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Objective:To explore the application effects of modified laparoscopic total extraperitoneal hernia repair (TEP) and laparoscopic transabdominal preperitoneal hernia repair (TAPP) in inguinal hernia.Methods:One hundred and twenty-five patients with inguinal hernia in Yiwu Central Hospital from February 2017 to December 2019 were selected for retrospective study. They were divided into modified TEP group (63 cases) and TAPP group (62 cases). The modified TEP group was treated with modified TEP, and the TAPP group was treated with TAPP. The perioperative operation related indexes, serum oxidative stress indexes, 1-year recurrence rate and semen quality indexes were compared between the two groups.Results:The scores of visual analogue scale after operation for 24 h in the modified TEP group was lower than that in the TAPP group: (1.68 ± 0.39) scores vs. (1.97 ± 0.46) scores, P<0.05. After operation for 3 d, the levels of serum superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) in the modified TEP group were higher than those in the TAPP group: (92.79 ± 8.82) μmol/L vs. (84.40 ± 7.36) μmol/L, (81.52 ± 9.37) U/L vs. (75.75 ± 8.50) U/L; and the level of malondialdehyde (MDA) in the modified TEP group was lower than that in the TAPP group: (23.42 ± 3.3) μmol/L vs. (26.71 ± 3.92) μmol/L; the differences were statistically significant ( P<0.05). There was no significant difference in 1-year recurrence rate between the two groups ( P>0.05). One year after operation, the levels of acid phosphatase (ACP), fructose (FRU) and α- glucosidase (α- Glu) in the modified TEP group were higher than those in the TAPP group: (180.87 ± 20.15) kU/L vs. (159.85 ± 14.50) kU/L, (3.37 ± 0.84) g/L vs.(2.53 ± 0.67) g/L, (62.94 ± 6.25) kU/L vs. (43.96 ± 5.31) kU/L, the differences were statistically significant ( P<0.05). Conclusions:Both modified TEP and TAPP are effective methods for the treatment of inguinal hernia, but the former can reduce surgical trauma, recover quickly, and protect normal reproductive function.
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Introducción: La hernia inguinal, es una de las enfermedades quirúrgicas que más polémicas ha provocado a través de la historia, existen disimiles clasificaciones e incontables técnicas para su reparación. Objetivo: Mostrar los resultados del tratamiento quirúrgico laparoscópico de la hernia inguinal en el Centro Nacional de Cirugía de Mínimo Acceso. Métodos: Se realizó un estudio retrospectivo y descriptivo de 737 pacientes intervenidos con el diagnóstico de hernia inguinal por cirugía laparoscópica en el Centro Nacional de Cirugía de Mínimo Acceso, en el período comprendido entre enero del 2011 hasta diciembre el 2018. Resultados: Se mostró la efectividad de las técnicas laparoscópicas, con un bajo índice de recidiva, de 1,4 por ciento, bajo índice de conversión, con 0,5 por ciento, la inguinodinia se presentó en 5 pacientes para un 0,5 por ciento y predominó el seroma entre las complicaciones postoperatorias. Conclusiones: La cirugía laparoscópica en la hernia inguinal es una opción segura y eficaz en el tratamiento de la enfermedad(AU)
Introduction: Inguinal hernia has been one of the most controversial surgical diseases throughout history. There are several classifications and countless techniques for inguinal hernia repair. Objective: To show the outcomes of laparoscopic surgical treatment of inguinal hernia at the National Center for Minimal Access Surgery. Methods: A retrospective and descriptive study was carried out of 737 patients with a diagnosis of inguinal hernia operated on by laparoscopic surgery, in the period from January 2011 to December 2018, at the National Center for Minimal Access Surgery. Results: The effectiveness of laparoscopic techniques was shown, with a low recurrence rate of 1.4 percent and a low conversion rate of 0.5 percent, while inguinodynia appeared in five patients, accounting for 0.5 percent, and postoperative seroma was a predominating complication. Conclusions: Laparoscopic surgery is a safe and effective treatment option for in inguinal hernia(AU)
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Humans , Postoperative Complications , Laparoscopy/methods , Hernia, Inguinal/diagnosis , Effectiveness , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
