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Matovu A, Löfgren J, Wladis A, Nordin P, Sandblom G, Pettersson HJ. Incidence of groin hernia repairs in women and parity: a population-based cohort study among women born in Sweden between 1956 and 1983. Hernia 2024:10.1007/s10029-024-03011-1. [PMID: 38520614 DOI: 10.1007/s10029-024-03011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/03/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION The aim of this study was to evaluate the association between parity and the incidence rate of groin hernia repair in women. METHOD This study was based on two Swedish national registers, the Medical Birth Register (MBR), and the Swedish Hernia Register (SHR). The cohort constituted of women born between 1956 and 1983. Data on vaginal and cesarean deliveries were retrieved from the MBR. The birth and hernia registers were cross matched to identify hernia repairs carried out after deliveries. RESULTS A total of 1,535,379 women were born between 1956 and 1983. Among these, 1,417,237 (92.3%) were registered for at least one birth. The incidence rate for Inguinal Hernia Repair (IHR) and Femoral Hernia Repair (FHR) was 10.7 per 100,000 person-year and 2.6 per 100,000 person-year, respectively. Compared with women registered for one delivery, the incidence rate ratio for IHR was 1.31 (95% Confidence Interval: 1.23-1.40) among women registered for two deliveries, 1.70 (1.58-1.82) among women registered for ≥ 3 deliveries. Additionally, the incidence rate ratios were higher 1.30 (1.14-1.49) and 1.70 (1.49-1.95) for FHR among women with two and ≥ 3 registered deliveries, respectively. CONCLUSION In the present cohort, higher parity was associated with a higher incidence of inguinal as well as FHRs.
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Affiliation(s)
- A Matovu
- Mubende Regional Referral Hospital, Plot 6, Kakumiro Road, P.O. Box 4, Mubende, Uganda.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - J Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A Wladis
- Linköping University, Linköping, Sweden
| | - P Nordin
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - G Sandblom
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - H J Pettersson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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2
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Kinet S, Kuppens EFP, Maes H, Van Cleven S, De Paepe P, Van Droogenbroeck J. Diffuse large B-cell lymphoma presenting as an inguinal hernia - case report. Acta Chir Belg 2023; 123:695-698. [PMID: 36069512 DOI: 10.1080/00015458.2022.2122320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) masquerading as a recurrent inguinal hernia is rare. We report the case of a 73-year-old male patient who presented with a symptomatic bulge in his left groin. Medical history revealed bilateral preperitoneal inguinal hernia repair, osteoporosis and atrial fibrillation. The patient's further history was not significant. METHODS Sonography revealed recurrence of an indirect inguinal hernia (4.5 cm × 2.3 cm) on the left, with bilateral subcutaneous lymph nodes that were deemed unremarkable. We planned an elective left-sided anterior inguinal repair. Apixaban was stopped two days prior to surgery. RESULTS During surgery we identified the bulge as a lump attached to the spermatic cord. No hernial sac was present. Together with the consulting urologist, we concluded a possible malignant etiology and performed an orchiectomy along with resection of the lump. CONCLUSION Microscopic and immunohistochemical analysis revealed a DLBCL with non-germinal center phenotype and c-MYC rearrangement. Further staging confirmed stage IE disease with extranodal paratesticular involvement. The patient was subsequently treated with rituximab in combination with cyclophosphamide, doxorubicin, vincristine, prednisone and showed complete metabolic remission after two cycles. This case illustrates the broad differential diagnosis of inguinal swelling and (para)testicular tumors.
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Affiliation(s)
- Sam Kinet
- KU Leuven, AZ Alma (General Hospital), Eeklo, Belgium
| | - Eddy F P Kuppens
- Department of Abdominal and General Surgery, AZ Alma (General Hospital), Eeklo, Belgium
| | - Hendrik Maes
- Department of Abdominal and General Surgery, AZ Alma (General Hospital), Eeklo, Belgium
| | - Stijn Van Cleven
- Department of Abdominal and General Surgery, AZ Alma (General Hospital), Eeklo, Belgium
| | - Pascale De Paepe
- Department of Pathology, AZ St Jan Brugge (General Hospital), Bruges, Belgium
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Ghafoor S, Alkadhi H. Comment to: Diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias. Author's reply. Hernia 2023; 27:1335-1336. [PMID: 37642772 DOI: 10.1007/s10029-023-02867-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023]
Affiliation(s)
- S Ghafoor
- Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland.
| | - H Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland
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Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2023; 82:e115-e155. [PMID: 37596025 DOI: 10.1016/j.annemergmed.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023]
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Garcia EM, Pietryga JA, Kim DH, Fowler KJ, Chang KJ, Kambadakone AR, Korngold EK, Liu PS, Marin D, Moreno CC, Panait L, Santillan CS, Weinstein S, Wright CL, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Hernia. J Am Coll Radiol 2022; 19:S329-S340. [PMID: 36436960 DOI: 10.1016/j.jacr.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Abdominopelvic hernias are common clinical entities composed of a wide variety of congenital, traumatic, and iatrogenic etiologies. Any weakness in the body wall may result in hernia of cavity contents with concomitant risks of morbidity and mortality. Presentations may be specific, palpable body wall mass/bulge, or vague, nonspecific pain through bowel obstruction. This document focuses on initial imaging of the adult population with signs of symptoms prompting suspicion of abdominopelvic hernia. Imaging of the abdomen and pelvis to evaluate defects is essential for prompt diagnosis and treatment. Often CT and ultrasound are the first-line modalities to quickly evaluate the abdomen and pelvis, providing for accurate diagnoses and management of patients. MRI protocols may be useful as first-line imaging studies, especially in patients with orthopedic instrumentation. Although often performed, abdominal radiographs and fluorographic procedures may provide indirect evidence of hernias but are usually not indicated for initial diagnosis of hernia. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Board Member, Taubman Museum of Art.
| | - Jason A Pietryga
- Division Chief, Emergency Radiology at UNC Chapel Hill, Chapel Hill North Carolina; and University of Alabama at Birmingham, Birmingham, Alabama
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; and Vice-Chair of Education, University of Wisconsin Department of Radiology
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; Chair ACR LI-RADS; Division Chief, SAR Portfolio Director, RSNA Radiology Senior Deputy Editor
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Section Chief of Abdominal Imaging, Director of MRI, Chair of Committee on C-RADS
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital and Medical Director, Martha's Vineyard Hospital Imaging
| | - Elena K Korngold
- Section Chief, Body Imaging/Chair, Department of Radiology Promotion and Tenure Committee; Oregon Health and Science University, Portland, Oregon
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Lucian Panait
- President, Minnesota Hernia Center, Minneapolis, Minnesota; American College of Surgeons; American Hernia Society (member of the Technology and Value Assessment Committee); Practice Advisory Committee Member, American Hernia Society
| | - Cynthia S Santillan
- Vice-Chair of Clinical Operations, Department of Radiology, University of California San Diego, San Diego, California
| | | | | | - Jennifer Zreloff
- Georgia, Primary Care Physician, Emory University, Atlanta, Georiga; Medical Director, Seavey General Medicine Clinic; Assistant Director of Innovation Seavey Comprehensive Internal Medicine Clinic, Emory University, Atlanta, Georgia
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Section Chief Abdominal Imaging, Director of MRI and CT
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Al Jalbout N, Liteplo A, Shokoohi H. Point-of Care Ultrasound in Stratifying Clinically Evolving Inguinal and Femoral Hernias. J Emerg Med 2022; 63:257-264. [PMID: 35871988 DOI: 10.1016/j.jemermed.2022.04.034] [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: 02/10/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is an optimal imaging modality for the risk stratification of patients presenting to the emergency department (ED) with inguinal and femoral hernias, allowing for better evaluation of clinical presentations and guiding appropriate treatment. The lack of ultrasound classification for inguinal and femoral hernias has led to inconsistent use and often underuse of POCUS in this patient population. Several groin hernia classifications are available, but most are complex and often targeted toward surgical management. OBJECTIVES The objective of this study is to review the use of POCUS in the diagnosis of inguinal and femoral hernias, providing a synopsis of critical ultrasound findings in determining signs of incarceration, strangulation, and small bowel obstruction, and suggesting a simple and educative sonographic classification for inguinal or femoral hernias. DISCUSSION POCUS can reliably confirm the presence of groin hernias and can uniquely identify specific ultrasound findings predictive of complications, such as aperistaltic nonreducible bowel loops, free fluid in the hernia sac, and lack of color doppler in the entrapped mesentery and bowel walls. POCUS can also aid in determining the presence of small bowel obstruction by detecting dilated loops of bowel >25 mm adjacent and proximal to the hernia site. CONCLUSIONS In the ED, POCUS can confirm the presence of a hernia sac and identify and predict surgical emergencies, such as bowel incarceration or strangulation, which are the most important elements in the management of patients presenting with possible inguinal or femoral hernias.
