Occurrence Of Hernia Research Articles

Analysis of risk factors of diaphragmatic hernia after thoraco-laparoscopic minimally invasive McKeown esophagectomy

Objective: To explore the related risk factors of diaphragmatic hernia after thoraco-laparoscopic minimally invasive Mckeown esophagectomy (MIME). Methods: This is a retrospective controlled study. A retrospective analysis was conducted on the clinical data of patients who underwent MIME at the Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, from January 2016 to December 2023. A total of 619 patients were included. There were 423 males and 196 females, aged (63.7±7.6) years (range: 37 to 87 years). The diagnosis of diaphragmatic hernia after MIME was made based on clinical symptoms and CT scans. Patients were divided into two groups: the diaphragmatic hernia group (n=16) and the non-diaphragmatic hernia group (n=603). Clinical data, including age, gender, body mass index (BMI), smoking history, tumor location (upper, middle, and lower thoracic esophagus), preoperative neoadjuvant therapy history, and tumor staging, were collected and analyzed. A BMI of 25 kg/m² and age of 65 years were used as cutoff values. The χ² test and Fisher's exact test were used to compare the data between the two groups, and Logistic regression was employed for risk factor analysis. The diaphragmatic hernia group and non-diaphragmatic hernia group were matched in a 1∶3 ratio with a caliper value of 0.02 by propensity score matching. Kaplan-Meier method was used for survival analysis and compared using the log-rank test for between-group differences. Results: The proportion of patients with diaphragmatic hernia after MIME who underwent surgical treatment was 6/16. Statistically significant differences were observed between the diaphragmatic hernia group and the non-diaphragmatic hernia group in terms of age (χ²=16.057, P<0.01), BMI (χ²=16.057, P<0.01), and tumor location (χ²=12.048, P=0.002). Multivariate logistic regression analysis revealed that age ≥65 years (OR=1.236, P=0.023) and BMI<25 kg/m² (OR=0.810, P<0.01) were independent risk factors for the development of diaphragmatic hernia after MIME. Survival analysis showed no significant difference in long-term survival between patients with and without diaphragmatic hernia after MIME (P=0.187), and whether patients with diaphragmatic hernia underwent surgery was not associated with long-term prognosis (P=0.560). Conclusion: Patients with BMI<25 kg/m2 and age ≥65 years are independent risk factors for diaphragmatic hernia after MIME. The occurrence of diaphragmatic hernia is not associated with prognosis, and whether patients with diaphragmatic hernia undergo surgery does not affect the prognosis.

Reconstruction de l’aponévrose musculaire de la zone donneuse du lambeau antérolatéral de cuisse par plaque synthétique : technique et bénéfice

The anterolateral thigh flap is sometimes harvested with a portion of the quadriceps muscle fascia, which can lead to muscle hernias or adhesions at the donor site. Studies report an 11 to 32% incidence of muscle hernias and an 8 to 26% incidence of persistent weakness at the donor site. There is no data in the scientific literature presenting a surgical technique for the prevention of muscle hernias at the donor site of the anterolateral thigh flap. The objective of our study is to describe our technique for placing a synthetic mesh when closure of the fascia is not possible during the harvesting of an anterolateral thigh flap, in order to reduce the risk of postoperative muscle hernias and to analyze its benefits. As part of a prospective study, we present here our technique for reconstructing the fascia by placing a non-resorbable synthetic mesh. Twenty-two patients underwent the placement of a mesh for the reconstruction of the fascial defect, which averaged 9.6cm. One year after the procedure, none of the patients presented with a muscle hernia or adhesions at the donor site. According to studies, muscle hernias and scar adhesions occur in 11 to 32% of cases and are both unsightly and disabling for patients. Although it is difficult to quantify the benefit in terms of muscle strength, fascia reconstruction effectively prevents this type of complication. When the defect is greater than 8cm, we believe it is essential to reconstruct the fascia during harvesting to prevent the occurrence of hernia or adhesion at the donor site. While not affecting limb function, muscle hernia is at least aesthetically bothersome and should be systematically prevented. Reconstruction of the muscle fascia at the donor site of the anterolateral thigh flap with a non-resorbable synthetic mesh, in cases of a defect greater than 8cm, prevents the occurrence of muscle hernias and adhesions, which can lead to aesthetic and functional complications.

Relationship between immune cell traits, circulating inflammatory cytokines, and the risk of incisional hernia after gastric surgery.

