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Surgical Endoscopy Dec 2017Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac/processus vaginalis has been widely performed for repair of inguinal hernia/hydrocele... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac/processus vaginalis has been widely performed for repair of inguinal hernia/hydrocele in children. However, a variety of surgical instruments and techniques were used, and significant differences existed among the SLPEC reports.
METHODS
A literature search was performed for all available studies concerning SLPEC for pediatric inguinal hernia/hydrocele in PubMed, Embase and Cochrane library. The surgical details and operative outcomes were pooled and analyzed with software StataSE 12.0.
RESULTS
49 studies fulfilled the predefined inclusion criteria of this review and 37 studies were finally included in the meta-analysis. The mean incidence of CPPV was 29.1% (range 5.73-43.0%). The average of mean operative time was 19.56 min (range 8.30-41.19 min) for unilateral SLPEC and 27.23 min (range 12.80-48.19 min) for bilateral SLPEC. The total incidence of injury, conversion, recurrence, hydrocele formation, knot reaction, severe pain, and scrotal swelling was 0.32% (range 0-3.24%), 0.05% (range 0-0.89%), 0.70% (range 0-15.5%), 0.23% (range 0-3.57%), 0.33% (range 0-3.33%), 0.05% (range 0-4.55%), and 0.03% (range 0-1.52%), respectively. There was no development of testicular atrophy. Subgroup analyses showed an inverse correlation between the injury incidence and adoption of assisted forceps, hydrodissection, and blunt puncture device, between the conversion rate and adoption of hydrodissection, between the recurrence/hydrocele incidence and adoption of assisted forceps, hydrodissection, nonabsorbable suture and the preventive measures to avoid ligating the unnecessary subcutaneous tissues, and between the rate of knot reaction and adoption of assisted forceps, hydrodissection, and the preventive measures.
CONCLUSIONS
SLPEC was a well-developed procedure for repair of pediatric inguinal hernia/hydrocele. Adoption of assisted forceps, hydrodissection, nonabsorbable suture, and the preventive measures to avoid ligating the unnecessary subcutaneous tissues could significantly reduce the intra- and postoperative complications.
Topics: Hernia, Inguinal; Herniorrhaphy; Humans; Laparoscopy; Male; Peritoneum; Testicular Hydrocele; Treatment Outcome
PubMed: 28389795
DOI: 10.1007/s00464-017-5491-3 -
Surgical Infections 2017Abdominal cocoon formation is an uncommon manifestation of abdominal tuberculosis that is characterized by the formation of a fibrous membrane-like sac around the small... (Review)
Review
BACKGROUND
Abdominal cocoon formation is an uncommon manifestation of abdominal tuberculosis that is characterized by the formation of a fibrous membrane-like sac around the small intestinal loops. Appropriate treatment and outcomes are uncertain Objectives: To review the clinical presentation, treatment, and outcomes for tubercular abdominal cocoon (TAC).
PATIENTS AND METHODS
We included studies published in the English language and listed in EMBASE or PubMed. All case series or reports that reported patients with TAC were considered for inclusion. Details regarding demographic, clinical presentation, and treatment received were tabulated.
RESULTS
The clinical features included predominantly abdominal pain, abdominal distension and features of intestinal obstruction, loss of appetite, and weight loss. The diagnosis was usually established at surgery, however, computed tomography was a useful tool. In most patients the treatment reported was surgical, however, conservative therapy with anti-tubercular therapy (ATT) did succeed in a subset of patients. The published literature includes only case series and reports. The outcomes, especially long-term outcomes, have not been reported in most studies.
CONCLUSION
Abdominal cocoon is an uncommon form of abdominal tuberculosis and conservative management with ATT may suffice in some patients whereas non-responsive cases require surgery.
Topics: Abdominal Pain; Adolescent; Adult; Aged; Child; Female; Humans; Intestinal Obstruction; Male; Middle Aged; Tuberculosis, Gastrointestinal; Young Adult
PubMed: 28759335
DOI: 10.1089/sur.2017.110 -
Interactive Cardiovascular and Thoracic... Mar 2020A pericardial hernia is defined as the protrusion of abdominal viscera through the central tendon of the diaphragm into the pericardial sac. It is a rare clinical entity...
OBJECTIVES
A pericardial hernia is defined as the protrusion of abdominal viscera through the central tendon of the diaphragm into the pericardial sac. It is a rare clinical entity whose symptoms vary considerably. The objective of this study was to evaluate the clinical manifestations of and the optimal surgical treatments for pericardial hernias.
METHODS
PubMed and the Cochrane bibliographical databases were searched (last search: 20 April 2019) for studies on pericardial diaphragmatic hernias in the adult population.
