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Liu L, Hu J, Zhang T, Zhang C, Wang S. Influence of the hernia sac treatment method on the occurrence of seroma after laparoscopic transabdominal preperitoneal hernia repair. Asian J Surg 2023; 46:718-722. [PMID: 35864042 DOI: 10.1016/j.asjsur.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/10/2022] [Accepted: 07/06/2022] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To determine whether transection of the hernia sac during laparoscopic transabdominal preperitoneal hernia repair (TAPP) affects the occurrence of seroma, and to explore the risk factors for seroma. METHODS In total, 330 consecutive male patients with indirect inguinal hernia who underwent TAPP repair at the Qingdao University Affiliated Hospital from January 2020 to June 2021 were retrospectively enrolled in this study. According to the intraoperative hernia sac treatment, patients were divided into a completely reduced sac group and a transected sac group. RESULTS Among the 330 inguinal hernia male patients, 240 received hernia sac reduction and 90 received hernia sac transection. Fifty-four patients developed seroma, with an incidence of 16.4%. In patients with a hernia defect measuring ≥3 cm and extension into the scrotum, the difference in the incidence of seroma between the two treatment groups approached significance (P = 0.052). The risk factors for seroma, high body mass index, hernia sac ≥3 cm, extension of the hernia into the scrotum and operation time were significantly associated with postoperative seroma. CONCLUSION This study showed that the incidence of seroma after TAPP was as high as 16.4%. For patients with a hernia sac that is too large and descended extends into the scrotum, transection may be better than complete dissection of the hernia sac and preventive measures should be taken for patients with high body mass index, hernia sac measuring ≥3 cm, and a high risk of the hernia extending into the scrotum.
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Affiliation(s)
- Lei Liu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Jilin Hu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Tinglong Zhang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Chao Zhang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Shouguang Wang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
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Lee MJ, Kim JK, Fervaha G, Chua ME, Brindle ME, Terry J, Koyle MA. A Canadian national survey: Perspectives on routine pathological examination of hernia sacs after inguinal hernia and hydrocele repair among pediatric urologists, surgeons, and pathologists. J Pediatr Urol 2022; 18:335-9. [PMID: 35367145 DOI: 10.1016/j.jpurol.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/07/2022] [Accepted: 03/03/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND/OBJECTIVE This study aims to understand perspectives on routine pathological examination of hernia sacs following pediatric inguinal hernia and hydrocele repair among Canadian pediatric urologists, surgeons, and pathologists. STUDY DESIGN All active members of Pediatric Urologists of Canada (PUC), Canadian Association of Pediatric Surgeons (CAPS), and the divisional heads of anatomical pathology at the Canadian children's hospitals (AP) were invited to participate between June 2019 and January 2021 in an anonymous multiple-choice-based questionnaire. RESULTS The response rates were 71% from PUC (24/34), 20% from CAPS (25/130), and 64% from AP (7/11). The majority of the surgeons (PUC:54%, CAPS:68%) did not routinely send hernia sacs for pathological examination after inguinal hernia repair. Most felt there was a little value in such examination (PUC:96%, CAPS:72%). Among those who submit hernia sacs, the majority did not receive reports that were clinically significant impacting patient management (PUC:82%, CAPS:50%). On the other hand, the pathologists had mixed opinion on the value of examining hernia sacs. Most of them only did gross examination (86%), unless requested by surgeons or concerning features were noted on gross examination. The majority have found clinically meaningful abnormal findings (71%), including vas deferens and portions of the spermatic cord. DISCUSSION Currently, there are no evidence-based clinical guidelines on pathological assessment of hernia sacs after pediatric inguinal hernia and hydrocele repair. Instead of making it mandatory, future guidelines should highlight specimens that should be submitted for further investigations (e.g., challenging cases where inadvertent surgical injuries might have occurred). Future studies should also address whether patients who may be at higher risk of having clinically significant pathology can be identified pre- or perioperatively to more efficiently triage specimens that would benefit from pathological examination. Limitation of the study includes low response rate from the CAPS members during the COVID-19 pandemic. CONCLUSIONS While most of the pediatric urologists and surgeons felt there is a little value of pathological examination of hernia sacs following inguinal hernia and hydrocele repair, half of the anatomical pathologists felt there is value. Future studies should aim to establish evidence-based clinical guidelines taking stakeholders perspectives into consideration.
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Pan C, Xu X, Si X, Yu J. Effect of complete reduction of hernia sac and transection of hernia sac during laparoscopic indirect inguinal hernia repair on seroma. BMC Surg 2022; 22:149. [PMID: 35468781 PMCID: PMC9036776 DOI: 10.1186/s12893-022-01599-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/13/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction This study investigated the effect of complete reduction and transection of the hernia sac during laparoscopic indirect inguinal hernia repair on seroma. Methods Retrospective analysis was performed on 1763 cases undergoing laparoscopic indirect inguinal hernia repair in three centers from January 2017 to September 2019, among them, 311 patients with transection of hernia sac and 1452 patients with reduction of hernia sac, the data of the two groups were tested by t-test. Logistic univariate analysis was performed on 233 cases of postoperative seroma, and variables p < 0.05 in univariate analysis were included for multivariate analysis. Then, the transection group and the reduction group were matched with 1:1 propensity score matching, and the caliper value was set at 0.05. Finally, 274 patients matched in each group were analyzed by univariate analysis again to evaluate whether the transection of hernia sac had an impact on postoperative seroma. Results The results of univariate analysis of 233 patients with postoperative seroma showed that: ASA-3 p = 0.031, classification-L3 p < 0.001, surgery-TEP p < 0.001, transect group p = 0.005. The results of multivariate analysis show that: ASA-3 p < 0.001, classification-L3 p < 0.001, surgery-TEP p < 0.001, transect group p = 0.020. The results of univariate analysis after propensity score matching showed that transection of the hernia sac is significant for postoperative seroma (p < 0.001). Conclusion Transection of the hernia sac during laparoscopic indirect inguinal hernia repair can significantly lead to postoperative seroma. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01599-8.
