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41.
Background Many centers use local anesthesia for adult inguinal hernia surgery in the setting of day-case surgery. There are no reports
on, or guidelines for, use of anesthesia for inguinal hernia surgery in adolescents. We describe our initial experience with
the use of local anesthesia and intravenous sedation for inguinal hernia surgery in adolescents in the setting of a day-surgery
facility.
Methods The charts of 14 consecutive adolescent patients (aged 12–17) who had inguinal hernia surgery from July 2004 to March 2005
were reviewed retrospectively. Intravenous sedation was administered 1–3 min before injection of local anesthetic. Sedation
consisted of midazolam 0.085 mg kg−1 and either fentanyl 0.85 μg kg−1 or ketamine 0.085 mg kg−1, according to the preference of the anesthesiologist. Additional sedation with half the initial dose was administered if
required. Local anesthesia using a combination of lignocaine and bupivacaine was administered by the surgeon with infiltration
in the skin and deep tissues.
Results Fourteen adolescents aged 12–17 years (mean 14.8 ± 1.37), weighing 34–100 kg (mean 61.2 ± 16.5), had 15 inguinal hernia repairs
with sedation and local anesthesia. All the patients were male. All completed the surgery with sedation and local anesthesia.
None required conversion to general anesthesia. There were no immediate or subsequent complications. Mean time from the end
of surgery to discharge home was under 2 h (mean 106 ± 36 min). Examination of patient charts did not reveal any complaints
regarding the surgery or the postoperative course at the postoperative follow up visit.
Conclusions The use of local anesthesia with intravenous sedation for inguinal hernia repair in the adolescent age group seems feasible
and requires further prospective study. 相似文献
42.
Foramen of Winslow hernia is a rare surgical condition that is notoriously difficult to diagnose and most patients are diagnosed only at the time of surgery. As such, a high index of suspicion is necessary to avoid potentially life‐threatening complications. The present paper describes two such cases. In the first case, a freely suspending gall bladder herniated into the lesser sac via the foramen of Winslow. This was diagnosed during a scheduled laparoscopic cholecystectomy. In the second case, the caecum herniated into the foramen of Winslow causing small bowel obstruction and ischaemic hepatitis. Diagnostic dilemma and treatment of the condition is also described. 相似文献
43.
Abstract A young male motorcyclist presented to the Pelvic Unit with an open-book fracture of his pelvis and an acute obstructed direct
inguinal hernia. He was managed operatively and made an excellent recovery. Traumatic abdominal wall hernias are rare. This
is a unique combination of injuries that the trauma surgeon should be aware of. 相似文献
44.
目的 探讨疝环充填式无张力修补术治疗腹股沟疝的经验并评价其临床价值.方法 回顾总结2000年1月至2007年6月疝环充填式无张力修补术治疗腹股沟疝262例临床资料,其中伴随高血压、冠心病、糖尿病、慢性呼吸系统疾病、便秘、前列腺肥大等238例,占90.8%.结果 全组均治愈,手术时间平均41分钟,无切口感染,术后4~7天出院,平均住院5天,随访3~64个月,疝复发1例,为0.4%.结论 该方法操作简便,符合腹股沟区生理解剖特点,强调对高龄患者的术前准备,强调严格的无菌操作,强调充填物放置到位和充填后修补到位是避免术后复发的关键. 相似文献
45.
46.
A Comman P Gaetzschmann T Hanner M Behrend 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2007,11(4):496-501
BACKGROUND: The incarcerated appendix in the femoral hernia represents a rare clinical case that was first described by the Frenchman de Garengeot in 1731. Besides the open procedures, laparoscopy presented itself as a treatment option. CASE REPORT: Our case concerns a 38-year-old patient with a right femoral hernia with an inflamed incarcerated appendix. Because of the clinically inconclusive finding, we chose transperitoneal preperitoneal hernia repair (TAPP) combined with a laparoscopic appendectomy. The intra- and postoperative course was uneventful. This case shows that a laparoscopic procedure is possible even in the case of an incarceration in conjunction with an appendicitis that has not spread to the adjacent peritoneum. DISCUSSION: Compared with open interventions, the subjective social advantages (shorter hospital stay, earlier return to work, less need for pain killers, and others) of laparoscopic hernia treatment have been extensively studied. The use of both methods in the case of an incarcerated hernia is open to dispute, though various small series confirm the feasibility. CONCLUSION: Here, TAPP seems to be the more reliable method in terms of patient safety because of the simultaneous possibility of using laparoscopy. 相似文献
47.