The systemic and local inflammatory response in patients after surgical operation is closely related to the quality of the wound healing. Low-quality wound healing and defects in the suture technique lead to the occurrence of incisional hernia (IH). However, the causal relationship between human circulating inflammatory cytokines, immune cell traits, and the risk of IH remains unclear. We used summary data from genome-wide association studies to assess the causal relationship between 91 types of circulating inflammatory factors, 731 types of circulating immune cell traits, and the risk of IH. The outcome dataset was obtained from FinnGen, including 6,336 patients with IH and 232,612 controls. We performed Mendelian Randomization (MR) analysis to identify their causal relationship and immune cell phenotypes upstream of inflammatory factors. Inverse variance weighting is considered to be the main analysis method. Among the identified cytokines, TNF-related activation-induced cytokine levels were associated with a lower risk of IH (OR: 0.89; 95% CI: 0.82-0.96; P = 0.003). In contrast, interleukin-5 levels were associated with an increased risk of IH (OR: 1.18; 95% CI: 1.06-1.31; P = 0.003). Additionally, a significant causal relationship was found between four immune cell traits and the risk of IH (P < 0.01). Through two-step MR analysis, we determined that interleukin-5 levels mediate the causal relationship between the relative count of CD25hi % CD4 + in Treg cells and the higher risk of IH. This study found a causal relationship between specific inflammatory cytokines, immune cell traits, and risk of IH. These results can help surgeons predict the risk of IH and take preventive measures.

Towards a better understanding of abdominal wall biomechanics: In vivo relationship between dynamic intra-abdominal pressure and magnetic resonance imaging measurements

BackgroundIn vivo mechanical behaviour of the abdominal wall has been poorly characterised and important details are missing regarding the occurrence and post-operative recurrence rate of hernias which can be as high as 30 %. This study aimed to assess the correlation between abdominal wall displacement and intra-abdominal pressure, as well as abdominal compliance. MethodsEighteen healthy participants performed audio-guided passive (breathing) and active (coughing, Valsalva maneuver) exercises. Axial dynamic changes of abdominal muscles and visceral area were measured using MRI, and intra-abdominal pressure with ingested pressure sensor. FindingsCorrelations between abdominal wall displacement and intra-abdominal pressure were specific to participant, exercise, and varying between rectus abdominis and lateral muscles. Strong correlations were found between rectus abdominis displacement and intra-abdominal pressure during breathing (r = 0.92 ± 0.06), as well as lateral muscles displacement with intra-abdominal pressure during coughing and Valsalva maneuver (r = −0.98 ± 0.03 and − 0.94 ± 0.05 respectively). The abdominal pseudo-compliance varied greatly among participants during muscular contraction, the coefficient of variation reaching up to 70 %. InterpretationThe combination of intra-abdominal pressure and dynamic MRI measurements enables the identification of participant-specific behaviour pattern. Intra-abdominal pressure and abdominal wall dynamic undergo consistent and predictable interactions. However, this relationship is subject-specific and may not be extrapolated to other individuals. Therefore, both intra-abdominal pressure and abdominal wall motion must be measured in the same participant in order to accurately characterise the abdominal wall behaviour. These results are of great importance for mesh design, surgical decision-making, and personalised healthcare.

Internal hernia following laparoendoscopic single site surgery: a case report

Laparoscopic donor nephrectomy was introduced in 1995 as a means of minimally invasive surgeries that entail kidney extraction from healthy individuals. Since then, it has widely overtaken the traditional open surgical approaches, especially in live donor nephrectomy procedures worldwide. Laparoendoscopic single-site surgery is considered a more optimized surgical approach utilizing a single incision instead of four. Various studies have scrutinized many of the risk factors related to such surgeries, most commonly: vascular problems, intraoperative organ injury, and postoperative ileus. Other rare complications have not been thoroughly explored due to their decreased prevalence. Internal hernias are considered a rare complication of laparoendoscopic single-site surgery with dangerous repercussions ranging from bowel obstruction to ischemia, and necrosis. Our study presents a rare case of a trans-mesenteric internal hernia following laparoendoscopic single-site surgery. The patient was relatively healthy with no serious medical conditions. However, the past medical history did record a diagnosis of irritable bowel syndrome a few years back. Knowing that the occurrence of internal hernias is infrequent, we recommend that mesenteric defects be taken seriously to avoid the risk of internal hernias and their complications.

