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

Herniation of abdominal viscera into the thorax following traumatic diaphragmatic hernia can simulate acute tension pneumothorax. A case is presented of a blunt trauma victim with apparent acute diaphragmatic rupture, tension hemothorax, or tension hemopneumothorax. Nasogastric tube insertion demonstrated tension gastrothorax, but was followed by acute clinical decompensation. Percutaneous needle thoracostomy decompressed the stomach without causing spillage of gastric contents. Autopsy experimentation was performed to demonstrate that needle decompression of the distended stomach is well tolerated. Tension gastrothorax is a rare, life-threatening complication of traumatic diaphragmatic hernia. Although nasogastric tube placement should be attempted first, it may exacerbate the condition. Percutaneous needle decompression of the stomach through the chest wall can stabilize the situation and is safer and more rapid than chest tube placement, which might be either ineffective or dangerous. Paralyzing the patient with acute diaphragmatic rupture before tracheal and gastric intubation might prevent progression to tension gastrothorax.
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PMID:Tension gastrothorax complicating acute traumatic diaphragmatic rupture. 162 87

A total of 212 cases of abdominal wound dehiscence requiring secondary closure occurred in 8632 surgical obstetric and gynaecological laparotomies over a 7-year period ending in December 1981. The incidence of abdominal wound dehiscence at Ibadan was 2.5%. Contaminated wounds were the most susceptible with an incidence of 19%. A detailed review of 60 cases revealed a mean age of 29 years. Wound infection was the most prominent contributory factor. Tension sutures appeared to be ineffective in preventing wound dehiscence. Following secondary closure, 53% of the patients developed further wound complications, mainly wound infection, incisional hernia and repeat dehiscence. The average duration of hospitalization was 35 days and 7% of the patients died post-operatively.
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PMID:Abdominal wound dehiscence: a review of 60 cases at the University College Hospital, Ibadan. 284 51

In 151 years since first described, there have been 112 reported cases of hernia through the foramen of Winslow (HFW). All thus far have described HFW as a primary entity. The case reported appears to be unique with HFW as a surgical complication. HFW is the least common of internal hernias. The primary symptom is pain referred from the herniated organ and the hepatoduodenal ligament. An interesting sign is that the patient is found curled up or stooped over for pain relief. Anatomic factors implicated in HFW are an enlarged epiploic foramen, a floppy cecum and ascending colon, or abnormal length of small bowel mesentery. Tension on these structures causes pain with the torso extended. Distention of bowel in the lesser sac mimics gastric obstruction. Organs herniated are: small bowel (63%); cecum, ascending colon, and terminal ileum (30%); and transverse colon (7%). Of 25 cases reported since 1966, cecal herniation comprised two-thirds. The diagnosis may be made radiologically and the treatment is surgical. The case and a review of the literature are presented with attention to the anatomy. Also provided are the signs and symptoms of this interesting and perplexing diagnosis.
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PMID:Hernia through the foramen of Winslow: a complication of cholecystectomy. A case report. 357 35

Tension-free repair, a prerequisite for long-term stability, cannot always be achieved with conventional techniques established for groin reconstruction. Lichtenstein gathered substantial experience simply by closing the hernia in a tension-free fashion using prosthetic material. However, most surgeons fearing graft infection are reluctant to further evaluate this technique. In a feasibility study we entered 70 patients (29 patients with recurrent hernia) receiving a polypropylene mesh (Marlex) to bridge the defect from the inguinal ligament to the internal oblique muscle. Only 1 wound infection and 1 local hematoma requiring reoperation were observed. Nearly 2 years follow-up data revealed no case of recurrence. The Lichtenstein procedure deserves more attention from surgical community and might be a reliable technique esp. in large hernias and redos.
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PMID:[Lichtenstein alloplastic repair of inguinal hernia]. 787 26

Tension and infection often cause wound dehiscence or incisional herniation after the fascial closure of congenital abdominal wall defects in neonates. To overcome these problems, a modification of the Boerema technique (a method for repairing large incisional hernia in adults) was applied to repair abdominal wall defects in 14 neonates. The efficacy of this technique is discussed in this report.
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PMID:Modified Boerema technique for the closure of congenital abdominal wall defects to prevent incisional herniation and infection. 916 56

