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Journal of Laparoendoscopic & Advanced... Mar 2024Laparoscopic sac disconnection and peritoneal closure represents an alternative to open pediatric hernia repair. We performed a retrospective review of our data to...
Laparoscopic sac disconnection and peritoneal closure represents an alternative to open pediatric hernia repair. We performed a retrospective review of our data to evaluate this alternative method. With REB approval, a retrospective chart review of all patients who underwent laparoscopic indirect inguinal hernia repair between June 2013 and July 2016 was conducted. Primary outcome was the recurrence rate. Secondary outcomes included length of surgery, postoperative hydrocele, and perioperative complications. Data were extracted from EPIC Hyperspace onto a standardized data extraction form. A total of 243 patients were included, of which 82% were males. Age ranged from 1 month to 17 years of age. A total of 322 defects were repaired. Eighty (32%) had contralateral patent processus vaginalis. Twelve (4%) patients presented with incarceration and three (1.2%) had a direct inguinal hernia defect. Recurrence rate was 0.6% ( = 2). There were no intraoperative complications. Operative time was an average of 40 and 54 minutes for unilateral and bilateral repairs, respectively. No testicular ascents, testicular atrophy, vas deferens injury, postoperative hydroceles, and wound infections were reported. Laparoscopic sac disconnection and peritoneal closure of pediatric inguinal hernia is a safe, feasible method with one of the lowest reported recurrence rate among the other laparoscopic methods.
PubMed: 38526574
DOI: 10.1089/lap.2023.0425 -
Radiographics : a Review Publication of... 2015Ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Uncommon implantation sites of... (Review)
Review
Ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Uncommon implantation sites of ectopic pregnancy include the cervix, interstitial segment of the fallopian tube, scar from a prior cesarean delivery, uterine myometrium, ovary, and peritoneal cavity. Heterotopic and twin ectopic pregnancies are other rare manifestations. Ultrasonography (US) plays a central role in diagnosis of uncommon ectopic pregnancies. US features of an interstitial ectopic pregnancy include an echogenic interstitial line and abnormal bulging of the myometrial contour. A gestational sac that is located below the internal os of the cervix and that contains an embryo with a fetal heartbeat is indicative of a cervical ectopic pregnancy. In a cesarean scar ectopic pregnancy, the gestational sac is implanted in the anterior lower uterine segment at the site of the cesarean scar, with thinning of the myometrium seen anterior to the gestational sac. An intramural gestational sac implants in the uterine myometrium, separate from the uterine cavity and fallopian tubes. In an ovarian ectopic pregnancy, a gestational sac with a thick hyperechoic circumferential rim is located in or on the ovarian parenchyma. An intraperitoneal gestational sac is present in an abdominal ectopic pregnancy. Intra- and extrauterine gestational sacs are seen in a heterotopic pregnancy. Two adnexal heartbeats suggest a live twin ectopic pregnancy. Recognition of the specific US features will help radiologists diagnose these uncommon types of ectopic pregnancy.
Topics: Adnexal Diseases; Adult; Cervix Uteri; Fallopian Tubes; Female; Humans; Myometrium; Ovary; Peritoneum; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Ultrasonography, Prenatal
PubMed: 25860721
DOI: 10.1148/rg.2015140202 -
International Journal of Surgery Case... Jan 2022With the widespread use of laparoscopic inguinal hernia repair, it is known that some clinically evident inguinal hernias lack a peritoneal sac and are referred to as...
INTRODUCTION AND IMPORTANCE
With the widespread use of laparoscopic inguinal hernia repair, it is known that some clinically evident inguinal hernias lack a peritoneal sac and are referred to as "sacless hernias".
PRESENTATION OF CASE
A 61-year-old man presented with a left inguinal bulge. On physical examination, the diagnosis of bilateral inguinal hernias was made, and laparoscopic transabdominal repair was performed. Intraoperatively, the left peritoneal hernia orifice was not identified from the peritoneal cavity and there was only a lipoma. Pressing the lipoma with forceps from inside the peritoneum confirmed the presence of a hernia. The preperitoneal space was opened and the hernia orifice revealed.
