WorldWideScience

Sample records for human incisional hernia

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

    Science.gov (United States)

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

    2011-01-01

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

  2. Laparoscopic incisional lumbar hernia repair.

    Science.gov (United States)

    Yavuz, N; Ersoy, Y E; Demirkesen, O; Tortum, O B; Erguney, S

    2009-06-01

    Incisional lumbar hernia is an uncommon hernia type. Open surgical procedures have significant postoperative morbidity and patient dissatisfaction, therefore, for the repair of seven incisional lumbar hernias, we attempted using an intraperitoneal laparoscopic technique that was described to have good short-term results and decreased morbidity. We applied a laparoscopic technique using polypropylene meshes in five patients and composite meshes in two patients to cover the defect, then placed prolene sutures and hernia staples to secure the mesh intraperitoneally. The technique was successful in all patients, and they tolerated the procedure well. All did well after surgery, ambulating and eating a regular diet on postoperative day 1. No postoperative complications developed. At a mean follow-up of 34.1 months (range 17-43 months) none of them had pain, mass, or evidence of recurrence, and furthermore, cosmesis was excellent. We believe that the laparoscopic approach is feasible, safe, and the least invasive choice for repairing difficult hernias such as incisional lumbar hernias.

  3. Unusual Complications of Incisional Hernia

    African Journals Online (AJOL)

    Incisional hernia (IH) represent a breakdown or loss of continuity of a fascia closure.[1] IH occur in 11-23% of laparotomies.[2] It enlarges over time and can give rise to such complications as pain, discomfort, bowel obstruction, incarceration and strangulation. Furthermore, IHs reduce the quality-of-life and the chances of ...

  4. 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...

  5. Laparoscopic Ventral and Incisional Hernia Repair

    NARCIS (Netherlands)

    Wassenaar, E.B.

    2009-01-01

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

  6. Lumbar Incisional Hernias: Diagnostic and Management Dilemma

    Science.gov (United States)

    Salloum, Ellis J.

    2004-01-01

    Introduction: Lumbar hernias occur infrequently and can be congenital, primary (inferior or Petit type, and superior or Grynfeltt type), posttraumatic, or incisional. They are bounded by the 12th rib, the iliac crest, the erector spinae, and the external oblique muscle. Most postoperative incisional hernias occur in nephrectomy or aortic aneurysm repair incisions. Case Report: We present 2 patients who had undergone flank incisions and subsequently developed significant bulging of that area. The first patient had an atrophy of the abdominal wall musculature while the other had a large lumbar incisional hernia that was repaired laparoscopically. Discussion: Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice and allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures. Principles of laparoscopic repair include lateral decubitus positioning with table flexed, adhesiolysis, and reduction of hernia contents, securing ePTFE mesh with spiral tacks and transfascial sutures to an intercostal space superiorly, iliac crest periosteum inferiorly, and rectus muscle anteriorly. Posteriorly, the mesh is secured to psoas major fascia with intracorporeal sutures to avoid nerve injury. Conclusion: Lumbar incisional hernia must be differentiated from muscle atrophy with no fascial defect. The laparoscopic approach provides an attractive option for this often challenging problem. PMID:15554289

  7. 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 organ

  8. CLINICAL STUDY AND MANAGEMENT OF INCISIONAL HERNIA

    Directory of Open Access Journals (Sweden)

    Jyothirmayi

    2016-05-01

    Full Text Available Incisional hernia follows operations on the anterolateral abdominal wall. It is a diffuse extrusion of peritoneum and abdominal contents through a weak scar due to the failure of the lines of closure of the abdominal wall following laparotomy. The incidence of incisional hernia varies widely in different series published and is at least 10% as shown in longterm follow-up studies. Clarification regarding the type of mesh and its positioning and operative methods of open surgery and laparoscopic repair needs to be addressed. In addition to surgical closure techniques, patient's risk factors also influence surgical outcome following wound closure. RESULTS Age, gender and risk factors such as diabetes, Hypertension, Anaemia, Obesity, COPD and Type of previous incision contribute to the development of primary and recurrent incisional hernia. Although complete prevention of development of incisional hernia is not possible, repair of hernia by replacement of simple suture technique with that of mesh reinforcement has shown better longterm results and patient satisfaction. CONCLUSION For management of incisional hernia, the available evidence has been favourable for good quality long term results with mesh repair techniques.

  9. 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...... procedure and severely lack evidence-based research from high-quality, large-scaled randomised studies....

  10. Management of adult incisional hernias at the University of ...

    African Journals Online (AJOL)

    Background: Incisional hernias (IH) represent a breakdown or loss of continuity of a fascial closure. They are thus unique as the only external wall hernias that are iatrogenic in aetiology. Incisional hernias are not uncommon complications of laparotomy closure with reported incidence of 2 to 11%. Objectives: To review our ...

  11. Spontaneous rapture of an incisional hernia: A case report ...

    African Journals Online (AJOL)

    An incisional hernia develops in the scar of a surgical incision. Rarely, a particularly thin-walled large incisional hernia may actually ulcerate at its fundus so that omentum protrudes or there is even the development of an intestinal fistula. Spontaneous rupture of an abdominal hernia is very rare and usually occurs in ...

  12. 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...... between 1991 and 2000. The cohort was followed from their first until 10 years after their last cesarean delivery within the inclusion period or until the first of the following events: hernia repair, death, emigration, abdominal surgery, or cesarean delivery after the inclusion period. For women who had...... a hernia repair, hospital records regarding the surgery and previous cesarean deliveries were tracked and manually analyzed to validate the relationship between hernia repair and cesarean delivery. Data were analyzed with a competing risk analysis that included each cesarean delivery. RESULTS: We...

  13. Recurrent Incisional Hernia due to Pseudomyxoma Peritonei

    Directory of Open Access Journals (Sweden)

    Zafer Ergul

    2011-01-01

    Full Text Available Pseudomyxoma peritonei is a rare but challenging neoplastic disease which is characterized with intraperitoneal mucinous-gelatinous fluid accumulation. It rarely presents as a mass mimicking abdominal wall hernias A recurrent incisional hernia due to pseudomyxoma peritonei is presented here. A 60-year-old female patient had been operated on for a left mucinous ovarian cyst 20 cm in diameter in 1998. Mucinous material had disseminated into interloop spaces through the right subdiaphragmatic region. Total abdominal hysterectomy + bilateral salpingooophorectomy and peritoneal toilet had been performed. She was rehospitalized for abdominal distention and a 4 cm defect over the incision and underwent a hernia repair using polypropylene mesh in 2001. Abdominal distention recurred to give a rise to an incisional hernia in 2006. She was reoperated for decompression and repair, but nothing could be done because of sticky adhesions and the incision were simply closed. The patient was referred to our department for operation. A prosthetic hernia repair with 30×30 cm polypropylene mesh was performed. The patient was discharged on the postoperative 5th day following an uneventful recovery. However, she died of disseminated disease after 18 months.

  14. 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

    of incisional hernia. Furthermore, risk factors for incisional hernia formation are not fully elucidated. The aim of this study was to evaluate the long-term effect of elective open versus laparoscopic surgery for colonic cancer on development of incisional hernia. METHODS: This nationwide cohort study included...... were performed. RESULTS: A total of 8489 patients were included, with a median follow-up of 8.8 (interquartile range 7.0-10.7) years. The incidence of incisional hernia was increased among patients operated on with open techniques compared with patients undergoing laparoscopic surgery (7.3 vs. 5.2 %, p...... hernia formation (hazard ratio [HR] 0.62, 95 % confidence interval [CI] 0.44-0.89; p = 0.009). Other factors associated with increased risk of incisional hernia were wound infection...

  15. Combining abdominoplasty with mesh repair of incisional hernia: a ...

    African Journals Online (AJOL)

    ... of incisional hernia is considered the gold standard. Open repair results in an unaesthetic long midline anterior abdominal wall scar. Combining the produce with an abdominoplasty ensures an all-round satisfactions. Keywords: Abdominoplasty, incisional hernia, prosthetic mesh. Nigerian Journal of Plastic Surgery Vol.

  16. Incarcerated fallopian tube presenting in an incisional hernia : a ...

    African Journals Online (AJOL)

    A patient with an incarcerated fallopian tihe complicating an incisional hernia, which was associated with a Pfannenstiel incision, is presented ancl cliscussed. Mechanisms responsible for this type of incisional hernia are outlined. Even though the use of mass closure has significantly decreased the rate of burst abdomen.

  17. 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.

  18. Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

    Helgstrand, Frederik; Rosenberg, Jacob; Kehlet, Henrik

    2013-01-01

    BACKGROUND: Incisional hernia repair is a frequent surgical procedure, but perioperative risk factors and outcomes have not been prospectively assessed in large-scale studies. The aim of this nationwide study was to analyze surgical risk factors for early and late outcomes after incisional hernia...... repair. STUDY DESIGN: We conducted a prospective nationwide study on all elective incisional hernia repairs registered in the Danish Ventral Hernia Database between January 1, 2007 and December 31, 2010. Main outcomes measures were surgical risk factors for 30-day readmission, reoperation (excluding...... recurrence), and mortality after incisional hernia repair. Late outcomes included reoperation for recurrence during the follow-up period. Follow-up was obtained by merging the Danish Ventral Hernia Database with the Danish National Patient Register. Results were evaluated by multivariate analyses. RESULT...

  20. 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...

  1. 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

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

    Science.gov (United States)

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

    2015-12-01

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

  3. 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.

  4. 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.

  5. Unusual complications of incisional hernia | Emegoakor | Annals of ...

    African Journals Online (AJOL)

    Incisional hernia represents a breakdown or loss of continuity of a fascial closure. These hernias are of particular concern not only for the high recurrence rates among them but also for the challenges that follow their repair. It is known to occur in 11‑23% of laparotomies. This paper presents two unusual complications of ...

  6. Classification of primary and incisional abdominal wall hernias

    NARCIS (Netherlands)

    F.E. Muysoms (Filip); M. Miserez; F. Berrevoet; G. Campanelli (Giampiero); G.G. Champault; E. Chelala; U.A. Dietz; H.H. Eker (Hasan); I. El Nakadi; P. Hauters; M. Hidalgo Pascual; A. Hoeferlin; U. Klinge; A. Montgomery; R.K.J. Simmermacher; M.P. Simons; M. Śmietański; C. Sommeling; T. Tollens; T. Vierendeels; A. Kingsnorth

    2009-01-01

    textabstractPurpose: A classification for primary and incisional abdominal wall hernias is needed to allow comparison of publications and future studies on these hernias. It is important to know whether the populations described in different studies are comparable. Methods: Several membersof the EHS

  7. 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

  8. Light weight meshes in incisional hernia repair

    Directory of Open Access Journals (Sweden)

    Schumpelick Volker

    2006-01-01

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

  9. Have Outcomes of Incisional Hernia Repair Improved With Time?

    Science.gov (United States)

    Flum, David R.; Horvath, Karen; Koepsell, Thomas

    2003-01-01

    Objective To determine if certain outcomes of incisional hernia repair have improved in recent eras. Summary Background Data Technological developments have been reported to improve outcomes in the repair of abdominal wall incisional hernias. Methods This retrospective, population-based cohort study was conducted using a 1987 to 1999 Washington hospital discharge database. Subjects were all Washington state residents assigned ICD9 procedure codes for incisional hernia repair with or without synthetic material (mesh). Main outcome measure was the rate of reoperative incisional hernia repair, length of hospitalization, and hospital charges based on the use of synthetic material and the era of operative repair (before and after 1995). Results A total of 10,822 Washington state patients underwent incisional hernia repair (mean age 58.7 ± 15.6, 64% female). Of patients undergoing incisional hernia repair, 12.3% underwent at least one subsequent reoperative incisional hernia repair within the first 5 years after initial repair (23.1% at 13 years follow-up). The 5-year reoperative rate was 23.8% after the first reoperation, 35.3% after the second, and 38.7% after the third. The use of synthetic mesh in incisional hernia repairs increased from 34.2% in 1987 to 65.5% in 1999. When controlling for age, sex, comorbidity index of the patient, year of the initial procedure, and hospital descriptors (rural location, nonprofit and teaching status), the hazard for recurrence was 24.1% higher if no mesh was used compared to the hazard if mesh was used. After similar adjustment, no differences were found in the hazard of reoperation based on the era of the operative repair. Mean length of stay for procedures performed after 1995 was 4.9 days compared to 4.8 days in preceding eras. Conclusions Incisional hernia repair is associated with high cumulative rates of reoperative repairs. The expectation that important measures of adverse outcome have improved in recent eras is not

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

    Directory of Open Access Journals (Sweden)

    Bülent Kaya

    2012-10-01

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

  11. FULL - TERM PREGNANCY IN AN INCISIONAL ~HERNIA - A CASE ...

    African Journals Online (AJOL)

    uterus in the incisional hernia sac hanging below the groin. She has had previous abdominal ... want more children. Caesarian section was performed and a life female baby was delivered (Figure 5). Bilateral Tubal ligation was also done. The uterus was. clOsed. 252 ... embarrass respiratory function. It has been suggested ...

  12. Incisional Hernia: Experience in a single surgical unit | Pillay | East ...

    African Journals Online (AJOL)

    Five patients needed management in the ICU. Hospital stay was 8 + 11 years. Conclusion: Most incisional hernias followed gynaecological surgery. There was no evidence of a nonabsorbable suture having been used at the original operation in over half of the patients. We recommend that meticulous technique is essential ...

  13. Spontaneous rupture of an incisional hernia | Eke | Highland ...

    African Journals Online (AJOL)

    She tested positive for HIV infection. The rupture was repaired under antibodies cover. She made an uneventful recovery but has since been lost to follow up. Lesson: The risk of spontaneous rupture is an indication for the elective repair of incisional hernias. Highland Medical Research Journal Vol. 4(1) 2006: 86-88 ...

  14. 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...

  15. Review of stoma site and midline incisional hernias after stoma reversal.

    Science.gov (United States)

    Nguyen, Mylan T; Phatak, Uma R; Li, Linda T; Hicks, Stephanie C; Moffett, Jennifer M; Arita, Nestor A; Berger, Rachel L; Kao, Lillian S; Liang, Mike K

    2014-08-01

    The incidence of incisional hernias after stoma reversal is not well reported. The aim of this study was to systematically review the literature reporting data on incisional hernias after stoma reversal. We evaluated both the incidence of stoma site and midline incisional hernias. A systematic review identified studies published between January 1, 1980, and December 31, 2012, reporting the incidence of incisional hernia after stoma reversal at either the stoma site or at the midline incision (in cases requiring laparotomy). Pediatric studies were excluded. Assessment of risk of bias, detection method, and essential study-specific characteristics (follow-up duration, stoma type, age, body mass index, and so forth) was done. Sixteen studies were included in the analysis; 1613 patients had 1613 stomas formed. Fifteen studies assessed stoma site hernias and five studies assessed midline incisional hernias. The median (range) incidence of stoma site incisional hernias was 8.3% (range 0%-33.9%) and for midline incisional hernias was 44.1% (range 8.7%-58.1%). When evaluating only studies with a low risk of bias, the incidence for stoma site incisional hernias is closer to one in three and for midline incisional hernias is closer to one in two. Stoma site and midline incisional hernias are significant clinical complications of stoma reversals. The quality of studies available is poor and heterogeneous. Future prospective randomized controlled trials or observational studies with standardized follow-up and outcome definitions/measurements are needed. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. 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.

  17. Laparoscopic surgery for treatment of incisional lumbar hernia

    Directory of Open Access Journals (Sweden)

    M. Tobias-Machado

    2005-08-01

    Full Text Available OBJECTIVE: To present results obtained with laparoscopic correction of incisional lumbar hernia in patients with minimum follow-up of 1 year. MATERIALS AND METHODS: We prospectively studied 7 patients diagnosed with incisional lumbar hernia after physical examination and computerized tomography. We used laparoscopic transperitoneal access through 3 ports. One polypropylene mesh was introduced in the abdominal cavity and fixed by titanium clamps to the margins of the hernia ring following release of the peritoneum. RESULTS: All cases were successfully completed with no conversion required. Mean surgical time was 120 minutes and discharge from hospital occurred between the 1st and the 2nd postoperative days. There were no intraoperative complications or hernia recurrence in any case. Postoperatively, we had 2 minor complications: one case of seroma that resolved spontaneously after 60 days and one patient presenting lumbar pain that persisted until the 3rd postoperative month. The return to usual activities occurred on average 3 weeks following intervention. Of the 7 patients, 6 were satisfied with the esthetical and functional effect produced by the procedure. CONCLUSIONS: The surgical correction of incisional lumbar hernia by laparoscopic access is an excellent option for a minimally invasive treatment, with adequate long-term results.

  18. The collagen turnover profile is altered in patients with inguinal and incisional hernia

    DEFF Research Database (Denmark)

    Henriksen, Nadia A; Mortensen, Joachim H; Sorensen, Lars T

    2015-01-01

    in the interstitial matrix (types I, III, and V collagens) and in the basement membrane (type IV collagen). MATERIAL AND METHODS: Patients with 3 different types of hernias were included: Primary unilateral inguinal hernia (n = 17), multiple hernias defined as ≥3 hernias (n = 21), and incisional hernia (n = 25......, and C4M) were measured in serum by validated, solid-phase competitive assays. RESULTS: In inguinal hernia patients, the turnover of the interstitial matrix collagens type III (P ... turnover profile of type IV collagens may predict the presence of inguinal and incisional hernia. Regulation of type IV collagen turnover may be crucial for hernia development....

  19. Post Incisional Hernia Meshplasty Vesicocutaneous Fistula – A Rare Complication

    Directory of Open Access Journals (Sweden)

    M. Raghavendran

    2017-07-01

    Full Text Available Laparoscopic meshplasty is gold standard in hernia surgery. Mesh migration into bowel/bladder has been documented after laparoscopic repair, though migration into bowel is more common than bladder. Only 12 cases of migration into bladder have been described post inguinal meshplasty. We report the 1st case of mesh migration into bladder post Incisional hernia meshplasty, presenting as vesicocutaneous fistula. The objectives of this report are highlighting important points enabling earlier diagnosis, treatment. We would also like to suggest important preventive measures during meshplasty which we believe will go a long way in avoiding this important complication, thus immensely benefiting patients.

  20. Bursting strength evaluation in an experimental model of incisional hernia.

    Science.gov (United States)

    Lucha, Paul A; Briscoe, Crystal; Brar, Harpreet; Schneider, James J; Butler, Ralph E; Jaklic, Beth; Francis, Michael

    2007-07-01

    Incisional hernias occur in up to 11 per cent of patients undergoing abdominal surgery. Up to 50 per cent of these patients with hernias will require repeat operative procedures. Management of these hernias have focused primarily on tensile strength of the mesh material, have not addressed currently used materials, and have not compared the strength of these repairs with each other. Forty-nine adult Sprague-Dawley rats had an incisional hernia created by removing a portion of their abdominal wall that was then repaired primarily, using either a composite mesh, Dual mesh (Gore-Tex), or polypropylene mesh. Six weeks after the repair, the rats were euthanized. Hydrostatic distension of the abdominal cavity was performed to compare bursting strength of each repair. Wound tensile strength was assessed and compared. Tissue samples were also taken to compare repair types for incorporation of prosthetic materials. The gross weight of the animals subjected to hydrostatic distention was equivalent between groups, as was the volume required prior to failure of the repair. There was a trend toward improved tensile strength of the Prolene mesh repair, which had a lower average inflammatory and fibrosis score on histology. Overall, the type of mesh used for repair does not seem to impact significantly the strength of the repair when assessed 6 weeks postoperatively. Choice of prosthetic material to repair the hernia should be made based on economics and handling characteristics alone. Prolene mesh has satisfactory strength with the least amount of inflammation and fibrosis.

  1. A Minimally Invasive Approach For Treating Postoperative Seromas After Incisional Hernia Repair

    National Research Council Canada - National Science Library

    Lehr, Shannon C; Schuricht, Alan L

    2001-01-01

    Background: The most frequent wound complication following repair of large incisional hernias is seroma formation, especially when the use of a mesh onlay requires extensive subcutaneous undermining...

  2. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia

    NARCIS (Netherlands)

    J.W.A. Burger (Jacobus); R.W. Luijendijk; W.C.J. Hop (Wim); J.A. Halm (Jens); E.G. Verdaasdonk; J. Jeekel (Hans)

    2004-01-01

    textabstractOBJECTIVE: The objective of this study was to determine the best treatment of incisional hernia, taking into account recurrence, complications, discomfort, cosmetic result, and patient satisfaction. BACKGROUND: Long-term results of incisional hernia repair are lacking.

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  4. The incidence of incisional hernias following ileostomy reversal in colorectal cancer patients treated with anterior resection.

    Science.gov (United States)

    Fazekas, Balazs; Fazekas, Bence; Hendricks, J; Smart, N; Arulampalam, T

    2017-04-01

    INTRODUCTION The aim of this study was to identify the rate of incisional hernia formation following ileostomy reversal in patients who underwent anterior resection for colorectal cancer. In addition, we aimed to ascertain risk factors for the development of reversal-site incisional hernias and to record the characteristics of the resultant hernias. MATERIALS AND METHODS Using a prospectively compiled database of colorectal cancer patients who were treated with anterior resection, we identified individuals who had undergone both ileostomy formation and subsequent reversal of their ileostomies from January 2005 to December 2014. Medical records were reviewed to record descriptive patient data about risk factors for hernia formation, operative details and any subsequent operations. Computed tomography reports were reviewed to identify the number, site and characteristics of incisional hernias. RESULTS A total of 121 patients were included in this study; 14.9% (n = 18) developed an incisional hernia at the ileostomy reversal site; 17.4% (n = 21) at a non-ileostomy site and 6.6% (n = 8) developed both. The reversal-site hernias were smaller both in width and length compared with the non-ileostomy-site hernias. Risk factors for the development of reversal-site incisional hernias were higher body mass index (BMI), lower age, open surgery, longer reversal time and a history of previous hernias. We did not detect a difference in the size of the incisional hernias that developed in patients with these specific risk factors. CONCLUSIONS Incisional hernias are a significant complication of ileostomy reversal. Further evaluation of the use of prophylactic mesh to reduce the incidence of incisional hernias may be worthwhile.

  5. [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.

  6. 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.

  7. Retrospective review of risk factors for surgical wound dehiscence and incisional hernia.

    Science.gov (United States)

    Walming, Sofie; Angenete, Eva; Block, Mattias; Bock, David; Gessler, Bodil; Haglind, Eva

    2017-02-22

    Several factors and patient characteristics influence the risk of surgical wound dehiscence and incisional hernia after midline laparotomy. The purpose of this study was to investigate whether a specified, or not specified, suture quota in the operative report affects the incidence of surgical wound complications and to describe the previously known risk factors for these complications. Retrospective data collection from medical records of all vascular procedures and laparotomies engaging the small intestines, colon and rectum performed in 2010. Patients were enrolled from four hospitals in the region Västra Götaland, Sweden. Unadjusted and adjusted Cox regression analyses were used when calculating the impact of the risk factors for surgical wound dehiscence and incisional hernia. A total of 1,621 patients were included in the study. Wound infection was a risk factor for both wound dehiscence and incisional hernia. BMI 25-30, 30-35 and >35 were risk factors for wound dehiscence and BMI 30-35 was a risk factor for incisional hernia. We did not find that documentation of the details of suture technique, regarding wound and suture length, influenced the rate of wound dehiscence or incisional hernia. These results support previous findings identifying wound infection and high BMI as risk factors for both wound dehiscence and incisional hernia. Our study indicates the importance of preventive measures against wound infection and a preoperative dietary regiment could be considered as a routine worth testing for patients with high BMI planned for abdominal surgical precedures.

  8. Incisional hernia recurrence following 'vest-over-pants' or vertical mayo repair of primary hernias of the midline

    NARCIS (Netherlands)

    R.W. Luijendijk; M.H.M. Lemmen (M. H M); W.C.J. Hop (Wim); J.C.J. Wereldsma

    1997-01-01

    textabstractA series of 68 primary midline incisional hernias with a vertical Mayo repair was evaluated retrospectively. Patients without documented hernia recurrence following this repair were invited for physical examination. Life- table methods were used for statistical analysis. The 1-, 3-, 5-,

  9. 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.

  10. Abdominal Wall Mycetoma Presented as Obstructed Incisional Hernia of Cesarean Section in Eastern Sudan

    Science.gov (United States)

    Elhardello, Osama A.; Adam, Elsadig S.; Adam, Ishag

    2007-01-01

    Mycetoma a worldwide disease frequently occurs in the tropics with the highest prevalence being in Africa. Madurella mycetomatis is the main causative organism of human eumycetoma in Sudan. The legs and feet were commonly the sites of the infection. A 22-year-old lady was presented with painful abdominal swelling around a previous caesarian section scar. A provisional diagnosis of obstructed incisional hernia was put. Histopathological examination revealed macroscopically four masses of soft tissue. Microscopic sections showed grains of Madurella mycetomatis. PMID:17485822

  11. Laparoscopic incisional and umbilical hernia repair in cirrhotic patients.

    Science.gov (United States)

    Belli, Giulio; D'Agostino, Alberto; Fantini, Corrado; Cioffi, Luigi; Belli, Andrea; Russolillo, Nadia; Langella, Serena

    2006-10-01

    Traditional approach to incisional hernias (IHs) in cirrhotic patients is plagued by a significant recurrence rate and frequent wound infections. The laparoscopic repair of IHs was designed to offer a minimally invasive and tension-free technique that yields less morbidity and fewer recurrences than the standard open repair. In cirrhotic patients there are additional reasons for the benefits of laparoscopy. First, preservation of the abdominal wall avoids interruption of large collateral veins. Second, nonexposure of viscera restricts electrolytic and protein losses, and improves absorption of ascites. Finally, the laparoscopic approach is associated with a lower perioperative blood loss (smaller abdominal incision). A retrospective review was performed for 14 consecutive patients with ventral hernias and affected by chronic hepatitis or cirrhosis related to hepatitis C-B virus, who underwent laparoscopic repair at our institution between September 2002 and October 2004. All patients were in class A of Child-Pugh classification. There was no conversion to open operation. The mean size of the defects was 87 cm (range 1 to 480); incarceration was present in 2 patients and multiple (Swiss-cheese) defects in 1. In all cases, the mesh (average, 287 cm) was secured with transabdominal sutures and metal tacks or staples leaving the sac in situ. Operative time and estimated blood loss averaged 88 min (range 18 to 270) and 30 mL (range 10 to 150). Length of hospital stay averaged 2.6 days (range 1 to 6). There were 11 minor complications: seroma lasting >4 weeks (5), postoperative ileus (2), suture site pain >2 weeks (2), urinary retention (1), and skin breakdown (1). We experienced no recurrences with an average follow-up of 8 months (range 3 to 24). Laparoscopic IH repair is technically feasible and safe even in cirrhotic patients with fascial defects. This operation decreases postoperative pain, shortens the recovery period, and seems to reduce postoperative morbidity

  12. Increased risk of incisional hernia after sigmoid colectomy for diverticulitis compared with colon cancer.

    Science.gov (United States)

    Pogacnik, Javier S; Messaris, Evangelos; Deiling, Susan M; Connelly, Tara M; Berg, Arthur S; Stewart, David B; McKenna, Kevin J; Poritz, Lisa S; Koltun, Walter A

    2014-05-01

    We aimed to determine if an increased incidence of incisional hernias is present in patients undergoing sigmoidectomy for diverticulitis vs cancer. The pathophysiology of diverticulitis is poorly understood, but might involve a collagen vascular abnormality that can predispose to incisional hernia. In this IRB-approved, retrospective study, patients who underwent sigmoid colectomies for diverticulitis or cancer between January 2003 and September 2012 were studied. Exclusion criteria included the development of surgical site infections and neoadjuvant chemoradiotherapy. A multivariate logistic regression was used with covariate adjustments for known risk factors for hernia development. Four hundred forty-two patients (mean age 59.3 ± 13.9 years) with a median follow-up of 30 months were analyzed. The incidence of incisional hernia was 15.1% in diverticulitis patients vs 5.8% in the cancer cohort (41 of 271 vs 10 of 171; p = 0.003). Univariate analysis of risk factors associated with postoperative incisional hernia included steroid use (p = 0.007), wound packing (p = 0.001), higher American Society of Anesthesiologists classification (p = 0.001), absorbable suture closure (p = 0.02), blood transfusion (p = 0.04), stoma formation (p = 0.02), increased body mass index (p = 0.008), and history of incisional hernia (p = 0.00008). Multivariate logistic regression demonstrated a persistent association between diverticulitis and hernia development (p = 0.01). Odds of a hernia developing after sigmoidectomy for diverticulitis were 2.82 times greater than in the cancer cohort (95% CI, 1.3-6.6). The incidence of an incisional hernia developing after a sigmoid colectomy is significantly higher when performed for diverticulitis as compared with cancer. This might be due to a connective tissue disorder, which predisposes to development of both diverticula and hernias. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Is laparoscopic treatment of incisional and recurrent hernias associated with an increased risk for complications?

    Science.gov (United States)

    Meyer, Rüdiger; Häge, Anna; Zimmermann, Markus; Bruch, Hans-Peter; Keck, Tobias; Hoffmann, Martin; Schlöricke, Erik

    2015-07-01

    Hernias of the ventral abdominal wall can be treated with an intraperitoneal onlay mesh (IPOM). The aim of this cohort study was to analyze the complications and recurrence rates after laparoscopic ventral hernia repair focusing especially on incisional and recurrent hernias. The study population comprised 149 patients with a hernia of the abdominal wall, which was treated with an IPOM between January 2006 and January 2011. Fifty-one patients had a primary hernia (group I) and 98 patients had preceding abdominal surgery (group II). In group II 64 patients had an incisional hernia and 34 patients had a recurrent hernia. The median body mass index was 30.3 kg/m(2) (14.8-69.1) without any significance in sub-group comparison. The mean duration of surgery and the length of stay were significantly longer in group II (p hernias as incisional hernias, recurrent hernias and hernias with interenteric and enteroperitoneal adhesions is associated with high rates of minor and major complications. A high level of expertise of the surgeon and the camera-guiding assistant is therefore needed. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    N. Merali

    2015-01-01

    Conclusion: This case has demonstrated how a planned multidisciplinary action can produce prosperous results in a severely obese immunocompromised patient with an SSI, following an incisional hernia repair.

  15. Short- and mid-term outcome after laparoscopic repair of large incisional hernia.

    Science.gov (United States)

    Baccari, P; Nifosi, J; Ghirardelli, L; Staudacher, C

    2013-10-01

    To compare the outcome after laparoscopic incisional and ventral herniorrhaphy (LIVH) for fascial defect larger or equal than 15 cm in width with the outcome after LIVH in patients with hernia defect smaller than 15 cm. From 2003 through 2010, 350 patients were submitted to LIVH. In 70 cases, hernia defect was ≥15 cm in width and in 280 was hernias were often recurrent, double or multiorificial. In the group of larger hernias, the rate of obesity, recurrent hernia and multiorificial hernia was 27.1, 24.2 and 12.8 %, respectively, and in the group of smaller hernias 27.3, 16.1 and 2.8 %, respectively. Patients were interviewed using McGill pain score test to measure postoperative quality of life (QoL) in the mid-term. LIVH for hernia ≥15 cm required longer surgical time (p = 0.034) and postoperative hospital stay (p = 0.0001). Besides, there were higher rate of postoperative prolonged ileus (p = 0.035) and polmonitis (p = 0.001). Overall recurrence rate was 2.6, 8.6 % for larger and 1.1 % for smaller incisional hernias, p = 0.045. Mc Gill pain test revealed no significant difference in the two groups of patients in postoperative QoL within 36 months. Laparoscopic approach seems safe and effective even to repair large incisional hernia, the rate of recurrence was higher, but acceptable, if compared to smaller hernias. To the best of our knowledge, this is the largest reported series of incisional hernias ≥15 cm managed by laparoscopy.

  16. Chronic kidney disease is associated with high abdominal incisional hernia rates and wound healing disturbances.

    Science.gov (United States)

    Heller, Andreas; Westphal, Saskia E; Bartsch, Peter; Haase, Michael; Mertens, Peter R

    2014-06-01

    Incisional hernias are among the most frequent complications following abdominal surgery with impact on morbidity and mortality rates. Elevated uremia toxins may inhibit granulation tissue formation and impair wound healing, thereby promoting incisional hernia development. Here, we quantified the hazard ratio for incisional hernia prevalence in patients at risk undergoing abdominal reoperations with interrelationship to kidney function. In the same cohort, incidence rates for de novo wound healing disturbances within a4-month follow-up period were determined. Upon hospitalization for elective abdominal surgery in a university hospital (tertiary medical center), past medical histories were recorded in 251 patients and incisional hernia prevalence rates were calculated. Known modifiers for hernia formation as well as laboratory values for estimated glomerular filtration rate (eGFR) were recorded. The status of wound healing was assessed by a blinded investigator 4 months postoperatively. Chronic kidney disease(CKD) was defined as eGFR healing disorder, multivariate regression analyses were performed. The incisional hernia prevalence was 24.3 % in the overall cohort. Patients with CKD (32/251; 12.8 %)were more likely to suffer from incisional hernias with an odds ratio (OR) of 2.8 ([95 % CI 1.2-6.1]; p = 0.014) than patients with eGFR >60 ml/min (219/251; 88.2 %). In multivariate analyses, CKD proved to be an independent risk factor for incisional hernia development with an OR similar to obesity (BMI>25; OR 2.6 [95 % CI 1.3-5.1];p = 0.007). In the prospective analysis, disturbed wound healing occurred in 32 of 251 (12.8 %) patients undergoing abdominal operations. Frequency of wound healing was increased when CKD was present (8/32; 25 %; OR 2.3[95 % CI 1.1–6.7]; p = 0.026) compared to patients with eGFR>60 ml/min (24/219; 11 %). Chronic kidney disease is associated with impaired wound healing and constitutes an independent risk factor for incisional hernia

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

  19. A Rare Complication of Biliary Stent Migration: Small Bowel Perforation in a Patient with Incisional Hernia

    Directory of Open Access Journals (Sweden)

    Özkan Yilmaz

    2015-01-01

    Full Text Available Endoscopic biliary stents have been recently applied with increasing frequency as a palliative and curable method in several benign and malignant diseases. As a reminder, although most of the migrated stents pass through the intestinal tract without symptoms, a small portion can lead to complications. Herein, we present a case of intestinal perforation caused by a biliary stent in the hernia of a patient with a rarely encountered incarcerated incisional hernia.

  20. Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure.

    Science.gov (United States)

    Lambrecht, J R; Vaktskjold, A; Trondsen, E; Øyen, O M; Reiertsen, O

    2015-06-01

    Supposing divergent aetiology, we found it interesting to investigate outcomes between primary (PH) versus incisional (IH) hernias. In addition, we wanted to analyse the effect of defect closure and mesh fixation techniques. 37 patients with PH and 70 with IH were enrolled in a prospective cohort-study, treated with laparoscopic ventral hernia repair (LVHR) and randomised to ± transfascial sutures. In addition, we analysed results from a retrospective study with 36 PH and 51 IH patients. Mean follow-up time was 38 months in the prospective study and 27 months in the retrospective study. 35 % of PH's and 10 % of IH's were recurrences after previous suture repair. No late infections or mesh removals occurred. Recurrence rates in the prospective study were 0 vs. 4.3 % (p = 0.55) and the complication rates were 16 vs. 27 % (p = 0.24) in favour of the PH cohort. The IH group had a mesh protrusion rate of 13 vs. 5 % in the PH group (p = 0.32), and significantly (p hernias and adhesion score, longer operating time (100 vs. 79 min) and admission time (2.8 vs. 1.6 days). Closure of the hernia defect did not influence rate of seroma, pain at 2 months, protrusion or recurrence. An overall increased complication rate was seen after defect closure (OR 3.42; CI 1.25-9.33). With PH, in comparison to IH treated with LVHR, no differences were observed regarding recurrence, protrusion or complication rates. Defect closure (raphe), when using absorbable suture, did not benefit long-term outcomes and caused a higher overall complication rate. (ClinicalTrials.gov number: NCT00455299).

