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Objectives:To investigate the clinical value of a novel non-crosslinked biological mesh in laparoscopic inguinal hernia repair.Methods:The prospective randomized controlled study was conducted. The clinical data of 50 adult patients with unilateral inguinal hernia who were admitted to 3 medical centers, including Ruijin Hospital of Shanghai Jiaotong University School of Medicine et al, from September 2019 to March 2020 were selected. Based on random number table, patients were divided into two groups. Patients using the novel non-crosslinked biological mesh in repair surgery were divided into the experiment group and patients using the lightweight, micro-porous, partially absorbable synthetic mesh in repair surgery were divided into the control group. Observation indicators: (1) grouping situations of the enrolled patients; (2) endpoint of the study. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the non-parameter rank sum test. Count data were described as absolute numbers and (or) persentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the non-parameter rank sum test. Repeated measurement data were analyzed using the repeated ANOVA. Taking the recurrence rate of hernia as the basis of efficacy evaluation, according to the intention-to-treat analysis, the confidence interval method (Newcombe Wilson method) was used to conduct non-inferiority statistical analysis of the recurrence rate of hernia between the experiment group and the control group. If the upper limit of 95% confidence interval of the difference of recurrence rate of hernia between the experiment group and the control group is less than 10%, the experiment group is considered to be non-inferior to the control group. Results:(1) Grouping situations of the enrolled patients. A total of 50 adult patients with inguinal hernia were selected for eligibility. There were 44 males and 6 females, aged (60±15)years. All 50 patients were randomly divided into to the experiment group and the control group with 25 cases each. One patient in the control group was not followed up at postoperative month 2, and the rest of 49 patients completed all expected follow-up. No patient in the two groups fell off or were removed. (2) Endpoint of the study. ① The primary endpoint of study. The recurrence rate of hernia was 0 in the experiment group, versus 4%(1/25) in the control group, respectively, showing no significant difference between the two groups ( P>0.05). Results of non-inferiority statistical analysis showed that the 95% confidence interval of the difference of recurrence rate of hernia between the two groups was -19.54% to 9.72%, with the upper limit as 9.72%, which was less than 10%. ② The secondary endpoint of study. There were 2 patients in the control group occurred seroma at postoperative day 14, and none of the rest of patient in the two groups occurred seroma during the follow-up, showing no significant difference in the occurrence of seroma between the two groups ( P>0.05). There was 1 patient in the control group feeling discomfort or foreign body sensation in groin area at postoperative month 2, and none of the rest of patient in the two groups feeling discomfort or foreign body sensation in groin area during the follow-up, showing no significant difference in the feeling discomfort or foreign body sensation in groin area between the two groups ( P>0.05). There was no patient occurred surgical site infection in the experiment group, and there was 1 patient in the control group occurred postoperative skin infection, which had no relationship with mesh. There was no patient in both two groups occurred fever, anaphylaxis and patch related serious adverse reaction during the follow-up. The resting visual analogue scale score, active visual analogue scale score of patients at postoperative 2 days and postoperative 18 months were 0.44±1.00, 1.28±1.46 and 0, 0 in the experiment group, versus 0.40±0.76, 1.28±1.14 and 0.24±1.20, 0.44±1.29 in the control group, respectively. There was a significant difference in the time effect of postoperative active visual analogue scale score of patients between the two groups ( Ftime=10.19, P<0.05). The thickness of the novel non-crosslinked biological mesh before implantation was 0.5?0.7 mm. Two months after operation, results of B-ultrasonic examination in groin area of 10 patients from the experiment group showed a strong echo area at the patch implant area with a thickness as 2 mm. Conclusion:Application of novel non-crosslinked biological mesh in laparoscopic inguinal hernia repair is safe and effective.
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Complex systems science (CSS) is an evaluation system that integrates the overall system and draws multilateral conclusions in the form of dynamic and reasonable interpreta-tion. Evaluation of modern hernia and abdominal wall surgery by CSS includes the application of artificial intelligence, data analysis and other methods. It implements the value oriented clinical quality improvement principle in the overall treatment cycle through the measurement of value, combined cost, quality evaluation and patient perspective. Finally, CSS will realize the sustainable development of hernia and abdominal wall surgical diagnosis and treatment system of medical care system.
