Kind Of Hernia Research Articles

Analysis of the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia

ObjectiveInguinal hernias are a common disease that may present at all ages. Adolescents are a unique patient population between children and adults. The etiology and the surgical treatment strategies of adolescent indirect hernias are not clear. Specifically, whether these kinds of hernias should be treated by high ligation or mesh repair remains controversial. We aimed to evaluate the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia.MethodsThe data of adolescent patients who underwent laparoscopic high hernia sac ligation at the The First People’s Hospital of Foshan,China, from January 2012 to December 2019 were analyzed retrospectively. Data collected included their age, gender, weight, surgical method, hernia ring diameter, operation time, postoperative recurrence rate and postoperative complications.ResultsA total of 70 patients were enrolled, including 61 males (87.14%) and 9 females (12.86%),all patients were aged 13–18 years old (mean 14.87 ± 1.56years), weighed 28-92 kg (mean 53.04 ± 10.60 kg). All 70 patients underwent laparoscopic surgery except 2 patients with irreducible hernias who converted to laparotomy.The hernia ring diameter ranged from 0.5 to 3 cm (mean 1.39 ± 0.49 cm), and was ≤ 2 cm in 68 cases (97.14%).The operative length ranged from 12 to 105 min (average 24.96 ± 12.61 min), There were 37(52.9%) right-sided hernias, 32 (45.7%) left-sided hernias, 1 (1.4%) bilateral hernia.There were 67(95.7%)reducible hernias,2(2.9%)irreducible hernias ,and 1(1.4%)incarcerated hernia.Hospital stays ranged from 1 to 5 days (mean 2.37 ± 1.05 days). Follow-ups were performed from 30-119months (mean 74.27 ± 28.14months). There were no cases of recurrence, howere, incision infection occured in 1 patient, who underwent a second operation 6 months after surgery, and 4 (5.7%) patients had complaints of intermittent pain around the ligation incision site, mostly during exercise .ConclusionLaparoscopic high hernia sac ligation is feasible for treatment of adolescent indirect hernias with a hernia ring diameter of ≤ 2 cm.

Modified port positions for totally extraperitoneal (TEP) repair for groin hernias: our experience

Totally extraperitoneal repair (TEP) is the preferred method of inguinal hernia repair for many surgeons worldwide. However, because of limited working space, there may be difficulties when operating on large and irreducible groin hernias and short stature patients. There are many ways in which the port positions can be modified during TEP for different kinds of hernias and according to the comfort of the surgeons. This is a retrospective analysis of prospectively collected data. We describe two different variations in port placement for TEP in patients with large irreducible hernias and short stature patients. A total of 19 procedures were performed with these port positions. Most of these were large irreducible hernias or patients with short stature. With these modified port positions, difficult hernias could be completed with extraperitoneal approach. We had no recurrence and 5 seromas that eventually settled in 1-3months. Modified port positions in TEP by shifting the ports farther away can be useful for hernias where the surgery is difficult due to limited working space and is a good alternative to TAPP.

An Unusual Kind of Herniation: A Case Report

Abdominal wall hernias are one of the most common reason for surgery globally. Spigelian hernia is a rare kind of this disease with an incidence of less than 2%. Because of its unic anatomical characteristics, it can be misdiagnosed or overlooked by physicians. Developments in radiological diagnostic tools facilitate correct and early diagnosis. Herein we presented a 76 year-old Spigelian hernia case and discussed anatomical characteristics, diagnosis and treatment methods of this rare kind of hernia with the literature knowledge.

The role of prophylactic cefazolin in the prevention of infection after various types of abdominal wall hernia repair with mesh

There are controversies about the benefits of prophylactic antibiotics in the prevention of postoperative surgical site infection (SSI) in mesh herniorrhaphy for a long time. This study aimed to evaluate the effectiveness and efficacy of systemic prophylactic cefazolin in prevention of wound infection in various types of hernia repair with mesh materials. This is a prospective randomized control study. We evaluated wound infection rates in 395 patients with various kinds of hernia who underwent elective mesh repair using polypropylene mesh from 2007 to 2011. A total of 237 (60.0%) patients received prophylactic cefazolin (study group) and the remaining 158 (40.0%) patients did not receive any prophylactic antibiotics (control group). Patients were followed for infection at the following periods after the operation by an independent surgeon: 10 days, 30 days, 12 months, and then annually for at least 2 years. Eight (2.03%) patients had infection in the site of surgery [2 (1.27%) in the control group and 6 (2.53%) in the study group]. The distribution of infection was not significantly different between the two groups (p=0.364). The superficial infections were managed by drainage and irrigation. One patient from the study group developed deep SSI and was readmitted and subsequently received antibiotic therapy, drainage, and debridement. Preoperative administration of single-dose cefazolin for prosthetic hernia repairs did not markedly decrease the risk of wound infection. Our results do not support the use of cefazolin as a prophylactic antibiotic for various kinds of abdominal wall hernia repair with mesh.

