Congenital Hernia Research Articles

A comparative prospective study of laparoscopic guided needle assisted hernial sac ligation versus open herniotomy surgery in congenital inguinal hernia management

Background: To evaluate if significant difference exists in surgical outcome following laparoscopic guided needle assisted congenital hernial sac ligation versus conventional open Herniotomy as later is treatment of congenital hernia and laparoscopy guided emerged as newer alternative. Objective was to know whether a significant difference exists in surgical outcomes following laparoscopic guided needle assisted congenital hernial sac ligation and conventional herniotomy in terms of mean operative time, post operative pain, recurrence, local complication, cosmetic results.Methods: Patients were randomized on basis of odd and even registrations for surgery in our institute. Patients who undergone laparoscopic guided needle assisted congenital hernial sac ligation or who undergone conventional open herniotomy for congenital hernia between November 2018 to April 2020 (50 in each arm) were followed for 1, 3, 6 and 12 months to evaluate the outcomes.Results: In our study, major complication in open herniotomy group was surgical site infection (22%), hematoma (10%), intra operative bleeding (16%), seroma formation (8%) with minimum operative duration was ~60 minutes, hospital stay of 2-3 days while no such complication reported in laparoscopic guided needle assisted hernia sac ligation group being operative time of ~20 minutes, hospital stay of 1 day with better cosmetic results.Conclusions: We conclude that laparoscopic guided needle assisted hernial sac ligation is simple, safe, efficacious with its own advantage in comparison to conventional open herniotomy and should be acceptable alternative to traditional open herniotomy approach for congenital hernia.

Internal hernia through dual defects: defects in transverse mesocolon and lesser omentum a rare presentation: case report

Internal hernias have the potential to cause small bowel obstruction. Congenital internal hernias are impossible to diagnose clinically and radiologically in asymptomatic patients. We presented a case of 36 years male with complaints of pain abdomen abdominal distension and vomiting, contrast-enhanced CT showed an internal hernia with small bowel obstruction. On exploration, small bowel loops were identified near the lesser curvature and they are congested an edema was present, a defect of 5×1 cm was identified in the transverse mesocolon and was managed by reducing the hernia sac and closure of the defect in the mesentery of the transverse colon. If the intervention was delayed internal hernia might lead to ischemia, gangrene increasing morbidity and mortality. Early intervention is the key to decrease morbidity and mortality.

P129 THORACIC VS. ABDOMINAL APPROACHES FOR DIAPHRAGMATIC HERNIA REPAIR: A NATIONWIDE STUDY OF CLINICAL OUTCOMES

Abstract Aim “To compare the outcomes of different surgical approaches for diaphragmatic hernia (DH) repair.” Material and Methods “Adult patients with a principal admitting diagnosis of uncomplicated DH registered in the National Inpatient Sample in the period 2010-2015 were included. Patients with obstruction, gangrene, or congenital hernias were excluded. The primary outcome was in-hospital mortality. Secondary outcomes were the incidence of complications, length of stay, and hospital charges. A multivariate logistic regression model adjusted by age, sex, elective admission, comorbidities, and hospital characteristics was used to analyze the impact of the surgical approach on the evaluated outcomes.” Results “A total of 14910 patients with DH were included (median age 65 years, 74% women). Abdominal approaches were the most commonly performed (78.9% laparoscopy and 13.6% open). Patients that underwent open abdominal and thoracic repairs had a higher risk of complications (sepsis, pneumonia, surgical site infection, prolonged postoperative ileus, and acute myocardial infarction), longer hospital stay, higher total hospital costs, and a significantly higher risk of mortality (OR 2.62. 95% CI 1.59-4.30 and OR 4.60; 95% CI 2.37-8.91, respectively) compared to patients that underwent laparoscopic abdominal repair. Individuals whose DH repair was performed through thoracoscopy had a similar mortality risk to those who underwent laparoscopic abdominal repair (OR 0.87; 95% CI 0.11-6.43).” Conclusions “Nowadays, laparoscopy has become the most used approach for DH repair. In the present cohort, it was associated with better outcomes in terms of complications, length of hospital stay, and mortality, as well as lower health costs. Additional studies assessing hernia characteristics are required to validate this result.”

