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

Large ventral hernia is a most common pathology in surgical practice in tropical countries. We reported 67 cases of large ventral hernia with mean diameter about 11.7 cm. There were 41 women and 26 men. It was incisional hernia in 49 cases; recurrent ventral hernia in ten cases (after first repair six cases and after the second repair in four cases). Ventral hernia occured in 18 women after many pregnancies (mean of five pregnancies in ten years): this etiology of ventral hernia is the particularity of our practice; rarely in developed countries where number of pregnancies by women varied from two and where the women had means to abdominal wall reeducation. Another factor was excessive weigh: in our country, woman must take some many kilogrammes after pregnancy by traditional practice. Without means in our hospital, preoperative exams were limited to detect and treated cardiorespiratory diseases. All patients had an repair of their ventral hernia by autoplasty like described by Judd completed by another layer with the same ligature. Postoperative time was marked by wound sepsis (11 cases), dyspnea (ten cases), intestinal pseudo-obstruction (eight cases) and three patients were died (failure of respiratory system in two cases and cardiac failure in one case). After 18 months there were seven recurrent ventral hernia, all in incisional hernia. Judd's autoplastic technic is an efficacy technic in primitive ventral hernia or for the first repair of incisional ventral hernia. Preoperative management must concern all respiratory problems and their treatment.
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PMID:[Large ventral hernia in tropical countries: etiology and results of treatment with the Judd technique]. 1182 9

Midline ventral hernia repair with bilateral sliding myofascial rectus abdominis flaps, or the "separation of parts" technique, has low hernia recurrence rates. However, this technique, as originally described, creates massively undermined skin and subcutaneous tissue flaps. These undermined skin flaps can suffer marginal skin loss, fat necrosis, and delayed wound healing. The authors propose that preserving the periumbilical rectus abdominis perforators to the abdominal skin flaps will decrease the prevalence of postoperative superficial wound complications. A retrospective review of 66 consecutive, large, midline hernia repairs using a separation of parts technique was undertaken to identify any correlation between the preservation of periumbilical rectus abdominis perforators to the skin flaps and the prevalence of postoperative wound complications. In 25 cases, the standard separation of parts technique was performed with wide undermining of the skin and subcutaneous tissues. In 41 cases, the modified separation of parts technique was performed with maintenance of the periumbilical rectus abdominis perforators to the abdominal skin flaps. Comparison of these two groups revealed no difference in age; sex; body mass index; initial hernia size on physical examination; prevalence of smoking, diabetes, or steroid use; or prevalence of a simultaneous intraabdominal procedure. A statistically significant difference was noted in postoperative wound complications between the two groups (p < 0.05). Of patients who underwent the standard separation of parts technique, five of 25 patients (20 percent) had wound complications as compared with one of 41 patients (2 percent) who underwent the modified separation of parts technique with perforator preservation. The postoperative hernia recurrence (7 percent and 8 percent, respectively) and hematoma (4 percent and 2 percent, respectively) rates were similar in both groups. A trend of increased wound complications was noted when separation of parts was combined with an intraabdominal procedure (18 percent versus 3 percent, p = 0.08). Interestingly, within this group, the modified separation of parts technique with preservation of the periumbilical rectus abdominis perforators demonstrated a trend of fewer wound complications as compared with the standard separation of parts technique (7 percent versus 31 percent, p = 0.15). The authors conclude that preservation of the periumbilical rectus abdominis perforators significantly reduces the prevalence of major postoperative superficial wound complications in separation of parts hernia repairs. Simultaneous intraabdominal procedures with separation of parts hernia repairs seem to increase the prevalence of wound complications. This increased prevalence of wound complications seems to be minimized when the modified separation of parts technique is performed.
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PMID:Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in "separation of parts" hernia repairs. 1204 49

