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

The primary use of laparoscopy is as a surgical tool, with sterilizations being the overwhelming indication. The laparoscope is used less frequently as a non-surgical tool, with the major indication being for diagnosing infertility and/or amenorrhea, and for evaluation of obscure pelvic pain. There would seem to be several indications for laparoscopy that have been neglected, these being in confirming the diagnosis of acute pelvic inflammatory disease; in the evaluation of malignancies and abdominal-pelvic trauma; and the surgical treatment of pelvic pain. Lapar-The majority of these contraindications are relative, and depend soley on the laparoscopist's ability and his clinical judgment. The problems of hernias seem to have been over-emphasized. The laparoscopist should be aware of potential problems with umbilical hernia, and he probably can ignore hiatal hernias except when they are large and quite symptomatic. However, generalized abdominal peritonitis, significant hemoperitoneum with intestinal obstruction are felt by most authors to be absolute contraindications. The most frequent complications of laparoscopy involve the physoperitoneum. Except for cardiac arrest the most serious complications involve electrical burns to small bowel.
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PMID:Indications, contraindications and complications of laparoscopy. 12 9

Definitions are offered for the concepts of sterility and infertility. The notion of infertility is expanded to cover not only habitual abortions (three or more miscarriages) but, as well, deliveries of defective children. --Five-hundred and fifty-five pregnancies so far have occurred to 240 infertile probands, among them 78 with habitual abortions and 162 with damaged children. Only one in ten of those pregnancies resulted in clinically intact live birth. --Abortion was the result of 95 per cent of all pregnancies of the women with habitual abortion. The same applied to 25 per cent of all pregnancies of the above women with defective children (e.g. Down's syndrome, neural tube defects, diaphragmatic hernia, hydrocephalus, and progressive muscular dystrophy). A damaged child was born in more than 50 per cent of the latter pregnancy cases. --The number of children born by 162 women has been 181, with only 96 of them alive. The causality relationship between abortion and birth of defective children is discussed. --Infertile women should be given special attention, before conception takes place, and they should be kept under intensive care to the end of pregnancy.
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PMID:[Infertility--a risk factor in obstetrics (author's transl)]. 53 55

Although the etiology of maldescended testes is multifactorial, dysfunction of hypothalamic-pituitary-gonadal axis should be considered as the most important factor. The hormonal treatment with Gn-RH on its own or followed by hCG can provoke testicular descent and should be applied at 10th month of life. Failure, partial or transient success needs orchidopexy within the first two years of life to prevent infertility. If a concomitant hernia or a true ectopia is encountered, if patients are seen at an adolescent age and if the testes are truly cryptorchid, surgery is the treatment of choice.
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PMID:[Current diagnosis and therapy of undescended testis]. 257 60

Endometriosis is a common gynecologic diagnosis. Typical complaints of patients with pelvic endometriosis include dysmenorrhea, menstrual irregularities, dyspareunia, and infertility. Endometriosis may also occur in extrapelvic sites and cause unusual symptoms and diagnostic dilemmas. Endometriosis has been described in the inguinal region, and this is illustrated in the first case history. The tender inguinal masses often fluctuate with the menstrual cycle but the condition initially may be confused with an inguinal hernia. Treatment is surgical. Abdominal wall scar endometriosis, seen in the second case, has been described in patients after a wide variety of gynecologic procedures. This also is initially noted as a tender mass, usually fluctuating with menstruation, and is often confused with an incisional hernia. Again, surgery is the treatment of choice. Pathologic features of endometriosis are constant, regardless of location. Microscopically, endometrial glands and stroma, fibrosis, chronic inflammation, and old hemorrhage are seen. Familiarity with the unusual types of endometriosis is important to the general surgeon.
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PMID:Extrapelvic endometriosis presenting as a hernia: clinical reports and review of the literature. 264 94

Benign mass lesions of the scrotum include spermatocele, hydrocele, varicocele, sperm granuloma after vasectomy, tuberculous masses, and epididymitis. A careful history and physical examination are paramount in making the diagnosis of a scrotal mass. Referral to a urologist is indicated for masses that do not transilluminate, are solid or fixed to the testicle, or for epididymitis that does not respond to antibiotics. Hydroceles associated with significant symptoms or with hernia and varicoceles with symptoms or associated infertility are also reasons for referral. After a sexual history is obtained, lesions of the anogenital area should be carefully inspected. Male partners of women with cervical dysplasia should be examined for evidence of human papillomavirus infection. Treatment of anogenital lesions resulting from a sexually transmitted disease involves both partners.
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PMID:Benign conditions of the external genitalia. 269 49

A case is presented in which a laparoscopic vasectomy was performed concomitantly with laparoscopic hernia repair. A laparoscopic vasectomy should not replace an office procedure done under local anesthesia and minimal complications. Reanastomosis after laparoscopic vasectomy is a more complicated procedure. The additional benefit of laparoscopic surgery to those men who desire infertility while having elective pelvic laparoscopic procedures is presented.
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PMID:Laparoscopic vasectomy. 786 19

