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Introducción: La hernia lumbar es un tipo muy infrecuente de hernia de la pared abdominal con un reducido número de casos publicados. Puede producirse a través de dos triángulos anatómicos: uno superior o triángulo de Grynfelt-Lesshaft y uno inferior o triángulo de Petit. Presentación del caso: Presentamos el caso de una mujer de 64 años con una tumoración blanda y reductible en la región posterolateral izquierda de la pared abdominal. La tomografía computarizada confirmó la existencia de una hernia lumbar a través del triángulo superior o Grynfelt-Lesshaft. Fue intervenida mediante un abordaje laparoscópico transabdominal en el que tras la reducción del contenido herniario (tejido graso) se colocó una malla de doble capa en posición intraperitoneal. Fue dada de alta a las 24 horas de la intervención sin observarse complicaciones inmediatas. Discusión: Se trata de un tipo muy infrecuente de hernia de la pared por lo que su diagnóstico requiere una alta sospecha clínica y a menudo una confirmación radiológica mediante tomografía computarizada. Conclusiones: La reparación de la hernia lumbar está indicada para evitar posibles complicaciones y puede realizarse tanto por vía abierta como laparoscópica, debiendo incluir la colocación de material prótesico en forma de malla para reducir el riesgo de recidiva.
Introduction: Lumbar hernia is a very rare type of abdominal wall hernia with a small number of published cases. It can occur through two anatomical triangles: an upper one or Grynfelt-Lesshaft triangle and a lower one or Petit triangle. Case presentation: We present the case of a 64-year-old woman with a soft and reducible tumor in the left posterolateral region of the abdominal wall. Computerized tomography confirmed the existence of a lumbar hernia through the superior triangle or Grynfelt-Lesshaft triangle. Patient was operated through a transabdominal laparoscopic approach in which after reduction of hernial content (fatty tissue) a double-layer mesh was placed in an intraperitoneal position. She was discharged 24 hours after the intervention and no immediate complications were observed. Discussion: Lumbar hernia is a very rare type of abdominal wall hernia and its diagnosis requires high clinical suspicion and often radiological confirmation by computerized tomography. Conclusion: Lumbar hernia repair is indicated to avoid possible complications and can be performed with an open or laparoscopic approach. Repair should include a mesh to reduce the risk of recurrence.
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In the past, hernia and abdominal wall surgery has been ignored, which may endanger the life of patients due to untimely treatment. In 1997, the concept of tension-free hernia repair was introduced to China. Chinese hernia and abdominal wall surgery entered a new era and developed rapidly. In 2015, scholars in China decided to create our own Hernia Registry. In 2017, Hernia Registry was officially released, and the Chinese Hernia Surgery Alliance was established in the same period. The Chinese Hernia Registry has became the second largest Hernia clinical registry database in the world. Although the follow-up rate needs to be improved, it is possible to have a preliminary understanding and analysis of the incidence of hernia disease in China. There are many difficulties in its application, and it requires the multi-level coordination and long-term commitment. The authors hope that through this work, the diagnosis and treatment of hernia and abdominal wall can be improved, and the ability of communication and cooperation at home and abroad will be enhanced, benefiting the general population of hernia patients.
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RESUMEN Introducción: el empleo de corticoesteroides es una estrategia eficaz para reducir el dolor postoperatorio. Objetivo: determinar la utilidad de la betametasona en la prevención del dolor postoperatorio en pacientes intervenidos por hernia discal lumbar. Métodos: se realizó un estudio cuasi-experimental en 100 pacientes intervenidos por hernia discal lumbar en el Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro¼, de la provincia de Villa Clara, durante el período de abril de 2013 a diciembre de 2015. Se dividieron en un grupo control y en un grupo estudio; previo a la incisión quirúrgica, se les administró diclofenaco 75 mg endovenoso y 8 mg de betametasona (solo en el grupo estudio). Resultados: el 70 % de los pacientes eran masculinos, y la edad media fue 45,99 años. En el grupo estudio el tiempo de aparición del dolor () y su intensidad, a las 4, 8 y 24 horas, fue significativamente menor que en el grupo control (pα< 0,010, pα< 0,001 y <0,001); el 48 % de los pacientes pudieron levantarse sin dolor, 32 % menos requirieron analgesia de rescate, y el grado de satisfacción fue significativamente mejor. Conclusiones: la administración de betametasona antes de la incisión quirúrgica resultó muy útil en la prevención del dolor postoperatorio en los pacientes intervenidos de hernia discal lumbar.
