Hernia inguinoescrotal gigante: un caso infrecuente

Introducción: Las hernias de la pared abdominal afectan entre el 10% al 15% de la población mundial, siendo hasta el 60% de estas hernias inguinales. Las hernias inguinales gigantes son poco comunes, pero con una gran carga de enfermedad para el paciente. Caso Clínico: Se presenta el caso de un paciente de 51 años, con antecedente de diabetes mellitus tipo II, proveniente de zona rural aislada, por cuatro días de evolución consistente en quemadura escrotal por metal caliente, relacionada a una hernia inguinoescrotal derecha gigante. Es llevado a intervención quirúrgica por cirugía general y urología. Por adecuada evolución clínica se da de alta al 5° día posoperatorio. Discusión: Las hernias inguinales gigantes son raras y frecuentemente se presentan en pacientes de bajo estrato socioeconómico, procedencia rural y cierto grado de negligencia. El reto del equipo quirúrgico consiste en lidiar con los posibles efectos adversos de la reducción del contenido herniario en un abdomen con diversos grados de pérdida del dominio. Se puede requerir resección o debulking del contenido abdominal o la expansión de la cavidad abdominal mediante frenectomía, neumoperitoneo progresivo perioperatorio o la creación de hernias ventrales mediante maniobras avanzadas. La reparación con malla libre de tensión disminuye el riesgo de recurrencia. Conclusión: La hernia inguinal gigante es una patología rara. El cirujano general está llamado a conocer el abanico de opciones que existen en caso de enfrentarse a estos pacientes, lo cual ayuda a reducir la elevada morbimortalidad y altas tasas de recurrencia.

Introduction: Abdominal wall hernias affect between 10% to 15% of the world population and up to 60% of these are inguinal hernias. Giant inguinal hernias are rare, but have high burden of disease for the patients. Clinical Case: We present the case of a 51-year-old patient, with a history of type II diabetes mellitus, from an isolated rural area, with four days of a scrotal burn by hot metal, related to a giant right inguinoscrotal hernia. He is taken to surgical intervention by general surgery and urology. Due to adequate clinical evolution, he was discharged on the 5th postoperative day. Discussion: Giant inguinal hernias are rare and frequently occur in patients of low socioeconomic status, rural origin and a certain degree of neglect. The challenge for the surgical team consist in dealing with the potential adverse effects of reducing hernia contents in an abdomen with varying degrees of loss of normal capacity. Resection or debulking of the abdominal contents or expansion of the abdominal cavity by frenectomy, perioperative progressive pneumoperitoneum, or the creation of ventral hernias by advanced maneuvers may be required. Tension-free mesh repair decreases the risk of recurrence. Conclusion: Giant inguinal hernia is a rare pathology. The general surgeon is called to know the range of options that exist in the event of facing these patients, which helps to reduce the high morbidity and mortality and high rates of recurrence.

Prevention and treatment of deep vein thrombosis during perioperative period in patients with abdominal wall hernia / 中华消化外科杂志

Deep vein thrombosis (DVT) refers to a venous reflux disorder caused by abnormal condensation of blood in deep veins,It is detected in cardinal veins of the whole body and often occurred in the lower extremities.Desquamation of thrombus may cause pulmonary embolism (PE).PE and DVT are two clinical manifestations of different stages of the same disease,which are collectively referred to as venous thromboembolism (VTE).Five famous experts in hernia and abdominal wall surgery explored the prevention and treatment of DVT during perioperative period in patients undergoing abdominal wall hernia surgery from different angles based on clinical experiences.Professor Liu Ziwen introduced the epidemiology of DVT during perioperative period in patients undergoing abdominal wall hernia surgery,emphasized its risks,analyzed systematically its mechanisms including slow venous blood flow,vein injury,high blood coagulation state,underlying diseases and specific factors of abdominal wall hernia surgery,focused on mechanisms of inflammation caused by meshes inducing DVT.Professor Zhang Guangyong introduced informatively its diagnosis with clear and careful thinking,from the clinical manifestations to assistant examinations and moreover to Wells quantitative scoring,from general to specific and from qualitative to quantitative,striving to achieve early and precise diagnosis in order to prevent misseddiagnosis or ignoration of its danger level.Professor Li Hangyu emphasized appropriate preventive and treatment measures according to different stages and risk levels by evaluating the risk factors of preoperative,intraoperative and postoperative DVT.Professor Shen Yingmo analyzed special factors of laparoscopic abdominal wall hernia inducing DVT during the perioperative period,and indicated that surgeons should select surgical methods individually after comprehensive evaluation and consideration because of uncertainty of risk degree in laparoscopic and open surgery inducing DVT during perioperative period based on exis-ting evidence-based medicine and related guidelines.Professor Lu Chaoyang introduced three categories of main treatments including anticoagulation therapy,thrombolytic therapy and surgical therapy,and specific drugs,indications,advantages and disadvantages,opportunities,recommended clinicians to select individually and rationally.