  1. Incarcerated incisional hernia of the sigmoid colon after appendectomy: A case report

    Directory of Open Access Journals (Sweden)

    Pyong Wha Choi

    2017-01-01

    Conclusion: Although incisional hernia of the colon after appendectomy is extremely rare and preoperative diagnosis by physical examination is difficult, CT is a useful method to make the correct diagnosis, avoiding unnecessary invasive intervention, particularly in patients with an unusual abdominal wall mass.

  2. Robot-assisted surgery and incisional hernia: a comparative study of ergonomics in a training model.

    Science.gov (United States)

    Sánchez, Alexis; Rodríguez, Omaira; Jara, Génesis; Sánchez, Renata; Vegas, Liumariel; Rosciano, José; Estrada, Luis

    2018-01-04

    Over the years, incisional hernia repair has evolved. Currently, primary closure of the defect before placing the mesh is a critical step in incisional hernia repair and minimally invasive surgery incorporation has an important role due to great advantages. Despite its benefits, laparoscopic closure with suture intracorporeal knotting is physically demanding and technically complex. Robotic technology provides an optimal three-dimensional view, maneuverability of the instruments but no study has assessed the impact of the DaVinci system in the ergonomics which is the objective in this study. Fourteen surgeons were able to achieve surgical repair of a defect in an incisional hernia inanimate model. The task was performed with conventional laparoscopy and robotic assistance. The mental effort was registered and physical disturbances were measured with the Local Experienced Discomfort scale. The subjects expressed discomfort mainly in the dominant side (p = 0.006). In the comparative analysis between the two approaches, upper limb less disturbance (p = 0.04) and lower mental effort (p = 0.001) were reported with robotic approach. Robotic assistance decreases mental and physical effort during the primary closure of a defect in an incisional hernia inanimate model.

  3. Recurrence rate after absorbable tack fixation of mesh in laparoscopic incisional hernia repair

    DEFF Research Database (Denmark)

    Christoffersen, Mette W; Brandt, E; Helgstrand, F

    2015-01-01

    absorbable or non-absorbable tacks for mesh fixation. METHODS: This was a nationwide consecutive cohort study based on data collected prospectively concerning perioperative information and clinical follow-up. Patients undergoing primary, elective, laparoscopic incisional hernia repair with absorbable or non...

  4. Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias

    NARCIS (Netherlands)

    D. den Hartog (Dennis); A.H.M. Dur (Alfons); A.G.A. Kamphuis (Alfons); W.E. Tuinebreijer (Wim); R.W. Kreis (Robert)

    2009-01-01

    textabstractBackground: The objective of this study is to determine the reliability and validity of ultrasonography (US) in diagnosing incisional hernias in comparison with computed tomography (CT). The CT scans were assessed by two radiologists in order to estimate the inter-observer variation and

  5. [Symptomatic lumbar incisional hernia after open nephrectomy: What are the risk factors?].

    Science.gov (United States)

    Marchand, C; Renard, Y; Avisse, C; Palot, J-P; Larre, S

    2016-04-01

    Lumbar incisional hernias after open nephrectomy are rare but can lead to aesthetic disorder, discomfort or intestinal obstruction. The aim of the study is to highlight their risk factors. The characteristics of patients who suffered from symptomatic and surgically treated lumbar incisionnal hernia after open nephrectomy (study group "GE") were compared to those of patients who underwent open nephrectomy without postoperative incisional hernia (control group "GT") using the Student's t test and Mann-Whitney test (statistical significance P valuelumbar incisionnal hernia vs 4 controls). From 2004 to 2014, 417 open nephrectomies were performed in one university hospital. Forty-five patients were included: 9 in GE and 36 in GT. There was no statistically significant difference between GT and GE for weight, height, body mass index (BMI), emergency, partial nephrectomy, laterality, rib resection, laparoscopic conversion to open surgery, postoperative complications, smoking, diabetes mellitus, cardiovascular history, obesity and sex, but there was a statistically significant difference for age, operative time, chronic obstructive pulmonary disease (COPD) and severe obesity (BMI>35) with, respectively, P=0.05, P=0.02, P=0.04 and P=0.02. Risk factors for lumbar incisional hernia after open nephrectomy are age, operative time, severe obesity and COPD. 5. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    G Ozturk

    2015-01-01

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

  8. Surgical treatment of large incisional hernias with intraperitoneal composite mesh: a cohort study.

    Science.gov (United States)

    Lasses Martínez, B; Peña Soria, M J; Cabeza Gómez, J J; Jiménez Valladolid, D; Flores Gamarra, M; Fernández Pérez, C; Torres García, A; Delgado Lillo, I

    2017-04-01

    Patients with large incisional hernias have significant morbidity and their management is a challenge for the surgical team because of the large abdominal wall involvement. The choice of surgical technique is still controversial. The purpose of this study is to analyze the predictive factors for recurrence after intraperitoneal mesh repair in patients with large incisional hernias. A retrospective cohort observational study with a prospectively collected database was performed in the Hospital Clinico San Carlos (Madrid, Spain). All consecutive patients operated on from January 2009 to December 2014 with incisional hernia of 10 or more centimeters in its transverse diameter were included. An intraperitoneal repair with a composite mesh fixed with discontinuous absorbable suture and fibrin sealant was performed. Demographic data, comorbidities, and early and long term outcomes were analyzed. The primary outcome was the presence of recurrence. One hundred and twenty patients were included. Mean age was 63.3 years (SD 12.9) and sex ratio was 1.4:1. Seventy-two patients (60%) were ASA III-IV. Forty-five patients (37.5%) had recurrent ventral hernias. Mean defect size was 14.7 cm (SD 3.21) of width. Overall postoperative morbidity rate was 25%. Median hospital stay was 6 days (IQR 4-8). Recurrence rate was 8.3%, after a median follow-up of 16 months (IQR 10-25). Multivariate analysis showed significant association between ASA III-IV, use of Composix Kugel™ mesh, superficial surgical site infection, and the presence of recurrence. The recurrence rate after intraperitoneal mesh repair in patients with large incisional hernias might be associated with ASA III-IV, use of Composix Kugel™ mesh, and superficial surgical site infection.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. The economic burden of incisional ventral hernia repair: a multicentric cost analysis.

    Science.gov (United States)

    Gillion, J-F; Sanders, D; Miserez, M; Muysoms, F

    2016-12-01

    A systematic review of literature led us to take note that little was known about the costs of incisional ventral hernia repair (IVHR). Therefore we wanted to assess the actual costs of IVHR. The total costs are the sum of direct (hospital costs) and indirect (sick leave) costs. The direct costs were retrieved from a multi-centric cost analysis done among a large panel of 51 French public hospitals, involving 3239 IVHR. One hundred and thirty-two unitary expenditure items were thoroughly evaluated by the accountants of a specialized public agency (ATIH) dedicated to investigate the costs of the French Health Care system. The indirect costs (costs of the post-operative inability to work and loss of profit due to the disruption in the ongoing work) were estimated from the data the Hernia Club registry, involving 790 patients, and over a large panel of different Collective Agreements. The mean total cost for an IVHR in France in 2011 was estimated to be 6451€, ranging from 4731€ for unemployed patients to 10,107€ for employed patients whose indirect costs (5376€) were slightly higher than the direct costs. Reducing the incidence of incisional hernia after abdominal surgery with 5 % for instance by implementation of the European Hernia Society Guidelines on closure of abdominal wall incisions, or maybe even by use of prophylactic mesh augmentation in high risk patients could result in a national cost savings of 4 million Euros.

  12. Incisional Hernia in Women: Predisposing Factors and Management Where Mesh is Not Readily Available

    Directory of Open Access Journals (Sweden)

    E Agbakwuru

    2009-01-01

    Full Text Available Background / Aim: Incisional hernia is still relatively common in our practice. The aim of the studywas to identify risk factors associated with incisional hernia in our region. The setting is the ObafemiAwolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria during a period when prostheticmesh was not readily available. Patients and Methods: All the women who presented with incisionalhernia between 1996 and 2005 were prospectively studied using a standard form to obtaininformation on pre-hernia (index operations and possible predisposing factors. They all had opensurgical repair and were followed up for 18-60 months. Results: Forty-four women were treatedduring study period. The index surgeries leading to the hernias were emergency caesarian section26/44 (59.1%, emergency exploratory laparotomy 6/44 (13.6%, and elective surgeries 12/44(27.3%. Major associated risk factors were the use of wrong suture materials for fascia repair, midlineincisions, wound sepsis, and overweight. Conclusion: For elective surgeries, reduction of weightshould be encouraged when appropriate, and transverse incisions are preferred. Absorbable sutures,especially chromic catgut, should be avoided in fascia closure. Antibiotics should be used forcomplicated obstetric cases.

  13. Laparoscopic treatment for incisional lumbar hernia in kidney donor: a new minimally invasive and efficient alternative

    Directory of Open Access Journals (Sweden)

    Marcos Tobias-Machado

    2005-09-01

    Full Text Available This report describes and discusses a new therapeutic laparoscopictechnique for incisional hernia secondary to lumbotomy in a kidneydonor. The transperitoneal laparoscopic approach was used with thepatient placed in left lateral decubitus. Three trocars were placedduring the surgery: the first, a 10-mm trocar at the level of the umbilicalscar; the second, a 5-mm trocar at the mid-clavicular line, 2 cm belowthe navel; and the third, a 12-mm trocar at the midline, between thenavel and the xiphoid process. The peritoneum was detached fromthe abdominal wall laterally to the hernia defect and parallel to thecolon inferiorly until complete exposure of the limits of the hernia ringwas achieved. A polypropylene mesh was placed in the abdominalcavity and fixed along the borders of the previously dissected andprepared hernia ring with titanium staples. Operative time was 148minutes and the patient was discharged 24 hours after the surgery.There was no intraoperative complication and no hernia recurrenceduring a 15-month follow-up. The patient resumed regular activities 3weeks after the surgery. We concluded that the repair of the incisionallumbar hernia in kidney donor via laparoscopic approach was a goodminimally invasive treatment option, with adequate functional andcosmetic results. The technique provided excellent exposure andview of the anatomical structures, with reduced pain, shorter recoverytime and earlier return to activities of daily life.

  14. Does site of specimen extraction affect incisional hernia rate after robot assisted laparoscopic radical prostatectomy?

    Science.gov (United States)

    Seveso, M; Melegari, S; Bozzini, G; De Francesco, O; Mandressi, A; Taverna, G

    2017-11-01

    Robot assisted laparoscopic radical prostatectomy (RALP) spread in the last decade as a minimally invasive alternative to open radical prostatectomy for men with localized prostate cancer. It is associated with excellent surgical, functional and oncological results with less postoperative pain and shorter convalescence. Anyway, the development of an incisional hernia (IH), may negate known benefits as it can lead not only to bothersome symptoms but also to severe complications, such as bowel obstruction, strangulation and perforation. Port-site or extraction site hernias, whose incidence rate is underdiagnosed, have become more commonly after minimally invasive surgery; but IH rate after robot-assisted radical prostatectomy has not been well characterized. This study aimed to evaluate the impact of extraction-site location (vertical supra-umbilical incision versus an off-midline incision) on incisional hernia rates in robotic prostatectomy. We included in the study 800 patients undergone RALP, 400 with a supra-umbilical incision for specimen extraction and 400 with off-midline incision. All were followed up for at least 3 years. The main study end point was IH occurrence at the extraction site (midline versus off-midline). IH rate for the entire series was 4.75%, in particular 5% for the midline group and 4.5% for the off-midline group. The hernias were diagnosed at a mean of 20.2 and 18.2 months after surgery, respectively in the two groups. There was no statistically significant differences in baseline characteristics; anyway larger prostate weight, wound infection and history of prior cholecystectomy were associated with higher proportion of IH. Extraction site hernias are a rare but a potentially serious complication following RALP. In our series, the midline extraction doesn't result in a significantly higher IH rate in comparison with the off-midline extraction site. Copyright © 2017. Published by Elsevier Ltd.

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

    OpenAIRE

    Jorge Satorre Rocha; Pablo Gonzalo Pol Herrera; Pedro López Rodríguez; Olga León González; Jorge Luis Anaya González

    2012-01-01

    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 carácte...

  16. Comparative analysis of autodermal graft and polypropylene mesh use in large incisional hernia defects reconstruction

    Directory of Open Access Journals (Sweden)

    Stojiljković Danilo

    2013-01-01

    Full Text Available Background. Large defects of the abdominal wall caused by incisional hernia still represent a challenging problem in plastic, reconstructive, and abdominal surgery. For their successful tension-free repair a proper selection of reconstructive material is essential. In the last decades, the use of synthetic meshes was dominant while biological autodermal grafts were rarely used. The aim of the study was to comparatively analyse efficacy and safety of autodermal graft and polypropylene mesh in surgical treatment of large abdominal wall defects. Methods. This prospective comparative clinical study enroled 40 patients surgically treated for large incisional hernia repair in a 10-year period. The patients were divided into two equal groups consisting of 20 subjects and treated either by biological autodermal graft or by synthetic polypropylene mesh. The surgical techniques of reconstruction, duration of surgery, the occurrence of early, minor, and major (severe and delyed complications and hospital stay were analyzed. The average follow-up took 2 years. Results. Statistically significant differences in demographic characteristics of patients and in size of defects were not found. The surgical technique of reconstruction with an autodermal graft was more complicated. The duration of surgery in patients treated with autodermal grafts was significantly longer. There was no statistically significant difference regarding occurrence of early, minor postoperative complications and hospital stay in our study. Two severe complications were registered in the synthetic mesh group: intestinal obstruction and enterocutaneous fistula. The recurrence rate was 10% in the autodermal graft group and 15% in the group with a synthetic mesh. Conclusion. Tension-free repair of large incisional hernia with autodermal grafts was unjustly neglected despite the fact that it is safe and effective. It can be applied in all cases where synthetic mesh are not indicated (presence

  17. 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

    including age, gender, comorbidity, tumor stage, and surgical approach at the index operation as well as postoperative anastomotic leakage, adjuvant chemotherapy and cancer recurrence. RESULTS: A total of 9214 patients were followed for median 6.4 years, during which 647 (7.0 %) were diagnosed...... 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...

  18. Revisión de casos sobre hernia incisional en el período de 2004 a 2010.

    OpenAIRE

    Satorre Rocha, Jorge; Pol Herrera, Pablo Gonzalo; López Rodríguez, Pedro; León González, Olga; Anaya González, Jorge Luis

    2012-01-01

    Enlace original: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-74932012000200003 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 Ca...

  19. 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...... was analyzed. RESULTS: Forty-one surgeons answered the questionnaire (68.3 %). The probability that two randomly chosen specialists agreed on whether restrictions should be given was generally low for the first two time periods (0-2 and 2-6 weeks); however, at >6 weeks there was a high level of agreement...

  20. Single incision laparoscopic primary and incisional ventral hernia repair as the standard of care in the ambulatory setting; Does less equal better outcomes; Case series and literature review

    Directory of Open Access Journals (Sweden)

    Ross O. Downes

    2016-01-01

    Conclusion: SILS prosthetic repair of primary and incisional ventral hernia is easily feasible. In our series, SILS ventral hernia repair appears to be safe and effective. It may decrease parietal trauma augmenting its use in the ambulatory setting. Technology will continue to improve the wide applicability of this technique. Larger randomized trial studies are required to determine the rates of port-site incisional hernia compared with multiport laparoscopy.

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Gary A Monteiro

    2013-10-01

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

  3. Outcomes for incisional hernia repair in patients undergoing concomitant surgical procedures.

    Science.gov (United States)

    Altom, Laura K; Graham, Laura A; Gray, Stephen H; Snyder, Christopher W; Vick, Catherine C; Hawn, Mary T

    2012-02-01

    The safety and efficacy of performing concomitant surgical procedures with an incisional hernia repair (IHR) is not well understood. There are conflicting reports on the outcomes for permanent mesh implantation in the setting of clean-contaminated procedures. The purpose of this study was to review the effect of concomitant surgical procedures on IHR outcomes. This is a retrospective multisite cohort of patients undergoing elective IHR at 16 Veterans Affairs hospitals from 1998 to 2002. Concomitant procedure status, hernia characteristics, and operative details were determined using physician-abstracted operative notes. Hernia outcomes of recurrence and mesh explantation were determined from the medical chart. χ(2) tests, Kaplan-Meier curves, and Cox regression were used to evaluate the effects of concomitant status on hernia outcomes. Of the 1495 elective IHRs, 75 (4.8%) were same site and 56 (3.8%) different site concomitant procedures. At median follow-up of 69.3 months (range 19.1-98.3), 33.6 per cent of patients had a recurrence, mesh explantation, or both. Permanent mesh placement was less likely among concomitant procedures as compared with nonconcomitant procedures (P process.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  6. Strangulated Richter's incisional hernia presenting as an abdominal mass with necrosis of the overlapping skin. A case report and review of the literature.

    Science.gov (United States)

    Sahsamanis, Georgios; Samaras, Stavros; Gkouzis, Konstantinos; Dimitrakopoulos, Georgios

    2017-03-01

    Although rare, clinicians must be alerted of Richter hernias in patients presenting with innocuous gastrointestinal obstruction symptoms, synchronous with an erythematous hernia. An incarcerated incisional hernia located in a previous laparoscopic insertion site further raises suspicion, while timely surgical management is essential to avoid bowel perforation or resection.

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

    Directory of Open Access Journals (Sweden)

    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

  8. 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....

  9. Incarceration of Meckel's diverticulum through a ventral incisional defect: a rare presentation of Littre's hernia.

    Science.gov (United States)

    Salemis, N S

    2009-08-01

    Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract and is the result of the incomplete obliteration of the omphalomesenteric duct. Herniation of Meckel's diverticulum is called Littre's hernia and is a rare occurrence. Herein is described an extremely rare case of incarcerated and strangulated Meckel's diverticulum through an incisional ventral defect in a 59-year-old female patient, who presented with manifestations of acute surgical abdomen. At emergency laparotomy, a strangulated small-bowel loop containing a Meckel's diverticulum was found, which had migrated through the subcutaneous tissues to the right iliac fossa, where a painful mass was palpated on admission. Segmental resection of the ischemic ileum was performed and the abdomen was closed without the use of a prosthetic mesh. Histopathological findings were suggestive of a true diverticulum containing heterotopic gastric mucosa.

  10. 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

    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...... = 0.005). There was no significant change of either hand grip strength or leg extension power. After AWR, the physical component of overall quality of life improved, whereas the mental component score remained unchanged. In the control group, surgery resulted in a decrease in both truncal flexion...... and truncal extension. Conclusions: AWR for incisional hernia specifically improved long-term abdominal wall muscular function and quality of life....

  11. 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

    (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......-up, the abdominal wall reconstruction group showed significant improvement in percent predicted peak expiratory flow and maximal expiratory mouth pressure, whereas all other measurements of lung function remained unchanged. Respiratory quality of life did not change significantly. Patients who underwent abdominal...... wall reconstruction showed a significantly greater improvement of percent predicted peak expiratory flow compared with patients undergoing colorectal resection. CONCLUSION: Abdominal wall reconstruction for large incisional hernia improved long-term expiratory lung function. Respiratory quality of life...

  12. Different methods of mesh fixation in open retromuscular incisional hernia repair: a comparative study in pigs.

    Science.gov (United States)

    Grommes, J; Binnebösel, M; Klink, C D; von Trotha, K T; Junge, K; Conze, J

    2010-12-01

    Reinforcement of the abdominal wall with alloplastic mesh material in incisional hernia repair is well established. To avoid dislocation and migration of the prostheses, mesh fixation is recommended. However, there seems to be a correlation between postoperative pain and mesh fixation. Furthermore, it remains unclear whether mesh fixation is necessary at all. A retromuscular mesh implantation was performed in 36 pigs using a polypropylene-polyglecaprone 25 composite mesh (Ultrapro(®), 12 × 18 cm). In group 1, the mesh was fixed to the posterior rectus sheet with non absorbable single sutures (Prolene(®) 2-0), in group 2 fixation was with absorbable sutures (Vicryl(®) 2-0), in group 3 mesh fixation was with 5 ml fibrin sealant (Quixil(®)), and, as a control, there was no fixation in group 4. The abdominal wall was explanted on postoperative day 7, 14 and 56. Mesh size and position was measured, and pull-out force of the mesh was analysed mechanically by tensiometry. The ratio of collagen type I/III was analysed to determine the quality of mesh integration. Neither mesh dislocation nor mesh migration was detected. Mesh size showed no significant differences, whether comparing time points or groups. No significant differences in the tensile strength of mesh integration were found when comparing the groups (group 1: 155 ± 17 mmHg; group 2: 175 ± 9 mmHg; group 3: 166 ± 24 mmHg; group 4: 172 ± 28 mmHg). Though the type I/III collagen ratio increased over time, no significant differences according to the type of fixation used were detected. Mesh fixation in open incisional hernia repair with retromuscular mesh augmentation to avoid mesh dislocation or migration in the early postoperative period appears to be unnecessary.

  13. Massive Incisional Hernia Repair with Parietex: Monocentric Analysis on 500 Cases Treated with a Laparoscopic Approach.

    Science.gov (United States)

    Caruso, Francesco; Ciccarese, Francesca; Cesana, Giovanni; Uccelli, Matteo; Castello, Giorgio; Olmi, Stefano

    2017-04-01

    The aim of this retrospective study is to demonstrate the safety and feasibility of the laparoscopic technique for treatment of massive incisional hernias (MIHs) and to compare three different fixation devices. From January 1, 2001, to December 31, 2014, we collected retrospective data from patients with large incisional hernias (IHs). Laparoscopic IH repair is performed by applying a three-dimensional polyester knit structure mesh with a resorbable collagen barrier on peritoneal side (Parietex™ Composite Mesh; Covidien, New Haven, CT). Patients were divided into three groups according to the different fixation devices. The mean follow-up was 19 (12-156) months. The mean defect size was 12.83 cm (10-26 cm) and the mean body mass index was 30.8 kg/m(2) (26-39 kg/m(2)). The EMS stapler™ was used on 260 patients, the Protack(®) on 210 patients, and the AbsorbaTack™ on 30 patients. The mean operative time was 69.9 minutes (38-130 minutes). Intraoperative morbidity rate was 1.6% (8 cases). Early reoperation rate was 0.2% (1 case). The mean length of hospital stay was 2.3 days (range 2-7 days). Seromas were observed in 20 patients (4.0%) and neuralgia in 10 patients (2.0%). Recurrence was observed in 12 patients (2.4%) with the majority in the absorbable tack group (10%). There were no conversions (0%) to open technique. The laparoscopic approach seems to be safe and appropriate for treatment of MIH. The Parietex composite mesh we used guarantees excellent intraabdominal laparoscopic repair of abdominal wall defects. Absorbatack system seems to give less postoperative neuralgia, but it is related to a high recurrence rate. Protack system seems to give more postoperative neuralgia than the Endopath EMS. In our experience, the best fixation system is the latter.

  14. Laparoscopic incisional hernia repair as a day surgery procedure: audit of 127 consecutive cases in a university hospital.

    Science.gov (United States)

    Moreno-Egea, Alfredo; Cartagena, Joaquin; Vicente, Juan Pablo; Carrillo, Andres; Aguayo, Jose Luis

    2008-06-01

    Findings have shown that laparoscopic incisional hernia repair is superior to conventional open techniques. The objective of the current study was to evaluate the results of laparoscopic surgery on incisional hernias in an outpatient surgery unit in a university hospital. Data were gathered prospectively for all laparoscopic incisional hernia repairs from January 1997 to December 2006. A total of 127 patients were operated in an outpatient surgery unit. The patients' clinical features, hernia type, intraoperative and postoperative complications, and reasons for hospital admission are studied. None of the patients required readmission to hospital, 15 had no need for analgesic treatment (11.8%) and the mean requirement was 6 days. The mean time of return to normal activity was less than 10 days and all the patients expressed their satisfaction with the procedure they received. During follow-up we detected 5 recurrences (4.4%). The statistical study showed no significant differences between the hospitalized patients and those treated on an ambulatory basis with regard to morbidity and recurrence rate (Pambulatory patients (Phernias can be performed as a highly efficient ambulatory procedure with igual morbidity and recurrences than hospitalized patients.

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

    Directory of Open Access Journals (Sweden)

    Linhuber Quirin

    2011-09-01

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

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

    Science.gov (United States)

    2011-01-01

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

  17. A simplified incision of the external oblique aponeurosis during the components separation technique for the repair of large incisional hernias.

    Science.gov (United States)

    Celdrán-Uriarte, Angel; Fraile, Maria; García-Vasquez, Carlos; York, Elisa; Manso, Belen; Granizo, Juan Jose

    2011-09-01

    Incising the external oblique muscle aponeurosis is an important part of the components separation technique for the repair of large incisional hernias. Endoscopically assisted section has been suggested to prevent complications of extensive skin flap formation. We used a simplified method for incising the external oblique aponeurosis, using a modified Collin Hartmann retractor, in 14 patients for the repair of large incisional hernias. Eight women and 6 men, with a mean (± standard deviation) age of 61.9 ± 14.9 years, underwent surgery. The median transverse diameter of the defect was 8.6 ± 3.0 cm. No postoperative morbidity occurred except 1 case of skin necrosis. One patient had a recurrence. Sectioning the external oblique aponeurosis during the components separation method using the technique described is a simple, safe, and economic approach that can prevent the complications described after the original techniques. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. The value of CT diagnosis of hernia recurrence after prosthetic repair of ventral incisional hernias

    Energy Technology Data Exchange (ETDEWEB)

    Gutierrez de la Pena, C. [Department of Surgery, Jerez General Hospital, Jerez de la Frontera (Spain); Vargas Romero, J.; Dieguez Garcia, J.A. [Department of Radiology, Jerez General Hospital, Jerez de la Frontera (Spain)

    2001-07-01

    Herein we present a prospective study made to compare the diagnostic value of a physical examination and a CT scan in the detection of a hernia relapse after carrying out of a intraperitoneal hernioplasty using a non-resorbable mesh. Fifty patients operated on for intraperitoneal hernioplasty with ePTFE mesh and postoperative symptomatology were assessed within a year of the operation via a physical exploration and CT. Each of the patients was subjected to an exploratory laparoscopy for the purpose of confirming the diagnosis. The data were analysed statistically using a chi-square test, sensitivity, specificity, confidence limits, positive predictive value, and negative predictive value. The hernia relapse was correctly diagnosed in 98% of cases by CT and in 88% of cases in the physical examination. The sensitivity was 1 in the CT examination and 0.75 in the physical examination, and the specificity results were 0.97 and 0.90, respectively. The positive predictive value in the CT exam was 0.88, whereas in the physical examination it was 0.60. The negative predictive values were 1 and 0.95, respectively. The differences between the values of both methods held a statistical meaning (chi-square test; p<0.05). The postoperative assessment by CT of symptomatic patients who have been operated on for an intraperitoneal hernioplasty with unabsorbable mesh facilitates carrying out a correct diagnosis in the detection or exclusion of hernial relapse. (orig.)

  19. Risk of recurrence following mesh associated incisional hernia repair using the retromuscular technique in patients with relevant medical conditions.

    Science.gov (United States)

    Stodolski, Maciej; Papadakis, Marios; Zirngibl, Hubert; Ambe, Peter C

    2018-02-14

    Incisional hernia is a common problem following open abdominal surgery. Hernia repair in patients with relevant medical conditions is a topic of controversy due to the high risk of morbidity and recurrence. We investigated the risk of recurrence in patients with relevant medical conditions managed with a prosthesis in the retromuscular position. A retrospective review of the data of patients undergoing midline incisional hernia repair was performed. The outcomes of patients with relevant concomitant medical conditions defined as ASA scores >2 were compared with those of healthier patients with ASA scores ≤2. 115 patients including 41 with ASA >2 and 74 with ASA ≤2 were included for analysis. There were no statistically significant differences amongst both groups with regard to the size of the hernia defect, the duration of surgery (123.0 ± 71 vs. 149.0 ± 92 min, p = 0.73), the incidence of postoperative seroma (14.6% vs. 29.7%, p = 0.07), postoperative hematoma (12.2% vs. 4.1%, p = 0.10) and surgical site infection (14.6% vs. 8.1%, p = 0.27). No statistically significant difference was seen amongst both groups with respect to the rate of long-term recurrence after a median follow-up of 63.0 ± 36 months (12.2% vs. 6.8%, p = 0.32). Relevant medical condition alone cannot be seen as a contraindication for midline incisional hernia repair using the retromuscular technique. Rates of morbidity and long-term recurrence following mesh-associated closure are not difference from those of healthier patients. Copyright © 2018. Published by Elsevier Taiwan.

  20. 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.

  1. Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected].

    Science.gov (United States)

    Silecchia, Gianfranco; Campanile, Fabio Cesare; Sanchez, Luis; Ceccarelli, Graziano; Antinori, Armando; Ansaloni, Luca; Olmi, Stefano; Ferrari, Giovanni Carlo; Cuccurullo, Diego; Baccari, Paolo; Agresta, Ferdinando; Vettoretto, Nereo; Piccoli, Micaela

    2015-09-01

    The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted an update of the first evidence-based Italian Consensus Conference Guidelines 2010 because a large amount of literature has been published in the last 4 years about the topics examined and new relevant issues. The scientific committee selected the topics to be addressed: indications to surgical treatment including special conditions (obesity, cirrhosis, diastasis recti abdominis, acute presentation); safety and outcome of intraperitoneal meshes (synthetic and biologic); fixing devices (absorbable/non-absorbable); abdominal border and parastomal hernia; intraoperative and perioperative complications; and recurrent ventral/incisional hernia. All the recommendations are the result of a careful and complete literature review examined with autonomous judgment by the entire panel. The process was supervised by experts in methodology and epidemiology from the most qualified Italian institution. Two external reviewers were designed by the EAES and EHS to guarantee the most objective, transparent, and reliable work. The Oxford hierarchy (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence") was used by the panel to grade clinical outcomes according to levels of evidence. The recommendations were based on the grading system suggested by the GRADE working group. The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial

  2. Assessment of Human Acellular Dermis Graft in Porcine Models for Ventral Hernia Repair.

    Science.gov (United States)

    Sahoo, Sambit; Baker, Andrew R; Haskins, Ivy N; Krpata, David M; Rosen, Michael J; Derwin, Kathleen A

    2017-08-03

    Preclinical evaluation of hernia meshes is commonly performed in porcine models. We recently developed two surgically induced porcine hernia models-an incisional and an excisional model-that formed persistent hernias in the absence of graft repair. Herein, we investigate if these models will continue to form a hernia after graft repair. Ten pigs were used to create two hernia models-a 10-cm partial-thickness incisional defect (n = 5) and an 8 × 8-cm full-thickness excisional defect (n = 5). The defects were repaired using a 12 × 12-cm human acellular dermis graft placed in a preperitoneal/retrorectus sublay position and fixed using transfascial sutures. Postoperative management included the use of suction drainage for 1 week and an abdominal binder for 4 weeks in the more severe excisional model. Hernia development was assessed clinically, and hernia defect size and volume were measured using postoperative computed tomography (CT) imaging over 12 weeks. Radiographic inflation testing (2 L inflation), biaxial mechanical testing, and histological evaluation were also performed at 12 weeks. All pigs with the excisional model, but none with the incisional model, developed a clinically relevant hernia. At the end of 12 weeks, the excisional model had a significantly greater hernia defect size (259 ± 51 cm(2) vs. 47 ± 16 cm(2)) and repair volume (865 ± 414 cm(3) vs. 85 ± 52 cm(3)) compared with the incisional model. The excisional model also showed an order of magnitude greater increase in repair volume (280 cm(3) vs. 47 cm(3)) compared with the incisional model upon 2 L inflation. Furthermore, the excisional model showed a trend of having higher dilatational strain at average biaxial load of 250 N and lower stiffness compared with the incisional model. The excisional model had a thin, hypercellular hernia sac spanning the defect, whereas the incisional model had a thick densely fibrotic scar bridging the defect

  3. Biomechanical evaluation of fixation properties of fibrin glue for ventral incisional hernia repair.

    Science.gov (United States)

    Stoikes, N; Sharpe, J; Tasneem, H; Roan, E; Paulus, E; Powell, B; Webb, D; Handorf, C; Eckstein, E; Fabian, T; Voeller, G

    2015-02-01

    Use of adhesives for mesh fixation in hernia is increasing. There has been minimal study of mesh incorporation and interface strength with adhesive fixation for ventral hernia repair. The purpose of this study was to evaluate the fixation properties of fibrin glue as it compared to suture fixation of mesh in an onlay position. Twenty-four mongrel pigs were divided into three study arms based on time points for biomechanical evaluation: 24 h (n = 8), 7 days (n = 8), and 14 days (n = 8). Initial procedures included placement of two 4 × 6 cm pieces of wide-pore polypropylene mesh in an onlay position. One was fixated with 4 ml of fibrin glue and the other with four interrupted 2-0 polypropylene sutures. The shear strength of fixation was evaluated using a uniaxial testing device along with histological evaluation. Maximum force was normalized by the width of the mesh. Mesh-tissue interface of glued and sutured specimens at 7 and 14 days did not fail in our testing configuration. Only at the 24-h time point the mesh detached from the tissue, and the sutured interface (10.4 N/cm) was significantly stronger than glued interface (4.9 N/cm, p = 0.004). Histopathologic and gross evaluations of the specimens revealed similar histologic features at all time points for both glued and sutured specimens. With mesh in the onlay position, fixation to the abdominal wall occurs quickly. Though sutures were stronger at 24 h, as early as 1 week, the strength of the fixation exceeded the tissue or the mesh strength in our testing configuration for both glue and suture groups. Fixation strength is independent of technique at the latter time points. There are potential clinical advantages to the exclusive use of fibrin glue for fixation including acute post-operative pain, chronic post-operative pain, and recurrence for ventral incisional hernia repair.

  4. 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.

  5. 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.

  6. 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

  7. 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

    2017-09-15

    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 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.

  8. Open retromuscular large mesh reconstruction of lumbar incisional hernias including the atrophic muscular area.

    Science.gov (United States)

    Renard, Y; de Mestier, L; Cagniet, A; Demichel, N; Marchand, C; Meffert, J-L; Kianmanesh, R; Palot, J-P

    2017-06-01

    Lumbar incisional hernias (LIH) are a rare wall defect, whose surgical management is challenging because no recommendation exists. Moreover, LIH are frequently associated with flank bulging which should be taken into account during LIH surgical repair. We aimed to describe a cohort of patients operated on for LIH using a homogeneous surgical technique and to report surgical outcomes. The records of all consecutive patients operated on in a specialized surgical center between January 2009 and January 2015 were retrospectively reviewed. The same open technique was performed, i.e., using a mesh into the retroperitoneal space posteriorly, placed with the largest overlap inferiorly and posteriorly, and fixed through the controlateral abdominal wall muscles under strong tension to correct the flank bulging. The cohort included 31 patients, of median age 62, who presented two or more comorbidities in 68% of cases. LIH was recurrent in 45% of patients, and was related to nephrectomy in 61% of patients. The mesh was totally extraperitoneal in 65% of patients. The postoperative mortality rate was null. The rate of specific surgical complications was 32.3%, and the rate of overall postoperative morbidity (Clavien-Dindo classification) was 38.7%. After a median follow-up of 27.5 months, the recurrence rate was 6.5% and 9.7% reported chronic pain. The open approach for LIH repair was safe and enabled treating flank bulging simultaneously in all patients. Due to the paucity of adequate scientific studies, this reproducible open method could help moving toward a standardization of LIH surgical management.

