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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A series of 80 patients with an incisional ventral hernia were treated with an extractable prosthesis in the period 1 January 1965--1 January 1974. The results are discussed. After a description of the advantages of an extractable prosthesis, attention is given to a number of factors which are possibly of importance in the development of such a hernia. This is most probably a multifactorial process, in which suturing technique, wound infection, obesity and postoperative rise of intra-abdominal pressure may play a part. The technique of inserting the extractable prosthesis is accurately described and illustrated with drawings and photographs. Success was ultimately obtained in 86.25% of the cases. The failure rate was 13.75%. In comparison with the data from the literature, this is a low percentage, the more so because the author's series consisted mainly of large incisional hernias. Recurrences can be treated successfully several times with an extractable prosthesis. This is, in general, easy in view of the smaller dimensions of the hernial orifices. The extractable prosthesis is recommended both for the treatment and prevention of incisional ventral hernia.
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PMID:Results of treatment of incisional hernias with extractable prostheses. 12 32

Displacement of the right kidney, simulating crossed renal ectopia, was associated with massive obesity and a ventral hernia.
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PMID:Renal displacement simulating crossed renal ectopia. 72 85

Mass closure of midline incisions with a running large-bore permanent monofilament polypropylene suture has been used in general surgery and gynecology patients with a reported small incidence of fascial dehiscence. Late-occurring wound sinus formation is one problem reported with the use of this permanent suture material. Over a 22-month period, 285 patients had midline incisions closed with a continuous, running no. 1 polyglyconate monofilament delayed absorbable suture. Closely spaced bites (about 1.5 cm apart) were taken and placed 2 cm lateral to the fascial edge. Over 60% of the patients had surgery because of gynecologic cancer. Other high-risk factors included obesity in 62%, diabetes in 19%, and previous irradiation or chemotherapy in 22%. An ovarian cancer staging procedure was done in 16% of the patients. Of the remaining patients, almost half had extensive operative procedures that ranged from exenterations to hysterectomies with lymph node dissection. Wound complications were noted in nine patients (3.2%). Seven had superficial infections, one had an evisceration, and one developed a ventral hernia. Wound sinuses did not occur. The closure technique is safe and expedient and distributes tension equally over a continuous line. It has the additional advantage of eventual absorption of the suture material, thereby avoiding the wound sinus problems occasionally reported with large-bore permanent sutures.
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PMID:Primary mass closure of midline incisions with a continuous polyglyconate monofilament absorbable suture. 221 39

A silicone collar containing circumferential tape was tied around the cardio-esophageal junction in eight patients with symptomatic, refractory reflux, who were not good candidates for a standard antireflux procedure. A fine polypropylene tie or clip secured the knot. In two patients with large hiatal defects, the crura were approximated loosely. Mean operating time, including one cholecystectomy and one ventral hernia repair, was 51 minutes. Patients who underwent this simple operation had a combination of hypertension, heart disease, obesity and old age, and two had undergone horizontal gastroplasty previously for morbid obesity. The reflux was associated with hiatal hernia in seven of the eight patients. Preoperative studies included barium swallow roentgenography in all eight patients, and endoscopy, manometry and Bernstein test in six. All the studies were repeated postoperatively. Follow-up ranged from 17 to 48 months (mean 37.8 +/- 10.6 months). Postoperatively, there was a significant (p less than 0.01) improvement in symptoms, endoscopic findings and lower esophageal sphincter pressures. No prosthesis has migrated yet.
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PMID:The Angelchik antireflux prosthesis. 397 Dec 43

A new method of laparoscopy have been designed: a laparoscope is introduced through a ventral hernia. The method can be used in patients with contraindications for a regular laparoscopy. Umbilical hernia with the hernia orifice less than 3 cm is a contraindication for "herniolaparoscopy". The method was used in 32 patients, including 17 patients with the acute cholecystitis. In 12 patients besides of umbilical hernia there were other contraindications, including postoperative scarring, obesity etc. There were no any complications with the use of the new method. In all cases pneumoperitoneum was preserved till the end of a procedure.
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PMID:[Method of laparoscopy in ventral hernia]. 875 20

