Search

Familial aggregation is known for both hernia development and recurrence. To date, only one genome-wide association study (GWAS) limited to inguinal hernia has been reported that identified four risk-associated loci. We aim to investigate polygenic architecture of abdominal wall hernia development and recurrence. A GWAS was performed in 367,394 subjects from the UK Biobank to investigate the polygenic architecture of abdominal wall hernia subtypes (inguinal, femoral, umbilical, ventral) and identify specific single nucleotide polymorphisms (SNPs) that are associated with their risk. Expression quantitative trait loci (eQTL) analysis was performed to identify genes whose expression levels are associated with these SNPs. A genetic risk score (GRS) was used to assess the cumulative effect of multiple independent risk-associated SNPs on hernia development and recurrence in independent subjects (n = 82,064). Heritability (h2) was 0.12, 0.06, 0.16, and 0.07 for inguinal, femoral, umbilical, and ventral hernias, respectively. A high-level of genetic correlation (rg) was found among these subtypes of hernia. We confirmed the aforementioned four loci and identified 57 novel loci (P

We sought to estimate the prevalence, incidence, and timing of surgery for elective and non-elective hernia repairs. We performed a retrospective cohort study, abstracting data on children 3 million dependents of U.S. Armed Services members. Our primary outcome was initial hernia repair (inguinal, umbilical, ventral, or femoral), stratified by elective versus non-elective repair and by age. We calculated prevalence, incidence rate, and time from diagnosis to repair. 19,398 children underwent hernia repair (12,220 inguinal, 5761 umbilical, 1373 ventral, 44 femoral). Prevalence of non-elective repairs ranged from 6% (umbilical) to 22% (ventral). Incidence rates of elective repairs ranged from 0.03 [95% CI: 0.02–0.04] (femoral) to 8.92 [95% CI: 8.76–9.09] (inguinal) per 10,000 person-years, while incidence rates of non-elective repairs ranged from 0.005 [95% CI: 0.002–0.01] (femoral) to 0.68 [95% CI: 0.64–0.73] (inguinal) per 10,000 person-years. Inguinal (median = 20, interquartile range [IQR] = 0–46 days), ventral (median = 23, IQR = 5–62 days), and femoral hernias (median = 0, IQR = 0–12 days) were repaired more promptly and with less variation than umbilical hernias (median = 66, IQR = 23–422 days). These data describe the burden of hernia repair in the U.S. The large variation in time between diagnosis and repair by hernia type identifies an important area of research to understand mechanisms underlying such heterogeneity and determine the ideal timing for repair. Prognosis study II.

Objective. Studying of first results of application of 3D visualization in various laparoscopic interventions. Materials and methods. There were performed 169 operations: 27 transabdominal preperitoneal plasties of inguinal hernias, 19 intraperitoneal alloplasties of umbilical and postoperative ventral hernias with suturing of hernia defect, 1 retromuscular alloplasty of umbilical hernia, 6 reconstructions of anterior abdominal wall for dyastasis of rectal abdominal muscles, 103 plasties of hiatal hernias with fundoplications, 7 Heller’s cardiomyotomies and Dor’s fundoplication, 1 subtotal, 3 atypical gastric resections and 2 sleeve gastric resections for obesity. Results. 3D laparoscopy have simplified and accelerated the parietal peritoneum suturing in conduction of transabdominal preperitoneal plasties of inguinal hernias, as well as while performance of intraperitoneal alloplasties of umbilical and postoperative ventral hernias – the hernia defect suturing. While doing the hiatal hernia plasty, fundoplication with crurorrhaphy 3D laparoscopy have provided the additional advantages of manipulations improvement in special anatomic zones. Analogous advantages were shown in gastric operations, using 3D visualization. Intra- and postoperative complications were absent, as well as the hernias recurrence in the 6 mo-1.5 yr follow-up. Conclusion. The 3D visualization guarantees a rapid and highly-precision performance of complex manipulations in technically hard anatomical zones. Further accumulation of the material and comparison of results of 3D and 2D laparoscopy in prospective investigations, using objective parameters, as well as studying of expediency for 3D visualization selective application, for instance while performance of the most complicated operative stages are necessary.

