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

A 44-year-old female was initially evaluated for a 3-cm umbilical hernia, which developed after a laparoscopic myomectomy performed seven years prior. The umbilical hernia was repaired using a synthetic mesh. Eight months after the umbilical hernia repair, the patient returned with chronic pain in a 3-cm raised mass originating from the umbilical hernia repair incision. The mass and mesh were surgically removed. The umbilical fascial defect was repaired with a primary fascia-to-fascia closure and the umbilicus was reconstructed from adjacent skin. The mass was found histologically to be endometriosis and fascial scarring with a foreign body reaction to synthetic mesh. Umbilical endometriosis developed either from peritoneal endometrial seeding from a laparoscopic myomectomy or from metaplasia of multipotential cells, which developed into endometriosis due to inflammatory stimulation by the synthetic mesh. Synthetic mesh probably should be avoided in the surgical repair of a laparoscopically caused umbilical hernia in a premenopausal female especially if there is a history of pelvic endometriosis.
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PMID:Scar endometriosis developing after an umbilical hernia repair with mesh. 1518 34

There are about 200,000 hernia repairs per year in Germany and about 770,000 in the U.S. In the United States most hernia repairs (80-90%) are performed as day surgery procedure; 90% of operations are open herniorrhaphies with mesh. Quality control includes the registration of complications, recurrence, and quality of life. In a prospective study 50 consecutive patients with inguinal hernia eligible for open mesh repair (modified Lichtenstein hernia repair), mostly Nyhus III and IV classification, were operated using light-weight Ultrapro-mesh (monocryl-prolene-composite, Ethicon Products), and interviewed 10 days after the operation according to a modified SF-36 questionnaire. Patients were examined three months later. There were 29 direct hernias, 21 combined (direct and indirect) hernias, 8 indirect hernias; 8 patients had hernias on both sides. 8 patients (16%) presented with recurrent hernias, mostly suture or laparoscopic repairs before. There were no intra-operative complications. 2 patients suffered from a moderate haematoma, which did not necessitate a surgical repair, after accidental intake of aspirin preoperatively in one case and after preoperative low-molecular-weight heparin prophylaxis. There were no other complications. All 50 patients (100%) had returned the questionnaire. 38 patients (78%) reported no or mild pain; only one patient (2%) suffered from severe pain, none had very severe pain. 32 patients (64%) applied no pain medication or only for 48 hours; only one patient (2%) used pain medication for more than 14 days. 34 patients (68%) admitted that their health status improved after the operation; 11 patients (22%) with good or very good health status indicated no change in health. Follow-up examination of the patients three months after the operation did not detect any recurrence. 49 patients (98%) were free of pain or restriction; one patient (2%) continued to have chronic pain which developed after two laparoscopic herniotomies performed at a different clinic before. There was no sign of mesh-related complication. The Ultrapro-mesh has been well accepted by the patients. In conclusion, open mesh repair according to Lichtenstein is safely done in specialised ambulatory day surgery clinics. Most patients benefit from this form of treatment according to a quality of life audit. The new light-weight mesh Ultrapro contributes to the improvement of hernia repair. There is evidence that ambulatory open mesh repair should be the method of choice for primary inguinal hernia. If in Germany an equal proportion of hernia repair as in the United States would be done as ambulatory procedure (80-90%), there would be an annual cost saving of several hundred million Euro.
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PMID:First results of Lichtenstein hernia repair with Ultrapro-mesh as cost saving procedure--quality control combined with a modified quality of life questionnaire (SF-36) in a series of ambulatory operated patients. 1525 75

Recurrent incisional hernia remains a major problem for the general surgeon. The high recurrence rate of incisional hernias after primary closure by tissue approximation led to the development of tension-free procedures using prosthetic materials. The goal of this study is to present the results of an extraperitoneal tension-free technique using a polyester mesh (Mersilene). A total of 43 patients with incisional hernias were surgically treated during a 9-year period in our department. Twenty-four patients (56%) had recurrent incisional hernias, 21 had primary repair by tissue approximation, and 3 had prolene mesh tension-free repair with wound infection. Patients' mean age was 68.2 years, and the mean postoperative follow-up was 54.4 months. Immediate postoperative complications were noticed in 9 patients (21%) subcutaneous seroma in 6 (14%) and wound infection in 3 (7%). Recurrence was noticed in 4 patients (9%) during the first 9 postoperative months. Late minor complications such as restriction of abdominal wall motility and chronic pain was noticed in 3 (7%) patients. In conclusion, the extraperitoneal onlay tension-free incisional hernia repair using polyester mesh is an easy and safe procedure with no major morbidity or recurrence rate.
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PMID:Incisional hernioplasty with extraperitoneal onlay polyester mesh. 1532 9

