ABSTRACT
Inguinal hernia is one of the common diseases in general surgery, and tension-free hernia repair is the most common treatment for inguinal hernia. Patch infection is the common complication after hernia repair, confuses many of the general surgeons for its complex condition and long duration. The pathogenetic factors of patch infection can be roughly divided into three aspects, which include patients' physical condition, operation details, material and structure of patch. Prevention in advance of the susceptible factors of mesh infection can significantly improve the prognosis of patients. As for the treatment of patch infection, there is no unified standard yet, and individual treatment plans should be formulated according to the patient's condition and experience of the clinician. This article reviews the latest research progress of the occurrence, diagnosis, prevention and treatment of patch infection after tension-free hernia repair.
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 investigate the clinical effect of mesh plug tension-free hernia repair on inguinal hernia and its impact on microenvironment related indicators in patients.Methods A total of 128 cases of patients with inguinal hernia admitted in our hospital were divided into control group and observation group with 64 cases in each group.The control group was treated with traditional hernioplasty,while the observation group mesh plug ten-sion-free hernia repair.The clinical effect and microenvironment related indicators 1d after the operation were com-pared between the two groups. Results Compared with the control group,the observation group had less blood loss during the surgery,and shorter time for recovery of out-of-bed ambulation and hospitalization(P<0.01),but no significant difference was found regarding surgery hours(P > 0.05). The VAS scores of the observation group were significantly lower than those of the control group at the same time points 1 and 3 days after operation(P <0.01). Compared with those of control group 1 day after operation,the serum beta-endorphin(β-EP)of observa-tion group was significantly reduced,but total antioxidant capacity(T-AOC),growth hormone(GH),insulin (InS)level increased significantly(P<0.01).Serum matrix metalloproteinases-9(MMP-2 and MMP-9)and tis-sue inhibitor of matrix metalloproteinases(TIMP-1 and TIMP-2)were significantly reduced(P<0.01).Acute uri-nary retention,scrotal effusion,the incidence of postoperative pain and postoperative recurrence rate of observa-tion group were significantly reduced when compared with those of control group(P < 0.01);there was no differ-ence of incidence of low thermal between the two groups(P>0.05).Conclusion Mesh plug tension-free hernia repair has a significant clinical effect on inguinal hernia with less complications,lower recurrence rate and lighter impact on microenvironment related indicators.
ABSTRACT
Objective To investigate the clinical effect of tension-free hernia repair in the treatment of inguinal hernia combined with ascites.Methods The retrospective cross-sectional study was conducted.The clinical data of 81 inguinal hernia patients with ascites who were admitted to the West China Hospital of Sichuan University from June 2008 to June 2014 were collected.Patients with peritoneal effusion received restriction of sodium in take and diuretic therapy,and patients with severe hypoproteinemia received intravenous injection of albumin.All the patients underwent tension-free hernia repair (Gilbert way).Observation indicators:(1) surgical and postoperative situations:operation time,diameter of hernia ring,defect area of hernia,postoperative plasma drainage,removal time of plasma drainage-tube,postoperative complications and duration of hospital stay;(2) follow-up situation:recurrence and long-term complications of inguinal hernia.Follow-up using telephone interview,outpatient examination and inpatient examination was performed to detect the hernia recurrence and long-term complications for 24 months up to June 2016.Measurement data with normal distribution were represented as (x)±s.Results (1) Surgical and postoperative situations:81 inguinal hernia patients with ascites underwent successful tension-free hernia repair.The operation time,diameter of hernia ring and defect area of hernia were respectively (46± 19) minutes,(3.1-± 0.7) cm and (25 ± 13) cm2.Sixty-five patients received indwelling plasma drainage-tube after repair,volume of light bloodstained fluid was respectively ≥ 100 mL in 39 patients and ＜ 100 mL in 26 patients at 24 hours postoperatively,with a removal time of plasma drainage-tube of (3.2± 1.0)days.Sixteen patients didn't receive indwelling plasma drainage-tube.Of 81 patients,9 and 4 were respectively complicated with mild seroma of incision and scrotal swelling,they were improved and then out of hospital after adequate drainage,with a duration of hospital stay (6.7-± 1.7)days.(2) Follow-up situation:of 81 patients,76 were followed up for 24 months,without recurrence and related complications of inguinal hernia.Conclusion The tension-free hernia repair in the treatment of inguinal hernia combined with ascites is safe and feasible,with good clinical effects.
