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

Spigelian hernia is a rare clinical entity. It has a subtle clinical presentation with vague abdominal pain that may warrant laparoscopy. Even though laparoscopic ventral hernia repair is increasingly popular, laparoscopic repair of spigelian hernia has not been adequately studied. Eight patients who underwent laparoscopic spigelian hernia repair are presented herein, along with a description of our simple technique for mesh placement. In addition, literature review of laparoscopic repair of spigelian hernia is also presented. Our case series included six females and two males; two patients presented acutely whereas the others presented with chronic pain. Laparoscopic repair was successfully performed in all of our patients with a mean operative time of 92.5 minutes. There were no postoperative complications or recurrence with a mean follow up of 36 months. Our scroll technique for laparoscopic repair is simple and feasible. It minimizes intracorporeal mesh manipulation, facilitates mesh fixation to the anterior abdominal wall, and maintains a precise orientation of the mesh in relation to the defect.
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PMID:Laparoscopic spigelian hernia repair: the scroll technique. 1830 58

Laparoscopic cholecystectomy reduces postoperative pain, hospital stay and recovery in comparison with the open procedure. This approach allows to treat most of vesicular pathologies, as acute cholecystitis and choledocal lithiasis, with excellent results. Biliary tract injuries represent however the most feared complication. Concerning groin hernia pathology, two different laparoscopic approaches are described, as the trans-abdominal pre-peritoneal approach (TAPP) and the total extra-peritoneal approach (TEP). The first technique is easier to perform, but associated with more frequent significant intraabdominal morbidity. Results are comparable to the classic open Lichtenstein technique in term of reccurence. Laparoscopic approach could be associated with a lower chronic pain rate, but further studies should confirm this statement.
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PMID:[Cholecystectomy and inguinal repair: frequent laparoscopic interventions]. 1867 44

Chronic groin pain is the most frequent long-term complication after inguinal hernia repair affecting up to 34 per cent of patients. Traditional surgical management includes groin exploration, mesh removal, and neurectomy. We evaluate outcomes of a combined laparoscopic and open approach to chronic pain after inguinal herniorrhaphy. All patients undergoing surgical exploration for chronic pain after inguinal herniorrhaphy were analyzed. In most, the operation consisted of mesh removal (open or laparoscopic), neurectomy, and placement of mesh in the opposite location of the first mesh (laparoscopic if the first was open and vice-versa). Main outcome measures included pain status, numbness, and hernia recurrence. Twenty-one patients (16 male and 5 female) with a mean age of 41 years (22-51 years) underwent surgical treatment for unilateral (n = 18) or bilateral (n = 3) groin pain. Percutaneous nerve block was unsuccessful in all patients. Four had previous surgery for pain. There were no complications. With a minimum of 6 weeks follow-up, 20 of 21 patients reported significant improvement or resolution of symptoms. A combined laparoscopic and open approach for postherniorrhaphy groin pain results in excellent patient satisfaction with minimal morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after hernia repair.
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PMID:Combined open and laparoscopic approach to chronic pain after inguinal hernia repair. 1870 69

Non-absorbable prosthetic materials in hernia surgery can cause relatively rare complications, which include chronic pain, a feeling of stiffness with reduced compliance of the abdominal wall, prosthetic erosion/fistulisation and an increased risk of persistent deep infection. Recently, to avoid these problems, new "biological" prosthetic materials have been developed and proposed for clinical use. These materials are all essentially composed of an extracellular matrix stripped of its cellular components, and differ substantially only in their source (porcine small intestine submucosa, porcine dermis or cadaveric human dermis). Because of the numerous variables involved, it is very difficult to conduct a randomised controlled trial. Therefore, the European Hernia Society (EHS) has decided to start the EHS Registry for Biological Prostheses (ERBP). This is a prospective registry in Europe on the use of collagen meshes in (potentially) contaminated circumstances or clean surgical fields. The registry intends to collect some preoperative data on the patient and indication, intraoperative data and outcome data.
Hernia 2009 Feb
PMID:New "biological" meshes: the need for a register. The EHS Registry for Biological Prostheses: call for participating European surgeons. 1894 32

Persistent post-operative pain is defined as a pain in the location of the surgery that persist for many months or even years beyond the usual course of an acute injury and is different of that suffered preoperatively. Persistent pain can be due to long lasting nociception caused by processes such as information, chronic infection or tumor. The most important causes are neuropathic pain states due to nerve compression, entrapment or other damage. Chronic pain, that is very often resistant to treatment, occurs after failed back surgery. Traumatic nerve injury during surgery results in persistent pain known as a post-surgical neuralgia. The most susceptible nerves are: intercostobrachial nerve, intervertebral nerves, ilio-hypogastric nerve, ilio-inguinal nerve, genito-femoral nerve and femoral and sciatic nerve. It means that after some, also elective, surgeries, e.g. mastectomy, thoracotomy, herniotomy, limb amputations, chelecystomy, hysterectomy and nephrectomy, persistent postoperative pain is more common than after other operations. Persistent pain can occur even in 60% patients after limb amputation, in 30% after breast tumor excicion or mastectomy, in 40% after thoracotomy and in 10-30% after hernia repair, but severe pain (NRS>5) lasting even for many years is observed in 5-10% after limb and breast amputation, thoracotomy and Post-CABG operations and in 2-4% patients after hernia repair. Modern approaches including satisfactory perioperative analgesia, nerve sparing, minimally invasive techniques, and the use of a surgical approach that minimizes tissue trauma are crucial. Following inguinal hernia repair, chronic pain is less common than after laparoscopic and mesh repairs. The prompt diagnosis of acute neuropathic pain after operation is very important and management is based on extrapolation of data from the chronic neuropathic pain setting.
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PMID:[Persistent post-operative pain]. 1914 Apr 88