Incisional hernia is a frequent complication of abdominal wall closure with a reported incidence of between 5% and 15% following vertical midline incisions at one-year follow-up. Evidence from randomised clinical trials and meta-analysis indicate that a continuous running non-absorbable or slowly absorbed suture such as polydioxanone is the method of choice for abdominal wall closure. Continuous polydioxanone has a similar incisional hernia rate to its non-absorbable counterparts but causes less chronic pain and wound sinuses. Evidence from randomised clinical trials indicates that a lateral paramedian incision is associated with a lower incidence of incisional hernia when compared with other abdominal incisions. Transverse abdominal incisions have no advantage over midline incisions in reducing incisional hernia rate. Although experimental and clinical evidence indicate that a greater number of stitches with a suture length to wound ratio of at least 4:1 is associated with a lower incidence of incisional hernia, there is no evidence from randomised clinical trials to support this. Intuitively one may think that putting as little tension as possible on the closure is important, but there is no evidence for this. Clinical trials evaluating these factors would be difficult to undertake making it important that surgeons continue to audit incisional hernia rates following abdominal closure.
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PMID:Factors involved in abdominal wall closure and subsequent incisional hernia. 1556 20

In a prospective study, 115 patients with a mean age of 55 years, presenting a primary or recurrent hernia were treated with a beta glucan-coated polypropylene mesh (Glucamesh). Fifty-eight underwent a Lichtenstein procedure and 57 had a laparoscopic procedure (TEP/TAPP). Oat beta glucan is an entirely natural plant product that eliminates the risk of viral or prion contamination associated with the use of collagen of animal origin. The beta glucan coated mesh is of lower weight and profile compared to a typical polypropylene implant. Preliminary results have been previously reported. With a mean follow up of 2 years, patients were evaluated by a physician and or a standardized questionnaire in order to evaluate the incidence rate of recurrence discomfort and residual chronic pain. One hundred nine (94.7%) questionnaires were returned. Of these, 104 (90.4%) were complete and analyzed. Mean follow up was 24 months (21-27). Two years after operation the recurrence rate was 1.9% (two cases: one in each group); 98 patients (94.2%) had no pain and have returned to normal activity, work and sport. Five patients (4.8%) had mild pain on moving or at rest and one (0.96%) had moderate pain at rest. There was no correlation between pain and hernia type or surgical technique. At 2 years follow up hernia repair with beta-glucan coated mesh has a low recurrence rate. Incidence of chronic pain is low. The situation is in relationship with a lightweight and smooth mesh of polypropylene and the role of oat beta glucan optimizing the healing and inclusion of the mesh into the tissues.
Hernia 2005 May
PMID:Inguinal hernia repair with beta glucan-coated mesh: results at two-year follow up. 1560 25

Persistent pain after hernia repair is common, although it is usually mild. In 3% of patients it is severe, however, and has significant effects on work and social activities. The purpose of this review was to examine factors that affect pain after hernia repair. Although the type of anaesthetic used, local or general, and the operation type, open or laparoscopic, seems to affect acute pain, chronic persistent pain is influenced by the age of the patient and whether the hernia was painful preoperatively. Preliminary evidence indicating that use of a lightweight mesh may reduce chronic pain requires further research before definitive conclusions can be drawn.
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PMID:Groin hernia repair: postherniorrhaphy pain. 1598 Oct 40

