Common Hernia Research Articles

Leiomyoma of round ligament masquerading as an inguinal hernia

Tumors of the round ligament of uterus are uncommon, with leiomyoma being the most common type among them with unknown exact incidence. Leiomyoma is a benign tumor and its location at inguinal area is confused with the clinical diagnosis of inguinal hernia, lymph node, or other nodal masses. Here, we report the case of a 47-year-old parous woman who presented with complaints of heavy menstrual bleeding and right groin swelling. A preoperative diagnosis of adenomyosis of uterus with inguinal hernia was made. She underwent nondescent vaginal hysterectomy, following which, on exploration of the inguinal region, a myoma was found and was confirmed as leiomyoma on histopathology. Hence, although rare, it is prudent to consider a round ligament leiomyoma as one of the differential diagnoses of the more common inguinal hernia, especially in a female patient.

Mesh penetrating the cecum and bladder following inguinal hernia surgery: a case report

BackgroundTension-free repair using mesh is a common inguinal hernia surgical procedure. However, various complications such as mesh-related infection and recurrence may develop as a result. Moreover, although rare, there are also reports of intestinal obstruction caused by adhesion of the mesh to the intestinal wall and cases of mesh migration into various organs. Here, we report our experience with a patient in whom mesh extraction was performed due to migration of mesh into the intestinal tract following inguinal hernia surgery and formation of a fistula with the bladder.Case presentationOur patient was a 63-year-old Japanese man who had a history of operative treatment for right inguinal hernia during early childhood. Because a relapse subsequently occurred, he was diagnosed as having recurrent right inguinal hernia at the age of 56 years for which operative treatment (the Kugel method) was performed. He presented to our hospital 6 years later with the chief complaint of lower abdominal pain. Computed tomography findings revealed a mass shadow in contact with his bladder and cecal walls, and enteric bacteria were detected in his urine. Furthermore, because lower gastrointestinal endoscopic findings confirmed mesh in the cecum, we performed operative treatment. The mesh had migrated into the cecum and a fistula with his bladder had formed. We removed the mesh through ileocecal resection and partial cystectomy.ConclusionsIt appeared that a peritoneal defect occurred when the mesh was placed, allowing the mesh to migrate into our patient’s intestinal tract. Because contact between the mesh and the cecum resulted in inflammation, a fistula formed in his bladder. It is important to completely close the peritoneum when placing the mesh.

A clinical study on ventral hernias in a tertiary care hospital

Background: Ventral hernias comprise the second most common hernia presentations in the surgical world. This study was undertaken to know the different clinical types, age incidence, predisposing factors for ventral hernia and also to study the post-operative results of different operative procedures.Methods: 250 cases of abdominal wall hernias were studied during the period of 3.5 years from January 2013 to June 2016. Out of which 150 cases were studied retrospectively from January 2013 to December 2014 with the help of the case sheets available in the MRD. The prospective study was done from January 2015 to June 2016 in which each patient was evaluated separately and thoroughly and his surgery planned so as to obtain satisfactory results. 69.6% were incisional hernias following an operation. 8% patients had presented with complications like irreducibility, obstruction and strangulation. The presence of associated diseases, large hernia, poor condition of local tissue (muscle), all make the surgical management of ventral hernia a complex problem. Either anatomical repair or Mesh repair were undertaken for all patients in this study.Results: Females were affected much more than the males. The proportion of females to males affected with ventral hernia was 5:1. Out of the three types of hernia that were studied only epigastric hernia showed more incidence in males whereas incisional and paraumbilical hernias were much more common in females. Most common age presentation was fourth and fifth decade. 92% of ventral hernias were uncomplicated at the time of presentation. In 100% of the cases swelling was the complaint followed by pain (18.8%). Previous surgery was the most common etiological factor in the development of ventral hernias (69.6%) followed by obesity (23.2%) In both groups mesh repair (63.6%) and anatomical repair (36.4%) there were no recurrences or deaths in the follow up period of 3 months.Conclusions: Ventral hernias are common surgical complaints. Prevention is the better treatment in the form of meticulous dissection and proper post-operative care to avoid incisional hernias. Presence of ventral hernia is an indication for surgery even in presence of co-morbid conditions like ascites, COPD, BPH as these patients are more prone for complications and of course these conditions need proper addressal. Mesh repair has nowadays become the standard of care but the results of the surgery depends upon the expertise of the surgeon.

