1
|
Simões MPB, Mansur AC, Pimentel SK. Lumbar and para-iliac hernias: an alternative technique. Rev Col Bras Cir 2021; 48:e20213029. [PMID: 34133656 PMCID: PMC10683433 DOI: 10.1590/0100-6991e-20213029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022] Open
Abstract
Lumbar and para-iliac hernias are rare and occur after removal of an iliac bone graft, nephrectomies, retroperitoneal aortic surgery, or after blunt trauma to the abdomen. The incidence of hernia after the removal of these grafts ranges from 0.5 to 10%. These hernias are a problem that surgeons will face, since bone grafts from the iliac crest are being used more routinely. The goal of this article was to report the technique to correct these complex hernias, using the technique of fixing the propylene mesh to the iliac bone and the result of this approach. In the period of 5 years, 165 patients were treated at the complex hernia service, 10 (6%) with hernia in the supra-iliac and lumbar region, managed with the technique of fixing the mesh to the iliac bone with correction of the failure. During the mean follow-up of 33 months (minimum of 2 and maximum of 48 months), there was no recurrence of the hernias.
Collapse
Affiliation(s)
- Maria Pessole Biondo Simões
- - Universidade Federal do Paraná, Departamento de Cirurgia - Curitiba - PR - Brasil
- - Complexo Hospitalar do Trabalhador, Serviço de Cirurgia Geral - Curitiba - PR - Brasil
| | | | - Silvania Klug Pimentel
- - Universidade Federal do Paraná, Departamento de Cirurgia - Curitiba - PR - Brasil
- - Complexo Hospitalar do Trabalhador, Serviço de Cirurgia Geral - Curitiba - PR - Brasil
| |
Collapse
|
2
|
Ramanathan S, Krishnamoorthy V, Ratnakar K, Thangavel P, Sundarraj R. Colovesical fistula secondary to hernia mesh migration: an unusual incident. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AbstractWe evaluated a 27-year old male with pneumaturia and fecaluria with a past history of right inguinal hernia repair. Though, cystoscopy and contrast enhanced computed tomography did not furnish any evidence to arrive at a diagnosis, interestingly, colonoscopy revealed a mesh in the sigmoid colon making apparent the diagnosis of colovesical fistula secondary to mesh migration. Later, surgical removal of the mesh from the sigmoid colon with rent closure of the fistulous opening was done successfully. Our case thus, highlights the vital role of common diagnostic tool like colonoscopy in making an uncommon diagnosis.
Collapse
Affiliation(s)
| | | | - Kini Ratnakar
- Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India
| | | | - Raju Sundarraj
- Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India
| |
Collapse
|
3
|
Kaminski S, Diamond S. The early laparoscopic repair of a traumatic lumbar hernia: safe and successful. J Surg Case Rep 2017; 2017:rjx188. [PMID: 28959431 PMCID: PMC5610582 DOI: 10.1093/jscr/rjx188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/15/2017] [Indexed: 11/14/2022] Open
Abstract
Abdominal wall hernias are a rare but important consequence of blunt trauma. The optimal timing and the method of repair are not well described in the current surgical literature. Advances in laparoscopic techniques have offered new options for treatment of this problem. We describe the case of a 43-year-old man who suffered a blunt traumatic lumbar hernia. He was taken to the operating room during his initial hospitalization where a laparoscopic repair was performed with the additional implantation of prosthetic mesh. His post-operative course was uneventful. In selected cases, early operative repair may be appropriate and result in improved outcomes.
