ObjectiveTo compare the outcomes after self-gripping mesh repair to ordinary polypropylene mesh secured with sutures in women’s Lichtenstein hernioplasty.MethodsThe clinical data of 116 female patients with primary unilateral inguinal hernia who were admitted to The First Affiliated Hospital of Zhengzhou University from January 2014 to January 2017 were prospectively analyzed. A randomized controlled trial was performed based on a random number table. All patients were allocated into self-gripping mesh group (PG group) and ordinary polypropylene mesh group (PL group). The outcomes included operative time, post-operative pain score, analgesic used, hospital stay, urinary retention, wound infection, and seroma were recorded. Patients were followed-up after 1 week, 1 months, 3 months, 1 year, and 2 years after operation. Follow-up data included chronic pain, foreign body feeling, affect daily activities, and recurrence.ResultsNinety-nine participants completed follow-up. There were 48 patients in the PG group and 51 participants in the PL group. The operative time of the PG group was significantly shorter than that of the PL group (P=0.045), but there was no significant difference in analgesic used, hospital stay, incidence of urinary retention and wound infection, visual analogue scale (VAS) of wound pain at rest at 1 week postoperatively, VAS of wound pain on coughing at 1 week postoperatively between the two groups (P>0.05). At 1 month after operation, the incidence of foreign body feeling in the PG group was significantly higher than that of the PL group (P=0.031), while there was no significant difference in ratio of VAS≥3 and incidence of affect daily activities (P>0.05). At 3 months, 1 year, and 2 years after operation, there was no significant difference in incidences of foreign body feeling, chronic pain, and affect daily activities between the two groups (P>0.05). There was one recurrence in the PL group and none in the PG group, without a significant difference (P=0.248).ConclusionThe surgical outcomes of self-gripping mesh are comparable to the ordinary polypropylene mesh with a reduced operation time in women’s Lichtenstein hernioplasty.
Objective To observe the clinical effect of vacuum sealing drainage (VSD) in the treatment of mesh infection following inguinal hernia repair. Methods A total of 24 patients who suffered form mesh infection following inguinal hernia repair and got treatment in our hospital from February 2012 to December 2015 were collected and divided into 2 groups according to the type of treatment, 12 patients (13 sides) of VSD group received treatment of VSD, and 12 patients (13 sides) of conventional group received conventional treatment. Comparison between the 2 groups in mesh retention rate, the wound healing time, hospitalization cost, and hospital stay was performed. Results There was significant difference in mesh retention rate〔76.9% (10/13)vs. 30.8% (4/13)〕, the wound healing time〔(20.5±4.4) dvs. (29.7± 6.7) d〕, hospitalization cost〔(18 430.1±7 180.2) RMBvs. (12 201.1±6 453.2) RMB〕, and hospital stay〔(23.5±4.1) dvs. (30.7±6.5) d〕between the VSD group and conventional group (P<0.050). Compared with conventional group, the mesh retention rate and hospitalization cost were higher, the wound healing time and hospital stay were shorter in VSD group. Conclusions VSD can effectively control the mesh infection following hernia repair, improve the mesh retention rate. The VSD can also promote growth of granulation tissue in cavity, shorten the wound healing time and hospital stay, but has a high hospitalization cost than conventional treatment.
ObjectiveTo investigate the clinical characteristics and risk factors of chronic pain after laparoscopic inguinal hernia repair.MethodsThe clinical data of 142 cases underwent laparoscopic inguinal hernia repair from January 2013 to December 2017 in The Second Affiliated Hospital of Xiamen Medical College were retrospectively analyzed.ResultsThe incidence of chronic pain after laparoscopic inguinal hernia repair was 12.7% (18/142), and 83.3% (15/18) of the patients were located in the inguinal region. Univariate analysis showed that postoperative chronic pain rates were higher in patients receiving standard patch, large patch, mechanical fixation patch, and with postoperative complications (P<0.05). Multivariate analysis showed that large patch [OR=1.82, 95% CI was (1.18, 5.36), P=0.023], mechanical fixation patch [OR=1.44, 95% CI was (1.07, 3.62), P=0.039], and postoperative complications [OR=2.53, 95% CI was (1.27, 7.31), P=0.011] were independent risk factors for postoperative chronic pain after laparoscopic inguinal hernia repair.ConclusionThe occurrence of chronic pain after laparoscopic inguinal hernia repair is the result of many factors, especially the complications and patch factors.
