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

Whereas open Lichtenstein inguinal herniorrhaphy is generally accepted as a safe, well-understood method with a high success rate, the laparoscopic repair of a inguinal hernia is a fairly recent technique. Although the laparoscopic approach to a hernia repair procedure is associated with less pain and faster recovery than open repair, many surgeons are not familiar with this technique owing to technical demands and a long learning curve. This study compares the results and complications between open tension-free mesh (Lichtenstein) repair and laparoscopic total extraperitoneal (TEP) repair. The study cohort was comprised of 345 consecutive patients who underwent an inguinal herniorraphy procedure. An open hernia repair was performed on one group of patients (n = 233), whereas TEP repair was performed on the other (n = 112), and then the comparison of intra- and postoperative complications and results obtained from both techniques was done. The mean hospital stay was similar in both groups. The average operative time in the TEP group was 58.6 +/- 18.1 minutes, and the average operative time in the open group was 58.2 +/- 17.8 minutes. There was no difference in postoperative complication rates between the two groups, except for urinary retention, which patients who underwent TEP repair were more likely to get. The following major complications were recorded: 2 cases of urinary bladder perforation-1 during TEP repair and the other during Lichtenstein repair, but both with good postoperative outcome-and 1 case of pneumothorax, which occurred during the TEP procedure. Despite the fact that TEP is a demanding procedure, it may be performed efficiently with an acceptable operating time and a low complication rate.
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PMID:Laparoscopic totally extraperitoneal hernia repair versus open Lichtenstein hernia repair: results and complications. 1790 68

Despite advances in intensive care, congenital diaphragmatic hernia (CDH) maintains a risk of death >35%. Mortality predictors have been claimed, using logistic regression. When the outcome of interest is rare (i.e. <20%), the odds ratio, measured by logistic regression, is approximately equal to the relative risk, calculated by log-binomial model. However, for common events, the odds ratio misleads the exposition risk. The aims are to identify independent predictors of mortality in high-risk CDH, using the log-binomial model and disclose if the exposition risks could differ applying in comparison the logistic regression. Details of 113 consecutive high-risk CDH neonates, baseline demographics and disease features were collected retrospectively. Log-binomial model and logistic regression were applied and compared. Overall mortality rate was 41.6% (47/113). The log-binomial model identified preoperative pneumothorax (pnx), birth weight < or = 2,500 g and liver herniation as independent mortality predictors; female gender, an advanced gestational age and a PaO(2) > or = 90 mmHg as protective factors. Using logistic regression, liver herniation and birth weight did not maintain the significance. The exposition risks for pnx, female gender and gestational age were overestimated. The odds ratio measured by logistic regression overestimated the exposition risks. Since the mortality rate is confirmed to be >20% and the exposition risks, measured by logistic regression, are misleading, the log-binomial model should be consider in CDH binary outcome studies. According to the mortality predictors identified, making every effort to plan delivery at term and lowering the risk of pnx could improve the outcome.
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PMID:Predictors and statistical models in congenital diaphragmatic hernia. 1827 5

Ribs are one of the most widely used grafts in craniofacial surgery. Harvesting a costochondral graft is easy and safe. The main complications are related to pneumothorax and chest-wall deformity in children. A complication is described in a patient who underwent an orbito-zygomatic reconstruction with two contiguous ribs and a latissimus dorsi free flap, and who subsequently developed a transthoracic hernia that required reconstruction with polypropylene mesh.
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PMID:Transthoracic hernia after harvesting a costal and latissimus dorsi flap. 1833 20

Nowadays, colonoscopy has become an invaluable tool in the diagnosis and treatment of diseases of the colon and rectum. Colonoscopy is still an invasive exam with several complications. The most common complications are perforation and bleeding, which occur in up to 1% after diagnostic colonoscopy and 3% of patients undergoing therapeutic colonoscopy. Less common complications include pneumothorax, pneumomediastinum, colonic volvulus, hernia incarceration, retroperitoneal abscess and mesenteric tear. Splenic rupture is a rare and potentially lethal colonoscopic complication with less than 45 cases reported in the world. The overall incidence is 0.004%. Mechanisms of injury and available treatment options remain discussed. We present a case of splenic rupture after colonoscopy with polypectomy in a 73-year-old woman managed first with nonoperative treatment and nine days later with surgical treatment. As the indications for colonoscopy expand, including the introduction of mass screening for colorectal cancer, endoscopists should be increasingly aware of that life-threatening complication after colonoscopy and know the emergency treatment.
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PMID:[Splenic trauma: an unusual complication of colonoscopy with polypectomy]. 1838 25

A 34-year old woman was admitted with pain in the upper right abdomen. The tentative diagnosis was gall stones, but none of the paraclinical results supported this diagnosis. A chest x-ray showed a completely white right lung. A later computertomography showed a colon-loop in the thorax and haemo-/pneumothorax. The patient's condition deteriorated, a life-threatening state of sepsis developed and she was transferred to a surgery facility where an incarcerated congenital diaphragmatic hernia was established. After surgery she was discharged with a temporary ostomy, but otherwise feeling well.
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PMID:[Diaphragmatic hernia--admitted under the gallstone diagnosis]. 1912 62