DISCUSSION
The terminology and definition of sacless hernias are poorly defined, even though this is not a rare condition. Consistent with Russell's dogma, there are arguments that any prolapse can only be called a hernia if there is an accompanying peritoneal sac. The proportion of patients with sacless hernias and pure cord lipomas are very similar and these conditions are often confused. Detailed and repeated physical examination may distinguish a sacless hernia from a pure lipoma. A watchful waiting strategy is useful and ensures safety.
CONCLUSION
Once the diagnosis of inguinal hernia is made on physical examination, open the preperitoneal cavity if a peritoneal hernia orifice was not identified during laparoscopy.
PubMed: 34902700
DOI: 10.1016/j.ijscr.2021.106667 -
Updates in Surgery Dec 2023Congenital inguinal hernia [CIH] can be treated laparoscopically using various methods documented in the literature. Many authors have recommended dividing the sac and... (Randomized Controlled Trial)
Randomized Controlled Trial
Congenital inguinal hernia [CIH] can be treated laparoscopically using various methods documented in the literature. Many authors have recommended dividing the sac and stitching peritoneal defects. Other studies claimed that peritoneal disconnection alone is sufficient. In this study, the feasibility, operative time, recurrence rate, and other postoperative complications of needlescopic disconnection of the CIH sac with or without peritoneal defect suturing were compared. A prospective controlled randomized trial was conducted between January 2020 and December 2022. Two hundred and thirty patients who met the study requirements were included. Patients were assigned at random to either Group A or Group B. A group of 116 patients (Group A) had needlescopic separation of the neck of the sac and peritoneal defect closure. The remaining 114 patients (Group B) underwent needlescopic separation without peritoneal defect closure (Sutureless group). A total of 260 hernial defects in 230 patients were repaired using needlescopic disconnection with or without suturing of the defect. There were 89 females (38.7%) and 141 males (61.3%), with a mean age of 5.14 ± 2.79 years. In Group A, the mean operation time was 27.98 ± 2.89 for a unilateral hernia and 37.29 ± 4.68 for a bilateral one, whereas, in Group B, the mean operation time was 20.37 ± 2.37 and 23.38 ± 2.22 for a unilateral and bilateral hernia, respectively. In terms of the operating time, whether unilateral or bilateral, there was a significant difference between the groups. There was no significant difference between groups A and B in the mean Internal Ring Diameter [IRD], which was 1.21 ± 0.18 cm in group A and 1.19 ± 0.11 cm in group B. Throughout the follow-up period, there was no postoperative hydrocele formation, recurrence, iatrogenic ascending of the testes, or testicular atrophy. All patients had nearly invisible scars with no keloid development at 3 months follow-up. Needlescopically separating the hernia sac without stitching the peritoneal defect is feasible, safe, and less invasive. It provides outstanding cosmetic results with a short operative time and no recurrence.
Topics: Male; Female; Humans; Child, Preschool; Child; Hernia, Inguinal; Laparoscopy; Prospective Studies; Sutureless Surgical Procedures; Peritoneum; Herniorrhaphy; Retrospective Studies; Recurrence; Treatment Outcome
PubMed: 37341905
DOI: 10.1007/s13304-023-01566-9 -
Seminars in Cell & Developmental Biology Aug 2019The vertebrate intestine has a continuous dorsal mesentery between pharynx and anus that facilitates intestinal mobility. Based on width and fate the dorsal mesentery... (Review)
Review
The vertebrate intestine has a continuous dorsal mesentery between pharynx and anus that facilitates intestinal mobility. Based on width and fate the dorsal mesentery can be subdivided into that of the caudal foregut, midgut, and hindgut. The dorsal mesentery of stomach and duodenum is wide and topographically complex due to strong and asymmetric growth of the stomach. The associated formation of the lesser sac partitions the dorsal mesentery into the right-sided "caval fold" that serves as conduit for the inferior caval vein and the left-sided mesogastrium. The thin dorsal mesentery of the midgut originates between the base of the superior and inferior mesenteric arteries, and follows the transient increase in intestinal growth that results in small-intestinal looping, intestinal herniation and, subsequently, return. The following fixation of a large portion of the abdominal dorsal mesentery to the dorsal peritoneal wall by adhesion and fusion is only seen in primates and is often incomplete. Adhesion and fusion of mesothelial surfaces in the lesser pelvis results in the formation of the "mesorectum". Whether Toldt's and Denonvilliers' "fasciae of fusion" identify the location of the original mesothelial surfaces or, alternatively, represent the effects of postnatal wear and tear due to intestinal motility and intra-abdominal pressure changes, remains to be shown. "Malrotations" are characterized by growth defects of the intestinal loops with an ischemic origin and a narrow mesenteric root due to insufficient adhesion and fusion.
