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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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Objective:To explore the influencing factors of seroma after transabdominal preperitoneal prosthetic (TAPP) inguinal hernia by laparoscopy.Methods:A retrospective cohort study was used to analyze the clinical data of 320 patients with inguinal hernia who received TAPP in Fuyang Fifth People′s Hospital from December 2019 to December 2022, including 226 males and 94 females, with an average age of (61.46±10.22) years (range: 23-76 years). Patients were divided into seroma group ( n=18) and non-seroma group ( n=302) according to whether seroma occurred after surgery. Multivariate Logistic analysis was used to screen the influencing factors of seroma after TAPP tension-free repair, and based on Softmax strategy, the artificial neural network model was constructed with binary classification variables survival 0 (no outcome event occurred) and 1 (outcome event occurred) as outcome variables. receiver operating characteristics (ROC) and cumulative gain graph were used to analyze the model differentiation and application value. The measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and independent sample t-test was used for comparison between groups. Chi-square test was used for comparison between count data groups. Results:The incidence of postoperative seroma in 320 patients was 5.63% (18/320), including 7 cases of type Ⅰ, 4 cases of type Ⅱ, and 7 cases of type Ⅲ, all of which were improved after symptomatic treatment. Combined with underlying diseases, anticoagulant drugs, duration of disease, operation time, intraoperative blood loss, hernia sac diameter, mesh fixation method, neutrophil to lymphocyte ratio (NLR) were factors influencing seroma ofter TAPP in inguinal hernia patients ( OR=1.732, 2.414, 2.346, 1.480, 2.159, 1.725, 1.248, 2.179; 95% CI: 1.385-2.942, 1.764-3.176, 1.280-3.209, 1.263-2.275, 1.331-2.861, 1.308-2.239, 1.005-1.764, 1.644-2.982; P<0.05). The ROC curve and cumulative gain graph showed that the artificial neural network model could well predict the probability of postoperative seroma. Conclusions:The occurrence of seroma after TAPP tension-free repair in inguinal hernia patients is related to underlying diseases, taking anticoagulant drugs, course of disease, operation time, intraoperative blood loss, diameter of hernia sac, patch fixation method, NLR and many other factors. Clinical attention should be paid to these problems to reduce the incidence of postoperative seroma.
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INTRODUCTION@#The superiority of laparoscopic repair over open repair of incisional hernias (IHs) in the elective setting is still controversial. Our study aimed to compare the postoperative outcomes of laparoscopic and open elective IH repair in an Asian population.@*METHODS@#This retrospective study was conducted in an acute general hospital in Singapore between 2010 and 2015. Inclusion criteria were IH repair in an elective setting, IHs with diameter of 3-15 cm, and location at the ventral abdominal wall. We excluded patients who underwent emergency repair, had recurrent hernias or had loss of abdominal wall domain (i.e. hernia sac containing more than 30% of abdominal contents or any solid organs). Postoperative outcomes within a year such as recurrence, pain, infection, haematoma and seroma formation were compared between the two groups.@*RESULTS@#There were 174 eligible patients. The majority were elderly Chinese women who were overweight. Open repair was performed in 49.4% of patients, while 50.6% underwent laparoscopic repair. The mean operation time for open repair was 116 minutes (116 ± 60.6 minutes) and 139 minutes (136 ± 64.1 minutes) for laparoscopic repair (P = 0.079). Within a year after open repair, postoperative wound infection occurred in 15.1% of the patients in the open repair group compared to 1.1% in the laparoscopic group (P = 0.0007). Postoperative pain, recurrence and haematoma/seroma formation were comparable.@*CONCLUSION@#Elective laparoscopic IH repair has comparable outcomes with open repair and may offer the advantage of reduced postoperative wound infection rates.
