1
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Sahota R, Jayant A, Wiles R, Katti A. Epigastric anterior abdominal wall hernia: An unusual cause of gastric outlet obstruction. Radiol Case Rep 2024; 19:5824-5827. [PMID: 39314653 PMCID: PMC11418109 DOI: 10.1016/j.radcr.2024.08.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/25/2024] Open
Abstract
A 79-year-old female presented with a 3-week history of dysphagia and vomiting, and an upper abdominal mass which had increased in size over the previous 2 weeks. CT scan showed a partial gastric outlet obstruction secondary to an epigastric hernia. This was assessed further on fluoroscopy, showing the distal stomach in the hernial sac and a delay in gastric emptying. We present the CT and fluoroscopic findings of this rare cause of gastric outlet obstruction.
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Affiliation(s)
- Ramandeep Sahota
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Mount Vernon St, Liverpool L7 8YE, England
| | - Abhishek Jayant
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Mount Vernon St, Liverpool L7 8YE, England
| | - Rebecca Wiles
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Mount Vernon St, Liverpool L7 8YE, England
| | - Ashok Katti
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Mount Vernon St, Liverpool L7 8YE, England
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2
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Chen Y, Zhang M, Li Y, Xie Q, Dai S, Ge X, Hao CM, Zhu T. Retroperitoneal leakage as an important cause of acquired ultrafiltration decline in peritoneal dialysis: clinical characteristics and related risk factors. J Nephrol 2024; 37:1997-2005. [PMID: 38997573 DOI: 10.1007/s40620-024-02009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/13/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Peritoneal dialysis (PD) is a widely-used renal replacement therapy while low ultrafiltration volume usually results in technique failure. Retroperitoneal leakage has been reported to be one of the causes of acquired decline in ultrafiltration. The present study investigated retroperitoneal leakage in PD patients and explored related risk factors. METHODS This study was designed as a prospective, observational study. A total of 420 PD patients regularly followed up at our center were enrolled from May 2011 to July 2021 and followed until December 2021. Retroperitoneal leakage was determined by magnetic resonance peritoneography and was used as the endpoint. Patients with retroperitoneal leakage were given intermittent PD or temporary hemodialysis (HD) as therapy. Cox regression models were used to identify risk factors for retroperitoneal leakage. RESULTS The cohort was followed up for up to 125.0 months (median: 46.4 months; interquartile range: 16.6 months). During the follow-up, 68 patients developed retroperitoneal leakage, with 31 (45.6%) cases occurring within the first year after PD initiation. A total of 62 (91.2%) patients recovered from retroperitoneal leakage and resumed their original PD regimen. Multivariate Cox regression analysis revealed that age and gender were independent predictors for retroperitoneal leakage. Younger males were more likely to develop retroperitoneal leakage. In females, waistline and body mass index (BMI) were found to be risk factors for retroperitoneal leakage. CONCLUSIONS Retroperitoneal leakage was common in PD patients with ultrafiltration insufficiency and was usually reversible after appropriate treatment. Age and gender were independent risk factors for retroperitoneal leakage.
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Affiliation(s)
- Yun Chen
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Min Zhang
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Yuan Li
- Division of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qionghong Xie
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Shuqi Dai
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xiaolin Ge
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Chuan-Ming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Tongying Zhu
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
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3
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Bender T, Owen P, Johnson K, Sorrell M, Rodel R. Synchronous cesarean delivery and revision of infected ventral hernia repair mesh in a complex abdominal wall. J Surg Case Rep 2024; 2024:rjae151. [PMID: 39329008 PMCID: PMC11427119 DOI: 10.1093/jscr/rjae151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 09/28/2024] Open
Abstract
Ventral hernias are a common abdominal wall defect vulnerable to the gravid abdomen's physiological changes. This case report describes a 38-year-old gravida 3 para 2002 female with a complex abdominal surgical history and a chronic infection of the abdominal wall at the site of prior hernia repair with mesh. She was managed conservatively with antibiotics until delivery. Abdominal wall debridement and repair was coordinated with her 39-week cesarean, which allowed for a successful delivery of her infant paralleled with surgical management of the infected mesh.
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Affiliation(s)
- Tiffany Bender
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD 57105, United States
| | - Parker Owen
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD 57105, United States
| | - Kristopher Johnson
- Department of General Surgery, University of South Dakota Sanford School of Medicine, Sioux Falls, SD 57105, United States
| | - Matthew Sorrell
- Department of General Surgery, Sanford Health, Sioux Falls, SD 57105, United States
| | - Rachel Rodel
- Department of Obstetrics and Gynecology, University of South Dakota Sanford School of Medicine, Sanford Health, Sioux Falls, SD 57105, United States
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4
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Shirahige T, Nakazawa K. An old female with emesis and distension of the upper abdominal wall. J Am Coll Emerg Physicians Open 2024; 5:e13214. [PMID: 38827501 PMCID: PMC11140165 DOI: 10.1002/emp2.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Affiliation(s)
- Tomoyuki Shirahige
- Departments of Emergency and Critical Care MedicineTokyo Bay Urayasu Ichikawa Medical CenterChibaJapan
| | - Kahoko Nakazawa
- Department of Emergency MedicineTokyo Kita Medical CenterTokyoJapan
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5
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Honma S, Takashima T, Ushikubo T, Ishikawa K, Suzuki T, Nakajima S. Enhanced-view totally extraperitoneal repair in a morbidly obese patient with epigastric and umbilical hernias in combination with rectus diastasis: A case report. Int J Surg Case Rep 2024; 117:109571. [PMID: 38518459 PMCID: PMC10972798 DOI: 10.1016/j.ijscr.2024.109571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION The use of enhanced-view totally extraperitoneal (eTEP) repair for patients with ventral hernias has become more widespread due to its ability to prevent mesh-and-tacker-related complications by placing the mesh in the retrorectus space. However, the efficacy of eTEP repair in obese patients remains unknown. Herein, we report a case of a morbidly obese patient with epigastric and umbilical hernias in combination with a rectus diastasis repaired using the eTEP technique. PRESENTATION OF CASE A 42-year-old man with a history of spontaneously reduced incarcerated epigastric hernia two weeks previously was referred to our hospital. His body mass index (BMI) was 42.9 kg/m2. Abdominal computed tomography revealed a small epigastric hernia, an umbilical hernia, and a rectus diastasis. We performed eTEP repair. The postoperative course was uneventful, and the patient was discharged on postoperative day 3. There has been no evidence of hernia recurrence after a follow-up period of 2 years. DISCUSSION We consider that the eTEP technique is rarely affected by intra-abdominal fat because endoscopic manipulation is performed in the bilateral retrorectus and preperitoneal spaces. Moreover, the eTEP allows the epigastric artery perforator to be spared. Therefore, eTEP repair is considered the best surgical option for morbidly obese patients with ventral hernias in combination with rectus diastasis. CONCLUSIONS This case provides support for the efficacy of eTEP repair in morbidly obese patients with epigastric and umbilical hernias in combination with a rectus diastasis.
