Influencing factors of small intestinal ischemia in elderly patients with incarcerated hernia / 中华外科杂志

Objective: To investigate the factors influencing small intestinal ischemia in elderly patients with incarcerated hernia. Methods: The clinical data of 105 elderly patients admitted for surgical procedures of incarcerated hernia at Department of General Surgery, Huadong Hospital between January 2014 and December 2021 were retrospectively analyzed. There were 60 males and 45 females, aged (86.1±4.3) years (range: 80 to 96 years). They were divided into normal group (n=55) and ischemic group (n=50) according to intraoperative intestinal canal condition. The t test, χ2 test and Fisher's exact probability method were used for the univariate analysis of the factors that influence intestinal ischemia in patients, and Logistic regression was used for multifactorial analysis. Results: In all patients, 18 patients (17.1%) had irreversible intestinal ischemia with bowel resection. Six patients died within 30 days, 3 cases from severe abdominal infection, 2 cases from postoperative exacerbation of underlying cardiac disease, and 1 case from respiratory failure due to severe pulmonary infection. The results of the univariate analysis showed that there were differences in gender, history of intussusception, duration of previous hernia, white blood cell count, neutrophil percentage, C-reactive protein, type of incarcerated hernia, and preoperative intestinal obstruction between the two groups (all P<0.05). The Logistic regression results showed that the short time to the previous hernia (OR=0.892, 95%CI 0.872 to 0.962, P=0.003), high C-reactive protein (OR=1.022, 95%CI 1.007 to 1.037, P=0.003), non-indirect incarcerated hernia (OR=10.571, 95%CI 3.711 to 30.114, P<0.01) and preoperative intestinal obstruction (OR=6.438, 95%CI 1.762 to 23.522, P=0.005) were independent risk factors for the development of intestinal ischemia in elderly patients with incarcerated hernia. Conclusions: The short duration of the previous hernia, the high values of C-reactive proteins, the non-indirect incarcerated hernia, and the preoperative bowel obstruction are influencing factors for bowel ischemia in elderly patients with incarcerated hernia. A timely operation is necessary to reduce the incidence of intestinal necrosis and improve the prognosis.

Opportunities and challenges for the high-quality development of hernia and abdominal wall surgery in China / 中华外科杂志

Hernia and abdominal wall surgery is a relatively new subspecialty in surgery. Although it started late in China, after 25 years of rapid development, it has made remarkable achievements and has become an important part of surgery, laying a solid foundation for the further development of the discipline. At the same time, one should also be soberly aware of the present deficiencies in this field. The development of the field should be more detailed and in-depth from the following aspects: correct understanding of new concepts of hernia and abdominal wall surgery, establishment of hernia patient registration and quality control system, technological innovation and development of technical equipment, especially the expansion of robot surgical systems, materials science progression to hernia and abdominal wall surgery. Faced with this challenge, China is expected to achieve high-quality development in the field of hernia and abdominal surgery.

Basic principles and repair material selection of abdominal wall defect after breast reconstruction for breast cancer surgery / 中国实用外科杂志

Autologous breast reconstruction after radical resection of breast cancer has been widely used in clinic.Some surgical methods of autologous breast reconstruction may cause abdominal wall defect to a certain extent.The abdominal wall defect leads to the loss of normal function,which leads to a series of serious pathophysiological changes.At present,transverse rectus abdominis myocutaneous flap(TRAM) and deep inferior epigastric artery perforator flap(DIEP) are commonly used for breast reconstruction.According to the different types of abdominal wall defect after breast autoreconstruction for breast cancer surgery,the corresponding surgical repair scheme should be formulated on the basis of strictly following the basic principles of abdominal wall repair.At the same time,appropriate materials for repairing abdominal wall defect are selected according to the different extent of abdominal wall defect.The posterior sheath and peritoneum of rectus abdominis are usually intact after breast reconstruction,and the anterior sheath of rectus abdominis may be retained.The different layers of abdominal wall can be repaired by surgical methods,and the application of repair materials is emphasized.

Clinical analysis on the technique of transverse fascia reinforcement with biological mesh in young inguinal hernia patients / 中国实用外科杂志

OBJECTIVE: To analyze the application value of biological mesh in inguinal hernia patients aged from 18 to44 years old. METHODS: The clinical data of 127 patients with inguinal hernia admitted from January 2013 to December 2018 in Huadong Hospital Affiliated to Fudan University were analyzed retrospectively. Through the abdominal transverse fascia reinforcement with biological mesh(tTRB), it was to observe indicators during perioperative and followup periods, to explore the application value and treatment experience of biological mesh in young patients with inguinal hernia. RESULTS: All the 127 cases were successfully completed. There were obvious pain in 3 cases and scrotal edema in 3 cases. No other patients were found to have obvious discomfort. All patients had no complications such as recurrence, chronic pain and infection after 3 to 12 months of follow-up. CONCLUSION: The rational use of biological mesh to repair young and middle-aged patients with inguinal hernia is effective. The advantage is that the effect of mesh minimize the impact on long-term quality of life in young patients. At the same time, the risk of postoperative infection and chronic pain is effectively reduced by reinforcement of transverse fascia with biological mesh, which is worthy of further study.

Characteristics of inguinal hernia in adolescents in China and the problems deserving attention in diagnosis and treatment / 中国实用外科杂志

There is no authoritative definition of adolescents in the world which is generally believed that the age ranges from 10 to 19. At present, there are few surveys on the prevalence of inguinal hernia among adolescents at home and abroad. Adolescents are in the process of vigorous growth and development, and the diagnosis and treatment of inguinal hernia is special. There is still much controversy in the treatment of inguinal hernia. In view of the special group of inguinal hernia patients, adolescents should formulate corresponding treatment plan according to their specific characteristics. Detailed preoperative evaluation should be done to find out if there were any special cases(such as hydrocele of testis and cryptorchidism). According to preoperative evaluation, reasonable surgical methods and repairing materials should be selected, carefully operate during surgery, and protect spermatic cord vessels and vas deferens to the maximum extent to avoid adverse complications. Tissue repair or patch reinforcement should be considered according to the degree of posterior inguinal canal defect.