scholarly journals Tension-free procedures in the treatment of groin hernias

2003 ◽  
Vol 131 (1-2) ◽  
pp. 82-91 ◽  
Author(s):  
Dragan Milic ◽  
Miljko Pejic
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Clinical Experience ◽  
Patch Repair ◽  
Failure Rates ◽  
Marlex Mesh ◽  
Hernia Surgery ◽  
Tension Free ◽  
Improved Outcomes ◽  
General Surgeons

Hernia repair is one of the most common surgical procedures performed in the United States, with 700,000 operations performed each year. Improvements in surgical technique, together with the development of new prosthetic materials and a better understanding of how to use them, have significantly improved outcomes for many patients. These improvements have occurred most notably in centers specializing in hernia surgery, with some institutions reporting failure rates of less than 1%. In contrast, failure rates for general surgeons, who perform most hernia repairs, remain significantly higher. This has important socioeconomic implications, adding an estimated $28 billion or more to the cost of treating the condition, based on calculations utilizing conservative estimates of failure rates and the average cost of a hernia repair. Success of groin hernia repair is measured primarily by the permanence of the operation, fewest complications, minimal costs, and earliest return to normal activities. This success depends largely on the surgeon's understanding of the anatomy and physiology of the surgical area as well as a knowledge of how to use most effectively the currently available techniques and materials. The most important advance in hernia surgery has been the development of tension-free repairs. In 1958, Usher described a hernia repair using Marlex mesh. The benefit of that repair he described as being "tension-eliminating", or what we now call "tension-free". Usher opened the posterior wall and sutured a swatch of Marlex mesh to the undersurface of the medial margin of the defect and to the shelving edge of the inguinal ligament. He created tails from the mesh that encircled the spermatic cord and secured them to the inguinal ligament. Every type of tension-free repair requires a mesh, whether it is done through an open anterior, open posterior, or laparoscopic route. The most common prosthetic open repairs done today are the Lichtenstein onlay patch repair the PerFix plug and patch repair, the Prolene Hernia System bilayer patch repair and Trabucco?s sutureless preshaped hernioraphy. General surgeons today have access to a wider and more sophisticated range of synthetic biomaterials for use in hernia repair than ever before. The advantages and disadvantages of each of these devices must be understood however, before surgeons select any of these implants. Meanwhile, a 1997 study of various biomaterials used in abdominal wall hernia repair further reported that the risk of infection, seroma formation biomaterial-related intestinal obstructions, and other complications can be minimized or eliminated by understanding the process underlying these problems and taking proper precautions. The surgeon's choice of the prosthesis used in hernia repair is based on a combination of factors, including patient characteristics; clinical experience, training, interest, and skill; understanding of the range of products available and the clinical studies that may have been performed on each; and the surgeon's familiarity with a particular product and/or surgical approach. Innovations in technique and product design will no doubt continue to spur advances in hernia repair, and it is hoped that they will continue to improve outcomes. The availability of these outcomes data, along with the ongoing accumulation of clinical experience with a broad range of materials and techniques, will help surgeons to better identify the most appropriate prosthesis for the clinician and the patient. It appears that herniology will remain in the realm of the surgeon, since it is doubtful that any medical measures will replace the operative treatment for abdominal wall hernias. Although operative procedures are not yet ideal important advances have been made in herniorrhaphy resulting in improved outcomes: The use of local techniques has maximized the safety of anesthesia time needed for care has been minimized, with most procedures now being done on an outpatient basis; and better instruments and prosthetic devices have dramatically improved patient outcomes. However, a greater appreciation for the vulnerability of the entire myopectineal orifice - and the secondary effects of localized mesh grafts - is necessary to avoid iatrogenically created recurrences. An increased awareness of these factors by both general surgeons and hernia specialists alike will improve results for all patients undergoing hernia surgery.

