Resultados a largo plazo del tratamiento quirúrgico de Hernias Hiatales tipo III y IV con y sin refuerzo protésico

Introducción: El tratamiento de las Hernias Hiatales (HH) tipo III y IV es quirúrgico. Hay controversia sobre el refuerzo con malla. Nuestro objetivo fue comparar los resultados a largo plazo entre el uso o no de refuerzos protésicos. Materiales y Métodos: Cohorte prospectiva de 95 pacientes con HH tipo III y IV, entre los años 1997 y 2015 en el Hospital Clínico de la Universidad de Chile. Se evaluaron las características radiológicas, endoscópicas y funcionales pre y postoperatorias. Recidiva definida como recurrencia mayor a 3 cm. Análisis estadístico con chi2 y Test U-Mam-Whitney. P-value a 10 años) de HH tipo III y IV reparadas quirúrgicamente, no hay diferencias en la recidiva clínica con o sin el uso de mallas.

Introduction: The treatment of Hiatal Hernias (HH) type III and IV is surgical. There is controversy about reinforcement with mesh. Our objective was to compare the long-term results between the use or not of prosthetic reinforcements. Materials and Methods: Prospective cohort of 95 patients with HH type III and IV, between 1997 and 2015 at the Clinical Hospital of the University of Chile. Pre and postoperative radiological, endoscopic and functional characteristics were evaluated. Recurrence defined as a recurrence greater than 3 cm. Statistical analysis with chi2 and U-Mann-Whitney test. p-value 10 years) of surgically repaired type III and IV HH, there are no differences in clinical recurrence with or without the use of mesh.

Novedades en la evaluación y tratamiento de la obstrucción intestinal alta

La obstrucción intestinal mecánica es un problema quirúrgico significativo en términos de prevalencia, morbimortalidad y costos económicos asociados. En los últimos años se han realizado avances en: detectar mecanismos fisiopatológicos del desarrollo de adherencias, optimizar el diagnóstico de pacientes aptos para manejo conservador, valorar la utilidad intraoperatoria de herramientas que definan la necesidad de resección intestinal y hallar terapias preventivas. El objetivo de esta revisión narrativa es sintetizar la evidencia científica actualizada, publicada referente al diagnóstico y tratamiento de una obstrucción intestinal alta mecánica.

Mechanical small bowel obstruction is a significant surgical problem in terms of prevalence, morbimortality, and associated economic costs. In recent years, advances have been made in: detection of physio pathological mechanisms of adhesion genesis, improvement in diagnosis of patients suitable for conservative treatment, assessment the efficacy of intraoperative tools that define the need for intestinal resection, and development of preventive therapies. The objective of this narrative review is to synthesize the updated scientific evidence published, regarding the diagnosis and treatment of mechanical small bowel obstruction.

Fisiopatología de la hernia diafragmática congénita en el recién nacido / Pathophysiology of congenital diaphramatic hernia in the newborn

La hernia diafragmática congénita es una discontinuidad del diafragma con herniación de los órganos abdominales a la cavidad torácica, actualmente se postula una hipótesis dual para su origen. Su fisiopatología está determinada por la hipoplasia pulmonar, la hipertensión pulmonar y la disfunción ventricular, entender estos elementos es necesario para un adecuado manejo y la mejoría del pronóstico.

Congenital diaphragmatic hernia is a discontinuity of the diaphragm with herniation of the abdominal organs into the thoracic cavity, currently a dual hypothesis for its origin is postulated. Its pathophysiology is determined by pulmonary hypoplasia, pulmonary hypertension and ventricular dysfunction, understanding these elements is necessary for adequate management and improve prognosis.

Toxina botulínica y neumoperitoneo secuencial en el manejo de hernia inguinoescrotal gigante: Reporte de caso / Botulinum toxin and sequential pneumoperitoneum in the management of giant inguinoscrotal hernia: Case report

Introducción. Las hernias gigantes con pérdida de domicilio son aquellas cuyo saco herniario alcanza el punto medio del muslo en bipedestación y su contenido excede el volumen de la cavidad abdominal. Estas hernias son un reto quirúrgico dada la difícil reducción de su contenido y del cierre primario de la fascia. Tienen mayor riesgo de complicaciones asociadas al síndrome compartimental abdominal, así como mayor tasa de recurrencia y morbilidad en los pacientes. Caso clínico. Paciente masculino de 81 años, reconsultante por hernia inguinoescrotal derecha gigante, de dos años de evolución, sintomática, con índice de Tanaka de 24 %. Se decidió aplicar el protocolo de neumoperitoneo secuencial (hasta 11.000 ml en total en cavidad) además de toxina botulínica en pared abdominal (dos sesiones). Resultados. Se logró la corrección exitosa de la hernia inguinoescrotal gigante, sin recaídas de su patología abdomino-inguinal. El paciente manifestó satisfacción con el tratamiento un año después del procedimiento. Conclusiones. El protocolo de neumoperitoneo secuencial es una alternativa en casos de hernias complejas, con alto riesgo de complicaciones, que requieren técnicas reconstructivas adicionales. La aplicación previa de toxina botulínica es un adyuvante considerable para aumentar la probabilidad de resultados favorables. Sin embargo, debe incentivarse la investigación en esta área para evaluar su efectividad.

