ObjectiveTo summarize the changes of inguinal hernia in The First Affiliated Hospital of Anhui Medical University in the past 7 years and the curative effect of each procedure.MethodsRetrospectively searched the clinical data of 1 078 patients with inguinal hernia operated in The First Affiliated Hospital of Anhui Medical University from January 2011 to December 2017. According to the surgical procedure, patients were divided into tissue repair group, laparoscopic hernia repair group (laparoscopic group), and open tension-free hernia repair group (open group). Subsequently, the patients of the open group were divided into the mesh plug technique group, the plain patch technique group, and the Ultrapro Hernia System (UHS) group. The postoperative of each procedure, such as recurrence, chronic pain, foreign body sensation, hard touch of the surgical site, male sexual function, and fertility status were compared.ResultsIn 1 078 patients, 52 patients underwent tissue repair, 889 patients underwent open tension-free hernia repair (687 patients were counted with mesh-seal tablets, 100 patients with plain patch count, 102 patients with preperitoneal hernia repair), and 137 patients underwent laparoscopic hernia repair. There was no significant difference in the incidence of total complication, chronic pain, foreign body sensation, and male sexual function decline in the laparoscopic group and the open group (P>0.05). However, the recurrence rate and hard touch of the surgical site rate of the laparoscopic group were lower (P<0.05), and the Numeric Rating Scale (NRS) score was also slightly lower (P=0.047). There was no significant difference in the incidence of the recurrence, chronic pain, foreign body sensation, and male sexual function decline between the three subgroups of the open group, but the total complication rate and hard touch of the surgical site rate in the UHS group were lower than those in the mesh plug group and the plain patch group (P<0.05).ConclusionsLaparoscopic repair of the inguinal herniorrhaphy has lower incidence of occurrence, it is worthy of clinical promotion. In the open tension-free surgery, the retroperitoneal herniorrhaphy may be a better choice.
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 summarize the experience of surgical treatment of late-onset mesh infection after open inguinal hernia tension-free repair. Methods The retrospective descriptive study was conducted. The clinical data of 128 mesh infection patients after open inguinal tension-free hernia who were admitted to the Department of General Surgery of Shaanxi Provincial People’s Hospital form December 2016 to December 2021 were collected. All patients underwent debridement under general anesthesia through a treatment process of laparoscopic exploration, methylene blue staining, removal of mesh, wound irrigation, and negative pressure closed drainage. Patients were observed for completion of surgery, postoperative recovery, and follow-up results. Results One hundred and twenty-eight patients underwent open debridement successfully. In 98 patients, no abnormality was found on laparoscopic exploration and the infected meshs were removed by direct debridement surgery. In 28 patients, laparoscopic exploration revealed that the meshs had broken through the peritoneum and were tightly adherent to the mesentery and intestinal canal. In 2 patients, revealed abdominal abscesses at the paracolic sulcus of the ascending colon and at the ileocecal tract. The infected meshs were removed relatively intact in 112 patients, and the residual meshs were not removed intact in 16 patients. The operative time of 128 patients were 75–345 minutes with an average of 154 minutes, the bleeding volume was 10–200 mL with an average of 37.4 mL, the time to remove the negative pressure drainage tube after surgery were 5–14 days with an average of 8.4 days, the postoperative hospital stay were 6–18 days with an average of 11.6 days. There were 114 cases of class A healing, 12 cases of class B healing, and 2 cases of class C healing. One hundred and twenty-eight patients underwent postoperative follow-up for 6 to 60 months, with a media follow-up time of 30 months. During the follow-up period, 4 patients developed ipsilateral inguinal hernia recurrence, 4 patients developed reinfection, and 3 patients developed varying degrees of pain in the inguinal region. Conclusions Late-onset mesh infection after open inguinal tension-free hernia repair requires removal mesh by surgical treatment. Laparoscopic exploration, methylene blue-assisted debridement, complete removal of the mesh, strict wound irrigation and negative pressure closure drainage are safe and reliable treatment.
