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PubMed2003

Morgagni hernia: a rare form of congenital diaphragmatic hernia.

A congenital diaphragmatic hernia (CDH) occurs in approximately 1 per 2000 pregnancies. Most CDHs that are recognized in utero are of the Bochdalek type, resulting from a posterior defect in the diaphragm. Morgagni hernias result from an anterior defect and are the least common type of CDH (5%). They are rarely seen in utero. Furthermore, when they are seen in utero, they may be mischaracterized. We present a case of an unusual type of Morgagni hernia diagnosed in utero. The type of Morgagni hernia reported here is particularly uncommon. Two cases with similar findings have been reported previously. The shared findings between these cases indicate that, although rare, this may be a recognizable type of CDH and one that is distinguishable from the Bochdalek type.

Adult↗
PubMed1988

[Morgagni hernia. A rare form of diaphragmatic hernia].

The Morgagni hernia is the rarest form of diaphragmatic hernias. Knowledge has been accumulated over time of combinations with other congenital malformations, familial occurrence, and traumatic genesis. Morgagni hernia has been more often recordable from women, along with rising age and usually located on the right hand side. Embryonic disorder of diaphragmatic differentiation is believed to be the major aetiological factor. Vitamin deficit as well as some chemical substances, primarily active in the foetal period, have become known as additional factors of predisposition. Intensive diagnosis to rule out malignancy is absolutely essential because of the variability of symptoms of this type of hernia. Colon fragments and large omentum were found to be most often contained in the hernial sac. Contrast medium X-ray checks of the gastrointestinal tract and pneumoperitoneum are preferential methods of examination. Exploratory laparotomy is generally considered the optional therapeutic approach because of possible saving of liver veins, safe removal of the hernial sac, and the possibility of abdominal exploration. Preoperative wide-range sterile covering of the patient's body around the site of surgery is recommended to allow for possible thoractomy, as may be required.

Female↗
PubMed2005

Randomized trial comparing the Prolene Hernia System, mesh plug repair and Lichtenstein method for open inguinal hernia repair.

BACKGROUND: Most surgeons favour the use of a mesh for open inguinal hernia repair as it has a low recurrence rate. Procedures used most frequently are the Lichtenstein method, mesh plug repair and the Prolene Hernia System. The choice of technique may be influenced by the effects on postoperative pain and quality of life. METHODS: A total of 334 patients were allocated blindly and at random to receive one of these three meshes for open hernia repair. Quality of life was assessed with the Short Form 36 and pain by a visual analogue scale 14 days, and 3 and 15 months after surgery. RESULTS: Operative complications were rare and comparable between the groups. Long-term follow-up was completed by questionnaire in 95.8 per cent of patients. There were no significant differences in pain parameters between the three meshes; overall, 43.3 per cent of patients reported some form of groin pain. The severity of the chronic pain correlated with a higher pain score in the first 2 weeks after surgery (P < 0.001). A significant reduction in scores for role emotional (short term) and vitality (long term) quality of life domains was found in patients who had a Lichtenstein repair. CONCLUSION: These short- and long-term results did not show any clinically significant difference in postoperative pain and quality of life between the three types of mesh hernia repair. Severe early postoperative pain reliably predicted the likelihood of persisting chronic groin pain.

Adult↗
PubMed2003

[Twenty-five years of experience in incisional hernia surgery. A comparative retrospective study of 432 incisional hernia repairs].

