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Complex hernia

Teresa Victoria, Savvas Andronikou, Diana Bowen, Pablo Laje, Dana A Weiss, Ann M Johnson, William H Peranteau, Douglas A Canning, N Scott Adzick
Abdominal wall defects range from the mild umbilical cord hernia to the highly complex limb-body wall syndrome. The most common defects are gastroschisis and omphalocele, and the rarer ones include the exstrophy complex, pentalogy of Cantrell and limb-body wall syndrome. Although all have a common feature of viscera herniation through a defect in the anterior body wall, their imaging features and, more important, postnatal management, differ widely. Correct diagnosis of each entity is imperative in order to achieve appropriate and accurate prenatal counseling and postnatal management...
April 2018: Pediatric Radiology
Steve Halligan, Sam G Parker, Andrew A Plumb, Alastair C J Windsor
Complex ventral hernia (CVH) describes large, anterior, ventral hernias. The incidence of CVH is rising rapidly due to increasing laparotomy rates in ever older, obese and co-morbid patients. Surgeons with a specific interest in CVH repair are now frequently referring these patients for imaging, normally computed tomography scanning. This review describes what information is required from preoperative imaging and the surgical options and techniques used for CVH repair, so that radiologists understand the postoperative appearances specific to CVH and are aware of the common complications following surgery...
March 12, 2018: European Radiology
Joanna L Kaplan, Catherine T Gunther-Harrington, Jessie S Sutton, Joshua A Stern
BACKGROUND: The teratogenic effects of immunomodulatory and certain antimicrobial therapies are described in small rodents and humans. While the described teratogenic effects in small rodents have been extrapolated to make conclusions about its use in the pregnant dam, teratogenic effects of prednisone and doxycycline have not yet been reported in the dog. Here we report and describe midline defects observed in a litter of golden retriever puppies exposed to mid-gestational immunosuppressive and antimicrobial therapy...
March 12, 2018: BMC Veterinary Research
Solina Tith, Garinder Bining, Laurent Bollag
Background : Opioid use during pregnancy is a growing concern in the United States. Buprenorphine has been recommended by "The American College of Obstetrics and Gynecology" as an alternative to methadone to decrease risks associated with the use of illicit opioids during pregnancy. The partial μ-opioid agonists' unique pharmacology, including its long half time and high affinity to the μ-opioid receptor, complicates patient management in a highly kinetic, and often urgent field like obstetric anesthesia...
2018: F1000Research
H Hande Aydinli, Colin Peirce, Erman Aytac, Feza H Remzi
INTRODUCTION: Abdominal wound closure is a challenge in patients undergoing colorectal surgery with a complex history of multiple abdominopelvic operations. Loss of domain of the abdominal fascia because of prior laparotomies precludes the use of simple, everyday abdominal wound closure techniques. Furthermore, ongoing intra-abdominal sepsis, with or without a concurrent entero- or colocutaneous fistula, increases the risk of postoperative morbidity and mortality in this patient population...
April 2018: Diseases of the Colon and Rectum
Giovanni Improta, Mario Alessandro Russo, Maria Triassi, Giuseppe Converso, Teresa Murino, Liberatina Carmela Santillo
Health technology assessments (HTAs) are often difficult to conduct because of the decisive procedures of the HTA algorithm, which are often complex and not easy to apply. Thus, their use is not always convenient or possible for the assessment of technical requests requiring a multidisciplinary approach. This paper aims to address this issue through a multi-criteria analysis focusing on the analytic hierarchy process (AHP). This methodology allows the decision maker to analyse and evaluate different alternatives and monitor their impact on different actors during the decision-making process...
March 5, 2018: Mathematical Biosciences
J D Hodgkinson, C A Leo, Y Maeda, P Bassett, S M Oke, C J Vaizey, J Warusavitarne
PURPOSE: This study aims to compare the outcomes of posterior component separation and transversus abdominis release (PCSTAR) with the open anterior component separation (OACS) technique. OACS, first described by Ramirez et al. (Plast Reconstr Surg 86(3):519-526, 1990), has become an established technique for local myofascial advancement in abdominal hernia surgery. PCSTAR, described by Novitsky et al. (Am J Surg 204(5):709-716, 2012), is being used more frequently and is rapidly becoming the technique of choice in complex ventral hernia repair...