Delayed Morbidity Associated with Surgical Management of Urosymphyseal Fistula

ObjectiveTo characterize and identify factors associated with long-term morbidity of definitive USF treatment. MethodsRetrospective chart review of a single institution database identified 57 patients who underwent operative treatment of USF between 2009-2022 with at least 90 days of follow-up. Delayed complications were considered those occurring ≥90 days following surgery. Morbidity related to surgery was assessed up to 10 years postoperatively. Statistical analysis was performed using Chi-Square, Fisher’s exact, and Mann Whitney-U tests. ResultsA total of 57 patients, median age of 71 years old, presented with USF. Delayed (>90d) postoperative complications requiring major intervention occurred in 26 (46%) patients at a median time of 11 months. Twelve (21%) patients required image-guided drain placement, 5 (9%) required nephrostomy tubes, and 14 (25%) patients required additional major surgery. The use of omentum, rectus, or no flap made no difference in hernia occurrence, or the type of hernia formed (p>0.05). Patients with recurrent osteomyelitis had smaller width of pubic bone resection (48mm vs 73mm, p=0.049). Delayed pelvic abscess formation was more common in patients who did not have flap interposition (40% vs 9%) (p=0.03). De novo or worsening sacral insufficiency (SI) fractures occurred in 14 (25%) patients. The width of pubic bone resection was not associated with developing new or worsening SI fracture (p=0.78). Durable resolution of pelvic pain was achieved in 40 (70%) patients and 49 (86%) patients were able to discontinue antibiotic therapy. ConclusionWhile definitive USF repair is associated with delayed morbidity most men are rendered free of infection and have resolution of pain following surgical treatment.

The Association of the Presence of Esophageal and Colonic Diverticula with Hiatal Hernia: A Cross-sectional Study.

This study investigates the association between the presence of diverticula in the colon and esophagus and the occurrence of hiatal hernia, seeking to understand potential shared pathophysiological underpinnings and risk factors. A cross-sectional study was conducted at a tertiary care center, including patients aged ≥18 years who underwent both gastroscopy and colonoscopy over 2 years. Exclusion criteria were prior gastrectomy or colectomy, incomplete medical records, and non-consent. The presence of hiatal hernia, colonic, and esophageal diverticulosis was identified via endoscopy. Logistic regression analysis assessed the associations, adjusting for age and sex. Among 3563 participants, males showed a higher prevalence of hiatal hernias compared to females (76.1% vs. 23.9%, P < 0.001). Hiatal hernia patients had a mean age of 51.28 years, slightly higher than those without (49.62 years, P = 0.034). A significant association was found between hiatal hernias and colonic diverticulosis (11.8% vs. 1.8%, P < 0.001), as well as between hiatal hernias and esophageal diverticulosis (2.4% vs. 0.3%, P < 0.001). Adjusted logistic regression revealed a 5-7 times higher likelihood of colonic diverticulosis in patients with hiatal hernias (odds ratio = 5.64, 95% confidence interval: 3.60-8.83; P < 0.001). The study demonstrates a notable association between hiatal hernias and the presence of both colonic and esophageal diverticula, suggesting common pathophysiological processes. These findings highlight the need for further research into shared risk factors and mechanisms underlying these conditions, potentially guiding improved management strategies for affected patients.

Comparison between Fibrin Glue vs Mechanical Mesh Fixation in Laparoscopic Inguinal Hernia Repair, A Prospective Study

Abstract Background Inguinal hernia repair is one of the most common surgical procedure in general surgery. The rate of occurrence of inguinal hernia is about 27– 43% in men and 3– 6% in women. An open or laparoscopic approach can be used. Mesh repair is recommended either by an open procedure or laparoscopic technique. There is no consensus on the best method to do inguinal hernia repair either open or laparoscopic. Objective To compare between glue vs mechanical mesh fixation in laparoscopic inguinal hernia repair as regard operative time, blood loss, hospital stay and short term complications. Patients and Methods This is a prospective comparative cohort study between fibrin glue versus mechanical mesh fixation in laparoscopic inguinal hernia repair. This study was conducted at (the General surgery department), Ain Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Between September 2022 and February 2023 with post-operative follow-up for maximum 6 months. Results There are many postoperative complications such seroma, numbness, wound infection and early recurrence. Early recurrence after open hernia repair which can occur in up to 63% of patients and affects quality of life in 5– 10% so there is increase in usage of the laparoscopic method to decrease the post-operative complication. Mesh fixation in laparoscopic inguinal hernia repair (LIHR) remains highly debated, being largely influenced by individual-surgeon preferences, the use of tackers or staples increase postoperative pain and associated with chronic and immediate postoperative pain and may risk neurovascular injury. Non-penetrative methods of mesh fixation using tissue glue have been used for LIHR, and been associated with improved postoperative complications and chronic pain. Conclusion The use fibrin glue in mesh fixation for laparoscopic inguinal hernia repair is a safe and viable option. It offers many advantages in terms of less fixation time, less seroma/hematoma rate and less wound infection. Whereas early recurrence and numbness was found to be similar in both groups.