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With the great improvement of living and material conditions in China, obesity concomitant with hernia and abdominal wall diseases become very common. As the particularities of obesity and associated metabolic diseases, a series of pathophysiological changes caused by obesity will significantly affect the treatment of hernia and abdominal wall diseases. In the authors' opinions, accurately evaluation the severity of obesity and associated metabolic diseases and effec-tively controlling are important prerequisites for determining the timing of surgery and surgical planning. Weight loss before surgery is the basic principle of the treatment and immediate or staged individualized surgical treatment is the guarantee of the successful treatment for obesity patients with hernia and abdominal wall disease.
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The quality control of inguinal hernia is a key point of herniology development in China, which is on the basis of continuous clinical quality improvement. The standardized operation of inguinal hernia repair requires the tacit cooperation of surgeons and the operating room nursing team. According to the existing mature seven step method in inguinal hernia surgery, the authors summarize the seven step nursing process of operation, in order to provide smoother and better operation guarantee in open and laparoscopic hernioplasty.
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Hernia and abdominal wall surgery has developed rapidly in nearly 20 years in China. Its diagnosis and treatment has reached a high level worldwide nowadays. On the topic of how to make a brand-new development in this field, the authors demonstrate that we need to improve in many aspects, including the innovation and optimization of surgical technology and the standardization of surgical operation, as well as the exploration of biological mesh and other hernia repair materials, quality control system, registration system, adverse events reporting system, real world research for the stable development of hernia surgery. This can promote the diagnosis and treatment of hernia and abdominal wall surgery personalized principles and innovative develop-ment in the future.
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Objective:To investigate the effect of laparoscopic cholecystectomy (LC) combined with common bile duct exploration (LCBDE) on pain stress and inflammatory factors in elderly patients with gallbladder stones and common bile duct stones.Methods:Eighty elderly patients with cholecystolithiasis and choledocholithiasis in Huadong Hospital Affiliated to Fudan University from January 2020 to January 2021 were selected. According to the surgical method, they were divided into observation group of 40 cases and control group of 40 cases. Patients in the observation group were treated with LC combined with LCBDE, and patients in the control group were treated with traditional open surgery. The perioperative indicators and complications, changes in pain stress and inflammatory factors before and 3 days after operation, and the quality of life before operation, 1 month after operation and 6 months after operation were compared between the two groups. Normally distributed measurement data were represented by mean±standard deviation ( Mean± SD), and t test was used to compare between groups. The chi-square test was used to compare the count data between groups. Results:The operation time, time to get out of bed, postoperative exhaust time, intraoperative blood loss, and postoperative complications in the observation group were (98.39±7.23) min, (1.56±0.37) d, (1.29±0.28) d, (38.94±5.64) mL, 5%, the control group were (107.53±9.98) min, (2.53±0.52) d, (2.16±0.34) d, (65.87±7.96) mL, 25%, the observation group were excellent in all indicators compared with the control group, the differences between the two groups were statistically significant ( P<0.05). After operation 3rd day, the serum 5-hydroxytryptamine, substance P and norepinephrine in the two groups were higher than before operation ( P<0.05); after operation 3rd day, serum 5-hydroxytryptamine, substance P and norepinephrine the observation group were (0.70±0.12) pg/mL, (175.42±17.87) ng/mL and (378.52±26.57) ng/mL, the control group were (1.02±0.18) pg/mL, (248.98±18.98) ng/mL, and (460.92±35.42) ng/mL. The indexes of the observation group were smaller than those of the control group, the differences between the two groups were statistically significant ( P<0.05). After operation 3rd day, the serum tumor necrosis factor-α, C-reactive protein and interleukin-6 in the two groups were higher than before operation ( P<0.05); after operation 3rd day, Serum tumor necrosis factor-α, C-reactive protein and interleukin-6 in the observation group were (108.76±10.86) pg/mL, (14.23±3.18) mg/L and (17.84±3.98) pg/mL, respectively, on the 3rd day after operation. The control group were (156.95±16.67) pg/mL, (26.52±4.59) mg/L and (28.53±5.67) pg/mL, the observation group indexes were all smaller than control group, the differences between the two groups were statistically significant ( P<0.05). The quality of life scores of the two groups at 1 month and 6 months after the operation were higher than before operation ( P<0.05); The quality of life scores of patients in the observation group at 1 month and 6 months after surgery were higher than control group ( P<0.05). Conclusion:LC combined with LCBDE treatment has little effect on pain stress and inflammatory factors in elderly patients with cholecystolithiasis and choledocholithiasis, and has fewer postoperative complications, and can improve the quality of life of patients.
