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Kumar N, Das A, Dhamala I, Basu S. The Use of CECT in the Diagnosis of Intestinal Obstruction: A Case of Difficult Diagnosis in a Strangulated Left Femoral Hernia. Niger J Clin Pract 2024; 27:534-536. [PMID: 38679778 DOI: 10.4103/njcp.njcp_590_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/04/2024] [Indexed: 05/01/2024]
Abstract
ABSTRACT A femoral hernia is an uncommon and acquired hernia in the groin. Its incidence in adults is 2%-8% of all abdominal wall hernias, and it has a female-to-male ratio of 1.8:1. It is usually found in elderly patients and is associated with increased morbidity due to delays in diagnosis leading to a high incidence of incarceration and strangulation. Accurate preoperative diagnosis of femoral hernia is challenging, especially in obese patients in whom a small femoral hernia can be hidden under the groin fat. Unlike an inguinal hernia, it rarely reduces on its own and if asymptomatic and small, is often unnoticed by the elderly obese patient. Femoral hernia is often unsuspected and overlooked in males as it is predominant among females. Delay in diagnosis can lead to intestinal gangrene and high morbidity. We present a case of an incarcerated left femoral hernia in an elderly obese male who presented with acute intestinal obstruction. He was managed with resection of the gangrenous segment and double barrel ileostomy. Although uncommon in males, a femoral hernia has a high incidence of strangulation, and therefore should always be ruled out as a cause of acute intestinal obstruction in elderly patients. Therefore, never forget to examine the groin in case of intestinal obstruction.
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Affiliation(s)
- N Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Beji H, Bouassida M, Chtourou MF, Zribi S, Laamiri G, Kallel Y, Mroua B, Mighri MM, Touinsi H. Predictive factors of bowel necrosis in patients with incarcerated femoral hernia. Hernia 2023; 27:1491-1496. [PMID: 36943519 DOI: 10.1007/s10029-023-02776-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Intestinal necrosis is a frequent complication in patients with incarcerated femoral hernias (IFH). Knowing the low incidence of IFH, few series with large samples studied predictive factors of intestinal necrosis. The main objectives of our study were to determine the predictive preoperative factors of intestinal necrosis in patients with IFH and to compare its morbidity with that related to incarcerate inguinal hernias (IIH). METHODS We conducted a retrospective observational cohort study in which we included patients with incarcerated groin hernias (IGH). This is a single-center study between January 2004 and December 2021. Patients were divided into two groups: group A (admitted for IFH) and group B (admitted for IIH). Intestinal necrosis was confirmed intraoperatively. RESULTS 383 patients with IGH were included in the study: 91 patients had IFH (23.76%) and 282 patients had IIH (76.24%). In patients with IFH, the median age was 67 years. We had 60 females (66%) and 31 males (34%). Bowel ischemia was present in 29 patients (32%). Bowel necrosis was present in 14 patients (16%). We identified three independent variables predicting bowel necrosis in patients with IFH: Duration from symptoms to surgery, NLR (Neutrophil to Lymphocyte ratio), and urea. Bowel ischemia and bowel necrosis were significantly higher in patients with IFH compared to those with IIH. CONCLUSIONS In summary, we found that duration from symptoms to surgery, NLR, and urea were significantly predictive of intestinal necrosis in patients with IFH.
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Affiliation(s)
- H Beji
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - M Bouassida
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - M F Chtourou
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - S Zribi
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - G Laamiri
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Y Kallel
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - B Mroua
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - M M Mighri
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - H Touinsi
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Bayissa BB, Borena AM. Transverse colon and omental incarceration in femoral hernia: a case report. J Surg Case Rep 2023; 2023:rjad496. [PMID: 37701449 PMCID: PMC10493078 DOI: 10.1093/jscr/rjad496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
A femoral hernia is one of the groin hernias with a high chance of incarceration and strangulation due to its narrow neck. Here, we report a case of transverse colon incarceration. A 65-year-old female patient presented with groin mass that failed to reduce and a dragging pain. Elective open femoral herniorrhaphy was done with the finding of viable incarcerated massive momentum along with transverse colon. Femoral hernias have a female-to-male ratio of about 10:1. Postmenopausal, increasing age, and constipation were some of the risk factors identified in our patient. Various types of organs can be found in the femoral hernia sac but one of the rarely reported organ was found in our case: a transverse colon. Femoral hernia with a large bulky soft mass can get incarcerated easily but relatively less prone to strangulation.
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Affiliation(s)
- Badhaasaa Beyene Bayissa
- Department of Surgery, College of Public Health and Medical Sciences, Haramaya University, Harar 251, Ethiopia
| | - Ayantu Mekonnon Borena
- Department of Obstetrics and Gynecology, College of Public Health and Medical Sciences, Haramaya University, Harar 251, Ethiopia
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Vomer RP, York E, DeMatas K, Shah NP, Larick RS, Punj M, Rosario-Concepcion RA, Pujalte GGA. Telemedicine Evaluation of Hip Ailments. Cureus 2023; 15:e38900. [PMID: 37303331 PMCID: PMC10257509 DOI: 10.7759/cureus.38900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Background During the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has provided new means of patient care while still allowing for physical examination and history to be obtained. Hip ailments are a common musculoskeletal problem leading to limited function. Today, we lack a standardized telemedicine hip evaluation protocol. Aim The aim of this manuscript is to provide an efficient means of extracting relevant information while performing telemedicine examinations of the hip. Methods The authors have created a step-by-step evaluation guide for physicians to evaluate hip complaints, including inspection, palpation, range of motion, strength testing, functional assessment, gait analysis, and special testing, with images of each maneuver. Results We have developed a table of evaluation questions and instructions and a glossary of images of each maneuver to facilitate hip examination via telemedicine. Conclusions This manuscript provides a structured template for performing a telehealth examination of hip ailments.