Clinical study of hernia in females

Background: Abdominal wall hernia is the most commonly encountered clinical problem in the surgical setting and also the incidence of various types of hernias are known to have gender variations. This study was done to analyse the pattern of different types of hernia and their incidence in female patients.Methods: This was a retrospective study done at Basaveshwara Teaching and General Hospital, Kalaburagi, Karnataka, India from January 2012 to December 2014. All the female patients who presented with different types of hernia like inguinal, umbilical, ventral, congenital and diaphragmatic hernias irrespective of the age have been included in the study from January 2012 to December 2014.Results: In this study total of 87 cases of different types of hernias were studied including ventral, inguinal, umbilical and diaphragmatic hernias. Among which ventral hernias were the most common including 42 cases and among them one case presented as obstructed hernia and the most common age of incidence was 31-40 years. The next most common presentation was inguinal hernia with total of 29 cases and the paediatric age group (0-10 years) was the most common presentation. The next common hernia was umbilical hernia and the most common age of presentation was 21-40 years. The least common presentation was that of diaphragmatic hernia with only 4 cases, age of the patients being 60 and above.Conclusions: In present study, most commonly encountered hernia was ventral hernia followed by inguinal, then umbilical and lastly diaphragmatic hernias.

Dealing with intramesosigmoid hernia: A rare variety of internal hernia

Internal hernia, as the cause of acute intestinal obstruction, is rare and sigmoid hernia is not one of the most common internal hernias. Moreover, intramesosigmod hernias are of the rarest variety. Establishing precise preoperative clinical diagnosis is a challenge for a surgeon. Strangulated sigmoid hernia has high morbidity and mortality. Prompt exploration has to be undertaken based on clinical signs and symptoms rather than searching for the exact cause of obstruction. Here, an extremely rare case of intramesosigmoid hernia is presented with a defect in the medial leaf of the mesentery leading to small bowel obstruction.

Modification of internal hernia classification system after laparoscopic Roux-en-Y bariatric surgery.

IntroductionThe occurrence of internal hernia is not an uncommon late complication following the laparoscopic bariatric Roux-en-Y gastric bypass procedure. In some instances, it can be life threatening if not treated in a timely manner. Although there are numerous publications in the literature addressing internal hernia, they are mostly retrospective, and focus mainly on describing the different reconstructive orientation as far as the bowel is concerned.AimOur study aim is to address the relationship between the three basic elements of internal hernia, namely: intestinal mesentery defect, the involved intestine and herniated loop direction. Although a developed and widely accepted classification system of internal hernia has not been established yet, we hope this study can help the system to be established.Material and methodsWe studied all patients who underwent revision bariatric operations in the Freiburg and Lübeck University Hospitals (2007–2013). A single surgeon performed and documented all revision procedures for internal hernia. The post-operative follow-up period is up to 6 years. All patients with internal hernias were included whether their primary surgery was performed in our center or performed in other institutions, being referred to our center for further management. The presence of hernia defect, the type of herniated intestinal loop and the direction by which the herniated intestinal loop migrated were analyzed.ResultsTwenty-five patients with internal hernia were identified; in 2 patients more than one hernia type coexisted. The most frequent constellation of internal hernias was BP limb herniation into the Brolin space and migrating from left to right direction (28%). The highest incidence of internal hernia was found to be following Roux-en-Y gastric bypass (68%); the biliopancreatic limb (BP) limb was the most commonly involved intestine (51.9%). The incidence of Petersen hernia was the highest (59.3%), and left-right direction was more common. The most common hernia direction of the biliopancreatic limb was from left to right (92.6%), but alimentary limb (AL; 57.1%) and common channel (CC; 66.7%) often favor the other course.ConclusionsThere are existing different types of internal hernias after bariatric operations including separate mesenterial spaces, various intestine parts and herniation direction. Our SDL classification system may offer a useful pathway that facilitates the understanding, and systematic approach to internal hernia, which can be used by bariatric quality registers.

