The presented article was designed to evaluate using polypropylene mesh alone and using Aloe vera gel for hernioplasty in rams. Under the protocol of sedations, local anesthesia, and strict surgical ...preparations, the 10 cm of experimental ventrolateral abdominal hernias were surgically induced in twenty-four rams. The animals were divided into two equal groups. Hernioplasty was done with polypropylene mesh in both groups. The first group remained without treatment and was considered the control group. In the second group, after hernioplasty the Aloe vera leaf gel spread equally along the repaired area, then the skin and subcutaneous tissues closed routinely. Clinical, Ultrasonographic, and Laparoscopic examinations were done. Clinically, all operative animals completely subsided the hernia ring. Laparoscopically, the results indicated less degree of adhesion and inflammatory reaction were occurs in the treated group at 45 days post-surgery. Ultrasonographic investigation in the control group at 30 days post-surgery exhibited Wavy echogenic representing inflammatory effusion. It represented Hypoechoic at muscle mass and mesh at 45 days, whereas in the treated group, the subcutaneous tissue appeared normal echotexture with a clear mesh at 45 days post-treatment. In conclusion, compatibility occurs between the implant and the edges of the hernia ring without signs of rejection, less degree of adhesion, and the hernia opening completely closed. The Aloe vera gel had a beneficial effect during hernioplasty in the ram.
Background and Objective: Inguinal hernioplasty is an ordinary operation all over the world. Many types of repair are present. Aim of the surgeon is to improve the outcome and decrease the ...recurrence. We evaluated the addition of a mesh plug with the usual repair as a synergistic way to reduce the recurrence.Patients and Methods: A clinical trial involved 200 inguinal hernia patients and was conducted in the General Surgery Department of the Faculty of medicine, Al-Azhar University, New Damietta. Patients were randomly divided into two equal groups; Group A: patients performed Onlay mesh hernioplasty surgery, whereas Group B patients performed combined Onlay-Plug mesh hernioplasty surgery. For six months, post-operative results in both groups were evaluated.Results: Group B patients who had undergone combination Onlay-Plug mesh hernioplasty surgery have increased incidences of after-surgery pain, scrotal swelling, cord sensitivity, and infected wounds, revealing a significant difference in the two groups.Conclusion: Adding mesh plug has no value. Onlay mesh is sufficient for the repair of inguinal hernioplasty.
We performed laparoscopic removal of an infected mesh sheet in a patient who had undergone laparoscopic hernioplasty 6 months previously. Using a laparoscope, we incised the thickened peritoneum to ...reach the abscess cavity and remove the infected mesh sheet. Although this operation was highly stressful, using a laparoscope, we could completely and safely remove the mesh of the tackers and wash the cavity firmly. The patient had no fever or complications and was discharged three days after the operation.Laparoscopic removal of an infected mesh sheet is a suitable method for cases of mesh infection after hernioplasty.
A 74-year-old woman had a history of right femoral hernioplasty with mesh implantation almost 9 years earlier. More than 4 years earlier, she underwent laparoscopic right hemicolectomy (D3 ...dissection) for cecal cancer, pStage IIIb, followed by postoperative adjuvant chemotherapy. One year earlier, abdominal CT showed a mass in the right inguinal region, which gradually increased in size. Three months earlier, right inguinal pain appeared, and PET-CT showed FDG accumulation in the same area. Suspecting recurrence of cecal cancer, laparoscopic anterior right inguinal mass resection was performed. There was a 40-mm mass located in the abdominal wall near the center of the mesh. There were no findings of intraperitoneal dissemination. Histopathologically, it was a well to moderately differentiated tubular adenocarcinoma, suggesting recurrence of cecal cancer. The tumor adhered to the mesh from the abdominal wall side, and it was considered to be a hematogenous metastasis rather than a peritoneal metastasis. It also appeared that the mesh may have been involved in the recurrence of the resected cecal cancer 4 years after its placement.
