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

The prescription of peritoneal dialysis should be individualized based on parameters of tolerance and adequacy. Determination of the intraperitoneal fill volume is essential for optimal patient care. Fill volume enhancement is a factor of exchange surface area recruitment: the wetted, contact peritoneal dialysis membrane. Nevertheless, fill volume enhancement can also lead to patient discomfort, with the potential risk of too high an intraperitoneal pressure (hernia, gastro-esophageal reflux). The perception of the individual patient is also a subjective parameter of fill volume tolerance assessment. In contrast, measurement of the hydrostatic intraperitoneal pressure (IPP, cmH(2)O) allows an objective approach to fill volume tolerance. From our clinical experience of more than 10 years of IPP measurements in child care, we can give a recommendation for normal values in children: less than 18 cm of water, usually between 5 and 15 cm, correlated to the intraperitoneal fill volume (naturally), but individually taking into account age, gender, "accustomization" and overall body mass index.
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PMID:Measurement of hydrostatic intraperitoneal pressure: a useful tool for the improvement of dialysis dose prescription. 1289 79

Transabdominal sutures (TAS) used for mesh fixation in laparoscopic ventral hernia repair (LVHR) are an occasional source of prolonged postoperative pain. We sought to analyze the incidence of TAS site pain and the efficacy of local treatment methods. A retrospective review of patients who underwent LVHR from January 1999 to August 2002 was performed to identify patients experiencing suture site pain. Patients were considered candidates for injection therapy if their discomfort lasted 10 days postoperatively. Patient demographics, hernia size, mesh size, and subjective pain intensity were recorded. Treatment consisted of injection circumferentially around the suture site with 0.25 per cent bupivacaine with one to 200,000 epinephrine and 1 per cent lidocaine at the level of the abdominal musculature. Statistical (P < 0.05) significance was determined by chi-square, logistic regression, and analysis of variance. One hundred three patients (42 men and 61 women) with a mean age of 53 years (range 26-78) and weight of 99.8 kg (range 61-239) underwent LVHR. Mean hernia size was 192 cm2 (range 12-450) and mean size of mesh placed measured 534 cm2 (range 100-1200). Twenty-four patients (23%) complained of prolonged discomfort at a transabdominal suture site and were injected postoperatively in the office as described. Of these 58 per cent were female and 42 per cent were male. Logistic regression demonstrated increasing mesh size was the only factor (P < 0.01) that correlated with the need for injection. Twenty-two of 24 patients (92%) undergoing injection therapy had complete relief of their symptoms. Twenty patients required a single injection and two patients required two injections to treat their TAS site pain. After local injection failure two patients were referred to an anesthesia pain service; one underwent intercostal nerve block with complete resolution of pain, while the other is currently in treatment. There were no complications. Suture site pain was present after LVHR in 23 per cent of our patients. Increasing mesh size is associated with a greater chance of suture site pain. It appears to be effectively treated postoperatively with the injection of a local anesthetic at the TAS site. The mechanisms by which short-duration anesthetics relieve chronic pain are not fully understood.
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PMID:Local injection for the treatment of suture site pain after laparoscopic ventral hernia repair. 1295 27

This retrospective study of 142 consecutive males operated on, including the learning-curve period, is aimed at evaluating the long-term outcome (>3 years) of Lichtenstein hernia repair. The response rate was 95%. One recurrence (0.7%) and one femoral hernia occurred. Pain persisted more than 2 weeks in 26% of patients, more than 3 months in 8%, and after 3 years in 4%. The corresponding figures for discomfort without need for analgesics are 49, 14, and 11%. Paresthesia persisted over 1 year in 9%. Morbidity due to extensive section of the cremaster muscle and shooting nuisance during ejaculation occurred in four patients. The mean social inactivity period was 3.2 weeks, the time to work resumption 5.4 weeks. The Lichtenstein hernioplasty proved to have a low recurrence rate and immediate morbidity, but the prevalence of chronic pain or discomfort are not to be underestimated.
Hernia 2003 Dec
PMID:Long-term follow-up after Lichtenstein hernioplasty in a general surgical unit. 1530 84

