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Inguinal hernia, hydrocele, and other hernias of the abdominal wall
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Sophia Abdulhai, Todd A. Ponsky
Testicular atrophy has been observed after repair of incarcerated hernias and in instances of large, acute tense hydroceles in young infants, but this is very rare after a typical hernia repair. There continues to be debate on the pros and cons of open versus laparoscopic inguinal hernia repair, as well as to the superiority of which method of laparoscopic repair. Several studies, including a prospective randomized controlled study, suggest that laparoscopic repair is associated with less pain, faster recovery, and improved cosmesis; in addition, laparoscopic hernioplasty allows detection and concomitant repair of contralateral hernia. With technical refinements of laparoscopic hernioplasty, the recurrence rate, which was high in some early series, is no longer a concern. While data on the long-term outcome of laparoscopic hernioplasty remain scarce, we have observed satisfactory results on patients with laparoscopic repair with more than 10 years’ follow up.
Rives-Stoppa Repair and Peritoneal Flap Hernioplasty
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
The peritoneal flap repair, grouped along with other ‘sandwich’ techniques, was among the most reliable of repairs in the review of techniques published in 2015.9 A series of 21 cases was published in 2014 with only one recurrence and very little morbidity23 while a more recent series from the same centre, involving over 200 cases and incorporating both midline and transverse incisions with 5 years’ follow-up,24 describes a recurrence rate of 3.5%, but recurrence was self-reported so may in fact be higher. Two small series of this technique also appear in the non-English literature with excellent results.25,26 For surgeons familiar with it, the peritoneal flap hernioplasty remains the default repair for ventral and incisional hernias in which primary fascial closure is unlikely to be achieved – that is, defects from greater than 8 cm in width. For hernia defects wider than this even peritoneal flap enthusiasts would concede that further adjunctive techniques might be required, such as Botox, components separation, and/or concomitant resection of bowel or omentum; such cases are challenging regardless of the procedure used.
Parastomal Hernias
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Arun Prasad, Sanjiv Haribhakti
There are a few case reports and video vignettes of parastomal hernioplasty done by the robotic assistance. Both the Sugarbaker type and retrorectus repair with or without transverses abdomonis release (TAR) have been described. A novel retrorectus Sugarbaker type of repair has also been performed (personal communication – Eric Pauli and Arun Prasad).
Robotic versus hybrid assisted ventral hernia repair: a prospective one-year comparative study of clinical outcomes
Published in Acta Chirurgica Belgica, 2023
Pirjo Käkelä, Kirsi Mustonen, Tuomo Rantanen, Hannu Paajanen
The main finding was that the rVHR group reported less pain at 1-month and at 1-year after the operation compared to the hybrid group. At the 1-month control visit, we found a significant difference in VAS. The mean pain scores were lower in the rVHR group (0.3) than in the hybrid group (2.5, p < 0.001, difference OD = −2.196, 95% CI −3.404 to −0.989). At the 1-year control, VAS was 0.1 vs 2.8 (p = 0.023, difference OD= −2.667, 95% CI −4.907 to −0.426) in the rVHR group vs the hybrid group, respectively (Table 2). The clinical outcome at the 1-year follow-up is shown in Table 2. There was one seroma formation, mesh bulging (p = 0.331, difference OD = −0.100, 95% CI −0.310 to 0.110) and hernia recurrence (p = 0.331, difference OD= −0.100, 95% CI −0.310 to 0.110) in the hybrid group, which did not give a statistically significant difference. All of these outcomes were in the same patient. Re-hernioplasty was performed because of the pain. The QoL questionnaires were gathered at two points: preoperatively, and 1-year after the operation. Subjective improvement in overall patient satisfaction was reported equally in both groups (Table 2). All nine SF-36 scale scores favoured the rVHR, but without statistical significance. However, emotional status (p = 0.049, difference OD = −40.0, 95% CI −79.68 to −0.32) and social functioning (p = 0.039, difference OD= 18.75, 95% CI 1.16 to 36.34) improved significantly in the rVHR group (Table 3).
Two surgeons’ collaboration to close an extreme open abdomen with loss of domain utilizing the abdominal dynamic tissue system and porcine urinary bladder matrix
Published in Baylor University Medical Center Proceedings, 2022
Christina Zhu, Ferris Zeitouni, Hannah Daniel, Theophilus Pham, Shirley McReynolds, Yana Puckett, Philip Hamby, Catherine A. Ronaghan
The local surgeon without DTS experience contacted the DTS-experienced surgeon, who drove over 350 miles for consultation to prevent further harm to the patient while being transferred. Botox was administered 48 hours before installation on postoperative day 42. Initial measurements included a myofascial gap of 30 cm, visceral extrusion of 13 cm, and incision length of 32 cm (Figure 2a). Elastomers were adjusted 14 days later. Bilateral osteopathic maneuvers were performed at bedside three times daily to relax the flat muscles and facilitate PMC. After 31 days, DTS was deinstalled, and PMC was achieved (Figure 2b). Nine days after deinstallation, an onlay hernioplasty utilizing PUBM with complete wound closure was performed (Figure 2b). The patient was discharged 6 weeks later and returned to all activities of daily life. At 12-month follow-up, she had no clinical or radiographic evidence of an incisional hernia.
Parastomal hernia after ileal conduit urinary diversion: re-visiting the predictors radiologically and according to patient-reported outcome measures
Published in Scandinavian Journal of Urology, 2020
Ahmed M. Harraz, Ahmed Elkarta, Mohamed H. Zahran, Amr A. Elsawy, Mohamed A. Elbaset, Ali Elsorougy, Yasser Osman, Ahmed Mosbah, Hassan Abol-Enein, Atallah A. Shaaban
A total of 346 patients attended their scheduled follow-up visits during the specified period and were evaluated according to the predetermined protocol. The median (IQR) follow-up was 77 (38–118) months. CT scan identified 138 (39.9%) patients with radiological evidence of PSH. The majority of PSH was grade I in 59 (42.8%) patients, while grades II, III, and IV occurred in 20 (14.5%), 44 (31.9%), and 15 (10.9%) patients, respectively. The mean ± SD defect size in cm was 5 ± 1.6 cm while the mean ± SD maximal length of the sac was 11 ± 4.4 cm and the maximal width was 5 ± 1.2 cm. On diagnosis, a conservative approach, using an abdominal binder, was adopted in 28 (20.3%) patients as they were asymptomatic and well-functioning. In another 28 (20.3%) patients, the intervention was denied. In 60 (43.5%) patients the procedure was not performed because of the presence of co-morbidities. The repair was scheduled in 22 (15.9%) patients among which 14 (10.1%) patients underwent hernioplasty. Table 1 demonstrates the characteristics of patients with PSH at the time of evaluation. The cumulative impact of the time elapsed since radical cystectomy is demonstrated in Figure 2. The cumulative incidence was gradually increasing until approximately 100 months when it showed a less steep rise thereafter.