Abdominal wall hernias

A hernia is an abnormal protrusion of a viscus, part of it, or its coverings from the wall of the cavity containing it. There are many different types of abdominal wall hernias and they can occur in any age group. The most common hernia occurs in the groin and this article explores these in some depth. It is important for a GP to be able to recognise in all abdominal wall hernias, those that are beginning to develop, as well as those already causing complications, in order to adequately treat them. This article explains the pathophysiology of hernias, their complications and when to refer to secondary care.

Repair of giant subcostal hernia using porcine acellular dermal matrix (Strattice™) with bone anchors and pedicled omental flap coverage: a case report

IntroductionGiant abdominal wall hernias represent a major challenge to the hernia surgeon in practice today. Of the common abdominal wall hernias, those located in the subcostal region are among the most difficult to repair, and have historically been plagued by higher recurrence rates than other locations, such as the midline. No technique has been identified as the clearly superior choice for hernias of this type.Case presentationWe report a successful repair of a giant, multiply recurrent subcostal hernia with loss of domain in a 45-year-old obese Caucasian man. This was accomplished in a novel fashion, using a porcine acellular dermal matrix (Strattice™) as the floor of the repair, which was fixed to the costal margin using orthopedic bone anchors (Mitek™), then covered with a pedicled omental flap to eliminate dead space and facilitate a more rapid revascularization of the porcine acellular dermal matrix implant.ConclusionsThis case emphasizes the need for a thorough understanding of the challenges of the specific type of hernia defect encountered, as well as knowledge of any available techniques that may be adjunctively employed to enhance the chances of achieving a successful result.

English

Inguinal hernia is the most common hernia seen in females. Only independent risk factors for inguinal hernia in females are positive family history and obstipation. Here we present a case of 60yr old female with irreducible inguinal hernia. On examination an intra-vaginal foreign body was found which was causing patient to strain during micturition leading to chronic increase in intra-abdominal pressure. A herniorrhaphy was done and foreign body was removed intra- operatively. INTRODUCTION : Inguinal hernia in females is relatively uncommon as compared to males but inguinal hernia is the most common hernia in females. The incidence of inguinal hernia in females is <5%. Inguinal hernias are nine times more common in men than in women. (1) The incidence of indirect hernia relates to the congenital weakness at the internal abdominal ring. The sac is formed by the unobliterated portion of the prenatal peritoneal invagination of the canal of nuck that runs along and partly covers the round ligament. Virtually nothing is known about risk factors for inguinal hernia in females. High sports activity is protective in inguinal hernia. Smoking, appendicectomy, abdominal operations and multiple deliveries are not associated with inguinal hernia in females. (2) Inguinal hernia has been reported to be more prevalent in people with low socio-economic status. (3) Inguinal hernias have an approximate incidence of incarceration of 10% and a portion of these may become strangulated. (4) In a study, bowel resection rate in patients with obstructed or strangulated hernias was 15.9%. The need for bowel resection closely correlated with the time interval between the onset of acute symptoms and subsequent operation. (5) Immediate operation should be done in all patients who are ill with incarcerated or obstructed hernia, without attempting reduction.

Does a penetrating diaphragm injury have an effect on morbidity and mortality?

In this study, we investigated the diaphragmatic ruptures that accompanied penetrating abdominal injury. Records of 237 patients with penetrating abdominal trauma seen in the General Surgery Clinic between January 1996 and December 2010 were investigated retrospectively. Patients without diaphragmatic rupture were allocated to Group I and those with were allocated to Group II. Diaphragmatic injury was not present in 177 patients and present in 60 patients. Diaphragmatic injury was on the right side in 12, left side in 41, and bilateral in 7. Eleven had thoracic herniation, and the most common hernia contents were the colon, stomach, greater omentum, small bowel, and spleen. The postoperative complication rate was 50% in Group I (n=89) and 47% in Group II (n=28), and there was no significant difference between the two groups (p>0.05). The length of hospital stay was slightly increased in Group II, but not significant (p>0.05). Seventeen patients (9.6%) in Group I and four patients (6.6%) in Group II died. The difference in mortality rates between the two groups was not significant (p>0.05). Diaphragmatic rupture is not common among patients with penetrating abdominal trauma. There was no difference between patients with penetrating injuries and with versus without diaphragmatic injuries in terms of mortality and morbidity.

