Hernia : the journal of hernias and abdominal wall surgery
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Randomized Controlled Trial
A pragmatic approach to cutaneous nerve division during open inguinal hernia repair.
Chronic pain following inguinal hernia repair may be related to the handling of cutaneous nerves. This study aims to investigate the frequency of cutaneous nerve division in routine practice and the effect that nerve division has on long-term pain outcomes. ⋯ The division of cutaneous nerves during inguinal hernia repair has no significant effect on postoperative pain. However, there are very few adverse outcomes, and so, a pragmatic approach of dividing nerves when they would otherwise be damaged may be appropriate.
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Blunt traumatic rupture of the diaphragm is a well known but uncommon event of thoracoabdominal traumatic injuries. It occurs in 1-5% of polytrauma patients and requires a high degree of suspicion for a rapid diagnosis. ⋯ A case of herniated splenic colic flexure through a defect in the left hemidiaphragm and the subsequent development of colon cancer in this area are presented. We emphasize the importance of making a prompt diagnosis in order to avoid further morbidity and mortality in this rare clinical entity.
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Case Reports
Subcutaneous emphysema: a rare manifestation of a perforated diverticulitis in a patent inguinal canal.
Patients with complicated diverticulitis rarely present with extraperitoneal manifestations but the manifestation of subcutaneous emphysema appears even more seldom. We present the case of a patient with a history of diabetes and immunosuppression, who was admitted with sepsis in association with cellulitis and subcutaneous emphysema of the left groin. ⋯ The final diagnosis was a perforated diverticulitis in a patent inguinal canal, which was only revealed after surgery. The various complications of diverticulitis, including extraperitoneal manifestations, and associated microorganisms implicated in cellulitis and subcutaneous emphysema are briefly reviewed.
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Necrotizing fasciitis is an acute surgical condition that demands prompt and multi-faceted treatment. Early recognition, aggressive surgical debridement, and targeted antibiotic therapy significantly affect the overall course of treatment and survival. ⋯ Two comorbidity factors (extreme obesity, diabetes) and the late diagnosis of necrotizing fasciitis, the latter masked by celullitis and phlegmona of the abdominal wall, resulted in overdue adequate surgical treatment. The combination of these factors contributed to medical treatment failure and, consequently, a lethal outcome.
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The use of prostheses in inguinal hernia repair reduces the incidence of recurrence. Quality of life and pain after hernia repair are largely correlated with the technique and type of prosthesis. ⋯ The utilization of beta-D: -glucan-coated mesh did not involve more recurrence and was accompanied by a significant decrease in chronic pain at 2 years, independent of the technique. After 2 years, the results of hernia repair show that the choice of prosthesis was more determinant than choice of technique.