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Bornemann-Kolatzki, Kirsten [Verfasser]. "Durchführung eines Genomscans mit polymorphen DNA-Markern und Genomic-Mismatch-Scanning (GMS) bei Sus scrofa zur Detektion Hernia inguinalis-scrotalis assoziierter Genomregionen / vorgelegt von Kirsten Bornemann-Kolatzki, geb. Bornemann." Wettenberg : VVB Laufersweiler, 2004. http://d-nb.info/97393736X/34.
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Arroyo, Torres Elmer Jesús. "Hernioplastia Lichtenstein en el Centro Médico Naval "CMST". Experiencia de 5 años." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2004. https://hdl.handle.net/20.500.12672/1887.
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Desde 1988 hasta la actualidad, la técnica de Lichtenstein (1) ha sido, sin duda ,la de mayor aceptación a nivel mundial; sin presentar hasta el momento un pico de descenso en su utilización y sin las complicaciones asociadas a las técnicas laparoscópicas que actualmente cobran muchos adeptos.
La técnica de Lichtenstein ha demostrado su eficacia al ser aplicable para todo tipo de hernias en el orificio miopectíneo de Fruchaud, similar principio utilizado en las hernioplastías laparoscópicas; pero con la ventaja de ser aplicable a todo tipo de hernias inguinales y reproducible en centros hospitalarios de formación quirúrgica (2), y no presentar complicaciones reporatadas y costos tan elevados con la laparoscópica (3)
En el Centro Médico Naval “CMST”, uno de los principales centros de referencia en el área quirúrgica en nuestro país, dicha técnica se viene reproduciendo desde hace más de 5 años, sin contar aún con un estudio retrospectivo que nos oriente hacia los beneficios obtenidos en comparación con las técnicas clásicas convencionales ni con las nuevas técnicas laparoscópicas de abordaje transabdominal (6,11,26,33) y extraperitoneal (3)
Los resultados recogidos en la bibliografía, tras reparación de una hernia inguinal primaria sin empleo de material protésico son variables, dependiendo de la técnica realizada,(3,8), así como de la experiencia del cirujano, con tasas de recidiva que oscilan entre 1% y el 10% (9,10,38). Se considera que la principal causa de estos resultados es la aproximación de tejidos bajo tensión. Por ello han surgido técnicas que incluyen la colocación de prótesis sintéticas (malla) (4,5,49,16) sobre el defecto, dentro de ellas está la técnica de Lichtenstein con baja tasa de recidiva (menor al 1%) (7). Sin embargo no previene ni trata a las hernias femorales (tipo III C), tampoco protege totalmente el área defectuosa principal (preperitoneal).Tesis de segunda especialidad
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Delgado, Quispe Johandi. "Comportamiento quirúrgico de las hernias de la región inguinal en el Hospital Nacional Arzobispo Loayza 2009 - 2011." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2012. https://hdl.handle.net/20.500.12672/12135.
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El documento digital no refiere asesorDescribe el comportamiento de las hernias inguinales, sus planteamientos y evolución en el manejo quirúrgico en los pacientes del servicio de cirugía general. HNAL 2009-.2011. La Herniorafia Inguinal, es una de las operaciones quirúrgicas que se realizan con más frecuencia en los Servicios de Cirugía General del Hospital Nacional Arzobispo Loayza cada año se realizan alrededor de 450 hernio rafias inguinales. Las hernias inguinales son las que presentan el mayor índice de recurrencia dentro de los dos primeros años de la intervención quirúrgica, más si la técnica realizada es con tensión, reduciendo de manera significativa con el empleo de material protésico, desarrollando técnicas sin tensión como las veremos más adelante.
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Beets, Geerard Lucien. "On the repair of inguinal hernia." [Maastricht ; Universiteit Maastricht] ; Maastricht : University Library, Maastricht University [Host], 1997. http://arno.unimaas.nl/show.cgi?fid=5831.
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Veen, Ruben Nico van. "New clinical concepts in inguinal hernia." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2008. http://hdl.handle.net/1765/11998.
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Page, Blaithin. "Chronic pain following inguinal hernia repair." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/2579/.
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Introduction: In the past five years chronic post herniorrhaphy pain has become the predominant post operative complication following the common procedure of inguinal hernia repair. However information regarding the precise aetiological factors of this chronic post surgical pain is lacking. To date no previous studies have assessed the long term outcome of patients who report chronic severe pain following inguinal hernia surgery. There are no studies assessing the presence of preoperative pain and the effect of surgical intervention on these pain scores. One factor thought to contribute to post herniorrhaphy chronic pain is the mesh type used by the surgeon. The characteristics of two different mesh types are evaluated with respect to postoperative chronic pain. Aims: The aim of the first study was to assess the outcome of patients who report severe or very severe pain three months after groin hernia repair. The aim of the second study was to quantify patients’ pain from their inguinal hernia prior to surgery and to examine the effect of surgery on this pain. The aim of the third study was to compare the composite partially absorbable and ultimately lighter weight (Vypro 11) mesh with an example of a conventional polyprolene mesh (Atrium) in a tension free repair of an inguinal hernia. Methods: One hundred and twenty five patients were identified as experiencing severe chronic pain at 3 months post herniorrhaphy, from the prospective National Hernia database1 of 5506 patients (97% of total) between 1 April 1998 and 31 march 1999. These 125 patients were assessed at 30 months post-surgery, with the use of the modified SF36 quality of life questionnaire. For the second study, consecutive patients referred for elective inguinal hernia repair between January 1998 and October 2000 completed visual analogue pain scores (VAS) pre- and 1 year post-repair. These patients were Western Infirmary patients who were part of a larger multicentre clinical trial comparing local versus general anaesthesia 2 for inguinal hernia repair. The third study examined patients who were involved in a multicentre trial comparing the incidence and severity of chronic pain following elective inguinal hernia repair, comparing the light weight or partially absorbable (PA) to the standard heavy weight or non-absorbable (NA) mesh. Results: In the first study, of the 125 patients who experienced severe chronic pain at three months post repair, at 30 months post-surgery 25% had persistent, unchanged chronic pain 45% had a reduction in pain to mild or very mild, and 29% were pain-free. In the 25% of patients that had persistence of severe chronic pain, the symptoms had a significant effect on all daily activities and quality of life, for example in measurement of general enjoyment of life, those with mild pain scored 2.32 (1.5-3.13) compared to 7.14 (5.97 - 8.30) in those with persistent severe pain (P<0.05) . In the second study 63% of patients completed VAS scores at follow-up. Prior to surgery the majority of patients had no pain or only mild pain at rest (80.5%) or on movement (58.8%). At 1 year follow-up the mean (SD) VAS score reduced by 2.9 (1.2) at rest, and reduced by 9.2 (1.8) on movement. However the majority of the beneficial effect was seen in those with moderate to high pre=operative pain scores. Those with preoperatively VAS score >10 had a reduction of 22.8 (3.7) at rest, compared to a slight increase in pain (+1.8) in those with no pain pre-operatively (P<0.05). Similar effects were seen on movement (improvement of 32.2 (4.8) in those with preoperative pain score >10, and little change in pain, -0.3 (1.6), in those with no, or only mild, preoperative pain (P<0.05). In the third study 162 patients received the PA mesh and 159 received the NA mesh. The PA mesh was not associated with less pain at 1 year postoperatively, compared to the NA mesh, with the proportion experiencing any pain being 39.5% in the PA group compared to 51.6% in the NA group (P=0.033). The proportion experiencing severe pain was similar, being 3% for the PA group and 4% for the NA group, and the recurrence rate was greater with the PA mesh compared to the NA mesh (4.9% versus 0.6%, P=0.037). Conclusion: Of those with chronic severe pain at 3 months post inguinal hernia repair, the majority will have still have some pain at 30 months post operatively. The greatest benefit in terms of pain reduction in patients undergoing inguinal hernia repair is experienced by those with the more severe preoperative pain. From our data there is no clear overall benefit in using the PA mesh over the standard mesh, as whilst pain scores were slightly lower in the PA group, this was countered by a higher recurrence rate. Further attention to the multiple factors that contribute to pain post-inguinal hernia repair is required, including the development of superior mesh technology.
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Vétu, Michel. "Traitement des hernies inguinales et recidives herniaires : à propos de 482 hernies." Montpellier 1, 1988. http://www.theses.fr/1988MON11174.
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Tardat, Eric. "Intérêt du traitement des hernies inguinales bilatérales en un seul temps et une seule voie." Bordeaux 2, 1992. http://www.theses.fr/1992BOR2M169.
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Andriani, Alexandre Ciro. "Estudo histológico do saco herniário de hérnias inguinais indiretas." Florianópolis, SC, 2000. http://repositorio.ufsc.br/xmlui/handle/123456789/78285.
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A musculatura lisa presente no saco herniário de hérnias inguinais do tipo indireta de pacientes adultos do sexo masculino foi estudada quanto a prevalência em seus três terços e a relação com o tempo, lado e tamanho da hérnia, bem como a idade do paciente e seu índice de massa corpórea, visando descobrir situações que tornem o saco herniário mais ou menos apto para sua utilização como reforço da parede posterior. Ocorreram diferenças histológicas significavas apenas em sacos herniários muito pequenos, que não apresentaram musculatura lisa. Concluímos que todos os sacos herniários de hérnias inguinais do tipo indireta podem ser utilizados no estudo da validade da técnica proposta por Lázaro da Silva.
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Alani, Ahmed M. "Management of asymptomatic inguinal hernias." Thesis, University of Glasgow, 2008. http://theses.gla.ac.uk/453/.