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Affiliation(s)
- Shusaku Honma
- Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagataku, Kobe, Hyogo 653-0013, Japan.
| | - Takashi Takashima
- Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagataku, Kobe, Hyogo 653-0013, Japan
| | - Tatsuhi Ushikubo
- Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagataku, Kobe, Hyogo 653-0013, Japan
| | - Kana Ishikawa
- Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagataku, Kobe, Hyogo 653-0013, Japan
| | - Takahisa Suzuki
- Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagataku, Kobe, Hyogo 653-0013, Japan
| | - Sanae Nakajima
- Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagataku, Kobe, Hyogo 653-0013, Japan
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6
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Barron-Cervantes NM, Martinez-Esteban A, Villegas-Tovar E, Nuccio-Giordano FM, D G Gidi A. Uncovering a Rare Case of Hepatic Round Ligament Epigastric Hernia. Cureus 2024; 16:e57553. [PMID: 38707161 PMCID: PMC11068476 DOI: 10.7759/cureus.57553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Abdominal wall hernias are one of the most common surgical diseases present in both males and females nowadays. However, with only a few cases reported in the literature, hepatic round ligament hernias are a rare clinical manifestation. This case shows how a common symptom such as epigastric pain can be associated with this rare condition. In general, abdominal computed tomography (CT) images are the choice of study to evaluate complications and the involvement of different intestinal sections. Some laboratory tests can be performed to suspect intestinal ischemia secondary to strangulated hernias. Primary repair utilizing mesh is the preferred surgical treatment. This procedure can be performed through laparoscopic or open technique, depending on the surgeon's skills and patient preference.
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Affiliation(s)
| | | | | | | | - Alejandro D G Gidi
- General and Gastrointestinal Surgery, Angeles Health System, Mexico City, MEX
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7
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Wang F, Ma B, Ma Q, Liu X. Global, regional, and national burden of inguinal, femoral, and abdominal hernias: a systematic analysis of prevalence, incidence, deaths, and DALYs with projections to 2030. Int J Surg 2024; 110:01279778-990000000-01010. [PMID: 38265437 PMCID: PMC11020045 DOI: 10.1097/js9.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/23/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Hernias, particularly inguinal, femoral, and abdominal, present a global health challenge. While the Global Burden of Disease (GBD) study offers insights, systematic analyses of hernias remain limited. This research utilizes the GBD dataset to explore hernia implications, combining current statistics with 2030 projections and frontier analysis. METHODS We analyzed data from the 2019 GBD Study, focusing on hernia-related metrics: prevalence, incidence, deaths, and disability-adjusted life years (DALYs) across 204 countries, grouped into 21 GBD regions by the SDI (SDI). Data analysis incorporated relative change calculations, Annual Percentage Change (APC), Average Annual Percentage Change (AAPC), and Joinpoint Regression Analysis. The study also employed frontier analysis and the Bayesian Age-Period-Cohort model for trend prediction up to 2030. Analyses utilized R version 4.2.3. RESULTS From 1990 to 2019, global hernia cases surged by 36%, reaching over 32.5 million, even as age-standardized rates declined. A similar pattern was seen in mortality and DALYs, with absolute figures rising but age-standardized rates decreasing. Gender data between 1990 and 2020 showed consistent male dominance in hernia prevalence, even as rates for both genders fell. Regionally, Andean Latin America had the highest prevalence, with Qatar and Bulgaria noting significant increases and decreases, respectively. Frontier analyses across 204 countries linked higher SDIs with reduced hernia prevalence. Yet, some high SDI countries, like Qatar and the UK, deviated unexpectedly. Predictions up to 2030 anticipate increasing hernia prevalence, predominantly in males, while death rates are expected to decline. DALYs, after declining, are stabilizing. CONCLUSIONS Our analysis reveals a complex interplay between socio-demographic factors and hernia trends, emphasizing the need for targeted healthcare interventions. Despite advancements, vigilance and continuous research are essential for optimal hernia management globally.
