Repair of lower abdominal incisional hernia is always a surgical challenge. TAPE technique has been described for the repair of supra-pubic midline incisional hernia with satisfactory outcome. Its indication can be extended for treatment of non-midline lower abdominal hernia. Peritoneal incision is created just below the hernia defect with pre-peritoneal dissection to expose supra-pubic preperitoneal space with Cooper's ligament exposed. Non-adhesive mesh then placed over preperitoneal space and partially intra-peritoneally, and cover the whole extra-peritoneal space prepared to ensure enough overlapping. Mesh is fixed by tackers for intra-peritoneal part, most inferior fixation points were at peritoneal incision line. Extra-peritoneal part of meshes is fixed at the safety zone and covered up by the peritoneal flap to avoid mesh migration. Fixation of the meshes at the lateral aspects were facilitated by the peritoneal flap and subsequent fibrosis and adhesion to the extra-peritoneal structures in cases of lateral lower abdominal hernia. Repair of midline and lateral lower abdominal incisional hernia with this novel modified technique with prosthetic mesh is safe and effective. A larger case series and longer follow-up is required for validation of this technique.
Fibrosis ; Follow-Up Studies ; Hernia ; Hernia, Abdominal ; Hernia, Ventral* ; Incisional Hernia ; Ligaments

Obturator hernia is a rare type of hernia, which is difficult to detect early because of its nonspecific symptoms. A delayed diagnosis could lead to high morbidity and mortality. We experienced an unusual patient who had multiple hernias including an obturator hernia. A very thin 85-year-old woman visited hospital complaining of pain in the right thigh and knee. One week later, she was admitted again due to whole abdominal pain and vomiting. The abdominal simple radiographs showed a small bowel obstruction. On Abdominal CT, a herniated small bowel was located between the right pectineus muscle and the right external obturator muscle. A concomitant right inguinal hernia, which contained fatty tissue, was observed. A coincidental hernia of the stomach into left chest was also noted. Laparotomy revealed a strangulated small bowel in a right-sided obturator foramen and an impacted omentum in a right-sided inguinal canal. The terminal ileum was perforated at the proximal site from the incarcerated portion. A 10 cm length ileum including the perforation site was resected, which was followed by a primary anastomosis. The hernial defect was closed with a prosthetic mesh plate. In conclusion, the use of a of permanent mesh in an obturator hernia is a adequate method for closing an obturator hernia.
Abdominal Pain ; Adipose Tissue ; Aged, 80 and over ; Delayed Diagnosis ; Female ; Hernia ; Hernia, Hiatal* ; Hernia, Inguinal* ; Hernia, Obturator* ; Humans ; Ileum ; Inguinal Canal ; Knee ; Laparotomy ; Mortality ; Omentum ; Stomach ; Thigh ; Thorax ; Tomography, X-Ray Computed ; Vomiting

Since large-scale popularization of the surgical treatment of hernia in the 1990s, China has made great process in the field of hernia and abdominal wall surgery. In the treatment of incisional hernia of abdominal wall, a relatively complete system has been established in China, for instance, the formulation of guidelines, the purpose of incisional hernia treatment, the principle of surgical treatment, the choice of surgical methods, the improvement of material application, standardized treatment process, optimized management system. Common procedures of incisional hernia are open operations, including direct repair suture, bridging repair, and separation techniques of tissue construction. Meanwhile, the laparoscopic repair develops quickly in China as well. Compared with Western countries however, we still have a long way in overall level, for instance, treatment innovation, data integrity accumulation, quality control, technical innovation, new materials research, and monitoring of side-effects of implant materials. What we should consider and pay attention to is how to further develop hernia surgery and make it sustainable. Based on surgical experiences of incisional hernia in China, this paper intends to share the modern knowledge of incisional hernia and abdominal wall surgery.
Abdominal Wall ; China ; Hernia ; Hernia, Ventral ; Herniorrhaphy ; Humans ; Incisional Hernia ; surgery ; Laparoscopy ; Surgical Mesh