Introduction. Giant hernias with loss of domain are those whose hernial sac reaches the midpoint of the thigh in standing position and whose content exceeds the volume of the abdominal cavity. These hernias are a surgical challenge given the difficult reduction of their contents and the primary fascial closure, with a higher risk of complications associated with abdominal compartment syndrome, as well as a higher rate of recurrence and morbidity in patients. Clinical case. A 81-year-old male patient with comorbidity, reconsulting due to a symptomatic giant right inguinoscrotal hernia of two years of evolution, with a Tanaka index of 24%, eligible for a sequential pneumoperitoneum protocol (up to a total of 11,000 cc in cavity) plus application of botulinum toxin (two sessions) in the abdominal wall. Results. Successful correction of the patient's giant inguinoscrotal hernia was achieved using this protocol, without recurrence of his abdomino-inguinal pathology and satisfaction with the procedure after one year. Conclusion. The sequential pneumoperitoneum protocol continues to be an important alternative in cases with a high risk of complications that require additional reconstructive techniques, while the previous application of botulinum toxin is a considerable adjuvant to further increase the rate of favorable results. However, research in the area should be encouraged to reaffirm its effectiveness.

Manejo expectante de amniocele en paciente con espectro de placenta accreta: reporte de caso / Expectant management of amniocele in a patient with placenta accreta: a case report

Introducción: El amniocele es una hernia del saco amniótico a través de un defecto en la pared del útero, el cual puede deberse a ruptura uterina, secundario a daños preexistentes, anomalías uterinas o en un útero sin cicatrices. Caso clínico: Presentamos el caso de una paciente de 37 años, con antecedente de dos partos por cesárea, a quien en la semana 25,5 de embarazo se le diagnostica por ecografía amniocele en la pared anterior de útero contenido por la vejiga, además de signos ecográficos de acretismo placentario. La posterior realización de resonancia magnética confirma el diagnóstico. Se realiza manejo expectante con estancia continua intrahospitalaria estricta. Resolución obstétrica a las 34 semanas por cesárea, con extracción fetal por fondo uterino sin complicaciones, con posterior realización de histerectomía con placenta in situ. Conclusiones: Este reporte de caso ilustra la importancia de la identificación temprana de esta condición por ser una complicación infrecuente, pero de grave pronóstico fetomaterno en ausencia de atención inmediata.

Introduction: Amniocele is a hernia of the amniotic sac through a defect in the uterine wall, which can be caused by uterine rupture secondary to preexisting damage, uterine anomalies, or a scarless uterus. Case report: We present a case of a 37-year-old patient with a history of two previous cesarean deliveries. At 25.5 weeks of gestation, the diagnosis of amniocele in the anterior uterine wall, contained by the bladder, along with ultrasound signs of placenta accreta, was confirmed through ultrasound. Subsequent magnetic resonance imaging further confirmed the diagnosis. Expectant management with strict continuous intrahospital stay was implemented. Obstetric resolution was achieved at 34 weeks through cesarean delivery, with uncomplicated fetal extraction through the uterine fundus. Subsequently, a hysterectomy was performed with the placenta left in situ. Conclusions: This case report illustrates the importance of early identification of this condition due to its infrequent but serious feto-maternal prognosis in the absence of immediate attention.

Hernia de la línea arcuata, una patología poco difundida

La hernia de la línea arcuata (HLA), es una entidad claramente reconocida, sin embargo, existen escasas publicaciones al respecto. Corresponde a un defecto en la vaina posterior del músculo recto del abdomen, separándose la línea arcuata del musculo, formando un bolsillo, lo que corresponde a un defecto inter-parietal y no una verdadera hernia. Probablemente este subdiagnosticado y sub reportado. Su relevancia es que puede constituir una parte relevante de las consultas en servicio de urgencia por dolor abdominal sin etiología demostrada1. El diagnóstico debe sospecharse ante la presencia de dolor abdominal de tipo orgánico, sin otra etiología demostrada. Se confirma con imágenes, especialmente la tomografía computada. El tratamiento, apoyándose en lo reportado en la literatura, sugiere que la vía laparoscópica sería de elección. A continuación, analizamos la anatomía de la linea arcuata, la presentación clínica de esta afección, sus hallazgos imagenológicos, quirúrgicos, y las diferentes alternativas de tratamiento que se han propuesto en la literatura.

