Case Of Hernia Research Articles

Use of Botulinum Toxin and Pneumoperitoneum for Hernias with Loss of Dominance

When the abdominal cavity's material migrates to the hernial sac (HSV) and the HSV/abdominal cavity volume ratio exceeds 25%, systemic alterations known as "loss of domain" occur, resulting in an estimated 5–30% of cases of post-incisional ventral hernia. Usage of botulinum toxin appears to be a secure way to do a tension-free repair on treatment for hernias with loss of dominance.

Cerebellar Tonsillar Herniation an Incidental Finding in Asymptomatic Patient

Cerebellar tonsillar herniation, often associated with Chiari malformation, involves the downward displacement of the cerebellar tonsils below the foramen magnum. This condition can lead to significant complications due to the limited intracranial space within the rigid skull. Timely diagnosis is crucial given its potentially fatal nature, with brain structural displacement evident on imaging studies. We present a case of a 27-year-old female with continuous headaches and dizziness, diagnosed with tonsillar herniation through MRI revealing 16 mm of tonsillar descent without associated hydrocephalus or syrinx. Tonsillar herniation, characterized by inferior descent of the cerebellar tonsils, may be congenital or acquired, with measurements typically referenced from the McRae line to the displaced tonsil tip. Complications include brainstem compression, obstruction of cerebrospinal fluid flow, syringomyelia, impaired blood flow, and various neurological and psychological symptoms. Management options vary based on symptom severity and may involve observation, medication, or surgical intervention to alleviate compression and improve cerebrospinal fluid flow. Consultation with a neurologist or neurosurgeon is essential for comprehensive evaluation and tailored management plans aiming to relieve pressure on the brainstem and spinal cord in tonsillar herniation cases.

A Rare Case of Spontaneous Diaphragmatic Hernia with Gastric Perforation Presenting Like an Empyema

Diaphragmatic hernias are rare and mostly congenital, rarely spontaneous. Perforation and other complications of diaphragmatic hernias are even rarer and associated with significant morbidity and mortality. We report a patient presenting to the emergency department with features of empyema requiring intercostal drainage. However, on clinical worsening, radiological imaging showed features of diaphragmatic hernia and a subsequent thoracostomy revealed a herniated gastric perforation. Such cases are very rare and need a high index of suspicion for the diagnosis and early appropriate surgical management. Otherwise, it is associated with very high rates of mortality.

Reducing an operational access for cholecystectomy on overweight patients

The development of laparoscopic surgery, based on technological progress, and the accumulation of clinical experience makes it possible to reduce operating access, reducе the postoperative complications. Material and methods. SILS cholecystectomy were performed in 27 patients with overweight and obesity. All operations were done as planned for chronic calculousis cholecystitis. Results and discussion. We used assistive technologies for organ traction (Patent N 103722 Russian Federation) in the event of a “conflict” of instruments, which made it possible to reduce the intervention time. The mean intervention time was 55.5±6.9 minutes. In 10 patients with risk factors for the formation of trocar hernias (obesity, advanced age, functional insufficiency of the connective tissue), the access area was preventively strengthened by an implant placed over the aponeurosis. All patients were discharged in a satisfactory condition 3-4 days after surgery. Subsequently, during observation and re-examinations up to 7 years after surgery, patients did not complain about surgical intervention, felt well, and not a single case of postoperative ventral hernia was recorded. Conclusion. The advantages of cholecystectomy in overweight and obese patients using the SILS technique are obvious, associated with a reduction in the invasiveness of the operation, an excellent cosmetic result, and the achievement of a fundamentally different quality of life for patients.

