate of hernia occurrence for the six patients who underwent stoma takedown. No incisional hernias were noted on physical exam with follow up ranging from 11 to 25 months. Conclusion: We conclude that placement of biologic mesh is a safe and effective way of preventing incisional hernias at stoma sites. Keywords: Biologic mesh, Ostomy takedown, Stoma reversal, Incisional hernia, Parastomal hernia, Hernia prophylaxis

  4. Incisional hernias after open versus laparoscopic surgery for colonic cancer

    DEFF Research Database (Denmark)

    Jensen, Kristian K.; Krarup, Peter-Martin; Scheike, Thomas

    2016-01-01

    patients operated on electively for colonic cancer with primary anastomosis in Denmark from 2001 to 2008. Patient data were obtained from the database of the Danish Colorectal Cancer Group and merged with data from the National Patient Registry. Multivariable Cox regression and competing risks analysis......, fascial dehiscence, anastomotic leak, and body mass index >25 kg/m(2). CONCLUSIONS: This nationwide analysis demonstrated that laparoscopic as compared with open access for curative resection of colonic cancer was associated with a decreased risk of incisional hernia formation....

  5. Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia.

    Science.gov (United States)

    Awaiz, A; Rahman, F; Hossain, M B; Yunus, R M; Khan, S; Memon, B; Memon, M A

    2015-06-01

    The utility of laparoscopic repair in the treatment of incisional hernia repair is still contentious. The aim was to conduct a meta-analysis of RCTs investigating the surgical and postsurgical outcomes of elective incisional hernia by open versus laparoscopic method. A search of PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane Central Register of Controlled Trials published between January 1993 and September 2013 was performed using medical subject headings (MESH) "hernia," "incisional," "abdominal," "randomized/randomised controlled trial," "abdominal wall hernia," "laparoscopic repair," "open repair", "human" and "English". Prospective RCTs comparing surgical treatment of only incisional hernia (and not primary ventral hernias) using open and laparoscopic methods were selected. Data extraction and critical appraisal were carried out independently by two authors (AA and MAM) using predefined data fields. The outcome variables analyzed included (a) hernia diameter; (b) operative time; (c) length of hospital stay; (d) overall complication rate; (e) bowel complications; (f) reoperation; (g) wound infection; (h) wound hematoma or seroma; (i) time to oral intake; (j) back to work; (k) recurrence rate; and (l) postoperative neuralgia. These outcomes were unanimously decided to be important since they influence the practical and surgical approach towards hernia management within hospitals and institutions. The quality of RCTs was assessed using Jadad's scoring system. Random effects model was used to calculate the effect size of both binary and continuous data. Heterogeneity amongst the outcome variables of these trials was determined by the Cochran Q statistic and I (2) index. The meta-analysis was prepared in accordance with PRISMA guidelines. Sufficient data were available for the analysis of twelve clinically relevant outcomes. Statistically significant reduction in bowel complications was noted with open surgery compared to the

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

    Science.gov (United States)

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

    2013-06-01

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

  7. Circulating levels of matrix metalloproteinases and tissue inhibitors of metalloproteinases in patients with incisional hernia

    DEFF Research Database (Denmark)

    Henriksen, Nadia A; Sørensen, Lars T; Jorgensen, Lars N

    2013-01-01

    Incisional hernia formation is a common complication to laparotomy and possibly associated with alterations in connective tissue metabolism. Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) are closely involved in the metabolism of the extracellular matrix. Our...

  8. The impact of incisional hernia on mortality after colonic cancer resection

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Erichsen, Rune; Krarup, Peter Martin

    2016-01-01

    intended colonic resection for cancer with primary anastomosis between 2001 and 2008 were included. The exposure of interest was incisional hernia, as registered in the NPR, and the outcome was long-term overall mortality. Extended cox regression analysis was used to adjust for confounding variables...... the impact of incisional hernia on mortality after colonic cancer resection. METHOD: This was a nationwide cohort study comprising data from the Danish Colorectal Cancer Group's database, the Danish National Patient Registry (NPR), and the Danish Central Person Registry. Patients who underwent curatively...... with increased mortality (adjusted hazard ratio 2.35, 95 % confidence interval 1.39-3.98), while incisional hernia repair did not increase mortality (adjusted hazard ratio 0.81, 95 % confidence interval 0.68-0.97). CONCLUSIONS: Incisional hernia diagnosis or repair subsequent to colonic cancer resection did...

  9. A CLINICAL AND SURGICAL STUDY OF INCISIONAL HERNIAS

    Directory of Open Access Journals (Sweden)

    Kethavath Changa Thavarya Naik

    2017-02-01

    Full Text Available BACKGROUND Incisions through the abdominal wall are based on anatomical principles. The intra-abdominal pressure is considerable and the surgeon aims at leaving the abdominal wall as strong as possible after operation, otherwise there exists a very real fear that portions of the abdominal contents may leave the abdominal cavity through the weak area, which are caused by a badly placed incision resulting in a condition known as scar incisional or ventral hernia. This study is intended to understand the clinical and surgical factors that may have been a contributory factor for the formation of the incisional hernias and also the treatment modality that is commonly employed to correct the discontinuity. This study is intended to help the practicing surgeons and also the young budding surgeons to understand the disease in detail. MATERIALS AND METHODS This study was done in the Department of General Surgery, RIMS Medical College, Ongole. Sixty patients who returned after undergoing the surgical procedures were included in the study. The study included 15 males and 45 females. The study was done from January 2014 to December 2016. RESULTS In the present study, the mean age of the total population was found to be 48.23 years. The female counterpart was found to be three times higher than that when compared to the males. The symptoms that tend to increase the intra-abdominal pressure tends to increase the mishap. The condition is more common in the early stages post-surgery. CONCLUSION In this study, the demographic pattern and the most common clinical and surgical factors that is thought to be directly involved with the condition has been reported.

  10. Abdominal muscle function and incisional hernia: a systematic review.

    Science.gov (United States)

    Jensen, K K; Kjaer, M; Jorgensen, L N

    2014-08-01

    Although ventral incisional hernia (VIH) repair in patients is often evaluated in terms of hernia recurrence rate and health-related quality of life, there is no clear consensus regarding optimal operative treatment based on these parameters. It was proposed that health-related quality of life depends largely on abdominal muscle function (AMF), and the present review thus evaluates to what extent AMF is influenced by VIH and surgical repair. The PubMed and EMBASE databases were searched for articles following a systematic strategy for inclusion. A total of seven studies described AMF in relation to VIH. Five studies examined AMF using objective isokinetic dynamometers to determine muscle strength, and two studies examined AMF by clinical examination-based muscle tests. Both equipment-related and functional muscle tests exist for use in patients with VIH, but very few studies have evaluated AMF in VIH. There are no randomized controlled studies to describe the impact of VIH repair on AMF, and no optimal surgical treatment in relation to AMF after VIH repair can be advocated for at this time.

  11. Fixation in laparoscopic incisional hernia repair: Suture versus tacks

    Directory of Open Access Journals (Sweden)

    Adil Bangash

    2013-01-01

    Full Text Available Aims and Objectives: To compare the frequency of complications of laparoscopic repair of incisional hernia using fixation of mesh with transabdominal sutures tacks. Materials and Methods: This study was conducted as part of an interventional multicenter trial at the Rehman Medical Institute, Peshawar, Peshawar Institute of Medical Sciences, and Pakistan Institute of Medical Science, Islamabad, from the 1 st of November 2008 till 31 st October 2011. The frequency of complications was calculated as the measure of comparing two methods of fixation in laparoscopic repair of incisional hernia using the IPOM technique. These patients were admitted via the outpatient department and their demographic data were collected on a pro forma basis. Forty-five patients were alternately placed in either group, and group I comprised patients with a ventral hernia that was fixed using spiral tacks whereas the other group was fixed with transabdominal sutures. A polytetraflouroethylene (Dual R mesh was applied in all cases. All data were collected onthe individual pro forma of each patient and was loaded on the SPSS R version 13.0. Results: The BMI in both groups was similar (P=0.94 The mean hospital stay was higher in the PTFE mesh group but the values were not significant (P=1.22.No perioperative death was observed in either group. One patient (2.2% from group I was readmitted with varying complaints and was diagnosed as having subacute intestinal obstruction (P>0.05. A higher but insignificant recurrence rate was observed in the polyester group over a one-year period of follow-up. Three patients (6.6% were diagnosed with recurrences in group I. Instead the PTFE group had a similar recurrence rate recurrence (P=1.00. Conclusion: The rate of recurrence in this study showed no significant difference by either mode of fixation. But statistically significant pain scores and increased operative time to fixation favors the use of tacks that limits to the few inner

  12. Silver microparticles plus fibrin tissue sealant prevents incisional hernias in rats.

    Science.gov (United States)

    Primus, Frank E; Young, David M; Grenert, James P; Harris, Hobart W

    2018-07-01

    Open abdominal surgery is frequently complicated by the subsequent development of an incisional hernia. Consequently, more than 400,000 incisional hernia repairs are performed each year, adding over $15 billion per year to U.S. health-care expenditures. While the vast majority of studies have focused on improved surgical techniques or prosthetic materials, we examined the use of metallic silver microparticles to prevent incisional hernia formation through enhanced wound healing. A rodent incisional hernia model was used. Eighty-two rats were randomly placed into two control groups (saline alone and silver microparticles alone), and three experimental groups (0 mg/cm, 2.5 mg/cm, and 25 mg/cm of silver microparticles applied with a fibrin sealant). Incisional hernia incidence and size, tensile strength, and tissue histology were assessed after 28 days. A significant reduction of both incisional hernia incidence and hernia size was observed between the control groups and 2.5 mg/cm group, and between the control and 25 mg/cm group by nearly 60% and 90%, respectively (P < 0.05). Histological samples showed a noticeable increase in new fibrosis in the treated animals as compared with the controls, whereas the tensile strength between the groups did not differ. The novel approach of using silver microparticles to enhance wound healing appears to be a safe and effective method to prevent incisional hernias from developing and could herald a new era of medicinal silver use. Copyright © 2018 Elsevier Inc. All rights reserved.

  13. Substantial variation among hernia experts in the decision for treatment of patients with incisional hernia

    DEFF Research Database (Denmark)

    Kokotovic, D; Gögenur, I; Helgstrand, F

    2017-01-01

    PURPOSE: Benign elective procedures give rise to heterogeneity in indication for surgery and surgical technique among specialized surgeons in a variety of surgical fields. The objective was to analyze the extent of agreement in surgical management among expert hernia surgeons when evaluating the ...... of treatment strategy for patients with incisional hernias was very low among experienced surgeons. A standardization of surgical decision making is desirable to develop new interventions and improve clinical outcomes....... was present in 14 cases (56%). The most common reason for not performing surgery was due to comorbidities. Agreement in operation type (open vs. laparoscopic) was present in 10 cases (40%). Agreement in mesh fixation (absorbable tacks/non-absorbable tacks/suture/other) method was also present in 10 cases (40...

  14. Abdominal wall reconstruction for large incisional hernia restores expiratory lung function

    DEFF Research Database (Denmark)

    Jensen, Kristian K; Backer, Vibeke; Jorgensen, Lars N

    2017-01-01

    BACKGROUND: Respiratory complications secondary to intermittent intra-abdominal hypertension and/or atelectasis are common after abdominal wall reconstruction for large incisional hernias. It is unknown if the respiratory function of this patient group is affected long term or impairs activities...... of daily living. We hypothesized that abdominal wall reconstruction for large incisional hernia would not lead to improved, long-term pulmonary function or respiratory quality of life. METHODS: Eighteen patients undergoing open abdominal wall reconstruction with mesh for a large incisional hernia...... (horizontal fascial defect width >10 cm) were compared with 18 patients with an intact abdominal wall who underwent colorectal resection. Patients were examined pre- and 1-year postoperatively. Examined measures included forced vital capacity, forced expiratory volume in first second, peak expiratory flow...

  15. Abdominal wall reconstruction for incisional hernia optimizes truncal function and quality of life

    DEFF Research Database (Denmark)

    Jensen, Kristian K.; Munim, Kanzah; Kjaer, Michael

    2017-01-01

    Objective: The aim of the study was to examine abdominal wall function in patients undergoing abdominal wall reconstruction (AWR) for incisional hernia. Background: The literature on abdominal wall function in patients with incisional hernia is sparse. It has been suggested that AWR leads...... to improvement in function, but it is unknown whether this is specific to the abdominal wall or due to an improvement in overall physical fitness. Methods: We performed a prospective case-control study of 18 consecutive patients with large incisional hernia undergoing AWR with linea alba restoration. Truncal...... flexion and extension strength, hand grip strength, leg extension power, and quality of life (SF-36 and Carolinas Comfort Scale) were assessed preoperatively and 1 year postoperatively. Patients were compared with a control group of patients with an intact abdominal wall undergoing colorectal resection (n...

  16. Risk of incisional hernia after minimally invasive and open radical prostatectomy.

    Science.gov (United States)

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

    2013-11-01

    The number of radical prostatectomies has increased. Many urologists have shifted from the open surgical approach to minimally invasive techniques. It is not clear whether the risk of post-prostatectomy incisional hernia varies by surgical approach. In the linked Surveillance, Epidemiology and End Results (SEER)-Medicare data set we identified men 66 years old or older who were treated with minimally invasive or open radical prostatectomy for prostate cancer diagnosed from 2003 to 2007. The main study outcome was incisional hernia repair, as identified in Medicare claims after prostatectomy. We also examined the frequency of umbilical, inguinal and other hernia repairs. We identified 3,199 and 6,795 patients who underwent minimally invasive and open radical prostatectomy, respectively. The frequency of incisional hernia repair was 5.3% at a median 3.1-year followup in the minimally invasive group and 1.9% at a 4.4-year median followup in the open group, corresponding to an incidence rate of 16.1 and 4.5/1,000 person-years, respectively. Compared to the open technique, the minimally invasive procedure was associated with more than a threefold increased risk of incisional hernia repair when controlling for patient and disease characteristics (adjusted HR 3.39, 95% CI 2.63-4.38, p<0.0001). Minimally invasive radical prostatectomy was associated with an attenuated but increased risk of any hernia repair compared with open radical prostatectomy (adjusted HR 1.48, 95% CI 1.29-1.70, p<0.0001). Minimally invasive radical prostatectomy was associated with a significantly increased risk of incisional hernia compared with open radical prostatectomy. This is a potentially remediable complication of prostate cancer surgery that warrants increased vigilance with respect to surgical technique. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  17. Late Recurrence of Benign Multicystic Peritoneal Mesothelioma Complicated with an Incisional Hernia

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    Emel Canbay

    2013-01-01

    Full Text Available Benign multicystic peritoneal mesothelioma (BMPM is a rare disease arising from the peritoneal mesothelium. Here, we report a 57-year-old woman admitted to our unit with an incisional hernia fifteen years later following her first operation due to BMPM. Computerized tomography demonstrated a cystic appearing mass with intraabdominal extension in hernia sac. The patient underwent en bloc resection of the mass and hernia repair. An immunohistochemical analysis of the mass confirmed the recurrence of BMPM. Our case supports that BMPM has slowly progressive nature and can recur with complicated incisional hernia long time after primary resection. Diagnosis and long-term followup are crucial for clarifying the characteristics of this disease.

  18. A comparative study of onlay and retrorectus mesh placement in incisional hernia repair

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    Kundan Kharde

    2013-01-01

    Full Text Available Introduction: Incisional hernia after abdominal surgery is a well-known complication and the incidence of incisional hernias continues to be 2-11% after laparotomy. The repair of incisional hernia has always been a challenge to the surgeon. Various operative techniques for the repair of incisional hernia are in practice; however, the management is not standardized. The retro-rectus mesh placement or the sub-lay technique, popularized by Rives and Stoppa in Europe, has been reported to be quite effective, with low recurrence rates (0-23% and minimal complications. Aims and Objective: The purpose of this study was to compare the traditional on-lay mesh and retro-rectus mesh placement in incisional hernia repairs in terms of time taken for surgery, early complications (wound infections, Mesh extrusion, and Delayed complications (Recurrence. Materials and Methods: This is a prospective study which was conducted in the surgical department of our hospital. A total of 50 cases were included in this study. Of these cases, 25 cases were operated by the on-lay mesh method and 25 by retro-rectus mesh placement. Only the patients with midline hernias up to 10 cm in diameter were included in the study. Result: The operative time for retro-rectus mesh placement was insignificantly higher than that of on-lay mesh repair, whereas, complications like superficial Surgical site infection SSI were identical in both the study groups, but deep SSI leading to infection of mesh was higher in on-lay mesh repair. The recurrence rate was found to be 4% in on-lay mesh repair and 0% in retro-rectus mesh repair. Conclusion: The follow-up period in this study was 6months; hence, late recurrences were not taken into account. However, the low rate of local complications and the low recurrence rate indicate that retro-rectus mesh repair has an advantage over traditional on-lay repair.

  19. Botulinum Toxin A as an Adjunct to Abdominal Wall Reconstruction for Incisional Hernia

    DEFF Research Database (Denmark)

    Soltanizadeh, Sinor; Helgstrand, Frederik; Jorgensen, Lars N

    2017-01-01

    BACKGROUND: Repair of large incisional hernias remains a surgical and costly challenge. Temporary paralysis of the lateral abdominal wall muscles with topical administration of botulinum toxin A (BTA) is a new therapeutic concept, which may obviate the need for component separation technique (CST...

  20. Laparoscopic versus open incisional hernia repair: a retrospective cohort study with costs analysis on 269 patients.

    Science.gov (United States)

    Soliani, G; De Troia, A; Portinari, M; Targa, S; Carcoforo, P; Vasquez, G; Fisichella, P M; Feo, C V

    2017-08-01

    To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS). Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014. Operative time was shorter in the laparoscopic versus open group (p costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3-4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS. Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients' characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.

  1. Surgical treatment of subcostal incisional hernia with polypropylene mesh - analysis of late results

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    Marco Antonio de Oliveira Peres

    Full Text Available OBJECTIVE: To evaluate the results of subcostal incisional hernia repair using polypropylene mesh, the technical aspects of musculo-aponeurotic reconstruction, routine fixation of supra-aponeurotic mesh and follow-up for five years.METHODS: We conducted a retrospective study that assessed 24 patients undergoing subcostal incisional hernia repair with use of polypropylene mesh; 15 patients (62.5% were female; ages ranged from 33 to 82, and 79.1% had comorbidities.RESULTS: Early complications: three cases (12.5% of wound infection, three cases (12.5% of seroma, one case (4.1% of hematoma; and one case (4.1% of wound dehiscence. Late complications occurred in one case (4.1% of hernia recurrence attributed to technical failure in the fixation of the mesh and in one case (4.1% of chronic pain. There were no cases of exposure or rejection of the mesh.CONCLUSION: The subcostal incisional hernia, though not very relevant, requires adequate surgical treatment. Its surgical correction involves rebuilding the muscle-aponeurotic defect, supra-aponeurotic fixation of polypropylene mesh, with less complexity and lower rates of complications and recurrences.

  2. A Rare Case of Strangulated Meckel%u2019s Diverticulum in an Incarcerated Ventral Incisional Hernia

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    Murat Kilic

    2014-02-01

    Full Text Available Incisional or postoperative hernia, one of the most common surgical procedure in general surgery practice, mostly occurs in the first years following abdominal operations. Incarceration or strangulation is a serious complication of these hernias, and mostly requires emergent surgery. Meckel%u2019s diverticulum, the most frequent congenital anomaly of the gastrointestinal tract, is rarely found within a hernial sac and this unusual condition is called as Littre%u2019s hernia. In addition, preoperative diagnosis of this unusual condition is rather difficult and it is almost always first discovered during operation. A small number of cases of strangulated Meckel%u2019s Diverticulum in an incarcerated ventral incisional hernia have been reported in the literature. Herein, we report a strangulated Meckel%u2019s Diverticulum through a ventral incisional hernia in a 65 year-old woman who presented with clinical signs of intestinal obstruction.

  3. Prevention of Incisional Hernias with Biological MeshA Systematic Review of the Literature

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    FILIP ETIENNE MUYSOMS

    2016-09-01

    Full Text Available Background: Prophylactic mesh augmented reinforcement during closure of abdominal wall incisions has been proposed in patients with increased risk for development of incisional hernias (IH. As part of the BioMesh consensus project, a systematic literature review has been performed to detect those studies where MAR was performed with a non-permanent absorbable mesh (biological or biosynthetic. Methods: A computerized search was performed within 12 databases (Embase, Medline, Web-of-Science, Scopus, Cochrane, CINAHL, Pubmed publisher, Lilacs, Scielo, ScienceDirect, ProQuest, Google scholar with appropriate search terms. Qualitative evaluation was performed using the MINORS score for cohort studies and the Jadad score for RCTs. Results: For midline laparotomy incisions and stoma reversal wounds, 2 RCTs, 2 case control studies and 2 case series were identified. The studies were very heterogeneous in terms of mesh configuration (cross linked versus non cross linked, mesh position (intraperitoneal versus retromuscular versus onlay, surgical indication (gastric bypass versus aortic aneurysm, outcome results (effective versus non effective. After qualitative assessment we have to conclude that the level of evidence on the efficacy and safety of biological meshes for prevention of incisional hernias is very low. No comparative studies were found comparing biological mesh with synthetic non-absorbable meshes for the prevention of incisional hernias. Conclusion: There is no evidence supporting the use of non-permanent absorbable mesh (biological or biosynthetic for prevention of incisional hernias when closing a laparotomy in high-risk patients or in stoma reversal wounds. There is no evidence that a non-permanent absorbable mesh should be preferred to synthetic non-absorbable mesh both in clean or clean-contaminated surgery.

  4. A case of closed loop small bowel obstruction within a strangulated incisional hernia in association with an acute gastric volvulus.

    Science.gov (United States)

    Kosai, Nik Ritza; Gendeh, H S; Noorharisman, M; Sutton, Paul Anthony; Das, Srijit

    2014-01-01

    Small bowel obstruction is a common clinical problem presenting with abdominal distention, colicky pain, absolute constipation and bilious vomiting. There are numerous causes, most commonly attributed to an incarcerated hernia, adhesions or obstructing mass secondary to malignancy. Here we present an unusual cause of a small bowel obstruction secondary to an incarcerated incisional hernia in association with an acute organoaxial gastric volvulus.

  5. Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia.

    Science.gov (United States)

    Bueno-Lledó, J; Torregrosa, A; Ballester, N; Carreño, O; Carbonell, F; Pastor, P G; Pamies, J; Cortés, V; Bonafé, S; Iserte, J

    2017-04-01

    Combination of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BT) has not been previously reported in the management of large incisional hernia (LIH). Observational study of 45 consecutive patients with LIH between June 2010 and July 2014. The diameters of the hernia sac, the volumes of the incisional hernia (VIH) and the abdominal cavity (VAC), and the VIH/VAC ratio were measured before and after PPP and BT using abdominal CT scan data. We indicated the combination of both techniques when the volume of the incisional hernia (VIH)/volume of the abdominal cavity (VAC) ratio was >20%. The median insufflated volume of air for PPP was 8.600 ± 3.200 cc (4.500-13.250), over a period of 14.3 ± 1.3 days (13-16). BT administration time was 40.2 ± 3.3 days (37-44). We obtained an average value of reduction of 14% of the VIH/VAC ratio after PPP and BT (p < 0.05). Complications associated with PPP were 15.5%, and with surgical technique, 26.6%. No complications occurred during the BT administration. Reconstructive technique was anterior CST and primary fascial closure was achieved in all patients. Median follow-up was 40.5 ± 19 months (12-60) and we reported 2 cases of hernia recurrence (4.4%). Preoperative combination of PPP and BT is feasible and a useful tool in the surgical management of LIH, although at the cost of some specific complications.

  6. External Validation of the European Hernia Society Classification for Postoperative Complications after Incisional Hernia Repair: A Cohort Study of 2,191 Patients.

    Science.gov (United States)

    Kroese, Leonard F; Kleinrensink, Gert-Jan; Lange, Johan F; Gillion, Jean-Francois

    2018-03-01

    Incisional hernia is a frequent complication after midline laparotomy. Surgical hernia repair is associated with complications, but no clear predictive risk factors have been identified. The European Hernia Society (EHS) classification offers a structured framework to describe hernias and to analyze postoperative complications. Because of its structured nature, it might prove to be useful for preoperative patient or treatment classification. The objective of this study was to investigate the EHS classification as a predictor for postoperative complications after incisional hernia surgery. An analysis was performed using a registry-based, large-scale, prospective cohort study, including all patients undergoing incisional hernia surgery between September 1, 2011 and February 29, 2016. Univariate analyses and multivariable logistic regression analysis were performed to identify risk factors for postoperative complications. A total of 2,191 patients were included, of whom 323 (15%) had 1 or more complications. Factors associated with complications in univariate analyses (p < 0.20) and clinically relevant factors were included in the multivariable analysis. In the multivariable analysis, EHS width class, incarceration, open surgery, duration of surgery, Altemeier wound class, and therapeutic antibiotic treatment were independent risk factors for postoperative complications. Third recurrence and emergency surgery were associated with fewer complications. Incisional hernia repair is associated with a 15% complication rate. The EHS width classification is associated with postoperative complications. To identify patients at risk for complications, the EHS classification is useful. Copyright © 2017. Published by Elsevier Inc.

  7. Incisional hernia in pediatric surgery - experience at a single UK tertiary centre.

    Science.gov (United States)

    Mullassery, Dhanya; Pedersen, Ami; Robb, Andrew; Smith, Nicola

    2016-11-01

    Incisional hernia (IH) is a recognized complication of open and laparoscopic visceral surgery, with reported rates of 10-50% in adult surgical literature. There is a paucity of data relating to incisional hernias in children. The aim of our study was to analyze the incidence and treatment of IH in children. Retrospective review of all patients admitted for incisional hernia repair at a tertiary pediatric surgical centre in the UK more than a 7-year period was performed. Data collected included age at initial surgery, time to IH repair, and type of IH repair and postoperative complications. Twenty one patients (14 male) underwent IH repair during the study period. The incidence of IH among children who had primary abdominal surgery in our institution less than the age of 6months was 2.3%. Median age at repair was 7.9months (range: 18days-5years). Median time from primary surgery to diagnosis of IH was 2months (range 0day-3years), with 81% (17/21) diagnosed within 1year of the preceding abdominal procedure. The most common pathology necessitating the primary operative procedure was necrotising enterocolitis (n=9) in babies of gestational age less than 30weeks. The highest rates of IH were noted in infants following closure of stoma (7.5%) and pyloromyotomy (2.52%). Primary closure was undertaken in all cases. Two children had recurrence of IH, one of which underwent surgical repair. Incidence of IH in children is low but significant. IH was most commonly diagnosed following closure of stoma for NEC in this study. Copyright © 2016. Published by Elsevier Inc.

  8. No consensus on restrictions on physical activity to prevent incisional hernias after surgery

    DEFF Research Database (Denmark)

    Pommergaard, H-C; Burcharth, J; Danielsen, Anne Kjaergaard

    2014-01-01

    of restrictions on physical activity recommended for patients operated for colorectal cancer and to evaluate the agreement among surgical specialists. METHODS: A questionnaire was sent to 60 general surgeons (specialists) in Denmark and Sweden working in academic departments of surgery with a high volume......PURPOSE: In the postoperative phase after colorectal surgery, restrictions on physical activity are often recommended for patients to prevent incisional hernias. However, evidence does not support that restrictions may prevent such hernias. The purpose of this study was to evaluate the extent...... of colorectal cancer resections. The questionnaire was case based and contained questions regarding possible restrictions on physical activity recommended for patients 0-2, 2-6 and >6 weeks after resection for colorectal cancer. Agreement among the surgeon on whether restrictions should be recommended...

  9. A CASE OF CLOSED LOOP SMALL BOWEL OBSTRUCTION WITHIN A STRANGULATED INCISIONAL HERNIA IN ASSOCIATION WITH AN ACUTE GASTRIC VOLVULUS

    Directory of Open Access Journals (Sweden)

    Nik Ritza Kosai

    2014-01-01

    Full Text Available Small bowel obstruction is a common clinical problem presenting with abdominal distention, colicky pain, absolute constipation and bilious vomiting. There are numerous causes, most commonly attributed to an incarcerated hernia, adhesions or obstructing mass secondary to malignancy. Here we present an unusual cause of a small bowel obstruction secondary to an incarcerated incisional hernia in association with an acute organoaxial gastric volvulus.

  10. Abdominal wall healing in incisional hernia using different biomaterials in rabbits

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    Ana Letícia Gomes Aramayo

    2013-04-01

    Full Text Available PURPOSE: To investigate abdominal wound healing using specific biomaterials in incisional hernias. METHODS: Incisional hernias were produced in 40 rabbits, after that they were reoperated with or without the use of meshes: PREMILENE® (PPL, ULTRAPRO® (UP, PROCEED® (PCD or repairing without mesh (TRANSPALB. After 30 days a macroscopic and microscopic study of the part withdrawn from the abdominal wall was performed. RESULTS: Macroscopic: adhesion Area: PPL> UP and PCD (p = 0.031. Vascularization: PPL> UP and PCD (p = 0.001. PPL groups (p = 0.032 and PCD (p PPL, UP and TRANSPALB (p = 0.010; eosinophils: PPL> UP, and TRANSPALB PCD (p = 0.010; granulation tissue: PPL and PCD> UP and TRANSPALB (p TRANSPALB (p UP (p = 0.009 and TRANSPALB (p TRANSPALB (p PCD and TRANSPALB (p <0.001. CONCLUSION: All types of meshes caused the formation of adhesions. The UP and PCD groups showed lower area and vascularization of the adhesions. The PPL and PCD groups showed higher meshes shrinkage and there was a predominance of acute inflammatory process in the PCD group.

  11. Hernia incisional grande: Resultado del tratamiento quirúrgico con material protésico

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    Juan Francisco Puerta Alvarez

    1996-12-01

    Full Text Available Se realizó un estudio observacional y prospectivo para evaluar el tratamiento quirúrgico de las grandes hernias incisionales, con material protésico en 75 pacientes operados en el Hospital Militar Docente "Joaquín Castillo Duany" de Santiago de Cuba, desde febrero de 1990 hasta julio de 1994. Se conformaron 2 grupos: de estudio con 50 pacientes (subdividido en 2 de 25 cada uno y testigo con 25. En este último la pared abdominal se cerró por planos con sutura irreabsorbible y sin material protésico, y al del estudio, en uno se practicó igual procedimiento pero utilizando malla de Mersilene y en el otro se sustituyó por duramadre homóloga. Las hernias incisionales grandes fueron más frecuentes en mujeres de 40 a 60 años con incisiones primarias medias; la mayoría de ellas obesas y diabéticas. Se comprobó que no hubo rechazo a la duramadre homóloga, grupo éste que mostró el menor índice de recidivas y complicaciones, y con los mejores resultados a los 5 años de seguimiento posoperatorioAn observation and prospective study was carried out to assess the surgical treatment of the big incisional hernias with prosthetic material in 75 operated patients in the "Joaquín Castillo Duany" Educational Military Hospital, at Santiago de Cuba, from February 1990 to July 1994. Two groups were formed: a study group with 50 patients, subdivided in two groups of 25 each, and a witness group with 25 patients. In this last group the abdominal wall was closed by planes with non reabsorbable suture and without prosthetic material, and in the study group, in one 25 patients subgroup the same procedure was carried out, but using Mersilene mesh, and in the other subgroup the mesh was substituted with homologous duramater. The big incisional hernias were more frequent in women from 40 to 60 years old with partial primary incision, mostly obese and diabetic. There was a confirmation of no reject to the homologous duramater. This group showed the smallets

  12. Extragenital malignant mixed Mullerian tumor in the incisional hernia - primary carcinosarcoma in the abdominal wall: Case report

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    Žuvela Marinko

    2015-01-01

    Full Text Available Introduction. This report presents a primary Mullerian carcinosarcoma localized in the incisional hernia i.e. anterior abdominal wall. There is no data in the literature about this localization of extragenital Mullerian carcinosarcoma. Case Outline. The patient had previous medical history of right-sided ovarian cystadenocarcinoma managed by hysterectomy, bilateral ovariectomy and chemotherapy. An incisional hernia occurred 1 year after the operation and Mullerian carcinosarcoma at the right border of the incisional hernia 16 years later. There was no tumor spreading into the abdominal cavity and pelvis. Full thickness of the abdominal wall resection and coexisting incisional hernia resulted in a large 25x20 cm abdominal wall defect managed by the modified components separation technique and implanting meshes. Conclusion. Major abdominal wall resection and abdominal wall reconstruction using the modified components separation technique reinforced with meshes could be one of possible solutions in the surgical treatment of primary malignant mixed Mullerian tumor localized in the abdominal wall. [Projekat Ministarstva nauke Republike Srbije, br. 41030

  13. Revisión de casos sobre hernia incisional en el período de 2004 a 2010 A case review of incisional hernia in the 2004-2010 period

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    Jorge Satorre Rocha

    2012-06-01

    Full Text Available Introducción: la hernia incisional es una complicación frecuente de la cirugía abdominal. Su incidencia varía entre 2 y 15 % de los pacientes, y algunos autores señalan que puede alcanzar un 23 % cuando está relacionada con una infección de la herida quirúrgica. Objetivo: describir las características de los pacientes operados por hernia incisional en el Hospital General Docente "Enrique Cabrera", entre los años 2004 y 2010. Métodos: se realizó un estudio observacional descriptivo con carácter retrospectivo en el Hospital General Docente "Enrique Cabrera", entre los años 2004 y 2010. Se tomó el total del universo constituido por 212 pacientes con diagnóstico preoperatorio de hernia incisional, operados entre enero de 2004 y diciembre de 2010. Se analizaron los parámetros demográficos, hábitos tóxicos, antecedentes patológicos personales, cirugías anteriores, localización de la incisión anterior, técnica quirúrgica, uso y localización de prótesis, antibioticoterapia y complicaciones posoperatorias. Resultados: el 85 % de los pacientes fueron del sexo femenino, el 40 % se encontraba entre 50 y 61 años de edad, el 58,3 % presentaba hábitos tóxicos, el 69,3 % de las hernias tenían localización infraumbilical, y la mayor incidencia correspondió a las histerectomías. La técnica de Stoppa fue la más aplicada en las hernioplastia y la técnica de Mayo en las herniorrafias. Conclusiones: la obesidad y la diabetes fueron las enfermedades más frecuentes halladas en el estudio. La mayoría de los pacientes eran fumadores. Las incisiones quirúrgicas infraumbilicales por histerectomías abdominales fueron la localización más frecuente de las hernias incisionales. La infección de la herida quirúrgica fue la complicación hallada con mayor frecuencia. La recidiva posoperatoria se presentó en el 4,6 % de los pacientes.Introduction: incisional hernia is a frequent complication of abdominal surgery. The incidence of this

  14. Methods of abdominal wall expansion for repair of incisional herniae: a systematic review.

    Science.gov (United States)

    Alam, N N; Narang, S K; Pathak, S; Daniels, I R; Smart, N J

    2016-04-01

    To systematically review the available literature regarding methods for abdominal wall expansion and compare the outcome of primary fascial closure rates. A systematic search of Pubmed and Embase databases was conducted using the search terms "Abdominal wall hernia", "ventral hernia", "midline hernia", "Botulinum toxin", "botox", "dysport", "progressive preoperative pneumoperitoneum", and "tissue expanders". Study quality was assessed using the Methodological Index for Non-Randomised Studies. 21 of the 105 studies identified met the inclusion criteria. Progressive preoperative pneumoperitoneum (PPP) was performed in 269 patients across 15 studies with primary fascial closure being achieved in 226 (84%). 16 patients had a recurrence (7.2%) and the complication rate was 12% with 2 reported mortalities. There were 4 studies with 14 patients in total undergoing abdominal wall expansion using tissue expanders with a fascial closure rate of 92.9% (n = 13). A recurrence rate of 10.0% (n = 1) was reported with 1 complication and no mortalities. Follow up ranged from 3 to 36 months across the studies. There were 2 studies reporting the use of botulinum toxin with 29 patients in total. A primary fascial closure rate of 100% (n = 29) was demonstrated although a combination of techniques including component separation and Rives-Stoppa repair were used. There were no reported complications related to the use of Botulinum Toxin. However, the short-term follow up in many cases and the lack of routine radiological assessment for recurrence suggests that the recurrence rate has been underestimated. PPP, tissue expanders and Botulinum toxin are safe and feasible methods for abdominal wall expansion prior to incisional hernia repair. In combination with existing techniques for repair, these methods may help provide the crucial extra tissue mobility required to achieve primary closure.

  15. Isometric abdominal wall muscle strength assessment in individuals with incisional hernia: a prospective reliability study

    DEFF Research Database (Denmark)

    Jensen, K. K.; Kjær, Michael; Jorgensen, L. N.

    2016-01-01

    Purpose To determine the reliability of measurements obtained by the Good Strength dynamometer, determining isometric abdominal wall and back muscle strength in patients with ventral incisional hernia (VIH) and healthy volunteers with an intact abdominal wall. Methods Ten patients with VIH and ten...... and extension showed excellent test–retest reliability for both patients with VIH (ICC 0.91 and 0.99) and healthy controls (ICC 0.97 and 0.96). Bland and Altman plots showed that no systematic bias was present for neither truncal flexion nor extension when assessing reliability. For patients with VIH...... and IPAQ was found. Conclusions The Good Strength dynamometer provided a reliable, low-cost measure of truncal flexion and extension in patients with VIH....

  16. Gallbladder carcinoma late metastases and incisional hernia at umbilical port site after laparoscopic cholecystectomy.

    Science.gov (United States)

    Ciulla, A; Romeo, G; Genova, G; Tomasello, G; Agnello, G; Cstronovo, Gaetano

    2006-05-01

    A potentially serious complication of laparoscopic cholecystectomy is the inadvertent dissemination of unsuspected gallbladder carcinoma. There are increasing reports of seeding of tumor at the trocar sites following laparoscopic cholecystectomy in patients with unexpected or inapparent gallbladder carcinoma. Although the mechanism of the abdominal wall recurrence is still unclear, laparoscopic handling of the tumor, perforation of the gallbladder, and extraction of the specimen without an endobag may be risk factors for the spreading of malignant cells. The Authors report the case of late development of umbilical metastasis after laparoscopic cholecystectomy; the presence of an incisional hernia and the finding of a stone in subcutaneous tissue demonstrate the diffusion of tumor cells into subcutaneous tissue during the extraction of gallbladder. The patient underwent an excision of the metastases. She is disease free two years after surgical treatment.

  17. A case of incisional hernia repair using Composix mesh prosthesis after antethoracic pedicled jejunal flap reconstruction following an esophagectomy.

    Science.gov (United States)

    Yasuda, Atsushi; Yasuda, Takushi; Kato, Hiroaki; Iwama, Mitsuru; Shiraishi, Osamu; Hiraki, Yoko; Tanaka, Yumiko; Shinkai, Masayuki; Imano, Motohiro; Kimura, Yutaka; Imamoto, Haruhiko

    2017-12-01

    An incisional hernia in a case of antethoracic pedicled jejunal flap esophageal reconstruction after esophagectomy is a very rare occurrence, and this hernia was distinctive in that the reconstructed jejunum had passed through the hernial orifice; a standard surgical treatment for such a presentation has not been established. Herein, we describe a case of repair using mesh prosthesis for an atypical and distinctive incisional hernia after antethoracic pedicled jejunal flap esophageal reconstruction. A 77-year-old woman with a history of subtotal esophagectomy who had undergone antethoracic pedicled jejunal flap reconstruction complained of epigastric prominence and discomfort without pain. On examination, she had an abdominal protrusion between the xiphoid process and the umbilicus that contained the small bowel. Computed tomography showed that the fenestration of the abdominal wall that was intentionally created for jejunum pull-up was dehisced in a region measuring 9 × 15 cm and the small intestine protruded through it into the subcutaneous space without strangulation. Because the hernial orifice was too large and the reconstructed jejunum was passing through the hernial orifice in this case, we applied a parastomal hernia repair method that was modified from the inguinal hernia repair using the Lichtenstein technique. After 3 years and 5 months following surgery, the patient has recovered without hernia recurrence or other complications. We consider this to be the first case of repair using Composix mesh prosthesis for repair of an atypical and distinctive incisional hernia after an antethoracic pedicled jejunal flap reconstruction. This method seems to be useful and could potentially be widely adopted as the surgical treatment for this condition.

  18. Ventral incisional hernia (VIH) repair after liver transplantation (OLT) with a biological mesh: experience in 3 cases.

    Science.gov (United States)

    Schaffellner, S; Sereinigg, M; Wagner, D; Jakoby, E; Kniepeiss, D; Stiegler, P; Haybäck, J; Müller, H

    2016-05-01

    Hernias after orthotopic liver transplant (OLT) occur in about 30 % of cases. Predisposing factors in liver cirrhotic patients of cases are ascites, low abdominal muscle mass and cachexia before and immunosuppression after OLT. Standard operative transplant-technique even in small hernias is to implant a mesh. For patients after liver transplantation a porcine non-cross linked biological patch being less immunogenic than synthetic and cross-linked meshes is chosen for ventral incisional hernia repair. 3 patients (1 female, 2 male), OLT indications Hepatitis C, exogenous- toxic cirrhosis, median-age 53 (51 - 56) and median time to hernia occurrence after OLT were 10 month (6 - 18 m) are documented. 2 patients suffered from diabetes, 2 from chronic-obstructive lung disease. Maintenance immunosuppressions were Everolimus in 1 patient, Everolimus + MMF in the second and Everolimus +Tacrolimus in the third patient. The biological was chosen for hernia repair due to the preexisting risk- factors. Meshes, 10 × 16 cm were placed, in IPOM (Intra-Peritonel-Onlay-Mesh) -position by relaparatomy. Insolvable, monofile, interrupted sutures were used. All patients recovered primarily, and were dismissed within 10 d post OP. No wound healing disorders or signs of postoperative infections occurred. All are free of hernia recurrence in a mean observation time of 22 month (10 - 36). The usage of porcine non-cross-linked biological patches seems feasible for incisional hernia repair after OLT. Wound infections in these patients have been observed with other meshes. Further investigation is needed to prove potential superiority of this biological to the other meshes. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Postoperative interstitial hernia as a cause of obscure incisional wound site pain

    OpenAIRE

    Modrzejewski, Andrzej; Śmietański, Maciej

    2011-01-01

    An interstitial hernia is one in which the hernia sac is located between the layers of the abdominal wall. The analysis of contemporary literature shows that interstitial hernias are most often seen in children as a type of inguinal hernia and often accompany undescended testis. The hernia sac is usually located between the external-oblique and internal-oblique muscles in a lateral-cephalic direction. The authors present 3 cases of interstitial hernia found during laparoscopic exploration of ...

  20. Procedural volume, cost, and reimbursement of outpatient incisional hernia repair: implications for payers and providers.

    Science.gov (United States)

    Song, Chao; Liu, Emelline; Tackett, Scott; Shi, Lizheng; Marcus, Daniel

    2017-06-01

    This analysis aimed to evaluate trends in volumes and costs of primary elective incisional ventral hernia repairs (IVHRs) and investigated potential cost implications of moving procedures from inpatient to outpatient settings. A time series study was conducted using the Premier Hospital Perspective ® Database (Premier database) for elective IVHR identified by International Classification of Diseases, Ninth revision, Clinical Modification codes. IVHR procedure volumes and costs were determined for inpatient, outpatient, minimally invasive surgery (MIS), and open procedures from January 2008-June 2015. Initial visit costs were inflation-adjusted to 2015 US dollars. Median costs were used to analyze variation by site of care and payer. Quantile regression on median costs was conducted in covariate-adjusted models. Cost impact of potential outpatient migration was estimated from a Medicare perspective. During the study period, the trend for outpatient procedures in obese and non-obese populations increased. Inpatient and outpatient MIS procedures experienced a steady growth in adoption over their open counterparts. Overall median costs increased over time, and inpatient costs were often double outpatient costs. An economic model demonstrated that a 5% shift of inpatient procedures to outpatient MIS procedures can have a cost surplus of ∼ US $1.8 million for provider or a cost-saving impact of US $1.7 million from the Centers for Medicare & Medicaid Services perspective. The study was limited by information in the Premier database. No data were available for IVHR cases performed in free-standing ambulatory surgery centers or federal healthcare facilities. Volumes and costs of outpatient IVHRs and MIS procedures increased from January 2008-June 2015. Median costs were significantly higher for inpatients than outpatients, and the difference was particularly evident for obese patients. A substantial cost difference between inpatient and outpatient MIS cases

  1. Isometric abdominal wall muscle strength assessment in individuals with incisional hernia: a prospective reliability study.

    Science.gov (United States)

    Jensen, K K; Kjaer, M; Jorgensen, L N

    2016-12-01

    To determine the reliability of measurements obtained by the Good Strength dynamometer, determining isometric abdominal wall and back muscle strength in patients with ventral incisional hernia (VIH) and healthy volunteers with an intact abdominal wall. Ten patients with VIH and ten healthy volunteers with an intact abdominal wall were each examined twice with a 1 week interval. Examination included the assessment of truncal flexion and extension as measured with the Good Strength dynamometer, the completion of the International Physical Activity Questionnaire (IPAQ) and the self-assessment of truncal strength on a visual analogue scale (SATS). The test-retest reliability of truncal flexion and extension was assessed by interclass correlation coefficient (ICC), and Bland and Altman graphs. Finally, correlations between truncal strength, and IPAQ and SATS were examined. Truncal flexion and extension showed excellent test-retest reliability for both patients with VIH (ICC 0.91 and 0.99) and healthy controls (ICC 0.97 and 0.96). Bland and Altman plots showed that no systematic bias was present for neither truncal flexion nor extension when assessing reliability. For patients with VIH, no significant correlations between objective measures of truncal strength and IPAQ or SATS were found. For healthy controls, both truncal flexion (τ 0.58, p = 0.025) and extension (τ 0.58, p = 0.025) correlated significantly with SATS, while no other significant correlation between truncal strength measures and IPAQ was found. The Good Strength dynamometer provided a reliable, low-cost measure of truncal flexion and extension in patients with VIH.

