Which level is responsible for gluteal pain in lumbar disc hernia?

Science.gov (United States)

Fang, Guofang; Zhou, Jianhe; Liu, Yutan; Sang, Hongxun; Xu, Xiangyang; Ding, Zihai

2016-08-22

There are many different reasons why patients could be experiencing pain in the gluteal area. Previous studies have shown an association between radicular low back pain (LBP) and gluteal pain (GP). Studies locating the specific level responsible for gluteal pain in lumbar disc hernias have rarely been reported. All patients with lumbar disc herniation (LDH) in the Kanghua hospital from 2010 to 2014 were recruited. All patients underwent a lumbar spine MRI to clarify their LDH diagnosis, and patients were allocated to a GP group and a non-GP group. To determine the cause and effect relationship between LDH and GP, all of the patients were subjected to percutaneous endoscopic lumbar discectomy (PELD). A total of 286 cases were included according to the inclusive criteria, with 168 cases in the GP group and 118 cases in the non-GP group. Of these, in the GP group, 159 cases involved the L4/5 level and 9 cases involved the L5/S1 level, while in the non-GP group, 43 cases involved the L4/5 level and 48 cases involved the L5/S1 level. PELD was performed in both groups. Gluteal pain gradually disappeared after surgery in all of the patients. Gluteal pain recrudesced in a patient with recurrent disc herniation (L4/5). As a clinical finding, gluteal pain is related to low lumbar disc hernia. The L4/5 level is the main level responsible for gluteal pain in lumbar disc hernia. No patients with gluteal pain exhibited involvement at the L3/4 level.

CT recognition of lateral lumbar disk herniation

International Nuclear Information System (INIS)

Williams, A.L.; Haughton, V.M.; Daniels, D.L.; Thornton, R.S.

1982-01-01

Although computed tomography (CT) has been shown to be useful in diagnosing posterolateral and central lumbar disk herniations, its effectiveness in demonstrating lateral herniated disks has not been emphasized. The myelographic recognition of those herniations may be difficult because root sheaths or dural sacs may not be deformed. A total of 274 CT scans interpreted as showing lumbar disk herniation was reviewed. Fourteen (5%) showed a lateral disk herniation. The CT features of a lateral herniated disk included: (1) focal protrusion of the disk margin within or lateral to the intervertebral foramen: (2) displacement of epidural fat within the intervertebral foramen; (3) absence of dural sac deformity; and (4) soft-tissue mass within or lateral to the intervertebral foramen. Because it can image the disk margin and free disk fragments irrespective of dural sac or root sheath deformity, CT may be more effective than myelography for demonstrating the presence and extent of lateral disk herniation

Contribution to differential diagnosis of lumbar spine disc hernia by computerized tomography

International Nuclear Information System (INIS)

Dolansky, J.

1989-01-01

The significance is discussed of computerized tomography in differential diagnosis of disc hernias of the lumbar spine. A simple technique is described that allows to differentiate disc hernias from epidural vein varices. It mostly includes repeat imaging of the same body section and/or the application of a contrast medium. (L.O.). 2 figs., 4 refs

Epidurography as a method of topecal diagnosis of hernias of the lumbar intervertebral disks

International Nuclear Information System (INIS)

Margolin, G.A.; Zelentsov, E.V.; Klepikova, I.I.

1986-01-01

Epidurograms of the lumbar spine of 446 patients with discogenic lumbosacral radiculitis were analyzed. In 147 of these patients discal hernians were removed at operation. Epidurography was shown to give an opportunity of specifying the site of discal hernians with relation to cross-section of the vertebral canal. Median hernians were characterized by light shadows of the contrast column in a straight view and by deformity in both of its lateral views. Lateral hernians were characterized by changes in a straight view where there was a niche on the contrast column from the affected side. Deformity of the contrast column in the front epidural space was characteristic for paramedian hernians in the lateral view from the affected side. The determination of the site of discal hernia with relation to the vertebral canal facilitates a choice of surgical tactics

Size of lumbar disc hernias measured using computed tomography and related to sciatic symptoms

Energy Technology Data Exchange (ETDEWEB)

Fagerlund, M.K.J.; Thelander, U.; Friberg, S. (Umeaa Univ. Hospital (Sweden). Dept. of Diagnostic Radiology Umeaa Univ. Hospital (Sweden). Dept. of Orthopedics)

1990-11-01

The change in the relative size of lumbar disc hernias and its relation to sciatic symptoms was investigated in 30 consecutive patients after conservative treatment of CT verified lumbar disc herniations. CT and clinical examination were performed before the start of therapy (CT1), as well as 3 months (CT2) and 24 months (CT3) after institution of treatment. In each patient the size of the lumbar disc herniation in relation to the size of the spinal canal was measured on identical CT slices and expressed as an index. The disc herniation index decreased markedly from CT1 to CT2 (p<0.001). Between CT2 and CT3 the reduction of the hernias was less pronounced and not significant for hernias located centrally but still significant for intermediate (p=0.03) and lateral (p=0.04) hernias. The degree of sciatic symptoms also decreased markedly between CT1 and CT2 (p=0.001) while no further improvement occurred from CT2 to CT3. There was a significant positive correlation between the improvement from sciatic pain and the reduction in the size of the individual hernia (CT1-CT2 p=0.02, CT2-CT3 p<0.001). Thus, the disc herniation index provided a method to study the anatomic effect of conservative treatment as well as a method to evaluate sciatic symptoms in relation to anatomic changes. (orig.).

Size of lumbar disc hernias measured using computed tomography and related to sciatic symptoms

International Nuclear Information System (INIS)

Fagerlund, M.K.J.; Thelander, U.; Friberg, S.; Umeaa Univ. Hospital

1990-01-01

The change in the relative size of lumbar disc hernias and its relation to sciatic symptoms was investigated in 30 consecutive patients after conservative treatment of CT verified lumbar disc herniations. CT and clinical examination were performed before the start of therapy (CT1), as well as 3 months (CT2) and 24 months (CT3) after institution of treatment. In each patient the size of the lumbar disc herniation in relation to the size of the spinal canal was measured on identical CT slices and expressed as an index. The disc herniation index decreased markedly from CT1 to CT2 (p<0.001). Between CT2 and CT3 the reduction of the hernias was less pronounced and not significant for hernias located centrally but still significant for intermediate (p=0.03) and lateral (p=0.04) hernias. The degree of sciatic symptoms also decreased markedly between CT1 and CT2 (p=0.001) while no further improvement occurred from CT2 to CT3. There was a significant positive correlation between the improvement from sciatic pain and the reduction in the size of the individual hernia (CT1-CT2 p=0.02, CT2-CT3 p<0.001). Thus, the disc herniation index provided a method to study the anatomic effect of conservative treatment as well as a method to evaluate sciatic symptoms in relation to anatomic changes. (orig.)

Herniated lumbar intervertebral disk

International Nuclear Information System (INIS)

Hochhauser, L.; Cacayorin, E.D.; Karcnik, T.J.; McGowan, D.P.; Clark, K.G.; Storrs, D.; Kieffer, S.A.

1988-01-01

From a series of 25 patients with low-back pain and sciatica who subsequently underwent surgical exploration, 24 lumbar herniated disks and one asymmetrically bulging disk were correctly diagnosed with use of a 0.5-T MR imaging unit. The radiologic findings on saggital images included a polypoid protrusion beyond the posterior margin of the vertebral bodies more clearly displayed with T1-weighted than with T-2 weighted sequences and a focal extension into the extradural space on axial views. In most, the signal intensity of HNP was isointense to the disk of origin. The study suggests that MR imaging is currently capable of accurately predicting an HNP. The diagnosis is based primarily on morphologic characteristics rather than signal intensity alterations

Effectiveness of the massage tuina and the Williams exercise like therapy in the hernia lumbar discal.

Directory of Open Access Journals (Sweden)

Andrés Alberto Padilla Rubio

2012-06-01

Full Text Available The high incidence of the hernia lumbar discal is known in relatively young people. It was carried out a prospective, longitudinal, explaratory and applicable study in the Provincial Hospital of Rehabilitation Faustino Pérez of Sancti Spiritus, between April of 2007 and September of 2008 with the objective of determining the effectiveness of this therapy in 40 patients that presented lumbar pain secondary to hernia lumbar discal. Twenty sick persons received massage and exercises, while at the twenty remaining were applied massage Tuina, being instructed in a group of postural care. The investigation denoted a bigger frequency of patient among 30 and 39 years and masculine sex that they carried out heavy work or intermediate. Decreased the frequency and intensity of the pain and the restrictions to carry out activities, in the two groups, when evaluating four moments, the very good therapeutic evaluation prevailed (50% followed by the excellent one (32.5%. The massage Tuina is an effective therapy to alleviate pain and to increase activity of the patients with hernia lumbar discal, mainly when it is used alone or associated to Williams exercises, from the last one better results are obtained.

THE INTERVERTEBRAL DISK PROTHESIS INSTALLATION AFTER ABLATION OF A DISK‘S HERNIA AT CERVICAL LEVEL

OpenAIRE

I.A.Norkin; A.A.Chekhonatsky; I.I.Sholomov

2008-01-01

The purpose ofthe present work was to study the possibility of use the artificial disk «PRODISK» at cervical level after ablation of intervertebraldisk’s hernia. The basis of this research is complexexamination and surgical treatment of a 52-years-old-woman with osteochondrosis of cervical spine and with radiculopathy syndrome because of compression of spinal hernia roots of intervertebral disk On May, 29th, 2007 the patientwas operated: «diskectomyC6-C7' disk’s hernia removal, implantat...

Three-dimensional evaluation of lumbar disc hernia and prediction of absorption by enhanced MRI

International Nuclear Information System (INIS)

Kawaji, Youichi; Uchiyama, Seiji; Yagi, Eiichi

2001-01-01

Both the spontaneous shrinkage and the disappearance of disc hernia have been confirmed through the use of computed tomography (CT) and magnetic resonance imaging (MRI). There is, however, no practical method to predict the likely absorption of the herniated mass. The objective of this study was to predict the spontaneous absorption of disc hernia by MRI, and to select the optimum treatment. The study involved 65 patients with lumbar disc hernias. Conservative treatment was carried out in 21 patients, while 44 patients underwent herniotomy. In the nonoperated patients, an MRI was taken both during the painful period, and shortly after pain remission. Hernial shrinkage was evaluated according to the decrease in the calculated volume, in addition to the decrease in hernial area, calculated by MRI. In the operated group, preoperative MRI enhancement, type of hernia, and invasion of granulation tissue in the histological specimens were studied. In the 21 nonoperated patients, the volume (mean ±SD) was 0.488±208 cm 3 (range, 0.197-0.931 cm 3 ) in the painful period and 0.214±0.181 cm 3 (range, 0.0-0.744 cm 3 ) in the remission period. This decrease in volume was statistically significant. There was also a greater decrease in hernias exhibiting positive enhancement by MRI. In the operated patients, hernias that penetrated the posterior longitudinal ligament (PLL) had high rates of preoperative enhancement, and these hernias showed invasion of granulation tissue with marked neovascularization. Positive enhancement by MRI confirms an ongoing absorption process. Enhanced MRI can be a good method for the prediction of spontaneous absorption of lumbar disc hernias. (author)

Three-dimensional evaluation of lumbar disc hernia and prediction of absorption by enhanced MRI

Energy Technology Data Exchange (ETDEWEB)

Kawaji, Youichi; Uchiyama, Seiji [Niigata Univ. (Japan). School of Medicine; Yagi, Eiichi

2001-07-01

Both the spontaneous shrinkage and the disappearance of disc hernia have been confirmed through the use of computed tomography (CT) and magnetic resonance imaging (MRI). There is, however, no practical method to predict the likely absorption of the herniated mass. The objective of this study was to predict the spontaneous absorption of disc hernia by MRI, and to select the optimum treatment. The study involved 65 patients with lumbar disc hernias. Conservative treatment was carried out in 21 patients, while 44 patients underwent herniotomy. In the nonoperated patients, an MRI was taken both during the painful period, and shortly after pain remission. Hernial shrinkage was evaluated according to the decrease in the calculated volume, in addition to the decrease in hernial area, calculated by MRI. In the operated group, preoperative MRI enhancement, type of hernia, and invasion of granulation tissue in the histological specimens were studied. In the 21 nonoperated patients, the volume (mean {+-}SD) was 0.488{+-}208 cm{sup 3} (range, 0.197-0.931 cm{sup 3}) in the painful period and 0.214{+-}0.181 cm{sup 3} (range, 0.0-0.744 cm{sup 3}) in the remission period. This decrease in volume was statistically significant. There was also a greater decrease in hernias exhibiting positive enhancement by MRI. In the operated patients, hernias that penetrated the posterior longitudinal ligament (PLL) had high rates of preoperative enhancement, and these hernias showed invasion of granulation tissue with marked neovascularization. Positive enhancement by MRI confirms an ongoing absorption process. Enhanced MRI can be a good method for the prediction of spontaneous absorption of lumbar disc hernias. (author)

Treatment and outcome of herniated lumbar intervertebral disk in a ...

African Journals Online (AJOL)

The goal of treatment in cases of lumbar disk herniation is to return the patient to .... instability during surgery on the lumbar spine for the treatment of reherniation ... H. H. Failure within one year following subtotal lumbar discectomy. J Bone ...

Compressive Lumbar Disc Hernia Spontaneously Disapeared in a Few Years - Case Report

OpenAIRE

Balasa D.; Ciufu Carmen; Baz R.; Hancu Anca

2016-01-01

We present a patient with left compressive L5-S1 lumbar disc hernia in lateral reces and foramina revealed by high intensity pain (Visual Autologus Scale 7/10) and paresthesias on the left S1 dermatoma for 5 months. He refused surgery and followed conservative treatment with very good results after 6 months. The radicular S1 pain became of a small intensity (Visual Autologus Scale 2-3/10) and intermitent and after one year it completely disapeared. After 4 years he repeated the lumbar magneti...

Age and sex-based distribution of lumbar multifidus muscle atrophy and coexistence of disc hernia: an MRI study of 2028 patients.

Science.gov (United States)

Ekin, Elif Evrim; Kurtul Yıldız, Hülya; Mutlu, Harun

2016-01-01

We aimed to investigate the prevalence of lumbar multifidus muscle (LMM) atrophy in patients having mechanical low back pain with and without disc hernia. In total, 2028 lumbar magnetic resonance imaging scans of low back pain patients (age range, 18-88 years) were re-evaluated retrospectively. LMM atrophy was visually assessed in axial sections of L4-L5 and L5-S1 levels. LMM atrophy prevalence at both levels was significantly higher in subjects ≥40 years compared with younger adults (P hernia, LMM atrophy was significantly more frequent than normal muscle (n=559 vs. n=392; P disc hernia was 13%. Hernia was more frequent in patients with LMM atrophy compared with patients without atrophy (P disc hernia is found more frequently in individuals with LMM atrophy.

A Diagnostic Algorithm for Eosinophilic Granulomatosis with Polyangiitis Initially Diagnosed as Lumbar Disc Hernia or Lumbar Spinal Stenosis: Personal Experience and Review of the Literature.

Science.gov (United States)

Nagata, Kosei; Yamamoto, Shinichi; Miyoshi, Kota; Sato, Masaki; Arino, Yusuke; Mikami, Yoji

2016-08-01

Eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) is a rare systemic vasculitis and is difficult to diagnose. EGPA has a number of symptoms including peripheral dysesthesia caused by mononeuropathy multiplex, which is similar to radiculopathy due to lumbar disc hernia or lumbar spinal stenosis. Therefore, EGPA patients with mononeuropathy multiplex often visit orthopedic clinics, but orthopedic doctors and spine neurosurgeons have limited experience in diagnosing EGPA because of its rarity. We report a consecutive series of patients who were initially diagnosed as having lumbar disc hernia or lumbar spinal stenosis by at least 2 medical institutions from March 2006 to April 2013 but whose final diagnosis was EGPA. All patients had past histories of asthma or eosinophilic pneumonia, and four out of five had peripheral edema. Laboratory data showed abnormally increased eosinophil counts, and nerve conduction studies of all patients revealed axonal damage patterns. All patients recovered from paralysis to a functional level after high-dose steroid treatment. We shortened the duration of diagnosis from 49 days to one day by adopting a diagnostic algorithm after experiencing the first case.

Delayed vertebral diagnosed L4 pincer vertebral fracture, L2-L3 ruptured vertebral lumbar disc hernia, L5 vertebral wedge fracture - Case report

Directory of Open Access Journals (Sweden)

Balasa D

2016-08-01

Full Text Available An association between delayed ruptured lumbar disc hernia, L5 vertebral wedge fracture and posttraumaticL4 pincer vertebral fracture (A2.3-AO clasification at different levels is a very rare entity. We present the case of a 55 years old male who falled down from a bicycle. 2 months later because of intense and permanent vertebral lumbar and radicular L2 and L3 pain (Visual Scal Autologus of Pain7-8/10 the patient came to the hospital. He was diagnosed with pincer vertebral L4 fracture (A2.3-AO clasification and L2-L3 right ruptured lumbar disc hernia in lateral reces. The patient was operated (L2-L3 right fenestration, and resection of lumbar disc hernia, bilateral stabilisation, L3-L4-L5 with titan screws and postero-lateral bone graft L4 bilateral harvested from iliac crest.

Preoperative dexamethasone reduces acute but not sustained pain after lumbar disk surgery

DEFF Research Database (Denmark)

Nielsen, Rikke V; Siegel, Hanna; Fomsgaard, Jonna S

2015-01-01

on acute and sustained pain after lumbar disk surgery. In this blinded study, 160 patients undergoing lumbar disk surgery were randomly assigned to 16 mg IV dexamethasone or placebo. All patients received perioperative paracetamol and ibuprofen, and postoperative IV patient-controlled analgesia...... months postoperatively. Acute pain during mobilization (weighted average area under the curve, 2-24 hours) was significantly reduced in the dexamethasone group: 33 (22) mm vs placebo 43 (18) mm, (95% confidence interval [CI] 3-16) P = 0.005. Vomiting 0 to 24 hours postoperatively was reduced....../paralysis of the legs in the dexamethasone and placebo groups, respectively, 3 months postoperatively (P = 0.20). In conclusion, preoperative dexamethasone significantly reduced pain during mobilization and vomiting, after lumbar disk surgery. No significant effects were observed 3 months postoperatively....

THE INTERVERTEBRAL DISK PROTHESIS INSTALLATION AFTER ABLATION OF A DISK‘S HERNIA AT CERVICAL LEVEL

Directory of Open Access Journals (Sweden)

I.A.Norkin

2008-12-01

Full Text Available The purpose ofthe present work was to study the possibility of use the artificial disk «PRODISK» at cervical level after ablation of intervertebraldisk’s hernia. The basis of this research is complexexamination and surgical treatment of a 52-years-old-woman with osteochondrosis of cervical spine and with radiculopathy syndrome because of compression of spinal hernia roots of intervertebral disk On May, 29th, 2007 the patientwas operated: «diskectomyC6-C7' disk’s hernia removal, implantation of an artificial disk« PRODISK»at the level C6- C7». The patient became active on the third day after the operation, and she was discharged in eight days. Her neurologic symptoms regressed completely. Range of cervical motions was in the normal condition (flexia/anteflexia-35 °-40 °. The pain syndrome was arrested (VAS-2, VRS-1. We consider that any operation causes disorder of structural and functional properties and requires prosthetics of intervertebral disk’s, which can fully reconstruct biomechanical qualities of the operated segment

Percutaneous automated diskectomy in the treatment of herniated lumbar disks

International Nuclear Information System (INIS)

Onik, G.; Mooney, V.; Wiltse, L.

1987-01-01

Described is a new automated lumbar disk aspiration technique in which a 2-mm suction cutting probe is used. The procedure allows rapid and safe removal of disk material percutaneously. The presentation describes the technique and the preliminary results of a cooperative study. The procedure is performed under local anesthesia and the aspiration probe is placed into the disk under fluoroscopic guidance and using a posterrolateral approach. One hundred twenty patients have met the study criteria, undergone the procedure, and had at least a 6-week follow-up. Of these, 74% have achieved good to excellent results, based on physician and patient satisfaction and three other criteria. Of 93 patients for whom 6-mont follow-up is available, 71% have achieved good to excellent results. No complications have been reported. The preliminary results indicate that percutaneous automated diskectomy is a low morbidity procedure that can be done on an outpatient basis and be used successfully to treat uncomplicated herniated lumbar disks

Aggressive discectomy for single level lumbar disk herniation

Directory of Open Access Journals (Sweden)

Md. Kamrul Ahsan

2017-09-01

Full Text Available Aggressive open lumbar discectomy is the most commonly performed surgical procedure for patients with persistent low back and leg pain. In this retrospective study,  1,380 patients were evaluated for long-term results of aggressive discectomy for the single level lumbar disk herniation. Demographic data, surgical data, complications and reherniation rate were collected and clinical outcomes were assessed using visual analogue score (VAS, Oswestry disability index (ODI and modified Mcnab criteria. The mean follow-up period was 28.8 months. According to the modified Mcnab criteria, the long-term results were excellent in 640 cases, good in 445 cases, fair in 255 cases, and poor in 40 cases. The mean VAS scores for back and radicular pains and ODI at the end of 2 years were 1.1 ± 1.0, 1.5 ± 0.5 and 6.6 ± 3.1% respectively. The complications were foot drop (n=7, dural tear (n=14, superficial wound infection (n=17, discitis (n=37 and reherniation (n=64. The dural tear and superficial wound infections resolved after treatment but 28 discitis patients were treated by conservatively and the remaining 9 underwent surgery. Among reherniation patients, 58 underwent revision discectomy and 4 underwent transforaminal lumbar interbody fusion and stabilization. Aggressive discectomy is an effective treatment of lumbar disk herniation and maintains a lower incidence of reherniation but leads to a collapse of disc height and in long run gives rise to intervertebral instability and accelerates spondylosis.

Low level laser therapy for patients with cervical disk hernia.

Science.gov (United States)

Takahashi, Hiroshi; Okuni, Ikuko; Ushigome, Nobuyuki; Harada, Takashi; Tsuruoka, Hiroshi; Ohshiro, Toshio; Sekiguchi, Masayuki; Musya, Yoshiro

2012-09-30

In previous studies we have reported the benefits of low level laser therapy (LLLT) for chronic shoulder joint pain, elbow, hand and finger pain, and low back pain. The present study is a report on the effects of LLLT for chronic neck pain. Over a 3 year period, 26 rehabilitation department outpatients with chronic neck pain, diagnosed as being caused by cervical disk hernia, underwent treatment applied to the painful area with a 1000 mW semi-conductor laser device delivering at 830 nm in continuous wave, 20.1 J/cm(2)/point, and three shots were given per session (1 treatment) with twice a week for 4 weeks. 1. A visual analogue scale (VAS) was used to determine the effects of LLLT for chronic pain and after the end of the treatment regimen a significant improvement was observed (pcervical spine range of motion were observed. 3. Discussions with the patients revealed that in order to receive continued benefits from treatment, it was important for them to be taught how to avoid postures that would cause them neck pain in everyday life. The present study demonstrates that LLLT was an effective form of treatment for neck and back pain caused by cervical disk hernia, reinforced by postural training.

Epidural phlebography - Its diagnostic value in the evaluation of lumbar discal hernia when compared with radiculography

International Nuclear Information System (INIS)

Santos, M.B. dos

1987-01-01

The objective of this study was to compare two neuroradiological methods used in the diagnosis of lumbar discal hernia-radiculography and epidural phlebography - as the result of the evaluation of 36 patients submitted to both procedures at the X-ray Diagnostic Service of the University Hospital of the University of Rio de Janeiro. The results of both examinations to which all the patients were submitted, were compared with the surgical reports (laminectomy) to which some of the patients were submitted. In this way it was possible to determine the sensitivity and the specificity of both methods. From these comparative study it could be verified that the procedures evaluated have a similar potentiality for the diagnosis of discal hernia. The analysis of other aspects of the two procedures showed that phlebography is more expensive, more difficult to interpret and to perform than radiculography. In terms of complications or side effects that may occur during or after the exams these can be more severe and may happen more oftern in the case of radiculography. In conclusion, we recommend radiculography as the method of choice for initial evaluation of a patient suspect of discal hernia. Phlebography should only be initially used for the evaluation of patients who refuse to submit themselves to lumbar puncture for the radiculography. In those patients where discal hernia is strongly suspected and the radiculography proves to be normal, the epidural radiculography could be used, without greater chances, however, of supplying more information that could benefit the patien in clarifying this clinical condition. (Author) [pt

Diffusion-weighted magnetic resonance imaging of symptomatic nerve root of patients with lumbar disk herniation

Energy Technology Data Exchange (ETDEWEB)

Eguchi, Yawara; Ohtori, Seiji; Yamashita, Masaomi; Yamauchi, Kazuyo; Suzuki, Munetaka; Orita, Sumihisa; Kamoda, Hiroto; Arai, Gen; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Ochiai, Nobuyasu; Kishida, Shunji; Inoue, Gen; Takahashi, Kazuhisa [Chiba University, Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba (Japan); Masuda, Yoshitada; Ochi, Shigehiro; Kikawa, Takashi [Chiba University Hospital, Department of Radiology, Chiba (Japan); Toyone, Tomoaki [Teikyo University Chiba Medical Center, Department of Orthopaedic Surgery, Chiba (Japan); Takaso, Masashi [Kitasato University, Department of Orthopaedic Surgery, School of Medicine, Sagamihara City, Kanagawa (Japan); Aoki, Yasuchika [Chiba Rosai Hospital, Department of Orthopedic Surgery, Ichihara, Chiba (Japan)

2011-09-15

Diffusion-weighted imaging (DWI) can provide valuable structural information that may be useful for evaluating pathological changes of the lumbar nerve root. Diffusion-weighted magnetic resonance (MR) neurography has recently been introduced as an alternative way to visualize nerves, but to date, quantitative DWI and MR neurography have not been applied to evaluate the pathology of lumbar nerve roots. Our purpose was to visualize lumbar nerve roots and to analyze their morphology by MR neurography, and to measure the apparent diffusion coefficient (ADC) of lumbar nerve roots compressed by herniated disks using 1.5-T MR imaging. Ten consecutive patients (median age, 48.0 and range, 20-72 years) with monoradicular symptoms caused by a lumbar herniated disk and 14 healthy volunteers were studied. Regions of interests were placed on the lumbar roots at dorsal root ganglia (DRG) and distal spinal nerves on DWI to quantify mean ADC values. The spinal nerve roots were also visualized by MR neurography. In the patients, mean ADC values were significantly greater in the compressed DRG and distal spinal nerves than in intact nerves. MR neurography also showed abnormalities such as nerve swelling at and below the compression in the symptomatic nerve root. Increased ADC values were considered to be because of edema and Wallerian degeneration of compressed nerve roots. DWI is a potential tool for analysis of the pathophysiology of lumbar nerve roots compressed by herniated disks. (orig.)

Diffusion-weighted magnetic resonance imaging of symptomatic nerve root of patients with lumbar disk herniation

International Nuclear Information System (INIS)

Eguchi, Yawara; Ohtori, Seiji; Yamashita, Masaomi; Yamauchi, Kazuyo; Suzuki, Munetaka; Orita, Sumihisa; Kamoda, Hiroto; Arai, Gen; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Ochiai, Nobuyasu; Kishida, Shunji; Inoue, Gen; Takahashi, Kazuhisa; Masuda, Yoshitada; Ochi, Shigehiro; Kikawa, Takashi; Toyone, Tomoaki; Takaso, Masashi; Aoki, Yasuchika

2011-01-01

Diffusion-weighted imaging (DWI) can provide valuable structural information that may be useful for evaluating pathological changes of the lumbar nerve root. Diffusion-weighted magnetic resonance (MR) neurography has recently been introduced as an alternative way to visualize nerves, but to date, quantitative DWI and MR neurography have not been applied to evaluate the pathology of lumbar nerve roots. Our purpose was to visualize lumbar nerve roots and to analyze their morphology by MR neurography, and to measure the apparent diffusion coefficient (ADC) of lumbar nerve roots compressed by herniated disks using 1.5-T MR imaging. Ten consecutive patients (median age, 48.0 and range, 20-72 years) with monoradicular symptoms caused by a lumbar herniated disk and 14 healthy volunteers were studied. Regions of interests were placed on the lumbar roots at dorsal root ganglia (DRG) and distal spinal nerves on DWI to quantify mean ADC values. The spinal nerve roots were also visualized by MR neurography. In the patients, mean ADC values were significantly greater in the compressed DRG and distal spinal nerves than in intact nerves. MR neurography also showed abnormalities such as nerve swelling at and below the compression in the symptomatic nerve root. Increased ADC values were considered to be because of edema and Wallerian degeneration of compressed nerve roots. DWI is a potential tool for analysis of the pathophysiology of lumbar nerve roots compressed by herniated disks. (orig.)

Efficacy of intravenous paracetamol and dexketoprofen on postoperative pain and morphine consumption after a lumbar disk surgery.

Science.gov (United States)

Tunali, Yusuf; Akçil, Eren F; Dilmen, Ozlem Korkmaz; Tutuncu, Ayse C; Koksal, Guniz Meyanci; Akbas, Sedat; Vehid, Hayriye; Yentur, Ercument

2013-04-01

We compared the analgesic effects of intravenous (IV) paracetamol with that of dexketoprofen on postoperative pain and morphine consumption during the first 24 hour after a lumbar disk surgery. This prospective, placebo-controlled, double blind study investigated the analgesic effects of IV paracetamol and dexketoprofen on postoperative pain, morphine consumption, and morphine-related side effects after a lumbar disk surgery. Sixty American Society of Anesthesiologists 1 or 2 status patients scheduled for elective lumbar disk surgery under general anesthesia were included in the study. Patients were treated using patient-controlled analgesia with morphine for 24 hours after a lumbar disk surgery and randomized to receive IV paracetamol 1 g, dexketoprofen 50 mg, or isotonic saline (placebo). The primary endpoint was pain intensity measured by the visual analogue scale, and secondary endpoints were morphine consumption and related side effects. Pain intensity was lower in the dexketoprofen group (P=0.01) but not in the paracetamol group (P=0.21) when compared with the control group. Cumulative morphine consumption and morphine-related side effects did not reveal significant differences between the groups. The study showed that pain intensity during 24 hours after the lumbar disk surgery was significantly lowered by dexketoprofen, but not with paracetamol, as a supplemental analgesic to morphine patient-controlled analgesia when compared with controls.

A very simple technique to repair Grynfeltt-Lesshaft hernia.

Science.gov (United States)

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

2010-08-01

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

Operated herniated disk and lumbar spinal stenosis in Togolese ...

African Journals Online (AJOL)

Objective: To determine the anatomical aspects and results of surgical treatment of herniated disk and lumbar spinal stenosis observed in the Rheumatology unit of CHU SO of Lomé. Patients and methods: This was a transversal study conducted on a series of patients cases admitted to the Rheumatology Unit of CHU SO of ...

The dose-response relationship between cumulative lifting load and lumbar disk degeneration based on magnetic resonance imaging findings.

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Hung, Yu-Ju; Shih, Tiffany T-F; Chen, Bang-Bin; Hwang, Yaw-Huei; Ma, Li-Ping; Huang, Wen-Chuan; Liou, Saou-Hsing; Ho, Ing-Kang; Guo, Yue L

2014-11-01

Lumbar disk degeneration (LDD) has been related to heavy physical loading. However, the quantification of the exposure has been controversial, and the dose-response relationship with the LDD has not been established. The purpose of this study was to investigate the dose-response relationship between lifetime cumulative lifting load and LDD. This was a cross-sectional study. Every participant received assessments with a questionnaire, magnetic resonance imaging (MRI) of the lumbar spine, and estimation of lumbar disk compression load. The MRI assessments included assessment of disk dehydration, annulus tear, disk height narrowing, bulging, protrusion, extrusion, sequestration, degenerative and spondylolytic spondylolisthesis, foramina narrowing, and nerve root compression on each lumbar disk level. The compression load was predicted using a biomechanical software system. A total of 553 participants were recruited in this study and categorized into tertiles by cumulative lifting load (ie, lifting load. The best dose-response relationships were found at the L5-S1 disk level, in which high cumulative lifting load was associated with elevated odds ratios of 2.5 (95% confidence interval [95% CI]=1.5, 4.1) for dehydration and 4.1 (95% CI=1.9, 10.1) for disk height narrowing compared with low lifting load. Participants exposed to intermediate lifting load had an increased odds ratio of 2.1 (95% CI=1.3, 3.3) for bulging compared with low lifting load. The tests for trend were significant. There is no "gold standard" assessment tool for measuring the lumbar compression load. The results suggest a dose-response relationship between cumulative lifting load and LDD. © 2014 American Physical Therapy Association.

Angiogenesis in the degeneration of the lumbar intervertebral disc

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David, Gh; Ciurea, AV; Iencean, SM; Mohan, A

2010-01-01

The goal of the study is to show the histological and biochemical changes that indicate the angiogenesis of the intervertebral disc in lumbar intervertebral disc hernia and the existence of epidemiological correlations between these changes and the risk factors of lumbar intervertebral disc hernia, as well as the patient's quality of life (QOL). We have studied 50 patients aged between 18 and 73 years old, who have undergone lumbar intervertebral disc hernia surgery, making fibroblast growth ...

Nucleoplasty for treating lumbar disk degenerative low back pain: an outcome prediction analysis

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Liliang PC

2016-10-01

Full Text Available Po-Chou Liliang,1 Kang Lu,1 Cheng-Loong Liang,1 Ya-Wen Chen,2,3 Yu-Duan Tsai,1 Yuan-Kun Tu4 1Department of Neurosurgery, E-Da Hospital, 2Department of Nursing, I-Shou University, 3School of Nursing, Kaohsiung Medical University, 4Department of Orthopedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan Purpose: Nucleoplasty is a minimally invasive technique that is considered efficacious in alleviating lumbar disk degenerative low back pain (LBP. The efficacy of nucleoplasty and identified variables that can predict pain relief for nucleoplasty was reported. Patients and methods: Between December 2013 and November 2015, 47 nucleoplasty procedures on 47 lumbar disks in 31 consecutive patients were performed. The outcome was evaluated using a visual analog scale (VAS score. Improvements of ≥50% in VAS scores were considered substantial pain relief. The variables associated with pain relief after nucleoplasty included: 1 age; 2 sex; 3 body mass index; 4 hyperintensity zone at the rear of the disk; 5 hypointensity of the disk; 6 Modic changes of the end plates; 7 spinal instability pain; and 8 discography results. Results: Twenty-one patients (67.7% experienced substantial pain relief. The most common side effects following nucleoplasty were soreness at the needle puncture site (64.5%, numbness in the lower leg (12.9%, and increased intensity of back pain (9.7%. All side effects were transient. Multivariate analysis revealed that the discography results were the most critical predictor for substantial pain relief of nucleoplasty (P=0.03. The sensitivity and specificity of discography were 92.8% and 62.5%, respectively. Conclusion: Discography results could improve the success rate of nucleoplasty in the treatment of disk degenerative LBP. Keywords: low back pain, lumbar disk degenerative, nucleoplasty, discography 

Clinical characterization of thoracolumbar and lumbar intervertebral disk extrusions in English Cocker Spaniels.