Quality of life and abdominal wall functionality after abdominal wall reconstruction: A prospective single center follow-up study

BackgroundFascial breakdown with the occurrence of an incisional hernia (IH) is an important and challenging complication of any laparotomy. For a long time, the success of the abdominal wall reconstruction (AWR) was measured only from the surgeon’s perspective by defining outcome measures such as wound morbidity and recurrence. The understanding that complete recovery is difficult to assess without considering patients has shifted the paradigm of optimal outcomes to Patient Reported Outcome Measures (PROMS) and Quality of Life (QoL), which are pivotal to evaluate the success and efficacy of AWR.MethodsWe conducted a prospective follow-up study of 91 patients undergoing mesh-augmented abdominal wall reconstruction for primary or recurrent incisional hernia between January 2021 and December 2023. Demographic data, comorbidities, and hernia characteristics were recorded. All patients were evaluated preoperatively by a native abdomino-pelvic CT scan to assess the characteristics of hernia (length, width, surface, and volume of the incisional hernia sac and of peritoneal cavity), the presence of mesh (if previously inserted), and abdominal wall muscles status. All intervention were performed by the same surgical team according to the techniques described by Rives – Stoppa (RS), Ramirez (ACS), and Novitsky (PCS). Abdominal wall function was assessed using trunk raising (TR) and double leg lowering (DLL) measurements performed preoperatively, 1 month, 6 months, and 1 year postoperatively. At the same time, pre- and post-operative quality of life was analysed using the EQ-5D score.ResultsMean age of 59.42 ± 12.28 years and a male/female ratio of 35/56 were recorded, most of them being obese. There were 36 (42%) patients with defects larger than 10 cm. The distribution of the type of surgical intervention was: RS 35 patients, ACS 13 patients, and PCS 43 patients. The mean value of combined score for the preoperative abdominal wall functionality was 4.41 ± 1.67 (2–8) while the mean value of preoperative EQ-5D index was 0.652 ± 0.026 (-0.32–1.00). QoL was poor and very poor for 48% (44) of the patients who recorded index values less than 0.56 (50% percentile). Preoperative EQ-5D index was highly correlated with Combined AWF score (r = 0.620; p < 0.0001) and the correlation was specific (AUC = 0.799; p < 0.0001; asymptotic 95%CI = 0.711–0.923). At 12 months, the AWF score increased to 8.13 ± 2.58 (1–10) and the QoL total score to 0.979 ± 0.007 (0.71–1). Good and very good total scores for QoL were recorded for 47 patients (84%) compared to 33 (36%) in the preoperative evaluation (χ2 with Yates continuity correction for two degrees of liberty = 46.04; p < 0.00001).ConclusionOur results suggest that patients can expect to see a significant overall improvement in all five components of QoL measured with the help of Eq. 5D questionnaire. This improvement is dependent by hernia size, and some individual patient’s factors (diabetes, cardiovascular diseases, and age over 60 years).

542. POST-ESOPHAGECTOMY PARACONDUIT HIATAL HERNIA DEVELOPMENT AND RECURRENCE

Abstract Background Hiatal hernia post esophagectomy is a delayed postoperative complication. Historically, in open surgery, the incidence is rare. The increased utilization of minimally invasive methods has increased the incidence of hiatal hernias. Current literature is limited to case series. There is even less on frequency and management of re-recurrent cases. Our objectives were to identify the incidence of hiatal hernia post esophagectomy and the outcomes of the recurrent cases. Methods A retrospective analysis of prospective data at a single center was conducted on esophagectomies performed 2017 to 2022. Non-gastric conduit reconstructions were excluded. Baseline patient demographics including comorbidities, type of tumor, neoadjuvant therapy, surgical approach (open versus minimally invasive [MIE]), and conduit construction were recorded. Radiographic presence of non-gastric conduit abdominal contents was defined as hiatal hernia. Time of hiatal hernia occurrence, details of the repair and timing re-recurrence was recorded. Associated factors described in literature including baseline demographics, neoadjuvant therapy, operative technique, conduit diameter and use of pexy techniques were analyzed with univariate analysis. P&amp;lt;0.05 was considered significant. Results A total of 565 esophagectomies met inclusion criteria, 78% (439/565) were MIE. Robotic-assisted comprised 33% (143/439) of the MIE cohort. A hiatal hernia was identified in 3% of patients (15/565). All had malignancy and were Ivor Lewis (11/15, 73%) or 3-hole (4/15, 27%). The majority had an MIE (13/15, 86%), one had open esophagectomy (6%), and one had hybrid (1/15, 6%). There was no difference in risk factors between the hernia and non-hernia groups. Median time to hernia was 5 months (IQR: 4, 12). All underwent repair. Recurrent hernia occurred in 33% of patients (5/15), all within the robotic-assisted MIE. Conclusion Hiatal hernia post esophagectomy occurred in 3% of cases, and most cases occurred within the MIE group. Recurrence of hernias occurred in robotic-assisted esophagectomy patients. Analysis of patient-specific factors such as prior hiatal hernia, body-mass index, neoadjuvant therapy, operative technique, conduit pexy technique all did not reveal significant correlation with hiatal hernia development. The recurrence of hiatal hernia all required redo repairs. Though we had no deaths in the hiatal hernia cohort, repeat surgeries affect morbidity in esophagectomy patients. Further analysis is needed to identify ways to minimize hernia recurrence in minimally invasive esophagectomy.

