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

We present a retrospective study of 40 consecutive patients admitted with umbilical herniae to Mpilo Central Hospital between January 1990 and December 1993. The majority of the patients 95 pc (38/40) were children and only 5 pc (2/40) were adults. The study included 18 males and 22 females giving a M:F ratio of 1:1,2. In children the age range was from 1 month to 13 years with 63 pc (24/38) occurring in the zero to five year age group. The commonest indication for admission was obstruction of the umbilical hernia in 37.5 pc (15/40) of cases. Other indications included: large umbilical hernia 30 pc (12/40), recurrent discomfort and peri-umbilical pain 20 pc (8/40), incidental finding in patients admitted for some other problem 7.5 pc (3/40), one case of recurrent hernia and one case of accidental injury. Spontaneous reduction of obstructed umbilical herniae occurred in 86 pc (13/15) of cases and operative reduction was carried out in 14 pc (2/15) of cases. There was no mortality recorded in this series. It is clear from our findings in this study that obstruction of the umbilical hernia in children in our practice although relatively uncommon, is a well recognised surgical emergency. On the basis of our findings we would recommend that prophylactic umbilical hernia repair should be performed in all girls over two years of age and in all children over four years of age.
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PMID:Umbilical hernia in Bulawayo: some observations from a hospital based study. 785 74

The study was designed to investigate the incidence of abdominal wall hernias (AWH) and related outcome in all end-stage renal disease (ESRD) patients who started peritoneal dialysis (PD) from January 1989 to December 1993. Between January 1989 and December 1993, a total of 158 ESRD patients (93 male, 65 female) entered our home program and were treated with peritoneal dialysis (PD) over 2789 patient-months. All PD catheters were placed in the lateral by two dedicated surgeons. AWH detected at the time of PD catheter placement was repaired simultaneously. The hernia repair was done using a polypropylene mesh. Inguinal hernias were noted by patients as a mass or discomfort. Umbilical and incisional hernias were observed during clinic visits. Twenty-one (13.3%) abdominal wall hernias were observed in 20 patients (12.7%). Eight (38.1%) inguinal hernias occurred in 8 male patients. Six inguinal hernias were repaired. PD was resumed after a mean of 12 days of hernia repair. Two patients resumed PD in 8 and 14 days without dialysis. One patient transferred to hemodialysis (HD) due to catheter malfunction. No complications occurred related to inguinal hernias. Ten (47.6%) umbilical hernias were observed in 10 patients (7 male, 3 female). The strangulation of umbilical hernias occurred in 2 patients, which required emergency small bowel resection and hernia repair. Both cases were complicated by candida peritonitis and enterobacter peritonitis, requiring PD catheter removal, and patients were then transferred to HD. Three (14.3%) incisional hernias were observed in 3 male patients. Two incisional hernias were repaired. No relation between AWH and PD modalities (CAPD/CCPD/IPD) was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Abdominal wall hernias in ESRD patients receiving peritoneal dialysis. 799 71

Tolerance to inguinal hernia repair under local anesthesia was prospectively evaluated in a consecutive series of 41 patients who underwent hernia repair with local infiltration of 0.75 per cent lidocaine. Intraoperative discomfort was measured by an analog visual scale. All complications were also recorded. Mean intraoperative pain was mild (1.6 +/- 1.4). There were two complications. Wound infection and wound hematoma occurred in one patient each. There was no operative mortality. Normal diet was tolerated the day of surgery in 39 patients, and 30 were discharged from the hospital on the same day. Our series supports good tolerance and a low complication rate when inguinal herniorrhaphy is performed under local anesthesia.
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PMID:Inguinal herniorrhaphy under local anesthesia: a study of intraoperative tolerance. 803 Aug 19

