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

Incisional hernias occur in up to 17% of patients after liver transplantation. Laparoscopic ventral hernia repair is associated with fewer wound complications and a decreased incidence of recurrence when compared to open hernia repair in nontransplant patients. This is a retrospective review of 13 patients who underwent laparoscopic incisional hernia repair (LAP group) after liver transplantation compared to 14 patients who had open repairs (OP group; all but one with mesh). Primary immunosuppression in both groups at the time of transplantation was tacrolimus, but more patients in the LAP group were on sirolimus at the time of hernia, while more patients in the OP group were on prednisone at the time of hernia repair. All operations were completed with a laparoscopic approach; there were no conversions to open. Length of stay differed significantly between the 2 groups, with a mean of 5.4 days for the LAP group compared to 2.7 days in the OP group (0.0059). Complications occurred in 2 (15%) of the patients in the LAP group and 5 (36%) in the OP group. One patient in the LAP group required mesh removal to exclude causes of recurrent ascites, and 1 in the OP group for mesh infection. One (7.6%) of the patients in the LAP group developed a recurrence, compared to 29% (4) of the OP group (P =0.3259). In conclusion, laparoscopic incisional hernia repair is safe in patients after liver transplantation, with a low risk of infection or recurrence.
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PMID:Laparoscopic incisional hernia repair after liver transplantation. 1796 89

Four patients treated laparoscopically for ventral hernia (LVH) using W3 mesh (Cousin Biotech, France) and Protack (Tyco Healthcare, USA) were reoperated laparoscopically after 5, 6, 14 and 23 months for recurrent hernia (two cases) and a new hernia proximal to the primary mesh (two cases). In all patients we found adhesions toward the mesh and fixation devices that increased in severity and extent with time, rendering dissection difficult and dangerous. These findings cause concern and suggest that current validation methods for materials used in LVH should be re-evaluated.
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PMID:[Adhesion after laparoscopic ventral hernia repair]. 1803 73

Rupture of abdominal wall with formation of ventral hernia is a rare complication following blunt abdominal trauma. Small intestinal rupture within such a hernial sac, resulting from a subsequent blunt trauma is rarer still. Ventral hernias often go untreated in developing countries because of their seemingly innocuous nature, ignorance and financial constraints. Blunt trauma in patients with hernia warrants a thorough clinical examination along with evaluation for intestinal injury, since even trivial trauma can cause potentially serious intra-peritoneal visceral injury. A case of fatal traumatic ileal perforation in pre-existing post-traumatic ventral hernia (from blunt trauma sustained 10 years earlier) is being reported.
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PMID:Traumatic ileal perforation in post-traumatic ventral hernia: adding insult to injury. 1818 44

Laparoscopic incisional and ventral hernia (LVIH) repair is becoming more popular throughout the world. Although individual series have presented their own information, few data have been collected to identify the risk of the most serious complication, enterotomy. A literature review has identified this to occur in 1.78% of patients who undergo this procedure. Large bowel injury represents only 8.3% of these injuries. Eighty-two percent of the time, these injuries will be recognized and repaired. In the majority of published series in which this occurred, the hernia repair was completed with a laparoscopically placed prosthesis, as only 43% were converted to the open procedure. Complications related to this approach are infrequent. The mortality rate of this operation was noted to be 0.05%. However, if an enterotomy occurred, it increased to 2.8%. A recognized enterotomy was associated with a mortality rate of 1.7%, but an unrecognized enterotomy had a rate of 7.7%. Careful technique and close inspection of the intestine at the completion of the adhesiolysis and the herniorrhaphy is recommended. If the hernia repair proceeds as planned following repair of enterotomy, continuation of antibiotics and the placement of an antimicrobial impregnated prosthesis are recommended. More study is necessary before firm recommendations can be made, as the majority of these events are most likely unreported. Safety concerns may require postponement of the hernia repair if an enterotomy occurs.
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PMID:Enterotomy and mortality rates of laparoscopic incisional and ventral hernia repair: a review of the literature. 1823 2

Laparoscopic ventral hernia repair (LVHR) is now widely performed. One of the most common complications of this procedure is seroma. Most seromas usually form anterior to the mesh and resolve with conservative management. In rare cases, some patients develop a pseudoneoperitoneum deep to the mesh which actively secretes fluid, forming a collection. We present a group of seven patients with persistent seroma posterior to the mesh and a possible treatment algorithm.
Hernia 2008 Aug
PMID:Chronic posterior seroma with neoperitoneum following laparoscopic ventral hernia repair: treatment algorithm. 1825 34

Several factors must be considered in deciding which mesh to use for a ventral hernia repair. Open hernia repairs with no exposure of mesh to viscera can be performed with unprotected synthetic mesh, preferably a "lightweight" option. For open repair with high risk for fascial dehiscence and visceral exposure to mesh, and for open underlay repair and laparoscopic underlay repair, recommendations call for a tissue-separating mesh that prevents ingrowth of intra-abdominal contents into the mesh. Although no long-term data are available about biologic (acellular collagen scaffold) meshes, these may have good results when used in contaminated or well-drained infected fields, and do best when used according to the principles of a high-quality synthetic mesh repair (wide mesh overlap, frequent fixation points). Evidence is still insufficient to support the use of biologic materials for primary hernia repair.
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PMID:Prosthetic material in ventral hernia repair: how do I choose? 1826 64

