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In recent years, due to the increasing population of ageing and obesity, the incidence rate of hernia is increasing year by year, which has become a social problem that needs to be focused. Although starting late, the hernia and abdominal wall surgery has developed rapidly in recent years in China, and many remarkable achievements have been made. The development of hernia and abdominal wall surgery is inseparable from the progress of medical technology, the continuous innovation of materials, the improvement of perioperative management concept and the improvement of registration and follow-up system. The authors investigate the relevant research at home and abroad in recent years, and summarize and prospect the materials science, the daytime surgery and the registration and follow-up system, in order to provide reference for the future development of hernia and abdominal wall surgery.
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Objective:To investigate the clinical result of biological mesh and synthetic mesh in the repair of hiatal hernia.Methods:a prospective cohort study was conducted to collect and analyze the clinical data of 60 patients with hiatal hernia who were treated at Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University from May 2019 to Jan 2020. Intraoperative blood loss, hospital stay, clinical symptoms (heartburn, acid regurgitation, belching, early satiety, chest pain), VAS score, postoperative recurrence rate and complications were evaluated.Results:There was no significant difference in the overall repair effect between biological mesh group and synthetic mesh group ( P>0.05). All of the 60 patients underwent successful laparoscopic hiatal hernia repair and fundoplication. There were no massive bleeding caused by organ or vascular injury, and no peri-operative death. No recurrence of hiatal hernia, massive hemorrhage, pneumothorax, pleural effusion, gastrointestinal fistula, mediastinal infection or abscess were found during the follow-up of 6 months. Conclusion:There is no significant difference in short-term clinical effect between the use of biological mesh and synthetic mesh after hiatal hernia repair.
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Objective@#To evaluate treatment experience for mesh infection after inguinal hernia repair.@*Methods@#392 cases underwent surgery for mesh infection after inguinal hernia repair in Beijing Chaoyang Hospital from Jan 2007 to Jun 2018. For mesh infection after open inguinal hernia repair, infected mesh and tissue were removed by open operation, while laparoscopic operation was adopted for mesh infection after laparoscopic inguinal hernia repair. Time of infection, type of bacteria, and hernia recurrence were evaluated.@*Results@#369 cases suffered mesh infection after open inguinal hernia repair and 23 cases were after laparoscopic inguinal hernia repair. 61 cases suffered mesh infection within 3 months, 258 cases were from 3 months to 1 year and 73 cases were after one year. During follow up of 6 to 36 months after operation, 29 cases suffered hernia recurrence in 24 to 34 months after removal of mesh. Bacterial culture were positive in 193 cases, including 126 cases of staphylococcus aureus, 18 cases of escherichia coli and 15 cases of pseudomonas aeruginosa.@*Conclusion@#Individualized treatment policy based on original mesh placement is safe and effective for mesh infection after inguinal hemiorrhaphy.
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Objective To evaluate treatment experience for mesh infection after inguinal hernia repair.Methods 392 cases underwent surgery for mesh infection after inguinal hernia repair in Beijing Chaoyang Hospital from Jan 2007 to Jun 2018.For mesh infection after open inguinal hernia repair,infected mesh and tissue were removed by open operation,while laparoscopic operation was adopted for mesh infection after laparoscopic inguinal hernia repair.Time of infection,type of bacteria,and hernia recurrence were evaluated.Results 369 cases suffered mesh infection after open inguinal hernia repair and 23 cases were after laparoscopic inguinal hernia repair.61 cases suffered mesh infection within 3 months,258 cases were from 3 months to 1 year and 73 cases were after one year.During follow up of 6 to 36 months after operation,29 cases suffered hernia recurrence in 24 to 34 months after removal of mesh.Bacterial culture were positive in 193 cases,including 126 cases of staphylococcus aureus,18 cases of escherichia coli and 15 cases of pseudomonas aeruginosa.Conclusion Individualized treatment policy based on original mesh placement is safe and effective for mesh infection after inguinal hemiorrhaphy.
