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

Prostheses of expanded polytetrafluoroethylene (e-PTFE) were used to repair 89 abdominal wall defects in which primary closure would produce undue tension on tissue. Over a 52-month period (median follow-up: 24 months), we observed three wound infections, one in a clean wound, and four hernia recurrences. No other complications were noted. Twenty-one e-PTFE grafts were placed directly over intraperitoneal viscera without clinical evidence of adhesions leading to intestinal obstruction. In grafts inspected postoperatively, no apparent evidence of fatigue or fragmentation was observed. Histologic findings concurred with experimental data obtained during animal trials revealing the creation of a new mesothelial lining. These results encourage the use of e-PTFE prostheses for the repair of abdominal wall hernias, particularly when the parietal peritoneum is absent.
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PMID:Hernia repair with expanded polytetrafluoroethylene. 155 82

Although a radiologic evaluation of the diaphragm is important in many clinical situations, visualization of the diaphragm is difficult because of its thinness, its domed contour, and its contiguity with abdominal soft tissues. Each clinical situation involving the diaphragm presents its own imaging difficulties, and each radiographic technique has advantages and disadvantages. No one modality is best for all situations. Often, several imaging modalities must be used to resolve the clinical question. The particular difficulties in diaphragmatic imaging are (1) distinguishing eventration from paralysis or hernia, (2) distinguishing lipoma from herniated omental fat, and (3) distinguishing unilateral paralysis from weakness and bilateral paralysis from respiratory fatigue. By selecting and applying the appropriate radiographic techniques, the radiologist can serve an essential role in assessing the disorders of the diaphragm.
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PMID:Imaging the diaphragm and its disorders. 264 11

The diaphragm is the main muscle of ventilation and the chief barrier separating the thorax from the abdomen. This article discusses diaphragmatic anatomy, physiology, pathology, and radiology, including hernia, eventration, rupture, tumors, paralysis, weakness, and fatigue. Imaging of the diaphragm involves plain radiography, fluoroscopy, computed tomography, and ultrasonography.
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PMID:Symposium on Nonpulmonary Aspects in Chest Radiology. The diaphragm. 638 23

The Mentor inflatable penile prosthesis is manufactured from Bioflex polyurethane, a material which is less elastic and more durable than silicone. Use of this new biocompatible polymer eliminates cylinder aneurysms and wear-induced cylinder leaks. The new prosthesis also incorporates a snap-on connector system designed to eliminate connector leaks and decrease operative time. The Mentor prosthesis has been implanted in 52 patients with organic impotence. The patients have been followed up for 2 to 16 months (average 8.3), the follow-up exceeding 1 year in 15 patients. A satisfactory cosmetic and functional result was achieved in 51 cases. Infection necessitated removal of the prosthesis in one patient. There were no pump, reservoir or tubing failures. After early connector failures there were no connector failures in the subsequent 48 patients. Additional complications included an incisional hernia and a cylinder failure which resulted from a manufacturing defect. There were no failures attributable to wear or material fatigue. The inherent reliability of this new prosthesis and the excellent functional and cosmetic results it produces justify its use in any patient who is a candidate for a penile prosthesis.
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PMID:Mentor inflatable penile prosthesis: clinical experience in 52 patients. 653 55

