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PubMed2001

Reoperation after recurrent groin hernia repair.

OBJECTIVE: To analyze reoperation rates for recurrent and primary groin hernia repair documented in the Swedish Hernia Register from 1996 to 1998, and to study variables associated with increased or decreased relative risks for reoperation after recurrent hernia. METHODS: Data were retrieved for all groin hernia repairs prospectively recorded in the Swedish Hernia register from 1996 to 1998. Actuarial analysis adjusted for patients' death was used for calculating the cumulative incidence of reoperation. Relative risk for reoperation was estimated using the Cox proportional hazards model. RESULTS: From 1996 to 1998, 17,985 groin hernia operations were recorded in the Swedish Hernia Register, 15% for recurrent hernia and 85% for primary hernia. At 24 months the risk for having had a reoperation was 4.6% after recurrent hernia repair and 1.7% after primary hernia repair. The relative risk for reoperation was significantly lower for laparoscopic methods and for anterior tension-free repair than for other techniques. Postoperative complications and direct hernia were associated with an increased relative risk for reoperation. Day-case surgery and local infiltration anesthesia were used less frequently for recurrent hernia than for primary hernia. CONCLUSIONS: Recurrent groin hernia still constitutes a significant quantitative problem for the surgical community. This study supports the use of mesh by laparoscopy or anterior tension-free repair for recurrent hernia operations.

Hernia, Inguinal↗
PubMed2004

Emergency repair of groin herniae: outcome and implications for elective surgery waiting times.

Patients with groin herniae do not always seek medical advice and, when listed for surgery, often wait many months for elective repair. We audited our emergency admissions for complicated groin herniae to establish whether a change in policy for elective surgery could lower their incidence. We performed a retrospective review of all admissions for complicated groin herniae from 1 January 2000 to 31 December 2001. Besides outcome, we recorded patients' awareness of their diagnosis before admission and whether they had been listed for elective surgery. We identified 19 patients (16 men and three women) with an inguinal and 19 (four men and 15 women) with a femoral hernia. Sixteen (42%) knew of their hernia before admission (11 inguinal and five femoral), but only three had been awaiting surgical repair for 1, 7 and 26 weeks, respectively. The median (interquartile range) age was 70 (54-84) years in inguinal and 79 (64-88) years in femoral herniae. Surgery was performed in all but an 84-year-old man who died pre-operatively. Two patients with inguinal and 11 with femoral herniae required a laparotomy (p = 0.006). Bowel resection was necessary in one patient with an inguinal and 12 with femoral herniae (p = 0.001). Complications occurred in 12 cases (31%). Four patients, all with femoral herniae, died post-operatively, for an overall mortality of 13% (5/38). Morbidity and mortality for complicated groin hernia, particularly femoral, remain high. As most patients were elderly and unaware of their diagnosis, reducing waiting times for elective repair is unlikely to influence the incidence of complicated herniae.

Aged↗
PubMed2005

Ectopic adrenocortical tissue found at groin exploration in children: incidence in relation to diagnosis, age and sex.

OBJECTIVE: To assess the incidence of ectopic adrenocortical tissue (EACT) in the groin in children, and examine the relationship between the incidence and the underlying diagnosis, age and sex. PATIENTS AND METHODS: From computer records, all groin explorations between 1988 and 2002 in patients < or = 15 years old were identified. Cases of EACT were identified from computer histology records, and the incidence in different groups compared. RESULTS: Of 935 groin explorations, EACT was identified in 25 (2.7%); there were no cases in girls. The incidence was 0.7% at inguinal herniotomy (IH), 4.1% at ligation of the patent processus vaginalis for communicating hydrocele (P = 0.03 vs IH), and 3.3% at exploration for undescended testes (P = 0.02 vs IH). In boys with undescended testes the incidence of EACT was similar in different age groups (0-7 years, 3.3%; 8-15 years 3.2%, P = 0.96). CONCLUSIONS: The overall incidence of EACT at groin exploration was 2.7%, with none detected in girls. There was no evidence of involution of EACT with increasing age. The incidence of EACT varied with the underlying diagnosis, but the reason for this is unknown.