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Hernia surgery remains one of the most common operations carried out by general surgeons worldwide with more than 800,000 repairs performed in the USA alone in 2003. Advancement in surgical technique has meant fewer recurrences are now encountered with figures dropping to less than 2% using the laparoscopic approach. Yet despite the progress achieved in securing the repair, post operative pain remains an issue with many authors reporting figures of 30% in patients following groin hernia repair 1,2, 3% of patients report sever pain that limits their daily activities and renders them off work. Many patients with inguinal hernia have very little in the way of symptoms and even some of them are asymptomatic, having noticed their hernia by accident or by their general practitioner. In order to clarify two issues (the first being the incidence of acute hernia presentation, its management and subsequent outcome, while the second was the management of patients with an asymptomatic inguinal hernia) 4 studies were carried out: The first study was a prospective observational study looking at all patients presenting to our unit with an acute hernia, the aim of the study was to prospectively assess the presentation and management of acute hernias in light of recent changes in hernia management. Data on all patients admitted with an acute hernia between 2001 and 2004 was collected prospectively. During the 3 year study period 91 patients were admitted with an acute hernia. 46 had a previous medical assessment either as an acute admission (12) at a surgical clinic (22) or by a General Practitioner (12). Eighteen had been declared unfit for operation at that assessment, 10 were ASA4, 5 ASA3 and 3 ASA2. Eleven patients were on the waiting list for operation 3 of whom had a previous acute hospital admission. For 30 patients this hospital admission was the first indication that they had a hernia while the remainder refused operation or did not seek medical advice. Five patients died, 2 while being assessed for operation and 3 postoperatively, 3 were ASA4 while 2 were ASA3. The number of patients undergoing operation for an acute hernia amounted to 8.4% (80 of 952) of all hernia operations carried-out during the study period. This study concluded that despite advances in hernia surgery there was still room for improvement, to ensure that all suitable patients presenting with an acute hernia receive an operation during their acute hospital admission. The second study was a prospective study of all patients presenting with subacute bowel obstruction in one teaching hospital between 2003 and 2004. The aim of the study was to identify the most frequent causes of strangulation in patients presenting with small bowel obstruction. During the study one hundred and sixty-one patients with symptoms and signs of small bowel obstruction were admitted. Eighty-nine were confirmed with contrast studies. The male: female ratio was 1:1.6. The aetiology of obstruction was hernia in 29 (18%), adhesions in 97 patients (60.2%), and miscellaneous in 35 (21.8%) Operative procedures were performed on 74 patients (46%), 31 of them (42%) with adhesions, 25 (34%) with hernias and 18 (24%) due to other causes. Strangulated bowel occurred in 15 patients (9.3%); 12 had hernias whilst three had adhesions (P < 0.0001). Of the strangulated hernias, ten were femoral, one was inguinal and one was paraumbilical. Our conclusion was that whilst adhesions are the most common cause of small bowel obstruction, femoral and not inguinal hernias remain the most frequent cause of strangulation. The third and main study was a prospective randomized trial comparing surgery and no intervention for asymptomatic inguinal hernias. The aim of the study was to compare operation with a wait and see policy in patients with an asymptomatic hernia. 160 male patients 55 years or older were randomly assigned to observation or operation. Patients were assessed clinically and sent questionnaires at 6 months and 1 year. The primary endpoint was pain and general health status at 12 months; other outcome measures included costs to the health service and the rate of operation for a new symptom or complication. At 12 months there were no significant differences between the randomised groups of observation or operation, in visual analogue pain scores at rest, 3.7mm versus 5.2mm (P=0.34), or on moving, 7.6mm versus 5.7mm (P=0.39). Also the number of patients who recorded pain on moving 29 versus 24 (P=0.31), and the number taking regular analgesia, 9 versus 17, (P=0.14) was similar. At 6 months there were significant improvements in most of the dimensions of the SF-36 for the operation group, while at 12 months although the trend remained the same the differences were only significant for change in health (P=0.039). The rate of crossover from observation to operation was 23 patients at a median follow-up of 574 days, this was higher than predicted. The observation group also suffered 3 serious hernia related adverse events compared to none in the operation group. Finally a sub study was generated from the non randomised patients within the asymptomatic trial. The aim here was to assess the outcome of patients opting for no surgery in terms of need for surgery and outcome. There were 72 patients (58 opting for observation and 14 wanting an operation), 13 patients (22.4%) in the observation group became symptomatic and required an operation, 9 patients had died at the time of data analysis, all of which were due to co morbid illnesses. The final 2 studies concluded that repair of an asymptomatic inguinal hernia did not affect the rate of long-term chronic pain and might be beneficial to patients in improving overall health and reducing potentially serious morbidity.
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Furtado, Marcelo Lopes. "Análise retrospectiva de casuística de hernioplastia inguinal videolaparoscópica TAPP /." Botucatu, 2015. http://hdl.handle.net/11449/139336.
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Orientador: Rogérioa Saad HossneCoorientador: Alexandre Bakonyi Neto
Banca: Nelson Ary Brandalise
Banca: Sérgio Roll
Banca: Fábio Guilherme Caserta Maryssael de Campos
Banca: Carlos Eduardo Jacob
Resumo: Introdução: A hérnia inguinal é a forma mais frequente das hérnias da parede abdominal e o seu reparo cirúrgico, depois da apendicectomia, é a cirurgia mais realizada pelo cirurgião geral. Estima-se que são realizadas cerca de 20 milhões de operações/ano no mundo. As técnicas mais modernas de reparo da hérnia inguinal buscam melhorar a qualidade de vida dos seus portadores, diminuindo as taxas de recidiva e dor crônica, por meio de prótese sem tensão. O desenvolvimento da laparoscopia nas últimas duas décadas, resgatou a importância da hérnia inguinal e seu tratamento para o cirurgião geral. O objetivo deste estudo foi analisar a casuística de 829 hernioplastias inguinais pela técnica Transabdominal (TAPP) e compara-la aos resultados da literatura enfatizando-se a dor crônica, taxa de recidiva e complicações. Método: Estudo retrospectivo de 616 pacientes submetidos à hernioplastia inguinal laparoscópica pela técnica Transabdominal Pré-Peritonial (TAPP) pelo mesmo cirurgião, em hospital privado, durante o período entre junho de 1996 e junho de 2010. Todos os pacientes foram reavaliados no décimo e trigésimo dia de pós operatório e seguidos tardiamente com 6, 12 e 24 meses. Resultados: O sexo predominante foi o masculino com 575 (93,3%) pacientes e a idade variou entre 19 e 78 anos, com média de 48,0 anos. As hérnias diretas foram as mais frequentes com 44,6% dos casos. Cento e quarenta e uma (22,9%) operações foram realizadas em hérnias recidivadas. A taxa global de complicações per e pós operatórias foi de 0,8% e 5,5%, respectivamente. Conversão para inguinotomia foi necessária em 2 casos (0,32%) e a recidiva ocorreu em 4 pacientes (0,65%). Conclusões: A técnica laparoscópica TAPP mostrou-se segura e eficiente no tratamento da hérnia inguinal no adulto, com alto índice de satisfação dos pacientes. Apresentou baixa morbidade e complicações gerais, tanto em número quanto em gravidade. A...
Abstract: Introduction: The inguinal hernia is the most common form of hernias of the abdominal wall and its surgical repair, after appendectomy, is the most performed surgery by the General Surgeon. It is estimated that are held about 20 million operations/year in the world. The modern techniques of inguinal hernia repair seek to improve the quality of life of patients, decreasing the rates of recurrence and chronic pain through tension-free prosthesis repair. The development of laparoscopy in the last two decades, rescued the importance of inguinal hernia and its treatment to the General Surgeon. The aim of this study was to analyze 829 cases of Transabdominal Pre peritoneal inguinal hernia repair (TAPP) and compare it to the results of the literature emphasizing chronic pain, complications and recurrence rate. Method: retrospective study of 616 patients undergoing laparoscopic inguinal hernia repair by TAPP by the same surgeon in private hospital, during the period between June 1996 and June 2010. All patients were reassessed on the 10th and 30th day of post-operative and followed later with 6, 12 and 24 months. Results: the predominant sex was male with 575 (93.3%) and the patients age ranged between 19 and 78 years, averaging 48.0 years. Direct hernias were the most frequent with 44.6% cases. One hundred and fortyone (22.9%) operations were carried out in recurrence hernias. The overall rate of per and postoperative complications was 0.8% and 5.5%, respectively. Conversion to open repair was needed in 2 cases(0.32%) and the recurrence occurred in 4 patients (0.65%). Conclusions: the laparoscopic technique TAPP was shown to be safe and effective in the treatment of inguinal hernia in adults with high level of patient satisfaction. Presented low morbidity and general complications, in number and severity. The minimum rate of recurrence appear, compares favorably to TAPP with other prosthetic tension free techniques, and should be incorporated ...
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Furtado, Marcelo Lopes [UNESP]. "Análise retrospectiva de casuística de hernioplastia inguinal videolaparoscópica TAPP." Universidade Estadual Paulista (UNESP), 2015. http://hdl.handle.net/11449/139336.
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000864051.pdf: 1498230 bytes, checksum: 23a49e1e9660269281dc1518ec7a0aa0 (MD5)Introdução: A hérnia inguinal é a forma mais frequente das hérnias da parede abdominal e o seu reparo cirúrgico, depois da apendicectomia, é a cirurgia mais realizada pelo cirurgião geral. Estima-se que são realizadas cerca de 20 milhões de operações/ano no mundo. As técnicas mais modernas de reparo da hérnia inguinal buscam melhorar a qualidade de vida dos seus portadores, diminuindo as taxas de recidiva e dor crônica, por meio de prótese sem tensão. O desenvolvimento da laparoscopia nas últimas duas décadas, resgatou a importância da hérnia inguinal e seu tratamento para o cirurgião geral. O objetivo deste estudo foi analisar a casuística de 829 hernioplastias inguinais pela técnica Transabdominal (TAPP) e compara-la aos resultados da literatura enfatizando-se a dor crônica, taxa de recidiva e complicações. Método: Estudo retrospectivo de 616 pacientes submetidos à hernioplastia inguinal laparoscópica pela técnica Transabdominal Pré-Peritonial (TAPP) pelo mesmo cirurgião, em hospital privado, durante o período entre junho de 1996 e junho de 2010. Todos os pacientes foram reavaliados no décimo e trigésimo dia de pós operatório e seguidos tardiamente com 6, 12 e 24 meses. Resultados: O sexo predominante foi o masculino com 575 (93,3%) pacientes e a idade variou entre 19 e 78 anos, com média de 48,0 anos. As hérnias diretas foram as mais frequentes com 44,6% dos casos. Cento e quarenta e uma (22,9%) operações foram realizadas em hérnias recidivadas. A taxa global de complicações per e pós operatórias foi de 0,8% e 5,5%, respectivamente. Conversão para inguinotomia foi necessária em 2 casos (0,32%) e a recidiva ocorreu em 4 pacientes (0,65%). Conclusões: A técnica laparoscópica TAPP mostrou-se segura e eficiente no tratamento da hérnia inguinal no adulto, com alto índice de satisfação dos pacientes. Apresentou baixa morbidade e complicações gerais, tanto em número quanto em gravidade. A...
