External Abdominal Hernias Research Articles

Incidence, types, and associated factors of external abdominal hernias among adult patients visiting the surgical outpatient department, eastern Ethiopia: a multicentre cross-sectional study

Background: Abdominal hernia is the most common surgical alignment that affects all age groups and sexes. It is characterized by the protrusion of abdominal contents through the abdominal wall's muscles and fascia. In this study, the incidence, types, and associated factors of external abdominal hernias at Hiwotfana Comprehensive Specialized Hospital and Jugal Regional Hospital, eastern Ethiopia, were ascertained. Objective: To identify the incidence, types, and associated factors of external abdominal hernia among adult patients who visited the surgical outpatient department of Hiwotfana comprehensive specialized hospital and Jugal regional hospital from 20 October to 5 December 2022. Methods: A cross-sectional study was conducted from 20 October to 5 December 2022, on adult patients who visited the surgical outpatient department at the Hiwotfana Comprehensive Specialized Hospital and Jugal Regional Hospital in eastern Ethiopia. All adult patients who visited the surgical outpatient department of each hospital were enroled in the study using a stratified random sampling technique. Both descriptive and inferential statistics were conducted, and the results were presented in text, graphs, and tables. Odd ratios for the strength and directions of association were used with a 95% CI, and a P value of less than 0.05 was considered to declare statistical significance. Result: A total of 403 participants were included in this study from two different governmental hospitals in Harar town, with a 100% response rate. The incidence of the external abdominal wall hernia was 41 (10.2%). The epigastric hernia had the highest prevalence (41.5%, n=17). Constipation [adjusted odds ratio (AOR)=2.91, CI=1.119–7.579), prolonged cough (AOR=3.993, CI=1.358–11.741), history of abdominal surgery (AOR=5.764, CI=1.837–18.083) and heavy lifting (AOR=5.476, CI=2.505–11.969) had statistically significant association (P≤0.05). Conclusion: The incidence of external abdominal wall hernia in our area is similar to the other existing literature reported from different areas. Epigastric hernia is the most prevalent type of external abdominal hernia and is commonly encountered in female patients. Constipation, a prolonged cough, previous abdominal surgery, and heavy lifting are significantly associated with an external abdominal wall hernia.

The possibilities of the thrombodynamics test in predicting, diagnosing and monitoring the effectiveness of the treatment of venous thromboembolic complications in planned surgical interventions

Introduction. The problem of venous thromboembolic complications after planned surgical interventions remains relevant and requires special research and analysis, which was the purpose of this work. Objective. To study and evaluate the possibilities of the thrombodynamics test for predicting, diagnosing, and monitoring the effectiveness of treatment of postoperative venous thromboembolic complications in planned surgical interventions. Materials and methods. In this study, we implemented the thrombodynamics test in parallel with ultrasound examination of the veins of the lower extremities and pelvis before planned surgery and in the postoperative period on 1–3, 7–9, 14–16, and 30 days in 120 patients with common surgical pathology (chronic calculous cholecystitis, external abdominal hernias, and varicose veins of the lower extremities) stratified into risk groups for postoperative venous thromboembolic complications. Results. It was revealed that, in the preoperative period, 16.6 % of patients have hypercoagulation at normal standard blood counts and 65 % of them are patients from a low-risk group of venous thromboembolic complications. In the postoperative period, the number of cases of hypercoagulation increased to 34.2 % due to elderly and senile patients from groups with an estimated moderate and high risk of venous thromboembolic complications. Deep vein thrombosis was detected in 18 (15 %) subjects (6 patients from each risk group) within 2–15 days after surgery and in all cases it developed in the presence of preoperative hypercoagulation. Conclusions. It is shown that the thrombodynamics test is highly informative in predicting, diagnosing and evaluating the effectiveness of venous thromboembolic complications treatment during planned surgical interventions.

