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

The aim of this study was to investigate the need to defunction the low anastomosis after anterior resection of the rectum with total mesorectal excision for rectal cancer. Two hundred consecutive patients (125 defunctioned, 75 non-defunctioned) undergoing low anterior resection for carcinoma were included in the study. Peritonitis requiring emergency laparotomy occurred in 8 per cent of the patients who did not have a defunctioning stoma compared with less than 1 per cent of those patients who had a defunctioning stoma (P less than 0.01). There was no mortality related to closure of the stoma but seven patients developed a faecal fistula and ten developed an incisional hernia. Despite current trends to avoid the defunctioning stoma, these results suggest that after total mesorectal excision the faecal stream should be temporarily diverted away from the anastomosis that is 6 cm or less from the anal verge to protect against potentially life-threatening anastomotic leakage.
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PMID:Risk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis. 1153 84

The hospital costs and clinical results of 304 patients who were more than 80 years old and who underwent general surgical procedures were evaluated. The over-all mortality rate was 14 per cent; 19.9 per cent occurred in patients admitted under emergency conditions as compared with 8.9 per cent that occurred in patients undergoing elective procedures (p less than 0.001). Seventy-nine per cent of the patients were discharged and 7 per cent required care in a skilled nursing facility. Survival rates were as good or better than standard life table survival rates for 80 year old patients. Costs were higher in those who were admitted under emergent conditions or who died in the hospital. Deaths were a result of complications of the primary disease rather than associated disease in most groups. Neither costs nor length of stay could accurately predict survival of individual patients. We concluded that health resources should be directed at treating problems, such as cholelithiasis, hernia or carcinoma, early before complications develop.
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PMID:A comparison of hospital costs and morbidity between octogenarians and other patients undergoing general surgical operations. 221 34

This study was undertaken to clarify the incidence of hiatus hernia and the functional changes in the cardia of post-gastrectomy patients. One hundred and four post-gastrectomy patients and 399 non-gastrectomy patients were selected for endoscopic study, and the diagnosis of hiatus hernia was made by observing the shape of the cardia inside the stomach. A manometric study was also done on 12 patients with gastric carcinoma and 14 patients with gallstones. Hiatus hernia was observed in 37.5 per cent of the post-gastrectomy patients, this incidence being significantly higher than the 19.3 per cent of the non-gastrectomy patients (p less than 0.01). In the latter group alone the incidence of hernia steadily increased with advancing age. In the post-gastrectomy patients, reflux esophagitis and heartburn were observed in 20.2 per cent and 27.9 per cent, respectively. These incidences tended to be higher in the patients with hernia but there were no significant differences. The manometric study revealed that lower esophageal sphincter pressure was significantly decreased after gastrectomy, but not after cholecystectomy.
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PMID:Endoscopic and manometric study of the cardia in post-gastrectomy patients. 230 88

An elderly woman presented with a lump in the right groin, clinically suggestive of a femoral hernia, but surgical exploration revealed a cystic mass of poorly differentiated adenocarcinoma. Post mortem examination showed it to be a metastic deposit of carcinoma of the gall-bladder. Presentation of gall-bladder carcinoma as a femoral hernia has not been previously reported.
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PMID:An unusual femoral hernia. 238 69

Abdominal-perineal resection for advanced rectal carcinoma may leave a large defect for which complete secondary healing can be slow. In such cases, the inferiorly based rectus abdominis myocutaneous flap, passed through the pelvis into the perineum, can provide a large amount of well-vascularized tissue that may be placed in the defect to facilitate primary healing and allow a quicker recovery. Additional advantages include displacement of the bowel out of the pelvis to facilitate postoperative radiotherapy, and the ability to reconstruct vaginal wall defects. We report a series of seven patients for whom the transpelvic rectus abdominis myocutaneous flap was used to cover perineal defects following abdominal-perineal resection. Although one flap failed, all patients healed rapidly and the only lasting complication was a possibly related small upper-abdominal hernia found one year after surgery.
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PMID:Transpelvic rectus abdominis flap reconstruction of defects following abdominal-perineal resection. 252 5