Collapse
Affiliation(s)
- Stephen Kaminski
- Department of Surgery, Cottage Health, 400W Pueblo Street, Santa Barbara, CA, USA
| | - Shawn Diamond
- Department of Surgery, Cottage Health, 400W Pueblo Street, Santa Barbara, CA, USA
| |
Collapse
|
4
|
Marchand C, Renard Y, Avisse C, Palot JP, Larre S. [Symptomatic lumbar incisional hernia after open nephrectomy: What are the risk factors?]. Prog Urol 2016; 26:304-9. [PMID: 27020415 DOI: 10.1016/j.purol.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 01/24/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Lumbar incisional hernias after open nephrectomy are rare but can lead to aesthetic disorder, discomfort or intestinal obstruction. The aim of the study is to highlight their risk factors. PATIENTS AND METHODS The characteristics of patients who suffered from symptomatic and surgically treated lumbar incisionnal hernia after open nephrectomy (study group "GE") were compared to those of patients who underwent open nephrectomy without postoperative incisional hernia (control group "GT") using the Student's t test and Mann-Whitney test (statistical significance P value<0.05). GT patients were randomly selected with a 1/4 ratio (1 lumbar incisionnal hernia vs 4 controls). RESULTS From 2004 to 2014, 417 open nephrectomies were performed in one university hospital. Forty-five patients were included: 9 in GE and 36 in GT. There was no statistically significant difference between GT and GE for weight, height, body mass index (BMI), emergency, partial nephrectomy, laterality, rib resection, laparoscopic conversion to open surgery, postoperative complications, smoking, diabetes mellitus, cardiovascular history, obesity and sex, but there was a statistically significant difference for age, operative time, chronic obstructive pulmonary disease (COPD) and severe obesity (BMI>35) with, respectively, P=0.05, P=0.02, P=0.04 and P=0.02. CONCLUSION Risk factors for lumbar incisional hernia after open nephrectomy are age, operative time, severe obesity and COPD. LEVEL OF EVIDENCE 5.
Collapse
Affiliation(s)
- C Marchand
- Service d'urologie et d'andrologie, hôpital Robert-Debré, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France.
| | - Y Renard
- Service de chirurgie générale, digestive et endocrinienne, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France
| | - C Avisse
- Service de chirurgie générale, digestive et endocrinienne, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France
| | - J-P Palot
- Service de chirurgie générale, digestive et endocrinienne, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France
| | - S Larre
- Service d'urologie et d'andrologie, hôpital Robert-Debré, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France
| |
Collapse
|
5
|
Ou CJ, Sternfeld WC, Stausmire JM. Iliac Crest Herniation Secondary to Autogenous Bone Grafting Found on Osteopathic Examination. J Osteopath Med 2015. [PMID: 26214826 DOI: 10.7556/jaoa.2015.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Surgical repair of difficult or nonunion fractures is frequently performed with autogenous bone grafts, most commonly from the iliac crest. Complications from this procedure may include vessel injury, nerve injury, pelvic instability, bowel herniation, and ileus. The authors report a case of iliac crest herniation in a patient presenting with a small-bowel obstruction 2 years after anterior iliac crest graft harvest for an open reduction and internal fixation repair of a right humeral shaft fracture. An emergency operation revealed that the right colon had herniated through an opening in the right iliac crest. The appendix had adhered to new osseous bone formed postoperatively, requiring an appendectomy. The hernia defect was successfully repaired with polypropylene mesh. A high index of suspicion for graft site herniation is needed for patients with a history of iliac crest bone grafting who present with symptoms of abdominal pain, flank or hip pain, ileus, or small-bowel obstruction.
Collapse
|
6
|
Abstract
Traumatic abdominal wall hernia following blunt trauma, although rare, can be successfully managed with a laparoscopic approach. Background: Traumatic abdominal wall hernias from blunt trauma usually occur as a consequence of motor vehicle collisions where the force is tangential, sudden, and severe. Although rare, these hernias can go undetected due to preservation of the skin overlying the hernia defect. Open repairs can be challenging and unsuccessful due to avulsion of muscle directly from the iliac crest, with or without bone loss. A laparoscopic approach to traumatic abdominal wall hernia can aid in the delineation of the hernia and allow for a safe and effective repair. Case Description: A 36-year-old female was admitted to our Level 1 trauma center with a traumatic abdominal wall hernia located in the right flank near the iliac crest after being involved in a high-impact motor vehicle collision. Computed tomography and magnetic resonance imaging of the abdomen revealed the presence of an abdominal wall defect that was unapparent on physical examination. The traumatic abdominal wall hernia in the right flank was successfully repaired laparoscopically. One-year follow-up has shown no sign of recurrence. Discussion: A traumatic abdominal wall hernia rarely presents following blunt trauma, but should be suspected following a high-impact motor vehicle collision. Frequently, repair is complicated by the need to have fixation of mesh to bony landmarks (eg, iliac crest). In spite of this challenge, the laparoscopic approach with tension-free mesh repair of a traumatic abdominal wall hernia can be accomplished successfully using an approach similar to that taken for laparoscopic inguinal hernia repair.