Resource allocation, including manpower and other expenses, have limited the evolution of minimally invasive surgical procedures to provide humanism and to improve surgical care for patients. Robotic enhancement has been proposed as a mechanism to improve the cost-benefit relationship for patients. To this end, we have used the robotic arm enhancement to minimize resource and personnel utilization during minimally invasive procedures. Phase I of our study has included the use of the robotic arm in 24 laparoscopic hernia repairs, cholecystectomies, and nissen fundoplications with the surgeon as a solo surgeon, i.e., the primary surgeon is the only participant in the operative sterile field. The scrub nurse did not participate in the procedures. During this study, there were no technical mishaps, no complications related to the solo surgeon-robotic arm concept, and the operative times were statistically similar to equivalent procedures utilizing multiple personnel. The hernia repair is least complex and most amenable to solo surgery due to the use of only three access ports; cholecystectomy occasionally requires four access ports increasing its complexity to a measurable degree. Nissen fundoplication, however, requires five access ports and proved to be the most complex of the procedures to adapt successfully to solo surgery utilizing robotic arm enhancement. Phase II of our study has involved the use of a combination of technologically complex and sophisticated technology to improve outcomes in complex laparoscopic procedures. The head-mounted display, the robotic arm, and the harmonic scalpel have been used in 140 complex minimally invasive procedures; the procedures were laparoscopic spine surgery (24 cases), laparoscopic gastric surgery (28 cases), and laparoscopic colon resection (88 cases). The use of these sophisticated technologies added safety, improved versatility, and did not increase the length of the operative procedures. The use of multiple technologies had an additive effect on the benefits. There were no experiences in which the technologies contributed to a technical complication or an adverse result for the patients. However, the successful use of these technologies requires an in depth educational experience for the surgeon and for the operating room team. In a further effort to improve efficiency and control of the visual fields during minimally invasive surgery, we have implemented a prototype voice activation, head-directed control, and instrument tracking by robotic arm enhancement in order to control the visual field through computer programming. Prototype voice activation and deactivation also allows instruments to be used in the visual field for the surgical procedure while not being used for tracking of the visual field. Tracking with the instrument utilizing a color-coded tracking system, and the head-directed control system have both been 100% effective in our hands, have not induced errors in technical performance of procedures, and have shortened the time required for performance of specific procedural tasks. Further, this process improves versatility for the surgeon, increases concentration, reduces fatigue and does not interfere with the position of the surgeon. Areas for improvement which have been observed utilizing these techniques are (1) the use of appropriate and consistent voice activation terminology, (2) the proper positioning of the instrument tracking unit in the most appropriate locations on the video screen and on the instrument within the visual field, and (3) the appropriate use of head-directed control of the robotic arm. We have concluded from these experiences that the robotic technology will continue to reduce costs and minimize risk for patients undergoing minimally invasive surgical procedures; moreover, safety, versatility, and diminished use of resources will accrue utilizing the additive benefit of sequential sophisticated technologies requiring a simultaneous educational
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PMID:Robotic arm enhancement to accommodate improved efficiency and decreased resource utilization in complex minimally invasive surgical procedures. 1017 47

The purpose of this study was to monitor the progress of patients given a permanent colostomy for colorectal carcinoma and to evaluate the need for nursing interventions or referral. A pretested semistructured interview schedule was used. Interviews were conducted at 1 week, 1 month, 6 months and 1 year after discharge. Complete data sets were obtained from 112 patients. In this study it was found that survival was strongly related to Dukes' staging system. More than half of those surviving to 1 year suffered fatigue, one in 10 had severe pain and one in five had parastomal hernia. At each interview approximately one in four people required intervention and one in 10 were referred. This study demonstrates the need for home visits and sustained patient contact. High priority should be given to a full benefit analysis of screening programmes, including the considerable costs of aftercare.
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PMID:Continuing care after discharge from hospital for stoma patients. 1183 41

To compare pulmonary effects, postoperative pain and fatigue, morbidity, patient satisfaction, and cost of different anesthetic techniques for inguinal hernia repair, 50 patients were randomized to local and general anesthesia groups (LA and GA). All patients received the same premedications and the same postoperative analgesic regimen. The standardized postoperative analgesic, intramuscular pyroxicam 20 mg, was given to all patients in the recovery room and an additional 20 mg on the same day was given as requested by each patient. Pulmonary function studies and arterial blood gas analysis were performed 1 h prior to the operation and at the postoperative 8th and 24th hours. All patients underwent Lichtenstein's tension-free hernioplasty. Postoperative pain and fatigue were registered 8 h and 24 h after the operation. A questionnaire was filled out by the patients, and they were asked to give grades for the general comfort of the anesthesia and the surgical procedure (1 = worst, 10 = best). Postoperative pulmonary function tests were significantly poorer in the GA group both on 8th- and 24th-hour measurements (P < 0.05). Patients who underwent LA had significantly lower PCO2 and higher PO2 at the postoperative 8th hour (P<0.05). Mean postoperative pain and fatigue scores revealed a significant difference in favor of local anesthesia at only the 8th hour (P<0.05). There were two complications, one in each group (a hematoma in LA and a urinary retention in GA). Patient satisfaction grades were not different in the two groups. We conclude that LA in inguinal hernia repair does not adversely affect pulmonary functions, patients feel less pain, and patient satisfaction is comparable to that with GA.
Hernia 2002 Mar
PMID:Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomized trial. 1209 May 78