  9. Comparison of PTFE, pericardium bovine and fascia lata for repair of incisional hernia in rat model, experimental study.

    Science.gov (United States)

    Kapan, S; Kapan, M; Goksoy, E; Karabicak, I; Oktar, H

    2003-03-01

    Incisional hernia is a frequent complication of abdominal surgery developing in 11-20 % of patients undergoing an abdominal operation. Regarding morbidity and loss of manpower, incisional hernias continue to be a fundamental problem for surgeons. In this experimental study, three commonly used mesh materials (Goretex PTFE; Tutoplast Fascia lata; Tutopatch Pericardium bovine) were compared according to effectiveness, strength, adhesion formation, histological changes, and early complications. Three groups, each consisting of 14 rats, have been formed as group A: polytetrafluoroethylene (PTFE), group B: pericardium bovine and group C: fascia lata. Evaluations were achieved at the end of the first and second postoperative week, respectively. Adhesion formation, wound maturation, bursting pressure, and tensile strength were evaluated. No statistically significant difference regarding adhesion formation was observed between groups although adhesion formation was less significant in PTFE and pericardium bovine groups than in the fascia lata group. Bursting pressure and tensile strength values were significantly higher in PTFE group than in the fascia lata group ( P<0.05). No statistically significant difference was observed between groups regarding wound maturation. In this experimental model, PTFE and pericardium bovine were found to be superior to fascia lata in abdominal wall repair.

  10. 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

  11. Challenging abdominal incisional hernia repaired with platelet-rich plasma and bone marrow-derived mesenchymal stromal cells. A case report

    Directory of Open Access Journals (Sweden)

    Gian Marco Palini

    2017-01-01

    Conclusion: This approach is likely to improve abdominal wall repair in high grade (IV incisional hernia, with the real possibility of improving prosthetic compatibility and reducing future recurrences. The authors agree with the necessity of further studies and trials to assure the safety profile and superiority of this procedure.

  12. Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques

    NARCIS (Netherlands)

    Wassenaar, E.; Schoenmaeckers, E.; Raymakers, J.; van der Palen, Jacobus Adrianus Maria; Rakic, S.

    2010-01-01

    BackgroundPersistent, activity-limiting pain after laparoscopic ventral or incisional hernia repair (LVIHR) appears to be related to fixation of the implanted mesh. A randomized study comparing commonly used fixation techniques with respect to postoperative pain and quality of life has not

  13. Polypropylene and polypropylene/polyglecaprone (Ultrapro®) meshes in the repair of incisional hernia in rats.

    Science.gov (United States)

    Utiyama, Edivaldo Massazo; Rosa, Maria Beatriz Sartor de Faria; Andres, Marina de Paula; Miranda, Jocielle Santos de; Damous, Sérgio Henrique Bastos; Birolini, Cláudio Augusto Vianna; Damous, Luciana Lamarão; Montero, Edna Frasson de Souza

    2015-06-01

    To compare the inflammatory response of three different meshes on abdominal hernia repair in an experimental model of incisional hernia. Median fascial incision and skin synthesis was performed on 30 Wistar rats. After 21 days, abdominal hernia developed was corrected as follows: 1) No mesh; 2) Polypropylene mesh; and, 3) Ultrapro(r) mesh. After 21 days, the mesh and surrounding tissue were submitted to macroscopic (presence of adhesions, mesh retraction), microscopic analysis to identify and quantify the inflammatory and fibrotic response using a score based on a predefined scale of 0-3 degrees, evaluating infiltration of macrophages, giant cells, neutrophils and lymphocytes. No significant difference was seen among groups in adherences, fibrosis, giant cells, macrophages, neutrophils or lymphocytes (p>0.05). Mesh shrinkage was observed in all groups, but also no difference was observed between polypropylene and Ultrapro mesh (7.0±9.9 vs. 7.4±10.1, respectively, p=0.967). Post-operatory complications included fistula, abscess, dehiscence, serohematic collection and reherniation, but with no difference among groups (p=0.363). There is no difference between polypropylene (high-density) and Ultrapro(r) (low-density) meshes at 21 days after surgery in extraperitoneal use in rats, comparing inflammatory response, mesh shortening, adhesions or complications.

  14. 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.

  15. 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.

  16. Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair

    DEFF Research Database (Denmark)

    Kokotovic, Dunja; Bisgaard, Thue; Helgstrand, Frederik

    2016-01-01

    . A total of 3242 patients with incisional repair were included. Follow-up until November 1, 2014, was obtained by merging data with prospective registrations from the Danish National Patient Registry supplemented with a retrospective manual review of patient records. A 100% follow-up rate was obtained...

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

    Science.gov (United States)

    Suwa, Katsuhito; Okamoto, Tomoyoshi; Yanaga, Katsuhiko

    2016-07-01

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

  18. Multi-staged repair of contaminated primary and recurrent giant incisional herniae in the same hospital admission: a proposal for a new approach.

    Science.gov (United States)

    Siddique, K; Shrestha, A; Basu, S

    2014-02-01

    Repair of primary and recurrent giant incisional herniae is extremely challenging and more so in the face of surgical field contamination. Literature supports the single- and multi-staged approaches including the use of biological meshes for these difficult patients with their associated benefits and limitations. This is a retrospective analysis of a prospective study of five patients who were successfully treated through a multi-staged approach but in the same hospital admission, not previously described, for the repair of contaminated primary and recurrent giant incisional herniae in a district general hospital between 2009 and 2012. Patient demographics including their BMI and ASA, previous and current operative history including complications and follow-up were collected in a secure database. The first stage involved the eradication of contamination, and the second stage was the definitive hernia repair with the new generation-coated synthetic meshes. Of the five patients, three were men and two women with a mean age of 58 (45-74) years. Two patients had grade 4 while the remaining had grade 3 hernia as per the hernia grading system with a mean BMI of 35 (30-46). All patients required extensive adhesiolysis, bowel resection and anastomoses and wash out. Hernial defect was measured as 204* (105-440) cm(2), size of mesh implant was 568* (375-930) cm(2) and the total duration of operation (1st + 2nd Stage) was 354* (270-540) min. Duration of hospital stay was 11* (7-19) days with a follow-up of 17* (6-36) months. We believe that our multi-staged approach in the same hospital admission (for the repair of contaminated primary and recurrent giant incisional herniae), excludes the disadvantages of a true multi-staged approach and simultaneously minimises the risks and complications associated with a single-staged repair, can be adopted for these challenging patients for a successful outcome (* indicates mean).

  19. 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.)

  20. 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

  1. Pneumatic positioning and mesh fixation in laparoscopic ventral/incisional hernia repair. New surgical technique and a new device.

    Science.gov (United States)

    Darecchio, Antonio; Bocchi, Paolo; Kukleta, Jan F

    2015-01-01

    To achieve full-surface contact of a prosthetic mesh with the abdominal wall (avoiding folds and wrinkles) in laparoscopic ventral/ incisional hernia repair (LVHR/ LIHR) and to fix the mesh with glue using a new surgical technique and a new device, developed for this specific procedure. New surgical technique associated with a new surgical pneumatic device allows perfect positioning and extension of the intraperitoneal mesh and facilitates the glue application and mesh fixation. A polyester composite mesh is used for intraperitoneal placement, cyanoacrylate glue is used for mesh fixation. Pigs cadavers were used to test this new technique and the device*. With the help of a pneumatic device the intraperitoneal mesh can be well positioned and perfectly extended without folds, thus allowing an efficient and strong mesh glue fixation. Presented pneumatic positioning device is useful to achieve an ideal alignment of mesh with the abdominal wall and supports the fixation task. The proposed technique enables the glue application safely, by avoiding possible spillage over intestinal loops and offering the necessary time for the distribution of such fast polymerizing glue. This technique could also be applied with other types of glue or self-adhesive mesh.

  2. 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.

  3. A randomised, multi-centre, prospective, observer and patient blind study to evaluate a non-absorbable polypropylene mesh vs. a partly absorbable mesh in incisional hernia repair.

    Science.gov (United States)

    Rickert, A; Kienle, P; Kuthe, A; Baumann, P; Engemann, R; Kuhlgatz, J; von Frankenberg, M; Knaebel, H P; Büchler, M W

    2012-12-01

    The implantation of a polymer mesh is considered as the standard treatment for incisional hernia. It leads to lower recurrence rates compared to suture techniques without mesh implantation; however, there are also some drawbacks to mesh repair. The operation is more complex and peri-operative infectious complications are increased. Yet it is not clear to what extent a mesh implantation influences quality of life or leads to chronic pain or discomfort. The influence of the material, textile structure and size of the mesh remain unclear. The aim of this study was to evaluate if a non-absorbable, large pore-sized, lightweight polypropylene (PP) mesh leads to a better health outcome compared to a partly absorbable mesh. In this randomised, double-blinded study, 80 patients with incisional hernia after a median laparotomy received in sublay technique either a non-absorbable mesh (Optilene® Mesh Elastic) or a partly absorbable mesh (Ultrapro® Mesh). Primary endpoint was the physical health score from the SF-36 questionnaire 21 days post-operatively. Secondary variables were patients' daily activity score, pain score, wound assessment and post-surgical complications until 6 months post-operatively. SF-36, daily activity and pain scores were similar in both groups after 21 days and 6 months, respectively. No hernia recurrence was observed during the observation period. Post-operative complication rates also showed no difference between the groups. The implantation of a non-absorbable, large pore-sized, lightweight PP mesh for incisional hernia leads to similar patient-related outcome parameters, recurrence and complication rates as a partly absorbable mesh.

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

    Science.gov (United States)

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

    2015-01-01

    Incisional hernia is the most common postoperative complication, affecting up to 20% of patients after abdominal surgery. Insertion of a synthetic surgical mesh has become the standard of care in ventral hernia repair. However, the implementation of a mesh does not reduce the risk of recurrence and the onset of hernia recurrence is only delayed by 2-3 years. Nowadays, more than 100 surgical meshes are available on the market, with polypropylene the most widely used for ventral hernia repair. Nonetheless, the ideal mesh does not exist yet; it still needs to be developed. Polycaprolactone nanofibers appear to be a suitable material for different kinds of cells, including fibroblasts, chondrocytes, and mesenchymal stem cells. The aim of the study reported here was to develop a functionalized scaffold for ventral hernia regeneration. We prepared a novel composite scaffold based on a polypropylene surgical mesh functionalized with poly-ε-caprolactone (PCL) nanofibers and adhered thrombocytes as a natural source of growth factors. In extensive in vitro tests, we proved the biocompatibility of PCL nanofibers with adhered thrombocytes deposited on a polypropylene mesh. Compared with polypropylene mesh alone, this composite scaffold provided better adhesion, growth, metabolic activity, proliferation, and viability of mouse fibroblasts in all tests and was even better than a polypropylene mesh functionalized with PCL nanofibers. The gradual release of growth factors from biocompatible nanofiber-modified scaffolds seems to be a promising approach in tissue engineering and regenerative medicine.

  5. Comparative study between two techniques of incisional hernia repair with polypropylene mesh in rabbits Estudo comparativo entre duas técnicas de tratamento da hérnia incisional em coelhos utilizando a tela de polipropileno

    Directory of Open Access Journals (Sweden)

    José Guilherme Minossi

    2010-10-01

    Full Text Available PURPOSE: To compare two different incisional hernia repair techniques (repair with a polypropylene mesh reinforcement on the peritonium-aponeurosis versus polypropylene mesh sutured to the borders of the hernial ring as a bridge in rabbits. METHODS: Incisional hernia was experimentally developed through a 4-cm median incision in 60 rabbits. After 30 days, half of the animals were operated for primary wall closure and placement of a polypropylene mesh reinforcement, while the other half had a polypropylene mesh sutured to the borders of the hernial ring as a bridge. Clinical development, scar breaking strength, as well as gross, microscopic and morphometric parameters were evaluated in all animals 30, 60, and 90 days after repair. RESULTS: No significant differences in breaking strength or histological parameters were observed between groups at any time point studied. No statistical difference regarding complications was detected, although denser and firmer adhesions to the abdominal wall were seen after the mesh was placed as a " bridge" . CONCLUSIONS: No significant differences between the incisional hernia repair techniques assessed were observed regarding breaking strength, and histological and morphometric parameters. The number of complications was similar in both study groups. However, adhesion of abdominal cavity organs to the scar area was much denser after the placement of a mesh to bridge the defect.OBJETIVO: Comparar duas técnicas de tratamento da hérnia incisional em coelhos utilizando a tela de polipropileno apoiando um reforço peritônio - aponeurótico ou suturada nas bordas do anel herniário 'em ponte" . MÉTODOS: Foram operados 60 coelhos para a produção de hérnia incisional, em uma incisão mediana de 4 centímetros. Após 30 dias, metade dos animais foram operados com o fechamento primário da parede, com colocação de uma tela de polipropileno apoiando o reforço e a outra metade dos animais com a colocação da tela

  6. Randomized controlled trial of the use of a large-pore polypropylene mesh to prevent incisional hernia in colorectal surgery.

    Science.gov (United States)

    García-Ureña, Miguel Ángel; López-Monclús, Javier; Hernando, Luis Alberto Blázquez; Montes, Daniel Melero; Valle de Lersundi, Alvaro Robín; Pavón, Camilo Castellón; Ceinos, Carmen Jiménez; Quindós, Patricia López

    2015-05-01

    To reduce the incidence of incisional hernia (IH) in colorectal surgery by implanting a mesh on the overlay position. The incidence of IH in colorectal surgery may be as high as 40%. IH causes severe health and cosmetic problems, and its repair increases health care costs. Randomized, controlled, prospective trial. Patients undergoing any colorectal procedure (both elective and emergency) through a midline laparotomy were divided into 2 groups. The abdomen was closed with an identical technique in both groups, except for the implantation of an overlay large-pore polypropylene mesh in the study group. Patients were followed up clinically and radiologically for 24 months. A total of 107 patients were included: 53 in the study group and 54 in the control group. Both groups were homogeneous, except for a higher incidence of diabetes in the mesh group. There were 20 emergency procedures in the study group and 17 in the control group. There were no statistical differences in surgical site infections, seromas, or mortality between the groups (33.3%, 13.8%, and 3.7% in the control group and 18.9%, 13.2%, and 3.8% in the study group). No mesh rejection was reported. The incidence of IH was 17 of 54 (31.5%) in the control group and 6 of 53 (11.3%) in the study group (P = 0.011). The incidence of IH is high in patients undergoing elective or emergency surgery for colorectal diseases. The addition of a prophylactic large-pore polypropylene mesh on the overlay position decreases the incidence of IH without adding morbidity.

  7. 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.

  8. Flap surgical techniques for incisional hernia recurrences. A swine experimental model.

    Science.gov (United States)

    Popa, Florina; Ardelean, Filip; Pestean, Cosmin; Purdoiu, Robert; Rosca, Oana; Georgescu, Alexandru

    2017-01-01

    In the age of synthetic prostheses most of hernia studies include a careful examination of the various types of prosthesis, their characteristics and their repair indications. Biological prostheses are also beginning to draw attention. But in terms of recurrence especially for poor or developing countries, the discussion is different, due to their high cost which makes them difficult to afford. In this article we present new flap reconstruction techniques for the reconstruction of the abdominal wall versus mesh repair, applied on swine models, outline the results of each technique, and specify the indications for their use. An experimental protocol using four swine models (PIC-FII-337 hybrid breed pigs), five months old, was conducted. All animal care and operative procedures were studied following the protocol approved by the Ethics Committee of the University of Medicine and Pharmacy resolution no. 281/2014 of the Department of Surgery of the University of Agricultural Sciences and Veterinary Medicine); the study was carried out between November 2015 and February 2016. The primary objective was to compare the effect of surgical strategies in the treatment of the abdominal wall defect using variable flaps versus mesh repair in a large-animal models. Physical examination and ultrasound imaging of the abdominal wall repair were done on determined periods, during one month. The complications occurring after the abdominal wall repair were edema, collections, superficial dehiscence an recurrences. No recurrences were reported at one month results, all seromas reported were solved over time by natural drainage. Superficial necrosis appeared in two swine models and superficial dehiscence occurred in one model, the perforator "plus" flap. Mesh infection was detected in the "onlay" swine model. In terms of recurrences, contaminated abdominal wall defects or other contraindications to the use of prosthetic materials, biological mesh repair or flap surgery are the only

  9. 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.

  10. Long-term outcome study in patients with abdominal wound dehiscence: a comparative study on quality of life, body image, and incisional hernia.

    Science.gov (United States)

    van Ramshorst, Gabrielle H; Eker, Hasan H; van der Voet, Jan A; Jeekel, Johannes; Lange, Johan F

    2013-08-01

    Long-term quality of life and body image of patients with abdominal wound dehiscence were assessed. Thirty-seven patients with abdominal wound dehiscence from a prospectively followed cohort of 967 patients (2007-2009) were reviewed. Patients completed the Short Form 36 quality of life questionnaire and Body Image Questionnaire and participated in semi-structured telephone interviews. For each patient, four controls were matched by age and gender. Analyses were adjusted for age, gender, comorbidity, and follow-up length. Of the 37 patients with abdominal wound dehiscence, 23 were alive after a mean follow-up of 40 months (range 33-49 months). Nineteen patients developed incisional hernias (83 %). Patients with abdominal wound dehiscence reported significantly lower scores for physical and mental component summaries (p = 0.038, p = 0.013), general health (p = 0.003), mental health (p = 0.011), social functioning (p = 0.002), and change (p = 0.034). No differences were found for physical functioning (p = 0.072), role physical (p = 0.361), bodily pain (p = 0.133), vitality (p = 0.150), and role emotional (p = 0.138). Patients with abdominal wound dehiscence reported lower body image scores (median 16.5 vs. 18, p = 0.087), cosmetic scores (median 13 vs. 16, p = 0.047), and total body image scores (median 30 vs. 34, p = 0.042). At long-term follow-up, patients with abdominal wound dehiscence demonstrated a high incidence of incisional hernia, low body image, and low quality of life.

  11. Hernia

    Science.gov (United States)

    Hernia - inguinal; Inguinal hernia; Direct and indirect hernia; Rupture; Strangulation; Incarceration ... when there is weakness in the belly wall. Inguinal hernias are common in boys. Some children do not ...

  12. Hernias

    Science.gov (United States)

    ... of hernia requires another surgery to repair it. Hiatal Hernias This type of hernia occurs at the opening ... you might feel heartburn, indigestion, and chest pain. Hiatal hernias can be treated with medication and diet changes, ...

  13. 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

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

    Directory of Open Access Journals (Sweden)

    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

  15. Cost-utility analysis of the use of prophylactic mesh augmentation compared with primary fascial suture repair in patients at high risk for incisional hernia.

    Science.gov (United States)

    Fischer, John P; Basta, Marten N; Wink, Jason D; Krishnan, Naveen M; Kovach, Stephen J

    2015-09-01

    Although hernia repair with mesh can be successful, prophylactic mesh augmentation (PMA) represents a potentially useful preventative technique to mitigate incisional hernia risk in select high-risk patients. The efficacy, cost-benefit, and societal value of such an intervention are not known. The aim of this study was to determine the cost-utility of using prophylactic mesh to augment fascial incisions. A decision tree model was employed to evaluate the cost-utility of using PMA relative to primary suture closure (PSC) after elective laparotomy. The authors adopted the societal perspective for cost and utility estimates. A systematic review of the literature on PMA was performed. The costs in this study included direct hospital costs and indirect costs to society, and utilities were obtained through a survey of 300 English-speaking members of the general public evaluating 14 health state scenarios relating to ventral hernia. PSC without mesh demonstrated an expected average cost of $17,182 (average quality-adjusted life-year [QALY] of 21.17) compared with $15,450 (expected QALY was 21.21) for PMA. PSC was associated with an incremental cost-efficacy ratio (ICER) of -$42,444/QALY compared with PMA such that PMA was more effective and less costly. Monte Carlo sensitivity analysis was performed demonstrating more simulations resulting in ICERs for PSC above the willingness-to-pay threshold of $50,000/QALY, supporting the finding that PMA is superior. Cost-utility analysis of PSC compared to PMA for abdominal laparotomy closure demonstrates PMA to be more effective, less costly, and overall more cost-effective than PSC. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience.

    Science.gov (United States)

    Chelala, E; Baraké, H; Estievenart, J; Dessily, M; Charara, F; Allé, J L

    2016-02-01

    This retrospective chart analysis reports and assesses the long-term (beyond 10 years) safety and efficiency of a single institution's experience in 1326 laparoscopic incisional and ventral hernia repairs (LIVHR), defending the principle of the suturing defect (augmentation repair concept) prior to laparoscopic reinforcement with a composite mesh (IPOM Plus). This study aims to prove the feasibility and validity of IPOM Plus repair, among other concepts, as a well-justified treatment of incisional or ventral hernias, rendering a good long-term outcome result. A single institution's systematic retrospective review of 1326 LIVHR was conducted between the years 2000 and 2014. A standardized technique of routine closure of the defect prior to the intraperitoneal onlay mesh (IPOM) reinforcement was performed in all patients. The standardized technique of "defect closure" by laparoscopy approximating the linea alba under physiological tension was assigned by either the transparietal U reverse interrupted stitches or the extracorporeal closure in larger defects. All patients benefited from the implant Parietex composite mesh through an Intraperitoneal Onlay Mesh placement with transfacial suturing. LIVHR was performed on 1326 patients, 52.57% female and 47.43% male. The majority of our patients were young (mean age 52.19 years) and obese (average BMI 32.57 kg/m2). The mean operating time was 70 min and hospital stay 2 days, with a mean follow-up of 78 months. On the overall early complications of 5.78%, we achieved over time the elimination of the dead space by routine closure of the defect, thus reducing seroma formation to 2.56%, with a low risk of infection benefits to the conventional advantages of LIVHR in terms of reducing the overall morbidity, with a low rate of recurrences. Based on our experience and study, the current best indications for a successful LIVHR procedure should be tailored upon the limitations of the defect's width and proper patient selection, to

  17. Hérnias incisionais no pós-operatório de correção de aneurisma de aorta abdominal Postoperative incisional hernias after open abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Fábio Hüsemann Menezes

    2012-09-01

    Full Text Available CONTEXTO: A incidência de hérnia incisional no pós-operatório da correção aberta de aneurisma de aorta abdominal é alta, variando de 10 a 37% e mais de três vezes mais comum do que em pacientes submetidos à correção para doença obstrutiva aorto-ilíaca. OBJETIVO: Apresentar a incidência de hérnia incisional em um grupo de pacientes acompanhados no pós-operatório da correção aberta de aneurisma de aorta abdominal. MÉTODOS: Série de casos em uma população de 144 pacientes operados por aneurisma de aorta abdominal, entre junho de 1989 e junho de 2010, e que estão em acompanhamento regular no Ambulatório de Moléstias Vasculares. RESULTADOS: O seguimento médio dos pacientes foi de 63 meses (1 a 238. A idade média foi de 67 anos (45 a 91 e o tamanho médio dos aneurismas foi de 6,54 cm. Foram realizadas 130 laparotomias medianas xifo-púbicas e 13 acessos extraperitoniais pelo flanco esquerdo. Nestes pacientes, a incidência de hérnia incisional foi de 18,5 e 7,7%, respectivamente, para incisões na linha média ou no flanco (p=0,315. Um paciente apresentou abaulamento da musculatura oblíqua por denervação. Foi realizada uma laparotomia transversa, que não apresentou hérnia no pós-operatório tardio. CONCLUSÕES: A incidência de hérnia incisional na cirurgia aberta para correção de aneurisma de aorta abdominal é alta, ocorre com maior frequência em incisões da linha média e tem relação direta com a técnica empregada para o fechamento da aponeurose, exigindo do cirurgião atenção especial para este tempo cirúrgico para evitar a causa mais comum de reoperação em tal grupo de pacientes.BACKGROUND: The incidence of incisional hernia in the post operatory of patients submitted to open abdominal aortic aneurysm repair is high, ranging from 10 to 37%, and is more than three times higher than the incidence of hernias in patients operated for aorto-iliac occlusion. OBJECTIVE: To evaluate the incidence of

  18. 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.

    2013-01-01

    Purpose 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. Methods 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). Conclusions 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

  19. The use of an algorithm for prophylactic mesh use in high risk patients reduces the incidence of incisional hernia following laparotomy for colorectal cancer resection.

    Science.gov (United States)

    Argudo, Núria; Iskra, M Pilar; Pera, Miguel; Sancho, Juan J; Grande, Luis; López-Cano, Manuel; Pereira, José Antonio

    2017-04-01

    Incisional hernia (IH) after colorectal surgery is highly prevalent. The objective of this study is to assess the utility of an algorithm to decide on mesh augmentation after a midline laparotomy for colorectal resection to prevent IH in high-risk patients. A prospective study was conducted including all patients undergoing a midline laparotomy for colorectal resection between January 2011 and June 2014, after the implementation of a decision algorithm for prophylactic mesh augmentation in selected high-risk patients. Intention-to-treat analyses were conducted between patients in which the algorithm was correctly applied and those in which it was not. From the 235 patients analysed, the algorithm was followed in 166 patients, the resting 69 cases were used as a control group. From an initial adherence to the algorithm of 40% in the first semester, a 90.3% adherence was achieved in the seventh semester. The incidence of IH decreased as the adherence to the algorithm increased (from 28 to 0%) with a time-related correlation (R(2)=0.781). A statistically significant reduction in IH incidence was demonstrated in high-risk groups in which the algorithm was correctly applied (10,2 vs. 46,3%; p=0,0001; OR: 7,58;95%; CI: 3,8-15). Survival analysis showed that the differences remained constant during follow-up. The implementation of the algorithm reduces the incidence of IH in high-risk patients. The adherence to the algorithm also correlates with a decrease in the incidence of IH. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Hernia surgery, South Africa 2015

    African Journals Online (AJOL)

    Abdominal hernia repair is one of the most common operations in general surgery. Abdominal wall hernias include inguinal, incisional, ventral and femoral hernias. The repair rate ranges from 10 per. 100 000 population in the UK to 28 per 100 000 in the US.[1,2] More than one million hernia repairs are performed.

  1. Transgastric biologic mesh delivery and abdominal wall hernia repair in a porcine model.

    Science.gov (United States)

    Sporn, E; Astudillo, J A; Bachman, S L; Mayfield, T P; Thaler, K; Miedema, B W

    2009-12-01

    Incisional abdominal wall hernias currently require repair with open or laparoscopic surgery, which is associated with wound complications and recurrent hernia formation. Natural orifice transluminal endoscopic surgery (NOTES) techniques may have the potential to decrease the morbidity associated with hernia repair. The aim of this study was to repair a chronic ventral hernia with a biologic mesh placed transgastrically in a porcine model. Six pigs underwent creation of an incisional abdominal wall hernia. At least 4 weeks later, transgastric repair was done using an underlay biologic mesh with at least 5 cm of overlap from the hernia fascial edge. The mesh was secured with transfascial sutures and the stomach was closed with a sutured gastropexy. Pigs were evaluated 2 weeks later by laparoscopy. Pigs were sacrificed and necropsy wa s performed 4 weeks after the repair. Six pigs underwent hernia repair lasting a mean (+/- SD) of 204 +/- 123 minutes, with one perioperative death. At 2 weeks after hernia repair, laparoscopy showed significant adhesions in all pigs; one pig had extensive mesh infection and was sacrificed. Necropsy on one pig at 2 weeks and four pigs at 4 weeks showed complete coverage of the hernia defect in all pigs. All pigs had mesh abscesses or a positive mesh culture. Transgastric repair of a chronic ventral hernia is technically feasible. Difficulties with mesh delivery and infection need to be overcome before this approach can be used in humans. Georg Thieme Verlag KG Stuttgart New York.

  2. External abdominal wall hernias in Abia State University teaching ...

    African Journals Online (AJOL)

    Result: 112 patients with 114 hernias were seen during the period. Inguinal hernias were the most common hernias in this study. It accounted for 73.3% of the hernias. The other hernias followed in the following descending order – Umbilical 14.3%, Incisional – 6.3%, Epigastric – 5.5%, Spigelian, Lumbar and femoral ...

  3. Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management.

    Science.gov (United States)

    Ibarra-Hurtado, T R; Nuño-Guzmán, C M; Miranda-Díaz, A G; Troyo-Sanromán, R; Navarro-Ibarra, R; Bravo-Cuéllar, L

    2014-10-01

    Abdominal wall hernia secondary to open abdomen management represents a surgical challenge. The hernia worsens due to lateral muscle retraction. Our objective was to evaluate if Botulinum Toxin Type A (BTA) application in lateral abdominal wall muscles modifies its thickness and length. A clinical trial of male trauma patients with hernia secondary to open abdomen management was performed from January 2009 to July 2011. Thickness and length of lateral abdominal muscles were measured by a basal Computed Tomography and 1 month after BTA application. A dosage of 250 units of BTA was applied at five points at each side between the external and internal oblique muscles under ultrasonographic guidance. Statistical analysis for differences between basal and after BTA application measures was performed by a paired Student's t test (significance: p muscle measure modifications in all the patients. Left muscle thickness: mean reduction of 1 ± 0.55 cm (p muscle thickness: mean reduction of 1.00 ± 0.49 cm (p muscle length: mean increase of 2.44 ± 1.22 cm (p muscle length: mean increase of 2.59 ± 1.38 cm (p follow-up of 49 months were observed. BTA application in lateral abdominal muscles decreases its thickness and increases its length in abdominal wall hernia patients secondary to open abdomen management.

  4. Spontaneous rupture: An uncommon complication of ventral hernia ...

    African Journals Online (AJOL)

    BACKGROUND: Literature is scarce about spontaneous rupture of hernia because spontaneous rupture of here is uncommon (1). Reported cases are complications of incisional hernias, recurrent inguinal hernia, and umbilical hernias. It is potentially life threatening (1) because the ensuing entrapment and tension on ...

  5. 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 ...

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

    Science.gov (United States)

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

    2017-01-01

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

  7. The Pattern Of Adult External Abdominal Hernias In Zaria | Garba ...

    African Journals Online (AJOL)

    Of these, patients with external abdominal hernias constituted nine hundred and eighteen (918). Operation for hernias constituted about 12.5% of the operative work-load of the general surgeons in this hospital. The descending order of occurrence of external abdominal hernias were inguinal, femoral and incisional.

  8. Inguinal hernia: an Overview | Agbakwuru | Journal of the Obafemi ...

    African Journals Online (AJOL)

    A hernia is the protrusion of a viscus or a part of it though a defect in the walls of its containing cavity. A hernia may be internal when the protrusion is not seen on the body wall or external when the protrusion may be seen on the body wall. External hernias, including inguinal, femoral, epigastric, incisional, umbilical, ...

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

    Directory of Open Access Journals (Sweden)

    Hiroshi Kishikawa

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

  10. Amyand’s hernia: A review

    Science.gov (United States)

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

    2014-01-01

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

  11. Systemic and local collagen turnover in hernia patients

    DEFF Research Database (Denmark)

    Henriksen, Nadia A

    2016-01-01

    . METHODS AND RESULTS: In a systematic literature review, a total of 55 original articles were reviewed evaluating connective tissue alterations in patients with abdominal wall hernias. Patients with inguinal and incisional hernias exhibit a decreased type I to III collagen ratio in fascia and skin biopsies...... to controls. Pro-MMP-2 and pro-MMP-9 levels in the PTFE tubes did not differ between hernia patients and controls. A fascia transversalis biopsy was excised perioperatively in all four patient groups. There were no significant differences between hernia patients and controls in total collagen concentration...... or morphology of the fascia transversalis. 
 CONCLUSIONS: Direct and recurrent inguinal hernia repair are associated with ventral hernia repair, suggesting a systemic predisposition to the hernia disease. MMPs are not suitable as serum biomarkers for inguinal or incisional hernia disease. Serum biomarkers...

  12. 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 number of hernia patients operated. Mean age was 41.66±24.46 years with a bimodal peak in the 1st and 7th decades. Inguinal hernia accounted for majority (50.5%) but incisional hernia predominated in the 30-49 age group, while ...

  13. European Hernia Society classification of parastomal hernias.

    Science.gov (United States)

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

    2014-02-01

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

  14. Eventraciones post-trasplante renal: análisis de factores de riesgo y técnica quirúrgica / Post kidney transplantatios incisional hernia: risk factors analysis and surgical repair techniques

    Directory of Open Access Journals (Sweden)

    Santa Maria Victoria

    2015-11-01

    Full Text Available Several factors increase the risk of insicional hernias post-kidney transplantation and different surgical techniques exist for solving this problem. A retrospective study analyzing the risk factors for developing an insicional hernia and eventroplasties made in the kidney transplants performed between 2006-2013 was performed. The incidence of hernias was 12.7%. All elements studied were statistically independent of the appearance of hernias, probably by influence when combined together and not each separately. Consistent with the literature in which patients did not mesh was used or an absorbable mesh used had a recurrence of 100%. It should be more study of the risk factors that influence the development of post-transplant hernias because of the contradictions that arise from the literature. Post-transplant renal ventral hernia repair is safe and effective provided it is carried out for non-resorbable mesh. The risk of post-surgical infections does not appear to be affected by the use of mesh when the necessary precautions are taken, and if it does not change the prognosis.

  15. Effect of acellular human dermis buttress on laparoscopic hiatal hernia repair.

    Science.gov (United States)

    Ward, Kyle C; Costello, Kevin P; Baalman, Sara; Pierce, Richard A; Deeken, Corey R; Frisella, Margaret M; Michael Brunt, L; Matthews, Brent D

    2015-08-01

    The objective of this study was to evaluate the performance of acellular human dermis reinforcement during laparoscopic hiatal hernia repair. A prospective non-randomized, single institution study enrolled patients undergoing laparoscopic hiatal hernia repair. Acellular human dermis, FlexHD (Musculoskeletal Transplant Foundation, Edison, NJ) or AlloDerm (LifeCell Inc., Branchburg, NJ) were used to buttress the repair after primary closure. A protocol barium swallow (BAS) was performed at 6 months and then as needed due to clinical indications. Primary outcome measure was recurrence. Patients completed preoperative and postoperative GERD symptom questionnaires and quality of life surveys (SF-36). Kruskal-Wallis ANOVA, Student's t test, Fisher's exact test, or Wilcoxon signed-rank test were utilized as appropriate (p hiatal hernia repair using Flex HD (n = 37) or AlloDerm (n = 17). Both groups were similar with respect to gender, age, hiatus size, hernia type [sliding/Type I (n = 14) or paraesophageal/Type III/IV (n = 40)], esophageal motor function (manometry), preoperative SF-36 quality of life surveys, and GERD symptom questionnaires. Forty-seven patients (87 %) completed the BAS at 6 months; each group had two recurrences (p = 0.597). At median follow-up of 33 months, there were 3 recurrences (18 %) in the AlloDerm group and 5 recurrences (14 %) in the Flex HD group (p = 0.365). Minimal differences in GERD symptoms or SF-36 scores were detected between groups. However, anti-reflux medication usage, GERD symptoms, and quality of life significantly improved for both groups after laparoscopic hiatal hernia repair. Laparoscopic hiatal hernia repair with acellular human dermis reinforcement results in improvement of GERD-related symptoms and quality of life without mesh-associated complications. The type of acellular human dermis did not influence recurrence rate.

  16. Single incision endoscopic surgery for lumbar hernia.

    Science.gov (United States)

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

    2011-01-01

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

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

    African Journals Online (AJOL)

    Results: Hernia surgery accounted for 5.9% (N=239) of all surgeries excluding obstetric operations. The male to female ratio was 1.6:1 and 35.6% were aged below 5 years. Inguinal hernia was the most common type (51.4%) followed by umbilical (21.5%), epigastric (17.5%), incisional (6.2%) and hiatus hernia (3.4%).

