Case Of Hernia Research Articles

Internal hernia following laparoendoscopic single site surgery: a case report

Laparoscopic donor nephrectomy was introduced in 1995 as a means of minimally invasive surgeries that entail kidney extraction from healthy individuals. Since then, it has widely overtaken the traditional open surgical approaches, especially in live donor nephrectomy procedures worldwide. Laparoendoscopic single-site surgery is considered a more optimized surgical approach utilizing a single incision instead of four. Various studies have scrutinized many of the risk factors related to such surgeries, most commonly: vascular problems, intraoperative organ injury, and postoperative ileus. Other rare complications have not been thoroughly explored due to their decreased prevalence. Internal hernias are considered a rare complication of laparoendoscopic single-site surgery with dangerous repercussions ranging from bowel obstruction to ischemia, and necrosis. Our study presents a rare case of a trans-mesenteric internal hernia following laparoendoscopic single-site surgery. The patient was relatively healthy with no serious medical conditions. However, the past medical history did record a diagnosis of irritable bowel syndrome a few years back. Knowing that the occurrence of internal hernias is infrequent, we recommend that mesenteric defects be taken seriously to avoid the risk of internal hernias and their complications.

Risk factors for parastomal hernia after abdominoperineal resection of rectal cancer.

To investigate risk factors associated with the formation of parastomal hernia after Miles operation, and to provide scientific evidence for the prevention and treatment of parastomal hernia. Clinical data from 205 patients with rectal cancer undergoing Miles operation in the Department of General Surgery, Affiliated Hospital of Xuzhou Medical University between May 2016 and May 2021 were analyzed retrospectively. Fourteen potential factors were selected and analyzed by single factor analysis and two element logistic regression analysis for their potential relationship to incidence of parastomal hernia. 49 cases of parastomal hernia occurred among 194 patients during follow-up (incidence 25.26%). Univariate analysis showed that age, thickness of subcutaneous abdominal fat, BMI, and stoma pathway were related to the formation of post-surgical parastomal hernia (P < 0.05). Two element logistic regression analysis showed that advanced age, thickness of subcutaneous abdominal fat, BMI > 25 kg/m2, and transperitoneal surgical approach were independent risk factors for the formation of parastomal hernia after Miles operation (P < 0.05). Advanced age, thickness of subcutaneous abdominal fat, BMI > 25 kg/m2, and transperitoneal surgical approach are independent risk factors for the formation of parastomal hernia after Miles.

Asuhan Keperawatan Pada Nn. S dengan Post Operasi Hernioraphy : Hernia Inguinalis Lateralis Dextra di Ruang Mawar 2 RSUD dr. Soeselo Kabupaten Tegal

Inguinal hernia is a condition where an organ protrudes into a cavity through a thin or weak part of the wall. The small intestine is usually the organ that enters the cavity, causing the protrusion. In 2018, hernia ranked 8th in Indonesia with a total of 18,145 cases or around 1.05%. The number of hernia cases in Central Java is estimated to be over 500, or approximately 1.01% of cases. If an inguinal hernia is not treated promptly, it will continue to grow and exert significant pressure on the surrounding tissues. A common consequence of untreated hernia is that it will enlarge and interfere with the patient's daily activities. One of the complications of hernia is swelling around the lump. One of the treatments for hernia is surgery. The writer is expected to provide optimal nursing care for patient. S, who has experienced a right lateral inguinal hernia post- operatively following herniorraphy in Mawar 2 ward of dr. Soeselo Regional Hospital, Tegal Regency.

