Improving prolene hernia system tension-free repair for inguinal hernia under ultrasound-guided local nerve block anesthesia / 国际外科学杂志

Objective To investigate the application of improving prolene hernia system(PHS) tensionfree repair for inguinal hernia under ultrasound-guided local nerve block anesthesia.Methods Retrospective analysis the clinical data of 40 patients with improving prolene hernia system(PHS) tension-free repair for inguinal hernia under ultrasound-guided local nerve block anesthesia from January 2013 to January 2014 in Gulou Hospital of Nanjing University.Results In group of ultrasound-guided local nerve block anesthesia , the average anesthesia time was (8.9 ± 1.5) min, the time to get out of bed was (5.6 ± 1.1) h, the length of stay was (2.9 ± 0.7) d,There were (12.4 4± 2.2) min, (10.2 ± 1.6) h and (3.7 ±± 0.7) d in general anesthesia group, and significant difference(P ＜0.05), the average operation time of two groups were (22.6 ± 2.0) min, (22.1 ± 2.4) min,the average duration of postoperative analgesia was (6.4 ± 1.6) h, (6.1 4± 1.5) h, and no significant difference (P ＞ 0.05).Conclusions Improving prolene hernia system(PHS) tension-free repair for inguinal hernia under ultrasound-guided local nerve block anesthesia is simple , easy and safe to be performed with mild pain, faster recovery and less bleeding.It is worthy of popularization and application.

Application of Millikan's modified modality in primary tension-free mesh-plug inguinal herniorrhaphy / 国际外科学杂志

Objective To summarize the clinical efficacy of Millikan's modified modality using tension-free mesh-plug inguinal herniorrhaphy. Methods A retrospective study was performed in 185 cases with in-guinal hernias. They received surgical treatment using Millikan's modality in our hospital from Jan. 2005 to Dec. 2006. Results There were 184 males and 1 female in these patients with a average age of 47 years ( range 32 - 75 years). Among them, 7 cases had bilateral hernia. The mean operative time of each hernia was 49 min (range 30 -70 min), and the average postoperative hospital stay was 5. 1 days (range 3 - 18 d). The complication rate was 10. 8% (20/185). All patients had no recurrence after following-up over 24 months. Conclusion Millikan's modified mesh-plug hemioplasty is a safe and effective modality in the pri-mary inguinal hernia repair, and has fewer complications and lower recurrence rate.

Open preperitoneal hernia repair with the Kugel patch for recurrent inguinal hernia / 国际外科学杂志

Objective To evaluate clinical application of Kngel patch in treating recurrent inguinal her-nia. Methods The clinical data of 65 patients with 77 sides recurrent inguinal hernia performed open preperitoneal inguinal hernia repairs from January 2005 to June 2009 were analyzed retrospectively. Kugel hernia patches were used in the operations. Results The operating time for unilateral hernia expended 40 ～ 150(76.5±20. 4) min. Postoperative pain was minimal and no incision infection appeared. The postopera-tive complications were 4 cases of uroschesis,6 cases of inguinoscrotal seroma, 2 cases of inguinoscrotal he-matoma and 3 cases of serotal hydrops. No serious complications such as sensation of foreign body, inguinal chronic pain and recurrence were observed during the follow-up of 3 to 54 months. Conclusions Open preperitoneal hernia repair with Kngel patch for adult recurrent inguinal hernia reparation is rational and fea-sible.

Comparing of Complications of Inguinal Hernia Repair Using Prolene Hernia System

PURPOSE: A tension-free hernia repair using mesh is considered the standard method. A prolene hernia system (PHS) is a more recently introduced hernia-repair device in Korea. We compared complications of beginners' PHS operation with those of experts in our department. METHODS: We retrospectively analysed 448 cases of herniorrhaphy using PHS from December 2002 to August 2007. We compared complication of 150 early cases and 150 late cases. RESULTS: There were 394 male and 54 female patients with ages 19 to 82: 321 indirect, 83 direct, 7 femoral, 4 pantaloon hernias. The most frequent complication of PHS repair was hematoma and wound swelling. The 150 early cases' complications included 7 hematoma and 9 wound swelling. The 150 late cases' complications included 7 hematoma and 8 wound swelling. There was no difference between early and late complications. CONCLUSION: In comparing complications of 150 early and late cases, there was no difference.