Objective:To investigate the diagnosis and treatment of emergency inguinal hernia.Methods:The retrospective cross-sectional study was conducted. The clinical data of 236 patients with emergency inguinal hernia who were admitted to the First Affiliated Hospital of Soochow University from January 2015 to May 2020 were collected. There were 194 males and 42 females, aged (69±30)years. Hospitalized patients received routine blood biochemistry test and imaging examinations for evaluation of characteristics of hernia contents and intestinal obstruction. Manual reduction and surgical treatment were selected according to the conditions of patients. Observation indicators: (1) treatment; (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect hernia recurrence and late-onset mesh infection up to August 2020. Measurement data were described as M (range) or M ( P25, P75), and comparison between groups was analyzed using the Wilcoxon rank sum test. Count data were represented as absolute numbers, and comparison between groups was done using the chi-square test. Results:(1) Treatment: of the 236 patients, 106 cases had successful manual reduction, 124 cases underwent emergency operation, 6 cases refused surgery. ① For 106 cases with successful manual reduction (including 4 cases guided by B-ultrasonography), the manual reduction time was 5 minutes (2 minutes,7 minutes). Ninety-three of 106 patients underwent selective operation after manual reduction, including 89 cases with indirect hernia, 2 cases with direct hernia and 2 cases with compound hernia. The time to selective operation was 3 days(2 days,5 days) after manual reduction. Patients underwent mesh repair, of which the operation time, volume of intraoperative blood loss, time to postoperative first flatus, duration of postoperative hospital stay were 44 minutes (29 minutes, 66 minutes),10 mL(5 mL,20 mL), 1 day(1 day,2 days), 1 day(1 day,2 days), respectively. Eleven patients didn't undergo selective operation. Two patients with abdominal pain and fever after manual reduction were diagnosed with perforation of intestine by emergency surgical exploration, and then underwent partial intestinal resection combined with high ligation of hernial sac. ② There were 93 of 124 patients undergoing emergency operation with indirect hernia, 18 cases with femoral hernia, 6 cases with obturator hernia, 6 cases with compound hernia and 1 case with direct hernia. There were 54 of 124 patients undergoing open operation, including 21 cases with Bassini surgery, 18 cases with Lichtenstein surgery, 9 cases with Mc Vay surgery, 6 cases with high ligation of hernia sac. There were 70 patients undergoing laparoscopic operation, including 57 cases with laparoscopic transperitoneal preperitoneal hernia repair (TAPP), 10 cases with laparoscopic explora-tion + tissue repair and 3 cases with laparoscopic exploration + closure of inner inguinal ring. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, cases with short-term postoperative complications were 60 minutes (50 minutes,76 minutes), 20 mL(14 mL,30 mL), 2 days(1 day,2 days), 15 cases for patients undergoing open surgery, respectively. The above indicators were 56 minutes (47 minutes,77 minutes), 20 mL(10 mL,25 mL), 2 days(1 day,2 days), 21 cases for patients under-going laparoscopic surgery. There was no significant difference in the above indicators between the two groups ( Z=?0.88, ?1.37, ?1.56, χ2=0.07, P>0.05). Cases with intraoperative placement of mesh and duration of hospital stay were 18 cases and 5 days(3 days,8 days) for patients undergoing open surgery, versus 57 cases and 3 days(2 days,5 days) for patients undergoing laparoscopic surgery, showing significant differences between the two groups ( χ2=29.50, Z=?4.32, P<0.05). (2) Follow-up: of 236 patients, 192 were followed up for 2?60 months, with a median follow-up time of 19 months. Seven patients had recurrence of hernia after emergency operation, including 3 with high ligation of the hernia sac, 2 with Bassini surgery, 1 with Lichtenstein surgery, and 1 with laparoscopic exploration + closure of inner inguinal ring. One patient with late-onset mesh infection after Lichtenstein surgery was improved after mesh removal. No long-term complications such as hernia recurrence or late-onset mesh infection occurred to the 184 patients. Conclusions:Emergency inguinal hernia had different state of illness, manual reduction is suitable for partial patients with incarceration. Surgery is the first choice, and the surgical procedure needs to be individually selected.
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An urachal cyst anomaly occurs in approximately 1/5,000 births. Its treatment is surgical excision. We present a case report of 16-year-old female with presenting complaints of lower abdominal pain with burning micturition and increased urinary frequency. Computed tomography revealed a 40×38 mm low-density cyst image located in midline cranial to the bladder apex, suggesting the diagnosis of urachal cyst. Traditional open surgery was used for its excision, but now minimally invasive approaches have been used more frequently to minimize the morbidity. We did a trans-abdominal preperitoneal approach, which aided in both the purpose of diagnostic laparoscopy and also utilize the advantage of preperitoneal surgery.
