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Epigastric Hernia

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1. Mesh OR Patch for Hernia on Epigastric and Umbilical Sites (MORPHEUS-Trial): The Complete Two-year Follow-up

Mesh OR Patch for Hernia on Epigastric and Umbilical Sites (MORPHEUS-Trial): The Complete Two-year Follow-up The objective of this trial was to identify a superior method for umbilical and epigastric hernia repair in terms of complications. Complications such as an extended operation duration, additional use of painkillers, reoperation, infection, seroma, extended wound care, extended hospitalization, and early recurrence were reported according to the Clavien-Dindo grading system.Over (...) the years mesh repair is proven the gold standard for umbilical and epigastric hernias. The question remains, which mesh should be used?In this randomized controlled, multicenter trial, all patients ≥ 18 years with a single, symptomatic, and primary small umbilical or epigastric hernia qualified for inclusion. Flat preperitoneal polypropylene mesh repair was compared with patch repair (PROCEED Ventral Patch) (PVP).A total of 352 patients were randomized; 348 patients received the intervention (n = 177

2018 EvidenceUpdates

2. Mesh Versus Patch Repair for Epigastric and Umbilical Hernia (MORPHEUS Trial); One-Year Results of a Randomized Controlled Trial

Mesh Versus Patch Repair for Epigastric and Umbilical Hernia (MORPHEUS Trial); One-Year Results of a Randomized Controlled Trial This trial is a randomized controlled, patient-blinded, multicentre, superiority trial.All patients ≥18 years with a single, symptomatic and primary umbilical or epigastric hernia (<2 fingers) qualified for participation in the study. Flat polypropylene mesh repair was compared to patch repair (PROCEED® Ventral Patch) (PVP). The objective of this trial was to identify (...) a superior method for umbilical and epigastric hernia repair in terms of complication rates.A total of 352 patients were randomized in this trial; 348 patients received the intervention (n = 177 PVP vs. n = 171 mesh). No peri-operative complications occurred. PVP placement was significantly faster compared to mesh placement (30 min, SD 11 vs. 35 min, SD 11) and was scored as an easier procedure. At 1-month follow-up, 76 patients suffered any kind of complication. There was no significant difference

2017 EvidenceUpdates

3. Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Open Epigastric Hernia Repair: A Prospective Randomized Controlled Study. (PubMed)

Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Open Epigastric Hernia Repair: A Prospective Randomized Controlled Study. Hernia repair is associated with considerable postoperative pain. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in patients undergoing open midline epigastric hernia repair (T6-T9).Sixty patients 18-65 years of age were randomly allocated into 2 groups. Patients in the erector spinae plane block group received (...) intraoperative fentanyl and postoperative rescue analgesia for patients undergoing open epigastric hernia repair.

2019 Anesthesia and Analgesia

4. Impact of Routine 12 mm Epigastric Trocar Site Closure on Incisional Hernia After Sleeve Gastrectomy: a Prospective Before/After Study. (PubMed)

Impact of Routine 12 mm Epigastric Trocar Site Closure on Incisional Hernia After Sleeve Gastrectomy: a Prospective Before/After Study. Recent studies have reported trocar site hernia (TSH) rates after bariatric surgery ranging from 0 to 45.2% based on imaging assessment. The objective of this study was to evaluate the TSH rate after sleeve gastrectomy (SG) comprising routine 12 mm epigastric trocar site closure (TSC).Prospective observational study with retrospective control cohort of a group (...) of patients undergoing primary SG with routine 12 mm epigastric TSC. The "before" group (control group) was a previously published group of patients without 12 mm epigastric TSC and the "after" group (closure group) concerned patients with routine 12 mm epigastric TSC. Primary endpoint was the TSH rate after routine epigastric TSC. Secondary endpoints were comparison of the TSH rate, TSC feasibility and causes of failure, TSC-related morbidity, evaluation of TSC time and its course, and identification

2019 Obesity Surgery

5. Pseudomyxoma peritonei presenting as irreducible epigastric hernia (PubMed)

Pseudomyxoma peritonei presenting as irreducible epigastric hernia Abdominal wall hernia is a common and usually straightforward pathology presenting in surgery clinics. On occasion, the surgeon is faced with unexpected findings requiring difficult intraoperative decision. We present a case of pseudomyxoma peritonei incidentally found during surgery for epigastric hernia. The patient complained of a long lasting epigastric hernia with recent onset pain and growth. Surgery was limited

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2018 Journal of surgical case reports

6. Prevascular femoral hernia and its relation with inferior epigastric vessels: a rare presentation of the femoral hernia sac (PubMed)

Prevascular femoral hernia and its relation with inferior epigastric vessels: a rare presentation of the femoral hernia sac A 61-year-old man presented to the emergency department, with a 2-week history of a painful lump on his right groin. A diagnosis of an irreducible right femoral hernia was made. As such, an urgent operation was carried out on the same day, and the patient was found to have a rare prevascular femoral hernia in which the sac was lying over the femoral vessels and split (...) by the inferior epigastric vessels into 2 components resembling 2 trouser limbs. The hernia sac presented in a different and challenging way that necessitated meticulous dissection and full orientation of the anatomy of the femoral triangle. Complete dissection and control of the inferior epigastric vessels, and complete reduction of the sac followed by repair with a prosthetic mesh plug were performed successfully. The patient was discharged home the next day.2016 BMJ Publishing Group Ltd.