Background. There are still questions about the plastic material for gernioplasty. This determines the relevance of the search for optimal, clinically appropriate material. The purpose of the work is ...to study the functional and metabolic state of tissues in the area of herniation in inguinal hernias of varying severity using a polypropylene graft. Materials and methods. Clinical and laboratory examination was carried out in 58 patients with inguinal hernias who used polypropylene mesh for Lichtenstein hernioplasty. Two groups of patients were identified. To divide patients into groups by the Nyhus classification (1993). In the first group of patients, inguinal hernias were type II (n=38), in the second (n=20) – type III (III A, III B) or IV (IV A, IV B). Results. The conducted studies have shown that in the early postoperative period, during herniation using a mesh polypropylene implant, a sufficiently pronounced inflammatory reaction and microcirculation disorders occur from the tissue structures of the wound and tissues captured by the suture material. Their degree of severity is associated with the type of hernias. In grades III and IV, they are more pronounced and prolonged than in type II and generally indicated greater tissue alteration and a slowdown in the reparative phase. This functional and structural circumstance could not but affect the occurrence of wound complications in the early postoperative period and the condition of the graft in the long term. Conclusions. The data obtained largely provide the basis for finding ways to improve gernioplasty. Firstly, less tissue injury is postulated during surgical manipulations, and secondly, there is an urgent need to find new transplants with fewer side effects.
Background: Hernia is the abnormal exit of an organ or fatty tissue, such as the bowel, through the weak wall of the cavity in which it normally resides. Repair of inguinal hernia is common surgical ... procedures. This study aims to compare between laparoscopic and open hernia repair.
Method: Study is non randomized comparative study. Study includes 76 patients who had undergone surgery for hernioplasty. Among them 38 undergone laparoscopic hernioplasty and 38 undergone open hernioplasty from June 2016 to August 2018.
Results: Mean hospital stay was 2.95 days in group 1 and 4.03 in group 2 .VAS was found to be 2.45 in group 1 and 5.71 in group 2 which is significantly low in group 1 patients with p<0.001. Duration of surgery is more in group 1 with mean duration of 94.08 minutes comparing to group 2 with mean duration of 43.55 minutes (with p<0.001).
Conclusion: Laparoscopic hernia repair offers advantages over open repair in terms of less hospital stay and lower pain score for patient not contraindicated for general anesthesia and complicated hernia.
Objective: To improve the results of surgical treatment of primary, postoperative and recurrent hernias of the lateral and anterolateral abdominal wall. Methods: Various types of hernioplasty were ...performed in 68 patients with lateral and anterolateral hernias of the abdominal wall (LALHAW) aged 24 to 67 years. Primary hernias were diagnosed in 10 patients, postoperative – in 30, recurrent – in 28. There were 16 men and 52 women enrolled on the study. Analysis of the anamnesis and medical records revealed that postoperative hernias (30) arose after the following surgical interventions: nephrectomy (11), nephrolithomy (8), appendectomy (4), cholecystectomy (3), drainage of the retroperitoneal space (2), surgery for hepatic echinococcosis (1) and adrenalectomy (1); 24 patients were admitted with recurrent hernia after traditional hernioplasty, and 4 patients – after combined methods of hernioplasty. Results: Among the total number of patients, traditional hernioplasty was performed in 25 (36.8%) patients, tension-free repair – in 5 (7.4%) and combined repair – in 38 (55.8%) patients. Simultaneous operations were performed in 14 cases, such as nephrolithotomy (3), resection of the ovarian cyst (3) and greater omentum (5), supravaginal amputation of the uterus (3). Surgical site complications developed in 12% of cases after traditional hernioplasty, and in 5.2%. after combined methods of operation. Among 5 patients operated using a tension-free method, seroma occurred in one observation. Recurrent hernia after traditional hernioplasty developed in one patient (4% of cases). Conclusion: Surgical treatment of LALHAW is a complicated problem of herniology, due to the complexity of anatomical architectonics of the anterior abdominal wall and limited plastic resources of the surrounding tissues. Currently, the results of traditional hernioplasty remain disappointing, as there is a trend towards increased recurrence and incidence of surgical site complications after its application. The widespread use of the combined methods of surgical treatment of hernias of this localization, along with reliable reinforcement of the hernia defect, provide the most optimal longterm functional results, allowing the patients resume their previous professional activities. The incidence of recurrent hernias after these operations tends to reduce, contributing to an improvement in the quality of life.
