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Showing papers in "Hernia in 2004"


Journal ArticleDOI
01 Feb 2004-Hernia
TL;DR: The objective of this paper is to outline the reasons behind the minor changes made during the short, 4-year evolution of the Lichtenstein tension-free hernioplasty, describe the key principles of the operation, and introduce a new mesh that, if elected to be used, automatically satisfies all the key Principles of the procedure and guides the surgeon to perform the operation correctly.
Abstract: To circumvent the degenerative nature of inguinal hernias and adverse effect of suture line tension, the Lichtenstein tension-free hernioplasty began in 1984 and evolved (between 1984 and 1988) to a procedure that is now considered the gold standard of hernia repair by the American College of Surgeons. The objective of this paper is to outline the reasons behind the minor changes made during the short, 4-year evolution of the technique, describe the key principles of the operation, and introduce a new mesh that, if elected to be used, automatically satisfies all the key principles of the procedure and guides the surgeon to perform the operation correctly. The worldwide reported result of the operation by experts and nonexperts alike is a recurrence and complication rate of less than 1%. When the key principles of the procedure, which, as reported by many authors, are easy to learn, perform, and teach, are respected, the operation results in an effectiveness (external validation) that is virtually the same as its efficacy (results of the experts), attesting to the simplicity of the procedure.

298 citations


Journal ArticleDOI
29 Jul 2004-Hernia
TL;DR: A one-stage surgical procedure resecting all three nerves from an anterior approach avoids a second operation through the flank and successfully treats chronic neuralgia.
Abstract: The recommended surgical treatment for chronic neuropathic pain after herniorrhaphy has been a two-stage operation including: (a) ilioinguinal and iliohypogastric neurectomies through an inguinal approach and (b) genital nerve neurectomy through a flank approach. Two hundred twenty-five patients underwent triple neurectomies with proximal end implantation to treat chronic postherniorrhaphy neuralgia. Four patients reported no improvement. Eighty percent of patients recovered completely, and 15% had transient insignificant pain with no functional impairment. These results are comparable to the results of the two-stage operation. Simultaneous neurectomy of the ilioinguinal, iliohypogastric, and genital nerves without mobilization of the spermatic cord is an effective one-stage procedure to treat postherniorrhaphy neuralgia. It can be performed under local anesthesia and avoids testicular complications. Proximal end implantation of the nerves prevents adherence of the cut ends to the aponeurotic structures of the groin, which can result in recurrence of the pain. A one-stage surgical procedure resecting all three nerves from an anterior approach avoids a second operation through the flank and successfully treats chronic neuralgia.

220 citations


Journal ArticleDOI
01 Feb 2004-Hernia
TL;DR: Repairs of large midline incisional hernias with the use of a polypropylene mesh carries a high risk of complications and has a high reherniation rate, so the underlay technique seems to be the better technique.
Abstract: Polypropylene mesh is widely used for the reconstruction of incisional hernias that cannot be closed primarily. Several techniques have been advocated to implant the mesh. The objective of this study was to evaluate, retrospectively, early and late results of three different techniques, onlay, inlay, and underlay. The records of 53 consecutive patients with a large midline incisional hernia -- 25 women and 28 men, mean age 60.4 (range 28-94) -- were reviewed. Polypropylene mesh was implanted using the onlay technique in 13 patients, inlay in 23 patients, and underlay in 17 patients. Either the greater omentum or a polyglactin mesh was interponated between the mesh and the viscera. The records of these 53 patients were reviewed with respect to: size and cause of the hernia, pre- and postoperative mortality and morbidity, with special attention to wound complications. Patients were invited to attend the outpatient clinic at least 12 months after implantation of the mesh for physical examination of the abdominal wall. Postoperative complications occurred in 14 (26.4%) patients. The onlay technique had significantly more complications, as compared to both other techniques. Reherniation occurred in 15 (28.3%) patients. The reherniation rate of the inlay technique was significantly higher than after the underlay technique (44% vs 12%, P=0.03) and tended to be higher than the onlay technique (44% vs 23%, P=0.22). Repair of large midline incisional hernias with the use of a polypropylene mesh carries a high risk of complications and has a high reherniation rate. The underlay technique seems to be the better technique.