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Affiliation(s)
| | - Andrew Liteplo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Hamid Shokoohi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Holmes RD, Yan YY, Mallinson PI, Andrews GT, Munk PL, Ouellette HA. Imaging Review of Hockey-related Lower Extremity Injuries. Semin Musculoskelet Radiol 2022; 26:13-27. [PMID: 35139556 DOI: 10.1055/s-0041-1731795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hockey is a fast-paced contact sport with a high incidence of injuries. Although injuries are more frequent among elite players, recreational hockey injuries are a common issue faced by primary care and emergency physicians. Lower extremity injuries in hockey are particularly important because they account for approximately a third of all injuries and > 60% of all overuse injuries. This pictorial review provides the general and specialty trained radiologist with a knowledge of the patterns of lower extremity injury that occur in ice hockey.
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Affiliation(s)
- R Davis Holmes
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Yet Yen Yan
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada.,Department of Radiology, Changi General Hospital, Singapore
| | - Paul I Mallinson
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Gordon T Andrews
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter L Munk
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Hugue A Ouellette
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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Chatzikonstantinou M, Toeima M, Ding T, Qazi A, Aston N. De Garengeot hernias. Over a century of experience. A systematic review of the literature and presentation of two cases. Acta Chir Belg 2022; 122:15-22. [PMID: 33153415 DOI: 10.1080/00015458.2020.1841484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
De Garengeot hernia is a rare femoral hernia that contains the vermiform appendix. It has always been a subject of interest, mainly because of its uncommon entity, but also because of the diagnostic challenge it presents and the lack of consensus in its surgical management. It mainly presents as an emergency, with strangulation of the femoral hernia and acute inflammation of the appendix. The purpose of this study is to present two cases of De Garengeot hernias, the different surgical approach in each one and to perform a systematic literature review on all published accounts of De Garengeot hernias focusing on the surgical management of the hernias that contained an inflamed appendix. A literature search was performed using the keywords 'De Garengeot hernia' and 'appendicitis in femoral hernia'. All the published papers in the English language from 1898 to the end of 2019, as well as two patients from Lewisham and Greenwich NHS Trust, were included. There were 110 female vs 17 males. The majority of the described approaches were via either a Lockwood, or a transinguinal (Lothestein/McVay) incision. Most of the operations were done with an open incision. In the presence of an inflamed appendix, most hernias were repaired with sutures. Forty-one patients had their hernia repaired with non-absorbable sutures and four with absorbable. Most of the patients recovered without complications and were discharged after an average of 4.82 days.
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Affiliation(s)
| | - Mohamed Toeima
- Department of General Surgery, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
| | - Tao Ding
- Department of Statistical Sciences, UCL, London, UK
| | - Almas Qazi
- Department of General Surgery, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Niall Aston
- Department of General Surgery, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
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Alomar OSK. Modified Halsted's operation for inguinal hernia repair: A new technique. Ann Med Surg (Lond) 2021; 71:102968. [PMID: 34712482 PMCID: PMC8529394 DOI: 10.1016/j.amsu.2021.102968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Inguinal hernia is a frequent problem presented to surgical clinic in Iraq. Surgical treatment options for inguinal hernia are numerous, selecting the appropriate method or technique depends on different factors. Aim of study To find a new technique for open inguinal hernia repair with no recurrence even in recurrent cases, without major complications during or after surgery, and can be used even by new surgeons with little experience. Patients & methods A retrospective cross sectional study conducted in the Medical City teaching hospital and Private Hospitals in Baghdad, during the period from January 1, 2000, to December 30, 2016 on convenient sample of 408 Iraqi patients with inguinal hernia. The patients were treated by modified Halsted's technique by open surgery applying polypropylene mesh. The patients were followed up through frequent visits and phone calls to assess the recurrence and complications. Results No recurrence of inguinal hernia was reported after 5-10 years follow up, while 94.9% of patients reported postoperative complications commonly oedema of spermatic cord. There was a highly significant association between male gender hernia patients and post Modified Halsted operation complications (p < 0.001). A highly significant association was observed between direct hernia and post Modified Halsted operation complications (p < 0.001). The significant risk factors related to complications were anemia and collagen disease. Conclusions The modified Halsted's operation for inguinal hernia repair is effective in treatment of inguinal hernia with low recurrence and complications rate.
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10
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Doukas SG, Doukas PG, Upadrasta N, Kothari N. Abdominal Pain and Examination of Hernial Orifices: The Forgotten Art of Physical Diagnosis. Cureus 2021; 13:e17486. [PMID: 34595069 PMCID: PMC8465645 DOI: 10.7759/cureus.17486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Acute abdominal pain can be the first manifestation of a hernial pathology. The estimated risk of incarcerated hernia is 1%-3% over a person's lifetime. Therefore, hernial orifice examination should be conducted routinely, especially in cases of abdominal pain. We hypothesized that physical examination of hernial orifices is not routinely performed and documented in patients presenting with acute abdominal pain. Methods: A retrospective chart review of 100 patients who were evaluated for abdominal pain over a three-month time frame at our institution. Results: From the 100 reviewed cases, the hernial orifice examination was performed in two cases by an Internal Medicine or Emergency Medicine physician (2%). Out of the eight cases with General Surgery consultation, only one case had hernial orifices examination (12.5%). In the 10 cases with Gastroenterology consultation, not a single case had hernial orifice examination. Conclusion: We demonstrate that hernial examination is infrequently performed in clinical practice and suggest that emphasis should be placed on the efficient performance of physical examination and maintain the art of physical diagnosis.