Development of Methods to Obtain Grafts for the Anterior Abdominal Wall in Surgical Treatment of External Abdominal Hernias

INTRODUCTION: Currently, tissue engineering is one of the most promising fields of medicine dealing with search for solutions to the problems of creation of biocompatible structures capable of partial or complete replacement of organs or tissues of an organism. An advanced method of tissue engineering implies using an extracellular matrix (ECM) cleared from the cellular material. The main problem of obtaining an ECM consists in the difficulty of selecting a suitable decellularization method and exposure time.
 AIM: Development of a method for obtaining grafts for the anterior abdominal wall (AAW) and evaluation of the histological properties of the ECM to determine the optimal protocol for donor tissue decellularization providing a complete removal of cellular material without any significant damage to the scaffold.
 MATERIALS AND METHODS: The experiments were conducted on 10 White Flemish Giant male rabbits. All the animals were withdrawn from the experiment, after which, on autopsy, AAW grafts were obtained for evaluation of the decellularization properties of three detergents (alkaline solutions): 2% SDS (sodium dodecyl sulfate) solution, 2% CHAPS (zwitterionic surfactant, 3-[(3-cholamidopropyl)-dimethylammonio]-2-hydroxy-1-propansulfonate) solution, and 1% Triton-X 100 solution. The decellularization quality was controlled in histological examination.
 RESULTS: Morphological evaluation of tissue samples revealed that after decellularization of the material with 2% SDS solution and 2% CHAPS solution, the number of cells remaining in the preparations was comparable and significantly less (Me = 10 in a microscope field) than after treatment with 1% Triton-X 100 solution (Me = 45 in a microscope field). However, decellularization with 2% CHAPS solution led to fiber ruptures and tissue edema manifested by an increase in the distance between the fibers (Me = 163 µm).
 CONCLUSIONS: Decellularization of the anterior abdominal wall tissues with 2% SDS solution provides a sufficient cell elimination while preserving the fiber integrity and ECM structure. 2% CHAPS solution was comparable to 2% SDS solution in terms of the quality of cell elements removal, but its more aggressive effect on collagen fibers was noted (their multiple ruptures and a more pronounced edema). 1% Triton-X 100 solution appeared to be of low efficiency in elimination of cellular material, although it had a minimal effect on the integrity of ECM network.

The thrombodynamics test as a new opportunity for a polyclinic surgeon to monitor postoperative venous thromboembolic complications

Introduction. Postoperative venous thromboembolic complications – a frequent and difficult to control problem for a polyclinic surgeon. Aim. To study and evaluate the possibilities of using the thrombodynamics test for the control of postoperative venous thromboembolic complications. Materials and methods. In 120 patients with common surgical pathology (chronic calculous cholecystitis, external abdominal hernias and varicose veins of the lower extremities), who underwent planned surgical treatment, stratified into risk groups of postoperative venous thromboembolic complications: low, moderate and high, in the postoperative period for 2–3, 7–9, 14–16, 30 days, a study of D-dimer, thrombodynamics test was conducted in parallel with ultrasound examination of the veins of the lower extremities. Results. It was revealed that hypercoagulation according to the thrombodynamics test was present in 34.2% of patients already at the first study, an increase in D-dimer was noted in 28.3% of patients at late follow-up, venous thrombosis was detected on ultrasound in 15% of the studied 6 people from each risk group within 2–15 days after surgery, carried in 83.3% The cases were asymptomatic, localized mainly in the deep veins of the lower leg and were always combined with hypercoagulation according to the thrombodynamics test and an increased level of D-dimer. It was noted that hypercoagulation against the background of the use of standard doses of anticoagulants in 61% of cases takes a positive trend, and in 39% remains unchanged. Discussion. Hypercoagulation recorded by the thrombodynamics test in the first days after surgery indicates insufficient effectiveness ofstandard thromboprophylaxis in the perioperative period. An increase in the D-dimer cannot be used as a prognosis of a prethrombotic state. Conclusions. Hypercoagulation as a precursor of venous thrombosis is well detected by the thrombodynamics test, its dynamics reflects the individual effectiveness of the use of anticoagulants, which justifies the possibility of using this indicator by a polyclinic surgeon in the control of postoperative venous thromboembolic complications.

