Perforated appendix and periappendicular abscess within an inguinal hernia

We report an extremely rare case of complicated Amyand’s hernia. A 61-year-old male patient was admitted with clinical signs of incarcerated right inguinal hernia and localised tenderness in the right iliac fossa. He underwent emergency surgery and the operative findings included perforated appendix and periappendicular abscess within a right inguinal hernia sac. Appendectomy and Shouldice’s herniorrhaphy without prosthetic mesh placement were performed. Histology revealed the presence of a villous adenoma near the base of the appendix. We point out that although Amyand’s hernia is a very rare clinical entity, it should always be considered in the differential diagnosis in cases with clinical signs of incarcerated right inguinal hernia, especially when there are no pathological findings on the abdominal X-rays.     

Endometriosis in an inguinal hernia

Summary Endometriosis is a common gynaecological condition characterised by the presence and proliferation of ectopic endometrial tissue. A wide variety of sites have been reported but endometriosis within the inguinal canal is uncommon [Clausen 1987]. The majority of reported cases have described the endometrial tissue as lying in the extraperitoneal portion of the round ligament or within an inguinal lymph node [Clausen 1987]. We report a rare case of endometriosis presenting within the sac of an indirect inguinal hernia.     

A prospective trial of primary inguinal hernia repair by surgical trainees

The main hypotheses were that the Lichtenstein inguinal hernia repair has a lower recurrence rate and similar incidence of chronic groin pain compared to sutured repairs when performed by surgical trainees. In a U.S. Veterans Administration Hospital, 150 primary hernia repairs were randomized to a Lichtenstein, McVay, or Shouldice repair. The Shouldice repair included a routine relaxing incision. First- and second-year residents, under the supervision of an experienced general surgeon, performed the procedure. Long-term follow-up was obtained in 81% of patients. Hernia recurrence rate was Lichtenstein 8%, McVay 10%, Shouldice 5% (P>0.1) at 6–9 years follow-up. More patients had chronic groin pain following Lichtenstein repair (38%) than after Shouldice repair (7%) (P<0.05). More information is needed on long-term groin pain following anterior mesh repair. The Shouldice inguinal hernia repair may have a role in open primary herniorrhaphy to decrease the risk of chronic groin pain.     

Inguinal hernia: a patch covering only the myopectineal orifice is effective

A large mesh in the preperitoneal space, spread on iliac vessels and bladder, can cause future difficulties in a case of urogenital or vascular disease. Since all recurrences are located in the area of the myopectineal orifice, a mesh covering only this area, as in the Rives procedure, is effective and avoids these drawbacks. However, the Rives procedure is demanding, which is why we tried to simplify the technique. A mesh 8–10 cm long and 6–7 cm wide was spread in the preperitoneal space using the inguinal approach, without any fixation or with only a few stitches; the fascia was then simply approximated over the mesh without tension. A total of 161 hernias (99% Nyhus type III and IV) were repaired using this technique. Only six benign complications (3.7%) occurred. With a median follow-up of 63 months (range, 18–94 months), only one recurrence occurred (0.7%), due to misplacement of the mesh, eight patients complained of mild pain, and no late complications were observed. In conclusion, placement of a small mesh covering only the myopectineal orifice using the inguinal approach is effective and is associated with a low risk of drawbacks and complications. Electronic Publication     

Can preoperative diagnosis affect the choice of treatment in Amyand’s hernia? Report of a case

Amyand’s hernia (AH) is defined as an appendix located in the inguinal hernia sac. Most cases are diagnosed intraoperatively and might undergo appendectomy besides hernia repair. Computerized tomography is effective in the preoperative diagnosis. Meanwhile, the number of reports concerning the preoperative diagnosis of AH is increasing. There is no standard protocol for the management of AH. Factors such as the presence of an inflamed appendix, contamination of the surgical field, patient age and anatomic features of the tissue are important determinants for appropriate surgery. Herein, we report an adult male patient with AH.     