Topics: Embryo, Mammalian; Fetus; Humans; Mesentery
PubMed: 30142441
DOI: 10.1016/j.semcdb.2018.08.009 -
Current Opinion in Obstetrics &... Aug 2016Surgery can be an important treatment option for women with symptomatic endometriosis. This review summarizes the recommended preoperative work up and techniques in... (Review)
Review
PURPOSE OF REVIEW
Surgery can be an important treatment option for women with symptomatic endometriosis. This review summarizes the recommended preoperative work up and techniques in minimally invasive surgery for treatment of deeply infiltrating endometriosis (DIE) involving the obliterated posterior cul-de-sac, bowel, urinary tract, and extrapelvic locations.
RECENT FINDINGS
Surgical management of DIE can pose a challenge to the gynecologic surgeon given that an extensive dissection is usually necessary. Given the high risk of recurrence, it is vital that an adequate excision is performed. With improved imaging modalities, preoperative counseling and surgical planning can be optimized. It is essential to execute meticulous surgical technique and include a multidisciplinary surgical team when indicated for optimal results.
SUMMARY
Advanced laparoscopic skills are often necessary to completely excise DIE. A thorough preoperative work up is essential to provide correct patient counseling and incorporation of the preferred surgical team to decrease complications and optimize surgical outcomes. Surgical management of endometriosis is aimed at ameliorating symptoms and preventing recurrence.
Topics: Digestive System Surgical Procedures; Douglas' Pouch; Endometriosis; Female; Humans; Intestinal Diseases; Laparoscopy; Minimally Invasive Surgical Procedures; Pelvic Pain; Postoperative Complications; Rectal Diseases; Reproductive Medicine; Treatment Outcome
PubMed: 27273310
DOI: 10.1097/GCO.0000000000000291 -
Gastroenterology Report Oct 2020The Denonvilliers' fascia (DVF) plays an important role in rectal surgery because of its anatomic position and its relationship to the surrounding organs. It affects the... (Review)
Review
The Denonvilliers' fascia (DVF) plays an important role in rectal surgery because of its anatomic position and its relationship to the surrounding organs. It affects the surgical plane anterior to the rectum in the procedure of total mesorectal excision (TME). Anatomical and embryological studies have helped us to understand this structure to some extent, but many controversies remain. In terms of its embryonical origin, there are three mainstream hypotheses: peritoneal fusion of the embryonic cul-de-sac, condensation of embryonic mesenchyme, and mechanical pressure. Regarding its architecture, the DVF may be a single, two, or multiple layers, or a composite single-layer structure. In women, most authors deem that this structure does exist but they are willing to call it the rectovaginal septum rather than the DVF. Operating behind the DVF is supported by most surgeons. This article will review those mainstream studies and opinions on the DVF and combine them with what we have observed during surgery to discuss those controversies and consensuses mentioned above. We hope this review may help young colorectal surgeons to have a better understanding of the DVF and provide a platform from which to guide future scientific research.
PubMed: 33163188
DOI: 10.1093/gastro/goaa053 -
Archives of Iranian Medicine Jun 2020Our aim was to investigate the pathologies in the hernia sac in adults, and the frequency of malignancy as well as to confirm the necessity of maintaining the current...
BACKGROUND
Our aim was to investigate the pathologies in the hernia sac in adults, and the frequency of malignancy as well as to confirm the necessity of maintaining the current applications in histological examination of the hernia sac.
METHODS
Patients who were operated for hernia in our clinic from 2013 to 2019 were included in the study. Patient data were evaluated retrospectively. We divided the patients into four groups, according to the type of hernia. We evaluated the demographic characteristics of the patients, the pathologies within the hernia sac, histopathological examination outcomes of the hernia sac and clinical features of malignancy in patients with malignancy.
