found that the biomechanical characteristics of the linea alba are not governed by the number of aponeurotic crossings but by the thickness and density of the fibers, and that the weak type of linea alba aponeurosis may be a predisposing factor for the development of a hernia . About 20% of epigastric hernias are multiple and about 80% are located just off the midline. Fascial defects vary in size from only millimeters to several centimeters. Most epigastric hernias, however, are small and are made up of preperitoneal fat only with no peritoneal sac; these are especially prone to incarceration and strangulation. Frequently, the preperitoneal fat herniating through this small defect grows over time and becomes chronically incarcerated. Larger hernias with a peritoneal sac mostly contain omentum, but also contain any upper intraperitoneal organ such as small bowel, colon, or stomach; these hernias seldom incarcerate or strangulate.
In 2007, Derici et al. published a retrospective study using univariate and multivariate analyses to investigate factors affecting morbidity and mortality rates in cases of incarcerated abdominalwallhernias . Using the univariate analysis, results showed that symptomatic pe- riods lasting longer than 8 h, the presence of comorbid disease, high American Society of Anesthesiologists (ASA) scores, the use of general anaesthesia, the pres- ence of strangulation, and the presence of necrosis sig- nificantly affect morbidity rates. In contrast, advanced age, the presence of comorbid diseases, high ASA scores, the presence of strangulation, the presence of necrosis, and hernia repair with graft were found to significantly affect mortality rates by univariate analysis; the presence of necrosis, however, was the only factor that appeared to significantly affect mortality rates based on multivari- ate analysis .
The word "hernia" is derived from a Latin term meaning "a rupture." The earliest reports of abdominalwallhernias date back to 1500 BC. During this early era, abdominalwallhernias were treated with trusses or bandage dressings. The first evidence of operative repair of a groin hernia dates to the first century AD. The original hernia repairs involved wide operative exposures through scrotal incisions requiring orchiectomy on the involved side. Centuries later, around 700 AD, principles of operative hernia repair evolved to emphasize mass ligation and en bloc excision of the hernia sac, cord, and testis distal to the external ring. The first report of groin hernia classification based on the anatomy of the defect (ie, inguinal versus femoral) dates to the 14th century, and the anatomical descriptions of direct and indirect types of inguinal hernia were first reported in 1559.
Many authors reported that early detection of progres- sion from an incarcerated hernia to a strangulated her- nia is difficult to achieve by either clinical or laboratory means, which presents a large challenge in early diagno- sis [15-17]. Signs of SIRS including fever, tachycardia, and leukocytosis, as well as abdominalwall rigidity, are considered common indicators of strangulated obstruc- tion. However, an investigation by Sarr et al. demon- strated that the combination of four classic signs of strangulation – continuous abdominal pain, fever, tachy- cardia, and leukocytosis – could not distinguish strangu- lated from simple obstructions . Furthermore, Shatilla et al. reported a low incidence of these classical findings and stated that their presence indicated an ad- vanced stage of strangulation, which would be of limited value for early diagnosis . In 2006, Tsumura et al. published a retrospective study investigating SIRS as a predictor of strangulated small bowel obstruction.
IL-2 receptor) were within normal limits. Helical com- puted tomography (CT) also revealed a solid mass (largest dimension, 10 cm in diameter) in the abdominalwall (Fig. 2). Magnetic resonance imaging showed a mass that exhibited low intensity on T2-weighted images, slightly high intensity on diffusion-weighted images, and gradual reinforcement on dynamic study (Fig. 3). Positron emis- sion tomography–CT revealed fluorodeoxyglucose accu- mulation in the mass only (SUVmax, 41) (Fig. 4). Because clinical and radiographic findings suggested malignant lymphoma, undifferentiated sarcoma, or liposarcoma, he underwent exploratory laparotomy and treatment.
The abdominal viscera begin to reside in the hernia defect and the abdominal musculature contracts. The repair of these defects can be quite challenging in the setting of intestinal obstruction with dilated bowel loops and intestinal wall edema. closing these wound under tension increases the risk of recurrence. Tension also increases the intra-abdominal pressure. This has the effect of elevating the diaphragm, thus decreasing respiratory excursion and consequently increasing the risk of development of pulmonary complications. Venous return to the heart is also decreased, resulting in a degree of abdominal compartment syndrome, this precludes anatomical repair in few subset of patients.
DOI: 10.4236/ojog.2017.78082 820 Open Journal of Obstetrics and Gynecology within cesarean section scars and characterized the sonographic findings. This study concluded that the sonographic appearance of cesarean section endome- triomas include a discrete subcutaneous, hypoechoic nodule, scattered with hypere- choic strands. Margins of the endometrioma were often noted to be irregular and speculated, infiltrating the abdominal muscular fascia, and circumscribed by a hyperechoic ring. Endometriomas larger than 3 cm demonstrated small cystic areas, as well as the loss of the well-circumscribed oval shape. Additionally, a vascular pedicle with arterial flow was seen entering the nodule with the use of color Doppler interrogation. It was noted that as endometriomas increase size, vascularization is more visible. Masses smaller than 1.5 cm demonstrated less vascularity than larger masses . In this study, sonography was the sole diag- nostic imaging modality utilized for diagnose and continued evaluation of the endometriomas.