The arcuate line hernia is a clearly recognized entity, but of which little is mentioned. It corresponds to a defect in the posterior wall of the rectus abdominis, separating the arcuate line of the muscle, forming a pocket, which corresponds to an interparietal defect and not a true hernia. It is probably underdiagnosed and underreported. Its relevance is that it can constitute a significant part of the consultations in the emergency department for abdominal pain without proven etiology. The diagnosis should be suspected in the presence of organic abdominal pain, with no other proven etiology. It is confirmed with images, especially computed tomography. The treatment, based on what has been reported in the literature, suggests that the laparoscopic approach should be the choice. We analyze the anatomy of the arcuate line, its clinical presentation, imaging and surgical findings, and the different treatment alternatives that have been proposed in the literature.

Siguiendo la trayectoria de la abdominoplastia TULUA ­ Revelación de su evolución e impacto global / Tracing the Trajectory of TULUA Abdominoplasty ­ Unveiling its Evolution and Global Impact

La técnica de abdominoplastia TULUA, fue concebida por el Dr. Francisco Villegas en Colombia, su acrónimo en inglés refleja sus principios fundamentales: plicatura Transversal, Sin despegamiento, Liposucción sin restricción que incluye la línea media y flancos, Neo umbilicoplastia, ubicación baja de cicatriz y libre posición del ombligo. A lo largo de los últimos 12 años, la técnica TULUA ha ganado espacio en América Latina, Norteamérica, la zona árabe e India. Destacando su relevancia, se ha propuesto la publicación de un libro monográfico, programado para 2024, que abarcará desde los principios fundamentales hasta las experiencias internacionales con la técnica. Las indicaciones de la abdominoplastia TULUA han evolucionado, incluyendo casos estéticos, secundarios, hernias, cicatrices previas, pérdida masiva de peso, alta definición, aumento muscular y combinaciones con otras plicaturas. Ha sido aplicada con éxito en cierre del abdomen donante de reconstrucción mamaria. A través de investigaciones especializadas y revisiones de pares, la TULUA ha sido reconocida por su aplicabilidad y beneficios, especialmente en la realización segura de liposucción en abdominoplastias. Se sugieren estudios adicionales para evaluar los resultados y posibles complicaciones, abriendo oportunidades para una mayor comprensión y refinamiento. El futuro de la abdominoplastia TULUA parece prometedor, anticipando trabajos prospectivos, indicaciones adicionales y un enfoque gradual para cirujanos en formación. En última instancia, la técnica se presenta como una adición al repertorio de procedimientos estéticos abdominales, contribuyendo al avance de la cirugía abdominal estética.

The TULUA abdominoplasty technique, conceived by Dr. Francisco Villegas in Colombia, its acronym in English reflects its fundamental principles: Transverse plication, no Undermined flap above the umbilicus, Liposuction without restrictions including midline and flanks, Neo umbilicoplasty, low scar placement, and free umbilical positioning. Over the past 12 years, the TULUA technique has gained acceptance in Latin America, North America, the Arab region, and India. Highlighting its relevance, the publication of a monographic book has been proposed, its launch is scheduled for 2024, covering from fundamental principles to international experiences with the technique. Indications for TULUA abdominoplasty have evolved, including aesthetic cases, secondary cases, hernias, previous scars, massive weight loss, high definition, muscle augmentation, and combinations with other plications. It has been successfully applied in closing the donor abdomen for breast reconstruction. Through specialized research and peer reviews, TULUA has been recognized for its applicability and benefits, especially in safely performing liposuction during abdominoplasties. Additional studies are suggested to evaluate results and potential complications, opening opportunities for greater understanding and refinement. The future of TULUA abdominoplasty appears promising, anticipating prospective works, additional indications, and a gradual approach for surgeons in training. Ultimately, the technique presents itself as an addition to the repertoire of abdominal aesthetic procedures, contributing to the advancement of aesthetic abdominal surgery.

Reparação da parede abdominal com membranas acelulares de pericárdio bovino - Parte I - Achados clínicos e radiológicos / Abdominal wall repair with acellular bovine pericardial membranes - Part I - Clinical and radiological findings

Introdução: Reduzindo os índices de recidiva de forma impactante, o emprego de biomateriais como "telas de reforço" na reparação de diferentes defeitos da parede abdominal tornou-se rotina quase obrigatória para o sucesso dessas reparações. A partir da década de 1990 houve a introdução de matrizes biológicas acelulares, iniciando-se assim uma nova era na reparação dos defeitos da parede abdominal. O objetivo é avaliar a funcionalidade do pericárdio bovino acelularizado em reparações da parede abdominal. Método: Trinta pacientes foram submetidos a reparação de defeitos da parede abdominal, com biopróteses acelulares de pericárdio bovino, perfazendo um total de 40 implantes anatomicamente individualizados. O seguimento médio foi de 31 meses, sendo os pacientes avaliados clinicamente e radiologicamente. Em três casos foram feitas biópsias das áreas implantadas permitindo análise histológica do material. Resultados: Não se observou recidiva das herniações em nenhum dos casos, tanto clinica como radiologicamente. Também não houve registro de hematomas, infecções ou qualquer fenômeno de natureza reacional local ou sistêmica. Radiologicamente, não foi possível visualizar as matrizes no local de implantação em qualquer dos períodos de pós-operatório analisados. Conclusão: As matrizes mostraram similaridade às demais membranas biológicas descritas na literatura internacional. Representando uma importante atualização e evolução conceitual, as membranas acelulares de pericárdio bovino podem ser incorporadas ao arsenal terapêutico nas reparações de parede abdominal.

