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PubMed2004

Endoscopic totally extraperitoneal repair for occult bilateral obturator hernias and multiple groin hernias.

INTRODUCTION: An obturator hernia is a rare hernia that is bilateral in about 6% of patients. Most patients present with chronic pelvic pain although a few patients may present with features of intestinal obstruction. Only about 10% of obturator hernias are diagnosed preoperatively. METHODS: A 65-year-old female patient with chronic obstructive pulmonary disease presented with bilateral groin swellings associated with local pain and heaviness. She also suffered from recurrent episodes of abdominal distension. She was diagnosed to have bilateral direct inguinal hernias and a left femoral hernia. At endoscopy under epidural anesthesia she was found to have a direct inguinal, an indirect inguinal, and a femoral hernia on the left side and an indirect inguinal hernia on the right side. Additionally, the endoscopic totally extraperitoneal approach to inguinal hernias identified hitherto undiagnosed bilateral obturator hernias. The hernias were reduced and polypropylene mesh was placed bilaterally covering the myopectineal orifice and pelvic floor bilaterally. RESULTS: The patient was discharged the next day and is symptom-free on followup at eight months. CONCLUSION: Endoscopic repair of groin hernias allows the surgeon not only to diagnose and treat unsuspected groin hernias but also allows identification, dissection, and repair of coincidental occult pelvic hernias like obturator hernias at the same time.

Aged↗
PubMed2000

Risk of contralateral manifestation in children with unilateral inguinal hernia: should hernia in children be treated contralaterally?

PURPOSE: This study was done to identify risk factors for metachronous manifestation of contralateral inguinal hernia in patients with unilateral inguinal hernia. METHODS: Characteristics of 156 patients with metachronous contralateral hernia were compared with those of 156 patients with unilateral hernia who were ascertained not to have presented with contralateral hernia. RESULTS: There was a tendency for the hernia to be more often on the left side in 88 of 156 patients (56.4%) with contralateral manifestation compared with 70 of 156 patients (44.9%) in the control group (P =.054). The age at hernia repair of the patients with contralateral manifestation, 1 to 120 months (median, 14 months), was significantly younger than the 1 to 149 months (median, 20 months) of the control patients (P =.016). More patients with contralateral manifestation had a family history of inguinal hernia, and the percentage, 24.4%, was significantly higher than the 14.7% in the control group (P =.046). A univariate analysis with the Cox regression models found that hernia on the left side and a positive family history were significantly associated with the metachronous manifestation of contralateral hernia (hazard ratio [HR], 1.40; P =. 037 and HR, 1.59; P =.013, respectively). CONCLUSION: The risk of metachronous manifestation of contralateral hernia is high in patients with left-side hernia and in those with a family history, and the incidence of contralateral hernia is at most 10% in these patients. The authors think that the incidence is still too low to justify routine exploration and surgery for a patent processus vaginalis. Contralateral exploration should therefore be reserved for high-risk patients in whom second anesthesia and surgery have to be avoided.

Adolescent↗
PubMed1998

[Management of complicated incisional hernias with underlay-technique implanted polypropylene mesh. An effective technique in French hernia surgery].

UNLABELLED: Incisional hernia repair with conventional techniques (simple closure, Mayo-technique) is associated with unacceptable recurrence rates of 30-50%. Therefore, surgical repair using different prosthetic biomaterials is becoming increasingly popular. Further to favourable results by French hernia surgeons, we studied the results of underlay prosthetic mesh repair using polypropylene mesh in complicated and recurrent incisional hernias. METHOD: After preparation and excision of the entire hernia sac, the posterior rectus sheath is freed from the muscle bellies on both sides. The peritoneum and posterior rectus sheaths are closed with a continuous looped polyglyconate suture. The prosthesis used for midline hernias is positioned on the posterior rectus sheath and extends far beyond the borders of the myoaponeurotic defect. The anterior rectus sheath is closed with a continuous suture. The prosthesis for lumbar and subcostal hernias is placed in a prepared space between the transverse and oblique muscles. Intraperitoneal placement of the mesh must be avoided. RESULTS: Between January 1996 and August 1997 we performed a total of 33 incisional hernia repairs (14 primary hernias, 19 recurrent hernias) using this technique (16 women, 17 men, mean age 56.19 +/- 12.92 years). Local complications occurred in four patients (12%): superficial wound infection (n = 2), postoperative bleeding, requiring reoperation (n = 1), minor hemato-seroma (n = 1). One patient suddenly died on the 3rd post-operative day from severe pulmonary embolism (mortality 3%). Twenty-two patients with a minimum follow up to 6 months were re-examined clinically. The average follow-up time for this group was 9 months (range 6-17 months). To date no recurrent hernias have been observed. There were only minor complaints like "a feeling of tension" in the abdominal wall (n = 3) and slight pain under physical stress (n = 6). CONCLUSIONS: The use of prosthetic mesh should be considered for repair of large or recurrent incisional hernias, especially in high-risk patients (obesity, obstructive lung disease) and complicated hernias. The aforementioned technique of underlay prosthetic repair using polypropylene mesh fixed onto the posterior rectus sheath allows for anatomical and consolidated reconstruction of the damaged abdominal wall with excellent results and low complication rates.

