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

The purpose of this study was to examine the presentation and management of strangulated hernia. The clinical course of 54 patients was recorded. Twenty-one patients (39%) presented after 48 h from the onset of symptoms. Fifteen (28%) had a bowel resection and two (4%) died. Twenty (37%) patients had previously consulted their general practitioner about the hernia, but only seven had been referred for surgery. Five (25%) had been warned of the risk of strangulation. In the 32 (59%) patients previously aware of a hernia, delayed presentation was related to ignorance of the risk of strangulation (P less than 0.01). The strangulated hernia was misdiagnosed by the general practitioner in 17 (33%) patients (necessitating a second visit) and by the hospital registrar in eight (15%). We conclude that strangulated hernia is too often misdiagnosed and all patients who present with a hernia must be referred to a surgeon and warned about strangulation.
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PMID:Delay in presentation and misdiagnosis of strangulated hernia: prospective study. 157 5

The article discusses experience in treating traumatic diaphragmatic hernias in 68 patients, 63 of them underwent operation. Closed injuries to the diaphragm suffered in falling from a height and in car accidents and knife thoracoabdominal injuries were the main causes of this type of hernia. The principal role in their diagnosis belongs to X-ray examination with obligatory contrast study of the organs of the gastrointestinal tract. Among 41 patients who were operated on for non-strangulated hernia of this localization one died. In a group of 21 patients with a strangulated diaphragmatic hernia 11 died after surgery. Necrosis of the gastric and colonic wall, incompetence of the anastomosis sutures, peritonitis, and pleuritis were causes of death.
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PMID:[The surgical treatment of traumatic diaphragmatic hernias]. 183 88

Elective preperitoneal or posterior repair for recurrent groin hernias and primary femoral hernias has been shown to be a technically advantageous approach. In addition to the ease of inguinal floor and femoral canal assessment, scar tissue from prior anterior herniorrhaphy can be avoided. The emergency management of the acutely incarcerated or strangulated hernia of the groin using this approach has not been addressed. During a 30-month period, all patients with a diagnosis of acute incarceration of a groin hernia (n = 28) were surgically managed using either the anterior approach (AA) (n = 14) or the preperitoneal approach (PA) (n = 14). Two patients with strangulated intestine in the AA group required an additional midline incision for bowel evaluation and resection. Intestinal evaluation was easily accomplished through the same incision in four patients in the PA group. The preperitoneal approach also allowed proximal control of incarcerated or strangulated viscera, thus avoiding excessive manipulation of gangrenous or necrotic intestine, potential spillage of infected contents into the peritoneal cavity, and entry of bacteria, toxins, potassium, and the metabolic waste products of anaerobic metabolism into the systemic circulation during hernia reduction. There have been no recurrences in either group, and minor complications, such as wound infection and cellulitis, in the two groups are not statistically different.
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PMID:Preperitoneal herniorrhaphy for the acutely incarcerated groin hernia. 200 99

Among a group of 2,060 patients who underwent operation for strangulated abdominal hernias, 127 (6.2%) died. Analysis of the fatal outcomes showed that factors causing a negative effect on the results of treatment are essentially homogeneous. These included: a high proportion of elderly patients, late hospitalization, and the doctors' therapeutic and diagnostic errors. The percentage of the latter in the in-patient clinic is quite high (20.5). Immediate hospitalization of patients with a strangulated hernia and skilled operative treatment, as well as planned preventive management of individuals with hernia, are still the main reserve in improving the results of treatment of this pathological condition.
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PMID:[Causes of death and errors in the therapy of patients with strangulated hernias]. 207 26

Para-duodenal strangulated hernia is an unusual operative finding. The entraped position of intestinal loops in a vascularized pouch allow to recognize the lesion, the site of the neck of the hernia point out its anatomic form. Pre-operative diagnosis seems difficult to access in spite of numerous investigation'means. The strangulation is generally few tight, so the treatment is very easy outside of a carefully dissection of the neck of the left para-duodenal hernias.
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PMID:[Internal hernia in the duodenal fossae. 3 cases]. 651 13

In a five year period, 62 patients aged 70 to 91 years underwent operative inguinal hernial repair. Other significant ailments were present in 46 of the 51 men and six of the 11 women. Postoperatively, complications occurred in 16 patients, four of whom died. In 44 patients with reducible hernia undergoing elective repair, there were no deaths and complications occurred in eight, while, in contrast, of the 18 with incarcerated or strangulated hernia, complications occurred in ten, and four died. The differences statistically significant. Local anesthesia was associated with the lowest complication rate. All cardiovascular complications and all deaths occurred in those receiving either general or spinal anesthesia. Inguinal herniorrhaphy can be safely performed in geriatric patients. Because of high morbidity and mortality associated with incarceration, elective repair of inguinal hernia under local anesthesia should be done whenever possible.
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PMID:Inguinal and femoral hernia repair in geriatric patients. 707 6

