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2.
Ugeskr Laeger ; 185(1)2023 Jan 02.
Artigo em Dinamarquês | MEDLINE | ID: mdl-36629293

RESUMO

Incisional and parastomal hernias are frequent complications after abdominal surgery. Patients with relevant symptoms should be referred to the local surgical department for diagnosis and indication for surgery. Patients with giant and parastomal hernias are referred to one of the five Danish regional hernia centres. Patients with parastomal hernias often benefit from being referred to a stoma nurse. The most frequent complications after hernia repair are wound complications and recurrence. In case of severe wound infection, incarceration, or strangulation the patient must always be referred acutely, as argued in this review.


Assuntos
Hérnia Ventral , Hérnia Incisional , Estomas Cirúrgicos , Humanos , Resultado do Tratamento , Hérnia Incisional/cirurgia , Hérnia , Estomas Cirúrgicos/efeitos adversos , Herniorrafia/efeitos adversos , Dinamarca , Telas Cirúrgicas/efeitos adversos , Hérnia Ventral/cirurgia
4.
Skeletal Radiol ; 52(1): 1-8, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35835878

RESUMO

This review illustrates the multimodality assessment of transfascial muscle and other soft tissue herniations of the extremities. Transfascial herniations of the extremities can develop from congenital or acquired disruptions of the deep fascia, resulting in herniation of the underlying muscle, nerve, or soft tissue tumor into the subcutaneous tissues. While most patients present with a painless subcutaneous nodule that may change in size with muscle activation, some may experience focal or diffuse extremity symptoms such as pain and paresthesias. Although the diagnosis may be clinically suspected, radiologic evaluation is useful for definitive diagnosis and characterization. Ultrasound is the preferred modality for initial workup through a focused and dynamic examination. Magnetic resonance imaging can be utilized for equivocal, complicated, and preoperative cases. Computed tomography is less useful in the evaluation of transfascial herniations in the extremities due to similarities in the attenuation between muscle and fascia, which can decrease the conspicuity of small defects.


Assuntos
Extremidades , Hérnia , Humanos , Extremidades/diagnóstico por imagem , Fáscia/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Músculos
5.
Biomaterials ; 292: 121940, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36493714

RESUMO

Intraperitoneal adhesions (IAs) are a major complication arising from abdominal repair surgeries, including hernia repair procedures. Herein, we fabricated a composite mesh device using a macroporous monofilament polypropylene mesh and a degradable elastomer coating designed to meet the requirements of this clinical application. The degradable elastomer was synthesized using an organo-base catalyzed thiol-yne addition polymerization that affords independent control of degradation rate and mechanical properties. The elastomeric coating was further enhanced by the covalent tethering of antifouling zwitterion molecules. Mechanical testing demonstrated the elastomer forms a robust coating on the polypropylene mesh does not exhibit micro-fractures, cracks or mechanical delamination under cyclic fatigue testing that exceeds peak abdominal loads (50 N/cm). Quartz crystal microbalance measurements showed the zwitterionic functionalized elastomer further reduced fibrinogen adsorption by 73% in vitro when compared to unfunctionalized elastomer controls. The elastomer exhibited degradation with limited tissue response in a 10-week murine subcutaneous implantation model. We also evaluated the composite mesh in an 84-day study in a rabbit cecal abrasion hernia adhesion model. The zwitterionic composite mesh significantly reduced the extent and tenacity of IAs by 94% and 90% respectively with respect to uncoated polypropylene mesh. The resulting composite mesh device is an excellent candidate to reduce complications related to abdominal repair through suppressed fouling and adhesion formation, reduced tissue inflammation, and appropriate degradation rate.


