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Concept: Hernia

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INTRODUCTION: Although blunt trauma to a hernia-containing bowel is known to cause bowel perforation, this report documents the first incident of a small bowel transection following a non-traumatic event. CASE PRESENTATION: We report the case of a 49-year-old African American man with a chronic incarcerated inguinal hernia awaiting elective repair. He presented to the Emergency Department with abdominal pain following an episode of coughing. On examination, he was found to have peritonitis. He underwent exploratory laparotomy, and had a complete small bowel transection. A bowel resection with primary anastomosis was performed, as well an inguinal hernia repair. CONCLUSION: Chronic hernia incarceration can lead to weakening and ischemia of the bowel, and minimal trauma can lead to perforation of the weakened segment. In such presentations, bowel resection and repair of the defect with a biological material is safe and feasible.

Concepts: Asthma, Surgery, Abdominal pain, Inguinal hernia, Hernia, Bowel obstruction, African American, Gastrointestinal perforation

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Iatrogenic right diaphragmatic hernia is very rare. We report the first case of a patient who had a diaphragmatic hernia after laparoscopic fenestration of liver cyst. A herniorrhaphy of the diaphragmatic defect was carried out after reducing the herniated organ. The postoperative course was uneventful. Diaphragmatic hernias are not as common as the traumatic type. Surgeons can easily miss diaphragmatic injuries during the operation especially after laparoscopy. Late diagnosis of iatrogenic diaphragmatic hernias is frequent. Ct scan is helpful for diagnosis. Surgery is the treatment of diaphragmatic hernia at the time of diagnosis, even with asymptomatic patients. The incidence of iatrogenic diaphragmatic hernia after surgery may be reduced if the surgeon checks for the integrity of the diaphragm before the end of the operation. A review of the literature is also performed regarding this rare complication.

Concepts: Hospital, Surgery, Liver, Physician, Hernia, Laparoscopic surgery, Congenital diaphragmatic hernia, Diaphragmatic hernia

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The use of mesh has become the gold standard in hernia operations recently due to advantages such as lower recurrence rates, lower post-surgical pain and earlier return to work. Plug mesh application, first described by Robins and Rutkow [Robbins AW, Rutkow IM (1993) The mesh-plug hernioplasty. Surg Clin North Am 73:501-512], is a popular method of hernia repair. Although rare, there may be complications of surgery using plug mesh. This report presents a case of mechanic bowel obstruction due to mesh migration, 3 years after a left inguinal hernia repair with plug mesh method.

Concepts: Surgery, Engineering, Inguinal hernia, Hernia, Gold, Bowel obstruction, Hernias, Herniorrhaphy

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Hernia repairs in contaminated fields are often reinforced with a bioprosthetic mesh. When choosing which of the multiple musculofascial abdominal wall planes provides the most durable repair, there is little guidance. We hypothesized that the retro-rectus plane would reduce recurrence rates versus intraperitoneal placement due to greater surface area contact of mesh with well-vascularized tissue.

Concepts: Surgery, Hernia, Hernias, Area, Surface area, Reinforcement, Pediatric surgery

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Ventral hernias are common surgical targets. The Bard(®) Ventralex™ Hernia Patch was introduced for the repair of such hernias in the early 2000s. Ethicon (Johnson & Johnson) introduced the Proceed™ Ventral Patch (PVP™) in the late 2000s for the same indication. The effectiveness and safety of the Bard(®) Ventralex™ Hernia Patch has been proven in a series of studies. There are no medical studies on the PVP™ in humans. This study examines the effectiveness and safety of PVP™ in the closure of ventral hernias.

Concepts: Surgery, Hernia, Pediatric surgery

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Elective repair for umbilical or epigastric hernia is a frequent minor surgical procedure. Several studies have demonstrated chronic pain after groin hernia repair but long-term complaints have been only scarcely studied. This study was undertaken to investigate long-term pain and discomfort after open repair for small umbilical or epigastric hernias.

