Diagnosis Of Abdominal Wall Hernia Research Articles

Haematological inflammatory markers for indicating ischemic bowel in patients with incarcerated abdominal wall hernias

To reveal the clinical significance of preoperative haematological inflammatory markers in the diagnosis of abdominal wall hernias with strangulation. The data of 200 patients who underwent surgery for incarcerated hernia were retrospectively analysed. The patients were grouped into three groups; Group 1; only surgical reduction and hernia repair, Group 2; small bowel resection and Group 3; omentum resection. Age, gender, hernia type, the presence of radiological bowel obstruction and preoperative complete blood count data were obtained. Neutrophil-leukocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), haematological inflammatory index (HII) and systemic immune-inflammation index (SII) values were calculated. The study was consisted of; Group 1: 119 patients (59.5%), Group 2: 46 patients (23%) and Group 3: 35 patients (17.5%). Advanced age (p = 0.001), female gender (p = 0.036), incisional hernias (p = < 0.001) and the presence of bowel obstruction (p = < 0.001) were found to be statistically significant in terms of strangulation. NLR, PLR and SII values were significantly higher in Group 2 compared to Group 1, and PLR values were significantly higher in Group 2 compared with Group 3 (p < 0.05). The preoperative elevated NLR, PLR and SII values may indicate strangulation and possible intestinal resection, in incarcerated abdominal wall hernias.

Importance of the physical exam: double-blind randomized controlled trial of radiologic interpretation of ventral hernias after selective clinical information.

Increasingly, radiologic imaging is obtained as part of the pathway in diagnosing ventral hernias. Often, radiologists receive incomplete or incorrect clinical information from clinicians. The aim of the study is to determine if clinical exam findings alter radiological interpretation of ventral hernias on CT. This is a single-institution double-blind, randomized trial. All patients with a recent abdominal/pelvic CT scan seen in various surgical clinics were enrolled. A surgeon blinded to the CT scan findings performed a standardized physical examination and assessed for the presence of a ventral hernia. Seven independent radiologists blinded to the study design reviewed the scans. Each radiologist received one of three types of clinical exam data per CT: accurate (correct), inaccurate (purposely incorrect), or none. Allocation was random and stratified by the presence of clinical hernia. The primary outcome was the proportion of radiologic hernias detected, analyzed by chi square. 115 patients were enrolled for a total of 805 CT scan reads. The proportion of hernias detected differed by up to 25% depending on if accurate, no, or inaccurate clinical information was provided. Inaccurate clinical data in patients with no hernia on physical exam led to a significant difference in the radiologic hernia detection rate (54.3% versus 35.7%, p = 0.007). No clinical data in patients with a hernia on physical exam led to a lower radiologic hernia detection rate (75.0% versus 93.8%, p = 0.001). The presence and accuracy of clinical information provided to radiologists impacts the diagnosis of abdominal wall hernias in up to 25% of cases. Standardization of both clinical and radiologic examinations for hernias and their reporting are needed. Clinicaltrials.gov, Number NCT03121131, https://clinicaltrials.gov/ct2/show/NCT03121131.

Predictors of mortality after elective ventral hernia repair: an analysis of national inpatient sample.

Deciding between surgery and non-operative management of a non-obstructive ventral hernia (VH) in a high-risk patient often poses a clinical challenge. The aim of this study is to evaluate a national series of open and laparoscopic ventral hernia repair (VHR), and to assess predictors of mortality after elective VHR. A retrospective analysis of 2008-2014 data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample was performed. All patients with a primary diagnosis of abdominal wall hernia were included. Inguinal, femoral, or diaphragmatic hernias were excluded. Patients were stratified by elective versus emergent repair. Factors associated with mortality after elective VHR were analyzed. 103,635 patients were studied, including 14,787 (14.3%) umbilical, 63,685 (61.5%) incisional, and 25,163 (24.3%) other ventral hernias. Operative procedures included 59,993 (57.9%) elective and 43,642 (42.1%) emergent VHR. 21.3% elective VHRs were laparoscopic versus 13% in emergent cases (P < 0.001). Mesh was used in 52,642 (87.7%) elective versus 27,734 (63.5%) emergent VHR (P < 0.001). Median (interquartile range) length of stay was 2(3)days in laparoscopic and 3(3)days in open group (P < 0.001). Mortality was 0.2% (n = 135) in elective and 0.6% (n = 269) in emergent group (P < 0.001). In elective group, mortality rates were equal among laparoscopic and open VHR (0.2%), while in emergent group, it was lower in laparoscopic VHR (0.4% vs 0.6%, P = 0.028). Multivariate analysis of elective VHR showed that the following factors were associated with mortality during hospitalization: age > 50years [Odds ratio (OR) = 1.96], male gender (OR = 2.37), congestive heart failure (OR = 2.15), pulmonary circulation disorders (OR = 5.26), coagulopathy (OR = 3.93), liver disease (OR = 1.89), fluid and electrolyte disturbances (OR = 8.66), metastatic cancer (OR = 4.66), neurological disorders (OR = 2.31), and paralysis (OR = 5.29). VHR has a low mortality, especially when performed laparoscopically. In patients undergoing elective VHR, higher age and some comorbidities are predictors of mortality. These include congestive heart failure, pulmonary circulation disorders, coagulopathy, liver disease, metastatic cancer, neurological disorders, and paralysis. Conservative management should be considered for these high-risk subgroups in context of the overall clinical presentation.