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Affiliation(s)
- Sotirios G Doukas
- Department of Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | | | - Nagasri Upadrasta
- Department of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Nayan Kothari
- Department of Medicine, Saint Peter's University Hospital, New Brunswick, USA
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Williams ML, McCarthy ASE, Lord SJ, Aczel T, Brooke-Cowden GL. Impact of ultrasound on inguinal hernia repair rates in Australia: a population-based analysis. ANZ J Surg 2021; 91:1604-1609. [PMID: 33870618 DOI: 10.1111/ans.16845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/09/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inguinal hernias are a common pathology that often requires surgical management. The use of groin ultrasound (GU) to investigate inguinal hernias is a growing area of concern as an inefficient use of healthcare resources. Our aim was to assess changes in the rates of GU and the impact on surgical practice. METHODS Medicare Item Reports and the Australian Institute of Health and Welfare Database were used to estimate annual GU and inguinal hernia repair (IHR) rates per 100 000 population for the period 2000/2001-2017/2018. Pearson's correlation coefficients and linear regression analyses were performed to assess associations between these variables. RESULTS Over the 18-year period, GU rates increased 13-fold from 88 to 1174 per 100 000 population. Overall, total IHR rates decreased from 217 to 192 per 100 000. Overall, unilateral IHR rates have decreased (182-146 per 100 000), bilateral IHRs have increased (35-46 per 100 000), laparoscopic IHR has increased (30-86 per 100 000) and open surgery has declined (187-106 per 100 000). The increase in GU rates were strongly associated with the decrease in unilateral (r = -0.936, P = <0.001) and increase in bilateral IHR rates (r = 0.924, P = <0.001). CONCLUSION The use of GU has increased substantially, potentially representing an unnecessary cost to the healthcare system. Rising GU rates are not associated with an increase in IHR, however, may contribute to the increasing rates of bilateral IHRs. This study supports the opinion that more extensive clinical and health policy initiatives are needed in Australia to address this health issue.
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Affiliation(s)
- Michael L Williams
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia
| | | | - Sally J Lord
- The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Thomas Aczel
- The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia.,Department of Surgery, Hawkesbury Hospital, Sydney, New South Wales, Australia
| | - Geoffrey L Brooke-Cowden
- The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia.,Department of Surgery, Auburn Hospital, Sydney, New South Wales, Australia
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Naidoo P, Levett K, Lord S, Meagher A, Williams N, Aczel T. How often are patients with clinically apparent inguinal hernias referred to a surgeon accompanied with an ultrasound? A prospective multicentre study. AUST HEALTH REV 2021; 45:36-41. [DOI: 10.1071/ah20027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/18/2020] [Indexed: 11/23/2022]
Abstract
ObjectivesThis study estimated the frequency of ultrasounds ordered for clinically obvious inguinal hernias in patients referred to surgeons and evaluated the clinical value of ultrasonography for this patient population.
MethodsThe present study was a prospective diagnostic and therapeutic impact study conducted in district, rural and tertiary referral hospitals in Sydney, Hawkesbury and Wagga Wagga, Australia. The study included adult patients (≥18 years of age) who had been referred to one of the participating surgeons for an elective inguinal hernia repair. The study determined the proportion of: (1) patients who underwent an inguinal hernia repair for a clinically obvious hernia and also had an ultrasound; (2) ultrasounds ordered by general practitioners (GPs); and (3) these ultrasounds that altered diagnosis and consequent surgical management from the surgeon’s perspective.
ResultsIn all, 144 participants were included in this study. Of these patients, 134 had a clinically apparent inguinal hernia on physical examination, and 63 of 133 patients (47%; 95% confidence interval (CI) 39–56%) underwent an ultrasound (information was missing for one patient). Overall 68 ultrasounds were ordered, with 63 ordered by GPs. Following the ultrasound, surgeons reported that one patient (1%; 95% CI 0–8 patients) had an altered diagnosis, and five patients (8%; 95% CI 3–17 patients) had altered management.
ConclusionThis study found that almost one in two patients referred to a surgeon with a clinically obvious inguinal hernia also underwent a groin ultrasound. These studies represent an unnecessary waste of limited healthcare resources and low-value medical care because they rarely affect the final diagnosis or surgical management.
What is known about the topic?Inguinal hernias are one of the most common presenting complaints to surgeons in Australia. Currently, there are no accepted Australian guidelines for the diagnosis of inguinal hernias. Ultrasound investigation has been shown to aid diagnosis when there is uncertainty after physical examination. There is increasing concern regarding low-value medical care that contributes to a significant waste of healthcare resources within Australia. The use of ultrasounds for the diagnosis of clinically apparent inguinal hernias is a potential area of concern.
What does this paper add?This paper is the first to estimate the frequency of ultrasounds being ordered for clinically apparent inguinal hernias. The study shows that approximately one in two patients who present to surgeons with a clinically obvious inguinal hernia have an ultrasound. GPs were the major referral source for these ultrasounds. Finally, these ultrasounds rarely altered final diagnosis or management for patients who presented to surgeons for definitive management.
What are the implications for practitioners?This study confirms that ultrasounds for clinically obvious inguinal hernias represent low-value medical care. Based on the results of this study, it is estimated that the cost to Medicare for unnecessary ultrasounds is approximately A$2.5 million per annum. Although it is beyond the scope of the present study to comment on the reasons for the apparent overinvestigation of ultrasounds for inguinal hernias, the findings suggest that clinical guidelines may help address this problem.
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Hoyos Brumbaugh ML, Drake B, Babij R. Complicated, Complete, Indirect, Irreducible Right Inguinoscrotal Hernia. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479320962010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Inguinal hernias are the most common of all hernias. A complicated hernia is irreducible, and the contents are obstructed or strangulated. Sonography is considered the imaging modality of choice for the diagnosis of abnormalities of the inguinal area. This case study is about a patient with an inguinal hernia that had not been repaired and progressed into a life-threatening, complicated inguinoscrotal hernia. The patient’s complaints and clinical findings required sonographic examinations of the abdomen, pelvis, inguinal canal, and scrotum. Sonographic findings were corroborated by findings with computed tomography (CT). After the compromised intestine was resected and the hernia was repaired, the patient developed a deep vein thrombosis (DVT), identified sonographically. The patient was successfully treated and discharged.
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Affiliation(s)
| | - Bryan Drake
- Retired, Family Medical Center, Weiser Memorial Hospital, Weiser, ID, USA
| | - Roman Babij
- Specialty Clinic, General Surgery, Weiser Memorial Hospital, Weiser, ID, USA
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Dhanani NH, Olavarria OA, Wootton S, Petsalis M, Lyons NB, Ko TC, Kao LS, Liang MK. Contralateral exploration and repair of occult inguinal hernias during laparoscopic inguinal hernia repair: systematic review and Markov decision process. BJS Open 2020; 5:6045324. [PMID: 33688950 PMCID: PMC7944513 DOI: 10.1093/bjsopen/zraa020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/09/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Contralateral clinically occult hernias are frequently noted at the time of laparoscopic unilateral inguinal hernia repair. There is no consensus on the role of contralateral exploration and repair. This systematic review assessed the safety and efficacy of operative repair of occult contralateral inguinal hernias found during unilateral repair. METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to February 2020. Adults diagnosed with a unilateral inguinal hernia undergoing laparoscopic repair were included. The primary outcome was the incidence of occult contralateral hernias. Summative outcomes of operative and expectant management were reported along with development of a Markov decision process. RESULTS Thirteen studies (1 randomized trial, 12 observational cohorts) with 5000 patients were included. The incidence of occult contralateral inguinal hernias was 14.6 (range 7.3-50.1) per cent. Among patients who underwent repair, 10.5 (4.3-17.0) per cent experienced a postoperative complication. Of patients managed expectantly, 29 per cent later required elective repair for symptoms. Mean follow-up was 36 (range 2-218) months. Using a Markov decision process, it was calculated that, for every 1000 patients undergoing unilateral inguinal hernia repair, contralateral exploration would identify 150 patients with an occult hernia. Repair would result in 15 patients developing a postoperative complication and 105 undergoing unnecessary repair. Alternatively, expectant management would result in 45 patients requiring subsequent repair. CONCLUSION Contralateral repair is not warranted in patients with occult hernias diagnosed at the time of elective hernia repair. The evidence is largely based on observational studies at high risk of bias.