Introduction: Reducing recurrence rates significantly, the use of biomaterials as "reinforcement meshes" in the repair of different abdominal wall defects has become an almost mandatory routine for the success of these repairs. From the 1990s onwards, acellular biological matrices were introduced, thus beginning a new era in the repair of abdominal wall defects. The objective is to evaluate the functionality of the acellularized bovine pericardium in abdominal wall repairs. Method: Thirty patients underwent repair of abdominal wall defects using acellular bovine pericardium bioprostheses, making a total of 40 anatomically individualized implants. The average follow-up was 31 months, with patients being evaluated clinically and radiologically. In three cases, biopsies were taken from the implanted areas, allowing histological analysis of the material. Results: No recurrence of herniations was observed in any of the cases, both clinically and radiologically. There were also no records of bruises, infections or any phenomenon of a local or systemic reaction nature. Radiologically, it was not possible to visualize the matrices at the implantation site in any of the postoperative periods analyzed. Conclusion: The matrices showed similarity to other biological membranes described in the international literature. Representing an important update and conceptual evolution, acellular bovine pericardial membranes can be incorporated into the therapeutic arsenal in abdominal wall repairs.

Reparação da parede abdominal com membranas acelulares de pericárdio bovino - Parte II - Análises histológicas e morfométricas / Repair of the abdominal wall with acellular bovine pericardial membranes - Part II - Histological and morphometric analyses

Introdução: Análise histológica é a principal ferramenta de avaliação de biopróteses acelulares, em sua maioria em caráter experimental. O objetivo é analisar histologicamente a matriz acelular de pericárdio bovino em reparações de parede abdominal implantada em humanos. Método: De uma série de 30 reparações com a membrana, 3 pacientes foram submetidas a revisão cirúrgica não relacionada aos implantes, aos 13, 22 e 23 meses de pós-operatório, obtendo-se biópsias das áreas previamente implantadas. Além da avaliação dos aspectos básicos de biocompatibilidade e neoformação tecidual, as lâminas foram digitalizadas e submetidas a análise computadorizada com o software ImageJ para quantificação da cinética de degradação das membranas, associada à análise da dimensão fractal das amostras. Os valores obtidos para porcentagens de membrana residual tiveram suas médias comparadas por análise de variância (ANOVA) e pelo teste T de Student não pareado, também utilizado para os valores da quantificação da dimensão fractal. Resultados: Foi demonstrada a biocompatibilidade do material, com neoformação tecidual, deposição de colágeno e tecido celularizado de aspecto normal, sem reações locais importantes. Fragmentos residuais da membrana foram quantificados em 40%±7% aos 13 meses, em 20%±6% aos 22 meses e em 17%±6% aos 23 meses de pós-operatório, com a análise da dimensão fractal indicando uma progressiva degradação dos implantes, com significância estatística entre 13 meses e as amostras tardias. Conclusão: Os resultados atestaram a funcionalidade do pericárdio bovino acelular sob diferentes níveis de estresse mecânico nas reparações da parede abdominal em humanos.

Introduction: Histological analysis is the main tool for evaluating acellular bioprostheses, mostly on an experimental basis. The objective is to histologically analyze the acellular matrix of bovine pericardium in abdominal wall repairs implanted in humans. Method: From a series of 30 repairs with the membrane, 3 patients underwent surgical revision unrelated to the implants at 13, 22, and 23 months postoperatively, obtaining biopsies of the previously implanted areas. In addition to evaluating the basic aspects of biocompatibility and tissue neoformation, the slides were digitalized and subjected to computerized analysis with the ImageJ software to quantify the kinetics of membrane degradation associated with the analysis of the fractal dimension of the samples. The values obtained for percentages of residual membrane had their means compared by analysis of variance (ANOVA) and the unpaired Student's T test, also used for the fractal dimension quantification values. Results: The biocompatibility of the material was demonstrated, with tissue neoformation, collagen deposition, and cellularized tissue with a normal appearance without important local reactions. Residual fragments of the membrane were quantified at 40%±7% at 13 months, at 20%±6% at 22 months, and at 17%±6% at 23 months postoperatively, with the analysis of the fractal dimension indicating a progressive degradation of implants, with statistical significance between 13 months and late samples. Conclusion: The results confirmed the functionality of the acellular bovine pericardium under different levels of mechanical stress in abdominal wall repairs in humans.