220 citations


Journal ArticleDOI
Stefan Sauerland1, M. Korenkov1, T. Kleinen, M. Arndt, A. Paul1 
01 Feb 2004-Hernia
TL;DR: This and other studies found hernia recurrence to be more likely in obese patients, therefore, such patients should receive mesh rather than suture repair.
Abstract: Background: Any individualisation of incisional hernia repair requires a profound knowledge of risk factors for recurrence. Methods: A series of 160 patients underwent incisional hernia repair and were prospectively followed up at 3, 6, 12, and 24 months after surgery. We analysed the importance of various variables to predict recurrence. Results: An overall recurrence rate of 11% (n=17) was observed. The risk for recurrence was not significantly affected by any of the clinical variables except for obesity (P=0.03). Even when controlling for the influence of age, gender, hernia size, and surgical technique, obesity remained a significant predictor with a rate ratio of 1.10 per unit BMI (95%-CI: 1.02–1.18; P=0.01). Conclusion: This and other studies found hernia recurrence to be more likely in obese patients. Probably, such patients, therefore, should receive mesh rather than suture repair.

219 citations


Journal ArticleDOI
01 Feb 2004-Hernia
TL;DR: Laparoscopic ventral and incisional hernia repair, based on the Rives-Stoppa technique, is a safe, feasible, and effective alternative to open techniques.
Abstract: Incisional hernias develop in 2%-20% of laparotomy incisions, necessitating approximately 90000 ventral hernia repairs per year. Although a common general surgical problem, a "best" method for repair has yet to be identified, as evidenced by documented recurrence rates of 25%-52% with primary open repair. The aim of this study was to evaluate the efficacy and safety of laparoscopic ventral and incisional herniorrhaphy. From February 1991 through November 2002, a total of 384 patients were treated by laparoscopic technique for primary and recurrent umbilical hernias, ventral incisional hernias, and spigelian hernias. The technique was essentially the same for each procedure and involved lysis of adhesions, reduction of hernia contents, closure of the defect, and 3-5 cm circumferential mesh coverage of all hernias. Of the 384 patients in our study group, there were 212 females and 172 males with a mean age of 58.3 years (range 27-100 years). Ninety-six percent of the hernia repairs were completed laparoscopically. Mean operating time was 68 min (range 14-405 min), and estimated average blood loss was 25 mL (range 10-200 mL). The mean postoperative hospital stay was 2.9 days and ranged from same-day discharge to 36 days. The overall postoperative complication rate was 10.1%. There have been 11 recurrences (2.9%) during a mean follow-up time of 47.1 months (range 1-141 months). Laparoscopic ventral and incisional hernia repair, based on the Rives-Stoppa technique, is a safe, feasible, and effective alternative to open techniques. More long-term follow-up is still required to further evaluate the true effectiveness of this operation.

213 citations


Journal ArticleDOI
26 Feb 2004-Hernia
TL;DR: Surgisis mesh appears to be a promising new prosthetic material for hernia repair and appears to function well, especially in contaminated or potentially contaminated fields.
Abstract: Surgisis is a new four- or eight-ply bioactive, prosthetic mesh for hernia repair derived from porcine small intestinal submucosa (SIS). It is a naturally occurring extracellular matrix, which is easily absorbed, supports early and abundant new vessel growth, and serves as a template for the constructive remodeling of many tissues. As such, we believe that Surgisis mesh is ideal for use in contaminated or potentially contaminated fields in which ventral, incisional, or inguinal hernia repairs are required. From November 2000–May 2003, 53 patients (23 male, 30 female) underwent placement of Surgisis mesh for a variety of different hernia repairs. A total of 58 hernia repairs were performed in our patient population. Twenty procedures (34%) were performed in a potentially contaminated setting (i.e., with incarcerated/strangulated bowel within the hernia or coincident with a laparocopic cholecystectomy/colectomy). Thirteen repairs (22%) were performed in a grossly contaminated field, including one in which an infected polypropylene mesh from a previous inguinal hernia repair was replaced with Surgisis mesh and one in which dead bowel was discovered within the hernia sac. Median follow-up is 19 months with a range of 1–30 months. Of the 58 total repairs, there was one wound infection complicated by enterocutaneous fistula in a patient originally operated on for ischemic bowel. The fistula was in a location independent of the Surgisis mesh. There have been no mesh-related complications or recurrent hernias in our early postoperative follow-up period. Surgisis mesh appears to be a promising new prosthetic material for hernia repair and appears to function well, especially in contaminated or potentially contaminated fields. Obviously, long-term follow-up is still required.