To investigate the clinical safety and effectiveness of acellular extracellular matrix (AEM) for inguinal hernia repair, 53 well-conducted and well-chosen sequential cases with inguinal hernia (56 inguinal hernias) were included in our multi-center study. All the inguinal hernias were repaired using conventional tension-free surgical procedures after being classified with Gilbert methods. No rejection was observed after operation. All the incisions healed well and no recurrence was found at the sixth month follow-up. At the seventh month after operation, one case of recurrence of right-side bilateral inguinal hernia (type IV) and another case of recurrence of left-side inguinal hernia (type V) were found. No other recurrence was observed at the 18th month follow-up. The AEM material has good histocompatibility and biomechanics characters and can be used for inguinal hernia repair. We observed no infection, chronic pain, funiculotesticular reaction, local nodular or feeling of discomfort after operation. But a further study of the usage of AEM in the repair of type IV and V inguinal hernias is still needed.
Hernia 2006 Jun
PMID:Acellular extracellular matrix for inguinal hernia repair. 1644 Jan 29

To determine the incidence of pain related sexual dysfunction 1 year after inguinal herniorrhaphy and to assess the impact pain has on sexual function. In contrast to the well-described about 10% risk of chronic wound related pain after inguinal herniorrhaphy, chronic genital pain, dysejaculation, and sexual dysfunction have only been described sporadically. The aim was therefore to describe these symptoms in a questionnaire study. A nationwide detailed questionnaire study in September 2004 of pain related sexual dysfunction in all men aged 18-40 years undergoing inguinal herniorrhaphy between October 2002 and June 2003 (n=1015) based upon the nationwide Danish Hernia Database collaboration. The response rate was 68.4%. Combined frequent and moderate or severe pain from the previous hernia site during activity was reported by 187 patients (18.4%). Pain during sexual activity was reported by 224 patients (22.1%), of which 68 (6.7%) had moderate or severe pain occurring every third time or more. Genital or ejaculatory pain was found in 125 patients (12.3%), and 28 (2.8%) patients reported that the pain impaired their sexual activity to a moderate or severe degree. Pain during sexual activity and subsequent sexual dysfunction represent a clinically significant problem in about 3% of younger male patients with a previous inguinal herniorrhaphy. Intraoperative nerve damage and disposition to other chronic pain conditions are among the most likely pathogenic factors.
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PMID:Pain related sexual dysfunction after inguinal herniorrhaphy. 1654 10

Obturator hernia is a rare variety of pelvic hernia. Preoperative diagnosis is still uncommon and influences treatment and prognosis. Clinical suspicion and tomography are fundamental for establishing a preoperative diagnosis. Subsequently, elective treatment via the total extraperitoneal laparoscopic approach seems to offer the best results for both the patient and the hospital. This management might reduce the high rates of associated morbidity and mortality. We present the case of a patient with chronic pelvic pain after hernia surgery in whom tomography confirmed the existence of a bilateral obturator hernia. Details are given of diagnostic and therapeutic management using ambulatory total extraperitoneal laparoscopy. We recommend ruling out obturator hernia as a possible cause of chronic pain after hernia repair.
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PMID:Obturator hernia as a cause of chronic pain after inguinal hernioplasty: elective management using tomography and ambulatory total extraperitoneal laparoscopy. 1655 84

The dynamic self-regulating prosthesis (protesi autoregolantesi dinamica, PAD) is a double-layered prosthesi, in use since 1992 in inguinal hernia repair. In 1999, we published the short-term results on 500 patients and herein we report the long-term follow-up. Five hundred eighty-five PAD procedures were performed on 500 adult male, unselected patients. Hernias were unilateral in 415 patients, were bilateral in 85 patients, were direct in 197 patients (33.7%), were indirect in 269 patients (46.0%), and were combined in 119 patients (20.3%). Four hundred sixty-four patients were alive at the follow-up period of minimum 5 years, whereas 36 died (7.2%) of causes unrelated to the hernia. No information was available on 73 patients (14.6%). Therefore, the follow-up was consisted of 391 patients (78.2%) with 469 hernias. The recurrence and testicular atrophy rates were nil. Three patients (0.77%) presented chronic pain and 18 (4.6%) suffered persistent discomfort or paresthesia. A hydrocoele was observed in one patient (0.2%). The long-term data confirm the efficacy of the dynamic self-regulating posthesis hernioplasty. We propose it as a standard of care in all cases of primary inguinal hernia in adult males, retaining it as a definitive and comfortable solution.
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PMID:Dynamic self-regulating prosthesis (protesi autoregolantesi dinamica): the long-term results in the treatment of primary inguinal hernias. 1655 27


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