SURGICAL TEATMENT OF VENTRAL HERNIA WITH INTESTINAL REPOSITION IN A 2 YEAR OLD LOCAL FEMALE CAT

Inguinal hernia is the protrusion of an organ, part of an organ, fat, or tissue through the inguinal ring, located between the groin and abdominal muscles. This case study aims to understand the diagnostic methods and management of inguinal hernia in a domestic cat. A three-month-old male domestic cat weighing 1 kg presented with a lump in the inguinal area. After clinical and radiographic examinations, the cat was diagnosed with an inguinal hernia with a favorable prognosis. Treatment was performed surgically using the herniorrhaphy technique to reposition the herniated contents into the abdominal cavity. Before surgery, the cat was given premedication with atropine (V-tropine® 0.02 mg/kg BW SC), followed by anesthesia using a combination of xylazine (xylazine® 1 mg/kg BW) and ketamine (ketamine® 11 mg/kg BW) intravenously. The surgical procedure involved repositioning the herniated contents and modifying the hernia ring to allow tissue adhesion. Layered suturing was performed using polyglycolic acid 3.0 for the peritoneum (simple interrupted pattern), catgut 3.0 for the subcutaneous layer (simple continuous pattern), and silk 2.0 for the skin (simple interrupted pattern). Postoperatively, the cat was administered cefotaxime (cefotaxime® 20 mg/kg BW q12h IM) for three days and tolfenamic acid (tolfedine® 4 mg/kg BW q24h IM) for four days, followed by cefixime (cefixime® 10 mg/kg BW q12h PO). On the eighth day, the cat was declared fully recovered with stable clinical conditions, good appetite, and normal urination and defecation. Surgical intervention using the herniorrhaphy technique proved effective in treating inguinal hernia in domestic cats, ensuring a fast recovery and a high success rate. Early diagnosis and prompt treatment are crucial to prevent serious complications, such as organ strangulation, which can lead to necrosis and systemic infection. Therefore, pet owners need to be more vigilant about the symptoms of inguinal hernia and promptly take their pets to a veterinarian for proper diagnosis and treatment

Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient’s tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal hernia patients who were prepared for hernia repair with preoperative progressive pneumoperitoneum and then treated successfully by graft hernioplasty. We observed that abdominal expansion correlated with the inflated volume and pressure during the first four days of pneumperitoneum. Although insufflated gas volume can be different among patients, we observed that the duration of insufflation may be the same for similar patients.

Objective To analyze the efficacy and safety in the treatment of patients with progressive pneumoperitoneum (PPP) prior to elective repair of the complex incisional hernia. Methods This retrospective study assessed twenty-one patients between January 2015 and February 2017 with complex incisional hernias. All patients underwent serial computed tomography of the abdomen with volume measurements of the peritoneal cavity and hernia sac before and after pneumoperitoneum. Results Twenty-one patients successfully completed the pneumoperitoneum. The mean overall duration of pneumoperitoneum was (16.6±1.8) days, the mean insufflated volume of air was (3.7±0.9) L; 4 patients (19.0%) suffered from pneumoperitoneum-related complications, consisting of one subcutaneous emphysema and three of scapular pain. Before and after PPP, the mean volume of the incisional hernia (VIH) was (901.0±430.8) ml, (1 115.1±481.9) ml, the mean volume of the abdominal cavity (VAbC) was (6 741.9±1 746.9) ml, (8 962.3±2 272.9) ml, VIH/(VIH+VAbC)×100% was (12±5)% and (11±4)%, the differences were statistically significant (t=11.3, 12.4, 2.9, all P<0.01). The mean gain in volume of the hernia sac was 214 ml (26.0%) and the abdominal cavity was 2 220 ml (33.7%) after PPP. Most patients showed spontaneous reduction of the hernia contents. The operations of all patients were successful, no bowel injury was found, the mean operative time and postoperative length of stay were (180.1±50.6) min, (11.4±9.0) d. Complete closure of the abdominal wall defect was performed in all patients. Postoperatively, there were 2 cases of seroma, 1 case of dyspnea, 1 case of pneumonia, all patients were better after symptomatic treatment. There were no patients experiencing abdominal hypertension and cardiorespiratory failure postoperatively. After a mean follow-up of (13.0±8.0) months, there were no hernia recurrences. Conclusions PPP is a useful adjunct in complex ventral hernia repair, allowing the reintroduction of herniated content into the abdominal cavity. Simultaneously, pneumoperitoneum has an acceptable overall morbidity. Key words: Pneumoperitoneum, artificial; Hernia, abdominal; Defect,abdominal wall; Herniorrhaphy