Assuntos
Polipropilenos , Telas Cirúrgicas , Coelhos , Camundongos , Animais , Telas Cirúrgicas/efeitos adversos , Adesivos , Elastômeros , Implantes Absorvíveis , Aderências Teciduais/prevenção & controle , Aderências Teciduais/etiologia , Hérnia/prevenção & controle
7.
BMC Surg ; 22(1): 411, 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36461067

RESUMO

BACKGROUND: Although umbilical two-port laparoscopic percutaneous extraperitoneal closure for the treatment of processus vaginalis patency of children has been verified to be safe and effective, the improvements of technical skills and instruments have been always on their ways. Recently, forcep-needle has begun to be used. In this study, we compared forcep-needle with hook-needle in this minimal invasive procedure for children suffered from hernia or hydrocele, with the aim to evaluate the instrumental convenience of the two needles. METHODS: From July 2021 to May 2022, we begun to use hook-needle or forcep-needle in umbilical two-port laparoscopic percutaneous extraperitoneal closure for children suffered from hernia or hydrocele. The hook-needle group included nineteen children and the forcep-needle group included twenty-four ones. The data of the patients age, sex, side, operation time, postoperative hospital-stay, follow-up time, postoperative complications were evaluated. Common silk thread was used to encircle the internal ring preperitoneally. RESULTS: There were no statistical differences between the two groups for the following items: age, sex, side, operation time, postoperative hospital-stay and postoperative complications (P > 0.05). The follow-up time of the hook-needle group was longer than that of the forcep-one (P = 0.0020). No open transfer happened for all the patients. One hydrocele boy in the hook-needle group reoccurred 1 month postoperatively due to the peritoneal broken. The single pole retreating of the hook-needle accompanied with chaotic movements, while for that of the forcep-needle, the double-arm retreating movements were more orderly. The outer surface of the forcep-needle was smooth without restrain, as for the hook-needle, an inlaid barb held the danger of brokening the peritoneum. CONCLUSION: In our preliminary experience of umbilical two-port laparoscopic percutaneous extraperitoneal closure using a hook-needle or a forcep-needle, in view of the instrumental convenience and safety, the double-arm and smooth outer surface designs of the forcep-needle contained more spatial orientation perceptions and safety.


Assuntos
Laparoscopia , Hidrocele Testicular , Masculino , Criança , Humanos , Hidrocele Testicular/cirurgia , Complicações Pós-Operatórias , Instrumentos Cirúrgicos , Hérnia
8.
Pol Przegl Chir ; 94(6): 61-70, 2022 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-36468514

RESUMO

<b>Introduction:</b> Perineal hernia (PH), also termed pelvic floor hernia, is a protrusion of intraabdominal viscera into the perineum through a defect in the pelvic floor. </br></br> <b>Aim:</b> The study was conducted to evaluate the cases of perineal hernia resulting as a complication of abdominoperineal resection (APR) of rectal cancer. </br></br> <b> Material and methods:</b> 30 cases from 24 articles published in reputable peer reviewed journals were evaluated for eight variables including [I] patient age, [II] gender, [III] time since APR, [IV] clinical presentation, [V] approach to repair, [VI] type of repair, [VII] presence/absence of pelvic adhesions [VIII] complications. </br></br> <b>Results:</b> There was a total of 30 cases (18 males and 12 females) with a mean age of 71.5 years. The time of onset of symptoms ranged from 6 days to 12 years. Perineal lump with pain was the chief presenting feature followed by intestinal obstruction. Different approaches were adopted to repair by various methods. </br></br> <b>Conclusions:</b> Perineal hernia as a complication of abdominoperineal resection is reported increasingly nowadays, as the approach to management of rectal cancer has gradually got shifted from open to minimally invasive in recent years. There is a need to spread awareness about this condition, so that it is actively looked for, during the postoperative follow-up. Management is surgical repair; the approach and type of repair should be individualized.