INTRODUCTION: Incisional hernia surgery in Germany is changing from conventional techniques to mesh implantation. The relevance of different factors such as surgical technique, mesh material, and patient-related parameters concerning the outcome following mesh repair is still under debate. METHODS: In a comparative retrospective study of 432 incisional hernia operations on 348 patients we analyzed 11 autodermic hernioplasties, 241 Mayo procedures,and 180 mesh repairs over a 25-year time period. In addition to the quality of life following mesh implantation,the prognostic relevance of demographic, pre- and intraoperative parameters, surgical technique, mesh material, and the surgeon's experience were subjected to both univariate and multivariate analysis. RESULTS: With a mean follow-up of 9.7+/-8.8 years, the rate of major complications following mesh repair was 9% in contrast to 3% after the Mayo procedure (p=0.091). The sublay technique revealed less complications compared to the onlay procedure (p=0.016). The total recurrence rate following the overlapping Mayo repair was 37% in contrast to 15% after mesh implantation (p=0.001), with a significant superiority of the sublay technique over the inlay technique (p=0.043). The rate of recurrences and complications after autodermic hernioplasty was 72% and 36%,respectively. After mesh repair, 86% of the patients were better satisfied with the results after Marlex mesh compared to GoreTex (p=0.016). Mesh size was the only significant prognostic factor concerning quality of life following mesh implantation. The complication rate was determined significantly by the patients' risk factors, size of hernia, surgical technique, and the surgeon's experience, whereas the rate of recurrences was significantly influenced by the parameters obesity (BMI >25), size of hernia,and surgical experience. The recurrence rate decreased significantly with the surgeon's experience: a minimum of 16 mesh repairs led to a recurrence rate of less than 10%. CONCLUSIONS: Only the mesh repair revealed acceptable recurrence rates with high patient comfort. The sublay technique is superior to onlay concerning the complication rate, whereas the autodermic hernioplasty and inlay techniques are obsolete. The material of choice is polypropylene. The most important prognostic factor following mesh repair is the surgeon's experience.

Adult↗
PubMed2002

Videolaparoscopy of the contralateral internal inguinal ring via the hernia sac in children with unilateral inguinal hernia-initial experience in Brazil, with a meta-analysis.

Videolaparoscopy of the contralateral internal inguinal ring (CIIR) via the hernia sac was performed in 100 children with a unilateral inguinal hernia (UIH) between August 1996 and May 1999. During general anesthesia, after dissection and opening of the hernia sac with the patient in the Trendelenburg position, the external cannula of a 10-mm trocar was introduced into the peritoneal cavity via the hernia sac. The abdomen was insufflated with CO(2) to a maximum pressure of 9 mmHg. A 10-mm, 30 degrees angled laparoscope attached to a video camera was then inserted through the trocar to examine the CIIR. Routine contralateral inguinal exploration was performed in the first 10 cases and in all children whose videolaparoscopic exam showed an open CIIR. There were no false-positive findings. The positive predictive value of the method was 100% for an open CIIR; the average time needed to perform the examination was 8.06 min. The frequency of an open CIIR was 21% and that of a closed CIIR was 79%. There was no statistically significant relationship between the morphology of the CIIR and the sex or race of the child. The frequency of an open CIIR was significantly higher (34.1%) in children with a left IH, than in those with a right IH (11.8%, chi(2) = 5.95, P = 0.0146). The frequency of an open CIIR was significantly higher (31.1%) in children aged 4 years or older than in those less than 4 years (12.7%, chi(2) = 3.99; P = 0.0456), although the sample was too small to study the correlation between the morphology of the CIIR and age. There were no intra- or postoperative complications. This method for examining the CIIR is safe, efficient and rapid and provides the surgeon with more objective anatomic data for the appropriate selection of children with a UIH who will benefit from contralateral inguinal exploration for ligature of the contralateral patent Processus vaginalis, during the same anesthetic in order to prevent a possible subsequent contralateral indirect IH. Our initial experience is presented with a meta-analysis.

Brazil↗
PubMed2006

Long-term outcome after hernia repair with the prolene hernia system.

