Case Of Recurrent Hernia Research Articles

Laparoscopic management of ventral hernia repair using intraperitoneal synthetic mesh: A 10-year retrospective observational study

ObjectiveVentral hernia is an anterior abdominal wall hernia, with an incidence of 2%–13%. Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique proven to be an effective treatment option. This study aims to assess the long-term outcomes of laparoscopic management of ventral hernia repair using intraperitoneal onlay mesh (IPOM) or intraperitoneal onlay mesh with defect closure (IPOM PLUS) technique with the usage of variety of synthetic meshes intraperitoneally. MethodsA retrospective study of 821 patients of a single institution for a decade was conducted. Long-term outcomes such as pain, mesh infections, enterocutaneous fistula, bowel adhesions and recurrence were assessed. ResultsThere were 801 primary, 12 incisional, and 8 recurrent hernia cases, including 532 females and 289 males with a mean age of 45.62±9.37 years. IPOM PLUS were underwent in 674 (82.10%) cases. Polypropylene, dual, titanium, composite meshes were applied in 473 (57.61%), 208 (25.33%), 82 (9.99%), and 58 (7.06%) cases respectively. Intraoperative bleeding occurred in 3 (0.37%) cases, seroma in 8 (0.97%), wound infection in 4 (0.49%), stitch abscess in 2 (0.24%). Recurrence was found in 8 (0.97%) cases, with 5 used polypropylene mesh and 3 used dual mesh. Mesh infections were discovered in 6 (2.88%) cases used dual, and foreign body sensation in 4 (0.85%) cases used polypropylene. Three (0.37%) patients had suture site hernia, and 3 (0.37%) had chronic sinus. ConclusionIPOM or IPOM PLUS holds good in small or medium sized ventral hernias. The safety and efficacy of intraperitoneal polypropylene mesh is comparable to that of other synthetic meshes. A mesh overlap of minimum 5 cm beyond defect edge is must to minimise hernia recurrence. Absorbable suture can be considered as alternative to tackers.

A comparative study of totally extraperitoneal versus transabdominal preperitoneal repair of inguinal hernias

Background: The two common procedures which are nowadays commonly performed for laparoscopic repair of inguinal hernia are transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) mesh repair. This retrospective study was aimed to compare these two, TAPP and TEP laparoscopic approaches for inguinal hernia repair in terms of various outcomes.Methods: In this retrospective study, we included 50 cases of inguinal hernia who underwent laparoscopic approach of inguinal hernia repair at Saveetha medical college and hospital between 2014 and 2016 for a duration of 3 years. Various parameters including the age, sex of patient, type of hernia, preoperative and post-operative complications, duration of hospital stay was analysed.Results: Of the 50 patients who underwent laparoscopic repair, 26 patients underwent TEP and 24 patients under went TAPP procedure. 31 cases were indirect inguinal hernias and 30 cases were direct inguinal hernias, totalling 61 hernia repairs, as 11 patients had bilateral hernia. One female inguinal hernia and 4 cases of recurrent hernia were operated by TAPP method. Postoperative complications like seroma formation; subcutaneous emphysema was seen in TEP group. Two cases of TEP were converted to TAPP and open lichenstein procedure. Postoperative pain was less in both the group. Patients who underwent TEP procedure spent less time in the hospital compared to those who underwent TAPP procedure.Conclusions: There is no major difference in the outcome after TEP and TAPP surgeries except for some minor complications and the results are comparable in both techniques TAPP and TEP. Both the procedures can be practiced according to surgeon’s familiarity of the procedure.

