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

Since 6 years, the totally extraperitoneal laparoscopic hernia repair has become our procedure of choice to manage inguinal hernia in adult patients, especially for bilateral hernias and recurrences after classical anterior repair. Between March 1993 and March 1999, 976 patients underwent 1259 hernia repairs by an endoscopic total extraperitoneal approach. A large polypropylene prosthesis (15 x 15 cm) is placed and covers all potential defects. Follow-up on patients ranged from 6 to 79 months (mean, 39 months). Per- and postoperative morbidity and complications were acceptable (8.4%) and included conversion to open surgery (0.4%), bleedings (0.3%), urinary retention (4.2%), seromas (2.7%), neuralgias (0.2%), vague persistent groin discomfort (0.4%), orchitis (0.08%) and sigmoido-cutaneous fistula (0.08%). Recurrence rate so far is 0.1%. This retrospective study shows that the totally extraperitoneal repair for inguinal hernia should have a promising future because of low morbidity and low recurrence rate.
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PMID:Laparoscopic inguinal hernia repair: review of 6 years experience. 1150 89

The results of laparoscopic repair of 281 recurrent inguinal hernias in 260 patients are presented. One hundred sixty-eight totally extraperitoneal (TEP) and 113 transabdominal preperitoneal (TAPP) procedures were performed. Four major complications occurred in the early postoperative period, three of them in the TAPP group. After 2-4 years, the results were controlled by questionnaires and clinical reexaminations, if necessary. Eleven percent of the TAPP patients and 2% of the TEP patients experienced a recurrence. About 20% of the patients reported occasional discomfort and pain in the operated groin. We conclude that laparoscopic herniorrhaphy provides acceptable results in reoperative hernia surgery.
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PMID:Laparoscopic treatment of recurrent inguinal hernias: experience from 281 operations. 1175 37

The inguinal hernia continues to challenge general surgeons as evidenced by the variety of new surgical techniques developed to treat this malady. The persistence of recurrence rates ranging from 0.5% to as high as 20% provides the impetus to find the "best" repair. Surgeons continue to pursue an easy approach to this condition that will provide minimal patient discomfort and low to absent recurrence rates. Open tension-free and laparoscopic repairs have been shown to produce less discomfort and lower recurrence rates than conventional repairs under tension. Some of these repairs are relatively complex and difficult to learn. The use of laparoscopy can add a significant cost to the repair. Rutkow and Robbins described a tension-free technique in 1993 that promised minimal dissection, rapid return to regular activities and low recurrence rates. The plug-and-patch repair has become a very popular method of herniorrhaphy. It is a quick procedure that is relatively easily learned. Since the initial description of the procedure, there have been anecdotal reports in the surgical literature describing an occasional interesting complication of this repair. There have been no comprehensive reviews of these occurrences. It appears that there are a significant number of patients who experience prolonged pain after this operation. Additionally, this plug often will shrink to a degree that results in a recurrence of the hernia. The most important finding of this study is that, as with other surgical procedures, attention to detail must be made to mitigate against adverse events.
Hernia 2001 Sep
PMID:Complications associated with the plug-and-patch method of inguinal herniorrhaphy. 1175 98

