Pub Date : 2023-01-01DOI: 10.4103/ijawhs.ijawhs_71_22
R. Tuominen, T. Jahkola, Jani Mikkonen, H. Luomajoki, J. Arokoski, J. Vironen
Purpose: Pregnancy-related low back pain is a common condition. Persistent postpartum diastasis recti may cause back pain and motor control dysfunction. The role of diastasis in pregnancy-related back pain remains debatable. This study aimed to compare participants with increased symptoms after index pregnancy with those reporting no change in back pain or subjective movement control and to analyze inter-rectus distance. Materials and Methods: This case-control study included a cohort of women who delivered 1 year earlier. We recruited participants with increased symptoms (n = 14) after index pregnancy and controls (n = 41) and recorded their inter-rectus distance using ultrasound. A questionnaire was completed, and an ultrasound performed twice for each study group. Results: At the baseline, there was no significant difference in inter-rectus distance between cases and controls (mean 2.45 ± 1.01 cm and 2.09 ± 1.03 cm, respectively). A year after index pregnancy symptomatic cases had significantly wider inter-rectus distance than controls (mean 3.45 ± 0.90 cm and 2.40 ± 0.79 cm, respectively). Motor control dysfunction test results were not associated with core stability problems or back pain in this cohort. There was a difference in the sit-up test between cases and controls (mean 4.7 ± 4.2 and 8.2 ± 3.9, respectively). Conclusion: Women who reported increased back pain and core instability after index pregnancy had wider inter-rectus diameter than controls. In the case group with more symptoms after pregnancy, the classification of rectus diastasis (RD) changed from mild abdominal RD (2–3 cm) to moderate (>3–5 cm). RD may contribute to persistent pregnancy-related lumbopelvic pain.
{"title":"Low back pain and motor control dysfunction after pregnancy: The possible role of rectus diastasis","authors":"R. Tuominen, T. Jahkola, Jani Mikkonen, H. Luomajoki, J. Arokoski, J. Vironen","doi":"10.4103/ijawhs.ijawhs_71_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_71_22","url":null,"abstract":"Purpose: Pregnancy-related low back pain is a common condition. Persistent postpartum diastasis recti may cause back pain and motor control dysfunction. The role of diastasis in pregnancy-related back pain remains debatable. This study aimed to compare participants with increased symptoms after index pregnancy with those reporting no change in back pain or subjective movement control and to analyze inter-rectus distance. Materials and Methods: This case-control study included a cohort of women who delivered 1 year earlier. We recruited participants with increased symptoms (n = 14) after index pregnancy and controls (n = 41) and recorded their inter-rectus distance using ultrasound. A questionnaire was completed, and an ultrasound performed twice for each study group. Results: At the baseline, there was no significant difference in inter-rectus distance between cases and controls (mean 2.45 ± 1.01 cm and 2.09 ± 1.03 cm, respectively). A year after index pregnancy symptomatic cases had significantly wider inter-rectus distance than controls (mean 3.45 ± 0.90 cm and 2.40 ± 0.79 cm, respectively). Motor control dysfunction test results were not associated with core stability problems or back pain in this cohort. There was a difference in the sit-up test between cases and controls (mean 4.7 ± 4.2 and 8.2 ± 3.9, respectively). Conclusion: Women who reported increased back pain and core instability after index pregnancy had wider inter-rectus diameter than controls. In the case group with more symptoms after pregnancy, the classification of rectus diastasis (RD) changed from mild abdominal RD (2–3 cm) to moderate (>3–5 cm). RD may contribute to persistent pregnancy-related lumbopelvic pain.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"119 1","pages":"30 - 36"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79417750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/ijawhs.ijawhs_4_23
S. Oyewale, Azeezat Ariwoola
Giant inguinal hernia presents a range of unique challenges in its treatment. Detailing the potential complications and outcomes of treatment can motivate patients with giant inguinal hernias (GIH) to seek an early surgical intervention and raise awareness of the risks of neglecting the condition. The aim of this review is to identify the rates of complications, especially the abdominal compartment syndrome, and the causes of mortality encountered in the treatment of GIH. Furthermore, a new classification system for GIH is proposed. The search resulted in 1,926 papers, and 10 papers were included in the study. The majority of the studies were conducted on subjects living in sub-Saharan Africa. The most frequently performed procedure was Nylon Darning, accounting for 46.5% and only 53 (12.5%) were laparoscopic repair. There were four deaths reported in two studies. Two were caused by pulmonary embolism, whereas renal failure and abdominal compartment syndrome were the causes of one death each. After a proportional meta-analysis, the pooled complication rate of the surgical interventions was 39% (95% confidence interval: 0.18–0.59) with a random effect model I2 = 82.6%. There was no recurrence in any of the studies. The complication rate for treating giant inguinal hernia is high but mortality is low. There was zero recurrence despite some subjects undergoing modified Bassini repair. Further research is needed to identify predictors of abdominal compartment syndrome and intra-abdominal hypertension. The proposed classification also requires further study on a large scale.