Prosthetic reinforcement is now routine in the management of inguinal hernia, and it significantly reduces the risk of recurrence. However, there may be postoperative pain and discomfort of late onset, the intensity of which appears to be related to the rigidity of the material and its ability to integrate with tissues. We have evaluated the results of implantation with beta glucan-coated polypropylene mesh both objectively (early recurrence) and functionally (pain and quality of life). The mass of the coated mesh is reduced by 50% compared to a typical polypropylene implant. Beta glucan is an entirely natural plant product that eliminates the risk of viral or prion contamination associated with the use of collagen of animal origin. One hundred fifteen patients with a mean age of 55 years with a primary or recurrent inguinal hernia were treated with a prosthesis (Glucamesh). Fifty-eight patients underwent a Lichtenstein procedure, and 57 had a laparoscopic procedure (TEP, TAPP). Mean operative time was 40 min. There was no mortality, and morbidity was 8.6%. At 3 months follow-up, no recurrences were observed. The characteristics of the prosthesis were considered to be good or excellent in 93.9-100% of cases. Residual postoperative pain (analogue pain score less than 2) occurred in 4.3% of cases at day 15 and in 2.7% at day 90. The quality-of-life health score of the SF36 questionnaire preoperatively and postoperatively showed a significant improvement ( P<0.05) in the scores and a quality of life equivalent to healthy control subjects. This prosthesis is associated with a rapid and significant resolution of postoperative pain and a quick return to normal activity with an improved quality of life. In addition, the plant origin of the prosthesis eliminates any risk of viral or prion contamination.
Hernia 2004 Feb
PMID:Inguinal hernia repair with beta glucan-coated mesh: prospective multicenter study (115 cases)--preliminary results. 1368 Mar 4

Ideal technique for effective inguinal hernia repair is still controversial. Although open tension free mesh techniques of inguinal hernia repair offers good results but the superiority of laparoscopic technique was reported for postoperative pain, discomfort and earlier return back to work. A prospective, randomized study was conducted to compare Lichtenstein open tension free mesh technique with the laparoscopic totally extraperitoneal technique. 62 male patients with Lichtenstein open tension free mesh technique and 61 male patients with totally extraperitoneal technique were operated and compared postoperatively. The patients were followed-up for 24 months with a median of 18 months. In terms of recurrence, postoperative pain, analgesic requirement, complications, hospital stay length, duration of limitation of normal daily activities there were no significant differences between the two groups. Operating time for totally extraperitoneal hernia repair was 16 minutes longer than Lichtenstein open tension free technique. The totally extraperitoneal technique was considerably expensive than Lichtenstein technique, however the duration of returning back to work was shorter in patients repaired with totally extraperitoneal technique. In conclusion in primary inguinal hernia repair Lichtenstein technique should be preferred and the totally extraperitoneal technique should be considered for recurrent and bilateral hernias.
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PMID:A prospective randomized study of Lichtenstein open tension-free versus laparoscopic totally extraperitoneal techniques for inguinal hernia repair. 1465 37

The primary radiologic evidence of intra-abdominal hernia is disturbance of normal small intestine arrangement. Loops of intestine are crowded together as if in a bag, giving the appearance of clumping or sacculation. Dilatation and loss of mobility may occur with varying degrees of stasis. Displacement of viscera or pressure deformity may be observed. Studies of the small bowel are necessary to demonstrate these conditions and must be made with the patient in the erect as well as the horizontal position. Repeated studies may be required, and the best time to make them is during an acute attack, as the hernia may be temporarily reduced during a remission. The clinical symptoms are sufficiently characteristic to suggest the diagnosis in most cases. The usual history is of repeated attacks of abdominal pain or discomfort, usually accompanied by distention, varying in periodicity and intensity, with or without nausea or vomiting, and not accompanied by laboratory data or clinical signs indicative of inflammatory disease. Similar or identical clinical and roentgenologic evidence may be produced by torsion of the small bowel or by peritoneal adhesions. The hernia or torsion may reduce spontaneously before or at the time of operation. Therefore, a careful search for abnormal fossae, mesenteric defects or adhesive bands is necessary if herniation or torsion is not found.
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PMID:Roentgen diagnosis of intra-abdominal hernia. 1479 74

This report describes the cases of two patients who underwent laparoscopic repair for treatment of Morgagni-Larrey hernia at United Hospital Center in Clarksburg. The first patient was a 40-year-old woman complaining of epigastric discomfort and tenderness. Her chest X-ray revealed an anterior cardiophrenic mass, and a CT scan showed a characteristic Morgagni hernia with incarcerated colon and omentum. After reduction of the incarcerated bowel and omentum, autosuture repair was carried out laparoscopically In the second case, a 22-year-old man with severe GERD was found to have a large Morgagni hernia with incarcerated transverse colon and omentum, which was discovered while he was undergoing an elective laparoscopic Nissen fundoplication. Laparoscopic repair of Morgagni hernia was carried out, in addition to Nissen fundoplication. Both patients did very well postoperatively. Minimally invasive laparoscopic repair can be successfully carried out, and mesh implantation is performed only in some cases. In order to avoid pleural injury, we prefer not to remove the hernia sac before a Morgagni hernia is repaired. Laparoscopic repair should be considered the standard and safest procedure for the treatment of a Morgagni hernia.
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PMID:Laparoscopic treatment of Morgagni-Larrey hernia. 1511 91