Polypropylene mesh versus nylon mosquito net mesh for external abdominal hernias repair in cattle and buffaloes

Herein, the effectiveness of locally sourced and autoclaved nylon mosquito net mesh for the repair of external abdominal hernias was investigated. Eleven animals (7 cattle and 4 buffaloes) having hernial ring sizes of 8 to 30 cm in diameter were divided into two Groups 1 (5 animals) and Group 2 (6 animals). In Group 1, nylon mosquito net mesh was used, and in Group 2, polypropylene mesh was used for the repair of defects. The animals were sedated with xylazine HCl and given local anaesthesia during surgery. Over the external hernial sac, an elliptical skin incision was made. The internal hernial sac was bluntly dissected and freed down to the hernial ring. The internal hernial sac was opened, and the hernial ring was repaired with nylon mosquito net mesh or polypropylene mesh using the inlay technique. After hernioplasty, the sac and subcutaneous tissue were repaired with prolene suture material. The skin incision was closed with simple interrupted mattress sutures using monofilament polyamide suture material. Antibiotics and analgesics were given postoperatively, and povidone iodine was used to treat the suture line daily. The skin sutures were removed on the 10th to 15th postoperative day, depending upon the wound condition. Mild inflammatory swelling in Group 1 was observed at the incision line, which had completely subsided by the 15th postoperative day. The wounds healed by first intention in both groups. In any case, no recurrence was seen in a follow-up period of 3 months. Without clinical signs of wound dehiscence, infection, or recurrence, all animals recovered uneventfully.

Wound complications after prosthetics of hernial defects of the anterior
 abdominal wall: causes and methods of prevention (literature review).

Goal. To review the literature data on wound complications after prosthetic repair of hernial defects of the anterior abdominal wall, causes and methods of prevention.Results. An analysis of the literature has shown that the problem of wound complications during endoprosthetics for external abdominal hernias has not been completely solved. Among all postoperative complications after such hernias, seroma, infiltration and prolonged exudation are most common, less often ligature fistula, subcutaneous fat infarction, postoperative wound suppuration, cyst, granuloma, rejection of the prosthesis. The effectiveness of various methods of preventing wound complications during abdominal wall prosthetics is ambiguous. Conclusions. It is necessary to improve the known and develop new endoprostheses that would cause a minimal reaction of the body with good integration into tissues and high strength (to exclude relapses).

Modern approaches to the treatment of postoperative hernias

One of the most common surgical pathologies are external abdominal hernias. The share of postoperative ventral hernias (POVH) accounts for up to 15-18% of the total number of patients with abdominal hernias. More than 1.5 million surgical interventions for ventral hernias are performed annually in the world, in the CIS countries this figure exceeds 200,000 operations. Modern studies have shown that the surgical treatment of patients with POVH should be based on a personalized approach, taking into account the existing concomitant pathologies, risk factors, surgical potential of the operating go doctor and hospital.

Modification of polypropylene mesh by titanium compound: An in Vivo and in Vitro study

Objective: Previous basic studies on the use of titanized polypropylene meshes in abdominal external hernia repair are not only limited, but also highly controversial. This study aims to investigate the modification effect of titanium compounds on polypropylene materials and compare the performance of two kinds of meshes both in vivo and in vitro.Methods: Human peritoneal mesothelial cells (HMrSV5), human epidermal fibroblasts (HSF), and human monocytic cells (THP-1) were cultured in vitro to simulate the abdominal external hernia environment. Titanized polypropylene meshes (Ti) and polypropylene mesh (Non-Ti) were co-cultured with the cells respectively. The effects of titanium compounds on cell growth were determined by cell activity and apoptosis, and the growth of cells on the mesh surface was assessed using a scanning electron microscope and a confocal microscope. In vivo experiments, different sizes titanized polypropylene meshes and polypropylene meshes were placed between the external oblique abdominal muscle and the internal oblique abdominal muscle, the parietal peritoneum, the serous layer of the descending colon, and the underside of the femoral nerve in rabbits. The effects of titanium compounds were evaluated by observing the anti-adhesion, anti-contraction, anti-fibrotic properties, and effects on nerves of the mesh.Results: Titanium compounds effectively reduced the effects of polypropylene material on cell growth, and improved the fixation and adhesion of HMrSV5, HSF and THP-1 (M0) on the surface of titanized polypropylene meshes. Furthermore, titanium compounds improved the adhesion, contraction and fibrosis of polypropylene material, as well as reduced nerve damage. This improvement demonstrated a regular trend with the type of titanized polypropylene meshes.Conclusion: The titanium compounds improved the biocompatibility of the polypropylene material, which was conducive to the fixation and adhesion of cells on the surface of the meshes, and alleviated the adhesion and contraction of the meshes, and the degree of tissue fibrosis, as well as the influence on nerves.