Approach to concurrent inguinal hernias during laparoscopic appendectomy for early appendicitis

PurposeConcurrent inguinal hernia can be a challenge for a pediatric surgeon during a laparoscopic appendectomy in children. We aimed to present our approach to inguinal hernias seen during laparoscopic appendectomy.MethodsIn our pediatric surgery clinic between July 2019 and December 2022, the records of patients aged 0–18 who underwent laparoscopic appendectomy were retrospectively investigated. The clinical findings, surgical procedure, and results of intervened inguinal hernia cases during laparoscopic appendectomy were evaluated.ResultsBetween the study dates, 293 laparoscopic appendectomies were performed in our clinic. Patent processus vaginalis was observed in 5 (1.7%) cases. Laparoscopic hernia repair was performed with the Burnia technique in 2 girls. In one case, the omentum was herniated and adhered to the hernia sac seen during laparoscopy. In another case, swelling in the groin occurred during the introduction of air into the abdomen at the beginning of the operation. Patent processus vaginalis seen in 3 asymptomatic cases was not intervened. There were no postoperative complications or recurrences in the two patients who underwent hernia repair.ConclusionHernia repair with the Burnia technique might be safely performed in symptomatic inguinal hernia cases seen during laparoscopic appendectomy for early appendicitis.

Clinical study of mesh repair in ventral hernia with comorbidities (diabetes mellitus and/or obesity and/or hypothyroidism) in a tertiary care hospital

Background: Ventral hernias comprise the second-most common hernia presentation, or 21–35% of all hernia types in the surgical world. Ventral hernias include incisional, umbilical, epigastric, and spigelian hernias, among others. This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications. Aims and Objectives: This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications. Materials and Methods: Forty-five cases of ventral hernias treated were studied prospectively from January 2021 to June 2022, in which each patient was evaluated thoroughly and surgery was planned to obtain a satisfactory outcome. The distribution of ventral hernias with respect to age, sex, comorbidities, and risk was recorded. Common presenting symptoms of ventral hernias, diagnosis, and complications were studied. The data collected was entered in a proforma, tabulated, and statistically analyzed. Results: Females were affected much more than males. Out of the three types of hernia that were studied, umbilical hernia showed more incidence (n=23/51%), followed by incisional hernia (n=15/33%), and epigastric hernia (n=7/16%). The most common age presentation was in the fourth and fifth decades. The most common type of mesh repair was pre-peritoneal repair in 28 (62%). The pain was relatively more common post-surgery complications, as noted in 11 (24%). In 100% of the cases, swelling was the complaint, followed by pain (18.8%). Obesity was the most common etiological factor in the development of ventral hernias (60%), followed by diabetes (35%). Conclusion: The most common ventral hernia was an umbilical hernia. Ventral hernias are more common in females. Obesity and diabetes are observed to be the major predisposing risk factors. Good pre-operative evaluation and preparation, sound anatomical knowledge, and meticulous attention to surgical detail are the most important factors for the prevention of postoperative complications. In view of the limited period of follow-up, we were not in a position to comment on recurrence rates, but when proper surgical procedures are adopted along with pre-operative correction of comorbid factors, results will always be excellent.

Impact of the novel coronavirus infection on pediatric surgery: an analysis of data from the National Clinical Database

PurposeThe coronavirus disease 2019 (COVID-19) pandemic limited the delivery of medical resources. Although surgeries are triaged according to disease severity and urgency, a delay in diagnosis and surgery can be detrimental. We conducted this study to analyze data on the impact of the COVID-19 pandemic on pediatric surgery for different diseases or disorders.MethodsWe compiled and compared data on pediatric surgical cases from 2018 to 2020, using the National Clinical Database. The number of diseases, severity, complication rates, mortality rates by disease/disorder, and the COVID-19 pandemic areas were analyzed.ResultsThe total number of cases of pediatric surgery in 2018, 2019, and 2020 was 50,026, 49,794, and 45,621, respectively, reflecting an 8.8% decrease in 2020 from 2018 and an 8.4% decrease in 2020 from 2019. A decrease was observed when the number of patients with COVID-19 was high and was greater in areas with a low infection rate. There was a marked decrease in the number of inguinal hernia cases. The number of emergency room visits and emergency surgeries decreased, but their relative proportions increased.ConclusionsThe COVID-19 pandemic decreased the number of pediatric surgeries, reflecting the limitations of scheduled surgeries and infection control measures.

Safety and effectiveness of laparoscopic adult groin hernia repair in Africa: a systematic review and meta-analysis.