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Cardy, Thomas J A; Tzounos, Caitlin E; Volk, Holger A; De Decker, Steven

2016-02-15

To assess the anatomic distribution of thoracolumbar and lumbar intervertebral disk extrusions (IVDEs) in English Cocker Spaniels as compared with findings in Dachshunds and to characterize clinical findings in English Cocker Spaniels with thoracolumbar or lumbar IVDEs affecting various regions of the vertebral column. Retrospective observational study. 81 English Cocker Spaniels and 81 Dachshunds with IVDEs. Signalment, clinical signs, neurologic examination findings, and affected intervertebral disk spaces (IVDSs) were recorded for both breeds. Management methods and outcomes were recorded for English Cocker Spaniels. Lesions were categorized as thoracolumbar (IVDSs T9-10 through L1-2), midlumbar (L2-3 through L4-5), or caudal lumbar (L5-6 through L7-S1). Midlumbar and caudal lumbar IVDEs were significantly more common in English Cocker Spaniels than in Dachshunds. English Cocker Spaniels with caudal lumbar IVDEs had a longer median duration of clinical signs before evaluation and more commonly had unilateral pelvic limb lameness or spinal hyperesthesia as the predominant clinical sign than did those with IVDEs at other sites. Those with caudal lumbar IVDEs less commonly had neurologic deficits and had a higher median neurologic grade (indicating lesser severity), shorter mean postoperative hospitalization time, and faster mean time to ambulation after surgery than those with other sites affected. These variables did not differ between English Cocker Spaniels with thoracolumbar and midlumbar IVDEs. Caudal and midlumbar IVDEs were more common in English Cocker Spaniels than in Dachshunds. English Cocker Spaniels with caudal lumbar IVDE had clinical signs and posttreatment responses that differed from those in dogs with midlumbar or thoracolumbar IVDE.

Imaging of lumbar degenerative disk disease: history and current state

International Nuclear Information System (INIS)

Emch, Todd M.; Modic, Michael T.

2011-01-01

One of the most common indications for performing magnetic resonance (MR) imaging of the lumbar spine is the symptom complex thought to originate as a result of degenerative disk disease. MR imaging, which has emerged as perhaps the modality of choice for imaging degenerative disk disease, can readily demonstrate disk pathology, degenerative endplate changes, facet and ligamentous hypertrophic changes, and the sequelae of instability. Its role in terms of predicting natural history of low back pain, identifying causality, or offering prognostic information is unclear. As available modalities for imaging the spine have progressed from radiography, myelography, and computed tomography to MR imaging, there have also been advances in spine surgery for degenerative disk disease. These advances are described in a temporal context for historical purposes with a focus on MR imaging's history and current state. (orig.)

Application of a semiautomatic classifier for modic and disk hernia changes in magnetic resonance

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Eduardo López Arce Vivas

2015-03-01

Full Text Available OBJECTIVE: Early detection of degenerative changes in lumbar intervertebral disc by magnetic resonance imaging in a semiautomatic classifier for prevention of degenerative disease. METHOD: MRIs were selected with a diagnosis of degenerative disc disease or back pain from January to May 2014, with a sample of 23 patients and a total of 170 disks evaluated by sagittal T2 MRI image, first evaluated by a specialist physician in training and them were introduced into the software, being the results compared. RESULTS: One hundred and fifteen discs were evaluated by a programmed semiautomatic classifier to identify MODIC changes and hernia, which produced results "normal or MODIC" and "normal or abnormal", respectively. With a total of 230 readings, of which 141 were correct, 84 were reading errors and 10 readings were undiagnosed, the semiautomatic classifier is a useful tool for early diagnosis or established disease and is easy to apply because of the speed and ease of use; however, at this early stage of development, software is inferior to clinical observations and the results were from around 65% to 60% certainty for MODIC rating and 61% to 58% for disc herniation, compared with clinical evaluations. CONCLUSION: The comparative results between the two doctors were 94 consistent results and only 21 errors, which represents 81% certainty.

Hernia of intervertebral disk in the lumbar vertebral column

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Beyer, H.K.; Uhlenbrock, D.; Steiner, G.

1986-02-01

Degenerations of the spinal disc especially in the lumbar region are the most frequent degenerative diseases in orthopedics. As diagnostic proceedings to discover disc herniation myelography and computerized tomography have been proven to be very useful. Each of those methods show a high sensitivity and accuracy. Computerized tomography seems to be the first procedure because of the lac of any risk. Myelography has been reserved for the second approach, if there is any doubt in diagnosis. This paper will especially discuss advantages and disadvantages of MRI-tomography for the diagnosis of disc herniation. In MRI-tomography we have no radiation, there is no risk for the patient and we have the possibility of slices in different orientations with the sagittal orientation having priority in diagnosis of disc herniation. A more pronounced contrast in MRI relatively to the computerized tomography with nearly the same spatial resolution is an other important fact in favour for MRI. The value of MRI diagnosis of the spine depends however mainly on the use of special surface coils and on the use of high magnetic fields which provides a good signal to noise relation and which would permit us to use a thin-slice technique. The main disadvantage by now are the relative high costs.

Hernia of intervertebral disk in the lumbar vertebral column

International Nuclear Information System (INIS)

Beyer, H.K.; Uhlenbrock, D.; Steiner, G.

1986-01-01

Degenerations of the spinal disc especially in the lumbar region are the most frequent degenerative diseases in orthopedics. As diagnostic proceedings to discover disc herniation myelography and computerized tomography have been proven to be very useful. Each of those methods show a high sensitivity and accuracy. Computerized tomography seems to be the first procedure because of the lac of any risk. Myelography has been reserved for the second approach, if there is any doubt in diagnosis. This paper will especially discuss advantages and disadvantages of MRI-tomography for the diagnosis of disc herniation. In MRI-tomography we have no radiation, there is no risk for the patient and we have the possibility of slices in different orientations with the sagittal orientation having priority in diagnosis of disc herniation. A more pronounced contrast in MRI relatively to the computerized tomography with nearly the same spatial resolution is an other important fact in favour for MRI. The value of MRI diagnosis of the spine depends however mainly on the use of special surface coils and on the use of high magnetic fields which provides a good signal to noise relation and which would permit us to use a thin-slice technique. The main disadvantage by now are the relative high costs. (orig.) [de

Factores de riesgo para la recurrencia de hernia de disco lumbar Fatores de risco de recorrência de hérnia de disco lombar Risk factors for recurrent lumbar disc herniation

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Angel Rodríguez Segura

2012-06-01

Full Text Available OBJETIVO: La recurrencia de hernia del disco lumbar es un padecimiento que implica algunas dificultades en relación con el diagnóstico y tratamiento. Es importante tratar de identificar los factores que puedan influir en la presentación de la recurrencia. MÉTODOS: Se revisaron los casos de pacientes operados por hernia de disco lumbar recurrente entre los años de 2006 y 2008, buscando identificar los factores que tuvieran relación con dicha patología, y también se revisaron los casos de pacientes operados por hernia de disco lumbar en forma primaria. RESULTADOS: Se analizaron los casos de 20 pacientes con hernia discal lumbar recurrente y de 27 con hernia discal lumbar operados en forma primaria. Para los pacientes con recurrencia, se encontró que el 95% de ellos presentaban algún grado de obesidad, determinado por la Fórmula de Quetelet basada en el Índice de Masa Corporal; se observó también que el 75% de los casos tenían protrusión, con resultados excelentes en 35%, y buenos en 55%, el 10% presentó molestias residuales de forma grave. Para los pacientes con hernia primaria se estudiaron 27 casos, en los que se observó que el 92% de ellos se operaron antes de los 6 meses de iniciado el cuadro, 38% tuvieron resultados excelentes, 40% buenos y el 19% malos resultados. Al estudiar las variables, con el índice de Pearson, se encontró relación de la recurrencia con tabaquismo, trabajo, diabetes e hipertensión, y nivel de estudios, no con la obesidad. CONCLUSIONES: es destacable que dos de los factores relacionados son susceptibles de modificación antes del evento quirúrgico o posteriormente a este, lo cual puede beneficiar el desenlace del mismo.OBJETIVO: A hérnia de disco envolve algumas dificuldades com relação ao diagnóstico e tratamento. É importante identificar os fatores que podem influenciar a recorrência. MÉTODOS: Foram analisados casos de pacientes operados de hérnia de disco lombar recidivante entre 2006 e

Diagnosis of lumbar disc hernia with computed tomography

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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.

Application of the kappa statistic in MRI diagnosis of lumbar disk herniation

International Nuclear Information System (INIS)

Li Dasheng; Zhang Fang; Gao Shuming; Gu Jinxiang; Li Lu; Qu Hui

2008-01-01

Objective: To assess the concordance of MRI diagnosis for patients suspected of lumbar disk herniation by using Kappa statistic. Methods: One hundred patients (48 males and 52 females) with lumbosacral radiculm pain, aged from 17 to 86 (average 61). All patients underwent fast spin-echo T 1 and T 2 weighted imaging on a 3.0 T MR scanner and spine surface coil. Two radiologists (doctor A and doctor B) evaluated the lumbar disks from L3-4, L4-5, and L5-S1 in 50 out of the 100 patients independently. The presence of a bulging disk or a herniation was reported. Images were interpreted twice: once before and once after disclosure of clinical information. And disks of 52 patients out of the 100 samples were interpreted by the two radiologists independently without clinical information as well. The Kappa statistics was employed to assess the concordance of each radiologist's diagnoses as well as the observer variation of the two radiologists. Results: Diagnoses before and after disclosure to clinical information were concordant in 114 disks for doctor A and in 109 for doctor B, respectively. Diagnoses before and after disclosure to clinical information were not concordant in 36 disks for doctor A and in 41 disks for doctor B, respectively. The Kappa values were 0.60±0.06 and 0.57±0.06 for doctor A and doctor B, respectively. The concordance was moderate. After disclosure to clinical information, the numbers of reported bulging disks increased significantly, by 10 and 31 for doctor A and doctor B, respectively. Without clinical information, the diagnoses of the two radiologists were concordant in 77 disks, while not concordant in 79 disks. The interobserver agreement was poor (Kappa=0.24±0.06). The difference on diagenoses made between with and without clinical information mainly happened on the differential diagnosis of normal disks and bulging disks. The different diagnoses made between with and without clinical information were on 20 disks and on 30 disks for doctor

Diagnosis of lumbar disc hernia with computed tomography

International Nuclear Information System (INIS)

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

1982-01-01

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

CT of lumbar spine disk herniation: correlation with surgical findings

International Nuclear Information System (INIS)

Firooznia, H.; Benjamin, V.; Kricheff, I.I.; Rafii, M.; Golimbu, C.

1984-01-01

Computed tomography (CT) of the lumbar spine was performed with selectively positioned 5-mm-thick axial cross sections to examine each disk level from the top of the neural foramen to the pedicle of the next caudad vertebra. One hundred consecutive patients with 116 surgical disk explorations were reviewed. There was agreement between the CT and surgical findings in 89 patients (104 explorations) in determination of presence or absence of a herniated nucleus pulposus (HNP). Discrepancy occurred in 12 instances (11 patients): two because of incorrect interpretations, five in previously operated patients, three in spondylolisthesis, and two in spinal stenosis. There were 97 true-positives, eight false-negatives, seven true-negatives, and four false-positives. If nine previously operated patients are excluded from the study, then CT was accurate in detection of presence or absence of an HNP in 93% of the disk explorations

Magnetic resonance imaging of lumbar intervertebral disks with its pathological cerrelation

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Kakitsubata, Yousuke; Nabeshima, Kazuki; Kihara, Yasushi; Harada, Kuniko; Mori, Yukiko; Kakitsubata, Sachiko; Watanabe, Katsushi

1988-02-01

Three cadaver spines were examined by magnetic resonance imaging (MRI) with 0.1 tesla resistive magnet. Anatomic sections of lumbar intervertebral disks were compared with various MR images, saturation recovery (SR), inversion recovery (IR), T1 and T2 weighted spin echo (SE) images. And the signal intensity of degenerated disks on T2 weighted images were correlated with the histological studies. The disks were well delineated by SR and their degenerative changes were detected most sensitively by T2 weighted SE image. Two parts of disk were delineated on T2 weighted SE image. The central portion of disk showed high signal intensity and the periphery a low signal intensity. The central high signal intensity area corresponded to the combination of annulus fibrosus and nucleus pulposus, which cannot be differenciated by MR. And the peripheral low signal intensity area corresponded to the collagenous fibers of annulus fibrosus. Histologically, disks with decreased signal intensity had marked increase of collagen fibers. The intranuclear cleft were evident on T2 weighted image, and the corresponding structures thought to be caused by invagination of the lamellae of the annulus into the nucleus in the histological specimens. MRI were useful modality for evaluation of intervertebral disks, but biochemical analysis may be needed for precise interpretation of MR images of disks in addition to histological studies.

Microscopic lumbar hernietomiya under CT control, experience in the treatment of disk-articular disease

International Nuclear Information System (INIS)

Choneva, I.; Amoreti, N.; Kujelstadt, P.

2013-01-01

Full text: Introduction Lumbar disc herniation can be treated with lumbar micro-invasive herniotomy under CT control through transforaminal posterolateral or transchannel approach. Percutaneous access by the fine needle probe in combination with X-ray and CT control is a micro - invasive surgery of the spine, which may be considered as an alternative to traditional surgery. The advantages of this method are: the small diameter of the used probe (not more than 16 G or 1,5 mm), allowing the dermal incision to be only a few millimeters as well as the realization of transchannel access, thereby reducing the risk for susceptible ligament injury and the avoidance of bone lesions on the back arc or neighboring muscular structures. Materials and Methods: The aim of this study is to demonstrate that percutaneous lumbar herniotomy under CT control and on posterolateral and foraminal disc herniation with symptoms of pain and root irritation, leads to a significant improvement of the complaints at times immediately postinterventsional and within 6 months ( D1 , D2, D7 , 1, 2 , 6 months) . This lecture presents 55 consecutive patients with symptoms of pain and root irritation, who have made significant progress after percutaneous lumbar herniotomy under CT control and who did not have satisfactory results despite an adapted medical treatment. All patients were clinically evaluated by using visual analogue scales (VAS) for pain, lumbar and root irritation, as well as by MR images postoperatively. Results: All 55 patients showed immediate postoperative improvement of clinical symptoms and signs. Postoperative MR images also show root decompression. It is not reported about complications during the procedure. After the first week it was noted a reduction in average VAS values of 71% and 67% in patients treated for posterolateral and foraminal herniated disc; in medial disc hernia it was noted an average reduction of only 45% . Six months after micro surgery treatment a positive

Cisto intraespinal em comunicação com o disco intervertebral na coluna lombar: relato de um caso e revisão da literatura Quiste intraespinhal en comunicación con el disco intervertebral em la columna lumbar: reporte de caso y revisión de la literatura Intraspinal cyst communicating with the intervertebral disk in the lumbar spine: case report and literature review

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Mauricio Marteleto Filho

2012-12-01

Full Text Available A hérnia discal lombar é causa importante bem como a mais freqüente de lombalgia e ciática. Muitos dos casos podem prontamente ser diagnosticados através do simples exame semiológico. A ressonância nuclear magnética (RNM estabelece um diagnóstico definitivo mesmo em bases ambulatoriais. Diversos tipos de cistos intraespinais com diferentes patogenias foram descritos no passado como cistos perineurais, cistos sinoviais, cistos aracnóides e cistos ganglionares, que são doenças difíceis de diferenciar da hérnia de disco lombar. Os autores observaram recentemente um caso de cisto intraespinal comunicante com o disco intervertebral correspondente, apresentando sinais e sintomas e mesmo alguns achados radiológicos indistinguíveis daqueles da herniação discal lombar. O diagnóstico foi estabelecido pela RNM e confirmado no momento da cirurgia. Este artigo descreve as características dessa entidade clínica, incluindo quadro clínico, aparência radiográfica e achados histológicos, a fim de discutir possíveis patogenias e tratamento.Una hernia de disco lumbar es una causa importante, así como la más frecuente causa del dolor lumbar y ciática. Muchos casos pueden ser fácilmente diagnosticados por el examen semiológico simple. La resonancia magnética (RM proporciona un diagnóstico definitivo, incluso en atención ambulatoria. Varios tipos de quistes intraespinales con diferentes patogénesis se han descrito en el pasado como quistes perineurales, quistes sinoviales, los quistes aracnoideos y quistes ganglionares, enfermedades que son difíciles de diferenciar de la hernia de disco lumbar. Los autores observaron recientemente un caso de quiste intraespinal, que en comunicación con el disco intervertebral correspondiente, presentando signos y síntomas e incluso algunos hallazgos radiológicos que no se distinguen de los de la hernia discal lumbar. El diagnóstico fue determinado por RM y confirmado en la cirugía. En este art

Comparison of preoperative neuroradiographic findings and surgical findings in lumbar disc herniation

International Nuclear Information System (INIS)

Takahara, Kazuhiro; Sera, Keisuke; Nakamura, Masakazu; Uchida, Takeshi; Ito, Nobuyuki.

1997-01-01

Surgical findings in lumbar disc hernia were compared to pre-operative MRI, CTM and myelogram findings. Ninety-one cases were studied using Love's method. The accuracy of hernia diagnosis in MRI was 59.3%, 41.2% in CTM, and 35.2% in myelogram. At the L5/S1 disc level, the accuracy of hernia diagnosis by CTM and myelogram was decreased. MRI was useful for the diagnosis and cure of lumbar disc herniation. (author)

Natural history of symptomatic lumbar disk herniation controlled by MRI

International Nuclear Information System (INIS)

Komori, Hiromichi; Yamaura, Isakichi; Kurosa, Yoshiro; Yoshida, Hirotoshi; Nakai, Osamu.

1994-01-01

The purpose of this study was to compare changes in clinical symptoms and sequential findings of magnetic resonance imaging (MRI) in 66 patients managed with conservative treatment for lumbar disc herniation. In all but 12 patients, there was a good correlation between leg pain and MRI findings, although findings of MRI tended to slightly follow symptom improvement. A notable reduction of herniated mass was seen in a high frequency in sequentrated herniation from an extremely degenerated lumbar disk. The greater the degree of sequentration, the greater the reduction of herniated mass. A shorter duration of leg pain was significantly associated with greater reduction of the herniated mass; leg pain disappeared within 2 months when the herniated mass disappeared on MRI. Because herniated mass disappeared within a short period of time, the involvement of immune reaction was suggested, as well as the possibility of sequentration, degeneration, and phagocytosis. (N.K.)

Acquired secondary Grynfeltt's hernia: a case report

International Nuclear Information System (INIS)

Renck, Decio Valente; Lopes Junior, Joao Ivan

2009-01-01

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

CT changes after lumbar percutaneous automated nucleotomy

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Dullerud, R. (Depts. of Radiology, Section of Neuroradiology and Neurosurgery, Ullevaal Univ. Hospital, Oslo (Norway)); Amundsen, T. (Depts. of Radiology, Section of Neuroradiology and Neurosurgery, Ullevaal Univ. Hospital, Oslo (Norway)); Nakstad, P.H. (Depts. of Radiology, Section of Neuroradiology and Neurosurgery, Ullevaal Univ. Hospital, Oslo (Norway)); Magnaes, B. (Depts. of Radiology, Section of Neuroradiology and Neurosurgery, Ullevaal Univ. Hospital, Oslo (Norway))

1994-09-01

In order to assess changes occurring in disk hernias and disk spaces following percutaneous nucleotomy a follow-up CT was carried out an average of 6 months after treatment of 69 disks in 60 patients. Forty-three of the disks were also reexamined at an average of 11 months after the first follow-up. Twenty-seven percent of the hernias were reduced in size at the first follow-up. Fourteen percent were reduced and 7% had increased between the first and second follow-ups. The medium-sized and large hernias were more frequently reduced compared to the smaller ones. Reduction of the disk space was found in 29% of the cases at first follow-up. An additional 24% were reduced between the first and second follow-ups. No association was demonstrated between change in size of the herniation or disk space and clinical outcome or amount of nucleous material removed at nucleotomy. (orig.).

Delayed vertebral diagnosed L4 pincer vertebral fracture, L2-L3 ruptured vertebral lumbar disc hernia, L5 vertebral wedge fracture - Case report

OpenAIRE

Balasa D; Schiopu M; Tunas A; Baz R; Hancu Anca

2016-01-01

An association between delayed ruptured lumbar disc hernia, L5 vertebral wedge fracture and posttraumaticL4 pincer vertebral fracture (A2.3-AO clasification) at different levels is a very rare entity. We present the case of a 55 years old male who falled down from a bicycle. 2 months later because of intense and permanent vertebral lumbar and radicular L2 and L3 pain (Visual Scal Autologus of Pain7-8/10) the patient came to the hospital. He was diagnosed with pincer vertebral L4 fracture (A2....

Comparison of preoperative neuroradiographic findings and surgical findings in lumbar disc herniation

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Takahara, Kazuhiro; Sera, Keisuke; Nakamura, Masakazu; Uchida, Takeshi [Nagasaki Mitsubishi Hospital (Japan); Ito, Nobuyuki

1997-09-01

Surgical findings in lumbar disc hernia were compared to pre-operative MRI, CTM and myelogram findings. Ninety-one cases were studied using Love`s method. The accuracy of hernia diagnosis in MRI was 59.3%, 41.2% in CTM, and 35.2% in myelogram. At the L5/S1 disc level, the accuracy of hernia diagnosis by CTM and myelogram was decreased. MRI was useful for the diagnosis and cure of lumbar disc herniation. (author)

Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

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Koshi Ninomiya

2014-01-01

Full Text Available A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI showed a large L2/3 disc hernia descending to the L3/4 level. Compared to the initial MRI, this hernia occurred in an “intact” disc among multilevel severely degenerated discs. Right leg paresis and bladder dysfunction appeared a few days after admission. Microscopic lumbar disc herniotomy was performed. The right leg motor weakness improved just after the operation, but the moderate left leg motor weakness and difficulty in urination persisted.

CT five years after myelographic diagnosis of lumbar disk herniation

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Hurme, M.; Katevuo, K.; Nykvist, F.; Aalto, T.; Alaranta, H.; Einola, S. (Turku Univ. Central Hospital (Finland). Dept. of Surgery Turku Univ. Central Hospital (Finland). Dept. of Diagnostic Radiology Social Insurance Inst., Turku (Finland). Rehabilitation Research Centre)

1991-07-01

Fifty-seven patients were examined with CT 5 years after primary myelography for disabling sciatica and suspected herniated lumbar disk. Forty were in an operated group, 22 with good and 18 with poor results evaluated by occupational handicap (21) 5 years after surgery. Seventeen patients had myelography indicating disk herniation, but were treated conservatively, 9 with good and 8 with poor result. Various spinal dimensions measured at CT did not correlate with outcome. Operated patients had narrower canals than others, and male canals were broader than those in females. Increased amount of scar tissue at L4 level correlated with poor result (p=0.008). Operated patients with poor result had more advanced lateral stenosis than those treated conservatively (p<0.001). Patients with good result after operation had more degeneration observed on CT of erector spinae muscle than those treated conservatively with good outcome. Only 9% of operated patients did not have muscle degeneration. A tendency for more frequent recurrent disk herniations could be ssen for conservatively treated patients. The narrowing of the spinal canal 5 years after operation did not correlate with the 5-year outcome. (orig.).

Management of Lumbar Conditions in the Elite Athlete.

Science.gov (United States)

Hsu, Wellington K; Jenkins, Tyler James

2017-07-01

Lumbar disk herniation, degenerative disk disease, and spondylolysis are the most prevalent lumbar conditions that result in missed playing time. Lumbar disk herniation has a good prognosis. After recovery from injury, professional athletes return to play 82% of the time. Surgical management of lumbar disk herniation has been shown to be a viable option in athletes in whom nonsurgical measures have failed. Degenerative disk disease is predominately genetic but may be accelerated in athletes secondary to increased physiologic loading. Nonsurgical management is the standard of care for lumbar degenerative disk disease in the elite athlete. Spondylolysis is more common in adolescent athletes with back pain than in adult athletes. Nonsurgical management of spondylolysis is typically successful. However, if surgery is required, fusion or direct pars repair can allow the patient to return to sports.

Biomechanical study of percutaneous lumbar diskectomy

International Nuclear Information System (INIS)

Li Yuan; Huang Xianglong; Shen Tianzhen; Hu Zhou; Hong Shuizong; Mei Haiying

2003-01-01

Objective: To investigate the stiffness of lumbar spine after the injury caused by percutaneous diskectomy and evaluate the efficiency of percutaneous lumbar diskectomy by biomechanical study. Methods: Four fresh lumbar specimens were used to analyse load-displacement curves in the intact lumbar spine and vertical disc-injured lumbar spine. The concepts of average flexibility coefficient (f) and standardized average flexibility coefficient (fs) were also introduced. Results: The load-displacement curves showed a good stabilization effect of the intact lumbar spine and disc-injured lumbar spine in flexion, extension, right and left bending. The decrease of anti-rotation also can be detected (P<0.05). Conclusion: In biomechanical study, percutaneous lumbar diskectomy is one of the efficiency methods to treat lumbar diac hernia

Evaluation of Water Retention in Lumbar Intervertebral Disks Before and After Exercise Stress With T2 Mapping.

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Chokan, Kou; Murakami, Hideki; Endo, Hirooki; Mimata, Yoshikuni; Yamabe, Daisuke; Tsukimura, Itsuko; Oikawa, Ryosuke; Doita, Minoru

2016-04-01

T2 mapping was used to quantify moisture content of the lumbar spinal disk nucleus pulposus (NP) and annulus fibrosus before and after exercise stress, and after rest, to evaluate the intervertebral disk function. To clarify water retention in intervertebral disks of the lumbar vertebrae by performing magnetic resonance imaging before and after exercise stress and quantitatively measuring changes in moisture content of intervertebral disks with T2 mapping. To date, a few case studies describe functional evaluation of articular cartilage with T2 mapping; however, T2 mapping to the functional evaluation of intervertebral disks has rarely been applied. Using T2 mapping might help detect changes in the moisture content of intervertebral disks, including articular cartilage, before and after exercise stress, thus enabling the evaluation of changes in water retention shock absorber function. Subjects, comprising 40 healthy individuals (males: 26, females: 14), underwent magnetic resonance imaging T2 mapping before and after exercise stress and after rest. Image J image analysis software was then used to set regions of interest in the obtained images of the anterior annulus fibrosus, posterior annulus fibrosus, and NP. T2 values were measured and compared according to upper vertebrae position and degeneration grade. T2 values significantly decreased in the NP after exercise stress and significantly increased after rest. According to upper vertebrae position, in all of the upper vertebrae positions, T2 values for the NP significantly decreased after exercise stress and significantly increased after rest. According to the degeneration grade, in the NP of grade 1 and 2 cases, T2 values significantly decreased after exercise stress and significantly increased after rest. T2 mapping could be used to not only diagnose the degree of degeneration but also evaluate intervertebral disk function. 3.

CT-guided intradiscal ozone injection combined with intervertebral facet joint steroid injection for lumbar disk herniation accompanied with intervertebral arthritis

International Nuclear Information System (INIS)

Zhang Li; Chen Zhaohui; Sun Xijun; Liu Jianping; Li Jiakai

2009-01-01

Objective: To compare the clinical effectiveness of ozone (O 3 ) nucleus pulposus ablation only with that of O 3 nucleus pulposus ablation combined with intervertebral facet joint injection of compound Betamethasome in treating lumbar disk herniation accompanied with intervertebral facet arthritis. Methods: Eighty patients with lumbar disk herniation and intervertebral facet arthritis were equally and randomly divided into two groups. Under CT guidance, O 3 nucleus pulposus ablation was performed in patients of group A(n=40), while O 3 nucleus pulposus ablation combined with intervertebral facet joint injection of compound Betamethasome (0.5-1 ml) was carried out in patients of group B(n=40). Using double blind method the therapeutic effectiveness was evaluated before and 1 week,3,6-months after the procedure by an Oswestry Low Back Pain Disability Questionnaire. Results: One week after the procedure the effective rate of group A and group B was 65% and 82.5% respectively. Three and six months after the treatment, the effective rate was 75% and 70% respectively for group A, while it was 90% and 92.5% respectively for group B. The difference between two groups was significant (P 3 combined with intervertebral facet joint injection of compound Betamethasome is an effective and safe treatment for lumbar disk herniation accompanied with intervertebral facet arthritis.It is worth popularizing this technique in clinical practice. (authors)

Discectomia simples: ainda há espaço para a técnica? Discectomía lumbar: todavía hay espacio para la técnica? Lumbar discectomy: is there still place for the technique?

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Felipe de Albuquerque Araujo Luyten

2010-03-01

Full Text Available OBJETIVO: avaliar retrospectivamente os resultados a longo prazo do procedimento de discectomia convencional como tratamento de dor ciática causada por hérnia discal lombar. MÉTODOS: análise retrospectiva de 96 pacientes com hernia discal lombar, submetidos à discectomia convencional, com acompanhamento mínimo de dois anos. RESULTADOS: pacientes apresentavam ciática esquerda em 54% dos casos, com hérnia discal extrusa em 60% e 48% no nível L4-5; média de idade de 42 anos, 53% do sexo feminino, VAS médio de 9,6 no pré-operatório e 2,2 no pós-operatório. CONCLUSÃO: a discectomia convencional mostrou-se eficaz no tratamento da dor ciatica originada por hernia discal lombar, com baixo custo e restabelecimento precoce do paciente.OBJETIVOS: evaluar de manera retrospectiva los resultados a largo plazo del procedimiento del discectomía convencional como tratamiento de dolor de la ciática causado por hernia discal lumbar. MÉTODOS: análisis retrospectiva de 96 pacientes con hernia discal lumbar, que fueron sometidos al discectomía convencional, con el acompañamiento mínimo de dos años. RESULTADOS: los pacientes presentaron ciática izquierda en el 54% de los casos, con extrusa discal de la hernia en el 60% y el 48% en el nivel L4-5; una media de la edad de 42 años, el 53% correspondiente al sexo femenino; el medio EAV de 9.6 en el pre-operatorio y 2.2 en el postoperatorio. CONCLUSIÓN: el discectomía convencional se reveló eficiente en el tratamiento del dolor de la ciática originado por hernia discal lumbar, con bajo costo y restablecimiento precoz del paciente.OBJECTIVES: retrospective evaluation of long term results of conventional discectomia as treatment to sciatic pain caused by lumbar disc hernia. METHODS: retrospective analysis of 96 patients with lumbar disc hernia submitted to conventional discectomia, with minimum follow-up of 2 years. RESULTS: the patients presented left sciatic pain in 54% of the cases, with

Accumulation of methylglyoxal increases the advanced glycation end-product levels in DRG and contributes to lumbar disk herniation-induced persistent pain.

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Liu, Cui-Cui; Zhang, Xin-Sheng; Ruan, Yu-Ting; Huang, Zhu-Xi; Zhang, Su-Bo; Liu, Meng; Luo, Hai-Jie; Wu, Shao-Ling; Ma, Chao

2017-08-01

Lumbar disk herniation (LDH) with discogenic low back pain and sciatica is a common and complicated musculoskeletal disorder. The underlying mechanisms are poorly understood, and there are no effective therapies for LDH-induced pain. In the present study, we found that the patients who suffered from LDH-induced pain had elevated plasma methylglyoxal (MG) levels. In rats, implantation of autologous nucleus pulposus (NP) to the left lumbar 5 spinal nerve root, which mimicked LDH, induced mechanical allodynia, increased MG level in plasma and dorsal root ganglion (DRG), and enhanced the excitability of small DRG neurons (DRG neurons ex vivo increased the number of action potentials evoked by depolarizing current pulses. Furthermore, inhibition of MG accumulation by aminoguanidine attenuated the enhanced excitability of small DRG neurons and the mechanical allodynia induced by NP implantation. In addition, NP implantation increased levels of advanced glycation end products (AGEs) in DRG, and intrathecal injection of MG-derived AGEs induced the mechanical allodynia and DRG neuronal hyperactivity. Intrathecal injection of MG also significantly increased the expression of AGEs in DRG. Importantly, scavenging of MG by aminoguanidine also attenuated the increase in AGEs induced by NP implantation. These results suggested that LDH-induced MG accumulation contributed to persistent pain by increasing AGE levels. Thus generation of AGEs from MG may represent a target for treatment of LDH-induced pain. NEW & NOTEWORTHY Our study demonstrates that methylglyoxal accumulation via increasing advanced glycation end-product levels in dorsal root ganglion contributes to the persistent pain induced by lumbar disk herniation, which proposed potential targets for the treatment of lumbar disk herniation-induced persistent pain. Copyright © 2017 the American Physiological Society.

Gd-DTPA: Clinical use in MR imaging of postoperative lumbar recurrent disk herniation and fibrosis

International Nuclear Information System (INIS)

Narang, A.K.; Hueftle, M.; Williams, A.; Modic, M.; Davis, D.O.

1987-01-01

Gd-DTPA, a paramagnetic MR contrast agent, is most familiarly utilized for delineation of brain and cord abnormalities. Since contrast-enhanced CT may help distinguish epidural fibrosis from recurrent herniated lumbar disk, the efficacy of Gd-DTPA-enhanced MR imaging was evaluated. Symptomatic patients with previous back surgery are being evaluated with pre- and post-Gd-DTPA T1- and T2-weighted images. Results to date (over 40 cases) suggest that this technique will be extremely helpful

Iliac artery pseudoaneurysm after lumbar disc hernia operation

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Mehmet Atay

2016-03-01

Full Text Available Lumbar disc herniation surgery is usually performed through a posterior approach. Vascular injuries can be counted among the complications. 39 years old male patient had lower extremity pain which has started after lumbar disc herniation surgery and continued for a month. Iliac arterial pseudoaneurysm has been detected in computerized tomography. It was successfully treated with vascular surgery [Cukurova Med J 2016; 41(0.100: 5-7

Surgical treatment of foraminal herniated disc of the lumbar spine

OpenAIRE

Halikov Shavkatbek; Abduhalikov Alimjon Karimjanovich

2017-01-01

Herniated lumbar intervertebral disc have a significant impact on both the patient’s life as well, and because of the high prevalence and economic impact on society as a whole. Designed scheduling algorithm foraminal hernia surgical treatment of lumbar intervertebral disc, based on the preoperative detection of compressing factors allows to define differentiated indications for decompressive or decompressive-stabilizing surgery.

Massive Lumbar Disk Herniation Following "Therapeutic" Water Boiling of the Lower Extremities: Case Report and Literature Review.