173 citations


Journal ArticleDOI
01 May 2004-Hernia
TL;DR: Longer duration of symptoms, late hospitalization, concomitant diseases, and high ASA class were found to be significant factors linked with unfavorable outcomes.
Abstract: Despite universal acceptance of the value of elective hernia repair, many patients present with incarceration or strangulation, which are associated with significant morbidity and mortality. We reviewed 147 patients who underwent emergency surgery for incarcerated groin hernias during a 10-year period in order to analyze the presentation and outcome in our practice. Median age of the patients was 70 years. There were 77 men and 70 women. Femoral hernias were seen in 77 patients and inguinal hernias in 70. Coexisting diseases were found in 82 cases (55.8%). Bowel resection was required in 19 patients (12.9%). The overall and major morbidity rates were 41.5% and 9.6%, respectively. The mortality rate was 3.4%. Longer duration of symptoms, late hospitalization, concomitant diseases, and high ASA class were found to be significant factors linked with unfavorable outcomes. Because of high morbidity and mortality associated with incarceration, elective repair of groin hernias should be done whenever possible.

148 citations


Journal ArticleDOI
08 Jun 2004-Hernia
TL;DR: In this study, a difference between ADM and ePTFE in their ability to repair ventral hernias at 9 months in a swine model was unable to be demonstrated.
Abstract: This study was designed to assess the long-term efficacy of allogenic acellular dermal matrix (ADM) used as an interpositional graft for ventral hernia repair in a swine model. We created 12×4-cm full-thickness abdominal wall defects in 22 Yucatan miniature pigs. The defect was repaired with either two 6×4-cm pieces of AlloDerm (acellular dermal matrix processed from pig skin in order to avoid a xenogenic response, LifeCell Corporation, Branchburg, NJ USA) (n=12), or expanded polytetrafluoroethylene mesh (ePTFE) (Gore-Tex, W.L. Gore & Associates, Inc., Newark, DE USA) (n=10). In six pigs, a separate 3-cm fascial incision was made, which was then suture repaired as a control for tensiometry testing. The surgical sites were evaluated at either 3 months or 9 months for the presence of a hernia, stretching of the implant, adhesions, vascularity, and biomechanical strength. Two hernias occurred in both the ADM and the ePTFE groups. There was minimal stretching of the implants and minimal adhesions in both groups. Fluorescein testing and histology indicated vascular ingrowth into the ADM. There was no statistical difference between the mean breaking strengths of the ADM-fascial interface (106.5 N±SD 40.1), the interface between two pieces of ADM (149.1 N±SD 76.7), and the primary fascial repair (108.1 N±SD 20.9) at 9 months. The ADM-fascial interface had a significantly higher breaking strength than that of the ePTFE-fascia interface (66.1 N±SD 30.1) (P=0.017, t-test, P=0.043 Wilcoxon rank sum test). In this study, we were unable to demonstrate a difference between ADM and ePTFE in their ability to repair ventral hernias at 9 months in a swine model. The ADM additionally supports vascular ingrowth and exhibits increased breaking strength at the fascia-implant interface.

136 citations


Journal ArticleDOI
11 Aug 2004-Hernia
TL;DR: The results show that the adhesive potential of different polypropylene meshes when placed in direct contact with intestine is significantly influenced by the pore size, and the IPOM rabbit model is suitable for investigation of biomaterials in the intra-abdominal position.
Abstract: Background. Polypropylene is a material widely used in surgery. Because of its association with formation of enterocutaneous fistulae and adhesions, direct contact between mesh and intestine is avoided. The following study was designed to investigate the adhesive potential of different polypropylene meshes when placed in direct contact with intestine. Material and methods. In an established experimental model, a total of 45 chinchilla rabbits underwent laparoscopic placement of meshes with different pore size (Group I: monofilament PP 0.6 mm, Group II: monofilament PP 2.5 mm, Group III: multifilament PP 4.0 mm) with the Intra-Peritoneal-Onlay-Mesh Technique (IPOM). The degree of adhesion formation was measured after 7, 21, and 90 days, evaluated by an adhesion score, quantified by computer-assisted planimetry, followed by histological and morphometric investigation of the perifilamental granuloma formation. Results. The heavyweight, small porous polypropylene meshes (PP 0.6) showed significantly stronger adhesion formation at all intervals of investigation compared with the lightweight meshes with a pore size >2.5 mm. Between the two different lightweight mesh variations, there was no significant difference. Granuloma formation was lowest in large-pore-size monofilament meshes (PP 2.5). Conclusion. The IPOM rabbit model is suitable for investigation of biomaterials in the intra-abdominal position. Our results show that the adhesive potential is significantly influenced by the pore size. However, the extent of the foreign-body reaction seems also to be influenced by the filament structure, respectively, the surface area, favouring monofilament material.

