Protrusion Of Abdominal Contents Research Articles

Comparative study of mesh fixation versus without mesh fixation in laparoscopic inguinal hernia repair by TAPP approach

Background: An inguinal hernia is a protrusion of abdominal contents through the inguinal canal. Laparoscopic TAPP inguinal hernia repair without mesh fixation is comparitively easy and safer than TAPP with mesh fixation with no increase in recurrence rate. Hence the current study was conducted to analyse complications after laparoscopic inguinal hernia repair (TAPP) with mesh fixation vs without mesh fixation in patients with inguinal hernia. Patients has provided informed consent for publication. Methods: It was an observational cohort study, comparing the outcome in 60 patients undergoing laparoscopic TAPP for inguinal hernia, where patients were randomly allotted into two groups as 30 with mesh fixation and 30 without mesh fixation over a period of two years October 2020 to September 2022. Results: In the current study, we observed that recurrence was reported among 3.33% study subjects without mesh fixation. While Recurrence reported among 6.67% study subjects with mesh fixation. However, the difference in the observations was statistically not found to be significant and there is significant reduction in postoperative pain, operation duration and hospital stay duration in laparoscopic TAPP without mesh fixation group. Conclusions: It was observed that laparoscopic TAPP repair without mesh fixation does not increase recurrence rate but reduces operative duration, hospital stay duration and decreases the incidence of postoperative pain compared to laparoscopic TAPP with mesh fixation.

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.

An uncommon hernia with an uncommon presentation: a case report on obturator hernia with ileal transection

Obturator hernia is a rare pelvic hernia with an incidence of 1%. It is the protrusion of abdominal content through the obturator foramen. Here we report a rare case of obturator hernia in thin, emaciated female patient of age 60 years with complication of ileal transection, hence emphasizing early presentation and diagnosis.

A Study to Assess the Effectiveness of Thoracic Expansion Exercise and Diaphragmatic Breathing Exercise in Post-Operative Hernia Patients to Improve Pulmonary Functions with and without Incentive Spirometry. - A Comparative Study

BACKGROUND: Hernia is the protrusion of abdominal content through the abdominal wall. The causes of the hernia are overstraining, lifting of overweight, chronic cough, chronic constipation, obesity, urinary causes or old age people with benign prostrate hypertrophy and carcinoma prostate, young age with stricture urethra and also pregnancy. Atelectasis is one of the common pulmonary complications in any abdominal surgery. Incentive spirometry is an adjunct to chest physiotherapy as a portable & hand-held device prescribed after postoperative lung complications. Either flow-oriented or volume-oriented IS devices are available. The chamber of a flow-oriented IS device has three connected columns, and inside are floats made of lightweight plastic. A flexible tube is joined to the chamber. IS seems to be an effective tool to improve lung function. METHODOLOGY: 46 samples were divided into 2 groups. Group A & Group B each group has 23 subjects. Group A received thoracic expansion exercise and diaphragmatic breathing exercise with incentive spirometry and Group B received thoracic expansion exercise and diaphragmatic breathing exercise without incentive spirometry for a period of 10 days. The pre and post-test - pulmonary function and thoracic expansion measurements were recorded both before and after the intervention of 10 days. RESULTS: The results suggest that there is a significant improvement in pulmonary function and an increase in thoracic expansion in both groups (Group A and B). But it is improved significantly in those who underwent thoracic expansion exercise and diaphragmatic breathing exercise with incentive spirometry (Group A) than in those who underwent thoracic expansion exercise and diaphragmatic breathing exercise without incentive spirometry (Group B). CONCLUSION: The conclusion of this study is that the effects of thoracic expansion exercise and diaphragmatic breathing exercise with incentive spirometry show significant improvement among post-operative hernia patients, increase the pulmonary function and thoracic expansion when compared to those who underwent thoracic expansion exercise and diaphragmatic breathing exercise without incentive spirometry.

Incarcerated obturator hernia, an extremely rare cause of intestinal obstruction: case series.