Ventral hernia is an abnormality in the median abdomen in the form of a lump caused by incomplete closure of the abdominal wall so that the visceral organs or omentum come out of the abdominal cavity. This case study aims to determine how to diagnose and treat cases of ventral hernia in female cats. A 2-year-old female tortie mix cat weighing 3.58 kg with clinical signs of a lump in the ventral abdomen after an ovariohysterectomy. Supporting examinations were carried out in the form of radiography (x-ray) to support the diagnosis and the results showed a radiolucent image in the area of ​​the lump containing fatty tissue (omentum). The cat was diagnosed with ventral hernia with a fausta prognosis. Treatment was carried out by laparotomy surgery to reposition the contents of the hernia into the abdominal cavity with general anesthesia using a combination of xylazine and ketamine. The closure of the abdominal wall and peritoneum was sutured with a simple interrupted pattern and the subcutaneous part with a simple continuous pattern and combined with subcuticular pattern sutures using Polyglycolic acid 3-0 thread. Postoperatively, the cat was given antibiotiks cefotaxime sodium (20 mg/kg BW, IV, q12h) for 3 consecutive days and continued with Cefixime (10 mg/kg BW, PO, q12h) for 5 consecutive days. On the 11th day, the cat was declared cured with the surgical wound that had healed and dried perfectly with normal appetite and drinking, smooth defecation and urination. It is recommended for owners not to take this condition lightly and a veterinary examination is required to prevent complications that could endanger the animal's health.

Enterocutaneous fistula 14 years after prosthetic mesh repair of a ventral incisional hernia: A life-long risk?

Background: The rupture of the suture in the abdominal wall, but with integrity of the cutaneous suture, results in a condition known as incisional hernia. It is characterized by the protrusion of the abdominal viscera through orifices or areas of the abdominal wall. In most of the cases these defects in the abdominal wall are iatrogenic. The incisional hernia occurs in an intact wall that is weakened by surgical incisions. The available literature on the incidence of incisional hernias in animals is scarce. With the aim to contribute to the information about incisional hernia in animals, it was decided to describe the case of incisional hernia in a female dog after performing ovariohysterectomy (OH).Case: An adult mongrel shelter bitch, of unknown age, weighing 9.5 kg was admitted for OH in a practical class of the veterinary surgical technical discipline. Once the anesthetic condition was established, a retro-umbilical cutaneous incision was made. After opening the abdominal cavity, the bitch was castrated routinely. The abdominal wall was sutured including peritoneum, muscle fascia, and rectus abdominis muscle with nylon thread and U-stitches. The subcutaneous tissue was then sutured with the same thread using Cushing suture. Ten days after the surgery, when the stitches were removed, the bitch revealed an increase in volume at the region of the surgical scar. Incisional hernia was diagnosed after careful palpation. For correction of the hernia, the bitch was submitted to surgical procedure. After the skin opening, an intense inflammatory reaction was observed in the subcutaneous tissue. The inflamed skin and subcutaneous tissue were removed. The abdominal cavity was closed with nylon thread by means of U-stitches. The subcutaneous and skin sutures were the same as the first surgery. Ten days after the second surgery, stitches were removed, and the bitch had fully recovered. Discussion: One of the factors that may have contributed to the occurrence of the hernia was carrying out the surgical procedure in a practical class. The difficulties shown by students are related to the long learning curve, the complexity of the invasive technique, and the lack of ability. The apprentice surgeon can cause injuries in the tissues due to excessive manipulation. Post-incision hernias are acquired and formed when a cavity wall closed by surgery is ruptured. Another factor that may have contributed to the occurrence of the hernia described here is unsatisfactory postoperative care, which may be considered as one of the factors for acute cases of incisional hernias. Information on postoperative care after the patient was returned to the shelter is not available. Therefore, it cannot be ruled out that the patient, in contact with other animals by means of games or even fights, could have ruptured the points, thus causing dehiscence of the suture in the abdominal wall. However, it was concluded that the most probable factors involved in the etiology of the hernia in question were nutritional deficiencies along with the inexperience of the surgeon. The treatment adopted in the patient (herniorrhaphy) was adequate for the correction of the hernia. The technique and the material to be used in the procedure are of great importance, since it must be resistant enough to avoid recurrences. In the patient in question, nylon thread was used in separate U-shaped stitches. In the literature, there are reports that unabsorbable yarns used at separate points present the lowest rate of dehiscence and relapse in the abdominal wall sutures. The incisional hernia can be prevented by preparing the patient for surgery, improving the nutritional requirements, and by a more intense training of the students performing the surgical procedure in the neutering program of dogs and cats during practical classes.