Introduction: The inguinal hernia is the most common form of hernias of the abdominal wall and its surgical repair, after appendectomy, is the most performed surgery by the General Surgeon. It is estimated that are held about 20 million operations/year in the world. The modern techniques of inguinal hernia repair seek to improve the quality of life of patients, decreasing the rates of recurrence and chronic pain through tension-free prosthesis repair. The development of laparoscopy in the last two decades, rescued the importance of inguinal hernia and its treatment to the General Surgeon. The aim of this study was to analyze 829 cases of Transabdominal Pre peritoneal inguinal hernia repair (TAPP) and compare it to the results of the literature emphasizing chronic pain, complications and recurrence rate. Method: retrospective study of 616 patients undergoing laparoscopic inguinal hernia repair by TAPP by the same surgeon in private hospital, during the period between June 1996 and June 2010. All patients were reassessed on the 10th and 30th day of post-operative and followed later with 6, 12 and 24 months. Results: the predominant sex was male with 575 (93.3%) and the patients age ranged between 19 and 78 years, averaging 48.0 years. Direct hernias were the most frequent with 44.6% cases. One hundred and fortyone (22.9%) operations were carried out in recurrence hernias. The overall rate of per and postoperative complications was 0.8% and 5.5%, respectively. Conversion to open repair was needed in 2 cases(0.32%) and the recurrence occurred in 4 patients (0.65%). Conclusions: the laparoscopic technique TAPP was shown to be safe and effective in the treatment of inguinal hernia in adults with high level of patient satisfaction. Presented low morbidity and general complications, in number and severity. The minimum rate of recurrence appear, compares favorably to TAPP with other prosthetic tension free techniques, and should be incorporated ...
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Bringman, Sven. "Minimally invasive hernia surgery /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-466-6/.
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Lau, Hung. "Endoscopic totally extraperitoneal inguinal hernioplasty : techniques and advances for optimal outcome." Click to view the E-thesis via HKUTO, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36425242.
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Decadt, Bart. "Evidence-based laparoscopic surgery." Thesis, University of East Anglia, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268504.
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Wright, David M. "Clinical studies comparing laparoscopic and open inguinal hernia repair." Thesis, University of Glasgow, 2001. http://theses.gla.ac.uk/5401/.
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Twenty-seven consultants from the UK and Ireland contributed 928 patients to a multicentre randomised trial to compare laparoscopic hernia repair with currently used open repairs. The laparoscopic group developed less wound haematomas (7.6% vs. 15.7%; 99% CI: -14.3 to -2.0), but there was no difference in the incidence of wound infection or general complications such as urinary retention. The laparoscopic group reported lower levels of post-operative pain and this was reflected in significantly better 'Short Form 36' functional scores at one week. By one month the only significant difference between groups was a better score for physical function in the laparoscopic group, and by three months there was no significant difference in any of the 'Short Form 36' domains. The early functional advantages for the laparoscopic repair were reflected in an earlier return to normal activities (10 days vs. 14 days; p<0.01) and work (28 days vs. 42 days; p=0.001). A simulator was constructed to measure the ability to perform an emergency stop following totally extraperitoneal or open prosthetic inguinal hernia repaid. Measurements were made pre-operatively and at one, three and six days post-operatively. The laparoscopic group did not demonstrate any increase in reaction times following hernia repair. The open group had significantly prolonged reaction times on days one and three, but had returned to pre-operative levels by day six. Therefore, laparoscopic repair does not impair driver reaction times, and open prosthetic repair appears to allow an earlier return to driving than the ten days previously recommended for open sutured repair.
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Magnusson, Niklas. "Postoperative aspects of inguinal hernia surgery : pain and recurrences." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-26054.
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Approximately one in four men will have surgery for ingunial hernia in their lifetime. In Sweden, 16 000 procedures are performed each year. To investigate the possible link between handling of nerves and sensory disturbance, 97 groins in 92 patients were examined one year after inguinal hernia surgery. Sensory disturbances were found to be common after open surgery (29 %), but were not seen after the laparoscopic procedures. No significant relationship between sensory disturbance and handling of nerves or pain was seen. The risk for recurrence has been significantly reduced due to the use of prosthetic meshes, but continued surveillance of this important outcome will always be necessary. In that context, the time frame in which recurrence develops in relation to possible risk factors can help our understanding of the underlying mechanisms. To explore such temporal relationships, 142,578 patients were included in a register study. A relative over-risk for early recurrence was seen after suture repair, laparoscopic repair, after postoperative complications, and after surgery for previous recurrence. Corticosteroids are known to decrease pain and nausea after several surgical procedures. In a randomised trial on open hernia surgery, 398 patients were randomised to treatment with 12 mg of betamethasone or placebo. Decreased levels of pain were seen on the day of surgery, the next day and after one month. No difference was seen on days 2-7 and after one year. Nausea was not common and did not differ between the groups. Reoperation is sometimes performed to correct a presumed structural defect thought to cause the long-term pain. In order to evaluate the result of such treatment, 111 cases were analysed based on register data, questionnaires and medical records. Sixty-two per-cent of the patients reported an improvement compared to before the reoperation, but a high level of pain remaining (42 %), and impaired quality of life was seen. There was no clear advantage for any surgical intervention over the other.
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Boulet-Cantet, Guillemette. "Aspect échographique des hernies externes du pli de l'aine." Montpellier 1, 2000. http://www.theses.fr/2000MON11065.
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BUGNON, BOULENGER PASCALE. "Le traitement chirurgical des hernies inguinales de l'adulte : a propos de 1025 patients operes entre 1970 et 1981." Lille 2, 1988. http://www.theses.fr/1988LIL2M181.
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Spagnolo, Julio David. "Avaliação do implante de pericárdio homólogo no recobrimento de anel vaginal de equino por laparoscopia." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-11012012-144518/.
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As hérnias inguino-escrotais afetam principalmente equinos machos, sendo caracterizadas como diretas ou indiretas e congênitas ou adquiridas. O emprego da laparoscopia para o fechamento do anel vaginal permite a fixação de implantes e retalhos peritoneais para recobrir a entrada do canal inguinal. As membranas biológicas empregadas como enxerto tecidual apresentam vantagens como baixo custo, fácil armazenamento, pouca reação tecidual, boa incorporação, elasticidade e resistência. Este estudo teve como objetivo avaliar a fixação e a presença do implante de pericárdio homólogo em anel vaginal de equino, realizado por sutura laparoscópica mecânica ou manual por um período de 11 semanas. Neste estudo foram utilizados seis equinos, machos inteiros, da raça Mangalarga, entre três e 12 anos, submetidos à anestesia inalatória, posicionados em Trendelenburg com elevação de 25 º da porção pélvica. Foram criados cinco portais, sendo um na cicatriz umbilical para entrada do laparoscópio e dois portais em cada hemi-abdômem, para acesso dos instrumentais. Em cada animal fixaram-se dois implantes de pericárdio, com medidas de 4 x 5 cm. Em um dos anéis a fixação foi realizada através de sutura manual e no contralateral por sutura mecânica. Avaliou-se o tempo cirúrgico, eventuais complicações, custo, eficiência, processo inflamatório e cicatrização. O tempo necessário para a realização da sutura manual em padrão contínuo simples foi em média 4,7 vezes maior (P > 0,05) que na sutura mecânica, apesar do tempo de sutura manual corresponder a apenas 40% do tempo total do procedimento. Porém, a sutura manual apresentou melhor ancoragem e estabilidade do implante quando comparado com a fixação mecânica. A fixação com endogrampeador aumentou em 50 % o custo total do procedimento quando comparado à sutura manual. Na avaliação macroscópica todos os implantes foram recobertos por tecido cicatricial, apresentando coloração esbranquiçada, difícil delimitação das margens e incorporação do implante pelo peritônio parietal. Os seis implantes fixados com sutura manual permaneceram no local, com boa oclusão do anel vaginal, sendo que em dois foi visualizada, aderência de epíplon e em outro uma sinéquia entre a cicatriz inguinal e o colón maior. Em dois dos seis implantes fixados por sutura mecânica ocorreu deiscência parcial, ocasionando migração de uma das margens e oclusão incompleta do anel vaginal. Uma aderência de epíplon foi observada no implante fixado por grampeamento. O líquido peritoneal no pós-operatório apresentou coloração avermelhada, aspecto turvo e alta celularidade, com diferença significativa (P >0,05), sendo basicamente neutrófilos. Essas alterações diminuíram gradativamente até a quarta semana quando os valores apresentaram-se normais para a espécie. Na avaliação histológica os implantes fixados pelos dois tipos de sutura apresentaram alterações similares, sendo identificado tecido cicatricial em fase de remodelação com moderado infiltrado de células mononucleares, apresentando discreta neovascularização e intensa fibroplasia. O uso de pericárdio homólogo para recobrimento do anel vaginal de equino, fixado através de sutura laparoscópica, manual ou mecânica, proporcionou oclusão satisfatória do anel vaginal, com vantagem para o uso de sutura manual quanto à fixação e custo e para a sutura mecânica quanto ao tempo operatório.The inguinal hernias affect mainly equine males, being classified as direct or indirect and congenital or acquired. The use of laparoscopy for vaginal ring closure allows the fixation of implants and peritoneal flaps to recover the vaginal canal. The biological membranes employed like flap tissue present advantages such as low cost, easy storage, mild reaction tissue, complete incorporation, elasticity and resistance. The aim of this study was to evaluate the homologous pericardium implanted at equine vaginal ring, carried out by mechanical or manual laparoscopic suture during and after a period of 11 weeks. Six males Mangalarga breed horses between three and 12 years old were used. They underwent general anesthesia, positioned in Trendelenburg with elevation of 25 º of the pelvic region. Five laparoscopic portals were created, one being in the umbilical scar for the entry of the laparoscope and two in each hemi-abdomen for access of the laparoscopic instruments. On each horse two pericardium implants measuring 4 x 5 cm were attached at the vaginal ring regions. In one of the rings the fixation was carried out through manual suture and the contra lateral using mechanical suture. The surgical time, complications, costs, efficiency, inflammatory response and healing were evaluated. The time to carry out the manual suture was 4,7 times longer (P> 0,05) than the mechanical suture. The time for manual suture execution was 40 % of the total time spent for the surgical and anesthetic procedures. However, the manual suture presented better anchorage and stability of the implant when compared with the mechanical fixation. The fixation with intracorporeal staples increased the total cost of the procedure in 50 % when compared to the manual suture. All the implants were covered and incorporated by scar tissue presenting whitish color, without graft definition. Six implants attached by manual suture remained at the place with adequate occlusion of the vaginal ring, and in two of them epiplon adhesions was visualized and in other one a synechia was identified between the inguinal scar and the large colon. In two of six implants attached by mechanical suture, partial dehiscence was occurred, as a result of implant migration and incomplete occlusion of the vaginal ring. An epiplon adhesion was observed in the implant attached by intracorporeal staple. The peritoneal fluid presented changes in color (reddish), aspect (turbidity) and cellularity with significant difference (P> 0, 05), being basically neutrophils. These changes reduced gradually up to the normal values at the fourth week. In the histological evaluation of the implants attached using both types of sutures the aspects were similar presenting healing in remodeling phase with moderate mononuclear cells infiltration, mild neovascularization and intense fibroplasia. The use of homologous pericardium for equine vaginal ring covering, attached by laparoscopic suture, manual or mechanical, provided satisfactory occlusion of the vaginal ring with advantage for the manual suture relative to efficiency and cost and for the mechanical suture relative to reduced surgical time.