Adult↗
PubMedDate not supplied

Laparoscopic ventral incisional hernia repair: a more effective alternative to conventional repair of recurrent incisional hernia.

Conventional repair of recurrent ventral incisional hernia is associated with a higher recurrence rate (30%-50%) than repair of primary incisional hernia (11%-20%). Laparoscopic incisional hernia repair (LIHR) can significantly reduce the recurrence rate of primary hernia to less than 5%. In this study, we evaluate the efficacy of repairing recurrent incisional hernia laparoscopically. One-hundred and seventy consecutive patients undergoing LIHR between January 1995 and December 2002 were prospectively reviewed. Patients with recurrent incisional hernia (n=69) were compared to patients with primary incisional hernia (n=101). Patient demographics and perioperative and postoperative data were recorded prospectively. Follow-up was obtained from office visits and telephone interviews. Statistical analysis was performed using the Student t test and the chi(2) test. Results are expressed as means +/- standard deviation. The patients with recurrent incisional hernia had a mean of 1.9 +/- 1.3 previous repairs, higher body mass index (BMI) (34 +/- 6 kg/m(2) vs. 33 +/- 8 kg/m(2), P=0.46), larger defect size (123 +/- 115 cm(2) vs. 101 +/- 108 cm(2), P=0.06), and longer operative time (119 +/- 61 minutes vs. 109 +/- 44 minutes, P=0.11). The complication rate was higher in the recurrent group (28% vs. 11%, P=0.01), but the recurrence rate was not different (7% vs. 5%, P=0.53). The mean time to recurrence was significantly shorter in the recurrent group (3 +/- 2 months vs. 14 +/- 7 months, P < 0.0001). The mean follow-up interval was 19 +/- 18 months in the recurrent group and 27 +/- 20 months in the primary group. Although laparoscopic repair of recurrent incisional hernia resulted in a higher recurrence and complication rate than laparoscopic repair of primary incisional hernia, the rates were lower than those reported for conventional repair of recurrent incisional hernia. Laparoscopic repair of recurrent incisional hernia is an effective alternative to conventional repair.

Chi-Square Distribution↗
PubMed2005

Comparison of the plasma and hernia sac tissue copper levels in direct and indirect inguinal hernia patients.

Although the inguinal hernia is among the most commonly encountered and well-described health problems all over the world, the etiology is still controversial. The aim of this study was to compare the plasma and hernia sac tissue copper levels in direct and indirect inguinal hernia patients. Plasma and hernia sac tissue copper levels obtained from patients operated under spinal anesthesia with primary direct (group I, n = 55, 45 male, mean age = 45.68 yr) and indirect (group II, n = 55, 40 male, mean age = 38.57 yr) hernias were detected by atomic absorption spectrophotometer. Significantly lower plasma and hernia sac tissue copper levels were detected in group I in comparison to group II (p < 0.001). Both plasma and hernia sac tissue copper levels were significantly lower in males when we compare the patients according to their sex characteristics, including both direct and indirect hernia groups (p < 0.05 and p < 0.01, respectively). Age was not a significant factor. The plasma and hernia sac tissue copper levels were significantly lower in direct hernia patients in comparison to indirect hernia patients. Copper is a cofactor of lysyl oxidase, an important enzyme in collagen tissue metabolism, so there might be a defect in the collagen synthesis of direct hernia patients because of the decreased activity of the lysyl oxidase. Further investigations are necessary to clarify this concept.

