External Abdominal Hernias Research Articles

An elderly woman with obstructed obturator hernia: a less common variety of external abdominal hernia

Obturator hernia is a type of external abdominal hernia. Site of hemiation is the obturator canal, which is the superolateral aspect of the obturator foramen. The herniation sac exits the pelvis near the obturator nerve and vessels. Herniated loops of small bowel extend between the pectineus and obturator muscles. In this report, we present a case of obstructed obturator hernia.

Pattern of Paediatric external hernia in Eku, Nigeria

Introduction: Paediatric external hernias form a major part of a general surgeon’s workload in Nigeria. The epidemiological pattern and management of external abdominal hernias in children was examined in a referral center in the country. Methods: A two-year retrospective study of all external abdominal hernias that presented at Baptist Medical Center, Eku (BMCE) from January 1st 2004 to December 31st 2005 was done. Case notes of all children with external abdominal hernia seen in the center were retrieved and analyzed. Results: There were 37 cases of external hernias in children available for the study. 91.8% of these cases were male and 8.2% were female. 94.6% of the patients had inguinal hernias and the other varieties were relatively uncommon. 8 cases (22.86%) were obstructed and two of the obstructed hernias were strangulated. There was a single case (2.70%) of wound infection and no mortality was recorded in this series. Conclusion: The pattern of external paediatric hernia in Baptist Medical Center, Eku was similar to other parts of the country. Early presentation and elective surgical management are recommended for improving treatment outcome. Improved public awareness of the condition and its potential complications will lead to earlier presentation and inclusion of hernia repair into existing child health programs will provide elective hernia repair in a wide scale. Keywords: Paediatric hernia, Eku, Nigeria.

Clinical application of herniorrhaphy with the plug and mesh for abdominal external hernia

Objective To assess the value of plug and mesh for tension free hernia in the treatment of abdominal external hernia.Methods 272 times of tension free repair of hernia for 250 patients performed in our hospital during the time from September 2000 to August 2008 were retrospectively reviewed 36%( 90/250 )of cases were complicated by diseases such as cardiopulmonary dysfunction, hypertension, diabetes mellitus, prostate hypertrophy, cirrhotic ascites and thrombocytopenia.Results All patients had the healing by first intention with no incisional infection or death, and they were discharged within 2 ～1 days after operation( 93% of patients were discharged 4 days after operation ).75.2% of patients were follower up for an average of 3 years and 4 months( 3 months ～ 7 years ).There was no recurrence during the follow-up.Conclusions Plug and mesh for the tension free repair has the advantages of less trauma, little postoperative discomfort,rapid recovery and low recurrent rate. Key words: Hernia, fold inguen; Reoperation

External abdominal wall hernias: experience with elective and emergency repairs in Nigeria.

External abdominal wall hernias: experience with elective and emergency repairs in Nigeria.

Hernia clinic in a teaching institution: creation and development.

The hypothesis that a hernia clinic could improve the results of external abdominal wall herniorrhaphy was tested in a teaching institution. From 1980 to 1988, all patients exhibiting external abdominal wall hernias were treated under protocol and separate from general surgical patients in a hernia clinic directed by a dedicated surgeon. The incidence of recurrence, infection, and testicular ischemia was significantly better than our previous institutional results. The incidence of incarceration/strangulation also fell significantly in patients over 65 years of age. Chart documentation was kept up to date for the duration of the project. Insufficient emphasis by the Clinic Director on the benefits of the proposed protocol and other factors contributing to the eventual clinic closure could be circumvented by better alternative planning. In our institution, the outcome of surgery for external abdominal wall surgery was significantly improved by the creation of a hernia clinic; our results equal those reported by other recognized herniorrhaphists. Barring some developmental obstacles, the concept of a hernia clinic should be advantageous to patients and residents alike.