Amyand’s hernia in premature twins

Amyand’s hernia (AH) is the presence of a normal or inflamed vermiform appendix in an inguinal hernia sac. This condition is unusual in neonates and in infants, and it has not been described in premature twins. We present two 32-day-old biovular twins with a right AH, treated with sparing of the appendix and herniotomy. The correct management of AH is discussed via a brief review of the literature.     

Epiploic appendicitis in inguinal hernia sac presenting an inguinal mass

Inguinal hernia sometimes surprises surgeons with its unexpected content. Epiploic appendagitis in hernia sac is a very rare entity. We report a 60-year-old male patient with a painless inguinal mass. Surgical exploration showed a 4-cm mass beneath the external oblique aponeurosis that consisted of a hernia sac containing an inflamed and remarkably swollen appendix epiploica of the sigmoid colon secondary to torsion. The patient recovered after the resection of epiploic appendix and a tension-free hernia repair.     

Are collagens the culprits in the development of incisional and inguinal hernia disease?

Incidence curves for the development of inguinal hernia disease and recurrences thereof exhibit a linear rise over the years and therefore suggest multi-factorial underlying causes. Several studies have revealed marked changes in the abundance and composition of interstitial collagens in patients with (recurrent) hernia diseases, adult groin hernia and incisional hernia. These observations led to the hypothesis that hernia formation and the recurrence of incisional hernia may be explained by disordered tissue renewal and by abnormal wound healing, respectively. Interstitial collagens, owing to their long half-lives and biomechanical strength, are most likely critical components of the biological system of tissue remodelling. An overview of the literature is provided, and the consequences for surgical practice are discussed.     

Ipsilateral Aymand’s and Richter’s hernia, complicated by necrosing fascitis

This study presents the case of a patient with necrobiosis or necrosing fascitis of the inguinal region, secondary to a complicated Amyand’s hernia with a concomitant ipsilateral Richter’s hernia. The patient was treated with open trans-abdominal surgery and hernia repair through the pre-peritoneal approach, plus anti-microbians, and thrice-daily wound cleansing and dressings to the inguinal region. Evolution was satisfactory. There are no reports in the literature of a case such as this.     

Mesothelial cyst presenting as an irreducible inguinal mass

Inguinal hernias are common in the pediatric population. We describe a 10-year-old child who presented with signs and symptoms suggestive of an incarcerated inguinal hernia. Ultrasound examination demonstrated an aperistaltic multicystic inguinal mass of uncertain origin. The mass was resected, and the adjacent hernia was repaired. Histologic examination identified the mass as a mesothelial cyst. Mesothelial cysts are rare groin lesions in children that can masquerade as an incarcerated inguinal hernia in a child.     

Peritoneal mesothelioma masquerading as an inguinal hernia

We report a case of an 80-year-old man who presented with a right inguinal hernia that appeared incarcerated. On exploration a sausage shaped mass was found in the sac, which was debulked and histologically shown to be a well differentiated malignant peritoneal mesothelioma. Rare tumours may present as inguinal hernias and palliative debulking may be effective when they present in inguinal hernia sacs.     

Groin pain in the absence of hernia: a new syndrome

Abstract Abstract. Groin pain may be produced by a true hernia, trauma to the groin structures or peripheral nerve, or root compression at various levels. Approximately 4,000 patients underwent inguinal herniorrhaphy (group A). An additional 134 patients complaining of groin pain and exhibiting no evidence of primary or recurrent hernia fell into two categories: 30 patients who had a previous herniorrhaphy (group B) and 104 patients without previous surgery (group C). Group B patients underwent a diagnostic nerve block which, when positive, suggested ilioinguinal nerve compromise at the wound. Those who failed conservative measures underwent nerve division. Group C patients were advised to decrease recreational and occupational activities; if that failed, they underwent lumbosacral spine imaging. There were no neuralgias in group A. Eight group B patients responded to conservative measures; the 22 others required ilioinguinal nerve division which relieved their pain. In group C, 42 patients responded to physical activity restriction plus NSAIDs; the remaining 62 underwent imaging which revealed lumbosacral bone pathology producing root compression and were referred to orthopedists. Lumbosacral spine pathology should be suspected in patients who complain of groin pain in the absence of hernia or previous herniorrhaphy. Recognition of this syndrome may avoid negative exploratory herniorrhaphies. Electronic Publication     

