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Objective:To investigate the effects of compression treatment on occurrence of venous thromboembolism (VTE) after tension-free inguinal hernia repair.Methods:The retrospective cohort study was conducted. The clinical data of 13 263 patients with inguinal hernia who were admitted to 58 medical centers from January to December in 2017 were collected, including 1 668 in Beijing Chaoyang Hospital of Capital Medical University, 782 in East Hospital Affiliated to Tongji University, 558 in Huadong Hospital of Fudan University, 525 in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 488 in Ruijin Hospital of Shanghai Jiaotong University School of Medicine, 382 in Tianjin People's Hospital, 378 in Peking University Third Hospital, 364 in Beijing Hospital, 356 in Shengjing Hospital of China Medical University, 348 in Huashan Hospital of Fudan University, 348 in Sichuan Provincial People's Hospital, 328 in Affiliated Hospital of Zunyi Medical University, 304 in Beijing Luhe Hospital of Capital Medical University, 296 in People's Hospital of Changshou District in Chongqing, 290 in Anhui Provincial Hospital, 281 in the First Affiliated Hospital of Dalian Medical University, 281 in Xinjiang Uygur Autonomous People's Hospital, 247 in Qilu Hospital of Shandong University, 220 in Wuhan NO.1 Hospital, 214 in the First Hospital of China Medical University, 213 in West China Hospital of Sichuan University, 206 in the Second Affiliated Hospital of Chongqing Medical University, 202 in Taiyuan Central Hospital of Shanxi Medical University, 197 in the First Affiliated Hospital of Wenzhou University, 191 in Zhongda Hospital of Southeast University, 190 in Tianjin Medical University General Hospital, 189 in Xuzhou Central Hospital, 188 in the First Affiliated Hospital of Harbin Medical University, 187 in the Second Hospital Affiliated to Naval Medical University, 175 in Chengdu Fifth People's Hospital, 173 in Tianjin Nankai Hospital, 172 in the Fourth Affiliated Hospital of China Medical University, 172 in Zhangjiakou First Hospital, 161 in Henan Provincial People's Hospital, 153 in the First Affiliated Hospital of Xi'an Jiaotong University, 149 in Shandong Provincial Hospital, 142 in the Second Hospital of Shandong University, 137 in the First Affiliated Hospital of Hunan University of Medicine, 136 in the Fourth Hospital of Harbin Medical University, 127 in Pingjiang District of the First Affiliated Hospital of Soochow University, 102 in the Central Hospital of Wuhan, 100 in the First Affiliated Hospital of Soochow University, 98 in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences, 97 in the First Affiliated Hospital of Chongqing Medical University, 96 in Xijing Hospital Affiliated to Air Force Medical University, 90 in the Fourth Medical Center of Chinese PLA General Hospital, 81 in Hunan Provincial Hospital of Traditional Medicine, 80 in the First Hospital of Tsinghua University, 80 in Xinhua Hospital of Hubei Province, 61 in the First Affiliated Hospital of Zhengzhou University, 57 in Peking University International Hospital, 50 in Peking University First Hospital, 39 in Zhongnan Hospital of Wuhan University, 38 in Jilin Yan'an Hospital, 37 in China-Japan Union Hospital of Jilin University, 20 in Taikang Xianlin Drum Hospital, 16 in Chinese PLA General Hospital, 3 in the First Affiliated Hospital of Fujian Medical University. There were 11 852 males and 1 411 females, aged from 18 to 102 years, with a median age of 64 years. Of 13 263 patients, 9 995 with compression treatment after tension-free inguinal hernia repair were divided into compression group and 3 268 without compression treatment after tension-free inguinal hernia repair were divided into non-compression group. Observation indicators: (1) compression treatment of patients in the compression group; (2) occurrence of VTE after tension-free inguinal hernia repair in the two groups; (3) analysis of influencing factors for VTE after tension-free inguinal hernia repair. Follow-up using telephone interview