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Affiliation(s)
- Rock P Vomer
- Family Medicine/Research, Mayo Clinic Jacksonville Campus, Jacksonville, USA
- Department of Family and Community Health/Department of Orthopedics, Division of Sports Medicine, Duke University, Durham, USA
| | - Emma York
- Family Medicine, Eastern Virginia Medical School, Norfolk, USA
| | - Kristina DeMatas
- Family Medicine/Sports Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
| | - Neil P Shah
- Family and Community Medicine, Mayo Clinic Jacksonville Campus, Jacksonville , USA
| | - Rayghan S Larick
- Family and Community Medicine, Eastern Virginia Medical School, Norfolk, USA
| | - Mantavya Punj
- Family Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
| | | | - George G A Pujalte
- Family Medicine/Orthopedics/Sports Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
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Comparison of mesh repair and suture repair for the treatment of incarcerated femoral hernia: a retrospective, single-center study. Surg Endosc 2023; 37:466-470. [PMID: 35999313 DOI: 10.1007/s00464-022-09488-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Femoral hernias often present with incarceration or strangulation that requires emergency surgery. However, recommendations vary regarding optimal approaches for incarcerated femoral hernia. The aim of this study is to compare clinical efficacy between mesh repair and suture repair for the treatment of incarcerated femoral hernia. METHODS Retrospective, single-center analysis of the clinical data from 48 patients with incarcerated femoral hernia, including 16 patients who underwent mesh repair (mesh repair group) and 32 patients who underwent traditional suture repair (suture repair group). RESULTS The mean age, body mass index, incarceration duration, hernia sac size, operation duration, and the rates of postoperative incision infection, recurrence, chronic pain, and mortality were not significantly different between the suture repair and mesh repair groups (P > 0.05 for all). In contrast, the female/male ratio; the rates of bowel obstruction, coexisting diseases, and nighttime operation; and the American Society of Anesthesiologists grade were higher and the rate of prophylactic antibiotic use and the mean cost of hospitalization were lower in the suture repair group than in the mesh repair group (P < 0.05 for all). CONCLUSION The surgical approach should be chosen based on the patient's condition. Mesh repair for the emergency treatment of incarcerated femoral hernia is safe and effective, whereas suture repair is suitable for elderly patients, those with more coexisting diseases, and those with limited life expectancy.
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Intestinal ischemia in patients with incarcerated groin hernia: proposal and validation of a score. Langenbecks Arch Surg 2022; 407:2547-2554. [PMID: 35478051 PMCID: PMC9045792 DOI: 10.1007/s00423-022-02521-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Abstract
Purpose Intestinal ischemia (II) is the most critical factor to determine in patients with incarcerated groin hernia (IGH) because II could be reversible, and it is considered as a “time sensitive condition.” Although predictive factors of II were identified in several previous studies, preoperative diagnosis of II cannot be reliably made or excluded by any known parameter. The aims of this study were: to devise and to validate a clinic-biologic score, with a strong discriminatory power, for predicting the risk of II in patients with IGH. Methods We conducted a retrospective bicentric study including 335 patients with IGH. Logistic regression analysis was used to identify independent predictive factors of II. We assigned points for the score according to the regression coefficient. The area under the curve (AUC) was determined using receiver operating characteristic (ROC) curves. The scoring system was then prospectively validated on a second independent population of 45 patients admitted for IGH in the same departments (internal validation). Results
Four independent predictive factors of II were identified: heart rate, duration of symptoms before admission, prothrombin, and neutrophil-to-lymphocyte ratio (NLR). A predictive score of II was established based on these independent predictive factors. Sensitivity was 94.50%; specificity was 92.70%. The AUC of this score was 0.97. The AUC was 0.96 when the score was applied on the second population of patients. Conclusions We performed a score to predict the risk of intestinal II with a good accuracy (the AUC of our score was 0.97). This score is reliable and reproducible, so it can help a surgeon to prioritize patients with II for surgery (especially at this time of COVID-19 pandemic), because ischemia could be reversible, avoiding thus intestinal necrosis.
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Coelho JCU, Hajar FN, Moreira GA, Hosni AVE, Saenger BF, Aguilera YSH, Costa MARD, Claus CMP. FEMORAL HERNIA: UNCOMMON, BUT ASSOCIATED WITH POTENTIALLY SEVERE COMPLICATIONS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1603. [PMID: 34669892 PMCID: PMC8521781 DOI: 10.1590/0102-672020210002e1603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although the laparoscopic access is becoming the preferable treatment for femoral hernia, there are only few studies on this important subject. AIM To assess the outcomes of the totally extraperitoneal laparoscopic (TEP) access in the treatment of femoral hernia. METHODS Data of 62 patients with femoral hernia who underwent herniorrhaphy were retrospectively reviewed. The diagnosis of femoral hernia was established by clinical and/or imaging exams in 55 patients and by laparoscopic findings in seven. RESULTS There were 55 (88.7%) females and 7 (11.3%) males, with female to male ratio of 8:1. The mean age was of 58.9±15.9 years, ranging from 22 to 92 years. Most patients (n=53; 85.5%) had single hernia and the remaining (n=9; 14.5%) bilateral, making a total of 71 hernias operated. Prior lower abdominal operations were recorded in 21 (33.9%) patients. Conversion to laparoscopic transabdominal preperitoneal procedure was performed in four (6.5%). Open herniorrhaphy was needed in two (3.2%), one with spontaneous enterocutaneous fistula in the groin region (Richter's hernia) and the another with incidental perforation of the adjacent small bowel that occurred during dissection of hernia sac. There was no mortality. CONCLUSION Femoral hernia is uncommon, and it may be associated with potentially severe complications. Most femoral hernias may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.
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Affiliation(s)
| | - Faissal Nemer Hajar
- Department of Surgery, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil
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Bowel obstruction as a serious complication of patients with femoral hernia. Surg Today 2020; 51:738-744. [PMID: 33030651 DOI: 10.1007/s00595-020-02158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The implications of bowel obstruction occurring secondary to femoral hernia have not been discussed in the literature recently. Thus, we report our experience of treating patients with femoral hernias complicated by bowel obstruction versus patients with femoral hernias not complicated by bowel obstruction. METHODS The subjects of this retrospective study were patients admitted to our hospital for the treatment of femoral hernias between 2016 and 2019. We used the Fisher and Student's T test to compare the preoperative characteristics, treatment, and outcomes of patients with bowel obstruction versus those without bowel obstruction. RESULTS A total of 53 patients (mean age, 66.9 ± 15.1 years) were treated, 18 (33.9%) of whom underwent elective surgery and 35 (66%) of whom required emergency surgery (p = 0.001). The mean time between the development of symptoms and hospitalization was 4.5 ± 3.1 days for the patients with bowel obstruction and 1.6 ± 3.2 days for those without bowel obstruction (p = 0.001). The length of hospital stay was 11.1 ± 21.1 days for the patients with bowel obstruction and 1 ± 1.8 days for those without bowel obstruction (p = 0.028). Overall morbidity and mortality rates were 13.2% and 5.6%, respectively. CONCLUSION Femoral hernias causing bowel obstruction are associated with greater time between the development of symptoms, hospitalization, and with a longer hospital stay.