This study included 125 women with specific complaints following tubal ligation. In most instances the ligations had been done 7 years previously, mostly for multiparity. 92% had been ligated by the abdominal route 88.8% had symptoms including menstrual irregularities, chronic pain, obesity, psychoses, intermittent acute retention of urine, ventral hernia, and 2 cases of sterilization failure. Average age at time of tubectomy had been 31 years; average parity, 3-4. There was a shift towards right in mean maturation index of cervical cells soon after sterilization. This shift then decreased for a year, then gradually rose, stabilizing at 12 years. Amenorrhea was present in 5 cases with high mean maturation levels. 17 cases of oligomenorrhea all showed ahigh estrogenic activtiy. Of 27 cases of menorrhagia endometrial biopsies were taken in 13. 12 showed the proliferative phase and 1 the secretory phase. These findings correlated with cytological findings, but cervical mucus in 3 cases did not coincide. Of the 27 cases 21 were anovular. In all the karyopyknotic index was high. 2 cases showed clinical evidence of inflammation. Of 10 cases of dysmenorrhea, 3 were ovulatory; inflammation was present in 3. In 12 cases of polymenorrhea 7 showed high estrogenic activities. In 1 a polyp had caused the irregular bleeding. The observed shifts of maturation index of cervical cells toward the right are considered indicative of hyperovarian activity. Results show that ovarian activity after sterilization by tubectomy was normal or increased. The increased activity was considered either psychological,neurovascular, or caused by inflammation. Of the 10 cases with inflammation, 9 were associated with menstrual disorders.
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PMID:Menstrual disorders after sterilization with special reference to ovarian activity. 1225 47

The authors take a treated clinical case as a starting point to consider lateral ventral hernia, generally referred to as "Spigelian hernia". Such hernias are rare (1-2% of all hernias), with a slightly higher incidence in the female sex. Obesity and multiparous status are known to be predisposing factors. Instrumental tests of great importance in terms of specificity and definition such as ultrasonography and computed tomography are available, in cases of diagnostic doubt, for a pathology that in any case has to be detected early in order to avoid possible complications. The treatment is essentially surgical. A personal variant of the surgical repair technique is described with the use of prosthetic material, which guarantees a better result in terms of strength and resistance compared to simple repair surgery.
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PMID:Spigelian hernia: a rare lateral ventral hernia. 1555 47

The objective of this study was to determine the molecular bases of disordered hepatic function and disease susceptibility in obesity. We compared global gene expression in liver biopsies from morbidly obese (MO) women undergoing gastric bypass (GBP) surgery with that of women undergoing ventral hernia repair who had experienced massive weight loss (MWL) following prior GBP. Metabolic and hormonal profiles were examined in MO vs. MWL groups. Additionally, we analyzed individual profiles of hepatic gene expression in liver biopsy specimens obtained from MO and MWL subjects. All patients underwent preoperative metabolic profiling. RNAs were extracted from wedge biopsies of livers from MO and MWL subjects, and analysis of mRNA expression was carried out using Affymetrix HG-U133A microarray gene chips. Genes exhibiting greater than twofold differential expression between MO and MWL subjects were organized according to gene ontology and hierarchical clustering, and expression of key genes exhibiting differential regulation was quantified by real-time-polymerase chain reaction (RT-PCR). We discovered 154 genes to be differentially expressed in livers of MWL and MO subjects. A total of 28 candidate disease susceptibility genes were identified that encoded proteins regulating lipid and energy homeostasis (PLIN, ENO3, ELOVL2, APOF, LEPR, IGFBP1, DDIT4), signal transduction (MAP2K6, SOCS-2), postinflammatory tissue repair (HLA-DQB1, SPP1, P4HA1, LUM), bile acid transport (SULT2A, ABCB11), and metabolism of xenobiotics (GSTT2, CYP1A1). Using gene expression profiling, we have identified novel candidate disease susceptibility genes whose expression is altered in livers of MO subjects. The significance of altered expression of these genes to obesity-related disease is discussed.
Obesity (Silver Spring) 2009 Aug
PMID:Hepatic gene expression in morbidly obese women: implications for disease susceptibility. 1926 96