Protrusion of abdominal contents through the obturator foramen is a rare type of abdominal wall hernia. It is usually seen unilaterally and right-sided. Predisposing factors are old age, high intra-abdominal pressure, pelvic floor dysfunction, and multiparity. Obturator hernia has one of the highest mortality rates of all abdominal wall hernias, with a difficult diagnostic process that can be misleading even for the most experienced surgeons. Therefore, to suspect and easily diagnose an obturator hernia, it is important to understand its characteristics. Computerized tomography scanning remains the best diagnostic tool with the highest sensitivity. Conservative ap-proach is not recommended in obturator hernia cases. Once diagnosed, urgent surgical repair is indicated to prevent further ischemia, necrosis, and risk of perforation that can lead to peritonitis, septic shock, and death. Although open repair is a widely used and effective method for reducing abdominal hernias, including obturator, laparoscopic repairs have been described and become preferred. In this study, we present female patients aged 86, 95, and 90 years who were operated with the diagnosis of obturator hernia on computed tomography. The diagnosis of obturatory hernia should always be kept in mind, especially in the presence of acute mechanical intestinal obstruction findings in an elderly woman.

HUBUNGAN USIA DENGAN JENIS HERNIA INGUINALIS DI RS PERTAMINA BINTANG AMIN LAMPUNG

Hernia is a condition where part of the intestines comes out of the abdominal cavity to form a bulge that can be seen and felt from the outside. In general, people who have reached old age, hernia is a disease that often occurs at that age, because the smooth muscle wall of the abdomen weakens in old age, so it is very risky for hernias to occur. This disease is characterized by the protrusion of abdominal contents through a weak part of the abdominal wall, this disorder is mainly found in the groin area. Increasing a person's age has an impact on decreasing system function in the body so that they are more susceptible to various diseases. Increasing age is also closely related to the prognosis of a disease and life expectancy. This study aimed to determine the relationship between age and the type of inguinal hernia at Pertamina Bintang Amin Hospital Bandar Lampung in 2019-2020. This type of research was cross -sectional. Sampling was done by total sampling. Bivariate data analysis withtest Spearman's. Statistical analysis using thetest Spearman showed the p-value for the analysis of the relationship between age and the type of inguinal hernia was 0.033 (p-value < 0.05). There was a relationship between age and type of inguinal hernia at Pertamina Bintang Amin Hospital Lampung in 2019-2020. Health institutions should be able to provide counseling related to the relationship between old age and inguinal hernia and conduct early inguinal hernia screening to the public.

Eventration of Diaphragm: A Rare Cadaveric Case Report

The respiratory diaphragm is a barrier between the thoracic and abdominal cavities. It is a chief skeletal muscle of respiration that plays a critical role in the process of inspiration. The defective diaphragm may be clinically present with or without obvious symptoms. Depending on the severity of its defects, it can lead to mild to severe fatal consequences. Protrusion of abdominal contents into the thoracic cavity through the weakened or defective part of the diaphragm is known as a diaphragmatic hernia. Such herniations will exist either in the form of congenital birth defects or acquired defects in the diaphragm. An acquired hernia may be due to spontaneous or iatrogenic causative factors. Congenital Diaphragmatic Hernia (CDH) can occur due to the disruption of various cellular mechanisms involved in organogenesis during the gestation period. Such herniations may exist with or without content protrusions into the cavity of the thorax, later referred to as Eventration of the Diaphragm (ED). In the Department of Anatomy at JSS Medical College, Mysuru, Karnataka, India, a rare case of diaphragmatic eventration was noticed in a male cadaver aged about 70 years, during the routine dissection class of preclinical medical students. In this rare case report, diaphragmatic eventration along with various factors involved in its presentation would be considered holistically

P034 STRANGULATED DIAPHRAGMATIC HERNIA: TEN CASES REPORTS

Abstract Aim A diaphragmatic hernia (DH) is a protrusion of abdominal contents into the thoracic cavity as a result of a defect within diaphragm. It is most common as a congenital phenomenon; however, there have also been cases where it can be acquired. DH can be life-threatening, resulting in incarceration and strangulation. Material and Methods From June 2009 to April 2021, ten cases of strangulated diaphragmatic hernia were admitted to our Emergency Surgery Department of General Surgery with respiratory and abdominal symptoms. Patients' characteristics, operation details, and postoperative complications were retrospectively analyzed. Results There were 5 (50%) men and 5 (50%) women with a mean age of 66 years (range, 20–85 years). . Emergency surgery was performed by laparoscopic in 4(40%) patients and open in 6(60%) patients. Two patients had a history of penetrating trauma to the left thoracoabdominal region. Segmental bowel resection was performed in 3 patients and total gastrectomy in 1 patient. Reconstruction was not performed in the patient who underwent total gastrectomy due to ischemia and perforation. In the postoperative period, wound infection was observed in 2 patients. Anastomotic leakage was observed in 1 patient and treated with end enterostomy. Empyema was observed in one patient after discharge, the empyema was evacuated and thoracoscopic decortication was performed .The patient who underwent total gastrectomy died due to septic shock and comorbid diseases. Conclusions Strangulated diaphragmatic hernia is a life-threatening condition and requires emergency surgery. Laparoscopic techniques can also be used in treatment.