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Affiliation(s)
- Fan Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
| | - Bangzhen Ma
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Qiuyue Ma
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
| | - Xiaoli Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
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8
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Kulkarni SV. An incarcerated epigastric hernia with unusual contents. Clin Case Rep 2023; 11:e8291. [PMID: 38076016 PMCID: PMC10697828 DOI: 10.1002/ccr3.8291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 10/16/2024] Open
Abstract
Key Clinical Message An epigastric hernia usually contains preperitoneal fat, but rarely may contain colon. This fact needs to be kept in mind by the operating surgeons. Abstract An epigastric hernia usually contains preperitoneal fat, but rarely may contain colon. Experience with such a singular case is presented and discussed. This fact needs to be kept in mind by the operating surgeons.
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Affiliation(s)
- Shrirang Vasant Kulkarni
- Department of GI Surgery & Liver TransplantationArmy Hospital Research and ReferralNew DelhiIndia
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9
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Haskins IN. Hernia Formation: Risk Factors and Biology. Surg Clin North Am 2023; 103:835-846. [PMID: 37709390 DOI: 10.1016/j.suc.2023.04.020] [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] [Indexed: 09/16/2023]
Abstract
The incidence of ventral hernias in the United States is in increasing. Herein, the author details the etiology of congenital and acquired ventral hernias as well as the risk factors associated with the development of each of these types of ventral hernias.
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Affiliation(s)
- Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
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10
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Knochenhauer HE, Lim SL, Brown DA, Darner G, Levinson H, Havrilesky LJ, Previs RA. An obstetrician-gynecologist's review of hernias: risk factors, diagnosis, prevention, and repair. Am J Obstet Gynecol 2023; 229:214-221. [PMID: 37120051 DOI: 10.1016/j.ajog.2023.04.024] [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: 12/31/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/01/2023]
Abstract
Management of obstetrical and gynecologic patients with hernias poses challenges to providers. Risks for hernia development include well-described factors that impair surgical wound healing and increase abdominal pressure. Among the diverse populations cared for by obstetricians and gynecologists, pregnant patients and those with gynecologic malignancies are at the highest risk for hernia formation. This article provides an overview of the existing literature, with a focus on patients cared for by obstetrician-gynecologists and commonly encountered preoperative and intraoperative scenarios. We highlight scenarios when a hernia repair is not commonly performed, including those of patients undergoing nonelective surgeries with known or suspected gynecologic cancers. Finally, we offer multidisciplinary recommendations on the timing of elective hernia repair with obstetrical and gynecologic procedures, with attention to the primary surgical procedure, the type of preexisting hernia, and patient characteristics.
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Affiliation(s)
| | - Stephanie L Lim
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC
| | - David A Brown
- Division of Plastic, Oral, and Maxillofacial Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | | | | | - Laura J Havrilesky
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC
| | - Rebecca A Previs
- Division of Gynecologic Oncology, Duke Cancer Institute, Durham, NC; LabCorp, Enterprise Oncology, Durham, NC.
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11
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Barranquero AG, Villalobos Mori R, Maestre González Y, Protti GP, López Soler G, Villarreal León F, González Alfaro IJ, Olsina Kissler JJ. Parietex™ Composite Ventral Patch for primary and incisional hernia repair. ANZ J Surg 2023; 93:1799-1805. [PMID: 37231992 DOI: 10.1111/ans.18524] [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: 01/06/2023] [Revised: 04/24/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUNDS Ventral hernia repair with a preformed device is a frequent intervention, but few reports exist with Parietex™ Composite Ventral Patch. The aim was to evaluate the results of this mesh with the open intraperitoneal onlay mesh (open IPOM) technique. METHODS Observational retrospective single institution study of all consecutive patients intervened for ventral or incisional hernia with a diameter inferior to 4 cm, from January 2013 to June 2020. The surgical repair was performed according to the open IPOM technique with Parietex™ Composite Ventral Patch. RESULTS A total of 146 patients were intervened: 61.6% with umbilical hernias, 8.2% with epigastric hernias, 26.7% with trocar incisional hernias, and 3.4% with other incisional hernias. The global recurrence rate was 7.5% (11/146). Specifically, it was 7.8% in umbilical hernias, 0% in epigastric hernias, 7.7% in trocar incisional hernias and 20% (1/5) in other incisional hernias. The median time for recurrence was 14 months (IQR: 4.4-18.7). The median indirect follow-up was 36.9 months (IQR: 27.2-49.6), and the median presential follow-up was 17.4 months (IQR: 6.5-27.3). CONCLUSION The open IPOM technique with a preformed patch offered satisfactory results for the treatment of ventral and incisional hernias.
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Affiliation(s)
- Alberto G Barranquero
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari, Arnau de Vilanova, Lleida, Spain
| | - Rafael Villalobos Mori
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari, Arnau de Vilanova, Lleida, Spain
| | - Yolanda Maestre González
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari, Arnau de Vilanova, Lleida, Spain
| | - Gian Pier Protti
- General and Digestive Surgery Department, Hospital Universitari, Germans Trias i Pujol, Badalona, Spain
| | - Guillermo López Soler
- General and Digestive Surgery Department, Hospital Universitari, Arnau de Vilanova, Lleida, Spain
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12
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Omameuda T, Shiozawa M, Miyahara Y, Kitabayashi H, Koizumi M, Kondo S, Kawai S, Kodama M. A rare presentation of linea alba hernia involving fibrolipoma of the hepatic round ligament: a case report and literature review. Surg Case Rep 2023; 9:91. [PMID: 37247100 DOI: 10.1186/s40792-023-01676-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Linea alba hernias are relatively rare types of hernias. They manifest as small protrusions situated in the linea alba between the umbilicus and xiphoid cartilage. Usually, hernia contents comprise the pre-peritoneal fat, omentum, and gastrointestinal tract. However, very few cases of linea alba hernias involving the hepatic round ligament have been reported, to date. CASE PRESENTATION An 80-year-old woman presented with upper abdominal pain and a 1-week history of a mass in the upper midline. Abdominal computed tomography revealed adipose tissue protruding from the abdominal wall contiguous with the hepatic round ligament, suggesting a linea alba hernia. During surgery, the hernial sac content was found to be a mass, which was resected. A linea alba hernia defect measuring 20 mm was repaired using a mesh. Histopathological findings revealed that the mass included mature adipocyte proliferation with broad fibrous septa, which was diagnosed as fibrolipoma of the hepatic round ligament. CONCLUSIONS We report the first case of a linea alba hernia involving fibrolipoma of the hepatic round ligament worldwide and describe the clinical features, diagnosis, and surgical procedure with a literature review.