  18. Contemporary hernia smartphone applications (apps).

    Science.gov (United States)

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

    2014-08-01

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

  19. An unusual case of inguinal hernia with spontaneous evisceration.

    Science.gov (United States)

    Zaz, Muneer A; Dass, T; Muhee, A; Kawoosa, U

    2011-12-01

    Spontaneous evisceration is a very rare and potentially fatal complication of abdominal wall hernia. It has been commonly reported in the case of umbilical hernia in patients with chronic liver disease with tense ascites. With other hernias, such as incisional hernia and inguinal hernia, the complication has been reported only once. Here we present a case report of spontaneous evisceration in an inguinal hernia in a patient with comorbid chronic obstructive airway disease. Management of the condition using prosthetic mesh repair risks mesh infection, while the use of non-prosthetic repair risks recurrence of the hernia due to the absence of stout natural tissues. Use of a biological mesh for the condition seems quite plausible. Thorough saline washes of the eviscerated organ, excision of redundant/unhealthy skin and strict adherence to the fundamental principles of hernia repair is desired in managing the condition.

  20. Inguinal Hernia

    Science.gov (United States)

    ... gentle massage. What are the complications of inguinal hernias? Inguinal hernias can cause the following complications: Incarceration. An ... pass gas nausea and vomiting fever How are inguinal hernias diagnosed? A health care provider diagnoses an inguinal ...

  1. 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.

  2. Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe

    DEFF Research Database (Denmark)

    Kokotovic, D; Sjølander, H; Gögenur, I

    2016-01-01

    PURPOSE: Due to risks of postoperative morbidity and recurrence some patients with a ventral hernia are not offered surgical repair. There is limited data on the rate and consequences of a watchful waiting (WW) strategy for these patients. The objective of this cohort study was to analyse outcome...... and umbilical/epigastric hernias. CONCLUSIONS: Watchful waiting appears to be a safe strategy in the treatment of incisional, umbilical and epigastric hernias....

  3. Incisional Negative Pressure Wound Therapy

    DEFF Research Database (Denmark)

    Hyldig, Nana; Vinter, Christina Anne; Bille, Camilla

    Background: Obese women undergoing caesarean section are at increased risk of surgical wound complications, which may lead to delayed recovery, pain, reduced quality of life, and increased health care cost. The aim of this study is to evaluate the effect of incisional Negative Pressure Wound...

  4. Surfactant maturation is not delayed in human fetuses with diaphragmatic hernia.

    Directory of Open Access Journals (Sweden)

    Olivier Boucherat

    2007-07-01

    Full Text Available BACKGROUND: Pulmonary hypoplasia and persistent pulmonary hypertension account for significant mortality and morbidity in neonates with congenital diaphragmatic hernia (CDH. Global lung immaturity and studies in animal models suggest the presence of surfactant deficiency that may further complicate the pathophysiology of CDH. However, data about surfactant status in human fetuses with CDH at birth are contradictory. The lack of a chronological study of surfactant content in late pregnancy has been a significant limitation. The appropriateness of administering surfactant supplements to neonates with CDH is therefore a debated question. METHODS AND FINDINGS: We investigated surfactant content in human fetuses with CDH compared to age-matched fetuses with nonpulmonary diseases used as controls. Concentrations of disaturated phosphatidylcholine and surfactant proteins were found to be similar at a given stage of pregnancy, with both components showing a similar pattern of increase with progressing pregnancy in fetuses with CDH and in control fetuses. Thyroid transcription factor 1, a critical regulator of surfactant protein transcription, similarly displayed no difference in abundance. Finally, we examined the expression of three glucocorticoid-regulated diffusible mediators involved in lung epithelial maturation, namely: keratinocyte growth factor (KGF, leptin, and neuregulin 1 beta 1 (NRG1-beta1. KGF expression decreased slightly with time in control fetuses, but remained unchanged in fetuses with CDH. Leptin and NRG1-beta1 similarly increased in late pregnancy in control and CDH lungs. These maturation factors were also determined in the sheep fetus with surgical diaphragmatic hernia, in which surfactant deficiency has been reported previously. In contrast to the findings in humans, surgical diaphragmatic hernia in the sheep fetus was associated with decreased KGF and neuregulin expression. Fetoscopic endoluminal tracheal occlusion performed in

  5. Human versus non-cross-linked porcine acellular dermal matrix used for ventral hernia repair: comparison of in vivo fibrovascular remodeling and mechanical repair strength.

    Science.gov (United States)

    Campbell, Kristin Turza; Burns, Nadja K; Rios, Carmen N; Mathur, Anshu B; Butler, Charles E

    2011-06-01

    Human acellular dermal matrix (HADM) and non-cross-linked porcine acellular dermal matrix (ncl-PADM) are clinically useful for complex ventral hernia repair. Direct comparisons between the two in vivo are lacking, however. This study compared clinically relevant early outcomes with these bioprosthetic materials when used for ventral hernia repair. Seventy-two guinea pigs underwent inlay repair of surgically created hernias with HADM (n = 37) or ncl-PADM (n = 35). Repair sites were harvested at 1, 2, or 4 weeks postoperatively. Adhesions were graded and quantified. Mechanical testing and histologic and immunohistologic (factor VIII) analyses of cellular and vascular infiltration were performed. No infections or recurrent hernias occurred. No difference was observed in mean adhesion surface area or tenacity between groups. Mean cellular infiltration (p hernia and/or bulge incidence.

  6. Evaluation of port site hernias, chronic pain and recurrence rates after laparoscopic ventral hernia repair: a monocentric long-term study.

    Science.gov (United States)

    Liot, Emilie; Bréguet, Romain; Piguet, Valérie; Ris, Frédéric; Volonté, Francesco; Morel, Philippe

    2017-12-01

    The aim of this study was to evaluate hernia appearance at the trocar site after laparoscopic treatment of primary or incisional ventral hernias using an intraperitoneal prosthetic mesh. Chronic pain at the trocar site and primary hernia recurrence were also evaluated. Two-hundred and twenty-six consecutive patients who underwent a standardized laparoscopic hernia repair for primary or incisional ventral hernia at our centre between January 2000 and December 2008 were included. All patients had clinical and radiological examinations. Primary end points were port site hernia and the occurrence of chronic trocar site pain. Secondary end point was primary hernia recurrence. Seventy-eight patients were excluded: 6 declined to participate, 48 were unreachable, and 24 did not meet the inclusion criteria (nine underwent a single site laparoscopic approach, ten died of unrelated disease, three were unable to visit the hospital and two had relocated). After exclusion, 148 remained in our study. Mean follow-up was 49 ± 12.6 months. Mean age at the time of surgery was 60 years (range, 28-83) In total, 504 port sites were clinically and radiologically evaluated, and only one (0.02%) had secondary herniation. Three patients (2.0%) had a recurrent hernia, and 14 (9.5%) had developed chronic pain at time of assessment. Nine patients (6.1%) were re-operated for the recurrent hernia before the follow-up evaluation. The overall recurrence rate is, therefore, 8.1%. Only two minor complications and no major complications occurred after surgery. No mortality was observed. Laparoscopic repair for primary or incisional ventral hernias is a safe surgical approach, with low rates of hernia recurrence and a low morbidity rate. When fascial closure is maintained for 10 mm port sites, the incidence of port site hernias is very low. Five millimetre ports do not require closure.

  7. Hiatal Hernia

    Science.gov (United States)

    A hiatal hernia is a condition in which the upper part of the stomach bulges through an opening in the diaphragm. ... into the esophagus. When you have a hiatal hernia, it's easier for the acid to come up. ...

  8. Some aspects of the epidemiology of external hernias in Kumasi, Ghana.

    Science.gov (United States)

    Ohene-Yeboah, M; Abantanga, F; Oppong, J; Togbe, B; Nimako, B; Amoah, M; Azorliade, R

    2009-10-01

    In our communities there are large numbers of longstanding external hernias that remain untreated. This paper describes the epidemiological characteristics of these hernias. The data is expected to provide guidelines for sustained national and international efforts to reduce the burden of hernia by performing large-scale elective hernia repairs. Between January 1998 and December 2007, a simple pro-forma was designed and used to record, in a prospective manner, the age, sex of patient and anatomical site of all external hernias seen and operated on both as emergencies and non-emergencies. These were patients who presented to a single general and paediatric surgeon at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. A total of 2,506 patients were studied, of which 1,930 were male and 576 female, giving a male:female ratio of 3.4:1. Inguinal hernia was seen in 1,766 patients: 1,613 males and 153 females, a male:female ratio of 10.5:1. Children 4 years old or younger accounted for 20.9% of inguinal hernias. Femoral hernia was seen in 79 patients: 70 females and 9 males. These groin hernias were diagnosed in 1,845 patients, accounting for 73.6% of all patients. Incisional hernia was diagnosed in 380 patients (15.2%): 179 males and 201 females-a male:female ratio of 1:1.1. These two hernia types (groin and incisional) were seen in 2,225 patients, representing 88.8% of all the patients studied. All other hernias studied, including para-umbilical, umbilical and epigastric, were seen in 281 patients, representing 11.2% of the hernias studied. The epidemiology of external hernias seen and treated in our hospital is no different from that of hernias in other communities. Sustained efforts at elective repair will reduce the vast numbers of untreated accumulated hernias in our communities and thus prevent unnecessary morbidity and mortality.

  9. Incisional endometriosis: Diagnosed by fine needle aspiration cytology

    Directory of Open Access Journals (Sweden)

    P Veda

    2010-01-01

    Full Text Available 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.

  10. [Lumbar hernia].

    Science.gov (United States)

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

    2010-03-22

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

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

    African Journals Online (AJOL)

    A. Adam

    2017-03-11

    Mar 11, 2017 ... As treatment alternatives, ureteroscopy and stone management or the use of ESWL in this situation may be considered to be safer options in some institutions. However,therecentEuropeanAssociationofUrology(EAU)guide- line recommends PCNL as first line in cases of renal calculi greater than 20 mm.

  12. 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

  13. Laparoscopic Repair Reduces Incidence of Surgical Site Infections for All Ventral Hernias

    Science.gov (United States)

    Arita, Nestor A.; Nguyen, Mylan T.; Nguyen, Duyen H.; Berger, Rachel L.; Lew, Debbie F.; Suliburk, James T.; Askenasy, Erik P.; Kao, Lillian S.; Liang, Mike K.

    2014-01-01

    Background The role of laparoscopic repair of ventral hernias remains incompletely defined. We hypothesize that laparoscopy, compared to open repair with mesh, decreases surgical site infection (SSI) for all ventral hernia types. Methods MEDLINE, EMBASE, and Cochrane databases were reviewed to identify studies evaluating outcomes of laparoscopic versus open repair with mesh of ventral hernias and divided into groups (primary or incisional). Studies with high risk of bias were excluded. Primary outcomes of interest were recurrence and SSI. Fixed effects model was used unless significant heterogeneity, assessed with the Higgins I-square (I2), was encountered. Results There were five and fifteen studies for primary and incisional cohorts. No difference was seen in recurrence between laparoscopic and open repair in the two hernia groups. SSI was more common with open repair in both hernia groups: primary (OR 4.17, 95%CI [2.03–8.55]) and incisional (OR 5.16, 95%CI [2.79–9.57]). Conclusions Laparoscopic repair, compared to open repair with mesh, decreases rates of SSI in all types of ventral hernias with no difference in recurrence. This data suggests that laparoscopic approach may be the treatment of choice for all types of ventral hernias. PMID:25294541

  14. 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.

  15. Herniamed: an internet-based registry for outcome research in hernia surgery.

    Science.gov (United States)

    Stechemesser, B; Jacob, D A; Schug-Paß, C; Köckerling, F

    2012-06-01

    Despite the high frequency of hernia surgery procedures and continuous improvements, thanks to new hernia meshes and fixation techniques, in Germany, for example, the recurrence rate and rate of chronic inguinal pain after inguinal surgery are more than 10% far too high. Introduction of a hernia register in Denmark led to a significant reduction in the recurrence rate. The aim of a hernia registry as an application-oriented outcome research tool is to monitor and evaluate (concomitant research) how the knowledge gleaned from evidence-based science is implemented in the everyday clinical setting and, ultimately, investigate its effectiveness (outcome research). The new Internet-based English- and German-language registry for the entire spectrum of inpatient and outpatient hernia surgery is designed to improve the quality of patient care and provide valid data on outcome research. Via the Internet, all relevant patient data (comorbidities, previous operations, staging, specific surgical technique, medical devices used, perioperative complications and follow-up data) can be entered into the registry database. The participating hospitals and surgeons can at any time view their own data by means of an evaluation statistics tool. The outcome research project Herniamed focuses on inguinal hernias, umbilical hernias, incisional hernias, epigastric hernias, parastomal hernias and hiatus hernias. The online-based outcome research registry meets the most stringent data protection criteria. With the Internet-based English- and German-language hernia register, a new instrument is now available for outcome research in hernia surgery.

  16. Increased TGF-β: a drawback of tracheal occlusion in human and experimental congenital diaphragmatic hernia?

    Science.gov (United States)

    Vuckovic, Aline; Herber-Jonat, Susanne; Flemmer, Andreas W; Ruehl, Ina M; Votino, Carmela; Segers, Valérie; Benachi, Alexandra; Martinovic, Jelena; Nowakowska, Dorota; Dzieniecka, Monika; Jani, Jacques C

    2016-02-15

    Survivors of severe congenital diaphragmatic hernia (CDH) present significant respiratory morbidity despite lung growth induced by fetal tracheal occlusion (TO). We hypothesized that the underlying mechanisms would involve changes in lung extracellular matrix and dysregulated transforming growth factor (TGF)-β pathway, a key player in lung development and repair. Pulmonary expression of TGF-β signaling components, downstream effectors, and extracellular matrix targets were evaluated in CDH neonates who died between birth and the first few weeks of life after prenatal conservative management or TO, and in rabbit pups that were prenatally randomized for surgical CDH and TO vs. sham operation. Before tissue harvesting, lung tissue mechanics in rabbits was measured using the constant-phase model during the first 30 min of life. Human CDH and control fetal lungs were also collected from midterm onwards. Human and experimental CDH did not affect TGF-β/Smad2/3 expression and activity. In human and rabbit CDH lungs, TO upregulated TGF-β transcripts. Analysis of downstream pathways indicated increased Rho-associated kinases to the detriment of Smad2/3 activation. After TO, subtle accumulation of collagen and α-smooth muscle actin within alveolar walls was detected in rabbit pups and human CDH lungs with short-term mechanical ventilation. Despite TO-induced lung growth, mediocre lung tissue mechanics in the rabbit model was associated with increased transcription of extracellular matrix components. These results suggest that prenatal TO increases TGF-β/Rho kinase pathway, myofibroblast differentiation, and matrix deposition in neonatal rabbit and human CDH lungs. Whether this might influence postnatal development of sustainably ventilated lungs remains to be determined. Copyright © 2016 the American Physiological Society.

  17. 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...... infection. However, the treatment is relatively costly compared to standard postoperative dressings and thus it was important to consider the rationale for using iNPWT before introducing the treatment in a clinical setting. This thesis assesses the current evidence of whether iNPWT reduces post...

  18. 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

  19. Impact of crural relaxing incisions, Collis gastroplasty, and non-cross-linked human dermal mesh crural reinforcement on early hiatal hernia recurrence rates.

    Science.gov (United States)

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

    2014-11-01

    Hernia recurrence is the leading form of failure after antireflux surgery and may be secondary to unrecognized tension on the crural repair or from a foreshortened esophagus. Mesh reinforcement has proven beneficial for repair of hernias at other sites, but the use of mesh at the hiatus remains controversial. The aim of this study was to evaluate the outcomes of hiatal hernia repair with human dermal mesh reinforcement of the crural closure in combination with tension reduction techniques when necessary. We retrospectively reviewed the records of all patients who had hiatal hernia repair using AlloMax Surgical Graft (Davol), a human dermal biologic mesh. Objective follow-up was with videoesophagram and/or upper endoscopy at 3 months postoperatively and annually. There were 82 patients with a median age of 63 years. The majority of operations (85%) were laparoscopic primary repairs of a paraesophageal hernia with a fundoplication. The crura were closed primarily in all patients and reinforced with an AlloMax Surgical Graft. A crural relaxing incision was used in 12% and a Collis gastroplasty in 28% of patients. There was no mesh-related morbidity and no mortality. Median objective follow-up was 5 months, but 15 patients had follow-up at 1 or more years. A recurrent hernia was found in 3 patients (4%). Tension-reducing techniques in combination with human biologic mesh crural reinforcement provide excellent early results with no mesh-related complications. Long-term follow-up will define the role of these techniques and this biologic mesh for hiatal hernia repair. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Inguinal hernia repair

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007406.htm Inguinal hernia repair To use the sharing features on this ... Inguinal hernia repair is surgery to repair a hernia in your groin. A hernia is tissue that bulges out of ...

  1. Hernia Surgical Mesh Implants

    Science.gov (United States)

    ... Procedures Implants and Prosthetics Hernia Surgical Mesh Implants Hernia Surgical Mesh Implants Share Tweet Linkedin Pin it ... between patients and their surgeons. What is a Hernia? A hernia occurs when an organ, intestine or ...

  2. Sir Ganga Ram Hospital classification of groin and ventral abdominal wall hernias

    Directory of Open Access Journals (Sweden)

    Chowbey Pradeep

    2006-01-01

    Full Text Available Background: Numerous classifications for groin and ventral hernias have been proposed over the past five to six decades. The old, simple classification of groin hernia in to direct, inguinal and femoral components is no longer adequate to understand the complex pathophysiology and management of these hernias. The most commonly followed classification for ventral hernias divide them into congenital, acquired, incisional and traumatic, which also does not convey any information regarding the predicted level of difficulty. Aim: All the previous classification systems were based on open hernia repairs and have their own fallacies particularly for uncommon hernias that cannot be classified in these systems. With the advent of laparoscopic/ endoscopic approach, surgical access to the hernia as well as the functional anatomy viewed by the surgeon changed. This change in the surgical approach and functional anatomy opened the doors for newer classifications. The authors have thus proposed a classification system based on the expected level of intraoperative difficulty for endoscopic hernia repair. Classification: In the proposed classification higher grades signify increasing levels of expected intraoperative difficulty. This functional classification grades groin hernias according to the: a Pre -operative predictive level of difficulty of endoscopic surgery, and b Intraoperative factors that lead to a difficult repair. Pre operative factors include multiple or pantaloon hernias, recurrent hernias, irreducible and incarcerated hernias. Intraoperative factors include reducibility at operation, degree of descent of the hernial sac and previous hernia repairs. Hernial defects greater than 7 cm in diameter are categorized one grade higher. Conclusion: Though there have been several classification systems for groin or inguinal hernias, none have been described for total classification of all ventral hernias of the abdomen. The system proposed by us includes

  3. Interparietal hernias after open retromuscular hernia repair.

    Science.gov (United States)

    Carbonell, A M

    2008-12-01

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

  4. Development of a critical-sized ventral hernia model in the pig.

    Science.gov (United States)

    Sahoo, Sambit; Baker, Andrew R; Haskins, Ivy N; Krpata, David M; Rosen, Michael J; Derwin, Kathleen A

    2017-04-01

    The pig is commonly used as a preclinical model for ventral hernia repair. However, no study has verified that an unrepaired surgically induced hernia (control) in the pig does not heal spontaneously but rather develops a persistent hernia. Without such verification in any given model, one cannot draw conclusions on the efficacy of the repair technique investigated. Three surgically induced hernia models with increasing severity were created in eight pigs. These included 10-cm retrorectus partial-thickness (model 1) and 15-cm preperitoneal full-thickness (model 2) incisional defects and an 8 × 8 cm preperitoneal full-thickness excisional defect (model 3). Postoperative management included use of an abdominal binder, and in some cases, suction drainage, for 2 wk to support the repair and prevent seroma. Models were evaluated for persistence of hernia at 5 wk using clinical and radiographic assessments. All pigs developed clinical hernias after 2 wk of defect creation, but only models 1 and 3 had clinically persistent hernias at 5 wk. At 5 wk, the average defect area was 97 cm(2) in model 1, 66 cm(2) in model 2, and 245 cm(2) in model 3. Dense fibrotic scarring was observed in the models with resolved hernias. Our results highlight the need to verify an unrepaired hernia injury model does not heal spontaneously prior to using it for hernia repair studies. The partial-thickness incisional model 1 and full-thickness excisional model 3 formed persistent hernias in pigs at 5 wk and should be further explored as models for investigating hernia repair strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Combined procedure of cesarean delivery and preperitoneal mesh repair for inguinal hernia: An initial experience

    Directory of Open Access Journals (Sweden)

    Onder Surgit

    2017-09-01

    Conclusion: Single anesthesia, single incisional scar, and single hospitalization are the major advantages of this simultaneous approach of cesarean delivery and preperitoneal mesh repair for inguinal hernia. Our analysis suggests that this combined procedure can be performed safely in selected cases.

  6. Umbilical Hernia

    Science.gov (United States)

    ... 15, 2015. Umbilical hernia Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  7. Emergency Open Incarcerated Hernia Repair with a Biological Mesh in a Patient with Colorectal Liver Metastasis Receiving Chemotherapy and Bevacizumab Uncomplicated Wound Healing

    Directory of Open Access Journals (Sweden)

    Alexandros Giakoustidis

    2014-01-01

    Full Text Available Bevacizumab is a humanized monoclonal antibody targeting vascular endothelial growth factor (VEGF, often used in combinational chemotherapy regimens for the treatment of patients with colorectal liver metastases. However adverse events have been attributed to the use of bevacizumab including gastrointestinal perforations, thrombotic events, hypertension, bleeding, and wound healing complications. 53-year-old male, with a history of colorectal cancer with liver metastasis, receiving a combination of cytotoxic chemotherapy (FOLFIRI, irinotecan with fluorouracil and folinic acid with bevacizumab presented as an emergency with an incarcerated incisional hernia. The last administration of chemotherapy and bevacizumab had taken place 2 weeks prior to this presentation. As the risk of strangulation of the bowel was increased, a decision was made to take the patient to theatre, although the hazard with respect to wound healing, haemorrhage, and infection risk was high due to the recent administration of chemotherapy with bevacizumab. The patient underwent an open repair of the incarcerated recurrent incisional hernia with placement of a biological mesh, and the postoperative recovery was uncomplicated with no wound healing or bleeding problems.

  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. Influencing factors for port-site hernias after single-incision laparoscopy.

    Science.gov (United States)

    Buckley, F P; Vassaur, H E; Jupiter, D C; Crosby, J H; Wheeless, C J; Vassaur, J L

    2016-10-01

    Single-incision laparoscopic surgery (SILS) has been demonstrated to be a feasible alternative to multiport laparoscopy, but concerns over port-site incisional hernias have not been well addressed. A retrospective study was performed to determine the rate of port-site hernias as well as influencing risk factors for developing this complication. A review of all consecutive patients who underwent SILS over 4 years was conducted using electronic medical records in a multi-specialty integrated healthcare system. Statistical evaluation included descriptive analysis of demographics in addition to bivariate and multivariate analyses of potential risk factors, which were age, gender, BMI, procedure, existing insertion-site hernia, wound infection, tobacco use, steroid use, and diabetes. 787 patients who underwent SILS without conversion to open were reviewed. There were 454 cholecystectomies, 189 appendectomies, 72 colectomies, 21 fundoplications, 15 transabdominal inguinal herniorrhaphies, and 36 other surgeries. Cases included 532 (67.6 %) women, and among all patients mean age was 44.65 (±19.05) years and mean BMI of 28.04 (±6). Of these, 50 (6.35 %) patients were documented as developing port-site incisional hernias by a health care provider or by incidental imaging. Of the risk factors analyzed, insertion-site hernia, age, and BMI were significant. Multivariate analysis indicated that both preexisting hernia and BMI were significant risk factors (p value = 0.00212; p value = 0.0307). Morbidly obese patients had the highest incidence of incisional hernias at 18.18 % (p value = 0.02). When selecting patients for SILS, surgeons should consider the presence of an umbilical hernia, increased age and obesity as risk factors for developing a port-site hernia.

  10. 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...

  11. Does pregnancy increase the risk of abdominal hernia recurrence after prepregnancy surgical repair?

    Science.gov (United States)

    Lappen, Justin R; Sheyn, David; Hackney, David N

    2016-09-01

    By increasing intraabdominal pressure, pregnancy may increase the risk of abdominal hernia recurrence. Current data are limited to studies with small sample size and thus the impact of pregnancy on recurrence is unclear. The objective of this analysis was to evaluate the impact of pregnancy on clinically significant abdominal hernia recurrence in a large multicenter cohort. A multiinstitution deidentified electronic health record database, EPM: Explore (Explorys Inc, Cleveland, OH) was utilized to perform a retrospective cohort study of women aged 18-45 years with a history of an abdominal hernia repair from 1999 through 2013. Abdominal hernia was defined to include ventral and incisional hernias, and other types were excluded. The presence or absence of a pregnancy following primary hernia repair was elucidated from the database. Subjects were excluded if a hernia repair occurred during pregnancy. The rate of hernia recurrence, defined as reoperation, was calculated. The association between pregnancy and hernia recurrence was evaluated with logistic regression, both unadjusted and adjusted for diabetes, obesity (body mass index >30 kg/m(2)), tobacco abuse, and wound complication at the time of initial hernia repair. A total of 11,020 women with a history of hernia repair were identified, of whom 840 had a subsequent pregnancy. Overall, 915 women in the cohort had a hernia recurrence (8.3%). Women with a history of pregnancy following primary hernia repair were more likely to have a body mass index >30 kg/m(2), a history of tobacco abuse, and a wound complication at the time of primary repair. In an unadjusted analysis, pregnancy was associated with an increase in the risk of hernia recurrence (13.1% vs 7.1%, odds ratio, 1.96, 95% confidence interval, 1.60-2.42). The association between pregnancy and hernia recurrence was attenuated but persisted after adjusting for confounding factors (adjusted odds ratio, 1.73, 95% confidence interval, 1.40-2.14). Pregnancy is

  12. 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

    of fascial closure. Currently, no recommendations can be given on the optimal technique to close emergency laparotomy incisions. Prophylactic mesh augmentation appears effective and safe and can be suggested in high-risk patients, like aortic aneurysm surgery and obese patients. For laparoscopic surgery......BACKGROUND: The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias...... and for important costs savings in health care. METHODS: The European Hernia Society formed a Guidelines Development Group to provide guidelines for all surgical specialists who perform abdominal incisions in adult patients on the materials and methods used to close the abdominal wall. The guidelines were developed...

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

    Science.gov (United States)

    Dixon, Steven; Sharma, Mitesh; Holtham, Stephen

    2014-05-26

    This case describes a 94-year-old woman who presented 2 years postsutured para-umbilical hernia repair with a painful black lump protruding through her scar with blood stained discharge. This was initially thought to be either ischaemic bowel secondary to strangulated incisional hernia or a large organised haematoma. An urgent CT scan was performed following which the patient passed two large calculi and bile-stained fluid spontaneously through the wound, making the diagnosis somewhat clearer. The scan revealed an incisional hernia containing the gallbladder and two large calculi at the skin surface and an incidental large caecal cancer with surrounding lymphadenopathy. Frail health and the incidental finding of a colon cancer rendered invasive surgical management inappropriate. Therefore, she was managed conservatively with antibiotics. A catheter was inserted into the fistula tract to allow free drainage and alleviate pressure-related symptoms. The patient was discharged following a multidisciplinary team discussion. 2014 BMJ Publishing Group Ltd.

  14. Congenital Lumbar Hernia

    OpenAIRE

    Sanjay Sharma; Gagan Bali; Satish Parihar; Neeraj Koul

    2008-01-01

    Lumbar hernia is a rare hernia. It constitutes less than one percent of all abdominal hernias. It can becongenital or acquired. Acquired can occur either spontaneously or after surgery or trauma. Only 300cases of lumbar hernia are reported till date. We report a case of congenital lumbar hernia in one month oldmale baby

  15. Transabdominal preperitoneal laparoscopic approach for incarcerated inguinal hernia repair

    Science.gov (United States)

    Yang, Shuo; Zhang, Guangyong; Jin, Cuihong; Cao, Jinxin; Zhu, Yilin; Shen, Yingmo; Wang, Minggang

    2016-01-01

    Abstract To investigate the efficacy, key technical points, and complication management of the transabdominal preperitoneal (TAPP) approach for incarcerated inguinal hernia repair. Seventy-three patients with incarcerated inguinal hernias underwent TAPP surgery in our department between Jan 2010 and Dec 2015. A retrospective review was performed by analyzing the perioperative data from these patients. The operation was successfully completed in all 73 patients. Operation time was 54.0 ± 18.8 minutes (range, 35–100 minutes). Length of stay was 3.9 ± 1.1 days (range, 3–9 days). There was 1 case of incisional infection, 32 cases of seroma, and 3 cases of postoperative pain during follow-up. All patients recovered after the appropriate treatment. No recurrence or fistula was observed. The TAPP approach represents a safe and effective technique for incarcerated inguinal hernia repair because of its potential in assessment of hernia content and decreasing incisional infection rate. However, it requires experienced surgeons to ensure safety with special attention paid to the key technical points as well as complication management. PMID:28033260

  16. Incidence, recurrence and risk factors of hernias following stoma reversal.

    Science.gov (United States)

    Oriel, Brad S; Chen, Qi; Itani, Kamal M F

    2017-08-01

    To determine the incidence and risk factors for stoma site (SSH) and incisional (IH) hernias following stoma reversal as well as their recurrence following repair. A cohort of VA Surgical Quality Improvement Program patients undergoing stoma reversal from 2002 to 2014 were evaluated at a single institution. Variables were selected a priori and evaluated by univariate analyses. Of 114 stoma reversals, 63 utilized a midline approach. The incidence of SSH and IH was 9.6% and 31.7% over a median follow-up of 5.7 (0.5-14) and 4.0 (0.1-14) years, respectively. Five SSH and 10 IH were repaired with no recurrences. Myofascial release and superficial surgical site infections (SSI) were associated with SSH while body mass index, preoperative radiotherapy, American Society of Anesthesiologists classification ≥3, operative duration ≥2.5 h and deep SSIs were associated with IH. Incisional hernia incidence after stoma reversal is high for both the stoma site and midline. Risk factors differ for each hernia type. A low recurrence rate exists in short term follow-up following repair of a hernia occurrence. Published by Elsevier Inc.

  17. Hernias (For Parents)

    Science.gov (United States)

    ... Giving Teens a Voice in Health Care Decisions Hernias KidsHealth > For Parents > Hernias Print A A A ... get your child the appropriate medical care. About Hernias When part of an organ or tissue in ...

  18. Femoral hernia repair

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007399.htm Femoral hernia repair To use the sharing features on this page, please enable JavaScript. Femoral hernia repair is surgery to repair a hernia near ...

  19. Incisional Endometriosis – Two Case Reports

    African Journals Online (AJOL)

    Little has changed since Rokitansky described endometriosis in 1861. Incisional or scar endometriosis is rare, reported in 0.03-1.08% of women following obstetric or gynaecological surgery, in most cases after caesarean section. Its incidence is expected to rise with the increase in numbers of caesarean sections and ...

  20. Un recorrido por la pared abdominal: evaluación de las hernias por tomografía computada multidetector

    Directory of Open Access Journals (Sweden)

    G. Matzke

    2017-01-01

    En el presente trabajo describimos los principales hallazgos por TCMD de las hernias y eventraciones de la pared abdominal (como la umbilical, epigástrica, hipogástrica, inguinal, de Spiegel, lumbar, obturatriz, intercostal e incisional y su contenido.

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

    Science.gov (United States)

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

    2015-12-01

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

  2. Endoscopic inguinal hernia repair

    NARCIS (Netherlands)

    M.T.T. Knook

    2002-01-01

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

  3. 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.

  4. 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...... 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. CONCLUSION: The 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...

  5. Rare case of a strangulated intercostal flank hernia following open nephrectomy: A case report and review of literature.

    Science.gov (United States)

    Akinduro, Oluwaseun O; Jones, Frank; Turner, Jacquelyn; Cason, Frederick; Clark, Clarence

    2015-01-01

    Flank incisions may be associated with incisional flank hernias, which may progress to incarceration and strangulation. Compromised integrity of the abdominal and intercostal musculature due to previous surgery may be associated with herniation of abdominal contents into the intercostal space. There have been six previously reported cases of herniation into the intercostal space after a flank incision for a surgical procedure. This case highlights the clinical picture associated with an emergent strangulated hernia and highlights the critical steps in its management. We present a case of a 79-year-old adult man with multiple comorbidities presenting with a strangulated flank hernia secondary to an intercostal incision for a right-sided open nephrectomy. The strangulated hernia required emergent intervention including right-sided hemi-colectomy with ileostomy and mucous fistula. Abdominal incisional hernias are rare and therefore easily overlooked, but may result in significant morbidity or even death in the patient.. The diagnosis can be made with a thorough clinical examination and ultrasound or computed topographical investigation. Once a hernia has become incarcerated, emergent surgical management is necessary to avoid strangulation and small bowel obstruction. Urgent diagnosis and treatment of this extremely rare hernia is paramount especially in the setting of strangulation. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Rare case of a strangulated intercostal flank hernia following open nephrectomy: A case report and review of literature

    Science.gov (United States)

    Akinduro, Oluwaseun O.; Jones, Frank; Turner, Jacquelyn; Cason, Frederick; Clark, Clarence

    2015-01-01

    Introduction Flank incisions may be associated with incisional flank hernias, which may progress to incarceration and strangulation. Compromised integrity of the abdominal and intercostal musculature due to previous surgery may be associated with herniation of abdominal contents into the intercostal space. There have been six previously reported cases of herniation into the intercostal space after a flank incision for a surgical procedure. This case highlights the clinical picture associated with an emergent strangulated hernia and highlights the critical steps in its management. Presentation of case We present a case of a 79-year-old adult man with multiple comorbidities presenting with a strangulated flank hernia secondary to an intercostal incision for a right-sided open nephrectomy. The strangulated hernia required emergent intervention including right-sided hemi-colectomy with ileostomy and mucous fistula. Discussion Abdominal incisional hernias are rare and therefore easily overlooked, but may result in significant morbidity or even death in the patient.. The diagnosis can be made with a thorough clinical examination and ultrasound or computed topographical investigation. Once a hernia has become incarcerated, emergent surgical management is necessary to avoid strangulation and small bowel obstruction. Conclusion Urgent diagnosis and treatment of this extremely rare hernia is paramount especially in the setting of strangulation. PMID:26629848

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

    Science.gov (United States)

    2017-01-03

    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

  8. Esophageal hiatal hernia in three exotic felines--Lynx lynx, Puma concolore, Panthera leo.

    Science.gov (United States)

    Hettlich, Bianca F; Hobson, H Phil; Ducoté, Julie; Fossum, Theresa W; Johnson, James H

    2010-03-01

    Hiatal hernia was diagnosed in three exotic felines-lynx (Lynx lynx), cougar (Puma concolore), and lion (Panthera leo). All cats had a history of anorexia. Thoracic and abdominal radiographs showed evidence of a soft tissue mass within the caudal mediastinum suggestive of a hiatal hernia in all animals. A barium esophagram was performed in one case. All animals underwent thoracic or abdominal surgery for hernia reduction. Surgical procedures included: intercostal thoracotomy with herniorrhaphy and esophagopexy (lynx and cougar), and incisional gastropexy (lion). Concurrent surgical procedures performed were gastrotomy for gastric foreign body removal and jejunostomy tube placement. Clinical signs related to the hiatal hernia disappeared after surgery and recurrence of signs was not reported for the time of follow-up.

