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1.
Medicine (Baltimore) ; 100(14): e25460, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832157

RESUMO

RATIONALE: We report a case with inguinal subcutaneous endometriosis without typical cyclic dysmenorrhea and accompanied with a hernia sac treated with resection of the tumor and herniorrhaphy. PATIENT CONCERNS: A 40-year-old woman had a painless enlarged inguinal nodule for 3 months. DIAGNOSES: Subcutaneous endometriosis accompanied with a hernia sac. INTERVENTIONS: Ultrasonography showed a hypoechoic lesion (3.0 cm × 2.0 cm), and an inguinal subcutaneous tumor was first suspected. After surgical exploration, a cystic lesion was excised and the hernia hole was repaired by herniorrhaphy. The immunohistochemical analysis of the small endometriotic cyst-like lesion revealed calretinin (-) in epithelial cells and CD10 (+) in stromal cells, indicative of subcutaneous endometriosis accompanied with a hernia sac. OUTCOMES: The patient was followed up for 1 year and without recurrence. LESSONS: Cutaneous endometriosis accompanied with a hernia sac can be presented without typical endometriosis-associated symptoms such as dysmenorrhea. Inguinal endometriosis might be the differential diagnosis of inguinal painless nodules.


Assuntos
Endometriose/diagnóstico , Hérnia Inguinal/etiologia , Adulto , Endometriose/complicações , Endometriose/patologia , Endometriose/cirurgia , Feminino , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/patologia , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Canal Inguinal/diagnóstico por imagem , Canal Inguinal/cirurgia
2.
Wiad Lek ; 74(2): 220-224, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33813475

RESUMO

OBJECTIVE: The aim of the study was to determine the possibility and effectiveness of simultaneous surgical interventions in umbilical and paraumbilical hernia repair. PATIENTS AND METHODS: Material and methods: 148 case histories were analyzed concerning patients who were routinely admitted to the surgical department of the Kharkiv Regional Council's Municipal Non-Profit Enterprise «Regional Clinical Hospital¼ between 2017 and 2019, and who underwent umbilical and paraumbilical hernia repair simultaneously with operations related to some other surgical pathology (group 1, n = 67) or in separate interventions (group 2, n = 81). All patients were routinely operated after a set of mandatory and additional general clinical, laboratory and instrumental research conducted in accordance with the existing guidelines. The structure and results of surgical interventions related to the underlying disease and simultaneous operations were studied. RESULTS: Results: Simultaneous operations were performed for comorbid cholecystolithiasis, diaphragmatic esophageal hernia with gastroesophageal reflux, inguinal hernia, white line hernia, benign diseases of the uterus and uterine appendages et al. The frequency of complications and recurrences of hernia in patients with simultaneous and isolated of umbilical hernia repair did not differ significantly. The outcome of the operation mostly depended on the method of operation (postoperative complications were most often observed in open sutures repair and were absent in laparoscopic hernia repair). Additional risk factors were weight gain and diabetes. CONCLUSION: Conclusions: Summarizing the data obtained, it can be concluded that application of modern endovideoscopic techniques in surgery makes simultaneous surgical interventions not only possible but also necessary in the presence of concomitant abdominal pathology that requires surgical treatment.


Assuntos
Hérnia Hiatal , Hérnia Inguinal , Laparoscopia , Feminino , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Recidiva , Telas Cirúrgicas
3.
Georgian Med News ; (311): 27-32, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33814385