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Affiliation(s)
- N H Dhanani
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - O A Olavarria
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - S Wootton
- Department of Pediatrics, Memorial Hermann Children's Hospital, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - M Petsalis
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - N B Lyons
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - T C Ko
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - L S Kao
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - M K Liang
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas, USA
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Truskett P. Hernia repair: are we looking through a 'keyhole' with rose-coloured glasses? ANZ J Surg 2020; 90:2155-2157. [PMID: 33200515 DOI: 10.1111/ans.16274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Philip Truskett
- Department of Surgery, Prince of Wales Clinical School UNSW, Sydney, New South Wales, Australia
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16
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Using Point-of-Care Ultrasound to Characterize Acute Inguinal Swelling of Young Children in the Pediatric Emergency Department. Pediatr Emerg Care 2020; 36:304-307. [PMID: 32011551 DOI: 10.1097/pec.0000000000002014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute inguinal swelling in young children is frequently assumed to be an inguinal hernia, often prompting a bedside reduction attempt. We report 3 cases of inguinal swelling where the use of point-of-care ultrasound changed the patients' management by identifying an alternate diagnosis, thus avoiding unnecessary and painful procedures as well as their associated sedation risks.
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Ruiz-Jasbon F, Ticehurst K, Ahonen J, Norrby J, Falk P, Ivarsson ML. Results at 3-year follow-up of totally extraperitoneal (TEP) hernia surgery with long-term resorbable mesh. Hernia 2020; 24:669-676. [PMID: 31925599 PMCID: PMC7210225 DOI: 10.1007/s10029-019-02116-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Synthetic non-resorbable mesh is almost standard in hernia surgery. However, several studies have showed negative effects of permanent implants such as chronic inflammation and complications involving different organs bordering the mesh. Such complications can raise the risk of chronic post-operative pain (CPP). Recently promising results regarding CPP have been published in patients with Lateral Inguinal Hernia (LIH) using a slowly resorbable mesh in Lichtenstein technique. For this reason the aim of the present study was to find the effect of a slowly resorbable implant on the long-term rate of hernia recurrence and chronic post-operative pain in patients with LIH repaired with TEP procedure. METHODS Prospective pilot study of TEP repair using TIGR® Matrix Surgical Mesh in 35 primary LIH. At 3-year follow-up the Visual Analogue Scale (VAS) and the Inguinal Pain Questionnaire were employed to assess pain. Recurrence was determined by ultrasound and clinical examination. RESULTS All patients completed the pain questionnaires but one patient did not attend the planned clinical examination for the 3-year follow-up. No patients had CPP, as defined in the World Guidelines for Groin Hernia Management. Almost all patients had lower VAS score in any activity 3 years following surgery in comparison to the preoperative period. Three patients (8.8%) suffered symptomatic recurrence during the 3-year follow-up. CONCLUSION TEP repair in patients with LIH using a synthetic long-term resorbable mesh was found to be encouraging respecting chronic post-operative pain at 3-year follow-up but at the cost of an increased risk of recurrence.
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Affiliation(s)
- F Ruiz-Jasbon
- Department of Surgery, Halland's Hospital, Kungsbacka, Sweden. .,Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
| | - K Ticehurst
- Department of Surgery, Halland's Hospital, Kungsbacka, Sweden
| | - J Ahonen
- Department of Surgery, Halland's Hospital, Kungsbacka, Sweden
| | - J Norrby
- Department of Surgery, Halland's Hospital, Kungsbacka, Sweden.,Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - P Falk
- Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - M-L Ivarsson
- Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
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18
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Chmiel E, Pearson K, Mori K. Over-ordering of ultrasound and pre-operative investigations for inguinal hernia repair at Northern Health: a Choosing Wisely audit. ANZ J Surg 2019; 89:1626-1630. [PMID: 31625220 DOI: 10.1111/ans.15495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/16/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Choosing Wisely Australia is an initiative aimed at reducing the incidence of unnecessary investigations. This study is an audit of Northern Health's adherence to two Choosing Wisely recommendations in the context of inguinal hernia repair. Recommendation 1: Avoid routinely performing pre-operative investigations in patients, but instead order in response to patient factors, signs and symptoms, disease or planned surgery. Recommendation 2: Do not order ultrasound for clinically apparent inguinal hernias. METHODS Records of 264 patients who underwent elective inguinal hernia repair at Northern Health in 2016 were reviewed. RESULTS Recommendation 1: Results demonstrated over-ordering of coagulation studies. Thirty-four percent of patients received coagulation studies, 86% of which were unindicated. There was better adherence to Choosing Wisely guidelines for other investigations: 38% of patients received a full blood examination (42% unindicated), 38% received a urea, electrolytes and creatinine (14% unindicated), 7% received a glycated haemaglobin (0% unindicated) and 38% received an electrocardiogram (11% unindicated). Recommendation 2: Seventy percent (n = 186) of patients received an ultrasound of which 25% (n = 46) had a documented indication. Correlation with surgical findings showed a positive predictive value of 95.6% and sensitivity of 97.8% for ultrasound. CONCLUSION Recommendation 1: Most pre-operative coagulation studies were unindicated, while adherence to Choosing Wisely guidelines was better for pre-operative full blood examination, urea, electrolytes and creatinine, glycated haemaglobin and electrocardiogram. Recommendation 2: The majority of patients received an inguinal hernia ultrasound, most of which had no documented indication.
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Affiliation(s)
- Edward Chmiel
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Department of General Surgery, Northern Health, Melbourne, Victoria, Australia.,Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kristen Pearson
- Department of General Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Krinal Mori
- Department of General Surgery, Northern Health, Melbourne, Victoria, Australia
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Imaging of diseases of the vagina and external genitalia in children. Pediatr Radiol 2019; 49:827-834. [PMID: 30612158 DOI: 10.1007/s00247-018-4324-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/29/2018] [Accepted: 12/09/2018] [Indexed: 10/27/2022]
Abstract
A wide range of congenital or acquired conditions, some pretty rare, may affect the vulva and vagina in children. Swelling, visible or palpable masses and abnormal discharges are common symptoms of conditions affecting the vulva and/or the lower genital tract. The majority of these diseases are benign. Ultrasonography is pivotal to elucidate the anatomical origin of these conditions and make the diagnosis. Magnetic resonance imaging can be relevant to improve diagnostic confidence and, if needed, to plan more accurate surgical treatment. The aim of this pictorial essay is to review the related imaging findings to help make radiologists familiar with these conditions.
