The effect of internal orifice narrowing in laparoscopic inguinoscrotal hernia repair to prevent seroma formation: a prospective double-blind randomized controlled trial.

OBJECTIVES: Seroma represents the most prevalent postoperative complication following laparoscopic inguinal hernia repair, particularly in the case of large inguinoscrotal hernias. This randomized controlled trial was undertaken with the objective of assessing the effects of internal orifice narrowing achieved by suturing the divided distal hernia sac in laparoscopic repair of indirect inguinoscrotal hernias. METHODS: A total of 58 patients aged 18 years or older, were randomized into two groups: Group I, which underwent internal orifice narrowing, and Group II, which served as the control without narrowing. The study's primary endpoint was the incidence and volume of seroma in the inguinal region on postoperative days 1 and 7, as well as at 1, 3, and 6 months following the procedure. Secondary outcomes encompassed metrics like total operative time, acute and chronic pain levels, duration of hospital stay, recurrence rates, and the occurrence of any additional complications. RESULTS: In comparison to the control group, the experimental group exhibited a significantly lower incidence of seroma formation at 7 days (P = 0.001). Furthermore, the ultrasonic assessment indicated a reduced seroma volume in the operative group on postoperative day 7 (8.84 ± 17.71 vs. 52.39 ± 70.78 mL; P < 0.001). Acute pain levels and hospital stay were similar between the two groups (1.22 ± 0.76 vs. 1.04 ± 0.53, P = 0.073; 1.22 ± 0.07 vs. 1.19 ± 0.08, P = 0.627, respectively). Notably, neither chronic pain nor early recurrence, nor any other postoperative complications were observed in either group throughout the follow-up period, which extended for at least 6 months (range: 6-18 months). CONCLUSION: In the context of laparoscopic inguinoscrotal hernia repair, the incidence and volume of seroma can be significantly reduced through the implementation of internal orifice narrowing achieved by suturing the divided distal hernia sac. And, this reduction in seroma formation was not associated elevation in postoperative pain levels or recurrence rates.

Prognostic Impact of Aberrantly Expressed Protein-coding Gene Associated With Gastric Cancer's Regulatory T Cells, Based on Online Databases.

Context: Gastric cancer (GC) remains one of the most prevalent malignancies worldwide, and no effective cure exists for advanced GC. Clinicians believe that molecularly targeted therapy through PCGs may replace surgery, radiotherapy, and other treatments as a breakthrough in curing malignancies. Objective: The study intended to examine the impact of aberrant expression of the protein-coding genes (PCGs) associated with regulatory T cells on the prognosis of patients with gastric cancer (GC). Design: The research team performed a genetic study through research of genetic data in online databases. Setting: The study took place at Zhongda Hospital. Outcome Measures: The research team selected a publicly available dataset, genetic suppressor element 109476 (GSE109476), from the Gene Expression Omnibus (GEO) database for differential gene analysis, gene ontology (GO) analysis, and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis to screen for PCGs associated with regulatory T cells as well as the Gene Expression Profiling Interactive Analysis (GEPIA) database with the Kaplan-Meier Plotter database to analyze the expression of the above PCGs in GC and the prognostic impact on GC. Results: The GEO2R analysis found 315 differentially expressed PCGs in GSE109476, among which nine PCGs were associated with regulatory T cells: (1) chemokine (C-C motif) ligand 19 (CCL19), (2) CCL21, (3) C-C chemokine receptor type 7 (CCR7), (4) cluster of differentiation 70 (CD70), (5) ephrin B3 (EFNB3), (6) early growth response 3 (EGR3), (7) interleukin-7 receptor (IL7R), (8) galectin-1 (LGALS1), and (9) tumor necrosis factor (TNF) receptor superfamily member 13C (TNFRSF13C). The GEPIA database indicated that no significant differences existed between the expression of CCL19, CCL21, CD70, EFNB3, EGR3, IL7R, and TNFRSF13C in stomach adenocarcinoma (STAD) tissues and that in normal tissues (P > .05), while expressions of CCR7 and LGALS1 were significantly elevated in STAD tissues compared to the normal tissues (P < .05). The Kaplan-Meier Plotter database analysis, on the other hand, showed a significant relationship between all of the above-mentioned PCGs, except CCL19, and the prognosis of GC. Conclusions: CCL19, CCL21, CCR7, CD70, EFNB3, EGR3, IL7R, LGALS1, and TNFRSF13C are PCGs are differentially expressed in GC and closely associated with regulatory T cells. They may affect the occurrence and development of GC through a variety of pathways, including regulation of immune infiltration and inflammation, and are of great potential research value.