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Affiliation(s)
- Chunpeng Pan
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Huangpu, Shanghai, 200011, China
| | - Xin Xu
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Huangpu, Shanghai, 200011, China
| | - Xianke Si
- Department of Minimally Invasive Surgery, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 164 Lanxi Road, Putuo, Shanghai, 200062, China.
| | - Jiwei Yu
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Huangpu, Shanghai, 200011, China.
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Maloku H, Shabani R, Haliti N, Shabani N, Maxhuni Q, Ferizi R. A rare case report - Ovary attached to testicle inside hernia sac. Urol Case Rep 2021; 38:101673. [PMID: 33912395 PMCID: PMC8066377 DOI: 10.1016/j.eucr.2021.101673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 67-year-old man, father of 3 children with left indirect inguinal hernia containing uterus with cervix, fallopian tube and an ovary attached to the testicle, also spread ovarian tissue and right congenital cryptorchidism. Coincidentally detected during an operation for left inguinal hernia. Persistent Mullerian duct syndrome is a rare form of male pseudo-hermaphroditism detected coincidently during surgical operation on cryptorchidism or inguinal hernia.
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Affiliation(s)
- Halit Maloku
- University of Prishtina, Faculty of Medicine, Department of Surgery, Prishtina, Kosovo, 10000, Albania
| | - Ragip Shabani
- University of Prishtina, Faculty of Medicine, Department of Pathology Anatomy, Prishtina, Kosovo, 10000, Albania
| | - Naim Haliti
- University of Prishtina, Faculty of Medicine, Department of Forensic Medicine, Prishtina, Kosovo, 10000, Albania
| | - Nora Shabani
- Johannas Wesling Klinikum Minden, Universitatklinikum Der Ruhr-Universitat Bochum, Minden, 32425, Germany
| | - Qenan Maxhuni
- Heimerer College, Laboratory Technician Programme, Veranda D4, Kalabri, Prishtina, Kosovo, 10000, Albania
| | - Rrahman Ferizi
- University of Prishtina, Faculty of Medicine, Premedical Department, Prishtina, Kosovo, 10000, Albania
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Adalbert JR, Pajaro RE. Adrenal ectopy and lipoma of an inguinal hernia sac: A case report & literature review. Int J Surg Case Rep 2021; 78:356-358. [PMID: 33388518 PMCID: PMC7787944 DOI: 10.1016/j.ijscr.2020.12.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022] Open
Abstract
Ectopic adrenocortical tissue is accessory adrenal cortex tissue outside of the adrenal glands. Ectopic adrenocortical tissue is a rare finding during inguinal hernia repair in adults. Adrenocortical tissue in inguinal hernia sacs can mimic metastatic deposits. Surgical excision of adrenocortical tissue may have endocrine implications. We have described a case of adrenocortical tissue identified in a lipoma of an inguinal hernia sac.
Introduction & importance Ectopic adrenocortical tissue is the presence of accessory adrenal cortex tissue located outside of the adrenal glands. It is a rare, incidental finding during inguinal hernia repair. This case report aims to discuss the anatomy and important patient implications related to this finding. Case presentation A 61-year-old male presented with a long-standing right direct inguinal hernia increasing in size and pain frequency. During open right anterior inguinal hernia repair, a lipoma was identified inside the hernia sac and removed. Further histopathological examination of the specimen revealed the presence of adrenocortical tissue inside the lipoma. No further interventions were performed. The postoperative and 2-year follow-up course were uneventful. Clinical discussion Adrenocortical tissue can parallel the descent of the gonads during embryogenesis, arresting at any point along this path, including the inguinal region. Ectopic adrenocortical tissue is commonly found during inguinoscrotal procedures in infants, suggesting early involution. Its incidence in hernia sacs should be recognized to prevent misdiagnosis as neuroendocrine tumors or melanomas. If adrenocortical tissue is identified during hernia reduction, further surgical exploration is not recommended. In terms of prognosis, endocrine imbalances following surgical removal cannot be ruled out, promoting careful patient monitoring. The lipoma containing the adrenal tissue in our case is a common finding during hernia repair, identified in 22% of patients at operation. Conclusion Ectopic adrenocortical tissue is a rare, incidental finding during inguinal hernia sac analysis in adults. This finding should be well-documented following removal and further studies are required to evaluate long-term outcomes.
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Affiliation(s)
- Jenna R Adalbert
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 1025 Walnut Street #100, Philadelphia, PA, 19107, USA.
| | - Rafael E Pajaro
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 1025 Walnut Street #100, Philadelphia, PA, 19107, USA; Morristown Medical Center of Atlantic Health System, 100 Madison Avenue, Morristown, NJ, 07960, USA.