Objective: Comparative evaluation of the results of laparoscopic (LHP) and conventional (CHP) hernioplasty in older patients (OP) and assessment of morphological changes in the tissues of the ...inguinal canal. Methods: The results of surgical treatment of 88 OP with inguinal hernias were studied. The main group consisted of 53 (60.2%) patients who underwent LHP, the control group included 35 (39.8%) patients after CHP; among them 77 (87.5%) patients had primary hernias, and 11 (12.5%) – recurrent hernias. The age of the patients varied from 60 to 84 years. In the main group patients underwent laparoscopic transabdominal preperitoneal (TAPP) hernioplasty. In the control group, various types of plasty of the posterior wall of the inguinal canal were applied: autoplasty using local tissues, Bassini and Postempsky repair. Muscle, aponeurotic and adipose tissues of the inguinal canal were sampled for morphological examination. Results: For all studied parameters (surgery duration, in-hospital duration, duration of complete rehabilitation), statistically significantly better results were obtained in in the LHP compared with CHP (p<0.05). Although the differences in complications were not statistically significant (Cox F test: p>0.05), the higher number of complications and their later onset tended to be seen in the CHP group compared with LHP. In patients with small hernias, decreased density of muscle tissue with increased density of the connective tissue were noted, while in patients with large hernias, thinning of the muscle tissue prevail, with expansion of dystrophic adipose tissue observed in all cases. Conclusion: The immediate results of LHP in OP showed its higher effectiveness compared with CHP. Significant changes in the tissues of the inguinal canal found in OP indicate their decreased resilience and potentially delayed reparation processes.
More than 20 million inguinal hernia surgeries are performed annually. An international group of herniologists recommended performing transabdominal preperitoneal plastic surgery (TAPP), total ...extraperitoneal plastic surgery, and Liechtenstein hernioplasty in adults. At the moment, there are no criteria for choosing the method of plastic surgery in patients who may have TAPP, Liechtenstein hernioplasty. The study of two groups of 30 patients devided by the method of surgical treatment: transabdominal preperitoneal plastic (TAPP) and Liechtenstein hernioplasty has been carried out. The study included male patients with primary unilateral inguinal hernia older than 18 years. The groups were compared in the early and late postoperative period. The data obtained revealed that in the early postoperative period, patients after TAPP showed a higher level of pain by the visual-analog scale (VAS) in comparison with the patients after Liechtenstein plastic surgery in 3 hours after surgery, with longer operation time. The assessment of pain level by VAS in 1 day after surgery, at the time of discharge, the fever level, the analgesics need, and the hospitalization duration showed the TAPP advantage over Liechtenstein hernioplasty. Long-term results were obtained by Carolinas Comfort Scale (CSS) questionnaire within 3, 6 months after the operation. Patients after TAPP showed slightly better results in comparison with patients after Liechtenstein hernioplasty. Therefore, TAPP is the preferred method of inguinal canal surgery in patients with open and laparoscopic surgery.
La hernia de Amyand es la hernia inguinal que contiene el apéndice cecal en su interior. Es una entidad poco frecuente y de hallazgo operatorio. En este reporte se describe el caso de un adulto mayor ...con tumoración blanda, aumento de volumen progresivo en región inguinal derecha y dolor reductible en el reposo. En el acto quirúrgico se encontró saco herniario y, en su interior, apéndice cecal aumentado de tamaño, con signos de inflamación. Se realizó apendicectomía. Se reintrodujo el saco herniario y se reparó la pared posterior del conducto inguinal (técnica mixta de Lichtenstein con Bassini). La evolución postoperatoria fue satisfactoria. Palabras clave: hernia de Amyand; hernioplastia; apendicectomía; hernia inguinal; caso clínico. Amyand's hernia is an inguinal hernia that contains the cecal appendix inside. It is a rare entity and its discovery is generally made intraoperatively. We present the case of a older male adult, with a soft tumor, with progressive increase in volume, in the right inguinal region accompanied by local pain, reducible at rest. During surgery, a hernial sac was found with an enlarged cecal appendix inside it, with signs of inflammation. An appendectomy was performed. The hernia sac was reintroduced and the posterior wall of the inguinal canal was repaired (Lichtenstein and Bassini mixed technique). Postoperative evolution was satisfactory. Keywords: Amyand's hernia; hernioplasty; appendectomy; inguinal hernia; case report.
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