One-stage Laparoscopic Repair of Morgagni and Inguinal Hernias in a Two-month Old Male

The development of Morgagni hernias is related to malformations of the embryologic septum transversum after failure of the sternal and costal fibrotendinous elements of the diaphragm to fuse. The overall incidence of Morgagni hernias among all congenital diaphragmatic defects is 3% to 4%. Inguinal hernias are the most common hernias in males and females (25% and 2%, respectively). An inguinal hernia is defined as a protrusion of the abdominal cavity contents through the inguinal canal. The combination of Morgagni and inguinal hernias is rare, and treatment using laparoscopic surgery has not been previously reported. This case presents a one-stage laparoscopic repair of Morgagni and inguinal hernias in a 2-month-old male.

LAPAROSCOPIC TOTAL EXTRAPERITONEAL (TEP) REPAIR OF INGUINAL HERNIA: A PROSPECTIVE CONTROLLED STUDY

Objectives: Inguinal hernia is the most common hernia and inguinal hernia repair is the most frequently performed operation in gerenal surgery. Hernioplasty by laparoscopy was gradually the standard method for inguinal hernia repair all over the world. The objective of this study is to demonstrate the effectness and safeness of laparoscopic totally extraperitoneal (TEP) hernia repair. Materials and methods: A prospective analysis of patients, admitted for groin hernia and operated by laparoscopic TEP hernia repair, performed between June 2010 and December 2011. Data were collected regarding general characteristics, complication rates, length of hospital stay and the recurrence rate postoperative of this laparoscopic method. Results: 35 patients underwent laparoscopic totally extraperitoneal (TEP) hernia repair with an average age of 51.3±13.8 years (range 31 – 72 years); 5.7% of the inguinal hernias were operated bilaterally, peritoneal laceration was noticed during dissection in 14.3%, there was no injury of the inferior epigastric vessels during dissection. Unilateral hernia had an operative time of 66.52 ± 17.4 minutes (range 45 – 115 minutes) and bilateral hernia took 107.5 minutes (range 95 – 120 minutes). All of these patients in the study were controlled, 5.7% had seroma at the time 3 months postoperative, there were no recurrences during follow-up ranging from 3 – 18 months (average 9.6 months). Conclusions: The laparoscopic (TEP) repair of inguinal hernia is safe and effective. That laparoscopy method should be the gold standard technique in treatment for the repair of inguinal hernias. Keywords: groin hernia – TEP hernioplasty - laparoscopy

Definitely NOT Just another Hernia

A 77-year-old male presented to our emergency department (ED) with a 3-hour history of acute severe lower abdominal pain, inability to void, a swollen scrotum, and one episode of vomiting. His relevant past medical history included: hypertension, diabetes mellitus, and distant right inguinal hernia repair. Vital signs were: 96.4° F, 101, 22, and 205/90. Examination revealed a normal abdomen and an irreducible left inguinal hernia. Foley catheter placement yielded a scant amount of infected urine that stopped flowing almost immediately and did not resume despite catheter flushing and repositioning. Additional laboratory data did not identify the cause of the patient’s symptoms. An abdominopelvic computed tomography (CT) was performed (Figures 1 and ​and2)2) after which the patient underwent emergent operative reduction of his incarcerated scrotal cystocele. Figure 1. Scrotal cystocele-transverse view. Bladder entering inguinal canal. Arrow marks focal volvulus. Figure 2. Asterisk marks distal obstructed bladder. Complete bladder herniation into an inguinal hernia sac is referred to as a scrotal cystocele. This very rare condition is previously unreported in the emergency medicine literature. Some bladder involvement occurs in 1 – 4% of all inguinal hernias1 and is often an incidental (generally benign) operative finding. Patients with partial bladder herniation may report “double phase micturition.” This occurs when the patient voids then passes more urine by applying pressure to their hernia.2 Scrotal cystocele can be associated with bilateral hydronephrosis, acute renal failure, bladder lithiasis and necrosis, vesicoureteral reflux, and scrotal abscess.1 This inherently serious condition mimics the far more common inguinal hernia containing fat or bowel. Risk factors include: patients over 50 years of age, males, and obesity. ED ultrasound may strongly suggest or confirm the diagnosis. CT is definitive. Due to its associated morbidity, emergency physicians should consider scrotal cystocele in males with obstructive uropathy and an associated inguinal hernia.

