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Objective:To investigate the safety and effectiveness of tension adjustment technique using anatomical landmarks during retropubic midurethral synthetic sling.Methods:The data of 36 consecutive female patients with urinary incontinence, who had underwent retropubic midurethral synthetic sling procedure from January to August 2019 were analyzed retrospectively. The mean age was (60.83±7.93) years old and the body mass index was (24.43±2.44) kg/m 2. Among the recruited subjects, 36 had positive stress test and Marshall-Marchetti test. 20 (55.6%) were pure stress urinary incontinence, and 16 (44.4%) were mixed urinary incontinence. The severity of incontinence was classified into mild (5 cases, 13.9%), moderate (14 cases, 38.9%), severe (13 cases, 36.1%) and very severe (4 cases, 11.1%) using one-hour pad tests. Urodynamics were performed in 17 cases, with 5 (29.4%) presented detrusor overactivity, 3 (17.7%) possessed intrinsic sphincter deficiency. For each case, the tension of the sling was adjusted based on the anatomical landmarks, i. e. using an angled clamp attached closely to the pubic symphysis ventrally and the tip parallel to the edge of hymen dorsally. All patients were catheter-free right after the procedure. The subjective and objective effectiveness, and safety (the rate of urinary retension after surgery and postvoid residual volume 3 months later) were evaluated.The subjective cure rate was was defined as complete leakage free or very mild leakage during excessive bladder filling and fierce cough. The subjective effectiveness was defined as over 50% improvement of the leakage symptom. The objective cure rate was defined as a negative stress test. Results:For all 36 patients, the median hospital stays was 8 (5-95)h. No bladder perforation or transfusion cases. All patients were catheter-free right after the procedure, with no incidence of urinary retention. 27 patients completed a 3-month follow-up, with 22 had post-void residual data, 23 had subjective effectiveness data and 23 had objective effectiveness data. The median post-void residual was 7.5 (5-64) ml, subjective cure rate was 91.3% (21/23), and objective cure rate was 95.7% (22/23). 8.7% (2/23) reported difficult urination alleviated without the necessity of clinical interference. No urethra erosion or vagina extrusion was found. At 2-year follow-up, 34 patients completed assessment by phone. The subjective cure rate was 91.2% (31/34), with only 2.9% (1/34) reported difficult urination. Besides, at 3-month follow-up, there was no difference regarding the subjective cure rate [100.0%(12/12) vs. 81.8%(9/11)]or objective cure rate [91.7%(11/12) vs. 100.0%(11/11)] between patients with stress and mixed incontinence. No difference was noted among patients with mild, moderate, severe and very severe leakage[75.0% (3/4) vs. 100.0%(6/6) vs. 90.0%(9/10) vs. 100.0%(3/3)]. Of the 12 cases with urodynamic records, the presence of detrusor overactivity [66.7%(2/3) vs. 88.9%(8/9)] or intrinsic sphincter deficiency [0(0/1) vs. 90.9%(10/11)] did not significantly affected the cure rate of the procedure. At 2-year follow-up, there was no difference regarding the subjective cure rate between patients with stress and mixed incontinence [94.7%(18/19) vs. 86.7%(13/15)]. No difference was also noted among patients with mild, moderate, severe and very severe leakage[80.0%(4/5) vs. 100.0%(13/13) vs. 83.3%(10/12) vs. 100.0%(4/4)]. Of the 16 cases with urodynamic records, the presence of detrusor overactivity [60.0%(3/5) vs. 90.9%(10/11)]or intrinsic sphincter deficiency [66.7%(2/3) vs. 84.6%(11/13)]did not significantly affected the cure rate of the procedure.Conclusions:Tension adjustment using anatomic landmarks during sling procedure is safe and feasible for urinary incontinence, with minimum complications and residual volume, and high subjective/objective cure rate.