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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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21
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Jayaram PR, Pereira FDA, Barrett JA. Evaluation of dynamic ultrasound scanning in the diagnosis of equivocal ventral hernias with surgical comparison. Br J Radiol 2018; 91:20180056. [PMID: 29745748 PMCID: PMC6209466 DOI: 10.1259/bjr.20180056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/24/2018] [Accepted: 05/02/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aims to compare ultrasonography for ventral hernias with surgical findings and establish its accuracy in equivocal cases. Comparison is also made against groin hernia ultrasound scanning, which has a positive predictive value ranging from 71-100%. METHODS A retrospective review of all patients who underwent an ultrasound scan between June 2011 and June 2015 was performed. The word "hernia" in the referral information was the sole inclusioncriterion. Patients who were found to have a clinically evident ventral hernia, unrelated hernia in aseparate location or had a known hernia were excluded. Thus, only patients with a clinically suspected ventral hernia and equivocal clinical assessment were included. These patients were followed up for at least 12 months and subsequent operation notes, if any, were also analysed. RESULTS 348 scans were included (F = 198, M = 150, F:M ratio = 1.32:1). The mean age was 53.4 years (range = 16-97 years). 101 scans were positive for hernias (29.0%), 190 were negative (54.3%), and 57 had other findings (e.g. seroma, lipoma; 16.3%). 54 patients were taken to surgery (15.5%), including 5 who were found to be negative on ultrasound. Of these, 45 were truepositives, 4 true-negatives, 4 false-negatives, and 1 false-positive, giving a sensitivity of 91.8% and positive predictive value of 97.8%. CONCLUSION This study confirms that ultrasound scans are effective in the diagnosis of equivocal ventral hernias. Advances in knowledge: The accuracy of ultrasound scanning specifically for ventral hernias is quantified, and are comparable to that of groin hernias.
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Affiliation(s)
| | | | - James A Barrett
- Radiology Department, West Suffolk Hospital, Bury Saint Edmunds, UK
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22
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Amato G, Romano G, Agrusa A, Rodolico V, Gordini L, Calò PG. Lipoma of the fossa femoralis mimicking a femoral hernia. Report of 2 cases. Int J Surg Case Rep 2018; 49:223-227. [PMID: 30032015 PMCID: PMC6076352 DOI: 10.1016/j.ijscr.2018.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Lipoma of the femoral fossa is uncommon. Often asymptomatic, femoral lipoma may growth within the circumscribed space of the femoral fossa causing pain and discomfort. A worsening pain caused by a lipomatous mass in the femoral area is a clinical feature that can mislead the diagnosis, resembling the more common condition of femoral hernia. METHODS Two cases of symptomatic lipomas of the femoral fossa mimicking an incarcerated femoral hernia are presented. In both, Caucasian female, patients clinical examination and ultrasound of the femoral region revealed a painful neoplasm suspected for incarcerated femoral hernia. RESULTS Intraoperatively, a mass of encapsulated fat arising from the bottom of the fossa femoralis was found. No visceral protrusion through the femoral ring could be documented. The neoplasms were removed in toto. Histology of the excised specimens evidenced the diagnosis of femoral lipomas suffering by chronic compressive damages. In a midterm postoperative follow up, both patients were symptom- free. DISCUSION A correct preoperative diagnosis of femoral lipoma is challenging, even following an accurate diagnostic pathway. The cases highlighted herewith seem to confirm that lipoma of the femoral fossa can be mistaken with a femoral hernia. CONCLUSIONS The clinical and histological features evidenced could result helpful in the differentiation of a lipomatous mass of the femoral fossa from a genuine femoral hernia.
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Affiliation(s)
- G Amato
- Postgraduate School of General Surgery, University of Cagliari, Monserrato, Cagliari, Italy.
| | - G Romano
- Department of General Surgery and Urgency, University of Palermo, Italy.
| | - A Agrusa
- Department of General Surgery and Urgency, University of Palermo, Italy.
| | - V Rodolico
- Department of Pathologic Anatomy and Histology, University of Palermo, Italy.
| | - L Gordini
- Department of Surgical Sciences, University of Cagliari, Monserrato, Cagliari, Italy.
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Monserrato, Cagliari, Italy.
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Childhood Asymmetry Labium Majus Enlargement (CALME): Description of Two Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071525. [PMID: 30029490 PMCID: PMC6069501 DOI: 10.3390/ijerph15071525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 11/21/2022]
Abstract
Background: Childhood asymmetry labium majus enlargement (CALME) is an uncommon, benign condition that occurs in pre- and early pubertal girls and is characterized by a painless, fluctuating, non-tender labial swelling with normal overlying skin. Recognition of this benign condition is essential. Differentiation with several other diseases that mimic CALME and require different diagnostic and therapeutic approaches is mandatory. Two cases of CALME are described in this report. Differential diagnoses and therapeutic approaches are highlighted. Case presentation: The first case was an 11-year-old Caucasian girl referred to our hospital for the evaluation of right labium majus, which showed a palpable, painless, soft, non-tender, non-erythematous enlargement measuring approximately 2 cm with indistinct borders. Ultrasound showed a mass 23 × 18 × 12 mm in diameter. Surgical excision of the mass was performed and in the histopathological evaluation, the tissue specimens were composed of haphazardly arranged vascular channels, adipose tissue and nervous elements that were components of the vulvar soft tissue and were compatible with the diagnosis of CALME. Case 2 was a 6-year-old Caucasian girl who presented a post-traumatic painless mass of left labium majus swelling that progressively increased in volume. Ultrasound study evidenced an ill-defined heterogeneous echotexture mass 26 × 15 × 10 mm in diameter and magnetic resonance imaging confirmed these findings. Histopathological examination was performed after bioptic sampling evidencing normal constituents of vulvar soft tissue, including fibroblast, collagen, adipose tissue, blood vessels and nerves compatible with CALME. Conclusions: CALME is a particular clinical condition that occurs mainly in pre-pubertal girls and has a benign course but poses numerous problems in differential diagnosis that can be solved only with careful clinical observation and with a careful use of radiological imaging techniques. Our cases, in agreement with recent literature, suggest that radical excision is not recommended and that surgical biopsy should be taken into consideration only in cases of doubt.
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Jansen CJ, Yielder PC. Evaluation of hernia of the male inguinal canal: sonographic method. J Med Radiat Sci 2018; 65:163-168. [PMID: 29665252 PMCID: PMC5986010 DOI: 10.1002/jmrs.275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 03/11/2018] [Indexed: 01/16/2023] Open
Abstract
Sonography of the male inguinal canal for hernia is a common request. There is debate about the accuracy and even need for sonographic assessment of inguinal hernia. A clear, concise method is presented, with correlated diagrams and sonographic images, which aims to improve the ability of sonographers to easily identify inguinal herniae.