COMPARATIVE CHARACTERISTICS OF MODERN HERNIOPLASTY METHODS IN WOMEN OF FERTILE AGE

In the traditional treatment of external abdominal hernias in women of fertile age in the early postoperative period, the frequency of surgical complications was 13.4%, in the long-term period, 8.5% of patients had a recurrence of hernia. The conducted critical analysis revealed that the unsatisfactory results were due to the shortcomings of tactical approaches in the possibility of performing alloplasty in women of reproductive age.

Acute Intestinal Obstruction: A 1-Year Prospective Audit into Causes.

Intestinal obstruction is a common general surgical emergency with high morbidity and mortality. Its aetiology varies widely between and within geographic regions, with gender, age, and time. Obstructed inguinal hernia is still considered the most common cause of intestinal obstruction in Sub-Saharan Africa and other low-income countries, but its incidence appears to be on the decrease as other causes of intestinal obstruction become more common in a particular society. To examine the spectrum of causes of intestinal obstruction in a tertiary hospital in southern Nigeria and compare the results with earlier studies in the region and Nigeria. A cross sectional, single-hospital study of adults diagnosed with and having clinical and radiological features of acute intestinal obstruction. Seventy patients were enrolled in the study, comprising of 35 (50%) males and 35 (50%) females, M:F = 1:1. The mean patient age was 44.8 years. Two peak age incidences of intestinal obstruction were observed in the 36-45 and 56-65 years age groups. Post-operative adhesion 13 (18.5%), obstructed external abdominal hernia 13 (18.5%), colonic cancer 11 (16%), and intussusception seven (10%) were the primary causes of intestinal obstruction. Obstructed inguinal hernia was commonly encountered in males while adhesions and colonic cancers were common in females. Obstructed external abdominal hernias and post-operative adhesion are at par as the main primary causes of intestinal obstruction. Colon cancer and intussusception are increasingly causing more obstructions.

Clinic-morphological substantiation of the parahernial tissues excision in hernio-abdominoplasty in patients with ventral obesity

Objective. To formulate clinic-morphological substantiation for application of calculated excision of excessive and pathologically changed parahernial tissues together with performance of improved abdominoplasty in surgical interventions in patients with hernias in conditions of ventral obesity.
 Materials and methods. The investigation is based on data of paraoperative examinations and own results of surgical treatment of 58 herniological patients. Rational methods of their operating are substantiated by patho- and morphometric characteristics, determined in accordance to the observed dimensions of ventral hernia deformation, and content of the fat-containing, fibrous-cicatricial and inflammatory-pathological components in it.
 Results. The program set «Statistica 6.1» was applied for elaboration of the results obtained. In accordance to own algorithm of the ventro- and sonometric investigations there was established, that the parahernial tissues extras in the patients with external hernias are localized and originated supraaponeurotically.
 Preoperative considerations concerning determination of optimal volumes of conduction of dermo- and fibro-lipectomies, performed before hernio-abdominoplasties on various hernias with signs of ventral obesity, have permitted to prevent the local purulent-inflammatory complications and to improve the indices of quality of life in the patient operated on.
 Conclusion. Application of the «with no surpluses» operating principle constitute a practical base for improvement of reconstructive-plastic interventions results in external abdominal hernias and a real component of the problem decision in medic-social and esthetic rehabilitation of herniological patients with obesity.

