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

The epidemiology of inguinal hernia was investigated in a community survey in a neighbourhood of western Jerusalem in 1969-71. The current prevalence rate, excluding operated hernias, was 18 per 100 men aged 25 and over, and the lifetime prevalence, including operated hernias, was 24 per 100. Prevalence rose markedly with age; the lifetime prevalence rate reached 40 per 100 men at the ages of 65-74 and 47 per 100 at 75 and over. The prevalence of hernia was significantly higher in the presence of varicose veins, in men who reported symptoms of prostatic hypertrophy, and, among lean men only, in the presence of haemorrhoids. These associations may reflect the role of increased abdominal pressure. The prevalence of hernia was low in the presence of overweight or adiposity, suggesting that obesity is a protective factor. No significant age-independent associations were found with chronic cough, constipation, physical activity at work, or a number of other variables. Two-thirds of the hernias had not been operated upon. The prevalence of unrepaired hernias rose with age; 13% of all men aged 65-74 and 23% of those aged 75 and over had unoperated groin swellings. One in every five operated hernias showed evidence of recurrence. No significant age-independent associations were found between evidence of occurrence and other characteristics. A comparison of interview responses and examination findings showed that interview data on the presence of hernias were of low validity, mainly because of under-reporting.
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PMID:The epidemiology of inguinal hernia. A survey in western Jerusalem. 9 77

A series of 80 patients with an incisional ventral hernia were treated with an extractable prosthesis in the period 1 January 1965--1 January 1974. The results are discussed. After a description of the advantages of an extractable prosthesis, attention is given to a number of factors which are possibly of importance in the development of such a hernia. This is most probably a multifactorial process, in which suturing technique, wound infection, obesity and postoperative rise of intra-abdominal pressure may play a part. The technique of inserting the extractable prosthesis is accurately described and illustrated with drawings and photographs. Success was ultimately obtained in 86.25% of the cases. The failure rate was 13.75%. In comparison with the data from the literature, this is a low percentage, the more so because the author's series consisted mainly of large incisional hernias. Recurrences can be treated successfully several times with an extractable prosthesis. This is, in general, easy in view of the smaller dimensions of the hernial orifices. The extractable prosthesis is recommended both for the treatment and prevention of incisional ventral hernia.
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PMID:Results of treatment of incisional hernias with extractable prostheses. 12 32

One hundred one carefully screened morbidity obese patients underwent jejunoileal bypass and were followed closely over a mean follow-up period of 32 months. Although there were no operative deaths, three per cent of patients died postoperatively of liver failure or its complications. A fourth patient died of a pulmonary embolus after reoperation, and the fifth patient died cachectic with severe diarrhea after excessive weight loss. Nineteen per cent of the patients required restoration of intestinal continuity (reversal), most for either liver failure or late fluid and electrolyte derangements. All but two survived reversal and are doing well despite massive weight gain. Fifty-eight per cent of the patients had major complications which either required major reoperation (reversal, cholecystectomy or incisional hernia repair) or were potentially life-threatening (liver failure, hepatic fibrosis or urinary tract stones). As described in other series, abnormalities in serum electrolytes and vitamins were seen. In addition, hypovitaminosis D occurred in a number of patients and as with other serum parameters measured, was time-dependent in that improvement was seen in most patients over the postoperative interval studied. Because of the high rate of complications and reversals, we believe that jejunoileal bypass should be reserved for patients with morbid obesity whose lives are imminently threatened by obesity or its sequellae.
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PMID:Jejunoileal bypass for morbid obesity. A critical appraisal. 34 3

This is an interim report of a prospective, randomized study involving 194 consecutive patients who underwent elective operation for treatment of duodenal ulcer. The results of parietal cell vagotomy without drainage (PCV) and selective vagotomy-antrectomy and Billroth I anastomosis (SV-A-B I) were compared. There was no mortality. Postoperatively patients were examined at two, six, 12 months and every 12 months thereafter. The two operations showed no statistical difference in the frequency of diarrhea. Dumping was less (p < .01) after PCV than after SV-A-B I. Weight loss was less (p < .01) after PCV than after SV-A-B I. There were no recurrent ulcers after SV-A-B I and five after PCV. In each instance but one the recurrent ulcer healed on withdrawal of an ulcerogenic drug. One patient required reoperation. Reoperations in the PCV group consisted of one for recurrent ulcer, one for gastric outlet obstruction and three for intestinal obstruction. The reoperations after SV-A-B I consisted of four for gastric outlet obstruction, three for intestinal obstruction, one for ruptured spleen and two for incisional hernia. PCV was technically feasible and practical to perform except in the occasional patient with severe pyloric stenosis. Obesity was never a deterrent. After PCV it is reasonable to assume that a recurrent ulcer rate in the range of 5-10% can be expected by surgeons who have been properly trained. This recurrence rate is higher than that after SV-A-B I but no higher than that encountered with TV-P. The recurrence rate is acceptable and is a fair exchange for the avoidance of dumping and weight loss that accompany SV-A-B I with significantly greater frequency and which on occasion can produce gastric crippling, although this did not occur in this study. All recurrent ulcers after PCV do not require reoperation but when operative treatment is required the patient has all the options that he had prior to PCV.
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PMID:An interim report on parietal cell vagotomy versus selective vagotomy and antrectomy for treatment of duodenal ulcer. 44 16