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Affiliation(s)
- Takahiko Omameuda
- Department of Surgery, Tochigi Medical Center Shimotsuga, Ohiramachi Kawazure 420-1, Tochigi, Tochigi, 329-4498, Japan.
| | - Mikio Shiozawa
- Department of Surgery, Tochigi Medical Center Shimotsuga, Ohiramachi Kawazure 420-1, Tochigi, Tochigi, 329-4498, Japan
| | - Yuzo Miyahara
- Department of Surgery, Tochigi Medical Center Shimotsuga, Ohiramachi Kawazure 420-1, Tochigi, Tochigi, 329-4498, Japan
| | - Hiroyuki Kitabayashi
- Department of Surgery, Tochigi Medical Center Shimotsuga, Ohiramachi Kawazure 420-1, Tochigi, Tochigi, 329-4498, Japan
| | - Masaru Koizumi
- Department of Surgery, Tochigi Medical Center Shimotsuga, Ohiramachi Kawazure 420-1, Tochigi, Tochigi, 329-4498, Japan
| | - Satoru Kondo
- Department of Surgery, Tochigi Medical Center Shimotsuga, Ohiramachi Kawazure 420-1, Tochigi, Tochigi, 329-4498, Japan
| | - Shigeo Kawai
- Department of Pathology, Tochigi Medical Center Shimotsuga, Ohiramachi Kawazure 420-1, Tochigi, Tochigi, 329-4498, Japan
| | - Masaaki Kodama
- Department of Surgery, Tochigi Medical Center Shimotsuga, Ohiramachi Kawazure 420-1, Tochigi, Tochigi, 329-4498, Japan
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13
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Yagnik VD, Dawka S, Garg P, Bhattacharya K. An incarcerated epigastric hernia containing stomach. Trop Doct 2023; 53:305-306. [PMID: 36744367 DOI: 10.1177/00494755231154301] [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] [Indexed: 02/07/2023]
Abstract
Most epigastric hernia contains preperitoneal fat or the omentum. Intraabdominal organ herniation is rare and, if present, contains mostly small bowel. Incarcerated epigastric hernia having the stomach as content is infrequent, and only one case has been reported in the literature so far. Herein, we report a rare case of incarcerated epigastric hernia that contains the stomach and was managed with emergency hernioplasty.
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Affiliation(s)
- Vipul D Yagnik
- Director and Consultant Surgeon, Surgical Gastroenterology, Director and Consultant Surgical Gastroenterologist, 552925Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India
| | - Sushil Dawka
- Professor of Surgery, Department of Surgery, SSR Medical College, Belle Rive, Mauritius
| | - Pankaj Garg
- Chief Colorectal Surgeon, Colorectal Surgery, Garg Fistula Research Institute (GFRI), Panchkula, Haryana, India
| | - Kaushik Bhattacharya
- Consultant Surgeon, Department of Surgery, CAPFs Composite Hospital BSF Kadamtala, Siliguri, West Bengal, India
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14
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Tinawi GK, Stringer MD. Epigastric Hernias in Children: A Personal Series and Systematic Review of the Literature. Eur J Pediatr Surg 2022; 32:139-145. [PMID: 33171519 DOI: 10.1055/s-0040-1719056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Epigastric hernias are relatively uncommon in children, and there is a paucity of literature on their incidence, presenting features, natural history, and surgical outcomes. A systematic review was conducted according to PRISMA guidelines. Articles describing the incidence, outcome, and interventions for pediatric epigastric hernias, both open and laparoscopic, were analyzed. Eight relevant articles published between 1975 and 2019 were included in the analysis. Of 81 children, 58% were females, 35% were symptomatic and 8% were multiple. All hernias contained preperitoneal fat only and were repaired using standard open surgery or laparoscopic techniques. No recurrences were recorded. In a personal series of 37 hernias in 36 children of median age 4 years, there were no recurrences; however, this series included two children with a recurrent or persistent epigastric hernia after surgery by others. Epigastric hernias in children are relatively uncommon. They typically contain only preperitoneal fat but more than a third are symptomatic. Standard open repair can be undertaken with minimal morbidity. Laparoscopic repair takes longer and provides a marginal cosmetic benefit.
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Affiliation(s)
- Georges K Tinawi
- Department of Paediatric Surgery, Wellington Children's Hospital, Wellington, New Zealand
| | - Mark D Stringer
- Department of Paediatric Surgery, Wellington Children's Hospital, Wellington, New Zealand
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15
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Das S, Shaikh O, Gaur NK, Balasubramanian G. Incarcerated Epigastric Hernia. Cureus 2022; 14:e22013. [PMID: 35340498 PMCID: PMC8913434 DOI: 10.7759/cureus.22013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/21/2022] Open
Abstract
An epigastric hernia is a form of ventral hernia. Most of these contain preperitoneal fat or the omentum. Herniation of intra-abdominal organs, a rare form of rectus sheath midline herniations, is seldom seen, and incarcerations in these cases are rare. A 56-year-old male presented with complaints of irreducible epigastric swelling. Thorough clinical examination and imaging studies revealed that the patient had an epigastric hernia. An intraoperative image showed that the small bowel had herniated through the epigastric defect and was obstructed; however, the small bowel was viable. The contents were reduced after enlarging the constricting ring, and anatomical repair with mesh reinforcement was done. Postoperatively, the patient had an uneventful recovery and was discharged.