The Pattern Of Adult External Abdominal Hernias In Zaria

Over a period of 12 years seven thousand, nine hundred and fifty-two (7952) patients with general surgical problems were operated on at the Ahmadu Bello University Teaching Hospital, Zaria. Of these, patients with external abdominal hernias constituted nine hundred and eighteen (918). Operation for hernias constituted about 12.5% of the operative work-load of the general surgeons in this hospital. The descending order of occurrence of external abdominal hernias were inguinal, femoral and incisional. Right inguinal hernias were commoner than left inguinal hernias with a ratio of 1.7:1. The indirect inguinal hernias accounted for 67.5% of cases of inguinal hernias. There were fifty (50) of cases of bilateral inguinal hernias. Femoral hernias were commoner in the female patient than in the males, though inguinal hernias will still the commonest hernias in the females. Generally speaking, femoral hernias were commoner on the left side than on the right side. Incisional hernias occurred in women following caesarean section for obstructed labour. The commonest mode of presentation in all hernias was a reducible simple hernia. Other modes of presentation included irreducible hernia, intestinal obstruction, intestinal strangulation with peritonitis and occasional giant hernias (fascial deflect diameter greater than 10cm). Femoral hernias obstructed more commonly than inguinal hernias. Modified Bassini repair was the method employed to repair the inguinal hernias, low approach for simple femoral hernias and high approach for complicated femoral hernias. Simple repairs also were employed for incisional hernias with Keel method for moderate-to-giant hernias (facial deflect > 10cm in diameter). Four patients died, three from overwhelming infection following strangulation obstruction of inguino-scrotal hernias and one from severe chest infection following repair for a giant incisional hernia. The follow up was poor. Most patients defaulted after their second visit to surgical out patient department . External abdominal hernias remain a significant surgical problem in our environment.(Nig J Surg Res 2000; 2:12-15) KEY WORDS: External abdominal hernia, Adults, Morbidity, Mortality

External abdominal wall herniorrhaphy in patients with Ehlers-Danlos syndrome technical considerations

Ehlers-Danlos syndrome encompasses a group of ten different categories of patients with altered collagen metabolism. Of those, Type IV is characterized by profound changes in tissue consistency resulting in premature death secondary to vascular, intestinal or uterine rupture. Three patients suffering from EDS underwent repair of external abdominal wall hernias. Two of type II offered no significant challenge. The third, type IV harboring an intralabial incarcerating inguinal hernia presented a significant surgical problem the characteristics of which are herewith described together with technical suggestions.

Femoral hernia: The dire consequences of a missed diagnosis

Femoral hernia has always presented more difficulty in diagnosis than other external abdominal hernias. The incidence of incarceration and strangulation is higher in our series than the published literature would suggest. A retrospective study was performed at our institution from February 1990 to June 1995. In that period, 22 patients were operated on for femoral hernia. There were 16 women and 6 men, average ages 51 and 48 years, respectively. The men weighed on average 209 lb, and the women, 154 lb. Three of our patients had elective repair of their hernias (16%); 19 were performed urgently or emergently (86%). Of the emergency repairs, 3 had strangulated small bowel requiring resection (16%), 1 had a strangulated vermiform appendix with abscess formation (5%), 3 had strangulated omentum requiring excision (16%), giving a total of 7 patients with strangulation and necrosis of the hernial contents (36%). The remainder had viable contents in the hernia sac. The time from the onset of symptoms to presentation at the hospital varied from 1 day to 3 years. The time from strangulation to presentation was between a few hours and 4 days. Surgery was performed on the day of admission (within 24 hours) on all but 2 of our patients. Procedures performed were McVay repair, 13; Bassini, 4; laparoscopic with Marlex mesh, 1 patient; drainage of a groin abscess in 2 patients with later repair; and on 2 patients the type of repair was not specified. One of the patients died. Postoperative wound infection occurred in 2 heavily contaminated patients, and 3 had pneumonia. Patients with no regular physician and no routine physical examinations are at higher risk for developing strangulation of femoral hernias. Emergency physicians and general practitioners are in the best position to diagnose these hernias early, when treatment can be elective.

