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Objective To investigate the effect of laparoscopic total extraperitoneal tension-free hernia repair (TEP) in the treatment of inguinal hernia with absorbable biological mesh.Methods A retrospective analysis of the clinical data of 19 patients with inguinal hernia with biological mesh was performed from September 2015 to September 2016 in Shengjing Hospital of China Medical University.The average operative time,average incision pain time,average postoperative venting time,average hospital stay,average operative cost,and long-term chronic pain,postoperative complications,and recurrence rate were observed.Results All the 19 patients were successfully operated.The average operation time was (35.0 ± 4.0) min,the average incision pain time was (1.5 ± 0.6) d,and the average postoperative venting time was (1.5 ± 1.2) d.The average hospital stay was (4.5 ±0.9) d,the average surgery cost was (23 534.6 ± 1 259.9) yuan.Two patients developed swelling of the scrotum after surgery,and one patient developed postoperative fat liquefaction.All patients were followed up for 1 year by telephone,with no recurrence,no serious complications,and chronic pain discomfort.Conclusions The application of absorbable biopsy TEP is a good and reliable way to treat inguinal hernia.Postoperative patients have mild pain and low complication rate.There is no recurrence in recent follow-up,and the short-term effect is satisfactory.It is a reliable method for the treatment of inguinal hernia.The cost is high,and can be selected according to age and individual needs.
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Objective To explore the clinical effect of tension-free repair in the treatment of inguinal hernia in elderly patient.Methods A total of 124 elderly patients with inguinal hernia admitted in our hospital in 2016 were randomly divided into a study group(n=62)and a control group (n=62).The control group was treated with open tension-free inguinal hernia repair,whereas with laparoscopic tension-free inguinal hernia repair in the study group.The operation time,intraoperative blood loss,the postoperative pain relief-time,mean days of hospitalization,postoperative recurrence rate,and complications rates were compared between the two groups.Results The more significant improvements were found in study group versus control group in the intraoperative bleeding volume [(19.9±2.0)ml vs.(36.8±-2.5)ml,t=41.564,P=0.000],in the mean hours of postoperative pain [(22.1 ± 4.2) h vs.(35.3 ± 7.0) h,t =12.732,P =0.000],in mean days of hospitalization [(5.5 ± 1.0)d vs.(9.2±1.9)d,t=13.569,P=0.000],in incidence rate of postoperative recurrence(0.0％ vs.6.5％,x2 =4.133,P=0.042),and in postoperative complications rate(3.2％ vs.12.9％,x2 =3.916,P=0.048).Nevertheless,the operation time was longer in the study group than in the control group[(87.0±5.0)min vs.(55.5±4.2)min,t=-37.984,=0.000],Conclusions As compared with open tension-free repair,the clinical efficacy of laparoscopic tension-free hernia repair is exactly sure in the treatment of inguinal hernia,with shorter postoperative hospitalization time and lower incidence of complications.
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Objective To investigate the effect of fentanyl citrate combined with psychological intervention on the treatment of elderly patients with inguinal hernia tension-free repair. Methods From May 2015 to May 2017, 110 elderly cases with inguinal hernia tension-free repair were divided into two groups, the control group and the observation group according to the different nursing intervention mode . The control group were received routine nursing intervention combined with midazolam. The observation group were given fentanyl citrate and routine nursing care combined with psychological intervention. The effect and safety in the two groups were recorded and compared. Results The curative effect in the observation group was remarkable, and the indexes during the operation were better than those in the control group. The incidence of adverse reactions was lower than that in the control group, and the nursing satisfaction was higher than that in the control group, the difference was statistically significant (P<0.05). Conclusion The effect is remarkable which Fentanyl citrate combined with routine nursing and psychological intervention were used on the treatment of elderly patients with inguinal hernia tension-free repair, the body indexes are stable, has less adverse reaction and high nursing satisfaction, is worthy of clinical application.