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Spallone, Aldo; Çelniku, Megi

2017-01-01

Legs burning for treating lumbar radicular pain are still in use nowadays in low socioeconomical environments. They are dangerous as the case we report shows clearly. A 49-year-old man came to our attention with severe flaccid paraparesis occurred 10 days before, almost immediately after he had immersed his legs in boiling water to treat his severe left lumbocrural pain. This was known to be due to a right L3/4 herniated disk diagnosed by magnetic resonance imaging. At the examination he showed severe motor paresis and absent reflexes of his lower limbs, while crural pain was mild and sensation and urinary function were unaffected. The results of his neurologic examination led us to suspect an acute motor axon degeneration related to thermal shock. Lumbar magnetic resonance imaging, performed before the planned electromyogram as an exception to the established routine, showed instead a giant 5- × 5.5-cm, herniated disk compressing the dural sac at L3. Prompt surgical decompression led to rapid improvement. We discuss here the pathophysiology of this unusual case and point out how medieval practices for treating sciatica-like pain are not only unjustified from a medical viewpoint but also potentially dangerous. Copyright © 2016 Elsevier Inc. All rights reserved.

Lumbo-costo-vertebral syndrome with congenital lumbar hernia.

Science.gov (United States)

Gupta, Lucky; Mala, Tariq Ahmed; Gupta, Rahul; Malla, Shahid Amin

2014-01-01

Lumbo-costo-vertebral syndrome (LCVS) is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. We present a case of LCVS in a 2-year-old girl who had a progressive swelling over left lumbar area noted for the last 12 months. Clinical examination revealed a reducible swelling with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the left lumbar region. Chest x-ray showed scoliosis and hemivertebrae with absent lower ribs on left side. Meshplasty was done.

Hernia discal lumbar: Tratamiento conservador

OpenAIRE

López-Sastre Núñez, Antonio; Candau Pérez, Ernesto

1999-01-01

Existe una gran demanda de patología lumbar crónica y aguda que debe de tratarse conjuntamente entre el especialista en Rehabilitación y el Cirujano de columna vertebral. En este trabajo se detallan las posibilidades del tratamiento conservador antes de optar por la cirugía. Se realiza una revisión bibliográfica de los resultados conservadores del tratamiento de la lumbociática de origen discal comparando aquellos estudios publicados con validez estadística. Se detallan las modernas pautas de...

Clinical evaluation of MRI for lumbar spinal disease

International Nuclear Information System (INIS)

Moriwaka, Yosuke; Nakayama, Sachiko; Murai, Nobuko; Watanabe, Katsushi; Kawano, Keiichiro; Tajima, Naoya; Kihara, Yasushi; Okada, Akihiko; Fujimoto, Toshiro.

1985-01-01

Thirty-two patients were examined to determine the clinical usefulness of magnetic resonance imaging (MRI) of the lumbar spine. MRI using a resistive magnet at 0.1 Tesla was compared with computed tomography (CT) and myelography. A saturation recovery (SR) technique with repetition time (TR) of 500 msec was used in all cases. There were 19 cases with disk herniation, 5 with canal stenosis, 2 with spondylosis deformans and 6 with other suspected disease. MRI showed the protrusion of disk, displacement of epidural fat and degenerative change of disk more clearly than CT and myelography. Of the 12 herniated disks, 8 disks were clearly shown and one was not detected by MRI. In some cases, herniated disk could not be differentiated from disk bulging. With further technical advance, MRI is likely to become the initial procedure for evaluation of lumbar spinal disease. (author)

The Impact of Lumbar Spine Disease and Deformity on Total Hip Arthroplasty Outcomes.

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Blizzard, Daniel J; Sheets, Charles Z; Seyler, Thorsten M; Penrose, Colin T; Klement, Mitchell R; Gallizzi, Michael A; Brown, Christopher R

2017-05-01

Concomitant spine and hip disease in patients undergoing total hip arthroplasty (THA) presents a management challenge. Degenerative lumbar spine conditions are known to decrease lumbar lordosis and limit lumbar flexion and extension, leading to altered pelvic mechanics and increased demand for hip motion. In this study, the effect of lumbar spine disease on complications after primary THA was assessed. The Medicare database was searched from 2005 to 2012 using International Classification of Diseases, Ninth Revision, procedure codes for primary THA and diagnosis codes for preoperative diagnoses of lumbosacral spondylosis, lumbar disk herniation, acquired spondylolisthesis, and degenerative disk disease. The control group consisted of all patients without a lumbar spine diagnosis who underwent THA. The risk ratios for prosthetic hip dislocation, revision THA, periprosthetic fracture, and infection were significantly higher for all 4 lumbar diseases at all time points relative to controls. The average complication risk ratios at 90 days were 1.59 for lumbosacral spondylosis, 1.62 for disk herniation, 1.65 for spondylolisthesis, and 1.53 for degenerative disk disease. The average complication risk ratios at 2 years were 1.66 for lumbosacral spondylosis, 1.73 for disk herniation, 1.65 for spondylolisthesis, and 1.59 for degenerative disk disease. Prosthetic hip dislocation was the most common complication at 2 years in all 4 spinal disease cohorts, with risk ratios ranging from 1.76 to 2.00. This study shows a significant increase in the risk of complications following THA in patients with lumbar spine disease. [Orthopedics. 2017; 40(3):e520-e525.]. Copyright 2017, SLACK Incorporated.

Caracterización clínica e imagenológica de la hernia discal mediante resonancia magnética Clinical and imaging characterization of discal hernia by means of magnetic resonance

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Yoandra Aroche Lafargue

2012-08-01

Full Text Available Se realizó un estudio descriptivo y transversal de 635 pacientes con hernia discal atendidos en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde diciembre del 2009 hasta igual mes del 2010, para determinar las características clínicas e imagenológicas de esta afección mediante resonancia magnética. En la casuística primaron el grupo etario de 30 a 49 años, el sexo masculino, la obesidad como principal factor de riesgo en las mujeres y la carga física excesiva en los hombres, así como el dolor, la localización lumbar y las hernias posteriores centrolaterales y laterales derechas. Se encontró que las protrusiones focales y difusas resultaron ser las más comunes, asociadas a edema óseo en las placas terminales, que la compresión medular y las mielopatías secundarias fueron provocadas por protrusiones focales cervicales y que la estenosis del canal se presentó mayoritariamente en el segmento lumbar.A descriptive and cross-sectional study of 635 patients with discal hernia assisted in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from December, 2009 to the same month of 2010, to determine the clinical and imaging characteristics of this disorder by means of magnetic resonance. The age group from 30 to 49 years, male sex, obesity as the main risk factor in the women and the excessive physical load in the men prevailed in the case material, as well as the pain, the lumbar localization and the right posterior centro-lateral and lateral hernias. It was found that the focal and diffuse protrusions turned out to be more common, associated with bony edema in the terminal plates, that the medullary compression and the secondary myelopathies were caused by cervical focal protrusions and the stenosis of the channel was mainly presented in the lumbar segment.

Minimally invasive discectomy versus microdiscectomy/ discectomy for symptomatic lumbar disc herniation

OpenAIRE

Rahimi-Movaghar, Vafa; Rasouli, Mohammad; Shokraneh, Farhad; Moradi-lakeh, Maziyar; Vakaro, Alex; Sadeghi-Naini, Mohsen

2012-01-01

Abstract: Background: Lumbar discectomy is a surgery to remove all or part of a disc cushion that helps protect the spinal column. These cushions, called disks, separate the spinal vertebrae/bones. When one of the disks herniates (moves out of place) in patients with protruded disc, the soft gel inside pushes through the wall of the disk. The disk may then place pressure on the spinal cord and nerves that are coming out of the spinal column. The lumbar discectomy procedure remained basically ...

Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

OpenAIRE

Ninomiya, Koshi; Iwatsuki, Koichi; Ohnishi, Yu-ichiro; Ohkawa, Toshika; Yoshimine, Toshiki

2014-01-01

A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to...

"Effectiveness of continuous vertebral resonant oscillation using the POLD method in the treatment of lumbar disc hernia". A randomized controlled pilot study.

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López-Díaz, Juan Vicente; Arias-Buría, José Luis; Lopez-Gordo, Estrella; Lopez Gordo, Sandra; Oyarzún, Alejandra P Aros

2015-06-01

This study analyses the efficacy of manual oscillatory therapy, following the POLD technique, for acute Lumbar Disc Hernia (LDH) and compares it to usual treatment. A randomised, controlled, triple-blind pilot clinical trial. The sample of 30 patients was divided into two homogeneous groups to receive usual treatment (A) or treatment with the POLD technique (B). We analysed range of motion and subjective variables such as the severity (visual analogue pain scale (VAS)) and extension of the pain. With the application of POLD therapy, patients presented significant changes on range of motion (forward flexion with p lumbar, glutaeus and thigh pain, which improved from 5.09 to 0.79, 5.07 to 0.97 and 4.43 to 0.49 respectively (p < 0.05), and also when compared to usual treatment (p < 0.05) for all body regions. Moreover, we observed a reduction in pain extension (centralization phenomena) (p < 0.001) in comparison with usual treatment. In our study the POLD Method was shown to be an effective manual therapy approach for reducing the severity and irradiation of the pain in LDH patients with sciatica, and more efficient than usual treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

A cross-sectional study: serum CCL3/MIP-1α levels may reflect lumbar intervertebral disk degeneration in Han Chinese people

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Zhang YL

2018-03-01

Full Text Available Yi-Li Zhang,1,2,* Bei Li,1,2,* Zeng-Huan Zhou1 1School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China; 2School of Health Services Management, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China *These authors contributed equally to this work Background: The macrophage inflammatory protein-1α (MIP-1α, also named chemokine cytokine ligand 3 (CCL3, has been detected in nucleus pulposus and increased following cytokine stimulation. Objective: The current study was performed to explore the relationship between serum CCL3/MIP-1α levels with lumbar intervertebral disk degeneration (IDD. Patients and methods: A total of 132 disk degeneration patients confirmed by magnetic resonance imaging and 126 healthy controls were enrolled in the current study. Radiological evaluation of the IDD was conducted using a 3.0-T magnetic resonance imaging scanner for entire lumbar vertebra region. Degeneration of intervertebral disk was assessed by Schneiderman criteria. Serum CCL3/MIP-1α levels were investigated using a sandwich enzyme-linked immunosorbent assay. The Visual Analog Scale scores and Oswestry Disability Index index were recorded for clinical severity. Results: Elevated concentrations of CCL3 in serum were found in IDD patients compared with asymptomatic volunteers. The case group included 49 IDD patients with grade 1, 42 with grade 2, and 41 with grade 3. Grade 3 and 2 had significantly higher CCL3 concentrations in serum compared with those with grade 1. The serum CCL3 levels were positively related to the degree of disk degeneration. In addition, the serum CCL3 levels also demonstrated a significant correlation with the clinical severity determined by Visual Analog Scale scores and Oswestry Disability Index index. Conclusion: Serum CCL3 may serve as a biomarker of IDD. Keywords: chemokine cytokine ligand 3, intervertebral disk degeneration, cross

Diabetes Mellitus, a New Risk Factor for Lumbar Spinal Stenosis: A Case–Control Study

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Leila Asadian

2016-01-01

Full Text Available Objectives This study aimed to determine the prevalence of diabetes mellitus in patients with spinal stenosis and lumbar vertebral disk degeneration, and the correlation of diabetes with these diseases. Study Design This is a cross-sectional study. Methods This case–control study was performed during 2012–2014 with 110 patients suffering from lumbar spinal stenosis and 110 patients with lumbar disk herniation, who were diagnosed using clinical and radiological evidences. Additionally, 110 participants who were referred to the clinic and did not show clinical signs of degenerative diseases of the lumbar spine entered the study as a control group. Demographic data and medical histories of the patients were collected using checklists. Results A total of 50 patients (15.2% were diagnosed with diabetes, which comprised 32 (29.1% in the stenosis group, 7 (6.4% in the lumbar disk herniation group, and 11 (10% in the control group. The prevalence of diabetes in women with spinal stenosis and women with lumbar disk herniation was 35.9% and 10.3%, respectively, whereas prevalence of diabetes in women was 10.9% in the control group. This difference was statistically significant in the spinal stenosis group in comparison with the controls ( P < 0.0001. Conversely, no significant difference was found in men. Conclusions There is an association between diabetes and lumbar spinal stenosis. Diabetes mellitus may be a predisposing factor for the development of lumbar spinal stenosis.

Spinal CT scan, 2. Lumbar and sacral spines

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Nakagawa, Hiroshi (Aichi Medical Univ., Aichi (Japan))

1982-08-01

Plain CT described fairly accurately the anatomy and lesions of the lumbar and sacral spines on their transverse sections. Since hernia of the intervertebral disc could be directly diagnosed by CT, indications of myelography could be restricted. Spinal-canal stenosis of the lumbar spine occurs because of various factors, and CT not only demonstrated the accurate size and morphology of bony canals, but also elucidated thickening of the joints and yellow ligament. CT was also useful for the diagnosis of tumors in the lumbar and sacral spines, visualizing the images of bone changes and soft tissues on the trasverse sections. But the diagnosis of intradural tumors required myelography and metrizamide CT. CT has become important for the diagnosis of spinal and spinal-cord diseases and for selection of the route of surgical arrival.

Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion--systematic review and meta-analysis.

Science.gov (United States)

Phan, Kevin; Thayaparan, Ganesha K; Mobbs, Ralph J

2015-01-01

To assess the clinical and radiographic outcomes and complications of anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF). A systematic literature search was conducted from six electronic databases. The relative risk and weighted mean difference (WMD) were used as statistical summary effect sizes. Fusion rates (88.6% vs. 91.9%, P = 0.23) and clinical outcomes were comparable between ALIF and TLIF. ALIF was associated with restoration of disk height (WMD, 2.71 mm, P = 0.01), segmental lordosis (WMD, 2.35, P = 0.03), and whole lumbar lordosis (WMD, 6.33, P = 0.03). ALIF was also associated with longer hospitalization (WMD, 1.8 days, P = 0.01), lower dural injury (0.4% vs. 3.8%, P = 0.05) but higher blood vessel injury (2.6% vs. 0%, P = 0.04). ALIF and TLIF appear to have similar success and clinical outcomes, with different complication profiles. ALIF may be associated with superior restoration of disk height and lordosis, but requires further validation in future studies.

Influence of nomenclature in the interpretation of lumbar disk contour on MR imaging: a comparison of the agreement using the combined task force and the nordic nomenclatures.

Science.gov (United States)

Arana, E; Kovacs, F M; Royuela, A; Estremera, A; Sarasíbar, H; Amengual, G; Galarraga, I; Martínez, C; Muriel, A; Abraira, V; Zamora, J; Campillo, C

2011-01-01

The CTF nomenclature had not been tested in clinical practice. The purpose of this study was to compare the reliability and diagnostic confidence in the interpretation of disk contours on lumbar 1.5T MR imaging when using the CTF and the Nordic nomenclatures. Five general radiologists from 3 hospitals blindly and independently assessed intravertebral herniations (Schmorl node) and disk contours on the lumbar MR imaging of 53 patients with low back pain, on 4 occasions. Measures were taken to minimize the risk of recall bias. The Nordic nomenclature was used for the first 2 assessments, and the CTF nomenclature, in the remaining 2. Radiologists had not previously used either of the 2 nomenclatures. κ statistics were calculated separately for reports deriving from each nomenclature and were categorized as almost perfect (0.81-1.00), substantial (0.61-0.80), moderate (0.41-0.60), fair (0.21-0.40), slight (0.00-0.20), and poor (<0.00). Categorization of intra- and interobserver agreement was the same across nomenclatures. Intraobserver reliability was substantial for intravertebral herniations and disk contour abnormalities. Interobserver reliability was moderate for intravertebral herniations and fair to moderate for disk contour. In conditions close to clinical practice, regardless of the specific nomenclature used, a standardized nomenclature supports only moderate interobserver agreement. The Nordic nomenclature increases self-confidence in an individual observer's report but is less clear regarding the classification of disks as normal versus bulged.

Why Lumbar Artificial Disk Replacements (LADRs) Fail.

Science.gov (United States)

Pettine, Kenneth; Ryu, Robert; Techy, Fernando

2017-07-01

A retrospective review of prospectively collected data. To determine why artificial disk replacements (ADRs) fail by examining results of 91 patients in FDA studies performed at a single investigational device exemption (IDE) site with minimum 2-year follow-up. Patients following lumbar ADR generally achieve their 24-month follow-up results at 3 months postoperatively. Every patient undergoing ADR at 1 IDE site by 2 surgeons was evaluated for clinical success. Failure was defined as <50% improvement in ODI and VAS or any additional surgery at index or adjacent spine motion segment. Three ADRs were evaluated: Maverick, 25 patients; Charité, 31 patients; and Kineflex, 35 patients. All procedures were 1-level operations performed at L4-L5 or L5-S1. Demographics and inclusion/exclusion criteria were similar and will be discussed. Overall clinical failure occurred in 26% (24 of 91 patients) at 2-year follow-up. Clinical failure occurred in: 28% (Maverick) (7 of 25 patients), 39% (Charité) (12 of 31 patients), and 14% (Kineflex) (5 of 35 patients). Causes of failure included facet pathology, 50% of failure patients (12 of 24). Implant complications occurred in 5% of total patients and 21% of failure patients (5 of 24). Only 5 patients went from a success to failure after 3 months. Only 1 patient went from a failure to success after a facet rhizotomy 1 year after ADR. Seventy-four percent of patients after ADR met strict clinical success after 2-year follow-up. The clinical success versus failure rate did not change from their 3-month follow-up in 85 of the 91 patients (93%). Overall clinical success may be improved most by patient selection and implant type.

Lumbar endoscopic percutaneous discolisis, with Holmium YAG laser - four years of experience

International Nuclear Information System (INIS)

Ramirez L, Jorge Felipe; Rugeles O, Jose G

2001-01-01

we have designed a prospective study over 220 patients with lumbar hernia. our purpose is to show the results that we have obtained with endoscopic percutaneous holmium YAG laser lumbar disc decompression. In all cases, ambulatory surgery was performed using local anesthesia, follow up based on Mac Nab criteria was made with excellent and good results in 75% of patients this is a useful safety outpatient procedure with good results, fewer complications, reduced costs and with the same or better results than traditional procedures

MR imaging of the lumbar disk herniation : relationship between the direction of herniated disc and pressure effect on nerve root and dural sac

International Nuclear Information System (INIS)

Cha, B. H.; Shon, M. Y.; Kim, K. W.; Lim, M. A.; Kwon, K. R; Kim, S. S.

1996-01-01

To evaluate the relationship between the direction of herniated disc and pressure effect on nerve root and dural sac, as seen on MRI. We retrospectively reviewed lumbar spine MR images of 122 cases of lumbar disk herniation 75 patients MRI findings were analyzed with regard to the relationship between the direction of the herniated disc and pressure effect on nerve root and dural sac. Pressure effect on nerve root and dural sac was arbitrarily divided into three types. Type I was defined as zero or minimal compression of nerve roots or thecal sac by the herniated disc ; type II was defined as mild to moderate compression, while III was defined as severe compression or displacement of nerve roots and/or thecal sac. Of the 122 cases seen in these 75 patients, 97(80%) were observed at L4-5 and L5-S1. The central type(71cases ; 58%) was more frequently observed than the posterolateral type(48cases ; 40%) or lateral type(3cases ; 2%). The totals of types I, II, and III were 44(36%), 43(35%) and 35 cases(29%), respectively. Seventy-seven %(34/44) of type I and 65%(28/43) of type II were of the central type but for type III, the corresponding figure was only 26%(9/35). On MR imaging, most of lumbar disk herniations were observed at L4-5 and L5-S1, with a predominance of the central type rather than the posterolateral one. Most of the central types were either type I or type II

Iliac artery pseudoaneurysm after lumbar disc hernia operation

OpenAIRE

Atay, Mehmet; Saydam, Onur; Türkyılmaz, Saygın; Kavala, Ali Aycan; Gülmalıyev, Cabir; Bakuy, Vedat

2016-01-01

Lomber disk hernisioperasyonu genellikle posterior yaklaşımla yapılmakta olup vasküleryaralanmalar operasyonun komplikasyonları arasında sayılabilmektedir. Sunulan 39yaşındaki olguda geçirilmiş lomber disk hernisi sonrası başlayan ve bir aydırdevam eden bacak ağrısı vardı. Yakınmaları operasyon sonrasında çıktığıöğrenilen hastada çekilen bilgisayarlı tomografi sonrasında iliak arter psödoanevrizmasıgörüldü. Olgu cerrahi olarak başarıyla tedavi edildi. 

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. 

Magnetic resonance imaging of canine degenerative lumbar spine diseases

International Nuclear Information System (INIS)

Karkkainen, M.; Punto, L.U.; Tulamo, R.M.

1993-01-01

Degenerative lumbar spine diseases, i.e., sacrolumbar stenosis, intervertebral disk degeneration and protrusion and spondylosis deformans of the canine lumbar spine were studied in eleven canine patients and three healthy controls using radiography and 0.02 T and 0.04 T low field magnetic resonance imaging. The T1 and T2 weighted images were obtained in sagittal and transverse planes. The loss of hydration of nucleus pulposus, taken as a sign of degeneration in the intervertebral disks, could be evaluated in both T1 and T2 weighted images. As a noninvasive method magnetic resonance imaging gave more exact information about the condition of intervertebral disks than did radiography. Sacrolumbar stenosis and compression of the spinal cord or cauda equina and surrounding tissue could be evaluated without contrast medium

[Impact of obesity in the pathophysiology of degenerative disk disease and in the morbidity and outcome of lumbar spine surgery].

Science.gov (United States)

Delgado-López, Pedro David; Castilla-Díez, José Manuel

Obesity (BMI>30Kg/m 2 ) is a pandemic with severe medical and financial implications. There is growing evidence that relates certain metabolic processes within the adipose tissue, preferentially abdominal fat, with a low-intensity chronic inflammatory state mediated by adipokines and other substances that favor disk disease and chronic low back pain. Obesity greatly conditions both the preoperative evaluation and the spinal surgical technique itself. Some meta-analyses have confirmed an increase of complications following lumbar spine surgery (mainly infections and venous thrombosis) in obese subjects. However, functional outcomes after lumbar spine surgery are favorable although inferior to the non-obese population, acknowledging that obese patients present with worse baseline function levels and the prognosis of conservatively treated obese cohorts is much worse. The impact of preoperative weight loss in spine surgery has not been prospectively studied in these patients. Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

Amyad's hernia while reparing the bilateral inguinal hernia

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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. 

Experimental substantiation and clinical use of functional pneumoepidurography in the diagnosis of lumbar osteochondrosis i

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Sharov, B.K.; Plekhanov, L.G. (Chelyabinskij Meditsinskij Inst. (USSR))

Anatomic and X-ray correlations in 31 postmortem unfixed specimens of the vertebral lumbar region have shown that in the diagnosis of disk prolapse and commissural processes in the anterior epidural space roentgenopositive contrast substances are not much superior to roentgenonegative ones. Functional pneumoepidurogaphy used in 102 patients with lumbar osteochondrosis helped to reveal intervertebral disk prolapse at all the stages of degenerative affection, to evaluate function of the disk-ligamentous apparatus and to specify the nature of a pathological process in the epidural space.

Human Amniotic Tissue-derived Allograft, NuCel, in Posteriolateral Lumbar Fusions for Degenerative Disc Disease

Science.gov (United States)

2017-09-14

Lumbar Degenerative Disc Disease; Spinal Stenosis; Spondylolisthesis; Spondylosis; Intervertebral Disk Displacement; Intervertebral Disk Degeneration; Spinal Diseases; Bone Diseases; Musculoskeletal Diseases; Spondylolysis

Tratamento cirúrgico de recidivas de hérnias discais lombares: que resultados? Tratamiento quirúrgico de recidivas de hernias lumbares de disco: cuáles son los resultados? Surgical treatment in recurrent lumbar disc herniation: what results?

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Pedro Alberto Pinto da Silva

2011-01-01

Full Text Available OBJETIVOS: No tratamento da recidiva de hérnia discal lombar, em particular no âmbito cirúrgico, vários aspectos se mantêm controversos. O presente trabalho pretende contribuir para definir características pré-operatórias que influenciem os resultados subjetivo e objetivo da cirurgia. MÉTODOS: Foram selecionados doentes submetidos à intervenção cirúrgica por hérnia discal lombar recidivada em um período de dez anos; foram revistos os processos clínicos e reavaliados os pacientes, de forma subjetiva (grau de satisfação, Pain Visual Analogue Scale, Score de Stanford e objetiva (Índice de Incapacidade de Oswestry, Questionário de Zurich. Foi realizada uma análise estatística desses dados. RESULTADOS: O número total foi de 55 doentes, com predomínio do sexo masculino. A taxa de complicações foi de 7,3%. Onze doentes (20% necessitaram de terceira intervenção cirúrgica. A grande maioria (91,5% dos doentes afirma-se satisfeita com o tratamento cirúrgico. Houve uma variação média favorável pelo Índice de Oswestry (-46,27%, confirmada pelas restantes escalas; 81,6% dos pacientes ativos retomaram a atividade laboral prévia. Foram encontrados preditores significativos do resultado funcional, e a necessidade de terceira cirurgia para o retorno à atividade laboral. CONCLUSÕES: O tratamento cirúrgico da recidiva de hérnia discal lombar permite resultados favoráveis no controle sintomático e funcional, em todos os testes aplicados. Algumas variáveis pré-operatórias podem ajudar a prever os pacientes menos susceptíveis à melhoria.OBJETIVOS: En el tratamiento de la hernia de disco lumbar recurrente, especialmente en relación con la cirugía, algunos aspectos siguen generando controversias. Este trabajo tiene por objetivo definir las características preoperatorias que influyen en los resultados subjetivos y objetivos de la cirugía. MÉTODOS: Seleccionamos los pacientes sometidos a cirugía de hernia de disco

The viscoelastic standard nonlinear solid model: predicting the response of the lumbar intervertebral disk to low-frequency vibrations.

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Groth, Kevin M; Granata, Kevin P

2008-06-01

Due to the mathematical complexity of current musculoskeletal spine models, there is a need for computationally efficient models of the intervertebral disk (IVD). The aim of this study is to develop a mathematical model that will adequately describe the motion of the IVD under axial cyclic loading as well as maintain computational efficiency for use in future musculoskeletal spine models. Several studies have successfully modeled the creep characteristics of the IVD using the three-parameter viscoelastic standard linear solid (SLS) model. However, when the SLS model is subjected to cyclic loading, it underestimates the load relaxation, the cyclic modulus, and the hysteresis of the human lumbar IVD. A viscoelastic standard nonlinear solid (SNS) model was used to predict the response of the human lumbar IVD subjected to low-frequency vibration. Nonlinear behavior of the SNS model was simulated by a strain-dependent elastic modulus on the SLS model. Parameters of the SNS model were estimated from experimental load deformation and stress-relaxation curves obtained from the literature. The SNS model was able to predict the cyclic modulus of the IVD at frequencies of 0.01 Hz, 0.1 Hz, and 1 Hz. Furthermore, the SNS model was able to quantitatively predict the load relaxation at a frequency of 0.01 Hz. However, model performance was unsatisfactory when predicting load relaxation and hysteresis at higher frequencies (0.1 Hz and 1 Hz). The SLS model of the lumbar IVD may require strain-dependent elastic and viscous behavior to represent the dynamic response to compressive strain.

Fine needle diagnosis in lumbar osteomyelitis

International Nuclear Information System (INIS)

Joshi, K.B.; Brinker, R.A.

1983-01-01

Lumbar vertebral body and disk infection, presenting as low back pain, is a relatively uncommon disease but is seen more often in drug addicts. Radiographs show typical changes of infection of the lumbar vertebrae and adjacent disc. Under local anesthesia a fine needle is placed, saline injected, and aspirated. The entire needle-syringe unit is submitted to the bacteriology department. Pseudomonas infection is usually found. This method of diagnosis is simple, cost effective, well accepted by the patients, and can be done on outpatients. (orig.)

Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging.

Science.gov (United States)

Altinkaya, Naime; Cekinmez, Melih

2016-01-01

To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P  0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation.

Hernia diafragmática traumática en un niño

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Erian Jesús Domínguez González

Full Text Available La hernia diafragmática traumática es una afección poco frecuente sobre todo en edades pediátricas. El objetivo de este trabajo es reportar un caso de hernia diafragmática secundaria a un trauma toracoabdominal cerrado. Se presenta el caso de un paciente de 12 años, masculino ingresado en el Servicio de Cirugía Pediátrica de la Provincia de Santiago de Cuba, por haber sufrido un accidente en el hogar (caída de una pared de ladrillos sobre su cuerpo, que produjo traumatismos a nivel craneal, torácico y lumbar. Los estudios radiológicos confirmaron el diagnóstico de hernia diafragmática traumática izquierda. En el acto quirúrgico se comprueba defecto del diafragma izquierdo de aproximadamente 15 cm, con hernia de estómago, bazo y colon. Se realizó reducción y frenorrafia con puntos de colchonero usando poliéster 0, más pleurostomía mínima baja izquierda. El paciente evolucionó satisfactoriamente y egresó a los 10 días para seguimiento en la consulta externa durante 6 meses hasta el alta definitiva.

Endoscopia lumbar póstero lateral con sistema YESS: reporte preliminar Endoscopia lombar póstero-lateral com sistema YESS: resultados preliminares Lumbar disc herniation treated with post lateral lumbar endoscopy by YESS system: preliminary results

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Carlos Montes García

2009-06-01

Full Text Available INTRODUCCIÓN: en los pacientes con diagnóstico de hernia de disco lumbar, los cuales son candidatos a tratamiento quirúrgico, la disectomía posterior abierta ha sido por muchos anos el estándar de oro. Sin embargo, las complicaciones de este procedimiento, en el que se invade el canal medular, han hecho que se busquen otros métodos menos invasivos. Uno de estos procedimientos es la disectomía endoscópica lateral con el método YESS (Young Endoscopic Spine System. OBJETIVO: revisar los resultados por dos años de cien pacientes diagnosticados con hernia de disco lumbar, tratados con endoscopia lateral con sistema YESS. MÉTODOS: se estudiaron cien pacientes con diagnóstico de hernia de disco lumbar comprobada con resonancia magnética y discografía evocativa positiva. Todos los pacientes nunca habían hecho un tratamiento quirúrgico y se les dio seguimiento durante dos años. RESULTADOS: los resultados se clasificaron en buenos, regulares, y malos. Se encontraron buenos resultados en 82 pacientes, regulares en 10, y malos en 8. CONCLUSIONES: los resultados del tratamiento de la hernia de disco lumbar con la endoscopia lateral y sistema YESS son, hasta el momento, similares con el abordaje posterior abierto, aunque el tiempo de recuperación y capacidad son menores así también como el costo, ya que es un procedimiento ambulatorio.INTRODUÇÃO: nos pacientes com diagnóstico de hérnia de disco lombar, candidatos ao tratamento cirúrgico, a discectomia posterior aberta tem sido por muitos anos o padrão-ouro. Embora as complicações deste procedimento, no qual se invade o canal medular, têm levado a procurar outros métodos menos invasivos. Um destes procedimentos é a discectomia endoscópica lateral com o método YESS (Young Endoscopic Spine System. OBJETIVO: revisar os resultados por dois anos de cem pacientes com diagnóstico de hérnia de disco lombar tratados com endoscopia lateral, com sistema YESS. MÉTODOS: foram estudados

Imaging of the lumbar spine after diskectomy

International Nuclear Information System (INIS)

Laredo, J.D.; Wybier, M.

1995-01-01

The radiological investigation of persistent or recurrent sciatica after lumbar diskectomy essentially consists of demonstrating recurrent disk herniation. Comparison between plain and contrast enhanced CT or MR examinations at the level of the diskectomy is the main step of the radiological survey. The meanings of the various radiological findings are discussed. Other lesions that may induce persistent sciatica after lumbar diskectomy include degenerative narrowing of the lateral recess, spinal instability, stress fracture of the remaining neural arch, pseudo-meningomyelocele after laminectomy. (authors). 34 refs., 5 tabs

Short stature with umbilical hernia - Not always due to cretinism: A report of two cases

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Sharvil S Gadve

2012-01-01

Full Text Available A 7-year-old boy presented with umbilical hernia and short stature. Growth retardation, recurrent upper respiratory tract infections and delayed developmental milestones were present from infancy. Umbilical hernia was diagnosed at the age of 5 years. On examination, he had short-trunk dwarfism, large head circumference, coarse facial features, joint stiffness, hepatosplenomegaly, and mild mental retardation. He had normal biochemical parameters, thyroid function tests and arterial blood gas analysis. Radiological evaluation showed that the child had Hunter syndrome with findings of J-shaped sellaturcica, proximal bulleting of metacarpals, spatulated ribs and anterior beaking of lumbar vertebrae. The second case was a 6-year-old girl with umbilical hernia, short stature, normal biochemistry and radiological findings of mucopolysaccharidosis. However, she also had corneal opacity; confirmed by slit-lamp examination, which led to the diagnosis of Hurler-Scheie syndrome. Enzymatic studies could not be done in both the cases, as they are not available at most centers.

Lumbar lordosis restoration following single-level instrumented fusion comparing 4 commonly used techniques.

Science.gov (United States)

Dimar, John R; Glassman, Steven D; Vemuri, Venu M; Esterberg, Justin L; Howard, Jennifer M; Carreon, Leah Y

2011-11-09

A major sequelae of lumbar fusion is acceleration of adjacent-level degeneration due to decreased lumbar lordosis. We evaluated the effectiveness of 4 common fusion techniques in restoring lordosis: instrumented posterolateral fusion, translumbar interbody fusion, anteroposterior fusion with posterior instrumentation, and anterior interbody fusion with lordotic threaded (LT) cages (Medtronic Sofamor Danek, Memphis, Tennessee). Radiographs were measured preoperatively, immediately postoperatively, and a minimum of 6 months postoperatively. Parameters measured included anterior and posterior disk space height, lumbar lordosis from L3 to S1, and surgical level lordosis.No significant difference in demographics existed among the 4 groups. All preoperative parameters were similar among the 4 groups. Lumbar lordosis at final follow-up showed no difference between the anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cage groups, although the posterolateral fusion group showed a significant loss of lordosis (-10°) (Plordosis and showed maintenance of anterior and posterior disk space height postoperatively compared with the other groups. Instrumented posterolateral fusion produces a greater loss of lordosis compared with anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cages. Maintenance of lordosis and anterior and posterior disk space height is significantly better with anterior interbody fusion with LT cages. Copyright 2011, SLACK Incorporated.

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

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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.

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.

Magnetic resonance imaging of lumbar spine disc diseases. Frequency of false negatives

International Nuclear Information System (INIS)

Berthelot, J.M.; Maugars, Y.; Delecrin, Y.; Caillon, F.; Prost, A.