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Chen P, Yang W, Zhang J, Wang C, Yu Y, Wang Y, Yang L, Zhou Z. Analysis of risk factors associated bowel resection in patients with incarcerated groin hernia. Medicine (Baltimore) 2020; 99:e20629. [PMID: 32502042 PMCID: PMC7306359 DOI: 10.1097/md.0000000000020629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Incarcerated groin hernia (IGH) is a common surgical emergency. However, there are few accurate and applicable predictors for differentiating patients with strangulated groin hernia from those with IGH. In this study, we aimed to identify the independent risk factors for bowel resection in patients with IGH. METHODS We retrospectively collected 323 patients who underwent emergency hernia repair surgery for IGH between January 2010 and October 2019. The patients were categorized into those who received bowel resection and those who did not require bowel resection. The receiver-operating characteristic curve was used to identify the best cutoff values for continuous variables. Following this, univariate and multivariate analyses were performed to identify potential risk factors for bowel resection in these patients. RESULTS Univariate analysis identified 6 variables that were significantly associated with bowel resection among patients with IGH. On multivariate analysis, neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] = 3.362, 95% confidence interval [CI] 1.705-6.628, P = .000) and bowel obstruction (OR = 3.191, 95% CI 1.873-5.437, P = 0.000) were identified as independent risk factors for bowel resection among patients with IGH. CONCLUSION In this study, an elevated NLR and those with bowel obstruction are associated with an increased risk of bowel resection among patients with IGH. Based on our findings, surgeons should prioritize prompt emergency surgical repair for patients who present with elevated NLR and bowel obstruction concurrent with IGH.
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Affiliation(s)
- Peng Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Wenming Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Jianhao Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Cun Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Yongyang Yu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Yong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
- Department of General Surgery, West China-Ziyang Hospital of Sichuan University/The First People's Hospital of Ziyang, Ziyang, Sichuan Province, China
| | - Zongguang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
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Marciniuk P, Jagielak D, Rogowski J, Gumiela P, Bury K. Femoral hernia in the era of TAVI - a potential obstacle for transfemoral approach: a case report and literature review. BMC Surg 2020; 20:26. [PMID: 32039722 PMCID: PMC7008545 DOI: 10.1186/s12893-020-0693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) via total percutaneous transfemoral approach is an increasingly common technique for aortic stenosis treatment. It is primarily indicated in elderly with serious comorbidities. The epidemiology of these patients tends to overlap with the incidence of femoral hernia (FH). The appearance of hernia sac at the approach site and insufficient preoperational examination can lead to serious complications. We present the first-ever reported case of subsequent femoral hernia repair during transfemoral TAVI. Case presentation This report presents a case of FH/TAVI coincidence and literature review of its epidemiology. Literature review was performed to analyze similarities of femoral hernia and TAVI. The case describes an 84-year old female referred for elective TAVI. Intraoperation incarcerated femoral hernia was noticed and directly repaired. Further TAVI steps were performed on regular basis. A 2-year follow-up reported no local and general complications related to procedures. Conclusions Unsuspected femoral hernia found subsequently with transfemoral TAVI may become a growing problem. The number of TAVI performed rises with indications expansion. Femoral hernia repairs constitute from 2 to 4% of all groin hernia. Both TAVI and FH are connected with elderly. Despite the fact of low FH incidence, growing number of TAVI performed and ageing of population, corresponds with higher possibility of complications. Most of these complications may end up fatal as they would involve high-risk patients. Insufficient attention is paid by cardiologists to the possible hernia appearance in the access site as this issue has been hardly ever presented in literature. Concomitant FH in TAVI patients should always be excluded in order to avoid serious complications. The case we report presents a successful subsequent FH repair during TAVI procedure. Further studies have to be conducted to provide data on how such problems ought to be managed.
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Affiliation(s)
- Piotr Marciniuk
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Dębinki 7, 80-952, Gdańsk, Poland.
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Dębinki 7, 80-952, Gdańsk, Poland
| | - Jan Rogowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Dębinki 7, 80-952, Gdańsk, Poland
| | - Piotr Gumiela
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Dębinki 7, 80-952, Gdańsk, Poland
| | - Kamil Bury
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Dębinki 7, 80-952, Gdańsk, Poland
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Köckerling F, Koch A, Lorenz R. Groin Hernias in Women-A Review of the Literature. Front Surg 2019; 6:4. [PMID: 30805345 PMCID: PMC6378890 DOI: 10.3389/fsurg.2019.00004] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/23/2019] [Indexed: 12/22/2022] Open
Abstract
Background: To date, there are few studies and no systematic reviews focusing specifically on groin hernia in women. Most of the existing knowledge comes from registry data. Objective: This present review now reports on such findings as are available on groin hernia in women. Materials and Methods: A systematic search of the available literature was performed in September 2018 using Medline, PubMed, Google Scholar, and the Cochrane Library. For the present analysis 80 publications were identified. Results: The lifetime risk of developing a groin hernia in women is 3-5.8%. The proportion of women in the overall collective of operated groin hernias is 8.0-11.5%. In women, the proportion of femoral hernias is 16.7-37%. Risk factors for development of a groin hernia in women of high age and with a positive family history. A groin hernia during pregnancy should not be operated on. The rate of emergency procedures in women, at 14.5-17.0%, is 3 to 4-fold higher than in men and at 40.6% is even higher for femoral hernia. Therefore, watchful waiting is not indicated in women. During surgical repair of groin hernia in females the presence of a femoral hernia should always be excluded and if detected should be repaired using a laparo-endoscopic or open preperitoneal mesh technique. A higher rate of chronic postoperative inguinal pain must be expected in females. Conclusion: Special characteristics must be taken into account for repair of groin hernia in women.