  2. Pilot study on objective measurement of abdominal wall strength in patients with ventral incisional hernia.

    Science.gov (United States)

    Parker, Michael; Goldberg, Ross F; Dinkins, Maryane M; Asbun, Horacio J; Daniel Smith, C; Preissler, Susanne; Bowers, Steven P

    2011-11-01

    Outcomes after ventral incisional hernia (VIH) repair are measured by recurrence rate and subjective measures. No objective metrics evaluate functional outcomes after abdominal wall reconstruction. This study aimed to develop testing of abdominal wall strength (AWS) that could be validated as a useful metric. Data were prospectively collected during 9 months from 35 patients. A total of 10 patients were evaluated before and after VIH repair, for a total of 45 encounters. The patients were tested simultaneously or in succession by two of three examiners. Data were collected for three tests: double leg lowering (DLL), trunk raising (TR), and supine reaching (SR). Raw data were compared and tested for validity, and continuous data were transformed to categorical data. Agreement was measured using the intraclass correlation coefficient (ICC) for DLL and using kappa for the ordinal measures. Simultaneous testing yielded the following interobserver reliability: DLL (0.96 and 0.87), TR (1.00 and 0.95), and SR (0.76). Reproducibility was assessed by consecutive tests, with correlation as follows: DLL (0.81), TR (0.81), and RCH (0.21). Due to poor interobserver reliability for the SR test compared with the DLL and TR tests, the SR test was excluded from calculation of an overall score. Based on raw data distribution from the DLL and TR tests, the DLL data were categorized into 10º increments, allowing construction of a 10-point score. The median AWS score was 5 (interquartile range [IQR], 4-7), and there was agreement within 1 point for 42 of the 45 encounters (93%). The findings from this study demonstrate that the 10-point AWS score may measure AWS in an accurate and reproducible fashion, with potential for objective description of abdominal wall function of VIH patients. This score may help to identify patients suited for abdominal wall reconstruction while measuring progress after VIH repair. Further longitudinal outcomes studies are needed.

  3. Mini- or Less-open Sublay Operation (MILOS): A New Minimally Invasive Technique for the Extraperitoneal Mesh Repair of Incisional Hernias.

    Science.gov (United States)

    Reinpold, Wolfgang; Schröder, Michael; Berger, Cigdem; Nehls, Jennifer; Schröder, Alexander; Hukauf, Martin; Köckerling, Ferdinand; Bittner, Reinhard

    2018-01-16

    Improvement of ventral hernia repair. Despite the use of mesh and other recent improvements, the currently popular techniques of ventral hernia repair have specific disadvantages and risks. We developed the endoscopically assisted mini- or less-open sublay (MILOS) concept. The operation is performed transhernially via a small incision with light-holding laparoscopic instruments either under direct, or endoscopic visualization. An endoscopic light tube was developed to facilitate this approach (EndotorchTM Wolf Company). Each MILOS operation can be converted to standard total extraperitoneal gas endoscopy once an extraperitoneal space of at least 8 cm has been created. All MILOS operations were prospectively documented in the German Hernia registry with 1 year questionnaire follow-up. Propensity score matching of incisional hernia operations comparing the results of the MILOS operation with the laparoscopic intraperitoneal onlay mesh operation (IPOM) and open sublay repair from other German Hernia registry institutions was performed. Six hundred fifteen MILOS incisional hernia operations were included. Compared with laparoscopic IPOM incisional hernia operation, the MILOS repair is associated with significantly a fewer postoperative surgical complications (P advantages of open sublay and the laparoscopic IPOM repair.ClinicalTrials.gov Identifier NCT03133000.

  4. Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (the HERNIA Project).

    Science.gov (United States)

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

    2015-04-01

    Ventral incisional hernias (VIH) develop in up to 20% of patients after abdominal surgery. No widely applicable preoperative risk-assessment tool exists. We aimed to develop and validate a risk-assessment tool to predict VIH after abdominal surgery. A prospective study of all patients undergoing abdominal surgery was conducted at a single institution from 2008 to 2010. Variables were defined in accordance with the National Surgical Quality Improvement Project, and VIH was determined through clinical and radiographic evaluation. A multivariate Cox proportional hazard model was built from a development cohort (2008 to 2009) to identify predictors of VIH. The HERNIAscore was created by converting the hazards ratios (HR) to points. The predictive accuracy was assessed on the validation cohort (2010) using a receiver operator characteristic curve and calculating the area under the curve (AUC). Of 625 patients followed for a median of 41 months (range 0.3 to 64 months), 93 (13.9%) developed a VIH. The training cohort (n = 428, VIH = 70, 16.4%) identified 4 independent predictors: laparotomy (HR 4.77, 95% CI 2.61 to 8.70) or hand-assisted laparoscopy (HAL, HR 4.00, 95% CI 2.08 to 7.70), COPD (HR 2.35; 95% CI 1.44 to 3.83), and BMI ≥ 25 kg/m(2) (HR1.74; 95% CI 1.04 to 2.91). Factors that were not predictive included age, sex, American Society of Anesthesiologists (ASA) score, albumin, immunosuppression, previous surgery, and suture material or technique. The predictive score had an AUC = 0.77 (95% CI 0.68 to 0.86) using the validation cohort (n = 197, VIH = 23, 11.6%). Using the HERNIAscore: HERNIAscore = 4(∗)Laparotomy+3(∗)HAL+1(∗)COPD+1(∗) BMI ≥ 25, 3 classes stratified the risk of VIH: class I (0 to 3 points),5.2%; class II (4 to 5 points),19.6%; and class III (6 points), 55.0%. The HERNIAscore accurately identifies patients at increased risk for VIH. Although external validation is needed, this provides a starting point to counsel patients and guide

  5. Predictors of outpatient resource utilization following ventral and incisional hernia repair.

    Science.gov (United States)

    Wade, Alex; Plymale, Margaret A; Davenport, Daniel L; Johnson, Sara E; Madabhushi, Vashisht V; Mastoroudis, Erica; Tancula, Charlie; Roth, John Scott

    2018-04-01

    Little is known about the predictors of increased ambulatory costs following open ventral and incisional hernia repair (VIHR); however, postoperative complications would be expected to be associated with an increased burden on outpatient resources. The purpose of this study is to evaluate the impact of perioperative factors on outpatient resource utilization following VIHR. With IRB approval, the surgery scheduling system was queried to identify all cases of VIHR done at our institution over 3 years. Cases with other procedures done at time of VIHR were excluded. National Surgical Quality Improvement Program clinical data, physician billing data which included market and payor across cases, and medical record review data were combined and evaluated in order to quantify care and predictors of usage during the 6 months postoperatively. Data were analyzed for 308 patients. Median patient age was 52 years (SD = 13.3), and over half were female. The number of outpatient visits to the surgical office varied from 0 to 18 [median = 2; interquartile range (IQR) = 1-3]. CDC Wound Class >1 was associated with increase of mean 1.4 visits (IQR: 0.5-2.3); p = 0.003. Component separation, longer duration of operation, and increased mesh size were also predictive of increased number of office visits (p < 0.01). Postoperative infected seroma/seroma requiring drainage added a mean 2.3 visits (IQR: 1.3-3.3), (p < 0.001); and deep wound infection added a mean 3.9 visits (IQR: 1.9-5.9) (p < 0.001). Postoperative complications confer a significant burden for patients and to the outpatient surgical office. In an era in which improved quality and cost-efficiency has become imperative, measures to decrease risk of postoperative complications particularly for more complex VIHR would be expected to decrease resource utilization and increase value of care.

  6. Staged abdominal closure with intramuscular tissue expanders and modified components separation technique of a giant incisional hernia after repair of a ruptured omphalocele

    Directory of Open Access Journals (Sweden)

    Yukihiro Tatekawa

    2016-07-01

    Full Text Available In patients with omphalocele, several different techniques are performed for repair of the abdominal wall defect. We present the case of a staged abdominal closure of a giant incisional hernia after repair of a ruptured omphalocele. At birth, skin flap coverage associated with silo formation occurred, but the abdominal wall defect remained, resulting in a giant abdominal hernia. To expand the layers of the abdominal wall, tissue expanders were placed between the bilateral internal oblique and transverses abdominis muscles. Postoperatively, a modified components separation technique was performed. The abdominal wall was closed in the midline. Upon closure of the skin in the midline, bilateral relaxing incisions were performed, covering the remaining defect with artificial dermis. At the age of one year and 7 months, the patient had no recurrent incisional hernia nor any wound complications.

  7. Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study.

    Science.gov (United States)

    Sabbagh, C; Dumont, F; Fuks, D; Yzet, T; Verhaeghe, P; Regimbeau, J-M

    2012-02-01

    Progressive preoperative pneumoperitoneum (PPP) is used to prepare incisional hernias with loss of domain (IHLD) operations. The aim of the present study was to analyze the effect of PPP on peritoneal volume [measured using a new computed tomography (CT)-based method] and respiratory function. From July 2004 to July 2008, 19 patients were included in a prospective, observational study. The volumes of the incisional hernia (VIH), the abdominal cavity (VAC), the total peritoneal content (VP) and the VIH/VP ratio were measured before and after PPP using abdominal CT scan data. Spirometric parameters were measured before and after PPP, and postoperative clinical data were evaluated. Before and after PPP, the mean VIH was 1,420 cc and 2,110 cc (P  VIH before PPP. After PPP, the spirometric measurements revealed a restrictive syndrome. The overall postoperative morbidity rate was 37%. PPP increased the hernia and abdominal volumes. PPP induced a progressive, restrictive syndrome.

  8. Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized controlled multicenter study.

    Science.gov (United States)

    Clay, L; Stark, B; Gunnarsson, U; Strigård, K

    2018-04-01

    Repair of large incisional hernias includes the implantation of a synthetic mesh, but this may lead to pain, stiffness, infection and enterocutaneous fistulae. Autologous full-thickness skin graft as on-lay reinforcement has been tested in eight high-risk patients in a proof-of-concept study, with satisfactory results. In this multicenter randomized study, the use of skin graft was compared to synthetic mesh in giant ventral hernia repair. Non-smoking patients with a ventral hernia > 10 cm wide were randomized to repair using an on-lay autologous full-thickness skin graft or a synthetic mesh. The primary endpoint was surgical site complications during the first 3 months. A secondary endpoint was patient comfort. Fifty-three patients were included. Clinical evaluation was performed at a 3-month follow-up appointment. There were fewer patients in the skin graft group reporting discomfort: 3 (13%) vs. 12 (43%) (p = 0.016). Skin graft patients had less pain and a better general improvement. No difference was seen regarding seroma; 13 (54%) vs. 13 (46%), or subcutaneous wound infection; 5 (20%) vs. 7 (25%). One recurrence appeared in each group. Three patients in the skin graft group and two in the synthetic mesh group were admitted to the intensive care unit. No difference was seen for the primary endpoint short-term surgical complication. Full-thickness skin graft appears to be a reliable material for ventral hernia repair producing no more complications than when using synthetic mesh. Patients repaired with a skin graft have less subjective abdominal wall symptoms.

  9. Component separation of abdominal wall with intraoperative botulinum A presents satisfactory outcomes in large incisional hernias: a case report.

    Science.gov (United States)

    Oliveira, Lucas Torres; Essu, Felipe Futema; de Mesquita, Gustavo Heluani Antunes; Jardim, Yuri Justi; Iuamoto, Leandro Ryuchi; Suguita, Fábio Yuji; Martines, Diego Ramos; Nii, Fernanda; Waisberg, Daniel Reis; Meyer, Alberto; Andraus, Wellington; D'Albuquerque, Luiz Augusto Carneiro

    2017-01-01

    Transplantation patients have a series of associated risk factors that make appearance of incisional hernia (IH) more likely. A number of aspects of the closure of large defects remain controversial. In this manuscript, we present the repair of a large IH following liver transplantation through the technique of posterior components separation combined with the anterior, together with the intraoperative use of botulinum toxin A and the placement of mesh. As a secondary objective, we analyze the incidence of IH following liver transplantation in our service. Between the years 2013 and 2016, 247 patients underwent liver transplantation in the Liver Transplantation Service at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. We analyzed the incidence of IH in these patients. One of these cases operated in March 2017 presented a defect in the abdominal wall of 22×16.6×6.4cm in the median and paramedian regions. We present the details of this innovative surgical technique. The total operating time was 470min. During the postoperative phase the patient presented ileus paralysis, without systemic repercussions. Resumption of an oral diet on the fifth postoperative day, without incident. Hospital discharge occurred on the 12th postoperative day, with outpatient follow up. In our service, the incidence of incisional hernias following liver transplantation is 14.5%. We described a successful approach for selected patient group for whom there is no established standard treatment. Given the complexity of such cases, however, more studies are necessary. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  10. Impact of minimally invasive surgery on healthcare utilization, cost, and workplace absenteeism in patients with Incisional/Ventral Hernia (IVH).

    Science.gov (United States)

    Mikami, Dean J; Melvin, W Scott; Murayama, Michael J; Murayama, Kenric M

    2017-11-01

    Incisional hernia repair is one of the most common general surgery operations being performed today. With the advancement of laparoscopy since the 1990s, we have seen vast improvements in faster return to normal activity, shorter hospital stays and less post-operative narcotic use, to name a few. The key aims of this review were to measure the impact of minimally invasive surgery versus open surgery on health care utilization, cost, and work place absenteeism in the patients undergoing inpatient incisional/ventral hernia (IVH) repair. We analyzed data from the Truven Health Analytics MarketScan ® Commercial Claims and Encounters Database. Total of 2557 patients were included in the analysis. Of the patient that underwent IVH surgery, 24.5% (n = 626) were done utilizing minimally invasive surgical (MIS) techniques and 75.5% (n = 1931) were done open. Ninety-day post-surgery outcomes were significantly lower in the MIS group compared to the open group for total payment ($19,288.97 vs. $21,708.12), inpatient length of stay (3.12 vs. 4.24 days), number of outpatient visit (5.48 vs. 7.35), and estimated days off (11.3 vs. 14.64), respectively. At 365 days post-surgery, the total payment ($27,497.96 vs. $30,157.29), inpatient length of stay (3.70 vs. 5.04 days), outpatient visits (19.75 vs. 23.42), and estimated days off (35.71 vs. 41.58) were significantly lower for MIS group versus the open group, respectively. When surgical repair of IVH is performed, there is a clear advantage in the MIS approach versus the open approach in regard to cost, length of stay, number of outpatient visits, and estimated days off.

  11. Incarcerated giant uterine leiomyoma within an incisional hernia: a case report.

    Science.gov (United States)

    Exarchos, Georgios; Vlahos, Nikolaos; Dellaportas, Dionysios; Metaxa, Linda; Theodosopoulos, Theodosios

    2017-11-01

    Uterine leiomyomas presenting as incarcerated or strangulated hernias in surgical emergencies are extremely rare and should be considered in the differential diagnosis in patients with known uterine fibroids and an irreducible ventral abdominal wall hernia. Detailed history and multidisciplinary approach optimize the diagnosis and decision making toward surgical treatment.

  12. Long-term results of incisional hernia repair with retromuscular mesh

    Directory of Open Access Journals (Sweden)

    Miran Rems

    2011-04-01

    Conclusions: The retromuscular mesh placement for postoperative hernia repair results in a low rate of recurrences and postoperative complications. Complications are more common in patients admitted due to incarceration and in patients having suffered from stoma. Pain inflicted by postoperative hernia repair is an underrated with treatment results.

  13. Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia

    Directory of Open Access Journals (Sweden)

    Attilio Ignazio Lo Monte

    2011-09-01

    Conclusion: This surgical procedure, like laparoscopic treatment, allows the surgeon to avoid dissection of the abdominal layer and improves prosthesis adhesion with reinforcement of the incisional area near the abdominal defect. The reduction in operation time is remarkable. Despite good results in terms of safety and minimal recurrence for laparoscopy in the management of IH, the use of minimally invasive techniques for large incisional wall defects, especially in elderly patients, is still controversial and practiced by few surgeons. This open technique avoids cardiopulmonary complications arising from pneumoperitoneum in the elderly.

  14. Preliminary report of a sutureless onlay technique for incisional hernia repair using fibrin glue alone for mesh fixation.

    Science.gov (United States)

    Stoikes, Nathaniel; Webb, David; Powell, Ben; Voeller, Guy

    2013-11-01

    The Rives repair for ventral/incisional (V/I) hernias involves sublay mesh placement requiring retrorectus dissection and transfascial stitches. Chevrel described a repair by onlaying mesh after a unique primary fascial closure. Although Chevrel fixated mesh to the anterior fascia with sutures, he used fibrin glue for fascial closure reinforcement. We describe an onlay technique with mesh fixated to the anterior fascia solely with fibrin glue without suture fixation. From January 2010 to January 2012, 50 patients underwent a V/I hernia onlay technique with fibrin glue mesh fixation. Records were reviewed for technical details, demographics, mesh characteristics, and postoperative outcomes. Primary fascial closure with interrupted permanent suture was done with or without myofascial advancement flaps. Onlay polypropylene mesh was placed providing 8 cm of overlap. Fibrin glue was applied over the prosthesis and subcutaneous drains were placed. Mean age was 62.4 years. Mean body mass index was 30.1 kg/m(2). Average mesh size was 14.5 cm × 19.1 cm. Mean operative time was 144.4 minutes (range, 38 to 316 minutes). Mean discharge was postoperative Day 2.9 (range, 0 to 15 days). Morbidity included eight seromas, one hematoma, and three wound infections. Seventeen patients required components separation. Mean follow-up was 19.5 months with no recurrences. This is the first series describing fibrin glue alone for mesh fixation for V/I hernia repair. It allows for immediate prosthesis fixation to the anterior fascia. Early results are promising. Potential advantages include less operative time, less technical difficulty, and less long-term pain. A prospective trial is needed to evaluate this approach.

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

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Tanja [Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Munich (Germany); Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Klinikum Innenstadt, Munich (Germany); Ladurner, Roland; Mussack, Thomas [Ludwig-Maximilians-University Munich, Department of Surgery and Traumatology, Klinikum Innenstadt, Munich (Germany); Gangkofer, Alexander; Reiser, Maximilian; Lienemann, Andreas [Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Munich (Germany)

    2007-12-15

    The aim of our study was to develop a method that allows the vizualiation and evaluation of implanted mesh in patients after incisional hernia repair with MRI. Furthermore, we assessed problems typically related with mesh implantation like adhesions and muscular atrophy. We enrolled 28 patients after incisional hernia repair. In 10 patients mesh implantation was done by laparoscopy (expanded polytetrafluoroethylene=ePTFE mesh) and in 18 by laparotomy (polypropylene mesh). Functional MRI was performed on a 1.5-T system in supine position. Sagittal and axial TrueFISP images of the entire abdomen were acquired with the patient repeatedly straining. Evaluation included: correct position and intact fixation of the mesh, furthermore visceral adhesions, recurrent hernia and atrophy of the rectus muscle. The ePTFE mesh was visible in all cases; the polypropylene mesh was not detectable. In seven of the ten ePTFE meshes the fixation was not intact; two recurrent hernias were detected. Twenty of 28 patients had intraabdominal adhesions. In 5 cases mobility of the abdominal wall was reduced, and 16 patients showed an atropy of the rectus muscle. Functional cine MRI is a suitable method for follow-up studies in patients after hernia repair. ePTFE meshes can be visualized directly, and typical complications like intestinal adhesions and abdominal wall dysmotility can be assessed reliably. (orig.)

  16. Health Technology Assessment of laparoscopic compared to conventional surgery with and without mesh for incisional hernia repair regarding safety, efficacy and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Willich, Stefan

    2008-03-01

    Full Text Available Introduction: Incisional hernias are a common complication following abdominal surgery and they represent about 80% of all ventral hernia. In uncomplicated postoperative follow-up they can develop in about eleven percent of cases and up to 23% of cases with wound infections or other forms of wound complications. Localisation and size of the incisional hernia can vary according to the causal abdominal scar. Conservative treatment (e. g. weight reduction is only available to relieve symptoms while operative treatments are the only therapeutic treatment option for incisional hernia. Traditionally, open suture repair was used for incisional hernia repair but was associated with recurrence rates as high as 46%. To strengthen the abdominal wall and prevent the development of recurrences the additional implantation of an alloplastic mesh is nowadays commonly used. Conventional hernia surgery as well as minimally invasive surgery, introduced in the early 90s, make use of this mesh-technique and thereby showed marked reductions in recurrence rates. However, there are possible side effects associated with mesh-implantation. Therefore recommendations remain uncertain on which technique to apply for incisional hernia repair and which technique might, under specific circumstances, be associated with advantages over others. Objectives: The goal of this HTA-Report is to compare laparoscopic incisional hernia repair (LIHR and conventional incisional hernia repair with and without mesh-implantation in terms of their medical efficacy and safety, their cost-effectiveness as well as their ethical, social und legal implications. In addition, this report aims to compare different techniques of mesh-implantation and mesh-fixation as well as to identify factors, in which certain techniques might be associated with advantages overothers. Methods: Relevant publications were identified by means of a structured search of databases accessed through the German Institute of

  17. Laparoscopic Repair of Incisional Hernia Following Liver Transplantation-Early Experience of a Single Institution in Taiwan.

    Science.gov (United States)

    Kuo, S-C; Lin, C-C; Elsarawy, A; Lin, Y-H; Wang, S-H; Wu, Y-J; Chen, C-L

    2017-10-01

    Ventral incisional hernia (VIH) is not uncommon following liver transplantation. Open repair was traditionally adopted for its management. Laparoscopic repair of VIH has been performed successfully in nontransplant patients with evidence of reduced recurrence rates and hospital stay. However, the application of VIH in post-transplantation patients has not been well established. Herein, we provide our initial experience with laparoscopic repair of post-transplantation VIH. From March 2015 to March 2016, 18 cases of post-transplantation VIH were subjected to laparoscopic repair (laparoscopy group). A historical control group of 17 patients who underwent conventional open repair (open group) from January 2013 to January 2015 were identified for comparison. The demographics and clinical outcomes were retrospectively compared. There were no significant differences among basic demographics between the 2 groups. No conversion was recorded in the laparoscopy group. Recurrence of VIH up to the end of the study period was not noted. In the laparoscopy group, the minor complications were lower (16.7% vs 52.9%; P = .035), the length of hospital stay was shorter (3 d vs 7 d, P = .007), but the median operative time was longer (137.5 min vs 106 min; P = .003). Laparoscopic repair of post-transplantation VIH is a safe and feasible procedure with shorter length of hospital stay. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Hacia una biología de la hernia incisional. Alteraciones celulares molecualres en el músculo y fascia humanos

    OpenAIRE

    Díaz Peña, Ramón

    2016-01-01

    La hernia incisional (HI) es una complicación potencialmente grave y de elevada incidencia de las laparotomías. Se caracteriza por la pérdida de estructura y de función miofasciales y la eventual ruptura del tejido. De progresión lenta, conlleva una morbilidad importante y su reparación quirúrgica usando biomateriales es un desafío. Aunque se han identificado diversos factores de riesgo (dependientes de la técnica o del paciente), la etiología fundamental de la HI es desconocida. Por el momen...

  19. Incisional hernia as an unusual cause of hepatic encephalopathy in a 62-year-old man with cirrhosis: a case report

    Directory of Open Access Journals (Sweden)

    Ustaoglu Muge

    2009-09-01

    Full Text Available Abstract Introduction Hepatic encephalopathy may be initiated by many factors such as gastrointestinal bleeding, infections, fluid and electrolyte disturbances. Hypokalemia is one of the most commonly encountered electrolyte abnormalities causing hepatic encephalopathy in patients with cirrhosis. Case presentation We present the case of a 62-year-old Caucasian man with decompensated liver cirrhosis having multiple episodes of hepatic encephalopathy precipitated by vomiting. He had an incisional hernia at the right lumbar region. A barium contrast study of the small intestine and magnetic resonance imaging showed that the hernial sac included gastric antrum and bowel. We observed that hepatic encephalopathy coincided with hypokalemia as a result of a large volume of vomiting triggered by the collapsed hernial sac. Hepatic encephalopathy was resolved by administration of intravenous potassium. Conclusion This case illustrates that a hernia causing a large volume of vomiting may be a precipitant factor in the development of hepatic encephalopathy.

  20. Left hepatic lobe herniation through an incisional anterior abdominal wall hernia and right adrenal myelolipoma: a case report and review of the literature.

    Science.gov (United States)

    Nuño-Guzmán, Carlos M; Arróniz-Jáuregui, José; Espejo, Ismael; Valle-González, Jesús; Butus, Hernán; Molina-Romo, Alejandro; Orranti-Ortega, Rodrigo I

    2012-01-10

    Herniation of the liver through an anterior abdominal wall hernia defect is rare. To the best of our knowledge, only three cases have been described in the literature. A 70-year-old Mexican woman presented with a one-week history of right upper quadrant abdominal pain, nausea, vomiting, and jaundice to our Department of General Surgery. Her medical history included an open cholecystectomy from 20 years earlier and excessive weight. She presented with jaundice, abdominal distension with a midline surgical scar, right upper quadrant tenderness, and a large midline abdominal wall defect with dullness upon percussion and protrusion of a large, tender, and firm mass. The results of laboratory tests were suggestive of cholestasis. Ultrasound revealed choledocholithiasis. A computed tomography scan showed a protrusion of the left hepatic lobe through the anterior abdominal wall defect and a well-defined, soft tissue density lesion in the right adrenal topography. An endoscopic common bile duct stone extraction was unsuccessful. During surgery, the right adrenal tumor was resected first. The hernia was approached through a median supraumbilical incision; the totality of the left lobe was protruding through the abdominal wall defect, and once the lobe was reduced to its normal position, a common bile duct surgical exploration with multiple stone extraction was performed. Finally, the abdominal wall was reconstructed. Histopathology revealed an adrenal myelolipoma. Six months after the operation, our patient remains in good health. The case of liver herniation through an incisional anterior abdominal wall hernia in this report represents, to the best of our knowledge, the fourth such case reported in the literature. The rarity of this medical entity makes it almost impossible to specifically describe predisposing risk factors for liver herniation. Obesity, the right adrenal myelolipoma mass effect, and the previous abdominal surgery are likely to have contributed to

  1. Left hepatic lobe herniation through an incisional anterior abdominal wall hernia and right adrenal myelolipoma: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Nuño-Guzmán Carlos M

    2012-01-01

    Full Text Available Abstract Introduction Herniation of the liver through an anterior abdominal wall hernia defect is rare. To the best of our knowledge, only three cases have been described in the literature. Case presentation A 70-year-old Mexican woman presented with a one-week history of right upper quadrant abdominal pain, nausea, vomiting, and jaundice to our Department of General Surgery. Her medical history included an open cholecystectomy from 20 years earlier and excessive weight. She presented with jaundice, abdominal distension with a midline surgical scar, right upper quadrant tenderness, and a large midline abdominal wall defect with dullness upon percussion and protrusion of a large, tender, and firm mass. The results of laboratory tests were suggestive of cholestasis. Ultrasound revealed choledocholithiasis. A computed tomography scan showed a protrusion of the left hepatic lobe through the anterior abdominal wall defect and a well-defined, soft tissue density lesion in the right adrenal topography. An endoscopic common bile duct stone extraction was unsuccessful. During surgery, the right adrenal tumor was resected first. The hernia was approached through a median supraumbilical incision; the totality of the left lobe was protruding through the abdominal wall defect, and once the lobe was reduced to its normal position, a common bile duct surgical exploration with multiple stone extraction was performed. Finally, the abdominal wall was reconstructed. Histopathology revealed an adrenal myelolipoma. Six months after the operation, our patient remains in good health. Conclusions The case of liver herniation through an incisional anterior abdominal wall hernia in this report represents, to the best of our knowledge, the fourth such case reported in the literature. The rarity of this medical entity makes it almost impossible to specifically describe predisposing risk factors for liver herniation. Obesity, the right adrenal myelolipoma mass effect, and

  2. Cancer Survivorship: Defining the Incidence of Incisional Hernia After Resection for Intra-Abdominal Malignancy.

    Science.gov (United States)

    Baucom, Rebeccah B; Ousley, Jenny; Beveridge, Gloria B; Phillips, Sharon E; Pierce, Richard A; Holzman, Michael D; Sharp, Kenneth W; Nealon, William H; Poulose, Benjamin K

    2016-12-01

    Cancer survivorship focuses largely on improving quality of life. We aimed to determine the rate of ventral incisional hernia (VIH) formation after cancer resection, with implications for survivorship. Patients without prior VIH who underwent abdominal malignancy resections at a tertiary center were followed up to 2 years. Patients with a viewable preoperative computed tomography (CT) scan and CT within 2 years postoperatively were included. Primary outcome was postoperative VIH on CT, reviewed by a panel of surgeons uninvolved with the original operation. Factors associated with VIH were determined using Cox proportional hazards regression. 1847 CTs were reviewed among 491 patients (59 % men), with inter-rater reliability 0.85 for the panel. Mean age was 60 ± 12 years; mean follow-up time 13 ± 8 months. VIH occurred in 41 % and differed across diagnoses: urologic/gynecologic (30 %), colorectal (53 %), and all others (56 %) (p VIH (adjusting for stage, age, adjuvant therapy, smoking, and steroid use) included: incision location [flank (ref), midline, hazard ratio (HR) 6.89 (95 %CI 2.43-19.57); periumbilical, HR 6.24 (95 %CI 1.84-21.22); subcostal, HR 4.55 (95 %CI 1.51-13.70)], cancer type [urologic/gynecologic (ref), other {gastrointestinal, pancreatic, hepatobiliary, retroperitoneal, and others} HR 1.86 (95 %CI 1.26-2.73)], laparoscopic-assisted operation [laparoscopic (ref), HR 2.68 (95 %CI 1.44-4.98)], surgical site infection [HR 1.60 (95 %CI 1.08-2.37)], and body mass index [HR 1.06 (95 %CI 1.03-1.08)]. The rate of VIH after abdominal cancer operations is high. VIH may impact cancer survivorship with pain and need for additional operations. Further studies assessing the impact on QOL and prevention efforts are needed.

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

    Directory of Open Access Journals (Sweden)

    Plencner M

    2014-07-01

    Full Text Available Martin Plencner,1,2,* Barbora East,3,* Zbynek Tonar,4 Martin Otáhal,5 Eva Prosecká,1,2 Michala Rampichová,2,6 Tomáš Krejčí,3 Andrej Litvinec,2,7 Matej Buzgo,2,6 Andrea Míčková,1,2,6 Alois Nečas,8 Jirí Hoch,3 Evžen Amler1,2,9 1Institute of Biophysics, Second Faculty of Medicine, Charles University in Prague, Prague, 2Laboratory of Tissue Engineering, Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Prague, 3Department of Surgery, Second Faculty of Medicine, Charles University in Prague, Prague, 4Biomedical Centre, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, 5Department of Anatomy and Biomechanics, Faculty of Physical Education and Sport, Charles University in Prague, Prague, 6University Center for Energy Efficient Buildings, Czech Technical University in Prague, Buštehrad, 7Department of Breeding and Zoohygiene of Laboratory Animals, Institute of Physiology, Academy of Sciences of the Czech Republic, Prague, 8Department of Surgery and Orthopedics, Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Science Brno, Central European Institute of Technology, Brno, 9Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic *These authors contributed equally to this work Abstract: Incisional hernia affects up to 20% of patients after abdominal surgery. Unlike other types of hernia, its prognosis is poor, and patients suffer from recurrence within 10 years of the operation. Currently used hernia-repair meshes do not guarantee success, but only extend the recurrence-free period by about 5 years. Most of them are nonresorbable, and these implants can lead to many complications that are in some cases life-threatening. Electrospun nanofibers of various polymers have been used as tissue scaffolds and have been explored extensively in the last decade, due to their low cost and good biocompatibility. Their

  4. Hérnia pós-incisão em cães e gatos Post incisional hernia in dogs and cats

    Directory of Open Access Journals (Sweden)

    Alceu Gaspar Raiser

    1999-12-01

    Full Text Available A hérnia pós-incisão foi analisada quanto à prevalência e protocolo terapêutico em nove cães e seis gatos cadastrados no Hospital Veterinário da Universidade Federal de Santa Maria, RS, Brasil. Os animais apresentaram peritonite localizada que foi tratada com reposição hidroeletrolítica, antibioticoterapia, irrigação abundante da cavidade abdominal e debridamento cirúrgico. Todos tiveram evolução favorável.The case records of nine dogs and six cats with post-incisional hernia were managed by surgical correction at the Veterinary Hospital of the Federal University of Santa Maria, RS, Brazil, between January 1980 and June, 1998. Dogs and cats presented focal peritonitis that were treated by fluid replacement, antibiotic therapy, copious abdominal lavage, surgical debridement and reparation. This terapeutic protocol was efficient and all animals survived.

  5. First human use of hybrid synthetic/biologic mesh in ventral hernia repair: a multicenter trial.

    Science.gov (United States)

    Bittner, James G; El-Hayek, Kevin; Strong, Andrew T; LaPinska, Melissa Phillips; Yoo, Jin S; Pauli, Eric M; Kroh, Matthew

    2018-03-01

    Mesh options for reinforcement of ventral/incisional hernia (VIH) repair include synthetic or biologic materials. While each material has known advantages and disadvantages, little is understood about outcomes when these materials are used in combination. This multicenter study reports on the first human use of a novel synthetic/biologic hybrid mesh (Zenapro ® Hybrid Hernia Repair Device) for VIH repair. This prospective, multicenter post-market clinical trial enrolled consecutive adults who underwent elective VIH repair with hybrid mesh placed in the intraperitoneal or retromuscular/preperitoneal position. Patients were classified as Ventral Hernia Working Group (VHWG) grades 1-3 and had clean or clean-contaminated wounds. Outcomes of ventral and incisional hernia were compared using appropriate parametric tests. In all, 63 patients underwent VIH repair with hybrid mesh. Most were females (54.0%), had a mean age of 54.8 ± 10.9 years and mean body mass index of 34.5 ± 7.8 kg/m 2 , and classified as VHWG grade 2 (87.3%). Most defects were midline (92.1%) with a mean area of 106 ± 155 cm 2 . Cases were commonly classified as clean (92.1%) and were performed laparoscopically (60.3%). Primary fascial closure was achieved in 82.5% with 28.2% requiring component separation. Mesh location was frequently intraperitoneal (69.8%). Overall, 39% of patients available for follow-up at 12 months suffered surgical site events, which were generally more frequent after incisional hernia repair. Of these, seroma (23.7%) was most common, but few (8.5%) required procedural intervention. Other surgical site events that required procedural intervention included hematoma (1.7%), wound dehiscence (1.7%), and surgical site infection (3.4%). Recurrence rate was 6.8% (95% CI 2.2-16.6%) at 12-months postoperatively. Zenapro ® Hybrid Hernia Repair Device is safe and effective in VHWG grade 1-2 patients with clean wounds out to 12 months. Short-term outcomes and recurrence rate

  6. Experimental models of longitudinal abdominal incisional hernia in rats Modelos experimentais de hérnias incisionais abdominais longitudinais, em ratos

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    Danilo N. S. Paulo

    1997-12-01

    Full Text Available Abdominal incisional hernias in rats has been produced after resection of a segment of abdominal muscle. In a attempt to create a model of incisional hernia in rats, without resection of abdominal muscle, the following surgical procedures were performed: (a Rats anesthetized with ether were submitted to a 4 cm long median incision, supra and infraumbilical, followed by dissection of the subcutaneous tissue 1.5 cm laterally to the median line in each side; after, one incision was performed in the linea alba and peritoneum, with the same extension of the skin incision; the skin incision was sutured. (b Rats were submited to a suprapubic transversal incision and a scissors introduced through this incision and used to dissect the subcutaneous tissue at least 1.5 cm for each side of median line; after, the linea alba and peritoneoum were incised and the transversal skin incision sutured. (c For control, rats were submitted to a resection of a 2.5 x 4 cm of the abdominal muscles, creating a large defect in the abdominal wall. All the animal, submitted to the three different procedures, developed similar well constituted hernias. We concluded that abdominal incisonal hernias are easily induced in rats after an incision of the abdominal wall, without partial resection of abdominal muscle, since the subcutaneous have been dissected at least 1.5 cm laterally to the median line.Hérnias incisionais abdominais no rato têm sido produzidas pela ressecção de fragmento dos músculos de parede abdominal. Na tentativa de criar um modelo de hérnia incisional abdominal no rato, sem ressecção de fragmentos de músculo de parede abdominal, os seguintes procedimentos cirúrgicos foram realizados: (a Ratos anestesiados com vapores de éter foram submetidos à uma incisão longitudinal mediana supra e infra umbilical, de 4 cm de comprimento, seguida do descolamento do tecido celular subcutaneo em uma extensão de 1,5 cm lateralmente à linha mediana; de cada lado

  7. Histologic and biomechanical evaluation of a novel macroporous polytetrafluoroethylene knit mesh compared to lightweight and heavyweight polypropylene mesh in a porcine model of ventral incisional hernia repair.

    Science.gov (United States)

    Melman, L; Jenkins, E D; Hamilton, N A; Bender, L C; Brodt, M D; Deeken, C R; Greco, S C; Frisella, M M; Matthews, B D

    2011-08-01

    To evaluate the biocompatibility of heavyweight polypropylene (HWPP), lightweight polypropylene (LWPP), and monofilament knit polytetrafluoroethylene (mkPTFE) mesh by comparing biomechanics and histologic response at 1, 3, and 5 months in a porcine model of incisional hernia repair. Bilateral full-thickness abdominal wall defects measuring 4 cm in length were created in 27 Yucatan minipigs. Twenty-one days after hernia creation, animals underwent bilateral preperitoneal ventral hernia repair with 8 × 10 cm pieces of mesh. Repairs were randomized to Bard(®)Mesh (HWPP, Bard/Davol, http://www.davol.com), ULTRAPRO(®) (LWPP, Ethicon, http://www.ethicon.com), and GORE(®)INFINIT Mesh (mkPTFE, Gore & Associates, http://www.gore.com). Nine animals were sacrificed at each timepoint (1, 3, and 5 months). At harvest, a 3 × 4 cm sample of mesh and incorporated tissue was taken from the center of the implant site and subjected to uniaxial tensile testing at a rate of 0.42 mm/s. The maximum force (N) and tensile strength (N/cm) were measured with a tensiometer, and stiffness (N/mm) was calculated from the slope of the force-versus-displacement curve. Adjacent sections of tissue were stained with hematoxylin and eosin (H&E) and analyzed for inflammation, fibrosis, and tissue ingrowth. Data are reported as mean ± SEM. Statistical significance (P 0.05 for all comparisons). However, for each mesh type, the maximum strength at 5 months was significantly lower than that at 1 month (P 0.05 for all comparisons). No significant differences with regard to inflammation, fibrosis, or tissue ingrowth were detected between mesh types at any time point (P > 0.09 for all comparisons). However, over time, inflammation decreased significantly for all mesh types (P 0.09). The maximum tensile strength of mesh in the abdominal wall decreased over time for HWPP, LWPP, and mkPTFE mesh materials alike. This trend may actually reflect inability to adequately grip specimens at later time points

  8. Unusual Complications of Incisional Hernia

    African Journals Online (AJOL)

    house and fell down, landing with her outstretched hands. She subsequently noticed that her gut was eviscerated. There was no associated bleeding or loss of .... macroporous structure, are sufficiently resistant to infections. In addition, poly propylene mesh allows for ingrowth of native fibroblasts and incorporation into the ...

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

    Czech Academy of Sciences Publication Activity Database

    Plencner, Martin; Prosecká, Eva; Rampichová, Michala; East, B.; Buzgo, Matej; Vysloužilová, L.; Hoch, J.; Amler, Evžen

    2015-01-01

    Roč. 10, č. 2015 (2015), s. 2635-2646 E-ISSN 1178-2013 Institutional support: RVO:68378041 Keywords : nanofibers * growth factors * polypropylene mesh * hernia regeneration * in vitro Subject RIV: FP - Other Medical Disciplines Impact factor: 4.320, year: 2015

  10. Systemic and local collagen turnover in hernia patients

    DEFF Research Database (Denmark)

    Henriksen, Nadia A

    2016-01-01

    composition appears altered in fascial tissue but also in skin biopsies, suggesting that the collagen alterations are systemic. More pronounced collagen alterations are found in patients with hernia recurrences. Hypothetically, primary inguinal hernias are formed due to a systemic predisposition to altered...... connective tissue, whereas impaired healing influences on the development of incisional hernias and hernia recurrences. The overall objective of this thesis was to investigate the collagen turnover systemically and locally in patients with primary inguinal hernia, multiple hernias and incisional hernia...... repair after adjustment for gender, age and surgical approach. In a multivariable subgroup analysis, direct and recurrent inguinal hernia repair were associated with primary ventral hernia surgery, whereas only recurrent inguinal hernia repair was associated with secondary ventral hernia surgery...

  11. Mesh fixation in laparoscopic incisional hernia repair: glue fixation provides attachment strength similar to absorbable tacks but differs substantially in different meshes.

    Science.gov (United States)

    Rieder, Erwin; Stoiber, Martin; Scheikl, Verena; Poglitsch, Marcus; Dal Borgo, Andrea; Prager, Gerhard; Schima, Heinrich

    2011-01-01

    Laparoscopic ventral hernia repair has gained popularity among minimally invasive surgeons. However, mesh fixation remains a matter of discussion. This study was designed to compare noninvasive fibrin-glue attachment with tack fixation of meshes developed primarily for intra-abdominal use. It was hypothesized that particular mesh structures would substantially influence detachment force. For initial evaluation, specimens of laminated polypropylene/polydioxanone meshes were anchored to porcine abdominal walls by either helical titanium tacks or absorbable tacks in vitro. A universal tensile-testing machine was used to measure tangential detachment forces (TF). For subsequent experiments of glue fixation, polypropylene/polydioxanone mesh and 4 additional meshes with diverse particular mesh structure, ie, polyvinylidene fluoride/polypropylene mesh, a titanium-coated polypropylene mesh, a polyester mesh bonded with a resorbable collagen, and a macroporous condensed PTFE mesh were evaluated. TF tests revealed that fibrin-glue attachment was not substantially different from that achieved with absorbable tacks (median TF 7.8 Newton [N], range 1.3 to 15.8 N), but only when certain open porous meshes (polyvinylidene fluoride/polypropylene mesh: median 6.2 N, range 3.4 to 10.3 N; titanium-coated polypropylene mesh: median 5.2 N, range 2.1 to 11.7 N) were used. Meshes coated by an anti-adhesive barrier (polypropylene/polydioxanone mesh: median 3.1 N, range 1.7 to 5.8 N; polyester mesh bonded with a resorbable collagen: median 1.3 N, range 0.5 to 1.9 N), or the condensed PTFE mesh (median 3.1 N, range 2.1 to 7.0 N) provided a significantly lower TF (p < 0.01). Fibrin glue appears to be an appealing noninvasive option for mesh fixation in laparoscopic ventral hernia repair, but only if appropriate meshes are used. Glue can also serve as an adjunct to mechanical fixation to reduce the number of invasive tacks. Copyright © 2010 American College of Surgeons. Published by Elsevier

  12. Incisional scar evisceration of fallopian tube in a pregnant woman ...

    African Journals Online (AJOL)

    Background: Herniation of pelvic and solid abdominal structures like the fallopian tubes especially in pregnancy is extremely rare. We report a case of an eviscerated fallopian tube through an incisional hernia in a pregnant woman. There has been no such report in literature at the time of report. Case presentation: A case of ...

  13. Laparoscopic repair of large suprapubic hernias.

    Science.gov (United States)

    Sikar, Hasan Ediz; Çetin, Kenan; Eyvaz, Kemal; Kaptanoglu, Levent; Küçük, Hasan Fehmi

    2017-09-01

    Suprapubic hernia is the term to describe ventral hernias located less than 4 cm above the pubic arch in the midline. Hernias with an upper margin above the arcuate line encounter technical difficulties, and the differences in repair methods forced us to define them as large suprapubic hernias. To present our experience with laparoscopic repair of large suprapubic hernias that allows adequate mesh overlap. Nineteen patients with suprapubic incisional hernias who underwent laparoscopic repair between May 2013 and January 2015 were included in the study. Patients with laparoscopic extraperitoneal repair who had a suprapubic hernia with an upper margin below the arcuate line were excluded. Two men and 17 women, with a mean age of 58.2, underwent laparoscopic repair. Most of the incisions were midline vertical (13/68.4%). Twelve (63.1%) of the patients had previous incisional hernia repair (PIHR group); the mean number of previous incisional hernia repair was 1.4. Mean defect size of the PIHR group was higher than in patients without previous repair - 107.3 cm 2 vs. 50.9 cm 2 (p < 0.05). Mean operating time of the PIHR group was higher than in patients without repair - 126 min vs. 77.9 min (p < 0.05). Although all complications occurred in the PIHR group, there was no statistically significant difference. Laparoscopic repair of large suprapubic hernias can be considered as the first option in treatment. The low recurrence rates reported in the literature and the lack of recurrence, as observed in our study, support this view.

