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

In a 42 year old woman a left coronary artery to pulmonary artery fistula was proved by catheterization and coronary angiography. During this investigations a right femoral hernia became symptomatic, and surgical correction was carried out. Three days postoperatively a massive pulmonary embolism occurred causing shock and fibrillation of the heart. After intubation the patient was brought to the operating theatre under external massage, and a pulmonary embolectomy using ECC was performed. The fistula in the main pulmonary artery was closed by suture. The vascular convolute was left in place. A primarily additional ligature of the fistula artery at the starting point was reopened because of a failing right ventricle under the assumption of a possible partial vascular supply of the right ventricular myocardium which could not be proved.
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PMID:[Correction of left coronary artery to pulmonary artery fistula on the occasion of pulmonary embolectomy (author's transl)]. 75 Dec 84

The present paper describes constriction of the femoral vein following hernioplasty ad modum McVay. In five cases, constriction of the femoral vein was demonstrated by phelbography, and pulmonary embolism by pulmonary scintigraphy. It is suggested that a number of postoperative thromboembolisms following hernia repair are caused by a unobserved constriction of the femoral vein. Moreover, constriction of the femoral vein following hernia repair occurs in a number of cases without thromboembolism.
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PMID:Constriction of the femoral vein following inguinal hernia repair. 115 80

450 successive celioscopic cholecystectomies (May, 1990-April, 1992) are reported for 312 cases of uncomplicated gallstone (69%) operated electively and 138 cases operated in emergency, including 120 cases of acute cholecystitis, 17 cases of biliary pancreatitis and 1 case of angiocholitis. Immediate conversion into laparotomy was required in 10 cases (2.2%) either for technical reasons (1.1%) or because of lithiasis of the common bile duct (1.1%). The stay in hospital lasted an average of 2.2% days for elective admission and 3.3 days for emergent admission. The average operating time was 65 minutes (75 minutes until May, 1991, and 55 minutes between May, 1991 and April, 1992). Preoperative retrograde cholangiography was performed in 67 cases and intraoperative cholangiography in 16 cases. Second surgery was required for suture in one case because of cholerrhagia in a secondary duct of the gallbladder bed. This cholerrhagia would not have been amenable to simple aspiration. One patient (0.2%) died of myocardial infarction at D + 10. Complications include 4 cases of pulmonary embolism, 3 cases of cystic biliary fistula without second surgery and 4 cases of umbilical hernia. A more peculiar case is that of a patient admitted 5 months after surgery for gangrenous acute cholecystitis. This patient was admitted for fever and epigrastric pain. He had a very low-flow duodenocutaneous fistula of uncertain origin. This patient was not operated again. This may not be a complication connected to celioscopic surgery. Celioscopic cholecystectomy is superseding conventional cholecystectomy. Surgeons' efforts should strive at eliminating operative errors, reducing postoperative morbidity, improving techniques and instruments, teaching celioscopic surgery and extending its indications to other intraabdominal operations.
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PMID:[Laparoscopic cholecystectomy. Apropos of 450 cases]. 134 88

A total of 74 patients, additionally treated with a pedicled omentoplasty, were studied retrospectively with regard to the complications. The pedicled omentoplasty was used extra- or intra-abdominally to reconstruct large soft-tissue defects, to treat radiation necrosis or to prevent radiation enteritis. Gastro-intestinal complaints were seen in six patients, three developed an ileus and needed a relaparotomy, one patient had herniation of the stomach through a diaphragm defect. Total necrosis of the omental flap was seen in two patients and infection in seven patients with an extra-abdominally used omentoplasty. An abscess in the pelvic cavity occurred five times in an intra-abdominally placed omentoplasty. In seven patients, an operative correction of an incisional hernia was necessary. One patient died of massive pulmonary embolism. This study indicates that the pedicled omentoplasty is a safe procedure and is associated with a moderate number of postoperative complications, which can be reduced if the right surgical technique is used.
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PMID:Complications of the pedicled omentoplasty. 178 2

