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

The improper fusion of the postero-lateral foramen of the diaphragm was first described by Bochdalek in 1848. The incidence of congenital diaphragmatic hernia varies from1:2000 to 1:5000 live births and Bochdalek hernias (BH) account for 75 to 85% of these. Although it is a well-known entity in neonates, it is occasionally discovered incidentally in adult patients. Until now, a total of around 100 cases of occult asymptomatic Bochdalek hernia have been reported. The symptomatic cases are encountered more rarely. Colon necrosis among the symptomatic cases was reported in some reports. We discuss the present case since we believe it to be, to the best of our knowledge, the first case of a Bochdalek hernia in an adult presenting with caecal perforation and faecal peritonitis and review the published literature about this rare condition.
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PMID:Caecal perforation with faecal peritonitis - unusual presentation of Bochdalek hernia in an adult: a case report and review of literature. 1941 47

The use of a sublay mesh in open surgery has been probed to be an efficient strategy for the prevention of parastomal hernia. Based on these previous reports, placing a composite mesh (polypropylene/cellulose) in an intraperitoneal fashion seems to be a good technique when a laparoscopic approach is performed. This technique is easy to perform. Mesh is kept in place with the help of tackers, normal intra-abdominal pressure, and the colon itself. We report the description of a laparoscopic technique for placing an intraperitoneal mesh for the prevention of a parastomal hernia.
Dis Colon Rectum 2009 May
PMID:Prosthetic mesh in parastomal hernia prevention. Laparoscopic approach. 1950 71

Parastomal hernia is a common complication after stoma formation. Its reported incidence varies from 30% to 50%. Loop ileostomy has the lowest risk (0%-6.2%), followed by end ileostomy, and loop colostomy with a similar risk of 28% to 30%. End colostomy carries the highest risk for parastomal hernia of 48%. Even though most hernias occur within the first 2 years after stoma construction, the risk of herniation extends up to 20 years. Theoretically, parastomal hernia occurs as a result of mechanical factors, an intrinsic defect in collagen metabolism, and wound repair. Parastomal hernia is asymptomatic most of the time, but it may be associated with serious complications such as strangulation and perforation; hence, elective repair is mandatory for carefully selected cases and surgical approaches. Primary closure of the aponeurosis at the hernia site, either via peristomal approach or through midline incision, is a simple procedure, but it carries a recurrence rate of 38% to 100%. Stoma relocation may result in a zero recurrence rate at the same hernia site, but the risk of a parastomal hernia after new stoma formation is still expected. In addition, an incisional hernia at the previous colostomy site closure may also occur. Similar to other sites of hernia repair, prosthetic mesh has been used to reinforce the hernia defect intraperitoneally through open incision and recently via the laparoscopic approach. Mesh repair has demonstrated the lowest risk of recurrence for parastomal hernia of 0% to 33%.
Dis Colon Rectum 2010 Sep
PMID:Laparoscopic parastomal hernia repair. 2070 79

Abdominal wall reconstruction in the digestive tract fistula patient is a complex issue. The authors review the available data and present information regarding the timing of surgery, techniques of abdominal wall reconstruction, hernia repair, and discuss pitfalls associated with the various options. A simple and basic approach to this problem is described.
Clin Colon Rectal Surg 2010 Sep
PMID:Abdominal wall reconstruction in patients with digestive tract fistulas. 2188 70

The construction of an intestinal stoma is fraught with complications and should not be considered a trivial undertaking. Serious complications requiring immediate reoperations can occur, as can minor problems that will subject the patient to daily and nightly distress. Intestinal stomas undoubtedly will dramatically change lifestyles; patients will experience physiologic and psychologic detriment with stoma-related problems, however minor they may seem. Common complications include poor stoma siting, high output, skin irritation, ischemia, retraction, parastomal hernia (PH), and prolapse. Surgeons should be cognizant of these complications before, during, and after stoma creation, and adequate measures should be taken to avoid them. In this review, the authors highlight these often seen problems and discuss management and prevention strategies.
Clin Colon Rectal Surg 2013 Jun
PMID:Avoidance and management of stomal complications. 2443 59