Concepts: Medicine, Surgery, Hernia, Cultural studies, Hernias, Herniorrhaphy, Pediatric surgery, Epigastric hernia

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BACKGROUND: Transabdominal preperitoneal (TAPP) repair is widely used to treat bilateral or recurrent inguinal hernias. Recently a self-gripping mesh has been introduced into clinical practice. This mesh does not need staple fixation and thus might reduce the incidence of chronic pain. This prospective study aimed to compare two groups of patients with bilateral (BIH) or monolateral (MIH) primary or recurrent inguinal hernia treated with TAPP using either a self-gripping polyester and polylactic acid mesh (SGM) or a polypropylene and poliglecaprone mesh fixed with four titanium staples [standard technique (ST)]. METHODS: In this study, 96 patients (mean age, 58 years) with BIH (73 patients with primary and recurrent hernia) or MIH (22 patients with recurrent hernia) underwent a TAPP repair. For 49 patients, the repairs used SGM, and for 46 patients, ST was used. The patients were clinically evaluated 1 week and then 30 days postoperatively. After at least 6 months, a phone interview was conducted. The short-form McGill Pain Questionnaire was administered to all the patients at the 6-month follow-up visit. RESULTS: The mean length of the procedure was 83 min in the SGM group and 77.5 min in the ST group. The mean follow-up period was 13.8 months (range 1.3-42.0 months) for the SGM group and 18.2 months (range 1.9-27.1 months) for the ST group. The recurrence rate at the last follow-up visit was 0 % in the SGM group and 2.2 % (1 patient) in the ST group. The incidence of mild chronic pain at the 6-month follow-up visit was 4.1 % in the SGM group and 9.1 % in the ST group, and the incidence of moderate or severe pain was respectively 2.1 and 6.8 %. CONCLUSIONS: The study population was not large enough to obtain statistically significant results. However, the use of SGM for TAPP repairs appeared to give good results in terms of chronic pain, and the incidence of recurrences was not higher than with ST. In our unit, SGM during TAPP repair of inguinal hernias has become the standard.

Concepts: Statistics, Surgery, Inguinal hernia, Pain, Hernia, Hernias, Herniorrhaphy, Recurrence relation

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Best practices promulgated by the Eastern Association for the Surgery of Trauma suggest that delay in surgery for adhesive small bowel obstruction (ASBO) should not exceed 5 days. This study aimed to probe the relationship between operative delay and adverse outcomes, defined as occurrence of a complication, requirement for bowel resection, prolonged postoperative stay, or death in ASBO using the Nationwide Inpatient Sample.

Concepts: Crohn's disease, Constipation, Hernia, Bowel obstruction, General surgery, Best practice, Nationwide Building Society

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BACKGROUND: The best approaches to repairing large inguinoscrotal hernias and handling of the distal sac are still debated. Complete dissection of a distal sac which extends deep into the scrotum carries a risk of orchitis and damage to the cord structures. However, failure to deal with the distal sac often results in the formation of a large and bothersome seroma or pseudohydrocele. We describe a technique for managing large distal sacs to avoid clinically important seromas when repairing large inguinoscrotal hernias, using the enhanced view totally extraperitoneal (e-TEP) endoscopic technique. METHODS: From October 2010 to November 2011, 94 consecutive elective hernia repairs were performed using the e-TEP technique. Six of these patients had large inguinoscrotal hernias, defined as hernias extending deep into the scrotum with a distal sac not amenable to dissection. In these six patients, we managed the distal sac by pulling it out of the scrotum and fixing it high and laterally to the posterior inguinal wall. We prospectively followed these patients and examined them at 8 days and 1 and 3 months postoperatively, looking specifically for signs or symptoms of seroma. Ultrasonography was performed at each follow-up visit. RESULTS: Only one of the patients had developed a seroma by the eighth postoperative day. The seroma was drained and did not recur or produce symptoms during the following 3 months. There were no major complications or early recurrences in the series. CONCLUSIONS: Patients with large inguinoscrotal hernias and sacs extending deep into the scrotum can benefit from reduction and fixation of the distal sac high and laterally to the posterior inguinal wall. This technique lowers the risk of developing clinically significant seroma.

Concepts: Inguinal hernia, Hernia, Aortic dissection, Fix, Herniorrhaphy, Illinois