Summary
Background
In case of large ventral hernias, the avoidance of a mesh infection caused by a surgical site infection (SSI) is crucial, as surgical options are limited. Pyoderma gangrenosum (PG) ...is a rare condition that mimics SSI, and is therefore often identified with significant delay. Mechanical alteration is known to maintain the progress of PG, outlining the importance of early discrimination against SSI.
Methods
We report our recent clinical experience with PG in a 73-year-old patient after ventral hernia repair.
Results
We present our experience, based on the case of a 73-year-old woman with postoperative PG.
Conclusions
By a systematic approach, we provide indicators to contribute to an earlier diagnosis and adequate treatment in future cases. To the best of our knowledge, this is the first to-the-point checklist in the published literature so far.
Background
Ventral incisional hernia patients develop limitation in physical activities as the hernia enlarges, leading to alteration in their lifestyle, quality of life, aesthetic deformities, and ...occasionally to complications. Cosmetic improvement of the abdomen, an important objective of hernia repair, can be achieved when hernia repair is combined with panniculectomy. The authors undertook this study to review their experience of the integration of hernia repair and panniculectomy to improve the understanding and treatment of this condition.
Methods
A retrospective analysis of the records of patients who underwent abdominal hernia repair with panniculectomy from 2005 to 2010 was undertaken. The records were reviewed for patient demographics, hernia etiology, risk factors for recurrence, previous surgeries, previous approach, type of repair, incision approach, complications, length of hospital stay, and duration of follow-up. Surgical management included mesh hernia repair and pannus excision.
Results
Of the total 45 patients, mean age was 42.37 years and mean follow-up was 24.4 months. Twelve patients had recurrent hernias. Most of the patients underwent retrorectus underlay mesh repair 39 (86.67 %), while 6 (13.33 %) underwent onlay mesh technique. Six (13.33 %) patients developed minor skin necrosis, while one (2.22 %) had skin flap necrosis requiring debridement and skin grafting, three (6.67 %) hernias recurred, one (2.22 %) had seroma formation, and one (2.22 %) developed sacral pressure sore.
Conclusion
This technique provides both functional and aesthetic benefits and generally meets the needs of the patients. It is safe, with a low risk of postoperative complications.
Level of Evidence: Level IV, therapeutic study.
Introducción: la hernia incisional se encuentra dentro de las complicaciones más temidas por los cirujanos tras la realización de una laparotomía. La aplicación de técnicas tisulares para su ...reparación se empleó tradicionalmente, pero estas no mostraron buenos resultados. El advenimiento de los materiales protésicos ha disminuido el índice de recidiva y el dolor posoperatorio en los pacientes con hernia incisional. Objetivo: conocer los resultados obtenidos en nuestro centro con la aplicación de un modelo de hernioplastia incisional para el tratamiento de la hernia poslaparotómica. Métodos: se realizó un estudio de carácter prospectivo longitudinal en el Hospital "Dr. Carlos J. Finlay", con 143 pacientes que presentaban hernias incisionales. Resultados: el sexo femenino fue el más afectado. La obesidad, el hábito de fumar, las enfermedades pulmonares obstructivas crónicas, y la colagenosis, se distinguen entre los factores de riesgo más frecuentes. La mayoría de los pacientes presentaban hernias medianas con anillos entre 10 y 15 cm. El seroma fue la complicación principal. El índice de recidiva fue solo del 2,06 %. Conclusiones: el modelo de hernioplastia incisional propuesto representa una alternativa segura, pues ofrece un índice de recidiva aceptable.Introduction: incisional hernia is included in the more fearsome complications by surgeons after carrying out of a laparotomy. The application of tissular techniques for its repair was traditionally used but these ones have not good results. The advent of prosthetic materials has decreased the relapse rate and the postoperative pain in patients presenting with incisional hernia. Objective: to know the results obtained in our center with application of an incisional hernioplasty model for treatment of post-laparotomy hernia. Methods: a longitudinal and prospective study was conducted in the "Dr. Carlos J. Finlay" Hospital in 143 patients with incisional hernias. Results: the female sex was the more involved one. Obesity, smoking, chronic obstructive pulmonary diseases and the collagenosis are included in the more frequent risk factors. Most of patients had medium hernias with rings between 10 and 15 cm. Seroma was the major complication. The relapse rate was only of 2.06 %. Conclusions: the proposed model of incisional hernioplasty is a safe alternative, thus it offers an acceptable relapse rate.