RESUMO

Using the mesh for hernia repair is the most common type of hernia surgery. There are many types of meshes made of various synthetic materials, but all of these meshes have their own respective disadvantages. The aim of this study was to provide preliminary results of a non-randomized clinical trial evaluation of novel porcine grafts XI-S+® (Colorado Therapeutics LLC. USA) for ventral and inguinal hernia repair. All patients underwent a standardized surgical procedure. Onlay surgical repair technique has been performed in ten patients with ventral hernia and Lichtenstein tension-free method has been used for ten patients with inguinal hernia repair. The XI-S+® mesh fixation was performed with multiple simple interrupted sutures using prolene thread. The average age of the patients with ventral hernia was 54±14 years, and 30% of patients were female and 70% of patients were male. The average age of the patients with inguinal hernia was 62.5±9.4 years, and 10% of patients were female and 90% of patients were male. The average hospitalization length was 2 days. During three years of observation, no recurrence of hernia was observed in patients. The XI-S + ® mesh has anti-adhesive properties, is extremely resistant to infections, provides favorable conditions for engraftment, early activity and patient rehabilitation. The clinical studies of the patients that underwent ventral and inguinal hernia repair using XI-S+® mesh have shown that the post-operative pain was minimal and easily controlled by the use of analgesics. As for the sensation of the mesh, in some patients it has been present up until 1 month from surgery, but it fully disappeared by the end of the 3rd month.


Assuntos
Hérnia Inguinal , Adulto , Idoso , Animais , Materiais Biocompatíveis/uso terapêutico , Feminino , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Masculino , Pessoa de Meia-Idade , Polipropilenos , Recidiva , Telas Cirúrgicas , Suínos , Resultado do Tratamento
4.
BMC Surg ; 21(1): 195, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858393

RESUMO

BACKGROUND: The aim of this multicenter cohort study was to compare the clinical courses between open and laparoscopic Petersen's hernia (PH) reduction. METHOD: We retrospectively collected the clinical data of patients who underwent PH repair surgery after gastrectomy for gastric cancer from 2015-2018. Forty patients underwent PH reduction operations that were performed by six surgeons at four hospitals. Among the 40 patients, 15 underwent laparoscopic PH reduction (LPH), and 25 underwent open PH reduction (OPH), including 4 patients who underwent LPH but required conversion to OPH. RESULTS: We compared the clinical factors between the LPH and OPH groups. In the clinical course, we found no differences in operation times or intraoperative bowel injury, morbidity, or mortality rates between the two groups (p > 0.05). However, the number of days on a soft fluid diet (OPH vs. LPH; 5.8 vs. 3.7 days, p = 0.03) and length of hospital stay (12.6 vs. 8.2 days, p = 0.04) were significantly less in the LPH group than the OPH group. Regarding postoperative complications, the OPH group had a case of pneumonia and sepsis with multi-organ failure, which resulted in mortality. In the LPH group, one patient experienced recurrence and required reoperation for PH. CONCLUSION: Laparoscopic PH reduction was associated with a faster postoperative recovery period than open PH reduction, with a similar incidence of complications. The laparoscopic approach should be considered an appropriate strategy for PH reduction in selected cases.


Assuntos
Hérnia Ventral/diagnóstico por imagem , Herniorrafia/métodos , Laparoscopia/métodos , Tempo de Internação/tendências , Complicações Pós-Operatórias/epidemiologia , Estudos de Coortes , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Resultado do Tratamento
5.
BMC Surg ; 21(1): 191, 2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33845820

RESUMO

BACKGROUND: Acute colonic pseudo-obstruction (ACPO) is a rare condition observed in patients with some underlying medical or surgical conditions. To the best of our knowledge, this is the first case report of a patient with ACPO development and rapid septic progression after laparoscopic inguinal hernia repair. CASE PRESENTATION: A 78-year-old man who underwent transabdominal preperitoneal hernia repair (TAPP) for right inguinal hernia presented with difficulty in defecation and abdominal distension. He visited our emergency department on the third postoperative day. Enhanced computed tomography (CT) detected marked enlargement from the cecum to the rectum. There was no evidence of mechanical obstruction, ischemia, or perforation. He was diagnosed with postoperative constipation and received conservative management. He gradually started to improve; however, he suddenly experienced cardiopulmonary arrest 30 h after admission and could not be resuscitated. CT imaging of the abdomen during autopsy did not show any significant change, such as perforation, from the time of admission. Based on the clinical course and examination results, postoperative ACPO was considered the fundamental cause of fulminant obstructive colitis leading to sepsis. CONCLUSIONS: ACPO following minimally invasive surgery is exceedingly rare. However, it is important to consider this disease as one of the differential diagnoses to avoid missing the chance for advanced therapy.