Epidemiology and Risk Factors for Recurrence of Inguinal Hernia

Following inguinal hernia surgery, the risk of recurrence is a major clinical concern. The issue involves several recurrent risk factors, including surgery. We have recognized the approach, recurrence, and familial background. Patient-related variables, while not technically complex, have an impact on the risk. Few studies have examined the risk of recurrence following inguinal hernia surgery. The statistical features of inguinal hernia incidence Both initially and later on, in addition to examining the patient's There are several factors that can lead to the failure of inguinal hernia surgery. The thesis includes research on historical and ecological issues. The epidemiologic data for groin hernias nationwide has been revealed. The geographical distribution of groin hernias and the risk of non-technical exposure is being investigated. elements linked to the recurrence of symptoms. According to the results, mundane, Characteristics that are specific to the patient have a significant impact on the risk. The incidence of recurrence following inguinal hernia repair is an important consideration. The rationale behind , combination of factors likely contribute to the recurrence of inguinal hernias, which typically occur in the range of patient-related risk factors, both technical and non-technical, are present. Furthermore, there are various types of groin hernias that can individual pathophysiologies. We need to put this knowledge into practice. utilized in clinical settings to reduce the risk of recurrence.Regarding the design of future studies that investigate recurrence after the consequence of inguinal hernia surgery Methods: All patients admitted to the hospital exhibited groin edema, soreness, or both. We palpated the patient's groins on all sides to look for a hernia, impulse, or scar from a prior procedure. We recorded additional details about the hernia, such as its primary or recurring nature. Results showed that the most prevalent age group was 31–60 years old, and that out of the 140 patients, 79.2% were male and 20.8% were female. While 25.5% of the cases were recurrent hernias, 74.5% were primary hernias. Although a small percentage of individuals experienced swelling for longer than two years, the vast majority experienced it for no more than six months. Incorrect defecation (46.7% of cases) and excessive lifting (52.4%) were the leading causes of hernias. Conclusions In order to aid future research in predicting the occurrence of inguinal hernias, it is necessary to undertake this type of study in every geographical location. Aim of study to show recurrence inguinal hernia after surgery related to epidemiology and risk factors.

A Clinical Study of Anterior Abdominal Wall Hernias and Its Management: A Medical College Experience.