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Objective:To explore the necessity of the preventive use of antibiotics and the effects of age and operation time on the efficacy of inguinal hernia repair without tension,and to elucidate the clinical significance of the preventive application of prophylactic antibiotics in inguinal hernia repair without tension.Methods:A total of 228 patients with inguinal hernia repair without tension were selected,amomg them 42 cases with high infection factors were treated with antibiotics (treated group),and 186 cases were not treated with antibiotics(untreated group) during the preoperative period.The prophylactic antibiotics were given 30 min before surgery,and the conventional dose was not used more than 48 h after surgery.All the cases were treated with artificial repair materials for the procedure of inguinal hernial repair without tension.The age,highest body temperature,white blood cell count,operation time,hospitalization time,and postoperative body temperature of all the 228 cases were recorded and analyzed statistically.Results:The preoperative and postoperative white blood cell counts had significant differences between the patients0.05).Compared with the patients with the operation time>90 min,the white blood cell count and hospitalization time of the patients with the operation time ≤90 min were increased (P90 min and the patients with the operation time≤90 min (P>0.05).The white blood cell count,operation time,hospitalization time and postoperative body temperature of the patients between treated group and untreated group had no significant differences (P>0.05).Conclusion:The use of antibiotics in the high-risk patients and non-use of antibiotics in the majority of elective inguinal hernia repair without tension can ensure the safe and performability of the patients.
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Hernia is ancient and common.With the emerging of new concepts,techniques,materials and equipments,treatment methods of hernia have undergone ever-changing changes in the 21st century.Hernia and abdominal wall surgery in China has been developing fast in the past 20 years,and has achieved remarkable progress.However,some problems still exist,such as unbalanced regional development,concept misunderstanding,classification confusions,less standardized technology,poor follow-up method,lack of innovation,and so on.Therefore,it's crucial to recognize the shortcomings of the current stagey,discuss the existing problems,sum up experiences and lessons,and clarify the direction of improvement,in order to provide a solid foundation for the sustainable development of hernia and abdominal surgery for our country.
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Groin incarcerated hernia and groin strangulated hernia in adults are common acute abdominal disease,usually with aging,male-dominated inguinal direct and indirect hernia and female dominated femoral hernia,high mortality.Groin hernia medical history,hernia specialist checkup and imaging examination are quick and accurate diagnosis of adult groin incarcerated and strangulated hernia necessary prerequisites.Traditional hernia surgery,tension-free repair,laparoscopy tension-free repair are commonly used in emergency surgery of groin incarcerated hernia and strangulated hernia in adults.The aim of this article is to summarize the timing of surgery and surgical methods of groin incarcerated and strangulated hernia in adults.
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ObjectiveTo evaluate the clinical application of Kugel hernioplasty via anterior approach for inguinal hernia repair.MethodsA retrospective study was made to analyze the clinical data of 851 cases(956 hernias) treated with Kugel hernioplasty via anterior approach for inguinal hernias from November 2005 to May 2011.ResultsOperative duration was(42 ± 11) minutes.The postoperative complications were detected on 21 hernias of seroma,8 hernias of hematoma,12 hernias of sub dermal ecchymosis,26 hernias of foreign body sensation and 5 hernias of recurrence.No incision infection occurred.Conclusions Kugel hernioplasty via anterior approach can repair and strengthen the whole anatomy area of myopectineal orifice.It is available for various kinds of inguinal hernias.
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Objective To evaluate the effects of the two different operations, such as open total extraperitoneal herniorrhaphy or traditional anterior approachs on tension-free repair of inguinal hernia. Methods In a prospective randomized controlled study, 165 cases with inguinal hernia were allocated randomly to either the anterior approach group (82 cases)or open total extraperitoneal herniorrhaphy group( 83 cases ).The index including the operation time, hospital stay, mean expense, time for returning to normal activity,and the recent or long-term operative complications and recurrence rate, were observed to evaluate the curative effect of open total extraperitoneal herniorrhaphy approach. Results The follow-up rate were 98.79% ,after (20.52 ± 1.54) months in average follow-up in the anterior approach group and (21.63 ± 1.76) months in the TEP group, and no significant differences were recorded between the two groups in the operation time, hospital stay, time for returning to normal activity, recurrence rate(3.66% vs 1.22% ) and urinary retention ( P > 0. 05 ), but operative complications in TEP group were significantly less than that in anterior approach group (P< 0.05). Conclusions The operative complications or postoperative unwell decrease significantly through the open total extraperitoneal herniorrhaphy approach in repairing inguinal hernias. Its curative effect was confirmed and deserves to be clinically popularized.
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Objective To explore the therapeutic efficacy and operation experience of Prolene Hernia System (PHS) in the tension-free repair operation of inguinal saddle hernia. Methods All 41 cases using PHS were selected as the subjects of this study and the results were analyzed. Results All patients were performed operation under the local anesthesia, and lasted from 25 min to 60 min. They had been keeping in ward for observation from 24 h to 72 h. No serotal swelling, hematoma, and incisional wound infection hap-pened after the operation. The follow-up time had been lasting from 6 months to 42 months, and none of pa-tients catehed a relapse or had the sensation of the foreign bodies. Conclusions Using PHS is safe and ef-fective in the tension-free repair operation, and it is more suited to inguinal saddle hernia. The key of opera-tion success is attaching importance to operation skills.
