Hernia : the journal of hernias and abdominal wall surgery
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Inguinal hernias are classified anatomically into indirect and direct types. We illustrate two cases of an inguinal hernia where the defect was demonstrated to lie between the deep ring and the inferior epigastric vessels, therefore, not fitting the standard criteria for either direct or indirect inguinal hernias. Taking this into account, we propose that the hernia which we describe should either be considered as a completely new type of inguinal hernia or, alternatively, all of the currently accepted classifications should be changed or adapted to incorporate it.
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In many centers in sub-Saharan Africa, adults and children aged over 12 years with indirect inguinal hernias are treated with Bassini's herniorrhaphy with many avoidable complications. The objective of this study was to determine the applicability of herniotomy in patients aged between 12 and 45 years. ⋯ Herniotomy was found to be safe, applicable, beneficial, and cost-effective in this age group, with many advantages over Bassini's herniorrhaphy.
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Chronic post-operative pain (CPP) following laparoscopic inguinal hernia repair (LIHR) may cause significant morbidity and be more problematic than recurrence. Determining pre-operative risk may reduce morbidity. Our aim was to determine prevalence of CPP following LIHR and identify risk factors for its development. ⋯ Chronic post-operative pain following LIHR is more prevalent than recurrence. Pre-operative pain, surgery for recurrent inguinal hernias (following anterior repair) and younger age at surgery predict development of CPP. Identification of 'high-risk' patients may improve management, reducing morbidity and cost.
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Review Case Reports
Soft right chest wall swelling simulating lipoma following motor vehicle accident: transdiaphragmatic intercostal hernia. A case report and review of literature.
Intercostal herniation of abdominal contents through a diaphragmatic defect is rare. We report a case of transdiaphragmatic intercostal hernia secondary to blunt trauma, initially misdiagnosed as lipoma, later confirmed by CT scan. ⋯ A thorough physical examination may suggest the diagnosis, but confirmation by chest radiograph, CT scan, and sometimes by gastrointestinal contrast studies is often helpful for preoperative planning. A high index of suspicion for diaphragmatic injury or intercostal herniation during the initial evaluation, coupled with chest and abdominal diagnostic testing once the patient is stable, can avert undue delay in diagnosis and catastrophe from incarceration of a hernia.
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The literature is inconclusive regarding the effect of local infiltration anaesthesia on the risk of recurrence after groin hernia repair. ⋯ These extensive nationwide data suggest that surgical experience and hernia type may be important factors for reoperation, and that it is independent of the type of anaesthesia. When performed in general hospitals, local anaesthesia may be a risk factor for recurrence after primary repair of a direct hernia.