{"title":"Outcomes in the surgical management of giant inguinal hernias: A systematic review","authors":"S. Oyewale, Azeezat Ariwoola","doi":"10.4103/ijawhs.ijawhs_4_23","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_4_23","url":null,"abstract":"Giant inguinal hernia presents a range of unique challenges in its treatment. Detailing the potential complications and outcomes of treatment can motivate patients with giant inguinal hernias (GIH) to seek an early surgical intervention and raise awareness of the risks of neglecting the condition. The aim of this review is to identify the rates of complications, especially the abdominal compartment syndrome, and the causes of mortality encountered in the treatment of GIH. Furthermore, a new classification system for GIH is proposed. The search resulted in 1,926 papers, and 10 papers were included in the study. The majority of the studies were conducted on subjects living in sub-Saharan Africa. The most frequently performed procedure was Nylon Darning, accounting for 46.5% and only 53 (12.5%) were laparoscopic repair. There were four deaths reported in two studies. Two were caused by pulmonary embolism, whereas renal failure and abdominal compartment syndrome were the causes of one death each. After a proportional meta-analysis, the pooled complication rate of the surgical interventions was 39% (95% confidence interval: 0.18–0.59) with a random effect model I2 = 82.6%. There was no recurrence in any of the studies. The complication rate for treating giant inguinal hernia is high but mortality is low. There was zero recurrence despite some subjects undergoing modified Bassini repair. Further research is needed to identify predictors of abdominal compartment syndrome and intra-abdominal hypertension. The proposed classification also requires further study on a large scale.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"22 4","pages":"6 - 13"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72476756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijawhs.ijawhs_40_22
H. Kulaçoğlu
Lichtenstein repair (LR) was described by Irving Lichtenstein in mid-1980s, and was announced to be the gold standard for the treatment of inguinal hernias in 1990s. The technique is a tension-free repair with a prosthetic patch. Today LR is one of the most widely used surgical methods in the world, but it is hard to talk about uniformity in the technique among surgeons. Almost every surgeon has made some modifications to the technique and produced somewhat different repairs independently. In this paper, the original LR and the suggested modifications by the Institute are reviewed, and some critical points are presented with intraoperative photographs. LR is an economic choice, easy to learn, and can be performed with local anesthesia especially when the patient is frail. The technique requires a permanent prosthetic patch. Mesh fixation should be done with separate sutures preferably with monofilament absorbable material. Mesh size should not be kept small, and a 2-cm overlap should be provided beyond the pubic tubercle. A 15 cm × 7 cm commercial mesh can be trimmed and used. Mesh should extend laterally to the internal inguinal ring for 5–6 cm. A proper technique in LR is important for low recurrence and chronic pain rates. Therefore, every surgeon at every level of her/his carrier must know how to perform a decent LR.