Damage to the vascular structures in inguinal hernia specimens

Few scientific reports to date describe the histological modification of structures outlining a hernia opening. This article is focused on the identification of the pathological changes in vascular structures in tissues excised from cadavers with inguinal hernia. A deeper comprehension of this topic could lead to essential improvements in the detection of hernia genesis. Different kinds of hernia, including indirect, direct and mixed, were identified in 30 autopsied subjects. Tissue samples were resected for histological study from abdominal wall structures close to the hernia opening. Histological examination focused on the detection of structural changes in arteries and veins. The results were compared with tissue specimens excised from equivalent sites of the inguinal area in a control group of 15 fresh cadavers without hernia. Significant modification of vascular structures were identified in the tissue specimens examined. The veins demonstrated parietal fibrosis, perivascular edema and vascular dilation due to congestion and stasis. The arterial structures detected showed thickening of the media due to medial hyperplasia, ranging from luminal sub-occlusion to a manifest artery occlusion. These findings are present independent of hernia type in cadavers with inguinal hernia. These pathological changes were lacking in the control group of cadavers without hernia. The notable changes in vascular structures described in the report could be the result of a steady compressive effect exerted by the abdominal viscera in the inguinal area. These pathological changes could represent one of the factors involved in the weakening of the inguinal region leading to hernia protrusion.

Peritoneal cyst mimicking a femoral hernia

Dear Editor, I read with great interest two papers published in the same issue of Hernia [vol 13(6) December 2009]: the Wrst from J.D. Ryan et al. (Haematoma in a hydrocele of the canal of Nuck mimicking a Richter’s hernia [1]), and the second by D.G. Mote (Hydrocoele of a femoral hernia sac [2]). These papers can be compared from a physiological perspective but diVer from an anatomical point of view. I had the opportunity to operate on two similar cases recently. I would like to congratulate J.D. Ryan et al. for their rare report and their incidental Wndings, which provide the opportunity to precise what is well know in males (processus vaginalis) but often not really known or understood in females. In fact, as the authors note in their paper, exactly the same process occurs during embryology, and if the canal of Nuck is not complete obliterated a cyst might form. I operated on a 35-year-old woman with a bulge palpated in the right upper-lateral area of the pubic tubercle—just the place where a direct hernia can occur, and indeed that was our preoperative diagnosis. By an inguinal direct approach we found that the transversalis fascia was correct and, above it, we found a cyst inside a Nuck canal. It was located inside the lacunar ligament (epigastric vessels). A resection of the hydrocele was easily performed; there was no communication with the abdominal cavity. The patient recovered well and was back home at day 1. So I agree with the conclusion of J.D. Ryan, and Benjamin [3]: resection of the sac and treatment of simultaneous inguinal hernia if present. Congratulations also to D.G. Mote for their exceptional case report. As they note, “hydrocoele of the femoral hernia sac is very rare” [4]. If we compare these two papers, we can make two kinds of comments. In both cases, a cyst appears in a peritoneal pouch, without communication with the abdominal cavity: a Nuck canal in the Wrst case (which is a peritoneal structure), and the peritoneal sac in the second. On the other hand, from an anatomical point of view they are located in two opposing places. The Nuck cyst corresponds to an indirect hernia in the inguinal canal, above the transversalis fascia, and is the result of a congenital problem. The peritoneal cyst inside the femoral canal is a direct acquired kind of hernia, of course below the transversalis fascia. So it is interesting to compare these two papers, and to be reminded, as the authors note, of the anatomical basis for understanding. I also recently operated such a peritoneal cyst mimicking a femoral hernia. A 63-year-old woman presented with a bulge in the upper part of the root of the right thigh, not really painful but causing some discomfort. It appeared some months ago, and we discovered that at the same time she had lost weight due to family problems. The examination showed that the bulge was not reducible and the inguinal area was normal, as was the left side. She had no history of previous hernia, even in childhood. Our idea was that part of the greatum omentum was strangulated in the femoral ring. An abdominal X-ray was not helpful and her laboratory Wndings were normal. By an inguinal approach we conWrmed that the inguinal canal was normal and, after opening the transversalis fascia, we saw the peritoneum strangulated in the femoral ring. It was necessary to open the inguinal ligament a little bit to O. Armstrong (&) CCDE, Hotel-Dieu, Centre Hospitalier Universitaire, Place Alexis Ricordeau, 44093 Nantes Cedex 1, France e-mail: Olivier.armstrong@chu-nantes.fr