Evaluation of Laparoscopic Versus Open Repair for Inguinal Hernias

Background: The inguinal hernia is a protrusion of abdominal contents into the inguinal canal through an abdominal wall defect, and the risk of inguinal hernia increases with age. Currently, inguinal hernia repair with a mesh is the mostly common method through surgical procedure. Objective: To compare the outcome of laparoscopic versus open repair for inguinal hernias. Patients and Methods: This prospective comparative study conducted at General Surgery Department, Faculty of Medicine, Zagazig University at the period between January 2021 till July 2021, between open technique (preperitoneal approach, conventional Lichtenstein repair) versus laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) mesh repair of inguinal hernia. 24 patients were randomized into 2 groups by the closed envelop method, 12 patients underwent open repair operation and 12 patients underwent laparoscopic repair operation. The clinical diagnosis of inguinal hernia was based on symptoms and signs elicited during clinical assessment. Results: we found that mean duration of operation in laparoscopic group was longer than open group with significant difference, as regard length of hospital stay there was significant differences between two groups. Return to daily activity (Days) was early among laparoscopic inguinal hernia repair group with mean 1.67±0.49 and range from 1 to 2 days versus 4.58±1.5 with range from 3 to 7 days in open repair for inguinal hernia group, the difference was highly statistically significant. Conclusions: Laparoscopic surgical techniques for inguinal hernia repair (TAPP and TEP) can be carried out with a very low rate of predominantly harmless complications and with an acceptable duration of operation.

Right-sided strangulating diaphragmatic hernia in an adult without history of trauma: a\xa0case report

BackgroundDiaphragmatic hernia involves protrusion of abdominal contents into the thorax through a defect in the diaphragm. This defect can be caused either by developmental failure of the posterolateral foramina to fuse properly, or by traumatic injury of the diaphragm. Left-sided diaphragmatic hernias are more common (80–90%) because the right pleuroperitoneal canal closes earlier and the liver protects the right diaphragm. Diaphragmatic hernias in adults are relatively asymptomatic, but in some cases may lead to incarcerated bowel, intraabdominal organ dysfunction, or severe pulmonary disease. The aim of this report is to enlighten clinical doctors about this rare entity that can have fatal consequences for the patient.Case presentationWe present a rare case of a right-sided strangulating diaphragmatic hernia in an adult Caucasian patient without history of trauma. Clinical examination revealed bowel sounds in the right hemithorax, which were confirmed by the presence of loops of small intestine into the right part of the thorax through the right diaphragm, as was shown on chest X-ray and computerized tomography. Deterioration of the clinical status of the patient led to an operation, which revealed strangulated necrotic small bowel. Approximately 1 m of bowel was removed, and laterolateral anastomosis was performed. The patient had an uneventful postoperative recovery and was discharged 8 days later.ConclusionsSurgery is required to replace emerged organs into the abdomen and to repair diaphragmatic lesion. A delayed approach can have catastrophic complications for a patient.

Laparoscopic Versus Open Retrorectus Mesh Repair of Incisional and Ventral Hernia: A Randomised Clinical Study

Introduction: Hernias are defects or holes in the abdominal wall with protrusion of abdominal contents and are common problems in daily surgical practice. The defects can develop following previous surgical procedure or can be primary in the absence of any past surgery. The operative repair of these hernias can be done by either open procedure or laparoscopic surgery. Aim: To compare the laparoscopic hernia repair with open surgical repair in terms of operative time, hospital stay, pain, complications, cost and recurrence. Materials and Methods: This randomised clinical study was conducted from April 2015 to December 2019. Patients undergoing elective surgery for primary ventral hernias and incisional hernias were included. There were 50 patients who underwent open mesh repair and 50 patients who had laparoscopic repair. The data was analysed using Mann-Whitney U test for continuous variables and Chi-square test for categorical variables. Results: The patients were comparable for age and sex distribution and also the type of hernia, primary ventral or incisional, size of defect and body mass index in both the groups. The patients undergoing laparoscopic mesh repair had significantly less operative time (90 vs 110 minutes, p=0.036), reduced postoperative pain (p=0.001) and decreased hospital stay (3.47 vs 6.43 days p=0.0005). The cost of the laparoscopic surgery was significantly high (p-value 0.0001) basically owing to the cost of mesh and disposable tacker. The recurrence at mean follow-up of 13 months was similar in both the groups. Conclusion: Laparoscopic hernia repair is superior to open repair in select group of patients with small and medium size defects without loss of abdominal domain if cost is not a consideration.