Adrenal Cortex↗
PubMed1999

The role of high resolution ultrasound with guided cytology of groin lymph nodes in the management of squamous cell carcinoma of the vulva: a pilot study.

The accuracy of high resolution ultrasound with guided fine needle aspiration cytology in detecting inguinal lymph node involvement was assessed in 24 women undergoing radical vulvectomy and groin node dissection for squamous cell vulval cancer. Of the 43 groins dissected, ultrasound correctly diagnosed the lymph node status in 36, with five false positive and two false negative results. Cytology in 40 groins showed no false positive and five false negative results. The sensitivity and specificity for the combined techniques were 83% and 82% respectively. Assessed together, the combined technique failed to detect metastatic disease in two groins; in both cases the extent of nodal metastatic involvement was a solitary focus < 3 mm in diameter. The ultrasound and fine needle aspiration procedure is safe and well tolerated and can be repeated as needed for surveillance. The authors suggest that this procedure should be evaluated further to determine whether a policy of individual selection for lymphadenectomy can be implemented based on this technique.

Aged↗
PubMed1989

The value of herniography in elderly women with groin pain of obscure origin.

In 64 women aged 60-90 (mean 69) years with groin pain of obscure origin (no palpable mass), the diagnostic contribution of positive-contrast herniography was retrospectively evaluated. Groin hernia was found in 28 patients (44%), and was judged to have caused the pain in 18 of them. In 13 of these patients herniorrhaphy relieved the symptoms, and in the other five surgery was contraindicated. The origin of the groin pain in the remaining 46 patients was judged to be musculoskeletal (21), intestinal (11), urogenital (3) or other (11). Herniography thus can substantially contribute in the clinical investigation of groin pain of unclear origin in elderly women.

Age Factors↗
PubMed1981

Radical vulvectomy and bilateral inguinal lymphadenectomy through separate groin incisions.

One hundred patients underwent radical vulvectomy and bilateral inguinal lymphadenectomy using separate groin incisions. Forty-nine had stage I disease, 37 stage II, and 14 stage III. Corrected actuarial 5-year survival for each stage was 97.4, 86, and 49.2%, respectively. Inguinal lymph nodes were positive in 25% of cases: 10.2% of stage I, 27% of stage II, and 71.4% of stage III cases. Major complications occurred in 21 patients, including major groin breakdown in 14. Thirty patients experienced no acute postoperative morbidity. The mean postoperative hospital stay was 19 days, and mean operative blood loss was 620 ml. No patients developed isolated metastases in either the groin or the inguinal skin bridge, but 2 stage III patients developed simultaneous metastases in the skin bridge and elsewhere. For appropriately selected patients, separate groin incisions for inguinal lymphadenectomy appear to result in lower morbidity than traditional methods, without compromising survival.

Adenocarcinoma↗
PubMed2006

Groin hernia: anatomical and surgical history.

The history of surgical repair of groin hernia is a lengthy record of assorted techniques in search of a cure for an ailment that comes in many sizes and shapes and that has plagued humanity for thousands of years. Although improvements are still being sought and found, for several decades surgeons have had the means to relieve most hernia sufferers. A remaining issue is whether the wide array of surgical procedures can or should be whittled down to a few "standard" operations that are safe, effective, and cost-efficient. The history of the anatomy of groin hernia shows how much there was to learn and how much remains to be learned. It also shows how important it is for the surgeon to know and understand both the anatomy of the area and the formation of groin hernia.

Anatomy↗
PubMed1990

Vacuum drainage of groin wounds after vascular surgery: a controlled trial.

A pilot study of 100 consecutive groin wounds after vascular surgery demonstrated lymph leaks in 12 per cent. Lymph leak was significantly associated with wound infection and with prolongation of in-patient stay. A controlled trial was therefore instituted to assess the influence of vacuum drainage in groin wound healing. One hundred and twenty-seven wounds were randomized to drainage (n = 65) or no drainage (n = 62) and the wounds were examined 'blind' by independent observers. No difference in the incidence of lymph leakage or wound infection was noted between the two groups. The routine use of suction drainage for groin wounds in vascular surgery is unnecessary.

