Cases reported "Hernia, Ventral"

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1/21. Endoscopically assisted "components separation" for closure of abdominal wall defects.

    The repair of ventral hernia defects of the abdominal wall challenges both general and plastic surgeons. Ventral herniation is a postoperative complication in 10 percent of abdominal surgeries; the repair of such defects has a recurrence rate as high as 50 percent. The "components separation" technique has successfully decreased the recurrence rates of ventral abdominal hernias. However, this technique has been associated with midline dehiscence and a prolonged postoperative stay at the authors' institutions. The purpose of this study was to determine whether endoscopically assisted components separation could minimize operative damage to the vasculature of the abdominal wall and decrease postoperative wound dehiscence. The study group consisted of seven patients who underwent endoscopically assisted components separation; the control group consisted of 30 patients who underwent open components separation. The two groups were similar regarding demographic data and defect size. The endoscopic group had a higher initial success rate than the open group (100 versus 77 percent). recurrence rates were not significantly different between the two groups. However, the endoscopically assisted components separation patients had fewer postoperative and long-term complications. In the authors' experience, endoscopically assisted components separation has proved to be a safe and effective method for the repair of complicated and recurrent midline ventral hernias.
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ranking = 1
keywords = wound
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2/21. 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 = 7
keywords = wound
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3/21. 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 = 1
keywords = wound
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4/21. Laparoscopic repair of incisional hernia.

    A 75-year-old man developed an incisional hernia over the upper abdomen following a wedge resection of a gastric stromal tumour in 1996. This is the first published report of a successful repair of an incisional hernia via a laparoscopic intraperitoneal on-lay technique using GORE-TEX DualMesh material in hong kong. Compared with conventional open repair of incisional hernia, long incisions and wound tension are avoided using the laparoscopic approach. This translates into a reduced risk of wound-related complications and facilitates recovery. In selected cases, minimally invasive surgery is a safe technique for the repair of incisional hernias.
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ranking = 2
keywords = wound
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5/21. review of wound healing with reference to an unrepairable abdominal hernia.

    A 58-year-old man has been under our care with an inguinal hernia that has recurred 8 times. This stimulated us to review the biochemistry of wound repair. We studied the composition of his collagen and tried to find out whether it was intrinsically faulty or whether its fault had been caused by the medication he was taken.
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ranking = 5
keywords = wound
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6/21. Successful salvage of infected PTFE mesh after ventral hernia repair.

    Rates of hernia recurrence following repair of abdominal wall hernia defects have been shown to be lower when prosthetic biomaterials are used, but their presence may be associated with a higher rate of infectious complications. Traditional surgical teaching has advocated removal of contaminated or exposed prosthetics, although the morbidity of these revisions is high. The case presented involves a ventral hernia repair complicated by methicillin-resistant staphylococcus aureus infection and exposed polytetrafluoroethylene mesh. The open abdominal wound was successfully managed with a combination of intravenous antibiotics, local wound debridement, vacuum-assisted closure, and soft tissue coverage of the mesh. Eighteen months following surgical closure of the wound, no hernia recurrence or infection was evident.
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ranking = 3
keywords = wound
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7/21. Management of traumatic abdominal wall hernia.

    Traumatic abdominal wall hernia (TAWH) can occur after blunt trauma and can be classified into low- or high-energy injuries. Low energy injuries occur after impact on a small blunt object. High-energy injuries are sustained during motor vehicle accidents or automobile versus pedestrian accidents. We present six cases of high-energy TAWH cases that were treated at our trauma center. All patients presented with varying degrees of abdominal tenderness with either abdominal skin ecchymosis or abrasions, which made physical examination difficult. CT scan confirmed the hernia in each patient. All six patients had associated injuries that required open repair. The abdominal wall defects were repaired primarily. Three patients (50%) in our series developed a postoperative wound infection or abscess. review of the literature on low-energy TAWH shows no associated abdominal injuries. In conclusion distinction between low- and high-energy injury is imperative in the management of TAWH. Hernias following low-energy injuries can be repaired after local exploration through an incision overlying the defect. TAWHs following high-energy trauma should undergo exploratory laparotomy through a midline incision. The defect should be repaired primarily and prosthetics avoided because of the high incidence of postoperative infection.
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ranking = 25.433772269342
keywords = wound infection, wound
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8/21. A laparoscopic approach to the surgical management of enterocutaneous fistula in a wound healing by secondary intention.

    Traditional surgical management of a chronic enterocutaneous fistula requires laparotomy, but the optimal site of incision is unclear. laparoscopy and adhesiolysis may offer an alternative approach. Two cases of non-healing enterocutaneous fistula within chronic, granulating wounds are described. The laparoscope was placed subcostally using the Hasson technique with additional ports placed under direct vision. After clearing the anterior abdominal wall of all but the fistula-containing bowel, an incision was made circumferentially around the granulation bed. Resection and primary anastomosis was performed in standard fashion. Lateral component separation allowed primary wound closure. Both patients were discharged without sequelae and doing well at last follow-up (mean 12 months). A laparoscopic approach to non-healing enterocutaneous fistulas seems safe and technically feasible. When combined with lateral component separation, it may result in reduction of inadvertent enterotomies and optimal management of the wound without the use of prosthetic mesh.
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ranking = 7
keywords = wound
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9/21. Laparoscopic-assisted primary repair of a complicated ventral incisional hernia.

    Postoperative wound dehiscence is a difficult problem for the general surgeon. Often, patients are too sick, or the wound environment is too hostile, to undergo primary repair. When an eventual repair is performed, a variety of methods are available, but most are associated with unacceptably high morbidity rates, specifically high incidences of recurrences and poor cosmetic outcome. We present here a case of postoperative wound dehiscence following a colostomy takedown repaired in a previously undescribed way--a laparoscopically assisted ventral incisional hernia repair. The method of repair is described, and the current literature regarding alternatives is reviewed.
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ranking = 3
keywords = wound
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10/21. Acellular dermal matrix (AlloDerm): new material in the repair of stoma site hernias.

    Parastomal hernias are a common complication after ileostomy or colostomy formation and can lead to complications, such as intestinal obstruction and strangulation. When a parastomal hernia presents, repair of the defect can pose a challenge to the surgeon to choose a repair that both reduces complications and recurrence rates. We present three cases of parastomal hernia repair using acellular dermal matrix (AlloDerm) as reinforcement to the primary hernia repair. We prospectively followed three patients who presented with parastomal hernia after ostomy formation in 2001-2002. The patients underwent repair of the parastomal hernia using primary fascial repair with reinforcement using AlloDerm as an on-lay patch. Two patients were followed for 6 months and 1 year, respectively, and remained hernia-free. One patient presented 8 months later with symptoms of intestinal obstruction that were relieved by nasogastric tube decompression and bowel rest. The patient subsequently returned 3 months later with intestinal obstruction and recurrent parastomal hernia that necessitated an operation for relocation of the stoma and repeat hernia repair. Repair of parastomal hernias using AlloDerm acellular dermal matrix as a substitute for a synthetic graft showed resilience to infection and, more importantly, tolerated exposure in an open wound without having to be removed. Larger studies with longer follow-up are needed to see if this material reduces the incidence of hernia recurrence.
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ranking = 1
keywords = wound
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