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

The interneural incision has clearly been demonstrated to be efficient, being executed rapidly and providing excellent exposure to the right upper abdominal quadrant. The postoperative period is marked by less subjective complaints; decreased narcotic requirements, and increased ease of walking, coughing and deep breathing. The result is improved pulmonary toilet and a negligible incidence of pulmonary complications. At long term observation, there is a scar which is cosmetically preferable, without neuroma or hernia formation and with no complaints of numbness or paresthesias in the area of the incision. For all these reasons, we have concluded that the interneural incision is superior, in the appropriate anatomic situation, than is either a vertical or subcostal incision for biliary tract operations.
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PMID:The interneural incision for biliary tract operations. 9 41

Intermittent clinical manifestations, the representative one of which is claudication, can be classified into two types; neurogenic and vasculogenic. Although cauda equina lesions are well known as a neurogenic cause, spinal disorders, especially cervical or thoracic cord lesions, have been paid more attention to by several authors recently. We encountered a 42-year-old man with cervical soft disc hernia and ossification of longitudinal ligament, who showed intermittent rectal dysfunction evoked by walking. This peculiar clinical manifestation successfully disappeared after surgical decompression of the spinal cord. Such an interesting case has not been reported in the world literature. The patient was admitted because of numbness in both hands. Neurological examinations on admission showed neither motor weakness nor abnormally increased tendon reflex. Hypesthesia and hypalgesia were noticed below the Th4 dermatome on both sides. Adding to those symptoms, he complained of fecal incontinence evoked by walking 100 meters. This rectal dysfunction became gradually worse. At last he showed fecal incontinence after walking only 10 meters. This was ten days after his admission. Myelogram and computed tomographic scan revealed a cervical soft disc hernia at the C5/6 level and findings of OPLL at the C5 and C6 level. Anterior cervical approach for OPLL and soft disc was used for bone graft insertion from the C4 to the C7 vertebral body. The rectal dysfunction completely disappeared after the operation. The possible mechanisms of intermittent rectal dysfunction evoked by walking were discussed.
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PMID:[A case report of cervical disc hernia presenting fecal incontinence evoked by walking; spinal intermittent rectal dysfunction]. 157 69

We conducted a prospective study to evaluate early complications and complaints of 60 patients who underwent laparoscopic transperitoneal hernia repair at our institution. Average follow-up was 9 months. Patients graded levels and duration of postoperative pain subjectively. Nine patients (15%) had complications of anterior/medial thigh numbness, 4 (6.7%) scrotal swelling, 4 (6.7%) scrotal ecchymosis, 3 (5%) hematoma, 2 (3.3%) prolonged sensation of tightness/pressure, 1 (1.7%) seroma, 1 (1.7%) urinary retention, and 1 (1.7%) pain with intercourse. Twenty-six (43%) had no postoperative complaints. Overall, 57 (95%) stated they were satisfied with their repair and would recommend the laparoscopic technique. Fifty-five patients (92%) returned to basic activities of daily living in less than 2 weeks. Thirty-five (73%) of the 48 patients who were employed returned to work within 3 weeks. In comparison, only 7 (29%) of 24 patients in an open hernia repair group resumed normal activity during the first 2 postoperative weeks, and only 3 (14%) of the 21 employed patients in this group returned to work at 3 weeks. The laparoscopic and traditional open herniorrhaphy methods were compared in terms of operating room time and cost. The average unilateral laparoscopic repair (n = 51) cost $3,094 and lasted 81 minutes. Bilateral laparoscopy procedures (n = 9) averaged $3,774 and 110 minutes. Unilateral traditional hernia repairs (n = 24) had an average cost of $1,990 and duration of 69 minutes. In follow-up ranging from 2 to 28 months, there has been only 1 recurrence to report in the laparoscopic group (1.7%). All patients continue to be followed to determine long-term recurrence risks.
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PMID:Early complications and outcomes of the current technique of transperitoneal laparoscopic herniorrhaphy and a comparison to the traditional open approach. 808 67

