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

A case of an incarcerated Richter's hernia in a 12-mm trocar site is presented. A 72 year old man underwent laparoscopic herniorrhapy because of a recurrent inguinal hernia. On the sixth postoperative day he developed abdominal pain, nausea, vomiting and abdominal distension. Plain abdominal X-ray showed bowel obstruction. Computed tomography with oral contrast showed herniation of small bowel above the fascia. The patient was immediately reoperated, the intestine was reduced, and the fascial defect at the trocar site closed. Three days later he underwent surgery again due to a small perforation of the small bowel and a persistent fascial defect. The patient had an uneventful postoperative course. Herniation through a trocar site is a rare complication-incarceration extremely rare. We recommend that all fascial defects of 10 mm or more are closed sufficiently.
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PMID:[Richter hernia in trocar site after laparoscopic herniotomy]. 748 3

Intraoperative analgesia was performed using a combination of tramal at a dose of 2-2.5 mg/kg and transcranial electrical stimulation under halothane-nitrous oxide-oxygen mask anesthesia. The study was performed in 12 apparently healthy boys aged 11-13 operated on for II to III degree varicocele. The efficacy of postoperative analgesia was assessed in 68 children aged 8 to 14 subjected to surgery for inguinal and umbilical hernia, varicocele, cryptorchidism. Parameters of central hemodynamics and cardiopolygraphy have been assessed. Intraoperative use of tramal was accompanied by a prompt recovery of the balance between sympathetic and parasympathetic impacts on the heart and stability of central hemodynamic parameters. Postoperative analgesia with tramal is an effective technique enabling a prompt recovery of pain-induced disturbances in the relations between sympathetic and parasympathetic compartments of the autonomic nervous system. Among the adverse events one can name nausea (25%), repeated vomiting (12%) and allergic reactions (1.4%).
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PMID:[Use of tramal during minor surgical interventions in children]. 794 99

To evaluate the symptomatic outcome after laparoscopic cholecystectomy, a standard symptom questionnaire was sent to three patient groups at least 1 year after surgery: 115 patients had undergone laparoscopic cholecystectomy; 200 had undergone open cholecystectomy; and 200 had had inguinal hernia repair. Return of questionnaires was higher after laparoscopic cholecystectomy (100 of 115; 87.0 per cent) than the open procedure (167 of 200; 83.5 per cent) or hernia repair (163 of 200; 81.5 per cent). There was no difference in the number of patients who considered the operation to have cured or improved their preoperative symptoms after laparoscopic cholecystectomy (94 of 100; 94.0 per cent), open cholecystectomy (157 of 167; 94.0 per cent) or hernia repair (154 of 163; 94.5 per cent). Similar numbers considered their operation to have been a success (94.0, 95.2 and 94.5 per cent respectively). The prevalence of abdominal pain, nausea, flatulence, food intolerance and heartburn was similar in all groups of patients following operation. Diarrhoea occurred more often following laparoscopic (6.0 per cent) and open (4.2 per cent) cholecystectomy than hernia repair (1.2 per cent). Patients who underwent laparoscopic cholecystectomy tended to have a higher incidence of nausea or vomiting than those undergoing the open procedure, and consumed significantly more antacids (23.0 versus 12.0 per cent, P < 0.02). Laparoscopic cholecystectomy achieved the same rate of patient satisfaction as open cholecystectomy, with no apparent symptomatic advantage.
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PMID:Symptomatic outcome after laparoscopic cholecystectomy. 840 84

