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Objective Summarize anterior open tension-free inguinal hemiorrhaphy, especially application experience and understanding in the 952 cases of day surgery, and clarify the advantages. Method During December 2004 - June 2007, we treated 952 Patients of inguinal hernia and femoral hernia,using local anesthesia, tension-free, in the form of day surgery. And the resulte were compare to traditional hemiorrhaphy, tension-free hemiorrhaphy of hospital in all aspects. Results Patients in this group were all cured.Intraoperative and postoperative pain was mild.All patients should be used only a small amount of postoperative oral analgesics, and no urinary retention. They got out of bed immediately after surgery, and they recorered fast ,with less complications. They could be discharged home in surgical day (2 h later). Af ter 18 months follow-up, only 2 cases recurrence. Conclusions (1) Compared with the traditional hemiorrhaphy and ambulatory tension-free hemiorrhaphy, tension-free during the day has lots of advantages, such as easier method, wider surgical indications, faster postoperative recovery, shorter hospital stay, less complications and lower recurrence rate;(2)Tension-free hernion'haphy day surgery is safe，feasible，and has obvi-ous advantages.
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Objective To evaluate the methods and outcome of laparoscopic degradable bio-patch repair of umbilical hernia in adults. Methods From January 2003 to October 2008, 21 adult patients underwent elective laparoscopic patch repair of umbilical hernia. There were 15 women and 6 men. The mean age was 56 years old (range of 36-73). The diameter of hernia ring was from 3 to 7.5 cm averaging at 5.2 cm. All patients received general anesthesia. Preoperative bowel preparation routinely started one day before the operation. The patients received prophylaxis systemic antibiotics 30 minutes before the operation. An appropriate size of prosthetic patch (Composix E/X, Bard, USA) was that extended the defect margin for about 3-5 cm. The mesh was then inserted into the peritoneal cavity and spreaded flattening, with the polyplypylene side facing outside and it's center coinciding with that of the defect. The mesh was fixed to the abdominal wall with staple tacks in two rings, which was 3-5 cm along the hernia ring and 1-2 cm along the edge of the mesh. Results There was no conversion to open repair. The operative time was 30 to 96 rain and the average was 52 min. Two patients suffered from a transient postoperative tympanites and which subsided 2 to 3 days after the operation. One patient had a severe pain in the repair area around the umbilical and underwent oral medicine treatment, which disappeared one week after operation. There was no seroma and incision or mesh infection occurred. The postoperative hospital stay was 3 to 8 days and the average was 4. 2 days. The follow-up time was 3 months to 5 years and the average was 32 months. No ileus or hernia recurrence during the follow-up. Conclusion Laparoscopic patch repair of umbilical hernia in adults is a safe and effective procedure.
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Objective To evaluate the prevention and treatment of prosthetic infections after tension free hernioplasty. Methods The clinical date of 12 prosthetic infections admitted from May 2005 to May 2008 were analyzed retrospectively. Patch was inserted under prefascial retromuscular site in 8 cases, between fascial edges in 2, Mesh plug and patch Lichentstein in one each. As for the material used there were flat knitted polypropylene in 7 cases, polytef in 1 case and composite prosthesis in 4 cases. Treatments were based on prothetic materials and levels infected. Infectious patchs were removed completely in 8 cases and partially removed in 2 cases, Open dress change with patchs left in situ in 2 cases. 3 cases in 10 cases of removed patchs were given immediate suturation with closed drainage. Results Infection was cured in all cases without mortality. There was no hemorrhage and injury of bladder during the procedures. No retention of urine, pain and other complications during postoperation. Change of dressing was made from 7 days to 6 months( median 2 weeks). Selected antibiotic was used from 3 to 7 days (average 4.5 days). All patients were followed up from 18 to 78 months (average 38.5 months) without hernia recurrence and infection. Conclusion It was most important to prevent infections after tension-free hernioplasty. Management should be individualized according to different type of patch used and the surgical procedure in hernia repair.
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Objective To study and summarize the successful experience and the safety, easibility, practicality and operation skills of totally laparoscopic extraperitoneal herniorrhaphy (TEP). Methods From October 2006 to May 2008,225 patients in our two hospitals were performed TEP (265 totally laparoscopic extraperitoneal hernia repairs for inguinal hernia), including 55 direct inguinal hernia, 197 indirect inguinal hernia and 13 complex inguinal hernia operations. Among the 225 patients, 185 patients had unilateral hernia and 40 patients had bilateral hernias, including 29 recurrent hernia. Results The operations were lasted for 30 to 182 minutes(the average operating duration was 48 minutes for unilateral hernia and 106 minutes for bilateral hernia). The patients stayed in hospital for 2 to 8 days(the average inpatient hospital stay was 3.0 ± 1.2 days). The most common complication was scrotum bematomas,which appeared in 18 cases. Urinary re-tention appeared in 21 cases. Inguinal pain appeared in 5 cases. Bladder injury appeared 1 case. All the pa-tients were followed up for 3 months- 3 years. There was only 1 case of recurrence. Conclusions The proce-dure of TEP is safe,with faster postoperative recover,less pain,lower incidence of pain,better comfort quality and lower recurrence rate. TEP should be the main laparoscopic procedure for inguinal hernia repair.
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The epidemiology of inguinal hernia,the mesh's side effects on the spermatic cord,the spermatic cord blood vessels,the was deferens and the testicular in inguinal hernia hemiorrhaphy of tension-free were reviewed.The effects of the inguinal hernia herniorrhaphy and the mesh in clinical and animal experiments which affected on the male reproductive function such as the location.extent and pathological changeswere summarized,and the mechanism of the tension-free inguinal herniorrhaphy affecting the male reproducrive function were discussed.Improvingthe operation skills and the more appropriate choice of the mesh may protect the male reproductive function in tension-free inguinal hernia hemiorrhaphy.
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Objective To study the application of Polypropylene-Prolene Hernia System ( PHS) in tension-free herniorrhaphy of femoral hernia. Methods A total of 36 patients with femoral hernia were randomly divided into 2 groups to receive respectively PHS or Plug repair procedure. Data collected included; operative time, hospital stay, postoperative complications and recurrence rate. Results In PHS and Plug groups, the operative time were (42?7) min and (41?4) min respectively, the hospital stay was (4. 1?1. 0) d and (4.4?1. 2) d respectively. During the follow up period from 6 to 30 months,there was no recurrence, one case of scrotal hydrocele in PHS group, and there were two cases of recurrence and one case of ecchymoma in Plug group. Five patients complained of foreign body feeling in Plug group, and no patient in PHS group ( P
ABSTRACT
Bladder injury is a rare complication of inguinal herniorrhaphy. Infants less than 6 months old may be more at risk because the medial aspect of indirect inguinal hernia sacs are associated closely with the wall of bladder (bladder ear). We report a case of injured bladde. ear during inguinal herniorrhaphy.