Assuntos
Pseudo-Obstrução do Colo , Hérnia Inguinal , Herniorrafia , Sepse , Idoso , Pseudo-Obstrução do Colo/complicações , Pseudo-Obstrução do Colo/diagnóstico , Pseudo-Obstrução do Colo/etiologia , Evolução Fatal , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Laparoscopia , Masculino , Sepse/etiologia
6.
BMC Surg ; 21(1): 182, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827518

RESUMO

BACKGROUND: Misdiagnosis or failure to intraoperatively detect occult hernia in the inguinal region can lead to the recurrence of postoperative hernia and the appearance of local pain symptoms, which affect the patient's quality of life and make it difficult to reperform hernia repair. METHODS: This study included 1066 inguinal hernia patients who underwent surgical treatment at Shanghai Tongren Hospital between January 2016 and October 2018 to investigate ipsilateral occult hernia epidemiology, to analyze the characteristics of ipsilateral occult hernias with regards to patient age, gender, classification and anatomical site, and to explore the superiority and inferiority of the expert hernia surgeons/ non-expert hernia surgeons group and of operation methods in finding occult inguinal hernias. RESULTS: The incidence of ipsilateral occult hernia in the surgical population was 8.26%. Ipsilateral occult hernia included indirect inguinal hernia, direct inguinal hernia, femoral hernia, obturator hernia, and spigelian hernia, among which the highest incidence was direct inguinal hernia (4.11%), followed by indirect inguinal hernia (2.45%). There was no difference in the incidence of ipsilateral occult hernia between males and females, but there were significant differences in the incidence of ipsilateral occult hernia, which decreased gradually with increasing age in patients younger than 70 years-old; there was no difference in incidence in patients over 70 years-old. There were significant differences in the incidence of ipsilateral occult hernia in the bilateral inguinal region between direct and femoral hernia, with the higher incidence found on the right side; in contrast, there was no difference in the incidence of indirect inguinal hernia in the bilateral inguinal region. There was no difference in the ability of experienced physicians to detect ipsilateral occult inguinal hernias, either professionally or by surgery. CONCLUSIONS: Ipsilateral occult inguinal hernia has a higher incidence in patients with inguinal hernia, especially older patients; therefore, it is necessary for experienced surgeons to carefully detect for possible occult hernia during the operation and in elderly patients.


Assuntos
Hérnia Inguinal , Herniorrafia , Idoso , China/epidemiologia , Feminino , Hérnia Inguinal/epidemiologia , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Incidência , Masculino , Recidiva , Estudos Retrospectivos
7.
BMC Surg ; 21(1): 183, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827542

RESUMO

BACKGROUND: Fistula formation due to mesh erosion into hollow viscera, such as the urinary bladder, is uncommon. To date, there have been no reports of fistula formation into the urinary bladder without evidence of mesh erosion after hernioplasty; herein, we report one such rare case, in which the clinical symptoms improved without any surgical intervention. CASE PRESENTATION: A 73-year-old man underwent a trans-abdominal preperitoneal repair for bilateral direct inguinal hernia. One month later, the patient experienced a painful induration in the right inguinal region, and computed tomography revealed fluid collection in this region. A culture of the aspirated fluid yielded no bacteria. Seven months later, he experienced another episode of painful induration in the same region. However, blood examination revealed a normal white blood cell count and C-reactive protein level. Moreover, no organisms were detected by aspirated fluid culture. Although the painful induration subsided after aspiration of the fluid collection, he developed gross hematuria and dysuria a month later. Cystoscopy revealed a fistula in the right wall of the urinary bladder that discharged a purulent fluid. Culture of the fluid revealed no bacteria, and there was no evidence of mesh erosion. Hematuria improved without therapeutic or surgical intervention. The patient's clinical symptoms improved without mesh removal. Moreover, cystoscopy revealed that the fistula was scarred 12 months after the initial appearance of urinary symptoms. No further complications were observed during a 42-month follow-up period. CONCLUSIONS: We report a rare case of a fistula in the urinary bladder without evidence of mesh erosion after laparoscopic hernioplasty. The patient's condition improved without mesh removal. Fluid collection due to foreign body reaction to meshes can cause fistula formation in the urinary bladder without direct mesh contact.


