Objective To summarize the cl inical effect of allogenic acellular dermal matrix in repair of abdominal wall hernia and defect. Methods The cl inical data were analyzed retrospectively from 31 patients with abdominal wall hernia and defect repaired by allogenic acellular dermal matrix between March 2007 and November 2009. There were 19 males and 12females with an age range of 10-70 years (median, 42 years), including 6 abdominal wall defects caused by abdominal wall tumor resection, 4 patchs infection after abdominal wall hernia repair using prosthetic mesh, 2 incisional hernia, 1 parastomal hernia, 1 recurrent parastomal hernia receiving mesh repair, 1 mesh infection caused by parastomal hernia repair using prosthetic patch, 3 mesh infection caused by tension free inguina after hernia repair, and 13 inguinal hernia. There were 12 patients with contaminated or infectious wound. The disease duration was from 1 to 34 months (6 months on average). The defect size of abdominal wall ranged from 6 cm × 4 cm to 19 cm × 10 cm. Abdominal wall hernia or defect underwent repair using allogenic acelluar demall matrix. Results Of the 31 patients, 29 patients recovered with primary wound heal ing. Chronic sinus tract occurred in 1 patient and the wound was cured by change dressing. Wound dehiscence and patch exposure occurred in 1 patient, and second heal ing was achieved after change dressing. All the 31 patients were followed up 6-36 months, no abdominal wall hernia or hernia recurrence occurred in other patients except 1 patient who had abdominal bulge. And no foreign body sensation or chronic pain in wound area occurred. Conclusion It is feasible and safe to use allergenic acellular dermal matrix patch for repair of abdominal wall hernia or soft tissue defect, especially in contaminated or infectious wound.
Objective To investigate the indication, approaches andpreventionof complications in treatment of female stress urinary incontinence(SUI) with tension-free vaginal tape (TVT). Methods From September 2003 to December 2004, 40 cases of female stress urinary incontinence were treated, including 8 cases in association with cystocele or rectocele and 1 case in association with uterine prolapse. They ranged from 30 to 70 years in age with an average of 56.3years. The disease course was 1.42 years(7.2 years on average). All patients received TVT. In the patients suffering from uterine prolapse and cystocele or rectocele, butterfly-shaped mesh patch was applied. Results All patients achieved satisfactory results.The complications included slight dysuria(2 cases),vesical perforation(1 case) and pelvic hematoma(1 case) and cleared up after treating. All cases were followed up 1 to 15 months and the results were satisfactory. No urinary incontinence and no dysuria reoccurred. Conclusion TVT is effective for SUI.
Objective To evaluate the effectiveness and safety of tension-free vaginal tapes (TVT) compared with Burch colposuspension for female stress urinary incontinence (SUI). Methods We searched MEDLINE (1966 to October 2007), EMBASE (1988 to October 2007), Cochrane Central Register of Controlled Trials (1993 to October 2007), CMCC (1979 to October 2007) and CNKI (January 1979 to October 2007). We collected randomized controlled trials (RCTs) comparing TVT with Burch colposuspension in the treatment of SUI. Data were extracted and evaluated by two reviewers independently. The Cochrane Collaboration’s RevMan 4.2 was used for data analyses. Results Ten RCTs reporting data on effectiveness and safety of TVE versus Burch colposuspension were included. Meta-analyses showed that TVT was superior to Burch colposuspension as measured by the overall cure rate (OR 1.73; 95%CI 1.26 to 2.38; P=0.0007), negative stress test (OR 2.54; 95%CI 1.71 to 3.78; Plt;0.00001) and negative pad test (OR 1.67; 95%CI 1.16 to 2.41; P=0.006). The total complication rate was higher after TVT (OR 1.39; 95% CI 1.08 to 1.80; P=0.01), while the re-operation rate was significantly higher after Burch colposuspension (OR 0.29; 95%CI 0.10 to 0.80; P=0.02). The incidences of haematoma (OR 1.06; 95% CI 0.39 to 2.84; P=0.91), urinary tract infection (OR 1.27; 95% CI 0.64 to 2.52; P=0.50) and lower urinary tract symptoms (OR 1.20; 95% CI 0.89 to 1.62; P=0.23) were similar after TVT and Burch colposuspension. Conclusion The evidence for short-term superiority of TVT is currently limited. Although the re-operation rate is lower, the risk of bladder or vaginal injury is higher with TVT. Methodologically sound and adequately powered RCTs with long-term follow-up are needed.
