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1.
Arch Gynecol Obstet ; 310(1): 11-21, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38839608

ABSTRACT

PURPOSE: Anterior enterocele is a rare but potentially serious complication after cystectomy with heterogeneous treatment options. METHODS: Here we report on the management of a 71-year-old patient with recurrence of anterior enterocele after cystectomy and provide a systematic review of the literature using the PubMed/MEDLINE database. RESULTS: The 71-year-old patient with recurrence of anterior enterocele after cystectomy was successfully treated with colpocleisis and anterior colporrhaphy at the Department of Gynecology and Gynecological Oncology, University Hospital Bonn. The use of a synthetic mesh was not needed. At 16-month follow-up postoperatively, the patient was asymptomatic and had no signs of recurrence. n = 14 publications including n = 39 patients were identified for the systematic review including case reports and reviews. The median duration of developing an anterior enterocele after cystectomy was 9 months (range 3 months to 8 years). Patients had a median age of 71 years (range 44-84). In all cases, a surgical approach was described using a wide variety of surgical procedures. In total, 36% of all patients developed a recurrence with an average time period of 7 months after primary surgery. A rare complication represents a vaginal evisceration with the need of urgent surgery. Furthermore, the occurrence of a fistula is a possible long-term complication. CONCLUSION: Anterior enterocele after cystectomy is a rare complication requiring an individual and interdisciplinary treatment.


Subject(s)
Cystectomy , Urinary Bladder Neoplasms , Humans , Female , Aged , Cystectomy/adverse effects , Urinary Bladder Neoplasms/surgery , Postoperative Complications/surgery , Postoperative Complications/etiology , Hernia/etiology , Recurrence
2.
Int J Colorectal Dis ; 39(1): 70, 2024 May 08.
Article in English | MEDLINE | ID: mdl-38717479

ABSTRACT

Pelvic exenteration (PE) is a technically challenging surgical procedure. More recently, quality of life and survivorship following PEs are being increasingly acknowledged as important patient outcomes. This includes evaluating major long-term complications such as hernias, defined as the protrusion of internal organs through a facial defect (The PelvEx Collaborative in Br J Surg 109:1251-1263, 2022), for which there is currently limited literature. The aim of this paper is to ascertain the incidence and risk factors for postoperative hernia formation among our PE cohort managed at a quaternary centre. METHOD: A retrospective cohort study examining hernia formation following PE for locally advanced rectal carcinoma and locally recurrent rectal carcinoma between June 2010 and August 2022 at a quaternary cancer centre was performed. Baseline data evaluating patient characteristics, surgical techniques and outcomes was collated among a PE cohort of 243 patients. Postoperative hernia incidence was evaluated via independent radiological screening and clinical examination. RESULTS: A total of 79 patients (32.5%) were identified as having developed a hernia. Expectantly, those undergoing flap reconstruction had a lower incidence of postoperative hernias. Of the 79 patients who developed postoperative hernias, 16.5% reported symptoms with the most common symptom reported being pain. Reintervention was required in 18 patients (23%), all of which were operative. CONCLUSION: This study found over one-third of PE patients developed a hernia postoperatively. This paper highlights the importance of careful perioperative planning and optimization of patients to minimize morbidity.


Subject(s)
Pelvic Exenteration , Postoperative Complications , Humans , Incidence , Female , Risk Factors , Pelvic Exenteration/adverse effects , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Aged , Hernia/etiology , Hernia/epidemiology , Adult , Retrospective Studies
3.
J Cardiothorac Surg ; 19(1): 231, 2024 Apr 16.
Article in English | MEDLINE | ID: mdl-38627781