A 65-year-old male complaining dyspnea on exertion and epigastric discomfort was diagnosed to have left traumatic diaphragmatic hernia elsewhere and referred to Keio university Hospital for treatment. He had thoracicio-abdominal trauma which was conservatively treated, 40 years ago. Because he was symptomatic and the possibility of future strangulation could not be denied, surgical repair of the hernia was performed. The defect in the diaphragm was too large to be directly sutured and it was repaired with GORE-TEX patch. The gastric fundus partially prolapsed in the paraesophageal region, but the diaphragm was repaired quite satisfactorily otherwise. Pulmonary function and dyspnea on exertion improved.
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PMID:[A case of traumatic diaphragmatic hernia repaired 40 years after the injury]. 819 53

Perineal hernia after abdominoperineal extirpation of the rectum is a rare condition. The most common symptom is perinea/discomfort and bulging. This condition most often develops within a year after extirpation of the rectum. In order to prevent perineal hernia great effort should be taken when closing the peritoneum and the muscular layer towards the pelvic cave. Several repair operations have been proposed in the literature. The authors recommend a transabdominal approach, possibly with interposition of a synthetic mesh. If the perineal skin is damaged, a combined approach with both transabdominal and perineal access should be used.
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PMID:[Perineal hernia after rectal extirpation]. 823 55

The authors present their experience with operations of 264 inguinal hernias in 238 subjects where Lichtenstein's technique was used. The principle of the operation is reconstruction of the posterior wall of the inguinal canal by means of a synthetic mesh-tension free. The attained results in this group (L) were compared with a control group of 68 operated patients (group C) where the classical McVaye technique was used. They did not find a difference in the time taken up by the operation or the time of hospitalization. The postoperative mortality was 0.4% in group L and 2.9% in group C, the morbidity was 15.5% and 42.6% resp. So far they did not record a case of relapsing hernia or rejection of the mesh. The operation is easy to perform, economically unpretentious, the postoperative pain is milder and the sensation of discomfort slighter than after the classical operation. With regard to the assembled experience, the authors recommend the new operation not only in inguinal but also other types of hernias where tension free repair is impossible. For reconstruction they use polyester mesh CHS 100 manufactured by the Hosiery Research Institute in Brno.
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PMID:[The Lichtenstein "tension free" operation for inguinal hernia]. 825 53

Since its introduction, laparoscopic inguinal hernia has been plagued with multiple technical problems. A series of 131 laparoscopic inguino-femoral hernia repairs is presented. The technique used was an original transabdominal pre-peritoneal approach using a SurgiPro mesh with two technical variations. In the beginning, this procedure was only offered to patients less than 50 years of age. These guidelines were eliminated as the study progressed. For our first 10 cases, our average operating time was 1 hour and 39 minutes. For the last 40 cases, it averaged 63 minutes. All but four patients were discharged the same day. Ninety-six per cent of all patients felt minimal pain or discomfort within 72 hours. Four per cent felt pain or discomfort until the tenth post-operative day. All patients were ambulatory the day of surgery, and 94 per cent of all patients resumed regular activities before the tenth postoperative day. No significant morbidity and no mortality were identified with the exception of five postoperative inguinal seromas, which were successfully aspirated. No recurrence was demonstrated, but this series is clearly insufficient to establish a rate of recurrence. The cost of these procedures appeared to be higher than for a conventional repair; however, it has recently been reduced. The procedures remain difficult, but the rate of recovery for these patients is shown to be significantly improved. The superiority of this procedure over its open counterpart has not yet been proven.
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PMID:Laparoscopic inguinal hernia repair results: 131 cases. 825 36