MODERN CAPABILITIES OF ULTRASOUND VISUALIZATION OF ABDOMINAL WALL HERNIAS

Abdominal wall hernias are the common pathology in modern clinical practice. Clinical data sometimes make the correct diagnosis not possible what requires the timely specific and targeted ultrasound examination. Aims of research. Revealing the capabilities of ultrasound examination at the assumption of abdominal wall hernias. Materials and methods. Within four years the ultrasound examination of 88 patients was carried out who suffered from different abdominal wall hernia, with the use of standard procedure of ultrasound examination and specific tests for evaluation of the condition of hernia’s content. The ultrasound scanning procedure was performed using B-mode and Color Doppler mapping mode. The majority of patients hereafter underwent the planned or emergency surgical treatment and subsequent ultrasound dynamic control. Results. The ultrasound examination gave the opportunity to reveal hernias in all the patients examined. Standards of morphometry, conditions of successful diagnosis and criterions of differential diagnosis signs of abdominal wall hernias have been detected. Criterions of differentiation of non-complicated and complicated hernias were concretized Conclusions. Ultrasound examination is a highly informative method for search, diagnosis and differential diagnosis of abdominal wall hernias. The targeted search of specific ultrasound signs allows making a correct diagnosis what has a great value for the timing of beginning of the adequate treatment.

Ultrasound Technique in Evaluation of Abdominal Wall Hernia

Background: Some sonographic positions for detection of abdominal wall hernias needed .In this paper we described the sonographic technique of abdominal wall hernia. Methods: From June 2013 to July 2016, three hundred seventy four patients referred in our department for evaluation of abdominal wall hernia (median age, 38 years; range 2 - 86 years). One hundred and ninety patients had abdominal hernia, 85 in inguinal-femoral regions, 58 in epigastria and Para-umbilical, 34 incisional and 13 Spigelian. Men most referred for inguinal regions, the women frequently referred for femoral, Para-umbilical and inscional hernia. All the patients are examined by one instrument with linear and convex multi-frequencies probes. Sononography performed first in supine position with and without valsalva manor, sitting and if possible standing view then added. Patients who operated after sonography the surgery reports compared with our findings. Conclusions: Although sonography routine request for diagnosis of abdominal wall hernia, experience and various positions needed for correct diagnosis. In this paper we described our experience in sonography of abdominal wall hernia.

Un recorrido por la pared abdominal: evaluación de las hernias por tomografía computada multidetector

Although the diagnosis of abdominal wall hernias is clinical, and the most appropriate study is ultrasound, in a lot of cases they are difficult to evaluate, or their presence is not suspected because of the biotype of the patient, the absence of symptoms, the presence of complications, or the appearance of rare hernias. Surgery weakness generated in the wall leads to organ hernia, sometimes unusual, as in the liver, bladder, or appendix. The use of multidetector computed tomography (MDCT) is a great advantage in these situations where the diagnosis can be difficult to determine with other methods. It also can be an incidental finding to consider eventual complications.In this paper, the main MDCT findings in abdominal wall hernias are described, including umbilical, epigastric, hypogastric, inguinal, Spiegel, lumbar, obturator, intercostal, and incisional, as well as their content.

P.2.d.052 Lurasidone treatment for bipolar I depression: effect on core depression symptoms

Emergency physicians can utilize bedside ultrasound to aid in the diagnosis of abdominal wall hernias and in the reduction of incarcerated hernias.To review the sonographic appearance and diagnostic criteria of abdominal wall hernias and to describe the potential use of ultrasound as an aid in hernia reduction.An emergency physician utilized bedside ultrasound to confirm the diagnosis of an incarcerated ventral abdominal wall hernia and to assist in its successful reduction.A physician trained in bedside ultrasound can diagnose an abdominal wall hernia and facilitate the appropriate treatment of an incarcerated hernia.