ABSTRACT Introduction: use of corticosteroids is an effective strategy to reduce postoperative pain. Objective: to determine usefulness of betamethasone in the prevention of postoperative pain in patients operated for lumbar disc herniation. Methods: a quasi-experimental study was carried out in 100 patients operated for lumbar disc herniation at "Arnaldo Milián Castro" Clinico-Surgical University Hospital, in Villa Clara province from April 2013 to December 2015. They were divided into a control group and a study one; prior to surgical incision, intravenous diclofenac 75mg and betamethasone 8mg were administered (only in the study group). Results: 70% of the patients were male, and the mean age was 45.99 years. In the study group, the time of onset of pain () and its intensity, at 4, 8 and 24 hours, was significantly lower than in the control group (pα <0.010, pα <0.001 and <0.001); 48% of the patients were able to get up without pain, 32 % less required rescue analgesia, and the degree of satisfaction was significantly better. Conclusions: administration of betamethasone before surgical incision was very useful in the prevention of postoperative pain in patients operated for lumbar disc herniation.
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Pain, Postoperative , Betamethasone , Hernia , Lumbar VertebraeABSTRACT
Objectives: Gauze remnants form gauzeomas after surgery, if infection has not occurred. We present a case of gauzeoma diagnosed after surgery.Patient: A 72-year-old man noticed a mass in his lower abdomen. He had undergone surgery for left inguinal hernia 21 years ago. A retroperitoneal mass was found on computed tomography (CT) and magnetic resonance imaging (MRI), and he was then referred to our hospital. A detailed abdominal ultrasonography, CT, and MRI revealed a cystic mass with a bulkhead-like structure near the bladder. These findings indicated the possibility of a malignant cyst; hence, an open surgery was performed to excise the mass. Macroscopically, the specimen was clearly bound, covered with a capsule, and filled with pus and had a gauze inside.Results: Based on the patient history and position of the mass, it was diagnosed as gauzeoma, which had strayed into the retroperitoneal cavity during the surgery for inguinal hernia.Conclusion: The imaging findings of gauzeoma are diverse; hence, it is often difficult to diagnose without surgery. However, gauzeoma can be lethal if the cystic mass is infected; thus, it is important to diagnose it correctly.
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Objective To investigate the effect of pre injection of penehyclidine hydrochloride on the airway gland secretion of children with laparoscopic inguinal hernia surgery under general anesthesia.Methods 72 cases of children undergoing laparoscopic inguinal hernia surgery under general anesthesia in pediatric surgery department in our hospital were selected and divided into two groups,grouped by random number table method,control group of 36 cases were treated with preoperative injection of atropine,the experiment group of 36 cases were treated with preoperative injection of penehyclidine hydrochloride.Heart rate on pre injection(T0),before induction of anesthesia(T1),five min after induction(T2),ten min after induction(T3)and extubation(T4),the airway gland secretion,respiratory function related indexes,and the incidence of adverse reactions were compared.Results Compared with the control group,re fixed rate of tracheal tube during operation and the incidence of choking tube at T4 time were lower,the levels of PIP、Raw were lower and the level of CL was higher on five min after intubation,the HR at T1,T2,T3,T4 time was lower,with statistical significance(P<0.05);the incidence of adverse reactions in the control group 30.56％was higher than the experiment group 11.11％,with statistical significance(P<0.05).Conclusion Pre injection of penehyclidine hydrochloride can inhibit airway gland secretion in children with laparoscopic inguinal hernia surgery under general anesthesia,protect the respiratory function,and does not increase heart rate,the safety was higher.
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Objective To evaluate the anesthetic effect and safety of ropivacaine combined with lidocaine caudal block in the treatment of pediatric laparoscopic hernia surgery.Methods A total of 70 cases with pediatric hernia surgery in Ningbo Women and Children’s Hospital from May 2014 to October 2015 in this study were divided into control group and experimental group with 35 cases in each group.The patients in the both groups were given routine examination, preoperative anesthesia induction, adopted 7 scalp injection needles to prick into the hiatus sacralis,patients in control group were treated by 1% lidocaine hydrochloride injection mixed liquid 1 mL/kg;patients in the experimental group were treated by 0.25%lidocaine hydrochloride injection and 0.25% ropivacaine hydrochloric injection mixed liquid 1 mL/kg; pediatric hernia surgery, intraoperative continuous pumped into propofol injection 4-6 mL/kg and maintain the mask to the oxygen.The visual analog pain scored( VAS) , visual satisfaction scored ( VSS) and adverse reactions were compared at the end of operation, after operation 0 h,0.5 h,1 h,2 h,4 h,8 h and 24 h.Results The sensory and motor block effective time in the experimental group were later than the control group, the sensory and motor block duration time were shorter than the control group (P<0.05).VAS score of the experimental group was significant lower than control group after operation 2 h ( P<0.05 ) . After operation, postoperative 0.5 h, postoperative 1 h, the VSS score of the experimental group was significant lower than control group ( P<0.05 ) .Lower limbs numbness discomfort duration time of the experimental group was significant lower than control group after operation ( P<0.05 ) . Postoperative agitation rate of the experimental group 8.57% was significant lower than the control group 34.29% (P<0.05).The incidence of adverse reactions of experimental group 5.71% was significant lower than the control group 25.71% ( P<0.05 ) .Conclusion Ropivacaine combined with lidocaine caudal block in the treatment of pediatric hernia surgery has the remarkable effect, with high safety.
