ACUTE INGUINAL HERNIA RECURRENCE; A REALITY ......Hernia occupies 10-15% of all surgical procedures....
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217 ABSTRACT Operation for inguinal hernia is one of the most commonly perform General surgical procedures in both children and adults. Defective surgical technique is thought to be the prime cause of recurrence. In this case report we are presenting a patient who was operated for left sided indirect inguinal hernia and presented within two weeks with recurrent strangulated inguinal hernia. Through this case report we wanted to see whether there are factors other than technical failure responsible for early recurrence of inguinal hernia. Literature review reveals that factor such as smoking previous history of recurrence;non mesh surgery and connective tissue problems are also responsible for recurrence. KEYWORDS: Inguinal hernia, Lichtenstein Repair, Totally Extraperitoneal Procedure (TEP), Transabdominal Preperitoneal Procedure (TAPP). CASE REPORT ACUTE INGUINAL HERNIA RECURRENCE; A REALITY NOT MYTH 1 1 2 OMAR SHAHZAD ALTAF , IHTASHAM MUHAMMAD CH , MALIHA YUNUS , 2 3 4 SALMAN AHMED TIPU , MUMTAZ AKHTAR , YASIR MASOOD KIANI 1. Assistant Professor 2. Associate Professor 3. Senior Registrar 4. Registrar Orthopedic Department of Surgery Al-Nafees Medical College & Hospital Isra University, Islamabad Campus, Islamabad Correspondence to: Dr. Omar Shahzad Altaf Assistant Professor of Surgery Al-Nafees Medical College & Hospital Isra University, Islamabad Campus, Islamabad E-mail: [email protected] ISRA MEDICAL JOURNAL | Volume 6 - Issue 3 (S) | Jul - Sep 2014 INTRODUCTION Hernia occupies 10-15% of all surgical procedures. Indirect inguinal hernia occurs in 55%, direct in 30% and pantaloon hernia in 15% of cases. Inguinal hernia is a leading cause of work 1 loss and disability . A large number of surgical procedures for inguinal hernias were developed over the years. Overall inguinal hernias can be operated by either anterior or posterior approach. Anterior approaches include open surgical 2 procedures like Lichtenstein's technique . The posterior approaches include mainly of laparoscopic procedures. The two major laparoscopic approaches include TAPP (transabdominal preperitonial) procedure and TEP (totallyextraperitonial) 3 procedure . Defective surgical technique is thought to be the prime cause of recurrence. Influence of a defective connective tissue, on hernia recurrence lead to assumption that endogenous or exogenous patient related factors also are 4 important in recurrent hernia . The open mesh repair when compared to suture repair has proven to be superior in terms of low recurrence , but still there is no gold standard for inguinal hernia repair. Mesh repair is becoming increasingly popular. The studies reveal that application of mesh does not prevent hernia recurrence totally, 1 rather it is delayed . CASE REPORT Patient 65 year of age known case hepatitis C virus presented with swelling left inguinal area for 15 months. The swelling was reducible cough and pulse positive, non tender. A clinical diagnosis of left sided reducible incomplete indirect inguinal hernia was made. He had a history of right sided Hernioraphy 18 years ago. Operative findings were an indirect hernia with no contents. Post operative recovery was uneventful and the patient was discharged. th The patient was readmitted on 14 post- operative daywith a tense tender swelling left inguinal area for 3 days. He also had abdominal distension and absolute constipation. On examination swelling was irreducible cough impulse was negative and it was tender. Abdominal examination revealed a tense, tender and distended abdomen with absent bowl sounds. Vitally patient had tachycardia and tachypnea. He was afebrile. Except for raised TLC rest of the labs were all within normal limit. A clinical diagnosis of recurrent strangulated left inguinal hernia was made. Ultrasound abdomen and inguinal area was ordered which showed that the left sided inguinal swelling contained gut with aperistaltic gut loops. The patient was resuscitated and was shifted to OT. Left sided inguinal exploration was done, per operative findings were strangulated left sided direct inguinal hernia coming from medial side of mesh. Contents included one foot of gangrenous ileum with sero sanguineous fluid in the sac. Resection and anastomosis of ileum was done. Patient was shifted to surgical ICU. Post op recovery was uneventful and patient was discharged. FIG – 1: PREOPERATIVE PICTURE SHOWING LEFT SIDED INGUINAL SWELLING
Transcript of ACUTE INGUINAL HERNIA RECURRENCE; A REALITY ......Hernia occupies 10-15% of all surgical procedures....