Laparoscopic mesh repair of incisional hernia: an alternative to the conventional open repair? 总被引:1,自引:0,他引:1
M. Stickel M. Rentsch D.-A. Clevert T. Hernandez-Richter K. W. Jauch F. Löhe M. K. Angele 《Hernia》2007,11(3):217-222
Background Tension-free incisional hernia repair using alloplastic material increasingly replaces conventional repair techniques. This
change resulted in a decreased recurrence rate (50% vs. 10%, respectively). Recently, laparoscopic approaches for the intraperitoneal
tension-free mesh application have been introduced. The decreased trauma at the incision site and the reduction in wound infections
appear to be the main advantages. The aim of the present study was to evaluate the early and long-term complications as well
as patients’ contentment.
Methods Laparoscopic hernia repair with intraperitoneal polytetrafluroethylene (PTFE) mesh implantation was performed on 62 patients
at the Klinikum Grosshadern between 2000 and 2005 (29 males, 33 females age 60.7). Intra- and postoperative complications
were registered prospectively and retrospectively analyzed. In addition, 57 patients were evaluated for recurrence, postoperative
pain and patient contentment (median follow-up 409 days).
Results A low complication rate was observed in our patient collective. One trocar bleeding occurred. Three patients presented with
wound hematoma. The recurrence rate was 8% (2/25). Sixty-two percent of the patients were free of complaints postoperatively.
Eighty-five percent would once again choose the laparoscopic approach for incisional hernia repair.
Conclusion The laparoscopic technique was associated with a low recurrence rate, a small rate of wound infections and high patient comfort.
Thus, the laparoscopic approach for mesh implantation appears to be a safe and effective method for the treatment of incisional
hernias. The efficiency for laparoscopic intraperitoneal mesh implantation, however, should be further evaluated within a
prospectively randomized multicenter trial.
M. Stickel and M. Rentsch contributed equally. 相似文献
48.
G G Varela A López-Loredo J F García León 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2007,11(1):127-130
BACKGROUND AND OBJECTIVE: We present the case of a female patient 29 years of age with antecedents of laparoscopic laser ablation for endometriosis, laparoscopic appendectomy, and umbilical hernioplasty. METHODS: The patient was admitted to the hospital's emergency room for abdominal pain in the epigastrium, transfixing, irradiating to both upper quadrants and to the lumbar region, accompanied by nausea and gastrobiliary vomiting. Lipase determination was 170 mg/dL. Other laboratory findings were normal. Plain abdominal films on the patient's admission were normal, and computed tomography (CT) showed data compatible with acute pancreatitis. Without improvement during the patient's hospital stay, pain and vomiting increased in intensity and frequency. RESULTS: New abdominal x-rays revealed dilatation of small bowel loops. Management was begun for intestinal obstruction, with intravenous hydration and placement of a nasogastric tube without a good response. At 48 hours, a diagnostic laparoscopy was performed, revealing a 3-cm internal hernia in the left broad ligament in which a 20-cm segment of terminal ileum was encased. We performed liberation of the ileal segment and closed the hernial orifice by using the laparoscopic approach. CONCLUSION: The patient's evolution was excellent. 相似文献
49.
闭孔疝的诊断和治疗 总被引:5,自引:0,他引:5
目的探讨闭孔疝的诊治方法。方法对15例闭孔疝病例诊治经过结合相关文献进行回顾性分析。结果15例中.术前确诊率仅20%(3/15),误诊率80%(12/15),全组均行疝环修补术,采用剖腹探查切口。本组治愈率100%,术后切口感染及愈合不良4例(21.67%),随访8例至今无复发。结论术前易误诊、漏诊;对年老体弱、多胎生育伴有不明原因肠梗阻表现的妇女,应高度考虑闭孔疝,Howship—Romberg征及Hannington—Kiff征阳性可确诊。疝环修补术是惟一有效的方法,首选腹腔内入路。早确诊.及时手术是减少并发症、降低死亡率的关键。 相似文献
50.
Adult umbilical hernia is a common surgical condition mainly encountered in the fifth and sixth decade of life. Despite the
high frequency of the umbilical hernia repair procedure, disappointingly high recurrence rates, up to 54% for simple suture
repair, are reported. Since both mesh and suture techniques are used in our clinic we set out to investigate the respective
recurrence rates and associated complications, retrospectively. Patients who were treated between January 1998 and December
2002 were identified from our hospital database and invited to attend the outpatient department for an extra follow-up, history
taking and physical examination. The use of prosthetic material, occurrence of surgical site infection, body mass and height
as well as recurrence were recorded at the time of this survey. In total, 131 consecutive patients underwent operative repair
of an umbilical hernia. Twenty-eight percent of the patients were female (n=37). In 12 patients (11%) umbilical hernia repair was achieved with mesh implantation. Fourteen umbilical hernia recurrences
were noted (13%); none had been repaired using mesh. No relationship was found between wound infection or obesity and umbilical
hernia recurrence. In the light of these results it is necessary to re-evaluate our clinical “guidelines” on mesh placement
in umbilical hernia repair: apparently not every umbilical fascial defect needs mesh repair. Research should focus on establishing
risk factors for hernia recurrence. 相似文献