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1.
Herniography has been used for 25 years in the diagnosis of occult herniation but has not gained widespread acceptance in
the UK, despite studies confirming its high sensitivity and specificity for occult hernias and an excellent record of safety
and patient acceptability. The traditional approach in the UK to suspected occult groin herniation has been surgical exploration.
This study examined the use of herniography in a single district general hospital to assess its impact in limiting unnecessary
groin explorations and allowing discharge of patients without hernias. The case notes of 90 successive patients referred for
herniography by the department of general surgery in a single UK district general hospital over an 18-month period were reviewed.
Eighty-seven completed examinations were analysed in which 23 hernias were diagnosed in 20 patients. Thirteen patients have
undergone hernia repair with resolution of symptoms. There were no false positive examinations, although two inguinal hernias
were incorrectly diagnosed radiologically as femoral hernias; there were two false negative examinations where additional
hernias were found at laparoscopic repair. There were no reported complications. Twenty-four patients were discharged directly
from the surgical clinic after a negative herniogram. Thirty patients were referred to other specialities. No patient had
undergone groin exploration after a negative herniogram. Herniography is a useful tool in assessing obscure groin pain and
potential occult herniation. It can reliably rule out the presence of a hernia and avoid the need for surgical exploration.
Many patients with a negative herniogram can be reassured and discharged, whilst others may be referred on to other specialities
safe in the knowledge that an occult hernia has been excluded. 相似文献
2.
Nawf Sharief Judith E. Kingston Vanessa M. Wright Kate Costeloe 《Pediatric hematology and oncology》1991,8(4):323-327
We describe a familial case of Marfan's syndrome with associated intrathoracic stomach detected during the neonatal period. The patient developed a primitive leukemia at 3 months of age. Acute leukemia in a patient with Marfan's syndrome has not previously been reported. 相似文献
3.
Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomized trial 总被引:3,自引:0,他引:3
To compare pulmonary effects, postoperative pain and fatigue, morbidity, patient satisfaction, and cost of different anesthetic
techniques for inguinal hernia repair, 50 patients were randomized to local and general anesthesia groups (LA and GA). All
patients received the same premedications and the same postoperative analgesic regimen. The standardized postoperative analgesic,
intramuscular pyroxicam 20 mg, was given to all patients in the recovery room and an additional 20 mg on the same day was
given as requested by each patient. Pulmonary function studies and arterial blood gas analysis were performed 1 h prior to
the operation and at the postoperative 8th and 24th hours. All patients underwent Lichtenstein's tension-free hernioplasty.
Postoperative pain and fatigue were registered 8 h and 24 h after the operation. A questionnaire was filled out by the patients,
and they were asked to give grades for the general comfort of the anesthesia and the surgical procedure (1=worst, 10=best).
Postoperative pulmonary function tests were significantly poorer in the GA group both on 8th- and 24th-hour measurements (P<0.05). Patients who underwent LA had significantly lower PCO2 and higher PO2 at the postoperative 8th hour (P<0.05). Mean postoperative pain and fatigue scores revealed a significant difference in favor of local anesthesia at only
the 8th hour (P<0.05). There were two complications, one in each group (a hematoma in LA and a urinary retention in GA). Patient satisfaction
grades were not different in the two groups. We conclude that LA in inguinal hernia repair does not adversely affect pulmonary
functions, patients feel less pain, and patient satisfaction is comparable to that with GA.
Electronic Publication 相似文献
4.
F. Berndsen D. Arvidsson L.-K. Enander C.-E. Leijonmarck U. Wingren C. Rudberg S. Smedberg G. Wickbom A. Montgomery 《Hernia》2002,6(2):56-61
Interest in inguinal hernia surgery has increased significantly with the introduction of new operating techniques during
the past decade. This multicenter study compared short-term results in patients treated by the laparoscopic transabdominal
preperitoneal patch technique (TAPP; n=518) and the Shouldice technique (n=524). We evaluated demographics, operative data, complications, hospital stay, postoperative pain, use of analgesics, functional
status, sick leave, and complaints up to 3 months postoperatively. The median operating time was shorter in the Shouldice
group (55 vs. 65 min), but there were no significant differences in complication rates, and major complications were rare.
The hospital stay was 1 day or less in over 98% of cases in both groups, but more operations were performed on outpatient
basis in the Shouldice group. In the TAPP group postoperative pain and analgesic consumption were less, postoperative functional
status was better, and sick leave was shorter (10 vs. 14 days). These results show that the two methods are equally safe and
have few major complications. The TAPP operation is associated with less postoperative pain, better postoperative functional
status, and shorter sick leave, but at the price of a longer operating time.
Electronic Publication 相似文献
5.