{"title":"Some more time with an old friend: Small details for better outcomes with Lichtenstein repair for inguinal hernias","authors":"H. Kulaçoğlu","doi":"10.4103/ijawhs.ijawhs_40_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_40_22","url":null,"abstract":"Lichtenstein repair (LR) was described by Irving Lichtenstein in mid-1980s, and was announced to be the gold standard for the treatment of inguinal hernias in 1990s. The technique is a tension-free repair with a prosthetic patch. Today LR is one of the most widely used surgical methods in the world, but it is hard to talk about uniformity in the technique among surgeons. Almost every surgeon has made some modifications to the technique and produced somewhat different repairs independently. In this paper, the original LR and the suggested modifications by the Institute are reviewed, and some critical points are presented with intraoperative photographs. LR is an economic choice, easy to learn, and can be performed with local anesthesia especially when the patient is frail. The technique requires a permanent prosthetic patch. Mesh fixation should be done with separate sutures preferably with monofilament absorbable material. Mesh size should not be kept small, and a 2-cm overlap should be provided beyond the pubic tubercle. A 15 cm × 7 cm commercial mesh can be trimmed and used. Mesh should extend laterally to the internal inguinal ring for 5–6 cm. A proper technique in LR is important for low recurrence and chronic pain rates. Therefore, every surgeon at every level of her/his carrier must know how to perform a decent LR.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"9 1","pages":"221 - 228"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80846719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijawhs.ijawhs_37_22
M. Al-Mansour, D. Neal, Cristina J. Crippen, T. Loftus, T. Read, P. Tighe
BACKGROUND: Transversus abdominis plane (TAP) block is often used for post-operative analgesia in ventral hernia repair (VHR). Most studies evaluating TAP in VHR are single-center studies. Our objective was to evaluate the outcomes of TAP in VHR using a national database. MATERIALS AND METHODS: We conducted a retrospective cohort study using Vizient Clinical Database. We included outpatient VHR in adults between 2017 and 2019. Patient, hernia, operative, and hospital characteristics were collected. The patients were divided into two groups depending on whether or not they received TAP. One-to-one propensity score matching (PSM) was used to create balanced groups. Rate of overnight stay, in-hospital opioid prescribing, and costs were compared between both groups. RESULTS: A total of 108,765 patients met the inclusion criteria. After PSM, there were 1,459 patients in each group. There were no statistically significant differences in baseline characteristics between the matched groups. There was no difference in the rates of overnight stay between the two groups (no-TAP=6%, TAP=7%, odds ratio [OR]=1.3, 95% confidence interval [CI] [0.997,1.77]). There were no clinically significant differences in the percentage of patients prescribed opioids (no-TAP=96%, TAP=95%, OR=0.70, 95% CI [0.50, 0.99]) or mean number of opioid doses prescribed (no-TAP=2.7, TAP=2.7, mean pairwise difference [MPD]=0.02, 95% CI [–0.10, 0.13]). The TAP group was associated with higher median direct cost ($4,400 vs. $3,200; MPD=$1,200, 95% CI [$1,000, $1,400]) and total cost ($7,100 vs. $5,200; MPD=$1,900, 95% CI [$1,600, $2,100]) when compared with the no-TAP group. CONCLUSION: We found no evidence that TAP in outpatient VHR was associated with the reduction in the rate of overnight stay or in-hospital opioid prescribing. However, TAP was associated with higher procedural costs.
{"title":"Outcomes of transversus abdominis plane block in ventral hernia repair: A propensity score matching analysis using a national database","authors":"M. Al-Mansour, D. Neal, Cristina J. Crippen, T. Loftus, T. Read, P. Tighe","doi":"10.4103/ijawhs.ijawhs_37_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_37_22","url":null,"abstract":"BACKGROUND: Transversus abdominis plane (TAP) block is often used for post-operative analgesia in ventral hernia repair (VHR). Most studies evaluating TAP in VHR are single-center studies. Our objective was to evaluate the outcomes of TAP in VHR using a national database. MATERIALS AND METHODS: We conducted a retrospective cohort study using Vizient Clinical Database. We included outpatient VHR in adults between 2017 and 2019. Patient, hernia, operative, and hospital characteristics were collected. The patients were divided into two groups depending on whether or not they received TAP. One-to-one propensity score matching (PSM) was used to create balanced groups. Rate of overnight stay, in-hospital opioid prescribing, and costs were compared between both groups. RESULTS: A total of 108,765 patients met the inclusion criteria. After PSM, there were 1,459 patients in each group. There were no statistically significant differences in baseline characteristics between the matched groups. There was no difference in the rates of overnight stay between the two groups (no-TAP=6%, TAP=7%, odds ratio [OR]=1.3, 95% confidence interval [CI] [0.997,1.77]). There were no clinically significant differences in the percentage of patients prescribed opioids (no-TAP=96%, TAP=95%, OR=0.70, 95% CI [0.50, 0.99]) or mean number of opioid doses prescribed (no-TAP=2.7, TAP=2.7, mean pairwise difference [MPD]=0.02, 95% CI [–0.10, 0.13]). The TAP group was associated with higher median direct cost ($4,400 vs. $3,200; MPD=$1,200, 95% CI [$1,000, $1,400]) and total cost ($7,100 vs. $5,200; MPD=$1,900, 95% CI [$1,600, $2,100]) when compared with the no-TAP group. CONCLUSION: We found no evidence that TAP in outpatient VHR was associated with the reduction in the rate of overnight stay or in-hospital opioid prescribing. However, TAP was associated with higher procedural costs.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"48 1","pages":"179 - 184"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73328436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijawhs.ijawhs_20_22
Yimin Xu, X. Shao, Z. Ji, Junsheng Li
Chronic postoperative pain is a complication of open and laparoscopic inguinal hernia surgery. The most important factor to the development of postoperative pain is nerve injury. Of all nerve injuries, the damage to the femoral nerve is very rare. Electromyogram and nerve conduction velocity may provide the clue to proper treatment. The authors present a rare case of femoral hernia injury following transabdominal preperitoneal inguinal repair for a primary right inguinal hernia and emphasize the importance of non- or atraumatic mesh fixation during laparoendoscopic inguinal hernia repair.