Conventional hernia repair is effective in terms of cure but is associated with considerable postoperative pain and delay in return to normal activity. Laparoscopic repair has the potential to reduce pain and speed return to normal activity, but there have been few published reports of the outcome of this operation in the UK. We present a prospective audit of 94 patients who underwent laparoscopic repair. Of the 94 patients, 87 (92.6%) were male and 7 (7.4%) were female. Thirteen of the repairs were bilateral and 12 were recurrent. Two had to be converted to open repair. The mean operating time for unilateral repair was 56 min and for bilateral repair 98 min. Sixty-three patients (67%) were discharged within 24 h and 21 (22.4%) were discharged within 48 h. There were minor complications in 20 patients (21%), eight of whom (8.5%) developed a haematoma. The other minor complications included seromas (2), bruising at the site of the entry port (2), hyperaesthesia in the groin (2), port hernia (1), shoulder tip pain after surgery (3) and postoperative urinary retention (2). Nine (9.5%) patients claimed to have had no pain or discomfort at all; 35 (37.2%) were pain and discomfort free in 2 weeks. Thirty-two (34%) patients returned to normal activities in 2 weeks. With a median follow-up of 8 months 3 (3.2%) recurrences were noted. It is emphasised that this series represents a learning curve and that the operation is developmental. We are now restricting laparoscopic repair to recurrent and bilateral hernias where the technique offers particular advantages.
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PMID:Laparoscopic hernia repair in Leicester General Hospital: a prospective audit of 94 patients. 871 51

A follow-up series of 509 transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repairs is presented. The technique used was an original TAPP approach using a SurgiPro Mesh with two technical variations. Age restrictions were removed after the first few cases; thereafter, all patients cleared for general anesthesia were entered into this study without restrictions. Our average operating time was 48 minutes for unilateral hernia repairs. All procedures were outpatient procedures with the exception of 11 overnight admissions for urinary retention. The procedure was well tolerated. Ninety-three per cent of all patients reported minimal pain or discomfort within 72 hours. All patients were instructed to resume unrestricted physical activities within 24 to 48 hours after the procedure; 89 per cent were able to resume activities within 5 days, 94 per cent within 7 days, and 97 per cent within 10 days. No significant morbidity nor mortality were reported, with the exception of two postoperative neuropathies. Nineteen patients developed postoperative seromas that were successfully aspirated. One recurrence has been reported to date. Due to the lack of long term follow-up, these results remain inadequate to establish an accurate recurrence rate. This procedure remains technically difficult and is subject to a learning curve, but the rate of recovery for these patients is significantly improved. In conclusion, the superiority of this procedure in comparison to its open counterpart cannot be proven until long term follow-up becomes available.
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PMID:Transabdominal preperitoneal laparoscopic inguinal herniorrhaphy: results of 509 repairs. 881 69

The two widely practised laparoscopic groin hernia repairs are: a) trans-abdominal preperitoneal (TAPP) and b) trans-extraperitoneal preperitoneal (TEPP) approaches. Early results are encouraging with both the techniques being associated with low recurrence rates (0% to 2%) comparable to the best, reported for standard open repair (Shouldice and Lichtenstein's). Other complications are higher in the beginning following laparoscopic hernia repair compared to the conventional method. These complications are related to the learning curve and expected to come down significantly with increasing experience of surgeons. Laparoscopic repair of recurrent groin hernia appears to be considerably superior to the conventional technique. The recurrence rates following conventional repair of recurrent groin hernias are between 1.5% and 35% (Table I) compared to none for laparoscopic repair of recurrent inguinal hernias. The disadvantages of laparoscopic repair include greater technical difficulty, higher incidence of serious complications and increased cost. Sutured open repair is associated with high postoperative discomfort, greater difficulty of repairing recurrent hernia with higher societal cost (due to prolonged time-off from work for 12% to 57% of patients operated for various open technique-Table II). The techniques of laparoscopic hernia repairs are nearly standardised today. Laparoscopic surgeons have an obligation to offer the new alternative and to ensure that it is safely used. Laparoscopic repair is another technique used for the repair of inguinal hernias, which is going to stay as a safe and effective alternative to open repair as the learning curve is over. There is an urgent need to have well-designed prospective randomised trials in the near future.
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PMID:Laparoscopic hernia repair--what are the results? 892 18


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