was performed to detect history of patient's thrombosis, medical history of patient's family and the incidence of postoperative VTE up to February 2018. Measurement data with skewed distribution were represented as M ( P25, P75) or M (range), and comparison between groups was analyzed using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate analysis and multivariate analysis were conducted using the Logistic regression model. Results:(1) Compression treatment of patients in the compression group: of the 9 995 patients in the compression group, 6 086 underwent compression treatment with 0.5 kg of sandbag or 500 mL of packed 0.9% sodium chloride solution, 1 881 underwent compression treatment with trusses, 745 underwent compression treatment with girdles, 675 underwent compression treatment with elastic underwear combined with 0.5 kg of sandbag, and 608 underwent compression treatment with elastic underwear. (2) Occurrence of VTE after tension-free inguinal hernia repair in the two groups: patients of the two groups after matching were followed up. Occurrence of VTE after matching were 15 and 1 in the compression group and non-compression group, respectively, showing no significant difference between the two groups ( χ2=2.010, P>0.05). (3) Analysis of influencing factors for VTE after tension-free inguinal hernia repair: results of univariate analysis showed that cases with varix of lower limb, cases with oral contracep-tives or hormone replacement therapy history, cases with VTE history, clinical classification, clinical typing, surgical method, cases with anticoagulant drugs history, cases undergoing oral antiplatelet drugs, cases undergoing postoperative VTE prevention with medication were related factors for occurrence of VTE after tension-free inguinal hernia repair ( odds ratio=13.98, 37.71, 19.21, 4.43, 4.21, 0.07, 0.08, 0.10, 31.04, 95% confidence interval: 3.15?62.11, 8.35?170.24, 6.15?60.00, 1.43?13.76, 1.20?14.82, 0.01?0.49, 0.02?0.27, 0.04?0.29, 8.53?112.93, P<0.05). Results of multivariate analysis showed that cases with VTE history and surgical method were independent influencing factors for occurrence of VTE after tension-free inguinal hernia repair ( odds ratio=7.78, 11.19, 95% confidence interval: 2.06?29.42, 1.45?86.55, P<0.05). Conclusion:Cases with VTE history and surgical method are independent influencing factors for occurrence of VTE after tension-free inguinal hernia repair.
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Background: Hernia is a common problem of the modern world with an incidence ranging from 5 to 7%. Of all groin hernias, around 75% are inguinal hernias. Recently with the advancement in laparoscopy, endoscopic repairs seem to offer better quality of life, decreasing hospital stay and early return to work. Aim of the work was to evaluate a new technique for mesh fixation by Zein method of suturing and compare it with stapled mesh fixation in laparoscopic inguinal hernia repair transabdominal preperitoneal approach.Methods: The study is a randomized, prospective single group study. The study was conducted after the approval of the ethical committee of the surgical department, Menoufia University. It was conducted in Menoufia University Hospital on 50 patients with inguinal hernia who were operated upon between September 2018 and September 2019 with a minimal follow-up of 6 months.Results: Age of studied patients ranged from 27 to 55 years with mean 42.82±7.90 age/years. Regarding sex of studied patients, more than half (74%) of studied patients were males and (26%) were females. Regarding comparsion between high and low overall cost burden on the patient, it was interestingly found that high cost is associated with presence of complication like hematoma, prolonged stay in the hospital and prolonged use of antibiotics.Conclusions: Both the use of sutures and fixation of mesh by absorbable tacks approaches are similarly effective in terms of operative time, the incidence of recurrence, complications, and chronic pain coinciding with all the available literature.
