Objective To explore the important role of preperitoneal space in laparoscopic transabdominal preperitoneal （TAPP） and totally extraperitoneal （TEP） hernia repair. Methods The clinical data of 66 patients （78 sides） performed laparoscopic TAPP and TEP hernia repair from January 2008 to April 2011 in this hospital were analyzed retrospectively. Results TAPP hernia repair were performed in 16 cases （20 sides），TEP hernia repair were performed in 50 cases （58 sides）. Three cases of TEP hernia repair transferred to TAPP hernia repair. The unilateral operation time was （86.92±36.38） min，intraoperative bleeding was （6.08±3.43） ml. Postoperative complication rate was 16.7% （11/66），including 3 cases of postoperative serum swelling，3 cases of temporary paraesthesia of nerve feeling in the repair area，2 cases of scrotum emphysema，2 cases of urinary retention，and 1 case of intestinal obstruction. There were 2 cases of recurrence. The hospital stay was （4.52±0.99） d. The return to activities and working time was （10.32±1.86） d after discharge. Sixty-six cases were followed up for （18.56±1.96） months （range 1-38 months），the patch infection，chronic pain，and testicular atrophy complications were not been observed. Conclusions Acquainting and mastering laparoscopic preperitoneal space and its important structure are the key to avoid intraoperative and postoperative complications of laparoscopic inguinal hernia repair.
ObjectiveTo explore the effectiveness of traditional Chinese medicine (TCM) acupuncture analgesia after laparoscopic total extraperitoneal inguinal hernia repair (TEP), aiming to reduce the use of analgesics post-surgery. MethodsPatients who underwent unilateral TEP in the Department of Hernia and Abdominal Wall Surgery at our hospital from May 2022 to May 2023 were selected as research subjects. Those who met the inclusion and exclusion criterias were randomly assigned to three groups: TCM acupuncture analgesia group, traditional Chinese medicine acupuncture analgesia plus western medicine analgesia group (referred to as Chinese and western medicine analgesia group), and western medicine analgesia group. The basic information, postoperative numerical rating scale (NRS) pain scores, postoperative recovery indicators, and complication rates of the three groups were analyzed and compared.ResultsThere was no statistically significant differences in the basic data of patients across the three groups (P>0.05). There were significant differences in NRS score, recovery time of intestinal function, first urination time after operation and first ambulation time after operation at each time point after analgesia (6 h, the next morning, 48 h, 72 h and 96 h after operation) among the three groups (P<0.05). The NRS scores in both the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group were lower than those in the western medicine analgesia group (P<0.05), Additionally, postoperative recovery outcomes were better in the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group compared with the western medicine group (P<0.05). There was no significant difference of the above results compared between the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group (P>0.05). There was no significant difference in postoperative complications among the three groups (P>0.05). ConclusionTCM acupuncture analgesia following TEP surgery is effective and leads to improved postoperative recovery compared with the use of oral analgesics alone, without an increase in adverse reactions.
Objective To review the clinical operation methods of abdominal incisional hernia. Methods Classification, operation method and fellow-up of 78 patients with abdominal incisional hernia were retrospectively analyzed. Results The average time of fellow-up was 26 months. Nineteen cases were repaired with simple suture with 3 cases (15.8%) recurrence, 57 cases were repaired with man-made material with 2 case （3.4%） recurrence. Conclusions Individual operation method should be chosen according to body condition, classification of the size of abdominal loss and abdominal hypertension. It is an effective method to repair the hernia of abdominal incision with man-made material.
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.
Objective To explore the risk factors of chronic postoperative inguinal pain (CPIP) after transabdominal preperitoneal hernia repair (TAPP), establish and verify the risk prediction model, and then evaluate the prediction effectiveness of the model. Methods The clinical data of 362 patients who received TAPP surgery was retrospectively analyzed and divided into model group (n=300) and validation group (n=62). The risk factors of CPIP in the model group were screened by univariate analysis and multivariate logistic regression analysis, and the risk prediction model was established and tested. Results The incidence of CPIP at 6 months after operation was 27.9% (101/362). Univariate analysis showed that gender (χ2= 12.055, P=0.001), age (t=–4.566, P<0.01), preoperative pain (χ2=44.686, P<0.01) and early pain at 1 week after operation (χ2=150.795, P<0.01) were related to CPIP. Multivariate logistic regression analysis showed that gender, age, preoperative pain, early pain at 1 week after operation, and history of lower abdominal surgery were independent risk predictors of CPIP. The area under curve (AUC) of the receiver operating characteristic (ROC) of the risk prediction model was calculated to be 0.933 [95%CI (0.898, 0.967)], and the optimal cut-off value was 0.129, while corresponding specificity and sensitivity were 87.6% and 91.5% respectively. The prediction accuracy, specificity and sensitivity of the model were 91.9% (57/62), 90.7% and 94.7%, respectively when the validation group data were substituted into the prediction model. Conclusion Female, age≤64 years old, preoperative pain, early pain at 1 week after operation and without history of lower abdominal surgery are independent risk factors for the incidence of CPIP after TAPP, and the risk prediction model established on this basis has good predictive efficacy, which can further guide the clinical practice.
