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

Lumbar hernia is a rare occurrence in infants and children. Congenital variants have been described, frequently associated with musculofascial and skeletal abnormalities, specifically "lumbocostovertebral syndrome" (LCV) and/or meningomyelocele. In LCV syndrome, lumbar herniation results from a single somatic defect occurring during the third to fifth week of embryonal development. Meningomyelocele may predispose to lumbar herniation secondary to abnormalities in muscular innervation related to nerve entrapment in the spinal dysraphism. Acquired lumbar hernia generally can be attributed to surgery, infection, or trauma. Localized neuropraxis, temporary or permanent, may be the underlying factor common to all these defects. The author presents two pediatric cases of lumbar hernia associated with intrathoracic neuroblastoma. The first patient, a 15 month old, had a lumbar hernia after excision of a thoracic ganglioneuroblastoma. This resolved within 1 year, without specific therapy. The second patient, a 4 month old with a lumbar hernia and a large intrathoracic neuroblastoma, had "resolution" of the hernia within 4 months of excision of the paravertebral tumor. In these cases it appears that the lumbar hernia resulted from neuropraxis secondary to intrathoracic paravertebral tumor and its management. In both cases, this deficiency was temporary and resolved without specific therapy. The association of lumbar hernia and intrathoracic neuroblastoma has not been reported previously. These cases suggest the advisability of a screening chest x-ray in children presenting with this diagnosis. Similarly, the cases suggest a role for conservative treatment for the hernia itself, when the neural impairment resulting in the defect is of a temporary nature.
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PMID:Neuroblastoma and lumbar hernia: a causal relationship? 793 72

In laparoscopic hernia repairs, the staples used to affix prosthetic mesh have resulted in entrapment neuropathies. This paper describes the diagnosis and treatment of nine cases of entrapment neuropathy. Injuries to all the branches of the lumbar plexus, with the exception of the obdurator nerve, have been treated. Generally, the entrapments are self-limiting, but chronic disability requiring surgical intervention can occur. Staple removal and neurolysis controlled the severe, chronic pain of one femoral nerve entrapment. A thorough understanding of the anatomy of these nerves can prevent stapling in the areas of danger and thus greatly reduce the incidence of this complication.
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PMID:Entrapment neuropathy in laparoscopic herniorrhaphy. 799 73

In order to define current issues and outcomes of living kidney donation, 100 consecutive living donors operated on between July 1996 and March 2001 were evaluated. The 64 women and 36 men ranged in age from 19 to 72 yr (mean 42.5 yr), and 65 were related to the recipient while 35 were unrelated donors. Hospital admission the morning of surgery and use of a minimal open approach to the donor kidney were standard, as were post-operative epidural pain control and plans for short hospital stay. The 100 donors were hospitalized for 2 (25), 3 (48), 4 (18), 5 (8), or 6 (1) days, with an average length of stay of 3.12 d (range 2-6 d). The mean charge for kidney donor hospitalization was 14,470 dollars (range 9671-22,808 dollars). There were no major intra or immediate post-operative complications. Six rehospitalizations occurred for post-donation nausea, vomiting, dehydration (n = 2); spinal headache; pneumonia and wound haematoma; and late wound reexploration (one hernia and one nerve entrapment). All donors returned to pre-operative functional status within 6 d to 6 wk of donation. All kidneys functioned immediately in the 100 recipients (50 women, 50 men) who averaged 46.6 yr of age (range 17-69 yr); recipient length of stay averaged 3.81 d (range 2-15 d). All donors survived in excellent health; recipient graft and patient survival, respectively, are 87 and 90% through the entire 5-yr period. Excellent long-term outcomes for living kidney donors may be accomplished using minimal open surgical technique, post-operative epidural pain control and plans for a brief hospitalization. Expansion of living donor resources in renal transplant programs may grow as unrelated kidney donation and non-directed donation as well as minimally invasive (open and laparoscopic) techniques evolve.
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PMID:One hundred consecutive living kidney donors: modern issues and outcomes. 1237 47