Gigant Morgagni Congenital Hernia Associated with Intestinal Malrotation and Meckel Diverticulum in Child with Down Syndrome- Clinical Case Presentation and Literature Review

Gigant Morgagni Congenital Hernia Associated with Intestinal Malrotation and Meckel Diverticulum in Child with Down Syndrome- Clinical Case Presentation and Literature Review

Congenital paraesophageal hernia presenting with chronic vomiting and iron deficiency anemia

Hiatal hernia (HH) is very rare in children and is mostly due to congenital defects unlike adults having acquired etiology. HH is either sliding or paraesophageal hernia (PEH). PEH is rarer than sliding type and usually presents with non-specific intestinal or respiratory symptoms. PEH is very uncommon cause of iron deficiency anemia which is due to chronic blood loss from gastric erosions/ulcer and iron malabsorption. Surgery is mandatory treatment for it to avoid complications. Herein, we present a 23 months old female manifesting as intermittent coffee ground vomiting, abdominal pain and constipation, diagnosed as PEH with iron deficiency anemia.

A case of congenital hernia

Joining the view of H. M. Nikolaev that every case of deformity that occurs should be studied within the limits of modern possibility, we decided to publish our case of congenital hernia with contents in the hernial sac of the liver, spleen and intestines, as a deformity that, judging by the literature available to us, is infrequent.

Bilateral congenital inguinal hernia with right-sided Amyand's hernia in a premature twin: Case report and a summary of clinical presentations, management and outcomes in neonates and infants with Amyand's hernia.

Introduction and importanceCongenital hernias occur 70% on the right side, 25% on the left side, and approximately 5% bilaterally. The finding of a congenital Amyand's hernia is of interest, especially in patients who do not present risk factors associated with connective tissue disorders, ascitic conditions, fetal developmental disorders or any condition that increases abdominal pressure.Case presentationMale patient, 6 months old, was brought to the pediatric surgery department due to a visible mass in the bilateral inguinal region, which protruded with crying. The parents report that he was a 36-week preterm, low birth weight, monochorionic monoamniotic twin with bilateral congenital inguinal hernia. An open herniorrhaphy was performed, showing a left communicating hydrocele with an indirect left inguinal hernia and right communicating hydrocele with indirect inguinal hernia containing cecal appendix with no signs of inflammation.Clinical discussionThe most common clinical presentation is the presence of a reducible or irreducible mass, erythema and/or inguino-scrotal edema, irritability manifested by crying and recurrent pain in older infants. This condition may be associated with cryptorchidism, intrauterine structural developmental disorder, and the presence of fistulas. Appendectomy and traditional hernia reduction are the most common surgical approach. The evolution of this condition is favorable with extremely low complication rates.ConclusionAmyand's hernia in the neonate is a rare presenting condition, which frequently involves nearby structures with risk of inflammation, incarceration and perforation, so repair should be performed early.

Needlescopic Disconnection and Peritoneal Closure for Pediatric Inguinal Hernia Repair: A Novel Technique.

There are many laparoscopic techniques for pediatric congenital inguinal hernia repair. Needlescopic surgery was introduced recently in pediatric patients aiming at getting excellent cosmetic outcomes. The aim of this study was to describe a novel technique for needlescopic inguinal hernia repair in children. Needlescopic division of the hernial sac was carried out on 369 children in 6 pediatric tertiary centers during the period from August 2016 to May 2019. All hernias were repaired by a novel needlescopic procedure that replicates all the steps of the open herniotomy. A total of 369 patients with 410 hernias were included in this study. They were 232 (62.9%) males and 137 (37.1%) females, with a mean age of 3.58±1.26 (range=2 to 8 y) and mean internal inguinal ring diameter was 13.65±3.85 mm (range=8 to 20 mm). The mean operative time was 23.36±4.67 minutes for bilateral and 14.28±2.98 minutes for unilateral cases. All cases were completed without conversion to conventional laparoscopy. All cases were followed up for a mean of 19.6±3.2 months. None of our patients developed recurrence or testicular atrophy and the scars were nearly invisible 3 months postoperatively. Needlescopic pediatric inguinal hernia repair using disconnection of the hernia sac at internal inguinal ring with purse-string suture closure of peritoneum is feasible and safe with no recurrence and with outstanding cosmetic results.