THE FEATURES OF CLINICAL COURSE, DIAGNOSIS AND TREATMENT OF LITTRE'S HERNIA

Among the complications of Meckel's diverticulum, which are rare, it is necessary to note Littre's hernia – the strangulation in the external abdominal hernia and its location in the hernia’s sac. Meckel's diverticulum is a protrusion of the wall of the ileum, which is formed as a result of incomplete obliteration of the bile duct, which is involved in embryotrophy. It occurs most often in inguinal and femoral hernias. This pathology is rarely observed in clinical practice, therefore, we present the clinical case of Littre's hernia. The aim of this research is to describe the features of the clinical course, diagnosis, and treatment of Littre's hernia, as well as to draw attention to the existence of such a disease. Clinical case. Patient V., born in 1960, was urgently admitted to the surgical department on January 19, 2022, with a diagnosis of “Strangulation of the left inguinal hernia”. On admission, he complained of acute pain in the protrusive area of the left inguinal zone. From the anamnesis: he had felt acute symptoms about two hours before admission. He had been noticing a bulge in the left inguinal area for 20 years. The patient was examined at the department and urgently operated on under spinal anesthesia. We conducted the resection of Meckel's diverticulum with allohernioplasty by Lichtenstein on the left. Postoperative diagnosis: strangulated left-sided inguinal hernia with strangulation of Meckel's diverticulum of the small intestine (Littre's hernia). The course of the postoperative period was uneventful. He was discharged from the hospital on the 7th day in satisfactory condition. At the time of discharge, the postoperative wound healed with primary tension. The patient was examined after 2 months: there were complaints of minor pain in the area of the postoperative wound during physical activity. The postoperative scar is in satisfactory condition. Thus, Littre's hernia is a rare surgical disease and is subject to urgent surgical treatment. At the same time, the scope of surgical treatment is determined during the operation and assessment of the condition of the intestine and diverticulum.

Pharmacological Regulation of the Inflammatory Response under Mesh Implant Prosthetics in the Treatment of Patients with External Abdominal Hernias

Introduction. Seromas and hematomas of the implantation area are among the most common complications in prosthetic repair of a hernia defect with a mesh implant. The adequate tissue inflammation response to prosthesis implantation is achieved by the local protective role of pro-inflammatory cytokines. With suppression of the body's immune system combined with existing comorbidities, mesh implants result in even greater suppression of the immune system, which is manifested by an inadequate inflammatory response, both local and systemic, leading to the development of complications.Previously, the authors studied the effect of pyrimidine preparation "Xymedon" (INN - hydroxyethyldimethyldihydropyrimidine) on the systemic inflammatory process after prosthetic repair of anterior abdominal wall hernias. Based on the results of the interim study, it was hypothised: Regulation of the inflammation response to prosthesis implantation in hernioplasty manifested by changes in cytokine concentration in the blood can reduce postoperative complications. The aim of the study was to reduce the number of postoperative complications in prosthetic hernioplasty by regulating inflammatory reactions that occur after mesh implants.Materials and methods. Experimental part of the study. The experiment involved 66 rats, both sexes, pure line, which were implanted with mesh prostheses. Animals in group I (n=33) the control one - received 1 ml of 0,9% sodium chloride solution, i.e. received no specific treatment. Animals in group II (n=33) - the main one - received "Ximedon" 21 mg/day as pharmacological support. Blood sampling to determine inflammation markers was performed on the 5th day after the intervention. Animals were withdrawn from the experiment and the implantation site was taken for histological and histomorphometric investigations on the 5th day of the study. The study was carried out in the SPF vivarium at the laboratory of the Center for Genetic Collections of Laboratory Animals, Lobachevsky State University of Nizhny Novgorod. The study consisted of 4 series of experiments (2018-2021). Clinical part of the study. Prospectively (2018 - February 2022), we analyzed clinical outcomes of 101 patients with prosthetic repair (by Liechtenstein, TAPP, eTAR, "sublay") of an aponeurosis hernia defect of the anterior abdominal wall who received treatment in the City Clinical Hospital №7 named after E.L. Berezow. Patients of the "control" group (n=33) received only conventional treatment; patients of the "Ximedon" group (n=68) received 0.5 mg of ximedon 3 times a day for 10 days orally from the first day after the operation. Blood sampling was carried out on the 5th day after surgery. The data obtained were processed and structured using Microsoft Excel 2019 (64 bit), and statistical values were calculated in StatSoft Statistica 12,5 (64 bit).Results. Xymedon has a significant effect on the increase in the area of ​​the vessels of the implantation area in the experiment. Its use is associated with a lower level of C-reactive protein and blood IL-6 on day 5 in the experimental group compared to the control group. In the clinical study ximedon has a significant effect on the cytokine concentration in the blood: C-reactive protein, TNF-a, interleukins 6, 8 and 10. In the experimental study the dynamic of C-reactive protein, blood interleukins 6 and 10 does not significantly differ from the clinical one. In the clinical study, xymedon intake was associated with fewer postoperative complications. Conclusion. The studies performed allow us to consider "ximedon" as a means of pharmacological support for prosthetic repair in external abdominal hernias due to a significant reduction in postoperative complications provided by the ability to regulate inflammation reactions and stimulate reparative regeneration.

Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction.

We aimed to analyze the computed tomography (CT) imaging signs of bowel wall ischemia in patients with acute intestinal obstruction and construct an imaging prediction model to guide clinical treatment. The CT imaging signs of patients with acute intestinal obstruction diagnosed in our center in recent 6 years were collected for retrospective analysis. The etiology of intestinal obstruction and incidence rate of bowel wall ischemia were recorded, and the specific CT findings of bowel wall ischemia, including mesenteric edema, bowel wall thickening, and fish tooth sign, were analyzed. Among the 302 patients selected, 130 surgically treated patients were eligible for analysis. Bowel wall ischemia in acute intestinal obstruction showed an incidence rate of 14.90%, and the incidence rates of bowel wall ischemia in intra-abdominal hernia, intussusception, incarcerated external abdominal hernia, and volvulus were about 92.30%, 50%, 35.71%, 33.33%, and 12.59%, respectively. The incidence rate of bowel wall ischemia in simple adhesive intestinal obstruction was about 12.59%, and that in malignancy-induced intestinal obstruction was about 6.56%. Univariate analysis revealed 5 factors with statistical significance, including bowel wall thickening, mesenteric edema, bowel wall pneumatosis, ascites, and fish tooth sign. Multivariate logistic regression analysis indicated that fish tooth sign, bowel wall thickening, and mesenteric edema were able to predict bowel wall ischemia, and the corresponding partial regression coefficients were 2.164, 1.129, and 1.173, odds ratios (ORs) were 8.707, 3.093, and 3.232, sensitivity was 0.356, 0.400, and 0.844, and specificity was 0.859, 0.835, and 0.529, respectively. Imaging signs of bowel wall thickening, mesenteric edema, and fish tooth sign are valuable in predicting bowel wall ischemia, among which bowel wall thickening and mesenteric edema have relatively high specificity and fish tooth sign has a relatively high sensitivity. Furthermore, a fish tooth sign has the most favorable predictive value for bowel wall ischemia in acute intestinal obstruction, followed by bowel wall thickening and mesenteric edema.

Rare cases in herniology: The contents of the hernia – part of the liver, metastatic carcinoma, a foreign body

Surgical treatment of patients with postoperative ventral hernias is one of the most pressing problems in herniology. Verification of the diagnosis of postoperative ventral hernia is usually not difficult. At the same time, there may be difficulties in diagnosis associated with determining the true size of the hernia orifices, the contents of the hernial sac. These moments are determined by various factors: the location of the hernia on the anterior abdominal wall, the age, sex of the patient, as well as anamnesis of hernia and the volume of surgery previously performed. One of the very rare situations in external abdominal hernias is the situation when the content of the hernial sac is the part of the parenchymal organ, the tumor process, as well as foreign bodies. The study presents the observation materials of three patients admitted for diagnosis and treatment to the surgical hospital clinics of Irkutsk State Medical University. When examined and treated, it was found that in one case the content of the hernia sac included a part of the left lobe of the liver, in another observation, the inguinal hernia sac contained metastatic carcinoma, in the third case – a foreign body was found. All patients underwent surgery (hernioplasty, hernioplasty). Diagnosis of hernia of the anterior abdominal wall was confirmed. A literary search was made for rare clinical examples in herniology. In the world literature, there are only eight observations when the content of the hernia sac was a part of the lobe of the liver; the presence of metastatic carcinoma and a free foreign body we found as single observations described by known specialists in herniology.

