Hernia of the lung

BACKGROUND: Lung hernia is uncommon and methods of management vary. During the past 17 years, we have seen 8 patients with this condition. METHODS: Between 1984 and 2000, 8 patients with lung hernias were seen on our service. Three hernias were caused by a thoracic operation, one was due to chronic cough, and in four, the hernia was congenital, with delayed presentation. RESULTS: Three patients had minimal symptoms and were not operated on. Closure of chest wall in the other patients was accomplished by suture approximation of ribs in 4 patients and by polypropylene mesh in 1 patient. There were no recurrences, and these patients remain asymptomatic. CONCLUSIONS: Intercostal hernias are usually symptomatic and should be treated by operative closure. In supraclavicular hernias, the symptoms are usually minimal and complications are unlikely. These hernias can be left untreated, but the patients should be followed.     

疝环充填式无张力疝修补术治疗腹股沟疝的临床应用

我们总结了105例疝环充填式无张力疝修科手术的经验和近期随访结果，现报告如下。临床资料1.一般情况1999年10月至2002年6月我们用疝环充填式无张力疝修补术治疗腹股沟疝105例，其中男98例，女7例。60岁以上老年病人46例，最高年龄95岁，病史2～30年。其中右侧腹股沟斜疝74例，左侧腹股沟斜疝21例，复发性腹股沟斜疝3例，右侧直疝3例，左侧直疝4例。有冠心病、糖尿病、肺癌、肺心病或高血压等伴随病57例。按目前改良分型法，本组病例以Ⅱ型最多，达73%，Ⅲ型14%，Ⅳ型8%，Ⅰ型5%。2.手术方法硬膜外麻醉96例，局麻9例。取常规疝切口，依次切…     

Evaluation of the Rebound Hernia Repair Device for Laparoscopic Hernia Repair

Background:

The characteristics of the ideal type of mesh are still being debated. Mesh shrinkage and fixation have been associated with complications. Avoiding shrinkage and fixation would improve hernia recurrence rates and complications. To our knowledge, this is the first study of a device with a self-expanding frame for laparoscopic hernia repair.

Methods:

Six Rebound Hernia Repair Devices were placed laparoscopically in pigs. This device is a condensed polypropylene, super-thin, lightweight, macro-porous mesh with a self-expanding Nitinol frame. The devices were assessed for adhesions, shrinkage, and histological examination. Laboratory and radiologic evaluations were also performed.

Results:

The handling properties of the devices facilitated their laparoscopic placement. They were easily identified with simple x-rays. The mesh was firmly integrated within the surrounding tissue. One device was associated with 3 small adhesions. The other 5 HRDs had no adhesions. We noted no shrinkage or folding. All devices preserved their original size and shape.

Conclusions:

At this evaluation stage, we found that the Rebound Hernia Repair Device may serve for laparoscopic hernia repair and has favorable handling properties. It prevents folding and shrinkage of the mesh. It may eliminate the need for fixation, thus preventing chronic pain. The Nitinol frame also allowed radiologic evaluation for gross movement. Further studies will be needed to evaluate its clinical application.     

Long-Term Outcome After Hernia Repair with the Prolene Hernia System

Purpose We evaluated the long-term outcome and symptoms after inguinal hernia repair using the Prolene Hernia System (PHS). Methods We reviewed the medical records of all patients who underwent PHS surgery at our hospital to assess the postoperative complications and recurrence rates. Late symptoms were evaluated by a standardized interview using a questionnaire. Results A total of 395 hernias in 367 patients were studied. Postoperative complications developed after 20 repairs (5.1%), including a severe mesh infection in one patient. Seven (1.8%) patients suffered recurrence. Of 395 cases, 363 (91.9%) responded to the interview. After a median follow-up interval of 19.3 months (range 1.0–55.8), moderate pain and moderate discomfort were reported by only 1.9% and 0.8% of patients, respectively. Conclusions Prolene Hernia System surgery is a safe and feasible procedure with low rates of complication, recurrence, and late symptoms.     

Laparoscopic Hernia Repair—When Is a Hernia Not a Hernia?

A wide range of diagnoses can present as inguinal hernia. Laparoscopic techniques are being increasingly used in the repair of inguinal hernias and offer the potential benefit of identifying additional pathology. The authors present the first reported case of a hydrocele of the canal of Nuck diagnosed laparoscopically. We review the incidence of identifying additional pathology through laparoscopy for inguinal hernia repair. We suggest that in patients with atypical presenting features of a hernia, the transabdominal preperitoneal, rather than a totally extraperitoneal, approach to groin hernia repair should be considered because of its greater diagnostic potential.     

Hernia of the foramen Morgagni

Left-side Morgagni's hernia described in this paper is a quite rare in surgery. Its usually asymptomatic and its almost always discovered accidentally, as a secondary medical findings. That was a case with our patient too. Diagnosis is usually confirmed by chest and abdominal X-rays or barium radiography. To prevent possible complications, surgical treatment is advised in all cases. We used transabdominal approach which was recommended in the literature. Surgical treatment was easy to perform and gave favourable results. There were no postoperative complications and in two years term there were no relapse.     

疝囊旷置术治疗小儿腹股沟斜疝

作者自 1985年起采用疝囊旷置术治疗 1.2～ 8岁小儿腹股沟斜疝 2 3 2例 ,方法简便 ,效果良好 ,报告如下。1　手术方法及结果采用氯胺酮全麻 ,5ｍｇ/Ｋｇ ,一次性肌肉注射。切口采用经下腹部自然横纹切口 ,长约 3ｃｍ ,依次切开皮肤、皮下脂肪 ,横行切开腹外斜肌腱膜 ,分开腹横肌 ,显露腹膜 ,横行切开腹膜 ,提取腹膜切口下缘 ,并向下牵拉即可显露疝囊内口。如有疝囊内容物 ,可牵出复位 ,而后用数把蚊式钳轻轻提起疝囊内口后唇 ,使精索血管与被提起的疝囊内口的后唇边缘分离。将疝囊内口后唇与腹膜切口的上缘用 4号丝线间断缝合关闭腹腔 ,使疝…