Case Of Hernia Research Articles

No Causal Association Between Inguinal Hernia and Aortic Aneurysm Using Mendelian Randomization Analysis.

Aortic aneurysm (AA) is a serious disease that affects the aging population worldwide. Potential risk or associated factors, such as inguinal hernia, have been suggested by conventional studies. In the present study, summary statistics data for the associations of inguinal hernia were derived from a large genome-wide association study including 18,791 inguinal hernia cases and 93,955 controls in the UK Biobank. Corresponding data of AA were extracted from FinnGen, comprising 7603 cases and 317,899 controls in Finland. The causal association was assessed using Mendelian Randomization-Egger, weighted median, and inverse variance weighting methods, and compared with observational estimates previously published. Our analysis found no convincing causal effect between genetically predicted inguinal hernia and the risk of AA (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 0.85-1.31, P = .65), abdominal aortic aneurysm (AAA, OR = 1.15, 95% CI = 0.92-1.46, P = .22), and thoracic aortic aneurysm (TAA, OR = 1.05, 95% CI = 0.85-1.30, P = .67). The results are in contrast to previous observational evidence suggesting a potentially common causal association between inguinal hernia and AA. Further research is needed to better understand the interplay between risk factors and their impact on aneurysm development.

Clinicodemographic profile and outcomes of congenital diaphragmatic hernia with sac: experience of a paediatric referral centre.

Congenital diaphragmatic hernia, in which viscera herniate into the thoracic cavity, is one of the common causes of onset of respiratory distress in neonates and children. Developmentally they may have a sac in rare cases. To analyse the clinical profile and the outcome of congenital diaphragmatic hernia with a sac in neonates and children in a paediatric referral centre. All surgically repaired patients with a congenital diaphragmatic hernia with sac, admitted and treated over a period of sixteen years from January 2005 to December 2021 in a tertiary care referral neonatal and paediatric centre, were included in this study. Forty-three children including neonates were analysed by their clinical characteristics, risk factors and mode of surgical interventions. Congenital diaphragmatic eventration and diaphragmatic hernial defects were excluded from this study. Forty-three study subjects were grouped into two groups for clinical and statistical analysis, based on their pre-operative and intra-operative findings as well their final diagnosis. Cases of left-sided congenial diaphragmatic hernia with sac (LCDHS) were included in group I (n = 30) and cases of right-sided congenital diaphragmatic hernia with sac (RCDHS) were included in group II (n = 13). Each group was further subclassified into A, B, C according to the age of presentation and side of the lesion in order to determine the prognosis in each subgroup. Level of evidence IV. Mere awareness and clinical suspicion of such a rare embryological defect - a congenital diaphragmatic hernia with sac - from the attending clinicians can improve the prognosis of affected babies, avoiding morbid consequences if referred early to a tertiary care paediatric and neonatal centre.

Case of laparoscopic treatment recurrent obturator hernia

Obturator hernia is an internal abdominal hernia in the pelvis, which is very rare in the practice of a surgeon. This hernia is more common in elderly women. The incidence varies but is approximately 0.05-0.07% of all hernias. Obturator hernias present a diagnostic challenge because signs and symptoms are often non-specific, making preoperative diagnosis difficult. They require high vigilance and caution in surgical treatment as many of these patients are elderly with the presence of comorbidities. Reports on the treatment modality, will benefit the surgical community regarding the management of obturator hernias. We present a rare case of recurrent obturator hernia causing recurrent small bowel obstruction in a 63- year-old woman.

Management of strangulated inguinal hernias in a district hospital: About 73 cases

Abstract BACKGROUND: Hernial strangulation is a surgical emergency characterized by tight, permanent constriction of the contents of the hernial sac. It is also called an irresistible hernia with impairment of perfusion. This work aims to evaluate the results of the management of strangulated hernias in a district hospital. METHOD: This was a cross-sectional study with prospective descriptive and analytical collection carried out in the General Surgery Department of Tessaoua District Hospital (Maradi, Niger), covering patients operated on for strangulated inguinal hernias managed from January 2020 to February 2022. RESULTS: We collected 73 cases of strangulated hernias representing 2.76% of admitted surgical emergencies and 1.92% of surgical procedures. The mean age was 49.30 years with extremes ranging from 20 to 80 years and a standard deviation of ±17.21. The sex ratio was 8.13. The admission time was less than 6 h in 45.21% of cases, between 6 and 9 h in 38.36% and more than 9 h in 15.07%. On exploration, the contents were of normal appearance in 61.64%; 17 cases whose contents were already necrotic, that is 23.29%, and 11 cases of sphacelic appearance, that is 15.07%. Anastomotic resection was performed in 21.92% of cases, followed by Desarda in 26.03% and Mac Vay in 12.33%. The average hospital stay was 7 days. CONCLUSION: Strangulated hernia is a frequent pathology in developing countries. Patients with a simple hernia must go for consultation, hence the importance of raising awareness for early management.