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Objective To compare the security between the sevoflurane anesthesia via laryngeal mask airway (LMA) composited nerve block in groin area and ketamine anesthesia in the pediatric hemioplasty.Methods 80 children (aged 2 -6,weight 10 -25kg,ASAⅠ -Ⅱ)with high ligation of hernia sac were divided into two groups according to the random number table method:group S -sevoflurane combined with inguinal region block under laryngeal airway ventilation;group K -ketamine combined with caudal block.Group S was inhalated with 6% -8% sevoflurane for foundation anesthesia,and then followed with vein induction:fentanyl 2μg/kg and propofol 2mg/kg.The laryngeal mask was placed when the temporomandibular joint was relaxed.Inguinal region was blocked by the surgeon after disinfect and spread towels.Anesthesia was maintained by 3% to 4% sevoflurane with mechanical ventilation interop-eration.Group K was adopted the intramuscular ketamine (5mg/kg)for basic anesthesia and then used modified sacral canal blocking.Ketamine 1mg/kg was administered before skin incision.Additional ketamine 0.5mg/kg was intravenously injected when it was appeared with body move,choking cough,etc.The values of MAP and HR in the two groups were recorded respectively at the time point of 1min before skin cutting (T0 ),1min after skin cutting (T1 ),5min after skin cutting (T2 ),the end of operation (T3 )and awaken time (T4 ).The body movement was observed intraoperation,the number of SpO2≤95% and awaken restlessness,the recovery time and residence time in anesthesia recovery room were recorded.Results The values of MAP in group S at time points of T1 ,T2 ,T3 were (77.6 ±6.2)mmHg,(77.8 ±6.4)mmHg,(76.5 ±4.7)mmHg respectively,and the values of MAP in group K at time points of T1 ,T2 ,T3 were (86.9 ±8.1)mmHg,(88.1 ±5.3)mmHg,(86.4 ±6.5)mmHg respectively.The t values at time points of T1 ,T2 ,T3 were 5.766,7.893,7.806 respectively when the group S compared with group K(P <0.0001),the group S was superior to group K.The values of HR in group S at time points of T1 ,T2 ,T3 were (121.3 ± 9.6)times/min,(121.9 ±8.4)times/min,(120.3 ±7.8)times/min respectively,and the values of HR in group K at time points of T1 ,T2 ,T3 were (138.6 ±9.4)times/min,(136.5 ±7.5)times/min,(128.7 ±6.9)times/min respec-tively.The t values at time points of T1 ,T2 ,T3 were 8.144,8.200,5.101 respectively(P <0.0001),the group S was superior to group K.The MAP and HR were more smoothly in group S than in group K.The recovery time in group S and K was (7.5 ±3.4)min and (16.7 ±5.5)min respectively(t =8.99,P <0.0001),it was shorter in group S than in group K.The residence time in anesthesia recovery room was (15.4 ±4.2)min and (23.7 ±6.3)min respectively (t =6.93,P <0.0001),it was shorter in group S than in group K.Intraoperative body movements was 3 cases and 15 cases respectively in group S and group K(χ2 =10.32,P <0.001);Cases of SpO2 ≤95% was 4 and 12 respec-tively in group S and group K(χ2 =10.32,P <0.001),the occurrence of body movements and SpO2 ≤95% cases was lower in group S than in group K.Conclusion The sevoflurane anesthesia via LMA composited nerve block in groin area has the advantages of faster induction,faster recovery,the hemodynamics was more stable,adverse reactions was fewer and so on,it can be safely used in pediatric anesthesia.