{"title":"Femoral nerve injury following transabdominal preperitoneal inguinal hernia repair: A case report","authors":"Yimin Xu, X. Shao, Z. Ji, Junsheng Li","doi":"10.4103/ijawhs.ijawhs_20_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_20_22","url":null,"abstract":"Chronic postoperative pain is a complication of open and laparoscopic inguinal hernia surgery. The most important factor to the development of postoperative pain is nerve injury. Of all nerve injuries, the damage to the femoral nerve is very rare. Electromyogram and nerve conduction velocity may provide the clue to proper treatment. The authors present a rare case of femoral hernia injury following transabdominal preperitoneal inguinal repair for a primary right inguinal hernia and emphasize the importance of non- or atraumatic mesh fixation during laparoendoscopic inguinal hernia repair.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"88 1","pages":"204 - 208"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85070667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijawhs.ijawhs_42_22
A. Nugroho, Y. Permata, Indah Jamtani, A. Widarso, R. Saunar
Long-term ascites and liver illness in its last stages might occasionally result in Flood syndrome. The abrupt surge of ascitic fluid that occurs along with an umbilical hernia that spontaneously ruptures gives rise to the syndrome′s name. We described a patient who had cirrhosis and valvular heart disease in the past and had Flood syndrome with intestinal evisceration. To stop the progression of intestinal necrosis and septic consequences, immediate surgery to reduce the eviscerated bowel and mesh reinforcement was performed. In summary, Flood syndrome is a serious condition that needs to be treated very away, much like other forms of intestinal evisceration. The efficient management of comorbid disorders is essential for a better therapeutic outcome.
{"title":"Emergency presentation of Flood syndrome requiring immediate repair of umbilical hernia: A case report","authors":"A. Nugroho, Y. Permata, Indah Jamtani, A. Widarso, R. Saunar","doi":"10.4103/ijawhs.ijawhs_42_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_42_22","url":null,"abstract":"Long-term ascites and liver illness in its last stages might occasionally result in Flood syndrome. The abrupt surge of ascitic fluid that occurs along with an umbilical hernia that spontaneously ruptures gives rise to the syndrome′s name. We described a patient who had cirrhosis and valvular heart disease in the past and had Flood syndrome with intestinal evisceration. To stop the progression of intestinal necrosis and septic consequences, immediate surgery to reduce the eviscerated bowel and mesh reinforcement was performed. In summary, Flood syndrome is a serious condition that needs to be treated very away, much like other forms of intestinal evisceration. The efficient management of comorbid disorders is essential for a better therapeutic outcome.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"49 1","pages":"218 - 220"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88510218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijawhs.ijawhs_43_22
A. Alptekin, Z. Ergul, M. Sonmez, C. Ugurlu, H. Gumus, H. Kulaçoğlu
INTRODUCTION: Nonsteroidal anti-inflammatory drugs have become a popular part of multimodal analgesic regimens particularly in ambulatory surgery. This study was designed to search the efficacy of preoperative administration of lornoxicam or paracetamol in patients who underwent open inguinal hernia repair. MATERIALS AND METHODS: American Society of Anesthesiologists Classification (ASA) I–III male patients with unilateral primary inguinal hernia scheduled for elective prosthetic repair under general anesthesia were randomly assigned to three groups. Group I patients were infused 100-ml normal saline 30 min before anesthesia (placebo), whereas Group II and Group III patients were given 8 mg lornoxicam or 1,000 mg paracetamol intravenously in 100-ml normal saline. Postoperative pain was treated with patient controlled intravenous morphine. Postoperative pain scores were evaluated with visual analog scale (VAS) in the recovery room and at 1st, 6th, 12th, and 24th hours postoperatively in all groups. Total amount of analgesics. Liker scale and SF-36 form was also used at 4th week follow-up in order assess quality of life. RESULTS: Totally 88 patients were completed the study (G1 = 28, G2 = 30, and G3 = 30). Preemptive use of both lornoxicam and paracetamol resulted in significantly lower recovery room VAS scores in comparison with placebo group (3.93, 3.73, and 5.25). Both lornoxicam and paracetamol groups (G2 and G3) displayed better results at 12th h than placebo group (P = 0.04). VAS scores at 24th hour were similar in three groups. Total morphine consumptions were also similar between the groups at all times. Total postoperative 1-week oral analgesic use was significantly less in G2 (lornoxicam), and G3 (paracetamol) in comparison with G1 (placebo). Quality of life indicators in Likert Scale and SF-36 form were also not different. CONCLUSION: Preemptive use of both lornoxicam and paracetamol may be effective in early postoperative pain control in patients undergo elective open inguinal hernia repair. However, there seems to be no difference between the efficacies of the two agents.