Postoperative perineal hernia repair: what is the evidence?

The present study determined the characteristics of perineal hernia treatment in the literature, and the incidence of postoperative recurrence was stratified according to repair techniques. A systematic search of the available literature on the treatment of postoperative perineal hernias was performed using a major database. The types of repair techniques and outcome were entered into an electronic database and a pooled analysis was performed. A total of 213 cases of postoperative perineal hernia repair were collected from 20 relevant articles in the literature after excluding case reports (n < 3). Synthetic mesh was the material used most frequently for perineal hernia repair (55.9%). The most frequently used approach in perineal hernia repair was the perineal approach (56.5%). The recurrence rate was highest with the use of biological mesh (40.4%) and the perineal approach (35.6%). The recurrence rate was lowest in the combined abdominal & perineal approach (0%), followed by the abdominal approach (8.8%) and the laparoscopic approach (11.8%). A number of different repair techniques have been described in the literature. The use of synthetic mesh via a combined abdominal-perineal approach or intraabdominal/laparoscopic approach was shown to be associated with a reduced postoperative recurrence rate.

Presentation and management of post-esophagectomy or Gastrectomy Hiatal Hernia.

PURPOSE: Hiatal hernia may development after esophagectomy or Gastrectomy. Post- esophago-gastric hiatal hernia is a rare but challenging condition. Nearly half of reported cases involve emergent situations, underscoring the urgency of addressing this condition. However, there is currently no consensus on the optimal treatment approach for this type of hernia. METHODS: All consecutive patients who underwent repair for Post- esophago-gastric hiatal hernia over the past five years were retrospectively reviewed. Patient characteristics and perioperative data were collected. The primary outcomes, repair methods, and surgical results following post-esophago-gastric hiatal repair were analyzed. RESULTS: A total of eight patients with post-esophago-gastric hiatal hernia were included in this study. All patients presented with emergent conditions, specifically bowel obstruction. Laparoscopic repair was successful in four cases, with a conversion rate to open surgery of 50% (4 out of 8). Primary suture was performed in three cases, while biological mesh repair was carried out in four cases, and one case was left unrepaired. Bowel gangrene and perforation occurred in one case. The most notable postoperative complications included wound infection and pleural fluid collection. Importantly, there were no instances of hernia recurrence during the follow-up period, which ranged from 2 to 55 months, with a 100% follow-up rate observed. CONCLUSION: Post-esophago-gastric hiatal hernia is a rare yet significant condition, often presenting emergently and linked to higher morbidity and mortality rates. Therefore, symptomatic patients warrant surgical repair, and immediate intervention should be provided to those with acute-onset symptoms and clinical signs of bowel obstruction. Primary suture repair, with or without biological mesh, appears to be a durable method of repair.

Impact of body fat location and volume on incisional hernia development and its outcomes following repair.

BACKGROUND: Obesity is known to increase the likelihood of developing abdominal wall hernias, body mass index (BMI) alone does not provide detailed information about the amount and location of body fat. The aim of this study was to investigate the link between various adipose tissue parameters and the incidence of incisional hernias (IHs), as well as the outcomes of hernia repair. METHODS: We conducted a comprehensive review of the existing literature to examine the relationship between various body fat parameters and the occurrence of IHs after abdominal surgeries, as well as the outcomes of hernia repair. RESULTS: Thirteen studies were included for analysis. Eight trials evaluated the IH development after abdominal surgeries via specific fat parameters, and five studies evaluated the postoperative outcomes after IH repair. The findings of this study suggest that an increase in visceral fat volume (VFA or VFV) and subcutaneous fat (SFA or SFV) are linked to a higher incidence of IHs after abdominal surgeries. Higher levels of VFV or VFA were associated with more challenging fascia closure and greater postoperative recurrence rates following repair. Whereas BMI did not demonstrate a significant association. CONCLUSION: Measuring visceral and subcutaneous fat composition preoperatively can be a useful tool for assessing the risk of IH, and is more reliable than BMI. Elevated levels of these fat parameters have been linked to increased recurrence of IH following hernia repair, as well as the use of complex surgical techniques during repair.

