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 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.
ObjectiveTo investigate the application of tension-free herniarepair under local anesthesia in senile inguinal hernia. MethodsClinical data of 163 cases of senile inguinal hernias with herniorrhaphy under local anesthesia in our department from October 2011 to October 2014 were analyzed retrospectively, including epidural anesthesia 90 patients and local anesthesia 73 patients. ResultsAll patients were successfully completed surgery. Hospital charges in local anesthesia were much cheaper than that in epidural anesthesia group (P=0.002). Hospital days in local anesthesia were much shorter than that in epidural anesthesia group (P=0.035). Lung complication in local anesthesia were much less than that in epidural anesthesia group (P=0.015). Other indicators were no significant difference between the two groups (P > 0.05). ConclusionTension-free herniorrhaphy under local anesthesia in elderly patients is safe, reliable, less invasive method with low costs, slight postoperative pain, and worthy of promotion.
ObjectiveTo evaluate rational use of antibiotics for hernioplasty in perioperative period by intervention-control study in order to provide a foundation for the clinical antibiotic use and management. MethodsThe data of the preventive use of antibiotics for hernia patients from January to October, 2010 in perioperative period were collected and compared. Interventions on patients from January to October, 2011 were carried out. ResultsIn the intervention group, the first three antibiotics used were changed from azlocillin, mezlocillin and aztreonam before intervention to cefazolin, clindamycin and azlocillin after intervention. Before intervention, antibiotics were first used after surgery for surgical prophylaxis, while after intervention, antibiotics were first used within 30 minutes before surgery or at the start of induction of anesthesia. The preventive medication time decreased from (3.50±2.07) days to (0.88±1.07) days (t'=14.601, P=0.000), the hospitalization days of post-surgery decreased from (5.17±1.90) days to (3.77±1.61) days (t'=7.313, P=0.000), the cost of antibiotics decreased from (342.39±415.50) yuan to (54.08±80.83) yuan (t'=8.831, P=0.000), the percentage of the cost of antibiotics in expenses for medicine declined from (47.53±25.51)% to (12.49±13.46)% (t'=15.776, P=0.000), and the percentage of the cost of antibiotics in hospitalization expenses declined from (6.59±5.49)% to (1.07±1.35)% (t'=12.662, P=0.000). The difference in inappropriate use of antibiotic drugs before and after prevention, such as choice of preventive drugs, preoperative medication occasion, course of postoperative medication and no indication of drug combination, had statistical significances (P<0.05). ConclusionThe intervention-control study shows that the rational use of antibiotics for hernioplasty in perioperative period can be improved, and the average hospitalization days and the cost of antibiotics can be reduced by intervention.
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.
【Abstract】Objective To investigate the effects and advantages of laparoscopic hernioplasty for hernia. Methods From June 1995 to June 2005, 222 patients with hernia were treated with laparoscopy. Transabdominal preperitoneal hernia repair (TAPP) were performed in 166 patients. Totally extraperitoneal hernia repair(TEP) were performed in 25 patients. Closure of the internal orifice of hernia was performed in 21 patients. Furthermore, incisional hernia in 2 patients, diaphragmatic hernia in 1 patient and mesenteric hernia in 1 patient were performed by laparoscopic hernioplasty and 6 patients with hernia of oesophagus finestra performed hernioplasty combined collapse gastric fundus with laparoscopy. In this series 45 patients associated with other abdominal disease were simultaneously treated with laparoscopy. Results All cases were operated successfully. The span of operation reduration was 42.5 min 〔(10～180 min)〕. The average length of postoperative hospital stay were 4.6 days. There was one early failure owing to the use of too small a piece of mesh.Conclusion The results indicate that mesh repair of hernias is a satisfactory technique with a low recurrence rate and a low major complication rate.
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 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 observe the effect of transabdominal preperitoneal (TAPP) laparoscopic hernia repair by same-day surgery mode for patients with inguinal hernia. MethodsThe patients who underwent TAPP laparoscopic hernia repair were retrospectively collected in the Day Surgery Center of West China Tianfu Hospital from July 2022 to June 2023. All patients in this study were admitted according to the same-day surgery plan, and those who were admitted to the hospital on the same day, operated on the same day, and returned to their homes on the same day, i.e., those who did not stay in the hospital overnight (the same-day surgery plan of the West China Tianfu Hospital of Sichuan University is now basically in the range of 8∶00–20∶00, and the latest discharge is at 21∶00) were classified as the same-day surgery group; however, the patients whose special cases needed to be postponed due to the condition of their illnesses, or those who were discharged from the hospital after 21∶00 due to safety considerations because of other reasons such as postoperative observation of patients with general anesthesia for a period of less than 2–4 h, or those who had a strong desire to be admitted to the hospital overnight, and whose hospital stay was not more than 24 h, were classified as the non-same-day surgery group. The age, gender, marital status, body mass index, hernia type, surgical site, home address, intraoperative bleeding, operative time, total hospitalization cost, pain score at discharge, unplanned revisit rate within 30 d after surgery, discharge satisfaction were compared between the patients of two groups. ResultsA total of 167 patients underwent TAPP laparoscopic hernia repair were enrolled in this study, including 97 in the same-day surgery group and 70 in the non-same-day surgery group. There were no statistically significant differences in the age, gender, marital status, body mass index, hernia type, surgical site, intraoperative bleeding, operative time, and total hospitalization cost between the two groups (P>0.05). However, it was found that the patients in the non-same-day surgery group had a higher pain score at discharge and a higher proportion of home address outside Chengdu city as compared with the same-day surgery group (P=0.042, P<0.001, respectively); The satisfaction rate of all patients in this group was 100% on the 28th day after discharge, and the unplanned revisit rate within 30 d after surgery was 3.6% (6/167), although which in the same-day surgery group was slightly higher than the non-same-day surgery group, the difference was not statistically significant by Fisher test [4.1% (4/97) versus 2.9% (2/70), P=0.226]. ConclusionFrom the analysis results of this study, TAPP laparoscopic hernia repair for patients with inguinal hernia by the same-day surgery mode is safe, and it can further shorten the hospitalization time as compared with the non-same-day surgery.
目的探讨疝环充填式无张力疝修补术在腹外疝修补术中的价值。方法回顾性总结1999年5月至2002年10月我院应用疝环充填式无张力疝修补术治疗腹外疝患者58例，共62例次。其中合并高血压、心肺功能不全、前列腺肥大、糖尿病者占39.7%（23/58）。 结果切口均为一期愈合。术后3～7 d出院。随访１～29个月，平均18个月，随访率为89.7%（52/58）,无一例复发。结论疝环充填式无张力疝修补术具有创伤小、符合解剖生理、痛苦少、恢复快及复发率低等优点。