Hiatal hernia and Morgagni hernia are sorts of diaphragmatic hernias that are rarely detected on transthoracic echocardiography. Although echocardiographic findings have an important role for differential diagnosis of cardiac masses, we often might overlook diaphragmatic hernia. We report three cases of diaphragmatic hernias having specific features. The first case is huge hiatal hernia that encroaches left atrium with internal swirling flow on transthoracic echocardiography. The second case is a hiatal hernia that encroaches on both atria, incidentally detected on preoperative echocardiography. The third case is Morgagni hernia which encroaches on the right atrium only. So, we need to consider possibility of diaphragmatic hernia when we find a cardiac mass with specific echocardiographic features.
Diagnosis, Differential ; Echocardiography ; Heart Atria ; Hernia ; Hernia, Diaphragmatic* ; Hernia, Hiatal

We report a distinctive case of a large traumatic diaphragmatic hernia (TDH) that presented 36-years after the preceding injury. We believe this case represents the most delayed (TDH) presentation ever reported in Korea. This paper describes the particular presentation, including the operative and postoperative management of this patient. We also review the management of long delayed TDH presentation and the postoperative issues concerning thoracic cavity dead space and propensity of the repaired diaphragm for developing abdominal compartment syndrome.
Diaphragm ; Hernia ; Hernia, Diaphragmatic, Traumatic ; Humans ; Intra-Abdominal Hypertension ; Korea ; Thoracic Cavity

Laparoscopic ventral hernia repair is performed less frequently than open repair because some ventral hernias are unsuitable for laparoscopic repair and the complications are more severe than those of open repair. However, currently, the incidence of laparoscopic hernia surgery has been gradually increasing. The technique for laparoscopic ventral hernia repair depends on the shape, size, location, number, recurrence, and symptoms of the hernia. Computed tomography (CT) is the most accurate method for identifying these factors. Ventral hernia repair begins with an approach to the peritoneal space. Having adequate space to place the mesh is the most important step in surgery. Cosmetic and medical results of primary closure of the hernia margin are superior to those of the bridging technique in laparoscopic ventral hernia repair. However, if primary closure is not possible, the component separation technique can be used to narrow the defect for primary repair of a ventral hernia. Making the abdominal skin flap during the conventional component separation technique can injure the perforator vessels in the abdominal wall, and an injured perforator shuts down the blood supply to the subcutaneous tissue of the abdomen, which then becomes necrotic. To prevent such complications, a perforator-preserving technique can be performed, such as the laparoscopic and posterior component separation techniques. Complications of laparoscopic ventral hernia repair include seroma, hemorrhage, intestinal injury, mesh infection, and recurrence. Mesh infection is one of the most severe complications that sometimes requires reoperation. To prevent infection, it is necessary to minimize contact between the mesh and skin during the surgical procedure.
Abdomen ; Abdominal Wall ; Hemorrhage ; Hernia ; Hernia, Ventral* ; Incidence ; Incisional Hernia ; Laparoscopy ; Methods ; Recurrence ; Reoperation ; Seroma ; Skin ; Subcutaneous Tissue

Incisional or ventral hernia is a very common multifactorial disease that requires surgery to prevent complications, including pain, discomfort, bowel obstruction, incarceration, and strangulation. To perform herniorrhaphy, it is essential to understand the pathogenesis of hernia, the anatomy and physiology of the abdominal wall, and surgical techniques. Several repair methods are available, including open suture repair, open mesh repair, the component separation technique, and tissue expansion assisted closure. Currently, laparoscopic incisional or ventral hernia repair is commonly used with the major advantage being the lower recurrence and all defects can be addressed at the time of surgery as well as reduced postoperative pain and length of hospital stay. On the other hand, to do it properly, a full understanding and appropriate selection of mesh and management of probable complications, such as seroma, bowel injury, enteric fistula, and recurrence, is essential. Therefore, the surgeon and the techniques used are of paramount importance in the repair of incisional ventral hernias.
Abdominal Wall ; Fistula ; Hand ; Hernia ; Hernia, Ventral* ; Herniorrhaphy ; Incisional Hernia ; Length of Stay ; Pain, Postoperative ; Physiology ; Recurrence ; Seroma ; Sutures ; Tissue Expansion