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Takada S, Ueno Y, Higashi Y, Nishijima K, Futagami F. Laparoscopic repair for primary epigastric hernia containing falciform ligament: A case report and review of literature. Asian J Endosc Surg 2022; 15:188-191. [PMID: 34142766 DOI: 10.1111/ases.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/31/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
Falciform ligament herniation is a rare type of epigastric hernia. We report a case of a primary epigastric hernia containing a falciform ligament repaired using nonabsorbable barbed suture under laparoscopic surgery. A 74-year-old woman presented with discomfort in the upper abdomen. Physical examination revealed a 3-cm non-tender mass, and abdominal computed tomography revealed epigastric hernia with an incarcerated falciform ligament. By observation with a laparoscope, the fascial defect was single and 1.0 cm in diameter, thus sutured repair was selected. At 4 months follow-up, she had no complications or recurrence. The laparoscopic approach is useful for diagnosis and deciding a repair method of an epigastric hernia. The barbed suture closure system is convenient and effective for intracorporeal hernial defect closing. Both primary and incisional falciform ligament herniation have been reported in the past, and we reviewed six cases, including our case.
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Affiliation(s)
- Satoshi Takada
- Department of Surgery, Japanese Red Cross Kanazawa Hospital, Kanazawa, Japan
| | - Yuhei Ueno
- Department of Surgery, Japanese Red Cross Kanazawa Hospital, Kanazawa, Japan
| | - Yuki Higashi
- Department of Surgery, Japanese Red Cross Kanazawa Hospital, Kanazawa, Japan
| | - Koji Nishijima
- Department of Surgery, Japanese Red Cross Kanazawa Hospital, Kanazawa, Japan
| | - Fumio Futagami
- Department of Surgery, Japanese Red Cross Kanazawa Hospital, Kanazawa, Japan
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What is the reality in epigastric hernia repair?-a trend analysis from the Herniamed Registry. Hernia 2021; 25:1083-1094. [PMID: 33837884 DOI: 10.1007/s10029-021-02408-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The proportion of epigastric hernias in the total collective of all operated abdominal wall hernias is 3.6-6.9%. The recently published guidelines for treatment of epigastric hernias of the European Hernia Society and the Americas Hernia Society recommend the use of a mesh for defect size of ≥ 1 cm, i.e., a preperitoneal flat mesh technique for sizes 1-4 cm, and laparoscopic IPOM technique for defects > 4 cm and/or obesity. Against that background, this analysis of data from the Herniamed Registry now aims to explore trends in epigastric hernia repair. METHODS To detect trends, the perioperative outcome was calculated separately for the years 2010 to 2019 and the 1-year follow-up for the years 2010 to 2018 and significant differences were identified. Analysis was based on 25,518 primary elective epigastric hernia repairs. The rates of postoperative surgical complications, pain at rest, pain on exertion, chronic pain requiring treatment and recurrence associated with the various surgical techniques were calculated separately for each year. Fisher's exact test for unadjusted analysis between years was applied with Bonferroni adjustment for multiple testing. RESULTS The proportion of laparoscopic IPOM repairs declined from 26.0% in 2013 to 18.2% in 2019 (p < 0.001). Instead, the proportion of open sublay repairs rose from 16.5% to 21.8% (p < 0.001). That was also true for innovative techniques such as the EMILOS, MILOS, eTEP and preperitoneal flat mesh technique (8.3% vs 15.3%; p < 0.001). This change in indication for the various surgical techniques led to a significant improvement in the postoperative surgical complication rate (3.8% vs 1.9%; p < 0.001). CONCLUSION The trend is for epigastric hernia repair to be performed less often in laparoscopic IPOM technique and instead more often in open sublay technique or the new innovative techniques.
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Vemulakonda SHP, Dutta S, Jain A, Reddy A, Nelamangala Ramakrishnaiah VP. Strangulated Epigastric Hernia: A Rare Occurrence. Cureus 2021; 13:e14038. [PMID: 33898124 PMCID: PMC8059479 DOI: 10.7759/cureus.14038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
An epigastric hernia is a rare type of abdominal hernia, described in the literature mostly as small, containing only preperitoneal fat. A large true epigastric hernia with herniation of the abdominal viscera is even rarer. Only a few case reports have given an account of strangulation in such an epigastric hernia. This case report describes a middle-aged, morbidly obese man with a big epigastric hernia presenting with incarceration and acute abdominal pain. Emergency surgical exploration revealed a 7 cm midline defect in the rectus sheath and a 30 cm segment of the jejunum and a 6 cm segment of the transverse colon were gangrenous. The gangrenous bowel segments were resected, and an end-to-end jejuno-jejunal and colo-colic anastomosis were done. The patient had an uneventful postoperative recovery.
