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Edholm D, Hofgård JO, Andersson E, Stenberg E, Olbers T. Very low risk of short bowel after Roux-en-Y gastric bypass - a large nationwide Swedish cohort study. Surg Obes Relat Dis 2024; 20:362-366. [PMID: 38114384 DOI: 10.1016/j.soard.2023.10.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/28/2023] [Accepted: 10/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures. Internal herniation may lead to small bowel ischemia requiring small bowel resection, resulting in short bowel syndrome. OBJECTIVE To determine the incidence of extensive small bowel resection in patients operated with RYGB. We also aimed to look for early clinical warning signs among patients requiring extensive small bowel resection. SETTING Cohort from national quality registers. METHODS All patients having undergone RYGB between January 2007 to June 2019 were analyzed in the Scandinavian Obesity Surgery Registry (SOReg). We identified patients with small bowel obstruction (SBO) for whom small bowel resection was necessary. Additionally, we assessed clinical signs in these patients. RESULTS The study included 57,255 patients having undergone RYGB. Closure of the mesenteric openings was performed in 78%. Surgery for SBO was required in 3659 (6%) of patients, and small bowel resection in 188 (.3%). Extensive small bowel resection, resulting in less than 1.5 meters of remaining small bowel, was required in 7 patients (.01%). All patients with extensive small bowel resection presented with abdominal pain and had confirmed internal herniation as the cause of the small bowel resection, and 2 of 7 patients died. Closure of mesenteric defects was not associated with a reduction in overall small bowel resection rates (P = .89) CONCLUSION: Surgery for SBO after RYGB was common (6%). The risk of extensive small bowel resection leading to short bowel was low (.01%). Patients with abdominal pain after RYGB should be assessed for internal hernia, as it can be devastating.
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Affiliation(s)
- David Edholm
- Department of Surgery, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Johan Olsson Hofgård
- Department of Surgery, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ellen Andersson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Torsten Olbers
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden; Department of Biomedical and Clinical Sciences and Wallenberg Centre for Molecular Medicine, Department of Biomedical and Clinical sciences, Linköping University, Linköping, Sweden
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2
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Bossen MF, Gormsen J, Kristensen SD, Helgstrand F. Smoking Is Correlated to Internal Hernia After Gastric Bypass Surgery: a Post hoc Analysis of Data from a Randomized Clinical Trial. Obes Surg 2024; 34:1097-1101. [PMID: 38376637 PMCID: PMC11026284 DOI: 10.1007/s11695-024-07097-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Internal herniation is a well-known complication of laparoscopic Roux-en-Y gastric bypass (L-RYGB). The aim of this study was to evaluate smoking as an independent risk factor for internal herniation after L-RYGB. MATERIALS AND METHODS This study was performed as an exploratory post hoc analysis of data from a previous published randomized controlled trial (RCT) designed to compare closure and non-closure of mesenteric defects in patients undergoing L-RYGB. The primary outcome of this study was to assess the significance of smoking as a risk factor for internal herniation after L-RYGB. Secondary outcome was early postoperative complications defined as Clavien-Dindo grade ≥ 2. RESULTS Four hundred one patients were available for post hoc analysis. The risk of internal herniation was significantly higher among patients who were smoking preoperatively (hazard ratio (HR) 2.4, 95% confidence interval (c.i.) 1.3 to 4.5; p = 0.005). This result persisted after adjusting for other patient characteristics (HR 2.2, 1.2 to 4.2; p = 0.016). 6.0% of the patients had postoperative complications within the first 30 days. 4.9% of these patients were smoking and 6.3% were not smoking, p = 0.657. 11.0% of the patients underwent surgery due to internal herniation by 5 years after the primary procedure. CONCLUSION Smoking is a significant risk factor for internal herniation but did not increase risk for 30 days postoperative complications.
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Affiliation(s)
- Marlene F Bossen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Section, Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - Johanne Gormsen
- Department of Surgery, Zealand University Hospital, 4600, Koege, Denmark
| | - Sara D Kristensen
- Department of Surgery, Zealand University Hospital, 4600, Koege, Denmark
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3
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Biere SSAY, El Aater K, van der Velden E, Tans RJJ, Faraj D, Biere-Rafi S. [An abdominal wall bulging: consider a neurological cause]. Ned Tijdschr Geneeskd 2024; 168:D7852. [PMID: 38375896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
A patient with a swelling of the abdominal wall is a regular occurrence in general practice and hospital. The diagnosis can often be made with a thorough history and physical examination. An abdominal wall hernia is characterized by an increase in swelling on standing physical examination and Valsalva maneuver, which is often reducible, and a hernia defect is palpable. If no interruption of the abdominal wall is palpable and there is hypoesthesia, there may be an abdominal wall paresis because of thoracic paramedian hernia nuclei pulposi (HNP). Where an abdominal wall hernia is treated surgically in case of symptoms, this is conservatively treated with an HNP.
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Affiliation(s)
- Surya S A Y Biere
- Acibadem International Medical Center, Amsterdam. Afd. Chirurgie
- Contact:
| | - Karim El Aater
- Acibadem International Medical Center, Amsterdam. Afd. Chirurgie
| | | | - Roeland J J Tans
- Acibadem International Medical Center, Amsterdam. Afd. Neurologie
| | - Dashti Faraj
- Acibadem International Medical Center, Amsterdam. Afd. Chirurgie
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Park JK, Kim DH, Jeon TY, Jeong SH, Kim TH, Min JS, Kim RB, Lee YJ, Park JH, Son YG, Yoon KY, Seo KW, Kim KH, Kim Y, Chae HD, Hwang SH, Lee SH, Chung JH, Kim HI, Park DJ, Kim KH, Seo SH, Oh SJ, Lee WY, In Choi C. Comparison between the mesenteric fixation method (MEFIX) and conventional methods at preventing the occurrence of Petersen's hernia: a study protocol for a multicenter randomized controlled trial. Trials 2024; 25:7. [PMID: 38167216 PMCID: PMC10759566 DOI: 10.1186/s13063-023-07841-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Petersen's hernia, which occurs after Billroth-II (B-II) or Roux-en-Y (REY) anastomosis, can be reduced by defect closure. This study aims to compare the incidence of bowel obstruction above Clavien-Dindo classification grade III due to Petersen's hernia between the mesenteric fixation method and the conventional methods after laparoscopic or robotic gastrectomy. METHODS This study was designed as prospective, single-blind, non-inferiority randomized controlled multicenter trial in Korea. Patients with histologically diagnosed gastric cancer of clinical stages I, II, or III who underwent B-II or REY anastomosis after laparoscopic or robotic gastrectomy are enrolled in this study. Participants who meet the inclusion criteria are randomly assigned to two groups: a CLOSURE group that underwent conventional Petersen's defect closure method and a MEFIX group that underwent the mesenteric fixation method. The primary endpoint is the number of patients who underwent surgery for bowel obstruction caused by Petersen's hernia within 3 years after laparoscopic or robotic gastrectomy. DISCUSSION This trial is expected to provide high-level evidence showing that the MEFIX method can quickly and easily close Petersen's defect without increased postoperative complications compared to the conventional method. TRIAL REGISTRATION ClinicalTrials.gov NCT05105360. Registered on November 3, 2021.
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Affiliation(s)
- Jae Kyun Park
- Department of Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Biomedical Institution, Busan, 49241, Republic of Korea
| | - Dae Hwan Kim
- Department of Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Biomedical Institution, Busan, 49241, Republic of Korea
| | - Tae-Yong Jeon
- Department of Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Biomedical Institution, Busan, 49241, Republic of Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Tae Han Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Republic of Korea
| | - Rock Bum Kim
- Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Young Joon Lee
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ji Ho Park
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Young Gil Son
- Department of Surgery, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Ki Young Yoon
- Department of Surgery, Kosin University College of Medicine, Busan, Republic of Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University College of Medicine, Busan, Republic of Korea
| | - Ki Hyun Kim
- Department of Surgery, Kosin University College of Medicine, Busan, Republic of Korea
| | - Yoonhong Kim
- Department of Surgery, Kosin University College of Medicine, Busan, Republic of Korea
| | - Hyun Dong Chae
- Department of Surgery, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sun Hwi Hwang
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Si-Hak Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jae Hun Chung
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Jin Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Kwang Hee Kim
- Department of Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sang Hyuk Seo
- Department of Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sung Jin Oh
- Department of Surgery, Inje University Haeundae Paik Hospital , Busan, Republic of Korea
| | - Woo Yong Lee
- Department of Surgery, Inje University Haeundae Paik Hospital , Busan, Republic of Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Biomedical Institution, Busan, 49241, Republic of Korea.