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Objective To discuss the feasibility and safety of tension-free mesh plug hernioplasty under local anesthesia in out-patient clinic.Methods Tension-free mesh plug hernioplasty under local anesthesia was performed in 65 cases of unilateral inguinal hernia in out-patient clinic from April 2003 to May 2005.There were 56 cases of indirect inguinal hernia(including 1 case of recurrent hernia) and 9 cases of direct hernia.Results The hernioplasty was successfully completed in all the 65 cases,with good anesthetic results registered.The operation time was 20~65 min(mean,32 min),and the length of clinic stay,3~20 h(mean,(4.8 h)).Incisional fat liquefaction occurred in 1 case.Follow-up visits for 2~24 months(mean,9.5 months) found no recurrence or testicular atrophy.Conclusions Tension-free mesh plug hernioplasty under local anesthesia is a safe,reliable,and cost-effective out-patient procedure for patients with type Ⅱ~Ⅲ unilateral inguinal hernia.
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In the present study,50 patients were treated by mesh & plug hernia repair with Bard R Mesh & FerFix R Plug. Operation time ranged from 24 min to 71 min with mean time being 43.2min.There was no need for analgestic.Hospitalization time ranged from 3d to 7d with mean time being 4.5d.The patients were followed up for 6w to 20 months.No recurrence occurred.
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Objective To evaluate the effect of the tention free repair on patient with abdominal insicion hernia. Methods 15 cases of abdominal insicion hernia were reviewed, all of them were repaired with polypropylene mesh. The mesh was overlaid on the defect, continuously monofilament nonabsorbable suture was used to fix the mesh on the edge of the defect and the mesh must be overlapped 2 cm on fascia abdominal layer and fixed by suture. Prophylactic antibiotics was used routinely in single dose. Result No relapse was found in follow up(rang 15～38 month). Conclusion The tension free hernia repair with polypropylene mesh in patient with abdominal incision hernia is a safe and simple operation with minimal postoperative pain.
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Objective To evaluate tension-free repair in the management of recurrent inguinal hernia. Methods From 1/1993 to 12/2002, 163 patients with recurrent inguinal hernia underwent reoperation, clinical data were reviewed. Results The male: female ratio was 138: 25, age from 34 to 76 years. The primary surgery had been traditional hemiorrhaphy without prothesis in 142 cases (87. 1 % , including 65 cases of Bassini ,35 cases of McWay and 42 cases of Shouldice) , a tension-free procedure in 12 cases(7. 4% , including 3 cases of laparoscopic mesh repair) and unknown techniques in 9 cases(5. 5% ). The average interval from the initial surgery to recurrence was 36?14 months (range from 3 months to 10 years). Recurrent hernias were treated with a Shouldice repair in 71 cases(43. 6% ) , a tension-free repair in 92 cases(56. 4% , including a laparoscopic mesh repair in 3 cases). All these 163 cases(100% ) were followed up for 56 ?1 months (range from 30 months to 12 years) after the second surgery. It was found that after reoperation the recurrence rate of Shouldice procedure and tension-free repair was 16. 1% (11/71) and 2. 2% (2/92) respectively (x2 = 8. 327 ,P
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Objective To evaluate tension-free hernia Onlay repair with premuscular positioning of the prosthesis for the treatment of ineisional henia of the abdominal wall.Methods In this study 126 patients with incisional henia were treated with a tension-free manner of hernia repair by using synthetic material ONLAY between September 1999 and June 2007.Results All operations were successful.There was no hospital death or severe postoperative complications.The average age was 58.5 years old ranging from 28 to 89.There were 67 patients in which the abdominal defect ranged from 5～10 cm,and 59 patients with abdominal defect≥10 cm.The mean operating time was 95(70～120)min,and the average intraoperative blood loss was 80 ml(60～250 ml).The mean postoperative hospitalization was 14.5 days(10～28 d). Patients were followed-up from 3 to 96 months,and 3 patients suffered from hernia recurrence(2.38%). Conclusions The ONLAY repair of ineisional hernia of the abdominal wall with synthetic material mesh was a safe procedure,especially for those with large abdominal wall defects.