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

Ischemic orchitis and testicular atrophy remain the most dreaded complications of inguinal hernioplasties. The current study examines these complications in a series of hernia repairs during a period of 20 years. The incidence of the complications in the ten year period from 1971 to 1981 was compared with the experience since 1981, from which time all distal indirect hernia sacs were left in place and increasing experience was gained in properitoneal repairs of recurrent hernias. The incidence of ischemic orchitis in primary hernia repairs was reduced from 0.65 per cent (11 instances in 1,682 repairs) to 0.03 per cent (one in 3,634 repairs). The incidence in recurrent hernia repairs was reduced from 2.25 per cent (seven in 311 repairs) to 0.97 per cent (eight in 827 repairs). These data have led us to emphasize the importance of minimizing cord dissection by leaving intact all significant distal hernia sacs and not dissecting beyond the pubic tubercle. Additionally, properitoneal repairs should be considered for repairs of recurrent hernias not only to reduce further recurrences but also to avoid testicular complications.
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PMID:Prevention of ischemic orchitis during inguinal hernioplasty. 157 Jun 18

Some authors recommend different prosthetic repairs for treatment of recurrent groin hernia. In our institution groin hernias are treated by a modified Shouldice-repair, which considers the transversalis fascia layer only. In this prospective study 240 consecutive patients with 298 groin hernias were operated on. 46 patients were treated for 53 recurrent hernias. It was possible to carry out the operative procedure of transversalis plasty in all recurrent cases. 90% of these patients were followed-up by personal examination after a median of 26 months after operation (range 12-36 months). 89% of the patients with primary operation have been checked 15 months postoperatively. 2 patients (4.5%) of the recurrent hernias had a recurrence. This compares well with the 3.2% recurrence rate (7 patients) in the patients with primary hernias. The difference is not significant (p greater than 0.5). The only observed difference between recurrent and primary hernias was in the rate of testicular atrophy (6.8% for recurrent and 0% for primary hernias). According to our experience large prosthetic repairs are not necessary for the common case of recurrent groin hernia, but may be useful in specially selected situations.
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PMID:[Recurrent inguinal hernias: surgery with transversalis fascia repair]. 164 4

Questionnaires were sent five years postoperatively to all patients between 15 and 80 years old at operation who were treated for inguinal or femoral hernia in 1984 at Motala Hospital. Patients were asked about pain or a lump in the operation area and a clinical examination was offered. Of 137 patients with 142 hernias, 92% answered the questionnaire and 88% came to the examination. Among patients who answered the questionnaire and attended the examination the cumulated recurrence rate was 19%, when recurrence was defined as an indication for reoperation or a bulge in the operation area that appeared or increased during abdominal straining. Predictive values for positive and negative questionnaire answers in relation to hernia recurrence were 69% and 95%, respectively. In 14% of hernia operations a reoperation had been performed or was needed. Testicular atrophy was found in 2.7% of male patients. A questionnaire follow-up may be appropriate for identifying patients with symptomatic recurrencies, but it is inadequate as a single indicator of quality assessment in hernia surgery.
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PMID:Quality assessment in hernia surgery. 178 88

Testicular atrophy is a complication of inguinal hernioplasty that angers men of all ages. It is caused by thrombosis of the spermatic cord. Experience with over 6,500 inguinal hernioplasties in men indicates that the thrombosis is induced by direct surgical trauma to the cord. Trauma to the cord can be minimized and the incidence of testicular atrophy can be reduced by 1) not dissecting beyond the pubic tubercle, by 2) leaving distal indirect hernia sacs attached to the cord or by 3) avoiding dissection of the spermatic cord altogether by employing a posterior properitoneal approach.
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PMID:[Testicular atrophy. A risk of inguinal hernioplasty]. 184 20

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

In a retrospective analysis the late results--mean follow-up 13.2 years--after herniotomy and Bassini repair are presented. The results of 837 interventions were evaluated with a questionnaire and among these 341 were clinically controlled. The overall recurrence rate was 10.5% with a cumulative recurrence rate of 26% after the first two years and 88% within 10 years. A testicular atrophy was observed in 1.1% and in 1.6% patients complained of pain in the groin or presented an entrapment of the nervus ilio-inguinalis. The personally conducted clinical evaluation showed a recurrence rate of 23%, a testicular atrophy in 1.2% and an entrapment in 2.9%. The recurrence rate was independent of sex, age, localisation, type of hernia, increased intraabdominal pressure or experience of the operator. Our results confirm that recurrences are only depicted by a clinical guided control after a sufficiently long follow-up period.
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PMID:[Late results following inguinal or femoral hernia surgery]. 240 15

