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Young patients have unique characteristics in terms of body structure and fertility needs. There is currently no consensus on the definition and treatment of inguinal hernia in adolescents and young adults. Biodegradable meshes are materials derived from homologous or heterologous tissues, which retain the three-dimensional fiber structure containing collagen after special processing. They can meet the requirements of high comfort and low impact on fertility while ensuring repair strength. The authors define inguinal hernia in young adults based on recent research results and summarize the application effect of biological meshes.
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In the past, hernia and abdominal wall surgery has been ignored, which may endanger the life of patients due to untimely treatment. In 1997, the concept of tension-free hernia repair was introduced to China. Chinese hernia and abdominal wall surgery entered a new era and developed rapidly. In 2015, scholars in China decided to create our own Hernia Registry. In 2017, Hernia Registry was officially released, and the Chinese Hernia Surgery Alliance was established in the same period. The Chinese Hernia Registry has became the second largest Hernia clinical registry database in the world. Although the follow-up rate needs to be improved, it is possible to have a preliminary understanding and analysis of the incidence of hernia disease in China. There are many difficulties in its application, and it requires the multi-level coordination and long-term commitment. The authors hope that through this work, the diagnosis and treatment of hernia and abdominal wall can be improved, and the ability of communication and cooperation at home and abroad will be enhanced, benefiting the general population of hernia patients.
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Hernia is a most common disease requiring surgery.In recent years,the number of newly emerging patients with inguinal hernia is 300-400 million cases per year and surgical amount of tension-free hernia repair surpasses 150 million cases per year in China.However,overall effects of hernia treatment are unsatisfactory and complications such as postoperative infection,chronic pain and hernia recurrence have troubled clinical surgeons and patients.How to improve diagnosis and treatment of hernia and abdominal wall surgery,how to achieve clinical data accumulation with which to evaluate,monitor and normalize medical behavior,how to realize polycentric data sharing,Chinese hernia registry and follow-up system provides effective helps for above mentioned aspects,especially lays a solid foundation for clinical standardization,quality monitoring,scientific research enhancement,ultimately provides mutual rewarding for both patients and clinical surgeons.
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Objective To explore the efficacy of debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair.Methods From January 2007 to December 2013,208 cases with nesh infections following inguinal hernia repairs were treated with debridement in Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital,147 cases were treated with primary suture (suture group) and 61 cases were treated with dressing change (open group).Results The mean time of mesh infection was (8.37 ± 6.89) months.The results of bacterial culture in the two groups were similar.First grade healing rate of suture group was 80.95% (119/147),compared to zero percent in open group.Length of stay [(20.86 ± 7.90) d vs.(31.82 ± 11.50) d,t =3.47,P =0.034] and hospital cost [(3 200 ± 5 800) yuan vs.(26 500 ± 6 600) yuan,t =4.51,P =0.02] in suture group were less than in open group.No patients developed recurrent hernia in suture group compared with one recurrence in open group.Conclusions Debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair could increase the rate of first grade healing,shorten average length of hospital stay and reduce total costs.
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Currently,the number of abdominal surgery has gradually increased,accompanied by the increasing of ventral hernia and parastomal hernia patients.The main reason is abdominal incision or abdominal stoma destroying the normal abdominal muscle fascia,as well as obesity,malnutrition,ascites,diabetes,infections leading to poor wound healing.The incidence of abdominal wall incisional hernia after abdominal surgery accounts for about 80% of ventral hernia.These incisional hernias and some other ventral hernias may easily become large ventral hernia without the standard treatment.Surgery is the only effective treatment for large ventral hernia.However,such hernia repair for surgeons is a great challenge.In clinical practice,after removing the huge sac and completely resetting the contents of the hernia sac can lead to decreasing of intraperitoneal volume and increasing of intra-abdominal pressure,or even lead to occurrence of abdominal compartment syndrome (ACS).The increasing of intra-abdominal pressure and occurrence of ACS has aroused the attention of clinicians after large ventral hernia operation.Some content reduction operation in the process of large ventral hernia surgery can effectively reduce postoperative intra-abdominal pressure,occurrence of intra-abdominal hypertension and ACS.More and more patients with large ventral hernia underwent the abdominal content reduction surgery combined with hernia repair.But there is still lack of evidencebased medical researches on large simples.Therefore,it still needs multi-center prospective clinical study on large samples to provide clinical treatment strategies for the volume reduction surgery and more base for further researches and clinical applications.
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Objective To construct new model of experimental abdominal aortic aneurysm (AAA) and detect the AAA outer diameter and the change of induce nitric oxide synthase(iNOS) in the abdominal aor-tic aneurysm in different period,and analysis the correlation between experimental AAA and iNOS.Methods During the operation of the experiment group,the vascular prosthesis of PTFE was implanted to the rabbit abdominal aorta to form an aneurysm,while sham operation was done in the control group.The tissue of ab-dominal aortic aneurysm was harvested in 1 d,7d,14d,and 28d after operation,respectively.The tissue bo-mogenate concentration of iNOS in the abdominal aortic aneurysm were detected by enzyme linked immu-nosorbent assay (ELISA).Results In experimental group,mean concentration of the tissue bomogenate concentration of iNOS in the abdominal aortic aneurysm in 1 d,7 d,14 d,28 d were (22.129 ±2.518)μ/mL,(27.337±5.321) μ/mL,(36.047±4.584)μ/mL,(44.756±1.799)μ/mL,respectively;In control group,that was (12.499±1.807)μ/mL.The concentration of iNOS in experimental group was significantly higher than that of control group (P < 0.01).The difference during the experimental group all had statisti-cal significance (P < 0.05).Conclusion It is possible that iNOS has some biological function during the formation and progression of the abdominal aortic aneurysm.
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Abdominal aortic aneurysm is one kind of common disease in clinic. For the disruption and followed high mortality, it has already caused people's deep concern. For the past few years, nitricoxide syn-thase has played an important role in the processes and development of abdominal aortic aneurysm. This arti-cle gave an overview of the subject.