PURPOSE: We evaluated the long-term outcome and symptoms after inguinal hernia repair using the Prolene Hernia System (PHS). METHODS: We reviewed the medical records of all patients who underwent PHS surgery at our hospital to assess the postoperative complications and recurrence rates. Late symptoms were evaluated by a standardized interview using a questionnaire. RESULTS: A total of 395 hernias in 367 patients were studied. Postoperative complications developed after 20 repairs (5.1%), including a severe mesh infection in one patient. Seven (1.8%) patients suffered recurrence. Of 395 cases, 363 (91.9%) responded to the interview. After a median follow-up interval of 19.3 months (range 1.0-55.8), moderate pain and moderate discomfort were reported by only 1.9% and 0.8% of patients, respectively. CONCLUSIONS: Prolene Hernia System surgery is a safe and feasible procedure with low rates of complication, recurrence, and late symptoms.

Adolescent↗
PubMed2004

Laparoscopic management of inferior lumbar hernia (Petit triangle hernia).

Lumbar hernias are rare defects in the posterolateral abdominal wall that may be congenital or acquired. We present a case of laparoscopic approach to repair an acquired inferior triangle (Petit) lumbar hernia in a woman by using polytetrafluoroethylene mesh. The size of the hernia was 8 x 10 cm. The length of her hospital stay was 2 days. The patient resumed normal activities in less than 2 weeks. The main advantage of this approach is excellent operative visualization, thus avoiding injury to structures near the hernia during repair. Patients benefit from a minimally invasive approach with less pain, shortened hospital course, less analgesic requirements, better cosmetic result, and minimal life-style interference.

Adult↗
PubMed2004

Hernia surgery changes in the Amsterdam region 1994-2001: decrease in operations for recurrent hernia.

Inguinal hernia (IH) surgery has changed substantially in the past decade. Conventional (nonmesh) techniques have largely given way to prostheses. This study's aim was to analyse whether changes in technique used for IH repair influenced the operation rate for recurrence. A retrospective study was performed on all adult males who had undergone IH surgery in the Amsterdam region during the calendar years of 1994, 1996, 1999, and 2001. Data were obtained for 3,649 subjects and included patient demographics, hernia type, and surgical technique. We observed a decrease in the use of conventional techniques and a significant increase (P<0.05) in the use of prosthetic materials. The number of operations performed for recurrent hernia decreased from 19.5% (216/1,108) in 1994, to 16.8% 197/1,170) in 1996, to 14.0% (152/1,088) in 1999, and to 14.1% (40/283) in 2001. When comparing 1999 and 2001 with 1994, there was a significant decrease in operations performed for recurrent hernia (P=0.005). There was also a significant increase in supervision of the surgical resident by a surgeon.

Adolescent↗
PubMed2005

Ambulatory inguinal hernia repair with prolene hernia system (PHS).

Study was conducted to evaluate the feasibility and benefits of inguinal hernia repair with prolene hernia system (PHS) mesh under local anaesthesia as a day surgery procedure in a multinational society of United Arab Emirates. One hundred and seventy-eight inguinal hernias in 172 consecutive adults of whom 154 (89.5%) fitted the criteria of inclusion in the day-case surgery settings were operated upon including one early recurrence. Conversion from local to general anaesthesia was required in five (2.8%) patients. The mean operation time was 65 min, including the anaesthesia injection. The mean hospital stay was 2.1 days for all patients and 1.01 days for those who fitted in the ambulatory surgery program. Inguinal hernia repair using the PHS technique under local anaesthesia could be mastered by many of the surgeons in our hospital with minimal morbidity and short hospital stay with a potential to lessen recurrence.

Adolescent↗
PubMed2005

Early results of a randomised trial comparing Prolene and VyproII-mesh in endoscopic extraperitoneal inguinal hernia repair (TEP) of recurrent unilateral hernias.