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5
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Tsouknidas I, Tasis N, Antonopoulou MI, Acheimastos V, Manatakis DK. Traumatic lumbar hernia: A systematic review of the literature. Chin J Traumatol 2024; 27:53-57. [PMID: 37507292 PMCID: PMC10859291 DOI: 10.1016/j.cjtee.2023.05.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/30/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE Traumatic lumbar hernia (TLH) constitutes a protrusion of content through a defect in the posterior abdominal wall, as a result of injury. This rare entity has been described in limited number of cases. METHODS A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology guidelines. The English literature from 1990 until 2021 was reviewed, using PubMed, EMBASE and Google Scholar bibliographic databases, to identify case reports and case series with patients that were diagnosed with TLH. For each eligible study, demographics, clinical presentation, hernia characteristics, preoperative imaging investigations, operation details, and postoperative data were extracted for assessment. Statistical analysis was performed on SPSS, version 20.0. RESULTS A total of 62 studies were included for review, with 164 patients with TLH. Mean age was (42.6 ± 14.3) years (47.6% males, 31.1% females, gender not specified in 35 cases). Mean diameter of hernia neck was (6.3 ± 3.1) cm, while the triangles of Petit and Grynfeltt were affected in 74.5% and 14.6%, respectively. Patients diagnosed in the emergency setting account for 54.2%, with CT scan establishing diagnosis in all but one case (97.7%). A delayed diagnosis was made in 45.8%, at a mean 1 year following trauma. Flank bulging (82.8%) and chronic back pain (34.3%) were the most frequent symptoms. In both delayed and acute group, open surgery (63.6% and 92.3%, respectively) was the preferred surgical approach. Postoperative complications were reported in 11.4% of acute and 15.0% of delayed patients. Hernia recurrence was 7%. CONCLUSIONS TLH is uncommon with 164 cases described since 1990. CT scan is the gold standard in diagnosis. Open surgery is generally the preferred approach, particularly in the emergency setting. Acute TLH can be treated either by primary suture repair or mesh, depending on the local conditions, whereas delayed cases usually require a mesh.
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Affiliation(s)
- Ioannis Tsouknidas
- Department of Surgery, Stony Brook University Hospital, Stony Brook, New York, USA.
| | - Nikolaos Tasis
- Department of Surgical Oncology, St Savvas Cancer Hospital, Athens, Greece; 2nd Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
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Broomfield M, Agabani Z, Guadagno E, Poenaru D, Baird R. The evidence mismatch in pediatric surgical practice. Pediatr Surg Int 2023; 39:295. [PMID: 37978994 DOI: 10.1007/s00383-023-05569-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Outpatient pediatric surgical practice often involves conditions of limited morbidity but significant parental concern. We explore existing evidence-based management recommendations and the mismatch with practice patterns for four common outpatient pediatric surgical conditions. METHODS Using the Cochrane Rapid Review Group recommendations and librarian oversight, we conducted a rapid review of four outpatient surgical conditions: dermoid cysts, epigastric hernias, hydroceles, and umbilical hernias. We extracted patient demographics, intervention details, outcome measures and evaluated justifications presented for chosen management options. A metric of evidence volume (patient/publication ratio) was generated and compared between diagnoses. RESULTS Out of 831 articles published since 1990, we identified 49 cohort studies (10-dermoid cyst, 6-epigastric hernia, 25-hydrocele, and 8-umbilical hernia). The 49 publications included 34,172 patients treated across 18 countries. The evidence volume for each outpatient condition demonstrates < 1 cohort/condition/year. The evidence mismatch rate varied between 33 and 75%; many existing recommendations are not evidence-based, sometimes conflicting and frequently misrepresentative of clinical practice. CONCLUSIONS Published literature concerning common outpatient pediatric surgical conditions is sparse and demonstrates wide variations in practice. All individual practice choices were justified using either risk of complications or patient preference. Most early intervention practices were based on weak or outdated studies and "common wisdom" rather than genuine evidence. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Marina Broomfield
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Zena Agabani
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
- University of Toronto, Toronto, ON, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Dan Poenaru
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Robert Baird
- Division of Pediatric Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, Canada.
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7
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Li J, Wu L, Shao X, Cheng T. Postoperative perineal hernia repair: what is the evidence? Surg Today 2023; 53:1105-1115. [PMID: 36720743 DOI: 10.1007/s00595-023-02654-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/27/2022] [Indexed: 02/02/2023]
Abstract
The present study determined the characteristics of perineal hernia treatment in the literature, and the incidence of postoperative recurrence was stratified according to repair techniques. A systematic search of the available literature on the treatment of postoperative perineal hernias was performed using a major database. The types of repair techniques and outcome were entered into an electronic database and a pooled analysis was performed. A total of 213 cases of postoperative perineal hernia repair were collected from 20 relevant articles in the literature after excluding case reports (n < 3). Synthetic mesh was the material used most frequently for perineal hernia repair (55.9%). The most frequently used approach in perineal hernia repair was the perineal approach (56.5%). The recurrence rate was highest with the use of biological mesh (40.4%) and the perineal approach (35.6%). The recurrence rate was lowest in the combined abdominal & perineal approach (0%), followed by the abdominal approach (8.8%) and the laparoscopic approach (11.8%). A number of different repair techniques have been described in the literature. The use of synthetic mesh via a combined abdominal-perineal approach or intraabdominal/laparoscopic approach was shown to be associated with a reduced postoperative recurrence rate.
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Affiliation(s)
- Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China.
| | - Lisheng Wu
- Department of Hernia and Bariatric SurgeryDivision of Life Science and MedicineAnhui Province, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, People's Republic of China
| | - Xiangyu Shao
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Tao Cheng
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
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8
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Romain B, Diab S. Management of post-traumatic lumbar hernia in Grynfeltt and Petit triangles (with video). J Visc Surg 2023; 160:386-388. [PMID: 37778947 DOI: 10.1016/j.jviscsurg.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Benoît Romain
- Service de chirurgie générale et digestive, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France.
| | - Samer Diab
- Service de chirurgie générale et digestive, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France
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9
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Zaigham H, Ekelund M, Regnér S. Long-Term Follow-up and Risk of Recurrence of Internal Herniation after Roux-en-Y Gastric Bypass. Obes Surg 2023; 33:2311-2316. [PMID: 37266865 PMCID: PMC10344975 DOI: 10.1007/s11695-023-06653-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE Internal herniation (IH) is the most common complication after Roux-en-Y gastric bypass surgery (RYGB). Although primary closure has reduced the incidence, recurrences are a continued problem. This study aimed to investigate long-term follow-up and recurrence risk of IH surgery. METHODS A retrospective cohort study of laparoscopic RYGB operated patients operated for a first IH between April 2012 and April 2015 at Skåne University Hospital in Malmö, Sweden. Status of primary closure of mesenteric gaps, time since RYGB, and findings at IH surgery were retrieved from medical records. Follow-up until December 31st, 2019, included recurrences of IH, number of computed tomography (CT) scans, emergency visits, readmissions, and other acute surgeries. RESULTS IH (n = 44) occurred almost equally in Petersen's space (n = 24) and beneath the jejunojejunostomy (n = 20). Long-term follow-up (median 75 months) of 43 patients registered an IH recurrence rate of 14% (n = 6). All recurrences occurred in the other mesenteric gap. One patient suffered a third IH, and one patient had four IH events. During follow-up, 56% (n = 24) had ER visits for abdominal pain, 47% (n = 20) had ≥ 1 abdominal CT scan, and 40% (n = 17) were readmitted. A third of readmitted (6/17) patients suffered a recurrence of internal herniation. Two other patients were readmitted ≥ 10 times for chronic abdominal pain. CONCLUSION Surgery for IH had a low risk of recurrence at the treated mesenteric gap, but a 14% recurrence risk at the other mesenteric gap, emphasizing the importance of carefully investigating weaknesses or gaps at the other mesenteric defect during surgery for IH.