Subject(s)
Humans , Female , Aged , Incisional Hernia/surgery , Surgical Wound Infection/epidemiology , Retrospective Studies , Seroma/surgery , Herniorrhaphy/adverse effects , Surgical Mesh , Recurrence , Hernia, Ventral/surgery , Laparoscopy/adverse effects , Postoperative Complications/surgeryABSTRACT
Objective:To investigate the clinical result of biological mesh and synthetic mesh in the repair of hiatal hernia.Methods:a prospective cohort study was conducted to collect and analyze the clinical data of 60 patients with hiatal hernia who were treated at Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University from May 2019 to Jan 2020. Intraoperative blood loss, hospital stay, clinical symptoms (heartburn, acid regurgitation, belching, early satiety, chest pain), VAS score, postoperative recurrence rate and complications were evaluated.Results:There was no significant difference in the overall repair effect between biological mesh group and synthetic mesh group ( P>0.05). All of the 60 patients underwent successful laparoscopic hiatal hernia repair and fundoplication. There were no massive bleeding caused by organ or vascular injury, and no peri-operative death. No recurrence of hiatal hernia, massive hemorrhage, pneumothorax, pleural effusion, gastrointestinal fistula, mediastinal infection or abscess were found during the follow-up of 6 months. Conclusion:There is no significant difference in short-term clinical effect between the use of biological mesh and synthetic mesh after hiatal hernia repair.
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Mesh-related visceral complications caused by mesh erosion after tension-free inguinal hernia repair are one kind of rare long-term complications, but they are easily neglected. Interval time from initial hernia repair to mesh-related visceral complications by preperitoneal and laparoscopic repair is short. Rutkow and transabdominal preperitoneal repair have the highest reported rate. Lichtenstein has the longest interval time and the lowest reported rate. The most frequently eroded organs are sigmoid colon, bladder and small intestine. The common clinical manifestations of sigmoid colon erosion are hematochezia, abdominal wall fistula and colitis, hematuria and recurrent urinary tract infection in bladder erosion cases, intestinal obstruction and abdominal wall fistula in intestinal erosion case, sigmoid-bladder fistula and intestinal-bladder fistula in multiple organ erosion cases. Resection or repair of corresponding organs with mesh removal have good efficacies in most patients. The authors summarize and analyze researches on mesh-related visceral complications after tension-free inguinal hernia repair from 1994 to 2021, review their advances, in order to raise awareness of such complications in clinicians.
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Abdominal incisional hernia is caused by poor healing of myofascial layer of abdominal wall and abdominal visceral organs protruding through the defect after abdominal surgery. The incidence of abdominal incisional hernia is 5.0%?20.0%, even higher after hepato-biliary and pancreatic surgery. Although great progress has been made in the methods of abdominal incision closure, hernia repair technology and materials, the overall incidence, repair effect and prognosis of abdominal incisional hernia are still not significantly improved. The incisional hernias after hepatobiliary and pancreatic surgery are relatively more complex, and the difficult problems of surgical repair are more prominent, including effectively controlling basic diseases, choosing a better surgical method, reasonably using a variety of abdominal wall defect closure and reconstruction techniques, and reducing the risk of postoperative complications. Relevant guidelines for abdominal incisional hernia repair and abdominal closure have been issued and updated all over the world. In order to improve the treatment of incisional hernia after hepatobiliary and pancreatic surgery and improve the prognosis of patients, the authors summarize the difficulties and new progress in the repair of incisional hernia after hepatobiliary and pancreatic surgery.
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Inguinal hernia is a common surgical disease, and most patients need surgical treatment. In recent years, minimally invasive surgery based on laparoscopy has been popularized in hernia surgery. With the release of clinical guidelines, the progress of instruments and materials, the update of treatment concepts and anatomical knowledge, laparoscopic inguinal hernia repair, especially laparoscopic total extraperitoneal hernia repair (TEP), is developing towards a more accurate and minimally invasive direction. Based on literatures in recent years and combined with clinical practice, the authors explore the advances in clinical application of laparoscopic TEP.