Paediatric external abdominal hernias in Zaria, Nigeria.

The author reports a 4-year experience of external abdominal hernias in children in the Paediatric Surgical Unit of the Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. A general surgeon with wide experience of paediatric surgery and his well tutored assistants performed operations on various abdominal hernias in 311 children aged from 2 weeks to 12 years (mean age: 3.2 years). Fourteen children had a strangulated inguinal hernia and seven others a strangulated umbilical hernia. Two bowel resections were performed on each type. The majority of patients were followed up for periods of from 3 months to 2 years. Eighty patients with uncomplicated inguinal hernia developed mild scrotal oedema. Infection was limited to the operation site in 15 patients, in addition to two scrotal wound infections in two of those who had bowel resection. There were two early recurrent groin hernias, and no deaths. There was no overt testicular ischaemia in patients with strangulated groin hernias. Our results were comparable with those from similar and specialist centres elsewhere.

Analyzing the content of physicians' medical practices.

For many large physician groups, about 75% of all revenues come from capitation contracts. These groups may reduce the variable expenses of patient care by conducting medical outcome studies. Physician groups will obtain the most benefit for their limited research dollars by focusing outcomes research on prevalent medical conditions. The purpose of this study is to provide a comprehensive analysis of the content of physicians' medical practices. We found that 21 diagnostic clusters defined 70% or more of the episodes treated by primary care physicians. For specialists, no more than eight diagnostic clusters were needed to define the majority of their practices. Outcomes research should initially focus on abdominal pain, acute lower respiratory infections, cataracts, cholelithiasis, congestive heart failure, diabetes mellitus, external abdominal hernias, ischemic heart disease, low back pain, maternity care, menstrual disorders, otitis media, peptic diseases, prostate cancer, psychotic episodes, renal calculi, seizure disorders, and thyroid diseases.

A modified technique for implantation of polypropylene mesh for the repair of external abdominal hernias in horses: A review of 21 cases

Summary During a 3-year period 21 horses were surgically treated because of large abdominal wall defects. In each case the defect was bridged with a polypropylene mesh, which was placed on the outside of the hernial ring. This was in contrast with the technique for mesh herniorrhaphy generally described in human and veterinary literature, in which the mesh is always implanted on the inside of the hernial ring. One horse was destroyed on the first postoperative day because of postanaesthetic myelomalacia. Surgical repair as described was successful in 18 patients. Recurrence of herniation occurred in two horses. On re-herniorrhaphy a second and larger mesh was successfully implanted.

Herniorrhaphy in the elderly: Benefits of a clinic for the treatment of external abdominal wall hernias

Elective abdominal herniorrhaphy carries morbidity and mortality rates of 26 percent and 1.5 percent, respectively, in patients over 65 years of age. These figures climb to 55 percent and 15 percent during emergent surgery. Our purpose was to investigate if standardization of treatment could improve such results. Our program stressed centralization of care in a hernia clinic; early operation of patients at risk of incarceration; optimization of underlying systemic disorders by consultative services; operation under local anesthesia; preoperative, operative, and postoperative protocol; and continuity of care by senior personnel. Over a 4 year period, we have performed 241 abdominal herniorrhaphies in patients over 65 years of age (median age 71.5 years old) who exhibited an 84 percent incidence of significant preoperative systemic disorders. Since the inception of our program, our rate of emergent operation has decreased significantly from 7 percent to 2 percent (chi-square ≤ 0.05). Our rate of systemic complications after elective operation was 1.2 percent and 0 after emergent operation. These data are statistically better than those reported in the literature (chi-square ≤ 0.05). These results suggest that the creation of a hernia clinic significantly improves the care of herniated patients.

Prosthetic Materials in the Repair of External Abdominal Hernias in Cattle

Paper from the 9th International Congress on Cattle Diseases.