Hernia recurrence as a problem of biology and collagen
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Abstract:
Usually an abdominal wall hernia is regarded as a mechanical problem with a local defect which has to be closed by technical means. Despite the introduction of several therapeutic improvements, recurrent hernias still appear in 10-15%. Therefore, reasons for a recurrence are discussed in a more fundamental way. It is assumed that a failure mainly depends on the quality of the repair. Correspondingly, in principle, the close causal relationship between the technical component and its failure during time is reflected by an s-shaped outcome curve. In contrast, the configuration of the outcome curve changes markedly if a breakdown is caused by numerous components. Then, the superposition of all incidence curves inevitably leads to a linear decline of the outcome curve without any s-shaped deformation. Regarding outcome curves after hernia repair, the cumulative incidences for recurrences of both incisional and inguinal hernia show a linear rise over years. Considering the configuration of outcome curves of patients with hernia disease, it may therefore be insufficient to explain a recurrence just by a failing technical repair. Rather, biological reasons should be suspected, such as a defective wound healing with impaired scarring process. Recent molecular-biological findings provide increasing evidence of underlying biochemical alterations in patients with recurrent hernia. Until predicting markers to identify patients with an impaired wound healing are available and considering the formation of insufficient scar as the underlying disease, the consequences for every surgical repair should be a supplementary reinforcement with nonabsorbable alloplastic nets as flat meshes with an extensive overlap.Keywords:
Hernia Repair
The author has developed and suggested a classification of hernias of the anterior abdominal wall. The new classification is grounded on observations over numerous clinical manifestations and peculiarities of the disease and subdivides these hernias according to the condition and shape of the hernia sac, localization, number and size of the hernias, time of the occurrence and incidence rate of the hernia following an operation, presence of concommitant diseases and the degree of disability of the patients.
Ventral hernia
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The objectives of abdominal hernial repair are to reconstruct the structural integrity of the abdominal wall while minimizing morbidity. Current techniques include primary closure, staged repair, and the use of prosthetic materials. Techniques for abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. By incorporating these aspects into hernial repairs, the procedures are made safer and the results are improved. The medical records were reviewed of 123 consecutive patients who underwent hernial repair. Seventy-six of these patients underwent a total of 82 herniorrhaphies using an abdominoplasty approach. This included using a transverse lower abdominal incision with or without extending it into an inverted-T incision. The hernial defect was then identified and isolated. Repair was obtained with primary fascial closure and plication, primary fascial approximation and reinforcement with absorbable Vicryl mesh, or placement of permanent mesh with or without fascial approximation. Overall, 8 of 82 hernias recurred. Most complications were minor and could be managed with local wound care only. Major complications included one enterocutaneous fistula, one occurrence of skin flap necrosis requiring operative debridement and skin grafting, and one delayed permanent mesh extrusion 2 years after repair. The abdominoplasty approach isolates the incision from the hernial defect and repair. This technique is safe with a low risk of complications and a low rate of recurrence. It is particularly helpful in obese patients, in patients with multiple hernias, and in those patients with recurrent hernias.
Abdominoplasty
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Abdominal hernia is the result of a defect in the supporting structures through which a contained organ or tissue may protrude [1]. Damage to the intercostal or upper lumbar nerves, which supply the abdominal wall musculature, may mimic a hernia by its appearance as an abdominal wall bulging. We describe four patients in whom abdominal wall bulging appeared after acquired denervation of the abdominal wall. In three of the cases, surgical repair of ` an abdominal hernia` was offered but deferred, and the ` bulge'' subsequently disappeared.
Intercostal nerves
Abdominal wall defect
Abdominal muscles
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A hernia is an abnormal protrusion of a viscus, part of it, or its coverings from the wall of the cavity containing it. There are many different types of abdominal wall hernias and they can occur in any age group. The most common hernia occurs in the groin and this article explores these in some depth. It is important for a GP to be able to recognise in all abdominal wall hernias, those that are beginning to develop, as well as those already causing complications, in order to adequately treat them. This article explains the pathophysiology of hernias, their complications and when to refer to secondary care.
Groin
Abdominal cavity
Abdominal Hernia
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Traumatic abdominal wall hernias are a type of acquired hernia secondary to blunt trauma Caused, by direct trauma from handlebar like objects. This rare hernia is named 'Handlebar hernia'. We report a case of such hernia without any significant intra-abdominal injury. The abdominal wall defect was repaired in layers by Jones technique. Postoperative course was uneventful. The authors recommend clinical suspicion for traumatic hernia in all patients with traumatic abdominal wall injury. Definitive treatment includes surgical exploration with primary repair of all tissue layers of the abdominal wall.