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Affiliation(s)
- Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
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12
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Midline preperitoneal repair for incarcerated and strangulated femoral hernia. Hernia 2018; 23:323-328. [PMID: 30448913 PMCID: PMC6456472 DOI: 10.1007/s10029-018-1848-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Femoral hernias constantly present as incarceration or strangulation and require emergency surgery. Incarcerated and strangulated femoral hernia repair remains challenging and controversial. The aim of our study was to analyze the efficacy of preperitoneal tension-free hernioplasty via lower abdominal midline incision for incarcerated and strangulated femoral hernia. METHODS Data of 47 patients who underwent emergency surgery for incarcerated or strangulated femoral hernias from January 2009 to December 2017 were retrospectively analyzed. According to the surgical incisions, they were divided into two groups: the observation group (21 cases) had a lower abdominal midline incision, and the control group (26 cases) had a traditional inguinal incision. General data of patients, intraoperative findings, operative time and postoperative complications were compared. RESULTS Patient characteristics showed that the two groups were comparable.15 cases (31.9%) underwent intestinal resection, and 32 cases (68.1%) underwent first-stage tension-free repair in total. The rate of first-stage tension-free hernioplasty was significantly higher in the observation group (18/21, 85.7% vs 14/26 53.8%, P = 0.020). No additional incision was required in the observation group, while six cases of the control group (23.1%) had an additional incision for intestinal resection and anastomosis (P = 0.026). Mean operative time (53.6 ± 24.7 min vs 77.9 ± 36.5 min, P = 0.012) and the length of hospital stay (6.3 ± 4.2 days vs 10.3 ± 6.9 days, P = 0.020) were significantly shorter in the observation group. The time of return to normal physical activity resulted significantly reduced compared to the control group (9.2 ± 4.1 days vs 13.3 ± 6.6 days, P = 0.017). The total incidence of postoperative complication (including chronic pain, foreign body sensation, hernia recurrence, wound infection and seroma/hematomas) in the observation group was lower (14.3% vs 42.3% P = 0.037). There were two recurrences in the control group. No mesh-related infection and no mortalities in two groups. CONCLUSIONS Midline preperitoneal approach for incarcerated and strangulated femoral hernia is a convenient and effective technique. It can improve the rate of first-stage tension-free repair of incarcerated femoral hernia and allow intestinal resection through the same incision, and with lower rate of postoperative complications.
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Incarcerated Femoral Hernia Repair with Ventralex™ Hernia Patch through Same Skin Incision and Suprainguinal Laparotomy. Case Rep Surg 2018; 2018:9719310. [PMID: 30425878 PMCID: PMC6217879 DOI: 10.1155/2018/9719310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/10/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To report our experience with incarcerated femoral hernia procedure, which allows laparotomy through same inguinal skin incision, inspection and resection of compromised bowel, and preperitoneal tension-free transabdominal repair with Ventralex™ Hernia Patch. Materials and Methods The suprainguinal laparotomy was performed via same groin incision without compromising iliopubic tract. The femoral ring was sealed with Ventralex™ Hernia Patch pulled through the abdominal cavity and secured outside. Five consecutive patients diagnosed with incarcerated femoral hernias were operated. All of them required laparotomy, either for bowel resection (n = 3) or for inspection of viability (n = 2). Results All patients tolerated the procedure well. There were no wound or mesh infections, incisional hernias, or recurrences during follow-up. Conclusions Our easy-to-master operative approach to incarcerated femoral hernia allows easy access to abdominal cavity through same groin incision without compromising iliopubic tract or midline laparotomy. Reduction of incarcerated bowel and its inspection and resection can be safely performed. The femoral ring defect can be effectively obliterated with Ventralex™ Hernia Patch.
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Dai W, Chen Z, Zuo J, Tan J, Tan M, Yuan Y. Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study. Hernia 2018; 23:267-276. [PMID: 30421299 PMCID: PMC6456471 DOI: 10.1007/s10029-018-1854-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/08/2018] [Indexed: 11/12/2022]
Abstract
Purpose This study aimed to explore risk factors of postoperative complications for adult patients with incarcerated groin hernia (IGH). Methods From January 2010 to December 2017, consecutive patients undergoing emergency hernia repair for IGH in our center were retrospectively reviewed. Postoperative complications, such as surgical site infection, seroma, hernia recurrence and mortality, were investigated, with risk factors for such complications analyzed using univariate and multivariate regressions. Results Sixty-four patients were included, with 51 males and 13 females (mean age 65.1, range 25–98 years). Ten patients (15.6%) underwent resection of necrotic bowel and anastomosis. 43 patients (67.2%) received open tension-free herniorrhaphy with polypropylene mesh, whereas the rest (32.8%) received herniorrhaphy without mesh. The overall postoperative complication rate was 40.6% (26/64), with an incisional complication rate of 31.2% (20/64) and an infection rate of 6.2% (4/64). At a median follow-up of 32 months, hernia recurrence and mortality were recorded in five cases each (7.8%). Mesh repair was associated with decreased recurrence rate compared with non-mesh repair (2.3% vs. 19.0%, p = 0.019). Diabetes mellitus (OR 8.611, 95%CI 1.292–57.405; p = 0.026) was an independent risk factor of postoperative complications, together with chronic obstructive pulmonary disease (COPD; OR 14.365, 95%CI 1.652–127.767, p = 0.016), intestinal necrosis (OR 14.260, 95%CI 1.079–188.460, p = 0.044), and general anesthesia (OR 14.543, 95%CI 1.682–125.711, p = 0.015) as risk for incisional complications after surgery. Conclusions Diabetes mellitus was an independent risk factor of postoperative complications for IGH, along with COPD, intestinal necrosis and general anesthesia associated with incisional complications. The use of polypropylene mesh did not increase infection or recurrence rate in this cohort.
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Affiliation(s)
- W Dai
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Z Chen
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - J Zuo
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - J Tan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - M Tan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China. .,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.
| | - Y Yuan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China. .,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.