Adult↗
PubMedDate not supplied

[Recurrent parastomal hernia and middle incisional hernia: surgical treatment through midline incision with wide prosthetic mesh].

Parastomal hernia is a frequent complication of stoma surgery. The results of parastomal hernia repair however are poor, showing an high incidence of postoperative recurrences. In the last years, hernia repair with prosthetic mesh has given better postoperative results. The parastomal hernia, however, is associated with middle incisional hernia. The authors review the problem of surgical repair of parastomal hernia and report a case of recurrent parastomal hernia associated to middle incisional hernia. The technique of surgical repair using, through midline incision, one, wide, prosthetic polypropylene mesh, in sublay position, according to Rives' technique, is described. The mesh has been incised in a trasverse direction for the stoma crossing. At 6 years follow-up the patient does not show postoperative recurrence. According literature and the authors' results, the parastomal hernia might be considered an incisional hernia and, therefore, a sing of diffuse abdominal wall disease. The Rives' surgical technique might be the gold standard for treatment of parastomal hernia, even if not associated to incisional hernia. The more complexity of Rives' technique compared to local fascial mesh repair is compensated by the result of total abdominal wall reinforcement.

Aged↗
PubMed1975

External herniae: ventral herniae and summary.

1. In three articles, inguinal, femoral, and ventral herniae have been discussed, one of the aims being to draw the attention of those who are new to surgery in the tropics to some of the things the author thought were peculiar to these herniae. Experiences in the 1,100-bed Korle Bu Hospital, Accra, where a retrospective survey showed that 609 external herniaw were mended in 15 months, formed the basis of the discussions. 2. The applied anatomy of the inguinal canal of adult Ghanaians was described. Three things were pointed out: the infantile type of inguinal hernia was the rule not the exception; the floor and the conjoint tendon were well developed and useful for repair; the pubic branch of the inferior epigastric artery was normal not aberrant. 3. IN Accra inguinal herniae are big and a man's disease. The differential diagnosis of scrotal hernia includes vaginal hydrocele, scrotal elephantiasis, testicular tumours, and tuberculous epididymoorchitis. A case was made in favour of differentiating between direct and indirect inguinal herniae preoperatively. 4. Elective herniorrhaphy was recommended as the treatment of choice and operative techniques were described. The suture material to employ for the Bassini repair must be non-absorbable, e.g. silk or nylon. Whereas herniotomy is adequate in children, in women herniorrhaphy is combined with clearance and obliteration of the inguinal canal. 5. The author did not recommend a truss for an inguinal let alone a femoral hernia. There is suggestive evidence that even in the tropics a man's hernia could be safely repaired on an out-patient basis. 6. Since femoral hernia is rare, it was recommended that in the interest of the patients, skillful surgeons should repair them. 7. The surgical anatomy of the femoral canal, and clinical features of femoral hernia were described. The differential diagnosis included inguinal hernia, abscesses in the groin, hydrocele of the femoral canal, saphena varix, lymphadenopathy, simple tumours and aneurysm of the femoral artery. 8. The treatment of choic is a surgical operation of which three were named and one described ("the low" operation of Lockwood). Recurrence is rare...

Cesarean Section↗
PubMed2000

Incidence of incipient contralateral hernia during laparoscopic hernia repair.

BACKGROUND: In addition to its well-known benefits of decreased postoperative pain and shorter recovery time, laparoscopic hernia repair has the major advantage of allowing the surgeon to explore the side contralateral to the clinically diagnosed hernia. The purpose of this study was to evaluate the incidence of incipient unsuspected contralateral hernia during totally extraperitoneal (TEP) laparoscopic inguinal herniorrhaphy and to analyze the risks and benefits of identifying these hernias at the time of the initial surgery. METHODS: We did a retrospective review of the charts of all of the 724 male patients who underwent laparoscopic TEP repair of 958 groin hernias between September 1991 and September 1999. The initial clinical impression of the existence of unilateral or bilateral hernias was noted and compared to our operative findings. The same surgeon performed all the repairs. Exploration of the contralateral side was performed in a systematic fashion. A second mesh prosthesis was placed if a contralateral hernia was found. RESULTS: Bilateral hernia repair was performed on 234 patients (32. 3%). In 62 of them (11.2%), the contralateral hernia was diagnosed only at the time of the procedure. Operative time ranged from 14 to 185 min (median, 38.6). The operative time for the contralateral exploration ranged from 2 to 5 min (median, 2.8). The rate of complications was 4.1%, but no complications were directly related to the exploration of the asymptomatic side. CONCLUSION: Our study shows that a large number of inguinal hernias are undiagnosed by physical examination (11.2%). Systematic contralateral exploration using the TEP approach is safe and does not greatly increase the operative time. Early identification and repair of a contralateral hernia obviates the need for reoperation, reduces overall costs to the health care system, and eliminates any further work loss for the patient.

