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

Laparoscopic repair is considered by many to be the operation of choice for a recurrent hernia. The aim of this study was to compare long-term outcome of laparoscopic and open preperitoneal repair of recurrent groin hernias. All patients operated on by one surgeon for recurrent groin hernia between January 1994 and December 2001 were reviewed. Forty-five percent had their data collected prospectively, while in 55% the data was collected retrospectively. Over the study period 128 patients underwent repair of a recurrent groin hernia of whom 99 had either a laparoscopic or open preperitoneal repair. The mean age was 60 years (range 15-88), 93 were men while 6 were women. Forty-five had their hernia repaired laparoscopically while 54 had an open preperitoneal repair. Patients have been followed for a median of 5 years (range 2-9 years). There has been no recurrence in either group of patients. Two patients in the laparoscopic group and four in the open group suffered from chronic groin pain. One patient in either group developed a Hydrocele that was dealt with surgically. Laparoscopic and open preperitoneal repair of a recurrent groin hernia are associated with similar long-term outcomes.
Hernia 2006 Apr
PMID:Laparoscopic or open preperitoneal repair in the management of recurrent groin hernias. 1634 24

Herniography has been used for 25 years in the diagnosis of occult herniation but has not gained widespread acceptance in the UK, despite studies confirming its high sensitivity and specificity for occult hernias and an excellent record of safety and patient acceptability. The traditional approach in the UK to suspected occult groin herniation has been surgical exploration. This study examined the use of herniography in a single district general hospital to assess its impact in limiting unnecessary groin explorations and allowing discharge of patients without hernias. The case notes of 90 successive patients referred for herniography by the department of general surgery in a single UK district general hospital over an 18-month period were reviewed. Eighty-seven completed examinations were analysed in which 23 hernias were diagnosed in 20 patients. Thirteen patients have undergone hernia repair with resolution of symptoms. There were no false positive examinations, although two inguinal hernias were incorrectly diagnosed radiologically as femoral hernias; there were two false negative examinations where additional hernias were found at laparoscopic repair. There were no reported complications. Twenty-four patients were discharged directly from the surgical clinic after a negative herniogram. Thirty patients were referred to other specialities. No patient had undergone groin exploration after a negative herniogram. Herniography is a useful tool in assessing obscure groin pain and potential occult herniation. It can reliably rule out the presence of a hernia and avoid the need for surgical exploration. Many patients with a negative herniogram can be reassured and discharged, whilst others may be referred on to other specialities safe in the knowledge that an occult hernia has been excluded.
Hernia 2006 Mar
PMID:Is herniography useful? 1685 22

Though groin pain is common, the differential diagnosis is broad, and narrowing down the diagnosis of an inguinal hernia can be challenging. Once a hernia is diagnosed, play becomes limited based on severity of symptoms and physician and patient comfort, and the athlete should be closely monitored for worsening symptoms. Several surgical approaches are available for the repair of inguinal hernias, but without knowing the true natural history of this disorder, it is difficult to know when it is appropriate to have a hernia repaired.
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PMID:Inguinal hernias: value of preparticipation examination, activity restriction decisions, and timing of surgery. 1652 79

The aim of the study was to evaluate whether the surgical treatment reserved for the ilioinguinal, iliohypogastric and genital branches of the genitofemoral nerves, during open hernia mesh repair, is effective in reducing chronic post-operative pain. A multicentre prospective study involving 11 Italian Institutions led to the recruitment of 973 cases of hernioplasty. All surgeons were asked to report whether or not each nerve had been identified and preserved or divided. The main endpoint of the study was the evaluation of moderate-severe chronic pain at 6 months and 1 year. Overall, presence of groin pain at 6 months and 1 year follow-up was 9.7% and 4.1%, respectively. Pain was mild in 7.9% and moderate-to-severe in 2.1% at 6 months, and mild in 3.6% and moderate-to-severe in 0.5% at 1 year. Univariate and multivariate analysis showed that lack of identification of nerves is significantly correlated with presence of chronic pain, the risk of developing inguinal pain increasing with the number of nerves not detected. Likewise, division of nerves was clearly correlated with presence of chronic pain. The present findings indicate that identification and preservation of nerves during open inguinal hernia repair reduce chronic incapacitating groin pain.
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PMID:[Chronic pain after inguinal hernia mesh repair: possible role of surgical manipulation of the inguinal nerves. A prospective multicentre study of 973 cases]. 1672 6

Groin pain is a common and often frustrating problem in athletes who engage in sports involving kicking, rapid accelerations and decelerations, and sudden direction changes. The most common problems are adductor strain, osteitis pubis, and sports hernia. Other causes must be considered, including nerve pain, stress fractures, and intrinsic hip pathology. There is significant overlap and multiple problems frequently coexist. Accurate diagnosis leads to directed treatment, with rehabilitation focused on functional closed-chain strengthening and core stability.
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PMID:Groin pain in athletes. 1706 96