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Background: Chronic groin pain (inguinodynia) following inguinal hernia repair is a significant, though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However, moderate to severe pain persisting more than 3 months after inguinal herniorrhaphy should be considered as pathological. The main aim of this study was to assess the incidence of inguinodynia in inguinal hernia repair patients at a tertiary centre.Methods: This non-randomized retrospective study was undertaken in the department of general surgery, SMIMER Hospital, Surat, Gujarat, India from August 2016 to July 2019. Total 940 patients were operated for inguinal hernia repair during this period. Out of these 940 patients, only 460 patients could be traced for clinical evaluation as Surat is an industrial city with very high percentage of migrant population and so only, they were included in the study.Results: In this study, total 460 patients were included, in which 310 patients were operated for open inguinal hernia repair and 150 patients were operated for laparoscopic hernia repair. Total 102 (22.17%) patients has developed inguinodynia out of 460 patients evaluated in this series. Incidence of inguinodynia is more in open inguinal hernia repair than laparoscopic inguinal hernia repair i.e., 24.83% versus 16.67%. Incidence of testicular complication in inguinodynia patients is more in open inguinal hernia repair and non in laparoscopic repair.Conclusions: Authors conclude that overall incidence of inguinodynia is 22.17% and incidence of inguinodynia is higher in open hernia repair in comparison to laparoscopic hernia repair (24.83% versus 16.67%). The incidence of mild inguinodynia is approximately eight times more common than severe inguinodynia.
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Background: Hernia is a common problem of the modern world with an incidence ranging from 5 to 7%. Of all groin hernias, around 75% are inguinal hernias. Recently with the advancement in laparoscopy, endoscopic repairs seem to offer better quality of life, decreasing hospital stay and early return to work. Aim of the work was to evaluate a new technique for mesh fixation by Zein method of suturing and compare it with stapled mesh fixation in laparoscopic inguinal hernia repair transabdominal preperitoneal approach.Methods: The study is a randomized, prospective single group study. The study was conducted after the approval of the ethical committee of the surgical department, Menoufia University. It was conducted in Menoufia University Hospital on 50 patients with inguinal hernia who were operated upon between September 2018 and September 2019 with a minimal follow-up of 6 months.Results: Age of studied patients ranged from 27 to 55 years with mean 42.82±7.90 age/years. Regarding sex of studied patients, more than half (74%) of studied patients were males and (26%) were females. Regarding comparsion between high and low overall cost burden on the patient, it was interestingly found that high cost is associated with presence of complication like hematoma, prolonged stay in the hospital and prolonged use of antibiotics.Conclusions: Both the use of sutures and fixation of mesh by absorbable tacks approaches are similarly effective in terms of operative time, the incidence of recurrence, complications, and chronic pain coinciding with all the available literature.
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Background: An important part of the procedures for admission to emergency surgery is incarcerated inguinal hernia repair. Minimally invasive surgical procedures have led surgeons to perform these operations laparoscopically. The aim of this study was to demonstrate the safety of laparoscopic inguinal hernia repair in patients admitted to the emergency department with incarcerated inguinal hernia.Methods: The files of patients who underwent laparoscopic surgery for incarcerated inguinal hernia between January 2015 and June 2019 in Bandirma State Hospital General Surgery Clinic was retrospectively reviewed. Pearson Chi-Square test was used as statistical method. Version 18 of the SPSS program was used. P<0.05 was considered significant as it should be.Results: A total of 63 patients were included in the study. The mean age was 52.8 years. A total of 64 repairs were performed on the right side in 41 (65%) cases, on the left side in 21 (33.3%) cases and on both sides in one (1.58%) case. Four (6.25%) of 63 patients had strangulation. Three of these patients (4.68%) had strangulated hernia, and one (1.56%) had strangulated and incarcerated hernia. Four patients (6.25%) presented with ileus. The mean operation time was 65 minutes (35-110 minutes). Mean duration of hospitalization was 2.4 days. The rate of minor complications was 4.68%. Only one (1.56%) major complication was iatrogenic small intestinal perforation. The mean follow-up time was 25.2 months. There was no early recurrence in patients.Conclusions: We suggest that laparoscopic transabdominal preperitoneal hernia repair can be performed safely in emergency procedures in patients with incarcerated inguinal hernia.