Laparoscopic incisional hernia repair

Background Recent advances in laparoscopic surgery have made various abdominal surgeries possible. To avoid wound infection, mesh repair of abdominal incisional hernias is performed laparoscopically. Here we present a new procedure to fix mesh to the abdominal wall. Surgical technique Four anchoring sutures are made using a suture-grasping device; the additional transabdominal sutures are then made with a modified double-needle device. Additional circumferential fixation with tacks is not necessary. Conclusions This new mesh fixation method involves simple suturing techniques and is less time consuming than the conventional procedure.     

Combined open and laparoscopic approach to chronic pain following open inguinal hernia repair

Introduction: Chronic groin pain is the most common long-term complication after open inguinal hernia repair. Traditional surgical management of the associated neuralgia consists of injection therapy followed by groin exploration, mesh removal, and nerve transection. The resultant hernia defect may be difficult to repair from an anterior approach. We evaluate the outcomes of a combined laparoscopic and open approach for the treatment of chronic groin pain following open inguinal herniorrhaphy. Methods: All patients who underwent groin exploration for chronic neuralgia after a prior open inguinal hernia repair were prospectively analyzed. Patient demographics, type of prior hernia repair, and prior nonoperative therapies were recorded. The operation consisted of a standard three trocar laparoscopic transabdominal preperitoneal hernia repair, followed by groin exploration, mesh removal, and nerve transection. Outcome measures included recurrent groin pain, numbness, hernia recurrence, and complications. Results: Twelve patients (11 male and 1 female) with a mean age of 41 years (range 29–51) underwent combined laparoscopic and open treatment for chronic groin pain. Ten patients complained of unilateral neuralgia, one patient had bilateral complaints, and one patient complained of orchalgia. All patients failed at least two attempted percutaneous nerve blocks. Prior repairs included Lichtenstein (n=9), McVay (n=1), plug and patch (n=1), and Shouldice (n=1). There were no intraoperative complications or wound infections. With a minimum of 6 weeks follow up, all patients were significantly improved. One patient complained of intermittent minor discomfort that required no further therapy. Two patients had persistent numbness in the ilioinguinal nerve distribution but remained satisfied with the procedure. Conclusions: A combined laparoscopic and open approach for postherniorrhaphy groin pain results in good to excellent patient satisfaction with no perioperative morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after prior open hernia repair.     

Prospective double-blind randomized study comparing Perfix® plug-and-patch with Lichtenstein patch in inguinal hernia repair: one year quality of life results

SummaryBackground The 14 day results of this study reported elsewhere demonstrated that the Perfix® plug-and-patch was as effective as the Lichtenstein patch but not as cost-effective. The present analysis looks at the results at one year to measure quality of life between the two groups.Patients and Methods 141 patients were randomly allocated in a doubleblind manner to receive either a Lichtenstein patch (patch) or a Perfix® plug- and-patch (plug-and-patch) for primary inguinal hernia. Quality of life at 6 months and one year was assessed by the short-form 36 (SF36). On a 3 point scale patients were asked at one year to rate groin, wound and testicular discomfort.Results Physical function by SF36 was similar in the 2 groups at 6 months, but at one year in the patch group (95.11 +/-20.07) was significantly better (p < 0.05) than physical function in the plug-and-patch group (82.5 ± 20.98). At one year the number of patients with wound discomfort limiting work or social activities was significantly greater in patients receiving the plug-and-patch (n = 12) compared with patients receiving the patch (n = 4), p < 0.031. At one year, 4 of 70 patients receiving the plug-and-patch had required reoperation to remove the preformed plug-and-patch device and replace it with a flat Lichtenstein patch, because of wound pain which was limiting activity.Conclusion A significant proportion of patients suffer chronic pain after placement of a Perfix® plug-and-patch for primary inguinal hernia repair. Removal of the Perfix® device is required in approximately i in 20 patients (5.6% in this series).     