Objective To investigate the effects of computed tomography (CT) examination in different body positions on the evaluation of abdominal incisional hernia volume. Methods The retrospective case-control study was conducted. The clinical data of 23 patients with abdominal incisional hernia who were admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from February to September in 2017 were collected. There were 14 males and 9 females, aged from 47 to 75 years, with an average age of 63 years. All patients underwent CT scan in supine position and lateral position. The volume of hernia sac, abdominal cavity and the volume ratio of hernia sac to abdominal cavity in different body positions were measured by multi-planar reconstruction and volume reappearance on the workstation. Observation indicators: (1) situations of CT examination of patients with abdominal incisional hernia in different positions; (2) correlation analysis of volume ratio increment of hernia sac to abdominal cavity between different positions by CT examination in patients with abdominal incisional hernia. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was performed using the pared t test. Count data were expressed as absolute numbers or percentages. Pearson correlation was used to analyze the volume ratio increment of hernia sac to abdominal cavity between different positions by CT examination in patients with abdominal incisional hernia. Results (1) Situations of CT examination of patients with abdominal incisional hernia in different positions: CT examination of 23 patients with abdominal incisional hernia showed that the contents of hernia increased and the abdominal wall deformed in the lateral position compared with conventional supine position, with manifestations as shortened abdominal transverse diameter and longer vertical diameter. The volume of the hernia sac in supine position and in lateral position by CT examination was (623±293)mL and (869±425)mL, respectively, showing a significant difference (t=-7.959, P<0.05). The volume of abdominal cavity in supine position and in lateral position by CT examination was (6 445±1 438)mL and (6 283±1 348)mL, respectively, showing a significant difference (t=2.762, P<0.05). The volume ratio of hernia sac to abdominal cavity in supine position and in lateral position by CT examination was 0.096±0.040 and 0.138±0.061, showing a significant difference (t=-8.093, P<0.05). The volume ratio of hernia sac to abdominal cavity in lateral position increased by 0.042 compared with that in supine position, with an increasing rate of 43.8%. All the 23 patients had volume ratio of hernia sac to abdominal cavity less than 20% in supine position by CT examination, however, 4 patients had volume ratio of hernia sac to abdominal cavity more than 20% in lateral position by CT examination. (2) Correlation analysis of volume ratio increment of hernia sac to abdominal cavity between different positions by CT examination in patients with abdominal incisional hernia: results of Pearson correlation analysis showed a positive correlation of volume ratio of hernia sac to abdominal cavity between supine position and lateral position by CT examination (r=0.742, P<0.05). Conclusions The volume of incisional hernia is influenced by different body positions. Compared with supine position, lateral position by CT examination has a more accurate reflection of abdominal incisional hernia. Key words: Hernia; Incisional hernia; Body position; Computed tomography, X-ray; Hernia sac volume; Abdominal cavity volume; Volume ratio

Objective To investigate the application and advantages of laparoscopy in children with acute abdomen. Methods The clinical data of 256 children with acute abdominal pain in hospital were retrospectively analyzed. Results Two hundred and fifty-six children with acute abdomen underwent laparoscopic exploration and surgical treatment, 21 cases were treated by lengthening the incision of the umbilicus, and some pathological lesions were taken out of the abdominal cavity or the pathological specimens were removed. One case was diagnosed under laparoscope, and the laparotomy was performed because of severe abdominal distension. The preoperative diagnosis rate was 89.45% (229/256), and the rate of intraoperative diagnosis was 100% (256/256), no complications or deaths occurred, and all of them were cured and discharged. After 3 months, 1 case was cured after two stage operation. Followed-up for 6-18 months, no intestinal obstruction, intestinal fistula, biliary fistula and incisional hernia, scar hidden in the umbilical fossa was not obvious. Conclusions Laparoscopy can completely detect abdominal and pelvic cavity, and make definite diagnosis at early stage. It has advantages of minimal invasion, less damage and quick recovery. It can be widely used in the treatment of acute abdomen in children. Key words: Children acute abdomen; Laparoscopy; Treatment