Surgery is the recommended treatment of groin hernia, and laparoscopic approach is increasingly accepted due to lower risk of chronic pain. This systematic review aims to evaluate results of laparoscopic groin hernia repair (LGHR) in Africa. We performed a literature search of published studies using electronic databases. Included African articles reported at least one of outcomes after LGHR in adult population. Newcastle-Ottawa Scale was used for quality assessment. A quantitative meta-analysis was performed to estimate the pooled prevalence of the post-operative outcomes. We included 19 studies from 6 countries which totalized 2329 hernia cases. Mean age was 44.5years and male patients were predominant (sex-ratio 19.8). The mean operative time was 69.1min. The pooled prevalence of conversion to open procedure was 2.578% (95% IC: 1.209-4.443). The pooled prevalence of surgical site infection and Hematoma/Seroma was respectively 0.626% (95%IC: 0.332-1.071) and 4.617% (95% IC: 2.990-6.577). The pooled prevalence of recurrence and chronic pain was respectively 2.410% (95% IC: 1.334-3.792) and 3.180% (95% IC: 1.435-5.580). We found that total morbidity for TAPP procedure was higher than TEP procedure (p = 0.0006; OR 1.8443). These results confirm that LGHR is safe and feasible and would be recommended in our African context.

Resolution of halitosis following repair of a primary parahiatal diaphragmatic hernia

Parahiatal diaphragmatic hernias are uncommon and often diagnosed incidentally on imaging, or in the emergency setting. Symptoms related to these defects can be like those of hiatus hernias (HH), however this is not always the case. We present a unique case of parahiatal diaphragmatic hernia that was characterised by severe halitosis which resolved with surgical repair.

An obstructed spigelian hernia with ipsilateral cryptorchidism: A rare case scenario of an obstructed spigelian hernia with ipsilateral cryptorchidism

A spigelian hernia is the type of ventral hernia that appears in the abdomen’s lower quadrant between an area of dense fibrous tissue and abdominal wall muscles, forming a spigelian aponeurosis. Undescended testicle” is the term used when one or both of the testicles fail to descend into the scrotum. Here, we report the case of a right lower quadrant spigelian hernia with ipsilateral undescended testes that may be a part of the new spigelian-cryptoorchidism syndrome in a 27-year-old male. An exploratory laparotomy was performed via the right paramedian incision. The right-sided orchidectomy was also done. The resected bowel and testes were sent for histopathological examination. The patient was discharged and is doing well on follow-up visits.

Effect of general and spinal anaesthesia on post-operative wound healing during laparoscopic totally extraperitoneal inguinal hernia repair: A meta-analysis.

Totally extraperitoneal prosthetic (TEP) is a surgical technique for the treatment of hernia. The purpose of this research is to compare the efficacy of both general anaesthesia and spine anaesthesia for TEP herniorrhaphy. The number of patients who received TEP operations related to the injury from 2008 to 2022 was counted in this study. Patients with TEP operation were classified into general anaesthesia and spine anaesthesia. In this research, 186 related articles were found in the data base, and in the end, 8 were analysed. This study involved 2452 cases of hernia. The data of the operation time, the infection of the wound and the bleeding of the wound were analysed. The analysis of the data was done with RevMan 5.3. Results indicated that there was no significant difference between general anaesthesia and spinal anaesthesia in post-surgical rates for post-operative wound infection (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.49-1.83; p = 0.86); In general anaesthesia, there was no difference in the risk of post-operative wound haematoma when compared with those treated with spinal anaesthesia (OR, 2.96; 95% CI, 0.37-23.69; p = 0.31). In the seven trials, there was no difference in the duration of the surgery between the general anaesthetic and the spinal anaesthesia group (mean difference, -1.44; 95% CI, -4.11 to 1.22; p = 0.29). Data from the available meta-analysis indicate that there is no difference in the risk of post-operative wound infection or wound haematoma when treated with TEP.