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Abstract
INTRODUCTION Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. METHODS An expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group's first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as "strong" (recommendations) or "weak" (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term "should" refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores. The risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with "watchful waiting" since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment should be tailored to the surgeon's expertise, patient- and hernia-related characteristics and local/national resources. Furthermore, patient health-related, life style and social factors should all influence the shared decision-making process leading up to hernia management. Mesh repair is recommended as first choice, either by an open procedure or a laparo-endoscopic repair technique. One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered. Day surgery is recommended for the majority of groin hernia repair provided aftercare is organized. Surgeons should be aware of the intrinsic characteristics of the meshes they use. Use of so-called low-weight mesh may have slight short-term benefits like reduced postoperative pain and shorter convalescence, but are not associated with better longer-term outcomes like recurrence and chronic pain. Mesh selection on weight alone is not recommended. The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques. The use of other implants to replace the standard flat mesh in the Lichtenstein technique is currently not recommended. In almost all cases, mesh fixation in TEP is unnecessary. In both TEP and TAPP it is recommended to fix mesh in M3 hernias (large medial) to reduce recurrence risk. Antibiotic prophylaxis in average-risk patients in low-risk environments is not recommended in open surgery. In laparo-endoscopic repair it is never recommended. Local anesthesia in open repair has many advantages, and its use is recommended provided the surgeon is experienced in this technique. General anesthesia is suggested over regional in patients aged 65 and older as it might be associated with fewer complications like myocardial infarction, pneumonia and thromboembolism. Perioperative field blocks and/or subfascial/subcutaneous infiltrations are recommended in all cases of open repair. Patients are recommended to resume normal activities without restrictions as soon as they feel comfortable. Provided expertise is available, it is suggested that women with groin hernias undergo laparo-endoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia. Watchful waiting is suggested in pregnant women as groin swelling most often consists of self-limited round ligament varicosities. Timely mesh repair by a laparo-endoscopic approach is suggested for femoral hernias provided expertise is available. All complications of groin hernia management are discussed in an extensive chapter on the topic. Overall, the incidence of clinically significant chronic pain is in the 10-12% range, decreasing over time. Debilitating chronic pain affecting normal daily activities or work ranges from 0.5 to 6%. Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months postoperatively and decreasing over time. CPIP risk factors include: young age, female gender, high preoperative pain, early high postoperative pain, recurrent hernia and open repair. For CPIP the focus should be on nerve recognition in open surgery and, in selected cases, prophylactic pragmatic nerve resection (planned resection is not suggested). It is suggested that CPIP management be performed by multi-disciplinary teams. It is also suggested that CPIP be managed by a combination of pharmacological and interventional measures and, if this is unsuccessful, followed by, in selected cases (triple) neurectomy and (in selected cases) mesh removal. For recurrent hernia after anterior repair, posterior repair is recommended. If recurrence occurs after a posterior repair, an anterior repair is recommended. After a failed anterior and posterior approach, management by a specialist hernia surgeon is recommended. Risk factors for hernia incarceration/strangulation include: female gender, femoral hernia and a history of hospitalization related to groin hernia. It is suggested that treatment of emergencies be tailored according to patient- and hernia-related factors, local expertise and resources. Learning curves vary between different techniques. Probably about 100 supervised laparo-endoscopic repairs are needed to achieve the same results as open mesh surgery like Lichtenstein. It is suggested that case load per surgeon is more important than center volume. It is recommended that minimum requirements be developed to certify individuals as expert hernia surgeon. The same is true for the designation "Hernia Center". From a cost-effectiveness perspective, day-case laparoscopic IH repair with minimal use of disposables is recommended. The development and implementation of national groin hernia registries in every country (or region, in the case of small country populations) is suggested. They should include patient follow-up data and account for local healthcare structures. A dissemination and implementation plan of the guidelines will be developed by global (HerniaSurge), regional (international societies) and local (national chapters) initiatives through internet websites, social media and smartphone apps. An overarching plan to improve access to safe IH surgery in low-resource settings (LRSs) is needed. It is suggested that this plan contains simple guidelines and a sustainability strategy, independent of international aid. It is suggested that in LRSs the focus be on performing high-volume Lichtenstein repair under local anesthesia using low-cost mesh. Three chapters discuss future research, guidelines for general practitioners and guidelines for patients. CONCLUSIONS The HerniaSurge Group has developed these extensive and inclusive guidelines for the management of adult groin hernia patients. It is hoped that they will lead to better outcomes for groin hernia patients wherever they live. More knowledge, better training, national audit and specialization in groin hernia management will standardize care for these patients, lead to more effective and efficient healthcare and provide direction for future research.
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van Hout L, Bökkerink WJV, Ibelings MS, Heisterkamp J, Vriens PWHE. Outcomes of surgery on patients with a clinically inapparent inguinal hernia as diagnosed by ultrasonography. Hernia 2018; 22:525-531. [PMID: 29380157 DOI: 10.1007/s10029-018-1744-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic post-operative inguinal pain (CPIP) is the most significant complication following inguinal hernia repair. Patients without a palpable hernia prior to surgery seemed to report more CPIP. Our aim was to evaluate the effects of surgery on patients with a clinically inapparent inguinal hernia as diagnosed using ultrasonography. METHODS A total of 179 hernia repairs in patients with a positive ultrasonography but negative physical examination were analysed retrospectively. Patients with recurrent hernias, femoral hernias or previous surgery to the inguinal canal were excluded. The primary outcome was the presence of chronic postoperative inguinal pain (pain > 3 months postoperatively). Data on preoperative complaints, surgical technique and findings during ultrasonography and surgery were also studied in relation to the development of CPIP. RESULTS A quarter (25.1%) of the patients reported chronic postoperative pain. Female gender (p = 0.03), high BMI (p = 0.04) and atypical symptoms prior to surgery (p < 0.001) were significant univariate risk factors for developing CPIP. Logistic regression showed a significant association between atypical symptoms and CPIP [OR = 6.31, p < 0.001, 95% CI (2.32, 17.16)], which was still present after correction for the significant univariate variables [OR = 4.23, p = 0.02, 95% CI (1.26, 14.21)]. CONCLUSION Patients with a clinically inapparent inguinal hernia as diagnosed using ultrasonography report a high incidence of CPIP after elective hernia repair. Patients with atypical groin pain prior to surgery are especially prone to CPIP. It is questionable whether these hernias should be classified and treated as symptomatic inguinal hernias. The results advocate taking other causes of groin pain into consideration before choosing surgical treatment.
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Affiliation(s)
- L van Hout
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
| | - W J V Bökkerink
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - M S Ibelings
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - J Heisterkamp
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - P W H E Vriens
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
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Reino-Pires P, Pêgo JM, Miranda A, Barroso C, España M, Correia-Pinto J. Ultrasound-guided dissection and ligation of the internal inguinal ring for hernia repair in pediatrics: an experimental animal study. J Pediatr Surg 2017; 52:1848-1852. [PMID: 28372803 DOI: 10.1016/j.jpedsurg.2017.03.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/01/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We aimed to test the feasibility and reliability of ultrasound-guided percutaneous internal inguinal ring suture in rabbits, as a model for inguinal hernia repair in pediatric population. METHODS Twenty-eight rabbits were divided in 2 groups: group I (female morphology) - persistence of the peritoneal-vaginal duct with gonads placed in intraperitoneal position; group II (male morphology) - persistence of the peritoneal-vaginal duct with gonads kept intact inside the duct. Under exclusive ultrasound-guided image we tried to perform a complete pre-peritoneal ligation of the peritoneal-vaginal duct at the level of the internal inguinal ring using a 20G peripheral IV catheter and 2-0 non-absorbable suture. Afterwards, an exploratory laparoscopy was performed to evaluate the ligation. RESULTS Ultrasound allowed characterization of inguinal-crural structures. Group I - complete and reliable suture 66.7%, incomplete but reliable suture 16.7%, inappropriate ligation 16.7%; group II - complete but unreliable suture 76.9%, incomplete and unreliable suture 11.5%, inappropriate suture 11.5%. No acute complications were logged. CONCLUSIONS Percutaneous dissection and ligation of internal inguinal ring through exclusive ultrasound guidance was feasible and likely reliable, namely for female inguinal hernia repair.
