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1.
Medicine (Baltimore) ; 100(9): e24973, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655965

RESUMO

RATIONALE: An abdominal pseudohernia is a protrusion of the abdominal wall that there is no actual muscular disruption. This report presents a case in which abdominal muscle activities were accurately and quantitatively measured using ultrasonography (US) and surface electromyography in a patient with abdominal pseudohernia. PATIENT CONCERNS: A 62-year-old man presented with a marked protrusion on the left abdomen with increasing abdominal pressure. DIAGNOSES: First, the thickness of the abdominal muscle was measured with US while the patient constantly blew the positive expiratory pressure device. When the force was applied to the abdomen, the mean thickness of the muscle layer on the lesion site was found to be thinner. Second, the activities of the abdominal muscles were measured using surface electromyography by attaching electrodes to 8 channels at the same time. When the same pressure was applied on both sides of the abdomen, more recruitment occurred to compensate for muscle weakness at the lesion site. Through the previous 2 tests, the decrease in muscle activity in the lesion area could be quantitatively evaluated. Third, the denervation of the muscle was confirmed using US-guided needle electromyography. INTERVENTIONS: The patient in this case was wearing an abdominal binder. In addition, he had been training his abdominal muscles through McGill exercise and breathing exercises such as with a positive expiratory pressure device. OUTCOMES: The patient was able to understand his symptoms. A follow-up test will be performed to see if there is any improvement. LESSONS: By using these outstanding assessment methods, proper diagnosis and rehabilitation treatment strategies can be developed.


Assuntos
Músculos Abdominais/diagnóstico por imagem , Eletromiografia/métodos , Fraturas por Compressão/complicações , Hérnia Abdominal/diagnóstico , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/lesões , Ultrassonografia/métodos , Músculos Abdominais/fisiopatologia , Fraturas por Compressão/diagnóstico , Hérnia Abdominal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/diagnóstico
2.
Folia Med Cracov ; 60(1): 55-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32658212

RESUMO

An incarcerated epigastric hernia (localized in linea alba) is a very rare observation. Here, we present a case of a 66-year-old white male who was admitted to the emergency department due to vomiting and epigastric pain. On physical examination, the only observed abnormality was a painless soft epigastric tumor located in the upper midline, measuring about 12 cm in diameter. The patient claimed that he had the tumor for more than 30 years and it never changed in diameter nor caused him any discomfort. A lipoma was initially suspected. However, an ultrasound of the abdomen revealed an incarcerated stomach, trapped due to the defect in the epigastric abdominal wall. The patient was sent for surgery and the presence of an incarcerated epigastric hernia of the linea alba, which contained the anterior wall of the stomach was confirmed. The presented case confirms that the use of ultrasonography may be an effective method to recognize unusual types of hernias, and that ultrasonography should be routinely used in emergency departments.


Assuntos
Artérias Epigástricas/cirurgia , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/cirurgia , Herniorrafia/métodos , Doenças Raras/diagnóstico , Doenças Raras/cirurgia , Ultrassonografia/métodos , Idoso , Humanos , Masculino , Período Pré-Operatório , Resultado do Tratamento
5.
J Surg Res ; 253: 121-126, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32353637

RESUMO

BACKGROUND: With the widespread use of advanced imaging there is a need to quantify the prevalence and impact of hernias. We aimed to determine the prevalence of abdominal wall hernias among patients undergoing computed tomography (CT) scans and their impact on abdominal wall quality of life (AW-QOL). METHODS: Patients undergoing elective CT abdomen/pelvis scans were enrolled. Standardized physical examinations were performed by surgeons blinded to the CT scan results. AW-QOL was measured through the modified Activities Assessment Scale. On this scale, 1 is poor AW-QOL, 100 is perfect, and a change of 7 is the minimum clinically important difference. Three surgeons reviewed the CT scans for the presence of ventral or groin hernias. The number of patients and the median AW-QOL scores were determined for three groups: no hernia, hernias only seen on imaging (occult hernias), and clinically apparent hernias. RESULTS: A total of 246 patients were enrolled. Physical examination detected 62 (25.2%) patients with a hernia while CT scan revealed 107 (43.5%) with occult hernias. The median (interquartile range) AW-QOL of patients per group was no hernia = 84 (46), occult hernia = 77 (57), and clinically apparent hernia = 62 (55). CONCLUSIONS: One-fourth of individuals undergoing CT abdomen/pelvis scans have a clinical hernia, whereas nearly half have an occult hernia. Compared with individuals with no hernias, patients with clinically apparent or occult hernias have a lower AW-QOL (by 22 and seven points, respectively). Further studies are needed to determine natural history of AW-QOL and best treatment strategies for patients with occult hernias.