ABSTRACT

BACKGROUND: Cardiac herniation occurs when there is a residual pericardial defect post thoracic surgery and is recognised as a rare but fatal complication. It confers a high mortality and requires immediate surgical correction upon recognition. We present a case of cardiac herniation occurring post thymectomy and left upper lobectomy. CASE PRESENTATION: Initial presentation: A 48-year-old male, hypertensive smoker presented with progressive breathlessness and was found to have a left upper zone mass confirmed on CT biopsy as carcinoid of unclear origin. PET-CT revealed avidity in a left anterior mediastinal area, left upper lobe (LUL) lung mass, mediastinal lymph nodes, and a right thymic satellite nodule. Intraoperatively: Access via left thoracotomy and sternotomy. The LUL tumour involved the left thymic lobe (LTL), left superior pulmonary vein (LSPV), left phrenic nerve and intervening mediastinal fat and pericardium, which were resected en-masse. The satellite nodule in the right thymic lobe (RTL) was adjacent to the junction between the left innominate vein and superior vena cava (SVC). The pericardium was resected from the SVC to the left atrial appendage. Clinical deterioration: Initially the patient was doing well clinically on day 1, however there was sudden bradycardia, hypotension, clamminess, and oligoanuria, with raised central venous pressures and troponins. ECG: no capture in leads V1-2, but positive deflections seen on posterior leads. Echo: no acoustic windows, but good windows seen posteriorly. CXR: left mediastinal shift. Redo operation: After initial resuscitation and stabilisation on the intensive care unit, on day 2 a redo-sternotomy revealed cardiac herniation into the left thoracic cavity with the left ventricular apex pointing towards the spine, and inferior caval kinking. After reduction and repair of the pericardial defect with a fenestrated GoreTex patch, the patient recovered well with complete resolution of the ECG and CXR. CONCLUSION: Cardiac herniation can even occur following sub-pneumonectomy lung resections and should be considered as a differential when faced with a sudden clinical deterioration, warranting early surgical correction.


Subject(s)
Clinical Deterioration , Heart Diseases , Male , Humans , Middle Aged , Thymectomy/adverse effects , Vena Cava, Superior/surgery , Positron Emission Tomography Computed Tomography , Heart Diseases/surgery , Hernia/etiology , Hernia/complications , Pneumonectomy/adverse effects
5.
Clin J Am Soc Nephrol ; 19(6): 784-790, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38190178

ABSTRACT

Peritoneal dialysis (PD) is a form of KRT that offers flexibility and autonomy to patients with ESKD. It is associated with lower costs compared with hemodialysis in many countries. However, it can be associated with unexpected interruptions to or discontinuation of therapy. Timely diagnosis and resolution are required to minimize preventable modality change to hemodialysis. This review covers mechanical complications, including leaks, PD hydrothorax, hernias, dialysate flow problems, PD-related pain, and changes in respiratory mechanics. Most mechanical complications occur early, either as a result of PD catheter insertion or the introduction of dialysate and consequent increased intra-abdominal pressure. Late mechanical complications can also occur and may require different treatment.


Subject(s)
Hydrothorax , Peritoneal Dialysis , Humans , Peritoneal Dialysis/adverse effects , Hydrothorax/etiology , Hydrothorax/therapy , Kidney Failure, Chronic/therapy , Kidney Failure, Chronic/physiopathology , Dialysis Solutions/adverse effects , Respiratory Mechanics , Hernia/etiology , Hernia/physiopathology , Risk Factors
6.
Ann Surg ; 279(3): 462-470, 2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38084600

ABSTRACT

OBJECTIVE: This study evaluated the postoperative mortality and morbidity outcomes following the different subtypes of gastrointestinal (GI) surgery over a 15-year period. BACKGROUND: Patients receiving chronic kidney replacement therapy (KRT) experience higher rates of general surgery compared with other surgery types. Contemporary data on the types of surgeries and their outcomes are lacking. KRT was defined as patients requiring chronic dialysis (hemodialysis or peritoneal dilaysis) or having a functioning kidney transplant long-term. METHODS: All incident and prevalent patients aged greater than 18 years identified in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry as receiving chronic KRT were linked with jurisdictional hospital admission datasets between January 1, 2000 until December 31, 2015. Patients were categorized by their KRT modality [hemodialysis (HD), peritoneal dialysis (PD), home hemodialysis (HHD), and kidney transplant (KT)]. GI surgeries were categorized as upper gastrointestinal (UGI), bowel (small and large bowel), anorectal, hernia surgery, cholecystectomy, and appendicectomy. The primary outcome was the rates of the different surgeries, estimated using Poisson models. Secondary outcomes were risks of 30-day/in-hospital postoperative mortality risk and nonfatal outcomes and were estimated using logistic regression. Independent predictors of 30-day mortality were examined using comorbidity-adjusted Cox models. RESULTS: Overall, 46,779 patients on chronic KRT were linked to jurisdictional hospital datasets, and 9,116 patients were identified as having undergone 14,540 GI surgeries with a combined follow-up of 76,593 years. Patients on PD had the highest rates of GI surgery (8 per 100 patient years), with hernia surgery being the most frequent. Patients on PD also had the highest risk of 30-day postoperative mortality following the different types of GI surgery, with the risk being more than 2-fold higher after emergency surgery compared with elective procedures. Infective postoperative complications were more common than cardiac complications. This study also observed a U-shaped association between body mass index (BMI) and mortality, with a nadir in the 30 to 35 kg/m 2 group. CONCLUSIONS: Patients on chronic KRT have high rates of GI surgery and morbidity, particularly in those who receive PD, are older, or are either underweight or moderately obese.