127 citations


Journal ArticleDOI
03 Jul 2004-Hernia
TL;DR: Recurrence will be increased by inadequate prosthetic overlap of the fascial defect, infection that involves the biomaterial, which then requires its removal, and lack of the use of transfascial sutures.
Abstract: Complications will occur with any operative procedure. The possibility of this must be considered for laparoscopic incisional and ventral hernia repair (LIVH) as well. The most commonly reported of these include: intraoperative intestinal injury (1–3.5%), infection involving the prosthetic biomaterial (0.7–1.4%), seromas (2.6–100%), postoperative ileus (1–8%), and persistent postoperative pain (1–2%). The incidence of enterotomy can be reduced by careful dissection and judicious use of any energy source. Infection can be minimized by the use of perioperative antibiotics, an antimicrobially impregnated biomaterial, and careful manipulation of the prosthesis during the procedure. Seromas are so common that they should be expected but can be decreased by the use of a postoperative abdominal binder. Aspiration will be necessary in a few instances. Similarly, ileus is expected when there is significant bowel dissection and bleeding. Early ambulation and standard use of postoperative bowel care will aid in the treatment of this problem. Persistent pain will generally occur at the site of a transfascial suture. It cannot be predicted or prevented with certainty. When it occurs, local injection with bupivacaine, steroids, or non-steroidal agents will help, but occasionally, removal of the offending suture(s) will be required. The average recurrence rate for LIVH is approximately 5.6% in the literature. Rates as high as 15.7%, however, have been reported. Recurrence will be increased by inadequate prosthetic overlap of the fascial defect, infection that involves the biomaterial, which then requires its removal, and lack of the use of transfascial sutures. To prevent these risks, the surgeon must assure that there is at least a 3-cm overlap of all portions of the hernia defect and insist that sutures are used at 5-cm intervals to fix the biomaterial. Infection that requires explantation of the patch will generally result in recurrence, as this must be repaired primarily. Alternatively, the use of a collagen prosthesis may allow immediate repair, but this is associated with a high failure rate. A staged repair will be necessary in the future in most patients.

114 citations


Journal ArticleDOI
01 Feb 2004-Hernia
TL;DR: Experimental and clinical studies have shown herniation may be associated with aging and genetic or acquired (smoking, etc.) systemic disease of connective tissue, and data, with prospective trials, all but mandate tensionless prosthetic repair.
Abstract: Billroth (1878) envisaged prostheses before Bassini's sutured cure (1887). Phelps (1894) reinforced with silver coils. Metals were replaced by plastic (Aquaviva 1944). Polypropylene (Usher 1962), resisting infection, became popular. Usher instituted tensionless, overlapping preperitoneal repair. Spermatic cord was parietalized, to obviate keyholing. Stoppa (1969) championed the sutureless Cheatle-Henry approach encasing the peritoneum. His technique, "La grande prosthese de renforcement du sac visceral" (GPRVS), was adopted by laparoscopists. Newman (1980) and Lichtenstein (1986) pioneered subaponeurotic positioning. Kelly (1898) inserted a plug into the femoral canal; Lichtenstein and Shore (1974) followed. Gilbert (1987) plugged the internal ring, and Robbins and Rutkow (1993) treated all groin herniae thus. Incisional herniation has been controlled by prefascial, retrorectus prosthetic placement (Rives-Flament 1973). ePTFE (Sher et al. 1980) is useful intraperitoneally, since it evokes few adhesions. Here, laparoscopy (Ger 1982) is competitive. Beginning in 1964 (Wirtschafter and Bentley), experimental and clinical studies have shown herniation may be associated with aging and genetic or acquired (smoking, etc.) systemic disease of connective tissue. These data, with prospective trials, all but mandate tensionless prosthetic repair.

Journal ArticleDOI
01 Feb 2004-Hernia
TL;DR: The high-risk patients, who are males, obese, older than 50 years and who have symptoms that indicate urological pathologies to a physician, are more likely to be in the high- risk group for bladder herniation.
Abstract: We report on a rare case of massive incarcerated inguinoscrotal bladder herniation in a direct hernia and present the review of the literature on urological findings in relation to the inguinal hernial sac. The English-based literature was searched using the words inguinal hernia, bladder, ureter, diverticule, and incarceration and discussed in relation to the present case. We found 190 cases of inguinal hernia associated with urological findings, such as herniation of the bladder, ureter, and diverticulum. We also found that 11.2% of these hernias were associated with urological malignancies and 23.5% of these were associated with a variety of complications. The high-risk patients, who are males, obese, older than 50 years and who have symptoms that indicate urological pathologies to a physician, are more likely to be in the high-risk group for bladder herniation.