Objective To evaluate the effectiveness of inguinal hernia treated by tension-free hernioplasty in adult. Methods Electronic databases were searched including CNKI (1993 to 2003), MEDLINE (1993 to 2003) and OVID (1993 to 2003). Personal contact with experts in the field of tension-free hernioplasty was performed to identify potentially relevant trials. Randomized controlled trials of plug amp; Mesh versus Mesh only repair and laparoscopic versus open Mesh hernia repair in recurrence, peri-operative complication or long term postoperative complication were included. Data related to the clinical outcome were extracted by two reviewers independently. Statistical analysis was performed by using RevMan 4.2 software. Results Twenty one studies involving 4 154 patients met the inclusion criteria from 1993 to 2003. Compared with Mesh only repair, plug amp; Mesh repair had no significant difference in recurrence rate (OR 1.14, 95%CI 0.37 to 3.47, P=0.82), preoperative complication rate (OR 1.01, 95%CI 0.63 to 1.63, P=0.95) and long term postoperative complication rate (OR 0.46, 95%CI 0.18 to 1.16, P=0.1). Compared with open Mesh hernioplasty, transabdominal preperitoreal repair (TAPP) group had no significant difference in recurrence rate (OR1.24, 95%CI 0.65 to 2.36, P=0.52), preoperative complication rate (OR 0.89, 95%CI 0.65 to 1.22, P=0.46) and persistent pain (OR 0.76, 95%CI 0.48 to 1.19, P=0.22); totally extrapevitoreal repair (TEP) group had no significant difference in recurrence rate (OR1.07, 95%CI 0.51 to 2.24, P=0.70) or persistent pain (OR 0.95, 95%CI 0.55 to 1.65, P=0.86), and had lower tendency persistent pain (OR 0.50, 95%CI 0.34 to 0.73, P=0.000 4) with statistical significance. Conclusion Current evidence suggests that there is no significant difference between anterior approach plug amp; Mesh repair (Rutkow’s repair) and the Mesh only repair (Lichtenstein’s repair). TEP of Laparoscopic hernioplasty is superior to open Mesh hernia repair in preoperative complication. More researches are needed for recurrence rate, persistent pain.
Objective To summary the experience of transabdominal preperitoneal space tension-free repair for inguinal saddle hernia. Methods 〗The clinical data of 151 cases of inguinal saddle hernias underwent transabdominal preperitoneal space tension-free repair with Prolene hernia system (PHS) were retrospectively analyzed. The operative time, postoperative pain, hospital stay, recurrence and postoperative complications were observed. Results The average operative time in unilateral hernias was (29.8±9.6) min. Postoperative complications included one case of pain in groin and 4 cases of scrotum edema. No incision infection and mortality occurred. Postoperative duration of hospital stay was 3 to 5 days. All cases were followed up for 1-5 years and no recurrence happened. Conclusion 〗Transabdominal preperitoneal space tension-free repair for inguinal saddle hernia by PHS is safe and reliable.
Objective To evaluate the clinical effect of Easy Prosthesis D-10 on open preperitoneal groin tension-free hernioplasty. Methods The operative time, operation-correlated complications, hospital stay and recent follow-up findings of 63 patients underwent preperitoneal groin tension-free hernioplasty were analyzed from October 2006 to April 2008. Results No case died in perioperative period. The average operative time was (47.6±10.5) minutes. None of incision infection and scrotal hydrocele occurred. The average hospital stay was (7.7±2.1) days. During follow-up period of 6 to 24 months, no recurrence, chronic pain and foreign body sensation were found. Conclusion The open preperioneal groin tension-free hernioplasty by Easy Prosthesis D-10 is safe and reliable, especially for the inguinal hernia with large hernia ring or defect of transversalis fascia and recurrent hernia.