Groin pain in athletes is not infrequently a cause of frustration and aggravation to both doctor and patient. Complaints in the groin region can prove difficult to diagnose, particularly when they are of a chronic nature. These injuries are seen more commonly in sports that require specific use (or overuse) of the proximal musculature of the thigh and lower abdominal muscles. Some of the more common sports would be soccer, skiing, hurdling, and hockey. The differential diagnosis can cover a rather broad area of possibilities. Most common groin injuries are soft-tissue injuries, such as muscular strains, tendinitis, or contusions. More difficult areas to pinpoint are such entities as osteitis pubis, nerve entrapment, the so-called "sports hernia," or avulsion fractures, to name but a few. The evaluation of such patients includes a familiarity with the sport and possible mechanism of injury (i.e., taking a careful history), meticulous physical examination of the groin, abdomen, hips, spine, and lower extremities. Diagnostic examinations may or may not prove helpful in formulating a final diagnosis. Some patients may be required to undergo procedures, such as laparoscopic evaluation of the region to obtain adequate information that allows a proper diagnosis and treatment plan. This article describes many of the possible causes of groin pain in athletes. The list is quite lengthy, and only the more common problems will be discussed in detail.
Hernia 2003 Jun
PMID:Groin pain in athletes. 1282 26

We present 30 cases of femoral nerve entrapment (1999-2003, age range 35-65 yrs), in 13 patients with diagnosis of idiopathic compression and 7 patients of neurovascular conflict. The compression, in the other 10 patients, was iatrogenic: 3 patients following cardiac catheterization for balloon valvotomy, 2 patients following intra-abdominal vascular surgery and 5 patients following laparoscopic hernia treatment. Microsurgical nerve decompression, and the elimination of neurovascular conflict gave satisfactory results. The best result has been observed in neurovascular conflict cases.
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PMID:Femoral nerve entrapment. 1583 Sep 69

Sportsmen often suffer prolonged inguinal pain which can become a serious debilitating condition. In most cases the pain originates from a musculoskeletal problem. However, for some patients it has been suggested that the etiology is a weakness of the inguinal canal. This syndrome was termed "sportsman's hernia" although a hernia can not be found on physical examination. Imaging findings were found to be inconclusive regarding the alleged hidden hernia. Various types of operations, based on the variable theories regarding the pathophysiological process, have been developed for the treatment of this syndrome. Some surgeons focus on the external elements of the inguinal canal, and repair the external oblique fascia or enforce the groin with the rectus abdominis. Other surgeons perform an inguinal hernia repair procedure, either with sutures, synthetic mesh, or laparoscopically. Some researchers believe that the problem is in the lower abdominal muscles, or is caused by nerve entrapment, and treat it accordingly. There are no controlled comparative data on the results of the various surgical approaches, and there is no evidence that surgical treatment is more beneficial than conservative treatment. We recommend to operate only if conservative therapy, with prolonged rest, fails. During the operation the inguinal canal should be thoroughly explored, and will be enforced only if a hernia, or a definite weakness of the canal's floor, are found. Similarly, the release of a nerve should be performed only when the exploration reveals clear evidence of entrapment.
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PMID:[Sportsman's hernia--a plea for conservative therapeutical approach]. 1593

Suprascapular nerve entrapment is an uncommon but often under-recognized entity caused by a variety of mechanisms and injuries to the shoulder area. The case presented is of a patient with neuropathy after a bilateral hernia repair. This is a previously undocumented association not closely adhering to the usually proposed mechanisms of injury. These mechanisms and the diagnosis and treatment of suprascapular nerve compression are reviewed.
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PMID:Shoulder pain due to suprascapular nerve compression during general anesthesia. 1907 61