{"title":"Can the preemptive use of lornoxicam or paracetamol prevent pain after inguinal hernia repair? A randomized prospective double-blind placebo controlled trial","authors":"A. Alptekin, Z. Ergul, M. Sonmez, C. Ugurlu, H. Gumus, H. Kulaçoğlu","doi":"10.4103/ijawhs.ijawhs_43_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_43_22","url":null,"abstract":"INTRODUCTION: Nonsteroidal anti-inflammatory drugs have become a popular part of multimodal analgesic regimens particularly in ambulatory surgery. This study was designed to search the efficacy of preoperative administration of lornoxicam or paracetamol in patients who underwent open inguinal hernia repair. MATERIALS AND METHODS: American Society of Anesthesiologists Classification (ASA) I–III male patients with unilateral primary inguinal hernia scheduled for elective prosthetic repair under general anesthesia were randomly assigned to three groups. Group I patients were infused 100-ml normal saline 30 min before anesthesia (placebo), whereas Group II and Group III patients were given 8 mg lornoxicam or 1,000 mg paracetamol intravenously in 100-ml normal saline. Postoperative pain was treated with patient controlled intravenous morphine. Postoperative pain scores were evaluated with visual analog scale (VAS) in the recovery room and at 1st, 6th, 12th, and 24th hours postoperatively in all groups. Total amount of analgesics. Liker scale and SF-36 form was also used at 4th week follow-up in order assess quality of life. RESULTS: Totally 88 patients were completed the study (G1 = 28, G2 = 30, and G3 = 30). Preemptive use of both lornoxicam and paracetamol resulted in significantly lower recovery room VAS scores in comparison with placebo group (3.93, 3.73, and 5.25). Both lornoxicam and paracetamol groups (G2 and G3) displayed better results at 12th h than placebo group (P = 0.04). VAS scores at 24th hour were similar in three groups. Total morphine consumptions were also similar between the groups at all times. Total postoperative 1-week oral analgesic use was significantly less in G2 (lornoxicam), and G3 (paracetamol) in comparison with G1 (placebo). Quality of life indicators in Likert Scale and SF-36 form were also not different. CONCLUSION: Preemptive use of both lornoxicam and paracetamol may be effective in early postoperative pain control in patients undergo elective open inguinal hernia repair. However, there seems to be no difference between the efficacies of the two agents.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"1 1","pages":"185 - 191"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82717377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijawhs.ijawhs_5_22
Sofía Gamboa Miño, M. Zeledon, Aníbal Solari, Gustavo Alcántara
INTRODUCTION: Littré hernia is defined as the presence of a Meckel’s diverticulum in any hernia sac. The case of an adult with Littré hernia associated with a cryptorchidic testicle in the inguinal canal has not been previously reported. Treatment of this rare case is controversial on many fronts. This report highlights the management of a case with an inguinal mixed Littré hernia and incidental cryptorchidism. CASE PRESENTATION: A 32-year-old male patient with an incarcerated right inguinal hernia presented to the emergency department. An incarcerated mixed Littré hernia was discovered associated with a cryptorchidic testicle. A Lichtenstein hernioplasty and an orchidopexy were performed without resection of Meckel’s diverticulum. DISCUSSION: There is currently no consensus on the treatment of a Littré hernia nor incidental cryptorchidism in an adult patient. Controversies arise on whether to perform diverticulectomy or not and the type of hernia repair. This case had the added unique feature of an undiagnosed cryptorchidic testicle in an adult, a pathology that also prolongs controversies on whether it is necessary to resect. CONCLUSION: Treatment of a Littré hernia, Meckel’s diverticulum, and cryptorchidism in adult patients continues to be a challenge. Given the lack of guidelines that establish appropriate treatment, it must be decided on a case by case basis; however, a conservative approach seems to be safe.