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Raitio A, Salim A, Losty PD. Congenital diaphragmatic hernia-does the presence of a hernia sac improve outcome? A systematic review of published studies. Eur J Pediatr 2021; 180:333-7. [PMID: 32808134 DOI: 10.1007/s00431-020-03779-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
Early reports have suggested survival benefits associated with a hernia sac in congenital diaphragmatic hernia (CDH). However, these studies have included only small subsets of patients. This systematic review aimed to evaluate differences in outcomes of CDH newborns with and without a hernia sac. PubMed and Embase databases were searched using relevant key terms. Papers were independently reviewed by two authors with final selection approved by the senior author. Original search retrieved 537 papers; the final review included 8 studies (n = 837 patients). There were 168 CDH patients (20%) with a hernia sac with an overall survival of 93% vs 73% for CDH newborns without a sac (p < 0.001). Twenty-three percent of patients with a CDH sac required diaphragm patch repair vs 44% patients without a sac (p < 0.001). Pulmonary hypertension was manifested in 44% of CDH babies with a hernia sac vs 64% without a sac (p < 0.001). Three studies compared ECMO requirement: 15% with a hernia sac and 34% without sac, p < 0.001.Conclusion: This study shows significant survival benefits in newborns associated with presence of a CDH sac. This may be likely related to these infants having more favourable physiology with less severe pulmonary hypertension and/or smaller anatomical defects requiring primary closure only. What is Known: • Early reports have suggested survival benefits associated with a hernia sac in CDH. • Previous studies have included only a small number of patients. What is New: • A systematic review of published studies clearly shows that CDH newborns with a hernia sac have better overall survival outcomes and less severe pulmonary hypertension. • ECMO utilization and patch repair were also less often required in newborns with a hernia sac.
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Çelik A, Kut A, İlhan B. A report of a case: unusual portosystemic shunt in a hernia sac who has portal hypertension due to cirrhosis. Surg Radiol Anat 2021; 43:385-8. [PMID: 32965518 DOI: 10.1007/s00276-020-02568-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/04/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Variations in the origin and branching pattern of splenic vein (SV) are relatively rare and asymptomatic. We describe here only the first case in the literature of accessory SV in hernia sac due to previous operation and increased portal pressure because of cirrhosis. CASE PRESENTATION This report describes a 66-year-old female, with a history of total abdominal hysterectomy (TAH) due to uterine myomatosis, signs of cirrhosis onset due to hepatitis B, who had been presented with recurrent abdominal pain attacks. Ultrasonography (USG) findings were nothing pathologic except a gallstone in the gallbladder without cholecystitis signs. Incisional hernia was found to contain an accessory SV in the hernia sac arising from a branch of main SV in the hilum, ongoing to the subcutaneous fat tissue and draining to the superficial femoral vein on computed tomography (CT). Videoendoscopy showed wide gastritis and multiple ulcers. The patient's symptoms diminished with proton pump inhibitor (PPI) treatment and they then underwent a hernia repair surgery with Prolene mesh patch as elective surgery. CONCLUSIONS A thorough knowledge of the normal anatomy, most frequent variations and congenital or acquired anomalies of the spleno-portal axis has great importance for hepatopancreaticobiliary and emergency surgical procedures. It is, therefore, essential for preoperative evaluation of the anatomical details of the spleno-portal venous axis and should be evaluated with imaging methods in detail.
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Lee MJ, Kim JK, Pokarowski M, Shiff M, Mitton P, Popescu A, Chung CT, Langer JC, Pierro A, Milner J, Lorenzo AJ, Koyle MA. Clinical and Economic Value of Routine Pathological Examination of Hernia Sacs and Scheduled Clinic Follow-Ups After Inguinal Hernia and Hydrocele Repair in a Canadian Tertiary Care Children's Hospital. J Pediatr Surg 2020; 55:1463-1469. [PMID: 31679775 DOI: 10.1016/j.jpedsurg.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/08/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The clinical and economical value of routine submission of hernia sacs for pathological examination and scheduled clinic follow-ups after inguinal hernia and hydrocele repair has been questioned. Herein, we assessed the institutional variability in these routine practices. METHODS We retrospectively reviewed patients who underwent unilateral or bilateral inguinal hernia and/or hydrocele repair, open or laparoscopically, at our institution from 2015 to 2018. RESULTS 1181 patients were included (1074 inguinal hernias and 157 hydroceles). Of 531 specimens obtained from 446 (38%) patients, 515 (97%) were normal. 16 (3%) abnormal pathological findings included 7 with mesothelial hyperplasia, 5 with nonfunctional genital ductal remnants, 3 with ectopic adrenal cortical tissues, and 1 epidydimal structure which was not recognized at the time of surgery. 418 (35%) patients had scheduled clinic follow-ups 65 (IQR 46-94) days postoperatively. 44 (4%) patients with unexpected postoperative Emergency Department visits within 30 days of surgery were identified. Only one patient required inpatient treatment, and the rest did not require intervention or admission. The total direct cost of analyzing specimens during the study period was $30,798 CAD ($10,266/year). The average cost to detect a potentially significant finding was $1924.88/specimen and $2053.20/patient. CONCLUSIONS Routine pathological examination of hernia sacs and scheduled clinic follow-ups were associated with significant costs and predominantly nonsignificant findings. They should therefore be reserved for patients with a high clinical suspicion of injuries/abnormalities or risk factors for potential complications. LEVEL OF EVIDENCE This is a level III evidence study.
