Laparoscopic repair of sciatic hernia recognizing the ureterohypogastric nerve fascia and vesicohypogastric fascia: a case report

Background Sciatic hernias are rare pelvic floor hernias that occur through the sciatic foramen and often present as abdominal or pelvic pain, particularly in women. Historically, they were repaired using an open approach, with limited reports on their laparoscopic treatment. Case presentation Here we present the case of an 85-year-old woman who had repeated abdominal pain and was referred to our hospital for sciatic hernia surgery after conservative treatment. We laparoscopically observed the deep pelvis and identified the right sciatic hernia. When an extraperitoneal space was dissected, an ureterohypogastric nerve fascia (UNF) and a vesicohypogastric fascia (VF) were identified. Moreover, the maneuver to mobilize the fasciae inside from the pelvic wall made it possible to separate the ureter and urinary bladder, which might have otherwise incarcerated in the hernia. We repaired the defect of the sciatic foramen with a mesh plug and patch. The patient had an uneventful recovery, and the absence of sciatic herniation recurrence was confirmed 1 year after surgery. Conclusion A laparoscopic repair of a sciatic hernia could permit detailed non-invasive observations of the deep pelvis and be performed effectively by recognizing an UNF and a VF located near the sciatic foramen.

A comparative study of negative suction drainage in inguinal hernia operations at Saraswathi Institute of Medical Sciences, Pilkhua, Hapur Uttar Pradesh

Background: The inguinal area is the weakest region of the abdominal wall. So, this is the most common site for the development of hernias. Inguinal hernias are the commonest amongst all the hernias and hernia repair is the most frequently done operation worldwide. There is no agreement among surgeons regarding the need for drains. Some use sparingly and some use it routinely. This study aims to evaluate the use of negative suction drain in inguinal hernia surgery.Methods: We studied sixty patients of inguinal hernias both direct and indirect for one year and followed up for next 1-2 years. This prospective study aimed to see the effect of negative suction drainage in hernia surgery.Results: Both the groups did well postoperatively. It was beneficial to put a negative suction drain in those patients who had a bigger hernia, fatty patients with the thick fatty lower abdominal wall and older patients.Conclusion: It is advisable to put a negative suction drain in inguinal hernia surgery and strongly advocated if the dissection had been difficult, old patients and fatty lower abdominal wall

Patient Views Around Their Hernia Surgery: A Worldwide Online Survey Promoted Through Social Media

Introduction: Hernias are one of the most common surgical diagnoses, and general surgical operations are performed. The involvement of patients in the decision making can be limited. The aim of this study was to explore the perspectives of patients around their hernia and its management, to aid future planning of hernia services to maximise patient experience, and good outcomes for the patient.Methods: A SurveyMonkey questionnaire was developed by patient advocates with some advice from surgeons. It was promoted on Twitter and Facebook, such as all found “hernia help” groups on these platforms over a 6-week period during the summer of 2020. Demographics, the reasons for seeking a hernia repair, decision making around the choice of surgeon, hospital, mesh type, pre-habilitation, complications, and participation in a hernia registry were collected.Results: In total, 397 questionnaires were completed in the study period. The majority of cases were from English speaking countries. There was a strong request for hernia specialists to perform the surgery, to have detailed knowledge about all aspects of hernia disease and its management, such as no operation and non-mesh options. Chronic pain was the most feared complication. The desire for knowledge about the effect of the hernia and surgery on the sexual function in all age groups was a notable finding. Pre-habilitation and a hernia registry participation were well-supported.Conclusions: Hernia repair is a quality of life surgery. Whether awaiting surgery or having had surgery with a good or bad outcome, patients want information about their condition and treatment, such as the effect on aspects of life, such as sex, and they wish greater involvement in their management decisions. Patients want their surgery by surgeons who can also manage complications of such surgery or recommend further treatment. A large group of “hernia surgery injured” patients feel abandoned by their general surgeon when complications ensue.