Arcuate line of the rectus sheath: an anatomist’s viewpoint

The article titled ‘Arcuate line of the rectus sheath: clinical approach’ by Loukas et al. generates much interest (Loukas et al. 2008). The authors should be applauded for their meticulous work. It was very surprising to find the omission of the ‘arcuate line’ as a possible keyword. Medline had previously accepted it as a possible keyword, so an important keyword might have been missed. The topographical anatomy of the arcuate line has been reported in the past, and the authors took special interest in citing all those works. The presence of AL on both sides of 100 cadavers is an interesting finding. Past studies have reported a prevalence rate of 14.97 and 1.35% in males and females, respectively (Coulier 2007). The authors describe that the existence of AL has been a subject of debate. Interestingly, the slower rate of the fibers of the rectus sheath from the posterior to anterior direction may result in the absence of AL, which occurs in 70% of cases (Rizk 1991). Likewise, the rapid rate of shifting of fibers from the posterior to anterior rectus sheath may account for the existence of double AL (Rizk 1991). The authors should have mentioned if the medial or the lateral end of the AL was higher. This is one of the most fundamental observations when describing the topographical anatomy of AL. Yes, I do agree with the authors that the exact topographical anatomical location of the AL may vary. Does the topographical anatomy of the AL really matter to a surgeon before opening up the abdomen? It has to be remembered that any physical activity such as sports may change the morphometric indices and echogeneity of the abdominal wall muscle (Kogut et al. 1993). Simply by observing that an individual is obese, one cannot have the preconception that the AL will vary considering that knowing the history of any physical activity of the individual is equally important. The authors should have mentioned clearly what they meant by evidence of any previous surgical procedures. Incisional marks predispose to hernias, but those marks may not always be visible. A proper clinical history of the individual is necessary. Spigelian hernia was mentioned as a keyword, but no anatomical details were specifically mentioned about this hernia. This kind of hernia usually affects the younger age group, and the association of this hernia with other congenital defects assumes much clinical importance. Below the umbilicus, the fibers of the internal oblique and the transverse abdominis muscles run parallel to each other, thereby accounting for the increase in incidence of Spigelian hernias, but above the umbilicus, the fibers of the internal oblique and transverses abdominis cross each other at right angles, thereby accounting for the reduced chance of occurrence of Spigelian hernias (Rehman et al. 2000). The article has highlighted all the necessary details pertaining to AL. I thank the authors and the editor for publishing such an important article.

Authors’ reply: Giant spigelian hernia due to abdominal wall injury: a case report [Hernia (2006) 11:67–69

To the Editors, We thank LosanoV and Basson for their critique of our case report. First of all, we wish to emphasize that our paper was not a review article; it was only a case report. The size that a Spigelian hernia (SH) needs to be before it can be termed “giant” is yet to be deWned in the English literature. Furthermore, a 10-cm-diameter muscular defect is very large for this kind of hernia. We presented only the diameter of the hernia neck, because it was a stable measurement; the clinical size of the hernia was actually much more than this. The authors doubt whether our case was a SH. Our patient did not show any history of SH before the trauma. Some post-traumatic SHs like ours have been reported in the literature previously, however [1, 2]. We agree with the authors’ skepticism regarding whether this kind of hernia should be called a SH or post-traumatic hernia. Abdominal trauma can suddenly increase the intraabdominal pressure and cause SH [3]. The term “Spigelian hernia” does not just refer to a type of hernia; the term also describes the location of the hernia. Therefore, it is diYcult to state that such a hernia that presents after trauma is not a SH. We used nonabsorbable multiWlament mesh in this case. The infection rate in abdominal wall reconstruction with mesh, for clean surgeries, is 1–2% of all grafts. Engelsman et al. [4] stated that multiWlament meshes have a higher infection rate in their review article. However, there was no reference that included a clinical study of this issue in their article. We think that bacterial contamination during surgery is the main factor in this rate. In one randomized clinical study, the recurrence rates for diVerent types of meshes used in hernia repair were not found to be signiWcantly diVerent [5]. Again, there is no published randomized controlled clinical trial in the English literature that reports that sublay or intermuscular mesh placement is better than onlay placement. We agree with LosanoV and Basson that laparoscopic SH repair is an alternative to the open technique. The open technique was our patient’s preference. Furthermore, laparoscopic hernia repair is more expensive than the open technique in our country. On the other hand, the recurrence rate is lower when the open technique is used in inguinal hernia repair rather than the laparoscopic technique, according to a study published recently [6].

Inguino-scrotal hernia of a double district ureter: case report and literature review

Ureteral hernia is uncommon and usually misdiagnosed. From an anatomic point of view, we can distinguish between two uretero-inguinal hernias: intraperitoneal and extraperitoneal. Ureter inguinal hernias are nearly always indirect. This kind of hernia can include the ureter alone or, frequently, other abdominal sliding organs within the hernia sac (bladder, bowel tracts, etc.). Kidneys and urinary tracts present normal anatomic conformation, although renal ptosis may be found. As of July 2004, 139 cases of ureteral hernia had been described in the literature. Here we report a case of inguino-scrotal herniation of double district ureter and review the current literature to analyze the main clinical characteristics of this pathology and to establish pitfalls.

On the question of the use of a prolapsed uterus in plastic surgery of an inguinal hernia in women

Being, according to the latest views, one of the manifestations of the general ptotic constitution, prolapse of the uterus, which, according to Halban and Tandler, is also a kind of hernia, of course, can occur in combination with other abdominal hernias. In 285 patients I operated on for prolapse of the uterus, I met a similar combination in 12 cases, and in 4 of them there were umbilical hernias, in 1 - a hernia of a straight line of the abdomen and in 7 - inguinal hernias, among which 3 required plastic surgery.