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Introducción. La hernia de Amyand es una condición en la que el apéndice cecal está contenido dentro del saco herniario inguinal. Su diagnóstico y su manejo continúan siendo un reto al tratarse de una patología poco frecuente. Caso clínico. Lactante varón de 10 meses con antecedente de prematuridad extrema, quien presentó hernia de Amyand derecha con apéndice normal. Se retornó el apéndice a la cavidad y se procedió a la reparación de la hernia. Resultado. Después de un año de seguimiento, el paciente no presentó complicaciones. Conclusiones. Se ha reportado que el riesgo de incarceración en niños nacidos a término es del 12 % y en prematuros del 39 %, por tanto, la reparación quirúrgica de una hernia inguinal siempre es necesaria. No existe un tratamiento estándar para la hernia de Amyand en niños, por tanto, la clasificación CiX podría considerarse para el manejo. Se presenta una propuesta de tratamiento en la población pediátrica, donde se incluyeron 3 tipos, considerando el estadio evolutivo del apéndice cecal y que casi la totalidad de hernias inguinales en niños son debidas a persistencia del proceso vaginal, por tanto, el tratamiento quirúrgico solo incluye herniotomía. Al no utilizar material protésico, se facilita el manejo y se reduce el riesgo de infección.
Introduction. Amyand's hernia is a condition in which the cecal appendix is contained within the inguinal hernia sac, its diagnosis and management continue to be a challenge as it is a rare pathology. Case report. A 10-month-old male infant with a history of extreme prematurity presented a right Amyand's hernia and a normal appendix. The appendix was returned to the cavity and the hernia was repaired. Result. After one year of follow-up, the patient had no complications. Conclusions. Has been reported that the risk of incarceration in full-term children is 12% and in premature babies it is 39%, therefore, surgical repair of an inguinal hernia is always necessary. There is no standard treatment for Amyand hernia in children, therefore the CiX classification could be considered for management. A treatment proposal is presented in the pediatric population, where three types were included, considering the evolutionary stage of the cecal appendix and that almost all inguinal hernias in children are due to persistence of the vaginal process; therefore, surgical treatment only includes herniotomy. By not using prosthetic material, handling is facilitated and the risk of infection is reduced.
Subject(s)
Humans , Appendicitis , Infant, Premature , Hernia, Inguinal , Appendix , Hernia , InfantABSTRACT
Introducción. Los pacientes octogenarios y nonagenarios conforman un grupo etario en progresivo crecimiento. La hernia inguinal es una patología que aumenta progresivamente con la edad. Este trabajo tuvo como objetivo conocer los resultados quirúrgicos de los pacientes mayores de 80 años a quienes se les realizó herniorrafía inguinal. Métodos. De acuerdo con las guías PRISMA, se realizó una revisión sistemática de PubMed, Embase y Google Scholar. Se incluyeron estudios que reportaron la incidencia de complicaciones y mortalidad después de una herniorrafía inguinal en los pacientes octogenarios y nonagenarios. Se calculó la proporción de pacientes con complicaciones después de una herniorrafía inguinal según los datos presentados, con su respectivo intervalo de confianza del 95 %. Resultados. Catorce estudios reportaron un total de 19.290 pacientes, entre quienes se encontró una incidencia acumulada de infección del sitio operatorio de 0,5 % (IC95% 0,460 - 0,678), seroma de 8,7 % (IC95% 6,212 - 11,842), hematoma de 2,6 % (IC95% 2,397 - 2,893), dolor crónico de 2,1 % (IC95% 0,778 - 4,090) y recidiva de 1,2 % (IC95%0,425 - 2,284), para una morbilidad de 14,7 % (IC95% 9,525 - 20,833). Conclusión. Las complicaciones de la herida quirúrgica, el dolor crónico y la recidiva en los pacientes mayores de 80 años a quienes se les realiza herniorrafia inguinal son comparables con las de la población general.
Introduction. Octogenarian and nonagenarian patients constitute a progressively growing age group. Inguinal hernia is a pathology that increases with age. This study aims to understand the surgical outcomes of inguinal herniorrhaphy in patients over 80 years of age. Methods. A systematic review of PubMed, Embase, and Google Scholar was conducted following PRISMA guidelines. Studies reporting the incidence of complications and mortality after inguinal herniorrhaphy in octogenarian and nonagenarian patients were included. The proportion of patients with complications after inguinal herniorrhaphy was calculated based on the data presented, with its respective 95% confidence interval. Results. Fourteen studies reported a total of 19,290 patients, among whom a cumulative incidence of surgical site infection of 0.5 (95% CI 0.460 0.678), seroma of 8.7% (95% CI 6.212 11.842), hematoma of 2.6% (95% CI 2.397 2.893), chronic pain 2.1% (95% CI 0.778 4.090), recurrence 1.2% (95% CI 0.425 2.284), and morbidity 14.7% (95% CI 9.525 20.833) were found. Conclusion. Surgical wound complications, chronic pain, and recurrence in patients over 80 years of age undergoing inguinal herniorrhaphy are comparable to those in the general population.