  14. Large Ventral Hernia

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    Meryl Abrams, MD

    2018-04-01

    Full Text Available History of present illness: A 46-year-old female presented to the emergency department (ED with diffuse abdominal pain and three days of poor oral intake associated with non-bilious, non-bloody vomiting. Initial vital signs consisted of a mild resting tachycardia of 111 with a temperature of 38.0 degrees Celsius (°C. On examination, the patient had a large pannus extending to the knees, which contained a hernia. She was tender in this region on examination. Laboratory values included normal serum chemistries and mild leukocytosis of 12.2. The patient reports that her abdomen had been enlarging over the previous 8 years but had not been painful until 3 days prior to presentation. The patient had no associated fever, chills, diarrhea, constipation, chest pain or shortness of breath. Significant findings: Computed tomography (CT scan with intravenous (IV contrast of the abdomen and pelvis demonstrated a large pannus containing a ventral hernia with abdominal contents extending below the knees (white circle, elongation of mesenteric vessels to accommodate abdominal contents outside of the abdomen (white arrow and air fluid levels (white arrow indicating a small bowel obstruction. Discussion: Hernias are a common chief complaint seen in the emergency department. The estimated lifetime risk of a spontaneous abdominal hernia is 5%.1 The most common type of hernia is inguinal while the next most common type of hernia is femoral, which are more common in women.1 Ventral hernias can be epigastric, incisional, or primary abdominal. An asymptomatic, reducible hernia can be followed up as outpatient with a general surgeon for elective repair.2 Hernias become problematic when they are either incarcerated or strangulated. A hernia is incarcerated when the hernia is irreducible and strangulated when its blood supply is compromised. A complicated hernia, especially strangulated, can have a mortality of greater than 50%.1 It is key to perform a thorough history

  15. A case report of unexpected pathology within an incarcerated ventral hernia

    Directory of Open Access Journals (Sweden)

    Erica D. Kane

    2017-01-01

    Conclusion: This is the first report of incisional hernia appendicitis with nonhealing colocutaneous fistulas secondary to Crohn’s. It is a lesson in developing a differential diagnosis of an inflammatory process within an incarcerated hernia and management of the complications related to laparoscopic hernial appendectomy in a patient with undiagnosed Crohn’s disease.

  16. Associated morbidities to congenital diaphragmatic hernia and a relationship to human milk.

    Science.gov (United States)

    Froh, Elizabeth B; Spatz, Diane L

    2012-08-01

    The majority of what is known in the recent literature regarding human milk studies in the neonatal intensive care setting is specific to term and/or preterm infants (including very-low-birth-weight preterm infants). However, there is a lack of human milk and breastfeeding literature concerning infants with congenital anomalies, specifically infants diagnosed with congenital diaphragmatic hernia (CDH). By applying human milk research conducted among other populations of infants, this article highlights how human milk may have a significant impact on infants with CDH. Recent human milk studies are reviewed and then applied to the CDH population in regard to respiratory and gastrointestinal morbidities, as well as infection and length of stay. In addition, clinical implications of these relationships are discussed and suggestions for future research are presented.

  17. Morgagni's Hernia

    International Nuclear Information System (INIS)

    Khalid, M.M.

    2004-01-01

    Congenital diaphragmatic hernias, including Morgagni's hernia, usually present in early childhood and are treated by surgical repair. This case report is about an unusual Morgagni's hernia, presenting with dyspepsia and chest pain, at the age 45 years. For many years the diagnosis remained a dilemma because patient's chest x-ray was not done and she was treated for 'ngina' and 'dyspepsia' Diagnosis was obvious once a chest x-ray was done, however, barium studies were performed for further confirmation. (author)

  18. Large renal calculus and ipsilateral flank (incisional) hernia ...

    African Journals Online (AJOL)

    A. Adam

    2017-03-11

    Mar 11, 2017 ... Abstract. Introduction: The use of the Mini PCNL has been gaining momentum since its first description in 2001. The range of indications for this particular procedure may also be expanding. We describe a case of a large renal calculus in a renal collecting system, found in a patient who underwent an ...

  19. Hernia incisional: puntos de vista para un consensus

    Directory of Open Access Journals (Sweden)

    José Miguel Goderich Lalán

    2003-12-01

    Full Text Available Aunque no se comparte el criterio en el tratamiento de esta entidad, durante 15 años los estudios realizados en hospitales de Santiago de Cuba y Ciudad de La Habana permitieron ofrecer los resultados de 529 enfermos operados con disímiles técnicas en un estudio retro y prospectivo, descriptivo y longitudinal. Se definen puntualmente los aspectos anatómicos, fisiológicos e histológicos, donde la interfase peritoneo-aponeurosis es determinante al igual que alteraciones de la micción, defecación y ventilación. Se detallan entre los factores pronósticos, el tamaño del anillo y la atrofia o distrofia muscular; en el preoperatorio la evaluación de las enfermedades asociadas, el neumoperitoneo seriado y el número de operaciones anteriores adquieren valores determinantes; son consideradas las variedades especiales (periostomales, lumbares y suprapúbicas. Se analizan las alteraciones psíquicas y las discapacidades. En el caso de los implantes la técnica más utilizada fue la de Rives, donde se utilizan mallas de polipropileno, politetrafluoroetileno y mersilene, preferentemente con anestesia epidural y la profilaxis antibiótica. Se discuten las lesiones transoperatorias y su profilaxis, así como los resultados por la utilización de mallas, lo que determina diferencias porcentuales de recidivas de 11,3 a 1,4 %. Se concluye a favor del uso sistemático de mallas y respeto con los tópicos señalados para un consensusAlthough there is not a shared criterion in the treatment of this entity, the studies conducted in hospitals of Santiago de Cuba and La Habana during 15 years allowed to show the results of a retrospective, descriptive and longitudinal study carried out among 529 patients operated on by different techniques. The anatomical, physiological and histological aspects were well defined. The peritoneum-aponeurosis interphase as well as the alterations of miction, defecation and ventilation were determinant. Among the prognostic factors, the size of the ring and the muscular atrophy or distrophy were stressed. In the preoperative, the evaluation of the associated diseases, the serial pneumoperitoneum and the number of previous operations acquired determinating values. The special varieties (periostomal, lumbar and suprapubic were considered. The psychical alterations and the disabilites were analyzed. In the case of the implants, the Rives' technique was the most used, in which meshes of polypropylene, polytetrafluoroethylene and mersilene were preferably used with epidural anesthesia and antibiotic prophylaxis. The transoperative injuries and their prophylaxis and the results obtained by using meshes were discussed, determining percentage differences of relapses from 11.3 to 1.4 %. The conclusions favored the systematic use of meshes and the respect for the topics approached for a consensus

  20. Incisional endometriosis: diagnosed by fine needle aspiration cytology.

    Science.gov (United States)

    Veda, P; Srinivasaiah, M

    2010-07-01

    Incisional endometriosis (IE) is a rare entity reported in 0.03-1.08% of women following obstetric or gynecologic surgeries. Most cases reported in literature have appeared after cesarean sections and were often clinically mistaken for hernia, abscess, suture granuloma or lipoma. We hereby report a case of IE following a second trimester hysterotomy, which was diagnosed by fine needle aspiration cytology (FNAC). Our patient was 26 years old, presenting with a mass over anterior abdominal wall, associated with incapacitating pain during each menstrual cycle. FNAC showed epithelial cells, stromal cells and hemosiderin laden macrophages. Based on the typical history, clinical and cytological features, the diagnosis of IE was established. Wide surgical excision was done and the resulting rectus sheath defect was repaired. Patient was followed for 6 months during which time she was symptom free. This article also reviews the spectrum of cytological features and the rare possibility of malignant transformation that can occur in IE.

  1. Surgery for diverticular disease results in a higher hernia rate compared to colorectal cancer: a population-based study from Ontario, Canada.

    Science.gov (United States)

    Tang, E S; Robertson, D I; Whitehead, M; Xu, J; Hall, S F

    2017-11-16

    Incisional hernias are a well described complication of abdominal surgery. Previous studies identified malignancy and diverticular disease as risk factors. We compared incisional hernia rates between colon resection for colorectal cancer (CRC) and diverticular disease (DD). We performed a retrospective, population-based, matched cohort study. Provincial databases were linked through the Institute for Clinical Evaluative Sciences. These databases include all patients registered under the universal Ontario Health Insurance Plan. Patients aged 18-105 undergoing open colon resection, without ostomy formation between April 1, 2002 and March 31, 2009, were included. We excluded those with previous surgery, hernia, obstruction, and perforation. The primary outcomes were surgery for hernia repair, or diagnosis of hernia in clinic. We identified 4660 cases of DD. These were matched 2:1 by age and gender to 8933 patients with CRC for a total of 13,593. At 5 years, incisional hernias occurred in 8.3% of patients in the CRC cohort, versus 13.1% of those undergoing surgery for DD. After adjusting for important confounders (comorbidity score, wound infection, age, diabetes, prednisone and chemotherapy), hernias were still more likely in patients with DD [HR 1.58, 95% Confidence Interval (CI) 1.43-1.76, P < 0.001]. The only significant covariate was wound infection (HR 1.63, 95% CI 1.43-1.87, P < 0.001). Our study found that incisional hernias occur more commonly in patients with DD than CRC.

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

    Directory of Open Access Journals (Sweden)

    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

  3. Asymptomatic Incisional Endometrioma Presenting as Abdominal ...

    African Journals Online (AJOL)

    Asymptomatic incisional endometrioma of the anterior abdominal wall is rare. Clinical diagnosis may be difficult. We present a 26 year old woman with incisional abdominal wall endometrioma discovered 5 years after caeserian section. It was painless and there was no change in size with menstruation. The patient's body ...

  4. Seroma in ventral incisional herniorrhaphy: incidence, predictors and outcome.

    Science.gov (United States)

    Kaafarani, Haytham M A; Hur, Kwan; Hirter, Angie; Kim, Lawrence T; Thomas, Anthony; Berger, David H; Reda, Domenic; Itani, Kamal M F

    2009-11-01

    Factors leading to seroma following ventral incisional herniorrhaphy (VIH) are poorly understood. Between 2004 and 2006, patients were prospectively randomized at 4 Veterans Affairs hospitals to undergo laparoscopic or open VIH. Patients who developed seromas within 8 weeks postoperatively were compared with those who did not. Multivariate analyses were performed to identify predictors of seroma. Of 145 patients who underwent VIH, 24 (16.6%) developed seromas. Patients who underwent open VIH had more seromas than those who underwent laparoscopic VIH (23.3% vs 6.8%, P = .011). Seroma patients had hernias that were never spontaneously reducible (0% vs 21%, P = .015), had more abdominal incisions preoperatively (mean, 2.4 vs 1.8; P = .037), and were less likely to have drain catheters placed than those without seromas (30.0% vs 63.1%, P = .011). In multivariate analyses, open VIH predicted seroma (odds ratio, 5.5; 95% confidence interval, 1.6-18.8), as well as the specific hospital at which the procedure was performed. Spontaneous resolution occurred in 71% of seromas; 29% required aspiration. Procedural characteristics and hernia characteristics rather than patient comorbidities predicted seroma in VIH.

  5. Umbilical Hernia

    Science.gov (United States)

    ... Prompt diagnosis and treatment can help prevent complications. Causes During pregnancy, the umbilical cord passes through a small opening ... abdominal pressure can cause an umbilical hernia. Possible causes in adults include: ... pregnancies Fluid in the abdominal cavity (ascites) Previous abdominal ...

  6. Incisional Negative Pressure Wound Therapy

    DEFF Research Database (Denmark)

    Hyldig, Nana

    the rate of surgical wound infection and wound exudate post-caesarean and that wound infection had a negative impact on quality of life one month after surgery. Alongside the clinical trial, a trial-based cost-effectiveness analysis demonstrated that the treatment is cost-effective in a high......Women with a pre-gestational body mass index (BMI) above 30 kg/m2 giving birth by caesarean section are at high risk of surgical wound infection compared with women with a BMI below 30 kg/m2. Incisional Negative Pressure Wound Therapy (iNPWT) is one strategy to reduce the rate of surgical wound...... a randomised controlled trial in two tertiary and three teaching hospitals in three regions of Denmark, the Happy Belly Study, investigating the effectiveness of iNPWT in a population of obese women after caesarean section. The Happy Belly Study has demonstrated that prophylactic iNPWT significantly reduced...

  7. Transvaginal Repair of a Large Chronic Porcine Ventral Hernia with Synthetic Mesh Using NOTES

    OpenAIRE

    Powell, Ben; Whang, Susan H.; Bachman, Sharon L.; Andres Astudillo, J.; Sporn, Emanuel; Miedema, Brent W.; Thaler, Klaus

    2010-01-01

    Background: Ventral incisional hernias still remain a common surgical problem. We tested the feasibility of transvaginal placement of a large synthetic mesh to repair a porcine hernia. Methods: Seven pigs were used in this survival model. Each animal had creation of a 5-cm hernia defect and underwent a transvaginal repair of the defect with synthetic mesh. A single colpotomy was made using a 12-cm trocar for an overtube. The mesh was cut to size and placed through the trocar. A single-channel...

  8. Mechanical response of the herniated human abdomen to the placement of different prostheses.

    Science.gov (United States)

    Hernández-Gascón, Belén; Peña, Estefanía; Grasa, Jorge; Pascual, Gemma; Bellón, Juan M; Calvo, Begoña

    2013-05-01

    This paper describes a method designed to model the repaired herniated human abdomen just after surgery and examine its static mechanical response to the maximum intra-abdominal pressure provoked by a physiological movement (standing cough). The model is based on the real geometry of the human abdomen bearing a large incisional hernia with several anatomical structures differentiated by MRI. To analyze the outcome of hernia repair, the surgical procedure was simulated by modeling a prosthesis placed over the hernia. Three surgical meshes with different mechanical properties were considered: an isotropic heavy-weight mesh (Surgipro®), a slightly anisotropic light-weight mesh (Optilene®), and a highly anisotropic medium-weight mesh (Infinit®). Our findings confirm that anisotropic implants need to be positioned such that the most compliant axis of the mesh coincides with the craneo-caudal direction of the body.

  9. Correlation between early surgical complications and readmission rate after ventral hernia repair.

    Science.gov (United States)

    Kokotovic, D; Sjølander, H; Gögenur, I; Helgstrand, F

    2017-08-01

    Postoperative surgical complications arising from ventral hernia repair have been assessed by a variety of outcome measures. The objective of this study was to correlate the Clavien Dindo Classification (CDC) graded complications with the 30-day readmission rate as early outcome measures in ventral hernia repair. Secondarily, we wanted to investigate whether the risk factors for Clavien Dindo class ≥1 and 30-day readmission were comparable. Single-centre retrospective study including all patients (≥18 years) who underwent ventral hernia repair between January 1, 2009 and September 1, 2014 at Zealand University Hospital. Data were obtained from hospital files and the Danish National Patient Registry. A 100% follow-up was obtained. In total, the study included 700 patients (261 patients with incisional hernia repair and 439 patients with umbilical or epigastric hernia repair). There was a significant association between a complication graded by the CDC ≥1 and 30-day readmission for both incisional and umbilical/epigastric hernia repair (p readmission. Recurrent (vs. primary) hernia repair was an independent risk factors for both CDC ≥1 and 30-day readmission in umbilical/epigastric hernia repair. Furthermore, hernia size 2-7 cm (vs. >2 cm) was a risk factor for CDC ≥1 but not for 30-day readmission in umbilical/epigastric hernia repair. Reports on 30-day readmission can be used as a general outcome measure in ventral hernia repair, however CDC provides a more precise and detailed registration of postoperative complications.

  10. Hiatal Hernia

    Science.gov (United States)

    ... happens. But a hiatal hernia might be caused by: Age-related changes in your diaphragm Injury to the area, for example, after trauma or certain types of surgery Being born with an unusually large hiatus Persistent and intense pressure on the surrounding muscles, such as while coughing , ...

  11. STUDY OF VARIOUS MODALITIES IN MANAGEMENT OF INCISION HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Raghu Rachha

    2018-03-01

    Full Text Available BACKGROUND Incisional hernias are a major problem following abdominal surgery and their repairs are among the common surgeries done by a general surgeon.1 Besides the preoperative factors such as anaemia, BMI over 25 kg/m2 and smoking which are leading causes contributing to the development of Incisional hernia, laparotomy performed through the abdominal incision doubles the risk of IH.2 In addition, wound infection, increases the risk of IH formation by 1.9 times.3 If left unattended they may attain large size therefore cause discomfort and lead to the complications like Obstruction, Strangulation, Incarceration increasing the risk of morbidity and mortality.4 Treatment of IH involves further major surgery and the results may be poor, with the recurrence rates of up to 49% reported.5 A wide spectrum of surgical techniques have been developed and recommended ranging from sutured techniques to the various types of prosthetic mesh. MATERIALS AND METHODS 30 patients were studied who presented to emergency department with incisional hernias during August 2014 – September 2016 at Gandhi Medical College and Hospital. All patients underwent definitive treatment. RESULTS From our study it is observed that 1. The maximum cases of incisional hernias presenting to the emergency surgical department were found to be in 51-60 years age group. 2. There was female preponderance. 3. Obstruction is the most common presenting symptom found in 60% of cases followed by irreducibility (33.3% and strangulation (6.67%. 4. The onset of incisional hernias is more after 10 years following previous surgery. 5. Among 30 patients, bowel was viable in 18 patients (60% and mesh repair was done in 13 patients. Bowel was gangrenous in 12 patients (40% and anatomical repair was done in 17 patients. 6. Out of 30, women got infected in 11 patients (36.67% wound dehiscence noted in 5 patients (16.67%. 7. The recurrence rate was 6.67% with 6 months follow up. CONCLUSION 1. The mean

  12. Etiology of Inguinal Hernias

    DEFF Research Database (Denmark)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

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

  13. Strangulated spigelian hernia

    International Nuclear Information System (INIS)

    Amin, F.M.; Sultan, T.

    2004-01-01

    Spigelian hernia is a rare ventral hernia. Strangulation is Spigelian hernia is common but still seen very rarely in clinical practice. We report a case of strangulated Spigelian hernia in an elderly women which was managed satisfactory and the patient discharged on ninth post operative day. (author)

  14. Incisional Endometriosis – Two Case Reports

    African Journals Online (AJOL)

    previous pelvic pain or dysmenorrhea. A CT Scan of the area suggested that the swelling was indeed an incarcerated hernia, with an incarcerated loop of bowel in it (Figure 2). Exploration in theatre revealed a solid mass with cystic areas containing a brown-coloured fluid. No hernia was present. The mass as well as the ...

  15. Epigastric hernia contiguous with the laparoscopic port site after endoscopic robotic total prostatectomy.

    Science.gov (United States)

    Moriwaki, Yoshihiro; Otani, Jun; Okuda, Junzo; Maemoto, Ryo

    2018-03-23

    Both laparoscopic and endoscopic robotic surgery are widely accepted for many abdominal surgeries. However, the port site for the laparoscope cannot be easily sutured without defect, particularly in the cranial end; this can result in a port-site incisional hernia and trigger the progressive thinning and stretching of the linea alba, leading to epigastric hernia. In the present case, we encountered an epigastric hernia contiguous with an incisional scar at the port site from a previous endoscopic robotic total prostatectomy. Abdominal ultrasound and CT revealed that the width of the linea alba was 30-48 mm. Previous CT images prepared before endoscopic robotic prostatectomy had shown a thinning of the linea alba. We should be aware of the possibility of epigastric hernia after laparoscopic and endoscopic robotic surgery. In laparoscopic and endoscopic robotic surgery for a high-risk patient for epigastric hernia, we should consider additional sutures cranial to the port-site incision to prevent of an epigastric hernia. © 2018 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  16. Incarcerated Pediatric Hernias.

    Science.gov (United States)

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

    2017-02-01

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

  17. Correlation between early surgical complications and readmission rate after ventral hernia repair

    DEFF Research Database (Denmark)

    Kokotovic, D; Sjølander, H; Gögenur, I

    2017-01-01

    PURPOSE: Postoperative surgical complications arising from ventral hernia repair have been assessed by a variety of outcome measures. The objective of this study was to correlate the Clavien Dindo Classification (CDC) graded complications with the 30-day readmission rate as early outcome measures...... in ventral hernia repair. Secondarily, we wanted to investigate whether the risk factors for Clavien Dindo class ≥1 and 30-day readmission were comparable. METHODS: Single-centre retrospective study including all patients (≥18 years) who underwent ventral hernia repair between January 1, 2009 and September 1......). There was a significant association between a complication graded by the CDC ≥1 and 30-day readmission for both incisional and umbilical/epigastric hernia repair (p readmission. Recurrent...

  18. 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], Poperative factors may facilitate accurate comparison of SSI rates between facilities.

  19. Prevalence of Hiatal Hernia and Related Risk Factors to Laparoscopic Cholecystectomy Using the Hasson Technique

    Directory of Open Access Journals (Sweden)

    AA Darzi

    2016-09-01

    Full Text Available BACKGROUND AND OBJECTIVE: One of the complications of laparoscopic cholecystectomy is trocar incision hernia (TSIH: Trocar Site Incisional Hernia, which occurs almost exclusively in the navel area and could cause significant problems. The aim of this study was to evaluate the prevalence of hiatal hernia in laparoscopic cholecystectomy and identify the associated risk factors. METHODS: This cross sectional study was done on patients who underwent laparoscopic cholecystectomy during one year in different hospitals of Babol. Information including age, gender, BMI, diagnosis prior to surgery, duration of hospitalization, duration of surgery, the thickness of the lining of the gallbladder, surgical site infection and umbilical hernia during 12 months follow-up for patients were confirmed and examined. FINDINGS: Among 270 studied patients, there were 236 women (87.4% and 34 men (12.59 %. Eleven patients (4.07% during the 12-month follow-up; they had a hiatal hernia surgical site infection in the navel area (223.82-4.33: CI-95%, OR: 31.14 and BMI (60.18-1.72 CI-95%; OR: 10.21 were associated with increased incidence of inguinal hernias. There was no relationship between other variables and umbilical hernia. CONCLUSION: According to the results of this study obesity and surgical site infections have been linked with an increased incidence of inguinal hernias.

  20. Hiatal hernia in the dog: a clinical report of four Chinese shar peis.

    Science.gov (United States)

    Guiot, Laurent P; Lansdowne, Jennifer L; Rouppert, Pierre; Stanley, Bryden J

    2008-01-01

    Four Chinese shar pei littermate puppies were presented for vomiting, regurgitation, hypersalivation, and poor growth. Diagnosis of hiatal hernia was made for each of the four dogs based on survey radiographs and barium esophagram studies. All dogs initially underwent medical therapy, to which only one dog responded. All dogs underwent surgical treatment, which included manual hernia reduction followed by phrenoplasty, esophagopexy, and left incisional gastropexy, 5 to 40 days following initiation of medical therapy. The three surgical techniques described eliminated the need to enter the pleural cavity and offered excellent long-term results with no recurrence of clinical signs following surgery.

  1. Etiology of Inguinal Hernias

    DEFF Research Database (Denmark)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

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

  2. Hernias (For Parents)

    Science.gov (United States)

    ... look like inguinal hernias, but are not: A communicating hydrocele is similar to a hernia, except that ... reviewed: September 2016 More on this topic for: Parents Kids Teens Medical Care and Your Newborn Undescended ...

  3. Ventral hernia repair

    Science.gov (United States)

    ... incarcerated) in the hernia and become impossible to push back in. This is usually painful. The blood supply ... you are lying down or that you cannot push back in. Risks The risks of ventral hernia repair ...

  4. Incisional Negative Pressure Wound Therapy in High Risk Patients Undergoing Panniculectomy: A Prospective Randomized Controlled Trial

    Science.gov (United States)

    2018-01-16

    Complications Wounds; Negative Pressure Wound Therapy; Wound Healing Delayed; Incisional; Panniculectomy; Incisional Negative Pressure Wound Therapy; Incisional Vac; Wound Vac; Obese; Renal Failure; Kidney Transplant; Complications; Wound Healing Complication

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

    OpenAIRE

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Arif Aslaner

    2015-01-01

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

  7. Treating and Preventing Sports Hernias

    Science.gov (United States)

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

  8. Mesh versus non-mesh repair of ventral abdominal hernias

    International Nuclear Information System (INIS)

    Jawaid, M.A.; Talpur, A.H.

    2008-01-01

    To investigate the relative effectiveness of mesh and suture repair of ventral abdominal hernias in terms of clinical outcome, quality of life and rate of recurrence in both the techniques. This is a retrospective descriptive analysis of 236 patients with mesh and non-mesh repair of primary ventral hernias performed between January 2000 to December 2004 at Surgery Department, Liaquat University of Medical and Health Sciences, Jamshoro. The record sheets of the patients were analyzed and data retrieved to compare the results of both techniques for short-term and long-term results. The data retrieved is statistically analyzed on SPSS version 11. There were 43 (18.22%) males and 193 (81.77%) females with a mean age of 51.79 years and a range of 59 (81-22). Para-umbilical hernia was the commonest of ventral hernia and accounted for 49.8% (n=118) of the total study population followed by incisional hernia comprising 24% (n=57) of the total number. There was a significant difference in the recurrent rate at 3 years interval with 23/101 (22.77%) recurrences in suture-repaired subjects compared to 10/135 (7.40%) in mesh repair group. Chronic pain lasting up to 1-2 years was noted in 14 patients with suture repair. Wound infection is comparatively more common (8.14%) in mesh group. The other variables such as operative and postoperative complications, total hospital stay and quality of life is also discussed. Mesh repair of ventral hernia is much superior to non-mesh suture repair in terms of recurrence and overall outcome. (author)

  9. Predictors of surgical site infection in laparoscopic and open ventral incisional herniorrhaphy.

    Science.gov (United States)

    Kaafarani, Haytham M A; Kaufman, Derrick; Reda, Domenic; Itani, Kamal M F

    2010-10-01

    Surgical site infection (SSI) after ventral incisional hernia repair (VIH) can result in serious consequences. We sought to identify patient, procedure, and/or hernia characteristics that are associated with SSI in VIH. Between 2004 and 2006, patients were randomized in four Veteran Affairs (VA) hospitals to undergo laparoscopic or open VIH. Patients who developed SSI within eight weeks postoperatively were compared to those who did not. A bivariate analysis for each factor and a multiple logistic regression analysis were performed to determine factors associated with SSI. The variables studied included patient characteristics and co-morbidities (e.g., age, gender, race, ethnicity, body mass index, ASA classification, diabetes, steroid use), hernia characteristics (e.g., size, duration, number of previous incisions), procedure characteristics (e.g., open versus laparoscopic, blood loss, use of postoperative drains, operating room temperature) and surgeons' experience (resident training level, number of open VIH previously performed by the attending surgeon). Antibiotic prophylaxis, anticoagulation protocols, preparation of the skin, draping of the wound, body temperature control, and closure of the surgical site were all standardized and monitored throughout the study period. Out of 145 patients who underwent VIH, 21 developed a SSI (14.5%). Patients who underwent open VIH had significantly more SSIs than those who underwent laparoscopic VIH (22.1% versus 3.4%; P = 0.002). Among patients who underwent open VIH, those who developed SSI had a recorded intraoperative blood loss greater than 25 mL (68.4% versus 40.3%; P = 0.030), were more likely to have a drain placed (79.0% versus 49.3%; P = 0.021) and were more likey to be operated on by surgeons with less than 75 open VIH case experience (52.6% versus 28.4%; P = 0.048). Patient and hernia characteristics were similar between the two groups. In a multiple logistic regression analysis, the open surgical technique was

  10. Cervical lung hernia

    Science.gov (United States)

    Lightwood, Robin G.; Cleland, W. P.

    1974-01-01

    Lightwood, R. G., and Cleland, W. P. (1974).Thorax, 29, 349-351. Cervical lung hernia. Lung hernias occur in the cervical position in about one third of cases. The remainder appear through the chest wall. Some lung hernias are congenital, but trauma is the most common cause. The indications for surgery depend upon the severity of symptoms. Repair by direct suture can be used for small tears in Sibson's (costovertebral) fascia while larger defects have been closed using prosthetic materials. Four patients with cervical lung hernia are described together with an account of their operations. PMID:4850946

  11. Adult abdominal hernias.

    LENUS (Irish Health Repository)

    Murphy, Kevin P

    2014-06-01

    Educational Objectives and Key Points. 1. Given that abdominal hernias are a frequent imaging finding, radiologists not only are required to interpret the appearances of abdominal hernias but also should be comfortable with identifying associated complications and postrepair findings. 2. CT is the imaging modality of choice for the assessment of a known adult abdominal hernia in both elective and acute circumstances because of rapid acquisition, capability of multiplanar reconstruction, good spatial resolution, and anatomic depiction with excellent sensitivity for most complications. 3. Ultrasound is useful for adult groin assessment and is the imaging modality of choice for pediatric abdominal wall hernia assessment, whereas MRI is beneficial when there is reasonable concern that a patient\\'s symptoms could be attributable to a hernia or a musculoskeletal source. 4. Fluoroscopic herniography is a sensitive radiologic investigation for patients with groin pain in whom a hernia is suspected but in whom a hernia cannot be identified at physical examination. 5. The diagnosis of an internal hernia not only is a challenging clinical diagnosis but also can be difficult to diagnose with imaging: Closed-loop small-bowel obstruction and abnormally located bowel loops relative to normally located small bowel or colon should prompt assessment for an internal hernia.

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

    Directory of Open Access Journals (Sweden)

    V. Lambropoulos

    2016-01-01

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

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

    Science.gov (United States)

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

    1991-01-01

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

  14. Abdominal wall hernias

    DEFF Research Database (Denmark)

    Henriksen, Nadia A; Mortensen, Joachim H; Lorentzen, Lea

    2016-01-01

    ) with a history of more than 3 hernia repairs and 86, age-matched men without hernias. Biomarkers for synthesis of collagen type IV (P4NP) and type V (P5CP) as well as breakdown (C4M and C5M) were measured in serum by validated, solid-phase, competitive assays. Collagen turnover was indicated by the ratio between...

  15. Traumatic lung hernia; Hernia pulmonar traumatica

    Energy Technology Data Exchange (ETDEWEB)

    Rabaza, M. J.; Alcazar, P. P.; Touma, C. [Hospital Universitario Virgen de las Nieves. Granada (Spain)

    2001-07-01

    Lung hernia is an uncommon entity that is defined as the protrusion of the lung parenchyma through a defect in the thoracic cavity. It is classified on the basis of its location (cervical, intercostal and diaphragmatic) and etiology (congenital and acquired). Acquired lung hernias can be further grouped as spontaneous, traumatic or pathological, depending on the responsible mechanism. Nearly half of them are secondary to chest trauma, whether penetrating or blunt. We present a case of lung hernia in a patient with penetrating chest trauma. The diagnosis was suspected from the radiographic images and was confirmed by computed tomography. We also review the literature concerning its classification and incidence, diagnostic methods used and treatment. (Author) 9 refs.

  16. Ventral hernia repair with poly-4-hydroxybutyrate mesh.

    Science.gov (United States)

    Plymale, Margaret A; Davenport, Daniel L; Dugan, Adam; Zachem, Amanda; Roth, John Scott

    2018-04-01

    Biomaterial research has made available a biologically derived fully resorbable poly-4-hydroxybutyrate (P4HB) mesh for use in ventral and incisional hernia repair (VIHR). This study evaluates outcomes of patients undergoing VIHR with P4HB mesh. An IRB-approved prospective pilot study was conducted to assess clinical and quality of life (QOL) outcomes for patients undergoing VIHR with P4HB mesh. Perioperative characteristics were defined. Clinical outcomes, employment status, QOL using 12-item short form survey (SF-12), and pain assessments were followed for 24 months postoperatively. 31 patients underwent VIHR with bioresorbable mesh via a Rives-Stoppa approach with retrorectus mesh placement. The median patient age was 52 years, median body mass index was 33 kg/m 2 , and just over half of the patients were female. Surgical site occurrences occurred in 19% of patients, most of which were seroma. Hernia recurrence rate was 0% (median follow-up = 414 days). Patients had significantly improved QOL at 24 months compared to baseline for SF-12 physical component summary and role emotional (p < 0.05). Ventral hernia repair with P4HB bioresorbable mesh results in favorable outcomes. Early hernia recurrence was not identified among the patient cohort. Quality of life improvements were noted at 24 months versus baseline for this cohort of patients with bioresorbable mesh. Use of P4HB mesh for ventral hernia repair was found to be feasible in this patient population. (ClinicalTrials.gov Identifier: NCT01863030).

  17. Suture, synthetic, or biologic in contaminated ventral hernia repair.

    Science.gov (United States)

    Bondre, Ioana L; Holihan, Julie L; Askenasy, Erik P; Greenberg, Jacob A; Keith, Jerrod N; Martindale, Robert G; Roth, J Scott; Liang, Mike K

    2016-02-01

    Data are lacking to support the choice between suture, synthetic mesh, or biologic matrix in contaminated ventral hernia repair (VHR). We hypothesize that in contaminated VHR, suture repair is associated with the lowest rate of surgical site infection (SSI). A multicenter database of all open VHR performed at from 2010-2011 was reviewed. All patients with follow-up of 1 mo and longer were included. The primary outcome was SSI as defined by the Centers for Disease Control and Prevention. The secondary outcome was hernia recurrence (assessed clinically or radiographically). Multivariate analysis (stepwise regression for SSI and Cox proportional hazard model for recurrence) was performed. A total of 761 VHR were reviewed for a median (range) follow-up of 15 (1-50) mo: there were 291(38%) suture, 303 (40%) low-density and/or mid-density synthetic mesh, and 167(22%) biologic matrix repair. On univariate analysis, there were differences in the three groups including ethnicity, ASA, body mass index, institution, diabetes, primary versus incisional hernia, wound class, hernia size, prior VHR, fascial release, skin flaps, and acute repair. The unadjusted outcomes for SSI (15.1%; 17.8%; 21.0%; P = 0.280) and recurrence (17.8%; 13.5%; 21.5%; P = 0.074) were not statistically different between groups. On multivariate analysis, biologic matrix was associated with a nonsignificant reduction in both SSI and recurrences, whereas synthetic mesh associated with fewer recurrences compared to suture (hazard ratio = 0.60; P = 0.015) and nonsignificant increase in SSI. Interval estimates favored biologic matrix repair in contaminated VHR; however, these results were not statistically significant. In the absence of higher level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Parastomal hernias after radical cystectomy and ileal conduit diversion

    Directory of Open Access Journals (Sweden)

    Timothy F. Donahue

    2016-07-01

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

  19. Animal model of chronic abdominal hernia in rabbit Modelo animal de hérnia abdominal crônica em coelhos

    Directory of Open Access Journals (Sweden)

    Walter da Silva

    2009-08-01

    Full Text Available PURPOSE: To create a feasible animal model of hernia that should be reliable to test the different types of mesh and/or surgical technique. METHODS: Thirty six male New Zealand albino rabbits were submitted to surgical procedure to provoke a standard hole in the abdominal wall. A metallic frame measuring 3 cm length and 1 cm width was allocated longitudinally on the umbilicus scar and the comprehensive three squared centimeters area was resected. A continuous 4.0 polyamide was performed to closure the subcutaneous and skin. RESULTS: During three weeks a score of signals/symptoms was performed to evaluate the wound and clinical conditions. No death or severe complications occurred. In the 3rd week the hernia ring and visceral adhesions were evaluated. Soft omental adherences were present in the hernial sac in all animals. The area of hernia ring ranged from 32.1±5.5 to 35.6±3.1 squared centimeter and the maximum was 39 cm² and the minimum was 30 cm². The model results in protrusion which was similar to a human incisional hernia with hernia sac, visceral adhesions and fibrous healing ring. CONCLUSION: The model was more reliable to test further techniques or mesh on hernia repair.OBJETIVO: Criação de um modelo animal de hérnia que seja confiável para testar as diferentes técnicas e tipos de telas. MÉTODOS: Trinta e seis coelhos foram submetidos a procedimento operatório que provocou uma falha na parede abdominal. Uma moldura metálica com 3 cm de comprimento e 1 cm de largura foi colocada longitudinalmente sobre a cicatriz umbilical e ressecada uma área de 3cm². Uma sutura contínua de poliamida 4.0 fechou a tela subcutânea e pele. RESULTADOS: durante três semanas o escore de sinais e sintomas foi coletado para avaliar as condições clínicas e da ferida operatória. Não ocorreram óbitos ou complicações graves. Na terceira semana o anel herniário e aderências peritoneais foram avaliadas. Aderências frouxas estavam presentes

  20. Athletic pubalgia (sports hernia).

    Science.gov (United States)

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

    2011-04-01

    Athletic pubalgia or sports hernia is a syndrome of chronic lower abdomen and groin pain that may occur in athletes and nonathletes. Because the differential diagnosis of chronic lower abdomen and groin pain is so broad, only a small number of patients with chronic lower abdomen and groin pain fulfill the diagnostic criteria of athletic pubalgia (sports hernia). The literature published to date regarding the cause, pathogenesis, diagnosis, and treatment of sports hernias is confusing. This article summarizes the current information and our present approach to this chronic lower abdomen and groin pain syndrome. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. ADULT ABDOMINAL WALL HERNIA IN IBADAN.

    African Journals Online (AJOL)

    ... method for this surgical procedure.11,12 Laparoscopic mesh repair of ... surgical practice. Groin hernia is the commonest type of abdominal wall hernias. There are several methods of hernia repair but tension-free repair (usually with .... GROIN HERNIA (N=922). Side of hernia. Right. Left. Bilateral. Type of hernia. Direct.

  2. Prostheses size dependency of the mechanical response of the herniated human abdomen.

    Science.gov (United States)

    Simón-Allué, R; Hernández-Gascón, B; Lèoty, L; Bellón, J M; Peña, E; Calvo, B

    2016-12-01

    Hernia repairs still exhibit clinical complications, i.e. recurrence, discomfort and pain and mesh features are thought to be highly influent. The aim of this study is to evaluate the impact of the defect size and mesh type in an herniated abdominal wall using numerical models. To do so, we have started from a FE model based on a real human abdomen geometry obtained by MRI, where we have provoked an incisional hernia of three different sizes. The surgical procedure was simulated by covering the hernia with a prostheses, and three surgical meshes with distinct mechanical properties were used for the hernia repair: an isotropic heavy-weight mesh (Surgipro @ ), a slightly anisotropic light-weight mesh (Optilene @ ) and a highly anisotropic medium-weight mesh (Infinit @ ). The mechanical response of the wall to a high intraabdominal pressure (corresponding to a coughing motion) was analyzed here. Our findings suggest that the anisotropy of the mesh becomes more relevant with the increase of the defect size. Additionally, according to our results Optilene @ showed the closest deformation to the natural distensibility of the abdomen while Infinit @ should be carefully used due to its excessive compliance.

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

    Science.gov (United States)

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

    2009-12-01

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

  4. Femoral hernia repair

    Science.gov (United States)

    Dunbar KB, Jeyarajah DR. Abdominal hernias and gastric volvulus. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease . 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap ...

  5. Incisional Recurrences After Endometrial Cancer Surgery.

    Science.gov (United States)

    Bogani, Giorgio; Dowdy, Sean C; Cliby, William A; Gostout, Bobbie S; Kumar, Sanjeev; Ghezzi, Fabio; Multinu, Francesco; Mariani, Andrea

    2015-11-01

    The aim of the present study was to estimate the incisional recurrence (IR) rate after endometrial cancer (EC) staging surgery and analyze characteristics of affected patients. We retrospectively searched for patients with EC at 2 institutions and analyzed the occurrence of IR after open, laparoscopic, or robotic surgery. Additionally, a review of the literature was performed. Out of 2,636 patients with EC, 1,732 (65.7%), 461 (17.5%), and 443 (16.8%) had open, laparoscopic, and robotic surgery, respectively. Only 3 patients (0.11%) had IR, all after open surgery. Additionally, 38 cases of IR were identified from the literature. Patients with non-isolated IR had worse overall survival than patients with isolated IR (p=0.04). Among this latter group, combined treatments may be associated with improved survival outcome. IR after EC surgery is rare and may occur after minimally-invasive or open operations. Combination of local and systemic treatments may provide favorable outcomes for patients with isolated IR. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  6. An animal model to train Lichtenstein inguinal hernia repair

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  7. Umbilical hernia repair - series (image)

    Science.gov (United States)

    ... treatment. The indications for umbilical hernia repair include: incarcerated (strangulated) umbilical hernia defects not spontaneously closed by 4 to 5 years of age children under 2 with very large defects unacceptable to ...

  8. Paraduodenal hernia. A case report

    International Nuclear Information System (INIS)

    Irion, K.L.

    1989-01-01

    The authors present a case of right paraduodenal hernia and a brief review of the embriology and anatomy of the paraduodenal fossae as well as of the clinical signs, symptoms and radiologic aspects of paraduodenal hernias. (author) [pt

  9. The Many Guises of Endometriosis: Giant Abdominal Wall Endometriosis Masquerading as An Incisional Hernia

    Directory of Open Access Journals (Sweden)

    Chiara Petrosellini

    2017-10-01

    Full Text Available Endometriosis is defined by the presence of ectopic endometrial tissue outside the uterine cavity. Although it is a leading cause of chronic pelvic pain and infertility, its clinical presentation can vary, resulting in diagnostic and therapeutic challenges. Extrapelvic endometriosis is particularly difficult to diagnose owing to its ability to mimic other conditions. Endometrial tissue in a surgical scar is uncommon and often misdiagnosed as a granuloma, abscess, or malignancy. Cyclical hemorrhagic ascites due to peritoneal endometriosis is exceptionally rare. We report the case of a pre-menopausal, nulliparous 44-year-old woman who presented with ascites and a large abdominal mass that arose from the site of a lower midline laparotomy scar. Five years previously, she had undergone open myomectomy for uterine fibroids. Soon after her initial operation she developed abdominal ascites, which necessitated percutaneous drainage on multiple occasions. We performed a laparotomy with excision of the abdominal wall mass through an inverted T incision. The extra-abdominal mass consisted of mixed cystic and solid components, and weighed 1.52 kg. It communicated with the abdominopelvic cavity through a 2 cm defect in the linea alba. The abdomen contained a large amount of odourless, brown fluid which drained into the mass. There was a large capsule that covered the small and large bowel, liver, gallbladder, and stomach. Final histology reported a 28×19×5 cm mass of endometrial tissue with no evidence of malignant transformation. The patient recovered well post-operatively and has remained asymptomatic. Our case illustrates that, despite being a common disease, endometriosis can masquerade as several other conditions and be missed or diagnosed late. Delay in diagnosis will not only prolong symptoms but can also compromise reproductive lifespan. It is therefore paramount that endometriosis is to be considered early in the management of premenopausal women who present with an irregular pelvic mass or hemorrhagic ascites.

  10. Challenges in the repair of large abdominal wall hernias in Nigeria: review of available options in resource limited environments.

    Science.gov (United States)

    Ezeome, E R; Nwajiobi, C E

    2010-06-01

    To evaluate the challenges and outcome of management of large abdominal wall hernias in a resource limited environment and highlight the options available to surgeons in similar conditions. A review of prospectively collected data on large abdominal wall hernias managed between 2003 and 2009. University of Nigeria Teaching Hospital, Enugu, Nigeria and surrounding hospitals. Patients with hernias more than 4 cm in their largest diameter, patients with closely sited multiple hernias or failed previous repairs and in whom the surgeon considers direct repair inappropriate. Demographics of patients with large hernias, methods of hernia repair, recurrences, early and late complications following the repair. There were 41 patients, comprising 28 females and 13 males with ages 14 - 73 years. Most (53.7%) were incisional hernias. Gynecological surgeries (66.7%) were the most common initiating surgeries. Fifteen of the patients (36.6%) have had failed previous repairs, 41.5% were obese, five patients presented with intestinal obstruction. Thirty nine of the hernias were repaired with prolene mesh, one with composite mesh and one by danning technique. Most of the patients had extra peritoneal mesh placement. Three patients needed ventilator support. After a mean follow up of 18.6 months, there was a single failed repair. Two post op deaths were related to respiratory distress. There were 12 wound infection and 8 superficial wound dehiscence, all of which except one resolved with dressing. One reoperation was done following mesh infection and extrusion. Large abdominal wall hernia repair in resource limited environments present several challenges with wound infection and respiratory distress being the most notable. Surgeons who embark on it in these environments must be prepared t o secure the proper tissue replacement materials and have adequate ventilation support.

  11. Unusual Presentation of Maydl's Hernia

    African Journals Online (AJOL)

    Nikhil NBA, Natarajan K, Mohanty A, et al. An. Unusual Case of Maydl's Hernia. Int J Cur Res Rev. 2013;5(6):22-5. 11. Ganesaratnam M. Maydl's hernia: Report of a Series of Seven Cases and Review of Literature. Brit J Surg. 1985;72:737-8. 12. Weledji EP, Mokake M, Ngowe MN. A Rare. Presentation of Maydl's Hernia.

  12. Healing incisional surgical wounds using Rose Hip oil in rats

    Directory of Open Access Journals (Sweden)

    Lainy Carollyne da Costa Cavalcante

    2017-03-01

    Full Text Available Purpose: To evaluate incisional surgical wound healing in rats by using Rose Hip (Rosa rubiginosa L. oil. Methods: Twenty-one days after the oophorectomy procedure, twenty-seven female, adult, Wistar rats were distributed into three groups: Control group (wound treatment with distilled water; Collagenase group (treatment with collagenase ointment; and Rose Hip group (wound treatment with Rose Hip oil. Each group was distributed according to the date of euthanasia: 7, 14 and 21 days. The wound was evaluated considering the macroscopic and microscopic parameters. Results: The results indicated differences in the healing of incisional wounds between treatments when compared to control group. Accelerated wound healing was observed in the group treated with Rose Hip oil in comparison to the control and collagenase, especially after the 14th day. Morphometric data confirmed the structural findings. Conclusion: There was significant effect in topical application of Rose Hip oil on incisional surgical wound healing.

