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At least 73 records · Page 4Linked to original sources
PubMed2005

Panniculectomy and the separation-of-parts hernia repair: a solution for the large infraumbilical hernia in the obese patient.

BACKGROUND: Infraumbilical hernias in the obese are problematic in terms of achieving adequate exposure and eventual wound healing. Simultaneous panniculectomy with separation-of-parts hernia repair is one approach to this reconstructive issue, but the feasibility of such a combination is untested. METHODS: Twenty-four simultaneous panniculectomy and separation-of-parts hernia repairs performed by the senior surgeon over a 6-year period are presented. Patients were analyzed by preoperative, intraoperative, and postoperative parameters. Complications were grouped into major and minor categories. RESULTS: Average patient body mass index was 39 (range, 29 to 57). Twenty of 24 (83 percent) of the hernias were recurrent on initial presentation. Almost one-half of the cases were contaminated (46 percent), marked by the presence of a preoperative wound (29 percent) or concurrent gastrointestinal procedure (17 percent). In 25 percent of cases, a preexisting laparotomy scar necessitated a vertical reopening of the abdominal skin, raising the stakes for postoperative wound breakdown. Despite these findings, major/minor wound complications (12.5 percent/33 percent) and additional surgery rates (17 percent) were relatively low considering this morbidly obese population. Postoperative wound complications, hernia recurrence, and reoperation rates were significantly increased among those patients whose body mass index exceeded 35(p < 0.05). All hernia recurrences (n = 4) were corrected definitively with a secondary direct repair. Mean follow-up was 10 months (range, 3 to 60 months). CONCLUSION: The separation-of-parts hernia repair in combination with pannus resection can be performed safely in obese patients, with complication rates comparable to those reported in the literature. This combined procedure has become the authors' procedure of choice in these difficult clinical situations.

Abdominal Wall↗
PubMed2026

Genetic Susceptibility to Incisional Hernia Evaluation of Hernia Polygenic Risk Scores.

OBJECTIVES: Incisional hernia (IH) affects 13-30% of people after abdominal surgery, resulting in substantial morbidity and costs. While clinical risk factors have been studied extensively, genomic risk for IH is incompletely understood. We aimed to evaluate the impact of polygenic risk scores (PRS) on IH risk prediction. METHODS: We created and evaluated three PRS for abdominal hernia, ventral hernia and latent hernia susceptibility for prediction of IH in an institutional biobank. The primary outcome was defined as the diagnosis or repair of an IH based on ICD-9/10-CM/PCS and CPT codes. Clinical covariates included age, sex, body mass index (BMI), smoking status, index procedure type, and perioperative surgical site infection. A phenome-wide association study (PheWAS) was performed to assess clinical associations with increased PRS. We then tested the ability of the PRS to improve prediction for IH by modeling clinical covariates with and without PRS in patients who underwent abdominal surgery. Model performance was assessed using 10 iterations of 5-fold cross-validation to estimate Brier scores and area under the receiver operating characteristic curve (AUROC), which were compared using cross-model Bayesian analysis of variance. RESULTS: In 55,809 subjects, assessed PRS was significantly associated with incisional, umbilical, and ventral hernia on PheWAS, with 1.19 greater odds of developing IH per 1-SD increase in PRS (95% CI: 1.13-1.25, P < 0.001). Of 9,909 subjects who underwent qualifying abdominal surgery, 706 developed IH. In this cohort, the latent hernia susceptibility PRS was associated with a 16% increased hazard of developing IH per 1-SD increase (HR 1.16; 95% CI: 1.07-1.26; P < 0.001). Compared to a predictive model using clinical covariates (Brier score = 0.047, 95% CI: 0.046-0.048; AUROC = 0.660, 95% CI: 0.653-0.666), addition of the PRS showed similar Brier score and AUROC estimates (Brier score = 0.047, 95% CI: 0.046-0.048; AUROC: 0.667, 95% CI: 0.661-0.673) at five years. Cross-model Bayesian analysis demonstrated >99% probability of practical equivalence when trying to detect a difference of &#x2265; 0.02. CONCLUSION: All three PRS for hernia were independently associated with IH, suggesting that genomic factors contribute significantly to IH development. However, none of the three PRS meaningfully improved clinical IH risk prediction in patients who underwent abdominal surgery. This suggests that clinical comorbidities and surgical techniques may be equally as important as genomic architecture.

