1/19. Transabdominal inguinal hernioplasty combined with abdominal aortic aneurysm repair.The number of patients being encountered with abdominal aortic aneurysm (AAA) and inguinal hernia is increasing. We describe herein a technique of performing a concomitant one-stage operation for both disorder. After conventional transperitoneal AAA repair, transabdominal preperitoneal hernia repair is carried out through the same incision using a prosthesis made from the same material as the graft used for AAA. The maneuver is similar to that of laparoscopic hernioplasty. We employed this technique in the treatment of four patients, none of whom developed any complications such as infection or recurrence of the inguinal hernia. Thus, we conclude that this one-stage operation for AAA and inguinal hernia may bring physical and economic benefits to patients who have both diseases concomitantly.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/19. Synchronically performed laparoscopic cholecystectomy and hernioplasty.Cholecystectomies and hernioplasties are the two most frequently performed surgical interventions. The laparoscopic technique can be offered for the simultaneous treatment with both operating indications. The synchronical operation can give all the advantages of the minimally invasive technique. Authors had performed laparoscopic cholecystectomy with laparoscopic hernioplasty in five cases. Two inguinal and three postoperative hernias were reconstructed. The cholecystectomy was performed with a "three punction method", and the hernioplasty by using the same approach, completed by inserting a fourth assisting trocar as required. The hernial ring was covered with an intraperitoneally placed mesh, which was fixed by staplers (the so-called "IPOM-method": intraperitoneal on-lay mesh). There was no intra-, nor postoperative complication. The hernioplasty combined with laparoscopic cholecystectomy did not have effect on postoperative pain and nursing time. The return to the normal physical activity was short, similar to laparoscopic hernioplasty (in 1-2 weeks). Authors conclude that the simultaneous, synchronous laparoscopic cholecystectomy and hernioplasty is recommended and should be the method of choice because it is more advantageous for patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/19. Inguinal hernias containing the uterus, fallopian tube, and ovary in premature female infants.Inguinal hernias were diagnosed at 42 and 38 weeks' postconceptional age in 2 premature girls. The hernial sac contained the uterus, one Fallopian tube, and one ovary. The diagnosis was made by physical and sonographic examination and was confirmed during surgical correction. We suggest sonography in the diagnostic workup in (premature) female infants with an inguinal hernia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/19. A case of transverse testicular ectopia with mullerian duct remnant.Transverse testicular ectopia (TTE) associated with persistent mullerian duct (PMD) is a rare genitourinary anomaly. The authors report a case with a review of the literature and stress the importance of careful physical examination and ultrasonography in making a correct preoperative diagnosis of TTE. One should be careful not to miss the tiny PMD structure at the operation. Transseptal orchidopexy is the surgical treatment of choice.- - - - - - - - - - ranking = 11.973855073999keywords = physical examination, physical (Clic here for more details about this article) |
5/19. Preperitoneal collection after endoscopic extraperitoneal inguinal hernioplasty in a patient with malignant ascites.Painful preperitoneal collection is a rare complication following endoscopic totally extraperitoneal inguinal hemioplasty. Here we present the case of a woman who underwent endoscopic extraperitoneal inguinal hernioplasty for a left inguinal hernia. Her past health was good. During the dissection of the extraperitoneal space, clear ascitic fluid was noted upon breaching the peritoneum near the round ligament. Endoscopic stapling was used to close the peritoneal tear, and the procedure was completed uneventfully. The patient complained of left iliac pain after the operation. A physical examination showed no swelling over the left iliac fossa. Contrast computed tomography of the abdomen revealed preperitoneal fluid collection over the hernioplasty site and a small amount of ascites. Expectant treatment with pain control by oral analgesics was adopted. A follow-up CT scan 4 months after the operation showed resolution of the preperitoneal fluid collection but with increased ascites. Abdominal paracentesis with peritoneal fluid for cytology analysis found adenocarcinoma cells. The patient succumbed to a terminal malignancy a year after surgery. Conversion of endoscopic extraperitoneal inguinal hernioplasty to open repair should be considered upon intraoperative discovery of ascites. Painful preperitoneal collection is a possible sequela following endoscopic extraperitoneal hernioplasty in patients with malignant ascites.- - - - - - - - - - ranking = 11.973855073999keywords = physical examination, physical (Clic here for more details about this article) |
6/19. abdominal wall neurofibroma presenting as an inguinal hernia.Inguinal hernias are a common cause of abdominal wall pain and are the most common abdominal wall abnormality. They can usually be differentiated from other abnormalities by history and physical examination. Occasionally, the diagnosis may be difficult with very small or very large lesions. The following case report describes an abdominal wall neurofibroma presenting as an inguinal hernia in a young, active duty, male soldier with previously undiagnosed neurofibromatosis.- - - - - - - - - - ranking = 11.973855073999keywords = physical examination, physical (Clic here for more details about this article) |
