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At least 19 recordsLinked to original sources
PubMed2002

Outcome of laparoscopic ventral hernia repair in correlation with obesity, type of hernia, and hernia size.

BACKGROUND: The morbidity and overall recovery time of ventral hernia repair can vary significantly depending on the hernia type or size and on other factors, such as the body mass index (BMI). The purpose of our study was to investigate the effects of type of hernia, hernia size, and BMI on the outcome of laparoscopic ventral hernia repair. METHODS: Fifty patients who underwent laparoscopic ventral hernia repair were retrospectively reviewed and stratified according to hernia type (incisional, IVH/primary, PVH), hernia size, and BMI. These subgroups were compared in regard to operative time, resumption of diet, hospital stay, pain control, and complication rate. RESULTS: Laparoscopic IVH repair was associated with a longer operative time (143 vs. 98 minutes, p = .02) and length of stay (2.2 vs. 0.6 days, p = .03) than PVH repair. The narcotic requirements were higher in the IVH group, but the difference did not reach statistical significance. Larger hernias were associated with a longer operative time (p = .04) and increased narcotic requirement (p = .03). The morbidity of the laparoscopic repair was not significantly affected by the hernia type or size. The BMI did not significantly alter any of the parameters examined. CONCLUSIONS: Laparoscopic repair of incisional and larger hernias is a technically demanding procedure that requires a longer operative time. In contrast to PVH repair, laparoscopic IVH repair usually cannot be performed on an outpatient basis. Surgeons need not be discouraged from recommending the laparoscopic approach for patients with large IVHs or with severe obesity because the morbidity remains low.

Body Mass Index↗
PubMed1991

Association of hiatus hernia with postero-lateral diaphragmatic hernia (Bochdalek's hernia).

A boy with hiatus hernia following the repair of the left postero-lateral diaphragmatic hernia (Bochdalek's hernia) was reported. At the age of one month, the repair of Bochdalek hernia was performed with transabdominal approach. At that time the stomach was located in the normal position. Eight days after the repair he developed vomiting and hiatus hernia was revealed by barium esophagram. Antireflux surgery was required because there was no response to the conservative management for two months. Esophageal pH study and manometric study were very useful for the diagnosis of hiatus hernia or GER and the evaluation of antireflux surgery.

Abnormalities, Multiple↗
PubMed2002

A massive hiatal hernia that mimics a congenital diaphragmatic hernia. An unusual presentation of hiatal hernia in childhood: report of a case.

A massive hiatal hernia containing the colon, intestine, and stomach with organoaxial volvulus is an uncommon entity in childhood. This clinical form of a hiatal hernia may mimic congenital diaphragmatic hernia and chest pathologies. In this paper, we describe a patient who presented with a massive hiatal hernia that mimicked a congenital diaphragmatic hernia, and discuss the pitfalls in diagnosing this clinical entity.

Adolescent↗
PubMed2001

When a hernia is not a hernia: the evaluation of inguinal hernias in the cirrhotic patient.

Herniorrhapy in patients with advanced portal hypertension and ascites should be approached with caution, and treated conservatively whenever possible. Cirrhosis increases the risk of significant perioperative complications such as infection, recurrence, and ascites leak. This paper reports two patients operated on for suspected inguinal hernias. The first patient was referred for elective repair of a presumed inguinal hernia before liver transplantation. The second patient presented with a history of an incarcerated inguinal hernia that was previously reduced in the emergency center. After examination by residents and senior faculty the patients were scheduled for elective herniorrhaphy. Intraoperatively no inguinal hernia could be identified in either patient. However, massively dilated veins (1.5-2.0 cm in diameter) were noted entering with the spermatic cord at the internal inguinal ring. In both cases the veins were clamped, transected, and suture ligated at the internal ring. Given the unusual presentation of these dilated veins in both patients we advocate the use of preoperative Doppler ultrasound in patients with cirrhosis and suspected inguinal hernias.

Aged↗
PubMed2001

Use of the prolene hernia system for inguinal hernia repair: retrospective, comparative time analysis versus other inguinal hernia repair systems.

No data are available for the duration of surgery for the various procedures currently used in hernia repair. This retrospective study was undertaken to determine the time required for the surgical repair of unilateral primary inguinal hernias using currently available procedures and to show specifically that the duration of surgery using the PROLENE Hernia System (PHS) was equal to or less than the duration of surgery using a plug-and-patch device. Data were collected from 1032 sequential hernia procedures performed by 16 surgeons at a community hospital between 1997 and 1999. To gain more accurate information to compare the PHS and plug-and-patch procedures data from four surgeons who had performed at least five of each procedure were used as the primary analysis database. The two most frequently used devices were the PHS (35.9%) and plug and patch (41.0%). The average times of surgery for these procedures were not significantly different (25.4 vs 27.2 minutes, respectively; P = 0.236). A significant variability was observed between surgeons in the duration of surgery and there was evidence for an inverse relationship between the duration of surgery and the number of procedures a surgeon had performed. Both procedures take approximately the same time to perform.

Female↗
PubMed1997

[Abdominal wall hernias (inguinal hernia, incisional hernia)].

Within the range of treatment of inguinal hernias, the paper concentrates on the following procedures: Shouldice, the "tension-free" repairs of Lichtenstein, Rutkow, TIPP, and the laparoscopic procedures TAPP and TEP. An individual, selective approach tailored to the type of hernia, as well as the age and profession of the patient is recommended. A multicenter study comparing these procedures would be useful. Conventional repair of incisional hernias (simple closure, Mayo) has a depressing recurrence rate of 30%-40%. Better results are obtained by using a synthetic prosthesis, which can be implanted using the sublay inlay, or onlay technique.

Cicatrix↗
PubMed1995

Association of hiatal hernia and gastroesophageal reflux: correlation between presence and size of hiatal hernia and 24-hour pH monitoring of the esophagus.

OBJECTIVE: The relationship of hiatal hernia to gastroesophageal reflux disease remains controversial. Previous endoscopic and radiologic studies of hiatal hernia and reflux esophagitis have shown that hiatal hernia is a poor predictor of the presence of endoscopic esophagitis, especially for smaller hernias. Similar correlations with 24-hr pH monitoring have not been done. The purpose of this study was to determine if there is a correlation between the presence and size of hiatal hernias and gastroesophageal reflux using 24-hr pH monitoring as a measure of the degree of reflux. MATERIALS AND METHODS: We reviewed the barium esophagograms and the results of pH monitoring of the esophagus in 319 patients (161 women and 158 men; mean age, 51 years). The presence and size of hiatal hernia were determined from the radiographic examination; size was categorized as "minimal" or "larger" (> or = 2 cm axial length). An abnormal result of pH monitoring was defined as a pH less than 4 for 6% or more of the 24-hr observation time. RESULTS: Abnormal results of pH monitoring were found in 61 (31%) of 199 patients with hiatal hernia compared with 21 (18%) of 120 patients without hiatal hernia (p < .05). Abnormal findings of pH monitoring were present in 33 (35%) of 95 patients with a larger hiatal hernia versus 28 (27%) of 104 patients with a minimal hiatal hernia (p > .05); a significant difference (p < .05) was observed when patients without hiatal hernia were compared with those with a larger hiatal hernia. CONCLUSION: Most patients in this study had normal results of pH monitoring of the esophagus regardless of the presence or absence of hiatal hernia. However, patients with larger hiatal hernias were more likely to have abnormal findings on pH monitoring; hiatal hernias of minimal size were a poorer predictor of the presence of abnormal gastroesophageal reflux.

Esophagus↗
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↗
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↗
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↗