Of 1202 hernia repairs performed according to the modified Lotheissen-McVay technique 1020 (84.9%) were followed up. The frequency of hernia increases with increasing age. The total recurrence rate after an average follow-up of 9 years was 9.2% for primary hernias and 11.5% for recurrences. The recurrence rate depends on the follow-up time and on sex. For primary hernias the recurrence rate was 0.7% after 1 year, 5% after 5 years, 9.1% after 10 years and 11.5% after 15 years. After 1 year the recurrence rate was 0.6% for women and 0.8% for men; after 5 years the corresponding figures were 3.9% and 5.2% and after 10 years, 6.6% and 9.5%. The results after repair of recurrent hernias are not much worse than those obtained in the case of primary hernias. The recurrence rate depends on the surgeon's experience. We found a recurrence rate of 3.6% in 319 operations performed by our most experienced surgeon, as against 16.3% among those performed by inexperienced surgeons. Therefore, careful assistance is paramount for the inexperienced surgeon, because training is indispensable. The most frequent complications of primary operations were hematoma and seroma (4.4%), wound infections (1.7%), pulmonary embolism (0.9%), deep vein thrombosis (0.7%) and testicular atrophy (0.4%). The traditional Lotheissen-McVay technique for hernia repair still has a place in the surgical treatment of hernia. This technique can be used as the standard treatment for all kinds of inguinal or femoral hernias, without higher complication rates, and it yields especially good results in recurrent hernias.
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PMID:[Lotheissen-McVay repair of hernia. Late follow-up analysis after 1202 operations for inguinal and femoral hernias]. 228 Jun 50

Hernial strangulation of Meckel's diverticulum (Littre's hernia) is a rare anatomoclinical form. It represents 10% of all complications of Meckel's diverticulum (8.8% of our cases), and complications like hemorrhage, perforation and diverticulitis are fairly frequent. Four cases of Littre's hernia are presented: two males and two females, with an average age of 67 years (range 50-83 years), representing 0.08% of all the inguinal-crural hernias operated in the department. The clinical manifestations were those of intestinal obstruction because a mixed type Littre's hernia was involved, with compromise of the diverticulum and its intestinal loop. Preoperative diagnosis is unlikely in strangulation without disturbances in the intestinal transit and, in fact, is even less likely if it is accompanied by obstruction. The diagnosis is thus almost always intraoperative. The correct treatment is surgery after restoring the patient's hemodynamic equilibrium. Simple and/or loop diverticulectomy via herniotomy, herniolaparotomy or laparotomy are debated. We think that this disorder can generally be resolved using the inguinal approach, as in any strangled hernia, with the technical option of using a larger, more comfortable and safer approach in cases of important obesity and/or deterioration of the loop (necrosis, perforation). In elderly patients with uncomplicated Littre's hernia and Meckel's diverticulum, abstention from diverticular exeresis may be justifiable. Of the four patients, the first two died from cardiogenic shock and pulmonary embolism, respectively; the last two evolved well (except for a wound abscess).
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PMID:[Hernial strangulation of Meckel's diverticulum: Littre's hernia. Apropos of 4 cases]. 261 52

The Angelchik prosthesis was used in 26 cases of gastroesophageal reflux disease resistant to medical therapy. The operations were crowned with success in 24 cases out of 26 (92.3%), with complete disappearance of reflux. The procedure failed in two cases: the prosthesis was removed in one case due to postoperative acute haemorrhagic gastritis with a subsequent positive outcome; in this patient the Angelchik ring had been removed as a precaution. Failure in the second case, a patient with oesophageal stenosis and a short oesophagus, was due to mediastinal migration of the prosthesis. In this latter case, a successful duodenal bypass was created with antrectomy and a long Roux-en-Y anastomosis. The only intraoperative complication in the patient sample was a splenectomy for rupture of the splenic capsule. Postoperative complications not directly related to the prosthesis were perforation of a duodenal ulcer not diagnosed preoperatively and treated with raphia without impairing the functional efficacy of the ring, one case of pulmonary embolism and one case of cardiac infarction, all resolved with medical therapy. In all, the prostheses were removed in 3 cases out of 26 (11.5%). In addition to the two cases already described, the prosthesis was removed in one patient one year after the operation at the patient's specific request for "psychological" reasons. Migration of the prosthesis occurred in four cases of severe oesophageal stenosis with a short oesophagus, in three of which the prosthesis functioned perfectly even in the intrathoracic site. At follow-up examinations there was radiological disappearance of the hiatal hernia in 20 cases out of 25. In one case there was no hernia even before the operation, and in four cases there was a short oesophagus with severe oesophagitis. Owing to the very easy performance of the operation together with its unquestionable antireflux efficacy, in our opinion three reliable indications emerge, namely: (i) in elderly patients at high surgical risk; (ii) in obese, brachytypical patients; and (iii) in the presence of severe oesophagitis, even with a short oesophagus.
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PMID:[Our experience on the use of the antireflux prosthesis by the Angelchik method (personal contribution of 26 cases)]. 263 19