Bayesian analysis↗
PubMed1994

[Preperitoneal implantation of Dacron mesh for treatment of recurrent inguinal hernia and bilateral inguinal hernia].

UNLABELLED: The preperitoneal approach with implantation of a dacron sheet was applied in 37 patients with recurrent hernias and in 30 patients with primary bilateral hernias. In total 120 hernias were repaired. The patients were controlled prospectively for serious complications. The patients were examined every 3 months in the first and every 6 months in the second year after operation. The mean follow-up time was 17.2 months. COMPLICATIONS: In one patient with a combined hernia an indirect hernia sac was not detected intraoperatively, so it persisted. Recurrences were not observed. COMPLICATIONS (hematoma, fluid collections, wound infections, intraabdominal adhesions) occurred in 13.2 of the patients. CONCLUSIONS: The preperitoneal implantation of a dacron sheet is a safe and reliable procedure for treatment of recurrent groin hernias and primary hernias with a high risk of recurrence. The rate of infection is low under preventing measures.

Adult↗
PubMed1997

Preoperative Nyhus classification of inguinal hernias and type-related individual hernia repair. A case for diagnostic laparoscopy.

The goal of this prospective study was to determine the clinical value (sensitivity and specificity) of preoperative hernia classification (Nyhus classification) using three distinct methods: clinical examination, Doppler ultrasonography, and diagnostic laparoscopy. Thirty patients with 35 suspected groin hernias were included. Definitive hernia classification was achieved by laparoscopic peritoneal incision and dissection of the inguinal floor. Twenty-eight laparoscopic hernia repairs followed. Sensitivity and specificity were calculated for each preoperative evaluation method. Clinical examination was found to be more accurate than Doppler ultrasonography. The highest scores for sensitivity (0.93) and specificity (1.00) were achieved, however, by diagnostic laparoscopy. Therefore, the authors consider diagnostic laparoscopy to be a valuable preoperative tool for assessing hernia type. An accurate preoperative hernia classification will allow an individualized type-related hernia repair (open: anterior, posterior approach, or laparoscopic: transabdominal preperitoneal, total preperitoneal, inner-ring closure, mesh insertion).

Adult↗
PubMed2006

Randomized clinical trial of Lichtenstein patch or Prolene Hernia System for inguinal hernia repair.

BACKGROUND: In this randomized prospective study the short- and long-term outcomes of patients undergoing inguinal hernia repair with either Lichtenstein mesh or the Prolene Hernia System (PHS) were evaluated. METHODS: Postoperative pain and time to return to work, driving and sporting hobbies were recorded after 300 inguinal hernia repairs done by one of the two methods. Long-term sequelae and complications were assessed at follow-up visits 1 week, 1 month and 1 year after the operation. RESULTS: The median duration of operation for unilateral primary hernia was 37 min for the Lichtenstein operation and 27 min for the PHS procedure (P < 0.001). Postoperative pain was similar after both operations. Median sick leave was 7 days in both groups. Time to driving a car was 4 versus 3 days, and time to return to sporting hobbies 13 versus 11 days, in the Lichtenstein and PHS groups, respectively. Apart from a residual femoral hernia after Lichtenstein repair, no recurrent inguinal hernias were detected. CONCLUSION: Both Lichtenstein and PHS methods resulted in rapid recovery and low recurrence rates. The PHS operation was significantly quicker.

Adult↗
PubMed2002

Intrascrotal hernia of the ureter and fatty hernia.