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Affiliation(s)
- Hassan Zaigham
- Surgery Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
- Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden.
| | - Mikael Ekelund
- Surgery Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | - Sara Regnér
- Surgery Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden
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Muir D, Choi B, Clements C, Ratnasingham K, Irukulla S, Humadi S. Mesenteric Defect Closure and the Rate of Internal Hernia in Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis. Obes Surg 2023; 33:2229-2236. [PMID: 37162714 DOI: 10.1007/s11695-023-06597-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/11/2023]
Abstract
Internal hernias are a worrying complication from laparoscopic Roux-en-Y gastric bypass (LRGB), with potential small bowel necrosis and obstruction. An electronic database search of Medline, Embase, and Pubmed was performed. All studies investigating the internal hernia rates in patients whose mesenteric defects were closed vs. not closed during LRGB were analysed. Odds ratios were calculated to assess the difference in internal hernia rate. A total of 14 studies totalling 20,553 patients undergoing LRGB were included. Internal hernia rate (220/12,445 (2%) closure vs. 509/8108 (6%) non-closure) and re-operation for small bowel obstruction (86/5437 (2%) closed vs. 300/3132 (10%) non-closure) were reduced when defects were closed. There was no difference observed when sutures were used to close the defects compared to clips/staples.
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Affiliation(s)
- Duncan Muir
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK.
| | - Byung Choi
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | | | | | - Shashi Irukulla
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Samer Humadi
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
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11
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Henry R, Tam B, Biswas S. Meckel's Diverticulum Causing an Interloop Adhesion and Bowel Obstruction from an Internal Hernia. Am Surg 2023; 89:1112-1114. [PMID: 33342298 DOI: 10.1177/0003134820979791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Reynold Henry
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Benjamin Tam
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Subarna Biswas
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
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12
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Nicolae S, Skovsen APG. [Internal bowel herniation due to clip adhaesion]. Ugeskr Laeger 2022; 184:V07210571. [PMID: 35244024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Small bowel obstruction (SBO) due to clip adhaesions from the line of staples is a rare complication and is scarcely reported in the literature. In this case report, a ten-year-old boy underwent laparoscopic appendectomy and five days later developed early postoperative SBO. Diagnostic laparoscopy revealed internal herniation of bowel through a defect created by clip adhesion from the staple line to the adjacent mesentery. The clip was removed, the internal hernia resolved, and the patient discharged the same day. We recommend reviewing the line of staples after surgery.
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Affiliation(s)
- Sermed Nicolae
- Kirurgisk Afdeling, Københavns Universitetshospital - Nordsjællands Hospital - Hillerød
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13
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Osawa H, Ide Y, Nakamoto R, Yoshida M, Seto H, Yoneda K, Ohashi T, Murakami K, Demura K, Morimoto O, Iwasaki T, Hatanaka N, Nishida T. [A Case of Internal Hernia Incarceration of a Mesenteric Defect following Laparoscopic Ileocecal Resection]. Gan To Kagaku Ryoho 2021; 48:2152-2154. [PMID: 35045522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 75-year-old man underwent laparoscopic ileocecal and partial small bowel resections for the management of appendiceal cancer. The pathological diagnosis was cecal cancer(T4b[ileum, abdominal wall],N0[0/13], M0, pStage Ⅱc). After 4 months of surgery, he suddenly experienced abdominal pain and vomiting and was presented to our emergency room. He was diagnosed with bowel obstruction following which, conservative treatment was initiated through a nasogastric ileus tube implantation; however, he did not show any improvement. Subsequently, he underwent experimental laparotomy on the 18th day of the disease. Intraabdominal examination revealed herniated small intestine through a mesenteric defect, which was closed following repositioning of the herniated small intestine. The postoperative course was good, and the patient was discharged on the 10th day after surgery. No recurrence of intestinal obstruction has been observed after 1 year and 6 months. Closure of the mesenteric defect, although not commonly performed in laparoscopic colorectal surgery, is worth considering because of the risk of developing an internal hernia requiring surgical treatment, as in our case.
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Affiliation(s)
- Hideki Osawa
- Dept. of Surgery, Japan Community Health care Organization(JCHO)Osaka Hospital
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14
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Amanda D, Elin P, Eva N, Stenberg E. The Influence of Mesenteric Defects Closure on the Use of Computed Tomography for Abdominal Pain 5 Years After Laparoscopic Gastric Bypass-a Post Hoc Analysis of a Randomized Clinical Trial. Obes Surg 2021; 32:266-272. [PMID: 34813038 PMCID: PMC8794995 DOI: 10.1007/s11695-021-05778-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/13/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022]
Abstract
Background Abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common and unwanted complication that typically leads to further exploration through radiology. Concerns have been raised regarding the consequences of this radiation exposure and its correlation with the lifetime risk of cancer. The aim of this study was to evaluate the differences in computed tomography (CT) use between LRYGB patients with open and closed mesenteric defects and to assess the radiological findings and radiation doses. Methods This subgroup analysis included 300 patients randomized to either closure (n = 150) or nonclosure (n = 150) of mesenteric defects during LRYGB. The total number of CT scans performed due to abdominal pain in the first 5 postoperative years was recorded together with the radiological findings and radiation doses. Results A total of 132 patients (44%) underwent 281 abdominal CT scans, including 133 scans for 67 patients with open mesenteric defects (45%) and 148 scans for 65 patients with closed mesenteric defects (43%). Radiological findings consistent with small bowel obstruction or internal hernia were found in 31 (23%) of the scans for patients with open defects and in 18 (12%) of the scans for patients with closed defects (p = 0.014). The other pathological and radiological findings were infrequent and not significantly different between groups. At the 5-year follow-up, the total radiation dose was 82,400 mGy cm in the nonclosure group and 85,800 mGy cm in the closure group. Conclusion Closure of mesenteric defects did not influence the use of CT to assess abdominal pain. Graphical abstract ![]()
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Affiliation(s)
- Demir Amanda
- Department of Surgery, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
| | - Påhlson Elin
- Department of Surgery, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
| | - Norrman Eva
- Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden.
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Vassiliu P, Parasyris S, Sidiropoulos TA, Margaris I, Oikonomopoulos N, Kostopanagiotou K, Smyrniotis V, Arkadopoulos N. Intrapericardial Hernia after Transdiaphragmatic Approach of Intrathoracic IVC. Ann Vasc Surg 2021; 77:349.e1-349.e4. [PMID: 34450288 DOI: 10.1016/j.avsg.2021.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/15/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022]
Abstract
Trauma and abdominal surgery that involves the diaphragm and pericardium rarely ends up in post-operative visceral herniation into the pericardial cavity. Urgent intervention is crucial to restore the cardiac output and prevent bowel strangulation. A case of a patient with intrapericardial hernia following nephrectomy for renal cell carcinoma and en block resection of an IVC neoplasmatic thrombus via transdiaphragmatic approach is presented.
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MESH Headings
- Aged
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/surgery
- Female
- Hernia, Abdominal/diagnostic imaging
- Hernia, Abdominal/etiology
- Hernia, Abdominal/surgery
- Hernia, Diaphragmatic/diagnostic imaging
- Hernia, Diaphragmatic/etiology
- Hernia, Diaphragmatic/surgery
- Herniorrhaphy
- Humans
- Jejunum/diagnostic imaging
- Jejunum/surgery
- Kidney Neoplasms/pathology
- Kidney Neoplasms/surgery
- Nephrectomy/adverse effects
- Pericardium/diagnostic imaging
- Pericardium/surgery
- Treatment Outcome
- Vascular Surgical Procedures/adverse effects
- Vena Cava, Inferior/pathology
- Vena Cava, Inferior/surgery
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Affiliation(s)
- Panteleimon Vassiliu
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Stavros Parasyris
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece.
| | - Theodoros A Sidiropoulos
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Ioannis Margaris
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Oikonomopoulos
- 2nd Department of Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Kostas Kostopanagiotou
- Department of Thoracic Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Vasileios Smyrniotis
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
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16
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Miyake Y, Watanabe S, Mizojiri G, Maruyama K, Lee K, Oka H. Mesh repair under the anterior lamina of the rectus sheath (MUAR) for abdominal incisional hernia. Surg Today 2021; 51:1649-1654. [PMID: 33866433 DOI: 10.1007/s00595-021-02282-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/31/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Abdominal incisional hernia is a frequent complication of major abdominal operations. Our method of performing mesh repair under the anterior lamina of the rectus sheath (MUAR) involves placing mesh between the dorsal surface of the anterior rectus sheath and the rectus abdominis muscle. We evaluated the short-term and long-term outcomes of our MUAR method. METHODS The subjects of this retrospective study were 80 patients with abdominal incisional hernia, who underwent MUAR at our hospital between August, 2009 and September, 2018. We investigated the rate of recurrence and postoperative complications in these patients, who were followed-up postoperatively for at least 18 months. Patients who completed all visits were then followed-up further with questionnaires. RESULTS The recurrence rate after MUAR was 0%. Postoperative complications consisted of subcutaneous wound infections in two patients (2.5%), successfully treated with wound cleansing and antibiotics; and subcutaneous hematoma in three patients (3.8%), which was spontaneously absorbed in two patients, and removed in one. There were no other complications, such as seroma, intestinal obstruction, mesh infection and bulging, or prolonged postoperative pain. CONCLUSION Mesh repair under the anterior lamina of the rectus sheath is simple and safe with positive short-term and long-term outcomes, suggesting that it is a good option for incisional hernia repair.