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2016 BMJ case reports

7. Endoscopic-assisted linea alba reconstruction: New technique for treatment of symptomatic umbilical, trocar, and/or epigastric hernias with concomitant rectus abdominis diastasis (PubMed)

Endoscopic-assisted linea alba reconstruction: New technique for treatment of symptomatic umbilical, trocar, and/or epigastric hernias with concomitant rectus abdominis diastasis Patients with symptomatic umbilical, trocar, and/or epigastric hernias and concomitant rectus abdominis diastasis represent a growing clinical problem. The optimal management of this complex hernia situation is the subject of debate in the literature. This paper reports the early results of an innovative surgical (...) invasive surgical procedure for treatment of patients with a complex abdominal wall hernia comprising symptomatic umbilical, trocar, and/or epigastric hernias with concomitant rectus abdominis diastasis.

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2017 European Surgery

8. Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery)

also improve accuracy in identifying perforators [6,27-29]. CTA has been accepted as the gold standard in preoperative planning for DIEP flaps with sensitivity of 96% for all perforators and sensitivity of 100% for perforators >1 mm [30]. ACR Appropriateness Criteria ® 4 Deep Inferior Epigastric Arteries Preoperative imaging with CTA demonstrates improved clinical outcomes including decreased length of surgery, decreased flap loss rate, decreased hernia rate, decreased intraoperative blood loss (...) Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery) New 2017 ACR Appropriateness Criteria ® 1 Deep Inferior Epigastric Arteries American College of Radiology ACR Appropriateness Criteria ® Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery) Variant 1: Imaging of deep inferior epigastric arteries for surgical planning (breast reconstruction surgery). Procedure Appropriateness Category Relative Radiation

2017 American College of Radiology

9. Endoscopic-Assisted Linea Alba Reconstruction plus Mesh Augmentation for Treatment of Umbilical and/or Epigastric Hernias and Rectus Abdominis Diastasis – Early Results (PubMed)

Endoscopic-Assisted Linea Alba Reconstruction plus Mesh Augmentation for Treatment of Umbilical and/or Epigastric Hernias and Rectus Abdominis Diastasis – Early Results Symptomatic umbilical and/or epigastric hernias are often seen concomitantly with rectus abdominis diastasis (RAD), and suture repair of such defects has a high recurrence rate. In the literature, there are reports of both endoscopic and open techniques for repair of symptomatic umbilical and/or epigastric hernias (...) in association with RAD. This paper now reports on the early results of a hybrid technique used for reconstruction of the linea alba and mesh augmentation [endoscopic-assisted linea alba reconstruction plus mesh augmentation (ELAR plus)].Between 15 June 2015 and 31 January 2016, 40 patients with symptomatic umbilical and/or epigastric hernia and concomitant RAD underwent reconstruction of the linea alba using a hybrid technique involving a small umbilical incision and the use of video-endoscopic equipment

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2016 Frontiers in surgery

10. Impact of the Systematic Closure of the Epigastric Trocar on Postoperative Incisional Hernia After Sleeve Gastrectomy Rate of First Intention. Monocentric Study, Before / After Prospective.

Impact of the Systematic Closure of the Epigastric Trocar on Postoperative Incisional Hernia After Sleeve Gastrectomy Rate of First Intention. Monocentric Study, Before / After Prospective. Impact of the Systematic Closure of the Epigastric Trocar on Postoperative Incisional Hernia After Sleeve Gastrectomy Rate of First Intention. Monocentric Study, Before / After Prospective. - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting (...) registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Impact of the Systematic Closure of the Epigastric Trocar on Postoperative Incisional Hernia After Sleeve Gastrectomy Rate of First Intention. Monocentric Study, Before / After Prospective. (TROCSLEEVE) The safety and scientific validity of this study is the responsibility

2016 Clinical Trials

11. Strangulated epigastric hernia in a 90-year-old man: Point-of-Care Ultrasound (POCUS) as a saving kit: Case report (PubMed)