Assuntos
Herniorrafia , Laparoscopia , Fístula da Bexiga Urinária , Idoso , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Fístula da Bexiga Urinária/diagnóstico , Fístula da Bexiga Urinária/etiologia
8.
Mymensingh Med J ; 30(2): 453-457, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33830128

RESUMO

Ventral hernia after abdominal surgery is a common complication. Several techniques for the repair of ventral hernia have been described from time to time and it is a great challenge for a surgeon. The mesh placement by sublay technique authorized by Rives and Stoppa in Europe has been reported to be effective with low recurrence rate. The objective of this study was to evaluate the efficacy of sublay technique of mesh placement in ventral hernia. This prospective study was carried out in the Department of Surgery, Dhaka Dental College, Bangladesh from January 2017 to December 2018. A total of 21 patients with ventral hernia were included in this study. Data collected in data collection sheet regarding demographic data, severity of symptoms and post operative complains of patients which were then analyzed. Age ranged from 21-60 years. Male were 5(23.80%) and female were 16(76.20%). Dragging pain were 7(33.33%), irreducibility were 4(19.05%) but swelling were 100%. Incisional hernia was 18(85.71%) and para-umbilical hernia was 3(14.29%). Post-operative complication were seroma1 (4.76%), major wound infection 1(4.76%), minor infection 1(4.76%) but no recurrence. Sublay mesh repair in ventral hernia was found to be a better and effective technique with minimal complication rate.


Assuntos
Hérnia Ventral , Telas Cirúrgicas , Adulto , Bangladesh , Feminino , Hérnia Ventral/cirurgia , Herniorrafia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Adulto Jovem
9.
BMC Surg ; 21(1): 152, 2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33743667

RESUMO

BACKGROUND: Inguinal hernia surgery is a frequent procedure among general surgeons in Costa Rica, but the management and technique are not uniform. The International Guideline for Groin Hernia management was published in 2018 to standardize the inguinal hernia surgery, but the diffusion of the guidelines and its adherence have been extremely varied. PURPOSE: Collect and analyze the current reality regarding groin hernia management in Costa Rica. Secondly evaluate the diffusion and development comparing it to the guideline's recommendations. METHOD: Questionnaire of 42 single and multiple answer questions according to the topics of the International Guideline directed to general surgeons. Diffusion of the inquiry through surgical and hernia association chats and email. Timeframe June-December 2019. RESULTS: 64 surveys were collected, which is a representative number of the general surgeons national college. The most frequent procedure between these was the abdominal wall surgery. Every surgeon did more than 52 groin hernia surgeries in one year, most of them outpatients. The epidural anesthesia was used the most and Lichtenstein's technique was the most frequently used (64%). 68% of the surgeons know how to perform a minimally invasive inguinal hernia surgery but with variable volumes. 38% of participants considered themselves experts in groin hernia management and 52% did not know the 2018 International Guideline. The recommendations of such guideline are followed only partially. CONCLUSIONS: The 2018 Hernia Surge International Guidelines have low diffusion among Costa Rican surgeons. The laparoscopic approach is widely accepted but there are no studies to assess the results and the quality. There should be protocols and studies adapted to Costa Rica's national situation.


Assuntos
Virilha/cirurgia , Fidelidade a Diretrizes/estatística & dados numéricos , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões , Adulto , Anestesia Local/estatística & dados numéricos , Costa Rica/epidemiologia , Feminino , Herniorrafia/normas , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Inquéritos e Questionários
10.
Rev Col Bras Cir ; 48: e20202879, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33787766