Clinical efficacies of ambulatory surgery for inguinal hernia in 1892 patients

Objective To explore the clinical efficacies of ambulatory surgery for inguinal hernia. Methods The clinical data of 1892 patients with inguinal hernia who underwent ambulatory surgery at the West China Hospital of Sichuan University from November 2009 to June 2015 were retrospectively analyzed. Preoperative examinations including blood routine test, blood bio-chemistry checking, blood electrolytes, coagulation convention, pre-transfusion test, blood type, chest X-ray, electrocardiogram were applied to patients. Operation time was rescheduled after abnormal indexes were corrected for elective surgery. Preventive use of antibiotics was not needed. Preperitoneal space tension-free repair or Bassini method was adopted after local infiltration anesthesia. Anesthesia method, operation method, patching material, operation time, number of patients transferred to inpatient department and reasons and treatment expense were recorded. Ambulatory surgery center did satisfaction survey on patients at the discharge. Patients were followed up at postoperative month 1, 3, 6, 12 regularly by the doctor responsible for the surgery till July 2015, including occurrence of complications and chronic pain, recurred hernia, number of readmission and reasons. Measurement data with normal distribution were presented as±s. Results Among 1 892 patients, 1 889 patients underwent operation under local anesthesia and 3 patients were transferred to general anesthesia. There were 1 874 patients undergoing tension-free repair including 1 592 using the material of ultrapro hernia system (UHS), 264 of ultrapro plug (UPP), 8 of prolene hernia system (PHS), 6 of Gore hernia patch, 4 of 3-dimensional plug (3DP), and 18 patients underwent Bassini without preoperativedeath. The operation time of 1 892 patients was (28±12) minutes. Three patients were transferred to inpatient department for postoperative cut incision pain, ecchymoma, abdominal distention after satiation and discharged from hospital after treatment. Among 26 patients with complications after discharge, 12 had superficial incision infection and recovered after dressing change without removal of patches, 5 had edema in scrotum and inguinal region, 3 had ecchymoma, 2 had nausea and vomiting, 2 had urinary retention, 2 had disruption of wound, and they all recovered smoothly after symptomatic treatment. Treatment expense of the 1 892 patients was (6 956±249)yuan per hermia. Satisfaction rate of patients was 99.049%(1 874/1 892) when discharged. The follow-up rate was 86.152%(1 630/1 892). The follow-up time was 1-67 months with a median time of 35 months. During the follow-up, 4 patients had chronic pain and recovered after analgesia and physiotherapy, 3 patients had recurrence of inguinal hernia including 1 case of recurrent hernia and 2 cases of huge hernia. Conclusion Ambulatory surgery for inguinal hernia is safe and effective, with the advantages of few complications, high satisfactory rate and low hospital expenses. Key words: Inguinal hernia; Ambulatory surgery; Efficacy; Quality control

A single-centre experience of relaparoscopy in complications of laparoscopic inguinal hernia repair-feasibility and outcomes

Management of complications of laparoscopic inguinal hernia repair remains challenging as well as debatable. Relaparoscopy in management of these complications is relatively newer concept. We tried to analyse the feasibility of relaparoscopy (transabdominal preperitoneal approach) in management of complications of laparoscopic inguinal hernia repair. The study group included 61 patients (referral cases) from a prospectively maintained database of previous laparoscopic inguinal hernia surgery with majority of the patients of recurrence (n=39). Other complications were mesh infections (n=15), pubic osteitis (n=3), migration of mesh into adjacent viscera (n=3) and meralgia paresthetica (n=1). All patients underwent transabdominal preperitoneal approach (TAPP) between January 2007 and December 2013. Most of the patients had previous TEP repair (n=49) with variable complications detected in the range of 9days to 38months. Small-sized mesh (n=12) and rolled up mesh (n=10) were the causes of recurrence in 57% cases. Mycobacterium tuberculosis (40%) and mixed bacterial infections (33%) strains were detected in the infected mesh. Pubic osteitis and meralgia paresthetica were tackers induced. All patients dealt with TAPP approach. Recurrent hernia cases underwent mesh placement and infected mesh was removed in mesh infection. Tackers were removed in cases of osteitis pubis and meralgia paraesthesia. Median operative time was 62min (42-126min) and hospital stay 3days (2-13days). The relaparoscopy was accomplished in 95.1% of cases with no major intraoperative complications and minimal postoperative morbidity. Relaparoscopy through TAPP approach remains safe and feasible option to deal with primary laparoscopic hernia repair complications. Surgical techniques during primary laparoscopic repair are important cause for aforementioned complications. Though, surgical expertize remains warranted for relaparoscopy.