RESULTS
A total number of 556 adult patients underwent inguinal, femoral, umbilical or incisional hernia repair in our hospital. Nine patients (0.61%) had malignancy in the hernia sac. Three out of nine patients (33%) had no preoperative diagnosis of malignancy. Six patients (67%) had a known history of malignancy. Two tumors were located in the inguinal (22.0%), six tumors in the incisional (67%), and one in the umbilical (11%) hernia sacs. Among these, 56% were of gastrointestinal, 22% of gynecological, 11% of breast and 11% of epididymis origin. Most of the other pathologies found in the hernia sac were herniated bowel segments, lipomas and omentum.
CONCLUSION
Since the hernia sac might be the first clue for an underlying cancer, if abnormal pathological findings are detected during surgery, histopathological examination should be performed to exclude malignancy. The purpose of histological examination is to detect a hidden malignancy.
Topics: Abdominal Neoplasms; Adolescent; Adult; Aged; Aged, 80 and over; Appendicitis; Child; Female; Hernia, Abdominal; Hernia, Femoral; Hernia, Inguinal; Herniorrhaphy; Humans; Lipoma; Male; Middle Aged; Omentum; Retrospective Studies; Young Adult
PubMed: 32536178
DOI: 10.34172/aim.2020.34 -
Surgical Endoscopy Jan 2021Ventral hernia repair is typically performed via a transabdominal approach and the peritoneal cavity is opened and explored. Totally extraperitoneal ventral hernia...
BACKGROUND
Ventral hernia repair is typically performed via a transabdominal approach and the peritoneal cavity is opened and explored. Totally extraperitoneal ventral hernia repair (TEVHR) facilitates dissection of the hernia sac without entering the peritoneal cavity. This study evaluates our experience of TEVHR, addressing technique, decision-making, and outcomes.
METHODS
This is an IRB-approved retrospective review of open TEVHR performed between January 2012 and December 2016. Medical records were reviewed for patient demographics, operative details, postoperative outcomes, hospital readmissions, and reoperations.
RESULTS
One hundred sixty-six patients underwent TEVHR (84 males, 82 females) with a mean BMI range of 30-39. Eighty-six percent of patients underwent repair for primary or first-time recurrent hernia, and 89% CDC wound class I. Median hernia defect size was 135 cm. Hernia repair techniques included Rives-Stoppa (34%) or transversus abdominis release (57%). Median operative time was 175 min, median blood loss 100 mL, and median length of stay 4 days. There were no unplanned bowel resections or enterotomies. Four cases required intraperitoneal entry to explant prior mesh. Wound complication rate was 27%: 9% seroma drainage, 18% superficial surgical site infection (SSI), and 2% deep space SSI. Five patients (3%) required reoperation for wound or mesh complications. Over the study, four patients were hospitalized for postoperative small bowel obstruction and managed non-operatively. Of the 166 patients, 96%, 54%, and 44% were seen at 3-month, 6-month, and 12-month follow-ups, respectively. Recurrences were observed in 2% of patients at 12-month follow-up. One patient developed an enterocutaneous fistula 28 months postoperatively.
CONCLUSIONS
TEVHR is a safe alternative to traditional transabdominal approaches to ventral hernia repair. The extraperitoneal dissection facilitates hernia repair, avoiding peritoneal entry and adhesiolysis, resulting in decreased operative times. In our study, there was low risk for postoperative bowel obstruction and enterotomy. Future prospective studies with long-term follow-up are required to draw definitive conclusions.
Topics: Abdominal Wall; Abdominoplasty; Aged; Female; Hernia, Ventral; Herniorrhaphy; Humans; Male; Middle Aged; Operative Time; Peritoneum; Postoperative Complications; Recurrence; Reoperation; Retrospective Studies; Seroma; Surgical Wound Infection
PubMed: 32030549
DOI: 10.1007/s00464-020-07374-1 -
Diseases of the Colon and Rectum Dec 2022
Topics: Humans; Female; Douglas' Pouch; Endometriosis
PubMed: 36102875
DOI: 10.1097/DCR.0000000000002604