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Objective:To explore the risk factors of chronic postoperative inguinal pain for laparoscopic trans-abdominal preperitoneal hernia repair and establish a nomogram prediction model for it.Methods:The clinical data of 576 patients who underwent laparoscopic trans-abdominal preperitoneal hernia repair for inguinal pain at the First Hospital of Lanzhou University from January 2015 to December 2020 were analyzed retrospectively. According to different postoperative outcomes, patients were divided into chronic pain group ( n=54) and non-chronic pain group ( n=522), compared two groups of patients in the material, including gender, age, BMI, smoking history, history of drinking, hypertension, diabetes, chronic bronchitis, abdominal surgery history, history of inguinal hernia, hernia type, the hernial sac size, prophylactic use of antibiotics, VAS score, mesh fixation techniques, operation time, length of stay. Measurement data with normal distribution were expressed as ( ± s) and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M( Q1, Q3), and the Mann-Whitney U test was used for comparision between groups. Chi-square test was used to compare the measurement data of counting data.Multivariate logistic regression was used to analyze the independent risk factors for chronic postoperative inguinal pain. R software was used to establish the drawing of the nomogram prediction model, and the consistency index, calibration chart and area under the receiver operating characteristic curve was used to evaluate the predictive ability of the nomogram prediction model. Results:According to the results of the Logistic regression analysis, age≤45 years ( OR=2.202, 95% CI: 1.080-4.491), BMI≥24 kg/m 2 ( OR=2.231, 95% CI: 1.204-4.134), hernial sac≤5 cm ( OR=2.623, 95% CI: 1.309-5.257), recurrent hernia ( OR=2.769, 95% CI: 1.118-6.860), preoperative pain ( OR=4.121, 95% CI: 2.004-8.476), suture fixation ( OR=2.204, 95% CI: 1.151-4.219)and Postoperative acute pain (VAS>3) ( OR=5.814, 95% CI: 2.532-13.350) were independent risk factors for chronic postoperative inguinal pain ( P<0.05). Based upon the above independent risk factors, the nomogram prediction model was established and verified. The area under the curve of the nomogram prediction model was 0.779 (95% CI: 0.718-0.840, P<0.01). After internal verification, the concordance index value of the prediction model was 0.779. Conclusion:age≤45 years, BMI ≥24 kg/m 2, hernial sac≤5 cm, recurrent hernia, preoperative pain, suture fixation and Postoperative acute pain (VAS>3) are independent risk factors for chronic postoperative inguinal pain for laparoscopic trans-abdominal preperitoneal hernia repair, the nomogram prediction model has a good accuracy and discrimination with a high value of clinical application.
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Resumen El reparo de la hernia hiatal es un tema de debate debido a las posibles complicaciones asociadas que han cambiado a través de los años. En la literatura se reportan complicaciones asociadas al procedimiento hasta en un 30 % de los casos. Las complicaciones diferentes a la recurrencia y a largo plazo son infrecuentes, reportadas en menos del 9 % de los casos. La inclusión de la malla protésica en el esófago es una rara complicación y solo se han reportado pocos casos sobre esta. Entre los factores asociados a este desenlace se encuentran descritos: el material protésico, la técnica quirúrgica y la tensión de la malla sobre el tejido intervenido; sin embargo, es difícil establecer asociaciones directas de cada factor dado que la literatura actual solo cuenta con reportes de casos. A continuación, se muestra el caso clínico de un paciente, quien, después de una reparación de hernia hiatal con malla, presenta la inclusión de material protésico en el esófago; se aborda el diagnóstico y el manejo de la misma.
Abstract Hiatal hernia repair has been a subject of debate due to the possible associated complications that have changed over the years. The literature reports up to 30% of cases with complications associated with the procedure. Complications other than recurrence and long-term complications are rare and reported in less than 9% of cases. The migration of the prosthetic mesh into the esophagus is a rare complication and only a few cases have been reported. The factors associated with this outcome include prosthetic material, surgical technique, and mesh tension on the intervened tissue. However, it is difficult to establish direct associations of each factor since the current literature has only case reports. The following is a clinical case of a patient in whom the prosthetic material migrated into the esophagus after a hiatal hernia repair with mesh. The diagnosis and treatment offered are discussed.
Subject(s)
Humans , Male , Aged, 80 and over , Surgical Mesh , Esophagogastric Junction , Hernia, Hiatal , Patients , DiagnosisABSTRACT
Resumen Balantidium coli es el único miembro de la familia Balantidiidae capaz de producir infección en seres humanos. Presentamos un caso en un hombre de 43 años que ingresa para corrección quirúrgica de hernia ventral durante la cual se realizó apendicetomía profiláctica. En el estudio histopatológico se observó apéndice cecal con arquitectura conservada, sin la presencia de apendicitis ni periapendicitis. En la luz se reconocieron estructuras grandes (aproximado de 50 μm) redondas con citoplasma amplio con vacuolas grandes, cilias periféricas y núcleos densos, los cuales correspondieron a trofozoitos de Balantidium coli.
Abstract Balantidium coli is the only member of the Balantidiiae family capable of infecting human beings. We present one in a 43 years-old male admitted for a surgical co rrection of an incisional hernia with prophylactic appendicectomy. Histopathological findings reported the cecal appendix within normal architecture, appendicitis and peri-appendicitis free. At the lumen big, rounded shape structures (aprox. 50 mm) were visible with broad cytoplasm, big vacuoles, peripheral cilia and dense nucleus, corresponding to Balantidium coli trophozoites.