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Background: The Desarda repair for inguinal hernias is a new tissue-based technique. Application of the external oblique muscle aponeurosis in the form of un-detached strip has been established as a new concept in tissue-based hernia repair.Methods: A prospective study was conducted among 126 cases with 148 inguinal hernias repaired by Desarda’s technique for a period of 3 years in Dr. B. R. Ambedkar Medical College and Hospital, Bangalore, Karnataka, India. The details pertaining to duration of hospital stay, pain, ambulation and complications were recorded.Results: The mean age of the patients was 38.4 years. Mean operating time was 62.5 min for unilateral and 123 min for bilateral hernias. About 97.8% patients were ambulatory within 6.42 hours and were freely mobile within 19.26 hours after surgery. About 96.4% patients returned to work within 6-14 days. About 91.26% patients were discharged on same day. The mean hospital stay duration of the patients was 1.11 days. Postoperative pain on movement out of bed was described as mild and tolerable in 92.6% patients on day 1. Two patients had seroma that subsided on its own. There were no long-term complications, recurrence of the hernias or chronic groin pain.Conclusions: The results of this new technique (Desarda repair) using continuous absorbable sutures appear promising. The continuous suturing saves time and just one packet of suture material without mesh saves cost.
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Objective@#To investigate the effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) on postoperative seroma.@*Methods@#The prospective study was conducted. The clinical data of 128 male patients with primary indirect inguinal hernia who were admitted to Fujian Medical University Union Hospital from October 2017 to March 2019 were selected. Patients were divided into two groups by random number method. Patients in experimental group had hernia sac stump sutured and fixed at the lower margin of rectus abdominis after transection of hernia sac in TAPP, and patients in control group had hernia sac stump free in the abdominal cavity after dissection and transection of hernia sac in TAPP. Observation indicators: (1) surgical situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect the incidence of postoperative seroma, incision infection, chronic pain, and hernia recurrence up to June 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test.@*Results@#A total of 128 male patients were screened for eligibility, including 60 patients in the experimental group and 68 patients in the control group. The 128 patients were aged from 47 to 74 years, with an average age of 61 years. (1) Surgical situations: operation time and hospital expenses were (102±34)minutes and (12 813±2 390)yuan for the experimental group, and (97±30)minutes and (12 125±2 205)yuan for the control group, respectively, showing no significant difference between the two groups (t=0.907, 1.685, P>0.05). (2) Follow-up: all the 128 patients received follow-up. There were 8 cases of seroma in both the experimental group and the control group, with no significant difference between the two groups (χ2=0.072, P>0.05). The extraction volume of patients with seroma was 20 mL (range, 4-31 mL) in the experimental group, and 43 mL (range, 23-98 mL) in the control group, showing a significant difference between the two groups (Z=-2.013, P<0.05). There was no incision infection, chronic pain or hernia recurrence in 3 months after operation in patients with seroma of either experimental group or control group.@*Conclusions@#During TAPP, suture and fixation of the hernia sac stump to the lower edge of rectus abdominis and free hernia sac stump in the abdominal cavity after dissection and transection of hernia sac can effectively repair indirect inguinal hernia. The former method can reduce the extraction volume of seroma after operation.
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Objective To investigate the effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) on postoperative seroma.Methods The prospective study was conducted.The clinical data of 128 male patients with primary indirect inguinal hernia who were admitted to Fujian Medical University Union Hospital from October 2017 to March 2019 were selected.Patients were divided into two groups by random number method.Patients in experimental group had hernia sac stump sutured and fixed at the lower margin of rectus abdominis after transection of hernia sac in TAPP,and patients in control group had hernia sac stump free in the abdominal cavity after dissection and transection of hernia sac in TAPP.Observation indicators:(1) surgical situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was conducted to detect the incidence of postoperative seroma,incision infection,chronic pain,and hernia recurrence up to June 2019.Measurement data with normal distribution were represented as Mean ±SD,and comparison between groups was done using the t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was done using the Mann-Whitney U test.Count data were described as absolute numbers and percentages,and comparison between groups was analyzed using the chisquare test.Results A total of 128 male patients were screened for eligibility,including 60 patients in the experimental group and 68 patients in the control group.The 128 patients were aged from 47 to 74 years,with an average age of 61 years.(1) Surgical situations:operation time and hospital expenses were (102±34) minutes and (12 813±2 390)yuan for the experimental group,and (97±30)minutes and (12 125±2 205)yuan for the control group,respectively,showing no significant difference between the two groups (t=0.907,1.685,P＞0.05).(2) Follow-up:all the 128 patients received follow-up.There were 8 cases of seroma in both the experimental group and the control group,with no significant difference between the two groups (x2 =0.072,P＞0.05).The extraction volume of patients with seroma was 20 mL (range,4-31 mL) in the experimental group,and 43 mL (range,23-98 mL) in the control group,showing a significant difference between the two groups (Z=-2.013,P＜0.05).There was no incision infection,chronic pain or hernia recurrence in 3 months after operation in patients with seroma of either experimental group or control group.Conclusions During TAPP,suture and fixation of the hernia sac stump to the lower edge of rectus abdominis and free hernia sac stump in the abdominal cavity after dissection and transection of hernia sac can effectively repair indirect inguinal hernia.The former method can reduce the extraction volume of seroma after operation.
