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【Objective】 To explore the rational management of contralateral patent processus vaginalis (CPPV) in laparoscopic high ligation of processus vaginalis. 【Methods】 A total of 300 children with unilateral oblique inguinal hernia/hydrocele who received laparoscopic high ligation of processus vaginalis in Baoding Children’s Hospital during Jun.2018 and Jun.2022 were selected and divided into two groups by random number table method, with 150 in either group. In the control group, 53 cases of CPPV were found intraoperatively, which were treated simultaneously. In the study group, 58 cases of CPPV were detected, among which 11 met the indications of high ligation and received simultaneous surgical treatment. The incidence of recurrence was compared between the two groups. 【Results】 After 1 year of follow-up, the recurrence rate was 8.62% in the study group and 1.88% in the control group (P>0.05). The detection rate of CPPV was 23.02% in children with unilateral inguinal hernia, significantly lower than that in children with unilateral hydrocele (49.07%, P<0.001). The detection rate of CPPV was 42.71% in children with left patent processus vaginalis and 32.95% in children with right patent processus vaginalis (P=0.19). The detection rate of CPPV was 62.93% in the age group of 1-2 years, significantly higher than that in other age groups (P<0.001). 【Conclusion】 The incidence of CPPV conversion into oblique inguinal hernia or hydrocele is low. Only children who meet the indications can be treated at the same time during surgery.
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Objective:To explore the clinical value of single-hole laparoscopic percutaneous extraperitoneal closure operation using a Kirschner wire assisted double-hook water-injection hernia needle in treating complicated pediatric oblique inguinal hernia.Methods:The clinical data of 366 children with oblique inguinal hernia treated in the Department of Urology Surgery, Children′s Hospital of Nanjing Medical University from December 2020 to October 2021 were retrospectively analyzed.According to the surgical methods, the children were divided into the ordinary crochet needle group and the Kirschner wire assisted group.Children treated by a single-port laparoscopic double hook water-injection hernia crochet needle (309 cases) were classified into the ordinary crochet needle group.Children treated by a single-port laparoscopic Kirschner wire assisted double hook water-injection hernia crochet needle (57 cases) were included in the Kirschner wire assisted group.The independent sample t-test and rank sum test was used to compare the relevant clinical indicators between the two groups. Results:Compared with the ordinary crochet needle group, children in the Kirschner wire assisted group were younger at surgery[(2.87±1.88) years vs.(4.91±2.39) years] and had larger hernia sacs [17 303.89(8 622.49, 37 295.42) mm 3vs.9 650.97(3 849.24, 17 539.51) mm 3]. The differences in the age at surgery and hernia sac volume were statistically significant ( t=-5.407, Z=-4.218; all P<0.001). There was no significant difference in body mass index between the 2 groups ( P>0.05). Taking hernias with sac volume >10 000 mm 3 as huge hernias, there were 70.18%(40/57 cases) and 47.25%(146/309 cases) of huge hernias in the Kirschner wire assisted group and the ordinary crochet needle group, respectively.The overall operation time of the Kirschner wire assisted group was significantly longer than that of the ordinary crochet needle group[(20(15, 20) min vs.15(15, 20) min] ( Z=-2.842, P<0.05). However, the operation time for huge oblique hernias with sac volume >10 000 mm 3 was not statistically significant between the 2 groups ( P>0.05). No recurrence in both groups was found during 6-16 months of follow-up. Conclusions:For complicated oblique inguinal hernia in children with a huge hernia or obvious retroperitoneal folds at the internal ring and heavy scar adhesion between the hernia sac and abdominal wall, the insertion of a Kirschner wire can help the hernia crochet needle to traverse the vas de-ferens and spermatic cord vessels smoothly.As a single port laparoscopic operation, the Kirschner wire assisted hernia crochet needle requires no addition of trocar holes and leaves only a small surgical scar.With good feasibility and safety, it is applicable for clinical popularization.
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Objective Through a prospective randomized controlled study , comparing the effects of three different anesthetic methods on the patients quality of recovery ( QoR ) score and surgical satisfaction after oblique inguinal hernia repair ( OIHR) .Methods Ninety patients who had underwent OIHR were divided into three groups:nerve block group(NB), spinal anesthesia group(SA) and combination of NB and single low-dose SA group(NB+SA). The first two were treated as control groups .Each group had equally thirty cases .The primary outcome was QoR score and surgical satisfaction , while the secondary outcomes included intraoperatively-adjuvant intravenous admin-istration, mean blood pressure (MBP) and heart rate (HR) during operation.Results The QoR score (median, interquartile range ) in NB+SA group was significantly higher than that of NB group and SA group in the first day af-ter surgery (P<0.05),which was NB group QoR 15(13,18),SA group QoR 16(15,17) and NB+SA group QoR 18(16,19)respectively.The second day after the surgery, the QoR score (median, interquartile range) in NB+SA group was still higher than that of SA group (P<0.05),which was correspondingly NB group QoR 18(15,20), SA group QoR 17(16,19) as well as NB+SA group QoR 20(18,20).As for surgical satisfaction, surgeons are more content with the method of NB+SA than that of SA and NB ( P<0.05 ) .In terms of adjuvant intravenous administra-tion, it was most common in NB group followed by NB +SA group and SA group ( P<0.05 ) .Conclusions Compared to NB and SA , patients with NB+SA have higher QoR and surgical satisfaction after surgery .
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Objective To explore the clinical effect of laparoscopic operation in the treatment of children with incarcerated oblique inguinal hernia.Methods 60 cases of children with incarcerated oblique inguinal hernia in our hospital from February 2012 to June 2014 were retrospectively analyzed.30 children undergoing laparoscopic op-eration were set as the observation group and 30 other patients undergoing traditional emergency operation as the con-trol group.The two groups were compared in terms the operation time, incision length, postoperative complications, hospitalization expenses and other data.Results The average operation time, bleeding quantity, length of incision, and hospitalization expenses in the observation group were lower than those of the control group.6 months of follow-up showed no recurrence in the two groups.Conclusion Laparoscopic operation in the treatment of children with in-carcerated oblique inguinal hernia is characterized by fast surgery, minimal incision, less complications, accurate de-termination of the incarcerated tissue activity, visibility of the side occult hernia and lower recurrence rate.Therefore, it is worthy of promotion and application.
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Objective To discuss the effect of psychological intervention on children patients after the operation of pedo-oblique inguinal hernia. Methods 960 children patients were randomly divided into the experimental and the control groups with 480 cases in each group, the control group adopted routine nursing measures, the experimental group also received psychological intervention based upon base nursing. The postoperative pain, wound flare and the recurrence of the two groups were compared. Results 193 patients had postoperative pain, 2 patients had wound flare and 3 patients recurred in the experimental group. 310 patients had postoperative pain,36 patients had wound flare and 11 patients recurred in the control group. Conclusions Psychological intervention can decrease the postoperative complication of pedooblique inguinal hernia, psychological nursing must be paid attention to in nursing work.
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Objective To investigate the modified herniorrhaphy method for adult oblique inguinal hernia. Methods From June 2001 to June 2005,the clinical data of 56 paitients with oblique inguinal her-nias were analyzed retrospectively. Results Rapid recovery,with few complication as well as low cost were achieved.Follow-up time was in 6 months to 5 years.Postoperative recurrence was not found. Conclusion With modified herniorrhaphy,the normal anatomical structure of internal ring were restored and the trans-verse fascia defect are strengthened at the same time. Normal anatomical structure of inguinal canal are main-tained. This procedure possesses a higher cure rate and postoperative recurrent rate may be reduced obviously.