Clinical efficacy analysis of femoral hernia repair / 中华消化外科杂志

Objective:To investigate the clinical efficacy of femoral hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 102 patients with femoral hernia who were admitted to People′s Hospital of Xinjiang Uygur Autonomous Region from January 2012 to January 2019 were collected. There were 13 males and 89 females, aged (65±9)years, with a range from 31 to 91 years. Patients underwent emergency or selective surgery according to Guideline for diagnosis and treatment of adult inguinal hernia (2018 edition), including laparoscopic transabdominal preperitoneal hernia repair (TAPP), McVay repair or open preperitoneal mesh hernioplasty. Observation indicators: (1) intraoperative and postoperative situations; (2) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detect complications and hernia recurrence up to February 2019. Measurement data with normal distribution were represented as Mean± SD, and count data were represented as absolute numbers. Results:(1) Intraoperative and postoperative situations: 102 patients had unilateral femoral hernia, including 57 of left hernia and 45 of right hernia. There were 79 patients with incanceration or strangulation, and 23 without incanceration or strangulation. The 79 patients with incancerated or strangulated hernia underwent emergency surgery, including 35 undergoing open McVay repair (5 had conversion from laparoscopic surgery) and 44 undergoing laparoscopic TAPP. The 23 patients without incanceration or strangulation underwent selective surgery, including 3 undergoing open preperitoneal mesh hernioplasty and 20 undergoing laparoscopic TAPP. Meshes were used on 87 of the 102 patients. The operation time, time to postoperative drainage tube removal, and duration of postoperative hospital stay were (62±3)minutes, (2.2±0.3)days, and (3.5±1.3)days, respectively. (2) Follow-up: 102 patients were followed up for (7±3)months, with a range from 1 to 12 months. During the follow-up, pulmonary infection, deep venous thrombosis, incisional infection, intestinal obstruction, seroma, intestinal fistula, and affected hernia recurrence were observed in 5, 4, 3, 3, 1, 1, and 1 of the 79 patients undergoing emergency surgery, respectively. There were 3 patients dead. One patient with intestinal obstruction underwent secondary enterostomy and then closure at postoperative 3 months. The other patients with complications were improved after symptomatic and supportive treatment. During the follow-up, seroma, intestinal fistula, and affected hernia recurrence were observed in 1, 1, and 1 of the 23 patients with selective surgery. The above patients with complications were improved after symptomatic and supportive treatment.Conclusion:Early and correct diagnosis, selection of appropriate surgical methods, and immediate surgery can effectively treat femoral hernia.

Efficacy comparison of laparoscopic Nissen, Toupet and Dor fundoplication in the treatment of hiatal hernia complicated with gastroesophageal reflux disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety among laparoscopic Nissen, Toupet and Dor fundoplication in the treatment of hiatal hernia complicated with gastroesophageal reflux disease (GERD).</p><p><b>METHODS</b>Clinical data of 276 patients of hiatal hernia complicated with GERD undergoing operation in our hospital from December 2012 to January 2015 were retrospectively analyzed, including 149 patients of laparoscopic Nissen fundoplication (Nissen group), 41 of laparoscopic Toupet fundoplication (Toupet group), and 86 patients of laparoscopic Dor fundoplication (Dor group). Esophageal reflux status, esophageal manometry, GERD Q rating scale, and postoperative recovery were compare among the three groups.</p><p><b>RESULTS</b>Reflux status was improved significantly in the three groups after operation(all P<0.05),except that the efficacy in reducing reflux episodes and reflux longest time was not obvious in Toupet group(P>0.05). There were no significant differences in postoperative reflux time, acid reflux time ratio, reflux longest time ratio, DeMeester score among the three groups (all P>0.05). Pairwise comparison showed that Dor group was significantly better than Toupet group in reducing the number of reflux episode(14.36±10.58 vs. 29.83±19.71) and long-reflux (0.64±0.21 vs. 6.20±3.48)(both P<0.05), but Nissen group was better than these two groups in reducing the number of long-reflux (0.38±0.16, P<0.05). As compared to pre-operation, the postoperative esophageal sphincter pressure and residual pressure increased significantly, and the relaxation rate reduced significantly (all P<0.05), while the episode of ineffective swallowing increased significantly in Toupet group (11.25±2.04 vs. 6.36±3.26, P<0.05). The contrast in esophageal manometry between Toupet and Dor group showed that Dor group was better than Toupet group in the recovery of lower esophageal sphincter pressure (mean resting breathing) [(20.69±13.95) mmHg vs.(12.91±6.89) mmHg] and the decrease of ineffective swallowing [9.15±6.44 vs. 11.25±2.04](both P<0.05), while such results of Dor group were similar to Nissen group[(19.87±10.40) mmHg, 6.15±2.95, all P>0.05]. The GERD Q scores were significantly decreased after operation in 3 groups(Nissen group:10.94±2.20 vs.7.41±1.43, t=11.667, P=0.001; Toupet group: 10.91±2.02 vs.7.18±1.33, t=5.109, P=0.005; Dor group: 10.69±1.69 vs. 7.10±1.30, t=7.610, P=0.002). There was no significant difference in GERD Q scores among three groups (F=1.465, P=0.207). The operative time, blood loss, hospital stay and complications were not significantly different among 3 groups (all P>0.05). Follow-up period was 12-51 months (median 19 months), and no significant difference in recurrence was found [Nissen group: 2 cases (1.3%), Toupet group: 1 case (2.4%), Dor group: 1 case (1.2%), χ=0.363, P=0.834].</p><p><b>CONCLUSIONS</b>It is safe and feasible for these three laparoscopic fundoplications to the treatment of hiatal hernia complicated with GERD. But laparoscopic Nissen and Dor fundoplication are better than Toupet fundoplication in reducing the number of reflux episodes, suppressing long reflux, increasing lower esophageal sphincter pressure (mean resting respiration) and decreasing the incidence of postoperative dysphagia.</p>

Laparoscopic repair of paraesophageal hernia / 国际外科学杂志

Objective To investigate the efficacy and safety of laparoscopic repair of paraesophageal her-nia. Methods Sixty-one patients underwent laparoscopic repair of paraesophageal hernia, all having laparo-scopic Toupet fundoplication. Results Laparoscopic repair of paraesophageal hernia was completed success-fully in all the 61 patients. The average operation time was 110 min and the blood loss 10～50 ml. Postopera-tive oral feedings were resumed 24～48 h after surgery, and no postoperative complication occurred. The me-dian postoperative hospital stay was 5.7 d. Conclusion Laparoscopic repair of paraesophageal hernia is an effective and safe surgical procedure of minimal invasion.