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Halgas B, Viera J, Dilday J, Bader J, Holt D. Femoral Hernias: Analysis of Preoperative Risk Factors and 30-Day Outcomes of Initial Groin Hernias Using ACS-NSQIP. Am Surg 2018. [DOI: 10.1177/000313481808400949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Femoral hernias are infrequently encountered groin hernias. The purpose of this study was to describe the natural history of femoral hernias by evaluating patient demographics, comorbidities, operative details, 30-day mortality, and risk factors for postoperative complications compared with inguinal hernias and in reducible versus incarcerated hernias. Overall 5360 femoral hernia repairs and 183,173 inguinal hernia repairs were identified using the 2005 to 2015 American College of Surgeon-National Surgical Quality Improvement Program's database. Univariate analysis was used to compare patient characteristics between femoral and inguinal hernias and between reducible and nonreducible femoral hernias. Multivariable logistic regression analyses were used to identify risk factors for 30-day postoperative complications after repair. Femoral hernias accounted for 2.8 per cent of initial groin hernias and 18.9 per cent of all groin hernias in females. A total of 56.5 per cent of initial femoral hernias were nonreducible and these patients were significantly older. Rates of small bowel resection (5.7 vs 0.3%, P < 0.0001), exploratory laparotomy (2.5% vs 0.4%, P < 0.0001), and diagnostic laparoscopy (2.0% vs 0.7%, P < 0.0001) were significantly higher in incarcerated femoral hernias compared with reducible femoral hernias. There were significantly higher rates of unplanned return to the OR, postoperative sepsis, and 30-day mortality in incarcerated femoral hernias versus reducible femoral hernias. Most femoral hernias present incarcerated in older, female patients. Femoral hernias present more commonly incarcerated in patients with significant comorbid diseases and are associated with significantly increased rates of systemic, local, major, and minor complications, return to OR, and mortality. Careful consideration should be given for the evaluation of intestinal viability in the acute setting.
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Affiliation(s)
- Barret Halgas
- William Beaumont Army Medical Center, El Paso, Texas
| | | | - Joshua Dilday
- William Beaumont Army Medical Center, El Paso, Texas
| | - Julia Bader
- William Beaumont Army Medical Center, El Paso, Texas
| | - Danielle Holt
- Walter Reed National Military Medical Center, Bethesda, Maryland
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Proportion of femoral hernia repairs performed for recurrence in the United States. Hernia 2018; 22:593-602. [PMID: 29411165 DOI: 10.1007/s10029-018-1743-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Recurrence rates after femoral hernia repair (FHR) have not been reliably established in the USA. We sought to determine this trend over time. METHODS The proportion of primary and recurrent FHRs was determined for patients age ≥ 18 from: ACS-NSQIP (1/2005-12/2014), Premier (1/2010-09/2015), and institutional (1/2005-12/2014) data. Trends were analyzed using a one-tailed Cochran-Armitage test. RESULTS In the NSQIP database, 6649 patients underwent a FHR. In females, the proportion of FHRs performed for recurrence decreased from 14.0% in 2005 to 6.2% in 2014, p = 0.02. In males, there was no change: 16.7-16.1% 2005-2014 (p = 0.18). The Premier database included 4495 FHRs and our institution 315 FHRs. There was no difference for either gender over time in either data source, all p > 0.05. CONCLUSIONS The proportion of femoral hernia repairs performed for recurrence in the USA remained relatively constant in males in two large national databases between 2005 and 2015. In females, a decrease was seen in one of the large national databases.
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Kim G, Yan So JB, Shabbir A. Totally extra-peritoneal repair for acute incarcerated femoral hernia with intestinal obstruction. Int J Surg Case Rep 2017; 32:16-18. [PMID: 28214396 PMCID: PMC5312649 DOI: 10.1016/j.ijscr.2017.01.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/14/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Femoral hernias frequently present with incarceration, resulting in obstruction and strangulation. Laparoscopic groin hernia repairs have been shown in the elective setting to be an effective alternative to open repair. Acute incarceration of groin hernia with obstruction, though previously seen as a relative contraindication, has been increasingly repaired with minimally invasive techniques, with the potential benefit of avoiding the morbidity associated with a laparotomy. PRESENTATION OF CASE AND DISCUSSION We describe a case of an acutely incarcerated femoral hernia with intestinal obstruction that was repaired using the totally extra-peritoneal approach. A releasing incision was performed to facilitate reduction of hernia prior to mesh repair. Diagnostic laparoscopy through a separate incision was then performed. CONCLUSION This modification of the TEP repair technique for the acutely incarcerated and obstructed femoral hernia serves to minimise potential contamination by keeping the pre-peritoneal plane strictly separate from the intra-peritoneal space.
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Affiliation(s)
- Guowei Kim
- University Surgical Cluster, National University Health System, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jimmy Bok Yan So
- Senior Consultant National University Hospital, Professor of Surgery National University of Singapore, Department of Surgery, Singapore
| | - Asim Shabbir
- University Surgical Cluster, National University Health System, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Predicting 30-day postoperative mortality for emergent anterior abdominal wall hernia repairs using the American College of Surgeons National Surgical Quality Improvement Program database. Hernia 2016; 21:323-333. [DOI: 10.1007/s10029-016-1538-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 09/08/2016] [Indexed: 11/27/2022]
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Ram BR, Goud VS, Kumar DR, Reddy BK, Boda KS, Madipeddi V. Strangulated Groin Hernia Repair: A New Approach for All. J Clin Diagn Res 2016; 10:PC04-6. [PMID: 27190878 DOI: 10.7860/jcdr/2016/18037.7613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/29/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The available classical approaches for Groin hernia are multiple. The change of approach with change of incision is needed with these approaches when the bowel is gangrenous. AIM To evaluate the efficacy and safety of a new approach for all strangulated groin hernias (inguinal, femoral and obturator), in terms of change of approach/complications. MATERIALS AND METHODS It was conducted in surgical unit-2 of MGM Hospital, Kakatiya Medical College Warangal, Telangana State, India, from Nov 2000 to Oct 2010. Total 52 patients operated with classical approach were compared with 52 patients operated present new approach. All the cases (52+52) were with gangrenous bowel which required resection and end to end anastomosis of bowel. All the cases (52+52) were managed with mesh repair and the results were analysed. RESULTS In classical approach: Three cases required laparotomy (5.7%). Twelve cases required change of approach with change of incision (23%). Eight cases developed wound infection after mesh repair (15%). Four cases required removal of mesh (7.6%). Two Cases developed recurrence (3.8%). In present new approach: No laparotomy (0%), no change of incision (0%), no removal of mesh (0%) and no recurrence(0%). Only 2 cases (3.8%) developed wound infection at lateral part of incision ie. p<0.05. CONCLUSION This new approach for all - gives a best approach for strangulated groin hernias as it is easy to follow. It obviates the change of incision and need for a laparotomy. It further retains normal anatomy, prevents contamination of the inguinal canal and permits a mesh repair leading to decreasing the chances of recurrence.