Collapse
Affiliation(s)
- Kenneth L Wilson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
| | | | | |
Collapse
|
7
|
Zhou X, Zhang J, Hu H. Kugel patch repair of superior lumbar hernias. Hernia 2013; 18:601-5. [DOI: 10.1007/s10029-013-1056-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/08/2013] [Indexed: 11/29/2022]
|
8
|
Petersen K, Snikeris J, Hall TS. Bleichner's hernia - lumbar hernia. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:26-9. [PMID: 23569557 PMCID: PMC3614380 DOI: 10.12659/ajcr.883760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 05/10/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND We present a case of a lumbar hernia and a review of the literature of this rare hernia type. CASE REPORT The case and the review will discuss the unusual presentations reported, common etiologies, the importance of early operative repair based on the high rate of incarceration and the recent recommendations regarding repair techniques. CONCLUSIONS Lumbar hernias are rare cases, but should be pursued in diagnosis and treated aggressively because of the high rate of incarceration. Repair can be accomplished with a minimally invasive technique.
Collapse
Affiliation(s)
- Katherine Petersen
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
| | - Jaclyn Snikeris
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
| | - Timothy S. Hall
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
| |
Collapse
|
9
|
Gagner M, Milone L, Gumbs A, Turner P. Laparoscopic repair of left lumbar hernia after laparoscopic left nephrectomy. JSLS 2011; 14:405-9. [PMID: 21333197 PMCID: PMC3041040 DOI: 10.4293/108680810x12924466007322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Laparoscopic transabdominal preperitoneal repair of a lumber hernia after laparoscopic retroperitoneal surgery can be performed safely with minimum postoperative pain. Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair.
Collapse
Affiliation(s)
- Michel Gagner
- Herbert Wertheim College of Medicine, Florida International University, Department of Surgery, Miami, Florida, PO Box 336 H, Scarsdale, NY 10583, USA.
| | | | | | | |
Collapse
|
10
|
Edwards C, Geiger T, Bartow K, Ramaswamy A, Fearing N, Thaler K, Ramshaw B. Laparoscopic transperitoneal repair of flank hernias: a retrospective review of 27 patients. Surg Endosc 2009; 23:2692-6. [PMID: 19462203 DOI: 10.1007/s00464-009-0477-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 01/08/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Incisional hernias of the flank are rare with scattered case reports regarding the feasibility of laparoscopic treatment. Treatment can be technically challenging due to patient positioning and adequate mesh overlap and fixation. The aim of this study is to describe the surgical technique and present outcomes of the largest known case series of laparoscopic repair of flank hernia. METHODS A retrospective chart review was performed from April 2002 to August 2006 at two university hospitals utilizing three surgeons' experience. All patients who underwent a laparoscopic repair of a flank hernia were identified and reviewed with regards to short-term outcomes. RESULTS Twenty-seven patients were identified with incisional flank hernia treated laparoscopically. Average defect size was 188 cm(2) repaired with an average mesh size of 650 cm(2). Mean operating room (OR) time was 144 min and mean length of stay (LOS) was 3.1 days. There were two reoperations within the cohort: one for a new, unrelated midline hernia 7 months after repair of the initial flank hernia and one for chronic pain with removal of a previously placed polypropylene mesh in the subcutaneous tissue of the abdominal wall. Neither patient had failure of the laparoscopic flank hernia repair. Two other patients were conservatively treated for chronic pain. Mean follow-up was 3.6 months. CONCLUSIONS In the laparoscopic repair of flank hernias adequate retroperitoneal dissection and wide mesh overlap is imperative. Laparoscopic repair can be performed safely and effectively with good short-term outcomes.
Collapse
Affiliation(s)
- Chris Edwards
- Division of General Surgery, Department of Surgery, University of Missouri, One Hospital Drive, DC075.00, Columbia, MO 65212, USA
| | | | | | | | | | | | | |
Collapse
|
11
|
Palanivelu C, Rangarajan M, John SJ, Madankumar MV, Senthilkumar K. Laparoscopic transperitoneal repair of lumbar incisional hernias: a combined suture and 'double-mesh' technique. Hernia 2007; 12:27-31. [PMID: 17668145 DOI: 10.1007/s10029-007-0270-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 07/10/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lumbar hernias that occur after surgery are called lumbar incisional hernias. Recently, laparoscopic repair of these hernias has been reported with excellent outcomes. This is a retrospective study of our series of patients with lumbar incisional hernias. PATIENTS AND METHODS We managed 11 patients with lumbar incisional hernias from 1996-2006. All the patients had undergone either nephrectomy or pyeloplasty in the past. Laparoscopic suturing of the defect and reinforcement with mesh were successfully performed for all the patients. RESULTS There were more males than females, the age range was 42-65 years, and mean operating time was 120 min; discharge was at 1-2 postoperative days. There was no recurrence or mortality. Three cases had seroma, out of which two required aspiration after 60 days. DISCUSSION Laparoscopic repair provides all the benefits of minimally invasive surgery, and the principles involved in repair of ventral hernias are applied in lumbar incisional hernias as well. Our technique involved suturing of the defect before placing a mesh over the defect. We theorize that approximating the ends of the muscles restores normal anatomy and results in functional improvement. For the larger hernias, we used two meshes to cover the defect--polypropylene and Parietex, sizes being 15 x 15 cm. CONCLUSION Laparoscopic repair with prosthetic reinforcement is feasible and effective in the treatment of lumbar incisional hernias. Also, suturing of the defect may provide additional benefits.