Objective To explore the cause and treatment of chronic pain after tension-free repair of inguinal hernia. Methods 〗The clinical data of 426 cases with inguinal hernia underwent the tension-free hernioplasty during February 2002 to September 2007 were retrospectively analyzed. Results 〗Tension-free hernioplasty was performed to all patients. According to operative methods, they were divided into two groups: polypropylene filling group (n=210) and expanded polytetrafluoroethylene (e-PTFE) mycromesh group (n=216). The chronic pain rate after operation, polypropylene filling group (9.0%, 19/210) was significantly higher than e-PTFE mycromesh group (4.2%, 9/216)， P＜0.05. Conclusion 〗The tension-free repair by e-PTFE mycromesh has less pain in the inguinal hernia due to the material is more suitable to human physiology, more soft and light, with less complications.
Objective To investigate the most suitable anaesthesia method for the tension-free herniorrhaphy.Methods A total of 422 unilateral inguinal hernia cases from 2002 to 2005 were collected and randomly divided into the local anaesthesia group and epidural anaesthesia group. Observation indices and some relative data, such as operative duration, date of ambulation, date of foodintake, length of hospital stay, operation-correlated complications, anaesthesia complications, usage rate of ancillary drug, satisfactory rate for anesthesia, cost of hospitalization, were included and recorded in the questionnaire, and all the patients who took the tension-free herniorrhaphy were asked to answer it as the follow-up research. Results It was found that the occurrence of postoperative anaesthetic complications, the cost of hospitalization, length of stay of local anaesthesia group were significantly less than those of epidural anaesthesia group, and the date of moving and the date of foodintake were also significantly earlier than those of the other group (P＜0.05). However, there was no significant difference of operative duration, postoperative recovery situation and the satisfactory rate between two groups (P＞0.05).Conclusion The local anaesthesia is suitable for most of the tension-free herniorrhaphy, and it may be used as the conventional anaesthetic method.
【Abstract】Objective To investigate the effects of tension-free herniorrhaphy on endocrine functions of patients with inguinal hernia. MethodsOne hundred and twenty-seven patients were randomly divided into tension-free group(n=65) and conventional group (n=62). The mean ages of tension-free group and conventional group were(51.8±14) year and(48.4±12) year respectively. There were 52 indirect hernias and 13 direct hernias in tension-free group. There were 51 indirect hernias and 11 direct hernias in conventional group. Bassini repair was used in conventional group. Peripheral blood samples were obtained preoperatively and 3 h, 24 h after operation for measuring the levels of cortisol, T3, TSH, insuline, Cpeptide and and glucose. The data were analysed through t test. ResultsThe levels of cortisol, C-peptide and glucose in conventional group were remarkably higher (P6”0.05) while the levels of T3,TSH were notably lower (P＜0.05) than those in tension-free group at 3 h, 24 h postoperatively, the level of insulin in conventional group was significantly higher than that in tension-free group at 24 h postoperatively. ConclusionThe results of this study indicate that tension-free repair imposes less influence on the endocrine functions of patients with inguinal hernia postoperatively than conventional repair does. This might explain pathophysiologically the quick recovery of the patients receiving tension-free herniorrhaphy.
ObjectiveTo compare the clinical outcome of tension-free vaginal tape (TVT) and TVT-obturator (TVT-O) for female stress urinary incontinence (SUI). MethodsSixty-one female SUI patients were included in our study, in which 33 received TVT procedure and 28 received TVT-O procedure. The patients were followed up for 1 to 62 months post-operatively, averaging at 22 months. Cure was defined as no leakage during the stress test and no residual urine showed by B ultrasound, improvement as less leakage during the stress test after operation, and inefficacy as leakage during the stress test and no difference was detected after operation. ResultsAge and disease course were not significantly different between the two groups (P>0.05). All patients underwent TVT or TVT-O procedure successfully. Time of TVT ranged from 26 to 45 min averaging at (35.5±4.3) minutes, and it was significantly different from the time of TVT-O which ranged from 15 to 20 min averaging at (7.2±3.1) minutes (P<0.05). Bleeding during the surgery was not significantly different between the two groups (P>0.05). The rate of complications occurring during TVT-O procedure was significantly less and milder than that during the TVT procedure (P<0.05). The cure rate and improvement rate indicated no significant differences between the two groups (P>0.05). ConclusionThe evidence available indicates that TVT and TVT-O procedure are both effective and safe for female SUI. Compared with TVT, TVT-O procedure has the advantages of being more convenient, shorter operation time, being less invasive, and fewer complications, and it may be more suitable for female SUI.