Subject(s)
Humans , Male , Adult , Appendix , Balantidium , Incidental Findings , Appendicitis , Coliforms , InfectionsABSTRACT
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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Objective:To investigate the effects of compression treatment on occurrence of venous thromboembolism (VTE) after tension-free inguinal hernia repair.Methods:The retrospective cohort study was conducted. The clinical data of 13 263 patients with inguinal hernia who were admitted to 58 medical centers from January to December in 2017 were collected, including 1 668 in Beijing Chaoyang Hospital of Capital Medical University, 782 in East Hospital Affiliated to Tongji University, 558 in Huadong Hospital of Fudan University, 525 in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 488 in Ruijin Hospital of Shanghai Jiaotong University School of Medicine, 382 in Tianjin People's Hospital, 378 in Peking University Third Hospital, 364 in Beijing Hospital, 356 in Shengjing Hospital of China Medical University, 348 in Huashan Hospital of Fudan University, 348 in Sichuan Provincial People's Hospital, 328 in Affiliated Hospital of Zunyi Medical University, 304 in Beijing Luhe Hospital of Capital Medical University, 296 in People's Hospital of Changshou District in Chongqing, 290 in Anhui Provincial Hospital, 281 in the First Affiliated Hospital of Dalian Medical University, 281 in Xinjiang Uygur Autonomous People's Hospital, 247 in Qilu Hospital of Shandong University, 220 in Wuhan NO.1 Hospital, 214 in the First Hospital of China Medical University, 213 in West China Hospital of Sichuan University, 206 in the Second Affiliated Hospital of Chongqing Medical University, 202 in Taiyuan Central Hospital of Shanxi Medical University, 197 in the First Affiliated Hospital of Wenzhou University, 191 in Zhongda Hospital of Southeast University, 190 in Tianjin Medical University General Hospital, 189 in Xuzhou Central Hospital, 188 in the First Affiliated Hospital of Harbin Medical University, 187 in the Second Hospital Affiliated to Naval Medical University, 175 in Chengdu Fifth People's Hospital, 173 in Tianjin Nankai Hospital, 172 in the Fourth Affiliated Hospital of China Medical University, 172 in Zhangjiakou First Hospital, 161 in Henan Provincial People's Hospital, 153 in the First Affiliated Hospital of Xi'an Jiaotong University, 149 in Shandong Provincial Hospital, 142 in the Second Hospital of Shandong University, 137 in the First Affiliated Hospital of Hunan University of Medicine, 136 in the Fourth Hospital of Harbin Medical University, 127 in Pingjiang District of the First Affiliated Hospital of Soochow University, 102 in the Central Hospital of Wuhan, 100 in the First Affiliated Hospital of Soochow University, 98 in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences, 97 in the First Affiliated Hospital of Chongqing Medical University, 96 in Xijing Hospital Affiliated to Air Force Medical University, 90 in the Fourth Medical Center of Chinese PLA General Hospital, 81 in Hunan Provincial Hospital of Traditional Medicine, 80 in the First Hospital of Tsinghua University, 80 in Xinhua Hospital of Hubei Province, 61 in the First Affiliated Hospital of Zhengzhou University, 57 in Peking University International Hospital, 50 in Peking University First Hospital, 39 in Zhongnan Hospital of Wuhan University, 38 in Jilin Yan'an Hospital, 37 in China-Japan Union Hospital of Jilin University, 20 in Taikang Xianlin Drum Hospital, 16 in Chinese PLA General Hospital, 3 in the First Affiliated Hospital of Fujian Medical University. There were 11 852 males and 1 411 females, aged from 18 to 102 years, with a median age of 64 years. Of 13 263 patients, 9 995 with compression treatment after tension-free inguinal hernia repair were divided into compression group and 3 268 without compression treatment after tension-free inguinal hernia repair were divided into non-compression group. Observation indicators: (1) compression treatment of patients in the compression group; (2) occurrence of VTE after tension-free inguinal hernia repair in the two groups; (3) analysis of influencing factors for VTE after tension-free inguinal hernia repair. Follow-up using telephone interview was performed to detect history of patient's thrombosis, medical history of patient's family and the incidence of postoperative VTE up to February 2018. Measurement data with skewed distribution were represented as M ( P25, P75) or M (range), and comparison between groups was analyzed using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate analysis and multivariate analysis were conducted using the Logistic regression model. Results:(1) Compression treatment of patients in the compression group: of