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

    Science.gov (United States)

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

    2014-10-01

    A brachycephalic dog was presented with an acute onset of retching and abdominal discomfort. The dog had a chronic history of stertor and exercise intolerance suggestive of brachycephalic airway obstructive syndrome. Radiographs were consistent with a Type II hiatal hernia. The dog was referred and within hours of admission became acutely painful and developed tympanic abdominal distension. A right lateral abdominal radiograph confirmed gastric dilatation and volvulus with herniation of the pylorus through the hiatus. An emergency exploratory coeliotomy was performed, during which the stomach was derotated, and an incisional gastropexy, herniorrhaphy and splenectomy were performed. A staphylectomy was performed immediately following the exploratory coeliotomy. The dog recovered uneventfully. Gastric dilatation and volvulus is a potentially life-threatening complication that can occur in dogs with Type II hiatal hernia and should be considered a surgical emergency. © 2014 British Small Animal Veterinary Association.

  14. Traumatic lung hernia

    International Nuclear Information System (INIS)

    Rabaza, M. J.; Alcazar, P. P.; Touma, C.

    2001-01-01

    Lung hernia is an uncommon entity that is defined as the protrusion of the lung parenchyma through a defect in the thoracic cavity. It is classified on the basis of its location (cervical, intercostal and diaphragmatic) and etiology (congenital and acquired). Acquired lung hernias can be further grouped as spontaneous, traumatic or pathological, depending on the responsible mechanism. Nearly half of them are secondary to chest trauma, whether penetrating or blunt. We present a case of lung hernia in a patient with penetrating chest trauma. The diagnosis was suspected from the radiographic images and was confirmed by computed tomography. We also review the literature concerning its classification and incidence, diagnostic methods used and treatment. (Author) 9 refs

  15. Evidence for replacement of an infected synthetic by a biological mesh in abdominal wall hernia repair

    Directory of Open Access Journals (Sweden)

    Agneta eMontgomery

    2016-01-01

    Full Text Available The incidence of deep infection using a synthetic mesh in inguinal hernia repair is low and reported to be well below 1%. This is in contrast to incisional hernia surgery where the reported incidence is 3% respective 13% comparing laparoscopic to open mesh repair reported in a Cochrane review. Main risk factors were long operation time, surgical site contamination and early wound complications. An infected mesh can be preserved using conservative treatment were negative pressure wound therapy (VAC® could play an important role. If strategy fails, the mesh needs to be removed. This review aims to look at evidence for situations were a biological mesh would work as a replacement of a removed infected synthetic mesh. Material and MethodsA literature search of the Medline database was performed using the PubMed search engine. Twenty publications were found relevant for this review.ResultsFor studies reviewed three options are presented: removal of the infected synthetic mesh alone, replacement with either a new synthetic or a new biological mesh. Operations were all performed at specialist centers. Removal of the mesh alone was an option limited to inguinal hernias. In ventral/incisional hernias the use of a biological mesh for replacement resulted in a very high recurrence rate, if bridging was required. Either a synthetic or a biological mesh seems to work as a replacement when fascial closure can be achieved. Evidence is though very low. ConclusionWhen required, either a synthetic or a biological meshes seems to work as a replacement for an infected synthetic mesh if the defect can be closed. It is however not recommended to use a biological mesh for bridging. Mesh replacement surgery is demanding and is recommended to be performed in a specialist center.

  16. Evaluation of Healing Intervals of Incisional Skin Wounds of Goats ...

    African Journals Online (AJOL)

    The aim of this study was to compare the healing intervals among simple interrupted (SI), ford interlocking (FI) and subcuticular (SC) suture patterns in goats. We hypothesized that these common suture patterns used for closure of incisional skin wounds may have effect on the healing interval. To test this hypothesis, two ...

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

  18. Transvaginal Repair of a Large Chronic Porcine Ventral Hernia with Synthetic Mesh Using NOTES

    Science.gov (United States)

    Powell, Ben; Whang, Susan H.; Bachman, Sharon L.; Andres Astudillo, J.; Sporn, Emanuel; Miedema, Brent W.

    2010-01-01

    Background: Ventral incisional hernias still remain a common surgical problem. We tested the feasibility of transvaginal placement of a large synthetic mesh to repair a porcine hernia. Methods: Seven pigs were used in this survival model. Each animal had creation of a 5-cm hernia defect and underwent a transvaginal repair of the defect with synthetic mesh. A single colpotomy was made using a 12-cm trocar for an overtube. The mesh was cut to size and placed through the trocar. A single-channel gastroscope with an endoscopic atraumatic grasper was used for grasping sutures. Further fascial sutures were placed every 5cm. Results: Mesh repair was feasible in all 7 animals. Mean operative time was 133 minutes. Technical difficulties were encountered. No gross contamination was seen at the time of necropsy. However, 5 animals had positive mesh cultures; 7 had positive cultures in the rectouterine space in enrichment broth or on direct culture. Conclusion: Transvaginal placement of synthetic mesh to repair a large porcine hernia using NOTES is challenging but feasible. Future studies need to be conducted to develop better techniques and determine the significance of mesh contamination. PMID:20932375

  19. Abdominal wall hernia and pregnancy

    DEFF Research Database (Denmark)

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

    2015-01-01

    PURPOSE: There is no consensus as to the treatment strategy for abdominal wall hernias in fertile women. This study was undertaken to review the current literature on treatment of abdominal wall hernias in fertile women before or during pregnancy. METHODS: A literature search was undertaken in Pub......Med and Embase in combination with a cross-reference search of eligible papers. RESULTS: We included 31 papers of which 23 were case reports. In fertile women undergoing sutured or mesh repair, pain was described in a few patients during the last trimester of a subsequent pregnancy. Emergency surgery...... of incarcerated hernias in pregnant women, as well as combined hernia repair and cesarean section appears as safe procedures. No major complications were reported following hernia repair before or during pregnancy. The combined procedure of elective cesarean section and abdominal wall hernia repair was reported...

  20. Laparoscopic Repair of Inguinal Hernias

    OpenAIRE

    Carter, Jonathan; Duh, Quan-Yang

    2011-01-01

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

  1. Sliding hiatal hernia in dogs

    OpenAIRE

    JOLANTA SPUŻAK; KRZYSZTOF KUBIAK; MARCIN JANKOWSKI; MACIEJ GRZEGORY; KAMILA GLIŃSKA-SUCHOCKA; JÓZEF NICPOŃ; VASYL VLIZLO; IGOR MAKSYMOVYCH

    2010-01-01

    Introduction Sliding hiatal hernia is a disorder resulting from a displacement of the abdominal part of the oesophagus and/or a part of the stomach into the thoracic cavity through the oesophageal hiatus of the diaphragm. The disorder may be congenital or acquired. Congenital hernia follows disturbances in the embryonic development. In the literature the predisposition to congenital sliding hiatal hernia is observed in the dogs of shar-pei and chow-chow breeds. Pathogenesis of acquired slidin...

  2. The inheritance of groin hernia

    DEFF Research Database (Denmark)

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

    2013-01-01

    Groin hernia has been proposed to be hereditary; however, a clear hereditary pattern has not been established yet. The purpose of this review was to analyze studies evaluating family history and inheritance patterns and to investigate the possible heredity of groin hernias.......Groin hernia has been proposed to be hereditary; however, a clear hereditary pattern has not been established yet. The purpose of this review was to analyze studies evaluating family history and inheritance patterns and to investigate the possible heredity of groin hernias....

  3. The Danish Inguinal Hernia Database

    Directory of Open Access Journals (Sweden)

    Friis-Andersen H

    2016-10-01

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

  4. Congenital diaphramatic hernia

    Energy Technology Data Exchange (ETDEWEB)

    Kline-Fath, Beth M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Fetal Care Center of Cincinnati, Cincinnati, OH (United States); Cincinnati Children' s Hospital Medical Center, Department of Radiology, MLC 5031, Cincinnati, OH (United States)

    2012-01-15

    Congenital diaphragmatic hernia, despite advances in therapy, remains a complex condition with significant morbidity and mortality. The etiology of the disorder is still incompletely understood, though the pulmonary hypoplasia and pulmonary hypertension that develop secondarily must be overcome to improve survival. Prenatal US and fetal MRI have helped in the development of a greater understanding of this disease. Also with these modalities, measurement techniques have been developed in an attempt to provide prognosticators for the development of pulmonary hypoplasia and pulmonary hypertension. There is a broad range of approaches for performing these measurements, and variability among imaging centers is noted. Despite inconsistent approaches, these techniques have become the foundation for counseling and prenatal and postnatal therapy. It is hoped that with further research with prenatal US and fetal MRI and the development of innovative medical and surgical therapies that the morbidity and mortality of children with congenital diaphragmatic hernias can be significantly reduced. (orig.)

  5. Hernia inguinal laparoscopic surgery

    International Nuclear Information System (INIS)

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

    2005-01-01

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

  6. Congenital diaphramatic hernia

    International Nuclear Information System (INIS)

    Kline-Fath, Beth M.

    2012-01-01

    Congenital diaphragmatic hernia, despite advances in therapy, remains a complex condition with significant morbidity and mortality. The etiology of the disorder is still incompletely understood, though the pulmonary hypoplasia and pulmonary hypertension that develop secondarily must be overcome to improve survival. Prenatal US and fetal MRI have helped in the development of a greater understanding of this disease. Also with these modalities, measurement techniques have been developed in an attempt to provide prognosticators for the development of pulmonary hypoplasia and pulmonary hypertension. There is a broad range of approaches for performing these measurements, and variability among imaging centers is noted. Despite inconsistent approaches, these techniques have become the foundation for counseling and prenatal and postnatal therapy. It is hoped that with further research with prenatal US and fetal MRI and the development of innovative medical and surgical therapies that the morbidity and mortality of children with congenital diaphragmatic hernias can be significantly reduced. (orig.)

  7. Bullhorn Hernia: A Rare Traumatic Abdominal Wall Hernia

    African Journals Online (AJOL)

    Department of Surgery, Government Medical College and Rajindra. Hospital, Patiala ‑ 147 001, Punjab, India. E‑mail: drbimal.undefined@gmail.com. INTRODUCTION. Traumatic abdominal wall hernia (TAWH) is uncommonly encountered despite the high prevalence of blunt abdominal trauma.[1] Bullhorn hernia is a rare, ...

  8. Healing incisional surgical wounds using Rose Hip oil in rats

    OpenAIRE

    Lainy Carollyne da Costa Cavalcante; Thyago Cezar Prado Pessôa; Rubens Fernando Gonçalves Ribeiro Júnior; Edson Yuzur Yasojima; Rosa Helena de Figueiredo Chaves Soares; Marcus Vinicius Henriques Brito; Eduardo Henrique Herbster Gouveia; Lucas Nascimento Galvão; Suzana Rodrigues Ramos; Adan Kristian Almeida Carneiro; Yuri Aarão Amaral Serruya; Mateus Malta de Moraes

    2017-01-01

    Purpose: To evaluate incisional surgical wound healing in rats by using Rose Hip (Rosa rubiginosa L.) oil. Methods: Twenty-one days after the oophorectomy procedure, twenty-seven female, adult, Wistar rats were distributed into three groups: Control group (wound treatment with distilled water); Collagenase group (treatment with collagenase ointment); and Rose Hip group (wound treatment with Rose Hip oil). Each group was distributed according to the date of euthanasia: 7, 14 and 21 days. ...

  9. Algunas hernias abdominales anteriores

    Directory of Open Access Journals (Sweden)

    Augusto Salazar Sánchez

    1947-09-01

    Full Text Available Las hernias epigástricas se presentan en dos tipos de individuos: los atléticos y los asténicos. Son casi una exclusividad del sexo masculino. En los atléticos aparecen durante la juventud y son la consecuencia de esfuerzos durante los cuales la resistencia de la línea alba cede a la presión intraabdominal, produciendose una ruptura de esa línea, generalmente de tamaño muy pequeño pero suficiente para que por allí pase una porción de la grasa pre-peritoneal, quedando constituida la hernia. Más tarde, la grasa arrastra consigo al peritoneo parietal y este contrae adherencia con el anillo hernario, siendo esta la fase en la cual el enfermo se da cuenta de su afección, porque es entonces cuando sobrevienen los dolores y demás sintomatología clínica que es propia de este tipo de hernias.

  10. Left Paraduodenal Hernia: An Autopsy Case

    DEFF Research Database (Denmark)

    Omland, Silje Haukali; Hougen, Hans Petter

    2011-01-01

    We present a case of a left paraduodenal hernia diagnosed at autopsy. A left paraduodenal hernia is an internal hernia of congenital origin due to the abnormal rotation of the midgut during embryonic development. Internal hernias are a rare cause of intestinal obstruction, with the paraduodenal...

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

    African Journals Online (AJOL)

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

  12. The Danish Inguinal Hernia database.

    Science.gov (United States)

    Friis-Andersen, Hans; Bisgaard, Thue

    2016-01-01

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

  13. Incarcerated umbilical hernia in children.

    Science.gov (United States)

    Chirdan, L B; Uba, A F; Kidmas, A T

    2006-02-01

    Umbilical hernia is common in children. Complications from umbilical hernias are thought to be rare and the natural history is spontaneous closure within 5 years. A retrospective analysis was performed of the medical records of a series of 23 children who presented with incarcerated umbilical hernias at our institution over an 8-year period. Fifty-two children with umbilical hernias were seen in the hospital over the period. Twenty-three (44.2%) had incarceration. Seventeen (32.7%) had acute incarceration while 6 (11.5%) had recurrent incarceration. There were 16 girls and 7 boys. The ages of the children with acute incarceration ranged from 3 weeks to 12 years (median 4 years), while the ages of those with recurrent incarceration ranged from 3-15 years (median 8.5 years). Incarceration occurred in hernias of more than 1.5 cm in diameter (in those whose defect size was measured). Twenty-one children (15 with acute and all six with recurrent incarceration) underwent repair of the umbilical hernia using standard methods. The parents of two children with acute incarceration declined surgery after spontaneous reduction of the hernia in one and taxis in the other. One boy had gangrenous bowel containing Meckel's diverticulum inside the sac, for which bowel resection with end-to-end anastomosis was done. Operation led to disappearance of pain in all 6 children with recurrent incarceration. Superficial wound infection occurred in one child. There was no mortality. Incarcerated umbilical hernia is not as uncommon as thought. Active observation of children with umbilical hernia is necessary to prevent morbidity from incarceration.

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

    Science.gov (United States)

    Nishihara, Yuichi; Isobe, Yoh; Kitagawa, Yuko

    2017-12-01

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

  15. Rectal duplication with sciatic hernia.

    Science.gov (United States)

    Nosek, Marzena; Golonka, Anna; Kalińska-Lipert, Anita; Nachulewicz, Paweł

    2015-07-01

    Rectal duplications represent 5% of all duplications in the alimentary tract, and they are very rarely diagnosed during the neonatal period. The authors present the method of investigation and the results of surgical treatment of a full-term neonate with a sciatic hernia containing a rectal duplication. The procedure started with three-port laparoscopy, but excision of the tubular duplication of the rectum was possible only by a transanal endorectal pull-through approach. The sciatic hernia was closed, and plastic sutures on the buttock finished the procedure. The coincidence of sciatic hernia with rectal duplication is extremely rare, and the method of treatment depends exclusively on the anatomical conditions.

  16. Groin hernia subtypes are associated in patients with bilateral hernias

    DEFF Research Database (Denmark)

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

    2015-01-01

    repair (89.9% males) were registered, and of those were 12,041 persons operated bilaterally (94.9% males). Females and males operated for a unilaterally direct inguinal hernia (DIH) had increased Hazard Ratios (HR) of 3.85 (CI 95% 2.14-6.19) and 4.46 (CI 95% 2.57-7.88) of being contralaterally operated...... for a DIH. Females and males operated for a unilaterally indirect inguinal hernia (IIH) had HRs of 6.93 (CI 95% 3.66-13.11) and 1.89 (CI95% 1.24-2.88) for being contralaterally operated for an IIH. The same tendency was seen for femoral hernias. CONCLUSIONS: All hernia subtypes were bilaterally associated...

  17. Incisiones verticales en SARPE Vertical incisions in SARPE

    OpenAIRE

    J. Gonzalez Lagunas; J.A. Hueto Madrid; G. Raspall Martín

    2005-01-01

    La expansión rápida de paladar asistida quirúrgicamente (SARPE) es una de las opciones terapeuticas de los transtornos transversales del maxilar superior. Presentamos nuestra experiencia inicial con una variante técnica consistente en una corticotomía de la pared lateral del maxilar combinada con una osteotomía palatina media transincisal, y efectuadas a través de tres pequeñas incisiones verticales.Surgically assisted rapid palatal expansion (SARPE) is one of the therapeutic options for the ...

  18. Etiology of Inguinal Hernias: A Comprehensive Review

    Directory of Open Access Journals (Sweden)

    Stina Öberg

    2017-09-01

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

  19. Preoperative combination of progressive pneumoperitoneum and botulinum toxin type A in patients with loss of domain hernia.

    Science.gov (United States)

    Bueno-Lledó, José; Torregrosa, Antonio; Jiménez, Raquel; Pastor, Providencia García

    2018-02-15

    Preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BT) are tools in the surgical preparation of patients with loss of domain hernias (LODH). The aim of this paper is to report our experience with these preoperative techniques in 70 patients with LODH. Observational study of 70 consecutive patients with LODH was conducted between May 2010 and May 2016. Diameters of the hernia sac, incisional hernia (VIH), and abdominal cavity (VAC) volumes, and VIH/VAC ratio were measured before and after PPP and BT, using abdominal CT scan data. Combination of both techniques was performed when the VIH/VAC ratio was > 20%. Median insufflated volume of air for PPP was 8450 ± 3400 cc (4500-13,450), over a period of 11.3 ± 2.3 days (9-16). BT administration time was 38.1 ± 3.7 days (35-44). An average reduction of 16.6% of the VIH/VAC ratio after PPP and BT was obtained (p VIH/VAC ratio and hernia defect diameters, which constitutes a key factor in the treatment of LODH.

  20. Prospective study of single-stage repair of contaminated hernias using a biologic porcine tissue matrix: the RICH Study.

    Science.gov (United States)

    Itani, Kamal M F; Rosen, Michael; Vargo, Daniel; Awad, Samir S; Denoto, George; Butler, Charles E

    2012-09-01

    In the presence of contamination, the repair of a ventral incisional hernia (VIH) is challenging. The presence of comorbidities poses an additional risk for postoperative wound events and hernia recurrence. To date, very few studies describe the outcomes of VIH repair in this high-risk population. A prospective, multicenter, single-arm, the Repair of Infected or Contaminated Hernias study was performed to study the clinical outcomes of open VIH repair of contaminated abdominal defects with a non-cross-linked, porcine, acellular dermal matrix, Strattice. Of 85 patients who consented to participate, 80 underwent open VIH repair with Strattice. Hernia defects were 'clean-contaminated' (n = 39), 'contaminated' (n = 39), or 'dirty' (n = 2), and the defects were classified as grade 3 (n = 60) or grade 4 (n = 20). The midline was restored, and primary closure was achieved in 64 patients; the defect was bridged in 16 patients. At 24 months, 53 patients (66%) experienced 95 wound events. There were 28 unique, infection-related events in 24 patients. Twenty-two patients experienced seromas, all but 5 of which were transient and required no intervention. No unanticipated adverse events occurred, and no tissue matrix required complete excision. There were 22 hernia (28%) recurrences by month 24. There was no correlation between infection-related events and hernia recurrence. The use of the intact, non-cross-linked, porcine, acellular dermal matrix, Strattice, in the repair of contaminated VIH in high-risk patients allowed for successful, single-stage reconstruction in >70% of patients followed for 24 months after repair. Published by Mosby, Inc.

  1. [Amyand's hernia--a clinical case].

    Science.gov (United States)

    Savlovschi, C; Brănescu, C; Serban, D; Tudor, C; Găvan, C; Shanabli, A; Comandaşu, M; Vasilescu, L; Borcan, R; Dumitrescu, D; Sandolache, B; Sajin, M; Grădinaru, S; Munteanu, R; Kraft, A; Oprescu, S

    2010-01-01

    Amyand's hernia, a rare entity in the surgical pathology, presupposes the presence of the vermiform appendix inside a inguinal hernia sac (1). The hernia sac peritonitis by appendix swelling is even more rare, very few cases being presented in the surgical literature (1). The preoperatory diagnosis of Amyand's hernia is therefore very difficult. We herein present the case of a 71-year old male patient, operated on an emergency basis for hernia, which eventually turned out to be Amyand's hernia, a case which determined us to research the literature dedicated to this topic.

  2. The Danish ventral hernia database

    DEFF Research Database (Denmark)

    Helgstrand, Frederik; Jorgensen, Lars Nannestad

    2016-01-01

    Aim: The Danish Ventral Hernia Database (DVHD) provides national surveillance of current surgical practice and clinical postoperative outcomes. The intention is to reduce postoperative morbidity and hernia recurrence, evaluate new treatment strategies, and facilitate nationwide implementation of ...... of operations and is an excellent tool for observing changes over time, including adjustment of several confounders. This national database registry has impacted on clinical practice in Denmark and led to a high number of scientific publications in recent years.......Aim: The Danish Ventral Hernia Database (DVHD) provides national surveillance of current surgical practice and clinical postoperative outcomes. The intention is to reduce postoperative morbidity and hernia recurrence, evaluate new treatment strategies, and facilitate nationwide implementation...... to the surgical repair are recorded. Data registration is mandatory. Data may be merged with other Danish health registries and information from patient questionnaires or clinical examinations. Descriptive data: More than 37,000 operations have been registered. Data have demonstrated high agreement with patient...

  3. The Danish Inguinal Hernia database

    DEFF Research Database (Denmark)

    Friis-Andersen, Hans; Bisgaard, Thue

    2016-01-01

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

  4. 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

  5. Incidental right Bochdalek hernia with interruption of the inferior ...

    African Journals Online (AJOL)

    2014-05-30

    May 30, 2014 ... Case Report doi:10.4102/sajr.v18i1.592 http://sajr.org.za. Incidental right Bochdalek hernia with interruption of the inferior vena cava and hepatic venous collateral continuation: A case report. Authors: Farzanah I. Ismail1. Rule Human2. Anith Chacko1. Parmanand Naran2. Samia Ahmad1. Siraj Ellemdin2.

  6. Abdominal wall hernias: computed tomography findings

    International Nuclear Information System (INIS)

    D'Ippolito, Giuseppe; Rosas, George de Queiroz; Mota, Marcos Alexandre; Akisue, Sandra R. Tsukada; Galvao Filho, Mario de Melo.

    2005-01-01

    Abdominal hernias are a common clinical problem Clinical diagnosis of abdominal hernias can sometimes be challenging, particularly in obese patients or patients with previous abdominal surgery. CT scan of the abdomen allows visualization of hernias and their contents and the differentiation from other masses of the abdominal wall such as tumors, hematomas and abscesses. Moreover, CT may identify complications such as incarceration, bowel obstruction, volvulus and strangulation. This study illustrates the CT scan findings observed in different types of abdominal wall hernias. (author)

  7. European Hernia Society guidelines on the closure of abdominal wall incisions

    DEFF Research Database (Denmark)

    Muysoms, F E; Antoniou, S A; Bury, K

    2015-01-01

    using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and methodological guidance was taken from Scottish Intercollegiate Guidelines Network (SIGN). The literature search included publications up to April 2014. The guidelines were written using the AGREE II...... of rapidly absorbable sutures. It is suggested using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique without separate closure of the peritoneum. A small bites technique with a suture to wound length (SL/WL) ratio at least 4/1 is the current recommended method......, it is suggested using the smallest trocar size adequate for the procedure and closure of the fascial defect if trocars larger or equal to 10 mm are used. For single incision laparoscopic surgery, we suggest meticulous closure of the fascial incision to avoid an increased risk of incisional hernias....

  8. Sigmoid Volvulus Through a Transmesenteric Hernia.

    Science.gov (United States)

    Brandão, Pedro Nuno; Martins, Vilma; Silva, Cristina; Davide, José

    2017-06-01

    Internal hernias are a rare pathology with very low incidence. Transmesenteric hernias represent less than 10% of all cases and may occur at any age. They involve more often the small bowel and, more rarely, the colon. We present a case of a sigmoid volvulus through a transmesenteric hernia in a 19-year-old patient.

  9. Incisiones verticales en SARPE Vertical incisions in SARPE

    Directory of Open Access Journals (Sweden)

    J. Gonzalez Lagunas

    2005-06-01

    Full Text Available La expansión rápida de paladar asistida quirúrgicamente (SARPE es una de las opciones terapeuticas de los transtornos transversales del maxilar superior. Presentamos nuestra experiencia inicial con una variante técnica consistente en una corticotomía de la pared lateral del maxilar combinada con una osteotomía palatina media transincisal, y efectuadas a través de tres pequeñas incisiones verticales.Surgically assisted rapid palatal expansion (SARPE is one of the therapeutic options for the correction of transverse maxillary collapse. We present our initial experience with a technique consisting in a lateral corticotomy of the maxilla plus a transincisal midpalatal osteotomy, both performed through minimal vertical incisions.

  10. Hernia Following Blunt Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    N Aghaie

    2009-10-01

    Full Text Available Traumatic abdominal wall hernia is a rare type of hernia, which follows blunt trauma to the abdomen, where disruption of the musculature and fascia occurs with the overlying skin remaining intact. Diagnosis of this problem is very difficult and delayed. Traumatic hernia is often diagnosed during laparatomy or laparascopy, but CT scan also has a role in distinguishing this pathology. Delay in diagnosis is very dangerous and can result in gangrene and necrosis of the organs in the hernia. The case report of a 35 years old man with liftruck blunt trauma is reported. His vital signs were stable. On physical examination, tenderness of RUQ was seen. He underwent Dpl for suspected hemoprotein. Dpl was followed up by laparatomy. Laparatomy revealed that the transverse and ascending colon partially herniated in the abdominal wall defect. The colon was reduced in the abdomen and repair of abdominal hernia was done. The patient was discharged after 5 day. The etiology, pathogenesis and management are discussed.

  11. Management of giant paraesophageal hernia.

    Science.gov (United States)

    Awais, O; Luketich, J D

    2009-04-01

    Management of giant paraesophageal hernia remains one of the most difficult challenges faced by surgeons treating complex benign esophageal disorders. These large hernias are acquired disorders; therefore, they invariably present in elderly patients. The dilemma that surgeons faced in the open surgical era was the risk of open surgery in this elderly, sick patient population versus the life threatening catastrophic complications, nearly 30% in some series, observed with medical management. During the 1990s, it was clearly recognized that laparoscopic surgery led to decreased morbidity with a quicker recovery. This has lead to a 6-fold increase in the surgical management of giant paraesophageal hernias over the last decade compared to a period of five decades of open surgery; however, this has not necessarily translated into better outcomes. One of the major issues with giant paraesophageal hernias is recognizing short esophagus and performing a lengthening procedure, if needed. Open series which report liberal use of Collis gastroplasty leading to a tension-free intraabdominal fundoplication have shown the best anatomic and clinical outcomes. As we duplicate the open experience laparoscopically, the principle of identifying a shortened esophagus and constructing a neo-esophagus must be honored for the success of the operation. The benefits of laparoscopy are obvious but should not come at the cost of a lesser operation. This review will illustrate that laparoscopic repair of giant paraesophageal hernia at experienced centers can be performed safely with similar outcomes to open series when the fundamental principles of the operation are maintained.

  12. An Unusual Trocar Site Hernia after Prostatectomy

    Directory of Open Access Journals (Sweden)

    Ryan K. Schmocker

    2016-01-01

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

  13. Preferential streaming of the ductus venosus toward the right atrium is associated with a worse outcome despite a higher rate of invasive procedures in human fetuses with left diaphragmatic hernia.

    Science.gov (United States)

    Stressig, R; Fimmers, R; Schaible, T; Degenhardt, J; Axt-Fliedner, R; Gembruch, U; Kohl, T

    2013-12-01

    Preferential streaming of the ductus venosus (DV) toward the right atrium has been observed in fetuses with left diaphragmatic hernia (LDH). The purpose of this retrospective study was to compare survival rates to discharge between a group with preferential streaming of the DV toward the right heart and a group in which this abnormal flow pattern was not present. We retrospectively searched our patient records for fetuses with LDH in whom liver position, DV streaming and postnatal outcome information was available. 55 cases were found and divided into two groups: Group I fetuses exhibited abnormal DV streaming toward the right side of the heart; group II fetuses did not. Various prognostic and outcome parameters were compared. 62 % of group I fetuses and 88 % of group II fetuses survived to discharge (p = 0.032). Fetoscopic tracheal balloon occlusion (FETO) was performed in 66 % of group I fetuses and 23 % of group II fetuses (p = 0.003). Postnatal ECMO therapy was performed in 55 % of group I fetuses and 23 % of group II infants (p = 0.025). Moderate to severe chronic lung disease in survivors was observed in 56 % of the survivors of group I and 9 % of the survivors of group II (p = 0.002). Preferential streaming of the DV toward the right heart in human fetuses with left-sided diaphragmatic hernia was associated with a poorer postnatal outcome despite a higher rate of invasive pre- and postnatal procedures compared to fetuses without this flow abnormality. Specifically, abnormal DV streaming was found to be an independent predictor for FETO. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Herniography off femoral, obturator and perineal hernias

    International Nuclear Information System (INIS)

    Ekberg, O.; Nordblom, I.; Fork, F.T.; Gullmo, A.

    1985-01-01

    Positive contrast herniography was used in the workup of 550 patients with unclear groin pain. The majority of these patients had rather characteristic hernias of indirect, direct or femoral type. However, now and then diagnostic problems arose. A femoral hernia may look like a direct or even obturator hernia. There is also a variety of multilocular femoral hernias and other types. A femoral hernia may be present together with other hernias in the ipsilateral or contralateral groin. Obturator hernias are usually small but are always confined to the obturator canal laterally in the obturator foramen. Abnormalities in the pouch of Douglas may include a deep rectogenital pouch, diverticula and true herniations. These uncommon herniographic findings are described and discussed. (orig.) [de

  15. Congenital transmesenteric hernia presenting as neonatal ascites

    Directory of Open Access Journals (Sweden)

    Andreia Felizes

    2018-01-01

    Full Text Available Transmesenteric hernia is an internal hernia without sac, which forms through a congenital mesentery defect. Mostly diagnosed intraoperatively, it as a variable prognosis, which can lead to high morbidity and mortality.The authors describe a case of transmesenteric hernia that presented as isolated fetal ascites. A 34 week preterm baby was delivered by forceps, with respiratory compromise due to abdominal distension. Orotracheal intubation and evacuation paracentesis were performed. After excluding major causes of neonatal ascites and persistent bowel loop distension, the newborn underwent an exploratory laparotomy, where a transmesenteric hernia and pellets of meconium were identified. Hernia reduction, enterectomy and enterostomies were performed, with good outcome. Cystic fibrosis was diagnosed during post-operatory period.This is the first reported case of transmesenteric hernia presenting as fetal ascites, without associated morbidity or mortality due to an early intervention. Keywords: Transmesenteric hernia, Fetal ascites, Cystic fibrosis

  16. 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

  17. Laparoscopic Hernia Repair in Infancy and Childhood; Evaluation of ...

    African Journals Online (AJOL)

    Materials & Methods: A prospective randomized controlled study was carried out in the ... Group B was subjected to laparoscopic hernia repair of inguinal hernia by ... Inclusion criteria included; bilateral inguinal hernia, recurrent hernia, hernia in ... By Country · List All Titles · Free To Read Titles This Journal is Open Access.

  18. Intrathoracic Hernia after Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Yoshihiko Tashiro

    2016-05-01

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

  19. Hernia surgery, South Africa 2015

    African Journals Online (AJOL)

    in the US.[1,2] More than one million hernia repairs are performed each year in the US. No published ... preoperative planning, but it is unclear if this approach is cost- effective. ... of compliance and outcomes data and adequate training. The.

  20. Congenital Morgagni's hernia in infants and children: a national review

    African Journals Online (AJOL)

    assisted repair, and in five (4.7%) patients the hernia was repaired .... 24 (23%) and inguinal hernia in 13 (12.6%) patients. Thirteen ... bilateral Morgagni's hernia (Fig. 4). ... repair using the open approach and one following a laparoscopic-.

  1. Abdominal wall hernias: computed tomography findings; Hernias da parede abdomino-pelvica: aspectos tomograficos

    Energy Technology Data Exchange (ETDEWEB)

    D' Ippolito, Giuseppe; Rosas, George de Queiroz; Mota, Marcos Alexandre; Akisue, Sandra R. Tsukada; Galvao Filho, Mario de Melo[Hospital e Maternidade Sao Luiz, Sao Paulo, SP (Brazil). Setor de US/TC/RMN]. E-mail: giuseppe_dr@uol.com.br

    2005-07-15

    Abdominal hernias are a common clinical problem Clinical diagnosis of abdominal hernias can sometimes be challenging, particularly in obese patients or patients with previous abdominal surgery. CT scan of the abdomen allows visualization of hernias and their contents and the differentiation from other masses of the abdominal wall such as tumors, hematomas and abscesses. Moreover, CT may identify complications such as incarceration, bowel obstruction, volvulus and strangulation. This study illustrates the CT scan findings observed in different types of abdominal wall hernias. (author)

  2. Upper Eyelid Fractional CO2 Laser Resurfacing With Incisional Blepharoplasty.

    Science.gov (United States)

    Kotlus, Brett S; Schwarcz, Robert M; Nakra, Tanuj

    2016-01-01

    Laser resurfacing, performed at the same time as blepharoplasty, has most commonly been applied to the lower eyelid skin but can effectively be used on the upper eyelid to reduce rhytidosis and improve skin quality. The authors evaluate the safety and efficacy of this procedure. Fractional CO2 laser resurfacing was performed in conjunction with incisional upper blepharoplasty. The ultrapulsed laser energy was applied to the sub-brow skin, the upper medial canthal skin, and the pretarsal skin in 30 patients. Photos were obtained preoperatively and at 3 months. All patients demonstrated reduction in upper eyelid rhytidosis without any serious complications. Independent rhytidosis grading (0-4) showed a mean improvement of 42%. One patient experienced wound dehiscence that satisfactorily resolved without intervention. Upper eyelid laser resurfacing is effective and can be safely performed at the same time as upper blepharoplasty. This approach reduces or eliminates the need for medial incisions to address medial canthal skin redundancy and rhytidosis and it directly treats upper eyelid wrinkles on residual eyelid and infra-brow skin during blepharoplasty.

  3. Efficacy of incisional gastropexy for prevention of GDV in dogs.

    Science.gov (United States)

    Benitez, Marian E; Schmiedt, Chad W; Radlinsky, MaryAnn G; Cornell, Karen K

    2013-01-01

    Incisional gastropexy (IG) is routinely performed as either a prophylactic procedure to prevent occurrence of gastric dilatation-volvulus (GDV) or at the time of surgical correction of GDV to prevent recurrence. Despite its common use, the long-term efficacy of the IG procedure has not been reported. The hypothesis of this study was that IG performed either during surgical treatment of GDV or as a prophylactic measure would effectively prevent GDV. Medical records of 61 dogs undergoing IG following either gastric derotation for treatment of GDV or as a prophylactic procedure were evaluated retrospectively. Median follow-up time for all dogs was 717 days (range, 49-2,511 days). Of the 61 dogs, 27 had prophylactic IG performed. The remaining 34 dogs presented for GDV and had an IG performed during surgical treatment of GDV. No dog experienced GDV after IG. Recurrence of gastric dilatation (GD) alone was noted in 3 of 34 patients (8.8%) undergoing IG during surgery for GDV and in 3 of 27 patients (11.1%) treated prophylactically with IG. This study confirmed the efficacy of IG for the long-term prevention of GDV in dogs.

  4. Preoperative diagnosis of Amyand's hernia by ultrasound and computed tomography

    Directory of Open Access Journals (Sweden)

    Husam Vehbi

    2016-06-01

    Full Text Available Inguinal hernia is the most common seen groin hernias which mostly contain bowel. The incidence of vermiform appendix in an inguinal hernia is seen in 1% of all inguinal hernia. This is known as Amyand's hernia. Appendix within a hernia can be normal or complicated by appendicitis. Most of these cases are not diagnosed preoperatively and managed during surgery. Preoperative diagnosis of these cases is so rare. Very few cases have been reported so far.In our case, we diagnosed an inflamed appendix in a 49 years old female within right inguinal hernia by using ultrasound and confirmed it by CT scan. Keywords: Amyand's hernia, Appendicitis

  5. 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...

  6. An Evaluation of Parastomal Hernia Repair Using the Americas Hernia Society Quality Collaborative.

    Science.gov (United States)

    Fox, Sarah S; Janczyk, Randy; Warren, Jeremy A; Carbonell, Alfredo M; Poulose, Benjamin K; Rosen, Michael J; Hope, William W

    2017-08-01

    The purpose of this review was to evaluate outcomes relating to parastomal hernia repair. Data from the Americas Hernia Society Quality Collaborative were used to identify patients undergoing parastomal hernia repair from 2013 to 2016. Parastomal hernia repairs were compared with other repairs using Pearson's test and Wilcoxon test with a P value Ostomy disposition included ostomy left in situ (47%), moved to a new site (18%), taken down (22%), and rematured in same location in (13%). Outcomes related to parastomal hernia repair included 10 per cent surgical site infection, 24 per cent surgical site occurrence, and 12 per cent surgical site occurrences requiring procedural interventions with a 13 per cent readmission rate and 6 per cent reoperation rate. When comparing parastomal hernias with other ventral hernia repairs, parastomal hernias had a significantly higher surgical site infection, surgical site occurrence, surgical site occurrences requiring procedural intervention, readmission, reoperation rate, and length of stay, and were less commonly performed laparoscopically (P < 0.05). Most parastomal hernias are being repaired open with synthetic mesh in the sublay position. Less favorable outcomes of parastomal hernia repair when compared with other ventral hernia repairs are likely related to the complexity of parastomal hernia repair.

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

    Directory of Open Access Journals (Sweden)

    Pavlidis Theodoros

    2011-09-01

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

  8. Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair.

    Science.gov (United States)

    Bittner, James G; Alrefai, Sameer; Vy, Michelle; Mabe, Micah; Del Prado, Paul A R; Clingempeel, Natasha L

    2018-02-01

    Transversus abdominis release (TAR) is a safe, effective strategy to repair complex ventral incisional hernia (VIH); however, open TAR (o-TAR) often necessitates prolonged hospitalization. Robot-assisted TAR (r-TAR) may benefit short-term outcomes and shorten convalescence. This study compares 90-day outcomes of o-TAR and r-TAR for VIH repair. A single-center, retrospective review of patients who underwent o-TAR or r-TAR for VIH from 2015 to 2016 was conducted. Patient and hernia characteristics, operative data, and 90-day outcomes were compared. The primary outcome was hospital length of stay, and secondary metrics were morbidity, surgical site events, and readmission. Overall, 102 patients were identified (76 o-TAR and 26 r-TAR). Patients were comparable regarding age, gender, body mass index, and the presence of co-morbidities. Diabetes was more common in the open group (22.3 vs. 0%, P = 0.01). Most VIH defects were midline (89.5 vs. 83%, P = 0.47) and recurrent (52.6 vs. 58.3%, P = 0.65). Hernia characteristics were similar regarding mean defect size (260 ± 209 vs. 235 ± 107 cm 2 , P = 0.55), mesh removal, and type/size mesh implanted. Average operative time was longer in the r-TAR cohort (287 ± 121 vs. 365 ± 78 min, P VIH offers the short-term benefits of low morbidity and decreased hospital length of stay compared to open TAR.

  9. Modern diagnosis and treatment of hiatal hernias.

    Science.gov (United States)

    Siegal, Steve R; Dolan, James P; Hunter, John G

    2017-12-01

    Hiatal hernias are a common finding on radiographic or endoscopic studies. Hiatal hernias may become symptomatic or, less frequently, can incarcerate or become a volvulus leading to organ ischemia. This review examines latest evidence on the diagnostic workup and management of hiatal hernias. A literature review of contemporary and latest studies with highest quality of evidence was completed. This information was examined and compiled in review format. Asymptomatic hiatal and paraesophageal hernias become symptomatic and necessitate repair at a rate of 1% per year. Watchful waiting is appropriate for asymptomatic hernias. Symptomatic hiatal hernias and those with confirmed reflux disease require operative repair with an anti-reflux procedure. Key operative steps include the following: reduction and excision of hernia sac, 3 cm of intraabdominal esophageal length, crural closure with mesh reinforcement, and an anti-reflux procedure. Repairs not amenable to key steps may undergo gastropexy and gastrostomy placement as an alternative procedure. Hiatal hernias are commonly incidental findings. When hernias become symptomatic or have reflux disease, an operative repair is required. A minimally invasive approach is safe and has improved outcomes.

  10. 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.

  11. CT discography for cervical soft disc hernia

    Energy Technology Data Exchange (ETDEWEB)

    Iwasa, Kenichi; Mizutani, Shigeru; Morimoto, Hiroyuki; Yamada, Hidehito; Iwasa, Satoru

    1985-03-01

    In this study the effectiveness of computed tomographic discography (CTD) in diagnosing cervical soft disc hernia was evaluated. Twenty-five intervertebral discs of 15 cases with cervical soft disc hernia were examined with a discography and then a CT scan. Results of the CT scan were as follows: three discs were protruded, 12 discs were prolapsed, 6 discs were extruded, and 4 discs were sequestrated. The findings were helpful in determining the location of soft disc hernias between the median and posterolateral discs. They were also valuable in classifying types of hernias and surgical approaches.

  12. 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.

  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. Colon Perforations Causing Morgagni Hernia Case

    Directory of Open Access Journals (Sweden)

    Mustafa Ugur

    2014-08-01

    Full Text Available Herniation of the intraabdominal organs through a diaphragmatic defect that occurs due to the joining anomaly of the sternal and costal segments of diaphragm is known as Morgagni Hernia. Although most of the patients with Morgagni Hernia are asymptomatic, intestinal obstruction, incarceration and strangulation can rarely occur. An 83 years old female patient admitted with acute abdomen to our clinic. Morgagni hernia was detected with preoperative thoracic and abdominal computed tomography. We aimed to present our management in Morgagni Hernia in this study.

  15. Spatial and temporal expression of glucocorticoid, retinoid, and thyroid hormone receptors is not altered in lungs of congenital diaphragmatic hernia

    NARCIS (Netherlands)

    Rajatapiti, Prapapan; Keijzer, Richard; Blommaart, Pietjan E.; Lamers, Wouter H.; de Krijger, Ronald R.; Visser, Theo J.; Tibboel, Dick; Rottier, Robbert

    2006-01-01

    The degree of associated pulmonary hypoplasia and persistent pulmonary hypertension are major determination factors for survival in congenital diaphragmatic hernia (CDH) patients. Glucocorticoids, thyroid hormone, and vitamin A have been shown to be involved in human lung development. To determine

  16. Anterior perineal hernia after anterior exenteration

    Directory of Open Access Journals (Sweden)

    Ka Wing Wong

    2017-10-01

    Full Text Available Perineal hernia is a rare complication of anterior exenteration. We reported this complication after an anterior exenteration for bladder cancer with bleeding complication requiring packing and second-look laparotomy. Perineal approach is a simple and effective method for repair of perineal hernia.

  17. Connective tissue alteration in abdominal wall hernia

    DEFF Research Database (Denmark)

    Henriksen, N A; Yadete, D H; Sørensen, Lars Tue

    2011-01-01

    The aetiology and pathogenesis of abdominal wall hernia formation is complex. Optimal treatment of hernias depends on a full understanding of the pathophysiological mechanisms involved in their formation. The aim of this study was to review the literature on specific collagen alterations in abdom...

  18. Lichtenstein versus Onstep for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

    2013-01-01

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

  19. Hiatal hernia | Samkari | Pan African Medical Journal

    African Journals Online (AJOL)

    Initial evaluation revealed paraesophageal hernia. EGD finding is grade II esophagitis with nodular mucosa and superficial ulceration, Distal part of the funds, body and the Antrum were rolled back into thoracic cavity. Abdominal computed tomography (CT) showed undulating diaphragm and large complex hiatal hernia.

  20. Ureteral sciatic hernia: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, So Young; Han, Hyun Young; Park, Suk Jin; Choe, Hyoung Shim; Kim, Eun Tak [Eulji University Hospital, Daejeon (Korea, Republic of)

    2008-09-15

    A ureteral hernia that occurs through the sciatic foramen is very rare. We present a case of a ureteral sciatic hernia with hydronephrosis. Intravenous urography (IVU) showed the presence of a curved, laterally displaced ureter, and computed tomography (CT) clearly depicted the herniated ureter through the sciatic foramen. The patient was treated transiently with a double J catheter.

  1. Acquired secondary Grynfeltt's hernia: a case report

    International Nuclear Information System (INIS)

    Renck, Decio Valente; Lopes Junior, Joao Ivan

    2009-01-01

    Lumbar hernia is a rare condition whose diagnosis is hardly achieved. The prevalence is higher in elderly men. The present case report describes the case of a male, 78-year-old patient who underwent pleural effusion drainage 17 years before presenting with clinical manifestations and tomographic findings compatible with acquired secondary Grynfeltt's hernia. (author)

  2. Congenital paraesophageal hiatus hernia with gastric volvulus

    Directory of Open Access Journals (Sweden)

    Kshirsagar Ashok

    2008-01-01

    Full Text Available Paraesophageal hiatus hernia is rarely seen in the neonatal period. An intrathoracic gastric volvulus complicating such a hernia is rarer. The upper gastrointestinal tract contrast study is diagnostic. Rapid diagnosis and treatment is essential. It avoids lethal complications as gastric dilatation, gangrene and perforation, which in turn may lead to cardiopulmonary arrest.