  9. The "Inside-out" Technique for Hernia Repair with Mesh Underlay.

    Science.gov (United States)

    Berhanu, Aaron E; Talbot, Simon G

    2015-06-01

    An improved method for mesh repair of ventral/incisional hernias after component separation is presented. The use of a Carter-Thomason suture passer (Cooper Surgical, http://www.coopersurgical.com) allows for safe passage of preplaced sutures on the mesh from within the abdominal cavity through the anterior rectus sheath. This "inside-out" method makes the underlay of mesh fast and easy by improving visualization and control of sharp instruments as they are passed through the abdominal cavity. Preplacement of sutures circumferentially on the mesh also improves the distribution of tension around the repair, which may ultimately reduce the risk of hernia recurrence. The "inside-out" technique was performed on 23 patients at a single tertiary academic medical center from November 2011 to February 2014. We have followed these patients for a median of 24.5 months to assess for postoperative complications and hernia recurrence. We report an acceptable hernia recurrence rate (2 of 23 = 8.7%). One recurrence was observed in a patient who underwent repair of a recurrent ventral hernia and the other had significant loss of domain requiring an inlay mesh. The "inside-out" technique for ventral hernia repair with a mesh underlay after component separation using a Carter-Thomason suture passer is easy, safe, and reliable. We have observed no hernia recurrence in patients who underwent repair for a primary ventral hernia with an underlay technique.

  10. Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias.

    Science.gov (United States)

    Chen, Y Julia; Huynh, Desmond; Nguyen, Scott; Chin, Edward; Divino, Celia; Zhang, Linda

    2017-03-01

    The aim of the study is to investigate the outcomes of the da Vinci robot-assisted laparoscopic hernia repair of small-sized ventral hernias with circumferential suturing of the mesh compared to the traditional laparoscopic repair with trans-fascial suturing. A retrospective review was conducted of all robot-assisted umbilical, epigastric and incisional hernia repairs performed at our institution between 2013 and 2015 compared to laparoscopic umbilical or epigastric hernia repairs. Patient characteristics, operative details and postoperative complications were collected and analyzed using univariate analysis. Three primary minimally invasive fellowship trained surgeons performed all of the procedures included in the analysis. 72 patients were identified during the study period. 39 patients underwent robot- assisted repair (21 umbilical, 14 epigastric, 4 incisional), and 33 patients laparoscopic repair (27 umbilical, 6 epigastric). Seven had recurrent hernias (robot: 4, laparoscopic: 3). There were no significant differences in preoperative characteristics between the two groups. Average operative time was 156 min for robot-assisted repair and 65 min for laparoscopic repair (p robot group [3.07 cm (1-9 cm)] than that for the laparoscopic group [2.02 cm (0.5-5 cm)] (p robot-assisted technique versus the standard laparoscopic repair.

  11. Laparoscopic management of nonmidline ventral hernia.

    Science.gov (United States)

    Lal, Romesh; Sharma, Deborshi; Hazrah, Priya; Kumar, Pawan; Borgharia, Saurabh; Agarwal, Abhinav

    2014-07-01

    Ventral hernias may be primary or incisional and classified as midline ventral hernias (MVHs) or non-MVHs (NMVHs). NMVHs are rarer, and their laparoscopic management is technically challenging because of varied anatomic locations, differences in patient positioning at time of surgery, and lack of adequate lateral space for mesh fixation, compounded by the proximity of major organs and bony landmarks. A retrospective review of all the NMVHs operated on in a clinical unit is presented. One hundred eighty-three cases met the criteria of ventral hernia, with 25 cases (13.66%) as NMVH. These NMVHs included lumbar (n=5), suprapubic (n=7), iliac (n=10), and subcostal (n=3). Univariate and multivariate analyses were done using SPSS version 19 software (IBM, Armonk, NY). Continuous data were analyzed using the Mann-Whitney U test/t test, and categorical data were analyzed using the chi-squared test. A P value of ≤.05 was considered significant. Demographic profile and presentation were similar in all groups. One case each had seromuscular intestinal injury in the iliac group (P=.668), splenic injury in the lumbar group, and liver injury in the subcostal group (P=.167). In the iliac group there was 1 patient with hematoma (P=.668), whereas seroma was seen in 1 lumbar group patient and 2 iliac group patients (P=.518). Persistent cough impulse was seen in 1 case each in the iliac and lumbar groups (P=.593). One case in the iliac group recurred after primary surgery (P=.668). NMVHs have a similar spectrum of difficulty and complication profile as those of laparoscopic MVH repairs. Laparoscopic repair of a non-midline hernia is technically challenging but definitely feasible. The incidence of complications and recurrence rate might be more than those for MVHs, but its actual validation needs a much larger comparative study having a longer follow-up.

  12. Left paraduodenal hernias; Hernias paraduodenales izquierdas

    Energy Technology Data Exchange (ETDEWEB)

    Lopez-Negrete, L.; Garcia-Lozano, J.; Sanchez, J. L.; Tejeiro, A.; Sala, J. [Hospital Valle del Nalon. Riano-Sama. Asturias (Spain)

    2002-07-01

    We report two cases of left paraduodenal internal hernias located in the fossa of Landzert that were diagnosed by CT. Internal hernias are an infrequent cause of acute abdomen, due to the intestinal sub occlusion they produce. Left paraduodenal hernias are responsible for about 50% of internal hernias. CT makes it possible to demonstrate the group of herniated loops between the stomach, fourth segment of the duodenum, descending colon, and tail of the pancreas. The identification of the loops in an atypical position together with displaced blood vessels (mesenteric vessels) and colon gives concerns on them a typical radiological semiology that makes them easily identifiable. (Author) 9 refs.

  13. Management of strangulated abdominal wall hernias with mesh; early results

    Science.gov (United States)

    Ozbagriacik, Mustafa; Bas, Gurhan; Basak, Fatih; Sisik, Abdullah; Acar, Aylin; Kudas, Ilyas; Yucel, Metin; Ozpek, Adnan; Alimoglu, Orhan

    2015-01-01

    OBJECTIVE: Surgery for abdominal wall hernias is a common procedure in general surgery practice. The main causes of delay for the operation are comorbid problems and patient unwillingness, which eventually, means that some patients are admitted to emergency clinics with strangulated hernias. In this report, patients who admitted to the emergency department with strangulated adominal wall hernias are presented together with their clinical management. METHODS: Patients who admitted to our clinic between January 2009 and November 2011 and underwent emergency operation were included in the study retrospectively. Demographic characteristics, hernia type, length of hospital stay, surgical treatment and complications were assessed. RESULTS: A total 81 patients (37 female, 44 male) with a mean age of 52.1±17.64 years were included in the study. Inguinal, femoral, umbilical and incisional hernias were detected in 40, 26, 9 and 6 patients respectively. Polypropylene mesh was used in 75 patients for repair. Primary repair without mesh was used in six patients. Small bowel (n=10; 12.34%), omentum (n=19; 23.45%), appendix (n=1; 1.2%) and Meckel’s diverticulum (n=1; 1.2%) were resected. Median length of hospital stay was 2 (1–7) days. Surgical site infection was detected in five (6.2%) patients. No significant difference was detected for length of hospital stay and surgical site infection in patients who had mesh repair (p=0.232 and 0.326 respectively). CONCLUSION: The need for bowel resection is common in strangulated abdominal wall hernias which undergo emergency operation. In the present study, an increase of morbidity was seen in patients who underwent bowel resection. No morbidity was detected related to the usage of prosthetic materials in repair of hernias. Hence, we believe that prosthetic materials can be used safely in emergency cases. PMID:28058336

  14. Sports Hernia (Athletic Pubalgia)

    Science.gov (United States)

    .org Sports Hernia (Athletic Pubalgia) Page ( 1 ) A sports hernia is a painful, so tissue injury that occurs in ... groin area. It most o en occurs during sports that require sudden changes of direction or intense ...

  15. Laparoscopic Inguinal Hernia Repair

    Science.gov (United States)

    ... Global Affairs and Humanitarian Efforts Log In Laparoscopic Inguinal Hernia Repair Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon About Your Inguinal Hernia and Laparoscopic Repair: Approximately 600,000 inguinal or ...

  16. Inguinal hernia (image)

    Science.gov (United States)

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

  17. Strangulated Spigelian hernia.

    OpenAIRE

    Kirby, R. M.

    1987-01-01

    Spigelian herniae rarely present as emergencies. There have been two cases requiring emergency surgery at this hospital within the last 5 years, representing 2.4% of all abdominal wall herniae requiring urgent treatment for strangulation.

  18. Diaphragmatic hernia repair - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100014.htm Diaphragmatic hernia repair - series—Normal anatomy To use the sharing ... Editorial team. Related MedlinePlus Health Topics Birth Defects Hernia A.D.A.M., Inc. is accredited by ...

  19. Umbilical hernia repair - slideshow

    Science.gov (United States)

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

  20. Hiatal hernia repair - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100028.htm Hiatal hernia repair - series—Normal anatomy To use the sharing ... M. Editorial team. Related MedlinePlus Health Topics Hiatal Hernia A.D.A.M., Inc. is accredited by ...

  1. Bilateral Retrovascular Femoral Hernia

    OpenAIRE

    Papanikitas, Joseph; Sutcliffe, Robert P.; Rohatgi, Ashish; Atkinson, Simon

    2008-01-01

    A 34-year-old woman with cystic fibrosis presented with bilateral femoral hernias, which were found to be retrovascular at operation. The hernias were not amenable to conventional open or laparoscopic repair, and were repaired using pre-peritoneal mesh inserted deep to transversalis fascia. The anatomical basis and management of uncommon variants of femoral hernia are discussed.

  2. Primary lumbar hernia: A rarely encountered hernia.

    Science.gov (United States)

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

    2016-01-01

    Lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. Presentation may be misleading and diagnosis often missed. An imaging study forms an indispensable aid in the diagnosis and surgery is the only treatment option. A 42 year old male presented with history of pain in lower back of 4 years duration and was being treated symptomatically over 4 years with analgesics and physiotherapy. He had noticed a swelling over the left side of his mid-back and consequently on examination was found to have a primary acquired lumbar hernia arising from the deep superior lumbar triangle of Grynfelt. Diagnosis was confirmed by Computed Tomographic imaging. A lumbar hernia may be primary or secondary with only about 300 cases of primary lumbar hernia reported in literature. Lumbar hernias manifest through two possible defects in the posterior abdominal wall, the superior being more common. Management remains surgical with various techniques emerging over the years. The patient at our center underwent an open sublay mesh repair with excellent outcome. A surgeon may encounter a primary lumbar hernia perhaps once in his lifetime making it an interesting surgical challenge. Sound anatomical knowledge and adequate imaging are indispensable. Inspite of advances in minimally invasive surgery, it cannot be universally applied to patients with lumbar hernia and management requires a more tailored approach. Copyright © 2016. Published by Elsevier Ltd.

  3. Primary lumbar hernia: A rarely encountered hernia

    Directory of Open Access Journals (Sweden)

    Sharada Sundaramurthy

    2016-01-01

    Conclusion: A surgeon may encounter a primary lumbar hernia perhaps once in his lifetime making it an interesting surgical challenge. Sound anatomical knowledge and adequate imaging are indispensable. Inspite of advances in minimally invasive surgery, it cannot be universally applied to patients with lumbar hernia and management requires a more tailored approach.

  4. 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

  5. Abdominal wall hernias

    DEFF Research Database (Denmark)

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

    2016-01-01

    BACKGROUND: Throughout life, inguinal hernia develops in approximately every fourth man, some of whom develop multiple hernias. If patients at risk of developing multiple hernias could be identified by a serologic biomarker, treatment might be able to be tailored and improved. Evidence suggests......) 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...

  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. 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. 

  8. Doxycycline administration improves fascial interface in hernia repair.

    Science.gov (United States)

    Tharappel, Job C; Bower, Curtis E; Whittington Harris, Jennifer; Ramineni, Sandeep K; Puleo, David A; Roth, J Scott

    2014-08-01

    Despite improvements in ventral hernia repair techniques, their recurrence rates are unacceptably high. Increased levels of matrix metalloproteinases (MMPs) and reduced collagen-1 to -3 ratios are implicated in incisional hernia formation. We have recently shown doxycycline treatment for 4 wk after hernia repair reduced MMP levels, significantly increased collagen-1 to -3 ratios, and increased tensile strength of repaired interface fascia. However, this increase was not statistically significant. In this study, we extended treatment duration to determine whether this would impact the tensile strength of the repaired interface fascia. Thirty-two male Sprague-Dawley rats underwent incision hernia creation and subsequent repair with polypropylene mesh. The animals received either saline (n = 16) or doxycycline (n = 16) beginning from 1 day before hernia repair until the end of survival time of 6 wk (n = 16) or 12 wk (n = 16). Tissue samples were investigated for MMPs and collagen subtypes using Western blot procedures, and tensiometric analysis was performed. At both 6 and 12 wk after hernia repair, the tensiometric strength of doxycycline-treated mesh to fascia interface (MFI) tissue showed a statistically significant increase when compared with untreated control MFI. In both groups, collagen-1, -2, and -3 ratios were remarkably increased in doxycycline-treated MFI. At 6 wk, the doxycycline-treated MFI group showed a significant decrease in MMP-2, an increase in MMP-3, and no change in MMP-9. At 12 wk, MMP-9 showed a remarkable reduction, whereas MMP-2 and -3 protein levels increased in the doxycycline-treated MFI group. Doxycycline administration results in significantly improved strength of repaired fascial interface tissue along with a remarkable increase in collagen-1, -2, and -3 ratios. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. 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 ...

  10. 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.

  11. Giant inguinoscrotal hernia repair.

    Science.gov (United States)

    Prochotsky, A; Dolak, S; Minarovjech, V; Medzo, I; Hutan, M; Mifkovic, A

    2017-01-01

    Giant inguinoscrotal hernia is defined as an inguinal hernia extending below the midpoint of inner thigh in standing position. The authors describe giant inguinoscrotal hernia and small umbilical hernia with 12 years history of this uncommon disease. After preoperative evaluation, US and CT examination he was operated on. It was very difficult to return the hernia sac contents back to the abdomen and additional infraumbilical incision was needed. Hernioplasty suo modo without mesh was done. Patient recovered uneventfully. In the discussion the authors present the newer classification of giant inguinal hernia, the current treatment options and known serious complications of surgery. Finally, it indicates that good treatment results can only be achieved by close cooperation of concerned professionals in the treatment and intensive intraoperative and postoperative patient monitoring (Fig. 9, Ref. 31).

  12. [Spontaneous bilateral Petit hernia].

    Science.gov (United States)

    Fontoura, Rodrigo Dias; Araújo, Emerson Silveira de; Oliveira, Gustavo Alves de; Sarmenghi Filho, Deolindo; Kalil, Mitre

    2011-01-01

    Petit's lumbar hernia is an uncommon defect of the posterior abdominal wall that represents less than 1% of all abdominal wall hernias. It is more often unilateral and founded in young females, rarely containing a real herniated sac. There are two different approaches to repair: laparoscopy and open surgery. The goal of this article is to report one case of spontaneous bilateral lumbar Petit's hernia treated with open surgery.

  13. Primary lumbar hernia: A rarely encountered hernia

    OpenAIRE

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

    2015-01-01

    Introduction: Lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. Presentation may be misleading and diagnosis often missed. An imaging study forms an indispensable aid in the diagnosis and surgery is the only treatment option. Presentation of case: A 42 year old male presented with history of pain in lower back of 4 years duration and was being treated symptomatically over 4 years with analgesics and physiotherapy. H...

  14. 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.

  15. Age-Correlated Phenotypic Alterations in Cells Isolated from Human Degenerated Intervertebral Discs With Contained Hernias.

    Science.gov (United States)

    Molinos, Maria; Cunha, Carla; Almeida, Catarina R; Gonçalves, Raquel M; Pereira, Paulo; Silva, Pedro Santos; Vaz, Rui; Barbosa, Mário A

    2017-07-03

    Human intervertebral disc (hIVD) cells were isolated from 41 surgically excised samples and assessed for their phenotypic alterations with age. Towards the design of novel anti-ageing strategies to overcome degenerative disc disease (DDD), we investigated age-correlated phenotypic alterations that occur on primary hIVD cells. Although regenerative medicine holds great hope, much is still to be unveiled on IVD cell biology and its intrinsic signalling pathways, which can lead the way to successful therapies for IDD. A greater focus on age-related phenotypic changes at the cell level would contribute to establish more effective anti-ageing/degeneration targets. The study was subdivided in four main steps: i) optimization of primary cells isolation technique; ii) high-throughput cell morphology analysis, by imaging flow-cytometry (FC) and subsequent validation by histological analysis; iii) analysis of progenitor cell surface markers expression, by conventional FC; and iv) statistical analysis and correlation of cells morphology and phenotype with donor age. Three subsets of cells were identified based on their diameter: small (SC), large (LC) and super large cells (SLC). The frequency of SCs decreased nearly 50% with age, whereas that of LCs increased nearly 30%. Interestingly, the increased cells size was due to an enlargement of the pericellular matrix (PCM). Moreover, the expression pattern for CD90 and CD73 was a reflexion of age, where older individuals show reduced frequencies of positive cells for those markers. Nevertheless, the elevated percentages of primary positive cells for the mesenchymal stem cells (MSC) marker CD146 found, even in some older donors, bring refreshed hope for the hypothetical activation of the self-renewal potential of the IVD. These findings highlight the remarkable morphological alterations that occur on hIVD cells with ageing and degeneration, while reinforcing previous reports on the gradual disappearance of an endogenous progenitor

  16. Hernia discal cervical

    National Research Council Canada - National Science Library

    Bachmann, J

    2009-01-01

    A patient suffering from a cervical disc hernia causing cervicobrachial syndrome, received a consecutive integrated therapy with acupuncture, oral and inflitrative medication, manual therapy, and TENS...

  17. 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.

  18. An animal model to train Lichtenstein inguinal hernia repair

    DEFF Research Database (Denmark)

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

    2013-01-01

    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...

  19. An unusually large paraesophageal hernia mimicking a Bochdalek hernia.

    Science.gov (United States)

    Selvakumar, Daneish; Sian, Karan; Iyengar, Ajay J; Mejia, Ross

    2017-08-01

    Hiatal hernias are due to defects in the esophageal hiatus in the diaphragm and can be classified into sliding or paraesophageal hernias. A 31-year-old male raised a suspicion of a Bochdalek hernia but at surgery had a large paraesophageal hernia. Bochdalek hernia, a congenital diaphragmatic hernia presents in adulthood asymptomatically or with vague abdominal symptoms. It is paramount to confirm the diagnosis and rule out any fatal complications with imaging studies. Prompt surgical management with large complicated hernias, such as in our case presentation would ensure the most favorable outcome.

  20. 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.

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

    Science.gov (United States)

    Putnis, Soni; Wong, April; Berney, Christophe

    2011-12-01

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

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

    Science.gov (United States)

    Muysoms, F E; Antoniou, S A; Bury, K; Campanelli, G; Conze, J; Cuccurullo, D; de Beaux, A C; Deerenberg, E B; East, B; Fortelny, R H; Gillion, J-F; Henriksen, N A; Israelsson, L; Jairam, A; Jänes, A; Jeekel, J; López-Cano, M; Miserez, M; Morales-Conde, S; Sanders, D L; Simons, M P; Śmietański, M; Venclauskas, L; Berrevoet, F

    2015-02-01

    The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias and for important costs savings in health care. The European Hernia Society formed a Guidelines Development Group to provide guidelines for all surgical specialists who perform abdominal incisions in adult patients on the materials and methods used to close the abdominal wall. The guidelines were developed 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 instrument. An update of these guidelines is planned for 2017. For many of the Key Questions that were studied no high quality data was detected. Therefore, some strong recommendations could be made but, for many Key Questions only weak recommendations or no recommendation could be made due to lack of sufficient evidence. To decrease the incidence of incisional hernias it is strongly recommended to utilise a non-midline approach to a laparotomy whenever possible. For elective midline incisions, it is strongly recommended to perform a continuous suturing technique and to avoid the use 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 of fascial closure. Currently, no recommendations can be given on the optimal technique to close emergency laparotomy incisions. Prophylactic mesh augmentation appears effective and safe and can be suggested in high

  3. Bochdalek hernia in pregnancy.

    Science.gov (United States)

    Ngai, Ivan; Sheen, Jean-Ju; Govindappagari, Shravya; Garry, David J

    2012-09-11

    Asymptomatic diaphragmatic hernias in reproductive-aged women are rare but pose significant morbidity for pregnancy. This is a case of a woman at 29 weeks' gestation with abdominal pain and shortness of breath. Five years prior she had been incidentally diagnosed with a small congenital diaphragmatic hernia of Bochdalek. Following preconception care, she opted against repair of the hernia prior to pregnancy due to lack of symptoms and no clear recommendation for repair from the surgeon. Imaging studies on emergency room presentation demonstrated a large herniation of viscera into her chest occupying her entire left chest with slight cardiac displacement. Through a multidisciplinary approach, she was stabilised and eventually delivered at 31 weeks due to worsening pulmonary function. The hernia was repaired postpartum. We recommend repair of any diaphragmatic hernia prior to conception to prevent significant maternal and fetal morbidity or mortality. A multidisciplinary approach allows for planning.

  4. 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

  5. Acute incarcerated external abdominal hernia

    OpenAIRE

    Yang, Xue-Fei; Liu, Jia-Lin

    2014-01-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surg...

  6. 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.

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

    Science.gov (United States)

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

    2012-10-01

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

  8. 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.

  9. Handlebar Hernia: A Rare Type of Abdominal Wall Hernia

    Directory of Open Access Journals (Sweden)

    Rooh-Allah Yegane

    2010-10-01

    Full Text Available Traumatic abdominal wall hernias are a type of acquired hernia secondary to blunt trauma Caused, by direct trauma from handlebar like objects. This rare hernia is named ‘Handlebar hernia'. We report a case of such hernia without any significant intra-abdominal injury. The abdominal wall defect was repaired in layers by Jones technique. Postoperative course was uneventful. The authors recommend clinical suspicion for traumatic hernia in all patients with traumatic abdominal wall injury. Definitive treatment includes surgical exploration with primary repair of all tissue layers of the abdominal wall.

  10. Handlebar Hernia: A Rare Type of Abdominal Wall Hernia

    Directory of Open Access Journals (Sweden)

    Rooh-Allah Yegane

    2010-09-01

    Full Text Available "nTraumatic abdominal wall hernias are a type of acquired hernia secondary to blunt trauma Caused, by direct trauma from handlebar like objects. This rare hernia is named ‘Handlebar hernia'. We report a case of such hernia without any significant intra-abdominal injury. The abdominal wall defect was repaired in layers by Jones technique. Postoperative course was uneventful. The authors recommend clinical suspicion for traumatic hernia in all patients with traumatic abdominal wall injury. Definitive treatment includes surgical exploration with primary repair of all tissue layers of the abdominal wall.

  11. Ipsilateral occult hernias during endoscopic groin hernia repair

    Directory of Open Access Journals (Sweden)

    Jain Mayank

    2008-01-01

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

  12. 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.

  13. 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

    for MMP-1, MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-10, MMP-12, MMP-13, TIMP-1, TIMP-2, and TIMP-4 using a multiplex sandwich fluorescent immunoassay supplemented with gelatin zymography. The screening indicated differences in serum MMP-9 and TIMP-1 levels. Consequently, MMP-9 and TIMP-1 levels were...

  14. Traumatic lumbar hernia

    National Research Council Canada - National Science Library

    Mayank Jayant Robin Kaushik

    2012-01-01

    ... missed.METHODS:Despite being operated for fracture of the femur after a road traffic accident,a50-year-old female patient remained undiagnosed with a right sided traumatic lumbar hernia for nearly six months...

  15. The effects of incisional bupivacaine infusions on postoperative ...

    African Journals Online (AJOL)

    2010-11-24

    Nov 24, 2010 ... Keywords: incisional bupivacaine infusions, total abdominal hysterectomy, postoperative pain control. Abstract. Background: The aim of this study was to determine opioid requirements and pain intensity scores in patients after a total .... complained of nausea or vomiting, prochlorperazine. 12.5 mg was ...

  16. Incisional Endometriosis – Two Case Reports | Sofianos | Annals of ...

    African Journals Online (AJOL)

    Little has changed since Rokitansky described endometriosis in 1861. Incisional or scar endometriosis is rare, reported in 0.03-1.08% of women following obstetric or gynaecological surgery, in most cases after caesarean section. Its incidence is expected to rise with the increase in numbers of caesarean sections and ...

  17. 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 ...

  18. Evaluation of lymphatic regeneration in rat incisional wound healing ...

    African Journals Online (AJOL)

    Objective: During the wound healing process, lymphatic regeneration in the injured skin has not been fully investigated. This work was designed to study the regeneration of lymphatic vessels in rat incisional wounds in relation to the duration after the wound infliction. Material and methods: We studied the regeneration of ...

  19. Evaluation of lymphatic regeneration in rat incisional wound healing ...

    African Journals Online (AJOL)

    Nevine M.F. El Deeb

    2014-06-20

    Jun 20, 2014 ... Abstract Objective: During the wound healing process, lymphatic regeneration in the injured skin has not been fully ... Material and methods: We studied the regeneration of lymphatic vessels in the rat skin incisional wounds (sutured ... lymphatic vessels sprouting in experimental rabbit ear wounds.9The ...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    BACKGROUND: To investigate the relation between groin hernia subtypes in patients operated for bilateral hernias. METHODS: With data from the Danish Hernia Database, we identified all patients operated for primary groin hernias from 1998 to 2012. Within this cohort all patients that were...... bilaterally operated were analyzed. Risk factors for bilateral groin hernia operation as well as the relationship between groin hernia subtypes bilaterally, were analyzed using multivariate Cox proportional hazards analysis and Kappa statistics. RESULTS: A total of 108, 775 persons with primary groin hernia...... repair (89.9% males) were registered, and of those were 12,041 persons operated bilaterally (94.9% males). Females and males operated for a unilaterally direct inguinal hernia (DIH) had increased Hazard Ratios (HR) of 3.85 (CI 95% 2.14-6.19) and 4.46 (CI 95% 2.57-7.88) of being contralaterally operated...

  1. Single centre observational study to evaluate the safety and efficacy of the Proceed™ Ventral Patch to repair small ventral hernias.

    Science.gov (United States)

    Bontinck, J; Kyle-Leinhase, I; Pletinckx, P; Vergucht, V; Beckers, R; Muysoms, F

    2014-10-01

    There is evidence that mesh repair for primary umbilical hernias results in less recurrences and similar wound complication rates compared to tissue repair. In recent years, several mesh devices for the repair of small ventral hernias have been developed, but some reports have been published on serious complications and adverse effects encountered with those mesh devices. The Proceed™ Ventral Patch (PVP™) is a partially absorbable lightweight polypropylene mesh. We introduced PVP™ in our department in April 2009 and collected patient data and outcome in an observational study of 101 consecutive patients until December 2011 (Clinical.Trials.gov: NCT01307696). In addition to the routine control 3 weeks postoperative, prospective follow-up included a questionnaire, clinical investigation and ultrasound after 12 months. The study included 91 primary (76 umbilical/15 epigastric) and 10 incisional ventral hernias (including 6 trocar hernias). In all patients a PVP™ with a diameter of 6.4 cm was used. Wound problems were the most frequent complication (n = 18). Follow-up of at least 12 months was achieved in 98 patients (97 %) and the mean follow-up time was 15.9 months. Follow-up by clinical examination diagnosed a recurrence in 11/92 patients (12.0 %). Only four patients were aware of their recurrent hernia, the seven others reported no problems in the questionnaire. The additional ultrasound performed did not reveal recurrences that were not already diagnosed by clinical examination. In five patients a reoperation for repair of the recurrence was performed (reoperation rate 5/98 = 5.1 %). Hernia defect size (p = 0.032) and type of hernia (p = 0.029) were found to be a significant risk factors for development of a recurrent hernia (Fisher's exact test). Hernia size was a significant risk factor both in a univariate (p = 0.005) and in a multivariate Cox model (p = 0.017). Incisional hernia was of borderline significance in a univariate (p

  2. INCISIONAL HERNIOPLASTY WITH MERSILEN MESH AND FULL AHDOMINOPLASTY

    Directory of Open Access Journals (Sweden)

    M HASHEMI

    2003-09-01

    Full Text Available ncisional Hernia is a complication after any abdominal incision. During 10 years we have done 25 incision Hernia repair by mersilen mesh and full abdominoplasty. The Hospital stay was 3-5 days, and has followed the patients for 3 months to 10 years. There was no recurrence, infection, fat emboli or other complication during this period. All the patients were satistitied frame their abdominal shape and surgical scar we advice this technique as an effective and simple method for repairing of incision hernia especially for recurrence.

  3. Clinical Significance of Hiatal Hernia

    National Research Council Canada - National Science Library

    Hyun, Jong Jin; Bak, Young-Tae

    2011-01-01

    The relationship between hiatal hernias and gastroesophageal reflux disease (GERD) has been greatly debated over the past decades, with the importance of hiatal hernias first being overemphasized and then later being nearly neglected...

  4. Unusual Presentation of Maydl's Hernia

    African Journals Online (AJOL)

    Maydl's hernia is an uncommon presentation of inguinal hernia whereby predominantly right sided afferent and efferent loops of bowel herniate into the sac with an intervening intra-abdominal loop of bowel that is prone to strangulation. This could be missed if hernia repair is performed with inguinal approach only.

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

    National Research Council Canada - National Science Library

    Bunting, David; Szczebiot, Lukasz; Cota, Alwyn

    2013-01-01

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

  6. Single-Port Laparoscopic Parastomal Hernia Repair with Modified Sugarbaker Technique

    Science.gov (United States)

    Turingan, Isidro; Zajkowska, Marta; Tran, Kim

    2014-01-01

    Introduction: Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery. Materials and Methods: All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, “inline” and “chopsticks” to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh. Results: Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m2 did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm2 with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months. Conclusion: Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care. PMID:24680140

  7. Single-port laparoscopic parastomal hernia repair with modified sugarbaker technique.

    Science.gov (United States)

    Tran, Hanh; Turingan, Isidro; Zajkowska, Marta; Tran, Kim

    2014-01-01

    Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery. All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, "inline" and "chopsticks" to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh. Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m(2) did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm(2) with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months. Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care.

  8. Umbilical hernias and cirrhose.

    Science.gov (United States)

    Dokmak, S; Aussilhou, B; Belghiti, J

    2012-10-01

    Umbilical hernia (UH) is the most frequent abdominal wall complication of ascites in cirrhotic patients. Treatment to control ascites, which mainly consists of repeated paracentesis or transjugular intrahepatic portosystemic shunt (TIPS), is mandatory; otherwise the risk of hernia recurrence is very high. Nowadays, surgical portosystemic shunts are rarely performed. Classically, hernia repair was offered only to patients with symptomatic UH, but presently, even if the hernia is minimally symptomatic, there is tendency to perform elective repair to avoid emergency surgery for complications associated with very high mortality and morbidity rates (rupture and strangulation). If liver transplantation is indicated, treatment of UH can be performed simultaneously, unless the hernia is highly symptomatic or complicated or if the waiting time on the transplantation list is long. During repair, necrotic skin tissue should be excised; the use of prosthetic material (if the defect is large) is possible with a low risk of infection as long as ascites is sterile. The advantage of laparoscopic repair of large UH is to avoid any skin incision (precluding ascitic fluid leak) and avoid exposing prosthetic mesh to necrotic infected tissue. If the defect is small, UH repair can be performed under local anesthesia. Copyright © 2012. Published by Elsevier Masson SAS.

  9. Acute incarcerated external abdominal hernia.

    Science.gov (United States)

    Yang, Xue-Fei; Liu, Jia-Lin

    2014-11-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surgery in some cases to achieve minimally invasive treatment. However, strict adherence to the indications and contraindications is still required.

  10. The impact of trocar-cannula design and simulated operative manipulation on incisional characteristics: a randomized trial.

    Science.gov (United States)

    Munro, Malcolm G; Tarnay, Christopher M

    2004-04-01

    To evaluate the hypothesis that abdominal muscular and fascial defects associated with 12-mm blunt conical trocar-cannula system will be similar to those associated with 8-mm pyramidal trocar-cannula system, both with and without simulated operative movements. A randomized trial was performed in an animal (white swine) model. Four trocar-cannula system groups were evaluated: group A, 12-mm blunt conical system, no operative manipulations; group B, 12-mm blunt conical system, standardized operative manipulation; group C, 8-mm pyramidal system, no operative manipulations; group D, 8-mm pyramidal system with standardized operative manipulation. These 4 groups were randomly assigned across 8 animals and 6 locations for a total of 48 insertions. After the cannulas were removed, the skin and subcutaneous tissues were dissected to expose the fascial wounds. Maximal incisional length, wound area, and muscle damage score were determined for each defect. Mean wound area was 8.58 mm(2) in group A, 9.71 mm(2) in group B, 9.83 mm(2) in group C, and 9.63 mm(2) in group D. Incisional length was 9.16 mm in group A, 9.61 mm in group B, 9.14 mm in group C, and 8.52 mm in group D. There were no statistically significant differences between any 2 groups. Mean muscle injury scores were also similar for all groups. Twelve-millimeter conical trocar-cannula systems create fascial defects similar to those of 8-mm pyramidal systems, both immediately after insertion and after simulated operative manipulations. Given the historical low risk of wound dehiscence and hernia associated with pyramidal devices less than 10-mm in outside diameter, fascial closure of wounds created by conical systems may be unnecessary.

  11. Direct diverticular inguinal hernia

    Energy Technology Data Exchange (ETDEWEB)

    Ekberg, O.; Kullenberg, K.

    Nineteen patients with direct diverticular inguinal hernia (DDIH) were examined with herniography and surgically explored. A lump medially in the groin and pain were the prominent clinical manifestations in 18 patients. Physical examination indicated the presence of a DDIH in 6 patients. In 16 patients herniography revealed hernial sacs protruding from the supravesical fossa in 5 and from the medial inguinal fossa in 11. At operation a circumscribed defect was found in the transverse fascia laterally and cranially to the pubic tubercle in all patients. In 16 patients peritoneal hernial sacs were demonstrated at surgery while in 3 only lipomas (fatty hernia) were contained within the defect. In our opinion DDIH is a specific variety of inguinal hernia with a fairly typical clinical presentation and radiographic appearance but probably often overlooked at surgery.

  12. Abdominal hernias: Radiological features

    Science.gov (United States)

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

    2011-01-01

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

  13. The suture pullout characteristics of human and porcine linea alba.

    Science.gov (United States)

    Cooney, Gerard M; Lake, Spencer P; Thompson, Dominic M; Castile, Ryan M; Winter, Des C; Simms, Ciaran K

    2017-04-01

    There is a substantial prevalence of post-operative incisional hernia for both laparoscopic and laparotomy procedures, but there have been few attempts at quantifying abdominal wound closure methodology in the literature. One method to ascertain a more robust method of wound closure is the identification of the influence of suture placement parameters on suture pullout force. Current surgical practice involves a recommended bite depth and bite separation of 10mm, but the evidence base for this is not clear. In this paper, the suture pullout characteristics of both porcine and human linea alba were investigated to ascertain a suture placement protocol for surgical wound closure. Uniaxial suture pullout force testing on fresh frozen porcine and human linea alba samples was performed using standard materials testing machines. The influence of the number of suture loops, the bite depth and the bite separation of the sutures and the orientation of the sutures with respect to the principal fibre direction in the linea alba were assessed. Results showed a clearly identifiable relationship between pullout force of the suture, bite separation and bite depth, with low suture separation and high suture depth as optimal parameters for increasing pullout force. Resistance to pullout could be improved by as much as 290% when optimizing test conditions. Both human and porcine tissue were observed to exhibit very similar pullout force characteristics, corroborating the use of a porcine model for investigations into wound closure methodology. Orientation of suture application was also found to significantly affect the magnitude of suture pullout, with suturing applied longitudinally across a transverse defect resulting in higher pullout forces for small suture bite separations. Although further assessment in an environment more representative of in vivo conditions is required, these findings indicate that increasing the bite depth and reducing the bite separation with respect to

  14. Bochdalek hernia in adult

    OpenAIRE

    Oliveira, Daniel Riccioppo C.f. De [UNIFESP; Aldo Junqueira Rodrigues Jr.