1995-01-01

Magnetic resonance imaging (MRI) has had an impressive impact on evaluation of degenerative diseases of the spine. Nevertheless, false negatives can occur on images involving lumbar discs. Degenerative disc diseases documented on discography and/or pathology examination of the discs can go unrecognized. Likewise sensitivity for the detection of protruding disc hernias is not totally satisfactory (20% false negatives). Finally, a magnetic resonance image visualizing displacement of the disc is not specific (10 to 15% false positives); images showing protrusion or hernia can be seen in 30% of asymptomatic patients. Although MRI gives slightly more information than other imaging techniques, false images do exist. Moreover, the usefulness of MRI to demonstrate disc disease in case of a negative CT-scan remains to be demonstrated. (authors). 26 refs

[Efficacy of transforaminal lumbar epidural steroid injections in patients with lumbar radiculopathy].

Science.gov (United States)

Çetin, Mehmet Fatih; Karaman, Haktan; Ölmez Kavak, Gönül; Tüfek, Adnan; Baysal Yildirim, Zeynep

2012-01-01

This study looks into the efficacy and safety of the transforaminal lumbar epidural steroid injection (TLESI) applied to patients with radiculopathy due to lumbar disk herniation. The patients' files which were applied TLESI, were retrospectively scanned. Patients who did not respond to one-month conservative treatment and who were detected to have bulging or protruding lumbar disk herniation as a result of imaging methods were included in the study. All applications were performed with C-arm fluoroscopy under local anesthesia by outpatient method. In all cases, a mix of 80 mg triamsinolone and 0.25% bupivacaine, was transforaminally injected to the anterior epidural area. Initial VAS pain scores were compared with the values of the 1, 3 and 6th months after the application. Patient satisfaction was determined through scoring. Furthermore, early and late term complications were collected for evaluation. A total of 222 patients were administered TLESI 460 times (average: 2.1, repeat interval: 1-6 times). The applications were carried out most frequently at the levels of L4-L5 and L5-S1. While the initial VAS score average was 8.2±0.7, after TLESI, it was 5.0±1.6, 4.8±1.5 and 5.1±1.5 in the 1, 3 and 6th months, respectively. 63.9% of the patients (n=142) defined the treatment as 'good and excellent'. No major complications were experienced and the overall minor complication rate was 11.1%. It was seen that TLESI was an efficient and safe method in the short and medium term.

Strangulated spigelian hernia

International Nuclear Information System (INIS)

Amin, F.M.; Sultan, T.

2004-01-01

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

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

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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.

The value of MRI and CT in the pre-operative diagnosis of lumbar disc herniation

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Hirabayashi, Shigeru; Kumano, Kiyoshi; Takahashi, Soichiro; Ishii, Jun (Kanto Rosai Hospital, Kawasaki, Kanagawa (Japan))

1991-05-01

A prospective analysis of computed tomography (CT) and magnetic resonance imaging (MRI) scans in 51 patients with lumbar disc herniation was made to determine the height of hernia for operation and, if impossible, the indications of myelography. Among the 51 patients, 40 (78%) received surgery based on these imaging modalities (Group A); and the remaining 11 (22%) underwent myelography for the confirmation of the height of hernia or detailed examination (Group B). Satisfactory or excellent surgical outcome was achieved in 95% in Group A and in 91% in Group B. Twenty seven patients had multiple disc herniation on CT and MRI; in 17 patients surgery was performed for one disc hernia that was radiologically found to compress the spinal nerve root; and in the other 10 hernia-related disc was not determined by either radiological or neurological manifestations. Satisfactory or excellent surgical outcome could, however, be achieved in 26 patients (96%). Myelography should be indicated when there is no neurological radicular sign in the lower extremities, and when there is no radiological evidence of the compressed spinal nerve root in spite of the presence of multiple disc herniation. The height of hernia may be determined when compression of the spinal nerve root is visualized on CT or MRI. (N.K.).

The value of MRI and CT in the pre-operative diagnosis of lumbar disc herniation

International Nuclear Information System (INIS)

Hirabayashi, Shigeru; Kumano, Kiyoshi; Takahashi, Soichiro; Ishii, Jun

1991-01-01

A prospective analysis of computed tomography (CT) and magnetic resonance imaging (MRI) scans in 51 patients with lumbar disc herniation was made to determine the height of hernia for operation and, if impossible, the indications of myelography. Among the 51 patients, 40 (78%) received surgery based on these imaging modalities (Group A); and the remaining 11 (22%) underwent myelography for the confirmation of the height of hernia or detailed examination (Group B). Satisfactory or excellent surgical outcome was achieved in 95% in Group A and in 91% in Group B. Twenty seven patients had multiple disc herniation on CT and MRI; in 17 patients surgery was performed for one disc hernia that was radiologically found to compress the spinal nerve root; and in the other 10 hernia-related disc was not determined by either radiological or neurological manifestations. Satisfactory or excellent surgical outcome could, however, be achieved in 26 patients (96%). Myelography should be indicated when there is no neurological radicular sign in the lower extremities, and when there is no radiological evidence of the compressed spinal nerve root in spite of the presence of multiple disc herniation. The height of hernia may be determined when compression of the spinal nerve root is visualized on CT or MRI. (N.K.)

Ultrasound diagnosis of cervical spine intervertebral disks hernia

International Nuclear Information System (INIS)

Abdullajev, R.Ya.; Gapchenko, V.V.; Ponomarenko, S.O.

2006-01-01

Forty-seven patients underwent ultrasonography followed by radiography, computed tomography (CT) or MRI. Due to its accessibility and safety for the patient ultrasonography allows not only to assess the presence and degree of the degenerative changes in the pulp ous nucleus and disk fibrous ring but also allows to observe the process dynamically

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

Science.gov (United States)

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

2014-10-01

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

Magnetic resonance imaging findings of the lumbar spine in elite horseback riders: correlations with back pain, body mass index, trunk/leg-length coefficient, and riding discipline.

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Kraft, Clayton N; Pennekamp, Peter H; Becker, Ute; Young, Mei; Diedrich, Oliver; Lüring, Christian; von Falkenhausen, Makus

2009-11-01

Most orthopaedic problems experienced by competitive horseback riders are related to pain in the lower back, hip joint, and hamstring muscles. Riders-especially, show jumpers-are frequently hampered in their performance because of lumbar pain. To date, there has been no research into lumbar disk degeneration in elite competitive riders. Competitive horseback riding accelerates lumbar disk degeneration. Cross-sectional study; Level of evidence, 3. Fifty-eight elite riders (18 men, 40 women; mean age, 32.4 years) and a control group of 30 nonriding volunteers (17 men, 13 women; mean age, 28.7 years) were evaluated for lumbar disk degeneration, cross-sectional area of paraspinal muscles, spondylolysis, and spondylolisthesis, using magnetic resonance imaging (MRI). The prevalence of disk degeneration between the 2 groups was compared, and the relationship was investigated between low back pain (LBP), riding discipline, body mass index (BMI), trunk/leg-length coefficient, and MRI results. Eighty-eight percent of elite riders (n = 51) had a history of LBP, versus 33% of the controls (P back pain. Although riders have a high prevalence of LBP, there is no conclusive MRI evidence to suggest that the cause lies in undue disk degeneration, spondylolysis, spondylolisthesis, or pathologic changes of the paraspinal muscles of the lumbar spine.

Do Lordotic Cages Provide Better Segmental Lordosis Versus Nonlordotic Cages in Lateral Lumbar Interbody Fusion (LLIF)?

Science.gov (United States)

Sembrano, Jonathan N; Horazdovsky, Ryan D; Sharma, Amit K; Yson, Sharon C; Santos, Edward R G; Polly, David W

2017-05-01

A retrospective comparative radiographic review. To evaluate the radiographic changes brought about by lordotic and nonlordotic cages on segmental and regional lumbar sagittal alignment and disk height in lateral lumbar interbody fusion (LLIF). The effects of cage design on operative level segmental lordosis in posterior interbody fusion procedures have been reported. However, there are no studies comparing the effect of sagittal implant geometry in LLIF. This is a comparative radiographic analysis of consecutive LLIF procedures performed with use of lordotic and nonlordotic interbody cages. Forty patients (61 levels) underwent LLIF. Average age was 57 years (range, 30-83 y). Ten-degree lordotic PEEK cages were used at 31 lumbar interbody levels, and nonlordotic cages were used at 30 levels. The following parameters were measured on preoperative and postoperative radiographs: segmental lordosis; anterior and posterior disk heights at operative level; segmental lordosis at supra-level and subjacent level; and overall lumbar (L1-S1) lordosis. Measurement changes for each cage group were compared using paired t test analysis. The use of lordotic cages in LLIF resulted in a significant increase in lordosis at operative levels (2.8 degrees; P=0.01), whereas nonlordotic cages did not (0.6 degrees; P=0.71) when compared with preoperative segmental lordosis. Anterior and posterior disk heights were significantly increased in both groups (Plordosis (lordotic P=0.86 vs. nonlordotic P=0.25). Lordotic cages provided significant increase in operative level segmental lordosis compared with nonlordotic cages although overall lumbar lordosis remained unchanged. Anterior and posterior disk heights were significantly increased by both cages, providing basis for indirect spinal decompression.

The treatment of lumbar disc herniation: a comparison between percutaneous lumbar diskectomy combined with ozone and percutaneous lumbar diskectomy combined with collagenase

International Nuclear Information System (INIS)

Zhong Liming; Wei Xin; Hu Hong; You Jian; Zhao Xiaowei; Hu Kongqiong

2012-01-01

Objective: To evaluate the short-term curative effect and the incidence of postoperative adverse events of percutaneous lumbar diskectomy (PLD) combined with ozone or PLD combined with collagenase in treating lumbar disk herniation. Methods: A total of 223 patients with lumbar disk herniation were enrolled in this study. Patients in the study group (n=108) were treated with PLD combined with ozone, while patients in the control group (n=115) were treated with PLD combined with collagenase. The short-term effectiveness and the incidence of postoperative adverse events were documented. The results were analyzed and compared between the two groups. Results: In the study group, the excellent and good therapeutic results were achieved in 85.18% of the patients (n=92) and the occurrence of adverse events was 5.56%, while in the control group, the excellent and good therapeutic results were achieved in 80.00% of the patients (n=92) and the occurrence of adverse events was 13.04%. No significant difference in the short-term effectiveness existed between the two groups (Pearson Chi-Square =1.038, P=0.308). And the difference in the occurrence of postoperative adverse events was not significant between the two groups (Pearson Chi-Square =3.661, P=0.056). No disc infection occurred in the study group. Conclusion: The short-term curative effect of PLD combined with ozone is not significantly different from that of PLD combined with collagenase. In order to maintain decompression within the disc for a long period and to reduce the incidence of postoperative adverse events PLD combined with ozone ablation is an effective complementary treatment. (authors)

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.

CT-discography in the evaluation of the post-operative lumbar spine

International Nuclear Information System (INIS)

Crenier, N.; Greselle, J.F.; Richard, O.; Houang, B.; Pinol-Daubisse, H.; Caille, J.M.; Vital, J.M.; Senegas, J.

1988-01-01

Thirty-three patients with recurrent sciatica after lumbar-disk surgery were studied for recurrent herniated nucleus pulposus (HNP) by CT alone and CT-discography (CTD). Twenty-six patients underwent surgical reexploration allowing correlation with CTD. CTD made a correct diagnosis of recurrent HNP in twenty-one patients showing an extravasation of the contrast medium from the disk space into the medullary canal. In two cases CTD was positive for recurrent HNP but surgery showed only fibrosis. The amount of contrast leak was very small in these two cases along the posterior common longitudinal ligament, and the junction with the disk was very narrow. Because of their clinical presentation three patients with negative studies were operated upon. One showed only fibrosis and the two others showed an associated disk fragment. Among the twenty-one true-positive cases, seven showed a combination of recurrent HNP and scarring. Contamination of CSF by the contrast medium through the dura was observed in two patients. Although a prospective comparative study between CTD and IV-contrast-enhanced CT is necessary, CTD appears to be a useful diagnostic procedure for recurrent HNP after surgery of the lumbar spine. (orig.)

Etiology of Inguinal Hernias

DEFF Research Database (Denmark)

Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

2017-01-01

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

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

Science.gov (United States)

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

2017-08-01

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

Disk degeneration in 14 year old children

International Nuclear Information System (INIS)

Erkintalo, M.; Salminen, J.J.; Paajanen, H.; Terho, P.; Kormano, M.

1989-01-01

This paper reports low back symptoms of 1,500 school children (14 years old) evaluated with a questionnaire and with a standardized clinical examination. Forty children who complained of recurrent and/or persistent low back pain and 40 matching symptomless controls were randomly chosen to undergo MR imaging of the lumbar spine. Premature disk degeneration was seen in 25.5% of asymptomatic children and in 40% of those with low back pain. The difference was statistically not significant. Disk degeneration is a surprisingly frequent MR finding in symptomless children. Premature disk degeneration may be the cause of low back pain in some children but is not always symptomatic in childhood

[The possibilities for diagnostics of prescription of death coming based on the changes in the lumbar intervertebral disks (the comparison of the morphological, immunohistochemical and topographical findings)].

Science.gov (United States)

Byval'tsev, V A; Stepanov, I A; Semenov, A V; Perfil'ev, D V; Belykh, E G; Bardonova, L A; Nikiforov, S B; Sudakov, N P; Bespyatykh, I V; Antipina, S L

The objective of the present study was the comprehensive analysis of the postmortem changes in the lumbar intervertebral disks within different periods after death. A total of seven vertebromotor segments were distinguished in the lumbosacral region of the vertebral column based on the examination of 7 corpses. All these segments were divided into three groups in accordance with the prescription of death coming as follows: up to 12 hours (group 1), between 12 and 24 hours (group 2), and between 24 and 36 hours (group 3) after death. The models of the segments thus obtained were subjected to the study by means of diffusion weighted MRI. The removed intervertebral disks were used for morphological and immunohistochemical investigations. The comparison of the diffusion coefficients (DI) revealed the significant difference between the intervertebral disks assigned to groups 1 and 2 (p<0.01). The number of the cells in the pulpal core, the vertebral end plate, and the fibrous ring in all the above groups of the intervertebral disks was significantly reduced (p<0.01). The analysis of the correlation dependence between cell density and diffusion coefficients has demonstrated the well apparent relationship between these characteristics of the intervertebral disks comprising groups 1 and 2. It is concluded that diffusion weighted MRI in the combination with the calculation of diffusion coefficients for the intervertebral disks provides a tool for diagnostics of prescription of death coming as confirmed by the results of the morphometric studies and immunohistochemical analysis.

Lumbar spine joint synovial cysts of intraspinal development. CT scan imaging

Energy Technology Data Exchange (ETDEWEB)

Vallee, C.; Chevrot, A.; Benhamouda, M. and others

CT scan imaging findings are described in 22 patients with lumbar spine joint synovial cysts, of intraspinal development, provoking sciatica or lumbosciatica from nerve compression in spinal canal. Diagnosis was suggested by a mass at the posterior joint level, of variable density, sometimes with peripheral calcification, presenting a vacuum appearance on occasions, and with enhanced image with contrast. Differential diagnosis is from excluded hernia and postoperative fibrosis. Posterior intra-articular arthrography can confirm diagnosis and allow treatment with prolonged action corticoid infiltrations.

[Clinical observation of post-extension pulling massage in treating lumbar disc herniation].

Science.gov (United States)

Lü, Li-Jiang; Ke, Xue-Ai; Mao, Xu-Dan; Chen, Xiao-Jie; Wu, Fang-Chao; Tong, Hong-Jie

2010-10-01

To observe the clinical effect of post-extension pulling massage in treating lumbar disc herniation. From January 2008 to December 2008, 61 patients with lumbar disc herniation, 34 males and 27 females, ranging in age from 17 to 67 years with an average of 42.6 years, were treated with post-extension pulling massage after continued traction for 30 minutes (on alternate days one time, 3 times as a course of treatment). There was bulging type in 9 cases, hernia type in 22, free type in 30. After a course of treatment, the clinical effects were evaluated according to standard of Macnab, the items included pain, lumbar activity, normal work and life of patients. All patients were followed up from 1 to 9 months with an average of 4.6 months. After treatment, the symptoms and signs of patients had obviously improved in above aspects. According to standard of Macnab, 48 cases got excellent result, 10 good, 2 fair, 1 poor. The post-extension pulling massage in treating lumbar disc herniation can obtain satisfactory results, which have localized site of action, small compression for vertebral body and can reduce accidental injury.

The DQB1 *03:02 HLA haplotype is associated with increased risk of chronic pain after inguinal hernia surgery and lumbar disc herniation.

Science.gov (United States)

Dominguez, Cecilia A; Kalliomäki, Maija; Gunnarsson, Ulf; Moen, Aurora; Sandblom, Gabriel; Kockum, Ingrid; Lavant, Ewa; Olsson, Tomas; Nyberg, Fred; Rygh, Lars Jørgen; Røe, Cecilie; Gjerstad, Johannes; Gordh, Torsten; Piehl, Fredrik

2013-03-01

Neuropathic pain conditions are common after nerve injuries and are suggested to be regulated in part by genetic factors. We have previously demonstrated a strong genetic influence of the rat major histocompatibility complex on development of neuropathic pain behavior after peripheral nerve injury. In order to study if the corresponding human leukocyte antigen complex (HLA) also influences susceptibility to pain, we performed an association study in patients that had undergone surgery for inguinal hernia (n=189). One group had developed a chronic pain state following the surgical procedure, while the control group had undergone the same type of operation, without any persistent pain. HLA DRB1genotyping revealed a significantly increased proportion of patients in the pain group carrying DRB1*04 compared to patients in the pain-free group. Additional typing of the DQB1 gene further strengthened the association; carriers of the DQB1*03:02 allele together with DRB1*04 displayed an increased risk of postsurgery pain with an odds risk of 3.16 (1.61-6.22) compared to noncarriers. This finding was subsequently replicated in the clinical material of patients with lumbar disc herniation (n=258), where carriers of the DQB1*03:02 allele displayed a slower recovery and increased pain. In conclusion, we here for the first time demonstrate that there is an HLA-dependent risk of developing pain after surgery or lumbar disc herniation; mediated by the DRB1*04 - DQB1*03:02 haplotype. Further experimental and clinical studies are needed to fine-map the HLA effect and to address underlying mechanisms. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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.

Changes in intervertebral disk dimensions after a loading task and the relationship with stature change measurements.

Science.gov (United States)

Lewis, Sandra E; Fowler, Neil E

2009-10-01

Lewis SE, Fowler NE. Changes in intervertebral disk dimensions after a loading task and the relationship with stature change measurements. To test the hypothesis that there would be a linear relationship between overall stature change determined by stadiometry and markers of lumbar disk height loss determined from magnetic resonance imaging (MRI). The short-term loading response of the lumbar spine was evaluated with both stadiometry and MRI, using a within-subject repeated-measures design. Measures were obtained both before and after 15 minutes of walking wearing a weighted vest (20% of body mass). Stature loss measured on the stadiometer was compared with change in lumbar spine length assessed from the MRI images. A university laboratory. Participants (N=13; mean age +/- SD, 28.5+/-5.2y; mean height +/- SD, 1.76+/-0.10m; mean body mass +/- SD, 76.6+/-14.9kg) were invited to take part in the investigation. The group was mixed (9 men, 4 women) and comprised people with no history of low back pain. Not applicable. Lumbar spine length assessed via MRI and stature change measured via stadiometry. A significant height loss was observed over the complete lumbar spine (Pstature loss (r=.61). The results were supportive of the use of stadiometry as an indirect measure of changes in intervertebral disk height.

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...

Correlation between T2 relaxation time and intervertebral disk degeneration

Energy Technology Data Exchange (ETDEWEB)

Takashima, Hiroyuki; Takebayashi, Tsuneo; Yoshimoto, Mitsunori; Terashima, Yoshinori; Tsuda, Hajime; Ida, Kazunori; Yamashita, Toshihiko [Sapporo Medical University, Department of Orthopedic Surgery, School of Medicine, Sapporo, Hokkaido (Japan)

2012-02-15

Magnetic resonance T2 mapping allows for the quantification of water and proteoglycan content within tissues and can be used to detect early cartilage abnormalities as well as to track the response to therapy. The goal of the present study was to use T2 mapping to quantify intervertebral disk water content according to the Pfirrmann classification. This study involved 60 subjects who underwent lumbar magnetic resonance imaging (a total of 300 lumbar disks). The degree of disk degeneration was assessed in the midsagittal section on T2-weighted images according to the Pfirrmann classification (grades I to V). Receiver operating characteristic (ROC) analysis was performed among grades to determine the cut-off values. In the nucleus pulposus, T2 values tended to decrease with increasing grade, and there was a significant difference in T2 values between each grade from grades I to IV. However, there was no significant difference in T2 values in the anterior or posterior annulus fibrosus. T2 values according to disk degeneration level classification were as follows: grade I (>116.8 ms), grade II (92.7-116.7 ms), grade III (72.1-92.6 ms), grade IV (<72.0 ms). T2 values decreased with increasing Pfirrmann classification grade in the nucleus pulposus, likely reflecting a decrease in proteoglycan and water content. Thus, T2 value-based measurements of intervertebral disk water content may be useful for future clinical research on degenerative disk diseases. (orig.)

Etiology of Inguinal Hernias

DEFF Research Database (Denmark)

Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

2017-01-01

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

Large Ventral Hernia

Directory of Open Access Journals (Sweden)

Meryl Abrams, MD

2018-04-01

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

Design of three-dimensional visualization based on the posterior lumbar pedicle screw fixation

Directory of Open Access Journals (Sweden)

Kai XU

2011-09-01

Full Text Available Objective To establish a three-dimensional visualization model of posterior lumbar pedicle screw fixation.Methods A patient with lumbar intervertebral disc hernia and another patient with compression fracture of lumbar vertebra were involved in the present study.Both patients underwent multi-slice spiral CT scan before and after lumbar pedicle screw fixation.The degree of preoperative vertebral compression,vertebral morphology before and after surgery,postoperative pedicle screw position,and decompression effects were observed.The original data of the multi-slice spiral CT were inputted into the computer.The three-dimensional reconstructed images of the lumbar and implanted screws were obtained using the software Amira 4.1 to show the three-dimensional shape of the lumbar vertebrae before and after surgery and the location of the implanted screws.Results The morphology and structure of the lumbar vertebrae before and after surgery and of the implanted screws were reconstructed using the digital navigation platform.The reconstructed 3D images could be displayed in multicolor,transparent,or arbitrary combinations.In the 3D surface reconstruction images,the location and structure of the implanted screws could be clearly observed,and the decompression of the spinal cord or nerve roots and the severity of the fracture and the compression of lumbar vertebrae could be fully evaluated.The reconstructed images before operation revealed the position of the vertebral pedicles and provided reference for intraoperative localization.Conclusions The three-dimensional computerized reconstructions of lumbar pedicle screw fixation may be valuable in basic research,clinical experiment,and surgical planning.The software Amira is one of the bases of three-dimensional reconstruction.

Morgagni's Hernia

International Nuclear Information System (INIS)

Khalid, M.M.

2004-01-01

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

Comparing the effects of epidural methylprednisolone acetate injected in patients with pain due to lumbar spinal stenosis or herniated disks: a prospective study

Directory of Open Access Journals (Sweden)

Gharibi F

2011-12-01

Full Text Available Jafar Mobaleghi1, Faramarz Allahdini2, Karim Nasseri3, Behzad Ahsan3, Shoaleh Shami4, Mansour Faizi5, Fardin Gharibi51Department of Surgery, 2Department of Neurosurgery, 3Department of Anesthesia, 4Faculty of Nursing, 5Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan, IranObjective: Satisfactory results have been seen with epidural steroid injections (ESI in patients with herniated disks (HD, but the role in lumbar spinal stenosis (LSS has been less investigated. We compared long-term effects of ESI in HD and LSS patients.Methods: In a prospective, single-blind uncontrolled study, 60 patients with radicular pain due to HD (n = 32 or LSS (n = 28 were enrolled over a 9-month period. Methylprednisolone acetate 80 mg plus 0.5% bupivacaine 10 mg were diluted in normal saline up to a total volume of 10 mL, and injected into the epidural space. The amount of pain based on numeric pain score, level of activity, and subjective improvement were reported by patients after 2 and 6 months by telephone. Demographic data were analyzed with the chi-square test. The differences in numeric pain scale scores between the two groups at different times were analyzed with the t-test.Results: There were no differences between HD and LSS patients regarding age, sex, and average duration of pain prior to ESI. The degree of pain was significantly higher in LSS patients in comparison with HD patients in the pre-injection period. The amount of pain was significantly reduced in both groups 2 months after injection. This pain reduction period lasted for 6 months in the HD group, but to a lesser extent in LSS patients (P < 0.05.Discussion: Epidural methylprednisolone injection has less analgesic effect in LSS, with less permanent effect in comparison with HD.Keywords: methylprednisolone acetate, lumbar spinal stenosis, herniated disk

CT-discography in the evaluation of the post-operative lumbar spine. Preliminary results

Energy Technology Data Exchange (ETDEWEB)

Crenier, N; Greselle, J F; Richard, O; Houang, B; Pinol-Daubisse, H; Caille, J M; Vital, J M; Senegas, J

1988-06-01

Thirty-three patients with recurrent sciatica after lumbar-disk surgery were studied for recurrent herniated nucleus pulposus (HNP) by CT alone and CT-discography (CTD). Twenty-six patients underwent surgical reexploration allowing correlation with CTD. CTD made a correct diagnosis of recurrent HNP in twenty-one patients showing an extravasation of the contrast medium from the disk space into the medullary canal. In two cases CTD was positive for recurrent HNP but surgery showed only fibrosis. The amount of contrast leak was very small in these two cases along the posterior common longitudinal ligament, and the junction with the disk was very narrow. Because of their clinical presentation three patients with negative studies were operated upon. One showed only fibrosis and the two others showed an associated disk fragment. Among the twenty-one true-positive cases, seven showed a combination of recurrent HNP and scarring. Contamination of CSF by the contrast medium through the dura was observed in two patients. Although a prospective comparative study between CTD and IV-contrast-enhanced CT is necessary, CTD appears to be a useful diagnostic procedure for recurrent HNP after surgery of the lumbar spine.

Bullhorn Hernia: A Rare Traumatic Abdominal Wall Hernia

African Journals Online (AJOL)

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

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

Science.gov (United States)

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

2018-02-01

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

Cervical lung hernia

Science.gov (United States)

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

1974-01-01

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

Groin hernia subtypes are associated in patients with bilateral hernias

DEFF Research Database (Denmark)

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

2015-01-01

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

ADULT ABDOMINAL WALL HERNIA IN IBADAN.

African Journals Online (AJOL)

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

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

Science.gov (United States)

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

2010-01-01

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

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

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Salman Assad

2018-05-01

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

Preperitoneal approach to parastomal hernia with coexistent large incisional hernia.

Science.gov (United States)

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

2002-03-01

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

Short term outcome of posterior dynamic stabilization system in degenerative lumbar diseases

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Mingyuan Yang

2014-01-01

Conclusion: Dynamic stabilization system treating lumbar degenerative disease showed clinical benefits with motion preservation of the operated segments, but does not have the significant advantage on motion preservation at adjacent segments, to avoid the degeneration of adjacent intervertebral disk.

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)

Effects of improper posture during work on lumbal pain syndrome of discogenic etiology

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Eldad Kaljić

2011-04-01

Full Text Available Introduction: Lumbar pain syndrome is the most common cause of why patients, especially the active ones, are reported to physicians. It is manifested as nonspecific or non-radicular lumbar pain syndrome which is not associated with neurological symptoms, and specific which is associated with spinal nerve root compression. Aims of this study were to determine correlation between inadequate equipment and improper position for work with disk caused lumbar pain syndrome.Methods: The study included 913 patients who have visited the Community-based rehabilitation ambulance "Praxis" due to low back pain syndrome and verified disc hernia in the five year period. Lumbar pain syndrome was diagnosed by clinical examination (history, inspection, palpation, Lasegue sign, neurologic and motoric dysfunction tests, then radiologic diagnostic methods (CT, MRI. The data about inadequate equipment and position during work were obtained in interview with  patients.Results: Lumbar pain syndrome is most common among workers (268 or 29.35%, followed by officials (239 or 26.17%. With the conducted research we determine that all the patients had inadequate equipment and the position of labor and weak abdominal and spinal muscles.Conclusion: Based on research conducted through the before mentioned variables, we can determine not only the association, but a strong influence of inadequate equipment and improper position for work to the occurrence of disk caused lumbar pain syndrome.

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

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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.

Magnetic resonance imaging of lumbar spine

International Nuclear Information System (INIS)

Murakami, Takamichi; Fujita, Norihiko; Harada, Koushi; Kozuka, Takahiro

1989-01-01

Sixteen patients including 13 cases with disk herniation and 3 cases with spondylosis of lumbar spine were examined on a resistive MRI system operating at 0.1 T. All lesions were studied with both multiple spin echo (MSE) and low flip angle gradient echo (LF) techniques to evaluate which technique is more effective in detecting the disk degeneration and the indentation on subarachnoid space. MSE images were obtained with repetition time (TR) of 1100-1500 ms or cardiac gating, an echo time (TE) of 30, 60, 90, 120, 150, and 180 ms symmetrical 6 echoes, and total acquisition time of more than 281 sec. LF images were obtained with TR of 500, 250, and 100 ms, TE of 18 ms, a flip angle of 30 degree, and total acquisition time of 128 sec. Eleven lesions of spinal disk degeneration and 12 of indentation on subarachnoid space were detected with LF. On the other hand, 26 lesions of spinal disk degeneration and 38 of indentation on subarachnoid space were detected with MSE. Although the parameters of LF employed in this study were relatively effective to emphasize T2 * -based contrast, the ability of LF in detection of spinal disk degeneration and indentation on subarachnoid space is less than that of MSE. Signal contrast to noise ratios for normal disk and degenerative disk, epidural-fat and disk herniated material, CSF and disk herniated material, and epidural-fat and CSF were less than 4 with LF, but more than 4 with MSE. This difference of contrast to noise ratio between MSE and LF was one of the main causes of the difference of the detection rate of spinal disk degeneration and indentation on subarachnoid space. (author)

Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging

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Altinkaya, Naime [Baskent University Medical School, Department of Radiology, Adana (Turkey); Cekinmez, Melih [Baskent University Medical School Adana, Department of Neurosurgery, Adana (Turkey)

2016-01-15

To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P < 0.05). The MLD increased on the diseased side with symptom duration by lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P < 0.05). The cut-off values for the MLD measurements were 5.3 mm (sensitivity = 62.3 %, specificity = 55.5 %; P < 0.05). In groups A, B, and C, the median CSA of the multifidus muscle was not significantly different between the diseased and the normal side (P > 0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation. (orig.)

Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging

International Nuclear Information System (INIS)

Altinkaya, Naime; Cekinmez, Melih

2016-01-01

To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P < 0.05). The MLD increased on the diseased side with symptom duration by lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P < 0.05). The cut-off values for the MLD measurements were 5.3 mm (sensitivity = 62.3 %, specificity = 55.5 %; P < 0.05). In groups A, B, and C, the median CSA of the multifidus muscle was not significantly different between the diseased and the normal side (P > 0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation. (orig.)

Hernias (For Parents)

Science.gov (United States)

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

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

Science.gov (United States)

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

2011-10-01

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

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

Science.gov (United States)

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

2009-03-01

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

Ventral hernia repair

Science.gov (United States)

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

Effects of anatomic conformation on three-dimensional motion of the caudal lumbar and lumbosacral portions of the vertebral column of dogs.

Science.gov (United States)

Benninger, Monika I; Seiler, Gabriela S; Robinson, Leanne E; Ferguson, Stephen J; Bonél, Harald M; Busato, André R; Lang, Johann

2006-01-01

To determine the association between the 3-dimensional (3-D) motion pattern of the caudal lumbar and lumbosacral portions of the canine vertebral column and the morphology of vertebrae, facet joints, and intervertebral disks. Vertebral columns of 9 German Shepherd Dogs and 16 dogs of other breeds with similar body weights and body conditions. Different morphometric parameters of the vertebral column were assessed by computed tomography (CT) and magnetic resonance imaging. Anatomic conformation and the 3-D motion pattern were compared, and correlation coefficients were calculated. Total range of motion for flexion and extension was mainly associated with the facet joint angle, the facet joint angle difference between levels of the vertebral column in the transverse plane on CT images, disk height, and lever arm length. Motion is a complex process that is influenced by the entire 3-D conformation of the lumbar portion of the vertebral column. In vivo dynamic measurements of the 3-D motion pattern of the lumbar and lumbosacral portions of the vertebral column will be necessary to further assess biomechanics that could lead to disk degeneration in dogs.

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

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Prakash Kumar Sahoo

2017-10-01

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

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 ...

Etiology of Inguinal Hernias: A Comprehensive Review

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Stina Öberg

2017-09-01

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

Hydrotherapy performance in elderly patients with herniated disk: a literature review

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Suzileide Oliveira Costa

2018-01-01

Full Text Available Disk herniation (DH is a protrusion of the nucleus pulposus through the fibrous ring, arising because of trauma to the spine, which over time will damage the intervertebral discs. The objective of this work is to analyze the hydrotherapy effects on DH. It was done a descriptive analysis, with a bibliographic review on lumbar disc herniation, as well as its prevention measures, and developed and based on the analysis of scientific articles. Eleven articles were founded using the key-words disk herniation, physiotherapy and hydrotherapy on PubMed site. One of all obey to the inclusion propositions. In this way it concludes that the conservative treatment for lumbar disc herniation most indicated would be the hydrotherapy, because the physical properties of the water diminish the impact on the intervertebral discs due to the fluctuation causing a pain relief, thus providing a better quality of life to the patient.

Unilateral lumbar spondylolysis on radiography and MRI: emphasis on morphologic differences according to involved segment.

Science.gov (United States)

Park, Ji Seon; Moon, Sung Kyoung; Jin, Wook; Ryu, Kyung Nam

2010-01-01

The objective of our study was to retrospectively compare the radiography and MRI findings of unilateral spondylolysis in the upper lumbar segment and in the lower lumbar segment and to consider how these radiologic findings can be applied in the diagnosis of unilateral spondylolysis. Thirty patients with unilateral lumbar spondylolysis were categorized into one of two groups according to the lumbar levels involved with pars interarticularis defects: group A (L1, L2, and L3) or group B (L4 and L5). On radiographs, we evaluated contour bulging of the affected pars interarticularis, reactive sclerosis in the contralateral pedicle, anterolisthesis of the involved vertebra, and deviation of the spinous process. On MRI, we assessed pseudoarticulation of the pars interarticularis defect, uneven distribution of posterior epidural fat, the interspinous distance between adjacent segments, facet and disk degeneration in adjacent segments, and other anomalous changes. Among the 63 patients with unilateral spondylolysis, the upper lumbar segment was involved in 29 and the lower lumbar segment, in 34. Group A often displayed contour bulging of the affected pars interarticularis, reactive sclerosis of the contralateral pedicle, and contralateral deviation of the spinous process, all of which were easily detectable on radiography. Group B frequently showed anterolisthesis, pseudoarticulation of the pars interarticularis defect, adjacent facet-disk degeneration, and other anomalous changes that were well observed on MRI. Unilateral lumbar spondylolysis displayed radiologic differences in morphology of the isthmic defect itself and in ancillary findings of the adjacent structures based on the segment involved. Recognition of different ancillary features of unilateral spondylolysis with the use of a feasible diagnostic tool can be helpful for the diagnosis of cases in which a direct sign of isthmic defect is equivocal.