Objective We aim to evaluate the various risk factors contributing to the occurrence of anterior abdominal wall hernias and assess the various surgical modalities. Materials and methods This prospective observational research was conducted between 2022 and 2024 at a tertiary care health center, involving 100 participants with an anterior abdominal wall hernia diagnosis aged over 14 years. The study excluded patients under 14 years with bleeding diathesis, inherited coagulopathies, inguinal or femoral hernias, or recurrent ventral hernias. Participants underwent detailed clinical examinations and biochemical evaluationsand underwent a primary ultrasonography (USG)/contrast-enhanced computed tomography (CECT) to determine defect size. Risk factors were documented, including age, gender, occupation, body mass index (BMI), comorbidities, previous surgery history, multiparity, smoking, chronic straining due to constipation or benign prostatic hyperplasia (BPH), malnutrition, chronic steroid use, chronic renal failure, and chronic liver disease. The surgical procedure was determined by the same surgical team for all cases. Standard antibiotic prophylaxis and preoperative painting/draping protocols were followed in all cases. Intraoperatively, intraoperative time (in hours) was documented. Postoperative parameters included pain, hematoma formation, seroma formation, surgical site infections (SSIs), and early recurrence. These intra- and postoperative findingsconstituted the primary outcome parameters. Secondary outcome parameters included hospital stayduration and time taken to return to work. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 16 (IBM SPSS Statistics, Armonk, NY) software. Results The study analyzed the occurrence of ventral hernias in 100 patients, with the fourth decade having the highest occurrence (n=42 (42%)). The majority of the participants were male (female: n=47 (47%), male: n=53 (53%)). The majority of the participants were laborers, and 24% (n=24) were office workers. The study found that hypertension, diabetes mellitus, and chronic obstructive pulmonary disease were risk factors for hernias. Other risk factors included obesity, previous history of surgery, multiparity, smoking, chronic straining, malnutrition, and chronic steroid use. The most common type of ventral hernia was umbilical hernia (n=33 (33%)), followed by paraumbilical hernias (n=30 (30%)), and incisional hernias (n=20 (20%)). Of the 100 patients, 74% underwent open hernia repair, with the mean operation time being minimal in cases managed with laparoscopic repair (2.5±0.67 hours). Postoperative painwas highest with the Rives-Stoppa (RS) repair with component separation group. The incidence of surgical site infection was the maximum among cases of open anatomical repair (41.7%), followed by RS repair (31.3%), while it was the minimum in laparoscopic repair (3.7%). Early recurrence was lower in the laparoscopic group (n=1 (3.7%)). Conclusion The study highlights risk factors for abdominal wall hernia and management approaches. Understanding these is crucial for identifying and preventing recurrence. Surgeons must choose the right surgical approach based on patient health and symptoms to achieve desired outcomes and minimize complications. In addition, surgical expertise, availability of resources, and knowledge of what works best for the surgeon constitute important determinants of surgical outcomes.

Hiatal hernia after laparoscopic radical gastrectomy for cardia cancer Case report

To analyze the occurrence and clinical features of hiatal hernias following laparoscopic radical gastrectomy for cardia cancer, and discuss potential causes and methods of prevention and treatment

Anatomical observations on 30 cadavers: new insights into the relationship between the posterior wall of the inguinal canal and the cremaster

PurposeClarify the composition of the Posterior wall of the Inguinal Canal(PWIC), the location and composition of the Transverse Fascia(TF), and the tissue origin of the Cremaster(C) by observing the anatomy of the inguinal region of the cadaver.Methods30 cadavers were dissected to observe the alignment of the muscles and fascia of the inguinal canal and the anterior peritoneal space. the anatomical levels of the posterior wall of the inguinal canal and the alignment of the Spermatic Cord(SC) were observed.Results(1) The posterior wall of the inguinal canal was white, bright, and tough tendon membrane-like tissue; (2) the transverse fascia was a thin fascial tissue with only one layer of membranous structure located in the abdominal wall under the abdominal wall on the side of the blood vessels of the peritoneal cavity; (3) the internal oblique muscle and its tendon membrane, and the transversus abdominis muscle and its tendon membrane extended on the surface of the spermatic cord, and fused and continued to the cremaster on the surface of the spermatic cord.Conclusions1. PWIC is mainly composed of Internal oblique muscle of abdomen (IOMA), Aponeurosis of internal oblique muscle of abdomen (AIOMA), Transverse abdominal muscle (TAM), and Transverse abdominal aponeurosis(TAA) as the following four types: (1) TAM and AIOMA fused to form a tendinous layer; (2) IOMA and TAM form the posterior wall of the muscle in the PWIC; (3) IOMA and AIOMA continue in the PWIC; 4) TAM and TAA continue in the PWIC. 2.TF is a thin fascial tissue with only one layer of membrane structure, TF is not involved in the composition of PWIC, so this fascia has nothing to do with resisting the occurrence of inguinal hernia. 3. The spermatic cord that travels in the inguinal canal is fixed to the lower wall of the inguinal canal by the tendon membrane of the cremaster, which is organized from the internal oblique and transversus abdominis muscles and their tendon membranes, The inguinal canal is a musculotendinous canal.

Management and Outcomes for Peritoneal Dialysis Patients Diagnosed with Abdominal Hernias.