A review of the history of inguinal hernia repair from the far surgical approach performed by Celso, trought the physiological reconstruction of inguinal canal by Bassini and the introduction of the concept of tensionfree repair, to the newest find in this specialist surgery. Nowadays in addition to the choice of approach (open vs laparoscopic, anterior vs preperitoneal), the plane where placing the mesh (in front of the trasversalis fascia vs preperitoneal space), and the fixation device (suture vs sutureless vs glue), surgeons can select among a wide range of prosthesis. Choosing the proper biomaterial can determine the success of an operation and prevent biomaterial-related complications. Indepth knowledge and understanding of the physical properties of the prosthesis, porosity, and pore size in particular are required. Modern advances in hernia repair are credited with reduced recurrence rate, so surgeons' attention is shifted from preventing recurrence to the new topic of chronic pain after surgery.
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PMID:Inguinal hernia: state of the art. 1918 15

Pain and other types of discomfort are frequent symptoms following the repair of an abdominal hernia. After 1 year, the incidence of light to moderate pain following inguinal hernia repair is as high as 10% and 2% for severe disabling chronic pain. Postoperative chronic pain not only affects the individual patient, but may also have a great impact on relatives and society, and may be a cause of concern for the responsible surgeon. This paper provides an overview of the anatomy, surgical procedures, and disposing factors (age, gender, ethnicity, genotype, previous hernia repair, pain prior to surgery, psychosocial characteristics, and surgical procedures) related to the postoperative pain conditions. Furthermore, the mechanisms for both acute and chronic pain are presented. We focus on inguinal hernia repair, which is the most frequent type of abdominal hernia surgery that leads to chronic pain. Finally, the paper provides an update on the diagnostic and treatment routines for postoperative pain.
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PMID:Pain following the repair of an abdominal hernia. 2003 34

The analysis surgical treatment results in 1187 patients. ageing 30-80 yrs old, in 2000-2009 period, for median postoperative abdominal hernia (MPOAH) is presented. Autoplasty was performed in 43 (3.6%) patients, suffering MPOAH of small and middle size without mm. recti abdomini diastasis. The "sub lay" method constitutes an optimal variant of alloplasty for MPOAH of small and middle size with mm. recti abdomini diastasis and of big size, and for giant MPOAH - the operations according to Ramirez method in our modification together with the net implants application. Intraabdominal hypertension was noted in 2 (0.8%) of 231 patients, suffering giant MPOAH, seroma--in 86 (7.2%), the wound suppuration - in 16 (1.3%). Pulmonary thromboembolism had constituted the cause of death in 2 (0.8%) patients, suffering giant MPOAH. Late results in terms 1-5 yrs were studied up in 520 patients. Chronic pain in the abdominal wall portion was noted by 17 (3.2%) patients and the hernia recurrence--7 (1.3%).
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PMID:[Optimization of surgical treatment of median postoperative abdominal hernias]. 2049 Dec 58

Bacterial biofilms have been implicated in multiple clinical scenarios involving infection of implanted foreign bodies, but have been little studied after hernia repair. We now report a case of revision inguinal herniorrhaphy complicated by chronic pain at the operated site without any external indication of infection. Computed tomographic imaging revealed a contrast-enhancing process in the left groin. Subsequent surgical exploration found an inflammatory focus centered on implanted porcine xenograft material and nonabsorbable monofilament sutures placed at the previous surgery. Confocal microscopic examination of these materials with Live/Dead staining demonstrated abundant viable bacteria in biofilm configuration. The removal of these materials and direct closure of the recurrent hernia defect eliminated the infection and resolved the patient's complaints. These results demonstrate that implanted monofilament suture and xenograft material can provide the substratum for a chronic biofilm infection.
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PMID:Bacterial biofilm on monofilament suture and porcine xenograft after inguinal herniorrhaphy. 2052 25

Tension-free, open-mesh, inguinal herniorrhaphies have gained wide acceptance. Current mesh techniques reinforcing the internal ring do not provide a comfortable lay to the mesh. To address this, we used the internal ring occlusion and floor support (IROFS) technique. A retrospective review was undertaken of all hernias operated on with the IROFS technique from January 2001 to December 2006. Five hundred twenty-five inguinal hernia repairs were done in 477 male patients. Telephone questionnaires looking into their postoperative course and recurrence were recorded. We contacted 275 (58%) patients. Patients' ages ranged from 29 to 81 years (mean, 57 years). The hernia was indirect in 50 per cent (n=146), direct in 35 per cent (n=102), or both in 15 per cent (n=44) of patients. The average operative time was 40 minutes. Acute wound pain lasted for less than 1 week in 55 per cent (n=151) and for 1 to 2 weeks in 24 per cent (n=66). Postoperative analgesic requirement was less than 1 week in 54 per cent (n=147) and 1 to 2 weeks in 27 per cent (n=74). Most patients returned to their daily activities in 2 weeks (75%) and to work in 3 weeks (74%). Chronic pain lasted for 6 to 48 months (mean, 20 months) in only seven patients. No recurrence of hernia was observed during follow-up visits (range, 26-96 months; mean, 53 months). In conclusion, IROFS can be performed with little difficulty, is cost-effective, and is well tolerated by the patient.
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PMID:Internal ring occlusion and floor support: a novel technique for inguinal hernia mesh repair. 2083 37


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