Incarcerated hernia or wound dehiscence are responsible for more than 10% of small bowel obstructions. The complication is easily recognized when hernia or wound dehiscence was previously diagnosed. Difficulties occur when mass is deeply located in a thick abdominal wall or inside the inguinal canal. Femoral hernias and direct inguinal hernias are those which strangulate the most. Strangulation in wound dehiscence is the most severe. Strangulated hernia should be routinely excluded in patient with intestinal obstruction, to avoid inappropriate surgical approach.
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PMID:[Strangulated hernia and eventration]. 834 49

A prospective study was conducted over a 5-year period to determine whether inguinal hernia repair could be safely performed with absorbable suture material (polydioxanone) with reference to recurrence rates, wound pain, haematoma formation and wound infection. Analysis is available for 111 operations involving 111 patients. Mean follow-up was 36 (range 21-66) months, with 81 procedures monitored for more than 2 years. Two-layered hernia repair was used in all cases with polydioxanone as the chosen suture material. Mean post-operative stay was 2.1 days, with no hospital wound infections and three haematomas. Review identified 1 wound infection. There have been two recurrences. Preliminary results suggest that hernia repair with absorbable suture materials is comparable to traditional non-absorbable repair in terms of recurrence and associated wound complications. The additional benefit is the absence of foreign material in the wound region following degradation of the absorbable material. This does not appear to compromise the integrity of the hernia repair. Mesh repairs are increasingly preferred to Shouldice-style repairs in elective inguinal hernias. However, we believe that polydioxanone should be the suture material of choice in obstructed or strangulated hernia. A larger study is required to verify this, as well as a longer follow-up period. The use of absorbable material warrants further investigation.
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PMID:A prospective study of adult inguinal hernia repairs using absorbable sutures. 944 8

Between January, 1991 and December, 1993, 208 subjects with monolateral and 19 with bilateral inguinal hernia were submitted to herniorrhaphy. Thirty-four were recurrent hernias. All but one bilateral hernias were treated at the same time. Eight cases were operated in emergency condition for acute strangulated hernia. Two-hundred and ten operations were performed under local, 17 under general and 1 under spinal anesthesia. Herniorrhaphy was performed in 14 cases with the Bassini and in 38 with the Shouldice technique. In 191 instances the "tension-free" and in 3 the "plug" techniques were adopted utilizing a polypropylene mesh. Following local anesthesia 13 episodes of bradycardia with hypotension were recorded during the operation and 4 in the early postop period. There were no general complications. Two elderly patients developed urinary retention following general anesthesia. Local complications included 6 (2.4%) cases of infection and 4 (1.6%) cases of hematoma of the wound, and 5 (2.0%) cases of edema with infiltration of the cord. Percentage of follow-up at 1, 2 and 3 years was 96, 95, and 93 percent respectively. Five recurrences were recorded: in 1 case following Bassini repair (7.6%), in 2 following Shouldice (5.6%), and in 2 following tension-free (1.5%). Local anesthesia has been confirmed to be well accepted by the patients, effective an safe, especially in the elderly patients with high operative risk. Similarly, the tension-free hernioplasty has been confirmed as a simple, easily reproducible technique, followed by less pain and disability as compared with other types of herniorrhaphies, and more effective mainly in the treatment of recurrent hernia.
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PMID:[Surgical treatment of inguinal hernia using a "tension-free" technique and local anesthesia. Initial experience]. 899 87

Hernioscopy is laparoscopy traversing a hernial sac used in the course of traditional treatment for groin hernia and it may be both diagnostic or therapeutic. The technique involves dissecting the hernial sac followed by incision, and the creation of a pouch into which a trocar is passed to permit laparoscopy. Once detected an abdominal lesion can also be treated laparoscopically: adhesiotomy, debridement, biopsy etc. The indications to this technique are: strangulated hernia after reduction of the intestinal loop; contralateral diagnosis of inguinal hernia in infants; hernias accompanied by abdominal pain or subocclusive syndromes. For surgeons who adopt the traditional approach to the treatment of groin hernias this technique represents an unexpected addition to their armoury.
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PMID:Hernioscopy: technique and indications. 918 17


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