    2008-01-01

    Bochdalek´s hernia is a congenital malformation of the posterolateral diaphragm region. It is more common on the left and more frequently seen in newborns and rare in adults, with over a few 100 reported cases. We present a case of Bochdalek´s hernia in a 49-year-old patient with long term dyspeptic symptoms. The upper endoscopy showed a gastric fundus herniation sliding into the chest through the diaphragmatic defect. The patient also presented with a rare pulmonary malformation ...

  15. 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; Astudillo, J Andres; Sporn, Emanuel; Miedema, Brent W; Thaler, Klaus

    2010-01-01

    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. 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 5 cm. 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. 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.

  16. Operative treatment of massive ventral hernia using polypropylene mesh: a challenge for surgeon and anesthesiologist.

    Science.gov (United States)

    Paajanen, H; Laine, H

    2005-03-01

    Surgical repair of very large ventral hernias has become feasible after the introduction of synthetic meshes and developments in intensive-care treatment. In addition to the operative challenges, postoperative disorders in the cardiovascular system, tissue oxygenation, increased intra-abdominal pressure, and pulmonary embolism expose the patient to severe risks. From 1997-2002 we operated on ten patients with giant ventral incisional or umbilical hernia (mean defect size 240 cm(2)) by using retromuscular polypropylene mesh. All patients were morbidly obese [mean Body Mass Index (BMI) 39+/-7.2 kg/m(2)]. Four of the operations were emergencies because of an acute intestinal occlusion, bowel gangrene, and skin complications. The patients were reinvestigated after the mean follow-up of 2.5 years to find out the frequency of recurrence and degree of disability. There was no intraoperative mortality, but one patient died at home after 5 weeks because of myocardial infarct and prolonged wound infection. She had mild stable coronary heart disease preoperatively. Although minor wound complications were observed in three patients, there was no need to remove the meshes. One small recurrent hernia was observed in the follow-up, but it was too small to be repaired. The quality of life after surgery was good for all patients, and they were satisfied with the operation. Retromuscular mesh hernioplasty associated with careful patient monitoring in intensive care is safe and feasible in the selected patients with massive ventral hernia.

  17. Genetics Home Reference: congenital diaphragmatic hernia

    Science.gov (United States)

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

  18. Clinical Significance of Hiatal Hernia

    Science.gov (United States)

    Hyun, Jong Jin

    2011-01-01

    The relationship between hiatal hernias and gastroesophageal reflux disease (GERD) has been greatly debated over the past decades, with the importance of hiatal hernias first being overemphasized and then later being nearly neglected. It is now understood that both the anatomical (hiatal hernia) and the physiological (lower esophageal sphincter) features of the gastroesophageal junction play important, but independent, roles in the pathogenesis of GERD, constituting the widely accepted "two-sphincter hypothesis." The gastroesophageal junction is an anatomically complex area with an inherent antireflux barrier function. However, the gastroesophageal junction becomes incompetent and esophageal acid clearance is compromised in patients with hiatal hernia, which facilitates the development of GERD. Of the different types of hiatal hernias (types I, II, III, and IV), type I (sliding) hiatal hernias are closely associated with GERD. Because GERD may lead to reflux esophagitis, Barrett's esophagus and esophageal adenocarcinoma, a better understanding of this association is warranted. Hiatal hernias can be diagnosed radiographically, endoscopically or manometrically, with each modality having its own limitations, especially in the diagnosis of hiatal hernias less than 2 cm in length. In the future, high resolution manometry should be a promising method for accurately assessing the association between hiatal hernias and GERD. The treatment of a hiatal hernia is similar to the management of GERD and should be reserved for those with symptoms attributable to this condition. Surgery should be considered for those patients with refractory symptoms and for those who develop complications, such as recurrent bleeding, ulcerations or strictures. PMID:21927653

  19. Ventral Abdominal Hernia

    Directory of Open Access Journals (Sweden)

    Georgi Tchernev

    2017-08-01

    Full Text Available A 63-year-old Caucasian female patient presented with redness of the both foot and lower legs, as well as edema of the left lower leg, accompanied by subjective complaints of burning. Fever was not reported. Well-circumscribed oval shaped tumor formation was revealed also on the abdominal wall, with hyperpigmented and depigmented areas on its ulcerated surface, measuring approximately 10/10cm in diameter, with soft-elastic texture on palpation.  The lesion occurred in 2011, according to the patient’s history. No subjective complaints were reported in association. The performed ultrasonography revealed intestinal loops in the hernial sac, without incarceration. The diagnosis of ventral abdominal hernia without mechanical ileus was made. The patient was referred for planned surgical procedure, because of her refusal on this stage.The clinical manifestation of the tumor formation on the abdominal wall, required wide spectrum of differential diagnosis, including aneurysm of the abdominal aorta, abdominal tumor, subcutaneous tumor or metastasis or hernia. In the presented cases, the abdominal wall mass was a sporadic clinical finding in the framework of the total-body skin examination in patient with erysipelas. The lack of subjective symptoms, as well as the reported history for hysterectomy and previously abscessus were not enough indicative symptoms for the correct diagnosis. The diagnosis of non-complicated hernia was made via ultrasonography, while the clinical differentiation between hernia and other life-threatening conditions as aneurysms or tumor was not possible.

  20. Laparoscopic management of inferior lumbar hernia (Petit triangle hernia).

    Science.gov (United States)

    Ipek, T; Eyuboglu, E; Aydingoz, O

    2005-05-01

    Lumbar hernias are rare defects in the posterolateral abdominal wall that may be congenital or acquired. We present a case of laparoscopic approach to repair an acquired inferior triangle (Petit) lumbar hernia in a woman by using polytetrafluoroethylene mesh. The size of the hernia was 8 x 10 cm. The length of her hospital stay was 2 days. The patient resumed normal activities in less than 2 weeks. The main advantage of this approach is excellent operative visualization, thus avoiding injury to structures near the hernia during repair. Patients benefit from a minimally invasive approach with less pain, shortened hospital course, less analgesic requirements, better cosmetic result, and minimal life-style interference.

  1. Bullhorn hernia: A rare traumatic abdominal wall hernia

    Directory of Open Access Journals (Sweden)

    Bimaljot Singh

    2015-01-01

    Full Text Available Traumatic abdominal wall hernia (TAWH is rare despite the high prevalence of blunt abdominal trauma. Bullhorn hernia occurs as a result of a direct blow to the abdominal wall by the horn of a bull, which disrupts the muscles and fascia and leads to hernia formation. We report a rare case of bullhorn TAWH in a 70-year-old patient who presented with swelling at the left lumbar region. The patient was managed by immediate surgical intervention. A surgeon must have high index of suspicion for the diagnosis of this condition as missed hernias in this setting pose a high risk of strangulation and gangrene.

  2. The Danish Inguinal Hernia database

    DEFF Research Database (Denmark)

    Friis-Andersen, Hans; Bisgaard, Thue

    2016-01-01

    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......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...

  3. 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...

  4. Pain after groin hernia repair

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Nielsen, R

    1998-01-01

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

  5. [Anterolateral hernias of the abdomen].

    Science.gov (United States)

    Mathonnet, M; Mehinto, D

    2007-01-01

    Anterolateral hernias of the abdomen group together umbilical, epigastric, and spigelian hernias and diastasis of the abdominal rectus. In spigelian hernias, 90% are located in the subumbilical region at the Monro line. They are asymptomatic in 90% of cases. The risk of strangulation is 10%-25% and requires surgical treatment. A herniorrhaphy is sufficient if the ring is less than 2 cm in diameter. Beyond 2 cm, open or celioscopic mesh repair is necessary. The risk of recurrence is less than 2%. Umbilical hernias result from progressive enlargement of the umbilical ring. The risk of strangulation is higher than 10%. The morbidity and mortality rate reaches 15% in large strangulated hernias. All umbilical hernias should therefore be treated surgically. If their diameter is under 2 cm, a simple herniorrhaphy can be done; otherwise mesh repair is required. In the cirrhosis patient, hernia treatment is part of the ascites treatment. The indication for surgery depends on liver function. Epigastric hernias are most often symptomatic: 80% have a ring smaller than 25 mm and 20% are multifocal. The risk of strangulation is low. If the ring is less than 20 mm, these hernias can be treated by herniorrhaphy. Recurrence is frequent - more than 10% - and always difficult to treat. Diastasis of the recti does not lead to complication, and treatment is not necessary. Cosmetic surgery can be used to manage diastasis.

  6. Bilateral inguinal hernias containing ovaries.

    Science.gov (United States)

    Basrur, Gurudutt Bhaskar

    2015-01-28

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

  7. Bilateral inguinal hernias containing ovaries

    Directory of Open Access Journals (Sweden)

    Gurudutt Bhaskar Basrur

    2015-03-01

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

  8. Sonographic imaging of Spigelian hernias

    OpenAIRE

    Andrzej Smereczyński; Katarzyna Kołaczyk; Jan Lubiński; Stefania Bojko; Maria Gałdyńska; Elżbieta Bernatowicz

    2012-01-01

    The aim of the work was to present clinical material referring to rarely occurring abdom‑ inal cavity hernias in semilunar line – Spigelian hernias diagnosed with the help of ultra‑ sound. Material and methods: In the period from 1995 to 2001 785 anterior abdominal wall hernias were diagnosed including 11 Spigelian hernias (1.4%) diagnosed in 10 pa‑ tients (7 women and 3 men) aged from 38 to 65 years old (average age 48). Eight patients complained of spastic pain in abdomen, in...

  9. 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....

  10. 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 ...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal hernias as opposed to patients with indirect inguinal hernias. The aim...... of the present study was to assess whether direct or recurrent inguinal hernias are associated with an elevated rate of ventral hernia surgery....

  12. 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.)

  13. Bochdalek's diaphragmatic hernia

    Energy Technology Data Exchange (ETDEWEB)

    Kuckein, D.

    1984-03-01

    Bochdalek's diaphragmatic hernia (hernia through trigonum lumbocostale of diaphragm) may be demonstrated unequivocally via computerised tomography. An additional scan in prone position is recommended. In this way, not only the relationship of the hernia to the diaphragm can be shown but also the diaphragmatic gap (trigonum lumbocostale). In some cases sagittal image reconstruction is helpful to identify the hernia.

  14. ADULT ABDOMINAL WALL HERNIA IN IBADAN.

    African Journals Online (AJOL)

    surgical practice. Groin hernia is the commonest type of abdominal wall hernias. There are several methods of hernia repair but tension-free repair (usually ... Aim: To describe the clinical profile of anterior abdominal wall hernias and our ... recent time but high cost and initial non-availability of the mesh limit its use in our.

  15. Nationwide prevalence of groin hernia repair

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  16. 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...

  17. Bochdalek hernia with obstructive uropathy.

    Science.gov (United States)

    Song, Young S; Hassani, Cameron; Nardi, Peter M

    2011-06-01

    Bochdalek hernias are postero-medial diaphragmatic defects that usually contain peritoneal fat and often remain asymptomatic. We present a unique case in which involvement of the adjacent ureter in the hernia defect resulted in obstructive uropathy. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Incarcerated inferior lumbar (Petit's) hernia.

    Science.gov (United States)

    Astarcioğlu, H; Sökmen, S; Atila, K; Karademir, S

    2003-09-01

    Petit's hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh reinforcement repair.

  19. Laparoscopic hernioplasty of hiatal hernia

    OpenAIRE

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

    2016-01-01

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

  20. Laparoscopic hernioplasty of hiatal hernia

    Science.gov (United States)

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

    2016-01-01

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

  1. Sports hernia: A pictorial review

    Directory of Open Access Journals (Sweden)

    Peter Mercouris

    2014-12-01

    Full Text Available Sports hernia represents a complex clinical and imaging entity. The purpose of the review is to provide a practical imaging approach to this condition. The review includes an overview of the anatomy and biomechanics of sports hernia by means of colour illustrations. The role of imaging, and particularly magnetic resonance imaging, is highlighted.

  2. Undescended testis in Spigelian hernia

    Directory of Open Access Journals (Sweden)

    Ravi Kumar V

    2007-01-01

    Full Text Available Spigelian hernias are uncommon in children. We report a 3-year-old boy with right spigelian hernia and right undescended testis. The hernial sac contained the testis, which is a rare presentation. The repair of the large defect with a prosthetic mesh and a concomitant orchidopexy were performed uneventfully.

  3. Bochdalek hernia: prevalence and CT characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Gale, M.E.

    1985-08-01

    The chest and abdominal computed tomography (CT) scans of 940 patients were reviewed to determine the prevalence of Bochdalek hernias and to evaluate the widely held concept that left-sided hernias occur more than nine times as often as right-sided hernias. Sixty Bochdalek hernias were identified in 52 patients, a prevalence of 6%, which is more than 100 times more frequent than previously reported. Left-sided hernias were found approximately twice as often as right-sided hernias. The Bochdalek hernia is a much more common congenital anomaly in the asymptomatic adult than previously thought and frequently can be identified on routine chest and abdominal CT images.

  4. Risk of femoral hernia after inguinal herniorrhaphy

    DEFF Research Database (Denmark)

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

    2002-01-01

    BACKGROUND: Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available. METHODS: Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July...... 2001, and included 34 849 groin hernia repairs. RESULTS: Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7.9 per cent of all reoperations for groin hernia recorded in the database....... The median time to reoperation for a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia...

  5. Interposition of the omentum and/or the peritoneum in the emergency repair of large ventral hernias with polypropylene mesh.

    Science.gov (United States)

    Sorour, Magdy A

    2014-01-01

    Ventral and incisional hernias are common surgical problems and their repairs are among the common surgeries done by a general surgeon. Repair of a large ventral hernia is still associated with high postoperative morbidity and recurrence rates. No single approach to ventral hernia repair will be the best choice for all patients. Large ventral hernias are often better approached with open surgery but may still be problematic when the defect is too wide for primary fascial closure to be achieved, as this leaves mesh exposed, bridging the gap. Techniques for incisional hernia repair have evolved over many years, and the use of mesh has reduced recurrence rates dramatically. The use of polypropylene mesh is reported to be associated with long-term complications such as severe adhesions and enterocutaneous fistula, which occur more commonly if the mesh is applied intraperitoneally with direct contact of the serosal surface of the intestine. Composite meshes containing expanded polytetrafluoroethylene (ePTFE) have been used recently; their major drawbacks lie in their high cost, inferior handling characteristics, and poor incorporation into the tissues. Although several studies have clearly demonstrated the safety and efficacy of prosthetic mesh repair in the emergency management of the incarcerated and/or strangulated inguinal and ventral hernias, however, surgeons remained reluctant to use prosthetics in such settings. The aim of this work was to evaluate the effectiveness and safety of placing the omentum and/or the peritoneum of the hernia sac as a protective layer over the viscera in the emergency repair of large ventral hernias using on-lay polypropylene mesh whenever complete tension-free closure of the abdominal wall was impossible. This study was carried out on all patients with large ventral hernia presented to the Gastrointestinal Surgery Unit, Main Alexandria University Hospital in an emergency situation during the period from October 2005 till October 2012

  6. Lumbar hernia: a diagnostic dilemma.

    Science.gov (United States)

    Ahmed, Syed Tausif; Ranjan, Rajeeva; Saha, Subhendu Bikas; Singh, Balbodh

    2014-04-15

    Lumbar hernia is one of the rare cases that most surgeons are not exposed to. Hence the diagnosis can be easily missed. This leads to delay in the treatment causing increased morbidity. We report a case of lumbar hernia in a middle-aged woman. It was misdiagnosed as lipoma by another surgeon. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Clinical and MRI findings were correlated to reach the diagnosis. We also highlight the types, the process of diagnosis and the surgical repair of lumbar hernias. We wish to alert our fellow surgeons to keep the differential diagnosis of the lumbar hernia in mind before diagnosing any lumbar swelling as lipoma.

  7. Mesh materials and hernia repair

    Science.gov (United States)

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

    2017-01-01

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

  8. Internal hernias: a brief review.

    Science.gov (United States)

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

    2013-06-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    PURPOSE: The purpose of this study was to establish the risk of recurrence after direct and indirect inguinal hernia operation in a large-scale female population and to establish the relationship between the type of hernia at the primary and recurrent procedure. METHODS: Using data from the Danish...... Hernia Database (DHDB), a cohort was generated: all females operated on electively for a primary inguinal hernia by either Lichtenstein’s technique or laparoscopy from 1998 to 2012. Within this prospectively collected cohort, the hernia type at the primary procedure (direct inguinal hernia (DIH......), indirect inguinal hernia (IIH), combination hernia), the hernia type at the recurrent procedure (DIH, IIH, combination hernia, femoral hernia), anesthesia type, and time from primary procedure to reoperation were registered. RESULTS: A total of 5,893 females with primary elective inguinal hernia operation...

  10. 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.

  11. The Danish Inguinal Hernia database

    Science.gov (United States)

    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 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. PMID:27822094

  12. Congenital Diaphragmatic Hernia

    Directory of Open Access Journals (Sweden)

    Tovar Juan A

    2012-01-01

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

  13. 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.

  14. 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.

  15. Sonographic imaging of Spigelian hernias.

    Science.gov (United States)

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

    2012-09-01

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

  16. Lumbar hernia: a diagnostic dilemma

    OpenAIRE

    Ahmed, Syed Tausif; Ranjan, Rajeeva; Saha, Subhendu Bikas; Singh, Balbodh

    2014-01-01

    Lumbar hernia is one of the rare cases that most surgeons are not exposed to. Hence the diagnosis can be easily missed. This leads to delay in the treatment causing increased morbidity. We report a case of lumbar hernia in a middle-aged woman. It was misdiagnosed as lipoma by another surgeon. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Clinical and MRI findings were correlated to reach the diagnosis. We also highlight the types, the process of diagnosis an...

  17. Etiology of Inguinal Hernias: A Comprehensive Review.

    Science.gov (United States)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    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. 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 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. The 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.

  18. Polypropylene-based composite mesh versus standard polypropylene mesh in the reconstruction of complicated large abdominal wall hernias: a prospective randomized study.

    Science.gov (United States)

    Kassem, M I; El-Haddad, H M

    2016-10-01

    To compare polypropylene mesh positioned onlay supported by omentum and/or peritoneum versus inlay implantation of polypropylene-based composite mesh in patients with complicated wide-defect ventral hernias. This was a prospective randomized study carried out on 60 patients presenting with complicated large ventral hernia in the period from January 2012 to January 2016 in the department of Gastrointestinal Surgery unit and Surgical Emergency of the Main Alexandria University Hospital, Egypt. Large hernia had an abdominal wall defect that could not be closed. Patients were divided into two groups of 30 patients according to the type of mesh used to deal with the large abdominal wall defect. The study included 38 women (63.3 %) and 22 men (37.7 %); their mean age was 46.5 years (range, 25-70). Complicated incisional hernia was the commonest presentation (56.7 %).The operative and mesh fixation times were longer in the polypropylene group. Seven wound infections and two recurrences were encountered in the propylene group. Mean follow-up was 28.7 months (2-48 months). Composite mesh provided, in one session, satisfactory results in patients with complicated large ventral hernia. The procedure is safe and effective in lowering operative time with a trend of low wound complication and recurrence rates.

  19. Open versus laparoscopic unilateral inguinal hernia repairs: defining the ideal BMI to reduce complications.

    Science.gov (United States)

    Willoughby, Ashley D; Lim, Robert B; Lustik, Michael B

    2017-01-01

    Open inguinal hernia repair is felt to be a less expensive operation than a laparoscopic one. Performing open repair on patients with an obese body mass index (BMI) results in longer operative times, longer hospital stay, and complications that will potentially impose higher cost to the facility and patient. This study aims to define the ideal BMI at which a laparoscopic inguinal hernia repair will be advantageous over open inguinal hernia repair. The NSQIP database was analyzed for (n = 64,501) complications, mortality, and operating time for open and laparoscopic inguinal hernia repairs during the time period from 2005 to 2012. Bilateral and recurrent hernias were excluded. Chi-square tests and Fisher's exact tests were used to assess associations between type of surgery and categorical variables including demographics, risk factors, and 30-day outcomes. Multivariable regression analyses were performed to determine whether odds ratios differed by level of BMI. The HCUP database was used for determining difference in cost and length of stay between open and laparoscopic procedures. There were 17,919 laparoscopic repairs and 46,582 open repairs in the study period. The overall morbidity (across all BMI categories) is statistically greater in the open repair group when compared to the laparoscopic group (p = 0.03). Postoperative complications (including wound disruption, failure to wean from the ventilator, and UTI) were greater in the open repair group across all BMI categories. Deep incisional surgical site infections (SSI) were more common in the overweight open repair group (p = 0.026). The return to the operating room across all BMI categories was statistically significant for the open repair group (n = 269) compared to the laparoscopic repair group (n = 70) with p = 0.003. There was no difference in the return to operating room between the BMI categories. The odds ratio (OR) was found to be statistically significant when comparing the obese

  20. [Creative surgery for hiatal hernia].

    Science.gov (United States)

    Galimov, O V; Khanov, V O; Mamadaliev, D Z; Sayfullin, R R; Sagitdinov, R R

    To present an experience of surgical treatment of hiatal hernia. An experience of more than thousand laparoscopic fundoplications in various modifications has been accumulated in the Clinic of Bashkir State Medical University for the period 2001-2016. An original device for intraoperative measurement of hiatal orifice is described. Hiatal orifice repair was indicated in case of its dimension over 3.5 cm. 310 patients underwent hiatal orifice repair including diaphragmocrurorrhaphy in 189 cases, hiatal orifice replacement by using of mesh implant in 121 cases. Simultaneous interventions were performed in 211 cases due to hiatal hernia combined with other abdominal diseases. Thus, selection of hiatal hernia patients for antireflux surgery should be clearly indicated according to clinical and instrumental data in the context of health care system reforming and widespread use of minimally invasive technologies. Laparoscopic operations for hiatal hernia are preferable and contribute to decrease of morbidity and improvement of outcomes.

  1. Inguinal hernia repair - series (image)

    Science.gov (United States)

    While the patient is sleepy (sedated) and pain-free (local anesthesia or spinal anesthesia) or deep asleep and pain-free (general anesthesia), an incision is made over the hernia. The bulging tissue ...

  2. The Danish Inguinal Hernia database

    DEFF Research Database (Denmark)

    Friis-Andersen, Hans; Bisgaard, Thue

    2016-01-01

    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...... 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...... 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...

  3. 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 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....

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

    Science.gov (United States)

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

    2014-01-01

    The purpose of this study was to establish the risk of recurrence after direct and indirect inguinal hernia operation in a large-scale female population and to establish the relationship between the type of hernia at the primary and recurrent procedure. Using data from the Danish Hernia Database (DHDB), a cohort was generated: all females operated on electively for a primary inguinal hernia by either Lichtenstein’s technique or laparoscopy from 1998 to 2012. Within this prospectively collected cohort, the hernia type at the primary procedure (direct inguinal hernia (DIH), indirect inguinal hernia (IIH), combination hernia), the hernia type at the recurrent procedure (DIH, IIH, combination hernia, femoral hernia), anesthesia type, and time from primary procedure to reoperation were registered. A total of 5,893 females with primary elective inguinal hernia operation on in the study period (61 % IIH, 37 % DIH, 2 % combined hernias) were included with a median follow-up time of 72 months (range 0 to 169). A total of 305 operations for suspected recurrences were registered (61 % inguinal recurrences, 38 % femoral recurrences, 1 % no hernias), which corresponded to an overall reoperation rate of 5.2 %. All femoral recurrences occurred after a previous open anterior operation. The crude reoperation rate after primary DIH operation was 11.0 %, 3.0 % after primary IIH operation and 0.007 % after combined hernia operation (p hernia recurrences exclusively existed after anterior open primary operation.

  5. Mild Ptosis Correction with the Stitch Method During Incisional Double Fold Formation

    Directory of Open Access Journals (Sweden)

    Edward Ilho Lee

    2014-01-01

    Full Text Available BackgroundNumerous methods exist for simultaneous correction of mild blepharoptosis during double eyelid surgery. These methods are generally categorized into either incisional (open or non-incisional (suture methods. The incisional method is commonly used for the creation of the double eyelid crease in patients with excessive or thick skin. However, concurrent open ptosis correction is often marred by the lengthy period of intraoperative adjustment, causing more swelling, a longer recovery time, and an increased risk of postoperative complications.MethodsThe authors have devised a new, minimally invasive technique to alleviate mild ptosis during incisional double eyelid surgery. The anterior lamella is approached through the incisional technique for the creation of a double eyelid while the posterior lamella, including Muller's and levator muscles, is approached with the suture method for Muller's plication and ptosis correction.ResultsThe procedure described was utilized in 28 patients from June 2012 to August 2012. Postoperative asymmetry was noted in one patient who had severe preoperative conjunctival scarring. Otherwise, ptosis was corrected as planned in the rest of the cases and all of the patients were satisfied with their postoperative appearance and experienced no complications.ConclusionsOur hybrid technique combines the benefits of both the incisional and suture methods, allowing for a predictable and easily reproducible correction of blepharoptosis with an aesthetically pleasing double eyelid.

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

    Science.gov (United States)

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

    2017-01-01

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

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

    African Journals Online (AJOL)

    Lichtenstein), and the 4-layer tissue repair (Shouldice) techniques of inguinal hernia surgery and to determine to what extent doctors in a general surgical unit were able to reproduce the excellent results reported from specialist hernia centres.

  8. Incarcerated appendix in a Spigelian hernia

    Directory of Open Access Journals (Sweden)

    Caroline Reinke

    2010-12-01

    Full Text Available Spigelian hernias are rare, making up only 1-2% of all hernias. Like other hernias, they may contain abdominal contents but are more likely to be incarcerated due to the small size of the fascial defect.(1 We describe here the case of a 71-year-old female with a 10-year history of right lower quadrant pain that remained undiagnosed despite multiple imaging studies. Prior to presentation the patient developed a new bulge and increasing pain at this site; an ultrasound revealed the presence of a bowel-containing hernia. The patient was taken urgently to the operating room for a laparoscopic Spigelian hernia repair, and was found to have an incarcerated appendix in the hernia. After the hernia was reduced, an appendectomy was performed and the hernia was repaired with biological mesh. Postoperatively, the patient did well, and her pain resolved.

  9. Hiatal hernia: An unusual presentation of dyspnea

    Science.gov (United States)

    Mirdamadi, Seied Ahmad; Arasteh, Mahfar

    2010-01-01

    Context: Hiatal hernia is an infrequent but serious cause of dyspnea. We report a case of acute dyspnea and paroxysmal nocturnal dyspnea secondary to hiatal hernia and epicardial fat pad. Case Report: A 78-year-old woman presented with dyspnea and paroxysmal nocturnal dyspnea. Lab data and physical examination were normal. Computed tomography scan demonstrated a large hiatal hernia and epicardial fat pad. Conclusion: Although rare, hiatal hernia should be suspected in patients who develop unexplained dyspnea. PMID:22737680

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

    Science.gov (United States)

    Barrero Candau, R; Garrido Morales, M

    2007-04-01

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

  11. Preoperative progressive pneumoperitoneum for giant inguinal hernias

    OpenAIRE

    Piskin, Turgut; Aydin, Cemalettin; Barut, Bora; Dirican, Abuzer; Kayaalp, Cuneyt

    2010-01-01

    Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient?s tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal her...

  12. 21 CFR 876.5970 - Hernia support.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hernia support. 876.5970 Section 876.5970 Food and... GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5970 Hernia support. (a) Identification. A hernia support is a device, usually made of elastic, canvas, leather, or metal, that is intended to be placed...

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

    African Journals Online (AJOL)

    Shouldice method being the more cost effective procedure should be encouraged in men with primary unilateral inguinal hernias. Key Words: Hernia, Lichtenstein, Shouldice, Clinical. Trial. CLINICAL TRIAL. Shouldice Versus Lichtenstein Hernia Repair. Techniques: A Prospective Randomized Study. Wamalwa AO1, Siwo ...

  14. Do large hiatal hernias affect esophageal peristalsis?

    Science.gov (United States)

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

    2013-01-01

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

  15. 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 abdominal wall hernia formation....

  16. 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.

  17. Development of a standardized curriculum concept for continuing training in hernia surgery: German Hernia School.

    Science.gov (United States)

    Lorenz, R; Stechemesser, B; Reinpold, W; Fortelny, R; Mayer, F; Schröder, W; Köckerling, F

    2017-04-01

    The increasingly more complex nature of hernia surgery means that training programs for young surgeons must now meet ever more stringent requirements. There is a growing demand for improved structuring and standardization of education and training in hernia surgery. In 2011, the concept of a Hernia School was developed in Germany and has been gradually implemented ever since. That concept comprises the following series of interrelated, tiered course elements: Hernie kompakt (Hernia compact), Hernie konkret (Hernia concrete), and Hernie complex (Hernia complex). All three course elements make provision for structured clinical training based on guest visits to approved hernia centers. The Hernia compact basic course imparts knowledge of anatomy working with fresh cadavers. Hernia surgery procedures can also be conducted using unfixed specimens. Knowledge of abdominal wall ultrasound diagnostics is also imparted and hernia surgery procedures simulated on pelvic trainers. In all three course elements, lectures are delivered by experts across the entire field of hernia surgery using evidence-based practices from the literature. To date, eight Hernie kompakt (Hernia compact) courses have been conducted, in each case with up to 55 participants, and with a total of 390 participants. On evaluating the course, over 95% of participants expressed the view that the Hernia compact course content improved hernia surgery training. Following that positive feedback, the more advanced Hernie konkret (Hernia concrete) and Hernie complex (Hernia complex) course elements were introduced in 2016. The experiences gained to date since the introduction of a Hernia School-a standardized curriculum concept for continuing training in hernia surgery-has been evaluated by participants as an improvement on hitherto hernia surgery training.

  18. Sonographic imaging of Spigelian hernias

    Directory of Open Access Journals (Sweden)

    Andrzej Smereczyński

    2012-09-01

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

  19. An animal model to train Lichtenstein inguinal hernia repair.

    Science.gov (United States)

    Rosenberg, J; Presch, I; Pommergaard, H C; Burcharth, J; Bagot d'Arc, M

    2013-04-01

    Inguinal hernia repair is a common surgical procedure, and the majority of operations worldwide are performed ad modum Lichtenstein (open tension-free mesh repair). Until now, no suitable surgical training model has been available for this procedure. We propose an experimental surgical training model for Lichtenstein's procedure on the male and female pig. In the pig, an incision is made 1 cm cranially to the inguinal sulcus where a string of subcutaneous lymph nodes is located and extends toward the pubic tubercle. The spermatic cord is located in a narrow sulcus in the pig, 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. 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. 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 facilitates the training in the positioning and fixation of the mesh and can be performed numerous times on the same pig. It is therefore a useful training method for inexperienced surgeons to obtain experience in aspects of the Lichtenstein procedure.

  20. Allograft AlloDerm(®) tissue for laparoscopic transabdominal preperitoneal groin hernia repair: A case report.

    Science.gov (United States)

    Amirlak, Bardia; Gerdes, Jodi; Puri, Varun; Fitzgibbons, Robert J

    2014-01-01

    Synthetic mesh is the prosthetic material used for most inguinal hernioplasties. However, when left in contact with intra-abdominal viscera, it often becomes associated with infection and migration, particularly in irradiated tissues, contaminated fields, immunosuppressed individuals, and patients with intestinal obstruction or fistula. AlloDerm(®) Regenerative Tissue Matrix (LifeCell Corporation, Branchburg, NJ) is derived from human cadaver skin and may be associated with fewer visceral adhesions and more durability in infected fields than synthetic mesh. We report the first case in which AlloDerm was used in a laparoscopic transabdominal preperitoneal repair of a multiple recurrent right inguinal hernia, a left femoral hernia, and an umbilical hernia in the same patient. Use of AlloDerm greatly enhanced the maneuverability during laparoscopic hernia repair due to its pliability and strength and eliminated the need to cover the prosthetic with peritoneum. Previous pelvic radiation and multiple previous groin repairs can render the peritoneum friable, resulting in obstacles to successful closure. AlloDerm is a reasonable choice for groin hernia repairs when such factors are present. The long-term durability of AlloDerm for laparoscopic groin hernia repairs is yet to be determined, but based on current data it seems prudent to use this technique in laparoscopic repair of complex groin hernias where infection is suspected or inadequate prosthetic coverage with peritoneum is anticipated. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Giant congenital diaphragmatic hernia in an adult

    Science.gov (United States)

    2014-01-01

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

  2. 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.

  3. 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

  4. Recurrence and Pain after Mesh Repair of Inguinal Hernias

    African Journals Online (AJOL)

    Hernia System and Lichtenstein Method for Open. Inguinal Hernia Repair. J Clin Diagn Res. 2015;. 9(6): PC04-PC07. 3. Grant AM. Open Mesh Versus Non-Mesh Repair of Groin Hernia: Meta-Analysis of Randomised. Trials Based on Individual Patient Data. EU Hernia. Trialists Collaboration. Hernia. 2002; 6(3):130-6. 4.

  5. 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

  6. An Adult Right-sided Bochdalek Hernia Accompanied with Hepatic Hypoplasia and Inguinal Hernia.

    Science.gov (United States)

    Choi, Yun Kyung; Ahn, Jae Ho; Kim, Kwan Chang; Won, Tae Hee

    2012-10-01

    We herein report a very rare case of adult right-sided Bochdalek hernia accompanied with hepatic hypoplasia and inguinal hernia. A 29-year-old man was admitted with right-sided pneumothorax. A computed tomography was performed and revealed large right sided Bochdalek hernia with hepatic hypoplasia. Under thoracolaparotomy, the defect was closed with Gore-Tex soft tissue patch. After the operation, left-sided inguinal hernia was found. However, it turned out that it had been present during infancy and spontaneously resolved during adolescence. This is the first report of right-sided Bochdalek hernia with hepatic hypoplasia and inguinal hernia in an adult.

  7. Hernia de Amyand: presentación de dos casos Amyand's hernia: report of two cases

    Directory of Open Access Journals (Sweden)

    Pedro López Rodríguez

    2005-03-01

    Full Text Available Encontrar una apendicitis en el interior de una hernia inguinal encarcelada es algo inusual y se conoce en la literatura como hernia de Amyand. Cuando ocurre, casi siempre es diagnosticada como una hernia inguinal encarcelada. Realizamos la presentación de dos casos y revisamos la literaturaFinding appendicitis in the interior of an arrested inguinal hernia is something unusual known as Amyand's hernia. When it occurs, it is usually diagnosed as an arrested inguinal hernia. Two cases are reported and the literature on this topic is reviewed

  8. Bullhorn Hernia: A Rare Traumatic Abdominal Wall Hernia

    African Journals Online (AJOL)

    Here, we report a unique case of a 70‑year‑old man hit by a bull with subsequent ... The tear in the mesocolon was repaired. ... the diagnosis of this condition as missed hernias in this setting pose a high risk of strangulation and gangrene. KEYWORDS: Blunt abdominal trauma, colostomy, mesh repair, primary repair.