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Summary Objective: all individuals regardless of their age or level of development require physical, emotional and cognitive preparation before an operation. It is known that the attitudes of pediatric nurses towards pediatric patients are influential on the anxiety levels of children awaiting an operation. This study aims to determine the effect of pre-op trainning on the anxiety levels of pediatric patients hospitalized for hernioplasty surgery. Methods: this cross sectional and quasi-experimental study included a total of 100 patients aged 7-12 years admitted for inguinal hernia surgery, 50 of which were the control group and 50 the experiment group. The data was gathered using the patients’ identification forms and a child steady state anxiety scale. Research data was evaluated with appropriate statistical methods. Results: the groups showed similar socio-demographic features and no statistically significant difference was observed (p>0.05). During the pre-op period neither of the groups showed any statistically significant difference in terms of both state and trait anxiety levels (p>0.05), however the experiment group showed a statistically significant drop in their anxiety levels during the post-op period (p<0.05). Conclusion: the state anxiety levels of children receiving a planned pre-op trainning are lower compared to children who did not receive such trainning. Reducing the anxiety levels of sick children is possible through giving visual and tangible information appropriate with the age and developmental level of the sick child during the pre-op period. .
Resumo Objetivo: todo indivíduo, independentemente da idade ou fase de desenvolvimento, requer preparo físico, emocional e cognitivo antes de qualquer operação. Sabe-se que a atitude dos enfermeiros frente ao paciente pediátrico tem influência sobre o nível de ansiedade das crianças que esperam para serem operadas. Este estudo tem como objetivo determinar o efeito do preparo pré-operatório sobre os níveis de ansiedade de pacientes pediátricos hospitalizados para procedimento de hernioplastia. Métodos: este estudo transversal e quase-experimental incluiu um total de 100 pacientes com idade de 7 a 12 anos internados para cirurgia de hérnia inguinal; 50 deles formaram o grupo de controle e os demais 50, o grupo de experimento. Os dados foram colhidos a partir de formulários de identificação dos pacientes e uma escala de estado-traço de ansiedade para crianças. Os dados da pesquisa foram avaliados com os devidos métodos estatísticos. Resultados: os grupos mostraram características sociodemográficas semelhantes e nenhuma diferença estatisticamente significativa foi observada (p>0,05). Durante o período pré- -operatório, nenhum dos grupos apresentou qualquer diferença estatisticamente significativa em termos de níveis de estado de ansiedade ou traços (p>0,05); no entanto, o grupo de experimento mostrou queda estatisticamente significativa dos níveis de ansiedade no período pós-operatório (p<0,05). Conclusão: os níveis de estado de ansiedade das crianças que receberam preparo pré-operatório planejado são mais baixos em comparação com as crianças que não receberam esse treinamento. Reduzir os níveis de ansiedade de crianças doentes é possível quando se oferece informações visuais e palpáveis adequadas à idade e à fase de desenvolvimento da criança no período pré-operatório. .
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Child , Female , Humans , Male , Anxiety/prevention & control , Anxiety/psychology , Preoperative Care/psychology , Case-Control Studies , Cross-Sectional Studies , TurkeyABSTRACT
El conocimiento de los biomateriales es una obligación de los cirujanos en la actualidad, debido al uso cada vez más aceptado de estos en los procedimientos quirúrgicos. De hecho, los resultados obtenidos con los implantes: cifras de recidivas muy bajas y número mínimo de complicaciones, lo demuestran. La introducción en Cuba de la malla Surgimesh® desarrollada por la compañía Aspide Medical, con características físico-químicas de polipropileno que proporcionan efectos óptimos, motivó a realizar esta revisión bibliográfica sobre el tema.
The knowledge of biomaterials is nowadays compulsory for surgeons, due to the increasingly acceptance in their use in the surgical procedures. In fact, the obtained results with implants: very low relapses cases and minimal number of complications, demonstrate it. The introduction in Cuba of the Surgimesh® mesh, developed by the Aspide Medical company, with physical-chemical characteristics of polypropylene which provide optimal effects, motivated to carry out this literature review on the topic.
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Biocompatible Materials , Hernia , General SurgeryABSTRACT
Introduction: This prospective study was undertaken to observe the prospects of daycare inguinal hernia surgery in general hospital setup in a developing country like Nepal and to assess the advantages, acceptability and safety of this approach. Methodology: The study was carried out prospectively for one year from March 2009- Feb 2010. Before surgery, children were examined in surgical referral clinic (SRC). Parents were given verbal and written instructions for pre-operative fasting. Operations were carried out under intravenous anesthesia without intubation by experienced consultant general surgeon or by registrar under supervision. Children were observed in recovery area till conscious. Once awake, the children were handed over to parents for further observation till fully conscious and could tolerate liquid. Oral Paracetamol and homecare instructions were given to parents. Appointment slip was given for follow up visit in SRC within 3-5 days. Results: There were 90 children, male 81 (89%), age 2 months to 13 years. Right inguinal hernias were 62 (70%). There were no major complications, mortality or readmission. Saving in terms of less disruption of routine work at home and office was more appreciated by parents. Conclusion: We conclude that day care inguinal hernia surgery in children in our setup is safe, economic well accepted by child and parent's both.