ObjectiveTo investigate the technique and early results of hybrid repair of parastomal hernia with the DynaMesh-IPST. MethodsA retrospective analysis was made on the clinical data of 28 patients who underwent DynaMesh-IPST hybrid repair of parastomal hernia between October 2013 and June 2016. There were 18 males and 10 females, aged 49-84 years (mean, 71 years). The disease duration of parastomal hernia was 6-60 months (mean, 27.6 months). The body mass index (BMI) was 17-35 (mean, 25.6); there were 15 obese patients (BMI > 26). ResultsThe operation was completed smoothly in all patients. The mean stoma diameter was 6 cm (range, 4-9 cm). The mean operation time was 142 minutes (range, 110-190 minutes). The mean hospital stay was 9 days (range, 7-12 days). Seroma was found in 2 patients, and was cured by needle aspiration and pressure bandage. All 28 cases were followed up 1-33 months (mean, 19 months). No recurrence, infection, intestinal fistula, and stoma-related problems were found. The appearance of abdominal wall was symmetrical. ConclusionDynaMesh-IPST hybrid repair is a safe and feasible method for parastomal hernia, and the short-term operative result is satisfactory.
Objective To discuss the surgical treatment and experience of mesh infection after prosthetic patch repair of inguinal hernia. Methods The clinical data of 67 cases of mesh infection after prosthetic patch repair who were treated in Chao-Yang Hospital from Jan. 2011 to Jun. 2012 were retrospectively analyzed. Results All patients were treated with surgical operation successfully， including removing the infected mesh and surrounding tissues， primary suture， and a placement of wound drainage， without replacement of a new patch substitute. The hospital stay of the patients was 10-25days with an average of 16days. Of the 67 patients， 51 patients got primary healed and the other 16 patients healed delayed after local dressing change due to the superficial infection following stitch removal. Sixty-six patients were followed-up for 6-24 months （average of 20 months） after operation without recurrence and complication， including seroma， wound infection， intestinal fistula， and postoperative pain. Conclusions The treatment of mesh infection after inguinal hernia repair is very complicated， but the primary suture repair and a placement of wound drainage after removing infected mesh with complete debridement is a effective therapy for it.
ObjectiveTo summarize the method and experience in surgical treatment for mesh infection after prosthetic patch repair of ventral hernia. MethodsThe clinical data of 16 patients with mesh infection after ventral hernia repair accepted surgical treatment in our department from June 2007 to May 2010 were analyzed retrospectively. There were 10 males and 6 females, the age range from 24 to 73 years with an average 45.2 years. The patients with mesh infection included 11 cases of infection after incisional hernia repair, 4 cases of infection after abdominal wall defects repair caused by abdominal wall tumor resection, 1 mesh infection combine with urinary fistula caused by parastomal hernia of ileal neobladder repaired by using prosthetic patch. Clinical manifestation included mesh exposion, abscess, chronic sinus, and enterocutaneous fistula. All patients accepted local treatment of change dressing by primary operative surgeon, but the wounds didn’t heal about 3 to 24 months. Then the patients performed radical removal of infected mesh and abdominal wall reconstruction. ResultsAll patients accepted affected mesh removal successfully. Five patients performed abdominal wall reconstruction by using components separation technique. Four cases accepted abdominal wall repair by using polypropylene mesh. Five patients performed abdominal wall repair by using human acelluar dermal matrix. One case accepted change dressing and vacuum aspiration on the infected wound surface without reconstruction. And one case closed the wound immediately after infected mesh removal. The postoperative hospitalization time was 9 to 25 d (average 14 d). Thirteen patients recovered with primary wound healing. The other 3 cases recovered with second healing by local change dressing. All patients were followed up from 6 to 34 months (average 22 months), no abdominal wall hernia recurrence occurred. ConclusionsIt is very difficult to deal with mesh infection after prosthetic patch repair of abdominal wall hernia or defect. The surgical treatment should be done according to specific condition of each individual so as to acquire satisfied results.
ObjectiveTo explore the effectiveness of proximal femoral nail antirotation (PFNA) assisted by mesh locator in treatment of intertrochanteric fracture in the elderly.MethodsNinety-four elderly patients with intertrochanteric fractures admitted between August 2014 and July 2017 were selected as the study subjects. They were randomly divided into trial group (48 cases) and control group (46 cases). In trial group, PFNA was implanted assisted by mesh locator after closed reduction; while in control group, PFNA was implanted by conventional method. There was no significant difference between the two groups in terms of gender, age, cause of injury, time from injury to admission, fracture side and classification, and medical complications (P>0.05). The operation time, intraoperative blood loss, fluoroscopy times, hospital stay, incision length, and complications were recorded. Visual analogue scale (VAS) was used to evaluate the degree of pain at 3 days after operation, and Harris score was used to evaluate hip function before operation and at 3, 6, and 9 months after operation.ResultsCompared with control group, the operation time and incision length of trial group shortened, the blood loss and fluoroscopy times reduced, the pain after operation alleviated obviously; the differences between the two groups were significant (P<0.05). There was no significant difference in hospital stay between the two groups (P>0.05). The patients in both groups were followed up 9-12 months, with an average of 10.6 months. X-ray films showed that the fractures healed in both groups, and the healing time in control group was (11.2±3.2) weeks, while that in trial group was (11.6±2.9) weeks, showing no significant difference between the two groups (t=1.262, P=0.120). There was no significant difference in Harris score between the two groups before operation and at 3, 6, and 9 months after operation (P>0.05). There was 1 case of incision infection, 2 cases of coxa vara, and 1 case of pressure ulcer in trial group, and the incidence of complications was 8.3%. There was 1 case of coxa vara, 2 cases of pressure ulcer, and 1 case of internal fixation loss in control group, and the incidence of complications was 8.7%. There was no significant difference in the incidence of complications between the two groups (χ2=0.783, P=0.112).ConclusionIt is feasible to implant PFNA assisted by mesh locator in treatment of intertrochanteric fracture in the elderly. Compared with the traditional operation, it can shorten the operation time, shorten the incision, and relieve the pain after operation.
ObjectiveTo analyze the effect and prognosis of laparoscopic patch repair of esophageal hiatal hernia.MethodsFrom October 2014 to January 2019, 100 patients with gastroesophageal reflux disease undergoing laparoscopic esophageal hiatus hernia repair were randomly divided into the patch group and the non-patch group. All patients underwent laparoscopic repair of esophageal hiatal hernia plus fundoplication (Nissen’s method). On that basis, the patients in the patch group used special mesh for esophageal hiatal hernia repair, while the ones in the non-patch group did not. All the patients were followed up for a long time. The operative effect, postoperative complication rate, recurrence rate, and satisfaction rate of the patients between the two groups were compared.ResultsA total of 98 patients were successfully followed up for more than one year, including 68 in the patch group and 30 in the non-patch group. One year after surgery, the differences between the patch group and the non-patch group in the improvements of reflux attack, heartburn, dysphagia, and food intake were statistically significant (P<0.05); there was no significant difference between the patch group and the non-patch group in satisfaction rate (82.4% vs. 73.3%, P>0.05); the differences in recurrence rate (2.9% vs. 26.7%) and incidence of dysphagia (47.0% vs. 6.7%) between the patch group and the non-patch group were statistically significant (P<0.05).ConclusionFor the patients with gastroesophageal reflux disease caused by esophageal hiatal hernia, the laparoscopic repair of esophageal hiatal hernia + Nissen fundoplication on the basis of reasonable selection of special mesh for esophageal hiatal hernia can obtain satisfactory clinical effect.