Spigelian hernia repair techniques use prostheses both in the traditional and the videolaparoscopic approach; only in selected cases direct suturing of the parietal defect is performed. The aim of this study is to describe a technique that uses a device proposed specifically for inguinal hernias, but which has not yet been described in the literature, namely the Prolene Hernia System (P.H.S.). Our personal experience consists of 7 cases (5 females and 2 males; mean age: 58 years) operated on from January 2002 to May 2003. Four patients were operated on in the ordinary hospitalisation regime with selective spinal anaesthesia and three patients were treated in the day surgery setting with local anaesthesia. With this technique, the underlay patch is positioned in an adequately prepared preperitoneal space and the onlay patch above the internal oblique muscle, while the connector acts as a plug positioned in the parietal defect. The method has proved simple, safe, and fast. It causes minimal discomfort to the patient in terms of postoperative pain and allows rapid rehabilitation. Moreover, it can also be performed in the day surgery setting. The authors conclude that the P.H.S. Spigelian hernia repair technique is a valid alternative to any of the other methods used to date.
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PMID:The treatment of Spigelian hernia with the Prolene Hernia System: notes on techniques. 1515 21

Breast reconstruction using the lower abdominal free superficial inferior epigastric artery (SIEA) flap has the potential to virtually eliminate abdominal donor-site morbidity because the rectus abdominis fascia and muscle are not incised or excised. However, despite its advantages, the free SIEA flap for breast reconstruction is rarely used. A prospective study was conducted of the reliability and outcomes of the use of SIEA flaps for breast reconstruction compared with transverse rectus abdominis musculocutaneous (TRAM) and deep inferior epigastric perforator (DIEP) flaps. Breast reconstruction with an SIEA flap was attempted in 47 consecutive free autologous tissue breast reconstructions between August of 2001 and November of 2002. The average patient age was 49 years, and the average body mass index was 27 kg/m. The SIEA flap was used in 14 (30 percent) of these breast reconstructions in 12 patients. An SIEA flap was not used in the remaining 33 cases because the SIEA was absent or was deemed too small. The mean superficial inferior epigastric vessel pedicle length was approximately 7 cm. The internal mammary vessels were used as recipients in all SIEA flap cases so that the flap could be positioned sufficiently medially on the chest wall. The average hospital stay was significantly shorter for patients who underwent unilateral breast reconstruction with SIEA flaps than it was for those who underwent reconstruction with TRAM or DIEP flaps. Of the 47 free flaps, one SIEA flap was lost because of arterial thrombosis. Medium-size and large breasts were reconstructed with hemi-lower abdominal SIEA flaps, with aesthetic results similar to those obtained with TRAM and DIEP flaps. The free SIEA flap is an attractive option for autologous tissue breast reconstruction. Harvest of this flap does not injure the anterior rectus fascia or underlying rectus abdominis muscle. This can potentially eliminate abdominal donor-site complications such as bulge and hernia formation, and decrease weakness, discomfort, and hospital stay compared with TRAM and DIEP flaps. The disadvantages of an SIEA flap are a smaller pedicle diameter and shorter pedicle length than TRAM and DIEP flaps and the absence or inadequacy of an arterial pedicle in most patients. Nevertheless, in selected patients, the SIEA flap offers advantages over the TRAM and DIEP flaps for breast reconstruction.
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PMID:Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAM and DIEP flaps. 1545 15

The aim of this study was to compare the rate and characteristics of postoperative neuralgia after 2 methods of inguinal hernia repairs. Between July 1997 and December 2000, 400 inguinal hernia repairs were performed and followed up in a prospective trial about postoperative nerve irritations: 200 patients with laparoscopic transabdominal hernioplasty (TAPP group), and 200 patients with tension-free hernia repair using Lichtenstein's technique (LICH group). We applied a clinic protocol of data about pain location, neuralgia characteristics, and period of time until the patient was completely pain free. The global rate of nerve irritation in the study was 7.6% (30 cases); in the TAPP group, it was 5.5% (n = 11) and in the LICH group, it was 9.5% (n = 19) (P = .03). The genitofemoral nerve was affected with particularly high frequency (4.3% in the global series); although in laparoscopic repair, the lateral cutaneous nerve of the thigh (LFC) was most damaged (3.3% in TAPP group). We observed more persistent symptoms in LICH group, while in TAPP group the most of cases was transitory (P = .08). There were no significant differences in pain characteristics according to clinical type of hernia. The TAPP method causes less rate of postoperative inguinal neuralgia than Lichtenstein repair, emphasizing more persistent discomfort in anterior approach than laparoscopic repair.
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PMID:Inguinodynia after two inguinal herniorrhaphy methods. 1547 50


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