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Affiliation(s)
- Pedro Reino-Pires
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal; Hospital de Dona Estefânia Hospital de Dona Estefânia, Serviço de Cirurgia Pediátrica, Rua Jacinta Marto, 1169-045 Lisbon, Portugal.
| | - José Miguel Pêgo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal
| | - Alice Miranda
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal
| | - Catarina Barroso
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal; Department of Paediatric Surgery, Hospital de Braga, 4710-243, Braga, Portugal
| | - Margarida España
- Hospital de Dona Estefânia Hospital de Dona Estefânia, Serviço de Cirurgia Pediátrica, Rua Jacinta Marto, 1169-045 Lisbon, Portugal
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal; Department of Paediatric Surgery, Hospital de Braga, 4710-243, Braga, Portugal
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Malouf PA, Descallar J, Berney CR. Bilateral totally extraperitoneal (TEP) repair of the ultrasound-diagnosed asymptomatic contralateral inguinal hernia. Surg Endosc 2017; 32:955-962. [PMID: 28791478 DOI: 10.1007/s00464-017-5771-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/18/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this series is to determine the clinical utility of routine ultrasound (US) of the contralateral, clinically normal groin when a unilateral inguinal hernia is referred for hernia repair-specifically assessing the morbidity and short-term change in quality-of-life (QoL) due to repair of this occult contralateral hernia when also repairing the symptomatic side. TEP inguinal hernia repair affords the opportunity to repair any groin hernia through the same small incisions. US detects 96.6% of groin hernias with 84.4% specificity. METHODS 234 consecutive male patients with clinically unilateral and clinically bilateral hernia were enrolled; those with a clinically unilateral hernia were sent for groin US and if positive, a bilateral TEP groin hernia repair was performed (USBH). If negative, a unilateral TEP groin hernia repair was performed (UNIH). Carolina's comfort scales (CCS) and visual analogue scores (VAS) were recorded at 2 and 6 weeks postoperatively, while a modified CCS (MCCS) was recorded for all patients preoperatively. RESULTS Bilateral TEP repair resulted in higher VAS scores than unilateral repair at 2 weeks but not 6 weeks. CCS were worse in the USBH group than UNIH group at 2 weeks but were similar by 6 weeks. Complications' rates were similar amongst all 3 groups. Factors contributing to worse scores were: smaller hernia, complications, worse preoperative MCCS results, recurrent hernia and bilateral rather than unilateral repair. CONCLUSION Bilateral TEP for the clinically unilateral groin hernia with an occult contralateral groin hernia can be performed without increased morbidity, accepting a minor and very temporary impairment of QoL.
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Affiliation(s)
- Phillip A Malouf
- Sutherland Hospital, University of New South Wales, Sydney, Australia. .,, Suite 105, 26-28 Gibbs St, Miranda, NSW, 2228, Australia.
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Abstract
Pediatric emergency medicine physicians may be able to use point-of-care ultrasound (POCUS) as a tool to evaluate abdominal wall masses. We present a case of a 2-month-old infant with a lower abdominal mass identified as a hernia sac by POCUS. It was initially thought to represent a Spigelian-type abdominal wall hernia but subsequently determined to be an unusual presentation of an inguinal hernia with testicular entrapment. We review each of these diagnoses in addition to relevant POCUS findings.
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Berger D. Evidence-Based Hernia Treatment in Adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 113:150-7; quiz 158. [PMID: 26987468 DOI: 10.3238/arztebl.2016.0150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 01/19/2016] [Accepted: 01/19/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Inguinal hernia repair is the most common general surgical procedure in industrialized countries, with a frequency of about 200 operations per 100 000 persons per year. Suture- and mesh-based techniques can be used, and the procedure can be either open or minimally invasive. METHODS This review is based on a selective search of the literature, with interpretation of the published findings according to the principles of evidence-based medicine. RESULTS Inguinal hernia is diagnosed by physical examination. Surgery is not necessarily indicated for a primary, asymptomatic inguinal hernia in a male patient, but all inguinal hernias in women should be operated on. For hernias in women, and for all bilateral hernias, a laparoscopic or endoscopic procedure is preferable to an open procedure. Primary unilateral hernias in men can be treated either by open surgery or by laparoscopy/endoscopy. Patients treated by laparoscopy/endoscopy develop chronic pain less often than those treated by open surgery. A mesh-based repair is generally recommended; this seems reasonable in view of the pathogenesis of the condition, which involves an abnormality of the extracellular matrix. CONCLUSION The choice of procedure has been addressed by international guidelines based on high-level evidence. Surgeons should deviate from their recommendations only in exceptional cases and for special reasons. Guideline conformity implies that hernia surgeons must master both open and endoscopic/laparoscopic techniques.
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Affiliation(s)
- Dieter Berger
- Clinic of Abdominal, Thoracic and Pediatric Surgery, Klinikum Mittelbaden/Balg, Baden-Baden
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Bisciotti GN, Volpi P, Zini R, Auci A, Aprato A, Belli A, Bellistri G, Benelli P, Bona S, Bonaiuti D, Carimati G, Canata GL, Cassaghi G, Cerulli S, Delle Rose G, Di Benedetto P, Di Marzo F, Di Pietto F, Felicioni L, Ferrario L, Foglia A, Galli M, Gervasi E, Gia L, Giammattei C, Guglielmi A, Marioni A, Moretti B, Niccolai R, Orgiani N, Pantalone A, Parra F, Quaglia A, Respizzi F, Ricciotti L, Pereira Ruiz MT, Russo A, Sebastiani E, Tancredi G, Tosi F, Vuckovic Z. Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete. BMJ Open Sport Exerc Med 2016; 2:e000142. [PMID: 28890800 PMCID: PMC5566259 DOI: 10.1136/bmjsem-2016-000142] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/14/2022] Open
Abstract
The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem.
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Affiliation(s)
- G N Bisciotti
- Qatar Orthopedic and Sport Medicine Hospital, Doha, Qatar
| | - P Volpi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy.,FC Internazionale, Milan, Italy
| | - R Zini
- Azienda Ospedaliera "Ospedale San Salvatore", Pesaro, Italy
| | - A Auci
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | | | - A Belli
- FC Internazionale, Milan, Italy
| | | | | | - S Bona
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - D Bonaiuti
- Fisioclinic Centro Medico Polispecialistico, Pesaro, Italy
| | - G Carimati
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - G Cassaghi
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | - S Cerulli
- Institute of Sports Medicine of Turin, Italy
| | - G Delle Rose
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - F Di Marzo
- Azienda Ospedaliera Universitaria di Udine, Italy
| | | | - L Felicioni
- Ospedale della Misericordia, Grosseto, Italy
| | | | - A Foglia
- Studio di fisioterapia Riabilita, Pesaro, Italy
| | - M Galli
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | | | - L Gia
- Azienda Ospedaliera Universitaria di Udine, Italy
| | | | - A Guglielmi
- Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - A Marioni
- Azienda Policlinico Università di Bari, Bari, Italy
| | | | | | - N Orgiani
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - F Parra
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | - A Quaglia
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - F Respizzi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - L Ricciotti
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | | | | | | | | | - F Tosi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - Z Vuckovic
- Qatar Orthopedic and Sport Medicine Hospital, Doha, Qatar
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Rafailidis V, Varelas S, Apostolopoulou F, Rafailidis D. Nonobliteration of the Processus Vaginalis. Sonography of Related Abnormalities in Children. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:805-818. [PMID: 26960801 DOI: 10.7863/ultra.15.04060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this pictorial essay is to systematically classify processus vaginalis– related disorders in the light of embryology and present illustrative sonograms with corresponding diagrams. Failure of the processus vaginalis to obliterate during gestation results in a wide spectrum of anomalies, including communicating and noncommunicating hydroceles and inguinal and inguinoscrotal hernias, along with other related disorders of the genital system. There are varying classifications in the literature regarding the aforementioned entities. Proper and timely diagnosis of these entities is essential, given the differences in treatment. Although physical examination can narrow the differential diagnosis, sonography plays an essential role in establishing the diagnosis.
