Value of MRI findings for the evaluation of a hernia sac in fetuses with congenital diaphragmatic hernia / 中华放射学杂志

Objective:To explore the value of MRI signs in assessing the presence or absence of hernia sacs in fetuses with congenital diaphragm hernia.Methods:MRI images of 57 patients with congenital diaphragm hernia confirmed by postpartum surgery were analyzed from November 2016 to December 2020 in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, with a gestational age of 20－40 (28±5) weeks. In postpartum surgery, 18 cases were found with hernia sacs (hernia sac group) and 39 cases without hernia sacs (hernia-free group). Seven MRI signs were analyzed, including hernia peripheral enveloping sensation, smooth lung-hernia interface, crescent-shaped lung compression, residual lung tissue on the affected side, heart displacement, effusion above the lung-hernia interface and effusion below the lung-hernia interface. The differences in MRI signs between the hernia sac and hernia-free groups were compared using the χ 2 test or Fisher′s exact probability method. The diagnostic efficacy of each sign was calculated. The MRI signs with statistical differences between the two groups were included in the predictive integration model, and 1 point was scored for each sign, the imaging score of each fetus was calculated, and the efficacy of imaging points in diagnosing the presence or absence of hernia sacs was assessed by the subject manipulation receiver operating characteristics (ROC) curve. Results:There were statistically significant differences in 5 MRI signs between the hernia sac and the hernia-free groups, namely hernia peripheral enveloping sensation (χ2=25.74, P<0.001), smooth lung-hernia interface (χ2=48.20, P<0.001), crescent-shaped lung compression (χ2=57.00, P<0.001), residual lung tissue on the affected side (χ2=12.14, P<0.001) and effusion above the lung-hernia interface (χ2=4.31, P=0.022). Among them, the sign of crescent-shaped lung compression had the highest diagnostic efficacy, and the sensitivity, specificity and accuracy all were 100%. Five statistically significant MRI signs were included in the predictive integration model, and the area under the ROC curve was 0.999, the sensitivity was 100%, the specificity was 94.9%, and the optimal threshold was 2 points. Conclusion:Fetal MRI signs and predictive integration model can effectively identify the presence or absence of hernia sacs in fetuses with congenital diaphragm hernia, which has certain clinical significance.

Hernia útero inguinal derecha atascada en mujer en edad fértil: reporte de un caso / Incarcerated right utero inguinal hernia in a woman of reproductive age: case report

Resumen Introducción: La hernia de pared abdominal es una patología habitual; la presentación más frecuente es de tipo inguinal, cercano a un 70% del total. La incidencia de un saco herniario inguinal conteniendo ovarios y trompas de Falopio, es un hecho reportado en 2,9% de los casos. Caso clínico: Se presenta una paciente, sexo femenino, de 42 años de edad, con historia de hernia inguinal derecha de larga data, ingresa por aumento de volumen doloroso e irreductible, en región inguinal derecha, no impresiona estrangulada; ingresa a pabellón de urgencia. Dentro de los hallazgos quirúrgicos destacan saco herniario que contiene útero y ambos ovarios, sin compromiso vascular. Paciente evoluciona de forma favorable egresando 2 días posterior a la cirugía.

Introduction: Abdominal wall hernia is a frequent pathology, the most frequent hernia are the inguinal type, closed to 70% of all. Although the incidence of inguinal hernial sac containing ovary and Fallopian tubes are reported on a 2.9% of the cases. Case Report: Female patient 42 years old, with a long-term history of right inguinal hernia, with sudden pain and irreducible increase of volume in the correspondent inguinal zone that doesn't look strangled; she was admitted to the emergency operating room. Among surgical findings hernia's sac content was uterus and both ovaries with no signs of vascular compromise. The patient's favorable evolved let her to be discharged from the hospital after 2 days from post operative care

Risk factors of postoperative complications after laparoscopic transabdominal preperitoneal hernia repair / 中国基层医药

Objective@#To investigate the risk factors of postoperative complications after laparoscopic transabdominal preperitoneal hernia repair.@*Methods@#The clinical data of 481 cases of laparoscopic preperitoneal hernia repair in the Central People's Hospital of Tengzhou from March 2014 to February 2018 were retrospectively analyzed.The patients were divided into complications group and control group according to whether complications occurred.The clinical data of the two groups were compared and the risk factors of complications were summarized.@*Results@#Postoperative complications occurred in 78 cases of 481 patients(16.22%). The proportions of age, operation time, diameter of hernia sac, intraoperative bleeding volume, incarcerated hernia and recurrent hernia in the complications group were 65.3%, 32.0%, 29.5%, 85.9%, 20.5% and 5.1%, respectively, which in the control group were 46.6%, 2.4%, 53.8%, 30.7%, 3.4% and 1.4%, respectively, the differences were statistically significant(χ2=9.175, 17.354, 84.692, 82.959, 32.444, 4.252, all P<0.05). The results showed that age>60 years, operation time>100 minutes, intraoperative bleeding>15 mL, hernia sac diameter>4 cm, incarcerated hernia were the risk factors of postoperative complications after laparoscopic transabdominal preperitoneal hernia repair.@*Conclusion@#Age>60 years old, operation time>100 minutes, intraoperative bleeding>15 mL, hernia sac diameter>4 cm, incarcerated hernia are the independent risk factors of postoperative complications after laparoscopic transperitoneal hernia repair.The patients combined with characteristics above should be given early intervention.

