Clinical effect of mesh plug tension-free hernia repair on inguinal hernia and its impact on microenviron-ment related indicators / 实用医学杂志

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.

Comparison between tension-free inguinal hernia repair with mesh plug and tension-free repair of preperi-toneal space with middle abdominal incision / 实用医学杂志

Objective To conduct a comparative study on postoperative complications and patients′quali-ty of life between tension-free inguinal hernia repair with mesh plug(Rutkow operation)and tension-free repair of preperitoneal space with middle incision of lower abdomen(Open TEP operation).Methods A retrospective anal-ysis of 122 cases of inguinal hernia was conducted.And 62 cases of Open TEP operation were concluded into obser-vation group and 60 cases of Rutkow operationinto control group. The basic information of the surgery,postopera-tive complications and the score of quality of life before and after treatment were compared between 2 groups. Results No bladder injury,ductus deferens damage,infections or hematoma on incisions were found after opera-tion and no relapse,patch rejection,infections or atrophia testiculi were seen during the follow-up. The incision pain of observation group lasted shorter than that of control group(P<0.01),while other operational indexes show no great difference(P > 0.05). The incidence of postoperative complications of observation group was 11.29%, much lower than that of control group(P<0.01).Both PCS and MCS scores of 2 groups after treatment increased obviously as compared with those before treatment(P<0.01),but the rise in observation group were more signifi-cant(P<0.01).Conclusion Less postoperative pain and complications,and better life quality are found in the treatment of inguinal hernia with open TEP operation outperforms Rutkow operation.

Evaluación: Resultados a 16 años de las dos técnicas más comunes de hernioplastía inguinal abierta / Assessment: Results at 16 years of the two most common techniques used in open inguinal hernioplasty

Objetivo: Evaluar los resultados obtenidos durante 16 años en los pacientes sometidos a reparación abierta, con las dos técnicas más comunes: Lichtenstein y Mesh Plug. Sede: Hospital regional 2do nivel de atención. Diseño: Estudio observacional, descriptivo, comparativo, retrospectivo. Análisis estadístico: t de Student y Chi cuadrada. Material y métodos: Se valoraron 1,293 procedimientos de Lichtenstein y 5,889 de Mesh-Plug, realizados de julio de 1993 a junio de 2002, seguidos hasta 2009 con promedio de 132 meses. Ambos procedimientos estandarizados de acuerdo a las técnicas originales, efectuadas por cirujanos generales no especialistas en hernia. Variables evaluadas: tiempo quirúrgico, estancia hospitalaria, ahorro en días cama, días de incapacidad, recurrencias, morbilidad y dolor crónico. Resultados: La media de tiempo quirúrgico en el procedimiento de Lichtenstein fue de 59 minutos, y con ''Mesh-Plug'' 25 minutos. Permanencia hospitalaria de 7.5 horas con Lichtenstein contra 3.5 horas de ''Mesh-Plug''. Ahorro de 26,573 días cama y 201,096 días de incapacidad laboral. Morbilidad de 1.04%. Recurrencia de 0.59% y 9 pacientes con inguinodinia crónica que requirieron retiro de material protésico. Conclusiones: Ambos procedimientos son seguros con pocas consecuencias nocivas. Mesh-Plug fue más rápida en su conformación hasta en un 50%, la estancia hospitalaria corta favoreció ahorros sustanciales en días de incapacidad y días-cama.

Objective: To evaluate the results obtained during 16 years in patients subjected to open hernia repair with the two most common techniques: Lichtenstein and Mesh-Plug. Setting: Second health care level hospital. Design: Observational, retrospective, descriptive, comparative study. Statistical analysis: Student's t and square chi tests. Material and methods: We assessed 1,293 Lichtenstein and 5,889 Mesh-Plug procedures, performed from July 1993 to June 2002, followed for an average of 132 months. Both procedures were standardized according to the original techniques and performed by general surgeons, not specializing in hernia. Assessed variables were: surgical time, hospital stay, savings in bed-days, working incapacity days, recurrences, morbidity, and chronic pain. Results: The mean of surgical time for the Lichtenstein procedures was of 59 min, and 25 min for the Mesh-Plug, Length of in-hospital stay with Lichtenstein was 7.5 h versus 3.5 h with the Mesh-Plug. Savings in bed-days amounted to 26,573 and 201,098 days of working incapacity days. Morbidity of 1.04%. Recurrence of 0.59%, and nine patients coursed with chronic inguinodynia and required retrieval of the prosthetic material. Conclusions: Both procedures are safe and have few noxious consequences. The mesh plug technique was faster in 50%, the shorter in-hospital stay favored substantial savings in working incapacity and bed days.