In three patients, a woman aged 87 years who presented with signs indicating a myocardial infarction, a man aged 31 suffering from postprandial epigastric pain that suddenly worsened, and a woman aged 60 years with longstanding postprandial pain and recent fatigue due to anaemia, a para-oesophageal hernia was diagnosed. Para-oesophageal herniation is an uncommon disorder accounting for approximately 5% of all hernias at the oesophageal hiatus. They are distinguished from the more common sliding hiatal hernia by a relative preservation of the intra-abdominal fixation of the gastro-oesophageal junction. These patients show that the clinical presentation of para-oesophageal rolling hernias is different from that of sliding hernias. Pathological reflux may occur; though symptoms associated with a relative obstruction of the stomach within the hernia sac, such as dysphagia, are more common. Rare non-specific symptoms such as anaemia and loss of weight are also seen. Adequate therapy differs from that of a sliding hernia and should be individualized: surgical correction is indicated in a healthy patient with a symptomatic para-oesophageal hernia, such as in the last patient. However, when the hernia is incidentally diagnosed or when comorbidity is present, such as in the first patient, a wait-and-see policy is recommended. Only in case of a threatening incarceration, such as in the second patient, is an emergency operation indicated.
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PMID:[The para-esophageal hernia: a rare hiatal hernia requiring a specific approach]. 1522 26

Prosthetic meshes are used as the standard of care in abdominal wall hernia repair. However, hernia recurrences and side effects remain unsolved problems. The demand by health care providers for increasingly efficient and cost-effective surgery encourages the development of newer strategies to improve devices and outcomes. Here, we evaluated whether l-arginine administration was able to ameliorate long-term polypropylene prostheses incorporation into the abdominal wall of Sprague-Dawley rats. Meshes were placed on-lay and continuous l-arginine was administered. In vivo biocompatibility was studied at 7, 25 and 30 days post-implantation. Effectively, l-arginine administration in combination with mesh triggered subtle changes in ECM composition that impinged on critical biochemical and structural features. Lastly, tensile strength augmented and stiffness decreased over the control condition. This could help to restructure the mechanical load transfer from the implant to the brittle surrounding tissues, i.e., impact load and fatigue load associated with mechanical tensions could be distributed between the mesh and the restored tissue in a more balanced manner, and ultimately help to reduce the incidence of loosening, recurrences, and local wound complications. Since the newly formed tissue is more mechanically stable, this approach could eventually be introduced to human hernia repair.
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PMID:Improved surgical mesh integration into the rat abdominal wall with arginine administration. 1609 79

The use of prosthetic mesh is the current acceptable standard for the repair of hernias. Recurrence rate has been greatly reduced since Lichtensen in 1986 first described mesh repair of inguinal hernias. The most common complication arising from inguinal hernia repair even with mesh is recurrence. There are isolated reports of migrated mesh in the three decades of mesh use in hernia repair. We present a case report of a migrated mesh plug presenting with features highly suggestive of an intra-abdominal neoplasm in a 63-year-old man who presented with weight loss, anorexia, fatigue, and a palpable right lower quadrant mass. Work up had revealed a large inflammatory mass involving the cecum and not amenable to percutaneous or colonoscopic biopsy, thus requiring diagnostic laparoscopy. He had a right inguinal hernia repair with mesh 8 years earlier. At diagnostic laparoscopy, an extensive right lower quadrant mass involving the cecum, bladder, and transverse colon and extending to the midline was found, necessitating conversion to open laparotomy and a right hemicolectomy. A mesh plug was found intimately involved with the specimen. Plugs used in inguinal hernia repair rarely migrate. It is rarer still for them to present as a possible colonic mass. This is the first known case report of mesh plug migration presenting as a suspected colonic malignancy.
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PMID:Migrating mesh mimicking colonic malignancy. 1721 20


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