Thoracic disc herniation is a rare and slowly progressive disease which most commonly occurs at the lower thoracic spine without any preceding trauma. We reported a case with acutely developed vesicorectal dysfunction due to a ruptured disc at Th 11-12. This symptom disappeared soon after disc removal via the transpedicular approach combined with transversectomy. This 45-year-old woman suddenly suffered, without previous trauma, from severe back pain radiating down to the posterior thighs. Since difficulty in urination and defecatory incontinence succeeded two days later, she was transferred to our hospital. Neurological examination on admission revealed anesthesia below S1, hypotonic bladder with almost perfectly preserved urinary sensation, complete lack of anal reflex, and only weak motor function in the lower extremities. Both knee and ankle jerks were diminished bilaterally. A herniated disc was initially suspected at L5-S1 on the MRI, but denied by both myelography and CT myelography. These studies showed a disc hernia compressing the cord at Th 11-12 on the left side. Since the hernia was located centrolaterally, we employed the transpedicular approach. To make removal of the more centrally located hernia easier, we further added transversectomy of the twelfth vertebra. This hernia was successfully removed under the operating microscope without further damage to the cord being incurred. We did not perform any instrumental fixation, because we thought preservation of the rib and costvertebral joint could contribute to the stability of the spine. Her vesicorectal symptom subsided immediately after the operation. She was free of any symptoms except for the remaining mild perianal numbness a year and seven months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Lower thoracic disc herniation with acutely developed vesicorectal dysfunction: case report]. 832 56

A 61-year-old woman began to suffer bronchial asthma in 1985. She then developed low back pain and numbness along the lower extremities, eventually leading to bilateral drop foot in 1990. At that time, she was diagnosed as having lumbar disc hernia, and extirpation of the discs at the L3-4 and L4-5 was performed. However, her clinical condition showed little improvement. Six months later, she was emaciated and bedridden with distal dominant muscular atrophy in all four limbs, purpura in the left leg and hypereosinophils. Motor conduction velocity (MCV) was not detected in the peroneal nerves. The toes gradually became cyanotic, and a skin biopsy from the cyanotic region revealed necrosis in the vessels surrounded by infiltration of a large number of neutrocytes and lymphocytes. She was diagnosed as having mononeuritis multiplex due to allergic granulomatous angiitis (AGA), which is characterized by bronchial asthma, hypereosinophilia and necrotizing vasculitis. Thirty mg/day prednisolone was then administered. However, the toes and calcaneal areas gradually became necrosed. Finally, amputation of both feet was necessary. We concluded that an early diagnosis of this syndrome is most important, and corticosteroids should be administered early.
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PMID:Peripheral neuropathy in allergic granulomatous angiitis. 933 54

The EU Hernia Trialists Collaboration was established to provide reliable evaluation of newer methods of groin hernia repair. It involved 70 investigators in 20 countries. The aim was to perform systematic reviews and enhance the value of individual studies by reanalysis of data from randomised controlled trials in meta-analyses. Forty-one eligible trials of laparoscopic versus open groin hernia repair were identified involving 7161 participants (with individual patient data available for 4165). Meta-analysis was performed, using individual patient data where possible. Operation times for laparoscopic repair were longer and there was a higher risk of rare serious complications. Return to usual activities was faster, and there was less persisting pain and numbness. Hernia recurrence was less common than after open non-mesh repair but not different to open mesh methods. The review showed that laparoscopic repair takes longer and has more serious complications, but recovery is quicker with less persisting pain. Reduced hernia recurrence was related to the use of mesh rather than the method of mesh placement.
Hernia 2002 Mar
PMID:Laparoscopic versus open groin hernia repair: meta-analysis of randomised trials based on individual patient data. 1209 May 75

Choice of anesthesia for inguinal hernia repair remains a controversial topic. Local anesthesia has been described in the literature as the optimal technique, however general and spinal anesthesia are commonly used in practice despite well-known complications and side effects. The regional technique of paravertebral block has been successfully used at our institution for the operative treatment of breast cancer. Its attributes are prolonged sensory block with minimization of postoperative pain, reduction of nausea and vomiting, shortened hospital stay, patient satisfaction, and rapid return to normal activities. These features are desirable in the practice of ambulatory hernia surgery; hence we initiated the use of thoracic/lumbar paravertebral block for that surgical procedure. Paravertebral block anesthesia was performed on 30 consecutive patients. Block placement took an average of 12.3 minutes, in six cases repeat injection at one or two spinal levels was required due to incomplete blockade. Paravertebral block achieved effective anesthesia in 28 of 30 cases; conversion to general anesthesia was performed for two failed blocks. We are reporting postoperative data on the 28 completed blocks. Supplementation of intravenous sedation or injection of local anesthesia successfully treated transient intraoperative pain in 10 cases. Epidural extension of anesthesia resulting in lower limb numbness and motor weakness delayed the discharge of two patients. There were no other complications of anesthesia and no cases of urinary retention. TIme to onset of pain averaged 15 hours, while duration of sensory block was 13 hours. Patients were prescribed a standing order of naproxen 500 mg B.I.D. for 4 days regardless of pain; supplemental oral narcotic use during the 48 hours following surgery averaged 3.5 tablets, with 6 patients not requiring any narcotic. ninety-six percent of patients scheduled for ambulatory surgery were discharged from the postanesthesia care unit, with an average stay of 2.5 hours. Employed patients returned to work on day 5.5 (range 3-10 days); patients who were not employed returned to regular activities in 5.8 days (range 1-14 days). Eighty-two percent of patients reported being "very satisfied" with the anesthetic technique.
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PMID:Paravertebral block anesthesia for inguinal hernia repair. 1265 86