Clinical and Biochimical Comorbidities and Complications in Abdominal Surgery Using Synthetic Prosthetic Material

2018 ◽  
Vol 69 (6) ◽  
pp. 1519-1523
Author(s):  
Vlad Dumitru Baleanu ◽  
Danut Vasile ◽  
Alexandru Marian Goganau ◽  
Paul Ioan Tomescu ◽  
Dragos Davitoiu ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Abdominal Wall ◽  
Abdominal Wall Hernia ◽  
Prosthetic Material ◽  
Hernia Surgery ◽  
Tension Free ◽  
Elective Repair ◽  
Scrotal Edema ◽  
Remarkable Recovery ◽  
Risks Assessment

Hernia can be defined as an organ disorder which protrudes the wall that contains it. Synthetic material for the repair of the abdominal wall are used frequently with good results and less complications. Our research included a number of 135 patients diagnosed with inguinal hernia hospitalized and operated in Clinical County Hospital of Craiova, between 1st January 2017-31 October 2017. The purpose of our work was to identify and analyze comorbidities and complications for inguinal hernia repaired with synthetic prosthetic material. hernia repair was performed in 135 patients, 16 were women and 119 were men. Tension free meshplasty was accomplished in 131 patients with uncomplicated inguinal hernia and herniorrhaphy was successfully performed at 4 patients with complicated inguinal hernia. From our study 107 patients had a remarkable recovery without any complication. Patients who underwent tension-free hernia surgery using prosthetic mesh,short-term complications were represented by 19 patients with urinary retention, 6 surgical local infection (superficial infections) and 2 scrotal edema. Nowadays surgeons try to find the best elective repair of inguinal hernia,to be safety for the patients despite of their age and with few complications and low mortality rate. Risks assessment include general conditions and associated comorbidities of the patients. In our study we reveal the type of comorbidities which we meet. We considered that it is significant to optimize cardiopulmonary status and the other comorbidities of the patient before to repair abdominal wall hernia in order to avoid both short and long term complication.

scholarly journals SEROMA AFTER TENSION-FREE INGUINAL HERNIA REPAIR – OUR EXPERIENCE

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Vinod Kumar Nigam ◽  
Siddarth Nigam
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Dead Space ◽  
Hernia Surgery ◽  
Tension Free ◽  
Body Tissues ◽  
Inguinal Hernia Surgery ◽  
Tissue Dissection ◽  
Low Incidence

Seroma Is a collection of fluid called serum that gets collected at the site of inguinal hernia surgery. It is common after inguinal hernia repair with a mesh. Usually seroma develops after 7 to 10 day of operation but can develop even earlier depending upon the amount of tissue dissection. More the dissection more the chances of development of seroma. The fluid in seroma is usually clear or straw colored. Seroma generally does not require any treatment; it disappears by absorption by body tissues within few weeks. Large seromas may require repeated aspiration. To avoid developing seroma after inguinal hernia surgery is to do minimal tissue dissection and avoid dead space formation. We operated 400 cases of inguinal hernia by a modified Lichtenstein tension-free procedure called NICH (Nigam’s inverted curtain hernioplasty) our incidence of development of seroma was 1.5% against international incidence of 7% which is a real low incidence. We have discussed the ways to avoid formation of seroma after open inguinal hernioplasty. Keywords: dead space, dissection, inguinal hernia, Lichtenstein, mesh, NICH, seroma.

Physiologic Tension: Technique for Measuring and Baseline Values

2019 ◽  
Vol 85 (9) ◽  
pp. 998-1000 ◽  
Author(s):  
Paul L. Tenzel ◽  
Jordan Bilezikian ◽  
William F. Powers ◽  
William W. Hope
Keyword(s):  
Abdominal Surgery ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Exploratory Laparotomy ◽  
Inclusion Criteria ◽  
Hernia Surgery ◽  
Institutional Review ◽  
Baseline Values ◽  
Average Tension ◽  
Larger Sample