Strangulated epigastric hernia in a 90-year-old man: Point-of-Care Ultrasound (POCUS) as a saving kit: Case report The physiological reserve of extreme elderly patients is very limited and has major impact on clinical decisions on their management. Hereby we report a 90-year-old man who presented with a strangulated epigastric hernia and who developed postoperative intra-abdominal bleeding, and highlight the value of Point-of-Care Ultrasound (POCUS) in critical decisions made during (...) the management of this patient.A 90-year-old man presented with a tender irreducible epigastric mass. Surgeon-performed POCUS using colour Doppler showed small bowel in the hernia with no flow in the mesentery. Resection anastomosis of an ischaemic small bowel and suture repair of the hernia was performed. Twenty four hours after surgery, in a routine follow up using POCUS, significant intra-peritoneal fluid was detected although the patient was haemodynamically stable. The fluid was tapped under bedside

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2016 International journal of surgery case reports

12. Epigastric Hernia

Epigastric Hernia Epigastric Hernia Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Epigastric Hernia Epigastric Hernia Aka (...) : Epigastric Hernia , Hypogastric hernia , Fatty Hernia of the Linea Alba From Related Chapters II. Pathophysiology Type of Consists of properitoneal fat (rarely peritoneal sac) Location Occurs through linea alba (midline) Occurs below xiphoid process and above III. Symptoms Pulling sensation on leaning backward IV. Signs Difficult to detect in obese patients Frequently presents as s of preperitoneal fat incarceration or strangulation is rare Examine patient in standing position Run finger down course

2018 FP Notebook

13. Shared and Nonshared Familial Susceptibility to Surgically Treated Inguinal Hernia, Femoral Hernia, Incisional Hernia, Epigastric Hernia, and Umbilical Hernia. (PubMed)

Shared and Nonshared Familial Susceptibility to Surgically Treated Inguinal Hernia, Femoral Hernia, Incisional Hernia, Epigastric Hernia, and Umbilical Hernia. The familial risk of abdominal wall hernia (AWH) is largely unknown. In addition, it is unknown whether inguinal hernia (IH), femoral hernia (FH), incisional hernia (INH), epigastric hernia (EH), and umbilical hernia (UH) share familial susceptibility. The aim of this nationwide study was to determine the familial risks of concordant AWH (...) calculated for siblings of individuals with hernia compared with the siblings of unaffected individuals. The procedure was repeated for spouses.All concordant and most discordant familial sibling risks were increased. Familial concordant SIRs for siblings were IH = 1.97 (95% CI, 1.94-1.99), FH = 3.40 (95% CI, 2.44-4.62), INH = 2.24 (95% CI, 2.04-2.46), EH = 5.57 (95% CI, 4.64-6.64), and UH = 3.61 (95% CI, 3.33-3.91). Concordant familial risks were higher than discordant risks. For example, when

2013 Journal of the American College of Surgeons

14. The impact of gallbladder retrieval from an epigastric vs. umbilical port on trocar-site complications A prospective randomized study. (PubMed)

The impact of gallbladder retrieval from an epigastric vs. umbilical port on trocar-site complications A prospective randomized study. Port-site infection and hernias are among the most of the complications following laparoscopic cholecystectomy (LC). Although surgical technique of LC is described to obtain critical view of safety, there is still no consensus on ideal portsite for gallbladder retrieval. In this comparative study, we aimed to investigate the effects of gallbladder retrieval site (...) on the postoperative day 1, 10 and 30.Demographic features were similar in both groups. Postoperative pain in terms of VAS score was significantly lower for Group B on the postoperative day 1 and 30 (p=0.019, and p=0.001 respectively). The need for enlargement and time of GB retrieval was similar between groups. There is no statistical difference in terms of port-site infection or hernia between groups.The findings of this study provide epigastric port retrieval in terms of plausible reasons including

2018 Annali italiani di chirurgia

15. Perioperative nursing for immediate breast reconstruction with deep inferior epigastric perforator flap after breast cancer resection (PubMed)

Perioperative nursing for immediate breast reconstruction with deep inferior epigastric perforator flap after breast cancer resection To investigate the value of the nursing cooperation workflow for immediate breast reconstruction with deep inferior epigastric perforator (DIEP) flap after breast cancer resection.The clinical data of 29 patients who had undergone immediate breast reconstruction with DIEP flap after breast cancer resection in our center from January 2016 to December 2017 were (...) . Neither complication such as local tumor recurrence, incision infection, flap necrosis, or upper limb lymphedema in the surgical area nor complication such as abdominal wall bulging, abdominal wall hernia, or fat liquefaction of incision in the donor area was reported. The shape of the reconstructed breasts was natural and satisfactory.Immediate breast reconstruction with DIEP flap after breast cancer resection involves two disciplines: tumor resection and plastic repair. It is time-consuming

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2018 Journal of thoracic disease

16. Intraperitoneal behaviour of a new composite mesh (Parietex™ Composite Ventral Patch) designed for umbilical or epigastric hernia repair. (PubMed)