The Danish Inguinal Hernia Database

Directory of Open Access Journals (Sweden)

Friis-Andersen H

2016-10-01

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

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...

Imaging of the lumbar spine after diskectomy; Imagerie du rachis lombaire apres discectomie

Energy Technology Data Exchange (ETDEWEB)

Laredo, J.D.; Wybier, M. [Hopital Lariboisiere, 75 - Paris (France)

1995-12-31

The radiological investigation of persistent or recurrent sciatica after lumbar diskectomy essentially consists of demonstrating recurrent disk herniation. Comparison between plain and contrast enhanced CT or MR examinations at the level of the diskectomy is the main step of the radiological survey. The meanings of the various radiological findings are discussed. Other lesions that may induce persistent sciatica after lumbar diskectomy include degenerative narrowing of the lateral recess, spinal instability, stress fracture of the remaining neural arch, pseudo-meningomyelocele after laminectomy. (authors). 34 refs., 5 tabs.

Studies on the pathogenesis of degenerative lumbar canal stenosis by computed tomography, 2. Investigation about measurements of the lumbar canal

Energy Technology Data Exchange (ETDEWEB)

Kido, Kenji

1987-07-01

To evaluate the significance of measurement parameters for the lumbar canal (LC), a retrospective analysis was made of computed tomography (CT) scans in a total of 129 patients, including 20 with degenerative lumbar canal stenosis (DLCS), 65 with degenerative spondylosis, 21 with disc hernia, and 23 with lumbar pain. The shape of the transverse LC was not reflected by the anteroposterior and transverse diameters of LC, but was somewhat reflected by the transverse area of LC. The transverse area of dural sac (DS) was considered important in determining the degree of stenosis. Regarding the transverse area, the DS correlated more strongly with the LC with soft-tissue windows than that with bone windows. The angle of intervertebral joint was likely to be related to the pathophysiology of the LC. In particular, sagittal tendency was seen at the levels of L3-4 and L4-5 in the DLCS group. There was correlation between the angle of intervertebral joint and the transverse areas of both soft-tissue LC and DS at the levels of L4-5. A multivariate analysis suggested the possibility that the significance of measurement parameters might vary depending on the vertebral level for the lower lumbar spine. The following criteria for indicating DLCS were obtained: 1) a transverse area of less than or equal to 100 mm/sup 2/ for DS or less than or equal to 118 mm/sup 2/ for soft-tissue LC at the levels of L3-4; 2) a transverse area of less than or equal to 90 mm/sup 2/ for DS and an angle of less than or equal to 90 deg for the intervertebral joint at the levels of L4-5; and 3) lateral recess of less than or equal to 3 mm in anteroposterior diameter at the levels of L5-S1. (Namekawa, K.).

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...

Systemic and local collagen turnover in hernia patients

DEFF Research Database (Denmark)

Henriksen, Nadia A

2016-01-01

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

Incarcerated umbilical hernia in children.

Science.gov (United States)

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

2006-02-01

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

The rat intervertebral disk degeneration pain model: relationships between biological and structural alterations and pain.

Science.gov (United States)

Kim, Jae-Sung; Kroin, Jeffrey S; Li, Xin; An, Howard S; Buvanendran, Asokumar; Yan, Dongyao; Tuman, Kenneth J; van Wijnen, Andre J; Chen, Di; Im, Hee-Jeong

2011-01-01

Degeneration of the interverterbral disk is as a cause of low-back pain is increasing. To gain insight into relationships between biological processes, structural alterations and behavioral pain, we created an animal model in rats. Disk degeneration was induced by removal of the nucleus pulposus (NP) from the lumbar disks (L4/L5 and L5/L6) of Sprague Dawley rats using a 0.5-mm-diameter microsurgical drill. The degree of primary hyperalgesia was assessed by using an algometer to measure pain upon external pressure on injured lumbar disks. Biochemical and histological assessments and radiographs of injured disks were used for evaluation. We investigated therapeutic modulation of chronic pain by administering pharmaceutical drugs in this animal model. After removal of the NP, pressure hyperalgesia developed over the lower back. Nine weeks after surgery we observed damaged or degenerated disks with proteoglycan loss and narrowing of disk height. These biological and structural changes in disks were closely related to the sustained pain hyperalgesia. A high dose of morphine (6.7 mg/kg) resulted in effective pain relief. However, high doses of pregabalin (20 mg/kg), a drug that has been used for treatment of chronic neuropathic pain, as well as the anti-inflammatory drugs celecoxib (50 mg/kg; a selective inhibitor of cyclooxygenase 2 (COX-2)) and ketorolac (20 mg/kg; an inhibitor of COX-1 and COX-2), did not have significant antihyperalgesic effects in our disk injury animal model. Although similarities in gene expression profiles suggest potential overlap in chronic pain pathways linked to disk injury or neuropathy, drug-testing results suggest that pain pathways linked to these two chronic pain conditions are mechanistically distinct. Our findings provide a foundation for future research on new therapeutic interventions that can lead to improvements in the treatment of patients with back pain due to disk degeneration.

Complications in lumbar spine surgery: A retrospective analysis

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Luca Proietti

2013-01-01

Full Text Available Background: Surgical treatment of adult lumbar spinal disorders is associated with a substantial risk of intraoperative and perioperative complications. There is no clearly defined medical literature on complication in lumbar spine surgery. Purpose of the study is to retrospectively evaluate intraoperative and perioperative complications who underwent various lumbar surgical procedures and to study the possible predisposing role of advanced age in increasing this rate. Materials and Methods: From 2007 to 2011 the number and type of complications were recorded and both univariate, (considering the patients′ age and a multivariate statistical analysis was conducted in order to establish a possible predisposing role. 133 were lumbar disc hernia treated with microdiscetomy, 88 were lumbar stenosis, treated in 36 cases with only decompression, 52 with decompression and instrumentation with a maximum of 2 levels. 26 patients showed a lumbar fracture treated with percutaneous or open screw fixation. 12 showed a scoliotic or kyphotic deformity treated with decompression, fusion and osteotomies with a maximum of 7.3 levels of fusion (range 5-14. 70 were spondylolisthesis treated with 1 or more level of fusion. In 34 cases a fusion till S1 was performed. Results: Of the 338 patients who underwent surgery, 55 showed one or more complications. Type of surgical treatment ( P = 0.004, open surgical approach (open P = 0.001 and operative time ( P = 0.001 increased the relative risk (RR of complication occurrence of 2.3, 3.8 and 5.1 respectively. Major complications are more often seen in complex surgical treatment for severe deformities, in revision surgery and in anterior approaches with an occurrence of 58.3%. Age greater than 65 years, despite an increased RR of perioperative complications (1.5, does not represent a predisposing risk factor to complications ( P = 0.006. Conclusion: Surgical decision-making and exclusion of patients is not justified only

The Danish Inguinal Hernia database.

Science.gov (United States)

Friis-Andersen, Hans; Bisgaard, Thue

2016-01-01

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

[Morpho-functional characteristic of the lumbar area of the human vertebral column in the individuals with various degrees of lumbar lordosis (on the basis of three-dimensional computer modeling)].

Science.gov (United States)

Koveshnikov, V G; Mavrich, V V; Bolgova, E S

2008-01-01

This investigation was aimed at the evaluation of the borders of individual variability of the human lumbar spine lordosis. 224 nuclear magnetic tomograms of persons of mature age were analyzed using morphometric, statistical methods, method of three-dimensional (3D) computer modeling and finite-element analysis. During the investigation, a hardware-software complex for morphometric research was created together with the new method of development of 3D computer models of the lumbar spine. The application of 3D modeling allowed to extend the knowledge of human spine biomechanics. Tensions and deformations were calculated in all lumbar vertebrae and intervertebral disks on the basis of spine 3D models developed. Finite-element analysis proved that a normal angle of lumbar lordosis was optimal for the transmission of the adequate compression loads, while the extreme forms of individual variability (high degrees of hyper- and hypolordosis), by changing the geometry of the vertebral column, result in the decrease of the functionality of this system.

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....

[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.

Inguinal hernia recurrence: Classification and approach

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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.

Clinical and imaging characteristics of foraminal nerve root disorders of the lumbar spine

International Nuclear Information System (INIS)

Nishi, Tomio; Tani, Takayuki; Suzuki, Norio; Aonuma, Hiroshi

2009-01-01

We analyzed cases of lumbar nerve root compression at intervertebral foramina, by comparing 19 cases of foraminal stenosis (FS), and 38 cases of foraminal hernia (FH) with 21 cases of lumbar canal stenosis (LCS). Japan Orthopedic Association (JOA) scores, intervertebral disc degeneration, anatomical measurements of the nerve root foramina and the MRI findings were reviewed. The scores for pain in the lower extremities, and walking ability were both lowest in the FS group. The scores for low back pain, lower extremities, and sensory disturbances were lowest in the FH group. Anterior-posterior diameters of the nerve root foramina were smaller in the FS group and FH group than in the LCS group. More degenerated discs and short length of upper part of the nerve root foramina were seen in FS group than in the other groups. The MRI images of so-called black out nerve root foramina were positive in 63.6% of FS cases, 75% of FH cases. (author)

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

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

2016-01-01

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

Laparoscopic repair of large suprapubic hernias.

Science.gov (United States)

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

2017-09-01

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

Treatment and Controversies in Paraesophageal Hernia Repair

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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.

Modern diagnosis and treatment of hiatal hernias.

Science.gov (United States)

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

2017-12-01

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

Herniography off femoral, obturator and perineal hernias

International Nuclear Information System (INIS)

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

1985-01-01

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

Traumatic lung hernia

International Nuclear Information System (INIS)

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

2001-01-01

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

Medical image of the week: Bochdalek hernia

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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 ...

Unusual Presentation of Maydl's Hernia

African Journals Online (AJOL)

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

Failure to Launch: What the Rejection of Lumbar Total Disk Replacement Tells us About American Spine Surgery.

Science.gov (United States)

Hart, Robert A; DePasse, J Mason; Daniels, Alan H

2017-07-01

Spine surgeon survey. The objective was to investigate the failure of widespread adoption of lumbar total disk replacement (L-TDR) in the United States. L-TDR has been available for use in the United States since 2005. L-TDR has not gained wide acceptance as a treatment for degenerative disk disease despite substantial investments in product development and positive results in randomized controlled trials. Estimates of the number of L-TDR procedures performed in the United States from 2005 to 2010 were calculated using the Nationwide Inpatient Sample database. Insurance policies were assessed for L-TDR coverage through Internet search. Finally, an 18-question survey regarding surgeons' opinions toward L-TDR was distributed to the members of North American Spine Society. The estimated number of primary L-TDR procedures performed in the United States decreased from 3650 in 2005 to 1863 in 2010, whereas revision L-TDR procedures increased from 420 to 499. Of 14 major insurers, 11 (78.6%) do not cover L-TDR. In total, 613 spine surgeons responded to the survey. Over half of respondents (51.1%, 313/612) have performed L-TDR, although only 44.6% (136/305) of initial adopters currently perform the surgery. However, 81.5% (106/130) of those currently performing L-TDR have been satisfied with the results. When asked about their perceptions of L-TDR, 65.0% (367/565) indicated a lack of insurance coverage for L-TDR in their region, 54.9% (310/565) worry about long-term complications, and 52.7% (298/565) worry about the technical challenges of revision. Despite early enthusiasm for L-TDR, wide adoption has not occurred. A primary reason for this failure seems to be a lack of insurance coverage, despite intermediate-term clinical success. In addition, surgeons continue to express concerns regarding long-term outcomes and the technical difficulties of revision. This case study of a failed surgical innovation may signal increasing involvement of payers in clinical decision

Sonographic prevalence of groin hernias and adductor tendinopathy in patients with femoroacetabular impingement.

Science.gov (United States)

Naal, Florian D; Dalla Riva, Francesco; Wuerz, Thomas H; Dubs, Beat; Leunig, Michael

2015-09-01

Femoroacetabular impingement (FAI) is a common debilitating condition that is associated with groin pain and limitation in young and active patients. Besides FAI, various disorders such as hernias, adductor tendinopathy, athletic pubalgia, lumbar spine affections, and others can cause similar symptoms. To determine the prevalence of inguinal and/or femoral herniation and adductor insertion tendinopathy using dynamic ultrasound in a cohort of patients with radiographic evidence of FAI. Case series; Level of evidence, 4. This retrospective study consisted of 74 patients (36 female and 38 male; mean age, 29 years; 83 symptomatic hips) with groin pain and radiographic evidence of FAI. In addition to the usual diagnostic algorithm, all patients underwent a dynamic ultrasound examination for signs of groin herniation and tendinopathy of the proximal insertion of the adductors. Evidence of groin herniation was found in 34 hips (41%). There were 27 inguinal (6 female, 21 male) and 10 femoral (9 female, 1 male) hernias. In 3 cases, inguinal and femoral herniation was coexistent. Overall, 5 patients underwent subsequent hernia repair. Patients with groin herniation were significantly older than those without (33 vs 27 years, respectively; P = .01). There were no significant differences for any of the radiographic or clinical parameters. Tendinopathy of the proximal adductor insertion was detected in 19 cases (23%; 11 female, 8 male). Tendinopathy was coexistent with groin herniation in 8 of the 19 cases. There were no significant differences for any of the radiographic or clinical parameters between patients with or without tendinopathy. Patients with a negative diagnostic hip injection result were more likely to have a concomitant groin hernia than those with a positive injection result (80% vs 27%, respectively). Overall, 38 hips underwent FAI surgery with satisfactory outcomes in terms of score values and subjective improvement. The results demonstrate that groin

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

Science.gov (United States)

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

2013-05-01

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

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.

Abdominal wall hernias

DEFF Research Database (Denmark)

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

2016-01-01

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

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

Science.gov (United States)

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

2010-12-01

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

Abdominal wall hernias: computed tomography findings

International Nuclear Information System (INIS)

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

2005-01-01

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

An Unusual Trocar Site Hernia after Prostatectomy

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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.

Hernia Following Blunt Abdominal Trauma

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N Aghaie

2009-10-01

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

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...

Intrathecal ligaments and nerve root tension: possible sources of lumbar pain during spaceflight.

Science.gov (United States)

Kershner, David; Binhammer, Robert

2004-04-01

Lumbar intrathecal ligaments have recently been demonstrated to randomly bind dorsal nerve roots to the dura within the lumbar vertebral column. Lengthening of the vertebral column and associated lumbar back pain experienced by astronauts is common in microgravity. This study was designed to investigate the relationship of lumbar intrathecal ligaments in spinal lengthening as a possible mechanism for back pain. A two-part study was designed using 36 vertebral columns from embalmed cadavers. There were 12 vertebral columns studied in mid-sagittal section to demonstrate the possible movement of the spinal cord during lengthening of the vertebral column. The remainder were assessed for the amount of tension placed on a dorsal nerve root by the lumbar intrathecal ligament during lengthening of the vertebral column. The spinal cord moves in a cephalic direction approximately 2.8 mm with 4 cm lengthening of the vertebral column. During lengthening, a loss of thoracic and lordotic curvature was noted with an increase in disk height. Tension was significantly increased on the dorsal nerve roots being tethered by the lumbar intrathecal ligaments in comparison to non-tethered nerve roots during lengthening of the vertebral column. A significant amount of tension is placed on dorsal nerve roots tethered by intrathecal ligaments within the lumbar spine during spinal lengthening. These ligaments randomly bind dorsal nerve roots in the lumbar spine and may be involved in the back pain experienced by astronauts in microgravity.

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

An Elderly Male with Amyand’s Hernia

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Saema Said

2017-09-01

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

Colon Perforations Causing Morgagni Hernia Case

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Mustafa Ugur

2014-08-01

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

Variação de conduta cirúrgica em doença degenerativa da coluna lombar Variación de conducta quirúrgica en la enfermedad degenerativa de la columna lumbar Surgical decision making variation in degenerative lumbar spine

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Luís Felipe Pamplona Novaes

2009-03-01

ínico y exámenes de imagen adecuados (todos tuvieron acceso a las mismas informaciones y orientados a responder basados en su práctica clínica. Los casos fueron: discopatía con inestabilidad vertebral en un paciente joven; hernia de disco extrusa en paciente joven; estenosis canal vertebral múltiples niveles sin deformidad; estenosis canal múltiples niveles con cifoescoliosis degenerativa; hernia discal con artrosis facetaria. El análisis estadístico utilizado fue el test "t" de Student para comparar el factor especialidad y promedios de edad con las variables de tratamiento (significativo con p OBJECTIVE: to determine the surgical decision making variation in five degenerative lumbar spine clinical situations. Determine whether factor related to spinal surgeon training program, experience and age are determinants in surgical decision making for each case. METHODS: ten orthopedists and ten neurosurgeons from different ages were questioned about surgery indication, approach options, need for decompression, need for fusion with instrumentation or not for five degenerative lumbar spinal clinical scenarios. Information about history, examination and image studies (all examiners had the same information and oriented to answer thinking in their own experience. Cases presented: instability and disc disease in a Young patient; extruded lumbar hérnia in a young patient; multiple level spinal stenosis without deformity; multiple spinal stenosis with degenerative kyphoscoliosis; lumbar hernia with facet degeneration. Effects on training background and surgeon mean age on surgical decision making were analyzed using Student "t" test (p<0.05. RESULTS: mean age was 42.15 years (varying 29 to 56 years. Twelve (60% participants were from Sao Paulo while resting eight (40% were from other states. Significative variation was not observed. In a general manner, orthopedists recommend fusion and instrumentation more often then neurosurgeons, reaching significance for degenerative

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.

Observations on the treatment of lumbar disk disease in college football players.

Science.gov (United States)

Day, A L; Friedman, W A; Indelicato, P A

1987-01-01

Over a 4 year period, 12 college players were treated for diskogenic injury. The most common position affected was down-lineman. Symptoms consisted of low back and/or radicular pain. No players could recall the onset of symptoms relative to football activity; weightlifting was associated with symptoms in three cases. Tentative clinical diagnosis was herniated disk disease. Method of diagnosis in the athletic population is presented along with results of surgical treatment. Percutaneous diskectomy appears to be successful for disk herniations occurring at the L4-5 space or higher.

Magnetic resonance imaging of lumbar spine disc diseases. Frequency of false negatives; Imagerie par resonance magnetique pour pathologie discale lombaire. Frequence des faux-negatifs

Energy Technology Data Exchange (ETDEWEB)

Berthelot, J.M.; Maugars, Y.; Delecrin, Y.; Caillon, F.; Prost, A. [Hopital Hotel-Dieu de Nantes, 44 (France)

1995-10-01

Magnetic resonance imaging (MRI) has had an impressive impact on evaluation of degenerative diseases of the spine. Nevertheless, false negatives can occur on images involving lumbar discs. Degenerative disc diseases documented on discography and/or pathology examination of the discs can go unrecognized. Likewise sensitivity for the detection of protruding disc hernias is not totally satisfactory (20% false negatives). Finally, a magnetic resonance image visualizing displacement of the disc is not specific (10 to 15% false positives); images showing protrusion or hernia can be seen in 30% of asymptomatic patients. Although MRI gives slightly more information than other imaging techniques, false images do exist. Moreover, the usefulness of MRI to demonstrate disc disease in case of a negative CT-scan remains to be demonstrated. (authors). 26 refs.

Laparoscopic Repair of Inguinal Hernias

OpenAIRE

Carter, Jonathan; Duh, Quan-Yang

2011-01-01

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

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

DEFF Research Database (Denmark)

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

2014-01-01

randomised controlled trials. The primary purpose of this paper is to compare early post-operative activity-related pain in patients undergoing laparoscopic ventral hernia repair with closure of the gap with patients undergoing standard laparoscopic ventral hernia repair (non-closure of the gap). Secondary...... outcomes are patient-rated cosmesis and hernia-specific quality of life. METHODS: A randomised, controlled, double-blinded study is planned. Based on power calculation, we will include 40 patients in each arm. Patients undergoing elective laparoscopic umbilical, epigastric or umbilical trocar-site hernia...... repair at Hvidovre Hospital and Herlev Hospital, Denmark, are invited to participate. CONCLUSION: The gap closure technique may induce more post-operative pain than the non-closure repair, but it may also be superior with regard to other important surgical outcomes. No studies have previously...

Functional myelographic differentiation of lumbar bulging annulus

Energy Technology Data Exchange (ETDEWEB)

Park, Choong Ki; Kim, Hong Kil; Park, Sang Gyu; Lee, Young Jung; Yoon, Jong Sup [Hallym University College of Medicine, Seoul (Korea, Republic of)

1988-08-15

Herniated disk and bulging annulus are the major causes of lower back pain. It is necessary to differentiate bulging annulus from herniated disk because of their different methods of treatment. Myelography is one of the useful diagnostic methods for disk diseases even though advanced diagnostic modalities such as CT and MRI are more accurate. Functional myelography is not a new technology expect for two additional views, flexion and extension, are obtained with conventional myelography. Differentiation between bulging annulus and herniated disk by conventional myelography is based on the extent and multiplicity of extradural deformity of the contrast filled dural sac and neural sleeve as well as the changes of nerve root. There is no previous report about differential points between bulging annulus and herniated disk according to functional myelography. It is the purpose of this study to find any additional differential points on functional myelography between bulging annulus and herniated disk over convectional myelography. Authors analysed functional myelographic findings of 152 cases from July 1986 to July 1987. Among them, 22 cases who had been suffered from cervical abnormality or vague lower back pain were diagnosed as normal by myelography, and 30 cases of L4-5 herniated disk and 21 cases of L4-5 bulging annulus which had been finally diagnosed by operation were studied. The results were as follows. 1. In normal group, anterior epidural space was gradually widened from the upper lumbar vertebra downward. And anterior epidural space was more sidened at the disk level in extension view than in flexion except for L5-S1 lever. 2. In bulging annulus group, the shape of anterior epidural space in flexion state was as similar as normal. Anoterior epidural space in extension state was more sidened at the buldging annulus than normal, but lesser than herniated disk. 3. In herniated disk group, widening of anterior epidural space at the herniated disk level was

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

A rare case report of Morgagni Hernia with Organo-Axial Gastric Volvulus and concomitant Para-esophageal hernia, repaired laparoscopically in a Septuagenarian

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Amol Mittal

Full Text Available Introduction: Simultaneous occurrence of Morgagni and the Para-esophageal hernia is a rare clinical condition with eight case reports in the English-language literature and only four managed laparoscopically. We describe a case of a Septuagenarian patient with Morgagni and concomitant Para-esophageal hernia treated laparoscopically. Presentation of a case: A 71-year-old male patient, presented with a one-month history of regurgitation of acid, retrosternal burning and vomiting after eating. Computed tomography (CT imaging demonstrated a large anterior diaphragmatic hernia, with herniation of bowel loops and anterosuperior displacement of the gastric antrum along with a grade III Para-esophageal hernia. The patient underwent simultaneous laparoscopic repair of Morgagni and Para-esophageal hernia with mesh reinforcement with Nissen’s total anti-reflux fundoplication. The patient’s postoperative recovery was uneventful. Discussion: A Morgagni Hernia is a rare congenital condition consisting of a Subcosto-sternal defect in the diaphragm. A Para-esophageal hernia is a rare variant of a hiatus hernia. Morgagni and Para-esophageal hernia may present with gastric volvulus or incarceration, requiring emergency treatment. Minimally invasive surgery is the preferred treatment, particularly for elderly patients and patients with comorbidities. The laparoscopic operation can provide excellent exposure and repair the hernia defect easily with minimal invasiveness and fewer complications. Conclusion: This case report highlights the co-existence of Morgagni and Para-esophageal hernias and validates the feasibility of laparoscopic repair of both hernias simultaneously. Keywords: Diaphragmatic hernia, Morgagni, Para-esophageal hernia, Minimally invasive surgery, Fundoplication, Case report

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

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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.

Tearing of the left iliac vessels in lumbar surgery revealed by multiphase post-mortem CT-angiography (MPMCTA).

Science.gov (United States)

Vilariño Villaverde, Raquel; Bruguier, Christine; Zerlauth, Jean-Baptiste; De Froidmont, Sébastien; Grabherr, Silke

2016-05-01

Lumbar surgery is regularly applied in cases of discal hernia and acquired lumbar stenosis. In this report, we present a case of a laceration in the left common iliac artery and iliac vein during a lumbar surgery and discuss the literature concerning this kind of event. In the present case, the surgical procedure was followed by a sudden decrease in blood pressure, and the surgeon discovered an intra-abdominal haemorrhage that led to the patient's death. Postmortem investigation confirmed the intra-abdominal haemorrhage and revealed a laceration of the proximal portion of the left common iliac artery and left iliac vein. The source of bleeding could be detected especially thanks to multi-phase postmortem CT angiography (MPMCTA), which was performed prior to autopsy. We also found a haemorrhagic path through the intervertebral disc between the L4-L5 vertebrae, caused by the surgeon's instrument (pituitary rongeur). To date, a few cases have been described of iatrogenic death resulting from a tear in the iliac vessels during lumbar surgery, but not from the postmortem perspective. Such investigations have recently been modernized thanks to the introduction of forensic imaging. In particular, MPMCTA offers new possibilities in postmortem investigations and can be considered the new gold standard for investigating deaths related to medical intervention. Here we describe the first case of a death during lumbar surgery using this new method. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Sliding hiatal hernia in dogs

OpenAIRE

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

2010-01-01

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

Sigmoid Volvulus Through a Transmesenteric Hernia.

Science.gov (United States)

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

2017-06-01

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

Umbilical hernia repair - series (image)

Science.gov (United States)

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

Inguinal Hernia in Athletes: Role of Dynamic Ultrasound.

Science.gov (United States)

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

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

Do positive MRI findings in the lumbar spine predict future seeking care for low back pain in young teenagers?

DEFF Research Database (Denmark)

Kjær, Per; Leboeuf-Yde, Charlotte; Korsholm, Lars

Background: In MRI studies lumbar disk degeneration and endplate changes have been found in children and adolescents. Such MRI findings appear to be more strongly associated with LBP than in adults. However, this knowledge is mainly based on cross-sectional studies from which no inferences regarded......, nucleus form, annular tears, high intensity zones, bulging, herniation, nerve root compression, endplate changes, Modic changes, and spondylolisthesis). Associations were sought through logistic regression at each lumbar level for boys and girls separately. Statistically significant results were presented......, and annular tears and bulging at L4. Moderate predictors included reduced signal L1 and L4, disk herniation and nerve root compression L4. Other levels and findings showed no statistically significant associations. Interestingly, the areas with the fewest findings showed the strongest associations to seeking...

Bochdalek Hernia with Adult Diaphragmatic Agenesis

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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.

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.

Comparative Study of the Difference of Perioperative Complication and Radiologic Results: MIS-DLIF (Minimally Invasive Direct Lateral Lumbar Interbody Fusion) Versus MIS-OLIF (Minimally Invasive Oblique Lateral Lumbar Interbody Fusion).

Science.gov (United States)

Jin, Jie; Ryu, Kyeong-Sik; Hur, Jung-Woo; Seong, Ji-Hoon; Kim, Jin-Sung; Cho, Hyun-Jin

2018-02-01

Retrospective observatory analysis. The purpose of this study was to compare the incidence of perioperative complication, difference of cage location, and sagittal alignment between minimally invasive oblique lateral lumbar interbody fusion (MIS-OLIF) and MIS-direct lateral lumbar interbody fusion (DLIF) in the cases of single-level surgery at L4-L5. MIS-DLIF using tubular retractor has been used for the treatment of lumbar degenerative diseases; however, blunt transpsoas dissection poses a risk of injury to the lumbar plexus. As an alternative, MIS-OLIF uses a window between the prevertebral venous structures and psoas muscle. A total of 43 consecutive patients who underwent MIS-DLIF or MIS-OLIF for various L4/L5 level pathologies between November 2011 and April 2014 by a single surgeon were retrospectively reviewed. A complication classification based on the relation to surgical procedure and effect duration was used. Perioperative complications until 3-month postoperatively were reviewed for the patients. Radiologic results including the cage location and sagittal alignment were also assessed with plain radiography. There were no significant statistical differences in perioperative parameters and early clinical outcome between 2 groups. Overall, there were 13 (59.1%) approach-related complications in the DLIF group and 3 (14.3%) in the OLIF group. In the DLIF group, 3 (45.6%) were classified as persistent, however, there was no persistent complication in the OLIF group. In the OLIF group, cage is located mostly in the middle 1/3 of vertebral body, significantly increasing posterior disk space height and foraminal height compared with the DLIF group. Global and segmental lumbar lordosis was greater in the DLIF group due to anterior cage position without statistical significance. In our report of L4/L5 level diseases, the OLIF technique may decrease approach-related perioperative morbidities by eliminating the risk of unwanted muscle and nerve manipulations. Using

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

African Journals Online (AJOL)

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

The Danish Inguinal Hernia database

DEFF Research Database (Denmark)

Friis-Andersen, Hans; Bisgaard, Thue

2016-01-01

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

Two Ports Laparoscopic Inguinal Hernia Repair in Children

Directory of Open Access Journals (Sweden)

Medhat M. Ibrahim

2015-01-01

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

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

African Journals Online (AJOL)

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

Stomal Closure: Strategies to Prevent Incisional Hernia

Science.gov (United States)

Harries, Rhiannon L.; Torkington, Jared

2018-01-01

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

Stomal Closure: Strategies to Prevent Incisional Hernia

Directory of Open Access Journals (Sweden)

Rhiannon L. Harries

2018-04-01

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

Initial experience of laparoscopic incisional hernia repair.

Science.gov (United States)

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

2006-06-01

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

Paraduodenal hernia. A case report

International Nuclear Information System (INIS)

Irion, K.L.

1989-01-01

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

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

Science.gov (United States)

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

2014-04-01

We aimed to report the outcomes of inguinal hernia repair performed at Tan Tock Seng Hospital and compare them with those performed at dedicated hernia centres. We retrospectively analysed the medical records and telephone interviews of 520 patients who underwent inguinal hernia repair in 2010. The majority of the patients were male (498 [95.8%] men vs. 22 [4.2%] women). The mean age was 59.9 ± 15.7 years. Most patients (n = 445, 85.6%) had unilateral hernias (25.8% direct, 64.3% indirect, 9.9% pantaloon). The overall recurrence rate was 3.8%, with a mean time to recurrence of 12.0 ± 8.6 months. Risk factors for recurrence included contaminated wounds (odds ratio [OR] 50.325; p = 0.004), female gender (OR 8.757; p = 0.003) and pantaloon hernias (OR 5.059; p = 0.013). Complication rates were as follows: chronic pain syndrome (1.2%), hypoaesthesia (5.2%), wound dehiscence (0.4%), infection (0.6%), haematoma/seroma (4.8%), urinary retention (1.3%) and intraoperative visceral injury (0.6%). Most procedures were open repairs (67.7%), and laparoscopic repair constituted 32.3% of all the inguinal hernia repairs. Open repairs resulted in longer operating times than laparoscopic repairs (86.6 mins vs. 71.6 mins; p hospital stays (2.7 days vs. 0.7 days; p = 0.020) and a higher incidence of post-repair hypoaesthesia (6.8% vs. 1.8%; p = 0.018). However, there were no significant differences in recurrence or other complications between open and laparoscopic repair. A general hospital with strict protocols and teaching methodologies can achieve inguinal hernia repair outcomes comparable to those of dedicated hernia centres.

Influence of hiatal hernia on lower esophageal sphincter function.

Science.gov (United States)

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

1981-01-01

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

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

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Christianakis Efstratios

2009-01-01

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

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....

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

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Husam Vehbi

2016-06-01

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

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, ...

Radiographic observation of congenital diaphragmatic hernia

International Nuclear Information System (INIS)

Rhee, Chung Sik

1973-01-01

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

Radiographic observation of congenital diaphragmatic hernia

Energy Technology Data Exchange (ETDEWEB)

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

1973-12-15

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

One-stop endoscopic hernia surgery: efficient and satisfactory.

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

2015-06-01

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

CT discography for cervical soft disc hernia

Energy Technology Data Exchange (ETDEWEB)

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

1985-03-01

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

De Garengeot’s Hernia: Two Case Reports with Correct Preoperative Identification of the Vermiform Appendix in the Hernia

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Zhaosheng Jin

2016-01-01

Full Text Available We present two cases of incarcerated de Garengeot’s hernia. This anatomical phenomenon is thought to occur in as few as 0.5% of femoral hernia cases and is a rare cause of acute appendicitis. Risk factors include a long pelvic appendix, abnormal embryological bowel rotation, and a large mobile caecum. In earlier reports operative treatment invariably involves simultaneous appendicectomy and femoral hernia repair. Both patients were correctly diagnosed preoperatively with computed tomography (CT. Both had open femoral hernia repair, one with appendectomy and one with the appendix left in situ. Both patients recovered without complications. Routine diagnostic imaging modalities such as ultrasonography and standard CT have previously shown little success in identifying de Garengeot’s hernia preoperatively. We believe this to be the first documented case of CT with concurrent oral and intravenous contrast being used to confidently and correctly diagnose de Garengeot’s hernia prior to surgery. We hope that this case report adds to the growing literature on this condition, which will ultimately allow for more detailed case-control studies and systematic reviews in order to establish gold-standard diagnostic studies and optimal surgical management in future.

The Danish ventral hernia database

DEFF Research Database (Denmark)

Helgstrand, Frederik; Jorgensen, Lars Nannestad

2016-01-01

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

Association between thoracic aortic disease and inguinal hernia.

Science.gov (United States)

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

2014-08-21

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

Clinical study on 44 cases of femoral hernia

International Nuclear Information System (INIS)

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

2012-01-01

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

Rectal duplication with sciatic hernia.

Science.gov (United States)

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

2015-07-01

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

Computerized tomography of the lumbar vertebral column after intervertebral disk operation. Pt. 1

International Nuclear Information System (INIS)

Schindler, G.; Klott, K.