Adolescent↗
PubMed2006

Post-radical retropubic prostatectomy inguinal hernia: an analysis of risk factors with special reference to preoperative inguinal hernia morbidity and pelvic lymph node dissection.

PURPOSE: Inguinal hernia after radical retropubic prostatectomy has been reported to occur in 7% to 21% of patients. We analyzed the impact of simultaneous pelvic lymph node dissection, preoperative inguinal hernia morbidity, postoperative anastomotic stricture, duration of surgery and patient age. We also compared the detection rate of inguinal hernia events in a retrospective patient file survey to that in a prospective patient administered questionnaire. MATERIALS AND METHODS: A total of 498 patients underwent radical retropubic prostatectomy plus pelvic lymph node dissection and 166 underwent radical retropubic prostatectomy only. Mean followup was 40 months (median 37, range 3 to 85). All 664 patients were analyzed in the patient file survey. The patient administered questionnaire was mailed preoperatively, and after 3, 6, 12, 18, 24 and 36 months to 271 patients who underwent operation between 2001 and 2002. A total of 207 patients (76.4%) completed the preoperative questionnaire. RESULTS: The cumulative incidence of inguinal hernia after 24 months was 11.6% in the patient file survey and 15.7% in the patient administered questionnaire. In the patient file survey patient age was the only studied factor that significantly influenced risk. The patient file survey failed to detect half of the men with preoperative inguinal hernia morbidity and a third of post-radical retropubic prostatectomy inguinal hernias compared to the patient administered questionnaire. On patient administered questionnaire analysis preoperative inguinal hernia morbidity was a significant risk factor for postoperative inguinal hernia (log rank Mantel-Cox test p = 0.010). CONCLUSIONS: Previous inguinal hernia morbidity and age increase the risk of post-radical retropubic prostatectomy inguinal hernia. Simultaneous pelvic lymph node dissection, postoperative anastomotic stricture and duration of surgery were not significant risk factors in this study. The patient file survey is inferior to the patient administered questionnaire for detecting inguinal hernia events.

Hernia, Inguinal↗
PubMed1990

[Lotheissen-McVay repair of hernia. Late follow-up analysis after 1202 operations for inguinal and femoral hernias].

Of 1202 hernia repairs performed according to the modified Lotheissen-McVay technique 1020 (84.9%) were followed up. The frequency of hernia increases with increasing age. The total recurrence rate after an average follow-up of 9 years was 9.2% for primary hernias and 11.5% for recurrences. The recurrence rate depends on the follow-up time and on sex. For primary hernias the recurrence rate was 0.7% after 1 year, 5% after 5 years, 9.1% after 10 years and 11.5% after 15 years. After 1 year the recurrence rate was 0.6% for women and 0.8% for men; after 5 years the corresponding figures were 3.9% and 5.2% and after 10 years, 6.6% and 9.5%. The results after repair of recurrent hernias are not much worse than those obtained in the case of primary hernias. The recurrence rate depends on the surgeon's experience. We found a recurrence rate of 3.6% in 319 operations performed by our most experienced surgeon, as against 16.3% among those performed by inexperienced surgeons. Therefore, careful assistance is paramount for the inexperienced surgeon, because training is indispensable. The most frequent complications of primary operations were hematoma and seroma (4.4%), wound infections (1.7%), pulmonary embolism (0.9%), deep vein thrombosis (0.7%) and testicular atrophy (0.4%). The traditional Lotheissen-McVay technique for hernia repair still has a place in the surgical treatment of hernia. This technique can be used as the standard treatment for all kinds of inguinal or femoral hernias, without higher complication rates, and it yields especially good results in recurrent hernias.