Intraperitoneal behaviour of a new composite mesh (Parietex™ Composite Ventral Patch) designed for umbilical or epigastric hernia repair. The most common treatment option for ventral and umbilical hernias is the implant of a prosthetic mesh. This study compares the behaviour of a new mesh, Parietex™ Composite Ventral Patch (Ptx), with two commercially available meshes, Ventralex™ ST Hernia Patch and Proceed™ Ventral Patch.The following meshes were tested in a umbilical-hernia repair model using (...) 54 rabbits: Ventralex™ ST Hernia Patch (Vent) (Bard Davol Inc., USA); Proceed™ Ventral Patch (PVP) (Ethicon, USA) and Ptx (Covidien, Sofradim, France) (n = 18 each). At 3, 7 and 14 days postimplantation, peritoneal behaviour and adhesion formation were assessed by sequential laparoscopy. Adhesions were scored for consistency and quantified by image analysis. The animals were euthanized at 2 (n = 27) and 6 weeks (n = 27) postsurgery. Mesothelial cover of meshes and tissue ingrowth were determined

2014 Surgical endoscopy

17. Epigastric hernia in pregnancy: a management plan based on a systematic review of literature and a case history. (PubMed)

Epigastric hernia in pregnancy: a management plan based on a systematic review of literature and a case history. Symptomatic epigastric hernia is rare in pregnant women. A case history, management of which prompted a systematic review of the literature and proposed plan for treatment of such cases, is hereby presented. There is paucity of information on management of this condition in the standard literature as searches in Pubmed, Science Direct, Hinari, Medline, African Journal Online, Bioone (...) as well as Cochrane library revealed. There are two schools of thought for the management of hernias in pregnancy-watchful waiting and herniorrhaphy in pregnancy. There is no consensus or definite guideline on the management of epigastric hernias in pregnancy. Based on the literature review, a management algorithm is proposed, which combines the two schools of thought.

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2014 The Indian journal of surgery

18. Mesh Or Patch for Hernia on Epigastric and Umbilical Sites (MORPHEUS trial): study protocol for a multi-centre patient blinded randomized controlled trial. (PubMed)

Mesh Or Patch for Hernia on Epigastric and Umbilical Sites (MORPHEUS trial): study protocol for a multi-centre patient blinded randomized controlled trial. Evidence is accumulating that, similar to other ventral hernias, umbilical and epigastric hernias must be mesh repaired. The difficulties involved in mesh placement and in mesh-related complications could be the reason many small abdominal hernias are still primary closed. In laparoscopic repair, a mesh is placed intraperitoneally, while (...) compared with pre-peritoneal meshes. The material of the patch is in direct contact with intra-abdominal organs, it is unknown if this leads to more complications. On the other hand, the smaller dissection in the pre-peritoneal plane may lead to a reduction in wound complications.346 patients suffering from an umbilical or epigastric hernia will be included in a multi-centre patient-blinded trial, comparing mesh repair with patch repair. Randomisation will take place for the two operation techniques

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2014 BMC Surgery

19. Sutured Repair of Primary Small Umbilical and Epigastric Hernias: Concomitant Rectus Diastasis Is a Significant Risk Factor for Recurrence. (PubMed)

Sutured Repair of Primary Small Umbilical and Epigastric Hernias: Concomitant Rectus Diastasis Is a Significant Risk Factor for Recurrence. Umbilical and epigastric hernias are common in the adult population and prompt repair is advised. We aimed to evaluate the impact of concomitant rectus diastasis on the outcome of patients who underwent primary sutured fascia closure of a hernia without mesh.We performed a retrospective analysis of 231 consecutive adult patients who had undergone elective (...) suture-based repair of small (<2 cm) and primary umbilical or epigastric hernias with respect to complications, recurrence, and chronic pain.Patients with rectus diastasis suffered from a significantly increased rate of hernia recurrence (29/93 vs. 9/108; p < 0.001). The use of absorbable sutures also had a negative influence on the recurrence rate (26/90 vs. 12/111; p = 0.001). Obesity (body mass index > 35 kg/m(2)) was associated with more complications (p = 0.02). Wound infections following hernia

2014 World Journal of Surgery

20. Randomized Clinical Trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair. (PubMed)

Randomized Clinical Trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair. Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma-reducing effect of an abdominal binder in patients undergoing laparoscopic umbilical (...) or epigastric hernia repair.Based on power analysis, a minimum of 54 patients undergoing laparoscopic umbilical and epigastric hernia repair were to be included. Patients were randomized to abdominal binders vs. no abdominal binders during the first postoperative week. Standardized surgical technique, anaesthesia, and analgesic regimens were used and study observers were blinded towards the intervention. Postoperative pain (visual analogue score) on day 1 was the primary outcome. In addition

2014 Hernia : the journal of hernias and abdominal wall surgery

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