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Hernia : the Journal of Hernias and... Feb 2014Mesh repair of large ventral or incisional hernias is problematic when primary fascial closure cannot be achieved, as this leaves mesh exposed, bridging the gap. We...
BACKGROUND
Mesh repair of large ventral or incisional hernias is problematic when primary fascial closure cannot be achieved, as this leaves mesh exposed, bridging the gap. We describe a modified retromuscular sublay repair which overcomes this problem and report a retrospective review of cases to assess outcome.
METHODS
Mesh is positioned between transposed flaps of preserved hernial sac and rectus sheath. Patients undergoing this repair by one author (BT) from 1 January 2004 to 31 December 2010 were identified, and clinical outcome was assessed by a combination of case-note review, outpatient consultation and telephone interview.
RESULTS
Twenty-one ventral and incisional hernias were treated by this method. Eighteen were incisional (13 midline, three transverse and two oblique incisions), and three were primary paraumbilical hernias. Defect sizes ranged from 25 to 500 cm(2) and mesh sizes from 300 to 900 cm(2). Patients were reviewed at 6 weeks, 6 months and at a median of 37 months post-operatively. Three cases of superficial skin edge necrosis, two superficial wound infections and two sizeable seromas developed, but all had resolved within 6 months. One patient developed abdominal wall necrosis requiring mesh removal and eventual abdominal wall reconstruction without mesh, resulting in late recurrence. All other cases achieved excellent long-term outcomes with a high degree of patient satisfaction.
CONCLUSION
This is a useful method for repairing large ventral and incisional hernias when primary fascial closure is not achievable, combining a sublay mesh repair with autologous tissue transposition across the fascial gap.
Topics: Abdominal Wall; Adult; Aged; Aged, 80 and over; Fasciotomy; Female; Hernia, Ventral; Herniorrhaphy; Humans; Male; Middle Aged; Necrosis; Patient Satisfaction; Peritoneum; Retrospective Studies; Seroma; Surgical Flaps; Surgical Mesh; Surgical Wound Infection
PubMed: 23568492
DOI: 10.1007/s10029-013-1086-7 -
An adolescent with ileum herniation through foramen of winslow: A case report and literature review.Nigerian Journal of Clinical Practice Aug 2022Herniation through foramen of Winslow is a relatively rare group of hernias characterized by protrusion of the abdominal contents into the lesser sac. To our knowledge,... (Review)
Review
BACKGROUND
Herniation through foramen of Winslow is a relatively rare group of hernias characterized by protrusion of the abdominal contents into the lesser sac. To our knowledge, this is the youngest and the only reported case related to adolescents in the last five years.
CASE PRESENTATION
A 15-year-old male patient presented to our emergency department after experiencing 4 hours of acute dull upper abdominal pain. We diagnosed the patient with herniation through foramen of Winslow by computed tomography (CT) and other complementary diagnostic methods. After a 3-trocar laparoscopic procedure, the hernia was successfully repositioned and no bowel resection was required. The patient was discharged on the fourth postoperative day without complications. He was no recurrence six months after operation.
CONCLUSIONS
Through the review of the literature, it is clear that herniation through foramen of Winslow (HFW) is a more challenging condition to diagnose preoperatively, which can be achieved with the help of complementary diagnostics especially CT. As a category of diseases with a very low postoperative recurrence rate, clinical experience tells us that only three-trocar laparoscopic surgery can successfully return HFW.
Topics: Abdomen, Acute; Adolescent; Hernia; Herniorrhaphy; Humans; Ileum; Laparoscopy; Male; Peritoneal Cavity
PubMed: 35975390
DOI: 10.4103/njcp.njcp_1778_21 -
Asian Journal of Surgery Oct 2023To explore a method of visually establishing preperitoneal space. In this paper, the procedure is described in detail and its safety and efficacy evaluated.
OBJECTIVE
To explore a method of visually establishing preperitoneal space. In this paper, the procedure is described in detail and its safety and efficacy evaluated.