A Tension-free Herniorrhaphy Using the Prolene Hernia System: Clinical Experiences

PURPOSE: The aim of this study was to detail clinical experiences with a new type of tension-free herniorrhaphy using the Prolene Hernia System (PHS) and analyze the system' usefulness. METHODS: We reviewed 48 cases of herniorrhaphy using PHS and 45 cases of conventional herniorrhaphy retrospectively by reviewing the medical records of patients undergoing either procedure between January 2000 and February 2005. RESULTS: There was no significant difference in the operation time (P=0.054) or the length of hospital stay (P=0.138) between the groups. However, the need for analgesic therapy in the PHS group was less than in the control group (P= 0.008). There were no serious postoperative complications, but wound complications occurred more often in the PHS group (6 seromas and 2 hematomas), and urinary retention occurred more frequently in the control group. The recurrence rate in the control group was 2.2% (1/45), but there were no recurrences in the PHS group for 46 months. CONCLUSION: Herniorrhaphy using the PHS is safe and effective as conventional surgery. It can be carried out under local anesthesia more easily, and it is less painful than the conventional surgery. We suggest that the PHS be widely adopted as a method of tension-free herniorrhaphy.

Direct Comparison of PHS(R) and Perfix(R) Herniorrhaphy under Local Anesthesia

PURPOSE: The aims of this study were to evaluate the feasibility of local anesthesia in tension-free herniorrhaphy, using prosthetic mesh, and to directly compare PHS(R) and Perfix(R) herniorrhaphy under local anesthesia. METHODS: Patients with a groin hernia, who underwent tension-free herniorrhaphy (n = 107) under local anesthesia between March 2003 and February 2006, were included. PHS(R) (n = 63) and Perfix(R) (n = 44) meshes were randomly used, with no difference between the PHS(R) and Perfix(R) groups in relation to mean age, gender, number of combined diseases, body mass index (BMI), recurred hernia and types of hernia. RESULTS: Intraoperative analgesics and/or sedatives were used in 55 patients (51.4 %) where local anesthesia was insufficient. In a univariate analysis, the additional use of intraoperative analgesics and/or sedatives was related to the patient's age and BMI. The patients at an older age and with a lower BMI were more tolerant to local anesthesia. However, only the BMI was found to be a statistically significant factor from the multivariate analysis. There was no significant difference between the PHS(R) and Perfix(R) groups on the additional use of intraoperative analgesics and/or sedatives, the use of postoperative analgesics, length of hospital stay, complication and recurrence (P > 0.05). CONCLUSION: With tension-free herniorrhaphy using the PHS(R) or Perfix(R) mesh, local anesthesia was acceptable and securable, regardless of the mesh type used. Among these patients, those at an older age and with a lower BMI were more tolerant to local anesthesia.

120 Cases of Hernia Repair with Bilayer Patch (Prolene Hernia System)

PURPOSE: A tension-free hernia repair using a mesh is considered to be the standard method. The Prolene Hernia system (PHS) is a more recently introduced hernia-repair device in Korea. We report the results of hernia repair using the PHS in 120 cases at our department. METHODS: We retrospectively analyzed 120 cased of herniorrhaphy using PHS. between December 2002 and September 2004. RESULTS: There were 104 male and 16 female patients with a mean age of 54 years: 85 indirect, 32 direct, 2 femoral, and 2 pantaloon hernias. There were 20 cases postoperative complications: including 6 hematoma, 3 seroma, 3 wound swelling, 2 dysuria, 2 testicular swelling, 1 scrotal swelling and 1 peritoneal irritation. There were no postoperative infection and recurrence. The median operative time was 54.6 min (range 23~165min). We thought that lesser than 30 cases need to be performed to become skillful in the hernia repair with PHS. CONCLUSION: Hernia repair with PHS is easy to learn and to perform. And this procedure has lesser postoperative complications.

Postoperative Endocrine Reaction in Patients with Inguinal Hernia after Herniorrhaphy: A Comparison Between Tension-Free Repair and Conventional Repair / 中国普外基础与临床杂志

Objective To investigate the effects of tension free herniorrhaphy on endocrine functions of patients with inguinal hernia. Methods One hundred and twenty seven patients were randomly divided into tension free group( n =65) and conventional group ( n =62). The mean ages of tension free group and conventional group were(51.8?14) year and(48.4?12) year respectively. There were 52 indirect hernias and 13 direct hernias in tension free group. There were 51 indirect hernias and 11 direct hernias in conventional group. Bassini repair was used in conventional group. Peripheral blood samples were obtained preoperatively and 3 h, 24 h after operation for measuring the levels of cortisol, T3, TSH, insuline, C peptide and and glucose. The data were analysed through t test. Results The levels of cortisol, C peptide and glucose in conventional group were remarkably higher ( P