{"title":"Management of an inguinal mixed Littré hernia and incidental cryptorchidism: A case report","authors":"Sofía Gamboa Miño, M. Zeledon, Aníbal Solari, Gustavo Alcántara","doi":"10.4103/ijawhs.ijawhs_5_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_5_22","url":null,"abstract":"INTRODUCTION: Littré hernia is defined as the presence of a Meckel’s diverticulum in any hernia sac. The case of an adult with Littré hernia associated with a cryptorchidic testicle in the inguinal canal has not been previously reported. Treatment of this rare case is controversial on many fronts. This report highlights the management of a case with an inguinal mixed Littré hernia and incidental cryptorchidism. CASE PRESENTATION: A 32-year-old male patient with an incarcerated right inguinal hernia presented to the emergency department. An incarcerated mixed Littré hernia was discovered associated with a cryptorchidic testicle. A Lichtenstein hernioplasty and an orchidopexy were performed without resection of Meckel’s diverticulum. DISCUSSION: There is currently no consensus on the treatment of a Littré hernia nor incidental cryptorchidism in an adult patient. Controversies arise on whether to perform diverticulectomy or not and the type of hernia repair. This case had the added unique feature of an undiagnosed cryptorchidic testicle in an adult, a pathology that also prolongs controversies on whether it is necessary to resect. CONCLUSION: Treatment of a Littré hernia, Meckel’s diverticulum, and cryptorchidism in adult patients continues to be a challenge. Given the lack of guidelines that establish appropriate treatment, it must be decided on a case by case basis; however, a conservative approach seems to be safe.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"5 1","pages":"200 - 203"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77973878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijawhs.ijawhs_38_22
Mustafa Okumu°, Elbrus Zerbaliyev, A. Akdağ
The etiopathogenesis of the relationship of congenital Spigelian hernia with ipsilateral undescended testis is still being debated. We have reviewed previous discussions of etiopathogenesis and presented our thoughts on the topic without mentioning the well-known diagnostic and treatment. On examination of a male newborn, swelling was detected in the right lower quadrant of the abdomen and the right testis could not be palpated. The infant was diagnosed with an ipsilateral undescended testis and a congenital Spigelian hernia after a consultation with a pediatric surgeon. A defect with a prominent margin of approximately 2–3 cm in diameter was detected during the surgery. The right orchiopexy and anatomical repair of the defect were done in the same session. In addition to Spigelian hernias, other ventral hernias can also appear with undescended testicles. We think that the main pathology is an ectopically located testis caused by abnormal gubernacular migration.