Aged↗
PubMed1993

Surgical management of groin node metastases from nonvulvar gynecologic malignancies.

Metastatic disease from nonvulvar gynecologic malignancies involving the groin lymph nodes is uncommon. The purpose of this study is to analyze the morbidity, recurrence-free interval, and survival in this group of surgically managed patients. Twenty patients underwent surgical resection of metastatic disease involving the groin lymph nodes between January 1, 1984 and December 31, 1991. Individual factors which have an impact on morbidity, recurrence, and survival were analyzed. Two patients developed wound infection and 2 had wound breakdown. Both of the patients with postoperative wound infection had clinically fixed nodes. None of the patients developed deep venous thrombosis. Long-term complications included lymphocytes in 2 patients and lymphedema in 4 patients. The median local disease progression-free interval was 10 months, with 5 of 20 patients developing local recurrence. The overall median survival was 11 months, with an adjusted 5-year survival rate of 11.5%. Patients with clinically fixed lymph nodes had a shorter median survival (3.6 months) than those with clinically mobile (median, 22.6 months) nodes (P = 0.0032). Metastatic disease from carcinoma of the ovary, fallopian tube, uterus, and cervix involving the groin lymph nodes can be managed safely and effectively with surgical resection. The acute and long-term morbidity is acceptable. Local control can be achieved in the majority of patients.

Adult↗
PubMed1997

Posterior exenteration through groin incision in a patient with stage III vulvar carcinoma.

During performance of bilateral groin incisions, an abdominal incision and a colostomy has the potential risks of devascularization of the lower abdominal wall and infection. A patient with locally advanced vulvar carcinoma requiring a posterior exenteration is presented. The posterior exenteration was performed by developing an abdominal skin flap from the groin incisions. This approach offers adequate exposure and a unique solution to the potential problems associated with combining an abdominal skin incision with bilateral groin incisions and end-descending sigmoid colostomy. In addition, this approach may be cosmetically more acceptable.

Carcinoma, Squamous Cell↗
PubMed1999

Anatomic basis of chronic groin pain with special reference to sports hernia.

Chronic pain on the ventral surface of the scrotum and the proximal ventro-medial surface of the thigh especially in athletes has been diagnosed in various ways; recently, in Europe the concept of "sports hernia" has been advocated. However, since few reports discuss the detailed course of the nerves in association with the pain, we examined the cutaneous branches in the inguinal region in 54 halves of 27 adult male cadavers. From our results, in addition to the cutaneous branches from the ilioinguinal n. (in 49 of 54: 90.7%), cutaneous branches originating from the genital branches of the genitofemoral nerve were found in the inguinal region in 19 of 54 halves (35.2%). In 7 cases (in 7 of 54: 13.0%) the genital branch and the ilioinguinal nerve united in the inguinal canal. In 6 cases the genital branch pierced the inguinal lig. to enter the inguinal canal, and in three cases the genital branch pierced the border between the ligament and the aponeurosis of the obliquus externus m. to be distributed to the inguinal region. Therefore, the courses of the genital branches vary considerably, and may have a very important role in chronic groin pain produced by groin hernia. In addition, entrapment by the ligament may be a reasonable candidate for the cause of chronic groin pain.

Adult↗
PubMed1995

Skin closure and the incidence of groin wound infection: a prospective study.

Groin wound infection is a dreaded complication of vascular surgery and may jeopardize an underlying graft. A variety of skin closures have been used and the object of this study was to prospectively determine the relationship between skin closure and wound infection. One hundred fourteen consecutive patients (70 men and 44 women) undergoing bypass surgery with a groin incision (n = 173) were randomly assigned to skin closure with subcuticular Maxon, interrupted nylon, continuous nylon, or clips following a standard two-layer closure of subcutaneous tissue. Fourteen (12%) patients had diabetes and 50 (44%) had digital ulceration and gangrene. Aortofemoral bypass was performed in 25% of the patients and infrainguinal bypass in the remaining 75%. Perioperative wound cultures were obtained before closure. Wounds were inspected and cultures repeated on postoperative days 3, 5, 7, 10, and 14. Infection was defined as a positive culture. Groin wound infection occurred in 3% of the population and graft infection in 0.6%. The type of suture did not influence the incidence of infection. This study failed to demonstrate a significant difference in the incidence of wound infection with the use of different suture materials. We conclude that suture material should be selected on the basis of surgeon preference and costs.

