Objective To investigate the application of transverse fascia in inguinal hernia repair. Methods In this study, 617 patients underwent inguinal hernia repair between January 1990 and December 2005 in our hospital were included, which were divided into two groups according to different operative ways: transverse fascia method group (n=337) and Bassini method group (n=280). Then intraoperative results, postoperative complications, and rehabilitated results of patients in two groups were compared. Results Compared with Bassini method group, the patients in transverse fascia method group did not show significant difference in operative time and blood loss during operation (Pgt;0.05). The differences of severe postoperative pain, testicular swelling, the time of the body’s restore for normal activities, and recurrence rate of patients between two groups were significant (Plt;0.05), while the difference of hematoma of scrotum and infection of incisional wound (Pgt;0.05). Conclusion The strengthening of posterior wall by transverse fascia and reconstruction of inner ring is a simple and effective method for inguinal hernia repair.
ObjectiveTo discuss the main auxiliary inspection methods and their guiding significance for inguinal hernia.MethodsBy searching literatures and international guidelines, to review the main auxiliary examination methods, such as ultrasound, CT, and MRI.ResultsClinical physical examination combined with ultrasound could increase diagnostic sensitivity. CT could provide surgeons with a better sense of wholeness and structural details, and could be used as a guide for specific types of inguinal hernia. The soft tissue recognition of MRI was good, and it had a good effect on the identification of hidden hernia, mesh conditions, and tissue inflammation.ConclusionEach examination has its own advantages, and should be selected based on clinical practice and medical center conditions.
Objective To evaluate the clinical experience and skills of laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection in order to spread and popularize this kind of operation. Methods Under general anesthesia, 32 patients (42 sides) with inguinal hernias were repaired by laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a dissection balloon from August 2005 to December 2007. Results All of operations were successfully performed. The operative time was 60-120 minutes, the blood loss was 20-60 ml, and the length of postoperative hospitalization was 3 days. All cases were followed up for 8 to 18 months and found no recurrence. Conclusion Laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection is feasible, reliable and effective, offering a low recurrence rate, while its price is higher than tension-free herniorrhaphy by traditional method.
ObjectiveTo compare the safety, effectiveness, and stability of 3D Max lightweight patch and standard patch in laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphy. MethodsThe clinical data of 147 patients who underwent laparoscopic TAPP herniorrhaphy with 3D Max from May 2013 to May 2014 in this hospital were collected. Of all the patients, the lightweight patches were used in 75 patients (observation group), the standard patches were used in 72 patients (control group). The mean operative time, mean early postoperative ambulation time, mean bleeding volume, postoperative pain, postoperative foreign body sensation, complications, average hospital stay, and average costs were compared between these two groups. The postoperative pain point was determined by using visual analogue scale (VAS). The foreign body sensation of postoperative groin area was determined basing on the pain point. ResultsThere were no significant differences in the terms of the mean operation time, the mean early postoperative ambulation time, the mean bleeding volume, the average costs, and the average hospital stay between the observation group and the control group (P > 0.05). On postoperative 2 d, the pain point of the observation group was slightly lower than that of the control group, but there was no statistically significant difference between these two groups (P=0.132); On postoperative 1 month and 6 months, the postoperative pain points of the observation group were significantly lower than those of the control group, the differences were statistically significant (P=0.031, P=0.018). There was no recurrence of hernia and complications in the two groups. ConclusionsThe cost of 3D Max lightweight patch in laparoscopic TAPP herniorrhaphy application is slightly higher than that in standard patch, but it could alleviate postoperative pain, reduce postoperative foreign body sensation, and make patients feel more comfortable. It is safe, effective, and stable in clinical application of laparoscopic TAPP herniorrhaphy.
摘要:目的:总结应用自体真皮片移植疝修补术治疗腹股沟疝20例的近期治疗效果。方法:使用自体真皮片移植,对20例各类腹股沟疝患者进行无张力修补治疗;观察手术方法及时间、手术指征、术后患者自主能力的恢复、术后伤口疼痛、并发症和复发率。结果:与传统疝修补手术相比,自体真皮移植疝修补术具有方法简便、手术指征广、术后疼痛轻、恢复快、并发症少和复发率低的优点。结论:自体真皮移植疝修补术是一项更符合人体解剖结构和疝的病理生理的手术方法,具有传统方法无法比拟的优势。尤其适于在基层医院推广。Abstract: Objective: To summarize the recently therapeutic effect of autodermis transplantation repair of inguinal hernia. Methods: Twenty patients were treated by tension free hernia repair with autodermis transplantation. The operative procedure, surgical indication,ability recovery,postoperative pain,complications and recurrence rate were studied. Results: Autodermis transplantation hernia repair was superior to the traditional because of easier performance,wider indications,blander postoperative pain,faster recovery,fewer complications and lower recurrence. Conclusion: Autodermis transplantation hernia repair is more consistent with human anatomic structure and hernial pathophysiology than the conventional method, especially suiltable for primary hospital.
目的 分析改良区域阻滞麻醉法在腹股沟疝手术中的临床应用价值。方法 对2003年12月至2008年12月期间我院收治的168例腹股沟疝患者应用区域阻滞麻醉，对术中疼痛、肌松程度、手术时间、术后并发症、住院时间和住院费用方面进行临床观察。结果 所有患者麻醉效果满意,肌肉松弛,解剖层次清楚,除5例在牵扯精索时有轻微酸痛外,余无任何不适,术后无特殊并发症。平均手术时间40 min(包括麻醉),平均住院9 d,普通疝修补术平均费用1 480元,无张力疝修补术平均费用3 265元。结论 改良区域阻滞麻醉下行腹股沟疝手术麻醉效果满意、安全性高、简单易行、经济实惠,可作为各种腹股沟疝手术的麻醉方法,更适合在基层医院应用。
目的 总结腹股沟疝无张力疝修补术的手术经验。方法 回顾性分析我院2002年2月至2009年1月期间126例腹股沟疝患者行无张力疝修补术的临床资料及手术方法。结果 本组126例患者无围手术期死亡者,并发症主要有局部肿胀、异物感、疼痛等,随访6个月～6年(平均38个月)有6例(4.8%)复发。结论 无张力疝修补术是治疗腹股沟疝较为理想的术式。
ObjectiveTo investigate the clinical characteristics and risk factors of chronic pain after laparoscopic inguinal hernia repair.MethodsThe clinical data of 142 cases underwent laparoscopic inguinal hernia repair from January 2013 to December 2017 in The Second Affiliated Hospital of Xiamen Medical College were retrospectively analyzed.ResultsThe incidence of chronic pain after laparoscopic inguinal hernia repair was 12.7% (18/142), and 83.3% (15/18) of the patients were located in the inguinal region. Univariate analysis showed that postoperative chronic pain rates were higher in patients receiving standard patch, large patch, mechanical fixation patch, and with postoperative complications (P<0.05). Multivariate analysis showed that large patch [OR=1.82, 95% CI was (1.18, 5.36), P=0.023], mechanical fixation patch [OR=1.44, 95% CI was (1.07, 3.62), P=0.039], and postoperative complications [OR=2.53, 95% CI was (1.27, 7.31), P=0.011] were independent risk factors for postoperative chronic pain after laparoscopic inguinal hernia repair.ConclusionThe occurrence of chronic pain after laparoscopic inguinal hernia repair is the result of many factors, especially the complications and patch factors.