Patient Evaluation
Laurence R. Sands, Dana R. Sands in Ambulatory Colorectal Surgery, 2008
Over the past few decades, there have been vast changes in the practice of surgery. Sutures and sewing have been ever increasingly replaced by stapling devices. Generous incisions are being replaced by small port sites. These advances have also been accompanied by cost-reducing measures. Elective inguinal hernia repair is no longer a three day hospital stay, but rather a three hour experience. During this time period, the concept of ambulatory surgery, surgery not requiring in-patient hospitalization, has become a reality. This includes patients who undergo surgery where they are admitted a few hours prior to surgery and discharged a few hours after surgery, or patients who are admitted for a 23-hour stay. The field of colorectal surgery, especially anorectal surgery, has accepted and welcomed this change.
SBA Answers and Explanations
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury in SBAs for the MRCS Part A, 2018
In the case of the plumber, he has an inguinal hernia. An inguinal hernia is a protrusion of abdominal cavity contents through the inguinal canal. A direct inguinal hernia enters through a weak point in the fascia of the abdominal wall, and its sac is noted to be medial to the inferior epigastric vessels. Direct inguinal hernias are more common in males (10x). These hernias protrude through a weakened area in the transversalis fascia within the inguinal or Hesselbach’s triangle. They are capable of protruding through the superficial inguinal ring and are not able to extend into the scrotum. Direct hernias tend to occur in the middle-aged and elderly. Additional risk factors include chronic constipation, overweight/obesity, chronic cough, and heavy lifting.
Abdominal wall, hernia and umbilicus
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Many structures pass into and out of the abdominal cavity creating weakness which can lead to hernia formation. The most common example is the inguinal canal in males, along which the testis descends from abdomen to scrotum at the time of birth. The testicular artery, veins and vas pass though this canal (the round ligament in females). The resultant weakness leads to an indirect or lateral-type inguinal hernia. In adult surgery, 80% of all hernia repairs are for inguinal hernia. The evolutionary advantage of testicular descent must outweigh the disadvantage of a high risk of herniation. Other examples are: oesophagus → hiatus hernia, femoral vessels → femoral hernia, obturator nerve → obturator hernia, sciatic nerve → sciatic hernia.
Long-standing groin pain in an elite athlete: usefulness of ultrasound in differential diagnosis and patient education – a case report
Published in European Journal of Physiotherapy, 2018
Kingsley S. R. Dhinakar, Anjanette Cantoria Lacaste
There are four defined clinical entities for groin pain described in Doha agreement. Adductor-related groin pain presents with adductor tenderness and pain on resisted adduction testing. Iliopsoas tenderness, pain on resisted hip flexion and/or pain on stretching the hip flexors are noted in iliopsoas-related groin pain. Inguinal-related groin pain presents with pain and tenderness in the inguinal canal, aggravated by resistance testing of abdominal muscles or on valsalva/cough/sneeze and with no palpable inguinal hernia. Tenderness of the pubic symphysis and adjacent bone with no particular resistance or provocation test are associated with pubic-related groin pain. Although DOHA agreement has defined clinical entities for groin pain, the exact physical examination was not being discussed and more than one clinical entity can be presented and instrumental diagnosis is not mandatory. Instrumental diagnosis can be often helpful as differential diagnosis needs multifactorial cause elimination. In addition, exploring the role of imaging in the prediction of treatment response or prognosis in those with groin pain is encouraged during the Doha agreement [5]. This information will enable better understanding of the clinical relevance and aid in diagnosis. There is consensus in the literature that groin pain and conjoint tendon laxity or loading variation are effectively diagnosed using ultrasound examination [13,14].
Genetic Analysis Reveals Complete Androgen Insensitivity Syndrome in Female Children Surgically Treated for Inguinal Hernia
Published in Journal of Investigative Surgery, 2021
Nurin A. Listyasari, Gorjana Robevska, Ardy Santosa, Aurore Bouty, AZ Juniarto, Jocelyn van den Bergen, Katie L. Ayers, Andrew H. Sinclair, Sultana MH Faradz
In summary, an inguinal hernia during childhood can be a clear early sign of CAIS. In cases of inguinal hernia, we urge clinicians to carry out appropriate examination to establish the definitive diagnosis and guide comprehensive management. In Indonesia, especially in rural areas, a karyotype should be requested as a first-tier test [23]. A thorough medical history, a cautious physical examination to discover the location and structure of the gonads should be considered. In addition, imaging to evaluate the hernia sac and other internal structures, hormonal assays, immunohistochemistry testing, cytogenetic analysis, and molecular studies such as SRY and AR gene sequencing are all suggested to establish a definitive diagnosis [1]. This comprehensive diagnostic procedure for CAIS in patients presenting with inguinal hernia will reduce mis-diagnosis and when combined with increased awareness among medical professionals, will ultimately lead to improved clinical management and health outcomes for patients and their families.
Effectiveness of Sugammadex on muscle relaxant reversal in preterm neonates
Published in Egyptian Journal of Anaesthesia, 2023
Ahmed Mohamed Ahmed Elshafie, Ahmed Ezzat Marzouq Sad Elrouby, Yasser Mohamed Osman
Following approval from the local ethics council, this randomised clinical trial was conducted on 60 preterm newborns at the Shatby University Hospital, Alexandria University, Egypt. Under general anaesthesia, elective inguinal hernia repair was planned for each participant in the study. The research was conducted between August 2020 and February 2021. Following a thorough explanation of the trial’s advantages and risks, the patient’s parents or legal guardian who consented to participate provided their signed informed permission. All procedures were carried out in compliance with the 1964 Helsinki Declaration and its later amendments, as well as the institutional, national, and research committee ethical standards. The study was approved by the ethical committee of faculty Medicine, Alexandria University (No.11/2019OBSGN27) and the study protocol was registered at Clinical Trials.gov (Identifier: NCT04566796).
Related Knowledge Centers
- Defecation
- Gastrointestinal Tract
- Hernia
- Inguinal Canal
- Obesity
- Abdominal Cavity
- Chronic Obstructive Pulmonary Disease
- Circulatory System
- Pregnancy
- Tobacco Smoking