  3. Medical image of the week: Bochdalek hernia

    Directory of Open Access Journals (Sweden)

    Omar M

    2016-06-01

    Full Text Available No abstract available. Article truncated at 150 words. A 61 year-old man presented for an evaluation of a nonproductive cough. He has a history of well-controlled asthma, allergic rhinitis and nasal polyposis, hypertension, gastro-esophageal reflux and obstructive sleep apnea. The ACE inhibitor used to treat hypertension was discontinued. The physical exam was unremarkable. Pulmonary function testing was normal. A PA and lateral chest radiograph was performed and revealed an abnormal contour of the left hemidiaphragm with a large lobulated opacity (Figure 1- blue arrows. Computed chest tomography revealed the lobulated opacity in the left lower lobe contained fat and was consistent with a Bochdalek hernia (Figure 2. Congenital diaphragmatic hernia is a major malformation in newborns and in the perinatal period. The diagnosis of congenital diaphragmatic hernia in adults is rare. There are three types of congenital diaphragmatic hernias: posterolateral (Bochdalek diaphragmatic hernia, subcostosternal (Morgagni hernia and esophageal hiatal hernia. The Bochdalek diaphragmatic hernia is the result of ...

  4. Adult abdominal wall hernia in Ibadan | Ayandipo | Annals of Ibadan ...

    African Journals Online (AJOL)

    Background: Abdominal wall hernias are very common diseases encountered in surgical practice. Groin hernia is the commonest type of abdominal wall hernias. There are several methods of hernia repair but tension-free repair (usually with mesh) offers the least recurrent rate. Aim: To describe the clinical profile of anterior ...

  5. Recurrence of gastric dilatation-volvulus after incisional gastropexy in a rottweiler.

    Science.gov (United States)

    Hammel, Scott P; Novo, Roberto E

    2006-01-01

    An adult, castrated male rottweiler with a history of gastric dilatation-volvulus (GDV), which was treated 4 months previously by surgical gastric resection and incisional gastropexy, had a recurrence of clinical signs. Abdominal exploratory surgery revealed a 180 degrees -clockwise GDV, with a stretched adhesion at the original gastropexy site. The stomach was repositioned, and additional gastropexies were performed adjacent to the original gastropexy site and at the gastric fundus. The recurrence of GDV in this dog with an intact gastropexy suggested that a risk for volvulus remains after therapeutic incisional gastropexy.

  6. Male Fertility After Inguinal Hernia Mesh Repair

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  7. Incisiones mínimas para mastoplastias reductoras

    Directory of Open Access Journals (Sweden)

    Víctor Manuel Sánchez Castillo

    2002-04-01

    Full Text Available Se realiza un estudio descriptivo y longitudinal, que abarcó el segundo semestre de 1999 y primer semestre del 2000, donde el universo estuvo formado por un total de 100 pacientes que recibieron tratamiento quirúrgico (mastoplastias reductoras al presentar diferentes grados de deformidad del volumen mamario, previa evaluación preoperatoria en consulta de Cirugía Plástica y en atención a los criterios de operabilidad, para lo cual fueron intervenidas quirúrgicamente en el Hospital Provincial Clinicoquirúrgico Docente «Celia Sánchez Manduley», de Manzanillo. Se analizaron las diferentes variables que se debían estudiar mediante la revisión de las historias clínicas e informes operatorios, donde se realizó el cierre en J ó en L, en este tipo de técnica quirúrgica empleada. Se concluye que los diferentes grados de hipertrofia mamaria y/o ptosis mamaria producen alteraciones funcionales y psicológicas importantes en las pacientes estudiadas. El posoperatorio fue satisfactorio en las pacientes tratadas con el método de incisiones cortas, el cual puede ser aplicado en pacientes con gigantomastias y en las diferentes técnicas de mastoplastias reductoras conocidasA descriptive and longitudinal study that included a total of 100 patients who underwent surgical treatment (reduction mastoplasties for presenting different degrees of deformity of the breast volume, previous preoperative evaluation at the Plastic Surgery Consulting Room and according to the operability criteria, was conducted from the second semester of 1999 to the first semester of 2000. They were operated on at "Celia Sánchez Manduley" Provincial Clinical and Surgical Teaching Hospital, in Manazanillo. The different variables that should be studied were analyzed by reviewing the medical histories and the surgical reports. J or L closure was performed in this type of surgical technique used. It was concluded that the different degrees of breast hypertrophy and/or breast

  8. Sportsman's hernia? An ambiguous term.

    Science.gov (United States)

    Dimitrakopoulou, Alexandra; Schilders, Ernest

    2016-04-01

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

  9. Surgical treatment of parastomal hernia

    International Nuclear Information System (INIS)

    Basti, Z.; Mayer, A.

    2013-01-01

    Stoma construction is among standard surgical skills and is performed for many indications. Every stoma means huge impact on quality of life for patients even with great improvement in surgical technique and ostomy devices. All patients are very sensitive to complication of stoma and the most frequent complication is parastomal hernia. Incidence reported in literature is very high and unacceptable, it is 30-70%. Surgical approach is very demanding on technical equipment and experiences of surgeon. Authors focus on each surgical approach for treating this complication weather it´s using mesh or laparoscopic or open approach. (author)

  10. Incisional endometriosis: A rare cause for a painful scar – A report ...

    African Journals Online (AJOL)

    Endometriosis is the presence of endometrial tissue outside the Uterus. The true incidence of endometriosis is not really known, but it is believed that 10‑15% of all women in their reproductive age will develop endometriosis and 25‑35% of all women who are infertile have endometriosis. Incisional endometriosis (IE) is a ...

  11. Randomized clinical trial comparing two options for postoperative incisional care to prevent poststernotomy surgical site infections

    NARCIS (Netherlands)

    Segers, Patrique; de Jong, Antonius P.; Spanjaard, Lodewijk; Ubbink, Dirk T.; de Mol, Bas A. J. M.

    2007-01-01

    Surgical site infection (SSI) remains an important complication of cardiac surgery. Prevention is important, as SSI is associated with high mortality and morbidity rates. Incisional care is an important daily issue for surgeons. However, there is still scant scientific evidence on which guidelines

  12. Hiatus Hernia as a Cause of Dysphagia.

    Science.gov (United States)

    Philpott, Hamish; Sweis, Rami

    2017-08-01

    This review aims to discuss the putative relationship between hiatus hernia and dysphagia. Proposed mechanisms of dysphagia in patients with hiatus hernia are usually difficult to identify, but recent advances in technology (high-resolution manometry with or without concomitant impedance, ambulatory pH with impedance, videofluoroscopy, and the endoluminal functional lumen imaging probe (EndoFLIP)) and methodology (inclusion of swallows of various consistencies and volumes or shifting position during the manometry protocol) can help induce symptoms and identify the underlying disorder. Chronic reflux disease is often associated with hiatus hernia and is the most common underlying etiology. Dysmotility because of impaired contractility and vigor can occur as a consequence of repeated acid exposure from the acid pocket within the hernia, and the resultant poor clearance subsequently worsens this insult. As such, dysphagia appears to be more common with increasing hiatus hernia size. Furthermore, mucosal inflammation can lead to fibrotic stricture formation and in turn obstruction. On the other hand, there appears to be a difference in the pathophysiology of smaller sliding hernias, in that those with dysphagia are more likely to have extrinsic compression at the crural diaphragm as compared to those with reflux symptoms only. Sliding hiatus hernia, especially when small, does not commonly lead to dysmotility and dysphagia; however, in those patients with symptoms, the underlying etiology can be sought with new technologies and, in particular, the reproduction of normal eating and drinking during testing.

  13. Inguinal hernia recurrence: Classification and approach

    Directory of Open Access Journals (Sweden)

    Campanelli Giampiero

    2006-01-01

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

  14. 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.

  15. Severe, recurrent hiatal hernia in schwartz syndrome

    International Nuclear Information System (INIS)

    Badshah, S.; Ghafoor, T.; Muhammad, S.

    2003-01-01

    An 18 months old boy presented with marked failure to thrive, abnormal facial grimacing and troublesome vomiting. The patient was diagnosed as having schwartz syndrome with hiatal hernia. Medical and surgical treatment was carried out and with supportive care the patient gained weight and his symptoms subsided. In 8 months, however, the patient developed hernia on the other side necessitating repeat surgery. The case is being reported to highlight the accompaniment of hiatal hernia not previously reported as part of the syndrome and to report the experience of using muscle relaxants in the condition. (author)

  16. Incarcerated umbilical cord hernia containing the gallbladder

    Directory of Open Access Journals (Sweden)

    Ann M. Kulungowski

    2017-06-01

    Full Text Available A 16 day-old boy infant with an umbilical mass underwent operative exploration of the umbilicus. The mass proved to be a gallbladder incarcerated in a hernia of the umbilical cord. Distinguishing an omphalocele from an umbilical cord hernia is not obvious and can be arbitrary. Morphologically, the two terms both describe congenital abdominal wall defects covered by a membrane, typically containing abdominal organs. Subtle differences and clinical features between omphalocele and umbilical cord hernia are highlighted in this report.

  17. Sports Hernia/Athletic Pubalgia

    Science.gov (United States)

    Larson, Christopher M.

    2014-01-01

    Context: Sports hernia/athletic pubalgia has received increasing attention as a source of disability and time lost from athletics. Studies are limited, however, lacking consistent objective criteria for making the diagnosis and assessing outcomes. Evidence Acquisition: PubMed database through January 2013 and hand searches of the reference lists of pertinent articles. Study Design: Review article. Level of Evidence: Level 5. Results: Nonsurgical outcomes have not been well reported. Various surgical approaches have return-to–athletic activity rates of >80% regardless of the approach. The variety of procedures and lack of outcomes measures in these studies make it difficult to compare one surgical approach to another. There is increasing evidence that there is an association between range of motion–limiting hip disorders (femoroacetabular impingement) and sports hernia/athletic pubalgia in a subset of athletes. This has added increased complexity to the decision-making process regarding treatment. Conclusion: An association between femoroacetabular impingement and athletic pubalgia has been recognized, with better outcomes reported when both are managed concurrently or in a staged manner. PMID:24587864

  18. THREE PORTS LAPAROSCOPIC REPAIR OF ADULT MORGAGNI HERNIA AND RARE SIMULTANEOUS PRESENTATION OF PARA-ESOPHAGEAL HERNIA WITH MORGAGNI HERNIA

    Directory of Open Access Journals (Sweden)

    Salman Assad

    2018-05-01

    Full Text Available We report two case reports of Morgagni hernia repair. Our first case was on 65 year old white male who presented with abdominal pain in right upper quadrant and right side of chest for last 3 days. He was having 3 episodes of dark appearing vomiting associated with pain. He also had two episodes of hematemesis. Patient had gastric outlet obstruction with severe distension of stomach because of incarcerated small bowel and colon in the right sided anterior diaphragmatic Morgagni hernia. Laparoscopic repair of incarcerated Morgagni hernia under general anesthesia was planned. We report our second case on rare simultaneous presentation of Morgagni Hernia with type 3 Para esophageal hernia. 60 years old female patient presented in clinic with a follow up of chest discomfort which was progressively increasing with shortness of breath and a chronic gastric reflux. Her vitals were within normal limits and had body mass index (BMI= 29.52kg/m2 (overweight category. Previous past medical history included multiple episodes of gastric regurgitation and cardiovascular intervention for coronary stenting. CT scan showed type 3 paraesophageal hernia (gastro esophageal junction with fundus of stomach displaced above diaphragm. The patient had more than 30% of her stomach incarcerated in the chest as a paraesophageal hernia. The gastro esophageal junction was intra-abdominal after lysis of adhesion. Mesh was placed after posterior crural repair, followed by Nissen fundoplication over a 54 French bougie patient also had an incidental finding of a reducible Morgagni hernia through an anterior defect, followed by a repair without mesh. Esophago-gastro-duodenoscopy showed there was no evidence of any air leak with good valve creation on retroflexion through a fundoplication.

  19. Inguinal/inguinoscrotal hernias are the com

    African Journals Online (AJOL)

    hi-tech

    with obstructed abdominal wall hernias between 1991 - 1996. ... Request for reprints to: Dr. A.R.K. Adesunkanmi, Department of Surgery, College of Health Sciences, Obafemi ... had operative intervention and other postoperative management.

  20. Primary ventral or groin hernia in pregnancy

    DEFF Research Database (Denmark)

    Oma, E; Bay-Nielsen, M; Jensen, K K

    2017-01-01

    BACKGROUND: Prevalence, management, and risk of emergency operation for primary ventral or groin hernia in pregnancy are unknown. The objective of this study was to estimate the prevalences of primary ventral or groin hernia in pregnancy and the potential risks for elective and emergency repair...... was conducted to identify patients registered with a primary ventral or groin hernia in pregnancy. Follow-up was conducted by review of medical record notes within the Capital Region of Denmark supplemented with structured telephone interviews on indication. RESULTS: In total, 20,714 pregnant women were...... included in the study cohort. Seventeen (0.08%) and 25 (0.12%) women were registered with a primary ventral and groin hernia, respectively. None underwent elective or emergency repair in pregnancy, and all had uncomplicated childbirth. In 10 women, the groin bulge disappeared spontaneously after delivery...

  1. Complicated childhood inguinal hernias in UITH, Ilorin

    Directory of Open Access Journals (Sweden)

    Kayode T Bamigbola

    2012-01-01

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

  2. The effect of local/topical analgesics on incisional pain in a pig model

    Directory of Open Access Journals (Sweden)

    Castel D

    2017-09-01

    Full Text Available David Castel,1 Itai Sabbag,2 Sigal Meilin3 1The Neufeld Cardiac Research Institute, Sheba Medical Centre, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, 2Lahav Research Institute, Kibutz Lahav, Negev, 3Neurology R&D Division, MD Biosciences, Nes-Ziona, Israel Abstract: Interest in the development of new topical/local drug administration for blocking pain at peripheral sites, with maximum drug activity and minimal systemic effects, is on the rise. In the review article by Kopsky and Stahl, four critical barriers in the process of research and development of topical analgesics were indicated. The active pharmaceutical ingredient (API and the formulation are among the major challenges. The road to the development of such drugs passes through preclinical studies. These studies, if planned correctly, should serve as guidance for choosing the right API and formulation. Although rodent models for pain continue to provide valuable data on the mechanisms driving pain, their use in developing topical and localized treatment approaches is limited for technical (intraplate injection area is small as well as mechanical reasons (non-similarity to human skin and innervation. It has been previously shown that pigs are comparable to humans in ways that make them a better choice for evaluating topical and local analgesics. The aim of this study was to summarize several experiments that used pigs for testing postoperative pain in an incisional pain model (skin incision [SI] and skin and muscle incision [SMI]. At the end of the surgery, the animals were treated with different doses of bupivacaine solution (Marcaine®, bupivacaine liposomal formulation (Exparel® or ropivacaine solution (Naropin. Von Frey testing demonstrated a decrease in the animals’ sensitivity to mechanical stimulation expressed as an increase in the withdrawal force following local treatment. These changes reflect the clinical condition in the level as well as in the duration of

  3. 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.

  4. Radiographic observation of congenital diaphragmatic hernia

    International Nuclear Information System (INIS)

    Rhee, Chung Sik

    1973-01-01

    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. Effect of intraperitoneal and incisional port site lidocaine on pain relief after gynecological laparoscopic surgery: A randomized controlled study

    Directory of Open Access Journals (Sweden)

    Nahla W. Shady

    2018-03-01

    Conclusions: This study clearly depicts that incisional and intraperitoneal infiltration of lidocaine is an easy, safe, inexpensive, and noninvasive method that provides good analgesia during the early post-operative period and also provides early recovery from laparoscopic surgery.

  6. It is highly unlikely that the development of an abdominal wall hernia can be attributable to a single strenuous event.

    Science.gov (United States)

    Pathak, Samir; Poston, Graeme J

    2006-03-01

    There is a commonly held belief that the development of a hernia can be attributed to a single strenuous or traumatic event. Hence, many litigants are successful in compensation claims, causing mounting financial burdens on employers, the courts, insurance companies and the tax-payer. However, there is very little scientific evidence to support this assertion. The aim of this study was to ascertain whether there was any causal link in this process. A total of 133 new patients with 135 abdominal herniae of all varieties (115 inguinal, 3 femoral, 9 umbilical, 4 incisional, and 4 ventral or epigastric), of which 25 were recurrent received structured questionnaires on arrival in the surgical clinic. These questionnaires covered all possible aetiological factors for hernia development (type of work, COAD, smoking, pregnancy, obesity, chronic bladder outflow obstruction, previous surgery including appendicectomy), in addition to any possible attribution to a single strenuous or traumatic event. We then reviewed the GP records in the surgery of all patients who answered positively to the latter possible cause. In the study group, 119 (89%) reported a gradual onset of symptoms. Of the 15 (12 male, 3 female; 11%) who believed that their hernia might be related to a single strenuous or traumatic event, 5 had no other aetiological factors. However, not one of the 15 was found to have contemporaneous forensic medical evidence to support their possible claim. We conclude that we are unable to find any clinical evidence to support the hypothesis that a hernia might develop as the result of one single strenuous or traumatic event. While we accept that this mechanism might still possibly occur, we believe that, at best, it is extremely uncommon. If a medical expert is preparing a report on such a case in a claim for personal injury, then they have a duty to the court to examine carefully all the contemporaneous medical records. If no clinical evidence exists to support the claim

  7. Imaging of congenital diaphragmatic hernias

    International Nuclear Information System (INIS)

    Taylor, George A.; Estroff, Judy A.; Atalabi, Omolola M.

    2009-01-01

    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.)

  8. 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.)

  9. European Hernia Society guidelines on prevention and treatment of parastomal hernias.

    Science.gov (United States)

    Antoniou, S A; Agresta, F; Garcia Alamino, J M; Berger, D; Berrevoet, F; Brandsma, H-T; Bury, K; Conze, J; Cuccurullo, D; Dietz, U A; Fortelny, R H; Frei-Lanter, C; Hansson, B; Helgstrand, F; Hotouras, A; Jänes, A; Kroese, L F; Lambrecht, J R; Kyle-Leinhase, I; López-Cano, M; Maggiori, L; Mandalà, V; Miserez, M; Montgomery, A; Morales-Conde, S; Prudhomme, M; Rautio, T; Smart, N; Śmietański, M; Szczepkowski, M; Stabilini, C; Muysoms, F E

    2018-02-01

    International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of

  10. The MRI findings of a de Garengeot hernia.

    LENUS (Irish Health Repository)

    Halpenny, D

    2012-03-01

    The presence of the appendix within a femoral hernia is rare. It was first described by the French surgeon Jacques Croissant de Garengeot in 1731. This phenomenon accounts for 0.8-1% of all femoral hernias. Acute appendicitis occurring within a femoral hernia is even rarer and is difficult to diagnose pre-operatively. This type of hernia is termed a de Garengeot hernia. The ultrasonographic and CT imaging features of de Garengeot hernias have been described previously. We report a case of a 57-year-old female who presented with a painful right-sided groin mass. She underwent MRI of the inguinal region, which successfully diagnosed this rare hernia pre-operatively. To our knowledge, this is the first description of a de Garengeot hernia diagnosed using MRI.

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

    African Journals Online (AJOL)

    risk accruing from leaving the hernia sac intact. .... adenomatoid malformation of the lung, pneumohe- mothorax, anterior mediastinal mass, or lung abscess .... factor in the diagnosis, management and outcome in patients of Morgagni hernia.

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

    African Journals Online (AJOL)

    ADMIN

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

  13. Obstructed abdominal hernia at the Wesley Guild Hospital, Nigeria ...

    African Journals Online (AJOL)

    Obstructed abdominal hernia at the Wesley Guild Hospital, Nigeria. ... wall hernia who had operative intervention and other postoperative management. ... elective in 23 patients (21%) who had spontaneous reduction while awaiting surgery.

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

    African Journals Online (AJOL)

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

  15. Recurrence and Pain after Mesh Repair of Inguinal Hernias

    African Journals Online (AJOL)

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

  16. Video-assisted repair of cervical lung hernia.

    Science.gov (United States)

    Zhang, P; Jiang, G; Xie, B; Ding, J

    2010-04-01

    Lung hernia is an extremely rare condition and the treatments vary. We report a case of cervical lung hernia without any trauma. The patient underwent video-assisted repair with a satisfactory result. Georg Thieme Verlag KG Stuttgart New York.

  17. Bilateral cervical lung hernia with T1 nerve compression.

    Science.gov (United States)

    Rahman, Mesbah; Buchan, Keith G; Mandana, Kyapanda M; Butchart, Eric G

    2006-02-01

    Lung hernia is a rare condition. Approximately one third of cases occur in the cervical position. We report a case of bilateral cervical lung hernia associated with neuralgic pain that was repaired using bovine pericardium and biological glue.

  18. 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

  19. Ventral hernia with uterine rupture after vaginal delivery

    Directory of Open Access Journals (Sweden)

    Jung Mi Byun

    2014-09-01

    Conclusion: If a patient has hernia-related symptoms or complications, the diagnosis and management of the hernia should be performed as soon as possible, regardless of the onset, to decrease maternal and fetal mortality.

  20. Vasitis mimicking an Amyand’s hernia: A case report

    Directory of Open Access Journals (Sweden)

    Juan Manuel Romero Marcos

    2017-01-01

    Conclusion: Presently, Amyand’s hernia is more frequently diagnosed preoperatively than intraoperatively. However when an Amyand’s hernia is preoperatively suspected, the possibility of a vasitis should always be ruled out in order to avoid unnecessary operations.

  1. Occurrence and recurrence of gastric dilatation with or without volvulus after incisional gastropexy

    OpenAIRE

    Przywara, John F.; Abel, Steven B.; Peacock, John T.; Shott, Susan

    2014-01-01

    This study investigated recurrence of gastric dilatation without (GD) or with volvulus (GDV) after incisional gastropexy (IG) in dogs that underwent IG for prevention of GDV. Signalment, concurrent surgical procedures, presence of GD or GDV at the time of IG were obtained from medical records of dogs that underwent IG. Owners were contacted to determine whether the dogs experienced GD or GDV after IG, dates of postoperative GD or GDV episodes, survival status, date of death for deceased dogs....

  2. Involvement of transient receptor potential vanilloid 2 in intra-oral incisional pain.

    Science.gov (United States)

    Urata, K; Shinoda, M; Ikutame, D; Iinuma, T; Iwata, K

    2018-03-05

    To examine whether transient receptor potential vanilloid 2 (TRPV2) contributes to the changes in intra-oral thermal and mechanical sensitivity following the incision of buccal mucosa. Buccal mucosal pain threshold was measured after the incision. Changes in the number of TRPV2-immunoreactive (IR) trigeminal ganglion (TG) neurons which innervate the whisker pad skin and buccal mucosa, changes in the number of isolectin B4-negative/isolectin B4-positive TRPV2-IR TG neurons which innervate the whisker pad skin and the buccal mucosa, and the effect of peripheral TRPV2 antagonism on the pain threshold of incisional whisker pad skin and buccal mucosa were examined after these injuries. Buccal mucosal pain hypersensitivities were induced on day 3 following the incision. The total number of TRPV2-IR TG neurons and the number of isolectin B4-negative TRPV2-IR TG neurons which innervate the whisker pad skin and buccal mucosa were increased. Buccal mucosal TRPV2 antagonism completely suppressed the heat and mechanical hypersensitivities, but not cold hypersensitivity. TRPV2 antagonist administration to the incisional whisker pad skin only partially suppressed pain hypersensitivities. The increased expression of TRPV2 in peptidergic TG neurons innervating the incisional buccal mucosa is predominantly involved in buccal mucosal heat hyperalgesia and mechanical allodynia following buccal mucosal incision. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.

  3. Hernia Surgery in Nyeri Provincial General Hospital, Kenya: Our 6 ...

    African Journals Online (AJOL)

    Introduction: Hernia is a common surgical condition world over. Much of hernia surgery in Africa is carried out as an emergency while elective procedures are few. Knowledge of the burden of hernia disease would facilitate optimal resource allocation. Methods: A retrospective audit between 2007 and 2012 was carried out ...

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

    African Journals Online (AJOL)

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

  5. Lumbar hernia - a case report and review of the literature

    International Nuclear Information System (INIS)

    D'Ippolito, Giuseppe; Yonamine, Claudia

    1999-01-01

    The authors present a case of lumbar hernia of inferior right space (Petit's triangle), classified as acquired hernia and diagnosed by clinical history and computed tomography. Lumbar hernia are quite rare. Authors have done a literature review of this disease. (author)

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

    African Journals Online (AJOL)

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

  7. Posterolateral diaphragmatic hernia with small-bowel incarceration ...

    African Journals Online (AJOL)

    Bochdalek hernia (BH), a closing defect of the peripheral posterior aspect of the diaphragm, is the most common of the congenital diaphragmatic hernias and is usually diagnosed in neonates. Symptomatic presentation of a right-sided diaphragmatic hernia in an adult is unusual. Owing to their rarity and varied presentation, ...

  8. Diagnosis of lumbar disc hernia with computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Yoshizumi, Atsuro; Ohira, Nobuhiro; Ojima, Tadashi; Oshida, Midori; Horaguchi, Mitsuru (Tohoku Rosai Hospital, Sendai (Japan))

    1982-07-01

    Results of computed tomography performed on patients with clinically diagnosed hernia were compared with those of myelography and operative findings. This comparative study suggested that computed tomography is quite different from other methods and very useful in diagnosis of hernia. Some cases of hernia were shown, and the characteristics of CT were reviewed.

  9. Diagnosis of lumbar disc hernia with computed tomography

    International Nuclear Information System (INIS)

    Yoshizumi, Atsuro; Ohira, Nobuhiro; Ojima, Tadashi; Oshida, Midori; Horaguchi, Mitsuru

    1982-01-01

    Results of computed tomography performed on patients with clinically diagnosed hernia were compared with those of myelography and operative findings. This comparative study suggested that computed tomography is quite different from other methods and very useful in diagnosis of hernia. Some cases of hernia were shown, and the characteristics of CT were reviewed. (Ueda, J.)

  10. Pattern of abdominal wall herniae in females: a retrospective analysis

    African Journals Online (AJOL)

    Background: Gender differences are expected to influence the pattern and outcome of management of abdominal wall hernias. Some of these are left to speculations with few published articles on hernias in females. Objectives: To describe the clinical pattern of abdominal wall hernias in females. Method: A 5 year ...

  11. Obturator hernia: a rare case of acute mechanical intestinal obstruction.

    Science.gov (United States)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ibrahim Aydin

    2013-01-01

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

  13. Management of chronic pain after hernia repair

    Directory of Open Access Journals (Sweden)

    Andresen K

    2018-04-01

    Full Text Available Kristoffer Andresen, Jacob Rosenberg Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark Abstract: Chronic pain following inguinal hernia repair is a common problem and feared complication. Up to 16% of people experience chronic pain following the repair of a groin hernia. The aim of this review was to provide an overview of treatment strategies for patients with chronic pain following inguinal hernia repair based on best practice guidelines and current clinical routines. The optimal management of chronic pain following inguinal hernia surgery should begin with a thorough clinical examination to rule out other causes of chronic pain and to rule out a recurrence. A scaled approach to treatment is recommended. Initially, watchful waiting can be tried if it can be tolerated by the patient and then systemic painkillers, escalating to blocks, and surgery as the final option. Surgery should include mesh removal and triple neurectomy following anterior approaches or mesh and tack removal following a posterior approach. The diagnosis and treatment strategies should be performed by or discussed with experts in the field. Keywords: inguinal hernia, chronic pain, management, surgery, pharmacology, radio frequency

  14. Sports Hernia: Diagnosis, Management and Operative Treatment

    Science.gov (United States)

    Emblom, Benton A.

    2017-01-01

    Objectives: Athletic Pubalgia, also known as sports hernia or core muscle injury, causes significant dysfunction in athletes. Increased recognition of this specific injury distinct from inguinal hernia pathology has led to better management of this debilitating condition. We hypothesize that patients who undergo our technique of athletic pubalgia repair will recover and return to high-level athletics. Methods: Using our billing and clinical database, patients who underwent sports hernia repair by single surgeon at a single institution were contacted for Harris hip score, functional outcome, and return to play data. Results: Of 101 patients who met criteria, 43 were contacted. 93% of patients were able to return to play at an average of 4.38 mo. Normal activities were rated at 95.5% and athletic function was rated at 88.9%. Negative predictors were female sex, multiple operations, and prior inguinal hernia repair. Overall complication rate was 4.6%, and reoperation rate was 4.6%. Conclusion: Our method of adductor to rectus abdominis turn up flap is a safe procedure with high return to play success. Patients who had previously undergone inguinal hernia repair or other hip/pelvic related surgery had a worse outcome.

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

    Directory of Open Access Journals (Sweden)

    Emin Kose

    2017-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ali Eraslan

    2017-11-01

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

  17. 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...... rate was 63.3%. In the 651 patients available for analysis, pain from the operated groin was reported by 88 (13.5%) patients whereof 13 (2.0%) patients reported frequent and moderate or severe pain. Pain occurred primarily when exercising sports or other leisure activities. Patients operated on before...

  18. Abdominal wall hernias: imaging with spiral CT

    International Nuclear Information System (INIS)

    Stabile Ianora, A.A.; Midiri, M.; Vinci, R.; Rotondo, A.; Angelelli, G.

    2000-01-01

    Computed tomography is an accurate method of identifying the various types of abdominal wall hernias, especially if they are clinically occult, and of distinguishing them from other diseases such as hematomas, abscesses and neoplasia. In this study we examined the CT images of 94 patients affected by abdominal wall hernias observed over a period of 6 years. Computed tomography clearly demonstrates the anatomical site of the hernial sac, the content and any occlusive bowel complications due to incarceration or strangulation. Clinical diagnosis of external hernias is particularly difficult in obese patients or in those with laparotic scars. In these cases abdominal imaging is essential for a correct preoperative diagnosis and to determine the most effective treatment. (orig.)

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

    Science.gov (United States)

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

    2011-10-01

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

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

    Science.gov (United States)

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

    2013-08-01

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

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

    Science.gov (United States)

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

    2008-10-01

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

  2. Amyand's hernia with appendicitis in the children: A delayed diagnosis

    Directory of Open Access Journals (Sweden)

    Asma Jabloun

    2016-10-01

    Full Text Available The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. It is an uncommon and rare condition estimated to be found in approximately 1 % of hernia. However, in just 0.08 %, the condition is complicated by an acute appendicitis. The clinical presentation varies, depending on the extent of inflammation of the appendix, and is most often misdiagnosed as an incarcerated inguinal hernia. As such, it is rarely recognized prior to surgical exploration. We report a case of Amyand’s hernia in a 2-month-old male, who presented as a right-sided congenital hernia with pain in the right groin. He underwent herniotomy, which revealed that the hernia sac containing elongated inflamed appendix appeared with some adhesions to sac, lying in the inguinal canal.

  3. The Amyand's Hernia: A Rare Clinical Entity Diagnosed by Computed Tomography.

    Science.gov (United States)

    Keskin, Suat; Simşek, Cihan; Keskin, Zeynep

    2013-01-01

    Amyand's hernia, named for the first person to describe an inguinal hernia containing the vermiform appendix, is an uncommon variant of an inguinal hernia. Amyand's hernia is an extremely rare condition and is often misdiagnosed. Traditionally, these hernias have been diagnosed at surgery but are increasingly diagnosed by abdominal computed tomography (CT) scans. CT of the abdomen may help in guiding the diagnosis.

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

    Science.gov (United States)

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

    2013-05-01

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

  5. Ovarian Spigelian hernia: A radiological diagnosis

    International Nuclear Information System (INIS)

    Hill, Ciaran Scott; Chahil, Balvinder; Marlow, Benjamin

    2012-01-01

    We describe that case of a 54 year old lady with achondroplasia who presented with ongoing left sided abdominal pain. Ultrasound and abdominal computerized tomography images demonstrated an enlarged left ovary and Fallopian tube trapped between the rectus abdominus and the lateral semilunar line under cover of the external oblique aponeurosis. A left sided salpingoophrectomy with mesh herniorrhaphy was performed and histological analysis confirmed the hernia contents were a hydrosalpinx and normal ovary. This case report presents the unusual radiographic images and intraoperative photographs of an ovarian Speglian hernia.

  6. CT discography for cervical soft disc hernia

    International Nuclear Information System (INIS)

    Iwasa, Kenichi; Mizutani, Shigeru; Morimoto, Hiroyuki; Yamada, Hidehito; Iwasa, Satoru

    1985-01-01

    In this study the effectiveness of computed tomographic discography (CTD) in diagnosing cervical soft disc hernia was evaluated. Twenty-five interververtebral discs of 15 cases with cervical soft disc hernia were examined with a discography and then a CT scan. Results of the CT scan were as follows: three discs were protruded, 12 discs were prolapsed, 6 discs were extruded, and 4 discs were sequestrated. The findings were helpful in determining the location of soft disc hernians between the median and posterolateral discs. They were also valuable in classifying types of hernians and surgical aproaches. (author)

  7. Influence of hiatal hernia on lower esophageal sphincter function.

    Science.gov (United States)

    Pettersson, G B; Bombeck, C T; Nyhus, L M

    1981-01-01

    Sliding hiatal hernia has long term been implicated as a cause of lower esophageal sphincter (LES) incompetence and gastroesophageal reflux. The physics of LES function in hiatal hernia were investigated in in vitro and in vivo experiments. In vitro models of sliding hernias were constructed from excised canine gastroesophageal specimens. A "sphincter" was simulated with a rubber band around the gastroesophageal junction. It was found that placement of a ligature "hernia ring" on the stomach increased the opening pressure of the model sphincter. Addition of a tissue "hernia sac" sutured to the esophagus above the sphincter further increased the opening pressure, the protective effect being related to the pressure transmitted from the stomach to the hernia sac. There was no fluid leakage from the hernia sac between the hernia ring and the stomach. In anesthetized dogs (in vivo model) gastric and esophageal pressures were measured during gastric infusion while the LES gas way to reflux. A ligature tied loosely around the stomach to simulate a "hernia ring" and a sliding hernia without a hernia sac increased both the opening and the closing pressures of the LES by 36 +/- 18% and 35 +/- 20% (mean +/- SD), respectively. The opening pressure was increased by a decrease in gastric wall tension at the gastroesophageal junction, which was caused by the decreased radius of the herniated portion of the stomach. Pressure transmitted from the stomach to the hernia sac added to the LES pressure, and thereby further increased the opening pressure of the sphincter. The results explain how gastroesophageal reflux may be prevented in patients with hiatal hernia. It was recognized that the hernia sac may protect the sphincter, provided that it inserts into the esophagus above the LES. PMID:7469555

  8. Case Report: De Garengeot’s hernia. Appendicitis within femoral hernia. Diagnosis and surgical management

    Directory of Open Access Journals (Sweden)

    Agustin Sibona, MD

    2016-01-01

    Conclusion: Although rare, the finding of a strangulated appendix within a femoral hernia represents a challenge. Here we present a case that may guide the surgeon who faces a similar case in the future.

  9. 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

    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...... 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...... repair at Hvidovre Hospital and Herlev Hospital, Denmark, are invited to participate. CONCLUSION: The gap closure technique may induce more post-operative pain than the non-closure repair, but it may also be superior with regard to other important surgical outcomes. No studies have previously...

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

    Directory of Open Access Journals (Sweden)

    Prakash Kumar Sahoo

    2017-10-01

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

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

    Science.gov (United States)

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

    2009-03-01

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

  12. Shouldice Versus Lichtenstein Hernia Repair Techniques: A ...

    African Journals Online (AJOL)

    inguinal hernia surgery and to determine to what extent doctors in ... The inclusion criteria was men between 18 ... length and a minimal amount of purulent material expressed ... examination and personal interview; done by the ... *Values are mean (standard deviation). ... a shorter time, reflecting the ease of the operation is.

  13. Femoral Hernia At Mulago Hospital, Uganda

    African Journals Online (AJOL)

    user

    2004-12-02

    Dec 2, 2004 ... consecutive patients operated for femoral hernia over a period of twelve months. Results: There were ... The age ranged from 42 years to 70 years old with a mean of 54.6 years old. All the .... cholecystectomy. At this point in ...

  14. THE mSTORY OF GROIN HERNIA*

    African Journals Online (AJOL)

    1971-07-03

    Jul 3, 1971 ... this simple test is omitted from the section on hernias in most of the general surgical ... step in the operation was to separate the external oblique from the internal ... Cambridge: Harvard University Press. 2. Galen, 2nd Century ...

  15. SCHISTOSOMAL APPENDICITIS IN A SLIDING HERNIA (CASE ...

    African Journals Online (AJOL)

    We report a rare case of a forty-seven year old Nigeria male with schistosomal appendicitis in a sliding hernia. The clinical and pathological features of the case are discussed, followed by a review of the literature. It is concluded that a high index of suspicion is necessary to diagnose unusual presentations of ...

  16. THE mSTORY OF GROIN HERNIA*

    African Journals Online (AJOL)

    1971-07-03

    Jul 3, 1971 ... 1: Bassini's original description of herniorrhaphy. (A) subcutaneous tissue, (B) external oblique, (C) fascia transversalis, (E) spermatic cord, (F) transversus, internal oblique and fascia transversus, (G) hernia sac. (From. Bassini's (j ber die Behandlung des Leisten-bruches,. Langenbecks Arch. klin. Chir., Vo\\.

  17. Rare abdominal wall hernias in South Sudan

    African Journals Online (AJOL)

    1. Ordinary direct inguinal hernias which are less frequent in Africa and seldom strangulate (as one has in Figure 6). They may cause no symptoms, remain the same size for long periods and may not need surgery. 2. The BH which is caused by a narrow defect in the conjoint tendon or transversalis fascia and consequently.

  18. Large Hiatal Hernia Compressing the Heart.

    Science.gov (United States)

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

    2016-02-01

    We describe a 41-year-old man with De Mosier's syndrome who presented with exercise intolerance and dyspnea on exertion caused by a giant hiatal hernia compressing the heart with relief by surgical treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. 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.

  20. Diaphragmatic Hernia Masquerading as Pleural Effusion | Nalladaru ...

    African Journals Online (AJOL)

    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 ...

  1. Diaphragmatic Hernia Masquerading as Pleural Effusion

    African Journals Online (AJOL)

    As many as 30% of diaphragmatic hernias present late.[1] We present an unusual case report of a late presentation of isolated diaphragmatic injury, after apparently minor blunt trauma, which was initially misdiagnosed as pleural effusion. CASE REPORT. A 40-year-old man slipped and fell against the edge of his bath tub.

  2. Genetics Home Reference: congenital diaphragmatic hernia

    Science.gov (United States)

    ... of cells in the embryo. Environmental factors that influence development before birth may also increase the risk of ... occur? How can gene mutations affect health and development? More about Mutations and ... is only one affected individual in a family. When congenital diaphragmatic hernia occurs as a feature ...

  3. 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.

  4. Sustained analgesic effect of clonidine co-polymer depot in a porcine incisional pain model

    Directory of Open Access Journals (Sweden)

    Wilsey JT

    2018-04-01

    Full Text Available Jared T Wilsey, Julie H Block Medtronic Spine Division, Memphis, TN, USA Background: Previous research suggests that the α2 adrenergic agonist clonidine, a centrally acting analgesic and antihypertensive, may also have direct effects on peripheral pain generators. However, aqueous injections are limited by rapid systemic absorption leading to off target effects and a brief analgesic duration of action. Purpose: The aim of this study was to examine the efficacy of a sustained-release clonidine depot, placed in the wound bed, in a pig incisional pain model. Methods: The depot was a 15 mm ×5 mm ×0.3 mm poly(lactide-co-caprolactone polymer film containing 3% (w/w clonidine HCl (MDT3. Fifty-two young adult mix Landrace pigs (9–11 kg were divided into seven groups. All subjects received a 6 cm, full-thickness, linear incision into the left lateral flank. Group 1 served as a Sham control group (Sham, n=8. Group 2 received three placebo strips (PBO, n=8, placed end-to-end in the subcutaneous wound bed before wound closure. Group 3 received one MDT3 and two PBO (n=8, Group 4 received two MDT3 and one PBO (n=8, and Group 5 received three MDT3 (n=8. Positive control groups received peri-incisional injections of bupivacaine solution (Group 6, 30 mg/day bupivacaine, n=8 or clonidine solution (Group 7, 225 µg/day, n=4. Results: The surgical procedure was associated with significant peri-incisional tactile allodynia. There was a dose-dependent effect of MDT3 in partially reversing the peri-incisional tactile allodynia, with maximum pain relief relative to Sham at 72 hours. Daily injections of bupivacaine (30 mg, but not clonidine (up to 225 µg, completely reversed allodynia within 48 hours. There was a statistically significant correlation between the dose of MDT3 and cumulative withdrawal threshold from 4 hours through the conclusion of the study on day 7. Conclusion: These data suggest that a sustained-release clonidine depot may be a

  5. Sustained analgesic effect of clonidine co-polymer depot in a porcine incisional pain model.

    Science.gov (United States)

    Wilsey, Jared T; Block, Julie H

    2018-01-01

    Previous research suggests that the α 2 adrenergic agonist clonidine, a centrally acting analgesic and antihypertensive, may also have direct effects on peripheral pain generators. However, aqueous injections are limited by rapid systemic absorption leading to off target effects and a brief analgesic duration of action. The aim of this study was to examine the efficacy of a sustained-release clonidine depot, placed in the wound bed, in a pig incisional pain model. The depot was a 15 mm ×5 mm ×0.3 mm poly(lactide-co-caprolactone) polymer film containing 3% (w/w) clonidine HCl (MDT3). Fifty-two young adult mix Landrace pigs (9-11 kg) were divided into seven groups. All subjects received a 6 cm, full-thickness, linear incision into the left lateral flank. Group 1 served as a Sham control group (Sham, n=8). Group 2 received three placebo strips (PBO, n=8), placed end-to-end in the subcutaneous wound bed before wound closure. Group 3 received one MDT3 and two PBO (n=8), Group 4 received two MDT3 and one PBO (n=8), and Group 5 received three MDT3 (n=8). Positive control groups received peri-incisional injections of bupivacaine solution (Group 6, 30 mg/day bupivacaine, n=8) or clonidine solution (Group 7, 225 µg/day, n=4). The surgical procedure was associated with significant peri-incisional tactile allodynia. There was a dose-dependent effect of MDT3 in partially reversing the peri-incisional tactile allodynia, with maximum pain relief relative to Sham at 72 hours. Daily injections of bupivacaine (30 mg), but not clonidine (up to 225 µg), completely reversed allodynia within 48 hours. There was a statistically significant correlation between the dose of MDT3 and cumulative withdrawal threshold from 4 hours through the conclusion of the study on day 7. These data suggest that a sustained-release clonidine depot may be a viable nonopioid, nonamide anesthetic therapy for the treatment of acute postsurgical nociceptive sensitization.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    Science.gov (United States)

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

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

  8. Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature.

    Science.gov (United States)

    Wauschkuhn, Constantin Aurel; Schwarz, Jochen; Boekeler, Ulf; Bittner, Reinhard

    2010-12-01

    Advantages and disadvantages of open and endoscopic hernia surgery are still being discussed. Until now there has been no study that evaluated the advantages and disadvantages of bilateral hernia repair in a large number of patients. Our prospectively collected database was analyzed to compare the results of laparoscopic bilateral with laparoscopic unilateral hernia repair. We then compared these results with the results of a literature review regarding open and laparoscopic bilateral hernia repair. From April 1993 to December 2007 there were 7240 patients with unilateral primary hernia (PH) and 2880 patients with bilateral hernia (5760 hernias) who underwent laparoscopic transabdominal preperitoneal patch plastic (TAPP). Of the 10,120 patients, 28.5% had bilateral hernias. Adjusted for the number of patients operated on, the mean duration of surgery for unilateral hernia repair was shorter than that for bilateral repair (45 vs. 70 min), but period of disability (14 vs. 14 days) was the same. Adjusted for the number of hernias repaired, morbidity (1.9 vs. 1.4%), reoperation (0.5 vs. 0.43%), and recurrence rate (0.63 vs. 0.42%) were similar for unilateral versus bilateral repair, respectively. The review of the literature shows a significantly shorter time out of work after laparoscopic bilateral repair than after the bilateral open approach. Simultaneous laparoscopic repair of bilateral inguinal hernias does not increase the risk for the patient and has an equal length of down time compared with unilateral repair. According to literature, recovery after laparoscopic repair is faster than after open simultaneous repair. Laparoscopic/endoscopic inguinal hernia repair of bilateral hernias should be recommended as the gold standard.