Evaluation of inguinal hernia in ambulatory surgery: A prospective monocentric study on 1009 inguinal hernia

Ambulatory surgery for inguinal hernia has not been really developed in our country.

Aim

We evaluated the feasibility of inguinal hernia surgery on ambulatory.

Patients and methods

From January 1995 to June 2004, we performed 1009 inguinal hernia. There were 934 men (92.8%) and 75 women (7.2%). Middle age was 58.36 years (range: 7–95 years). All the patients were examined by their primary doctor on the first and the third day and by the surgeon on the tenth day after discharge. Telephone follow-up on the patient's condition was performed by a registered nurse on postoperative days 1 and 3.

Results

Eight hundred and thirty three patients were operated on by ambulatory surgery (82.5%). Overall morbidity was 8.5% (n = 86). Satisfaction index was excellent for 93.8% (n = 948). Locoregional anesthesia alone or associated with general anesthesia was used for 900 patients (98.1%). Only 466 patients (46.2%) were painful, 258 (25.55%) had a discomfort, and 285 (28.24%) had no symptomatology.

Conclusion

Tension-free technique under locoregional anesthesia for inguinal hernia allows ambulatory surgery with a low rate of morbidity and high satisfaction index.     

Amyand’s hernia: history,imaging, and management

BACKGROUND: Amyand's hernia is an inguinal hernia containing vermiform appendix. We report a case of this rare condition, diagnostic findings, and management considerations. A short review and history of Amyand's hernia is presented as well. METHODS: A literature search from Medline was done, and the published articles were reviewed. A case of Amyand's hernia, which was recently managed by the authors, was studied and the data reviewed. RESULTS: Diagnosis of the Amyand's hernia is usually made intraoperatively. The majority of the existing literature recommends doing open or laparoscopic appendectomy with open repair of the inguinal hernia, although some authors advise mesh repair of the hernia if the appendix is normal. CONCLUSION: Amyand's hernia can be a challenge for the surgeon. We recommend laparoscopic appendectomy and open repair of the inguinal hernia without using mesh.     

Obstruction of an ileal urinary conduit in an incarcerated right inguinal hernia

We present the case of a 72-year-old man with a history of anuria from his ileal conduit 15 months following its formation. That conduit had become incarcerated in a right-sided ingunial hernia. The patient presented with anuria and an acute kidney injury. A clincal diagnosis of an incarcerated hernia was made, and he was taken to theatre for reduction and repair of the hernia. On removal of the conduit from the hernial sac, it began to drain immediately. He made a full recovery, with normalisation of his renal function.     

Primary omental liposarcoma presenting as an incarcerated inguinal hernia

Herein, we present a case of primary liposarcoma of the omentum found in an incarcerated inguinal hernia in a 52-year-old male patient. The patient was admitted to our hospital in June 2000 with sudden onset of left-sided abdominal and groin pain of 12 hours duration with a large, irreducible inguinal hernia. This was not associated with nausea or vomiting. An emergency operation was performed, and in the hernia sac the tumor, arising from the greater omentum, was found. After we opened the transversal fascia and peritoneum, the tumor was resected with a block of the greater omentum, and hernioplasty was performed using Shouldices method. The histopathological diagnosis of resected tumor showed myxoid type liposarcoma. In the English medical literature, omental liposarcoma has never before been reported as the content of a hernia sac.