Subject(s)
Humans , Herniorrhaphy , Hernia, Inguinal , Postoperative Complications , Recurrence , Aged, 80 and over , Meta-AnalysisABSTRACT
Background: Inguinal hernia repair is one of the commonly performed procedure and has undergone a paradigm shift from open to laparoscopic approach in the era of minimally invasive surgery but the superiority is still debatable. The aim was to compare open (Lichtenstein) versus laparoscopic transabdominal preperitoneal approach (TAPP) hernia repair techniques. Methods: A total of 60 patients were enrolled in the study and divided into two equal groups (open versus laparoscopic) were compared. Results: It was observed that laparoscopic repair (TAPP) has statistically significant superiority than open inguinal hernioplasty in terms of lesser post-operative pain (VAS score of 4.8±0.66, 3.67±0.66, 2.53±0.82 versus 6.7±0.92, 5.03±0.72, 3.83±0.65 at 24 hours, 48 hours and 72 hours post operatively, p value <0.001), shorter duration of hospital stay (3.1±0.71 days versus 5.83±0.75 days, p value <0.001) and early resumption to regular activities (10.57±2.28 days versus 12.2±1.52 days, p value 0.002). It also showed that incidence intra operative and post-operative complications was lesser in laparoscopic group but not statistically significant. Whereas duration of surgery was prolonged in laparoscopic group (104±27.49 min versus 61.5±17.08 min, p value <0.001). Conclusions: Laparoscopic inguinal hernioplasty (TAPP) is superior to open inguinal hernioplasty in terms of lesser intra operative and post-operative complications, lesser post-operative pain, shorter duration of hospital stay with early resumption to regular activities having better subjective and objective cosmetic results in short term follow-up. However, duration of surgery was prolonged on comparison with Lichtenstein open inguinal hernioplasty.
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Introducción. Las hernias gigantes con pérdida de domicilio son aquellas cuyo saco herniario alcanza el punto medio del muslo en bipedestación y su contenido excede el volumen de la cavidad abdominal. Estas hernias son un reto quirúrgico dada la difícil reducción de su contenido y del cierre primario de la fascia. Tienen mayor riesgo de complicaciones asociadas al síndrome compartimental abdominal, así como mayor tasa de recurrencia y morbilidad en los pacientes. Caso clínico. Paciente masculino de 81 años, reconsultante por hernia inguinoescrotal derecha gigante, de dos años de evolución, sintomática, con índice de Tanaka de 24 %. Se decidió aplicar el protocolo de neumoperitoneo secuencial (hasta 11.000 ml en total en cavidad) además de toxina botulínica en pared abdominal (dos sesiones). Resultados. Se logró la corrección exitosa de la hernia inguinoescrotal gigante, sin recaídas de su patología abdomino-inguinal. El paciente manifestó satisfacción con el tratamiento un año después del procedimiento. Conclusiones. El protocolo de neumoperitoneo secuencial es una alternativa en casos de hernias complejas, con alto riesgo de complicaciones, que requieren técnicas reconstructivas adicionales. La aplicación previa de toxina botulínica es un adyuvante considerable para aumentar la probabilidad de resultados favorables. Sin embargo, debe incentivarse la investigación en esta área para evaluar su efectividad.
Introduction. Giant hernias with loss of domain are those whose hernial sac reaches the midpoint of the thigh in standing position and whose content exceeds the volume of the abdominal cavity. These hernias are a surgical challenge given the difficult reduction of their contents and the primary fascial closure, with a higher risk of complications associated with abdominal compartment syndrome, as well as a higher rate of recurrence and morbidity in patients. Clinical case. A 81-year-old male patient with comorbidity, reconsulting due to a symptomatic giant right inguinoscrotal hernia of two years of evolution, with a Tanaka index of 24%, eligible for a sequential pneumoperitoneum protocol (up to a total of 11,000 cc in cavity) plus application of botulinum toxin (two sessions) in the abdominal wall. Results. Successful correction of the patient's giant inguinoscrotal hernia was achieved using this protocol, without recurrence of his abdomino-inguinal pathology and satisfaction with the procedure after one year. Conclusion. The sequential pneumoperitoneum protocol continues to be an important alternative in cases with a high risk of complications that require additional reconstructive techniques, while the previous application of botulinum toxin is a considerable adjuvant to further increase the rate of favorable results. However, research in the area should be encouraged to reaffirm its effectiveness.