  9. Effect of prosthetic material on adhesion formation after laparoscopic ventral hernia repair in a porcine model.

    Science.gov (United States)

    Borrazzo, E C; Belmont, M F; Boffa, D; Fowler, D L

    2004-05-01

    Intraperitoneal placement of prosthetic mesh causes adhesion formation after laparoscopic incisional hernia repair. A prosthesis that prevents or reduces adhesion formation is desirable. In this study, 21 pigs were randomized to receive laparoscopic placement of plain polypropylene mesh (PPM), expanded polytetrafluoroethylene (ePTFE), or polypropylene coated on one side with a bioresorbable adhesion barrier (PPM/HA/CMC). The animals were sacrificed after 28 days and evaluated for adhesion formation. Mean area of adhesion formation was 14% (SD+/-15) in the PPM/HA/CMC group, 40% (SD+/-17) in the PPM group, and 41% (SD+/-39) in the ePTFE group. The difference between PPM/HA/CMC and PPM was significant ( P=0.013). A new visceral layer of mesothelium was present in seven out of seven PPM/HA/CMC cases, six out of seven PPM cases, and two out of seven ePTFE cases. Thus, laparoscopic placement of PPM/HA/CMC reduces adhesion formation compared to other mesh types used for laparoscopic ventral hernia repairs.

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

    Science.gov (United States)

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

    2013-02-01

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

  11. Muscle degeneration in inguinal hernia specimens.

    Science.gov (United States)

    Amato, G; Agrusa, A; Romano, G; Salamone, G; Gulotta, G; Silvestri, F; Bussani, R

    2012-06-01

    There are few articles in the literature reporting the histological changes of groin structures affected by inguinal hernia. A deeper knowledge of this matter could represent an important step forward in the identification of the causes of hernia protrusion. This study aimed to recognise the pathological modifications of muscular structures in autopsy specimens excised from tissues surrounding the hernia orifice. Inguinal hernia was identified in 30 autopsied cadavers, which presented different varieties of hernia, including indirect, direct and mixed. Tissue specimens were resected for histological study from structures of the inguinal area surrounding the hernia opening, following a standardised procedure. The histological examination was focussed on the detection of structural changes in the muscle tissues. The results were compared with biopsy specimens resected from corresponding sites of the inguinal region in a control group of 15 fresh cadavers without hernia. Significant modification of the muscular arrangement of the inguinal area was recognized. Pathological alterations such as atrophy, hyaline and fibrotic degeneration, as well as fatty dystrophy of the myocytes were detected. These findings were observed consistently in the context of multistructural damage also involving vessels and nerves. In cadavers with hernia these alterations were always present independent of hernia type. No comparable damage was found in control cadavers without hernia. The high degree of degenerative changes in the muscle fibres in the inguinal area involved in hernia protrusion described in this report seems to be consistent with chronic compressive damage. These alterations could embody one important factor among the multifactorial sources of hernia genesis. Conjectures concerning its impact on the physiology and biodynamics of the inguinal region are made. The relationship between the depicted degenerative injuries and the genesis of inguinal hernia is also a focus of

  12. Developments in inguinal hernia repair

    NARCIS (Netherlands)

    Voorbrood, C E H

    2016-01-01

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

  13. Acute traumatic abdominal wall hernia

    NARCIS (Netherlands)

    D. den Hartog (Dennis); W.E. Tuinebreijer (Wim); P.P. Oprel (Pim); P. Patka (Peter)

    2011-01-01

    textabstractAlthough blunt abdominal trauma is frequent, traumatic abdominal wall hernias (TAWH) are rare. We describe a large TAWH with associated intra-abdominal lesions that were caused by high-energy trauma. The diagnosis was missed by clinical examination but was subsequently revealed by a

  14. 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.

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

    Science.gov (United States)

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

    2011-08-01

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

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

    Science.gov (United States)

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

    2015-06-01

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

  17. 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)

  18. 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

  19. 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.

  20. Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair.

    Science.gov (United States)

    Schwarz, J; Reinpold, W; Bittner, Reinhard

    2017-02-01

    The "MILOS concept" (mini/less open sublay repair) was developed to realize the benefits of minimally invasive surgery and avoid the disadvantages of traditional open techniques in repair of primary and secondary abdominal wall hernias. Utilizing the MILOS concept, the mesh can be placed in the retromuscular position without opening of the abdominal cavity or without the necessity to perform a large skin incision. The dissection of the retromuscular plane may be done by an open technique (MILOS) or endoscopically (EMILOS). From June 2015 to July 2016, a total of 33 patients were operated using the MILOS concept, 8 patients underwent the original MILOS technique, and 25 patients had the EMILOS operation. The operative steps of this novel endoscopic variation, the EMILOS procedure (endoscopic mini/less open sublay), are described in detail. Operative indications were a midline umbilical, epigastric, or incisional hernia with a coexisting rectus diastasis. In all cases, a large mesh (20 × 30) was implanted in the retromuscular space without any fixation. The average skin incision was 5.2 cm; mean operative time was 157 min and 122 min in the last five cases. The average hospital stay was 3.2 days. The median pain score (VAS) under physical stress (e.g., climbing stairs) was 2.7. The EMILOS operation has the potential to become an important supplementary method in the spectrum of surgical techniques for repair of abdominal wall hernias. The technique is reliable, reproducible, and easy to standardize.

  1. Unsuspected femoral hernia in patients with a preoperative diagnosis of recurrent inguinal hernia

    DEFF Research Database (Denmark)

    Henriksen, N A; Thorup, J; Jorgensen, L N

    2012-01-01

    Small femoral hernias may be difficult to diagnose by physical examination and are sometimes identified unexpectedly by laparoscopy. The aim of this study was to examine the incidence of unsuspected femoral hernia discovered during laparoscopic inguinal hernia repair in two well-defined patient...

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    Saud Al-Subaie

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-07-01

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

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

    Science.gov (United States)

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

    2015-11-01

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

  6. Surgical approach for recurrent inguinal hernias

    DEFF Research Database (Denmark)

    Öberg, S; Andresen, K; Rosenberg, J

    2016-01-01

    Purpose: Guidelines recommend that the reoperation of a recurrent inguinal hernia should be by the opposite approach (anterior–posterior) than the primary repair. However, the level of evidence supporting the guidelines is partially low. The purpose of this study was to compare re-reoperation rates...... between repairs performed according to the guidelines with the ones performed against it. Methods: This cohort study was based on the Danish Hernia Database, including 4344 patients with two inguinal hernia repairs in the same groin. Four groups were compared as follows: Lichtenstein–Lichtenstein vs......-reoperation for Lichtenstein–Lichtenstein was only seen if the primary hernia was medial. Conclusions: A primary Lichtenstein repair of a primary medial hernia should be reoperated with a laparoscopic repair. A primary Lichtenstein repair of a primary lateral hernia can be reoperated with either a Lichtenstein...

  7. Decreased hernia recurrence using autologous platelet-rich plasma (PRP) with Strattice™ mesh in a rodent ventral hernia model.

    Science.gov (United States)

    Van Eps, Jeffrey; Fernandez-Moure, Joseph; Cabrera, Fernando; Wang, Xin; Karim, Azim; Corradetti, Bruna; Chan, Paige; Dunkin, Brian; Tasciotti, Ennio; Weiner, Bradley; Ellsworth, Warren

    2016-08-01

    angiogenesis, myofibroblast recruitment and tissue ingrowth, ADM preservation, less severe peritoneal adhesions, and diminished hernia recurrence. We advocate further investigation regarding PRP augmentation of human VHR.

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

    Science.gov (United States)

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

    2005-07-01

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

  9. 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.

  10. Primary lumbar hernia : analysis of three cases.

    Science.gov (United States)

    Baraket, Oussema; Berriche, Ali; Zribi, Riadh; Chokki, Adel

    2011-07-01

    Lumbar hernia is relatively rare; it is due to a defect of the posterior abdominal wall. To report three new cases of lumbar hernia and insist of the modalities of treatment. There are 2 women and one man. Mean age was 78 years. The mean symptom was lumbar mass. All patients had open surgery (by lumbar incision). The post operative course was uneventful. Primary lumbar hernias are rare. Earlier diagnosis of non complicated hernia should be of primary importance to avoid some serious complication. The only curative treatment is surgery and must be done as soon as the diagnosis was made.

  11. Primary lumbar hernia repair: the open approach.

    Science.gov (United States)

    Cavallaro, G; Sadighi, A; Miceli, M; Burza, A; Carbone, G; Cavallaro, A

    2007-01-01

    Lumbar hernias arise through posterolateral abdominal wall defects, named inferior triangle (Petit) and superior triangle (Grynfelt). Most of the lumbar hernias are secondary to trauma or previous surgery, while primary lumbar hernias are rare. There are two possible surgical approaches: the anterior approach with lumbar incision and the laparoscopic (transabdominal or totally extraperitoneal) approach. We present a series of nine surgical procedures for primary lumbar hernia in 7 adult patients (2 affected by bilateral hernias). Seven were Grynfelt hernias, and two were Petit hernias. All surgical repairs were performed using synthetic mesh placed in the extraperitoneal space, below the muscular layers, using a tension-free technique. There was no surgical complication, except for 1 case with a subcutaneous haematoma. The mean hospital stay was 2.3 days. All patients returned to normal daily activities within 15 days after surgery. After a median follow-up period of 25 months, there was no case of recurrence or postsurgical sequelae, such as pain or muscular weakness. Primary lumbar hernias are rare congenital defects of the abdominal wall. Repair of these rare hernias can be successfully performed via the anterior approach with the use of synthetic mesh - this method of repair is easy, safe, and effective. Copyright 2007 S. Karger AG, Basel.

  12. 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.

  13. [Larrey or Morgagni hernias treated by laparoscopy].

    Science.gov (United States)

    Ridai, M; Boubia, S; Kafih, M; Zerouali, O N

    2002-09-14

    Diaphragmatic hernia or Morgagni-Larrey hernia is a rare entity. Its treatment is surgical and hence raises the question of the surgical approach. Two patients underwent laparoscopic surgery for Morgagni-Larrey hernia. The first, aged 17 exhibited a chromosomic abnormality (trisomie 21). The second was 18 years old. Both patients underwent surgery by laparoscopy. In both cases, the surgical act performed was resection of the hernia and closure of the orifice with separate sutures. Their post-surgical courses were uneventful, even two years later. In the age of mini-invasive surgery, laparoscopy is an excellent alternative to laparotomy in this benign pathology.

  14. 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.

  15. Laparoscopic repair of hiatal hernia after esophagectomy.

    Science.gov (United States)

    Erkmen, Cherie P; Raman, Vignesh; Ghushe, Neil D; Trus, Thadeus L

    2013-08-01

    Herniation of abdominal contents via the diaphragmatic hiatus is a potentially life-threatening complication of esophagectomy. Mounting evidence suggests that hiatal hernias are more common following minimally invasive esophagectomy. Therefore, post-esophagectomy hiatal hernia and its treatment bear increasing significance. We retrospectively reviewed the records of five patients with hiatal hernia following esophagectomy over a 5-year period. Successful laparoscopic reduction of a post-esophagectomy hiatal hernia was done without mesh reinforcement in three patients. One patient underwent mesh reinforcement. One patient was found to have carcinomatosis upon laparoscopic inspection, and repair of the hiatal hernia was abandoned. There were no perioperative deaths or complications. One patient developed a recurrent hiatal hernia 14 months after repair of the initial hiatal hernia. Patients were discharged within a mean of 1.75 days after surgical repair. We have successfully used laparoscopy to treat hiatal hernias after esophagectomy. The benefits conferred by laparoscopy, including better visualization of the right gastroepiploic artery supplying the gastric conduit, minimally invasive evaluation of the field for metastasis, and shorter recovery time, make it our favored approach. Here, we describe our experience with hiatal hernia following esophagectomy and our operative technique.

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

    Science.gov (United States)

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

    2015-03-01

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

  17. 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 ...

  18. Incisional surgical site infections after colorectal surgery: time to appraise its true incidence.

    Science.gov (United States)

    Sergeant, G; Buffet, W; Fieuws, S; de Gheldere, C; Vanclooster, P

    2008-01-01

    Surgical site infections (SSI) are the leading cause of complications in surgical patients. For colorectal surgery the reported incidence of SSI varies between 10 and 15%. This incidence however, has been challenged recently. In this study, we evaluated the incidence of incisional SSI after colorectal surgery in our department. We performed a retrospective analysis of 115 non-laparoscopic colorectal resections between July 1st 2004 and July 31st 2005. After exclusion, 101 patients were retained. Demographic, clinical and operative variables were collected. Univariable and multivariable analysis were performed to identify risk factors for the development of incisional SSI. 21 SSI were diagnosed (20.7%). Seventeen cases were incisional SSI (16.8%). Multivariable analysis identified longer operation time (p = 0.014), pre-operative obstructive lung disease (p = 0.02) and fewer postoperative days on TPN (p = 0.04) as independent predictors of incisional SSI. In comparison with recent publications, the incidence of SSI in our series was higher compared to what is generally reported.

  19. Reconstruction of the symphysis pubis to repair a complex midline hernia in the setting of congenital bladder exstrophy.

    Science.gov (United States)

    Kohler, J E; Friedstat, J S; Jacobs, M A; Voelzke, B B; Foy, H M; Grady, R W; Gruss, J S; Evans, H L

    2015-08-01

    A 40-year-old man with congenital midline defect and wide pubic symphysis diastasis secondary to bladder exstrophy presented with a massive incisional hernia resulting from complications of multiple prior abdominal repairs. Using a multi-disciplinary team of general, plastic, and urologic surgeons, we performed a complex hernia repair including creation of a pubic symphysis with rib graft for inferior fixation of mesh. The skin graft overlying the peritoneum was excised, and the posterior rectus sheath mobilized, then re-approximated. The previously augmented bladder and urethra were mobilized into the pelvis, after which a rib graft was constructed from the 7th rib and used to create a symphysis pubis using a mortise joint. This rib graft was used to fix the inferior portion of a 20 × 25 cm porcine xenograft mesh in a retro-rectus position. With the defect closed, prior skin scars were excised and the wound closed over multiple drains. The patient tolerated the procedure well. His post-operative course was complicated by a vesico-cutaneous fistula and associated urinary tract and wound infections. This resolved by drainage with a urethral catheter and bilateral percutaneous nephrostomies. The patient has subsequently healed well with an intact hernia repair. The increased intra-abdominal pressure from his intact abdominal wall has been associated with increased stress urinary incontinence. Although a difficult operation prone to serious complications, reconstruction of the symphysis pubis is an effective means for creating an inferior border to affix mesh in complex hernia repairs associated with bladder exstrophy.

  20. Post-operative benefits of Tisseel®/Tissucol® for mesh fixation in patients undergoing Lichtenstein inguinal hernia repair: secondary results from the TIMELI trial

    DEFF Research Database (Denmark)

    Campanelli, G; Pascual, M H; Hoeferlin, A

    2014-01-01

    PURPOSE: The Tisseel/Tissucol for mesh fixation in Lichtenstein hernia repair (TIMELI) study showed that mesh fixation with human fibrin sealant during inguinal hernia repair significantly reduced moderate-severe complications of pain 12 months post-operatively compared with sutures. Further...

  1. 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

    The nationwide Danish Hernia Database, recording more than 10,000 inguinal and 400 femoral hernia repairs annually, provides a unique opportunity to present valid recommendations in the management of Danish patients with groin hernia. The cumulated data have been discussed at biannual meetings...... and guidelines have been approved by the Danish Surgical Society. Diagnosis of groin hernia is based on clinical examination. Ultrasonography, CT or MRI are rarely needed, while herniography is not recommended. In patients with indicative symptoms of hernia, but no detectable hernia, diagnostic laparoscopy may...... be an option. Once diagnosed, hernia repair is recommended in the presence of symptoms affecting daily life. In male patients with minimal or absent symptoms watchful waiting is recommended. In females, however, repair is recommended also in asymptomatic patients. In male patients with primary unilateral...

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

    Science.gov (United States)

    Saeed, Uzma; Mazhar, Naveed; Zameer, Shahla

    2014-11-01

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

  3. Bochdalek hernia with intrathoracic kidney.

    Science.gov (United States)

    Shah, Arti D; Ajay, Stani; Adalia, Mayur; Rathi, Amar

    2012-10-01

    Bochdalek hernia is a congenital diaphragmatic defect that allows abdominal viscera to herniate into the thorax. Intrathoracic kidney is a very rare finding representing less than 5% of all renal ectopias. A 20 year old female presented with complaints of dry cough since 15 days and intermittent fever of 4 days duration. As part of routine investigation chest X-ray was done which showed a left retro-cardiac homogenous opacity, rest of the lung field appeared normal. Abdominal ultrasound showed the right kidney to be normal, left kidney was not visualized. Computed tomography scan demonstrated left-sided Bochdalek hernia with the left kidney within the thorax. An IVP was done to confirm the diagnosis. Many a times intrathoracic kidney is confused with a thoracic mass and the patient undergoes a battery of unnecessary investigations, surgical interventions and image guided biopsies for the same, hence to avoid this we are reporting this case.

  4. Bochdalek hernia with intrathoracic kidney

    Directory of Open Access Journals (Sweden)

    Arti D Shah

    2012-01-01

    Full Text Available Bochdalek hernia is a congenital diaphragmatic defect that allows abdominal viscera to herniate into the thorax. Intrathoracic kidney is a very rare finding representing less than 5% of all renal ectopias. A 20 year old female presented with complaints of dry cough since 15 days and intermittent fever of 4 days duration. As part of routine investigation chest X-ray was done which showed a left retro-cardiac homogenous opacity, rest of the lung field appeared normal. Abdominal ultrasound showed the right kidney to be normal, left kidney was not visualized. Computed tomography scan demonstrated left-sided Bochdalek hernia with the left kidney within the thorax. An IVP was done to confirm the diagnosis. Many a times intrathoracic kidney is confused with a thoracic mass and the patient undergoes a battery of unnecessary investigations, surgical interventions and image guided biopsies for the same, hence to avoid this we are reporting this case.

  5. Acute traumatic abdominal wall hernia

    OpenAIRE

    Hartog, Dennis; Tuinebreijer, Wim; Oprel, Pim; Patka, Peter

    2011-01-01

    textabstractAlthough blunt abdominal trauma is frequent, traumatic abdominal wall hernias (TAWH) are rare. We describe a large TAWH with associated intra-abdominal lesions that were caused by high-energy trauma. The diagnosis was missed by clinical examination but was subsequently revealed by a computed tomography (CT) scan. Repair consisted of an open anatomical reconstruction of the abdominal wall layers with reinforcement by an intraperitoneal composite mesh. The patient recovered well and...

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

    Science.gov (United States)

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

    2014-06-01

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

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

    African Journals Online (AJOL)

    Results: There were 110 patients with 111 obstructed hernias, accounting for 26.4% of all abdominal wall hernias. The age ranged from 19 - 79 years with mean of 49.7 years. Males accounted for 81%. Inguinoscrotal hernia was the commonest occurring in 75.7%, 16.2% patients presented with inguinal hernia and five ...

  8. The History of groin hernia | Wapnick | South African Medical Journal

    African Journals Online (AJOL)

    In The first century AD Celsus described a method of recognition of groin hernia. It was not until Casper Stromayr (16th century) published his work on hernia that the distinction between a direct and indirect inguinal hernia was appreciated. Stromayr also introduced a hernia truss which was designed to prevent a groin ...

  9. [Incarcerated Spigelian hernia: a rare cause of ileus

    NARCIS (Netherlands)

    Ozdemir-van Brunschot, D.; Buyne, O.R.

    2012-01-01

    BACKGROUND: First described in 1764, the hernia of the semilunar line is called a Spigelian hernia. Spigelian hernias are rare: comprising only 1-2% of all abdominal hernias. CASE DESCRIPTION: A 73-year-old man presented at the emergency department complaining of not having defaecated and swelling

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

    African Journals Online (AJOL)

    pattern of hernia presentation and outcome of man- agement between males and females owing to the ... who had hernia repair at Obafemi Awolowo University. Teaching Hospitals Complex Ile-Ife, Nigeria which ... cases of adult inguinal hernias (28.8%) were repaired with mesh prosthesis. Hernias were safely repaired in.

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

    Science.gov (United States)

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

    2011-10-01

    A Petit lumbar hernia is an uncommon hernia. Congenital forms are seen in children. Incarceration may occur as an unreducible lumbar mass, associated with bilious vomiting and abdominal distention. Abdominal X-ray shows sided-wall bowel gas. In this case, reduction and primary closure must be performed as emergency repair. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  12. Obstructive right paraduodenal hernia: A case report

    African Journals Online (AJOL)

    surgical management of paraduodenal hernia. Ann. Surg. 1968; 168: 249-254. 8. Surgery: Scientific principles and practice – Lipincott and Raven: Second edition, Lazar J. Greenfield. 1997. 9. Sinohara T., Okugawa K. and Furuta C. Volvulus of the small intestine caused by right paraduodenal hernia. J. Pediat. Surg. 2004 ...

  13. THE mSTORY OF GROIN HERNIA*

    African Journals Online (AJOL)

    1971-07-03

    Jul 3, 1971 ... Kahn, J. 1.. and Koiransky H. (1933): Amer. J. Dis. Child.. 46, 40. THE mSTORY OF GROIN HERNIA*. SIMO I. WAPNICK, M.D., FR.C.S., Lecturer in Surgery, University of Rhodesia, Salisbury. SUMMARY. In The first century AD Cefsus described a method of recognition of groin hernia. It was not until Casper.

  14. 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.

  15. Groin hernia diagnostics: dynamic inguinal ultrasound (DIUS).

    Science.gov (United States)

    Niebuhr, Henning; König, Anita; Pawlak, Maciej; Sailer, Marco; Köckerling, Ferdinand; Reinpold, Wolfgang

    2017-11-01

    Although clinical examination is the gold standard for the diagnosis of groin hernia, imaging procedures can improve the detection of femoral hernias, incipient hernias, and less-common types of hernias (e.g., an obturator hernia). The aim of this study is to evaluate the sensitivity and specificity of dynamic inguinal ultrasound (DIUS). Between July 2010 and June 2015, 4951 clinical and ultrasound examinations of the groin area were conducted at the Hanse-Hernienzentrum in Hamburg, Germany. The ultrasonographic findings were prospectively evaluated to determine the number of inguinal and femoral hernia diagnoses that were ultrasonically confirmed and also to consider cases in which clinical examination overlooked these diagnoses. The results were compared with the intraoperative findings. The results show that standardized ultrasound examination of the groin area with high-frequency, small-part linear transducers also serves to accurately display femoral and small or occult groin hernias. The high-level specificity (0.9980) and sensitivity (0.9758) are proof of the procedure's quality. To ensure high-quality hernia treatment, regular use of standardized ultrasound examinations is recommended.

  16. New Clinical Concepts in Inguinal Hernia

    NARCIS (Netherlands)

    R.N. Veen, van (Ruben Nico)

    2008-01-01

    textabstractHernia surgery is one of the earliest forms of surgery and currently the most frequently performed operation in general surgery. Relatively modest improvements of clinical outcomes or savings of resource use in inguinal hernia repair would already have a signifi cant medical and

  17. Inguinal Hernia Management: Focus on Pain

    NARCIS (Netherlands)

    A.R. Wijsmuller

    2010-01-01

    textabstractIn the Netherlands approximately 31,000 inguinal hernias are corrected yearly, making it one of the most frequently performed operations in surgery. The majority of inguinal hernia repairs is conducted in male patients older than 50 years. Since recurrence rates have been reduced to a

  18. Pain characteristics after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  19. 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.

  20. Ambulatory groin and ventral hernia repair.

    Science.gov (United States)

    Ngo, P; Pélissier, E; Levard, H; Perniceni, T; Denet, C; Gayet, B

    2010-10-01

    Ambulatory surgery is not commonly practiced in France today. The aim of this study was to prospectively evaluate the feasibility of ambulatory hernia repair in a consecutive series of unselected patients. From June 2008 to October 2009, 257 patients (238 men and 19 women, median age 65 years) were treated in a same-day surgery unit for 270 hernias (244 groin hernias, 25 ventral hernias and one Spiegelian hernia). For groin hernia, the techniques included the totally extraperitoneal repair (TEP) in 108 cases, the transinguinal preperitoneal (TIPP) approach in 106 cases and other alternative techniques in 30 cases; for ventral hernias, the technique was an open suture in 20 cases, an open prosthetic repair in four cases and laparoscopic repair in one case. Anesthesia was general in 145 cases, local in 121 cases and spinal in four cases. Repair was completed in a same-day surgery setting in 242 (89.6%) cases; hospital stay greater than 23 hours was planned for 21 (7.8%) patients while non-programmed hospitalizations were necessary for seven (2.6%) patients. There were two (0.7%) readmissions and nine (3.3%) benign postoperative complications. These results suggest that groin and ventral hernia repair can be performed in an outpatient setting in nearly 90% of unselected patients. Copyright © 2010. Published by Elsevier Masson SAS.

  1. 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 ...

  2. 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.

  3. Sliding inguinal hernia is a risk factor for recurrence

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Bisgaard, Thue; Rosenberg, Jacob

    2015-01-01

    PURPOSE: A sliding inguinal hernia is defined as a hernia where part of the hernial sac wall is formed by an organ, e.g., the colon or bladder. Thus, repair of a sliding inguinal hernia may have higher risk of complications and recurrence compared with non-sliding inguinal hernia. The aim...... of this study was to investigate the incidence and reoperation rates following sliding inguinal hernia repair. METHODS: This study was based on data from the Danish Hernia Database covering the period between January 1, 1998 and February 22, 2012. Data were collected prospectively and nationwide. RESULTS......: In total, 70,091 primary hernia repairs were included for analysis. The occurrence of sliding inguinal hernias of the total group of included hernia repairs was 9.4 % among males and 2.9 % among females (p inguinal hernias had a higher cumulated reoperation rate...

  4. Convalescence after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

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

    2016-01-01

    BACKGROUND: Duration of convalescence after inguinal hernia repair is of major socio-economic interest and an often reported outcome measure. The primary aim was to perform a critical analysis of duration of convalescence from work and activity and secondary to identify risk factors for unexpected...... prolonged convalescence after laparoscopic inguinal hernia repair. METHODS: A qualitative systematic review was conducted. PubMed, Embase and the Cochrane database were searched for trials reporting convalescence after laparoscopic inguinal hernia repair in the period from January 1990 to January 2016...... factors for prolonged convalescence extending more than a few days after laparoscopic inguinal hernia repair. CONCLUSIONS: Patients should be recommended a duration of 1-2 days of convalescence after laparoscopic inguinal hernia repair. Short and non-restrictive recommendations may reduce duration...

  5. 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....

  6. [Umbilical hernia repair in conjunction with abdominoplasty].

    Science.gov (United States)

    Bai, Ming; Dai, Meng-Hua; Huang, Jiu-Zuo; Qi, Zheng; Lin, Chen; Ding, Wen-Yun; Zhao, Ru

    2012-09-01

    To investigate the feasibility and clinical benefits of umbilical hernia repair in conjunction with abdominoplasty. The incision was designed in accord with abdominoplasty. The skin and subcutaneous tissue was dissected toward the costal arch, and then the anterior sheath of rectus abdominus was exposed. After exposure and dissection of the sac of umbilical hernia, tension-free hernioplasty was performed with polypropylene mesh. After dissecting the redundant skin and subcutaneous tissue, the abdominal wall was tightened. Between May 2008 and May 2011, ten patients were treated in the way mentioned above. The repair of umbilical hernia and the correction of abdominal wall laxity were satisfactory. There was no recurrence of umbilical hernia, hematoma, seroma or fat liquefaction. Through careful selection of patients, repair of umbilical hernia and body contouring could be achieved simultaneously.

  7. 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

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

    Science.gov (United States)

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

    2009-12-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

  10. Laparoscopic transabdominal extraperitoneal mesh repair of lumbar hernia

    OpenAIRE

    Nam, Soon Young; Kee, Se Kook; Kim, Jae Oh

    2011-01-01

    Lumbar hernias are rare posterolateral abdominal wall defects that may be congenital or acquired. There are two types of lumbar hernia, the superior lumbar hernia through Grynfeltt triangle, and the inferior lumbar hernia through Petit triangle. Many techniques have been described for the surgical repair of lumbar hernias including primary repair, local tissue flaps, and conventional mesh repair. But these open techniques require a large skin incision. We report a case of superior lumbar hern...

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

    Science.gov (United States)

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

    2014-06-01

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

  12. Association of HOXA10, ZFPM2, and MMP2 genes with scrotal hernias evaluated via biological candidate gene analyses in pigs.

    Science.gov (United States)

    Zhao, Xia; Du, Zhi-Qiang; Vukasinovic, Natascha; Rodriguez, Fernanda; Clutter, Archie C; Rothschild, Max F

    2009-08-01

    To evaluate the associations between 14 biological candidate genes and scrotal hernias in pigs. 1,534 Pietrain-based pigs, including 692 individuals from 298 pig families and 842 male pigs without family information. Pigs were classified as affected or unaffected for scrotal hernias. Single nucleotide polymorphisms of candidate genes were analyzed via PCR assays and genotyped. Statistical analyses were performed on the family-trio and the case-control data. 2 genes involved in collagen metabolism (homeobox A10 [HOXA10] and matrix metalloproteinases 2 [MMP2]) and 1 gene encoding zinc finger protein multitype 2 (ZFPM2, important in the development of diaphragmatic hernia) were significantly associated with hernias. Pigs with these genotypes had high odds of developing scrotal hernias in the case and control groups (2 ZFPM2 variants: odds ratio, 4.3 [95% confidence interval, 2.78 to 6.64] and 4.45[95%confidenceinterval,2.88to6.88]). Anothergene, collagentypeII A 1(COL2A1),was potentially involved in hernia development. HOXA10, ZFPM2, MMP2, and COL2A1 could have important roles in pig hernia development and potentially be useful for marker-assisted selection in the pig industry. Pigs are used for the study of many human diseases because of their physiologic similarities. Genes associated with scrotal hernias in this study may be directly used in understanding the molecular mechanisms underlying this defect in humans.

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

    Science.gov (United States)

    Hirabayashi, Takeshi; Ueno, Shigeru

    2013-07-20

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    INTRODUCTION: Closure of the hernia gap in laparoscopic ventral hernia repair before mesh reinforcement has gained increasing acceptance among surgeons despite creating a tension-based repair. Beneficial effects of this technique have been reported sporadically, but no evidence is available from...... randomised controlled trials. The primary purpose of this paper is to compare early post-operative activity-related pain in patients undergoing laparoscopic ventral hernia repair with closure of the gap with patients undergoing standard laparoscopic ventral hernia repair (non-closure of the gap). Secondary...... 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...

  15. 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

    INTRODUCTION: Closure of the hernia gap in laparoscopic ventral hernia repair before mesh reinforcement has gained increasing acceptance among surgeons despite creating a tension-based repair. Beneficial effects of this technique have been reported sporadically, but no evidence is available from...... randomised controlled trials. The primary purpose of this paper is to compare early post-operative activity-related pain in patients undergoing laparoscopic ventral hernia repair with closure of the gap with patients undergoing standard laparoscopic ventral hernia repair (non-closure of the gap). Secondary...... 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...

  16. Pain and convalescence following laparoscopic ventral hernia repair.

    Science.gov (United States)

    Eriksen, Jens Ravn

    2011-12-01

    observed. No significant difference in strength of ingrowth was found between different fixation methods or mesh types. Furthermore, no significant difference was found in grade or strength of adhesions or any histological parameters. In Study III - a randomised, controlled, double-blinded, multicenter trial - 40 patients with umbilical hernia defects between 1.5-5 cm, were randomly assigned to receive FS or titanium tacks for mesh fixation in LVHR. Patients, care givers and those assessing the outcomes were blinded to group assignment. The primary outcome was average pain from POD 0-2 (VAS score). Secondary outcome parameters were fatigue, general well-being and time to resume normal daily activity. Follow-up was one month for all. Patients in the FS group reported significantly less pain at POD 0-2 (median VAS 38 (range 6-98) vs. 60 (18-96), p = 0.01). Absolute VAS score difference between groups was 20 mm (95% CI 4-35 mm) at activity, and 19 mm (95% CI 3-34 mm) at rest. Patients in the FS group reported significantly less discomfort from POD 0-2 and POD 0-10, compared with the tack group. No significant difference was found in fatigue score between groups. No significant difference in hospital stay, hernia diameter, or morphine consumption in the post anesthesia care unit was found between groups. Patients in the FS group resumed normal daily activity at POD 7 (1-66) versus POD 18 (1-95) in the tack group (p = 0.03). No recurrences were observed. No adverse events or side effects were observed. No significant differences in predefined complications were found between groups. In conclusion, pain is a significant clinical problem after LVHR with impact on general well-being, quality of life and patient satisfaction. This issue must have first priority in future ventral hernia repair research. It is now documented, that the simple application of fibrin glue instead of titanium tacks for mesh fixation in LVHR of defects hernia defects including large incisional hernias, as

  17. Diagnosis and treatment of obturator hernia

    Energy Technology Data Exchange (ETDEWEB)

    Nakayama, Takamori; Kobayashi, Seiji; Shiraishi, Kou; Nishiumi, Takao; Mori, Syunji; Isobe, Kiyoshi; Furuta, Yoshiaki [Shizuoka Red Cross Hospital (Japan)

    2002-09-01

    Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n=7) or an inguinal approach (n=5). The hernial orifice was closed using the uterine fundus (n=6), a patch (n=5), and direct suture (n=1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery. (author)

  18. 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.

  19. Pain after groin hernia repair

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Nielsen, R

    1998-01-01

    -90 years, pain was scored (none, light, moderate or severe) at rest, while coughing and during mobilization, daily for the first postoperative week and after 4 weeks. Pain scores were added together over the first postoperative week. RESULTS: On days 1, 6 and 28, 66, 33 and 11 per cent respectively had...... moderate or severe pain while coughing or mobilizing. Total pain scores were higher while coughing or mobilizing than at rest (P mobilizing (P0... between types of surgery or hernia. CONCLUSION: Pain remained a problem despite the pre-emptive use of opioids, non-steroidal anti-inflammatory drugs and local anaesthesia, irrespective of surgical technique....

  20. 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.

  1. Evaluation of the Rebound Hernia Repair Device for Laparoscopic Hernia Repair

    OpenAIRE

    Torres-Villalobos, Gonzalo; Sorcic, Laura; Ruth, George R.; Andrade, Rafael; Martin-del-Campo, Luis A.; Anderson,J. Kyle

    2010-01-01

    Background: The characteristics of the ideal type of mesh are still being debated. Mesh shrinkage and fixation have been associated with complications. Avoiding shrinkage and fixation would improve hernia recurrence rates and complications. To our knowledge, this is the first study of a device with a self-expanding frame for laparoscopic hernia repair. Methods: Six Rebound Hernia Repair Devices were placed laparoscopically in pigs. This device is a condensed polypropylene, super-thin, lightwe...

  2. Modified Double-Eyelid Blepharoplasty Using the Single-Knot Continuous Buried Non-Incisional Technique

    Directory of Open Access Journals (Sweden)

    Kyung-Chul Moon

    2013-07-01

    Full Text Available Background Buried non-incisional double-eyelid blepharoplasty is a popular aesthetic procedure. Although various modified continuous suture techniques have been used to create a more natural appearance and to reduce downtime, complications such as loosening of the double fold, asymmetry, and foreign body reactions have been observed.Methods This study included 250 patients who underwent double-eyelid blepharoplasty between March 1997 and November 2012 using a modified single-knot continuous buried non-incisional technique. With 4 stab incisions in the upper eyelids, one of two needles loaded with double-armed 7-0 nylon was passed in one direction alternately through the dermis and the conjunctiva, while the other needle was passed subconjunctivally in the opposite direction. Both ends of the sutures were knotted within a lateral stab incision of the upper eyelids and were buried in the orbicularis oculi muscle.Results Most patients displayed satisfactory aesthetic results, and no significant complications occurred. There was no obvious regression of the double fold; however, 3 patients required reoperation to correct loosening of the fold on one side during the follow-up period. One patient presented with the suture knot subcutaneously, and the knot was removed in the clinic.Conclusions The modified single-knot continuous buried non-incisional technique is a simple and less time-consuming method for a durable double fold and provides satisfactory aesthetic results.

  3. 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.