Laparoscopy was carried out using a simplified open method on 585 patients. In the group, 173 (29.5%) had undergone a previous laparoscopy or laparotomy, 28 (4.8%) suffered from gross obesity and 1 patient had a large umbilical hernia. Laparoscopy was diagnostic in 216 (37%) patients and operative in 369 (63%). In this series there were no technical failures or major complications; the incidence of minor complications was 2.7%. The above results seem to suggest that open laparoscopy compared to the closed method may offer the advantage of a lack of contraindications secondary to previous surgery, no risk of failure with unintended laparotomy and, possibly, decreased postoperative discomfort. A larger, randomized series to settle the controversy between closed and open laparoscopy regarding the safety differences between the two approaches may result in more widespread use of the open technique.
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PMID:Laparoscopy using a simplified open technique. A review of 585 cases. 146 Jun 10

The records of 172 patients with repair of incisional hernia in 1976-1985 were reviewed. Follow-up data were collected with a questionnaire and the 40% of patients with symptoms were clinically re-examined. The follow-up time was 3 months to 12 years, mean 4.5 years. The median time between primary operation and first symptoms of incisional hernia was 7 months. Sex, age, smoking, chronic lung disease, obesity, fascial diastasis, site of hernia, surgeon's experience, closure method and suture material were among the factors evaluated as possibly causal. At the time of follow-up 34% of the patients had recurrent hernia. A multifactorial logistic regression analysis revealed obesity as the only factor clearly impairing the result of incisional hernioplasty--good in 87% of the patients with normal weight and in 61% of the overweight. Repeat hernioplasty was performed in 35 cases, but succeeded in only 17. In obese patients repair of an incisional hernia that does not cause serious symptoms is not indicated. More careful selection of patients would improve the results of incisional hernia repair.
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PMID:Results of incisional hernia repair. A retrospective study of 172 unselected hernioplasties. 167 78

To determine the incidence, the mortality, the risk factors and the most appropriate method for treatment of sternal infections, 9,742 charts were reviewed retrospectively of patients having undergone a sternotomy for cardiac surgery at the Montreal Heart Institute. One hundred and eleven sternal infections (1.1%) were identified: 55 (0.57%) superficial, 56 (0.57%) profound (mediastinitis). The treatment for these profound infections was either debridement, open or closed with drainage irrigation, pectoral flap closure-repair, or epiplooplasty closure. The risk factors for those patients experiencing profound infections were diabetes, obesity, length of the surgical intervention, the time spent in the operating room, and the duration of endotracheal intubation. Eleven of the 111 patients died. The average length of hospitalization were similar for those patients treated by pectoral flap repair and by the epiplooplasty closure. All patients (100%) treated by the epiplooplasty closure developed an epigastric hernia. Six cases of recurrent infection were observed in the group treated by debridement. The average hospital stay was shortened for those patients benefiting from the pectoral flap and epiplooplasty closures. A high incidence of mortality is associated with profound sternal infection. The methods of treatment are various. We recommend as treatment of choice, the pectoral flap closure because there is relatively low risks with this procedure, little to no recurrence of infection, a shorter hospital stay and this procedure does not provoke epigastric hernia.
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PMID:[Post-sternotomy mediastinitis: strategy of treatment]. 178 19

282 acquired inguinal hernias in 183 adult patients were treated between 1974 and 1986 by means of a pre-peritoneal prosthesis. Posterior herniorrhaphy with reconstruction of the internal inguinal ring was associated with this procedure from 1981 onwards. 75% of the patients were reviewed with a mean follow-up of 58 months. Analysis of the results demonstrated a significant correlation between recurrences and the use of a single midline prosthesis for bilateral hernias and parietalisation of the spermatic cord and between septic complications and the use of a silicone-coated velvet prothesis, which subsequently had to be abandoned. Age, sex, obesity, type of hernia and a history of herniorrhaphy did not have any influence on the results. In group of 150 hernias treated with a single, lateralised Rhodergon prosthesis with a transprosthetic cord and reconstruction of the internal inguinal ring, the recurrence rate was 1.3% (2 cases) and the deep infection rate was 0.6% (1 case). Apart from early recurrences due to technical errors, the long-term efficacy of this technique appears to be permanent.
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PMID:[Pre-peritoneal inguinal hernioplasty using Rhodergon's prosthesis. Study of a series of 282 hernia operations]. 185 18

A functioning peritoneal access is crucial to the success of peritoneal dialysis. We report retrospective analysis of our experience using 44 Tenckhoff and 23 column disc, double-cuff, catheters in 46 patients receiving peritoneal dialysis. Postoperative care was identical in both groups. Both catheter groups were comparable with regards to age, sex, obesity and prior abdominal surgery. Catheter removal due to drainage failure was significantly greater with the column disc than the Tenckhoff catheters (22% vs 5%, p = 0.04). In addition, 39% of column disc catheters compared to 11% Tenckhoff catheters were removed as a result of therapy resistant peritonitis (p = 0.011). Furthermore, there was a greater incidence of peritonitis with the column disc than with the Tenckhoff catheters at the end of the first year (71% vs 42%, p less than 0.01). There was no difference between the two groups with respect to other complications, such as pericatheter leak, catheter infections, catheter cuff-extrusion or hernia. Our experience indicates that the column disc catheter is associated with higher complication rates and does not offer any advantage over the Tenckhoff catheter.
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PMID:Peritoneal catheters: a comparative study of column disc and Tenckhoff catheters. 236 82

In a prospectively randomized trial polyglycolic acid (PGA) was tested against polyester for recurrence rate in Bassini hernia repair. After a median observation period of 2 years a distinct but statistically insignificant difference was found (12.0% recurrence for PGA against 7.0% for polyester). Within prospectively defined risk groups statistically significant differences were found for men (15.4% PGA, 6.4% polyester) and in the presence of at least one of the risk factors obesity, bronchitis, recurrent hernia, size of hernial sac greater than 8 cm, the last of which being the strongest unfavourable variable for PGA.
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PMID:[Bassini operation with polyglycolic acid or polyester. A prospective randomized study of 300 cases]. 254 81


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