Intrascrotal hernia of the ureter is a rare event. We describe here one such case. There are two anatomic types of such ureteral hernias. The paraperitoneal type has a peritoneal indirect sac, which pulls the ureter with it. The extraperitoneal ureteral hernia is without a peritoneal sac. In such cases, which are almost always indirect hernias, there is usually a large amount of fat. It is, in fact, retroperitoneal fat, which slides, and pulls the ureter with it by gravity. Such a case is a genuine prolapse of the retroperitoneal structures. This anomaly, which has been rarely studied, is worth knowing about, because the ureter may be damaged during hernia dissection. The surgeon should be cautious when discovering huge fatty hernias, and should avoid the excision of fat and simply return the fatty mass to its normal place after its separation from the cord.

Adipose Tissue↗
PubMed2006

Inguinal hernia repair: are ASA grades 3 and 4 patients suitable for day case hernia repair?

The American Society of Anaesthesiologists (ASA) 3 and 4 patients are generally considered unsuitable for day case hernia repair. There are minimal data regarding the acceptability of day case repair in these patients. This study analysed day case hernia rates with special emphasis on ASA grades. A retrospective review of all adult inguinal hernia repairs, under the care of one surgeon over a 9-year period, was performed. The data collected included demographics, ASA grades, the mode of anaesthesia and early complications. 577 patients underwent inguinal hernia repair during the study period. 204 (35%) patients were ASA grade 1, 214 (37%) ASA grade 2, 132 (23%) ASA grade 3 and 29 (5%) ASA grade 4. Day case rates for ASA grades 1-4 under LA were 86, 83, 77 and 76% and under GA, 59, 36, 32 and 0%, respectively (P<0.05). There was no significant difference in the wound complication rates for different ASA grades under GA and LA. ASA grades 3 and 4 patients can undergo day case inguinal hernia repair, with similar complication rates to ASA grades 1 and 2 patients, when surgery is performed under local anaesthesia. ASA grades 3 and 4 patients need not be excluded from day case hernia repair.

Adolescent↗
PubMed2006

Intraperitoneal tension-free repair of small midline ventral abdominal wall hernias with a Ventralex hernia patch: initial experience in 51 patients.

Midline ventral hernias are common. Tension-free mesh repair of ventral hernias is becoming popular due to the high recurrence rate with conventional techniques. We have used an open intraperitoneal technique using the Bard Ventralex hernia patch in midline ventral hernias (<or=3 cm). Fifty-one patients were treated (34 males and 17 females) with a mean age of 52.4 years (range 18-82). Forty-three patients were day cases. Operative times, analgesic use, overnight hospital stay and postoperative complications were recorded prospectively. The mean operative time was 30 min (range 10-68). Thirty-six patients required mild/moderate postoperative analgesia. Two patients had minor wound infections and one had seroma. There was one recurrence. Our early experience suggests that Ventralex hernia patch repair of small midline ventral hernias can be performed as a day case with minimal postoperative complications.

Adolescent↗
PubMedDate not supplied

The inguinal hernia: not always straightforward, not always a hernia.

Swelling in the groin may represent much more than an inguinal hernia and an inguinal hernia may be much more complicated than it seems upon superficial consideration. Intraperitoneal or retroperitoneal hemorrhage as well as many other congenital, inflammatory, infectious, or neoplastic processes occurring either locally or at distance from the groin may present in the groin, simulating a hernia, or within an inguinal hernia sac itself. Delayed and spontaneous rupture of the spleen are not rare occurrences. The case discussed, an episode of delayed rupture of the spleen presenting as blood within an inguinal hernia sac, serves to emphasize that following a complete clinical evaluation many entities other than simple inguinal hernia must be considered if a thorough differential diagnosis of a groin mass is to be developed.

Adult↗
PubMed1996

Autopenetrating hernia: a novel form of traumatic abdominal wall hernia--case report and review of the literature.

Traumatic abdominal wall hernias remain relatively rare entities despite the increased incidence of blunt trauma. Mechanisms reported in the literature include a combination of a sudden increase in intra-abdominal pressure and powerful shear forces applied to the abdominal wall. These hernias are noteworthy in that they may be associated with significant intra-abdominal injuries. We describe a novel form of traumatic hernia with a unique mechanism. A blunt force leads to the fracture of a rib and penetration of the abdominal wall by the jagged costal remnant, creating a hernia defect. This autopenetrating hernia is presented in the context of a classification scheme for traumatic abdominal wall hernias.