Assuntos
Cavidade Abdominal , Obstrução Intestinal , Protectomia , Neoplasias Retais , Feminino , Masculino , Humanos , Idoso , Protectomia/efeitos adversos , Neoplasias Retais/cirurgia , Hérnia/etiologia
9.
Ulus Travma Acil Cerrahi Derg ; 28(12): 1758-1760, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36453794

RESUMO

Mesanenin inguinal kanal içine herniasyonu nadir görülen bir klinik antitedir ve tüm inguinal hernilerin yaklasik %1-4'ünü olusturmaktadir. Genellikle yasli erkek hastalarda ve sag tarafta sik görülmektedir. Hastalar çogunlukla asemptomatik oldugundan, intraoperatif olarak tani almaktadir. Preoperatif süreçte taninin dogrulanmasi, olasi mesane yaralanmalarinin önüne geçebilmek adina önem teskil etmektedir. Biz de bu çalismamizda; akut mekanik intestinal obstrüksiyon ve strangülasyon semptomlariyla acil servise basvuran hastada, mesane herniasyonunun eslik ettigi nadir bir pantolon herni olgusunu literatür esliginde sunmayi amaçladik.


Assuntos
Hérnia , Bexiga Urinária , Humanos
10.
Cir. Esp. (Ed. impr.) ; 100(12): 780-782, dic. 2022.
Artigo em Inglês | IBECS | ID: ibc-212491

RESUMO

The surgical repair of lateral hernias is considered a challenge. Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) has been described as a minimally invasive technique for primary incisional ventral hernias of the midline, especially for M2 to M4 ventral hernias but the indications of the concept associated to LIRA are beginning to expand to other complex locations. The aim of this video is to show the surgical steps for lateral hernias where the concept associated to LIRA is followed to repair this type of hernias. (AU)


La reparación quirúrgica de las hernias laterales se considera un reto. La aponeuroplastia intracorpórea de rectos laparoscópica (LIRA) ha sido descrita como una técnica mínimamente invasiva para tratar las hernias incisionales primarias de la línea media, especialmente para las hernias ventrales M2 a M4, pero las indicaciones del concepto asociado a LIRA comienzan a expandirse a otras localizaciones complejas. El objetivo de este vídeo es mostrar los pasos quirúrgicos de las hernias ÿaterals siguiendo el concepto asociado a LIRA para reparar este hernias. (AU)


Assuntos
Humanos , Hérnia , Reto , Laparoscopia , Hérnia Ventral , Cirurgia Geral
13.
BMJ Case Rep ; 15(12)2022 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-36585052

RESUMO

A female patient in her 80s presented with a 2-day history of abdominal pain and absolute constipation, having previously undergone a robotic left distal ureterectomy with ureteric re-implantation. CT revealed a closed-loop small bowel obstruction with transition point adjacent to the left ureter and resultant upstream hydronephrosis. An emergency laparotomy revealed small bowel herniation into a paraureteric space created by her previous surgery and defined by the distal ureter medially, the common iliac vessels laterally and the mobilised bladder dome anteriorly. The viable small bowel was reduced, and the space was eliminated by omental flap transposition after omentoplasty. The patient made a full recovery. Preoperative diagnosis of such an unusual cause of internal herniation can be challenging. This very rarely reported case raises awareness of the condition and proposes a treatment strategy.


Assuntos
Obstrução Intestinal , Ureter , Humanos , Feminino , Ureter/diagnóstico por imagem , Ureter/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Hérnia/complicações , Dor Abdominal/etiologia
14.
J Emerg Med ; 63(6): 791-794, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36522813