This was described by Eduardo Bassini in 1884. Bassini’s operation epitomized the essential steps for an ideal tissue repair. He opened the external oblique aponeurosis through the external ring, resected the cremasteric fascia to expose the spermatic cord, He then divided the canal’s posterior wall to expose the preperitoneal space and did a high dissection and ligation of the peritoneal sac. Bassini then reconstructed the canal’s postr. wall in 3 layers. He approximated the medial tissues, including the internal oblique muscle, transverses abdominus muscle and transversalis fascia to the shelving edge of the inguinal ligament with interrupted sutures.
In this study we have presented the first reported case in the English literature of an abdominalwall ancient schwannoma and discussed the key clinical, radiological and pathological features of the condition. As this was picked up asymptomatically on a private health whole body CT screen given to the patient as a birthday pre- sent, we have extolled the pitfalls of such tests as well as offered an insight into the clinical, ethical and health economic issues that they raise. Wider marketing and availability of these services may lead to increased non evidence based patient-led screening in the private sec- tor. Unfortunately, this may add an unnecessary burden to public health resources.
rine cavity, most common location is in the pelvis. Extra-pelvic endometriosis is rare, and its true prevalence is unknown given its lack of formal epidemiological study . It has been reported to occur in nearly all body cav- ities and organs but its most common location is the abdominalwall . Endometriosis in the abdominalwall, usually in the vicinity of a prior abdominal surgery, occurs most frequently after incision of a gravid uterus -. Characteristic presentation is of a painful, palpable mass with cyclic bleeding or discharge and worsen- ing of pain and bleeding with menses  . Imaging findings are usually non-specific with ultrasound-guided fine needle aspiration providing more definitive diagnosis. Treatment options include medical or surgical man- agement  . We reported here our experience with the surgical and pathologic diagnosis of a fistulous track between a pelvic endometrioma and abdominalwall endometriotic lesion in a previous cesarean delivery scar that was surgically treated resulting in complete resolution of the fistulous tract.
Independent from the testicular descent, the peritoneum of the abdominal cavity evaginates on either side of the midline into the ventral abdominalwall. This evagination called the Processus vaginalis, follows the course of the gubernaculum testis into the scrotal swellingsand carries all the fascial and muscular layers of the abdominalwall into the scrotumresulting in the formation of the inguinal canal. The opening produced in the transversalis fascia by the processus is the deep inguinal ring and that in the external oblique aponeurosis becomes the external or superficial inguinal ring. Between the rings is the inguinal canal.
to inadequate mesh fixation medially, whereas recurrence after a quiet long period can be attributed to various factors like predisposing factor with patient, type of mesh used and so on. Sinus formation following hernioplasty is extremely rare. The difference in type of mesh and composition of mesh may have influence on subsequent seroma formation, infection and sinus formation. Granuloma followed by sinus formation is most commonly due to polypropylene component of mesh by foreign body reaction. One patient had sinus formation post operatively. The patient was admitted and wound exploration done under field block and sinus tract along with part of mesh is excised and resutured. Patient recovered well. Mesh infection is the worst complication to deal with. Infected part of mesh or sometimes complete mesh needs to be removed for complete cure. No cases of enterocutaneous fistula and mesh infection is seen in this study.
Abdominalwallhernias were repaired with the direct suture repair surgical technique when the defect did not exceed 3 cm or in cases of a contaminated/dirty surgical field; otherwise, the mesh-repair technique was adopted with sublay retromuscular positioning of a polyester mesh fixed at the posterior fascia of the rectus abdominis muscle with non-reabsorbable sutures. Indirect inguinal hernias were repaired with the plug- and mesh-mediated technique using a polypropylene plug fixed in the internal inguinal ring at the conjoint tendon and Cooper ligament; the polypropylene mesh was then positioned under the aponeurosis of the external oblique muscle (Trabucco
Careful analysis of the current surgical literature including four recently published meta analyses indicates that a consistent conclusion can be made regarding an optimal technique. The abdominal closure technique should be fast, easy and cost effective while preventing both early and late complications. The technique involves mass closure incorporating all the layers of abdominalwall (except skin) as one structure in a simple running technique using 1-0 or 2-0 absorbable monofilament suture material with a suture length to wound length ratio of 4:1.
prolonged the ICI relative to that resulting from typical bladder filling rates in unrestrained/unanesthetized rats. The ICI may have been further shortened in the previous study by anxiety produced by restraint in awake rats. The discrepancy between volume infused (4.8 ml/hr infused vs. 1.8 ml/hr voided) represents volume loading. Over the course of a 4–6 hour long observation period, a volume surplus certainly developed of a magnitude similar to Davis' acute volume loading . Their observation was that GFR increased to accommodate this load, and there- fore had our rats survived post-experiment, this excess vol- ume (minus insensible and metabolic losses) would have been excreted. It seems unlikely that this aggressive hydra- tion could alter the abdominalwall response to voiding or the urine flow parameters resulting from physiologic diu- resis.