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Acute cholecystitis and acute cholangitis are common acute abdomen in biliary surgery. The morbidity of acute cholecystitis is high, and abdominal ultrasound has become the first choice for imaging examination. Disease assessment and severity grading are used to guide the formulation of treatment plan. Early laparoscopic cholecystectomy is the first choice for mild acute cholecystitis. Supportive treatment should be used in patients with severe acute cholecystitis to improve symptoms for elective cholecystectomy. For patients with severe cholecystitis who can not tolerate the risk of surgery and have no effect on conservative treatment, gallbladder drainage should be performed in time. Acute cholangitis is an acute disease with high mortality. Magnetic resonance cholangiopancreatography is an important imaging examination. The treatment principle of acute cholangitis is early biliary decompression, antibiotic application and general supportive treatment. The common methods of biliary decompression include percutaneous transhepatic cholangiography drainage, endoscopic duodenal papillary bile duct drainage, endoscopic ultrasound-guided biliary drainage, and surgical placement of T-tube drainage.
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Objective:To compare the application value of different polypropylene mesh in inguinal hernia repair of adults.Methods:The prospective cohort study was conducted. The clinical data of 120 adult patients with inguinal hernia who were admitted to two medical centers (60 in Huadong Hospital affiliated to Fudan University and 60 in Shanghai Ninth People′s Hospital affiliated to Shanghai Jiaotong University from March 2012 to Match 2014 were collected. Patients were randomly divided into study group and control group using the random number table. Patients in the study group underwent repair of inguinal hernia using the SMP95958X mesh, and patients in the control group underwent repair of inguinal hernia using the modified Kugel mesh. All patients underwent preperitoneal repair by senior hernia surgery specialists. Observation indicators: (1) postoperative pain; (2) complications and follow-up. Patients were followed up at postoperative 3 months and 6 months using outpatient examination to detect the short-term complications by physical or color doppler ultrasonography examination, and at postoperative 5 years using telephone interview or outpatient examination to detect long-term complications including infection, foreign body sensation and recurrence of hernia. The follow-up was up to March 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), comparison between groups was analyzed using the nonparametric rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square, continuous correction chi-square test or Fisher exact probability. Comparison of ranked data were analyzed using the nonparametric rank sum test. Results:A total of 118 patients with inguinal hernia were selected for eligibility, including 116 males and 2 females, aged (64±12)years, with a range from 29 to 84 years. Of the 118 patients, 59 were in the study group and 59 were in the control group, respectively. (1) Postoperative pain: of the 59 patients in the control group, 34 took painkiller and 1 case lost the data of taking painkiller at postoperative 2 days. Of the 59 patients in the study group, 29 cases took painkiller. There was no significant difference in taking painkiller between the two groups ( χ2=1.055, P>0.05). The pain score at postoperative 2 days and 3 months were 3.26(range, 0.70-6.90) and 0.87(range, 0.00-4.10) of the control group, respectively, and 3.03(range, 0.00-8.80) and 0.83(range, 0.00-3.10) of the study group, respectively, showing no significant difference between the two groups ( Z=0.782, 0.729, P>0.05). (2) Complications and follow-up: the incidence of postoperative complications at perioperative period (within postoperative 2 days) was 1.7%(1/59) and 1.7%(1/59) in the control group and study group, respectively, showing no significant difference between the two groups ( P>0.05). Both of 59 patients in the control group and study group were followed up for 6 months after operation, respectively. The incidence of postoperative complications at 3 months and 6 months after operation was 1.7%(1/59) and 1.7%(1/59) in the control group, respectively, and 5.1%(3/59) and 5.1%(3/59) in the study group, showing no significant difference between the two groups ( P>0.05). Fifty-five patients of the control group and 52 patients of the study group were followed up for 5 years after operation, respectively. There was 1 case of infection in the control group, with the incidence of postoperative long-term ( within 5 years after operation) complication of 1.8%(1/55), and there were 2 cases of infection and 1 case of foreign body sensation in the study group with the incidence of postoperative long-term (within 5 years after operation) complication of 5.8%(3/52), showing no significant difference between the two group ( P>0.05). There was no recurrence of hernia in either group. Conclusion:Both of the SMP95958X mesh and the modified Kugel mesh can be used in preperitoneal repair of inguinal hernia, showing no significant difference in the efficacy between them.
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The purpose of modern hernia surgery is to repair the defects of abdominal wall and restore abdominal wall function, eliminate all complications, and improve the quality of life in patients ultimately. A kind of "PERFECT" patch should not only has ideal tensile strength, but also has the optimal biocompatibility. Although many kinds of patches are beneficial to hernia patients, there is still no universal patch that can be used at any time, in any patient, in any kind of hernia and by any surgical technique. In the past 10 years, biological patch has been used in the field of abdominal wall hernia and achieved certain curative effects, but there are also some problems which are worthy of summary and reflection. In the future, a series of functional biomaterials represented by "tissue-induced biomaterials" may be the closest patch to "IDEALIZATION" in our time.