The paper presents a new method of surgical access to the small pelvis in which laparotomy is performed by using the transverse incision through both inguinal canals and cutting off the public insertions of the straight muscles of the abdomen. The inguinal canals with the posterior wall were opened according to the Shouldice procedure, and they were closed suturing the public insertions of rectus abdominis, in 8 cases the inguinal canals were repaired by using the Halsted procedure with our modification [1] and in three case our own method was used [2]. From April 28, 1998 to September 06, 2000, 11 operations for rectal carcinoma were performed using this method. Simultaneously, in 5 patients inguinal hernias were repaired. In 6 cases of rectal carcinoma, the abdominoperineal resection of the rectum was performed using the Miles method (in one case accompanied by total hysterotomy, partial ileoectomy and appendectomy, "en bloc"). In 2 cases resection of the rectum using the Hartman method was done. In 2 case the anterior rectal resection by the Dixon method and in another one partial rectalctomy were performed. The abdominal wounds healed by first intension. Among complications showed: difficult healing of the perineal wound was observed in 1 patient, another one required reoperation due to obstruction, in 1 patient inguinal reherniation was found and in another one the hernia around the colostomy occurred. Surgical access suggested by us enables extensive removal of the tissues around the rectum, including adjacent organs (considering easy technical terms), the simultaneous supply of inguinal hernias, in the cases of abdominoperineal resection of the rectum the abdominal anus was created through the left straight muscle of the abdomen, leaving more than 4 cm between a colostomy and an abdominal wound. The low, transverse incision caused only slight surgical discomfort (and patients quickly resumed ambulation) and good cosmetic effect of scar.
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PMID:[New method of abdominal cavity opening in surgery of rectum]. 1177 Mar 14

This paper describes previously unreported, acute inguinal herniation during high +Gz air combat maneuvers. The flight surgeon aircrew member involved incorrectly analyzed the etiology of the abdominal wall discomfort during and immediately after the mission. Several factors contributed to the delayed diagnosis. Surgical exploration and repair revealed larger than expected defects. An open, anterior "tension-free" repair using polypropylene mesh grafts adequately reinforced the muscular and fascial defects. Return to full flight status occurred 4 wk following surgery. Post-operatively, repeat exposures to both a high +Gz flight environment and exertionally induced increased intra-abdominal pressures were well tolerated. Minimal sequelae from the injury and repair resolved within 1 yr of the surgery and did not affect mission capability or lifestyle activities. This article includes a review of hernia repairs and their aeromedical implications, with a discussion of epidemiology, surgical techniques, risk factors, surgical complications and recovery times for return to full activity.
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PMID:High +Gz induced acute inguinal herniation in an F-16 aircrew member: case report and review. 1181 22

A case of spigelian hernia in a 33-year-old woman, diagnosed preoperatively and operated on laparoscopically, is described. Simultaneously, a bilateral femoral hernia without previous symptoms was diagnosed and treated. Goretex dualmesh was used for the spigelian hernia, polypropylene plugs for the femoral hernias, fixation with Goretex sutures and metal coils. Laparoscopic approach for the diagnosis and treatment of rare hernias in the abdominal wall is advocated, because of the diagnostic potential and reduced postoperative discomfort.
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PMID:[Laparoscopic surgery of Spiegelian hernia]. 1189 13

There are three types of lumbar hernia: congenital, acquired, and incisional hernias. Acquired hernia can appear in two forms: the inferior (Petit) type and the superior type, first described by Grynfeltt in 1866. We report endoscopic extraperitoneal repair of a Grynfeltt hernia. A 46-year-old woman presented with a painful swelling in the left lumbar region that had caused her increasing discomfort. The diagnosis of Grynfeltt's hernia was made, and she underwent surgery. With the patient in a left-side decubitus position, access to the extraperitoneal space was gained by inserting a 10-mm inflatable balloon trocar just anteriorly to the midaxillary line between the 12th rib and the superior iliac crest through a muscle-splitting incision into the extraperitoneal space. After the balloon trocar had been removed a blunt-tip trocar was inserted. Using two 5-mm trocars, one above and another below the 10-mm port in the midaxillary line, the hernia could be reduced. A polypropylene mesh graft was introduced through the 10-mm trocar and tacked with spiral tackers. The patient could be discharged the next day after requiring only minimal analgesics. At this writing, 2 (1/2) years after the operation, there is no sign of recurrence. This Grynfeltt hernia could safely be treated using the extraperitoneal approach, which obviates opening and closing the peritoneum, thereby reducing operative time and possibly postoperative complications.
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PMID:Endoscopic extraperitoneal repair of a Grynfeltt hernia. 1197 31