Congenital Diaphragmatic Hernia (Bochkdalek)—Becomes Symptomatic in Seventh Decade of Life—a Rare Case Report

Congenital diaphragmatic hernia (CDH) is a condition characterized by defect in the diaphragm which leads to protrusion of abdominal contents or viscera into the thoracic cavity interfering with normal development of the lungs. CDH is a developmental defect of diaphragm associated with significant neonatal mortality and morbidity. Incomplete development of diaphragm allows the abdominal content to invade the thoracic cavity resulting in compression of the developing lungs. Most of the CDH diagnosed in the new born or early childhood. Around 1% with CDH have no symptoms and may be detected incidentally. Diaphragmatic hernias can be divided into two broad categories: congenital and acquired. A congenital diaphragmatic hernia (CDH) occurs through embryologic defects in the diaphragm, and most patients present early in life rather than later. However, a subset of adults may present with a smaller CDH that was undetected during childhood. Infants with CDH often present in the neonatal period with severe respiratory distress. Early surgery is mainstay of treatment in newborn as mortality is very high in this condition. Here, we are describing very late presentation of a case of congenital diaphragmatic hernia treated by surgery with good post operative outcome. This case report summarizes how to diagnose and manage a late-presenting congenital diaphragmatic hernia to prevent further complications.

Resolução cirúrgica de eventração inguinal em tartaruga terrestre argentina (Chelonoidis chilensis) – relato de caso

Eventration is a separation of the musculoaponeurotic layers of the abdominal wall resulting in protrusion of abdominal contents, and characterized by the absence of the hernial sac and intact skin. We describe a case of chronic left sided eventration associated with deformity of the right femoral fossa in a 30-year-old female Argentine land tortoise. The animal was referred for evaluation of a soft and non-painful deformity of the left lumbar fossa and third degree lameness of the left posterior limb. Eventration of one bladder lobe and oviduct loops was diagnosed by ultrasonography. We describe the anesthetic protocol and the surgical technique used in the treatment with approach to the coelomic cavity through the prefemoral fossa, as well as the resolution of the abdominal wall defect.

A comparative study of laparoscopic trans abdominal pre peritoneal ventral hernia repair versus open pre peritoneal ventral hernia repair

Background: Ventral hernias are defined as a protrusion of abdominal contents through the abdominal wall muscle. It can be categorised as spontaneous or acquired or by their location on the abdominal wall like epigastric hernia, umbilical hernia, para umbilical hernia etc. This original article reveals that laparoscopic trans abdominal pre peritoneal (TAPP) mesh placement for ventral hernia usually follows the current principle of hernia surgery and give better results from open pre peritoneal ventral hernia repair.Methods: A prospective study conducted in Dr. D. Y. Patil Medical College and Hospital, Pune for the period of 2017-2019 comparing laparoscopic TAPP vs. open preperitoneal ventral hernia repair. Total of 25 patients for laparoscopic TAPP repair and 25 patients for open preperitoneal repair were compared.Results: Total 50 cases were studies in which 25 for laparoscopic and 25 for open repair. Majority of patients were female than males. Incidence of para umbilical (56%) was found to be more. Intra operative, post-operative complications were found to be more in open repair than laparoscopic TAPP repair.Conclusions: Laparoscopic TAPP ventral hernia repair is safe with fewer complications. Therefore, offers successful treatment for ventral hernia repair with added benefits of laparoscopy such as better visualization and magnification of the hernia defects which are not clinically apparent and less chances of injury which is not possible by open technique. Laparoscopic TAPP ventral hernia repair gives equal results in terms of recurrence and less complications than open ventral hernia repair.