Rives – Stoppa surgery – the foundation of the modern concept of treatment of patients with ventral hernias (55 years in surgery)

The treatment of ventral hernias in the history of surgery has always been an urgent problem. In the 90s of the XIX century, hernioplasty using metal threads and plates began, but the long-term results of treatment of patients remained unsatisfactory. A particularly urgent problem in herniology during the last century was the treatment of postoperative ventral hernias, and patients with large and even more giant hernias were often recognized as incurable. The great revolution in herniology was the introduction into practice of biologically inert mesh polymer materials. A fundamentally different method of endoprosthesis of the abdominal wall is retromuscular («sublay») hernioplasty, proposed by the French surgeon of Algerian origin Rene Stoppa in 1965. In 1966, a compatriot, colleague and friend R. Stoppa Jean Rives used the principles of this technique when eliminating postoperative median hernia by prosthetics of the anterior abdominal wall retromuscularly through the xiphopubic incision. Decades later, during the rapid development of endovideosurgery, the principle of operation Rives-Stoppa was the foundation for the development of modern minimally invasive and highly effective methods for eliminating inguinal and other ventral hernias. Thus, the method of prosthetics of the anterior abdominal wall proposed 55 years ago by Rives-Stoppa was an ideological breakthrough in herniology and significantly improved the results of operations for external abdominal hernias.

Application of 3D reconstruction through CT to measure the abdominal cavity volume in the treatment of external abdominal hernia.

To evaluate 3D reconstruction through CT in the measurement of abdominal cavity volume. From January 1, 2019 to December 31, 2019, 61 patients diagnosed as external abdominal hernia were included in this prospective study. Multislice computed tomography (MSCT) was applied to patients scanning, and the images were transferred to post-processing workstation for further analysis. We measured the abdominal cavity volumes using volume rendering (VR) method and diameter rendering (DR) method, and the results were used to test whether there is a correlation between them. In addition, the time required for the measurement was recorded and analyzed. In this study, we found that there was no significant difference in the abdominal cavity volumes between these two groups (VR vs. DR = 7857.316 ± 2035.786cm3 vs. 7967.268 ± 2925.792cm3, P > 0.05). Besides, the correlation analysis between the measured values of VR method and DR method showed there was a significant positive correlation (r = 0.922, P < 0.01). The linear regression equation based on the scatter plot was established as follows: y = 0.6417x + 2745, R2 = 0.8504. Furthermore, this regression equation was simplified as follows: y = 0.64x + 2800, R2 = 0.8499. Meanwhile, the time required for measurement of VR was significantly longer than that of DR (VR vs. DR = 64.3 ± 7.1min vs. 2.6 ± 0.6min, P < 0.01). In conclusion, the DR method can quickly measure and calculate the abdominal cavity volume, and its accuracy can more suitable for clinical requirement.

Imaging Postoperative Abdominal Hernias: A Review with a Clinical Perspective

AbstractPostoperative internal hernia is a challenging but critical diagnosis in postoperative patients presenting with acute abdomen. Postoperative internal hernias are increasingly being recognized after Roux-en-Y gastric bypass (RYGB) and bariatric surgeries. These internal hernias have a high risk of closed-loop obstruction and bowel ischemia; therefore, prompt recognition is necessary. Computed tomography (CT) is the imaging modality of choice in cases of postoperative acute abdomen. Understanding the types of postoperative internal hernia and their common imaging features on CT is crucial for the abdominal radiologist. Postoperative external hernias are usually a result of defect or weakness of the abdominal wall created because of the surgery. CT helps in the detection, delineation, diagnosis of complications, and surgical planning of an external hernia. In this article, the anatomy, pathophysiology, and CT features of common postoperative hernias are discussed. Afterreading this review, the readers should be able to (1) enumerate the common postoperative internal and external abdominal hernias, (2) explain the pathophysiology and surgical anatomy of Roux-en-Y gastric bypass-related hernia, (3) identify the common imaging features of postoperative hernia, and (4) diagnose the complications of postoperative hernias.