EP592 - A surgical case report of an epiploic hernia - A mobile right colon herniating through the foramen of Winslow

Abstract Introduction An Epiploic Hernia is an extremely rare type of abdominal hernia with &amp;lt;0.1 % incidence where the bowel or other intra-abdominal contents herniate through the Foramen of Winslow. A case of an Epiploic hernia in a middle-aged female is presented here. Presentation of case A woman in her 60s was admitted to a tertiary level hospital with severe right sided intermittent upper abdominal pain associated with nausea, bloating and constipation. The symptoms were thought to be due to biliary colic and managed conservatively. Since the symptoms persisted and a computed tomography scan of abdomen was organized. CT scan showed that the caecum was in the upper left quadrant. A laparoscopy was performed and demonstrated that her right colon was mobile herniating through the Foramen of Winslow into the lesser sac. The hernia was reduced, and the bowel was viable. The patient was discharged with no complications. Discussion There have been case reports of small bowel as the content of the hernia with lesser occurrences of caecum, ascending colon, transverse colon, gall bladder, omentum, or Meckel's diverticulum. A caecal herniation through the Foramen of Winslow is reported only with an incidence of 0.02 %. &amp;lt;10 % of these Epiploic hernias are diagnosed preoperatively making it a potentially life-threatening condition if not treated promptly due to high risk of bowel strangulation and mortality of up to 50 %. Conclusion A high index of suspicion is needed for the diagnosis of this internal hernia and radiological investigation is fundamental in making this diagnosis for allowing prompt surgical treatment.

EP454 - Left Paraduodenal Hernia and Large Bowel Obstruction: A Case Report

Abstract Aims Internal hernias are uncommon and difficult to diagnose clinically. Of these, a paraduodenal hernia is the most common, but remains a rare condition. Cases reported in the literature are few and often describe small bowel obstruction as a result of small bowel herniation into the left paraduodenal space and lesser sac. Here we describe a case of left paraduodenal hernia resulting in large bowel obstruction. Method Written consent from the patient has been obtained to present the case and associated radiological and intra-operative images. A 50 year old male with no surgical history presented to the general surgical team via the emergency department with a 12 hour history of epigastric pain, vomiting, abdominal distension and 24 hours history of absolute constipation. CT showed a large bowel obstruction with a transition point in the mid transverse colon with a swirling of the mesentery and large bowel concerning for left paraduodenal hernia. Results Open laparotomy was the preferred approach. There was gross dilatation of the large bowel with a competent ileocaecal valve. The hepatic flexure was found herniating into the lesser sac under the ligament of Treitz. This was reduced and the large bowel decompressed via the appendix. The narrow based small bowel mesentery was expanded by dividing the mesenteric parietal peritoneum. The large defect was closed with interrupted non-absorbable sutures. The patient made an unremarkable post-operative recovery. Conclusion This is a rare pathology with interesting surgical anatomy and we present its radiological and intraoperative findings and operative management strategy.

532. OPERATIVE TRENDS AND CLINICAL OUTCOMES OF OPEN, LAPAROSCOPIC AND ROBOTIC APPROACHES TO HIATAL AND PARAOESOPHAGEAL HERNIAS-A STUDY OF 1834 PATIENTS

Abstract Background Indications for repair of hiatal and paraesophageal hernia (HH/PEH) repair evolved significantly over the past two decades, impacted by the increasing application of minimally invasive surgical (MIS) approaches. This transition underscores the importance of evaluating the operative trends and clinical outcomes associated with open (open), laparoscopic (lap), and robotic surgeries especially in cases of giant hernias (over 50% intrathoracic stomach). Understanding these dynamics is crucial, especially as MIS becomes increasingly prevalent in managing complex cases, including giant hernias. The aim of this study is to assess critical outcomes achieved during the evolution from open to lap to robotic HH/PEH repair in a high volume center. Methods This is a retrospective review of 1834 patients undergoing open (958), lap (390), and robot (486), consecutive HH/PEH repairs prospectively entered into an IRB approved database from 2000 to 2023 at a high-volume center. Patient demographics, operative techniques, and top three most common presenting symptoms were studied overtime. Impact of operative technique, hernia type and size, operative outcomes including length of stay (LOS), radiographic recurrence (esophagram at 3 and 12 months), revisional surgery, on post-operative symptom resolution was evaluated. Results Annual volume increased overtime, with 418 repairs (78% robotic) in the last two years. Average hernia size decreased over the study period. The majority of patients (99.1%) presented with symptoms (Fig 1) and robotic repair had significantly better symptomatic resolution than open surgery (p&amp;lt;0.05). This advantage persists with symptoms in giant hernias (p&amp;lt;.001) LOS decreased over the study period (Fig 1). Overall radiographic recurrence (8.6%) and reoperative rate (2.4%) did not differ among operative techniques, however robotic repair had higher radiographic recurrence rate in case of giant hernia (18%, p&amp;lt;.001). Conclusion The operative volume of HH/PEH repair has increased overtime associated with the increased application along with advancements in MIS and robotic operative techniques. Surgical interventions markedly ameliorate HH/PEH symptoms, with greater improvement observed in large hernia cases. Significant improvement in LOS and at least equivalent clinical results favors MIS, particularly robotic surgery. Although the incidence of anatomic recurrent hernia and reoperation is relatively low continued assessment of especially robotic operations to decrease this incidence further is warranted.