A Case of Internal Hernia after Hepaticojejunostomy with Roux-en-Y Reconstruction

A Case of Internal Hernia after Hepaticojejunostomy with Roux-en-Y Reconstruction

Twist in Tale: A Story of Strangulated Paraduodenal Hernias

Abstract The term “paraduodenal hernia (PDH)” refers to a herniation of the entire/partial small bowel into a sac derived from folds of peritoneum and fossae normally found at the terminal or 4th portion of the duodenum. It is rare, having variable presentation, and the severity of symptoms/signs is directly proportional to the degree of obstruction. We present three cases of paraduodenal hernias presenting in emergency with signs of with acute intestinal obstruction. Here we attempt to re-evaluate the representative features of PDHs, and to highlight the perioperative complications and management strategies that surgeons need to be aware of.

Strangulated femoral Littre hernia in a 72-year-old female: A case report

Abstract Littre’s hernia is an uncommon hernia, in which a Meckel’s diverticula protrudes through a potential opening in the abdominal wall. Littre’s hernia is seen in less than 1% of patients with a Meckel’s diverticulum, and the most common sites of the hernia include inguinal, umbilical, and femoral. In this report, we present a case of a femoral Littre hernia in a 72-year-old female repaired with femoral herniorrhaphy and laparoscopic-assisted small bowel resection.

A prospective study to assess the feasibility of single port laparoscopic needle assisted repair of pediatric inguinal hernias

Background: Congenital inguinal hernias are very common paediatric surgical conditions with incidence of 0.8 – 4.4% in children and up to 30% in preterm babies, which occur due to the failure of closure of the processus vaginalis. While the gold standard treatment remains to be open herniotomy, in the last two decades minimally invasive surgeries have revolutionized the hernia surgery and have evolved from 3 port to single port, intracorporeal knotting to extracorporeal knotting and 5 mm camera port to 3 mm camera port with multiple benefits. Methodology: This is a prospective study conducted at a single tertiary care centre over 1 year. All the patients admitted under the Department of Paediatric Surgery, with a clinical and/or radiological diagnosis of inguinal hernia and planned for single port laparoscopic needle assisted repair were included in the study. Data was collected in terms of intra operative finding, duration of procedure, complications, pain and post operative hospital stay. Results: A total of 40 patients were included in the study with a male predominance. Clinically majority were right inguinal hernia which was reducible. Intraoperatively, 7 cases of bilateral hernia were identified which were not detected pre operatively. 2 patients who underwent this procedure had complications and majority of the patients had mild pain. Conclusion: Single port laparoscopic herniotomy is at par with gold standard open herniotomy in the paediatric population. This procedure has better cosmesis, lesser post operative pain, hospital stay and most importantly it could identify occult hernias.

Direct Inguinal Hernia in Pediatrics: Two case reports

Pediatric inguinal hernia occurs due to failure of closure of processus vaginalis. Aim of the procedure of indirect type in pediatrics is complete ligation of the sac. Direct and femoral hernias are extremely rare in pediatrics which could be easily detected from inside the abdomen especially during laparoscopic management. We present two rare cases of direct inguinal hernia

Congenital Diaphragmatic Hernia with Spleen Herniation - A Case Report

Congenital diaphragmatic hernia is a condition characterized by the herniation of abdominal contents into the chest leading to respiratory distress shortly after birth. In the present case along with bowel herniation spleen herniation was also noted which is a very rare occurrence. This case was diagnosed antenatally and the diagnosis was further confirmed postnatally with a chest and abdominal X-ray as well as a chest ultrasound. The baby was stabilized and shifted for surgical intervention where the patient underwent a laparotomy revealing a diaphragmatic defect with herniation of the ileum colon and spleen. Surgically the defect was closed and the bowel and spleen were reduced back into the abdomen for proper opening of the lung. No complications were noticed during the postoperative period. Therefore we believe that this rare case of spleen herniation which was managed promptly as a valuable contribution to the existing literature.