  9. Multidetector-Row CT Findings of an Internal Supravesical Hernia: A Case Report

    International Nuclear Information System (INIS)

    Kim, Sang Won; Shin, Hyeong Cheol; Kim, Hyung Hwan; Kim, Young Tong; Kim, Il Young; Kang, Kil Ho

    2010-01-01

    A supravesical hernia occurs in the supravesical fossa and is either classified as an external or internal supravesical hernia. Most patients with internal supravesical hernias present with small bowel obstruction. Internal supravesical hernias are less common than external supravesical hernia. To date, there are few reports describing the radiological findings of supravesical hernias. To our knowledge, this is the first reported multidetector row CT (MDCT) depiction of this type of hernia. We report here on the MDCT findings of a patient with an internal supravesical hernia presenting with small bowel obstruction

  10. Biomimetic collagen/elastin meshes for ventral hernia repair in a rat model.

    Science.gov (United States)

    Minardi, Silvia; Taraballi, Francesca; Wang, Xin; Cabrera, Fernando J; Van Eps, Jeffrey L; Robbins, Andrew B; Sandri, Monica; Moreno, Michael R; Weiner, Bradley K; Tasciotti, Ennio

    2017-03-01

    Ventral hernia repair remains a major clinical need. Herein, we formulated a type I collagen/elastin crosslinked blend (CollE) for the fabrication of biomimetic meshes for ventral hernia repair. To evaluate the effect of architecture on the performance of the implants, CollE was formulated both as flat sheets (CollE Sheets) and porous scaffolds (CollE Scaffolds). The morphology, hydrophylicity and in vitro degradation were assessed by SEM, water contact angle and differential scanning calorimetry, respectively. The stiffness of the meshes was determined using a constant stretch rate uniaxial tensile test, and compared to that of native tissue. CollE Sheets and Scaffolds were tested in vitro with human bone marrow-derived mesenchymal stem cells (h-BM-MSC), and finally implanted in a rat ventral hernia model. Neovascularization and tissue regeneration within the implants was evaluated at 6weeks, by histology, immunofluorescence, and q-PCR. It was found that CollE Sheets and Scaffolds were not only biomechanically sturdy enough to provide immediate repair of the hernia defect, but also promoted tissue restoration in only 6weeks. In fact, the presence of elastin enhanced the neovascularization in both sheets and scaffolds. Overall, CollE Scaffolds displayed mechanical properties more closely resembling those of native tissue, and induced higher gene expression of the entire marker genes tested, associated with de novo matrix deposition, angiogenesis, adipogenesis and skeletal muscles, compared to CollE Sheets. Altogether, this data suggests that the improved mechanical properties and bioactivity of CollE Sheets and Scaffolds make them valuable candidates for applications of ventral hernia repair. Due to the elevated annual number of ventral hernia repair in the US, the lack of successful grafts, the design of innovative biomimetic meshes has become a prime focus in tissue engineering, to promote the repair of the abdominal wall, avoid recurrence. Our meshes (Coll

  11. Update on Bioactive Prosthetic Material for the Treatment of Hernias.

    Science.gov (United States)

    Edelman, David S; Hodde, Jason P

    2011-12-01

    The use of mesh in the repair of hernias is commonplace. Synthetic mesh, like polypropylene, has been the workhorse for hernia repairs since the 1980s. Surgisis® mesh (Cook Surgical, Bloomington, IN), a biologic hernia graft material composed of purified porcine small intestinal submucosa (SIS), was first introduced to the United States in 1998 as an alternative to synthetic mesh materials. This mesh, composed of extracellular matrix collagen, fibronectin and associated glycosaminoglycans and growth factors, has been extensively investigated in animal models and used clinically in many types of surgical procedures. SIS acts as a scaffold for natural growth and strength. We reported our initial results in this publication in July 2006. Since then, there have been many more reports and numerous other bioactive prosthetic materials (BPMs) released. The object of this article is to briefly review some of the current literature on the use of BPM for inguinal hernias, sports hernias, and umbilical hernias.

  12. Wound healing efficacy of a 660-nm diode laser in a rat incisional wound model.

    Science.gov (United States)

    Suzuki, Ryoichi; Takakuda, Kazuo

    2016-11-01

    This study aimed to elucidate the optimum usage parameters of low reactive-level laser therapy (LLLT) in a rat incisional wound model. In Sprague-Dawley rats, surgical wounds of 15-mm length were made in the dorsal thoracic region. They were divided into groups to receive 660-nm diode laser irradiation 24 h after surgery at an energy density of 0 (control), 1, 5, or 10 J/cm 2 . Tissue sections collected on postoperative day 3 were stained with hematoxylin-eosin and an antibody for ED1 to determine the number of macrophages around the wound. Samples collected on day 7 were stained with hematoxylin-eosin and observed via polarized light microscopy to measure the area occupied by collagen fibers around the wound; day 7 skin specimens were also subjected to mechanical testing to evaluate tensile strength. On postoperative day 3, the numbers of macrophages around the wound were significantly lower in the groups receiving 1 and 5 J/cm 2 irradiation, compared to the control and 10 J/cm 2 irradiation groups (p diode laser with energy density of 1 and 5 J/cm 2 enhanced wound healing in a rat incisional wound model. However, a higher radiation energy density yielded no significant enhancement.

  13. Association Between Thoracic Aortic Disease and Inguinal Hernia

    OpenAIRE

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

    2014-01-01

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

  14. Postoperative analgesic efficacy of ultrasound-guided ilioinguinal-iliohypogastric nerve block compared with medial transverse abdominis plane block in inguinal hernia repair: A prospective, randomised trial.

    Science.gov (United States)

    Bhatia, Nidhi; Sen, Indu Mohini; Mandal, Banashree; Batra, Ankita

    2018-03-29

    Analgesic efficacy of ultrasound-guided transverse abdominis plane block, administered a little more medially, just close to the origin of the transverse abdominis muscle has not yet been investigated in patients undergoing unilateral inguinal hernia repair. We hypothesised that medial transverse abdominis plane block would provide comparable postoperative analgesia to ilioinguinal-iliohypogastric nerve block in inguinal hernia repair patients. This prospective, randomised trial was conducted in 50 ASA I and II male patients≥18 years of age. Patients were randomised into two groups to receive either pre-incisional ipsilateral ultrasound-guided ilioinguinal-iliohypogastric nerve block or medial transverse abdominis plane block, with 0.3ml/kg of 0.25% bupivacaine. Our primary objective was postoperative 24-hour analgesic consumption and secondary outcomes included pain scores, time to first request for rescue analgesic and side effects, if any, in the postoperative period. There was no significant difference in the total postoperative analgesic consumption [group I: 66.04mg; group II: 68.33mg (P value 0.908)]. Time to first request for rescue analgesic was delayed, though statistically non-significant (P value 0.326), following medial transverse abdominis plane block, with excellent pain relief seen in 58.3% patients as opposed to 45.8% patients in ilioinguinal-iliohypogastric nerve block group. Medial transverse abdominis plane block being a novel, simple and easily performed procedure can serve as an useful alternative to ilioinguinal-iliohypogastric nerve block for providing postoperative pain relief in inguinal hernia repair patients. Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  15. Prosthetic Mesh Repair for Incarcerated Inguinal Hernia

    Directory of Open Access Journals (Sweden)

    Cihad Tatar

    2016-08-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Michael Leshen

    2016-01-01

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

  18. Pre-operative pain and sensory function in groin hernia

    DEFF Research Database (Denmark)

    Aasvang, Eske K; Hansen, Jeanette B; Kehlet, Henrik

    2009-01-01

    BACKGROUND: Although persistent postherniotomy occurs in 5-10% of patients, pathogenic mechanisms remain debatable. Since pre-operative pain has been demonstrated to be a risk factor for persistent postherniotomy pain, pre-operative alterations in nociceptive function may be a potential pathogenic...... mechanism. AIMS: To investigate the correlation between pre-operative pain intensity and sensory functions in the groin hernia area. METHODS: Patients with unilateral groin hernia were examined preoperatively by quantitative sensory testing (thermal, mechanical, and pressure [detection and pain thresholds...... (7%), all whom experienced no pain or pain less than weekly. Only cool detection thresholds were significantly lower between the hernia vs. contralateral side (poperative groin hernia...

  19. 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...

  20. Left-Sided Congenital Diaphragmatic Hernia with Multiple Congenital Cardiac Anomalies, Hernia Sac, and Microscopic Hepatic Heterotopia: A Case Report

    Directory of Open Access Journals (Sweden)

    Maria Arafah

    2011-01-01

    Full Text Available Congenital diaphragmatic hernia is a common congenital anomaly of uncertain etiology. Its association with multiple congenital anomalies in various organs is well recognized and antenatal radiological evidence of congenital diaphragmatic hernia warrants thorough evaluation to detect other anomalies, some of which can be life threatening. Rarely, heterotopic hepatic tissue is identified in the hernia, a rare pathological finding, exhibiting more than one macroscopic and microscopic characteristics, and always associated with cardiac congenital anomalies. Herein, we report a case of left-sided microscopic heterotopic hepatic tissue in a congenital diaphragmatic hernia in an infant with multiple cardiac congenital anomalies, but with preserved pericardium.

  1. 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.

  2. Prenatal diagnosis of congenital paraesophageal hiatal hernia

    Directory of Open Access Journals (Sweden)

    Min Jeng Cho

    2018-05-01

    Full Text Available Abstracts: Congenital paraesophageal hiatal hernia (CPEH is a rare condition. CPEH can cause important clinical problems such as gastric volvulus, hematemesis, vomiting, failure to thrive, and respiratory distress, it requires early diagnosis and prompt surgical treatment. In this paper, we describe a case of CPEH that was suspected in a prenatal ultrasound. Postnatal upper gastrointestinal contrast series confirmed a CPEH with intrathoracic gastric volvulus. An emergency operation was performed. The stomach was reduced, the hiatal defect was repaired by crural approximation, and a Nissen fundoplication was done. The prenatal diagnosis of CPEH is unusual, but prenatal detection is important because it allows planned neonatal surgery before the onset of complications and reduces long-term morbidity. Keywords: Congenital paraesophageal hiatal hernia, Antenatal diagnosis, Gastric volvulus

  3. Open preperitoneal groin hernia repair with mesh

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    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...... 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......-analysis. Open preperitoneal techniques with placement of a mesh through an open approach seem promising compared with the standard anterior techniques. This systematic review provides an overview of these techniques together with a description of surgical methods and clinical outcomes....

  4. Open preperitoneal groin hernia repair with mesh

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    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......: 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......-analysis. Open preperitoneal techniques with placement of a mesh through an open approach seem promising compared with the standard anterior techniques. This systematic review provides an overview of these techniques together with a description of surgical methods and clinical outcomes....

  5. Parastomal hernia - current knowledge and treatment.

    Science.gov (United States)

    Styliński, Roman; Alzubedi, Adam; Rudzki, Sławomir

    2018-03-01

    Intestinal stoma creation is one of the most common surgical procedures. The most common long-term complication following stoma creation is parastomal hernia, which according to some authors is practically unavoidable. Statistical differences of its occurrence are mainly due to patient observation time and evaluation criteria. Consequently, primary prevention methods such as placement of prosthetic mesh and newly developed minimally invasive methods of stoma creation are used. It seems that in the light of evidence-based medicine, the best way to treat parastomal hernia is the one that the surgeon undertaking therapy is the most experienced in and is suited to the individuality of each patient, his condition and comorbidities. As a general rule, reinforcing the abdominal wall with a prosthetic mesh is the treatment of choice, with a low rate of complications and relapses over a long period of time. The current trend is to use lightweight, large pore meshes.

  6. Convalescence after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

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

    2016-01-01

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

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

    Czech Academy of Sciences Publication Activity Database

    Plencner, M.; East, B.; Tonar, Z.; Otáhal, M.; Prosecká, E.; Rampichová, M.; Krejčí, T.; Litvinec, Andrej; Buzgo, M.; Míčková, A.; Nečas, A.; Hoch, J.; Amler, E.

    2014-01-01

    Roč. 9, č. 2014 (2014), s. 3263-3227 E-ISSN 1178-2013 Institutional support: RVO:67985823 Keywords : nanofibers * growth factors * surgical mesh Subject RIV: FP - Other Medical Disciplines Impact factor: 4.383, year: 2014

  8. AUTOTRANSPLANTATION OF MESENCHYMAL STEM CELLS FROM ADIPOSE TISSUE – INNOVATIVE PATHOGENETIC METHOD OF TREATMENT OF PATIENTS WITH INCISIONAL HERNIAS (FIRST CASES REPORT

    Directory of Open Access Journals (Sweden)

    V. G. Bogdan

    2012-01-01

    Full Text Available In the article a complex technology of receiving a biological transplant with autologous mesenchymal stem cells from the adipose tissue is presented. Possibility of successful clinical performance of reconstruction of extensive defects of anterior belly wall with the use of a multicomponent biological transplant with autologous mesenchy- mal stem cells from the adipose tissue, differentiated in the fibroblast direction is shown. The use of the proposed method of plasticity promotes the improvement of quality of surgical treatment, expansies the scope of cellular technologies in practical health care, improves the patients quality of life in the postoperative period. 

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

    Czech Academy of Sciences Publication Activity Database

    Plencner, Martin; East, B.; Tonar, Z.; Otáhal, M.; Prosecká, Eva; Rampichová, Michala; Krejčí, T.; Litvinec, Andrej; Buzgo, Matej; Míčková, Andrea; Nečas, A.; Hoch, J.; Amler, Evžen

    2014-01-01

    Roč. 9, č. 1 (2014), s. 3263-3277 E-ISSN 1178-2013 R&D Projects: GA MŠk CZ.1.05/1.1.00/02.0068 Grant - others:GA MŠk(CZ) project IPv6 ; GA UK(CZ) 545313; GA UK(CZ) 384311; GA UK(CZ) 270513; GA UK(CZ) 424213; GA UK(CZ) 648112; GA MZd(CZ) NT12156; GA MŠk(CZ) ED2.1.00/03.0076; Středoevropský technologický institut CZ.1.05/1.1.00/02.0068 Institutional support: RVO:68378041 Keywords : nanofibers * growth factors * surgical mesh Subject RIV: FP - Other Medical Disciplines Impact factor: 4.383, year: 2014

  10. Laparoscopic hernia repair and bladder injury.

    Science.gov (United States)

    Dalessandri, K M; Bhoyrul, S; Mulvihill, S J

    2001-01-01

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

  11. Sports hernia repair with adductor tenotomy.

    Science.gov (United States)

    Harr, J N; Brody, F

    2017-02-01

    Sports hernias, or athletic pubalgia, is common in athletes, and primarily involves injury to the fascia, muscles, and tendons of the inguinal region near their insertion onto the pubic bone. However, management varies widely, and rectus and adductor tenotomies have not been adequately described. The purpose of this manuscript is to demonstrate a suture repair and a rectus and adductor longus tenotomy technique for sports hernias. After magnetic-resonance-imaging confirmation of sports hernias with rectus and adductor tendonitis, 22 patients underwent a suture herniorrhaphy with adductor tenotomy. The procedure is performed through a 4-cm incision, and a fascial release of the rectus abdominis and adductor tenotomy is performed to relieve the opposing vector forces on the pubic bone. All 22 patients returned to their respective sports and regained their ability to perform at a high level, including professional status. No further surgery was required. In athletes with MRI confirmation of rectus and adductor longus injuries, tenotomies along with a herniorraphy may improve outcomes. A suture repair to reinforce the inguinal floor prevents mesh-related complications, especially in young athletes.

  12. Financial implications of ventral hernia repair: a hospital cost analysis.

    Science.gov (United States)

    Reynolds, Drew; Davenport, Daniel L; Korosec, Ryan L; Roth, J Scott

    2013-01-01

    Complicated ventral hernias are often referred to tertiary care centers. Hospital costs associated with these repairs include direct costs (mesh materials, supplies, and nonsurgeon labor costs) and indirect costs (facility fees, equipment depreciation, and unallocated labor). Operative supplies represent a significant component of direct costs, especially in an era of proprietary synthetic meshes and biologic grafts. We aim to evaluate the cost-effectiveness of complex abdominal wall hernia repair at a tertiary care referral facility. Cost data on all consecutive open ventral hernia repairs (CPT codes 49560, 49561, 49565, and 49566) performed between 1 July 2008 and 31 May 2011 were analyzed. Cases were analyzed based upon hospital status (inpatient vs. outpatient) and whether the hernia repair was a primary or secondary procedure. We examined median net revenue, direct costs, contribution margin, indirect costs, and net profit/loss. Among primary hernia repairs, cost data were further analyzed based upon mesh utilization (no mesh, synthetic, or biologic). Four-hundred and fifteen patients underwent ventral hernia repair (353 inpatients and 62 outpatients); 173 inpatients underwent ventral hernia repair as the primary procedure; 180 inpatients underwent hernia repair as a secondary procedure. Median net revenue ($17,310 vs. 10,360, p costs for cases performed without mesh were $5,432; median direct costs for those using synthetic and biologic mesh were $7,590 and 16,970, respectively (p financial loss was $8,370. Outpatient ventral hernia repairs, with and without synthetic mesh, resulted in median net losses of $1,560 and 230, respectively. Ventral hernia repair is associated with overall financial losses. Inpatient synthetic mesh repairs are essentially budget neutral. Outpatient and inpatient repairs without mesh result in net financial losses. Inpatient biologic mesh repairs result in a negative contribution margin and striking net financial losses. Cost

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

    Science.gov (United States)

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

    2015-09-16

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

  14. Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy (GATT) in Eyes With Prior Incisional Glaucoma Surgery.

    Science.gov (United States)

    Grover, Davinder S; Godfrey, David G; Smith, Oluwatosin; Shi, Wei; Feuer, William J; Fellman, Ronald L

    2017-01-01

    To report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior incisional glaucoma surgery. A retrospective review was performed for all patients who underwent a GATT procedure with a history of prior incisional glaucoma surgery. Thirty-five eyes of 35 patients were treated. The mean age was 67.7 years. Nineteen eyes had a prior trabeculectomy, 13 eyes had a prior glaucoma drainage device, 4 eyes had a prior trabectome, and 5 eyes had prior endocyclophotocoagulation. Mean follow-up time was 22.7 months. For all eyes, the mean preoperative intraocular pressure (IOP) (SD) was 25.7 (6.5) mm Hg on 3.2 (1.0) glaucoma medications and at 24 months, the mean IOP (SD) was 15.4 (4.9) mm Hg on 2.0 (1.4) glaucoma medications (P<0.001). The prior trabeculectomy group had a preoperative IOP (SD) of 24.6 (6.4) mm Hg on 3.2 (1.0) medications and at month 24, the mean IOP (SD) was 16.7 (5.6) mm Hg on 2.1 (1.4) glaucoma medications. In the prior glaucoma drainage device group, the mean preoperative IOP (SD) was 27.0 (7.1) mm Hg on 3.4 (1.1) glaucoma medications and at 24 months, the mean IOP (SD) was 12.9 (2.6) mm Hg on 2.1 (1.2) glaucoma medications. At 24 months, the cumulative proportion of failure was 0.4 and the cumulative proportion of reoperation was 0.29. GATT appears to be safe and successful in treating 60% to 70% of open-angle patients with prior incisional glaucoma surgery. When considering all eyes, there was a significant decrease in IOP and required glaucoma medications at 24 months. This surgery should be considered in certain patients with open angles who have failed a primary traditional glaucoma surgery.

  15. Occurrence and recurrence of gastric dilatation with or without volvulus after incisional gastropexy.

    Science.gov (United States)

    Przywara, John F; Abel, Steven B; Peacock, John T; Shott, Susan

    2014-10-01

    This study investigated recurrence of gastric dilatation without (GD) or with volvulus (GDV) after incisional gastropexy (IG) in dogs that underwent IG for prevention of GDV. Signalment, concurrent surgical procedures, presence of GD or GDV at the time of IG were obtained from medical records of dogs that underwent IG. Owners were contacted to determine whether the dogs experienced GD or GDV after IG, dates of postoperative GD or GDV episodes, survival status, date of death for deceased dogs. Gastric dilatation and GDV recurrence rates were calculated for 40 dogs that had at least 2 y follow-up from the time when IG was performed and for dogs that experienced GD or GDV during the follow-up period. No dogs experienced GDV after IG and 2 dogs (5.0%) experienced GD after IG. The results suggest that GD and GDV rates after IG may be comparable to recurrence rates after other methods of gastropexy.

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

    African Journals Online (AJOL)

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

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

    DEFF Research Database (Denmark)

    Reimers, J I; Latocha, J E

    1990-01-01

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

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

    Science.gov (United States)

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

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

  19. Bowel obstruction in obturator hernia: A challenging diagnosis

    Directory of Open Access Journals (Sweden)

    L. Conti

    2018-01-01

    Conclusion: Obturator hernia is a rare type of hernia due to his diagnosis, which is often unclear; a prompt suspect based for the non-specific symptoms is crucial for the diagnosis. Surgical management depends on early diagnosis and it is the only possible treatment for this pathology.

  20. Laparoscopic repair of Morgagni diaphragmatic hernia in children ...

    African Journals Online (AJOL)

    Minimal invasive surgery allows for excellent visualisation of the diaphragm, and is increasingly used for the repair of diaphragmatic hernias in children. This report describes laparoscopic repairs between 2001 and 2007 of four Morgagni hernias in children. All defects were treated successfully using the laparoscopic ...

  1. Primary lumbar hernia in an elderly woman: case report | Ouma ...

    African Journals Online (AJOL)

    Surgical dissection revealed a large hernial sac, which contained retro peritoneal fat, protruding through a 3-4 centimetres defect in the transversalis fascia lining the floor of the superior lumbar triangle. The hernia sac was reduced and the defect closed. There was no recurrence four months post-operative. Lumber hernias ...

  2. Transdiaphragmatic intercostal hernia: imaging aspects in three cases

    Directory of Open Access Journals (Sweden)

    Ana Carolina Sandoval Macedo

    2013-06-01

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

  3. Clinical study on 44 cases of femoral hernia

    International Nuclear Information System (INIS)

    Yamamoto, Ryo; Shinozaki, Hiroharu; Kase, Kenichi; Kobayashi, Kenji; Sasaki, Junichi

    2012-01-01

    Femoral hernia is a surgical disease that is frequently associated with incarceration and necessitates emergency surgery. However, there are only a few studies referred which have compared emergency and elective surgery for femoral hernias. We retrospectively reviewed the clinical characteristics of patients diagnosed as having femoral hernia between 2005 and 2009 in our institution. The clinical features of emergency repairs were compared with those of elective ones, and diagnostic values of preoperative diagnostic modalities were studied. The mean age of the patients was 73±12 years. Females comprised 68% of the cases, and right femoral hernias comprised 70% of the cases. Incarceration was associated with 66% of the cases (29 patients), and emergency surgery was performed in 52% of the patients (23 patients). Bowel resection was performed in 32% of the cases (14 patients). The mean age, body temperature, white blood cell (WBC) count, and LDH value were higher in the emergency repairs than in the elective one, and most of the hernias were repaired with McVay's procedure. CT scans had a high diagnostic value in detecting femoral hernias (44%) and incarceration (88%). It was confirmed that femoral hernias were frequently associated with incarceration and CT scan has a high diagnostic value in femoral hernias. (author)

  4. Obturator Hernia: diagnosis and management under conditions of ...

    African Journals Online (AJOL)

    85.7%) underwent full resection and anastomosis, and one (14.3%) had partial resection. Hernia defect was closed in four (57.1%). Wound infection was common (71.4%) and three (43%) died. Conclusion: Obturator hernia is mainly a disease ...

  5. An inguinal hernia sac tumor of extrahepatic cholangiocarcinoma origin

    Directory of Open Access Journals (Sweden)

    Yamazaki Hidehiro

    2006-03-01

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

  6. Bilateral giant inguinoscrotal Hernia: psychosocial issues and a new ...

    African Journals Online (AJOL)

    Background: Bilateral giant inguinoscrotal hernias pose challenging psychosocial problems to the patient. The engulfed phallus and hernia size are socially embarrassing and may make penetration during coitus increasingly difficult and uncomfortable. This paper presents a classification and the psychosocial aspects of ...

  7. Y-to-V umbilicoplasty for proboscoid umbilical hernia | Almetaher ...

    African Journals Online (AJOL)

    Background/purpose Several techniques are proposed for reconstruction of proboscoid umbilical hernia in the pediatric patients. In this work, we reported our experience with Y-to-V umbilicoplasty in the surgical repair of proboscoid umbilical hernia in infants and children. Patients and methods A 3-year prospective study ...

  8. Neonatal perforated Amyand's hernia presenting as an enterocutaneous scrotal fistula

    Directory of Open Access Journals (Sweden)

    Antonios Panagidis

    2015-07-01

    Full Text Available Perforation of the vermiform appendix in a septic neonate with an Amyand's hernia resulted in the formation of a scrotal enterocutaneous fistula. In conclusion from this exceptional complication, active parental awareness for any neonatal scrotal swelling is required, and an early operative policy for the neonatal inguinal hernia is significant.

  9. Pattern of abdominal wall herniae in females: a retrospective analysis.

    African Journals Online (AJOL)

    Result: There were 181 female patients with 184 hernias representing 27.9% of the total ... It is not unexpected to find variations in the pattern of hernia presentation and outcome of man- .... with majority typically found in elderly females with a.

  10. Perineal hernias in children: Case report and review of the literature ...

    African Journals Online (AJOL)

    Perineal hernias (pelvic floor hernias) are extremely rare occurring through defects in musculature of the pelvic floor. This report presents a successfully treated case of primary perineal hernia and takes a review of the existing literature. The case of a 14-month-old girl with a great perineal hernia is presented. Diagnosis was ...

  11. Imaging diagnosis--positive contrast peritoneographic features of true diaphragmatic hernia.

    Science.gov (United States)

    Choi, Jihye; Kim, Hyunwook; Kim, Mieun; Yoon, Junghee

    2009-01-01

    A true diaphragmatic hernia is a congenital diaphragmatic malformation that can appear identical to a peritoneopericardial diaphragmatic hernia (PPDH). True diaphragmatic hernias are rare in dogs. Herein we describe the use of positive contrast peritoneography for diagnosis of a true diaphragmatic hernia in two dogs.

  12. Amyand\\'s Hernia - A Case Report | Nimako | African Journal of ...

    African Journals Online (AJOL)

    The finding of a vermiform appendix as the content of an inguinal hernia sac is rare. Even rarer is the finding of an inflamed appendix in the hernia sac, referred to asAmyand\\'s hernia.We report a case of a 5-year-old boy who presented with an inflamed appendix as the content of an incarcerated right inguinal hernia.

  13. High-frequency electroacupuncture versus carprofen in an incisional pain model in rats

    Energy Technology Data Exchange (ETDEWEB)

    Teixeira, F.M.; Castro, L.L.; Ferreira, R.T.; Pires, P.A.; Vanderlinde, F.A.; Medeiros, M.A. [Departamento de Ciências Fisiológicas, Universidade Federal Rural do Rio de Janeiro, Rio de Janeiro, RJ (Brazil)

    2012-08-24

    The objective of the present study was to compare the effect of electroacupuncture (EA) and carprofen (CP) on postoperative incisional pain using the plantar incision (PI) model in rats. A 1-cm longitudinal incision was made through skin, fascia and muscles of a hind paw of male Wistar rats and the development of mechanical and thermal hypersensitivity was determined over 4 days using the von Frey and Hargreaves methods, respectively. Based on the experimental treatments received on the third postoperative day, the animals were divided into the following groups: PI+CP (CP, 2 mg/kg, po); PI+EAST36 (100-Hz EA applied bilaterally at the Zusanli point (ST36)); PI+EANP (EA applied to a non-acupoint region); PI+IMMO (immobilization only); PI (vehicle). In the von Frey test, the PI+EAST36 group had higher withdrawal force thresholds in response to mechanical stimuli than the PI, PI+IMMO and PI+EANP groups at several times studied. Furthermore, the PI+EAST36 group showed paw withdrawal thresholds in response to mechanical stimuli that were similar to those of the PI+CP group. In the Hargreaves test, all groups had latencies higher than those observed with PI. The PI+EAST36 group was similar to the PI+IMMO, PI+EANP and PI+CP groups. We conclude that 100-Hz EA at the ST36 point, but not at non-acupoints, can reduce mechanical nociception in the rat model of incisional pain, and its effectiveness is comparable to that of carprofen.

  14. High-frequency electroacupuncture versus carprofen in an incisional pain model in rats

    Directory of Open Access Journals (Sweden)

    F.M. Teixeira

    2012-12-01

    Full Text Available The objective of the present study was to compare the effect of electroacupuncture (EA and carprofen (CP on postoperative incisional pain using the plantar incision (PI model in rats. A 1-cm longitudinal incision was made through skin, fascia and muscles of a hind paw of male Wistar rats and the development of mechanical and thermal hypersensitivity was determined over 4 days using the von Frey and Hargreaves methods, respectively. Based on the experimental treatments received on the third postoperative day, the animals were divided into the following groups: PI+CP (CP, 2 mg/kg, po; PI+EAST36 (100-Hz EA applied bilaterally at the Zusanli point (ST36; PI+EANP (EA applied to a non-acupoint region; PI+IMMO (immobilization only; PI (vehicle. In the von Frey test, the PI+EAST36 group had higher withdrawal force thresholds in response to mechanical stimuli than the PI, PI+IMMO and PI+EANP groups at several times studied. Furthermore, the PI+EAST36 group showed paw withdrawal thresholds in response to mechanical stimuli that were similar to those of the PI+CP group. In the Hargreaves test, all groups had latencies higher than those observed with PI. The PI+EAST36 group was similar to the PI+IMMO, PI+EANP and PI+CP groups. We conclude that 100-Hz EA at the ST36 point, but not at non-acupoints, can reduce mechanical nociception in the rat model of incisional pain, and its effectiveness is comparable to that of carprofen.

  15. High-frequency electroacupuncture versus carprofen in an incisional pain model in rats

    International Nuclear Information System (INIS)

    Teixeira, F.M.; Castro, L.L.; Ferreira, R.T.; Pires, P.A.; Vanderlinde, F.A.; Medeiros, M.A.

    2012-01-01

    The objective of the present study was to compare the effect of electroacupuncture (EA) and carprofen (CP) on postoperative incisional pain using the plantar incision (PI) model in rats. A 1-cm longitudinal incision was made through skin, fascia and muscles of a hind paw of male Wistar rats and the development of mechanical and thermal hypersensitivity was determined over 4 days using the von Frey and Hargreaves methods, respectively. Based on the experimental treatments received on the third postoperative day, the animals were divided into the following groups: PI+CP (CP, 2 mg/kg, po); PI+EAST36 (100-Hz EA applied bilaterally at the Zusanli point (ST36)); PI+EANP (EA applied to a non-acupoint region); PI+IMMO (immobilization only); PI (vehicle). In the von Frey test, the PI+EAST36 group had higher withdrawal force thresholds in response to mechanical stimuli than the PI, PI+IMMO and PI+EANP groups at several times studied. Furthermore, the PI+EAST36 group showed paw withdrawal thresholds in response to mechanical stimuli that were similar to those of the PI+CP group. In the Hargreaves test, all groups had latencies higher than those observed with PI. The PI+EAST36 group was similar to the PI+IMMO, PI+EANP and PI+CP groups. We conclude that 100-Hz EA at the ST36 point, but not at non-acupoints, can reduce mechanical nociception in the rat model of incisional pain, and its effectiveness is comparable to that of carprofen

  16. High-frequency electroacupuncture versus carprofen in an incisional pain model in rats.

    Science.gov (United States)

    Teixeira, F M; Castro, L L; Ferreira, R T; Pires, P A; Vanderlinde, F A; Medeiros, M A

    2012-12-01

    The objective of the present study was to compare the effect of electroacupuncture (EA) and carprofen (CP) on postoperative incisional pain using the plantar incision (PI) model in rats. A 1-cm longitudinal incision was made through skin, fascia and muscles of a hind paw of male Wistar rats and the development of mechanical and thermal hypersensitivity was determined over 4 days using the von Frey and Hargreaves methods, respectively. Based on the experimental treatments received on the third postoperative day, the animals were divided into the following groups: PI+CP (CP, 2 mg/kg, po); PI+EAST36 (100-Hz EA applied bilaterally at the Zusanli point (ST36)); PI+EANP (EA applied to a non-acupoint region); PI+IMMO (immobilization only); PI (vehicle). In the von Frey test, the PI+EAST36 group had higher withdrawal force thresholds in response to mechanical stimuli than the PI, PI+IMMO and PI+EANP groups at several times studied. Furthermore, the PI+EAST36 group showed paw withdrawal thresholds in response to mechanical stimuli that were similar to those of the PI+CP group. In the Hargreaves test, all groups had latencies higher than those observed with PI. The PI+EAST36 group was similar to the PI+IMMO, PI+EANP and PI+CP groups. We conclude that 100-Hz EA at the ST36 point, but not at non-acupoints, can reduce mechanical nociception in the rat model of incisional pain, and its effectiveness is comparable to that of carprofen.

  17. Use of Liposomal Bupivacaine for Postoperative Analgesia in an Incisional Pain Model in Rats (Rattus norvegicus).

    Science.gov (United States)

    Kang, Stacey C; Jampachaisri, Katechan; Seymour, Travis L; Felt, Stephen A; Pacharinsak, Cholawat

    2017-01-01

    The local anesthetic bupivacaine is valuable for perioperative analgesia, but its use in the postoperative period is limited by its short duration of action. Here, we evaluated the application of a slow-release liposomal formulation of bupivacaine for postoperative analgesia. The aim was to assess whether liposomal bupivacaine effectively attenuates postoperative mechanical and thermal hypersensitivity in a rat model of incisional pain. Rats (n = 36) were randomly assigned to 1 of 5 treatment groups: saline, 1 mL/kg SC every 12 h for 2 d; buprenorphine HCl, 0.05 mg/kg SC every 12 h for 2 d (Bup HCl); 0.5% bupivacaine, 2 mg/kg SC local infiltration once (Bupi); liposomal bupivacaine, 1 mg/kg SC local infiltration once (Exp1); and liposomal bupivacaine, 6 mg/kg SC local infiltration once (Exp6). Mechanical and thermal hypersensitivity were evaluated daily on days -1, 0, 1, 2, 3, and 4. The saline group exhibited both hypersensitivities through all 4 evaluated postoperative days. Bup HCl attenuated mechanical hypersensitivity for 2 d and thermal hypersensitivity for 1 d. Bupi attenuated only thermal hypersensitivity for 4 d. Rats in the Exp1 group showed attenuation of both mechanical and thermal hypersensitivity for 4 d, and those in the Exp6 group had attenuation of mechanical hypersensitivity on day 0 and thermal hypersensitivity for 4 d. These data suggest that a single local infiltration of liposomal bupivacaine at a dose of 1 mg/kg SC effectively attenuates postoperative mechanical and thermal hypersensitivity for 4 d in a rat model of incisional pain.

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

    Directory of Open Access Journals (Sweden)

    Hyo Seong Kim

    2012-05-01

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

  19. Anti-hyperalgesic effect of electroacupuncture in a model of post-incisional pain in rats

    Directory of Open Access Journals (Sweden)

    R. Oliveira

    2000-08-01

    Full Text Available Electroacupuncture has been proposed to be a low cost and practical method that allows effective pain management with minimal collateral effects. In this study we have examined the effect of electroacupuncture against the hyperalgesia developed in a model of post-incisional pain in rats. A 1-cm longitudinal incision was made through the skin and fascia of the plantar region of the animal hind paw. Mechanical hyperalgesia in the incision was evaluated 135 min after the surgery with von Frey filaments. The tension threshold was reduced from 75 g (upper limit of the test to 1.36 ± 0.36 g (mean ± SEM in control rats. It is shown that a 15-min period of electroacupuncture applied 120 min after surgery to the Zusanli (ST36 and Sanyinjiao (SP6 points, but not to non-acupoints, produces a significant and long-lasting reduction of the mechanical hyperalgesia induced by the surgical incision of the plantar surface of the ipsilateral hind paw. The tension threshold was reduced from 75 to 27.6 ± 4.2 g in animals soon after the end of electroacupuncture. The mechanical threshold in this group was about 64% less than in control. Electroacupuncture was ineffective in rats treated 10 min earlier with naloxone (1 mg/kg, ip, thus confirming the involvement of opioid mechanisms in the antinociceptive effects of such procedure. The results indicate that post-incisional pain is a useful model for studying the anti-hyperalgesic properties of electroacupuncture in laboratory animals.

  20. A very simple technique to repair Grynfeltt-Lesshaft hernia.

    Science.gov (United States)

    Solaini, Leonardo; di Francesco, F; Gourgiotis, S; Solaini, Luciano

    2010-08-01

    A very simple technique to repair a superior lumbar hernia is described. The location of this type of hernia, also known as the Grynfeltt-Lesshaft hernia, is defined by a triangle placed in the lumbar region. An unusual case of a 67-year-old woman with a superior lumbar hernia is reported. The diagnosis was made by physical examination. The defect of the posterior abdominal wall was repaired with a polypropylene dart mesh. The patient had no evidence of recurrence at 11 months follow up. The surgical approach described in this paper is simple and easy to perform, and its result is comparable with other techniques that are much more sophisticated. No cases on the use of dart mesh to repair Grynfeltt-Lesshaft hernia have been reported by surgical journals indexed in PubMed.

  1. High resolution computed tomography evaluation of cervical disk hernia

    International Nuclear Information System (INIS)

    Halversen, G.L.; Thoen, D.D.; Satovick, R.M.; Goldstein, M.L.

    1986-01-01

    Previous difficulties in the diagnosis of cervical disk hernia were related to lack of non-invasive imaging techniques, but the gap has now been filled by CT scan imaging. A total of 442 patients with pains in neck, shoulder or arm were referred for a CT scan to exclude a cervical disk hernia. Of the group studied, 2% were found to have a herniated disk, 16% a lateral hernia and 9% combined lateral hernia-narrow cervical canal due to concomitant arthrotic changes. Assessment of correlation between CT scan images and myelographic and surgical findings indicated that CT scan imaging is a very precise, non-invasive method for investigation of cervical disk hernia [fr

  2. High resolution computed tomography evaluation of cervical disk hernia

    Energy Technology Data Exchange (ETDEWEB)

    Halversen, G.L.; Thoen, D.D.; Satovick, R.M.; Goldstein, M.L.

    1986-05-01

    Previous difficulties in the diagnosis of cervical disk hernia were related to lack of non-invasive imaging techniques, but the gap has now been filled by CT scan imaging. A total of 442 patients with pains in neck, shoulder or arm were referred for a CT scan to exclude a cervical disk hernia. Of the group studied, 2% were found to have a herniated disk, 16% a lateral hernia and 9% combined lateral hernia-narrow cervical canal due to concomitant arthrotic changes. Assessment of correlation between CT scan images and myelographic and surgical findings indicated that CT scan imaging is a very precise, non-invasive method for investigation of cervical disk hernia.

  3. Traumatic diaphragmatic hernias: Retrospective analysis

    Directory of Open Access Journals (Sweden)

    J.P.A. Sousa

    2006-05-01

    Full Text Available Aims: This study classifies cases of traumatic diaphragmatic hernias (TDH in patients admitted to the Intensive Care Unit (ICU of the Coimbra University Hospitals (HUC from 1990 to 2004. Methods: Retrospective analysis of 34 cases of TDH, studying anatomical location, place and time of diagnosis, complementary tests aiding diagnosis, herniated organs, associated traumatism, morbidity and mortality. Results: Twenty-eight male and six female patients with an average age of 40.5 years ± 20.5, average SAPS score 38.8. Average lenght of stay was 19.1 ± 13.6 days, all suffered from closed traumatism and were put on artificial ventilation. The left-side diaphragm was more frequently affected (94.1% then the right. Diagnosis in 19 cases was made up in the first six hours following the diagnosis of traumatism, in four cases within 12 hours and in the remaining cases between 48 hours and 16 years after traumatism. In 13 patients the diagnosis was established intra-operatively. The stomach was typically one of the herniated organs. The most frequently associated lesions at the thoracic level were pulmonary contusion, haemothorax and pneumothorax, and at the abdominal level, haemoperitoneum and splenic lesion. The rates for complications and mortality were 55.8% and 11.7% respectively. Conclusions: TDH mainly occurs on the left side through closed thoraco-abdominal trauma following road traffic accidents. This group of patients, on average younger than others admitted to ICU, presents a longer average hospitalisation period, but has lower rates of mortality and lower SAPS severity scores. The most commonly herniated organ was the stomach and the most frequently encountered lesions were cranial-encephalic, splenic and pleural traumatisms. Pre-operative diagnosis of diaphragmatic injuries is difficult and a high index of clinical suspicion is needed after thoracoabdominal trauma. This diagnosis should always be considered a possibility in

  4. The feasibility, safety and cost of infiltration anaesthesia for hernia repair. Hvidovre Hospital Hernia Group

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Kehlet, H

    1998-01-01

    Data from 400 consecutive elective ambulatory operations for inguinal hernia under unmonitored local anaesthesia with limited pre-operative testing were prospectively obtained by the use of standardised files and questionnaires to assess the feasibility, patient satisfaction and potential cost re...

  5. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Bisgaard, Thue; Kehlet, Henrik

    2011-01-01

    a mesh secured with a nonabsorbable monofilament suture. In laparoscopic repair a mesh without a slit and with a minimum size of 15 by 10 cm is used. For mesh fixation absorbable or nonabsorbable tacks or glue can be used. Elective surgery for groin hernia should be performed in an outpatient setting...

  6. One-stop endoscopic hernia surgery: efficient and satisfactory.

    Science.gov (United States)

    Voorbrood, C E H; Burgmans, J P J; Clevers, G J; Davids, P H P; Verleisdonk, E J M M; Schouten, N; van Dalen, T

    2015-06-01

    One-stop surgery offers patients diagnostic work-up and subsequent surgical treatment on the same day. In the present study, patient satisfaction and efficiency from an institutional perspective were evaluated in patients who were referred for one-stop endoscopic inguinal hernia repair. In a high-volume inguinal hernia clinic, all consecutive patients referred for one-stop surgical treatment, were registered prospectively. An instructed secretary screened patients for eligibility for the one-stop option when the appointment was made. Totally extraperitoneal hernia repair under general anaesthesia was the preferred operative technique. Patient's satisfaction, successful day surgery and institutional efficiency were evaluated. Between January 2010 and January 2012 a total of 349 patients (17 % of all patients in the hernia clinic) were referred for one-stop hernia repair. Mean age was 47.5 years and 96.3 % were males. Three hundred thirty-six patients underwent hernia surgery on the same day (96.3 %). In thirteen patients (3.7 %) no operative repair was done on the day of presentation due to an incorrect diagnosis (n = 7), a watchful waiting policy for asymptomatic hernia (n = 3), rescheduling due to a large scrotal hernia, and there were two "no shows". Following hernia repair 97 % of the patients were discharged on the same day, while ten patients required hospitalization. Based on the questionnaires the main satisfaction score among patients was 9.0 (8.89-9.17 95 % CI) on a scale ranging from 0 to 10. One-stop hernia surgery is feasible and satisfactory from an institutional as well as from a patient's perspective.

  7. Umbilical Hernia Repair and Pregnancy: Before, during, after…

    Directory of Open Access Journals (Sweden)

    Hakan Kulacoglu

    2018-01-01

    Full Text Available Umbilical hernias are most common in women than men. Pregnancy may cause herniation or render a preexisting one apparent, because of progressively raised intra-abdominal pressure. The incidence of umbilical hernia among pregnancies is 0.08%. Surgical algorithm for a pregnant woman with a hernia is not thoroughly clear. There is no consensus about the timing of surgery for an umbilical hernia in a woman either who is already pregnant or planning a pregnancy. If the hernia is incarcerated or strangulated at the time of diagnosis, an emergency repair is inevitable. If the hernia is not complicated, but symptomatic an elective repair should be proposed. When the patient has a small and asymptomatic hernia it may be better to postpone the repair until she gives birth. If the hernia is repaired by suture alone, a high risk of recurrence exists during pregnancy. Umbilical hernia repair during pregnancy can be performed with minimal morbidity to the mother and baby. Second trimester is a proper timing for surgery. Asymptomatic hernias can be repaired, following childbirth or at the time of cesarean section (C-section. Elective repair after childbirth is possible as early as postpartum of eighth week. A 1-year interval can give the patient a very smooth convalescence, including hormonal stabilization and return to normal body weight. Moreover, surgery can be postponed for a longer time even after another pregnancy, if the patients would like to have more children. Diastasis recti are very frequent in pregnancy. It may persist in postpartum period. A high recurrence risk is expected in patients with rectus diastasis. This risk is especially high after suture repairs. Mesh repairs should be considered in this situation.

  8. Laparoscopic surgery into mixed hiatal hernia: Results pre-operative and post-operative Tratamiento quirúrgico laparoscópico en la hernia de hiato mixta: Resultados peroperatorios y del seguimiento a medio plazo

    Directory of Open Access Journals (Sweden)

    A. Pagán Pomar

    2009-09-01

    úrgicas clásicas presentan elevada morbimortalidad relacionada con la amplitud de las incisiones, con largas estancias hospitalarias y lenta recuperación. Material y métodos: entre octubre de 2001 a noviembre de 2007 revisamos 39 pacientes con hernia hiatal mixta con una edad media de 65 años (35-78 años. En posición de Lloyd-Davies, se reduce el contenido herniario y se reseca el saco redundante. Se suturan los pilares diafragmáticos con material no reabsorbible. Se interpuso malla de refuerzo en 7/39 reparaciones. Se finaliza con un antirreflujo parcial o completo dependiendo del informe manométrico. Resultados: el tiempo operatorio medio fue de 126 min. La estancia hospitalaria de 2,46 días. Las complicaciones perioperatorias son principalmente cardiorrespiratorias. Un paciente falleció por una perforación intestinal inadvertida durante la intervención y de diagnóstico tardío. Realizamos tránsito gastroduodenal a los 12 meses en 28 pacientes (71,7%. Encontramos recidiva en 8 pacientes (20,5%. Cuatro pacientes asintomáticos, con hallazgo casual en el control radiológico. Tres pacientes con pirosis que requiere tratamiento y una de las recidivas precisó reintervención por estrangulación de un vólvulo gástrico. Conclusiones: la laparoscopia ofrece seguridad y eficacia con rápida recuperación postoperatoria, menor morbilidad y estancia hospitalaria. Tras la cirugía, la recidiva a largo plazo presenta similares resultados a la cirugía abierta, aunque la interposición de malla puede propiciar su disminución.