Umbilical double-port laparoscopy combined with extraperitoneal water injection for the treatment of giant inguinal hernias in infants and young children

ObjectiveExploration of the efficacy of treating large indirect inguinal hernias in infants and young children using umbilical double-port laparoscopy combined with extraperitoneal water injection.MethodsA retrospective analysis was conducted on 165 cases of primary unilateral large indirect inguinal hernias in infants and young children treated at our hospital from May 2018 to May 2023. Among them, 90 cases underwent umbilical double-port laparoscopic surgery combined with extraperitoneal water injection and high ligation of the hernia sac (Double-Port Group), and another 75 cases underwent conventional three-port laparoscopic high ligation of the hernia sac (Three-Port Group). The two groups were compared in terms of operation time, postoperative pain scores at 24 hours, hospital stay, incision complications, and recurrence within one year after surgery.ResultsBoth groups successfully completed the surgery without any intraoperative complications. The pain score at 24 hours postoperatively was lower in the Double-Port Group compared to the Three-Port Group, and there was no statistically significant difference in operation time, hospital stay, and incision complications between the two groups (P > 0.05). Both groups were followed up for one year postoperatively; the Three-Port Group had one recurrence that was cured after further treatment, while there were no recurrences in the Double-Port Group.ConclusionUmbilical double-port laparoscopy combined with extraperitoneal water injection for the treatment of large indirect inguinal hernias in infants and young children has the advantages of being safe and reliable, with concealed and aesthetic incisions, and rapid recovery.

Amyand’s Hernia: A Case Report

Amyand's hernia is defined as the presence of the appendix vermiformis (inflamed or non-inflamed) within the inguinal hernia sac. It is seen in approximately 1% of inguinal hernia cases. This extremely rare condition is often diagnosed conventionally, at surgery. However, with the increasing use of computed tomography (CT) and ultrasonography (US) examinations, preoperative diagnosis is also possible. The treatment approach varies depending on whether the appendix inside the hernia sac is inflamed or not. For this reason, imaging examinations are of great importance in making a diagnosis and directing treatment. As a result of imaging examinations in an elderly patient in our clinic, colon, small intestine segments, omentum and appendix were detected in the right inguinal canal. Since the appendix was also located within the hernia sac, the case was called Amyand's hernia. In this article, we wanted to draw attention to Amyand's hernia in general and the place of radiological examination in diagnosis and treatment of this disease.

Increased age and the volume of intraoperative fluid administered predict urinary retention after elective inguinal herniorrhaphy