Bilateral congenital flank hernias due to complete lateral abdominal wall muscular agenesis

We report a case of a 4-week-old female presenting with congenital bilateral flank hernias. The patient was born at term and was found to have large bilateral flank bulges. Although her hernias were asymptomatic, bilateral lower extremity jerking movements prompted further workup which revealed thoracolumbar spinal cord dysraphism. No other congenital anomalies were identified. Given the low risk of incarceration, repair was delayed until 9 months of age. At operation, complete bilateral agenesis of the oblique and transversus abdominus musculature was found. Open repair was performed with bilateral latissimus dorsi rotational muscle flaps and biological mesh. Congenital flank hernias are extremely rare with few cases reported in the literature. While they can appear externally similar to the more widely reported congenital lumbar hernia, the herniation through the absent oblique and transversus musculature makes this case anatomically distinct. The exact etiology of congenital flank hernias is unclear, although given the presence of associated congenital anomalies, migrational failure during embryogenesis represents a likely culprit. Surgeons approaching this pathology should understand the importance of a thorough multidisciplinary evaluation for associated anomalies prior to operation and be familiar with complex hernia repair techniques such as rotational flaps.

Laparoscopic Morgagni Hernia Repair without Sutures Using Only Composite Mesh in Patients with Large Defects

In this report, we present the clinical characteristics and surgical outcomes of three pediatric patients who presented to our clinic with congenital Morgagni hernia and were treated with laparoscopic surgery using only mesh.

Novel G6PC3 Mutations in Patients with Congenital Neutropenia: Case Reports and Review of the Literature

Severe congenital neutropenia (SCN4) caused by mutations in glucose-6- phosphatase catalytic subunit 3 (G6PC3) is characterized by recurrent infections due to severe neutropenia, may be accompanied by other extra-hematopoietic manifestations; including structural heart defects, urogenital abnormalities, prominent superficial venous markings, growth retention, and inflammatory bowel diseases with rare incidence. The homozygous or compound heterozygous mutations of G6PC3 are responsible for most cases of autosomal recessive SCN4. Herein, we present two cases of SCN4 affected by novel mutations in the G6PC3, in addition to a summarized list of variants in G6PC3 gene that are reported as pathogenic and related to the SCN4 phenotype. Herein, we present two cases of SCN4; the first case was a three-months old boy with severe neutropenia and prior history of hospitalization due to umbilical separation, umbilical herniation, omphalitis, and pyelonephritis; and the second case was an eight-year-old with a history of neutropenia, recurrent and severe episodes of intractable diarrhea, refractory rectovaginal and rectoperineal fistula, congenital inguinal hernia, and ASD type 2. Whole exome sequencing was performed for both cases, which revealed two novel homozygous missense mutations in G6PC3 that were predicted to be deleterious; c.337G>A, p. Gly113Arg in the first case and c.479C>T; P. Ser160Leu in the second case. To our knowledge, both of these two mutations have not been reported in the G6PDC3 gene. In patients with severe neutropenia with varying extra hematopoietic syndrome, mutation of G6PC3 should be suspected after ruling out other mutations related to neutropenia. This study pointed toward novel G6PC3 mutations that should be considered in order to diagnose patients with severe congenital neutropenia.

A curious case of toddler with hernia and much more

Transverse testicular ectopia (TTE) with fused vas deferens is an extremely rare clinical entity. Herein, we presented a case of a 2 years old patient with left inguino-scrotal swelling associated with pain lasting for 3 days. Clinical examination revealed an empty right hemi-scrotum, a left-sided giant inguino-scrotal swelling. Laboratory tests were normal. Ultrasound imaging (US) of the scrotum demonstrated the presence of both testes in the same left hemi-scrotum with inguinal hernia and enterocele as content. Surgical intervention in suspicion of obstruction was carried out through inguinal incision. There was a congenital inguinal hernia with appendix (type 1-Amyand’s hernia) and cecum as content with two well developed testes on the same side with separate epididymis and vas deferens. Both the testes were united by a mesorchium. Hence, reduction of contents with herniotomy and both the testes were anchored to inner aspect of left thigh one above the other. We reviewed the literature for rare diagnosis of TTE.