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Affiliation(s)
- Yuichiro Miyake
- Department of Surgery, Moriguchi-Keijinkai Hospital, 2-47-12 Yagumo-higashimachi, Moriguchi, Osaka, 570-0021, Japan.
| | - Souta Watanabe
- Department of Surgery, Moriguchi-Keijinkai Hospital, 2-47-12 Yagumo-higashimachi, Moriguchi, Osaka, 570-0021, Japan
| | - Gaku Mizojiri
- Department of Surgery, Moriguchi-Keijinkai Hospital, 2-47-12 Yagumo-higashimachi, Moriguchi, Osaka, 570-0021, Japan
| | - Kentaro Maruyama
- Department of Surgery, Moriguchi-Keijinkai Hospital, 2-47-12 Yagumo-higashimachi, Moriguchi, Osaka, 570-0021, Japan
| | - Kyowon Lee
- Department of Surgery, Moriguchi-Keijinkai Hospital, 2-47-12 Yagumo-higashimachi, Moriguchi, Osaka, 570-0021, Japan
| | - Hiroshi Oka
- Department of Surgery, Moriguchi-Keijinkai Hospital, 2-47-12 Yagumo-higashimachi, Moriguchi, Osaka, 570-0021, Japan
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17
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Espinosa-de-Los-Monteros A, Frias-Frias R, Alvarez-Tostado-Rivera A, Caralampio-Castro A, Llanes S, Saldivar A. Postoperative Abdominal Bulge and Hernia Rates in Patients Undergoing Abdominally Based Autologous Breast Reconstruction: Systematic Review and Meta-Analysis. Ann Plast Surg 2021; 86:476-484. [PMID: 33720921 DOI: 10.1097/sap.0000000000002538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
ABSTRACT Bulge and hernia may occur after abdominally based breast reconstruction. The purpose of this study is to provide an estimate of the effects that the type of flap used for breast reconstruction (ie, transverse rectus abdominis muscle [TRAM] vs muscle-sparing [MS]-2 TRAM vs DIEP) has on the postoperative development of both abdominal bulge and abdominal hernia, taking into consideration the method of donor site closure (ie, with mesh vs without mesh), based on the available literature. Twenty-eight studies met the inclusion criteria and were included in the systematic review. From these, 9 studies were comparative and suitable for meta-analysis. The results showed that, for unilateral breast reconstructions, there was no statistically significant difference in hernia/bulge rates in the following techniques: MS-2 TRAM flap without mesh, MS-2 TRAM flap with mesh, and DIEP flap without mesh, and they showed significantly lower hernia/bulge rates compared with TRAM flap without mesh, and TRAM flap with mesh, whereas for bilateral reconstructions, there was no statistically significant difference in hernia/bulge rates in the following techniques: MS-2 TRAM flaps with mesh and DIEP flaps without mesh, and they showed significantly lower hernia/bulge rates compared with TRAM flaps without mesh, TRAM flaps with mesh, and MS-2 TRAM flaps without mesh.
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18
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Choi MS, Jang MH, Lee BJ, Shin YB, Kim SH. A novel assessment of abdominal pseudohernia after thoracolumbar vertebral compression fractures using surface electromyography and ultrasonography: A case report. Medicine (Baltimore) 2021; 100:e24973. [PMID: 33655965 PMCID: PMC7939196 DOI: 10.1097/md.0000000000024973] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/27/2021] [Accepted: 02/11/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE An abdominal pseudohernia is a protrusion of the abdominal wall that there is no actual muscular disruption. This report presents a case in which abdominal muscle activities were accurately and quantitatively measured using ultrasonography (US) and surface electromyography in a patient with abdominal pseudohernia. PATIENT CONCERNS A 62-year-old man presented with a marked protrusion on the left abdomen with increasing abdominal pressure. DIAGNOSES First, the thickness of the abdominal muscle was measured with US while the patient constantly blew the positive expiratory pressure device. When the force was applied to the abdomen, the mean thickness of the muscle layer on the lesion site was found to be thinner. Second, the activities of the abdominal muscles were measured using surface electromyography by attaching electrodes to 8 channels at the same time. When the same pressure was applied on both sides of the abdomen, more recruitment occurred to compensate for muscle weakness at the lesion site. Through the previous 2 tests, the decrease in muscle activity in the lesion area could be quantitatively evaluated. Third, the denervation of the muscle was confirmed using US-guided needle electromyography. INTERVENTIONS The patient in this case was wearing an abdominal binder. In addition, he had been training his abdominal muscles through McGill exercise and breathing exercises such as with a positive expiratory pressure device. OUTCOMES The patient was able to understand his symptoms. A follow-up test will be performed to see if there is any improvement. LESSONS By using these outstanding assessment methods, proper diagnosis and rehabilitation treatment strategies can be developed.
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Affiliation(s)
- Min Soo Choi
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
| | - Myung Hun Jang
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
| | - Byeong Ju Lee
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Republic of Korea
| | - Sang Hun Kim
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
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19
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Brammerloo YGA, Vannijvel M, Devriendt S, Verhaak T, Ultee G, Göttgens KWA, Langenhoff BS. Internal Hernia After Laparoscopic Gastric Bypass Without Preventive Closure of Mesenteric Defects: a Single Institution's Experience. J Gastrointest Surg 2021; 25:623-634. [PMID: 32767016 DOI: 10.1007/s11605-020-04761-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/06/2020] [Accepted: 07/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Internal herniation (IH) is a well-known complication after laparoscopic gastric bypass (LGB). Diagnosing and managing IH can be challenging. This retrospective cohort study aimed to achieve a greater understanding of symptomatology, diagnostic tools, complications, risk of IH recurrence, and symptom relief in IH patients. METHODS We included patients who underwent LGB surgery at our institution between 2011 and 2015. Mesenteric defects were not preventively closed during LGB. We focused on LGB patients who underwent surgical intervention(s) for suspected IH during a 7-year study period. We studied patient characteristics, (predictive) symptoms and signs, abdominal imaging, operative findings, post-operative course, and risk of (recurrent) IH. RESULTS A total of 1588 patients were included. In total, 243 patients underwent IH-related diagnostic laparoscopy. Radiating pain to the back (OR 2.45, p = .03), post-prandial pain (OR 3.23, p = .00), and leukocytosis (OR 15.53, p = .01) were identified as predictors of IH. The estimated risk of IH-related diagnostic laparoscopy was 16% at 3 years post-LGB, and the risk of confirmed IH was 12%. The estimated risk of diagnostic laparoscopy for suspected recurrent IH was 10% at 5 years post-LGB. In patients who underwent secondary mesenteric defects closure, post-operative symptom relief was reported in 84%. CONCLUSION This study demonstrates a considerable risk of developing IH after LGB without preventive closure of the mesenteric defects. We emphasize the value of diagnostic laparoscopy to achieve symptom relief in patients with suspicion of IH. Preoperative diagnosis of IH can be improved by being watchful of specific symptoms and signs which can predict the intra-operative presence of IH.
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Affiliation(s)
- Y G A Brammerloo
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands.
| | - M Vannijvel
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - S Devriendt
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - T Verhaak
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - G Ultee
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - K W A Göttgens
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - B S Langenhoff
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
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20
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Torensma B, Kooiman L, Liem R, Monpellier VM, Swank DJ, Tseng L. Internal Herniation Incidence After RYGB and the Predictive Ability of a CT Scan as a Diagnostic Tool. Obes Surg 2021; 31:127-132. [PMID: 32748202 PMCID: PMC7808966 DOI: 10.1007/s11695-020-04892-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The clinical diagnosis of an internal herniation (IH) after a Roux-en-Y Gastric Bypass (RYGB) remains difficult; therefore, performing a CT scan is usually part of the diagnostic process. The goal of this study was to assess the incidence of IH in patients with open and closed MD (mesenteric defect) and to study if the ability to diagnose an IH with a CT scan is different between these groups. MATERIALS AND METHODS IH was defined as a visible intestine through the mesenteric defect underneath the jejunojejunostomy and/or in the Petersen's space. CT scan outcomes were compared with the clinical diagnosis of an IH. Until 31 June 2013, standard care was to leave mesenteric defects (MDs) open; after this date, they were always closed. RESULTS The incidence of IH in the primarily non-closed group was 3.9%, and in the primarily closed group, this was 1.3% (p = 0.001). In group A (non-closed MD and CT), the sensitivity of the CT scan was 80%, and specificity was 0%. In group C (closed MD and CT), the sensitivity was 64.7%, and specificity was 89.5%. In group B (non-closed, no CT), an IH was visible in 58.7% of the cases and not in 41.3%. In group D (only a re-laparoscopy), an IH was visible in 34.3% of the cases and not in 65.7%. CONCLUSIONS Using the CT scan in suspected IH is not useful in if the MDs were not closed. If the MDs were closed, then a CT scan is predictive for the diagnosis IH.