Diagnosis and Reduction of a Hernia by Bedside Ultrasound: A Case Report

BackgroundEmergency physicians can utilize bedside ultrasound to aid in the diagnosis of abdominal wall hernias and in the reduction of incarcerated hernias. ObjectivesTo review the sonographic appearance and diagnostic criteria of abdominal wall hernias and to describe the potential use of ultrasound as an aid in hernia reduction. Case ReportAn emergency physician utilized bedside ultrasound to confirm the diagnosis of an incarcerated ventral abdominal wall hernia and to assist in its successful reduction. ConclusionsA physician trained in bedside ultrasound can diagnose an abdominal wall hernia and facilitate the appropriate treatment of an incarcerated hernia.

La valoración cualitativa y cuantitativa de la hernia abdominal con tomografía computarizada multidetector

There are increasing therapeutic possibilities in the pathology of the abdominal wall. This implies an increasing need for anatomical information. Multidetector computed tomography (MDCT) has become the most commonly used technique due to the extensive information that provides of the entire abdominal and pelvic cavity, as well as for its speed of acquisition.MDCT helps to establish an efficient diagnosis of abdominal wall hernias and inguinal region, differentiating them from other situations that simulate hernias. It is also useful for accurately determining the size and morphology of the hernial orifice through multiplanar and three-dimensional reconstructions, allowing classification of the hernia pathology according to recent criteria of the European Hernia Society. This information may be relevant in patients with large hernias that present a «loss of the right of domain».MDCT allows a full assessment of the abdominal wall musculature, identifying areas of atrophy, rupture, muscle detachment or other complications. It can also show false hernias that do not require surgery, as diastasis of the rectus abdominis in the midline or weaknesses of the wall.It is important to do this exploration with functional maneuvers that increase intra-abdominal pressure (Valsalva, lateral decubitus) to reduce the number of false negatives.Thus, MDCT is the technique of choice for assessing hernia complications and postoperative complications, being very useful in the presurgical evaluation of large hernias.

Static and Dynamic Sonography for Diagnosis of Abdominal Wall Hernias

Sonography is a fast, painless, inexpensive, and widely available tool usually regarded as a first-line imaging modality for abdominal wall evaluation. This article provides illustrative images and videos on the use of sonography for diagnosis of abdominal wall hernias. A variety of pitfalls that may present clinically as pseudohernias are also described.

Multi detector CT Imaging of Abdominal and Diaphragmatic Hernias: Pictorial Essay.

Diagnosis of abdominal wall hernia is often a clinical problem, especially in occult or in obese patients. Multidetector CT is an accurate method of detecting various types of abdominal and diaphragmatic hernias. It clearly demonstrates the anatomical sites of hernial sac, its contents and possible complications.

Laparoscopic incisional and ventral hernia repair (LIVHR) with PARIETEX™ Composite mesh

Objectives: Laparoscopic incisional and ventral hernia repair (LIVHR) is widely used although its clinical indications are often debated. The aim of this study was to retrospectively describe the experience of our surgical centre in order to establish the safety, efficacy, and feasibility of LIVHR using PARIETEX™ Composite mesh (Covidien, Mansfield, MA, USA). Material and methods: Between January 2007 and November 2010, 87 patients were admitted to the Division of General Surgery of Aosta, with the diagnosis of abdominal wall hernia and underwent laparoscopic repair using PARIETEX™ Composite mesh. The type and size of surgical defects, mean operative time, morbidity, mortality and rate of recurrence at one-year follow-up were retrospectively analysed. Results: We performed 87 LIVHR: 51.7% for incisional hernia and 48.3% for epigastric or umbilical hernias. Mean operative time was 100 min., conversion rate was 3.4%. The mean size of abdominal defect was 6 cm (range: 2–15); in relation to umbilical hernias, mean size was 5.4 cm (range: 2–8). The mortality rate was 0%; overall morbidity was 16%. At one-year follow-up, we observed two cases of hernia recurrences. Conclusions: LIVHR using PARIETEX™ Composite mesh is an effective and safe procedure with very low morbidity and low rates of postoperative pain and recurrence, especially in hernias with diameter of between 5 and 15 cm and in obese patients without previous laparotomies.

Incidence and Risk Factors of Stomal Complications in Patients Undergoing Cystectomy With Ileal Conduit Urinary Diversion for Bladder Cancer