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Volkamer HM, Steele B, Broder J. Man With Sharp Periumbilical Pain. Ann Emerg Med 2016; 67:437-54. [PMID: 27015917 DOI: 10.1016/j.annemergmed.2015.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Indexed: 11/19/2022]
Affiliation(s)
| | - Brianne Steele
- Division of Emergency Medicine, Duke University Hospital, Durham, NC
| | - Joshua Broder
- Division of Emergency Medicine, Duke University Hospital, Durham, NC
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Sakamoto T, Shimaguchi M, Lefor AK, Kishida A. Laparoscopic reduction and repair of a strangulated interparietal inguinal hernia. Asian J Endosc Surg 2016; 9:83-5. [PMID: 26781535 DOI: 10.1111/ases.12244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/02/2015] [Accepted: 08/14/2015] [Indexed: 11/30/2022]
Abstract
An interparietal hernia is defined as a hernia in which the hernial sac lies between the tissue layers comprising the abdominal wall. A strangulated interparietal inguinal hernia without an external bulge is a rare cause of an acute abdomen and difficult to diagnose preoperatively. We report a patient with a history of a right inguinal hernia who presented with abdominal pain without inguinal bulging. An interparietal (preperitoneal) inguinal hernia was diagnosed and treated by laparoscopic reduction and a transabdominal preperitoneal hernia repair. This is the first case report of an interparietal inguinal hernia managed entirely laparoscopically. Although the laparoscopic approach is not considered standard treatment for strangulated intestinal obstruction, it may be worth considering, especially for patients with uncertain etiology, because of its decreased invasiveness compared to open exploration.
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Affiliation(s)
- Takashi Sakamoto
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center (Noguchi Hideyo Memorial International Hospital), Urayasu, Japan
| | - Mayu Shimaguchi
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center (Noguchi Hideyo Memorial International Hospital), Urayasu, Japan
| | - Alan K Lefor
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center (Noguchi Hideyo Memorial International Hospital), Urayasu, Japan.,Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Akihiro Kishida
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center (Noguchi Hideyo Memorial International Hospital), Urayasu, Japan
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Brandel DW, Girish G, Brandon CJ, Dong Q, Yablon C, Jamadar DA. Role of Sonography in Clinically Occult Femoral Hernias. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:121-128. [PMID: 26657750 DOI: 10.7863/ultra.15.02061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/06/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this article is to evaluate the diagnostic accuracy of sonography in clinically occult femoral hernias and to describe our sonographic technique. METHODS The clinical and imaging data for 93 outpatients referred by general surgeons, all of whom underwent sonographic evaluation and surgery, were reviewed retrospectively. Of these, 55 patients who underwent surgical exploration for groin hernias within 3 months of sonography and met all inclusion criteria were included in the study. The sonographic technique involves using the pubic tubercle as an osseous landmark to identify and appropriately visualize the femoral canal. The Valsalva maneuver is then used to differentiate the movement of normal fat (a potential pitfall) from true herniation in the femoral canal. Surgical findings were used as the reference standard by which sonographic results were judged. Two-by-two contingency tables were used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS In these 55 patients, surgery revealed 15 femoral hernias. Eight femoral hernias occurred in women, and 7 occurred in men. For diagnosing femoral hernias, sonography demonstrated sensitivity of 80%, specificity of 88%, a positive predictive value of 71%, and a negative predictive value of 92%. True-positive cases of femoral hernias have a sonographic appearance of a hypoechoic sac with speckled internal echoes. When examining during the Valsalva maneuver, a femoral hernia passes deep to the inguinal ligament, expands the femoral canal, displacing the normal canal fat, and effaces the femoral vein. CONCLUSIONS Sonography can exclude femoral hernias with high confidence in light of its exceptional negative predictive value. With attention to technique and imaging criteria, the diagnostic accuracy of sonography can be enhanced.
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Affiliation(s)
- David W Brandel
- From the University of Michigan Health System, Ann Arbor, Michigan USA
| | - Gandikota Girish
- From the University of Michigan Health System, Ann Arbor, Michigan USA.
| | | | - Qian Dong
- From the University of Michigan Health System, Ann Arbor, Michigan USA
| | - Corrie Yablon
- From the University of Michigan Health System, Ann Arbor, Michigan USA
| | - David A Jamadar
- From the University of Michigan Health System, Ann Arbor, Michigan USA
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Lee RKL, Griffith JF, Ng WHA. High accuracy of ultrasound in diagnosing the presence and type of groin hernia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:538-547. [PMID: 25944106 DOI: 10.1002/jcu.22271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/07/2014] [Accepted: 02/28/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND To evaluate the accuracy of ultrasound (US) in diagnosing the the presence and type of groin hernia. METHODS We retrospectively studied the results of 172 US examinations of the groin in 151 patients (101 men and 50 women; mean age, 59 years) who had undergone US examination for suspected groin hernia. In total, 119 of the groin hernias had been diagnosed on US, and 108 (91%) had required subsequent surgery. All patients who had had positive results for hernia on US and did not undergo surgery (n = 11) and most of the patients whose US results had been negative for hernia (n = 48) underwent limited MRI or CT scanning. We determined the sensitivity, specificity, and accuracy of US in diagnosing the presence and type of groin hernia. To identify any change in the accuracy of US over time at our institution, we compared the sensitivity, specificity, and accuracy of its use from January 2002 through December 2010 (n = 54 groins) with those from January 2011 through December 2012 (n = 118 groins). RESULTS The overall rates of sensitivity and specificity of US for diagnosing the presence of groin hernia were 96% and 96%. These rates reflect improvements from 92% and 88% prior to 2011 to 98% and 100% beginning in 2011. In addition, the overall accuracy of US for diagnosing the type of groin hernia was 96%. This also improved over time at our center from 91% prior to 2011 to 98% beginning in 2011. CONCLUSIONS US is highly accurate at diagnosing the presence and type of groin hernia.
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Affiliation(s)
- Ryan Ka Lok Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, The Chinese University of Hong Kong, Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, The Chinese University of Hong Kong, Hong Kong
| | - Wing Hung Alex Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, The Chinese University of Hong Kong, Hong Kong
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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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41
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Affiliation(s)
- John M A Bohnen
- Department of Surgery, St. Michael's Hospital; Faculty of Medicine, University of Toronto, Toronto, Ont.
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42
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The role of ultrasound in the management of patients with occult groin hernias. Int J Surg 2014; 12:918-22. [DOI: 10.1016/j.ijsu.2014.07.266] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/05/2014] [Accepted: 07/22/2014] [Indexed: 11/19/2022]
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43
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Siadecki SD, Frasure SE, Saul T, Lewiss RE. Diagnosis and Reduction of a Hernia by Bedside Ultrasound: A Case Report. J Emerg Med 2014; 47:169-71. [DOI: 10.1016/j.jemermed.2013.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 09/20/2013] [Accepted: 09/23/2013] [Indexed: 11/15/2022]
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