There are differing opinions regarding the cause of inguinal hernias in adults. It seems that a patent vaginal process may determine the type of herniation that occurs in an adult but may not actually cause the hernia. Also, altered collagen metabolism seems to play a significant role in many cases of hernias in adults. Thus, most of these hernias are actually caused by a mixture of congenital and acquired factors. Consequently, it follows that there are a variety of opinions regarding surgical repair. This follow-up study on recurrence after inguinal hernia repair in Saudi Arabia was aimed at testing the effectiveness of Bassini's repair and the results achieved when it is employed for primary inguinal hernia repair in adults. One hundred forty patients (95 with indirect and 45 with direct hernias) who had Bassini's repair were studied. Only pure direct or indirect hernias were included. Combined direct, indirect bilateral, recurrent, or femoral hernias were not investigated. All the patients were followed for 2 years after repair, with a total recurrence rate of 2.14 percent. The projected recurrence rate at 25 years is 5.3 percent. These results are comparable to those achieved with other techniques. Therefore, I believe that the criticisms of Bassini's repair are based on theoretic grounds only. Bassini's repair has stood the test of time, is easier to teach and to perform by junior surgeons, and the chance of being complicated by thrombophlebitis and pulmonary embolism is less than the chance with Cooper's ligament repair.
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PMID:Inguinal hernia in Saudi Arabia. A 10 year experience. 399 55

Single photon emission computed tomography (SPECT) of the lung was performed, in addition to conventional camera scintigraphy, in 41 patients with pulmonary disorders as well as with regular pulmonary perfusion. For SPECT investigation a rotating gamma camera (Gammatome) was used consisting of a system with a high-resolution parallel-hole collimator interfaced with a digital computer. In 6 of 41 patients the diagnostic accuracy of pulmonary scintigraphy was improved by SPECT. Topographic identification of segmental perfusion defects in pulmonary embolism seems to be particularly promising. Special abnormalities that cannot be assessed by conventional lung imaging are mediastinal hernia and recessus retrotrachealis as a normal variant. For a detailed evaluation of this method a large number of patients must be investigated.
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PMID:Single photon emission computed tomography of the lung: preliminary results. 697 15

Fourteen women with severe obesity resistant to previous dietetic measures underwent intestinal bypass using Scott's method. Weight loss ranged from 1-2 kg to 50 kg (mean = 25 kg) but weas unpredictable and varied from patient to patient; most remained obese. The other results of the operation were similar to those already reported. There was a decrease in total plasma cholesterol, while HDL cholesterol remained normal. Calcaemia was in the lower range of normal values; one patient developed severe hypokaliaemia (1.8 mEq); low blood magnesium levels and steatorrhoea were common. Fibrosis of the liver was observed in one patient and probably in another. Five patients were re-operated upon for incisional hernia or intestinal occlusion. Other complications reported in the literature (pulmonary embolism, arthralgias, kidney stones and gall stones) did not occur in this series. Because of these complications we decided to stop using intestinal bypass for the treatment of severe obesity. However, in view of the potential dangers of severe obesity we feel that other surgical techniques, such as Mason's gastric bypass, should be considered in some patients.
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PMID:[Intestinal bypass in the treatment of obesity. Results of 14 cases (author's transl)]. 706 89


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