Subject(s)
Digestive System Surgical Procedures , Kidney Failure, Chronic , Humans , Aged , Kidney Failure, Chronic/therapy , Cohort Studies , Renal Dialysis/adverse effects , Renal Dialysis/methods , Renal Replacement Therapy , Hernia/etiology
7.
Pediatr Transplant ; 28(1): e14656, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37984827

ABSTRACT

BACKGROUND: Lung herniation is a rare complication of heart-lung transplantation that can be fatal owing to vascular compromise and airway obstruction. To date, only five cases of lung herniation related to heart-lung transplantation have been reported in the literature; however, to the best of our knowledge, this is the first worldwide report of heart-lung transplantation-related lung herniation in an infant. METHODS: We describe the case of lung herniation as a rare heart-lung transplantation-related complication in an infant. A 12-month-old female baby developed severe bronchopulmonary dysplasia with severe pulmonary hypertension, and she underwent extracorporeal membrane oxygenation for cardiac collapse and lung support. Then, we performed heart-lung transplantation to manage the irreversible deterioration of her lung function. After the heart-lung transplantation, we found the radiological abnormalities persisted on follow-up chest radiographs until the 13th postoperative day diagnosed as lung herniation of the right lower lobe on chest computed tomography. RESULTS: After the relocation of the herniated lung, the clinical condition of the patient improved, and the patient is currently growing without any respiratory symptoms. CONCLUSIONS: In this case report, we emphasize that clinical awareness and high suspicion of this rare complication are needed for early diagnosis and proper treatment to prevent post-transplantation morbidity and mortality related to potential ischemic injury.


Subject(s)
Heart-Lung Transplantation , Hypertension, Pulmonary , Lung Transplantation , Infant , Infant, Newborn , Humans , Female , Lung/diagnostic imaging , Hernia/diagnosis , Hernia/etiology , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Lung Transplantation/adverse effects
8.
Cell Rep Med ; 5(1): 101343, 2024 01 16.
Article in English | MEDLINE | ID: mdl-38154462

ABSTRACT

Parastomal hernia (PSH) is a common complication in patients receiving ileal conduit urinary diversion after radical cystectomy. In this randomized controlled clinical trial, we validate our previous finding that extraperitonealization of ileal conduit decreases incidence of PSH. In total, 104 consecutive patients undergoing radical cystectomy at Sun Yat-sen University Cancer Center are randomized 1:1 to receive either modified (extraperitonealized) ileal conduit (n = 52) or conventional ileal conduit (n = 52). Primary endpoint is incidence of radiological PSH during follow-up. Incidence of radiological PSH is lower in the modified group than in the conventional group (11.5% vs. 28.8%; p = 0.028) after a median follow-up of 32 months, corresponding to a hazard ratio of 0.374 (95% confidence interval: 0.145-0.965, p = 0.034) in the modified conduit group. The results support our previous finding that extraperitonealization of the ileal conduit is effective for reducing risk of PSH in patients receiving ileal conduit diversion.