The athletic hernia is an obscure condition of uncertain etiology commonly seen in soccer and rugby players. The pain is often debilitating and may place an athletic career at risk. Treatment failures are frustrating to the athlete and the physician. The anatomy involved, diagnostic criteria, and treatment modalities are inconsistently described in the medical, surgical and orthopaedic literature. There is no evidence-based consensus available to guide decision-making. We performed an overview of the anatomy and pathoanatomy and a systematic review of the literature to gain insight into the disease and its treatment. Most studies are Level IV. The most common operative finding is a deficient posterior wall of the inguinal canal, although other abdominal wall abnormalities are frequently found. Open and laparoscopic repairs produce excellent results, but the latter allows earlier return to play. Magnetic resonance imaging appears to have excellent diagnostic potential for athletic hernia. A multidisciplinary approach to groin pain in the athlete is recommended.
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PMID:The athletic hernia: a systematic review. 1714 62

We report a case of epididymal microlithiasis that was diagnosed sonographically in a 75-year-old man undergoing scrotal sonographic examination to investigate right groin pain associated with an inguinal hernia. The sonographic appearance was that of multiple comet-shaped foci of microcalcification throughout both epididymides, with associated comet-tail artifacts. The testes had normal appearance with no evidence of testicular microlithiasis. The patient subsequently remained well after hernia repair. To our knowledge, epididymal microlithiasis has only previously been reported in a cadaveric study; the authors of that study hypothesized that the condition is caused by aging, with ischemia likely implicated in the pathogenesis. There are many other patterns of extratesticular calcification, including sperm granuloma, hematoma, and chronic epididymitis. We discuss how these differ in appearance from epididymal microlithiasis. Epididymal microlithiasis is a completely separate entity from testicular microlithiasis and should be recognized and dismissed by sonographers and radiologists.
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PMID:Sonographic appearance of epididymal microlithiasis. 1737 89

Sportsman's hernia (SH) is a controversial cause of chronic groin pain in athletes. Most commonly seen in soccer and ice hockey players, SH can be encountered in a variety of sports and in a variety of age groups. Although there are several reports of SH in women, it is almost exclusively found in men. SH is largely a clinical diagnosis of exclusion. History of chronic groin pain that is nonresponsive to treatment should raise suspicion of SH, but physical examination findings are subtle and most diagnostic tests do not definitively confirm the diagnosis. Conservative treatment of SH does not often result in resolution of symptoms. Surgical intervention results in pain-free return of full activities in a majority of cases.
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PMID:Sportsman's hernia. 1737 39

Chronic groin pain is a common symptom experienced by soccer players, resulting in many athletes undergoing prolonged periods of conservative treatment. In a high proportion of these cases, however, the cause of groin pain is due to impalpable hernias, thus nullifying the usefulness of a conservative approach. Of the current surgical procedures for inguinal hernia repair, the Lichtenstein technique is widely used. The present study aims to evaluate the efficacy of mesh fixation with human fibrin glue (Tissucol) in open, tension-free inguinal repair, in the treatment of soccer players with groin hernia. A sutureless Lichtenstein technique was employed in 16 consecutive soccer players with primary groin hernia. Inguinal nerves were prepared and preserved. Human fibrin glue was used for mesh fixation, in place of conventional sutures. Results were rated as excellent in all cases, with no reported intra- or postoperative complications. All patients were discharged 4 - 5 h after the operation, and all returned to full pre-injury level sporting-activity, on average, 31 days (range 24 - 42 days) post surgery. This study confirms the efficacy of sutureless tension-free hernia repair with human fibrin glue for the treatment of soccer players suffering from chronic groin pain due to impalpable groin hernia.
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PMID:Sutureless tension-free hernia repair with human fibrin glue (tissucol) in soccer players with chronic inguinal pain: initial experience. 1749 95

Groin pain is a common entity in athletes involved in soccer, ice hockey, Australian Rules football, skiing, running, and hurdling. An increasingly recognized cause of groin pain in these athletes is a sports hernia, an occult hernia caused by weakness or tear of the posterior inguinal wall, without a clinically recognizable hernia, that leads to a condition of chronic groin pain. The patient typically presents with an insidious onset of activity-related, unilateral, deep groin pain that abates with rest. Although the physical examination reveals no detectable inguinal hernia, a tender, dilated superficial inguinal ring and tenderness of the posterior wall of the inguinal canal are found. The role of imaging studies in this condition is unclear; most imaging studies will be normal. Unlike most other types of groin pain, sports hernias rarely improve with nonsurgical measures; thus, open or laparoscopic herniorrhaphy should be considered.
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PMID:Sports hernia: diagnosis and therapeutic approach. 1766 70


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