Diathermy versus Scalpel Skin Incision for Open Inguinal Hernia Surgery: An Interventional Study

Introduction: Inguinal hernia is one of the most encountered surgical-related problems worldwide. For years, there has been debate among surgeons about which type of skin incision to use: cutting with electrocautery or the traditional method of a surgical scalpel. Aim: To compare the skin incisions made with electrocautery versus traditional scalpel incisions in terms of incision time, blood loss, postoperative pain, and scar evaluation. Materials and Methods: A hospital-based prospective interventional study was conducted at the Department of General Surgery, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India, from November 2019 to September 2021. Written informed consent was obtained from 130 consecutive cases scheduled for open inguinal hernia surgery. Patients were alternately assigned to undergo incision with electrocautery (group A) or a conventional steel scalpel (group B), with each group comprising 65 patients. Bilateral hernia cases were treated as separate entities. Data analysis was performed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) software version 24.0, employing the Student’s t-test and Chi-square test. A p-value of <0.05 was considered statistically significant. Results: The age distribution in group A was 49.69±15.74 years and in Group B was 52.81±14.25 years. The time taken for incision in the electrocautery group was much shorter at 12.57±11.55 seconds than in the scalpel group at 20.63±2.99 seconds, with a p-value of <0.001. The average amount of blood loss in group A was 1.02±0.35 mL and in group B was 2.03±0.32 mL, with a significant p-value of <0.001. The postoperative pain, calculated by the Visual Analogue Scale (VAS), showed a significant difference in the early postoperative period at 6 hours after surgery in Group A at 6.58±0.9 compared to group B at 7.05±1, with a p-value of 0.005. However, no significant difference was noted between the two groups at 12, 24, and 48 hours after surgery. There was no significant difference in scar evaluation between group A and group B at 12 weeks, with a p-value of 0.673 for the patient score and 0.189 for the observer score. Conclusion: Electrocautery can be recommended for hernia skin incision due to its advantage of shorter incision time, minimal blood loss, and less early postoperative pain.

Right paraduodenal hernia, classification, and selection of surgical methods: a case report and review of the literature

BackgroundConsidering that right paraduodenal hernia is a rare internal hernia with abnormal anatomy and is often encountered during an emergency, surgeons may lack knowledge about it and choose incorrect treatment. Thus, this case report is a helpful complement to the few previously reported cases of right paraduodenal hernia. Additionally, we reviewed all the reported right paraduodenal hernia cases and proposed appropriate surgical strategies according to different anatomical features.Case presentationThe case involved a 33-year-old Chinese male patient who was admitted to the hospital due to abdominal pain. The patient was initially diagnosed with small bowel obstruction, and conservative treatment failed. An emergency operation was arranged, during which a diagnosis of right paraduodenal hernia was made instead. After surgery, the patient recovered well without abdominal pain for 2 years.ConclusionAlthough right paraduodenal hernia accounts only for a small proportion of paraduodenal hernia, its anatomical characteristics can vary considerably. We divided right paraduodenal hernia into three types, with each type requiring a different surgical strategy.

Surgical management of an elderly patient with strangulated inguinal hernia and cryptorchidism: A case report

Cryptorchidism, the condition of undescended testicles, and inguinal hernia share a common embryological origin, often presenting together. This case report describes the surgical intervention for a 73-year-old diabetic male with a 20-year history of left inguinal hernia and a single right testicle. The patient presented to the emergency department due to obstructed inguinal hernia, reporting pain, bowel obstruction, abdominal distension, and vomiting. Physical examination revealed a left inguinal hernia measuring 10 cm, which was incarcerated, non-expansile, and irreducible. Intraoperative exploration unveiled a strangulated oblique external left inguinal hernia with a 10 cm sac and a narrow neck containing an ischemic, yet non-necrotic, small bowel. Orchidectomy was performed due to testicular atrophy. The hernia repair utilized the Lichtenstein technique with a polypropylene mesh. Postoperatively, the patient recovered well without complications. Follow-up at 5 months showed no hernia recurrence or mesh infection. This case highlights the importance of timely surgical intervention in managing complex cases of hernia and cryptorchidism, particularly in elderly patients, and underscores the significance of careful intraoperative decision-making for optimal patient outcomes.