Comparison of curative efficacy and impact of IL-6 and CRP between laparoscopic and open surgery in treatment adults abdominal wall hernia / 中国内镜杂志

Objective To compare the curative efficacy and prognosis between laparoscopic and open surgery in treatment of adults abdominal wall hernia. Methods 129 patients of adult abdominal wall hernia from January 2011 to April 2014 were selected as research objects. Retrospectively analyzed their clinical data and then divided them into control group (n = 62) and observation group (n = 67) according to operation method. The control group was given open surgery of herniorrhaphy, while the observation group was given laparoscopic surgery of herniorrhaphy. Then, operation features, postoperative complications incidence, inflammatory factors levels and recurrence rate were record and compared. Results All patients underwent successful operation with herniorrhaphy. In comparison with the control group, the observation group had statistically less bleeding volume during surgery [(21.60 ± 5.80) vs (61.60 ± 10.30) ml], shorter pain time, evacuation active time and hospitalization time [(30.60 ± 6.30) vs (45.20 ± 7.40) h, (14.70 ± 2.50) vs (20.80 ± 4.60) h, (5.30 ± 0.90) vs (8.70 ± 1.30) d, all P 0.05). The total incidence of postoperative complications in the observation was statistically lower than that in control group (14.9 % vs 33.9 %, P 0.05). Conclusion Open and laparoscopic surgery of herniorrhaphy are both effective operation methods for adult patients with abdominal wall hernia. However, laparoscopic surgery of herniorrhaphy has less surgical trauma, and it showed more advantages in reducing incidence of postoperative complications, alleviating inflammatory damage caused by operation.

Traumatic abdominal wall hernia from handlebar injury, laparoscopic repair - Report of two cases / Hernia traumática de la pared abdominal por lesión del manubrio, reparación laparoscópica - Informe de dos casos

Although rare, traumatic abdominal wall hernia associated with handlebar injury is a well-described entity in the pediatric population with about 40 cases and only one laparoscopic repair reported in children. We present two cases of male patients, 9 and 13 years old, who were assessed in our emergency room for blunt abdominal trauma associated with handlebar injury. The patients showed signs of handlebar trauma in the abdominal wall: one presented with a painful mass, and the other with intermittent pain in the area of trauma with no palpable mass. Neither of the patients were hemodynamically unstable or showed any peritoneal signs. Ultrasound and CT scans were performed in both patients to identify abdominal wall hernias containing bowel content in the absence of other injuries. Laparoscopic repair was performed uneventfully in both patients with interrupted non-absorbable multifilament suture with 2 and 3 ports respectively. Oral intake was initiated one day after surgery and both patients were discharged the following day. In the follow-up visit, the patients were asymptomatic and no signs of abdominal wall hernias were found. Laparoscopic repair of blunt traumatic abdominal wall hernias is safe and technically possible in children and should be considered as the standard initial approach in the stable patient.