Umbilical hernia is a common cause for patient presentation to the surgeon, often on a nonemergent basis for a bulge at or lateral to the umbilicus but occasionally under emergency circumstances for pain or bowel obstruction when the hernia contents become incarcerated or strangulated. Risk factors for umbilical hernia include female gender, obesity, and ascites. A defect in the abdominal wall fascia at the umbilicus allows the preperitoneal adipose tissue, omentum, or small or large bowel to protrude through the defect. Rarely described is herniation of the appendix through an umbilical hernia, though appendix-containing femoral hernia (de Garengeot hernia) and appendix-containing inguinal hernia (Amyand hernia) are more common. There are 10 available case reports in the medical literature that describe an appendix-containing umbilical hernia; in this case report, we present the 11th case report of appendicitis within an umbilical hernia.

Abdominal wall hernias can occur in pregnancy as a result of increased intraabdominal pressure and tension on the abdominal wall. Symptoms include pain, nausea, vomiting, abdominal distention, and absence of flatus and stool. Physical exam findings may include a palpable lump or defect that may or may not be reducible, prior incisional scars, and skin erythema or tenderness. Ultrasound may be used to further confirm the diagnosis. Pregnant patients with evidence of bowel incarceration, strangulation, perforation, or an irreducible umbilical hernia should have urgent surgery for hernia repair via open or laparoscopic approach. For non-emergent hernias, elective repair via open or laparoscopic approach, with or without mesh, should be considered in pregnant patients and women of child-bearing age with consideration for gestational age, likelihood of recurrence, and potential for incarceration during pregnancy. Further prospective studies are needed to determine best practice for treatment of hernias during pregnancy.

Purpose: Simultaneous surgeries are increasingly applied in all surgical fields. They bring cost and health advantages to the patient and the economy. Pregnancy is one of the risk factors of hernia in females. We conducted a study for simultaneous tissue repairs of inguinal and umbilical hernias during cesarean section. Methods: Between January 1997 and August 2013 we have operated 42 patients with 45 hernias either umbilical or inguinal. We performed the repairs from the Pfannenstiel incision. Data about maternal age, parity, cause of cesarean section, length of operation, length of stay, complications and patient satisfaction were collected. Results: Within this period there were 19,904 deliveries in total. Incidence of umbilical hernia was found 0.2% and it was 0.1% for the inguinal hernia. Simultaneous hernia repairs significantly prolonged the operative time. There was no recurrence and complication. Conclusions: Our results showed that hernia repair can be performed without any additional risks during cesarean section. We believe that if there is an indication for cesarean section in a pregnancy complicated by an abdominal wall hernia, patients should be informed that it would be safe and effective to repair these hernias during cesarean section. This approach also enables tension-free pure tissue repairs.

Introduction: The abdominal wall hernias in patients with liver cirrhosis have a significant higher prevalence than those in non- cirrhotic patients. The best surgical treatment option and the optimal operative time still represent a subject of debate. Material and method: We have retrospectively analyzed the cases of abdominal wall hernias in patients with liver cirrhosis admitted in the Surgical Department of the Sfantul Pantelimon Clinical Emergency Hospital from Bucharest, undergoing surgical treatment between January 2012 and December 2016. Data regarding the laboratory results (the serum albumin and bilirubin levels, the Prothrombin Time) and the clinical aspects (the presence of ascites or encephalopathy) that helped establish the grade of the disease according to Child classification system, and, also, the information regarding the type of hernia, the character of the surgical indication (emergency or elective), the surgical technique and the postoperative evolution have been collected from the medical documents of the patients included in the present study. The statistical analysis has been made using the chi- square test. Results: 32 cases out of the total 65 patients included in the study, that underwent surgical intervention for the treatment of the abdominal wall defects, had umbilical hernia (49,23%), 18 cases presented with inguinal hernia (27.69%), 11 with incisional hernia (16.92%) and 4 with epigastric hernia (6.15%). 29 patients were subjected to elective surgery (44.6%) and 36 to emergency surgery (55,4%). Regarding the Child classification system used in the present study, 24 patients presented with Child A grade of cirrhosis (36.92%), 30 with Child B (46.15%) and 11 with Child C (16.92%). The postoperative morbidity rate was 45,83% in Child A group, 56,66% in Child B group and 81,8% in Child C group. The mortality rate was 4,16% in the Child A group (one death), 13.33% in the Child B group (4 deaths) and 72.72% in Child C group (8 cases). The highest mortality rates have been registered in patients that underwent emergency surgical intervention. Conclusions: The parietal defects in patients with liver cirrhosis can be surgically treated with satisfactory outcomes. The best results have been registered in patients with compensated form of the cirrhosis or in cases undergoing elective surgery. The methods used for the surgical treatment of the abdominal wall defects vary from herniorrhaphy to alloplastic techniques. For patients with ascites, a good control of this complication represents an important factor for the favourable postoperative evolution. The emergency surgical interventions are associated with greater risks of morbidity and mortality.