Tension is one of the most discussed terms related to hernia surgery and repair. Despite the universally accepted opinion that tension and reduction of tension are important concepts in hernia repair, there is very little known about the physiologic tension of the abdominal wall related to ventral hernia repair. The purpose of this project was to attempt to measure physiologic tension in patients without hernia repair and help determine a normal baseline tension. Patients were enrolled in a prospective institutional review board–approved protocol to measure abdominal wall tension from February 2014 to present. Patients undergoing abdominal surgery without hernia repair were included. Demographic information and operative details were documented. Abdominal wall tensions were measured using scales attached to Kocher clamps that are clamped to the fascia and then brought together in the midline. Total tension, surgeon's estimation of tension, and grading of the fascia were recorded. Descriptive statistics were calculated. Eleven patients met the inclusion criteria and had tension measurements performed during surgery. The average age was 58 years, with 55 per cent of them being white and 82 per cent being male, with an average BMI of 27. Operations included exploratory laparotomy for small bowel pathology in six patients, colorectal surgery in three patients, and splenectomy in a trauma patient. Average tension measurements for these patients were 1.9 lbs. Surgeon grading of tension was an average of 2.2 (range, 1–5). Obtaining tension measurements is feasible during abdominal surgery. Physiologic tension seems to be approximately 2 pounds. Further study is needed with a larger sample of patients.

scholarly journals The Management of Incisional Hernia

2006 ◽  
Vol 88 (3) ◽  
pp. 252-260 ◽  
Author(s):  
Andrew Kingsnorth
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Failure Rate ◽  
Anterior Abdominal Wall ◽  
General Surgeon ◽  
Failure Rates ◽  
Large Problem ◽  
Hernia Surgery ◽  
The Past ◽  
Recent Advances

Many thousand laparotomy incisions are created each year and the failure rate for closure of these abdominal wounds is between 10–15%, creating a large problem of incisional hernia. In the past many of these hernias have been neglected and treated with abdominal trusses or inadequately managed with high failure rates. The introduction of mesh has not had a significant impact because surgeons are not aware of modern effective techniques which may be used to reconstruct defects of the abdominal wall. This review will cover recent advances in incisional hernia surgery which affect the general surgeon, and also briefly review advanced techniques employed by specialist surgeons in anterior abdominal wall surgery.

scholarly journals Current trends in diagnostic and treatment tactics in patients with strangulated ventral hernias

2021 ◽  
Vol 23 (4) ◽  
pp. 583-589
Author(s):  
B. I. Slonetskyi ◽  
М. I. Tutchenko ◽  
I. V. Verbytskyi ◽  
V. O. Kotsiubenko
Keyword(s):  
Abdominal Wall ◽  
Critical Evaluation ◽  
Abdominal Wall Hernia ◽  
Integrated Approach ◽  
Hernia Surgery ◽  
Tension Free ◽  
Urgent Surgery ◽  
Current Trends ◽  
Selective Approach ◽  
Ventral Hernias

The aim of the work. To analyze the world achievements in modern diagnostic and treatment tactics in patients with strangulated ventral hernias, as well as to outline promising and pragmatic directions for further research. The literature review presents current trends and views on the choice of individual components of the integrated diagnostic approach in patients with strangulated ventral hernias, and focuses on various principles of therapeutic tactics. The need to further improve the examination methods of abdominal organs, anterior abdominal wall, hernia contents (polypositional roentgenoscopy or roentgenography, ultrasound, CT, MRI) is emphasized and prospects of allohernioplasty and videolaparoscopic technologies with an integrated approach in choosing the method for correction or reconstruction of abdominal wall depending on the prognostic risk factors of postoperative complications are substantiated. Comparison of individual priorities of planned hernia surgery provided the opportunity to define the main directions in terms of urgent medical treatment features for patients with strangulated ventral hernias, taking into account a phasal nature of the pathological process and the availability and applicability of various synthetic implants. The literature analysis allowed for enough critical evaluation of the current state of tension-free allohernioplasty – the main fundamental principle of modern urgent surgery for ventral hernias and determining the main pragmatic directions of a selective approach in choosing the therapeutic tactics for patients with infected surgical wound. Conclusions. Urgent surgery of strangulated ventral hernias requires adequate and timely provision of individual and differentiated approaches in choosing the volume and method of surgery. Improvement of methods for predicting and preventing complications in patients with strangulated ventral hernias will expand the indications for the use of advanced types of tension-free hernioplasty.

