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.
【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 explore the operative result of intrarectal proctoptosis accompanying hernia of pelvic floor due to common outlet obstructive constipation(OOC).MethodsEleven cases of intrarectal proctoptosis with of pelvic floor surgically treated were analysed. Results In a week following operation, 9 of 11 patients’ symptoms disappeared, the other 2 cases recovered after 3 months, functional exercise. Conclusion Functional rectal suspension combined with repair of pelvic, partial sigmoidectomy, surgical elevation of pelvic floor and hysteropexy are highly effective in alleviating symptoms in patients with intrarectal proctoptosis accompanying pelvic floor herniation.
Objective To summarize the surgical technique and the effectiveness of CK Parastomal patch in laparoscopic repair of parastomal hernia. Methods The cl inical data were retrospectively analysed from 24 patients who received laparoscopic repair of parastomal hernia using CK Parastomal patch between June 2006 and March 2010. There were 15 males and 9 females with a median age of 55 years (range, 47-80 years). Among them, 19 patients were with colon parastomalhernia in the left lower quadrant and 5 patients with ileum parastomal hernia in the right lower quadrant. The parastomal hernia duration was 1 to 4 years (mean, 2.4 years). The maximal diameter of the hernia ring was 3 to 7 cm (mean, 5.2 cm). All patients did not receive hernia repair. Results Laparoscopic repair of parastomal hernia was successfully performed in 18 cases, and open repair was used in 6 cases because of extensive adhesion. The average operating time was 121 minutes (range, 78 to 178 minutes). All wounds healed by first intention. Wound seroma occurred in 8 cases at 3 to 7 days after operation and disappeared by aspiration. Eleven patients complained of pain in the operative area within 1 month after operation and it disappeared without intervention. All patients were followed up 6 to 39 months (mean, 27 months). One recurrence occurred at 3 months after operation, and no recurrence occurred in the other patients. Conclusion Laparoscopic repair of parastomal hernia using CK Parastomal patch is a safe and feasible procedure with a satisfactory short-term effectiveness, but the long-term effectiveness should be further observed.
Objective To explore the method and effectiveness of laparoscopic bundled fastigiated mesh in repairing inguinal hernia. Methods Between January 2003 and December 2009, 1 215 patients (1 363 sides) with inguinal hernia were treated. There were 1 132 males (1 268 sides) and 83 females (95 sides), aged from 18 to 89 years (median, 58 years). The cases included 1 187 cases (1 329 sides) of primary hernia and 28 cases (34 sides) of recurrent hernia. There were indirect inguinal hernia in 728 cases (786 sides), direct inguinal hernia in 416 cases (499 sides), femoral hernia in 43 cases (45 sides), and unusual hernia in 28 cases (33 sides). According to the hernia classification criteria, there were 31 cases (38 sides) in type I, 683 cases (754 sides) of type II, 403 cases (452 sides) of type III, and 98 cases (119 sides) of type IV. The disease duration was 1 to 9 days with an average of 3.8 days. To repair the hernia, the bundled fastigiated mesh was patched through the internal inguinal ring and fixed on the internal inguinal fascia by three-point fixation. The mesh would be wrapped in the peritoneum by purse-string suture. Results The surgeries were performd successfully. The operative time ranged from 18-32 minutes (mean, 22 minutes). Postoperative tractional pain in the inguinal region occurred in 19 cases (21 sides), acute uroschesis in 8 cases, and far-end hernial sac effusion in 2 cases (2 sides); all were cured after symptomatic treatment. All incisions healed by first intention, and no complications of fever, infection, or hematoma occurred. A total of 1 095 cases (1 182 sides) were followed up 1 to 7 years (median, 3 years and 9 months). Five patients died of medical illnesses at 1-3 years after operation. Three cases recurred and then were cured by a second surgery. No intestinal adhesion or obstruction occurred. Conclusion The bundled fastigiated mesh in laparoscopic inguinal hernia repair has the advantages of minimal invasiveness, easy-to-operate, less complications, and lower recurrence rate.
To summarize the therapeutic method and effectiveness of parastomal hernia repair in situ with sublay methods. Methods Between February 2003 and May 2009, 34 patients with parastoma hernia were treated with Sublay methods using primary midl ine incision approach and polypropylene patch. There were 23 males and 11 females withan average age of 58.4 years (range, 43-78 years). The disease duration was 1 to 17 years (mean, 4.7 years). Of 34 patients, 6 had recurrent parastoma hernia. The diameter of hernia ring was 5-12 cm (mean, 7.2 cm). Results Sublay technique repair was successfully performed in all patients. The operative time was 96-160 minutes (mean, 116 minutes). The gastric tube was pulled out 12 hours to 5 days (mean, 3 days) after operation. The drainage tube was taken out at 2-7 days (mean, 4 days) after operation. The postoperative hospital ization time was 7 to 15 days (mean, 9 days). And the incisions of 32 patients healed by first intention. Incisional fat l iquefaction occurred in 1 case and infection in 1 case, and their incisions healed after dressing change. Seroma at the upper of the patch occurred in 7 patients and was cured by 2 to 3 times of percutaneous puncture and local pressure. Thirty-two patients were followed up 6-75 months (mean, 32 months). No chronic pain, lumping sensation, or local expansion in wound area occurred. Two recurrences occurred 3 months and 7 months after operation, respectively, and patients restored after expectant treatment or re-operation. Conclusion The in situ Sublay methods using primary midl ine incision approach and nonabsorbable patch is a feasible and safe method for parastomal hernia repair.