Injectable Double Crosslinked Hydrogel-Polypropylene Composite Mesh for Repairing Full-Thickness Abdominal Wall Defects.

Abdominal wall defects are common clinical diseases, and mesh repair is the standard treatment method. The most commonly used polypropylene (PP) mesh in clinical practice has the advantages of good mechanical properties, stable performance, and effective tissue integration effect. However, direct contact between abdominal viscera and PP mesh can lead to severe abdominal adhesions. To prevent this, the development of a hydrogel-PP composite mesh with anti-adhesive properties may be an effective measure. Herein, biofunctional hydrogel loaded with rosmarinic acid is developed by modifying chitosan and Pluronic F127, which possesses suitable physical and chemical properties and commendable in vitro biocompatibility. In the repair of full-thickness abdominal wall defects in rats, hydrogels are injected onto the surface of PP mesh and applied to intraperitoneal repair. The results indicate that the use of hydrogel-PP composite mesh can alleviate abdominal adhesions resulting from traditional PP mesh implantation by decreasing local inflammatory response, reducing oxidative stress, and regulating the fibrinolytic system. Combined with the tissue integration ability of PP mesh, hydrogel-PP composite mesh has great potential for repairing full-thickness abdominal wall defects.

Comparison of Different Weight Meshes in Ventral/Incisional Hernia Repair, the Outcomes of Systematic Review and Meta-analysis.

BACKGROUND: The use of mesh is not without complications. Decreasing the mesh weight with the light-weight (LW) mesh may improve tissue growth and diminish mesh-related complications, yet, clinically, there are conflicting results regarding the influence of different weight meshes in ventral/incisional hernia repair. The aim of the present study is to compare the outcomes of different weight meshes for ventral/incisional hernia repair. METHODS: The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies were published through January 1, 2022, using the keywords "heavy weight" "light weight" "mesh" "ventral hernia" "incisional hernia". All relevant articles and reference lists in these original studies were also obtained from the above databases. RESULTS: Eight trials (4 randomized controlled trials, 3 prospective studies, and 1 retrospective study) containing 1844 patients were included in the present meta-analysis. The pooled results showed that there was a significantly more rate of foreign body perception in the heavy-weight mesh group compared with the LW mesh group (odds ratio = 5.02, 95% CI: 1.05, 24.06). There was no significant difference concerning hernia recurrence, seroma, hematoma, surgical site infection, reoperation rate, chronic pain, quality of life, and hospital stay among different weight mesh groups. CONCLUSION: Different weight meshes showed similar clinical results in ventral/incisional hernia repair, except that, perception of foreign body was reported more frequently in the heavy-weight mesh group as compared with the LW mesh group. However, the long-term hernia recurrence with different weights of meshes needs to be reevaluated considering the relative short-term follow-up in these studies.

A Novel Prognostic Biomarker CCR8 for Gastric Cancer and Anti-CCR8 Blockade Attenuate the Immunosuppressive Capacity of Tregs In Vitro.

Objective: To investigate the immunotherapeutic roles and functions of C-C Motif Chemokine Receptor 8 (CCR8) molecule in gastric cancer (GC). Materials and Methods: Clinicopathological features of 95 GC cases were collected by a follow-up survey. The expression level of CCR8 was measured by immunohistochemistry (IHC) staining and analyzed with the cancer genome atlas database. The relationship between CCR8 expression and Clinicopathological features of GC cases was evaluated by univariate and multivariate analysis. Flow cytometry was used to determine the expression of cytokines and the proliferation of CD4+ regulator T cells (Tregs) and CD8+ T cells. Results: An upregulated expression of CCR8 in GC tissues was associated with tumor grade, nodal metastasis, and overall survival (OS). Tumor-infiltrated Tregs with higher expression of CCR8 produced more IL10 molecules in vitro. In addition, anti-CCR8 blocking downregulated IL10 expression produced by CD4+ Tregs, and reversed the suppression by Tregs on the secretion and proliferation of CD8+ T cells. Conclusion: CCR8 molecule could be a prognostic biomarker for GC cases and a therapeutic target for immune treatments.