scholarly journals A CONCISE PICTURE OF HERNIA

2021 ◽  
pp. 14-20
Author(s):  
ATHIRA ROY ◽  
KRISHNA RAVI ◽  
REEJA T REJI
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Abdominal Pressure ◽  
Abdominal Muscles ◽  
Regular Exercise ◽  
Precipitating Factors ◽  
Tension Free ◽  
Laparoscopic Techniques

A hernia is a disease wherein organs or tissues, like the bowel, bulge through the abdominal wall. The etiological, as well as precipitating factors for hernia include abdominal pressure, pre-existing weakness of abdominal muscles, gender, obesity, age, diet, lack of regular exercise, and smoking. Swelling, stiffness, and discomfort seem to be the most prevalent hernia symptoms, particularly while straining, moving, or bending down. Open and laparoscopic techniques are mainly used for hernia repair, both use mesh to counterbalance the abdominal wall flaws and provide a tension-free restoration.

scholarly journals A comparative study of laparoscopic trans abdominal pre peritoneal ventral hernia repair versus open pre peritoneal ventral hernia repair

2019 ◽  
Vol 7 (1) ◽  
pp. 274
Author(s):  
Pravin N. Shingade ◽  
Anshu Rawat ◽  
Rizhin Sooraj
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Ventral Hernia ◽  
Umbilical Hernia ◽  
Ventral Hernia Repair ◽  
Open Repair ◽  
Hernia Surgery ◽  
Mesh Placement ◽  
Medical College ◽  
A Prospective Study

Background: Ventral hernias are defined as a protrusion of abdominal contents through the abdominal wall muscle. It can be categorised as spontaneous or acquired or by their location on the abdominal wall like epigastric hernia, umbilical hernia, para umbilical hernia etc. This original article reveals that laparoscopic trans abdominal pre peritoneal (TAPP) mesh placement for ventral hernia usually follows the current principle of hernia surgery and give better results from open pre peritoneal ventral hernia repair.Methods: A prospective study conducted in Dr. D. Y. Patil Medical College and Hospital, Pune for the period of 2017-2019 comparing laparoscopic TAPP vs. open preperitoneal ventral hernia repair. Total of 25 patients for laparoscopic TAPP repair and 25 patients for open preperitoneal repair were compared.Results: Total 50 cases were studies in which 25 for laparoscopic and 25 for open repair. Majority of patients were female than males. Incidence of para umbilical (56%) was found to be more. Intra operative, post-operative complications were found to be more in open repair than laparoscopic TAPP repair.Conclusions: Laparoscopic TAPP ventral hernia repair is safe with fewer complications. Therefore, offers successful treatment for ventral hernia repair with added benefits of laparoscopy such as better visualization and magnification of the hernia defects which are not clinically apparent and less chances of injury which is not possible by open technique. Laparoscopic TAPP ventral hernia repair gives equal results in terms of recurrence and less complications than open ventral hernia repair.

Rationale and Technique for Measuring Abdominal Wall Tension in Hernia Repair

2018 ◽  
Vol 84 (9) ◽  
pp. 1446-1449 ◽  
Author(s):  
William W. Hope ◽  
Zachary F. Williams ◽  
James W. Rawles ◽  
W. Borden Hooks ◽  
Thomas V. Clancy ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Linear Regression Analysis ◽  
Prospective Trial ◽  
Multiple Linear Regression Analysis ◽  
Wall Tension ◽  
Hernia Surgery ◽  
Hernia Defect ◽  
Institutional Review ◽  
Average Patient

We describe a method to measure abdominal wall tension during hernia surgery and evaluate a possible correlation between hernia defect width and abdominal wall tension. After Institutional Review Board approval and informed consent, a prospective trial to measure intra-abdominal tension was undertaken (May 2013 through March 2017). Tension measurements were obtained using tensiometers. Total tension, hernia defect width, and surgeon's estimation of tension were recorded. Correlation between defect width and total abdominal wall tension was assessed using multivariate analysis and a multiple linear regression analysis. An r-squared value > 0.6 was considered significant. Fifty-nine patients underwent hernia repair with concomitant tension measurements obtained at surgery. The average patient age was 61 years (range 29–81 years), 85 per cent were white, and 56 per cent female. The average total tension was 6.7 pounds (range 0.2–22 pounds) and average defect width was 8.6 cm (range 2–25 cm). The surgeon rated the fascia to be excellent in 15 per cent, good in 58 per cent, and fair in 27 per cent. The average estimation of tension by the surgeon was 5 pounds (range 2–10 pounds). We found no correlation between hernia defect size and total abdominal wall tension and no correlation between the surgeon-estimated tension and objectively measured tension. We found no correlation between the width of the hernia defect and tension associated with approximating the midline. Further study regarding the practicality and usefulness of abdominal wall tension measurements during hernia surgery is needed.