The placement and fixation of mesh plug and patch in tension-free hernioplasty / 中国医师进修杂志

Objective To explore the method of correctly placing and fixing mesh plug and patch in tension-free hernioplasty. Methods The data of 123 cases of plug-mesh tension-free hernioplasty with the method of placing and fixing mesh plug and patch were reviewed. Observed the incidence of postoperative effusion, infection, sinus formation, skin flap necrosis and hernia recurrence. Results All patients were restored after operation 8 days. Followed-up 1.5 -10.0 years,there was no incision effusion, infection,skin flap necrosis in all cases. No relapse happened on the operated side and 5 cases of inguinal hernia occurred on the non-operated side. Conclusions Mesh plug and patch must be placed to cover the whole abdominal wall defects,and contact closely with surrounding healthy tissue. They need to be placed neatly,fixed firmly and perpetually without any damage to the normal tissue structure.

Comparison of Three Types of Hernioplasty Using Meshes for Adult Inguinal Hernia: Lichtenstein, Mesh-plug, Prolene Hernia System

PURPOSE: The aim of this study was to compare three types of hernioplasty using a mesh: Lichtenstein, Mesh-plug and Prolene Hernia System. METHODS: From February 2002 to April 2007, we retrospectively studied the clinical outcome of 138 cases of adult inguinal hernia patients who had operations performed with the use of mesh. Three types of mesh operations were composed of Lichtenstein repair group (LR group; N=18), Mesh plug repair group (MR group; N=38) and Prolene hernia system group (PHS group; N=82). The Clinical features and outcomes of the three groups were compared by age, sex, operation time, lengths of hospital stay, numbers of post-operative intravenous analgesics, complications, and recurrence. RESULTS: Mean age of three groups was 50.2+/-20.7, 51.0+/-18.4 and 61.5+/-15.9 years for LR. MR, PHS groups, respectively. The PHS group was significantly older than other two groups (P=0.002). The sex, operation time and lengths of hospital stay were not significantly different among the three groups. Numbers of intravenous analgesics used after the operations were 1.7+/-1.2, 2.7+/-2.2, 3.3+/-2.0 in the LR, MR, PHS groups, respectively. A lesser amount of IV analgesics was injected into the LR group than the PHS group. Although some complications occurred such as wound infection, hematoma, dehiscence, testicular edema in the three groups, there were no significant differences among the three groups. There were no recurrences in all three groups. CONCLUSION: We could not find any better outcome among the LR, MR and PHS groups.

The causes of postoperative complications of mesh plug hernia repair / 国际外科学杂志

Objective To analyze the causes of postoperative complications of Mesh plug hernia repair of inguinal hernia. Methods The 332 ingunial hernia patients from June 2002 to May 2007 who underwent Mesh plug repair were summarized retrospectivdy. the causes of postoperative complications were analyzed. Results All the patients were followed up 15～60 months.there were 3 cases of durative pain,1 case of recurring,16 cases of scrotal edema,20 cases of urinary retention. Condusion Anatomizing carefully during operation is the key to decrease the postoperative complications of Mesh plus hernia repair.

A Comparison of Three Methods of Hernioplasty for Adult Inguinal Hernia: Bassini Repair Versus Lichtenstein Repair Versus Mesh-Plug Repair

PURPOSE: The aim of this study was to compare three methods of hernioplasty: the Bassini, Lichtenstein and mesh- plug repair, and to ascertain the usefulness of mesh- plug repair. METHODS: Patients with primary a unilateral inguinal hernia who underwent Bassini (n=41), Lichtenstein (n=41) or a mesh-plug repair (n=40) between January 2000 and December 2002 were retrospectively reviewed. The clinical features analyzed were age, gender, operation time, use of postoperative analgesics, and length of hospital stay, complications, and recurrence. RESULTS: The operation times were (mean+/-SD) 57.3+/-5.4, 65.9+/-5.7 and 53.2+/-5.4 min for the Bassini (BR), Lichtenstein (LR), and mesh-plug repair groups (MR), respectively (P<0.001). The average number of analgesics used after the operations were 8.1+/-1.7, 4.9+/-1.3 and 2.8+/-0.8 in the BR, LR and MR groups, respectively (P<0.001). The lengths of hospital stay were 6.3+/-2.2, 4.4+/-0.7 and 3.7+/-0.8 days in the BR, LR and MR groups, respectively (P<0.001). There were three and two postoperative hematomas and two and one wound infections in the BR and LR groups, respectively but no postoperative complications in the MR groups. Two patients in the BR group had a recurrence, but there were no recurrences in the LR and MR groups. CONCLUSION: The mesh-plug repair is superior to the Bassini and Lichtenstein repairs in terms of operation time, postoperative pain and length of hospital stay. However, there were no significant differences between the groups in terms of postoperative complications and recurrences.