A female newborn was delivered by Caesarean section in 36/37 week of pregnancy, due to prenatally diagnosed congenital diaphragmatic hernia. She was admitted to the intensive care unit in the first minutes of life. It was the first uneventful pregnancy of a 25 year old woman. The newborn's Apgar score was 0, at both 1(st) and 5(th) minute of life. She was immediately intubated, given adrenaline and 4.2% NaHCO(3). High frequency oscillatory ventilation, with high ventilation parameters was initiated. Right-sided pneumothorax was found by auscultation and pleural drainage was installed. On X-ray a left-sided congenital diaphragmatic hernia was noted with presence of the stomach, spleen, small intestine and left lobe of the liver in the thorax. Because of deteriorating clinical condition fluid resuscitation and continuous noradrenaline infusion were used. Despite implemented treatment, severe bradycardia and hypotension developed. Patient died 1.5 hours after birth. On autopsy left-sided diaphragmatic hernia, bilateral pneumothorax, pneumoperitoneum, severe lung hypoplasia and transposition of the great arteries were found. Prenatal diagnosis of cardiac defects by routine ultrasonography may be difficult in a neonate with diaphragmatic hernia, due to altered anatomical conditions. Postnatal echocardiographic examination of the heart is suggested in such infants to exclude the presence of cardiovascular anomalies.
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PMID:[Transposition of great arteries in a newborn with congenital diaphragmatic hernia - case report]. 1930 30

The Marfan syndrome is an inherited disorder of the connective tissue which is mainly caused by a mutation in the fibrillin-1 gene. The defect in the connective tissue protein can lead to several organ dysfunctions. For the life expectancy, the cardiovascular aspect is of paramount importance. Patients with Marfan syndrome may develop aortic aneurysms and valvular heart defects. The risk of aortic aneurysms consists in the development of aortic dissection or rupture with their fatal consequences. Besides the cardiovascular manifestation, the skeletal and ocular system can also be affected. The skeletal manifestation is often characterised by long limbs, arachnodactyly, and abnormal joint flexibility along with other signs. Patients may also have dislocated lenses, ectasia of the dural sac, stretch marks, spontaneous pneumothorax, recurrent hernia, or a family history suspicious for Marfan. During the past years, other related connective tissue disorders with analogous organ manifestation have been described (e.g., Loeys-Dietz syndrome). In this article we present the basic knowledge about these connective tissue disorders, and we mention new insights in the recently explored pathophysiology of the disorder which is a possible target for future medical treatment options. Furthermore, recent new concepts for the prophylactic treatment of the aortic manifestation are explained.
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PMID:[The Marfan syndrome and related connective tissue disorders]. 1955 31

We examined the effect of overnight birth on treatment and outcome (including initial cardiorespiratory stabilization) in newborns with congenital diaphragmatic hernia (CDH). CDH births between May 2005 and May 2008 were abstracted from a national CDH database. Overnight birth was defined as occurring between 8 PM and 8 AM. Patient characteristics, treatment, and outcomes were compared between birth time groups, including the subset of infants in whom a prenatal diagnosis of CDH had been made. Of 132 cases evaluated, 106 (80%) survived. Forty-nine babies (37%) were born overnight. Eighty-five infants (64%) with a prenatal diagnosis were evenly distributed between the birth time cohorts. Survival to discharge, surgical management, duration of mechanical ventilation, and length of hospital stay were comparable between the risk-matched (SNAP-II score) birth time groups. Overnight birth did predict a lower rate of cesarean section deliveries (P = 0.03). Escalation of ventilator mode, inability to achieve/maintain blood gas targets, development of pneumothorax, and need for extracorporeal membrane oxygenation were all considered "stabilization failures." Overnight birth predicted a failure to maintain or improve pH to within target range (P = 0.008). Overnight birth did not adversely affect outcome in this birth time comparison of newborns with CDH.
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PMID:Does overnight birth influence treatment or outcome in congenital diaphragmatic hernia? 1982 62

A traumatic diaphragmatic hernia is a well-known complication following blunt abdominal or penetrating thoracic trauma. Although the majority of cases are diagnosed immediately, some patients may present later with a diaphragmatic hernia. It occurs in approximately 3% of abdominal traumas. Diagnosis requires a high index of suspicion since diaphragmatic injury can only reliably be ruled out by direct visualization, i.e., laparoscopy. Hence, delayed presentation with complications secondary to the injury is not uncommon. We discuss a case of a young man who presented in respiratory distress 5 years after a stab wound to the left chest. The patient was hypoxic, with a chest X-ray (CXR) demonstrating a pneumothorax with effusion. A chest tube was placed with a rush of air and feculent drainage. CT scan revealed an incarcerated transverse colon in a diaphragmatic hernia. The laparotomy demonstrated necrotic colon in the chest with gross fecal contamination in the chest. The diaphragmatic defect was closed and a Hartmann's procedure performed. The patient developed empyema in the postoperative period. Our patient is the twelfth reported case of a tension fecopneumothorax resulting from traumatic diaphragmatic herniation. This paper reviews all cases, including the diagnostic workup, operative approach, and expected postoperative course of this unusual condition.
Hernia 2011 Feb
PMID:Traumatic diaphragmatic hernia presenting as a tension fecopneumothorax. 2005 98

Single Incision Laparoscopic Surgery (SILS) has recently been used by general surgeons to perform cholecystectomies and pre-peritoneal hernia repairs with mesh using minimally invasive surgery, thus decreasing post-operative pain and a more cosmetic result of the surgery being obtained. We describe the first cases of video-assisted thoracic surgery (VATS) in spontaneous pneumothorax using the SILS system. There are no previous reports on the use of the SILS system in VATS for spontaneous pneumothorax. This system also allows us to obtain a more cosmetic surgical result, as well as decreasing the mean post-operative hospital stay and the need for analgesics to improve the post-operative pain.
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PMID:[Single port thorascopic surgery using the SILS tool as a novel method in the surgical treatment of pneumothorax]. 2009 28


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