Evidence-based perioperative care plans after colorectal surgery serve to improve quality outcome, decrease complications, and reduce medical cost. The benefits of routine nasogastric decompression and prolonged enteral restriction after bowel resection are not supported in this new era of evidence-based surgical care. Prophylactic nasogastric decompression fails to improve bowel function, length of stay, and prevent anastomotic leak, wound complications (infection, fascial dehiscence, incisional hernia), pulmonary complications (atelectasis, aspiration, pneumonia, fever, pharyngolaryngitis), and abdominal discomfort (distension, nausea, vomiting). Patients have earlier return of bowel function without the use of a nasogastric tube (NGT). Early refeeding within 24 hours after bowel resection is well tolerated in 80 to 90% of patients, and associated with earlier hospital discharge, decreased risk of infection, and improved postoperative hyperglycemic control. Abdominal discomfort is the most common complication observed in patients treated with early feeding and without a NGT, but does not result in higher therapeutic nasogastric intubation, postoperative ileus, aspiration, or other complications. The use of multimodal adjuncts in combination with these guidelines should be considered to improve outcome. The current literature is reviewed with suggestions for achieving better outcomes after colorectal resection.
Clin Colon Rectal Surg 2013 Sep
PMID:The Evidence against Prophylactic Nasogastric Intubation and Oral Restriction. 2443 72

Wound healing is a complex, dynamic process that is vital for closure of cutaneous injuries, restoration of abdominal wall integrity after laparotomy closure, and to prevent anastomotic dehiscence after bowel surgery. Derangements in healing have been described in multiple processes including diabetes mellitus, corticosteroid use, irradiation for malignancy, and inflammatory bowel disease. A thorough understanding of the process of healing is necessary for clinical decision making and knowledge of the current state of the science may lead future researchers in developing methods to enable our ability to modulate healing, ultimately improving outcomes. An exciting example of this ability is the use of bioprosthetic materials used for abdominal wall surgery (hernia repair/reconstruction). These bioprosthetic meshes are able to regenerate and remodel from an allograft or xenograft collagen matrix into site-specific tissue; ultimately being degraded and minimizing the risk of long-term complications seen with synthetic materials. The purpose of this article is to review healing as it relates to cutaneous and intestinal trauma and surgery, factors that impact wound healing, and wound healing as it pertains to bioprosthetic materials.
Clin Colon Rectal Surg 2014 Dec
PMID:A primer on wound healing in colorectal surgery in the age of bioprosthetic materials. 2543 21

The use of biologic mesh has increased greatly in recent years in response to the need for a solution in managing contaminated hernias. Multiple different meshes are commercially available, and are derived from a variety of sources, including human dermis as well as animal sources. For a mesh to be effective, it must be resistant to infection, have adequate tensile strength for hernia repair, and be well tolerated by the host. To achieve this end, biologic meshes go through an intense processing that varies from one product to the next. In this article, the authors review the types of mesh available, how they are processed, and examine these characteristics in terms of their strengths and weaknesses in application to surgical technique.
Clin Colon Rectal Surg 2014 Dec
PMID:Biomaterials: so many choices, so little time. What are the differences? 2543 22

Hernia formation after surgical procedures continues to be an important cause of surgical morbidity. Incisional reinforcement at the time of the initial operation has been used in some patient populations to reduce the risk of subsequent hernia formation. In this article, reinforcement techniques in different surgical wounds are examined to identify situations in which hernia formation may be prevented. Mesh use for midline closure, pelvic floor reconstruction, and stoma site reinforcement is discussed. Additionally, the use of retention sutures, closure of the open abdomen, and reinforcement after component separation are examined using current literature. Although existing studies do not support the routine use of mesh reinforcement for all surgical incisions, certain patient populations appear to benefit from reinforcement with lower rates of subsequent hernia formation. The identification and characterization of these groups will guide the future use of mesh reinforcement in surgical incisions.
Clin Colon Rectal Surg 2014 Dec
PMID:Incisional reinforcement in high-risk patients. 2543 23

Parastomal hernia is a prevalent problem and treatment can pose difficulties due to significant rates of recurrence and morbidities of the repair. The current standard of care is to perform parastomal hernia repair with mesh whenever possible. There exist multiple options for mesh reinforcement (biologic and synthetic) as well as surgical techniques, to include type of repair (keyhole and Sugarbaker) and position of mesh placement (onlay, sublay, or intraperitoneal). The sublay and intraperitoneal positions have been shown to be superior with a lower incidence of recurrence. This procedure may be performed open or laparoscopically, both having similar recurrence and morbidity results. Prophylactic mesh placement at the time of stoma formation has been shown to significantly decrease the rates of parastomal hernia formation.
Clin Colon Rectal Surg 2014 Dec
PMID:Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials. 2543 25


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