Subject(s)
Urinary Bladder Neoplasms , Urinary Diversion , Humans , Cystectomy , Hernia/etiology , Incidence , Urinary Bladder Neoplasms/surgery , Urinary Diversion/adverse effects , Urinary Diversion/methods
9.
Microsurgery ; 43(8): 855-864, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37697962

ABSTRACT

BACKGROUND: Despite improvement in abdominal morbidity with deep inferior epigastric perforator (DIEP) flap breast reconstruction compared to prior abdominally-based free flap breast reconstruction, abdominal bulge, and hernia rates have been cited anywhere from 2% to 33%. As a result, some surgeons utilize mesh or other reinforcement upon donor-site closure, but its benefit in preventing abdominal wall morbidity has not been well-defined for DIEP flaps. The purpose of this systematic review is to evaluate DIEP donor-site closure techniques and the impact of mesh type and plane on abdominal-wall morbidity including hernia and bulge, relative to primary fascial closure. METHODS: MEDLINE, PubMED, Cochrane Library, and SCOPUS were systematically reviewed for studies evaluating DIEP flap breast reconstruction abdominal-donor site closure, where any mesh reinforcement or primary fascial closure was specified, and postoperative outcomes of hernia and/or abdominal bulge were reported. Analysis was performed in Review Manager (RevMan) evaluating mesh use, type, and plane relative to primary fascial closure, using the Mantel-Haenszel method to calculate odds ratios (ORs) of significance level p < .05, and a random effects model to account for inter-study heterogeneity. RESULTS: Of the 2791 DIEP patients across 11 studies, 1901 patients underwent primary closure and 890 were repaired with mesh. When hernia and/or bulge were combined into a single complication, the use of any mesh did not significantly reduce its odds compared to primary closure (OR = 0.69, p = .20). Similarly, the use of any mesh did not significantly reduce the odds of bulge alone compared to primary closure (OR = 0.62, p = .43). However, the odds of hernia alone were significantly reduced by 72% with any mesh use (OR = 0.28, p = .03). CONCLUSION: Mesh use was significantly associated with decreased odds of hernia alone with DIEP flap surgery, but there was no difference in bulge or combined hernia/bulge rates. As bulge is the more common abdominal morbidity after DIEP flap harvest in a patient with no prior abdominal surgery or risk factor for hernia, mesh use is not indicated in abdominal closure of all DIEP patients. Future prospective studies are warranted to characterize the specific indications for mesh use in the setting of DIEP flap surgery.


Subject(s)
Abdominal Wall , Mammaplasty , Perforator Flap , Humans , Surgical Mesh , Mammaplasty/methods , Abdominal Wall/surgery , Hernia/etiology
10.
J Trauma Acute Care Surg ; 95(6): 839-845, 2023 12 01.
Article in English | MEDLINE | ID: mdl-37533145

ABSTRACT

BACKGROUND: Costal margin rupture (CMR) injuries are under-diagnosed and inconsistently managed, while carrying significant symptomatic burden. We hypothesized that the Sheffield Classification system of CMR injuries would relate to injury patterns and management options. METHODS: Data were collected prospectively between 2006 and 2023 at a major trauma center in the United Kingdom. Computed tomography scans were interrogated and injuries were categorized according to the Sheffield Classification. Clinical, radiologic, management and outcome variables were assessed. RESULTS: Fifty-four patients were included in the study. Intercostal hernia (IH) was present in 30 patients and associated with delayed presentation ( p = 0.004), expulsive mechanism of injury (i.e. such as occurs with coughing, sneezing, or retching), higher body mass index ( p < 0.001), and surgical management ( p = 0.02). There was a bimodal distribution of the level of the costal margin rupture, with IH Present and expulsive mechanism injuries occurring predominantly at the ninth costal cartilage, and IH Absent cases and other mechanisms at the seventh costal cartilage ( p < 0.001). There were correlations between the costal cartilage being thin at the site of the CMR and the presence of IH and expulsive etiology ( p < 0.001). Management was conservative in 23 and surgical in 31 cases. Extrathoracic mesh IH repairs were performed in 3, Double Layer Mesh Repairs in 8, Suture IH repairs in 5, CMR plating in 8, CMR sutures in 2, and associated Surgical Stabilization of Rib Fractures in 11 patients. There was one postoperative death. There were seven repeat surgical procedures in five patients. CONCLUSION: The Sheffield Classification is associated statistically with presentation, related chest wall injury patterns, and type of definitive management. Further collaborative data collection is required to determine the optimal management strategies. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.