The authors report their experience in laparoscopic repair of inguinal hernias in children. From May 2010 to November 2013, 122 patients with inguinal hernia underwent laparoscopic herniorrhaphy (92 males and 30 females). Telescope used was 5 mm, while trocars for the operative instruments were 3 or 2 mm. After introducing the camera at the umbilical level and trocars in triangulation, a 4-0 nonabsorbable monofilament suture was inserted directly through the abdominal wall. The internal inguinal ring was then closed by N or double N suture. All operations were performed in one-day surgery setting. In the case of association of inguinal and umbilical hernia an original technique was performed for positioning and fixing the umbilical trocar and for the primary closure of the abdominal wall defect. The postoperative follow-up consisted of outpatient visits at 1 week and 1, 3, and 6 months. The mean age of patients was 38.5 months. Of all patients, 26 were also suffering from umbilical hernia (19 males and 7 females). A total of 160 herniorrhaphies were performed; 84 were unilateral (66 inguinal hernia, 18 inguinal hernia associated with umbilical hernia), 38 bilateral (30 inguinal hernia, 8 inguinal hernia associated with umbilical hernia). Nine of 122 patients (6 males and 3 females) were operated in emergency for incarcerated hernia. A pre-operative diagnosis of unilateral inguinal hernia was performed in 106 cases. Of these patients, laparoscopy revealed a controlateral open internal inguinal ring in 22 cases (20.7%). The mean operative time was 29.9±15.9 min for the monolateral herniorrhaphies, while in case of bilateral repair the mean operative time was 41.5±10.4 min. The mean operative time for the repair of unilateral inguinal hernia associated with umbilical hernia was 30.1±7.4 while for the correction of bilateral inguinal hernia associated with umbilical hernia 39.5±10.6 min. There were 3 recurrences (1.8%): 2 cases in unilateral repair and 1 case a unilateral recurrence in a bilateral repair. No other complications were seen. Laparoscopic repair of inguinal hernia in children performed in this experience resulted a safe and effective procedure.

Background: Delay in presentation and treatment of abdominal wall hernias is phenomenal in Africa. The three-pronged problem of delayed presentation, multiple comorbidities, and advancing age makes management of complicated abdominal wall hernias more tasking and hazardous. The purpose of this study was to determine the causes of delayed presentation and treatment outcomes of complicated abdominal wall hernias in our environment. Patients and Methods: This was a 3-year multicenter prospective study of the causes of delayed presentation and treatment outcomes of complicated abdominal wall hernias in rural Southeast Nigeria. Results: A total of 138 patients with complicated abdominal wall hernias were enrolled and comprised of 117 males and 21 females. Of the entire patients, those with inguinal hernia represented 76.1% followed by umbilical hernia (8.0%). Only 18.1% presented within 24 h after the onset of complications, 24.6% between 24 and 48 h, 29.0% between 49 and 72 h, and 28.3% after 72 h. In the preoperative period, theater waiting time was 0–12 h in 10.9%, 13–24 h in 23.2%, 25–48 h in 39.1%, and >48 h in 18.1%. The major barriers against early presentation were financial constraint (23.9%) and treatment at alternative homes (15.9%). The overall morbidity rate was 58.0%, whereas the mortality rate was 13.8%. The bowel resection rate was 26.1%, and majority of the resection (77.8%) and deaths (73.7%) occurred in those who had overall delay beyond 72 h before surgical repair. Conclusion: The rates of morbidity and mortality were proportionally related to the length of delay in the presentation and duration of waiting time before operative repair.

Littré’s hernia is caused by the protrusion of Meckel’s diverticulum through an orifice in the abdominal wall. Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract that is generally asymptomatic and only manifests in a specific way when complications exist. An unusual complication of Meckel’s diverticulum is known as Littre’s hernia. It comprises less than 1% of all Meckel’s diverticulum. Usual sites of Littre hernia are right inguinal (50% of cases), umbilical hernia (20%), and femoral hernia (20%). We present a case of Littré’s hernia where we found a strangulated Meckel’s diverticulum in an inguinal hernia sac.