ABSTRACT
BACKGROUND: This report examines recurrent pediatric groin hernias and the role of diagnostic laparoscopy in the management of these recurrences. METHODS: A chart review of 19 children presenting with recurrent hernias was performed, analyzing the type of primary hernia, nature of recurrence, preexisting medical conditions, surgical complications at primary repair, and time to recurrence. Diagnostic laparoscopy (DL) was used during the remedial repair of the last nine patients. RESULTS: Seventeen indirect hernias were repaired during the primary repair, and 1 femoral hernia was identified. In one child, no inguinal hernia was identified at the initial operation. Overall, 11 recurrences were found to consist of indirect sacs, and 4 were found to have attenuation of the inguinal floor. Four additional recurrences were found to be femoral hernias. In only 1 patient was a wound factor (infection) thought to play a role in the recurrence. Diagnostic laparoscopy in 9 patients found 4 (44%) to have unsuspected intraoperative findings. Four femoral hernias were identified (3 with unsuspected contralateral femoral hernias). Additionally, 1 unsuspected recurrence of an indirect sac was identified. CONCLUSIONS: Laparoscopy accurately identifies the nature of the defect in children with recurrent groin hernias, detecting unsuspected contralateral indirect, direct, or femoral hernias in 44% of those undergoing laparoscopy.
Subject(s)
Hernia, Femoral/surgery , Hernia, Inguinal/surgery , Child , Female , Hernia, Femoral/diagnosis , Hernia, Femoral/epidemiology , Hernia, Inguinal/diagnosis , Hernia, Inguinal/epidemiology , Humans , Incidence , Infant , Laparoscopy , Male , Recurrence , ReoperationSubject(s)
Hernia, Inguinal/surgery , Child , Child, Preschool , Hernia, Inguinal/diagnosis , Humans , Infant , LaparoscopyABSTRACT
Standard methods of running subcuticular closures frequently leave the completion knot close to the epidermis, resulting in stitch abcesses and suture extrusion. A simple technique for the subcutaneous placement of completion knots following subcuticular sutures, resulting in fewer stitch abcesses, is described.
Subject(s)
Suture Techniques , Humans , SkinSubject(s)
Medical Audit , Cataract Extraction , Cholecystectomy , Evaluation Studies as Topic , Female , Humans , Hysterectomy , Nursing Audit , Pneumonia , Pulmonary EdemaSubject(s)
Leprosy/diagnostic imaging , Adolescent , Bone Diseases/etiology , Child , Female , Finger Joint , Foot/diagnostic imaging , Foot Diseases/etiology , Hand/diagnostic imaging , Humans , Leprosy/complications , Male , Radiography , Toe JointABSTRACT
A method for the simultaneous measurement of gastrointestinal protein loss and total albumin turnover entailing the use of a combination of (125)iodine- and (51)chromium-labeled albumin is described. Albumin turnover was calculated by the measurement of albumin-(125)I plasma decay and cumulative urinary excretion, and the results obtained agreed closely with previous studies utilizing albumin-(131)I. Gastrointestinal catabolism was calculated from the rate of fecal excretion of (51)Cr and the specific activity of plasma albumin-(51)Cr, and these data were related to the calculated albumin turnover results. During the period of 6-14 days after administration, the ratio of specific activties of albumin-(125)I and -(51)Cr in plasma and in extravascular spaces or gastric and biliary secretions remained almost identical. Fecal excretion of (51)Cr was also quite stable at this time. In six normal subjects gastrointestinal catabolism accounted for less than 10% of total albumin catabolism. Excessive gastrointestinal protein losses did not contribute to the low serum albumin in three patients with cirrhosis or in two adults with the nephrotic syndrome. Multiple mechanisms leading to hypoalbuminemia were demonstrated in other subjects with a variety of gastrointestinal disorders.