Congenital intrabdominal hernia with atypical pain as first manifestation:A case report and literature review / 吉林大学学报(医学版)

Objective:To discuss the clinical characteristics,diagnosis processes,and treatment methods of one patient with congenital intrabdominal hernia,and to summarize the potential misconceptions during the diagnostic and treatment processes,and to improve the clinicians'awareness of this disease.Methods:The clinical data and auxiliary examination results of one patient with congenital intrabdominal hernia were collected and analyzed,and the related literatures were reviewed.Results:The patient,a 65-year-old male,sought care at the local hospital due to upper abdominal pain before 2 d;there were no significant abnormalities in the examination results at the cocal hospital;blood glucose>25 mmol·L-1.After receiving hypoglycemic,rehydration,and blood purification treatment,the condition of the patient was worsened,presenting with confusion,hypotension,and respiratory distress;the patient admitted in our hospital for further diagnosis and treatment.After admission,the patient was given despite fluid resuscitation,mechanical ventilation,and supportive treatment,but there was no improvement in the symptoms;interventional radiology was performed angiography of the abdominal artery and right femoral vein,which showed no significant vascular abnormalities in the abdomen.An abdominal paracentesis yielded a mixed bloody fluid,suggesting the concealed intraperitoneal disease;exploratory laparotomy was performed.During operation,the intrabdominal hernia with small intestine necrosis and septic shock were diagnosed,and partial small intestine resection,anastomosis,adhesiolysis,and abdominal irrigation and drainage were carried out.The patient had a good recovery and was discharged on the 14th day after operation.Conclusion:Congenital intrabdominal hernia is a very rare cause of intestinal obstruction in the adults,and high suspicion for intrabdominal hernia is one of the differential diagnosis for atypical acute abdomen;early multidisciplinary intervention can be lifesaving for the patients.

To compare the effects of false hernia sac exclusion,barbed suture and circular suture in transperitoneal preperitoneal laparoscopic hernia repair for direct hernia / 临床外科杂志

Objective To investigate the difference of surgical effect of exclusion,simple continuous suture and circular suture suspension in TAPP for the treatment of false hernia sac in patients with direct inguinal hernia.Method From May 2020 to May 2022,120 patients diagnosed with direct inguinal hernia and treated with TAPP in our hospital were retrospectively.The false hernia sacs were divided into three groups according to different methods of treatment patients treated with false hernia sac exclusion were included in group A,those treated with simple continuous suture were included in group B,and those treated with circular suture suspension were included in group C.There were 40 patients in each group.The perioperative indicators(operation time,intraoperative blood loss,postoperative hospital stay,hospitalization cost)and postoperative effects(chronic pain,seroma,incision or mesh infection,foreign body traction feeling)were compared among the three groups.Results All 120 patients successfully completed TAPP surgery.There was no significant difference in general condition,intraoperative blood loss,postoperative hospital stay,wound or mesh infection and chronic pain among the three groups(P＞0.05).The operation time of group B and C was longer than that of group A,and the incidence of seroma was significantly lower than that of group A,the difference was statistically significant(P＜0.05).The incidence of foreign body traction in group A and group C was lower than that in group B,and the difference was statistically significant(P＜0.05).The hospitalization cost of group B and group C was lower than that of group A,with statistically significant difference(P＜0.05).Conclusion In clinical practice,direct hernia and false hernia sac often need to be treated.In direct hernia TAPP operation,simple continuous suture method and circular suture suspension method have the effect of improving the condition of the false hernia sac,but in terms of economy and postoperative effect,the circular suture suspension method can benefit patients more.

Application of Extracorporeal Suture Traction-assisted Two-port Laparoscopic Inner Ring Closure for Inguinal Hernia With Folded Peritoneum Around Orifice in Children / 中国微创外科杂志