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Affiliation(s)
- Min Joon Lee
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Jin K Kim
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martha Pokarowski
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mitchell Shiff
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Patricia Mitton
- Rotman School of Management, University of Toronto, Toronto, ON, Canada
| | - Andreea Popescu
- Rotman School of Management, University of Toronto, Toronto, ON, Canada
| | - Catherine T Chung
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jacob C Langer
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joseph Milner
- Rotman School of Management, University of Toronto, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
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Heiwegen K, van Heijst AFJ, Daniels-Scharbatke H, van Peperstraten MCP, de Blaauw I, Botden SMBI. Congenital diaphragmatic eventration and hernia sac compared to CDH with true defects: a retrospective cohort study. Eur J Pediatr 2020; 179:855-863. [PMID: 31965300 PMCID: PMC7220865 DOI: 10.1007/s00431-020-03576-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 11/25/2022]
Abstract
Congenital diaphragmatic eventration (CDE) and congenital diaphragmatic hernia (CDH) with or without hernia sac are three different types of congenital diaphragmatic malformations, which this study evaluates. All surgically treated patients with CDE or Bochdalek type CDH between 2000 and 2016 were included in this retrospective analysis. Demographics, CDH-characteristics, treatment, and clinical outcome were evaluated. In total, 200 patients were included. Patients with an eventration or hernia sac had no significant differences and were compared as patients without a true defect to patients with a true defect. The 1-year survival of patients with a true defect was significantly lower than patients with no true defect (76% versus 97%, p = 0.001). CDH with no true defect had significantly better short-term outcomes than CDH with true defect requiring patch repair. However, at 30 days, they more often required oxygen supplementation (46% versus 26%, p = 0.03) and had a higher recurrence rate (8% versus 0%, p = 0.006) (three eventration and two hernia sac patients). Conclusion: Patients without a true defect seem to have a more similar clinical outcome than CDH patients with a true defect, with a better survival. However, the recurrence rate and duration of oxygen supplementation at 30 days are higher than CDH patients with a true defect.What is Known:• Congenital diaphragmatic hernia with or without hernia sac and congenital diaphragmatic eventration (incomplete muscularization) are often treated similarly.• Patients with hernia sac and eventration are thought to have a relatively good outcome, but exact numbers are not described.What is New:• Congenital diaphragmatic eventration and patients with hernia sac seem to have a more similar clinical outcome than Bochdalek type CDH with a true defect.• Patients without a true defect (eventration or hernia sac) have a high recurrence rate.
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Affiliation(s)
- Kim Heiwegen
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Arno FJ van Heijst
- Department of Neonatology, Radboudumc-Amalia Children’s Hospital, Nijmegen, Netherlands
| | - Horst Daniels-Scharbatke
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Michelle CP van Peperstraten
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Ivo de Blaauw
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Sanne MBI Botden
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
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Bolat H, Teke Z. Spilled gallstones found incidentally in a direct inguinal hernia sac: Report of a case. Int J Surg Case Rep 2019; 66:218-220. [PMID: 31874379 PMCID: PMC6931096 DOI: 10.1016/j.ijscr.2019.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/11/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the preferred surgical treatment for symptomatic gallstones. Iatrogenic gallbladder perforation and spillage of gallstones during LC is a frequent occurrence. There are many different clinical presentations of complications resulting from dropped gallstones. We herein present a case of scattered gallstones after LC encountered incidentally during a direct inguinal hernia repair. PRESENTATION OF CASE A 62-year-old male presented with a 4-year history of swelling of both right and left groins. He had undergone LC for acute calculous cholecystitis at another hospital 5 months earlier. Physical examination revealed reducible both right and left direct inguinal hernias. Surgical exploration of the right side revealed foreign bodies at the fundus of the sac attached to the inner wall, with a fibrotic reaction around it. On closer inspection these foreign bodies were macroscopically consistent with gallstones. The gallstones were removed, and bilateral herniotomies and Lichtenstein's prolene mesh repair were performed. Pathologic evaluation confirmed 10 foreign bodies of 5-mm in size to be cholesterol gallstones. DISCUSSION Gallstones have been very rarely reported previously within a hernia sac after LC. Most of the spilled gallstones are clinically silent and rarely become symptomatic. Complications may occur from the immediately postoperative period to a long time interval of 20 years. Treatment of complications is based on its type and location. CONCLUSION This case presents a very rare entity resulting from leaving spilled gallstones behind. We recommend that every effort should be made to retrieve any scattered stones during LC in order to avoid complications.
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Affiliation(s)
- Haci Bolat
- Nigde Omer Halisdemir University, Faculty of Medicine, Department of General Surgery, Nigde, Turkey.
| | - Zafer Teke
- Cukurova University, Faculty of Medicine, Department of Surgical Oncology, Adana, Turkey
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Li W, Li Y, Ding L, Xu Q, Chen X, Li S, Lin Y, Xu P, Sun D, Sun Y. A randomized study on laparoscopic total extraperitoneal inguinal hernia repair with hernia sac transection vs complete sac reduction. Surg Endosc 2019; 34:1882-1886. [PMID: 31820158 DOI: 10.1007/s00464-019-07303-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The management of the hernia sac is the core step of laparoscopic indirect inguinal hernioplasty. In this study, a randomized controlled trial was conducted to evaluate the clinical effect of laparoscopic total extraperitoneal inguinal herniorrhaphy (TEP) with hernia sac transection and complete sac reduction. METHOD From May 2017 to May 2018, 70 patients aged 18-75 with primary indirect inguinal hernia in our hospital were randomly divided into a transected sac group (TS) and a completely reduced sac group (RS). The primary outcomes compared between the two groups were the hernia sac treatment time, operation time, and the incidence of seroma formation after operation. Secondary outcomes included acute pain, chronic pain (pain which lasted for at least 3 months), hospital stay, recurrence rate, and other complications. RESULT There were no significant differences in baseline demographic characteristics including age, sex, hernia type, size of hernia defect, and follow-up time between the two groups. The times required for hernia sac separation and operation in the TS group were significantly shorter than in the control group (6.1 ± 2.3 vs. 25 ± 5.8 min for hernia sac separation, p < 0.01; and 35.10 ± 3.50 vs. 54.40 ± 4.20 min for operation, p < 0.01). There was no significant difference in hospitalization time, incidence of acute pain, seroma formation, or urinary retention between the two groups. During the 12-month follow-up period, chronic pain, early recurrence, and other complications were not found in either group. CONCLUSION Both the hernia sac transection technique and the complete sac reduction technique are safe and reliable. The hernia sac transection technique is a simple and effective hernia sac treatment method. It reduces the operation time and does not increase seroma or acute or chronic pain. It is valuable and likely to be popularly applied.