Strangulated Obturator Hernia: Mesh-Plug Technique

Although obturator herniae are rare, they are associated with a high mortality, as diagnosis is often delayed and the condition tends to occur in the elderly. The preoperative diagnosis is difficult because of nonspecific symptoms and sign. They often produce a small bowel obstruction. The treatment is always surgical. Several repair techniques have been described: a sac ligation alone, a direct suture repair, and the use of autologous tissue or prosthetic repair. Recently, the placement of permanent mesh prostheses, in a clean contaminated operative field, has been performed due to the minimal wound-related morbidity and patient mortality. Thus, utilization of a permanent mesh in an obturator hernia is a new, simple and effective method for repair. Two cases of a strangulated obturator hernia were experienced in elderly women. The peritoneal cavity was not overly contaminated, with only necrotic foci on the herniated small bowel wall noted. A segmental resection of the small bowel was performed. Consequently, the hernia defect was closed with mesh- plug between the peritoneum and periosteum of the obturator foramen. Here, two cases of obturator herniae treated by use of a mesh-plug are reported, with a brief review of the literature.

New Tension-free Hernioplasty Using Umbrella- Shaped Mesh

PURPOSE: Lichtenstein`s tension-free repair & mesh-plug hernia repair are the most frequently used procedures for inguinal hernia repair by american surgeons. A new tension- free hernioplasty procedure, maintaining the advantages of both of these procedures, was invented by an experienced surgeon in our hospital. In this procedure, an umbrella- shaped mesh is applied to the entire posterior wall, not only to the defective area. We analyzed the results of this procedure in comparison with those from conventional repair (Bassini procedure). METHODS: From March 1998 to March 2001, 69 cases of hernioplasty were performed by one staff surgeon. Among these cases, we excluded 2 cases of bilateral inguinal hernia, 1 case of femoral hernia, and 6 cases which were impossible to follow up. In addition, we analyzed 29 cases of tension-free hernioplasty using an umbrella-shaped mesh (U group) and 31 cases of conventional repair (B group). Retrospective chart reviews and telephone interviews were carried out. Operation duration, length of hospital stay, period of analgesics use, complications, time required to return to usual activity, and recurrence were compared between these two groups. RESULTS: No significant differences were found concerning operation duration, period of hospital stay, complications, and time for return to usual activity. The period of analgesic use was significantly shorter in the U group than in the B group (p=0.001, 2.0 days vs 2.9 days). Only one recurrence occurred in B group. CONCLUSION: This new procedure has all the properties of tension free hernioplasty and plug hernia repair. This procedure can be used for all types of inguinal hernia and for a much lower cost than the preformed plug method. No incidence of recurrence was found folling the use of this procedure.

Mesh Plug Hernia Repair

PURPOSE: A mesh plug hernia repair has revealed encouraging results in inguinal hernia repair. This article compares our results with both conventional hernia repair and the mesh plug hernia repair procedure. METHODS: From January 1999 to October 2000, we performed 171 herniorrhaphies. Among these cases, we analyzed 49 cases of mesh plug hernia repair and 47 cases of conventional hernia repair. We recorded incidents of recurrence, postoperative complications, surgical time, duration of hospital stay, and the use of narcotics and antibiotics. RESULTS: There were no significant differences observed concerning recurrence, postoperative complications, duration of hospital stay, or the use of antibiotics and analgesics, however the surgical time was significantly reduced in the mesh plug hernia repair procedure. (55.51+/-25.46 minutes versus 65.65+/-18.87 minutes, P<0.05) CONCLUSION: Compared with the conventional sutured surgical technique, a mesh plug hernia repair uses less overall dissection and ensures a tension free hernioplasty, resulting in a shortened surgical time, greater patient comfort, rapid rehabilitation, decreased recurrence and lower rates overall complications.