  9. Incidental De Garengeot?s hernia: A case report of dual pathology to remember

    OpenAIRE

    Whitehead-Clarke, Thomas; Parampalli, Umesh; Bhardwaj, Rakesh

    2015-01-01

    Introduction: A De Garengeot’s hernia is the very rare dual pathology of a vermiform appendix within a femoral hernia. Presentation of case: We discuss the rare case of a 62 year old female who presented as an emergency with a strangulated femoral hernia. Within the hernia sac a partly necrotic vermiform appendix was discovered. The patient successfully underwent an appendicectomy and repair of her femoral hernia. The post-operative period was uneventful, with no further issues at follow-u...

  10. The Amyand’s Hernia: A Rare Clinical Entity Diagnosed by Computed Tomography

    Directory of Open Access Journals (Sweden)

    Suat Keskin

    2013-01-01

    Full Text Available Amyand’s hernia, named for the first person to describe an inguinal hernia containing the vermiform appendix, is an uncommon variant of an inguinal hernia. Amyand’s hernia is an extremely rare condition and is often misdiagnosed. Traditionally, these hernias have been diagnosed at surgery but are increasingly diagnosed by abdominal computed tomography (CT scans. CT of the abdomen may help in guiding the diagnosis.

  11. Surgical management of a De Garengeot’s hernia using a biologic mesh: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Amandine Klipfel

    2017-01-01

    Conclusion: The De Garengeot hernia is an uncommon differential diagnosis for patients presenting with clinical signs of strangled femoral hernia. Although hernia repairs with a synthetic mesh in the presence of appendicitis have been reported, we describe a case of femoral hernia repair using a biologic mesh, in a patient with a De Garengot hernia.

  12. The History of Hiatal Hernia Surgery

    Science.gov (United States)

    Stylopoulos, Nicholas; Rattner, David W.

    2005-01-01

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

  13. Bochdalek hernia of adult in emergency situation

    Directory of Open Access Journals (Sweden)

    Nooruldin F Shakir

    2012-05-01

    Full Text Available We report a case of Bochdalek hernia of the diaphragm in an adult who presented with acute upper abdominal pain and vomiting. We report this case because it is a rare condition, with little more than 100 cases reported in the literature [1]. Moreover, this is a condition mostly found in neonates and children, rarely carrying over into adulthood. This case details how to recognize the condition and how a lack of awareness around it carries a real and a serious potential for misdiagnosis.

  14. Congenital diaphragmatic hernia with gastrointestinal symptomatology

    International Nuclear Information System (INIS)

    Siroka, M.; Bilicky, J.; Hernesniemi, B.

    2014-01-01

    The authors report a case of 6-week-old baby boy with congenital diaphragmatic hernia(CDH). He presented with nonspecific gastrointestinal symptoms. CDH is commonly manifested by nonspecific respiratory problems. The symptoms of CDH in older infants are atypical and misleading. Children may have only gastrointestinal problems even the acute abdomen. In our case, the ultrasound examination of abdomen did not detect the exact cause of vomiting and intolerance of oral intake, but the explanation has brought classic chest X-ray. (author)

  15. Parastomal gallbladder hernia in a septic patient

    Directory of Open Access Journals (Sweden)

    Joseph Frankl, BS

    2017-09-01

    Full Text Available Parastomal gallbladder herniation is a rare complication of enterostomies with only 6 previously reported cases. Most cases have occurred in elderly women. Patients typically presented with acute abdominal pain and the majority was managed operatively. Here, we report the clinical course of an 88-year-old female who presented with signs of sepsis and minimal abdominal symptoms. She was subsequently found to have a parastomal gallbladder herniation and Klebsiella pneumoniae bacteremia. Given the patient's multiple comorbidities, she was managed nonoperatively with manual reduction of the parastomal hernia and antibiotics.

  16. Sportsman’s hernia? An ambiguous term

    Science.gov (United States)

    Dimitrakopoulou, Alexandra; Schilders, Ernest

    2016-01-01

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

  17. Epidemiology of congenital diaphragmatic hernia in Europe

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...

  18. Effect of a high-dose target-controlled naloxone infusion on pain and hyperalgesia in patients following groin hernia repair: study protocol for a randomized controlled trial

    DEFF Research Database (Denmark)

    Pereira, Manuel Pedro; Utke Werner, Mads; Berg Dahl, Joergen

    2015-01-01

    no volunteer developed significant secondary hyperalgesia after the placebo infusion. In order to consistently demonstrate latent sensitization in humans, a pain model inducing deep tissue inflammation, as used in animal studies, might be necessary. The aim of the present study is to examine whether a high......-dose target-controlled naloxone infusion can reinstate pain and hyperalgesia following recovery from open groin hernia repair and thus consistently demonstrate opioid-mediated latent sensitization in humans. METHODS/DESIGN: Patients submitted to unilateral, primary, open groin hernia repair will be included...

  19. Mesh hernia repair and male infertility: a retrospective register study.

    Science.gov (United States)

    Hallén, Magnus; Westerdahl, Johan; Nordin, Pär; Gunnarsson, Ulf; Sandblom, Gabriel

    2012-01-01

    Previous studies have suggested that the use of mesh in groin hernia repair may be associated with an increased risk for male infertility as a result of inflammatory obliteration of structures in the spermatic cord. In a recent study, we could not find an increased incidence of involuntary childlessness. The aim of this study was to evaluate this issue further. Men born between 1950 and 1989, with a hernia repair registered in the Swedish Hernia Register between 1992 and 2007 were cross-linked with all men in the same age group with the diagnosis of male infertility according to the Swedish National Patient Register. The cumulative and expected incidences of infertility were analyzed. Separate multivariate logistic analyses, adjusted for age and years elapsed since the first repair, were performed for men with unilateral and bilateral repair, respectively. Overall, 34,267 men were identified with a history of at least 1 inguinal hernia repair. A total of 233 (0.7%) of these had been given the diagnosis of male infertility after their first operation. We did not find any differences between expected and observed cumulative incidences of infertility in men operated with hernia repair. Men with bilateral hernia repair had a slightly increased risk for infertility when mesh was used on either side. However, the cumulative incidence was less than 1%. Inguinal hernia repair with mesh is not associated with an increased incidence of, or clinically important risk for, male infertility. Copyright © 2012 Mosby, Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-10-01

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

  1. Properties of meshes used in hernia repair: a comprehensive review of synthetic and biologic meshes.

    Science.gov (United States)

    Ibrahim, Ahmed M S; Vargas, Christina R; Colakoglu, Salih; Nguyen, John T; Lin, Samuel J; Lee, Bernard T

    2015-02-01

    Data on the mechanical properties of the adult human abdominal wall have been difficult to obtain rendering manufacture of the ideal mesh for ventral hernia repair a challenge. An ideal mesh would need to exhibit greater biomechanical strength and elasticity than that of the abdominal wall. The aim of this study is to quantitatively compare the biomechanical properties of the most commonly used synthetic and biologic meshes in ventral hernia repair and presents a comprehensive literature review. A narrative review of the literature was performed using the PubMed database spanning articles from 1982 to 2012 including a review of company Web sites to identify all available information relating to the biomechanical properties of various synthetic and biologic meshes used in ventral hernia repair. There exist differences in the mechanical properties and the chemical nature of different meshes. In general, most synthetic materials have greater stiffness and elasticity than what is required for abdominal wall reconstruction; however, each exhibits unique properties that may be beneficial for clinical use. On the contrary, biologic meshes are more elastic but less stiff and with a lower tensile strength than their synthetic counterparts. The current standard of practice for the treatment of ventral hernias is the use of permanent synthetic mesh material. Recently, biologic meshes have become more frequently used. Most meshes exhibit biomechanical properties over the known abdominal wall thresholds. Augmenting strength requires increasing amounts of material contributing to more stiffness and foreign body reaction, which is not necessarily an advantage. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

    Science.gov (United States)

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

    2012-04-01

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

  3. Association between thoracic aortic disease and inguinal hernia.

    Science.gov (United States)

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

    2014-08-21

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

  4. Comparison of postoperative pain and inflammation reaction in dogs undergoing preventive laparoscopic-assisted and incisional gastropexy

    OpenAIRE

    HARAGUCHI, Tomoya; KIMURA, Shiho; ITOH, Harumichi; NISHIKAWA, Shimpei; HIYAMA, Masato; TANI, Kenji; ISERI, Toshie; ITOH, Yoshiki; NAKAICHI, Munekazu; TAURA, Yasuho; ITAMOTO, Kazuhito

    2017-01-01

    This study compared the effects of postoperative pain and inflammation reaction after preventive laparoscopic-assisted gastropexy (LAG) and incisional gastropexy (IG) in 10 clinically normal Beagles. Surgical time, incision length, visual analog scale (VAS) score, University of Melbourne Pain Scale (UMPS) score, and plasma C-reactive protein (CRP), plasma cortisol (COR), and serum interleukin-6 (IL-6) levels were evaluated. The VAS and UMPS scores and COR and IL-6 levels were recorded at 0.5,...

  5. Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

    International Nuclear Information System (INIS)

    Lee, Kwang Lae; Yim, Yoon Myung; Lim, Oh Kyung; Park, Ki Deok; Choi, Chung Hwan; Lee, Ju Kang

    2009-01-01

    Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

  6. Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kwang Lae; Yim, Yoon Myung; Lim, Oh Kyung; Park, Ki Deok; Choi, Chung Hwan; Lee, Ju Kang [Gachon University of Medicine and Science, Incheon (Korea, Republic of)

    2009-12-15

    Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

  7. [Sciatic hernia as a cause of chronic pelvic pain].

    Science.gov (United States)

    De los Ríos, José F; Calle, Gustavo; Castañeda, Juan D; Serna, Eduardo A; Vásquez, Ricardo A; Arango, Adriana M; López, Claudia C

    2013-04-01

    Sciatic hernia constitutes the scarcest group of hernias of pelvic floor; however, they should be considered in the origin of chronic pelvic pain. The proper diagnosis of sciatic hernias has allowed to surgeons treating successfully patients with acute or chronic pelvic pain, with intestinal or ureteral obstruction and with urinary or gluteus sepsis. It has to be considered as differential diagnosis before the finding of a congenital or acquired gluteus mass. Laparoscopist gynecologist should know the existence of this defect, to be familiar with its aspect in laparoscopic view and to know the laparoscopic treatment of this disease.

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

    Science.gov (United States)

    Paksoy, Melih; Sekmen, Ümit

    2016-01-01

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

  9. Sigmoid colon cancer in an incarcerated left inguinal hernia

    OpenAIRE

    González González, Daniel Alfredo; Tarigo, Nicolás

    2017-01-01

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

  10. Incidental Hiatal Hernia Detected with Meckel's Scintigraphy

    International Nuclear Information System (INIS)

    Aksoy, Tamer; Kiratli, Pinar Ozgen

    2011-01-01

    Congenital hiatal hernia (CHH) in children is a very rare condition that occurs in about 1 in every 2,000 to 5,000 live births, with a male to female ratio of 2:3. In 97% of cases the anomaly is unilateral with a left side preponderance. The hernia content can include the stomach, bowel loops, spleen or part of the liver. CHH may remain asymptomatic or induce only nonspecific gastro intestinal and/or thoracic symptoms. The symptomatology og these patients is usually non specific, in the form of repeated attacks of chest infection and/or recurrent vomiting, but can be associated with serious complications such as intrathoracic gastric volvulus with incarceration and strangulation. Because of the gastroesophageal reflux, linear ulcerations on the esophageal mucosa might occur and cause intermittent bleeding. Plan chest radiographs, AP and lateral, may raise a suspicion of the condition, while upper gastrointestinal contrast series are diagnostic. The treatment is surgery consisting of excision of the hernial sac after reducing the stomach and repair of the diaphragmatic defect by tightening the crura of the esophageal hiatus. If the defect is large and associated with displacement of the gastroesophageal junction (GEJ) into the thorax, adding an anti reflux procedure to the repair is appropriate. This can be achieved transabdominally either by laparotomy or laparoscopically. To the best of our knowledge, this is the second case diagnosed with Meckel's scintigraphy.

  11. 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...

  12. An Elderly Male with Amyand’s Hernia

    Directory of Open Access Journals (Sweden)

    Saema Said

    2017-09-01

    Full Text Available History of present illness: A 67-year-old male, with a history of diabetes, coronary artery disease, and chronic kidney disease, presented with two weeks of a new right inguinal bulge and right lower quadrant abdominal pain extending to the groin. He denied nausea, vomiting, fever, and changes in bowel movement. His initial vital signs were: temperature 37.4°C, blood pressure 142/100, heart rate 62, and respiratory rate 18. Physical examination revealed mild right lower quadrant abdominal tenderness, right inguinal and testicular tenderness and swelling, and a non-reducible bulging inguinal mass with no overlying skin changes. Lab results showed a leukocytosis of 13.6. Significant findings: Ultrasound of the right scrotum shows a right inguinal hernia with an air-containing loop of bowel (white arrow and a non-compressible appendix (yellow arrow. Coronal and axial views of abdomen-pelvis CT show a right inguinal hernia containing a loop of small bowel (white arrow and appendix (yellow arrow. Discussion: In the case presented above, ultrasound and abdomen and pelvis computed tomography (CT showed an Amyand’s hernia. The patient was taken emergently to surgery, which revealed an incarcerated right inguinal hernia with perforated appendicitis in the hernia sac. The patient underwent an appendectomy and hernia repair, and had no post-surgical complications. Amyand’s hernia is a form of inguinal hernia characterized by the presence of the appendix in the hernia sac. The hernia may be reducible, incarcerated, or strangulated; and the appendix may be normal, inflamed, or perforated.1 The patient presented above had an incarcerated hernia with no overlying skin changes suggestive of strangulation. Amyand’s hernia accounts for 0.4-1% of all inguinal hernias and 0.1% of all cases of appendicitis.2 It is thought to be due to patency of the processus vaginalis, and as such occurs more frequently in young children.1,2,3 Clinical diagnosis of Amyand

  13. Enhanced electroscalpel incisional wound healing potential of honey in wistar rats

    Directory of Open Access Journals (Sweden)

    David O. Eyarefe

    2017-12-01

    Full Text Available Electrosurgery reduces surgical bleeding, and delayed wound healing. This study evaluated comparative incisional wound healing potential of honey in wound created with electroscalpel and cold scalpel. The study used twelve (12 adult male albino rats (130 ± 20 g, randomly grouped into Electro-cautery (n = 6 and Cold scalpel (n = 6. Each rat had three full thickness (6 mm diameter skin wounds (a, b and c created on its dorsum with either Electroscalpel (ES or Cold blade scalpel (CS, and treated topically with Silver sulphadiazine (SSD, wound a, untreated (control, wound b and Bee honey (H, wound c. The wounds were evaluated for gross (exudation, edema, hyperemia, contraction, histologic (granulation, angiogenesis, fibroplasia, epithelialization and immunologic healing indices using standard techniques. Data were analyzed with Chi-square, Two-way Analysis of Variance (ANOVA and Duncan Multiple Range tests (DMRT at α = 0.05. Wound hyperemia and edge edema were prominent in the ES group from day 4 to 6 (P = .000. Percentage wound contraction was higher in the CS than ES group from days 5 to 7 (P = .006 and in the CS treated with honey than ES treated with honey from days 7 to 14 (P = .000. Granulation tissue reduced in ES group treated with SSD than in honey and control wounds. Fibroelastic tissue increased in SSD and honey treated wounds of ES group, and higher in honey treated wounds of CS group (P < .05. Fibroplasia was sustained in honey and SSD treated wounds than control. Honey can be applied to electroscalpel surgical wound to facilitate rapid healing during surgical management of tumours having vascular network. Keywords: Incisional methods, Honey, Silver sulphadiazide, Wound management

  14. Laparoscopic diaphragmatic hernia repair using expanded polytetrafluoroethylene (ePTFE) for delayed traumatic diaphragmatic hernia.

    Science.gov (United States)

    Jee, Yeseob

    2017-06-01

    Traumatic diaphragmatic hernia (TDH) is an uncommon surgical problem, and diagnosis is often delayed. However, the mortality from bowel necrosis can reach 80%. Therefore, suspicion is needed and surgery is required to prevent complications. A 50-year-old man was transferred due to abdominal pain and vomiting. Chest X-ray and computed tomography (CT) scan showed herniation of the stomach through the left diaphragm. The patient had fallen down 15 months ago and CT scan at that time revealed a small defect of the diaphragm without herniation. We diagnosed delayed herniation of TDH and the patient underwent laparoscopic repair using an expanded polytetrafluoroethylene (ePTFE) mesh. Recovery was uneventful and the CT scan at 3 months after the operation showed no recurrence. We reported a delayed presenting TDH and considered a laparoscopic approach to be safe and feasible during elective surgery. Moreover, use of an ePTFE mesh for repair of large diaphragmatic hernia was also feasible.

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

    Directory of Open Access Journals (Sweden)

    Shahbaz Habib Faridi

    2014-01-01

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

  16. Neurological Findings in Relation to the Level of Lumbar Disc Hernia

    OpenAIRE

    谷代, 弘三; Yashiro, Kouzou

    1989-01-01

    Real neurological findings in 177 cases of lumbar disc hernia, the levels of which were operatively proved were compared with those described as corresponding to a certain level of hernia in books hitherto published. Sensory change in Keegan's L5 dermatome was accordant with L4-5 hernia only in 41%, that in S1 dermatome with L5-S1 hernia in 44%, and that in L4 dermatome with L3-4 hernia in 67%. Weakness of an entire lower limb or of lliopsoas was proved in accordance with L1-2 or L2-3 hernia....

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

    Science.gov (United States)

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

    2015-02-01

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

  18. Traumatic abdominal wall hernia: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Osama S. Al Beteddini

    2016-01-01

    Conclusion: Traumatic abdominal wall hernia presents a diagnostic as well as a therapeutic challenge. The therapeutic approach is governed by a multitude of factors emphasizing the need of a patient-tailored, case by case management plan.

  19. Acute appendicitis in inguinal hernia: report of two cases | Kidmas ...

    African Journals Online (AJOL)

    Amyand's hernia). One patient had gangrenous appendicitis that affected the adjoining caecum. A limited right hemicolectomy was done by extending the groin incision laterally and proximally. The second patient had simple appendicectomy.

  20. Laparoscopic management of right paraduodenal hernia along with ...

    African Journals Online (AJOL)

    laparoscopic repair of a right PDH and the third in the pediatric age ... perinephric space laterally to open the hernia defect widely. ... the operative approach in this situation. Only five ... bilateral inguinal, and epigastric pain associated with.

  1. Laparoscopic approach to incarcerated inguinal hernia in children.

    Science.gov (United States)

    Kaya, Mete; Hückstedt, Thomas; Schier, Felix

    2006-03-01

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

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

    Science.gov (United States)

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

    1995-09-01

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

  3. Rare Abdominal Wall Malformation: Case Report of Umbilical Cord Hernia

    Directory of Open Access Journals (Sweden)

    Andro Gliha

    2018-02-01

    Full Text Available The umbilical cord hernia is the rarest form of abdominal wall malformations, anatomically completely different from gastroschisis and omphalocele. It occurs due to the permanent physiological evisceration of abdominal organs into umbilical celom and persistence of a patent umbilical ring. The umbilical cord hernia is often mistaken for omphalocele and called “small omphalocele”. Here we present a case of a female newborn with umbilical cord hernia treated in our Hospital. After preoperative examinations surgery was done on the second day of life. The abdominal wall was closed without tension. The aim of this article is to present the importance of the proper diagnose of these three entities and to stimulate academic community for the answer, is this umbilical cord hernia or small omphalocele.

  4. Congenital hernia of cord: an often misdiagnosed entity

    Science.gov (United States)

    Raju, Rubin; Satti, Mohamed; Lee, Quoc; Vettraino, Ivana

    2015-01-01

    Congenital hernia of the cord, also known as umbilical cord hernia, is an often misdiagnosed and under-reported entity, easily confused with a small omphalocele. It is different from postnatally diagnosed umbilical hernias and is believed to arise from persistent physiological mid-gut herniation. Its incidence is estimated to be 1 in 5000. Unlike an omphalocele, it is considered benign and is not linked with chromosomal anomalies. It has been loosely associated with intestinal anomalies, suggesting the need for a complete fetal anatomical ultrasound evaluation. We present a case of a fetal umbilical cord hernia diagnosed in a 28-year-old woman at 21 weeks gestation. The antenatal and intrapartum courses were uncomplicated. It was misdiagnosed postnatally as a small omphalocele, causing unwarranted anxiety in the parents. Increased awareness and knowledge of such an entity among health professionals is important to prevent unwarranted anxiety from misdiagnosis, and inadvertent bowel injury during cord clamping at delivery. PMID:25899514

  5. Rare Abdominal Wall Malformation: Case Report of Umbilical Cord Hernia.

    Science.gov (United States)

    Gliha, Andro; Car, Andrija; Višnjić, Stjepan; Zupancic, Bozidar; Kondza, Karmen; Petracic, Ivan

    The umbilical cord hernia is the rarest form of abdominal wall malformations, anatomically completely different from gastroschisis and omphalocele. It occurs due to the permanent physiological evisceration of abdominal organs into umbilical celom and persistence of a patent umbilical ring. The umbilical cord hernia is often mistaken for omphalocele and called "small omphalocele". Here we present a case of a female newborn with umbilical cord hernia treated in our Hospital. After preoperative examinations surgery was done on the second day of life. The abdominal wall was closed without tension. The aim of this article is to present the importance of the proper diagnose of these three entities and to stimulate academic community for the answer, is this umbilical cord hernia or small omphalocele.

  6. Internal Hernia in a Liver Transplant Recipien: A Case Report

    Directory of Open Access Journals (Sweden)

    Hironori Hayashi

    2013-01-01

    Full Text Available Biliary complications have great importance for liver transplant recipients because of affecting long-term prognosis. In rare situations, an internal hernia of the Roux-en-Y loop cause graft injury. A 42-year-old woman with a history of living donor liver transplantation 6 years ago presented with prolonged graft injury during the past 6 months. She suddenly developed ileus of the small bowel with internal hernia through the defect of the mesentery around the Roux-en-Y limb of the hepaticojejunostomy. Emergent surgery was performed to reduce the hernia and volvulus; also the mesenteric rent was closed with interrupted suture of silk. Internal hernia of the small bowel after liver transplantation is rare but causes graft injury due to associated biliary complications and rapid deterioration of patient’s condition.

  7. Establishment and initial experiences from the Danish Ventral Hernia Database

    DEFF Research Database (Denmark)

    Helgstrand, F; Rosenberg, J; Bay-Nielsen, M

    2010-01-01

    , use of mesh or no mesh, type of suture material, and placement of the mesh. A total of 5,629 elective and 661 acute ventral hernia repairs were registered. After the first 2 years the registration rate was 70%. CONCLUSION: The first national ventral hernia database has been established. Preliminary...... of the Danish Ventral Hernia Database (DVHD). Furthermore, the first 2-year data from 2007 to 2008 are presented. METHODS: Registrations were based on surgeons' web registrations and validated by cross checking with data from the Danish National Patient Register. RESULTS: The DVHD was established in June 2006...... and is based on prospective online web-registration of perioperative data, and individualised tracking of follow up data. During the first 2 years (2007-2008) data showed a large variation in almost all aspects of ventral hernia repair regarding surgical technique, use of open versus laparoscopic technique...

  8. Ossificação heterotópica em saco herniário incisional

    Directory of Open Access Journals (Sweden)

    Renato Miranda de Melo

    Full Text Available O achado de ossificação heterotópica (OH sobre cicatriz cirúrgica abdominal é um evento raro, mas que soma morbidade ao paciente. Manifesta-se por dor, endurecimento ou desconforto na cicatriz, levando a novas abordagens cirúrgicas. Relatamos um caso de OH no saco herniário incisional com o objetivo precípuo de chamar a atenção para o potencial "totipotente" do fibroblasto, já que sua íntima relação com a OH é inegável. A partir dessa prerrogativa, qualquer forma de tratamento das hérnias incisionais deveria associar o reparo tecidual ao uso de prótese (tela, para enriquecê-lo com os fibroblastos e seus fatores de crescimento celular do próprio paciente, todos autólogos e prontos para uso. A tática é oferecer uma abordagem combinada ou mista, com menores chances de recidiva na correção dessas afecções.

  9. Effect of laser treatment on first-intention incisional wound healing in ball pythons (Python regius).

    Science.gov (United States)

    Cole, Grayson L; Lux, Cassie N; Schumacher, Juergen P; Seibert, Rachel L; Sadler, Ryan A; Henderson, Andrea L; Odoi, Agricola; Newkirk, Kim M

    2015-10-01

    To evaluate effects of laser treatment on incisional wound healing in ball pythons (Python regius). 6 healthy adult ball pythons. Snakes were sedated, a skin biopsy specimen was collected for histologic examination, and eight 2-cm skin incisions were made in each snake; each incision was closed with staples (day 0). Gross evaluation of all incision sites was performed daily for 30 days, and a wound score was assigned. Four incisions of each snake were treated (5 J/cm(2) and a wavelength of 980 nm on a continuous wave sequence) by use of a class 4 laser once daily for 7 consecutive days; the other 4 incisions were not treated. Two excisional skin biopsy specimens (1 control and 1 treatment) were collected from each snake on days 2, 7, 14, and 30 and evaluated microscopically. Scores were assigned for total inflammation, degree of fibrosis, and collagen maturity. Generalized linear models were used to investigate the effect of treatment on each variable. Wound scores for laser-treated incisions were significantly better than scores for control incisions on day 2 but not at other time points. There were no significant differences in necrosis, fibroplasia, inflammation, granuloma formation, or bacterial contamination between control and treatment groups. Collagen maturity was significantly better for the laser-treated incisions on day 14. Laser treatment resulted in a significant increase in collagen maturity at day 14 but did not otherwise significantly improve healing of skin incisions.

  10. Left Sided Amyand's Hernia, A Rare Occurance: A Case Report.

    Science.gov (United States)

    Ravishankaran, Praveen; Mohan, G; Srinivasan, A; Ravindran, G; Ramalingam, A

    2013-06-01

    This is a case report about a 35 year old man admitted with complains of obstructed left sided inguinal hernia. On exploration of the left inguinal canal to our surprise a normal appendix was found in addition to a gangrenous omentum. Resection of the gangrenous omentum was done. Appendectomy was done. This case is reported for its rare occurance as only three such cases of left sided amyand's hernia has been reported so far in literature[4-6].

  11. Incarcerated umbilical hernia leading to small bowel ischemia.

    Science.gov (United States)

    Lutwak, Nancy; Dill, Curt

    2011-09-19

    A 59-year-old male with history of hepatitis C, refractory ascites requiring multiple paracentesis and transjugular intrahepatic portosystemic shunt placement presented to the emergency department with 2 days of abdominal pain. Physical examination revealed blood pressure of 104/66 and pulse of 94. The abdomen was remarkable for distention and a tender incarcerated umbilical hernia. The skin overlying the hernia was pale with areas of necrosis. The patient immediately underwent laparotomy which was successful.

  12. Two Ports Laparoscopic Inguinal Hernia Repair in Children

    OpenAIRE

    Ibrahim, Medhat M.

    2015-01-01

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

  13. 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. © 2013 National Medical Association. Published by Elsevier Inc. All rights reserved.

  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 a...... approach or laparoscopically. The review is a critical discussion of these and other issues in pediatric herniorrhaphy pointing out the need for further research Udgivelsesdato: 2008/4...

  15. Damage control apronectomy for necrotising fasciitis and strangulated umbilical hernia.

    LENUS (Irish Health Repository)

    Coyle, P

    2012-01-31

    We present a case of a 50-year-old morbidly obese woman who presented with a case of necrotizing fasciitis of the anterior abdominal wall due to a strangulated umbilical hernia. The case was managed through damage control surgery (DCS) with an initial surgery to stabilise the patient and a subsequent definitive operation and biological graft hernia repair. We emphasise the relevance of DCS principles in the management of severe abdominal sepsis.

  16. SEGMENTAL EPIDURAL ANAESTHESIA FOR INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Sachidanand

    2015-09-01

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

  17. Outcome of laproscopic totally extraperitoneal hernioplasty for inguinal hernia

    International Nuclear Information System (INIS)

    Hanif, H.; Memon, S.H.

    2015-01-01

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

  18. Gastric necrosis secondary to strangulated giant paraesophic hiatal hernia.

    Science.gov (United States)

    Díez Ares, José Ángel; Peris Tomás, Nuria; Estellés Vidagany, Nuria; Periáñez Gómez, Dolores

    2016-08-01

    Asymptomatic giant hiatal hernia comprises a relatively common disease, mostly presented in women with 50 years onwards. The therapeutic approach remains controversial in recent years. Under the latest SAGES`revision, all the symptomatic hernias must be repaired, but the symptomatic hiatal hernia definition isn`t even now established. We present the case os a A 67 - year old woman with an asymptomatic hiatal hernia, that is admitted to our hospital owing to toracic and abdominal pain. This pain was related with food intake for 6 months. The patient presents a clear worsening in the last 24 hours, with no other asociated symptomatology. Suspecting an incarcerated hiatal hernia with stomach perforation, the patient is taken to theatre for a laparotomy during the early hours. An atypic gastrectomy of the greater curvature with a gastropexy is performed with fixation to the anterior abdominal wall. The surgery is completed with a feeding jejunostomy. The Manegement of giant paraesophagic hernias, still remains as one of the challenge of the esophageal surgeons.

  19. [Hiatal hernias: why and how should they be surgically treated].

    Science.gov (United States)

    Braghetto, Italo; Csendes, Attila; Korn, Owen; Musleh, Maher; Lanzarini, Enrique; Saure, Alex; Hananias, Baydir; Valladares, Héctor

    2013-01-01

    There is controversy in the literature about the choice of expectant medical treatment versus surgical treatment of hiatal hernias, depending on the presence or absence of symptoms. This study presents the results obtained by our group, considering disease duration and postoperative results. A total of 121 patients were included and divided by age, disease duration, type of hiatal hernia and postoperative outcome. In 32% of the patients younger than 70 years, symptom duration was longer than 11 years and 68% of those aged more than 71 years had long-term symptoms (p<.05). Type iv hernias (complex) and those with diameters measuring more than 16 cm were observed in the group with longer symptom duration. Complications were more frequent in the older age group, in those with longer symptom duration and in those with type iv complex hernias. There was no postoperative mortality and only one patient (0.8%) with a type iii hernia and severe oesophagitis required reoperation. We recommend that patients with hiatal hernia undergo surgery at diagnosis to avoid complications and risks. Older patients should not be excluded from surgical indication but should undergo a complete multidisciplinary evaluation to avoid complications and postoperative mortality. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  20. Acute testicular ischemia caused by incarcerated inguinal hernia.

    Science.gov (United States)

    Orth, Robert C; Towbin, Alexander J

    2012-02-01

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

  1. Celiac artery compression syndrome with bilateral Bochdalek hernia

    International Nuclear Information System (INIS)

    Kara, K.; Verim, S.; Bozkurt, Y.; Tasar, M.

    2012-01-01

    Full text: Introduction: Celiac artery compression syndrome or median arcuate ligament syndrome is rare and controversial condition. The definition of the syndrome relies on a combination of both clinical and radiographic features. It typically occurs in young patients, who may present with epigastric pain and weight loss. Bochdalek hernia is the most common congenital diaphragmatic hernia in adults. Bilaterality of this pathology is rare. There are not many reports about the associated pathologies to Bochdalek hernia. Objectives and tasks: We aimed to demonstrate the computed tomography (CT) angiography findings of celiac artery compression syndrome with Bochdalek hernia that has detected incidentally. Materials and methods: A CT angiography was performed to 32-year-old patient having postphelebitic syndrome for the possible diagnosis as pulmonary embolus. Results: At the imaging pulmonary arteries and the branches were normal. Celiac artery compression syndrome with Bochdalek Hernia was detected incidentally. A %75 stenosis at the origin of celiac artery and post stenotic dilatation after the stenosis was seen due to the compression. A poster medial defect at the diaphragm was seen as an additional finding for the cause of Bochdalek hernia. Conclusion: Many incidental finding can be detected at vascular and non vascular area in the routine CT angiography imaging. The pathologies like celiac artery compression syndrome and congenital diaphragm pathologies can be detected easily at CT angiography method

  2. Chronic diaphragmatic hernia in 34 dogs and 16 cats.

    Science.gov (United States)

    Minihan, Anne C; Berg, John; Evans, Krista L

    2004-01-01

    Medical records of 34 dogs and 16 cats undergoing surgical repair of diaphragmatic hernia of >2 weeks' duration were reviewed, and long-term follow-up information was obtained. The most common clinical signs were dyspnea and vomiting; however, many of the animals were presented for nonspecific signs such as anorexia, lethargy, and weight loss. Thoracic radiographs revealed evidence of diaphragmatic hernia in only 66% of the animals, and additional imaging tests were often needed to confirm the diagnosis. Thirty-six hernias were repaired through a midline laparotomy; 14 required a median sternotomy combined with a laparotomy. In 14 animals, division of mature adhesions of the lungs or diaphragm to the herniated organs was necessary to permit reduction of the hernia. Fourteen animals required resection of portions of the lungs, liver, or intestine. All hernias were sutured primarily without the use of tissue flaps or mesh implants. Twenty-one of the animals developed transient complications in the postoperative period; the most common of these was pneumothorax. The mortality rate was 14%. Thirty-four (79%) of the animals that were discharged from the hospital had complete resolution of clinical signs, and none developed evidence of recurrent diaphragmatic hernia during the follow-up period. Nine were lost to follow-up.

  3. The value of fetal ultrasonography and magnetic resonance imaging in the assessment of diaphragmatic hernias

    International Nuclear Information System (INIS)

    Amim, Bruno; Guerra, Fernando; Marchiori, Edson; Gasparetto, Emerson Leandro

    2008-01-01

    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)

  4. Inguinal hernia repair: anaesthesia, pain and convalescence

    DEFF Research Database (Denmark)

    Callesen, Torben

    2003-01-01

    of less serious complications is lower by local anaesthesia, compared to other anaesthetic techniques. Of special interest is, that the rate of urinary retention can be eliminated by the use of local anaesthesia. Local anaesthesia results, in comparative studies, in a higher degree of patient satisfaction...... than other anaesthetic techniques. Local anaesthesia also facilitates faster mobilisation and earlier discharge/fulfilment of discharge criteria from post anaesthetic care units than other anaesthetic techniques. Pain after hernia repair is more pronounced at mobilisation or coughing than during rest....... 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...

  5. Internal hernia following laparoscopic colorectal surgery

    DEFF Research Database (Denmark)

    Svraka, Melina; Wilhelmsen, Michał; Bulut, Orhan

    2017-01-01

    Although internal hernias are rare complications of laparoscopic colorectal surgery, they can lead to serious outcomes and are associated with a high mortality of up 20 %. AIM OF THE STUDY: The aim of this study was to describe our experience regarding internal herniation following laparoscopic...... colorectal surgery. MATERIALS AND METHODS: From 2009 to 2015, more than 1,093 laparoscopic colorectal procedures were performed, and 6 patients developed internal herniation. Data were obtained from patients' charts and reviewed retrospectively. Perioperative course and outcomes were analyzed. RESULTS: All...... patients were previously operated due to colorectal cancer. Two patients presented with ischemia at laparotomy, and 2 had endoscopic examinations before surgery. One patient was diagnosed with cancer on screening colonoscopy. One patient died after laparotomy. CONCLUSION: Internal herniation that develops...

  6. Hiatial hernia in gastroesophageal reflux disease

    Energy Technology Data Exchange (ETDEWEB)

    Kaul, B.; Petersen, H.; Myrvold, H.E.; Grette, K.; Roeysland, P.; Halvorsen, T.

    1986-01-01

    Upper gastrointestinal endoscopy and radiologic examination were performed in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. Hiatus hernia (HH) was found in 50 patients diagnosed by radiography or endoscopy, or both, in 22, 19, and 9 patients respectively. Severe endoscopic esophagitis (grades III and IV) was found more often in the patients with HH than in those without. The same was true for the early positive timed acid perfusion tests. Furthermore, the patients with HH more often had reflux by the standard acid reflux test (42 og 50 versus 28 of 51, gastroesophageal scintigraphy (47 of 50 versus 40 of 51; and radiography (20 of 50 versus 2 of 51; than the patients without HH. The results show that severe GER disease can occur without an associated HH and indicate that patients with symptoms of GER disease and associated HH are likely to have a more severe GER disease than those without HH.

  7. 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.

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

    Science.gov (United States)

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

    2014-04-01

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

  9. OUTCOMES OF SURGICAL TREATMENT OF HIATAL HERNIA

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    Zhurbenko G. A.

    2018-05-01

    Full Text Available Background: In traditionally performed fundoplications during the treatment of sliding diaphragmatic hernias, the improvement of surgical techniques to restore acute angle of His remains topical. Aim: To develop a method of surgical treatment of hiatus hernias to restore acute angle of His. Material and methods: Patients (n = 74 were divided into two groups: the main group (I (n = 45, in which the developed operation method was applied and the control group (II (n = 29, in which Toupet method was applied to 26 patients, Nissen method – to 3 patients. GERD-Q and GERD-HRQL questionnaires were applied to all patients of the first group before the operation, during discharge from hospital and 6-12 12-18 18-24 months after surgical intervention. Patients of the second group were surveyed 6-12 months after the operation. Results: According to the results of the survey after 6-12 months statistically significant differences were not revealed in the groups: GERD-Q, p<0,386; GERD-HRQL, p<0,1089. In the main group there was a tendency to decrease the points in the GERD-Q survey when compared before and after surgery, p <0.0001. Out of 16 (55% patients of the second group hospitalized after the operation the relapse was revealed in 9 patients, 7 of them were re-operated. 20(43,3% patients of group I underwent inpatient examination, 2 relapsed and no one was re-operated. Conclusion: The efficiency of the suggested operation technique is comparable to Toupet method in the early stages, although when assessing the remote results there are a less number of relapses.

  10. Randomized clinical trial of mesh fixation with "double crown" versus "sutures and tackers" in laparoscopic ventral hernia repair.

    Science.gov (United States)

    Muysoms, F; Vander Mijnsbrugge, G; Pletinckx, P; Boldo, E; Jacobs, I; Michiels, M; Ceulemans, R

    2013-10-01

    Although laparoscopic intra-peritoneal mesh repair (LVHR) is a well-established treatment option to repair ventral and incisional hernias, no consensus in the literature can be found on the best method of fixation of the mesh to the abdominal wall. Between December 2004 and July 2008, 76 patients undergoing a LVHR were randomized between mesh fixation using a double row of spiral tackers (DC) (n = 33) and mesh fixation with transfascial sutures combined with one row of spiral tackers (S&T) (n = 43), in the WoW trial (with or without sutures). Patients were clinically examined and evaluated using a visual analog scale for pain (VAS) in rest and after coughing 4 h post-operatively, after 4 weeks and 3 months after surgery. Primary endpoint of the study was abdominal wall pain, defined as a VAS score of at least 1.0 cm, at 3 months post-operative. Quality of life was quantified with the SF-36 questionnaire preoperatively and after 3 months. Secondary endpoint was the recurrence rate at 24-month follow-up. The DC and S&T group were comparable in age, gender, ASA score, BMI, indication, hernia, and mesh variables. The DC group had a significant shorter operating time compared with the S&T group (74 vs 96 min; p = 0.014) and a significant lower mean VAS score 4 h post-operatively (in rest; p = 0.028/coughing; p = 0.013). At 3 months, there were significant more patients in the S&T group with VAS score ≥1.0 cm (31.4 vs 8.3 %; p = 0.036). Clinical follow-up at 24 months was obtained in 63 patients (82.9 %). The recurrence rate at 24 months was 7.9 % overall (5/63). There were more recurrences in the S&T group (4/36) than in the DC group (1/27), but this difference was not significant (11.1 vs 3.7 %; p = 0.381). We found that double-crown fixation of intra-peritoneal mesh during laparoscopic ventral hernia repair was quicker, was less painful immediately post-operative and after 3 months, and did not increase the recurrence rate at 24

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

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    Christianakis Efstratios

    2009-01-01

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

  12. De Garengeot’s Hernia: Two Case Reports with Correct Preoperative Identification of the Vermiform Appendix in the Hernia

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    Zhaosheng Jin

    2016-01-01

    Full Text Available We present two cases of incarcerated de Garengeot’s hernia. This anatomical phenomenon is thought to occur in as few as 0.5% of femoral hernia cases and is a rare cause of acute appendicitis. Risk factors include a long pelvic appendix, abnormal embryological bowel rotation, and a large mobile caecum. In earlier reports operative treatment invariably involves simultaneous appendicectomy and femoral hernia repair. Both patients were correctly diagnosed preoperatively with computed tomography (CT. Both had open femoral hernia repair, one with appendectomy and one with the appendix left in situ. Both patients recovered without complications. Routine diagnostic imaging modalities such as ultrasonography and standard CT have previously shown little success in identifying de Garengeot’s hernia preoperatively. We believe this to be the first documented case of CT with concurrent oral and intravenous contrast being used to confidently and correctly diagnose de Garengeot’s hernia prior to surgery. We hope that this case report adds to the growing literature on this condition, which will ultimately allow for more detailed case-control studies and systematic reviews in order to establish gold-standard diagnostic studies and optimal surgical management in future.

  13. A rare case report of Morgagni Hernia with Organo-Axial Gastric Volvulus and concomitant Para-esophageal hernia, repaired laparoscopically in a Septuagenarian

    Directory of Open Access Journals (Sweden)

    Amol Mittal

    Full Text Available Introduction: Simultaneous occurrence of Morgagni and the Para-esophageal hernia is a rare clinical condition with eight case reports in the English-language literature and only four managed laparoscopically. We describe a case of a Septuagenarian patient with Morgagni and concomitant Para-esophageal hernia treated laparoscopically. Presentation of a case: A 71-year-old male patient, presented with a one-month history of regurgitation of acid, retrosternal burning and vomiting after eating. Computed tomography (CT imaging demonstrated a large anterior diaphragmatic hernia, with herniation of bowel loops and anterosuperior displacement of the gastric antrum along with a grade III Para-esophageal hernia. The patient underwent simultaneous laparoscopic repair of Morgagni and Para-esophageal hernia with mesh reinforcement with Nissen’s total anti-reflux fundoplication. The patient’s postoperative recovery was uneventful. Discussion: A Morgagni Hernia is a rare congenital condition consisting of a Subcosto-sternal defect in the diaphragm. A Para-esophageal hernia is a rare variant of a hiatus hernia. Morgagni and Para-esophageal hernia may present with gastric volvulus or incarceration, requiring emergency treatment. Minimally invasive surgery is the preferred treatment, particularly for elderly patients and patients with comorbidities. The laparoscopic operation can provide excellent exposure and repair the hernia defect easily with minimal invasiveness and fewer complications. Conclusion: This case report highlights the co-existence of Morgagni and Para-esophageal hernias and validates the feasibility of laparoscopic repair of both hernias simultaneously. Keywords: Diaphragmatic hernia, Morgagni, Para-esophageal hernia, Minimally invasive surgery, Fundoplication, Case report

  14. Efficacy of pre-incisional peritonsillar infiltration of ketamine for post-tonsillectomy analgesia in children

    International Nuclear Information System (INIS)

    Siddiqui, A.S.; Raees, U.S.; Siddiqui, S.Z.; Raza, S.A.

    2013-01-01

    Objective: To assess the efficacy of pre-incisional peritonsillar infiltration of two doses of ketamine on postoperative analgesia compared with peritonsillar normal saline in children undergoing tonsillectomy. Study Design: Double blind, randomized controlled trial. Place and Duration of Study: Department of Anaesthesiology, Surgical Intensive Care and Pain Management, Civil Hospital, Karachi, Dow University of Health Sciences, from August 2008 to January 2009. Methodology: Seventy-five ASA physical status one patients, aged 5 - 12 years scheduled for tonsillectomy were enrolled in this study. Patients were divided into three groups of 25 each. Group-A received normal saline, Group-B, ketamine 0.5 mg/kg while group-C ketamine 1 mg/kg respectively. All medications were 2 ml and were applied 1 ml per tonsil; 3 minutes before tonsillectomy incision. Anaesthesia was induced and maintained with standard technique. All patients were monitored throughout surgery. The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wilson sedation scale were used to evaluate pain levels and sedation respectively after operation. Results: Mean duration of analgesia was significantly higher in group-C (17.28 +- 5.33 hours) as compared to group-B (11.36 +- 4.15 hours) and A (3.2 +- 0.71 hours) as well as group-B was also significantly higher than group-A (p < 0.05). Group-A had significantly higher pain scores than group-B and group-C. Both B and C groups had comparable pain scores, which were statistically significant at 6 and 8 hours. Conclusion: Single 0.5 or 1 mg/kg injection of ketamine given before surgical incision by peritonsillar infiltration provides efficient pain relief during postoperative period without significant side-effects in children undergoing tonsillectomy. (author)

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

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    Hyo Seong Kim

    2012-05-01

    Full Text Available Background Among all facial fractures, nasal bone fractures are the most common, andthey have been reduced by closed reduction (CR for a long time. But several authors havereported suboptimal results when using CR, and the best method of nasal bone reduction isstill being debated. We have found that indirect open reduction (IOR through an endonasalincisional approach is a useful method for more accurate reduction of the nasal bone.Methods A retrospective chart review was performed of 356 patients who underwentreduction of a nasal bone fracture in our department from January, 2006, to July, 2011.We treated 263 patients with IOR. We assessed patients’ and doctors’ satisfaction withsurgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing tomucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsalaugmentation rhinoplasty.Results According to the analysis of the satisfaction scores, both patients and doctors weresignificantly more satisfied in the IOR group than the CR group (P<0.05. Mucosal injury withnasal bleeding occurred much less in the IOR group (5.3% than the CR group (12.9%. Dorsalaugmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them(31/34 showed satisfaction with the outcomes.Conclusions IOR enables surgeons to manipulate the bony fragment directly through theendonasal incisional approach. However, we propose that CR is the proper technique forpatients under 16 and for those with comminuted nasal bone fractures because submucosaldissection in IOR can damage the growth or circulation of nasal bone.