A flexible pressure sensor with highly customizable sensitivity and linearity via positive design of microhierarchical structures with a hyperelastic model.

The tactile pressure sensor is of great significance in flexible electronics, but sensitivity customization over the required working range with high linearity still remains a critical challenge. Despite numerous efforts to achieve high sensitivity and a wide working range, most sensitive microstructures tend to be obtained only by inverting naturally existing templates without rational design based on fundamental contact principles or models for piezoresistive pressure sensors. Here, a positive design strategy with a hyperelastic model and a Hertzian contact model for comparison was proposed to develop a flexible pressure sensor with highly customizable linear sensitivity and linearity, in which the microstructure distribution was precalculated according to the desired requirement prior to fabrication. As a proof of concept, three flexible pressure sensors exhibited sensitivities of 0.7, 1.0, and 1.3 kPa- 1 over a linear region of up to 200 kPa, with a low sensitivity error (<5%) and high linearity (~0.99), as expected. Based on the superior electromechanical performance of these sensors, potential applications in physiological signal recognition are demonstrated as well, and such a strategy could shed more light on demand-oriented scenarios, including designable working ranges and linear sensitivity for next-generation wearable devices.

The salvage of mesh infection after hernia repair with the use of negative pressure wound therapy (NPWT), a systematic review.

BACKGROUND: Mesh infection is the most feared postoperative complication after abdominal wall hernia repair, often needs mesh removal. Negative pressure wound therapy (NPWT) has been used in these situations with diverse results. The aim of this study was to investigate the efficacy of the NPWT in the treatment of mesh infection, the primary outcome was the mesh salvage rates of different type of meshes and mesh positions. METHODS: Major databases were searched using the keywords negative pressure wound therapy, VSD, vacuum assisted, hernia, mesh infection, including various combinations of the terms. All relevant articles and reference lists in these original studies were also obtained from the above databases. RESULTS: Ten articles containing 265 patients on the treatment of mesh infection after hernia repair with the use of NPWT method were included. The general infected mesh salvage rate with NPWT was 76.2%. The highest mesh salvage rate was achieved in polypropylene mesh (93.5%), followed by Proceed mesh (83.3%), and the mesh salvage rate was lower in polyester mesh (PCO) (0%) and the ePTFE mesh (14/3%). The salvage rate was higher when mesh placed in the onlay position (82.6%) or retromuscular/sublay position (98.5%), but lower in the IPOM position (55.6%). CONCLUSION: The treatment of mesh infection after hernia repair should be individualized according to the mesh type, mesh position and the severity of infection. Infected mesh with favourable mesh materials (large pore and monofilament polypropylene) and favourable positions (onlay or sublay/retromuscular) can be salvaged with the use of NPWT based conservative method.

Transabdominal Partial Extraperitoneal Repair of Lateral Hernias of the Abdomen and Flank.

Background: Lateral hernia (LH) repair is a challenging and debated topic in abdominal wall surgery because of the anatomical location and mesh placement and fixation. Large LHs should be managed with an open procedure; however, there is no consensus regarding the repair of small- to medium-sized LHs. We report our treatment of this type of LH using the transabdominal partial extraperitoneal (TAPE) technique. Methods: After retrospective review of the prospective hernia database at two hernia centers, patients with small- to medium-sized LHs who underwent the TAPE technique were identified and analyzed. The key components of our technique include wide dissection of peritoneum off the defect and use of that peritoneum to cover the lower and medial part of the mesh as much as possible. The parameters studied included patient demographics, intraoperative data, and postoperative outcome. Results: We studied 19 patients with small- to medium-sized LHs repaired using the TAPE procedure between 2017 and 2020. LH etiologies were primary hernia (n = 3), incisional hernia (n = 15), and traumatic hernia (n = 1). Mean defect size was 5.8 ± 2.1 cm (range 2.5-10 cm), mean operative time 118.1 ± 41.7 minutes (range 65-240 minutes), and mean postoperative stay 6.4 ± 2.0 days (range 6-9 days). There were no perioperative complications. At a mean follow-up of 20 months, no patient had recurrence of LH. Discussion: For small- to medium-sized LHs, the laparoscopic TAPE technique is minimally invasive and safe; the procedure is associated with minimal postoperative complications.