Journal ArticleDOI
18 Mar 2004-Hernia
TL;DR: The incidence of adhesions and work and strength of adhesion separation are reduced when using a treated mesh, compared to the untreated mesh and the control group without mesh.
Abstract: New materials have been devised to prevent postoperative adhesions when placing a prosthesis in contact with abdominal contents. Eighty rats underwent laparotomy and denudation of the serosa of the cecum and peritoneal covering of the abdominal wall. Five treated mesh products (Parietex Composite, Parietene Composite, Bard Composix E/X, Sepramesh, and Gore-Tex Dual Mesh) and one untreated mesh product (untreated Parietene) were randomly placed between the cecum and abdominal wall. A group without mesh was used as control. The animals were sacrificed at 21 days following surgery and analyzed for the presence of adhesions. The incidence of adhesion formation, mean adhesion area, maximum adhesion length, and strength of adhesion separation were similar between Parietex Composite, Parietene Composite, and Bard Composix E/X, and they were significantly less than with Sepramesh, untreated Parietene, and the control group. Gore-Tex Dual Mesh resulted in less adhesions, adhesion area, mean strength of separation, and work of separation than the untreated Parietene group and the control group. Sepramesh resulted in less strength and work of separation compared to the control group. The incidence of adhesions and work and strength of adhesion separation are reduced when using a treated mesh, compared to the untreated mesh and the control group without mesh. Parietex Composite, Parietene Composite, Bard Composix E/X, and Gore-Tex Dual Mesh were superior to Sepramesh, untreated Parietene, and the control group in the prevention of adhesion formation.

Journal ArticleDOI
09 Apr 2004-Hernia
TL;DR: The multiple theories on mechanisms of hernia formation have, at last, melded into one single Unified Theory ofHernia formation: collagen.
Abstract: The perusal of surgical journals suggests that the etiology and the treatment of hernias are still based on the understanding of a simple mechanical defect, an idiopathic happenstance requiring a reliable hernia repair, preferably with a prosthetic mesh or device. The need for additional elucidation does not constitute an aim that is pervasive in the surgical community or with the corporate manufacturers of surgical implements. This may well be because surgeons are not trained scientists and laboratory workers. Fortunately, several disciplines are injecting a healthy dose of curiosity matched by ingenuity. Among these contributors, we can count anatomists, electron microscopists, biochemists, organic chemists, pathologists, geneticists, and molecular biologists, who have looked at collagen, enzymes, tobacco smoke, congenital diseases, and chromosomal defects. Every aspect of the researchers' work has identified and converged onto a final common organ: collagen. It is the pathological changes in collagen that set the stage for the development of a hernia. The multiple theories on mechanisms of hernia formation have, at last, melded into one single Unified Theory of hernia formation.

Journal ArticleDOI
16 Jun 2004-Hernia
TL;DR: Prosthetic repair is the gold standard for inguinal, incisional, and all abdominal wall hernias and should be used, with the method described, even in potentially contaminated areas, and the use of a prosthesis has to be avoided in clearly infected cases.
Abstract: Introduction Prosthetic repair for abdominal wall hernia currently represents the gold standard. However, it is still difficult to identify the correct indication for prosthetic implant in borderline cases. The authors propose evaluating whether a prosthetic implant is absolutely contraindicated in potentially infected operating fields through the review of literature and personal experience.

Journal ArticleDOI
02 Mar 2004-Hernia
TL;DR: The original Pfannenstiel incision is discussed including the technique, history, current indications, advantages, and disadvantages, including the principles of less traumatic surgery and long-time use.
Abstract: The original Pfannenstiel incision is discussed including the technique, history, current indications, advantages, and disadvantages. Excellent cosmetic results, principles of less traumatic surgery, and a rare incisional hernia complication rate of about 0–2%, as well as long-time use characterise this access path to the pelvic organs first described by the German gynaecologist in 1900. Complications of nerve damage, however, should be recognised, especially when extending the incision too far laterally.

Journal ArticleDOI
01 Feb 2004-Hernia
TL;DR: The recent experience with a life-threatening emergency due to a BH in a 29-year-old male patient prompted us to reinforce that this entity does exist in adults and should be considered in the differential of acute abdominal pain.
Abstract: A Bochdalek hernia (BH) occurs when abdominal contents herniate through the posterolateral segment of the diaphragm. Most BHs present with life-threatening cardiorespiratory distress in the neonatal period. Rarely, hernias that remain clinically silent until adulthood present as life-threatening surgical emergencies. Our recent experience with a life-threatening emergency due to a BH in a 29-year-old male patient prompted us to reinforce that this entity does exist in adults and should be considered in the differential of acute abdominal pain.