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Affiliation(s)
- Weiming Li
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Yijun Li
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Lili Ding
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Qingwen Xu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Xiongzhi Chen
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Shumin Li
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Yueying Lin
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Pengyuan Xu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Dali Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China.
| | - Yanbo Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China.
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12
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Shalaby R, Abdalrazek M, Hamed A, Elhady S, Ibrahim R, Shahin M, Helal A, Elsaied A, Mohamad S, Mahfouz M, Elsherbeny M, El-Lithy MM. Novel application of the sewing machine principle; a new simplified intracorporeal suturing technique for pediatric inguinal hernia. J Pediatr Surg 2019; 54:1505-1509. [PMID: 30827487 DOI: 10.1016/j.jpedsurg.2019.01.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The desire of pediatric surgeon to reduce incision related morbidity and pain while achieving good cosmetic results has recently led to the introduction of single incision pediatric endosurgery [SIPES] and needlescopic surgery. Intracorporeal suturing and knot tying during SIPES remain challenging. The aim of this study is to introduce a novel and simple technique for intracorporeal suturing of the pediatric inguinal hernia after needlescopic disconnection of hernia sac using just needles rather than laparoscopic instruments. It is an imitation of the principles of sewing machine. METHODS The first author discussed the idea of the technique with the coauthors and a demonstration was done on a Silicon Pad before application of the technique on children with congenital inguinal hernia [CIH] for peritoneum closure after needlescopic disconnection of the hernia sac. The main outcome measures were feasibility of the technique, suturing and knotting time and recurrence rate. RESULTS The sutures were snugly applied to the ridges of Silicon Pad with good approximation and the knot was firmly tightened in all experiments. After applying and mastering the technique on a Silicon Pad, we shifted to use it on 373 children with 491 hernia defects. All operations were completed by the needlescopic technique without the need for insertion of any laparoscopic instruments. The time required for suturing of the peritoneum around internal inguinal ring [IIR] and knot tying, decreased considerably from 6 min 27 s in the first operation to less than 4 min after the fifth operation and stabilized at approximately 4 min 30 s. No major intraoperative complication. There was no recurrence during a mean follow-up period of 19.6 ± 1.2 months. CONCLUSION The closure of the peritoneum around the IIR using needles mimicking what is happening in sewing machine suturing is a feasible, safe and effective line of treatment of children with CIH. The cosmetic results are 42 outstanding without any recurrence.
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Affiliation(s)
| | | | | | | | | | | | | | - Adham Elsaied
- Mansoura University Children Hospital, Mansoura, Egypt
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13
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Levesque M, Derraugh G, Schantz D, Morris MI, Shawyer A, Lum Min SA, Keijzer R. The presence of a hernia sac in isolated congenital diaphragmatic hernia is associated with less disease severity: A retrospective cohort study. J Pediatr Surg 2019; 54:899-902. [PMID: 30824242 DOI: 10.1016/j.jpedsurg.2019.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION We aimed to determine if the presence of a hernia sac in neonates with isolated congenital diaphragmatic hernia (CDH) was associated with better clinical outcomes. METHODS We performed a retrospective cohort study of infants with isolated CDH from 1991 to 2015. Primary outcome measures were oxygen-dependence and mortality at 28 days. Secondary measures were: inhaled nitric oxide use, vasoactive medication use, ventilator support, and recurrence rates. RESULTS Seventy-one patients met the inclusion criteria: 14 patients (19.7%) had a hernia sac, and 57 patients (80.3%) did not. Mortality did not differ between the 2 groups [0 of 14 versus 3 of 57 (5.3%) (p = 1.000)]. Hernia sac patients had similar oxygen-dependence after 28 days [1 of 14 (7.1%) versus 14 of 57 (24.6%) (p = 0.273)]. Hernia sac children required less iNO (0.64 ± 2.41 vs. 6.35 ± 12.2 days, p = 0.002), vasoactive medications (2.79 ± 3.07 vs. 5.36 ± 5.52, p = 0.027), and time on ventilation (7.62 ± 6.12 vs. 15.9 ± 19.2, p = 0.010). Hernia sac children had similar recurrence rates within 2 years [0 of 14 versus 7 of 57 (12.3%) (p = 0.331)]. CONCLUSION The presence of a hernia sac was not associated with lower rates of oxygen dependency or death at 28 days but was associated with decreased inhaled nitric oxide, vasoactive medication, and ventilator use. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Matthew Levesque
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics, and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gabrielle Derraugh
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics, and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Daryl Schantz
- Department of Pediatrics, Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Melanie I Morris
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics, and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anna Shawyer
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics, and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suyin A Lum Min
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics, and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Keijzer
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics, and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
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14