Incidental Hiatal Hernia on Chest X-ray

History of present illness: A 58-year-old male with history of smoking presented to the emergency department for productive cough, subjective fevers, shortness of breath, and pleuritic chest pain. Patient was discharged three days prior from another hospital where he was admitted for pneumonia and chronic obstructive pulmonary disease (COPD) exacerbation. He was discharged with prescriptions for antibiotics and steroids, which he did not fill. On exam, patient was afebrile and hemodynamically stable. Labs including respiratory syncytial virus and influenza panel were negative. Significant findings: The two-view chest X-ray shows mild opacification of the bilateral lower lobes concerning for pneumonia (red arrows). Incidental retrocardiac opacity with air-fluid level consistent with large hiatal hernia is also observed (green arrow). Discussion: A hiatal hernia (HH) is defined as a protrusion of abdominal contents into the thoracic cavity through the diaphragmatic esophageal hiatus.1 HHs can be congenital (1/3000 live births) or, more commonly, acquired.2 HHs are more common in women than in men, and their frequency increases with age, from 10% in patients younger than 40 to 70% in patients over 70 years old.1,3 Acquired HHs can be classified as sliding, paraesophageal, or mixed. Sliding hernias make up greater than 90% of all HHs and occur when the abdominal portion of the esophagus and the cardia & fundus of the stomach slide superiorly through the esophageal hiatus.1 Sliding hernias are clinically significant due to their association with reflux disease.1 Paraesophageal hernias make up less than 10% of all HHs and only involve the stomach fundus passing superiorly into the thoracic cavity.1 Paraesophageal hernias tend to enlarge over time potentially leading to incarceration and subsequent strangulation or perforation.4Patients with HHs can be asymptomatic or have symptoms such as epigastric fullness, postprandial distress, regurgitation, nausea, chest pain, or cough.4,5 Radiography studies, especially an upper GI barium series, are the preferred examination method to diagnosing HHs with a sensitivity of 77%.6 The primary diagnostic finding is a retrocardiac air-fluid level located within a paraesophageal hernia or intrathoracic stomach.1 Asymptomatic hernias may not require treatment. HH with reflux disease can be managed medically. Symptomatic HHs and paraesophageal hernias might require surgical intervention; thus surgical consultation is recommended.4 In this case, the chest X-ray was concerning for pneumonia, and a large, incidental hiatal hernia was also appreciated. Patient was started on antibiotics for the pneumonia and admitted to internal medicine. The hiatal hernia was not operated on because the patient was asymptomatic. Topics: Hiatal hernia, sliding hernia, paraesophageal hernia, retrocardiac air bubble.

Natural History and Predictors of Parastomal Hernia after Robot-Assisted Radical Cystectomy and Ileal Conduit Urinary Diversion

We investigated the prevalence of and variables associated with parastomal hernia and its outcomes after robot-assisted radical cystectomy and ileal conduit creation for bladder cancer. We retrospectively reviewed the records of patients who underwent robot-assisted radical cystectomy at our institution. Parastomal hernia was defined as the protrusion of abdominal contents through the stomal defect in the abdominal wall on cross-sectional imaging. Parastomal hernia was further described in terms of patient and hernia characteristics, symptoms, management and outcomes. The Kaplan-Meier method was used to determine time to parastomal hernia and time to surgery. Multivariate stepwise logistic regression was done to evaluate variables associated with parastomal hernia. A total of 383 patients underwent robot-assisted radical cystectomy and ileal conduit creation. Of the patients 75 (20%) had parastomal hernia, which was symptomatic in 23 (31%), and 11 (15%) underwent treatment. Median time to parastomal hernia was 13 months (IQR 9-22). Parastomal hernia developed in 9%, 23% and 32% of cases at 1, 2 and 3 years, respectively. Patients with parastomal hernia had a significantly higher body mass index (30 vs 28 kg/m2, p = 0.02), longer overall operative time (357 vs 340 minutes, p = 0.01) and greater blood loss (325 vs 250 ml, p=0.04). On multivariate analysis operative time (OR 1.25, 95% CI 1.21-3.90, p <0.001), a fascial defect 30 mm or greater (OR 5.23, 95% CI2.32-11.8, p <0.001) anda lower postoperative estimated glomerular filtration rate (OR 2.17, 95% CI 1.21-3.90, p = 0.01) were significantly associated with parastomal hernia. Symptoms develop in approximately a third of patients with parastomal hernia and 15% will require surgery. The risk of parastomal hernia plateaued after postoperative year 3. Longer operative time, a larger fascial defect and lower postoperative kidney function were associated with parastomal hernia.