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BACKGROUND: Chronic pain after tension-free inguinal hernia repair is a common postoperative complication. An important cause of chronic pain is nerve injury. OBJECTIVE: To observe the effect of iliohypogastric nerve preposition on chronic pain after inguinal hernia repair and analyze its mechanics. METHODS: Totally 76 male inguinal hernia patients, from August 2013 to November 2016, aged 36-95 years in Second People’s Hospital of Lianyungang were selected. The patients were all treated with large-size polypropylene non-absorbable mesh insertion. The iliohypogastric nerve was placed in front of the mesh. Pain was followed up at 3, 6, and 12 months after operation. This study was approved by the Ethics Committee of Second People’s Hospital of Lianyungang. RESULTS AND CONCLUSION: (1) No chronic pain or recurrence was found in the 76 patients at 3, 6 and 12 months after surgery. (2) The pressure included vertical pressure and tangent pressure formed from intra-abdominal pressure on abdominal wall, directly affecting abdominal wall and artificial repair materials. This was the basic cause of the relative mechanical relationship between nerve and mesh. (3) The results showed that the tension-free inguinal hernia repair with the iliohypogastric nerve preposition could reduce the incidence of postoperative chronic pain, which may be related to the effect of postoperative abdominal pressure on tissue repair, especially the repair around the mesh.
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Trans-obturator tape (TOT) and tension free vaginal tape (TVT) procedures are efficient treatment options, which reduce the surgical complications and provide adequate support to urethra in case of increased abdominal pressure to prevent stress urinary incontinence (SUI). The aim of this study is to evaluate the effect and efficacy of 3D printed female anatomical model on the training of TOT and TVT procedures. A 3D printed female anatomical model was produced for MedTRain3DModSim, Erasmus+ European Union project led by Turkey with the participation of Greece, Italy, Czech Republic and South Korea. Face and content validities of the model evaluated by the participants and the experts respectively. During two learning & teaching & training activities and a multiplier event of the project between 2016 and 2018; 41 medical students, 30 residents and 19 specialists of urology and gynecology were educated and performed TOT and TVT procedures with this model under the mentorship of 3 experts. All participants were assessed and scored for their achievement on both procedures with model according to 7 parameters by the experts. There was no statistical difference between the students and residents for each parameter. All the parameters of the students and specialists were statistically different. 3D anatomical models produced from real data and mimicking different types of tissues are suitable for basic anatomy education of students and residents, hands on training for junior surgeons before cadaveric courses in hybrid education system, surgical planning of the surgeons and informing the patients before the operation.
Los procedimientos de cinta transobturadora (TOT) y cinta vaginal sin tensión (TVT) son opciones de tratamiento eficientes, que reducen las complicaciones quirúrgicas y proporcionan un soporte adecuado a la uretra en caso de aumento de la presión abdominal para prevenir la incontinencia urinaria de esfuerzo (IUE). El objetivo de este estudio fue evaluar el efecto y la eficacia del modelo anatómico femenino impreso en 3D en el entrenamiento de los procedimientos TOT y TVT. Se produjo un modelo anatómico femenino impreso en 3D para MedTRain3DModSim, proyecto Erasmus + de la Unión Europea dirigido por Turquía con la participación de Grecia, Italia, la República Checa y Corea del Sur. Validez facial y de contenido del modelo fueron evaluados por los participantes y los expertos respectivamente. Durante dos actividades de aprendizaje, enseñanza y capacitación y un evento multiplicador del proyecto entre 2016 y 2018; 41 estudiantes de medicina, 30 residentes y 19 especialistas en urología y ginecología fueron capacitados y realizaron procedimientos TOT y TVT de este modelo bajo la tutoría de 3 expertos. Todos los participantes fueron evaluados y calificados por los expertos, por su logro en ambos procedimientos con el modelo de acuerdo con 7 parámetros. No hubo diferencia estadística entre los estudiantes y los residentes para cada parámetro. Todos los parámetros de los estudiantes y especialistas fueron estadísticamente diferentes. Los modelos anatómicos en 3D producidos a partir de datos reales e imitando diferentes tipos de tejidos son adecuados para la educación básica de anatomía de estudiantes y residentes. Además de ofrecer una capacitación práctica para los cirujanos antes de los cursos cadavéricos en el sistema educativo, y una planificación quirúrgica de los cirujanos e información para los pacientes antes de la cirugía.