Providing humanitarian hernia surgery as a registrar in Mongolia with operation hernia

Providing humanitarian hernia surgery as a registrar in Mongolia with operation hernia

Needlescopic Totally Extraperitoneal Hernioplasty for Unilateral Inguinal Hernia in Adult Patients

Totally extraperitoneal (TEP) inguinal hernioplasty for inguinal hernia is associated with less postoperative pain, shorter hospital stays, less chronic pain, and increased patient satisfaction when compared with the open Lichtenstein approach‥ However, only few studies to date have compared conventional with needlescopic TEP hernioplasty for treating unilateral inguinal hernias in adult patients. We report our prospective study that compared the postoperative outcomes of these two approaches over a 2-year period. From July 2007 to June 2009, a total of 32 patients underwent attempted unilateral needlescopic TEP hernioplasty. All data were prospectively collected and analysed, including demographic features, types of hernia, and postoperative outcome. The results were compared with those of an agematched cohort of 32 patients who underwent conventional TEP hernioplasty in the same period. Needlescopic TEP hernioplasty was successfully performed in 24 patients. The other eight procedures were completed with conventional TEP approaches after changing one or two 5-mm ports. The most common hernia type was Nyhus type III (38/64, 59.3%). There was no significant difference in the mean operative time, hospital stay, and postoperative pain scores between the needlescopic and conventional approaches. There was no major complication detected on the first visit, except seroma formation (9 patients in the needlescopic group and 11 in the conventional group), all of which was resolved with conservative management. No recurrence of hernia was noted in either group during the mean follow-up period of 88.0 weeks. Needlescopic TEP hernioplasty was a feasible technique in selected patients for inguinal hernia repair. Postoperative recovery following both approaches was similar. However, because this was a small cohort study, larger prospective, randomized controlled trials are required to establish the longterm benefit, safety and complications of needlescopic surgery.

Risk factors related with unfavorable outcomes in groin hernia repairs

Hernia repairs are a common surgical procedure, and are associated with a significant cost. Despite the acceptance of the advantages of early elective hernia repairs, the incidence of emergency admissions with complicated presentations remains high, and the natural history of an untreated hernia is not obvious. This study aimed to define risk factors related with unfavorable outcomes in groin hernia repairs. We analyzed the records of 685 elective or emergency repairs of groin hernias between December 2005 and June 2009. Patient age ranged from 17 to 85 years, with 240 (35%) of patients being older than 60 years of age. Indirect inguinal hernias were the most common hernia type in both sexes of patients. Coexisting cardiopulmonary problems were noted in 294 male and 33 female patients. American Society of Anaesthesiologists (ASA) grades 3 and 4 were encountered in 61 (9%) patients. Data were analyzed by chi-square test. Significantly high incarceration and strangulation rates were found in females and femoral hernia type. The overall morbidity rate was 7%, major complications 3%. No mortality was observed in the series and postoperative complications were significantly more common in patients with high ASA score and severe coexisting cardiopulmonary problems. Advanced age, delayed admission, femoral type hernia and female sex were also linked with unfavorable outcomes. The risk of complicated presentation and unfavorable outcome in patients with groin hernia is significant in the presence of factors such as advanced age, femoral hernia, female sex, delayed admission, severe coexisting cardiopulmonary problems and high ASA score. Although it is difficult to estimate the natural history of untreated hernia, hernia repairs of patients with the above-mentioned risk factors should be timely and elective.

GS01 HERNIA REPAIR: ARE WE THERE YET?

