Laparoscopic repair of recurrent inguinal hernias.

Background: Repair of recurrent inguinal hernias is associated with recurrence rates as high as 30% and complication rates higher than for primary hernias.

Patients And Methods: In a prospective study, results were evaluated after laparoscopic transabdominal preperitoneal hernia repair in 192 patients with 200 recurrent inguinal hernias. A total of 132 hernia repairs followed one previous repair, 41 followed two repairs, 17 followed three repairs, 6 followed four, 3 followed five, and 1 followed six previous repairs.

Sonography in the postoperative evaluation of laparoscopic inguinal hernia repair.

We evaluated the use of sonography as a means of assessing hernial occlusion and possible postoperative changes such as hematomas or seromas in the inguinal and scrotal regions after 1139 laparoscopic repairs of hernias between August 1992 and November 1994. Changes after laparoscopic hernia repair were found in 307 patients (27%). Hematomas or seromas were seen in 132 patients, protrusion of the prosthetic mesh in 17, mesh infection in two, and small bowel entrapment in an insufficient peritoneal suture in two.

[Laparoscopic surgery of inguinal hernia by transperitoneal implantation of an artificial mesh. Technique and early results].

We report on 250 patients with 342 inguinal hernias operated laparoscopically by pre-peritoneal implantation of a prosthetic mesh. 167 hernias were indirect, 175 direct, including 92 bilateral, 71 recurrent and 4 femoral hernias. There were four major complications: two lesions of the urinary bladder, treated in one case by laparotomy and two foreign body reactions against the mesh, which had to be removed.

[The effect of sonography on the therapeutic outcome in posttraumatic, postoperative and inflammatory soft tissue lesions].

A total of 135 patients with a suspected diagnosis of post-traumatic, postoperative or inflammatory soft-tissue lesions were examined by ultrasound. The majority of patients (n = 48) showed post-traumatic soft-tissue hematomas with or without muscle rupture. Post-operative hematomas were found in 23 and hematomas after anticoagulation therapy in 4 patients.

[The value of seminal vesicle sonography in transrectal ultrasonic examination of the prostate].

During the course of four and a half years, transrectal sonography was performed in 724 men; in each case the seminal vesicles and prostate were evaluated. In 149 examinations, changes were found in the seminal vesicles and in 143 of these, the sonographic finding suggested that the changes were due to prostatic disease. In 95 histologically proven prostatic carcinomas, infiltration of the seminal vesicles could be demonstrated.

The value of sonography in the diagnosis and follow-up of patients with blunt renal trauma.

Eighty-eight patients with blunt renal trauma were examined sonographically. Rupture of the kidney was diagnosed in 41 patients and contusion of the kidney in 45. The correlation between operative findings, sonography and urography showed positive sonographic findings to be correct in all patients with rupture of the kidney.

Transrectal ultrasonography as a follow-up method in prostatic carcinoma after external beam and interstitial radiotherapy.

Transrectal ultrasonography and ultrasonometrics were employed for follow-up in a total of 28 prostatic carcinoma patients subjected to external beam or interstitial radiotherapy. These two methods permit more accurate staging of prostatic carcinoma and have also proved to be valuable in the follow-up care of patients suffering from locoregional prostatic carcinoma. Of the 20 patients subjected to external beam radiotherapy four patients initially did not show capsular infiltration, 2B2, 2A2, whereas 16 patients presented with infiltration of the capsule and seminal vesicles.

Ultrasound in patients with blunt renal trauma managed by surgery.

We investigated 24 patients with blunt renal trauma by excretory urography plus nephrotomography and ultrasound. The results of these investigations were correlated with the operative findings. The ultrasound diagnosis was correct in 16 of 18 patients with parenchymal injuries.

Clinical significance of sonography of the ureter.

The relevance of sonography compared with conventional methods is demonstrated by means of 103 patients investigated with obstruction of the ureter. The knowledge of the exact topographic anatomy of the ureter in all sections enables the experienced investigator to demonstrate cause and position of ureteral obstruction by sonography in up to 75% of cases. Ultrasound is not sufficiently accurate to be used as the primary modality, but could be the initial modality in specific circumstances such as pregnancy, children or patients with a history of reaction to contrast media.