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Affiliation(s)
| | - Souradeep Dutta
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ankit Jain
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Abhinaya Reddy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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19
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Open versus laparoscopic umbilical and epigastric hernia repair: nationwide data on short- and long-term outcomes. Surg Endosc 2021; 36:526-532. [PMID: 33528663 DOI: 10.1007/s00464-021-08312-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/09/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND It is unclear whether an open or laparoscopic approach results in the best outcomes for repair of umbilical and epigastric hernias. The aim of the study was to evaluate the rates of 90-day readmission and reoperation for complication, together with rate of operation for recurrence after either open or laparoscopic mesh repair for primary umbilical or epigastric hernias with defect widths above 1 cm. METHODS A merge of data between the Danish Hernia Database and the National Patient Registry provided data from 2007 to 2018 on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence. RESULTS A total of 6855 patients were included, of whom 4106 (59.9%) and 2749 (40.1%) patients had an open or laparoscopic repair, respectively. There were significantly more patients readmitted with a superficial surgical site infection 2.5% (102/4106) after open repair compared with laparoscopic repair (0.5% (15/2749), P < 0.001. The 90-day reoperation rate for complications was significantly higher for open repairs 5.0% (205/4106) compared with laparoscopic repairs 2.7% (75/2749), P < 0.001. The incidence of a reoperation for a severe condition was significantly increased after laparoscopic repair 1.5% (41/2749) compared with open repair 0.8% (34/4106), P = 0.010. The 4-year cumulative incidence of operation for hernia recurrence was 3.5% after open and 4.2% after laparoscopic repairs, P = 0.302. CONCLUSIONS Recurrence rates were comparable between open and laparoscopic repair of umbilical and epigastric hernias. Open repair was associated with a significantly higher rate of readmission and reoperation due to surgical site infection, whereas the rate of reoperation due to a severe complication was significantly higher after laparoscopic repair.
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20
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Liang TJ, Wang KC, Tsai CC, Chen IS. Laparoscopic preperitoneal repair for primary falciform ligament herniation. Ann R Coll Surg Engl 2020; 102:e102-e104. [PMID: 32159370 DOI: 10.1308/rcsann.2020.0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Epigastric hernia involving the falciform ligament is exceptionally rare. Most reported cases are incisional hernia secondary to prior abdominal surgery. We report a case of primary falciform ligament herniation into the epigastric region repaired by the laparoscopic preperitoneal approach. In this case, an accompanying vessel along the herniated falciform ligament was identified. This finding provides a basis for the hypothesis of a perforating vessel piercing the linea alba and thereby creating a weak point for hernia protrusion (Moschowitz theory). The patient had an uneventful recovery and was discharged home on the postoperative day two. A laparoscopic preperitoneal approach is feasible for the repair of primary falciform ligament herniation. The magnified endoscopic view enables surgeons to achieve definite repair without missing occult defects.
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Affiliation(s)
- T J Liang
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - K C Wang
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - C C Tsai
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - I S Chen
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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21
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Epigastric hernia as a rare manifestation of a bile duct cyst and gallbladder cancer: A first case report. Int J Surg Case Rep 2020; 68:145-147. [PMID: 32145567 PMCID: PMC7058844 DOI: 10.1016/j.ijscr.2020.02.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/23/2020] [Accepted: 02/26/2020] [Indexed: 12/12/2022] Open
Abstract
Gallbladder cancer is asymptomatic in the early stages, but when symptoms are present, they are similar to biliary colic or chronic cholecystitis. Epigastric hernia is usually asymptomatic too, with localized pain being the main symptom when present. Abdominal ultrasound showed a giant cyst and cholelithiasis. The presence of a bile duct cyst within a hernia is a very rare finding, especially making the diagnosis through an epigastric hernia.
Introduction Elective repair epigastric hernia is a frequent minor surgical procedure. In most cases the hernial content is pre-peritoneal fat. Presentation of case We report the case of a patient with epigastric hernia containing part of a bile duct cyst. Discussion Bile duct cysts are often asymptomatic, but when symptoms are present they may include intermittent, recurrent epigastric or right hypochondrial pain; abdominal tenderness; fever and mild jaundice. Conclusion The presence of a bile duct cyst within a hernia is a very rare finding, especially making the diagnosis through an epigastric hernia. This case report is the first of a bile duct cyst within an epigastric hernia.
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22
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Primary non-complicated midline ventral hernia: is laparoscopic IPOM still a reasonable approach? Hernia 2019; 23:915-925. [PMID: 31456098 DOI: 10.1007/s10029-019-02031-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/07/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE Ventral hernia repair has become a common procedure, but the way in which it is performed still depends on surgeon's skill, experience, and habit. The initial open approach is faced with extensive dissection and a high risk of infection and prolonged hospital stay. To tackle these problems, minimally invasive procedures are gaining interest. Several new techniques are emerging, but laparoscopic intra-peritoneal onlay mesh (IPOM) is still the mainstay for many surgeons. We will discuss why laparoscopic IPOM is still a valuable approach in the treatment of primary non-complicated midline hernias and review the current literature. METHODS We performed a literature search across PubMed and MEDLINE using the following search terms: "Laparoscopic hernia repair", "Ventral hernia repair" and "Primary ventral hernia". Articles corresponding to these search terms were individually reviewed by the primary author and selected on relevance. CONCLUSION Laparoscopic IPOM still is a good approach for the efficient treatment of primary non-complicated midline hernias. Several techniques are emerging, but are faced with increased costs, technical difficulties, and low study patient volume. Further research is warranted to show superiority and applicability of these new techniques over laparoscopic IPOM, but until then laparoscopic IPOM should remain the go-to technique.