Tension-free Herniorrhaphy Using PerFix(R) Plug: A Preliminary Report

PURPOSE: The PerFix(R) plug is preformed as a Marlex mesh hernia plug, and consists of a fluted outer layer combined with an inner arrangement of eight mesh "petals." In contrast to hand-rolled hernia plugs, which can collapse on themselves, the PerFix(R) plug's petals maintain the device's open conelike shape. The fluted design allows the plug to more readily conform to the configuration of any indirect or direct defect. METHODS: Bewteen January 1996 and April 2000 126 conventional herniorrhaphies (C group: Bassini: 23, Shouldice: 15, McVay: 5, Lichtenstein: 83) were performed, and between May 2000 and April 2002, 124 PerFix(R) plug repairs (P group) were completed. The operation times, lengths of hospital stay, visual analogue pain scales, time of analgesics use, and complication and recurrence rates were compared between these two groups. RESULTS: The operation times and lengths of hospital stay for groups C and P were 56.4 vs. 31.1 minutes and 4.4 vs. 2.8 days, respectively, so where significantly shorter in the P group (P<0.01). The times of use for the analgesics, AAP and Nubaine, were 6.6 vs. 0.6 times and 1.7 vs. 0.9 times, in group C and P, respectively, so were significantly fewer in the P group (P<0.01). There were 5 recurrences (3.9%) in the C group during the follow up period (2~6 years), but there were none in the P group during the follow up period (5 months~2 years). The complications were similar in both groups. CONCLUSION: Compared with conventional surgical techniques, including the Lichtenstein tension free method, the PerFix(R) plug method is the most simple, and shows superiority in the following areas; the operation time, length of hospital stay, times of analgesics use and recurrence. However, with regard to the recurrence, longer follow up and observation periods are required.

Comparative Analysis of Local Anaesthesia and Epidural Anaesthesia in Tension-Free Herniorrhaphy / 中国普外基础与临床杂志

Objective To investigate the most suitable anaesthesia method for the tension-free herniorrhaphy.Methods A total of 422 unilateral inguinal hernia cases from 2002 to 2005 were collected and randomly divided into the local anaesthesia group and epidural anaesthesia group. Observation indices and some relative data, such as operative duration, date of ambulation, date of foodintake, length of hospital stay, operation-correlated complications, anaesthesia complications, usage rate of ancillary drug, satisfactory rate for anesthesia, cost of hospitalization, were included and recorded in the questionnaire, and all the patients who took the tension-free herniorrhaphy were asked to answer it as the follow-up research. Results It was found that the occurrence of postoperative anaesthetic complications, the cost of hospitalization, length of stay of local anaesthesia group were significantly less than those of epidural anaesthesia group, and the date of moving and the date of foodintake were also significantly earlier than those of the other group (P0.05). Conclusion The local anaesthesia is suitable for most of the tension-free herniorrhaphy, and it may be used as the conventional anaesthetic method.

A Comparing Study of Herniorrhaphies Laparoscopy, Lichtenstein and Conventional Repairs

PURPOSE: The optimal surgical technique for inguinal hernia repair continues to be debated. This study was designed to investigate optimal surgical procedures in inguinal or femoral hernia. METHOD: We analyzed 153 cases of herniorrhaphy on inguinal or femoral hernias between August 1996 and November 2000. We divided patient into four groups according to the methods of hernia repair, i.e., 1) 78 cases of laparoscopic herniorrhaphy, 2) 42 cases of Lichtenstein herniorrhaphy, 3) 24 cases of Bassini herniorrhaphy and 4) 9 cases of McVay herniorrhaphy. RESULTS: The patient in the laparoscopic and Lichtenstein herniorrhaphy groups needed shorter hospital stays than those in the Bassini or McVay herniorrhaphy groups. The severity of pain was assessed by the total amount and duration of nonsteroidal anti-inflammatory drug injections, which was minimal in the laparoscopic group. There were no differences in complications between the groups. One patient in the laparoscopy group had a hernia recurrence and was reoperated with Lichtenstein herniorrhaphy. We compared two tension-free herniorrhaphies with each other. The numbers of patients not needing analgesic injections were more in the laparoscopic than the Lichtenstein herniorrhaphy group, reflecting less pain in the former group. Hospital stays were also shorter in the laparoscopic than the Lichtenstein herniorrhaphy group. CONCLUSION: We concluded that tension-free herniorrhaphy is superior to tension herniorrhaphy in terms of postoperative pain & recovery. Of the tension-free herniorrhaphies, laparoscopic herniorrhaphy is associated with less postoperative pain and shorter hospital stays than Lichtenstein herniorrhpahy.