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Humanos , Femenino , Incontinencia Urinaria de Esfuerzo , Sistema Urinario/anatomía & histología , Cabestrillo Suburetral , Modelos Anatómicos , Impresión TridimensionalRESUMEN
When a part of neural tube fails to develop or close properly, it manifests as spina bifida. Spina bifida defects range from the mild form (spina bifida occulta) to severe form (meningomyelocele). Meningomyelocele is to be closed surgically as early as possible to prevent infection and other complications. Many methods are available for treatment of meningomyelocele defects ranging from skin graft to flap cover. Meningomyelocele defects when small in size can be closed primarily. Large meningomyelocele defects poses technical challenge to reconstructive surgeon. Many flap cover techniques were described to cover the large meningomyelocele defects. We wanted to evaluate bilateral opposing fasciocutaneous flaps method for closure of large defects without tension.METHODSTo cover large meningomyelocele defects, fasciocutaneous flaps give good and stable cover, and prevents wear and tear, and infections. We have used double opposing fasciocutaneous flaps method for reconstruction of large meningomyelocele defects. The advantages of this technique are its simplicity and it being a single stage procedure. 20 children with meningomyelocele defects of various sizes were operated with this method and followed for 6 months for wound dehiscence and CSF leak.RESULTSClosure of large meningomyelocele defects is made possible with simple and easy technique. Ease of planning and execution even for the inexperienced are the most noticeable features. All children were well post operatively. Two patients in whom flaps were taken with acute angles suffered tip necrosis. All flaps gave stable cover to the defect without dehiscence at the suture line. The entire reconstructive process consumed less time and was without major complications.CONCLUSIONSNeural tube malformation congenitally causes spina bifida defects. Spina bifida cases may range from simple to severe defects. Treatment of meningomyelocele spans from primary closure to flap cover closure. Closure of large meningomyelocele defect by bilateral fasciocutaneous flaps is a good method to adopt. This method is simple, less time consuming, technically non-demanding and easily reproducible.
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Background: Inguinal hernia repair is one of the most commonly performed procedures by general surgeons. Cyanoacrylate is the generic name for a family of fast acting adhesives. The aim of the present study done in Department of General Surgery, Safdarjung Hospital, New Delhi was to compare the newer emerging technique of mesh fixation.Methods: A total of sixty patients were included in the present study and were allotted in case and control group randomly by sealed envelope technique. In case (study) group, all the patients underwent mesh fixation by cyanoacrylate glue and in control group, by prolene 3-0 sutures.Results: Most frequency in age group 31-40 yrs, males:females ratio >1 and right sided inguinal hernia was more common. Bi-lateral hernia was common in elderly. Indirect: direct ratio 4.5:1. Operating time period for the patients of the case (study) group is less than control group. P value of post-operative pain in immediate post-operative period (day 1 and 2) and POD 30, 60 and 90 was not of clinical significance whereas the p-value on 6,120,150 and 180 post op day was of clinical significance. In our study, there was a case of incidental observation: a) reaction due to use of cyanoacrylate glue, b) rejection of mesh for which mesh had to be removed.Conclusions: There is no statistically significant difference between mesh fixation with cyanoacrylate glue and mesh fixation by prolene suture techniques in immediate post-operative pain. Statistically significant difference favoring mesh fixation by cyanoacrylate glue technique was seen with respect to operating time and post-operative groin pain with increasing post-operative duration.
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Inguinal hernia is one of the common diseases in general surgery, and tension-free hernia repair is the most common treatment for inguinal hernia. Patch infection is the common complication after hernia repair, confuses many of the general surgeons for its complex condition and long duration. The pathogenetic factors of patch infection can be roughly divided into three aspects, which include patients' physical condition, operation details, material and structure of patch. Prevention in advance of the susceptible factors of mesh infection can significantly improve the prognosis of patients. As for the treatment of patch infection, there is no unified standard yet, and individual treatment plans should be formulated according to the patient's condition and experience of the clinician. This article reviews the latest research progress of the occurrence, diagnosis, prevention and treatment of patch infection after tension-free hernia repair.
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The World Health Organization defines youth as 14 to 25 years old, and the inguinal hernia patients in this age group are still in the development stage of the body with special physiological characteristics and special needs for the protection of reproductive functions. Therefore, the repair method should be carefully selected for the special group and the principle of individualized treatment should be adhered to.The synthetic mesh has problems such as failure to extend with body growth, excessive scar hyperplasia compressing the spermaduct, and long-term invasion. The biological patch also has the risk of long-term recurrence or local bulging. For youth, standard tissue repair surgery can mending the defect well, with reasonable perioperative management, also can minimize the discomfort, which caused by excessive early postoperative tension. At the same time, tissue repair can adapt to the growth of the body, with relatively small impact on reproductive function, or can be combined with biological materials to repair large defects if necessary. After mastering tissue repair technology, the recurrence rate of tissue repair is acceptable. Therefore, tissue repair is of irreplaceable value in the treatment of young inguinal hernia patients.