Assuntos
Parede Abdominal/diagnóstico por imagem , Doenças Assintomáticas/epidemiologia , Hérnia Abdominal/epidemiologia , Qualidade de Vida , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Parede Abdominal/fisiopatologia , Adulto , Idoso , Estudos Transversais , Feminino , Hérnia Abdominal/complicações , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos
6.
Ann R Coll Surg Engl ; 102(7): e155-e157, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32326724

RESUMO

Small bowel obstruction from internal hernias is a familiar pathology for the surgeon, with an incidence of 0.5-5.8%. However, pericaecal hernia is a very uncommon type of internal hernia. Diagnosis and early treatment are essential to avoid strangulation and necrosis of the incarcerated small bowel. We report a case of an 84-year-old woman with no previous history of abdominal surgery who came to our hospital having endured 6 hours of abdominal pain and vomiting. Following physical examination and computed tomography, a diagnosis of small bowel obstruction caused by pericaecal hernia was made and emergency surgery was performed. The hernia was successfully reduced with a laparoscopic approach. Although pericaecal hernia is a rare disease, surgeons should bear it in mind as a differential diagnosis in small bowel obstruction.


Assuntos
Hérnia Abdominal/complicações , Herniorrafia/métodos , Obstrução Intestinal/etiologia , Intestino Delgado/cirurgia , Laparoscopia/métodos , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/cirurgia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
J Surg Res ; 252: 222-230, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32289579

RESUMO

BACKGROUND: Investigate the diagnostic and therapeutic utility of laparoscopy in the management of patients with chronic abdominal pain of unknown origin. METHODS: Ovid MEDLINE, PubMed, and SCOPUS databases were queried to identify relevant published studies. Data on the diagnostic and therapeutic utility of laparoscopy were abstracted and summarized. RESULTS: Laparoscopy achieved a diagnosis in 65% to 94% of patients with chronic abdominal pain of unknown origin. Common intraoperative findings included adhesions, chronic appendicitis, hernias, and enlarged mesenteric lymph nodes. These findings corresponded with the therapeutic procedures that were performed, including laparoscopic adhesiolysis, appendectomy, and hernia repair. Therapeutic utility of laparoscopy based on pain relief, patient satisfaction, and quality of life ranged from 63% to 94%. CONCLUSIONS: Based on current available evidence, diagnostic laparoscopy (DL) is a safe and effective method for identifying organic causes of chronic abdominal pain. Laparoscopic treatment also resulted in substantial pain relief for a majority of patients. However, the efficacy of laparoscopic adhesiolysis remains controversial. We would recommend the use of DL as an early diagnostic tool, but more robust studies are needed to establish the breadth of its therapeutic utility in clinical practice.


Assuntos
Dor Abdominal/cirurgia , Apendicite/diagnóstico , Dor Crônica/cirurgia , Hérnia Abdominal/diagnóstico , Laparoscopia , Aderências Teciduais/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Apendicite/complicações , Apendicite/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Hérnia Abdominal/complicações , Hérnia Abdominal/cirurgia , Humanos , Medição da Dor , Aderências Teciduais/complicações , Aderências Teciduais/cirurgia , Resultado do Tratamento
8.
Ann R Coll Surg Engl ; 102(5): e102-e104, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32159370

RESUMO

Epigastric hernia involving the falciform ligament is exceptionally rare. Most reported cases are incisional hernia secondary to prior abdominal surgery. We report a case of primary falciform ligament herniation into the epigastric region repaired by the laparoscopic preperitoneal approach. In this case, an accompanying vessel along the herniated falciform ligament was identified. This finding provides a basis for the hypothesis of a perforating vessel piercing the linea alba and thereby creating a weak point for hernia protrusion (Moschowitz theory). The patient had an uneventful recovery and was discharged home on the postoperative day two. A laparoscopic preperitoneal approach is feasible for the repair of primary falciform ligament herniation. The magnified endoscopic view enables surgeons to achieve definite repair without missing occult defects.