RESUMO

INTRODUCTION: currently, there are several clinical applications for robot-assisted surgery and in the hernia scenario, robot-assisted surgery seems to have the ability to overcome laparoscopic ventral hernias repairs limitations, facilitating dissection, defect closure, and mesh positioning. Exponentially grown in numbers of robotic approaches have been seen and even more complex and initially not suitable cases have recently become eligible for it. An appropriate tension-free reestablishment of the linea alba is still a major concern in hernia surgery and even with the robotic platform, dissecting and suturing in anterior abdominal wall may be challenging. This article reports a technical image artifice during a da vinci Xi-platform robotic ventral hernia repair allowing the surgeon to establish a more familiar and ergonomic manner to perform dissection and suturing in anterior abdominal wall. TECHNICAL REPORT: a step by step guided technique of image inversion artifice is described using detailed commands and figures to assure optimal surgical field and ergonomics whenever acting in robotic ventral hernias repair with the da Vinci Xi-platform. Our group brief experience is also reported, showing an easy and reproducible feature among surgeons with safe outcomes. CONCLUSION: we consider that image inversion artifice is a simple and reproducible feature in robotic ventral hernia repair. Through a step-by-step guide, this report enables the creation of an artifice providing a comfortable operative field and allowing the surgeon to achieve its best proficiency in hernia surgery.


Assuntos
Parede Abdominal , Hérnia Ventral , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Hérnia Ventral/cirurgia , Herniorrafia , Humanos , Telas Cirúrgicas
11.
Medicine (Baltimore) ; 100(9): e25007, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655970

RESUMO

ABSTRACT: Surgical site infection (SSI) is a costly postoperative complication with a decrease in the quality of life. We aimed to probe the predictive role of peripheral blood inflammation markers for SSI following mesh repair of groin hernia (GH).This retrospective study assessed the data of 1177 patients undergoing elective mesh repair of GH (open/laparoscopy) in the absence of antibiotic prophylaxis. The relation between demographics, surgical factors, pre-surgical laboratory results and the occurrence of SSI were investigated by univariate and multivariate analyses. Receiver operating characteristic analysis was performed to determine the optimal threshold of parameters and compare their veracity.The overall SSI rate was 3.2% with 1-year follow-up (38 superficial and 1 deep SSI). Patients with SSI had significant higher pre-surgical neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) than those without (P = .029 and P = .045, respectively); their NLR and PLR correlated positively with postoperative total days of antibiotic treatment for SSI (r = .689, P = .000; r = .493, P = .001; respectively). NLR and PLR had larger areas under the receiver operating characteristics curves than neutrophil (.875 vs. .601; P = .000; .726 vs. .601; P = .017). The combination of PLR and neutrophil/NLR raised the predictive sensitivity of PLR for SSI (sensitivity: PLR: 74.36%; PLR + neutrophil: 82.05%; PLR + NLR: 83.57%). On multivariate analyses, higher preoperative NLR (cut-off 2.44) and PLR (cut-off 125.42) were independent predictors for SSI.Higher pre-surgical NLR and PLR may be valuable predictors for SSI following elective mesh repair of GH.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Inflamação/sangue , Linfócitos/patologia , Neutrófilos/patologia , Telas Cirúrgicas/efeitos adversos , Infecção da Ferida Cirúrgica/sangue , Adulto , Idoso , Biomarcadores/sangue , Plaquetas/patologia , Feminino , Seguimentos , Humanos , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Qualidade de Vida , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia
12.
BMC Surg ; 21(1): 158, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752652

RESUMO

BACKGROUND: Laparoscopic paraesophageal hernia repair is associated with higher recurrence rate. Mesh is used to reduce the recurrence rate. This retrospective study is to review our experience of biological mesh fixed with suture and medical glue in hiatal hernias repairs. METHODS: A retrospective chart review was conducted for a consecutive series of patients undergoing laparoscopic hiatal herniorrhaphy between January 2018 and January 2019. After hiatus closure, a piece of biological prosthesis was fixed with medical glue and suture for reinforcement of the crural closure. Clinical outcomes were reviewed, and data were collected regarding operative details, complications, symptoms, and follow-up imaging. Radiological evidence of any size of hiatal hernia was considered to indicate a recurrence. RESULTS: Thirty-six patients underwent surgery uneventfully without any serious complication. There was no mortality. The follow-up was, on average, 18.4 months, and there was no symptomatic recurrence. There was one anatomical recurrence without any related presentation. The method of mesh fixation with medical glue and suture took 12 min on average, and the handling was fairly easy. CONCLUSIONS: Biological mesh fixed with suture and medical glue was safe and effective for repairing large hiatal hernias. Of course, a longer follow-up is still needed for determining long-term outcomes.