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23
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Moriwaki Y, Otani J, Okuda J, Maemoto R. Epigastric hernia contiguous with the laparoscopic port site after endoscopic robotic total prostatectomy. Asian J Endosc Surg 2018; 11:420-422. [PMID: 29573185 DOI: 10.1111/ases.12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/09/2018] [Accepted: 01/25/2018] [Indexed: 11/29/2022]
Abstract
Both laparoscopic and endoscopic robotic surgery are widely accepted for many abdominal surgeries. However, the port site for the laparoscope cannot be easily sutured without defect, particularly in the cranial end; this can result in a port-site incisional hernia and trigger the progressive thinning and stretching of the linea alba, leading to epigastric hernia. In the present case, we encountered an epigastric hernia contiguous with an incisional scar at the port site from a previous endoscopic robotic total prostatectomy. Abdominal ultrasound and CT revealed that the width of the linea alba was 30-48 mm. Previous CT images prepared before endoscopic robotic prostatectomy had shown a thinning of the linea alba. We should be aware of the possibility of epigastric hernia after laparoscopic and endoscopic robotic surgery. In laparoscopic and endoscopic robotic surgery for a high-risk patient for epigastric hernia, we should consider additional sutures cranial to the port-site incision to prevent of an epigastric hernia.
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Affiliation(s)
| | - Jun Otani
- Department of Surgery, Unnan City Hospital, Unnan, Japan
| | - Junzo Okuda
- Department of Surgery, Unnan City Hospital, Unnan, Japan
| | - Ryo Maemoto
- Department of Surgery, Unnan City Hospital, Unnan, Japan
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Jun Z, Na J, Zhen C, Xuan Y, Yan-Dong W, Shu-Li L, Long L. Single-incision laparoscopic approach for linea alba hernia in children. J Minim Access Surg 2018; 15:42-45. [PMID: 29483378 PMCID: PMC6293676 DOI: 10.4103/jmas.jmas_211_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: The aim of this study is to describe the technique and to evaluate the outcome of single-incision laparoscopic (SILC) approach for linea alba hernia in children. Materials and Methods: A 2 cm vertical umbilical incision was made and stretched horizontally. A 5-mm trocar was inserted through middle port for the telescope. Another extra-long 5-mm 30° trocar was inserted through the lateral port, 5 mm beside the middle port. The extraperitoneal fat was removed, and the defect of linea alba was repaired after hernial sac was excised. The peritoneum was reconstructed with interrupted suture. Results: From May 2014 to May 2015, eight children with linea alba hernia underwent SILC. Pre-operative abdominal ultrasound showed the average diameter of hernia ring was 3.2 ± 0.7 cm. Mean operation time was 32.5 min (range = 30–45 min). Oral intake was resumed during anaesthesia recovery period. All could endure pain and discharge on the post-operative 12 h. There was no post-operative wound infection. The follow-up period was 1–12 months, no recurrence and other complications occurred. Conclusions: SILC approach for linea alba hernia is a safe and effective, minimally invasive new technology. The linea alba hernia could be repaired with a cosmetic outcome.
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Affiliation(s)
- Zhang Jun
- Department of Pediatric Surgery, The Capital Institute of Pediatrics, Beijing, China
| | - Jia Na
- Department of Cardiology, Beijing Hospital, Beijing, China
| | - Chen Zhen
- Department of Pediatric Surgery, The Capital Institute of Pediatrics, Beijing, China
| | - Yang Xuan
- Department of Pediatric Surgery, The Capital Institute of Pediatrics, Beijing, China
| | - Wei Yan-Dong
- Department of Pediatric Surgery, The Capital Institute of Pediatrics, Beijing, China
| | - Liu Shu-Li
- Department of Pediatric Surgery, The Capital Institute of Pediatrics, Beijing, China
| | - Li Long
- Department of Pediatric Surgery, The Capital Institute of Pediatrics, Beijing, China
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25
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Yang HC, Kim SY, Kim SK, Oh CS, Chung IH, Nam KI. A cadaveric study on mylohyoid herniation of the sublingual gland. Eur Arch Otorhinolaryngol 2016; 273:4413-4416. [PMID: 27180250 DOI: 10.1007/s00405-016-4095-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/10/2016] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to document the presence of a sublingual gland (SLG) herniating inferiorly through the mylohyoid muscle into the submandibular area. A total of 100 half-heads of 50 adult Korean cadavers were enrolled in this study. The floor of the mouth was dissected from the neck, and mylohyoid muscle patency and position of the sublingual gland were evaluated. Demographic factors of the donor and characteristics of the herniation were evaluated. Herniation was found in 29 (58.0 %) of the 50 cadavers or 42 of the 100 half-heads. Herniation was more frequently observed in females than in males (p = 0.009). However, no laterality was observed. Classifying the location of SLG herniation from the midpoint of the mandible to the hyoid bone into 3 regions, 32 (63 %) of herniations were found in the anterior one-third. No ranula formation was observed. The size and weight of normal glands tended to be larger than those of herniated glands, but no statistical significance was observed. An SLG hernia is a very common condition and is more frequently observed in females. As such, SLG herniation should be considered when a submental neck mass is evaluated.
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Affiliation(s)
- Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Si Yoen Kim
- Research Institute of Medical Sciences, Chonnam National University, Gwangju, South Korea
| | - Sun Kyung Kim
- Research Institute of Medical Sciences, Chonnam National University, Gwangju, South Korea
| | - Chang Seok Oh
- Department of Anatomy, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - In Hyuk Chung
- Institute of Applied Anatomy, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Kwang Il Nam
- Department of Anatomy, Chonnam National University Medical School, Gwangju, 501-746, South Korea.