Assuntos
Parede Abdominal/patologia , Hérnia Abdominal/cirurgia , Laparoscopia , Ligamentos/patologia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/cirurgia , Idoso , Feminino , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/patologia , Humanos , Ligamentos/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia
10.
Surgery ; 167(5): 876-882, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32151368

RESUMO

BACKGROUND: Weight loss is often encouraged or required before open ventral hernia repair. This study evaluates the impact of weight change on total, intra-abdominal, subcutaneous, and hernia volume. METHODS: Patients who underwent open ventral hernia repair from 2007 to 2018 with two preoperative computed tomography scans were identified. Scans were reviewed using 3D volumetric software. Demographics, operative characteristics, and outcomes were evaluated. The impact of weight change on intra-abdominal, subcutaneous, and hernia volume was assessed using Spearman's correlation coefficients and linear regression models. RESULTS: A total of 250 patients met the criteria with a mean defect area of 155.6 ± 155.4 cm2, subcutaneous volume of 6,800.0 ± 3,868.8 cm3, hernia volume of 915.7 ± 1,234.5 cm3, intra-abdominal volume equaling 4,250.2 ± 2,118.1 cm3, and time between computed tomography scans 13.9 ± 11.0 months. Weight change was associated with change in hernia, intra-abdominal, total, and subcutaneous volume (Spearman's correlation coefficients 0.17, 0.48, 0.51, 0.45, respectively, P ≤ 0.03 all values) and not associated in hernia length, width, or area (P ≥ 0.18 all values). A Δ5 kg was significantly associated with Δintra-abdominal volume (164.1 ± 30.0 cm3/Δ5 kg,P < .0001), Δtotal volume (209.9 ± 33.0 cm3/Δ5 kg, P < .0001), and Δsubcutaneous volume (234.4 ± 50.8 cm3/Δ5 kg, P < .0001). Per Δ5 kg, male patients had more than double the Δintra-abdominal, Δtotal, and Δsubcutaneous volume than did female patients. A weight change of 5 kg to10 kg was associated with approximately double the change in computed tomography parameters/Δ5 kg than any weight change after 10 kg. Regardless of weight change, all measured hernia parameters increased over time, with mean hernia volume of +40.6 ± 94.9 cm3/mo and area of +7.8 ± 13.3 cm2/mo (Spearman's correlation coefficient -0.03 to 0.07, P value 0.37-0.96). CONCLUSION: Weight change is linearly correlated with intra-abdominal and subcutaneous fat gain or loss. Males show greater abdominal-related response to weight gain or loss. Hernia dimensions increase over time regardless of weight change.


Assuntos
Peso Corporal , Hérnia Abdominal/epidemiologia , Hérnia Abdominal/etiologia , Gordura Abdominal/patologia , Idoso , Feminino , Hérnia Abdominal/diagnóstico , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Tomografia Computadorizada por Raios X
11.
BMJ Case Rep ; 13(1)2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996382

RESUMO

Laparoscopic pancreatoduodenectomy (LPD) is increasingly performed worldwide as an alternative to the open conventional method, with the aim of advancing recovery. Because of its recent introduction, little is known about late surgical complications from this procedure. Here, we describe a case of a 76-year-old woman who underwent LPD with end-to-side gastrojejunostomy and presented with pain in the right upper quadrant of the abdomen 6 months thereafter. CT showed signs of an internal herniation. Elective diagnostic laparoscopy demonstrated a hernia of the efferent loop in Petersen's space. The loop was repositioned and Petersen's space was closed. The patient was discharged on the same day. Apart from a short readmission for nausea and vomiting, which were managed conservatively, the patient recovered without any further complications. Internal herniation should be considered in patients with abdominal complaints following LPD.


Assuntos
Hérnia Abdominal/diagnóstico , Hérnia Abdominal/etiologia , Pancreaticoduodenectomia/efeitos adversos , Idoso , Feminino , Humanos , Laparoscopia , Radiografia Abdominal
12.
Am J Surg ; 220(1): 214-216, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31668708