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Oliver ER, DeBari SE, Adams SE, Didier RA, Horii SC, Victoria T, Hedrick HL, Adzick NS, Howell LJ, Moldenhauer JS, Coleman BG. Congenital diaphragmatic hernia sacs: prenatal imaging and associated postnatal outcomes. Pediatr Radiol 2019; 49:593-599. [PMID: 30635693 DOI: 10.1007/s00247-018-04334-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/19/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The presence of a hernia sac in congenital diaphragmatic hernia (CDH) has been reported to be associated with higher lung volumes and better postnatal outcomes. OBJECTIVE To compare prenatal imaging (ultrasound and MRI) prognostic measurements and postnatal outcomes of CDH with and without hernia sac. MATERIALS AND METHODS We performed database searches from January 2008 to March 2017 for surgically proven cases of CDH with and without hernia sac. All children had a detailed ultrasound (US) examination and most had an MRI examination. We reviewed the medical records of children enrolled in our Pulmonary Hypoplasia Program. RESULTS Of 200 cases of unilateral CDH, 46 (23%) had hernia sacs. Cases of CDH with hernia sac had a higher mean lung-to-head ratio (LHR; 1.61 vs. 1.17; P<0.01), a higher mean observed/expected LHR (0.49 vs. 0.37; P<0.01), and on MRI a higher mean observed/expected total lung volume (0.53 vs. 0.41; P<0.01). Based on a smooth interface between lung and herniated contents, hernia sac or eventration was prospectively questioned by US and MRI in 45.7% and 38.6% of cases, respectively. Postnatally, hernia sac is associated with shorter median periods of admission to the neonatal intensive care unit (45.0 days vs. 61.5 days, P=0.03); mechanical ventilation (15.5 days vs. 23.5 days, P=0.04); extracorporeal membrane oxygenation (251 h vs. 434 h, P=0.04); decreased rates of patch repair (39.0% vs. 69.2%, P<0.01); and pulmonary hypertension (56.1% vs. 75.4%, P=0.03). CONCLUSION Hernia sac is associated with statistically higher prenatal prognostic measurements and improved postnatal outcomes. Recognition of a sharp interface between lung and herniated contents may allow for improved prenatal diagnosis; however, delivery and management should still occur at experienced quaternary neonatal centers.
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Affiliation(s)
- Edward R Oliver
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA.
| | - Suzanne E DeBari
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA
| | - Samantha E Adams
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ryne A Didier
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA
| | - Steven C Horii
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Teresa Victoria
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA
| | - Holly L Hedrick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Scott Adzick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie S Moldenhauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Beverly G Coleman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA
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15
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Hosokawa T, Tanami Y, Sato Y, Oguma E, Omata K, Kawashima H, Yamada Y. Postnatal ultrasonography for evaluation of hernia sac of neonate with congenital diaphragmatic hernia. Radiol Case Rep 2019; 14:683-686. [PMID: 30976368 PMCID: PMC6439226 DOI: 10.1016/j.radcr.2019.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/26/2022] Open
Abstract
Congenital diaphragmatic hernia (CDH) is one of the most common major congenital anomalies. The presence of a hernia sac is associated with additional benefits in terms of improved neonatal survival. Here, we report a case of CDH with a hernia sac detected via postnatal ultrasonography. Our literature search did not find other cases where CDH with hernia sac was found by postnatal ultrasound in neonates. In prenatal imaging, the diagnosis of CDH with a hernia sac is challenging. In our case, the meniscus of the thymus was clearly noted, and smooth convexity between the hernia contents and thymus was detected. Although evaluation of the presence of a hernia sac with postnatal ultrasonography might be difficult, our findings suggest that a hernia sac could be evaluated with postnatal ultrasonography.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku, Saitama 330-8777, Japan
- Corresponding author.
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku, Saitama 330-8777, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku, Saitama 330-8777, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku, Saitama 330-8777, Japan
| | - Kanako Omata
- Department of Surgery, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku, Saitama 330-8777, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku, Saitama 330-8777, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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16
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Aydin E, Lim FY, Kingma P, Haberman B, Rymeski B, Burns P, Peiro JL. Congenital diaphragmatic hernia: the good, the bad, and the tough. Pediatr Surg Int 2019; 35:303-313. [PMID: 30680439 DOI: 10.1007/s00383-019-04442-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES We aim to determine factors that are associated with better outcomes of CDH patients. METHODS A retrospective review was performed on all CDH patients admitted to our institution between 2003 and 2016. This study was performed at a single institution which has a fetal care center. Patients admitted with CDH with at least 1-year follow-up during the analysis were included in the study. RESULTS Twenty-six (13.8%) patients had a hernia sac, 124 (59%) patients had liver herniation, and 56 (25.1%) patients had an accompanying syndrome. Overall survival to discharge was 73.1% while overall survival to date was 69.5%. The presence of a hernia sac, liver herniation, and accompanying syndromes showed as independent predictors influencing the survival, B 1.968, p = 0.04, OR 7.158, 95% CI 0.907-56.485, B - 1.178, p = 0.01, OR 3.932, 95% CI 1.798-8.602 and B - 1.032, p = 0.05, OR 2.795, 95% CI 0.976-7.764, respectively. CONCLUSION In our CDH cohort, the presence of a hernia sac was proven to be associated with better outcomes, while thoracic herniation of the liver was associated with worse outcomes. The accompanying syndromes although being more difficult to manage had a little effect on the outcome of the disease itself.