Journal ArticleDOI
01 Feb 2004-Hernia
TL;DR: It is concluded that a single dose of intravenous Cefazolin decreases the risk of wound infection during open mesh inguinal hernia repair under local anesthesia on an ambulatory basis.
Abstract: Mesh prosthesis, local anesthesia, and ambulatory care have been widely introduced in recent decades in the treatment of inguinal hernia. The use of antibiotic prophylaxis during open inguinal hernia repair has been controversial. No prospective trial has been conducted to assess the role of antibiotic prophylaxis in patients operated on for inguinal hernia under the above-mentioned conditions. A prospective, randomized, double-blinded trial was initiated to assess the efficacy of antibiotic prophylaxis in the prevention of wound infection during open mesh inguinal hernia repair under local anesthesia on an ambulatory basis. Ninety-nine consecutive hernia repairs were randomized to receive 1 g of parenteral Cefazolin preoperatively or a placebo. No wound infections existed in the therapeutic group (0/50). Four infections appeared in the control group (4/49), and the study was suspended for ethical reasons when differences reached values close to statistical significance (P=0.059). We conclude that a single dose of intravenous Cefazolin decreases the risk of wound infection during open mesh inguinal hernia repair under local anesthesia on an ambulatory basis.

Journal ArticleDOI
08 Jan 2004-Hernia
TL;DR: The technique appears safe and efficacious, and patients were periodically followed in the outpatient clinic for at least 12 months postoperatively and contacted at the time of this review.
Abstract: We describe the whole cohort of patients operated on laparoscopically for ventral hernias at our institution Information on early results, complications, and long-term follow-up was collected prospectively Of 90 operations attempted, five (58%) required conversion Of the remaining 85 patients, 65 (76%) had an incisional hernia, while 20 (24%) had primary defects Three trocars were routinely employed (Hasson and two 5-mm) The prosthetic mesh used was ePTFE inserted through the first trocar and fixed using helicoidal staplers Patients were periodically followed in the outpatient clinic for at least 12 months postoperatively and contacted at the time of this review Mean operative time was 101 min We had three small bowel injuries repaired laparoscopically Postoperative pain was limited Bowel movements, deambulation, and discharge were prompt We had six (7%) urinary retentions, eight (9%) seromas, three (35%) cases of pneumonia, two (2%) cases of postoperative vomiting, and one (1%) prolonged ileus, which resolved spontaneously on postoperative day 2 Mean postoperative stay was 4 days One patient was readmitted after 4 weeks with incomplete obstruction, resolved conservatively There were three recurrences (35%), which developed within 1 year of the operation, and a trocar-site herniation (1%) The technique appears safe and efficacious

Journal ArticleDOI
18 Jun 2004-Hernia
TL;DR: The clinical symptoms and signs usually allow for easy diagnosis and excision of the sac and high ligation, followed by repair using either surrounding tissue or prosthetic material, provided satisfactory results.
Abstract: Background. Lumbar hernia is a relatively rare phenomenon. The aim of this study was to investigate the clinical manifestation, the diagnosis of lumbar hernia, and the outcome of the surgical procedure. Methods. Eleven cases of lumbar hernia were studied by clinical observation retrospectively from July 1998 to July 2000. Results. All the patients were diagnosed clinically and confirmed operatively. The typical manifestation was a semi-spherical painful mass in the superior or inferior triangle. If the gut was incarcerated, bowel obstruction may subsequently develop. Ten of the eleven patients were treated successfully. Conclusions. The clinical symptoms and signs usually allow for easy diagnosis. Excision of the sac and high ligation, followed by repair using either surrounding tissue or prosthetic material, provided satisfactory results.

Journal ArticleDOI
01 May 2004-Hernia
TL;DR: Male veterans with unilateral primary inguinal hernia, classified intraoperatively as Gilbert Type III or IV, were randomized to subaponeurotic or preperitoneal repair under general or spinal anesthesia, with no statistically significant difference in the recurrence rate between the two repairs.
Abstract: Male veterans with unilateral primary inguinal hernia, classified intraoperatively as Gilbert Type III or IV, were randomized to subaponeurotic (Lichtenstein, n=126) or preperitoneal (Read-Rives, n=121) repair under general or spinal anesthesia. The two groups of patients were comparable in age, body weight index, comorbidities, and size and type of hernia. Of the 247 patients enrolled, 224 were followed for at least 2 years (median 82 months, range 24–110 months), 16 were lost to follow-up, and seven died from causes unrelated to the surgery. The average operative time of the Read-Rives repair was 9 min longer than that of the Lichtenstein repair. There were no wound infections, and the frequencies of other short- and long-term complications were low and similar in the two groups. Six patients developed hernia recurrence, five in the Lichtenstein group (4.3%), and one in the Read-Rives group (<1%), (P=0.21). Both anterior repairs are associated with low postoperative morbidity and recurrence rates. The Lichtenstein repair is technically easier and less time consuming. There is no statistically significant difference in the recurrence rate between the two repairs.