RESUMO

BACKGROUND: Internal hernia rate after Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is variable (0.5%-9%). METHODS: We retrospectively reviewed all patients who underwent diagnostic laparoscopy for possible internal hernia after RYGB from 2009 to 2016. All internal hernia defects were closed. RESULTS: We performed 574 RYGB cases between 2013 and 2016, 33 diagnostic laparoscopies were performed (6 after RYGB done at our institution & 27 after RYGB done at outside institutions). Diagnostic laparoscopies after RYGB done at our institution showed internal hernia in 3/6 (50%), none at Petersen space, none had incarcerated small bowel or were converted to open. While 20/27 (74%) of diagnostic laparoscopies after RYGB done at outside institutions had an internal hernia, 18/20 (90%) at Petersen space, 15/27 (55%) had incarcerated small bowel and 3.7% needed small bowel resection or were converted to open. Our internal hernia rate after RYGB was 0.5%. Computerized Tomography (CT scan) was falsely negative in 44-50% of patients with laparoscopy after RYGB. CONCLUSION: Diagnostic laparoscopy is more accurate than CT scan in evaluating patients with abdominal pain after RYGB.


Assuntos
Algoritmos , Derivação Gástrica/efeitos adversos , Hérnia Abdominal/diagnóstico , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Tomografia Computadorizada por Raios X/métodos , Seguimentos , Hérnia Abdominal/etiologia , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo
14.
Trials ; 20(1): 738, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842966

RESUMO

BACKGROUND: Incisional hernias are among the most frequent complications following abdominal surgery and cause substantial morbidity, impaired health-related quality of life and costs. Despite improvements in abdominal wall closure techniques, the risk for developing an incisional hernia is reported to be between 10 and 30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia risks, namely the small stitches technique and the placement of a prophylactic mesh. So far, these two techniques have not been evaluated in combination. METHODS: The HULC trial is a multicentre, randomized controlled, observer- and patient-blinded surgical effectiveness trial with two parallel study groups. A total of 812 patients scheduled for elective abdominal surgery via a midline laparotomy will be randomized in 12 centres after informed consent. Patients will be randomly assigned to the control group receiving closure of the midline incision with a slowly absorbable monofilament suture in the small stitches technique or to the intervention group, who will receive a small stitches closure followed by augmentation with a light-weight polypropylene mesh in the onlay technique. The primary endpoint will be the occurrence of incisional hernias, as defined by the European Hernia Society, within 24 months after surgery. Further perioperative parameters, as well as patient-reported outcomes, will be analysed as secondary outcomes. DISCUSSION: The HULC trial will address the yet unanswered question of whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the risk of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00017517. Registered on 24th June 2019.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Hérnia Abdominal/prevenção & controle , Hérnia Incisional/prevenção & controle , Telas Cirúrgicas , Técnicas de Sutura/instrumentação , Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Método Duplo-Cego , Alemanha , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/etiologia , Humanos , Hérnia Incisional/diagnóstico , Hérnia Incisional/etiologia , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Técnicas de Sutura/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
15.
Sci Rep ; 9(1): 12847, 2019 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492915

RESUMO

Internal hernia (IH)-related surgical acute abdomen is not well understood because of the rarity of cases and underdiagnosis. This study was performed to further understand the clinicopathological features and multi-detector computed tomography (MDCT) findings of IH in cases confirmed by surgery. In all, 51 patients with a definite diagnosis of IH confirmed during surgical exploration from Feb. 2012 to Feb. 2018 in our hospital were included in this research. Medical records, including MDCT images and intra-operative findings, were collected retrospectively. In all, 39 and 12 cases were categorized as adhesive IH (76.5%) and non-adhesive IH (23.5%), respectively. Among the patients with adhesive IH, 73% had a history of abdominal or pelvic surgery. Additionally, the mesentery was the most common component of adhesive bands (64.1%). Congenital peritoneal abnormalities and gastrointestinal reconstruction were the main causes of non-adhesive IH.As a specific sign, the fat notch sign was much more common in adhesive IH than in non-adhesive IH (P = 0.023). Bowel wall thickening (P = 0.041), abnormal bowel wall enhancement (P = 0.006) and twisted bowels with the vessel swirl sign (P = 0.004) were indicators of bowel necrosis. Among all of the cases of IH, 34 (66.7%) were complicated by bowel necrosis, and 1 patient died. In conclusion, non-adhesive IH has different clinicopathological features and MDCT findings from those of adhesive IH. MDCT is a useful tool with high sensitivity for confirming IH and may help to guide the early treatment of IH.