Subject(s)
Hernia, Hiatal , Hernias, Diaphragmatic, Congenital , Humans , Rib Cage/surgery , Hernia/etiology , Hernia, Hiatal/complications , Hernias, Diaphragmatic, Congenital/surgery , Herniorrhaphy/methods , Rupture/surgery
11.
Kyobu Geka ; 76(8): 657-660, 2023 Aug.
Article in Japanese | MEDLINE | ID: mdl-37500557

ABSTRACT

A 72-year-old man who underwent aortic valve replacement by a minimally invasive cardiac surgery (MICS) approach two years ago was visited our hospital complaining of swelling and pain in the right anterior chest. A chest computed tomography (CT) scan showed that the right upper lobe protruded beyond the right second intercostal space and outside the thorax. He was diagnosed as a right intercostal lung hernia and underwent chest wall reconstruction with a substitute method. Postoperative course was uneventful without any evidence of recurrence. Postoperative intercostal lung hernias in MICS may increase with the increment in MICS, and it is necessary to accumulate cases as one of the complications.


Subject(s)
Cardiac Surgical Procedures , Lung Diseases , Surgery, Plastic , Male , Humans , Aged , Lung Diseases/surgery , Hernia/etiology , Hernia/complications , Lung , Cardiac Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures
12.
Spinal Cord ; 61(8): 441-446, 2023 08.
Article in English | MEDLINE | ID: mdl-37380759

ABSTRACT

STUDY DESIGN: Retrospective multicenter study. OBJECTIVES: Although surgery is frequently selected for the treatment of idiopathic spinal cord herniation (ISCH), its impact on functional outcomes has yet to be fully understood given the limited number of patients in previous studies. This study aims to evaluate the symptomatic history and surgical outcomes of ISCH. SETTING: Three institutions in Japan. METHODS: A total of 34 subjects with ISCH were retrospectively enrolled and followed up for at least 2 years. Demographic information, imaging findings, and clinical outcomes were collected. Functional status was assessed using the JOA score. RESULTS: The types of neurologic deficit were monoparesis, Brown-Sequard, and paraparesis in 5, 17, and 12 cases, with their mean disease duration being 1.2, 4.2, and 5.8 years, respectively. Significant differences in disease duration were observed between the monoparesis and Brown-Sequard groups (p < 0.01) and between the monoparesis and paraparesis groups (p = 0.04). Surgery promoted significantly better recovery rates from baseline. Correlations were observed between age at surgery and recovery rate (p < 0.01) and between disease duration and recovery rate (p = 0.04). The mean recovery rates were 82.6%, 51.6%, and 29.1% in the monoparesis, Brown-Sequard, and paraparesis groups, respectively. The monoparesis group had a significantly higher recovery rate than did the Brown-Sequard (p = 0.045) and paraparesis groups (p < 0.01). CONCLUSIONS: Longer disease duration was correlated with the progression of neurologic deficit. Older age, and worse preoperative neurologic status hindered postoperative functional recovery. These results highlight the need to consider surgical timing before neurologic symptoms deteriorate.


Subject(s)
Brown-Sequard Syndrome , Spinal Cord Diseases , Spinal Cord Injuries , Humans , Spinal Cord Diseases/diagnostic imaging , Spinal Cord Diseases/surgery , Retrospective Studies , Magnetic Resonance Imaging/methods , Hernia/etiology , Hernia/diagnosis , Spinal Cord , Paresis , Paraparesis/etiology , Paraparesis/surgery , Treatment Outcome
13.
Prague Med Rep ; 124(2): 181-188, 2023.
Article in English | MEDLINE | ID: mdl-37212137

ABSTRACT

Spinal anaesthesia (SA) is one of the most prevalent types of anaesthetic procedures. There are very few reports of cord herniation through the site of spinal canal stenosis due to tumour. A 33-year-old female presented with acute paraparesis after spinal anaesthesia for caesarean section. Magnetic resonance imaging (MRI) revealed an intradural mass from posterior of T6 to T8-T9 interface. We operated the patient and after laminectomy of T6 to T9, dermoid tumour containing hairs was totally resected and cord was completely decompressed. After 6 months, the patient is without any neurological deficit. Puncturing the dura with cerebrospinal fluid (CSF) in the presence of an extramedullary mass could cause cord herniation through the blockade. In these cases, awareness about related signs even in absence of symptoms or complaints could help us to prevent post-SA neurological deficit.