METHODS
A retrospective style was adopted. The clinical data of 33 patients who accepted the total visceral sac separation (TVS) procedure from December 2019 to November 2021 were collected. Observation indices included location and area of abdominal defect; surgical method and duration of operation to establish preperitoneal space and any postoperative complications; developments during follow-up. Follow-up was performed up to December 2021 using outpatient examination and telephone interview to detect any complications of incision or recurrence of ventral hernia.
RESULTS
For operative indices, all patients underwent the TVS procedure successfully except for one who had to be converted to laparoscopic intraperitoneal onlay mesh (IPOM) due to failure to establish preperitoneal space. The time required to establish preperitoneal space was 185.75 ± 44.37 s and the duration of hospital stay was 8.27 ± 1.42 days. No complications, such as abdominal bleeding or digestive tract injury, occurred during hospitalization. No complications of incision were observed during follow up, which lasted 2-24 months with an average of 7 months.
CONCLUSIONS
Preliminary results of the novel attempt to establish the preperitoneal space visually confirmed this to be a safe and feasible method. However, the sample size used here was small, with a short follow up. The details and notes need to be further discussed.
Topics: Humans; Retrospective Studies; Surgical Mesh; Hernia, Ventral; Laparoscopy; Peritoneum; Herniorrhaphy; Recurrence
PubMed: 37003886
DOI: 10.1016/j.asjsur.2023.03.055 -
The Journal of Obstetrics and... Jun 2004Omental ectopic pregnancy is a rare form of ectopic pregnancy. Presented here is a case primary omental ectopic pregnancy according to Studdiford's criteria. This...
Omental ectopic pregnancy is a rare form of ectopic pregnancy. Presented here is a case primary omental ectopic pregnancy according to Studdiford's criteria. This patient presented with epigastric pain and anemia without vaginal bleeding, lower abdominal or pelvic pain. Pregnancy status was confirmed after admission. Transvaginal ultrasound examination revealed intrauterine contraceptive device in situ and a large amount of free peritoneal fluid, but no intrauterine sac or adnexal mass. Laparoscopy was performed but pelvic pathology did not account for the 2500 mL of haemoperitoneum. Laparotomy was carried out and partial omentectomy was performed.
Topics: Adult; Diagnosis, Differential; Female; Humans; Omentum; Pregnancy; Pregnancy, Abdominal
PubMed: 15210048
DOI: 10.1111/j.1447-0756.2004.00188.x -
Peritoneal Dialysis International :... 2010Peritonitis in peritoneal dialysis (PD) patients is characterized by abdominal pain and dialysate leukocytosis. Abdominal abscesses have been reported in PD patients...
Peritonitis in peritoneal dialysis (PD) patients is characterized by abdominal pain and dialysate leukocytosis. Abdominal abscesses have been reported in PD patients with relapsing peritonitis. We report here 3 cases of lesser sac infection in PD patients who had severe abdominal pain but not generalized or diffuse peritonitis.
Topics: Abdominal Abscess; Abdominal Pain; Anti-Bacterial Agents; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Laparotomy; Male; Middle Aged; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Risk Assessment; Sampling Studies; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 20829546
DOI: 10.3747/pdi.2009.00093 -
Surgery, Gynecology & Obstetrics Oct 1955
Topics: Anatomy; Douglas' Pouch; Histological Techniques; Humans; Peritoneum; Racial Groups
PubMed: 13256326
DOI: No ID Found -
The Surgical Clinics of North America Apr 1984In a prospective randomized study, the need for a high ligature of the hernial sac at operation for indirect hernia was studied. Herniectomy without ligation of the sac... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
In a prospective randomized study, the need for a high ligature of the hernial sac at operation for indirect hernia was studied. Herniectomy without ligation of the sac did not increase the recurrence rate. In addition, the nonligated patients had less pain in the postoperative period. Herniography was used pre- and postoperatively to improve the diagnostics.