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DELAUNAY, CULIERE FRANCOISE. "Chirurgie ambulatoire des hernies de l'aine de l'adulte : a propos de 200 observations." Nice, 1994. http://www.theses.fr/1994NICE6559.
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PARIGI, HERVE. "Les hernies de l'aine de l'adulte : traitement chirurgical par prothese de dacron : a propos de 397 observations." Lille 2, 1988. http://www.theses.fr/1988LIL2M295.
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Lau, Hung, and 劉雄. "Endoscopic totally extraperitoneal inguinal hernioplasty: techniquesand advances for optimal outcome." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B36425242.
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Alcantara, Torres Victor Manuel. "“COMPLICACIONES POSTQUIRURGICAS EN CIRUGIA DE HERNIA INGUINAL, HOSPITAL GENERAL DE IXTLAHUACA, ISEM, 2012”." Tesis de Licenciatura, Medicina-Quimica, 2013. http://hdl.handle.net/20.500.11799/14264.
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Dahlstrand, Ursula. "Femoral and Inguinal Hernia : How to Minimize Adverse Outcomes Following Repair." Doctoral thesis, Uppsala universitet, Kolorektalkirurgi, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-162203.
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Groin hernia is common, and each year 200 repairs per 100 000 adult inhabitants are performed in Sweden. Groin hernias are either inguinal or femoral (2-4%). Elective repair is not associated with an excess mortality, but adverse outcomes include recurrence and long-term pain. Emergency procedures have a 4% mortality rate with an increased risk for bowel resection and postoperative complications. The aim of this thesis was to identify risk factors for adverse outcomes and to propose measures to improve groin hernia treatment. Twenty-three per cent of female hernias were femoral. Thirty-six per cent of femoral hernias, and 5% of inguinal hernias, have emergency procedures. Females (OR 1.47) and patients above 65 years-of-age (OR 2.24) were at higher risk for emergency repair. Bowel resection was performed in 23% of emergency femoral repairs, and the 30-day mortality was 10 times that of an age- and gender-matched population. The majority of emergency patients were unaware of their hernia, and one third had previously had no groin symptoms. Femoral repairs were at larger risk for recurrence than inguinal repairs. The surgical techniques with least risk for recurrence were preperitoneal mesh repairs (open HR 0.28, and laparoscopic HR 0.31). Long-term pain was present in 24% of femoral hernia patients, of whom 5.5% described pain interfering with daily activities. The only factor predicting the risk for long-term pain was pain preoperatively. Pain decreased with time. In a randomized study on inguinal hernia, TEP resulted in less pain six weeks after surgery than Lichtenstein repair performed under local anesthesia (LLA). TEP patients were to a larger extent able to perform sporting activities. No difference was seen in intra-operative complications. Femoral hernias should be given high priority for repair and preperitoneal techniques should be used. Earlier diagnosis, in the elective setting, is probably difficult to attain. Heightened awareness in the emergency department is required. TEP is safe, and results in less pain than LLA six weeks after surgery. A widening of indications for TEP in primary inguinal hernia repair is justifiable.
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Fortuny, Anguera Gerard. "Dynamical Analysis of Lower Abdominal Wall in the Human Inguinal Hernia." Doctoral thesis, Universitat Politècnica de Catalunya, 2009. http://hdl.handle.net/10803/6697.
Full textAbstract:
En aquesta tesi es construeix un simulador numèric de la paret abdominal inferior, per tal de determinar la gènesis i les causes de les hernies inguinal humanes. Així, un model amb dades reals d'aquesta regió del cos humà (correctament discretitzades) ens permetrà reproduir les propietats dinàmiques de diferents elements de la regió permetent la simulació de la hernia en el moment que te lloc.La simulació muscular en general, ha tingut un paper secundari en la simulació numèrica, ja que en ocasions sols han interessat les propietats genèriques del múscul (per això es considera el múscul com un sol element) i no en un estudi detallat de les parts del múscul. El camp on la simulació ha estat més productiva ha estat la simulació cardíaca, a causa del constant interès en la creació de models del múscul cardíac i es per aquest motiu que sols es troben models detallats en aquest cas.
La contracció de la fibra muscular va ser simulada fen servir el model reològic de Hill-Maxwell presentat per en J.
Bestel en el que es regula la contracció muscular amb una funció de potencial d'activació u(t). Aquest model és el primer model dinàmic en dimensió u a nivell microscòpic de la contracció muscular.
Actualment, existeixen moltes conjectures sobre les causes de les hèrnies, malgrat tot, no ha estat possible un estudi detallat sobre l'origen de les hèrnies. Per altra banda, és impossible captar el moment en que es genera una hèrnia, i per altra banda hi ha una carència de model prou detallats de la contracció muscular.
En aquesta tesi es presenta un estudi dinàmic de la paret abdominal inferior amb els elements actius (els músculs) i els elements passius (fàscies, lligaments i altres teixits), és per això que es pot dur a terme un estudi amb varis aspectes físics i químics que intervenen a la gènesis de les hernies. El model reprodueix la dinàmica real del àrea tal i com A. Keith i W.J. Lytle varen conjecturar als inicis del segle passat i que són usualment acceptats per la comunitat de cirurgians.
Aquest és el primer model que reprodueix la dinàmica real de la regió inguinal, prova la existència de dos mecanismes de defensa (el mecanisme de persiana i el mecanisme de esfínter a l'anell inguinal). Amb aquest model de contracció muscular podem estudiar diversos paràmetres que tenen un paper important a la gènesis de les hernies inguinals i podem dur a terme un estudi més detallat sobre els elements de risc. Aquests paràmetres ( el mòdul de Young, el coeficient de Poison o la pressió intraabdominal, per exemple) tenen un efecte hipotètic no provat en la gènesis de les hèrnies. Aquest treball, avalua l'efecte real de diversos paràmetres al model lineal i proposa una simulació no lineals per la simulació muscular.
ABSTRACT
This PhD thesis aims to build a numerical simulator of the inferior abdominal wall, in order to determine the genesis and causes of the inguinal hernia. Thus, a model with real data on the region of human body (properly discretized) has been built that reproduces the dynamic properties of the various elements of the region allowing the simulation of the moment at which the hernia occurs.
Muscular simulation in general, has became a secondary subjec regarding numerical simulation, because on many occasions the interest has been concentrated in the general properties of the muscle (so that the muscle is considered a single element) and not in a detailed study of each of the parts of the muscle. The field where simulation has possibly been more productive is the cardiac simulation because of the constant interest in creating models of the cardiac muscle and it is for this reason that the only detailed models that exist are those related to the cardiac muscle.
The muscular fibre contraction was simulated using the Hill-Maxwell rehologic model presented by J. Bestel which it regulates the contraction and recovery by means of potential activation function u(t). This model is the first dynamic model in dimension one of a microscopic muscle level.
Currently, there is much varying conjecture regarding the causes of hernias, despite this however, a detailed study of their genesis, has not been possible. This is because on the one hand, it is impossible to catch the moment in which a hernia is generated, and, on the other, there is a lack of sufficiently detailed models of the muscles involved.
We present a dynamic model of the inferior abdominal wall with the active elements (the muscles) and the passive elements (fascias, ligaments and other tissues), so that a study can be made of the various physical and chemical aspects that generate hernias. The model reproduces the real dynamic of the area, as A. Keith and W.J. Lytle conjectured at the beginning of the past century and commonly accepted by surgery community.
This is the first model which reproduces the real dynamic in the inguinal area, so that we can prove the existence of the two defence mechanisms (the shutter mechanism and the sphincter mechanism in the inguinal ring). With this muscular contraction model we can study several parameters that it have an important role in the inguinal hernia genesis and we can do an accurate study about risk elements in the hernia inguinal. This parameters (Young's modulus, Poison's coefficient or intraabdominal pressure, for instance) have an hypothetical and no proved effect in the genesis of inguinal hernias. This work, evaluate the real effect of several parameters in the lineal model and propose a non linear model for the muscular simulation.
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Lau, Hung, and 劉雄. "Inguinal hernia repair: the impact of ambulatory and minimal access surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B25257614.
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Lau, Hung. "Inguinal hernia repair : the impact of ambulatory and minimal access surgery." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25257614.
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Combes, Laurent. "Traitement chirurgical des hernies de l'aine par prothese parietale mediane : a propos de 327 cas." Bordeaux 2, 1988. http://www.theses.fr/1988BOR25266.
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RAMGULAM, SHYAM. "Les hernies inguinales de l'adulte et leur traitement selon la technique de shouldice." Lyon 1, 1990. http://www.theses.fr/1990LYO1M426.
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Bouchard, Eric. "Meralgie iatrogene apres cure de hernie inguinale : a propos de deux cas." Reims, 1989. http://www.theses.fr/1989REIMM067.
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CAHEN, JEAN. "Traitement prothetique des hernies de l'aine par voie horizontalisee de pfannenstiel : description d'une technique originale a propos de 157 patients." Amiens, 1994. http://www.theses.fr/1994AMIEM078.
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Eklund, Arne. "Laparoscopic or Open Inguinal Hernia Repair - Which is Best for the Patient?" Doctoral thesis, Uppsala universitet, Centrum för klinisk forskning, Västerås, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-107630.