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Background: Inguinal mesh hernioplasty is one of the common procedures performed all over the world. It can be done either through open or laparoscopic techniques. The aim of this study was to compare the outcomes of Lichtenstein tension free hernioplasty versus laparoscopic transabdominal pre-peritoneal (TAPP) mesh repair considering, duration of the surgery, hospital stay, and duration to resume normal activity, degree of postoperative pain, wound infection, recurrence and complications.Methods: Adult patients presented to the general surgical OPD, with the diagnosis of inguinal hernia underwent either Lichtenstein repair or laparoscopic repair by TAPP.Results: Patients in Group A (open-repair) had significantly greater level of local pain during rest and during routine activities than those within Group B (laparoscopic group) during the postoperative period assessed on the visual-analogue scale. Mean operative time for open hernia repair was 43.7 minutes and for laparoscopic hernia repair was 59.03 minutes and the difference were statistically significant (p=0.0001). The mean duration of hospital stay for open hernia repair was 2.16 days and that for laparoscopic hernia repair was 1.08 days with a (p=0.00001) which was statistically significant. The time to resume routine activities was much shorter among Group B patients than patients in Group A. Only one recurrence (3.3%) was seen in Group B after 6 months follow up.Conclusions: It is concluded that laparoscopic TAPP repair of inguinal hernia in adults is safe and preferred operation as compared to open inguinal hernia repair.
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Background: Transabdominal pre-peritoneal repair is a wellaccepted method of inguinal hernia repair involving bothoptions of fixation or non-fixation of mesh. Objective was toanalyse the comparison between mesh fixation versus nomesh fixation in laparoscopic inguinal hernia repair– TAPP, interms of: operative time, post-operative pain, length of hospitalstay and recurrence.Materials and Methods: This prospective randomised studywas conducted on a sample of 30 male patients whounderwent TAPP inguinal hernia repair. 15 of these underwentfixation and the remaining 15 with non-fixation of mesh.Results: Mesh fixation increases postoperative pain andoperative time. No difference observed in terms of hospital staybetween the 2 groups. Fixation doesn’t prevent recurrence.Conclusion: Mesh non -fixation can be utilised as a safe andeffective approach in TAPP hernia repair.
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Objective To investigate the effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) on postoperative seroma.Methods The prospective study was conducted.The clinical data of 128 male patients with primary indirect inguinal hernia who were admitted to Fujian Medical University Union Hospital from October 2017 to March 2019 were selected.Patients were divided into two groups by random number method.Patients in experimental group had hernia sac stump sutured and fixed at the lower margin of rectus abdominis after transection of hernia sac in TAPP,and patients in control group had hernia sac stump free in the abdominal cavity after dissection and transection of hernia sac in TAPP.Observation indicators:(1) surgical situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was conducted to detect the incidence of postoperative seroma,incision infection,chronic pain,and hernia recurrence up to June 2019.Measurement data with normal distribution were represented as Mean ±SD,and comparison between groups was done using the t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was done using the Mann-Whitney U test.Count data were described as absolute numbers and percentages,and comparison between groups was analyzed using the chisquare test.Results A total of 128 male patients were screened for eligibility,including 60 patients in the experimental group and 68 patients in the control group.The 128 patients were aged from 47 to 74 years,with an average age of 61 years.(1) Surgical situations:operation time and hospital expenses were (102±34) minutes and (12 813±2 390)yuan for the experimental group,and (97±30)minutes and (12 125±2 205)yuan for the control group,respectively,showing no significant difference between the two groups (t=0.907,1.685,P＞0.05).(2) Follow-up:all the 128 patients received follow-up.There were 8 cases of seroma in both the experimental group and the control group,with no significant difference between the two groups (x2 =0.072,P＞0.05).The extraction volume of patients with seroma was 20 mL (range,4-31 mL) in the experimental group,and 43 mL (range,23-98 mL) in the control group,showing a significant difference between the two groups (Z=-2.013,P＜0.05).There was no incision infection,chronic pain or hernia recurrence in 3 months after operation in patients with seroma of either experimental group or control group.Conclusions During TAPP,suture and fixation of the hernia sac stump to the lower edge of rectus abdominis and free hernia sac stump in the abdominal cavity after dissection and transection of hernia sac can effectively repair indirect inguinal hernia.The former method can reduce the extraction volume of seroma after operation.