RESUMO

BACKGROUND: Trocar site hernia is a rare but potentially serious complication of laparoscopic surgery that may lead to bowel incarceration and strangulation. Prompt diagnosis by emergency physicians facilitates timely intervention that prevents bowel necrosis. We report a case of trocar site hernia presenting to the emergency department (ED) with abdominal pain that was correctly diagnosed and promptly managed. CASE REPORT: A 25-year-old woman, gravida 2, abortion 2, underwent outpatient surgery and laparoscopic removal of a ruptured right-sided tubal pregnancy without any intraoperative difficulties. However, 48 h later, she presented to the ED complaining of acute abdominal pain and nausea. Computed tomography revealed a loop of small bowel herniating through a 12-mm right lower quadrant trocar site defect in the fascia. She was taken back to the operating room, where the computed tomography findings were confirmed and the entrapped bowel was successfully reduced and the fascial defect repaired. The patient was discharged home feeling much improved. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Trocar site hernia is a rare but potentially dangerous complication that can present with acute symptoms or be asymptomatic if late in onset. Intestinal necrosis begins as soon as 6 h after constriction of blood flow to entrapped bowel, so timely intervention is critically important. Therefore, trocar site hernias should be considered in patients presenting with abdominal complaints after laparoscopic surgery and included in the differential diagnosis of bowel obstruction.


Assuntos
Hérnia , Laparoscopia , Feminino , Humanos , Adulto , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Instrumentos Cirúrgicos/efeitos adversos , Dor Abdominal/etiologia , Necrose/complicações
15.
Chirurgie (Heidelb) ; 93(Suppl 2): 129-140, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36480037

RESUMO

The surgical treatment of parastomal hernias is considered complex and is known to be prone to complications. Traditionally, this condition was treated using relocation techniques or local suture repairs. Since then, several mesh-based techniques have been proposed and are nowadays used in minimally invasive surgery. Since the introduction of robot-assisted surgery to the field of abdominal wall surgery, several adaptations to these techniques have been made, which may significantly improve patient outcomes. In this contribution, we provide an overview of available techniques in robot-assisted parastomal hernia repair. Technical considerations and preliminary results of robot-assisted modified Sugarbaker repair, robot-assisted Pauli technique, and minimally invasive use of a funnel-shaped mesh in the treatment of parastomal hernias are presented. Furthermore, challenges in robot-assisted ileal conduit parastomal hernia repair are discussed. These techniques are illustrated by photographic and video material. Besides providing a comprehensive overview of robot-assisted parastomal hernia repair, this article focuses on the specific advantages of robot-assisted techniques in the treatment of this condition.


Assuntos
Hérnia Incisional , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Herniorrafia/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Telas Cirúrgicas , Hérnia Incisional/etiologia , Hérnia
16.
Acta Med Okayama ; 76(6): 731-736, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36549776

RESUMO

We report a rare case of idiopathic spinal cord herniation (ISCH) with a history of cerebrospinal fluid (CSF) leakage. ISCH is a protrusion of the spinal cord through a dural defect. Thin constructive interference in steady-state (CISS) images clearly demonstrated the herniated cord in the present case. The myelopathy worsened and the patient underwent surgery for reduction of herniated spinal cord; the dural defect was filled by placing collagen matrix graft (DuraGen®) between the inner and outer dural layers. The patient's symptoms have improved without relapse for 8 months since surgery. This method may be a good surgical option for cases of spinal cord herniation.


Assuntos
Doenças da Medula Espinal , Vértebras Torácicas , Humanos , Vértebras Torácicas/cirurgia , Hérnia , Doenças da Medula Espinal/cirurgia , Doenças da Medula Espinal/diagnóstico , Herniorrafia/métodos , Imageamento por Ressonância Magnética
17.
J Ayub Med Coll Abbottabad ; 34(Suppl 1)(4): S1053-S1055, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36550676

RESUMO

Haemothorax is presence of blood in pleural cavity and is usually caused by chest trauma. Spontaneous rib fractures leading to haemothorax due to excessive coughing has seldom been described in the literature. We report an unusual case with asthma exacerbation who developed intense coughing followed by chest pain, breathlessness, and widespread bruising, without trauma or coagulopathy. Initial chest X-ray (CXR) and CT pulmonary angiogram (CTPA) showed no significant abnormality. CT scan on subsequent presentation showed left sided haemothorax with rib fractures. The patient was managed successfully with chest tube drainage. On follow up imaging, haemothorax resolved but he was found to have malunited rib fractures with chest wall hernia due to wide separation between ribs. He was referred to cardiothoracic surgeons for rib fixation and chest wall repair.