摘要:目的:總結應用自體真皮片移植疝修補術治療腹股溝疝20例的近期治療效果。方法:使用自體真皮片移植,對20例各類腹股溝疝患者進行無張力修補治療;觀察手術方法及時間、手術指征、術后患者自主能力的恢復、術后傷口疼痛、并發癥和復發率。結果:與傳統疝修補手術相比,自體真皮移植疝修補術具有方法簡便、手術指征廣、術后疼痛輕、恢復快、并發癥少和復發率低的優點。結論:自體真皮移植疝修補術是一項更符合人體解剖結構和疝的病理生理的手術方法,具有傳統方法無法比擬的優勢。尤其適于在基層醫院推廣。Abstract: Objective: To summarize the recently therapeutic effect of autodermis transplantation repair of inguinal hernia. Methods: Twenty patients were treated by tension free hernia repair with autodermis transplantation. The operative procedure, surgical indication,ability recovery,postoperative pain,complications and recurrence rate were studied. Results: Autodermis transplantation hernia repair was superior to the traditional because of easier performance,wider indications,blander postoperative pain,faster recovery,fewer complications and lower recurrence. Conclusion: Autodermis transplantation hernia repair is more consistent with human anatomic structure and hernial pathophysiology than the conventional method, especially suiltable for primary hospital.
ObjectiveTo explore the effectiveness of traditional Chinese medicine (TCM) acupuncture analgesia after laparoscopic total extraperitoneal inguinal hernia repair (TEP), aiming to reduce the use of analgesics post-surgery. MethodsPatients who underwent unilateral TEP in the Department of Hernia and Abdominal Wall Surgery at our hospital from May 2022 to May 2023 were selected as research subjects. Those who met the inclusion and exclusion criterias were randomly assigned to three groups: TCM acupuncture analgesia group, traditional Chinese medicine acupuncture analgesia plus western medicine analgesia group (referred to as Chinese and western medicine analgesia group), and western medicine analgesia group. The basic information, postoperative numerical rating scale (NRS) pain scores, postoperative recovery indicators, and complication rates of the three groups were analyzed and compared.ResultsThere was no statistically significant differences in the basic data of patients across the three groups (P>0.05). There were significant differences in NRS score, recovery time of intestinal function, first urination time after operation and first ambulation time after operation at each time point after analgesia (6 h, the next morning, 48 h, 72 h and 96 h after operation) among the three groups (P<0.05). The NRS scores in both the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group were lower than those in the western medicine analgesia group (P<0.05), Additionally, postoperative recovery outcomes were better in the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group compared with the western medicine group (P<0.05). There was no significant difference of the above results compared between the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group (P>0.05). There was no significant difference in postoperative complications among the three groups (P>0.05). ConclusionTCM acupuncture analgesia following TEP surgery is effective and leads to improved postoperative recovery compared with the use of oral analgesics alone, without an increase in adverse reactions.
ObjectiveTo summarize the research status of risk factors of chronic postoperative inguinal pain (CPIP).MethodWe searched and summarized the domestic and foreign literatures about the risk factors of CPIP in recent years.ResultsThere was no doubt that the risk factors of CPIP included preoperative pain, acute pain at postoperative, recurrent inguinal hernia, smaller hernia sac, higher body mass index (BMI), and surgical methods. These effects were controversial such as age, gender, and the mesh. In recent years, hypertension and a past history of chronic pain may also be risk factors for the development of CPIP.ConclusionsThe risk factors of CPIP still need the further study.
ObjectiveTo systematically evaluate the clinical effect and safety of robotic inguinal hernia repair (robotic surgery).MethodsThe control studies on robotic surgery in treatment of inguinal hernia were searched in the English databases (PubMed, Cochrane Library, Embase) and Chinese databases (CNKI, Wanfang, VIP). The search time was from the establishment of the database to December 2020. After screening the literatures according to the inclusion and exclusion criteria, the Jadad scale was used to evaluate the literature quality of randomized controlled studies, the Newcastle-Ottawa scale (NOS) was used to evaluate the literature quality of the retrospective studies, and the RevMan5.3 software was used for meta-analysis.ResultsTwelve relevant articles with a total sample size of 7 661 cases that met the criteria were included in this study, including 1 746 cases of robotic inguinal hernia repair (robotic surgery), 4 361 cases of open inguinal hernia repair (open surgery), and 1 554 cases of laparoscopic inguinal hernia repair (laparoscopic surgery). The surgery time of the robotic surgery was longer than that of the traditional (including open and laparoscopic) surgery (P<0.01), open surgery (P<0.01) or laparoscopic surgery (P<0.01); The hospitalization cost of the robotic surgery was higher than that of traditional surgery (P<0.01) and open surgery (P<0.01). However, the readmission rate of the robotic surgery was lower than that of the traditional surgery (P<0.01) and open surgery (P<0.01). There were no significant differences in the other indicators between the robotic surgery and open surgery or laparoscopic surgery (P>0.05).ConclusionRobotic inguinal hernia repair is safe and feasible, which provides us a new way to treat inguinal hernia.