Inguinal Gravid Hysterocele in Feline

Background: Hysterocele is an inheritance rare in feline, characterized by the protrusion of the uterus by the inguinal channel, a situation related with the congenital abnormality of the inguinal ring, allowing the protrusion of abdominal contents for the subcutaneous space. As differential diagnosis of hysterocele are the breast cancer, abscesses and bruises and image exams such as radiography and ultrasonography have large relevance for identifying the disease and, additionally, clarify the hernia content. The purpose of this study was to describe one case report of the inguinal gravid hysterocele in a cat.Case: A 1-year-old female feline, without history of trauma of increase of volume in the inguinal region was referred for clinical evaluation. Due to the presence of three gestational vesicles, the decision by following-up the fetal development was taken, by means of periodical ultrasound evaluations, for performing operative procedure. At 56 days of gestation, when intestinal peristaltic movements of the three kittens were observed, cesarean was indicated. The procedure began by an oblique incision in the left retro-umbilical region, however, due to adhesions, there was no proper uterine exposition for hysterotomy. Retro-umbilical celiotomy, adhesiolise and return of the uterus for the abdominal cavity were performed in order to execute the cesarean followed by ovariohysterectomy. The hernial ring was debrided and sutured in order to keep patent the inguinal ring. No post-operatory complications were noted indicating that the established conduct allowed the survival of the parturient and its kittens.Discussion: In a casuistic study where data from 1988 until 2007 were collected, from the Faculty of Veterinary Medicine from the University of São Paulo, a higher occurrence of inguinal hernias was observed in female dogs, when compared with male dogs and, until that period, the inguinal hernia was not reported in the feline species. It is known that the inguinal ring may dilate with the obesity and increase of the intra-abdominal pressure, linked with the weakening of the adjacent structures. Besides, the appearance of hysterocele in females is also related with the estrus or gestation, caused by the hormonal imbalance, leading to the weakening of the conjunctive tissue, resulting in the enlargement of the inguinal rings, which is according to what was observed in this report where the animal was pregnant. Additionally, the application of contraceptive (progestin’s) could have accentuated the muscle fragility, favoring the projection of the uterus by the inguinal ring. In most of the cases described in literature, animals have no discomfort to the handling of the herniated content however, for some authors, the prolongation of surgical resolution may aggravate the clinical condition, predisposing the formation of adherences that may cause discomfort or pain, particularly when the bladder or intestinal loops are involved, resulting in difficulty urinating and defecating, respectively. Care must be taken during the reduction of the inguinal ring, in order to avoid compromising the external pudendal artery and vein, and of the genito-femoral nerve, which emerge from the tail-medial aspect of the ring. In this study, it was tried to perform the hernia suture in a way that the inguinal ring remained patent. On the same way that was performed in this study recommend the execution of ovariohysterectomy in order to avoid relapse and because it is an hereditary condition. The inguinal gravid hysterocele in feline may be adequately manage until the ideal moment for cesarean without prejudice to the parturient and to its products.