Subject(s)
Humans , Pneumoperitoneum, Artificial , Botulinum Toxins, Type A , Hernia, Inguinal , Prostheses and Implants , Hernia, Abdominal , HerniorrhaphyABSTRACT
Background: Hernia is defined as abnormal protrusion of whole or a part of a viscus through the wall that contains it. Among all external abdominal hernias, inguinal hernia is one most typically encountered. Many factors are responsible for the formation of hernia. We intended to study the risk of inguinal hernia in low lying pubic tubercle. Methods: The study was conducted on patients in AJIMS, India. It is a case-control study with 80 cases and 80 control meeting inclusion criteria, in all patients, following parameters SS line, ST line, height, weight was recorded and evaluated. Results: The average SS value for case which was much above the average in control.ST value was higher case group than control group, and p<0.0001 which was significant. when it comes to the mean of (SS/ST ratio)/height was higher in the case group than control group. Results developed show majority of the subjects with a low-lying pubic tubercle were inguinal hernia patients. Conclusions: Based on my study, interspinal distance (SS line) and pubo-spinal distance (ST line) are more in cases compared to control. Configuration of bony pelvis seems to be a major contributing factor in determining the risk of development of inguinal hernia as evidenced by the variations in ST length. This low-lying pubic tubercle is very important before selecting the patient for any surgical correction. So, the proper demonstration of anatomy of inguinal region is very important before selecting the surgical technique.
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Objective To investigate the difference of surgical effect of exclusion,simple continuous suture and circular suture suspension in TAPP for the treatment of false hernia sac in patients with direct inguinal hernia.Method From May 2020 to May 2022,120 patients diagnosed with direct inguinal hernia and treated with TAPP in our hospital were retrospectively.The false hernia sacs were divided into three groups according to different methods of treatment patients treated with false hernia sac exclusion were included in group A,those treated with simple continuous suture were included in group B,and those treated with circular suture suspension were included in group C.There were 40 patients in each group.The perioperative indicators(operation time,intraoperative blood loss,postoperative hospital stay,hospitalization cost)and postoperative effects(chronic pain,seroma,incision or mesh infection,foreign body traction feeling)were compared among the three groups.Results All 120 patients successfully completed TAPP surgery.There was no significant difference in general condition,intraoperative blood loss,postoperative hospital stay,wound or mesh infection and chronic pain among the three groups(P＞0.05).The operation time of group B and C was longer than that of group A,and the incidence of seroma was significantly lower than that of group A,the difference was statistically significant(P＜0.05).The incidence of foreign body traction in group A and group C was lower than that in group B,and the difference was statistically significant(P＜0.05).The hospitalization cost of group B and group C was lower than that of group A,with statistically significant difference(P＜0.05).Conclusion In clinical practice,direct hernia and false hernia sac often need to be treated.In direct hernia TAPP operation,simple continuous suture method and circular suture suspension method have the effect of improving the condition of the false hernia sac,but in terms of economy and postoperative effect,the circular suture suspension method can benefit patients more.
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Objective To explore the application value of single-port laparoscopic high ligation of processus vaginalis by using the Veress needle.Methods A retrospective analysis was conducted on data of 51 cases of single-port laparoscopic high ligation of processus vaginalis with the Veress needle from January 2021 to March 2023.A Veress needle was used instead of hernia needle to perform high ligation of processus vaginalis.Results All the operations were successful without additional auxiliary ports or conversion to open surgery.The time of unilateral operation in 46 cases was 6-15 min(mean,8.9±1.9 min).The bilateral operation time in 5 cases was 13-19 min(mean,15.4±2.3 min).After 6 months of follow-up after surgery,there was no recurrence in all children,and no complications such as suture knot reaction,scrotal edema,scrotal hematoma,iatrogenic cryptorchidism,and testicular atrophy occurred.Conclusions Single-port laparoscopic high ligation of processus vaginalis by using the Veress needle has the advantages of single-port surgery,single puncture,and simple performance.The therapeutic effect is definite and it is worthy to be popularized.