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Affiliation(s)
- Bart Torensma
- Department of Anaesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Surgery, Dutch Obesity Clinic West & LUMC, The Hague, The Netherlands.
| | - Laurens Kooiman
- Department of Surgery, Dutch Obesity Clinic West & LUMC, The Hague, The Netherlands
| | - Ronald Liem
- Department of Surgery, Dutch Obesity Clinic West & LUMC, The Hague, The Netherlands
| | - Valerie M Monpellier
- Department of Surgery, Dutch Obesity Clinic West & LUMC, The Hague, The Netherlands
| | - Dingeman J Swank
- Department of Surgery, Dutch Obesity Clinic West & LUMC, The Hague, The Netherlands
| | - Larissa Tseng
- Department of Surgery, Dutch Obesity Clinic West & LUMC, The Hague, The Netherlands
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21
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Zheng X, Zhang J, Wang L, Sang Q, Zhu B, Zhang N, Sun Z. Case Report: an Unusual Complex Internal Hernia After Roux-en-Y Gastric Bypass. Obes Surg 2020; 31:1833-1835. [PMID: 33078339 DOI: 10.1007/s11695-020-05060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Xuejing Zheng
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Jianlu Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Liang Wang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Qing Sang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Bin Zhu
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Nengwei Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China.
| | - Zhipeng Sun
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China.
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22
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Miller DT, Maganty A, Theisen KM, Hrebinko R. Novel Creation of a Noneverted Stoma During Ileal Conduit Urinary Diversion: Technique and Short-term Outcomes. Urology 2020; 146:260-264. [PMID: 32791293 DOI: 10.1016/j.urology.2020.07.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report our experience with a noneverted stoma technique used in ileal conduit urinary diversion. We successfully utilize this technique in patients when traditional everted stoma maturation is difficult due to a thick abdominal wall, bulky mesentery, and poor bowel compliance. METHODS We retrospectively reviewed all patients who underwent surgical creation of ileal conduit using a noneverted stoma technique between 2009 and 2018. We recorded demographic and perioperative information, including 30-day postoperative complications, and stoma appearance at last follow-up visit. Using R software, chi-square testing of the distribution of stoma outcomes for obese and nonobese patients was performed. RESULTS There were a total of 42 patients who underwent noneverted stoma maturation technique by a single surgeon. Our cohort meets obese criteria with a mean body mass index (BMI) of 30.2. Mean length of follow-up was 16.6 months (1-62). On follow-up, 35 (83.3%) of stomas were pink and everted appearing, 4 (9.5%) were flush, small, or noneverted, 1 (2.3%) had an eschar or area of granulation tissue around the stoma, and 2 (4.7%) did not have a stoma description documented. There were 9 (21%) stoma-related complications in our cohort. There was no statistical difference in stoma outcomes between obese (BMI > 30) and nonobese (BMI < 30) patients (P= .65). CONCLUSION Ileal conduit creation with a noneverted stoma provides good stoma protuberance in patients with a thick abdominal wall, bulky mesentery, and poor bowel compliance. This technique is safe and should be considered in patients in whom stoma maturation is difficult.
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Affiliation(s)
- David T Miller
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Katherine M Theisen
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ronald Hrebinko
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Bara T, Gurzu S, Borz C, Muresan M, Jung I, Fulop Z, Bara T. Retromuscular mesh and hernial sac technique in the reconstruction of 139 cases of large median incisional hernias: one institution's experience. Hernia 2020; 24:99-105. [PMID: 30806887 DOI: 10.1007/s10029-019-01915-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/19/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Incisional hernia is the most common complication of laparotomy. Postoperative parietal defects tend to relapse, even after the most optimal surgical methods. The aim of this study was to present the effectiveness of an adapted retromuscular technique with prolene mesh and a hernial sac, in patients with large incisional median hernias. The reported results were obtained by our team after more than 15 years of experience. METHODS This retrospective study included 139 consecutive cases of large median incisional hernias operated on using a retromuscular mesh and hernial sac technique. The cross-sectional diameter of incisional hernias was larger than 10 cm, being classified in the W3 group, according to the European Hernia Society classification. RESULTS The study included 83 females (59.71%) and 56 males (40.29%) with a median age of 62.4 ± 16.6 years and an average body mass index of 32.4 ± 7.6 kg. The hernia was supraumbilically located in 54 cases, subumbilically in 61 cases, and supra- and subumbilically in 24 cases. Postoperative complications were recorded in eight cases (5.75%): one case with a hematoma in the right abdominal muscle sheath; five cases with supra-aponeurotic seromas; two cases with skin necrosis and one with a mesh infection. Recurrence occurred in seven cases (5.03%): four cases in the first 2 years postoperatively and three cases in the third year after surgery. CONCLUSIONS The retromuscular technique with prolene mesh and a hernial sac is an effective method of restoring the integrity of the abdominal wall in large median incisional hernias with low rates of morbidity and recurrence.
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Affiliation(s)
- T Bara
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania
| | - S Gurzu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, 38 Gheorghe Marinescu Street, 540139, Tîrgu Mureş, Romania.
- Advanced Medical and Pharmaceutical Research Center (CCAMF), University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania.
| | - C Borz
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania
| | - M Muresan
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania
| | - I Jung
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, 38 Gheorghe Marinescu Street, 540139, Tîrgu Mureş, Romania
| | - Z Fulop
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, 38 Gheorghe Marinescu Street, 540139, Tîrgu Mureş, Romania
| | - T Bara
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania
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[A focal abdominal swelling after an accident with a 'space scooter']. Ned Tijdschr Geneeskd 2020; 163:D3986. [PMID: 32186818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 7-year-old boy presents at the Emergency Department with an abdominal swelling after an accident with a space scooter. He was diagnosed with a traumatic anterior abdominal wall hernia, for which he underwent surgical correction.
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Kanao H, Omi M, Takeshima N. Laparoscopic Mesh Repair for Perineal Hernia after En Bloc Resection of an Aggressive Angiomyxoma Using a Modified Sacral Colpopexy Technique. J Minim Invasive Gynecol 2019; 27:1258-1259. [PMID: 31863864 DOI: 10.1016/j.jmig.2019.12.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To demonstrate laparoscopic mesh repair of perineal hernia (PH) by a modified sacral colpopexy technique. DESIGN Step-by-step demonstration of the technique used for the surgical repair of PH after gynecologic surgery. SETTING PH is defined as a pelvic floor defect through which the intra-abdominal viscera may protrude [1]. The reported incidence of PH ranges from 0.6% to 3%, and it generally occurs after rectal or prostate surgery [2]. Owing to its low incidence, there is no standard procedure to treat PH [3]. Herein, we demonstrate a successful case of PH treatment with a composite mesh (Dual Mesh; W. L. Gore & Associates, Newark, DE) after gynecologic surgery by a modified laparoscopic sacral colpopexy technique, which was approved by our institutional review board. INTERVENTIONS The patient had undergone extralevator abdominoperineal excision for an aggressive angiomyxoma and developed a sigmoid colon-protrudent PH after the surgery [4]. The patient suffered from defecatory dysfunction and dysmenorrhea. A total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and mesh repair of the PH were performed at 2 years after the primary surgery, and they were successful without any intra- or postoperative complications. Because the pelvic floor defect was too large to secure the mesh by a simple placement, we applied the modified sacral colpopexy technique using 2-0 proline (ETHICON, Tokyo, Japan) to cover and support this defect. At 12 months after the second surgery, there was no sign of recurrence of PH and aggressive angiomyxoma, and the preoperative symptoms had diminished. CONCLUSION Laparoscopic mesh repair by the modified sacral colpopexy technique is safe and effective to manage PH.