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Background: Inguinal hernia repair is one of the common surgeries performed in general population under spinal anesthesia. Though Spinal anesthesia is relatively safe it has a short duration of action and can’t be used when the surgery is expected to be prolonged. To overcome this drawback various adjuvants are being increasingly used. Spinal anesthesia with 0.5% hyperbaric Bupivacaine, along with adjuvants, is routinely administered for lower abdominal surgeries. Intrathecal Nalbuphine added to Bupivacaine (0.5% Hyperbaric) has the potential to provide good intraoperative analgesia & prolongs early post-operative analgesia. Methods: 30 ASA I and II patients of age group 20-65 years, scheduled for inguinal hernia repair were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were randomized in two equal groups of 30 each. Group I patients received bupivacaine 0.5% heavy 3.1 ml + intrathecal nalbuphine 0.4 ml (0.4mg) whereas patients in group II received bupivacaine 0.5% heavy 3.1ml + 0.4ml NS. Onset of sensory and motor blockade, duration of analgesia, need for rescue analgesia, hemodynamic parameters and incidence of adverse effects was compared in both the groups. P value less than 0.05 was taken as statistically significant. Results: Demographic parameters such as gender, height, weight and BMI were found to be comparable in both the groups. Moreover, ASA grades, duration of surgery, Time of onset of sensory and motor blocks were also found to be comparable. Duration of sensory and motor block and duration of postoperative analgesia was found to be significantly more in group I as compared to group II. Hemodynamic parameters and incidence of side effects was found to be comparable in both the groups. Conclusion: Addition of nalbuphine to Bupivacaine in patients undergoing inguinal hernia repair under spinal anesthesia is associated with prolonged duration of sensory and motor blockade as well as reduced need for giving rescue analgesia without increase in incidence of side effects.
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Objective To compare the influence of laparoscopic inguinal hernia repair ( TAPP) and open inguinal hernia repair(Lichtenstein) on clinical serum swelling and the prevention and treatment strategy.Methods From September 2015 to September 2016,117 patients with inguinal hernia in the Second People's Hospital of Shantou were selected.The patients were divided into TAPP group and Lichtenstein group according to the operation mode .The incidence of seroma,occurrence,characteristics and diagnosis and treatment of the two groups were compared.Results There were 64 cases in the TAPP group,aged 25-73 years old,the median age was 57 years,58 cases of indirect inguinal hernia,4 cases of direct hernia ,2 cases of femoral hernia ,3 cases of refractory hernia.There were 53 cases in the Lichtenstein group,aged 24-84 years old,the median age was 63 years,41 cases of indirect inguinal hernia , 10 cases of direct hernia,2 cases of femoral hernia ,7 cases of refractory hernia.There was no statistically significant difference in the incidence rate of seroma between the two groups (P＝0.875).There were no statistically significant differences in the incidence rate of different types of seroma (all P＞0.05).There was no need for treatment of 0-II type seroma.The type III -IVa clinical seroma could be given local puncture parallel compression treatment , improved after treatment.After drainage and anti -inflammatory treatment, type IVb seroma was improved. Conclusion There is no difference in the incidence of seroma and the treatment between the two surgical procedures after inguinal hernia repair.