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ABSTRACT
Operation for inguinal hernia is one of the most commonly perform General surgical procedures in both children and adults. Defective surgical technique is thought to be the prime cause of recurrence. In this case report we are presenting a patient who was operated for left sided indirect inguinal hernia and presented within two weeks with recurrent strangulated inguinal hernia. Through this case report we wanted to see whether there are factors other than technical failure responsible for early recurrence of inguinal hernia. Literature review reveals that factor such as smoking previous history of recurrence;non mesh surgery and connective tissue problems are also responsible for recurrence.KEYWORDS: Inguinal hernia, Lichtenstein Repair, Totally Extraperitoneal Procedure (TEP), Transabdominal Preperitoneal Procedure (TAPP).
CASE REPORT
ACUTE INGUINAL HERNIA RECURRENCE; A REALITY NOT MYTH1 1 2OMAR SHAHZAD ALTAF , IHTASHAM MUHAMMAD CH , MALIHA YUNUS ,
2 3 4SALMAN AHMED TIPU , MUMTAZ AKHTAR , YASIR MASOOD KIANI
1. Assistant Professor 2. Associate Professor 3. Senior Registrar4. Registrar Orthopedic
Department of SurgeryAl-Nafees Medical College & HospitalIsra University, Islamabad Campus, Islamabad
Correspondence to:Dr. Omar Shahzad AltafAssistant Professor of SurgeryAl-Nafees Medical College & HospitalIsra University, Islamabad Campus, IslamabadE-mail: [email protected]
ISRA MEDICAL JOURNAL | Volume 6 - Issue 3 (S) | Jul - Sep 2014
INTRODUCTION
Hernia occupies 10-15% of all surgical procedures. Indirect inguinal hernia occurs in 55%, direct in 30% and pantaloon hernia in 15% of cases. Inguinal hernia is a leading cause of work
1loss and disability . A large number of surgical procedures for inguinal hernias were developed over the years. Overall inguinal hernias can be operated by either anterior or posterior approach. Anterior approaches include open surgical
2procedures like Lichtenstein's technique . The posterior approaches include mainly of laparoscopic procedures. The two major laparoscopic approaches include TAPP (transabdominal preperitonial) procedure and TEP (totallyextraperitonial)
3procedure . Defective surgical technique is thought to be the prime cause of recurrence. Influence of a defective connective tissue, on hernia recurrence lead to assumption that endogenous or exogenous patient related factors also are
4important in recurrent hernia .The open mesh repair when compared to suture repair has proven to be superior in terms of low recurrence , but still there is no gold standard for inguinal hernia repair. Mesh repair is becoming increasingly popular. The studies reveal that application of mesh does not prevent hernia recurrence totally,
1rather it is delayed .
CASE REPORT
Patient 65 year of age known case hepatitis C virus presented
with swelling left inguinal area for 15 months. The swelling was reducible cough and pulse positive, non tender. A clinical diagnosis of left sided reducible incomplete indirect inguinal hernia was made. He had a history of right sided Hernioraphy 18 years ago. Operative findings were an indirect hernia with no contents. Post operative recovery was uneventful and the patient was discharged.
thThe patient was readmitted on 14 post- operative daywith a tense tender swelling left inguinal area for 3 days. He also had abdominal distension and absolute constipation. On examination swelling was irreducible cough impulse was negative and it was tender. Abdominal examination revealed a tense, tender and distended abdomen with absent bowl sounds. Vitally patient had tachycardia and tachypnea. He was afebrile. Except for raised TLC rest of the labs were all within normal limit. A clinical diagnosis of recurrent strangulated left inguinal hernia was made. Ultrasound abdomen and inguinal area was ordered which showed that the left sided inguinal swelling contained gut with aperistaltic gut loops.The patient was resuscitated and was shifted to OT. Left sided inguinal exploration was done, per operative findings were strangulated left sided direct inguinal hernia coming from medial side of mesh. Contents included one foot of gangrenous ileum with sero sanguineous fluid in the sac. Resection and anastomosis of ileum was done. Patient was shifted to surgical ICU. Post op recovery was uneventful and patient was discharged.
FIG – 1: PREOPERATIVE PICTURE SHOWING LEFT SIDEDINGUINAL SWELLING