Assuntos
Hérnia Abdominal/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Tomografia Computadorizada Multidetectores , Aderências Teciduais/diagnóstico por imagem , Feminino , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/cirurgia , Humanos , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Masculino , Pessoa de Meia-Idade , Necrose , Peritônio/diagnóstico por imagem , Peritônio/patologia , Raios X
16.
Surg Obes Relat Dis ; 15(9): 1633-1640, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31378635

RESUMO

Improved fertility following a Roux-en-Y gastric bypass (RYGB) can lead to pregnancy and increase the risk of internal herniation. A developing fetus and symptoms of pregnancy can mask the diagnosis and delay intervention, leading to deleterious maternal and fetal consequences. The aim of this systematic review is to summarize the literature regarding internal hernias during pregnancy, their management, and patient outcomes. A comprehensive literature search was undertaken on PubMed and Google Scholar to identify cases of internal hernias presenting during pregnancy after RYGB. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for eligibility and inclusion of articles. Twenty-seven articles, with a total of 59 patients, regarding internal herniation during pregnancy after RYGB were identified. Epigastric pain and nausea and vomiting was the most common presentation. Regardless of orientation of the Roux limb and despite previous closure of mesenteric defects, internal herniation can still occur. A triad of epigastric pain, pregnancy, and a history of RYGB should be a red flag for clinicians to consider internal hernias as a top differential diagnosis. Prompt bariatric consultation and rapid intervention will improve maternal and fetal outcomes.


Assuntos
Derivação Gástrica/efeitos adversos , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/etiologia , Obesidade Mórbida/cirurgia , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Feminino , Hérnia Abdominal/terapia , Humanos , Gravidez , Complicações na Gravidez/terapia
17.
Surg Laparosc Endosc Percutan Tech ; 29(6): e102-e107, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31385923

RESUMO

INTRODUCTION: Congenital hernias are rare findings, and their diagnosis is often delayed due to an incorrect interpretation of the clinical symptoms and/or images. We present a rare case of left-sided paraduodenal hernia at the ligament of Treitz, followed by a review of the literature. CASE PRESENTATION: We report the case of a 20-year-old patient with unusual, recurring abdominal pain in the past 3 months. There were no previous operations or past illnesses in the patient's history. The computed tomographic scan showed a misplacement of small bowel into the lesser sack. With high suspicion of an internal hernia, we performed a diagnostic laparoscopy, which revealed a Treitz hernia. The reduction and fixation could be carried out fully with minimally invasive surgery with an uneventful postoperative course and complete recovery. CONCLUSION: A Treitz hernia is a rare cause of unspecific abdominal pain and the clinical signs are difficult to interpret. However, its knowledge may help to avoid emergency procedures and provide quick recovery of the patients. We recommend the laparoscopic approach as the first choice of treatment in all cases of internal hernia in the absence of peritoneal irritation or severe bowel obstruction.


Assuntos
Duodenopatias/cirurgia , Duodeno/anormalidades , Hérnia Abdominal/cirurgia , Herniorrafia/métodos , Obstrução Intestinal/cirurgia , Laparoscopia/métodos , Duodenopatias/diagnóstico , Duodenopatias/etiologia , Hérnia Abdominal/congênito , Hérnia Abdominal/diagnóstico , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Masculino , Tomografia Computadorizada por Raios X , Adulto Jovem
18.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439565

RESUMO

Pregnant women who previously had bariatric surgery may develop acute abdominal pain during pregnancy. Two patients, 38-year-old twin primigravida (gestational age of 24+6 weeks) and a 26-year-old woman (gestational age of 24+0 weeks), both of whom had laparoscopic gastric bypass surgery previously, developed abdominal pain. The patients both had diffuse abdominal pain in combination with normal blood tests and imaging. Patient B had undergone laparoscopy at another centre after 5 weeks of gestation for internal herniation. After referral to our multidisciplinary bariatric-obstetric-neonatal (MD-BON) team, diagnostic laparoscopy was advised as internal herniation was deemed possible. In both patients, internal herniation was indeed found in Petersen's space and jejunal mesenteric defect, which was closed using laparoscopic surgery. Both women delivered healthy offspring afterwards. The presence of an MD-BON team allows for an increased awareness of potential long-term complications associated with earlier bariatric surgery in pregnancy.