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Laparoscopic inguinal hernia repair (LIHR) is a surgical procedure of preperitoneal repair under laparoscope.It is well suited for young patients due to the advantages of postoperative slighter pain,faster resuming non-restrictive activities and better cosmetic effect.Total extraperitoneal and transabdominal preperitoneal (TAPP) are alternative for experienced surgeons and TAPP is recommended for complicated hernias or beginners.Most of the inguinal hernias in young males are congenital indirect hernias,accompanied with varicocele or cryptorchid.Varicocele can be handled simultaneously during LIHR and treatment scheme for cryptorchid should be formulated before LIHR according to different situations.Cryptorchid located in abdominal cavity or inner mouth can be resected in LIHR for resectable cryptorchid.Incaecerated scrotal hernia is common in young males and can be treated by hybridization technique.Femoral hernia should be paid attention in young females.Femoral hernia of most patients can be excised completely under laparoscope if combined with cyst of uterus round ligament.If possible,young females are suggested to preserve round ligament of uterus.Keyhole surgery and T-dissection are available for selected.
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ABSTRACT We evaluated a 27-year old male with pneumaturia and fecaluria with a past history of right inguinal hernia repair. Though, cystoscopy and contrast enhanced computed tomography did not furnish any evidence to arrive at a diagnosis, interestingly, colonoscopy revealed a mesh in the sigmoid colon making apparent the diagnosis of colovesical fistula secondary to mesh migration. Later, surgical removal of the mesh from the sigmoid colon with rent closure of the fistulous opening was done successfully. Our case thus, highlights the vital role of common diagnostic tool like colonoscopy in making an uncommon diagnosis.
RESUMO Avaliamos um homem de 27 anos com pneumaturia e fecalúria com antecedentes de reparo da hérnia inguinal direita. Embora a cistoscopia e a tomografia computadorizada com contraste (TCC) não tenham fornecido nenhuma evidência para obter-se um diagnóstico, curiosamente, a colonoscopia revelou uma malha no cólon sigmoide, estabelecendo o diagnóstico de fístula colovesical (FCV) secundária à migração da malha. Mais tarde, foi feita a remoção cirúrgica da malha do cólon sigmoide com fechamento da abertura fistulosa com sucesso. Nosso caso, portanto, destaca o papel vital de uma ferramenta diagnóstica comum, como a colonoscopia, para obter-se um diagnóstico incomum.
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Humanos , Masculino , Adulto , Fístula Intestinal/diagnóstico , Hérnia Inguinal/complicações , Poliomielite/complicaçõesRESUMO
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.
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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 study clinical effect after laparoscopic abdominal preperitoneal inguinal hernia repair methodwithout stapler. Methods 80 cases of inguinal hernia(hospitalized from February 2015 to January 2017)were divided into two groups according to the random number table method ,with 40 patients in each group. Traditional laparoscopic peritoneal inguinal hernia repair method was applied in the control group. Free stapler group received free stapler laparoscopic preperitoneal inguinal hernia repair treatment method. Operation time , amount of bleeding during surgery , the average hospitalization time after operation , the total cost of hospitalization,postoperative pain score,postoperative recovery activities time,patients′satisfaction,operation effusion after operation occurred scrotal hematoma and other complications were comparedbetween the two groups of patients. Results In free stapler group,patients′ satisfaction rate was significantly higher than the control group (P 0.05). Conclusion Operation time and amount of bleeding were similar between traditional laparoscopic transabdominal preperitoneal inguinal hernia repair method and free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair.Clinical effect of free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair proves to be effective with less complications ,less pain, faster postoperative recovery, and can reduce the cost of treatment.Free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair has satisfactory cosmetic results and was well received by patients,worthy of promotion.