Polypropylene mesh combined with electrospun poly (L-lactic acid) membrane in situ releasing sirolimus and its anti-adhesion efficiency in rat hernia repair.

This study developed, a novel polypropylene (PP) mesh combined with poly (L-lactic acid) (PLA) electrospun nanofibers loaded sirolimus (SRL). The PP mesh was combined with PLA/SRL (1/0, 1/0.01, 1/0.02; mass ratios) composed electrospun membrane characterized by FTIR spectroscopy, XPS and SEM, and evaluated for cytocompatibility in vitro. In an in vivo study, a total of 84 Sprague-Dawley rats were employed to evaluate the efficacy of the novel composite PP mesh anti-adhesion, mechanical properties and inflammation. As a results, the PLA/SRL membrane could compound with PP mesh stably and load SRL. Although tensile testing showed that the mechanical properties of composite mesh decreased in vivo, the integration strength between the tissue and mesh was still able to counteract intra-abdominal pressure. Compared with the native PP mesh group, the novel PP mesh group showed a lower score for abdominal adhesion and inflammation. More importantly, the novel PP mesh completely integrated with the abdominal wall and had sufficient mechanical strength to repair abdominal wall defects.

The Management of Indirect Inguinal Hernia Sac in Laparoscopic Inguinal Hernia Repair: A Systemic Review of Literature.

BACKGROUND: The aim of this study is to investigate the current management strategy of indirect hernia sac during laparoscopic inguinal hernia repair. OBJECTIVES: The aim was to evaluate the various indirect hernia sac management strategies when performing laparoscopic inguinal hernia repair. DATA SOURCES: Major databases (PubMed, Embase, Springer, and Cochrane Library). REVIEW METHODS: MeSH and free-text searching include "laparoscopic inguinal hernia" "TAPP," "TEP," "inguinal hernia," "indirect inguinal hernia sac," "distal sac," "sac transection," "sac ligation," and "sac reduction." RESULTS: The present study enrolled 7 trials, 4 studies compared the results of indirect hernia sac transection and complete sac reduction. The pooled results indicated that indirect hernia sac transection was associated increased seroma formation (odds ratio=2.74, 95% confidence interval: 1.41-4.31), and there was no statistical difference in the incidence of postoperative pain, operative time, hernia recurrence, and time to return to normal activity between the sac transection and sac reduction groups. Two studies reported the application of adjuncts in the management of distal sac during laparoscopic large inguinoscrotal hernia repair. The seroma formation could be reduced by adjuncts of fixing the distal hernia sac to posterior abdominal wall with either suture or tacks. CONCLUSION: Indirect sac transection during laparoscopic indirect inguinal hernia repair is associated with a higher incidence of postoperative seroma. Additional adjuncts to the divided distal hernia sac, including distal sac fixation with either suture or tacks, are effective methods to prevent postoperative seroma.

Long-Term Follow-Up of Lichtenstein Repair of Inguinal Hernia in the Morbid Patients With Self-Gripping Mesh (ProgripTM).