An unusual case of the Amyand hernia with perforated appendicitis and a sessile serrated lesion within a recurrent inguinal hernia

The Amyand hernia is a rare type of inguinal hernia where the appendix is located within the hernial sac. It is present in less than 1% of inguinal hernias and in 0.13% of cases, it is associated with complications including acute appendicitis and perforation. This case details an 81-year-old female with recurrent Amyand hernia with perforated appendicitis and a sessile serrated lesion. A literature review was conducted to identify existing cases of the Amyand hernia and neoplasm or recurrent inguinal hernia. Fifteen cases of neoplastic appendix within an Amyand hernia were identified in the literature. All cases found acute appendicitis, three of which were perforated. Histology varied from adenocarcinoma, goblet cell, carcinoid, fibroma, and mucinous cystadenoma. There were nine identified cases of Amyand hernia within a recurrent inguinal hernia. Seven of these cases had acute appendicitis, three of which were perforated, whilst one was gangrenous. All cases performed an appendicectomy, and various open techniques were used for hernia repair with or without mesh. The most interesting finding of the literature review was that Amyand hernia is rarely diagnosed pre-operatively, and that there was a high incidence of appendicitis when in the presence of a neoplastic appendix or a recurrent inguinal hernia. This paper highlights the first reported case of an Amyand hernia with a simultaneous neoplasm and recurrent inguinal hernia, which was managed using a laparoscopic approach without hernia repair.

Diagnosis and treatment of severe diaphragmatic hernia in a cat: A case study

Hernia refers to the condition where visceral organs protrude through weak points or fissures in the diaphragm into the thoracic cavity or other anatomical cavities. Diaphragmatic hernia in cats is a pathological state where one or more visceral organs from the abdominal cavity enter the thoracic cavity through a ruptured diaphragmatic opening. It is predominantly caused by accidental trauma to the diaphragm or congenital diaphragmatic developmental anomalies. Timely treatment of diaphragmatic hernia in cats is crucial to prevent respiratory distress and potential life-threatening consequences. This article presents a case study of a severely affected cat with diaphragmatic hernia, its diagnosis through clinical and laboratory examinations, successful surgical treatment, and postoperative care, providing valuable insights for the management of similar feline diaphragmatic hernia cases.

Abdominal viscera in the thoracic cavity: a case of large Bochdalek hernia in an adult

Introduction: Bochdaleck hernias (BH) are a congenital defect in the diaphragm's postero lateral part that may cause the abdominal viscera's protrusion into the chest cavity. This type of hernia is rare in adults. Most cases are referred to the emergency department with gastrointestinal obstruction and visceral strangulation symptoms. Case presentation: A 50-year-old man was referred to the emergency department complaining of abdominal pain in the left upper quadrant, intermittent vomiting, and pain in the left hemithorax from one day ago. We found a large diaphragmatic hernia on the left side during evaluation, which causes intra-abdominal organ shift to the left hemithorax. The patient underwent surgery for diaphragmatic herniorrhaphy. Conclusion: Congenital diaphragmatic Bochdaleck hernias are rare and are associated with nonspecific symptoms in adults. They may be symptom-free during the patient's life as in our case. It is necessary to investigate more cases and long-term follow-ups of patients, to improve the diagnosis and treatment of these patients.

Iatrogenic spinal cord herniation

Introduction: Spinal cord herniation occurs idiopathically or is due to defective or weakened dura mater resulting from iatrogenic or traumatic lesions. Although there have been many reports of idiopathic cases, there are few reports of postoperative iatrogenic spinal cord herniation. The authors describe a rare case of postoperative spinal cord herniation in the cervical spine, with an extensive analysis of reported cases Materials and methods: This article reports a documented case of postoperative spinal cord herniation. The case description is followed by an analysis of the literature. Results: A 67-year-old woman who had cervical laminectomy 3 weeks before for cervical laminectomy, presented with neck pain and torticollis after coughing. The MRI findings showed a cervical medulla herniation with cerebrospinal fluid (CSF) leakage. The patient underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms. Over the previous 50 years (1973–2023), 16 post-operative spinal cord herniation cases were reported. The mean patient age was 43.3 years (range 15–67 years). There was a male predominance (80%). The mean onset period after surgery was 292 weeks (range, 1 week to 728 weeks). Clinical symptomatology was polymorphic with non-specific signs. Conclusion: Iatrogenic spinal cord herniation is an extremely rare occurrence after spine surgery. The diagnosis must be evoked in case of any neurological degradation after surgery of the cervical spine, thoracic spine or thoracolumbar junction. The surgical management gives satisfactory clinical results.

