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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred severty-one cases of mechanical intestinal obstruction were studied. One hundred fifteen had small bowel obstruction and fifty-six had large bowel obstruction. Adhesion (32.8 per cent), hernia (21.6 per cent), and neoplasm (18.1 per cent) were the cause of obstruction in more than 70 per cent of all cases. More than 40 per cent of patients were older than 60 years and the average age was 52.7. The numbers of males and females were approximately equal. There were twice as many whites as blacks, and the mortality rate was higher among blacks. The overall uncorrected mortality rate was 18.7 per cent. Operation was performed in 105 patients (61.4 per cent), with a postoperative mortality of 19 per cent and corrected postoperative mortality of 4.5 per cent. Contributing factors that were significant were high incidence of metastatic diseases, elderly patients, and delay in admission.
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PMID:Intestinal obstruction. 115 23

Since 1983, the authors encountered 270 cases of lumbar disc hernia, which were operated on with the microsurgery. In the present study, the operative procedures were described and the results, especially the results of the reoperations were examined. Good results were obtained in 252 patients (93%). In nine patients, some kind of lumbago continued, which required other treatments, such as epidural block (3.3%). Reoperations were performed in nine patients (3.3%). In lumbar discectomy, extent of removal of the bony structures and the disc material seemed important. In "microlumbar discectomy", which was advocated by Williams, only the flavectomy with no bony structure removal was performed. In this procedure, discectomy is limited to the protruded disc material. On the contrary, some authors, who also adopt microsurgical lumbar discectomy as Wilson and Hudgins do, perform subtotal removal of the disc material with removal of some bony structures. In the present series, microsurgical lumbar discectomy following the procedures advocated by Wilson et al was performed. Reoperations after lumbar discectomy have been reported after all kinds of operations. In the present series, the rate of reoperation was 3.3%. As to the reasons for reoperations, true recurrence of disc hernia was the most prevalent. The hernias recurred at the same level and on the same side. Adhesion or fibrosis around the nerve root also played an important role. From the results of the present study, microsurgical lumbar discectomy with good illumination and high magnification has proved to bring satisfactory results. Recurrence, however, can occur after this procedure, so further inventions are required to ensure more satisfactory results.
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PMID:[Clinical analysis of 270 cases of microsurgical lumbar discectomy]. 185 49

A large abdominal wall hernia, not amenable to primary closure, may require insertion of a prosthesis. The ideal prosthesis maintains strength, is incorporated by surrounding tissues, and does not stimulate adhesions. These qualities vary among available synthetic prostheses. We tested tensile strength, bursting strength, and adhesion formation in response to six materials used in repair of abdominal wall hernias. Adult Sprague-Dawley rats (196) were randomly divided into a control group and six experimental groups. A 4 by 4 cm full-thickness resection of abdominal wall was closed with patches of polypropylene mesh (Marlex), polyglactin 910 mesh (Vicryl), expanded polytetrafluoroethylene (Gore-tex), Dacron-reinforced silicone rubber (Silastic), preserved human dura (PHD), or polypropylene mesh overlying gelatin film (Marlex and Gelfilm, respectively). In controls the 4 cm longitudinal full-thickness incisions were closed primarily. Seven rats randomly selected from each group were sacrificed after 1, 2, 4, and 8 weeks; bursting and tensile strength (tensiometer) and adhesion formation were assessed. There were no differences in bursting strength among the experimental groups at each testing period. Although bursting strength increased linearly with time it was significantly weaker than in controls at 1 and 8 weeks (P less than 0.05). Tensiometric data were inconclusive due to wide variability within the experimental groups. Adhesion formation was moderate to maximal at all evaluation periods for Marlex and Gore-tex. Early adhesion formation was minimal to moderate for both PHD and Vicryl, but later increased with PHD and decreased with Vicryl as this prosthesis was absorbed. No adhesions formed with Marlex and Gelfilm until the gelatin dissolved (1 week), after which the adhesion response was similar to that with Marlex alone. No adhesions formed after Silastic implantation, but graft extrusion and evisceration were common (75%). Controls had no adhesions at all evaluation periods. Wound strength was similar for all prosthetic materials. Absorbable prosthetic Vicryl provided the best long-term protection against adhesions.
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PMID:A comparison of prosthetic materials used to repair abdominal wall defects. 622 7