Enteral feedings demonstrably lower the risk of septic complications. However, complications associated with the specific method of enteral feeding may diminish the intended benefits. The objective was to determine the short and long-term complications associated with needle catheter jejunostomy (NCJ). All NCJs placed at a Level I trauma center over an 8-year period were reviewed. Short-term complications directly attributable to NCJ were defined as tube leakage with intraabdominal or intraparietal spillage, intraabdominal abscess, small bowel obstruction at the catheter site, tube blockage or dislodgement, or soft tissue infection. Telephone interviews were conducted to elicit long-term complications, including operations to correct a complication of the NCJ, chronic nausea, vomiting, diarrhea, bloating, hernia, or change in appetite. Of 122 study patients, short-term complications (N = 22) included two abscesses, one bowel obstruction, two abdominal wall infections, three leaks, one local soft tissue infection, one enterocutaneous fistula, three blocked catheters, and nine tube dislodgements. Fifty patients were contacted by telephone; 19 had long-term complications, including two operations for adhesions. Complications associated with NCJ are common, may be life-threatening, and may require surgical intervention. In many cases, other methods of enteral feeding access may be preferable to NCJ.
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PMID:Analysis of complications and long-term outcome of trauma patients with needle catheter jejunostomy. 854 Jun 44

Postoperative pain may be a significant reason for delayed discharge from hospital, increased morbidity and reduced patient satisfaction with ambulatory hernia surgery. This study compared two postoperative oral analgesic protocols after day case inguinal hernia repair; 30 mg morphine sulphate (MST) and 10 mg metoclopramide every 8 h for 48 h or 75 mg diclofenac twice daily for 48 h. The pain reported in the MST group was significantly greater on both the day of operation and the first postoperative day (P < 0.05, Mann-Whitney U test). A significantly higher proportion of patients taking MST complained of nausea on the day of operation and on the 1st postoperative day (P < 0.05, chi 2). The time taken to walk, dress and leave home alone were achieved in a significantly shorter duration in patients taking diclofenac. We conclude that diclofenac provides effective analgesia, has a more acceptable side-effect profile than morphine sulphate and is the treatment of choice after ambulatory hernia surgery.
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PMID:Comparison of diclofenac sodium and morphine sulphate for postoperative analgesia after day case inguinal hernia surgery. 913 50

A 22-year-old woman presented with left subcostal pain and nausea. A radiograph and a computed tomographic scan of the chest revealed diaphragmatic hernia. Thoracoscopic surgery was performed. The herniated organs were put back into the peritoneal cavity and the hernial hilum was closed with interrupted silk suturing.
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PMID:Thoracoscopic repair of diaphragmatic hernia. 872 3

Case 1, a 9-year-old woman, was admitted to our hospital because of nausea, vomiting, and epigastralgia. Diagnosis of Bochdalek hernia was made by the unusual course of naso-gastric tube. At surgery through the left posterorateral thoracotomy, the herniation of the stomach, small intestine, and colon to the thoracic cavity through the dorsolateral defect of the diaphragm were revealed. Case 2, a 35-year-old man, was admitted to our hospital because of dyspnea. Similar diagnosis was made by the examination of upper G1 series and barium enema, which demonstrated the presence of multiple loops of the small intestine and colon in the left thoracic cavity. Their postoperative courses were uneventful. Most of Bochdalek hernia is observed in infancy, and adolescent or adult case is is rarely reported (approximately 10% of all cases). Since this often misdiagnosed as pleuritis or pulmonary tuberculosis, a cautious examination is necessary for the establishment of the correct diagnosis.
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PMID:[Two cases of the congenital posterolateral diaphragmatic hernia were reported]. 899 51