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The adolescent inguinal hernia has particularity in modern surgical treatment. Because of in the stage of growth and development, it can not be used only for the inguinal hernia sac high ligation, nor can it be treated as an adult inguinal hernia with artificial synthesis material mesh.Therefore, there are still many disputes in adolescent inguinal hernia treatment. As a kind of absorbable material, biologic mesh can repair inguinal hernia defect and induce the growth of cells and fibrous tissue to repair the defect of the inguinal wall. It can be degraded and absorbed by the body after the repair of the defect by the proliferation of autologous tissue,which does not affect the growth and development of adolescents,and its advantages have been affirmed by more scholars. Biologic mesh has become an ideal choice for the repair of inguinal hernia in adolescents.
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Objective To investigate the effect of laparoscopic total extraperitoneal tension-free hernia repair (TEP) in the treatment of inguinal hernia with absorbable biological mesh.Methods A retrospective analysis of the clinical data of 19 patients with inguinal hernia with biological mesh was performed from September 2015 to September 2016 in Shengjing Hospital of China Medical University.The average operative time,average incision pain time,average postoperative venting time,average hospital stay,average operative cost,and long-term chronic pain,postoperative complications,and recurrence rate were observed.Results All the 19 patients were successfully operated.The average operation time was (35.0 ± 4.0) min,the average incision pain time was (1.5 ± 0.6) d,and the average postoperative venting time was (1.5 ± 1.2) d.The average hospital stay was (4.5 ±0.9) d,the average surgery cost was (23 534.6 ± 1 259.9) yuan.Two patients developed swelling of the scrotum after surgery,and one patient developed postoperative fat liquefaction.All patients were followed up for 1 year by telephone,with no recurrence,no serious complications,and chronic pain discomfort.Conclusions The application of absorbable biopsy TEP is a good and reliable way to treat inguinal hernia.Postoperative patients have mild pain and low complication rate.There is no recurrence in recent follow-up,and the short-term effect is satisfactory.It is a reliable method for the treatment of inguinal hernia.The cost is high,and can be selected according to age and individual needs.
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Objective To explore the efficacy and safety of modified transobturator tape (TOT) for female stress urinary incontinence (SUI).Methods From June 2015 to June 2017,a total of 87 SUI patients,including 35 patients underwent standard TOT operation (standard TOT group) and 52 patients underwent modified TOT operation (modified TOT group),were retrospectively reviewed.There was no statistical difference of age [(59.7 ± 10.3) yea~ vs.(56.3 ± 9.1) years],BMI [(24.I ± 9.7) kg/m2 vs.(24.6 ± 9.3) kg/m2],diabetes history [31.4％ (11/35) vs.26.9％ (14/52)],mixed urinary incontinence [45.7％ (16/35) vs.48.1％ (25/52)] and the daily amount of urine pad [(4.3 ±2.7) vs.(3.9 ± 2.1)] between the two groups (P ＞ 0.05).The operative time,intraoperative complications,and postoperative complications were collecteded in two groups.Patients were followed up at 3 months,6 months,and 1 year after surgery.Results There was no significant difference in operation time [(21.1 ± 4.3) min vs.(20.5 ± 5.7) min],intraoperative hemorrhage [(18.3 ± 9.1) ml vs.(25.7 ± 8.3) ml] and postoperative incidence of urinary retention [2.9％ (1/35) vs.3.8％ (2/52)] between the two groups (P ＞ 0.05).The incidence of postoperative leg pain was significantly lower in modified TOT group than in TOT group[1.9％ (1/52) vs.20.0％ (7/35),P ＜ 0.05].There was no significant difference in subjective cure rate and objective cure rate between the two groups at 3 months,6 months and 1 year after surgery (P ＞ 0.05).Conclusions Compared with the standard TOT,the modified TOT of modified puncture port has a similar cure rate and efficiency.However,the use of modified TOT can significantly reduce the incidence of postoperative short-term leg pain,but the long-term efficacy still needs to be further followed-up.