March 7, 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Alvaro Robin-Lersundi, Luis Blazquez Hernando, Javier López-Monclús, Arturo Cruz Cidoncha, Carlos San Miguel Méndez, Elena Jimenez Cubedo, Miguel Angel García-Ureña
BACKGROUND: Posterior component separation with transversus abdominis release technique is increasingly being used for abdominal wall reconstruction in complex abdominal wall repair. The main purpose of this study is to present a modification of the surgical technique originally described that facilitates the surgical procedure and offers additional advantages. METHODS: Based on the knowledge of the anatomy of the retromuscular space and the preperitoneal aerolar tissue distribution, we start the incision on the posterior rectus sheath from the arcuate line in a down to up direction...
March 3, 2018: Langenbeck's Archives of Surgery
Steve Halligan, Sam G Parker, Andrew A Plumb, Chris Pj Wood, Richard W Bolton, Susan Mallett, Alastair Cj Windsor
OBJECTIVE: Complex ventral hernia repair is performed increasingly, exacerbated by the obesity epidemic. Imaging can characterise hernia morphology and diagnose recurrence. By systematic review we investigated the extent to which studies employ imaging. METHODS: The PubMed database was searched for studies of ventral hernia repair January 1995 to March 2016. Hernias of all size were eligible. Independent reviewers screened articles and extracted data from selected studies related to study design, use of pre- and post-operative hernia imaging, and the proportion of subjects imaged...
February 27, 2018: British Journal of Radiology
Cornelis Klop, Laura N Deden, Edo O Aarts, Ignace M C Janssen, Milan E J Pijl, Anneline van den Ende, Bart P L Witteman, Gabie M de Jong, Theo J Aufenacker, Cornelis H Slump, Frits J Berends
PURPOSE: The purposes of the study are to outline the complexity of diagnosing internal herniation after Roux-en-Y gastric bypass (RYGB) surgery and to investigate the added value of computed tomography angiography (CTA) for diagnosing internal herniation. MATERIALS AND METHODS: A cadaver study was performed to investigate the manifestations of internal hernias and mesenteric vascularization. Furthermore, a prospective, ethics approved study with retrospective interpretation was conducted...
February 5, 2018: Obesity Surgery
Colin G DeLong, Justin A Doble, Amber L Schilling, Eric M Pauli, David I Soybel
BACKGROUND: After open complex ventral hernia repair (cVHR), chronic pain has a significant impact on quality of life and processes of care. METHODS: Records of 177 patients undergoing cVHR were reviewed in order to characterize the burden of managing postoperative pain in the first post-operative year following open cVHR. RESULTS: In this cohort, 91 patients initiated at least one unsolicited complaint of pain, though phone call (37), unscheduled clinic visit (45) or evaluation in the emergency room (9); among these an actionable diagnosis was found in 38 (41...
February 2, 2018: American Journal of Surgery
Jill Smolevitz, Richard Jacobson, Milot Thaqi, Samantha Millikan, Keith W Millikan
BACKGROUND: Consensus guidelines recommend against elective ventral hernia repair (VHR) in patients with BMI >30 kg/m2 without preoperative weight loss intervention. We aim to compare hernia recurrence and perioperative complications in VHR utilizing anterior component separation (CS) in patients with class III obesity (BMI >40 kg/m2). METHODS: A retrospective review of patients undergoing VHR with CS was performed. The primary endpoint was hernia recurrence; secondary endpoints were wound complications, postoperative medical complications, mortality and length of stay...
November 11, 2017: American Journal of Surgery
Philip G Truskett
No abstract text is available yet for this article.
January 2018: ANZ Journal of Surgery
F Köckerling, N N Alam, S A Antoniou, I R Daniels, F Famiglietti, R H Fortelny, M M Heiss, F Kallinowski, I Kyle-Leinhase, F Mayer, M Miserez, A Montgomery, S Morales-Conde, F Muysoms, S K Narang, A Petter-Puchner, W Reinpold, H Scheuerlein, M Smietanski, B Stechemesser, C Strey, G Woeste, N J Smart
INTRODUCTION: Although many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations...