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Objective@#To investigate the effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) on postoperative seroma.@*Methods@#The prospective study was conducted. The clinical data of 128 male patients with primary indirect inguinal hernia who were admitted to Fujian Medical University Union Hospital from October 2017 to March 2019 were selected. Patients were divided into two groups by random number method. Patients in experimental group had hernia sac stump sutured and fixed at the lower margin of rectus abdominis after transection of hernia sac in TAPP, and patients in control group had hernia sac stump free in the abdominal cavity after dissection and transection of hernia sac in TAPP. Observation indicators: (1) surgical situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect the incidence of postoperative seroma, incision infection, chronic pain, and hernia recurrence up to June 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test.@*Results@#A total of 128 male patients were screened for eligibility, including 60 patients in the experimental group and 68 patients in the control group. The 128 patients were aged from 47 to 74 years, with an average age of 61 years. (1) Surgical situations: operation time and hospital expenses were (102±34)minutes and (12 813±2 390)yuan for the experimental group, and (97±30)minutes and (12 125±2 205)yuan for the control group, respectively, showing no significant difference between the two groups (t=0.907, 1.685, P>0.05). (2) Follow-up: all the 128 patients received follow-up. There were 8 cases of seroma in both the experimental group and the control group, with no significant difference between the two groups (χ2=0.072, P>0.05). The extraction volume of patients with seroma was 20 mL (range, 4-31 mL) in the experimental group, and 43 mL (range, 23-98 mL) in the control group, showing a significant difference between the two groups (Z=-2.013, P<0.05). There was no incision infection, chronic pain or hernia recurrence in 3 months after operation in patients with seroma of either experimental group or control group.@*Conclusions@#During TAPP, suture and fixation of the hernia sac stump to the lower edge of rectus abdominis and free hernia sac stump in the abdominal cavity after dissection and transection of hernia sac can effectively repair indirect inguinal hernia. The former method can reduce the extraction volume of seroma after operation.
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Objective@#To study the efficacy of relieving the postoperation pain by using mesh to stuture and fixate tissue during transabdominal preperitoneal hernioplasty (TAPP) in inguinal hernia patients.@*Metholds@#A retrospective analysis of 156 patients with inguinal hernia who underwent TAPP in Nanhai Hospital Affiliated to Southern Medical University from January 2016 to January 2017 was conducted, they were males, the average age was 50.84 years and the age range was from 33 to 62 years. Patients were divided into sacral nail group (n=120) and absorbable line group (n=36) according to the different methods of fixation of the iliac crest. Among them, the patients in the sacral nail group were fixed with iliac screws, and the patients in the absorbable line group were sutured with absorbable sutures. Pain visual analog scale (VAS) was used to compare the extent of postoperative pain in both groups. After the operation, through the outpatient review and telephone follow-up for 1 year, observed the recurrence of inguinal hernia in both groups. Measurement data were expressed as mean ± standard deviation (Mean±SD), t-test was used for comparison between groups; the Chi-square test was used to compare the count data between the two groups.@*Results@#Among them, 19 patients with moderate pain after operation in the nail group had an incidence of 15.8%. Two patients with moderate pain in the absorbable line group had an incidence of 5.6%. The difference between the two groups was statistically significant (χ2=2.511, P=0.013). The pain VAS of the patients in the sacral nail group was (3.08±1.36), and the absorbable line group was (2.50±0.91), the difference between the two groups was statistically significant (t=2.973, P=0.001). All patients had no recurrence after outpatient review and telephone follow-up for 1 year.@*Conclusion@#In TAPP, the application of absorbable suture fixed patch can effectively reduce postoperative pain.
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Objective To study the efficacy of relieving the postoperation pain by using mesh to stuture and fixate tissue during transabdominal preperitoneal hernioplasty (TAPP) in inguinal hernia patients.Metholds A retrospective analysis of 156 patients with inguinal hernia who underwent TAPP in Nanhai Hospital Affiliated to Southern Medical University from January 2016 to January 2017 was conducted,they were males,the average age was 50.84 years and the age range was from 33 to 62 years.Patients were divided into sacral nail group (n =120) and absorbable line group (n =36) according to the different methods of fixation of the iliac crest.Among them,the patients in the sacral nail group were fixed with iliac screws,and the patients in the absorbable line group were sutured with absorbable sutures.Pain visual analog scale (VAS) was used to compare the extent of postoperative pain in both groups.After the operation,through the outpatient review and telephone follow-up for 1 year,observed the recurrence of inguinal hernia in both groups.Measurement data were expressed as mean ± standard deviation (Mean ±-SD),t-test was used for comparison between groups;the Chi-square test was used to compare the count data between the two groups.Results Among them,19 patients with moderate pain after operation in the nail group had an incidence of 15.8％.Two patients with moderate pain in the absorbable line group had an incidence of 5.6％.The difference between the two groups was statistically significant (x2 =2.511,P =0.013).The pain VAS of the patients in the sacral nail group was (3.08-± 1.36),and the absorbable line group was (2.50 ±0.91),the difference between the two groups was statistically significant (t =2.973,P =0.001).All patients had no recurrence after outpatient review and telephone follow-up for 1 year.Conclusion In TAPP,the application of absorbable suture fixed patch can effectively reduce postoperative pain.