ABSTRACT
Objective To study the application value of lightweight mesh in the ventral hernia tension-free hernia repair in middle-age and elderly patients. Methods The retrospective cohort study method was used to analyze the clinical data and followed information about 284 cases of tension-free hernia repair in our hospital. The patients were randomly divid-ed into experimental group and control group. The lightweight mesh and heavyweight mesh were used in experimental group and control group respectively. The information was collected including age, sex, inguinal hernia type, combined chronic dis-ease, operative time, blood loss, the duration of hospitalization, surgical expenses and other indicators. Data were followed up in patients including postoperative chronic pain, limited mobility, surgical numbness, the recurrent, foreign body sensation. Results The average cost of surgery was higher in experimental group[ (9 404.54±314.87) yuan]than that in control group [(7 613.94±329.68) yuan]. There were no significant differences in the operative time, blood loss and length of hospital stay between two groups. Results of follow-up data showed that the early postoperative chronic pain, early and long-term activity limitation, long-term surgery area numbness and foreign body sensation were lower in experimental group than those in con-trol group. Conclusion The cost of lightweight mesh was higher than that of heavyweight mesh in the ventral tension-free hernia repair therapy. It is worth to apply the lightweight mesh, which can reduce the incidence of postoperative pain, numb-ness and other adverse reactions.
ABSTRACT
ObjectiveTo explore the clinical effect of the different surgical treatment for patients with inguinal hernia.Methods98 patients with inguinal hernia were randomly divided into two groups and 49 cases in each group.The observation group was given filling tension-free hernia repair,the control group using traditional hernia repair.The postoperative follow-up were compared in clinical efficacy and recurrence.ResultsIn the observation group and control group,the duration of postoperative pain,surgical time and patient recovery time was 93.9％ (46/49) vs 81.6％ (40/49) (x2 =2.645,P＜0.01),(45.2 ±7.2)min vs (51.4 ±6.4)min(P ＜0.05),(60.8±5.4) min vs (71.4 ± 6.7) min ( P ＜ 0.05 ),( 2.0 ± 2.1 ) d vs (4.9 ± 1.8) d ( P ＜ 0.05 ).Postoperative follow-up found that both groups of patients relapse rate was statistically significant( x2 =3.279,P ＜0.01 ).ConclusionTwo different surgical treatment of inguinal hernia,the tension-free hernia repair compared with the traditional hernia repair was more suitable for the body,surgery time and recovery time was short,reducing the relapse rate in patients with inguinal hernia,was an effective means of treatment.
ABSTRACT
ObjectiveTo evaluate results of the Lichtenstein tension-free mesh repair and summaraize the clinical experience in the treatment of the inguinal hernia. MethodsIn this retrospective study, 4011 tension-free inguinal hernia repairs were performed in 3631 patients, using a polypropylene mesh (Lichtenstein technique). Results The average hospitalization was 3.8 days, the overall complication rate was 2.4％, the recurrence rate was 0.1％. ConclusionThe Lichtenstein repair for the treatment of inguinal hernia has the advantage of less postoperative pain and low recurrence and is highly suitable for day case surgery.
ABSTRACT
PURPOSE: Tension-free open repair for inguinal hernia is a safe and popular operation with a high success rate, but laparoscopic techniques are fairly recent. Comparing the tension-free herniorrhaphy using mesh and plug (Perfix(R)) with laparoscopic totally extraperitoneal (TEP) hernia repair is the aim of this study. METHODS: We compared two groups of patients in which 39 patients with inguinal hernias were treated by tension-free repair using Perfix(R) (group P) and 39 patients were treated by laparoscopic TEP repair (group T). Information about operation time, length of hospital stay, use of analgesics (pain), recurrence, complications, cosmetic satisfaction, medical costs, and time until return to work were evaluated retrospectively. RESULTS: Mean operation time, postoperative hospital stay, and the time until return to work were 101+/-33 min, 1.9+/-1.0 days, 11+/-8 days in group T, 86+/-28 min, 2.0+/-0.8 days, 12+/-10 days in group P. Postoperative complications, medical costs and the cosmetic satisfaction were 20.5%, 821,048 won, 94% (32/24) in group T, 7.7%, 692,149 won, 79% (19/24) in group P. There was difference between the two groups but not significant statistically. Group P used more analgesics than group T, significantly (P<0.05). There was only 1 recurrence in group T. CONCLUSION: Although we need more experience in patients with inguinal hernias, laparoscopic TEP repair may be a secure and feasible procedure compared to tension-free repair using Perfix(R).
Subject(s)
Humans , Analgesics , Cosmetics , Follow-Up Studies , Hernia, Inguinal , Herniorrhaphy , Length of Stay , Postoperative Complications , Pyrazines , Recurrence , Retrospective Studies , Return to WorkABSTRACT
Objective To discuss the operation style of filling,film-style,three-dimensional double-layer mesh tension-free for hernia and the repair materials,the selectlon of surgical operation style for reducing recurrence.Methods We used the style of plug-and-chip,two-dimensional mesh tension-free hernia repair for the treatment of 130 cases of inguinal hernia patients.Results In 130 cases of patients with 1~5 years of follow-up,there was no recurrence.Conclusion A reasonable choice of repair materials and improving the surgical operation can be effective in reducing recurrence.