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.
Objective To explore the application effect of same-day surgery mode in adult patients with inguinal hernia repair under enhanced recovery after surgery mode. Methods The perioperative data of adults undergoing inguinal hernia repair in the Day Surgery Center of West China Hospital, Sichuan University between August 2020 and March 2022 were analyzed retrospectively. The adult patients with inguinal hernia repair who received routine daytime surgery were taken as the control group (routine group), and the adult patients with inguinal hernia repair who received same-day surgery were selected as the trial group (same-day group). The differences in safety, cost and patient experience between the two groups were compared and analyzed. Results A total of 319 patients were included, including 152 in the routine group and 167 in the same-day group. There was no significant difference in gender, education level, occupation and hernia ring diameter between the two groups (P>0.05). The age of the patients in the same-day group was older than that in the routine group [(49.49±12.88) vs. (46.41±14.12) years, P<0.05]. The hernia position of the two groups was mostly on the right side, but there was a difference in the hernia position (P<0.05). In terms of safety indicators, the majority of patients in the two groups used local anesthesia. The proportion of local anesthesia (98.2% vs. 76.3%), the amount of intraoperative bleeding [2.8 (2.0, 5.0) vs. 1.3 (0.0, 5.0) mL] in the same-day group were higher than those in the routine group, and the operation time [25.2 (20.0, 33.0) vs. 32.3 (26.0, 40.7) min] in the same-day group was shorter than that in the routine group (P<0.05). There was no significant difference between the two groups in the time of getting out of bed and the complications rate on the 3rd and 28th days after operation (P>0.05). There were no intraoperative complications in both groups. In terms of cost indicators, there was no significant difference between the two groups in the hospitalization cost (P>0.05). The surgery cost of the same-day group was higher than that of the routine group [1472.0 (1438.1, 1614.6) vs. 1450.3 (1428.1, 1438.1) yuan, P<0.05]. The drug cost [109.2 (81.3, 138.7) vs. 255.8 (127.0, 261.6) yuan] and the total medical cost [8418.5 (8207.4, 9129.9) vs. 8912.1 (8325.9, 9177.9) yuan] in the same-day group were lower than those in the routine group (P<0.05). In terms of patient experience indicators, the postoperative pain score [0.3 (0.0, 1.0) vs. 0.2 (0.0, 0.0)] and satisfaction score [3.3 (3.0, 4.0) vs. 3.0 (3.0, 3.0)] of the same-day group were higher than those of the routine group (P<0.05). Conclusion Both the same-day surgery mode and the routine surgery mode of adult patients with inguinal hernia repair have high safety, but the same-day surgery mode is more economical and patient satisfaction is higher than the routine surgery mode, which suggest that the same-day surgery mode of adult patients with inguinal hernia repair under enhanced recovery after surgery mode is feasible, safe and economic, and further optimizes and improves the content and quality of daytime surgical medical services.
ObjectiveTo compare the outcomes after self-gripping mesh repair to ordinary polypropylene mesh secured with sutures in women’s Lichtenstein hernioplasty.MethodsThe clinical data of 116 female patients with primary unilateral inguinal hernia who were admitted to The First Affiliated Hospital of Zhengzhou University from January 2014 to January 2017 were prospectively analyzed. A randomized controlled trial was performed based on a random number table. All patients were allocated into self-gripping mesh group (PG group) and ordinary polypropylene mesh group (PL group). The outcomes included operative time, post-operative pain score, analgesic used, hospital stay, urinary retention, wound infection, and seroma were recorded. Patients were followed-up after 1 week, 1 months, 3 months, 1 year, and 2 years after operation. Follow-up data included chronic pain, foreign body feeling, affect daily activities, and recurrence.ResultsNinety-nine participants completed follow-up. There were 48 patients in the PG group and 51 participants in the PL group. The operative time of the PG group was significantly shorter than that of the PL group (P=0.045), but there was no significant difference in analgesic used, hospital stay, incidence of urinary retention and wound infection, visual analogue scale (VAS) of wound pain at rest at 1 week postoperatively, VAS of wound pain on coughing at 1 week postoperatively between the two groups (P>0.05). At 1 month after operation, the incidence of foreign body feeling in the PG group was significantly higher than that of the PL group (P=0.031), while there was no significant difference in ratio of VAS≥3 and incidence of affect daily activities (P>0.05). At 3 months, 1 year, and 2 years after operation, there was no significant difference in incidences of foreign body feeling, chronic pain, and affect daily activities between the two groups (P>0.05). There was one recurrence in the PL group and none in the PG group, without a significant difference (P=0.248).ConclusionThe surgical outcomes of self-gripping mesh are comparable to the ordinary polypropylene mesh with a reduced operation time in women’s Lichtenstein hernioplasty.