Risk factors of postoperative complications after laparoscopic transabdominal preperitoneal hernia repair / 中国基层医药

Objective To investigate the risk factors of postoperative complications after laparoscopic transabdominal preperitoneal hernia repair.Methods The clinical data of 481 cases of laparoscopic preperitoneal hernia repair in the Central People's Hospital of Tengzhou from March 2014 to February 2018 were retrospectively analyzed.The patients were divided into complications group and control group according to whether complications occurred.The clinical data of the two groups were compared and the risk factors of complications were summarized.Results Postoperative complications occurred in 78 cases of 481 patients(16.22％).The proportions of age,operation time,diameter of hernia sac,intraoperative bleeding volume,incarcerated hernia and recurrent hernia in the complications group were 65.3％,32.0％,29.5％,85.9％,20.5％ and 5.1％,respectively,which in the control group were 46.6％,2.4％,53.8％,30.7％,3.4％ and 1.4％,respectively,the differences were statistically significant(x2 =9.175,17.354,84.692,82.959,32.444,4.252,all P ＜ 0.05).The results showed that age ＞ 60 years,operation time ＞ 100 minutes,intraoperative bleeding ＞ 15 mL,hernia sac diameter ＞ 4 cm,incarcerated hernia were the risk factors of postoperative complications after laparoscopic transabdominal preperitoneal hernia repair.Conclusion Age ＞ 60 years old,operation time ＞ 100 minutes,intraoperative bleeding ＞ 15 mL,hernia sac diameter ＞ 4 cm,incarcerated hernia are the independent risk factors of postoperative complications after laparoscopic transperitoneal hernia repair.The patients combined with characteristics above should be given early intervention.

Different hernia sac management in laparoscopic trans-abdominal preperitoneal repair for total scrotal hernia / 中华普通外科杂志

Objective To compare between different hernia sac management during laparoscopic trans-abdominal preperitoneal repair (TAPP) for total scrotal hernia.Methods From Jan 2015 to Aug 2016,98 patients underwent TAPP repair (hernia sac length ＞ 10 cm),including group A (n =35) with complete sac dissection,group B (n =30) incomplete sac dissection and group C (n =33) with sac transection.Results Group C patients had shorter operation time [(36.0 ± 6.5) min,P =0.00] while suffered from more seromas (24.2％,P =0.035).The overall scrotal complications were comparable between the three groups.Statistical analysis showed no significant differences in the postoperative stay,pain or nerve sensory deficit,and recurrence between the three groups.Conclusions TAPP repair is a feasible procedure for total scrotal hernias.The different methods of hernia sac management do not have an impact on the long-term outcome.

Application of Improved Micro-laparoscopic High Ligation in Pediatric Inguinal Hernia / 昆明医科大学学报

Objective To compare the treatment effects between improved micro-laparoscopic hernia sac high ligation and traditional hernia sac high ligation.Methods Retrospective analysis was conducted.A total of 200 pediatric patients diagnosed with inguinal hernia in our hospital from 2013 to 2014,ranging in age from 8 months to 14 years,were enrolled and divided into observational group and control group (n=100) The two groups received improved-micro-laparoscopic hernia sac high ligation and traditional hernia sac high ligation respectively.We recorded intraoperative blood loss,operative incision length and operation time during the operation,and hospitalization time,pain time and total cost after the operation.Recurrence rate and complication were followed up for 6 months.Treatment effects were compared between these two groups.Results Smaller incision length,less blood loss and postoperative pain,shorter operative time and hospitalization time and lower recurrence rate were found in observational group and they were of statistical significance (P＜0.05).Conclusion Improved-micro-laparoscopic hernia sac high ligation for pediatric inguinal hernia shows better treatment effect,lower recurrence rate and better prognosis and it is an ideal approach.