Objective To evaluate the clinical effectiveness and safety of different mesh fixation techniques in laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) by using network meta-analysis. Methods CNKI, WanFang Data, VIP, CBM, the Cochrane Library, PubMed, Embase, and Web of Science databases were retrieved to collect randomized controlled trials (RCTs) studies comparing different fixation methods of patches in laparoscopic TAPP. The retrieval time limit was from the establishment of the database to March 1, 2022. After two researchers independently screened the literatures, extracted the data, and evaluated the bias risk, Bayesian network meta-analysis was conducted by using R4.1.2 software. Results Twenty-nine RCTs were included, including 4 095 patients. The results of network meta-analysis showed that the risk of chronic postoperative inguinal pain was higher in staples fixation than that of no fixation [OR=0.06, 95%CI (0.01, 0.26), P＜0.001], glue fixation [OR=0.21, 95%CI (0.04, 0.53), P=0.001] and self-gripping mesh [OR=0.09, 95%CI (0.01, 0.52), P=0.009], the incidence of chronic postoperative inguinal pain with suture fixation was higher than that with no fixation [OR=0.10, 95%CI (0.01, 0.70), P= 0.020]. Postoperative visual analogue scale of staples fixation was higher than those of no fixation [MD=–0.90, 95%CI (–1.49, –0.33), P=0.002] and glue fixation [MD=–0.92, 95%CI (–1.35, –0.49), P＜0.001], the postoperative visual analogue scale with suture fixation was higher than those of no fixation [MD=–0.83, 95%CI (–1.61, –0.08), P=0.030] and glue fixation [MD=–0.85, 95%CI (–1.56, –0.13), P=0.020]. There was no significant difference in the incidence of seroma and hematoma, hospital stay and hernia recurrence among different fixation methods. Conclusions The network meta-analysis shows that medical glue and self-gripping mesh have certain advantages in reducing chronic pain after surgery, which may be the better patch fixation method in TAPP. The non fixation mesh will not increase the risk of postoperative recurrence, and can be used in clinical practice. This conclusion needs to be further verified by large sample, long-term follow-up and high-quality RCTs.
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.
Objective To evaluate the clinical effectiveness of laparoscopic and open tension-free hernia repairs in adults. Methods A fully recursive literature search was conducted in PubMed (2002 to September, 2009), EMBASE (2002 to September, 2009), Cochrane Central Register of Controlled Trials (Issue 3, 2009), CBM (2002 to September, 2009) , CNKI and VIP Chinese Scientific Journals Full-text Database (2002 to September, 2009) in any language. Randomized or quasi-randomized controlled trials of inguinal hernia treated by laparoscopic and open methods in adults were considered for inclusion. The four analyzed outcome variables were chronic pain, long term recurrence, intraoperative complications and postoperative complication. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out using RevMan 5.0 software. Results Eighteen published reports of eligible studies involving 5816 participants met the inclusion criteria. Compared with open methods, laparoscopic inguinal hernia had no significant differences in long-term recurrence rate [OR 1.53, 95%CI (1.00 to 2.34), P=0.05] and postoperative complication rate [OR 0.74, 95%CI (0.52 to 1.05), P=0.09], and had lower tendency chronic pain [OR 0.45, 95%CI (0.34 to 0.59) , Plt;0.000 01] with statistical significance. There were significant differences in intraoperative complications between the two groups [OR 2.15, 95%CI (1.32 to 3.53), P=0.002]. Conclusion Current evidence suggests that laparoscopic hernia repair is superior to open methods in chronic pain .There is no significant difference in long-term recurrence rate and postoperative complications between the two methods. More studies are needed for intraoperative complications and other long-term postoperative complications.
Objective To retrospectively compare short-term outcomes and health economics of PHS versus UHS for inguinal hernia repair. Methods We included 105 patients suffering from reducible inguinal hernia hospitalized in the First Affiliated Hospital of Lanzhou University from September, 2007 and September, 2012. The referred hernia types involved direct and indirect hernia (unilateral and bilateral). Based on different repair materials, the patients were divided into two groups, PHS group (n=53) and UHS group (n=52). Outcome parameters for comparison included incidences of seroma and scrotum edema, hospital duration, costs, etc. Results There were no differences in age, sex, hernia type, incidences of seroma and scrotum edema after surgery, hospital duration and costs between the two groups. However, the patients in the PHS group spent less money than those in the UHS group regarding the costs of materials and hospitalization, with significant differences. Conclusion For inguinal hernia repair, PHS and UHS are alike in reducing short-term complications, but PHS can significantly reduce patients’ economic burden due to less costs.
Objective To explore the clinical efficacy of nursing measures based on the concept of enhanced recovery after surgery (ERAS) for patients undergoing day surgery of inguinal hernia repair. Methods A total of 120 patients scheduled for day surgery of inguinal hernia repair between January and June 2015 were randomized into ERAS group (n=60) and control group (n=60). Patients in the ERAS group received nursing optimized by the idea of ERAS during the perioperative period, while those in the control group received traditional routine nursing intervention. Postoperative visual analogue scale (VAS) scores, adverse responses, early ambulation, influence of pain on patients’ sleep, satisfaction of the patients and prolonged hospital stay rate were analyzed and compared between the two groups. Results VAS scores during hours 0-2, 2-4, 4-8, and 8-12 in the ERAS group were significantly lower than those in the control group (P < 0.05). Between hour 12 and 24, the VAS sco res were not significantly different between the two groups of patients (P > 0.05). Early postoperative ambulation, influence of pain on the sleep, and patients’ satisfaction on pain control and nursing care in the ERAS group were all significantly better than those in the control group (P <0.05). Conclusion Based on the concept of ERAS nursing intervention model, we can effectively reduce postoperative complications after inguinal hernia repair, accelerate patients’ postoperative rehabilitation, and increase patients’ satisfaction.