Incisional hernias after abdominal operations are a significant cause of long-term morbidity and have been reported to occur in 3 to 20 per cent of laparotomy incisions. Traditional primary suture closure repair is plagued with up to a 50 per cent recurrence rate. With the introduction of prosthetic mesh repair recurrence decreased, but complications with mesh placement emerged ushering in the development of laparoscopic incisional herniorrhaphy. The records of patients who underwent laparoscopic incisional hernia repair between June 1, 1995 and September 1, 2001 were reviewed. Patient demographics, hernia defect size, recurrence, operative time, and procedure-related complications were evaluated. Fifty patients (22 male and 28 female, mean age 57 years with range of 24-83) were scheduled for laparoscopic incisional hernia repair between June 1, 1995 and September 1, 2001. The average patient was obese with a mean body mass index of 35.8 kg/m2 (range 16-57 kg/m2). Two patients (4%) had primary ventral hernias. Forty-eight patients (96%) had incisional hernias with 22 (46%) of these previously repaired with prosthetic mesh. Mean defect size was 206.1 cm2 (range 48-594 cm2). The average mesh size was 510.2 cm2 (range 224-1050 cm2). Gore-Tex DualMesh and Bard Composite Mesh were used in 84 and 16 per cent of the repairs, respectively. Mean operating time was 97 minutes. There were no deaths. Complications were seen in 12 per cent patients (six occurrences) and included two small bowel enterotomies, a symptomatic seroma requiring aspirate, a mesh reaction requiring a short course of intravenous antibiotics, and trocar site pain (two patients). There were no recurrences during a mean follow-up of 41 months (range 3-74 months). We conclude that laparoscopic incisional herniorrhaphy offers a safe and effective repair for large primary and recurrent ventral hernia with low morbidity.
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PMID:Laparoscopic repair of large incisional hernias. 1207 34

The introduction of laparoscopic techniques after residency training has created a new paradigm dependent on laparoscopic workshops. This study tested the benefit of an animate course and evaluated the role of proctoring in learning to perform laparoscopic ventral hernia repair (LVHR). Surgeons who had taken a 1-day LVHR course (n = 59) were polled to determine previous experience with laparoscopic procedures and experience with LVHR after the course. Forty-eight (81%) surgeons completing the course responded. Thirty-two (67%) surgeons had performed 179 LVHRS (mean 5.6) since the course. There were no statistically significant differences between the groups performing and not performing LVHR regarding academic/private practice (P=0.8) or opportunities to perform a ventral herniorrhaphy (P = 0.6). Fifteen (31%) surgeons were precepted in their hospital operating room by the lead author. Thirteen (87%) of precepted surgeons had performed a LVHR compared with 19 (58%) of the 33 surgeons taking the course without a precepted intervention (P = 0.05). Surgeons with experience performing laparoscopic inguinal hernia repair, Nissen fundoplication, and common bile duct exploration were more likely to perform LVHR (P=0.0001). Surgeons performing only laparoscopic cholecystectomy tended to be less likely to perform LVHR, nearing statistical significance (P=0.08). Surgeons with prior advanced laparoscopic surgery experience are thus more likely to perform LVHR after participating in a 1-day course. Surgeons precepted in their hospital operating room were also more likely to perform LVHR. Participation in an animate laboratory and a precepted experience can impact the future performance of advanced laparoscopic surgery.
Hernia 2002 Mar
PMID:Optimal teaching environment for laparoscopic ventral herniorrhaphy. 1209 May 74

The rationale for laparoscopic repair of incisional hernias lies in the fact that any kind of incisional hernia is caused by an intrinsic defect of wound healing. This means that the abdominal wall needs to be reinforced with foreign nonresorbable material. During laparoscopic repair a nonresorbable mesh with the characteristic feature that its two surfaces are quite different is used to completely cover the original incision. One surface is designed to ensure stable incorporation into the abdominal wall and the other, to keep adhesions between the mesh and the bowel to a minimum. Experience reported since its first description in 1993 has clearly shown that the main advantage of the laparoscopic technique over conventional methods is that it involves an extremely low risk of mesh infection. The reported recurrence rates of 1-11% are mainly attributable to technical error and demonstrate that in this way too, the laparoscopic technique is at least as good as the open techniques. Up to now, no mesh-related complications in the form of fistula or mesh migration have been described. In conclusion, then, laparoscopic repair of ventral hernia is an important addition to the surgical armamentarium, which at least in our hands has almost completely replaced conventional techniques.
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PMID:[Laparoscopic repair of incisional hernias]. 1229 56

Rates of hernia recurrence following repair of abdominal wall hernia defects have been shown to be lower when prosthetic biomaterials are used, but their presence may be associated with a higher rate of infectious complications. Traditional surgical teaching has advocated removal of contaminated or exposed prosthetics, although the morbidity of these revisions is high. The case presented involves a ventral hernia repair complicated by methicillin-resistant Staphylococcus aureus infection and exposed polytetrafluoroethylene mesh. The open abdominal wound was successfully managed with a combination of intravenous antibiotics, local wound debridement, vacuum-assisted closure, and soft tissue coverage of the mesh. Eighteen months following surgical closure of the wound, no hernia recurrence or infection was evident.
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PMID:Successful salvage of infected PTFE mesh after ventral hernia repair. 1237 2