  16. Internal hernia through the pouch of douglas after hysterectomy: A case report

    International Nuclear Information System (INIS)

    Yang, Dong Jin; Cho, Seung Hyun; Shin, Hyun Woong; Kim, Tae Eun; Kim, Byung Young; Kim, Hee Jin

    2012-01-01

    Internal hernia is a rare cause of small bowel obstruction. Among the different types of internal hernias, the pelvic hernia is extremely rare. We report the radiographic findings of a patient with a Douglas pouch hernia presenting with closed loop obstruction at the anterior aspect of the distal rectum. The patient was a 60 year old female, who had undergone a hysterectomy 20 years prior, for treatment of a uterine myoma

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

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    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.

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

    OpenAIRE

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

    2003-01-01

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

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

    Science.gov (United States)

    Ohene-Yeboah, Michael; Beard, Jessica H; Frimpong-Twumasi, Benjamin; Koranteng, Adofo; Mensah, Samuel

    2016-04-01

    Inguinal hernia is thought to be common in rural Ghana, though no recent data exist on hernia prevalence in the country. This information is needed to guide policy and increase access to safe hernia repair in Ghana and other low-resource settings. Adult men randomly selected from the Barekese sub-district of Ashanti Region, Ghana were examined by surgeons for the presence of inguinal hernia. Men with hernia completed a survey on demographics, knowledge of the disease, and barriers to surgical treatment. A total of 803 participants were examined, while 105 participants completed the survey. The prevalence of inguinal hernia was 10.8 % (95 % CI 8.0, 13.6 %), and 2.2 % (95 % CI 0, 5.4 %) of participants had scars indicative of previous repair, making the overall prevalence of treated and untreated inguinal hernia 13.0 % (95 % CI 10.2, 15.7 %). Prevalence of inguinal hernia increased with age; 35.4 % (95 % CI 23.6, 47.2 %) of men aged 65 and older had inguinal hernia. Untreated inguinal hernia was associated with lower socio-economic status. Of those with inguinal hernia, 52.4 % did not know the cause of hernia. The most common reason cited for failing to seek medical care was cost (48.2 %). Although inguinal hernia is common among adult men living in rural Ghana, surgical repair rates are low. We propose a multi-faceted public health campaign aimed at increasing access to safe hernia repair in Ghana. This approach includes a training program of non-surgeons in inguinal hernia repair headed by the Ghana Hernia Society and could be adapted for use in other low-resource settings.

  20. Use of the AHP methodology in system dynamics: Modelling and simulation for health technology assessments to determine the correct prosthesis choice for hernia diseases.

    Science.gov (United States)

    Improta, Giovanni; Russo, Mario Alessandro; Triassi, Maria; Converso, Giuseppe; Murino, Teresa; Santillo, Liberatina Carmela

    2018-05-01

    Health technology assessments (HTAs) are often difficult to conduct because of the decisive procedures of the HTA algorithm, which are often complex and not easy to apply. Thus, their use is not always convenient or possible for the assessment of technical requests requiring a multidisciplinary approach. This paper aims to address this issue through a multi-criteria analysis focusing on the analytic hierarchy process (AHP). This methodology allows the decision maker to analyse and evaluate different alternatives and monitor their impact on different actors during the decision-making process. However, the multi-criteria analysis is implemented through a simulation model to overcome the limitations of the AHP methodology. Simulations help decision-makers to make an appropriate decision and avoid unnecessary and costly attempts. Finally, a decision problem regarding the evaluation of two health technologies, namely, the evaluation of two biological prostheses for incisional infected hernias, will be analysed to assess the effectiveness of the model. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  1. 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.

  2. [Laparoscopic approach in large hiatal hernia--particular considerations].

    Science.gov (United States)

    Munteanu, R; Copăescu, C; Iosifescu, R; Timişescu, Lucia; Dragomirescu, C

    2003-01-01

    Large hiatal hernia are associated with permanent or intermittent protrusion of more than 1/3 of the stomach into the chest, single or in associated with other organs, a hiatal defect greater than 5 cm and various complications related to the morphological and physiological modifications. While the laparoscopic approach in small hiatal hernia and gastro-esophageal reflux disease is a standard procedure in large hiatal hernia persists a number of questions and controversies. Between 1995 and 2002 a number of 23 patients with large hiatal hernia (9 men, 14 women), mean age 65.8 years (range 49 to 77) underwent laparoscopic surgery. The majority of the patients had complications of the disease (dysphagia, severe esophagitis, anemia, respiratory and cardiac failure). In 16 cases was a sliding hernia (one recurrent after open procedure), in 2 paraesophageal and in 5 a mixed hernia (two "upside-down" type). In 7 cases we perform, in the same operation, cholecystectomy for gallbladder stones and in one cases Heller myotomy for achalasia. In all cases the repairs was performed by using interrupted stitches to approximate the crurae, but in three of them (recurrent and upside down hernia) we consider necessary to repair with a polypropylene mesh (10 x 5 cm) with a "keyhole" for the esophagus. In these particular cases we do not perform a antireflux procedure, in others 20 cases a short floppy Nissen was done. During the operation one patient developed a left pneumothorax and required pleural drainage. Postoperatively one patient had dysphagia treated by pneumatic dilatation and another die 3 weeks after the surgery because severe respiratory and cardiac failure. Laparoscopic approach is a feasible and effective procedure with good postoperatively results, but required good skills in mininvasive technique.

  3. Presurgical ketoprofen, but not morphine, dipyrone, diclofenac or tenoxicam, preempts post-incisional mechanical allodynia in rats

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    Prado W.A.

    2002-01-01

    Full Text Available The treatment of pain before it initiates may prevent the persistent pain-induced changes in the central nervous system that amplify pain long after the initial stimulus. The effects of pre- or postoperative intraperitoneal administration of morphine (2 to 8 mg/kg, dipyrone (40 and 80 mg/kg, diclofenac (2 to 8 mg/kg, ketoprofen (10 and 20 mg/kg, and tenoxicam (10 and 20 mg/kg were studied in a rat model of post-incisional pain. Groups of 5 to 8 male Wistar rats (140-160 g were used to test each drug dose. An incision was made on the plantar surface of a hind paw and the changes in the withdrawal threshold to mechanical stimulation were evaluated with Von Frey filaments at 1, 2, 6 and 24 h after the surgery. Tenoxicam was given 12 or 6 h preoperatively, whereas the remaining drugs were given 2 h or 30 min preoperatively. Postoperative drugs were all given 5 min after surgery. No drug abolished allodynia when injected before or after surgery, but thresholds were significantly higher than in control during up to 2 h following ketoprofen, 6 h following diclofenac, and 24 h following morphine, dipyrone or tenoxicam when drugs were injected postoperatively. Significant differences between pre- and postoperative treatments were obtained only with ketoprofen administered 30 min before surgery. Preoperative (2 h intraplantar, but not intrathecal, ketoprofen reduced the post-incisional pain for up to 24 h after surgery. It is concluded that stimuli generated in the inflamed tissue, rather than changes in the central nervous system are relevant for the persistence of pain in the model of post-incisional pain.

  4. Clinical, echocardiographic, and radiographic findings of peritoneopericardial diaphragmatic hernia in two dogs and a cat

    International Nuclear Information System (INIS)

    Hay, W.H.; Woodfield, J.A.; Moon, M.A.

    1989-01-01

    Peritoneopericardial diaphragmatic hernia was diagnosed in 2 dogs and a cat. One dog was referred because of clinical signs of cardiac tamponade and acute decompensation from liver entrapment within the hernia. Surgical correction of the hernia alleviated clinical signs in all 3 animals. Echocardiography was used in combination with radiography to provide a rapid and accurate diagnosis

  5. Garengeot’s hernia: two case reports with CT diagnosis and literature review

    Directory of Open Access Journals (Sweden)

    Garcia-Amador Cristina

    2016-01-01

    Full Text Available Garengeot’s hernia (GH is defined as the presence of the appendix inside a femoral hernia. It occurs in 0.9% of femoral hernias and is usually an incidental finding during surgery. Its treatment is controversial and the aim of this article is to review the diagnostic methods and surgical considerations.

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

    Science.gov (United States)

    Burcharth, Jakob

    2014-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Ruzaimie Noor

    2017-06-01

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

  8. Polyester composite versus PTFE in laparoscopic ventral hernia repair.

    Science.gov (United States)

    Colon, Modesto J; Telem, Dana A; Chin, Edward; Weber, Kaare; Divino, Celia M; Nguyen, Scott Q

    2011-01-01

    Both polyester composite (POC) and polytetrafluoroethylene (PTFE) mesh are commonly used for laparoscopic ventral hernia repair. However, sparse information exists comparing perioperative and long-term outcome by mesh repair. A prospective database was utilized to identify 116 consecutive patients who underwent laparoscopic ventral hernia repair at The Mount Sinai Hospital from 2004-2009. Patients were grouped by type of mesh used, PTFE versus POC, and retrospectively compared. Follow-up at a mean of 12 months was achieved by telephone interview and office visit. Of the 116 patients, 66 underwent ventral hernia repair with PTFE and 50 with POC mesh. Patients were well matched by patient demographics. No difference in mean body mass index (BMI) was demonstrated between the PTFE and POC group (31.8 vs. 32.5, respectively; P=NS). Operative time was significantly longer in the PTFE group (136 vs.106 minutes, PPTFE group and none in the POC group (P NS). No other major complications occurred in the immediate postoperative period (30 days). At a mean follow-up of 12 months, no significant difference was demonstrated between the PTFE and POC groups in hernia recurrence (3% vs. 2%), wound complications (1% vs. 0%), mesh infection, requiring removal (3% vs. 0%), bowel obstruction (3% vs. 2%), or persistent pain or discomfort (28% vs. 32%), respectively (P=NS). Our study demonstrated no significant association between types of mesh used and postoperative complications. In the 12-month follow-up, no differences were noted in hernia recurrence.

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

    Science.gov (United States)

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

    2001-01-01

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

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

    Science.gov (United States)

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

    2001-03-01

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

  11. Clinical And Surgical Anatomy Of Lumbar Hernia: A Review

    Directory of Open Access Journals (Sweden)

    João Victor Souza Sanders

    2017-10-01

    Full Text Available Lumbar hernia is defined as the presence of failure in the transverse fascia or in the aponeurosis of the transverse abdominal muscle that results in the extrusion of intra or extra peritoneal organs through the discontinuity of the postero lateral abdominal wall. The aim of this study was to conduct a methodical review of the anatomy of the hernia form grynfelt dated from 2006 to 2017. For this, we performed a bibliographic review by means of electronic databases like SciELO, PubMed, Science Direct, LILACS and Bireme to get better approach to the subject. It has been found that the lumbar hernia is a disease little known by doctors whose diagnostics are often performed in the wrong way and for surgical correction needs a good anatomical knowledge. Lumbar hernias, although rare, must be taken into account, since ischemia of herniated intestinal segments can lead to the death of the patient, especially in the elderly. Knowledge about the anatomy of the lumbar region is of vital importance because it makes surgery safe and reduces risks of complications and recidivating of the hernia.

  12. Amyand’s Hernia: Rare Presentation of a Common Ailment

    Directory of Open Access Journals (Sweden)

    Sanjeev Singhal

    2015-01-01

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

  13. Hiatus hernia in gastroesophageal reflux disease

    International Nuclear Information System (INIS)

    Kaul, B.; Petersen, H.; Myrvold, H.E.; Grette, K.; Roeysland, P.; Halvorsen, T.

    1986-01-01

    Upper gastrointestinal endoscopy and radiologic examination were performed in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. Hiatus hernia (HH) was found in 50 patients diagnosed by radiography or endoscopy, or both, in 22, 19, and 9 patients respectively. Severe endoscopic esophagitis (grades III and IV) was found more often (p<0.05) in the patients with HH than in those without. The same was true for the early positive timed acid perfusion tests (p<0.02). Furthermore, the patients with HH more often had reflux by the standard acid reflux test (42 og 50 versus 28 of 51; p<0.01), gastroesophageal scintigraphy (47 of 50 versus 40 of 51; p<0.05), and radiography (20 of 50 versus 2 of 51; p<0.001) than the patients without HH. The results show that severe GER disease can occur without an associated HH and indicate that patients with symptoms of GER disease and associated HH are likely to have a more severe GER disease than those without HH

  14. [Congenital diaphragmatic hernia: respiratory and vascular outcomes].

    Science.gov (United States)

    Pennaforte, T; Rakza, T; Sfeir, R; Aubry, E; Bonnevalle, M; Fayoux, P; Deschildre, A; Thumerelle, C; de Lagausie, P; Benachi, A; Storme, L

    2012-02-01

    Congenital diaphragmatic hernia (CDH) is a life-threatening anomaly associated with a variable degree of pulmonary hypoplasia (PH) and persistent pulmonary hypertension (PPH). Despite remarkable advances in neonatal resuscitation and intensive care, and new postnatal treatment strategies, the rates of mortality and morbidity in the newborn with CDH remain high as the result of severe respiratory failure secondary to PH and PPH. Later, lung function assessments show obstructive and restrictive impairments due to altered lung structure and lung damage due to prolonged ventilatory support. The long-term consequences of pulmonary hypertension are unknown. Other problems include chronic pulmonary aspiration caused by gastro-oesophageal reflux and respiratory manifestations of allergy such as asthma or rhinitis. Finally, failure to thrive may be caused by increased caloric requirements due to pulmonary morbidity. Follow-up studies that systematically assess long-term sequelae are needed. Based on such studies, a more focused approach for routine multidisciplinary follow-up programs could be established. It is the goal of the French Collaborative Network to promote exchange of knowledge, future research and development of treatment protocols. Copyright © 2012. Published by Elsevier Masson SAS.

  15. Recurrent Congenital Diaphragmatic Hernia in Ehlers-Danlos Syndrome

    International Nuclear Information System (INIS)

    Lin, I.C.; Ko, S.F.; Shieh, C.S.; Huang, C.F.; Chien, S.J.; Liang, C.D.

    2006-01-01

    Ehlers-Danlos syndrome (EDS) includes a group of connective tissue disorders with abnormal collagen metabolism and a diverse clinical spectrum. We report two siblings with EDS who both presented with congenital diaphragmatic hernia (CDH). The elder sister suffered from recurrent diaphragmatic hernia twice and EDS was overlooked initially. Echocardiography as well as contrast-enhanced magnetic resonance angiography (MRA) showed dilatation of the pulmonary artery, and marked elongation and tortuosity of the aorta and its branches. A diagnosis of EDS was eventually established when these findings were coupled with the clinical features of hyperelastic skin. Her younger brother also had similar features. This report emphasizes that EDS may present as CDH in a small child which could easily be overlooked. Without appropriate surgery, diaphragmatic hernia might occur. Echocardiographic screening is recommended in patients with CDH. Contrast-enhanced MRA can be helpful in delineation of abnormally tortuous aortic great vessels that are an important clue to the early diagnosis of EDS

  16. Hernia diafragmática congénita atascada

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    Miurkis Endis Miranda

    Full Text Available La hernia diafragmática congénita constituye uno de los retos pendientes dentro de las enfermedades quirúrgicas del recién nacido. Se presenta un caso muy inusual, en el cual se diagnosticó una hernia diafragmática derecha atascada, con compromiso de gran parte del intestino. Se describen los medios diagnósticos utilizados, el procedimiento quirúrgico realizado y las complicaciones presentadas. La hernia diafragmática congénita atascada es una complicación potencialmente letal, por el amplio compromiso vascular que produce en los órganos abdominales y que conlleva a la necrosis de estos si no se diagnostica precozmente. Por ello, debe ser considerada en el diagnóstico diferencial de la insuficiencia respiratoria en los recién nacidos y lactantes pequeños.

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

    DEFF Research Database (Denmark)

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

    2018-01-01

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

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

    Science.gov (United States)

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

    2011-02-01

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

  19. Reliable and valid assessment of Lichtenstein hernia repair skills

    DEFF Research Database (Denmark)

    Carlsen, C G; Lindorff Larsen, Karen; Funch-Jensen, P

    2014-01-01

    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...... of an assessment tool designed to measure surgical skills in Lichtenstein hernia repair. METHODS: Key issues were identified through a focus group interview. On this basis, an assessment tool with eight items was designed. Ten surgeons and surgical trainees were video recorded while performing Lichtenstein hernia...... a significant difference between the three groups which indicates construct validity, p skills can be assessed blindly by a single rater in a reliable and valid fashion with the new procedure-specific assessment tool. We recommend this tool for future assessment...

  20. [Plug-technique for umbilical hernia repair in the adult].

    Science.gov (United States)

    Brancato, G; Privitera, A; Gandolfo, L; Donati, M; Caglià, P

    2002-02-01

    Umbilical hernia represents 6% of all abdominal wall hernias in the adult. Surgical repair should always be carried out due to possible occurrence of complications. Aim of this paper is to evaluate the efficacy of the plug-technique. From October 1995 to April 2000, the authors performed 21 operations for acquired umbilical hernia with a defect smaller than 4 cm. Local anesthesia was used and a light intravenous sedation added in particularly anxious patients. The repair was achieved by insertion of a polypropylene dart plug sutured to the margins of the hernial defect. All patients were up and about straightaway and were discharged within 24 hours of surgery. Postoperative pain was mild and required hospital analgesia in only 19% of cases and domiciliary analgesia in 24%. During a follow-up ranging from 6 to 60 months (mean 30), only one recurrence has been recorded. This tension-free technique allows immediate rehabilitation, with few complications and a low recurrence rate.

  1. Thoracoscopic approach in management of congenital diaphragmatic hernia.

    Science.gov (United States)

    Liem, Nguyen Thanh

    2013-10-01

    Thoracoscopic repair is feasible and safe for congenital diaphragmatic hernia (CDH). The operation can be performed with three trocars using carbon dioxide insufflations at a pressure of 4-6 mmHG. From January 2001 to July 2012, we performed thoracoscopic repair for 311 children with CDH including 152 newborns and 159 infants and toddlers. Mean operative time was 75 ± 27 min. HFOV was used in 24 patients. Direct closure of two rims of diaphragmatic hernia was carried out in 175 patients. Closure of two rims of diaphragmatic hernia with the thoracic wall was performed in 136 patients. Prosthetic patches were required in 54 patients. Conversion to open surgery was required in 38 patients (12.2%). There were no intraoperative deaths. 38 patients died postoperatively (13.5%).

  2. The prevalence of umbilical and epigastric hernia repair

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...... hernia repairs was seen in males aged 60-70 years with a 5-year prevalence of 0.53 % (95 % CI 0.51-0.56 %) and the highest age-specific 5-year prevalence of epigastric hernia repair was seen in 40-50 year females with a 5-year prevalence of 0.086 % (95 % CI 0.077-0.095 %). CONCLUSION: The gender and age...

  3. Pulmonary Hernia in a Two-Year-Old Child

    Directory of Open Access Journals (Sweden)

    Jenna Fine

    2014-01-01

    Full Text Available Pulmonary hernia, also known as lung herniation or intercostal herniation, is best explained as the lung parenchyma protruding beyond the confines of the thoracic wall. This rare finding can be classified as congenital or acquired. Acquired pulmonary herniations are often the complication of blunt or penetrating trauma to the chest wall. This report describes a two-year-old male who fell onto a rigid post, striking his left lower chest. Imaging studies demonstrated a small pneumothorax as well as pulmonary herniation. The patient underwent a diagnostic thoracoscopy and repair of a pulmonary hernia within the 7th intercostal space without complication. In this case report, we aim to add to the limited body of existing literature on the surgical management of pulmonary hernias.

  4. Intraperitoneal And Incisional Bupivacaine Analgesia For Major Abdominal/Gynecologic Surgery: A Placebocontrolled

    Directory of Open Access Journals (Sweden)

    R. Azarfarin

    2006-05-01

    Full Text Available Background:Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with perioperative administration of analgesics (pre-emptive analgesia it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after major gynecologic abdominal surgeries. Methods: In this prospective, double-blinded, randomized, and placebocontrolled trial, 60 ASA physical status I and II patients undergoing major abdominal gynecologic surgeries were randomized to receive 45 mL of bupivacaine 0.375% or 45mL of normal saline; 30 mL and 15 mL of the treatment solution was administered into the peritoneal cavity and incision, respectively, before wound closure. The pain score of the patients was evaluated by the visual analogue scale (VAS on awakening, and at 6, 12, and 24h after surgery. Time to first analgesia request and total analgesic requirements in the first 24h were recorded. Results: Pain scores were significantly higher in the placebo group than in the bupivacaine group on awakening (5.98±1.01 v.s 1.05±1.05; p<0.001, and at 6h after surgery (5.37±0.85 vs. 2.51±1.02; p<0.001. First request to analgesia was significantly longer in the bupivacaine patients than in the placebo group (5.87±3.04 h vs.1.35±0.36; p<0.001.Meperidine consumption over 24h was 96.00 ±17.53 mg in the placebo group compared with 23.28 ±14.89 mg in the bupivacaine patients (p<0.001.Conclusion:A combination of intraperitoneal and incisional bupivacaine infiltration at the end of abdominal gynecologic surgeries reduces postoperative pain on awakening and for 6 hours after surgery, and provides significant opioidsparing analgesia for 24 h after gynecologic abdominal surgeries.

  5. The diagnostic utility of resistive MRI for lumbar disc hernias

    International Nuclear Information System (INIS)

    Sakaida, Hiroshi; Hanakita, Junya; Suwa, Hideyuki; Nishihara, Kiyoshi; Nishi, Shogo; Ohta, Fumito; Iihara, Kouji

    1990-01-01

    The diagnostic utility of the 0.1 tesla resistive magnetic resonance imaging (MRI) system was studied for 78 lumbar disc hernias in surgically treated 70 patients. Myelographic appearance of the lumbar disc hernias fell into the following three categories: (1) medial type, compressing the thecal sac; (2) mediolateral type, compressing both the nerve root and thecal sac; and (3) lateral type, compressing the nerve root. MRI was performed in low-flip angle (LF) and saturation-recovery (SR) radiofrequency-pulse sequences for the midline and paramedian sagittal sections, respectively. A transverse section was found positive when the laterality of the disc hermia was obtained. A coronal section was found positive when high-intensity disc material compresisng the nerve root was recognized. Diagnostic capability of MRI was graded in three scores: Excellent- the optimal information was provided; Fair- some pieces of information was obtained, but not enough for diagnosis; Poor- the information was not helpful for diagnosis in deciding the operative procedure. Of 13 medial disc hernias, 84.6% was positive in the sagittal plane and 88.9% in the transverse plane. MRI was superior to myelography in 9 lesions. Of 38 mediolateral disc hernias, 84.2% were positive in the sagittal plane, 74.2% in the transverse plane, and 26.7% in the coronal plane. MRI was judged as excellent for 17 lesions, fair for 15 lesions, and poor for 6 lesions. Of 27 lateral disc hernias, 55.6% were positive in the sagittal plane, 50.0% in the transverse plane, and 30.0% in the coronal plane. MRI was judged as excellent for 4 lesions, fair for 11 lesions, and poor for 12 lesions. Resistive MRI system was of limited value in diagnosing surgical indication of lateral lumbar disc hernias, especially for small but painful lesions. (N.K.)

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

    Directory of Open Access Journals (Sweden)

    Ahmet Serdar Karaca

    2013-10-01

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

  7. 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.

  8. Congenital asymptomatic diaphragmatic hernias in adults: a case series.

    Science.gov (United States)

    Bianchi, Enrica; Mancini, Paola; De Vito, Stefania; Pompili, Elena; Taurone, Samanta; Guerrisi, Isabella; Guerrisi, Antonino; D'Andrea, Vito; Cantisani, Vito; Artico, Marco

    2013-05-13

    Congenital diaphragmatic hernia is a major malformation occasionally found in newborns and babies. Congenital diaphragmatic hernia is defined by the presence of an orifice in the diaphragm, more often to the left and posterolateral, that permits the herniation of abdominal contents into the thorax. The aim of this case series is to provide information on the presentation, diagnosis and outcome of three patients with late-presenting congenital diaphragmatic hernias. The diagnosis of congenital diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray films and computed tomography scans. In the present report three cases of asymptomatic abdominal viscera herniation within the thorax are described. The first case concerns herniation of some loops of the large intestine into the left hemi-thorax in a 75-year-old Caucasian Italian woman. The second case concerns a rare type of herniation in the right side of the thorax of the right kidney with a part of the liver parenchyma in a 57-year-old Caucasian Italian woman. The third case concerns herniation of the stomach and bowel into the left side of the chest with compression of the left lung in a 32-year-old Caucasian Italian man. This type of hernia may appear later in life, because of concomitant respiratory or gastrointestinal disease, or it may be an incidental finding in asymptomatic adults, such as in the three cases featured here. Patients who present with late diaphragmatic hernias complain of a wide variety of symptoms, and diagnosis may be difficult. Additional investigation and research appear necessary to better explain the development and progression of this type of disease.

  9. Surgical repair of a congenital pericardial diaphragmatic hernia

    International Nuclear Information System (INIS)

    Wright, R.P.; Wright, R.; Scott, R.

    1987-01-01

    Objective: To describe the surgical repair and pre- and postoperative management of a peritoneopericardial diaphragmatic hernia (PPDH) in a pregnant dog. Case summary: A pregnant dog was presented for vomiting, lethargy, and pale mucous membranes. Pulsus paradoxus was noted on physical examination. The dog was diagnosed with a PPDH via thoracic radiographs, abdominal ultrasound, and a n echocardiogram. The hernia was surgically repaired and the dog received supportive medical care until the puppies were old enough to be delivered via cesarean section. The mother and all puppies survived. New or unique information provided: This is the first report that describes the surgical repair and postoperative management of a PPDH in a pregnant dog

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

    Science.gov (United States)

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

    2016-08-01

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

  11. Diaphragmatic hernia in the Coffin-Siris syndrome.

    Science.gov (United States)

    Delvaux, V; Moerman, P; Fryns, J P

    1998-01-01

    At 32 weeks of gestation, delivery of a female fetus was induced because of severe malformations seen on ultrasonogram: congenital diaphragmatic hernia and cerebellar hypoplasia. The diagnosis of Coffin-Siris syndrome was based on the physical examination: coarse face with low-set ears, low nuchal hairline, scalp hypotrichosis and hypoplasia of the nails of fingers and toes with absence of the right fifth fingernail. Autopsy confirmed the prenatally diagnosed major associated abnormalities: hypoplasia of the cerebellum and congenital diaphragmatic hernia. Various clinical entities are included in the differential diagnosis.

  12. Mortality following emergency groin hernia surgery in Denmark

    DEFF Research Database (Denmark)

    Kjærgaard, Jesper; Bay-Nielsen, M; Kehlet, H

    2010-01-01

    The mortality following emergency groin hernia repair in Denmark is more than twice as high (7%) as in comparable countries. This article describes in detail the population that died following emergency herniotomy in order to identify aspects of care that may improve outcome.......The mortality following emergency groin hernia repair in Denmark is more than twice as high (7%) as in comparable countries. This article describes in detail the population that died following emergency herniotomy in order to identify aspects of care that may improve outcome....

  13. 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.

  14. Strangulated obturator hernia - an unusual presentation of intestinal obstruction.

    LENUS (Irish Health Repository)

    Zeeshan, Saqib

    2012-01-31

    An 81-year-old Caucasian emaciated female presented with 3 days history of colicky abdominal pain nausea, projectile vomiting and abdominal distension. A pre-operative diagnosis of mechanical bowel obstruction was made. The absence of characteristic clinical signs in this thin elderly woman with a small bowel obstruction failed to provide a pre-operative diagnosis. She underwent a midline laparotomy and resection and anastomosis of small bowel and repair of the strangulated right obturator hernia. The high mortality rate associated with this type of abdominal hernias requires a high index of suspicion to facilitate rapid diagnosis and prompt surgical intervention if the survival rate is to be improved.

  15. Preclinical evaluation of the effect of the combined use of the Ethicon Securestrap® Open Absorbable Strap Fixation Device and Ethicon Physiomesh™ Open Flexible Composite Mesh Device on surgeon stress during ventral hernia repair

    Directory of Open Access Journals (Sweden)

    Sutton N

    2017-12-01

    Full Text Available Nadia Sutton,1 Melinda H MacDonald,2 John Lombard,1 Bodgan Ilie,3 Piet Hinoul,4 Douglas A Granger5,6 1Global Health Economics and Market Access, Johnson & Johnson Medical Devices, New Brunswick, NJ, USA; 2Preclinical Center of Excellence, Johnson & Johnson Medical Devices Companies, Somerville, NJ, USA; 3Biostatistics, Ethicon, Somerville, NJ, USA; 4Medical Affairs, Ethicon, Somerville, NJ, USA; 5Institute for Interdisciplinary Salivary Bioscience Research (IISBR, University of California at Irvine, Irvine, CA, USA; 6Johns Hopkins University School of Nursing, Bloomberg School of Public Health, and School of Medicine, Baltimore, MD, USA Aim: To evaluate whether performing ventral hernia repairs using the Ethicon Physiomesh™ Open Flexible Composite Mesh Device in conjunction with the Ethicon Securestrap® Open Absorbable Strap Fixation Device reduces surgical time and surgeon stress levels, compared with traditional surgical repair methods. Methods: To repair a simulated ventral incisional hernia, two surgeries were performed by eight experienced surgeons using a live porcine model. One procedure involved traditional suture methods and a flat mesh, and the other procedure involved a mechanical fixation device and a skirted flexible composite mesh. A Surgery Task Load Index questionnaire was administered before and after the procedure to establish the surgeons’ perceived stress levels, and saliva samples were collected before, during, and after the surgical procedures to assess the biologically expressed stress (cortisol and salivary alpha amylase levels. Results: For mechanical fixation using the Ethicon Physiomesh Open Flexible Composite Mesh Device in conjunction with the Ethicon Securestrap Open Absorbable Strap Fixation Device, surgeons reported a 46.2% reduction in perceived workload stress. There was also a lower physiological reactivity to the intraoperative experience and the total surgical procedure time was reduced by 60

  16. Mesh fixation in endoscopic inguinal hernia repair: evaluation of methodology based on a systematic review of randomised clinical trials.

    Science.gov (United States)

    Lederhuber, Hans; Stiede, Franziska; Axer, Stephan; Dahlstrand, Ursula

    2017-11-01

    The issue of mesh fixation in endoscopic inguinal hernia repair is frequently debated and still no conclusive data exist on differences between methods regarding long-term outcome and postoperative complications. The quantity of trials and the simultaneous lack of high-quality evidence raise the question how future trials should be planned. PubMed, EMBASE and the Cochrane Library were searched, using the filters "randomised clinical trials" and "humans". Trials that compared one method of mesh fixation with another fixation method or with non-fixation in endoscopic inguinal hernia repair were eligible. To be included, the trial was required to have assessed at least one of the following primary outcome parameters: recurrence; surgical site infection; chronic pain; or quality-of-life. Fourteen trials assessing 2161 patients and 2562 hernia repairs were included. Only two trials were rated as low risk for bias. Eight trials evaluated recurrence or surgical site infection; none of these could show significant differences between methods of fixation. Two of 11 trials assessing chronic pain described significant differences between methods of fixation. One of two trials evaluating quality-of-life showed significant differences between fixation methods in certain functions. High-quality evidence for differences between the assessed mesh fixation techniques is still lacking. From a socioeconomic and ethical point of view, it is necessary that future trials will be properly designed. As small- and medium-sized single-centre trials have proven unable to find answers, register studies or multi-centre studies with an evident focus on methodology and study design are needed in order to answer questions about mesh fixation in inguinal hernia repair.

  17. Congenital diaphragmatic hernia: a modern day approach.

    Science.gov (United States)

    Waag, Karl-Ludwig; Loff, Steffan; Zahn, Katrin; Ali, Mansour; Hien, Steffen; Kratz, Markus; Neff, Wolfgang; Schaffelder, Regine; Schaible, Thomas

    2008-11-01

    Centralization of all complicated congenital diaphragmatic hernias (CDH) was organized in Germany from 1998, collecting 325 consecutive patients with striking increasing survival rates. This series report 244 patients from 2002 to 2007. Today, large defects are detected early in pregnancy by ultrasound and magnetic resonance imaging (MRI). In extracorporeal membrane oxygenation (ECMO) patients, prenatal lung head ratio (LHR) was 1.2 (median) at the 34th week of gestation or less than 25 ml lung tissue in MRI. This means that all patients below LHR of 1.4 should be transferred prenatally in a tertiary center. High risk group for survival was defined as LHR below 0.9, ie, 10 ml in MRI planimetry. Inborn patients show better results than outborns. In algorithm therapy, gentle ventilation plays an important role in preventing damage to the lung tissue and avoiding long term ventilation. When PaCO(2) was more than 75 mmHg, ventilation was changed to high frequency oscillatory ventilation (HFOV). Indication for ECMO was seen in preductal PaO(2) less than 50 mmHg over 2-4 h or less than 40 mmHg over 2 h. ECMO related risks included intracerebral bleeding (9%), intrapulmonary bleeding (14%), and convulsions (16%). Surgically, a longitudinal midline incision for exposure of the defect, the duodenal kinking, and probably for abdominal patching was perfect. A cone formed goretex patch provided more abdominal space and reduced abundant intrathoracical cavity. No drain was used. Postoperative complications were described. Overall survival in 244 consecutive patients was 86.5% for all patients born alive. All those who needed ECMO survived in 71%, underlining ECMO as a treatment of last choice. Follow-up for quality of life after CDH is described.

  18. 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.

  19. A genome-wide association study of copy number variations with umbilical hernia in swine.

    Science.gov (United States)

    Long, Yi; Su, Ying; Ai, Huashui; Zhang, Zhiyan; Yang, Bin; Ruan, Guorong; Xiao, Shijun; Liao, Xinjun; Ren, Jun; Huang, Lusheng; Ding, Nengshui

    2016-06-01

    Umbilical hernia (UH) is one of the most common congenital defects in pigs, leading to considerable economic loss and serious animal welfare problems. To test whether copy number variations (CNVs) contribute to pig UH, we performed a case-control genome-wide CNV association study on 905 pigs from the Duroc, Landrace and Yorkshire breeds using the Porcine SNP60 BeadChip and penncnv algorithm. We first constructed a genomic map comprising 6193 CNVs that pertain to 737 CNV regions. Then, we identified eight CNVs significantly associated with the risk for UH in the three pig breeds. Six of seven significantly associated CNVs were validated using quantitative real-time PCR. Notably, a rare CNV (CNV14:13030843-13059455) encompassing the NUGGC gene was strongly associated with UH (permutation-corrected P = 0.0015) in Duroc pigs. This CNV occurred exclusively in seven Duroc UH-affected individuals. SNPs surrounding the CNV did not show association signals, indicating that rare CNVs may play an important role in complex pig diseases such as UH. The NUGGC gene has been implicated in human omphalocele and inguinal hernia. Our finding supports that CNVs, including the NUGGC CNV, contribute to the pathogenesis of pig UH. © 2016 Stichting International Foundation for Animal Genetics.

  20. Pyloro-duodenal hernia with formation of enterocutaneous fistula in ...

    African Journals Online (AJOL)

    Pyloro-duodenal hernia with formation of enterocutaneous fistula in a buffalo calf following a dog attack. ... Frequently Asked Questions about PDFs. Alternatively, you can download the PDF file directly to your computer, from where it can be opened using a PDF reader. To download the PDF, click the Download link above.

  1. 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…

  2. Traumatic abdominal wall hernia secondary to motorcycle handle bar injury

    Directory of Open Access Journals (Sweden)

    R S Jamabo

    2011-01-01

    Conclusion: We recommend a high level of clinical suspicion for traumatic abdominal wall herniation in all patients with traumatic abdominal wall injuries. It is instructive that the area be explored with primary repair of the hernia and other tissue planes of the abdominal wall.

  3. Surgical management of chronic pain after inguinal hernia repair

    DEFF Research Database (Denmark)

    Aasvang, E; Kehlet, H

    2005-01-01

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

  4. Laparoscopic treatment of type III para-oesophageal hernia | Van ...

    African Journals Online (AJOL)

    Type III congenital para-oesophageal hernia is a rare condition in children and is ... portion of the stomach and the gastro-oesophageal junction into the chest. ... in the hands of paediatric surgeons familiar with laparoscopic anti-reflux surgery.

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

    Science.gov (United States)

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

    2016-01-01

    Complications associated with implantation of polymeric hernia meshes remain a difficult surgical challenge. We report here on our work, developing for the first time, an injectable viscous material that can be converted to a solid and elastic implant in vivo, thus successfully closing herniated tissue. In this study, long-chain fatty acids were used for the preparation of telechelic macromonomers end-capped with methacrylic functionalities to provide UV curable systems possessing high biocompatibility, good mechanical strength and flexibility. Two different systems, comprising urethane and ester bonds, were synthesized from non-toxic raw materials and then subjected to UV curing after injection of viscous material into the cavity at the abdominal wall during hernioplasty in a rabbit hernia model. No additional fixation or sutures were required. The control group of animals was treated with commercially available polypropylene hernia mesh. The observation period lasted for 28 days. We show here that artificially fabricated defect was healed and no reherniation was observed in the case of the fatty acid derived materials. Importantly, the number of inflammatory cells found in the surrounding tissue was comparable to these found around the standard polypropylene mesh. No inflammatory cells were detected in connective tissues and no sign of necrosis has been observed. Collectively, our results demonstrated that new injectable and photocurable systems can be used for minimally invasive surgical protocols in repair of small hernia defects. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Laparoscopic Hiatal Hernia Repair in the Elderly Patient

    NARCIS (Netherlands)

    Oor, J. E.; Koetje, J. H.; Roks, D. J.; Nieuwenhuijs, V. B.; Hazebroek, E. J.

    Background Hiatal hernias (HH) are more common among elderly patients, with an increase in incidence with advancing age. Elderly patients frequently suffer from comorbidity, causing them to have an increased risk of perioperative mortality and morbidity. The aim of this study is to assess the safety

  7. Congenital Morgagni's hernia in infants and children: a national review

    African Journals Online (AJOL)

    Background: Congenital Morgagni's hernia (CMH) is rare and has unique features in terms of clinical presentation, high incidence of bilaterality, and associated anomalies. This is a review of all CMH cases reported from Saudi Arabia, highlighting clinical features, associated anomalies, aspects of diagnosis, and ...

  8. Hernia Surgery in Nyeri Provincial General Hospital, Kenya: Our 6 ...

    African Journals Online (AJOL)

    The average length of hospital stay was 3 days. Of the inguinal ... on hernia disease with reference to prevalence, pattern and management at a provincial general hospital in Kenya. Methods. After obtaining permission from the hospital administration, we .... financial constraint on hospitals, length of hospital stay and enable ...

  9. Pain and convalescence following laparoscopic ventral hernia repair

    DEFF Research Database (Denmark)

    Eriksen, Jens Ravn

    Severe pain is usual after laparoscopic ventral hernia repair (LVHR). Mesh fixation with titanium tacks may play a key role in the development of acute and chronic pain and alternative fixation methods should therefore be investigated. This PhD thesis was based on three studies and aimed too: 1) ...

  10. Strangulated external hernias in Kumasi | Ohene-Yeboah | West ...

    African Journals Online (AJOL)

    Background: In our hospital, Komfo Anokye, Kumasi theatre records show that more than 65 per cent of hernia repairs are performed for strangulation. The low level of elective repair may be linked to poverty, ignorance and fear, factors commonly found in a rapidly expanding young city like Kumasi with ever increasing ...

  11. Morgagni hernia presenting with lung consolidation unresponsive to ...

    African Journals Online (AJOL)

    Congenital diaphragmatic hernia (CDH) is a congenital malformation of the diaphragm that allows the abdominal organs to push into the chest cavity. We report the case of a 15-month-old patient who presented with a non-resolving opacity on a chest radiograph despite extensive antibiotic treatment. A large anterior ...

  12. Congenital diaphragmatic hernia: A 4-year experience in a single ...

    African Journals Online (AJOL)

    Abstract. Background: This study aimed to evaluate congenital diaphragmatic hernia (CDH) patients in our department during a 4-year period. Patients and Methods: A retrospective study of 10 cases of CDH patients managed in the Neonatology and Pediatric Surgery Units of Goztepe Teaching Hospital from 2000 to 2004.

  13. External abdominal wall hernias in Abia State University teaching ...

    African Journals Online (AJOL)

    Background: External abdominal wall hernias are common surgical conditions worldwide. In Africa, they not only make up a significant part of the surgeons workload, but are a major cause of mechanical intestinal obstruction. They are a leading cause of work loss and disability with lethal complications at times. Knowledge ...

  14. Reliable and valid assessment of Lichtenstein hernia repair skills.

    Science.gov (United States)

    Carlsen, C G; Lindorff-Larsen, K; Funch-Jensen, P; Lund, L; Charles, P; Konge, L

    2014-08-01

    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 of an assessment tool designed to measure surgical skills in Lichtenstein hernia repair. Key issues were identified through a focus group interview. On this basis, an assessment tool with eight items was designed. Ten surgeons and surgical trainees were video recorded while performing Lichtenstein hernia repair, (four experts, three intermediates, and three novices). The videos were blindly and individually assessed by three raters (surgical consultants) using the assessment tool. Based on these assessments, validity and reliability were explored. The internal consistency of the items was high (Cronbach's alpha = 0.97). The inter-rater reliability was very good with an intra-class correlation coefficient (ICC) = 0.93. Generalizability analysis showed a coefficient above 0.8 even with one rater. The coefficient improved to 0.92 if three raters were used. One-way analysis of variance found a significant difference between the three groups which indicates construct validity, p fashion with the new procedure-specific assessment tool. We recommend this tool for future assessment of trainees performing Lichtenstein hernia repair to ensure that the objectives of competency-based surgical training are met.

  15. 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...

  16. Pyloro-duodenal hernia with formation of enterocutaneous fistula in ...

    African Journals Online (AJOL)

    A body wall hernia entrapping abomasum and concurrent duodenal fistula in a buffalo calf aged about 8 months, secondary to a dog bite was successfully treated by closure of fistulous orifice and ventro lateral herniorrhaphy. Keywords: Abomaso-epiplocele, Buffalo calf, Duodenal fistula, Herniorrhaphy.

  17. Prevention of parastomal hernia in the emergency setting

    DEFF Research Database (Denmark)

    Lykke, Anna; Andersen, Johnny F.B.; Jorgensen, Lars N.

    2017-01-01

    and mortality were not different between the two groups. No patients underwent removal of the mesh and no clinical mesh infections were seen. Conclusion: Use of a resorbable synthetic mesh during emergency ostomy formation showed no significant preventive effect on formation of parastomal hernia after 1 year...

  18. Contemporary engagement with social media amongst hernia surgery specialists.

    Science.gov (United States)

    Lui, D H; McDonald, J J; de Beaux, A; Tulloh, B; Brady, R R W

    2017-08-01

    Healthcare professional engagement is increasing. This study aims to identify levels of adoption and engagement of several social media platforms by a large international cohort of hernia surgery specialists. Hernia specialists attending the 38th International Congress of the European Hernia Society were identified. A manual search was then performed on Twitter, ResearchGate, and LinkedIn to identify those who had named accounts. Where accounts were identified, data on markers of utilisation were assessed. 759 surgeons (88.5% male) from 57 countries were identified. 334 surgeons (44%) engaged with a social media platform. 39 (5.1%) had Twitter accounts, 189 (24.9%) had ResearchGate accounts and 265 (34.9%) had LinkedIn accounts. 137 surgeons (18.1%) had accounts on 2 or more social media platforms. There was no gender association with social media account ownership (p > 0.05). Engagement in one social media platform was associated with increased engagement and utilisation on other platforms; LinkedIn users were more likely to have Twitter accounts (p social media amongst Hernia surgeons is similar to other surgical specialities. Geographical variation in SM engagement is seen. Engagement with one SM platform is associated with presence on multiple platforms.

  19. Pelvic ventral hernia repair in a pygopagus conjoint twin | Bhullar ...

    African Journals Online (AJOL)

    Pelvic ventral hernia repair in a surviving conjoint twin with multiple congenital anomalies that make surgery a challenge. Conjoint twins are a rare. The incidence is reported to be in the range of 1/50 000 to 1/100 000 live births. Of the conjoint twins, 40% are stillborn and an additional one-third die within 24 h of birth.

  20. Umbilicoplasty in children with huge umbilical hernia | Komlatsè ...

    African Journals Online (AJOL)

    With a mean follow-up of 10 months, we had 10 excellent results and two fair results according to our criteria. Conclusion: Our two lateral fl aps umbilicoplasty is well-adapted to HUH in children. Itis simple and assures a satisfactory anatomical and cosmetic result. Key words: Children, huge umbilical hernia, Togo, umbilical ...