The purpose of this study was to compare a lightweight mesh to a standard polypropylene hernia mesh in endoscopic extraperitoneal hernioplasty in recurrent hernias. A total of 140 men with recurrent unilateral inguinal hernias were randomised to a totally extraperitoneal endoscopic hernioplasty (TEP) with Prolene or VyproII in a single-blinded multi-center trial. The randomisation and all data handling were performed through the Internet. 137 patients were operated as allocated. Follow-up was completed in 88% of the patients. The median operation times were 55 (24-125) min and 53.5 (21-123) min for the Prolene and VyproII groups, respectively. The meshes had comparable results in the surgeon's assessment of the handling of the mesh, return to work, return to daily activities, complications, postoperative pain and quality of life during the first 8 weeks of rehabilitation, except in General Health (GH) SF-36, where the VyproII-group had a significantly better score (P=0.045). The use of Prolene and VyproII-meshes in endoscopic repair of recurrent inguinal hernia seems to result in similar short-term outcomes and quality of life.

Adult↗
PubMed1978

"Paratransplant" hernia. Three patients with a new variant of internal hernia.

Three cases of bowel obstruction due to internal hernia caused by entrapment of bowel or omentum through a defect in the peritoneum covering the transplanted kidney are described. All three patients survived due to early surgical intervention and reduction of the hernia and/or resection of necrotic bowel or omentum. In view of the high mortality of peritonitis in transplant patients, early surgical treatment is indicated in all cases of intestinal obstruction to avoid the sequelae of bowel infarction. This "paratransplant" hernia represents the newest type of internal hernia described.

Adult↗
PubMed2000

Laparoscopic hernia repair in patients with bilateral groin hernias.

OBJECTIVE: To compare outcome of unilateral and bilateral laparoscopic hernia repair. DESIGN: Prospective consecutive trial. SETTING: University hospital, Sweden. SUBJECTS: 380 patients who had unilateral hernias repaired laparoscopically and 64 patients who had bilateral hernias repaired. The median (range) age in the two groups was 56 (21-86) and 61 (30-85) years, respectively and the median (range) follow-up was 42 (24-58) months. MAIN OUTCOME MEASURES: Operating time, hospital stay, complications, and time to recovery. RESULTS: The median (range) operating time was 70 (25-240) minutes in the unilateral and in the bilateral group 113 (55-330) minutes. The complication rate, recurrence rate, and time to full recovery did not differ between the groups. CONCLUSION: The laparoscopic approach seems to be a good option for patients with bilateral inguinal hernias.

Adult↗
PubMed2004

Comparative laparoscopic evaluation of the PROLENE Polypropylene Hernia System vs. the PerFix Plug repair in a porcine groin hernia repair model.

BACKGROUND: Both the PROLENE Polypropylene Hernia System (Ethicon, Johnson & Johnson, Cincinnati, OH) and plug-and-patch devices including the Bard PerFix Plug repair (C.R. Bard. Inc., Murray Hill, NJ) are currently used in open groin herniorrhaphy. These systems rely on incorporating two mesh prostheses of different designs. In this animal study, early results for the two types of device were compared laparoscopically. MATERIALS AND METHODS: Twenty-four uncastrated male pigs (average weight, 25 kg) were randomized into two groups of 12 each for repair of unilateral groin hernia defects with the PROLENE Hernia System (Prolene) or the PerFix Plug (PerFix). Laparoscopic examination was performed immediately after the surgery to check the configuration and coverage area of the preperitoneally positioned mesh devices, with stress-loading tests to compare their primary efficiency. RESULTS: By contrast to the PerFix prostheses, in which the preperitoneal cone-shaped mesh only obliterated the primary fascial defect, in two-thirds of the Prolene repairs the flat and widely deployed underlay patch not only overlapped the defect but also covered the entire myopectineal orifice. Under heavy stress loading (25 newtons), the Prolene group also had a significantly lower incidence of fascial defect exposure in comparison to the PerFix counterparts (P = 0.003). In the stress-loading tests, four Prolene and eight PerFix plugs failed (P >0.005), mainly due to tissue disruption. CONCLUSION: Properly implanted Prolene devices have a wider coverage area and lower risk of fascial defect exposure and thus should be the treatment of choice for large groin hernia defects where the inguinal floor is attenuated. Where the PerFix devices are used under these conditions, they must be adequately secured to a healthy fascial edge, with onlay coverage patches to eliminate any weak points that might cause early recurrence.