Large series of laparoscopic ventral hernia repair have shown excellent results. However, published comparative studies have had conflicting outcomes. We retrospectively reviewed the first 29 laparoscopic ventral hernia repairs performed at a VA Medical Center from January 2000 to June 2001. The outcome was compared to that of open repairs performed during the same time period. Outcomes between the groups were similar in all respects, except for the length of stay. The conversion rate for the laparoscopic approach was 13.8%. There was one death in the laparoscopic group due to an unrecognized enterotomy. There were three recurrences in the open group and one in the laparoscopic group with a mean follow up of 13 months. In our series, laparoscopic hernia repair resulted in a shorter hospital stay but no other significant benefits, along with a risk of missed enterotomy. The risk-benefit ratio for this procedure may be high during the learning curve.
Hernia 2002 Dec
PMID:Laparoscopic ventral hernia repair during the learning curve. 1242 98

The surgical journal, Repair of Ventral Hernias, was reviewed with regard to recurrence of hernia. Ventral hernias must be operated on with a tension-free technique. It is recommended that hernias larger than 4 cm are repaired with mesh. A randomised, controlled trial has yet to be carried out to determine whether even small hernias should be repaired with mesh. Controlled and uncontrolled studies have shown that the use of mesh to repair larger hernias results in a lower recurrence rate. The operative technique with the mesh placed to bridge the wall defect gives a higher rate of recurrence than does an overlap technique. The overlap of the mesh and its placement in relation to the different layers of abdominal wall are not defined. The laparoscopic operation using the overlap technique and intraperitoneal mesh has shown a lower recurrence rate than the open technique. However, a randomised, controlled study comparing the laparoscopic and open overlap technique over a long follow-up period still needs to be conducted.
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PMID:[Ventral herniotomy. Development of surgical technique and effect on the frequency of recurrence]. 1261 44

This report describes the technique and early results obtained with a simple laparoscopic intraperitoneal onlay Composix mesh repair for postoperative ventral hernia. Composix mesh is constructed from one layer of polypropylene mesh and another layer of expanded polytetrafluoroethylene (ePTFE). From March 2000 to October 2001, we performed laparoscopic repair of postoperative ventral hernia in 9 patients. Four (44%) of these patients had a history of at least one failed hernia repair. The size of the abdominal wall defect varied from 4 x 5 cm to 10 x 12 cm (median, 8 x 9 cm). In all cases, the Composix mesh (Bard Inc. USA) was stapled to the peritoneal surface of the abdominal wall, leaving the sac in situ. No death occurred as a result of surgery. Intraoperative small bowel injury occurred in one patient (11.1%) for whom surgery was converted to laparotomy and small bowel resection. No infection was observed. The length of hospital stay varied from 5 to 10 days (median, 5.6 days). During the follow-up period of 8 to 15 months (median, 2 months), there was no recurrence of hernia. Laparoscopic Composix mesh onlay repair is a safe, easy, and effective procedure with minimal discomfort and a low early recurrence rate.
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PMID:Laparoscopic intraperitoneal repair of postoperative ventral incisional hernia using Composix mesh. 1265 66

Laparoscopic repair of ventral abdominal wall hernias involves intraperitoneal placement of a mesh, which may lead to adhesion formation and bowel fistulation. The first series of selected patients with ventral abdominal wall hernias treated laparoscopically by extraperitoneal placement of a polypropylene mesh is presented. Thirty-four patients (24 women and 10 men; median age, 52 years [range, 34-70]) were selected from among 122 patients undergoing laparoscopic ventral hernia repair. Of these patients, 18 had a primary ventral abdominal wall hernia and 16 had an incisional hernia. After reduction of sac contents and adhesiolysis intraperitoneally, a large flap of peritoneum (with extraperitoneal fat, fascia, and posterior rectus sheath where present) was raised to accommodate a suitably sized polypropylene mesh, which was then covered again with the peritoneal flap at the end of the procedure. Intraoperatively, apart from circumcision of the hernial sac at the neck, a total of 24 iatrogenic peritoneal tears occurred in 20 patients, mainly at the site of the previous scar. In two patients, it was observed that greater than 25% of the mesh was exposed after the procedure. The median (+/-SD) duration of hospitalization postoperatively was 1 day (+/-0.56). One patient's hernia recurred 4 months after surgery, and one patient's infected mesh was removed 8 months after surgery. Laparoscopic extraperitoneal placement of a mesh is feasible and appears to be an advance over laparoscopic intraperitoneal mesh placement for ventral abdominal wall hernias in selected patients. However, longer follow-up and controlled clinical trials will be necessary before any firm conclusions can be drawn.
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PMID:Laparoscopic ventral hernia repair with extraperitoneal mesh: surgical technique and early results. 1270 15


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