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Meyer R, Häge A, Zimmermann M, Bruch HP, Keck T, Hoffmann M, Schlöricke E. Is laparoscopic treatment of incisional and recurrent hernias associated with an increased risk for complications? Int J Surg 2015; 19:121-7. [PMID: 26038293 DOI: 10.1016/j.ijsu.2015.05.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/22/2015] [Accepted: 05/21/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hernias of the ventral abdominal wall can be treated with an intraperitoneal onlay mesh (IPOM). The aim of this cohort study was to analyze the complications and recurrence rates after laparoscopic ventral hernia repair focusing especially on incisional and recurrent hernias. METHODS The study population comprised 149 patients with a hernia of the abdominal wall, which was treated with an IPOM between January 2006 and January 2011. RESULTS Fifty-one patients had a primary hernia (group I) and 98 patients had preceding abdominal surgery (group II). In group II 64 patients had an incisional hernia and 34 patients had a recurrent hernia. The median body mass index was 30.3 kg/m(2) (14.8-69.1) without any significance in sub-group comparison. The mean duration of surgery and the length of stay were significantly longer in group II (p < 0.05). The overall rate of minor complications was 18.1%. There were significantly more minor complications in group II (7.8% vs. 23.5%, p = 0.02). Notably, there were also significantly more major complications in group II (14.3% vs. 2.0%; p = 0.02). The recurrence rate was significantly higher in group II (group I: 3.9% vs. group II: 16.3%, p < 0.05). There were no early recurrences in group I, but 5 early recurrences in group II. CONCLUSION Laparoscopic treatment of complex hernias as incisional hernias, recurrent hernias and hernias with interenteric and enteroperitoneal adhesions is associated with high rates of minor and major complications. A high level of expertise of the surgeon and the camera-guiding assistant is therefore needed.
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Affiliation(s)
- Rüdiger Meyer
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
| | - Anna Häge
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Markus Zimmermann
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Hans-Peter Bruch
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Martin Hoffmann
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Erik Schlöricke
- Department of General, Visceral, Thoracic and Vascular Surgery, Westküstenklinikum Heide, Esmarchstraße 50, D-25746 Heide, Germany
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Ponten JEH, Leenders BJM, Charbon JA, Nienhuijs SW. A consecutive series of 235 epigastric hernias. Hernia 2014; 19:821-5. [PMID: 24519807 DOI: 10.1007/s10029-014-1227-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 01/23/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Epigastric herniation is a common, though not always symptomatic condition. It is likely, that in accordance to the tension-free principles for other hernias, epigastric hernia repair should be mesh based. METHODS Patients from two large hospitals were investigated retrospectively if they were operated on an epigastric hernia for the past 6 years. Follow-up was completed with a postal questionnaire. RESULTS A total of 235 patients (50 % male) were operated. Sixty-eight patients were operated with mesh and 167 patients with suture repair. Forty-six patients were loss-to follow-up (19.6 %). In the mesh operated patients the recurrence rate was 10.9 % (n = 6) compared to 14.9 % (n = 20) in the suture repair group. Cox-regression analysis showed an increased risk for recurrence in the suture repair group (odds ratio 1.43; 95 % CI 0.56-3.57; p = 0.44). Operation time for mesh repair (47 min) was significantly longer compared to suture repair (29 min) (p < 0.0001). Thirty-seven patients had previous or other anterior wall hernias. A total of 51 patients smoked and 14 patients had diabetes mellitus. Fourteen patients used steroids and 22 patients suffered from a chronic lung disease. Subgroup analysis showed a significant difference for pain in patients in which re-operation for a recurrence occurred (p = 0.004). CONCLUSIONS This is one of the largest reported series on solely epigastric hernias. A recurrence occurred more often after sutured repair compared to mesh repair. No differences in chronic pain was seen between mesh and suture repaired patients. Male:female ratio of 1:1, which is different from the 3:1 ratio found in previous older smaller studies, could be more reliable.
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Affiliation(s)
- J E H Ponten
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - B J M Leenders
- Department of Surgery, Maxima Medical Center Veldhoven/Eindhoven, Eindhoven, The Netherlands
| | - J A Charbon
- Department of Surgery, Maxima Medical Center Veldhoven/Eindhoven, Eindhoven, The Netherlands
| | - S W Nienhuijs
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Ponten JEH, Thomassen I, Nienhuijs SW. A Collective Review on Mesh-Based Repair of Umbilical and Epigastric Hernias. Indian J Surg 2013; 76:371-7. [PMID: 26396470 DOI: 10.1007/s12262-013-0920-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 04/17/2013] [Indexed: 12/14/2022] Open
Abstract
In accordance with the tension-free principles for other hernias, umbilical and epigastric hernia repair should probably be mesh-based. The number of randomized studies is increasing, most of them showing significantly less recurrences with the use of a mesh. Different devices are available and are applicable by several approaches. The objective of this review was to evaluate recent literature for the different types of mesh for umbilical and epigastric hernia repair and recurrences after mesh repair. A multi-database search was conducted to reveal relevant studies since 2001 reporting mesh-based repair of primary umbilical/epigastric hernia and their outcomes in adult patients. A total of 20 studies were included, 15 of them solely involved umbilical hernias, whereas the remaining studies included epigastric hernias as well. A median of 124 patients (range, 17-384) was investigated per study. Three quarters of the included studies had a follow-up of at least 2 years. Six studies described the results of laparoscopic approach, of which one reported a recurrence rate of 2.7 %; in the remaining studies, no recurrences occurred. Two comparative studies reported a lower incidence of complications and postoperative pain after laparoscopic repair compared to open repair. Seventeen studies reported results of open techniques, of which seven studies showed no recurrence. Other studies reported recurrence rates up to 3.1 %. A wide range of complication rates were reported (0-33 %). This collective review showed acceptable recurrence rates for mesh-based umbilical and epigastric hernia repair. A wide range of devices was investigated. A tendency toward more complications after laparoscopic repair was found compared to open repair.
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Affiliation(s)
- Jeroen E H Ponten
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Irene Thomassen
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
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