OBJECTIVE: To investigate the effectiveness of polypropylene path (Prolene) in hernia prevention following harvesting of rectus abdominis is myocutaneous flap. METHODS: From November 1999 to October 2000, Prolene patches were applied in 26 cases to repair the anterior rectus sheath following harvesting free rectus abdominis myocutaneous flap. Data concerning each case included size of rectus flap, defect of rectus sheath, size of patch used, wound healing and complications. RESULTS: Prolene patch showed good biocompatibility with abdominal tissue. No foreign-body rejection occurred after operation. Seroma developed in 1 case, and was drained bedside without complication. All prolene patches healed well in the body during follow-up. Hernia formation and abdominal bulge were not observed. CONCLUSION: Prolene patch is a satisfactory material for repair of the anterior rectus sheath after harvesting free rectus abdominis myocutaneous flap.
Objective To evaluate and select essential medicine for herniated lumbar disc based on the burden of disease for township health centers located in eastern, central and western regions of China. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Six clinical guidelines on herniated lumbar disc were included, five of which were evidence-based. (2) In total, there were 35 medicines (of four classes) listed in the guidelines. (3) We offer a b recommendation for paracetamol and ibuprofen as essential medicine and a weak recommendation for aspirin, indometacin and diazepam according to WHOEML (2011), NEML (2009), CNF (2010), clinical guidelines and the quantity and quality of evidence. (4) Five recommended medicines have been marketed in China with the dosage forms and specifications corresponding to guidelines and their prices were affordable (0.31 to 3.38 yuan daily). (5) Results of domestic low-quality studies indicated that ibuprofen and aspirin were effective with efficiencies of 63% to 84.5%; however, both of which were less effective than other trial medicines (efficiencies: 88.60% to 95.2%). We didn’t find any efficacy or pharmacoeconomic evidence of other medicines in Chinese literature databases. Conclusion (1) Pharmacotherapy should focus on symptomatic treatment of herniated lumbar disc. (2) We offer a b recommendation for paracetamol and ibuprofen used in the treatment of herniated lumbar disc and a weak recommendation for aspirin, indometacin and diazepam. (3) There is lack of evidence and high-quality guidelines on pharmacotherapy of lumbar intervertebral disc in China, especially pharmacoeconomic evidence. (4) We propose that guidelines should be established in basis of evidence so as to effectively direct clinical treatment. The effect of medicine in clinical practice should be based on current evidence from inside and outside China.
Objective To summarize the experiences and methods on reoperation of recurrent incisional hernia after mesh repair with prosthetic patch. Methods Sixteen patients who got reoperation from January 2007 to December 2010 because of recurrent incisional hernia after mesh repair were analyzed retrospectively. Results All patients received prosthetic patch repair for reoperation. Thirteen patients received new mesh repair accompanied with old mesh removal, repair conducted by suturing new mesh with old mesh together in two patients, and repair performed by new mesh overlapping the old mesh in one patient. All patients recovered with primary wound healing. Fluid upon the mesh occurred in 3 patients and cured by percutaneous puncture and pressure dressing. Postoperative hospital stay was 7 to 16 days and the average 9 days. The drainage was removed 2 to 7 days after operation and the average was 4 days. All the 16 patients were followed up. And during a follow-up range of 5 to 36 months and the average 20 months, there was slight foreign body sensation in one patient, no chronic pain in wound area occurred. And no abdominal wall hernia recurrence occurred. Conclusions Reoperation of recurrent incisional hernia after mesh repair need to consider the recurrent position, material of the previous mesh, and the previous surgical methods, and should select appropriate prosthetic patch and surgical procedure, then could gain satisfied results.
Objective To summarize the surgical technique and curative effect of laparoscopic repair for suprapubic incisional hernia using composite patch. Methods The clinical data of 25 cases performed laparoscopic repair of suprapubic incisional hernia using composite patch from March 2007 to October 2010 were reviewed retrospectively. There were 13 males and 12 females， and aged 35-83 years （median age was 52 years）. Among them 2 patients were recurrences. The distance between the lower margin of hernia defect and pubic arc was less than 5 cm. The composite patch was fixed to the abdominal wall using spiral tacks （Protack） in direct vision. The lower margin of the patch was lower to the pubic arc in 2 cm， and to be fixed to the pubic arc and bilateral pectineal ligament， and it should be extended. Results Laparoscopic repair were successfully performed in all patients without convert to open repair. The max diameter of the hernia ring was 6.1-12.5cm and the average was 9.5 cm. The average operating time was 128 min （ranging from 90 to 180 min）. And the total complication rate was 28% （7/25）， including bladder damage during operation in 1 case， wound seroma upon the patch in 4 cases and cured by aspiration， pain in the operative area and disappeared within one month without intervention in 1 case. Twenty-two patients were followed-up with a follow-up rate of 88%. During a follow-up range of 6-48 months（average 30 months）， one case recurrence occurred in 2 months after the repair with the recurrent rate of 4%. Conclusions Laparoscopic repair of suprapubic incisional hernia is a safe and feasible technique， and the patch should cover and exceed the margin of the defect for 5 cm in all direction. The lower margin of the patch should be fixed to the bilateral pectineal ligament so as to strengthen the fix， and lower the recurrence rate.