Subject(s)
Anesthesia, Spinal , Dermoid Cyst , Thoracic Neoplasms , Pregnancy , Humans , Female , Adult , Cesarean Section , Dermoid Cyst/diagnosis , Dermoid Cyst/surgery , Dermoid Cyst/pathology , Thoracic Vertebrae/pathology , Thoracic Vertebrae/surgery , Spinal Puncture , Hernia/diagnosis , Hernia/etiology , Hernia/pathology , Magnetic Resonance Imaging , Thoracic Neoplasms/pathology
14.
Port J Card Thorac Vasc Surg ; 30(1): 57-59, 2023 Apr 04.
Article in English | MEDLINE | ID: mdl-37029942

ABSTRACT

Pulmonary hernias are rare. They can be congenital, but mostly are acquired. Usually asymptomatic, they are diagnosed on physical examination or, incidentally, on imaging exams. Surgical treatment is required for large, increasing, or symptomatic hernias, and incarcerated or strangulated ones. This is a clinical case of a symptomatic postoperative pulmonary hernia. It occurred two years after a posterolateral thoracotomy for the resection of an intercostal myxolipoma. The tumor was resected en bloc with a partial segment of the 10th left rib and immediate reconstruction was made with an onlay polypropylene mesh. The postoperative hernia was successfully treated with a double-faced mesh of polypropylene and ePTFE. This surgery provided a functional and aesthetic enhancement for the patient, greatly improving his quality of life. This approach is, therefore, considered safe and effective.


Subject(s)
Herniorrhaphy , Incisional Hernia , Lipoma , Surgical Mesh , Thoracotomy , Humans , Hernia/etiology , Hernia/therapy , Herniorrhaphy/methods , Incisional Hernia/etiology , Incisional Hernia/surgery , Polypropylenes/therapeutic use , Quality of Life , Thoracotomy/adverse effects , Thoracotomy/methods , Polytetrafluoroethylene/therapeutic use , Lipoma/pathology , Lipoma/surgery
15.
Kyobu Geka ; 76(3): 201-204, 2023 Mar.
Article in Japanese | MEDLINE | ID: mdl-36861276

ABSTRACT

A 51 years old male had underwent aortic valve replacement (AVR) by minimally invasive cardiac surgery (MICS) for aortic regurgitation. About one year after the surgery, bulging of the wound and pain appeared. His chest computed tomography showed an image of the right upper lobe protruding from the thoracic cavity through the right second intercostal space, and the patient was diagnosed as having an intercostal lung hernia and the surgical treatment was performed using a unsintered hydroxyapatite and poly-L-lactide (u-HA/PLLA) mesh plate and monofilament polypropylene (PP) mesh. Postoperative course was uneventful without any evidence of recurrence.


Subject(s)
Aortic Valve Insufficiency , Cardiac Surgical Procedures , Thoracic Cavity , Male , Humans , Middle Aged , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Polypropylenes , Hernia/diagnostic imaging , Hernia/etiology
16.
Gan To Kagaku Ryoho ; 50(2): 221-223, 2023 Feb.
Article in Japanese | MEDLINE | ID: mdl-36807178

ABSTRACT

A 70s woman with a history of asthma and dyslipidemia underwent a robot-assisted abdominoperineal resection for rectal cancer. The ports were placed as per the method of Shizuoka Cancer Center and no intraoperative complications were observed. The colostomy was constructed in the left lower abdomen by the retroperitoneal route. The 12-mm port part was closed in 2 layers, the fascia and dermis, and the 8-mm port part was closed only in the dermis. The postoperative course was good; however, the patient vomited 10 days after surgery. Abdominal computed tomography revealed an incarcerated small intestine in the 8-mm port of the left abdomen, and it was diagnosed as port-site hernia incarceration. Emergency laparotomy hernia repair was performed on the day. A part of the 8-mm port was incised to 30-mm and the fascia dilatation to 30-mm was observed. The color tone of the incarcerated small intestine was good. Only adhesion peeling was performed, the small intestine was returned, and the fascia was closed. The postoperative course was uneventful and the patient was discharged 17 days after the second surgery. At the 1 year postoperative follow-up, recurrence of hernia or rectal cancer was not observed.