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Objective To evaluate the value of MSCT and MRI in diagnosis of early postoperative complications of inguinal hernia repair (IHR).Methods Imaging and clinical data in 1 6 patients with early complications of IHR were analyzed retrospectively.Re-sults Among the complications,postoperative infection in 2 was found including incision infection in 1 and groin cellulitis in other 1. CT showed swelling abdominal wall and heterogeneous enhancement for incision infection,and inguinal mass,deep inguinal ring thickening,edema of residual sac with fluid and air collections for groin cellulitis.Seroma was found in 8,and CT and MRI demon-strated residual sac effusion,spermatic cord thickening and spermatic vascular tortuosity.Residual sac edema was found in 4,and CT and MRI showed thickening spermatic cord without effusion in residual sac or scrotum.Effusions between patch and anterior abdom-inal wall were detected by MRI in 2,one of which was accompanied by patch shrinking.Conclusion With specific clinical background for early complications of IHR,MSCT and MRI provide more anatomical information of inguinal region,which may contribute to di-agnosis and treatment of early postoperative complications.
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Objective To evaluate the effect of special rectification of clinical antimicrobial use in a hospital. Methods Medical records of patients receiving inguinal hernia repair before (in 2011)and after (in 2012)the per-formance of special rectification were reviewed,and the rationality of perioperative antimicrobial prophylaxis was compared.Results Prophylactic antimicrobial usage rate in patients receiving inguinal hernia repair decreased from 53.90%(76/114)in 2011 to 5.59%(10/179)in 2012,the difference was significant (χ2 =93.68,P <0.05);aver-age expense of antimicrobial use per patient decreased by 86.95% (from ￥ 624.73 in 2011 to ￥ 81 .52 in 2012);Combination use and single use was 93.42% and 80.00% respectively.Surgical site infection did not occur in both groups.Conclusion Through the special rectification activities of the clinical antimicrobial use,perioperative anti-microbial prophylaxis and expense of antimicrobial agents in patients receiving inguinal hernia repair is effectively re-duced.
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Regional anatomy of inguinal hernia is one of the teaching difficulties.The students always feel confused due to deficiency of visual and vivid teaching materials.The thesis analyzed the efficacy of using high-definition video of laparoscopic inguinal hernia repair (LIHR) in the clinical teaching of inguinal region anatomy aiming to deepen the understanding,inspire the enthusiasm and initiative of students and improve the quality of teaching.
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PURPOSE: We describe the clinical characteristics and assess the outcomes and stability of inguinal hernia repair under local anesthesia for patients with liver cirrhosis accompanied by ascites. METHODS: We retrospectively reviewed the medical records of 22 patients with cirrhosis and ascites who underwent mesh plug hernia repair performed by a single surgeon from January 2002 to August 2009, and the clinical characteristics and outcomes of the patients were analyzed. RESULTS: Twenty-two patients were included in the study. Fifteen (68.2%) were Child's class B and seven (31.8%) were Child's class C. Hernia repairs were successful without major complications or recurrence in all patients. Minor complications occurred in only three patients, consisting of two hematomas and one case of scrotal swelling. Complications were resolved spontaneously without the need for blood transfusion or reintervention. Thirteen patients died during follow-up (59.1%); eight of these patients died within 1 year after hernia repair. However, there was no 30-day postoperative mortality. Five of the eight patients who died were Child's class B and the remaining three patients were Child's class C. Deaths were all related to cirrhotic complications, and there was no operation-related mortality. CONCLUSION: Inguinal hernia repairs under local anesthesia in patients with cirrhosis accompanied by ascites were performed safely and effectively. Therefore, surgical repair is recommended even in patients with refractory ascites and poor hepatic function to prevent life-threatening complications or severe pain and improve quality of life.