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Inguinal hernia repair is the most common operation in general surgery. Its main challenge is to achieve low recurrence rates. With the introduction of mesh implants, first in open and later in laparoscopic repair, recurrence rates have decreased substantially. Therefore, the focus has been shifted from clinical outcome, such as recurrence, towards patient-experienced endpoints, such as chronic pain. In order to compare the results of open and laparoscopic hernia repair, a randomised multicentre trial - the Swedish Multicentre trial of Inguinal hernia repair by Laparoscopy (SMIL) - was designed by a study group from 11 hospitals. Between November 1996 and August 2000, 1512 men aged 30-70 years with a primary inguinal hernia were randomised to either laparoscopic (TEP, Totally ExtraPeritoneal) or open (Lichtenstein) repair. The primary endpoint was recurrence at five years. Secondary endpoints were short-term results, frequency of chronic pain and a cost analysis including complications and recurrences up to five years after surgery. In total, 1370 patients, 665 in the TEP and 705 in the Lichtenstein group, underwent operation. With 94% of operated patients available for follow-up after 5.1 years, the recurrence rate was 3.5% in the TEP and 1.2% in the Lichtenstein group. Postoperative pain was lower in the TEP group up to 12 weeks after operation, resulting in five days less sick leave and 11 days shorter time to full recovery. Patients in the TEP group had a slightly increased risk of major complications. Chronic pain was reported by 9-11% of patients in the TEP and 19-25% in the Lichtenstein group at the different follow-up points. Hospital costs for TEP were higher than for Lichtenstein, while community costs were lower due to shorter sick leave. By avoiding disposable laparoscopic equipment, the cost for TEP would be almost equal compared with Lichtenstein. In conclusion, both TEP and Lichtenstein repair have advantages and disadvantages for the patient. Depending on local resources and expertise both methods can be used and recommended for primary inguinal hernia repair.
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Dal, Gobbo Bruno. "Cure par plaque preperitoneale des recidives et des hernies bilaterales de l'aine : serie homogene de 142 cas." Lyon 1, 1993. http://www.theses.fr/1993LYO1M076.
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BUTTY, PICELLI LILIANE. "Utilisation d'un fil de polytetrafluoroethylene dans la cure de hernie inguinale par la technique de shouldice." Lyon 1, 1992. http://www.theses.fr/1992LYO1M320.
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HAIKAL, SLEYMAN. "La technique de shouldice dans le traitement des hernies inguinales : a propos de 105 cas operes a l'hopital de dunkerque, resultats preliminaires." Lille 2, 1988. http://www.theses.fr/1988LIL2M313.
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Fränneby, Ulf. "Patient-orientated aspects of the postoperative course after hernia surgery /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-810-X/.
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Barcelos, Neto Heitor Sebastião de 1959. "Tratamento das hernias inguinais primarias diretas ou mistas : estudo prospectivo comparativo, entre as tecnicas de Shouldicc e McVay. Analise de resultados." [s.n.], 1993. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310600.
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Orientador : Luiz Sergio LeonardiDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A hérnia inguinal tem alta prevalência na humanidade, atingindo todas as faixas etárias e é urna doença de tratamento eminentemente cirúrgico. A partir de um protocolo pré-estabelecido, foi realizado um estudo prospectivo para o tratamento de hérnias inguinais primárias com componente direto presente através de duas técnicas cirúrgicas Shouldice e McVay, e com avaliações através do exame físico, e com seguimento mínimo de dois anos. Durante um período de dois anos, 109 pacientes do sexo masculino (86 com hérnias diretas e 23 com hérnias mistas), foram operados pela equipe de cirurgia do Hospital Municipal de Paulínia, previamente preparada para este fim. Os pacientes receberam preparo ambulatorial, não sendo encaminhados a cirurgia antes de terem suas doenças de base controladas clinica ou cirurgicamente. Foram avaliados quanto a eficácia da utilização da anestesia local para este tipo de cirurgia, que mostrou ser superior aos outros tipos de anestesia, tanto no tempo de internação corno na deambulação e nas taxas de complicações pós-operatórias. Na comparação pós-operatória das duas técnicas cirúrgicas, Shouldice e McVay, não houve diferença estatística significativa entre elas, porém as recidivas só apareceram neste período de observação nos pacientes operados pela técnica de Mc Vay, assim como, numericamente houve mais casos de pacientes com dor no pós operatório (precoce e tardio) nos operados sob esta técnica, enquanto o único paciente que desenvolveu atrofia testicular, havia sido operado pela técnica de Shouldice
Abstract: The inguinal hemia presents high prevalence on humanity, involving all age groups and it is a disease wihich treatment is prominently surgical. From a pre-established protocol on, a prospective study was carried out for the treatment of primary inguinal hemias with direct component through two surgical techniques: Shouldice and McVay, and with evaluations through physical examination, and with folIow-up at a least two years. In a period of two years, 109 patients, males (86 with direct hemias and 23 with mixed hemias) were operated by the surgery staff of Paulinia City Hospital, that was welltrained previously. All patientes were submitted to an ambulatorial preparation and they were not indicatde for surgery procedure before having their primary diseases clinically or surgically controlled. The efficacy of the use of a local anesthesia for this type of surgery that showed to be superior to other types, even in admission time as in digression and lates of postoperative complications. In the postoperative comparison between both surgicaI techniques, Shouldice and McVay, there was no significative statistical difference between them, otherwise the receurrence appeared in the period of observation only in patients submitted to Mc Vay surgicaI technique, such as mummericaly tere were more cases of patients with postooperative pain (early and laty) in patients submitted to this same technique, while the only patient that presented testicular atrophy had been operated by Shouldice tecnique
Mestrado
Mestre em Cirurgia
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Munhequete, Eduardo G. "Estudio de las estructuras anatómicas relacionadas con la formación de las hernias inguinales." Doctoral thesis, Universitat Autònoma de Barcelona, 2003. http://hdl.handle.net/10803/4222.
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La disposición anatómica de las estructuras que conforman la región inguinal es uno de los factores etiológicos en la formación de las hernias inguinales. Existen diferencias entre los autores cuando se refieren al área débil susceptible a la formación de las hernias inguinales y su relación con los diámetros de la pelvis mayor.
En nuestro estudio nos hemos propuesto identificar dicha área, describir las estructuras anatómicas que participan en su delimitación, determinar su extensión, identificar la relación existente entre el área y la configuración ósea de la pelvis mayor e identificar el patrón de variación de estos parámetros en función de los sexos y de las razas estudiadas.
Para ello hemos utilizado 63 regiones inguinales pertenecientes a 17 cadáveres humanos adultos de raza blanca y a 15 de raza negra, siendo 21 regiones del sexo femenino y 42 del sexo masculino.
El área presentó siempre una forma ovoidea, y no triangular, quedando limitada por las fibras inferiores del músculo oblicuo interno y por el ligamento inguinal, los cuáles alcanzaban medialmente el tubérculo del pubis. Hemos propuesto la denominación de "espacio inguinal" para esta región y no hemos observado que su extensión variara en función del sexo o de la raza.
Hemos también identificado una zona aun más débil de la región inguinal, de morfología triangular, que quedaba limitada por el ligamento inguinal, por el borde inferior del músculo oblicuo interno y por los vasos epigástricos inferiores. En ella se localizaba la abertura del anillo inguinal superficial, a cuyo nivel su pared estaba formada tan sólo por la fascia transversalis. Hemos propuesto el término de "triángulo de herniación" para denominar a esta región. El ángulo ínfero-interno, que corresponde a la zona que resiste mayor presión en la postura bípeda, no cambiaba en función del sexo ni de la raza.
El anillo inguinal superficial presentó una morfologia irregularmente ovalada y se localizó en el tercio medial del "espacio inguinal", por delante del "triángulo de herniación". Nuestros resultados han determinado que dicho anillo es más vertical en la raza negra que en la raza blanca [p-valor <0,0001], pero sin diferencia estadísticamente significativa en lo que respecta al valor medio de su eje transversal máximo. Comparando los sexos, se presentó una mayor longitud de su eje transversal máximo [ p-valor <0,0001] y una disposición más vertical [ p-valor <0,0001] en el sexo masculino.
Las fibras inferiores de los músculos oblicuo interno y transverso se originaron en el ligamento inguinal y terminaron en el tubérculo del pubis, describiendo un trayecto arqueado. El borde caudal del músculo oblicuo interno fue de constitución muscular y sobrepasaba caudalmente al músculo transverso, que fue músculo-aponeurótico. No hemos observado ningún caso de unión parcial o total de las fibras inferiores de ambos músculos.
El ligamento inguinal presentó un trayecto arqueado y su longitud media fue de 111 milímetros.
El ligamento interfoveolar de Hesselbach fue observado en 14% de los casos y en ellos reforzaba parte de la pared del "espacio inguinal" y del "triángulo de herniación".
El anillo inguinal profundo presentó forma de U. Su vértice se localizaba en el espacio inguinal y sus dos pilares en relación con las fibras aponeuróticas (el medial) y musculares (el lateral) del músculo transverso. Las fibras inferiores del músculo oblicuo interno se encontraban por delante del anillo inguinal profundo, cubriendo los 2/3 o _ superiores del mismo. Su longitud transversal máxima fue de 15 milímetros en el sexo masculino y de 10 milímetros en el sexo femenino [p-valor <0,0001]. El estudio comparativo entre las razas no determinó diferencias estadísticamente significativas.
El parámetro arco púbico (longitud que separa el tubérculo del pubis de una línea interespinosa) se mostró como el parámetro más fiable de la pelvimetria externa. Su longitud aumentó con el aumento de la longitud del ligamento inguinal [p-valor < 0,0001] y con la disminución de la longitud de la línea interespinosa [p-valor < 0,0001]. Fue mayor en el sexo femenino y en la raza blanca [ p-valor de 0,001].
Cuando el arco púbico era bajo (≥ 75 mm) el área del espacio inguinal fue mayor [p-valor = 0,004] y el eje transversal del anillo inguinal profundo también mayor [p-valor = 0,024]. Consecuentemente existe una mayor predisposición para la formación de hernias inguinales.
El arco púbico no variaba en función de la longitud de los ejes transversal [p-valor de 0,106] y longitudinal [p-valor de 0,468] del anillo inguinal superficial, y tampoco variaba con el ángulo de inclinación del mismo respecto al plano horizontal trazado a nivel de los tubérculos del pubis [p-valor de 0,546].
The anatomical disposition of the structures that conform the inguinal region is one of the main factors noted in the etiology of the inguinal hernia.
There are differences in the authors' opinions regarding the assignment of the most susceptible area for the formation of inguinal hernias and their relation to the diametres of the major pelvis.
In the present study we want to identify the aforementioned area, describe the anatomical structures that participate in its delimitation, determine its area, identify the relation between that area and the bone configuration of the major pelvis and finally to identify the different variations of these parameters concerning genders and races.
Therefore we studied 63 inguinal regions corresponding to 17 white human adults cadavers and to 15 black ones, 21 of the regions were female and 42 male.
The area was always ovoidal and not triangular. It was limited by the inferior fibres of the internal oblique muscle and the inguinal ligament. Therefore we have proposed the term "inguinal space". According to our observations its extension does not change according to different sexes and races.