A 71-year-old woman presented with vomiting, abdominal pain and vague right gluteal discomfort. Abdominal ultrasound showed ascites and dilated small bowel loops with peristaltic movement, while transgluteal ultrasound revealed entrapped ascites beneath gluteal muscles and an oedematous, immobile bowel loop trapped between the sacrum and iliac bone with barely visible colour Doppler flow suggestive of an incarcerated sciatic hernia. CT demonstrated similar findings and subsequent surgery confirmed the diagnosis. To our knowledge, this is the first report of a pre-operative diagnosis of incarcerated sciatic hernia on ultrasound.
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PMID:Small bowel obstruction due to incarcerated sciatic hernia: ultrasound diagnosis. 1200 Jun 99

This report describes the technique and early results obtained with a simple laparoscopic intraperitoneal onlay Composix mesh repair for postoperative ventral hernia. Composix mesh is constructed from one layer of polypropylene mesh and another layer of expanded polytetrafluoroethylene (ePTFE). From March 2000 to October 2001, we performed laparoscopic repair of postoperative ventral hernia in 9 patients. Four (44%) of these patients had a history of at least one failed hernia repair. The size of the abdominal wall defect varied from 4 x 5 cm to 10 x 12 cm (median, 8 x 9 cm). In all cases, the Composix mesh (Bard Inc. USA) was stapled to the peritoneal surface of the abdominal wall, leaving the sac in situ. No death occurred as a result of surgery. Intraoperative small bowel injury occurred in one patient (11.1%) for whom surgery was converted to laparotomy and small bowel resection. No infection was observed. The length of hospital stay varied from 5 to 10 days (median, 5.6 days). During the follow-up period of 8 to 15 months (median, 2 months), there was no recurrence of hernia. Laparoscopic Composix mesh onlay repair is a safe, easy, and effective procedure with minimal discomfort and a low early recurrence rate.
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PMID:Laparoscopic intraperitoneal repair of postoperative ventral incisional hernia using Composix mesh. 1265 66

We performed a prospective study to evaluate the feasibility of performing endoscopic total extraperitoneal repair of groin hernia (TEP) under epidural anesthesia in selected patients considered to be at high risk or unfit for general anesthesia. Fifty-eight endoscopic total extraperitoneal hernia repairs were performed in 36 patients between January 1997 and December 1999 under epidural anesthesia since they were considered a high risk or unfit for general anesthesia. All patients received intramuscular diclofenac sodium for preemptive analgesia. Intraoperatively, all were sedated with intravenous midazolam and fentanyl. Endoscopic TEP repair was successful under epidural anesthesia in 33 of 36 patients. In the remaining three patients, the procedure had to be converted to Lichtenstein's repair due to shoulder discomfort experienced by the patients as a result of pneumoperitoneum, which was produced by incidental peritoneal tears during extraperitoneal dissection. Intraoperatively, one patient had bleeding from the inferior epigastric artery, which was controlled with clipping of the artery. The mean operative time was 48 minutes (range, 28-72 minutes) in the TEP group and 94 minutes (range, 84-102 minutes) in the converted group. All the patients received an epidural top-up dose at the end of surgery for postoperative analgesia. All patients were ambulatory the same day. Postoperative pain was assessed by a visual analogue scale (VAS). The mean pain score was 1.2 (+/- 0.8) on discharge in the TEP group. During follow-up, seven patients developed scrotal swelling with cord induration, which was treated conservatively with scrotal support and analgesics. In all patients, resolution was observed within 6 weeks. One patient was detected to have a recurrence 4 months after surgery. Endoscopic TEP repair under epidural anesthesia appears to be safe, technically feasible, and an acceptable alternative in patients who are at high risk or unfit for general anesthesia.
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PMID:Extraperitoneal endoscopic groin hernia repair under epidural anesthesia. 1281 3


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