Beginning in 1990, the tension-free inguinal hernioplasties were adopted for the treatment of primary groin hernias in men. 1252 tension-free hernioplasties were performed in 1,076 men and followed for one to six years. Lichenstein's tension-free hernioplasty and Gilbert's sutureless hernioplasty were used, usually in combination. Anesthesia was local in 97% of the operations. 15 complications occurred (1.2%): one wound infection, one seroma, 12 hematomas, and one ilioinguinal neuralgia, 6 recurrences occurred (0.5%): 4 indirect, one direct and one femoral. No indirect recurrences have occurred since placing Gilbert's cone shaped plug in the deep ring. Tension-free hernioplasties consisting of a patch of polypropylene mesh plus a cone plug of the same material, placed in the deep ring when an indirect hernia is present, produce excellent results and are the preferred methods to manage the majority of primary inguinal hernias in men.
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PMID:[My experience in repairing, without tension, primary inguinal hernia in men]. 923 2

Tension-free hernia repair plus recovery expectancy statements return personnel to work more quickly. On the day of primary inguinal hernia repair, patients were given statements about their likelihood of returning from convalescent leave after 7 days and performing nonstrenuous work. Similar statements were given to them by telephone at 72 hours postoperatively and at a 1-week follow-up appointments. Seventy-four percent of the 73 patients returned to nonstrenuous work within 7 days, and 90% returned to strenuous work within 30 days. In this small sample, 385 work days were saved from the Navy's recommended 14 days of convalescent leave. By combining recovery expectancy statements with an effective surgical procedure, it is possible to avoid prolonged convalescence, thereby enhancing military readiness.
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PMID:Back to work more quickly after an inguinal hernia repair. 1105 Aug 71

Tension-free hernioplasty in the Day Hospital or Short Stay Surgery setting is now considered the gold standard for hernia treatment, but early discharge is not synonymous with a rapid recovery, and pain in the inguinal region may persist for months after the operation. The authors examined 100 tension-free hernioplasties, performed in 1999. 72 Lichtenstein and 28 Trabucco hernioplasties were performed in 97 men and 3 women (min age 18 yrs., max. 90 yrs., mean 55 yrs.). Three months after hernioplasty residual inguinal pain was present in 10 patients (mild in 9, moderate in 1). Hypo-dysaesthesia in the inguino-crural region was also present in 8 patients (mild in 7, moderate in 1). Operative technique, emergency surgery and the surgeon himself were not correlated with results; occupational status was significantly associated with residual pain, which affected active workers more than retired patients.
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PMID:[Postoperative pain in inguinal hernioplasty: does it exist?]. 1128 Aug 18

This subject has been well covered in recent years. Yet it seems appropriate to search for major advances in hernia methodology during the last 100 years. Eduardo Bassini is credited with pioneering the modern era. His "triple layer" repair was corrupted through the years and, as a result, he did not receive sufficient credit for his attention to the posterior inguinal wall. Chester McVay, renowned surgeon-anatomist, renewed interest in the Cooper's ligament and the posterior inguinal wall. Surgeons from the Universities of Washington and Illinois perfected approaches to the posterior inguinal wall. Thus, these investigators paved the way for several effective posterior hernia operations. The name of Usher will forever be remembered in terms of practical prosthetic mesh (polypropylene). This material, as well as others, has become an important addition to the surgeon's armamentarium. Rene Stoppa reminded us of the Pascal principle and clearly demonstrated how giant prostheses can remain in the preperitoneal space without the need for sutures. Tension-free operations, plug techniques, and laparoscopic hernia methodology must await further analysis.
Hernia 2001 Dec
PMID:Evolution of hernia repair: a salute to Professor Piero Pietri. 1200 48

Tension-free prosthetic mesh repair of giant, complex, or recurrent ventral hernias in the form of a modified Stoppa technique has been used in 60 cases. Complication rate has been comparable with other such studies. In obese patients with a pendulous anterior abdominal wall, limited panniculectomy was carried out while repairing the hernia through a low transverse abdominal incision. None of the patients required a progressive preoperative pneumoperitoneum. The incidence of wound infection was 5%. One patient had a wound hematoma that required evacuation; minor wound complications occurred in 11% cases. The hospital stay ranged from 1 to 6 weeks (mean, 10.3 days). One case required readmission for resuturing of the wound. None of the cases required removal of the mesh. There was no recurrence at follow-up (mean, 26 months) in 80% of the cases. This technique is an excellent but somewhat tedious procedure.
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PMID:Tension-free open mesh repair of ventral hernias--Stoppa's technique. 1205 67


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