We have also identified an even weaker zone of triangular morphology in the inguinal region which is delimited by the inguinal ligament, the inferior border of the internal oblique muscle and the inferior epigastric vessels. In this zone we observe the opening of the superficial inguinal ring and the transversalis fascia. We have proposed the term "herniation triangle" to call this zone. Regarding to this herniation triangle, we have showed that its internal and inferior angle, which corresponds to a zone that must resist a major pressure, does not change according to different sexes and races.
The superficial inguinal ring, with an irregularly oval form, is located in the medial third of the "inguinal space" in front to the "herniation triangle". Its disposition with regard to these two spaces allows us to observe that the broader and the more vertical the ring, the larger is the unprotected area of the inguinal space. According to our results the superficial inguinal ring of black people is more vertical than the one of white people [p<0,0001], but there are no significant statistic differences with regard to the average value of the maximum transversal axis. Comparing the two different sexes, we find a longer maximum transversal axis [p<0,0001] and a more vertical disposition [p<0,0001] in males.
The inferior fibres of the internal oblique and transversal muscles originated in the inguinal ligament and inserted on the pubic tubercle. Its inferior border was muscular and surpassed the transversus that was muscle-aponeurotic. In any case could we find a partial or total union of inferior fibres of both muscles.
The inguinal ligament is the inferior and external border of the "inguinal space". Its average length was 111 milimeters.
The interfoveolar ligament of Hesselbach was observed in 14% of cases and it reinforced the walls of the "inguinal space" and "herniation triangle".
The deep inguinal ring was an U-shaped form. Its vertex was located inside the "inguinal space", and its inner crus was attached to the transversus aponeurosis fibres and its outer crus to the transversus muscle fibres and two thirds or three quarters of its area were covered by inferior fibres of the internal oblique muscle. Its maximum transversal length was 15 mm in male and 10 mm in female [p<0001]. We couldn´t find any statistical differences between black and white people.
The pubic arc (length between the pubic tubercle and the interespinuous line) was revealed to be a more reliable parameter of external pelvimetry. Its length increase with the increase of the inguinal ligament length [p<0,0001] and with the decrease of the interespinal line length [p< 0,0001]. The pubic arc was major on female and white persons [ p= 0,001].
When the pubic arc is low (≥ 75 mm) the "inguinal space" area is larger [ p = 0,004] and the maximum transversal length of deep inguinal ring is also major [p = 0,024]. As a consequence it is easier to develop inguinal hernia.
The pubic arc does not vary according to the transversal axis length [p = 0,106], the longitudinal axis [p = 0,468] and the angle of the superficial inguinal ring [ p = 0,546].
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Marsal, Cavallé Francesc. "Hernioplastia sin tensión para el tratamiento ambulatorio de la hernia inguinal.estudio clinico propes." Doctoral thesis, Universitat Rovira i Virgili, 1992. http://hdl.handle.net/10803/8868.
Full textAbstract:
Desde hace más de 100 años, la prevalencia de hernia inguinal recidivada (10-20% de todas las hernias operadas), no se ha modificado. Recientemente, se ha introducido el concepto de "Hernioplastia sin Tensión" (HST) para la reparación de la hernia inguinal, mediante la implantación de una malla de material sintético cubriendo los defectos sobre la fascia transversalis, sin otras modificaciones anatómicas, obteniéndose un índice de recidiva prácticamente nulo. Con el propósito de comparar las propiedades de los biomateriales de uso clínico mas frecuente, implantamos subcutáneamente sobre la pared abdominal anterior de la rata Wistar (200-250g), retales de malla de polipropileno ( Prolene®-PP), politetrafluoroetileno expandido ( Gore-Tex®-PTFE) y poliglactin 910 ( Vicryl®-P910). Siguiendo la normativa de la " American Society for Testing and Materials", (ASTM), los animales fueron repartidos en tres grupos y sacrificados a la semana, 4 semanas y 12 semanas, obteniendo las muestras del conjunto pared muscular + malla. Cada muestra fue dividida en dos partes, una para estudio histológico y otra para estudio biomecánico.Los resultados fueron evaluados por un observador neutral mediante una escala semicuantitativa de grados. Los tres tipos de malla desencadenaron una reacción inflamatoria mínima, sobre los tejidos de experimentación. La fibrosis desencadenada, fue progresiva en las tres mallas y en todo momento más marcada en el P910.
Las muestras del conjunto malla+ pared muscular obtenidas a las 4 semanas, fueron traccionadas con un dinamómetro de precisión Instron®, a velocidad constante, generando curvas de fuerza tensil - tiempo, hasta el momento de la ruptura. En todos los casos la resistencia a la ruptura fue mayor en las muestras ensayadas que en la pared musculoaponeurótica indemne de la rata.
Con el doble propósito de comprobar la eficacia de la técnica de HST mediante la implantación de una malla de Prolene®, en términos de tolerancia, morbilidad y recidiva, y de comprobar las ventajas del tratamiento bajo anestesia local y en régimen ambulatorio de la hernia inguinal, en términos económicos y de grado de satisfacción de los pacientes, emprendimos nuestro estudio clínico prospectivo. Entre Junio 90 y Junio 92, 139 pacientes (17-85 años) portadores de hernia inguinal, en uno (n=118) o ambos lados (n=21), fueron seleccionados por un mismo cirujano para ser tratados ambulatoriamente en un solo acto operatorio (n=122) o en dos sesiones por separado (n=17), constituyendo un total de 156 casos operatorios. Estos pacientes, previa evaluación preoperatoria, recibieron instrucciones verbales y por escrito sobre el preoperatorio domiciliario. El día de la operación, acudieron al hospital con un acompañante responsable, con vehículo propio, fueron instalados en la habitación donde pasarían el postoperatorio inmediato, preparados para el quirófano e intervenidos bajo anestesia local, mediante HST. Una o dos horas mas tarde, los pacientes que estaban en condiciones (90% casos) fueron alta hospitalaria con instrucciones sobre el postoperatorio domiciliario. El cirujano responsable del alta, llamaba por teléfono la noche de la intervención y al día siguiente, por la mañana. Los pacientes fueron revisados entre el 4º - 7º día postoperatorio y posteriormente al mes, tres meses y una vez al año. Durante el seguimiento (15 pacientes perdidos, 10%), un mismo cirujano completó un cuestionario de cada paciente para evaluar el resultado del tratamiento de satisfacción.Con seguimiento de 2 meses a dos años (X=11), se registró una recidiva y un total de 20 complicaciones postoperatorias (14.3%), sin ninguna intolerancia a la malla de Prolene®. El grado de dolor y ansiedad experimentado por los pacientes, fue mínimo en más de 90% de los pacientes, siendo la anestesia local mejor tolerada en pacientes añosos que en los más jóvenes.
Straps of (2 x 0.5 cm) of polypropylene (PP), PTFE and 910-polyglactin (910-P), were inserted subcutaneously over the anterior abdominal wall on 15 Wistar rats (200-250g). Animals were sacrificed at one; four and 12 weeks after operation, and samples of abdominal wall + mesh were obtained for histological and mechanical study. All meshes developed minimal inflammation. One week after surgery, the smallest amount of granulation tissue was observed around PP. 910-P disappeared around the fourth week and developed a greater fibrosis than PP and PTFE. Samples of abdominal wall + mesh obtained four weeks after operation were tested for tensile strength. In all cases, tensile strength was greater in these samples than in the undisturbed abdominal wall of the rat (control = 1.2+/- 0.5 kg/cm). However, tensile strength with PP (8.9 +/- 0.65) and PTFE (9.4 +/- 1.3) was greater than with 910-P (1.7+/- 0.74).
One hundred-thirty-nine patients (age 17-85) were selected by the same surgeon for ambulatory treatment of unilateral (118) or bilateral (21) inguinal hernia. The latter group were treated in one (4) or two (17) operations, with a total of 156 cases. All cases were operated on under local anaesthesia by the technique of tension-free-hernioplasty, by placement of a polypropylene mesh. In 141 cases (90%), the patient was discharged home on the same day of operation. There was no operative mortality and only one case of recurrence in this series (follow up = 2-24 months; 90% of patients). There were 20 postoperative complications (14.3%), with no intolerance of the prosthetic mesh. Patients were requested to fill in questionnaires to asses the degree of pain and anxiety experienced before, during and after the operation. Pain anxiety was minimal in more than 90% cases, local anaesthesia showing better tolerance among older patients.
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Stranne, Johan. "Inguinal hernia after urologic surgery in males with special reference to radical retropubic prostatectomy : a clinical, epidemiological and methodological study /." Göteborg : Department of Urology, Institute of Clinical Sciences, The Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, 2006. http://hdl.handle.net/2077/706.
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Nordin, Pär. "Groin hernia surgery : studies on anaesthesia and surgical technique /." Linköping : Univ, 2003.
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Jones, Michael Edwin. "Pre-natal and early life risk factors for diabetes, cryptorchism and inguinal hernia in children." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1996. http://researchonline.lshtm.ac.uk/682237/.
Full textAbstract:
Findings are presented from matched case-control studies of risk factors for diabetes, cryptorchidism and inguinal hernia in children using routine data collected by the Oxford Record Linkage Study since 1965. There were 315 cases born 1965-85 in the diabetes study, 947 and 1449 cases in studies of cryptorchidism diagnosed at birth and at orchidopexy respectively, and 1701 male and 347 female cases in the study of inguinal hernia. Each case was individually matched with up to eight controls on sex, year, and hospital or place of birth. A potential bias caused by differential migration of cases and controls was identified. A sample of 753 controls born in Oxfordshire was checked against the Oxfordshire Family Health Services Authority register to determine migration out of the study area in relation to perinatal risk factors. A general procedure was developed to estimate the strength of the migration bias. Pre-eclampsia was identified as a significant pre-natal risk factor for diabetes. The studies of cryptorchidism identified significantly raised risks with low birth weight, low social class and breech presentation. The results suggested that asymmetric growth retardation in the third trimester may be involved in the aetiology of undescended testes that do not spontaneously descend in later life. Analysis of risk factors among siblings of cases and controls suggested that permanent changes to the mother may occur around the time of the pregnancy involving the affected child. Low birth weight, short gestation and smoking during pregnancy were associated with significantly raised risks of inguinal hernia among boys. Among girls the results were similar, suggesting that mechanisms independent of the sex of the child may be important in the aetiology of this condition. Estimates of disease risk in siblings showed a strong familial aggregation, especially among girls.
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Haapaniemi, Staffan. "Quality assessment in groin hernia surgery : the role of a register /." Linköping : Univ, 2001. http://www.bibl.liu.se/liupubl/disp/disp2001/med685s.pdf.
