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1.
Wiad Lek ; 73(4): 755-760, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32731711

RESUMO

OBJECTIVE: The aim of the study is to specify diagnostic MRI and ultrasound criteria for a sports hernia in order to verify its diagnosis in football players. PATIENTS AND METHODS: Materials and methods: The study included 50 professional and amateur football players aged 15 to 34 from 2016 to 2019. The criteria for inclusion in the study were: the presence of groin pain in football players, which prevented them from continuing to actively participate in sports activities. RESULTS: Results: The findings of the study revealed that during MRI the two factors, which had the strongest influence, were "increased MR signal intensity on PDfs observed from the structures of the inguinal canal" and "increased MR signal intensity on PDfs observed from bone marrow of superior ramus of the pubic bone". During ultrasound of the inguinal area, the main criterion for a sports hernia diagnosis was "increased size of the inguinal canal". The verification of the diagnosis was carried out on the basis of the presence of a protrusion in the posterior wall of the inguinal canal. For a sports hernia diagnosis the MRI sensitivity is 91.67% (95% CI 77.5 - 98.2), specificity -78.57% (95% CI 49.2 - 95.3) and the sensitivity of ultrasound is 88.89% (95% CI 73.9 - 96.9), the specificity - 50% (95% CI 23.0 - 77). CONCLUSION: Conclusions: The combination of MRI and ultrasound makes it possible to accurately detect the presence of a sports hernia in the football player. Based on the findings of our study, we formulated MRI and ultrasound criteria for a sports hernia diagnosis.


Assuntos
Futebol Americano , Hérnia Inguinal , Adolescente , Adulto , Virilha , Hérnia , Humanos , Imagem por Ressonância Magnética , Adulto Jovem
5.
Am J Surg ; 219(5): 776-779, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32172925

RESUMO

BACKGROUND: Currently, no evidence compares outcomes for techniques utilizing surgical specimen extractions bags versus unprotected extraction. METHODS: Evaluation of sleeve gastrectomies performed at two high-volume centers. Cases where an extraction bag was used (+EB) were compared to bag-less extraction (-EB). Outcomes included operative contamination, surgical site infections and extraction-site hernias. RESULTS: 674 patients were evaluated (417 in the +EB group and 257 in the -EB group). Preoperative characteristics were similar between groups. There was a trend toward shorter operative times with the -EB group (-EB = 100 min vs + EB = 106 min, p = 0.07). Gross spillage was documented as a contaminated case in 0.4% of -EB cases compared to 1.2% in +EB cases (p = 0.51). Two superficial infections were appreciated (1.2% = +EB vs 0.7% = -EB, p = 0.7) with one post-operative abscess in the -EB group (p = 0.61). One post-operative hernia was seen in each group (p = 0.62). DISCUSSION: Bag-less extraction is a safe, resource conscious method that may potentially decreased operative time.


Assuntos
Gastrectomia/métodos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Manejo de Espécimes/instrumentação , Adulto , Feminino , Gastrectomia/economia , Hérnia/epidemiologia , Humanos , Laparoscopia/economia , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Manejo de Espécimes/economia , Infecção da Ferida Cirúrgica/epidemiologia
8.
Lancet ; 395(10222): 417-426, 2020 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-32035551

RESUMO

BACKGROUND: Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. METHODS: In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. FINDINGS: Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43-0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26-0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60-1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54-1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. INTERPRETATION: Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. FUNDING: National Institute for Health Research Research for Patient Benefit and Allergan.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Hérnia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas , Estomas Cirúrgicos , Adulto , Idoso , Colágeno , Colo/cirurgia , Método Duplo-Cego , Feminino , Hérnia/etiologia , Hérnia/prevenção & controle , Humanos , Íleus/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos
10.
BMC Surg ; 20(1): 14, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31948420

RESUMO

BACKGROUND: An intro-abdominal hernia through the lesser omentum is a rare but severe condition that can cause intestinal obstruction and other life-threating complications. Until now, only a handful of cases have been reported worldwide. The diagnosis of lesser omental hernia remains challenging for emergency surgeons because of the unspecific symptoms. Therefore, there is a need for a better understanding of the characteristics of this condition. CASE PRESENTATION: In this report, we described the case of a 73-year-old female patient who was diagnosed with a lesser omental hernia caused by previous total colectomy. The patient underwent emergency surgery, and the intraoperative findings revealed a 200-cm segment of the small intestine was herniated through a defected lesser omentum (approximately 3 × 4 cm) from the lesser retrogastric curvature of the stomach. Besides, we summarize the specific abdominal computed tomography (CT) findings of lesser omental hernia by reviewing the literature. CONCLUSION: The lesser omental hernia is extremely rare but can cause serious complications. The cause of lesser omental hernia can be congenital or acquired. Careful examination of the small omentum before the closure of the abdomen is expected to reduce the occurrence of these abdominal surgery-associated complications. The specific features of abdominal CT in cases of lesser omental hernia, which are summarized in this article, can help other clinicians to obtain accurate diagnoses of lesser omentum hernia in the future.