Pattern of abdominal wall hernia in Shisong, Cameroon

Introduction: There is the obscurity of published data on surgical management of external abdominal wall hernias in our environment. This study was, therefore, to describe the pattern, outcome, and experience in the surgical management of anterior abdominal wall hernias in Shisong, Cameroon. Methods: This was a descriptive retrospective study conducted at St. Elizabeth Catholic General Hospital, Shisong. The various cases of abdominal wall hernias performed in the hospital during the study period of three years covering January 2017 to December 2019 by the surgical teams were included. We ensured that Ethical clearance and written informed consent were obtained before the start of the project. Information includes detailed sociodemographic data collected and analyzed by using SPSS 22 statistical software. Results: 465 cases of various abdominal wall hernias were included in this study. The most common type of hernia was indirect inguinal hernia (86.5%), and one rare Spigelian hernia was also there. The sub-arachnoid block was the most prevalent form of anesthesia. The various surgical procedures performed, including herniotomy (8.7%), hernioplasty (38.7%), and herniorrhaphy (28.6%), which were done for various inguinal hernias. In contrast, only mesh repair (9%) was performed for epigastric, lumbar, umbilical, Spigelian, and incisional hernia. Amongst the inguinal hernias, 55.2% were right-sided, 40.6% were left-sided, and 4.2% were bilateral, whereas 50% each of femoral hernia was left and right-sided. Overall, the annual recurrence rate for groin hernia was 1.9%. Conclusion: Inguinal Hernia was the most common type of hernia (86.3%). Among the inguinal hernia, the right side was more common (58.42%). The adoption of newer modalities of care should be considered standard. However, in resource-constrained settings like ours in Cameroon, the goal should be to perform a skillful and technically effective technique. Also, it is critical to ensure adequate anesthesia for optimal post-operative pain control, coupled with minimal morbidity.

Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia : in Terms of Patient Satisfaction

Background- Inguinal hernia is the most common type of external abdominal hernia. Open Lichtenstein method or laparoscopic method can be employed to repair inguinal hernia. The superiority of laparoscopic mesh hernioplasty over open mesh hernioplasty is debatable. Method- This prospective study was done on 120 patients in the department of surgery, LLRM medical college, Meerut to evaluate the usefulness of laparoscopic mesh hernioplasty (TEP Technique) for inguinal hernia repair versus conventional open mesh hernioplasty (Lichtenstein Technique) in terms of complications, pain and recurrence. Equal number of subjects were put in two groups : open mesh repair group and laparoscopic mesh repair group. Results- The mean age of the patients with inguinal hernia including both groups was 50 yrs. The mean operation time of Laparoscopic TEP mesh hernioplasty was 71.33 minutes while that of Open Lichtenstein repair was 36.33 minutes. Postoperative analgesic requirement was significantly lower in the patients operated by TEP technique as compared with patients treated by Open Lichtenstein’s technique. In TEP group, two patients developed neuralgia, one patient developed fever, 1 patient developed hematoma whereas in the open group there were 3 cases of neuralgia formation and 3 cases of fever. Conclusion- In all, Laparoscopic mesh hernioplasty using TEP technique is a novel technique with its share of advantages and disadvantages. There are potential benefits of laparoscopic inguinal hernia repair for inguinal hernias in terms of post-operative pain, hospital stay and post operative complications. We recommend that a surgeon should use this laparoscopic technique for hernia repair after knowing all the pros and cons of the technique, his expertise for the technique and the infrastructure available.