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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.
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Objective To explore the clinical feasibility of ambulatory surgery for inguinal hernia in 70 years of age or older patients.Methods The retrospective cohort study was adopted.The clinical data of 675 patients undergoing ambulatory surgery for inguinal hernia and 464 patients (age ≥ 70 years) undergoing inpatient surgery for inguinal hernia who were admitted to the West China Hospital of Sichuan University from January 2015 to May 2016 were collected.Of 675 patients undergoing ambulatory surgery,594 patients with age ＜ 70 years and 81 with age≥70 years were respectively allocated into the under 70 years group and 70 years or older group.Four hundred sixty-four patients undergoing inpatient surgery with age ≥ 70 years were allocated into the inpatient surgery group.Observation indicators included:(1) efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time,② cases with delayed discharge and cases with unplanned readmission,③postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection.(2) Efficacies of patients with inpatient surgery:①type of anesthesia,surgical procedures and operation time,② postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection,③ duration of postoperative hospital stay.(3) Follow-up.Patients were regularly followed up using telephone interview at postoperative day 1,2,3,and using outpatient examination and telephone interview at postoperative week 2 and month 3,6,12 up to July 2016.Follow-up included the survival of patients,recurrence of hernia and number of readmission.Measurement data with normal distribution were represented as （x） ± s and comparison between groups was evaluated with the t test.Comparison of count data were analyzed using the chi-square or Fisher exact probability.Results (1) Efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time:patients in the under 70 years group and 70 years or older group underwent tensionfree repair under local anesthesia.The operation time in the under 70 years group and 70 years or older group was respectively (29 ± 11) minutes and (28 ± 10) minutes,with no statistically significant difference between 2 groups (t =0.378,P ＞ 0.05).② The cases with delayed discharge and with unplanned readmission:there were 2 patients with delayed discharge and 1 with unplanned readmission in the under 70 years group and no case in the 70 years older group,with no statistically significant difference between the 2 groups (x2=0.601,0.137,P ＞ 0.05).③ The postoperative complications:wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain were detected in 4,2,1,3 patients in the under 70 years group and 1,0,0,1 patients in the70 years or older group,respectively,showing no statistically significant difference between the 2 groups (P ＞ 0.05).No patch infection occurred.(2) Efficacies of patients undergoing inpatient surgery:① type of anesthesia,surgical procedures and operation time:patients in the inpatient surgery group underwent tension-free repair under local anesthesia and operation time was (29 ± 10) minutes.There was no statistically significant difference in operation time between the inpatient surgery group and 70 years or older group (t =0.806,P ＞ 0.05).② The wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain in the inpatient surgery group were respectively detected in 3,1,1,2 patients,showing no statistically significant difference between the inpatient surgery group and 70 years or older group (P ＞ 0.05).No patch infection occurred.③ Duration of postoperative hospital stay was less than 1 day in 439 patients and more than 1 day in 25 patients in the inpatient surgery group,respectively.(3) Follow-up:625 of 675 patients undergoing ambulatory surgery were followed up for a median time of 9 months (range,2-18 months).One patient in the under 70 years group was complicated with recurrence of hernia and then was cured by reoperation.There was no recurrence of hernia in the 70 years or older group.Of 464 patients in the inpatient surgery group,432 were followed up for a median time of 9 months (range,2-18 months),and 1 patient with recurrence of hernia was cured by reoperation.Conclusion Ambulatory surgery for inguinal hernia is feasible in 70 years or older patients.
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Objective To explore the clinical efficacies of ambulatory surgery for inguinal hernia.Methods The clinical data of 1 892 patients with inguinal hernia who underwent ambulatory surgery at the West China Hospital of Sichuan University from November 2009 to June 2015 were retrospectively analyzed.Preoperative examinations including blood routine test, blood bio-chemistry checking, blood electrolytes, coagulation convention, pre-transfusion test, blood type, chest X-ray, electrocardiogram were applied to patients.Operation time was rescheduled after abnormal indexes were corrected for elective surgery.Preventive use of antibiotics was not needed.Preperitoneal space tension-free repair or Bassini method was adopted after local infiltration anesthesia.Anesthesia method, operation method, patching material, operation time, number of patients transferred to inpatient department and reasons and treatment expense were recorded.Ambulatory surgery center did satisfaction survey on patients at the discharge.Patients were followed up at postoperative month 1, 3, 6, 12 regularly by the doctor responsible for the surgery till July 2015, including occurrence of complications and chronic pain, recurred hernia, number of readmission and reasons.Measurement data with normal distribution were presented as x ± s.Results Among 1 892 patients, 1 889 patients underwent operation under local anesthesia and 3 patients were transferred to general anesthesia.There were 1 874 patients undergoing tension-free repair including 1 592 using the material of ultrapro hernia system (UHS) , 264 of ultrapro plug (UPP), 8 of prolene hernia system (PHS), 6 of Gore hernia patch, 4 of 3-dimensional plug (3DP), and 18 patients underwent Bassini without preoperative death.The operation time of 1 892 patients was (28 ± 12) minutes.Three patients were transferred to inpatient department for postoperative cut incision pain, ecchymoma, abdominal distention after satiation and discharged from hospital after treatment.Among 26 patients with complications after discharge, 12 had superficial incision infection and recovered after dressing change without removal of patches, 5 had edema in scrotum and inguinal region, 3 had ecchymoma, 2 had nausea and vomiting, 2 had urinary retention, 2 had disruption of wound, and they all recovered smoothly after symptomatic treatment.Treatment expense of the 1 892 patients was (6 956 ± 249) yuan per hermia.Satisfaction rate of patients was 99.049％ (1 874/1 892) when discharged.The follow-up rate was 86.152％ (1 630/1 892).The follow-up time was 1-67 months with a median time of 35 months.During the follow-up, 4 patients had chronic pain and recovered after analgesia and physiotherapy, 3 patients had recurrence of inguinal hernia including 1 case of recurrent hernia and 2 cases of huge hernia.Conclusion Ambulatory surgery for inguinal hernia is safe and effective, with the advantages of few complications, high satisfactory rate and low hospital expenses.
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<p><b>OBJECTIVE</b>To assess the feasibility of laparoscopic total mesorectal excision (TME) for low or ultralow anterior resection of rectal cancer.</p><p><b>METHODS</b>Excision of the mesorectum and low (ultralow) colo-anal anastomoses were performed laparoscopically in 62 patients with low rectal cancer based on the concept of TME and double stapling technique (DST).</p><p><b>RESULTS</b>Sixty-two operations with TME and DST were performed in a totally laparoscopic manner, and only one was converted to open procedures because of dysfunction of coagulation. The operative time was 125 min (110-210 min) and the operative blood loss 20 ml (5-80 ml). The time for bowel function recovery and post-operatively dietary intake was 1-2 days. Twenty-eight patients received postoperative analgesics. Average hospital stay was 8 days (5-14 days). Complications were observed in only 2 of the 62 patients, one had suffered from urinary retention and the other, anastomotic leakage.</p><p><b>CONCLUSIONS</b>Totally laparoscopic excision of the mesorectum for low or ultralow anterior resection of rectal cancer is a minimally invasive technique with sphincter preservation, less postoperative pain, and rapid recovery.</p>