Introduction: ''Lichtenstein'' tension-free mesh repair is the most common surgical techniques used for inguinal hernia repair." Read-Rives" method is tension-free, too, but here prosthesis is placed ...just over the peritoneum, and there is no weak area. The aim of this study was to compare the results of "Read-Rives" and Lichtenstein method in the hernioplasty. Methods and Materials: In this prospective randomized clinical trial 126 patients who had unilateral inguinal hernia were examined: 64 patients operated with Lichtenstein and 62 patients operated with Rives method. They evaluated for early post-operative complications, duration of surgery and hospital stay, return to normal activity, and then they followed for recurrence of hernia. Results: Postoperative pain was significantly lower and the return to normal activity was shorter in Rives group. Duration of surgery and hospital stay and recurrence rate was equal, lower postoperative wound infection was found within Rives method. Conclusions: Although the ''Read-Rives'' method is not technically as simple as ''Lichtenstein'' method, but this procedure is easy to learn, so it is recommended because of its better final outcome in comparison with Lichtenstein repair.
Inguinal hernia repair is one of the most common operation in surgical practice. Despite its common occurrence, hernia often poses a surgical dilemma even for a skilled surgeon. The unexpected ...hernial content constitutes one of these cases. Although the often-reported, unusual contents of a hernia sac include ovary, fallopian tube, vermiform appendix, Meckel diverticulum, and urinary bladder, the herniation of a large ovarian cyst into the inguinal canal has been hardly reported. Majority of the ovarian cysts are asymptomatic or present with vague lower abdominal pain, whereas the presentation of a large ovarian cyst as an inguinolabial swelling as in our patient is extremely rare. We present here one of the few reported cases of a laparoscopic excision of a large ovarian cyst herniating into the inguinal canal and discuss the pathogenesis of an ovarian cyst as hernial content, the advantages and concerns of a laparoscopic approach in resecting large ovarian cysts, and simultaneous management of the inguinal hernia.
The repair of recurrent inguinal hernias after prosthetic mesh repair is usually diffucult due to considerable technical challenge and complications. There is also a greater risk of developing ...further recurrence. The aim of this study was to investigate the outcome of preperitoneal repair (open posterior approach) for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty.
We performed a prospective clinical study in 44 patients having recurrent inguinal hernias the period 2002- 2008. Preperitoneal repair was performed on all patients who have had Lichtenstein tension-free hernioplasty previously. The age, gender, operating time, hospital stay, postoperative complication rates and recurrence rates of patients were evaluated.
There were no serious intraoperative complications. There were 36 men and 9 women in the study, whose average age was 38.45 (25-68) years. The average operative time and hospital stay were 44.56 (30-120) min and 1.6 (1-3) days, respectively. Complications included 4.5 % seromas, 4.5 % hematomas and urinary retention in 9.09 % patients. Follow-up to date is 1-90 months (range, median 40 months).
We concluded that the preperitoneal repair (open posterior approach) in recurrent inguinal hernias after Lichtenstein tension-free hernioplasty is a safe and efficient method with low complication and rerecurrence rates.
Background: Although groin hernia repairs carry different eponyms according to the approach, the techniques have similar objectives. Postoperative recovery is uncomplicated in most patients. However, ...some patients continue to experience chronic pain and discomfort for months or even years after hernia repair. Reported rates of chronic pain following hernia repair vary, as prospective studies are few and chronic pain is not a primary outcome parameter in most studies. Objectives: In this study, we tried to compare the incidence and severity of chronic groin pain in patients undergoing totally extraperitoneal (TEP) repair and open tension-free hernioplasty for inguinal hernia. Secondary factors studied were incidence of seroma, haematoma and return to normal activities in the two groups. Material and methods: This was a prospective non-randomized study. Group I (n=50) included patients undergoing endoscopic TEP repair and Group II (n=50) included patients undergoing open meshplasty. In each group, patients were reviewed for chronic groin pain at 3 months postoperatively and secondary factors including seroma, haematoma formation and return to normal activities. Results: In the open hernia repair group, 13 patients (26%) had chronic groin pain that persisted for more than 3 months. While in the TEP repair group, 5 patients (10%) suffered from chronic groin pain after 3 months, which was statistically different (p=0.03). Conclusion: Our study shows that TEP repair of inguinal hernia is associated with less incidence of chronic groin pain as compared to open Lichtenstein hernioplasty.
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