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Vilallonga, Puy Ramon. "Estudio de los parámetros de calidad de la cirugía de la hernia inguinal. Valor de un cuestionario postal." Doctoral thesis, Universitat Autònoma de Barcelona, 2006. http://hdl.handle.net/10803/4293.
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Introducción:El uso del abdordage preperitoneal en la cirugía de la hernia inguinal es conocido des de hace tiempo. Wantz, siguiendo los principios de Stoppa introdujo la malla con la finalidad de encontrar la técnica ideal de la malla. Otro aspecto importante en la cirugía de la hernia inguinal es el seguimiento de los pacientes. El examen clínico en las consultas externas puede ser impracticable en hospitales terciarios con áreas de influencia sobre grandes grupos poblacionales.
El objetivo del presente estudio es analizar los parámetros de la calidad a largo plazo de la cirugía de la hernia inguinal y la utilidad de un cuestionario postal con visita selectiva combinado con llamada telefónica en el seguimiento.
Método:
Se han incluido los pacientes intervenidos por una hernia inguinal mediante un abordaje preperitoneal y de forma ambulatoria en el Servicio de Cirugía General de un hospital terciario, entre el 1/1/1999 y el 31/12/2003.
El cuestionario con seis preguntas con la opción de contestación si o no: ¿era la primera vez que le operaban la hernia?, ¿era del lado derecho, lado izquierdo o los dos a la vez?, ¿ha notado de nuevo un bulto en la zona operada?, ¿ha tenido dolor en la zona operada pasado un mes de la intervención?, ¿le continua doliendo en la actualidad la zona operada?, ¿esta satisfecho con la cirugía que se realizó?
Resultados:
Un total de 841 pacientes (72.9%) devolvieron el cuestionario después de tres envios (512 después del primero, 205 después del segundo y 124 después del tercero). El cuestionario con respuesta positiva se halló en 152 pacientes (18.1%) y con respuesta negativa en 689 pacientes (81.9%). De los 152 pacientes que respondieron "si" a alguna de las preguntas sobre dolor en la actualidad y/o recurrencia, 91 no quisieron ser visitados en consultas externas, 24 no se pudieron contactar por teléfono, y 37 quisieron ser visitados. De los 312 pacientes que no respondieron el cuestionario postal, 8 habían fallecido, 124 no quisieron ser visitados y 180 no se localizaron. La tasa de recurrencia hallada fue de 2.7% y la de dolor crónico de 5.9%.
Conclusiones:
1.La tasa de recidiva herniaria en nuestra serie puede oscilar entre el 4,3% y el 0,12% según como se tomen los criterios de recidiva y como se escoja la muestra de control.
2.El dolor crónico postcirugía no se ha presentado y sólo se ha encontrado un 7,3% de parestesias y molestias inespecíficas en la región operada.
3.El 95,2% de los pacientes que han respondido al cuestionario postal han manifestando estar satisfechos con la cirugía. Cuando se aplica el cuestionario SF-36, todos presentan unas puntuaciones medias superiores a 60 en cualquiera de sus dimensiones.
4.El abordaje preperitoneal en régimen de Cirugía Mayor Ambulatoria es una buena técnica en nuestro ámbito.
5.El uso de un cuestionario postal nos ha determinado una respuesta del 72,9%. Esto nos hace concluir que es una modalidad muy útil para la obtención de datos cuando se pretenden realizar estudios de calidad y de control del procedimiento.
6.El uso del cuestionario postal con visita selectiva no ha aportado datos significativos para control sucesivo de un paciente.
7.Una vez evaluada la calidad de la técnica y establecidos unos resultados a partir de un cuestionario postal, la utilización de un protocolo para el seguimiento no aporta ningún resultado añadido que lo justifique a menos que se modifique la técnica o el equipo.
8.Al paciente intervenido consideramos que se le ha de proponer una única visita postoperatoria, donde a parte de hacer el control posquirúrgico pertinente, hay que informarle de que su hernia operada no necesita más controles.
Background:
The open preperitoneal surgery for hernia repair is known since ages. Wantz, following Stoppa principles introduced the mesh trying to find, with this way, the ideal hernia repair technique. In the other hand, follow-up of the patient who have had a hernia repair is still an important problem nowadays for the general Surgeon. Classical follow-up with the patient are nearly impossible when the amount of patients is very high, and also, because of the low recurrence rate.
This is the reason why we decided to evaluate the quality control parameters in hernia surgery (recurrence and pain) and also to assessed the usefulness of a short postal questionnaire and selective clinical examination combined with repeat mailing and telephone reminders for quality assessment in hernia surgery.
Method:
All patients (n = 1153) who underwent tension-free hernioplasty through an open preperitoneal approach between 1999 and 2003 received a 6-item questionnaire with a covering letter and a stamped addressed enveloped. Non-responders received two successive new questionnaires and a telephone call.
Concerning to the questionnaire, we asked the patients to answer 6 questions: 1-Was it your first hernia surgery procedure? 2-You were operated of the right, left or both hernia? 3-After a month since surgery, have you had a lump in the groin? 4-After a month since surgery, have you had pain in the groin? 5-Do you still have pain in the groin? 6-Are you satisfied with the surgery?
Results:
A total of 841 (72.9%) patients returned questionnaires after three reminders (512 after the first mailing, 205 after the second, and 124 after the third). Positive questionnaire answers were documented for 152 (18.1%) repairs and negative answers for 689 (81.9%). Of the 152 patients who answered "yes" to either of the questions regarding recurrence and/or current pain, 91 declined clinical appointment, 24 could not be contacted by phone, and 37 underwent physical examination. Of the 312 patients who did not return the questionnaire, 8 had died, 124 were not willing to be visited, and 180 could not be localised. The recurrence rate was 2.7% and the chronic pain rate 5.9%.
Conclusions:
1. Recurrence is estimated to be between 4.3% and 0,12% depending recurrence criteria and patients selection.
2. Chronic pain has not been reported and 7.3% of patient refer paresthesias and unspecific pain.
3. In our study, patients are satisfied with surgery (95.2%), SF-36 shows good results and our surgery quality in terms of satisfaction and recurrence is acceptable.
4. Low recurrence rate, no chronic pain and few paresthesias added to a high number of patients satisfied allows us to say that preperitoneal technique in Ambulatory Surgery is a good option in our area.
5. The use of a postal questionnaire in our area could be a useful way to obtain information when a quality control of the surgery is done.
6. The use of a postal questionnaire in our area with selective physical examination, has not added significant data for the control of patients.
7. Once evaluated the quality of the technique and established some results about the postal questionnaire, unless the technique or the team changes, the use of a protocol is not required.
8. The patient who underwent a surgery of inguinal hernia, has to be visited only once after operation and inform him that his hernia does not need more examinations.
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Rocha, Lucimara Collodoro. "Análise de polimorfismos do gene da fibrilina-1 em indivíduos portadores de hérnia inguinal através do seqüenciamento de DNA." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-11032008-091043/.
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A hérnia inguinal é uma doença multifatorial que emerge do orifício de Fruchaud, fechado somente pela fáscia transversal. Nos últimos tempos tem sido demonstrado que desordens dos elementos do tecido conjuntivo, como fibras colágenas e elásticas, estão relacionados com a gênese da hérnia inguinal. Estudos prévios demonstraram alterações estruturais e quantitativas das fibras elásticas com o envelhecimento da fáscia transversal, relacionado ao aparecimento de hérnia inguinal a partir da quinta década da vida. Estudos recentes demonstraram associação entre uma mutação pontual do éxon 20 do gene da elastina, componente amorfo das fibras elásticas, e hérnia inguinal em indivíduos do sexo masculino. A fibrilina-1 é o principal componente microfibrilar das fibras elásticas e está relacionada ao surgimento de síndromes genéticas, como Marfan, Ehlers-Danlos e Williams, que também apresentam indivíduos portadores de hérnias. Nesse sentido, o objetivo do presente estudo foi investigar a presença de polimorfismos no gene da fibrilina-1 (FBN1) em indivíduos portadores de hérnia inguinal. Estudou-se o ácido desoxirribonucléico (DNA) genômico de 60 pacientes com hérnia inguinal e 60 controles. Os exons 4, 13, 24, 25, 26, 27, 31 32, 39, 41, 59 e 65 foram amplificados pela Reação em Cadeia da Polimerase e, posteriormente, foram avaliados os polimorfismos em gel de poliacrilamida. Todos os exons estudados apresentaram alguns indivíduos com padrão de bandeamento diverso. O produto de amplificação destes exons foi então avaliado através de seqüenciamento e confrontado com a base de dados do National Human Genome Research Institute. Alterações de inserção e/ou deleção consistentes foram observadas no éxon 27: 1) inserção de uma base entre os codons 1119 e 1120 (GAT -> AGA); 2) inserção de uma base entre os codons 1116 e 1117 (TGT -> CTG): 3) inserção de uma base no códon 1148 (CCC -> CGC); e no éxon 31: inserção de uma base entre os codons 1282 e 1283 (GAG -> CGA). Não houve significância estatística que indique associação entre o gene FBN1 e hérnia inguinal. Entretanto, como o gene da fibrilina-1 é bastante grande (350 kD, dividido em 65 exons) e, em outras doenças como a Síndrome de Marfan mais de 500 mutações já foram descritas, sem haver exons que possuam uma maior responsabilidade pela Síndrome, é possível que outros exons possam estar relacionados com o acometimento da hérnia inguinal.The inguinal hernia is a multifactorial disease that emerge from the Fruchaud orifice, closed only by the transversalis fascia. Lately it has been showed that disorders on the connective tissue elements, as the collagen and elastic fibers, are related to the inguinal hernia genesis. Previous studies have showed structural and quantitative changes of the elastic fibers at the transversalis fascia with aging, that may be related to inguinal hernia at the fifth decade of life. Recent studies have demonstrated an association among a punctual mutation on exon 20 of the elastin gene, amorfous component of the elastic fibers, and male individuals with inguinal hernia. The fibrillin-1 is the main microfibrillar component of the elastic fibers and is associated to genetic syndromes as Marfan, Ehlers-Danlos and Williams, that also present inidividuals with hernias. Thus, the objective of this study was to investigate the presence of polymorphisms on the fibrillin-1 gene (FBN1) on individuals who developed inguinal hernia. The desoxirribonucleic acid (DNA) of 60 individuals with inguinal hernia and 60 controls have been studied. The exons 4, 13, 24, 25, 26, 27, 31, 32, 39, 41, 59 and 65 were amplyfied by the Polymerase Chain Reaction and later evaluated the polymorphisms on polyacrilamide gel. The amplification product of these exons were evaluated by DNA sequencing and compared to the National Human Genome Research Institute database. Consistent mutations were observed at exon 27: 1) insertion of a base between codons 1119 and 1120 (GAT -> AGA); 2) insertion of a base between codons 1116 and 1117 (TGT -> CTG); 3) insertion of a base on codon 1148 (CCC -> CGC); and at exon 31: insertion of a base between codons 1282 and 1283 (GAG -> CGA). There was no statistic significance that could indicate the association between FBN1 gene and inguinal hernia. However, FBN1 is a large gene (350 kD, shared in 65 exons) and in other disorders as Marfan Syndrome, more than 500 mutations have already been described, without the existence of prevalent exons that have major responsability about the Syndrome, it is possible that other exons could be related to the happening of inguinal hernia.