Objective To investigate the value of applying closed continuous negative pressure drainage in preventing postoperative complications of inguinal hernia. Methods The clinical data of 107 adult male patients diagnosed with inguinal giant hernia (incarcerated 16 cases, non-incarcerated 91 cases) undergoing tension-free hernioplasty using the Ultrapro Hernia System (UHS) between April 2011 and June 2016 in our hospital were retrospective analyzed. Prophylactic use of antibiotics was not adopted except patients with incarcerated hernia, diabetes, or elderly. Multi-lateral hole plasma drainage tube were used in 61 patients, 46 cases without indwelling plasma tube. The postoperative scrotum pain, scrotal hematoma, scrotal effusion, and incision infection of two groups patients were observed. Results Of the 61 patients with plasma drainage, the mean drainage time was 2 days, the longest was 5 days. Postoperative scrotal pain was found in 2 cases (3.3%) without scrotal hematoma or scrotal effusion. Of the 2 patients, the drainage of 1 case was obstructed, the drainage was extubated and the patient was cured and discharged after 5 days by sucking the drainage tube using empty needle. The average hospital stay in this group was 4 days. Of the 46 patients without plasma drainage, 7 patients (15.2%) suffered scrotal pain, 7 patients (15.2%) suffered scrotal hematoma. The average hospital stay was 6 days. The incidence of scrotal pain and scrotal hematoma was significantly higher in patients without plasma drainage than those with drainage (P<0.05). The condition of scrotal hematoma would be improved after 1–3 times outpatient dressing change and repeated hematoma sucking. One case was not improved after repeated suction, the condition was improved after scrotum incision, drainage, and dressing. Conclusion Closed continuous negative pressure drainage potentially prevents oblique hernia pain and scrotal hematoma without increasing the incidence of incision infection or hospitalization time.
ObjectiveTo evaluate the short-term safety and efficacy of domestic porcine small intestinal submucosal decellularized matrix (SIS) mesh in laparoscopic inguinal hernia repair (LIHR), and observe its clinical outcomes related to tissue repair. MethodsA multicenter open-label single-arm study included 169 patients undergoing LIHR with domestic SIS mesh. The primary assessment index was the excellent rate on postoperative Day 180, the secondary efficacy indexes were the hernia recurrence rate, incision healing rate, wound healing time, mesh infection, chronic pain, and discomfort at the repair site after the operation. ResultsAll surgeries were successfully completed, with the excellent rate was 100% on postoperative Day 180 which was significantly higher than the value of preset target (91%). The incision healing rate was 100%, and the median wound healing time was 8 days. 97.04% patients showed immediate painless after surgery, 98.20% patients were painless on postoperative Day 7, all patients were painless on postoperative Day 28. Immediately after the operation, 97.04% patients had no discomfort at the repair site, 98.20% patients had no discomfort on postoperative Day 7, all patients had no discomfort on postoperative Day 28. There was no recurrence or infection after operation. ConclusionDomestic SIS mesh is safe and effective in the laparoscopic treatment of inguinal hernia, and is worth popularizing for clinical use.
ObjectiveTo discuss the main auxiliary inspection methods and their guiding significance for inguinal hernia.MethodsBy searching literatures and international guidelines, to review the main auxiliary examination methods, such as ultrasound, CT, and MRI.ResultsClinical physical examination combined with ultrasound could increase diagnostic sensitivity. CT could provide surgeons with a better sense of wholeness and structural details, and could be used as a guide for specific types of inguinal hernia. The soft tissue recognition of MRI was good, and it had a good effect on the identification of hidden hernia, mesh conditions, and tissue inflammation.ConclusionEach examination has its own advantages, and should be selected based on clinical practice and medical center conditions.