BackgroundInguinal hernia repair (IHR) is a common surgical procedure worldwide. Although IHR can be performed by the minimally invasive method, which accelerates recovery, postoperative urinary retention (POUR) remains a common complication that significantly impacts patients. Thus, it is essential to identify the risk factors associated with POUR to diminish its negative impact.MethodsWe conducted a single-center retrospective review of elective IHR from 2018 to 2021. POUR was defined as the postoperative use of straight catheter or placement of an indwelling catheter to relieve the symptoms. Adjusted multivariate regression analysis was performed to address the associations of clinicodemographic, surgical, and intraoperative factors with POUR.ResultsA total of 946 subjects were included in the analysis after excluding cases of emergent surgery, recurrent hernia, or concomitant operations. The median age was 68.4 years, and 92.0% of the patients were male. Twenty-three (2.4%) patients developed POUR. In univariate analysis, POUR in comparison with non-POUR was significantly associated with increased age (72.2 versus 68.3 years, P = 0.012), a greater volume of intraoperative fluid administered (500 versus 400 ml, P = 0.040), and the diagnosis with benign prostate hypertrophy (34.8% versus 16.9%, P = 0.025). In the multivariate model, both increased age (odds ratio [OR] 1.04, 95% CI 1.01–1.08; P = 0.049) and a greater volume of intraoperative fluid administered (OR 1.12 per 100-mL increase, 95% CI 1.01–1.27; P = 0.047) were significantly associated with the occurrence of POUR.ConclusionsWe found that increased age and a greater volume of intraoperative fluid administered were significantly associated with the occurrence of POUR. Limiting the administration of intraoperative fluid may prevent POUR. From the perspective of practical implications, specific guidelines or clinical pathways should be implemented for fluid management and patient assessment.

Clinical analysis of 18 cases of obturator hernia

Clinical analysis of 18 cases of obturator hernia

A case of late-presenting congenital diaphragmatic hernia diagnosed at 5 years with acute abdomen

BackgroundSome congenital diaphragmatic hernias are diagnosed beyond 1 month. A late-presenting congenital diaphragmatic hernia shows a variety of clinical manifestations, and the preoperative clinical course is variable. We herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as acute abdomen.Case presentationA 5-year-old boy was brought to our hospital because of herniation of the intestine into the left thoracic cavity, which was observed on radiography performed for abdominal pain. Enhanced computed tomography showed herniation of the small intestine and colon into the left thoracic cavity. Emergency laparoscopic surgery was performed based on the diagnosis of left diaphragmatic hernia. The entire small intestine and part of the colon herniated from the posterolateral defect of the diaphragm. We were able to retract the herniated intestine back into the abdomen but confirmed that the diaphragmatic defect and closure of the defect seemed to be technically challenging via laparoscopy; therefore, we converted the procedure to open laparotomy. The diaphragmatic defect was directly closed with interrupted sutures, and the thoracic cavity was degassed. Postoperatively, the left lung was found to be poorly expanded, but pulmonary hypoplasia was not evident in this case.ConclusionsWe herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as abdominal pain. Late-presenting congenital diaphragmatic hernias present with a wide variety of symptoms; therefore, it is important to be reminded of these conditions and check chest radiographs in children presenting with acute or chronic respiratory or gastrointestinal symptoms of unknown etiology.

Laparoscopic totally extraperitoneal management of giant inguinoscrotal hernia with loss of domain.

A giant inguinoscrotal hernia extends below the level of the midpoint of the thigh, in an upright position. They are usually due to the neglect of the patient and fear of surgical intervention. Patients typically present with lower urinary tract symptoms, ulcers over the scrotum caused due to dribbling of urine and rarely with obstruction or strangulation. Here, we present a similar case of an uncomplicated giant inguinoscrotal hernia with a Tanaka index of 74% who was preoperatively optimised with BOTOX (BOtulinum TOXin-A) and pre-operative progressive pneumoperitoneum and was managed laparoscopically with enhanced totally extraperitoneal repair. This signifies the importance of optimisation of the patients, especially with loss of domain help in managing such cases without any resection of bowel or omentum. Moreover, this proper pre-operative optimisation also helped us in managing such a case laparoscopically.

Laparoscopic repair of a symptomatic right congenital morgagni hernia in an elderly patient: a rare case report

Morgagni hernia is a rare form of congenital diaphragmatic defect on the anterior part of the diaphragm with a prevalence of 2-3%. We report a case of a 70-year-old female who presented with burning chest pain, intermittent and colicky upper abdominal pain occasionally associated with nausea and vomiting, and constipation for 4 months. Imaging studies, including X-ray, ultrasound, CT scan, and MRI, were suggestive of a right-sided congenital Morgagni hernia. Late diagnosis of this condition in adults is extremely rare, and in the elderly, it is even rarer. The patient underwent successful laparoscopic diaphragmatic hernia repair with prosthetic mesh placement. The postoperative period was uneventful, and the patient was discharged on the fifth postoperative day. Minimally invasive surgical techniques provide definitive treatment for patients with uncomplicated Morgagni hernia cases, offering a shorter recovery time and a low complication rate.