The success of peritoneal dialysis is highly dependent on the integrity of the abdominal wall. Therefore, routine examination and treatment of abdominal hernias can prevent peritoneal dialysis (PD) failure, discontinuation, and conversion to hemodialysis. In this present study, we present our examination protocol for patients proposed for PD and our attitude in treating parietal defects in patients on peritoneal dialysis. highlight whether PD is a risk factor for the occurrence of ventral hernias, the relationship between associated pathologies and the occurrence of hernias and the need for an HD switch in the postoperative period. Between January 2016 and December 2022, a group of 133 patients proposed for insertion of a PD catheter were evaluated according to the protocol established by our hospital. Routine examination for the diagnosis of abdominal hernias and repair before starting the DP is part of the procedure. We included patients with a 3 year minimum follow-up after insertion and evaluated the incidence of parietal defects that appeared during PD treatment. Nine patients were diagnosed and operated on for abdominal hernia before starting peritoneal dialysis and none of them had a recurrence of hernia during PD. Twelve patients were diagnosed with abdominal hernias during dialysis treatment (9% incidence) and the median length of time at which parietal defects occur during PD is 12.5 months [range 2-48]. Median BMI is 27.12 [range 22.3-31.24], with a female-male ratio of 2:1 Five patients were transferred to HD, three permanently and two patients temporarily. No patient abandoned PD treatment due to the presence of an abdominal parietal defect. Diagnosis of ventral hernias prior to the time of catheterization for PD leads to a decrease in the incidence of parietal defects during PD and is mandatory in patients who are candidates for PD. Open alloplastic surgical procedures are safe procedures with a low recurrence rate in PD patients. The postoperative continuation of PD is feasible but the decision is to be made by the multidisciplinary team and individualized for each patient.

Wound healing and hernia after abdominal aortic aneurysm repair: Onlay self-gripping polyester mesh reinforcement compared with small bite sutured closure.

Prophylactic mesh implantation following open surgical repair of abdominal aortic aneurysm is a debatable subject. To assess the efficacy of a self-gripping polyester mesh used in on-lay technique to prevent incisional hernia after open abdominal aortic aneurysm repair. We retrospectively reviewed the records of 495 patients who underwent aortic surgery between May 2017 and May 2021. Patients included in the study underwent open surgical repair for infrarenal abdominal aortic aneurysm (AAA) with closure of the abdominal wall with either small bite suture technique or prophylactic mesh reinforcement. Primary endpoint of the study was the occurrence of incisional hernia during a two-year follow-up period. Secondary endpoints were mesh-related complications. Mesh implantation with the on-lay technique was successful in all cases. No patient in the mesh group developed an incisional hernia during the 24-month follow-up period. Two patients in the non-mesh group developed a symptomatic incisional hernia during the follow-up period at 6 months. Three cases of post-operative access site complications were observed in the mesh group. Application of a self-gripping polyester mesh using the on-lay technique demonstrates acceptable early-durability after open surgical repair of abdominal aortic aneurysms. However, it appears to be associated with a number of post-operative access site complications.

The downregulation of genes encoding muscle proteins have a potential role in the development of scrotal hernia in pigs.

Testicular descent is a physiological process regulated by many factors. Eventually, disturbances in the embryological/fetal development path facilitate the occurrence of scrotal hernia, a congenital malformation characterized by the presence of intestinal portions within the scrotal sac due to the abnormal expansion of the inguinal ring. In pigs, some genes have been related to this anomaly, but the genetic mechanisms involved remain unclear. This study aimed to investigate the expression profile of a set of genes potentially involved with the manifestation of scrotal hernia in the inguinal ring tissue. Tissue samples from the inguinal ring/canal of normal and scrotal hernia-affected male pigs with approximately 30 days of age were used. Relative expression analysis was performed using qPCR to confirm the expression profile of 17 candidate genes previously identified in an RNA-Seq study. Among them, the Myosin heavy chain 1 (MYH1), Desmin (DES), and Troponin 1 (TNNI1) genes were differentially expressed between groups and had reduced levels of expression in the affected animals. These genes encode proteins involved in the formation of muscle tissue, which seems to be important for increasing the resistance of the inguinal ring to the abdominal pressure, which is essential to avoid the occurrence of scrotal hernia. The downregulation of muscular candidate genes in the inguinal tissue clarifies the genetic mechanisms involved with this anomaly in its primary site, providing useful information for developing strategies to control this malformation in pigs and other mammals.

Evaluation of the Risk Factors for the Incisional Hernia Occurrence After Robot-Assisted Laparoscopic Radical Prostatectomy.