{"title":"Congenital spigelian hernia and ipsilateral undescended testis: An ongoing etiological debate - A case report","authors":"Mustafa Okumu°, Elbrus Zerbaliyev, A. Akdağ","doi":"10.4103/ijawhs.ijawhs_38_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_38_22","url":null,"abstract":"The etiopathogenesis of the relationship of congenital Spigelian hernia with ipsilateral undescended testis is still being debated. We have reviewed previous discussions of etiopathogenesis and presented our thoughts on the topic without mentioning the well-known diagnostic and treatment. On examination of a male newborn, swelling was detected in the right lower quadrant of the abdomen and the right testis could not be palpated. The infant was diagnosed with an ipsilateral undescended testis and a congenital Spigelian hernia after a consultation with a pediatric surgeon. A defect with a prominent margin of approximately 2–3 cm in diameter was detected during the surgery. The right orchiopexy and anatomical repair of the defect were done in the same session. In addition to Spigelian hernias, other ventral hernias can also appear with undescended testicles. We think that the main pathology is an ectopically located testis caused by abnormal gubernacular migration.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"11 1","pages":"209 - 211"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74363335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijawhs.ijawhs_61_22
W. Reinpold, C. Berger, R. Bittner
Introduction: Abdominal wall hernia and incisional hernia repair are among the most frequent operations in general surgery. However, despite the use of mesh and other recent improvements, the open mesh techniques and laparoscopic IPOM repair have specific disadvantages and risks. Materials and Methods: To minimize complications of the existing open and laparoscopic techniques we developed the endoscopic Mini- or Less Open Sublay (EMILOS) and endoscopically assisted Mini- or Less Open Sublay (MILOS) concept. We report on our large series of minimally invasive sublay repair of and ventral incisional hernias. The operation is performed transhernially with light-holding laparoscopic instruments either under direct, or endoscopic visualization, while the abdominal wall is circumferentially elevated with retractors. An endoscopic light tube was developed to facilitate this approach (Endotorch,TM Wolf Company). Each MILOS operation can be converted to standard total extraperitoneal gas endoscopy (EMILOS repair) once an extraperitoneal space of at least 8 cm has been created. The technique allows minimal invasive repair of ventral hernias with concomitant rectus diastasis. In large eventrations E/MILOS m. transversus abdominis release (TAR) can be performed. All MILOS operations were prospectively documented in the German Hernia registry Herniamed. Technical modifications and improvements from the inception of the E/MILOS concept including variants of the EMILOS technique are addressed. Results: The total and surgical complication rates of 1745 E/MILOS incisional hernia operations were 4.6% and 3.1%, respectively. The reoperation rate was 1.7%. Haemorrhage, seroma, enterotomy, infection and bowel obstruction were detected in 1.0, 0.9, 0.2, 0.3 and 0.4 percent of the cases, respectively. The recurrence rate after one year was 1.2%. Chronic pain at rest, at activities and chronic pain requiring therapy was reported in 3.8, 7.4 and 3.6 percent, respectively. Conclusion: The MILOS technique allows minimally invasive transhernial repair of incisional hernias using large retromuscular / preperitoneal meshes with low morbidity. The technique is reproducible, cost effective, easy to standardize and combines the advantages of open sublay and the laparoscopic IPOM repair.
{"title":"Endoscopic and endoscopically assisted mini or less open sublay mesh repair (EMILOS and MILOS) of abdominal wall hernias: Update and 10-year experience of a single insitution","authors":"W. Reinpold, C. Berger, R. Bittner","doi":"10.4103/ijawhs.ijawhs_61_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_61_22","url":null,"abstract":"Introduction: Abdominal wall hernia and incisional hernia repair are among the most frequent operations in general surgery. However, despite the use of mesh and other recent improvements, the open mesh techniques and laparoscopic IPOM repair have specific disadvantages and risks. Materials and Methods: To minimize complications of the existing open and laparoscopic techniques we developed the endoscopic Mini- or Less Open Sublay (EMILOS) and endoscopically assisted Mini- or Less Open Sublay (MILOS) concept. We report on our large series of minimally invasive sublay repair of and ventral incisional hernias. The operation is performed transhernially with light-holding laparoscopic instruments either under direct, or endoscopic visualization, while the abdominal wall is circumferentially elevated with retractors. An endoscopic light tube was developed to facilitate this approach (Endotorch,TM Wolf Company). Each MILOS operation can be converted to standard total extraperitoneal gas endoscopy (EMILOS repair) once an extraperitoneal space of at least 8 cm has been created. The technique allows minimal invasive repair of ventral hernias with concomitant rectus diastasis. In large eventrations E/MILOS m. transversus abdominis release (TAR) can be performed. All MILOS operations were prospectively documented in the German Hernia registry Herniamed. Technical modifications and improvements from the inception of the E/MILOS concept including variants of the EMILOS technique are addressed. Results: The total and surgical complication rates of 1745 E/MILOS incisional hernia operations were 4.6% and 3.1%, respectively. The reoperation rate was 1.7%. Haemorrhage, seroma, enterotomy, infection and bowel obstruction were detected in 1.0, 0.9, 0.2, 0.3 and 0.4 percent of the cases, respectively. The recurrence rate after one year was 1.2%. Chronic pain at rest, at activities and chronic pain requiring therapy was reported in 3.8, 7.4 and 3.6 percent, respectively. Conclusion: The MILOS technique allows minimally invasive transhernial repair of incisional hernias using large retromuscular / preperitoneal meshes with low morbidity. The technique is reproducible, cost effective, easy to standardize and combines the advantages of open sublay and the laparoscopic IPOM repair.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"45 1","pages":"165 - 178"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84887278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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