Assuntos
Colectomia/efeitos adversos , Hérnia/etiologia , Omento/patologia , Idoso , Emergências , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Omento/cirurgia , Doenças Peritoneais/patologia , Tomografia Computadorizada por Raios X
11.
World Neurosurg ; 137: 18-23, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31954912

RESUMO

BACKGROUND: Cavernous sinus dural arteriovenous fistulas (CS dAVFs) occasionally behave aggressively (e.g., intracranial hemorrhage, venous infarction, seizures) depending on the drainage flow and presence of a collateral route of cortical or basal cerebral venous drainage. When a CS dAVF with aggressive behavior is encountered, a radical cure is required to avoid catastrophic deficits. However, conventional transvenous cavernous sinus (CS) embolization via the inferior petrosal sinus does not always achieve shunt obliteration. We herein report a case of surgical venous drainage disconnection in an 83-year-old woman with a CS dAVF. CASE DESCRIPTION: The patient presented with coma and anisocoria due to intracranial hemorrhage. Because of the patient's critical condition, we had no choice but to perform emergency decompressive craniectomy and hematoma evacuation without detailed preoperative hemodynamic information obtained by digital subtraction angiography. Postoperative digital subtraction angiography showed a CS dAVF with retrograde venous drainage of the deep middle cerebral vein (DMCV) and varix formation in the affected DMCV, causing hemorrhagic episodes. Five days after admission, the patient's neurologic state worsened because of rebleeding from the varix, which had increased in size. The percutaneous transvenous approach failed because of compartmentalization within the CS. Open surgery was performed; the deep vasculature was exposed by the transsylvian approach, and the arterialized DMCV was permanently clipped at its proximal segment with disconnection from the venous varix and fistulous point. Shunt obliteration was successfully achieved. CONCLUSIONS: Surgical venous drainage disconnection from the fistulous point may be an alternative radical therapy for CS dAVFs with aggressive behaviors.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/terapia , Embolização Terapêutica/métodos , Varizes/terapia , Idoso de 80 Anos ou mais , Anisocoria/etiologia , Encefalopatias/cirurgia , Seio Cavernoso , Coma/etiologia , Craniectomia Descompressiva/métodos , Feminino , Giro do Cíngulo , Hérnia/complicações , Herniorrafia/métodos , Humanos , Hemorragias Intracranianas/terapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Ruptura Espontânea/etiologia , Ruptura Espontânea/terapia
12.
World Neurosurg ; 133: 318-323, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449999

RESUMO

BACKGROUND: Idiopathic spinal cord herniation is a disorder in which the spinal cord herniates through a dural defect. We present a case in which both the standard surgical method and a salvage method failed. CASE DESCRIPTION: A 36-year-old man presented with 2 years of progressive numbness and proximal hip flexion weakness of both lower extremities. Magnetic resonance imaging of the thoracic spine was suggestive for a ventral spinal cord herniation at the T6/7 level. He was initially treated with reduction of his cord herniation, placement of a ventral sling of collagen matrix over the dural defect to prevent re-herniation, with a laminoplasty. He developed a blood-pressure-dependent paraparesis that did not recover despite a return to the operating room (OR) for removal of the laminoplastic bone flap. He was again taken to the OR, the sling was removed and we enlarged the ventral dural defect rostrally and caudally to prevent strangulation of the hernia as described by Watanabe. Though in the short term he was able to recover and transfer to physical therapy, after going home he developed lower extremity weakness and low-pressure headaches. Magnetic resonance imaging showed a ventral epidural cerebrospinal fluid pocket retropulsing the spinal cord, as well as pockets of ventral cerebrospinal fluid collections remote from the surgery site. The patient returned to the OR and the initial surgery with the ventral sling was re-performed with resolution of the headaches; the patient was neurologically stable and transferred to rehabilitation. Long-term he developed left intercostal pain at the level of the surgery without radiological correlate. CONCLUSIONS: In this patient there was no single satisfactory surgical treatment of his ventrally herniated spinal cord-partly related to the herniated component of the cord acting as a mass within a narrow canal at the apex of the thoracic kyphosis. We encountered previously unreported complications of the ventral defect widening technique of surgical treatment.


Assuntos
Herniorrafia , Doenças da Medula Espinal/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Hérnia , Humanos , Imagem por Ressonância Magnética , Masculino , Vértebras Torácicas/diagnóstico por imagem , Falha de Tratamento
13.
Orthopade ; 49(3): 211-217, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31515590

RESUMO

As a result of the complexity and diversity of diseases in the region of the groin, differentiation of the various soft-tissue and bone pathologies remains a challenge for differential diagnosis in routine clinical practice. In the case of athletes with pain localized in the area of the groin, femoroacetabular impingement (FAI) and athlete's groin must be considered as important causes of the groin pain, whereby the common occurrence of double pathologies further complicates diagnosis. Despite the importance of groin pain and its differential diagnoses in everyday clinical practice, there has been a lack of recognized recommendations for diagnostic procedure to date. To this end, a consensus meeting was held in February 2017, in which a group composed equally of groin and hip surgeons took part. With the formulation of recommendations and the establishment of a practicable diagnostic path, colleagues that are involved in treating such patients should be sensitized to this issue and the quality of the diagnosis of groin pain improved in routine clinical practice.