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Affiliation(s)
- Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan (all authors)..
| | - Makiko Omi
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan (all authors)
| | - Nobuhiro Takeshima
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan (all authors)
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26
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Lopez-Cano M, Harris HW, Fisher JP, Pereira JA, Garcia-Alamino JM, Hope WW. Practice Patterns and Attitudes of Surgeons on the Use of Prophylactic Mesh to Prevent Parastola Hernia: A Cross-sectional Survey. Wound Manag Prev 2019; 65:14-23. [PMID: 31702989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
UNLABELLED Information about surgeons' attitudes toward using prophylactic mesh (PM) for parastomal hernia (PSH) prevention is limited. PURPOSE A survey was conducted to assess attitudes/beliefs and surgical practice related to PM use for preventing PSH. METHODS A cross-sectional email survey was conducted during April 2017 among members (surgeons) of the American Hernia Society, European Hernia Society, and International Hernia Collaboration. Survey items included participant demographic characteristics, knowledge about the incidence of PSH, number of permanent stomas created annually, beliefs/opinions (knowledge/interest) regarding the use of PM, and surgical practices (mesh type and position). Data were collected and tallied using SurveyMonkey. Descriptive statistics were used to analyze the data. RESULTS Of the 5445 emails sent, 497 responses were received, 235 (47.3%) from the United States and 197 (39.6%) from Europe. The majority of participants were general surgeons (371, 74.6%); a small percentage were colorectal surgeons (37, 7.4%). Most respondents (353, 71.0%) reported at least 11 years of surgical experience, with 37.3% reporting >20 years' experience. The majority of respondents (340, 68.4%) created <15 ostomies per year, more than half (252, 50.7%) consider the incidence of PSH 30% or below, and 107 (22%) use PM. The most common reason for not using mesh was concern about mesh-related complications (141, 41.5%). When asked about type of mesh, most surgeons (153/245, 62.4%) preferred permanent mesh and an open retromuscular approach (97/278, 34.9%). CONCLUSION Results of the present survey show ongoing ambiguity regarding the use of PM for PSH prevention. Education to increase awareness about the incidence of PSH and well-designed safety and effectiveness studies of preventive strategies are needed to help surgeons optimize PSH prevention strategies.
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Affiliation(s)
- Manuel Lopez-Cano
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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27
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Royalty AK, Nash NA, Motameni AT, Arnold LF. Tension Gastrothorax Causing Hemodynamic Instability in a Traumatic Diaphragm Rupture. Am Surg 2019; 85:e260-e261. [PMID: 31126383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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28
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Perim CA, Guedes MAE, Carvalho MFCE, Lopes PGF, Simões RL. A SIMPLE METHOD FOR THE DIAGNOSIS OF PETERSEN'S HERNIA COMPROMISING THE BILIOPANCREATIC LIMB. Arq Bras Cir Dig 2019; 32:e1429. [PMID: 30758477 PMCID: PMC6368160 DOI: 10.1590/0102-672020180001e1429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 11/22/2018] [Indexed: 11/22/2022]
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29
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Schutte T, Beukhof CM, Loffeld RJLF. [An unexpected cause of nausea]. Ned Tijdschr Geneeskd 2019; 163:D3141. [PMID: 30719892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An 88-year old woman had a sudden onset of nausea and vomiting. She had an end colostomy following a curative resection of rectal cancer six years earlier. As we suspected a high gastrointestinal obstruction, an abdominal CT scan was made. This showed a paracolostomic herniation, including herniation of the stomach.
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Affiliation(s)
- Tim Schutte
- Zaans Medisch Centrum, afd. Interne Geneeskunde, Zaandam
- Contact: dr. T. Schutte
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30
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Vincent K, Cheah SD. Traumatic abdominal wall hernia - a case of handlebar hernia. Med J Malaysia 2018; 73:425-426. [PMID: 30647222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Traumatic abdominal wall hernia (TAWH) after blunt injury is uncommon. Diagnosis requires careful examination and high index of suspicion. We report a case of a 12-year-old boy who complained of painful abdominal swelling over the left iliac fossa after a bicycle-handlebar hit his abdomen. TAWH was diagnosed clinically and confirmed with ultrasound and computed tomography (CT) scan. He developed incarceration after 12 hours of admission and subsequently underwent primary repair without mesh. As TAWH is usually associated with other concomitant injuries, it is important that we are meticulous to rule out other serious concomitant injuries.
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Affiliation(s)
- K Vincent
- Hospital Langkawi, Department of Surgery, Kedah Darul Aman, Malaysia.
| | - S D Cheah
- Hospital Kulim, Departmentof Surgery, Jalan Mahang, Kulim, Kedah, Malaysia
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31
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Schizas D, Katsaros I, Tsapralis D, Moris D, Michalinos A, Tsilimigras DI, Frountzas M, Machairas N, Troupis T. Littre's hernia: a systematic review of the literature. Hernia 2018; 23:125-130. [PMID: 30506463 DOI: 10.1007/s10029-018-1867-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/25/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE A hernia containing Meckel's diverticulum is called a Littre's Hernia. It's a rare entity and its diagnosis is often incidental during routine hernia repair surgery. The objective of this study is the evaluation of the current evidence on Littre's hernias regarding their clinical presentation and optimal treatment approach. METHODS PubMed and Cochrane bibliographical databases were searched from the beginning of time (last search: August 1st, 2018) for studies reporting on Littre's hernias in adult population. RESULTS Forty-five studies met our inclusion criteria and reported collectively on 53 patients (21 males and 32 females) presenting at health care units with a Littre's hernia. The most common sites of occurrence were femoral (39.6%) and inguinal (34%). The vast majority of cases (77.4%) concerned incarcerated hernias. All patients underwent surgical hernia repair accompanied by a diverticulectomy and 16.9% of them received mesh. Only 7.5% of patients experienced immediate postoperative complications. CONCLUSIONS A Littre hernia is a rare complication of Meckel's diverticulum. It requires surgical attention and all medical professionals should be encouraged to report such cases to expand our experience and optimize the therapeutic approach.
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Affiliation(s)
- D Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 str., Goudi, 15771, Athens, Greece
| | - I Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 str., Goudi, 15771, Athens, Greece.
| | - D Tsapralis
- Surgical Department, General Hospital of Ierapetra, Ierapetra, Greece
| | - D Moris
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A Michalinos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 str., Goudi, 15771, Athens, Greece
| | - D I Tsilimigras
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 str., Goudi, 15771, Athens, Greece
| | - M Frountzas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 str., Goudi, 15771, Athens, Greece
| | - N Machairas
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - T Troupis
- Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
RATIONALE Traumatic abdominal wall hernia (TAWH) is a rare form of hernia that is caused by disruption of the abdominal wall musculature and fascia. The diagnostic criteria and classification of TAWH are still unclear; furthermore, the ideal timing and method of surgical treatment are still unclear. Herein, we report a case of TAWH and describe the surgical approach used. PATIENT CONCERNS A 71-year-old Han Chinese female presented for swelling in the right lower abdominal quadrant. The patient underwent exploratory laparotomy because of a car collision before 1 year ago. DIAGNOSIS She was finally diagnosed with TAWH according to the abdominal computed tomography (CT) and surgery. INTERVENTIONS She was performed with an open surgery to repair the TAWH. OUTCOMES The patient was discharged without complications and showed no recurrence or complications during a follow-up period of 6 months. LESSONS TAWH is a rare form of hernia that presents a diagnostic and therapeutic challenge. The appropriate timing and approach of surgical treatment for TAWH depend on a case-by-case basis. This case highlights that delayed selective surgery may be more suitable for stable patients.
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Love MW, Mansour R, Hale AL, Bour ES, Shenouda I, Ewing JA, Mcdermott S, Scott JD. Use of Bioabsorbable Tissue Reinforcement Reduces Incidence of Internal Hernia in Roux-en-Y Gastric Bypass Patients. Am Surg 2018; 84:1756-1761. [PMID: 30747629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Internal hernias are one of the most devastating late, postsurgical complications associated with laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of this study was to determine whether placement of a bioabsorbable tissue matrix in soft tissue defects after gastric bypass resulted in a lower incidence of internal hernia development. Prospective database was used to identify all patients who underwent LRYGB between January 2002 and January 2016. These patients were then retrospectively reviewed to determine the development of internal hernia. Before 2009, the retro-Roux defect was left open during the primary operation and the defect at the jejunojejunostomy was closed with sutures or staples. Beginning in 2009, all soft tissue internal defects were reinforced with an 8 cm × 8-cm piece of bioabsorbable matrix. The incidence of subsequent internal hernia development was compared between these two groups: no bioabsorbable matrix versus use of a bioabsorbable matrix. A total of 2771 patients underwent LRYGB during our study period. From these, 1215 procedures were performed without tissue reinforcement and 1556 were performed using a bioabsorbable matrix. During the study period, 274 patients developed an internal hernia. Patients who did not have tissue reinforcement at closure had a significantly higher internal hernia rate [225/1215 (18.5%) vs 49/1556 (3.1%), P < 0.005]. This study demonstrates a statistically significant reduction in internal hernia formation after LRYGB with the addition of a bioabsorbable tissue matrix. Although prospective studies are needed, early evidence suggests that reinforcement with a bioabsorbable tissue scaffold is an effective method for minimizing internal hernias after LRYGB.