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Scout, Earl. "What is the current practice of inguinal hernia repair at University of Cape Town affiliated hospitals?" Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31788.
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Background: Various inguinal hernia repair techniques exist, without one ‘single best’ option. Hernia society guidelines recommend laparoscopic repair as one of its mainstays, provided surgeons are adequately trained. The current practice for hernia repair in South Africa as well as the surgical resident exposure to laparoscopic repair training is unknown. Aim: To quantify the current practice of inguinal hernia surgery in hospitals affiliated to the University of Cape Town (UCT) and to assess trainee exposure to laparoscopic repair. Methods: All adult patients who underwent inguinal hernia repair during the 12-month study period, at the four UCT affiliated hospitals (Groote Schuur, Mitchell’s Plain, Victoria and New Somerset) were included. Collected data parameters included age, gender, primary or recurrent hernia, uni- or bilaterality, primary surgeon consultant or non-consultant, operative time, and open or laparoscopic technique used. Results: 380 patients were included. Eighty-eight (23.2%) repairs were performed laparoscopically, of which 5 (5.7%) were converted to open. Non-consultants were present at 70/88 (79.5%) cases performed laparoscopically and were primary surgeon at 15 (17%). Laparoscopic repair was performed for 63.6% of bilateral versus 19.3% of unilateral hernias, 39.3% of recurrent hernias and 45% of hernias in females. Conclusion: Inguinal hernias in our setting are predominantly repaired by open surgery. The likelihood of laparoscopic repair varies significantly depending on which hospital the patient is referred to. Non-consultants have limited exposure to performing laparoscopic hernia repairs as the primary surgeon.
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Granda, Pereira Ana Cecilia. "Técnicas de lichtenstein y nyhus en el manejo de hernias inguinales en el hospital Militar Central." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2015. https://hdl.handle.net/20.500.12672/4140.
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Objetivos: Determinar si hay diferencias significativas en la frecuencia de complicaciones tempranas y tardías secundarias al uso de las técnicas de Lichtenstein y Nyhus en el manejo de hernias inguinales en el Hospital Militar Central.
Material y métodos: Se realizó un estudio de tipo transversal con los registros quirúrgicos e historias clínicas de los pacientes con diagnóstico de hernia inguinal tratados quirúrgicamente en el Hospital Militar Central durante el período 2012-2014.
Resultados: Del total de pacientes tratados quirúrgicamente, el 89% se realizó con la técnica de Lichtenstein y el 11% con la técnica de Nyhus. Al comparar ambas técnicas no encontraron diferencias en términos de tiempos quirúrgicos (43.0 ± 13.6 vs. 39.1 ± 8.9 minutos, p =0.140) y tiempos de hospitalización (3.9 ± 1.2 vs. 3.8 ± 0.8 días, p =0.635). Al comparar la frecuencia se encontraron diferencias significativas en la complicaciones tempranas (17% vs. 0%, p =0.028) pero no en el caso de las complicaciones tardías (4% vs. 0%, p =0.603).
Conclusiones: Las técnicas de Lichtenstein y Nyhus demostraron ser seguras en el manejo quirúrgico de las hernias inguinales. Ambas se asociaron a niveles bajos de complicaciones, siendo las complicaciones tempranas significativamente más frecuentes entre los casos tratados con la técnica de Lichtenstein.Tesis
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Guardia, Ricra Manuel Christian. "Uso de malla protésica en la reparación quirúrgica de hernia inguinal complicada. Hospital Nacional Dos de Mayo. Periodo 2008-2012." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2015. https://hdl.handle.net/20.500.12672/13490.
Full textAbstract:
El documento digital no refiere asesorOBJETIVO: Evaluar si el uso de malla protésica en la reparación quirúrgica de emergencia en el manejo de las hernias inguinales complicadas está asociado con un menor riesgo de complicaciones postoperatorias. METODOLOGÍA: Estudio observacional, analítico – comparativo, retrospectivo. Se estudió a 126 pacientes con diagnóstico de hernia inguinal complicada, donde 88 pacientes usaron malla protésica y 38 pacientes no utilizaron malla. En el análisis descriptivo de las variables cualitativas se utilizó frecuencias absolutas y relativas, para las variables cuantitativas se estimó medidas de tendencia central y de dispersión; para relacionar las variables y determinar el factor de riesgo se usó la prueba de Chi-cuadrado y Odds ratio con un nivel de confianza del 95%. RESULTADOS: La edad promedio de los pacientes fue 58,9±17,0 años, donde la mayoría tenían más de 60 años; asimismo, predominaba el sexo masculino (83,3%). En cuanto al tiempo de enfermedad en los pacientes eran < 1 día (45,2%); asimismo el tipo de hernia complicada fue mayormente la incarcerada (80,2%). Por otro lado al 17,5% de los pacientes se le realizó resección intestinal. Respecto a las características operatorias se encontró diferencia significativa (p<0,05) con respecto al uso de la malla protésica; asimismo se observó que los pacientes de ambos grupos estuvieron en sala de operaciones entre 1 a 2 horas (59,1% vs 39,5%); además la técnica empleada en los pacientes con malla protésica fue Lichtenstein (90,9%) y en los que no utilizaron malla protésica fue la técnica Bassini (63,1%). Las comorbilidades más frecuentes en los pacientes que utilizaron la malla protésica fueron la hipertensión arterial (11,4%), la diabetes mellitus (6,8%) y la tuberculosis (5,7%); mientras que los pacientes que no usaron la malla protésica fueron la hipertensión arterial (21,1%) seguidamente la tuberculosis (10,5%). En la técnica quirúrgica empleada se encontró diferencia significativa con respecto al tipo de hernia complicada (p<0.001); asimismo se observó que en el tipo de hernia Incarcerada se empleó la técnica Lichtenstein (77,2%), seguido de la técnica Bassini (13,9%); mientras que en el tipo de hernia Estrangulada se empleó la técnica Bassini (44,0%) seguido de la técnica McVay (28,0%). Por otro lado en las características sociodemográficas se encontró que existe diferencia significativa en el sexo de los pacientes (p=0.003) según el uso de la malla protésica; asimismo se observó a los pacientes que usaron la malla protésica presentaron una edad media 59,0±16,3 años, mientras que a los pacientes que no utilizaron la malla protésica fue de 58,5±18,8 años. Los pacientes que usaron la malla protésica presentaron complicaciones como la infección de sitio operatorio (4,5%), retiro de malla (1,1%) y recidiva de hernia (1,1%). CONCLUSIONES: El uso de la malla protésica en la reparación quirúrgica de hernia inguinal complicada resultó ser de menor riesgo en las complicaciones quirúrgicas, es decir que las complicaciones son menos frecuentes en el grupo de pacientes que utilizan malla protésica en comparación a los pacientes que no utilizan malla protésica.
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Castillo, Ramos Diego Alexis. "Factores de riesgos sistémicos asociados a hernia inguinal recidivada en pacientes del Hospital Nacional Arzobispo Loayza durante el periodo 2015 – 2019." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2020. https://hdl.handle.net/20.500.12672/16032.
Full textAbstract:
Las hernias inguinales recidivadas son consecuencia de un defecto en la
pared abdominal debido a una reintervención quirúrgica en el lugar donde ya se presentó una
hernia con anterioridad. Los factores que intervienen en presencia de una recidiva son
importantes para poder mejorar su manejo y evitar su recurrencia con las medidas preventivas
oportunas. La presente investigación describe la asociación entre los factores de riesgo sistémico y la recidiva de hernia inguinal en pacientes de un hospital peruano durante el periodo 2015-2019. Realiza un estudio analítico, observacional retrospectivo, transversal y cuantitativo. Los
datos se obtuvieron de historias clínicas del Hospital Nacional Arzobispo Loayza. Se realizó
una regresión logística para el análisis de los datos. Las covariables del modelo se seleccionaron
a través del método estadístico. Se consideró un p valor menor a 0.05 como significativo para
todos los análisis. Se evaluaron 1308 pacientes de los cuales 1230
correspondieron a hernia inguinal no recidivada y 78 a hernia inguinal recidivada. Se evidenció
que la técnica operatoria más utilizada en pacientes con hernia recidivada fue la técnica de
Nyhus con 65.38%. El año que más frecuencia de hernia inguinal recidivada se intervino
quirúrgicamente fue el 2017 con 7.93 % de las operaciones. El Índice de Masa Corporal
promedio de los pacientes con hernia inguinal recidivada fue de 25.54 con una DS 3.19. La
mayoría de los pacientes con hernia inguinal recidivada tenía sobrepeso (53.85%, p:<0.001);
89.74% de los pacientes con hernia inguinal recidivada no presentaron estreñimiento (p: 0.003).
51.2% de los pacientes con hernia recidivada desempeñaban actividades de esfuerzo ligero (p:
0.002). Al realizar la regresión logística, se evidenció que los pacientes con sobrepeso tenían
un 73% menos probabilidad de presentar hernia inguinal recidivada (OR 0.27; IC 95%: 0.15-
0.46) y los que padecieron de estreñimiento tuvieron un 255% mayor probabilidad (OR: 3.55;
IC 95%: 1.46-9.65). Concluye que la adultez mayor fue el grupo etario de mayor
frecuencia dentro de los pacientes que presentaron hernia inguinal recidivada y no recidivada;
dentro de la hernia inguinal recidivada se presentó en mayor frecuencia en el sexo masculino,
en aquellos que ejercieron una ocupación de esfuerzo ligero y mínima presencia en pacientes
con EPOC. Los factores anteriormente mencionados no resultaron estadísticamente
significativos. El sobrepeso no es un factor de riesgo y el estreñimiento está directamente
asociado con la presencia de recurrencia de hernia inguinal.