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Objective To explore the clinical effect of tension-free repair in the treatment of inguinal hernia in elderly patient.Methods A total of 124 elderly patients with inguinal hernia admitted in our hospital in 2016 were randomly divided into a study group(n=62)and a control group (n=62).The control group was treated with open tension-free inguinal hernia repair,whereas with laparoscopic tension-free inguinal hernia repair in the study group.The operation time,intraoperative blood loss,the postoperative pain relief-time,mean days of hospitalization,postoperative recurrence rate,and complications rates were compared between the two groups.Results The more significant improvements were found in study group versus control group in the intraoperative bleeding volume [(19.9±2.0)ml vs.(36.8±-2.5)ml,t=41.564,P=0.000],in the mean hours of postoperative pain [(22.1 ± 4.2) h vs.(35.3 ± 7.0) h,t =12.732,P =0.000],in mean days of hospitalization [(5.5 ± 1.0)d vs.(9.2±1.9)d,t=13.569,P=0.000],in incidence rate of postoperative recurrence(0.0％ vs.6.5％,x2 =4.133,P=0.042),and in postoperative complications rate(3.2％ vs.12.9％,x2 =3.916,P=0.048).Nevertheless,the operation time was longer in the study group than in the control group[(87.0±5.0)min vs.(55.5±4.2)min,t=-37.984,=0.000],Conclusions As compared with open tension-free repair,the clinical efficacy of laparoscopic tension-free hernia repair is exactly sure in the treatment of inguinal hernia,with shorter postoperative hospitalization time and lower incidence of complications.
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Objective To investigate the incidence and influence factors of chronic postoperative inguinal pain (CPIP) after tension-free repair for inguinal hernia.Methods The retrospective case-control study was conducted.The clinicopathological data of 1 188 patients who underwent tension-free repair for inguinal hernia in the People's Hospital of Xinjiang Uygur Autonomous Region between January 2011 and August 2017 were collected.Observation indicators:(1) surgical and postoperative situations;(2) follow-up;(3) influence factors analysis of CPIP.Follow-up using outpatient examination and telephone interview was performed to detect inguinal pain and complications at 1,3,6 months and 1 year postoperatively up to August 2018.Measurement data with normal distribution were represented as x ±s.Measurement data with skewed distrubution were described as M (range).The univariate and multivariate analysis were done using the chi-square test and Logistic regression model.Results (1) Surgical and postoperative situations:1 188 patients underwent successful tension-free repair for inguinal hernia.Eighty-five patients (7.155％,85/1 188) had CPIP,including 76 (8.370％,76/908) undergoing open surgery and 9 (3.214％,9/280) undergoing laparoscopic surgery.(2) Follow-up:1 188 patients were followed up for 12-36 months,with a median time of 19 months.Incidence rates of CPIP with visual analogue score ＞ 3were 11.785％(140/1 188),7.155％(85/1 188),5.808％(69/1 188),3.199％(38/1 188) at 1,3,6 months and 1 year postoperatively.Patients were given individualized and reasonable treatment according to their own conditions and CPIP was relieved after conservative treatment including drug treatment,physiotherapy such as acupuncture,nerve block and psychotherapy.Of 5 patients with CPIP after tension-free repair for inguinal hernia undergoing surgeries,1 was relieved nerve ligation by surgery,3 with mesh related pain were removed meshes,1 was taken the fixed stiches out.They were relieved CPIP after above treatments.During the follow-up,161 patients with incisional seroma,75 with incisional infection and 5 with disruption of wound were cured by symptomatic treatments including reinforced incision management,dressing change and physiotherapy.Seven patients with mesh infection were removed meshes.Of 68 patients with hernia recurrence,53 had reoperation,18 complicated with diseases induced severe increased intra-abdominal pressure were suggested to undergo surgeries after treatment of complications.(3) Influence factors analysis of CPIP:① results of univariate analysis showed that sex,age,bodymass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection were related factors affecting CPIP after tension-free repair for inguinal hernia (x2 =21.002,6.715,6.012,8.563,11.887,49.447,10.025,P＜0.05).② Results of multivariate analysis showed that sex,body mass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection were independent related factors affecting CPIP after tension-free repair for inguinal hernia (odds ratio =1.267,2.986,1.661,3.208,2.034,1.871,95％ confidence interval:1.042-1.392,1.372-4.901,0.998-2.758,1.933-6.013,1.556-3.118,1.095-3.534,P＜0.05).Conclusions Sex,body mass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection are independent related factors affecting CPIP after tension-free repair for inguinal hernia.Preoperative pain management and psychological counseling,intraoperative refine performance,inguinal nerve protection and postoperative incisional management should be reinforced to prevent and reduce incidence of CPIP.