Topics: Adult; Follow-Up Studies; Hernia, Inguinal; Humans; Ligation; Male; Pain, Postoperative; Peritoneum; Postoperative Care; Postoperative Complications; Radiography; Recurrence; Time Factors; Wound Healing
PubMed: 6729671
DOI: 10.1016/s0039-6109(16)43286-x -
ANZ Journal of Surgery Dec 2021
Topics: Humans; Intestinal Obstruction; Intestinal Volvulus; Peritoneal Cavity
PubMed: 33949068
DOI: 10.1111/ans.16906 -
Journal of Minimally Invasive Gynecology 2020Laparoscopic uterine artery ligation may be performed during myomectomy or other uterine invasive procedures to reduce the amount of blood loss during surgery. In this...
OBJECTIVE
Laparoscopic uterine artery ligation may be performed during myomectomy or other uterine invasive procedures to reduce the amount of blood loss during surgery. In this video, the authors describe 3 different laparoscopic techniques to approach the uterine artery.
DESIGN
Step-by-step video demonstration of 3 different surgical techniques.
SETTING
Private hospital in Curitiba, Paraná, Brazil.
INTERVENTIONS
The main steps of uterine artery ligation are described in detail as well as different laparoscopic variants to this procedure.
ANTERIOR APPROACH
The impression of the uterine vessels can usually be seen anteriorly and laterally to the uterine cervix. After identification of the path of the uterine arteries, the peritoneum of the anterior cul-de-sac is opened over the vessels and the uterine artery is carefully dissected next to the lateral border of the uterine cervix. This dissection must be performed with extreme caution because the uterine veins are very close to the artery. Venous bleeding at this point of the dissection can be very difficult to control without ligating the vessels. After circumferential dissection of the artery, temporary occlusion is conducted using 2-0 polyester suture.
POSTERIOR APPROACH, LATERAL TO THE INFUNDIBULOPELVIC LIGAMENT
For ligation of the uterine artery posteriorly to the uterus and laterally to the pelvic infundibulum, opening of the peritoneum of the broad ligament should start immediately below the round ligament, parallel and medial to the external iliac vessels toward the base of the pelvic infundibulum. The avascular space is dissected by blunt dissection (traction and countertraction), identifying the lateral (external iliac vessels) and medial (pelvic infundibulum and the ureter attached to the peritoneum of the ovarian fossa) landmarks. The external iliac artery is dissected cranially to find the bifurcation of the common iliac artery and the internal iliac artery. The first medial branch of the anterior division of the internal iliac usually is the uterine artery. After circumferential dissection of the uterine artery, it may be ligated according to the same technique described above.
MEDIAL APPROACH
For the medial approach, the peritoneum should be opened medial to the infundibulopelvic ligament. The assistant grasps the infundibulopelvic ligament, creating a peritoneal tent. Immediately after broad ligament opening, anatomic landmarks are identified. First, the ureter is identified and medialized. For the identification of vascular anatomy, movement of the obliterated umbilical artery is made active, which reduces the risk of error to ligate the uterine artery. After circumferential dissection of the artery, it may be ligated according to the same technique described above.
CONCLUSION
Laparoscopic uterine artery ligation may be performed during laparoscopic myomectomy to reduce intraoperative blood loss. According to the position of the myomas within the uterus as well as the uterine volume, the surgeon may choose among 1 of the above-mentioned techniques to perform. This technique could also be applied to other types of invasive uterine procedures to reduce blood loss. Standardization of these techniques could help to reduce the laparoscopic learning curve.
Topics: Female; Humans; Laparoscopy; Peritoneum; Uterine Artery; Uterine Cervical Neoplasms; Uterus
PubMed: 31493570
DOI: 10.1016/j.jmig.2019.08.026 -
Peritoneal Dialysis International :... 2011
Topics: Abdominal Abscess; Abdominal Pain; Female; Humans; Male; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis
PubMed: 21555421
DOI: 10.3747/pdi.2010.00266