Abdominal incisional hernia is the result of the loss of the integrity and tension balance of the abdominal wall. According to clinical manifestation and physical examination, most incisional hernia can be clearly diagnosed. For small and concealed incisional hernia, the diagnosis can be confirmed by imaging examination. According to size of defect, it can be divided into small, middle, large, and giant incisional hernia. According to location of lesion, it can be divided into incisional hernia in the central or peripheral region of the anterior abdominal wall, in the lateral abdominal wall, and in the back. According to the presence of recurrence, it can be divided into primary and recurrent incisional hernia. Patients with definite diagnosis and suitable for surgical treatment after risk assessment are recommended for elective surgery. For patients who are not suitable for surgery, appropriate abdominal bandages are recommended to limit the development of incisional hernia. Surgical methods:(1) Simple suture repair is suitable for small incisional hernia; (2) Reinforcement repair using materials is recommended for middle incisional hernia or above; (3) When the materials are used in open repair, onlay and sublay methods are usually adopted. (4) IPOM or underlay methods are always adopted when materials are used for laparoscopic repair; (5) Hybrid repair is performed by combining open and laparoscopic techniques; (6) Methods to increase the abdominal cavity capacity include compartmental separation technology(CST) and lateral transverse abdominal muscle release technology (TAR); (7) Abdominal wall reconstruction with muscle fascial flap can be supplemented with mesh. According to the clinical practice of our country in the recent 4 years and based on "China Guideline for Diagnosis and Treatment of Incisional Hernia (2014 edition)", the " China Guideline for Diagnosis and Treatment of Incisional Hernia (2018 edition) " was completed after discussion and consultation with more than 50 experts and scholars in China. The definitions, etiology, pathophysiology, classification, diagnosis, differential diagnosis, treatment were comprehensively updated, and the viewpoints, measures and methods supported by evidence-based medicine were pointed out. The relevant medical institutions and surgeons in China are requested to carry out the guide according to actual clinical reference.
Abdominal Wall ; China ; Hernia, Ventral ; Herniorrhaphy ; Humans ; Incisional Hernia ; diagnosis ; surgery ; Recurrence ; Surgical Mesh

PURPOSE: In the field of pediatric surgery, neonatal surgery occupies a special portion and has clinical varieties. Recently many associated physicians, such as pediatric surgeons, neonatologists, anesthetists, pathologists and radiologists, work collaboratively for care. This study was designed to identify characteristics of neonatal surgery based on clinical experiences in a single institute. METHODS: Neonates receiving operation during a 5-year period between Jan. 2003 and Dec. 2007 in Pusan National University Children's Hospital were reviewed. Patients were divided into 2 groups of age after birth; early neonatal (before 7 days) and late neonatal period (after 7 days) and the operation was classified as a primary procedure for definite treatment and a staged procedure including 2nd look operation. We analyzed their clinical data and postoperative results. RESULTS: 286 cases of neonates were included during this period, 118 cases (41.3%) in early neonatal and 168 (58.7%) in late neonatal period. Distribution of diseases was as follows, sequentially; 60 (21.0%) anorectal malformations, 46 (16.1%) intestinal atresia, 44 (15.4%) Hirschsprung's disease, 35 (12.2%) necrotizing enterocolitis, 24 (8.3%) hypertrophic pyloric stenosis, 20 (6.9%) inguinal hernia, 13 (4.5%) malrotation, 9 (3.1%) tumor, 8 (2.7%) diaphragmatic hernia, 6 (2.0%) abdominal wall defect and 21 (7.3%) others. According to the operation, a primary procedure was performed in 205 cases (71.7%) and a staged procedure in 81 cases (28.3%). The morbidity and mortality was 3.1% and 2.8% respectively. CONCLUSION: When considering morbidity and mortality after neonatal surgery for patients who have associated anomalies, collaborative care is necessary to expect a good outcome.
Abdominal Wall ; Enterocolitis, Necrotizing ; Hernia, Diaphragmatic ; Hernia, Inguinal ; Hirschsprung Disease ; Humans ; Infant, Newborn ; Intestinal Atresia ; Pyloric Stenosis, Hypertrophic

This is a case report of a sliding hiatal hernia with severe gastroesophageal reflux (GER) after repair of congenital diaphragmatic hernia(CDH). It was not possible to determine whether the hiatal hernia is a de novo lesion which was missed at the original operation or a consequence of overzealous repair of the Bochdalek defect at the expense of weakening of the diaphragmatic crura. This case demonstrates that a sliding hiatal hernia can be a cause of severe gastroesophageal reflux that should be managed surgically.
Gastroesophageal Reflux ; Hernia ; Hernia, Hiatal ; Hernias, Diaphragmatic, Congenital ; Herniorrhaphy