Animals↗
PubMed1987

Meckel's diverticulum in a femoral hernia: a Littre's hernia.

We have described a patient with strangulation of a Meckel's diverticulum in a femoral hernia. In the case of Littre's hernia, true diagnosis before surgical intervention is rare if not impossible. It is therefore important that the surgeon be well versed in the management of such cases, as well as in distinguishing a Littre's hernia from a Richter's hernia during the intraoperative period.

Aged↗
PubMed1998

Laparoscopic hernia repair of an incisional hernia secondary to placement of an implantable cardioverter defibrillator.

We present the laparoscopic repair of a large incisional hernia secondary to placement of a subcostal ICD pulse generator. Laparoscopic repair of large incisional hernias provides a unique and technically feasible form of repair in the 2%-13% of patients who will develop an incisional hernia following an abdominal surgery. This form of hernia repair is associated with minimal morbidity and prompt resumption of patient activities and work.

Aged↗
PubMed1997

Incarcerated Spigelian hernia in morbidly obese patients: the role of intraoperative ultrasonography for hernia localization.

BACKGROUND: Spigelian hernias are uncommon and their diagnosis can be difficult. Ultrasonography is, as a rule helpful in making the diagnosis, but extensive exploration is sometimes needed to locate the defect. METHODS: Two patients are described in whom the diagnosis was made preoperatively by ultrasonography, but intraoperative location of the hernias proved extremely difficult because of the patients' obesity. RESULTS: In the first patient, the hernia was located by means of intraoperatively performed ultrasonography. In the second patient, ultrasonography was combined with intraoperatively insufflated pneumoperitoneum and this proved successful in identifying the position of the sac. CONCLUSION: Intraoperative ultrasonography is a valid option for accurate localization of Spigelian hernias, especially in obese patients; extensive intraoperative dissection, distortion of tissue planes, and associated morbidity risks may be avoided.

Adult↗
PubMedDate not supplied

The treatment of Spigelian hernia with the Prolene Hernia System: notes on techniques.

Spigelian hernia repair techniques use prostheses both in the traditional and the videolaparoscopic approach; only in selected cases direct suturing of the parietal defect is performed. The aim of this study is to describe a technique that uses a device proposed specifically for inguinal hernias, but which has not yet been described in the literature, namely the Prolene Hernia System (P.H.S.). Our personal experience consists of 7 cases (5 females and 2 males; mean age: 58 years) operated on from January 2002 to May 2003. Four patients were operated on in the ordinary hospitalisation regime with selective spinal anaesthesia and three patients were treated in the day surgery setting with local anaesthesia. With this technique, the underlay patch is positioned in an adequately prepared preperitoneal space and the onlay patch above the internal oblique muscle, while the connector acts as a plug positioned in the parietal defect. The method has proved simple, safe, and fast. It causes minimal discomfort to the patient in terms of postoperative pain and allows rapid rehabilitation. Moreover, it can also be performed in the day surgery setting. The authors conclude that the P.H.S. Spigelian hernia repair technique is a valid alternative to any of the other methods used to date.

Adult↗
PubMedDate not supplied

Spigelian hernia: a rare lateral ventral hernia.

The authors take a treated clinical case as a starting point to consider lateral ventral hernia, generally referred to as "Spigelian hernia". Such hernias are rare (1-2% of all hernias), with a slightly higher incidence in the female sex. Obesity and multiparous status are known to be predisposing factors. Instrumental tests of great importance in terms of specificity and definition such as ultrasonography and computed tomography are available, in cases of diagnostic doubt, for a pathology that in any case has to be detected early in order to avoid possible complications. The treatment is essentially surgical. A personal variant of the surgical repair technique is described with the use of prosthetic material, which guarantees a better result in terms of strength and resistance compared to simple repair surgery.

Adult↗