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At present,the hernia and abdominal wall surgery in China is still operating the traditional mode of "center of excellence",which helps to maintain quality of hernia treatment,actually fosters mediocrity and inhibits positive individualization and innovation in the diagnosis and treatment of hernia.For a better development in this field and treatment solutions improvement,a complex system of a sustainable and adjustable organizational structure and diagnostic and treatment options is required.The core concept is that hernia treatment can be completed based on continuous clinical quality improvement (CCQI) system.The key point of the CCQI system is to establish a specialized hernia medical team,with engagement and participation of the patients and family in the care process,formulate a scheme reflecting true value measured by the health care system and adapt these concepts to the community setting.The above initiatives will be conducive to the improvement of continuous clinical quality.The establishment of a working system based on this standard will play a positive role in the diagnosis and treatment of hernia,so as to achieve better treatment results and lower medical costs.
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Inguinal hernia refers to an extraperitoneal hernia occurring in the inguinal region. The etiology of inguinal hernia is not completely clear, but is related to gender, age and family history. According to the anatomy of hernia, there are indirect hernia, direct hernia, femoral hernia, composite hernia and peripheral femoral hernia. According to the content of the hernia sac, it is divided into reducible hernia, irreducible hernia, incarcerated hernia and strangulated hernia. There are also several special types of hernia. Typical inguinal hernia can be diagnosed by medical history, symptoms and physical examination. If the diagnosis is unclear or difficult, the imaging examination can assist the establishment of diagnosis. Only through surgery, inguinal hernia in adult patients could heal. The following requirements should be fulfilled: (1)The surgeons need to acquire accreditation of medical residency and should have corresponding surgical training; (2)The qualification of laparoscopic surgeons require the completion of basic laparoscopic training and hernia fellowship training as well as passing relative examinations; (3)Training of hernia and abdominal wall surgeons should be completed in centers with corresponding qualifications; (4)Preoperative education should be provided to patients and/or their families, emphasizing the communication with patients before surgery and indicating the operation principle and measures, whether mesh should be used, and informed consent should be given. Hernia repair materials are mainly non-absorbable inert mesh. Surgery could be divided into two types: open and laparoscopic surgery, including tissue suture repair, repair with materials, total extraperitoneal repair (TEP) and trans-abdominal preperitoneal repair(TAPP), etc. Combined with the clinical practice in China,we completed the "Guideline for Diagnosis and Treatment of Adult Groin Hernia (2018 edition)" on the basis of the previous edition of the guideline. The relevant medical institutions and peers in China are requested to carry out this guideline according to actual clinical reference.
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Adult , Humans , China , Groin , Hernia, Femoral , Hernia, Inguinal , General Surgery , Herniorrhaphy , Laparoscopy , Surgical MeshABSTRACT
Abdominal incisional hernia is the result of the loss of the integrity and tension balance of the abdominal wall. According to clinical manifestation and physical examination, most incisional hernia can be clearly diagnosed. For small and concealed incisional hernia, the diagnosis can be confirmed by imaging examination. According to size of defect, it can be divided into small, middle, large, and giant incisional hernia. According to location of lesion, it can be divided into incisional hernia in the central or peripheral region of the anterior abdominal wall, in the lateral abdominal wall, and in the back. According to the presence of recurrence, it can be divided into primary and recurrent incisional hernia. Patients with definite diagnosis and suitable for surgical treatment after risk assessment are recommended for elective surgery. For patients who are not suitable for surgery, appropriate abdominal bandages are recommended to limit the development of incisional hernia. Surgical methods:(1) Simple suture repair is suitable for small incisional hernia; (2) Reinforcement repair using materials is recommended for middle incisional hernia or above; (3) When the materials are used in open repair, onlay and sublay methods are usually adopted. (4) IPOM or underlay methods are always adopted when materials are used for laparoscopic repair; (5) Hybrid repair is performed by combining open and laparoscopic techniques; (6) Methods to increase the abdominal cavity capacity include compartmental separation technology(CST) and lateral transverse abdominal muscle release technology (TAR); (7) Abdominal wall reconstruction with muscle fascial flap can be supplemented with mesh. According to the clinical practice of our country in the recent 4 years and based on "China Guideline for Diagnosis and Treatment of Incisional Hernia (2014 edition)", the " China Guideline for Diagnosis and Treatment of Incisional Hernia (2018 edition) " was completed after discussion and consultation with more than 50 experts and scholars in China. The definitions, etiology, pathophysiology, classification, diagnosis, differential diagnosis, treatment were comprehensively updated, and the viewpoints, measures and methods supported by evidence-based medicine were pointed out. The relevant medical institutions and surgeons in China are requested to carry out the guide according to actual clinical reference.