With the rise in prevalence of obesity, most general surgeons will have to face the problem of the obese patient with an abdominal wall defect. Treatment of these bariatric patients raises unique challenges, and at this time there is still no consensus on the best treatment option. This study was performed in a high-volume bariatric and minimally invasive surgery center at a tertiary care facility in the USA. Twenty-eight morbidly obese patients treated at our facility between 2003 and 2008 were separated into four groups according to anatomic features and symptoms. Patients with the following characteristics were classified as having a favorable anatomy: body mass index not exceeding 50 kg/m(2), gynecoid body habitus, reducible hernias found in a central location, abdominal wall thickness less than 4 cm, and the defect's largest diameter not exceeding 8 cm. All other patients were classified as having an unfavorable anatomy. In this study, we report a systematic treatment approach for the morbidly obese patient presenting with a ventral hernia based on whether the hernia is symptomatic or asymptomatic, as well as the distinct characteristics of the hernia and body habitus features. We followed up on these patients postoperatively for at least 2 years, with a mean follow-up period of 30 months. Only a total of three hernia recurrences were observed. Successful treatment of ventral hernias in morbidly obese patients should be individualized based on the patient's symptoms and defined hernia characteristics.
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PMID:Ventral hernias in morbidly obese patients: a suggested algorithm for operative repair. 2469 15

The optimal technique for complex ventral hernia repair (VHR) remains controversial. Component separation (CS) reinforced with porcine acellular dermal matrix (PADM) has shown favorable results compared with series of conventional bridged VHR, but few comparative studies exist. We conducted a retrospective cohort study comparing 40 randomly selected patients who underwent CS/PADM reinforcement against an identical number of patients who underwent conventional open VHR with mesh at our institution. Patient characteristics, operative findings, outcomes, complications, reoperations, and recurrences were obtained by chart review. Fisher's exact/t test compared outcomes between the two cohorts. Statistical significance was set as P < 0.05. Mean follow-up was 33.1 months. Patient groups did not differ significantly in race (P = 1.00), age (P = 0.82), body mass index (P = 0.14), or comorbid conditions (smoking, chronic obstructive pulmonary disease, obesity, steroid use; P values 0.60, 0.29, 0.08, and 0.56, respectively). Defect size was greater in the CS/PADM group (mean, 372.5 vs 283.7 cm(2), P = 0.01) as was the percentage Ventral Hernia Working Group Grade III/IV hernias (65.0 vs 30.0%, P = 0.03). Recurrences were lower in the CS/PADM group (13.2 vs 37.5%, P = 0.02). Mesh infection was lower in the CS/PADM group (0 vs 23% in the bridged group, P = 0.002), all of which occurred with synthetic mesh. Indications for reoperation (recurrence or complications requiring reoperation) were also lower in the CS/PADM group (17.5 vs 52.5%, P = 0.002). Superior results are achieved with CS/PADM reinforcement over traditional bridged VHR. This is evidenced by lower recurrence rates and overall complications requiring reoperation, particularly mesh infection. This is despite the greater use of CS in larger defects and contaminated hernias (VHWG Grade III and IV). CS/PADM reinforcement should be strongly considered for the repair of significant midline ventral hernia defects.
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PMID:Component separation with porcine acellular dermal reinforcement is superior to traditional bridged mesh repairs in the open repair of significant midline ventral hernia defects. 2510 88


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