the 9 995 patients in the compression group, 6 086 underwent compression treatment with 0.5 kg of sandbag or 500 mL of packed 0.9% sodium chloride solution, 1 881 underwent compression treatment with trusses, 745 underwent compression treatment with girdles, 675 underwent compression treatment with elastic underwear combined with 0.5 kg of sandbag, and 608 underwent compression treatment with elastic underwear. (2) Occurrence of VTE after tension-free inguinal hernia repair in the two groups: patients of the two groups after matching were followed up. Occurrence of VTE after matching were 15 and 1 in the compression group and non-compression group, respectively, showing no significant difference between the two groups ( χ2=2.010, P>0.05). (3) Analysis of influencing factors for VTE after tension-free inguinal hernia repair: results of univariate analysis showed that cases with varix of lower limb, cases with oral contracep-tives or hormone replacement therapy history, cases with VTE history, clinical classification, clinical typing, surgical method, cases with anticoagulant drugs history, cases undergoing oral antiplatelet drugs, cases undergoing postoperative VTE prevention with medication were related factors for occurrence of VTE after tension-free inguinal hernia repair ( odds ratio=13.98, 37.71, 19.21, 4.43, 4.21, 0.07, 0.08, 0.10, 31.04, 95% confidence interval: 3.15?62.11, 8.35?170.24, 6.15?60.00, 1.43?13.76, 1.20?14.82, 0.01?0.49, 0.02?0.27, 0.04?0.29, 8.53?112.93, P<0.05). Results of multivariate analysis showed that cases with VTE history and surgical method were independent influencing factors for occurrence of VTE after tension-free inguinal hernia repair ( odds ratio=7.78, 11.19, 95% confidence interval: 2.06?29.42, 1.45?86.55, P<0.05). Conclusion:Cases with VTE history and surgical method are independent influencing factors for occurrence of VTE after tension-free inguinal hernia repair.
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Introducción: La incidencia de eventración post quirúrgica es del 2-20%, se da mayormente en pacientes con factores de riesgo durante los primeros tres años posteriores a la cirugía inicial. La mayoría de las hernias de la pared abdominal pueden ser reparadas fácilmente, sin embargo, las hernias gigantes (>10cm de diámetro) o aquellas con pérdida de domicilio requieren métodos de expansión gradual de la pared abdominal pre y/o transoperatoriamente. Se ha descrito que posterior a la aplicación de toxina botulínica serotipo A (TBA) de forma bilateral en la pared abdominal, los defectos disminuyen clínica y tomográficamente hasta 5.25cm, por su efecto selectivo en terminaciones nerviosas periféricas colinérgicas, provocando atrofia muscular sin fibrosis. El efecto máximo ocurre al mes de la aplicación y dura 28 semanas. Esta técnica permite planear preoperatoriamente la magnitud de la cirugía. Nuestro caso, paciente masculino de 33 años. Quien ingresa por politrauma. Se realiza procedimiento quirúrgico abdominal y posteriormente se eviscera en múltiples ocasiones. Se cierra herida y posteriormente desarrolla hernia ventral gigante con la que egresa. Se realiza TC abdominal evidenciando defecto herniario de 15.9cm, con este resultado se aplica toxina botulínica serotipo A en la pared abdominal bilateral (50 unidades en cada lado) guiado por ultrasonido. 25 días después se realiza TC abdominal control que evidencia defecto herniario de 14.7cm y se decide ingreso para cirugía electiva. Se decide llevar a sala de operaciones donde se realiza hernioplastía con liberación de componentes anteriores mas colocación de malla de polietileno (cuatro semanas posteriores a la aplicación de la toxina), quedando defecto totalmente cerrado y sin tensión. Paciente con adecuada evolución posterior a intervención por lo que egresa. Actualmente sin defecto herniario recurrente. Conclusión: El uso de toxina botulínica serotipo A es un nuevo recurso prequirúrgico para la preparación de pacientes con hernias ventrales gigantes, ya que permite el cierre sin tensión en la mayoría de los casos. Además, ayuda a que transoperatoriamente la separación de componentes se realice de una mejor manera, ya que se da mejor manipulación al momento de desplazar las estructuras musculares. Idealmente se debe de realizar la intervención quirúrgica cuatro semanas posteriores a su aplicación. (AU)