Journal ArticleDOI
03 Jul 2004-Hernia
TL;DR: LA was found to be well tolerated and associated with significant advantages compared to GA and RA in a general surgical setting and overall satisfaction and quality of life was found.
Abstract: Type of anaesthesia and patient acceptance in groin hernia repair : a multicentre randomised trial.

Journal ArticleDOI
29 Jul 2004-Hernia
TL;DR: A collagen-coated polyester mesh (PCO) will form fewer adhesions than an ePTFE-polypropylene composite (BC) and absorbable tacks are equivalent to metal tacks and there is no difference in the ingrowth of the two mesh types.
Abstract: Introduction Laparoscopic ventral hernia repair uses tacks to secure mesh The mesh is designed to maximize tissue ingrowth while minimizing adhesions We hypothesized: (1) a collagen-coated polyester mesh (PCO) will form fewer adhesions than an ePTFE-polypropylene composite (BC) and (2) absorbable tacks are equivalent to metal tacks

Journal ArticleDOI
05 Jun 2004-Hernia
TL;DR: An anatomical study in human corpses is performed to investigate the abdominal wall with its different structures, with emphasis on the overlap of the mesh under the linea alba.
Abstract: Open retromuscular mesh repair has become a standard procedure in incisional hernia repair. This technique led to a significant decrease of recurrences. Recurrences after this technique typically occur at the upper mesh border and are a result of the technical complexity of reaching the postulated underlay of 5 cm in the region of the linea alba. We performed an anatomical study in human corpses to investigate the abdominal wall with its different structures, with emphasis on the overlap of the mesh under the linea alba. The overlap can be achieved by incision of the posterior lamina of the rectus sheath, on both sides close to the linea alba. The incision opens the preperitoneal space and appears in the shape of a "fatty triangle". The anterior lamina of the rectus sheath above the hernia defect remains intact and facilitates a sufficient thrust bearing for a retromuscular mesh implantation. Knowledge of the anatomy and preparation of the "fatty triangle" enables a mesh positioning according to the principles of retromuscular mesh repair.

Journal ArticleDOI
01 May 2004-Hernia
TL;DR: Laroscopic placement of PPM/HA/CMC reduces adhesion formation compared to other mesh types used for laparoscopic ventral hernia repairs.
Abstract: Intraperitoneal placement of prosthetic mesh causes adhesion formation after laparoscopic incisional hernia repair. A prosthesis that prevents or reduces adhesion formation is desirable. In this study, 21 pigs were randomized to receive laparoscopic placement of plain polypropylene mesh (PPM), expanded polytetrafluoroethylene (ePTFE), or polypropylene coated on one side with a bioresorbable adhesion barrier (PPM/HA/CMC). The animals were sacrificed after 28 days and evaluated for adhesion formation. Mean area of adhesion formation was 14% (SD±15) in the PPM/HA/CMC group, 40% (SD±17) in the PPM group, and 41% (SD±39) in the ePTFE group. The difference between PPM/HA/CMC and PPM was significant (P=0.013). A new visceral layer of mesothelium was present in seven out of seven PPM/HA/CMC cases, six out of seven PPM cases, and two out of seven ePTFE cases. Thus, laparoscopic placement of PPM/HA/CMC reduces adhesion formation compared to other mesh types used for laparoscopic ventral hernia repairs.

Journal ArticleDOI
01 Feb 2004-Hernia
TL;DR: Elective neurectomy is safe to perform, well tolerated by patients, and is not associated with chronic postoperative inguinal pain.
Abstract: Chronic postoperative inguinal pain syndromes are potentially debilitating sequelae following elective inguinal hernia repair. Diagnosis and definitive treatment constitute challenging issues for both the surgeon and the patient. In this prospective trial, we evaluated the impact of elective iliohypogastric and ilioinguinal nerve resection on the incidence of pain, numbness, and sensory loss following anterior, "tension-free" herniorrhaphy. One hundred ninety-one patients were enrolled and were reviewed 1 month, 6 months, and 1 year postoperatively. Pain, numbness, or any loss of sensation were recorded and categorized on a "mild," "moderate," or "severe" scale. No persistent pain syndrome was encountered. Numbness was found in 9.42% of the patients at the first month and in 6.28% of the patients after 1 year. Sensation loss (1.04%) was never bothersome or incapacitating at the end of the follow-up period. Elective neurectomy is safe to perform, well tolerated by patients, and is not associated with chronic postoperative inguinal pain.