Objective To investigate the safety and feasibility of two-port laparoscopic inner ring closure assisted by extracorporeal suture traction for indirect inguinal hernia with folded peritoneum around inner orifice in children.Methods Between October 2019 and February 2023,a total of 322 children with indirect inguinal hernia underwent two-port laparoscopic inner ring closure,in which 186 cases(292 sides)with folded peritoneum around inner ring orifice were given assistance by extracorporeal suture traction.Under laparoscopic vision in the umbilicus,a needle with a non-absorbable suture was inserted into the abdominal cavity through the outer lower edge of the inner ring,followed by inserted from the extraperitoneal space to the outer edge of the spermatic cord blood vessel.The needle was again inserted at the outer edge of the spermatic cord blood vessel,and the suture tail was gently pulled outside the body.Under direct laparoscopy,the retroperitoneal space near the insertion point was enlarged.Afterwards the suture was crossed the surface of the spermatic cord blood vessel in the retroperitoneal space.In the same way the extracorporeal suture traction was engaged to expand folded peritoneum and enlarge extraperitoneal space for convenience of needle passing through the Doom's triangle,as well as the vas deferens.The inner wall and upper wall peritoneal tissue of the inner ring were continuously sutured under direct visualization.The needle was removed and a knot was made at the initial insertion point,with the inner ring opening being closed.Results In 292 sides,after extracorporeal suture was used to stretch the folded peritoneum,the suture was able to smoothly cross the spermatic cord blood vessels,the Doom's triangle,and the surface of the vas deferens.The operating time for unilateral hernia was(18.5±3.2)min in80 cases and for bilateral hernia was(32.6±5.3)min in106 cases.No intraoperative complications were found and all the patients were discharged from hospital within 6 hours.A total of 122 cases were followed up for 3-18 months(mean,8.5 months)after surgery.No complications such as incision infection,iatrogenic cryptorchidism,or testicular atrophy were observed.There were no recurrent hernia or hydrocele.Conclusion For indirect hernia with folded peritoneum around inner ring orifice,extracorporeal suture traction effectively expands the folded peritoneum,and assists the needle with suture passing through the surface of spermatic cord blood vessels,the Doom's triangle,and the vas deferens in extraperitoneal space,and decreases the difficulty of surgery,presenting better safety and feasibility.

Transumbilical Approach Repair for Hernia of Linea Alba Within 3 cm Above the Umbilicus in Children / 中国微创外科杂志

Objective To investigate the safety and effectiveness of transumbilical repair for hernia of linea alba within 3 cm above the umbilicus.Methods Clinical data of 26 patients who underwent transumbilical approach hernia repair in our hospital from June 2016 to July 2022 were retrospectively analyzed.Color ultrasound examination showed that the distance from the lower edge of the hernia to the upper edge of the umbilicus was≤3 cm.The hernia repair was performed through the fascial space via the upper edge approach of the umbilical ring.There were 7 boys and 19 girls.The age was 7 months to 11 years old(median,3 years old).The distance from the lower edge of the hernia sac to the upper edge of the umbilicus was(1.46±0.66)cm,and the diameter of the hernia of linea alba was(1.16±0.57)cm.Results The surgery was completed smoothly.The operation time was(39.1±26.3)min.No complication was noted.All the patients were discharged one day after surgery.The follow-ups lasted for 1 year and 2 months to 7 years and 3 months(median,5 years and 1 month).No wound infection,bleeding or other complications occurred.No recurrence of hernia or formation of skin granulomas happened.Conclusion Transumbilical approach repair for hernia of linea alba within 3 cm above the umbilicus is safe and effective,with good cosmetic results.

Clinical Analysis of 12 Cases of Trocar Site Hernia After Laparoscopic Surgery / 中国微创外科杂志

Objective To summarize the clinical features,diagnosis and treatment and prognosis of trocar site hernia(TSH).Methods Clinical data of 12 patients with TSH receiving laparoscopic surgery from January 2019 to January 2023 were retrospectively analyzed.The clinical manifestations included intestinal obstruction in 8 cases,trocar incision prolongation with fluid seepage in 1 case,and no obvious symptoms in 3 cases.The patients were diagnosed by abdominal CT in 9 cases,by small intestine contrast imaging in 1 case,by abdominal MRI in 1 case,and by abdominal plain film combined with abdominal color ultrasound in 1 case.The hernia was located in the right lower abdomen in 5 cases,the left lower abdomen in 4 cases,and the right upper abdomen in 3 cases.The trocar diameter was 12 mm in 6 cases,10 mm in 5 cases,and 5 mm in 1 case.A drainage tube was placed at trocar site in 5 cases.Open operations were performed in 11 cases,including small intestine reduction and abdominal wall layer-by-layer suture in 4 cases,partial small intestine resection and anastomosis in 3 cases,Onlay repair in 3 cases,and partial omentectomy,transverse colon reduction and Onlay repair in 1 case.Another case developed trocar site refractoriness which did not heal,and the patient refused surgery,who was given dynamic observation.Results The operation was successful in the 11 cases.Postoperatively,1 case of inflammatory intestinal obstruction underwent intestinal decompression tube implantation,1 case of incision bleeding underwent emergency operation again to stop bleeding,and the rest recovered smoothly.All the 12 patients were followed up for 5-48 months,with a median of 13 months.The patient without surgery had persistent induration and intermittent exudation at the trocar site.One case died due to tumor metastasis,and none of the others had hernia recurrence.Conclusions The most common manifestation of TSH is intestinal obstruction,which mostly occurs at trocar with diameter≥10 mm.If there are symptoms,it should be treated by surgery as soon as possible.