Subject(s)
Laparoscopy , Proctectomy , Rectal Neoplasms , Robotics , Female , Humans , Laparoscopy/adverse effects , Hernia/etiology , Abdomen/surgery , Proctectomy/adverse effects , Rectal Neoplasms/surgery
17.
Hernia ; 27(4): 751-763, 2023 08.
Article in English | MEDLINE | ID: mdl-36840829

ABSTRACT

PURPOSE: A perineal hernia is a subtype of pelvic floor hernias, and especially primary perineal hernias are rare. No guideline exists on how to handle this type of hernia. Therefore, the primary aim of this scoping review was to investigate the surgical treatment options in adults for primary perineal hernias. METHODS: This systematic scoping review included studies with original data on at least one adult operated for a primary perineal hernia. Studies from 1990 and forward were included to cover contemporary surgical techniques. Three databases were systematically searched: PubMed, Embase, and Cochrane CENTRAL. Furthermore, a snowball search was performed. The primary outcome was to narratively present details about the surgical techniques. The secondary outcomes were to give an overview of symptoms, diagnostics, intraoperative complications, and postoperative course. RESULTS: Twenty-two case studies reported repairs on 22 patients suffering from primary perineal hernia. Common symptoms were pain and discomfort, and a bulge was often found during physical examination. Different diagnostic methods were used, and MRI-scans most often found an abnormality. Different surgical procedures can repair the condition, however, laparotomy and the use of a permanent mesh was the most common option. Far from all studies reported on outcomes, but no severe intraoperative event was reported, and the postoperative course was overall uneventful. CONCLUSION: Primary perineal hernia is a very rare condition presenting with pain/discomfort and bulging and it can be visualized with different imaging modalities. Laparotomy with a permanent mesh was often used for repair, and the postoperative course was mostly uneventful.


Subject(s)
Hernia, Abdominal , Herniorrhaphy , Adult , Humans , Herniorrhaphy/adverse effects , Herniorrhaphy/methods , Surgical Mesh/adverse effects , Hernia/etiology , Hernia, Abdominal/surgery , Laparotomy/adverse effects , Pain/surgery , Perineum/surgery
20.
Surg Today ; 53(10): 1105-1115, 2023 Oct.
Article in English | MEDLINE | ID: mdl-36720743

ABSTRACT

The present study determined the characteristics of perineal hernia treatment in the literature, and the incidence of postoperative recurrence was stratified according to repair techniques. A systematic search of the available literature on the treatment of postoperative perineal hernias was performed using a major database. The types of repair techniques and outcome were entered into an electronic database and a pooled analysis was performed. A total of 213 cases of postoperative perineal hernia repair were collected from 20 relevant articles in the literature after excluding case reports (n < 3). Synthetic mesh was the material used most frequently for perineal hernia repair (55.9%). The most frequently used approach in perineal hernia repair was the perineal approach (56.5%). The recurrence rate was highest with the use of biological mesh (40.4%) and the perineal approach (35.6%). The recurrence rate was lowest in the combined abdominal & perineal approach (0%), followed by the abdominal approach (8.8%) and the laparoscopic approach (11.8%). A number of different repair techniques have been described in the literature. The use of synthetic mesh via a combined abdominal-perineal approach or intraabdominal/laparoscopic approach was shown to be associated with a reduced postoperative recurrence rate.


Subject(s)
Hernia, Abdominal , Incisional Hernia , Humans , Herniorrhaphy/methods , Surgical Mesh/adverse effects , Hernia, Abdominal/etiology , Hernia, Abdominal/surgery , Abdomen/surgery , Incisional Hernia/surgery , Perineum/surgery , Hernia/epidemiology , Hernia/etiology , Hernia/prevention & control , Postoperative Complications/etiology
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