Cases reported "Hernia, Ventral"

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11/97. Incisional hernia and fascial defect following laparoscopic surgery.

    Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, italy. Incisional hernia incidence is 1%. risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. malnutrition may have a major role in many cases. calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.
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ranking = 1
keywords = operative
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12/97. Congenital spigelian hernia and cryptorchidism: cause or coincidence?

    Congenital spigelian hernia (SH) is very rare in the pediatric age group. This is a report of two cases of SH in 1-week and 3-month-old male infants. A review of the literature revealed only 35 cases of SH in children younger than 17 years of age, bringing the total including our 2 cases to 37. There were 25 males and 12 females, a ratio of 2.1:1. Their ages ranged from 6 days to 17 years (mean 4.52 years). The hernia was situated on the right side in 13, the left side in 19, and was bilateral in 4. In one case the side of the hernia was not mentioned. In 29 cases the hernia was spontaneous while in 5 it was caused by trauma. In 3 children the hernia developed postoperatively, in 2 following repair of a congenital diaphragmatic hernia and in 1 following excision of a mediastinal neuroblastoma. Two children presented with a strangulated SH. Eleven of the 35 previously reported children had associated conditions; in 5 there was an ipsilateral undescended testis (UDT). Our two infants with SH also had an ipsilateral UDT. The significance of this association is discussed.
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ranking = 1
keywords = operative
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13/97. Recurrent ventral herniation in ehlers-danlos syndrome.

    ehlers-danlos syndrome is an inherited collagen disorder characterized by skin hyperextensibility, joint laxity, and tissue friability. In this study, it was hypothesized that ehlers-danlos syndrome is frequently undiagnosed in patients who present for repair of ventral abdominal wall hernias. A retrospective chart review was conducted, and patients who had presented for elective repair of recurrent abdominal wall herniation were identified. In all patients, one or more prior attempts at repair with either mesh or autologous tissues had failed. patients in whom abdominal wall components were lost secondary to extirpation or trauma, patients who had required acute closure, and patients with less than 2 months of follow-up were excluded. Twenty patients met these criteria. Twenty cases of recurrent ventral hernia repairs were reviewed, with special attention to identification of the preoperative diagnosis of ehlers-danlos syndrome. patients ranged in age from 29 to 75 years, with a mean age of 54 years. Five patients were male (25 percent), and 15 were female (75 percent). The majority (95 percent) were Caucasian. The most common initial procedures were gynecologic in origin (35 percent). A precise closure technique that minimizes recurrence after ventral hernia repairs was used. With use of this technique, there was only one recurrence over a follow-up period that ranged from 2 to 60 months (mean follow-up duration, 25.7 months). Two patients with ehlers-danlos syndrome were identified, and their cases are presented in this article. The "components separation" technique with primary component approximation and mesh overlay was used for defect closure in the two cases presented. The identification of these two patients suggests the possibility of underdiagnosis of ehlers-danlos syndrome among patients who undergo repeated ventral hernia repair and who have had previous adverse postoperative outcomes. There are no previous reports in the literature that address recurrent ventral abdominal herniation in patients with ehlers-danlos syndrome.
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ranking = 2
keywords = operative
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14/97. Small-bowel occlusion after operative laparoscopy: our experience and review of the literature.

    Bowel complications as a consequence of laparoscopic surgery are usually due to direct injuries; on the other hand, bowel occlusion is a rarely described event. We have retrospectively analyzed our data in this field. Out of 2652 laparoscopies performed between July 1996 and March 2000, three cases of small-bowel occlusion were observed. Two cases were due to bowel hernia through a 5-mm trocar port incision, the third was a consequence of an adhesion between the ileum and lost fragment of myoma. Two cases were treated laparoscopically, while in the third a laparotomy was required. At the time of writing, all the patients are well after a mean follow-up of 6 months. It appears important to also perform closure of the fascia and peritoneum after a 5-mm trocar port incision where there has been extensive manipulation.
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ranking = 4
keywords = operative
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15/97. Preperitoneal Richter hernia after a laparoscopic gastric bypass.

    Trocar-site incisional hernias are potentially dangerous because of their susceptibility to become Richter hernias. The authors describe a morbidly obese patient in whom developed an unusual type of Richter hernia after a laparoscopic isolated Roux-en-Y gastric bypass at a 10-mm trocar site. Although the fascial closure of the trocar hernia site was intact, a hernia developed through the peritoneum into the preperitoneal space. For morbidly obese patients, the thick preperitoneum is a potential space that allows for the development of a Richter hernia, despite adequate fascial closure. It is recommended that all 10-mm and 12-mm trocar sites be closed, incorporating the peritoneum into the fascial closure to obliterate the preperitoneal space, to prevent this postoperative complication.
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ranking = 1
keywords = operative
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16/97. Laparoscopic management of Spigelian hernia.