Application of Veress Needle in Single-port Laparoscopic High Ligation of Processus Vaginalis / 中国微创外科杂志

Objective To explore the application value of single-port laparoscopic high ligation of processus vaginalis by using the Veress needle.Methods A retrospective analysis was conducted on data of 51 cases of single-port laparoscopic high ligation of processus vaginalis with the Veress needle from January 2021 to March 2023.A Veress needle was used instead of hernia needle to perform high ligation of processus vaginalis.Results All the operations were successful without additional auxiliary ports or conversion to open surgery.The time of unilateral operation in 46 cases was 6-15 min(mean,8.9±1.9 min).The bilateral operation time in 5 cases was 13-19 min(mean,15.4±2.3 min).After 6 months of follow-up after surgery,there was no recurrence in all children,and no complications such as suture knot reaction,scrotal edema,scrotal hematoma,iatrogenic cryptorchidism,and testicular atrophy occurred.Conclusions Single-port laparoscopic high ligation of processus vaginalis by using the Veress needle has the advantages of single-port surgery,single puncture,and simple performance.The therapeutic effect is definite and it is worthy to be popularized.

Advances in the diagnosis and treatment of ureterosciatic hernia / 现代泌尿外科杂志

Ureterosciatic hernia is a rare type of pelvic floor herniation with no typical symptoms. The resulting ureteral obstruction may lead to hydronephrosis and complications such as urinary tract infection and urosepsis.Fewer than 40 ureterosciatic hernia cases have been reported all over the world. Active surveillance, manual reduction, ureteral stenting and surgical repair are common treatment options. Among them, the safety and effectiveness of laparoscopic herniorrhaphy have been recognized. This article review the advances in the diagnosis and treatment of ureterosciatic hernia.

Non-reducible inguinoscrotal hernia of the urinary bladder as a direct component of a pantaloon hernia: A case report and review of literature

@#Pantaloon hernias are a subset of abdominal hernias wherein both indirect and direct components of inguinal hernias are present on one side. Inguinoscrotal hernia of the urinary bladder is a rare condition involved in less than 4% of inguinal hernias and more so if they are part of a direct component of a pantaloon hernia. This is a case of a 65-year-old male who presented a non-reducible right inguinoscrotal mass. Inguinoscrotal herniation of the urinary bladder was preoperatively diagnosed through imaging. Intra-operatively a pantaloon hernia was noted with the herniated urinary bladder as the direct component and omentum as the indirect component. The patient underwent cystourethroscopy, inguinal exploration right, and mesh hernioplasty. The patient had an unremarkable post-operative course and was discharged with improved conditions. Awareness of this clinical condition will aid in the diagnosis, and proper management and prevent post-operative complications.

Traumatic lumbar hernia: A systematic review of the literature / 中华创伤杂志(英文版)

PURPOSE@#Traumatic lumbar hernia (TLH) constitutes a protrusion of content through a defect in the posterior abdominal wall, as a result of injury. This rare entity has been described in limited number of cases.@*METHODS@#A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology guidelines. The English literature from 1990 until 2021 was reviewed, using PubMed, EMBASE and Google Scholar bibliographic databases, to identify case reports and case series with patients that were diagnosed with TLH. For each eligible study, demographics, clinical presentation, hernia characteristics, preoperative imaging investigations, operation details, and postoperative data were extracted for assessment. Statistical analysis was performed on SPSS, version 20.0.@*RESULTS@#A total of 62 studies were included for review, with 164 patients with TLH. Mean age was (42.6 ± 14.3) years (47.6% males, 31.1% females, gender not specified in 35 cases). Mean diameter of hernia neck was (6.3 ± 3.1) cm, while the triangles of Petit and Grynfeltt were affected in 74.5% and 14.6%, respectively. Patients diagnosed in the emergency setting account for 54.2%, with CT scan establishing diagnosis in all but one case (97.7%). A delayed diagnosis was made in 45.8%, at a mean 1 year following trauma. Flank bulging (82.8%) and chronic back pain (34.3%) were the most frequent symptoms. In both delayed and acute group, open surgery (63.6% and 92.3%, respectively) was the preferred surgical approach. Postoperative complications were reported in 11.4% of acute and 15.0% of delayed patients. Hernia recurrence was 7%.@*CONCLUSIONS@#TLH is uncommon with 164 cases described since 1990. CT scan is the gold standard in diagnosis. Open surgery is generally the preferred approach, particularly in the emergency setting. Acute TLH can be treated either by primary suture repair or mesh, depending on the local conditions, whereas delayed cases usually require a mesh.