RESULTS
Eighty studies met our inclusion criteria and reported on 85 patients (62 men and 23 women) with a mean age of 55.86 ± 15.79 years (mean ± standard deviation) presenting with a pericardial hernia at health care facilities. The leading aetiology was trauma (56.5%) followed by iatrogenic interventions (30.6%). The most common herniated organs were the transverse colon (49.4%) and the greater omentum (48.2%). Seventy-one patients (83.5%) underwent an open surgical repair, whereas 14 (16.5%) had a laparoscopic approach. Mesh or a patch was applied in 41.9% of cases. A postoperative morbidity rate of 16.9% was recorded, whereas the mortality rate reached 2.4%.
CONCLUSIONS
Pericardial hernia is a rare disease characterized by abdominal organs herniating into the pericardium. It requires a high degree of suspicion for early diagnosis, and all medical professionals should be encouraged to report such cases to clarify the best available therapeutic approach.
Topics: Adult; Hernia, Diaphragmatic; Herniorrhaphy; Humans; Laparoscopy; Omentum; Pericardium; Surgical Mesh
PubMed: 31808516
DOI: 10.1093/icvts/ivz292 -
World Journal of Surgery Feb 2019Large ventral hernias are a significant surgical challenge. "Loss of domain" (LOD) expresses the relationship between hernia and abdominal volume, and is used to predict...
Large ventral hernias are a significant surgical challenge. "Loss of domain" (LOD) expresses the relationship between hernia and abdominal volume, and is used to predict operative difficulty and success. This systematic review assessed whether different definitions of LOD are used in the literature. The PubMed database was searched for articles reporting large hernia repairs that explicitly described LOD. Two reviewers screened citations and extracted data from selected articles, focusing on the definitions used for LOD, study demographics, study design, and reporting surgical specialty. One hundred and seven articles were identified, 93 full-texts examined, and 77 were included in the systematic review. Sixty-seven articles were from the primary literature, and 10 articles were from the secondary literature. Twenty-eight articles (36%) gave a written definition for loss of domain. These varied and divided into six broad groupings; four described the loss of the right of domain, six described abdominal strap muscle contraction, five described the "second abdomen", five describing large irreducible hernias. Six gave miscellaneous definitions. Two articles gave multiple definitions. Twenty articles (26%) gave volumetric definitions; eight used the Tanaka method [hernia sac volume (HSV)/abdominal cavity volume] and five used the Sabbagh method [(HSV)/total peritoneal volume]. The definitions used for loss of domain were not dependent on the reporting specialty. Our systematic review revealed that multiple definitions of loss of domain are being used. These vary and are not interchangeable. Expert consensus on this matter is necessary to standardise this important concept for hernia surgeons.
Topics: Abdominal Cavity; Hernia, Ventral; Humans
PubMed: 30187090
DOI: 10.1007/s00268-018-4783-7 -
Medicine Jul 2022Abdominal cocoon or sclerosing encapsulating peritonitis is an uncommon condition in which the small bowel is completely or partially encased by a thick fibrotic...
BACKGROUND
Abdominal cocoon or sclerosing encapsulating peritonitis is an uncommon condition in which the small bowel is completely or partially encased by a thick fibrotic membrane. Our study presents a case of sclerosing encapsulating peritonitis and conducts a literature review.
METHODS
A bibliographic research was conducted. Our research comprised 97 articles. Gender, age, symptoms, diagnostic procedures, and treatment were all included in the database of patient characteristics.
CASE PRESENTATION
A 51-year-old man complaining of a 2-day history of minor diffuse abdominal pain, loss of appetite, and constipation was presented in emergency department. Physical examination was indicative of intestinal obstruction. Laboratory tests were normal. Diffuse intraperitoneal fluid and dilated small intestinal loops were discovered on computed tomography (CT). An exploratory laparotomy was recommended, in which the sac membrane was removed and adhesiolysis was performed. He was discharged on the tenth postoperative day.
RESULTS
There were 240 cases of abdominal cocoon syndrome in total. In terms of gender, 151 of 240 (62.9%) were male and 89 of 240 (37%) were female. Ages between 20 and 40 are most affected. Symptoms include abdominal pain and obstruction signs. For the diagnosis of abdominal cocoon syndrome, CT may be the gold standard imaging method. The surgical operation was the treatment of choice in the vast majority of cases (96.7%). Only 69 of 239 patients (28.9%) were detected prior to surgery, and CT was applied in these cases.
CONCLUSION
Abdominal cocoon is a rare condition marked by recurrent episodes of intestinal obstruction. Surgical therapy is the most effective treatment option.
Topics: Abdominal Pain; Adult; Female; Humans; Intestinal Obstruction; Intestine, Small; Male; Middle Aged; Peritoneal Fibrosis; Peritonitis; Young Adult
PubMed: 35801789
DOI: 10.1097/MD.0000000000029837