    Spigelian hernia (SH) is an uncommon abdominal wall hernia. Its clinical symptoms are not characteristic, and the preoperative diagnosis is often difficult because SH can simulate the symptoms of more classical lower quadrant abdominal diseases. We report a case of SH in an 80-year-old woman that was complicated by incarceration and diagnosed by physical examination and ultrasound. At the time of presentation, she had an abdominal mass that was soft and occasionally painful, and aggravated by movements that increase intraabdominal pressure. Laparoscopic examination of the abdominal cavity identified the incarcerate jejunum ansae. The defect was a large opening in the peritoneum along the lateral margin of the rectus abdominis muscle. After dissection of the intestinal adhesions, a prosthetic polypropylene mesh was introduced and fixed with staples into the lateral abdominal wall. There were no postoperative complications. We conclude that the laparoscopic approach is a feasible alternative to the conventional open technique that is easy, safe, and allows excellent operative visualization.
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ranking = 3
keywords = operative
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17/97. Restoration of abdominal wall integrity as a salvage procedure in difficult recurrent abdominal wall hernias using a method of wide myofascial release.

    The management of primary and recurrent giant incisional hernias remains a complex and frustrating challenge even with multiple alloplastic and autogenous closure options. The purpose of this study was to develop a reconstructive technique of restoring abdominal wall integrity to a subcategory of patients, who have failed initial hernia therapy, by performing superior and lateral myofascial release. Over a 1.5-year period, 10 patients with previously unsuccessful treatment of abdominal wall hernias, using either primary repair or placement of synthetic material, were studied. The patients had either recurrence of the hernia or complications such as infections requiring removal of synthetic material. The hernias were not able to be treated with standard primary closure techniques or synthetic material. The average defect size was 19 x 9 cm. Each patient underwent wide lysis of bowel adhesions releasing the posterior abdominal wall fascia to the posterior axillary line, subcutaneous release of the anterior abdominal wall fascia to a similar level, and complete removal of any synthetic material (if present). The abdominal domain was reestablished by releasing the laterally retracted abdominal wall. The amount of available abdominal wall tissue was increased by wide release of the cephalic abdominal wall fascia overlying the costal margin and the external oblique fascia and muscle laterally. If needed, partial thickness of the internal oblique muscle and its anterior fascia were also released laterally to perform a tension-free primary closure of the defect. All repairs were closed with satisfactory functional and aesthetic results. All alloplastic material was removed. Fascial release was limited so as to close only the hernia defect without tension. No significant release of the rectus sheath and muscle was needed. Good, dynamic muscle function was noted postoperatively. All repairs have remained intact, and no further abdominal wall hernias have been noted on follow-up.
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ranking = 1
keywords = operative
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18/97. Incarcerated hernia in a 5-mm cannula wound.

    Laparoscopic suturing and repairing of the fascial opening at 10- to 12-mm cannula puncture sites is well established; however, closing a 5-mm cannula wound is not well documented. We often leave the wound open without suture and cover it with gauze after removing the surgical drainage tube. An unusual early postoperative complication of laparoscopic surgery was an incarcerated hernia in a 5-mm cannula site. The 9-year-old girl underwent laparoscopic surgery due to an 8-cm ovarian mature teratoma. After 7 days, she came to our hospital because of a protruding mass in the left cannula wound. The mass was excised, and incarcerated fallopian tube torsion with necrotic change was diagnosed.
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ranking = 1
keywords = operative
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19/97. Transperitoneal preperitoneal laparoscopic lumbar incisional herniorrhaphy.

    PURPOSE: Flank incisions may be associated with flank hernias, which may be complicated by incarceration and strangulation. Furthermore, they may be the cause of significant patient dissatisfaction with the surgical outcome. To avoid an open surgical procedure with its associated morbidity for hernia repair we describe a novel laparoscopic technique for repairing flank hernias with minimal morbidity and an excellent outcome. MATERIALS AND methods: Three cases of flank hernia were managed by the transperitoneal preperitoneal laparoscopic approach using polypropylene mesh to repair the fascial defect. An initial transperitoneal approach helps to identify the limits of the hernia. A 2 to 3 cm. margin of overlying peritoneum is incised around the hernia margin. It is important not to dissect overlying bowel. The mesh is placed behind the peritoneal envelope and secured with hernia staples. RESULTS: All cases were managed successfully via laparoscopy. There were no intraoperative or postoperative complications. At a mean followup of 12 months cosmesis has been excellent and there have been no recurrences. CONCLUSIONS: We describe a minimally invasive, versatile technique for laparoscopic repair of flank incisional hernias with excellent functional and cosmetic results. This approach avoids the significant morbidity associated with open repair of incisional flank hernias.
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ranking = 2
keywords = operative
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20/97. A minimally invasive approach for treating postoperative seromas after incisional hernia repair.

    BACKGROUND: The most frequent wound complication following repair of large incisional hernias is seroma formation, especially when the use of a mesh onlay requires extensive subcutaneous undermining. Treatment options for postoperative seromas include observation for spontaneous resolution, percutaneous aspiration, closed suction drainage, abdominal binders, and sclerosant. methods: A novel technique for treating persistent postoperative seromas is presented herein. This technique involves a 3-puncture minimally invasive approach that can be performed in an outpatient setting. Evacuation of serous fluid and fibrinous debris is followed by argon beam scarification of the seroma cavity lining. talc slurry is then introduced into the cavity. Three patients have been treated with this technique. RESULTS: All 3 patients had successful ablation of seromas that had persisted despite standard treatment modalities. CONCLUSION: A minimally invasive approach is a reasonable and safe alternative for treating persistent postoperative seromas.
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ranking = 7
keywords = operative
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