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Objective To investigate the clinical significance of the chorda arteriae umbilicalis in laparoscopic transabdominal preperi-toneal(TAPP)hernia repair.Methods The clinical data of 60 patients with inguinal hernia admitted to Xinrui Hospital in Xinwu District of Wuxi City from June 2019 to June 2022 were analyzed,and the patients were randomly divided into two groups according to whether the chorda arteriae umbilicalis was used as a marker during operation.Both the control group and the observation group were operated according to the routine procedure.The observation group exposed the chorda arteriae umbilicalis,which was used as a reference to precisely free the surgical plane and gap to complete the parietalization of spermatic cord,meanwhile,the angle formed by the intersection of the deferens and umbilical artery cord was used to assist in fixing the patch.The operation time,time of parietalization of spermatic cord,hospital stay,bladder surface bleeding volume,removal rate of hernial sac,the occurrence of postoperative complications and recurrence of patients were compared between the two groups.Results There was no significant difference in the operation time,removal rate of hernial sac,hospital stay,recurrence rate or the incidence of postoperative complications such as chronic pain,uroschesis of patients between the two groups(P>0.05).The time of parietalization of spermatic cord,bladder surface bleeding volume,and incidence of seroma of patients in the observation group were shorter/lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion The chorda arteriae umbilicalis has a constant morphology and relatively fixed anatomical position and alignment.The chorda arteriae umbilicalis can be used as a reference and guiding mark,especially when the anatomical layer is dense and unclear or strayed into the layer in TAPP hernia repair,whihc can guide to operate at the correct layer,standardize the parietalization of spermatic cord,reduce bleeding and vice-damage,and also assist the fixation of the patch and prevent the displacement of the patch.
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La hernia inguinal supone la patología de pared abdominal más frecuente hoy en día. En el saco herniario podemos encontrar diferentes estructuras, como grasa preperitoneal, intestino delgado, colon o incluso la vejiga, resultando inusual la presencia de la trompa de Falopio y el ovario. El contenido tubo-ovárico supone un hallazgo frecuente en población pediátrica, mientras que resulta un hecho extremadamente raro en mujeres en edad reproductiva o menopáusica, siendo imprescindible su tratamiento con el fin de evitar complicaciones relacionadas con la fertilidad y la viabilidad de los anejos. Con el objetivo de revisar la bibliografía descrita al respecto dado la infrecuencia que supone este hallazgo en mujeres adultas, se presenta el siguiente caso clínico de forma resumida, con la consiguiente revisión de la literatura disponible. Se trata de una paciente mujer de 50 años, con antecedentes de mioma uterino, intervenida de forma programada de hernioplastia inguinal derecha, observando contenido tubo-ovárico en el saco herniario, en la cual se realiza hernioplastia inguinal según la técnica de Lichtenstein con preservación de anejos sin complicaciones postoperatorias. Como conclusiones finales, consideramos que los hallazgos intraoperatorios de contenido tubo-ovárico en la cirugía de hernia inguinal en mujeres adultas supone un hecho infrecuente, cuyo conocimiento y manejo resulta necesario para el cirujano general, precisando de un índice de alta sospecha con el fin de evitar complicaciones y otorgar el tratamiento quirúrgico más óptimo para el bienestar de los pacientes.
Inguinal hernia represents the most common pathology of the abdominal wall currently. In the hernia sac, various structures can be found, such as preperitonealphat, smallbowel, colon, oreventhe bladder, but the presence of the fall opiantube and ovaryisun common. Tubo-ovarian content is a frequent finding in pediatric population, while infection is extremely rare in women of reproductive or menopausal age, requiring essential treatment to prevent complications related to fertility and adnexal viability. In order to review the literature described in this regard, given the infrequency of this finding in adult women, we present the following clinical case, along with a review of the available literature. The patient is a 50-year-old woman with a history of uterine fibroids, who underwent surgery of a right inguinal hernioplasty, revealing tube-ovarian content in the hernia sac. Inguinal hernioplasty was performed using the Lichtenstein technique with preservation of adnexa, and there were no postoperative complications. In final conclusions, we consider that intraoperative finding of tube-ovarian content in inguinal hernia surgery in adult women are uncommon, and knowledge and management of this condition are necessary for the general surgeon. A high index of suspicion is required to avoid complications and provide the most optimal surgical treatment for the well-being of patients.
A hérnia inguinal representa uma patologia comum da parede abdominal nos dias seguintes. No saco herniário, podem ser encontradas diferentes estruturas, como gordura pré-peritoneal, intestino delgado, cólon propriamente dito com a bexiga, sendoincomum com presença da trompa de Falópio e do ovário. O conteúdo trompa-ovariano é muito comum em populações pediátricas, mas é extremamente raro em mulheres em saúde reprodutiva ou na menopausa, sendo essencial ou seutratamento para evitar complicações relacionadas à fertilidade e à viabilidade dos dois anexos. Com o objetivo de revisar a bibliografia descrita a esse respeito, dado pouco discutido em mulheres adultas, o seguinte caso clínico é apresentado de forma resumida, juntamente com uma revisão da literatura disponível. Trata-se de paciente do sexo feminino, 50 anos, com história de mioma uterino, submetida a hernioplastia inguinal direta programada, observando-se conteúdo da tuba ovariana e saco herniário. A hernioplastia inguinal foi realizada segundo a técnica de Lichtenstein, comprimindo dois anexos e sem complicações operatórias. Como conclusões finais, consideramos que a redução intraoperatória do conteúdo tubo-ovariano na cirurgia de hérnia inguinal em mulheres adultas é incomum, e o conhecimento e o manejo dos procedimentos necessários à cirurgia geral requerem um alto índice de suspeita para evitar complicações e proporcionar tratamento cirúrgico . maisadequado para ou bem-est dois pacientes.
