Management of various rare and atypical hernias: experience at a tertiary care centre in central India

Abstract

INTRODUCTIONHernia is derived from a Latin word meaning "a rupture". Abdominal wall hernias are most frequently encountered in surgical practice accounting for 15% -18% of all surgical procedures.1,2 Worldwide, more than 20 million hernias are operated per year.The incidence of abdominal wall hernia in different countries varies from 100-300/100000 per year.3 Of which most common being the inguinal hernias and femoral hernia being the least common. Midline ventral hernias are the next common variety of abdominal wall hernia after inguinal hernia, most common after interventions involving the lower abdomen (incisional hernia). According to their locations, these are further ABSTRACT Background: Abdominal wall hernias are most frequently encountered in surgical practice accounting for 15% -18% of all surgical procedures. The incidence of abdominal wall hernia in different countries varies from 100 -300/100000 per year. Of which most common being the inguinal hernias and femoral hernia being the least common. Midline ventral hernias are the next common variety of abdominal wall hernia after inguinal hernia. Ours is a tertiary care hospital, medical college and PG institute in central India. Apart from routine hernias, we have managed successfully some very rare varieties and developed management protocols. Here we are providing an analysis of these unusual presentations. Methods: This is a retrospective study in which we analyzed the data's of hernia patients presented in our institute over the period of 7 years (2008)(2009)(2010)(2011)(2012)(2013)(2014). Out of 765 patients, who were diagnosed having hernia, 680 were operated in our institute. Among these cases, we have selected 12 very rare and unusual cases which stood as diagnostic and management challenge and which were operated by a single surgeon and his team. Results: Out of the 12 cases of atypical hernias, 11 patients underwent surgical intervention. There was no mortality. 6 patients had some postoperative complications which were managed during their Hospital stay only. After discharge, all the patients were followed at regular intervals. There was no recurrence or other complication noted in 1 year follow up. Most common post-op complication was seroma which was seen in 50% of the operated patients. Other complications were wound infection (16.66%) and wound dehiscence (8.33%). Conclusions:The infrequent encounter with the unusual varieties of Hernias can lead to the mental bias and becomes a diagnostic challenge for the general surgeon. The purpose of publication of these rare varieties is to increase our spectrum of knowledge and to provide diagnostic and therapeutic armamentarium to deal with these difficult situations.

A Busoga Hernia: A Rare Case Report in India

“…Inguinal hernias present a wide spectrum of scenarios. Approximately 30% of cases remain asymptomatic, and up to 50% of individuals are unaware of their hernia [14]. Some cases present with emergent symptoms unrelated to the hernia, as hernia repair is typically an elective procedure unless strangulated or obstructed.…”

“…BH typically presents as a small hernia containing small gut, often of the Richter variety, and may lack a peritoneal sac, with only the urinary bladder or extraperitoneal fats being herniated. Management of BH is generally similar to that of inguinal hernias, prioritizing the identification of the sac, meticulous dissection to avert unintentional injury to the hernial contents, and efficient closure to strengthen the weak wall [14]. Notably, there are no documented case reports of BH in individuals of Indian origin, underscoring the importance of reporting such cases.…”

Incisional hernia secondary to suprapubic catheter insertion: a case report and literature review

“…Given its rarity, not surprisingly, the true incidence and prevalence are unknown. However, in an analysis of the data in the centre of Jain and Venkatesh, 1 the authors have only come across two incisional herniae secondary to suprapubic catheters out of 680 patients operated over 7 years by a single surgeon and his team.…”

Challenging hernias: a case series of atypical hernias and review of literature

“…Out of the above, 4 were managed in an elective setting, while 2 were managed as emergencies. 3 of the above developed post-operative complications in the form of wound infection (1), flap necrosis (1) and respiratory compromise (1). All of the above complications were successfully managed and mitigated during the hospital stay and all of the above patients were discharged in health.…”