1984-01-01

Problems after intervertebral disk operations are to be expected in about 25-40% of the patients operated. Progressive degnerative alterations at the disks, the vertebrae and the intervertebral joints entail chronic mechanical pain resulting from the sensitive innervation of the structures mentioned, or lead in severe cases to the alteration of the epidural space respectively the spinal nerves with corresponding peripheral neurological symptoms. As post-surgical complications spondylodiscitis, spondylitis, haematomae, liquor fistulae, and split-off bone fragments can be the cause of complaints, for which computerized tomography is a better diagnostical method than myelography. (BWU) [de

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

Science.gov (United States)

Burcharth, Jakob

2014-05-01

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

An inguinal hernia sac tumor of extrahepatic cholangiocarcinoma origin

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Yamazaki Hidehiro

2006-03-01

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

Síndrome de la cola de caballo secundario a hernia discal traumática Horse-tail syndrome secondary to traumatic disc herniation

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Isael Olazábal Armas

2012-09-01

Full Text Available La cola de caballo representa la continuación caudal de la médula espinal. Esta porción del sistema nervioso es asiento de numerosas patologías. Se presenta un caso clínico que debutó de forma aguda con un síndrome de la cola de caballo, secundario a una hernia discal lumbar traumática. Se trata de un paciente masculino de 45 años de edad, que acude al servicio de urgencias, porque refiere síntomas que inician siete días antes de forma aguda y progresiva, luego de haber caído de una altura de tres metros. Al interrogarlo existía debilidad muscular del miembro inferior izquierdo y dificultad para caminar. El examen físico corroboró la disminución de la fuerza muscular y arreflexia Aquileo-plantar. Se realizó estudio de resonancia magnética, que demostró una hernia discal extruída en el interespacio L5-S1. El paciente se llevó al salón de urgencia y se realizó exeresis de la hernia. Egresó al séptimo día con discreta mejoría clínica. Se ha seguido en consulta externa durante un periodo de 8 meses, con muy poca recuperación del control esfinteriano, de la actividad motora y sensitiva.Horse-tail represents the caudal continuation of the spinal cord. This portion of the nervous system is the seat of numerous pathologies. We present a case report of acute debuted with a syndrome of the cauda equina, secondary to traumatic lumbar disc herniation. This is a male patient aged 45, who was admitted to the emergency room because he referred acute and progressive symptoms starting seven days before, after falling from three meters high. By questioning, we found muscle weakness in his left leg and difficulty at walking. The physical examination confirmed the decrease in muscle strength and Achilles-plantar areflexia. We performed MRI, which showed extruded disc herniation in L5-S1 interspace. The patient was taken to the emergency room and we performed the hernia excision. He was discharged at the seventh day with mild clinical

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

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Hakan Kulacoglu

2018-01-01

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

Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

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Avinash Chennamsetty

2015-01-01

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

Bias in the physical examination of patients with lumbar radiculopathy

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Katz Jeffrey N

2010-11-01

Full Text Available Abstract Background No prior studies have examined systematic bias in the musculoskeletal physical examination. The objective of this study was to assess the effects of bias due to prior knowledge of lumbar spine magnetic resonance imaging findings (MRI on perceived diagnostic accuracy of the physical examination for lumbar radiculopathy. Methods This was a cross-sectional comparison of the performance characteristics of the physical examination with blinding to MRI results (the 'independent group' with performance in the situation where the physical examination was not blinded to MRI results (the 'non-independent group'. The reference standard was the final diagnostic impression of nerve root impingement by the examining physician. Subjects were recruited from a hospital-based outpatient specialty spine clinic. All adults age 18 and older presenting with lower extremity radiating pain of duration ≤ 12 weeks were evaluated for participation. 154 consecutively recruited subjects with lumbar disk herniation confirmed by lumbar spine MRI were included in this study. Sensitivities and specificities with 95% confidence intervals were calculated in the independent and non-independent groups for the four components of the radiculopathy examination: 1 provocative testing, 2 motor strength testing, 3 pinprick sensory testing, and 4 deep tendon reflex testing. Results The perceived sensitivity of sensory testing was higher with prior knowledge of MRI results (20% vs. 36%; p = 0.05. Sensitivities and specificities for exam components otherwise showed no statistically significant differences between groups. Conclusions Prior knowledge of lumbar MRI results may introduce bias into the pinprick sensory testing component of the physical examination for lumbar radiculopathy. No statistically significant effect of bias was seen for other components of the physical examination. The effect of bias due to prior knowledge of lumbar MRI results should be considered

Bias in the physical examination of patients with lumbar radiculopathy

Science.gov (United States)

2010-01-01

Background No prior studies have examined systematic bias in the musculoskeletal physical examination. The objective of this study was to assess the effects of bias due to prior knowledge of lumbar spine magnetic resonance imaging findings (MRI) on perceived diagnostic accuracy of the physical examination for lumbar radiculopathy. Methods This was a cross-sectional comparison of the performance characteristics of the physical examination with blinding to MRI results (the 'independent group') with performance in the situation where the physical examination was not blinded to MRI results (the 'non-independent group'). The reference standard was the final diagnostic impression of nerve root impingement by the examining physician. Subjects were recruited from a hospital-based outpatient specialty spine clinic. All adults age 18 and older presenting with lower extremity radiating pain of duration ≤ 12 weeks were evaluated for participation. 154 consecutively recruited subjects with lumbar disk herniation confirmed by lumbar spine MRI were included in this study. Sensitivities and specificities with 95% confidence intervals were calculated in the independent and non-independent groups for the four components of the radiculopathy examination: 1) provocative testing, 2) motor strength testing, 3) pinprick sensory testing, and 4) deep tendon reflex testing. Results The perceived sensitivity of sensory testing was higher with prior knowledge of MRI results (20% vs. 36%; p = 0.05). Sensitivities and specificities for exam components otherwise showed no statistically significant differences between groups. Conclusions Prior knowledge of lumbar MRI results may introduce bias into the pinprick sensory testing component of the physical examination for lumbar radiculopathy. No statistically significant effect of bias was seen for other components of the physical examination. The effect of bias due to prior knowledge of lumbar MRI results should be considered when an isolated

Robotic Inguinal Hernia Repair: Technique and Early Experience.

Science.gov (United States)

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

2016-10-01

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

Distraction manipulation reduction of an L5-S1 disk herniation.

Science.gov (United States)

Cox, J M; Hazen, L J; Mungovan, M

1993-06-01

A computed tomography (CT)-confirmed L5-S1 disk protrusion is reported to be reduced following chiropractic adjustment, as seen on repeat CT scanning. Correlation of the CT reports with the patient's symptoms before and after manipulation is reported. A 38-yr-old female was treated for low back pain and right lower extremity first sacral dermatome sciatica. CT confirmed disk herniations at both the L4-L5 and L5-S1 levels were found. Motor weakness of the right gluteus maximus muscle was found and extremely tight hamstring muscles accompanying positive straight leg signs were elicited. A clinical and imaging diagnosis of an L5-S1 disk herniation was made. Distraction type chiropractic manipulation, electrical stimulation, exercises, nutrition advice and low back wellness class were administered with complete relief of sciatic pain and nearly complete relief of low back pain. Chiropractic distraction manipulation is an effective treatment of lumbar disk herniation, if the chiropractor is observant during its administration for patient tolerance to manipulation under distraction and any signs of neurological deficit demanding other types of care.

Postoperative lumbar MR imaging with contrast enhancement. Comparison between symptomatic and asymptomatic patients

International Nuclear Information System (INIS)

Grane, P.; Tullberg, T.; Rydberg, J.; Lindgren, L.

1995-01-01

Contrast-enhanced MR imaging of the spine after surgery for lumbar disk herniation almost always shows pathologic changes. To investigate to what extent these changes are correlated to patients' actual clinical symptoms, we compared the postoperative MR findings in 19 asymptomatic patients with 42 symptomatic patients (43 levels). The asymptomatic patients underwent MR examination one year after surgery. Twenty-six of the symptomatic patients underwent MR one year of less after surgery, and in 16 patients (17 levels) MR was performed more than one year after surgery. Sixteen percent of the asymptomatic and 42% of the symptomatic patients had disk herniation at the level of previous surgery. Most of the herniated disks were found in the symptomatic patients less than one year after surgery. The amount of epidural scar tissue, displacement and thickening of nerve roots, and compression of the dural sac were also studied. Disk herniation as a probable cause of recurrent sciatica was a common finding among symptomatic patients examined one year or less after surgery. In comparing asymptomatic patients and symptomatic patients with more than one year between surgery and MR examination, no significant radiologic differences, including disk herniation, were found. (orig.)

Postoperative lumbar MR imaging with contrast enhancement. Comparison between symptomatic and asymptomatic patients

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Grane, P. [Dept. of Neuroradiology, Karolinska Hospital, Stockholm (Sweden); Tullberg, T. [Dept. of Orthopaedics, St. Goeran`s Hospital, Stockholm (Sweden); Rydberg, J. [Dept. of Radiology, St. Goeran`s Hospital, Stockholm (Sweden); Lindgren, L. [Dept. of Neurosurgery, Karolinska Hospital, Stockholm (Sweden)

1995-05-01

Contrast-enhanced MR imaging of the spine after surgery for lumbar disk herniation almost always shows pathologic changes. To investigate to what extent these changes are correlated to patients` actual clinical symptoms, we compared the postoperative MR findings in 19 asymptomatic patients with 42 symptomatic patients (43 levels). The asymptomatic patients underwent MR examination one year after surgery. Twenty-six of the symptomatic patients underwent MR one year of less after surgery, and in 16 patients (17 levels) MR was performed more than one year after surgery. Sixteen percent of the asymptomatic and 42% of the symptomatic patients had disk herniation at the level of previous surgery. Most of the herniated disks were found in the symptomatic patients less than one year after surgery. The amount of epidural scar tissue, displacement and thickening of nerve roots, and compression of the dural sac were also studied. Disk herniation as a probable cause of recurrent sciatica was a common finding among symptomatic patients examined one year or less after surgery. In comparing asymptomatic patients and symptomatic patients with more than one year between surgery and MR examination, no significant radiologic differences, including disk herniation, were found. (orig.).

Hiatus Hernia as a Cause of Dysphagia.

Science.gov (United States)

Philpott, Hamish; Sweis, Rami

2017-08-01

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

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

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Maria Arafah

2011-01-01

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

Correlação do sinal de Lasègue e manobra da elevação da perna, retificada com os achados cirúrgicos em pacientes com ciatalgia portadores de hérnia discal lombar Correlación del signo de Lasègue y maniobra de elevación de la pierna recta con los resultados quirúrgicos en pacientes con ciática que tenían hernia lumbar discal Correlation of Lasègue sign and the straight-leg-raising test with surgical findings in patients with sciatica and lumbar disc herniation

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Jonatas Sanchez Fernandez

2012-01-01

Full Text Available OBJETIVO: Investigar a correlação entre as manobras de estiramento do nervo ciático, como o Teste de Lasègue (TL e o Teste de Elevação da Perna Estendida (TEPE, com os achados cirúrgicos nos pacientes com ciatalgia. MÉTODOS: 178 pacientes portadores de hérnia de disco lombar foram examinados previamente pelo autor através do TL e do TEPE. Os achados cirúrgicos foram anotados e comparados com os achados do exame clínico. RESULTADOS: Dos pacientes estudados, 162 (91% apresentaram TL positivo enquanto 118 (66,2% apresentaram a TEPE positivo. CONCLUSÃO: O TL foi a manobra diagnóstica pré-operatória mais sensível em correlação com a hérnia discal lombar.OBJETIVO: Investigar la correlación entre las maniobras de estiramiento del nervio ciático, como la Prueba de Lasègue (PL y la Prueba de Elevación de la Pierna Extendida (PEPE, con los resultados quirúrgicos en pacientes con ciática. MÉTODOS: 178 pacientes con hernia discal lumbar fueron examinados previamente por el autor mediante la PL y la PEPE. Los resultados quirúrgicos fueron registrados y comparados con los hallazgos en el examen clínico. RESULTADOS: De los pacientes estudiados, 162 (91% fueron positivos en la PL, mientras que 118 (66,2% presentaron PEPE positiva. CONCLUSIÓN: La PL fue la maniobra de diagnóstico preoperatorio más sensible en correlación con hernia discal lumbar.OBJECTIVE: To investigate the correlation between maneuversfor stretching the sciatic nerve, as the Lasègue Sign (LS and the Straight-Leg-Raising Test (SLRT, with surgical findings in patients with sciatica. METHODS: 178 patients with herniated lumbar disc were previously examined by the author through LS and SLRT. Surgical findings were recorded and compared with findings on clinical examination. RESULTS: Of the patients studied, 162 (91% had positive LS while 118 (66.2% were positive to SLRT. CONCLUSION: The LS was the most sensitive preoperative physical diagnostic test with respect

Complicated childhood inguinal hernias in UITH, Ilorin

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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.

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

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

2009-01-01

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

Association between CT-evaluated lumbar lordosis and features of spinal degeneration, evaluated in supine position

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Kalichman, Leonid; Li, Ling; Hunter, David; Been, Ella

2013-01-01

Background Context Few studies have directly evaluated the association of lumbar lordosis and segmental wedging of the vertebral bodies and intervertebral disks with prevalence of spinal degenerative features. Purpose To evaluate the association of CT-evaluated lumbar lordosis, segmental wedging of the vertebral bodies and that of the intervertebral disks with various spinal degeneration features. Study design This cross-sectional study was a nested project to the Framingham Heart Study. Sample A random consecutive subset of 191 participants chosen from the 3590 participants enrolled in the Framingham Heart Study who underwent multi-detector CT to assess aortic calcification. Outcome Measures Physiologic Measures Dichotomous variables indicating the presence of intervertebral disc narrowing, facet joint osteoarthritis, spondylolysis, spondylolisthesis and spinal stenosis and density (in Hounsfield units) of multifidus and erector spinae muscles were evaluated on supine CT, as well as the lordosis angle (LA) and the wedging of the vertebral bodies and intervertebral disks. Sum of vertebral bodies wedging (ΣB) and sum of intervertebral discs wedging (ΣD) were used in analyses. Methods Mean values (±SD) of LA, ΣB and ΣD were calculated in males and females and compared using the t-test. Mean values (±SD) of LA, ΣB and ΣD in 4 age groups: 0.05) with increasing age. LA showed statistically significant association with presence of spondylolysis (OR(95%CI): 1.08(1.02–1.14)) and with density of multifidus (1.06 (1.01–1.11). as well as a marginally significant association with isthmic spondylolisthesis (1.07(1.00–1.14). ΣB showed a positive association with degenerative spondylolisthesis and disc narrowing ((1.14(1.06–1.23) and 1.04 (1.00–1.08), correspondingly), whereas ΣD showed negative one (0.93(0.87–0.98) and (0.93(0.89–0.97), correspondingly). Conclusions Significant associations were found between lumbar lordosis evaluated in supine position

Microdiscectomia lombar tubular com o uso de seringas descartáveis de diâmetros progressivos: resultados cirúrgicos Microdiscectomía lumbar tubular con el uso de seringas desechables de diámetros progresivos: resultados quirúrgicos Tubular lumbar microdiscectomy using disposable syringes of progressive diameters: surgical results

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Diogo Valli Anderle

2010-06-01

Full Text Available OBJETIVO: descrever técnica minimamente invasiva para abordagem das hérnias discais com material de baixo custo. MÉTODOS: estudo prospectivo da avaliação dos resultados cirúrgicos de dez pacientes submetidos à microdiscectomia lombar tubular com uso de seringas descartáveis de diâmetros progressivos. RESULTADOS: utilizando os critérios de MacNab modificados, 60% dos pacientes apresentaram resultados considerados excelentes, 30% bons e 10% razoáveis. O tempo médio de cirurgia foi de 70 minutos e o de permanência hospitalar, de 14 horas. CONCLUSÃO: o uso de seringas descartáveis para microdiscectomia tubular foi seguro, de baixo custo e com resultados preliminares semelhantes aos da literatura para o tratamento minimamente invasivo da hérnia discal lombar.OBJETIVO: describir una técnica mínimamente invasiva para el abordaje de las hernias discales con material de bajo costo y de fácil acceso. MÉTODOS: estudio prospectivo de la evaluación de los resultados quirúrgicos de diez pacientes sometidos a una microdiscectomía lumbar utilizando jeringas desechables de diámetros progresivos. RESULTADOS: utilizando los criterios de MacNab cambiados, un 60% de los pacientes tuvieron resultados considerados como excelentes, el 30% buenos y el 10% razonables. El tiempo medio de cirugía fue 70 minutos y de permanencia en el hospital fue de 14 horas. CONCLUSIÓN: los resultados del estudio indican que la técnica es viable, de bajo costo y con resultados similares a los reportados en la literatura para el tratamiento mínimamente invasivo de la hernia discal lumbar.OBJECTIVE: to describe a minimally invasive technique to treat lumbar disc herniation with low-cost material. METHODS: this is a prospective evaluation of ten patients submitted to a tubular lumbar microdiscectomy with disposable syringes for herniated disc. The modified MacNab criteria were used to evaluate the surgical results. RESULTS: according to the modified Mac

Pain following the repair of an abdominal hernia

DEFF Research Database (Denmark)

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

2010-01-01

Pain and other types of discomfort are frequent symptoms following the repair of an abdominal hernia. After 1 year, the incidence of light to moderate pain following inguinal hernia repair is as high as 10% and 2% for severe disabling chronic pain. Postoperative chronic pain not only affects......, psychosocial characteristics, and surgical procedures) related to the postoperative pain conditions. Furthermore, the mechanisms for both acute and chronic pain are presented. We focus on inguinal hernia repair, which is the most frequent type of abdominal hernia surgery that leads to chronic pain. Finally...

Prognostic factors of congenital diaphragmatic hernia accompanied by cardiovascular malformation.

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

2013-08-01

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

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

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

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Asma Jabloun

2016-10-01

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

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

International Nuclear Information System (INIS)

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

2010-01-01

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

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

African Journals Online (AJOL)

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

Anterior perineal hernia after anterior exenteration

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Ka Wing Wong

2017-10-01

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

Studies on the pathogenesis of degenerative lumbar canal stenosis by computed tomography, 2

International Nuclear Information System (INIS)

Kido, Kenji

1987-01-01

To evaluate the significance of measurement parameters for the lumbar canal (LC), a retrospective analysis was made of computed tomography (CT) scans in a total of 129 patients, including 20 with degenerative lumbar canal stenosis (DLCS), 65 with degenerative spondylosis, 21 with disc hernia, and 23 with lumbar pain. The shape of the transverse LC was not reflected by the anteroposterior and transverse diameters of LC, but was somewhat reflected by the transverse area of LC. The transverse area of dural sac (DS) was considered important in determining the degree of stenosis. Regarding the transverse area, the DS correlated more strongly with the LC with soft-tissue windows than that with bone windows. The angle of intervertebral joint was likely to be related to the pathophysiology of the LC. In particular, sagittal tendency was seen at the levels of L3-4 and L4-5 in the DLCS group. There was correlation between the angle of intervertebral joint and the transverse areas of both soft-tissue LC and DS at the levels of L4-5. A multivariate analysis suggested the possibility that the significance of measurement parameters might vary depending on the vertebral level for the lower lumbar spine. The following criteria for indicating DLCS were obtained: 1) a transverse area of ≤ 100 mm 2 for DS or ≤ 118 mm 2 for soft-tissue LC at the levels of L3-4; 2) a transverse area of ≤ 90 mm 2 for DS and an angle of ≤ 90 deg for the intervertebral joint at the levels of L4-5; and 3) lateral recess of ≤ 3 mm in anteroposterior diameter at the levels of L5-S1. (Namekawa, K.)

Analgesia and sedation practices for incarcerated inguinal hernias in children.

Science.gov (United States)

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

2008-10-01

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

Algunas hernias abdominales anteriores

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Augusto Salazar Sánchez

1947-09-01

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

Coronal MR imaging of the normal 3rd, 4th, and 5th lumbar and 1st sacral nerve roots

International Nuclear Information System (INIS)

Hald, J.K.; Nakstad, P.H.; Hauglum, B.E.

1991-01-01

Seven healthy volunteers underwent coronal MR imaging at 1.5 tesla of the normal 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots. Coronal slices, 3-mm-thick with a 0.3-mm gap between the slices were obtained (TR/TE 600/22) through the lumbar spinal canal. All the nerve roots were visible on at least one image. One can routinely expect to demonstrate the 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots on T1-weighted, 3-mm-thick coronal MR scans. We found no correlation between the degree of lumbar lordosis and the lengths of the visible nerve roots. Five patients with one of the following spinal problems: anomaly, tumor, disk herniation, and failed back surgery syndrome were examined according to our protocol. In all these cases coronal MR imaging gave the correct diagnosis. (orig.)

Coronal MR imaging of the normal 3rd, 4th, and 5th lumbar and 1st sacral nerve roots

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Hald, J K; Nakstad, P H; Hauglum, B E [National Hospital, Oslo (Norway). Dept. of Radiology

1991-05-01

Seven healthy volunteers underwent coronal MR imaging at 1.5 tesla of the normal 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots. Coronal slices, 3-mm-thick with a 0.3-mm gap between the slices were obtained (TR/TE 600/22) through the lumbar spinal canal. All the nerve roots were visible on at least one image. One can routinely expect to demonstrate the 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots on T1-weighted, 3-mm-thick coronal MR scans. We found no correlation between the degree of lumbar lordosis and the lengths of the visible nerve roots. Five patients with one of the following spinal problems: anomaly, tumor, disk herniation, and failed back surgery syndrome were examined according to our protocol. In all these cases coronal MR imaging gave the correct diagnosis. (orig.).

A STUDY ON INCISIONAL HERNIA FOLLOWING OBSTETRICS AND GYNAECOLOGICAL SURGERIES

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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.

No differences in post-operative rehabilitation across municipalities in patients with lumbar disc herniation

DEFF Research Database (Denmark)

Paulsen, Rune Tendal; Bergholdt, Erik; Carreon, Leah

2015-01-01

decompressive surgery for lumbar disc herniation were identified. Changes in Oswestry disability index (ODI), EuroQol-5D (EQ-5D) and duration of sick leave were compared among the municipalities. RESULTS: Patient-reported outcome measures showed no statistical difference in ODI, EQ-5D or sick leave at the one...... between hospital and rehabilitation unit to ensure the best possible patient treatment. Further studies should focus on the effect of rehabilitation. FUNDING: not relevant. TRIAL REGISTRATION: not relevant........ This study examined rehabilitation in the 22 municipalities of the Region of Southern Denmark for patients with lumbar disk herniation. METHODS: A total of 22 physiotherapists answered a questionnaire regarding their rehabilitation programmes. The municipalities of 789 patients who had undergone...

MRI in differentiation between recurrent disk herniation and postoperative scar. Value of FLAIR sequences

International Nuclear Information System (INIS)

Capiel, Carlos A. h; Bouzas, Carlos A.; Porto, Viviana G.

2000-01-01

The differential diagnosis between epidural fibrosis and recurrent or residual disk herniation in symptomatic patients who have been operated is often difficult. The MRI with Spin Echo T1 sequences before and after i.v. gadolinium plays and important role in the differentiation of these two entities. The signal characteristics in T1 and T2 sequences are not reliable to distinguish between herniated disk and scar. In order to evaluate the use of the FLAIR technique in the differentiation between herniated disk and epidural fibrosis we used MRI to study 37 symptomatic patients who had been operated of lumbar disk herniation, with FSE-T2 sequences in axial and sagittal planes, FLAIR in axial sections and SE-T1 in sagittal and axial sections before and after i.v. gadolinium. This sequence was used as gold standard for the final diagnosis. We conclude that the FLAIR technique is a reliable alternative in the differential diagnosis between epidural fibrosis and herniated disk, providing a positive correlation to the SE-T1-weighted images with i.v. gadolinium in 100% of the patients. (author)

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

Science.gov (United States)

Keskin, Suat; Simşek, Cihan; Keskin, Zeynep

2013-01-01

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

Evaluation of a novel tool for bone graft delivery in minimally invasive transforaminal lumbar interbody fusion

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Kleiner JB

2016-05-01

Full Text Available Jeffrey B Kleiner, Hannah M Kleiner, E John Grimberg Jr, Stefanie J Throlson The Spine Center of Innovation, The Medical Center of Aurora, Aurora, CO, USA Study design: Disk material removed (DMR during L4-5 and L5-S1 transforaminal lumbar interbody fusion (T-LIF surgery was compared to the corresponding bone graft (BG volumes inserted at the time of fusion. A novel BG delivery tool (BGDT was used to apply the BG. In order to establish the percentage of DMR during T-LIF, it was compared to DMR during anterior diskectomy (AD. This study was performed prospectively. Summary of background data: Minimal information is available as to the volume of DMR during a T-LIF procedure, and the relationship between DMR and BG delivered is unknown. BG insertion has been empiric and technically challenging. Since the volume of BG applied to the prepared disk space likely impacts the probability of arthrodesis, an investigation is justified. Methods: A total of 65 patients with pathology at L4-5 and/or L5-S1 necessitating fusion were treated with a minimally invasive T-LIF procedure. DMR was volumetrically measured during disk space preparation. BG material consisting of local autograft, BG extender, and bone marrow aspirate were mixed to form a slurry. BG slurry was injected into the disk space using a novel BGDT and measured volumetrically. An additional 29 patients who were treated with L5-S1 AD were compared to L5-S1 T-LIF DMR to determine the percent of T-LIF DMR relative to AD. Results: DMR volumes averaged 3.6±2.2 mL. This represented 34% of the disk space relative to AD. The amount of BG delivered to the disk spaces was 9.3±3.2 mL, which is 2.6±2.2 times the amount of DMR. The BGDT allowed uncomplicated filling of the disk space in <1 minute. Conclusion: The volume of DMR during T-LIF allows for a predictable volume of BG delivery. The BGDT allowed complete filling of the entire prepared disk space. The T-LIF diskectomy debrides 34% of the disk

Management of giant paraesophageal hernia.

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Awais, O; Luketich, J D

2009-04-01

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

[Lumbar spondylosis].

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Seichi, Atsushi

2014-10-01

Lumbar spondylosis is a chronic, noninflammatory disease caused by degeneration of lumbar disc and/or facet joints. The etiology of lumbar spondylosis is multifactorial. Patients with lumbar spondylosis complain of a broad variety of symptoms including discomfort in the low back lesion, whereas some of them have radiating leg pain or neurologenic intermittent claudication (lumbar spinal stenosis). The majority of patients with spondylosis and stenosis of the lumbosacral spine can be treated nonsurgically. Nonsteroidal anti-inflammatory drugs and COX-2 inhibitors are helpful in controlling symptoms. Prostaglandin, epidural injection, and transforaminal injection are also helpful for leg pain and intermittent claudication. Operative therapy for spinal stenosis or spondylolisthesis is reserved for patients who are totally incapacitated by their condition.

Assessment of Lumbar Lordosis and Lumbar Core Strength in Information Technology Professionals.

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Mehta, Roma Satish; Nagrale, Sanket; Dabadghav, Rachana; Rairikar, Savita; Shayam, Ashok; Sancheti, Parag

2016-06-01

Observational study. To correlate lumbar lordosis and lumbar core strength in information technology (IT) professionals. IT professionals have to work for long hours in a sitting position, which can affect lumbar lordosis and lumbar core strength. Flexicurve was used to assess the lumbar lordosis, and pressure biofeedback was used to assess the lumbar core strength in the IT professionals. All subjects, both male and female, with and without complaint of low back pain and working for two or more years were included, and subjects with a history of spinal surgery or spinal deformity were excluded from the study. Analysis was done using Pearson's correlation. For the IT workers, no correlation was seen between lumbar lordosis and lumbar core strength (r=-0.04); however, a weak negative correlation was seen in IT people who complained of pain (r=-0.12), while there was no correlation of lumbar lordosis and lumbar core in IT people who had no complains of pain (r=0.007). The study shows that there is no correlation of lumbar lordosis and lumbar core strength in IT professionals, but a weak negative correlation was seen in IT people who complained of pain.

Incarcerated umbilical cord hernia containing the gallbladder

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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.

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

African Journals Online (AJOL)

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

Oblique lumbar spine radiographs: importance in young patients

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Libson, E.; Bloom, R.A.; Dinari, G.; Robin, G.C.

1984-04-01

Spondylolysis is a direct precursor of spondylolisthesis and can lead to crippling back pain. Of 1,743 patients surveyed, including 936 who were asymptomatic and 807 with back pain, 165 (including 91 who were asymptomatic and 74 with back pain) had spondylolysis, which was seen only on oblique lumbar views in 20% of cases. Because of the high false-negative rate of AP and lateral views, oblique views are essential in children and young adults. As spondylolysis is rare above L3, radiographs can be limited to L3-S1. Significantly less spondylolysis was seen in persons older than 30 with back pain usually caused by disk degeneration.

Oblique lumbar spine radiographs: importance in young patients

International Nuclear Information System (INIS)

Libson, E.; Bloom, R.A.; Dinari, G.; Robin, G.C.

1984-01-01

Spondylolysis is a direct precursor of spondylolisthesis and can lead to crippling back pain. Of 1,743 patients surveyed, including 936 who were asymptomatic and 807 with back pain, 165 (including 91 who were asymptomatic and 74 with back pain) had spondylolysis, which was seen only on oblique lumbar views in 20% of cases. Because of the high false-negative rate of AP and lateral views, oblique views are essential in children and young adults. As spondylolysis is rare above L3, radiographs can be limited to L3-S1. Significantly less spondylolysis was seen in persons older than 30 with back pain usually caused by disk degeneration

Gastric necrosis secondary to strangulated giant paraesophic hiatal hernia.

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Díez Ares, José Ángel; Peris Tomás, Nuria; Estellés Vidagany, Nuria; Periáñez Gómez, Dolores

2016-08-01

Asymptomatic giant hiatal hernia comprises a relatively common disease, mostly presented in women with 50 years onwards. The therapeutic approach remains controversial in recent years. Under the latest SAGES`revision, all the symptomatic hernias must be repaired, but the symptomatic hiatal hernia definition isn`t even now established. We present the case os a A 67 - year old woman with an asymptomatic hiatal hernia, that is admitted to our hospital owing to toracic and abdominal pain. This pain was related with food intake for 6 months. The patient presents a clear worsening in the last 24 hours, with no other asociated symptomatology. Suspecting an incarcerated hiatal hernia with stomach perforation, the patient is taken to theatre for a laparotomy during the early hours. An atypic gastrectomy of the greater curvature with a gastropexy is performed with fixation to the anterior abdominal wall. The surgery is completed with a feeding jejunostomy. The Manegement of giant paraesophagic hernias, still remains as one of the challenge of the esophageal surgeons.

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

DEFF Research Database (Denmark)

Andresen, Kristoffer; Bisgaard, Thue; Kehlet, Henrik

2014-01-01

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

Umbilical Hernia

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

Current evidence of percutaneous nucleoplasty for the cervical herniated disk: a systematic review.

Science.gov (United States)

Wullems, Jorgen A; Halim, Willy; van der Weegen, Walter

2014-07-01

Although percutaneous cervical nucleoplasty (PCN) has been shown to be both safe and effective, its application is still debated. PCN applied in disk herniation has not been systematically reviewed before, resulting in a limited insight into its effectiveness and safety, and the quality of available evidence. Therefore, we systematically reviewed the evidence on the efficacy and safety of PCN in patients with a (contained) herniated disk. MEDLINE, EMBASE, and the Cochrane Library (Central Register of Controlled Trials) were searched for randomized controlled trials (RCTs) and nonrandomized studies using the following keywords: "Nucleoplasty," "Cervical," "Hernia," "Herniation," "Prolapse," "Protrusion," "Intervertebral disk," and "Percutaneous disk decompression." First, all articles were appraised for methodological quality, and then, RCTs were graded for the level of evidence according a best-evidence synthesis, because a meta-analysis was not possible. Finally, the RCTs' applicability and clinical relevance also was assessed. Of 75 identified abstracts, 10 full-text articles were included (3 RCTs and 7 nonrandomized studies). These studies represented a total of 1021 patients: 823 patients (≥ 892 disks) were treated by PCN. All studies showed low methodological quality, except for two. The level of evidence of the RCTs was graded as moderate, with low to moderate applicability and clinical relevance. All included studies showed PCN to be an effective and safe procedure in the treatment of (contained) herniated disks at short-, mid-, and long-term follow-up. However, the level of evidence is moderate and shows only low to moderate applicability and clinical relevance. © 2013 World Institute of Pain.

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 ...

Clinical significance of gas myelography and CT gas myelography of the thoracic spine and the lumbar spine

International Nuclear Information System (INIS)

Yoshinaga, Haruhiko

1984-01-01

Basic and clinical applications relating to air myelography of the cervical spine have already been studied and extensively been used as an adjuvant diagnostic method for diseases of the spine and the spinal cord. However, hardly any application and clinical evaluation have been made concerning gas myelography of the thoracic spine and the lumbar spine. The author examined X-ray findings of 183 cases with diseases of the thoracic spine and the lumbar spine, including contral cases. Gas X-ray photography included simple profile, forehead tomography, sagittal plane, and CT section. Morphological characteristics of normal X-ray pictures of the throacic spine and the lumbar spine were explained from 54 control cases, and all the diameters of the subarachnoidal space from the anterior to the posterior part were measured. X-ray findings were examined on pathological cases, namely 22 cases with diseases of the throacic spine and 107 cases with diseases of the lumbar spine, and as a result these were useful for pathological elucidation of spinal cord tumors, spinal carries, yellow ligament ossification, lumbar spinal canal stenosis, hernia of intervertebral disc, etc. Also, CT gas myelography was excellent in stereoobservation of the spine and the spinal cord in spinal cord tumors, yellow ligament ossification, and spinal canal stenosis. On the other hand, it is not suitable for the diagnoses of intraspinal vascular abnormality, adhesive arachinitis, and running abnormality of the cauda equina nerve and radicle. Gas myelography of the thoracic spine and the lambar spine, is very useful in clinics when experienced techniques are used in photographic conditions, and diagnoses are made, well understanding the characteristics of gas pictures. Thus, its application has been opened to selection of an operative technique, determination of operative ranges, etc. (J.P.N.)

