ABSTRACT
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.
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Objective To investigate the incidence and influence factors of chronic postoperative inguinal pain (CPIP) after tension-free repair for inguinal hernia.Methods The retrospective case-control study was conducted.The clinicopathological data of 1 188 patients who underwent tension-free repair for inguinal hernia in the People's Hospital of Xinjiang Uygur Autonomous Region between January 2011 and August 2017 were collected.Observation indicators:(1) surgical and postoperative situations;(2) follow-up;(3) influence factors analysis of CPIP.Follow-up using outpatient examination and telephone interview was performed to detect inguinal pain and complications at 1,3,6 months and 1 year postoperatively up to August 2018.Measurement data with normal distribution were represented as x ±s.Measurement data with skewed distrubution were described as M (range).The univariate and multivariate analysis were done using the chi-square test and Logistic regression model.Results (1) Surgical and postoperative situations:1 188 patients underwent successful tension-free repair for inguinal hernia.Eighty-five patients (7.155％,85/1 188) had CPIP,including 76 (8.370％,76/908) undergoing open surgery and 9 (3.214％,9/280) undergoing laparoscopic surgery.(2) Follow-up:1 188 patients were followed up for 12-36 months,with a median time of 19 months.Incidence rates of CPIP with visual analogue score ＞ 3were 11.785％(140/1 188),7.155％(85/1 188),5.808％(69/1 188),3.199％(38/1 188) at 1,3,6 months and 1 year postoperatively.Patients were given individualized and reasonable treatment according to their own conditions and CPIP was relieved after conservative treatment including drug treatment,physiotherapy such as acupuncture,nerve block and psychotherapy.Of 5 patients with CPIP after tension-free repair for inguinal hernia undergoing surgeries,1 was relieved nerve ligation by surgery,3 with mesh related pain were removed meshes,1 was taken the fixed stiches out.They were relieved CPIP after above treatments.During the follow-up,161 patients with incisional seroma,75 with incisional infection and 5 with disruption of wound were cured by symptomatic treatments including reinforced incision management,dressing change and physiotherapy.Seven patients with mesh infection were removed meshes.Of 68 patients with hernia recurrence,53 had reoperation,18 complicated with diseases induced severe increased intra-abdominal pressure were suggested to undergo surgeries after treatment of complications.(3) Influence factors analysis of CPIP:① results of univariate analysis showed that sex,age,bodymass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection were related factors affecting CPIP after tension-free repair for inguinal hernia (x2 =21.002,6.715,6.012,8.563,11.887,49.447,10.025,P＜0.05).② Results of multivariate analysis showed that sex,body mass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection were independent related factors affecting CPIP after tension-free repair for inguinal hernia (odds ratio =1.267,2.986,1.661,3.208,2.034,1.871,95％ confidence interval:1.042-1.392,1.372-4.901,0.998-2.758,1.933-6.013,1.556-3.118,1.095-3.534,P＜0.05).Conclusions Sex,body mass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection are independent related factors affecting CPIP after tension-free repair for inguinal hernia.Preoperative pain management and psychological counseling,intraoperative refine performance,inguinal nerve protection and postoperative incisional management should be reinforced to prevent and reduce incidence of CPIP.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical efficacy of argon plasma coagulation (APC) combined with laparoscopic hiatal hernia repair and fundoplication in the treatment of hiatal hernia associated with Barrett esophagus.</p><p><b>METHODS</b>A total of 61 cases of hiatal hernias with Barrett esophagus from June 2010 to January 2014 in the Department of Minimal Invasive Surgery, Hernia and Abdominal wall Surgery, People's Hospital of Xinjiang Uyhur Autonomous Region were prospectively enrolled and were randomly allocated into two groups by computer system. Twenty-nine patients received esomeprazole 40 mg/d after APC treatment for 8 weeks (APC with medicine group). Thirty-two patients underwent laparoscopic hiatal hernia repair and Nissen fundoplication after APC treatment (APC with surgery group). All the patients were reviewed by gastroscope and pathologic examination at half a year and one year after operation respectively. Differences of disease improvement and recurrence between the two groups were evaluated.</p><p><b>RESULTS</b>In APC with medicine group, the Barrett's esophagus was relieved after one or two times of APC treatment, however, gastroscope and pathology revealed recurrence of Barrett's esophagus in 7 cases at half a year, and cumulative 16 cases of recurrences were detected after one year follow-up(16/29, 55.2%). In APC with surgery group, only one patient had recurrent Barrett's esophagus at half a year, and a total of two at one year follow-up by gastroscope examination(2/32, 6.3%). Significantly low recurrence rate of Barrett's esophagus was observed in APC with surgery group compared to APC with medicine group(P<0.01). Furthermore, recurrent hiatal hernia was detected in only one case in APC with surgery group. No esophageal cancer was found in both groups during follow-up.</p><p><b>CONCLUSION</b>APC combined with laparoscopic hiatal hernia repair and fundoplication is an ideal method for patients with hiatal hernia and Barrett's esophagus.</p>