Subject(s)
Humans , Female , Middle Aged , Ovary/surgery , Fallopian Tubes/surgery , Hernia, Inguinal/surgery , Hernia, Inguinal/complications , Ovary/pathology , Perimenopause , Fallopian Tubes/pathology , HerniorrhaphyABSTRACT
Background: Herniotomy for congenital inguinal hernia in children is a fairly common surgical procedure. Inguinal hernias in infants can be repaired by conventional surgery as well as laparoscopic approach. Open repair of inguinal hernias in children without opening the inguinal canal, thereby maintaining the normal anatomy was done at our centre. Objective was to evaluate the course and outcome of paediatric congenital inguinal hernia cases operated at our centre. Methods: This study was conducted in a service hospital (Military Hospital Jammu), on 67 patients presenting with congenital inguinal hernia during October 2014 to June 2017. Results: Sixty-two children were male and five were female. 18 were less than one year, 38 between two to five year and 11 more than five years. All the patients were evaluated preoperatively and taken up for surgery under general anesthesia (n=18) spinal block (n=36) and caudal anesthesia (n=13). Approximate length of skin incision was 1.5 to 2.0 cm. External inguinal ring was opened in 3 cases only. Approximate postoperative stay in hospital was 1-2 days. Nine patients had reactive hydrocele and one patient developed surgical site infection (SSI). On 12 months post-operative follow up, none of the patients had any further complications. Conclusions: Inguinal hernias are common in children, with increased risk of incarceration if not repaired early. Open technique without altering the inguinal canal anatomy is also a suitable alternative to congenital inguinal hernia repair in children with favourable comparable outcome.
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Inflamed appendix as a cause of incarcerated inguinal hernia is a rare presentation in any age group. Appendix as a content in an inguinal hernial sac was named after the French surgeon Claudius Amyand (c.1681-1740), who performed the first successful appendectomy, on an 11-year-old boy who presented with an inflamed, perforated appendix in his inguinal hernia sac. Treatment of this condition is herniotomy with its repair with or without appendectomy depending on its involvement (inflammation status). We are reporting the case, in which, the inflamed appendix was presented as incarcerated inguinal hernia. The management of Amyand抯 hernia depends on the variability of involvement of the appendix however, in children and neonates, it is better to perform appendectomy during the hernia repair.
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Introducción: la hernia inguinal es uno de los principales motivos de consulta quirúrgica y su reparación es uno de los procedimientos más comunes en cirugía. Objetivo: determinar la experiencia en el abordaje laparoscópico de las hernias inguinales por técnica transabdominal preperitoneal en el Servicio de Cirugía General del Centro Médico Nacional-Hospital Nacional. Metodología: estudio observacional descriptivo retrospectivo de corte temporal transversal. En pacientes de 16 a 90 años de edad con diagnóstico de hernia inguinal internados en el Servicio de Cirugía General del Centro Médico Nacional-Hospital Nacional para hernioplastia electiva. Resultados: se llevaron a cabo 30 hernioplastias por técnica técnica trans-abdominal pre-peritoneal de los cuales el 73 % fue realizado en hombres y 27 % en mujeres; se identificó una media de edad de 48,4 años, el grupo etario con mayor frecuencia fue de 38 a 48 años. En el examen físico pre quirúrgico se encontraron hernias inguinales unilaterales en el 76.6 % y bilaterales en el 23.3 %; en la mayor parte de los pacientes las hernias fueron primarias en el 86.6 %y recidivada en el 13.3 %. El tiempo quirúrgico en promedio fue de 93.1 minutos; con un tiempo máximo de 120 minutos y mínimo de 60 minutos. El tiempo de hospitalización en el 100 % de los pacientes fue de 48 h. De las complicaciones post operatorias se establece que el 76.6 % no presento ningún tipo de complicación; el 20 % presentó seroma como complicación principal y 3.3 % infección del sitio quirúrgico. Conclusión: debido a su alta frecuencia y a su impacto en la incapacidad laboral y social, las hernias inguinales representan una de las patologías quirúrgicas más importantes con bajas tasas de complicaciones post operatorias y corta estancia hospitalaria.