Application of indocyanine green-labeled fluorescence technology in laparoscopic total extra-peritoneal inguinal hernia repair surgery:a preliminary study

BackgroundLaparoscopic Total Extra-peritoneal Inguinal Hernia Repair(TEP) presents escalated risks of surgical complications, notably bleeding, particularly in European Hernia Society (EHS) types 3 and recurrent inguinal hernia. In this study, we introduced an innovative technique using indocyanine green-labeled fluorescence laparoscopy to mitigate intraoperative complications, including bleeding and rupture of the hernial sac.MethodsThis retrospective study reviewed records of 17 patients who underwent TEP repair at Anqing Municipal Hospital between July and August 2023. Intraoperatively, fluorescence imaging was utilized to trace the pathway of the spermatic vessels and outline the boundaries of the hernia sac to facilitate a thorough dissection.ResultsThe procedure was successfully completed in all 17 patients, with a median operation time of 42 min (range: 30–51 min). Median intraoperative blood loss was 5 ml (range: 3–8 ml). Complete dissection of the hernia sac was achieved in each case without any incidents of sac rupture. Hemodynamic parameters of blood flow within the spermatic artery on postoperative day 1 showed no statistically significant deviations from the preoperative values. Furthermore, during the 7-month follow-up period, there were no cases of seroma formation or hernia recurrence.ConclusionOur findings suggest that employing indocyanine green-labeled fluorescence technology in TEP repair significantly reduces intraoperative complications, notably bleeding and rupture of the hernial sac. This technique demonstrated a negligible impact on the hemodynamic parameters of the spermatic artery and reduced the overall surgical time.

Spontaneous Chest Wall Hernias: Intercostal Lung Hernia and Inverted Intercostal Hernia

AbstractIntercostal lung hernia and inverted intercostal hernia are rare chest wall hernias usually asymptomatic and detected incidentally on chest radiograph. In this case report, we discussed here on the chest radiograph and computed tomography imaging findings of two cases of these rare hernias with an emphasis being in differential diagnosis of chest tumors.

Клинический случай врожденной назоорбитальной черепно-мозговой грыжи

Congenital craniocerebral hernias are malformations in which the brain and the meninges protrude through congenital defects of the skull. Treatment of this pathology is only surgical and should be carried out as early as possible to prevent changes in the facial skull and pathology of the optic nerve. The patients require constant observation by neurologist and ophthalmologist. The article presents a clinical case of left-sided congenital nasoorbital craniocerebral hernia. Due to the untimely surgery, there was a progressive decrease of visual acuity due to partial optic nerve atrophy and formation of complex hyperopic astigmatism. Key words: nasoorbital craniocerebral hernia; surgical treatment; partial optic nerve atrophy.

A Case of an Adult Complicated Left Diaphragmatic Hernia: Case Report and Literature Review

Introduction: Diaphragmatic hernia by definition is the protrusion of abdominal structures into the thoracic cavity. Classified as either congenital or acquired, adult diaphragmatic hernia without a history of trauma is rare, and iatrogenic diaphragmatic hernia is rarer. The array of symptoms may be acute or latent and will depend on the herniated organ, which certainly makes this pathology a challenge at the level of diagnosis and subsequent management. Case Report: Here we present the case of a 73-year-old male patient who presented one year post left nephrectomy complicated by splenectomy (post splenic injury), with two weeks history of diffuse abdominal pain, non-bilious vomiting, and shortness of breath. Workup done revealed a left diaphragmatic hernia containing necrotic-perforated small bowel loops. A laparotomy with intestinal resection, loop ileostomy along with a primary repair of the diaphragmatic defect were performed. Conclusion: Although a great portion of acquired diaphragmatic hernias remain asymptomatic, they may be presenting with severe symptomatology and aggravating complications. At the level of clinical manifestation, suspicion of diaphragmatic hernia ascends the ladder of differential diagnosis in a patient with combined respiratory and gastrointestinal symptoms and hence is essential to avoid delayed treatment and superimposing lethal complications. Definitive treatment of diaphragmatic hernia is surgical repair given the high morbidity and mortality associated with such injury.