This report describes the first in utero repair of diaphragmatic hernia in Australia. The patient was a 32 year old woman with major infertility problems who was diagnosed at 15 weeks gestation as having an infant with diaphragmatic hernia. After extensive consideration and counselling the parents requested in utero repair. This was performed at 28 weeks gestation and was technically successful, but the infant was found to be dead after uterine closure. The mother has subsequently been delivered of normal twins at term by Caesarean section. In utero repair of diaphragmatic hernia requires a high degree of team work, is technically demanding and has major ethical implications. It should be restricted to nationally designated units.
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PMID:In utero repair of diaphragmatic hernia. 824 Aug 71

Polyorchidism is a rare anomaly with approximately 70 cases reported in literature. The exact explanation for the production of polyorchidism is not known, although several theories have been proposed, including anomalous appropriation of cells, initial longitudinal duplication of the genital ridge and transverse division of the genital ridge, either through some local accident of development of peritoneal bands. A functional classification based upon the embryogenic development is provided. Type I: the supernumerary testis lacks an epididymis and vas. The split-off part of the primordial gonad does not communicate with the mesonephric tubules from which the epididymis develops. Type II: the supernumerary testis is linked to the regular testis by a common epididymis and shares a common vas with it. The division of the genital ridge occurs in the region where the primordial gonads are attached to the mesonephric ducts, although the latter are not divided (incomplete division). Type III: the supernumerary testis has its own epididymis but shares the vas with the regular testis. This variant results from a complete transverse division of the genital ridge. In the majority of the reported cases, the patients are asymptomatic and have painless groin or testicular masses. Approximately 50% occur as maldescent or cryptorchidism, and about 30% are associated with indirect hernia. The remaining 20% are discovered variously in relation to torsion, or are associated with hydrocele, epididymitis, varicocele or infertility. Moreover, since there is a 20 to 40 fold increase in testicular malignancy in patients with cryptorchidism compared with the normal testis, tumours of the supernumerary testicles are not unusual. We reported two cases of polyorchidism: the first patient is probably a longitudinal division of the genital ridge and the second is a completely duplication of the primordial gonads. The patients described vague, intermittent, testicular pain. Physical examination and the scrotal sonography and magnetic resonance revealed in the first patient a supernumerary testis in the right scrotal space and in the second a bilateral double testis. In conclusion we think that in the absence of any concomitant disorder and if testicular tumor can be ruled out by ultrasonography and magnetic resonance imaging, surgical exploration with biopsy is unnecessary.
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PMID:[Polyorchidism: 2 case reports]. 947 18

The purpose of this report is to assess the impact of fetal surgery on future maternal fertility, subsequent pregnancy outcome, and the incidence of pregnancy complications. Retrospective data were collected on 70 mothers who underwent fetal surgery between April 1981 and June 1996. Indications for open hysterotomy fetal surgery included congenital diaphragmatic hernia (n = 44), congenital cystic adenomatoid malformation of the lung (n = 11), urinary obstruction (n = 9), sacrococcygeal teratoma (n = 4), heart block (n = 1), and acardiac-acephalic twin reduction (n = 1). The following data were obtained: number of pregnancy attempts, number of successful pregnancies, pregnancy outcome including obstetrical and neonatal complications, and infertility after fetal surgery. There were 45 respondents, of whom 35 attempted subsequent pregnancies. Thirty-two were successful, resulting in 31 livebirths. Two women had a strong prefetal surgery history of infertility, 1 has only attempted to conceive for 3 months. We report this experience because the effect of open fetal surgery on futrue fertility is such an important question for our patients and referring physicians. This analysis suggests that hysterotomy and open fetal surgery has a negligible impact on maternal fertility.
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PMID:Maternal fertility is not affected by fetal surgery. 1036 73

Indirect inguinal hernia is neglected by many female patients. When women undergo laparoscopy for infertility work-up or other gynaecological conditions, the hernia appears pressurized by the pneumoperitoneum. A large opening on the peritoneum followed by the patent canal of Nuck-as seen in the patient in this case report-is accompanied by a bulge above the labia major. This situation was treated with simple ligation of the canal of Nuck from the internal inguinal ring, and the vulvar bulging mass quickly disappeared, even while under pneumoperitoneal pressure. Laparoscopic hernia repair is currently performed with a mesh prosthesis to cover the defect; however, in female patients it seems unnecessary to use such an invasive method designed largely for males. According to our experience, the concomitant simple closure method for female indirect inguinal hernia is a quick and simple procedure, and deals with the problem during the same laparoscopy. In addition, disappearance of the bulging mass under the pneumoperitoneum offers a useful diagnostic test to secure hernia management.
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PMID:Concomitant closure of patent canal of Nuck during laparoscopic surgery: case report. 1115 34


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