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Humans , Abdominal Wall , China , Hernia, Ventral , Herniorrhaphy , Incisional Hernia , Diagnosis , General Surgery , Recurrence , Surgical MeshABSTRACT
Since large-scale popularization of the surgical treatment of hernia in the 1990s, China has made great process in the field of hernia and abdominal wall surgery. In the treatment of incisional hernia of abdominal wall, a relatively complete system has been established in China, for instance, the formulation of guidelines, the purpose of incisional hernia treatment, the principle of surgical treatment, the choice of surgical methods, the improvement of material application, standardized treatment process, optimized management system. Common procedures of incisional hernia are open operations, including direct repair suture, bridging repair, and separation techniques of tissue construction. Meanwhile, the laparoscopic repair develops quickly in China as well. Compared with Western countries however, we still have a long way in overall level, for instance, treatment innovation, data integrity accumulation, quality control, technical innovation, new materials research, and monitoring of side-effects of implant materials. What we should consider and pay attention to is how to further develop hernia surgery and make it sustainable. Based on surgical experiences of incisional hernia in China, this paper intends to share the modern knowledge of incisional hernia and abdominal wall surgery.
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Humans , Abdominal Wall , China , Hernia , Hernia, Ventral , Herniorrhaphy , Incisional Hernia , General Surgery , Laparoscopy , Surgical MeshABSTRACT
Objective To investigate the clinical efficacy of mesh repair via inguinal approach in acute femoral hernia.Methods The retrospective cohort study was conducted.The clinical data of 48 patients with acute femoral hernia who were admitted to Huadong Hospital Affiliated to Fudan University between January 2007 and December 2016 were collected.Of 48 patients,29 undergoing hernia repair with polypropylene mesh and 19 undergoing hernia repair with suture were allocated into the study group and control group respectively.All the patients underwent hernia repair via inguinal approach.Observation indicators:(1) surgical and postoperative situations;(2) follow-up and survival situations.Follow-up was performed by outpatient examination and telephone interview to detect complications,hernia recurrence,survival situations at 1-,3-month and 1 year postoperatively for 1 year up to December 2017.Measurement data with normal distribution were represent as x±s and comparison between groups was done by the t test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Surgical and postoperative situations:patients in the 2 groups underwent successful incarcerated or strangulated acute femoral hernia repair.There were 3 and 4 patients receiving small bowel resection in the study group and control group respectively,with no statistically significant difference between groups (x2=1.50,P＞0.05).The operation time was respectively (82±16)minutes and (96± 13)minutes in the study group and control group,with statistically significant difference between groups (t =-2.94,P＜0.05).There was no femoral vascular injury in the 2 groups.The time of drainage-tube removal and duration of postoperative hospital stay were respectively (4.5 ± 1.6) days and (9±4) days in the study group and (3.9± 1.3)days and (10±4)days in the control group,with no statistically significant difference between groups (t =1.36,-0.33,P＞0.05).(2) Follow-up and survival situations:all the 48 patients were followed up for one year.No mesh infection was found in the study group.[ncisional infection was detected in 4 and 2 patients of the study group and control group respectively,with no statistically significant difference between groups (x2 =0.11,P＞ 0.05).Patients with incisional infection were cured after incision open drainage.Two and 2 patients had postoperative chronic pain in the study group and control group respectively,with no statistically significant difference between groups (x2 =0o 20,P＞0.05).The 4 patients had mild intermittent pain,without special treatment.There were no seroma occurred in the 2 groups.Hernia recurrence was occurred in 0 aud 5 patients of the study group and control group respectively,with statistically significant difference between groups (x2 =8.52,P＜0.05).There were 2 and 1 patient dead in the study group and control group respectively,with no statistically significant difference between groups (P ＞ 0.05).Conclusions Hernia repair with Polypropylene mesh via inguinal approach in acute femoral hernia is safe and feasible.Compared to suture repair,it can not only shorten operation time and reduce hernia recurrence,but also had no mesh infection and cannot iucrease postoperative complications.
