Huge, irreducible femoral hernia interpreted as a preperitoneal lipoma in radiological findings

IntroductionThe Lichtenstein technique is currently considered the “gold standard” of open, anterior inguinal hernia repair. It is not free, however, of adverse effects, which may be caused by the implemented synthetic material.AimDetermination the influence of the mesh employed on treatment results including immediate complications, return to everyday activities, chronic pain occurrence and hernia recurrence.Material and methodsTension-free hernia repair using the Lichtenstein technique was performed in all the 59 patients randomized to trial groups. Group P with heavyweight polypropylene mesh contained 34 patients; group V with lightweight, partially absorbable mesh (polypropylene/polyglactin 910) consisted of 25 people. Controlled, scheduled follow-up appointments took place after the 7th day and the 3rd and 6th month. Patients were clinically assessed and pain intensity was determined on an analogue-visual scale.ResultsNo statistically significant influence of the type of mesh on the risk of early complications, severe pain intensity, the length of hospital stay, time of recovery, or patients’ satisfaction with treatment was observed. After 6 months also no statistically significant differences were observed between groups with regard to recurrence rate (P 3.4% vs. V 4.0%), chronic pain (P 5.9% vs. V 4.0%) and ailments such as “foreign body presence” (V vs. P, OR = 0.30, 95% CI 0.077-1.219, p = 0.093) incidence, although their probability was 70% lower for V mesh.ConclusionsThe preliminary results confirm the effectiveness of the Lichtenstein technique for hernia repair with both types of meshes. It appears that use of a partially absorbable mesh is connected with lower risk of postoperative complications, but the final results require multicentre trials in a larger series of patients.

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial comparing inguinal hernia repair with Lichtenstein technique using non-absorbable or partially absorbable mesh. Preliminary report.

Pielaciński

Szczepanik²,

Misiak³

et al. 2011

“…Multi-annual disease status, obesity and delayed surgical management all favor the development of giant hernias. Publications concerning giant hernias are based on small series of patients and often on single cases [5–9]. Tension-free repair of inguinal hernias was described by Lichtenstein in 1987 and is considered by many a “gold standard” in surgical inguinal hernia management [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Lichtenstein repairs in planned treatment of giant inguinal hernia - own experience.

Bierca¹,

Kosim²,

Kołodziejczak³

et al. 2012

IntroductionOccurrence of giant inguinal hernias is not frequent because of growing medical awareness in the community as well as progress in surgical treatment in this field.AimTo evaluate the effectiveness of repairs using the Lichtenstein technique in scheduled treatment of giant inguinal hernias.Material and methodsBetween 2006 and 2010 in the Department of Surgery with the Subdepartment of Proctology, Hospital at Solec in Warsaw, 909 repairs of inguinal hernia were performed, including 15 patients (1.65%) with the diagnosis of giant hernia. In 3 cases it was direct inguinal hernia and in 12 cases indirect inguinal hernia. All giant hernias occurred in male patients between 33 and 87 years of age (mean age 65 years old) and developed for many years, median of 14.2 years. All patients underwent scheduled repairs using the tension-free Lichtenstein technique. A non-absorbable polypropylene mesh was used for hernioplasty. Exact Fisher's test (p < 0.01) was used for statistical analysis.ResultsIn all cases contents of the hernial sac consisted of loops of small intestine, colon and omentum. Early complications occurred in 11 patients (73%) in the group of patients with giant hernias, whereas in the remaining group of patients early complications occurred in 53 patients (5.9%). The difference was statistically significant. In the group of patients with giant hernias no recurrence was observed over the observation period ranging from 6 months to 4.5 years. In the remaining group of patients recurrences occurred in 23 patients (2.6%).ConclusionsThe Lichtenstein technique of repair is effective in management of giant inguinal hernias. A statistically significantly higher percentage of complications was observed in the group of patients with giant hernias as compared to the remaining group of patients with inguinal hernias. Patients with giant hernias require proper preparation for surgery, especially in relation to their respiratory efficiency.

“…In addition to muscles overlying the hernia sac, the surgical scar also interfered with making the proper diagnosis. Still, ultrasound also does not show other types of hernia in all cases, and in other patients (such as those with groin pain syndrome) the diagnosis is confirmed intraoperatively [12, 13]. The reason for the development of the described hernias is not explained by the healing process of the external musculature.…”

Section: Discussionmentioning

confidence: 95%

Postoperative interstitial hernia as a cause of obscure incisional wound site pain.

Modrzejewski¹,

Śmietański²

2011

An interstitial hernia is one in which the hernia sac is located between the layers of the abdominal wall. The analysis of contemporary literature shows that interstitial hernias are most often seen in children as a type of inguinal hernia and often accompany undescended testis. The hernia sac is usually located between the external-oblique and internal-oblique muscles in a lateral-cephalic direction. The authors present 3 cases of interstitial hernia found during laparoscopic exploration of the front abdominal wall done due to incisional wound site pain. No previous diagnosis of hernia was considered in all the cases. Hernias were found as complications of appendectomy and wound healing after radiotherapy of uterine and cervical cancer. In conclusion, in obscure wound site pain, the presence of an interstitial postoperative hernia should be considered as a possible reason for the complaint. Laparoscopic examination of the anterior abdominal wall during adhesiolysis in patients with abdominal pain enables proper diagnosis and treatment.