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↗
PubMed2003

Inguinal hernia: obligatory indication for elective surgery? A prospective assessment of quality of life before and after plug and patch inguinal hernia repair.

BACKGROUND: Incarcerated inguinal hernia may be treated effectively by recent surgical techniques with a low rate of complications, but it is unclear whether quality of life is improved by elective inguinal hernia repair. Therefore we investigated the quality of life before and after inguinal hernia repair using plug and patch technique. PATIENTS AND METHODS: Quality of life was prospectively assessed in 123 patients before and 3 months after plug and patch inguinal hernia repair using the Short Form 36 questionaire and a visual analog scale. All patients complained preoperatively of pain associated with the clinical findings of inguinal hernia (visual analog scale: reduced quality of life 6.8+/-2.7; reduced daily activity: 5.5+/-2.6). Clinical characteristics (operation times, in-hospital stay, complications, need for pain medication) were documented. Inclusion criteria were patients with symptomatic inguinal hernia, scheduled for elective unilateral inguinal hernia repair by plug and patch technique. RESULTS: There were no major in-hospital complications. At 3 months no recurrences of inguinal hernia or late onset complications were observed; seven patients complained of dumbness, and eight felt pressure at the operation site with a tendency for resolving pain within this time. At 3 months patients had a significantly improved quality of life regarding freedom from pain, vitality, and physical activity compared to preoperatively. CONCLUSIONS: Plug and patch repair of unilateral inguinal hernia improves quality of life with a very low rate of procedural complications. Regarding freedom from pain, vitality, and physical activity there is significant improvement as compared to preoperatively. Therefore inguinal hernia repair should be intended in all elective cases and plug and patch repair appears as an excellent technique to improve quality of life.

Aged↗
PubMed1999

Bilateral lumbar hernia associated with abdominal hernias. A case report.

Multiple abdominal hernias constitute a quite rare event in surgical practice. Lumbar hernias are even rarer and, to our knowledge, this is the first report in the English literature of its association with abdominal hernias. A case of multiple abdominal hernias, namely an epigastric hernia and a left inguinal hernia together with a bilateral lumbar hernia in a 65-year-old man attending the Out-patient department of Hoima Hospital-Uganda is described. A one-stage repair under local anaesthesia was chosen. The patient recovered uneventfully and no recurrence was noted at 1 year follow-up. This case report supports that a "one-stage" procedure under local anaesthesia can be appropriate as surgical treatment of multiple abdominal hernias when abdominal defects are of a small size. A minimal surgical approach to lumbar hernias seems also suitable when transverse muscle aponeurosis defect can be carefully repaired and covered with adjacent muscles.

Aged↗
PubMed2000

Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants.

BACKGROUND: Congenital diaphragmatic hernia, although rare (1 per 2-4,000 births), is associated with high mortality and cost. Opinion regarding the timing of surgical repair has gradually shifted from emergent repair to a policy of stabilization using a variety of ventilatory strategies prior to operation. Whether delayed surgery is beneficial remains controversial. OBJECTIVES: To summarize the available data regarding whether surgical repair in the first 24 hours after birth rather than later than 24 hours of age improves survival to hospital discharge in infants with congenital diaphragmatic hernia who are symptomatic at or immediately after birth. SEARCH STRATEGY: Search of Medline (1966-1999), Embase (1978-1999) and the Cochrane databases using the terms "congenital diaphragmatic hernia" and "surg*"; citations search, and contact with experts in the field to locate other published and unpublished studies. SELECTION CRITERIA: Studies were eligible for inclusion if they were randomized or quasi-randomized trials that addressed infants with CDH who were symptomatic at or shortly after birth, comparing early (<24 hours) vs late (>24 hours) surgical intervention, and evaluated mortality as the primary outcome. DATA COLLECTION AND ANALYSIS: Data were collected regarding study methods and outcomes including mortality, need for ECMO and duration of ventilation, both from the study reports and from personal communication with investigators. Analysis was performed in accordance with the standards of the Cochrane Neonatal Review Group. MAIN RESULTS: Two trials met the pre-specified inclusion criteria for this review. Both were small trials (total n<90) and neither showed any significant difference between groups in mortality. Meta-analysis was not performed because of significant clinical heterogeneity between the trials. REVIEWER'S CONCLUSIONS: There is no clear support for either immediate (within 24 hours of birth) or delayed (until stabilized) repair of congenital diaphragmatic hernia, but a substantial advantage to either one cannot be ruled out. A large, multicenter randomized trial would be needed to answer this question.