During laparoscopic ventral hernia repair (LVHR), it is not always possible to reduce incarcerated omentum through a tight defect and it may tear or require transection within the abdomen. This leaves an ischemic mass of tissue within the hernia sac which can cause pain, infection, or the appearance of hernia recurrence postoperatively. We describe a technique which allows extraction of any retained omentum within the hernia sac, mesh insertion, and laparoscopic completion of the procedure using only 5 mm trocars. After obtaining access to the abdomen with a 5 mm optical trocar in select patients, lysis of adhesions is performed as needed. When incarcerated omentum that cannot be safely reduced is discovered, it is transected at the level of the abdominal wall using electrocoagulation or ultrasonic dissection. At this point, we make a 2-3 cm skin incision overlying the retained omentum, open the hernia sac, and remove the amputated omentum. The rolled up piece of mesh utilized for the repair is then inserted through this opening. The hernia sac is closed with absorbable suture, allowing reinsufflation of the abdomen and completion of the laparoscopic repair. This method enables us to safely remove any retained omentum from the hernia sac and utilize the same incision for mesh insertion. We utilize only 5 mm trocars without the need for a larger port through which to place the mesh into the abdomen. This reduces the risk of postoperative trocar site hernias as the opening for mesh insertion is covered by the mesh after it is fixed in place. This technique may also decrease the need for conversion to open hernia repair by allowing an alternative approach to reduce incarcerated omentum.
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PMID:A novel approach to extraction of incarcerated omentum and mesh insertion in laparoscopic ventral hernia repair. 1864 94

Spigelian hernia is a rare clinical entity. It has a subtle clinical presentation with vague abdominal pain that may warrant laparoscopy. Even though laparoscopic ventral hernia repair is increasingly popular, laparoscopic repair of spigelian hernia has not been adequately studied. Eight patients who underwent laparoscopic spigelian hernia repair are presented herein, along with a description of our simple technique for mesh placement. In addition, literature review of laparoscopic repair of spigelian hernia is also presented. Our case series included six females and two males; two patients presented acutely whereas the others presented with chronic pain. Laparoscopic repair was successfully performed in all of our patients with a mean operative time of 92.5 minutes. There were no postoperative complications or recurrence with a mean follow up of 36 months. Our scroll technique for laparoscopic repair is simple and feasible. It minimizes intracorporeal mesh manipulation, facilitates mesh fixation to the anterior abdominal wall, and maintains a precise orientation of the mesh in relation to the defect.
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PMID:Laparoscopic spigelian hernia repair: the scroll technique. 1830 58

Overall 605 patients with postoperative ventral hernia underwent plasty of anterior abdominal wall by combined methods and on-lay or in-lay disposition of synthetic implant. Concomitant diseases were diagnosed 432 (71.4%) patients that required 495 simultaneous operations at 283 (43.8%) patients. Wound complications after surgery were seen at 21 (3.47%) patients. Long-term results were followed-up to 11 years: recurrences of hernia were diagnosed at 12 (1.9%) patients, 3 (0.5%) patients died due to pulmonary embolism. It is concluded that the treatment of patients with postoperative ventral hernia requires complex approach and leads to good short- and long-term results.
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PMID:[Complex treatment of the patients with postoperative ventral hernia]. 1842 92

The application of laparoscopic principles to ventral or incisional hernia repair has recently been shown to be a safe and effective alternative to open procedures. In this study we analyzed our recent experience with laparoscopic incisional-ventral hernia repair. The outcomes of 75 consecutive patients (January 2002 to July 2006) who underwent laparoscopic repair for incisional-ventral hernia were reviewed. Patient's demographics, hernia parameters, and intraoperative and postoperative data were collected. Of the 75 patients, 44 were females and 31 males. Mean age was 59.1 yrs (range 29-80 yrs). Mean BMI was 25.9 (range 19.4-36.7). Twenty-one patients had primary ventral hernias while 54 patients had an incisional hernia. Fifty-three patients had a single defect and 22 patients multiple defects. In 45 cases the incisional hernia was a primary hernia; in 4 cases it was a first recurrence; in 2 cases a 2nd recurrence; and in 3 cases a 3rd recurrence. The mean defect size was 52,7 cm2 (range 4-432). Laparoscopic hernia repair was successfully performed in 71 cases (94.7%). The mean mesh size was 211 cm2 (range 63-694). Mean operating time was 101 min (range 50-220 min). The mean hospital stay was 4.7 days. The postoperative morbidity rate was 14%. After a mean follow-up of 24.6 months (range 7-56) the recurrence rate was 7% (5/71). Laparoscopic repair of incisional-ventral hernias seems to be safe and effective. Medium-term outcomes were promising with a relatively low rate of conversion to open surgery, a low complication rate and a low risk of recurrence.
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PMID:[Laparoscopic repair of incisional and ventral hernia]. 1870 80


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