Congenital pulmonary hernia secondary to absence of ribs

Congenital lung hernia is extremely rare with less than 50 reported cases.We report two cases of lung hernia, secondary to congenital absence of ribs – A 4‐year‐old girl without any antecedent history of chronic cough or chest trauma presenting with a left lower lobe hernia secondary to an absent left 9th rib; a 7 month‐old girl with recurrent pneumonia presenting with severe respiratory distress, fever and severe malnourishment, found to have absent 6th-9th ribs on right side with associated liver and lung herniation. The older girl has been kept on observation without surgery but the infant expired within 48 hours of admission due to respiratory failure. The clinical scenario is a rarity and can be managed conservatively in most cases. Surgical treatment should be considered in symptomatic patients and in those with severe complications. Repair for cosmetic reasons is sometimes justified.

Congenital Spigelian hernia in a neonate associated with several anomalies: A case report

Background: Spigelian hernia (SH) is a rare entity characterized by a defect of the anterior abdominal wall located along the Spigelian line, it may be congenital or acquired.Association with other anomalies is worth reporting. Case Presentation: A 22-day-old male newborn was admitted with strangulated right inguinal hernia and operated on emergently. Clinical examination also revealed a Spigelian hernia in the left lower abdominal quadrant with bilateral cryptorchidism, associated with polydactyly of the small right finger and anal stenosis. At surgery, the SH contained a part of the small intestine and the ipsilateral undescended testis. Conclusion: Pediatric SH is rare, but its association with undescended ipsilateral testis is frequent. Other abnormalities can be concomitant to this association.

Ectopic intestinal duplication presenting as a congenital gluteal mass

Extra-abdominal intestinal duplication is a very condition of unknown etiology. It may be a result of an intestinal duplication with underlying congenital pelvic defect or hernia. The duplicated intestine received its blood supply through an aberrant mesenteric vasculature. Literature review using PubMed, Medline, and Google Scholar with searching of congenital gluteal mass or gluteal intestinal duplication revealed no previous report of this rare clinicopathologic entity. This report describes a 14 days old full-term female neonate who presents with a left gluteal mass associated with lower limb anomalies. The mass consists of a hernial sac containing a loop of blind-ended small and large bowels associated with a congenital defect in the iliac bone. Gluteal intestinal duplication is seldom considered in the differentials of the gluteal mass. Theoretically, in this particular Case; antenatal herniation of intestinal duplication through the iliac bone defect is a possible etiology.

Laparoskopické riešenie kongenitálnej paraezofageálnej hernie u 18-mesačnej pacientky – kazuistika a prehľad literatúry

Congenital paraesophageal hernia (CPEH) is an uncommon type of diaphragmatic hernia in the paediatric age. It can be asymptomatic, present with a variety of chronic gastrointestinal and respiratory symptoms or complicated by acute gastric volvulus with strangulation in serious cases. Its rare occurrence and presentation with non-specific clinical features may delay the dia­gnosis. The principles of surgical treatment are generally well established with anti-reflux procedures included. Traditionally, surgery has been done using an open approach. Recently, laparoscopic repairs with encouraging outcomes have been reported. We present the case of an 18-month-old patient referred to an outpatient Clinic of Paediatric Surgery with incidental X-ray finding of CPEH type II confirmed by CT scan. The patient underwent an elective laparoscopy accompanied with Nissen fundoplication. According to our experience and literature review, we suggest laparoscopic repair of CPEH as an effective and safe method of treatment in infants and children.