Lichtenstein's Tension Free Herniorrhaphy in Adult Inguinal Hernia

BACKGROUND: Since the herniorrhaphy was performed by Bassini, that method has been the standard for herniorrhaphy for over a hundred year, although it has been modified by other surgeons. During recent decades, biomaterials were introduced to the medical field, and polypropylene mesh was applied to reconstruct the defective abdominal wall of an inguinal hernia in an adult. The Lichtenstein Hernia Institute is regarded as the leading group for the tension-free herniorrhaphy using Marlex mesh under local anesthesia. METHODS: We designed this study prospectively to investigate the characteristics of groin hernias and the results, including complications and recurrence after surgery. The primary method of surgery was a Lichtenstein's tension-free herniorrhaphy using Prolene mesh. We performed 196 hernioplasties in 180 patients having a groin hernia, which included 16 bilateral hernias. RESULTS: 139 indirect hernias, 51 direct hernias, and 3 femoral hernias were included; there were 15 recurrent hernias. A Lichtenstein's tension-free herniorrhaphy was performed in 84.2% of the cases, a preperitoneal mesh graft in 10.2%, and a Bassini's method in 4.6%. There were four recurrences; three were through the femoral canal after the repair of a direct hernia in a female, and one was a recurrent direct hernia in a male patient. CONCLUSIONS: With the use of a mesh prosthesis, a tension-free herniorrhaphy is possible with neither distortion of the normal anatomy nor suture-line tension. However, it should be carefully applied to a direct hernia only after thorough exploration of the groin through the retroinguinal space of Bogros to rule out coexisting intraparietal or femoral hernias. It is necessary to provide enough laxity for the mesh because prolene mesh can shrink up to 20%, and recurrence might be caused by the tension in the applied mesh.

Retrospective Study Comparing Tension-free Herniorrhaphy with Open Anterior Approaches in Inguinal Hernias

BACKGROUND: A tension-free herniorrhaphy has revealed encouraging results in inguinal hernia repair. However, it is still questionable whether a tension-free herniorrhaphy is the best method of inguinal hernia repair. METHODS: In our retrospective study, the postoperative results of a tension-free herniorrhaphy (n=50), a Bassini herniorrhaphy (n=50), and a Shouldice herniorrhaphy (n=50) were compared. The main endpoints were recurrence, postoperative complications, operative time, postoperative hospital stay, period of return to normal activities, postoperative pain, and the use of postoperative analgesics. RESULTS: In recurrence, there was no statistical difference among the three groups. The main postoperative complications were bleeding, hematoma, scrotal swelling, wound infection, and urinary retention. There was no significant difference in postoperative complication rate and operative time, among the three groups. However, the postoperative hospital stay and the period of return to normal activities were significantly shorter with a tension-free herniorrhaphy (3.2+/-2.1 days/13.4+/- 7.6 days) than with a Bassini herniorrhaphy (4.5+/-3.4 days/19.6+/-10.5 days) and a Shouldice herniorrhaphy (6.3+/-3.6 days/24.5+/-13.2 days), (p<0.01, f=12.56; p<0.01, f=13.56). Postoperative pain analogues (postoperaive 1 day & 3 days) were lower in the tension-free herniorrhaphy (1.6+/-0.8/1.0+/-0.5) than in the Bassini herniorrhaphy (2.7+/-1.4/2.2+/-1.6) and the Shouldice herniorrhaphy (3.7+/-1.3/3.6+/-1.8), (p<0.01, f=38.58; p<0.01, f=41.98). In the numbers of analgesic uses (operative day and postoperative 1 day), the tension- free herniorrhaphy (0.6+/-0.3/0.5+/-0.2) was also lower than the Bassini herniorrhaphy (1.9+/-0.8/1.7+/-0.7) and the Shouldice herniorrhaphy (2.4+/-1.2/2.7+/-1.3), (p<0.01, f=59.68; p<0.01, f=81.98). CONCLUSIONS: A tension-free herniorrhaphy is a ecellent method of inguinal hernia repair in adults because it offers a shorter postoperative hospital stay, a shorter period of return to normal activities, lower postoperative pain, and lower use of analgesics than other hernia repairs.