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A 75-year-old woman presented with a painful abdominal lump. Clinically and sonographically it was diagnosed as an abscess. Surgical exploration revealed a Spigelian hernia with Richter's type of strangulation. The strangulated portion of the ileum had perforated, leading to abscess formation.
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The authors describe the case of a 74-year-old male presenting with an incarcerated epigastric hernia. An algorithm for successful management of such a case is proposed.
Interest in inguinal hernia surgery has increased significantly with the introduction of new operating techniques during the past decade. This multicenter study compared short-term results in patients treated by the laparoscopic transabdominal preperitoneal patch technique (TAPP; n = 518) and the Shouldice technique (n = 524). We evaluated demographics, operative data, complications, hospital stay, postoperative pain, use of cs, functional status, sick leave, and complaints up to 3 months postoperatively. The median operating time was shorter in the Shouldice group (55 vs. 65 min), but there were no significant differences in complication rates, and major complications were rare. The hospital stay was 1 day or less in over 98% of cases in both groups, but more operations were performed on outpatient basis in the Shouldice group. In the TAPP group postoperative pain and analgesic consumption were less, postoperative functional status was better, and sick leave was shorter (10 vs. 14 days). These results show that the two methods are equally safe and have few major complications. The TAPP operation is associated with less postoperative pain, better postoperative functional status, and shorter sick leave, but at the price of a longer operating time.
BACKGROUND: Refinements in the configuration of mesh may ease handling and placement and reduce postoperative discomfort. MATERIAL AND METHODS: A total of 206 patients were randomly and blindly allocated to receive the Prolene Hernia System (PHS) or Lichtenstein patch. Collected data included: surgical incision size, procedure time, pain scores, analgesic medication, complications, return to activity and work, and quality of life as measured by Short-Form 36 on days 3 and 14. RESULTS: Immediate post-operative pain was significantly lower with PHS than with the patch. The proportion of PHS patients taking longer than 3 days to return to normal activity was 15.5%, compared to 28.4% of patch patients. Operating time was significantly shorter with PHS (34.1 vs. 38.3 min). There was no treatment effect on any of the quality of life scales as measured by Short-Form 36. There were two recurrences in the patch group. CONCLUSIONS: The study indicates a reduction in operating time (4 min) and postoperative recovery with the PHS compared with patch.
An unusual complication of a Meckel's diverticulum, a strangulated Littre's femoral hernia, is presented. The incidence and complications of Meckel's diverticulum are discussed. It is emphasized that most complications occur before age 30. Thus in an adult an incidentally discovered Meckel's diverticulum should not be resected.
Traumatic abdominal wall herniation (TAWH) caused by direct trauma from bicycle handlebars are rare. There are only 21 reported cases of handlebar hernias. An 11-year-old boy presented to the emergency room soon after falling from his bicycle and hitting his right lower quadrant on the handlebars. The patient's vital signs and initial laboratory studies were normal. Physical exam showed a soft tissue bulge in the right lower quadrant with superficial ecchymosis and tenderness to palpation. Computed tomography showed intestinal loops protruding through a defect in the abdominal wall into the subcutaneous space. Surgical exploration found a defect throughout his entire abdominal wall including the fascia, muscular layers, and peritoneum, with bowel protruding into the subcutaneous space. The defect was repaired in layers, and the child's postoperative course was unevenful. The authors recommend a high level of clinical suspicion for TAWH in all patients with traumatic abdominal wall injuries. Definitive treatment includes surgical exploration with primary repair of all tissue layers of the abdominal wall.
Data from 400 consecutive elective ambulatory operations for inguinal hernia under unmonitored local anaesthesia with limited pre-operative testing were prospectively obtained by the use of standardised files and questionnaires to assess the feasibility, patient satisfaction and potential cost reductions for such a technique. The median age of the patients was 59 years, and 29 operations were performed in ASA group III patients. The median postoperative hospital stay was 85 min. Conversion to general anaesthesia was necessary only in two cases, and nine patients needed overnight admission. One week postoperative morbidity was low with one case of transient cerebral ischaemia and one case of pneumonia, but no case of urinary retention. On follow-up, 88% were satisfied with the procedure, including unmonitored local anaesthesia. The cost reduction was at least 160 Pounds per patient compared with general/regional anaesthesia. We conclude that elective inguinal herniorrhaphy may be performed routinely under unmonitored local anaesthesia with a low postoperative morbidity, a high satisfaction rate and significant cost reductions.
In the report a new method of tension-free repair of inguinal hernia using a prolene-mash PHS is described.
Authors report 10 case of tension free inguinal hernia repair with PHS double mesh grafts, used for the first time in Hungary. The operative technique is described in details. The first results are promising. Patients had minimal postoperative pain and recovery time was small. On the base of the results, the procedure is suitable for day surgery.
The A. describe a case of Littré's hernia drawn from personal experience. The article discusses Meckel's diverticulum complications, difficult presurgical diagnosis and different surgical techniques of performing diverticulectomy.
A rare case of narrowed Meckel's diverticulum in a right crural hernia sac is reported in a male patient.
We report on a 73-year-old patient with an incarcerated right sided groin hernia. First the incarcerated small bowel was gently retracted laparoscopically; then using the extraperitoneal endoscopic approach the hernial sack was redused and a 15/13 cm prosthesis (polypropylene mesh) brought in appropriate position and fixed with endo-staples. Prior to closing the trocar-incisions the vitality of the small bowel was checked once again laparoscopically.
The author presents the technique and intermediate results of retroperitoneal laparoscopic inguinal hernia repair in a series of 864 cases. The retroperitoneal technique is now well defined and the various key points are described. Analysis of the results shows the very good immediate post-operative course and the very low medium-term recurrence rate.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.