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Affiliation(s)
- Emrah Aydin
- Division of Pediatric General and Thoracic Surgery, The Center for Fetal Cellular and Molecular Therapy, Cincinnati Fetal Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA.
| | - Foong-Yen Lim
- Division of Pediatric General and Thoracic Surgery, The Center for Fetal Cellular and Molecular Therapy, Cincinnati Fetal Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Paul Kingma
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth Haberman
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth Rymeski
- Division of Pediatric General and Thoracic Surgery, The Center for Fetal Cellular and Molecular Therapy, Cincinnati Fetal Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Patricia Burns
- Division of Pediatric General and Thoracic Surgery, The Center for Fetal Cellular and Molecular Therapy, Cincinnati Fetal Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Jose L Peiro
- Division of Pediatric General and Thoracic Surgery, The Center for Fetal Cellular and Molecular Therapy, Cincinnati Fetal Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
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17
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Kimura J, Lefor AK, Fukai S, Yoshikawa K, Sasamatsu S, Sakamoto T, Mizokami K, Kanzaki M, Kubota T, Saito A, Izumi H, Honjo K, Nagakari K, Fukunaga M. Metastatic colon cancer derived from a diverticulum incidentally found at herniorrhaphy: a case report. Surg Case Rep 2018; 4:47. [PMID: 29766314 PMCID: PMC5953913 DOI: 10.1186/s40792-018-0455-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/08/2018] [Indexed: 11/20/2022] Open
Abstract
Background There are few reports of metastases from colon cancer to an inguinal hernia sac, and few reports of colon cancer originating in diverticula. We report a patient with carcinoma of the sigmoid colon arising in two diverticula, who presented with peritoneal seeding to an inguinal hernia sac, and a review of the literature. Case presentation A 55-year-old male underwent open herniorrhaphy for a left inguinal hernia. At operation, a nodule in the inguinal hernia sac was resected and histologic examination revealed adenocarcinoma, which was suspected to be a metastasis from a distant primary lesion. Postoperative evaluation included colonoscopy and positron emission tomography which showed two suspected lesions in sigmoid diverticula. Laparoscopic subtotal colectomy was performed, and pathology revealed adenocarcinoma in two sigmoid diverticula. Conclusions If a nodule is found in an inguinal hernia sac, especially in older patients, peritoneal metastases should be considered. Resection of the nodule with histopathologic evaluation is essential. Colon cancer arising in a diverticulum should be considered as a possible site of the primary lesion.
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Affiliation(s)
- Jiro Kimura
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan.
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan
| | - Shota Fukai
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Kentaro Yoshikawa
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Shingo Sasamatsu
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Takashi Sakamoto
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Ken Mizokami
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Masaki Kanzaki
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Tadao Kubota
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Akira Saito
- Department of Pathology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Hiroshi Izumi
- Department of Pathology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Kunpei Honjo
- Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, Chiba, Japan
| | - Kunihiko Nagakari
- Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, Chiba, Japan
| | - Masaki Fukunaga
- Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, Chiba, Japan
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18
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Val-Bernal JF, Mayorga M, Val D, Garijo MF. Low-grade serous primary peritoneal carcinoma incidentally found in a hernia sac. Pathol Res Pract 2015; 211:550-5. [PMID: 25953339 DOI: 10.1016/j.prp.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/23/2015] [Accepted: 04/08/2015] [Indexed: 01/05/2023]
Abstract
Very rarely, a primary peritoneal serous carcinoma can be observed in a hernia sac. We herein describe a low-grade serous primary peritoneal carcinoma incidentally found in a postmenopausal woman following examination of the femoral hernia repair sac. Our case is significant for its unusual presentation. The lesion initially appeared as a 0.3-cm tumor that disseminated in the peritoneum, persisted, and progressed for 75 months. The absence of ovarian disease indicated a primary peritoneal origin. Tumor cells were immunohistochemically positive for PAX8, claudin-4, and VE1, excluding the possibility of being of mesothelial origin. Recognition that a low-grade serous primary peritoneal carcinoma can be incidentally found in a hernia sac should simplify future diagnoses. Immunohistochemistry is helpful in making the correct diagnosis.
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Affiliation(s)
- José-Fernando Val-Bernal
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain.
| | - Marta Mayorga
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain
| | - Daniel Val
- Laboratoire National de Santé, Division d́Anatomie Pathologique, Dudelange, Luxembourg
| | - María-Francisca Garijo
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain
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19
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Chesley PM, Black GE, Martin MJ, Johnson EK, Maykel JA, Steele SR. The utility of pathologic evaluation of adult hernia specimens. Am J Surg 2015; 209:783-6; discussion 786. [PMID: 25725504 DOI: 10.1016/j.amjsurg.2014.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/21/2014] [Accepted: 12/30/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pathological examination of hernia sac specimens adds additional steps and cost to a surgical procedure but has no proven benefit. Although well studied in pediatrics, there are limited data in the adult literature pertaining to this practice. METHODS This is a retrospective analysis from a single institution referral center over a 4-year period (2007 to 2011). All inguinal, incisional, ventral, and umbilical hernia repairs greater than 18 years of age were included. RESULTS A total of 1,216 inguinal (55.4%), incisional (11.4%), umbilical (21.5%), or ventral hernia (11.7%) repairs were included. In 246 cases (20.2%), hernia sac specimens were sent to pathology (open 96.7%; laparoscopic 3.3%). There were no cases in which management of the patient changed because of the final results. CONCLUSION The rarity of changes in diagnosis and treatment from routine pathologic examination of a hernia sac does not justify this practice and indicates that it may be omitted except in unique circumstances.