scholarly journals Patient-reported outcomes after incisional hernia repair

Hernia ◽  
2021 ◽  
Author(s):  
N. van Veenendaal ◽  
M. M. Poelman ◽  
B. van den Heuvel ◽  
B. J. Dwars ◽  
W. H. Schreurs ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Patient Reported Outcomes ◽  
Incisional Hernia Repair ◽  
Hernia Surgery ◽  
Incisional Hernias ◽  
Patient Reported ◽  
Postoperative Symptoms

Abstract Purpose Patient-reported outcomes (PROs) are pivotal to evaluate the efficacy of surgical management. Debate persists on the optimal surgical technique to repair incisional hernias. Assessment of PROs can guide the selection of the best management of patients with incisional hernias. The objective of this cohort study was to present the PROs after incisional hernia repair at long term follow-up. Methods Patients with a history of incisional hernia repair were seen at the out-patient clinic to collect PROs. Patients were asked about the preoperative indication for repair and postoperative symptoms, such as pain, feelings of discomfort, and bulging of the abdominal wall. Additionally, degree of satisfaction was asked and Carolina Comfort Scales were completed. Results Two hundred and ten patients after incisional hernia repair were included with a median follow-up of 3.2 years. The main indication for incisional hernia repair was the presence of a bulge (60%). Other main reasons for repair were pain (19%) or discomfort (5%). One hundred and thirty-two patients (63%) reported that the overall status of their abdominal wall had improved after the operation. Postoperative symptoms were reported by 133 patients (63%), such as feelings of discomfort, pain and bulging. Twenty percent of patients reported that the overall status of their abdominal wall was the same, and 17% reported a worse status, compared to before the operation. Ten percent of the patients would not opt for operation in hindsight. Conclusion This study showed that a majority of the patients after incisional hernia repair still report pain or symptoms such as feelings of discomfort, pain, and bulging of the abdominal wall 3 years after surgery. Embedding patients’ expectations and PROs in the preoperative counseling discussion is needed to improve decision-making in incisional hernia surgery.

scholarly journals Lichtenstein mesh hernioplasty: the extreme refinement in hernia surgery

2017 ◽  
Vol 5 (1) ◽  
pp. 87
Author(s):  
Srinivas N. M. ◽  
Devaprashanth M.
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Recurrence Rate ◽  
Treatment Modalities ◽  
Hernia Surgery ◽  
Bilateral Hernia ◽  
Tension Free ◽  
Early Return ◽  
Mesh Hernioplasty

Background: Inguinal hernia repair is the most commonly performed operation, owing to a significant lifetime incidence and variety of successful treatment modalities. The Lichtenstein tension-free repair has become the dominant method of inguinal hernia repair. The advantages of this repair were its association with less pain, rapid postoperative recovery, early return to normal activity and very low recurrence rate. We evaluated the treatment outcome of the tension free repair of inguinal hernias by the Lichtenstein mesh repair using polypropylene mesh.Methods: 200 patients treated for inguinal hernia with Lichtenstein mesh hernioplasty between May 2015 to April 2016 were reviewed. Data recorded included age, sex, symptoms, site of hernia, unilateral or bilateral hernia, postoperative complications, and recurrence in follow up period of one year.Results: 55% patients had indirect and 41% had direct inguinal hernia while 4% had pantaloon hernia. Seroma occurred in 2% patients and hematoma in 6%. Superficial surgical site infection was seen in 3% patients. Transient testicular swelling was noticed in 7% patients.Conclusions: Lichtenstein tension-free mesh hernioplasty is simple, safe, effective and economical and has good patient satisfaction and low recurrence rate. 

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