Assuntos
Algoritmos , Traumatismos em Atletas/diagnóstico , Impacto Femoroacetabular/diagnóstico , Hérnia/diagnóstico , Atletas , Consenso , Virilha , Humanos , Dor , Esportes
17.
Ann R Coll Surg Engl ; 102(3): e73-e74, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845821

RESUMO

Lung herniation is a rare entity, defined as a protrusion of the lung above the normal confines of thorax; it is caused by increased intrathoracic pressure and defects or weakness of the chest wall. Intercostal lung hernia can occur spontaneously or following thoracic trauma or surgery. Postoperative hernias are more commonly associated with less extensive surgical procedures, such as thoracoscopic surgery or mini-thoracotomy incisions, rather than with major thoracic procedures. We describe the first reported case of postoperative intercostal lung hernia following two-stage totally minimally invasive oesophagectomy for cancer, together with its successful surgical repair.


Assuntos
Esofagectomia/efeitos adversos , Hérnia/etiologia , Pneumopatias/etiologia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-Operatórias , Adenocarcinoma/cirurgia , Idoso , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Hérnia/terapia , Herniorrafia/métodos , Humanos , Pneumopatias/cirurgia , Masculino , Reoperação , Toracotomia/métodos
18.
BMJ Case Rep ; 12(12)2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31811091

RESUMO

A 34-year-old man presented with acute severe left-sided abdominal and flank pain with associated postprandial nausea and vomiting. CT imaging revealed findings suspicious for a closed loop small bowel obstruction. Intraoperative findings were that of a left paraduodenal hernia (of Landzert) secondary to a mesenteric defect immediately posterior to the ascending branch of the left colic artery. The defect was closed via minilaparotomy. Unfortunately, his postoperative course was complicated by small bowel obstruction which required further laparotomy and adhesiolysis. The patient eventually made a good recovery. Here, we present a rare case of intestinal obstruction and discuss the aetiologies and management of this unusual phenomenon.


Assuntos
Duodenopatias/diagnóstico , Hérnia/diagnóstico , Obstrução Intestinal/diagnóstico , Dor Abdominal/etiologia , Adulto , Diagnóstico Diferencial , Duodenopatias/complicações , Duodenopatias/diagnóstico por imagem , Duodenopatias/cirurgia , Hérnia/complicações , Hérnia/diagnóstico por imagem , Humanos , Obstrução Intestinal/complicações , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Masculino , Tomografia Computadorizada por Raios X
19.
Am J Case Rep ; 20: 1837-1840, 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31813928

RESUMO

BACKGROUND Gastroesophageal reflux disease (GERD) is a common condition that may be refractory to medical treatment with proton pump inhibitors (PPIs). Laparoscopic Nissen fundoplication is the recommended surgical treatment for GERD and is safe and effective. This report is of a rare case of internal gastroduodenal hernia as a late complication of laparoscopic Nissen fundoplication for the management of GERD in a 19-year-old woman. CASE REPORT A 19-year-old woman was admitted to the emergency department with a three-day history of epigastric pain, anorexia, and altered bowel habit. She had a history of GERD that was treated two years previously by laparoscopic Nissen fundoplication. On the most recent hospital admission, abdominal computed tomography (CT) showed an internal hernia of the gastroduodenal junction through the tissues used as a fundoplication wrap of the abdominal esophagus. The imaging findings were confirmed at exploratory laparoscopy, at which time surgical takedown of the fundoplication was performed. CONCLUSIONS This report is of a rare case of gastroduodenal hernia through a fundoplication wrap two years after a Nissen fundoplication. However, clinicians should be aware of this rare diagnosis in patients with a history of Nissen fundoplication who present with acute upper gastrointestinal symptoms.


Assuntos
Fundoplicatura/efeitos adversos , Refluxo Gastroesofágico/cirurgia , Hérnia/etiologia , Herniorrafia , Enteropatias/cirurgia , Complicações Pós-Operatórias/cirurgia , Gastropatias/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Adulto Jovem
20.
BMJ Case Rep ; 12(12)2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31843775

RESUMO

Left paraduodenal hernias are the most common type of congenital internal hernia, but they are difficult to diagnose without appropriate imaging. A 79-year-old man with a history of recurrent abdominal pain had another similar episode of abdominal pain, which prompted him to seek evaluation. The pain resolved spontaneously on arrival to the hospital. Enhanced CT scan showed the characteristic findings of a left paraduodenal hernia and laparoscopic repair was undertaken. The small intestine was reduced successfully, and the hernia orifice was approximated with a continuous closure. He was discharged uneventfully 4 days after admission. The characteristic clinical and imaging findings of paraduodenal hernias are reviewed. Laparoscopic repair is reasonable in patients who have a paraduodenal hernia without intestinal ischemia.


Assuntos
Duodenopatias/cirurgia , Hérnia/diagnóstico , Herniorrafia/métodos , Laparoscopia/métodos , Dor Abdominal/etiologia , Idoso , Duodenopatias/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios X
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