New technique for herniotomy in children

Objective This study aimed to assess the necessity of hernial sac ligation after its transection in herniotomy in children and to compare the recurrence and complication rates between two methods of hernial repair in children (the classic method with ligation of the hernial sac and a new method without sac ligation). Study design This was a randomized-controlled trial (or a randomized comparative trial). Materials and methods A total of 200 children, newborns to children 12 years of age, with inguinal hernia were admitted to Emam-Reza Hospital, Kermanshah, Iran, between March 2011 and 2012 for elective hernial surgery. Patients who were more susceptible to recurrence such as patients with incarcerated hernia and increased intraabdominal pressure were excluded from the study. After exclusion of a few patients, 182 children were included in the study. They were allocated randomly to two groups: a study group (herniotomy without sac ligation) and a control group (herniotomy with sac ligation). Both groups were followed up for a period of 1–1.5 years postoperatively for recurrence or other complications. Results There was only one case of recurrent hernia in the control group and none in the study group. There was no statistically significant difference in the rate of recurrence or other complications between the two groups. Conclusion This study showed that hernial sac ligation after its transection is not necessary in pediatric herniotomy. Omission of ligation did not result in any significant effect on early and late complications. Keywords : children, hernial sac, herniotomy, non ligation, recurrence

Outcome of tension free repair of incisional hernia

Background: The surgical treatment ofincisional hernia has changed rapidly during the last decade with the increasing use of mesh technique and the introduction oflaparoscopy. However, many questions concerning mesh type, mesh positioning, fixation method and operation type still remain unanswered. Methods: The study includes 100 cases of anterior abdominal wall hernias, including incisional hernia (cicatricial or paralytic types). The idea of the tension free repair of anterior abdominal wall hernia depends on repair of the defect by double layer onlay polypropylene mesh the deeper mesh is fixed to the free edge of the defect by polypropylene (No.1). The mean operative time was 2 hours (ranging between 1.5- 4 hours). Follow up of the patients was performed every 3 month with maximum follow up of two years and a minimum of six months. Results: The early postoperative course was uneventful in 96 patients (96%). Four patients presented with wound infection, two patients presented with superficial infection, the other two patients presented with deep infection and exposed mesh. The follow up revealed 8 cases of recurrent hernia (8%), two ofthese cases were associated with obesity, and one case was associated with bronchial asthma. Conclusion: In our study we modified the onlay technique for incisional hernia repair by using double layer onlay polypropylene mesh the deeper mesh is fixed to the free edge of the external oblique muscle, this modification insured a tension free repair of the hernia, the technique is universal and can be applied in both scar and paralytic insicional hernia.

Stoppas Procedure: Place in present era

Background: Inguinal hernias are frequently encountered disease. When not treated may lead to their complications like obstruction and strangulation. Though there has been extensive search but no one has been able to find the ideal way to repair inguinal hernia. Aim: To evaluate and analyze the effectivity of Stoppa procedure in the management of bilateral inguinal hernia. Patients and methods: study was carried out between October 2011 and January 2013. Hundred patients of bilateral inguinal hernia were operated using Stoppa Technique. Of these 12 were cases of recurrent hernia. The parameters evaluated were operative time, length of hospitalization, minor complications, recurrence and chronic groin pain. Results: The outcome at the end of 1 yr follow-up was good. Average duration of surgery was 38.5 min. In the early post operative period 3 patients had seroma, 3 patients had spinal headache, and a single case of urinary retention. 93 patients were discharged on the day after operation. At the end of 2 year follow-up none had recurrence or chronic groin pain. Conclusions: Stoppa procedure is an operation devised to cure hernias and also prevented other types of hernia occurring through myopecteneal orifice. Its low complication and recurrence rates have made it an attractive option for hernia therapy.

New Technique for Herniotomy in Children-Clinical Trial

Objective: to assessment of hernial sac ligation necessity after its transection in children herniotomy and compare the recurrence and complication rates between two methods of hernial repair in children (the classic method with ligation of the hernial sac and a new method without sac ligation). study design: this is a randomized controlled trial (RCT) Method: A total of 200 children ranging from neonates to 12 years of age, with inguinal hernia were admitted to Emam-Reza Hospital, Kermanshah, Iran between march 2011 and march2012, for elective hernial surgery The patients who were more prone to recurrence; such as patients with incarcerated hernia and increased intra-abdominal pressure were excluded from the study. After exclusion of some patients, 182children included in the study. They were randomly allocated into two groups, a study group (herniotomy without sac ligation) and a control group (herniotomy with sac ligation). Both groups were followed up for a period of 1-1.5 years postoperatively for recurrence or other complications. Results: There was only one case of recurrent hernia in the control group, and none in the study group. There was no statistically significant difference in the rate of recurrence or other complications between the two groups. Conclusions: This study showed that hernial sac ligation after its transection is not necessary in pediatric herniotomy. Omitting ligation did not result in any significant effect on early and late complication.