Clinical significance of gas myelography and CT gas myelography of the thoracic spine and the lumbar spine

Energy Technology Data Exchange (ETDEWEB)

Yoshinaga, Haruhiko (Tokyo Medical Coll. (Japan))

1984-05-01

Basic and clinical applications relating to air myelography of the cervical spine have already been studied and extensively been used as an adjuvant diagnostic method for diseases of the spine and the spinal cord. However, hardly any application and clinical evaluation have been made concerning gas myelography of the thoracic spine and the lumbar spine. The author examined X-ray findings of 183 cases with diseases of the thoracic spine and the lumbar spine, including contral cases. Gas X-ray photography included simple profile, forehead tomography, sagittal plane, and CT section. Morphological characteristics of normal X-ray pictures of the throacic spine and the lumbar spine were explained from 54 control cases, and all the diameters of the subarachnoidal space from the anterior to the posterior part were measured. X-ray findings were examined on pathological cases, namely 22 cases with diseases of the throacic spine and 107 cases with diseases of the lumbar spine, and as a result these were useful for pathological elucidation of spinal cord tumors, spinal carries, yellow ligament ossification, lumbar spinal canal stenosis, hernia of intervertebral disc, etc. Also, CT gas myelography was excellent in stereo observation of the spine and the spinal cord in spinal cord tumors, yellow ligament ossification, and spinal canal stenosis. On the other hand, it is not suitable for the diagnoses of intraspinal vascular abnormality, adhesive arachinitis, and running abnormality of the cauda equina nerve and radicle. Gas myelography of the thoracic spine and the lambar spine, is very useful in clinics when experienced techniques are used in photographic conditions, and diagnoses are made, well understanding the characteristics of gas pictures. Thus, its application has been opened to selection of an operative technique, determination of operative ranges, etc.

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

Science.gov (United States)

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

2015-09-16

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

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

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José Maximiliano Garófano-Jerez

2011-09-01

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

Sports Hernia: Diagnosis, Management and Operative Treatment

Science.gov (United States)

Emblom, Benton A.

2017-01-01

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

Management of chronic pain after hernia repair

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Andresen K

2018-04-01

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

Primary ventral or groin hernia in pregnancy

DEFF Research Database (Denmark)

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

2017-01-01

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

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

OpenAIRE

Modrzejewski, Andrzej; Śmietański, Maciej

2011-01-01

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

Nationwide quality improvement of groin hernia repair from the Danish Hernia Database of 87,840 patients from 1998 to 2005

DEFF Research Database (Denmark)

Kehlet, H.; Bay-Nielsen, M.

2008-01-01

BACKGROUND: Increased focus and research on surgical technique and anaesthesia in groin hernia repair have improved outcomes from centres of interest in hernia surgery, but little information is available from nationwide data to document the incorporation of scientific evidence into general...... rates, increased use of the Lichtenstein hernia technique, higher rate of outpatient surgery, near elimination of regional anaesthesia, and documentation and focus on incidence and mechanisms of chronic pain. CONCLUSION: Establishment of nationwide groin hernia databases leads to general improvement...... in outcomes and, due to the large number of patients, allows analyses of specific sub-groups or complications which otherwise could not be obtained from single centres. Nationwide collaboration is important for multi-centre research and further improvement of outcomes, especially in chronic pain...

Severe, recurrent hiatal hernia in schwartz syndrome

International Nuclear Information System (INIS)

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

2003-01-01

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

Video-assisted repair of cervical lung hernia.

Science.gov (United States)

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

2010-04-01

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

Effectiveness of a Rapid Lumbar Spine MRI Protocol Using 3D T2-Weighted SPACE Imaging Versus a Standard Protocol for Evaluation of Degenerative Changes of the Lumbar Spine.

Science.gov (United States)

Sayah, Anousheh; Jay, Ann K; Toaff, Jacob S; Makariou, Erini V; Berkowitz, Frank

2016-09-01

Reducing lumbar spine MRI scanning time while retaining diagnostic accuracy can benefit patients and reduce health care costs. This study compares the effectiveness of a rapid lumbar MRI protocol using 3D T2-weighted sampling perfection with application-optimized contrast with different flip-angle evolutions (SPACE) sequences with a standard MRI protocol for evaluation of lumbar spondylosis. Two hundred fifty consecutive unenhanced lumbar MRI examinations performed at 1.5 T were retrospectively reviewed. Full, rapid, and complete versions of each examination were interpreted for spondylotic changes at each lumbar level, including herniations and neural compromise. The full examination consisted of sagittal T1-weighted, T2-weighted turbo spin-echo (TSE), and STIR sequences; and axial T1- and T2-weighted TSE sequences (time, 18 minutes 40 seconds). The rapid examination consisted of sagittal T1- and T2-weighted SPACE sequences, with axial SPACE reformations (time, 8 minutes 46 seconds). The complete examination consisted of the full examination plus the T2-weighted SPACE sequence. Sensitivities and specificities of the full and rapid examinations were calculated using the complete study as the reference standard. The rapid and full studies had sensitivities of 76.0% and 69.3%, with specificities of 97.2% and 97.9%, respectively, for all degenerative processes. Rapid and full sensitivities were 68.7% and 66.3% for disk herniation, 85.2% and 81.5% for canal compromise, 82.9% and 69.1% for lateral recess compromise, and 76.9% and 69.7% for foraminal compromise, respectively. Isotropic SPACE T2-weighted imaging provides high-quality imaging of lumbar spondylosis, with multiplanar reformatting capability. Our SPACE-based rapid protocol had sensitivities and specificities for herniations and neural compromise comparable to those of the protocol without SPACE. This protocol fits within a 15-minute slot, potentially reducing costs and discomfort for a large subgroup of

Comparison of two surgical techniques in large incisional hernias

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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

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

African Journals Online (AJOL)

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

CT-diskography, diskomanometry and MR imaging as predictors of the outcome of lumbar percutaneous automated nucleotomy

Energy Technology Data Exchange (ETDEWEB)

Dullerud, R. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Radiology; Amundsen, T. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. Neurology; Lie, H. [Chrismed, Oslo (Norway); Juel, N.G. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Physical Medicine; Magnaes, B. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Neurosurgery

1995-11-01

This prospective study was performed to assess whether CT-diskography (CT-D), diskomanometry (DMM) including recording of the pain response, or the MR signal intensity of the disks are reliable predictors of the outcome of nucleotomy. Ninety-one patients, 44 females and 47 males aged 18-68 years (mean 37.4) treated at 99 disk levels were included. All had plain CT, MR imaging, CT-D and DMM performed prior to automated percutaneous nucleotomy with the Nucleotome R system. Sixity-nine (76%) of the patients responded well to treatment within 3 months. Due to recurrences, the success rate at 1 year was reduced to 65%. Except for better results following nucleotomy in patients with similar and identical pain as the presenting complaint provoked at diskography, no association was demonstrated between diskographic parameters, or loss of signal on MR, and the outcome. Better results were also seen in patients with a short history of disk disease, but not in patients with predominantly sciatica and focal hernias compared to those with predominantly low-back pain and diffuse posterior buldges. The results do not justify routine use of diskography prior to nucleotomy in patients with pathologic disks demonstrated by noninvasive methods and localizing sciatic pain. (orig./UG).

CT-diskography, diskomanometry and MR imaging as predictors of the outcome of lumbar percutaneous automated nucleotomy

International Nuclear Information System (INIS)

Dullerud, R.; Juel, N.G.; Magnaes, B.

1995-01-01

This prospective study was performed to assess whether CT-diskography (CT-D), diskomanometry (DMM) including recording of the pain response, or the MR signal intensity of the disks are reliable predictors of the outcome of nucleotomy. Ninety-one patients, 44 females and 47 males aged 18-68 years (mean 37.4) treated at 99 disk levels were included. All had plain CT, MR imaging, CT-D and DMM performed prior to automated percutaneous nucleotomy with the Nucleotome R system. Sixity-nine (76%) of the patients responded well to treatment within 3 months. Due to recurrences, the success rate at 1 year was reduced to 65%. Except for better results following nucleotomy in patients with similar and identical pain as the presenting complaint provoked at diskography, no association was demonstrated between diskographic parameters, or loss of signal on MR, and the outcome. Better results were also seen in patients with a short history of disk disease, but not in patients with predominantly sciatica and focal hernias compared to those with predominantly low-back pain and diffuse posterior buldges. The results do not justify routine use of diskography prior to nucleotomy in patients with pathologic disks demonstrated by noninvasive methods and localizing sciatic pain. (orig./UG)

Acute testicular ischemia caused by incarcerated inguinal hernia.

Science.gov (United States)

Orth, Robert C; Towbin, Alexander J

2012-02-01

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

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.

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

African Journals Online (AJOL)

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

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

Science.gov (United States)

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

2009-12-01

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

Association Between Thoracic Aortic Disease and Inguinal Hernia

OpenAIRE

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

2014-01-01

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

Presence of Inguinal Hernia in Soccer Players with Osteitis Pubis

Directory of Open Access Journals (Sweden)

Ali Eraslan

2017-11-01

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

Patient-Related Risk Factors for Recurrence After Inguinal Hernia Repair

DEFF Research Database (Denmark)

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

2015-01-01

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

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

Science.gov (United States)

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

2015-10-01

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

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

African Journals Online (AJOL)

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

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

Science.gov (United States)

Ohene-Yeboah, Michael; Beard, Jessica H; Frimpong-Twumasi, Benjamin; Koranteng, Adofo; Mensah, Samuel

2016-04-01

Inguinal hernia is thought to be common in rural Ghana, though no recent data exist on hernia prevalence in the country. This information is needed to guide policy and increase access to safe hernia repair in Ghana and other low-resource settings. Adult men randomly selected from the Barekese sub-district of Ashanti Region, Ghana were examined by surgeons for the presence of inguinal hernia. Men with hernia completed a survey on demographics, knowledge of the disease, and barriers to surgical treatment. A total of 803 participants were examined, while 105 participants completed the survey. The prevalence of inguinal hernia was 10.8 % (95 % CI 8.0, 13.6 %), and 2.2 % (95 % CI 0, 5.4 %) of participants had scars indicative of previous repair, making the overall prevalence of treated and untreated inguinal hernia 13.0 % (95 % CI 10.2, 15.7 %). Prevalence of inguinal hernia increased with age; 35.4 % (95 % CI 23.6, 47.2 %) of men aged 65 and older had inguinal hernia. Untreated inguinal hernia was associated with lower socio-economic status. Of those with inguinal hernia, 52.4 % did not know the cause of hernia. The most common reason cited for failing to seek medical care was cost (48.2 %). Although inguinal hernia is common among adult men living in rural Ghana, surgical repair rates are low. We propose a multi-faceted public health campaign aimed at increasing access to safe hernia repair in Ghana. This approach includes a training program of non-surgeons in inguinal hernia repair headed by the Ghana Hernia Society and could be adapted for use in other low-resource settings.

LUMBAR CORSETS CAN DECREASE LUMBAR MOTION IN GOLF SWING

Directory of Open Access Journals (Sweden)

Koji Hashimoto

2013-03-01

Full Text Available Swinging a golf club includes the rotation and extension of the lumbar spine. Golf-related low back pain has been associated with degeneration of the lumbar facet and intervertebral discs, and with spondylolysis. Reflective markers were placed directly onto the skin of 11young male amateur golfers without a previous history of back pain. Using a VICON system (Oxford Metrics, U.K., full golf swings were monitored without a corset (WOC, with a soft corset (SC, and with a hard corset (HC, with each subject taking 3 swings. Changes in the angle between the pelvis and the thorax (maximum range of motion and angular velocity in 3 dimensions (lumbar rotation, flexion-extension, and lateral tilt were analyzed, as was rotation of the hip joint. Peak changes in lumbar extension and rotation occurred just after impact with the ball. The extension angle of the lumbar spine at finish was significantly lower under SC (38° or HC (28° than under WOC (44° conditions (p < 0.05. The maximum angular velocity after impact was significantly smaller under HC (94°/sec than under SC (177°/sec and WOC (191° /sec conditions, as were the lumbar rotation angles at top and finish. In contrast, right hip rotation angles at top showed a compensatory increase under HC conditions. Wearing a lumbar corset while swinging a golf club can effectively decrease lumbar extension and rotation angles from impact until the end of the swing. These effects were significantly enhanced while wearing an HC

Connective tissue alteration in abdominal wall hernia

DEFF Research Database (Denmark)

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

2011-01-01

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

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.

The influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination during weightlifting.

Science.gov (United States)

Hu, Boyi; Ning, Xiaopeng

2015-01-01

Lumbar muscle fatigue is a potential risk factor for the development of low back pain. In this study, we investigated the influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination patterns during weightlifting. Each of the 15 male subjects performed five repetitions of weightlifting tasks both before and after a lumbar extensor muscle fatiguing protocol. Lumbar muscle electromyography was collected to assess fatigue. Trunk kinematics was recorded to calculate lumbar-pelvic continuous relative phase (CRP) and CRP variability. Results showed that fatigue significantly reduced the average lumbar-pelvic CRP value (from 0.33 to 0.29 rad) during weightlifting. The average CRP variability reduced from 0.17 to 0.15 rad, yet this change ws statistically not significant. Further analyses also discovered elevated spinal loading during weightlifting after the development of lumbar extensor muscle fatigue. Our results suggest that frequently experienced lumbar extensor muscle fatigue should be avoided in an occupational environment. Lumbar extensor muscle fatigue generates more in-phase lumbar-pelvic coordination patterns and elevated spinal loading during lifting. Such increase in spinal loading may indicate higher risk of back injury. Our results suggest that frequently experienced lumbar muscle fatigue should be avoided to reduce the risk of LBP.

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

Science.gov (United States)

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

2013-01-01

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

Incidence of Incisional Hernia after Cesarean Delivery

DEFF Research Database (Denmark)

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

2014-01-01

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

Recurrence and complications of pediatric inguinal hernia repair ...

African Journals Online (AJOL)

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

The experience of surgical treatment of hiatal hernia with laparoscopic access

Directory of Open Access Journals (Sweden)

V.M. Ratchik

2017-09-01

Full Text Available Background. Diagnosis and treatment of hiatal hernia — one of the most pressing problems of modern medicine. The objective of the study is to present the experience of surgical treatment of hiatal hernia with laparoscopic access. Materials and methods. 67 patients with hiatal hernia underwent surgical treatment with laparoscopic access in the department of digestive of SI “Institute of Gastroenterology of the NAMS of Ukraine” for the period of 2013–2017. Results. Hiatal hernia type I was diagnosed in 60 (88.2 % patients, hiatal hernia type II — in 7 (10.4 % patients, mixed hiatal hernia with short esophagus — in 1 (1.5 % patient. Hernia cruroplasty was performed in 100 % patients with hiatal hernia: posterior cruroplasty — in 60 (89.6 % patients, anterior cruroplasty — in 2 (2.9 % patients, сombined cruroplasty — in 5 (7.5 % patients, alloplasty with cruroplasty — in 6 (8.9 % patients. We used the following options of laparoscopic fundoplication in patients with hiatal hernia: Nissen fundoplication — in 46 (68.7 %, Dor fundoplication — in 7 (10.4 % patients, Toupet fundoplication — in 14 (20.9 % patients. Fixing the cuff to the diaphragm crus were performed in 61 (91.0 % patients. Deaths after surgery were not registered. Conclusions. The results of the study indicate the high efficacy of laparoscopic access in the surgical treatment of patients with hiatal hernia.

Hiatal Hernia

Science.gov (United States)

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

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

Science.gov (United States)

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

2018-03-01

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

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.

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

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Suat Keskin

2013-01-01

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

Celiac artery compression syndrome with bilateral Bochdalek hernia

International Nuclear Information System (INIS)

Kara, K.; Verim, S.; Bozkurt, Y.; Tasar, M.

2012-01-01

Full text: Introduction: Celiac artery compression syndrome or median arcuate ligament syndrome is rare and controversial condition. The definition of the syndrome relies on a combination of both clinical and radiographic features. It typically occurs in young patients, who may present with epigastric pain and weight loss. Bochdalek hernia is the most common congenital diaphragmatic hernia in adults. Bilaterality of this pathology is rare. There are not many reports about the associated pathologies to Bochdalek hernia. Objectives and tasks: We aimed to demonstrate the computed tomography (CT) angiography findings of celiac artery compression syndrome with Bochdalek hernia that has detected incidentally. Materials and methods: A CT angiography was performed to 32-year-old patient having postphelebitic syndrome for the possible diagnosis as pulmonary embolus. Results: At the imaging pulmonary arteries and the branches were normal. Celiac artery compression syndrome with Bochdalek Hernia was detected incidentally. A %75 stenosis at the origin of celiac artery and post stenotic dilatation after the stenosis was seen due to the compression. A poster medial defect at the diaphragm was seen as an additional finding for the cause of Bochdalek hernia. Conclusion: Many incidental finding can be detected at vascular and non vascular area in the routine CT angiography imaging. The pathologies like celiac artery compression syndrome and congenital diaphragm pathologies can be detected easily at CT angiography method

Laparoscopic repair of Morgagni diaphragmatic hernia in infants ...

African Journals Online (AJOL)

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

Femoral hernia repair

Science.gov (United States)

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

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

Science.gov (United States)

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

2015-02-01

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

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

Science.gov (United States)

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

2013-01-01

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

Update on Bioactive Prosthetic Material for the Treatment of Hernias.

Science.gov (United States)

Edelman, David S; Hodde, Jason P

2011-12-01

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

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.

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

Science.gov (United States)

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

2005-01-29

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

Lichtenstein versus Onstep for inguinal hernia repair

DEFF Research Database (Denmark)

Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob

2013-01-01

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

Pre-operative pain and sensory function in groin hernia

DEFF Research Database (Denmark)

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

2009-01-01

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

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

Science.gov (United States)

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

2017-08-01

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

Pattern of abdominal wall herniae in females: a retrospective analysis

African Journals Online (AJOL)

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

Magnetic resonance imaging for diagnostic evaluation of hernia of an invertebral disk

International Nuclear Information System (INIS)

Beyer, H.K.; Oppel, G.; Bluemm, R.; Uhlenbrock, D.

1988-01-01

The article reports experience gained within three years with diagnostic NMR imaging of the lumbar spine. On the basis of results obtained by almost 500 examinations, an optimisation concept with regard to measuring sequences and orientation of sectional cuts is presented. Imaging of the spine in three planes, with sectional layer thickness between 3 and 5 mm, using a 1.5 Tesla system, seems to yield the diagnostic optimum, and in our opinion is superior over invasive myelography and CT scanning. A prospective study we made indicates a hit rate of 97.2%, and of 100% for evaluation of the results obtained with the 1.5 Tesla system together with an evaluation of the paraxial sections. The magnetic field intensity of 1.5 Tesla especially improves the quality of images of paraxial cuts as compared with the 0.5 Tesla field system, due to the better contrast-to-noise ratio, and thinner sections. (orig.) [de

Long-term follow-up results of umbilical hernia repair.

Science.gov (United States)

Venclauskas, Linas; Jokubauskas, Mantas; Zilinskas, Justas; Zviniene, Kristina; Kiudelis, Mindaugas

2017-12-01

Multiple suture techniques and various mesh repairs are used in open or laparoscopic umbilical hernia (UH) surgery. To compare long-term follow-up results of UH repair in different hernia surgery groups and to identify risk factors for UH recurrence. A retrospective analysis of 216 patients who underwent elective surgery for UH during a 10-year period was performed. The patients were divided into three groups according to surgery technique (suture, mesh and laparoscopic repair). Early and long-term follow-up results including hospital stay, postoperative general and wound complications, recurrence rate and postoperative patient complaints were reviewed. Risk factors for recurrence were also analyzed. One hundred and forty-six patients were operated on using suture repair, 52 using open mesh and 18 using laparoscopic repair technique. 77.8% of patients underwent long-term follow-up. The postoperative wound complication rate and long-term postoperative complaints were significantly higher in the open mesh repair group. The overall hernia recurrence rate was 13.1%. Only 2 (1.7%) patients with small hernias ( 30 kg/m 2 , diabetes and wound infection were independent risk factors for umbilical hernia recurrence. The overall umbilical hernia recurrence rate was 13.1%. Body mass index > 30 kg/m 2 , diabetes and wound infection were independent risk factors for UH recurrence. According to our study results, laparoscopic medium and large umbilical hernia repair has slight advantages over open mesh repair concerning early postoperative complications, long-term postoperative pain and recurrence.

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

African Journals Online (AJOL)

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

Obturator Hernia: A Rare Case of Acute Mechanical Intestinal Obstruction

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Ibrahim Aydin

2013-01-01

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

Laparoscopic inguinal hernia repair: review of 6 years experience.

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

2001-01-01

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

[Laparoscopic approach in large hiatal hernia--particular considerations].

Science.gov (United States)

Munteanu, R; Copăescu, C; Iosifescu, R; Timişescu, Lucia; Dragomirescu, C

2003-01-01

Large hiatal hernia are associated with permanent or intermittent protrusion of more than 1/3 of the stomach into the chest, single or in associated with other organs, a hiatal defect greater than 5 cm and various complications related to the morphological and physiological modifications. While the laparoscopic approach in small hiatal hernia and gastro-esophageal reflux disease is a standard procedure in large hiatal hernia persists a number of questions and controversies. Between 1995 and 2002 a number of 23 patients with large hiatal hernia (9 men, 14 women), mean age 65.8 years (range 49 to 77) underwent laparoscopic surgery. The majority of the patients had complications of the disease (dysphagia, severe esophagitis, anemia, respiratory and cardiac failure). In 16 cases was a sliding hernia (one recurrent after open procedure), in 2 paraesophageal and in 5 a mixed hernia (two "upside-down" type). In 7 cases we perform, in the same operation, cholecystectomy for gallbladder stones and in one cases Heller myotomy for achalasia. In all cases the repairs was performed by using interrupted stitches to approximate the crurae, but in three of them (recurrent and upside down hernia) we consider necessary to repair with a polypropylene mesh (10 x 5 cm) with a "keyhole" for the esophagus. In these particular cases we do not perform a antireflux procedure, in others 20 cases a short floppy Nissen was done. During the operation one patient developed a left pneumothorax and required pleural drainage. Postoperatively one patient had dysphagia treated by pneumatic dilatation and another die 3 weeks after the surgery because severe respiratory and cardiac failure. Laparoscopic approach is a feasible and effective procedure with good postoperatively results, but required good skills in mininvasive technique.

Laparoscopic approach to incarcerated inguinal hernia in children.

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Kaya, Mete; Hückstedt, Thomas; Schier, Felix

2006-03-01

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

Effect of aging and lumbar spondylosis on lumbar lordosis

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Francis Osita Okpala

2018-01-01

Full Text Available Background: Lumbar lordosis (LL, the anterior convexity of the lumbar spine in the mid-sagittal plane, gives the spine some resilience and helps in protecting it from compressive forces because some of the force is taken by the anterior longitudinal ligaments. In aging and lumbar spondylosis, the intervertebral discs undergo the same degenerative changes though at different rates, and in both, while some authors reported a straightening of LL, others reported no significant change. This morphologic information would hopefully influence therapeutic decision-making, particularly in lumbar spondylosis, which though usually asymptomatic, is a common cause of low back pain. Aim: The aim of the study was to investigate the effect of aging and lumbar spondylosis on LL. Subjects and Methods: Lumbosacral joint angle (LSJA, an angular measure of LL, was retrospectively measured in 252 normal and 329 spondylotic adolescent and adult supine lateral lumbosacral spine archival radiographs, and data were analyzed with IBM SPSS Statistics 23.0 (New York, USA. Results: Normal LSJA range was 5°–39°; the mean was 18.7° and showed insignificant variation with gender and aging. Spondylotic range was 5°–40° and the mean (20.8° differed from the normal mean by about 2°, which probably have inconsequential effect on the lumbar curvature, suggesting that the normal and spondylotic mean values are essentially equal. The spondylotic mean also showed insignificant variation with aging and inconsequential 1° gender difference in favor of females. Conclusion: LL is substantially maintained in aging and lumbar spondylosis.

Chronic diaphragmatic hernia in 34 dogs and 16 cats.

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Minihan, Anne C; Berg, John; Evans, Krista L

2004-01-01

Medical records of 34 dogs and 16 cats undergoing surgical repair of diaphragmatic hernia of >2 weeks' duration were reviewed, and long-term follow-up information was obtained. The most common clinical signs were dyspnea and vomiting; however, many of the animals were presented for nonspecific signs such as anorexia, lethargy, and weight loss. Thoracic radiographs revealed evidence of diaphragmatic hernia in only 66% of the animals, and additional imaging tests were often needed to confirm the diagnosis. Thirty-six hernias were repaired through a midline laparotomy; 14 required a median sternotomy combined with a laparotomy. In 14 animals, division of mature adhesions of the lungs or diaphragm to the herniated organs was necessary to permit reduction of the hernia. Fourteen animals required resection of portions of the lungs, liver, or intestine. All hernias were sutured primarily without the use of tissue flaps or mesh implants. Twenty-one of the animals developed transient complications in the postoperative period; the most common of these was pneumothorax. The mortality rate was 14%. Thirty-four (79%) of the animals that were discharged from the hospital had complete resolution of clinical signs, and none developed evidence of recurrent diaphragmatic hernia during the follow-up period. Nine were lost to follow-up.

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

African Journals Online (AJOL)

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

Congenital paraesophageal hiatus hernia with gastric volvulus

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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.

Abdominal wall hernias: imaging with spiral CT

International Nuclear Information System (INIS)

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

2000-01-01

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

Complaints of the lumbar spine: The value of myelography and computerized tomography

International Nuclear Information System (INIS)

Rittmeyer, K.; Dralle, A.

1988-01-01

In the radiological examination of the lumbar spine and vertebral canal there are currently two methods of choice, computer tomography and myelography. Comparing the advantages of one method over another reveals that computer tomography is particularly useful in especially diagnosing a lateral process of the intervertebral disk, whereas myelography is especially applicable in the case of an intervertebrals disk prolapse within the narrow confines of the spinal canal proper. Myelography also has the additional advantage of visualizing a number of segments at once, although repeated use increases the risk of arachnitis despite the high tolerance of current contrast medium. However, myelography should be performed, if there is clinical evidence of nerve root compression even though the computer tomography was negative. The reverse is also true. Myelography is also useful initially, due to the lower radiation dosis, if the clinical symptoms don't allow a specific localisation of the process. (orig.) [de

Bilateral Morgagni Hernia: A Unique Presentation of a Rare Pathology

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Michael Leshen

2016-01-01

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

Factors Influencing Choice of Inguinal Hernia Repair Technique ...

African Journals Online (AJOL)

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

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

African Journals Online (AJOL)

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

Inguinal hernia repair in the Amsterdam region 1994-1996.

Science.gov (United States)

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

2001-03-01

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

Surgical treatment for giant incisional hernia

DEFF Research Database (Denmark)

Eriksson, A; Rosenberg, J; Bisgaard, T

2014-01-01

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

Bowel obstruction in obturator hernia: A challenging diagnosis

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L. Conti

2018-01-01

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

Transdiaphragmatic intercostal hernia: imaging aspects in three cases

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Ana Carolina Sandoval Macedo

2013-06-01

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

Laparoscopic repair of Morgagni diaphragmatic hernia in children ...

African Journals Online (AJOL)

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

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

Science.gov (United States)

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

2015-01-01

A De Garengeot's hernia is the very rare dual pathology of a vermiform appendix within a femoral hernia. We discuss the rare case of a 62 year old female who presented as an emergency with a strangulated femoral hernia. Within the hernia sac a partly necrotic vermiform appendix was discovered. The patient successfully underwent an appendicectomy and repair of her femoral hernia. The post-operative period was uneventful, with no further issues at follow-up. Our case report displays the successful treatment of a De Garengeot's hernia as an emergency admission, with a shorter than average admission time, and no post-operative complications. This is a rare case of dual pathology, of which we believe there are few published cases. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

An incarcerated Amyand’s hernia: Shall we apply appendectomy routinely?

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Gökhan Demiral

2018-03-01

Full Text Available Amyand’s hernia is a very rare clinical condition characterized by the presence of a normal or inflammed appendix within the inguinal hernia sac. It may be present as an acute apendicitis inside the sac or incarcerated hernia. Sometimes it may be asymptomatic. We report a case of 70-year-old male patient that was presented to our emergency service with a huge right inguinal mass that was diagnosed as an incarcerated inguinal hernia and underwent operation. The intraoperative findings included small intestinal segment, large omental tissue and mobile cecum with healthy appendix inside the sac. There was no sign of strangulation. Lichtenstein herniorhaphy was done without appendectomy.

Congenital hernia of cord: an often misdiagnosed entity

Science.gov (United States)

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

2015-01-01

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

Side effects after diagnostic lumbar puncture and lumbar iohexol myelography

International Nuclear Information System (INIS)

Sand, T.; Stovner, L.J.; Salvesen, R.; Dale, L.

1987-01-01

A prospective, controlled study was performed to compare side effect incidences after lumbar iohexol myelography (n=97) and diagnostic lumbar puncture (n=85). No significant side effect incidence differences (iohexol vs. controls) were found regarding number of patients with any side effect (63 vs. 73%), headache (44 vs. 54%), nausea, dizziness, visual, auditory, or psychic symptoms. Early-onset headache occurred significantly more often in the iohexol group (16 vs 5%), while postural headache occurred most frequently after lumbar puncture (25 vs. 41%). These results suggest that apart from the slight early-onset headache, most side effets after lumbar iohexol myelography are related to the puncture per se, not to the contrast agent. (orig.)

Comparison of the postoperative analgesic effects of paracetamol–codeine phosphate and naproxen sodium–codeine phosphate for lumbar disk surgery

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Reyhan Polat

2015-09-01

Full Text Available The aim of this study was to compared the efficacy of paracetamol–codeine phosphate and naproxen sodium–codeine phosphate on postoperative pain and tramadol consumption during the first 24 hours after a lumbar disk surgery. After Ethics Committee approval and informed consent had been obtained, 64 patients were allocated into three groups. Patients received oral paracetamol–codeine (300 mg + 30 mg; Group P, naproxen sodium–codeine (550 mg + 30 mg; Group N, or placebo tablets (Group C 30 minutes prior to induction of anesthesia. Patient-controlled analgesia was supplied postoperatively using tramadol. Pain intensity, tramadol consumption, and side effects were recorded every 1 hour, 2 hours, 6 hours, 12 hours, and 24 hours after surgery. Whole study period pain intensity (visual analogue scale scores was lower in Group P (p = 0.007 and Group N (p = 0.001, compared with Group C, however, there was no statistically significant difference between Group P and Group N regarding pain intensity (p > 0.05. Tramadol consumption was lower in Group P and Group N, compared with Group C (p < 0.001, and in turn the lowest incidence of tramadol consumption was detected in Group P compared with Group N (p < 0.001 and Group C (p < 0.001. Side effects were similar between the groups. Preemptive administration of paracetamol–codeine and naproxen sodium–codeine combination significantly reduced tramadol consumption and provided more effective analgesia compared with placebo. The paracetamol–codeine combination was superior to naproxen sodium–codeine with regard to tramadol consumption.

Internal hernia through the pouch of douglas after hysterectomy: A case report

International Nuclear Information System (INIS)

Yang, Dong Jin; Cho, Seung Hyun; Shin, Hyun Woong; Kim, Tae Eun; Kim, Byung Young; Kim, Hee Jin

2012-01-01

Internal hernia is a rare cause of small bowel obstruction. Among the different types of internal hernias, the pelvic hernia is extremely rare. We report the radiographic findings of a patient with a Douglas pouch hernia presenting with closed loop obstruction at the anterior aspect of the distal rectum. The patient was a 60 year old female, who had undergone a hysterectomy 20 years prior, for treatment of a uterine myoma

Recurrence and Pain after Mesh Repair of Inguinal Hernias

African Journals Online (AJOL)

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

Influence of Lumbar Lordosis on the Outcome of Decompression Surgery for Lumbar Canal Stenosis.

Science.gov (United States)

Chang, Han Soo

2018-01-01

Although sagittal spinal balance plays an important role in spinal deformity surgery, its role in decompression surgery for lumbar canal stenosis is not well understood. To investigate the hypothesis that sagittal spinal balance also plays a role in decompression surgery for lumbar canal stenosis, a prospective cohort study analyzing the correlation between preoperative lumbar lordosis and outcome was performed. A cohort of 85 consecutive patients who underwent decompression for lumbar canal stenosis during the period 2007-2011 was analyzed. Standing lumbar x-rays and 36-item short form health survey questionnaires were obtained before and up to 2 years after surgery. Correlations between lumbar lordosis and 2 parameters of the 36-item short form health survey (average physical score and bodily pain score) were statistically analyzed using linear mixed effects models. There was a significant correlation between preoperative lumbar lordosis and the 2 outcome parameters at postoperative, 6-month, 1-year, and 2-year time points. A 10° increase of lumbar lordosis was associated with a 5-point improvement in average physical scores. This correlation was not present in preoperative scores. This study showed that preoperative lumbar lordosis significantly influences the outcome of decompression surgery on lumbar canal stenosis. Copyright © 2017 Elsevier Inc. All rights reserved.

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

OpenAIRE

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

2015-01-01

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

Clinical anatomy and 3D virtual reconstruction of the lumbar plexus with respect to lumbar surgery

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Ding Zi-hai

2011-04-01

Full Text Available Abstract Background Exposure of the anterior or lateral lumbar via the retroperitoneal approach easily causes injuries to the lumbar plexus. Lumbar plexus injuries which occur during anterior or transpsoas lumbar spine exposure and placement of instruments have been reported. This study aims is to provide more anatomical data and surgical landmarks in operations concerning the lumbar plexus in order to prevent lumbar plexus injuries and to increase the possibility of safety in anterior approach lumbar surgery. Methods To study the applied anatomy related to the lumbar plexus of fifteen formaldehyde-preserved cadavers, Five sets of Virtual Human (VH data set were prepared and used in the study. Three-dimensional (3D computerized reconstructions of the lumbar plexus and their adjacent structures were conducted from the VH female data set. Results The order of lumbar nerves is regular. From the anterior view, lumbar plexus nerves are arranged from medial at L5 to lateral at L2. From the lateral view, lumbar nerves are arranged from ventral at L2 to dorsal at L5. The angle of each nerve root exiting outward to the corresponding intervertebral foramen increases from L1 to L5. The lumbar plexus nerves are observed to be in close contact with transverse processes (TP. All parts of the lumbar plexus were located by sectional anatomy in the dorsal third of the psoas muscle. Thus, access to the psoas major muscle at the ventral 2/3 region can safely prevent nerve injuries. 3D reconstruction of the lumbar plexus based on VCH data can clearly show the relationships between the lumbar plexus and the blood vessels, vertebral body, kidney, and psoas muscle. Conclusion The psoas muscle can be considered as a surgical landmark since incision at the ventral 2/3 of the region can prevent lumbar plexus injuries for procedures requiring exposure of the lateral anterior of the lumbar. The transverse process can be considered as a landmark and reference in surgical

Clinical anatomy and 3D virtual reconstruction of the lumbar plexus with respect to lumbar surgery.