Z. Malazgirt K. Topgul S. Sokmen S. Ersin A. G. Turkcapar H. Gok N. Gonullu M. Paksoy M. Ertem 《Hernia》2006,10(4):326-330
Most of the papers published on spigelian hernia are either case reports or small retrospective series. In this prospective
multicenter study, we aimed to outline the specific features of spigelian hernias and patients’ characteristics more clearly.
Surgeons enrolled patients to be entered into the database as they diagnosed and treated the hernias at will. The baseline
and surgical outcome parameters were noted in each patient. A painful mass was the main presenting complaint in half of 34
patients. Accurate preoperative diagnosis was possible in 31 patients. Open intraperitoneal mesh repair was the preferred
technique. The mean hospital stay and time until return to normal daily activities were 4.1 and 15.6 days. Although a rare
condition, diagnosis of a spigelian hernia is not difficult once remembered. Its surgical repair seems to cause few complications
and is very well tolerated by the patient. 相似文献
6.
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. 相似文献
7.
硬膜外穿刺针外套管在腹腔镜小儿斜疝高位结扎术中的应用 总被引:3,自引:0,他引:3
目的探讨硬膜外穿刺针外套管在腹腔镜小儿斜疝疝囊高位结扎中的应用价值。方法2003年4月-2006年5月,我院对230例小儿斜疝手术应用硬膜外穿刺针外套管代替雪橇钩针实施腹腔镜疝内环口荷包高位结扎术。结果230例手术均获得成功,手术时间:单侧161例8-10 min,嵌顿疝39例15-20 min,双侧30例16-20 min;术后未见有阴囊水肿及睾血疼痛及缺血坏死。术后随访2-6个月111例,6-12个月52例,12-24个月37例,24-36个月30例,无复发。结论硬膜外刺针外套管可替代小儿疝囊结扎专用的雪橇钩针,简便,经济,适合在所有基层医院推广。 相似文献
8.
Background The incidence rate of incisional hernias after open surgery has been reported to be higher than that of port site hernias
after laparoscopic surgery. No studies have compared the costs for the health care system in treating those two types of hernia.
Methods A systematic review was conducted to obtain the baseline data, and a decision analysis model was created to simulate the occurrence
and recurrence of incisional and port site hernias.
Results The overall risk of having incisional hernias was eight-times higher than that of having port site hernias (7.4% vs 0.9%).
A cost savings of £93 per patient can be generated for the health care system in the UK. Similar results were obtained for
Germany, Italy and France.
Conclusions The additional treatment costs for incisional hernia should be taken into account when the costs of a surgery performed by
open approach are compared with by laparoscopy. 相似文献
9.
Inguinal hernia is a known complication after radical retropubic prostatectomy (RRP). We have investigated whether other types
of lower midline incision surgery in males increase the risk of inguinal hernia. Male patients operated with open prostatectomy
for benign prostate hyperplasia (n = 95), pelvic lymph node dissection for staging of prostate cancer (n = 88), or cystectomy for bladder cancer (n = 76) were identified and were sent questionnaires in which they were asked about postoperative inguinal hernia morbidity.
Two-hundred and seventy-one men operated with RRP had previously received a similar questionnaire. The answers were compared
with those from a control group of 953 men who had not undergone surgery. Annual attributional hernia morbidity and Kaplan–Meier
hernia-free survival were calculated. The cumulative incidence of post-operative inguinal hernia and annual attributional
hernia morbidity after the respective surgical procedures were clearly higher during the early years post-operation than for
nonoperated patients. Inguinal hernia is a common postoperative complication in males after all the lower midline incision
surgery investigated. 相似文献
10.
Mesh fixation with human fibrin glue (Tissucol) in open tension-free inguinal hernia repair: a preliminary report 总被引:2,自引:0,他引:2
S. Canonico A. Santoriello F. Campitiello A. Fattopace A. Della Corte I. Sordelli R. Benevento 《Hernia》2005,9(4):330-333
Background: The Lichtenstein technique for inguinal hernia repair is easy to learn and associated with few complications. However, recent
studies have suggested that this technique is inferior to some ‘sutureless’ repair systems in terms of perceived difficulty,
operating time, surgeon satisfaction, etc. Methods: We employed a sutureless Lichtenstein technique in 80 consecutive patients with primary unilateral inguinal hernia, to assess
patient and trainee surgeon outcomes. Human fibrin glue was used in place of conventional sutures. Results: The mean operating time was 36 min and all patients were discharged 5–6 h after the operation. On a 100-point visual analogue
scale, the surgeons rated the difficulty of the operation as low (mean score, 31), and perceived satisfaction as high (mean
score, 84). No complications were observed at 12-month follow-up. Conclusion: This study confirms the efficacy of mesh fixation with human fibrin glue, and supports the viability of a sutureless Lichtenstein
procedure. 相似文献