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Affiliation(s)
- Bapurapu Raja Ram
- Associate Professor, Deparment of General Surgery, Mahathma Gandhi Memorial Hospital, Kakatiya Medical College , Warangal, Talangana, India
| | - Vallabhdas Srinivas Goud
- Associate Professor, Deparment of General Surgery, Mahathma Gandhi Memorial Hospital, Kakatiya Medical College , Warangal, Talangana, India
| | - Dodda Ramesh Kumar
- Professor, Deparment of General Surgery, Mahathma Gandhi Memorial Hospital, Kakatiya Medical College , Warangal, Talangana, India
| | - Bande Karunakar Reddy
- Professor, Deparment of General Surgery, Mahathma Gandhi Memorial Hospital, Kakatiya Medical College , Warangal, Talangana, India
| | - Kumara Swamy Boda
- Assistant Professor, Deparment of General Surgery, Mahathma Gandhi Memorial Hospital, Kakatiya Medical College , Warangal, Talangana, India
| | - Venkanna Madipeddi
- Assistant Professor, Deparment of General Surgery, Mahathma Gandhi Memorial Hospital, Kakatiya Medical College , Warangal, Talangana, India
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Muus Steffensen S, Ahm Sørensen J. Femoral hernia, a rare complication following deep inguinal lymph node dissection. BMJ Case Rep 2015; 2015:bcr2014208177. [PMID: 25858926 PMCID: PMC4401912 DOI: 10.1136/bcr-2014-208177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/04/2022] Open
Abstract
A 72-year-old woman underwent complete deep inguinal lymph node dissection on her right side subsequent to metastasis from malignant melanoma. On the second postoperative day, the patient reported of nausea and vomiting. She presented with a mass in the resected area that gradually increased in size to approximately 15×20 cm. The wound was opened a few hours after onset of symptoms and a large femoral hernia with 40 cm of small intestine was immediately revealed protruding in the groin. Prophylactic suturing of the inguinal ligament and Coopers ligament can reduce the risk of postoperative femoral hernia. Further, the authors argue that drainage for seroma and haematoma should be performed with utmost care, considering other possible causes and, if necessary, guided by ultrasonography.
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Affiliation(s)
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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Abstract
Reports on the outcomes of emergency and elective femoral hernia surgery are scarce. Most studies do not distinguish femoral hernia from other types of groin hernia; studies of femoral hernia alone are few in number. The main objective of the present study was to identify factors affecting morbidity of femoral hernia patients. We retrospectively analyzed data on 80 patients who underwent femoral hernia surgery between June 2009 and June 2013. Patients who did and did not experience morbidity were compared in terms of age, sex, hernia location, the presence of any comorbid disease, the type of anesthesia employed, the operative technique used, the type of surgical intervention, and performance of small bowel resection. Forty-three patients (53.8%) underwent emergency surgery because of incarceration. Of these, 18 (41.9%) experienced strangulation and underwent resection. Postoperative complications developed in 11 patients (13.8%). Upon multiple logistic regression analysis, visceral organ resection (of the small bowel and/or omentum) was the only independent predictor of significant morbidity (P < 0.05; odds ratio [OR]: 14.010, 95% confidence interval [CI]: 1.001-196.143). When diagnosed, femoral hernias should be electively repaired as soon as possible. The cumulative probability of strangulation rises over time. A requirement for bowel resection seems to significantly increase morbidity.
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Kulacoglu H. Mini-mesh repair for femoral hernia. Int J Surg Case Rep 2014; 5:574-6. [PMID: 25105770 PMCID: PMC4201027 DOI: 10.1016/j.ijscr.2014.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/20/2014] [Accepted: 07/07/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Femoral hernia consists only 4% of all primary groin hernias. It is described as “the Bête Noire of Hernias” because of its nature and anatomy which is difficult to understand for the surgeons and tendency to recurrence. Although there is some large series of femoral hernia in the literature, few studies prospectively comparing repair techniques especially for this type of hernia has been published. A new technique named mini-mesh repair is described here. PRESENTATION OF CASE After hernia sac is dissected completely and sent back into the preperitoneal space, femoral canal is exposed. A round or oval shaped patch is prepared in 1.5–2.5 cm in diameter according to the size of the femoral canal. Mesh is secured to the Cooper's ligament with 2/0 polypropylene suture. Eight femoral hernias in 8 patients were repaired with this new technique. Patient satisfaction is very good. One seroma and one limited ecchymosis were recorded. No recurrence was observed in a mean follow-up of 22.4 months. No chronic pain was recorded. DISCUSSION Many techniques for femoral hernia repair have been described to date with a variety of clinical outcomes. Each technique has its own advantages and disadvantages. Mesh repairs without tension seems to be better choices. When the transversalis fascia is healthy and strong in a patient with femoral hernia a large piece of mesh may be unnecessary. The simple technique described in this paper can be a good alternative. It is totally problem-oriented, and the burden of prosthetic material is very limited. CONCLUSION Mini mesh repair may be a good solution for selected patients with femoral hernia.
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Affiliation(s)
- Hakan Kulacoglu
- Diskapi Yildirim Beyazit Teaching and Research Hospital, Department of Surgery, Ankara, Turkey; Rize University School of Medicine, Department of Surgery, Rize, Turkey.
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Nishiwada S, Ishikawa H, Tsuji Y, Nakamura K, Mukogawa T, Matsusaka M, Ko S, Watanabe A. Kugel patch method prevents the development of a femoral hernia after inguinal herniorrhaphy. Surg Today 2014; 45:57-62. [PMID: 24633897 DOI: 10.1007/s00595-014-0880-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE A femoral hernia is a relatively rare condition, and no standard surgical methods have so far been established. In this study, we investigated the development of a femoral hernia after inguinal herniorrhaphy. METHODS A total of 1,969 patients who underwent surgery for an inguinal hernia from April 1992 to March 2012 were enrolled in this study. The patients were composed of 1,934 (98.2 %) inguinal hernia and 35 (1.8 %) femoral hernia patients. Of these, we retrospectively studied the femoral hernia cases with reference to the use of inguinal herniorrhaphy. RESULTS Of all 35 femoral hernia cases, six cases (17.1 %) were femoral type recurrences after inguinal herniorrhaphy performed by the conventional or mesh plug methods. The surgical methods used for the 35 cases were mesh plug repair in 15 cases (42.9 %), the Kugel patch method in seven (20.0 %) and conventional repair in 13 patients (37.2 %). Inguinal type recurrences developed in three cases (8.6 %) that were re-repaired by mesh plug repair or sac resection. There were no femoral or inguinal type recurrences after Kugel patch repair for a femoral hernia. CONCLUSIONS The results of this study suggested the importance of repairing all hernia orifices when repairing a groin hernia. The Kugel patch repair method is available for all inguinal region hernias by the same approach, and it seems to be useful for preventing the development of recurrence after surgery.