Curative effect analysis on treatment of transabdominal extraperitoneal hernia sac exclusion for children with hernia / 局解手术学杂志

Objective To explore the treatment of children with hernia,and the advantage of transabdominal extraperitoneal hernia sac exclusion was analyzed.Methods A total of 102 patients in our hospital from January 2005 to January 2015 were randomly divided into 2 groups,55 cases who treated by the surgery of transabdominal extraperitoneal hernia sac exclusion were treatment group,47 cases who treated by the surgery of high ligation of the hernia sac throug the inguinal incision were control group.The operative time,length of hospital stay, length of incision,postoperative pain and hospitalization costs between two groups were compared.Results The effect of the treatment group was superior to the control group on operative time,length of incision and postoperative pain,the difference was significant(P <0.05).Con-clusion There are some advantages of more simplified operation,shorter time of the surgery,less complication,lower recurrence rate and more reliable curative effect in the treatment of transabdominal extraperitoneal hernia sac exclusion for children with hernia,which is worthy of clinical promotion.

Presence of Hernia Sac in Prediction of Postoperative Outcome in Congenital Diaphragmatic Hernia.

We conducted this study to assess the value of presence of hernia sac in prediction of postoperative outcome in congenital diaphragmatic hernia (CDH). Data were obtained form medical records of 70 children operated for CDH between 2002-12. Postoperative neonatal death occurred in 1/10 (10%) of infants with a hernia sac and 26/60 (43.3%) in cases without a hernia sac, respectively (P =0.04). Perinatal morbidity in surviving infants was lower in the group with a hernia sac although not significantly. We conclude that the presence of a hernia sac is associated with better postoperative outcome and overall prognosis of CDH.

Histologia dos sacos herniários das hérnias inguinais indiretas, diretas, recidivadas e encarceradas em adultos e crianças: identificação de fibras musculares lisas / Histology of the hernial sacs of direct, indirect, relapsed and incarcerated inguinal hernias in adults and children: identification of smooth muscles fibers

OBJETIVO: Pesquisar a presença de fibras de músculo liso (FML) nos sacos peritoneais das hérnias indiretas, diretas, recidivadas e encarceradas e estudar a influência do sexo, cor e idade dos pacientes, bem como a região do saco herniário, largura, comprimento e espessura da biópsia coletada. MÉTODO: Foram obtidos 252 sacos herniários no período de fevereiro de 1999 a dezembro de 2000 e encaminhados para o estudo histopatológico através da coloração por hematoxilina-eosina e tricrômico de Gomori. A idade variou entre um mês a 87 anos com média de 42,3 anos e desvio-padrão de 22,5 anos. RESULTADOS: Foi utilizado o teste do Qui-quadrado e observada FML em 76,5 por cento dos pacientes com hérnia indireta, 55,9 por cento direta, 46,4 por cento encarcerada e 68,7 por cento recidivada. No estudo global foram encontradas FML em 67,9 por cento dos espécimes com maior incidência na porção proximal do saco herniário (53,2 por cento) e em pacientes melanodérmicos (75 por cento). As FML estiveram presentes em maior freqüência no lado direito (67,7 por cento) e no sexo feminino (73,3 por cento). Do total de 252 amostras de sacos herniários examinados, foi encontrada FML em 171 biópsias, e esse achado foi menos freqüente nas hérnias diretas e encarceradas quando comparadas com as indiretas e recidivadas. CONCLUSÕES: Como hipótese, a presença de FML na parede do saco herniário pode representar um reforço tecidual no sentido de dificultar o crescimento do saco peritoneal, comportando-se como fator de resistência elástica e dinâmica à expansão da hérnia. Por outro lado, pode também significar uma formação aberrante ou a persistência de uma estrutura que deveria regredir ou mesmo desaparecer durante o desenvolvimento normal.

BACKGROUND: To determine the presence of smooth muscle fibers (SMF) in the peritoneal sacs of indirect, direct, recurrent and strangulated hernias and to evaluate the influence of sex, color and patients'age well as location, width, length and thickness of the hernia sac collected biopsy. METHOD: 252 hernia sacs - obtained between February 1999 and December 2000 - were sent to histopathological examination using hematoxylin and eosin stain and Gomori Trichrome. The ages varied between 1 month to 87 years with a mean age of 42,3± 22,5 years. RESULTS: SMF were observed in 76,5 percent of the patients with indirect hernia, 55,9 percent with direct hernia, 46,4 percent with strangulated hernia and 68,7 percent with recurrent hernia. Overall , SMF were found in 67,9 percent of the specimens , with larger incidence in the proximal portion of the hernia sac (53,2 percent) , and in melanodermic patients (75 percent). SMF were present, in larger frequency, on the right side (67,7 percent) and in the feminine sex (73,3 percent). Of the total of 252 samples of examined hernia sacs , SMF were found in 171 biopsies, wich wass less frequent in direct and strangulated hernias when compared with to indirect and recurrent hernias. CONCLUSIONS: The presence of SMF in the hernia sac wall could represent tissue reinforcement by hindering peritoneal sac growth, behaving as factor of elastic and dynamic resistance to the hernia expansion. On the other hand, it could also mean an aberrant formation or persistence of a structure that could be subject to regression or even disappear during normal development.