Currently there are more than 80 different types of meshes available on the market for IPOM repair of abdo- minal wallhernias. Synthetic meshes can be broadly classi- fied into macroporous, microporous and composite meshes. Macroporous meshes such as polyp-propylene (PP) allows for ingrowth of scar tissue. However if these are put in con- tact with the bowel surface they cause formation of adhe- sions and enterocutaneous fistulas (7). Microporous mesh- es such as expanded Polytetraflouroethylene (ePTFE) does not allow for tissue ingrowth but may lead to encapsulation and subsequent infection. ePTFE has been shown to cause infection requiring explanation of meshes in several cases (8) . To deal with these problems synthetic meshes with anti adhesive coatings have also been developed. Most of the coating material comprises of an absorbable layer such as collagen hydrogel, omega 3 fatty acids and oxygenated cellulose. There are some experimental trials claiming reduced risk of adhesions to composite and coated synthet- ic meshes when compared to traditional synthetics (9-10). Biological meshes are expensive and are normally reserved for repair of hernias in potentially infected fields. In the absence of randomised controlled trials there is no data to suggest the superiority of the various meshes available, one over the other.
be of low methodological quality [9,11]. The meta-analy- sis by Hodgson et al. was of high quality and reported sig- nificantly less incisional hernias after closure with continuous non-absorbable sutures but also found signif- icantly more suture sinuses and wound pain requiring fur- ther interventions. This material was not used in the present survey which demonstrates the harm caused by this material in practice. Unfortunately, the authors com- pared absorbable and non-absorbable materials only and did not distinguish between rapidly and slowly absorbing sutures [10,12]. Therefore, a further meta-analysis was performed by van't Riet et al.  which was not evalu- ated in the above mentioned critical appraisal, but can be considered to be well-designed according to the methods of the Cochrane collaboration. However, it failed to show a clear superiority of one strategy regarding the prevention of incisional hernia, if all details of closure technique, clo- sure material, and needle type are taken into account . In particular, it could not demonstrate a significant advan- tage between interrupted rapidly absorbable and continu- ous slowly absorbable sutures in terms of incisional hernia development. The rationale of the INSECT-Trial was based on these findings .
Presentation may be from asymptomatic hernia (which is seen in about 30% of patients) to a painful lump (commonest presentation - 66% of patients), this pain is mild in about 53.9% and severe in less than 1% of patient . focal pain in hernia is unusual ,in such case we should suspect hernia incarceration or strangulation. The most common symptom is a dull feeling of discomfort or heaviness in the groin region, which gets aggravated by activies causing increased intra abdominal pressure. Pain develops as a tight ring of fascia outlining the hernia defect compresses intra-abdominal structures with a visceral neuronal supply. pain gets worse at the end of the day after prolonged standing
*) Biologic mesh: The last few years has seen a number of biologic mesh available for the management of ventral hernias. The common principle behind these meshes is to take animal or human tissue, get rid of the cellular component to avoid allergic reaction and stabilise its protein structure so that it can act as a scaffold. These are considered as the collagen implants which allow native fibroblasts to deposit more collagen to form a biologic mesh.
Our numerical results demonstrate nicely that despite the existence of the ILT almost the entire blood pressure is transmitted to the wall. This was also confirmed by others  and explains why wall stress does not change whether the pressure is applied dir- ectly on the wall and or on the luminal surface of the ILT . Most interestingly we showed that the ILT remarkably reduces the stress in the wall at the same time. This is in good agreement with both experimental data [17,23,24] and published numerical analyses [25,26,28,55]. Consequently, it integrates conflicting views regarding the role of the ILT in AAA biomechanics and demonstrates that the ILT helps to carry the load, in spite of the wall being exposed to the entire mean blood pressure. Specifically, for the investigated AAA models the ILT reduced wall tensile stress by a value between 46% (AAA60) and 62% (AAA80) relative to the model neglecting the ILT as shown in Table 2. It should be emphasised that this significant decrease in wall stress was obtained with a rather soft ILT , and using a stiffer ILT model [22,38] would reinforce the wall stress-diminishing effect  which explains why we obtained signifi- cantly higher wall stresses than the other study considering poroelastic description of the ILT . On the other hand, it is noted that the predicted stress-diminishing effect is rather strong due to axisymmetry of the used model. For patient-specific geometries the PWS decrease due to the presence of the ILT varies from 5% to 59% [25,26].