Journal ArticleDOI
13 Mar 2004-Hernia
TL;DR: Umbilical hernia repair can be carried out safely and securely under LA with a tension-free mesh technique (cone or a sublay patch) with a low morbidity, negligible recurrence rate, and a high degree of patient satisfaction.
Abstract: Background: Umbilical hernias are a common surgical problem with a high recurrence rate using conventional suture techniques. This prospective study examined the feasibility of tension-free mesh repair as a day case using local anaesthetic (LA) for all primary umbilical hernias. Method: Fifty-four patients (eight women) were operated on; 49 using LA. Through a periumbilical skin incision the margins of the sac were freed from the edges of the defect, and a space was made in the extraperitoneal plane. In defects 3 cm, a flat piece of pp mesh was inserted into the extraperitoneal space as a sublay. No attempt was made to close the fascial defect. Results: Postoperative pain was graded as mild (n=37) and moderate (n=17). No patient had severe postoperative pain. Seven superficial wound infections responded to oral antibiotics. In no case it was necessary to remove the mesh. There were no other complications. Patients were recalled between 2 and 6 years postopertively—mean follow-up 43 months (28– 67). There were no recurrences. Conclusion: Umbilical hernia repair can be carried out safely and securely under LA with a tension-free mesh technique (cone or a sublay patch) with a low morbidity, negligible recurrence rate, and a high degree of patient satisfaction. It should be the procedure of choice for all such hernias.

Journal ArticleDOI
01 May 2004-Hernia
TL;DR: Preperitoneal approach (open or laparoscopic) seems to be a good option in recurrent inguinal hernia when these procedures are done by experienced surgeons.
Abstract: Background: The aim of this study was to investigate the outcome of preperitoneal repair using laparoscopic (TEP) and open (OPM) approach in recurrent inguinal hernia. Methods: We performed a prospective controlled nonrandomized clinical study in 188 patients with 207 recurrent inguinal hernias over a period of 5 years. TEP repair was employed for 86 repairs, and OPM was used in 121 procedures. The main outcome measurements were: recurrence rate, operating time, hospital stay, and postoperative complications. Results: There were three recurrences (1.7%). Two in the OPM group (1.8%) and one (1.3%) in the TEP group [P=NS (not significant)]. The TEP procedure was faster than OPM for unilateral repair (40.8 vs 46.3 min) (P<0.001). Postoperative complications were more frequent in the OPM group (23.9%) than the TEP group (13.9%) (P=NS). Hospital stay was significantly shorter in the TEP group (1.2 vs 3.9 days) (P<0.001). Conclusions: Preperitoneal approach (open or laparoscopic) seems to be a good option in recurrent inguinal hernia when these procedures are done by experienced surgeons.

Journal ArticleDOI
01 May 2004-Hernia
TL;DR: The first case of a mesh repair of a lower midline laprotomy incisional hernia complicated by erosion of the mesh into the bladder which presented as haematuria is reported.
Abstract: Late complications of mesh repair are commonly due to mesh migration and erosion into neighbouring visceri. We report the first case of a mesh repair of a lower midline laprotomy incisional hernia complicated by erosion of the mesh into the bladder which presented as haematuria.

Journal ArticleDOI
01 May 2004-Hernia
TL;DR: Lichtenstein’s operation with either Prolene or Vypro II is safe and well tolerated with an acceptable postoperative rehabilitation time and a high quality of life 2 months after surgery.
Abstract: Background: The standard polypropylene mesh used in Lichtenstein’s operation induces a strong foreign-tissue reaction with potentially harmful effects. A mesh with less polypropylene could possibly be beneficial. Patients and methods: Six hundred men with inguinal hernias were randomized to Lichtenstein’s operation with Prolene or Vypro II in a single-blinded multicenter trial. The randomization was performed by a computer algorithm in a database through the Internet. All data were entered and directly validated in the database through the Internet. Results The meshes had comparable results in return to work, return to daily activities, complications, postoperative pain, and quality of life during the first 8 weeks of rehabilitation. Conclusions Lichtenstein’s operation with either Prolene or Vypro II is safe and well tolerated with an acceptable postoperative rehabilitation time and a high quality of life 2 months after surgery. The study was facilitated by the use of a database through the Internet.