Inguinal hernia repair, according to Lichtenstein, is very popular due to its minimal invasiveness (local anaesthesia), easy and reproducible technique, low recurrence rate, and low morbidity. However, recent publications demonstrate an elevated rate of chronic irritations and pain, probably due to tension or nerve compression by the fixing sutures. We, therefore, established a concept to avoid these sutures by attaching the prosthesis with glue. After a pilot study, a randomised prospective trial was started. The aim of our study was to compare the results of the classical Lichtenstein repair (group 1) vs the "Sutureless Lichtenstein" (group 2) in terms of postoperative complications and recurrences. Operative access and management of the hernial sac was equal to Lichtenstein for both groups. In group 1, we sutured the mesh with PDS 2/0; in group 2, the mesh was glued with n-butyl-cyanoacrylate. In both groups, the operation was then completed according to Lichtenstein, and unrestricted activity was allowed after 2 weeks. A total of 46 patients have been operated on. The follow-up results at 3 weeks and [3 months] were: group 1 ( n=24) vs group 2 ( n=22): recurrences 0 [0] vs 0 [0], minor pain 8 [4] vs 4 [1], local numbness 14 [10] vs 10 [6]. No adhesive-related complications were seen. Patients will be followed for 2 years. The results in group 2 were excellent, and there was no difference vs group 1. Furthermore, there was a tendency for better results in group 2. These results are very promising and justify a continuation of the study.
Hernia 2003 Jun
PMID:Sutureless Lichtenstein: first results of a prospective randomised clinical trial. 1529 Jun 15

Chronic postoperative inguinal pain syndromes are potentially debilitating sequelae following elective inguinal hernia repair. Diagnosis and definitive treatment constitute challenging issues for both the surgeon and the patient. In this prospective trial, we evaluated the impact of elective iliohypogastric and ilioinguinal nerve resection on the incidence of pain, numbness, and sensory loss following anterior, "tension-free" herniorrhaphy. One hundred ninety-one patients were enrolled and were reviewed 1 month, 6 months, and 1 year postoperatively. Pain, numbness, or any loss of sensation were recorded and categorized on a "mild," "moderate," or "severe" scale. No persistent pain syndrome was encountered. Numbness was found in 9.42% of the patients at the first month and in 6.28% of the patients after 1 year. Sensation loss (1.04%) was never bothersome or incapacitating at the end of the follow-up period. Elective neurectomy is safe to perform, well tolerated by patients, and is not associated with chronic postoperative inguinal pain.
Hernia 2004 Feb
PMID:Elective neurectomy during open, "tension free" inguinal hernia repair. 1458 77

Endoscopic hernia repair methods have become increasingly popular over the past 15 years. The postulated main advantages of the endoscopic technique are less postoperative pain, early recovery and lower recurrence rates. Fixation of the endoscopic mesh seems to be necessary to minimize the risk of recurrence. Stapling has been implicated to cause chronic inguinal pain syndromes. We performed a retrospective study on male patients who were endoscopically operated on primary inguinal hernias. Our aim was to clarify whether mesh fixation using a fibrin sealant is as safe and reliable as conventional stapling. Additionally, we compared the prevalence of chronic inguinal pain. A standardized population of 133 male patients (mean age 55.9 years) with 186 (80 unilateral; 53 bilateral) consecutive primary laparoscopic total extraperitoneal inguinal hernia repairs was assigned to two groups, depending on whether stapling or a fibrin sealant had been used for mesh fixation. A retrospective case control study was performed to conduct statistical analysis based on the following parameters: recurrence, complications, chronic inguinal pain, foreign body sensation and numbness. Hernia repairs numbering 173 (staples n=87; fibrin n=86) were followed up for a mean duration of 23.7 (11-47) months. The prevalence of chronic inguinal pain was significantly (P=0.002; Fisher exact test) higher in the stapled group-20.7% than in the fibrin sealant group with a prevalence of 4.7%. In terms of recurrence rate, complications and foreign body sensation, fewer patients were affected in the fibrin group than in the reference population, although the differences were not statistically significant. There were no major complications in either of the groups. The mean postoperative stay in hospital was 1.4 days. Fibrin sealing is as effective as stapling in providing secure mesh fixation. The fibrin group displayed a statistically significant lower prevalence of chronic pain syndromes. Mesh sealing provides adequate fixation and reduces the risk of chronic inguinal pain as a complication of the intervention.
Hernia 2006 Jun
PMID:Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair. 1655 80


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