Assuntos
Hérnia Hiatal , Herniorrafia , Laparoscopia , Adesivos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas , Suturas , Resultado do Tratamento
13.
Surg Clin North Am ; 101(2): 307-321, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33743971

RESUMO

Ventral and incisional hernias in obese patients are particularly challenging. Suboptimal outcomes are reported for elective repair in this population. Preoperative weight loss is ideal but is not achievable in all patients for a variety of reasons, including access to bariatric surgery, poor quality of life, and risk of incarceration. Surgeons must carefully weigh the risk of complications from ventral hernia repair with patient symptoms, the ability to achieve adequate weight loss, and the risks of emergency hernia repair in obese patients.


Assuntos
Cirurgia Bariátrica/métodos , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Obesidade/cirurgia , Qualidade de Vida , Telas Cirúrgicas , Hérnia Ventral/complicações , Humanos , Obesidade/complicações
14.
Rev Col Bras Cir ; 48: e20202672, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33681911

RESUMO

Incisional hernia is a late complication of the most frequent after abdominal surgeries, with resulting morbidity that can worsen the condition. The treatment has been done both by open techniques, using screens or not, and by laparoscopic and robotic methods, which use them systematically. However, introducing a permanent foreign body into the tissues requires more surgical time, despite not closing the parietal defect in most cases and a higher risk of infections. New technologies have been trying to improve these results, with absorbable prostheses (biological or synthetic), but their high cost and recurrences remain a severe problem. Even so, standard repair establishes reinforcement with screens, routine, and whether the approach is traditional or mini-invasive. The authors report their first case of endoscopic repair of incisional hernia, which occurred two years ago, with a Brazilian technique already fifty years old: the transposition with the hernia sac proposed by Prof. Alcino Lázaro da Silva in 1971.


Assuntos
Endoscopia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Telas Cirúrgicas , Brasil , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
Br J Surg ; 108(2): 138-144, 2021 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-33711123

RESUMO

BACKGROUND: There is a shortage of high-quality studies regarding choice of mesh in open anterior inguinal hernia repair in relation to long-term chronic pain. The authors hypothesized that heavyweight compared with lightweight mesh causes increased postoperative pain. METHODS: An RCT was undertaken between 2007 and 2009 at two sites in Sweden. Men aged 25 years or older with an inguinal hernia evaluated in the outpatient clinic were randomized in an unblinded fashion to heavyweight or lightweight mesh for open anterior inguinal hernia repair. Data on pain affecting daily activities, as measured by the Short-Form Inguinal Pain Questionnaire 9-12 years after surgery, were collected as the primary outcome. Differences between groups were evaluated by generalized odds and numbers needed to treat. RESULTS: A total of 412 patients were randomized; 363 were analysed with 320 questionnaires sent out. A total of 271 questionnaires (84.7 per cent) were returned; of these, 121 and 150 patients were in the heavyweight and lightweight mesh groups respectively. Pain affecting daily activities was more pronounced in patients randomized to heavyweight versus lightweight mesh (generalized odds 1.33, 95 per cent c.i. 1.10 to 1.61). This translated into a number needed to treat of 7.06 (95 per cent c.i. 4.28 to 21.44). Two reoperations for recurrence were noted in the heavyweight mesh group, and one in the lightweight mesh group. CONCLUSION: A large-pore lightweight mesh causes significantly less pain affecting daily activities a decade after open anterior inguinal hernia repair. Registration number: NCT00451893 (http://www.clinicaltrials.gov).