Objective To investigate the value of applying closed continuous negative pressure drainage in preventing postoperative complications of inguinal hernia. Methods The clinical data of 107 adult male patients diagnosed with inguinal giant hernia (incarcerated 16 cases, non-incarcerated 91 cases) undergoing tension-free hernioplasty using the Ultrapro Hernia System (UHS) between April 2011 and June 2016 in our hospital were retrospective analyzed. Prophylactic use of antibiotics was not adopted except patients with incarcerated hernia, diabetes, or elderly. Multi-lateral hole plasma drainage tube were used in 61 patients, 46 cases without indwelling plasma tube. The postoperative scrotum pain, scrotal hematoma, scrotal effusion, and incision infection of two groups patients were observed. Results Of the 61 patients with plasma drainage, the mean drainage time was 2 days, the longest was 5 days. Postoperative scrotal pain was found in 2 cases (3.3%) without scrotal hematoma or scrotal effusion. Of the 2 patients, the drainage of 1 case was obstructed, the drainage was extubated and the patient was cured and discharged after 5 days by sucking the drainage tube using empty needle. The average hospital stay in this group was 4 days. Of the 46 patients without plasma drainage, 7 patients (15.2%) suffered scrotal pain, 7 patients (15.2%) suffered scrotal hematoma. The average hospital stay was 6 days. The incidence of scrotal pain and scrotal hematoma was significantly higher in patients without plasma drainage than those with drainage (P<0.05). The condition of scrotal hematoma would be improved after 1–3 times outpatient dressing change and repeated hematoma sucking. One case was not improved after repeated suction, the condition was improved after scrotum incision, drainage, and dressing. Conclusion Closed continuous negative pressure drainage potentially prevents oblique hernia pain and scrotal hematoma without increasing the incidence of incision infection or hospitalization time.
Objective To explore the application effect of PDCA cycle management on reducing the unplanned overnight recovery rate in patients undergoing transabdominal preperitoneal inguinal hernia repair (TAPP) under the same-day surgery model. Methods The unplanned overnight recovery rate in patients who underwent TAPP at West China Tianfu Hospital of Sichuan University between January and October 2023 (pre-improvement phase) was analyzed. A quality control group was established, and PDCA cycle management was employed to define control objectives and implement strategies to reduce the unplanned overnight recovery rate. The unplanned overnight recovery rate in patients who underwent TAPP between November 2023 and April 2024 (post-improvement phase) was compared with that in the pre-improvement phase. Results After the implementation of PDCA cycle management, the unplanned overnight recovery rate in patients undergoing TAPP under the same-day surgery reduced from 23.87% (37/155) in the pre-improvement phase to 9.05% (19/210) in the post-improvement phase, with a statistically significant difference (P<0.05). Conclusion The application of PDCA cycle in the process management of TAPP under the same-day surgery model significantly reduces the unplanned overnight recovery rate in patients.