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34
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Fernandes E, Tan J, Farrant G, Kodeda K. Redundant laparoscopic adjustable gastric band tubing causing internal hernia and small bowel obstruction. N Z Med J 2018; 131:90-93. [PMID: 30116070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Erika Fernandes
- Surgical Registrar, Department of General Surgery, Taranaki Base Hospital, New Plymouth
| | - James Tan
- Surgical Registrar, Department of General Surgery, Taranaki Base Hospital, New Plymouth
| | - Glenn Farrant
- General Surgeon, Department of General Surgery, Taranaki Base Hospital, New Plymouth
| | - Karl Kodeda
- General Surgeon, Department of General Surgery, Taranaki Base Hospital, New Plymouth
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35
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Abstract
Laparoscopic Roux-en-Y gastric bypass has become the most common obesity surgery procedure worldwide over the last two decades. Many patients undergoing the procedure are women of reproductive age. This carries a risk for developing gastric bypass-related complications during pregnancy. One of the potentially serious risks is an internal hernia. We present a patient in the third trimester of pregnancy with an internal hernia following a laparoscopic Roux-en-Y gastric bypass for morbid obesity. We discuss the importance of computed tomography (CT) in the diagnosis of an internal hernia and review key CT findings including compression of the superior mesenteric vein, which proved to be crucial in diagnosing the internal hernia in this patient.
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Affiliation(s)
- Bogna Warsza
- Department of Radiology, Haugesund hospital Helse Fonna, Haugesund, Norway
| | - Blazej Richter
- Department of Radiology, Haugesund hospital, University of Bergen, Norway
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36
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Affiliation(s)
- Petra Ganschow
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Campus Großhadern, Marchioninistraße 15, D-81377, München, Deutschland.
| | - Jens Werner
- München, Campus Großhadern, München, Deutschland
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37
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Schmidt MS, Rosenberg J, Tolver MA. [Traumatic bicycle handlebar hernia in a child]. Ugeskr Laeger 2018; 180:V08170616. [PMID: 30672448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Traumatic abdominal wall hernia in children caused by a bicycle handlebar is a rare injury. This is a case report of a 15-year-old boy with a traumatic hernia in the right groin, where a physical examination revealed a small bulge in the right inguinal region, and an ultrasonography confirmed the diagnosis. The condition was initially treated conservatively. However, the patient had surgery performed three days later because of pain. Surgical repair with open layered closure is the preferred method. Laparoscopic sutured repair may also be performed, especially if diagnostic laparoscopy is performed anyway.
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38
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Randomized controlled trial of standard closure of a stoma site vs biological mesh reinforcement: study protocol of the ROCSS trial. Colorectal Dis 2018; 20:O46-O54. [PMID: 29314655 DOI: 10.1111/codi.13997] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Closure of complex and contaminated abdominal wounds is challenging and carries risks, including wound dehiscence and incisional hernia. Hernia formation at closed stoma sites occurs in up to 30% of patients. Use of biological meshes in these situations may provide a safe method of reducing these complications, especially long-term incisional hernias. METHOD The Reinforcement of Closure of Stoma Site (ROCSS) study is a Phase III multicentre randomized controlled trial (RCT) with an internal feasibility study. The primary objective of ROCSS is to assess whether a biological mesh (collagen tissue matrix) reduces the incidence of clinically detectable stoma closure site hernias at 2 years compared with standard closure techniques. Patients will be randomized in a 1:1 ratio to either standard suture (nonmesh) closure or closure with an intra-abdominal biological mesh reinforcement. Patients and outcome assessors are masked to treatment allocation. ROCSS aims to recruit 560 patients, with an option to recruit to 790 patients to increase power. The primary outcome measure is the occurrence of clinically detectable hernias years 2 years postrandomization. The secondary outcome measures are the radiological hernia rate at 1 year, incidence of symptomatic hernia, the surgical complication/re-intervention rate, quality of life, postoperative pain and cost-benefit analysis. DISCUSSION ROCSS is a multicentre RCT assessing the placement of a biological mesh at the site of stoma closure on clinical hernia rate. Our hypothesis is that reinforcing the stoma closure site with a collagen mesh is superior to the standard technique in reducing the risk of herniation at 2 years. These findings could influence future closure of stomas and other complex and/or contaminated abdominal wounds in settings around the world.
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Lier EJ, Nielsen K, Govaert MJPM. [A woman with acute abdominal pain after a gastric bypass]. Ned Tijdschr Geneeskd 2018; 162:D1989. [PMID: 29372677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 35-year-old woman with a history of gastric bypass presented with acute abdominal pain, nausea and an urge to move. She showed normal vital signs. We found abdominal guarding and elevated ASAT, ALAT and LDH. A CT scan showed the whirl sign, caused by a mesenteric herniation through the Roux-en-Y gastric bypass.
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Affiliation(s)
- E J Lier
- Westfriesgasthuis, afd. Chirurgie, Hoorn
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40
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Ceci F, D'Amore L, Grimaldi MR, Annesi E, Bambi L, Bruzzone P, Negro P, Gossetti F. Central mesh failure (CMF) after abdominal wall repair. A rare cause of recurrence. Ann Ital Chir 2018; 89:266-269. [PMID: 30588921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Central Mesh Failure (CMF) after abdominal wall repair (AWR) is uncommon but should be considered in case of recurrence. The mechanism is unclear and different theories are actually proposed, as the action of opposite forces acting in the abdominal wall on the prosthesis, and the characteristics of the device to be implanted. The use of lightweight meshes in some cases could be inadequate to withstand the bursting strenght of the abdominal wall. Three cases of incisional hernia recurrence due to central mesh failure are here reported. KEY WORDS: Abdominal wall repair (AWR), Central mesh failure (CMF), Hernia recurrence, Lightweight mesh.
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41
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Bouhout T, Serji B, Egyir EU, Amri BE, Bouhout I, Soufi M, Bouziane M, Harroudi TE. An unusual complication of Meckel�s diverticulum: Littre�s hernia. Pan Afr Med J 2018; 31:243. [PMID: 31448000 PMCID: PMC6691296 DOI: 10.11604/pamj.2018.31.243.10740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/17/2016] [Indexed: 11/20/2022] Open
Abstract
Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract. Any hernia sacs containing Meckel’s diverticulum is called Littre’s hernia. It was described for the first time in 1700 by Alexis Littre. The diagnosis is unlikely to be made preoperatively and surgery is the treatment of choice. We report a rare case of Littre’s hernia who presented with clinical signs of intestinal obstruction.
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Affiliation(s)
| | - Badr Serji
- Chirurgie B, CHU Mohammed VI, Oujda, Maroc
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42
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Abstract
Wendy Osborne, Educational Officer, ASCN UK, and Clinical Lead Ostomy Division, Coloplast Ltd, summarises the ASCN UK parastomal hernia workshop, which took place at the ASCN UK 2017 annual conference.
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Affiliation(s)
- Wendy Osborne
- Educational Officer, ASCN UK, and Clinical Lead Ostomy Division, Coloplast Ltd
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43
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Takayama Y, Kaneoka Y, Maeda A, Fukami Y, Takahashi T, Onoe S, Uji M. Internal hernia after proximal gastrectomy with jejunal interposition. Updates Surg 2017; 70:85-90. [PMID: 29103209 DOI: 10.1007/s13304-017-0497-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/25/2017] [Indexed: 11/27/2022]
Abstract
Although internal hernia (IH) has been reported after laparoscopic distal or total gastrectomy with Roux-en-Y reconstruction, there are few reports of IH after proximal gastrectomy with jejunal interposition (PG-JI). The aim of this study was to analyze the incidence and clinical features of IH after PG-JI. This study retrospectively reviewed 71 patients who underwent PG-JI for gastric cancer at a single institution between July 2007 and December 2016. The median follow-up period after PG-JI was 50 months. Four patients (5.6%) developed IH. IH occurred in 3 of 38 patients after open PG (7.9%) and 1 of 33 after laparoscopic PG (3.1%; p = 0.38). The site of IH was Petersen in all cases, where the Petersen defect was not closed. All patients had abdominal pain at onset, and the CT revealed a whirl sign. Bowel resection was required in three patients (75%). There was no morbidity. IH after PG-JI occurred regardless of operative approach (open or laparoscopic). A high degree of suspicion for IH should be maintained in patients after gastrectomy with abdominal pain and a whirl sign on CT. Closure of the mesenteric defects should be considered to reduce the incidence of IH after surgery.