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Dor Pós-Operatória/etiologia , Telas Cirúrgicas , Idoso , Dor Crônica/etiologia , Herniorrafia/instrumentação , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Telas Cirúrgicas/efeitos adversos , Inquéritos e Questionários
16.
Adv Clin Exp Med ; 30(2): 135-138, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33636062

RESUMO

BACKGROUND: The laparoscopic totally extraperitoneal inguinal hernia repair (TEP), unlike the Lichtenstein tension-free mesh repair, allows for inspecting the femoral canal area for the presence of an occult femoral hernia. OBJECTIVES: To determine the incidence of an unsuspected femoral hernia in patients undergoing TEP repair. MATERIAL AND METHODS: Data was collected prospectively from 180 patients (23 women) who underwent hernia repair, including examination of the femoral canal, between November 2017 and March 2019, and the incidence of a femoral hernia was determined. Correlations between the incidence of a femoral hernia and sex, age and the type of inguinal hernia diagnosed in the patients (indirect, direct, both indirect and direct) were assessed. RESULTS: Femoral hernias were found in 14 patients (7.77%). None of the hernias had previously been detected clinically. The incidence of a femoral hernia was higher in women (6/23, 26.07%) than in men (8/157, 5.09%). The incidence of a femoral hernia was higher in older patients: the average age of patients with a femoral hernia was 57.86 years (median: 60 years), whereas the average age of patients without a femoral hernia was 49.92 years (median: 49 years). However, the correlation was not statistically significant. No correlation was found between the incidence of a femoral hernia and the type of inguinal hernia diagnosed in the patients (direct, indirect, both indirect and direct). CONCLUSIONS: The TEP repair allows for detecting and repairing an occult femoral hernia.


Assuntos
Hérnia Femoral , Hérnia Inguinal , Laparoscopia , Idoso , Feminino , Hérnia Femoral/epidemiologia , Hérnia Femoral/cirurgia , Hérnia Inguinal/epidemiologia , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade
17.
Zentralbl Chir ; 146(2): 194-199, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33556982

RESUMO

Net augmentation in surgical care of hiatus hernias has many advantages, but is still controversial. Optimal surgical treatment of symptomatic hiatus hernia is to provide long-term correction of the malposition of the stomach and other organs that have been displaced in the thorax, as well as reducing the necessity of risky reoperations. In order to assess the role of net augmentation in repair of the hiatus here, the benefit in the form of the avoidance of symptomatic recurrence and reoperations must be balanced against the risk of net-associated complications. In the present review article, we present a detailed evaluation of current evidence on net augmentation. We conclude that net augmentation in large hernias (> 5 cm), with or without paraesophageal involvement, should be routinely employed, as this reduces the risk of recurrence and the need for complex reoperations with a high risk of complications. Net-associated complications are rare and can largely be avoided with the correct implantation technique and proper net materials. The level of evidence could be improved if more validated register and randomised controlled studies were performed.


Assuntos
Refluxo Gastroesofágico , Hérnia Hiatal , Laparoscopia , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Herniorrafia , Humanos , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas
18.
Zentralbl Chir ; 146(2): 204-209, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33567462

RESUMO

BACKGROUND: The hernia recurrence rate after surgical treatment of large hiatal hernias is still very high. The optimal technique to reduce the recurrence rate is still under debate. The aim of this work is to clarify whether pledgeted reinforced sutures or a resorbable mesh can reduce the recurrence rate compared to hiatus closure with only sutures. MATERIALS AND METHODS: An Austria-wide, multi-centre, prospective, randomised study was planned. The study protocol was prepared by the main test centre (University Clinic for General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg). The study includes patients who are scheduled to undergo laparoscopic or robot-assisted surgery for a large symptomatic hiatal hernia. A large hiatal hernia is defined as > 5 cm in manometry or gastroscopy or at least ⅓ of the stomach lying intrathoracically. The primary study endpoint is defined as the hernia recurrence rate, objectively assessed by gastroscopy. After inclusion in the study, patients will be followed up for 6 months, 1 year, 3 years and 5 years after the operation, using standardised questionnaires and gastroscopy. The power calculation showed a requirement of 55 patients per group. Preoperative randomisation and data management are software-based. RESULTS: The study approval by the leading ethics committee is currently pending and the study itself has been registered on ClinicalTrials.gov since October 2020. The Clinical Trials Registration Number is NCT04591860. Five clinics are participating in the study at the moment and all centres are actively enrolling patients. The duration of the study is set until January 2027. CONCLUSION: This study is the world's first prospective randomised study that examines the value of pledgets and resorbable mesh to reduce the recurrence rate after treatment of large hiatal hernias. The results will help to find the optimal technique to close the hiatus of large hiatal hernias.