Accidents, Occupational↗
PubMed2003

Laparoscopic repair of ventral hernias: nine years' experience with 850 consecutive hernias.

OBJECTIVE: To evaluate the efficacy and safety of laparoscopic repair of ventral hernias. SUMMARY BACKGROUND DATA: The recurrence rate after standard repair of ventral hernias may be as high as 12-52%, and the wide surgical dissection required often results in wound complications. Use of a laparoscopic approach may decrease rates of complications and recurrence after ventral hernia repair. METHODS: Data on all patients who underwent laparoscopic ventral hernia repair (LVHR) performed by 4 surgeons using a standardized procedure between November 1993 and October 2002 were collected prospectively (85% of patients) or retrospectively. RESULTS: LVHR was completed in 819 of the 850 patients (422 men; 428 women) in whom it was attempted. Thirty-four percent of completed LVHRs were for recurrent hernias. The patient mean body mass index was 32; the mean defect size was 118 cm2. Mesh, averaging 344 cm2, was used in all cases. Mean operating time was 120 min, mean estimated blood loss was 49 mL, and hospital stay averaged 2.3 days. There were 128 complications in 112 patients (13.2%). One patient died of a myocardial infarction. The most common complications were ileus (3%) and prolonged seroma (2.6%). During a mean follow-up time of 20.2 months (range, 1-94 months), the hernia recurrence rate was 4.7%. Recurrence was associated with large defects, obesity, previous open repairs, and perioperative complications. CONCLUSION: In this large series, LVHR had a low rate of conversion to open surgery, a short hospital stay, a moderate complication rate, and a low risk of recurrence.

Body Mass Index↗
PubMed2003

Repair of incisional hernia with prolene hernia system.

A 70-year-old woman was admitted to our hospital with a complaint of bulging in the right lower portion of the abdomen. The bulging was in accordance with an old operative scar for appendicitis. The findings of computed tomography (CT) showed defects in the abdominal muscles and the protrusion of the intestine into the subcutaneous fat. The patient was diagnosed with incisional hernia after appendectomy and underwent a repair of the incisional hernia, using the prolene hernia system double-layer mesh. The patient's post-operative course was excellent. Recently, the prolene hernia system, double-layer mesh was reported to be effective for groin hernias due to its advantageous protection the recurrence through reinforcement of the patient's myopectrial orifice. It is suggested that this new device is also useful for small incisional hernias.

Aged↗
PubMedDate not supplied

[Treatment of inguinal hernia with the Prolene Hernia System (P.H.S.)].

Among the several techniques available for the treatment of inguinal hernia, the Prolene Hernia System (P.H.S.) has gained widespread acceptance over the past few years. This is an original prosthetic device that combines, in a single step, what other techniques offer separately, namely an underlay patch (preperitoneal placement), an onlay patch (subfascial placement) and a connector that joins them together and works as a plug. The aims of this study were to specify the indications and the technique of this method and to evaluate its efficacy in our experience. From January 1999 to July 2003 we performed 156 inguinal herniorraphies with the P.H.S. in 152 patients (143 male, 9 female; mean age 62.4 years). One hundred and thirty-six cases were primary hermias (mainly types III, IV and VI according to the Rutkow and Robbins classification) and 18 were recurrences (mainly type R3 according to the Campanelli classification). In 56.5% of cases the operations were performed in the day surgery setting, 37.5% as ordinary admissions and 6% as emergency procedures. Locoregional (62.5%) or local (34.2%) anaesthesia were mainly given. Early postoperative complications (7%) were 7 haematomas and 4 seromas. In 125 patients with a follow-up of at least 6 months, the late postoperative complications included 4 cases of persistent inguinocrural pain among the primary hernias (3.7%) and a new recurrence among the recurring hernias. The Authors believe that hernia repair with the P.H.S. is a valid choice comparable to the other common techniques but they suggest its use particularly in primary hernias with major relaxation of the posterior inguinal wall of the inguinal canal or of the entire myopectineal orifice.