Science.gov (United States)

Lu, Sheng; Chang, Shan; Zhang, Yuan-zhi; Ding, Zi-hai; Xu, Xin Ming; Xu, Yong-qing

2011-04-14

Exposure of the anterior or lateral lumbar via the retroperitoneal approach easily causes injuries to the lumbar plexus. Lumbar plexus injuries which occur during anterior or transpsoas lumbar spine exposure and placement of instruments have been reported. This study aims is to provide more anatomical data and surgical landmarks in operations concerning the lumbar plexus in order to prevent lumbar plexus injuries and to increase the possibility of safety in anterior approach lumbar surgery. To study the applied anatomy related to the lumbar plexus of fifteen formaldehyde-preserved cadavers, Five sets of Virtual Human (VH) data set were prepared and used in the study. Three-dimensional (3D) computerized reconstructions of the lumbar plexus and their adjacent structures were conducted from the VH female data set. The order of lumbar nerves is regular. From the anterior view, lumbar plexus nerves are arranged from medial at L5 to lateral at L2. From the lateral view, lumbar nerves are arranged from ventral at L2 to dorsal at L5. The angle of each nerve root exiting outward to the corresponding intervertebral foramen increases from L1 to L5. The lumbar plexus nerves are observed to be in close contact with transverse processes (TP). All parts of the lumbar plexus were located by sectional anatomy in the dorsal third of the psoas muscle. Thus, access to the psoas major muscle at the ventral 2/3 region can safely prevent nerve injuries. 3D reconstruction of the lumbar plexus based on VCH data can clearly show the relationships between the lumbar plexus and the blood vessels, vertebral body, kidney, and psoas muscle. The psoas muscle can be considered as a surgical landmark since incision at the ventral 2/3 of the region can prevent lumbar plexus injuries for procedures requiring exposure of the lateral anterior of the lumbar. The transverse process can be considered as a landmark and reference in surgical operations by its relative position to the lumbar plexus. 3D

Radiation dose reduction in CT-guided periradicular injections in lumbar spine: Feasibility of a new institutional protocol for improved patient safety

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Artner Juraj

2012-08-01

Full Text Available Abstract Background Image guided spinal injections are successfully used in the management of low back pain and sciatica. The main benefit of CT-guided injections is the safe, fast and precise needle placement, but the radiation exposure remains a serious concern. The purpose of the study was to test a new institutional low-dose protocol for CT-guided periradicular injections in lumbar spine to reduce radiation exposure while increasing accuracy and safety for the patients. Methods We performed a retrospective analysis of a prospective database during a 4-month period (Oct-Dec 2011 at a German University hospital using a newly established low-dose-CT-protocol for periradicular injections in patients suffering from lumbar disc herniation and nerve root entrapment. Inclusion criteria were acute or chronic nerve root irritation due to lumbar disc hernia, age over 18, compliance and informed consent. Excluded were patients suffering from severe obesity (BMI > 30, coagulopathy, allergy to injected substances, infection and non-compliant patients. Outcome parameters consisted of the measured dose length product (mGycm2, the amount of scans, age, gender, BMI and the peri-interventional complications. The results were compared to 50 patients, treated in the standard-interventional CT-protocol for spinal injections, performed in June-Oct 2011, who met the above mentioned inclusion criteria. Results A total amount of 100 patients were enrolled in the study. A significant radiation dose reduction (average 85.31% was achieved using the institutional low-dose protocol compared to standard intervention mode in CT-guided periradicular injections in lumbar spine. Using the low-dose protocol did not increase the complications rate in the analyzed cohort. Conclusions Low-dose-CT-protocols for lumbar perineural injections significantly reduce the exposure to radiation of non-obese patients without an increase of complications. This increases long-time patient

Pathomechanisms of sciatica in lumbar disc herniation: effect of periradicular adhesive tissue on electrophysiological values by an intraoperative straight leg raising test.

Science.gov (United States)

Kobayashi, Shigeru; Takeno, Kenichi; Yayama, Takafumi; Awara, Kousuke; Miyazaki, Tsuyoshi; Guerrero, Alexander; Baba, Hisatoshi

2010-10-15

This study is aimed to investigate the changes of nerve root functions during the straight leg raising (SLR) test in vivo. To investigate the relationship between nerve root movement and the electrophysiological values during an intraoperative SLR test. The SLR test is one of the most significant signs for making a clinical diagnosis of lumbar disc herniation. A recent study showed that intraradicular blood flow apparently decreased during the SLR test in patients with disc herniation. The study included 32 patients who underwent microdiscectomy. During the surgery, the nerve root motion affected by the hernia was observed during the SLR test. The patients' legs were allowed to hang down to the angle at which sciatica had occurred and the change of nerve root action potentials was measured. After removal of the hernia, a similar procedure was repeated. The periradicular specimens collected during surgery were examined by light and electron microscope. In all patients intraoperative microscopy revealed that the hernia was adherent to the dura mater of the nerve roots. During the SLR test, the limitation of nerve root movement occurred by periradicular adhesive tissue and amplitude of action potential showed a sharp decrease at the angle that produced sciatica. After removal of the hernia, all the patients showed smooth gliding of the nerve roots during the test, and there was no marked decrease of amplitude. Our data suggest that temporary ischemic changes in the nerve root cause transient conduction disturbances. Pathologic examination showed that the periradicular tissue consisted of the granulation with vascularization and many inflammatory cell infiltrations. The presence of periradicular fibrosis will compound the nerve root pain by fixing the nerve in one position, thereby increasing the susceptibility of the nerve root to tension or compression.

Retrospective Study (2009-2014): Perineal Hernias and Related Comorbidities in Bitches.

Science.gov (United States)

Hayashi, Ayne Murata; Rosner, Sandra Aparecida; de Assumpção, Thais Cristine Alves; Stopiglia, Angelo João; Matera, Julia Maria

2016-12-01

Retrospective study based on data extracted from medical records of dogs diagnosed with perineal hernia between 2009 and 2014; medical records of bitches were selected for further analysis to determine the prevalence of perineal hernias in bitches and to investigate potential comorbidities. Perineal hernia was diagnosed in 182 dogs (174 males and 8 females; 96% and 4%, respectively). Surgical correction was performed in 6 bitches. Surgical procedures corresponded to internal obturator muscle transposition with or without polypropylene mesh reinforcement (n = 5) and semitendinosus muscle transposition flap (n = 1). Major comorbidities associated with perineal hernias in adult bitches were trauma (n = 3; 7.3 ± 1.5 years; 7.1 ± 8.5kg) and persistent cough secondary to conditions such as bronchitis, tracheal collapse, and cardiopathy in aged, small-sized patients (n = 3; 13.6 ± 2.0 years; 2.3 ± 0.1kg). Perineal hernias are uncommon in bitches and tend to be associated with comorbidities in these patients. Aged female dogs suffering from uncontrolled chronic cough secondary to cardiopathy or bronchitis are at risk of developing perineal hernia. Previous trauma to the pelvis is another potential risk factor for perineal hernia development in female dogs. Copyright © 2016. Published by Elsevier Inc.

Modified semitendinosus muscle transposition to repair ventral perineal hernia in 14 dogs.

Science.gov (United States)

Morello, E; Martano, M; Zabarino, S; Piras, L A; Nicoli, S; Bussadori, R; Buracco, P

2015-06-01

To describe a modified technique of semitendinosus muscle transposition for the repair of ventral perineal hernia. Retrospective review of case records of dogs with ventral perineal hernia that were treated by transposing the medial half of the longitudinally split semitendinosus muscle of one limb. The transposition of the internal obturator muscle was used when uni- or bilateral rectal sacculation was also present in addition to ventral perineal hernia; colopexy and vas deferens pexy were also performed. Fourteen dogs were included. In addition to ventral perineal hernia, unilateral and bilateral perineal hernia was also present in five and six of the dogs, respectively. The mean follow-up time was 890 days. Ventral perineal hernia was successfully managed by the modified semitendinosus muscle transposition with minor complications in all the dogs included in the study. Despite the small number of dogs included, the unilateral transposition of the medial half of the longitudinally split semitendinosus muscle consistently supported the ventral rectal enlargement in perineal hernia without obvious adverse effects. © 2015 British Small Animal Veterinary Association.

Amyand’s Hernia, State of the Art and New Points of View

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Guido Mantovani

2017-01-01

Full Text Available Background. Amyand’s hernia (AH is an inguinal hernia containing the vermiform appendix, with an incidence between 0.4% and 1% of all inguinal hernias. Acute or perforated appendicitis can complicate AH. Case Presentation. A 75-year-old Caucasian man presented with incarceration of vermiform appendix in inguinal hernia sac. Diagnosis was posed preoperatively with computed tomography (CT scan. Patient underwent urgent surgery and simultaneous appendectomy and hernia repair by Bassini’s technique were performed. Conclusions. Preoperative diagnosis of AH is rare; however it could be useful for surgeon to choose operative approach. Treatment of AH depends on grade of appendix inflammation and/or perforation. The technique utilized to repair hernia depends largely on surgeon’s preferences; the presence of inflamed or perforated appendix is not an absolute contraindication for using a prosthetic mesh.

Conventional X-ray examination of hiatus hernia in aged people (31 cases report)

International Nuclear Information System (INIS)

Xu Xiaoyuan; Xie Zirong; Liao Chengyang; Xiong Bo

2008-01-01

Objective: To evaluate methods and features of X-ray examination in aged people with hiatus hernia. Methods: Imaging features of chest film, fluoroscopy and barium meal examination of 31 cases with hiatus hernia diagnosed by barium meal examination were retrospectively analyzed. Results Sac shadows behind the heart were showed in all 23 cases, including chest film (14/23 cases) and fluoroscopy (9/23 cases), 20 cases of which were irreducible hiatus hernia diagnosed by barium meal immediately. 3 cases were misdiagnosed by the chest film, with occupying lesions of the left lower lung (2/3 cases) or aneurysm of descending aorta (1/3 cases). Gastric mucosa was showed in thorax above the left hemidiaphragm in another 8 cases with hiatus hernia evaluated by barium meal, including 5 cases irreducible hiatus hernia and 3 cases sliding hiatus hernia. Conclusion: Chest film, fluoroscopy and barium meal play different roles in the diagnosis of hiatus hernia. Though chest film and fluoroscopy could detect easily, barium meal is of the most importance in evaluation of hiatus hernia due to its characteristics. (authors)

The value of fetal ultrasonography and magnetic resonance imaging in the assessment of diaphragmatic hernias

International Nuclear Information System (INIS)

Amim, Bruno; Guerra, Fernando; Marchiori, Edson; Gasparetto, Emerson Leandro

2008-01-01

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

The prevalence of umbilical and epigastric hernia repair

DEFF Research Database (Denmark)

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

2015-01-01

in Denmark on December 31st, 2010 was performed. Within this population all umbilical and epigastric hernia repairs from January 1st, 2006 to December 31st, 2010 were identified using data from the Danish National Hospital Register, and 5-year prevalence estimates were calculated. RESULTS: The study...... hernia repairs was seen in males aged 60-70 years with a 5-year prevalence of 0.53 % (95 % CI 0.51-0.56 %) and the highest age-specific 5-year prevalence of epigastric hernia repair was seen in 40-50 year females with a 5-year prevalence of 0.086 % (95 % CI 0.077-0.095 %). CONCLUSION: The gender and age...

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

African Journals Online (AJOL)

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

Vasitis mimicking an Amyand’s hernia: A case report

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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.

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

Science.gov (United States)

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

2007-07-01

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

Surgical treatment of the giant hiatal hernia - A single-center experience

DEFF Research Database (Denmark)

Jensen, Jonas Sanberg

Introduction All symptomatic giant hiatal hernias, defined as any hiatal hernia where more than 30% of the stomach is placed intrathoracically, should be addressed with elective surgery, significantly reducing the risk of complications. Symptoms of incarceration require immediate emergency surgery...... and occur in less than 2% per year. The purpose of this study was to evaluate perioperative data, outcome and patient satisfaction in patients undergoing emergency or planned surgery for giant hiatal hernia in a Danish centre. Methods and Procedures This retrospective study was performed using patient...... records of all patients undergoing emergency (E) or planned (P) primary laparoscopic repair for giant hiatal hernia at a single center over a six-year period. Demographics and characteristics of hiatal hernia and surgery were registered. Admission length, complications and readmission within 30 days were...

Sonography in the postoperative evaluation of laparoscopic inguinal hernia repair.

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

1995-09-01

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

Outcome of laproscopic totally extraperitoneal hernioplasty for inguinal hernia

International Nuclear Information System (INIS)

Hanif, H.; Memon, S.H.

2015-01-01

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

Bilateral cervical lung hernia with T1 nerve compression.

Science.gov (United States)

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

2006-02-01

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

[Hiatal hernias: why and how should they be surgically treated].

Science.gov (United States)

Braghetto, Italo; Csendes, Attila; Korn, Owen; Musleh, Maher; Lanzarini, Enrique; Saure, Alex; Hananias, Baydir; Valladares, Héctor

2013-01-01

There is controversy in the literature about the choice of expectant medical treatment versus surgical treatment of hiatal hernias, depending on the presence or absence of symptoms. This study presents the results obtained by our group, considering disease duration and postoperative results. A total of 121 patients were included and divided by age, disease duration, type of hiatal hernia and postoperative outcome. In 32% of the patients younger than 70 years, symptom duration was longer than 11 years and 68% of those aged more than 71 years had long-term symptoms (p<.05). Type iv hernias (complex) and those with diameters measuring more than 16 cm were observed in the group with longer symptom duration. Complications were more frequent in the older age group, in those with longer symptom duration and in those with type iv complex hernias. There was no postoperative mortality and only one patient (0.8%) with a type iii hernia and severe oesophagitis required reoperation. We recommend that patients with hiatal hernia undergo surgery at diagnosis to avoid complications and risks. Older patients should not be excluded from surgical indication but should undergo a complete multidisciplinary evaluation to avoid complications and postoperative mortality. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

An animal model to train Lichtenstein inguinal hernia repair

DEFF Research Database (Denmark)

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

2013-01-01

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

Lumbar facet syndrome - Lumbar facet joint injection and low back pain

International Nuclear Information System (INIS)

Acevedo Gonzalez, Juan Carlos; Jimenez Hakim, Enrique; Rodriguez, Jose Maria; Hakim Daccach, Fernando; Quinonez, German; Rodriguez Munera, Andres

2004-01-01

The authors conducted a retrospective study lo evaluate the effectiveness of injection therapy in the lumbar zygapophysial joints with anesthetics and steroids in patients with persisting low back pain and lumbar facer syndrome. Thirty-seven patients with low back pain who reported immediate relief of their pain after controlled blocks into the facet joints between the fourth and fifth lumbar vertebrae and the fifth lumbar and first sacral vertebrae were evaluated. Outcome was evaluated using the visual analog pain scales. All outcome measures were repeated at eight days and six weeks alter controlled injection. At six-week follow-up examination 83,7% of thirty-seven patients experienced a good response to controlled blocks of the lumbar zygaphyseal (facet) joints. Good result is the pain relief of 50% or more. Fifteen patients experienced a good response with pain relief of eight points or more in the VAS

Congenital diaphramatic hernia

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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.)

Congenital diaphramatic hernia

International Nuclear Information System (INIS)

Kline-Fath, Beth M.

2012-01-01

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

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

Science.gov (United States)

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

2018-07-01

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

LAPAROSCOPIC MANAGEMENT OF GIANT PARAESOPHAGEAL HERNIA WITH A SILICONE-COATED BIFACIAL MESH

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S. Unguryanu

2016-01-01

Full Text Available BACKGROUND. Paraesophageal hernias are relatively uncommon. The incidence of this disease has increased recently, and esophageal hernias now account for 5–10% of all hiatus hernias. Surgical treatment is recommended for all patients with this disease because of high risk of complications: strangulation or perforation.CASE REPORT. A 44-year-old male patient with a giant and symptomatic paraesophageal hernia. The diagnosis was confirmed by instrumental examination. We performed laparoscopic repair using silicone-coated polypropylene bifacial mesh. The postoperative period was uneventful.CONCLUSION. The laparoscopic approach may be successfully used as a therapeutic option in the treatment for hiatal hernias. Our clinical experience showed, that the technique appeared to be valid and safe. In cases of large hiatal hernia with a defect greater than 5 cm, it is recommended to apply the mesh in order to minimize the recurrence rate.

Incisional abdominal hernia repair with concomitant abdominoplasty: Maintaining umbilical viability

OpenAIRE

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

2018-01-01

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

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

Science.gov (United States)

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

2011-06-01

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

Laparoscopic repair of hiatal hernias: Experience after 200 consecutive cases

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Bjelović Miloš

2014-01-01

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

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

Science.gov (United States)

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

2012-01-01

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

A new classification of parastomal hernias--from the experience at Bielański Hospital in Warsaw.

Science.gov (United States)

Gil, Grzegorz; Szczepkowski, Marek

2011-08-01

Parastomal hernia is the most common local stoma complication. The incidence of parastomal hernia reaches 48%, and in a certain proportion of patients it is considered to be an inevitable consequence of stoma formation. The current classifications of parastomal hernias (Rubin, Devlin) are of little clinical value, which is supported by the fact that they have not been used in any publication presenting surgical treatment results in parastomal hernia. Moreover, these classifications do not include recommendations regarding surgical approach selection in those cases where surgical treatment is indicated. These disadvantages clearly indicate a need for developing a new classification of a greater practical value. was to present a suggested new parastomal hernia classification, based on structural criteria, and its use in surgical approach selection. The authors presented a group of 52 patients registered in Outpatient Stoma Clinic at Bielański Hospital in Warsaw, who had been diagnosed with parastomal hernia, defined as a type of hernia associated with postoperative artificial external intestinal fistula, who also had indications for surgical treatment of this stomal complication. These patients underwent a reconstructive procedure of their parastomal hernia with a surgical technique involving the placement of a monofilament polypropylene mesh in the preperitoneal space and repair of co-existing stomal complications using the variants of surgical techniques adequate for a given parastomal hernia type. Based on our studies and clinical experience, we propose a new classification of parastomal hernias, based on structural criteria. All hernias were divided into four groups (type I-IV) depending on hernia size and the presence of hernia in the postoperative scar. Qualification of a given hernia to a specific type was achieved based on physical examination, which makes the suggested classification a simple tool, useful in everyday practice. Each parastomal hernia type

Pain during sexual activity before and after laparoscopic inguinal hernia repair

DEFF Research Database (Denmark)

Tolver, Mette A; Rosenberg, Jacob

2015-01-01

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

Prevention of Incisional Hernias after Open Abdomen Treatment

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Frederik Berrevoet

2018-02-01

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

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

African Journals Online (AJOL)

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

Rare Abdominal Wall Malformation: Case Report of Umbilical Cord Hernia

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Andro Gliha

2018-02-01

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

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

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

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

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

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

2018-02-01

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

Ovarian Spigelian hernia: A radiological diagnosis

International Nuclear Information System (INIS)

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

2012-01-01

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

Mesh versus non-mesh repair of ventral abdominal hernias

International Nuclear Information System (INIS)

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

2008-01-01

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

Diaphragmatic hernia: diagnostic approaches with review of the literature

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

2005-06-01

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

Incidental De Garengeot’s hernia: A case report of dual pathology to remember

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

2015-01-01

Introduction A De Garengeot’s hernia is the very rare dual pathology of a vermiform appendix within a femoral hernia. Presentation of case We discuss the rare case of a 62 year old female who presented as an emergency with a strangulated femoral hernia. Within the hernia sac a partly necrotic vermiform appendix was discovered. The patient successfully underwent an appendicectomy and repair of her femoral hernia. The post-operative period was uneventful, with no further issues at follow-up. Discussion Our case report displays the successful treatment of a De Garengeot's hernia as an emergency admission, with a shorter than average admission time, and no post-operative complications. Conclusion This is a rare case of dual pathology, of which we believe there are few published cases. PMID:26520035

Quality of Life after Ventral Hernia Repair with Endoscopic Component Separation Technique

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Thomsen, C Ø; Brøndum, T L; Jørgensen, Lars Nannestad

2016-01-01

of the hernia size. Demographic data, operative information, and postoperative complications were recorded. All patients completed two similar questionnaires regarding their function level, cosmetic satisfaction, analgesic medication, alcohol consumption, and self-estimated physical and mental health before...... center operated on with endoscopic components separation. MATERIAL AND METHODS: A total of 19 consecutive patients scheduled for open hernia repair with endoscopic components separation from October 2010 to June 2012 were included. All procedures included endoscopic components separation because...... and after the hernia repair. Patients were assessed as outpatient median 2 months and 16 months after operation for exclusion of hernia recurrence and completion of the postoperative questionnaire. RESULTS AND CONCLUSIONS: Operating room time was median 204 min and correlated significantly with the hernia...

Clinical anatomy and surgical repair of prepubic hernia in dogs and cats.

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Beittenmiller, Menolly R; Mann, F A; Constantinescu, Gheorghe M; Luther, Jill K

2009-01-01

Prepubic hernia is a traumatic hernia in small animals, most often associated with severe trauma to the caudal abdomen. Common causes include vehicular trauma, dog fights, and kicks by large animals. Rupture of the prepubic tendon in dogs and of its equivalent in cats results in a ventral abdominal hernia. Due to the traumatic nature of the injury, concurrent injuries are frequently seen. Clinical signs of herniation are often nonspecific, and the resultant hernia may not be readily apparent during routine physical examination. This being so, diagnosis is often based on a thorough physical examination in conjunction with abdominal radiography and, possibly, abdominal ultrasonography. Multiple methods of repair of prepubic hernia have been reported, and survival rates are quite good if concurrent injuries are not severe.

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

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

2013-04-01

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

Sigmoid colon cancer in an incarcerated left inguinal hernia

OpenAIRE

González González, Daniel Alfredo; Tarigo, Nicolás

2017-01-01

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

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

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H.F. Hartmann

2015-12-01

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

[Biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy].

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Qian, J; Yu, S S; Liu, J J; Chen, L; Jing, J H

2018-04-03

Objective: To analyze the biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy using the finite element method. Methods: Three healthy adult males (aged 35.6 to 42.3 years) without spinal diseases were enrolled in this study and 3D-CT scans were carried out to obtain the parameters of lumbar spine. Mimics software was applied to build a 3D finite element model of lumbar spine. Graded resections (1/4, 2/4, 3/4 and 4/4) of the left superior articular process of L(5) were done via percutaneous transforaminal endoscopic lumbar discectomy. Then, the pressure of the L(4/5) right facets, the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine were recorded after simulating the normal flexion and extension, lateral flexion and rotation of the lumbar spine model during different resections. The data were compared among groups with analysis of variance. Results: Comparing with the normal group, after 1/4 resection of the left superior articular process of L(5), the pressure of the L(4/5) right facets showed significant differences during left lateral flexion and rotation of lumbar spine ( q =8.823, 8.248, both P biomechanics and the stability of lumbar spine changed partly after 1/4 resection of the superior articular process and obviously after more than 2/4 is resected. The superior articular process should be paid more attention during foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy.

Internal Hernia in a Liver Transplant Recipien: A Case Report

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Hironori Hayashi

2013-01-01

Full Text Available Biliary complications have great importance for liver transplant recipients because of affecting long-term prognosis. In rare situations, an internal hernia of the Roux-en-Y loop cause graft injury. A 42-year-old woman with a history of living donor liver transplantation 6 years ago presented with prolonged graft injury during the past 6 months. She suddenly developed ileus of the small bowel with internal hernia through the defect of the mesentery around the Roux-en-Y limb of the hepaticojejunostomy. Emergent surgery was performed to reduce the hernia and volvulus; also the mesenteric rent was closed with interrupted suture of silk. Internal hernia of the small bowel after liver transplantation is rare but causes graft injury due to associated biliary complications and rapid deterioration of patient’s condition.

Abdominal Wall Reconstruction with Concomitant Ostomy-Associated Hernia Repair: Outcomes and Propensity Score Analysis.

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Mericli, Alexander F; Garvey, Patrick B; Giordano, Salvatore; Liu, Jun; Baumann, Donald P; Butler, Charles E

2017-03-01

The optimal strategy for abdominal wall reconstruction in the presence of a stomal-site hernia is unclear. We hypothesized that the rate of ventral hernia recurrence in patients undergoing a combined ventral hernia repair and stomal-site herniorraphy would not differ clinically from the ventral hernia recurrence rate in patients undergoing an isolated ventral hernia repair. We also hypothesized that bridged ventral hernia repairs result in worse outcomes compared with reinforced repairs, regardless of stomal hernia. We retrospectively reviewed prospectively collected data from consecutive abdominal wall reconstructions performed with acellular dermal matrix (ADM) at a single center between 2000 and 2015. We compared patients who underwent a ventral hernia repair alone (AWR) and those who underwent both a ventral hernia repair and ostomy-associated herniorraphy (AWR+O). We conducted a propensity score matched analysis to compare the outcomes between the 2 groups. Multivariable Cox proportional hazards and logistic regression models were used to study associations between potential predictive or protective reconstructive strategies and surgical outcomes. We included 499 patients (median follow-up 27.2 months; interquartile range [IQR] 12.4 to 46.6 months), 118 AWR+O and 381 AWR. After propensity score matching, 91 pairs were obtained. Ventral hernia recurrence was not statistically associated with ostomy-associated herniorraphy (adjusted hazard ratio [HR] 0.7; 95% CI 0.3 to 1.5; p = 0.34). However, the AWR+O group experienced a significantly higher percentage of surgical site occurrences (34.1%) than the AWR group (18.7%; adjusted odds ratio 2.3; 95% CI 1.4 to 3.7; p < 0.001). In the AWR group, there were significantly fewer ventral hernia recurrences when the repair was reinforced compared with bridged (5.3% vs 38.5%; p < 0.001). There was no statistically significant difference in ventral hernia recurrence between the AWR and AWR+O groups. Bridging was associated

Efficacy of local anaesthesia in repair of inguinal hernia

International Nuclear Information System (INIS)

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

2017-01-01

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

Sports hernia repair with adductor tenotomy.

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Harr, J N; Brody, F

2017-02-01

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

Early prenatal diagnosis of a lumbo-costo-vertebral syndrome.

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Pristavu, Anda Ioana; Furnica, Cristina; Ifrim, Mona Mihaela; Popovici, Razvan Mihai

2018-04-01

Lumbo-costo-vertebral syndrome (LCVS) is a rare type of lumbar hernia with associated abnormalities of the vertebral bodies, ribs, and trunk muscles. Only a few cases have been reported in the literature, all of which were diagnosed after birth. We present a case of LCVS diagnosed early in the second trimester of pregnancy using two- and three-dimensional ultrasound. In our case, the associated anomalies were: multiple costovertebral anomalies, lumbar hernia, anal imperforation, left hand supernumerary digit, and clubfoot.

Hernia inguinal laparoscopic surgery

International Nuclear Information System (INIS)

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

2005-01-01

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

Thoracoscopic approach in management of congenital diaphragmatic hernia.

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Liem, Nguyen Thanh

2013-10-01

Thoracoscopic repair is feasible and safe for congenital diaphragmatic hernia (CDH). The operation can be performed with three trocars using carbon dioxide insufflations at a pressure of 4-6 mmHG. From January 2001 to July 2012, we performed thoracoscopic repair for 311 children with CDH including 152 newborns and 159 infants and toddlers. Mean operative time was 75 ± 27 min. HFOV was used in 24 patients. Direct closure of two rims of diaphragmatic hernia was carried out in 175 patients. Closure of two rims of diaphragmatic hernia with the thoracic wall was performed in 136 patients. Prosthetic patches were required in 54 patients. Conversion to open surgery was required in 38 patients (12.2%). There were no intraoperative deaths. 38 patients died postoperatively (13.5%).

Pulmonary Hernia in a Two-Year-Old Child

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Jenna Fine

2014-01-01

Full Text Available Pulmonary hernia, also known as lung herniation or intercostal herniation, is best explained as the lung parenchyma protruding beyond the confines of the thoracic wall. This rare finding can be classified as congenital or acquired. Acquired pulmonary herniations are often the complication of blunt or penetrating trauma to the chest wall. This report describes a two-year-old male who fell onto a rigid post, striking his left lower chest. Imaging studies demonstrated a small pneumothorax as well as pulmonary herniation. The patient underwent a diagnostic thoracoscopy and repair of a pulmonary hernia within the 7th intercostal space without complication. In this case report, we aim to add to the limited body of existing literature on the surgical management of pulmonary hernias.

Ozone therapy for t he complex prolapse of lumbar intervertebral disc: a clinical observation

International Nuclear Information System (INIS)

Peng Yong; Wei Mengqi; Wu Juan; Zhou Jianshou; Yang Yong; Zhao Hongliang; Shi Mingguo

2010-01-01

Objective: To evaluate the therapeutic outcome of ozone injection therapy for the treatment of complex prolapse of lumbar intervertebral disc, which is accompanied with spinal stenosis due to hypertrophy of ligamentum flavum, degeneration of intervertebral facet joints, intervertebral hyperosteogeny and degeneration, lumbar muscle strain and negative pressure in intervertebral discs. Methods: Seventy patients with simple intervertebral disc prolapse (simple group) and 70 patients with complex intervertebral disc prolapse (complex group) were selected for the study. The complex intervertebral disc prolapse included negative pressure in intervertebral disc (n=11), recurrence after resection of nucleus polposus of intervertebral disc (n=5), spinal stenosis (n=10), degeneration of intervertebral facet joints and interver-tebral hyperosteogeny (n=30), stenosis of lateral recess (n=4) and lumbar muscle strain (n=10). All patients were treated with ozone injection under the CT guidance. A total of 2-3 ml ozone with the concentration of 40-50 μg / ml was injected into the intervertebral disk and a total of 5-8 ml ozone with the concentration of 30-40 μg / ml was injected into the paraspinal space. Infiltration injection into the pain spots with 20 ml ozone was carried out in patients with lumbar muscle strain. Results: A comparison of the therapeutic outcomes between simple group and complex group was made. Immediate relief from clinical symptoms was obtained in 80% of all treated patients. The effective rate one week after the procedure was 95%, which became 96% at 3-6 months after the treatment. Conclusion: Correct clinical diagnosis, skilled and accurate manipulation during the surgery and reasonable use of ozone injection in the treatment of soft tissue injury, etc. can markedly improve the therapeutic effect for complex lumbar intervertebral disc prolase. (authors)

Disk

NARCIS (Netherlands)

P.A. Boncz (Peter); L. Liu (Lei); M. Tamer Özsu

2008-01-01

htmlabstractIn disk storage, data is recorded on planar, round and rotating surfaces (disks, discs, or platters). A disk drive is a peripheral device of a computer system, connected by some communication medium to a disk controller. The disk controller is a chip, typically connected to the CPU of

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

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Sepehr Lalezari

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

Chronic pain after childhood groin hernia repair

DEFF Research Database (Denmark)

Aasvang, Eske Kvanner; Kehlet, Henrik

2007-01-01

BACKGROUND: In contrast to the well-described 10% risk of chronic pain affecting daily activities after adult groin hernia repair, chronic pain after childhood groin hernia repair has never been investigated. Studies of other childhood surgery before the age of 3 months suggest a risk of increased...... pain responsiveness later in life, but its potential relationship to chronic pain in adult life is unknown. METHODS: This was a nationwide detailed questionnaire study of chronic groin pain in adults having surgery for a groin hernia repair before the age of 5 years (n = 1075). RESULTS: The response...... rate was 63.3%. In the 651 patients available for analysis, pain from the operated groin was reported by 88 (13.5%) patients whereof 13 (2.0%) patients reported frequent and moderate or severe pain. Pain occurred primarily when exercising sports or other leisure activities. Patients operated on before...

[Type IV paraesophageal hernia with 60% of gastric necrosis. Case report].

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Navarro-Tovar, Fernando; Juárez-de La Torre, Juan Carlos; Pérez-Ayala, Luis Carlos; Quintero-Cabrera, Eduardo

2014-01-01

Paraesophageal hernias are rare and, when associated with symptoms, the risk of complications increases, becoming a surgical emergency. We report a case of a 53 year-old female with 3 weeks of clinical evolution including abdominal pain, nausea and occasional vomiting; 24 h prior to admission she presented intestinal occlusion. Radiographic and tomographic findings showed a paraesophageal hernia, requiring exploratory laparotomy, which demonstrated a 9 cm paraesophageal diaphragmatic defect with a hernia sac containing transverse colon, omentum, fundus and body of the stomach (this last one presented ~60% of necrosis), performing nonanatomic gastrectomy and simple diaphragmatic reconstruction. The patient had a complicated postoperative period requiring two additional surgeries attempting to correct gastrectomy dehiscence and ending with a third procedure for cervical esophagostomy and Witzel jejunostomy. Elective repair is recommended in all patients with asymptomatic paraesophageal hernia in order to avoid possible complications. The approach method is dependent on the surgeon's experience and the conditions of the hernia and involved structures at the time of diagnosis.

Laparoscopic-assisted repair of Morgagni–Larrey hernia by anterior ...

African Journals Online (AJOL)

Various techniques have been described to repair Morgagni–Larrey hernia. There is still concerns on the sufficiency of a simple laparoscopic anterior abdominal wall fixation. We aim to report of two children undergoingthe laparoscopic-assisted anterior abdominal wall repair for Morgagni–Larrey hernia, and to discuss this ...

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

African Journals Online (AJOL)

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

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

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Paksoy, Melih; Sekmen, Ümit

2016-01-01

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

Garengeot’s hernia: two case reports with CT diagnosis and literature review

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Garcia-Amador Cristina

2016-01-01

Full Text Available Garengeot’s hernia (GH is defined as the presence of the appendix inside a femoral hernia. It occurs in 0.9% of femoral hernias and is usually an incidental finding during surgery. Its treatment is controversial and the aim of this article is to review the diagnostic methods and surgical considerations.

Congenital asymptomatic diaphragmatic hernias in adults: a case series.

Science.gov (United States)

Bianchi, Enrica; Mancini, Paola; De Vito, Stefania; Pompili, Elena; Taurone, Samanta; Guerrisi, Isabella; Guerrisi, Antonino; D'Andrea, Vito; Cantisani, Vito; Artico, Marco

2013-05-13

Congenital diaphragmatic hernia is a major malformation occasionally found in newborns and babies. Congenital diaphragmatic hernia is defined by the presence of an orifice in the diaphragm, more often to the left and posterolateral, that permits the herniation of abdominal contents into the thorax. The aim of this case series is to provide information on the presentation, diagnosis and outcome of three patients with late-presenting congenital diaphragmatic hernias. The diagnosis of congenital diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray films and computed tomography scans. In the present report three cases of asymptomatic abdominal viscera herniation within the thorax are described. The first case concerns herniation of some loops of the large intestine into the left hemi-thorax in a 75-year-old Caucasian Italian woman. The second case concerns a rare type of herniation in the right side of the thorax of the right kidney with a part of the liver parenchyma in a 57-year-old Caucasian Italian woman. The third case concerns herniation of the stomach and bowel into the left side of the chest with compression of the left lung in a 32-year-old Caucasian Italian man. This type of hernia may appear later in life, because of concomitant respiratory or gastrointestinal disease, or it may be an incidental finding in asymptomatic adults, such as in the three cases featured here. Patients who present with late diaphragmatic hernias complain of a wide variety of symptoms, and diagnosis may be difficult. Additional investigation and research appear necessary to better explain the development and progression of this type of disease.