Introduction: inguinal hernia is one of the main reasons TAPP, e-TEP (Totally extraperitoneal with extended vision) for surgical consultation and its repair is one of the most common surgical procedures. Objective: to determine the experience in the laparoscopic approach of inguinal hernias by preperitoneal transabdominal technique in the Servicio de Cirugía General of the Centro Médico Nacional-Hospital Nacional. Methodology: retrospective descriptive observational study of cross-sectional time. In patients from 16 to 90 years of age with a diagnosis of inguinal hernia admitted to the Servicio de Cirugía General of the Centro Médico Nacional-Hospital Nacional for elective hernioplasty. Results: 30 hernioplasties were carried out by the TAPP technique, of which 73 % were performed in men and 27 % in women; a mean age of 48.4 years was identified, the age group most frequently being 38 to 48 years. In the pre-surgical physical examination, unilateral inguinal hernias were found in 76.6 % and bilateral in 23.3 %; in most of the patients the hernias were primary in 86.6 % and recurred in 13.3 %. Average surgical time was 93.1 minutes; with a maximum time of 120 minutes and a minimum of 60 minutes. The hospitalization time in 100 % of the patients was 48 hours. Of the post-operative complications, it is established that 76.6% did not present any type of complication; 20 % presented seroma as the main complication and 3.3 % surgical site infection. Conclusion: due to its high frequency and its impact on work and social disability, inguinal hernias represent one of the most important surgical pathologies with low rates of postoperative complications and short hospital stay.
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Background: Repair of hernia has seen a paradigm shift from open technique to laparoscopic technique. Laparoscopic transabdominal preperitoneal mesh hernioplasty is the latest technique with several advantages over open repair. Polypropylene (PP) mesh is the most frequently preferred product, as are easily and cheaply available, provide enough strength for the technique with good biocompatibility and less tissue reaction. Objective was to study the outcome of usage of polypropylene mesh in TAPP hernia repair. Methods: It was a prospective study on patients with diagnosis of inguinal hernia and underwent TAPP hernia repair with polypropylene mesh. Results: Total of 60 patients were included. Majority of the patients (18; 30%) were in age groups of 46-55 years and 56-65 years. 67% cases of inguinal hernia were of indirect type, 30% direct type and 3% both direct and indirect. Right-sided inguinal hernia (57%) was more frequent, followed by left sided (23%) and bilateral (20%). Average time taken was 72 to 98 minutes with a mean of 81.33 minutes in the surgery for unilateral repair and 90 to 103 minutes with a mean of 97.66 minutes for bilateral repair. 40 (67%) patients returned to work within 2 weeks of surgery. Conclusions: Inguinal hernia repair is a common surgical procedure performed on daily basis around the world. Delay in treatment can lead to complications. Laparoscopic approach has shown clear advantages regarding less postoperative pain, numbness, fast return to normal activities and decrease in the incidence of wound infection and hematoma. Polypropylene has proven physical, chemical and biological properties and is currently the most widely used allograft in laparoscopic inguinal hernias.
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Background: Repair of hernia has seen a paradigm shift from open technique to laparoscopic technique. Laparoscopic transabdominal preperitoneal mesh hernioplasty is the latest technique with several advantages over open repair. Polypropylene (PP) mesh is the most frequently preferred product, as are easily and cheaply available, provide enough strength for the technique with good biocompatibility and less tissue reaction. Objective was to study the outcome of usage of polypropylene mesh in TAPP hernia repair. Methods: It was a prospective study on patients with diagnosis of inguinal hernia and underwent TAPP hernia repair with polypropylene mesh. Results: Total of 60 patients were included. Majority of the patients (18; 30%) were in age groups of 46-55 years and 56-65 years. 67% cases of inguinal hernia were of indirect type, 30% direct type and 3% both direct and indirect. Right-sided inguinal hernia (57%) was more frequent, followed by left sided (23%) and bilateral (20%). Average time taken was 72 to 98 minutes with a mean of 81.33 minutes in the surgery for unilateral repair and 90 to 103 minutes with a mean of 97.66 minutes for bilateral repair. 40 (67%) patients returned to work within 2 weeks of surgery. Conclusions: Inguinal hernia repair is a common surgical procedure performed on daily basis around the world. Delay in treatment can lead to complications. Laparoscopic approach has shown clear advantages regarding less postoperative pain, numbness, fast return to normal activities and decrease in the incidence of wound infection and hematoma. Polypropylene has proven physical, chemical and biological properties and is currently the most widely used allograft in laparoscopic inguinal hernias.