The problem of postoperative ventral hernias remains relevant due to the high frequency of their development — in 7–24% of patients.Aim.To evaluate the effectiveness of prevention of postoperative ventral hernias using a new technique of access to the abdominal cavity in comparison with traditional laparotomy.Materials and methods.The proposed new technique of access to the abdominal cavity along the midline of the abdomen with dissection of the navel and umbilical ring was carried out in accordance with the method developed by us, registered by the patent of the Russian Federation. For the final analysis, 134 patients were selected, divided into group 1 (n = 67), in which the median access was performed using a new technique, and group 2, in which the traditional median access was performed with the left umbilical ring bypass (n = 67). The initial parameters of patients, characteristics during and after surgery were evaluated. The duration of follow-up after surgery was 24 months.Results.Groups 1 and 2 were comparable by gender, age, body mass index, and the presence of comorbidities. In 79% of patients in group 1 and in 67% of patients in group 2 (the difference is not significant), indications for surgery were malignancies of the abdominal cavity. The groups did not differ in the types of median laparotomy, the time of surgery, the amount of blood loss, the time of removal of postoperative sutures, and the duration of hospitalization. All patients were followed up for 24 months. Postoperative ventral hernia developed in one patient (1.5%) in group 1 and in 5 (7.5%) patients in group 2 within 12 to 24 months after surgery. There were no statistically significant differences in the frequency of hernia development (Mantel — Cox test, p = 0.100)Conclusion.A new method of median laparotomy in the treatment of patients with planned surgical pathology of the abdominal cavity is characterized by a low rate of postoperative hernia development.

Comparative Study of Laparoscopic versus Open Ventral Hernia Repair.

Large incisional hernias with loss of domain represents a challenge for the surgeon. Pre-operative tools such as progressive pneumoperitoneum or botulinum toxin type A have been reported as useful tools for effective and successful surgical procedure in patients with large incisional hernias. Both the mentioned procedures are complementary to hernia repair, using no-strain mesh techniques that support patients’ integral management. The objective of current investigation was to assess the potential of pre-operative botulinum toxin in the treatment of large incisional hernias. Thirteen patients with large incisional hernias were investigated and examined for different parameters including diameters of the abdominal cavity and hernia sac, volume of the contents of incisional hernia and volume of the abdominal cavity which were calculated from CT scan. The current investigation was carried for a duration of two years from December 2020 and January 2022. After thorough clinical examination patients were operated for ventral incisional hernia repair. Eleven patients underwent complete repair of abdominal wall; one patient underwent mesh bridging and one patient required onlay repair. Botulinum toxin was observed to be a safe technique, which has good patient tolerance and can constitute as an effective preoperative tool in the treatment of large incisional hernia. This technique was observed to be aidful in significantly reducing the hernia content into the abdominal cavity, which in turn is an important factor in the treatment of large incisional hernia.

Aim Anterior abdominal wall incisional hernias are a problem present in approximately 11–20% of patients undergoing laparotomy. Incisional hernias with loss of right of abode are associated with many physical, physiological and psychological problems. In order to surgically repair these incisional hernias with loss of right of abode, we need to perform a prehabilitation of the incisional hernias. Effective prehabilitation is required in order to close the aponeurotic defect without tension and to return the hernial contents to the abdominal cavity. Material and methods A 59-year-old female patient with a history of open cholecystectomy and incisional hernia repaired on three occasions, presenting with multisaccular midline incisional hernia (M1-M4 W3) containing colon and greater omentum. Results After application of botulinum toxin and Fasciotens, it is possible to perform Rives-Stoppa retrorectus repair, being able to reduce the hernial content without tension and without increasing intra-abdominal pressure. Conclusions Prehabilitation in complex abdominal wall surgery is essential to repair large aponeurotic defects without tension. In addition, the application of Fasciotens after administration of botulinum toxin allows closure of the aponeurotic defect using standard abdominal wall closure techniques.