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Objective To study clinical effect after laparoscopic abdominal preperitoneal inguinal hernia repair methodwithout stapler. Methods 80 cases of inguinal hernia(hospitalized from February 2015 to January 2017)were divided into two groups according to the random number table method ,with 40 patients in each group. Traditional laparoscopic peritoneal inguinal hernia repair method was applied in the control group. Free stapler group received free stapler laparoscopic preperitoneal inguinal hernia repair treatment method. Operation time , amount of bleeding during surgery , the average hospitalization time after operation , the total cost of hospitalization,postoperative pain score,postoperative recovery activities time,patients′satisfaction,operation effusion after operation occurred scrotal hematoma and other complications were comparedbetween the two groups of patients. Results In free stapler group,patients′ satisfaction rate was significantly higher than the control group (P 0.05). Conclusion Operation time and amount of bleeding were similar between traditional laparoscopic transabdominal preperitoneal inguinal hernia repair method and free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair.Clinical effect of free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair proves to be effective with less complications ,less pain, faster postoperative recovery, and can reduce the cost of treatment.Free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair has satisfactory cosmetic results and was well received by patients,worthy of promotion.
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Objective To explore the clinical efficacy of laparoscopic transabdominal preperitoneal (TAPP) hernia repair and risk factors affecting postoperative complications.Methods The retrospective casecontrol study was conducted.The clinical data of 595 patients who received laparoscopic TAPP hernia repair in the First Affiliated Hospital of Soochow University from February 2008 to August 2016 was collected.Operations were performed by the same doctors' team.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up situations;(4) risk factors affecting complications after laparoscopic TAPP hernia repair.Follow-up using outpatient examination and telephone interview was performed to detect the recovery time of non-restricted activity,postoperative complications and hernia recurrence up to February 2017.Measurement data with normal distribution were represented as (x)±s.The univariate analysis and multivariate analysis were done using the chi-square test and Logistic regression model.Results (1) Surgical situations:595 patients underwent laparoscopic TAPP hernia repair using the heavy meshes.Overall operation time and overall volume of blood loss were (55±25) minutes and (7±5)mL,including operation time of (50±20)minutes in 502 unilateral hernias and operation time of (81 ± 29)minutes in 93 bilateral hernias.Of 595 patients,34 had incarcerated hernia,the contents of hernia:greater omentum,small intestine and sigmoid colon were detected in 21,11 and 2 patients,respectively,with an incarcerated time of 2-21 hours;4 with incarcerated hernia induced small intestinal necrosis received laparoscopy-assisted small intestinal resection ± anastomosis,1 with sigmoid colon necrosis received necrotic sigmoid canal resection ± sigmoidostomy and 29 received repair after the contents restoration of hernia.Operation time and volume of intraoperative blood loss in 34 patients with incarcerated hernia were (84 ± 39)minutes and (12±6) mL.Thirteen of 595 patients (10 with indirect hernia and 3 with direct hernia) had recurrent hernia,and operation time and volume of intraoperative blood loss were (75±-26)minutes and (10± 5)mL.(2) Postoperative situations:time to initial exsufflation of 595 patients was (19± 12)hours.Of 595 patients,590 took fluid diet at 6 hours postoperatively and 5 undergoing enterectomy took fluid diet at 24 hours postoperatively.The pain score at 1 day postoperatively and duration of hospital stay were respectively 2.5± 1.4 and (2.1± 1.9)days.(3) Follow-up situations:of 595 patients,593 recovered non-restricted activity at 2 weeks postoperatively and 2 didn't recover non-restricted activity at 2 weeks postoperatively.Of 595 patients,542 were followed up for 6-60 months,with a median time of 31 months.Fifty-seven,25,13 and 1 patients were respectively complicated with seroma,surgical pain,urinary retention and enteroparalysis,they were improved by symptomatic treatment,and the same patient can have multiple complications.There were no severe complications which needed surgical intervention,such as vascular injury,damnify of intestinal canal and poke hole hernia.Of 2 patients with recurrence of hernia,1 with right indirect hernia had recurrence of direct hernia and then received Lichtenstein tension-free hernia repair,and 1 received treatment in other hospital.