Age Factors↗
PubMed2004

Inguinal mass due to an external supravesical hernia and acute abdomen due to an internal supravesical hernia: a case report and review of the literature.

Although supravesical hernias were described as early as 1804, there have been fewer than 100 cases reported in the literature. The supravesical fossa is a triangular area bounded laterally and above by median and medial umbilical ligaments, and below by the peritoneal reflection that passes from the anterior abdominal wall to the dome of the bladder. A hernia starting in this fossa usually protrudes through the abdominal wall as a direct inguinal hernia (external supravesical hernia). Less commonly, it remains within the abdomen, passing into spaces around the bladder (internal supravesical hernia). A 43-year-old mill worker presented with an enlarged painful mass in the left groin. He underwent a surgical repair of a direct inguinal hernia without addressing an unrecognized supravesicular component. Eight hours after his discharge next morning, he presented with acute abdomen, nausea, vomiting, and abdominal distention. The second surgery revealed the presence of a left lateral internal supravesical hernia with incarcerated small bowel. This was also repaired, and the patient was discharged in stable condition. This report aims to review and discuss the surgical anatomy of these rare supravesical hernias and calls attention to this type of hernia as an unusual cause of small bowel obstruction.

Abdomen, Acute↗
PubMed2002

Laparoscopic transabdominal preperitoneal inguinal hernia repair for recurrent inguinal hernia.

Laparoscopic transabdominal preperitoneal inguinal herniorrhaphy (TAPP) was attempted on 989 hernias in 708 patients. Of these 137 (14%) hernias were recurrent after conventional anterior repair. Laparoscopic repair was performed on 135 recurrences in 120 patients (the study cohort). There were 119 males and three females with an average age of 59 years (22-83 years). One hundred twelve (83%) were the first recurrences, and 23 (17%) were multiple recurrences. In 90 recurrences (66.7%) the last repair was performed more than 10 years previously. Seventy-seven patients (64%) had a prior or concomitant repair of a contralateral hernia. Direct recurrences and right-side recurrences were more common (73% and 61% respectively). Postoperative complications occurred in 18 repairs (13%). These included 15 hematomas, two seromas, and one urinary retention. Re-recurrence occurred in one patient (0.7%) in whom hernia staples were not used. No recurrence has occurred since the hernia staples became available. We conclude that the overall incidence of recurrent inguinal hernia is high (14%). Patients with recurrent hernia have a tendency toward a contralateral hernia (64%). Most recurrences occurred 10 or more years after the previous repair (66.7%). The laparoscopic repair (TAPP) offers a good repair for recurrent inguinal hernia avoiding the scar tissue and with low complication and recurrence rates.

Adult↗
PubMed2004

[The para-esophageal hernia: a rare hiatal hernia requiring a specific approach].

In three patients, a woman aged 87 years who presented with signs indicating a myocardial infarction, a man aged 31 suffering from postprandial epigastric pain that suddenly worsened, and a woman aged 60 years with longstanding postprandial pain and recent fatigue due to anaemia, a para-oesophageal hernia was diagnosed. Para-oesophageal herniation is an uncommon disorder accounting for approximately 5% of all hernias at the oesophageal hiatus. They are distinguished from the more common sliding hiatal hernia by a relative preservation of the intra-abdominal fixation of the gastro-oesophageal junction. These patients show that the clinical presentation of para-oesophageal rolling hernias is different from that of sliding hernias. Pathological reflux may occur; though symptoms associated with a relative obstruction of the stomach within the hernia sac, such as dysphagia, are more common. Rare non-specific symptoms such as anaemia and loss of weight are also seen. Adequate therapy differs from that of a sliding hernia and should be individualized: surgical correction is indicated in a healthy patient with a symptomatic para-oesophageal hernia, such as in the last patient. However, when the hernia is incidentally diagnosed or when comorbidity is present, such as in the first patient, a wait-and-see policy is recommended. Only in case of a threatening incarceration, such as in the second patient, is an emergency operation indicated.

Adult↗