MP24-17 NATURAL HISTORY, PREVALENCE, PREDICTORS &amp; OUTCOMES OF PARASTOMAL HERNIA AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2017MP24-17 NATURAL HISTORY, PREVALENCE, PREDICTORS & OUTCOMES OF PARASTOMAL HERNIA AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY Youssef Ahmed, Ahmed Hussein, Paul May, Basim Ahmad, Taimoor Ali, and Khurshid Guru Youssef AhmedYoussef Ahmed More articles by this author , Ahmed HusseinAhmed Hussein More articles by this author , Paul MayPaul May More articles by this author , Basim AhmadBasim Ahmad More articles by this author , Taimoor AliTaimoor Ali More articles by this author , and Khurshid GuruKhurshid Guru More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3311AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Parastomal hernia (PH) is a frequent complication of urinary diversion after radical cystectomy. We investigated the prevalence, predictors and outcomes of PH. Clinical and radiologic evidence of PH was also investigated. METHODS Retrospective review of 446 patients who underwent RARC at our institution from 2005 was conducted. Data was reviewed for demographics, clinical findings, imaging results and other perioperative outcomes. Radiologic PH was defined as protrusion of abdominal content through the stoma defect in the abdominal wall. PH was further described in terms of symptoms and their management. Kaplan Meier method was used to depict time to developing PH and logistic regression to evaluate predictors of PH. RESULTS 384 patients who underwent RARC and IC were included in the analysis. Mean age was 70 years with median follow up of 18 months (IQR 6.8-34-.7). 74 (19%) patients had radiological evidence of PH, 24 (32%) were symptomatic and 8 (11%) underwent treatment. Median time to develop PH was 13 months (IQR 8.8-22). PH occurred at a rate of 10%, 33% and 36% at 1, 3 and 5 years respectively (Fig 1). Median time to symptoms was 24 months after RARC (IQR 7-39.6) and (8 months after radiological diagnosis. Patients with PH had significantly higher BMI (30 vs 28, p=0.009), longer overall operative time (347 vs 388 min, p=0.01), urinary diversion time (128 vs 108 p=0.03) and higher blood loss (400 vs 250, p=0.01). The incidence of PH was studied based on incorporation of intra-corporeal diversion in the program (Fig 2). On Multivariable analysis operative time was the only variable associated with higher incidence of PH (OR 1.25, 95% CI 1.02-1.04, p<0.001). CONCLUSIONS PH is a common complication following RARC (20%). Approximately one-third will develop symptoms and 10% will require surgical treatment. Risk for developing PH plateaus after the 3rd year. Longer operative time was associated with higher incidence of PH. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e308 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Youssef Ahmed More articles by this author Ahmed Hussein More articles by this author Paul May More articles by this author Basim Ahmad More articles by this author Taimoor Ali More articles by this author Khurshid Guru More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A clinical study of abdominal wound dehiscence with emphasis on surgical management in Bangalore medical college and research institute, Karnataka, India

Background: Wound dehiscence is described as partial or complete disruption of abdominal wound closure with or without protrusion of abdominal contents. It is among the most dreaded complications faced by surgeons and regarded as a severe postoperative complication, with mortality rates reported as high as 45%. Incidence in literature ranges from 0.4% to 3.5%.This study aimed at finding out the prevalence of abdominal wound dehiscence with different risk factors and also to study the effective management of abdominal wound dehiscence. Methods: All cases presenting with wound dehiscence after surgery were included. An elaborate clinical history was taken in view of the significant risk factors, the types of surgery performed including surgical incisions taken and the type of disease involved. A total of 60 cases were included in this prospective study. Data was analyzed using appropriate software. Results: The results concluded that male patients have a higher incidence of laparotomy wound dehiscence and in 5th decade. Patients presenting with peritonitis secondary to hollow viscus perforation are more prone to abdominal wound dehiscence. Patients classified with contaminated wounds with emergency surgeries show higher predilection for wound dehiscence. Conclusions: Co morbidities like diabetes, malnutrition, anemia, COPD, play significant role in delaying wound healing. Simple routine laboratory investigations may help identifying predisposing factors and be corrected accordingly. Most of the patients can be managed conservatively and with secondary suturing without the need of re exploration and repeated surgery.

Comparison between open and closed methods of herniorrhaphy in calves affected with umbilical hernia

Umbilical hernias in calves commonly present to veterinary clinics, which are normally secondary to failure of the normal closure of the umbilical ring, and which result in the protrusion of abdominal contents into the overlying subcutis. The aim of this study was to compare the suitability of commonly-used herniorrhaphies for the treatment of reducible umbilical hernia in calves. Thirty-four clinical cases presenting to the Veterinary Teaching Hospital, Chittagong Veterinary and Animal Sciences University, Chittagong, Bangladesh from July 2004 to July 2007 were subjected to comprehensive study including history, classification of hernias, size of the hernial rings, presence of adhesion with the hernial sacs, postoperative care and follow-up. They were reducible, non-painful and had no evidence of infection present on palpation. The results revealed a gender influence, with the incidence of umbilical hernia being higher in female calves than in males. Out of the 34 clinical cases, 14 were treated by open method of herniorrhaphy and 20 were treated by closed method. Complications of hernia were higher (21%) in open method-treated cases than in closed method-treated cases (5%). Hernia recurred in three calves treated with open herniorrhaphy within 2 weeks of the procedure, with swelling in situ and muscular weakness at the site of operation. Shorter operation time and excellent healing rate (80%) were found in calves treated with closed herniorrhaphy. These findings suggest that the closed herniorrhaphy is better than the commonly-used open method for the correction of reducible umbilical hernia in calves.