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Nowadays,hernia and abdominal wall surgery developes rapidly in China.Tension-free repair for inguinal hernia and abdominal wall incisional hernia is popular,and laparoscopic and even Da Vinci robotic hernia repair have been promoted rapidly.Due to the unbalanced development in different areas of China,there is still existence of irregular diagnosis and treatment in hernia.Registry system of hernia and abdominal wall surgery and quality control standards are urgently needed.A few etiology,genetics and molecular epidemiology studies have been reported,although basic research of hernia is weak in the whole world.The exact pathogenesis and inheritance pattern are worthy of further study.The progress of hernia and abdominal surgery is inseparable from the development of repairing materials.At present,the repairing materials are mainly composed of synthetic materials and biomaterials.Although prosthetic repair can reduce postoperative hernia recurrence rate,mesh related adverse events in the long term should not be ignored,including common complications such as mesh shrinkage,erosion,adhesion,infection and so on.There is no ideal repairing material yet,but the innovative research and development of materials is worthy of the expectation in hernia and abdominal wall surgeons.
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In recent 20 years,the hernia and abdominal wall surgery in China was in a fast developing stage.The paper published in Issue 5,2017 of the Lancet gave scores for 25-year development of 32 diseases,and a high score of 99 points on diagnosis and treatment of inguinal hernia in China was in fourth place globally,which has far outstripped the other countries of the world.But there is still a wide gap on comprehensive strength between Chinese and international levels.Authors have to make further efforts in many aspects,including the standardization,guideline,basic research,innovation and development of surgical techniques,registration system and quality control of hernia and abdominal wall surgery in China,in order to encourage and inspire surgeons to have continuously inheritance,development and innovation in the achievement and historical problems.
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In recent 20 years, hernia and abdominal wall surgery has made great progress in China. However, what we′ve done still leaves much to be desired. Related guidelines of hernia disease had been conducted, but China is short of multi-center, prospective, and large-sample research evidence. These guidelines are still with low evidence level, and contents need additional modified to well meet Chinese real situation. In terms of treatment of inguinal and abdominal wall incisional hernia, some consensus has been reached from certain key issues globally, but further exploration are still needed. To stand at top of the world, we are a long distance. We should not only strengthen training and quality control but also establish patient registration system and overall management process.
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Objective To analyze the clinical value of laparoscopic and hybrid technique for the repair of incisional hernia.Methods The clinical data of 70 cases of incisional hernia undergoing laparoscopic and hybrid repair from Jan 2014 to Dec 2015 in Huadong Hospital were analyzed retrospectively.Results All cases were operated on successfully and recovered.The operation time was (60 ± 27) min for laparoscopic and (120 ± 32) min for hybrid repair.The length of incision was (6 ± 4) cm for laparoscopic repair and (8 ± 6) cm for hybrid.Postoperative complications included seroma in 1 case in laparoscopic group,incisional fat liquefation in 1 case in hybrid group.All were cured with conservative treatment.Hospital stay was (8 ± 5) days in hybrid group and (14 ± 16) days in hybrid group.No recurrence was observed during 6-30 months of follow-up.Conclusion Both laparoscopic and hybrid technique for incisional hernia repair are safe and effective.
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Some aspects of hernia and abdominal wall surgery in China have come up to an international advanced level,such as number and quality of operation.The latest issue of The Lancet gave a high score of 99 points on diagnosis and treatment of inguinal hernia in China,which has far outstripped the other developed countries of the world,with China in fourth place globally.The journal commented that,considering the treatment of inguinal hernia rely mainly on surgery,the reason Chinese surgeon performed well recalled for the great number of patients,surgery of huge quantity and the strong operation ability of the doctors in China.But there is still a wide gap on comprehensive strength between Chinese and international levels,and quality control standard is one of major aspects.If hernia and abdominal wall surgery wants to develop further,perfect quality control system is a crucial step.
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Groin incarcerated hernia and groin strangulated hernia in adults are common acute abdominal disease,usually with aging,male-dominated inguinal direct and indirect hernia and female dominated femoral hernia,high mortality.Groin hernia medical history,hernia specialist checkup and imaging examination are quick and accurate diagnosis of adult groin incarcerated and strangulated hernia necessary prerequisites.Traditional hernia surgery,tension-free repair,laparoscopy tension-free repair are commonly used in emergency surgery of groin incarcerated hernia and strangulated hernia in adults.The aim of this article is to summarize the timing of surgery and surgical methods of groin incarcerated and strangulated hernia in adults.