Congenital Dual Internal Hernias Causing Small Bowel Obstruction in a Man with no Prior Surgical History: A Report of a Very Rare Case

Patient: Male, 51-year-oldFinal Diagnosis: Congenial dual internal hernia with small bowel obstructionSymptoms: Abdominal pain • vomiting • constipationMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Rare diseaseBackground:Internal hernias involve protrusion of the small bowel through a peritoneal or mesenteric space in the abdominal or pelvic cavity. Congenital internal small bowel hernias are rare and patients with them usually present with small bowel obstruction (SBO) at a young age, whereas in older patients, internal small bowel hernias usually are acquired secondary to previous surgery. The present report is of a rare case of SBO due to dual congenital internal small bowel hernias in a 51-year-old man with no history of abdominal surgery.Case Report:We report a case of dual congenital internal hernias of the small bowel in a patient who presented with symptoms and signs of SBO. He had no history of abdominal trauma, surgery, or comorbid conditions. His abdomen was mildly distended with minimal tenderness in the upper left quadrant but there was no guarding or rebound tenderness. Abdominal X-rays confirmed the SBO. A contrast-enhanced computed tomography scan of the patient’s abdomen revealed SBO with transition at 2 points, suggestive of a closed-loop obstruction. However, the exact cause of the SBO was confirmed at laparotomy, which revealed dual internal hernias (intramesosigmoid and paraduodenal). The hernias were managed individually and the patient had a successful outcome after surgery.Conclusions:Although the present report is of a rare presentation of internal small bowel hernia, the case underscores that patients with this condition may present with SBO. Successful surgical management requires knowledge of the intra-abdominal peritoneal spaces and management of the hernia sac.

How to do a combined endoscopic and tailored open extraperitoneal approach for large congenital inguinoscrotal hernia.

Large inguinoscrotal hernias require experienced and skilful laparoscopic hernia surgeons to reap the benefits of laparoscopic versus open surgery. We advocate for an alternative hybrid TEP-open technique that allows tissue extraction away from the groin area, whenever necessary, thus avoiding more painful conventional open herniorrhaphy incision.

An interesting case of left paraduodenal hernia.

Paraduodenal fossa hernias (PDFHs) represent 53% of all congenital internal hernias and 0.2-0.9% of all small bowel obstructions. Most of these hernias are diagnosed incidentally on laparotomy, and carry up to 50% lifetime risk of development of small bowel obstruction. We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia in a 17 year male, containing over 30% of the small bowel (jejunum and ileum), presenting with a history of recurrent incomplete small bowel obstruction. Plain abdominal radiography showed distended loops of jejunum and few air fluid levels. After laparotomy and identification of hernia, small gut was reduced and examined, which was found to be structurally and functionally intact with normal vascularity. The defect was closed with continuous absorbable suture (Vicryl 2-0) sparing the inferior mesenteric vessels. Patient’s post-operative recovery remained uneventful and he was discharged on 4th post-operative day.

Laparoscopic and needlescopic hernia repair for pediatric inguinal hernia: A systematic review with meta-analysis

Background: congenital inguinal hernia is considered to be among the commonest paediatric surgical procedures in daily practice. Open herniotomy with high ligation is of the hernial sac is the gold standard treatment against which all modalities of laparoscopic repair should be compared. With the advances of minimally invasive laparoscopic techniques, less complications and better cosmesis has become the point of study. Objective: was to review the current literature about laparoscopic and needlescopic techniques and highlighting its surgical outcomes. Data source: English midline search using the keywords inguinal hernia, paediatric age, laparoscopy, minimally invasive surgery, needlescopic repair in PubMed, Google scholar, research gate and science direct during the period 1997- 2020. Study selection: article of high quality, randomised controlled trial are only included Data extraction: data were collected, organised according the type of study and extracted systematicallyfrom these studies Data analysis: performed with the IBM SPSS 20.0 software. Conclusion: Laparoscopy has become a good substitution for the open method in the last years due to its advantages and by time minimally invasive manoeuvres became a good substitution for the conventional type of laparoscopic repair as they are easier for the laparoscopic beginners, carry less learning curve, almost have the same results, recurrence rate and have better cosmoses.