  4. 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

    and guidelines have been approved by the Danish Surgical Society. Diagnosis of groin hernia is based on clinical examination. Ultrasonography, CT or MRI are rarely needed, while herniography is not recommended. In patients with indicative symptoms of hernia, but no detectable hernia, diagnostic laparoscopy may...... 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...

  5. Late presenting Bochdalek hernia with gastric perforation.

    Science.gov (United States)

    Ozkan, Aybars; Bozkurter Cil, Asudan Tugce; Kaya, Murat; Etcioglu, Inci; Okur, Mesut

    2015-01-01

    Late-onset congenital diaphragmatic hernias that give symptoms beyond the neonatal period are rare and are difficult to diagnose. The diagnosis is usually made in case of complications such as intestinal obstruction, strangulation, and perforation, which further necessitate immediate surgical repair. The case of a 5-year-old child presenting with acute respiratory distress with gastric strangulation and perforation secondary to Bochdalek hernia is reported here. Although presentation in the latter ages is less common, congenital diaphragmatic hernia should be included in the differential diagnosis of respiratory distress in children. Symptoms and diagnostic tools should truly be interpreted. Gastrointestinal complications must urgently be recognized, and early surgical intervention must be performed.

  6. Bochdalek hernia in a symptomatic adult.

    Science.gov (United States)

    Herling, Anique; Makhdom, Fahd; Al-Shehri, Abdullah; Mulder, David S

    2014-08-01

    Bochdalek hernias usually present in neonates with respiratory failure, need to be operated early and are associated with a high mortality. We describe an adult patient who came to the emergency department with nonspecific recurrent chest and abdominal pain. A computed tomography scan showed a large posterolateral diaphragmatic defect and an oversized spleen. The hernia was repaired by a thoracoabdominal approach and Gore-Tex patch. Congenital diaphragmatic hernias are rare and are associated with nonspecific symptoms in adults. With suspicious chest or abdominal radiographs, a computed tomography scan is essential to plan an individualized surgical intervention. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Lumbar hernia: a short historical survey.

    Science.gov (United States)

    Cavallaro, Antonino; De Toma, Giorgio; Cavallaro, Giuseppe

    2012-01-01

    Lumbar hernia is a rare form of abdominal hernia, which has been recognized later along the early development of the modern surgery. it has been, on many occasions, the object of heavy debate regarding its anatomical background and as well its etiology. The authors reports the historical aspects of this rare pathology, focusing on the earliest descriptions of hernia arising in lumbar regions, on the first reports of surgical repair, and on the anatomical description of the lumbar weakness areas, that are currently named Petit's triangle and Grynfeltt and Lesshaft's triangle.

  8. OPEN INGUINAL HERNIA REPAIR IN ADULT PATIENTS

    Directory of Open Access Journals (Sweden)

    M. S. Tomin

    2014-06-01

    Full Text Available The review presents the frequency, anatomy, classification, diagnosis, and the most effective open methods of inguinal hernia’s operative therapy in adult patients. These findings are in agreement with the recommendations of the Ukrainian association of surgeons-herniologists and the European European Hernia Society (EHS. The article does not deal with laparoendoscopic options of hernia repair (TAPP and TEP, as they require a separate section in the anatomy of the inguinal region and endoscopic techniques’ volumetric description. Besides, in Ukraine inguinal hernia repair is most frequently performed of open access that causes the topic’s timeliness.

  9. ONSTEP versus laparoscopy for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

    2015-01-01

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

  10. Childhood Morgagni hernia: report of two cases

    Directory of Open Access Journals (Sweden)

    Kamal Nain Rattan

    2017-01-01

    Full Text Available Morgagni diaphragmatic hernia is a rare congenital anomaly to be seen in the pediatric age group. We are reporting two cases of Morgagni hernia, which presented with non-specific symptoms and posed a diagnostic dilemma. One of the patients was 10 years old and associated with asplenia and Down’s syndrome; the second case presented as isolated Morgagni hernia in an 8 month baby. The diagnosis was confirmed with radiography and computed chest tomography. Both cases were managed successfully with surgical repair of the diaphragmatic defect through trans-abdominal approach.

  11. 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...... months does not increase the risk of chronic pain. Udgivelsesdato: 2007-Aug...

  12. 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.

  13. Right congenital pleuro-peritoneal hiatus hernia

    Directory of Open Access Journals (Sweden)

    Sankar DK

    2009-12-01

    Full Text Available Congenital diaphragmatic hernias are of various types which are due to the defect in the diaphragm and can be encountered in any period of life. Left mediastinal shift with right congenital diaphragmatic hernia is rare and life threatening malformation. We describe a case of right congenital diaphragmatic hernia of a newborn male infant, which died shortly after birth. The lobes of the liver were enlarged and occupied whole of the abdominal cavity. The stomach and intestinal loops were herniated into the right pleural cavity and partly into the left pleural cavity. Severe hypoplastic right lung, trilobed left lung and dextrocardia also were observed.

  14. Infants With Bochdalek Diaphragmatic Hernia

    Science.gov (United States)

    Pober, Barbara R.; Lin, Angela; Russell, Meaghan; Ackerman, Kate G.; Chakravorty, Sharmila; Strauss, Bernarda; Westgate, Marie Noel; Wilson, Jay; Donahoe, Patricia K.; Holmes, Lewis B.

    2010-01-01

    Congenital diaphragmatic hernia (CDH) is a common and often devastating birth defect. In order to learn more about possible genetic causes, we reviewed and classified 203 cases of the Bochdalek hernia type identified through the Brigham and Women’s Hospital (BWH) Active Malformation Surveillance Program over a 28-year period. Phenotypically, 55% of the cases had isolated CDH, and 45% had complex CDH defined as CDH in association with additional major malformations or as part of a syndrome. When classified according to likely etiology, 17% had a Recognized Genetic etiology for their CDH, while the remaining 83% had No Apparent Genetic etiology. Detailed analysis using this largest cohort of consecutively collected cases of CDH showed low precurrence among siblings. Additionally, there was no concordance for CDH among five monozygotic twin pairs. These findings, in conjunction with previous reports of de novo dominant mutations in patients with CDH, suggest that new mutations may be an important mechanism responsible for CDH. The twin data also raise the possibility that epigenetic abnormalities contribute to the development of CDH. PMID:16094667

  15. 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

  16. Surgical treatment of chronic groin and testicular pain after laparoscopic and open preperitoneal inguinal hernia repair.

    Science.gov (United States)

    Amid, Parviz K; Chen, David C

    2011-10-01

    Standard triple neurectomy does not address inguinodynia secondary to neuropathy of the genitofemoral nerve and the preperitoneal segment of its genital branch seen after inguinal hernia repair performed laparoscopically or in open preperitoneal fashion. Standard triple neurectomy was extended to include the genitofemoral nerve. Sixteen patients with chronic groin pain after laparoscopic and open preperitoneal inguinal hernia repair underwent operative triple neurectomy, with resection of the main trunk of the genitofemoral nerve in the retroperitoneum over the psoas muscle. All patients had previously undergone unsuccessful extensive nonsurgical pain management. Fourteen of 16 patients had significant improvement of their pain, as evidenced by a decrease in subjectively reported postoperative pain levels as compared with their preoperative baseline, a decrease or complete elimination of daily narcotic dependence, and return to baseline activities of daily living and work. One of the nonresponder patients underwent a previous open prostatectomy, and exposure of the genitofemoral nerve was not possible due to scarring from the prostatectomy. The other nonresponder patient continues to experience subjective pain equivalent to preoperative levels due to the sensation of firmness and incisional pain that arose in the setting of a postoperative wound infection. He does, however, report that his pain is of different character and quality from his preneurectomy pain and is primarily centered around the incision. His follow-up has not been long enough to determine if his symptoms will improve as his incision and scar remodel. Extension of the standard triple neurectomy to include the genitofemoral nerve for treatment of inguinodynia after open and laparoscopic preperitoneal mesh repair is a safe and effective procedure. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-01-01

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

  18. Symptomatic Bochdalek hernia in an adult.

    Science.gov (United States)

    Hamid, Kamran S; Rai, Surjit S; Rodriguez, Joaquin A

    2010-01-01

    Bochdalek hernias are congenital diaphragmatic defects resulting from the failure of posterolateral diaphragmatic foramina to fuse in utero. Symptomatic Bochdalek hernias in adults are infrequent and may lead to gastrointestinal dysfunction or severe pulmonary disease. We describe our experience with this rare entity. A retrospective chart review was performed on a single patient for data collection purposes. The patient is a morbidly obese 53-year-old female who presented with epigastric pain and diffuse abdominal tenderness. Computed tomography scans of the chest and abdomen revealed a small posterior diaphragmatic defect containing gastric fundal diverticulum. Laboratory work and imaging revealed no other findings. Laparoscopic repair of the Bochdalek hernia was done via an abdominal approach and utilized primary closure with an AlloDerm patch apposed to the defect. The patient has had significant clinical improvement and continues to do well at 9 months postoperatively. Laparoscopic repair of symptomatic adult Bochdalek hernias can be performed successfully and may result in significant clinical improvement.

  19. Congenital diaphragmatic hernia in identical twins

    Directory of Open Access Journals (Sweden)

    Mustafa T Gurbaz

    2012-01-01

    Full Text Available Congenital diaphragmatic hernia (CDH, Bochdalek type is rarely seen in both members of identical twins. Herein, we report a 37 weeks′ twins with CDH along with a brief review of the literature. Both the neonates survived.

  20. Laparoscopic transabdominal extraperitoneal repair of lumbar hernia

    Directory of Open Access Journals (Sweden)

    Sharma A

    2005-01-01

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

  1. Lumbar hernia repaired using a new technique.

    Science.gov (United States)

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

    2007-01-01

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

  2. Amyand´s hernia: Case report

    Directory of Open Access Journals (Sweden)

    Edwin Oveimar Muñoz-Ruiz

    2012-09-01

    Full Text Available Objective: To report an unusual case of Amyand’s hernia in an 87 years old men. Methods: We performed the medical register in emergency service and the patient’ surgery in a three level hospital attention in Popayan Colombia. We consulted the available literature in pubmed data base since 1930’s to the present. Results: 87 years old men was received to the emergency service with a history of three days of inguinal pain associated to sensation of inguinal mass without fever and vomiting, was diagnosed intraoperatory as Amyand’s hernia. This disease is a rare disorder and its clinical diagnostic is difficult by its non specific symptoms. CT- Scan (Computerized Axial Tomography is the most sensible method for diagnostic. Conclusion: Amyand’s hernia must be taken into account a possible diagnostic the acute appendicitis with right incarcerated inguinal hernia.

  3. Lichtenstein versus Onstep for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

    2013-01-01

    Inguinal hernia is a common condition that affects millions of people world-wide every year. In Denmark (population of 5.5 million), more than 10,000 repairs of inguinal hernias are performed annually. The optimal surgical procedure for mesh placement and fixation is still being debated because...... of which is to evaluate chronic pain and sexual dysfunction after inguinal hernia repair using the Lichtenstein repair compared with the Onstep approach....... of long-term complications such as persisting pain and impairment of sexual function. The Onstep approach is a newer type of groin hernia repair with promising preliminary results in terms of very few cases of chronic pain and recurrences. This protocol describes a randomised clinical trial the objective...

  4. Inguinal hernia repair: anaesthesia, pain and convalescence

    DEFF Research Database (Denmark)

    Callesen, Torben

    2003-01-01

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

  5. Laparoscopic transabdominal extraperitoneal repair of lumbar hernia

    National Research Council Canada - National Science Library

    Sharma, A; Panse, R; Khullar, R; Soni, V; Baijal, M; Chowbey, P K

    2005-01-01

    ... fixation of the mesh under vision to the underlying fascia. Laparoscopic lumbar hernia repair by this technique is a tensionless repair that diffuses total intra-abdominal pressure on each square inch of implanted mesh...

  6. Hiatal Hernia as a Total Gastrectomy Complication

    National Research Council Canada - National Science Library

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

    2016-01-01

    .... Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy...

  7. Hiatal Hernia After Esophagectomy for Cancer

    NARCIS (Netherlands)

    Brenkman, Hylke J F; Parry, Kevin; Noble, Fergus; van Hillegersberg, Richard; Sharland, Donna; Goense, Lucas; Kelly, Jamie; Byrne, James P; Underwood, Timothy J; Ruurda, Jelle P

    2017-01-01

    BACKGROUND: Hiatal hernia (HH) after esophagectomy is becoming more relevant due to improvements in survival. This study evaluated and compared the occurrence and clinical course of HH after open and minimally invasive esophagectomy (MIE). METHODS: The prospectively recorded characteristics of

  8. Pain characteristics after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  9. Primary ventral or groin hernia in pregnancy

    DEFF Research Database (Denmark)

    Oma, Erling; 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...

  10. 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.

  11. Planned inguinal herniorrhaphy but no hernia sac?

    DEFF Research Database (Denmark)

    Jensen, P; Bay-Nielsen, M; Kehlet, H

    2004-01-01

    Planned inguinal herniorrhaphy may present a clinical dilemma when no hernia is found. No large-scale data are available on the incidence of this problem, and, therefore, no recommendations exist for choice of surgical intervention.......Planned inguinal herniorrhaphy may present a clinical dilemma when no hernia is found. No large-scale data are available on the incidence of this problem, and, therefore, no recommendations exist for choice of surgical intervention....

  12. Complicated cases of Morgagni's hernia and Bochdalek's hernia. With special reference of CT examination

    Energy Technology Data Exchange (ETDEWEB)

    Ono, Seiji; Kakitsubata, Yosuke; Hoshi, Hiroaki; Watanabe, Katsuji; Hayashi, Mami; Shibata, Koichiro; Koga, Yasunori

    1985-04-01

    Usefulness of CT in the diagnosis of diaphragmatic hernia was described. A 63 year-old woman without any complaints was pointed out abnormal shadow on chest X-ray films. CT scan revealed encapsulated fat tissue density masses at the right lower anterior mediastinum and the lower posterior lung field. At surgery, these two masses were diaphragmatic hernia (Morgagni's hernia and Bochdalek's hernia). Hernia contents were omentum and hernia sacs were peritoneum in each portion. It was found that CT clearly demonstrated the extent and nature of this disease.

  13. Nerve degeneration in inguinal hernia specimens.

    Science.gov (United States)

    Amato, G; Ober, E; Romano, G; Salamone, G; Agrusa, A; Gulotta, G; Bussani, R

    2011-02-01

    The histological study of the herniated inguinal area is rare in the literature. This report is focused on the detection of structural changes of the nerves within tissues bordering the inguinal hernia of cadavers. Their physiopathological consequences are hypothesized. Primary inguinal hernia was diagnosed in 30 fresh cadavers. Tissue specimens from the inguinal region close to and around the hernia opening were excised for histological examination. A control of the data was achieved through tissue samples excised from equivalent sites of the inguinal region in 15 cadavers without hernia. The detected nerves in the inguinal area demonstrated pathological changes such as fibrotic degeneration, atrophy, and fatty dystrophy of the axons. The thickening of the perineural sheath was constantly seen. These findings were consistently present, independent of the hernia type. The detected nerve alterations lead us to imagine a worsening, or even the cessation, of the nervous impulse to the muscles, leading to atrophy and weakening of the abdominal wall. This could represent one of the multifactorial causes of hernia genesis.

  14. Umbilical Hernia Repair: Analysis After 934 Procedures.

    Science.gov (United States)

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

    2015-09-01

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

  15. Feasibility and outcome after laparoscopic ventral hernia repair using Proceed mesh

    DEFF Research Database (Denmark)

    Rosenberg, J.; Burcharth, J.

    2008-01-01

    BACKGROUND: There are many different meshes available for laparoscopic repair of ventral hernias. A relatively new product is the Proceed mesh with a bioresorbable layer against the bowels and a polypropylene layer against the abdominal wall. There are, however, no human data available. The aim...

  16. Left Amyand’s hernia: An unexpected finding during inguinal hernia surgery

    Directory of Open Access Journals (Sweden)

    Ahmed M. Al Maksoud

    2015-01-01

    Conclusion: There are less than 20 cases reported in the literature describing left-sided Amyand’s hernia. Awareness of such very unusual condition may help surgeons to be prepared for appropriate management of a very usual procedure as inguinal hernia repair.

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-08-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  20. 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.)

  1. 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.

  2. 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

  3. A large incarcerated Meckel's diverticulum in an inguinal hernia

    Directory of Open Access Journals (Sweden)

    Michael J. Horkoff

    2014-01-01

    CONCLUSION: Littre's hernia, although rare, should be a consideration at the time of repair for any abdominal hernia involving small bowel as resection of the Meckel's diverticulum is critical in avoiding recurrent complications.

  4. 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.

  5. 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.

  6. Combined inguinal hernia in the elderly. Portraying the progression of hernia disease.

    Science.gov (United States)

    Amato, Giuseppe; Agrusa, Antonino; Rodolico, Vito; Puleio, Roberto; Di Buono, Giuseppe; Amodeo, Silvia; Gulotta, Eliana; Romano, Giorgio

    2016-09-01

    Identification of a combined hernia is a common occurrence in the course of inguinal hernia repair. This type of protrusion disease seems to affect the elderly, in particular. Very few investigations have been carried out to ascertain the structural changes that occur in the groin affected by this clinical condition. Analysis of intraoperative findings of combined inguinal hernias evidenced in the elderly, from the most recent 100 groin hernia repair procedures carried out by a single operator, represents the basis of the article. Protrusions that presumably represent the forerunner of this type of hernia were also analyzed: double ipsilateral inguinal hernias composed of a direct and an indirect protrusion. The gross anatomical, as well as histological, modifications occurring during the development of combined protrusions were also evaluated. Combined hernia was the most frequent protrusion in patients over 65 years, accounting for 36% of the total in this patient group. In the same patient cohort, double inguinal hernia further involves 22% of elderly subjects. Macroscopically, progressive disruption of the inguinal back wall and degenerative reabsorption of the inferior epigastric vessels were evidenced. Histologically, inflammatory infiltrate, significant nerve and vascular injuries, along with severe muscle degeneration were recognized. The results seem to confirm that inguinal hernia is an unremitting progressive disease caused by chronic compressive structural damage. Combined hernias represent a frequent clinical condition in the elderly consequent to long-term degenerative damage. Therapy of combined protrusions must consider the impact of visceral vector forces. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  7. 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

    2017-11-13

    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

  8. A "self adhering" prosthesis for hernia repair: experimental study.

    Science.gov (United States)

    Champault, G; Polliand, C; Dufour, F; Ziol, M; Behr, L

    2009-02-01

    Prosthetic reinforcement is now routine in the management of inguinal and incisional hernia, and it significantly reduces the risk of recurrence. After surgery, chronic pain is often attributed to the characteristics of the mesh and to the method of fixation in the wound, with a potential risk of nerve or muscle injuries. To evaluate the properties of a new "self adhering" prosthesis in an experimental animal study. The self adhering prosthesis, a lightweight (40 mg/m(2)) polypropylene mesh coated with a synthetic glue on one side, was implanted laparoscopically in pigs. Removal of the prosthesis was performed at one day, one week and one month post operatively. A macroscopic and microscopic evaluation was performed. The results, using a quantitative score, were compared to those of a control group using the same polypropylene mesh without glue, but fixed by staples. The operative time was significantly lower in the self adhering group: 23 min (15-32) versus 31 min (21-40) (P = 0.01). The average time interval from the introduction of the mesh into the preperitoneal space until the appearance of the first tough adhesion was 3 min (2-4). In the control group, the mesh handling time was 8.3 min (5-14) (P = 0.01). At the time of implantation, the score was at a maximum value in all cases for the self adhering prostheses, especially concerning handling and adhesiveness. Upon removal, this score was noted to be good or very good in 90-100% of the cases. There was a good integration in the muscle confirmed histologically, and there was no shrinkage, no mobilisation and no migration. At one month, the thickness of the fibrosis at the limits of the meshes was significantly higher for the self adhering prostheses (P = 0.02). In this experimental study, the self adhering prosthesis demonstrated its adhesive properties and its ability to be well tolerated, with a good macroscopic and microscopic integration into the abdominal wound. This should allow us to perform a clinical

  9. Asymptomatic Presentation of Bochdalek’s Hernia in an Adult

    OpenAIRE

    Venkatesh, S. P.; Ravi, M. J.; Thrishuli, P. B.; Sharath Chandra, B. J.

    2011-01-01

    Bochdalek hernia, a type of congenital diaphragmatic hernia usually presents in the immediate neonatal period with respiratory distress. Presentation in an adult is rare and asymptomatic. We report one such case of Bochdalek hernia, in a 35 year old male, who presented only with mild chest discomfort on left side. Radiological investigations were suggestive of a huge left side Bochdalek hernia with stomach and intestines in the left thorax. This case emphasizes the rarity of presentation of B...

  10. A Rare Presentation of Maydl’s Hernia

    Directory of Open Access Journals (Sweden)

    Elroy Patrick Weledji

    2014-01-01

    Full Text Available We present a case of an unsual type of obstructed indirect inguinal hernia with impending strangulation. The operative findings revealed a sliding Maydl’s hernia with an ischemic inner ileal loop and an adherent inflamed appendix. This case highlights the importance of intraoperative examination of the intra-abdominal bowel loops proximal to the hernia sac of an incarcerated, obstructed, or strangulated hernia.

  11. Correlation Between Incisional Biopsy Histological Subtype and a Mohs Surgery Specimen for Nonmelanoma Skin Cancer.

    Science.gov (United States)

    Cortés-Peralta, E C; Ocampo-Candiani, J; Vázquez-Martínez, O T; Gutiérrez-Villarreal, I M; Miranda-Maldonado, I; Garza-Rodríguez, V

    Histological diagnosis of a clinically suspected nonmelanoma skin cancer (NMSC) is recommended before treatment. For NMSC, concordance between the histological subtype of the preoperative biopsy and the excision specimen of basal cell carcinoma (BCC) has been reported to range from 10% to 81%. No large study on the concordance between NMSC histology seen in a preoperative biopsy with the following tumour specimen from Mohs micrographic surgery (MMS) has been performed in a Latin American population. The aim of this study was to analyse and compare the histological subtype of the incisional biopsies reviewed by the dermatopathologist with the histological subtype of the tumour specimen obtained during MMS interpreted by the dermatopathologist and the Mohs surgeon. A retrospective analysis of 320 NMSC was performed. The interobserver correlation was based on kappa values. The mean weighted kappa value between the preoperative NMSC biopsy and intraoperative histological subtype of the tumour specimen from MMS analysed by the Mohs surgeon and the dermatopathologist was 0.22 and 0.24, respectively. The correlation in the histologic subtype of the intraoperative tumour specimen from MMS that was interpreted by the dermatopathologist and Mohs surgeon was 0.58. Dermatologists need to be aware of the limited value of incisional biopsies to accurately diagnose the histological subtype of a NMSC. The concordance rate in the histological diagnosis of the tumour specimens that were obtained from MMS between the Mohs surgeon and the dermatopathologist is moderate. However, the correlation is low compared with incisional biopsy subtypes. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Laparoscopic retroperitoneal repair of a right-sided Bochdalek hernia.

    Science.gov (United States)

    Rosen, M J; Ponsky, L; Schilz, R

    2007-04-01

    Bochdalek hernias are rare congenital diaphragmatic defects. We report a case of a 50-year-old male with chronic shortness of breath who was diagnosed with a right-sided Bochdalek hernia. This hernia was repaired using a laparoscopic retroperitoneal approach.

  13. Case of Bochdalek hernia in the elderly: success with laparotomy.

    Science.gov (United States)

    Yamauchi, Hayato; Ojima, Hitoshi; Idetsu, Akihito; Yamaki, Ei; Hosouchi, Yasuo; Nishida, Yasuji; Kuwano, Hiroyuki

    2009-01-01

    Bochdalek hernia is usually diagnosed in pediatric patients and not in the elderly. In adults, there are some cases resulting in misdiagnosis of pneumonia, pleural effusion, congenital bulla, and pneumothorax by chest roentgenogram. We present here a rare case of Bochdalek hernia in an elderly patient who suffered from sudden back pain and had the hernia repaired with laparotomy.

  14. 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.

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

    Science.gov (United States)

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

    2010-02-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  17. 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, ...

  18. 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 ...

  19. A cadaveric massive strangulated left indirect inguinal hernia | Yinka ...

    African Journals Online (AJOL)

    Many forms of inguinal hernias have been found to have different contents ranging from abdominal to pelvic organs. A form of inguinal hernia with its contents made up of almost the whole of the small intestine and having a herniating sac as long as 28cm in length is indeed a rare form of inguinal hernia. Strangulated ...

  20. Femoral hernias in children at the Olabisi Onabanjo University ...

    African Journals Online (AJOL)

    Five patients (71%) were correctly diagnosed preoperatively by the attending surgeon while two were thought to be inguinal hernias. Conclusion: The diagnosis of femoral hernia remains a challenging problem in childhood because of its rarity and similar clinical presentation as inguinal hernia. East African Medical Journal ...

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

    African Journals Online (AJOL)

    Congenital retrosternal diaphragmatic hernia is rare in children. Morgagni hernias account for 1–6% of all surgically corrected diaphragmatic hernias [1,2]. Numer- ous approaches ... abdominal wall through the middle of the posterior edge of the defect using a .... Chest infection with Down's syndrome. Chest radiograph. 50.

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

    African Journals Online (AJOL)

    Introduction and aim Inguinal hernia is one of the most common pediatric diseases in children and it presents most commonly during the first year of life. The aim of this study was to determine epidemiologic indexes and complications of inguinal hernia repair in pediatric patients who underwent inguinal hernia surgery.

  3. Abdominal wall hernias in upper Egypt: A different spectrum ...

    African Journals Online (AJOL)

    Background: Hernia is a very common surgical condition affecting all ages and both sexes. To describe and find the possible differences in the spectrum of abdominal hernias and document trends in their management, we carried out a descriptive study of all patients with abdominal hernias admitted to a single tertiary ...

  4. Unusual presentation of Maydl's hernia | Wamalwa | Annals of ...

    African Journals Online (AJOL)

    Maydl's hernia is an uncommon presentation of inguinal hernia whereby predominantly right sided afferent and efferent loops of bowel herniate into the sac with an intervening intra-abdominal loop of bowel that is prone to strangulation. This could be missed if hernia repair is performed with inguinal approach only.

  5. Case Report: Profile of Paediatric Umbilical Hernias Managed at ...

    African Journals Online (AJOL)

    BACKGROUND: Umbilical hernias are common in children but many resolve spontaneously within the first five years of life .Most umbilical herniorrhaphies in our environment are due to symptomatic hernias which constitute a small percentage of all umbilical hernias. PATIENTS AND METHODS :A retrospective review of all ...

  6. Mesh repair of hernias of the abdominal wall

    NARCIS (Netherlands)

    W.W. Vrijland (Wietske)

    2003-01-01

    textabstractA hernia of the abdominal wall is a permanent or intermittent protrusion of abdominal contents outside the abdominal cavity through a defect in the abdominal wall. Approximately 75% of all hernias occur in the inguinal region. Other types of hernias of the ventral abdominal wall are

  7. International guidelines for groin hernia management.

    Science.gov (United States)

    2018-02-01

    Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. An expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group's first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as "strong" (recommendations) or "weak" (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term "should" refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores. The risk factors for inguinal hernia (IH) include: family history, previous contra

  8. Congenital cranial ventral abdominal hernia, peritoneopericardial diaphragmatic hernia and sternal cleft in a 4-year-old multiparous pregnant queen

    OpenAIRE

    Camille Bismuth; Claire Deroy

    2017-01-01

    Case summary Cranial ventral midline hernias, most often congenital, can be associated with other congenital abnormalities, such as sternal, diaphragmatic or cardiac malformations. A 4-year-old multiparous queen with a substernal hernia was admitted for evaluation of a mammary mass. During CT examination, a bifid sternum, the abdominal hernia containing the intestines, spleen, omentum, three fetuses, a mammary mass and an incidental peritoneopericardial diaphragmatic hernia were identified. S...

  9. Lumbar hernia - a case report and review of the literature; Hernia lombar - relato de um caso e revisao da literatura

    Energy Technology Data Exchange (ETDEWEB)

    D' Ippolito, Giuseppe; Yonamine, Claudia [Escola Paulista de Medicina - Universidade Federal de Sao Paulo, SP (Brazil). Dept. de Diagnostico por Imagem

    1999-09-01

    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)

  10. 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.

  11. Adult right-sided Bochdalek hernia with ileo-cecal appendix: Almeida-Reis hernia.

    Science.gov (United States)

    Costa Almeida, C E; Reis, Luis S; Almeida, Carlos M Costa

    2013-01-01

    Bochdalek hernia is one of the most common congenital abnormalities manifested in infants. In the adult is a rarity, with a prevalence of 0.17-6% of all diaphragmatic hernias. Right-sided Bochdalek hernias containing colon are even more rare, with no case described in the literature with ileo-cecal appendix. The authors present a case of a right-sided Bochdalek hernia in an adult female of 49 years old, presented with severe respiratory failure. During laparotomy for hernia correction, were found in an intrathoracic position the cecum and ileo-cecal appendix, the right colon and the transverse colon. Although useful in patient evaluation, clinical history and physical examination are not helpful in making diagnosis because of their nonspecific character. CT scan is the most accurate exam for making diagnosis. Most of the times there is no hernial sac. Surgery is the treatment of choice, and it is always indicated even if asymptomatic. In general suture of the defect is possible. Due to patient's weak respiratory function we chose laparotomy by Kocher incision. Being the first case of a right-sided Bochdalek hernia in the adult with a herniated ileo-cecal appendix, we name it Almeida-Reis hernia. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  12. Amyand's hernia in the children: a single center experience.

    Science.gov (United States)

    Cankorkmaz, Levent; Ozer, Hatice; Guney, Cengiz; Atalar, Mehmet H; Arslan, Mehmet S; Koyluoglu, Gokhan

    2010-01-01

    The presence of a vermiform appendix in an inguinal hernial sac is termed Amyand's hernia. It may present as a tender inguinal or inguinoscrotal swelling, and it is often misdiagnosed as an incarcerated or strangulated hernia. Between 1998 and 2006, we have managed 564 patients with acute appendicitis, 1,090 patients with inguinal hernia, 33 patients with incarcerated inguinal hernia, and 12 patients with Amyand's hernia on our pediatric surgery service. A retrospective analysis of clinical data of these patients with Amyand's hernia was performed. All patients with Amyand's hernia were boys with a median age of 40 days (range, 15 days-14 months). One patient's condition was diagnosed pre-operatively. All of them, therefore, underwent emergency operation with a presumptive diagnosis of either incarcerated or strangulated inguinal hernia. Operative findings included 2 normal appendices, 6 inflamed appendices, and 4 appendices with external signs of serosal inflamation of uncertain significaince in the inguinal hernial sac. Two patients with a normal appendix had hernia repair without an appendectomy. The other 10 patients with an abnormal appendix underwent an emergency open appendectomy with repair of the inguinal hernia. None of the patients developed recurrent hernia. The median postoperative follow-up period was 2.5 years. In pediatric patients with Amyand's hernia, the inflammatory status of the appendix can be used to determine the type of hernia repair and the operative approach. Incidental appendectomy in the case of a normal appendix is not favored by us. Treatment includes appendectomy (via the hernia sac) and hernia repair in children with an inflamed appendix. Copyright (c) 2010 Mosby, Inc. All rights reserved.

  13. Single-Incision Laparoscopic Repair of Spigelian Hernia

    Science.gov (United States)

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

    2015-01-01

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

  14. External hernia of the supravesical fossa: Rare or simply misidentified?

    Science.gov (United States)

    Amato, G; Romano, G; Erdas, E; Medas, F; Gordini, L; Podda, F; Calò, P

    2017-05-01

    External hernias of the supravesical fossa are considered rare, perhaps wrongly. Highlighting clinical and anatomical features could be useful for correct, preoperative diagnosis, thus avoiding the risk of complications such as incarceration. The study aims to demonstrate that the incidence of external protrusions of the supravesical fossa is higher that supposed. Probably, being mistaken for direct hernias, these hernia types are misidentified and not included in current classifications. This issue deserves attention due to the elevated risk of incarceration related to its distinctive structure. 249 consecutive open anterior inguinal hernia procedures were analyzed. Hernias were categorized according to the Nyhus classification. A subgroup of direct hernias involved true hernias of the supravesical fossa. Multiple ipsilateral, as well as combined hernias having a multi-component structure, were also considered. 13 true hernias of the supravesical fossa and 19 multiple ipsilateral or combined hernias composed of direct and/or indirect hernia, together with one hernia of the supravesical fossa were identified. 4 true hernias of the supravesical fossa presented signs of incarceration. In three other combined protrusions, the herniated component of the supravesical fossa also showed incarceration of the visceral content. Hernias of the supravesical fossa would appear to be more frequent than imagined. These protrusions show a diverticular shape and the base is often tightened by the stiffer medial umbilical fold. This explains the apparently higher tendency to incarceration that distinguishes this hernia type. Preoperative signs of inguinal pain and irreducibility are pathognomonic for correct diagnosis. In these cases, surgical treatment in the short term is recommended. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  15. Adult Bochdalek hernia with bowel incarceration.

    Science.gov (United States)

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

    2008-10-01

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

  16. Adult Bochdalek Hernia with Bowel Incarceration

    Directory of Open Access Journals (Sweden)

    Yeh-Huang Hung

    2008-10-01

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

  17. Grynfelt hernia: case report and literature review.

    Science.gov (United States)

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

    2012-02-01

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

  18. Non-traumatic lateral abdominal wall hernia.

    Science.gov (United States)

    Castillo-Sang, M; Gociman, B; Almaroof, B; Fath, J; Cason, F

    2009-06-01

    A rare lateral abdominal wall hernia is described in an adult patient. This was diagnosed in a patient with a prominent right lateral abdominal wall deformity. The patient had been experiencing pain that increased progressively in severity over time. A computerized tomography (CT) scan of the abdomen revealed the location of the lateral abdominal wall defect. The hernia defect was through the transversus abdominis and the internal oblique, with the inferior aspect of the 11th rib forming part of the superior border of the defect. A 4-cm bony spur from the inferior aspect of the rib formed part of the lateral margin of the defect. The hernia sac was contained within a space underneath the external oblique muscle. The association of the hernia defect with a bony spur was highly suggestive of a congenital etiology. The hernia was successfully repaired laparoscopically with Parietex mesh (Sofradim, Lyons, France), and the patient had resolution of the symptoms on discharge and follow-up visits.

  19. Paraesophageal hernia repair with bifacial mesh

    Science.gov (United States)

    Ungureanu, S; Șipitco, N; Gladun, N; Lepadatu, C

    2016-01-01

    Abstract Background.The paraesophageal hiatus hernias (PHH) are relatively uncommon, but an increased incidence has been reported and they now account for 5–10% of all hiatus hernias. The surgical treatment is recommended for all the patients with this pathology because of high risk of complications: obstruction, incarceration, strangulation or perforation. The use of prostheses is recommended in the process of repairing the giant PHH because the main problem of this operation is the high rate of recurrence. Case presentation.The patient is a 44-year-old male with a large and symptomatic paraesophageal hernia. Diagnosis was confirmed by instrumental examination. An elective laparoscopic repair was carried out by using polypropylene bifacial anti adhesive synthetic mesh (Surgimesh XB Aspide Medical). The postoperative period passed without severe complications. Conclusions.The laparoscopic approach as a therapeutic option can be successfully used in the repair of paraesophageal hernia. A selective use based on clinical experience was recommended, as the technique appeared to be safe, and in case of large hiatus hernia with hiatal defect, greater than 5 cm, the application of synthetic material to minimize the recurrence rate was recommended. PMID:27974917

  20. Diaphragmatic hernia in horse: case report

    Directory of Open Access Journals (Sweden)

    Augusto Jose Savioli de Almeida Sampaio

    2012-12-01

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