Hernia Research Today is a free monthly online journal that collates and summarizes the latest research about Hernia, including details on hiatal, inguinal, umbilical, abdominal, treatment.

A new era in esophageal diagnostics: the image-based paradigm of high-resolution manometry.

Salvador R, Dubecz A, Polomsky M, Gellerson O, Jones CE, Raymond DP, Watson TJ, Peters JH

Department of Surgery, Division of Thoracic and Foregut Surgery, University of Rochester, Rochester, NY 14642, USA.

BACKGROUND: The development of high-resolution (HRM) catheters and software displays of manometric recordings in color-coded pressure plots has changed the diagnostic assessment of esophageal disease. HRM may offer advantages over conventional methods, including improved identification of motility disorders, hiatal hernia, and outflow obstruction, and ease interpretation. STUDY DESIGN: HRM studies were obtained in 50 healthy volunteers and 106 patients. HRM was performed using a 36-channel catheter, with sensors spaced at 1-cm intervals. Manometric findings were classified into abnormalities of the gastroesophageal barrier and those of the esophageal body and validated by comparison with endoscopic and radiographic diagnostic methods. RESULTS: The mean time for HRM was significantly lower than that for a conventional method (8.1versus 24.4 minutes; p < 0.0001). A structurally defective lower esophageal sphincter (LES) was present in 53 (57.3%) patients, a hypertensive LES in 6 (7.8%), and impaired LES relaxation in 17 patients (16.7%). Validating the LES findings, 86.3% (44 of 51) of patients with a defective sphincter by HRM had radiographic or endoscopic evidence of a hiatal hernia, and 80% (41 of 51) had a positive pH study, endoscopic erosive esophagitis, or Barrett's esophagus. Evidence of a hiatal hernia by HRM was seen in 33 (56%) patients; a hiatal hernia was seen in 91% (30 of 33) of these on endoscopy and 81% (17 of 21) on barium swallow. Fifty-eight patients (54.7%) had an abnormal body motility. CONCLUSIONS: HRM studies are shorter than those using conventional methods. Interpretation is image based, and correlation with objective endoscopic and physiologic findings confirms the accuracy of interpretation. The introduction of HRM is a significant advance in the outpatient evaluation of esophageal function.

Published 29 May 2009 in J Am Coll Surg, 208(6): 1035-44.
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Articles on Hernia published 29 May 2009:

Comparison of a new self-gripping mesh with other fixation methods for laparoscopic hernia repair in a rat model.   J Am Coll Surg, 208(6): 1107-14.

BACKGROUND: Microhooks are small structures on the surface of the Progrip (PG; Sofradim Corp) mesh to ensure its anchorage in tissue. Additional fixation is not required. The aim of this animal study was to compare the strength of incorporation, foreign body reaction, and changes in material after implantation of this novel mesh with the current fixation alternatives, namely the hernia stapler (HS) and fibrin glue (FG). STUDY DESIGN: Forty Sprague-Dawley rats were used in this two-phase, ... [Abstract] [Full-text]

MRI and pathology in persistent postherniotomy pain.   J Am Coll Surg, 208(6): 1023-8; discussion 1028-9.

BACKGROUND: Persistent postherniotomy pain impairs everyday life in 5% to 10% of patients. MRI can potentially be useful in the investigation of pathogenic mechanisms and guide surgeons in mesh removal and neurectomy. No study has investigated interobserver agreement or MRI-specific findings in persistent postherniotomy pain. STUDY DESIGN: Thirty-two patients with persistent postherniotomy pain > 1 year after uni- or bilateral groin hernia repair and 6 pain-free postherniotomy controls were ... [Abstract] [Full-text]

Articles on Hernia published 7 May 2009:

Upper gastrointestinal symptoms and associated disorders in morbidly obese patients: a prospective study.   Dig Dis Sci, 54(6): 1243-6.

OBJECTIVE: To prospectively evaluate the frequency of upper gastrointestinal symptoms and associated disorders in morbidly obese patients with endoscopy and histology prior to their gastric bypass surgery in comparison with age- and sex-matched nonobese control subjects. METHODS: All patients who were scheduled to undergo laparoscopic gastric bypass for treatment of morbid obesity (body mass index, BMI > 40 kg/m(2)) during a 1-year period (n = 101) were included in the study. Age- and ... [Abstract] [Full-text]

Articles on Hernia published 5 May 2009:

Audit of ultrasound and decision to operate in groin pain of unknown aetiology with ultrasound technique explained.   Clin Radiol, 64(6): 608-14.

AIM: To determine the ability of a groin ultrasound service to identify inguinal/femoral hernias in patients with groin pain and equivocal clinical signs, and to evaluate the number of positive cases undergoing surgery. METHODS AND MATERIALS: A retrospective review of 243 examinations performed during the period January 2000 to June 2004 was undertaken. The referral information, as well as details of the examination and subsequent follow-up, were obtained through our hospital/radiological ... [Abstract] [Full-text]

Infant with concomitant presence of hernia/hydrocele and primary paratesticular neuroblastoma: a diagnostic and therapeutic challenge.   J Pediatr Hematol Oncol, 31(5): 349.

We report an 8-month-old boy with stage 1 neuroblastoma, whose "testicular tumor" was removed during a "radical orchiectomy" by a pediatric surgeon who encountered a scrotal mass during a hernia repair. Pathologic examination of the specimen suggested seminoma and the surgeon sent the patient for cisplatin-based chemotherapy. However, follow-up examination showed a normal testis. Reexamination of the specimen in other laboratories proved neuroblastoma. The patient is tumor ... [Abstract] [Full-text]

Articles on Hernia published 27 April 2009:

Reconstruction of complex abdominal wall hernias using acellular human dermal matrix: a single institution experience.   Am J Surg, 197(5): 599-603; discussion 603.

BACKGROUND: Acellular human dermal matrix (AHDM) has mechanical properties suitable for complex abdominal wall reconstructions and physiologic properties that allow more resistance to infection in contaminated fields. The purpose of this study was to determine which patient and technical factors lead to optimal surgical outcomes. METHODS: A retrospective review was conducted of 144 abdominal wall reconstructions using AHDM over a 33-month period. Data were recorded and analyzed. RESULTS: ... [Abstract] [Full-text]

Prophylactic mesh to prevent incisional hernia: a note of caution.   Am J Surg, 197(5): 595-8; discussion 598.

BACKGROUND: Ventral hernia is a common complication of open Roux-en-Y gastric bypass (RYGB). The aim of this study was to determine whether prophylactic mesh placement during RYGB would reduce the incidence of postoperative hernias. METHODS: Obese patients undergoing RYGB by a single surgeon had prosthetic mesh placed in a subfascial location at the conclusion of the procedure. The incidences of recurrent hernia and morbidity associated with the placement of mesh were assessed. RESULTS: Sixteen ... [Abstract] [Full-text]

Articles on Hernia published 17 April 2009:

Ultrasound versus landmark-based technique for ilioinguinal-iliohypogastric nerve blockade in children: the implications on plasma levels of ropivacaine.   Anesth Analg, 108(5): 1488-92.

BACKGROUND: Ilioinguinal-iliohypogastric nerve blockade (INB) is associated with high plasma concentrations of local anesthetics (LAs) in children. Ultrasonographic guidance enables exact anatomical administration of LA, which may alter plasma levels. Accordingly, we compared plasma levels of ropivacaine after ultrasonographic versus landmark-based INB. METHODS: After induction of general anesthesia, 66 children (8-84 mo) scheduled for inguinal hernia repair received INB with 0.25 mL/kg of ... [Abstract] [Full-text]

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