(4) Risk factors affecting complications after laparoscopic TAPP hernia repair:results of univariate analysis showed that age,diameter of hernia sac,incarcerated hernia,recurrent hernia,operation time and volume of intraoperative blood loss were related factors affecting complications after laparoscopic TAPP hernia repair (x2 =6.657,55.296,44.305,5.253,117.461,100.722,P＜0.05).Results of multivariate analysis showed that diameter of hernia sac ≥ 4 cm,incarcerated hernia,operation time ≥ 100 minutes and volume of intraoperative blood loss ≥ 10 mL were independent risk factors affecting complications after laparoscopic TAPP hernia repair (OR =3.610,11.315,12.401,7.346,95％ confidence interval:2.009-6.486,3.579-35.772,5.408-28.437,3.739-14.434,P＜ 0.05).Conclusion Laparoscopic TAPP approach for inguinal hernia is safe and effective,and diameter of hernia sac ≥4 cm,incarcerated hernia,operation time ≥ 100 minutes and volume of intraoperative blood loss ≥ 10 mL are independent risk factors affecting complications after laparoscopic TAPP hernia repair.
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There is a longer learning curve in laparoscopic transabdominal preperitoneal inguinal hernia repair.Improvements of surgical procedures and skills can effectively shorten the learning curve.The experiences and operative skills that were summarized by the author can shorten the operation time and simplify the operation procedures,therefore will shorten the learning curve of laparoscopic hernia repair.
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Objective To compare the efficacy and safety of transabdominal preperitoneal prosthetic and lichtenstein operation for treating recurrent inguinal hernia.Methods In this study,116 patients with recurrent inguinal hernia treated in First People's Hospital of Xianyang from June 2012 to June 2016 were divided into transabdominal preperitoneal prosthetic group (n =58) and Lichtenstein group (n =58) according to the operation method.The operation time,hospitalization time,postoperative exhaust time and postoperative temperature and cost were compared between two groups.Postoperative complications including wound infection,urinary retention,visceral injury,and foreign body sensation in groin area were recorded.Results Lichtenstein group had significantly higher operative time,hospital stay,postoperative exhaust time and postoperative temperature than those in transabdominal preperitoneal prosthetic group [(55.4 ± 9.6) min and (41.5 ± 5.2) min;(4.15 ± 1.08) d and(2.66±0.43) d;(0.82 ±0.40) d and (0.45±0.21) d;(38.1 ±0.9) ℃ and (37.2±0.6) ℃ respectively],but the cost of lichtenstein group [(3 110 ± 614) yuan] was lower than that of transabdominal preperitoneal prosthetic group [(4 586 ± 925) yuan],with the statistically significant differenc (P ＜ 0.05).Conclusions Transabdominal preperitoneal prosthetic has better clinical outcome and safety for treating recurrent inguinal hernia,compared to litchtenstein operation.Therefore,transabdominal preperitoneal prosthetic surgery is a clinical treatment worthy listening.
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Background: The occurrence of groin hernias is so common that the overall lifetime risk of developing one is 15% in male and about 5% in female. The most significant advances to impact inguinal hernia repair have been the addition of prosthetic materials to conventional repair and the introduction of laparoscopy to general surgical procedures. Materials and Methods: A total of 100 consecutive consenting cases who presented with a primary diagnosis of uncomplicated inguinal hernia to the Department of General Surgery at Father Muller Medical College Hospital from the period December 2013 to January 2016. Following a detailed history and clinical diagnosis a provisional diagnosis was made and the investigations. The following details regarding the patient were collected age of the patient, symptoms, and their duration, treatment given, complications if any, duration of hospital stay, and duration of return to work. Results: In our study, the mean age was 47.43 years and the most common age group when hernia occurred was 35-54 years with 54% of the cases. 97% were males and 3% females. Swelling was the most common presenting. Most hernias 43% occurred on the right side, followed by 18% on the left and 39% had bilateral involvement. The duration of surgery in the totally extraperitoneal (TEP) group the mean duration was 47.60 min the transabdominal preperitoneal (TAPP) group the mean duration was 48.90 min. The only post-operative complication occurred in our study was urinary retention. Conclusion: There is statistically significant difference between the two groups, namely, TEP and TAPP with respect to the duration of surgery and resuming routine activity postoperatively. The only finding of significance is the post-operative complication was urinary retention; this is not a major one, and this contributed an increase in the post-operative hospital stay being increased in the TEP group than the TAPP group with a two-tailed P = 0.