Spigelian hernia: a multi-site review of operative outcomes of surgical repair in the adult population

PurposeSpigelian hernias arise at the linear semilunaris and account for approximately 1–2% of abdominal hernias. The aetiology is due to a defect of the aponeurosis of the transverse abdominis and when discovered, management is surgical intervention. The aim of this study was to observe operative outcomes for open and minimally invasive repair.MethodsA retrospective chart review was conducted at two hospitals in Townsville, The Townsville University Hospital and The Mater Private Hospital over a 10-year period (2010 to 2020). A surgical database search (ORMIS & IEMR) was performed at both locations using key search terms, including “spigelian hernia”, “laparoscopic”, “open”. Descriptive statistics were utilised to analyse patient factors and operative outcomes in the public and private setting.Results43 cases of Spigelian hernias (25 female, 18 male) were reported over the study period. The average age was 66. There were 36 elective cases and 7 emergency cases. A laparoscopic approach was the preferred method of repair, occurring in 74% of cases. Of these cases, the predominant hernial content was fat only. 65% of cases had a history of prior abdominal surgery unrelated to the “Spigelian belt” location. Complications occurred in 19% of cases. Other variables, such as ethnicity, smoking status, defect size, predisposing factors and recurrence rate, were analysed and did not yield statistical significance.ConclusionAlthough a small sample size, the data suggest there is no statistically significant difference between operative outcomes, complication rate and predisposing factors between open and minimally invasive case groups.

Comparison of Skin Staples versus Skin Sutures After Inguinal Hernioplasty in Terms of Surgical Site Infection

Background: Surgical site infection is a major concern following inguinal hernia repair, potentially leading to extended hospital stays, increased morbidity, patient discomfort, and higher healthcare costs. This study aimed to conduct a comparative analysis between skin staples and skin sutures in inguinal hernioplasty, explicitly focusing on their impact on surgical site infection rates. Methods: From September 2022 to June 2023, a randomized control trial study was carried out at the Surgery Department, Kulsoom Bai Valika Hospital Karachi. A total of 100 patients who underwent Lichtenstein tension-free mesh hernioplasty were allocated into two groups: the stapler group (n=50) and the polypropylene suture group (n=50). The patients were monitored for 3 to 6 hours post-surgery and safely discharged on the first postoperative day. Follow-up was scheduled 7 days after surgery to assess wound complications, specifically surgical site infections. Comparison between both groups was done using the Chi-square/Fisher exact test for surgical site infection and independent samples t-test for pain score. The level of significance was set at 5%. Results: The incidence of postoperative pain was slightly lower in the stapler group compared to the suture group (10% vs. 16%), this difference was not statistically significant (p=0.544). Moreover, the surgical site infection rate was significantly lower in the stapler group (3%) than in the suture group (12%) with p=0.012. Conclusion: When securing the mesh in inguinal hernia cases, the utilization of skin staples was considered a safe approach and was associated with lower surgical site infection as compared to skin sutures.

To use a simple hernia needle for single-port laparoscopic percutaneous inguinal hernia repair in children: a 5-year experience study.

The aim of this study is to investigate the technique and practical significance of using a simple hernia needle in single-port laparoscopic herniorrhaphy in pediatric patients. The study conducted a retrospective analysis of all pediatric patients who underwent treatment for inguinal hernia using single-port laparoscopic herniorrhaphy with a simple hernia needle at Yellow River Sanmenxia Hospital from June 2018 to May 2023. The medical records of all the children were collected, and clinical characteristics, procedural information, and follow-up data were carefully reviewed. A total of 848 patients underwent inguinal hernia repair, with ages ranging from 7 months to 13 years (2.99 ± 2.49 years), including 756 males and 92 females. A total of 528 cases of unilateral hernia and 310 cases of bilateral hernia were reported, with intra-operative findings revealing contralateral occult hernia in 253 cases. Single-port laparoscopic herniorrhaphy was successfully completed in all patients, with no instances of conversion to open surgery. The mean operation time for unilateral hernia repair was (7.50 ± 4.80) min, while for bilateral hernia repair it was (11.55 ± 7.27) min. Five patients presented with subcutaneous emphysema, while two patients experienced a recurrence of inguinal hernia. No complications, such as scrotal hematoma, trocar umbilical hernia and testicular atrophy, were observed. The duration of the follow-up period ranged from 3 to 24 months. The promotion and utilization of single-port laparoscopy combined with a simple hernia needle in clinical practice are justified. Our initial investigation indicates that this surgical approach is both safe and dependable for the management of pediatric inguinal hernia. The procedure presents numerous benefits, including the utilization of uncomplicated instruments, straightforward operation, a clear curative impact, minimal tissue damage, rapid recovery, and the absence of scarring.