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Objective To investigate the clinical efficacy of laparoscopic fundoplication for gastroesophageal reflux disease complicated with Barrett's esophagus.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 12 patients with gastroesophageal reflux disease complicated with Barrett's esophagus who were admitted to Beijing Chao-Yang Hospital of Capital Medical University between July 2012 to July 2016 were collected.Preoperative tests of patients included distal esophageal manometry and 24-hour pH monitoring,gastroscopy and upper gastroenterography.According to preoperative evaluation of patients,laparoscopic Nissen fundoplication was preferred,and laparoscopic Dor fundoplication was used for patients with discordant esophageal peristalsis function.Observation indicators:(1) surgical and postoperative recovery situations;(2) follow-up:① subjective changes of reflux symptoms;② distal esophageal manometry and 24-hour pH monitoring after operation;③ progression of esophageal mucosal lesions.Patients were followed up using outpatient examination and telephone interview with questionnaire at one month after operation and gastroscopy every 6 months up to June 2018.Measurement data with normal distribution were represented as (x)±s and measurement data with skewed distribution were described as M (range).Results (1) Surgical and postoperative recovery situations:of 12 patients,7 underwent laparoscopic Nissen fundoplication and 5 underwent laparoscopic Dor fundoplication.Seven patients complicated with esophageal hiatal hernia underwent laparoscopic repair of esophageal hiatal hernia,without conversion to open surgery.Operation time,volume of intraoperative blood loss and duration of hospital stay were (98±21) minutes,(27± 13) mL,(2.3± 1.2) days.There were no intraoperative and postoperative severe complications in the 12 patients.(2) Follow-up:12 patients were followed up for 20-42 months with a average time of 32 months.① Subjective changes of reflux symptoms:12 patients completed questionnaires at one month after operation.Scores of heartburn in the 12 patients were 0.Acid regurgitation in the 12 patients was relieved,requiring no acid-inhibitory drugs.Upper abdominal dull pain in 3/4 of the patients and retrosternal pain in 2 patients were relieved.Patients had mild dysphagia or abdominal distention at 2 weeks after operation and recovered to normal diet by dietary instruction within 4 weeks.Score of dysphagia was 2 (range,0-4) and no patient need hospitalization or surgical treatment.Score of surgery satisfaction was 9 (range,7-10) in the patients.② Distal esophageal manometry and 24-hour pH monitoring after operation:lower esophageal sphincter pressure and DeMeester score were (12.8 ± 2.8) mmHg (1 mmHg =0.133 kPa) and 11±3 respectively.③ Progression of esophageal mucosal lesions:2 of 9 patients with short Barrett's esophagus were detected complete regression of esophageal mucosal lesions at postoperative one year,1 was detected partial regression of esophageal mucosal lesions at postoperative one year and 6 were detected no change at postoperative 2 years.One of 3 patients with long Barrett's esophagus was detected partial regression of esophageal mucosal lesions at postoperative one year and 2 complicated with mild poor differentiation were detected no change at postoperative 2 years.Conclusion Laparoscopic fundoplication for gastroesophageal reflux disease complicated with Barrett's esophagus can improve subjective symptom and objective markers of patients and provide satisfactory efficacy.
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Objective To explore the feasibility and reliability of laparoscopic fundoplication in the treatment of severe gastro-esophageal refulx disease. Methods Five cases of laparoscopic fundoplication were reviewed retrospectively from June 2001 to October 2001. Results Laparoscopic Nissen Fundoplication was performed in 3 cases, Laparoscopic Toupet Fundoplication in 2 cases. Preoperative symptoms were completely relieved. The postoperative esophageal manometry increased from (7 32?1 34)mmHg to (18 20?3 43)mmHg( t =12 23, P
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Objective To study on the effectiveness and reliability of endoscopic varicose vein ligation (EVL) combined with hand-assisted laparoscopic splenectomy (HLS) in portal hypertensive patients. Methods Retrospectively 15 cases of EVL combined with HLS were reviewed from June 2001 to October 2004. These patients with severe esophageal varicose and hypersplenism were adapted to perform endoscopic varicose vein ligation, then 1 -2 weeks after the varicose became milder or disappeared, hand-assisted laparoscopic splenectomy was conducted. Results The number of preoperative ligation was 2. 2 times in average. Esophageal varicose was completely disappeared in 11 and mild in 4. There were no postoperative complications, conversion and death in Hand-assisted laparoscopic splenectomy. The average postoperative count of platelets were (38-67) ? 106/L preoperatively raised to (89-310) ? 106/L postoperatively. In the follow up period (average 17. 6 months) , no varicose vein bleeding happened. Conclusions EVL combined with HLS is not only minimal invasive, but also a secure and effective measure for portal hypertension.
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Objective To explore the feasibility and rel ia bility of laparoscopic fundoplication in the treatment of severe gastro-esopha geal reflux disease.Methods Retrospectively forty-two cases of laparoscopic fundop lication were reviewed from June 2001 to March 2004.Results Laparoscopic Nissen fundoplication was performed in 33 cases, and laparoscopic Toupet fundoplication in 9 Symptom score was decreased from 11 56?1 32 to 2 04?1 36 (P