ABSTRACT
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
Objective To explore the application value of the preoperative multi-slice spiral computed tomography (MSCT) for the repair of huge abdominal incisional hernia.Methods The retrospective crosssectional study was conducted.The clinical data of 61 patients with huge abdominal incisional hernia who were admitted to the Xinjiang Uygur Autonomous Region People's Hospital from January 2012 to February 2016 were collected.All patients underwent preoperative MSCT and three-dimensional reconstruction to measure the percentage of volumes of the hernia sac and abdominal cavity and then selected the individualized surgical methods according to the percentage,and length of small intestine resected was calculated in patients undergoing initiative volume reduction combined with onlay repair.Observation indicators:(1) pre-and post-operative situations:percentage of volumes of the hernia sac and abdominal cavity,duration of preoperative hospital stay,surgical procedure,length of small intestine resected in patients undergoing initiative volume reduction combined with onlay repair,operation time and volume of intraoperative blood loss;(2) postoperative recovery situation:intraabdominal pressure at postoperative 48 hours,recovery time of postoperative gastrointestinal function,removal time of postoperative abdominal drainage-tube,postoperative complications and duration of postoperative hospital stay;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative hernia recurrence and long-term complications up to March 2017.Measurement data with normal distribution were represented as (x)±s and measurement data with skewed distribution were described as M (range).Results (1) Pre-and post-operative situations:percentage of volumes of the hernia sac and abdominal cavity in 61 patients was 19％ ± 4％,and duration of preoperative hospital stay was (7 ± 5) days.All the 61 patients underwent successful operation,including 48 receiving onlay repair and 13 receiving initiative volume reduction combined with onlay repair,without conversion to other surgery.Length of small intestine resected in 13 patients undergoing initiative volume reduction combined with onlay repair was (48±8)cm.Operation time and volume of intraoperative blood loss in 61 patients were (2.6 ± 0.8) hours and (82± 50) mL.(2) Postoperative recovery situation:intra-abdominal pressure at postoperative 48 hours,recovery time of postoperative gastrointestinal function and removal time of postoperative abdominal drainage-tube in 61 patients were (9.6 ± 2.9) mmHg (1 mmHg=0.133kPa),(2.1 ± 0.9) days and (3.5 ± 1.1) days,respectively.Twelve patients had postoperative complications,and grade Ⅰ intra-abdominal hypertension,grade Ⅱ intra-abdominal hypertension,incisional effusion,incisional infection,incisional sinus,mesh infection and urinary retention were respectively detected in 4,2,4,2,1,1,1 in patients undergoing the onlay repair and 2,1,1,0,0,0,0 in patients undergoing initiative volume reduction combined with onlay repair.Some patients had 2 or more of complications.There was no occurrence of abdominal compartment syndrome and perioperative death.Patients with complications were cured or improved by symptomatic treatment.Duration of postoperative hospital stay in 61 patients was (8±4)days.(3) Follow-up:all the patients were followed up for 6-36 months,with a median time of 19 months.During follow-up,2 patients with recurrence of huge abdominal incisional hernia received tentative follow-up,and were suggested to treat risk factors of recurrence firstly and then undergo reoperations.Other patients didn't have long-term complications.Conclusion MSCT can provide the accurate data of percentage of volumes of the hernia sac and abdominal cavity before repair of huge abdominal incisional hernia,it also has the important clinical value of choosing the individualized surgical method,preserving the maximum out of normal organs in initiative volume reduction combined with onlay repair and increasing surgical outcomes.