Laparoscopic hernioraphy: a better approach for recurrent hernia in boys?

We aimed to compare laparoscopic hernia repair and open hernia repair in recurrent cases after first open repair according to the length of time taken to perform the procedure. Between November 2009 and December 2011, the medical records of 26 male paediatric patients who were treated with laparoscopic surgery (with Schier's intracorporal "N" suture closure) and open surgery (with high ligation technique) in our institution for recurrent inguinal hernia were reviewed for the length of the operative time and post-operative complications retrospectively. Thirteen cases operated with laparoscopic repair were regarded as Group 1 and other 13 cases operated with the open high ligation repair were regarded as Group 2. All recurrent hernia cases had been performed in other hospitals with the open high ligation technique previously. Thirteen internal inguinal ring closures in Group 1 were performed laparoscopically. In Group 2, 13 cases underwent open high ligation repair. Comparing the laparoscopic and open-repair techniques in the recurrent cases (Group 1 vs. Group 2; 32.36 vs. 61.07 min, respectively) showed that the length of the operation time was much shorter in laparoscopic repair group (Group 1) than open repair group (Group 2). A statistically significant difference was also observed (p = 0.001). No post-operative testicular atrophy or recurrence was seen until present time in all groups. We propose that laparoscopic repair in recurrent childhood inguinal hernia cases, developed after open repair, avoids entering a fibrotic inguinal canal, making the procedure easier and shorter. Laparoscopic herniorrhaphy is a good alternative option in recurrent childhood hernia.

A New Classification of Parastomal Hernias - from the Experience at Bielański Hospital in Warsaw

Parastomal hernia is the most common local stoma complication. The incidence of parastomal hernia reaches 48%, and in a certain proportion of patients it is considered to be an inevitable consequence of stoma formation. The current classifications of parastomal hernias (Rubin, Devlin) are of little clinical value, which is supported by the fact that they have not been used in any publication presenting surgical treatment results in parastomal hernia. Moreover, these classifications do not include recommendations regarding surgical approach selection in those cases where surgical treatment is indicated. These disadvantages clearly indicate a need for developing a new classification of a greater practical value. was to present a suggested new parastomal hernia classification, based on structural criteria, and its use in surgical approach selection. The authors presented a group of 52 patients registered in Outpatient Stoma Clinic at Bielański Hospital in Warsaw, who had been diagnosed with parastomal hernia, defined as a type of hernia associated with postoperative artificial external intestinal fistula, who also had indications for surgical treatment of this stomal complication. These patients underwent a reconstructive procedure of their parastomal hernia with a surgical technique involving the placement of a monofilament polypropylene mesh in the preperitoneal space and repair of co-existing stomal complications using the variants of surgical techniques adequate for a given parastomal hernia type. Based on our studies and clinical experience, we propose a new classification of parastomal hernias, based on structural criteria. All hernias were divided into four groups (type I-IV) depending on hernia size and the presence of hernia in the postoperative scar. Qualification of a given hernia to a specific type was achieved based on physical examination, which makes the suggested classification a simple tool, useful in everyday practice. Each parastomal hernia type requires selecting a suitable surgical approach. In the study group, 44 patients were diagnosed with primary hernia, and 8 - with recurrent hernia. In one case of recurrent hernia it was another recurrence. There were 11 type I hernias, 7 type II hernias, 24 type III hernias, and 4 type IV hernias in the study group. No statistically significant relationship between the type of hernia and the sex of the patients was observed for p = 0.05. However, there was a significant difference between the BMI values and individual hernia types. Patients with type I hernia had the lowest mean BMI value and patients with type IV hernia had the highest mean BMI value. The mean duration of postoperative follow-up was 58 months. There were 5 cases (9.6%) of parastomal hernia recurrence in the study group. A statistical analysis of the results showed that parastomal hernia types identified based on structural criteria differ from one another in parameters such as BMI, indications for surgery, or recurrence rates. The new classification of parastomal hernias is a simple way of identifying patients who require a different therapeutic approach. Thus, it has a practical application as it helps to select a suitable surgical technique. It may be also used for identification of homogeneous groups of patients and therefore allows for a reliable and objective comparison of treatment outcomes.