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Affiliation(s)
- Yuichi Takayama
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-shi, Gifu-ken, 503-8502, Japan.
| | - Yuji Kaneoka
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-shi, Gifu-ken, 503-8502, Japan
| | - Atsuyuki Maeda
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-shi, Gifu-ken, 503-8502, Japan
| | - Yasuyuki Fukami
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-shi, Gifu-ken, 503-8502, Japan
| | - Takamasa Takahashi
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-shi, Gifu-ken, 503-8502, Japan
| | - Shunsuke Onoe
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-shi, Gifu-ken, 503-8502, Japan
| | - Masahito Uji
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-shi, Gifu-ken, 503-8502, Japan
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Ulucay KE, Younis MU. Laparoscopic Approach To A Rare Interstitial Incisional Hernia Following Appendectomy. J Ayub Med Coll Abbottabad 2017; 29:344-346. [PMID: 28718262] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Among the complications of an open appendectomy is the presentation of an incisional hernia. An interstitial or interparietal hernia is the one in which the hernia sac is present between the muscle layers of the abdominal wall which makes the presentation of a post-operative incisional interstitial hernia quite a rarity. A 52-year-old female was admitted through the outpatient clinic presenting with the complaints of discomfort and a bulge felt in the right hypochondrium for the last 3 years. Radiological investigations were able to delineate an interstitial incisional hernia through the previous open appendectomy scar. A laparoscopic approach to repair of this hernia was successfully undertaken without any complications. This is an interesting case of incisional hernia that may pose a diagnostic challenge to the unsuspecting surgeon with an unusual presentation which may cause unnecessary delays in treatment as well as unnecessary operations. Very few comparable cases can be found in literature.
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45
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Xu Z, Guo W. [Clinical research progress of mesenteric internal hernia after Roux-en-Y reconstruction]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:352-356. [PMID: 28338170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Postoperative internal hernia is a rare clinical complication which often occurs after digestive tract reconstruction. Roux-en-Y anastomosis is a common type of digestive tract reconstruction. Internal hernia after Roux-en-Y reconstruction, which occurs mainly in the mesenteric defect caused by incomplete closure of mesenteric gaps in the process of digestive tract reconstruction, is systematically called, in our research, as mesenteric internal hernia after Roux-en-Y reconstruction. Such internal hernia can be divided, according to the different structures of mesentric defect, into 3 types: the type of mesenteric defect at the jejunojejunostomy (J type), the type of Petersen's defect (P type), and the type of mesenteric defect in the transverse mesocolon (M type). Because of huge differences in the number of cases and follow-up time among existing research reports, the morbidity of internal hernia after LRYGB fluctuates wildly between 0.2% and 9.0%. Delayed diagnosis and treatment of mesenteric internal hernia after Roux- en-Y reconstruction may result in disastrous consequences such as intestinal necrosis. Clinical manifestations of internal hernia vary from person to person: some, in mild cases, may have no symptoms at all while others in severe cases may experience acute intestinal obstruction. Despite the difference, one common manifestation of internal hernia is abdominal pain. Surgical treatment should be recommended for those diagnosed as internal hernia. A safer and more feasible way to conduct the manual reduction of the incarcerated hernia is to start from the distal normal empty bowel and trace back to the hernia ring mouth, enabling a faster identification of hernia ring and its track. The prevention of mesenteric internal hernia after Roux-en-Y reconstruction is related to the initial surgical approach and the technique of mesenteric closure. Significant controversy remains on whether or not the mesenteric defect should be closed in laparoscopic Roux-en-Y anastomosis. This article is to review the reports and researches on internal hernia resulting from the mesenteric defect after Roux-en-Y digestive tract reconstruction in recent years, so as to promote understanding and attention on this disease. And more active preventive measures are strongly suggested to be taken in operations where digestive tract reconstruction is involved.
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Affiliation(s)
- Zhengrong Xu
- Department of Surgical, Chinese PLA NO.520 Hospital, Sichuan Mianyang 621000, China.
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Ermolov AS, Koroshvili VT, Blagovestnov DA, Yartsev PA, Shlyakhovsky IA. [Postoperative abdominal hernia: a modern view on incidence and etiopathogenesis]. Khirurgiia (Mosk) 2017:76-82. [PMID: 28514387 DOI: 10.17116/hirurgia2017576-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- A S Ermolov
- Chair of Emergency and General Surgery of the Russian Medical Academy of Postgraduate Education, Moscow; Sklifosovsky Research Institute for Emergency Care, Moscow
| | - V T Koroshvili
- Chair of Emergency and General Surgery of the Russian Medical Academy of Postgraduate Education, Moscow; Sklifosovsky Research Institute for Emergency Care, Moscow
| | - D A Blagovestnov
- Chair of Emergency and General Surgery of the Russian Medical Academy of Postgraduate Education, Moscow; Sklifosovsky Research Institute for Emergency Care, Moscow
| | - P A Yartsev
- Chair of Emergency and General Surgery of the Russian Medical Academy of Postgraduate Education, Moscow; Sklifosovsky Research Institute for Emergency Care, Moscow
| | - I A Shlyakhovsky
- Chair of Emergency and General Surgery of the Russian Medical Academy of Postgraduate Education, Moscow; Sklifosovsky Research Institute for Emergency Care, Moscow
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Occhionorelli S, Andreotti D, Tartarini D, Cappellari L, Stano R, Morganti L, Vasquez G. Delayed diagnosis of blunt carotid trauma in a seat belt syndrome with associated abdominal wall injury A case report. Ann Ital Chir 2016; 5:S2239253X16025391. [PMID: 27904004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal trauma because, carotid artery injury consequent to blunt trauma is rare, affecting less than 1% of patients as reported in literature. A 45-years-old female, involved in a traffic accident, arrived to Emergency Room hemodynamically stable, with a Glasgow Coma Scale of 15, complaining abdominal pain, without any neurological signs. She underwent Computed Tomography (CT) scan that showed a complete disruption of left abdominal wall muscles, associated with massive bowel loops herniation. No free air nor other visceral injuries were found. The radiological brain evaluation was negative for neurological injuries. Considering the nature of the trauma, an explorative laparotomy was performed. During the fifth postoperative day, the patient presented neurological side signs with right facial-brachial-crural hemiparesis and expressive aphasia. Head and neck CT scan revealed a lesion of the left common carotid artery with distal embolization of the internal carotid. A left-carotid-axis revascularization procedure and a surgical endarterectomy were immediately performed. Patient was discharged after 20 days without neurological consequences. Physicians should be aware of neck vascular injuries when evaluating patients with multiple trauma, even in neurological asymptomatic patients without seatbelt abrasions of the neck skin. KEY WORDS Abdominal Hernia, Carotid artery, Seat belt, Surgery.
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MESH Headings
- Abdominal Injuries/diagnostic imaging
- Abdominal Injuries/etiology
- Abdominal Wall/diagnostic imaging
- Accidents, Traffic
- Aphasia/etiology
- Carotid Artery Injuries/diagnosis
- Carotid Artery Injuries/diagnostic imaging
- Carotid Artery Injuries/etiology
- Carotid Artery Injuries/surgery
- Carotid Artery Thrombosis/etiology
- Carotid Artery, Common/diagnostic imaging
- Carotid Artery, Internal
- Delayed Diagnosis
- Endarterectomy, Carotid
- Female
- Hernia, Abdominal/diagnostic imaging
- Hernia, Abdominal/etiology
- Humans
- Middle Aged
- Multiple Trauma/diagnostic imaging
- Multiple Trauma/etiology
- Paresis/etiology
- Seat Belts/adverse effects
- Tomography, X-Ray Computed
- Wounds, Nonpenetrating/diagnosis
- Wounds, Nonpenetrating/diagnostic imaging
- Wounds, Nonpenetrating/etiology
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Murji A, De Gasperis-Brigante C, Leyland N. Richter's Hernia After Laparoscopic Surgery. J Minim Invasive Gynecol 2016; 24:518-519. [PMID: 27491348 DOI: 10.1016/j.jmig.2016.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Ally Murji
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
| | | | - Nicholas Leyland
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
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