A successful thoracoscopic treatment of bilateral congenital false diaphragmal hernia in a newborn

Introduction. Congenital diaphragmatic hernia (CDH) occurs with frequency of 1:2000 to 1:4000 live births. False CDH are more common. Out of unilateral diaphragm defects, left-sided ones predominate (9–24 times more often depending on hernia type). Bilateral diaphragmatic hernia is an extremely rare malformation which accounts for no more than 1% of all diaphragmatic hernias.
 Description of observation. The authors present their own experience in treating a rare clinical case of bilateral false diaphragmatic hernia in a newborn with the left-sided component manifested immediately after the birth and with the right-sided one – in 2 weeks after the correction of the first one, as well as its successful thoracoscopic treatment.
 Conclusion. The authors consider that one of the possible reasons for not detecting this pathology at ultrasound examination is translocation of the abdominal organs to the chest (which can occur antenatally, intra- and postnatally).

CURE PROTHETIQUE DES EVENTRATIONS POST-OPERATOIRES DE L’ADULTE A L’HOPITAL NATIONAL IGNACE DEEN, CHU DE CONAKRY (GUINEE)

Abstract Background and purpose: The aim of this study was to report our experience in the use of mesh for adult incisional hernia repair at Ignace Deen national hospital, university hospital of Conakry (Guinea). Patients and methods: This was a threeyear retrospective study (January 2020 to December 2022) of patients aged 18 years or older managed in our department for incisional hernia. Patients who had a mesh repair with at least 3 months post-operative follow-up were included. Variables studied included demographic characteristics, nature of initial surgery, time to consultation, risk factors, technique of repair and post-operative follow-up Results: Over a three-year period, we collected 209 cases of incisional hernia, representing 6.7% of all abdominal surgical procedures, of which 176 met our selection criteria. These included 57 men and 119 women. The mean age was 40.25±17 years (extremes: 18 and 62 years). The width of the incisional hernia was between 4 and 10 cm in 108 cases (61.4%) and greater than 10 cm in 68 cases (38.6%). The mesh was placed in a prefascial, retro-muscular position in 60.8% of cases, and pre-peritoneum in 39.2%. We noted 23 cases (13.1%) of surgical site infection, 19 of which responded favorably to antibiotic therapy; while the others (n=4) required removal of the mesh followed by simple suture repair. With a mean postoperative follow-up of 28.3 months, no recurrence was reported. Conclusion: the method of incisional hernia repair using mesh, although very recent in our practice gives satisfactory results in the short and medium term. Key words: Incisional hernia, Repair, Mesh, Conakry, Guinea

Roboticassisted incisional hernia surgery-Retromuscular techniques

The trend to minimally invasive surgery has also made its way into the surgical treatment of incisional hernias. Unlike other areas of visceral surgery, recent years have seen aresurgence of open sublay repair in incisional hernia procedures, primarily due to the recognition of the retromuscular layer as the optimal mesh placement site. Additionally, with the growing availability of robotic systems in visceral surgery, these procedures are increasingly being offered in the form of minimally invasive procedures. These methods can be categorized based on the access routes: robotic-assisted transperitoneal procedures (e.g., r‑Rives, r‑TARUP, r‑TAR) and total extraperitoneal hernia repair (e.g., r‑eTEP, r‑eTAR). Notably, the introduction of transversus abdominis muscle release enables the robotic-assisted treatment of larger and more complex hernia cases with complete fascial closure. With respect to the comparison with open surgery required in retromuscular hernia treatment, the currently available literature on incisional hernia repair seems to show initial advantages of robotic-assisted surgery in the perioperative course. New technologies create new possibilities. In the context of surgical training the use of surgical robot systems with double consoles opens up completely new perspectives. Furthermore, the robot enables the implementation of models of artificial intelligence and augmented reality and could therefore open up novel dimensions in surgery.