Aged↗
PubMed2006

[Surgical treatment of groin soft tissue defects].

BACKGROUND: Treatment of groin defects remains challenging due to their location and origin. Such defects commonly result from resection of tumours but can also occur after surgical or medical therapy. MATERIAL AND METHODS: From 2003 to 2005, 11 patients were treated with groin defects following radiation therapy and resection of lymph node metastasis, primary carcinoma, and sarcoma. Seven patients received wound closure with rectus femoris muscle flaps, and three had vertical rectus abdominis muscle flaps. One patient was amputated at the hip, and the defect was covered with dorsally pedicled muscle and skin flaps. RESULTS: All flaps healed primarily. There were no secondary infections or lymphorrhea. CONCLUSION: The flaps described here are well vascularised standard flaps which are easily harvested with no major donor site morbidity. They provide sufficient coverage for the groin, reduce long-term conservative treatment, hospitalisation, and problems such as scar contracture.

Carcinoma, Squamous Cell↗
PubMed2006

[Differential diagnosis of hip and groin pain. Symptoms and technique for physical examination].

The differential diagnosis of hip and groin pain with respect to the high frequency of referred pain from the lumbar spine, lower abdomen, and pelvis is demanding. A systematic approach to the hip and groin area is important to identify the origin of pain. Both the history and quality of symptoms and the physical exam are the basics of the diagnostic algorithm. Roentgenograms and possibly an injection with a local anesthetic to the suspected origin of pain often complete the diagnostic work-up.The following report summarizes the typical symptoms of hip and groin disorders. A detailed description of the physical exam including functional tests for impingement, apprehension, adductor-, psoas-, and inguinal-related pain is included.

Arthralgia↗
PubMed2002

Sonographic findings of tensor fascia lata tendinopathy: another cause of anterior groin pain.

OBJECTIVE: To describe the sonographic appearances of the normal tensor fascia lata (TFL) origin and to describe the sonographic changes that were present in the TFL of a group of athletes presenting with anterior groin pain. DESIGN: The sonographic appearances of the TFLs of 40 healthy asymptomatic volunteers were evaluated. The TFLs of approximately 200 patients aged between 16 and 55 years presenting with anterior groin pain were evaluated in the course of routine sonographic assessment of the hip. Twelve abnormal TFLs were identified in 12 patients aged between 16 and 53 years. A retrospective review of the appearance of the normal and abnormal tendon with respect to its overall size and echotexture was made. RESULTS: The normal TFL has a thin ribbon-like appearance with a clearly defined fibrillar pattern and a mean anteroposterior (AP) size of 2.1 mm (range 1.5-3.1 mm). In the patient cohort the TFL typically appeared enlarged and contained a cone-shaped area of hypoechogenicity based on the iliac crest within the deep fibers of the origin. The TFL origin was enlarged up to 2 1/2 times its normal size. The mean AP size of the abnormal TFL was 4.7 mm (range 3.1-7.0 mm). CONCLUSION: Tendinopathy of the TFL is a cause of anterior groin pain. Sonography can be used to depict changes in the TFL, confirming the diagnosis and assessing the severity of the tendinopathy.

Adolescent↗
PubMed2004

Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings.