Construction of continent colonic urinary reservoir was performed in 44 patients after exenteration for invasive bladder carcinoma or various gynecologic tumors. The distal ileum was tapered over a 14 French red rubber catheter. The ileocecal valve was reinforced with three circumferential silk sutures in a purse-string fashion. Full continence was obtained in all patients (100%). A non-tunneled, non-refluxing ureterocolonic anastomosis was performed in all 88 ureters. No obstruction or reflux was observed in 84 ureters (95%). There were 7 early postoperative complications and 3 of them required reoperation (pelvic abscess 1, urinary leak from ureterocolonic anastomosis 1, pouch-vaginal fistula 1). Moreover, there were 7 late complications and 3 of them required reoperation (stomal stenosis 1, parastomal hernia 2). These results suggest that this method is a safe, simple and useful one for permanent urinary diversion.
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PMID:[Clinical experience of tapered distal ileum for construction of a continent colonic urinary reservoir]. 262 31

Twenty-two carcinoma patients aged less than 65 years were subjected to radical nephrectomy through total median laparotomy. This type of approach provides excellent access to both essential operation phases: vessel management and lymphadenectomy. Postoperative abdominal complications and hernia have not been encountered.
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PMID:Radical nephrectomy through total median laparotomy. 280 76

In patients about to have hernia repair, preoperative screening studies for early colorectal cancer using the rigid proctosigmoidoscope and barium enema have previously shown minimal cost effectiveness and poor patient acceptance. Flexible sigmoidoscopy may be more acceptable to patients and of greater diagnostic value. Between October 1980 and December 1983, 100 consecutive asymptomatic male surgical patients were examined using the Olympus 60 flexible proctosigmoidoscope. All patients were admitted for elective hernia repair. Age ranged from 21 to 88 years (mean 59.7). All patients with stool positive for occult blood on admission were excluded from this study. In addition, patients with any gastrointestinal symptoms, history of colorectal disease, or family history of colorectal polyps or carcinoma were excluded. Examinations were done under direct supervision of an attending surgeon (W.W. or C.S.C.). Of the 22 patients who had one or more benign polyps, three had villous adenomas. Two additional patients had carcinoma. Results of examination were completely normal in 63, while 13 patients were found to have hemorrhoids or diverticular disease. There were no complications and the procedure was well tolerated by all patients.
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PMID:Flexible sigmoidoscopy as a screening procedure for asymptomatic colorectal carcinoma in patients with inguinal hernia. 407 Nov 66

In an effort to avoid the failures of perineal wound healing that are common after proctectomy, 57 patients who had abdominoperineal resection of the rectum or total proctocolectomy for ulcerative colitis (35 patients), Crohn's colitis (12), or carcinoma (10) had primary closure of the levator muscles and perineal tissues. No attempt was made to approximate the pelvic peritoneum. The small bowel was allowed to fill the pelvic space, which was also drained by suction catheters brought out through the lower abdominal wall. The skin and subcutaneous tissues were allowed to heal by secondary intention in seven patients who had excessive preoperative perineal sepsis from fistulas, deep fissures, and abscesses. All seven wounds healed within 2 months. Of the other 50 patients, whose wounds were closed to the skin, 48 were discharged with completely healed perineal wounds. Two patients had sterile pelvic hematomas that drained through the perineum and delayed wound healing 1 month and 2 months. There were no postoperative perineal, pelvic, or intraabdominal abscesses. Immediate postoperative ambulation was allowed. There was no increased short-term or long-term incidence of small bowel obstruction related to this procedure, nor did perineal hernia occur after long-term observation (mean: 5.3 years). This method of accomplishing perineal wound healing is simpler, safer, more comfortable, and remarkably effective in eliminating the prolonged morbidity of an unhealed perineal wound. It is superior to any other reported method of managing the perineal wound in patients with inflammatory bowel disease and may be applicable to the treatment of cancer without compromising the chances for cure.
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PMID:Improved management of the perineal wound after proctectomy. 407 88

This report describes the use of a rotated gracilis muscle to repair a perineal hernia that occurred 18 months following pelvic exenteration for recurrence of cervical carcinoma. The anatomy of the gracilis muscle and the operative technique of the hernia repair are described. The gracilis muscle procedure offers a satisfactory correction for this complication of pelvic exenteration. The ability to mobilize the gracilis muscle for reconstructive procedures in the pelvis is a valuable procedure for the gynecologist.
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PMID:Gracilis muscle repair of perineal hernia following pelvic exenteration. 742 79


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