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Affiliation(s)
- Satoshi Nishiwada
- Department of Surgery, Nara Prefectural Nara Hospital, 1-30-1 Hiramatsu, Nara, 631-0846, Japan,
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Vagholkar K. Strangulated Femoral Hernia: A Challenging Surgical Vignette —Case Report and Review of Literature. INTERNATIONAL JOURNAL OF CLINICAL MEDICINE 2014. [DOI: 10.4236/ijcm.2014.52013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ramirez Valderrama A, Ruiz D, Malik M, Tiszenkel H. Femoral hernia sac laparoscopy: a case report. MINIM INVASIV THER 2013; 23:55-7. [PMID: 23992388 DOI: 10.3109/13645706.2013.831108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We present the case of a 64-year-old female with an incarcerated right femoral hernia, associated with a small bowel obstruction that was successfully treated with an open femoral hernia repair with plug. At the same time we performed a hernia sac laparoscopy to evaluate the viability of the previously reduced small bowel. The hernioscopy was performed with a 0° 5 mm scope with reliable evaluation of the peritoneal cavity. We confirm that hernioscopy is a safe and feasible procedure and provides useful information for the appropriate management of acute incarcerated femoral/inguinal hernias.
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Improved outcomes of incarcerated femoral hernia: a multivariate analysis of predictive factors of bowel ischemia and potential impact on postoperative complications. Am J Surg 2013; 205:188-93. [DOI: 10.1016/j.amjsurg.2012.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 02/02/2012] [Accepted: 03/22/2012] [Indexed: 11/18/2022]
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Donati M, Biondi A, Brancato G, Donati A, Basile F. Venous aneurysms of saphena magna: is this really a rare disease? : Comment to: A challenging hernia: primary venous aneurysm of the proximal saphenous vein. Hernia 2012; 17:115-7. [PMID: 23132637 DOI: 10.1007/s10029-012-1003-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
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Thomas PT, Kittappa K. The Thomas Repair of the strangulated femoral hernia - one skin incision for all. J Surg Case Rep 2011; 2011:8. [PMID: 24950046 PMCID: PMC3649276 DOI: 10.1093/jscr/2011.7.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Several methods of femoral hernia repair have been described. It is the one most likely to strangulate, its repair must often be accompanied by examination of, and sometimes resection of, bowel or omentum. We describe a new method to repair such a hernia.
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Affiliation(s)
- P T Thomas
- Department of General Surgery, Blackpool Victoria Hospital, Blackpool, UK
| | - K Kittappa
- Department of General Surgery, Blackpool Victoria Hospital, Blackpool, UK
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Roth N, Gangl O, Havlicek W, Függer R. The impact of emergency surgery on results of femoral hernia repair. Eur Surg 2010. [DOI: 10.1007/s10353-010-0573-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Incarcerated femoral hernia containing ipsilateral fallopian tube. Case Rep Med 2010; 2010:741915. [PMID: 20981264 PMCID: PMC2964038 DOI: 10.1155/2010/741915] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 10/03/2010] [Indexed: 11/18/2022] Open
Abstract
Femoral hernias are more common in women and lead to a substantial higher rate for an emergency operation, due to strangulation. Incarcerated femoral hernia with fallopian tube as a content is an extremely rare condition. A 20-year-old woman presented to the emergency department complaining of a 6-day right groin swelling, which became painful and tender to palpation during the last 48 hours. Preoperative ultrasonography detected an oedematous hernia sac, above the femoral vessels, suggesting the presence of an incarcerated femoral hernia. The patient eventually underwent emergency surgery and the diagnosis of a strangulated femoral hernia sac, containing fallopian tube, was established. No resection of the uterine tube was performed and the hernia was repaired with polypropylene plug. The postoperative period was uneventful and the woman was discharged on the second postoperative day.
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Tiernan JP, Katsarelis H, Garner JP, Skinner PP. Excellent outcomes after emergency groin hernia repair. Hernia 2010; 14:485-8. [DOI: 10.1007/s10029-010-0667-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 04/16/2010] [Indexed: 12/01/2022]
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Antal A, Hadjiev J. [Modified mesh implantation technique in traditional femoral hernia repairs]. Magy Seb 2010; 63:59-61. [PMID: 20400395 DOI: 10.1556/maseb.63.2010.2.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mesh implantation techniques are increasingly common in groin hernia repairs in Hungary. The mesh can be inserted via the traditional Lichtenstein technique or laparoscopic methods. We modified the traditional operation technique to reduce the incidence of femoral hernia recurrence. The medial and wider part of the mesh was slid in the preperitoneal space under Cooper's ligament and Lotheissen's sutures were fixed 1.5 centimeters from the edge of the mesh. Thus, in the case of a possible suture insufficiency, the probability of hernia recurrence is reduced due to the adhesion between the mesh and the surrounding tissue.
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Affiliation(s)
- András Antal
- Nagyatád Városi Kórház Sebészeti Osztály Nagyatád Bajcsy-Zsilinszky u. l.
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Garg P, Ismail M. Laparoscopic total extraperitoneal repair in femoral hernia without fixation of the mesh. JSLS 2009; 13:597-600. [PMID: 20042125 PMCID: PMC3030798 DOI: 10.4293/108680809x12589999537995] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We report on laparoscopic total extraperitoneal repair without fixation of mesh for femoral hernia in 6 patients. METHODS During a 3-year period, laparoscopic total extraperitoneal repair of femoral hernia was performed without mesh fixation in 6 patients. The recurrence rate, pain scores, hospital stay, and other morbidity parameters were noted. Pain scores were 1=no pain, 2=mild pain, 3=moderate pain, 4=severe pain, and 5=intolerable pain. RESULTS All 6 patients were females and had unilateral hernias. Mean age was 33.8+/-18.6 years, and follow-up ranged from 12 months to 36 months. Four patients were operated on while under spinal anesthesia, and 2 patients were operated on while under general anesthesia. Mean operating time was 29.2+/-10.7 minutes. The mean pain scores 24 hours and the first week after operation were, respectively, 2.33+/-0.52 and 1.33+/-0.52. Mean hospital stay was 1.17+/-0.41 days, and mean days to resumption of normal activities were 8.5+/-2.1 days. No patient had urinary retention or seroma formation in the postoperative period. At follow-up, no hernia had recurred. CONCLUSIONS Laparoscopic femoral hernia repair without fixing the mesh is safe, feasible, and associated with minimal morbidity and recurrence rates.