OBJECTIVE: To evaluate gadolinium-enhanced MR imaging in athletes with chronic groin pain and correlate with the clinical features. DESIGN AND PATIENTS: MR examinations performed in 52 athletes (51 male, 1 female; median age 26 years) with chronic groin pain and 6 asymptomatic control athletes (6 male; median age 29 years) were independently reviewed by two radiologists masked to the clinical details. Symptom duration (median 6 months) and clinical side of severity were recorded. Anatomical areas in the pelvis were scored for abnormality (as normal, mildly abnormal or abnormal) and an overall assessment for side distribution of abnormality was recorded, initially without post-gadolinium sequences and then, 3 weeks later (median 29 days), the post-gadolinium sequences only. Correlation between radiological and clinical abnormality was calculated by Spearman's correlation. RESULTS: Abnormal anterior pubis and enthesis enhancement significantly correlated with clinical side for both radiologists (both P=0.008). Abnormal anterior pubis and adductor longus enthesis oedema was significant for one radiologist ( P=0.009). All other features showed no significant correlation ( P>0.05). In the control cases there was no soft tissue abnormality but symphyseal irregularity was present ( n=2). For both radiologists assessment of imaging side severity significantly correlated with clinical side for post-gadolinium ( P=0.048 and P=0.023) but not non-gadolinium sequences ( P>0.05). CONCLUSION: The extent and side of anterior pubis and adductor longus enthesis abnormality on MR imaging significantly and reproducibly correlates with the athletes' current symptoms in chronic adductor-related groin pain.

Adolescent↗
PubMed2002

Planned reduction of incarcerated groin hernias with hernia sac laparoscopy.

BACKGROUND: Laparoscopic techniques have been described as adjuncts in the management of acutely incarcerated groin hernias, with the intention of reducing operative morbidity and patients discomfort. However, the use of laparoscopy in acute incarcerations, as well as its appropriateness, remains to be elucidated. Herein we discuss the use of hernia sac laparoscopy in the algorithm of managing incarcerated groin hernias. METHODS: Five patients presenting with small bowel obstruction secondary to incarcerated groin hernias underwent surgical reduction of the hernia followed by hernia sac laparoscopy. The purpose of hernia sac laparoscopy was to determine the viability of the incarcerated bowel segment based on color, peristalsis, and venous congestion. When bowel resection was required, a separate incision was made after repair of the hernia. RESULTS: Bowel viability was assessed accurately with this method. Although hemorrhagic fluid in the hernia sac was noted in three patients, only one patient required a limited exploration through a separate incision for nonviable bowel. Postoperative recovery was standard, with no morbidity or mortality. Patients were discharged in 2-5 days. CONCLUSIONS: Hernia sac laparoscopy, without additional trocar placements, is a safe adjunct for determining the viability of the incarcerated bowel segment. This method reduces the need for laparotomy so long as the reduced incarcerated segment meets the criteria for viability. Videoscopic inspection potentially offers additional information, such as the existence of ascites and peritoneal tumors.

Adult↗
PubMed2004

Operative morbidity associated with groin dissections.

PURPOSE: Groin dissection remains the treatment of choice for malignant neoplasms of the skin in the lower extremities and perineum. We sought to quantify the hospital complications after groin dissection, and to identify the patient- and procedure-related factors affecting these complications. METHODS: We reviewed 20 consecutive patients who underwent a collective 25 groin dissections for malignant neoplasms of the skin between 1996 and 2002 to determine the incidence and degree of morbidity, and to analyze the clinical factors associated with morbidity. An S-shaped incision was used for the first 8 procedures, whereas a straight incision was used for the next 17. RESULTS: The overall incidences of complications were 24% for wound infection, 52% for skin flap problems, 32% for seromas, 40% for edema, and 4% for hemorrhage, whereas the incidences of moderate to severe complications were 16% for wound infection, 16% for skin flap problems, 12% for seromas, 4% for edema, and 4% for hemorrhage. The incidence of wound infection tended to be higher after S-shaped incisions than after straight incisions ( P = 0.059), and the incidence of leg edema was significantly higher after S-shaped incisions than after straight incisions ( P = 0.028). CONCLUSION: S-shaped incisions more often resulted in lymphatic collection and stagnation, with a higher incidence of wound infections and leg edema than straight incisions. Therefore, we now perform straight incisions to minimize the risk of wound infections and leg edema.

Adult↗