January 31, 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Zsolt T Stockinger, Caryn A Turner, Jennifer M Gurney
BACKGROUND: Abdominal surgery constitutes approximately 13% of surgical procedures performed for combat injuries. This study examines the frequencies and type of abdominal surgical procedures performed during recent U.S. Military operations. METHODS: A retrospective analysis of the Department of Defense Trauma Registry (DoDTR) was performed for all Role 2 (R2) and Role 3 (R3) medical treatment facilities (MTFs), from January 2002 to May 2016. The 273 ICD-9-CM procedure codes that were identified as abdominal surgical procedures were stratified into 24 groups based on anatomic and functional classifications and then grouped by whether or not they were laparoscopic...
January 24, 2018: Journal of Trauma and Acute Care Surgery
J J Ahn, M Shnorhavorian, C Katz, A B Goldin, P A Merguerian
INTRODUCTION: Delayed closure of bladder exstrophy has become more popular; however, there is limited the evidence of its success. Existing literature focuses on intermediate and long-term outcomes, and short-term postoperative outcomes are limited by the small number of cases and varying follow-up methods. OBJECTIVE: The objectives of the current study were to: 1) compare 30-day complications after early and delayed closure of bladder exstrophy, and 2) evaluate practice patterns of bladder exstrophy closure...
December 15, 2017: Journal of Pediatric Urology
J S Winder, A Majumder, M Fayezizadeh, Y W Novitsky, E M Pauli
BACKGROUND: A minority of patients undergoing posterior component separation (PCS) have abdominal wall defects that preclude complete reconstruction of the visceral sac with native tissue. The use of absorbable mesh bridges (AMB) to span such defects has not been established. We hypothesized that AMB use during posterior sheath closure of PCS is safe and provides favorable outcomes. METHODS: We performed a retrospective review of consecutive patients undergoing PCS with AMB at two hernia centers...
January 18, 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Joshua J Weis, Matthew Goldblatt, Aurora Pryor, Brian J Dunkin, L Michael Brunt, Daniel B Jones, Daniel J Scott
BACKGROUND: The American health care system faces deficits in quality and quantity of surgeons. SAGES is a major stakeholder in surgical fellowship training and is responsible for defining the curriculum for the Advanced GI/MIS fellowship. SAGES leadership is actively adapting this curriculum. METHODS: The process of reform began in 2014 through a series of iterative meetings and discussions. A working group within the Resident and Fellow Training Committee reviewed case log data from 2012 to 2015...
January 17, 2018: Surgical Endoscopy
John Kuckelman, Riyad Karmy-Jones, Elizabeth Windell, Seth Izenberg, Jean-Stephane David, William Long, Matthew J Martin
BACKGROUND: Traumatic Rib Cage Hernias (TRCH) requiring operative repair are rare and there is currently no literature to guiding surgical management. METHODS: Perioperative review of TRCH over 32 years. Five operative grades were developed based on extent of tissue/bone damage, size, and location. RESULTS: Twenty-four patients (20 blunt, 4 penetrating) underwent operative repair. Lung was the herniated organ in 88% with a median of 4 rib fractures and average size of 60...
January 5, 2018: American Journal of Surgery
Paola Mendelsberg-Fishbein, Constanza García-Delgado, Linda B Muñoz-Martínez, Maura Robledo-Cayetano, Leonardo J Mejía-Marín, Luis E Martínez-Barrera, Mabel Cerrillo-Hinojosa, Verónica F Moran-Barroso
Pallister-Killian syndrome is caused by a tetrasomy 12p mosaicism and is characterized by facial dysmorphism, pigmentary skin anomalies, congenital heart defects, diaphragmatic hernia, epilepsy and mental retardation. The diagnosis is complex as the cytogenetic analysis in blood is usually normal, requiring karyotyping in other tissues, therefore the clinical suspicion is critical to guide the diagnostic tests and the patient requires an interdisciplinary clinical evaluation regarding the several manifestation of the syndrome...
February 1, 2018: Archivos Argentinos de Pediatría
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