Aunque rara, la hernia traumática de la pared abdominal asociada a una lesión en el manubrio es una entidad bien descrita en la población pediátrica, con aproximadamente 40 casos y solo se informó una reparación laparoscópica en niños. Presentamos dos casos de pacientes varones, de 9 y 13 años de edad, que fueron evaluados en nuestra sala de emergencias por un traumatismo abdominal cerrado asociado con una lesión en el manubrio. Los pacientes mostraron signos de traumatismo del manubrio en la pared abdominal: uno presentó una masa dolorosa y el otro con dolor intermitente en el área de trauma sin masa palpable. Ninguno de los pacientes presentaba inestabilidad hemodinámica ni signos peritoneales. Se realizaron ecografías y tomografías computarizadas en ambos pacientes para identificar las hernias de la pared abdominal que contenían contenido intestinal en ausencia de otras lesiones. La reparación laparoscópica se realizó sin incidentes en ambos pacientes con sutura discontinua no reabsorbible interrumpida con 2 y 3 puertos respectivamente. La ingesta oral se inició un día después de la cirugía y ambos pacientes fueron dados de alta al día siguiente. En la visita de seguimiento, los pacientes estaban asintomáticos y no se encontraron signos de hernias de la pared abdominal. La reparación laparoscópica de las hernias de pared abdominal traumáticas romas es segura y técnicamente posible en los niños y debe considerarse como el abordaje inicial estándar en el paciente estable.

Abdominal wall healing in incisional hernia using different biomaterials in rabbits

PURPOSE: To investigate abdominal wound healing using specific biomaterials in incisional hernias. METHODS: Incisional hernias were produced in 40 rabbits, after that they were reoperated with or without the use of meshes: PREMILENE® (PPL), ULTRAPRO® (UP), PROCEED® (PCD) or repairing without mesh (TRANSPALB). After 30 days a macroscopic and microscopic study of the part withdrawn from the abdominal wall was performed. RESULTS: Macroscopic: adhesion Area: PPL> UP and PCD (p = 0.031). Vascularization: PPL> UP and PCD (p = 0.001). PPL groups (p = 0.032) and PCD (p <0.001) showed greater meshes shrinkages when compared to UP. Microscopic: neutrophils: PCD> PPL, UP and TRANSPALB (p = 0.010); eosinophils: PPL> UP, and TRANSPALB PCD (p = 0.010); granulation tissue: PPL and PCD> UP and TRANSPALB (p <0.001); macrophages : PPL, UP and PCD> TRANSPALB (p <0.001); lymphocytes: PPL and PCD> UP (p = 0.009) and TRANSPALB (p <0.001); giant cells: PPL, UP and PCD> TRANSPALB (p <0.001); viscera adhered: PPL and UP> PCD and TRANSPALB (p <0.001). CONCLUSION: All types of meshes caused the formation of adhesions. The UP and PCD groups showed lower area and vascularization of the adhesions. The PPL and PCD groups showed higher meshes shrinkage and there was a predominance of acute inflammatory process in the PCD group.

Post-traumatic synchronous twin inter-muscular abdominal and diaphragmatic hernias: A rare presentation.

Simultaneous occurrence of traumatic abdominal wall hernia (TAWH) and traumatic diaphragmatic hernia (TDH) is uncommon. Our report documents the rare delayed presentation of simultaneous occurrence of TAWH and TDH in a patient who sustained a bicycle handlebar injury as a consequence of the bicycle he was riding colliding with a motorbike in a road-traffic accident. Excellent outcome could be achieved in this patient with surgical repair without requiring the use of a mesh.

Traumatic Abdominal Wall Hernia (TAWH): Repair by using a Prolen Mesh

Traumatic abdominal wall hernia after blunt abdominal trauma is rare. The prevalence of traumatic abdominal wall hernia in published series is approximately 1%. Recently, by the use of computed tomography has increased the number of occult traumatic abdominal wall hernias (TAWH). A 47-year-old woman presented to the emergency room soon after a traffic accident. She was fully conscious and complained of diffuse, dull, abdominal pain. She had a seat belt on at the time of the accident. Initial computed tomography showed that the lower left abdominal wall had a defect and that a part of the small bowel had herniated through the defect. During the operation, we made an incision at the defect site and confirmed the defect. The defect size was about 15x5 cm. The muscle layers were repaired in layers with absorbable sutures. Prolen mesh was layed down and fixed on the site of the repaired muscle defect. After 6 months, hernia had not recurred, and no weakness of the repaired abdominal wall layers was identified. The patient`s postoperative body functions were normal.