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Handlebar hernias are abdominal wall hernias resulting from direct trauma to the anterior abdominal wall. They usually result at weak anatomic locations of the abdominal wall. Such traumatic hernias are rare, requiring a high index of suspicion for a clinical diagnosis. We report the case of a handlebar hernia resulting from an injury sustained during a vehicular injury, and discuss the management of such injuries.
Abdominal Hernia
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OBJECTIVE To summarize the clinical effect of allogenic acellular dermal matrix in repair of abdominal wall hernia and defect. METHODS The clinical data were analyzed retrospectively from 31 patients with abdominal wall hernia and defect repaired by allogenic acellular dermal matrix between March 2007 and November 2009. There were 19 males and 12 females with an age range of 10-70 years (median, 42 years), including 6 abdominal wall defects caused by abdominal wall tumor resection, 4 patches infection after abdominal wall hernia repair using prosthetic mesh, 2 incisional hernia, 1 parastomal hernia, 1 recurrent parastomal hernia receiving mesh repair, 1 mesh infection caused by parastomal hernia repair using prosthetic patch, 3 mesh infection caused by tension free inguinal after hernia repair, and 13 inguinal hernia. There were 12 patients with contaminated or infectious wound. The disease duration was from 1 to 34 months (6 months on average). The defect size of abdominal wall ranged from 6 cm x 4 cm to 19 cm x 10 cm. Abdominal wall hernia or defect underwent repair using allogenic acellular dewall matrix. RESULTS Of the 31 patients, 29 patients recovered with primary wound healing. Chronic sinus tract occurred in 1 patient and the wound was cured by change dressing. Wound dehiscence and patch exposure occurred in 1 patient, and second healing was achieved after change dressing. All the 31 patients were followed up 6-36 months, no abdominal wall hernia or hernia recurrence occurred in other patients except 1 patient who had abdominal bulge. And no foreign body sensation or chronic pain in wound area occurred. CONCLUSION It is feasible and safe to use allergenic acellular dermal matrix patch for repair of abdominal wall hernia or soft tissue defect, especially in contaminated or infectious wound.
Seroma
Abdominal wall defect
Wound dehiscence
Hernia Repair
Abdominal Hernia
Surgical mesh
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Purpose. Animal models play an important role in abdominal wall hernia research. However, there is still no standard animal models for abdominal wall hernia. This study aimed to introduce a novel rabbit model of giant abdominal wall hernia. Methods. Sixteen 1-year-old New Zealand rabbits weighing 3 to 5 kg were used. After general anesthesia, a 5-cm longitudinal incision was made 2 cm lateral to the ventral midline, and a full-thickness laparotomy incision was made en bloc including the peritoneum (except skin). A full-thickness defect of the abdominal wall with a diameter of 3 cm was created. To increase the intraabdominal pressure, constipation was induced by deprivation of water perioperatively. The development of giant abdominal wall hernia was recorded. The bulge area of these rabbits was redissected to assess the hernia 3 months postoperatively. Results. Of the 16 rabbits, 13 (81.25%) rabbits had grade I healing and 3 (18.75%) rabbits had grade III healing. Reversible abdominal bulge at the incisional site was observed in all rabbits 3 to 18 days postoperatively. The average maximum diameter of the bulge was 8.73 ± 1.00 cm. Redissection of the bulge area showed successful establishment of giant abdominal wall hernia. Conclusion. We successfully established a rabbit model of giant abdominal wall hernia, which may provide an easy-to-use tool for the research of abdominal wall hernia.
Incisional Hernia
Abdominal Hernia
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Groin
Hernia Repair
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Objective:To evaluate the usefulness of multi-slice CT examination in the diagnosis of the abdominal wall hernias.Methods:The hernias of abdominal wall of 86 cases were all undergone multi-slice CT examination and proved by surgeons.Results:In 86 cases,there were the hernia of operative incision(n=19),the hernia of lineal alba(n=2),the ambilical hernia(n=8),the inguinal hernia(n=46),the hernia of medical opening of abdominal wall(n=6),the obturator hernia(n=3),three hernias in one case(n=2).Usually,the diameters of hernia of operative incision and medical opening of abdominal wall were larger than the else.In the same time,small bowel obstruction was found in 21 cases and one infection in the hernia of operative incision.Multi-slice could display the type,number,size,content and complication of the hernias.Conclusion:Multi-slice CT examination is helpful in the diagnosis of the abdominal wall hernias and plays an important role in hernia surgery.
Abdominal Hernia
Obturator hernia
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