Literature Review : Pengaruh Terapi Distraksi Musik Klasik Terhadap Intensitas Nyeri Pada Pasien Post Operasi Hernia

Hernia is the expulsion Of body contents through the weakest part Of a Wall Of the abdominal cavity. Handling is done by surgery. The surgical procedures will cause pain. One of the non-pharmacological therapies to treat pain in post-hernia surgery patients is classical music distraction therapy. This study aims to describe the effect of classical music distraction therapy on reducing pain intensity in post hernia surgery patients. The design of this scientific paper used a literature review with a total of 3 articies taken from the Googie Scholar page with the keywords a pain, post hemia surgery, classical music therapy" in the form of full-text articles published in 2014-2018. The results showed that the average value before being given therapy was 5.11 and after being given therapy, the average pain was 3.11 with a p-value <0.05. Therefore it can be concluded that there is an effect of giving classical music distraction techniques to reducing pain intensitu in post hernia surgery patients. This result can be used as a consideration for nurses to apply classical music distraction therapy to reduce pain in post hernia surgery patients.Keywords: Pain; Post Hernia Surgery; Classical Music Therapy AbstrakHernia yaitu keluarnya isi tubuh melewati bagian terlemah dari suatu dinding rongga perut. Penanganan yang dilakukan yaitu dengan pembedahan, dan prosedur pembedahan akan menimbulkan rasa nyeri. Salah satu terapi non farmakologi untuk mengatasi nyeri pada pasien post operasi hernia adalah terapi distraksi music klasik. Penelitian ini bertujuan untuk menggambarkan pengaruh terapi distraksi musik klasik terhadap penurunan intensitas nyeri pada pasien post operasi hernia. Desain karya tulis ilmiah ini menggunakan literature review dengan jumlah 3 artikel yang diambil dari laman google scholar dengan kata kunci “nyeri, post operasi hernia, terapi musik klasik” berupa artikel fulltex dengan tahun terbit 2014-2018. Hasil analisa dari literature review 3 artikel didapatkan nilai rata-rata sebelum diberikan terapi adalah 5,11 dan setelah diberikan terapi rata-rata nyeri menjadi 3,11 dengan p-value <0,05. Simpulan dari literature review ini yaitu terdapat pengaruh pemberian teknik distraksi music klasik terhadap penurunan intensitas nyeri pada pasien post operasi hernia. Saran bagi perawat dapat menerapkan terapi distraksi musik klasik untuk menurunkan nyeripasien post operasi hernia.Kata kunci: : Nyeri; Post Operasi Hernia; Terapi Musik Klasik

O-EGS01 Emergency Giant Hiatal Hernia Repairs: Experiences in fundoplication versus gastropexy

Background An emergency presentation with a hiatal hernia tends to be life-threatening with a high associated mortality rate. Operative management aims to reduce the herniated stomach, dissect the hernial sac and reapproximate the crura. This will often be followed by a fundoplication or a gastropexy to reduce the risk of recurrence. This study compares the recurrence rates between patients who underwent fundoplication and gastropexy. Methods Over 8 years, from October 2012 to November 2020, 80 patients were admitted to a tertiary oesophagogastric centre requiring emergency surgery to repair a giant hiatal hernia. We conducted a retrospective review and analysis of their admission and follow-up. The primary outcome measure was acute and post-discharge symptomatic recurrence of hiatal hernia, and secondary outcomes were patient mortality and readmission rate. Results Of the 80 patients requiring emergency hiatal hernia surgery, 38% had fundoplication procedures, 53% had gastropexy, and 3% had both (n = 30, 42, 2 respectively). One patient had neither, and 6% (n = 5) patients had a complete or partial resection of the stomach due to necrosis, so they were not suitable for gastropexy or fundoplication. Eight patients (10%) had symptomatic recurrence of hiatal hernia requiring a repeat operation; three within the index admission, five post-discharge. 50% had undergone fundoplication, 38% underwent gastropexy and 13% underwent a resection (n = 4, 3, 1)(p-value=0.5). 19% (n = 15) patients were readmitted. Post-operative mortality was 6% (n = 5). Conclusions Emergency surgery for giant hiatal hernias is usually complex, and a significant cohort of these patients are elderly with significant co-morbidities. Nevertheless, there is no conclusive evidence in the literature favouring fundoplication versus gastropexy. Choice of technique is influenced by the surgeon’s experience and perioperative factors that influence the duration of the operation. This review, which includes the largest cohort of patients available in the literature, demonstrates that surgical technique does not influence the symptomatic recurrence rate in our patient group.

Thrombosis of Right Spermatic Vein: A Case Report

Spermatic vein thrombosis is a rare event that mostly affects the left vein thrombosis, but, in our report, it had developed on the right one that requires a meticulous physical examination for diagnosis. The purpose of this case report is to introduce an adult patient with right spermatic vein thrombosis in a 30-year-old man admitted to the operating room for hernia surgery. Spermatic vein thrombosis is an unexpected finding in the differential diagnosis of acute testicular pain.