Dissection of embalmed and untreated water buffalo carcasses (n=10) revealed that hernias had occurred at the musculotendinous junction of the diaphragm, ventral to the foramen venae cavae and slightly lateral to the median plane. The diameter of the hernial ring varied from 7 cm to 20 cm. Herniation was more common in the right thoracic cavity with the reticulum firmly adherent to the hernia ring. Adhesions between the herniated portion of the reticulum and pleura, lung, pericardium or thoracic wall were present, while in a few cases thick fibrous tracts concealing metallic bodies were found. In two cases, involvement of esophageal groove with malalignment of cardia and reticulo-omasal opening was observed. Displacement and compression of the heart was observed in four animals.
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PMID:Patho-anatomy of herniation of the reticulum through the diaphragm in the bovine. 734 Sep 24

A radiopaque biofragmentable anastomosis ring was used for end-to-end anastomosis in a 3-month-old calf with a nonreducible umbilical hernia and partial small intestinal obstruction. Recovery was normal, and the ring degraded to several small fragments that passed in the feces between days 18 and 26 after surgery. The calf had normal weight gain; thus, it was slaughtered 9 months after surgery. Adhesions were found to involve 60% of the circumference of the intestine at the site of anastomosis. At histologic examination, the muscular layers were bridged by fibrous tissue. Double-contrast radiography revealed that the luminal diameter at the site of anastomosis corresponded exactly to the ID of the biofragmentable anastomosis ring. This was 69% smaller than the ID of healthy small intestine, because the normal intestine had grown substantially during the 9 months after surgery.
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PMID:End-to-end anastomosis of the jejunum by use of a biofragmentable anastomosis ring in a calf. 838 54

Contaminated defects of the abdominal wall continue to be a significant problem for patients and surgeons. The lack of sufficient tissue may require the insertion of a prosthetic material. Polypropylene (PP) mesh is still the most widely used material for this purpose, although the propensity to induce extensive visceral adhesions and erosion of the skin or intestine is a well-known drawback. Expanded polytetrafluoroethylene (PTFE) patch has better mechanical properties and has a low potential for infection. Therefore, we used expanded PTFE patch to repair contaminated abdominal wall defects in three patients. In one patient, the postoperative course was uneventful. In the other two patients, the patch had to be removed for ongoing wound sepsis and because the patch disintegrated. In an experimental study, contaminated abdominal wall defects created in Wistar rats were repaired with expanded PTFE patch (PTFE group, n = 21) or PP (PP group, n = 21). Wound infection occurred in 16 rats in the PTFE group and in 14 rats in the PP group. Two rats in each group died. Two rats in the PTFE group died as a result of peritonitis, one rat in the PP group died as a result of ileus and one as a result of peritonitis. Incisional hernia was found to be significantly more frequent in the PTFE group (n = 13) than in the PP group (n = 3). Fistula formation was only found in three rats in the PP group. Adhesion formation was more pronounced in rats in the PP group. It is concluded that the expanded PTFE is unsuitable for the reconstruction of contaminated abdominal wall defects and that PP mesh is more suitable, although this material has a high risk of complications.
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PMID:Expanded polytetrafluoroethylene patch versus polypropylene mesh for the repair of contaminated defects of the abdominal wall. 842 1

Adhesion formation involving intraperitoneal contents is a significant complication of incisional hernia repair. We evaluated the rate of peritoneal adhesion formation following closure of experimentally induced large ventral fascial defects using selected synthetic prosthetic materials in a well standardized porcine model. Sixty 25 kg hogs had a 4 x 6 cm ventral fascial defect induced and were randomized to repair with either interrupted 0-Prolene suture, Marlex surgical mesh (Mx), GoreTex Dual Mesh (Gore-DM), or an experimental version of the latter having multiple 0.4 mm fenestrations (Gore-DMH). Mx mesh induced significantly more adhesions than did Gore-DM when the two materials were placed in a comparable manner (P < 0.001). Those animals whose defects were closed primarily with Prolene suture alone developed significantly fewer adhesions than either Mx or Gore-DM (with or without holes) when these materials were sutured in an overlaying (i.e., extraperitoneal) manner (Mx, P < 0.0001; Gore-DM, P < 0.05; Gore-DMH, P < 0.01). The intraperitoneal placement of the Gore-DM materials (i.e., underlay manner) resulted in a rate of adhesion formation that was not statistically different from that induced by closure with Prolene alone (P = 0.08 for Gore-DM and P = 0.07 for Gore-DMH). Our findings support the use of Gore-DM biomaterial as the preferred material in the repair of large abdominal fascial defects when the use of a synthetic prosthetic material is necessitated by the defect size.
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PMID:Adhesion formation after incisional hernia repair: a randomized porcine trial. 889 16