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Humanos , Anestesia Local , Ascite , Transfusão de Sangue , Fibrose , Seguimentos , Hematoma , Hérnia Inguinal , Herniorrafia , Fígado , Cirrose Hepática , Prontuários Médicos , Qualidade de Vida , Recidiva , Estudos RetrospectivosRESUMO
Minimally invasive techniques for pediatric inguinal hernia repair have been evolving in recent years. We applied the laparoscopic method to repair pediatric inguinal hernia using the techniques of sac transection and intra-corporeal ligation. Between November 2008 and August 2010, 67 pediatric patients (47 boys and 20 girls) with inguinal hernias were included in this study. Postoperative activities, pain, and complication were checked prospectively at regular follow-up. One patient presented with clinically bilateral hernia, and three patients had metachronous hernias. Thirty-two cases out of 63 patients with unilateral hernias had a patent processus vaginalis on the contralateral side. Mean operation time was 35+/-11.4 minutes for unilateral hernias and 43+/-11 minutes for bilateral hernias. There were no intra-operative complications. One patient had a small hematoma on the groin postoperatively, which subsided spontaneously in a week. Recurrence and metachronous hernia were not found at follow up. In summary, laparoscopic inguinal repair in children is safe, easy to perform and has an additional advantage of contralateral exploration. Further studies should include long term follow-up.
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Criança , Humanos , Seguimentos , Virilha , Hematoma , Hérnia , Hérnia Inguinal , Herniorrafia , Imidazóis , Laparoscopia , Ligadura , Nitrocompostos , Estudos Prospectivos , RecidivaRESUMO
PURPOSE: A tension-free hernia repair using mesh is considered the standard method. A prolene hernia system (PHS) is a more recently introduced hernia-repair device in Korea. We compared complications of beginners' PHS operation with those of experts in our department. METHODS: We retrospectively analysed 448 cases of herniorrhaphy using PHS from December 2002 to August 2007. We compared complication of 150 early cases and 150 late cases. RESULTS: There were 394 male and 54 female patients with ages 19 to 82: 321 indirect, 83 direct, 7 femoral, 4 pantaloon hernias. The most frequent complication of PHS repair was hematoma and wound swelling. The 150 early cases' complications included 7 hematoma and 9 wound swelling. The 150 late cases' complications included 7 hematoma and 8 wound swelling. There was no difference between early and late complications. CONCLUSION: In comparing complications of 150 early and late cases, there was no difference.
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Feminino , Humanos , Masculino , Hematoma , Hérnia , Hérnia Inguinal , Herniorrafia , Concentração de Íons de Hidrogênio , Coreia (Geográfico) , Polipropilenos , Estudos RetrospectivosRESUMO
PURPOSE: We are to describe the clinical characteristics and treatment outcomes in patients aged between 80 and 89 years who underwent inguinal hernia repair under local anesthesia. METHODS: We retrospectively reviewed the medical records of patients aged between 20 and 89 years who underwent tension free hernia repair under local anesthesia by a single surgeon between June 2001 and January 2009 and compared clinical characteristics and outcomes between octogenarians who were the eldest and sexagenarians whose incidence was the highest. RESULTS: Of the 514 patients, the number of octogenarians was 52 (8.6%) and sexagenarians were 225 (35.0%). Body mass index (BMI) was 22.5 kg/m2 in octogenarians and 23.7 kg/m2 in sexagenarians (P=0.003). Underlying diseases were present in 67.3% of octogenarians and 73.5% of sexagenarians (P=0.238). The incidence of liver disease was significantly lower in the octogenarians (1.9% vs 15.7%, P=0.004). The proportion of patients who underwent local anesthesia was significantly higher among the octogenarians (94.5% vs 82.2%, P=0.014). Operative time and postoperative hospital stay had no significant difference between both groups. Postoperative complications developed in 4 (7.7%) of the octogenarians and in 18 (9.7%) of the sexagenarians. Scrotal swelling was developed most frequently and surgery-related mortality did not developed in both groups. CONCLUSION: If local anesthesia is used appropriately, inguinal hernia repair in octogenarians is a safe procedure as like in sexagenarians and may reduce the psychiatric burden related to complications for both surgeons and elderly patients.