Even after more than 100 years of inguinal hernia repair, the rate of complications and recurrence remains unacceptably high. In the last decades, few effective advances in surgical technique and materials have been made. The authors see them as minor adjustments in the shape and materials of the prosthetic implants. Still, the underlying genesis of inguinal hernia remains undefined. Based upon this, it seems the surgical repair of inguinal protrusions cannot be based upon the pathogenesis because the etiology to date has not been addressed. Most hernia repairs are performed with some degree of point fixation (sutures/tacks) to stop the mesh from migrating and creating high recurrence rates. This should be a priority for our considerations, as fixating mesh puts it in stark contrast to the physiology and dynamics of the myotendineal structures of the groin. Following years of surgical practice, implant fixation, mesh shrinkage, and poor quality of tissue ingrowth still represent an unresolved issue in modern hernia repair. Conventional prosthetics used for inguinal hernia repair are static and passive. They do not move in harmony with the dynamic elements of the groin structure and, as a result, induce the ingrowth of thin scar plates or shrinking regressive tissue that colonizes the implants. The authors strongly believe that these characteristics may be a contributing factor for recurrences and patient discomfort. Other complications are reported in the literature to be a direct result of fixation of the implants, such as bleeding, nerve entrapment, hematoma, pain, discomfort, and testicular complications. To improve results by respecting the physiology and kinetics of the inguinal region, we felt that a new type of prosthesis should be designed that induces a more structured tissue ingrowth similar to the natural biologic components of the abdominal wall. This prosthetic device was specifically designed to be placed with no point fixation. This was achieved by using inherent radial recoil, vertical buffering, friction, and delivering the device in a constrained state. A secondary benefit of this "dynamic" design is that the implant moves in a three-dimensional way in unison with the movements of the myotendineal structures of the groin. The results appear to show that the three-dimensional structure not only acts as a suitable scaffold for a full thickness ingrowth of a tissue barrier but also seems to induce an ordered, supple, elastic tissue, which allows for neorevascularization and neoneural growth. The outcomes indicate a reduced impact of fibrotic shrinkage on the implant/scar tissue when compared with shrinkage of polypropylene meshes reported in the literature. This pilot study shows the features of such an implant in a porcine experimental model.
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PMID:A new prosthetic implant for inguinal hernia repair: its features in a porcine experimental model. 2175 35

Inguinal hernia repair remains controversial, despite advances in technique and materials. Conventional implants are typically static (passive) and do not move in concert with the groin's motility. Inguinal hernia repair with mesh fixation on dynamic groin structures are not tension free, and are associated with tissue tearing, bleeding, hematoma, and nerve entrapment--all which might contribute to mesh dislocation. The poor quality of tissue ingrowth within static meshes/plugs embodies another crucial issue in prosthetic hernia repair. Because the prosthetics used for inguinal hernia repair are incorporated by rigid fibrotic tissue (hence the term "scar plate"), the regressive tissue leads to shrinkage and reduction of the mesh surface area--a significant cause of recurrence and discomfort. To improve inguinal hernia repair, a new 3D dynamic (inherent recoil), self-retaining implant has been developed. It achieved excellent outcomes in the porcine model, and demonstrated that the dynamic compliant movement and recoil of the 3D prosthetic structure within the groin's natural tissues allowed for the critical cyclical physiologic loading that is missing with other implants. Because enhanced biologic response and improved quality of tissue ingrowth result from its dynamic interactions with groin tissue, the shrinkage of the implant is nearly absent, even after long-term implantation. We discuss this dynamic hernia repair concept in this report. The use of this new 3D implant represented a faster and simpler surgical approach to inguinal hernia repair. The procedure was based on the centrifugal expansion of the device, whose design features converted ejection forces into gripping forces, and avoided the need for suturing the implant (eliminating a cause of complications related to prosthesis fixation).
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PMID:Fixation-free inguinal hernia repair using a dynamic self-retaining implant. 2306 7

Groin and hip injuries are seen in athletes who perform quick directional changes and cutting movements. Because forces generated through athletic performance are transferred through the hip, injuries to these areas may limit athletes with mild pain or lead to career-ending injuries. The anatomy of the hip and groin is complex and symptoms often overlap. This article discusses some athletic causes, but other medical conditions may be associated with hip and groin pain as well. Updates in evaluation and treatment are discussed for adductor strains, hip osteoarthritis, femoroacetabular impingement, sports hernia, osteitis pubis, and obturator nerve entrapment.
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PMID:The athlete's hip and groin. 2366 47


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