ntroduction: The incidence of post-surgical eventration is 2-20%, it occurs mostly in patients with risk factors during the first three years after the initial surgery. Most abdominal wall hernias can be easily repaired, however, giant hernias (>10cm of diameter) or those with the loss of domain require methods of gradual expansion of the abdominal wall pre or intraoperatively. It has been described that after the application of botulinum toxin A bilaterally in the abdominal wall, the defect can decrease clinically and tomographically up to 5.25cm, due to its selective effect on cholinergic peripheral nerve endings, that cause muscle atrophy without fibrosis. The maximum effect occurs one month after the application and lasts 28 weeks. This technique allows to plan preoperatively the magnitude of the surgery. Description of case: A 33 year old male patient, who entered the emergency room due to polytrauma. Abdominal surgical procedure was performed and later he eviscerates on multiple occasions. The wound was closed and later he develops a giant ventral hernia with which it is discharged. An abdominal CT was performed, showing a hernia defect of 15.9cm. With this result botulinum toxin A was applied guided by ultrasound bilaterally in the abdominal wall (50 U on each side). A control abdominal CT was performed after 25 days, which it revealed a hernia defect of 14.7 cms, so admission was decided for elective surgery. The patient was taken to the operating room where a hernioplasty with anterior components separation plus the placement of a polyethylene mesh was performed (four weeks after the application of the botulinum toxin A), the hernia defect was completely close without tension. The patient had an adequate post-surgical evolution for which it was discharge. Currently without a recurrent hernia defect. Conclusion: The use of botulinum toxin A is a new pre-surgical resource for the preparation of patients with giant ventral hernias, since it allows the closure without tension in most cases. In addition, it helps transoperatively with the components separation, since there is a better manipulation at the time of displacing the muscular structures. Ideally, the surgical intervention should be performed four weeks after its application. (AU)
Subject(s)
Humans , Male , Adult , Wounds and Injuries/complications , Botulinum Toxins, Type A/administration & dosage , Hernia, Ventral/surgery , Surgical Mesh/trends , Intraoperative Complications/diagnosis , Laparotomy/instrumentationABSTRACT
Background: In our tertiary care hospital, we receive a large number of acute abdomen cases. Raised intra-abdominal pressure (IAP) makes laparostomy mandatory initially and abdominal wall approximation cannot be completed due to compromised state in most cases. Large incisional hernias were seen on complete healing and this study was done to see the feasibility of component separation technique (CST) with mesh augmentation.Methods: 30 patients were subjected to CST with mesh augmentation. Preoperative defect size mapping, Pre- and post-operative monitoring of IAP were done. Pain scoring by visual analogue scale (VAS), early and late complications was noted. Patients were followed up for 60 months.Results: CST with mesh augmentation was found to be feasible with 96.77% success rate as no recurrence was noted in follow up. Preoperative average Basal metabolic index was 26.09. Size of defect varied from 17-20×9-16 cm2 (length X width). Seroma seen in 50% of patients was managed without any intervention. Skin necrosis in 6.6% and wound dehiscence in 3.33%, managed with minimal debridement & local wound care respectively. Respiratory compromise and hematoma were not seen and no patient required any active ICU care. Average length of hospital stay was 5.22 days. Close monitoring of IAP in immediate post-operative period was found to be significant.Conclusion: Physical acceptance of stable abdominal wall gives a psychological boost to patients with early recovery in form of ambulation and early return to work.
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Background: Incisional hernias repair being done in large numbers there is still not a consensus about the best repair. Very few studies have been done on comparison open and laparoscopic incisional hernia repair.Methods: A prospective, cross-sectional study was undertaken in Department of Surgery of Civil Hospital. The study included total 50 patients, out of which 25 patients underwent open approach and rest of 25 patients, underwent laparoscopic approach. Patients were assigned to both the groups randomly.Results: Pain, duration of post-operative stay, and return to routine work is earlier in patients with laparoscopic repair mainly due to decreased pain, fewer complications, early mobility and faster return of bowel movements. Laparoscopic repair is more expensive and operative time is more as compared to open method.Conclusions: Keeping in view the advantages and limitations of laparoscopic repair, the choice among two surgical modalities should be made on a case to case basis depending on patient preference and characteristics.