Objective: Our aim was to evaluate patient-related factors and compare the techniques used for surgical specimen removal [trocar extension (TE) and Pfannenstiel incision (PF)] in terms of incisional hernia (IH) occurrence in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP). Materials and Methods: The records of 219 patients who underwent RALRP in our clinic between November 2017 and March 2021 were analyzed retrospectively. Postoperative complication data and functional (continence and potency status) and oncological outcomes were recorded. Hernia type, location, and treatments applied were also noted. Results: After exclusion, complete data were available on 192 patients undergoing RALRP between the specified dates. The TE technique for removing the surgical specimen was performed in 135 patients, and the lower abdominal transverse incision technique (PF) in 57 patients. Preoperative patient- and tumor-related characteristics (age, body mass index [BMI], American Society of Anesthesiologists (ASA) score, T stage, and prostate size) were similar in both surgical groups. IH was detected in 16 patients (14 in the TE group and 2 in the PF group) (P = .156). Thirteen patients underwent surgery for IH, and three were followed up clinically. Conclusion: In our study, no statistically significant demographic or surgical technique-related factors were found to explain the occurrence of IH in patients who underwent RALRP for prostate cancer. It was observed that IH occurred more frequently in the cases where the surgical specimen was removed with the TE technique compared with the PF incision, but this result was not statistically significant. There was also no statistically significant difference between these two groups regarding oncological and functional outcomes in the early postoperative period.

Evaluation of the Role of Ultrasonography in Predicting a Metachronous Contralateral Inguinal Hernia in Children

Abstract Background Inguinal hernia remains one of the most common surgical disorders in children. Almost all pediatric hernias are indirect. The incidence of pediatric inguinal hernia is highest during the first year of life and then gradually decreases thereafter. The incidence of contralateral occurrence of an inguinal hernia after unilateral herniorrhaphy has been reported as 5.6 to 22%. The management of the contralateral inguinal hernia in a child with unilateral CIH has been always debated. Routine contralateral exploration of the inguinal canal has been practiced by many surgeons. Routine contralateral exploration may be associated with a high incidence of negative exploration and lengthening of the operative time in addition to possible increasing morbidity in those patients. Aim of the Work This study aims to evaluate the role of preoperative assessment by ultrasonography in predicting contralateral inguinal hernia in children with unilateral inguinal hernia without clinical evidence of contralateral inguinal hernia. Patients and Methods Fifty infants and children presented to pediatric surgery clinic at Ain Shams University and Nasr City Health Insurance Hospitals aged 1 month till 12 years of age complaining of unilateral inguinal hernia without clinical evidence of contralateral inguinal hernia underwent preoperative US. Results Cases with a width of the contralateral side &amp;gt;3.5 mm at the level of the internal ring determined using the US are likely to be at high risk of developing a contralateral hernia with a sensitivity of 80.0%, specificity of 77.5%, and area under the curve (AUC) of 78.4%. Conclusion Ultrasonography is a rapid, sensitive, convenient, and non-invasive method for screening patients with contralateral occult CIH. It is a reliable tool for preventing unnecessary exploration or additional operations at a later stage. It can be performed in all cases of inguinal hernia to determine the necessity for contralateral exploration. Children having a width of contralateral side &amp;gt;3.5 mm at the level of the internal ring determined using the US are likely to be at high risk of developing a contralateral hernia with a sensitivity of 80.0%, specificity of 77.5%, and area under the curve (AUC) of 78.4%.Therefore, we recommend routine preoperative use of ultrasonography for all patients with unilateral CIH to determine which patient should be subjected to a contralateral exploration.

247 Prophylactic Use of 3D Intraperitoneal Mesh in the Prevention of Parastomal Hernia in Permanent Colostomies After Rectal Cancer Resection

Abstract Background Parastomal hernia (PSH) is the most common complication of stomas associated with significant morbidity. Prophylactic mesh in preventing PSH is less well studied, and evidence is conflicting. We compare PSH rates in patients in whom 3D intraperitoneal mesh was and was not used prophylactically in a cohort of rectal cancer patients undergoing elective curative resection. Method Retrospective data from the Somerset Database and Electronic Patient Record were collected on patients under a single consultant surgeon between May 2016 and December 2021. Follow up was for a minimum of 2 years (excluding deaths). Appropriate statistical tests of difference significance were performed for proportions of categorical data, and time to hernia occurrence in patients with and without Dynamesh IPST placement. (Fisher’s Exact test; Kaplan Meier) Results From 397 colorectal cancer patients under the care of a single surgeon, 223 had elective surgery with curative intent, of which 63 (28%) underwent total mesorectal excision (TME) (30 TME &amp; ileostomy, 12 TME Hartmann and 21 APER) - 90% laparoscopic. 16 patients had prophylactic mesh used. Demographics and co-morbidities between groups were similar. PSH incidence was 1 (6%) (radiological) vs.7 (41%) (clinical) in the mesh vs. non-mesh group; P=0.039. Post operative complications and pain scores differed only slightly. Time to hernia development did not differ between groups. Conclusions Use of prophylactic mesh during permanent stoma formation in our practice appears safe, and effective in preventing PSH. Further studies may answer the question “Should 3D collared mesh be routinely placed during the formation of permanent stomas to prevent parastomal hernia?”