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Affiliation(s)
- Pankaj Garg
- Moulana Hospital, Perintalmanna, India; MM Institute of Medical Sciences and Research, Mullana, Haryana, India.
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Differentiation of Femoral and Inguinal Hernias on the Basis of Anteroposterior Relationship to the Inguinal Ligament on Multidimensional Computed Tomography. J Comput Assist Tomogr 2009; 33:678-81. [DOI: 10.1097/rct.0b013e3181977a0a] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yoo HG, Lee KM, Choi UJ. The Diagnostic Concordance of Femoral Hernia and the Factors Influencing Diagnosis. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.76.3.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ho-gil Yoo
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Kwang-man Lee
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Un-jong Choi
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
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No SM, Cho HC. Clinical Analysis of Femoral Hernia in Adult. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.76.6.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sang-Moon No
- Department of Surgery, Hernial Center, Daegu Fatima Hospital, Daegu, Korea
| | - Hae-Chang Cho
- Department of Surgery, Hernial Center, Daegu Fatima Hospital, Daegu, Korea
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Abstract
Inguinal hernias are common, with a lifetime risk of 27% in men and 3% in women. Inguinal hernia repair is one of the most common operations in general surgery. Despite more than 200 years of experience, the optimal surgical approach to inguinal hernia remains controversial. Surgeons and patients face many decisions when it comes to inguinal hernias: repair or no repair, mesh or no mesh, what kind of mesh, open or laparoscopic, extraperitoneal or transabdominal, and so forth. Inguinal hernia repairs have morbidity and recurrence rates that are not inconsequential. The search for the gold standard of repair continues.
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Affiliation(s)
- Jon Gould
- University of Wisconsin School of Medicine and Public Health, Department of Surgery, H4/726 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
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Longterm Results of a Prospective Study of 225 Femoral Hernia Repairs: Indications for Tissue and Mesh Repair. J Am Coll Surg 2008; 207:360-7. [DOI: 10.1016/j.jamcollsurg.2008.04.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 04/08/2008] [Accepted: 04/08/2008] [Indexed: 11/15/2022]
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Re: mortality after groin hernia surgery. Ann Surg 2008; 247:560; author reply 560. [PMID: 18376217 DOI: 10.1097/sla.0b013e3181661813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yau KK, Siu WT, Cheung YSH, Wong CHJ, Chung CCC, Li KWM. Laparoscopic management of acutely incarcerated femoral hernia. J Laparoendosc Adv Surg Tech A 2008; 17:759-62. [PMID: 18158805 DOI: 10.1089/lap.2006.0231] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Incarcerated femoral hernia is a common surgical emergency condition. Diagnosis is always obvious and straightforward by clinical examination, and open surgical repair is the mainstay of treatment. In the era of minimally invasive surgery, laparoscopic repair of femoral hernia has been shown to be feasible and safe. However, laparoscopic repair of acutely incarcerated femoral hernia has gained little discussion in the past. In this paper, we report the results of 8 consecutive cases of strangulated femoral hernia that was successfully managed by the laparoscopic approach.
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Affiliation(s)
- Kwok-Kay Yau
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
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Kim SK, Park CY, Choi SJN. The Clinical Characteristics and Recent Methods of Treatment in Femoral Hernia. Chonnam Med J 2008. [DOI: 10.4068/cmj.2008.44.2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Shin Kon Kim
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Chan Yong Park
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Jin Na Choi
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Suppiah A, Gatt M, Barandiaran J, Heng MS, Perry EP. Outcomes of emergency and elective femoral hernia surgery in four district general hospitals: a 4-year study. Hernia 2007; 11:509-12. [PMID: 17628736 DOI: 10.1007/s10029-007-0262-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 06/14/2007] [Indexed: 01/29/2023]
Abstract
INTRODUCTION A large number of femoral herniae present as emergencies accounting for significant morbidity and mortality, which have remained unchanged over the last decade. Reports of outcomes in femoral hernia surgery are scarce, even more so in district general hospitals where a significant proportion of surgeries are performed. This study compares results of emergency and elective femoral hernia surgery in four district general hospitals against published rates up to a decade ago. MATERIALS AND METHODS A retrospective study of all patients undergoing femoral hernia surgery in four district hospitals between 2000 and 2004. RESULTS Seventy-three patients had 75 (28 emergency, 47 elective) femoral hernia repairs. Emergency presentations were associated with increased age(P = 0.001) and right-sided hernias (P = 0.024). Emergency surgery led to increased bowel resection (10.7 vs. 0%, P < 0.001) and longer hospital stays (8 vs. 1 day, P < 0.001) compared to elective surgery. There was no difference in complication rates between emergency and elective surgery (21.4 vs. 12.8%, P = 0.322) or opposition and pectineal flap repair (12.9 vs. 36.4%, P = 0.149). Overall recurrence, morbidity, and mortality were 4.2, 16 and 1.3%, respectively. One patient (3.6%) died after emergency surgery, and no deaths occurred with elective surgery. CONCLUSION The proportion of femoral herniae presenting as emergencies remained unchanged. This accounts for the morbidity and mortality in femoral surgery, which remains high and similar to a decade ago. Early diagnosis by clinicians and general practitioners and elective surgery are required to reduce mortality. Further investigation into the effect of the opposition technique on femoral vein compression and deep venous thrombosis is warranted.
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Affiliation(s)
- A Suppiah
- Scarborough General Hospital, Woodlands Drive, Scarborough, Yorkshire YO12 6QL, UK.
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Baldassarre E, Valenti G, Torino G. Treatment of femoral hernia: systematically or occasionally? Am J Surg 2007; 193:290-1. [PMID: 17236867 DOI: 10.1016/j.amjsurg.2005.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 12/15/2005] [Indexed: 11/22/2022]
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