Herniae have been documented since ancient times, but the era of modern hernia treatment is accepted as starting with the surgery of Bassini. Suture repairs of various types then dominated the treatment of hernia until the era of mesh repair championed by Stoppa and Lichtenstein.Surgeons feel that mesh repairs have revolutionized hernia surgery. Have the mesh repairs really made such a difference? There is evidence that all is not as it seems! Published recurrence figures don't seem to withstand close scrutiny.One of the trendy terms in herniology is the “myo‐pectineal orifice”, while many hernia specialists pay lip service to this concept, very few available hernia operations address this problem.The latest area of interest in the world of hernia surgery is the area of post‐hernia groin pain, either neuralgic or non‐neuralgic. There are studies showing an incidence of chronic groin pain following anterior repairs of 30% or more, and yet these operations are the most common hernia operations in the world!Keith in 1924 first postulated the concept of herniosis and was criticized. However there is a large volume of convincing evidence that herniae are manifestations of a metabolic disorder. They are associated with abdominal aortic aneurysm and possibly with such diverse conditions as diverticular disease, cholelithiasis, and perhaps haemorrhoidal disease.Are we there yet? The answer is certainly no. However research into the metabolic problem of hernia development means that we are surely closer than we have ever been before.

El nuevo síndrome de hernia de Spiegel congénita y criptorquidia. Análisis de 16 casos

Spigelian hernias in childhood are extremely uncommon. The aim of this study was to analyse the pathogenetic factors of paediatric Spigelian hernias. A retrospective review of worldwide literature for infants who had undergone surgical repair of a Spigelian hernia from 1950 to 2006. Descriptive statistical techniques were applied and percentages and means were calculated. There were 33 patients in whom 40 Spigelian hernias were repaired, 26 males and 7 females, with a sex ratio of 3.7/1. The mean age was 2.7 years. 7 hernias are bilateral. anal stenosis (n = 1). Associated defects: cryptorchidism (n = 22), inguinal hernia (n = 5), umbilical hernia (n = 2). The most common hernia contents are testicle (40%), small intestine ( 27.5%) and omentum (15%). The mean age of Spigelian hernia in children was 2.7 years, which would suggest a congenital cause. Spigelian hernias in infants are more common in males. There were 21.2% bilateral hernias. No risk factors were detected. Combined hernias accounted for 15.1% of the total. The most frequent hernia content is the testicle (40%). Interestingly, 48.4% of those infants with Spigelian hernias had ipsilateral cryptorchidism, which may suggest a new syndrome.

Arthur Keith, the anatomist who envisioned herniosis

Arthur Keith (1866-1955) was a renowned anatomist who published 529 contributions emphasizing the interaction between structure, function, and patient care. His only practice was 4 years as a family doctor, although he later trained to be a surgeon. Ten of his many articles related to hernia; two (1906, 1924) dealt with etiology. In these he rejected Russell's congenital saccular theory of abdominal herniation, since the latter's assertions regarding peritoneal diverticula were not supported by embryological research. Instead, Keith became the first to hypothesize that defects in the belly wall of adults were brought about by pathological damage to fasciae, aponeuroses and tendons, secondary to systemic connective tissue disease abetted by aging. The pelvis was similarly afflicted, leading to vaginal prolapse, the most common hernia among women. Diverticula were likely to sprout from a weakened alimentary tract. He stated that prevention was a serious consideration. The surgical establishment, overburdened by dogmas accumulated from 5,000 years of being solely responsible for the care of patients with herniae, ignored his hypothesis for decades. However, recent research in herniology has made him a prophet.

Hernia. The Pathologic Anatomy of the More Common Hernias and Their Anatomic Repair. By Chester B. McVay, M.D., Ph.D., Clinical Professor of Surgery and Associate Professor of Anatomy, The University of South Dakota School of Medical Sciences. 11 × 8⅜ in. Pp. 40 + xvi, with 19 illustrations. 1954. Springfield, Ill.: Charles C. Thomas. (Oxford: Blackwell Scientific Publications.) 34s

Hernia. The Pathologic Anatomy of the More Common Hernias and Their Anatomic Repair. By Chester B. McVay, M.D., Ph.D., Clinical Professor of Surgery and Associate Professor of Anatomy, The University of South Dakota School of Medical Sciences. 11 × 8⅜ in. Pp. 40 + xvi, with 19 illustrations. 1954. Springfield, Ill.: Charles C. Thomas. (Oxford: Blackwell Scientific Publications.) 34s