Adult↗
PubMedDate not supplied

[The meshes of polypropylene in emergency surgery for strangulated hernias and incisional hernias].

INTRODUCTION: The Authors present their experience on the use of meshes of polypropylene in septic surgery of the abdominal wall defects. MATERIALS AND METHODS: From April 1999 to October 2003, 23 patients underwent intestinal resection (20 small intestine, 3 large intestine) for ischemic necrosis strangulation caused by defects in the abdominal wall (inguinal hernia 8, crural hernia 4, umbilical hernia 3, post-incisional hernia under umbilicus 3, post-incisional hernia epigastric 3, giant post-incisional hernia 2). RESULTS: No patient died and the removal of the mesh was never required in cases of infection of the surgical wound; 2 surgical wounds festered, with the reopening of the cutaneous wound and showing of the prosthesis, 5 hygromas were all treated in a conservative way. DISCUSSION: The macroporous structure of the meshes of polypropylene, with pores of diameter larger than 70 microns, allows contact among the bacteria, which measure one micron in diameter, and the cells of the immune system, granulocytes and macrophages, with a diameter of 15-20 microns, allowing the recovery from infections, and determining an high resistance rate to infections. CONCLUSIONS: Polypropylene prostheses, thanks to their macroporous structure, are sufficiently resistant to infections and therefore may be safely used in the surgery of the defects of the abdominal wall, when, following ischemic necrosis, an intestinal resection is necessary.

Adult↗
PubMed2005

De Garengeot hernia: appendicitis within a femoral hernia.

Many surgeons are familiar with Amyand hernia, which is an inguinal hernia sac containing an appendix. However, few surgeons know of the contribution of Rene Jacques Croissant de Garengeot, an 18th century Parisian surgeon, to hernias. He is quoted in the literature as the first to describe the appendix in a femoral hernia sac. We discuss the case of an 81-year-old woman who presented with appendicitis within a femoral hernia, a rare finding at surgery that is almost never diagnosed preoperatively. We also propose crediting Croissant de Garengeot by naming this condition after him. Although his full last name is Croissant de Garengeot, for convenience we suggest the simple diagnosis of "de Garengeot hernia."

Aged↗
PubMed2001

Pre-vascular hernia: a rare cause of chronic obscure groin pain after inguinal hernia repair.

A rare case of pre-vascular hernia is reported in a woman complaining of chronic obscure groin pain following an inguinal hernia repair. The condition was only diagnosed by means of a herniogram, emphasising the value of this investigation in unexplained groin pain. The hernia was successfully repaired using a polypropylene mesh plug, a simple technique widely employed in both femoral and recurrent inguinal hernia, but never before described in pre-vascular hernia.

Adult↗
PubMed1995

Abdominal wall hernia repair: use of the Gianturco-Helfrich-Eberbach hernia mesh.

A new polyester hernia mesh (Gianturco-Helfrich-Eberbach) is introduced for laparoscopic repair of the abdominal wall and groin hernias. The device incorporates the optional use of an internal wire to form a circular shape. A detachable carrier is used, permitting easy, accurate preperitoneal placement. Thirty-four patients with groin hernias and five with ventral hernias were repaired without significant complication. This innovative device greatly facilitates mesh placement during transabdominal or extraperitoneal laparoscopic repair, reducing technical difficulty and operative time. It further broadens the use of laparoscopy to repair ventral hernias.

Adult↗
PubMed1994

Traumatic diaphragmatic hernia presenting as an intercostal hernia: case report.

Intercostal hernias are rarely reported in the literature. We report a case of intercostal hernia secondary to a ruptured right hemidiaphragm and fractured costal margin caused by blunt trauma. The patient was ventilated at initial hospitalization because of rib fractures and advanced age, and the intercostal hernia was not evident. After physical rehabilitation treatment elsewhere, a painful chest wall bulge developed. A chest film and computed tomographic scan revealed the hernia. Surgery with a thoraco-abdominal incision in the line of the hernia allowed reduction of the hernial contents.

Aged↗