7/19. Simultaneous extraperitoneal laparoscopic radical prostatectomy and intraperitoneal inguinal hernia repair with mesh.OBJECTIVE: This report depicts the feasibility of the concomitant repair of a large direct inguinal hernia with mesh by using the intraperitoneal onlay approach after extraperitoneal laparoscopic radical prostatectomy. methods: A 66-year-old man with localized adenocarcinoma of the prostate was referred for laparoscopic radical prostatectomy. The patient also had a 4-cm right, direct inguinal hernia, found on physical examination. To minimize the risk of infection of the mesh, an extraperitoneal laparoscopic prostatectomy was performed in the standard fashion after which transperitoneal access was obtained for the hernia repair. The hernia repair was completed by reduction of the hernia sac, followed by prosthetic mesh onlay. In this fashion, the peritoneum separated the prostatectomy space from the mesh. A single preoperative and postoperative dose of cefazolin was administered. RESULTS: The procedure was completed with no difficulty. Total operative time was 4.5 hours with an estimated blood loss of 450 mL. The final pathology revealed pT2cN0M0 prostate cancer with negative margins. No infectious or bowel complications occurred. At 10-month follow-up, no evidence existed of recurrence of prostate cancer or the hernia. CONCLUSION: Concomitant intraperitoneal laparoscopic mesh hernia repair and extraperitoneal laparoscopic prostatectomy are feasible. This can decrease the risk of potential infectious complications by separating the mesh from the space of Retzius where the prostatectomy is performed and the lower urinary tract is opened.- - - - - - - - - - ranking = 11.973855073999keywords = physical examination, physical (Clic here for more details about this article) |
8/19. Femoral hernia in children: an infrequent problem revisited.Femoral hernias are of very rare occurrence at any age, but are exceedingly rare in the pediatric population. A 10-year survey, 1979-1989, of our experience with pediatric hernias produced a total of 1,134 inguinal hernias and 6 femoral hernias, supporting an incidence of 0.5% for femoral hernias in our population. The correct diagnosis was made in only two cases preoperatively. These two patients had undergone inguinal herniorrhaphies less than 6 months prior to presenting with recurrent groin masses. Femoral hernias were most frequently misdiagnosed as inguinal hernias. Inclusion of this entity in the differential diagnosis of groin masses, an accurate preoperative physical exam, and a careful surgical exploration will allow one to make the correct diagnosis and prevent unnecessary reoperations. In addition, early recurrence of a groin mass after inguinal exploration and herniorrhaphy should make one suspicious of a femoral hernia. At surgery, our recommendations include a simple infra-inguinal exploration medial to the femoral vessels when an inguinal hernia is unexpectedly not found at groin exploration and a Cooper's ligament repair when a femoral hernia is encountered. All six cases in our review were repaired with Cooper's ligament repair without complication.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/19. The irreducible ovary: a true emergency.The management of a child with an irreducible ovary remains inconsistent in pediatric surgical centers. An informal survey of senior pediatric surgeons and an extensive review of the literature showed a prevailing view that the trapped ovary is not at significant risk of vascular compromise. Two recent cases prompted a review of our experience from 1984 to 1989, during which 1,699 children with inguinal hernias underwent operation, 386 (23%) of whom were girls. Fifteen girls (4%) had irreducible ovaries present at the time of operation and in 4 of the 15 (27%) the ovary was twisted and infarcted. Two of the 4 girls were known to have an irreducible ovary prior to the day of operation--1 was noted 2 months earlier and 1 was noted 1 month earlier. At the time of the initial diagnosis, neither patient had physical findings of vascular compromise of the ovary. In the other two girls, evidence of an infarcted ovary was present when the hernia was first diagnosed and an emergency operation was performed. A 27% incidence of torsion and strangulation of irreducible ovaries appears to be high, but reports of strangulated ovaries have been reported in 2% to 33% of other series. The normal anatomy is altered when an ovary is trapped in a hernia sac, and these changes make torsion more likely. Although an irreducible ovary is not at great risk of compression of its blood supply, this report identifies a significant risk of torsion. This risk warrants treating the asymptomatic irreducible ovary as any other incarcerated hernia--as a true emergency.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/19. radionuclide imaging in the diagnosis of hernias related to peritoneal dialysis.Abdominal hernias are noted with increasing frequency in association with peritoneal dialysis as this mode of dialysis becomes increasingly popular. These hernias often present as localized groin edema, without evidence of a mass, on physical examination. diagnosis is more difficult when the edema encompasses both groins. radionuclide imaging peritoneography offers a safe, simple, well-tolerated, highly accurate method of localizing peritoneal defects. We used this method to locate and lateralize inguinal hernias in three patients receiving continuous ambulatory peritoneal dialysis who presented with bilateral scrotal edema and who had unrevealing physical examination findings. All three had unilateral, indirect inguinal herniorrhaphies under local anesthesia and have returned successfully to peritoneal dialysis without complication.- - - - - - - - - - ranking = 23.947710147999keywords = physical examination, physical (Clic here for more details about this article) |
| | Next -> |