Case Report: Congenital diaphragmatic hernia in one twin followed by ex-utero intrapartum treatment (EXIT) procedure: Pearls & pitfalls

Cases of congenital diaphragmatic hernia (CDH) in one twin have been reported rarely. This study aimed to report a rare case while also analyzing the pearls and pitfalls in diagnosing and managing this case. A 32-year-old multiparous woman referred to a tertiary hospital with multiple pregnancies and suspected CDH on the 1st baby. The patient underwent further investigation and the first fetus had a severe CDH on the left side. The second fetus was in a transverse lie and no other abnormalities were found. The babies were delivered through caesarean section and the first baby underwent the ex-utero intrapartum treatment (EXIT) procedure without prior antepartum fetal therapy. A large defect measuring 7.5 x 6 centimeters on the left side (Bochdalek type) was found in the first baby during surgery to make repairs. The baby died the next day due to some complications from the previous repair. As a pearl of this case, prenatal diagnosis and multidisciplinary approach hold pivotal roles. In prenatal imaging, CDH is distinguished by the visualization of thorax filled with abdominal contents and the mediastinal shifting from the defect to the contralateral side. EXIT procedures could be performed after the baby with CDH is delivered and the infant will still require post-natal surgical repair and its success rate depends on many factors. In conclusion, proper prenatal diagnosis with ultrasound evaluation from the second trimester, close and regular maternal-fetal monitoring, prenatal intervention, intrapartum ultrasound guidance, and post-natal procedures are all critical.

Single-Port Laparoscopic Extraperitoneal Repair of Pediatric Inguinal Hernias and Hydroceles by Using Hernia Crochet Needle With a Cannula.

Numerous modifications laparoscopic techniques have mushroomed in recent years. Here we describe a modified technique of extracorporeal ligation of processus vaginalis in children using a hernia crochet needle with a cannula. Processus vaginalis repair was carried out on patients diagnosed with inguinal hernia or hydroceles using this novel technique between June 2021 and June 2022. The processus vaginalis was closed extracorporeally using a hernia crochet needle with a cannula. In the presence of patent processus vaginalis, the same procedure would be performed on the contralateral side. The primary outcomes was the safety and efficiency of this modified procedure, and the secondary outcomes was the post operative complications. A total of 212 (165 inguinal hernia and 47 hydroceles) children were corrected by this novel technique. The mean operation time was 27.49min for unilateral inguinal hernia cases and 36.55min for bilateral cases. The unilateral hydrocele median operation time was 27.83min and that for the bilateral cases was 37.30min. During the mean of 10.92months of follow-up, there was only a boy subject to a metachronous contralateral occurrence of hernia 10months after surgery, and no other complications (knot reactions, testicular atrophy, postoperative hydrocele or iatrogenic) have been observed yet. This study shown a unique procedure with using a hernia crochet needle with a cannula to be simple, safe, and effective in managing inguinal hernias and hydroceles in the pediatric population.

Infantile inguinal hernia complicated with ileoileal intussusception

Indirect inguinal hernias occur due to patent processus vaginalis. One-third of cases present before 6 months of age. Despite being one of the most performed surgeries, inguinal hernia repair can be complicated due to unusual contents in the hernia sac. One commonly encountered unusual structure is the vermiform appendix. Less commonly, epiploic appendages, ovaries, uterus, urinary bladder, and fallopian tubes have also been encountered in the hernia sac. Intussusception as a content of the hernial sac is rare. We present a case of an indirect inguinal hernia complicated by ileoileal intussusception causing acute intestinal obstruction in a 2-month-old infant. To our knowledge, no such case has been described in the literature in the pediatric population.

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.