Collapse
Affiliation(s)
- C Palanivelu
- GEM Hospital, 45-A, Pankaja Mill Road, Ramnathapuram, Coimbatore 641045, India
| | | | | | | | | |
Collapse
|
12
|
Tobias-Machado M, Rincon FJ, Lasmar MT, Zambon JP, Juliano RV, Wroclawski ER. Laparoscopic surgery for treatment of incisional lumbar hernia. Int Braz J Urol 2006; 31:309-14. [PMID: 16137398 DOI: 10.1590/s1677-55382005000400003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Accepted: 04/29/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To present results obtained with laparoscopic correction of incisional lumbar hernia in patients with minimum follow-up of 1 year. MATERIALS AND METHODS We prospectively studied 7 patients diagnosed with incisional lumbar hernia after physical examination and computerized tomography. We used laparoscopic transperitoneal access through 3 ports. One polypropylene mesh was introduced in the abdominal cavity and fixed by titanium clamps to the margins of the hernia ring following release of the peritoneum. RESULTS All cases were successfully completed with no conversion required. Mean surgical time was 120 minutes and discharge from hospital occurred between the 1st and the 2nd postoperative days. There were no intraoperative complications or hernia recurrence in any case. Postoperatively, we had 2 minor complications: one case of seroma that resolved spontaneously after 60 days and one patient presenting lumbar pain that persisted until the 3rd postoperative month. The return to usual activities occurred on average 3 weeks following intervention. Of the 7 patients, 6 were satisfied with the esthetical and functional effect produced by the procedure. CONCLUSIONS The surgical correction of incisional lumbar hernia by laparoscopic access is an excellent option for a minimally invasive treatment, with adequate long-term results.
Collapse
Affiliation(s)
- M Tobias-Machado
- Section of Urology, ABC Medical School, Santo Andre, Sao Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
13
|
Pitrez FAB, Pioner SR, Lemchen HF, Rech D, Menegotto LB. Eventrações lombares: revisão tardia de 20 pacientes. Rev Col Bras Cir 2006. [DOI: 10.1590/s0100-69912006000100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Desde a primeira descrição em 1731 por DeGarangoet até 1994 poucos casos de hérnia lombar incisional (HLI) foram relatados, restringindo-se a aproximadamente 300 casos. No entanto, esse número deve ser muito maior do que o encontrado na literatura pesquisada1,2. Não há maiores relatos com experiência significativa nesta afecção e, da mesma forma, não há descrição de uma técnica cirúrgica padrão para sua correção. OBJETIVO: Transmitir a experiência dos autores, alcançada no tratamento cirúrgico dos pacientes com HLI, confrontando-a com os dados vigentes na literatura. MÉTODO: Foram analisados, retrospectivamente, 20 casos de hérnia lombar submetidos ao tratamento cirúrgico no Serviço de Cirurgia Geral da ISCMPA/FFFCMPA nos últimos 10 anos. RESULTADOS: Foram identificados 20 pacientes, a idade média foi de 49 anos (28 - 68 anos). A maioria (19 casos) correspondeu a hérnias incisionais lombares. O seguimento médio foi de 60 meses (5-72 meses), porém sete casos não compareceram às revisões ambulatoriais de rotina. Não houve recidiva nos casos acompanhados em um seguimento que variou de seis meses a 8,5 anos. Em um caso persistiu o abaulamento, dois apresentaram seroma, e um apresentou infecção de ferida operatória. CONCLUSÕES: Os autores recomendam a intervenção convencional, com reparo primário nos casos com diâmetro inferior a 5 cm e a utilização de tela nos casos em que há tensão na linha de sutura.
Collapse
|