Objective: This study aimed to demonstrate the safety and the efficacy of the self-gripping mesh (ProgripTM) for inguinal hernia repair in morbid patients of the higher American Society of Anesthesiologists (ASA) classification (ASA III and IV). The incidence of chronic pain, postoperative complications, and hernia recurrence was evaluated. Methods: Data were collected retrospectively from the files of the patient and were analyzed for 198 hernias in 147 patients. All the patients included in this study had undergone inguinal hernia repair by Lichtenstein approach with the self-gripping mesh (ProgripTM) in the same clinical center. Preoperative, perioperative, and postoperative data were collected and a long-term follow-up of 31.8 ± 19.5 m (5-60 m) was performed. Complications, pain scored on a 0-10 numeric rating scale (NRS), and hernia recurrence were assessed. Results: During the past 5 years, 198 hernias in 147 patients were repaired with the Lichtenstein procedure with the self-gripping mesh (ProgripTM). The majority of the patients were high level of the ASA classification (ASA III and IV) (95.9%), with ASA III (10.2%) and IV (85.7%). The mean operation time was 71.2 ± 23.8 min. The mean length of postoperative stay was 2.5 ± 2.1 days. There were no intraoperative complications. About 14 cases (7.1%) suffered from postoperative surgical wound complications, which were limited to the skin and subcutaneous tissue and were cured with the conservative methods successfully; there was no mesh infection, the acute postoperative pain was low or mild [visual analog scale (VAS) score ≤ 4] and the chronic postoperative pain was reported in three patients (1.5%) and tolerable, hernia recurrence (femoral hernia recurrence) occurred in one patient half a year after during the follow-up period. Conclusion: This study demonstrated the advantages of the self-gripping mesh in hernia repair of the high-risk patients with inguinal hernia (ASA III and IV) by Lichtenstein procedure under local anesthesia.

Another type of diaphragmatic hernia to remember: parahiatal hernia.

BACKGROUND: Parahiatal hernia is a less common form of diaphragmatic hernia, with the defect lateral to the crus and oesophageal hiatus, and the unfamiliarity of this disease would cause confusion to general surgeons. In the present study, the literature on parahiatal hernia were reviewed, the clinical profile of this disease, as well as our own experience is presented and analysed. METHODS: In the present study, a thorough identification of all published reports on parahiatal hernias was made, together with our own cases, the available data were summarized, analysed and discussed. RESULTS: A total of 27 cases of parahiatal hernias were identified since 1987. Among them, 19 cases were primary parahiatal hernias, and eight cases were secondary or acquired parahiatal hernias. None of the 27 cases were pre-operatively diagnosed, and the majority of them were pre-operatively diagnosed as paraoesophageal hernias. Detailed treatment data were available in 26 of the 27 cases. Three patients received open surgery, and 23 patients were treated with laparoscopic procedures. Suture repair was used in 12 cases, and 14 cases were repaired with mesh reinforcement. In addition, two cases underwent partial gastrectomy, stomach suture was performed in another two cases. CONCLUSION: Patients with parahiatal hernia have a high risk of developing hernia incarceration or gastric vovulus. Laparoscopic treatment of parahiatal hernia is feasible and safe in the majority cases. Surgeons should be aware of this disease when performing paraoesophageal hernia repair, as parahiatal hernias may occur with or without previous diaphragmatic surgery.

lncRNA PVT1 Promotes Tumorigenesis of Colorectal Cancer by Stabilizing miR-16-5p and Interacting with the VEGFA/VEGFR1/AKT Axis.

Recently, the long noncoding RNA (lncRNA) plasmacytoma variant translocation 1 (PVT1) was reported to be involved in the pathogenesis of several cancers, including human colorectal cancer (CRC). However, the molecular basis for cancer initiation, development, and progression remains unclear. In this study, we observe that upregulated PVT1 is associated with poor prognosis and bad clinicopathological features of CRC patients. In vitro means of PVT1 loss in a CRC cell line inhibit cell proliferation, migration, and invasion. Furthermore, dual-luciferase reporter and RNA pull-down assays indicated that PVT1 binds to miR-16-5p, which has been shown to play strong tumor suppressive roles in CRC. Targeted loss of miR-16-5p partially rescues the suppressive effect induced by PVT1 knockdown. Vascular endothelial growth factor A (VEGFA), a direct downstream target of miR-16-5p, was suppressed by PVT1 knockdown in CRC cells. Overexpression of VEGFA is known to modulate the AKT signaling cascade by activating vascular endothelial growth factor receptor 1 (VEGFR1). We, therefore, show that PVT1 loss combined with miR-16-5p overexpression reduces tumor volume maximally when propagated within a mouse xenograft model. We conclude that the PVT1-miR-16-5p/VEGFA/VEGFR1/AKT axis directly coordinates the response in CRC pathogenesis and suggest PVT1 as a novel target for potential CRC therapy.