COMPARISION OF LICHTESTEIN OPEN TENSION-FREE VERSUS LAPROSCOPIC TOTALLY EXTRAPERTIONEAL TECHNIQUE FOR INGUINAL HERNIA REPAIR

Objectives: The study aimed to assess and compare Litchtenstein’s open tension-free and laparoscopic totally extraperitoneal (TEP) mesh repair. Methods: This hospital-based comparative type of observational study was conducted on 50 cases for each of two groups at upgraded Department of General Surgery, SMS Hospital, Jaipur, between January 2014 and January 2016. All the cases of elective inguinal hernia coming to SMS outpatient department in a single surgical unit operated by a single surgeon in the given period which meet the inclusion and exclusion criteria. Thus, collected data were entered in Microsoft Excel sheet and analysis was done by Epi info software of CDC. Results: Total 100 patients were included in this study; 50 each in the two groups, the laparoscopic TEP group and open Lichtenstein group. Mean age in the laparoscopic group was 39.54 years and the open Lichtenstein group was 42.78 years. The mean pain score out of 10 at 24 h was 2.96 (±0.638) and 3.60 (±0.969) in TEP and Lichtenstein groups, respectively. The mean return to work for open group was 17.00 and TEP group was 11.34 days. There is no any recurrence and readmission in both groups. Conclusion: Laparoscopic TEP repair may be done in all uncomplicated inguinal hernia by an experienced surgeon for those desiring less pain, better cosmotic results, less post-operative complications, less hospital stay, and early return to work.

Repair of recurrent umbilical hernia with Duramesh™, a suturable mesh: Our first application experience

Suture tension due to the structure of the sutures used during closure of laparotomies and the technique applied, or the cutting of the tissue while the stitches are being pulled, predisposes to incisional hernia. It is known that repairs made with the use of mesh provide more successful results in incisional hernia surgery compared to primary closure of the defect with sutures. For this reason, a multifilament suturable mesh was developed to prevent the suture from cutting the tissue due to tension at the stitch and tissue interface. In this case, the approach and early results of a recurrent umbilical hernia case operated on with suture-shaped mesh (Duramesh™), a new product developed for use in incisional hernias and abdominal closure, are presented.

Laparoscopic surgery for De Garengeot’s hernia in a man after inguinal hernia surgery with a mesh plug: a case report and review of literature

BackgroundDe Garengeot’s hernia is a rare case of a femoral hernia that contains the appendix. Here we report a case of De Garengeot’s hernia that occurred in a male patient who had a history of inguinal hernia surgery using a mesh plug. There were no reports of De Garengeot’s hernia with a history of surgery for inguinal hernia, and the surgical question was whether we could successfully treat a patient with minimally invasive laparoscopic surgery using a mesh.Case presentationThis case involved 75-year-old man with a history of right indirect inguinal hernia surgery using a mesh plug without on-lay mesh, who presented with a 5-day history of a right groin lump. Abdominal CT revealed an incarcerated appendix within the right femoral hernia and fluid collection around the appendix. Laparoscopic surgery was initiated and the incarcerated appendix was released with traction. There was no contamination around the appendix or the femoral ring, the appendix was removed, and the femoral hernia was repaired using mesh. Laparoscopic surgery was useful in first evaluating the inflammatory status of the appendix. As it was determined that there was little inflammation around the appendix and femoral ring, it was possible to repair the hernia using mesh.ConclusionsDe Garengeot’s hernias are rare and there is currently no standardized approach. Even if it is a recurrent hernia in the groin, laparoscopic surgery can be useful for diagnosis and treatment, but the use of mesh requires further careful consideration.