Assuntos
Hérnia Hiatal , Laparoscopia , Áustria , Hérnia Hiatal/cirurgia , Herniorrafia , Humanos , Estudos Prospectivos , Recidiva , Telas Cirúrgicas , Suturas , Resultado do Tratamento
19.
Br J Surg ; 108(1): 14-23, 2021 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-33640918

RESUMO

BACKGROUND: The optimal choice for mesh fixation in laparoscopic inguinal hernia repair (LIHR) has not been well established. This review compared the effects of glue versus mechanical mesh fixation in LIHR on incidence of chronic postoperative inguinal pain (CPIP) and other secondary outcomes, including acute pain, seroma, haematoma, hernia recurrence and other postoperative complications. METHODS: A systematic review of English/non-English studies using MEDLINE, the Cochrane Library, OpenGrey, OpenThesis and Web of Science, and searching bibliographies of included studies was completed. Search terms included laparoscopic, hernia, fibrin glue, Tisseel, Tissucol, cyanoacrylate, Glubran and Liquiband. Only RCTs comparing mechanical with glue-based fixation in adult patients (aged over 18 years) that examined CPIP were included. Two authors independently completed risk-of-bias assessment and data extraction against predefined data fields. All pooled analyses were computed using a random-effects model. RESULTS: Fifteen RCTs met the inclusion criteria; 2777 hernias among 2109 patients were assessed. The incidence of CPIP was reduced with use of glue-based fixation (risk ratio (RR) 0.36, 95 per cent c.i. 0.19 to 0.69; P = 0.002), with moderate heterogeneity that disappeared with sensitivity analysis (8 d.f.) for patient-blinded studies (RR 0.43, 0.27 to 0.86). Trial sequential analysis provided evidence for a relative risk reduction of at least 25 per cent. The incidence of haeamtoma was reduced by using glue-based fixation (RR 0.29, 0.10 to 0.82; P = 0.02) with no significant effects on seroma formation or hernia recurrence (RR 1.07, 0.46 to 2.47; P = 0.88). CONCLUSION: Glue-based mesh fixation appears to reduce the incidence of CPIP and haematoma after LIHR compared with mechanical fixation, with comparable recurrence rates.


Assuntos
Adesivos/uso terapêutico , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Telas Cirúrgicas , Herniorrafia/instrumentação , Humanos , Laparoscopia/instrumentação , Dor Pós-Operatória/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542008

RESUMO

A 76-year-old man was referred to our clinic after a foreign body seen in his sigmoid colon during a colonoscopy. He had undergone three operations for a left inguinal hernia within the previous 8 years, and the first procedure was a laparoscopic totally extraperitoneal approach. Four years later, removal of migrated and infected mesh was conducted by open approach. He then had a positive stool occult blood test for routine check-up 4 years after the remnant mesh removal. An ill-defined lesion was identified on colonoscopy. CT revealed a 2.7 cm diameter enhancing lesion in the sigmoid colon. Laparoscopic sigmoidectomy was performed, and remnant mesh fragment was found in the sigmoid colon and removed. The migrated mesh could not be wholly removed by open abdominal approach and the remnant mesh fragment migrated to sigmoid colon. It suggests the importance of a laparoscopic approach to remove the entire mesh.


Assuntos
Colo Sigmoide/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Hérnia Inguinal/complicações , Herniorrafia , Laparoscopia , Telas Cirúrgicas/efeitos adversos , Idoso , Humanos , Masculino , Sangue Oculto , Complicações Pós-Operatórias/cirurgia
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