Ropivacaine is a new, long-acting local anaesthetic, prepared as a single enantiomer (the S form). Ropivacaine has a pKa of 8.07, a protein binding of approximately 94%, but a lower lipid solubility than bupivacaine. Extensive animal toxicological studies have shown a lower propensity for cardiotoxicity with ropivacaine than with bupivacaine. Studies in sheep have shown that the systemic toxicity of ropivacaine is not enhanced by gestation. Studies in human male volunteers have shown that ropivacaine is associated with at least 25% less CNS and cardiovascular adverse effects than bupivacaine following use of intravenous infusions of either drug at a rate of 10 mg/min, to a maximum dose of 150 to 250 mg. With its lower toxicity, especially cardiovascular toxicity, and less intense motor blockade, ropivacaine may have advantages over bupivacaine in epidural pain relief during labour. In general, comparative studies have shown ropivacaine and bupivacaine to have similar efficacy, but ropivacaine has a greater degree of separation between motor and sensory blockade than bupivacaine when it given epidurally for epidural pain relief during labour (as intermittent doses or continuous infusion) or for caesarean section. A significantly lower rate of instrumental deliveries and significantly higher neurological and adaptive capacity scores in neonates at 24 hours were noted for following epidural relief during labour with ropivacaine in a meta-analysis of 6 studies comparing this agent with bupivacaine. Ropivacaine is also of great interest when used as an epidural infusion for postoperative analgesia. There are a few studies evaluating epidural infusions of ropivacaine 0.1%, 0.2% or 0.3% (10 ml/h for 21 hours) after upper or lower abdominal or orthopaedic surgery, and epidural infusion of ropivacaine 0.2% (6 to 14 ml/h) after orthopaedic surgery. The studies show that ropivacaine provides postoperative pain relief in a dose-related manner with minimal or a low degree of dose-related motor blockade. Recommended doses of ropivacaine given epidurally to control postsurgical pain or labour pain are 20 to 40 mg as a bolus with 20 to 30 mg as a top-up with an interval > or = 30 minutes. Alternatively, ropivacaine 2 mg/ml (0.2%) can be given as a continuous epidural infusion at a rate of 6 to 14 ml/h (lumbar) or 4 to 8 ml/h (thoracic). Epidural ropivacaine 0.2% provides a good level of analgesia with minimal motor block, but the effects of a combination of ropivacaine and an opioid administered epidurally could have potential and need to be investigated. Preoperative or postoperative subcutaneous wound infiltration, during cholecystectomy or hernia repair, with ropivacaine 100 to 175 mg has been shown to be more effective than placebo and as effective as bupivacaine in reducing wound pain. The adverse effects associated with epidural administration of ropivacaine include hypotension, nausea, bradycardia, transient paraesthesia, back pain, urinary retention and fever. In comparative studies of ropivacaine and bupivacaine, the 2 drugs appear to be associated with a similar incidence of similar types of adverse effects excluding cardiovascular and CNS toxicities which are lower with ropivacaine. In conclusion, ropivacaine is effective for pain relief during labour and in the postoperative period. Ropivacaine is associated with less cardiovascular and CNS toxicity than bupivacaine and provides a greater degree of dissociation between sensory and motor effects producing less intense motor blockade and more rapid recovery to full patient mobilisation.
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PMID:Preliminary risk-benefit analysis of ropivacaine in labour and following surgery. 924 93

A 38-year-old female was admitted to Shonai Hospital with severe abdominal pain and nausea after playing at a tug of war in the athletic meeting. The X-ray film showed air above the left diaphragm, and CT scan and barium enema revealed the incarcerated transverse colon to the left thoracic cavity. Operation was performed through a thoracotomy. Because of no evidence of trauma, the case was diagnosed as adult Bochdalek hernia. Repair could be done by direct suture and her postoperative course was uneventful.
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PMID:[Adult bochdalek hernia after playing at a tug of war]. 933 May 23

Paraduodenal hernias have traditionally been treated by conventional laparotomy. We report the first case of a left paraduodenal hernia treated laparoscopically. A 44-year-old man was admitted with abdominal pain and nausea. Computed tomography and an upper gastrointestinal series with small-bowel followthrough showed accumulation of the small bowel on the left side of the abdomen. A laparoscopic repair was performed. The small bowel was observed beneath a thin hernia capsule. Approximately 1.5 m of jejunum was easily reduced into the abdominal cavity. The hernia orifice (5-cm diameter) was closed intracorporeally with five interrupted sutures. Good exposure of the operative field is critical to this procedure; poor exposure may limit the applicability of the laparoscopic approach. This minimally invasive operation is currently indicated in nonobstructive paraduodenal hernias, especially on the left.
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PMID:Laparoscopic repair of a paraduodenal hernia. 941 3


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