Forty-eight boys were assessed for an acutely painful scrotum. Thirty-six (75%) of them underwent radionuclide scanning of the scrotum; the average age of this group was 11 years. The scan revealed epididymitis in 19 cases, spermatic cord torsion in 9, appendix testis torsion in 7 and acute hernia-hydrocele in 1. The diagnosis was confirmed at operation in all nine cases of spermatic cord torsion. Boys who had epididymitis received antibiotics only; all were available for short-term follow-up, and 16 were also assessed at a mean of 6 months after infection. Only one boy had testicular atrophy; he had undergone repair of an inguinal hernia, which could not be ruled out as a cause. Bacteriuric epididymitis occurred in three boys; two had known predisposing genitourinary anomalies, the third had no abnormalities. Boys who had nonbacteriuric epididymitis were investigated by renal and pelvic ultrasonography or voiding cystourethrography; no important abnormalities were detected. This prospective study indicates that radionuclide scanning can reliably differentiate spermatic cord torsion from other acute scrotal disease.
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PMID:Acute scrotal pain in children: prospective study of diagnosis and management. 291 Mar 75

From 1978 to 1985, 679 boys were operated for an inguinal hernia. 3 groups of patients must be considered. The bilateral inguinal hernias group (119 children) 73 patients were operated on both sides. 46 presented signs of hernia on the opposite side after the first operation and were operated again. In this group, there is a more important frequency of premature. But the classical notion that bilateral hernia are more common when the presenting hernia is on the left side, is not noticed. As a matter of fact, among the 46, there were 33 children operated at first on the right side. If a systematic bilateral exploration had been realised, it would here been useless in 82 per cent of the cases. The incarcerated inguinal hernia group 177 (26%) children were hospitalised for an incarcerated inguinal hernia diagnosis. 23 infants required emergency operation. Mostly, it was the first episode of a right hernia in a child under 3 months of age. 8 times a testicular infarction was noticed. The incidence of testicular lesion following incarceration of inguinal hernia is more important that the testicular atrophy after primary hernioplasty. This justify the surgical treatment for children of any age. The premature group 126 children were premature infants. In this group, a more important frequency of bilateral and incarcerated hernias are noted. 24 among these patients presented recurrent apnea episodes. To 8 of those children, the intervention was probably a benefit for the evolution of their apneas.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Complications of inguinal hernia in children]. 344 21

Magnetic resonance (MR) imaging of the scrotum with a high-resolution surface coil was performed in ten healthy volunteers and 20 patients with scrotal abnormalities demonstrated by high-resolution real-time ultrasound (US). Four patients had an abnormal testis (two tumors, one cyst, one testicular atrophy), and 16 patients had extratesticular abnormalities (four hydroceles, five epididymal cysts, one hernia, and six cases of epididymitis). The normal structures of the scrotum were depicted clearly on MR images. In all cases, the tunica albuginea was easily differentiated from the testis and epididymis. MR imaging enabled one to distinguish intratesticular from extratesticular lesions and to determine whether a lesion was solid or cystic. Complicated and simple fluid collections could also be differentiated. In general, MR imaging and US scanning provided similar information. A potential advantage of MR imaging is in the evaluation of patients with painful scrotal lesions that may limit US evaluation.
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PMID:MR imaging of the scrotum with a high-resolution surface coil. 354 97

This is a retrospective review of 62 patients with Stage II testicular seminoma treated either by initial radiation therapy (48 patients) or by platinum-containing chemotherapy (14 patients). For all 62 cases, disease-free survival from 2 to 20 years was 86%, uncorrected survival was 86% at 5 years and 83% at 15 years, and survival corrected for deaths from intercurrent disease was 90% from 2 to 20 years. There were no significant differences in outcome between the two treatment groups. An analysis of potential prognostic factors for the initial radiation therapy group and for the whole group revealed that age, site of primary, cryptorchidism, ipsilateral hernia repair, contralateral testicular atrophy, scrotal incision, elevated postorchiectomy beta-human chorionic gonadotropin level, epididymal invasion, spermatic cord involvement, and vascular invasion in the primary were not significant. However, bulk of abdominal disease was a prognostic factor. Patients with small-volume abdominal disease defined as nonpalpable disease or as a mass less than 10 cm in largest diameter accounted for two-thirds of the series and had a disease-free survival of 95% when treated with initial radiation therapy. Patients with bulky disease, either palpable or greater than or equal to 10 cm in diameter, had a disease-free survival of 64%. The relative roles of the two treatments in bulky abdominal disease are discussed, but in the absence of a prospective study it is not possible to definitively answer the question of which modality is best in this setting. In our series, the patients treated with platinum-containing chemotherapy fared as well as the primarily irradiated patients, but 71% of the former had palpable masses, compared with 22% of the latter. The chemotherapy-treated patients who relapsed were treated with radiation therapy for salvage, leading to a 100% survival corrected for intercurrent death. We have therefore elected to continue the policy of initial radiation therapy for small-volume (less than 10 cm) disease and platinum-containing chemotherapy for bulky disease (greater than or equal to 10 cm), with irradiation used for residual masses.
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PMID:The role of radiation in stage II testicular seminoma. 381 84


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