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Introducción. El espacio extraperitoneal, se define como el segmento topográfico ubicado entre el peritoneo parietal internamente y la fascia transversalis externamente. Como resultado del desarrollo y consolidación de la cirugía laparoscópica, en particular de la herniorrafia inguinal por esta vía, se ha presentado un renovado y creciente interés en esta área anatómica, debido a la importancia de su conocimiento detallado en la cirugía de mínima invasión. Métodos. Se hizo una revisión narrativa de la literatura para presentar una información actualizada y detallada sobre la anatomía del espacio extraperitoneal y su importancia en diferentes procedimientos quirúrgicos realizados actualmente. Resultados. Por fuera del espacio peritoneal, se encuentran las áreas anatómicas externas al peritoneo parietal, que incluyen la preperitoneal y la retroperitoneal. Mediante la laparoscopia, se pueden localizar en estos espacios cinco triángulos anatómicos, además de la corona mortis y el triángulo supra vesical. Conclusión. El conocimiento del espacio extraperitoneal es de gran importancia para el cirujano general, teniendo en cuenta los múltiples procedimientos que requieren el abordaje de esta área topográfica
Introduction. The extraperitoneal space is defined as the topographic segment located between the parietal peritoneum internally and the fascia transversalis externally. As a result of the development and consolidation of laparoscopic surgery, particularly inguinal herniorrhaphy by this route, there has been a renewed and growing interest in this anatomical area, due to the importance of its detailed knowledge in minimally invasive surgery. Methods. A narrative review of the literature was made to present updated and detailed information on the anatomy of the extraperitoneal space and its importance in different surgical procedures currently performed. Results. Outside the peritoneal space are the anatomical areas external to the parietal peritoneum, including the preperitoneal and extraperitoneal. Using laparoscopy, five anatomical triangles, in addition to the corona mortis and the supravesical triangle, can be located in these spaces. Conclusion. Knowledge of the extraperitoneal space is of great importance for the general surgeon, taking into account the multiple procedures that require the approach of this topographic area
Subject(s)
Humans , Retroperitoneal Space , Hernia, Inguinal , Peritoneal Cavity , Laparoscopy , AnatomyABSTRACT
An Amyand hernia is a protrusion of an organ or its fascia through the wall of the abdominal cavity which contains the appendix, which has an incidence rate of 0.5–1% of the many hernia cases. This review reports the case findings of a 63-year-old male patient with an inguinal hernia containing the appendix (Amyand hernia). The patient came with complaints of abdominal pain and a lump in his testicles, with a history of frequent lumps coming and going. Physical examination from the right inguinal to the scrotal sac found a lump the size of three adult fists with the same skin color as the surroundings. The patient was diagnosed with a giant right scrotal hernia and underwent herniorrhaphy surgery and mesh placement. During the operation, the appendix and mesoappendix were visible upon opening the hernia sac, so it was decided to perform an appendectomy, return the contents of the hernia sac into the abdominal cavity, and do a mesh installation. Amyand hernia itself presents a diagnostic challenge because of its low incidence, vague clinical signs and symptoms, and lack of clear radiological diagnostic features. In addition, there are still no clear guidelines for its management.
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Objective:To investigate the characteristics and surgical management of mesh infection after tension-free repair of inguinal hernia.Methods:The clinical and follow-up data of 87 patients with mesh infection after tension-free repair of inguinal hernia at the Department of Hernia and Abdominal Wall Surgery,Beijing Chaoyang Hospital from 2018 to 2020 were retrospectively analyzed.Results:The most frequent type of repair was plug implantation, accounting for 57.5% of the procedures. The most common clinical presentation was a chronic sinus. 79.3% patients had a >3-month history of chronic infection. Staphylococcus aureus was the most common bacteria. All patients underwent open debridement. Fifty-one patients had a complete removal of the infected mesh, and 36 had partial removal. All patients were followed up for 18.7-54.2 months. There was no significant difference in the incidence of wound infection, seroma, hematoma, inguinal hernia recurrence, and chronic pain between those with complete removal and that partial removal (all P>0.05). Seventeen cases suffered recurrent sinus in the partial mesh removal group, and the incidence was significantly higher than that in the complete mesh removal group ( P<0.001). Conclusion:Infected mesh removal is an effective treatment for mesh infection after tension-free repair of inguinal hernia and should be removed as completely as possible.