[Value of sonography following pancreas transplantation].

The authors report on 15 patients with pancreas transplants hospitalised at their clinic and treated appropriately between 1979 and 1984. Nine of these patients were subjected to control sonography directly after the operation and subsequently once weekly. The sonographic findings were compared with laboratory data and the clinical course of the patients' condition.

[Sonographic monitoring in blunt abdominal injuries in children].

Sonography is nowadays the most important examination in diagnosing lesions of the parenchymatous organs after blunt abdominal trauma. Also for monitoring this method is recommended. Under the premises of 1.

[Sonographic diagnosis of an aneurysm of the superior mesenteric artery].

This is a report on a patient with a mycotic aneurysm of the superior mesenteric artery proved by histology. Because of a marked intolerance of contrast media we abstained from angiography. It is shown that real-time sonography gives a definite diagnosis, if the multiple vascular structures of the upper abdomen are precisely identified.

[Value of sonography for acute diagnosis and for further examination of blunt abdominal trauma in children].

For the investigation of the abdomen following blunt trauma there are, in addition to clinical examination, peritoneal lavage, laparoscopy, sonography, CT and scintigraphy. Sonography has proved particularly reliable without stressing the patient. This has been demonstrated by the examination of 73 children in whom there was only one false positive and no false negative finding.

[Echographic differential diagnosis of scrotal contents. A contribution to evaluation of the method].

Ten patients were selected from a clinical material comprising 336 sonograms of the scrotal contents in order to discuss the differential diagnosis of testicular and extra-testicular conditions. The decision whether a tumour is testicular or extra-testicular does not usually pose a problem, but may be impossible for small peripheral tumours. The shape of the epididymis and vas deferens and the structure of the testes is of significance in the differentiation between torsion and epididymitis.

[Use of an improved simultaneous film cassette in linear tomography].

An improved simultaneous tomography cassette according to P. Landau was tried out for four months using four tomographs in routine work. The mode of operation is based on accurate control of the relative speeds of the individual x-ray films resulting in simultaneous imaging of 6 equidistant tomographic levels.

[Percutaneous ultrasound-controlled drainage of liver abscesses].

By means of 20 liver abscesses in fourteen patients it is described how percutaneous drainage of abscesses can be applied. Method, technique, indications, contraindications as well as possible complications of this procedure are described and illustrated in four cases. In addition both principal differences and common features of percutaneous sonographic drainage and incision of the abscess are described.

[Diagnosis of congenital pleuropericardial defects].

Pleuro-pericardial defects have been found incidentally during post mortems or chest surgery but, because of their usual lack of symptoms, are rarely found otherwise. If suspicion of such a malformation arises, it should be clarified because of possible herniation of the atrium or ventricle. The necessary diagnostic steps are discussed in relation to two patients and the value of chest x-rays is stressed.

[Comparative histopathologic and sonomorphological prostate studies].

Ten cadaver prostates were divided into 50 sections and corresponding sections were compared, using ultrasound, with respect to their echogenic structure and histomorphology. The results of normal prostatic tissues, benign prostatic hyperplasia and prostatic carcinomas are described and discussed. It was shown that malignant prostatic lesions showed echo-poor sonograms in vitro.

[Sonography of the lower urinary tract].

According to literature and to our experiences sonography should be the first investigation of the lower urinary tract in children, if there is suspicion of obstruction or malformation. In many cases the localisation of obstruction or the diagnosis of malformation can be found. Furthermore by sonographic follow-up studies of ureter obstructions by tumors, by concrements or after surgery, the normal radiographic investigations like urography or retrograde pyelography can be reduced.

Sonometrics of the prostate.

Determination of prostatic size by rectal examination is inaccurate if objective and reproducible values are desired. Sonometrics, a combination of transrectal sonography and biometrics, is a simple method to determine prostatic weight. The optomanual image analyzing system (BIT PAD-TRS 80) consists of a digitizer tablet, cursor, processing unit and keyboard (TRS 80).

[Classification of bladder tumours by sonography (author's transl)].

Sonography was used for classifying bladder tumours by the T.N.M.