Traumatic Abdominal Wall Hernia (TAWH): A Case Study Highlighting Surgical Management

We report a rare case of traumatic abdominal wall hernia (TAWH) caused by a traffic accident. A 47-year-old woman presented to the emergency room soon after a traffic accident. She complained of diffuse, dull abdominal pain and mild nausea. She had no history of prior abdominal surgery or hernia. We found a bulging mass on her right abdomen. Plain abdominal films demonstrated a protrusion of hollow viscus beyond the right paracolic fat plane. Computed tomography (CT) showed intestinal herniation through an abdominal wall defect into the subcutaneous space. She underwent an exploratory surgery, followed by a layer-by-layer interrupted closure of the wall defect using absorbable monofilament sutures without mesh and with no tension, despite the large size of the defect. Her postoperative course was uneventful.

Hernia asintomáiica de pared abdominal como halazgo durante cirugía laparoscóppica ginecológica / Asymptomatic hernia of the abdominal wall as a finding during laparoscopic gynecological surgery

OBJETIVO: Conocer la incidencia y determinar la factibilidad del diagnóstico de hernias asintomáticas de pared abdominal, como hallazgo durante cirugía laparoscópicas por causa ginecológica. MÉTODO: Estudio prospectivo de 100 pacientes ingresadas para cirugía ginecológica laparoscópica, en las cuales se descartó hernia de pared abdominal mediante la anamnesis y examen físico en la evaluación preoperatoria. Se observó rutinariamente la pared abdominal durante la laparoscopia, buscando defectos herniarios. RESULTADO: De las 100 pacientes ingresadas al estudio, se constató 1 caso de hernia de pared abdominal (hernia inguinal indirecta). CONCLUSIÓN: La incidencia para el grupo estudiado, fue de 1 hernia de pared abdominal asintomática (1%), encontrada como hallazgo durante un procedimiento laparoscópico por causa ginecológica. Los defectos de pared abdominal pueden constituir, aunque escasos, un hallazgo durante la cirugía laparoscópica ginecológica. Se discute la necesidad de reparación durante el acto quirúrgico primario.

OBJECTIVE: To determine the feasibility of diagnosing hernial abdominal wall defect and to find out the incidence of asymptomatic abdominal wall hernias like finding during laparoscopic gynecologic surgeries. METHOD: Prospective study of 100 consecutive laparoscopic gynecologic surgeries in which a thorough visualization of the abdominal wall and the areas of common wall defects were examined during surgery. None of the patients had symptoms or physical findings suggestive of hernias in the preoperative evaluation. RESULTS: Only one abdominal wall hernia was found in this series (1 in a 100). The defect was an indirect right inguinal hernia. CONCLUSIONS: A complete examination of the abdominal wall during gynecologic laparoscopy allows the diagnosis of asymptomatic hernias. The incidence of hernia found in this series was 1%. The necessity of repair during the same surgical act is discussed.

Abdominal Traumatic Handlebar Hernia

Traumatic abdominal wall hernia (TAWH) is an unusual type of hernia that may follow direct blunt trauma to the abdomen. Moreover, TAWH that is caused by bicycle handlebars is a rare finding. Despite an overall increase in the incidence of blunt abdominal trauma, the cases of TAWH remain rare, probably due to the elasticity of the abdominal wall for resisting the shear forces generated by a traumatic impact. Although the first case was described by Selby in 1906, very few cases of TAWH have been reported in the literature. Also, "Handlebar hernia" was described by Dimyan et al. in 1980. These injuries are localized hernias resulting from local blunt trauma to the abdominal wall from an object with insufficient force to penetrate the skin, yet this trauman is able to disrupt the deeper tissues of the muscle and fascia. The significance of such hernias is underestimated, and although they can be not immediately life-threatening, they can be fatal if associated with such complications as incarceration and strangulation. We describe here a case of traumatic handlebar hernia in a 55-year old man who presented with left lower quadrant pain that was caused by a motorcycle accident.