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Objective To investigate the clinical effect of mesh plug tension-free hernia repair on inguinal hernia and its impact on microenvironment related indicators in patients.Methods A total of 128 cases of patients with inguinal hernia admitted in our hospital were divided into control group and observation group with 64 cases in each group.The control group was treated with traditional hernioplasty,while the observation group mesh plug ten-sion-free hernia repair.The clinical effect and microenvironment related indicators 1d after the operation were com-pared between the two groups. Results Compared with the control group,the observation group had less blood loss during the surgery,and shorter time for recovery of out-of-bed ambulation and hospitalization(P<0.01),but no significant difference was found regarding surgery hours(P > 0.05). The VAS scores of the observation group were significantly lower than those of the control group at the same time points 1 and 3 days after operation(P <0.01). Compared with those of control group 1 day after operation,the serum beta-endorphin(β-EP)of observa-tion group was significantly reduced,but total antioxidant capacity(T-AOC),growth hormone(GH),insulin (InS)level increased significantly(P<0.01).Serum matrix metalloproteinases-9(MMP-2 and MMP-9)and tis-sue inhibitor of matrix metalloproteinases(TIMP-1 and TIMP-2)were significantly reduced(P<0.01).Acute uri-nary retention,scrotal effusion,the incidence of postoperative pain and postoperative recurrence rate of observa-tion group were significantly reduced when compared with those of control group(P < 0.01);there was no differ-ence of incidence of low thermal between the two groups(P>0.05).Conclusion Mesh plug tension-free hernia repair has a significant clinical effect on inguinal hernia with less complications,lower recurrence rate and lighter impact on microenvironment related indicators.
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Objective To investigate the effect of collagen line in the tension－free suture of the incision of oral implant and the effect on the healing time of the wound. Methods 100 patients were selected from January 2016 to January 2017 for repair of dental implant in Zhong Hua Dental clinic of Jinghong city, and they were randomly divided into control group and study group,with 50 cases in each group. The control group was treated with non absorbable sutures of silk suture wounds, while the study group using collagen suture wounds, then we compared two groups of patients with wound healing grade, suture line absorption, wound healing time and formation rate. Results The research group of grade A healing rate was 96%, significantly higher than 80% in the control group (P＜0.05), and the adverse reactions of the study group was 6%, lower than 20% in the control group (P＜0.05);the complete absorption rate and smooth incision rates in the study group for suture in different times were 84%, 96% 100%, and 86%, which were significantly higher than the control group's 62%, 78%, 80% and 68% (P＜ 0.05) . The wound's healing time and postoperative VAS score of 3 d, 5 d and 7 d were significantly lower than the control group (P＜0.05) . Conclusion Collagen line in oral implant surgery incision tension－free suture of wound healing and postoperative recovery is significantly better than that of silk and non absorbable sutures, and collagen can be degradated orally,which effectively improves the wound healing of patients with grades and wound flat rate, and effectively accelerates wound healing, with the value of application.
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ABSTRACT:Objective To evaluate the curative effect of tension-free vaginal tape-obturator (TVT-O)and modified TVT-O in treating female stress urinary incontinence (SUI).Methods We selected 1 1 3 female patients diagnosed with SUI from January to December 2013 in our department and divided them into standard TVT-O group (group A,5 6 cases)and modified TVT-O group (group B,5 7 cases).We evaluated prospectively the safety,short-term efficacy and complications of operation in the two groups.Results The length from bilateral obturator membrane to the puncture point in the skin was greater in group A than in group B.The average intraoperative blood loss was more in group A than in group B.The median NRS score of postoperatie thigh pain in group A was higher than in group B (P0.05).Conclusion Both TVT-O and modified TVT-O techniques are effective in treating female SUI.Modified TVT-O has a short path to get through the adductor muscles and less intraoperative blood loss;therefore,it can significantly reduce the complications such as postoperative pain to enhance the quality of life after operation.
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Objective To investigate the effect of fentanyl citrate combined with psychological intervention on the treatment of elderly patients with inguinal hernia tension-free repair. Methods From May 2015 to May 2017, 110 elderly cases with inguinal hernia tension-free repair were divided into two groups, the control group and the observation group according to the different nursing intervention mode . The control group were received routine nursing intervention combined with midazolam. The observation group were given fentanyl citrate and routine nursing care combined with psychological intervention. The effect and safety in the two groups were recorded and compared. Results The curative effect in the observation group was remarkable, and the indexes during the operation were better than those in the control group. The incidence of adverse reactions was lower than that in the control group, and the nursing satisfaction was higher than that in the control group, the difference was statistically significant (P<0.05). Conclusion The effect is remarkable which Fentanyl citrate combined with routine nursing and psychological intervention were used on the treatment of elderly patients with inguinal hernia tension-free repair, the body indexes are stable, has less adverse reaction and high nursing satisfaction, is worthy of clinical application.