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【Objective】 To introduce a modified microdot two-layer microsurgical vasovasostomy (MVV) and to analyze its effectiveness in patients with vas deferens obstruction caused by inguinal herniorrhaphy. 【Methods】 Clinical data of patients treated during Mar.2015 and Oct.2020 were retrospectively analyzed. According to different surgical methods, the patients were divided into the modified group and traditional group. The general data, intraoperative conditions, efficacies and complications of the two groups were compared. 【Results】 There were 59 cases in the modified group, 54(91.5%) of whom were successfully followed up, and 41 cases in the traditional group, 38(92.7%) of whom were successfully followed up. There were no significant differences in age, inguinal herniorrhaphy history, and unilateral/bilateral ratio between the two groups (P>0.05). The average operation time for unilateral lesions in the modified group was shorter than that in the traditional group [(89.44±24.86) vs. (112.04±43.40) min, P=0.032]. The postoperative patency rate (83.3% vs.73.7%, P>0.05) and natural pregnancy rate (33.3% vs.28.9%, P>0.05) of the modified group and traditional group were comparable. Incision fat liquefaction occurred in 2 cases (3.70%) in the modified group and in 1 case (2.63%) in the traditional group (P>0.05). 【Conclusion】 The modified microdot two-layer MVV is a safe surgical method with comparable effectiveness as the traditional approach. By adjusting the position of the marking points and the order of suturing, it helps the management of sutures, reduces the difficulty of vasovasostomy, shortens operation time, and can be applied to repair vas deferens obstruction caused by inguinal herniorrhaphy.
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【Objective】 To explore the rational management of contralateral patent processus vaginalis (CPPV) in laparoscopic high ligation of processus vaginalis. 【Methods】 A total of 300 children with unilateral oblique inguinal hernia/hydrocele who received laparoscopic high ligation of processus vaginalis in Baoding Children’s Hospital during Jun.2018 and Jun.2022 were selected and divided into two groups by random number table method, with 150 in either group. In the control group, 53 cases of CPPV were found intraoperatively, which were treated simultaneously. In the study group, 58 cases of CPPV were detected, among which 11 met the indications of high ligation and received simultaneous surgical treatment. The incidence of recurrence was compared between the two groups. 【Results】 After 1 year of follow-up, the recurrence rate was 8.62% in the study group and 1.88% in the control group (P>0.05). The detection rate of CPPV was 23.02% in children with unilateral inguinal hernia, significantly lower than that in children with unilateral hydrocele (49.07%, P<0.001). The detection rate of CPPV was 42.71% in children with left patent processus vaginalis and 32.95% in children with right patent processus vaginalis (P=0.19). The detection rate of CPPV was 62.93% in the age group of 1-2 years, significantly higher than that in other age groups (P<0.001). 【Conclusion】 The incidence of CPPV conversion into oblique inguinal hernia or hydrocele is low. Only children who meet the indications can be treated at the same time during surgery.
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Background: There is enormous pool of unmet need for inguinal hernia (IH) repair in our environment due to numerous factors against elective repair. This has led to a large number of patients presenting emergently with complications. The aim of this study is to document the epidemiology and outcome of surgical management of complicated inguinal hernia (CIH) in a low-income rural southeast Nigeria. Methods: This was a multi-centre, retrospective cross-sectional analytical study of patients who received surgical treatment for CIH over eight years period (January 2013- December 2020) at three selected district hospitals in Southeast Nigeria. The trend over time and outcome of surgical treatment were evaluated. The main outcome. measures analyzed were morbidity, mortality and length of hospital stay (LOHS). The various clinical, demographic and perioperative indices that impacted on morbidity and mortality were evaluated. Results: Of the 540 patients evaluated, there were 89 (16.5%) bilateral and 451 (83.5%) unilateral IHs. Majority (78.5%) were inguinoscrotal/inguinolabial hernias. Nearly a third (30.4%) presented after 72hours of complications. At presentation, all (540,100.0%) had irreducible groin swellings and abdominal pain, but 68.95 had abdominal swelling. Comorbidities were present in 26.3% of patients. Strangulation, obstruction and incarceration were present in 46.5%, 42.0% and 11.5% respectively. Morbidity was increased in cases of laparotomy and bowel resection(p=0.000), emergency repair (p<0.001), large hernias (p=0.004) and operations performed by lower rank of surgeon (p=0.001). Bowel resection rate was 28.5%. Overall, morbidity and mortality rates were 47.4% and 8.1% respectively. Mortality was significantly higher in patients with delayed presentation > 24hours (OR:13.42;C.I:6.74-29.44;p=0.001), strangulated cases (OR:3.34;C.I:2.85-11.16;p=0.02), comorbidity (OR:6.72;C.I:10.42-37.55;p=0.01) and advanced age (OR:14.38;C.I:13.46-47.72;p=0.03). Conclusions: Majority of the patients had voluminous hernias and presented late with attendant high morbidity and mortality. Bowel resection, delayed presentation, advanced age, comorbidity and lower rank of surgeon executing the repair were responsible for high adverse postoperative outcomes