Analgesic effect of different regional block techniques guided by ultrasound in older adult patients undergoing inguinal hernia repair surgery / 中国基层医药

Objective:To investigate the analgesic effect of ultrasound-guided transversus abdominis plane block versus ultrasound-guided quadratus lumborum block in older adult patients undergoing inguinal hernia repair surgery. Methods:A total of 150 older adult patients who underwent inguinal hernia repair surgery at the Marine Police Corps Hospital of Chinese People's Armed Police Force from April 2019 to May 2022 were included in this study. They were randomly divided into a control group ( n = 75) and a study group ( n = 75) using a random number table method. All patients underwent elective laparoscopic tension-free inguinal hernia repair surgery. Patients in the control group received ultrasound-guided transversus abdominis plane block after inguinal hernia repair surgery, while those in the study group received ultrasound-guided quadratus lumborum block. The changes in Visual Analog Scale (VAS) score and Ramsay score within 48 hours after surgery were compared between the two groups. Inflammatory factors and stress factors including serum tumor necrosis factor alpha, interleukin-6, norepinephrine, and cortisol, were measured at 24 and 48 hours after surgery. The use of analgesics, drug-related adverse reactions, and incidence of nerve block-related complications within 48 hours after surgery were also compared between the two groups. Results:There was no significant difference in Ramsay score between the two groups at 4, 8, 12, 24, and 48 hours after surgery (all P > 0.05). There was no significant difference in VAS score between the two groups at 4 and 8 hours after surgery (both P > 0.05). At 12, 24, and 48 hours after surgery, the VAS score in the study group was (1.36 ± 0.57) points, (2.05 ± 0.56) points, and (1.79 ± 0.55) points, respectively, which were significantly lower than (1.92 ± 0.59) points, (2.68 ± 0.62) points, and (2.36 ± 0.59) points in the control group ( t = 6.65, 7.31, 5.86, all P < 0.001). At 24 and 48 hours after surgery, serum tumor necrosis factor alpha, interleukin-6, norepinephrine, and cortisol levels in the study group [24 hours: (63.89 ± 4.65) ng/L, (156.59 ± 8.62) ng/L, (97.02 ± 6.95) g/L, (36.95 ± 3.26) g/L; 48 hours: (49.66 ± 3.74) ng/L, (131.45 ± 7.73) ng/L, (74.63 ± 5.91) g/L, (30.41 ± 2.96) g/L] were significantly lower than those in the control group [24 hours: (76.42 ± 5.17) ng/L, (189.32 ± 10.41) ng/L, (105.53 ± 7.83) g/L, (45.16 ± 3.74) g/L; 48 hours: (58.15 ± 3.94) ng/L, (162.74 ± 8.49) ng/L, (89.51 ± 6.37) g/L, (36.92 ± 3.31) g/L, t = 10.49-26.38, all P < 0.001]. The proportion of patients who received analgesics within 48 hours after surgery in the study group was 8.00% (6/75), which was significantly lower than 25.33% (19/75) in the control group ( χ2 = 8.11, P = 0.004). The overall incidence of drug-related adverse reactions within 48 hours after surgery in the study group [6.67% (3/75)] was significantly lower than that in the control group [11% (11/75), χ2 = 4.61, P = 0.032]. Conclusion:Compared with ultrasound-guided transversus abdominis plane block, ultrasound-guided quadratus lumborum block better helps alleviate postoperative pain in older adult patients undergoing inguinal hernia repair surgery, inhibits inflammation and stress reactions, reduces the dosage of analgesic drugs, and decreases the incidence of adverse drug reactions.

Clinical significance of chorda arteriae umbilicalis in laparoscopic transabdominal preperitoneal hernia repair / 局解手术学杂志

Objective To investigate the clinical significance of the chorda arteriae umbilicalis in laparoscopic transabdominal preperi-toneal(TAPP)hernia repair.Methods The clinical data of 60 patients with inguinal hernia admitted to Xinrui Hospital in Xinwu District of Wuxi City from June 2019 to June 2022 were analyzed,and the patients were randomly divided into two groups according to whether the chorda arteriae umbilicalis was used as a marker during operation.Both the control group and the observation group were operated according to the routine procedure.The observation group exposed the chorda arteriae umbilicalis,which was used as a reference to precisely free the surgical plane and gap to complete the parietalization of spermatic cord,meanwhile,the angle formed by the intersection of the deferens and umbilical artery cord was used to assist in fixing the patch.The operation time,time of parietalization of spermatic cord,hospital stay,bladder surface bleeding volume,removal rate of hernial sac,the occurrence of postoperative complications and recurrence of patients were compared between the two groups.Results There was no significant difference in the operation time,removal rate of hernial sac,hospital stay,recurrence rate or the incidence of postoperative complications such as chronic pain,uroschesis of patients between the two groups(P>0.05).The time of parietalization of spermatic cord,bladder surface bleeding volume,and incidence of seroma of patients in the observation group were shorter/lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion The chorda arteriae umbilicalis has a constant morphology and relatively fixed anatomical position and alignment.The chorda arteriae umbilicalis can be used as a reference and guiding mark,especially when the anatomical layer is dense and unclear or strayed into the layer in TAPP hernia repair,whihc can guide to operate at the correct layer,standardize the parietalization of spermatic cord,reduce bleeding and vice-damage,and also assist the fixation of the patch and prevent the displacement of the patch.