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Objective:To explore the necessity of the preventive use of antibiotics and the effects of age and operation time on the efficacy of inguinal hernia repair without tension,and to elucidate the clinical significance of the preventive application of prophylactic antibiotics in inguinal hernia repair without tension.Methods:A total of 228 patients with inguinal hernia repair without tension were selected,amomg them 42 cases with high infection factors were treated with antibiotics (treated group),and 186 cases were not treated with antibiotics(untreated group) during the preoperative period.The prophylactic antibiotics were given 30 min before surgery,and the conventional dose was not used more than 48 h after surgery.All the cases were treated with artificial repair materials for the procedure of inguinal hernial repair without tension.The age,highest body temperature,white blood cell count,operation time,hospitalization time,and postoperative body temperature of all the 228 cases were recorded and analyzed statistically.Results:The preoperative and postoperative white blood cell counts had significant differences between the patients0.05).Compared with the patients with the operation time>90 min,the white blood cell count and hospitalization time of the patients with the operation time ≤90 min were increased (P90 min and the patients with the operation time≤90 min (P>0.05).The white blood cell count,operation time,hospitalization time and postoperative body temperature of the patients between treated group and untreated group had no significant differences (P>0.05).Conclusion:The use of antibiotics in the high-risk patients and non-use of antibiotics in the majority of elective inguinal hernia repair without tension can ensure the safe and performability of the patients.
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Hernia is ancient and common.With the emerging of new concepts,techniques,materials and equipments,treatment methods of hernia have undergone ever-changing changes in the 21st century.Hernia and abdominal wall surgery in China has been developing fast in the past 20 years,and has achieved remarkable progress.However,some problems still exist,such as unbalanced regional development,concept misunderstanding,classification confusions,less standardized technology,poor follow-up method,lack of innovation,and so on.Therefore,it's crucial to recognize the shortcomings of the current stagey,discuss the existing problems,sum up experiences and lessons,and clarify the direction of improvement,in order to provide a solid foundation for the sustainable development of hernia and abdominal surgery for our country.
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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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PURPOSE: To evaluate the impact of preoperative patient characteristics and flow rate on failure, early postoperative complications, and voiding in patients who underwent transvaginal tension-free vaginal tape-obturator (TVT-O) treatment for uncomplicated stress urinary incontinence (SUI). METHODS: We retrospectively reviewed patients who underwent TVT-O for SUI at 3 Italian centres. The exclusion criteria were predominant voiding and storage symptoms suggestive of detrusor overactivity, the presence of grade >1 urogenital prolapse, previous pelvic radiotherapy or other clinical contraindications for surgical procedures, neurogenic bladder dysfunction, and collagen diseases. Multivariate logistic regression models were constructed to identify predictors of early voiding dysfunction after TVT-O. RESULTS: A total of 219 patients underwent TVT-O between January 2010 and December 2015. All patients received follow-up at 3, 6, and 12 months, and underwent a stress test, uroflowmetry, and bladder ultrasound to evaluate the postvoid residual volume. They also responded to the Urogenital Distress Inventory (UDI-6) questionnaire. The rates of persistent incontinence after TVT-O, postoperative complications, and satisfaction were 16.4% (36 of 219), 24.2% (53 of 219), and 86.3% (189 of 219), respectively. Nineteen patients (9.5%) experienced early voiding dysfunction. Based on an analysis of baseline characteristics, we determined that a cutoff value of 9.0 on the UDI-6 predicted postoperative SUI with 62% specificity, 72% sensitivity, and 66% accuracy. In the multivariate logistic regression analysis, a preoperative UDI-6≥9.0 was an independent predictor of postoperative SUI. The predictors of complications were menopause (P = 0.04) and the preoperative UDI-6 score (P = 0.01). CONCLUSIONS: Menopause and UDI-6 scores could be prognostic factors for persistent SUI after TVT-O. Well-designed prospective studies with a suitable number of patients are needed to corroborate our findings.