The treatment of giant incisional hernia (IH) with loss of domain (LOD, IHLD) is considerably challenging due to technical difficulties and subsequent post-operative complications. These post-operative risks may be anticipated by calculating the abdominal cavity (AC) volume (ACV) and the IH volume (IHV) on the preoperative CT-scans, using the AC and IH dimensions (Tanaka's method) or using tridimensional volumetry (Sabbagh's method). These techniques are often time-consuming and require specific softwares. The aim of the present study was to develop a simple method to rapidly obtain the LOD-ratio on the preoperative CT-Scan. The CT-scans (n = 89) of patients with IHLD were retrospectively studied. Several ratios were calculated using different parameters of the AC and the IH, including width, height and depth, the areas (axial and sagittal ellipse, as well as freehand sagittal surface areas) and these were compared with the reference methods of Sabbagh et al. and Tanaka et al. RESULTS: The LOD ratios calculated from the two reference methods gave similar results (ICC = 0.82, p < 0.0001). The new "R-ratios" (Reims-ratios) obtained from the IH and AC surface areas measured using the "freehand ROI" tool on sagittal view or roughly evaluated by an ellipse on axial view showed excellent correlation with both reference ratios (all ICC ≥ 0.71, p < 0.0001). The LOD ratio may be quickly obtained by drawing two circles on the pre-operative CT scan ("R ratios") and available on the webpage https://romeo.univ-reims.fr/Rratio/ . This will certainly help surgeons to routinely anticipate the post-operative complications before IHLD repair.

Objective To investigate the clinical application value of the preoperative progressive pneumoperitoneum (PPP) in the treatment of large incisional hernias in the elderly. Methods The clinical data of 19 elderly patients with large incisional hernia who underwent PPP prior to hernia repair in the Sixth Hospital Affiliated of Sun Yat-sen University from February 2017 to February2018 were analyzed retrospectively. Abdominal computed tomography (CT) scan, pulmonary function and arterial blood gas analysis were performed before and after PPP. The following indicators were mainly observed: (1) PPP situations: insufflation time (days), completion, the median insufflated volume of air; (2) Changes in the volumes of the incisional hernia (VIH), the volumes of the abdominal cavity (VAC), the pulmonary function and arterial blood gas (PaO2 and PaCO2) before and after PPP; (3) operation, postoperative recovery and follow-up situations. Results (1) PPP situations: the insufflation time in 19 patients ranged from 11-18 d, 18 patients successfully completed PPP, the median insufflated volume of air for PPP was 4 400-7 200 mL. (2) Changes in the volumes of the incisional hernia (VIH), the volumes of the abdominal cavity (VAC), the pulmonary function and arterial blood gas (PaO2 and PaCO2) before and after PPP: Before and after PPP, the mean VIH was (1 086.7±438.9) mL and (1 275.8±521.4) mL (t=3.228, P 0.05), FEV1 decreased by 6.52% (t=2.137, P 0.05) and PaCO2 decreased by 9.14% (t=3.39). (3) Operation, postoperative recovery and follow-up situations: The operations was performed successfully in 19 patients, the mean operating time was 137 to 265 minutes, fascia closure was possible in 89.5% of cases (n=17). No severe complications such as ACS or cardiopulmonary failure occurred. The mean postoperative length of stay in hospital was 4 to 12 days. All patients were followed up for 6-18 months, and there was no hernia recurrence. Conclustion PPP is safe and effective in elderly patients with large incisional hernia repair, which is worthy of clinical promotion and application. Key words: Large incisional hernia; Preoperative progressive pneumoperitoneum; Elderly; Hernia repair; Complication

Introduction: The common practice in laparoscopic ventral hernia repair (LVHR)is to place a dual mesh to prevent visceral adhesions, as majority of the patients are not ableto afford the expense of these meshes. We use prolene mesh to repair hernia. Objectives: Theaim of this study was to determine the frequency of success of laparoscopic ventral hernia repair(LVHR) using omentum as a barrier in patients presenting with ventral hernia. Study Design:Descriptive case series. Setting: Surgical Unit 3, Services Hospital Lahore, Pakistan. Period:6 months duration from 16th of July 2015 to 15st January 2016. Methods: 60 patients wereselected fulfilling the criteria from Department of General Surgery. 10mm telescope angled at 30degree was employed. Hernial contents were reduced but the peritoneal sac was left as such.The prolene mesh was inserted into the abdominal cavity through a port of 10mm diameterand fixed. Omentum was then sandwiched between abdominal wall and viscera. Patients werefollowed-up in OPD for 12 months. Results: Majority of the patients were females (56.7%) withthe mean age of 46.40 years and mean weight of 68 kg. The patients were averagely foundobese with a mean BMI of 25.40kg/m2. Majority of the patients (n=50, 83.3%) had success inhernia repair. Stratification of patients by age, gender and BMI showed (p-value was &gt;0.05 in all3 cases) statistically insignificant difference between various subgroups. Conclusion: LVHR is auseful technique and simple proline mesh with omental barrier is a safe and low-cost alternativeto dual mesh technique.