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Affiliation(s)
- Patrick M Chesley
- Department of Surgery, Madigan Army Medical Center, Ft. Lewis, WA, USA
| | - George E Black
- Department of Surgery, Madigan Army Medical Center, Ft. Lewis, WA, USA
| | - Matthew J Martin
- Department of Surgery, Madigan Army Medical Center, Ft. Lewis, WA, USA
| | - Eric K Johnson
- Department of Surgery, Madigan Army Medical Center, Ft. Lewis, WA, USA
| | - Justin A Maykel
- Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Scott R Steele
- Department of Surgery, Madigan Army Medical Center, Ft. Lewis, WA, USA.
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20
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Val-Bernal JF, Mayorga M, Val D, Garijo MF. Well-differentiated papillary mesothelioma manifesting in a hernia sac. Pathol Res Pract 2014; 210:609-12. [PMID: 24860916 DOI: 10.1016/j.prp.2014.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/27/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
Well-differentiated papillary mesothelioma (WDPM) is a tumor of uncertain malignant potential that usually occurs as a multifocal lesion of the female peritoneum, and is incidentally found at the time of surgery. We present here a multifocal case that had arisen from the lining of a hernia sac. To our knowledge, only four cases of this event have been previously described. A review of the five cases reported, including our case, revealed that the mean age of the patients was 56.6±8.35 years. There was predominance in men (4:1). In four cases, the lesion was incidental. Most tumors were found in inguinal hernias. Four cases presented with gross abnormalities in the hernia sac. All the five patients were alive with no evidence of WDPM after a mean follow-up of 38.6 months. Extensive sampling of this rare lesion helps to rule out an epithelial malignant mesothelioma and prevents overtreatment.
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Affiliation(s)
- José Fernando Val-Bernal
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IFIMAV, Santander, Spain.
| | - Marta Mayorga
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IFIMAV, Santander, Spain
| | - Daniel Val
- Anatomical Pathology Service, Carlos III Hospital, Madrid, Spain
| | - María Francisca Garijo
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IFIMAV, Santander, Spain
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Berney CR. Beware of spontaneous reduction "en masse" of inguinal hernia. Hernia 2014; 19:995-7. [PMID: 24430579 DOI: 10.1007/s10029-014-1215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 01/05/2014] [Indexed: 10/25/2022]
Abstract
Reduction 'en masse' of inguinal hernia is a rare entity defined as manual reduction of an external hernia sac back through the abdominal wall but where its content still remains incarcerated or strangulated into a displaced position, most often in the pre-peritoneal space. Small bowel obstruction habitually follows requiring urgent repair, preferentially via a trans-abdominal approach. Pre-operative clinical diagnosis is difficult and abdominal CT-scan imaging is the investigation of choice.
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Affiliation(s)
- C R Berney
- Department of Surgery, University of New South Wales, Bankstown-Lidcombe Hospital, Eldridge Road, Bankstown, NSW, 2200, Australia.
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Zamora IJ, Cass DL, Lee TC, Welty S, Cassady CI, Mehollin-Ray AR, Fallon SC, Ruano R, Belfort MA, Olutoye OO. The presence of a hernia sac in congenital diaphragmatic hernia is associated with better fetal lung growth and outcomes. J Pediatr Surg 2013; 48:1165-71. [PMID: 23845602 DOI: 10.1016/j.jpedsurg.2013.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/08/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the relationship between the presence of a hernia sac and fetal lung growth and outcomes in infants with Congenital, Diaphragmatic Hernia (CDH). METHODS The medical records of all neonates with CDH treated in our institution between 2004 and 2011 were reviewed. The presence of a hernia sac was confirmed at the time of surgical repair or at autopsy. Data were analyzed using parametric and non-parametric tests where appropriate. Multivariable regression and survival analyses were applied. RESULTS Of 148 neonates treated for CDH, 107 (72%) had isolated CDH and 30 (20%) had a hernia sac. Infants with a hernia sac had significantly lower need for ECMO, patch repair, supplemental oxygen at 30 days of life, and shorter duration of mechanical ventilation and hospital stay. Ninety-three patients had prenatal imaging. The mean observed-to-expected total fetal lung volume in the sac group was higher throughout gestation. Although a greater percentage of sac patients had liver herniation as a dichotomous variable, the amount of herniated liver (%LH and LiTR) was significantly lower in the presence of a hernia sac. CONCLUSION The presence of a hernia sac in Congenital Diaphragmatic Hernia is associated with less visceral herniation, greater fetal lung growth, and better post-natal outcomes.
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Affiliation(s)
- Irving J Zamora
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX 77030, USA
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Sobhani R, Alsaeidi S, Mahmoudabadi A. Metastatic hernial sac tumor in a patient with FUO. Int J Surg Case Rep 2011; 2:97-9. [PMID: 22096694 PMCID: PMC3199623 DOI: 10.1016/j.ijscr.2011.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 02/19/2011] [Accepted: 02/21/2011] [Indexed: 10/18/2022] Open
Abstract
The presence of primary or metastatic cancer within a hernia sac is uncommon, which occurs in fewer than 0.5% of all surgically excised sacs (1). This article demonstrates a case of a metastatic pancreatic cancer, one of which presented as an inguinal hernia with fever of unknown origin (FUO). A 44-year-old male presented with a history of FUO and a painful inguinal hernia. Inguinal canal exploration revealed a mass like lesion in the sac without any correlation to abdominopelvic viscera. Postoperative evaluations confirmed moderately differentiated metastatic adenocarcinoma from pancreatic origin.
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Affiliation(s)
- Roohollah Sobhani
- Department of General Surgery, 15 Khordad Hospital, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Samira Alsaeidi
- Department of Internal Medicine, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Mahmoudabadi
- Department of Radiology, 15 Khordad Hospital, Gonabad University of Medical Sciences, Gonabad, Iran
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