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Background: Laparoscopic inguinal hernia repair (LIHR) is usually done by two methods, which vary in approach to the preperitoneal space; transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). This study aimed at comparing the effect of mesh fixation and non-fixation in terms of operative time, hospital stay, analgesic requirement, complications and cost analysis with respect to fixation device in LIHR.Methods: This prospective randomized comparative study included 60 patients of inguinal hernias admitted to the Department of Surgery at Rajendra Hospital, G.M.C, Patiala from July 2016 to September 2017 (duration of study was 15 months). Cases were divided into two groups by draw of lots with group A as mesh fixation (n=30) and group B as non-fixation (n=30).Results: The results were calculated with chi square test (p value). Results were found to be not significant in two groups in the terms of postoperative analgesia, complications i.e. (intraoperative, postoperative and long term) postoperative hospital stay and time to return for work. The cost of procedure was found to be very high in Group A and results were highly significant (p<0.001).Conclusion: LIHR repair without mesh fixation shows advantages over mesh fixation, which includes significant less cost of surgery, with comparable intraoperative, postoperative and long-term complications (with no increase in hernia recurrence), hospital stay and mean operative time. Hence, our study favours LIHR without mesh fixation a valuable alterative option.
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Aims: A ventral hernia is a protrusion of viscera through an abdominal wall defect. Ventral hernias are mostly treated by a surgical procedure called open ventral hernia repair (OVHR). However, complications arising from the OVHR procedure mayresult in the recurrence of a hernia.This study was aimed to measure the recurrence rate of ventral hernia after OVHR with mesh and the reasons for failure.Study Design:It was a cross-sectional retrospective study conducted on all patients who underwent an OVHR with mesh, between 2010 and 2017, at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Data were extracted from KAUH medical records. A total of 241 patients were included in the study, divided into two groups; group 1-patients with recurrence(37 patients) and group 2-patients with no recurrence(204 patients).Consent was taken from patientsand preoperative assessment of procedures were performed under general anesthesia. The variables in the study are parameters like age, sex, parity, and history of chronic liver disease and their correlation with recurrence of thehernia. Different variables Data were analyzed by SPSS v 21. Association between the variables was determined using the t-test and Pearson’s Chi-squared tests.Results:The relationship between recurrence and age was statistically significant (P=0.019). The recurrence of hernia was more frequent in females than males. Patients with a history of multiparity(P=0.00) and liver diseases (P=0.041) showed significant differences in terms of recurrence. The umbilical hernia was more prevalent (133 cases; 55.2%) than other types of hernia. The most frequent site of hernia in the recurrence group was supraumbilical(38.46%; P=0.039).Conclusion:OVHR is a commonly performed surgical procedure at KAUH. Because of multiparity, ventral hernia recurrence was more common in women than men. To reduce recurrences, we recommend doing exercises to strengthen the abdominal muscles. Patients with chronic liver diseases in the form of portal hypertension should avoid surgical repair. For the surgeons, the type of mesh does not have a significant impact on recurrence
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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: The Desarda repair for inguinal hernias is a new tissue-based technique. Application of the external oblique muscle aponeurosis in the form of un-detached strip has been established as a new concept in tissue-based hernia repair.Methods: A prospective study was conducted among 126 cases with 148 inguinal hernias repaired by Desarda’s technique for a period of 3 years in Dr. B. R. Ambedkar Medical College and Hospital, Bangalore, Karnataka, India. The details pertaining to duration of hospital stay, pain, ambulation and complications were recorded.Results: The mean age of the patients was 38.4 years. Mean operating time was 62.5 min for unilateral and 123 min for bilateral hernias. About 97.8% patients were ambulatory within 6.42 hours and were freely mobile within 19.26 hours after surgery. About 96.4% patients returned to work within 6-14 days. About 91.26% patients were discharged on same day. The mean hospital stay duration of the patients was 1.11 days. Postoperative pain on movement out of bed was described as mild and tolerable in 92.6% patients on day 1. Two patients had seroma that subsided on its own. There were no long-term complications, recurrence of the hernias or chronic groin pain.Conclusions: The results of this new technique (Desarda repair) using continuous absorbable sutures appear promising. The continuous suturing saves time and just one packet of suture material without mesh saves cost.