Adhesion formation, which is almost inevitable following incisional hernia repair with prosthetic mesh, may lead to intestinal obstruction and enterocutaneous fistulae. Physical barriers, namely carboxymethylcellulose and hyaluronic acid, have been reported to lessen the intra-abdominal adhesions. To evaluate the effects of Seprafilm (Genzyme Corp., Cambridge, MA), a bioresorbable, translucent membrane composed of carboxymethylcellulose and hyaluronic acid, in the presence of a foreign body such as polypropylene mesh, an incisional hernia model in rats was used. Twenty-four male rats were divided into two groups: control (12) and Seprafilm (12). A defect, measuring 1.5 x 2.5 cm, was created in each animal. Control animals had the polypropylene mesh sutured to the defect, whereas in the other group, two membranes of Seprafilm were laid over the abdominal viscera before repair with polypropylene mesh. Half of the animals from each group were killed at postoperative day 7 and remaining half at day 30 for adhesion scoring and histological evaluation of wound healing. Seprafilm animals had fewer adhesions compared with control animals (P = 0.0008). Seprafilm had no adverse effect on wound healing. This membrane seems to have the potential to lessen the adhesion-related morbidity following incisional hernia repair.
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PMID:Prevention of adhesions by Seprafilm, an absorbable adhesion barrier: an incisional hernia model in rats. 992 59

Polypropylene mesh is commonly used in open and laparoscopic hernia repairs. We tested the hypothesis that intra-abdominal adhesion formation secondary to polypropylene mesh is greater when mesh is placed in an intraperitoneal versus an extraperitoneal position. Fifty adult male rats underwent midline laparotomy with or without implantation of a nonabsorbable mesh. There were ten rats in each of the following five groups: EP-M, creation of an extraperitoneal pocket without mesh placement; EP+M, mesh placement in an extraperitoneal pocket; IP+M, intraperitoneal mesh; IT-M, creation of an abdominal wall ischemic defect without mesh placement; IT+M, ischemic defect plus mesh. Adhesion formation was graded on a scale of 0 to 5, 2 weeks after operation. All groups formed adhesions. Tissue injury or the placement of a mesh in an intraperitoneal position resulted in significantly more adhesions. An entirely extraperitoneal approach to mesh placement is needed to minimize adhesions after laparoscopic hernia repair.
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PMID:Adhesion formation after intraperitoneal and extraperitoneal implantation of polypropylene mesh. 948 86

The aim of this experimental study was to compare the effects of polytetrafluoroethylene patch, polypropylene mesh, and porcine dermal collagen implant in rats for the repair of abdominal wall defects. We created experimental abdominal wall defects in 45 rats (three groups of fifteen) and repaired them with polytetrafluoroethylene, polypropylene mesh, and porcine dermal collagen implant by onlay technique. We sacrificed 4 rats from each group at 4, 8, 10, and 12 weeks after implantation and observed if hernia, adhesion, effusion, or infection occurred. We measured the tensile strengths of meshes by a digital tensometer. We made histological and electron microscopic evaluations of the meshes. Postoperative infection and effusion occurred in one rat in each group. Hernia was not found throughout the trial. The tensile strength of polytetrafluoroethylene patch and polypropylene mesh increased more than porcine dermal collagen implant until the end of week 12. Adhesion formation was minimal in the porcine dermal collagen group and moderate in the polytetrafluoroethylene patch and polypropylene mesh groups. Polytetrafluoroethylene patch showed minimum absorption and maximum foreign body reaction. Our results show that although none of the material reached the criteria of ideal mesh, polypropylene mesh is the better mesh for the repair of abdominal defects. Polytetrafluoroethylene patch though expensive, can also be used as a reliable mesh. We do not advise porcine dermal collagen implant as a mesh for abdominal defects due to its weak structure.
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PMID:Comparison of meshes for the repair of experimental abdominal wall defects. 982 49


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