Assuntos
Fraturas das Costelas , Traumatismos Torácicos , Parede Torácica , Masculino , Humanos , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Traumatismos Torácicos/complicações , Tosse/etiologia , Hérnia/complicações
18.
Ann Plast Surg ; 89(6): 670-674, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416697

RESUMO

BACKGROUND: In complex abdominal wall reconstruction, maintenance and follow-up are vital to effective long-term patient care. This can present a challenge for individuals from a low-income household who may have less ability to afford time away from work or caring for dependents as well as challenges with transportation to and from follow-up appointments. Given the expenses and high complication rate in abdominal wall reconstruction, we elected to determine whether socioeconomic status had an impact on patient outcomes. METHODS: After obtaining institutional review board approval, all patients who underwent complex abdominal wall reconstruction between 2002 and 2021 by the senior author were reviewed in a retrospective cohort analysis of a prospectively maintained database. Complications were classified into overall, major, infection, and delayed wound healing. Outcomes were classified into recurrence and reoperation. The cohort was divided by median household income (MHI) level and race. RESULTS: A total of 478 patients received complex abdominal wall repair over a 19-year interval. A total of 324 patients identified MHI as <$75,000 (low MHI), and 154 patients identified MHI as > $75,000 (high MHI). Mean patient age was 53.9 (SD, 12.3) years. Mean patient body mass index (BMI) was 32.1 (SD, 7.8) kg/m 2 . There was no significant difference in age between the 2 MHI cohorts. There was a significant difference in BMI between MHI cohorts, with higher BMI among patients with low MHI ( P = 0.0001). The majority of risk factors and surgical techniques were comparable. There was a statistically significant difference in hernia etiology, with higher rates of recurrent hernia repair among patients with low MHI ( P = 0.007). The risk of overall complications ( P = 0.0307) and delayed wound healing ( P = 0.0263) was higher among patients with low MHI. Median household income was found to be an independent risk factor for complications after controlling for BMI, diabetes mellitus, and hernia etiology. There was no significant difference in follow-up time between cohorts. CONCLUSION: Patients with low MHI who undergo complex abdominal wall reconstruction are at an increased risk for complications and poor outcomes, including delayed wound healing and hernia recurrence. This indicates the need to provide resources to address barriers to follow-up and maintenance following complex abdominal wall reconstruction in this patient cohort.


Assuntos
Parede Abdominal , Abdominoplastia , Humanos , Pessoa de Meia-Idade , Parede Abdominal/cirurgia , Estudos Retrospectivos , Classe Social , Hérnia
19.
J Am Coll Radiol ; 19(11S): S329-S340, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36436960

RESUMO

Abdominopelvic hernias are common clinical entities composed of a wide variety of congenital, traumatic, and iatrogenic etiologies. Any weakness in the body wall may result in hernia of cavity contents with concomitant risks of morbidity and mortality. Presentations may be specific, palpable body wall mass/bulge, or vague, nonspecific pain through bowel obstruction. This document focuses on initial imaging of the adult population with signs of symptoms prompting suspicion of abdominopelvic hernia. Imaging of the abdomen and pelvis to evaluate defects is essential for prompt diagnosis and treatment. Often CT and ultrasound are the first-line modalities to quickly evaluate the abdomen and pelvis, providing for accurate diagnoses and management of patients. MRI protocols may be useful as first-line imaging studies, especially in patients with orthopedic instrumentation. Although often performed, abdominal radiographs and fluorographic procedures may provide indirect evidence of hernias but are usually not indicated for initial diagnosis of hernia. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.


Assuntos
Meios de Contraste , Sociedades Médicas , Humanos , Medicina Baseada em Evidências , Imageamento por Ressonância Magnética/métodos , Hérnia
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