Assuntos
Cirurgia Bariátrica , Hérnia Abdominal/diagnóstico , Complicações na Gravidez/diagnóstico , Dor Abdominal/etiologia , Adulto , Feminino , Hérnia Abdominal/complicações , Hérnia Abdominal/diagnóstico por imagem , Hérnia Abdominal/cirurgia , Humanos , Laparoscopia , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/cirurgia , Segundo Trimestre da Gravidez , Gravidez de Gêmeos
19.
Surgery ; 166(5): 849-853, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31262568

RESUMO

BACKGROUND: Pathways of enhanced recovery after surgery represent a standardized, multimodal approach to postoperative care with the goal of accelerating recovery without increasing morbidity. We hypothesized that implementation of an enhanced recovery after surgery pathway for abdominal wall reconstruction would result in a decreased duration of stay. METHODS: We compared 100 historic controls to 100 consecutive patients undergoing abdominal wall reconstruction with use of a newly implemented, enhanced recovery after surgery pathway to detect a difference in duration of stay of 1 day. Groups were compared on demographics and clinical characteristics using χ2, Fisher exact, Mann-Whitney U test, and 2 sample t tests as appropriate for the data. RESULTS: There was no change in duration of stay with the enhanced recovery after surgery protocol (median 5 vs 5 days, P = .78). There was no difference in time to regular diet (median 3 vs 3 days, P = .14). There was a trend toward decreased time epidurals or patient-controlled analgesia used (median 3 vs 3 day, P = .01). There was no increase in readmission rates. In a subgroup analysis, factors associated with a duration of stay <4 days were hernia width 9.5 ± 7.2 cm (P = .009), operative time 2.5 ± 0.9 hours (P = .001), and preoperative quality-of-life scores (HerQles) 59.5 ± 11.7 (P = .008). CONCLUSION: Our enhanced recovery after surgery study group did not show a decrease in duration of stay. Although smaller hernia defects, lesser operative times, and better baseline quality-of-life scores were associated with shorter duration of stay, the benefits of enhanced recovery after surgery seem limited in patients with the more complex hernia repairs.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Hérnia Abdominal/cirurgia , Herniorrafia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Qualidade de Vida , Adulto , Idoso , Feminino , Hérnia Abdominal/complicações , Hérnia Abdominal/diagnóstico , Herniorrafia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo
20.
Rev. medica electron ; 41(3): 748-755, mayo.-jun. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1094082

RESUMO

RESUMEN La hernia de Spiegel es un defecto raro de la pared abdominal. Su diagnóstico se hace muy difícil por lo infrecuente y por la dificultad para diferenciarla de la hernia inguinal supravesical. Precisamente, por lo poco común, los médicos muchas veces no valoran seriamente la presencia de esta variedad de hernia. Constituye una patología en la que el diagnóstico al igual que el resto de las hernias de la pared abdominal, es esencialmente clínico. El objetivo de este trabajo es informar un caso con un tipo de hernia poco común. Paciente de 50 años de edad, de color de piel blanca, obesa, multípara de procedencia urbana, con antecedentes personales patológico de relativa buena salud. Acudió a consulta por presentar dolor en la región inferior derecha, en la unión del flanco derecho con el mesogastrio, desde hacía varios meses. Fue diagnosticada con una hernia de Spiegel. Se le realizaron los estudios correspondientes fue intervenida quirúrgicamente realizándose hernioplastia.


ABSTRACT Spiegelian hernia is a rare defect of the abdominal wall. Its diagnosis is very difficult because of its infrequency and the difficult of differentiating it from the supravesical inguinal hernia. Precisely due to its infrequence the doctors usually do not seriously evaluate the presence of this kind of hernia. It is a pathology in which, like in the rest of the abdominal wall hernias, the diagnosis is essentially clinical. The aim of this work is to report a case of a patient with an uncommon kind of hernia: a female, obese, multiparous, white patient, aged 50 years, from urban precedence, with personal pathological antecedents of relatively good health, assisted the consultation presenting pain in the right inferior region, in the place where the right flank meets the mesogastrium for several months. She was diagnosed a Spiegel's hernia. The correspondent studies were carried out and she underwent a hernioplasty.


Assuntos
Humanos , Feminino , Adulto , Telas Cirúrgicas , Tomografia Computadorizada por Raios X , Cefazolina/uso terapêutico , Hérnia Abdominal/cirurgia , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/etiologia , Hérnia Abdominal/sangue , Hérnia Abdominal/epidemiologia , Hérnia Abdominal/diagnóstico por imagem , Herniorrafia , Dor/diagnóstico , Polipropilenos , Hemostasia
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