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Objective To investigate the security and validity of transabdominal preperitoneal prosthetic (TAPP) in treatment of incarcerated hernia.Methods One hundred and twenty-four patients with incarcerated hernia were divided into 2 groups by random pair method:observation group with treatment of laparoscopic reposition and TAPP (56 cases) and control group with treatment of open reduction and tension-free hernioplasty (68 cases).The operative time,hospital stay,bed time,hospital costs,recurrence rate and complication were compared between the 2 groups.Results All patients in observation group were received laparoscopic surgery successfully.The operation time,hospital stay,bed time in observation group were significandy shorter than those in control group [(37.52 ± 7.78) min vs.(44.23 ± 11.32) min,(4.53 ± 0.89) d vs.(6.85 ± 2.03) d,(9.30 ± 2.65) h vs.(12.63 ± 3.97) h],there were statistical differences (P ＜0.05).The hospital costs in observation group was significandy higher than that in control group [(9 324 ± 599) yuan vs.(7 203 ± 507) yuan],there was statistical difference (P ＜ 0.05).There was no statistical difference in complication rate between the 2 groups (P ＞ 0.05).Follow-up 1 year,there was no recurrence patient in observation group and 1 patient was recurrence in control group,there was no statistical difference between the 2 groups (P ＞ 0.05).Conclusions TAPP is safe and effective with advantages of mini-invasion,quicker recovery but more hospital costs in treatment of incarcerated hernia.The recurrence rate of TAPP is similar to tension-free hernioplasty.
ABSTRACT
Objective To evaluate the clinical outcomes of different stages of transabdominal preperitoneal hernia repair (TAPP) and open hernia repair surgery (Rutkow) in treating adult inguinal hernia.Methods The clinical data of patients with inguinal hernia undergoing hernia repair(TAPP,TAPP Ⅰ group:56 patients administered TAPP during January 2003 to December 2005 ; TAPP Ⅱ group:76 patients administered TAPP during January to December 2010) and Rutkow hernia-ring filling (Rutkow group:78 patients administered Rutkow during January 2003 and December 2005) were analyzed retrospectively.Clinical indexes and effective indicators were observed to compare the treatment effects of the operation procedures,including duration of surgery,post-operation hospital stay,post-operation leaving bed time,post-operation free activity time,hospitalization costs,time of beginning taking food,and complications.Results The TAPP Ⅱ group had significantly shorter average length of stay,time of beginning taking food,post-operation leaving bed time and post-operation free activity time than the other two groups (average length of stay:(2.6 ± 1.6) d vs.(4.1 ±2.6) d vs.(4.2 ± 1.9) d; time of beginning taking food:(8.6 ± 3.1) h vs.(22.2 ± 3.8) h vs.(20.7 ± 3.2)h;post-operation leaving bed time:(4.6 ±2.2) h vs.(18.3 ±2.3) h vs (20.5 ±3.1) h;Post-operation free activity time:(8.6 ± 2.9) d vs.(15.2 ± 3.3) d vs.(17.1 ± 3.8) d ; P ＜ 0.05).There were no significant differences between TAPP Ⅰ and Rutkow groups on average length of stay,time of beginning taking food,postoperation leaving bed time and post-operation free activity time (P ＞ 0.05).TAPP Ⅰ group had significantly longer duration of operation than the other two groups ((113.3 ± 18.6) min vs.(50.4 ± 11.8) min vs.(48.6 ± 12.1) min,P ＜ 0.05).There was no difference on surgery duration between Rutkow and TAPP Ⅱ groups (P ＞ 0.05).No difference was observed regarding rates of postoperative complications and recurrence (P ＞ 0.05).Conclusion With the advancement of technology,TAPP shows more advantages compared to traditional herniorrhaphy,such as minimal trauma,fewer complications and shorter duration of operation and lower recurrence rate.TAPP is an excellent hernia repair for inguinal hernia.