In this study we examined the incidence and associated factors of stomal complications in patients undergoing radical cystectomy with ileal conduit urinary diversion for bladder cancer. In addition, we evaluated the treatment and outcomes of surgical procedures in patients in whom stoma related complications developed. From 2001 to 2005 a total of 137 patients underwent ileal conduit diversion after cystectomy or exploration for bladder cancer, had complete clinical followup and were followed for at least 12 months after surgery. The incidence of stomal complications (including parastomal hernia, stomal stenosis and stomal prolapse) is reported with correlations made to age, race, gender, body mass index, smoking history, alcohol consumption, preoperative laboratory values (creatinine, hematocrit), operative estimated blood loss and surgical complications. In addition, management of stomal complications is reported. Of the 137 patients 21 stomal complications (15.3%) occurred in 20 patients (14.6%). The most common complication was parastomal hernia in 19 patients (13.9 %). Stomal stenosis developed in 1 patient (0.7%) and stomal prolapse developed in 1 patient with a parastomal hernia (0.7%). There were no significant differences in gender, age, race, preoperative laboratory values or history of abdominal/pelvic radiation therapy between patients with or without complications. However, patients in whom complications developed had a significantly higher mean body mass index compared to those without complications (30.8 vs 26.5 kg/m(2), respectively, p = 0.012). Operative outcomes, extent of disease and length of postoperative followup were also similar between patients with or without stomal complications. In addition, there were no significant differences in lifestyle factors (eg smoking, alcohol abuse) in patients in whom complications developed. Stomal complications associated with ileal conduit urinary diversion are not uncommon and occur in almost 15% of patients, with the most common problem being parastomal hernia. Evaluation of possible risk factors demonstrates that obesity may be a contributing factor in the development of stomal complications, particularly in the elderly. Furthermore, our experience suggests that subsequent repairs of parastomal hernias are only moderately successful.

The use of ultrasound in the diagnosis of abdominal wall hernias

The diagnosis of abdominal wall hernias is not always straightforward and may require additional investigative modalities. Real-time ultrasound is accurate, non-invasive, relatively inexpensive, and readily available. The value of ultrasound as an adjunctive tool in the diagnosis of abdominal wall hernias in both pre-operative and post-operative patients was studied. Retrospective analysis of 200 patients treated at the Hernia Institute of Florida was carried out. In these cases, ultrasound had been used to assist with case management. Patients without previous hernia surgery and those with early and late post-herniorrhaphy complaints were studied. Patients with obvious hernias were excluded. Indications for ultrasound examination included patients with abdominal pain without a palpable hernia, a palpable mass of questionable etiology, and patients with inordinate pain or excessive swelling during the early post-operative period. Patients were treated with surgery or conservative therapy depending on the results of the physical examination and ultrasound studies. Cases in which the ultrasound findings influenced the decision-making process by confirming clinical findings or altering the diagnosis and changing the treatment plan are discussed. Of the 200 patients, 144 complained of pain alone and on physical exam no hernia or mass was palpable. Of these 144 patients with pain alone, 21 had a hernia identified on the US examination and were referred for surgery. The 108 that had a negative ultrasound were treated conservatively with rest, heat, and anti-inflammatory drugs, most often with excellent results. Of the 56 remaining patients who had a mass, with or without pain, 22 had hernias identified by means of ultrasound examination. In the other 34, the etiology of the mass was not a hernia. Abdominal wall ultrasound is a valuable tool in the scheme of management of patients in whom the diagnosis of abdominal wall hernia is unclear. Therapeutic decisions can be influenced by the ultrasound findings that can provide more efficient and economical treatment by expediting their clinical management.

Illustrated review of new imaging techniques in the diagnosis of abdominal wall hernias.

The assessment of abdominal wall hernias has long been a clinical skill that only occasionally required the supplementary radiological assistance of herniography. However, with the advent of cross-sectional imaging, a new range of diagnostic tools is now available to help the clinician in difficult cases. This review explores the ability of computed tomography and magnetic resonance imaging to demonstrate many of the hernias encountered in the anterior abdominal wall. Also discussed is the role of imaging techniques in the management of a variety of hernias. Cross-sectional imaging techniques are being employed with increasing frequency for the assessment of hernias. Although the anatomical detail can usually be delineated clearly, the accuracy of the various methods and their place in the clinical management of hernias has yet to be fully determined.

CT in the diagnosis of abdominal wall hernias: a preliminary study.

The aim of the study was to estimate the value of CT in the diagnosis of abdominal wall hernias and at the same time to create a standard for this CT investigation. Twenty-four patients with suspected hernia of the abdominal wall were examined. All were operated on. The CT scans were assessed by two radiologists to estimate the interobserver variation. The CT diagnoses made by the two radiologists were correct in 83 % and 79 % of cases, respectively. The sensitivity was 0.83 in both CT evaluations and the specificity was 0.83 and 0.67, respectively. The predictive value of a positive CT finding was 0.94 and 0.88, while the predictive value of a negative CT finding was 0.63 and 0.57, respectively. The interobserver variation (kappa) was 0.87. The study therefore indicates that a positive CT finding of abdominal wall hernia is reliable, while a negative finding does not exclude the diagnosis. The interobserver variation of the CT diagnoses is acceptable. To achieve the highest diagnostic accuracy, it is recommended to always use the Valsalva manoeuvre, oral intake of contrast and 10/10 mm CT slices.