Objective To observe the clinical effect of vacuum sealing drainage (VSD) in the treatment of mesh infection following inguinal hernia repair. Methods A total of 24 patients who suffered form mesh infection following inguinal hernia repair and got treatment in our hospital from February 2012 to December 2015 were collected and divided into 2 groups according to the type of treatment, 12 patients (13 sides) of VSD group received treatment of VSD, and 12 patients (13 sides) of conventional group received conventional treatment. Comparison between the 2 groups in mesh retention rate, the wound healing time, hospitalization cost, and hospital stay was performed. Results There was significant difference in mesh retention rate〔76.9% (10/13)vs. 30.8% (4/13)〕, the wound healing time〔(20.5±4.4) dvs. (29.7± 6.7) d〕, hospitalization cost〔(18 430.1±7 180.2) RMBvs. (12 201.1±6 453.2) RMB〕, and hospital stay〔(23.5±4.1) dvs. (30.7±6.5) d〕between the VSD group and conventional group (P<0.050). Compared with conventional group, the mesh retention rate and hospitalization cost were higher, the wound healing time and hospital stay were shorter in VSD group. Conclusions VSD can effectively control the mesh infection following hernia repair, improve the mesh retention rate. The VSD can also promote growth of granulation tissue in cavity, shorten the wound healing time and hospital stay, but has a high hospitalization cost than conventional treatment.
ObjectiveTo investigate the relation between preoperative peripheral blood neutrophil/albumin (NEU/ALB) or hypersensitive C-reactive protein (hs-CRP)/ALB ratio and seroma after laparoscopic transabdominal preperitoneal (LTAPP) hernia repair. MethodsThe patients diagnosed with inguinal hernia and underwent LTAPP hernia repair admitted to the Heji Hospital Affiliated to Changzhi Medical College from June 2020 to June 2023 were retrospectively collected. The multivariate logistic regression analysis was conducted to identify the risk factors affecting the occurrence of seroma after LTAPP hernia repair. The area under receiver operating characteristic curve (AUC) and 95% confidence interval (95%CI) were used to evaluate the discriminatory value of preoperative peripheral blood NEU/ALB ratio and hs-CRP/ALB ratio for seroma after LTAPP hernia repair. Delong test was used to compare the discriminatory value of these indicators. The test level was α=0.05. ResultsA total of 357 patients who met the inclusion criteria were included in this study, and the seroma occurred in 42 cases (11.8%). The results of multivariate logistic regression analysis showed that the larger the diameter of the hernia sac [OR (95%CI)=4.654 (2.829, 7.657), P<0.001], the more intraoperative bleeding [OR (95%CI)=3.021 (1.498, 6.094), P=0.002], and the higher NEU/ALB ratio [OR (95%CI)=2.585 (1.618, 4.130), P<0.001] or hs-CRP/ALB ratio [OR (95%CI)=1.874 (1.239, 2.834), P=0.003], the higher the probability of seroma after LTAPP hernia repair. The AUC (95%CI) of NEU/ALB or hs-CRP/ALB indicator for predicting seroma after LTAPP hernia repair was 0.750 (0.702, 0.794) and 0.762 (0.715, 0.806), respectively. The optimal cutoff values were 2.970 and 4.001, with sensitivity of 78.6% and 73.8%, and specificity of 60.3% and 65.7%, respectively. The AUC (95%CI) of the NEU/ALB in combination with hs-CRP/ALB in predicting seroma after LTAPP hernia repair was 0.851 (0.810, 0.886), with sensitivity and specificity of 71.4% and 87.0%, respectively. The AUC of the NEU/ALB in combination with hs-CRP/ALB in predicting seroma after LTAPP hernia repair was higher than that of NEU/ALB (Z=2.864, P=0.004) or hs-CRP/ALB alone (Z=2.956, P=0.003). ConclusionFrom the data analysis results of this study, the occurrence rate of seroma after LTAPP hernia repair is not low, and the occurrence of seroma should be paid close attention to patients with larger hernia sac diameter, more intraoperative bleeding, and higher NEU/ALB or hs-CRP/ALB ratio.