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.
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.
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 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.
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。
ObjectiveTo survey the feasibility of laparoscopic high ligation for pediatric inguinal hernias by performing the surgery on rabbit models. MethodsLaparoscopic high ligation was operated on 32 healthy New-Zealand male rabbits. Eight random rabbits were observed under laparoscope on the 7th, 15th, 30th, and 60th days after operation, and the anti-tension strength at the instant when hernial inner ring cracked was measured. Repair regions were resected. After HE-staining, the syzygial status of the repair regions were checked. ResultsNone of the rabbits died during the research with no such complications as ankylenteron intestinal obstruction or hernia relapses after surgery. The anti-tension strength by the inguinal regions of the experimental rabbits after surgery on the 7th, 15th, 30th, and 60th days was respectively (42.69±6.98), (69.31±6.52), (102.64±7.91), and (106.53±7.54) mm Hg (1 mm Hg=0.133 kPa). As for the pathological section observation, the agglutination of the repair region was consistent with reparative process of chronic nonbacterial inflammation. ConclusionThe operation of laparoscopic high ligation for repairing inguinal hernia on rabbits is safe and reliable.
Objective To evaluate the clinical application of the different operative approaches of the laparoscopicrepair of inguinal hernia and provide a more rational and scientific choice for the surgeon. Methods The strict inclusion and exclusion criteria were set up. All the randomized controlled trials （RCT） about laparoscopic transabdominal preperi-toneal （TAPP） and totally extraperitoneal （TEP） approaches of laparoscopic inguinal hernia repair were collected. Meta an-alysis was performed according to the recommendation by the Cochrane handbook. Results Seven RCTs including 552 patients were analyzed， who were divided into TAPP group （n=302） and TEP group （n=250）. Compared with TAPP group， there were no significant differences of the operation time〔WMD=8.49， 95% CI （-1.37， 18.35）， P=0.09〕， postoperative hospitalization〔SMD=0.11， 95% CI （-0.12， 0.34）， P=0.34〕， postoperative recurrence rate 〔OR=1.37， 95% CI （0.36， 5.20）， P=0.64〕， and complications （incision infection， urinary retention） 〔Incision infection：OR=4.27， 95% CI （0.85， 21.57）， P=0.08；Urinary retention：OR=0.61， 95% CI （0.21， 1.78）， P=0.36〕in the TEP group. But the postoperative 24 h pain in the TEP group was significantly milder than that in the TAPP group 〔WMD=0.72， 95% CI （0.58， 0.87）， P＜0.000 01〕. Conclusions The currently available evidence shows that postoperative 24 h pain in the TEP group is more milder than that in the TAPP group. The time of the operation， postoperative hospitalization， postoperative recurrence， and complications are no significant differences between TAPP group and TEP group. Large-scale， high-quality RCTs are still needed to confirm or refuse the available evidence.
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.