Recurrent inguinal herniorrhaphy: the centripetal approach utilizing a pre-formed polypropylene plug.

Background: Recurrence is the most common complication of inguinal herniorrhaphy and its mending carries an unacceptably high recurrence rate. During the development of a hernia clinic we initially repaired recurrent inguinal hernias using the Shouldice technique which requires complicated dissection followed by tissue approximation under tension. The necessary tissue exposure may injure anatomical elements incorporated into the scarred tissues.

Inguinal herniorrhaphy: 25-year results of technical improvements leading to reduced morbidity in 4,029 patients.

Since 1981, 4,029 consecutive inguinal herniorrhaphies (IH) were performed under protocol utilizing several emerging techniques progressively incorporated to lower complication rates. Patients were operated with identical protocols from 1981 to 1988 at a teaching institution (Group A patients) and from 1988 till the present at two community hospitals (Group B patients). Emergent techniques were sequentially incorporated, progressing from a modified Shouldice approach to the Rives technique, Lichtenstein rolled plugs, and finally to the Rutkow-Robbins mesh plug.

Postmesh herniorrhaphy wound infections: can they be eliminated?

The present infection rate of 3 to 4% for inguinal herniorrhaphy should be considered unacceptable. Modern understanding of bacterial film formation, dynamics, and molecular composition should allow the performance of virtually infection-free inguinal and ventral herniorrhaphy. In our service, the reinstitution of accepted and time-tested aseptic regimens combined with antiseptic measures consisting of 1 gram of intravenous cefazolin administered 1 hour before surgery plus frequent wound irrigations with a solution of 80 mg of gentamycin sulphate dissolved in 250 ml of normal saline solution have yielded an infection rate of 0.

Infection control in a hernia clinic: 24 year results of aseptic and antiseptic measure implementation in 4,620 "clean cases".

Post Mesh Herniorrhaphy Infection [PMHI] occurs between 3 to 4% of inguinal and 8 to 14% of ventral herniorrhaphies producing an unacceptably high morbidity. Before opening a Hernia Clinic, our infection rate was around 5% for "clean" inguinals and 8% for "clean" ventral herniorrhaphies. Starting in 1982 we implemented a stricter operative aseptic protocol plus the per-operative administration of 1 g of intravenous Cefazolin.

Spigelian and other uncommon hernia repairs.

This article offers an overview of abdominal wall hernias, which are uncommon because of the unusual contents of their sacs. These include: Meckel's diverticulum, segments of the intestinal wall antimesenteric border, the vermiform appendix, the bladder; plus the penetration by the sac within the different muscle layers of the abdominal wall. These hernias present diagnostic difficulties and some are associated with high morbidity, but modern technology may help their prognosis.

Groin pain in the absence of hernia: a new syndrome.

Groin pain may be produced by a true hernia, trauma to the groin structures or peripheral nerve, or root compression at various levels. Approximately 4,000 patients underwent inguinal herniorrhaphy (group A). An additional 134 patients complaining of groin pain and exhibiting no evidence of primary or recurrent hernia fell into two categories: 30 patients who had a previous herniorrhaphy (group B) and 104 patients without previous surgery (group C).

Hernia clinic in a teaching institution: creation and development.

The hypothesis that a hernia clinic could improve the results of external abdominal wall herniorrhaphy was tested in a teaching institution. From 1980 to 1988, all patients exhibiting external abdominal wall hernias were treated under protocol and separate from general surgical patients in a hernia clinic directed by a dedicated surgeon. The incidence of recurrence, infection, and testicular ischemia was significantly better than our previous institutional results.

Pathophysiology, prevention, and management of prosthetic infections in hernia surgery.

Because hernias are repaired increasingly with mesh and plugs, surgeons performing these operations should make an extended effort to prevent infection, and, when infections occur, to treat them expeditiously. This article discusses bacterial binding, infection reduction, the patient-doctor relationship during the care of an infected wound, and other related topics.

Spigelian hernias: a new repair technique using preshaped polypropylene umbrella plugs.

The spigelian hernia is a rare kind of abdominal wall defect that has been treated using a variety of techniques. Recently, we encountered 6 patients with spigelian hernias in whom we have used a new modality consisting of the tension-free occlusion of the hernia ring with a preshaped polypropylene umbrella-type plug. The follow-up was more than 1 year without evidence of recurrence.

Hernia repair with expanded polytetrafluoroethylene.

Prostheses of expanded polytetrafluoroethylene (e-PTFE) were used to repair 89 abdominal wall defects in which primary closure would produce undue tension on tissue. Over a 52-month period (median follow-up: 24 months), we observed three wound infections, one in a clean wound, and four hernia recurrences. No other complications were noted.

Inguinal herniorrhaphy. Reduced morbidity by service standardization.

To ascertain if service specialization and procedure standardization would improve the complication rate of inguinal herniorrhaphy, the results of all inguinal herniorrhaphies performed during a 3-year period by board-certified general surgeons who also performed a variety of other procedures common to the field of general surgery, assisted by general surgical residents (group B, 390 patients), were compared in the same institution with the results of inguinal herniorrhaphy when performed during 3 years under protocol by a Hernia Service directed by a senior faculty member assisted by junior surgical residents (group C, 442 patients). Group B patients had essentially no follow-up until they reappeared for care at the Hernia Service, whereas patients in group C achieved an 82% 7-year follow-up. The infection and recurrence rates of group C patients (0.

Herniorrhaphy in the elderly. Benefits of a clinic for the treatment of external abdominal wall hernias.

Elective abdominal herniorrhaphy carries morbidity and mortality rates of 26 percent and 1.5 percent, respectively, in patients over 65 years of age. These figures climb to 55 percent and 15 percent during emergent surgery.

The management of recurrent inguinal hernias by muscle transposition--a preliminary communication.

Recurrent inguinal hernias occur almost exclusively in adult men. The rarity of both direct and recurrent hernias in women is due, among other factors, to the muscularity of an inguinal canal that has not been partially replaced by fibrous tissue to allow the passage of a large spermatic cord. Throughout the body, contractile dynamic muscular tissue resists strains and stresses better than do fascia and ligaments.

Chronic haematogenous osteomyelitis; studies on an experimental model.

The progression of acute haematogenous osteomyelitis into a chronic infection was investigated in a group of ten dogs in which the infection was produced by injection of micropaque barium mixed with Staphylococcus aureus or Salmonella Group C-2 into the tibial nutrient artery. Antibiotics were not used. Twenty four months later the infected limb of the surviving animals exhibited clinical, histological, radiological and microbiological changes which closely resembled those found in chronic haematogenous osteomyelitis (CHO) in humans.

Albumin shifts across the extracellular space secondary to experimental infections.

The pathway across tissue spaces of intravenously injected 125I albumin was studied in five dogs before and after the injection of Escherichia coli endotoxin by the use of perforated plastic capsules placed in the subcutaneous tissue. The already negative extracellular space pressure became less so after the endotoxin injection, when albumin was detected shifting from the intravascular space into the extracellular space compartment and then into the intralymphatic space. The injection of endotoxin produced a marked increase in the thoracic duct lymph flow, while, at the same time, erythrocytes entered the lymphatic stream.